II. OF DISEASES (part 1 of 2)

II. OF DISEASES (part 1 of 2)

CHAP. XII. OF THE KNOWLEDGE AND CURE OF DISEASES.

The knowledge of diseases does not depend so much upon scientific principles as many imagine. It is chiefly the result of experience and observation. By attending the sick, and carefully observing the various occurrences in diseases, a great degree of accuracy may be acquired, both in distinguishing their symptoms, and in the application of medicines. Hence sensible nurses, and other persons who wait upon the sick, often discover a disease sooner than those who have been bred to physic. We do not however mean to insinuate that a medical education is of no use: it is doubtless of the greatest importance; but it never can supply the place of observation and experience.

Every disease may be considered as an assemblage of symptoms, and must be distinguished by those which are most obvious and permanent. Instead therefore of giving a classical arrangement of diseases, according to the systematic method, it will be more suitable, in a performance of this nature, to give a full and accurate description of each particular disease as it occurs; and, where any of the symptoms of one disease have a near resemblance to those of another, to take notice of that circumstance, and at the same time to point out the peculiar or characteristic symptoms by which it may be distinguished. By a due attention to these, the investigation of diseases will be found to be a less difficult matter than most people would at first be ready to imagine.

A proper attention to the patient’s age, sex, temper of mind, constitution, and manner of life, will likewise greatly assist, both in the investigation and treatment of diseases.

In childhood the fibres are lax and soft, the nerves extremely irritable, and the fluids thin; whereas in old age the fibres are rigid, the nerves become almost insensible, and many of the vessels imperviable. These and other peculiarities render the diseases of the young and aged very different, and of course they must require a different method of treatment.

Females are liable to many diseases which do not afflict the other sex: besides, the nervous system being more irritable in them than in men, their diseases require to be treated with greater caution. They are less able to bear large evacuations; and all stimulating medicines ought to be administered to them with a sparing hand.

Particular constitutions not only dispose persons to peculiar diseases, but likewise render it necessary to treat these diseases in a peculiar manner. A delicate person, for example, with weak nerves, who lives mostly within doors, must not be treated, under any disease, precisely in the same manner as one who is hardy and robust, and who is much exposed to the open air.

The temper of mind ought to be carefully attended to in diseases. Fear, anxiety, and a fretful temper, both occasion and aggravate diseases. In vain do we apply medicines to the body to remove maladies which proceed from the mind. When it is affected, the best medicine is to sooth the passions, to divert the mind from anxious thought, and to keep the patient as easy and cheerful as possible.

Attention ought likewise to be paid to the climate, or place where the patient lives, the air he breathes, his diet, &c. Such as live in low marshy situations are subject to many diseases which are unknown to the inhabitants of high countries. Those who breathe the impure air of cities, have many maladies to which the more happy rustics are entire strangers. Persons who feed grossly, and indulge in strong liquors, are liable to diseases which do not affect the temperate and abstemious, &c.

It has already been observed, that the different occupations and situations in life dispose men to peculiar diseases. It is therefore necessary to inquire into the patient’s occupation, manner of life, &c. This will not only assist us in finding out the disease, but will likewise direct us in the treatment of it. It would be very imprudent to treat the laborious and the sedentary precisely in the same manner, even supposing them to labour under the same disease.

It will likewise be proper to inquire, whether the disease be constitutional or accidental; whether it has been of long or short duration; whether it proceeds from any great and sudden alteration in the diet, manner of life, &c. The state of the patient’s body, and of the other evacuations, ought also to be inquired into; and likewise whether he can with ease perform all the vital and animal functions, as breathing, digestion, &c.

Lastly, it will be proper to inquire what diseases the patient has formerly been liable to, and what medicines were most beneficial to him; if he has a strong aversion to any particular drug, &c.

As many of the indications of cure may be answered by diet alone, it is always the first thing to be attended to in the treatment of diseases. Those who know no better, imagine that every thing which goes by the name of a medicine possesses some wonderful power or secret charm, and think, if the patient swallows enough of drugs, that he must do well. This mistake has many ill consequences; it makes people trust to drugs, and neglect their own endeavours; besides, it discourages all attempts to relieve the sick where medicines cannot be obtained.

Medicines are no doubt useful in their place; and, when administered with prudence, they may do much good; but when they are put in place of every thing else, or administered at random, which is not seldom the case, they must do mischief. We would therefore wish to call the attention of mankind from the pursuit of secret medicines, to such things as they are acquainted with. The proper regulation of these may often do much good, and there is little danger of their ever doing hurt.

Every disease weakens the digestive powers. The diet ought therefore, in all diseases, to be light and of easy digestion. It would be as prudent for a person with a broken leg to attempt to walk, as for one in a fever to eat the same kind of food, and in the same quantity, as when he was in perfect health. Even abstinence alone will often cure a fever, especially when it has been occasioned by excess in eating or drinking.

In all fevers attended with inflammation, as pleurisies, peripneumonies, &c. thin gruels, wheys, watery infusions of mucilaginous plants, roots, &c. are not only proper for the patients food, but they are likewise the best medicines which can be administered.

In fevers of a slow, nervous, or putrid kind, where there are no symptoms of inflammation, and where the patient must be supported with cordials, that intention can always be more effectually answered by nourishing diet and generous wines, than by any medicines yet known.

Nor is a proper attention to diet of less importance in chronic than in acute diseases. Persons afflicted with low spirits, wind, weak nerves, and other hypochondriacal affections, generally find more benefit from the use of solid food and generous liquors, than from all the cordial and carminitive medicines which can be administered to them.

The scurvy, that most obstinate malady, will sooner yield to a proper vegetable diet, than to all the boasted antiscorbutic remedies of the shops.

In consumptions, when the humours are vitiated, and the stomach so much weakened as to be unable to digest the solid fibres of animals, or even to assimilate the juices of vegetables, a diet consisting chiefly of milk will not only support the patient, but will often cure the disease after every other medicine has failed.

Nor is an attention to other things of less importance than to diet. The strange infatuation which has long induced people to shut up the sick from all communication with the external air, has done great mischief. Not only in fevers, but in many other diseases, the patient will receive more benefit from having the fresh air prudently admitted into his chamber, than from all the medicines which can be given him.

Exercise may likewise in many cases be considered as a medicine. Sailing, or riding on horseback, for example, will be of more service in the cure of consumptions, glandular obstructions, &c. than any medicine yet known. In diseases which proceed from a relaxed state of the solids, the cold bath, and other parts of the gymnastic regimen, will be found equally beneficial.

Few things are of greater importance in the cure of diseases than cleanliness. When a patient is suffered to lie in dirty clothes, whatever perspires from his body is again resorbed, or taken up into it, which serves to nourish the disease and increase the danger. Many diseases may be cured by cleanliness alone; most of them may be mitigated by it, and in all of them it is highly necessary both for the patient and those who attend him.

Many other observations, were it necessary, might be adduced to prove the importance of a proper regimen in diseases. Regimen will often cure diseases without medicine, but medicine will seldom succeed where a proper regimen is neglected. For this reason, in the treatment of diseases, we have always given the first place to regimen. Those who are ignorant of medicine may confine themselves to it only. For others who have more knowledge, we have recommended some of the most simple but approved forms of medicine in every disease. These however are never to be administered but by people of better understanding; nor even by them without the greatest precaution.

CHAP. XIII. OF FEVERS IN GENERAL.

As more than one half of mankind is said to perish by fevers, it is of importance to be acquainted with their causes. The most general causes of fevers are, infection, errors in diet, unwholesome air, violent emotions of the mind, excess or suppression of usual evacuations, external or internal injuries, and extreme degrees of heat or cold. As most of these have already been treated of at considerable length, and their effects shewn, we shall not now resume the consideration of them, but shall only recommend it to all, as they would wish to avoid fevers and other fatal diseases, to pay the most punctual attention to these articles.

Fevers are not only the most frequent of all diseases, but they are likewise the most complex. In the most simple species of fever there is always a combination of several different symptoms. The distinguishing symptoms of fever are, increased heat, frequency of pulse, loss of appetite, general debility, pain in the head, and a difficulty in performing some of the vital or animal functions. The other symptoms usually attendant on fevers are, nausea, thirst, anxiety, delirium, weariness, wasting of the flesh, want of sleep, or the sleep disturbed and not refreshing.

When the fever comes on gradually, the patient generally complains first of languor or listlessness, soreness of the flesh, or the bones, as the country people express it, heaviness of the head, loss of appetite, sickness, with clamminess of the mouth; after some time come on excessive heat, violent thirst, restlessness, &c.

When the fever attacks suddenly, it always begins with an uneasy sensation of excessive cold, accompanied with debility and loss of appetite; frequently the cold is attended with shivering, oppression about the heart, and sickness at stomach, or vomiting.

Fevers are divided into continual, remitting, intermitting, and such as are attended with cutaneous eruption or topical inflammation, as the small-pox, erysipelas, &c. By a continual fever is meant that which never leaves the patient during the whole course of the disease, or which shews no remarkable increase or abatement in the symptoms. This kind of fever is likewise divided into acute, slow, and malignant. The fever is called acute when its progress is quick, and the symptoms violent; but when these are more gentle, it is generally denominated slow. When livid or petechial spots shew a putrid state of the humours, the fever is called malignant, putrid, or petechial.

A remitting fever differs from a continual only in a degree. It has frequent increases and decreases, or exacerbations and remissions, but never wholly leaves the patient during the course of the disease. Intermitting fevers or agues are those which, during the time that the patient may be said to be ill, have evident intervals or remissions of the symptoms.

As a fever is only an effort of Nature to free herself from an offending cause, it is the business of those who have the care of the sick to observe with diligence which way Nature points, and to endeavour to assist her operations. Our bodies are so framed, as to have a constant tendency to expel or throw off whatever is injurious to health. This is generally done by urine, sweat, stool, expectoration, vomit, or some other evacuation.

There is reason to believe, if the efforts of Nature, at the beginning of a fever, were duly attended to and promoted, it would seldom continue long; but when her attempts are either neglected or counteracted, it is no wonder if the disease proves fatal. There are daily instances of persons who, after catching cold, have all the symptoms of a beginning fever; but by keeping warm, drinking diluting liquors, bathing their feet in warm water, &c. the symptoms in a few hours disappear, and the danger is prevented.

When fevers of a putrid kind threaten, the best method of obviating their effects is by repeated vomits.

Our design is not to enter into a critical inquiry into the nature and immediate causes of fevers, but to mark their most obvious symptoms, and to point out the proper treatment of the patient with respect to his diet, drink, air, &c. in the different stages of the disease. In these articles the inclinations of the patient will in a great measure direct our conduct.

Almost every person in a fever complains of great thirst, and calls out for drink, especially of a cooling nature. This at once points out the use of water, and other cooling liquors. What is so likely to abate the heat, attenuate the humours, remove spasms and obstructions, promote perspiration, increase the quantity of urine, and in short produce every salutary effect in an ardent or inflammatory fever, as drinking plentifully of water, thin gruel, or any other weak liquor, of which water is the basis? The necessity of diluting liquors is pointed out by the dry tongue, the parched skin, and the burning heat, as well as by the unquenchable thirst of the patient.

Many cooling liquors, which are extremely grateful to patients in a fever, may be prepared from fruits, as decoctions of tamarinds, apple-tea, orange-whey, and the like. Mucilaginous liquors might also be prepared from marsh-mallow roots, linseed, lime-tree buds, and other mild vegetables. These liquors, especially when acidulated, are highly agreeable to the patient, and should never be denied him.

At the beginning of a fever the patient generally complains of great lassitude or weariness, and has no inclination to move. This evidently shews the propriety of keeping him easy, and if possible in bed. Lying in bed relaxes the spasms, abates the violence of the circulation, and gives Nature an opportunity of exerting all her force to overcome the disease. The bed alone would often remove a fever at the beginning; but when the patient struggles with the disease, instead of driving it off, he only fixes it the deeper, and renders it more dangerous. This observation is too often verified in travellers, who happen when on a journey to be seized with a fever. Their anxiety to get home induces them to travel with the fever upon them, which conduct seldom fails to render it fatal.

In fevers the mind as well as the body should be kept easy. Company is seldom agreeable to the sick. Indeed every thing that disturbs the imagination increases the disease; for which reason every person in a fever ought to be kept perfectly quiet, and neither allowed to see nor hear any thing that may in the least affect or discompose his mind.

Though the patient in a fever has the greatest inclination for drink, yet he seldom has any appetite for solid food; hence the impropriety of urging him to take victuals is evident. Much solid food in a fever is every way hurtful. It oppresses nature, and, instead of nourishing the patient, serves only to feed the disease. What food the patient takes should be in small quantity, light, and of easy digestion. It ought to be chiefly of the vegetable kind, as panada, roasted apples, gruels, and such like.

Poor people, when any of their family are taken ill, run directly to their rich neighbours for cordials, and pour wine, spirits, &c. into the patient, who perhaps never had been accustomed to taste such liquors when in health. If there be any degree of fever, this conduct must increase it, and if there be none, this is the ready way to raise one. Stuffing the patient with sweetmeats and other delicacies is likewise very pernicious. These are always harder to digest than common food, and cannot fail to hurt the stomach.

Nothing is more desired by a patient in a fever than fresh air. It not only removes his anxiety, but cools the blood, revives the spirits, and proves every way beneficial. Many patients are in a manner stifled to death in fevers for want of fresh air; yet such is the unaccountable infatuation of most people, that the moment they think a person in a fever, they imagine he should be kept in a close chamber, into which not one particle of fresh air must be admitted. Instead of this, there ought to be a constant stream of fresh air into a sick person’s chamber, so as to keep it moderately cool. Indeed its degree of warmth ought never to be greater than is agreeable to one in perfect health.

Nothing spoils the air of a sick person’s chamber, or hurts the patient more, than a number of people breathing in it. When the blood is inflamed, or the humours in a putrid state, air that has been breathed repeatedly will greatly increase the disease. Such air not only loses its spring, and becomes unfit for the purpose of respiration, but acquires a noxious quality, which renders it in a manner poisonous to the sick.

In fevers, when the patient’s spirits are low and depressed, he is not only to be supported with cordials, but every method should be taken to cheer and comfort his mind. Many, from a mistaken zeal, when they think a person in danger, instead of solacing his mind with the hopes and consolations of religion, fright him with the views of hell and damnation. It would be unsuitable here to dwell upon the impropriety and dangerous consequences of this conduct; it often hurts the body, and there is reason to believe seldom benefits the soul.

Among common people, the very name of a fever generally suggests the necessity of bleeding. This notion seems to have taken its rise from most fevers in this country having been formerly of an inflammatory nature; but true inflammatory fevers are now seldom to be met with. Sedentary occupations, and a different manner of living, have so changed the state of diseases in Britain, that there is now hardly one fever in ten where the lancet is necessary. In most low, nervous, and putrid fevers, which are now so common, bleeding is really hurtful, as it weakens the patient, sinks his spirits, &c. We would recommend this general rule, never to bleed at the beginning of a fever, unless there be evident signs of inflammation. Bleeding is an excellent medicine when necessary, but should never be wantonly performed.

It is likewise a common notion, that sweating is always necessary in the beginning of a fever. When the fever proceeds from an obstructed perspiration, this notion is not ill-founded. If the patient only lies in bed, bathes his feet and legs in warm water, and drinks freely of water-gruel, or any other weak diluting liquor, he will seldom fail to perspire freely. The warmth of the bed, and the diluting drink, will relax the universal spasm, which generally affects the skin at the beginning of a fever; it will open the pores, and promote the perspiration, by means of which the fever may often be carried off. But instead of this, the common practice is to heap clothes upon the patient, and to give him things of a hot nature, as spirits, spiceries, &c. which fire his blood, increase the spasms, and render the disease more dangerous.

In all fevers a proper attention should be paid to the patient’s longings. These are the calls of Nature, and often point out what may be of real use. Patients are not indeed to be indulged in every thing that the sickly appetite may crave; but it is generally right to let them have a little of what they eagerly desire, though it may not seem altogether proper. What the patient longs for, his stomach will generally digest; and such things have sometimes a very happy effect.

When a patient is recovering from a fever, great care is necessary to prevent a relapse. Many persons, by too soon imagining themselves well, have lost their lives, or contracted other diseases of an obstinate nature. As the body after a fever is weak and delicate, it is necessary to guard against catching cold. Moderate exercise in the open air will be of use, but great fatigue is by all means to be avoided; agreeable company will also have a good effect. The diet must be light, but nourishing. It should be taken frequently, but in small quantities. It is dangerous at such a time to eat as much as the stomach may crave.

CHAP. XIV. OF INTERMITTING FEVERS, OR AGUES.

Intermitting fevers afford the best opportunity both of observing the nature of a fever, and also the effects of medicine. No person can be at a loss to distinguish an intermitting fever from any other, and the proper medicine for it is now almost universally known.

The several kinds of intermitting fevers take their names from the period in which the fit returns, as quotidian, tertian, quartan, &c.

CAUSES.——Agues are occasioned by effluvia from putrid stagnating water. This is evident from their abounding in rainy seasons, and being most frequent in countries where the soil is marshy, as in Holland, the Fens of Cambridgeshire, the Hundreds of Essex, &c. This disease may also be occasioned by eating too much stone fruit, by a poor watery diet, damp houses, evening dews, lying upon the damp ground, watching, fatigue, depressing passions, and the like. When the inhabitants of a high country remove to a low one, they are generally seized with intermitting fevers, and to such the disease is most apt to prove fatal. In a word, whatever relaxes the solids, diminishes the perspiration, or obstructs the circulation in the capillary or small vessels, disposes the body to agues.

SYMPTOMS.——An intermitting fever generally begins with a pain of the head and loins, weariness of the limbs, coldness of the extremities, stretching, yawning, with sometimes great sickness and vomiting; to which succeed shivering and violent shaking. Afterwards the skin becomes moist, and a profuse sweat breaks out, which generally terminates the fit or paroxysm. Sometimes indeed the disease comes on suddenly, when the person thinks himself in perfect health; but it is more commonly preceded by listlessness, loss of appetite, and the symptoms mentioned above.

REGIMEN.——While the fit continues, the patient ought to drink freely of water-gruel, orange-whey, weak camomile-tea; or, if his spirits be low, small wine-whey, sharpened with the juice of lemon. All his drink should be warm, as that will assist in bringing on the sweat, and consequently shorten the paroxysm[58].

Between the paroxysms the patient must be supported with food that is nourishing, but light and easy of digestion, as veal or chicken-broths, sago, gruel with a little wine, light puddings, and such like. His drink may be small negus, acidulated with the juice of lemons or oranges, and sometimes a little weak punch. He may likewise drink infusions of bitter herbs, as camomile, wormwood, or water-trefoil, and may now and then take a glass of small wine, in which gentian root, centaury, or some other bitter, has been infused.

As the chief intentions of cure in an ague are to brace the solids, and promote perspiration, the patient ought to take as much exercise between the fits as he can bear. If he be able to go abroad, riding on horseback, or in a carriage, will be of great service. But if he cannot bear that kind of exercise, he ought to take such as his strength will permit. Nothing tends more to prolong an intermitting fever, than indulging a lazy indolent disposition.

Intermitting fevers, under a proper regimen, will often go off without medicine; and when the disease is mild, in an open dry country, there is seldom any danger from allowing it to take its course; but when the patient’s strength seems to decline, or the paroxysms are so violent that his life is in danger, medicine ought immediately to be administered. This however should never be done till the disease be properly formed, that is to say, till the patient has had several fits of shaking and sweating.

MEDICINE.——The first thing to be done in the cure of an intermitting fever, is to cleanse the stomach and bowels. This not only renders the application of other medicines more safe, but likewise more efficacious. In this disease, the stomach is generally loaded with cold viscid phlegm, and frequently great quantities of bile are discharged by vomit; which plainly points out the necessity of such evacuations. Vomits are therefore to be administered before the patient takes any other medicine. A dose of ipecacuanha will generally answer this purpose very well. A scruple or half a dram of the powder will be sufficient for an adult, and for a younger person the dose must be less in proportion. After the vomit begins to operate, the patient ought to drink plentifully of weak camomile-tea. The vomit should be taken two or three hours before the return of the fit, and may be repeated at the distance of two or three days. Vomits not only cleanse the stomach, but increase the perspiration, and all the other secretions, which render them of such importance, that they often cure intermitting fevers without the assistance of any other medicine.

Purging medicines are likewise useful and often necessary in intermitting fevers. A smart purge has been known to cure an obstinate ague, after the Peruvian bark and other medicines had been used in vain. Vomits however are more suitable in this disease, and render purging less necessary; but if the patient be afraid to take a vomit, he ought in this case to cleanse the bowels by a dose or two of Glauber’s salt, jalap, or rhubarb.

Bleeding may sometimes be proper at the beginning of an intermitting fever, when excessive heat, a delirium, &c. give reason to suspect an inflammation; but as the blood is seldom in an inflammatory slate in intermitting fevers, this operation is rarely necessary. When frequently repeated, it tends to prolong the disease.

After proper evacuations the patient may safely use the Peruvian bark, which may be taken in any way that is most agreeable to him. No preparation of the bark seems to answer better than the most simple form in which it can be given, viz. in powder.

Two ounces of the best Peruvian bark, finely powdered, may be divided into twenty-four doses. These may either be made into boluses as they are used, with a little syrup of lemon, or mixed in a glass of red wine, a cup of camomile-tea, water-gruel, or any other drink that is more agreeable to the patient[59].

In an ague which returns every day, one of the above doses may be taken every two hours during the interval of the fits. By this method the patient will be able to take five or six doses between each paroxysm. In a tertian or third-day ague it will be sufficient to take a dose every third hour during the interval, and in a quartan every fourth. If the patient cannot take so large a dose of the bark, he may divide each of the powders into two parts, and take one every hour, &c. For a young person a smaller quantity of this medicine will be sufficient, and the dose must be adapted to the age, constitution, and violence of the symptoms[60].

The above quantity of bark will frequently cure an ague; the patient, however, ought not to leave off taking the medicine as soon as the paroxysms are stopped, but should continue to use it till there is reason to believe the disease is entirely overcome. Most of the failures in the cure of this disease are owing to patients not continuing to use the medicine long enough. They are generally directed to take it till the fits are stopped, then to leave it off, and begin again at some distance of time; by which means the disease gathers strength, and often returns with as much violence as before. A relapse may always be prevented by the patient’s continuing to take small doses of the medicine for some time after the symptoms disappear. This is both the most safe and effectual method of cure.

An ounce of gentian root, calamus aromaticus, and orange-peel, of each half an ounce, with three or four handfuls of camomile-flowers, and an handful of coriander-seed, all bruised together in a mortar, may be used in form of infusion or tea. About half an handful of these ingredients may be put into a tea-pot, and an English pint of boiling water poured on them. A cup of this infusion drank three or four times a day will greatly promote the cure. Such patients as cannot drink the watery infusion, may put two handfuls of the same ingredients into a bottle of white wine, and take a glass of it twice or thrice a day. If patients drink freely of the above, or any other proper infusion of bitters, a smaller quantity of bark than is generally used, will be sufficient to cure an ague[61].

Those who cannot swallow the bark in substance, may take it in decoction or infusion. An ounce of bark in powder may be infused in a bottle of white wine for four or five days, frequently shaking the bottle, afterwards let the powder subside, and pour off the clear liquor. A wine glass may be drank three or four times a day, or oftener, as there is occasion. If a decoction be more agreeable, an ounce of the bark, and two drams of snake-root bruised, with an equal quantity of salt of wormwood, may be boiled in a quart of water, into an English pint. To the strained liquor may be added an equal quantity of red wine, and a glass of it taken frequently.

In obstinate agues, the bark will be found much more efficacious when assisted by brandy, or other warm cordials, than taken alone. This I have had frequently occasion to observe in a country where intermittent fevers were endemical. The bark seldom succeeded unless assisted by snake-root, ginger, canella alba, or some other warm aromatic. When the fits are very frequent and violent, in which case the fever often approaches towards an inflammatory nature, it will be safer to keep out the aromatics, and to add salt of tartar in their stead. But in an obstinate tertian or quartan, in the end of autumn or beginning of winter, warm and cordial medicines are absolutely necessary[62].

As autumnal and winter agues generally prove much more obstinate than those which attack the patient in spring or summer, it will be necessary to continue the use of medicines longer in the former than in the latter. A person who is seized with an intermitting fever in the beginning of winter, ought frequently, if the season proves rainy, to take a little medicine, although the disease may seem to be cured, to prevent a relapse, till the return of the warm season. He ought likewise to take care not to be much abroad in wet weather, especially in cold easterly winds.

When agues are not properly cured, they often degenerate into obstinate chronical diseases, as the dropsy, jaundice, &c. For this reason all possible care should be taken to have them radically cured, before the constitution has been too much weakened.

Though nothing is more rational than the method of treating intermitting fevers, yet, by some strange infatuation, more charms and whimsical remedies are daily used for removing this than any other disease. There is hardly an old woman who is not in possession of a nostrum for stopping an ague; and it is amazing with what readiness their pretensions are believed. Those in distress eagerly grasp at any thing that promises sudden relief; but the shortest way is not always the best in the treatment of diseases. The only method to obtain a safe and lasting cure, is gradually to assist Nature in removing the cause of the disorder.

Some indeed try bold, or rather fool-hardy experiments to cure agues, as drinking great quantities of strong liquors, jumping into a river, &c. These may sometimes have the desired effect, but must always be attended with danger[63]. When there is any degree of inflammation, or the least tendency to it, such experiments may prove fatal. The only patient whom I remember to have lost in an intermittent fever, evidently killed himself by drinking strong liquor, which some person had persuaded him would prove an infallible remedy.

Many dirty things are extolled for the cure of intermitting fevers, as spiders, cobwebs, snuffings of candles, &c. Though these may sometimes succeed, yet their very nastiness is sufficient to set them aside, especially when cleanly medicines will answer the purpose better. The only medicine that can be depended upon, for thoroughly curing an intermittent fever, is the Peruvian bark. It may always be used with safety: and I can honestly declare, that in all my practice I never knew it fail, when combined with the medicines mentioned above, and duly persisted in.

Where agues are endemical, even children are often afflicted with that disease. Such patients are very difficult to cure, as they can seldom be prevailed upon to take the bark, or any other disagreeable medicine. One method of rendering this medicine more palatable, is to make it into a mixture with distilled waters and syrup, and afterwards to give it an agreeable sharpness with the elixir or spirit of vitriol. This both improves the medicine, and takes off the nauseous taste. In cases where the bark cannot be administered, the saline mixture may be given with advantage to children[64].

Wine-whey is a very proper drink for a child in an ague; to half an English pint of which may be put a tea-spoonful of the spirit of hartshorn. Exercise is likewise of considerable service; and when the disease proves obstinate, the child ought, if possible, to be removed to a warm dry air. The food ought to be nourishing, and sometimes a little generous wine should be allowed.

To children, and such as cannot swallow the bark, or when the stomach will not bear it, it may be given by clyster. Half an ounce of the extract of bark, dissolved in four ounces of warm water, with the addition of half an ounce of sweet oil, and six or eight drops of laudanum, in the form recommended by Dr. Lind for an adult, and this to be repeated every fourth hour, or oftener, as the occasion shall require. For children the quantity of extract and laudanum must be proportionally lessened. Children have been cured of agues by making them wear a waistcoat with powdered bark quilted between the folds of it; by bathing them frequently in a strong decoction of the bark, and by rubbing the spine with strong spirits, or with a mixture of equal parts of laudanum and the saponaceous liniment.

We have been the more full upon this disease, because it is very common, and because few patients in an ague apply to physicians unless in extremities. There are, however, many cases in which the disease is very irregular, being complicated with other diseases, or attended with symptoms which are both very dangerous and very difficult to understand. All these we have purposely passed over, as they would only bewilder the generality of readers. When the disease is very irregular, or the symptoms dangerous, the patient ought immediately to apply to a physician, and strictly to follow his advice.

To prevent agues, people must endeavour to avoid their causes. These have been already pointed out in the beginning of this section; we shall therefore only add one preventive medicine, which may be of use to such as are obliged to live in low marshy countries, or who are liable to frequent attacks of this disease.

Take an ounce of the best Peruvian bark; Virginian snake-root, and orange-peel, of each half an ounce; bruise them all together, and infuse for five or six days in a bottle of brandy, Holland gin, or any good spirit; afterwards pour off the clear liquor; and take a wine glass of it twice or thrice a day. This indeed is recommending a dram; but the bitter ingredients in a great measure take off the ill effects of the spirit. Those who do not chuse it in brandy, may infuse it in wine; and such as can bring themselves to chew the bark, will find that method succeed very well. Gentian root, or calamus aromaticus, may also be chewed by turns for the same purpose. All bitters seem to be antidotes to agues, especially those that are warm and astringent.

CHAP. XV. OF AN ACUTE CONTINUAL FEVER.

This fever is denominated acute, ardent, or inflammatory. It most commonly attacks the young, or persons about the prime or vigour of life, especially such as live high, abound with blood, and whose fibres are strong and elastic. It seizes people at all seasons of the year; but is most frequent in the spring and beginning of summer.

CAUSES.——An ardent fever may be occasioned by any thing that overheats the body, or produces plethora, as violent exercise, sleeping in the sun, drinking strong liquors, eating spiceries, a full diet, with little exercise, &c. It may likewise be occasioned by whatever obstructs the perspiration, as lying on the damp ground, drinking cold liquor when the body is hot, night-watching, or the like.

SYMPTOMS.—A rigour or chilliness generally ushers in this fever, which is soon succeeded by great heat, a frequent and full pulse, pain of the head, dry skin, redness of the eyes, a florid countenance, pains in the back, loins, &c. To these succeed difficulty of breathing, sickness, with an inclination to vomit. The patient complains of great thirst, has no appetite for solid food, is restless, and his tongue generally appears black and rough.

A delirium, excessive restlessness, great oppression of the breast, with laborious respiration, starting of the tendons, hiccup, cold clammy sweats, and an involuntary discharge of urine, are very dangerous symptoms.

As this disease is always attended with danger, the best medical assistance ought to be procured as soon as possible. A physician may be of use at the beginning, but his skill is often of no avail afterwards. Nothing can be more unaccountable than the conduct of those who have it in their power, at the beginning of a fever, to procure the best medical assistance, yet put it off till things come to an extremity. When the disease, by delay or wrong treatment, has become incurable, and has exhausted the strength of the patient, it is in vain to hope for relief from medicine. Physicians may indeed assist Nature; but their attempts must ever prove fruitless, when she is no longer able to co-operate with their endeavours.

REGIMEN.—From the symptoms of this disease, it is evident, that the blood and other humours require to be diluted; that the perspiration, urine, saliva, and all the other secretions, are in too small quantity; that the vessels are rigid, and the heat of the whole body too great: all these clearly point out the necessity of a regimen calculated to dilute the blood, correct the acrimony of the humours, allay the excessive heat, remove the spasmodic stricture of the vessels, and promote the secretions.

These important purposes may be greatly promoted by drinking plentifully of diluting liquors; as water-gruel, or oatmeal-tea, clear whey, barley-water, balm-tea, apple-tea, &c. These may be sharpened with juice of orange, jelly of currants, raspberries, and such like: orange-whey is likewise an excellent cooling drink. It is made by boiling among milk and water a bitter orange sliced, till the curd separates. If no orange can be had, a lemon, a little cream of tartar, or a few spoonfuls of vinegar, will have the same effect. Two or three spoonfuls of white wine may occasionally be added to the liquor when boiling.

If the patient be costive, an ounce of tamarinds, with two ounces of stoned raisins of the sun, and a couple of figs, may be boiled in three English pints of water to a quart. This makes a very pleasant drink, and may be used at discretion. The common pectoral decoction is likewise a very proper drink in this disease. A tea-cupful of it may be taken every two hours, or oftener, if the patient’s heat and thirst be very great[65].

The above liquids must all be drank a little warm. They may be used in smaller quantities at the beginning of a fever, but more freely afterwards, in order to assist in carrying off the disease by promoting the different excretions. We have mentioned a variety of drinks, that the patient may have it in his power to chuse those which are most agreeable; and that when tired of one, he may have recourse to another.

The patient’s diet must be very spare and light. All sorts of flesh-meats, and even chicken-broths, are to be avoided. He may be allowed groat-gruel, panado, or light bread boiled in water; to which may be added a few grains of common salt, and a little sugar, which will render it more palatable. He may eat roasted apples with a little sugar, toasted bread with jelly of currants, boiled prunes, &c.

It will greatly relieve the patient, especially in an hot season, to have fresh air frequently let into his chamber. This, however, must always be done in such a manner as not to endanger his catching cold.

It is too common in fevers to load the patient with bed-clothes, under the pretence of making him sweat, or defending him from the cold. This custom has many ill effects. It increases the heat of the body, fatigues the patient, and retards, instead of promoting, the perspiration.

Sitting upright in bed, if the patient is able to bear it, will often have a good effect. It relieves the head, by retarding the motion of the blood to the brain. But this posture ought never to be continued too long: and if the patient is inclined to sweat, it will be more safe to let him lie, only raising his head a little with pillows.

Sprinkling the chamber with vinegar, juice of lemon, or vinegar and rose-water, with a little nitre dissolved in it, will greatly refresh the patient. This ought to be done frequently, especially if the weather is hot.

The patient’s mouth should be often washed with a mixture of water and honey, to which a little vinegar may be added, or with a decoction of figs in barley-water. His feet and hands ought likewise frequently to be bathed in lukewarm water; especially if the head is affected.

The patient should be kept as quiet and easy as possible. Company, noise, and every thing that disturbs the mind, is hurtful. Even too much light, or any thing that affects the senses, ought to be avoided. His attendants should be as few as possible, and they ought not to be too often changed. His inclinations ought rather to be soothed than contradicted; even the promise of what he craves will often satisfy him as much as its reality.

MEDICINE.——In this and all other fevers, attended with a hard, full, quick pulse, bleeding is of the greatest importance. This operation ought always to be performed as soon as the symptoms of an inflammatory fever appear. The quantity of blood to be taken away, however, must be in proportion to the strength of the patient and the violence of the disease. If after the first bleeding the fever should increase, and the pulse become more frequent and hard, there will be a necessity for repeating it a second, and perhaps a third, or even a fourth time, which may be done at the distance of twelve, eighteen, or twenty-four hours from each other, as the symptoms require. If the pulse continues soft, and the patient is tolerably easy after the first bleeding, it ought not to be repeated.

If the heat and fever be very great, forty or fifty drops of the dulcified or sweet spirit of nitre may be made into a draught, with an ounce of rose-water, two ounces of common water, and half an ounce of simple syrup, or a bit of loaf-sugar. This draught may be given to the patient every three or four hours while the fever is violent; afterwards once in five or six hours will be sufficient.

If the patient be afflicted with retching, or an inclination to vomit, it will be right to assist Nature’s attempts, by giving him weak camomile-tea, or lukewarm water to drink.

If the body is bound, a clyster of milk and water with a little salt, and a spoonful of sweet oil or fresh butter in it, ought daily to be administered. Should this not have the desired effect, a tea-spoonful of magnesia alba, or cream of tartar, may be frequently put into his drink. He may likewise eat tamarinds, boiled prunes, roasted apples, and the like.

If about the tenth, eleventh, or twelfth day, the pulse becomes more soft, the tongue moister, and the urine begins to let fall a reddish settlement, there is reason to expect a favourable issue to the disease. But if, instead of these symptoms, the patient’s spirits grow languid, his pulse sinks, and his breathing becomes difficult; with a stupor, trembling of the nerves, starting of the tendons, &c. there is reason to fear that the consequences will be fatal. In this case blistering plasters must be applied to the head, ancles, inside of the legs or thighs, as there may be occasion; poultices of wheat-bread, mustard, and vinegar, may likewise be applied to the soles of the feet, and the patient must be supported with cordials, as strong wine-whey, negus, sago-gruel with wine in it, and such like.

A proper regimen is not only necessary during the fever, but likewise after the patient begins to recover. By neglecting this, many relapse, or fall into other diseases, and continue valetudinary for life. Though the body is weak after a fever, yet the diet for some time ought to be rather light than of too nourishing a nature. Too much food, drink, exercise, company, &c. are carefully to be avoided. The mind ought likewise to be kept easy, and the patient should not attempt to pursue study, or any business that requires intense thinking.

If the digestion is bad, or the patient is seized at times with feverish heats, an infusion of Peruvian bark in cold water will be of use. It will strengthen the stomach, and help to subdue the remains of the fever.

When the patient’s strength is pretty well recovered, he ought to take some gentle laxative. An ounce of tamarinds and a dram of sena may be boiled for a few minutes in an English pint of water, and an ounce of manna dissolved in the decoction; afterwards it may be strained, and a tea-cupful drank every hour till it operates. This dose may be repeated twice or thrice, five or six days intervening between each dose.

Those who follow laborious employments ought not to return too soon to their labour after a fever, but should keep easy till their strength and spirits are sufficiently recruited.

CHAP. XVI. OF THE PLEURISY.

The true pleurisy is an inflammation of that membrane called the pleura, which lines the inside of the breast. It is distinguished into the moist and dry. In the former the patient spits freely; in the latter, little or none at all. There is likewise a species of this disease, which is called the spurious or bastard pleurisy, in which the pain is more external, and chiefly affects the muscles between the ribs. The pleurisy prevails among labouring people, especially such as work without doors, and are of a sanguine constitution. It is most frequent in the spring season.

CAUSES.——The pleurisy may be occasioned by whatever obstructs the perspiration; as cold northerly winds; drinking cold liquors when the body is hot; sleeping without doors on the damp ground; wet clothes; plunging the body into cold water, or exposing it to the cold air, when covered with sweat, &c. It may likewise be occasioned by drinking strong liquors; by the stoppage of usual evacuations; as old ulcers, issues, sweating of the feet or hands, &c. the sudden striking in of any eruption, as the itch, the measles, or the small-pox. Those who have been accustomed to bleed at a certain season of the year are apt, if they neglect it, to be seized with a pleurisy. Keeping the body too warm by means of fire, clothes, &c. renders it more liable to this disease. A pleurisy may likewise be occasioned by violent exercise, as running, wrestling, leaping, or by supporting great weight, blows on the breast, &c. A bad conformation of the body renders persons more liable to this disease, as a narrow chest, a straitness of the arteries of the pleura, &c.

SYMPTOMS.—This, like most other fevers, generally begins with chillness and shivering, which are followed by heat, thirst, and restlessness. To these succeeds a violent pricking pain in one of the sides among the ribs. Sometimes the pain extends towards the back bone, sometimes towards the fore-part of the breast, and at other times towards the shoulder blades. The pain is generally most violent when the patient draws his breath.

The pulse in this disease is commonly quick and hard, the urine high-coloured; and if blood be let, it is covered with a tough crust, or buffy coat. The patient’s spittle is at first thin, but afterwards it becomes grosser, and is often streaked with blood.

REGIMEN.——Nature generally endeavours to carry off this disease by a critical discharge of blood from some part of the body, by expectoration, sweat, loose stools, thick urine, or the like. We ought therefore to second her intentions by lessening the force of the circulation, relaxing the vessels, diluting the humours, and promoting expectoration.

For these purposes the diet, as in the former disease, ought to be cool, slender, and diluting. The patient must avoid all food that is viscid, hard of digestion, or that affords much nourishment; as flesh, butter, cheese, eggs, milk, and also every thing that is of a heating nature. His drink may be whey, or an infusion of pectoral and balsamic vegetables[66].

Barley-water, with a little honey or jelly of currants mixed with it, is likewise a very proper drink in this disease. It is made by boiling an ounce of pearl-barley in three English pints of water to two, which must afterwards be strained. The decoction of figs, raisins, barley, recommended in the preceding disease, is here likewise very proper. These and other diluting liquors are not to be drank in large quantities at a time, but the patient ought to keep continually sipping them, so as to render his mouth and throat always moist. All his food and drink should be taken a little warm.

The patient should be kept quiet, cool, and every way easy, as directed under the foregoing disease. His feet and hands ought daily to be bathed in lukewarm water; and he may sometimes sit up in bed for a short space, in order to relieve his head.

MEDICINE.——Almost every person knows, when a fever is attended with a violent pain of the side, and a quick hard pulse, that bleeding is necessary. When these symptoms come on, the sooner this operation is performed the better; and the quantity at first must be pretty large, provided the patient is able to bear it. A large quantity of blood let at once, in the beginning of a pleurisy, has a much better effect than repeated small bleedings. A man may lose twelve or fourteen ounces of blood as soon as it is certainly known that he is seized with a pleurisy. For a younger person, or one of a delicate constitution, the quantity must be less.

If, after the first bleeding, the stitch, with the other violent symptoms, should still continue, it will be necessary, at the distance of twelve or eighteen hours, to let eight or nine ounces more. If the symptoms do not then abate, and the blood shews a strong buffy coat, a third or even a fourth bleeding may be requisite. If the pain of the side abates, the pulse becomes softer, or the patient begins to spit freely, bleeding ought not to be repeated. This operation is seldom necessary after the third or fourth day of the fever, and ought not then to be performed, unless in the most urgent circumstances.

The blood may be many ways attenuated without bleeding. There are likewise many things that may be done to ease the pain of the side without this operation, as fomenting, blistering, &c. Fomentations may be made by boiling a handful of the flowers of elder, camomile, and common mallows, or any other soft vegetables, in a proper quantity of water. The herbs may be either put into a flannel bag, and applied warm to the side, or flannels may be dipped in the decoction, afterwards wrung out, and applied to the part affected, with as much warmth as the patient can easily bear. As the clothes grow cool, they must be changed, and great care taken that the patient do not catch cold. A bladder may be filled with warm milk and water, and applied to the side, if the above method of fomenting be found inconvenient. Fomentations not only ease the pain, but relax the vessels, and prevent the stagnation of the blood and other humours. The side may likewise be frequently rubbed with a little of the volatile liniment[67].

Topical bleeding has often a very good effect in this disease. It may either be performed by applying a number of leeches to the part affected, or by cupping, which is both a more certain and expeditious method than the other.

Leaves of various plants might likewise be applied to the patient’s side with advantage. I have often seen great benefit from young cabbage-leaves applied warm to the side in a pleurisy. These not only relax the parts, but likewise draw off a little moisture, and may prevent the necessity of blistering-plasters; which however, when other things fail, must be applied.

If the stitch continues after repeated bleedings, fomentations, &c. a blistering-plaster must be applied over the part affected, and suffered to remain for two days. This not only procures a discharge from the side, but takes off the spasm, and by that means assists in removing the cause of the disease. To prevent a strangury when the blistering-plaster is on, the patient may drink freely of the Arabic emulsion[68].

If the patient is costive, a clyster of thin water-gruel, or of barley-water, in which a handful of mallows, or any other emollient vegetable has been boiled, may be daily administered. This will not only empty the bowels, but have the effect of a warm fomentation applied to the inferior viscera, which will help to make a derivation from the breast.

The expectoration of spitting may be promoted by sharp, oily, and mucilaginous medicines. For this purpose an ounce of the oxymel, or the vinegar of squills, may be added to six ounces of the pectoral decoction, and two table-spoonfuls of it taken every two hours.

Should the squill disagree with the stomach, the oily emulsion may be administered[69]; or, in place of it, two ounces of the oil of sweet almonds, or oil of olives, and two ounces of the syrup of violets, may be mixed with as much sugar-candy powdered, as will make an electuary of the consistence of honey. The patient may take a tea-spoonful of this frequently, when the cough is troublesome. Should oily medicines prove nauseous, which is sometimes the case, two table-spoonfuls of the solution of gum ammoniac in barley-water may be given three or four times a-day[70].

If the patient does not perspire, but has a burning heat upon his skin, and passes very little water, some small doses of purified nitre and camphire will be of use. Two drams of the former may be rubbed with five or six grains of the latter in a mortar, and the whole divided into six doses, one of which may be taken every five or six hours, in a little of the patient’s ordinary drink.

We shall only mention one medicine more, which some reckon almost a specific in the pleurisy, viz. the decoction of the seneka rattle-snake root[71]. After bleeding and other evacuations have been premised, the patient may take two, three, or four table-spoonfuls of this decoction, according as his stomach will bear it, three or four times a-day. If it should occasion vomiting, two or three ounces of simple cinnamon-water may be mixed with the quantity of decoction here directed, or it may be taken in smaller doses. As this medicine promotes perspiration and urine, and likewise keeps the body easy, it may be of some service in a pleurisy, or any other inflammation of the breast.

No one will imagine that these medicines are all to be used at the same time. We have mentioned different things, on purpose that people may have it in their power to chuse; and likewise, that when one cannot be obtained, they may make use of another. Different medicines are no doubt necessary in the different periods of a disorder; and where one fails of success, or disagrees with the patient, it will be proper to try another.

What is called the crisis, or height of the fever, is sometimes attended with very alarming symptoms, as difficulty of breathing, an irregular pulse, convulsive motions, &c. These are apt to frighten the attendants, and induce them to do improper things, as bleeding the patient, giving him strong stimulating medicines, or the like. But they are only the struggles of Nature to overcome the disease, in which she ought to be assisted by plenty of diluting drink, which is then peculiarly necessary. If the patient’s strength however be much exhausted by the disease, it will be necessary at this time to support him with frequent small draughts of wine-whey, negus, or the like.

When the pain and fever are gone, it will be proper, after the patient has recovered sufficient strength, to give him some gentle purges, as those directed towards the end of the acute continual fever. He ought likewise to use a light diet, of easy digestion, and his drink should be butter-milk, whey, and other things of a cleansing nature.

Of the BASTARD PLEURISY.

That species of pleurisy which is called the bastard or spurious, generally goes off by keeping warm for a few days, drinking plenty of diluting liquors, and observing a cooling regimen.

It is known by a dry cough, a quick pulse, and a difficulty of lying on the affected side, which last does not always happen in the true pleurisy. Sometimes indeed this disease proves obstinate, and requires bleeding, with cupping, and scarifications of the part affected. These, together with the use of nitrous and other cooling medicines, seldom fail to effect a cure.

Of the PARAPHRENITIS.

The paraphrenitis, or inflammation of the diaphragm, is so nearly connected with the pleurisy, and resembles it so much in the manner of treatment, that it is scarce necessary to consider it as a separate disease.

It is attended with a very acute fever, and an extreme pain in the part affected, which is generally augmented by coughing, sneezing, drawing in the breath, taking food, going to stool, making water, &c. Hence the patient breathes quick, and draws in his bowels to prevent the motion of the diaphragm; is restless, anxious, has a dry cough, a hiccup, and often a delirium. A convulsive laugh, or rather a kind of involuntary grin, is no uncommon symptom of this disease.

Every method must be taken to prevent a suppuration, as it is impossible to save the patient’s life when this happens. The regimen and medicine are in all respects the same as in the pleurisy. We shall only add, that in this disease emollient clysters are peculiarly useful, as they relax the bowels, and by that means make a derivation from the part affected.

CHAP. XVII. OF A PERIPNEUMONY, OR INFLAMMATION OF THE LUNGS.

As this disease affects an organ which is absolutely necessary to life, it must always be attended with danger. Persons who abound with thick blood, whose fibres are tense and rigid, who feed upon gross aliment, and drink strong viscid liquors, are most liable to a peripneumony. It is generally fatal to those who have a flat breast, or narrow chest, and to such as are afflicted with an asthma, especially in the decline of life. Sometimes the inflammation reaches to one lobe of the lungs only, at other times the whole of the organ is affected; in which case the disease can hardly fail to prove fatal.

When the disease proceeds from a viscid pituitous matter obstructing the vessels of the lungs, it is called a spurious or bastard peripneumony. When it arises from a thin acrid defluxion on the lungs, it is denominated a catarrhal peripneumony, &c.

CAUSES.——An inflammation of the lungs is sometimes a primary disease, and sometimes it is the consequence of other diseases, as a quinsey, a pleurisy, &c. It proceeds from the same causes as the pleurisy, viz. an obstructed perspiration from cold, wet clothes, &c. or from an increased circulation of the blood by violent exercise, the use of spiceries, ardent spirits, and such like. The pleurisy and peripneumony are often complicated; in which case the disease is called a pleuro-peripneumony.

SYMPTOMS.——Most of the symptoms of a pleurisy likewise attend an inflammation of the lungs; only in the latter the pulse is more soft, and the pain less acute; but the difficulty of breathing, and oppression of the breast, are generally greater.

REGIMEN.——As the regimen and medicine are in all respects the same in the true peripneumony as in the pleurisy, we shall not here repeat them, but refer the reader to the treatment of that disease. It may not however be improper to add, that the aliment ought to be more slender and thin in this than in any other inflammatory disease. The learned Dr. Arbuthnot asserts, that even common whey is sufficient to support the patient, and that decoctions of barley, and infusions of fennel roots in warm water with milk, are the most proper both for drink and nourishment. He likewise recommends the steam of warm water taken in by the breath, which serves as a kind of internal fomentation, and helps to attenuate the impacted humours. If the patient has loose stools, but is not weakened by them, they are not to be stopped, but rather promoted by the use of emollient clysters.

It has already been observed, that the spurious or bastard peripneumony is occasioned by a viscid pituitous matter obstructing the vessels of the lungs. It commonly attacks the old, infirm, and phlegmatic, in winter and wet seasons.

The patient at the beginning is cold and hot by turns, has a small quick pulse, feels sense of weight upon his breast, breathes with difficulty, and sometimes complains of a pain and giddiness of his head. His urine is usually pale, and his colour very little changed.

The diet in this, as well as in the true peripneumony, must be very slender, as weak broths, sharpened with the juice of orange or lemon, and such like. His drink may be thin water-gruel sweetened with honey, or a decoction of the roots of fennel, liquorice, and quick grass. An ounce of each of these may be boiled in three English pints of water to a quart, and sharpened with a little currant-jelly, or the like.

Bleeding and purging are generally proper at the beginning of this disease; but if the patient’s spittle is pretty thick, or well concocted, neither of them are necessary. It will be sufficient to assist the expectoration by some of the sharp medicines recommended for that purpose in the pleurisy, as the solution of gum ammoniac with oxymel of squills, &c. Blistering plasters have generally a good effect, and ought to be applied pretty early.

If the patient does not spit, he must be bled according as his strength will permit, and have a gentle purge administered. Afterwards his body may be kept open by clysters, and the expectoration promoted, by taking every four hours two table-spoonfuls of the solution mentioned above.

When an inflammation of the breast does not yield to bleeding, blistering, and other evacuations, it commonly ends in a suppuration, which is more or less dangerous, according to the part where it is situated. When this happens in the pleura, it sometimes breaks outwardly, and the matter is discharged by the wound.

When the suppuration happens within the substance or body of the lungs, the matter may be discharged by expectoration; but if the matter floats in the cavity of the breast, between the pleura and the lungs, it can only be discharged by an incision made betwixt the ribs.

If the patient’s strength does not return after the inflammation is to all appearance removed; if his pulse continues quick though soft, his breathing difficult and oppressed; if he has cold shiverings at times, his cheeks flushed, his lips dry; and if he complains of thirst, and want of appetite, there is reason to fear a suppuration, and that a phthisis or consumption of the lungs will ensue. We shall therefore next proceed to consider the proper treatment of that disease.

CHAP. XVIII. OF CONSUMPTIONS.

A consumption is a wasting or decay of the whole body from an ulcer, tubercles, or concretions of the lungs, an empyema, a nervous atrophy, or a cachexy.

Dr. Arbuthnot observes, that in his time consumptions made up above one-tenth part of the bills of mortality in and about London. There is reason to believe they have rather increased since, and we know from experience, that they are not less fatal in some other towns of England than in London.

Young persons, between the age of fifteen and thirty, of a slender make, long neck, high shoulders, and flat breasts, are most liable to this disease.

Consumptions prevail more in England than in any other part of the world, owing perhaps to the great use of animal food and malt liquors, the general application to sedentary employments, and the great quantity of pit-coal which is there burnt; to which we may add the perpetual changes in the atmosphere, or variableness of the weather.

CAUSES.——It has already been observed, that an inflammation of the breast often ends in an imposthume: consequently whatever disposes people to this disease, must likewise be considered as a cause of consumption.

Other diseases, by vitiating the habit, may likewise occasion consumptions; as the scurvy, the scrophula, or king’s evil, the venereal disease, the asthma, small-pox, measles, &c.

As this disease is seldom cured, we shall endeavour the more particularly to point out its causes, in order that people may be enabled to avoid it. These are:

——Confined or unwholesome air. When this fluid is impregnated with the fumes of metals or minerals, it proves extremely hurtful to the lungs, and often corrodes the tender vessels of that necessary organ.

——Violent passions, exertions, or affections of the mind; as grief, disappointment, anxiety, or close application to the study of abstruse arts or sciences.

——Great evacuations; as sweating, diarrhœas, diabetes, excessive venery, the fluor albus, an over-discharge of the menstrual flux, giving suck too long, &c.

——The sudden stoppage of customary evacuations; as the bleeding piles, sweating of the feet, bleeding at the nose, the menses, issues, ulcers, or eruptions of any kind.

——Injuries done to the lungs, calculi, &c. I lately saw the symptoms of a phthisis occasioned by a small bone sticking in the bronchæ. It was afterwards vomited along with a considerable quantity of purulent matter, and the patient, by a proper regimen, and the use of the Peruvian bark, recovered.

——Making a sudden transition from a hot to a very cold climate, change of apparel, or whatever greatly lessens the perspiration.

——Frequent and excessive debaucheries. Late watching, and drinking strong liquors, which generally go together, can hardly fail to destroy the lungs. Hence the bon companion generally falls a sacrifice to this disease.

——Infection. Consumptions are likewise caught by sleeping with the diseased; for which reason this should be carefully avoided. It cannot be of great benefit to the sick, and must hurt those in health.

——Occupations in life. Those artificers who sit much, and are constantly leaning forward, or pressing upon the stomach and breast, as cutlers, taylors, shoemakers, seamstresses, &c. often die of consumptions. They likewise prove fatal to singers, and all who have occasion to make frequent and violent exertions of the lungs.

——Cold. More consumptive patients date the beginning of their disorders from wet feet, damp beds, night air, wet clothes, or catching cold after the body had been heated, than from all other causes.

Sharp, saline, and aromatic aliments, which heat and inflame the blood, are likewise frequently the cause of consumptions.

We shall only add, that this disease is often owing to an hereditary taint, or a scrophulous habit; in which case it is generally incurable.

SYMPTOMS.——This disease generally begins with a dry cough, which often continues for some months. If a disposition to vomit after eating be excited by it, there is still greater reason to fear an approaching consumption. The patient complains of a more than usual degree of heat, a pain and oppression of the breast, especially after motion; his spittle is of a saltish taste, and sometimes mixed with blood. He is apt to be sad; his appetite is bad, and his thirst great. There is generally a quick, soft, small pulse; though sometimes the pulse is pretty full, and rather hard. These are the common symptoms of a beginning consumption.

Afterwards the patient begins to spit a greenish, white, or bloody matter. His body is extenuated by the hectic fever, and colliquative sweats, which mutually succeed one another, viz. the one towards night, and the other in the morning. A looseness, and an excessive discharge of urine, are often troublesome symptoms at this time, and greatly weaken the patient. There is a burning heat in the palms of the hands, and the face generally flushes after eating; the fingers become remarkably small, the nails are bent inwards, and the hairs fall off.

At last the swelling of the feet and legs, the total loss of strength, the sinking of the eyes, the difficulty of swallowing, and the coldness of the extremities, shew the immediate approach of death, which however the patient seldom believes to be so near. Such is the usual progress of this fatal disease, which, if not early checked, commonly sets all medicine at defiance.

REGIMEN.——On the first appearance of a consumption, if the patient lives in a large town, or any place where the air is confined, he ought immediately to quit it, and to make choice of a situation in the country, where the air is pure and free. Here he must not remain inactive, but take every day as much exercise as he can bear.

The best method of taking exercise is to ride on horseback, as this gives the body a great deal of motion without much fatigue. Such as cannot bear this kind of exercise, must make use of a carriage. A long journey, as it amuses the mind by a continual change of objects, is greatly preferable to riding the same ground over and over. Care however must be taken to avoid catching cold from wet clothes, damp beds, or the like. The patient ought always to finish his ride in the morning, or at least before dinner; otherwise it will oftener do harm than good.

It is pity those who attend the sick seldom recommend riding in this disease, till the patient is either unable to bear it, or the malady has become incurable. Patients are likewise apt to trifle with everything that is in their own power. They cannot see how one of the common actions of life should prove a remedy in an obstinate disease, and therefore they reject it, while they greedily hunt after relief from medicine, merely because they do not understand it.

Those who have strength and courage to undertake a pretty long voyage, may expect great advantage from it. This, to my knowledge, has frequently cured a consumption after the patient was, to all appearance, far advanced in that disease, and where medicine had proved ineffectual. Hence it is reasonable to conclude, that if a voyage were undertaken in due time, it would seldom fail to perform a cure[72].

Such as try this method of cure ought to carry as much fresh provisions along with them as will serve for the whole time they are at sea. As milk is not easily obtained in this situation, they ought to live upon fruits, and the broth of chickens, or other young animals which can be kept alive on board. It is scarce necessary to add, that such voyages should be undertaken, if possible, in the mildest season, and that they ought to be towards a warmer climate[73].

Those who have not courage for a long voyage may travel into a more southern climate, as the south of France, Spain, or Portugal; and if they find the air of these countries agree with them, they should continue there, at least till their health be confirmed.

Next to proper air and exercise, we would recommend a due attention to diet. The patient should eat nothing that is either heating or hard of digestion, and his drink must be of a soft and cooling nature. All the diet ought to be calculated to lessen the acrimony of the humours, and to nourish and support the patient. For this purpose he must keep chiefly to the use of vegetables and milk. Milk alone is of more value in this disease than the whole materia medica.

Asses milk is commonly reckoned preferable to any other; but it cannot always be obtained; besides, it is generally taken in a very small quantity; whereas, to produce any effects, it ought to make a considerable part of the patient’s diet. It is hardly to be expected, that a gill or two of asses milk, drank in the space of twenty-four hours, should be able to produce any considerable change in the humours of an adult; and when people do not perceive its effects soon, they lose hope, and so leave it off. Hence it happens that this medicine, however valuable, very seldom performs a cure. The reason is obvious; it is commonly used too late, is taken in too small quantities, and is not duly persisted in.

I have known very extraordinary effects from asses milk in obstinate coughs, which threatened a consumption of the lungs; and do verily believe, if used at this period, that it would seldom fail; But if it be delayed till an ulcer is formed, which is generally the case, how can it be expected to succeed?

Asses milk ought to be drank, if possible, in its natural warmth, and, by a grown person, in the quantity of half an English pint at a time. Instead of taking this quantity night and morning only, the patient ought to take it four times, or at least thrice a-day, and to eat a little light bread along with it, so as to make it a kind of meal.

If the milk should happen to purge, it may be mixed with old conserve of roses. When that cannot be obtained, the powder of crabs claws may be used in its stead. Asses milk is usually ordered to be drank warm in bed; but as it generally throws the patient in a sweat when taken in this way, it would perhaps be better to give it after he rises.

Some extraordinary cures in consumptive cases have been performed by women’s milk. Could this be obtained in sufficient quantity, we would recommend it in preference to any other. It is better if the patient can suck it from the breast, than to drink it afterwards. I knew a man who was reduced to such a degree of weakness in a consumption, as not to be able to turn himself in bed. His wife was at that time giving suck, and the child happening to die, he sucked her breasts, not with a view to reap any advantage from the milk, but to make her easy. Finding himself however greatly benefited by it, he continued to suck her till he became perfectly well, and is at present a strong and healthy man.

Some prefer butter-milk to any other, and it is indeed a very valuable medicine, if the stomach be able to bear it. It does not agree with every person at first; and is therefore often laid aside without a sufficient trial. It should at first be taken sparingly, and the quantity gradually increased, until it comes to be almost the sole food. I never knew it succeed unless where the patient almost lived upon it.

Cows milk is most readily obtained of any, and though it be not so easily digested as that of asses or mares, it may be rendered lighter by adding to it an equal quantity of barley-water, or allowing it to stand for some hours, and afterwards taking off the cream. If it should notwithstanding prove heavy on the stomach, a small quantity of brandy or rum, with a little sugar, may be added, which will render it both more light and nourishing.

It is not to be wondered, that milk should for some time disagree with a stomach that has not been accustomed to digest any thing but flesh and strong liquors, which is the case with many of those who fall into consumptions. We do not however advise those have been accustomed to animal food and strong liquors, to leave them off all at once. This might be dangerous. It will be necessary for such to eat a little once a-day of the flesh of some young animal, or rather to use the broth made of chickens, veal, lamb, or such like. They ought likewise to drink a little wine made into negus, or diluted with twice or thrice its quantity of water, and to make it gradually weaker till they can leave it off altogether.

These must be used only as preparatives to a diet consisting chiefly of milk and vegetables, which the sooner the patient can be brought to bear, the better. Rice and milk, or barley and milk, boiled with a little sugar, is very proper food. Ripe fruits roasted, baked, or boiled, are likewise proper, as goose or currant berry tarts, apples roasted, or boiled in milk, &c. The jellies, conserves, and preserves, &c. of ripe subacid fruits, ought to be eaten plentifully, as the jelly of currants, conserve of roses, preserved plums, cherries, &c.

Wholesome air, proper exercise, and a diet consisting chiefly of these and other vegetables, with milk, is the only course that can be depended on in a beginning consumption. If the patient has strength and sufficient resolution to persist in this course, he will seldom be disappointed of a cure.

In a populous town in England[74], where consumptions are very common, I have frequently seen consumptive patients, who had been sent to the country with orders to ride, and live upon milk and vegetables, return in a few months quite plump, and free from any complaint. This indeed was not always the case, especially when the disease was hereditary, or far advanced; but it was the only method in which success was to be expected: where it failed, I never knew medicine succeed.

If the patient’s strength and spirits flag, he must be supported by strong broths, jellies, and such like. Some recommend shell-fish in this disorder, and with some reason, as they are nourishing and restorative[75]. All the food and drink ought however to be taken in small quantities, lest an overcharge of fresh chyle should oppress the lungs, and too much accelerate the circulation of the blood.

The patient’s mind ought to be kept as easy and cheerful as possible. Consumptions are often occasioned, and always aggravated, by a melancholy cast of mind; for which reason music, cheerful company, and every thing that inspires mirth, are highly beneficial. The patient ought seldom to be left alone, as brooding over his calamities is sure to render them worse.

MEDICINE.——Though the cure of this disease depends chiefly upon regimen and the patient’s own endeavours, yet we shall mention a few things which may be of service in relieving some of the more violent symptoms.

In the first stage of a consumption, the cough may sometimes be appeased by bleeding; and the expectoration may be promoted by the following medicines. Take fresh squills, gum-ammoniac, and powdered cardamum seeds, of each a quarter of an ounce; beat them together in a mortar, and if the mass proves too hard for pills, a little of any kind of syrup may be added to it. This may be formed into pills of a moderate size, and four or five of them taken twice or thrice a-day, according as the patient’s stomach will bear them.

The lac ammoniacum, or milk of gum-ammoniac, as it is called, is likewise a proper medicine in this stage of the disease. It may be used as directed in the pleurisy.

A mixture made of equal parts of lemon-juice, fine honey, and syrup of poppies, may likewise be used. Four ounces of each of these may be simmered together in a sauce-pan, over a gentle fire, and a table-spoonful of it taken at any time when the cough is troublesome.

It is common in this stage of the disease to load the patient’s stomach with oily and balsamic medicines. These, instead of removing the cause of the disease, tend rather to increase it, by heating the blood, while they pall the appetite, relax the solids, and prove every way hurtful to the patient. Whatever is used for removing the cough, besides riding and other proper regimen, ought to be medicines of a sharp and cleaning nature; as oxymel, syrup of lemon, &c.

Acids seem to have peculiarly good effects in this disease; they both tend to quench the patient’s thirst and to cool the blood. The vegetable acids, as apples, oranges, lemons, &c. appear to be the most proper. I have known patients suck the juice of several lemons every day with manifest advantage, and would for this reason recommend acid vegetables to be taken in as great quantity as the stomach will bear them.

For the patient’s drink, we would recommend infusions of the bitter plants, as ground-ivy, the lesser centaury, camomile flowers, or water-trefoil. These infusions may be drank at pleasure. They strengthen the stomach, promote digestion, rectify the blood, and at the same time answer all the purposes of dilution, and quench thirst much better than things that are luscious or sweet. But if the patient spits blood, he ought to use, for his ordinary drink, infusions or decoctions of the vulnerary roots, plants, &c.[76]

There are many other mucilaginous plants and seeds, of a healing and agglutinating nature, from which decoctions or infusions may be prepared with the same intention; as the orches, the quince-seed, coltsfoot, linseed, sasaparilla, &c. It is not necessary to mention the different ways in which these may be prepared. Simple infusion or boiling is all that is necessary, and the dose may be at discretion.

The conserve of roses is here peculiarly proper. It may either be put into the decoction above prescribed, or eaten by itself. No benefit is to be expected from trifling doses of this medicine. I never knew it of any service, unless where three or four ounces at least were used daily for a considerable time. In this way I have seen it produce very happy effects, and would recommend it wherever there is a discharge of blood from the lungs.

When the spitting up of gross matter, oppression of the breast, and the hectic symptoms, shew that an imposthume is formed in the lungs, we would recommend the Peruvian bark, that being the only drug which has any chance to counteract the general tendency which the humours then have to putrefaction.

An ounce of the bark in powder may be divided into eighteen or twenty doses, of which one may be taken every three hours through the day, in a little syrup, or a cup of horehound tea.

If the bark should happen to purge, it may be made into an electuary, with the conserve of roses, thus: Take old conserve of roses a quarter of a pound, Peruvian bark in powder an ounce, syrup of orange or lemon, as much as will make it of the consistence of honey. This quantity will serve the patient four or five days, and may be repeated as there is occasion.

Such as cannot take the bark in substance, may infuse it in cold water. This seems to be the best menstruum for extracting the virtues of that drug. Half an ounce of bark in powder may be infused for twenty-four hours in half an English pint of water. Afterwards let it be passed through a fine strainer, and an ordinary tea-cupful of it taken three or four times a-day.

We would not recommend the bark while there are any symptoms of an inflammation of the breast; but when it is certainly known that matter is collected there, it is one of the best medicines which can be used. Few patients indeed have resolution enough to give the bark a fair trial at this period of the disease, otherwise we have reason to believe that some benefit might be reaped from it.

When it is evident that there is an imposthume in the breast, and the matter can neither be spit up nor carried off by absorption, the patient must endeavour to make it break inwardly, by drawing in the steams of warm water or vinegar with his breath, coughing, laughing, or bawling aloud, &c. When it happens to burst within the lungs, the matter may be discharged by the mouth. Sometimes indeed the bursting of the vomica occasions immediate death, by suffocating the patient. When the quantity of matter is great, and the patient’s strength exhausted, this is commonly the case. At any rate the patient is ready to fall into a swoon, and should have volatile salts or spirits held to his nose.

If the matter discharged be thick, and the cough and breathing become easier, there may be some hopes of a cure. The diet at this time ought to be light, but restorative, as chicken-broths, sago-gruel, rice-milk, &c. the drink, butter-milk, or whey, sweetened with honey. This is likewise a proper time for using the Peruvian bark, which may be taken as directed above.

If the vomica or imposthume should discharge itself into the cavity of the breast, betwixt the pleura and the lungs, there is no way of getting the matter out but by an incision, as has already been observed. As this operation must always be performed by a surgeon, it is not necessary here to describe it. We shall only add, that it is not so dreadful as people are apt to imagine, and that it is the only chance the patient in this case has for his life.

A nervous consumption is a wasting or decay of the whole body, without any considerable degree of fever, cough, or difficulty of breathing. It is attended with indigestion, weakness, and want of appetite, &c.

Those who are of a fretful temper, who indulge in spirituous liquors, or who breathe an unwholesome air, are most liable to this disease.

We would chiefly recommend, for the cure of a nervous consumption, a light and nourishing diet, plenty of exercise in a free open air, and the use of such bitters as brace and strengthen the stomach; as the Peruvian bark, gentian root, camomile, horehound, &c. These may be infused in water or wine, and a glass of it drank frequently.

It will greatly assist the digestion, and promote the cure of this disease, to take twice-a-day twenty or thirty drops of the elixir of vitriol in a glass of wine or water. The chalybeate wine is likewise an excellent medicine in this case. It strengthens the solids, and powerfully assists Nature in the preparation of good blood[77].

Agreeable amusements, cheerful company, and riding about, are however preferable to all medicines in this disease. For which reason, when the patient can afford it, we would recommend a long journey of pleasure, as the most likely means to restore his health.

What is called a symptomatic consumption cannot be cured without first removing the disease by which it is occasioned. Thus, when a consumption proceeds from, the scrophula or king’s evil, from the scurvy, the asthma, the venereal disease, &c. a due attention must be paid to the malady from whence it arises, and the regimen and medicine directed accordingly.

When excessive evacuations of any kind occasion a consumption, they must not only be restrained, but the patient’s strength must be restored by gentle exercise, nourishing diet, and generous cordials. Young and delicate mothers often fall into consumptions, by giving suck too long. As soon as they perceive their strength and appetite begin to fail, they ought immediately to wean the child, or provide another nurse, otherwise they cannot expect a cure.

Before we quit this subject, we would earnestly recommend it to all, as they wish to avoid consumptions, to take as much exercise without doors as they can, to avoid unwholesome air, and to study sobriety. Consumptions owe their present increase not a little to the fashion of sitting up late, eating hot suppers, and spending every evening over a bowl of hot punch or other strong liquors. These liquors, when too freely used, not only hurt the digestion, and spoil the appetite, but heat and inflame the blood, and set the whole constitution on fire.

CHAP. XIX. OF THE SLOW OR NERVOUS FEVER.

Nervous fevers have increased greatly of late years in this island, owing doubtless to our different manner of living, and the increase of sedentary employments; as they commonly attack persons of a weak relaxed habit, who neglect exercise, eat little solid food, study hard, or indulge in spirituous liquors.

CAUSES.——Nervous fevers may be occasioned by whatever depresses the spirits, or impoverishes the blood; as grief, fear, anxiety, want of sleep, intense thought, living on poor watery diet, unripe fruits, cucumbers, melons, mushrooms, &c. They may likewise be occasioned by damp, confined, or unwholesome air. Hence they are very common in rainy seasons, and prove most fatal to those who live in dirty low houses, crowded streets, hospitals, jails, or such-like places.

Persons whose constitutions have been broken by excessive venery, frequent salivations, too free an use of purgative medicines, or any other excessive evacuations, are most liable to this disease.

Keeping on wet clothes, lying on the damp ground, excessive fatigue, and whatever obstructs the perspiration, or causes a spasmodic stricture of the solids, may likewise occasion nervous fevers. We shall only add, frequent and great irregularities in diet. Too great abstinence, as well as excess, is hurtful. Nothing tends so much to preserve the body in a sound state as a regular diet; nor can any thing contribute more to occasion fevers of the worst kind than its opposite.

SYMPTOMS.——Low spirits, want of appetite, weakness, weariness after motion, watchfulness, deep sighing, and dejection of mind, are generally the forerunners of this disease. These are succeeded by a quick low pulse, a dry tongue without any considerable thirst, chillness and flushing in turns, &c.

After some time the patient complains of a giddiness and pain of the head, has a nausea, with reachings and vomiting; the pulse is quick, and sometimes intermitting; the urine pale, resembling dead small-beer, and the breathing is difficult, with oppression of the breast, and slight alienations of mind.

If towards the ninth, tenth, or twelfth day, the tongue becomes more moist, with a plentiful spitting, a gentle purging, or a moisture upon the skin; or if a suppuration happens in one or both ears, or large pustules break out about the lips and nose, there is reason to hope for a favourable crisis.

But if there is an excessive looseness, or wasting sweats, with frequent fainting fits; if the tongue, when put out, trembles excessively, and the extremities feel cold, with a fluttering or slow creeping pulse; if there is a starting of the tendons, an almost total loss of sight and hearing, and an involuntary discharge by stool and urine, there is great reason to fear that death is approaching.

REGIMEN.——It is very necessary in this disease to keep the patient cool and quiet. The least motion would fatigue him, and will be apt to occasion weariness, and even faintings. His mind ought not only to be kept easy, but soothed and comforted with the hopes of a speedy recovery. Nothing is more hurtful in low fevers of this kind than presenting to the patient’s imagination gloomy or frightful ideas. These of themselves often occasion nervous fevers, and it is not to be doubted but they will likewise aggravate them.

The patient must not be kept too low. His strength and spirits ought to be supported by nourishing diet and generous cordials. For this purpose his gruel, panado, or whatever food he takes, must be mixed with wine according as the symptoms may require. Pretty strong wine-whey, or small negus, sharpened with the juice of orange or lemon, will be proper for his ordinary drink. Mustard-whey is likewise a very proper drink in this fever, and may be rendered an excellent cordial medicine by the addition of a proper quantity of white-wine[78].

Wine in this disease, if it could be obtained genuine, is almost the only medicine that would be necessary. Good wine possesses all the virtues of the cordial medicines, while it is free from many of their bad qualities. I say good wine; for however common this article of luxury is now become, it is rarely to be obtained genuine, especially by the poor, who are obliged to purchase it in small quantities.

I have often seen patients in low nervous fevers where the pulse could hardly be felt, with a constant delirium, coldness of the extremities, and almost every other mortal symptom, recover by using in whey, gruel, and negus, a bottle or two of strong wine every day. Good old sound claret is the best, and may be made into negus, or given by itself, as circumstances require.

In a word, the great aim in this disease is to support the patient’s strength, by giving him frequently small quantities of the above, or other drinks of a warm and cordial nature. He is not however to be overheated either with liquor or clothes; and his food ought to be light, and given in small quantities.

MEDICINE.——Where a nausea, load, and sickness at stomach, prevail at the beginning of the fever, it will be necessary to give the patient a gentle vomit. Fifteen or twenty grains of ipecacuanha in fine powder, or a few spoonfuls of the vomiting julep[79], will generally answer this purpose very well. This may be repeated any time before the third or fourth day, if the above symptoms continue. Vomits not only clean the stomach, but, by the general shock which they give, promote the perspiration, and have many other excellent effects in slow fevers, where there are no signs of inflammation, and nature wants rousing.

Such as dare not venture upon a vomit, may clean the bowels by a small dose of Turkey rhubarb, or an infusion of senna and manna.

In all fevers, the great point is to regulate the symptoms, so as to prevent them from going to either extreme. Thus, in fevers of the inflammatory kind, where the force of the circulation is too great, or the blood dense, and the fibres too rigid, bleeding and other evacuations are necessary. But in nervous fevers, where nature flags, where the blood is vapid and poor, and the solids relaxed, the lancet must be spared, and wine, with other cordials, plentifully administered.

It is the more necessary to caution people against bleeding in this disease, as there is generally at the beginning an universal stricture upon the vessels, and sometimes an oppression and difficulty of breathing, which suggest the idea of a plethora, or too great a quantity of blood. I have known even some of the faculty deceived by their own feelings in this respect, so far as to insist upon being bled, when it was evident from the consequences that the operation was improper.

Though bleeding is generally improper in this disease, yet blistering is highly necessary. Blistering-plasters may be applied at all times of the fever with great advantage. If the patient is delirious, he ought to be blistered on the neck or head, and it will be the safest course, when the insensibility continues, as soon as the discharge occasioned by one blistering-plaster abates, to apply another to some other part of the body, and by that means keep up a continual succession of them till he be out of danger.

I have been more sensible of the advantage of blistering in this than in any other disease. Blistering-plasters not only stimulate the solids to action, but likewise occasion a continual discharge, which may in some measure supply the want of critical evacuations, which seldom happen in this kind of fever. They are most proper, however, either towards the beginning, or after some degree of stupor has come on, in which last case it will always be proper to blister the head.

If the patient is costive through the course of the disease, it will be necessary to procure a stool, by giving him every other day a clyster of milk and water, with a little sugar, to which may be added a spoonful of common salt, if the above does not operate.

Should a violent looseness come on, it may be checked by small quantities of Venice treacle, or giving the patient for his ordinary drink the white decoction[80].

A miliary eruption sometimes breaks out about the ninth or tenth day. As eruptions are often critical, great care should be taken not to retard Nature’s operation in this particular. The eruption ought neither to be checked by bleeding nor other evacuations, nor pushed out by a hot regimen; but the patient should be supported by gentle cordials, as wine-whey, small negus, sago-gruel with a little wine in it, and such like. He ought not to be kept too warm; yet a kindly breathing sweat should by no means be checked.

Though blistering and the use of cordial liquors are the chief things to be depended on in this kind of fever; yet, for those who may chuse to use them, we shall mention one or two of the forms of medicine which are commonly prescribed in it[81].

In desperate cases, where the hiccup and starting of the tendons have already come on, we have sometimes seen extraordinary effects from large doses of musk frequently repeated. Musk is doubtless an antispasmodic, and may be given to the quantity of a scruple three or four times a-day, or oftener if necessary. Sometimes it may be proper to add to the musk a few grains of camphire, and salt of hartshorn, as these tend to promote perspiration and the discharge of urine. Thus fifteen grains of musk, with three grains of camphire, and six grains of salt of hartshorn, may be made into a bolus with a little syrup, and given as above.

If the fever should happen to intermit, which it frequently does towards the decline, or if the patient’s strength should be wasted with colliquative sweats, &c. it will be necessary to give him the Peruvian bark. Half a drachm, or a whole drachm, if the stomach will bear it, of the bark in fine powder, may be given four or five times a-day in a glass of red port or claret. Should the bark in substance not sit easy on the stomach, an ounce of it in powder may be infused in a bottle of Lisbon or Rhenish wine for two or three days, afterwards it may be strained, and a glass of it taken frequently[82].

Some give the bark in this and other fevers, where there are no symptoms of inflammation, without any regard to the remission or intermission of the fever. How far future observations may tend to establish this practice, we will not pretend to say; but we have reason to believe that the bark is a very universal febrifuge, and that it may be administered with advantage in most fevers where bleeding is not necessary, or where there are no symptoms of topical inflammation.

CHAP. XX. OF THE MALIGNANT, PUTRID, OR SPOTTED FEVER.

This may be called the pestilential fever of Europe, as in many of its symptoms it bears a great resemblance to that dreadful disease the plague. Persons of a lax habit, a melancholy disposition, and those whose vigour has been wasted by long fasting, watching, hard labour, excessive venery, frequent salivations, &c. are most liable to it.

CAUSES.——This fever is occasioned by foul air, from a number of people being confined in a narrow place, not properly ventilated; from putrid animal and vegetable effluvia, &c. Hence it prevails in camps, jails, hospitals and infirmaries, especially where such places are too much crowded, and cleanliness is neglected.

A close constitution of the air, with long rainy or foggy weather, likewise occasions putrid fevers. They often succeed great inundations in low and marshy countries, especially when these are preceded or followed by a hot and sultry season.

Living too much upon animal food, without a proper mixture of vegetables, or eating fish or flesh that has been kept too long, are likewise apt to occasion this kind of fever. Hence sailors on long voyages, and the inhabitants of besieged cities, are very often visited with putrid fevers.

Corn that has been greatly damaged by rainy seasons, or long keeping, and water which has become putrid by stagnation, &c. may likewise occasion this fever.

Dead carcases tainting the air, especially in hot seasons, are very apt to occasion putrid diseases. Hence this kind of fever often prevails in countries which are the scenes of war and bloodshed. This shews the propriety of removing burying grounds, slaughterhouses, &c. at a proper distance from great towns.

Want of cleanliness is a very general cause of putrid fevers. Hence they prevail amongst the poor inhabitants of large towns, who breathe a confined unwholesome air, and neglect cleanliness. Such mechanics as carry on dirty employments, and are constantly confined within doors, are likewise very liable to this disease.

We shall only add, that putrid, malignant, or spotted fevers, are highly infectious, and are therefore often communicated by contagion. For which reason all persons ought to keep at a distance from those affected with such diseases, unless their attendance is absolutely necessary.

SYMPTOMS.——The malignant fever is generally preceded by a remarkable weakness or loss of strength, without any apparent cause. This is sometimes so great, that the patient can scarce walk, or even sit upright, without being in danger of fainting away. His mind too is greatly dejected; he sighs, and is full of dreadful apprehensions.

There is a nausea, and sometimes a vomiting of bile; a violent pain of the head, with a strong pulsation or throbbing of the temporal arteries; the eyes often appear red and inflamed, with a pain at the bottom of the orbit; there is a noise in the ears, the breathing is laborious, and often interrupted with a sigh; the patient complains of a pain about the region of the stomach, and in his back and loins; his tongue is at first white, but afterwards it appears black and chaped; and his teeth are covered with a black crust. He sometimes passes worms both upwards and downwards, is affected with tremors or shaking, and often becomes delirious.

If blood is let, it appears dissolved, or with a very small degree of cohesion, and soon becomes putrid; the stools smell extremely fœtid, and are sometimes of a greenish, black, or reddish cast. Spots of a pale purple, dun, or black colour, often appear upon the skin, and sometimes there are violent hæmorrhages, or discharges of blood from the mouth, eyes, nose, &c.

Putrid fevers may be distinguished from the inflammatory, by the smallness of the pulse, the great dejection of mind, the dissolved state of the blood, the petechiæ, or purple spots, and the putrid smell of the excrements. They may likewise be distinguished from the low or nervous fever by the heat and thirst being greater, the urine of a higher colour, and the loss of strength, dejection of mind, and all the other symptoms more violent.

It sometimes happens, however, that the inflammatory, nervous, and putrid symptoms are so blended together, as to render it very difficult to determine to which class the fever belongs. In this case the greatest caution and skill are requisite. Attention must be paid to those symptoms which are most prevalent, and both the regimen and medicines adapted to them.

Inflammatory and nervous fevers may be converted into malignant and putrid, by too hot a regimen or improper medicines.

The duration of putrid fevers is extremely uncertain; sometimes they terminate between the seventh and fourteenth day, and at other times they are prolonged for five or six weeks. Their duration depends greatly upon the constitution of the patient, and the manner of treating the disease.

The most favourable symptoms are, a gentle looseness after the fourth or fifth day, with a warm mild sweat. These, when continued for a considerable time, often carry off the fever, and should never be imprudently stopped. Small miliary pustules appearing between the petechiæ or purple spots are likewise favourable, as also hot scabby eruptions about the mouth and nose. It is a good sign when the pulse rises upon the use of wine, or other cordials, and the nervous symptoms abate; deafness coming on towards the decline of the fever, is likewise often a favourable symptom[83], as are abscesses in the groin or parotid glands.

Among the unfavourable symptoms may be reckoned an excessive looseness, with a hard swelled belly; large black or livid blotches breaking out upon the skin; apthæ in the mouth; cold clammy sweats; blindness; change of the voice; a wild flaring of the eyes; difficulty of swallowing; inability to put out the tongue; and a constant inclination to uncover the breast. When the sweat and saliva are tinged with blood, and the urine is black, or deposits a black sooty sediment, the patient is in great danger. Starting of the tendons, and fœtid, ichorous, involuntary stools, attended with coldness of the extremities, are generally the forerunners of death.

REGIMEN.——In the treatment of this disease we ought to endeavour as far as possible to counteract the putrid tendency of the humours; to support the patient’s strength and spirits; and to assist Nature in expelling the cause of this disease, by gently promoting perspiration and the other evacuations.

It has been observed, that putrid fevers are often occasioned by unwholesome air, and of course they must be aggravated by it. Care should therefore be taken to prevent the air from stagnating in the patient’s chamber, to keep it cool, and renew it frequently, by opening the doors or windows of some adjacent apartment. The breath and perspiration of persons in perfect health soon render the air of a small apartment noxious; but this will sooner happen from the perspiration and breath of a person whose whole mass of humours are in a putrid state.

Besides the frequent admission of fresh air, we would recommend the use of vinegar, verjuice, juice of lemon, Seville orange, or any kind of vegetable acid that can be most readily obtained. These ought frequently to be sprinkled upon the floor, the bed, and every part of the room. They may also be evaporated with a hot iron, or by boiling, &c. The fresh skins of lemons or oranges ought likewise to be laid in different parts of the room, and they should be frequently held to the patient’s nose. The use of acids in this manner would not only prove very refreshing to the patient, but would likewise tend to prevent the infection from spreading among those who attend him. Strong scented herbs, as rue, tansy, rosemary, wormwood, &c. may likewise be laid in different parts of the house, and smelled to by those who go near the patient.

The patient must not only be kept cool, but likewise quiet and easy. The least noise will affect his head, and the smallest fatigue will be apt to make him faint.

Few things are of greater importance in this disease than acids, which ought to be mixed with all the patient’s food as well as drink. Orange, lemon, or vinegar whey, are all very proper, and may be drank by turns, according to the patient’s inclination. They may be rendered cordial by the addition of wine in such quantity as the patient’s strength seems to require. When he is very low, he may drink negus, with only one half water, and sharpened with the juice of orange or lemon. In some cases a glass of wine may now and then be allowed. The most proper wine is Rhenish; but if the body be open, red port or claret is to be preferred.

When the body is bound, a tea-spoonful of the cream of tartar may be put into a cup of the patient’s drink, as there is occasion; or he may drink a decoction of tamarinds, which will both quench his thirst, and promote a discharge by stool.

If camomile-tea will sit upon his stomach, it is a very proper drink in this disease. It may be sharpened by adding to every cup of the tea ten or fifteen drops of the elixir of vitriol.

The food must be light, as panado or groat-gruel, to which a little wine may be added, if the patient be weak and low; and they ought all to be sharpened with the juice of orange, the jelly of currants, or the like. The patient ought likewise to eat freely of ripe fruits, as roasted apples, currant or gooseberry tarts, preserved cherries, or plums, &c.

Taking a little food or drink frequently, not only supports the spirits, but counteracts the putrid tendency of the humours; for which reason the patient ought frequently to be sipping small quantities of some of the acid liquors mentioned above, or any that may be more agreeable to his palate, or more readily obtained.

If he is delirious, his feet and hands ought to be frequently fomented with a strong infusion of camomile flowers. This, or an infusion of the bark, to such as can afford it, cannot fail to have a good effect. Fomentations of this kind not only relieve the head, by relaxing the vessels in the extremities, but as their contents are absorbed, and taken into the system, they may assist in preventing the putrescency of the humours.

MEDICINE.——If a vomit be given at the beginning of this fever, it will hardly fail to have a good effect; but if the fever has gone on for some days, and the symptoms are violent, vomits are not quite so safe. The body however is always to be kept gently open by clysters, or mild laxative medicines.

Bleeding is seldom necessary in putrid fevers. If there be signs of an inflammation, it may sometimes be permitted at the first onset; but the repetition of it generally proves hurtful.

Blistering plasters are never to be used unless in the greatest extremities. If the petechiæ or spots should suddenly disappear, the patient’s pulse sink remarkably, and a delirium, with other bad symptoms, come on, blistering may be permitted. In this case the blistering plasters are to be applied to the head, and inside of the legs or thighs. But as they are sometimes apt to occasion a gangrene, we would rather recommend warm cataplasms or poultices of mustard and vinegar to be applied to the feet, having recourse to blisters only in the utmost extremities.

It is common in the beginning of this fever to give the emetic tartar in small doses, repeated every second or third hour, till it shall either vomit, purge, or throw the patient into a sweat. This practice is very proper, provided it be not pushed so far as to weaken the patient.

A very ridiculous notion has long prevailed, of expelling the poisonous matter of malignant diseases by trifling doses of cordial or alexipharmic medicines. In consequence of this notion, the contrayerva-root, the cordial confection, the mithridate, &c. have been extolled as infallible remedies. There is reason however to believe, that these seldom do much good. Where cordials are necessary, we know none that is superior to good wine; and therefore again recommend it both as the safest and best. Wine, with acids and antiseptics, are the only things to be relied on in the cure of malignant fevers.

In the most dangerous species of this disease, when it is attended with purple, livid, or black spots, the Peruvian bark must be administered. I have seen it, when joined with acids, prove successful, even in cases where the petechiæ had the most threatening aspect. But, to answer this purpose, it must not only be given in large doses, but duly persisted in.

The best method of administering the bark is certainly in substance. An ounce of it in powder may be mixed with half an English pint of water, and the same quantity of red wine, and sharpened with the elixir or the spirit of vitriol, which will both make it sit easier on the stomach, and render it more beneficial. Two or three ounces of the syrup of lemon may be added, and two table-spoonfuls of the mixture taken every two hours, or oftener, if the stomach is able to bear it.

Those who cannot take the bark in substance may infuse it in wine, as recommended in the preceding disease.

If there be a violent looseness, the bark must be boiled in red wine with a little cinnamon, and sharpened with the elixir of vitriol, as above. Nothing can be more beneficial in this kind of looseness than plenty of acids, and such things as promote a gentle perspiration.

If the patient be troubled with vomiting, a dram of the salt of wormwood, dissolved in an ounce and half of fresh lemon-juice, and made into a draught with an ounce of simple cinnamon water, and a bit of sugar, may be given and repeated as often as it is necessary.

If swellings of the glands appear, their suppuration is to be promoted by the application of poultices, ripening cataplasms, &c. And as soon as there is any appearance of matter in them, they ought to be laid open, and the poultices continued.

I have known large ulcerous sores break out in various parts of the body, in the decline of this fever, of a livid gangrenous appearance, and a most putrid cadaverous smell. These gradually healed, and the patient recovered, by the plentiful use of Peruvian bark and wine, sharpened with the spirits of vitriol.

For preventing putrid fevers we would recommend a strict regard to cleanliness; a dry situation; sufficient exercise in the open air; wholesome food, and a moderate use of generous liquors. Infection ought above all things to be avoided. No constitution is proof against it. I have known persons seized with a putrid fever, by only making a single visit to a patient in it; others have caught it by lodging for one night in a town where it prevailed; and some by attending the funerals of such as died of it[84].

When a putrid fever seizes any person in a family, the greatest attention is necessary to prevent the disease from spreading. The sick ought to be placed in a large apartment, as remote from the rest of the family as possible; he ought likewise to be kept extremely clean, and should have fresh air frequently let into his chamber; whatever comes from him should be immediately removed, his linen should be frequently changed, and those in health ought to avoid all unnecessary communication with him.

Any one who is apprehensive of having caught the infection, ought immediately to take a vomit, and to work it off by drinking plentifully of camomile-tea. This may be repeated in a day or two, if the apprehensions still continue, or any unfavourable symptoms appear.

The person ought likewise to take an infusion of the bark and camomile flowers for his ordinary drink; and before he goes to bed, he may drink an English pint of pretty strong negus, or a few glasses of generous wine. I have been frequently obliged to follow this course, when malignant fevers prevailed, and have likewise recommended it to others with constant success.

People generally fly to bleeding and purging as antidotes against infection; but these are so far from securing them, that they often, by debilitating the body, increase the danger.

Those who wait upon the sick in putrid fevers, ought always to have a piece of spunge or a handkerchief dipt in vinegar, or juice of lemon, to smell to while near the patient. They ought likewise to wash their hands, and, if possible, to change their clothes, before they go into company.

CHAP. XXI. OF THE MILIARY FEVER.

This fever takes its name from the small pustules or bladders which appear on the skin, resembling, in shape and size, the seeds of millet. The pustules are either red or white, and sometimes both are mixed together.

The whole body is sometimes covered with pustules; but they are generally more numerous where the sweat is most abundant, as on the breast, the back, &c. A gentle sweat, or moisture on the skin, greatly promotes the eruption; but, when the skin is dry, the eruption is both more painful and dangerous.

Sometimes this is a primary disease; but it is much oftener only a symptom of some other malady, as the small-pox, measles, ardent, putrid, or nervous fever, &c. In all these cases it is generally the effect of too hot a regimen or medicines.

The miliary fever chiefly attacks the idle and the phlegmatic, or persons of a relaxed habit. The young and the aged are more liable to it than those in the vigour and prime of life. It is likewise more incident to women than men, especially the delicate and the indolent, who, neglecting exercise, keep continually within doors, and live upon weak watery diet. Such females are extremely liable to be seized with this disease in child-bed, and often lose their lives by it.

CAUSES.——The miliary fever is sometimes occasioned by violent passions or affections of the mind; as excessive grief, anxiety, thoughtfulness, &c. It may likewise be occasioned by excessive watching, great evacuations, a weak watery diet, rainy seasons, eating too freely of cold, crude, unripe fruits, as plums, cherries, cucumbers, melons; &c. Impure waters, or provisions which have been spoiled by rainy seasons, long keeping, &c. may likewise cause miliary fevers. They may also be occasioned by the stoppage of any customary evacuation, as issues, setons, ulcers, the bleeding piles in men, or the menstrual flux in women, &c.

This disease in child-bed-women is sometimes the effect of great costiveness during pregnancy; it may likewise be occasioned by their excessive use of green trash, and other unwholesome things, in which pregnant women are too apt to indulge. But its most general cause is indolence. Such women as lead a sedentary life, especially during pregnancy, and at the same time live grossly, can hardly escape this disease in child-bed. Hence it proves extremely fatal to women of fashion, and likewise to those women in manufacturing towns, who, in order to assist their husbands, sit close within doors for almost the whole of their time. But among women who are active and laborious, who live in the country, and take sufficient exercise without doors, this disease is very little known.

SYMPTOMS.——When this is a primary disease, it makes its attack, like most other eruptive fevers, with a slight shivering, which is succeeded by heat, loss of strength, faintishness, sighing, a low quick pulse, difficulty of breathing, with great anxiety and oppression of the breast. The patient is restless, and sometimes delirious; the tongue appears white, and the hands shake, with often a burning heat in the palms; and in child-bed-women the milk generally goes away, and the other discharges stop.

The patient feels an itching or pricking pain under the skin, after which innumerable small pustules of a red or white colour begin to appear. Upon this the symptoms generally abate, the pulse becomes more full and soft, the skin grows moister, and the sweat, as the disease advances, begins to have a peculiar fœtid smell; the great load on the breast, and oppression of the spirits, generally go off, and the customary evacuations gradually return. About the sixth or seventh day from the eruption, the pustules begin to dry and fall off, which occasions a very disagreeable itching in the skin.

It is impossible to ascertain the exact time when the pustules will either appear or go off. They generally come out on the third or fourth day, when the eruption is critical; but, when symptomatic, they may appear at any time of the disease.

Sometimes the pustules appear and vanish by turns. When that is the case, there is always danger; but when they go in all of a sudden, and do not appear again, the danger is very great.

In child-bed-women the pustules are commonly at first filled with clear water, afterwards they grow yellowish. Sometimes they are interspersed with pustules of a red colour. When these only appear the disease goes by the name of a rash.

REGIMEN.——In all eruptive fevers, of whatever kind, the chief point is to prevent the sudden disappearing of the pustules, and to promote their maturation. For this purpose the patient must be kept in such a temperature, as neither to push out the eruption too fast, nor to cause it to retreat prematurely. The diet and drink ought therefore to be in a moderate degree nourishing and cordial; but neither strong nor heating. The patient’s chamber ought neither to be kept too hot nor cold; and he should not be too much covered with clothes. Above all, the mind is to be kept easy and cheerful. Nothing so certainly makes an eruption go in as fear, or the apprehension of danger.

The food must be weak chicken-broth with bread, panado, sago, or groat gruel, &c. to a gill of which may be added a spoonful or two of wine, as the patient’s strength requires, with a few grains of salt and a little sugar. Good apples roasted or boiled, with other ripe fruits of an opening cooling nature, may be eaten.

The drink may be suited to the state of the patient’s strength and spirits. If these be pretty high, the drink ought to be weak; as water-gruel, balm-tea, or the decoction mentioned below[85].

When the patient’s spirits are low, and the eruption does not rise sufficiently, his drink must be a little more generous; as wine-whey, or small negus, sharpened with the juice of orange or lemon, and made stronger or weaker as circumstances may require.

Sometimes the miliary fever approaches towards a putrid nature, in which case the patient’s strength must be supported with generous cordials, joined with acids; and, if the degree of putrescence be great, the Peruvian bark must be administered. If the head be much affected, the body must be kept open by emollient clysters[86].

MEDICINE.——If the food and drink be properly regulated, there will be little occasion for medicine in this disease. Should the eruption however not rise, or the spirits flag, it will not only be necessary to support the patient with cordials, but likewise to apply blistering plasters. The most proper cordial, in this case, is good wine, which may either be taken in the patient’s food or drink; and if there be signs of putrescence, the bark and acids may be mixed with wine, as directed in the putrid fever.

Some recommend blistering through the whole course of this disease; and where Nature flags, and the eruption comes and goes, it may be necessary to keep up a stimulus, by a continual succession of small blistering plasters; but we would not recommend above one at a time. If however the pulse should sink remarkably, the pustules fall in, and the head be affected, it will be necessary to apply several blistering plasters to the most sensible parts, as the inside of the legs and thighs, &c.

Bleeding is seldom necessary in this disease, and sometimes it does much hurt, as it weakens the patient, and depresses his spirits. It is therefore never to be attempted unless by the advice of a physician. We mention this, because it has been customary to treat this disease in child-bed-women by plentiful bleeding, and other evacuations, as if it were highly inflammatory. But this practice is generally very unsafe. Patients in this situation bear evacuations very ill. And indeed the disease seems often to be more of a putrid than of an inflammatory nature.

Though this fever is often occasioned in child-bed-women by too hot a regimen, yet it would be dangerous to leave that off all of a sudden, and have recourse to a very cool regimen, and large evacuations. We have reason to believe, that supporting the patient’s spirits, and promoting the natural evacuations, is here much safer than to have recourse to artificial ones, as these, by sinking the spirits, seldom fail to increase the danger.

If the disease proves tedious, or the recovery slow, we would recommend the Peruvian bark, which may either be taken in substance, or infused in wine or water, as the patient inclines.

The miliary fever, like other eruptive diseases, requires gentle purging, which should not be neglected, as soon as the fever is gone off, and the patient’s strength will permit.

To prevent this disease, a pure dry air, sufficient exercise, and wholesome food, are necessary. Pregnant women should guard against costiveness, and take daily as much exercise as they can bear, avoiding all green trashy fruits, and other unwholesome things; and when in child-bed, they ought strictly to observe a cool regimen.

CHAP. XXII. OF THE REMITTING FEVER.

This fever takes its name from a remission of the symptoms, which happens sometimes sooner, and sometimes later, but generally before the eighth day. The remission is commonly preceded by a gentle sweat, after which the patient seems greatly relieved, but in a few hours the fever returns. These remissions return at very irregular periods, and are sometimes of longer, sometimes of shorter duration; the nearer however that the fever approaches to a regular intermittent, the danger is the less.

CAUSES.——Remitting fevers prevail in low marshy countries abounding with wood and stagnating water; but they prove most fatal in places where great heat and moisture are combined, as in some parts of Africa, the province of Bengal in the East Indies, &c. where remitting fevers are generally of a putrid kind, and prove very fatal. They are most frequent in close calm weather, especially after rainy seasons, great inundations, or the like. No age, sex, or constitution, is exempted from the attack of this fever; but it chiefly seizes persons of a relaxed habit, who live in low dirty habitations, breathe an impure stagnating air, take little exercise, and use unwholesome diet.

SYMPTOMS.——The first symptoms of this fever are generally yawning, stretching, pain, and giddiness in the head, with alternate fits of heat and cold. Sometimes the patient is affected with a delirium at the very first attack. There is a pain, and sometimes a swelling, about the region of the stomach; the tongue is white, the eyes and skin frequently appear yellow, and the patient is often afflicted with bilious vomitings. The pulse is sometimes a little hard, but seldom full, and the blood, when let, rarely shews any signs of inflammation. Some patients are exceedingly costive, and others are afflicted with a very troublesome looseness.

It is impossible to describe all the symptoms of this disease, as they vary according to the situation, the season of the year, and the constitution of the patient. They may likewise be greatly changed by the method of treatment, and by many other circumstances too tedious to mention. Sometimes the bilious symptoms predominate, sometimes the nervous, and at other times the putrid. Nor is it at all uncommon to find a succession of each of these, or even a complication of them at the same time, in the same person.

REGIMEN.——The regimen must be adapted to the prevailing symptoms. When there are any signs of inflammation, the diet must be slender, and the drink weak and diluting. But when nervous or putrid symptoms occur, it will be necessary to support the patient with food and liquors of a more generous nature, such as are recommended in the immediately preceding fevers. We must however be very cautious in the use of things of a heating quality, as this fever is frequently changed into a continual by an hot regimen, and improper medicines.

Whatever the symptoms are, the patient ought to be kept cool, quiet, and clean. His apartment, if possible, should be large, and frequently ventilated by letting in fresh air at the doors or windows. It ought likewise to be sprinkled with vinegar, juice of lemon, or the like. His linen, bed-clothes, &c. should be frequently changed, and all his excrements immediately removed. Though these things have been recommended before, we think it necessary to repeat them here, as they are of more importance to the sick than practitioners are apt to imagine[87].

MEDICINE.——In order to cure this fever, we must endeavour to bring it to a regular intermission. This intention may be promoted by bleeding, if there be any signs of inflammation; but when that is not the case, bleeding ought by no means to be attempted, as it will weaken the patient and prolong the disease. A vomit however will seldom be improper, and is generally of great service. Twenty or thirty grains of ipecacuanha will answer this purpose very well; but, where it can be obtained, we would rather recommend a grain or two of tartar emetic, with five or six grains of ipecacuanha, to be made into a draught, and given for a vomit. This may be repeated once or twice at proper intervals, if the sickness or nausea continues.

The body ought to be kept open either by clysters or gentle laxatives, as weak infusions of senna and manna, small doses of the lenitive electuary, cream of tartar, tamarinds, stewed prunes, or the like; but all strong or drastic purgatives are to be carefully avoided.

By this course the fever in a few days may generally be brought to a pretty regular or distinct intermission, in which case the Peruvian bark may be administered, and it will seldom fail to perfect the cure. It is needless here to repeat the methods of giving the bark, as we have already had occasion frequently to mention them.

The most likely way to avoid this fever is to use a wholesome and nourishing diet, to pay the most scrupulous attention to cleanliness, to keep the body warm, to take sufficient exercise, and in hot countries to avoid damp situations, night air, evening dews, and the like. In countries where it is endemical, the best preventive medicine which we can recommend, is the Peruvian bark, which may either be chewed, or infused in brandy or wine, &c. Some recommend smoking tobacco as very beneficial in marshy countries, both for the prevention of this and intermitting fevers.

CHAP. XXIII. OF THE SMALL-POX.

This disease, which originally came from Arabia, is now become so general, that very few escape it at one time of life or another. It is a most contagious malady; and has for many years proved the scourge of Europe.

The small-pox generally appear towards the spring. They are very frequent in summer, less so in autumn, and least of all in winter. Children are most liable to this disease; and those whose food is unwholesome, who want proper exercise, and abound with gross humours, run the greatest hazard from it.

The disease is distinguished into the distinct and confluent kind; the latter of which is always attended with danger. There are likewise other distinctions of the small-pox; as the crystalline, the bloody, &c.

CAUSES.——The small-pox is commonly caught by infection. Since the disease was first brought into Europe, the infection has never been wholly extinguished, nor have any proper methods, as far as I know, been taken for that purpose; so that now it has become in a manner constitutional. Children who have overheated themselves by running, wrestling, &c. or adults after a debauch, are most apt to be seized with the small-pox.

SYMPTOMS.——This disease is so generally known, that a minute description of it is unnecessary. Children commonly look a little dull, seem lifeless and drowsy for a few days before the more violent symptoms of the small-pox appear. They are likewise more inclined to drink than usual, have little appetite for solid food, complain of weariness, and, upon taking exercise, are apt to sweat. These are succeeded by slight fits of cold and heat in turns, which, as the time of the eruption approaches, become more violent, and are accompanied with pains of the head and loins, vomiting, &c. The pulse is quick, with a great heat of the skin, and restlessness. When the patient drops asleep, he wakes in a kind of horror, with a sudden start, which is a very common symptom of the approaching eruption; as are also convulsion-fits in very young children.

About the third or fourth day from the time of sickening, the small-pox generally begin to appear; sometimes indeed they appear sooner, but that is no favourable symptom. At first they very nearly resemble flea-bites, and are soonest discovered on the face, arms, and breast.

The most favourable symptoms are a slow eruption, and an abatement of the fever as soon as the pustules appear. In a mild distinct kind of small-pox the pustules seldom appear before the fourth day from the time of sickening, and they generally keep coming out gradually for several days after. Pustules which are distinct, with a florid red basis, and which fill with thick purulent matter, first of a whitish, and afterwards of a yellowish colour, are the best.

A livid brown colour of the pustules is an unfavourable symptom; as also when they are small and flat, with black specks in the middle. Pustules which contain a thin watery ichor are very bad. A great number of pox on the face is always attended with danger. It is likewise a very bad sign when they run into one another.

It is a most unfavourable symptom when petechiæ, or purple, brown, or black spots are interspersed among the pustules. These are signs of a putrid dissolution of the blood, and shew the danger to be very great. Bloody stools or urine, with a swelled belly, are bad symptoms; as is also a continual strangury. Pale urine and a violent throbbing of the arteries of the neck are signs of an approaching delirium, or of convulsion-fits. When the face does not swell, or falls before the pox come to maturity, it is very unfavourable. If the face begins to fall about the eleventh or twelfth day, and at the same time the hands and feet begin to swell, the patient generally does well; but when these do not succeed to each other, there is reason to apprehend danger. When the tongue is covered with a brown crust, it is an unfavourable symptom. Cold shivering fits coming on at the height of the disease are likewise unfavourable. Grinding of the teeth, when it proceeds from an affection of the nervous system, is a bad sign; but sometimes it is occasioned by worms, or a disordered stomach.

REGIMEN.——When the first symptoms of the small-pox appear, people are ready to be alarmed, and often fly to the use of medicine, to the great danger of the patient’s life. I have known children, to appease the anxiety of their parents, bled, blistered, and purged, during the fever which preceded the eruption of the small-pox, to such a degree, that Nature was not only disturbed in her operation, but rendered unable to support the pustules after they were out; so that the patient, exhausted by mere evacuations, sunk under the disease.

When convulsions appear, they give a dreadful alarm. Immediately some nostrum is applied, as if this were a primary disease; whereas it is only a symptom, and far from being an unfavourable one, of the approaching eruption. As the fits generally go off before the actual appearance of the small-pox, it is attributed to the medicine, which by this means acquires a reputation without any merit[88].

All that is, generally speaking, necessary during the eruptive fever, is to keep the patient cool and easy, allowing him to drink freely of some weak diluting liquors; as balm-tea, barley-water, clear whey, gruels, &c. He should not be confined to bed, but should sit up as much as he is able, and should have his feet and legs frequently bathed in lukewarm water. His food ought to be very light; and he should be as little disturbed with company as possible.

Much mischief is done at this period by confining the patient too soon to his bed, and plying him with warm cordials or sudorific medicines. Every thing that heats and inflames the blood increases the fever, and pushes out the pustules prematurely. This has numberless ill effects. It not only increases the number of pustules, but likewise tends to make them run into one another; and when they have been pushed out with too great violence, they generally fall in before they come to maturity.

The good women, as soon as they see the small-pox begin to appear, commonly ply their tender charge with cordials, saffron, and marigold-teas, wine, punch, and even brandy itself. All these are given with a view, as they term it, to throw out the eruption from the heart. This, like most other popular mistakes, is the abuse of a very just observation, that when there is a moisture on the skin, the pox rise better, and the patient is easier, than when it continues dry and parched. But that is no reason for forcing the patient into a sweat. Sweating never relieves unless where it comes spontaneously, or is the effect of drinking weak diluting liquors.

Children are often so peevish, that they will not lie a-bed without a nurse constantly by them. Indulging them in this, we have reason to believe, has many bad effects both upon the nurse and child. Even the natural heat of the nurse cannot fail to augment the fever of the child, but if she too proves feverish, which is often the case, the danger must be increased[89].

Laying several children who have the small-pox in the same bed has many ill consequences. They ought if possible never to be in the same chamber, as the perspiration, the heat, the smell, &c. all tend to augment the fever, and to heighten the disease. It is common among the poor to see two or three children lying in the same bed, with such a load of pustules that even their skins stick together. One can hardly view a scene of this kind without being sickened by the sight. But how must the effluvia affect the poor patients, many of whom perish by this usage[90]!

A very dirty custom prevails among the lower class of people, of allowing children in the small-pox to keep on the same linen during the whole period of that loathsome disease. This is done lest they should catch cold; but it has many ill consequences. The linen becomes hard by the moisture which it absorbs, and frets the tender skin. It likewise occasions a bad smell, which is very pernicious both to the patient and those about him; besides, the filth and sordes which adhere to the linen being resorbed, or taken up again into the body, greatly augment the disease.

A patient should not be suffered to be dirty in an internal disease, far less in the small-pox. Cutaneous disorders are often occasioned by nastiness alone, and are always increased by it. Were the patient’s linen to be changed every day, it would greatly refresh him. Care indeed is to be taken that the linen be thoroughly dry. It ought likewise to be put on when the patient is most cool.

So strong is the vulgar prejudice in this country, notwithstanding all that has been said against the hot regimen in the small-pox, that numbers still fall a sacrifice to that error. I have seen poor women travelling in the depth of winter, and carrying their children along with them in the small-pox, and have frequently observed others begging by the way-side, with infants in their arms covered with the pustules; yet I could never learn that one of these children died by this sort of treatment. This is certainly a sufficient proof of the safety at least, of exposing patients in the small-pox to the open air. There can be no reason however for exposing them to public view. It is now very common in the environs of great towns to meet patients in the small-pox on the public walks. This practice, however well it may suit the purposes of boasting inoculators, is dangerous to the citizens, and contrary to the laws of humanity and sound policy.

The food in this disease ought to be very light, and of a cooling nature, as panado, or bread boiled with equal quantities of milk and water, good apples roasted or boiled with milk, and sweetened with a little sugar, or such like.

The drink may be equal parts of milk and water, clear sweet whey, barley-water, or thin gruel, &c. After the pox are full, butter-milk, being of an opening and cleansing nature, is a very proper drink.

MEDICINE.——This disease is generally divided into four different periods, viz. the fever which precedes the eruption, the eruption itself, the suppuration, or maturation of the pustules, and the secondary fever.

It has already been observed, that little more is necessary during the primary fever than to keep the patient cool and quiet, allowing him to drink diluting liquors, and bathing his feet frequently in warm water. Though this be generally the safest course that can be taken with infants, yet adults of a strong constitution and plethoric habit sometimes require bleeding. When a full pulse, a dry skin, and other symptoms of inflammation render this operation necessary, it ought to be performed; but, unless these symptoms are urgent, it is safer to let it alone; if the body is bound, emollient clysters may be thrown in.

If there is a great nausea or inclination to vomit, weak camomile-tea or lukewarm water may be drank, in order to clean the stomach. At the beginning of a fever, Nature generally attempts a discharge, either upwards or downwards, which, if promoted by gentle means, would tend greatly to abate the violence of the disease.

Though every method is to be taken during the primary fever, by a cool regimen, &c. to prevent too great an eruption; yet after the pustules have made their appearance, our business is to promote the suppuration, by diluting drink, light food, and, if Nature seems to flag, by generous cordials. When a low, creeping pulse, faintishness, and great loss of strength, render cordials necessary, we would recommend good wine, which may be made into negus, with an equal quantity of water, and sharpened with the juice of orange, the jelly of currants, or the like. Wine-whey, sharpened as above, is likewise a proper drink in this case; great care however must be taken not to overheat the patient by any of these things. This, instead of promoting, would retard the eruption.

The rising of the small-pox is often prevented by the violence of the fever; in this case the cool regimen is strictly to be observed. The patient’s chamber must not only be kept cool, but he ought likewise frequently to be taken out of bed, and to be lightly covered with clothes while in it.

Excessive restlessness often prevents the rising and filling of the small-pox. When this happens, gentle opiates are necessary. These however ought always to be administered with a sparing hand. To an infant, a tea-spoonful of the syrup of poppies may be given every five or six hours till it has the desired effect. An adult will require a table-spoonful in order to answer the same purpose.

If the patient be troubled with a strangury, or suppression of urine, which often happens in the small-pox, he should be frequently taken out of bed, and, if he be able, should walk across the room with his feet bare. When he cannot do this, he may be frequently set on his knees in bed, and should endeavour to pass his urine as often as he can. When these do not succeed, a tea-spoonful of the sweet spirits of nitre may be occasionally mixed with his drink. Nothing more certainly relieves the patient, or is more beneficial in the small-pox, than a plentiful discharge of urine.

If the mouth be foul, and the tongue dry and chapped, it ought to be frequently washed, and the throat gargled with water and honey, sharpened with a little vinegar or currant jelly.

During the rising of the small-pox, it frequently happens that the patient is eight or ten days without a stool. This not only tends to heat and inflame the blood, but the fæces, by lodging so long in the body, become acrid, and even putrid; from whence bad consequences must ensue. It will therefore be proper, when the body is bound, to throw in an emollient clyster every second or third day, through the whole course of the disease. This will greatly cool and relieve the patient.

When petechiæ, or purple, black, or livid spots appear among the small-pox, the Peruvian bark must immediately be administered in as large doses as the patient’s stomach can bear. For a child, two drachms of the bark in powder may be mixed in three ounces of common water, one ounce of simple cinnamon-water, and two ounces of the syrup of orange or lemon. This may be sharpened with the spirits of vitriol, and a table-spoonful of it given every hour. If it be given to an adult in the same form, he may take at least three or four spoonfuls every hour. This medicine ought not to be trifled with, but must be administered as frequently as the stomach can bear it; in which case it will often produce very happy effects. I have frequently seen the petechiæ disappear, and the small-pox, which had a very threatening aspect, rise and fill with laudable matter, by the use of the bark and acids.

The patient’s drink ought likewise in this case to be generous, as wine or strong negus acidulated with spirits of vitriol, vinegar, the juice of lemon, jelly of currants, or such like. His food must consist of apples roasted or boiled, preserved cherries, plums, and other fruits of an acid nature.

The bark and acids are not only necessary when the petechiæ or putrid symptoms appear, but likewise in the lymphatic or crystalline small-pox, where the matter is thin, and not duly prepared. The Peruvian bark seems to possess a singular power of assisting Nature in preparing laudable pus, or what is called good matter; consequently it must be beneficial both in this and other diseases, where the crisis depends on a suppuration. I have often observed where the small-pox were flat, and the matter contained in them quite clear and transparent, and where at first they had the appearance of running into one another, that the Peruvian bark, acidulated as above, changed the colour and consistence of the matter, and produced the most happy effects.

When the eruption subsides suddenly, or, as the good women term it, when the small-pox strike in, before they have arrived at maturity, the danger is very great. In this case blistering-plasters must be immediately applied to the wrists and ancles, and the patient’s spirits supported with cordials.

Sometimes bleeding has a surprising effect in raising the pustules after they have subsided; but it requires skill to know when this is proper, or to what length the patient can bear it. Sharp cataplasms however may be applied to the feet and hands, as they tend to promote the swelling of these parts, and by that means to draw the humours towards the extremities.

The most dangerous period of this disease is what we call the secondary fever. This generally comes on when the small-pox begin to blacken, or turn on the face; and most of those who die of the small-pox are carried off by this fever.

Nature generally attempts, at the turn of the small-pox, to relieve the patient by loose stools. Her endeavours this way are by no means to be counteracted, but promoted, and the patient at the same time supported by food and drink of a nourishing and cordial nature.

If, at the approach of the secondary fever, the pulse be very quick, hard, and strong, the heat intense, and the breathing laborious, with other symptoms of an inflammation of the breast, the patient must immediately be bled. The quantity of blood to be let must be regulated by the patient’s strength, age, and the urgency of the symptoms.

But, in the secondary fever, if the patient be faintish, the pustules become suddenly pale, and if there be great coldness of the extremities, blistering plasters must be applied, and the patient must be supported with generous cordials. Wine and even spirits have sometimes been given in such cases with amazing success.

As the secondary fever is in great measure, if not wholly, owing to the absorption of the matter, it would seem highly consonant to reason, that the pustules, as soon as they come to maturity, should be opened. This is every day practiced in other phlegmons which tend to suppuration; and there seems to be no cause why it should be less proper here. On the contrary, we have reason to believe, that by this means the secondary fever might always be lessened, and often wholly prevented.

The pustules should be opened when they begin to turn of a yellow colour. Very little art is necessary for this operation. They may either be opened with a lancet or a needle, and the matter absorbed by a little dry lint. As the pustules are generally first ripe on the face, it will be proper to begin with opening these, and the others in course as they become ripe. The pustules generally fill again, a second or even a third time; for which cause the operation must be repeated, or rather continued as long as there is any considerable appearance of matter in the pustules.

We have reason to believe that this operation, rational as it is, has been neglected from a piece of mistaken tenderness in parents. They believe that it must give great pain to the poor child; and therefore would rather see it die than have it thus tortured. This notion however is entirely without foundation. I have frequently opened the pustules when the patient did not see me, without his being in the least sensible of it; but suppose it were attended with a little pain, that is nothing in comparison to the advantages which arise from it.

Opening the pustules not only prevents the resorption of the matter into the blood, but likewise takes off the tension of the skin, and by that means greatly relieves the patient. It likewise tends to prevent the pitting, which is a matter of no small importance. Acrid matter, by lodging long in the pustules, cannot fail to corrode the tender skin; by which many a handsome face becomes so deformed as hardly to bear a resemblance to the human figure[91].

It is generally necessary, after the small-pox are gone off, to purge the patient. If however the body has been open through the whole course of the disease, or if butter-milk and other things of an opening nature have been drank freely after the height of the small-pox, purging becomes less necessary; but it ought never wholly to be neglected.

For very young children, an infusion of senna and prunes, with a little rhubarb, may be sweetened with coarse sugar, and given in small quantities till it operates. Those who are farther advanced must take medicines of a sharper nature. For example, a child of five or six years of age may take eight or ten grains of fine rhubarb in powder over night, and the same quantity of jalap in powder next morning. This may be wrought off with fresh broth or water-gruel, and may be repeated three or four times, five or six days intervening between each dose. For children further advanced, and adults, the dose must be increased in proportion to the age and constitution[92].

When imposthumes happen after the small-pox, which is not seldom the case, they must be brought to suppuration as soon as possible, by means of ripening poultices; and when they have been opened, or have broke of their own accord, the patient must be purged. The Peruvian bark and a milk diet will likewise be useful in this case.

When a cough, a difficulty of breathing, or other symptoms of a consumption, succeed to the small-pox, the patient must be sent to a place where the air is good, and put upon a course of asses milk, with such exercise as he can bear. For further directions in this case, see the article Consumptions.

OF INOCULATION.

Though no disease, after it is formed, baffles the powers of medicine more effectually than the small-pox, yet more may be done before-hand to render this disease favourable than any one we know, as almost all the danger from it may be prevented by inoculation. This salutary invention has been known in Europe above half a century; but, like most other useful discoveries, it has till of late made but slow progress. It must however be acknowledged, to the honour of this country, that inoculation has met with a more favourable reception here, than among any of our neighbours. It is still however far from being general, which we have reason to fear will be the case, as long as the practice continues in the hands of the faculty.

No discovery can be of general utility, while the practice of it is kept in the hands of a few. Had the inoculation of the small-pox been introduced as a fashion, and not as a medical discovery, or had it been practiced by the same kind of operators here, as it is in those countries from whence we learned it, it had long ago been universal. The fears, the jealousies, the prejudices, and the opposite interests of the faculty, are, and ever will be, the most effectual obstacles to the progress of any salutary discovery. Hence it is that the practice of inoculation never became in any measure general, even in England, till taken up by men not bred to physic. These have not only rendered the practice more extensive, but likewise more safe, and by acting under less restraint than the regular practitioners, have taught them that the patient’s greatest danger arose, not from the want of care, but from the excess of it.

They know very little of the matter, who impute the success of modern inoculators to any superior skill, either in preparing the patient or communicating the disease. Some of them indeed, from a sordid desire of engrossing the whole practice to themselves, pretend to have extraordinary secrets or nostrums for preparing persons for inoculation, which never fail of success. But this is only a pretence calculated to blind the ignorant and inattentive. Common sense and prudence alone are sufficient both in the choice of the subject and management of the operation. Whoever is possessed of these may perform this office for his children whenever he finds it convenient, provided they be in a good state of health.

This sentiment is not the result of theory, but of observation. Though few physicians have had more opportunities of trying inoculation in all its different forms, so little appears to me to depend on those, generally reckoned important circumstances, of preparing the body, communicating the infection by this or the other method, &c. that for several years past I have persuaded the parents or nurses to perform the whole themselves, and have found that method followed with equal success, while it is free from many inconveniences that attend the other[93].

The small-pox may be communicated in a great variety of ways with nearly the same degree of safety and success. In Turkey, from whence we learned the practice, the women communicate the disease to children, by opening a bit of the skin with a needle, and putting into the wound a little matter taken from a ripe pustule. On the coast of Barbary they pass a thread wet with the matter through the skin between the thumb and fore-finger; and in some of the states of Barbary, inoculation is performed by rubbing in the variolous matter between the thumb and fore-finger, or on other parts of the body. The practice of communicating the small-pox, by rubbing the variolous matter upon the skin, has been long known in many parts of Asia and Europe, as well as in Barbary, and has generally gone by the name of buying the small-pox.

The present method of inoculating in Britain is to make two or three slanting incisions in the arm, so superficial as not to pierce quite through the skin, with a lancet wet with fresh matter taken from a ripe pustule; afterwards the wounds are closed up, and left without any dressing. Some make use of a lancet covered with the dry matter; but this is less certain, and ought never to be used unless where fresh matter cannot be obtained: when this is the case, the matter ought to be moistened by holding the lancet for some time in the steam of warm water[94].

Indeed, if fresh matter be applied long enough to the skin, there is no occasion for any wound at all. Let a bit of thread, about half an inch long, wet with the matter, be immediately applied to the arm, midway between the shoulder and the elbow, and covered with a piece of the common sticking-plaster, and kept on for eight or ten days. This will seldom fail to communicate the disease. We mention this method, because many people are afraid of a wound; and doubtless the more easily the operation can be performed, it has the greater chance to become general. Some people imagine, that the discharge from a wound lessens the eruption; but there is no great stress to be laid upon this notion; besides, deep wounds often ulcerate, and become troublesome.

We do not find that inoculation is at all considered as a medical operation in those countries from whence we learned it. In Turkey it is performed by the women, and in the East Indies by the Brachmins or priests. In this country the custom is still in its infancy; we make no doubt, however, but it will soon become so familiar, that parents will think no more of inoculating their children, than at present they do of giving them a purge.

No set of men have it so much in their power to render the practice of inoculation general as the clergy, the greatest opposition to it still arising from some scruples of conscience, which they alone can remove. I would recommend it to them not only to endeavour to remove the religious objections which weak minds may have to this salutary practice, but to enjoin it as a duty, and to point out the danger of neglecting to make use of a mean which Providence has put in our power for saving the lives of our offspring. Surely such parents as wilfully neglect the means of saving their children’s lives, are as guilty as those who put them to death. I wish this matter were duly weighed. No one is more ready to make allowance for human weakness and religious prejudices, yet I cannot help recommending it, in the warmest manner, to parents, to consider how great an injury they do their children, by neglecting to give them this disease in the early period of life.

The numerous advantages arising from the inoculation of the small-pox have been pretty fully pointed out by the learned Dr. M‘Kenzie, in his History of Health[95]. To those mentioned by the Doctor we shall only add, that such as have not had the small-pox in the early period of life, are not only rendered unhappy, but likewise in a great measure unfit for sustaining many of the most useful and important offices. Few people would chuse even to hire a servant who had not had the small-pox, far less to purchase a slave who had the chance of dying of this disease. How could a physician or a surgeon, who had never had the small-pox himself, attend others under that malady? How deplorable is the situation of females, who arrive at mature age without having had the small-pox! A woman with child seldom survives this disease: and if an infant happen to be seized with the small-pox upon the mother’s breast, who has not had the disease herself the scene must be distressing! If she continue to suckle the child, it is at the peril of her own life; and if she wean it, in all probability it will perish. How often is the affectionate mother forced to leave her house, and abandon her children, at the very time when her care is most necessary? Yet should parental affection get the better of her fears, the consequences would often prove fatal. I have known the tender mother and her sucking infant laid in the same grave, both untimely victims to this dreadful malady. But these are scenes too shocking even to mention. Let parents who run away with their children to avoid the small-pox, or who refuse to inoculate them in infancy, consider to what deplorable situations, they may be reduced by this mistaken tenderness!

As the small-pox is now become an epidemical disease in most parts of the known world, no other choice remains but to render the malady as mild as possible. This is the only manner of extirpation now left in our power; and though it may seem paradoxical, the artificial method of communicating the disease, could it be rendered universal, would amount to nearly the same thing as rooting it out. It is a matter of small consequence, whether a disease be entirely extirpated, or rendered so mild as neither to destroy life nor hurt the constitution; but that this may be done by inoculation, does not now admit of a doubt. The numbers who die under inoculation hardly deserve to be named. In the natural way, one in four or five generally dies; but by inoculation not one of a thousand. Nay, some can boast of having inoculated ten thousand without the loss of a single patient.

I have often wished to see some plan established for rendering this salutary practice universal; but am afraid I shall never be so happy. The difficulties indeed are many; yet the thing is by no means impracticable. The aim is great; no less than saving the lives of one-fourth part of mankind. What ought not to be attempted in order to accomplish so desirable an end?

The first step towards rendering the practice universal, must be to remove the religious prejudices against it. This, as already observed, can only be done by the clergy. They must not only recommend it as a duty to others, but likewise practise it on their own children. Example will ever have more influence than precept.

The next thing requisite is to put it in the power of all. For this purpose we would recommend it to the Faculty to inoculate the children of the poor gratis. It is hard that so useful a part of mankind should by their poverty be excluded from such a benefit.

Should this fail, it is surely in the power of any State to render the practice general, at least as far as their dominion extends. We do not mean that it ought to be enforced by a law. The best way to promote it would be to employ a sufficient number of operators at the public expence to inoculate the children of the poor. This would only be necessary till the practice became general; afterwards custom, the strongest of all laws, would oblige every individual to inoculate his children to prevent reflections.

It may be objected to this scheme, that the poor would refuse to employ the inoculators: this difficulty is easily removed. A small premium to enable mothers to attend their children while under the disease, would be a sufficient inducement; besides, the success attending the operation would soon banish all objections to it. Even considerations of profit would induce the poor to embrace this plan. They often bring up their children to the age of ten or twelve, and when they come to be useful, they are snatched away by this malady, to the great loss of their parents, and detriment of the public.

The British legislature has of late years shewn great attention to the preservation of infant lives, by supporting the foundling hospital, &c. But we will venture to say, if one-tenth part of the sums laid out in supporting that institution, had been bestowed towards promoting the practice of inoculation of the small-pox among the poor, that not only more useful lives had been saved, but the practice ere now rendered quite universal in this island. It is not to be imagined what effect example and a little money will have upon the poor; yet, if left to themselves, they would go on for ever in the old way, without thinking of any improvement. We only mean this as a hint to the humane and public-spirited. Should such a scheme be approved, a proper plan might easily be laid down for the execution of it.

But as public plans are very difficult to bring about, and often, by the selfish views and misconduct of those intrusted with the execution of them, fail of answering the noble purposes for which they were designed; we shall therefore point out some other method by which the benefits of inoculation may be extended to the poor.

There is no doubt but inoculators will daily become more numerous. We would therefore have every parish in Britain to allow one of them a small annual salary for inoculating all the children of the parish at a proper age. This might be done at a very trifling expence, and it would enable every one to enjoy the benefit of this salutary invention.

Two things chiefly operate to prevent the progress of inoculation. The one is a wish to put the evil day as far off as possible. This is a principle in our nature; and as inoculation seems rather to be anticipating a future evil, it is no wonder mankind are so averse to it. But this objection is sufficiently answered by the success. Who in his senses would not prefer a lesser evil to-day to a greater to-morrow, provided they were equally certain?

The other obstacle is the fear of reflections. This has very great weight with the bulk of mankind. Should the child die, they think the world would blame them. This they cannot bear. Here lies the difficulty; and till that be removed, inoculation will make but small progress. Nothing however can remove it but custom. Make the practice fashionable, and all objections will soon vanish. It is fashion alone that has led the multitude since the beginning of the world, and will lead them to the end. We must therefore call upon the more enlightened part of mankind to set a pattern to the rest. Their example, though it may for some time meet with opposition, will at length prevail.

I am aware of an objection to this practice from the expence with which it may be attended: this is easily obviated. We do not mean that every parish ought to employ a Sutton or a Dimsdale as inoculators. These have by their success already recommended themselves to crowned heads, and are beyond the vulgar reach; but have not others an equal chance to succeed? They certainly have. Let them make the same trial, and the difficulties will soon vanish. There is not a parish, and hardly a village in Britain, destitute of some person who can bleed. But this is a far more difficult operation, and requires both more skill and dexterity than inoculation.

The persons to whom we would chiefly recommend the performance of this operation are the clergy. Most of them know something of medicine. Almost all of them bleed, and can order a purge, which are all the qualifications necessary for the practice of inoculation. The priests among the less enlightened Indians perform this office, and why should a Christian teacher think himself above it? Surely the bodies of men, as well as their souls, merit a part of the pastor’s care; at lead the greatest Teacher who ever appeared among men seems to have thought so.

Should all other methods fail, we would recommend it to parents to perform the operation themselves. Let them take any method of communicating the disease they please; provided the subjects be healthy, and of a proper age, they will seldom fail to succeed to their wish. I have known many instances even of mothers performing the operation, and never so much as heard of one bad consequence. A planter in one of the West India islands is said to have inoculated, with his own hand, in one year, three hundred of his slaves, who, notwithstanding the warmth of the climate, and other unfavourable circumstances, all did well. Common mechanics have often, to my knowledge, performed the operation with as good success as physicians. We do not however mean to discourage those who have it in their power, from employing people of skill to inoculate their children, and attend them while under the disease, but only to shew, that where such cannot be had, the operation ought not upon that account to be neglected.

Instead of multiplying arguments to recommend this practice, I shall just beg leave to mention the method which I took with my own son, then an only child. After giving him two gentle purges, I ordered the nurse to take a bit of thread which had been previously wet with fresh matter from a pock, and to lay it upon his arm, covering it with a piece of sticking-plaster. This remained on six or seven days, till it was rubbed off by accident. At the usual time the small-pox made their appearance, and were exceedingly favourable. Surely this, which is all that is generally necessary, may be done without any skill in medicine.

We have been the more full upon this subject because the benefits of inoculation cannot be extended to society by any other means than making the practice general. While it is confined to a few, it must prove hurtful to the whole. By means of it the contagion is spread, and is communicated to many who might otherwise never have had the disease. Accordingly it is found that more die of the small-pox now than before inoculation was introduced; and this important discovery, by which alone more lives might be saved than by all the endeavours of the Faculty, is in a great measure lost by its benefits not being extended to the whole community[96].

The spring and autumn have been usually reckoned the most proper seasons for inoculation, on account of the weather being then most temperate; but it ought to be considered that these are generally the most unhealthy seasons of the whole year. Undoubtedly the best preparation for the disease is a previous good state of health. I have always observed that children in particular are more sickly towards the end of spring and autumn than at any other time of the year. On this account, as well as for the advantage of cool air, I would propose winter as the most proper season for inoculation; though, on every other consideration, the spring would seem to be preferable.

The most proper age for inoculation is between three and five. Many approve of inoculating on the breast, and where no circumstances forbid this practice, I have no objection to it. Children, however, are more liable to convulsions at this time than afterwards; besides, the anxiety of the mother or nurse, should the child be in danger, would not fail to heighten it by spoiling the milk.

Children who have constitutional diseases must nevertheless be inoculated. It will often mend the habit of body; but ought to be performed at a time when they are most healthy. Accidental diseases should always be removed before inoculation.

It is generally thought necessary to regulate the diet for some time before the disease be communicated. In children, however, great alteration in diet is seldom necessary, their food being commonly of the most simple and wholesome kind, as milk, water-pap, weak broths, bread, light pudding, mild roots, and white meats.

But children who have been accustomed to a hotter diet, who are of a gross habit, or abound with bad humours, ought to be put upon a spare diet before they are inoculated. Their food should be of a light cooling nature, and their drink whey, butter-milk, and such like.

We would recommend no other medicinal preparation but two or three mild purges, which ought to be suited to the age and strength of the patient. The success of inoculators does not depend on the preparation of their patients, but on their management of them while under the disease. Their constant care is to keep them cool, and their bodies gently open, by which means the fever is kept low, and the eruption greatly lessened. The danger is seldom great when the pustules are few; and their number is generally in proportion to the fever which precedes and attends the eruption. Hence the chief secret of inoculation consists in regulating the eruptive fever, which generally may be kept sufficiently low by the methods mentioned above.

The regimen during the disease is in all respects the same as under the natural small-pox. The patient must be kept cool, his diet should be light, and his drink weak and diluting, &c. Should any bad symptoms appear, which is seldom the case, they must be treated in the same way as directed in the natural small-pox. Purging is not less necessary after the small-pox by inoculation than in the natural way, and ought by no means to be neglected.

CHAP. XXIV. OF THE MEASLES.

The measles appeared in Europe about the same time with the small-pox, and have a great affinity to that disease. They both came from the same quarter of the world, are both infectious, and seldom attack the same person more than once. The measles are most common in the spring season, and generally disappear in summer. The disease itself, when properly managed, seldom proves fatal; but its consequences are often very troublesome.

CAUSE.——This disease, like the small-pox, proceeds from infection, and is more or less dangerous according to the constitution of the patient, the season of the year, the climate, &c.

SYMPTOMS.——The measles, like other fevers, are preceded by alternate fits of heat and cold, with sickness, and loss of appetite. The tongue is white, but generally moist. There is a short cough, a heaviness of the head and eyes, drowsiness, and a running at the nose. Sometimes indeed the cough does not come before the eruption has appeared. There is an inflammation and heat in the eyes, accompanied with a defluxion of sharp rheum, and great acuteness of sensation, so that they cannot bear the light without pain. The eye-lids frequently swell so as to occasion blindness. The patient generally complains of his throat; and a vomiting or looseness often precedes the eruption. The stools in children are commonly greenish; they complain of an itching of the skin, and are remarkably peevish. Bleeding at the nose is common, both before and in the progress of the disease.

About the fourth day, small spots, resembling flea-bites, appear, first upon the face; then upon the breast, and afterwards on the extremities: these may be distinguished from the small pox by their scarcely rising above the skin. The fever, cough, and difficulty of breathing, instead of being removed by the eruption as in the small pox, are rather increased; but the vomiting generally ceases.

About the sixth or seventh day from the time of sickening, the measles begin to turn pale on the face, and afterwards upon the body; so that by the ninth day they entirely disappear. The fever; however, and difficulty of breathing, often continue, especially if the patient has been kept upon too hot a regimen. Petechiæ, or purple spots, may likewise be occasioned by this error.

A violent looseness sometimes succeeds the measles; in which case the patient’s life is in imminent danger.

Such as die of the measles generally expire about the ninth day from the invasion, and are commonly carried off by a peripneumony, or inflammation of the lungs.

The most favourable symptoms are a moderate looseness, a moist skin, and a plentiful discharge of urine.

When the eruption suddenly falls in, and the patient is seized with a delirium, he is in the greatest danger. If the measles turn too soon of a pale colour, it is an unfavourable symptom, as are also great weakness, vomiting, restlessness, and difficulty of swallowing. Purple or black spots appearing among the measles are very unfavourable. When a continual cough, with hoarseness, succeeds the disease, there is reason to suspect an approaching consumption of the lungs.

Our business in this disease is to assist Nature, by proper cordials, in throwing out the eruption, if her efforts be too languid; but when they are too violent they must be restrained by evacuations, and cool diluting liquors, &c. We ought likewise to endeavour to appease the most urgent symptoms, as the cough, restlessness, and difficulty of breathing.

REGIMEN.——The cool regimen is necessary here as well as in the small-pox. The food too must be light, and the drink diluting. Acids however do not answer so well in the measles as in the small-pox, as they tend to exasperate the cough. Small beer likewise, though a good drink in the small-pox, is here improper. The most suitable liquors are decoctions of liquorice with marsh-mallow roots and sarsaparilla, infusions of linseed, or of the flowers of elder, balm-tea, clarified whey, barley-water, and such like. These, if the patient be costive, may be sweetened with honey; or, if that should disagree with the stomach, a little manna may occasionally be added to them.

MEDICINE.——The measles being an inflammatory disease, without any critical discharge of matter, as in the small-pox, bleeding is commonly necessary, especially when the fever runs high, with difficulty of breathing, and great oppression of the breast. But if the disease be of a mild kind, bleeding may be omitted[97].

Bathing the feet and legs frequently in lukewarm water both tends to abate the violence of the fever, and to promote the eruption.

The patient is often greatly relieved by vomiting. When there is a tendency this way, it ought to be promoted by drinking lukewarm water, or weak camomile-tea.

When the cough is very troublesome, with dryness of the throat, and difficulty of breathing, the patient may hold his head over the steam of warm water, and draw the steam into his lungs.

He may likewise lick a little sperma-ceti and sugar-candy pounded together; or take now and then a spoonful of the oil of sweet almonds, with sugar-candy dissolved in it. These will soften the throat, and relieve the tickling cough.

If at the turn of the disease the fever assumes new vigour, and there appears great danger of suffocation, the patient must be bled according to his strength, and blistering-plasters applied, with a view to prevent the load from being thrown on the lungs, where if an inflammation should fix itself, the patient’s life will be in imminent danger.

In case the measles should suddenly disappear, it will be necessary to pursue the same method which we have recommended when the small-pox recede. The patient must be supported with wine and cordials. Blistering-plasters must be applied to the legs and arms, and the body rubbed all over with warm flannels. Warm poultices may likewise be applied to the feet and palms of the hands.

When purple or black spots appear, the patient’s drink should be sharpened with spirits of vitriol; and if the putrid symptoms increase, the Peruvian bark must be administered in the same manner as directed in the small-pox.

Opiates are sometimes necessary, but should never be given except in cases of extreme restlessness, a violent looseness, or when the cough is very troublesome. For children, the syrup of poppies is sufficient. A tea-spoonful or two may be occasionally given, according to the patient’s age, or the violence of the symptoms.

After the measles are gone off, the patient ought to be purged. This may be conducted in the same manner as directed in the small-pox.

If a violent looseness succeeds the measles, it may be checked by taking for some days a gentle dose of rhubarb in the morning, and an opiate over night; but if these do not remove it, bleeding will seldom fail to have that effect.

Patients recovering after the measles should be careful what they eat or drink. Their food for some time ought to be light, and in small quantities, and their drink diluting, and rather of an opening nature, as butter-milk, whey, and such like. They ought also to beware of exposing themselves too soon to the cold air, lest a suffocating catarrh, an asthma, or a consumption of the lungs, should ensue.

Should a cough, with difficulty of breathing, and other symptoms of a consumption, remain after the measles, small quantities of blood may be frequently let at proper intervals, as the patient’s strength and constitution will permit. He ought likewise to drink asses milk, to remove to a free air, if in a large town, and to ride daily on horseback. He must keep close to a diet consisting of milk and vegetables; and lastly, if these do not succeed, let him remove to a warmer climate[98].

OF THE SCARLET FEVER.

The scarlet fever is so called from the colour of the patient’s skin, which appears as if it were tinged with red wine. It happens at any season of the year, but is most common towards the end of summer; at which time it often seizes whole families; children and young persons are most subject to it.

It begins like other fevers, with coldness and shivering, without any violent sickness. Afterwards the skin is covered with red spots, which are broader, more florid, and less uniform than the measles. They continue two or three days, and then disappear; after which the cuticle, or scarf-skin, falls off.

There is seldom any occasion for medicine in this disease. The patient ought however to keep within doors, to abstain from flesh, strong liquors, and cordials, and to drink freely of cool diluting liquors. If the fever runs high, the body must be kept gently open by emollient clysters, or small doses of nitre and rhubarb. A scruple of the former, with five grains of the latter, may be taken thrice a-day, or oftener, if necessary.

Children and young persons are sometimes seized at the beginning of this disease with a kind of stupor and epileptic fits. In this case the feet and legs should be bathed in warm water, a large blistering-plaster applied to the neck, and a dose of the syrup of poppies given every night till the patient recovers[99].

The scarlet fever however is not always of so mild a nature. It is sometimes attended with putrid or malignant symptoms, in which case it is always dangerous. In the malignant scarlet fever the patient is not only affected with coldness and shivering, but with languor, sickness, and great oppression, to these succeed excessive heat, nausea and vomiting, with a soreness of the throat; the pulse is extremely quick, but small and depressed; the breathing frequent and laborious; the skin hot, but not quite dry; the tongue moist, and covered with a whitish mucus; the tonsils inflamed and ulcerated. When the eruption appears, it brings no relief: on the contrary, the symptoms generally grow worse, and fresh ones come on, as purging, delirium, &c.

When this disease is mistaken for a simple inflammation, and treated with repeated bleedings, purging and cooling medicines, it generally proves fatal. The only medicines that can be depended on in this case are cordials and antiseptics, as the Peruvian bark, wine, snake-root, and the like. The treatment must be in general similar to that of the putrid fever, or of the malignant ulcerous sore throat[100].

OF THE BILIOUS FEVER.

When a continual, remitting, or intermitting fever is accompanied with a frequent or copious evacuation of bile, either by vomit or stool, the fever is denominated bilious. In Britain the bilious fever generally makes its appearance about the end of summer, and ceases towards the approach of winter. It is most frequent and fatal in warm countries, especially where the soil is marshy, and when great rains are succeeded by sultry heats. Persons who work without doors, lie in camps, or who are exposed to the night air, are most liable to this kind of fever.

If there are symptoms of inflammation at the beginning of this fever, it will be necessary to bleed, and to put the patient upon the cool diluting regimen recommended in the inflammatory fever. The saline draught may likewise be frequently administered, and the patient’s body kept open by clysters or mild purgatives. But if the fever should remit or intermit, bleeding will seldom be necessary. In this case a vomit may be administered, and, if the body be bound, a gentle purge; after which the Peruvian bark will generally complete the cure.

In case of a violent looseness, the patient must be supported with chicken broth, jellies of hartshorn, and the like; and he may use the white decoction for his ordinary drink[101]. If a bloody flux should accompany this fever, it must be treated in the manner recommended under the article Dysentery.

When there is a burning heat, and the patient does not sweat, that evacuation may be promoted by giving him, three or four times a day, a table-spoonful of Mindererus’s spirit[102] mixed in a cup of his ordinary drink.

If the bilious fever be attended with the nervous, malignant, or putrid symptoms, which is sometimes the case, the patient must be treated in the same manner as directed under these diseases.

After this fever, proper care is necessary to prevent a relapse. For this purpose the patient, especially towards the end of autumn, ought to continue the use of the Peruvian bark for some time after he is well. He should likewise abstain from all trashy fruits, new liquors, and every kind of flatulent aliment.

CHAP. XXV. OF THE ERYSIPELAS, OR ST. ANTHONY’S FIRE.

This disease, which in some parts of Britain is called the rose, attacks persons at any period of life, but is most common between the age of thirty and forty. Persons of a sanguine or plethoric habit are most liable to it. It often attacks young people, and pregnant women; and such as have once been afflicted with it are very liable to have it again. Sometimes it is a primary disease, and at other times only a symptom of some other malady. Every part of the body is liable to be attacked by an erysipelas, but it most frequently seizes the legs or face, especially the latter. It is most common in autumn, or when hot weather is succeeded by cold and wet.

CAUSES.——The erysipelas may be occasioned by violent passions or affections of the mind; as fear, anger, &c. When the body has been heated to a great degree, and is immediately exposed to the cold air, so that the perspiration is suddenly checked, an erysipelas will often ensue[103]. It may also be occasioned by drinking to excess, by continuing too long in a warm bath, or by any thing that overheats the blood. If any of the natural evacuations be obstructed, or in too small quantity, it may cause an erysipelas. The same effect will follow from the stoppage of artificial evacuations; as issues, setons, or the like.

SYMPTOMS.——The erysipelas attacks with shivering, thirst, loss of strength, pain in the head and back, heat, restlessness, and a quick pulse; to which may be added vomiting, and sometimes a delirium. On the second, third, or fourth day, the part swells, becomes red, and small pustules appear at which time the fever generally abates.

When the erysipelas seizes the foot, the parts contiguous swell, the skin shines; and, if the pain be violent, it will ascend to the leg, and will not bear to be touched.

When it attacks the face, it swells, appears red, and the skin is covered with small pustules filled with clear water. One or both eyes are generally closed with the swelling; and there is a difficulty of breathing. If the mouth and nostrils be very dry, and the patient drowsy, there is reason to suspect an inflammation of the brain.

If the erysipelas affects the breast, it swells and becomes exceedingly hard, with great pain, and is apt to suppurate. There is a violent pain in the arm-pit on the side affected, where an abscess is often formed.

If in a day or two the swelling subsides, the heat and pain abate, the colour of the part turns yellow, and the cuticle breaks and falls off in scales, the danger is over.

When the erysipelas is large, deep, and affects a very sensible part of the body, the danger is great. If the red colour changes into a livid or black, it will end in a mortification. Sometimes the inflammation cannot be discussed, but comes to a suppuration; in which case fistulas, a gangrene, or mortification, often ensue.

Such as die of this disease are commonly carried off by the fever, which is attended with difficulty of breathing, and sometimes with a delirium and great drowsiness. They generally die about the seventh or eighth day.

REGIMEN.——In the erysipelas the patient must neither be kept too hot nor too cold, as either of these extremes will tend to make it retreat, which is always to be guarded against. When the disease is mild, it will be sufficient to keep the patient within doors, without confining him to his bed, and to promote the perspiration by diluting liquors, &c.

The diet ought to be slender, and of a moderately cooling and moistening quality, as groat-gruel, panado, chicken or barley-broth, with cooling herbs and fruits, &c. avoiding flesh, fish, strong drink, spices, pickles, and all other things that may heat and inflame the blood; the drink may be barley-water, an infusion of elder-flowers, common whey, and such like.

But if the pulse be low, and the spirits sunk, the patient must be supported with negus, and other things of a cordial nature. His food may be sago-gruel with a little wine, and nourishing broths taken in small quantities, and often repeated. Great care however must be taken not to overheat him.

MEDICINE.——In this disease much mischief is often done by medicine, especially by external applications. People, when they see an inflammation, immediately think that something ought to be applied to it. This indeed is necessary in large phlegmons; but in an erysipelas the safer course is to apply nothing. Almost all ointments, salves, and plasters, being of a greasy nature, tend rather to obstruct and repel, than promote any discharge from the part. At the beginning of this disease it is neither safe to promote a suppuration, nor to repel the matter too quickly. The erysipelas in many respects resembles the gout, and is to be treated with the greatest caution. Fine wool, or very soft flannel, are the safest applications to the part. These not only defend it from the external air, but likewise promote the perspiration, which has a great tendency to carry off the disease. In Scotland the common people generally apply a mealy cloth to the parts affected, which is far from being improper.

It is common to bleed in the erysipelas; but this likewise requires caution. If however the fever be high, the pulse hard and strong, and the patient vigorous, it will be proper to bleed; but the quantity must be regulated by these circumstances, and the operation repeated as the symptoms may require. If the patient has been accustomed to strong liquors, and the disease attacks his head, bleeding is absolutely necessary.

Bathing the feet and legs frequently in lukewarm water, when the disease attacks the face or brain, has an excellent effect. It tends to make a derivation from the head, and seldom fails to relieve the patient. When bathing proves ineffectual, poultices, or sharp sinapisms, may be applied to the soles of the feet, for the same purpose.

In cases where bleeding is requisite, it is likewise necessary to keep the body open. This may be effected by emollient clysters, or small doses of nitre and rhubarb. Some indeed recommend very large doses of nitre in the erysipelas; but nitre seldom sits easy on the stomach when taken in large doses. It is however one of the best medicines when the fever and inflammation run high. Half a drachm of it, with four or five grains of rhubarb, may be taken in the patient’s ordinary drink, four times a day.

When the erysipelas leaves the extremities, and seizes the head so as to occasion a delirium or stupor, it is absolutely necessary to open the body. If clysters and mild purgatives fail to have this effect, stronger ones must be given. Blistering plasters must likewise be applied to the neck, or behind the ears, and sharp cataplasms laid to the soles of the feet.

When the inflammation cannot be discussed, and the part has a tendency to ulcerate, it will then be proper to promote suppuration, which may be done by the application of ripening poultices with saffron, warm fomentations, and such like.

When the black, livid, or blue colour of the part shews a tendency to mortification, the Peruvian bark must be administered. It may be taken along with acids, as recommended in the small-pox, or in any other form more agreeable to the patient. It must not however be trifled with, as the patient’s life is at stake. A drachm may be given every two hours, if the symptoms be threatening, and cloths dipped in warm camphorated spirits of wine, or the tincture of myrrh and aloes, may be applied to the part, and frequently renewed. It may likewise be proper in this case to apply poultices of the bark, or to foment the part affected with a strong decoction of it.

In what is commonly called the scorbutic erysipelas, which continues for a considerable time, it will only be necessary to give gentle laxatives, and such things as purify the blood and promote the perspiration. Thus, after the inflammation has been checked by opening medicines, the decoction of woods[104] may be drank, after which a course of bitters will be proper.

Such as are liable to frequent attacks of the erysipelas ought carefully to guard against all violent passions; to abstain from strong liquors, and all fat, viscid, and highly nourishing food. They should likewise take sufficient exercise, carefully avoiding the extremes of heat or cold. Their food should consist chiefly of milk, and such fruits, herbs, and roots, as are of a cooling quality; and their drink ought to be small-beer, whey, butter-milk, and such like. They should never suffer themselves to be long costive. If that cannot be prevented by suitable diet, it will be proper to take frequently a gentle dose of rhubarb, cream of tartar, the lenitive electuary, or some other mild purgative.

CHAP. XXVI. OF THE PHRENITIS, OR INFLAMMATION OF THE BRAIN.

This is sometimes a primary disease, but oftener only a symptom of some other malady; as the inflammatory, eruptive, or spotted fever, &c. It is very common however as a primary disease in warm climates, and is most incident to persons about the prime or vigour of life. The passionate, the studious, and those whose nervous system is irritable in a high degree, are most liable to it.

CAUSES.——This disease is often occasioned by night-watching, especially when joined with hard study: it may likewise proceed from hard drinking, anger, grief, or anxiety. It is often occasioned by the stoppage of usual evacuations; as the bleeding piles in men, the customary discharges of women, &c. Such as imprudently expose themselves to the heat of the sun, especially by sleeping without doors in a hot season with their heads uncovered, are often suddenly seized with an inflammation of the brain, so as to awake quite delirious. When repellents are imprudently used in an erysipelas, an inflammation of the brain is sometimes the consequence. It may likewise be occasioned by external injuries, as blows or bruises upon the head, &c.

SYMPTOMS.——The symptoms which usually precede a true inflammation of the brain are pain of the head, redness of the eyes, a violent flushing of the face, disturbed sleep, or a total want of it, great dryness of the skin, costiveness, a retention of urine, a small dropping of blood from the nose, singing of the ears, and extreme sensibility of the nervous system.

When the inflammation is formed, the symptoms in general are similar to those of the inflammatory fever. The pulse indeed is often weak, irregular, and trembling; but sometimes it is hard and contracted. When the brain itself is inflamed, the pulse is always soft and low; but when the inflammation only affects the integuments of the brain, viz. the dura and pia mater, it is hard. A remarkable quickness of hearing is a common symptom of this disease; but that seldom continues long. Another usual symptom is a great throbbing or pulsation in the arteries of the neck and temples. Though the tongue is often black and dry, yet the patient seldom complains of thirst, and even refuses drink. The mind chiefly runs upon such objects as have before made a deep impression on it; and sometimes, from a sullen silence, the patient becomes all of a sudden quite outrageous.

A constant trembling and starting of the tendons is an unfavourable symptom, as are also a suppression of urine; a total want of sleep; a constant spitting; a grinding of the teeth, which last may be considered as a kind of convulsion. When a phrenitis succeeds an inflammation of the lungs, of the intestines, or of the throat, &c. it is owing to a translation of the disease from these parts to the brain, and generally proves fatal. This shews the necessity of proper evacuations, and the danger of repellents in all inflammatory diseases.

The favourable symptoms are, a free perspiration, a copious discharge of blood from the nose, the bleeding piles, a plentiful discharge of urine, which lets fall a copious sediment. Sometimes the disease is carried off by a looseness, and in women by an excessive flow of the menses.

As this disease often proves fatal in a few days, it requires the most speedy applications. When it is prolonged, or improperly treated, it sometimes ends in madness, or a kind of stupidity which continues for life.

In the cure, two things are chiefly to be attended to, viz. to lessen the quantity of blood in the brain, and to retard the circulation towards the head.

REGIMEN.——The patient ought to be kept very quiet. Company, noise, and every thing that affects the senses, or disturbs the imagination, increases the disease. Even too much light is hurtful: for which reason the patient’s chamber ought to be a little darkened, and he should neither be kept too hot nor cold. It is not however necessary to exclude the company of an agreeable friend, as this has a tendency to sooth and quiet the mind. Neither ought the patient to be kept too much in the dark, lest it should occasion a gloomy melancholy, which is too often the consequence of this disease.

The patient must, as far as possible, be soothed and humoured in every thing. Contradiction will ruffle his mind, and increase his malady. Even when he calls for things which are not to be obtained, or which might prove hurtful, he is not to be positively denied them, but rather put off with the promise of having them as soon as they can be obtained, or by some other excuse. A little of any thing that the mind is set upon, though not quite proper, will hurt the patient less than a positive refusal. In a word, whatever he was fond of, or used to be delighted with when in health, may here be tried, as pleasing stories, soft music, or whatever has a tendency to sooth the passions and compose the mind. Boerhaave proposes several mechanical experiments for this purpose; as the soft noise of water distilling by drops into a bason, and the patient trying to reckon them, &c. Any uniform sound, if low and continued, has a tendency to procure sleep, and consequently may be of service.

The aliment ought to be light, consisting chiefly of farinaceous substances; as panado, and water-gruel sharpened with jelly of currants, or juice of lemons, ripe fruits roasted or boiled, jellies, preserves, &c. The drink small, diluting, and cooling; as whey, barley-water, or decoctions of barley and tamarinds, which latter not only render the liquor more palatable, but likewise more beneficial, as they are of an opening nature.

MEDICINE.——In an inflammation of the brain, nothing more certainly relieves the patient than a free discharge of blood from the nose. When this comes of its own accord, it is by no means to be stopped, but rather promoted, by applying cloths dipped in warm water to the part. When bleeding at the nose does not happen spontaneously, it may be provoked, by putting a straw, or any other sharp body, up the nostril.

Bleeding in the temporal arteries greatly relieves the head: but as this operation cannot always be performed, we would recommend in its stead bleeding in the jugular veins. When the patient’s pulse and spirits are so low, that he cannot bear bleeding with the lancet, leeches may be applied to the temples. These not only draw off the blood more gradually, but by being applied nearer to the part affected, generally give more immediate relief.

A discharge of blood from the hæmorrhoidal veins is likewise of great service, and ought by all means to be promoted. If the patient has been subject to the bleeding piles, and that discharge has been stopped, every method must be tried to restore it; as the application of leeches to the parts, sitting over the steams of warm water, sharp clysters, or suppositories made of honey, aloes, and rock-salt.

If the inflammation of the brain be occasioned by the stoppage of evacuations either natural or artificial, as the menses, issues, setons, or such like, all means must be used to restore them as soon as possible, or to substitute others in their stead.

The patient’s body must be kept open by stimulating clysters or smart purges; and small quantities of nitre ought frequently to be mixed with his drink. Two or three drachms, or more, if the case be dangerous, may be used in the space of twenty-four hours.

The head should be shaved and frequently rubbed with vinegar and rose-water. Cloths dipped in this mixture may likewise be applied to the temples. The feet ought frequently to be bathed in lukewarm water, and soft poultices of bread and milk may be kept constantly applied to them.

If the disease proves obstinate, and does not yield to these medicines, it will be necessary to apply a blistering-plaster to the whole head.

CHAP. XXVII. OF THE OPHTHALMIA, OR INFLAMMATION OF THE EYES.

This disease may be occasioned by external injuries; as blows, burns, bruises, and the like. It may likewise proceed from dust, quicklime, or other substances, getting into the eyes. It is often caused by the stoppage of customary evacuations; as the healing of old sores, drying up of issues, the suppressing of gentle morning sweats, or of the sweating of the feet, &c. Long exposure to the night air, especially in cold northerly winds, or whatever suddenly checks the perspiration, especially after the body has been much heated, is very apt to cause an inflammation of the eyes. Viewing snow or other white bodies for a long time, or looking stedfastly at the sun, a clear fire, or any bright object, will likewise occasion this malady. A sudden transition from darkness to very bright light will often have the same effect.

Nothing more certainly occasions an inflammation of the eyes than night-watching, especially reading or writing by candle-light. Drinking spirituous liquors, and excess of venery, are likewise very hurtful to the eyes. The acrid fumes of metals, and of several kinds of fuel, are also pernicious. Sometimes an inflammation of the eyes proceeds from a venereal taint, and often from a scrophulous or gouty habit. It may likewise be occasioned by hairs in the eye-lids turning inwards, and hurting the eyes. Sometimes the disease is epidemic, especially after wet seasons; and I have frequently known it prove infectious, particularly to those who lived in the same house with the patient. It may be occasioned by moist air, or living in low damp houses, especially in persons who are not accustomed to such situations. In children it often proceeds from imprudently drying up of scabbed heads, a running behind the ears, or any other discharge of that kind. Inflammations of the eyes often succeed the small-pox or measles, especially in children of a scrophulous habit.

SYMPTOMS.——An inflammation of the eyes is attended with acute pain, heat, redness, and swelling. The patient is not able to bear the light, and sometimes he feels a pricking pain, as if his eyes were pierced with a thorn. Sometimes he imagines his eyes are full of motes, or thinks he sees flies dancing before him. The eyes are filled with a scalding rheum, which rushes forth in great quantities, whenever the patient attempts to look up. The pulse is generally quick and hard, with some degree of fever. When the disease is violent, the neighbouring parts swell, and there is a throbbing or pulsation in the temporal arteries, &c.

A slight inflammation of the eyes, especially from an external cause, is easily cured; but when the disease is violent, and continues long, it often leaves specks upon the eyes, or dimness of sight, and sometimes total blindness.

If the patient be seized with a looseness, it has a good effect; and when the inflammation passes from one eye to another, as it were by infection, it is no unfavourable symptom. But when the disease is accompanied with a violent pain of the head, and continues long, the patient is in danger of losing his sight.

REGIMEN.——The diet, unless in scrophulous cases, can hardly be too spare, especially at the beginning. The patient must abstain from every thing of a heating nature. His food should consist chiefly of mild vegetables, weak broths, and gruels. His drink may be barley-water, balm-tea, common whey, and such like.

The patient’s chamber must be darkened, or his eyes shaded by a cover, so as to exclude the light, but not to press upon the eyes. He should not look at a candle, the fire, or any luminous object, and ought to avoid all smoke, as the fumes of tobacco, or any thing that may cause coughing, sneezing, or vomiting. He should be kept quiet, avoiding all violent efforts, either of body or mind, and encouraging sleep as much as possible.

MEDICINE.——This is one of those diseases wherein great hurt is often done by external applications. Almost every person pretends to be possessed of a remedy for the cure of sore eyes. These remedies generally consist of eye-waters and ointments, with other external applications, which do mischief twenty times for once they do good. People ought therefore to be very cautious how they use such things, as even the pressure upon the eyes often increases the malady.

Bleeding, in a violent inflammation of the eyes, is always necessary. This should be performed as near the part affected as possible. An adult may lose ten or twelve ounces of blood from the jugular vein, and the operation may be repeated according to the urgency of the symptoms. If it should not be convenient to bleed in the neck, the same quantity may be let from the arm, or any other part of the body.

Leeches are often applied to the temples, or under the eyes, with good effect. The wounds must be suffered to bleed for some hours, and if the bleeding stop soon, it may be promoted by the application of cloths dipt in warm water. In obstinate cases, it will be necessary to repeat this operation several times.

Opening and diluting medicines are by no means to be neglected. The patient may take a small dose of Glauber’s salts, and cream of tartar, every second or third day, or a decoction of tamarinds with senna. If these be not agreeable, gentle doses of rhubarb and nitre, a little of the lenitive electuary, or any other mild purgative, will answer the same end. The patient at the same time must drink freely of water-gruel, tea, whey, or any other weak diluting liquor. He ought likewise to take, at bed-time, a large draught of very weak wine-whey, in order to promote perspiration. His feet and legs must frequently be bathed in lukewarm water, and his head shaved twice or thrice a-week, and afterwards washed in cold water. This has often a remarkably good effect.

If the inflammation does not yield to these evacuations, blistering-plasters must be applied to the temples, behind the ears, or upon the neck, and kept open for some time by the mild blistering ointment. I have seldom known these, if long enough kept open, fail to remove the most obstinate inflammation of the eyes; but for this purpose it is often necessary to continue the discharge for several weeks.

When the disease has been of long standing, I have seen very extraordinary effects from a seton in the neck, or between the shoulders, especially the latter. It should be put upwards and downwards, or in the direction of the spine, and in the middle between the shoulder-blades. It may be dressed twice a-day with yellow basilicon. I have known patients, who had been blind for a considerable time, recover sight by means of a seton placed as above. When the seton is put across the neck, it soon wears out, and is both more painful and troublesome than between the shoulders; besides, it leaves a disagreeable mark, and does not discharge so freely.

When the heat and pain of the eyes are very great, a poultice of bread and milk, softened with sweet oil or fresh butter, may be applied to them, at least all night; and they may be bathed with lukewarm milk and water in the morning.

If the patient cannot sleep, which is sometimes the case, he may take twenty or thirty drops of laudanum, or two spoonfuls of the syrup of poppies, over night, more or less according to his age, or the violence of the symptoms.

After the inflammation is gone off, if the eyes still remain weak and tender, they may be bathed every night and morning with cold water and a little brandy, six parts of the former to one of the latter. A method should be contrived by which the eye can be quite immersed in the brandy and water, where it should be kept for some time. I have generally found this, or cold water and vinegar, as good a strengthener of the eyes as any of the most celebrated collyriums.

When an inflammation of the eyes proceeds from a scrophulous habit, it generally proves very obstinate. In this case the patient’s diet must not be too low, and he may be allowed to drink small negus, or now and then a glass of wine, The most proper medicine is the Peruvian bark, which may either be given in substance, or prepared in the following manner:

Take an ounce of the bark in powder, with two drachms of Winter’s bark, and boil them in an English quart of water to a pint; when it has boiled nearly long enough, add half an ounce of liquorice-root sliced. Let the liquor be strained. Two, three, or four table-spoonfuls, according to the age of the patient, may be taken three or four times a-day, It is impossible to say how long this medicine should be continued, as the cure is sooner performed in some than in others; but in general it requires a considerable time to produce any lasting effects.

Dr. Cheyne says, ‘That Æthiops mineral never fails in obstinate inflammations of the eyes, even scrophulous ones, if given in a sufficient dose, and duly persisted in.’ There is no doubt but this and other preparations of mercury may be of singular service in ophthalmias of long continuance, but they ought always to be administered with the greatest caution, or by persons of skill in physic.

It will be proper frequently to look into the eyes, to see if any hairs be turned inwards, or pressing upon them[105]. These ought to be removed by plucking them out with a pair of small pincers.

Those who are liable to frequent returns of this disease, ought constantly to have an issue in one or both arms. Bleeding or purging in the spring and autumn, will be very beneficial to such persons. They ought likewise to live with the greatest regularity, avoiding strong liquor, and every thing of a heating quality. Above all, let them avoid the night-air and late studies[106].

CHAP. XXVIII. OF THE QUINSEY, OR INFLAMMATION OF THE THROAT.

This disease is very common in Britain, and is frequently attended with great danger. It prevails in the winter and spring, and is most fatal to young people of a sanguine temperament.

CAUSES.——In general it proceeds from the same causes as other inflammatory disorders, viz. an obstructed perspiration, or whatever heats or inflames the blood. An inflammation of the throat is often occasioned by omitting some part of the covering usually worn about the neck, by drinking cold liquor when the body is warm, by riding or walking against a cold northerly wind, or any thing that greatly cools the throat, and parts adjacent. It may likewise proceed from the neglect of bleeding, purging, or any customary evacuation.

Singing, speaking loud and long, or whatever strains the throat, may likewise cause an inflammation of that organ. I have often known the quinsey prove fatal to jovial companions, who, after sitting long in a warm room, drinking hot liquors, and singing with vehemence, were so imprudent as to go abroad in the cold night-air. Sitting with wet feet, or keeping on wet clothes, are very apt to occasion, this malady. It is likewise frequently occasioned by continuing long in a moist place, sitting near an open window, sleeping in a damp bed, sitting in a room that has been newly plastered, &c. I know people who never fail to have a sore throat if they sit even but a short time in a room that has been lately washed.

Acrid or irritating food may likewise inflame the throat, and occasion a quinsey. It may also proceed from bones, pins, or other sharp substances sticking in the throat, or from the caustic fumes of metals or minerals, as arsenic, antimony, &c. taken in by the breath. This disease is sometimes epidemic and infectious.

SYMPTOMS.——The inflammation of the throat is evident from inspection, the parts appearing red and swelled; besides, the patient complains of pain in swallowing. His pulse is quick and hard, with other symptoms of a fever. If blood be let, it is generally covered with a tough coat of a whitish colour, and the patient spits a tough phlegm. As the swelling and inflammation increase, the breathing and swallowing become more difficult; the pain affects the ears; the eyes generally appear red; and the face swells. The patient is often obliged to keep himself in an erect posture, being in danger of suffocation; there is a constant nausea, or inclination to vomit, and the drink, instead of passing into the stomach, is often returned by the nose. The patient is sometimes starved at last, merely from an inability to swallow any kind of food.

When the breathing is laborious, with straitnesss of the breast, and anxiety, the danger is great. Though the pain in swallowing be very great, yet while the patient breathes easy, there is not so much danger· An external swelling is no unfavourable symptom; but if it suddenly falls, and the disease affects the breast, the danger is very great. When a quinsey is the consequence of some other disease, which has already weakened the patient, his situation is dangerous. A frothing at the mouth, with a swelled tongue, a pale, ghastly countenance, and coldness of the extremities, are fatal symptoms.

REGIMEN.——The regimen in this disease is in all respects the same as in the pleurisy, or peripneumony. The food must be light, and in small quantity, and the drink plentiful, weak, and diluting, mixed with acids.

It is highly necessary that the patient be kept easy and quiet. Violent affections of the mind, or great efforts of the body, may prove fatal. He should not even attempt to speak but in a low voice. Such a degree of warmth as to promote a constant, gentle sweat, is proper. When the patient is in bed, his head ought to be raised a little higher than usual.

It is peculiarly necessary that the neck be kept warm; for which purpose several folds of soft flannel may be wrapt round it. That alone will often remove a slight complaint of the throat, especially if applied in due time. We cannot here omit observing the propriety of a custom which prevails among the peasants of Scotland. When they feel any uneasiness of the throat, they wrap a stocking about it all night. So effectual is this remedy, that in many places it passes for a charm, and the stocking is applied with particular ceremonies: the custom, however, is undoubtedly a good one, and should never be neglected. When the throat has been thus wrapped up all night, it must not be exposed to the cold air through the day, but a handkerchief or a piece of flannel kept about it till the inflammation be removed.

The jelly of black currants is a medicine very much in esteem for complaints of the throat; and indeed it is of some use. It should be almost constantly kept in the mouth, and swallowed down leisurely. It may likewise be mixed in the patient’s drink, or taken any other way. When it cannot be obtained, the jelly of red currants, or of mulberries, may be used in its stead.

Gargles for the throat are very beneficial, They may be made of sage-tea, with a little vinegar and honey, or by adding to half an English pint of the pectoral decoction two or three spoonfuls of honey, and the same quantity of currant-jelly. This may be used three or four times a-day; and if the patient be troubled with tough viscid phlegm, the gargle may be rendered more sharp and cleansing, by adding to it a tea-spoonful of the spirit of sal ammoniac. Some recommend gargles made of a decoction of the leaves or bark of the black currant-bush; but where the jelly can be had, these are unnecessary.

There is no disease wherein the benefit of bathing the feet and legs in lukewarm water is more apparent: that practice ought therefore never to be neglected. If people were careful to keep warm, to wrap up their throats with flannel, to bathe their feet and legs in warm water, and to use a spare diet, with diluting liquors, at the beginning of this disease, it would seldom proceed to a great height, or be attended with any danger; but when these precautions are neglected, and the disease becomes violent, more powerful medicines are necessary.

MEDICINE.——An inflammation of the throat being a most acute and dangerous distemper, which sometimes takes off the patient very suddenly, it will be proper, as soon as the symptoms appear, to bleed in the arm, or rather in the jugular vein, and to repeat the operation if circumstances require.

The body should likewise be kept gently open. This may either be done by giving the patient for his ordinary drink a decoction of figs and tamarinds, or small doses of rhubarb and nitre, as recommended in the erysipelas. These may be increased according to the age of the patient, and repeated till they have the desired effect.

I have often known very good effects from a bit of sal prunel, or purified nitre, held in the mouth, and swallowed down as it melted. This promotes the discharge of saliva, by which means it answers the end of a gargle, while at the same time it abates the fever, by promoting the discharge of urine, &c.

The throat ought likewise to be rubbed twice or thrice a-day with a little of the volatile liniment. This seldom fails to produce some good effects. At the same time the neck ought to be carefully covered with wool or flannel, to prevent the cold from penetrating the skin, as this application renders it very tender. Many other external applications are recommended in this disease, as a swallow’s nest, poultices made of the fungus called Jew’s ears, album Græcum, &c. But as we do not look upon any of these to be preferable to a common poultice of bread and milk, we shall take no farther notice of them.

Some recommend the gum guaiacum as a specific in this disease. Half a dram of the gum in powder may be made into an electuary with the rob of elderberries, or the jelly of currants for a dose, and repeated occasionally[107].

Blistering upon the neck or behind the ears in violent inflammations of the throat is very beneficial; and in bad cases it will be necessary to lay a blistering-plaster quite across the throat, so as to reach from ear to ear. After the plasters are taken off, the parts ought to be kept running by the application of issue ointment, till the inflammation is gone; otherwise, upon their drying up, the patient will be in danger of a relapse.

When the patient has been treated as above, a suppuration seldom happens. This however is sometimes the case, in spite of all endeavours to prevent it. When the inflammation and swelling continue, and it is evident that a suppuration will ensue, it ought to be promoted by drawing the steam of warm water into the throat through a tunnel, or the like. Soft poultices ought likewise to be applied outwardly, and the patient may keep a roasted fig constantly in his mouth.

It sometimes happens, before the tumour breaks, that the swelling is so great, as entirely to prevent any thing from getting down into the stomach. In this case the patient must inevitably perish, unless he can be supported in some other way. This can only be done by nourishing clysters of broth, or gruel with milk, &c. Patients have often been supported by these for Several days, till the tumour has broke; and afterwards they have recovered.

Not only the swallowing, but the breathing, is often prevented by the tumour. In this case nothing can save the patient’s life, but opening the trachea or wind-pipe. As that has been often done with success, no person, in such desperate circumstances, ought to hesitate a moment about the operation; but as it can only be performed by a surgeon, it is not necessary here to give any directions about it.

When a difficulty of swallowing is not attended with an acute pain or inflammation, it is generally owing to an obstruction of the glands about the throat, and only requires that the part be kept warm, and the throat frequently gargled with something that may gently stimulate the glands, as a decoction of figs with vinegar and honey; to which may be added a little mustard, or a small quantity of spirits. But this gargle is never to be used where there are signs of an inflammation. This species of angina has various names among the common people, as the pap of the throat, the falling down of the almonds of the ears, &c. Accordingly, to remove it, they lift the patient up by the hair of the head, and thrust their fingers under his jaws, &c. all which practices are at best useless, and often hurtful.

Those who are subject to inflammations of the throat, in order to avoid that disease, ought to live temperate. Such as do not chuse to observe this rule, must have frequent recourse to purging and other evacuations, to discharge the superfluous humours. They ought likewise to beware of catching cold, and should abstain from aliment and medicines of an astringent or stimulating nature.

Violent exercise, by increasing the motion and force of the blood, is apt to occasion an inflammation of the throat, especially if cold liquor be drank immediately after it, or the body suffered suddenly to cool. Those who would avoid this disease ought therefore, after speaking aloud, singing, running, drinking warm liquor, or doing any thing that may strain the throat, or increase the circulation of the blood towards it, to take care to cool gradually, and to wrap some additional coverings about their necks.

I have often known persons who had been subject to sore throats, entirely freed from that complaint by only wearing a riband, or a bit of flannel, constantly about their necks, or by wearing thicker shoes, a flannel waistcoat, or the like. These may seem trifling, but they have great effect. There is danger indeed in leaving them off after persons have been accustomed to them; but surely the inconveniency of using such things for life, is not to be compared with the danger which may attend the neglect of them.

Sometimes, after an inflammation, the glands of the throat continue swelled, and become hard and callous. This complaint is not easily removed, and is often rendered dangerous by the too frequent application of strong stimulating and styptic medicines. The best method is to keep it warm, and to gargle it twice a-day with a decoction of figs sharpened a little with the elixir or spirit of vitriol.

OF THE MALIGNANT QUINSEY, OR PUTRID, ULCEROUS SORE THROAT.

This kind of quinsey is but little known in the northern parts of Britain, though, for some time past, it has been fatal in the more southern counties. Children are more liable to it than adults, females than males, and the delicate than those who are hardy and robust. It prevails chiefly in autumn, and is most frequent after a long course of damp or sultry weather.

CAUSES.——This is evidently a contagious distemper, and is generally communicated by infection. Whole families, and even entire villages, often receive the infection from one person. This ought to put people upon their guard against going near such patients as labour under the disorder; as by that means they endanger not only their own lives, but likewise those of their friends and connexions. Whatever tends to produce putrid or malignant fevers, may likewise occasion the putrid ulcerous sore throat, as unwholesome air, damaged provisions, neglect of cleanliness, &c.

SYMPTOMS.——It begins with alternate fits of shivering and heat. The pulse is quick, but low and unequal, and generally continues so through the whole course of the disease. The patient complains greatly of weakness and oppression of the breast, his spirits are low, and he is apt to faint away when set upright; he is troubled with a nausea, and often with a vomiting or purging. The two latter are most common in children. The eyes appear red and watery, and the face swells. The urine is at first pale and crude; but, as the disease advances, it turns more of a yellowish colour. The tongue is white, and generally moist, which distinguishes this from an inflammatory disease. Upon looking into the throat it appears swelled, and of a florid red colour. Pale or ash-coloured spots, however, are here and there interspersed, and sometimes one broad patch or spot, of an irregular figure, and pale white colour, surrounded with florid red, only appears. These whitish spots or sloughs cover so many ulcers.

An efflorescence, or eruption upon the neck, arms, breast, and fingers, about the second or third day, is a common symptom of this disease. When it appears, the purging and vomiting generally cease.

There is often a slight degree of delirium, and the face frequently appears bloated, and the inside of the nostrils red and inflamed. The patient complains of a disagreeable putrid smell, and his breath is very offensive.

The putrid, ulcerous sore throat may be distinguished from the inflammatory by the vomiting and looseness with which it is generally ushered in; the foul ulcers in the throat covered with a white or livid coat; and by the excessive weakness of the patient; with other symptoms of a putrid fever.

Unfavourable symptoms are, an obstinate purging, extreme weakness, dimness of the sight, a livid or black colour of the spots, and frequent shiverings, with a weak, fluttering pulse. If the eruption upon the skin suddenly disappears, or becomes of a livid colour, with a discharge of blood from the nose or mouth, the danger is very great.

If a gentle sweat break out about the third or fourth day, and continue with a slow, firm, and equal pulse; if the sloughs cast off in a kindly manner, and appear clean and florid at the bottom; and if the breathing is soft and free, with a lively colour of the eyes, there is reason to hope for a salutary crisis.

REGIMEN.——The patient must be kept quiet, and for the most part in bed, as he will be apt to faint when taken out of it. His food must be nourishing and restorative; as sago-gruel with red wine, jellies, strong broths, &c. His drink ought to be generous, and of an antiseptic quality; as red-wine negus, white-wine whey, and such like.

MEDICINE.——The medicine in this kind of quinsey is entirely different from that which is proper in the inflammatory. All evacuations, as bleeding, purging, &c. which weaken the patient, must be avoided. Cooling medicines, as nitre and cream of tartar, are likewise hurtful. Strengthening cordials alone can be used with safety; and these ought never to be neglected.

If at the beginning there is a great nausea, or inclination to vomit, the patient must drink an infusion of green tea, camomile flowers, or carduus benedictus, in order to cleanse the stomach. If these are not sufficient, he may take a few grains of the powder of ipecacuanha, or any other gentle vomit.

If the disease is mild, the throat may be gargled with an infusion of sage and rose leaves, to a gill of which may be added a spoonful or two of honey, and as much vinegar as will make it agreeably acid; but when the symptoms are urgent, the sloughs large and thick, and the breath very offensive, the following gargle may be used:

To six or seven ounces of the pectoral decoction, when boiling, add half an ounce of contrayerva-root; let it boil for some time, and afterwards strain the liquor; to which add two ounces of white-wine vinegar, an ounce of fine honey, and an ounce of the tincture of myrrh. This ought not only to be used as a gargle, but a little of it should frequently be injected with a syringe to clean the throat, before the patient takes any meat or drink. This method is peculiarly necessary for children, who cannot use a gargle.

It will be of great benefit if the patient frequently receives into his mouth, through an inverted funnel, the steams of warm vinegar, myrrh, and honey.

But when the putrid symptoms run high, and the disease is attended with danger, the only medicine that can be depended upon is the Peruvian bark. It may be taken in substance, if the patient’s stomach will bear it. If not, an ounce of bark grossly powdered, with two drachms of Virginian snake-root, may be boiled in an English pint and a half of water to half a pint; to which a tea-spoonful of the elixir of vitriol may be added, and an ordinary tea-cupful of it taken every three or four hours. Blistering-plasters are very beneficial in this disease, especially when the patient’s pulse and spirits are low. They may be applied to the throat, behind the ears, or upon the back part of the neck.

Should the vomiting prove troublesome, it will be proper to give the patient two table-spoonfuls of the saline julep every hour. Tea made of mint and a little cinnamon will be very proper for his ordinary drink, especially if an equal quantity of red-wine be mixed with it.

In case of a violent looseness, the size of a nutmeg of diascordium, or the japonic confection, may be taken two or three times a-day, or oftener if necessary.

If a discharge of blood from the nose happens, the steams of warm vinegar may be received up the nostrils frequently; and the drink must be sharpened with spirits of vitriol, or tincture of roses.

In case of a strangury, the belly must be fomented with warm water, and emollient clysters given three or four times a-day.

After the violence of the disease is over, the body should still be kept open with mild purgatives; as manna, senna, rhubarb, or the like.

If great weakness and dejection of spirits, or night-sweats, with other symptoms of a consumption, should ensue, we would advise the patient to continue the use of the Peruvian bark, with the elixir of vitriol, and to take frequently a glass of generous wine. These, together with a milk diet, and riding on horseback, are the most likely means for recovering his strength.

CHAP. XXIX. OF COLDS AND COUGHS.

It has already been observed, that colds are the effect of an obstructed perspiration; the common causes of which we have likewise endeavoured to point out, and shall not here repeat them. Neither shall we spend time in enumerating all the various symptoms of colds, as they are pretty generally known. It may not however be amiss to observe, that almost every cold is a kind of fever, which only differs in degree from some of those that have already been treated of.

No age, sex, or constitution, is exempted from this disease; neither is it in the power of any medicine or regimen to prevent it. The inhabitants of every climate are liable to catch cold, nor can even the greatest circumspection defend them at all times from its attacks. Indeed, if the human body could be kept constantly in an uniform degree of warmth, such a thing as catching cold would be impossible: but as that cannot be effected by any means, the perspiration must be liable to many changes. Such changes, however, when small, do not affect the health; but, when great, they must prove hurtful.

When oppression of the breast, a stuffing of the nose, unusual weariness, pain of the head, &c. give ground to believe that the perspiration is obstructed, or, in other words, that the person has caught cold, he ought immediately to lessen his diet, at least the usual quantity of his solid food, and to abstain from all strong liquors. Instead of flesh, fish, eggs, milk, and other nourishing diet, he may eat light bread-pudding, veal or chicken broth, panado, gruels, and such like. His drink may be water-gruel sweetened with a little honey; an infusion of balm, or linseed sharpened with the juice of orange or lemon; a decoction of barley and liquorice, with tamarinds, or any other cool, diluting, acid liquor.

Above all, his supper should be light; as small posset, or water-gruel sweetened with honey, and a little toasted bread in it. If honey should disagree with the stomach, the gruel may be sweetened with treacle or coarse sugar, and sharpened with the jelly of currants. Those who have been accustomed to generous liquors may take wine-whey instead of gruel, which may be sweetened as above.

The patient ought to lie longer than usual a-bed, and to encourage a gentle sweat, which is easily brought on towards morning, by drinking tea, or any kind of warm diluting liquor. I have often known this practice carry off a cold in one day, which in all probability, had it been neglected, would have cost the patient his life, or have confined him for some months. Would people sacrifice a little time to ease and warmth, and practice a moderate degree of abstinence when the first symptoms of a cold appear, we have reason to believe, that most of the bad effects which flow from an obstructed perspiration might be prevented. But, after the disease has gathered strength by delay, all attempts to remove it often prove vain. A pleurisy, a peripneumony, or a fatal consumption of the lungs, are the common effects of colds which have either been totally neglected or treated improperly.

Many attempt to cure a cold, by getting drunk. But this, to say no worse of it, is a very hazardous experiment. No doubt it may sometimes succeed, by suddenly restoring the perspiration; but when there is any degree of inflammation, which is frequently the case, strong liquors, instead of removing the malady, will increase it. By this means a common cold may be converted into an inflammatory fever.

When those who labour for their daily bread have the misfortune to catch cold, they cannot afford to lose a day or two, in order to keep themselves warm, and take a little medicine; by which means the disorder is often so aggravated as to confine them for a long time, or even to render them ever after unable to sustain hard labour. But even such of the labouring poor as can afford to take care of themselves, are often too hardy to do it; they affect to despise colds, and as long as they can crawl about, scorn to be confined by what they call a common cold. Hence it is, that colds destroy such numbers of mankind. Like an enemy despised, they gather strength from delay, till at length they become invincible. We often see this verified in travellers, who, rather than lose a day in the prosecution of their business, throw away their lives by pursuing their journey, even in the severest weather, with this disease upon them.

It is certain, however, that colds may be too much indulged. When a person, for every slight cold, shuts himself up in a warm room, and drinks great quantities of warm liquor, it may occasion such a general relaxation of the solids as will not be easily removed. It will therefore be proper, when the disease will permit, and the weather is mild, to join to the regimen mentioned above gentle exercise; as walking, riding on horseback, or in a carriage, &c. An obstinate cold, which no medicine can remove, will yield to gentle exercise and a proper regimen of the diet.

Bathing the feet and legs in warm water has a great tendency to restore the perspiration. But care must be taken that the water be not too warm, otherwise it will do hurt. It should never be much warmer than the blood, and the patient should go immediately to bed after using it. Bathing the feet in warm water, lying in bed, and drinking warm water-gruel, or other weak liquors, will sooner take off a spasm, and restore the perspiration, than all the hot sudorific medicines in the world. This is all that is necessary for removing a common cold; and if this course be taken at the beginning, it will seldom fail.

But when the symptoms do not yield to abstinence, warmth, and diluting liquors, there is reason to fear the approach of some other disease, as an inflammation of the breast, an ardent fever, or the like. If the pulse therefore be hard and frequent, the skin hot and dry, and the patient complains of his head or breast, it will be necessary to bleed, and to give the cooling powders recommended in the scarlet fever every three or four hours, till they give a stool.

It will likewise be proper to put a blistering-plaster on the back, to give two table-spoonfuls of the saline mixture every two hours, and in short to treat the patient in all respects as for a slight fever. I have often seen this course, when observed at the beginning, remove the complaint in two or three days, when the patient had all the symptoms of an approaching ardent fever, or an inflammation of the breast.

The chief secret of preventing colds lies in avoiding, as far as possible, all extremes either of heat or cold, and in taking care, when the body is heated, to let it cool gradually. These and other circumstances relating to this important subject, are so fully treated of under the article Obstructed Perspiration, that it is needless here to resume the consideration of them.

OF A COMMON COUGH.

A cough is generally the effect of a cold, which has either been improperly treated, or entirely neglected. When it proves obstinate, there is always reason to fear the consequences, as this shews a weak state of the lungs, and is often the forerunner of a consumption.

If the cough be violent, and the patient young and strong, with a hard quick pulse, bleeding will be proper; but in weak and relaxed habits, bleeding rather prolongs the disease. When the patient spits freely, bleeding is unnecessary, and sometimes hurtful, as it tends to lessen that discharge.

When the cough is not attended with any degree of fever, and the spittle is viscid and tough, sharp pectoral medicines are to be administered; as gum ammoniac, squills, &c. Two table-spoonfuls of the solution of gum ammoniac may be taken three or four times a-day, more or less, according to the age and constitution of the patient. Squills may be given various ways; two ounces of the vinegar, the oxymel, or the syrup, may be mixed with the same quantity of simple cinnamon water, to which may be added an ounce of common water and an ounce of balsamic syrup. Two table-spoonfuls of this mixture may be taken three or four times a-day.

A syrup made of equal parts of lemon-juice, honey, and sugar-candy, is likewise very proper in this kind of cough. A table-spoonful of it may be taken at pleasure.

But when the defluxion is sharp and thin, these medicines rather do hurt. In this case gentle opiates, oils, and mucilages, are more proper. A cup of an infusion of wild poppy leaves, and marsh-mallow roots, or the flowers of coltsfoot, may be taken frequently; or a tea-spoonful of the paregoric elixir may be put into the patient’s drink twice a-day. Fuller’s Spanish infusion is also a very proper medicine in this case, and may be taken in the quantity of a tea-cupful three or four times a-day[108].

When a cough is occasioned by acrid humours tickling the throat and fauces, the patient should keep some soft pectoral lozenges almost constantly in his mouth; as the Pontefract liquorice cakes, barley-sugar, the common balsamic lozenges, Spanish juice, &c. These blunt the acrimony of the humours, and by taking off their stimulating quality, help to appease the cough[109].

In obstinate coughs, proceeding from a flux of humours upon the lungs, it will often be necessary, besides expectorating medicines, to have recourse to issues, setons, or some other drain. In this case I have often observed the most happy effects from a Burgundy-pitch plaster applied between the shoulders. I have ordered this simple remedy in the most obstinate coughs, in a great number of cases, and in many different constitutions, without ever knowing it fail to give relief, unless where there were evident signs of an ulcer in the lungs.

About the bulk of a nutmeg of Burgundy-pitch may be spread thin upon a piece of soft leather, about the size of the hand, and laid between the shoulder-blades. It may be taken off and wiped every three or four days, and ought to be renewed once a fortnight or three weeks. This is indeed a cheap and simple medicine, and consequently apt to be despised; but we will venture to affirm, that the whole materia medica does not afford an application more efficacious in almost every kind of cough. It has not indeed always an immediate effect; but, if kept on for some time, it will succeed where most other medicines fail.

The only inconveniency attending this plaster is the itching which it occasions; but surely this may be dispensed with, considering the advantage which the patient may expect to reap from the application; besides, when the itching becomes very uneasy, the plaster may be taken off, and the part rubbed with a dry cloth, or washed with a little warm milk and water. Some caution indeed is necessary in discontinuing the use of such a plaster; this however may be safely done by making it smaller by degrees, and at length quitting it altogether in a warm season[110].

But coughs proceed from many other causes besides defluxions upon the lungs. In these cases the cure is not to be attempted by pectoral medicines. Thus, in a cough proceeding from a foulness and debility of the stomach, syrups, oils, mucilages, and all kinds of balsamic medicines do hurt. The stomach cough may be known from one that is owing to a fault in the lungs by this, that in the latter the patient coughs whenever he inspires, or draws in his breath fully; but in the former that does not happen.

The cure of this cough depends chiefly upon cleansing and strengthening the stomach; for which purpose gentle vomits and bitter purgatives are most proper. Thus, after a vomit or two, the sacred tincture, as it is called, may be taken for a considerable time in the dose of one or two table-spoonfuls twice a-day, or as often as it is found necessary, to keep the body gently open. People may make this tincture themselves, by infusing an ounce of hiera picra[111] in an English pint of white wine, letting it stand a few days, and then draining it.

In coughs which proceed from a debility of the stomach, the Peruvian bark is likewise of considerable service. It may either be chewed, taken in powder, or made into a tincture along with other stomachic bitters.

A nervous cough can only be removed by change of air and proper exercise; to which may be added the use of gentle opiates. Instead of the saponaceous pill, the paregoric elixir, &c. which are only opium disguised, ten, fifteen, twenty, or twenty-five drops of liquid laudanum, more or less, as circumstances require, may be taken at bed-time, or when the cough is most troublesome. Immersing the feet and hands in warm water will often appease the violence of a nervous cough.

When a cough is only the symptom of some other malady, it is in vain to attempt to remove it without first curing the disease from which it proceeds. Thus when a cough is occasioned by teething, keeping the body open, scarifying the gums, or whatever facilitates the cutting of the teeth, likewise appeases the cough. In like manner, when worms occasion a cough, such medicines as remove these vermin will generally cure the cough; as bitter purgatives, oily clysters, and such like.

Women, during the last months of pregnancy, are often greatly afflicted with a cough, which is generally relieved by bleeding, and keeping the body gently open. They ought to avoid all flatulent food, and to wear a loose easy dress.

A cough is not only a symptom, but is often likewise the forerunner of diseases. Thus, the gout is frequently ushered in by a very troublesome cough, which affects the patient for some days before the coming on of the fit. This cough is generally removed by a paroxysm of the gout, which should therefore be promoted, by keeping the extremities warm, drinking warm liquors, and bathing the feet and legs frequently in lukewarm water.

OF THE HOOPING-COUGH, OR CHIN-COUGH.

This cough seldom affects adults, but proves often fatal to children. Such children as live upon thin watery diet, who breathe unwholesome air, and have too little exercise, are most liable to this disease, and generally suffer most from it.

The chin-cough is so well known, even to nurses, that a description of it is unnecessary. Whatever hurts the digestion, obstructs the perspiration, or relaxes the solids, disposes to this disease: consequently its cure must depend upon cleansing and strengthening the stomach, bracing the solids, and at the same time promoting perspiration and the different secretions.

The diet must be light, and of easy digestion; for children, good bread made into pap or pudding, chicken-broth, with other light spoon meats, are proper; but those who are farther advanced may be allowed sago-gruel, and if the fever be not high, a little boiled chicken, or other white meats. The drink may be hyssop, or penny-royal tea, sweetened with honey or sugar-candy, small wine-whey; or, if the patient be weak, he may sometimes be allowed a little negus.

One of the most effectual remedies in the chin-cough is change of air. This often removes the malady, even when the change seems to be from a purer to a less wholesome air. This may in some measure depend on the patient’s being removed from the place where the infection prevails. Most of the diseases of children are infectious; nor is it at all uncommon to find the chin-cough prevailing in one town or village, when another, at a very small distance, is quite free from it. But whatever be the cause, we are sure of the fact. No time ought therefore to be lost in removing the patient at some distance from the place where he caught the disease, and, if possible, into a more pure and warm air[112].

When the disease proves violent, and the patient is in danger of being suffocated by the cough, he ought to be bled, especially if there be a fever with a hard full pulse. But as the chief intention of bleeding is to prevent an inflammation of the lungs, and to render it more safe to give vomits, it will seldom be necessary to repeat the operation; yet if there are symptoms of an inflammation of the lungs, a second or even a third bleeding may be requisite.

It is generally reckoned a favourable symptom when a fit of coughing makes the patient vomit. This cleanses the stomach, and greatly relieves the cough. It will therefore be proper to promote this discharge, either by small doses of ipecacuanha, or the vomiting julep recommended in the Appendix[113].

It is very difficult to make children drink after a vomit. I have often seen them happily deceived, by infusing a scruple or half a drachm of the powder of ipecacuanha in a tea-pot, with half an English pint of boiling water. If this be disguised with a few drops of milk and a little sugar, they will imagine it tea, and drink it very greedily. A small tea-cupful of this may be given every quarter of an hour, or rather every ten minutes, till it operates. When the child begins to puke, there will be no occasion for drinking any more, as the water already on the stomach will be sufficient.

Vomits not only cleanse the stomach, which in this disease is generally loaded with viscid phlegm, but they likewise promote the perspiration and other secretions, and ought therefore to be repeated according to the obstinacy of the disease. They should not however be strong; gentle vomits frequently repeated are both less dangerous, and more beneficial than strong ones.

The body ought to be kept gently open. The best medicines for this purpose are rhubarb and its preparations, as the syrup, tincture, &c. Of these a tea-spoonful or two may be given to an infant twice or thrice a-day, as there is occasion. To such as are farther advanced, the dose must be proportionally increased, and repeated till it has the desired effect. Those who cannot be brought to take the bitter tincture, may have an infusion of senna and prunes, sweetened with manna, coarse sugar, or honey; or a few grains of rhubarb mixed with a tea-spoonful or two of syrup, or currant jelly, so as to disguise the taste. Most children are fond of syrups and jellies, and seldom refuse even a disagreeable medicine when mixed with them.

Many people believe that oily, pectoral, and balsamic medicines possess wonderful virtues for the cure of the chin-cough, and accordingly exhibit them plentifully to patients of every age and constitution, without considering that every thing of this nature must load the stomach, hurt the digestion, and of course aggravate the disorder[114].

The millepedes, or woodlice, are greatly recommended for the cure of a chin-cough. Those who chuse to make use of these insects, may infuse two ounces of them bruised in an English pint of small white-wine for one night. Afterwards the liquor may be drained through a cloth, and a table-spoonful of it given to the patient three or four times a-day.

Opiates are sometimes necessary to allay the violence of the cough. For this purpose a little of the syrup of poppies, or five, six, or seven drops of laudanum, according to the age of the patient, may be taken in a cup of hyssop or penny-royal-tea, and repeated occasionally[115].

The garlic ointment is a well-known remedy in North Britain for the chin-cough. It is made by beating in a mortar garlic with an equal quantity of hogs lard. With this the soles of the feet may be rubbed twice or thrice a-day; but the best method is to spread it upon a rag, and apply it in the form of plaster. It should be renewed every night and morning at least, as the garlic soon loses its virtue. This is an exceeding good medicine both in the chin-cough, and in most other coughs of an obstinate nature. It ought not however to be used when the patient is very hot or feverish, lest it should increase these symptoms.

The feet should be bathed once every two or three days in lukewarm water; and a Burgundy-pitch plaster kept constantly between the shoulders. But when the disease proves very violent, it will be necessary, instead of it, to apply a blistering-plaster, and to keep the part open for some time with issue ointment.

When the disease is prolonged, and the patient is free from a fever, the Peruvian bark, and other bitters, are the most proper medicines. The bark may either be taken in substance, or in a decoction or infusion, as is most agreeable. For a child, ten, fifteen, or twenty grains, according to the age of the patient, may be given three or four times a day. For an adult, half a drachm or two scruples will be proper. Some give the extract of the bark with cantharides; but to manage this requires a considerable attention. It is more safe to give a few grains of castor along with the bark. A child of six or seven years of age may take seven or eight grains of castor, with fifteen grains of powdered bark, for a dose. This may be made into a mixture with two or three ounces of any simple distilled water, and a little syrup, and taken three or four times a-day.

CHAP. XXX. INFLAMMATION OF THE STOMACH, AND OTHER VISCERA.

All inflammations of the bowels are dangerous, and require the most speedy assistance; as they frequently end in a suppuration, and sometimes in a mortification, which is certain death.

CAUSES.——An inflammation of the stomach may proceed from any of the causes which produce an inflammatory fever; as cold liquor drank while the body is warm, obstructed perspiration, or the sudden striking in of any eruption. It may likewise proceed from the acrimony of the bile, or from acrid and stimulating substances taken into the stomach; as strong vomits or purges, corrosive poisons, and such like. When the gout has been repelled from the extremities, either by cold or improper applications, it often occasions an inflammation of the stomach. Hard or indigestible substances taken into the stomach, as bones, the stones of fruit, &c. may likewise have that effect.

SYMPTOMS.——It is attended with a fixed pain and burning heat in the stomach; great restlessness and anxiety; a small, quick, and hard pulse; vomiting, or, at least, a nausea and sickness; excessive thirst; coldness of the extremities; difficulty of breathing; cold clammy sweats; and sometimes convulsions and fainting fits. The stomach is swelled, and often feels hard to the touch. One of the most certain signs of this disease is the sense of pain, which the patient feels upon taking any kind of food or drink, especially if it be either too hot or too cold.

When the patient vomits every thing he eats or drinks, is extremely restless, has a hiccup, with an intermitting pulse, and frequent fainting fits, the danger is very great.

REGIMEN.——All acrimonious, heating, and irritating food and drink are carefully to be avoided. The weakness of the patient may deceive the bystanders, and induce them to give him wines, spirits, or other cordials; but these never fail to increase the disease, and often occasion sudden death. The inclination to vomit may likewise impose on the attendants, and make them think a vomit necessary; but that too is almost certain death.

The food must be light, thin, cool, and easy of digestion. It must be given in small quantities, and should neither be quite cold nor too hot. Thin gruel made of barley or oatmeal, light toasted bread dissolved in boiling water, or very weak chicken broth, are the most proper. The drink should be clear whey, barley-water, water in which toasted bread has been boiled, or decoctions of emollient vegetables; as liquorice and marsh-mallow roots, sarsaparilla, &c.

MEDICINE.——Bleeding in this disease is absolutely necessary, and is almost the only thing that can be depended on. When the disease proves obstinate, it will often be proper to repeat this operation several times, nor must the low state of the pulse deter us from doing so. The pulse indeed generally rises upon bleeding, and as long as that is the case, the operation is safe.

Frequent fomentations with lukewarm water, or a decoction of emollient vegetables, are likewise beneficial. Flannel cloths dipped in these must be applied to the region of the stomach, and removed as they grow cool. They must neither be applied too warm, nor be suffered to continue till they become quite cold, as either of these extremities would aggravate the disease.

The feet and legs ought likewise to be frequently bathed in lukewarm water, and warm bricks or poultices may be applied to the soles of the feet. The warm bath, if it can be conveniently used, will be of great service.

In this, and all other inflammations of the bowels, an epispastic, or blistering-plaster, applied over the part affected, is one of the best remedies I know. I have often used it, and do not recollect one instance wherein it did not give relief to the patient.

The only internal medicines which we shall venture to recommend in this disease, are mild clysters. These may be made of warm water, or thin water-gruel; and if the patient is costive, a little sweet oil, honey, or manna, may be added. Clysters answer the purpose of an internal fomentation, while they keep the body open, and at the same time nourish the patient, who is often in this disease unable to retain any food upon his stomach. For these reasons they must not be neglected, as the patient’s life may depend on them.

INFLAMMATION OF THE INTESTINES.

This is one of the most painful and dangerous diseases that mankind is liable to. It generally proceeds from the same causes as the inflammation of the stomach; to which may be added costiveness, worms, eating unripe fruits, or great quantities of nuts, drinking hard windy malt liquors, as stale bottled beer or ale, sour wine, cyder, &c. It may likewise be occasioned by a rupture, by schirrous tumours of the intestines, or by their opposite sides growing together.

The inflammation of the intestines is denominated Iliac passion, Enteritis, &c. according to the name of the parts affected. The treatment however is nearly the same whatever part of the intestinal canal be the seat of the disease; we shall therefore omit these distinctions, lest they should perplex the reader.

The symptoms here are nearly the same as in the foregoing disease; only the pain, if possible, is more acute, and is situated lower. The vomiting is likewise more violent, and sometimes even the excrements, together with the clysters, are discharged by the mouth. The patient is continually belching up wind, and has often an obstruction of his urine.

While the pain shifts, and the vomiting only returns at certain intervals, and while the clysters pass downwards, there is ground for hope; but when the clysters and fæces are vomited, and the patient is exceeding weak, with a low fluttering pulse, a pale countenance, and a disagreeable or stinking breath, there is great reason to fear that the consequences will prove fatal. Clammy sweats, black fœtid stools, with a small intermitting pulse, and a total cessation of pain, are signs of a mortification already begun, and of approaching death.

REGIMEN.——The regimen in this disease is in general the same as in an inflammation of the stomach. The patient must be kept quiet, avoiding cold, and all violent passions of the mind. His food ought to be very light, and given in small quantities; his drink weak and diluting; as clear whey, barley-water, and such like.

MEDICINE.——Bleeding in this, as well as in the inflammation of the stomach, is of the greatest importance. It should be performed as soon as the symptoms appear, and must be repeated according to the strength of the patient, and the violence of the disease.

A blistering plaster is here likewise to be applied immediately over the part where the most violent pain is. This not only relieves the pain of the bowels, but even clysters and purgative medicines, which before had no effect, will operate when the blister begins to rise.

Fomentations and laxative clysters are by no means to be omitted. The patient’s feet and legs should frequently be bathed in warm water; and cloths dipped in it applied to his belly. Bladders filled with warm water may likewise be applied to the region of the navel, and warm bricks, or bottles filled with warm water, to the soles of the feet. The clysters may be made of barley-water or thin gruel with salt, and softened with sweet oil or fresh butter. These may be administered every two or three hours, or oftener, if the patient continues costive.

If the disease does not yield to clysters and fomentations, recourse must be had to pretty strong purgatives; but as these, by irritating the bowels, often increase their contraction, and by that means frustrate their own intention, it will be necessary to join them with opiates, which, by allaying the pain, and relaxing the spasmodic contractions of the guts, greatly assist the operation of purgatives in this case.

What answers the purpose of opening the body very well, is a solution of the bitter purging salts. Two ounces of these may be dissolved in an English pint of warm water, or thin gruel, and a tea-cupful of it taken every half hour till it operates. At the same time fifteen, twenty, or twenty-five drops of laudanum may be given in a glass of peppermint or simple cinnamon-water, to appease the irritation, and prevent the vomiting, &c.

Acids have often a very happy effect in staying the vomiting, and appeasing the other violent symptoms of this disease. It will therefore be of use to sharpen the patient’s drink with cream of tartar, juice of lemon; or, when these cannot be obtained, with vinegar.

But it often happens that no liquid whatever will stay on the stomach. In this case the patient must take purging pills. I have generally found the following answer very well: Take jalap in powder, and vitriolated tartar, of each half a drachm, opium one grain, Castile soap as much as will make the mass fit for pills. These must be taken at one dose, and if they do not operate in a few hours, the dose may be repeated.

If a stool cannot be procured by any of the above means, it will be necessary to immerse the patient in warm water up to the breast. I have often seen this succeed when other means had been tried in vain. The patient must continue in the water as long as he can easily bear it without fainting, and if one immersion has not the desired effect, it may be repeated as soon as the patient’s strength and spirits are recruited. It is more safe for him to go frequently into the bath, than to continue too long at a time; and it is often necessary to repeat it several times before it has the desired effect.

It has sometimes happened, after all other means of procuring a stool had been tried to no purpose, that this was brought about by immersing the patient’s lower extremities in cold water, or making him walk upon a wet pavement, and dashing his legs and thighs with the cold water. This method, when others fail, at least merits a trial. It is indeed attended with some danger; but a doubtful remedy is better than none.

In desperate cases it is common to give quicksilver. This may be given to the quantity of several ounces, or even a pound, but should not exceed that[116]. When there is reason to suspect a mortification of the guts, this medicine ought not to be tried. In that case it cannot cure the patient, and will only hasten his death. But when the obstruction is occasioned by any cause that can be removed by force, quicksilver is not only a proper medicine, but the best that can be administered, as it is the fittest body we know for making its way through the intestinal canal.

If the disease proceed from a rupture, the patient must be laid with his head very low, and the intestines returned by gentle pressure with the hand. If this, with fomentations and clysters, should not succeed, recourse must be had to a surgical operation, which may give the patient relief.

Such as would avoid this excruciating and dangerous disease, must take care never to be too long without a stool. Some who have died of it have had several pounds of hard dry fæces taken out of their guts. They should likewise beware of eating too freely of sour or unripe fruits, or drinking stale windy liquors, &c. I have known it brought on by living too much on baked fruits, which are seldom good. It likewise proceeds frequently from cold caught by wet clothes, &c. but especially from wet feet.

OF THE COLIC.

The colic has a great resemblance to the two preceding diseases, both in its symptoms and method of cure. It is generally attended with costiveness and acute pain of the bowels; and requires diluting diet, evacuations, fomentations, &c.

Colics are variously denominated according to their causes, as the flatulent, the bilious, the hysteric, the nervous, &c. As each of these requires a particular method of treatment, we shall point out their most general symptoms, and the means to be used for their relief.

The flatulent, or wind-colic, is generally occasioned by an indiscreet use of unripe fruits, meats of hard digestion, windy vegetables, fermenting liquors, and such like. It may likewise proceed from an obstructed perspiration, or catching cold. Delicate people, whose digestive powers are weak, are most liable to this kind of colic.

The flatulent colic may either affect the stomach or intestines. It is attended with a painful stretching of the affected part. The patient feels a rumbling in his guts, and is generally relieved by a discharge of wind, either upwards or downwards. The pain is seldom confined to any particular part, as the vapour wanders from one division of the bowels to another till it finds a vent.

When the disease proceeds from windy liquor, green fruit, sour herbs, or the like, the best medicine on the first appearance of the symptoms is a dram of brandy, gin, or any good spirits. The patient should likewise sit with his feet upon a warm hearth-stone, or apply warm bricks to them; and warm cloths may be applied to his stomach and bowels.

This is the only colic wherein ardent spirits, spiceries, or any thing of a hot nature, may be ventured upon. Nor indeed are they to be used here unless at the very beginning, before any symptoms of inflammation appear. We have reason to believe, that a colic occasioned by wind or flatulent food might always be cured by spirits and warm liquors, if they were taken immediately upon perceiving the first uneasiness; but when the pain has continued for a considerable time, and there is reason to fear an inflammation of the bowels is already begun, all hot things are to be avoided as poison, and the patient is to be treated in the same manner as for the inflammation of the intestines.

Several kinds of food, as honey, eggs, &c. occasion colics in some particular constitutions. I have generally found the best method of cure for these was to drink plentifully of small diluting liquors, as water-gruel, small posset, water with toasted bread soaked in it, &c.

Colics which proceed from excess and indigestion generally cure themselves by occasioning vomiting or purging. These discharges are by no means to be stopped, but promoted by drinking plentifully of warm water, or weak posset. When their violence is over, the patient may take a dose of rhubarb, or any other gentle purge, to carry off the dregs of his debauch.

Colics which are occasioned by wet feet, or catching cold, may generally be removed at the beginning, by bathing the feet and legs in warm water, and drinking such warm diluting liquors as will promote the perspiration, as weak wine-whey, or water-gruel, with a small quantity of spirits in it.

Those flatulent colics, which prevail so much among country people, might generally be prevented were they careful to change their clothes when they get wet. They ought likewise to take a dram, or to drink some warm liquor after eating any kind of green trash. We do not mean to recommend the practice of dram-drinking, but in this case ardent spirits prove a real medicine, and indeed the best that can be administered. A glass of good peppermint water will have nearly the same effect as a glass of brandy, and in some cases is rather to be preferred.

The bilious colic is attended with very acute pains about the region of the navel. The patient complains of great thirst, and is generally costive. He vomits a hot, bitter, yellow-coloured bile, which being discharged, seems to afford some relief, but is quickly followed by the same violent pain as before. As the distemper advances, the propensity to vomit sometimes increases so as to become almost continual, and the proper motion of the intestines is so far perverted, that there are all the symptoms of an impending iliac passion.

If the patient be young and strong, and the pulse full and frequent, it will be proper to bleed, after which clysters may be administered. Clear whey or gruel, sharpened with the juice of lemon, or cream of tartar, must be drank freely. Small chicken-broth, with a little manna dissolved in it, or a slight decoction of tamarinds, are likewise very proper, or any other thin, acid, opening liquor.

Besides bleeding and plentiful dilution, it will be necessary to foment the belly with cloths dipped in warm water, and if this should not succeed, the patient must be immersed up to the breast in warm water.

In the bilious colic the vomiting is often very difficult to restrain. When this happens, the patient may drink a decoction of toasted bread, or an infusion of garden-mint in boiling water. Should these not have the desired effect, the saline draught, with a few drops of laudanum in it, may be given, and repeated according to the urgency of the symptoms. A small quantity of Venice treacle may be spread in form of a cataplasm, and applied to the pit of the stomach. Clysters, with a proper quantity of Venice treacle or liquid laudanum in them, may likewise be frequently administered.

Such as are liable to frequent returns of the bilious colic should use flesh sparingly, and live chiefly upon a light vegetable diet. They should likewise take frequently a dose of cream of tartar with tamarinds, or any other cool acid purge.

The hysteric colic bears a great resemblance to the bilious. It is attended with acute pains about the region of the stomach, vomiting, &c. But what the patient vomits in this case is commonly of a greenish colour. There is a great sinking of the spirits, with dejection of mind and difficulty of breathing, which are the characteristic symptoms of this disorder. Sometimes it is accompanied with the jaundice, but this generally goes off of its own accord in a few days.

In this colic all evacuations, as bleeding, purging, vomiting, &c. do hurt. Every thing that weakens the patient, or sinks the spirits, is to be avoided. If however the vomiting should prove violent, lukewarm water, or small posset, may be drank to cleanse the stomach. Afterwards the patient may take fifteen, twenty, or twenty-five drops of liquid laudanum in a glass of cinnamon water. This may be repeated every ten or twelve hours till the symptoms abate.

The patient may likewise take four or five of the fœtid pills every six hours, and drink a cup of penny-royal tea after them. If asafœtida should prove disagreeable, which is sometimes the case, a tea-spoonful of the tincture of castor in a cup of penny-royal tea, or thirty or forty drops of the balsam of Peru dropped upon a bit of loaf-sugar, may be taken in its stead. The anti-hysteric plaster may also be used, which has often a good effect[117].

The nervous colic prevails among miners, smelters of lead, plumbers, the manufacturers of white lead, &c. It is very common in the cyder counties of England, and is supposed to be occasioned by the leaden vessels used in preparing that liquor. It is likewise a frequent disease in the West Indies, where it is termed the dry belly-ache.

No disease of the bowels is attended with more excruciating pain than this. Nor is it soon at an end. I have known it continue eight or ten days with very little intermission, the body all the while continuing bound in spite of medicine, yet at length yield, and the patient recover[118]. It generally however leaves the patient weak, and often ends in a palsy.

The general treatment of this disease is so nearly the same with that of the iliac passion, or inflammation of the guts, that we shall not insist upon it. The body is to be opened by mild purgatives given in small doses, and frequently repeated, and their operation must be assisted by soft oily clysters, fomentations, &c. The castor oil is reckoned peculiarly proper in this disease. It may both be mixed with the clysters and given by the mouth.

The Barbadoes tar is said to be an efficacious medicine in this complaint. It may be taken to the quantity of two drachms three times a day, or oftner if the stomach will bear it. This tar, mixed with an equal quantity of strong rum, is likewise proper for rubbing the spine, in case any tingling, or other symptoms of a palsy, are felt. When the tar cannot be obtained, the back may be rubbed with strong spirits, or a little oil of nutmegs or of rosemary.

If the patient remains weak and languid after this disease, he must take exercise on horseback, and use an infusion of the Peruvian bark in wine. When the disease ends in a palsy, the Bath-waters are found to be extremely proper.

To avoid this kind of colic, people must shun all sour fruits, acids, and austere liquors, &c. Those who work in lead ought never to go to their business fasting, and their food should be oily or fat. They may take a glass of sallad oil, with a little brandy or rum every morning, but should never take spirits alone. Liquid aliment is best for them; as fat broths, &c. but low living is bad. They should frequently go a little out of the tainted air; and should never suffer themselves to be costive. In the West Indies, and on the coast of Guinea, it has been found of great use, for preventing this colic, to wear a piece of flannel round the waist, and to drink an infusion of ginger by way of tea.

Sundry other kinds of this disease might be mentioned, but too many distinctions would tend only to perplex the reader. Those already mentioned are the most material, and should indeed be attended to, as their treatment is very different. But even persons who are not in a condition to distinguish very accurately in these matters, may nevertheless be of great service to patients in colics of every kind, by only observing the following general rules, viz. To bathe the feet and legs in warm water; to apply bladders filled with warm water, or cloths dipped in it, to the stomach and bowels; to make the patient drink freely of diluting mucilaginous liquors; and to give him an emollient clyster every two or three hours. Should these not succeed, the patient ought to be immersed in warm water.

INFLAMMATION OF THE KIDNEYS.

CAUSES.——This disease may proceed from any of those causes which produce an inflammatory fever. It may likewise be occasioned by wounds or bruises of the kidneys; small stones or gravel lodging within them; by strong diuretic medicines; as spirits of turpentine, tincture of cantharides, &c. Violent motion, as hard riding or walking, especially in hot weather, or whatever drives the blood too forcibly into the kidneys, may occasion this malady. It may likewise proceed from lying too soft, too much on the back, involuntary contractions, or spasms, in the urinary vessels, &c.

SYMPTOMS.——There is a sharp pain about the region of the kidneys, with some degree of fever, and a stupor or dull pain in the thigh of the affected side. The urine is at first clear, and afterwards of a reddish colour; but in the worst kind of the disease it generally continues pale, is passed with difficulty, and commonly in small quantities at a time. The patient feels great uneasiness when he endeavours to walk or sit upright. He lies with most ease on the affected side, and has generally a nausea or vomiting, resembling that which happens in the colic.

This disease however may be distinguished from the colic by the pain being seated farther back, and by the difficulty of passing urine with which it is constantly attended.

REGIMEN.——Every thing of a heating or stimulating nature is to be avoided. The food must be thin and light; as panado, small broths, with mild vegetables, and the like. Emollient and thin liquors must be plentifully drank; as clear whey, or balm-tea sweetened with honey, decoctions of marsh-mallow roots, with barley and liquorice, &c. The patient, notwithstanding the vomiting, must constantly keep sipping small quantities of these or other diluting liquors. Nothing so safely and certainly abates the inflammation, and expels the obstructing cause, as copious dilution. The patient must be kept easy, quiet, and free from cold, as long as any symptoms of inflammation remain.

MEDICINE.——Bleeding is generally necessary, especially at the beginning. Ten or twelve ounces may be let from the arm or foot with a lancet, and if the pain and inflammation continue, the operation may be repeated in twenty-four hours, especially if the patient be of a full habit. Leeches may likewise be applied to the hæmorrhoidal veins, as a discharge from these will greatly relieve the patient.

Cloths dipped in warm water, or bladders filled with it, must be applied as near as possible to the part affected, and renewed as they grow cool. If the bladders be filled with a decoction of mallows and camomile flowers, to which a little saffron is added, and mixed with about a third part of new milk, it will be still more beneficial.

Emollient clysters ought frequently to be administered; and if these do not open the body, a little salt and honey or manna may be added to them.

The same course is to be followed where gravel or stone is lodged in the kidney, but when the gravel or stone is separated from the kidney, and lodges in the Ureter[119], it will be proper, besides the fomentations, to rub the small of the back with sweet oil, and to give gentle diuretics; as juniper-water sweetened with the syrup of marsh-mallows: a tea-spoonful of the sweet spirits of nitre, with a few drops of laudanum, may now and then be put in a cup of the patient’s drink. He ought likewise to take exercise on horseback, or in a carriage, if he be able to bear it.

When the disease is protracted beyond the seventh or eighth day, and the patient complains of a stupor and heaviness of the part, has frequent returns of chillness, shivering, &c. there is reason to suspect that matter is forming in the kidney, and that an abscess will ensue.

When matter in the urine shews that an ulcer is already formed in the kidney, the patient must be careful to abstain from all acrid, sour, and salted provisions; and to live chiefly upon mild mucilaginous herbs and fruits, together with the broth of young animals, made with barley, and common pot-herbs, &c. His drink may be whey, and butter-milk that is not sour. The latter is by some reckoned a specific remedy in ulcers of the kidneys. To answer this character, however, it must be drank for a considerable time. Chalybeate waters have likewise been found beneficial in this disease. This medicine is easily obtained, as it is found in every part of Great Britain. It must likewise be used for a considerable time, in order to produce any salutary effects.

Those who are liable to frequent returns of inflammation, or obstructions of the kidneys, must abstain from wines, especially such as abound with tartar; and their food ought to be light, and of easy digestion. They should use moderate exercise, and should not lie too hot, nor too much on their back.

INFLAMMATION OF THE BLADDER.

The inflammation of the bladder proceeds, in a great measure, from the same causes as that of the kidneys. It is known by an acute pain towards the bottom of the belly, and difficulty of passing urine, with some degree of fever, a constant inclination to go to stool, and a perpetual desire to make water.

This disease must be treated on the same principles as the one immediately preceding. The diet must be light and thin, and the drink of a cooling nature. Bleeding is very proper at the beginning, and in robust constitutions it will often be necessary to repeat it. The lower part of the belly should be fomented with warm water, or a decoction of mild vegetables; and emollient clysters ought frequently to be administered, &c.

The patient should abstain from every thing that is of a hot, acrid, and stimulating quality, and should live entirely upon small broths, gruels, or mild vegetables.

A stoppage of urine may proceed from other causes besides an inflammation of the bladder; as a swelling of the hæmorrhoidal veins, hard fæces lodged in the rectum; a stone in the bladder; excrescences in the urinary passages, a palsy of the bladder, hysteric affections, &c. Each of these requires a particular treatment, which does not fall under our present consideration. We shall only observe, that in all of them mild and gentle applications are the safest, as strong diuretic medicines, or things of an irritating nature, generally increase the danger.

I have known some persons kill themselves by introducing probes into the urinary passages, to remove, as they thought, somewhat that obstructed the discharge of urine, and others bring on a violent inflammation of the bladder, by using strong diuretics, as oil of turpentine, &c. for that purpose.

INFLAMMATION OF THE LIVER.

The liver is less subject to inflammation than most of the other viscera, as in it the circulation is slower; but when an inflammation does happen, it is with difficulty removed, and often ends in a suppuration or scirrhus.

CAUSES.——Besides the common causes of inflammation, we may here reckon the following, viz. excessive fatness, a scirrhus of the liver itself, violent shocks from strong vomits when the liver was before unsound, an adust or atrabiliarian state of the blood, any thing that suddenly cools the liver after it has been greatly heated, stones obstructing the course of the bile, drinking strong wines and spirituous liquors, using hot spicy aliment, obstinate hypochondriacal affections, &c.

SYMPTOMS.——This disease is known by a painful tension of the right side under the false ribs, attended with some degree of fever, a sense of weight, or fulness of the part, difficulty of breathing, loathing of food, great thirst, with a pale or yellowish colour of the skin and eyes.

The symptoms here are various, according to the degree of inflammation, and likewise according to the particular part of the liver where the inflammation happens. Sometimes the pain is so inconsiderable, that an inflammation is not so much as suspected; but when it happens in the upper or convex part of the liver, the pain is more acute, the pulse quicker, and the patient is often troubled with a dry cough, a hiccup, and a pain extending to the shoulder, with difficulty of lying on the left side, &c.

This disease may be distinguished from the pleurisy by the pain being less violent, seated under the false ribs, the pulse not so hard, and by the difficulty of lying on the left side. It may be distinguished from the hysteric and hypochondriac disorders by the degree of fever with which it is always attended.

This disease, if properly treated, is seldom mortal. A constant hiccuping, violent fever, and excessive thirst, are bad symptoms. If it ends in a suppuration, and the matter cannot be discharged outwardly, the danger is great. When the scirrhus of the liver ensues, the patient, if he observes a proper regimen, may nevertheless live a number of years tolerably easy; but if he indulge in animal food and strong liquors, or take medicines of an acrid or irritating nature, the scirrhus will be converted into a cancer, which must infallibly prove fatal.

REGIMEN.——The same regimen is to be observed in this as in other inflammatory disorders. All hot things are to be carefully avoided, and cool diluting liquors, as whey, barley-water, &c. drank freely. The food must be light and thin, and the body, as well as the mind, kept easy and quiet.

MEDICINE.——Bleeding is proper at the beginning of this disease, and it will often be necessary, even though the pulse should not feel hard, to repeat it. All violent purgatives are to be avoided; the body however must be kept gently open. A decoction of tamarinds, with a little honey or manna, will answer this purpose very well. The side affected must be fomented in the manner directed in the foregoing diseases. Mild laxative clysters should be frequently administered; and, if the pain should notwithstanding continue violent, a blistering plaster may be applied over the part affected.

Medicines which promote the secretion of urine have a very good effect here. For this purpose half a drachm of purified nitre, or a tea-spoonful of the sweet spirits of nitre, may be taken in a cup of the patient’s drink three or four times a-day.

When there is an inclination to sweat, it ought to be promoted, but not by warm sudorifics. The only thing to be used for that purpose is plenty of diluting liquors drank about the warmth of the human blood. Indeed the patient in this case, as well as in all other topical inflammations, ought to drink nothing that is colder than the blood.

If the stools should be loose, and even streaked with blood, no means must be used to stop them, unless they be so frequent as to weaken the patient. Loose stools often prove critical, and carry off the disease.

If an abscess or imposthume is formed in the liver, all methods should be tried to make it break and discharge itself outwardly, as fomentations, the application of poultices, ripening cataplasms, &c. Sometimes indeed the matter of an abscess comes away in the urine, and sometimes it is discharged by stool, but these are efforts of Nature which no means can promote. When the abscess bursts into the cavity of the abdomen at large, death must ensue; nor will the event be more favourable when the abscess is opened by an incision, unless in cases where the liver adheres to the peritonæum, so as to form a bag for the matter, and prevent it from falling into the cavity of the abdomen; in which case opening the abscess by a sufficiently large incision will probably save the patient’s life[120].

If the disorder, in spite of all endeavours to the contrary, should end in a scirrhus, the patient must be careful to regulate his diet, &c. in such a manner as not to aggravate the disease. He must not indulge in flesh, fish, strong liquors, or any highly seasoned or salted provisions; but should, for the most part, live on mild vegetables, as fruits and roots; taking gentle exercise, and drinking whey, barley-water, or butter-milk. If he takes any thing stronger, it should be fine mild ale, which is less heating than wines or spirits.

We shall take no notice of inflammations of the other viscera. They must in general be treated upon the same principles as those already mentioned. The chief rule with respect to all of them, is to let blood, to avoid every thing that is strong, or of a heating nature, to apply warm fomentations to the part affected, and to cause the patient to drink a sufficient quantity of warm diluting liquors.

CHAP. XXXI. OF THE CHOLERA MORBUS, AND OTHER EXCESSIVE DISCHARGES FROM THE STOMACH AND BOWELS.

The cholera morbus is a violent purging and vomiting, attended with gripes, sickness, and a constant desire to go to stool. It comes on suddenly, and is most common in autumn. There is hardly any disease that kills more quickly than this, when proper means are not used in due time for removing it.

CAUSES.——It is occasioned by a redundancy and putrid acrimony of the bile; cold; food that easily turns rancid or sour on the stomach; as butter, bacon, sweetmeats, cucumbers, melons, cherries, and other cold fruits[121]. It is sometimes the effect of strong acrid purges or vomits, or of poisonous substances taken into the stomach. It may likewise proceed from violent passions or affections of the mind; as fear, anger, &c.

SYMPTOMS.——It is generally preceded by a cardialgia, or heart-burn, sour belchings, and flatulencies, with pain of the stomach and intestines. To these succeed excessive vomiting, and purging of green, yellow, or blackish-coloured bile, with a distension of the stomach, and violent griping pains. There is likewise a great thirst, with a very quick unequal pulse, and often a fixed acute pain about the region of the navel. As the disease advances, the pulse often sinks low as to become quite imperceptible, the extremities grow cold, or cramped, and are often covered with a clammy sweat, the urine is obstructed, and there is a palpitation of the heart. Violent hiccuping, fainting, and convulsions, are the signs of approaching death.

MEDICINE.——At the beginning of this disease the efforts of Nature to expel the offending cause should be assisted, by promoting the purging and vomiting. For this purpose the patient must drink freely of diluting liquors; as whey, butter-milk, warm water, thin water-gruel, small posset, or, what is perhaps preferable to any of them, very weak chicken broth. This should not only be drank plentifully to promote the vomiting, but a clyster of it given every hour in order to promote the purging.

After these evacuations have been continued for some time, a decoction of toasted oat-bread may be drank to stop the vomiting. The bread should be toasted till it is of a brown colour, and afterwards boiled in spring water. If oat-bread cannot be had, wheat-bread, or oatmeal well toasted, may be used in its stead. If this does not put a stop to the vomiting, two table-spoonfuls of the saline julep, with ten drops of laudanum, may be taken every hour till it ceases.

The vomiting and purging however ought never to be stopped too soon. As long as these discharges do not weaken the patient, they are salutary, and may be allowed to go on, or rather ought to be promoted. But when the patient is weakened by the evacuations, which may be known from the sinking of his pulse, &c. recourse must immediately be had to opiates, as recommended above; to which may be added strong wines, with spirituous cinnamon-waters, and other generous cordials. Warm negus, or strong wine-whey, will likewise be necessary to support the patient’s spirits, and promote the perspiration. His legs should be bathed in warm water, and afterwards rubbed with flannel cloths, or wrapped in warm blankets, and warm bricks applied to the soles of his feet. Flannels wrung out of warm spirituous fomentations should likewise be applied to the region of the stomach.

When the violence of the disease is over, to prevent a relapse, it will be necessary for some time to continue the use of small doses of laudanum. Ten or twelve drops may be taken in a glass of wine, at least twice a day, for eight or ten days. The patient’s food ought to be nourishing, but taken in small quantities, and he should use moderate exercise. As the stomach and intestines are generally much weakened, an infusion of the bark, or other bitters, in small wine, sharpened with the elixir of vitriol, may be drank for some time.

Though physicians are seldom called in due time in this disease, they ought not to despair of relieving the patient even in the most desperate circumstances. Of this I lately saw a very striking proof in an old man and his son, who had been both seized with it about the middle of the night.

I did not see them till next morning, when they had much more the appearance of dead than of living men. No pulse could be felt; the extremities were cold and rigid; the countenance was ghastly, and the strength almost quite exhausted. Yet from this deplorable condition they were both recovered by the use of opiates and cordial medicines.

OF A DIARRHŒA, or LOOSENESS.

A looseness, in many cases, is not to be considered as a disease, but rather as a salutary evacuation. It ought therefore never to be stopped, unless when it continues too long, or evidently weakens the patient. As this however sometimes happens, we shall point out the most common causes of a looseness, with the proper method of treatment.

When a looseness is occasioned by catching cold, or an obstructed perspiration, the patient ought to keep warm, to drink freely of weak diluting liquors, to bathe his feet and legs frequently in lukewarm water, to wear flannel next his skin, and to take every other method to restore the perspiration.

In a looseness which proceeds from excess or repletion, a vomit is the proper medicine. Vomits not only cleanse the stomach, but promote all the secretions, which renders them of great importance in carrying off a debauch. Half a drachm of ipecacuanha in powder will answer this purpose very well. A day or two after the vomit, the same quantity of rhubarb may be taken, and repeated two or three times, if the looseness continues. The patient ought to live upon light vegetable food of easy digestion, and to drink whey, thin gruel, or barley-water.

A looseness, occasioned by the obstruction of any customary evacuation, generally requires bleeding. If that does not succeed, other evacuations may be substituted in the room of those which are obstructed. At the same time, every method is to be taken to restore the usual discharges, as not only the cure of the disease, but the patient’s life, may depend on this.

A periodical looseness ought never to be stopped. It is always an effort of Nature to carry off some offending matter, which, if retained in the body, might have fatal effects. Children are very liable to this kind of looseness, especially while teething. It is however so far from being hurtful to them, that such children generally get their teeth with least trouble. If these loose stools should at any time prove sour or griping, a tea-spoonful of magnesia alba, with four or five grains of rhubarb, may be given to the child in a little panado, or any other food. This, if repeated three or four times, will generally correct the acidity, and carry off the griping stools.

A diarrhœa, or looseness, which proceeds from violent passions or affections of the mind, must be treated with the greatest caution. Vomits in this case are highly improper. Nor are purges safe, unless they be very mild, and given in small quantities. Opiates, and other antispasmodic medicines, are most proper. Ten or twelve drops of liquid laudanum may be taken in a cup of valerian or penny-royal tea every eight or ten hours, till the symptoms abate. Ease, cheerfulness, and tranquillity of mind, are here of the greatest importance.

When a looseness proceeds from acrid or poisonous substances taken into the stomach, the patient must drink large quantities of diluting liquors, with oil or fat broths, to promote vomiting and purging. Afterwards, if there be reason to suspect that the bowels are inflamed, bleeding will be necessary. Small doses of laudanum may likewise be taken to remove their irritation.

When the gout, repelled from the extremities, occasions a looseness, it ought to be promoted by gentle doses of rhubarb, or other mild purgatives. The gouty matter is likewise to be solicited towards the extremities by warm fomentations, cataplasms, &c. The perspiration ought at the same time to be promoted by warm diluting liquors; as wine-whey, with spirits of hartshorn, or a few drops of liquid laudanum, in it.

When a looseness proceeds from worms, which may be known from the sliminess of the stools, mixed with pieces of decayed worms, &c. medicines must be given to kill and carry off these vermin, as the powder of tin with purges of rhubarb and calomel. Afterwards lime-water, either alone, or with a small quantity of rhubarb infused, will be proper to strengthen the bowels, and prevent the new generation of worms.

A looseness is often occasioned by drinking bad water. When this is the case, the disease generally proves epidemical. When there is reason to believe that this or any other disease proceeds from the use of unwholesome water, it ought immediately to be changed, or, if that cannot be done, it may be corrected by mixing with it quicklime, chalk, or the like.

In people whose stomachs are weak, violent exercise immediately after eating will occasion a looseness. Though the cure of this is obvious, yet it will be proper, besides avoiding violent exercise, to use such medicines as tend to brace and strengthen the stomach, as infusions of the bark, with other bitter and astringent ingredients, in white-wine. Such persons ought likewise to take frequently a glass or two of old red port, or good claret.

From whatever cause a looseness proceeds, when it is found necessary to check it, the diet ought to consist of rice boiled with milk, and flavoured with cinnamon; rice-jelly; sago, with red port; and the lighter sorts of flesh-meat roasted. The drink may be thin water-gruel, rice-water, or weak broth made from lean veal, or with a sheep’s head, as being more gelatinous than mutton, beef, or chicken-broth.

Persons who, from a peculiar weakness, or too great an irritability of the bowels, are liable to frequent returns of this disease, should live temperately, avoiding crude summer fruits, all unwholesome food, and meats of hard digestion. They ought likewise to beware of cold, moisture, or whatever may obstruct the perspiration, and should wear flannel next their skin. All violent passions, as fear, anger, &c. are likewise carefully to be guarded against.

OF VOMITING.

Vomiting may proceed from various causes; as excess in eating and drinking; foulness of the stomach; the acrimony of the aliments; a translation of the morbific matter of ulcers, of the gout, the erysipelas, or other diseases, to the stomach. It may likewise proceed from a looseness having been too suddenly stopped; from the stoppage of any customary evacuation, as the bleeding piles, the menses, &c. from a weakness of the stomach, the colic, the iliac passion, a rupture, a fit of the gravel, worms; or from any kind of poison taken into the stomach. It is an usual symptom of injuries done to the brain; as contusions, compressions, &c. It is likewise a symptom of wounds or inflammations of the diaphragm, intestines, spleen, liver, kidneys, &c.

Vomiting may be occasioned by unusual motions; as sailing, being drawn backwards in a cart or coach, &c. It may likewise be excited by violent passions, or by the idea of nauseous or disagreeable objects, especially of such things as have formerly produced vomiting. Sometimes it proceeds from a regurgitation of the bile into the stomach: in this case, what the patient vomits is generally of a yellow or greenish colour, and has a bitter taste. Persons who are subject to nervous affections are often suddenly seized with violent fits of vomiting. Lastly, vomiting is a common symptom of pregnancy. In this case it generally comes on about two weeks after the stoppage of the menses, and continues during the first three or four months.

When vomiting proceeds from a foul stomach or indigestion, it is not to be considered as a disease, but as the cure of a disease. It ought therefore to be promoted by drinking lukewarm water, or thin gruel. If this does not put a stop to the vomiting, a dose of ipecacuanha may be taken, and worked off with weak camomile-tea.

When the retrocession of the gout, or the obstruction of customary evacuations, occasion vomiting, all means must be used to restore these discharges; or, if that cannot be effected, their place must be supplied by others, as bleeding, purging, bathing the extremities in warm water, opening issues, setons, perpetual blisters, &c.

When vomiting is the effect of pregnancy, it may generally be mitigated by bleeding, and keeping the body gently open. The bleeding however ought to be in small quantities at a time, and the purgatives should be of the mildest kind, as figs, stewed prunes, manna, or senna. Pregnant women are most apt to vomit in the morning, immediately after getting out of bed, which is owing partly to the change of posture, but more to the emptiness of the stomach. It may generally be prevented by taking a dish of coffee, tea, or some light breakfast in bed. Pregnant women who are afflicted with vomiting ought to be kept easy both in body and mind. They should neither allow their stomachs to be quite empty, nor should they eat much at once. Cold water is a very proper drink in this case; if the stomach be weak, a little brandy may be added to it. If the spirits are low, and the person apt to faint, a spoonful of cinnamon-water, with a little marmalade of quinces or oranges, may be taken.

If vomiting proceeds from weakness of the stomach, bitters will be of service. Peruvian bark infused in wine or brandy, with as much rhubarb as will keep the body gently open, is an excellent medicine in this case. The elixir of vitriol is also a good medicine. It may be taken in the dose of fifteen or twenty drops, twice or thrice a day, in a glass of wine or water. Habitual vomitings are sometimes alleviated by making oysters a principal part of diet.

A vomiting, which proceeds from acidities in the stomach, is relieved by alkaline purges. The best medicine of this kind is the magnesia alba, a tea-spoonful of which may be taken in a dish of tea or a little milk, three or four times a day, or oftener if necessary, to keep the body open.

When vomiting proceeds from violent passions, or affections of the mind, all evacuants must be carefully avoided, especially vomits. These are exceedingly dangerous. The patient in this case ought to be kept perfectly easy and quiet, to have the mind soothed, and to take some gentle cordial, as negus, or a little brandy and water, to which a few drops of laudanum may occasionally be added.

When vomiting proceeds from spasmodic affections of the stomach, musk, castor, and other antispasmodic medicines, are of use. Warm and aromatic plasters have likewise a good effect. The stomach plaster of the London or Edinburgh dispensatory may be applied to the pit of the stomach, or a plaster of theriaca, which will answer rather better. Aromatic medicines may likewise be taken inwardly, as cinnamon or mint-tea, wine with spiceries boiled in it, &c. The region of the stomach may be rubbed with æther, or, if that cannot be had, with strong brandy, or other spirits. The belly should be fomented with warm water, or the patient immersed up to the breast in a warm bath.

I have always found the saline draughts taken in the act of effervescence, of singular use in stopping a vomiting, from whatever cause it proceeded. These may be prepared by dissolving a drachm of the salt of tartar in an ounce and half of fresh lemon-juice, and adding to it an ounce of peppermint-water, the same quantity of simple cinnamon-water, and a little white sugar. This draught must be swallowed before the effervescence is quite over, and may be repeated every two hours, or oftner, if the vomiting be violent. A violent vomiting has sometimes been stopped by cupping on the region of the stomach after all other means had failed.

As the least motion will often bring on the vomiting again, even after it has been stopped, the patient must avoid all manner of action. The diet must be so regulated as to sit easy upon the stomach, and nothing should be taken that is hard of digestion. We do not however mean that the patient should live entirely upon slops. Solid food, in this case, often sits easier on the stomach than liquids.

CHAP. XXXII. OF THE DIABETES, AND OTHER DISORDERS OF THE KIDNEYS AND BLADDER.

The diabetes is a frequent and excessive discharge of urine. It is seldom to be met with among young people; but often attacks persons in the decline of life, especially those who follow the more violent employments, or have been hard drinkers in their youth.

CAUSES.——A diabetes is often the consequence of acute diseases, as fevers, fluxes, &c. where the patient has suffered by excessive evacuations; it may also be occasioned by great fatigue, as riding long journies upon a hard-trotting horse, carrying heavy burdens, running, &c. It may be brought on by hard drinking, or the use of strong stimulating diuretic medicines, as tincture of cantharides, spirits of turpentine, and such like. It is often the effect of drinking too great quantities of mineral waters. Many imagine that these will do them no service unless they be drank in great quantities, by which mistake it often happens that they occasion worse diseases than those they were intended to cure. In a word, this disease may either proceed from too great a laxity of the organs which secrete the urine, from something that stimulates the kidneys too much, or from a thin dissolved state of the blood, which makes too great a quantity of it run off by the urinary passages.

SYMPTOMS.——In a diabetes, the urine generally exceeds in quantity all the liquid food which the patient takes. It is thin and pale, of a sweetish taste, and an agreeable smell. The patient has a continual thirst, with some degree of fever; his mouth is dry, and he spits frequently a frothy spittle. The strength fails, the appetite decays, and the flesh wastes away till the patient is reduced to skin and bone. There is a heat of the bowels; and frequently the loins, testicles, and feet are swelled.

This disease may generally be cured at the beginning; but after it has continued long, the cure becomes very difficult. In drunkards, and very old people, a perfect cure is not to be expected.

REGIMEN.——Every thing that stimulates the urinary passages, or tends to relax the habit, must be avoided. For this reason the patient should live chiefly on solid food. His thirst may be quenched with acids; as sorrel, juice of lemon, or vinegar. The mucilaginous vegetables, as rice, sago, and salop, with milk, are the most proper food. Of animal substances, shell-fish are to be preferred; as oysters, crabs, &c.

The drink may be Bristol-water. When that cannot be obtained, lime-water, in which a due proportion of oak bark has been macerated, may be used. The white decoction[122], with isinglass dissolved in it, is likewise a very proper drink.

The patient ought daily to take exercise, but it should be so gentle as not to fatigue him. He should lie upon a hard bed or matrass. Nothing hurts the kidneys more than lying too soft. A warm dry air, the use of the flesh-brush, and every thing that promotes perspiration, is of service. For this reason the patient ought to wear flannel next his skin. A large strengthening plaster may be applied to the back; or, what will answer better, a great part of the body may be wrapt in plaster.

MEDICINE.——Gentle purges, if the patient be not too much weakened by the disease, have a good effect. They may consist of rhubarb, with cardamum seeds, or any other spiceries, infused in wine, and may be taken in such quantities as to keep the body gently open.

The patient must next have recourse to astringents and corroborants. Half a drachm of powder made of equal parts of allum and the inspissated juice commonly called Terra Japonica, may be taken four times a-day, or oftner, if the stomach will bear it. The allum must first be melted in a crucible; afterwards they may both be pounded together. Along with every dose of this powder the patient may take a tea-cupful of the tincture of roses[123].

If the patient’s stomach cannot bear the allum in substance, whey may be made of it, and taken in the dose of a tea-cupful three or four times a-day. The allum-whey is prepared by boiling two English quarts of milk over a slow fire, with three drachms of allum, till the curd separates.

Opiates are of service in this disease, even though the patient rests well. They take off spasm and irritation, and at the same time lessen the force of the circulation. Ten or twelve drops of liquid laudanum may be taken in a cup of the patient’s drink three or four times a-day.

The best corroborants which we know, are the Peruvian bark and wine. A drachm of bark may be taken in a glass of red port or claret three times a-day. The medicine will be both more efficacious and less disagreeable, if fifteen or twenty drops of the acid elixir of vitriol be added to each dose. Such as cannot take the bark in substance may use the decoction, mixed with an equal quantity of red wine, and sharpened as above.

There is a disease incident to labouring people in the decline of life, called an INCONTINENCY of urine. But this is very different from a diabetes, as the water passes off involuntarily by drops, and does not exceed the usual quantity. This disease is rather troublesome than dangerous. It is owing to a relaxation of the sphincter of the bladder, and is often the effect of a palsy. Sometimes it proceeds from hurts, or injuries occasioned by blows, bruises, preternatural labours, &c. Sometimes it is the effect of a fever. It may likewise be occasioned by a long use of strong diuretics, or of stimulating medicines injected into the bladder.

This disease may be mitigated by the use of astringent and corroborating medicines, such as have been mentioned above; but we do not remember ever to have seen it cured.

In an incontinency of urine, from whatever cause, a piece of sponge ought to be worn, or a bladder applied in such a manner as to prevent the urine from galling and excoriating the parts.

OF A SUPPRESSION OF URINE.

It has already been observed, that a suppression of urine may proceed from various causes; as an inflammation of the kidneys, or bladder; small stones or gravel lodging in the urinary passages, hard fæces lying in the rectum, pregnancy, a spasm or contraction of the neck of the bladder, clotted blood in the bladder itself, a swelling of the hæmorrhoidal veins, &c.

Some of these cases require the catheter, both to remove the obstructing matter, and to draw off the urine; but as this instrument can only be managed with safety by persons skilled in surgery, we shall say nothing further of its use. A bougee may be used by any cautious hand, and will often succeed better than the catheter.

We would chiefly recommend, in all obstructions of urine, fomentations and evacuants. Bleeding, as far as the patient’s strength will permit, is necessary, especially where there are symptoms of topical inflammation. Bleeding in this case not only abates the fever, by lessening the force of the circulation, but, by relaxing the solids, it takes off the spasm or stricture upon the vessels which occasioned the obstruction.

After bleeding, fomentations must be used. These may either consist of warm water alone, or of decoctions of mild vegetables; as mallows, camomile-flowers, &c. Cloths dipped in these may either be applied to the part affected, or a large bladder filled with the decoction may be kept continually upon it. Some put the herbs themselves into a flannel bag, and apply them to the part, which is far from being a bad method. These continue longer warm than cloths dipped in the decoction, and at the same time keep the part equally moist.

In all obstructions of urine, the body ought to be kept open. This is not however to be attempted by strong purgatives, but by emollient clysters, or gentle infusions of senna and manna. Clysters in this case not only open the body, but answer the purpose of an internal fomentation, and greatly assist in removing the spasms of the bladder and parts adjacent.

The food must be light, and taken in small quantities. The drink may be weak broth, or decoctions and infusions of mucilaginous vegetables, as marsh-mallow roots, lime-tree buds, &c. A tea-spoonful of the sweet spirits of nitre, or a drachm of Castile soap, may be frequently put into the patient’s drink; and, if there be no inflammation, he may drink small gin-punch.

Persons subject to a suppression of urine ought to live very temperate. Their diet should be light, and their liquor diluting. They should avoid all acids and austere wines, should take sufficient exercise, lie hard, and avoid study and sedentary occupations.

OF THE GRAVEL AND STONE.

When small stones are lodged in the kidneys, or discharged along with the urine, the patient is said to be afflicted with the gravel. If one of these stones happens to make a lodgment in the bladder for some time, it accumulates fresh matter, and at length becomes too large to pass off with the urine. In this case the patient is said to have the stone.

CAUSES.——The stone and gravel may be occasioned by high living; the use of strong astringent wines; a sedentary life; lying too hot, soft, or too much on the back; the constant use of water impregnated with earthy or stony particles; aliments of an astringent or windy nature, &c. It may likewise proceed from an hereditary disposition. Persons in the decline of life, and those who have been much afflicted with the gout or rheumatism, are most liable to it.

SYMPTOMS.——Small stones or gravel in the kidneys occasion pain in the loins; sickness; vomiting; and sometimes bloody urine. When the stone descends into the ureter, and is too large to pass along with ease, all the above symptoms are increased; the pain extends towards the bladder; the thigh and leg of the affected side are benumbed; the testicles are drawn upwards, and the urine is obstructed.

A stone in the bladder is known from a pain, at the time, as well as before and after making water; from the urine coming away by drops, or stopping suddenly when it was running in a full stream; by a violent pain in the neck of the bladder upon motion, especially on horseback, or in a carriage on a rough road; from a white, thick, copious, stinking, mucous sediment in the urine; from an itching in the top of the penis; from bloody urine; from an inclination to go to stool during the discharge of urine; from the patient’s passing his urine more easily when lying than in an erect posture; from a kind of convulsive motion occasioned by the sharp pain in discharging the last drops of the urine; and lastly, from sounding or searching with the catheter.

REGIMEN.——Persons afflicted with the gravel or stone should avoid aliments of a windy or heating nature, as salt meats, sour fruits, &c. Their diet ought chiefly to consist of such things as tend to promote the secretion of urine, and to keep the body open. Artichokes, asparagus, spinnage, lettuce, parsley, succory, purslane, turnips, potatoes, carrots, and radishes, may be safely eaten. Onions, leeks, and celery are, in this case, reckoned medicinal. The most proper drinks are whey, butter-milk, milk and water, barley-water; decoctions or infusions of the roots of marsh-mallows, parsley, liquorice, or of other mild mucilaginous vegetables, as linseed, lime-tree buds or leaves, &c. If the patient has been accustomed to generous liquors, he may drink small gin-punch.

Gentle exercise is proper; but violent motion is apt to occasion bloody urine. We would therefore advise that it should be taken in moderation. Persons afflicted with gravel often pass a great number of stones after riding on horseback, or in a carriage; but those who have a stone in the bladder are seldom able to bear these kinds of exercise. Where there is a hereditary tendency to this disease, a sedentary life ought never to be indulged. Were people careful, upon the first symptoms of gravel, to observe a proper regimen of diet, and to take sufficient exercise, it might often be carried off, or at least prevented from increasing; but if the same course which occasioned the disease is persisted in, it must be aggravated.

MEDICINE.——In what is called a fit of the gravel, which is commonly occasioned by a stone sticking in the ureter or some part of the urinary passages, the patient must be bled, warm fomentations should likewise be applied to the part affected, emollient clysters administered, and diluting mucilaginous liquors drank, &c. The treatment of this case has been fully pointed out under the articles, inflammation of the kidneys and bladder, to which we refer.

Dr. Whytt advises patients who are subject to frequent fits of gravel in the kidneys, but have no stone in the bladder, to drink every morning, two or three hours before breakfast, an English pint of oyster or cockle-shell lime-water. The Doctor very justly observes, that though this quantity might be too small to have any sensible effect in dissolving a stone in the bladder, yet it may very probably prevent its growth.

When a stone is formed in the bladder, the Doctor recommends Alicant soap, and oyster or cockle-shell lime-water[124], to be taken in the following manner: The patient must swallow every day, in any form that is least disagreeable, an ounce of the internal part of Alicant soap, and drink three or four English pints of oyster or cockle shell lime-water. The soap is to be divided into three doses; the largest to be taken fasting in the morning early; the second at noon; and the third at seven in the evening; drinking above each dose a large draught of the lime-water; the remainder of which he may take any time betwixt dinner and supper, instead of other liquors.

The patient should begin with a smaller quantity of the lime-water and soap than that mentioned above; at first an English pint of the former, and three drachms of the latter, may be taken daily. This quantity, however, he may increase by degrees, and ought to persevere in the use of these medicines, especially if he finds any abatement of his complaints, for several months; nay, if the stone be very large, for years. It may likewise be proper for the patient, if he be severely pained, not only to begin with the soap and lime-water in small quantities, but to take the second or third lime-water instead of the first. However, after he has been for some time accustomed to these medicines, he may not only take the first water, but, if he finds he can easily bear it, heighten its dissolving power still more by pouring it a second time on fresh calcined shells.

The caustic alkali, or soap-lees, is the medicine chiefly in vogue at present for the stone. It is of a very acrid nature, and ought therefore to be given in some gelatinous or mucilaginous liquor; as veal-broth, new milk, linseed-tea, a solution of gum-arabic, or a decoction of marsh-mallow roots. The patient must begin with small doses of the lees, as thirty or forty drops, and increase by degrees, as far as the stomach can bear it[125].

Though the soap-lees and lime-water are the most powerful medicines which have hitherto been discovered for the stone; yet there are some things of a more simple nature, which in certain cases are found to be beneficial, and therefore deserve a trial. An infusion of the seeds of daucus sylvestris, or wild carrot, sweetened with honey, has been found to give considerable ease in cases where the stomach could not bear any thing of an acrid nature. A decoction of raw coffee berries taken morning and evening, to the quantity of eight or ten ounces, with ten drops of sweet spirit of nitre, has likewise been found very efficacious in bringing away large quantities of earthy matter in flakes. Honey is likewise found to be of considerable service, and may be taken in gruel, or in any other form that is more agreeable.

The only other medicine which we shall mention is the uva ursi. It has been greatly extolled of late both for the gravel and stone. It seems however to be in all respects inferior to the soap and lime-water; but it is less disagreeable, and has frequently, to my knowledge, relieved gravelly complaints. It is generally taken in powder from half a drachm to a whole drachm, two or three times a day. It may however be taken to the quantity of seven or eight drachms a day, with great safety and good effect.

CHAP. XXXIII. OF INVOLUNTARY DISCHARGES OF BLOOD.

Spontaneous or involuntary discharges of blood, often happen from various parts of the body. These however are so far from being always dangerous, that they often prove salutary. When such discharges are critical, which is frequently the case in fevers, they ought not to be stopped. Nor indeed is it proper at any time to stop them, unless they be so great as to endanger the patient’s life. Most people, afraid of the smallest discharge of blood from any part of the body, fly immediately to the use of styptic and astringent medicines, by which means an inflammation of the brain, or some other fatal disease, is occasioned, which, had the discharge been allowed to go on, might have been prevented.

Periodical discharges of blood, from whatever part of the body they proceed, must not be stopped. They are always the efforts of Nature to relieve herself; and fatal diseases have often been the consequence of obstructing them. It may indeed be sometimes necessary to check the violence of such discharges; but even this requires the greatest caution. Instances might be given where the stopping of a small periodical flux of blood, from one of the fingers, has proved fatal.

In the early period of life, bleeding at the nose is very common. Those who are farther advanced in years are more liable to hæmoptoe, or discharge of blood from the lungs. After the middle period of life, hæmorrhoidal fluxes are most common; and in the decline of life, discharges of blood from the urinary passages.

Involuntary fluxes of blood may proceed from very different, and often from quite opposite causes. Sometimes they are owing to a particular construction of the body, as a sanguine temperament, a laxity of the vessels, a plethoric habit, &c. At other times they proceed from a determination of the blood towards one particular part, as the head, the hæmorrhoidal veins, &c. They may likewise proceed from an inflammatory disposition of the blood, in which case there is generally some degree of fever: this likewise happens when the flux is occasioned by an obstructed perspiration, or a stricture upon the skin, the bowels, or any particular part of the system.

But a dissolved state of the blood will likewise occasion hæmorrhages. Thus, in putrid fevers, the dysentery, the scurvy, the malignant small-pox, &c. there are often very great discharges of blood from different parts of the body. They may likewise be brought on by too liberal an use of medicines which tend to dissolve the blood, as cantharides, the volatile alkaline salts, &c. Food of an acrid or irritating quality may likewise occasion hæmorrhages; as also strong purges and vomits, or any thing that greatly stimulates the bowels.

Violent passions or agitations of the mind will likewise have this effect. These often cause bleeding at the nose, and I have known them sometimes occasion an hæmorrhage in the brain. Violent efforts of the body, by overstraining or hurting the vessels, may have the same effect, especially when the body is long kept in an unnatural posture, as hanging the head very low, &c.

The cure of an hæmorrhage must be adapted to its cause. When it proceeds from too much blood, or a tendency to inflammation, bleeding, with gentle purges, and other evacuations, will be necessary. It will likewise be proper for the patient in this case to live chiefly upon a vegetable diet, to avoid all strong liquors, and food that is of an acrid, hot, or stimulating quality. The body should be kept cool, and the mind easy.

When an hæmorrhage is owing to a putrid or dissolved state of the blood, the patient ought to live chiefly upon acid fruits with milk, and vegetables of a nourishing nature, as sago, salop, &c. His drink may be wine diluted with water, and sharpened with the juice of lemon, vinegar, or spirits of vitriol. The best medicine in this case is the Peruvian bark, which may be taken according to the urgency of the symptoms.

When a flux of blood is the effect of acrid food, or of strong stimulating medicines, the cure is to be effected by soft and mucilaginous diet. The patient may likewise take frequently about the bulk of a nutmeg of Locatelli’s balsam, or the same quantity of sperma-ceti.

When an obstructed perspiration, or a stricture upon any part of the system, is the cause of an hæmorrhage, it may be removed by drinking warm diluting liquors, lying a-bed, bathing the extremities in warm water, &c.

OF BLEEDING AT THE NOSE.

Bleeding at the nose is commonly preceded by some degree of quickness of the pulse, flushing in the face, pulsation of the temporal arteries, heaviness in the head, dimness of the sight, heat and itching of the nostrils, &c.

To persons who abound with blood this discharge is very salutary. It often cures a vertigo, the head-ach, a phrenzy, and even an epilepsy. In fevers, where there is a great determination of blood towards the head, it is of the utmost service. It is likewise beneficial in inflammations of the liver and spleen, and often in the gout and rheumatism. In all diseases where bleeding is necessary, a spontaneous discharge of blood from the nose is of much more service than the same quantity let with a lancet.

In a discharge of blood from the nose, the great point is to determine whether it ought to be stopped or not. It is a common practice to stop the bleeding, without considering whether it be a disease, or the cure of a disease. This conduct proceeds from fear; but it has often bad, and sometimes fatal consequences.

When a discharge of blood from the nose happens in an inflammatory disease, there is always reason to believe that it may prove salutary; and therefore it should be suffered to go on, at least as long as the patient is not weakened by it.

When it happens to persons in perfect health, who are full of blood, it ought not to be suddenly stopped, especially if the symptoms of plethora, mentioned above, have preceded it. In this case it cannot be stopped without risking the patient’s life.

In fine, whenever bleeding at the nose relieves any bad symptom, and does not proceed so far as to endanger the patient’s life, it ought not to be stopped. But when it returns frequently, or continues till the pulse becomes low, the extremities begin to grow cold, the lips pale, or the patient complains of being sick or faint, it must immediately be stopped.

For this purpose the patient should be set nearly upright, with his head reclining a little, and his legs immersed in water about the warmth of new milk. His hands ought likewise to be put in lukewarm water, and his garters may be tied a little tighter than usual. Ligatures may be applied to the arms, about the place where they are usually made for bleeding, and with nearly the same degree of tightness. These must be gradually slackened as the blood begins to stop, and removed entirely as soon as it gives over.

Sometimes dry lint put up the nostrils will stop the bleeding. When this does not succeed, dossils of lint dipped in strong spirits of wine, may be put up the nostrils, or if that cannot be had, they may be dipped in brandy. Blue vitriol dissolved in water may likewise be used for this purpose, or a tent dipped in the white of an egg beat up, may be rolled in a powder made of equal parts of white sugar, burnt allum, and white vitriol, and put up the nostril from whence the blood issues.

Internal medicines can hardly be of use here, as they have seldom time to operate. It may not however be amiss to give the patient half an ounce of Glauber’s salt, and the same quantity of manna, dissolved in four or five ounces of barley-water. This may be taken at a draught, and repeated, if it does not operate, in a few hours. Ten or twelve grains of nitre may be taken in a glass of cold water and vinegar every hour, or oftner, if the stomach will bear it. If a stronger medicine be necessary, a tea-cupful of the tincture of roses, with twenty or thirty drops of the weak spirit of vitriol, may be taken every hour. When these things cannot be had, the patient may drink water, with a little common salt in it, or equal parts of water and vinegar.

If the genitals be immersed for some time in cold water, it will generally stop a bleeding at the nose. I have not known this fail.

Sometimes, when the bleeding is stopped outwardly, it continues inwardly. This is very troublesome, and requires particular attention, as the patient is apt to be suffocated with the blood, especially if he falls asleep, which he is very ready to do after losing a great quantity of blood.

When the patient is in danger of suffocation from the blood getting into his throat, the passages may be stopped by drawing threads up the nostrils, and bringing them out at the mouth, then fastening pieces of spunge, or small rolls of linen cloth to their extremities; afterwards drawing them back, and tying them on the outside with a sufficient degree of tightness.

After the bleeding is stopped, the patient ought to be kept as easy and quiet as possible. He should not pick his nose, nor take away the tents or clotted blood, till they fall off of their own accord, and should not lie with his head low.

Those who are affected with frequent bleeding at the nose ought to bathe their feet often in warm water, and to keep them warm and dry. They ought to wear nothing tight about their necks, to keep their body as much in an erect posture as possible, and never to view any object obliquely. If they have too much blood, a vegetable diet, with now and then a cooling purge, is the safest way to lessen it.

But when the disease proceeds from a thin dissolved flare of the blood, the diet should be rich and nourishing; as strong broths and jellies, sago-gruel with wine and sugar, &c. Infusions of the Peruvian bark in wine ought likewise to be taken and persisted in for a considerable time.

OF THE BLEEDING AND BLIND PILES.

A discharge of blood from the hæmorrhoidal vessels is called the bleeding piles. When the vessels only swell, and discharge no blood, but are exceeding painful, the disease is called the blind piles.

Persons of a loose spungy fibre, of a bulky size, who live high, and lead a sedentary inactive life, are most subject to this disease. It is often owing to a hereditary disposition. Where this is the case, it attacks persons more early in life than when it is accidental. Men are more liable to it than women, especially those of a sanguine, plethoric, or a scorbutic habit, or of a melancholy disposition.

The piles may be occasioned by an excess of blood, by strong aloetic purges, high-seasoned food, drinking great quantities of sweet wines, the neglect of bleeding, or other customary evacuations, much riding, great costiveness, or any thing that occasions hard or difficult stools. Anger, grief, or other violent passions, will likewise occasion the piles. I have often known them brought on by sitting on the damp ground. A pair of thin breeches will excite the disorder in a person who is subject to it, and sometimes even in those who never had it before. Pregnant women are often afflicted with the piles.

A flux of blood from the anus is not always to be treated as a disease. It is even more salutary than bleeding at the nose, and often prevents or carries off diseases. It is peculiarly beneficial in the gout, rheumatism, asthma, and hypochondriacal complaints, and often proves critical in colics, and inflammatory fevers.

In the management of the patient, regard must be had to his habit of body, his age, strength, and manner of living. A discharge which might be excessive and prove hurtful to one, may be very moderate, and even salutary to another. That only is to be esteemed dangerous which continues too long, and is in such quantity as to waste the patient’s strength, hurt the digestion, nutrition, and other functions necessary to life.

When this is the case, the discharge must be checked by a proper regimen, and astringent medicines. The DIET must be cool but nourishing, consisting chiefly of bread, milk, cooling vegetables and broths. The drink may be chalybeate water, orange-whey, decoctions or infusions of the astringent and mucilaginous plants, as the tormentil root, bistort, the marsh-mallow-roots, &c.

Old conserve of red roses is a very good medicine in this case. It may be mixed with new milk, and taken in the quantity of an ounce three or four times a-day. This medicine is in no great repute, owing to its being seldom taken in such quantity as to produce any effects; but when taken as here directed, and duly persisted in, I have known it perform very extraordinary cures in violent hæmorrhages, especially when assisted by the tincture of roses; a tea-cupful of which may be taken about an hour after every dose of the conserve.

The Peruvian bark is likewise proper in this case, both as a strengthener and astringent. Half a drachm of it may be taken in a glass of red-wine, sharpened with a few drops of the elixir of vitriol, three or four times a-day.

The bleeding piles are sometimes periodical, and return regularly once a month, or once in three weeks. In this case they are always to be considered as a salutary discharge, and by no means to be stopped. Some have entirely ruined their health by stopping a periodical discharge of blood from the hæmorrhoidal veins.

In the blind piles bleeding is generally of use. The diet must be light and thin, and the drink cool and diluting. It is likewise necessary that the body be kept gently open. This may be done by small doses of the flowers of brimstone and cream of tartar. These may be mixed in equal quantities, and a tea-spoonful taken two or three times a-day, or oftner if necessary. Or an ounce of the flowers of brimstone and half an ounce of purified nitre may be mixed with three or four ounces of the lenitive electuary, and a tea-spoonful of it taken three or four times a-day.

Emollient clysters are here likewise beneficial; but there is sometimes such an astriction of the anus, that they cannot be thrown up. In this case I have known a vomit have a very good effect.

When the piles are exceeding painful and swelled, but discharge nothing, the patient must sit over the steams of warm water. He may likewise apply a linen cloth dipped in warm spirits of wine to the part, or poultices made of bread and milk, or of leeks fried with butter. If these do not produce a discharge, and the piles appear large, leeches must be applied as near them as possible, or, if they will fix upon the piles themselves, so much the better. When leeches will not fix, the piles may be opened with a lancet. The operation is very easy, and is attended with no danger.

Various ointments, and other external applications, are recommended in the piles; but I do not remember to have seen any effects from these worth mentioning. Their principal use is to keep the part moist, which may be done as well by a soft poultice, or an emollient cataplasm. When the pain however is very great, a liniment made of two ounces of emollient ointment, and half an ounce of liquid laudanum, beat up with the yolk of an egg, may be applied.

SPITTING OF BLOOD.

We mean here to treat of that discharge of blood from the lungs only which is called an hæmoptoe, or spitting of blood. Persons of a slender make, and a lax fibre, who have long necks and strait breasts, are most liable to this disease. It is most common in the spring, and generally attacks people before they arrive at the prime or middle period of life. It is a common observation, that those who have been subject to bleeding at the nose when young, are afterwards most liable to an hæmoptoe.

CAUSES.——An hæmoptoe may proceed from excess of blood, from a peculiar weakness of the lungs, or a bad conformation of the breast. It is often occasioned by excessive drinking, running, wrestling, singing, or speaking aloud. Such as have weak lungs ought to avoid all violent exertions of that organ, as they value life. They should likewise guard against violent passions, excessive drinking, and every thing that occasions a rapid circulation of the blood.

This disease may likewise proceed from wounds of the lungs. These may either be received from without, or they may be occasioned by hard bodies getting into the wind-pipe, and so falling down upon the lungs, and hurting that tender organ. The obstruction of any customary evacuation may occasion a spitting of blood; as neglect of bleeding or purging at the usual seasons, the stoppage of the bleeding piles in men, or the menses in women, &c. It may likewise proceed from a polypus, scirrhous concretions, or any thing that obstructs the circulation of the blood in the lungs. It is often the effect of a long and violent cough; in which case it is generally the forerunner of a consumption. A violent degree of cold suddenly applied to the external parts of the body will occasion an hæmoptoe. It may likewise be occasioned by breathing air which is too much rarified to be able properly to expand the lungs. This is often the case with those who work in hot places, as furnaces, glasshouses, or the like. It is likewise said to happen to such as ascend to the top of very high mountains, as the Peak of Teneriff, &c.

Spitting of blood is not always to be considered as a primary disease. It is often only a symptom, and in some diseases not an unfavourable one. This is the case in pleurisies, peripneumonies, and sundry other fevers. In a dropsy, scurvy, or consumption, it is a bad symptom, and shews that the lungs are ulcerated.

SYMPTOMS.——Spitting of blood is generally preceded by a sense of weight, and oppression of the breast, a dry tickling cough, hoarseness, and a difficulty of breathing. Sometimes it is ushered in with shivering coldness of the extremities, costiveness, great lassitude, flatulence, pain of the back and loins, &c. As these shew a general stricture upon the vessels, and a tendency of the blood to inflammation, they are commonly the forerunners of a very copious discharge. The above symptoms do not attend a discharge of blood from the gums or fauces, by which means these may always be distinguished from an hæmoptoe. Sometimes the blood that is spit up is thin, and of a florid red colour; and at other times it is thick, and of a dark or blackish colour; nothing however can be inferred from this circumstance, but that the blood has lain a longer or shorter time in the breast before it was discharged.

Spitting of blood, in a strong healthy person, of a sound constitution, is not very dangerous; but when it attacks the tender and delicate, or persons of a weak lax fibre, it is with difficulty removed. When it proceeds from a scirrhus or polypus of the lungs, it is bad. The danger is greater when the discharge proceeds from the rupture of a large vessel than of a small one. When the extravasated blood is not spit up, but lodges in the breast, it corrupts, and greatly increases the danger. When the blood proceeds from an ulcer in the lungs, it is generally fatal.

REGIMEN.——The patient ought to be kept cool and easy. Every thing that heats the body or quickens the circulation, increases the danger. The mind ought likewise to be soothed, and every occasion of exciting the passions avoided. The diet should be soft, cooling, and slender; as rice boiled with milk, small broths, barley-gruels, panado, &c. The diet, in this case, can scarce be too low. Even water-gruel is sufficient to support the patient for some days. All strong liquors must be avoided. The patient may drink milk and water, barley-water, whey, butter-milk, and such like. Every thing however should be drank cold, and in small quantities at a time. He should observe the strictest silence, or at least speak with a very low voice.

MEDICINE.——This, like the other involuntary discharges of blood, ought not to be suddenly stopped by astringent medicines. More mischief is often done by these than if it were suffered to go on. It may however proceed so far as to weaken the patient, and even endanger his life; in which case proper means must be used for restraining it.

The body should be kept gently open by laxative diet; as roasted apples, stewed prunes, and such like. If these should not have the desired effect, a tea-spoonful of the lenitive electuary may be taken twice or thrice a-day, as is found necessary. If the bleeding proves violent, ligatures may be applied to the extremities, as directed for a bleeding at the nose.

If the patient be hot or feverish, bleeding and small doses of nitre will be of use; a scruple or half a drachm of nitre may be taken in a cup of his ordinary drink twice or thrice a-day. His drink may likewise be sharpened with acids, as juice of lemon, or a few drops of the spirit of vitriol; or he may take frequently a cup of the tincture of roses.

Bathing the feet and legs in lukewarm water has likewise a very good effect in this disease. Opiates too are sometimes beneficial; but these must be administered with caution. Ten or twelve drops of laudanum may be given in a cup of barley-water twice a-day, and continued for some time, provided they be found beneficial.

The conserve of roses is likewise a very good medicine in this case, provided it be taken in sufficient quantity, and long enough persisted in. It may be taken to the quantity of three or four ounces a-day; and, if the patient be troubled with a cough, it should be made into an electuary with balsamic syrup, and a little of the syrup of poppies.

If stronger astringents be necessary, fifteen or twenty drops of the elixir of vitriol may be given in a glass of water three or four times a-day.

Those who are subject to frequent returns of this disease should avoid all excess. Their diet should be light and cool, consisting chiefly of milk and vegetables. Above all, let them beware of vigorous efforts of the body, and violent agitations of the mind.

VOMITING OF BLOOD.

This is not so common as the other discharges of blood which have already been mentioned; but it is very dangerous, and requires particular attention.

Vomiting of blood is generally preceded by pain of the stomach, sickness, and nausea; and is accompanied with great anxiety, and frequent fainting fits.

This disease is sometimes periodical; in which case it is less dangerous. It often proceeds from an obstruction of the menses in women; and sometimes from the stopping of the hæmorrhoidal flux in men. It may be occasioned by any thing that greatly stimulates or wounds the stomach, as strong vomits or purges, acrid poisons, sharp or hard substances taken into the stomach, &c. It is often the effect of obstructions in the liver, the spleen, or some of the other viscera. It may likewise proceed from external violence, as blows or bruises, or from any of the causes which produce inflammation. In hysteric women, vomiting of blood is a very common, but by no means a dangerous symptom.

A great part of the danger in this disease arises from the extravasated blood lodging in the bowels, and becoming putrid, by which means a dysentery or putrid fever may be occasioned. The best way of preventing this, is to keep the body gently open, by frequently exhibiting emollient clysters. Purges must not be given till the discharge is stopt, otherwise they will irritate the stomach, and increase the disorder. All the food and drink must be of a mild cooling nature, and taken in small quantities. Even drinking cold water has sometimes proved a remedy, but it will succeed better when sharpened with the weak spirits of vitriol. When there are signs of an inflammation, bleeding may be necessary; but the patient’s weakness will seldom permit it. Opiates may be of use; but they must be given in very small doses, as four or five drops of liquid laudanum twice or thrice a-day.

After the discharge is over, as the patient is generally troubled with gripes, occasioned by the acrimony of the blood lodged in the intestines, gentle purges will be necessary.

OF BLOODY URINE.

This is a discharge of blood from the vessels of the kidneys or bladder, occasioned by their being either enlarged, broken, or eroded. It is more or less dangerous according to the different circumstances which attend it.

When pure blood is voided suddenly without interruption and without pain, it proceeds from the kidneys; but if the blood be in small quantity, of a dark colour, and emitted with heat and pain about the bottom of the belly, it proceeds from the bladder. When bloody urine is occasioned by a rough stone descending from the kidneys to the bladder, which wounds the ureters, it is attended with a sharp pain in the back, and difficulty of making water. If the coats of the bladder are hurt by a stone, and the bloody urine follows, it is attended with the most acute pain, and a previous stoppage of urine.

Bloody urine may likewise be occasioned by falls, blows, the lifting or carrying of heavy burdens, hard riding, or any violent motion. It may also proceed from ulcers of the bladder, from a stone lodged in the kidneys, or from violent purges, or sharp diuretic medicines, especially cantharides.

Bloody urine is always attended with some degree of danger: but it is peculiarly so when mixed with purulent matter, as this shews an ulcer somewhere in the urinary passages. Sometimes this discharge proceeds from excess of blood, in which case it is rather to be considered as a salutary evacuation than a disease. If the discharge however be very great, it may waste the patient’s strength, and occasion an ill habit of body, a dropsy, or a consumption.

The treatment of this disorder must be varied according to the different causes from which it proceeds.

When it is owing to a stone in the bladder, the cure depends upon an operation; a description of which would be foreign to our purpose.

If it be attended with a plethora, and symptoms of inflammation, bleeding will be necessary. The body must likewise be kept open by emollient clysters, or cooling purgative medicines; as cream of tartar, rhubarb, manna, or small doses of lenitive electuary.

When bloody urine proceeds from a dissolved state of the blood, it is commonly the symptom of some malignant disease; as the small-pox, a putrid fever, or the like. In this case the patient’s life depends on the liberal use of the Peruvian bark and acids, as has already been shewn.

When there is reason to suspect an ulcer in the kidneys or bladder, the patient’s diet must be cool, and his drink of a soft, healing, balsamic quality, as decoctions of marsh-mallow roots with liquorice, solutions of gum-arabic, &c. Three ounces of marsh-mallow roots, and half an ounce of liquorice, may be boiled in two English quarts of water to one; two ounces of gum-arabic, and half an ounce of purified nitre, may be dissolved in the strained liquor, and a tea-cupful of it taken four or five times a-day.

The early use of astringents in this disease has often bad consequences. When the flux is stopped too soon, the grumous blood, by being confined in the vessels, may produce inflammations, abscess, and ulcers. If however the case be urgent, or the patient seems to suffer from the loss of blood, gentle astringents may be necessary. In this case the patient may take three or four ounces of lime-water, with half an ounce of the tincture of Peruvian bark, three times a-day.

OF THE DYSENTERY, OR BLOODY FLUX.

This disease prevails in the spring and autumn. It is most common in marshy countries, where, after hot and dry summers, it is apt to become epidemic. Persons are most liable to it who are much exposed to the night-air, or who live in places where the air is confined and unwholesome. Hence it often proves fatal in camps, on shipboard, in jails, hospitals, and such like places.

CAUSES.——The dysentery may be occasioned by any thing that obstructs the perforation, or renders the humours putrid; as damp beds, wet clothes, unwholesome diet, air, &c. But it is most frequently communicated by infection. This ought to make people extremely cautious in going near such persons as labour under the disease. Even the smell of the patient’s excrements has been known to communicate the infection.

SYMPTOMS.——It is known by a flux of the belly, attended with violent pain of the bowels, a constant inclination to go to stool, and generally more or less blood in the stools. It begins, like other fevers, with chillness, loss of strength, a quick pulse, great thirst, and an inclination to vomit. The stools are at first greasy and frothy, afterwards they are streaked with blood, and at last have frequently the appearance of pure blood, mixed with small filaments resembling bits of skin. Worms are sometimes passed both upwards and downwards through the whole course of the disease. When the patient goes to stool, he feels a bearing down, as if the whole bowels were falling out, and sometimes a part of the intestine is actually protruded, which proves exceeding troublesome, especially in children. Flatulency is likewise a troublesome symptom, especially towards the end of the disease.

This disease may be distinguished from a diarrhœa or looseness, by the acute pain of the bowels, and the blood which generally appears in the stools. It may be distinguished from the cholera morbus by its not being attended with such violent and frequent fits of vomiting, &c.

When the dysentery attacks the old, the delicate, or such as have been wasted by the gout, the scurvy, or other lingering diseases, it generally proves fatal. Vomiting and hiccuping are bad signs, as they shew an inflammation of the stomach. When the stools are green, black, or have an exceeding disagreeable cadaverous smell, the danger is very great, as it shows the disease to be of the putrid kind. It is an unfavourable symptom when clysters are immediately returned; but still more so, when the passage is so obstinately shut, that they cannot be injected. A feeble pulse, coldness of the extremities, with difficulty of swallowing, and convulsions, are signs of approaching death.

REGIMEN.——Nothing is of more importance in this disease than cleanliness. It contributes greatly to the recovery of the patient, and no less to the safety of such as attend him. In all contagious diseases the danger is increased, and the infection spread, by the neglect of cleanliness, but in no one more than this. Every thing about the patient should be frequently changed. The excrements should never be suffered to continue in his chamber, but removed immediately, and buried under ground. A constant stream of fresh air should be admitted into the chamber; and it ought frequently to be sprinkled with vinegar, juice of lemon, or some other strong acid.

The patient must not be discouraged, but his spirits kept up in hopes of a cure. Nothing tends more to render any putrid disease mortal, than the fears and apprehensions of the sick. All diseases of this nature have a tendency to sink and depress the spirits, and when that is increased by fears and alarms from those whom the patient believes to be persons of skill, it cannot fail to have the worst effects.

A flannel waistcoat worn next the skin has often a very good effect in the dysentery. This promotes the perspiration without overheating the body. Great caution however is necessary in leaving it off. I have often known a dysentery brought on by imprudently throwing off a flannel waistcoat before the season was sufficiently warm. For whatever purpose this piece of dress is worn, it should never be left off but in a warm season.

In this disease the greatest attention must be paid to the patient’s diet. Flesh, fish, and every thing that has a tendency to turn putrid or rancid on the stomach, must be abstained from. Apples boiled in milk, water-pap, and plain light pudding, with broth made of the gelatinous parts of animals, may constitute the principal part of the patient’s food. Gelatinous broth not only answers the purpose of food, but likewise of medicine. I have often known dysenteries, which were not of a putrid nature, cured by it after pompous medicines had proved ineffectual[126].

Another kind of food very proper in the dysentery, which may be used by such as cannot take the broth mentioned above, is made by boiling a few handfuls of fine flour, tied in a cloth, for six or seven hours, till it becomes as hard as starch. Two or three table-spoonfuls of this may be grated down, and boiled in such a quantity of new milk and water as to be of the thickness of pap. This may be sweetened to the patient’s taste, and taken for his ordinary food[127].

In a putrid dysentery the patient may be allowed to eat freely of most kinds of good ripe fruit; as apples, grapes, gooseberries, currant-berries, strawberries, &c. These may either be eaten raw or boiled, with or without milk, as the patient chuses. The prejudice against fruit in this disease is so great, that many believe it to be the common cause of dysenteries. This however is an egregious mistake. Both reason and experience shew, that good fruit is one of the best medicines, both for the prevention and cure of the dysentery. Good fruit is in every respect calculated to counteract that tendency to putrefaction, from whence the most dangerous kind of dysentery proceeds. The patient in such a case ought therefore be allowed to eat as much fruit as he pleases, provided it be ripe[128].

The most proper drink in this disorder is whey. The dysentery has often been cured by the use of clear whey alone. It may be taken both for drink and in form of clyster. When whey cannot be had, barley-water sharpened with cream of tartar may be drank, or a decoction of barley and tamarinds; two ounces of the former and one of the latter may be boiled in two English quarts of water to one. Warm water, water-gruel, or water wherein hot iron has been frequently quenched, are all very proper, and may be drank in turns. Camomile-tea, if the stomach will bear it, is an exceeding proper drink. It both strengthens the stomach, and by its antiseptic quality tends to prevent a mortification of the bowels.

MEDICINE.——At the beginning of this disease it is always necessary to cleanse the first passages. For this purpose a vomit of ipecacuanha must be given, and wrought off with weak camomile-tea. Strong vomits are seldom necessary here. A scruple, or at most half a drachm of ipecacuanha, is generally sufficient for an adult, and sometimes a very few grains will suffice. The day after the vomit, half a drachm, or two scruples of rhubarb, must be taken; or, what will answer the purpose rather better, an ounce or an ounce and a half of Epsom salts. This dose may be repeated every other day for two or three times. Afterwards small doles of ipecacuanha may be taken for some time. Two or three grains of the powder may be mixed in a table-spoonful of the syrup of poppies, and taken three times a day.

These evacuations, and the regimen prescribed above, will often be sufficient to effect a cure. Should it however happen otherwise, the following astringent medicines may be used.

A clyster of starch or fat mutton-broth, with thirty or forty drops of liquid laudanum in it, may be administered twice a-day. At the same time an ounce of gum-arabic, and half an ounce of gum-tragacanth, may be dissolved in an English pint of barley-water, over a slow fire, and a table-spoonful of it taken every hour.

If these have not the desired effect, the patient may take, four times a-day, about the bulk of a nutmeg of the Japonic confection, drinking after it a tea-cupful of the decoction of logwood[129].

Persons who have been cured of this disease are very liable to suffer a relapse; to prevent which, great circumspection with respect to diet is necessary. The patient must abstain from all fermented liquors, except now and then a glass of good wine; but he must drink no kind of malt-liquor. He should likewise abstain from animal food, as fish and flesh, and live principally on milk and vegetables.

Gentle exercise and wholesome air are likewise of importance. The patient should go to the country as soon as his strength will permit, and should take exercise daily on horseback, or in a carriage. He may likewise use bitters infused in wine or brandy, and may drink twice a-day a gill of lime-water mixed with an equal quantity of new milk.

When dysenteries prevail, we would recommend a strict attention to cleanliness, a spare use of animal food, and the free use of sound ripe fruits, and other vegetables. The night air is to be carefully avoided, and all communication with the sick. Bad smells are likewise to be shunned, especially those which arise from putrid animal substances. The necessaries where the sick go are carefully to be avoided.

When the first symptoms of the dysentery appear, the patient ought immediately to take a vomit, to go to bed, and drink plentifully of weak warm liquor, to promote a sweat. This, with a dose or two of rhubarb at the beginning, would often carry off the disease. In countries where dysenteries prevail, we would advise such as are liable to them, to take either a vomit or a purge every spring or autumn, as a preventive.

There are sundry other fluxes of the belly, as the LIENTERY and CŒLIAC PASSION, which, though less dangerous than the dysentery, yet merit consideration. These diseases generally proceed from a relaxed state of the stomach and intestines, which is sometimes so great, that the food passes through them without almost any sensible alterations; and the patient dies merely from the want of nourishment.

When the lientery or cœliac passion succeeds to a dysentery, the case is bad. They are always dangerous in old age, especially when the constitution has been broken by excess or acute diseases. If the stools be very frequent, and quite crude, the thirst great, with little urine, the mouth ulcerated, and the face marked with spots of different colours, the danger is very great.

The treatment of the patient is in general the same as in the dysentery. In all obstinate fluxes of the belly, the cure must be attempted, by first cleansing the stomach and bowels with gentle vomits and purges; afterwards such a diet as has a tendency to heal and strengthen the bowels, with opiates and astringent medicines, will generally perfect the cure.

The same observation holds with respect to a TENESMUS, or frequent desire of going to stool. This disease resembles the dysentery so much, both in its symptoms and method of cure, that we think it needless to insist upon it.

CHAP. XXXIV. OF THE HEAD-ACH.

Aches and pains proceed from very different causes, and may affect any part of the body; but we shall point out those only which occur most frequently, and are attended with the greatest danger.

When the head-ach is slight, and affects a particular part of the head only, it is called cephalalgia; when the whole head is affected, cephalæa; and when on one side only, hemicrania. A fixed pain in the forehead, which may be covered with the end of the thumb, is called the clavis hystericus.

There are also other distinctions. Sometimes the pain is internal, sometimes external; sometimes it is an original disease, and at other times only symptomatic. When the head-ach proceeds from a hot bilious habit, the pain is very acute and throbbing, with a considerable heat of the part affected. When from a cold phlegmatic habit, the patient complains of a dull heavy pain, and has a sense of coldness in the part. This kind of head-ach is sometimes attended with a degree of stupidity or folly.

Whatever obstructs the free circulation of the blood through the vessels of the head, may occasion a head-ach. In persons of a full habit, who abound with blood, or other humours, the head-ach often proceeds from the suppression of customary evacuations; as bleeding at the nose, sweating of the feet, &c. It may likewise proceed from any cause that determines a great flux of blood towards the head; as coldness of the extremities, or hanging down the head for a long time. Whatever prevents the return of the blood from the head will likewise occasion a head-ach; as looking long obliquely at any object, wearing any thing tight about the neck, or the like.

When a head-ach proceeds from the stoppage of a running at the nose, there is a heavy, obtuse, pressing pain in the fore-part of the head, in which there seems to be such a weight, that the patient can scarce hold it up. When it is occasioned by the caustic matter of the venereal disease, it generally affects the skull, and often produces a caries of the bones.

Sometimes the head-ach proceeds from the repulsion or retrocession of the gout, the erysipelas, the small-pox, measles, itch, or other eruptive diseases. What is called a hemicrania generally proceeds from crudities or indigestion. Inanition, or emptiness, will often also occasion head-achs. I have often seen instances of this in nurses who gave suck too long, or who did not take a sufficient quantity of solid food.

There is likewise a most violent, fixed, constant, and almost intolerable head-ach, which occasions great debility both of body and mind, prevents sleep, destroys the appetite, causes a vertigo, dimness of sight, a noise in the ears, convulsions, epileptic fits, and sometimes vomiting, costiveness, coldness of the extremities, &c.

The head-ach is often symptomatic in continual and intermitting fevers, especially quartans. It is likewise a very common symptom in hysteric and hypochondriac complaints.

When a head-ach attends an acute fever, with pale urine, it is an unfavourable symptom. In excessive head-achs, coldness of the extremities is a bad sign.

When the disease continues long, and is very violent, it often terminates in blindness, an apoplexy, deafness, a vertigo, the palsy, epilepsy, &c.

In this disease the cool regimen in general is to be observed. The diet ought to consist of such emollient substances as will correct the acrimony of the humours, and keep the body open; as apples boiled in milk, spinage, turnips, and such like. The drink ought to be diluting; as barley-water, infusions of mild mucilaginous vegetables, decoctions of the sudorific woods, &c. The feet and legs ought to be kept warm, and frequently bathed in lukewarm water; the head should be shaved, and bathed with water and vinegar. The patient ought as much as possible to keep in an erect posture, and not to lie with his head too low.

When the head-ach is owing to excess of blood, or an hot bilious constitution, bleeding is necessary. The patient may be bled in the jugular vein, and the operation repeated if there be occasion. Cupping also, or the application of leeches to the temples, and behind the ears, will be of service. Afterwards a blistering-plaster may be applied to the neck behind the ears, or to any part of the head that is most affected. In some cases it will be proper to blister the whole head. In persons of a gross habit, issues or perpetual blisters will be of service. The body ought likewise to be kept open by gentle laxatives.

But when the head-ach proceeds from a copious vitiated serum stagnating in the membranes, either within or without the skull, with a dull, heavy, continual pain, which will neither yield to bleeding nor gentle laxatives, then more powerful purgatives are necessary, as pills made of aloes, resin of jalap, or the like. It will also be necessary in this case to blister the whole head, and to keep the back part of the neck open for a considerable time by a perpetual blister.

When the head-ach is occasioned by the stoppage of a running at the nose, the patient should frequently smell to a bottle of volatile salts; he may likewise take snuff, or any thing that will irritate the nose, so as to promote a discharge from it; as the herb mastich, ground-ivy, &c.

A hemicrania, especially a periodical one, is generally owing to a foulness of the stomach, for which gentle vomits must be administered, as also purges of rhubarb. After the bowels have been sufficiently cleared, chalybeate waters, and such bitters as strengthen the stomach, will be necessary. A periodical head-ach has been cured by wearing a piece of flannel over the forehead during the night.

When the head-ach arises from a vitiated state of the humours, as in the scurvy and venereal disease, the patient, after proper evacuations, must drink freely of the decoction of woods, or the decoction of sarsaparilla, with raisins and liquorice[130]. These promote perspiration, sweeten the humours, and, if duly persisted in, will produce very happy effects. When a collection of matter is felt under the skin, it must be discharged by an incision, otherwise it will render the bone carious.

When the head-ach is so intolerable as to endanger the patient’s life, or is attended with continual watching, delirium, &c. recourse must be had to opiates. These, after proper evacuations by clysters or mild purgatives, may be applied both externally and internally. The affected part may be rubbed with Bate’s anodyne balsam, or a cloth dipped in it may be applied to the part. The patient may, at the same time, take twenty drops of laudanum, in a cup of valerian or penny-royal tea, twice or thrice a day. This is only to be done in case of extreme pain. Proper evacuations ought always to accompany and follow the use of opiates[131].

When the patient cannot bear the loss of blood, his feet ought frequently to be bathed in lukewarm water, and well rubbed with a coarse cloth. Cataplasms with mustard or horse-radish ought likewise to be applied to them. This course is peculiarly necessary when the pain proceeds from a gouty humour affecting the head.

When the head-ach is occasioned by great heat, hard labour, or violent exercise of any kind, it may be allayed by cooling medicines; as the saline draughts with nitre, and the like.

A little of Ward’s essence, dropt into the palm of the hand, and applied to the forehead, will sometimes remove a violent head-ach; and so will æther, when applied in the same manner.

OF THE TOOTH-ACH.

This disease is so well known, that it needs no description. It has great affinity with the rheumatism, and often succeeds pains of the shoulders and other parts of the body.

It may proceed from obstructed perspiration, or any of the other causes of inflammation. I have often known the tooth-ach occasioned by neglecting some part of the usual coverings of the head, by sitting with the head bare near an open window, or exposing it any how to a draught of cold air. Food or drink taken either too hot or too cold is very hurtful to the teeth. Great quantities of sugar, or other sweetmeats, are likewise hurtful. Nothing is more destructive to the teeth than cracking nuts, or chewing any kind of hard substances. Picking the teeth with pins, needles, or any thing that may hurt the enamel with which they are covered, does great mischief, as the tooth is sure to be spoiled whenever the air gets into it. Breeding women are very subject to the tooth-ach, especially during the first three or four months of pregnancy. The tooth-ach often proceeds from scorbutic humours affecting the gums. In this case the teeth are sometimes wasted, and fall out without any considerable degree of pain. The more immediate cause of the tooth-ach is a rotten or carious tooth.

In order to relieve the tooth-ach, we must first endeavour to lessen the flux of humours to the part affected. This may be done by mild purgatives, scarifying the gums, or applying leeches to them, and bathing the feet frequently with warm water. The perspiration ought likewise to be promoted, by drinking freely of weak wine-whey, or other diluting liquors, with small doses of nitre. Vomits too have often an exceeding good effect in the tooth-ach. It is seldom safe to administer opiates, or any kind of heating medicines, or even to draw a tooth, till proper evacuations have been premised; and these alone will often effect the cure.

If this fails, and the pain and inflammation still increase, a suppuration may be expected, to promote which a toasted fig should be held between the gum and the cheek; bags filled with boiled camomile-flowers, flowers of elder, or the like, may be applied near the part affected, with as great a degree of warmth as the patient can bear, and renewed as they grow cool: the patient may likewise receive the steams of warm water into his mouth, through an inverted funnel, or by holding his head over the mouth of a porringer filled with warm water, &c.

Such things as promote the discharge of saliva, or cause the patient to spit, are generally of service. For this purpose, bitter, hot, or pungent vegetables may be chewed; as gentian, calamus aromaticus, or pellitory of Spain. Allen recommends the root of yellow water flower-de-luce in this case. This root may either be rubbed upon the tooth, or a little of it chewed. Brookes says he hardly ever knew it fail to ease the tooth-ach. It ought however to be used with caution.

Many other herbs, roots, and seeds, are recommended for curing the tooth-ach; as the leaves of roots of millefoil or yarrow chewed, tobacco smoked or chewed, staves-acre, or the seeds of mustard chewed, &c. These bitter, hot, and pungent things, by occasioning a greater flow of saliva, frequently give ease in the tooth-ach.

Opiates often relieve the tooth-ach. For this purpose a little cotton wet with laudanum may be held between the teeth; or a piece of sticking-plaster, about the bigness of a shilling, with a bit of opium in the middle of it, of a size not to prevent the sticking of the other, may be laid on the temporal artery, where the pulsation is most sensible. De la Motte affirms, that there are few cases wherein this will not give relief. If there be a hollow tooth, a small pill made of equal parts of camphire and opium, put into the hollow, is often beneficial. When this cannot be had, the hollow tooth may be filled with gum mastich, wax, lead, or any substance that will stick in it, and keep out the external air.

Few applications give more relief in the tooth-ach than blistering-plasters. These may be applied between the shoulders; but they have the best effect when put behind the ears, and made so large as to cover a great part of the lower jaw.

After all, when a tooth is carious, it is often impossible to remove the pain without extracting it; and, as a spoilt tooth never becomes sound again, it is prudent to draw it soon, lest it should affect the rest. Tooth-drawing, like bleeding, is very much practiced by mechanics, as well as persons of the medical profession. The operation however is not without danger, and ought always to be performed with care. A person unacquainted with the structure of the parts will be in danger of hurting the jaw-bone, or of drawing a sound tooth instead of a rotten one[132].

When the tooth-ach returns periodically, and the pain chiefly affects the gums, it may be cured by the bark.

Some pretend to have found great benefit in the tooth-ach, from the application of an artificial magnet to the affected tooth. We shall not attempt to account for its mode of operation; but, if it be found to answer, though only in particular cases, it certainly deserves a trial, as it is attended with no expence, and cannot do any harm. Electricity has likewise been recommended, and particular instruments have been invented for sending a shock through the affected tooth.

Persons who have returns of the tooth-ach at certain seasons, as spring and autumn, might often prevent it by taking a purge at these times.

Keeping the teeth clean has no doubt a tendency to prevent the tooth-ach. The best method of doing this is to wash them daily with salt and water, a decoction of the bark, or with cold water alone. All brushing and scraping of the teeth is dangerous, and, unless it be performed with great care, does mischief.

OF THE EAR-ACH.

This disorder chiefly affects the membrane which lines the inner cavity of the ear called the meatus auditorius. It is often so violent as to occasion great restlessness, anxiety, and even delirium. Sometimes epileptic fits, and other convulsive disorders, have been brought on by extreme pain in the ear.

The ear-ach may proceed from any of the causes which produce inflammation. It often proceeds from a sudden suppression of perspiration, or from the head being exposed to cold when covered with sweat. It may also be occasioned by worms, or other insects getting into the ear, or being bred there; or from any hard body sticking in the ear. Sometimes it proceeds from the translation of morbific matter to the ear. This often happens in the decline of malignant fevers, and occasions deafness, which is generally reckoned a favourable symptom.

When the ear-ach proceeds from insects, or any hard body sticking in the ear, every method must be taken to remove them as soon as possible. The membranes may be relaxed by dropping into the ear oil of sweet almonds, or olive oil. Afterwards the patient should be made to sneeze, by taking snuff, or some strong sternutatory. If this should not force out the body, it must be extracted by art. I have seen insects, which had got into the ear, come out of their own accord upon pouring in oil, which is a thing they cannot bear.

When the pain of the ear proceeds from inflammation, it must be treated like other topical inflammations, by a cooling regimen, and opening medicines. Bleeding at the beginning, either in the arm or jugular vein, or cupping in the neck, will be proper. The ear may likewise be fomented with steams of warm water; or flannel bags filled with boiled mallows and camomile flowers may be applied to it warm; or bladders filled with warm milk and water. An exceeding good method of fomenting the ear is to apply it close to the mouth of a jug filled with warm water, or a strong decoction of camomile flowers.

The patient’s feet should be frequently bathed in lukewarm water, and he ought to take small doses of nitre and rhubarb, viz. a scruple of the former, and ten grains of the latter, three times a-day. His drink may be whey, or decoction of barley and liquorice with figs or raisins. The parts behind the ear ought frequently to be rubbed with camphorated oil, or a little of the volatile liniment.

When the inflammation cannot be discussed, a poultice of bread and milk, or roasted onions, may be applied to the ear, and frequently renewed, till the abscess breaks, or can be opened. Afterwards the humours may be diverted from the part by gentle laxatives, blisters, or issues; but the discharge must not be suddenly dried up by any external application.

PAIN OF THE STOMACH, &c.

This may proceed from various causes; as indigestion; wind; the acrimony of the bile; sharp, acrid, or poisonous substances taken into the stomach, &c. It may likewise be occasioned by worms; the stoppage of customary evacuations; a translation of gouty matter to the stomach, the bowels, &c.

Women in the decline of life are very liable to pains of the stomach and bowels, especially such as are afflicted with hysteric complaints. It is likewise very common to hypochondriac men of a sedentary and luxurious life. In such persons it often proves so extremely obstinate as to baffle all the powers of medicine.

When the pain of the stomach is most violent after eating, there is reason to suspect that it proceeds from some fault either in the digestion or the food. In this case the patient ought to change his diet, till he finds what kind of food agrees best with his stomach, and should continue chiefly to use it. If a change of diet does not remove the complaint, the patient may take a gentle vomit, and afterwards a dose or two of rhubarb. He ought likewise to take an infusion of camomile flowers, or some other stomachic bitter, either in wine or water. I have often known exercise remove this complaint, especially sailing, or a long journey on horseback, or in a carriage.

When a pain of the stomach proceeds from flatulency, the patient is constantly belching up wind, and feels an uneasy distention of the stomach after meals. This is a most deplorable disease, and is seldom thoroughly cured. In general, the patient ought to avoid all windy diet, and every thing that sours on the stomach, as greens, roots, &c. This rule however admits of some exceptions. There are many instances of persons very much troubled with wind, who have received great benefit from eating parched pease, though that grain is generally supposed to be of a windy nature[133].

This complaint may likewise be greatly relieved by labour, especially digging, reaping, mowing, or any kind of active employment by which the bowels are alternately compressed and dilated. The most obstinate case of this kind I ever met with was in a person of a sedentary occupation, whom I advised, after he had tried every kind of medicine in vain, to turn gardener; which he did, and has ever since enjoyed good health.

When a pain of the stomach is occasioned by the swallowing of acrid or poisonous substances, they must be discharged by vomit; this may be excited by butter, oils, or other soft things, which sheath and defend the stomach from the acrimony of its contents.

When pain of the stomach proceeds from a translation of gouty matter, warm cordials are necessary, as generous wines, French brandy, &c. Some have drank a whole bottle of brandy or rum, in this case, in a few hours, without being in the least intoxicated, or even feeling the stomach warmed by it. It is impossible to ascertain the quantities necessary upon these occasions. This must be left to the feelings and discretion of the patient. The safer way however is, not to go too far. When there is an inclination to vomit, it may be promoted by drinking an infusion of camomile flowers, or carduus benedictus.

If a pain of the stomach proceed from the stoppage of customary evacuations, bleeding will be necessary, especially in sanguine and very full habits. It will likewise be of use to keep the body gently open by mild purgatives; as rhubarb or senna, &c. When this disease affects women, in the decline of life, after the stoppage of the menses, making an issue in the leg or arm will be of peculiar service.

When the disease is occasioned by worms, they must be destroyed, or expelled by such means as are recommended in the following section.

When the stomach is greatly relaxed and the digestion bad, which often occasion flatulencies, the elixir of vitriol will be of singular service. Fifteen or twenty drops of it may be taken in a glass of wine or water twice or thrice a-day.

Persons afflicted with flatulency are generally unhappy unless they be taking some purgative medicines; these, though they may give immediate ease, tend to weaken and relax the stomach and bowels, and consequently increase the disorder. Their best method is to mix purgatives and stomachics together. Equal parts of Peruvian bark and rhubarb may be infused in brandy or wine, and taken in such quantity as to keep the body gently open.

CHAP. XXXV. OF WORMS.

These are chiefly of three kinds, viz. the tænia, or tape-worm; the teres, or round and long worm; and the ascarides, or round and short worm. There are many other kinds of worms found in the human body; but as they proceed, in a great measure, from similar causes, have nearly the same symptoms, and require almost the same method of treatment as these already mentioned, we shall not spend time in enumerating them.

The tape-worm is white, very long, and full of joints. It is generally bred either in the stomach or small intestines. The round and long worm is likewise bred in the small guts, and sometimes in the stomach. The round and short worms commonly lodge in the rectum, or what is called the end gut, and occasion a disagreeable itching about the seat.

The long round worms occasion squeamishness, vomiting, a disagreeable breath, gripes, looseness, swelling of the belly, swoonings, loathing of food, and at other times a voracious appetite, a dry cough, convulsions, epileptic fits, and sometimes a privation of speech. These worms have been known to perforate the intestines, and get into the cavity of the belly. The effects of the tape-worm are nearly the same with those of the long and round, but rather more violent.

Andry says, the following symptoms particularly attend the solium, which is a species of the tape-worm, viz. swoonings, privation of speech, and a voracious appetite. The round worms called ascarides, besides an itching of the anus, cause swoonings, and tenesmus, or an inclination to go to stool.

CAUSES.——Worms may proceed from various causes; but they are seldom found except in weak and relaxed stomachs, where the digestion is bad. Sedentary persons are more liable to them than the active and laborious. Those who eat great quantities of unripe fruit, or who live much on raw herbs and roots, are generally subject to worms. There seems to be a hereditary disposition in some persons to this disease. I have often seen all the children of a family subject to worms of a particular kind. They seem likewise frequently to be owing to the nurse. Children of the same family, nursed by one woman, have often worms, when those nursed by another have none.

SYMPTOMS.——The common symptoms of worms are, paleness of the countenance, and at other times, an universal flushing of the face; itching of the nose; this however is doubtful, as children pick their noses in all diseases; starting, and grinding of the teeth in sleep; swelling of the upper lip; the appetite sometimes bad, at other times quite voracious; looseness; a sour or stinking breath; a hard swelled belly; great thirst; the urine frothy, and sometimes of a whitish colour; griping, or colic pains; an involuntary discharge of saliva, especially when asleep; frequent pains of the side, with a dry cough, and unequal pulse; palpitations of the heart; swoonings; drowsiness; cold sweats; palsy; epileptic fits, with many other unaccountable nervous symptoms, which were formerly attributed to witchcraft, or the influence of evil spirits. Small bodies in the excrements resembling melon or cucumber seeds are symptoms of the tape-worm.

I lately saw some very surprising effect of worms in a girl about five years of age, who used to lie for whole hours as if dead. She at last expired, and, upon opening her body, a number of the teres, or long round worms, were found in her guts, which were considerably inflamed; and what anatomists call an intus susceptio, or involving of one part of the gut within another, had taken place in no less than four different parts of the intestinal canal[134].

MEDICINE.——Though numberless medicines are extolled for expelling and killing worms[135], yet no disease more frequently baffles the physician’s skill. In general, the most proper medicines for their expulsion are strong purgatives; and to prevent their breeding, stomachic bitters, with now and then a glass of good wine.

The best purge for an adult is jalap and calomel. Five and twenty or thirty grains of the former with six or seven of the latter, mixed in syrup, may be taken early in the morning, for a dose. It will be proper that the patient keep the house all day, and drink nothing cold. The dose may be repeated once or twice a week, for a fortnight or three weeks. On the intermediate days the patient may take a drachm of the powder of tin, twice or thrice a-day, mixed with syrup, honey, or treacle.

Those who do not chuse to take calomel may make use of the bitter purgatives; as aloes, hiera picra, tincture of senna, and rhubarb, &c.

Oily medicines are sometimes found beneficial for expelling worms. An ounce of sallad oil and a table-spoonful of common salt may be taken in a glass of red port wine thrice a-day, or oftner, if the stomach will bear it. But the more common form of using oil is in clysters. Oily clysters, sweetened with sugar or honey, are very efficacious in bringing away the short round worms called ascarides, and likewise the teres.

The Harrowgate water is an excellent medicine for expelling worms, especially the ascarides. As this water is impregnated with sulphur, we may hence infer, that sulphur alone must be a good medicine in this case; which is found to be a fact. Many practitioners give flour of sulphur in very large doses, and with great success. It should be made into an electuary with honey or treacle, and taken in such quantity as to purge the patient.

Where Harrowgate water cannot be obtained, sea-water may be used, which is far from being a contemptible medicine in this case. If sea-water cannot be had, common salt dissolved in water may be drank. I have often seen this used by country nurses with very good effect. Some flour of sulphur may be taken over night, and the salt-water in the morning.

But worms, though expelled, will soon breed again, if the stomach remains weak and relaxed; to prevent which, we would recommend the Peruvian bark. Half a drachm of bark in powder may be taken in a glass of red port wine three or four times a-day, after the above medicines have been used. Lime-water is likewise good for this purpose, or a table-spoonful of the chalybeate wine taken twice or thrice a-day. Infusions or decoctions of bitter herbs may likewise be drank; as the infusion of tansy, water-trefoil, camomile flowers, tops of wormwood, the lesser centaury, &c.

For a child of four or five years old, six grains of rhubarb, five of jalap, and two of calomel, may be mixed in a spoonful of syrup or honey, and given in the morning. The child should keep the house all day, and take nothing cold. This dose may be repeated twice a-week for three or four weeks. On the intermediate days the child may take a scruple of powdered tin and ten grains of æthiops mineral in a spoonful of treacle twice a-day. This dose must be increased or diminished according to the age of the patient.

Bisset says, the great bastard black hellebore, or bear’s foot, is a most powerful vermifuge for the long round worms. He orders the decoction of about a drachm of the green leaves, or about fifteen grains of the dried leaves in powder for a dose to a child between four and seven years of age. This dose is to be repeated two or three times. He adds, that the green leaves made into a syrup with coarse sugar, is almost the only medicine he has used for round worms for three years past. Before pressing out the juice, he moistens the bruised leaves with vinegar, which corrects the medicine. The dose is a tea-spoonful at bed-time, and one or two next morning.

I have frequently known those big bellies, which in children are commonly reckoned a sign of worms, quite removed by giving them white soap in their pottage, or other food. Tansy, garlic, and rue, are all good against worms, and may be used various ways. We might here mention many other plants, both for external and internal use, as the cabbage-bark, &c. but think the powder of tin with æthiops mineral, and the purges of rhubarb and calomel, are more to be depended on.

Ball’s purging vermifuge powder is a very powerful medicine. It is made of equal parts of rhubarb, seammony, and calomel, with as much double refined sugar as is equal to the weight of all the other ingredients. These must be well mixed together, and reduced to a fine powder. The dose for a child is from ten grains to twenty, once or twice a-week. An adult may take a drachm for a dose[136].

Parents who would preserve their children from worms ought to allow them plenty of exercise in the open air; to take care that their food be wholesome and sufficiently solid; and, as far as possible, to prevent their eating raw herbs, roots, or green trashy fruits. It will not be amiss to allow a child who is subject to worms, a glass of red wine after meals; as every thing that braces and strengthens the stomach is good both for preventing and expelling these vermin[137].

CHAP. XXXVI. OF THE JAUNDICE.

This disease is first observable in the white of the eye, which appears yellow. Afterwards the whole skin puts on a yellow appearance. The urine too is of a saffron hue, and dies a white cloth of the same colour. There is likewise a species of this disease called the Black Jaundice.

CAUSES.——The immediate cause of the jaundice is an obstruction of the bile. The remote or occasional causes are, the bites of poisonous animals, as the viper, mad dog, &c. the bilious or hysteric colic; violent passions, as grief, anger, &c. Strong purges or vomits will likewise occasion the jaundice. Sometimes it proceeds from obstinate agues, or from that disease being prematurely stopped by astringent medicines. In infants it is often occasioned by the meconium not being sufficiently purged off. Pregnant women are very subject to it. It is likewise a symptom in several kinds of fever. Catching cold, or the stoppage of customary evacuations, as the menses, the bleeding piles, issues, &c. will occasion the jaundice.

SYMPTOMS.——The patient at first complains of excessive weariness, and has great aversion to every kind of motion. His skin is dry, and he generally feels a kind of itching or pricking pain over the whole body. The stools are of a whitish or clay colour, and the urine, as was observed above, is yellow. The breathing is difficult, and the patient complains of an unusual load or oppression on his breast. There is a heat in the nostrils, a bitter taste in the mouth, loathing of food, sickness at the stomach, vomiting, flatulency, and other symptoms of indigestion.

If the patient be young, and the disease complicated with no other malady, it is seldom dangerous; but in old people, where it continues long, returns frequently, or is complicated with the dropsy or hypochondriac symptoms, it generally proves fatal. The black jaundice is more dangerous than the yellow.

REGIMEN.——The diet should be cool, light, and diluting, consisting chiefly of ripe fruits and mild vegetables; as apples boiled or roasted, stewed prunes, preserved plums, boiled spinage, &c. Veal or chicken-broth, with light bread, are likewise very proper. Many have been cured by living almost wholly for some days on raw eggs. The drink should be butter-milk, whey sweetened with honey, or decoctions of cool opening vegetables; or marsh-mallow roots, with liquorice, &c.

The patient should take as much exercise as he can bear, either on horseback, or in a carriage; walking, running, and even jumping, are likewise proper, provided he can bear them without pain, and there be no symptoms of inflammation. Patients have been often cured of this disease by a long journey, after medicines had proved ineffectual.

Amusements are likewise of great use in the jaundice. The disease is often occasioned by a sedentary life, joined to a dull melancholy disposition. Whatever therefore tends to promote the circulation, and to cheer the spirits, must have a good effect; as dancing, laughing, singing, &c.

MEDICINE.——If the patient be young, of a full sanguine habit, and complains of pain in the right side about the region of the liver, bleeding will be necessary. After this a vomit must be administered, and if the disease proves obstinate, it may be repeated once or twice. No medicines are more beneficial in the jaundice than vomits, especially where it is not attended with inflammation. Half a drachm of ipecacuanha in powder will be a sufficient dose for an adult. It may be wrought off with weak camomile-tea, or lukewarm water. The body must likewise be kept open by taking a sufficient quantity of Castile soap, or the pills for the jaundice recommended in the Appendix.

Fomenting the parts about the region of the stomach and liver, and rubbing them with a warm hand or flesh-brush, are likewise beneficial; but it is still more so for the patient to sit in a bath of warm water up to the breast. He ought to do this frequently, and should continue in it as long as his strength will permit.

Many dirty things are recommended for the cure of the jaundice; as lice, millepedes, &c. But these do more harm than good, as people trust to them, and neglect more valuable medicines; besides, they are seldom taken in sufficient quantity to produce any effects. People always expect that such things should act as charms, and consequently seldom persist in the use of them. Vomits, purges, fomentations, and exercise, will seldom fail to cure the jaundice when it is a simple disease; and when complicated with the dropsy, a scirrhous liver, or other chronic complaints, it is hardly to be cured by any means.

Numberless British herbs are extolled for the cure of this disease. The author of the Medicina Britannica mentions near a hundred, all famous for curing the jaundice. The fact is, the disease often goes off of its own accord; in which case the last medicine is always said to have performed the cure. I have sometimes however seen considerable benefit, in a very obstinate jaundice, from a decoction of hempseed. Four ounces of the seed may be boiled in two English quarts of ale, and sweetened with coarse sugar. The dose is half an English pint every morning. It may be continued for eight or nine days.

I have likewise known Harrowgate sulphur-water cure a jaundice of very long standing. It should be used for some weeks, and the patient must both drink and bathe.

The soluble tartar is a very proper medicine in the jaundice. A drachm of it may be taken every night and morning in a cup of tea or water-gruel. If it does not open the body, the dose may be increased.

Persons subject to the jaundice ought to take as much exercise as possible, and to avoid all heating and astringent aliments.

CHAP. XXXVII. OF THE DROPSY.

The dropsy is a preternatural swelling of the whole body, or some part of it, occasioned by a collection of watery humour. It is distinguished by different names, according to the part affected, as the anasarca, or a collection of water under the skin; the ascites, or a collection of water in the belly; the hydrops pectoris, or dropsy of the breast; the hydrocephalus, or dropsy of the brain, &c.

CAUSES.——The dropsy is often owing to an hereditary disposition. It may likewise proceed from drinking ardent spirits, or other strong liquors. It is true almost to a proverb, that great drinkers die of a dropsy. The want of exercise is also a very common cause of the dropsy. Hence it is justly reckoned among the diseases of the sedentary. It often proceeds from excessive evacuations, as frequent and copious bleedings, strong purges often repeated, frequent salivations, &c. The sudden stoppage of customary or necessary evacuations, as the menses, the hæmorrhoids, fluxes of the belly, &c. may likewise cause a dropsy.

I have known the dropsy occasioned by drinking large quantities of cold, weak, watery liquor, when the body was heated by violent exercise. A low, damp, or marshy situation is likewise a frequent cause of it. Hence it is a common disease in moist, flat, fenny countries. It may also be brought on by a long use of poor watery diet, or of viscous aliment that is hard of digestion. It is often the effect of other diseases, as the jaundice, a scirrhus of the liver, a violent ague of long continuance, a diarrhœa, a dysentery, an empyema, or a consumption of the lungs. In short, whatever obstructs the perspiration, or prevents the blood from being duly prepared, may occasion a dropsy.

SYMPTOMS.——The anasarca generally begins with a swelling of the feet and ancles towards night, which for some time disappears in the morning. In the evening the parts, if pressed with the finger, will pit. The swelling gradually ascends, and occupies the trunk of the body, the arms, and the head. Afterwards the breathing becomes difficult, the urine is in small quantity, and the thirst great; the body is bound, and the perspiration is greatly obstructed. To these succeed torpor, heaviness, a slow wasting fever, and a troublesome cough. This last is generally a fatal symptom, as it shews that the lungs are affected.

In an ascites, besides the above symptoms, there is a swelling of the belly, and often a fluctuation, which may be perceived by striking the belly on one side, and laying the palm of the hand on the opposite. This may be distinguished from a tympany by the weight of the swelling, as well as by the fluctuation. When the anasarca and ascites are combined, the case is very dangerous. Even a simple ascites seldom admits of a radical cure. Almost all that can be done is, to let off the water by tapping, which seldom affords more than a temporary relief.

When the disease comes suddenly on, and the patient is young and strong, there is reason however to hope for a cure, especially if medicine be given early. But if the patient be old, has led an irregular or a sedentary life, or if there be reason to suspect that the liver, lungs, or any of the viscera are unsound, there is great reason to fear that the consequences will prove fatal.

REGIMEN.——The patient must abstain, as much as possible, from all drink, especially weak and watery liquors, and must quench his thirst with mustard-whey, or acids, as juice of lemons, oranges, sorrel, or such like. His aliment ought to be dry, of a stimulating and diuretic quality, as toasted bread, the flesh of birds, or other wild animals roasted; pungent and aromatic vegetables, as garlic, mustard, onions, cresses, horse-radish, rocambole, shalot, &c. He may also eat sea-biscuit dipt in wine or a little brandy. This is not only nourishing, but tends to quench thirst. Some have been actually cured of a dropsy by a total abstinence from all liquids, and living entirely upon such things as are mentioned above. If the patient must have drink, the Spa-water, or Rhenish wine, with diuretic medicines infused in it, are the best.

Exercise is of the greatest importance in a dropsy. If the patient be able to walk, dig, or the like, he ought to continue these exercises as long as he can. If he is not able to walk or labour, he must ride on horseback, or in a carriage, and the more violent the motion so much the better, provided he can bear it. His bed ought to be hard, and the air of his apartments warm and dry. If he lives in a damp country, he ought to be removed into a dry one, and, if possible, into a warmer climate. In a word, every method should be taken to promote the perspiration, and to brace the solids. For this purpose it will likewise be proper to rub the patient’s body, two or three times a day, with a hard cloth, or the flesh-brush; and he ought constantly to wear flannel next his skin.

MEDICINE.——If the patient be young, his constitution good, and the disease has come on suddenly, it may generally be removed by strong vomits, brisk purges, and such medicines as promote a discharge by sweat and urine. For an adult, half a drachm of ipecacuanha in powder, and half an ounce of oxymel of squills, will be a proper vomit. This may be repeated as often as is found necessary, three or four days intervening between the doses. The patient must not drink much after taking the vomit, otherwise he destroys its effect. A cup or two of camomile-tea will be sufficient to work it off.

Between each vomit, on one of the intermediate days, the patient may take the following purge: Jalap in powder half a drachm, cream of tartar, two drachms, calomel six grains. These may be made into a bolus with a little syrup of pale roses, and taken early in the morning. The less the patient drinks after it the better. If he be much griped, he may now and then take a cup of chicken-broth.

The patient may likewise take every night at bed-time the following bolus: To four or five grains of camphor add one grain of opium, and as much syrup of orange-peel as is sufficient to make them into a bolus. This will generally promote a gentle sweat, which should be encouraged by drinking now and then a small cup of wine-whey, with a tea-spoonful of the spirits of hartshorn in it. A tea-cupful of the following diuretic infusion may likewise be taken every four or five hours through the day:

Take juniper-berries, mustard-seed, and horse-radish, of each half an ounce, ashes of broom half a pound; infuse them in a quart of Rhenish wine or strong ale for a few days, and afterwards strain off the liquor. Such as cannot take this infusion, may use the decoction of seneka-root, which is both diuretic and sudorific. I have known an obstinate anasarca cured by an infusion of the ashes of broom in wine.

The above course will often cure an incidental dropsy, if the constitution be good; but when the disease proceeds from a bad habit, or an unsound state of the viscera, strong purges and vomits are not to be ventured upon. In this case, the safer course is to palliate the symptoms by the use of such medicines as promote the secretions, and to support the patient’s strength by warm and nourishing cordials.

The secretion of urine may be greatly promoted by nitre. Brookes says, he knew a young woman who was cured of a dropsy by taking a drachm of nitre every morning in a draught of ale, after she had been given over as incurable. The powder of squills is likewise a good diuretic. Six or eight grains of it, with a scruple of nitre, may be given twice a-day in a glass of strong cinnamon-water. Ball says, a large spoonful of unbruised mustard-seed taken every night and morning, and drinking half an English pint of the decoction of the tops of green broom after it, has performed a cure after other powerful medicines had proved ineffectual.

I have sometimes seen good effects from cream of tartar in this disease. It promotes the discharges by stool and urine, and will at least palliate, if it does not perform a cure. The patient may begin by taking an ounce every second or third day, and may increase the quantity to two or even to three ounces, if the stomach will bear it. This quantity is not however to be taken at once, but divided into three or four doses.

To promote perspiration, the patient may use the decoction of seneka-root, as directed above; or he may take two table-spoonfuls of Mindererus’s spirit in a cup of wine-whey three or four times a-day. To promote a discharge of urine, the following infusion of the London hospitals will likewise be beneficial:

Take of zedoary-root two drachms; dried squills, rhubarb, and juniper-berries bruised, of each a drachm; cinnamon in powder, three drachms; salt of wormwood, a drachm and a half; infuse in an English pint and a half of old hock-wine, and when fit for use, filter the liquor. A wine-glass of it may be taken three or four times a-day.

In the anasarca it is usual to scarify the feet and legs. By this means the water is often discharged; but the operator must be cautious not to make the incisions too deep; they ought barely to pierce through the skin, and especial care must be taken, by spirituous fomentations and proper digestives, to prevent a gangrene.

In an ascites, when the disease does not evidently and speedily give way to purgative and diuretic medicines, the water ought to be let off by tapping. This is a very simple and safe operation, and would often succeed, if it were performed in due time; but if it be delayed till the humours are vitiated, or the bowels spoiled, by long soaking in water, it can hardly be expected that any permanent relief will be procured[138].

After the evacuation of the water, the patient is to be put on a course of strengthening medicines; as the Peruvian bark; the elixir of vitriol; warm aromatics, with a due proportion of rhubarb, infused in wine, and such like. His diet ought to be dry and nourishing, such as is recommended in the beginning of the Chapter; and he should take as much exercise as he can bear without fatigue. He should wear flannel next his skin, and make daily use of the flesh-brush.

CHAP. XXXVIII. OF THE GOUT.

There is no disease which shews the imperfection of medicine, or sets the advantages of temperance and exercise in a stronger light, than the gout. Excess and idleness are the true sources from whence it originally sprung, and all who would avoid it must be active and temperate.

Though idleness and intemperance are the principal causes of the gout, yet many other things may contribute to bring on the disorder in those who are not, and to induce a paroxysm in those who are subject to it; as intense study; too free an use of acidulated liquors; night-watching; grief or uneasiness of mind; an obstruction or defect of any of the customary discharges, as the menses, sweating of the feet, perspiration, &c.

SYMPTOMS.——A fit of the gout is generally preceded by indigestion, drowsiness, belching of wind, a slight head-ach, sickness, and sometimes vomiting. The patient complains of weariness and dejection of spirits, and has often a pain in the limbs, with a sensation as if wind or cold water were passing down the thigh. The appetite is often remarkably keen a day or two before the fit, and there is a slight pain in passing urine, and sometimes an involuntary shedding of tears. Sometimes these symptoms are much more violent, especially upon the near approach of the fit; and some observe, that as is the fever which ushers in the gout, so will the fit be; if the fever be short and sharp, the fit will be so likewise; if it be feeble, long, and lingering, the fit will be such also. But this observation can only hold with respect to very regular fits of the gout.

The regular gout generally makes its attack in the spring, or beginning of winter, in the following manner: About two or three in the morning, the patient is seized with a pain in his great toe, sometimes in the heel, and at other times in the ancle or calf of the leg. This pain is accompanied with a sensation as if cold water were poured upon the part, which is succeeded by a shivering, with some degree of fever. Afterwards the pain increases, and fixing among the small bones of the foot, the patient feels all the different kinds of torture, as if the part were stretched, burnt, squeezed, gnawed, or torn in pieces, &c. The part at length becomes so exquisitely sensible, that the patient cannot bear to have it touched, or even suffer any person to walk across the room.

The patient is generally in exquisite torture for twenty-four hours, from the time of the coming on of the fit: he then becomes easier, the part begins to swell, appears red, and is covered with a little moisture. Towards morning he drops asleep, and generally falls into a gentle breathing sweat. This terminates the first paroxysm, a number of which constitutes a fit of the gout; which is longer or shorter according to the patient’s age, strength, the season of the year, and the disposition of the body to this disease.

The patient is always worse towards night, and easier in the morning. The paroxysms however generally grow milder every day, till at length the disease is carried off by perspiration, urine, and the other evacuations. In some patients this happens in a few days; in others, it requires weeks, and in some, months, to finish the fit. Those whom age and frequent fits of the gout have greatly debilitated, seldom get free from it before the approach of summer, and sometimes not till it be pretty far advanced.

REGIMEN.——As there are no medicines yet known that will cure the gout, we shall confine our observations chiefly to regimen, both in and out of the fit.

In the fit, if the patient be young and strong, his diet ought to be thin and cooling, and his drink of a diluting nature; but where the constitution is weak, and the patient has been accustomed to live high, this is not a proper time to retrench. In this case he must keep nearly to his usual diet, and should take frequently a cup of strong negus, or a glass of generous wine. Wine-whey is a very proper drink in this case, as it promotes the perspiration without greatly heating the patient. It will answer this purpose better if a tea-spoonful of sal volatile oleosum, or spirits of hartshorn, be put into a cup of it twice a-day. It will likewise be proper to give at bed-time a tea-spoonful of the volatile tincture of guaiacum in a large draught of warm wine-whey. This will greatly promote perspiration through the night.

As the most safe and efficacious method of discharging the gouty matter is by perspiration, this ought to be kept up by all means, especially in the affected part. For this purpose the leg and foot should be wrapt in soft flannel, fur, or wool. The last is most readily obtained, and seems to answer the purpose better than any thing else. The people of Lancashire look upon wool as a kind of specific in the gout. They wrap a great quantity of it about the leg and foot affected, and cover it with a skin of soft dressed leather. This they suffer to continue for eight or ten days, and sometimes for a fortnight or three weeks, or longer, if the pain does not cease. I never knew any external application answer so well in the gout. I have often seen it applied when the swelling and inflammation were very great, with violent pain, and have found all these symptoms relieved by it in a few days. The wool which they use is generally greased, and carded or combed. They chuse the softest which can be had, and seldom or never remove it till the fit be entirely gone off.

The patient ought likewise to be kept quiet and easy during the fit. Every thing that affects the mind disturbs the paroxysm, and tends to throw the gout upon the nobler parts. All external applications that repel the matter are to be avoided as death. They do not cure the disease, but remove it from a safer to a more dangerous part of the body, where it often proves fatal. A fit of the gout is to be considered as Nature’s method of removing something that might prove destructive to the body, and all that we can do, with safety, is to promote her intentions, and to assist her in expelling the enemy in her own way. Evacuations by bleeding, stool, &c. are likewise to be used with caution; they do not remove the cause of the disease, and sometimes by weakening the patient prolong the fit: but where the constitution is able to bear it, it will be of use to keep the body gently open by diet, or very mild laxative medicines.

Many things will indeed shorten a fit of the gout, and some will drive it off altogether: but nothing has yet been found which will do this with safety to the patient. In pain we eagerly grasp at any thing that promises immediate ease, and even hazard life itself for a temporary relief. This is the true reason why so many infallible remedies have been proposed for the gout, and why such numbers have lost their lives by the use of them. It would be as prudent to stop the small-pox from rising, and to drive them into the blood, as to attempt to repel the gouty matter after it has been thrown upon the extremities. The latter is as much an effort of Nature to free herself from an offending cause as the former, and ought equally to be promoted.

When the pain however is very great, and the patient is restless, thirty or forty drops of laudanum, more or less, according to the violence of the symptoms, may be taken at bed-time. This will ease the pain, procure rest, promote perspiration, and forward the crisis of the disease.

After the fit is over, the patient ought to take a gentle dose or two of the bitter tincture of rhubarb, or some other warm stomachic purge. He should also drink a weak infusion of stomachic bitters in small wine or ale, as the Peruvian bark, with cinnamon, Virginian snake-root, and orange-peel. The diet at this time should be light, but nourishing, and gentle exercise ought to be taken on horseback, or in a carriage.

Out of the fit, it is in the patient’s power to do many things towards preventing a return of the disorder, or rendering the fit, if it should return, less severe. This however is not to be attempted by medicine. I have frequently known the gout kept off for several years by the Peruvian bark and other astringent medicines; but in all the cases where I had occasion to see this tried, the persons died suddenly, and, to all appearance, for want of a regular fit of the gout. One would be apt, from hence, to conclude, that a fit of the gout, to some constitutions, in the decline of life, is rather salutary than hurtful.

Though it may be dangerous to stop a fit of the gout by medicine, yet if the constitution can be so changed by diet and exercise, as to lessen or totally prevent its return, there certainly can be no danger in following such a course. It is well known that the whole habit may be so altered by a proper regimen, as quite to eradicate this disease; and those only who have sufficient resolution to persist in such a course have reason to expect a cure.

The course which we would recommend for preventing the gout, is as follows: In the first place, universal temperance. In the next place sufficient exercise[139]. By this we do not mean sauntering about in an indolent manner, but labour, sweat, and toil. These only can render the humours wholesome, and keep them so. Going early to bed, and rising betimes, are also of great importance. It is likewise proper to avoid night studies, and all intense thought. The supper should be light, and taken early. All strong liquors, especially generous wines and sour punch, are to be avoided.

We would likewise recommend some doses of magnesia alba and rhubarb to be taken every spring and autumn; and afterwards a course of stomachic bitters, as tansey or water-trefoil tea, an infusion of gentian and camomile flowers, or a decoction of burdock root, &c. Any of these, or an infusion of any wholesome bitter that is more agreeable to the patient, may be drank for two or three weeks in March and October twice a-day. An issue or perpetual blister has a great tendency to prevent the gout. If these were more generally used in the decline of life, they would not only often prevent the gout, but also other chronic maladies. Such as can afford to go to Bath, will find great benefit from bathing and drinking the water. It both promotes digestion, and invigorates the habit.

Though there is little room for medicine during a regular fit of the gout, yet when it leaves the extremities, and falls on some of the internal parts, proper applications to recal and fix it become absolutely necessary. When the gout affects the head, the pain of the joints ceases, and the swelling disappears, while either severe head-ach, drowsiness, trembling, giddiness, convulsions, or delirium come on. When it seizes the lungs, great oppression, with cough and difficulty of breathing, ensue. If it attacks the stomach, extreme sickness, vomiting, anxiety, pain in the epigastric region, and total loss of strength, will succeed.

When the gout attacks the head or lungs, every method must be taken to fix it in the feet. They must be frequently bathed in warm water, and acrid cataplasms applied to the soles. Blistering-plasters ought likewise to be applied to the ancles or calves of the legs. Bleeding in the feet or ancles is also necessary, and warm stomachic purges. The patient ought to keep in bed for the most part, if there be any signs of inflammation, and should be very careful not to catch cold.

If it attacks the stomach with a sense of cold, the most warm cordials are necessary; as strong wine boiled up with cinnamon or other spices; cinnamon-water; peppermint-water; and even brandy or rum. The patient should keep his bed, and endeavour to promote a sweat by drinking warm liquors; and if he should be troubled with a nausea, or inclination to vomit, he may drink camomile-tea, or any thing that will make him vomit freely.

When the gout attacks the kidneys, and imitates gravel-pains, the patient ought to drink freely of a decoction of marsh-mallows, and to have the parts fomented with warm water. An emollient clyster ought likewise to be given, and afterwards an opiate. If the pain be very violent, twenty or thirty drops of laudanum may be taken in a cup of the decoction.

Persons who have had the gout should be very attentive to any complaints that may happen to them about the time when they have reason to expect a return of the fit. The gout imitates many other disorders, and by being mistaken for them, and treated improperly, is often diverted from its regular course, to the great danger of the patient’s life.

Those who never had the gout, but who, from their constitution or manner of living, have reason to expect it, ought likewise to be very circumspect with regard to its first approach. If the disease, by wrong conduct or improper medicines, be diverted from its proper course, the miserable patient has a chance to be ever after tormented with head-achs, coughs, pains of the stomach and intestines; and to fall at last a victim to its attack upon some of the more noble parts.

OF THE RHEUMATISM.

This disease has often a resemblance to the gout. It generally attacks the joints with exquisite pain, and is sometimes attended with inflammation and swelling. It is most common in the spring, and towards the end of autumn. It is usually distinguished into acute and chronic; or the rheumatism with and without a fever.

CAUSES.——The causes of a rheumatism are frequently the same as those of an inflammatory fever, viz. an obstructed perspiration, the immoderate use of strong liquors, and the like. Sudden changes of the weather, and all quick transitions from heat to cold, are very apt to occasion the rheumatism. The most extraordinary case of a rheumatism that I ever saw, where almost every joint of the body was distorted, was a man who used to work one part of the day by the fire, and the other part of it in the water. Very obstinate rheumatisms have likewise been brought on by persons not accustomed to it, allowing their feet to continue long wet. The same effects are often produced by wet clothes, damp beds, sitting or lying on the damp ground, travelling in the night, &c.

The rheumatism may likewise be occasioned by excessive evacuations, or the stoppage of customary discharges. It is often the effect of chronic diseases, which vitiate the humours; as the scurvy, the lues venerea, obstinate autumnal agues, &c.

The rheumatism prevails in cold, damp, marshy countries. It is most common among the poorer sort of peasants, who are ill clothed, live in low damp houses, and eat coarse unwholesome food, which contains but little nourishment, and is not easily digested.

SYMPTOMS.——The acute rheumatism commonly begins with weariness, shivering, a quick pulse, restlessness, thirst, and other symptoms of fever. Afterwards the patient complains of flying pains, which are increased by the least motion. These at length fix in the joints, which are often affected with swelling and inflammation. If blood be let in this disease, it has generally the same appearance as in the pleurisy.

In this kind of rheumatism the treatment of the patient is nearly the same as in an acute or inflammatory fever. If he be young and strong, bleeding is necessary, which may be repeated according to the exigencies of the case. The body ought likewise to be kept open by emollient clysters, or cool opening liquors; as decoctions of tamarinds, cream of tartar whey, senna-tea, and the like. The diet should be light, and in small quantity, consisting chiefly of roasted apples, groat-gruel, or weak chicken-broth. After the feverish symptoms have abated, if the pain still continues, the patient must keep his bed, and take such things as promote perspiration; as wine-whey, with spiritus Mindereri, &c. He may likewise take, for a few nights, at bed-time, in a cup of wine-whey, a drachm of the cream of tartar, and half a drachm of gum guaiacum in powder.

Warm bathing, after proper evacuations, has often an exceeding good effect. The patient may either be put into a bath of warm water, or have cloths wrung out of it applied to the parts affected. Great care must be taken that he do not catch cold after bathing.

The chronic rheumatism is seldom attended with any considerable degree of fever, and is generally confined to some particular part of the body, as the shoulders, the back, or the loins. There is seldom any inflammation or swelling in this case. Persons in the decline of life are most subject to the chronic rheumatism. In such patients it often proves extremely obstinate, and sometimes incurable.

In this kind of rheumatism the regimen should be nearly the same as in the acute. Cool and diluting diet, consisting chiefly of vegetable substances, as stewed prunes, coddled apples, currants or gooseberries boiled in milk, is most proper. Arbuthnot says, “If there be a specific in aliment for the rheumatism, it is certainly whey,” and adds, “That he knew a person subject to this disease, who could never be cured by any other method but a diet of whey and bread.” He likewise says, “That cream of tartar in water-gruel, taken for several days, will ease rheumatic pains considerably.” This I have often experienced, but found it always more efficacious when joined with gum guaiacum, as already directed. In this case the patient may take the dose formerly mentioned twice a-day, and likewise a tea-spoonful of the volatile tincture of gum guaiacum, at bed-time, in wine-whey.

This course may be continued for a week, or longer, if the case proves obstinate, and the patient’s strength will permit. It ought then to be omitted for a few days, and repeated again. At the same time leeches or a blistering-plaster may be applied to the part affected. What I have generally found answer better than either of these, in obstinate fixed rheumatic pains, is the warm plaster[140]. I have likewise known a plaster of Burgundy pitch worn for some time on the part affected give great relief in rheumatic pains. My ingenious friend, Dr. Alexander of Edinburgh, says, he has frequently cured very obstinate rheumatic pains by rubbing the part affected with tincture of cantharides. When the common tincture did not succeed, he used it of a double or treble strength. Cupping upon the part affected is likewise often very beneficial, and is greatly preferable to the application of leeches.

Though this disease may not seem to yield to medicines for some time, yet they ought still to be persisted in. Persons who are subject to frequent returns of the rheumatism, will often find their account in using medicines, whether they be immediately affected with the disease or not. The chronic rheumatism is similar to the gout in this respect, that the most proper time for using medicines to extirpate it, is when the patient is most free from the disorder.

To those who can afford the expence, I would recommend the warm baths of Buxton or Matlock in Derbyshire. These have often, to my knowledge, cured very obstinate rheumatisms, and are always safe either in or out of the fit. When the rheumatism is complicated with scorbutic complaints, which is not seldom the case, the Harrowgate waters, and those of Moffat, are proper. They should both be drank and used as a warm bath.

There are several of our own domestic plants which may be used with advantage in the rheumatism. One of the best is the white mustard. A table-spoonful of the seed of this plant may be taken twice or thrice a-day, in a glass of water or small wine. The water-trefoil is likewise of great use in this complaint. It may be infused in wine or ale, or drank in form of tea. The ground-ivy, camomile, and several other bitters, are also beneficial, and may be used in the same manner. No benefit however is to be expected from these, unless they be taken for a considerable time. Excellent medicines are often despised in this disease, because they do not perform an immediate cure; whereas nothing would be more certain than their effect, were they duly persisted in. Want of perseverance in the use of medicines is one reason why chronic diseases are so seldom cured.

Cold bathing, especially in salt-water, often cures the rheumatism. We would also recommend riding on horseback, and wearing flannel next the skin. Issues are likewise very proper, especially in chronic cases. If the pain affects the shoulders, an issue may be made in the arm; but if it affects the loins, it should be put into the leg or thigh.

Persons afflicted with the scurvy are very subject to rheumatic complaints. The best medicines in this case are bitters and mild purgatives. These may either be taken separately or together, as the patient inclines. An ounce of Peruvian bark, and half an ounce of rhubarb in powder, may be infused in a bottle of wine; and one, two, or three wine glasses of it taken daily, as shall be found necessary for keeping the body gently open. In cases where the bark itself proves sufficiently purgative, the rhubarb may be omitted.

Such as are subject to frequent attacks of the rheumatism ought to make choice of a dry, warm situation, to avoid the night-air, wet clothes, and wet feet, as much as possible. Their clothing should be warm, and they should wear flannel next their skin, and make frequent use of the flesh-brush.

CHAP. XXXIX. OF THE SCURVY.

This disease prevails chiefly in cold northern countries, especially in low damp situations, near large marshes, or great quantities of stagnating water. Sedentary people, of a dull melancholy disposition, are most subject to it. It proves often fatal to sailors on long voyages, particularly in ships that are not properly ventilated, have many people on board, or where cleanliness is neglected.

It is not necessary to mention the different species into which this disease has been divided, as they differ from one another chiefly in degree. What is called the land-scurvy, however, is seldom attended with those highly putrid symptoms which appear in patients who have been long at sea, and which, we presume, are rather owing to confined air, want of exercise, and the unwholesome food eaten by sailors on long voyages, than to any specific difference in the disease.

CAUSES.——The scurvy is occasioned by cold moist air; by the long use of salted or smoke-dried provisions, or any kind of food that is hard of digestion, and affords little nourishment. It may also proceed from the suppression of customary evacuations; as the menses, the hæmorrhoidal flux, &c. It is sometimes owing to a hereditary taint, in which case a very small cause will excite the latent disorder. Grief, fear, and other depressing passions, have a great tendency both to excite and aggravate this disease. The same observation holds with regard to neglect of cleanliness; bad clothing; the want of proper exercise; confined air; unwholesome food; or any disease which greatly weakens the body, or vitiates the humours.

SYMPTOMS.——This disease may be known by unusual weariness, heaviness, and difficulty of breathing, especially after motion; rottenness of the gums, which are apt to bleed on the slightest touch; a stinking breath; frequent bleeding at the nose; crackling of the joints; difficulty of walking; sometimes a swelling and sometimes a falling away of the legs, on which there are livid, yellow, or violet-coloured spots; the face is generally of a pale or leaden colour. As the disease advances, other symptoms come on; as rottenness of the teeth, hæmorrhages, or discharges of blood from different parts of the body, foul obstinate ulcers, pains in various parts, especially about the breast, dry scaly eruptions all over the body, &c. At last a wasting or hectic fever comes on, and the miserable patient is often carried off by a dysentery, a diarrhœa, a dropsy, the palsy, fainting fits, or a mortification of some of the bowels.

CURE.——We know no way of curing this disease but by pursuing a plan directly opposite to that which brings it on. It proceeds from a vitiated state of the humours, occasioned by errors in diet, air, or exercise; and this cannot be removed but by a proper attention to these important articles.

If the patient has been obliged to breathe a cold, damp, or confined air, he should be removed, as soon as possible, to a dry, open, and moderately warm one. If there is reason to believe that the disease proceeds from a sedentary life, or depressing passions, as grief, fear, &c. the patient must take daily as much exercise in the open air as he can bear, and his mind should be diverted by cheerful company and other amusements. Nothing has a greater tendency either to prevent or remove this disease, than constant cheerfulness and good humour. But this, alas! is seldom the lot of persons afflicted with the scurvy; they are generally surly, peevish, and morose.

When the scurvy has been brought on by a long use of salted provisions, the proper medicine is a diet consisting chiefly of fresh vegetables; as oranges, apples, lemons, limes, tamarinds, water-cresses, scurvy-grass, brook lime, &c. The use of these, with milk, pot-herbs, new bread, and fresh beer or cyder, will seldom fail to remove a scurvy of this kind, if taken before it be too far advanced; but to have this effect, they must be persisted in for a considerable time. When fresh vegetables cannot be obtained, pickled or preserved ones may be used; and where these are wanting, recourse must be had to the chymical acids. All the patient’s food and drink should in this case be sharpened with cream of tartar, elixir of vitriol, vinegar, or the spirit of sea-salt.

These things however will more certainly prevent than cure the scurvy; for which reason sea-faring people, especially on long voyages, ought to lay in plenty of them. Cabbages, onions, gooseberries, and many other vegetables, may be kept a long time by pickling, preserving, &c. and when these fail, the chymical acids, recommended above, which will keep for any length of time, may be used. We have reason to believe, if ships were well ventilated, had good store of fruits, greens, cyder, &c. laid in, and if proper regard were paid to cleanliness and warmth, that sailors would be the most healthy people in the world, and would seldom suffer either from the scurvy or putrid fevers, which are so fatal to that useful set of men; but it is too much the temper of such people to despise all precaution; they will not think of any calamity till it overtakes them, when it is too late to ward off the blow.

It must indeed be owned, that many of them have it not in their power to make the provision we are speaking of; but in this case it is the duty of their employers to make it for them; and no man ought to engage in a long voyage without having these articles secured.

I have often seen very extraordinary effects in the land-scurvy from a milk diet. This preparation of Nature is a mixture of animal and vegetable properties, which of all others is the most fit for restoring a decayed constitution, and removing that particular acrimony of the humours, which seems to constitute the very essence of the scurvy, and many other diseases. But people despise this wholesome and nourishing food, because it is cheap, and devour with greediness, flesh, and fermented liquors, while milk is only deemed fit for their hogs.

The most proper drink in the scurvy is whey or butter-milk. When these cannot be had, sound cyder, perry, or spruce-beer, may be used. Wort has likewise been found to be a proper drink in the scurvy, and may be used at sea, as malt will keep during the longest voyage. A decoction of the tops of the spruce fir is likewise proper. It may be drank in the quantity of an English pint twice a-day. Tar-water may be used for the same purpose, or decoctions of any of the mild mucilaginous vegetables; as sarsaparilla, marsh-mallow roots, &c. Infusions of the bitter plants, as ground-ivy, the lesser centaury, marsh-trefoil, &c. are likewise beneficial. I have seen the peasants in some parts of Britain express the juice of the last-mentioned plant, and drink it with good effect in those foul scorbutic eruptions with which they are often troubled in the spring season.

Harrowgate water is certainly an excellent medicine in the land-scurvy. I have often seen patients who had been reduced to the most deplorable condition by this disease, greatly relieved by drinking the sulphur-water, and bathing in it. The chalybeate water may also be used with advantage, especially with a view to brace the stomach after drinking the sulphur-water, which, though it sharpens the appetite, never fails to weaken the powers of digestion.

A slight degree of scurvy may be carried off by frequently sucking a little of the juice of a bitter orange, or a lemon. When the disease affects the gums only, this practice, if continued for some time, will generally carry it off. We would however recommend the bitter orange as greatly preferable to lemon; it seems to be as good a medicine, and is not near so hurtful to the stomach. Perhaps our own sorrel may be little inferior to either of them.

All kinds of sallad are good in the scurvy, and ought to be eaten very plentifully, as spinage, lettuce, parsley, celery, endive, radish, dandelion, &c. It is amazing to see how soon fresh vegetables in the spring cure the brute animals of any scab or foulness which is upon their skins. It is reasonable to suppose that their effects would be as great upon the human species, were they used in proper quantity for a sufficient length of time.

I have sometimes seen good effects in scorbutic complaints of very long standing, from the use of a decoction of the roots of water-dock. It is usually made by boiling a pound of the fresh root in six English pints of water, till about one-third of it be consumed. The dose is from half a pint to a whole pint of the decoction every day. But in all the cases where I have seen it prove beneficial, it was made much stronger, and drank in larger quantities. The safest way, however, is for the patient to begin with small doses, and increase them both in strength and quantity as he finds his stomach will bear it. It must be used for a considerable time. I have known some take it for many months, and have been told of others who had used it for several years, before they were sensible of any benefit, but who nevertheless were cured by it at length.

The leprosy, which was so common in this country long ago, seems to have been near-akin to the scurvy. Perhaps its appearing so seldom now, may be owing to the inhabitants of Britain eating more vegetable food than formerly, living more upon tea and other diluting diet, using less salted meat, being more cleanly, better lodged and clothed, &c.—For the cure of this disease we would recommend the same course of diet and medicine as in the scurvy.

OF THE SCROPHULA, OR KING’S EVIL.

This disease chiefly affects the glands, especially those of the neck. Children and young persons of a sedentary life are very subject to it. It is one of those diseases which may be removed by proper regimen, but seldom yields to medicine. The inhabitants of cold, damp, marshy countries are most liable to the scrophula.

CAUSES.——This disease may proceed from a hereditary taint, from a scrophulous nurse, &c. Children who have the misfortune to be born of sickly parents, whose constitutions have been greatly injured by the pox, or other chronic diseases, are apt to be affected with the scrophula. It may likewise proceed from such diseases as weaken the habit or vitiate the humours, as the small-pox, measles, &c. External injuries, as blows, bruises, and the like, sometimes produce scrophulous ulcers; but we have reason to believe, when this happens, that there has been a predisposition in the habit to this disease. In short, whatever tends to vitiate the humours or relax the solids, paves the way to the scrophula; as the want of proper exercise, too much heat or cold, confined air, unwholesome food, bad water, the long use of poor, weak, watery aliments, the neglect of cleanliness, &c. Nothing tends more to induce this disease in children than allowing them to continue long wet[141].

SYMPTOMS.——At first small knots appear under the chin or behind the ears, which gradually increase in number and size, till they form one large hard tumour. This often continues for a long time without breaking, and when it does break, it only discharges a thin sanies, or watery humour. Other parts of the body are likewise liable to its attack, as the armpits, groins, feet, hands, eyes, breasts, &c. Nor are the internal parts exempt from it. It often affects the lungs, liver, or spleen; and I have frequently seen the glands of the mesentery greatly enlarged by it.

Those obstinate ulcers which break out upon the feet and hands with swelling, and little or no redness, are of the scrophulous kind. They seldom discharge good matter, and are exceedingly difficult to cure. The white swellings of the joints seem likewise to be of this kind. They are with difficulty brought to a suppuration, and when opened they only discharge a thin ichor. There is not a more general symptom of the scrophula than a swelling of the upper lip and nose.

REGIMEN.——As this disease proceeds, in a great measure, from relaxation, the diet ought to be generous and nourishing, but at the same time light and of easy digestion; as well-fermented bread, made of sound grain, the flesh and broth of young animals, with now and then a glass of generous wine, or good ale. The air ought to be open, dry, and not too cold, and the patient should take as much exercise as he can bear. This is of the utmost importance. Children who have sufficient exercise are seldom troubled with the scrophula.

MEDICINE.——The vulgar are remarkably credulous with regard to the cure of the scrophula; many of them believing in the virtue of the royal touch, that of the seventh son, &c. The truth is, we know but little either of the nature or cure of this disease, and where reason or medicines fail, superstition always comes in their place. Hence it is, that in diseases which are the most difficult to understand, we generally hear of the greatest number of miraculous cures being performed. Here, however, the deception is easily accounted for. The scrophula, at a certain period of life, often cures of itself; and, if the patient happens to be touched about this time, the cure is imputed to the touch, and not to Nature, who is really the physician. In the same way the insignificant nostrums of quacks and old women often gain applause when they deserve none.

There is nothing more pernicious than the custom of plying children in the scrophula with strong purgative medicines. People imagine it proceeds from humours which must be purged off, without considering that these purgatives increase the debility and aggravate the disease. It has indeed been found, that keeping the body gently open for some time, especially with sea-water, has a good effect; but this should only be given in gross habits, and in such quantity as to procure one, or at most two stools every day.

Bathing in the salt-water has likewise a very good effect, especially in the warm season. I have often known a course of bathing in salt-water, and drinking it in such quantities as to keep the body gently open, cure a scrophula, after many other medicines had been tried in vain. When salt-water cannot be obtained, the patient may be bathed in fresh water, and his body kept open by small quantities of salt and water, or some other mild purgative.

Next to cold bathing, and drinking the salt-water, we would recommend the Peruvian bark. The cold bath may be used in summer, and the bark in winter. To an adult half a drachm of the bark in powder may be given in a glass of red wine four or five times a-day. Children, and such as cannot take it in substance, may use the decoction made in the following manner:

Boil an ounce of Peruvian bark and a drachm of Winter’s bark, both grossly powdered, in an English quart of water to a pint: towards the end half an ounce of sliced liquorice-root, and a handful of raisins may be added, which will both render the decoction less disagreeable, and make it take up more of the bark. The liquor must be strained, and two, three, or four table-spoonfuls, according to the age of the patient, given three times a-day.

The Moffat and Harrowgate waters, especially the latter, are likewise very proper medicines in the scrophula. They ought not however to be drank in large quantities, but should be taken so as to keep the body gently open, and must be used for a considerable time.

The hemlock may sometimes be used with advantage in the scrophula. Some lay it down as a general rule, that the sea-water is most proper before there are any suppuration or symptoms of tabes; the Peruvian bark, when there are running sores, and a degree of hectic fever, and the hemlock in old inveterate cases, approaching to the scirrhous or cancerous state. Either the extract or the fresh juice of this plant may be used. The dose must be small at first, and increased gradually as far as the stomach is able to bear it.

External applications are of little use. Before the tumour breaks, nothing ought to be applied to it, unless a piece of flannel, or something to keep it warm. After it breaks, the sore may be dressed with some digestive ointment. What I have always found to answer best, was the yellow basilicon mixed with about a sixth or eighth part of its weight of red precipitate of mercury. The sore may be dressed with this twice a-day; and if it be very fungous, and does not digest well, a larger proportion of the precipitate may be added.

Medicines which mitigate this disease, though they do not cure it, are not to be despised. If the patient can be kept alive by any means till he arrives at the age of puberty, he has a great chance to get well; but if he does not recover at this time, in all probability he never will.

There is no malady which parents are so apt to communicate to their offspring as the scrophula, for which reason people ought to beware of marrying into families affected with this disease.

For the means of preventing the scrophula, we must refer the reader to the observations on nursing, at the beginning of the book.

OF THE ITCH.

Though this disease is commonly communicated by infection, yet it seldom prevails where due regard is paid to cleanliness, fresh air, and wholesome diet. It generally appears in form of small watery pustules, first about the wrists, or between the fingers; afterwards it affects the arms, legs, thighs, &c. These pustules are attended with an intolerable itching, especially when the patient is warm a-bed, or sits by the fire. Sometimes indeed the skin is covered with large blotches or scabs, and at other times with a white scurf, or scaly eruption. This last is called the dry itch, and is the most difficult to cure.

The itch is seldom a dangerous disease, unless when it is rendered so by neglect, or improper treatment. If it be suffered to continue too long, it may vitiate the whole mass of humours; and, if it be suddenly drove in, without proper evacuations, it may occasion fevers, inflammations of the viscera, or other internal disorders.

The best medicine yet known for the itch is sulphur, which ought to be used both externally and internally. The parts most affected may be rubbed with an ointment made of the flower of sulphur, two ounces; crude sal ammoniac finely powdered two drachms; hog’s lard, or butter, four ounces. If a scruple or half a drachm of the essence of lemon be added, it will entirely take away the disagreeable smell. About the bulk of a nutmeg of this may be rubbed upon the extremities at bed-time twice or thrice a-week. It is seldom necessary to rub the whole body; but when it is, it ought not to be done all at once, but by turns, as it is dangerous to stop too many pores at the same time.

Before the patient begins to use the ointment, he ought, if he be of a full habit, to bleed or take a purge or two. It will likewise be proper, during the use of it, to take every night and morning as much of the flower of brimstone and cream of tartar, in a little treacle or new milk, as will keep the body gently open. He should beware of catching cold, should wear more clothes than usual, and take every thing warm. The same clothes, the linen excepted, ought to be worn all the time of using the ointment; and such clothes as have been worn while the patient was under the disease, are not to be used again, unless they have been fumigated with brimstone, and thoroughly cleaned, otherwise they will communicate the infection anew[142].

I never knew brimstone, when used as directed above, fail to cure the itch; and I have reason to believe, that, if duly persisted in, it never will fail; but if it be only used once or twice, and cleanliness neglected, it is no wonder if the disorder returns. The quantity of ointment mentioned above will generally be sufficient for the cure of one person; but, if any symptoms of the disease should appear again, the medicine may be repeated. It is both more safe and efficacious when persisted in for a considerable time, than when a large quantity is applied at once. As most people dislike the smell of sulphur, they may use in its place the powder of white hellebore root made up into an ointment, in the same manner, which will seldom fail to cure the itch.

People ought to be extremely cautious lest they take other eruptions for the itch; as the stoppage of these may be attended with fatal consequences. Many of the eruptive disorders to which children are liable, have a near resemblance to this disease; and I have often known infants killed by being rubbed with greasy ointments that made these eruptions strike suddenly in, which Nature had thrown out to preserve the patient’s life, or prevent some other malady.

Much mischief is likewise done by the use of mercury in this disease. Some persons are so fool-hardy as to wash the parts affected with a strong solution of the corrosive sublimate. Others use the mercurial ointment, without taking the least care either to avoid cold, keep the body open, or observe a proper regimen. The consequences of such conduct may be easily guessed. I have known even the mercurial girdles produce bad effects, and would advise every person, as he values his health, to beware how he uses them. Mercury ought never to be used as a medicine without the greatest care. Ignorant people look upon these girdles as a kind of charm, without considering that the mercury enters the body.

It is not to be told what mischief is done by using mercurial ointment for curing the itch and killing vermin; yet it is unnecessary for either: the former may be always more certainly cured by sulphur, and the latter will never be found where due regard is paid to cleanliness.

Those who would avoid this detestable disease ought to beware of infected persons, to use wholesome food, and to study universal cleanliness[143].

CHAP. XL. OF THE ASTHMA.

The asthma is a disease of the lungs, which seldom admits of a cure. Persons in the decline of life are most liable to it. It is distinguished into the moist and dry, or humoural and nervous. The former is attended with expectoration or spitting; but in the latter the patient seldom spits, unless sometimes a little tough phlegm by the mere force of coughing.

CAUSES.——The asthma is sometimes hereditary. It may likewise proceed from a bad formation of the breast; the fumes of metals or minerals taken into the lungs; violent exercise, especially running; the obstruction of customary evacuations, as the menses, hæmorrhoids, &c. the sudden retrocession of the gout, or striking in of eruptions, as the small-pox, measles, &c. violent passions of the mind, as sudden fear or surprise. In a word, the disease may proceed from any cause that either impedes the circulation of the blood through the lungs, or prevents their being duly expanded by the air.

SYMPTOMS.——An asthma is known by a quick laborious breathing, which is generally performed with a kind of wheezing noise. Sometimes the difficulty of breathing is so great, that the patient is obliged to keep in an erect posture, otherwise he is in danger of being suffocated. A fit or paroxysm of the asthma generally happens after a person has been exposed to cold easterly winds, or has been abroad in thick foggy weather, or has got wet, or continued long in a damp place under ground, or has taken some food which the stomach could not digest, as pastries, toasted cheese, or the like.

The paroxysm is commonly ushered in with listlessness, want of sleep, hoarseness, a cough, belching of wind, a sense of heaviness about the breast, and difficulty of breathing. To these succeed heat, fever, pain of the head, sickness and nausea, great oppression of the breast, palpitation of the heart, a weak and sometimes intermitting pulse, an involuntary flow of tears, bilious vomitings, &c. All the symptoms grow worse towards night; the patient is easier when up than in bed, and is very desirous of cool air.

REGIMEN.——The food ought to be light, and of easy digestion. Boiled meats are to be preferred to roasted, and the flesh of young animals to that of old. All windy food, and whatever is apt to swell in the stomach, is to be avoided. Light puddings, white broths, and ripe fruits baked, boiled, or roasted, are proper. Strong liquors of all kinds, especially malt-liquor, are hurtful. The patient should eat a very light supper, or rather none at all, and should never suffer himself to be long costive. His clothing should be warm, especially in the winter-season. As all disorders of the breast are much relieved by keeping the feet warm, and promoting the perspiration, a flannel shirt or waistcoat, and thick shoes, will be of singular service.

But nothing is of so great importance in the asthma as pure and moderately warm air. Asthmatic people can seldom bear either the close heavy air of a large town, or the sharp, keen atmosphere of a bleak hilly country; a medium therefore between these is to be chosen. The air near a large town is often better than at a distance, provided the patient be removed so far as not to be affected by the smoke. Some asthmatic patients indeed breathe easier in town than in the country; but this is seldom the case, especially in towns where much coal is burnt. Asthmatic persons who are obliged to be in town all day, ought at least to sleep out of it. Even this will often prove of great service. Those who can afford it ought to travel into a warmer climate. Many asthmatic persons who cannot live in Britain, enjoy very good health in the south of France, Portugal, Spain, or Italy.

Exercise is likewise of very great importance in the asthma, as it promotes the digestion, preparation of the blood, &c. The blood of asthmatic persons is seldom duly prepared, owing to the proper action of the lungs being impeded. For this reason such people ought daily to take as much exercise, either on foot, horseback, or in a carriage, as they can bear.

MEDICINE.——Almost all that can be done by medicine in this disease, is to relieve the patient when seized with a violent fit. This indeed requires the greatest expedition, as the disease often proves suddenly fatal. In the paroxysm or fit, the body is generally bound; a purging clyster, with a solution of asafœtida, ought therefore to be administered, and if there be occasion, it may be repeated two or three times. The patient’s feet and legs ought to be immersed in warm water, and afterwards rubbed with a warm hand, or dry cloth. Bleeding, unless extreme weakness or old age should forbid it, is highly proper. If there be a violent spasm about the breast or stomach, warm fomentations, or bladders filled with warm milk and water, may be applied to the part affected, and warm cataplasms to the soles of the feet. The patient must drink freely of diluting liquors, and may take a tea-spoonful of the tincture of castor and of saffron mixed together, in a cup of valerian-tea, twice or thrice a-day. Sometimes a vomit has a very good effect, and snatches the patient, as it were, from the jaws of death. This however will be more safe after other evacuations have been premised. A very strong infusion of roasted coffee is said to give ease in an asthmatic paroxysm.

In the moist asthma, such things as promote expectoration or spitting ought to be used; as the syrup of squills, gum ammoniac, and such like. A common spoonful of the syrup, or oxymel of squills, mixed with an equal quantity of cinnamon-water, may be taken three or four times through the day, and four or five pills made of equal parts of asafœtida and gum-ammoniac, at bed-time[144].

For the convulsive or nervous asthma, antispasmodics and bracers are the most proper medicines. The patient may take a tea-spoonful of the paregoric elixir twice a-day. The Peruvian bark is sometimes found to be of use in this case. It may be taken in substance, or infused in wine. In short, every thing that braces the nerves, or takes off spasm, may be of use in a nervous asthma. It is often relieved by the use of asses milk; I have likewise known cows milk drank warm in the morning have a very good effect in this case.

In every species of asthma, setons and issues have a good effect; they may either be set in the back or side, and should never be allowed to dry up. We shall here, once for all, observe, that not only in the asthma, but in most chronic diseases, issues are extremely proper. They are both a safe and efficacious remedy; and though they do not always cure the disease, yet they will often prolong the patient’s life.

CHAP. XLI. OF THE APOPLEXY.

The apoplexy is a sudden loss of sense and motion, wherein the patient is to all appearance dead; the heart and lungs however still continue to move. Though this disease proves often fatal, yet it may sometimes be removed by proper care. It chiefly attacks sedentary persons of a gross habit, who use a rich and plentiful diet, and indulge in strong liquors. People in the decline of life are most subject to the apoplexy. It prevails most in winter, especially in rainy seasons, and very low states of the barometer.

CAUSES.——The immediate cause of an apoplexy is a compression of the brain, occasioned by an excess of blood, or a collection of watery humours. The former is called a sanguine, and the latter a serous apoplexy. It may be occasioned by any thing that increases the circulation towards the brain, or prevents the return of the blood from the head; as intense study; violent passions[145]; viewing objects for a long time obliquely; wearing any thing too tight about the neck; a rich and luxurious diet; suppression of urine; suffering the body to cool suddenly after having been greatly heated; continuing long in a warm or a cold bath; the excessive use of spiceries, or high-seasoned food; excess of venery; the sudden striking in of any eruption; suffering issues, setons, &c. suddenly to dry up, or the stoppage of any customary evacuation; a mercurial salivation pushed too far, or suddenly checked by cold; wounds or bruises on the head; long exposure to excessive cold; poisonous exhalations, &c.

SYMPTOMS, and method of cure.——The usual forerunners of an apoplexy are giddiness, pain and swimming of the head; loss of memory; drowsiness; noise in the ears; the night-mare; a spontaneous flux of tears, and laborious respiration. When persons of an apoplectic make observe these symptoms, they have reason to fear the approach of a fit, and should endeavour to prevent it by bleeding, a slender diet, and opening medicines.

In the sanguine apoplexy, if the patient does not die suddenly, the countenance appears florid, the face is swelled or puffed up, and the blood-vessels, especially about the neck and temples, are turgid; the pulse beats strong; the eyes are prominent and fixed, and the breathing is difficult, and performed with a snorting noise. The excrements and urine are often voided spontaneously, and the patient is sometimes seized with vomiting.

In this species of apoplexy every method must be taken to lessen the force of the circulation towards the head. The patient should be kept perfectly easy and cool. His head should be raised pretty high, and his feet suffered to hang down. His clothes ought to be loosened, especially about the neck, and fresh air admitted into his chamber. His garters should be tied pretty tight, by which means the motion of the blood from the lower extremities will be retarded. As soon as the patient is placed in a proper posture, he should be bled freely in the neck or arm, and, if there be occasion, the operation may be repeated in two or three hours. A laxative clyster, with plenty of sweet oil, or fresh butter, and a spoonful or two of common salt in it, may be administered every two hours; and blistering-plasters applied between the shoulders, and to the calves of the legs.

As soon as the symptoms are a little abated, and the patient is able to swallow, he ought to drink freely of some diluting opening liquor, as a decoction of tamarinds and liquorice, cream-tartar-whey, or common whey with cream of tartar dissolved in it. Or he may take any cooling purge, as Glauber’s salt, manna dissolved in an infusion of senna, or the like. All spirits and other strong liquors are to be avoided. Even volatile salts held to the nose do mischief. Vomits, for the same reason, ought not to be given, nor any thing that may increase the motion of the blood towards the head.

In the serous apoplexy, the symptoms are nearly the same, only the pulse is not so strong, the countenance is less florid, and the breathing less difficult. Bleeding is not so necessary here as in the former case. It may however generally be performed once with safety and advantage, but should not be repeated. The patient should be placed in the same posture as directed above, and should have blistering-plasters applied, and receive opening clysters in the same manner. Purges here are likewise necessary, and the patient may drink strong balm-tea. If he be inclined to sweat, it ought to be promoted by drinking small wine-whey, or an infusion of carduus benedictus. A plentiful sweat kept up for a considerable time has often carried off a serous apoplexy.

When apoplectic symptoms proceed from opium, or other narcotic substances taken into the stomach, vomits are necessary. The patient is generally relieved as soon as he has discharged the poison in this way.

Persons of an apoplectic make, or those who have been attacked by it, ought to use a very spare and slender diet, avoiding all strong liquors, spiceries, and high-seasoned food. They ought likewise to guard against all violent passions, and to avoid the extremes of heat and cold. The head should be shaved, and daily washed with cold water. The feet ought to be kept warm, and never suffered to continue long wet. The body must be kept open either by food or medicine, and a little blood may be let every spring and fall. Exercise should by no means be neglected; but it ought to be taken in moderation. Nothing has a more happy effect in preventing an apoplexy than perpetual issues or setons; great care however must be taken not to suffer them to dry up, without opening others in their stead. Apoplectic persons ought never to go to rest with a full stomach, or to lie with their heads low, or wear any thing too tight about their necks.

CHAP. XLII. OF COSTIVENESS, AND OTHER AFFECTIONS OF THE STOMACH AND BOWELS.

We do not here mean to treat of those astrictions of the bowels which are the symptoms of diseases, as of the colic, the iliac passion, &c. but only to take notice of that infrequency of stools which sometimes happens, and which in some particular constitutions may occasion diseases.

Costiveness may proceed from drinking rough red wines, or other astringent liquors; too much exercise, especially on horseback. It may likewise proceed from a long use of cold insipid food, which does not sufficiently stimulate the intestines. Sometimes it is owing to the bile not descending to the intestines, as in the jaundice; and at other times it proceeds from diseases of the intestines themselves, as a palsy, spasms, torpor, tumours, a cold dry state of the intestines, &c.

Excessive costiveness is apt to occasion pains of the head, vomiting, colics, and other complaints of the bowels. It is peculiarly hurtful to hypochondriac and hysteric persons, as it generates wind and other grievous symptoms. Some people however can bear costiveness to a great degree. I know persons who enjoy pretty good health, yet do not go to stool above once a-week, and others not above once a fortnight. Indeed I have heard of some who do not go above once a month.

Persons who are generally costive should live upon a moistening and laxative diet, as roasted or boiled apples, pears, stewed prunes, raisins, gruels with currants, butter, honey, sugar, and such like. Broths with spinage, leeks, and other soft pot-herbs, are likewise proper. Rye-bread, or that which is made of a mixture of wheat and rye together, ought to be eaten. No person troubled with costiveness should eat white bread alone, especially that which is made of fine flour. The best bread for keeping the body soluble is what in some parts of England they call meslin. It is made of a mixture of wheat and rye, and is very agreeable to those who are accustomed to it.

Costiveness is increased by keeping the body too warm, and by every thing that promotes the perspiration; as wearing flannel, lying too long a-bed, &c. Intense thought, and a sedentary life, are likewise hurtful. All the secretions and excretions are promoted by moderate exercise without doors, and by a gay, cheerful, sprightly temper of mind.

The drink should be of an opening quality. All ardent spirits, austere and astringent wines, as port, claret, &c. ought to be avoided. Malt-liquor that is fine, and of a moderate strength, is very proper. Butter-milk, whey, and other watery liquors, are likewise proper, and may be drank in turns, as the patient’s inclination directs.

Those who are troubled with costiveness, ought, if possible, to remedy it by diet, as the constant use of medicines for that purpose is attended with many inconveniencies, and often with bad consequences[146]. I never knew any one get into a habit of taking medicine for keeping the body open, who could leave it off. In time the custom becomes necessary, and generally ends in a total relaxation of the bowels, indigestion, loss of appetite, wasting of the strength, and death.

When the body cannot be kept open without medicine, we would recommend gentle doses of rhubarb to be taken twice or thrice a-week. This is not near so injurious to the stomach as aloes, jalap, or the other drastic purgatives so much in use. Infusions of senna and manna may likewise be taken, or half an ounce of soluble tartar dissolved in water-gruel. About the size of a nutmeg of lenitive electuary taken twice or thrice a-day generally answers the purpose very well.

WANT OF APPETITE.

This may proceed from a foul stomach; indigestion; the want of free air and exercise; grief; fear; anxiety; or any of the depressing passions; excessive heat; the use of strong broths, fat meats, or any thing that palls the appetite, or is hard of digestion, the immoderate use of strong liquors, tea, tobacco, opium, &c.

The patient ought, if possible, to make choice of an open dry air; to take exercise daily on horseback or in a carriage; to rise betimes; and to avoid all intense thought. He should use a diet of easy digestion; and should avoid excessive heat and great fatigue.

If want of appetite proceeds from errors in diet, or any other part of the patient’s regimen, it ought to be changed. If nausea and reachings shew that the stomach is loaded with crudities, a vomit will be of service. After this a gentle purge or two of rhubarb, or of any of the bitter purging salts, may be taken. The patient ought next to use some of the stomachic bitters infused in wine. Though gentle evacuations be necessary, yet strong purges and vomits are to be avoided, as they weaken the stomach, and hurt digestion.

Elixir of vitriol is an excellent medicine in most cases of indigestion, weakness of the stomach, or want of appetite. From twenty to thirty drops of it may be taken twice or thrice a-day in a glass of wine or water. It may likewise be mixed with the tincture of the bark, one drachm of the former to an ounce of the latter, and two tea-spoonfuls of it taken in wine or water, as above.

The chalybeate waters, if drank in moderation, are generally of considerable service in this case. The salt-water has likewise good effects; but it must not be used too freely. The waters of Harrowgate, Scarborough, Moffat, and most other Spas in Britain, may be used with advantage. We would advise all who are afflicted with indigestion and want of appetite, to repair to these places of public rendezvous. The very change of air, and the cheerful company, will be of service; not to mention the exercise, dissipation, amusements, &c.

OF THE HEART-BURN.

What is commonly called the heart-burn, is not a disease of that organ, but an uneasy sensation of heat or acrimony about the pit of the stomach, which is sometimes attended with anxiety, nausea, and vomiting.

It may proceed from debility of the stomach, indigestion, bile, the abounding of an acid in the stomach, &c. Persons who are liable to this complaint ought to avoid stale liquors, acids, windy or greasy aliments, and should never use violent exercise soon after a plentiful meal. I know many persons who never fail to have the heart-burn if they ride soon after dinner, provided they have drank ale, wine, or any fermented liquor; but are never troubled with it when they have drank rum or brandy and water without any sugar or acid.

When the heart-burn proceeds from debility of the stomach, or indigestion, the patient ought to take a dose or two of rhubarb; afterwards he may use infusions of the Peruvian bark, or any other of the stomachic bitters, in wine or brandy. Exercise in the open air will likewise be of use, and every thing that promotes digestion.

When bilious humours occasion the heart-burn, a tea-spoonful of the sweet spirit of nitre in a glass of water, or a cup of tea, will generally give ease. If it proceeds from the use of greasy aliments, a dram of brandy or rum may be taken.

If acidity or sourness of the stomach occasions the heart-burn, absorbents are the proper medicines. In this case an ounce of powdered chalk, half an ounce of fine sugar, and a quarter of an ounce of gum-arabic, may be mixed in an English quart of water, and a tea-cupful of it taken as often as is necessary. Such as do not chuse chalk may take a tea-spoonful of prepared oyster-shells, or of the powder called crabs eyes, in a glass of cinnamon or peppermint-water. But the safest and bed absorbent is magnesia alba. This not only acts as an absorbent, but likewise as a purgative; whereas chalk, and other absorbents of that kind, are apt to lie in the intestines, and occasion obstructions. This powder is not disagreeable, and may be taken in a cup of tea, or a glass of mint-water. A large tea-spoonful is the usual dose; but it may be taken in a much greater quantity when there is occasion. These things are now generally made up into lozenges for the conveniency of being carried in the pocket, and taken at pleasure.

If wind be the cause of this complaint, the most proper medicines are those called carminatives; as anniseeds, juniper-berries, ginger, canella alba, cardamom seeds, &c. These may either be chewed, or infused in wine, brandy, or other spirits. One of the safest medicines of this kind is the tincture made by infusing an ounce of rhubarb, and a quarter of an ounce of the lesser cardamom seeds, in an English pint of brandy. After this has digested for two or three days, it ought to be strained, and four ounces of white sugar-candy added to it. It must stand to digest a second time till the sugar be dissolved. A table-spoonful of it may be taken occasionally for a dose.

I have frequently known the heart-burn cured, particularly in pregnant women, by chewing green tea. Two table-spoonfuls of what is called the milk of gum-ammoniac, taken once or twice a-day, will sometimes cure the heart-burn.

CHAP. XLIII. OF NERVOUS DISEASES.

Of all diseases incident to mankind, those of the nervous kind are the most complicated and difficult to cure. A volume would not be sufficient to point out their various appearances. They imitate almost every disease; and are seldom alike in two different persons, or even in the same person at different times. Proteus-like, they are continually changing shape; and upon every fresh attack, the patient thinks he feels symptoms which he never experienced before. Nor do they only affect the body; the mind likewise suffers, and is often thereby rendered extremely weak and peevish. The low spirits, timorousness, melancholy, and fickleness of temper, which generally attend nervous disorders, induce many to believe that they are entirely diseases of the mind; but this change of temper is rather a consequence, than the cause of nervous diseases.

CAUSES.——Every thing that tends to relax or weaken the body, disposes it to nervous diseases, as indolence, excessive venery, drinking too much tea, or other weak, watery liquors warm, frequent bleeding, purging, vomiting, &c. Whatever hurts the digestion, or prevents the proper assimilation of the food, has likewise this effect; as long fasting, excess in eating or drinking, the use of windy, crude, or unwholesome aliments, an unfavourable posture of the body, &c.

Nervous disorders often proceed from intense application to study. Indeed few studious persons are entirely free from them. Nor is this at all to be wondered at; intense thinking not only preys upon the spirits, but prevents the person from taking proper exercise, by which means the digestion is impaired, the nourishment prevented, the solids relaxed, and the whole mass of humours vitiated. Grief and disappointment likewise produce the same effects. I have known more nervous patients, who dated the commencement of their disorders from the loss of a husband, a favourite child, or from some disappointment in life, than from any other cause. In a word, whatever weakens the body, or depresses the spirits, may occasion nervous disorders, as unwholesome air, want of sleep, great fatigue, disagreeable apprehensions, anxiety, vexation, &c.

SYMPTOMS.——We shall only mention some of the most general symptoms of these disorders, as it would be both an useless and an endless task to enumerate the whole. They generally begin with windy inflations or distentions of the stomach and intestines; the appetite and digestion are usually bad; yet sometimes there is an uncommon craving for food, and a quick digestion. The food often turns sour on the stomach; and the patient is troubled with vomiting of clear water, tough phlegm, or a blackish-coloured liquor resembling the grounds of coffee. Excruciating pains are often felt about the navel, attended with a rumbling or murmuring noise in the bowels. The body is sometimes loose, but more commonly bound, which occasions a retention of wind and great uneasiness.

The urine is sometimes in small quantity, at other times very copious and quite clear. There is a great straitness of the breast, with difficulty of breathing; violent palpitations of the heart; sudden flushings of heat in various parts of the body; at other times a sense of cold, as if water were poured on them; flying pains in the arms and limbs; pains in the back and belly, resembling those occasioned by gravel; the pulse very variable, sometimes uncommonly slow, and at other times very quick; yawning, the hiccup, frequent sighing, and a sense of suffocation, as if from a ball or lump in the throat; alternate fits of crying and convulsive laughing; the sleep is unsound and seldom refreshing; and the patient is often troubled with the night-mare.

As the disease increases, the patient is molested with head-achs, cramps, and fixed pains in various parts of the body; the eyes are clouded, and often affected with pain and dryness; there is a noise in the ears, and often a dulness of hearing; in short, the whole animal functions are impaired. The mind is disturbed on the most trivial occasions, and is hurried into the most perverse commotions, inquietudes, terror, sadness, anger, diffidence, &c. The patient is apt to entertain wild imaginations and extravagant fancies; the memory becomes weak, and the judgment fails.

Nothing is more characteristic of this disease than a constant dread of death. This renders those unhappy persons who labour under it peevish, fickle, impatient, and apt to run from one physician to another; which is one reason why they seldom reap any benefit from medicine, as they have not sufficient resolution to persist in any one course till it has time to produce its proper effects. They are likewise apt to imagine that they labour under diseases from which they are quite free; and are very angry if any one attempts to set them right, or laugh them out of their ridiculous notions.

REGIMEN.——Persons afflicted with nervous diseases ought never to fast long. Their food should be solid and nourishing, but of easy digestion. Fat meats and heavy sauces are hurtful. All excess should be carefully avoided. They ought never to eat more at a time than they can easily digest; but if they feel themselves weak and faint between meals, they ought to eat a bit of bread, and drink a glass of wine. Heavy suppers are to be avoided. Though wine in excess enfeebles the body, and impairs the faculties of the mind, yet taken in moderation, it strengthens the stomach, and promotes digestion. Wine and water is a very proper drink at meals; but if wine sours on the stomach, or the patient is much troubled with wind, brandy and water will answer better. Every thing that is windy or hard of digestion must be avoided. All weak and warm liquors are hurtful, as tea, coffee, punch, &c. People may find a temporary relief in the use of these, but they always increase the malady, as they weaken the stomach and hurt digestion. Above all things, drams are to be avoided. Whatever immediate ease the patient may feel from the use of ardent spirits, they are sure to aggravate the malady, and prove certain poisons at last. These cautions are the more necessary, as most nervous people are peculiarly fond of tea and ardent spirits; to the use of which many of them fall victims.

Exercise in nervous disorders is superior to all medicines. Riding on horseback is generally esteemed the best, as it gives motion to the whole body, without fatiguing it. I have known some patients, however, with whom walking agreed better, and others who were most benefited by riding in a carriage. Every one ought to use that which he finds most beneficial. Long sea-voyages have an excellent effect; and to those who have sufficient resolution, we would by all means recommend this course. Even change of place, and the sight of new objects, by diverting the mind, have a great tendency to remove these complaints. For this reason a long journey, or a voyage, is of much more advantage than riding short journeys near home.

A cool and dry air is proper, as it braces, and invigorates the whole body. Few things tend more to relax and enervate than hot air, especially that which is rendered so by great fires, or stoves in small apartments. But when the stomach or bowels are weak, the body ought to be well guarded against cold, especially in winter, by wearing a thin flannel waistcoat next the skin. This will keep up an equal perspiration, and defend the alimentary canal from many impressions to which it would otherwise be subject, upon every sudden change from warm to cold weather. Rubbing the body frequently with a flesh-brush, or a coarse linen cloth, is likewise beneficial, as it promotes the circulation, perspiration, &c. Persons who have weak nerves ought to rise early, and take exercise before breakfast, as lying too long a-bed cannot fail to relax the solids. They ought likewise to be diverted, and to be kept as easy and cheerful as possible. There is not any thing which hurts the nervous system, or weakens the digestive powers, more than fear, grief, or anxiety.

MEDICINES.——Though nervous diseases are seldom radically cured, yet their symptoms may sometimes be alleviated, and the patient’s life rendered at least more comfortable by proper medicines.

When the patient is costive, he ought to take a little rhubarb, or some other mild purgative, and should never suffer his body to be long bound. All strong and violent purgatives are however to be avoided, as aloes, jalap, &c. I have generally seen an infusion of senna and rhubarb in brandy answer very well. This may be made of any strength, and taken in such quantity as the patient finds necessary. When digestion is bad, or the stomach relaxed and weak, the following infusion of Peruvian bark and other bitters may be used with advantage:

Take of Peruvian bark an ounce, gentian root, orange-peel, and coriander-seed, of each half an ounce; let these ingredients be all bruised in a mortar, and infused in a bottle of brandy or whiskey, for the space of five or six days. A table-spoonful of the strained liquor may be taken in half a glass of water, an hour before breakfast, dinner, and supper.

Few things tend more to strengthen the nervous system than cold bathing. This practice, if duly persisted in, will produce very extraordinary effects; but when the liver or other viscera are obstructed, or otherwise unsound, the cold bath is improper. It is therefore to be used with very great caution. The most proper seasons for it are summer and autumn. It will be sufficient, especially for persons of a spare habit, to go into the cold bath three or four times a-week. If the patient be weakened by it, or feels chilly for a long time after coming out, it is improper.

In patients afflicted with wind, I have always observed the greatest benefit from the elixir of vitriol. It may be taken in the quantity of fifteen, twenty, or thirty drops, twice or thrice a-day in a glass of water. This both expels wind, strengthens the stomach, and promotes digestion.

Opiates are generally extolled in these maladies; but as they only palliate the symptoms, and generally afterwards increase the disease, we would advise people to be extremely sparing in the use of them, lest habit render them at last absolutely necessary.

It would be an easy matter to enumerate many medicines which have been extolled for relieving nervous disorders; but whoever wishes for a thorough cure must expect it from regimen alone; we shall therefore omit mentioning more medicines, and again recommend the strictest attention to DIET, AIR, EXERCISE, and AMUSEMENTS.

OF MELANCHOLY.

Melancholy is that state of alienation or weakness of mind which renders people incapable of enjoying the pleasures, or performing the duties of life. It is a degree of insanity, and often terminates in absolute madness.

CAUSES.——It may proceed from an hereditary disposition; intense thinking, especially where the mind is long occupied about one object; violent passions or affections of the mind, as love, fear, joy, grief, over-weening pride, and such like. It may also be occasioned by excessive venery; narcotic or stupefactive poisons; a sedentary life; solitude; the suppression of customary evacuations; acute fevers, or other diseases. Violent anger will change melancholy into madness; and excessive cold, especially of the lower extremities, will force the blood into the brain, and produce all the symptoms of madness. It may likewise proceed from the use of aliment that is hard of digestion, or which cannot be easily assimilated; from a callous state of the integuments of the brain, or a dryness of the brain itself. To all which we may add gloomy or mistaken notions of religion.

SYMPTOMS.——When persons begin to be melancholy, they are timorous; watchful; fond of solitude; fretful; fickle; captious and inquisitive; solicitous about trifles; sometimes niggardly, and at other times prodigal. The body is generally bound; the urine thin, and in small quantity; the stomach and bowels inflated with wind; the complexion pale; the pulse slow and weak. The functions of the mind are also greatly perverted, in so much that the patient often imagines himself dead, or changed into some other animal. Some have imagined their bodies were made of glass, or other brittle substances, and were afraid to move, lest they should be broken to pieces. The unhappy patient, in this case, unless carefully watched, is apt to put an end to his own miserable life.

When the disease is owing to an obstruction of customary evacuations, or any bodily disorder, it is easier cured than when it proceeds from affections of the mind, or an hereditary taint. A discharge of blood from the nose, looseness, scabby eruptions, the bleeding piles, or the menses, sometimes carry off this disease.

REGIMEN.——The diet should consist chiefly of vegetables of a cooling and opening quality. Animal food, especially salted or smoke-dried fish or flesh, ought to be avoided. All kinds of shell-fish are bad. Aliments prepared with onions, garlic, or any thing that generates thick blood, are likewise improper. All kind of fruits that are wholesome may be eaten with advantage. Boerhaave gives an instance of a patient who, by a long use of whey, water, and garden-fruit, recovered, after having evacuated a great quantity of black-coloured matter.

Strong liquors of every kind ought to be avoided as poison. The most proper drink is water, whey, or very small beer. Tea and coffee are improper. If honey agrees with the patient, it may be eaten freely, or his drink may be sweetened with it. Infusions of balm-leaves, penny-royal, the roots of wild valerian, or the flowers of the lime-tree, may be drank freely, either by themselves, or sweetened with honey, as the patient shall chuse.

The patient ought to take as much exercise in the open air as he can bear. This helps to dissolve the viscid humours, it removes obstructions, promotes the perspiration, and all the other secretions. Every kind of madness is attended with a diminished perspiration; all means ought therefore to be used to promote that necessary and salutary discharge. Nothing can have a more direct tendency to increase the disease than confining the patient to a close apartment. Were he forced to ride or walk a certain number of miles every day, it would tend greatly to alleviate his disorder; but it would have still a better effect, if he were obliged to labour a piece of ground. By digging, hoeing, planting, sowing, &c. both the body and mind would be exercised. A long journey, or a voyage, especially towards a warmer climate, with agreeable companions, has often very happy effects. A plan of this kind, with a strict attention to diet, is a much more rational method of cure, than confining the patient within doors and plying him with medicines.

MEDICINE.——In the cure of this disease particular attention must be paid to the mind. When the patient is in a low state, his mind ought to be soothed and diverted with variety of amusements, as entertaining stories, pastimes, music, &c. This seems to have been the method of curing melancholy among the Jews, as we learn from the story of King Saul; and indeed it is a very rational one. Nothing can remove diseases of the mind so effectually as applications to the mind itself, the most efficacious of which is music. The patient’s company ought likewise to consist of such persons as are agreeable to him. People in this state are apt to conceive unaccountable aversions against particular persons; and the very sight of such persons is sufficient to distract their minds, and throw them into the utmost perturbation.

When the patient is high, evacuations are necessary. In this case he must be bled, and have his body kept open by purging medicines, as manna, rhubarb, cream of tartar, or the soluble tartar. I have seen the last have very happy effects. It may be taken in the dose of half an ounce, dissolved in water-gruel, every day, for sundry weeks, or even for months, if necessary. More or less may be given according as it operates. Vomits have likewise a good effect; but they must be pretty strong, otherwise they will not operate.

Whatever increases the evacuation of urine or promotes perspiration, has a tendency to remove this disease. Both these secretions may be promoted by the use of nitre and vinegar. Half a drachm of purified nitre may be given three or four times a-day in any manner that is most agreeable to the patient; and an ounce and a half of distilled vinegar may be daily mixed with his drink. Dr. Locker seems to think vinegar the best medicine that can be given in this disease.

Camphire and musk have likewise been used in this case with advantage. Ten or twelve grains of camphire may be rubbed in a mortar with half a drachm of nitre, and taken twice a-day, or oftner, if the stomach will bear it. If it will not sit upon the stomach in this form, it may be made into pills with gum asafœtida and Russian castor, and taken in the quantity above directed. If musk is to be administered, a scruple or twenty-five grains of it may be made into a bolus with a little honey or common syrup, and taken twice or thrice a-day. We do not mean that all these medicines should be administered at once; but whichever of them is given, must be duly persisted in, and where one fails another may be tried.

As it is very difficult to induce patients in this disease to take medicines, we shall mention a few outward applications, which sometimes do good; the principal of these are issues, setons, and warm bathing. Issues may be made in any part of the body, but they generally have the best effect near the spine. The discharge from these may be greatly promoted by dressing them with the mild blistering ointment, and keeping what are commonly called the orrice pease in them. The most proper place for a seton is between the shoulder-blades; and it ought to be placed upwards and downwards, or in the direction of the spine.

OF THE PALSY.

The palsy is a loss or diminution of sense or motion, or of both, in one or more parts of the body. Of all the affections called nervous, this is the most suddenly fatal. It is more or less dangerous, according to the importance of the part affected. A palsy of the heart, lungs, or any part necessary to life, is mortal. When it affects the stomach, the intestines, or the bladder, it is highly dangerous. If the face be affected, the case is bad, as it shews that the disease proceeds from the brain. When the part affected feels cold, is insensible, or wastes away, or when the judgment and memory begin to fail, there is small hope of a cure.

CAUSES.——The immediate cause of palsy is any thing that prevents the regular exertion of the nervous power upon any particular muscle or part of the body. The occasional and predisposing causes are various, as drunkenness; wounds of the brain, or spinal marrow; pressure upon the brain or nerves; very cold or damp air; the suppression of customary evacuations; sudden fear; want of exercise; or whatever greatly relaxes the system, as drinking much tea[147], or coffee, &c. The palsy may likewise proceed from wounds of the nerves themselves, from the poisonous fumes of metals or minerals, as mercury, lead, arsenic.

In young persons of a full habit, the palsy must be treated in the same manner as the sanguine apoplexy. The patient must be bled, blistered, and have his body opened by sharp clysters or purgative medicines. But, in old age, or when the disease proceeds from relaxation or debility, which is generally the case, a quite contrary course must be pursued. The diet must be warm and invigorating, seasoned with spicy and aromatic vegetables, as mustard, horse-radish, &c. The drink may be generous wine, mustard-whey, or brandy and water. Friction with the flesh-brush, or a warm hand, is extremely proper, especially on the parts affected. Blistering-plasters may likewise be applied to the affected parts with advantage. When this cannot be done, they may be rubbed with the volatile liniment, or the nerve ointment of the Edinburgh dispensatory. One of the best external applications is electricity. The shocks, or rather vibrations, should be received on the part affected; and they ought daily to be repeated for several weeks.

Vomits are very beneficial in this kind of palsy, and ought frequently to be administered. Cephalic snuff, or any thing that makes the patient sneeze, is likewise of use. Some pretend to have found great benefit from rubbing the parts affected with nettles; but this does not seem to be any way preferable to blistering. If the tongue is affected, the patient may gargle his mouth frequently with brandy and mustard; or he may hold a bit of sugar in his mouth wet with the palsy-drops or compound spirits of lavender. The wild valerian-root is a very proper medicine in this case. It may either be taken in an infusion with sage-leaves, or half a drachm of it in powder may be given in a glass of wine three times a-day. If the patient cannot use the valerian, he may take of sal volatile oleosum, compound spirits of lavender, and tincture of castor, each half an ounce; mix these together, and take forty or fifty drops in a glass of wine three or four times a-day. A table-spoonful of mustard-seed taken frequently is a very good medicine. The patient ought likewise to chew cinnamon bark, ginger, or other warm spiceries.

Exercise is of the utmost importance in the palsy; but the patient must beware of cold, damp, and moist air. He ought to wear flannel next his skin; and, if possible, should remove into a warmer climate.

OF THE EPILEPSY, OR FALLING SICKNESS.

The epilepsy is a sudden deprivation of all the senses, wherein the patient falls suddenly down, and is affected with violent convulsive motions. Children, especially those who are delicately brought up, are most subject to it. It more frequently attacks men than women, and is very difficult to cure. When the epilepsy attacks children, there is reason to hope it may go off about the time of puberty. When it attacks any person after twenty years of age, the cure is difficult; but when after forty, a cure is hardly to be expected. If the fit continues only for a short space, and returns seldom, there is reason to hope; but if it continues long, and returns frequently, the prospect is bad. It is a very unfavourable symptom when the patient is seized with the fits in his sleep.

CAUSES.——The epilepsy is sometimes hereditary. It may likewise proceed from blows, bruises, or wounds on the head; a collection of water, blood, or serous humours in the brain; a polypus; tumours or concretions within the skull; excessive drinking; intense study; excess of venery; worms; teething; suppression of customary evacuations; too great emptiness or repletion; violent passions or affections of the mind, as fear, joy, &c.; hysteric affections; contagion received into the body, as the infection of the small-pox, measles, &c.

SYMPTOMS.——An epileptic fit is generally preceded by unusual weariness; pain of the head; dulness; giddiness; noise in the ears; dimness of sight; palpitation of the heart; disturbed sleep; difficult breathing; the bowels are inflated with wind; the urine is in great quantity, but thin; the complexion is pale; the extremities are cold; and the patient often feels, as it were, a stream of cold air ascending towards his head.

In the fit, the patient generally makes an unusual noise; his thumbs are drawn in towards the palms of the hands; his eyes are distorted; he starts, and foams at the mouth; his extremities are bent or twitted various ways; he often discharges his seed, urine, and fæces involuntarily; and is quite destitute of all sense and reason. After the fit is over, his senses gradually return, and he complains of a kind of stupor, weariness, and pain of his head; but has no remembrance of what happened to him during the fit.

The fits are sometimes excited by violent affections of the mind, a debauch of liquor, excessive heat, cold, or the like.

This disease, from the difficulty of investigating its causes, and its strange symptoms, was formerly attributed to the wrath of the gods, or the agency of evil spirits. In modern times it has often, by the vulgar, been imputed to witchcraft or fascination. It depends however as much upon natural causes as any other malady; and its cure may often be effected by persisting in the use of proper means.

REGIMEN.——Epileptic patients ought, if possible, to breathe a pure and free air. Their diet should be light but nourishing. They ought to drink nothing strong, to avoid swine’s flesh, water-fowl, and likewise all windy and oily vegetables, as cabbage, nuts, &c. They ought to keep themselves cheerful, carefully guarding against all violent passions, as anger, fear, excessive joy, and the like.

Exercise is likewise of great use; but the patient must be careful to avoid all extremes either of heat or cold, all dangerous situations, as standing upon precipices, riding, deep waters, and such like.

MEDICINE.——The intentions of cure must vary according to the cause of the disease. If the patient be of a sanguine temperament, and there be reason to fear an obstruction in the brain, bleeding and other evacuations will be necessary. When the disease is occasioned by the stoppage of customary evacuations, these, if possible, must be restored; if this cannot be done, others may be substituted in their place. Issues or setons in this case have often a very good effect. When there is reason to believe that the disease proceeds from worms, proper medicines must be used to kill, or carry off these vermin. When the disease proceeds from teething, the body should be kept open by emollient clysters, the feet frequently bathed in warm water, and, if the fits prove obstinate, a blistering-plaster may be put betwixt the shoulders. The same method is to be followed, when epileptic fits precede the eruption of the small-pox, or measles, &c.

When the disease is hereditary, or proceeds from a wrong formation of the brain, a cure is not to be expected. When it is owing to a debility, or too great an irritability of the nervous system, such medicines as tend to brace and strengthen the nerves may be used, as the Peruvian bark, and steel; or the anti-epileptic electuaries, recommended by Fuller and Mead[148].

The flowers of zinc have of late been highly extolled for the cure of the epilepsy. Though this medicine will not be found to answer the expectations which have been raised concerning it, yet in obstinate epileptic cases it deserves a trial. The dose is from one to three or four grains, which may be taken either in pills or a bolus, as the patient inclines. The best method is to begin with a single grain four or five times a day, and gradually to increase the dose as far as the patient can bear it. I have known this medicine, when duly persisted in, prove beneficial.

Musk has sometimes been found to succeed in the epilepsy. Ten or twelve grains of it, with the same quantity of factitious cinnabar, may be made up into a bolus, and taken every night and morning.

Sometimes the epilepsy has been cured by electricity.

Convulsion-fits proceed from the same causes, and must be treated in the same manner as the epilepsy.

There is one particular species of convulsion-fits which commonly goes by the name of St. Vitus’s dance, wherein the patient is agitated with strange motions and gesticulations, which by the common people are generally believed to be the effects of witchcraft. This disease may be cured by repeated bleedings and purges; and afterwards using the medicines prescribed above for the epilepsy, viz. the Peruvian bark and snake-root, &c. Chalybeate waters are found to be beneficial in this case. The cold bath is likewise of singular service, and ought never to be neglected when the patient can bear it.

OF THE HICCUP.

The hiccup is a spasmodic or convulsive affection of the stomach and midriff, arising from any cause that irritates their nervous fibres.

It may proceed from excess in eating or drinking; from a hurt of the stomach; poisons; inflammations or scirrhous tumours of the stomach, intestines, bladder, midriff, or the rest of the viscera. In gangrenes, acute and malignant fevers, a hiccup is often the forerunner of death.

When the hiccup proceeds from the use of aliment that is flatulent, or hard of digestion, a draught of generous wine, or a dram of any spirituous liquor, will generally remove it. If poison be the cause, plenty of milk and oil must be drank, as has been formerly recommended. When it proceeds from an inflammation of the stomach, &c. it is very dangerous. In this case the cooling regimen ought to be strictly observed. The patient must be bled, and take frequently a few drops of the sweet spirits of nitre in a cup of wine-whey. His stomach should likewise be fomented with cloths dipped in warm water, or have bladders filled with warm milk and water applied to it.

When the hiccup proceeds from a gangrene or mortification, the Peruvian bark, with other antiseptics, are the only medicines which have a chance to succeed. When it is a primary disease, and proceeds from a foul stomach, loaded either with a pituitous or a bilious humour, a gentle vomit and purge, if the patient be able to bear them, will be of service. If it arises from flatulencies, the carminative medicines directed for the heart-burn must be used.

When the hiccup proves very obstinate, recourse must be had to the most powerful aromatic and antispasmodic medicines. The principal of these is musk; fifteen or twenty grains of which may be made into a bolus, and repeated occasionally. Opiates are likewise of service; but they must be used with caution. A bit of sugar dipped in compound spirits of lavender, or the volatile aromatic tincture, may be taken frequently. External applications are sometimes also beneficial; as the stomach plaster, or a cataplasm of the Venice treacle of the Edinburgh or London dispensatory, applied to the region of the stomach.

I lately attended a patient who had almost a constant hiccup for above nine weeks. It was frequently stopped by the use of musk, opium, wine, and other cordial and antispasmodic medicines, but always returned. Nothing however gave the patient so much ease as brisk small-beer. By drinking freely of this, the hiccup was often kept off for several days, which was more than could be done by the most powerful medicines. The patient was at length seized with a vomiting of blood, which soon put an end to his life. Upon opening the body, a large scirrhous tumour was found near the pylorus or right orifice of the stomach.

The hiccup may be removed by taking vinegar, or a few drops of the oil of vitriol taken in water.

CRAMP OF THE STOMACH.

This disease often seizes people suddenly, is very dangerous, and requires immediate assistance. It is most incident to persons in the decline of life, especially the nervous, gouty, hysteric, and hypochondriac.

If the patient has any inclination to vomit, he ought to take some draughts of warm water, or weak camomile-tea, to cleanse his stomach. After this, if he has been costive, a laxative clyster may be given. He ought then to take laudanum. The best way of administering it is in a clyster. Sixty or seventy drops of liquid laudanum may be given in a clyster of warm water. This is much more certain than laudanum given by the mouth, which is often vomited, and in some cases increases the pain and spasms in the stomach.

If the pain and cramps return with great violence, after the effects of the anodyne clyster are over, another, with an equal or a larger quantity of opium, may be given; and every four or five hours a bolus, with ten or twelve grains of musk, and half a drachm of the Venice treacle.

In the mean time, the stomach ought to be fomented with cloths dipped in warm water, or bladders filled with warm milk and water should be constantly applied to it. I have often seen these produce the most happy effects. The anodyne balsam may also be rubbed on the part affected; and an anti-hysteric plaster worn upon it for some time after the cramps are removed, to prevent their return.

In very violent and lasting pains of the stomach, some blood ought to be let, unless the weakness of the patient forbids it. When the pain or cramps proceed from a suppression of the menses, bleeding is of use. If they be owing to the gout, recourse must be had to spirits, or some of the warm cordial waters. Blistering plasters ought likewise in this case to be applied to the ancles. I have often seen violent cramps and pains of the stomach removed by covering it with a large plaster of Venice treacle.

OF THE NIGHT-MARE.

In this disease the patient, in time of sleep, imagines he feels an uncommon oppression or weight about his breast or stomach, which he can by no means shake off. He groans, and sometimes cries out, though oftner he attempts to speak in vain. Sometimes he imagines himself engaged with an enemy, and in danger of being killed, attempts to run away, but finds he cannot. Sometimes he fancies himself in a house that is on fire, or that he is in danger of being drowned in a river. He often thinks he is falling over a precipice, and the dread of being dashed to pieces suddenly awakes him.

This disorder has been supposed to proceed from too much blood; from a stagnation of blood in the brain, lungs, &c. But it is rather a nervous affection, and arises chiefly from indigestion. Hence we find that persons of weak nerves, who lead a sedentary life, and live full, are most commonly afflicted with the night-mare. Nothing tends more to produce it than heavy suppers, especially when eaten late, or the patient goes to bed soon after. Wind is likewise a very frequent cause of this disease; for which reason those who are afflicted with it ought to avoid all flatulent food. Deep thought, anxiety, or any thing that oppresses the mind, ought also to be avoided.

As persons afflicted with the night-mare generally moan, or make some noise in the fit, they should be waked, or spoken to by such as hear them, as the uneasiness generally goes off as soon as the patient is awake. Dr. Whytt says, he generally found a dram of brandy, taken at bed-time, prevent this disease. That however is a bad custom, and in time loses its effect. We would rather have the patient depend upon the use of food of easy digestion, cheerfulness, exercise through the day, and a light supper taken early, than to accustom himself to drams. A glass of peppermint-water will often promote digestion as much as a glass of brandy, and is much safer. After a person of weak digestion, however, has eaten flatulent food, a dram may be necessary; in this case we would recommend it as the most proper medicine.

Persons who are young, and full of blood, if troubled with the night-mare, ought to take a purge frequently, and use a spare diet.

OF SWOONINGS.

People of weak nerves or delicate constitutions are liable to swoonings or fainting fits. These indeed are seldom dangerous when duly attended to; but when wholly neglected, or improperly treated, they often prove hurtful, and sometimes fatal.

The general causes of swoonings are, sudden transition from cold to heat; breathing air that is deprived of its proper spring or elasticity; great fatigue; excessive weakness; loss of blood; long fasting; fear, grief, and other violent passions or affections of the mind.

It is well known, that persons who have been long exposed to cold, often faint or fall into a swoon, upon coming into the house, especially if they drink hot liquor, or sit near a large fire. This might easily be prevented by people taking care not to go into a warm room immediately after they have been exposed to the cold air, to approach the fire gradually, and not to eat or drink any thing hot, till the body has been gradually brought into a warm temperature.

When any one, in consequence of neglecting these precautions, falls into a swoon, he ought immediately to be removed to a cooler apartment, to have ligatures applied above his knees and elbows, and to have his hands and face sprinkled with vinegar or cold water. He should likewise be made to smell to vinegar, and should have a spoonful or two of water, if he can swallow, with about a third part of vinegar mixed with it, poured into his mouth. If these should not remove the complaint, it will be necessary to bleed the patient, and afterwards to give him a clyster.

As air that is breathed frequently loses its elasticity or spring, it is no wonder if persons who respire in it often fall into a swoon or fainting fit. They are in this case deprived of the very principle of life. Hence it is that fainting fits are so frequent in all crowded assemblies, especially in hot seasons. Such fits however must be considered as a kind of temporary death; and, to the weak and delicate, they sometimes prove fatal. They ought therefore with the utmost care to be guarded against. The method of doing this is obvious. Let assembly-rooms, and all other places of public resort, be large and well ventilated; and let the weak and delicate avoid such places, particularly in warm seasons.

A person who faints, in such a situation, ought immediately to be carried into the open air; his temples should be rubbed with strong vinegar or brandy, and volatile spirits of salts held to his nose. He should be laid upon his back with his head low, and have a little wine, or some other cordial, as soon as he is able to swallow it, poured into his mouth. If the person has been subject to hysteric fits, castor or asafœtida should be applied to the nose, or burnt feathers, horn, or leather, &c.

When fainting fits proceed from mere weakness or exhaustion, which is often the case after great fatigue, long fasting, loss of blood, or the like, the patient must be supported with generous cordials, as jellies, wines, spirituous liquors, &c. These however must be given at first in very small quantities, and increased gradually as the patient is able to bear them. He ought to be allowed to lie quite still and easy upon his back, with his head low, and should have fresh air admitted into his chamber. His food should consist of nourishing broths, sago-gruel with wine, new milk, and other things of a light and cordial nature. These things are to be given out of the fit. All that can be done in the fit is, to let him smell to a bottle of Hungary-water, eau de luce, or spirits of hartshorn, and to rub his temples with warm brandy, or to lay a compress dipped in it to the pit of the stomach.

In fainting fits that proceed from fear, grief, or other violent passions or affections of the mind, the patient must be very cautiously managed. He should be suffered to remain at rest, and only made to smell to some vinegar. After he is come to himself he may drink freely of warm lemonade, or balm-tea, with some orange or lemon-peel in it. It will likewise be proper, if the fainting fits have been long and severe, to clean the bowels by throwing in an emollient clyster.

It is common in fainting fits, from whatever cause they proceed, to bleed the patient. This practice may be very proper in strong persons of a full habit; but in those who are weak and delicate, or subject to nervous disorders, it is dangerous. The proper method with such people is, to expose them to the free air, and to use cordial and stimulating medicines, as volatile salts, Hungary-water, spirits of lavender, tincture of castor, and the like.

OF FLATULENCIES, OR WIND.

All nervous patients, without exception, are afflicted with wind or flatulencies in the stomach and bowels, which arise chiefly from the want of tone or vigour in these organs. Crude flatulent aliment, as green peas, beans, coleworts, cabbages, and such like, may increase this complaint; but strong and healthy people are seldom troubled with wind, unless they either overload their stomachs, or drink liquors that are in a fermenting state, and consequently full of elastic air. While therefore the matter of flatulence proceeds from our aliments, the cause which makes air separate from them in such quantity as to occasion complaints, is almost always a fault of the bowels themselves, which are too weak either to prevent the production of elastic air, or to expel it after it is produced.

To relieve this complaint, such medicines ought to be used as have a tendency to expel wind, and by strengthening the alimentary canal, to prevent its being produced there[149].

The list of medicines for expelling wind is very numerous; they often however disappoint the expectations of both the physician and his patient. The most celebrated among the class of carminatives are juniper berries; the roots of ginger and zedoary; the seeds of anise, caraway, and coriander; gum asafœtida and opium; the warm waters, tinctures, and spirits, as the aromatic water, the tincture of wood-soot, the volatile aromatic spirit, æther, &c.

Dr. Whytt says, he found no medicines more efficacious in expelling wind than æther and laudanum. He generally gave the laudanum in a mixture with peppermint-water and tincture of castor, or sweet spirits of nitre. Sometimes, in place of this, he gave opium in pills with asafœtida. He observes that the good effects of opiates are equally conspicuous, whether the flatulence be contained in the stomach or intestines; whereas those warm medicines, commonly called carminatives, do not often give immediate relief, except when the wind is in the stomach.

With regard to æther, the Doctor says, he has often seen very good effects from it in flatulent complaints, where other medicines failed. The dose is a tea-spoonful mixed with two table-spoonfuls of water[150]. In gouty cases he observes, that æther, a glass of French brandy, or of the aromatic water, or ginger, either taken in substance or infused in boiling water, are among the best medicines for expelling wind.

When the case of flatulent patients is such as makes it improper to give them warm medicines inwardly, the Doctor recommends external applications, which are sometimes of advantage. Equal parts of the anti-hysteric and stomach plaster may be spread upon a piece of soft leather, of such size as to cover the greater part of the belly. This should be kept on for a considerable time, provided the patient be able to bear it; if it should give great uneasiness, it may be taken off, and the following liniment used in its stead:

Take of Bates’s anodyne balsam an ounce; of the expressed oil of mace half an ounce; oil of mint two drachms. Let these ingredients be mixed together, and about a table-spoonful well rubbed on the parts at bed-time.

For strengthening the stomach and bowels, and consequently for lessening the production of flatulence, the Doctor recommends the Peruvian bark, bitters, chalybeates, and exercise. In flatulent cases, he thinks some nutmeg or ginger should be added to the tincture of the bark and bitters, and that the aromatic powder should be joined with the filings of iron.

When windy complaints are attended with costiveness, which is often the case, few things will be found to answer better than four or five of the following pills taken every night at bed-time:

Take of asafœtida two drachms; succotorine aloes, salt of iron, and powdered ginger, of each one drachm; as much of the elixir proprietatis as will be sufficient to form them into pills.

On the other hand, when the body is too open, twelve or fifteen grains of rhubarb, with half a drachm or two scruples of the Japonic confection, given every other evening, will have very good effects.

In those flatulent complaints which come on about the time the menses cease, repeated small bleedings often give more relief than any other remedy.

With regard to diet, the Doctor observes, that tea, and likewise all flatulent aliments, are to be avoided; and that for drink, water with a little brandy or rum is not only preferable to malt liquor, but in most cases also to wine.

As Dr. Whytt has paid great attention to this subject, and as his sentiments upon it in a great measure agree with mine, I have taken the liberty to adopt them; and shall only add to his observations, that exercise is in my opinion superior to all medicine, both for preventing the production and likewise for expelling of flatulencies. These effects, however, are not to be expected from sauntering about, or lolling in a carriage; but from labour, or such active amusements as give exercise to every part of the body.

OF LOW SPIRITS.

All who have weak nerves are subject to low spirits in a greater or less degree. Generous diet, the cold bath, exercise, and amusements, are the most likely means to remove this complaint. It is greatly increased by solitude and indulging gloomy ideas; but may often be relieved by cheerful company and sprightly amusements.

When low spirits are owing to a weak relaxed state of the stomach and bowels, an infusion of the Peruvian bark with cinnamon or nutmeg will be proper. Steel joined with aromatics may likewise in this case be used with advantage; but riding, and a proper diet, are most to be depended on.

When they arise from a foulness of the stomach and intestines, or obstruction in the hypochondriac viscera, aloetic purges will be proper. I have sometimes known the Harrowgate sulphur-water of service in this case.

When low spirits proceed from a suppression of the menstrual or of the hæmorrhoidal flux, these evacuations may either be restored, or some others substituted in their place, as issues, setons, or the like. Dr. Whytt observes, that nothing has such sudden good effects in this case as bleeding.

When low spirits have been brought on by long-continued grief, anxiety, or other distress of mind, agreeable company, variety of amusements, and change of place, especially travelling into foreign countries, will afford the most certain relief.

Persons afflicted with low spirits should avoid all kinds of excess, especially of venery and strong liquors. The moderate use of wine and other strong liquors is by no means hurtful; but when taken to excess they weaken the stomach, vitiate the humours, and depress the spirits. This caution is the more necessary, as the unfortunate and melancholy often fly to strong liquors for relief, by which means they never fail to precipitate their own destruction.

OF HYSTERIC AFFECTIONS.

These likewise belong to the numerous tribe of nervous diseases, which may be justly reckoned the reproach of medicine. Women of a delicate habit, whose stomach and intestines are relaxed, and whose nervous system is extremely sensible, are most subject to hysteric complaints. In such persons a hysteric fit, as it is called, may be brought on by an irritation of the nerves of the stomach or intestines, by wind, acrid humour, or the like. A sudden suppression of the menses often gives rise to hysteric fits. They may likewise be excited by violent passions or affections of the mind, as fear, grief, anger, or great disappointments.

Sometimes the hysteric fit resembles a swoon or fainting fit, during which the patient lies as in a sleep, only the breathing is so low as scarce to be perceived. At other times the patient is affected with catchings and strong convulsions. The symptoms which precede hysteric fits are likewise various in different persons. Sometimes the fits come on with coldness of the extremities, yawning and stretching, lowness of spirits, oppression and anxiety. At other times the approach of the fit is foretold by a feeling, as if there were a ball at the lower part of the belly, which gradually rises towards the stomach, where it occasions inflation, sickness, and sometimes vomiting; afterwards it rises into the gullet, and occasions a degree of suffocation, to which quick breathing, palpitation of the heart, giddiness of the head, dimness of the sight, loss of hearing, with convulsive motions of the extremities and other parts of the body, succeed. The hysteric paroxysm is often introduced by an immoderate fit of laughter, and sometimes it goes off by crying. Indeed there is not much difference between the laughing and crying of an highly hysteric lady.

Our aim in the treatment of this disease must be to shorten the fit or paroxysm when present, and to prevent its return. The longer the fits continue, and the more frequently they return, the disease becomes the more obstinate. Their strength is increased by habit, and they induce so great a relaxation of the system, that it is with difficulty removed.

It is customary, during the hysteric fit or paroxysm, to bleed the patient. In strong persons of a plethoric habit, and where the pulse is full, this may be proper; but in weak and delicate constitutions, or where the disease has been of long standing, or arises from inanition, it is not safe. The best course in such cases is to rouse the patient by strong smells, as burnt feathers, asafœtida, or spirits of hartshorn, held to the nose. Hot bricks may also be applied to the soles of the feet, and the legs, arms, and belly may be strongly rubbed with a warm cloth. But the best application is to put the feet and legs into warm water. This is peculiarly proper when the fits precede the flow of the menses. In case of costiveness, a laxative clyster with asafœtida will be proper; and as soon as the patient can swallow, two table-spoonfuls of a solution of asafœtida, or of some cordial julep, may be given[151].

The radical cure of this disorder will be best attempted at a time when the patient is most free from the fits. It will be greatly promoted by a proper attention to diet. A milk and vegetable diet, when duly persisted in, will often perform a cure. If however the patient has been accustomed to a more generous diet, it will not be safe to leave it off all at once, but by degrees. The most proper drink is water with a small quantity of spirits. A cool dry air is the best. Cold bathing and every thing that braces the nerves, and invigorates the system, is beneficial; but lying too long in bed, or whatever relaxes the body, is hurtful. It is of the greatest importance to have the mind kept constantly easy and cheerful, and, if possible, to have it always engaged in some agreeable and interesting pursuit.

The proper medicines are those which strengthen the alimentary canal and the whole nervous system, as the preparations of iron, the Peruvian bark, and other bitters. Twenty drops of the elixir of vitriol, in a cup of the infusion of the bark, may be taken twice or thrice a day. The bark and iron may likewise be taken in substance, provided the stomach can bear them; but they are generally given in too small doses to have any effect. The chalybeate waters generally prove beneficial in this disorder.

If the stomach is loaded with phlegm, vomits will be of use; but they should not be too strong, nor frequently repeated, as they tend to relax and weaken the stomach. If there be a tendency to costiveness, it must be removed either by diet, or by taking an opening pill as often as it shall be found necessary.

To lessen the irritability of the system, antispasmodic medicines will be of use. The best antispasmodic medicines are musk, opium, and castor. When opium disagrees with the stomach, it may either be applied externally, or given in clysters. It is often successful in removing those periodical head-achs to which hysteric and hypochondriac patients are subject. Castor has in some cases been found to procure sleep where opium failed; for which reason Dr. Whytt advises, that they should be joined together. He likewise recommends the anti-hysteric plaster to be applied to the abdomen[152].

Hysteric women are often afflicted with cramps in various parts of the body, which are most apt to seize them in bed, or when asleep. The most efficacious medicines in this case are opium, blistering-plasters, and warm bathing or fomentations. When the cramp or spasm is very violent, opium is the remedy most to be depended on. In milder cases, immersing the feet and legs in warm water, or applying a blistering-plaster to the part affected, will often be sufficient to remove the complaint. In patients whose nerves are uncommonly delicate and sensible, it will be better to omit the blistering-plaster, and to attempt the cure by opiates, musk, camphire, and the warm bath.

Cramps are often prevented or cured by compression. Thus cramps in the legs are prevented, and sometimes removed, by tight bandages; and when convulsions arise from a flatulent distention of the intestines, or from spasms beginning in them, they may be often lessened or cured by making a pretty strong compression upon the abdomen by means of a broad belt. A roll of brimstone held in the hand is frequently used as a remedy for cramps. Though this seems to owe its effect chiefly to imagination; yet, as it sometimes succeeds, it merits a trial[153]. When spasms or convulsive motions arise from sharp humours in the stomach and intestines, no lasting relief can be procured till these are either corrected or expelled. The Peruvian bark has sometimes cured periodic convulsions after other medicines had failed.

OF HYPOCHONDRIAC AFFECTIONS.

This disease generally attacks the indolent, the luxurious, the unfortunate, and the studious. It becomes daily more common in this country, owing, no doubt, to the increase of luxury and sedentary employments. It has so near a resemblance to the immediately preceding, that many authors consider them as the same disease, and treat them accordingly. They require however a very different regimen; and the symptoms of the latter, though less violent, are more permanent than those of the former.

Men of a melancholy temperament, whose minds are capable of great attention, and whose passions are not easily moved, are, in the advanced periods of life, most liable to this disease. It is usually brought on by long and serious attention to abstruse subjects, grief, the suppression of customary evacuations, excess of venery, the repulsion of cutaneous eruptions, long-continued evacuations, obstructions in some of the viscera, as the liver, spleen, &c.

Hypochondriac persons ought never to fast long, and their food should be solid and nourishing. All acescent and windy vegetables are to be avoided. Flesh-meats agree best with them, and their drink should be old claret, or good madeira. Should these disagree with the stomach, water with a little brandy or rum in it may be drank.

Cheerfulness and serenity of mind are by all means to be cultivated. Exercise of every kind is useful. The cold bath is likewise beneficial; and, where it does not agree with the patient, frictions with the flesh-brush or a coarse cloth may be tried. If the patient has it in his power, he ought to travel either by sea or land. A voyage or a long journey, especially towards a warmer climate, will be of more service than any medicine.

The general intentions of cure, in this disease, are to strengthen the alimentary canal, and to promote the secretions. These intentions will be best answered by the different preparations of iron and the Peruvian bark, which, after proper evacuations, may be taken in the same manner as directed in the preceding disease.

If the patient be costive, it will be necessary to make use of some gentle opening medicine, as pills composed of equal parts of aloes, rhubarb, and asafœtida, with as much of the elixir proprietatis as is necessary to form the ingredients into pills. Two, three, or four of these may be taken as often as it shall be found needful, to keep the body gently open. Such as cannot bear the asafœtida may substitute Spanish soap in its place.

Though a cheerful glass may have good effects in this disease, yet all manner of excess is hurtful. Intense study, and every thing that depresses the spirits, are likewise pernicious.

Though the general symptoms and treatment of nervous disorders were pointed out in the beginning of this chapter; yet, for the benefit of the unhappy persons afflicted with those obstinate and complicated maladies, I have treated several of their capital symptoms under distinct or separate heads. These however are not to be considered as different diseases, but as various modifications of the same disease. They all arise from the same general causes, and require nearly the same method of treatment. There are many other symptoms that merit particular attention, which the nature of my plan will not permit me to treat of at full length. I shall therefore omit them altogether, and conclude this chapter with a few general remarks on the most obvious means of preventing or avoiding nervous disorders.

In all persons afflicted with nervous disorders, there is a great delicacy and sensibility of the whole nervous system, and an uncommon degree of weakness of the organs of digestion. These may be either natural or acquired. When owing to a defect in the constitution, they are hardly to be removed; but may be mitigated by proper care. When induced by diseases, as long or repeated fevers, profuse hæmorrhages, or the like, they prove also very obstinate, and will yield only to a course of regimen calculated to restore and invigorate the habit.

But nervous affections arise more frequently from causes, which it is in a great measure in our own power to avoid, than from diseases, or an original fault in the constitution, &c. Excessive grief, intense study, improper diet, and neglect of exercise, are the great sources of this extensive class of diseases.

It has been already observed, that grief indulged destroys the appetite and digestion, depresses the spirits, and induces an universal relaxation and debility of the whole system. Instances of this are daily to be seen. The loss of a near relation, or any other misfortune in life, is often sufficient to occasion the most complicated series of nervous symptoms. Such misfortunes indeed are not to be avoided, but surely their effects, by a vigorous and proper exertion of the mind, might be rendered less hurtful. For directions in this matter we must refer the reader to the article GRIEF, in the chapter on the passions.

The effects of intense study are pretty similar to those occasioned by grief. It preys upon the animal spirits, and destroys the appetite and digestion. To prevent these effects, studious persons ought, according to the Poet, to toy with their books[154]. They should never study too long at a time; nor attend long to one particular subject, especially if it be of a serious nature. They ought likewise to be attentive to their posture, and should take care frequently to unbend their minds by music, diversions, or going into agreeable company.

With regard to diet, I shall only observe, that nervous diseases may be induced either by excess or inanition. Both of these extremes hurt indigestion, and vitiate the humours. When Nature is oppressed with fresh loads of food, before she has had time to digest and assimilate the former meal, her powers are weakened, and the vessels are filled with crude humours. On the other hand, when the food is not sufficiently nourishing, or is taken too seldom, the bowels are inflated with wind, and the humours, for want of regular fresh supplies of wholesome chyle, are vitiated. These extremes are therefore with equal care to be avoided. They both tend to induce a relaxation, and debility of the nervous system, with all its dreadful train of consequences.

But the most general cause of nervous disorders is indolence. The active and laborious are seldom troubled with them. They are reserved for the children of ease and affluence, who generally feel their keenest force. All we shall say to such persons is, that the means of prevention and cure are both in their own power. If the constitution of human nature be such, that man must either labour or suffer diseases, surely no individual has any right to expect an exemption from the general rule.

Those however who are willing to take exercise, but whose occupations confine them to the house, and perhaps to an unfavourable posture, really deserve our pity. We have in a former part of the book endeavoured to lay down rules for their conduct; and shall only add, that where these cannot be complied with, their place may, in some measure, be supplied by the use of bracing and strengthening medicines, as the Peruvian bark, with other bitters; the preparations of steel; the elixir of vitriol, &c.

CHAP. XLIV. DISORDERS OF THE SENSES.

We do not mean to treat of the nature of our sensations, or to give a minute description of the various organs by which they are performed; but to point out some of the diseases to which these organs are most liable, and to shew how they may be prevented or remedied.

OF THE EYE.

No organ of the body is subject to more diseases than the eye; nor is there any one of which the diseases are more difficult to cure. Though more ignorant persons pretend to cure these than any other class of diseases; yet a very superficial acquaintance with the structure of the eye, and the nature of vision, will be sufficient to convince any one of the danger of trusting to them. These diseases often exceed the skill of the most learned physician; hence we may easily infer the danger of trusting them to ignorant quacks, who, without all peradventure, put out more eyes than they cure. But, though the diseases of the eye can seldom be cured, they might often, by due care, be prevented; and, even where the sight is totally lost, many things might be done, which are generally neglected, to render the unhappy person both more useful to himself and to society[155].

The eyes are hurt by viewing bright or luminous objects; keeping the head too long in a hanging posture; violent head-achs; excessive venery; the long use of bitters; the effluvia from acrid or volatile substances; various diseases; as the small-pox, measles, &c. but, above all, from night-watching, and candle-light studies. Long fasting is likewise hurtful to the eyes, and frequent heats and colds are no less pernicious. The eyes are often hurt by the stoppage of customary evacuations; as morning sweats; sweating of the feet; the menses in women; and the bleeding piles in men. All kinds of excess are likewise hurtful to the sight, particularly the immoderate use of ardent spirits and other strong liquors.

In all diseases of the eyes, especially those attended with inflammation, the cool regimen ought to be observed. The patient must abstain from all spirituous liquors. The smoke of tobacco, smoky rooms, the vapours of onions and garlic, and all vivid lights and glaring colours, are carefully to be avoided. The drink may be water, whey, or small beer; and the aliment must be light and of easy digestion.

For preventing disorders of the eyes, issues and setons are of prime use. Every person, whose eyes are tender, ought to have one or more of these in some part of the body. It will likewise be of use to keep the body gently open, and either to bleed or purge every spring and fall. All excess and night studies are to be avoided. Such as do not chuse a seton or an issue, will find benefit from wearing a small Burgundy-pitch plaster between their shoulders.

A gutta serena, or amaurosis, is an abolition of the sight without any apparent cause or fault in the eyes. When it is owing to a decay or wasting of the optic nerve, it does not admit of a cure; but when it proceeds from a compression of the nerves by redundant humours, these may in some measure be drained off, and the patient relieved. For this purpose, the body must be kept open with the laxative mercurial pills. If the patient be young and of a sanguine habit, he may be bled. Cupping, with scarifications on the back part of the head, will likewise be of use. A running at the nose may be promoted by volatile salts, stimulating powders, &c. But the most likely means for relieving the patient are issues or blisters kept open for a long time on the back part of the head, behind the ears, or on the neck. I have known these restore sight, even after it had been for a considerable time lost.

Should these fail, recourse must be had to a mercurial salivation; or what will perhaps answer the purpose better, twelve grains of the corrosive sublimate of mercury may be dissolved in an English pint and a half of brandy, and a table-spoonful of it taken twice a-day, drinking half a pint of the decoction of sarsaparilla after it.

A cataract is an obstruction of the pupil, by the interposition of some opaque substance which either diminishes or totally extinguishes the sight. It is generally an opacity of the crystalline humour. In a recent or beginning cataract, the same medicines are to be used as in the gutta serena; and they will sometimes succeed. But when this does not happen, and the cataract becomes firm, it must be couched, or rather extracted. I have resolved a recent cataract by giving the patient frequent purges with calomel, keeping a poultice of fresh hemlock constantly upon the eye, and a perpetual blister on the neck.

The myopia, or short sightedness, and the presbyopia, or seeing only at too great a distance, are disorders which depend on the original structure or figure of the eye, therefore admit of no cure. The inconveniencies arising from them may however be, in some measure, remedied by the help of proper glasses. The former requires the aid of a concave, and the latter of a convex glass.

A strabismus, or squinting, depends upon an irregular contraction of the muscles of the eye from a spasm, palsy, epilepsy, or an ill habit. Children often contract this disorder by having their eyes unequally exposed to the light. They may likewise acquire it by imitation from a squinting nurse or play-fellow, &c. As this disorder can hardly be cured, parents ought to be careful to prevent it. Almost the only thing which can be done for it is, to contrive a mask for the child to wear, which will only permit him to see in a straight direction.

Spots or specks on the eyes are generally the effect of inflammation, and often appear after the small-pox, the measles, or violent ophthalmias. They are very difficult to cure, and often occasion total blindness. If the specks are soft and thin, they may sometimes be taken off by gentle caustics and discutients; as vitriol, the juice of celandine, &c. When these do not succeed, a surgical operation may be tried: the success of this however is always very doubtful.

The blood-shot eye may be occasioned by a stroke, a fall, retching, vomiting, violent coughing, &c. I have frequently known it happen to children in the hooping-cough. It appears at first like a bit of scarlet, and is afterwards of a livid or blackish colour. This disorder generally goes off without medicine. Should it prove obstinate, the patient may be bled, and have his eyes fomented with a decoction of comphrey roots and elder flowers. A soft poultice may be applied to the eyes; and the body should be kept open by gentle purgatives.

The watery, or weeping eye, is generally occasioned by a relaxation or weakness of the glandular parts of that organ. These may be braced and strengthened by bathing the eye with brandy and water, Hungary-water, rose-water with white vitriol dissolved in it, &c. Medicines which make a revulsion are likewise proper; as mild purgatives, perpetual blisters on the neck, bathing the feet frequently in lukewarm water, &c.

When this disease proceeds from an obstruction of the lachrymal duct, or natural passage of the tears, it is called a fistula lachrymalis, and can only be cured by a surgical operation.

OF THE EAR.

The functions of the ear may be injured by wounds, ulcers, or any thing that hurts its fabric. The hearing may likewise be hurt by excessive noise; violent colds in the head; fevers; hard wax, or other substances sticking in the cavity of the ear; too great a degree of moisture or dryness of the ear. Deafness is very often the effect of old age, and is incident to most people in the decline of life. Sometimes it is owing to an original fault in the structure or formation of the ear itself. When this is the case, it admits of no cure; and the unhappy person not only continues deaf, but generally likewise dumb, for life[156].

When deafness is the effect of wounds or ulcers of the ears, or of old age, it is not easily removed. When it proceeds from cold of the head, the patient must be careful to keep his head warm, especially in the night; he should likewise take some gentle purges, and keep his feet warm, and bathe them frequently in lukewarm water at bed-time. When deafness is the effect of a fever, it generally goes off after the patient recovers. If it proceeds from dry wax sticking in the ears, it may be softened by dropping oil into them; afterwards they must be syringed with warm milk and water.

If deafness proceeds from dryness of the ears, which may be known by looking into them, half an ounce of the oil of sweet almonds, and the same quantity of liquid apodeldoch, or tincture of asafœtida, may be mixed together, and a few drops of it put into the ear every night at bed-time, stopping them afterwards with a little wool or cotton. Some, instead of oil, put a small slice of the fat of bacon into each ear, which is said to answer the purpose very well. When the ears abound with moisture, it may be drained off by an issue or seton, which should be made as near the affected parts as possible.

Some, for the cure of deafness, recommend the gall of an eel mixed with spirit of wine, to be dropped into the ear; others, equal parts of Hungary-water and spirit of lavender. Etmuller extols amber and musk; and Brookes says, he has often known hardness of hearing cured by putting a grain or two of musk into the ear with cottonwool. But these and other applications must be varied according to the cause of the disorder[157].

Though such applications may sometimes be of service, yet they much oftner fail, and frequently they do hurt. Neither the eyes nor ears ought to be tampered with; they are tender organs, and require a very delicate touch. For this reason, what we would chiefly recommend in deafness, is, to keep the head warm. From whatever cause the disorder proceeds, this is always proper; and I have known more benefit from it alone, in the most obstinate cases of deafness, than from all the medicines I ever used.

OF THE TASTE AND SMELL.

Though these senses are not of so great importance to man in a state of society, as the sight and hearing; yet, as the loss of them is attended with some inconveniency, they deserve our notice. They are seldom to be restored when lost; which ought to make us very attentive to their preservation, by carefully avoiding whatever may in the least prove injurious to them. As there is a very great affinity between the organs of tasting and smelling, whatever hurts the one generally affects the other.

Luxury is highly injurious to these organs. When the nose and palate are frequently stimulated by fragrant and poignant dishes, they soon lose the power of distinguishing tastes and odours with any degree of nicety. Man, in a state of nature, may perhaps have these faculties as acute as any other animal.

The sense of smelling may be diminished or destroyed by diseases; as, the moisture, dryness, inflammation or suppuration of that membrane which lines the inside of the nose, commonly called the olfactory membrane; the compression of the nerves which supply this membrane, or some fault in the brain itself at their origin. A defect, or too great a degree of solidity, of the small spungy bones of the upper jaw, the caverns of the forehead, &c. may likewise impair the sense of smelling. It may also be injured by a collection of fœtid matter in those caverns, which keeps constantly exhaling from them. Few things are more hurtful to the sense of smelling than taking great quantities of snuff.

When the nose abounds with moisture, after gentle evacuations, such things as tend to take off irritation, and coagulate the thin sharp serum, may be applied; as the oil of anise mixed with fine flour; camphire dissolved in oil of almonds, &c. The vapours of amber, frankincense, gum-mastic, and benjamin, may likewise be received into the nose and mouth.

For moistening the mucus when it is too dry, some recommend snuff made of the leaves of marjoram, mixed with the oil of amber, marjoram and aniseed; or a sternutatory of calcined white vitriol; twelve grains of which may be mixed with two ounces of marjoram-water, and filtrated. The steam or vapour of vinegar upon hot iron received up the nostrils is likewise of use for softening the mucus, opening obstructions, &c.

If there is an ulcer in the nose, it ought to be dressed with some emollient ointment, to which, if the pain be very great, a little laudanum may be added. If it be a venereal ulcer, it is not to be cured without mercury. In that case, the solution of the corrosive sublimate in brandy may be taken, as directed in the gutta serena. The ulcer ought likewise to be washed with it; and the fumes of cinnabar may be received up the nostrils.

If there be reason to suspect that the nerves which supply the organs of smelling are inert, or want stimulating, volatile salts, strong snuffs, and other things which occasion sneezing, may be applied to the nose. The forehead may likewise be anointed with balsam of Peru, to which may be added a little of the oil of amber.

The taste may be diminished by crusts, filth, mucus, aphthæ, pellicles, warts, &c. covering the tongue: it may be depraved by a fault of the saliva, which, being discharged into the mouth, gives the same sensation as if the food which the person takes had really a bad taste; or it may be entirely destroyed by injuries done to the nerves of the tongue and palate. Few things prove more hurtful either to the sense of tasting or smelling than obstinate colds, especially those which affect the head.

When the taste is diminished by filth, mucus, &c. the tongue ought to be scraped and frequently washed with a mixture of water, vinegar, and honey, or some other detergent. When the saliva is vitiated, which seldom happens unless in fevers or other diseases, the curing of the disorder is the cure of this symptom. To relieve it however in the mean time, the following things may be of use; if there be a bitter taste, it may be taken away by vomits, purges, and other things which evacuate bile. What is called a nidorous taste, arising from putrid humours, is corrected by the juice of citrons, oranges, and other acids. A salt taste is cured by plentiful dilution with watery liquors. An acid taste is destroyed by absorbents, and alkaline salts, as powder of oyster-shells, salt of wormwood, &c.

When the sensibility of the nerves which supply the organs of taste is diminished, the chewing of horse-radish, or other stimulating substances, will help to recover it.

OF THE TOUCH.

The sense of touching may be hurt by any thing that obstructs the nervous influence, or prevents its being regularly conveyed to the organs of touching; as pressure, extreme cold, &c. It may likewise be hurt by too great a degree of sensibility, when the nerve is not sufficiently covered by the cuticle or scarf-skin, or where there is too great a tension of it, or it is too delicate. Whatever disorders the functions of the brain and nerves, hurts the sense of touching. Hence it appears to proceed from the same general causes as palsy and apoplexy, and requires nearly the same method of treatment.

In a stupor, or defect of touching, which arises from an obstruction of the cutaneous nerves, the patient must first be purged; afterwards such medicines as excite the action of the nerves, or stimulate the system, may be used. For this purpose, the spirit of hartshorn, sal volatile oleosum, horse-radish, &c. may be taken inwardly; the disordered parts, at the same time, may be frequently rubbed with fresh nettles or spirit of sal ammoniac. Blistering-plasters and sinapisms applied to the parts will likewise be of use, as also warm bathing, especially in the natural hot baths.

CHAP. XLV. OF A SCIRRHUS AND CANCER.

A scirrhus is a hard indolent tumour seated in some of the glands; as the breasts, the armpits, &c. If the tumour becomes large, unequal, of a livid, blackish, or leaden colour, and is attended with violent pain, it gets the name of an occult cancer. When the skin is broken, and a sanies or ichorous matter of an abominably fœtid smell is discharged from the sore, it is called an open or ulcerated cancer. Persons after the age of forty-five, particularly women, and those who lead an indolent sedentary life, are most subject to this disease.

CAUSES.——This disease is often owing to suppressed evacuations; hence it proves so frequently fatal to women of a gross habit, particularly old maids and widows, about the time when the menstrual flux ceases. It may likewise be occasioned by excessive fear, grief, anger, religious melancholy, or any of the depressing passions. Hence the unfortunate, the choleric, and those persons who devote themselves to a religious life in convents or monasteries, are often afflicted with it. It may also be occasioned by the long-continued use of food that is too hard of digestion, or of an acrid nature; by barrenness; celibacy; indolence; cold; blows; friction; pressure; or the like. Women often suffer from the last of these by means of their stays, which squeeze and compress their breast so as to occasion great mischief. Sometimes the disease is owing to an hereditary disposition.

SYMPTOMS.——This disorder seems often very trifling at the beginning. A hard tumour about the size of a hazle-nut, or perhaps smaller, is generally the first symptom. This will often continue for a long time without seeming to increase, or giving the patient great uneasiness; but if the constitution be hurt, or the tumour irritated by pressure, or improper treatment of any kind, it begins to extend itself towards the neighbouring parts by pushing out a kind of roots or limbs. It then gets the name of cancer, from a fancied resemblance between these limbs and the claws of a crab. The colour of the skin begins to change, which is first red, afterwards purple, then bluish, livid, and at last black. The patient complains of heat, with a burning, gnawing, shooting pain. The tumour is very hard, rough, and unequal, with a protuberance, or rising, in the middle; its size increases daily, and the neighbouring veins become thick, knotty, and of a blackish colour.

The skin at length gives way, and a thin sharp ichor begins to flow, which corrodes the neighbouring parts till it forms a large unsightly ulcer. More occult cancers arise, and communicate with the neighbouring glands. The pain and stench become intolerable; the appetite fails; the strength is exhausted by a continual hectic fever; at last, a violent hæmorrhage, or discharge of blood, from some part of the body, with faintings, or convulsion fits, generally put an end to the miserable patient’s life.

REGIMEN.——The diet ought to be light, but nourishing. All strong liquors, and high-seasoned or salted provisions, are to be avoided. The patient may take as much exercise as he can easily bear; and should use every method to divert thought, and amuse his fancy. All kinds of external injury are carefully to be guarded against, particularly of the affected part, which ought to be defended from all pressure, and even from the external air, by covering it with fur or soft flannel.

MEDICINE.——This is one of those diseases for which no certain remedy is yet known. Its progress however may sometimes be retarded, and some of its most disagreeable symptoms mitigated, by proper applications. One misfortune attending the disease is, that the unhappy patient often conceals it too long. Were proper means used in due time, a cancer might often be cured; but after the disorder has arrived at a certain height, it generally sets all medicine at defiance.

When a scirrhous tumour is first discovered, the patient ought to observe a proper regimen, and to take twice or thrice a-week a dose of the common purging mercurial pill. Some blood may also be let, and the part affected may be gently rubbed twice a-day with a little of the mercurial ointment, and kept warm with fur or flannel. The food must be light, and an English pint of the decoction of woods or sarsaparilla may be drank daily. I have sometimes discussed hard tumours, which had the appearance of beginning cancers, by a course of this kind.

Should the tumour however not yield to this treatment, but, on the contrary, become larger and harder, it will be proper to extirpate it, either by the knife or caustic. Indeed, whenever this can be done with safety, the sooner it is done the better. It can answer no purpose to extirpate a cancer after the constitution is ruined, or the whole mass of humours corrupted by it. This however is the common way, which makes the operation so seldom succeed. Few people will submit to the extirpation till death stares them in the face; whereas, if it were done early, the patient’s life would not be endangered by the operation, and it would generally prove a radical cure.

When the cancer is so situated that it cannot be cut off, or if the patient will not submit to the operation, such medicines as will mitigate or relieve the most urgent symptoms may be used. Dr. Home says, that half a grain of the corrosive sublimate of mercury, dissolved in a proper quantity of brandy, and taken night and morning, will often be of service in cancers of the face and nose. He likewise recommends an infusion of the solanum, or night-shade, in cancers of the breasts.

But the medicine most in repute at present for this disease is hemlock. Dr. Stork, physician at Vienna, has of late recommended the extract of this plant as very efficacious in cancers of every kind. The Doctor says, he has given some hundred weights of it without ever hurting any body, and often with manifest advantage. He advises the patient however to begin with very small doses, as two or three grains, and to increase the dose gradually till some good effect be perceived, and there to rest without further increase. From two or three grains at first, the Doctor says he has increased the dose to two, three, or four drachms a-day, and finds that such doses may be continued for several weeks without any bad consequences.

The regimen which the Doctor recommends during the use of the medicine, is to avoid farinaceous substances not fermented, and too acrid aromatics. He says, good wine will not be hurtful to those who are accustomed to it, nor a moderate use of acids; and adds, that the patient should live in a pure free air, and keep his mind as quiet and cheerful as possible.

The Doctor does not pretend to fix the time in which a cancer may be resolved by the use of hemlock, but says he has given it for above two years in large doses without any apparent benefit; nevertheless the patient has been cured by persisting in the use of it for half a year longer. This is at least encouragement to give it a fair trial. Though we are far from thinking the hemlock merits those extravagant encomiums which the Doctor has bestowed upon it, yet, in a disease which has so long baffled the boasted powers of medicine, we think it ought always to be tried.

The powder of hemlock is by some preferred to the extract. They are both made of the fresh leaves, and may be used nearly in the same manner. Dr. Nicholson of Berwick says, he gradually increased the dose of the powder from a few grains to half a drachm, and gave near four drachms of it in the day with remarkably good effects. The hemlock may also be used externally either as a poultice or fomentation. The sore may likewise be kept clean by injecting daily a strong decoction of the tops and leaves into it.

Few things contribute more to the healing of foul sordid ulcers of any kind than keeping them thoroughly clean. This ought never to be neglected. The best application for this purpose seems to be the carrot poultice. The root of the common carrot may be grated, and moistened with as much water as will bring it to the consistence of a poultice or cataplasm. This must be applied to the sore, and renewed twice a-day. It generally cleans the sore, eases the pain, and takes away the disagreeable smell, which are objects of no small importance in such a dreadful disorder[158].

Wort, or an infusion of malt, has been recommended not only as a proper drink, but as a powerful medicine in this disease, It must be frequently made fresh, and the patient may take it at pleasure. Two, three, or even four English pints of it may be drank every day for a considerable time. No benefit can be expected from any medicine in this disease, unless it be persisted in for a long time. It is of too obstinate a nature to be soon removed; and, when it admits of a cure at all, it must be brought about by inducing an almost total change of the habit, which must always be a work of time. Setons or issues in the neighbourhood of the cancer have sometimes good effects[159].

When all other medicines fail, recourse must be had to opium, as a kind of solace. This will not indeed cure the disease, but it will ease the patient’s agony, and render life more tolerable while it continues.

To avoid this dreadful disorder, people ought to use wholesome food; to take sufficient exercise in the open air; to be as easy and cheerful as possible; and carefully to guard against all blows, bruises, and every kind of pressure upon the breasts or other glandular parts[160].

CHAP. XLVI. OF POISONS.

Every person ought, in some measure, to be acquainted with the nature and cure of poisons. They are generally taken unawares, and their effects are often so sudden and violent, as not to admit of delay, or allow time to procure the assistance of physicians. Happily indeed no great degree of medical knowledge is here necessary; the remedies for most poisons being generally at hand, or easily obtained, and nothing but common prudence needful in the application of them.

The vulgar notion, that every poison is cured by some counter-poison, as a specific, has done much hurt. People believe they can do nothing for the patient, unless they know the particular antidote to that kind of poison which he has taken. Whereas the cure of all poisons taken into the stomach, without exception, depends chiefly on discharging them as soon as possible.

There is no case wherein the indications of cure are more obvious. Poison is seldom long in the stomach before it occasions sickness, with an inclination to vomit. This shews plainly what ought to be done. Indeed common sense dictates to every one, that, if any thing has been taken into the stomach which endangers life, it ought immediately to be discharged. Were this duly regarded, the danger arising from poisons might generally be avoided. The method of prevention is obvious, and the means are in the hands of every one.

We shall not take up the reader’s time with a detail of the ridiculous notions which have prevailed among ignorant people in different ages with regard to poisons; neither shall we mention the boasted antidotes, which have been recommended either for preventing or obviating their effects; but shall content ourselves with pointing out the poisons most common in this country, and the means of avoiding their dangerous consequences.

Poisons either belong to the mineral, the vegetable, or the animal kingdom.

Mineral poisons are commonly of an acrid or corrosive quality; as arsenic, cobalt, the corrosive sublimate of mercury, &c.

Those of the vegetable kind are generally of a narcotic or stupefactive quality; as poppy, hemlock, henbane, berries of the deadly night-shade, &c.

Poisonous animals communicate their infection either by the bite or sting. This poison is very different from the former, and only produces its effects when received into the body by a wound.

MINERAL POISONS.——Arsenic is the most common of this class; and, as the whole of them are pretty similar both in their effects and method of cure, what is said with respect to it will be applicable to every other species of corrosive poison.

When a person has taken arsenic, he soon perceives a burning heat, and a violent pricking pain in his stomach and bowels, with an intolerable thirst, and an inclination to vomit. The tongue and throat feel rough and dry; and, if proper means be not soon administered, the patient is seized with great anxiety, hiccuping, faintings, and coldness of the extremities. To these succeed black vomits, fœtid stools, with a mortification of the stomach and intestines, which are the immediate forerunners of death.

On the first appearance of these symptoms the patient should drink large quantities of new milk and sallad oil till he vomits; or he may drink warm water mixed with oil. Fat broths are likewise proper, provided they can be got ready in time. Where no oil is to be had, fresh butter may be melted and mixed with the milk or water. These things are to be drank as long as the inclination to vomit continues. Some have drank eight or ten English quarts before the vomiting ceased; and it is never safe to leave off drinking while one particle of the poison remains in the stomach.

These oily or fat substances not only provoke vomiting, but likewise blunt the acrimony of the poison, and prevent its wounding the bowels; but if they should not make the person vomit, half a drachm or two scruples of the powder of ipecacuanha must be given, or a few spoonfuls of the oxymel or vinegar of squills may be mixed with the water which he drinks. Vomiting may likewise be excited by tickling the inside of the throat with a feather. Should these methods however fail, half a drachm of white vitriol, or five or six grains of emetic tartar, must be administered.

If tormenting pains are felt in the lower belly, and there is reason to fear that the poison has got down to the intestines, clysters of milk and oil must be very frequently thrown up; and the patient must drink emollient decoctions of barley, oatmeal, marsh-mallows, and such like. He must likewise take an infusion of senna and manna, a solution of Glauber’s salts, or some other purgative.

After the poison has been evacuated, the patient ought, for some time, to live upon such things as are of a healing and cooling quality; to abstain from flesh and all strong liquors, and to live upon milk, broth, gruel, light puddings, and other spoon meats of easy digestion. His drink should be barley-water, linseed-tea, or infusions of any of the mild mucilaginous vegetables.

VEGETABLE POISONS, besides heat and pain of the stomach, commonly occasion some degree of giddiness, and often a kind of stupidity or folly. Persons who have taken these poisons must be treated in the same manner as for the mineral or corrosive.

Though the vegetable poisons, when allowed to remain in the stomach, often prove fatal; yet the danger is generally over as soon as they are discharged. Not being of such a caustic or corrosive nature, they are less apt to wound or inflame the bowels than mineral substances: no time, however, ought to be lost in having them discharged.

Opium, being frequently taken by mistake, merits particular attention. It is used as a medicine both in a solid and liquid form, which latter commonly goes by the name of laudanum. It is indeed a valuable medicine when taken in proper quantity; but as an over-dose proves a strong poison, we shall point out its common effects, together with the method of cure.

An over-dose of opium generally occasions great drowsiness, with stupor and other apoplectic symptoms. Sometimes the person has so great an inclination to sleep, that it is almost impossible to keep him awake. Every method must however be tried for this purpose. He should be tossed, shaked, and moved about. Sharp blistering-plasters should be applied to his legs or arms, and stimulating medicines, as salts of hartshorn, &c. held under his nose. It will also be proper to let blood. At the same time every method must be taken to make him discharge the poison. This may be done in the manner directed above, viz. by the use of strong vomits, drinking plenty of warm water with oil, &c.

Mead, besides vomits, in this case, recommends acid medicines with lixivial salts. He says, that he has often given salt of wormwood mixed with juice of lemon in repeated doses with great success.

If the body should remain weak and languid after the poison has been discharged, nourishing diet and cordials will be proper; but when there is reason to fear that the stomach or bowels are inflamed, the greatest circumspection is necessary both with regard to food and medicine.

OF THE BITES OF POISONOUS ANIMALS.

We shall begin with the bite of a mad dog, as it is both the most common and dangerous animal-poison in this country.

The creatures naturally liable to contract this disease are, as far as we yet know, all of the dog kind, viz. foxes, dogs, and wolves. Hence it is called the rabies canina, or dog madness. Of the last we have none in this island; and it so seldom happens that any person is bit by the first, that they scarce deserve to be taken notice of. If such a thing should happen, the method of treatment is precisely the same as for the bite of a mad dog.

The symptoms of madness in a dog are as follow: At first he looks dull, shews an aversion to food and company: he does not bark as usual, but seems to murmur, is peevish, and apt to bite strangers: his ears and tail droop more than usual, and he appears drowsy: afterwards he begins to loll out his tongue, and froth at the mouth, his eyes seeming heavy and watery: he now, if not confined, takes off, runs panting along with a kind of dejected air, and endeavours to bite every one he meets. Other dogs are said to fly from him. Some think this a certain sign of madness, supposing that they know him by the smell; but it is not to be depended on. If he escapes being killed, he seldom runs above two or three days, till he dies exhausted with heat, hunger, and fatigue.

This disease is most frequent after long, dry, hot seasons; and such dogs as live upon putrid stinking carrion, without having enough of fresh water, are most liable to it.

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