II. OF DISEASES (part 2 of 2)

II. OF DISEASES (part 2 of 2)

When any person has been bit by a dog, the strictest inquiry ought to be made whether the animal was really mad. Many disagreeable consequences arise from neglecting to ascertain this point. Some people have lived in continual anxiety for many years, because they had been bit by a dog which they believed to be mad; but, as he had been killed on the spot, it was impossible to ascertain the fact. This should induce us, instead of killing a dog the moment he has bit any person, to do all in our power to keep him alive, at least till we can be certain whether he be mad or not.

Many circumstances may contribute to make people imagine a dog mad. He loses his master, runs about in quest of him, is set upon by other dogs, and perhaps by men. The creature, thus frightened, beat, and abused, looks wild, and lolls out his tongue as he runs along. Immediately a crowd is after him; while he, finding himself closely pursued, and taking every one he meets for an enemy, naturally attempts to bite him in self-defence. He soon gets knocked on the head, and it passes currently that he was mad, as it is then impossible to prove the contrary.

This being the true history of, by far, the greater part of those dogs which pass for mad, is it any wonder that numberless whimsical medicines have been extolled for preventing the effects of their bite? This readily accounts for the great variety of infallible remedies for the bite of a mad dog, which are to be met with in almost every family. Though not one in a thousand has any claim to merit, yet they are all supported by numberless vouchers. No wonder that imaginary diseases should be cured by imaginary remedies. In this way, credulous people first impose upon themselves, and then deceive others. The same medicine which was supposed to prevent the effects of the bite, when the dog was not mad, is recommended to a person who has had the misfortune to be bit by a dog that was really mad. He takes it, trusts to it, and is undone.

To these mistakes we must impute the frequent ill success of the medicines used for preventing the effects of the bite of a mad dog. It is not owing so much to a defect in medicine, as to wrong applications. I am persuaded, if proper medicines were administered immediately after the bite is received, and continued for a sufficient length of time, we should not lose one in a thousand of those who have the misfortune to be bit by a mad dog.

This poison is generally communicated by a wound, which nevertheless heals as soon as a common wound: but afterwards it begins to feel painful, and as the pain spreads towards the neighbouring parts, the person becomes heavy and listless. His sleep is unquiet with frightful dreams; he sighs, looks dull, and loves solitude. These are the forerunners, or rather the first symptoms of that dreadful disease occasioned by the bite of a mad dog. But as we do not propose to treat fully of the disease itself, but to point out the method of preventing it, we shall not take up time in shewing its progress from the first invasion to its commonly fatal end.

The common notion, that this poison may lie in the body for many years, and afterwards prove fatal, is both hurtful and ridiculous. It must render such persons as have had the misfortune to be bit very unhappy, and can have no good effects. If the person takes proper medicines for forty days after the time of his being bit, and feels no symptoms of the disease, there is reason to believe him out of danger.

The medicines recommended for preventing the effects of the bite of a mad dog, are chiefly such as promote the different secretions, and antispasmodics.

Dr. Mead recommends a preventive medicine, which he says he never knew fail, though in the space of thirty years he had used it a thousand times.

The Doctor’s prescription is as follows:

“Take ash-coloured ground liver-wort, cleaned, dried, and powdered, half an ounce; of black pepper powdered, a quarter of an ounce. Mix these well together, and divide the powder into four doses; one of which must be taken every morning fasting, for four mornings successively, in half an English pint of cows milk warm.

“After these four doses are taken, the patient must go into the cold bath, or a cold spring or river, every morning fasting, for a month; he must be dipped all over, but not stay in (with his head above water) longer than half a minute, if the water be very cold. After this he must go in three times a-week for a fortnight longer.

“The person must be bled before he begins to use the medicine[161].”

We shall next mention the famous East India specific, as it is called. This medicine is composed of cinnabar and musk. It is esteemed a great antispasmodic; and, by many, extolled as an infallible remedy for preventing the effects of the bite of a mad dog.

“Take native and factitious cinnabar, of each twenty-four grains, musk sixteen grains. Let these be made into a fine powder, and taken in a glass of arrack or brandy.”

This single dose is said to secure the person for thirty days, at the end of which it must be repeated; but if he has any symptoms of the disease, it must be repeated in three hours.

The following is likewise reckoned a good antispasmodic medicine:

“Take of Virginian snake-root in powder, half a drachm, gum asafœtida twelve grains, gum camphire seven grains; make these into a bolus with a little syrup of saffron.”

Camphire may also be given in the following manner:

“Take purified nitre half an ounce, Virginian snake-root in powder two drachms, camphire one drachm; rub them together in a mortar, and divide the whole into ten doses.”

Mercury is likewise recommended as of great efficacy, both in the prevention and cure of this kind of madness. When used as a preventive, it will be sufficient to rub daily a drachm of the ointment into the parts about the wound.

Vinegar is likewise of considerable service, and should be taken freely, either in the patient’s food or drink.

These are the principal medicines recommended for preventing the effects of the bite of a mad dog. We would not however advise people to trust to any one of them; but from a proper combination of their different powers, there is the greatest reason to hope for success.

The great error in the use of these medicines lies in not taking them for a sufficient length of time. They are used more like charms, than medicines intended to produce any change in the body. To this, and not to the insufficiency of the medicines, we must impute their frequent want of success.

Dr. Mead says, that the virtue of his medicine consists in promoting urine. But how a poison should be expelled by urine, with only three or four doses of any medicine, however powerful, it is not easy to conceive. More time is certainly necessary, even though the medicine were more powerful than that which the Doctor prescribes.

The East India specific is still more exceptionable on this account.

As these and most other medicines, taken singly, have frequently been found to fail, we shall recommend the following course:

If a person be bit in a fleshy part, where there is no hazard of hurting any large blood-vessel, the parts adjacent to the wound may be cut away. But if this be not done soon after the bite has been received, it will be better to omit it.

The wound may be dressed with salt and water, or a pickle made of vinegar and salt, and afterwards dressed twice a-day with yellow basilicon mixed with red precipitate of mercury.

The patient should begin to use either Dr. Mead’s medicine, or some of the others mentioned above. If he takes Mead’s medicine, he may use it as the Doctor directs for four days successively. Let him then omit it for two or three days, and again repeat the same number of doses as before.

During this course, he must rub into the parts about the wound, daily, one drachm of the mercurial ointment. This may be done for ten or twelve days at least.

When this course is over, he may take a purge or two, and wait a few days till the effect of the mercury be gone off. He must then begin to use the cold bath, into which he may go every morning for five or six weeks. If he should feel cold and chilly for a long time after coming out of the cold bath, it will be better to use a tepid one, or to have the water a little warmed.

In the mean time, we would advise him not to leave off all internal medicines, but to take either one of the boluses of snake-root, asafœtida, and camphire; or one of the powders of nitre, camphire, and snake-root, twice a-day. These may be used during the whole time he is bathing.

During the use of the mercurial ointment, the patient must keep within doors, and take nothing cold.

A proper regimen must be observed throughout the whole course. The patient should abstain from flesh, and all salted and high-seasoned provisions. He must avoid strong liquors, and live mostly upon a light and rather spare diet. His mind should be kept as easy and cheerful as possible, and all excessive heat and violent passions avoided with the utmost care.

I have never seen this course of medicine, with proper regimen, fail to prevent the hydrophobia, and cannot help again observing, that the want of success must generally be owing either to the application of improper medicines, or not using proper ones for a sufficient length of time.

Mankind are extremely fond of every thing that promises a sudden or miraculous cure. By trusting to these they often lose their lives, when a regular course of medicine would have rendered them absolutely safe. This holds remarkably in the present case. Numbers of people, for example, believe if they or their cattle were once dipped in the sea, it is sufficient; as if the salt-water were a charm against the effects of the bite. This, and such like whims, have proved fatal to many.

It is a common notion, if a person be bit by a dog which is not mad, that, if he should go mad afterwards, the person would be affected with the disorder at the same time; but this notion is too ridiculous to deserve a serious consideration. It is a good rule, however, to avoid dogs as much as possible, as the disease is often upon them for some time before its violent symptoms appear. The hydrophobia has been occasioned by the bite of a dog which shewed no other symptoms of the disease but listlessness and a sullen disposition.

Though we do not mean to treat fully of the cure of the hydrophobia, yet we are far from reckoning it incurable. The notion that this disease could not be cured, has been productive of the most horrid consequences. It was usual either to abandon the unhappy persons, as soon as they were seized with the disease, to their fate, to bleed them to death, or to suffocate them between matrasses or feather-beds, &c. This conduct certainly deserved the severest punishment! We hope, for the honour of human nature, it will never again be heard of.

I have never had an opportunity of treating this disease, and therefore can say nothing of it from my own experience; but the learned Dr. Tissot says, it may be cured in the following manner:

1. The patient must be bled to a considerable quantity; and this may be repeated twice, or thrice, or even a fourth time, if circumstances require it.

2. The patient should be put, if possible, into a warm bath; and this should be used twice a-day.

3. He should every day receive two, or even three emollient clysters.

4. The wound, and the parts adjoining to it, should be rubbed with the mercurial ointment twice a-day.

5. The whole limb which contains the wound should be rubbed with oil, and be wrapped up in an oily flannel.

6. Every three hours a dose of Cob’s powder should be taken in a cup of the infusion of lime-tree and elder-flowers. This powder is made, by rubbing together in a mortar, to a very fine powder, of native and factitious cinnabar, each twenty-four grains; of musk, sixteen grains[162].

7. The following bolus is to be given every night, and to be repeated in the morning, if the patient is not easy, washing it down with the infusion mentioned above: Take one drachm of Virginian snake-root in powder; of camphire and asafœtida, ten grains each; of opium, one grain; and, with a sufficient quantity of conserve, or rob of elder, make a bolus.

8. If there be a great nausea at the stomach, with a bitterness in the mouth, thirty-five or forty grains of ipecacuanha, in powder, may be taken for a vomit.

9. The patient’s food, if he takes any, must be light; as panado, soups made of farinaceous or mealy vegetables, &c.

10. If the patient should long continue weak, and subject to terrors, he may take half a drachm of the Peruvian bark thrice a-day.

The next poisonous animal which we shall mention is the VIPER. The grease of this animal rubbed into the wound is said to cure the bite. Though that is all the viper-catchers generally do when bit, we should not think it sufficient for the bite of an enraged viper. It would surely be more safe to have the wound well sucked[163], and afterwards rubbed with warm salad-oil. A poultice of bread and milk, softened with salad-oil, should likewise be applied to the wound; and the patient ought to drink freely of vinegar whey, or water-gruel with vinegar in it, to make him sweat. Vinegar is one of the best medicines which can be used in any kind of poison, and ought to be taken very liberally. If the patient be sick, he may take a vomit. This course will be sufficient to cure the bite of any of the poisonous animals of this country.

With regard to poisonous insects, as the bee, the wasp, the hornet, &c. their stings are seldom attended with danger, unless when a person happens to be stung by a great number of them at the same time; in which case something should be done to abate the inflammation and swelling. Some, for this purpose, apply honey, others lay pounded parsley to the part. A mixture of vinegar and Venice treacle is likewise recommended; but I have always found rubbing the part with warm salad-oil succeed very well. Indeed, when the stings are so numerous as to endanger the patient’s life, which is sometimes the case, he must not only have oily poultices applied to the part, but should likewise be bled, and take some cooling medicines, as nitre, or cream of tartar, and should drink plentifully of diluting liquors.

It is the happiness of this island to have very few poisonous animals, and those which we have are by no means of the most virulent kind. Nine-tenths of the effects attributed to poison or venom in this country, are really other diseases, and proceed from quite different causes.

We cannot however make the same observation with regard to poisonous vegetables. These abound every where, and prove often fatal to the ignorant and unwary. This indeed is chiefly owing to carelessness. Children ought early to be cautioned against eating any kind of fruit, roots, or berries, which they do not know, and all poisonous plants to which they can have access, ought, as far as possible, to be destroyed. This would not be so difficult a task as some people imagine.

Poisonous plants have no doubt their use, and they ought to be propagated in proper places; but, as they prove often destructive to cattle, they should be rooted out of all pasture-grounds. They ought likewise, for the safety of the human species, to be destroyed in the neighbourhood of all towns and villages; which, by the bye, are the places where they most commonly abound. I have seen the poisonous hemlock, henbane, wolfsbane, and deadly night-shade, all growing within the environs of a small town, where, though several persons, within the memory of those living in it, had lost their lives by one or other of these plants; yet no method, that I could hear of, had ever been taken to root them out; though this might be done at a very trifling expence.

Seldom a year passes but we have accounts of several persons poisoned by eating hemlock-roots instead of parsnips, or some kinds of fungus which they had gathered for mushrooms. These examples ought to put people upon their guard with respect to the former, and to put the latter entirely out of use. Mushrooms may be a delicate dish, but they are a dangerous one, as they are generally gathered by persons who do not know one kind of fungus from another, and take every thing for a mushroom which has that appearance.

We might here mention many other plants and animals of a poisonous nature which are found in foreign countries; but, as our observations are chiefly intended for this island, we shall pass these over. It may not however be amiss to observe, for the benefit of such of our countrymen as go to America, that an effectual remedy is now said to be found for the bite of the rattle-snake.—The prescription is as follows: Take of the roots of plantain and horehound, in summer, roots and branches together, a sufficient quantity; bruise them in a mortar, and squeeze out the juice, of which give, as soon as possible, one large spoonful; if the patient be swelled, you must force it down his throat. This generally will cure; but, if he finds no relief in an hour after, you may give another spoonful, which never fails.—If the roots are dried, they must be moistened with a little water. To the wound may be applied a leaf of good tobacco moistened with rum.

We give this upon the faith of Dr. Brookes, who says it was the invention of a negro; for the discovery of which he had his freedom purchased, and a hundred pounds per annum settled upon him during life, by the General Assembly of Carolina.

It is possible there may be in nature specific remedies for every kind of poison; but as we have very little faith in any of those which have yet been pretended to be discovered, we shall beg leave again to recommend the most strict attention to the following rules, viz. That when any poisonous substance has been taken into the stomach, it ought, as soon as possible, to be discharged by vomits, clysters, and purges; and, when poison has been received into the body by a wound, that it be expelled by medicines which promote the different secretions, especially those of sweat, urine, and insensible perspiration; to which may be joined antispasmodics, or such medicines as take off tension and irritation; the chief of which are opium, musk, camphire, and asafœtida.

CHAP. XLVII. OF THE VENEREAL DISEASE.

In the first edition of this book the venereal disease was omitted. The reasons however which at that time induced me to leave it out, have upon more mature consideration vanished. Bad consequences, no doubt, may arise from ignorant persons tampering with medicine in this disorder; but the danger from that quarter seems to be more than balanced by the great and solid advantages, which must arise to the patient from an early knowledge of his case, and an attention to a plan of regimen, which, if it does not cure the disease, will be sure to render it more mild, and less hurtful to the constitution.

It is peculiarly unfortunate for the unhappy persons who contract this disease, that it lies under a sort of disgrace. This renders disguise necessary, and makes the patient either conceal his disorder altogether, or apply to those who promise a sudden and secret cure; but who in fact only remove the symptoms for a time, while they fix the disease deeper in the habit. By this means a slight infection, which might have been easily removed, is often converted into an obstinate, and sometimes incurable malady.

Another unfavourable circumstance attending this disease is, that it assumes a variety of different shapes, and may with more propriety be called an assemblage of diseases, than a single one. No two diseases can require a more different method of treatment than this does in its different stages. Hence the folly and danger of trusting to any particular nostrum for the cure of it. Such nostrums are however generally administered in the same manner to all who apply for them, without the least regard to the state of the disease, the constitution of the patient, the degree of infection, and a thousand other circumstances of the utmost importance.

Though the venereal disease is generally the fruit of unlawful embraces, yet it may be communicated to the innocent as well as the guilty. Infants, nurses, midwives, and married women whose husbands lead dissolute lives, are often affected with it, and frequently lose their lives by not being aware of their danger in due time. The unhappy condition of such persons will certainly plead our excuse, if any excuse be necessary, for endeavouring to point out the symptoms and cure of this too common disease.

To enumerate all its different symptoms, however, and to trace the disease minutely through its various stages, would require a much larger space than falls to this part of my subject; I shall therefore confine my observations chiefly to circumstances of importance, omitting such as are either trifling, or which occur but seldom. I shall likewise pass over the history of the disease, with the different methods of treatment which it has undergone since it was first introduced into Europe, and many other circumstances of a similar nature; all of which, though they might tend to amuse the reader, yet could afford him little or no useful knowledge.

OF THE VIRULENT GONORRHŒA.

The virulent gonorrhœa is an involuntary discharge of infectious matter from the parts of generation in either sex. It generally makes its appearance within eight or ten days after the infection has been received: sometimes indeed it appears in two or three days, and at other times not before the end of four or five weeks. Previous to the discharge, the patient feels an itching with a small degree of pain in the genitals. Afterwards a thin glary matter begins to distil from the urinary passage, which stains the linen, and occasions a small degree of titillation, particularly in the time of making water; this gradually increasing, arises at length to a degree of heat and pain, which are chiefly perceived about the extremity of the urinary passage, where a slight degree of redness and inflammation likewise begin to appear.

As the disorder advances, the pain, heat of urine, and running, increase, while fresh symptoms daily ensue. In men the erections become painful and involuntary, and are more frequent and lasting than when natural. This symptom is most troublesome when the patient is warm in bed. The pain which was at first only perceived towards the extremity, now begins to reach all up the urinary passage, and is most intense just after the patient has done making water. The running gradually recedes from the colour of seed, grows yellow, and at length puts on the appearance of matter.

When the disorder has arrived at its height, all the symptoms are more intense; the heat of urine is so great, that the patient dreads the making water; and though he feels a constant inclination this way, yet it is rendered with the greatest difficulty, and often only by drops: the involuntary erections now become extremely painful and frequent; there is also a pain, heat, and sense of fulness about the seat, and the running is plentiful and sharp, of a brown, greenish, and sometimes of a bloody colour.

By a proper treatment the violence of the symptoms gradually abates; the heat of urine goes off; the involuntary and painful erections, and the heat and pain about the seat, become easier; the running also gradually decreases, grows whiter and thicker, till at last it entirely disappears.

By attending to these symptoms, the gonorrhœa may be generally distinguished from any other disease. There are however some few disorders for which it may be mistaken, as an ulcer in the kidnies or bladder, the fluor albus or whites in women, &c. But in the former of these, the matter comes away only with the urine, or when the sphincter of the bladder is open; whereas in a gonorrhœa, the discharge is constant. The latter is more difficult to distinguish, and must be known chiefly from its effects, as pain, communicating the infection, &c.

REGIMEN.——When a person has reason to suspect that he has caught the venereal infection, he ought most strictly to observe a cooling regimen, to avoid every thing of a heating nature, as wines, spirituous liquors, rich sauces, spiced, salted, high-seasoned and smoke-dried provisions, &c. as also all aromatic and stimulating vegetables, as onions, garlic, shallot, nutmeg, mustard, cinnamon, mace, ginger, and such like. His food ought chiefly to consist of mild vegetables, milk, broths, light puddings, panado, gruels, &c. His drink may be barley-water, milk and water, decoctions of marsh-mallows and liquorice, linseed-tea, or clear whey. Of these he ought to drink plentifully. Violent exercise of all kinds, especially riding on horseback, and venereal pleasures, are to be avoided. The patient must beware of cold, and when the inflammation is violent, he ought to keep his bed.

MEDICINE.——A virulent gonorrhœa cannot always be cured speedily and effectually at the same time. The patient ought therefore not to expect, nor the physician to promise it. It will often continue for two or three weeks, and sometimes for five or six, even where the treatment has been very proper.

Sometimes indeed a slight infection may be carried off in a few days, by bathing the parts in warm milk and water, and injecting frequently up the urethra a little sweet oil or linseed-tea about the warmth of new milk. Should these not succeed in carrying off the infection, they will at least have a tendency to lessen its virulence.

To effect a cure, however, astringent injections will generally be found necessary. These may be various ways prepared, but I think those made with the white vitriol are both most safe and efficacious. They can be made stronger or weaker as circumstances may require; but it is best to begin with the more gentle, and increase their power if necessary. I generally order a drachm of white vitriol to be dissolved in eight or nine ounces of common or rose-water, and an ordinary syringe full of it to be thrown up three or four times a-day. If this quantity does not perform a cure, it may be repeated, and the dose increased[164].

Whether injections be used or not, cooling purges are always proper in the gonorrhœa. They ought not however to be of the strong or drastic kind. Whatever raises a violent commotion in the body increases the danger, and tends to drive the disease deeper into the habit. Procuring two or three stools every second or third day for the first fortnight, and the same number every fourth or fifth day for the second, will generally be sufficient to remove the inflammatory symptoms, to diminish the running, and to change its colour and consistence. It gradually becomes more white and ropy as the virulence abates[165].

When the inflammatory symptoms run high, bleeding is always necessary at the beginning. This operation, as in other topical inflammations, must be repeated according to the strength and constitution of the patient, and the vehemence and urgency of the symptoms.

Medicines which promote the secretion of urine, are likewise proper in this stage of the disorder. For this purpose, an ounce of nitre and two ounces of gum-arabic, pounded together, may be divided into twenty-four doses, one of which may be taken frequently in a cup of the patient’s drink. If these should make him pass his urine so often as to become troublesome to him, he may either take them less frequently, or leave out the nitre altogether, and take equal parts of gum-arabic and cream of tartar. These may be pounded together, and a tea-spoonful taken in a cup of the patient’s drink four or five times a-day. I have generally found this answer extremely well both as a diuretic, and for keeping the body gently open.

When the pain and inflammation are seated high towards the neck of the bladder, it will be proper frequently to throw up an emollient clyster, which, besides the benefit of procuring stools, will serve as a fomentation to the inflamed parts.

Soft poultices, when they can conveniently be applied to the parts, are of great service. They may be made of the flour of linseed, or of wheat-bread and milk, softened with fresh butter or sweet oil. When poultices cannot be conveniently used, cloths wrung out of warm water, or bladders filled with warm milk and water, may be applied. I have often known the most excruciating pains, during the inflammatory state of the gonorrhœa, relieved by one or other of these applications.

Few things tend more to keep off inflammation in the spermatic vessels, than a proper truss for the scrotum. It ought to be so contrived as to support the testicles, and should be worn from the first appearance of the disease till it has ceased some weeks.

The above treatment will sometimes remove the gonorrhœa so quickly, that the person will be in doubt whether he really laboured under that disease. This, however, is too favourable a turn to be often expected. It more frequently happens, that we are able only to procure an abatement or remission of the inflammatory symptoms, so far as to make it safe to have recourse to the great antidote mercury.

Many people, on the first appearance of a gonorrhœa, fly to the use of mercury. This is a bad plan. Mercury is often not at all necessary in a gonorrhœa; and when taken too early, it does mischief. It may be necessary to complete the cure, but can never be proper at the commencement of it.

When bleeding, purging, fomentations, and the other things recommended above, have eased the pain, softened the pulse, relieved the heat of urine, and rendered the involuntary erections less frequent, the patient may begin to use mercury in any form that is least disagreeable to him.

If he takes the common mercurial pill, two at night and one in the morning will be a sufficient dose at first. Should they affect the mouth too much, the dose must be lessened; if not at all, it may be gradually increased to five or six pills in the day. If calomel be thought preferable, two or three grains of it, formed into a bolus with a little of the conserve of hips, may be taken at bed-time, and the dose gradually increased to eight or ten grains. One of the most common preparations of mercury now in use is the corrosive sublimate. This may be taken in the manner afterwards recommended under the confirmed lues or pox. I have always found it one of the most safe and efficacious medicines when properly used.

The above medicines may either be taken every day or every other day, as the patient is able to bear them. They ought never to be taken in such quantity as to raise a salivation, unless in a very slight degree. The disease may be more safely, and as certainly, cured without a salivation as with it. When the mercury runs off by the mouth, it is not so successful in carrying off the disease, as when it continues longer in the body, and is discharged gradually.

Should the patient be purged or griped in the night by the mercury, he must take an infusion of senna, or some other purgative, and drink freely of water-gruel to prevent bloody stools, which are very apt to happen should the patient catch cold, or if the mercury has not been duly prepared. When the bowels are weak and the mercury is apt to gripe or purge, these disagreeable consequences may be prevented by taking, with the above pills or bolus, half a drachm or two scruples of diascordium, or of the Japonic confection.

To prevent the disagreeable circumstance of the mercury’s affecting the mouth too much, or bringing on a salivation, it may be combined with purgatives. With this view the laxative mercurial pill has been contrived, the usual dose of which is half a drachm, or three pills, night and morning, to be repeated every other day; but the safer way is for the patient to begin with two, or even with one pill, gradually increasing the dose.

To such persons as can neither swallow a bolus nor a pill, mercury may be given in a liquid form, as it can be suspended even in a watery vehicle, by means of gum-arabic; which not only serves this purpose, but likewise prevents the mercury from affecting the mouth, and renders it in many respects a better medicine[166].

It happens very fortunately for those who cannot be brought to take mercury inwardly, and likewise for persons whose bowels are too tender to bear it, that an external application of it will answer equally well, and in some respects better. It must be acknowledged, that mercury, taken inwardly for any length of time, greatly weakens and disorders the bowels; for which reason, when a plentiful use of it becomes necessary, we would prefer rubbing to the mercurial pills. The common mercurial or blue ointment will answer very well. Of that which is made by rubbing together equal quantities of hog’s lard and quicksilver, about a drachm may be used at a time. The best time for rubbing it on is at night, and the most proper place the inner side of the thighs. The patient should stand before the fire when he rubs, and should wear flannel drawers next his skin at the time he is using the ointment. If ointment of a weaker or stronger kind be used, the quantity must be increased or diminished in proportion.

If, during the use of the ointment, the inflammation of the genital parts, together with the heat and feverishness, should return, or if the mouth should grow sore, the gums tender, and the breath become offensive, a dose or two of Glauber’s salts, or some other cooling purge, may be taken, and the rubbing intermitted for a few days. As soon, however, as the signs of spitting are gone off, if the virulency be not quite corrected, the ointment must be repeated, but in smaller quantities, and at longer intervals than before. Whatever way mercury is administered, its use must be persisted in as long as any virulency is suspected to remain.

During this, which may be called the second stage of the disorder, though so strict a regimen is not necessary as in the first or inflammatory state, yet intemperance of every kind must be avoided. The food must be light, plain, and of easy digestion; and the greatest indulgence that may be allowed with respect to drink is, a little wine diluted with a sufficient quantity of water. Spirituous liquors are to be avoided in every shape. I have often known the inflammatory symptoms renewed and heightened, the running increased, and the cure rendered extremely difficult and tedious, by one fit of excessive drinking.

When the above treatment has removed the heat of urine, and soreness of the genital parts; when the quantity of running is considerably lessened, without any pain or swelling in the groin or testicle supervening; when the patient is free from involuntary erections; and lastly, when the running becomes pale, whitish, thick, void of ill smell, and tenacious or ropy; when all or most of these symptoms appear, the gonorrhœa is arrived at its last stage, and we may gradually proceed to treat it as a gleet with astringent and agglutinating medicines.

OF GLEETS.

A gonorrhœa frequently repeated, or improperly treated, often ends in a gleet, which may either proceed from relaxation, or from some remains of the disease. It is however of the greatest importance in the cure of the gleet, to know from which of these causes it proceeds. When the discharge proves very obstinate, and receives little or no check from astringent remedies, there is ground to suspect that it is owing to the latter; but if the drain is inconstant, and is chiefly observable when the patient is stimulated by lascivious ideas, or upon straining to go to stool, we may reasonably conclude that it is chiefly owing to the former.

In the cure of a gleet proceeding from relaxation, the principal design is to brace, and restore a proper degree of tension to the debilitated and relaxed vessels. For this purpose, besides the medicines recommended in the gonorrhœa, the patient may have recourse to stronger and more powerful astringents, as the Peruvian bark[167], alum, vitriol, galls, tormentil, bistort, baldustines, tincture of gum kino, &c. The injections may be rendered more astringent by the addition of a few grains of alum, or increasing the quantity of vitriol as far as the parts are able to bear it.

The last remedy which we shall mention in this case is the cold bath, than which there is not perhaps a more powerful bracer in the whole compass of medicine. It ought never to be omitted in this species of gleet, unless there be something in the constitution of the patient which renders the use of it unsafe. The chief objections to the use of the cold bath are, a full habit, and an unsound state of the viscera. The danger from the former may always be lessened, if not removed, by purging and bleeding; but the latter is an insurmountable obstacle, as the pressure of the water, and the sudden contraction of the external vessels, by throwing the blood with too much force upon the internal parts, are apt to occasion ruptures of the vessels, or a flux of humours upon the diseased organs. But where no objection of this kind prevails, the patient ought to plunge over head in water every morning fasting, for three or four weeks together. He should not however stay long in the water, and should take care to have his skin dried as soon as he comes out.

The regimen proper in this case is the same as was mentioned in the last stage of the gonorrhœa: the diet must be drying and astringent, and the drink Spa, Pyrmont, or Bristol waters, with which a little claret or red wine may sometimes be mixed. Any person may now afford to drink these waters, as they can be every where prepared at almost no expence, by a mixture of common chalk and oil of vitriol.

When the gleet does not in the smallest degree yield to these medicines, there is reason to suspect that it proceeds from ulcers. In this case recourse must be had to mercury, and such medicines as tend to correct any predominant acrimony with which the juices may be affected, as the decoction of China, sarsaparilla, sassafras, or the like.

Mr. Fordyce says, he has seen many obstinate gleets of two, three, or four years standing, effectually cured by a mercurial inunction, when almost every other medicine has been tried in vain. Dr. Chapman seems to be of the same opinion; but says, he has always found the mercury succeed best in this case when joined with terebinthinate and other agglutinating medicines. For which reason the Doctor recommends pills made of calomel and Venice turpentine[168]; and desires that their use may be accompanied with a decoction of guaiacum or sarsaparilla.

The last kind of remedy which we shall mention for the cure of ulcers in the urinary passage, are the suppurating candles or bougies: as these are prepared various ways, and are generally to be bought ready made, it is needless to spend time in enumerating the different ingredients of which they are composed, or teaching the manner of preparing them. Before a bougie be introduced into the urethra, however, it should be smeared all over with sweet oil, to prevent it from stimulating too suddenly; it may be suffered to continue in from one to seven or eight hours, according as the patient can bear it. Obstinate ulcers are not only often healed, but tumours and excrescences in the urinary passages taken away, and an obstruction of urine removed by means of bougies. Obstinate gleets may be removed by the use of bougies.

OF THE SWELLED TESTICLE.

The swelled testicle may either proceed from infection lately contracted, or from the venereal poison lurking in the blood: the latter indeed is not very common, but the former frequently happens both in the first and second stages of a gonorrhœa; particularly when the running is unseasonably checked, by cold, hard drinking, strong drastic purges, violent exercise, the too early use of astringent medicines, or the like.

In the inflammatory stage bleeding is necessary, which must be repeated according to the urgency of the symptoms[169]. The food must be light, and the drink diluting. High-seasoned food, flesh, wines, and every thing of a heating nature, are to be avoided. Fomentations are of singular service. Poultices of bread and milk, softened with fresh butter or oil, are likewise very proper, and ought constantly to be applied when the patient is in bed: when he is up, the testicles should be kept warm, and supported by a bag or truss, which may easily be contrived in such a manner as to prevent the weight of the testicle from having any effect.

If it should be found impracticable to clear the testicle by the cooling regimen now pointed out, and extended according to circumstances, it will be necessary to lead the patient through such a complete antivenereal course as shall ensure him against any future uneasiness. For this purpose, besides rubbing the mercurial ointment on the part, if free from pain, or on the thighs, as directed in the gonorrhœa, the patient must be confined to bed, if necessary, for five or six weeks, suspending the testicle all the while with a bag or truss, and plying him inwardly with strong decoctions of sarsaparilla.

When these means do not succeed, and there is reason to suspect a scrophulous or cancerous habit, either of which may support a scirrhous induration, after the venereal poison is corrected, the parts should be fomented daily with a decoction of hemlock, the bruised leaves of which may likewise be added to the poultice, and the extract at the same time taken inwardly[170]. This practice is strongly recommended by Dr. Stork in scirrhous and cancerous cases; and Mr. Fordyce assures us, that by this method he has cured diseased testicles of two or three years standing, even when ulcerated, and when the scirrhus had begun to be affected with pricking and lancing pains.

OF BUBOES.

Venereal buboes are hard tumours seated in the groin, occasioned by the venereal poison lodged in this part. They are of two kinds; viz. such as proceed from a recent infection, and such as accompany a confirmed lues.

The cure of recent buboes, that is, such as appear soon after impure coition, may be first attempted by dispersion, and, if that should not succeed, by suppuration. To promote the dispersion of a bubo, the same regimen must be observed as was directed in the first stage of a gonorrhœa. The patient must likewise be bled, and take some cooling purges, as the decoction of tamarinds and senna, Glauber’s salts, and the like. If, by this course, the swelling and other inflammatory symptoms abate, we may safely proceed to the use of mercury, which must be continued till the venereal virus is quite subdued[171].

But if the bubo should, from the beginning, be attended with great heat, pain, and pulsation, it will be proper to promote its suppuration. For this purpose the patient may be allowed to use his ordinary diet, and to take now and then a glass of wine. Emollient cataplasms, consisting of bread and milk softened with oil or fresh butter, may be applied to the part; and, in cold constitutions, where the tumour advances slowly, white lily-roots boiled, or sliced onions raw, and a sufficient quantity of yellow basilicon, may be added to the poultice.

When the tumour is ripe, which may be known by its conical figure, the softness of the skin, and a fluctuation of matter plainly to be felt under the finger, it may be opened either by a caustic or a lancet, and afterwards dressed with digestive ointment.

It sometimes however happens, that buboes can neither be dispersed nor brought to a suppuration, but remain hard, indolent tumours. In this case the indurated glands must be consumed by caustic; if they should become scirrhous, they must be dissolved by the application of hemlock, both externally and internally, as directed in the scirrhous testicle.

OF CHANCRES.

Chancres are superficial, callous, eating ulcers; which may happen either with or without a gonorrhœa. They are commonly seated about the glans, and make their appearance in the following manner: First a little red pimple arises, which soon becomes pointed at top, and is filled with a whitish matter inclining to yellow. This pimple is hot, and itches generally before it breaks: afterwards it degenerates into an obstinate ulcer, the bottom of which is usually covered with a viscid mucus, and whose edges gradually become hard and callous. Sometimes the first appearance resembles a simple excoriation of the cuticle; which however, if the cause be venereal, soon becomes a true chancre.

A chancre is sometimes a primary affection, but it is much oftner symptomatic, and is the mark of a confirmed lues. Primary chancres discover themselves soon after impure coition, and are generally seated in parts covered with a thin cuticle, as the lips, the nipples of women, the glans penis of men, &c.[172].

When a chancre appears soon after impure coition, its treatment is nearly similar to that of the virulent gonorrhœa. The patient must observe the cooling regimen, lose a little blood, and take some gentle doses of salts and manna. The parts affected ought frequently to be bathed, or rather soaked, in warm milk and water, and, if the inflammation be great, an emollient poultice or cataplasm may be applied to them. This course will, in most cases, be sufficient to abate the inflammation, and prepare the patient for the use of mercury.

Symptomatic chancres are commonly accompanied with ulcers in the throat, nocturnal pains, scurfy eruptions about the roots of the hair, and other symptoms of a confirmed lues. Though they may be seated in any of the parts mentioned above, they commonly appear upon the private parts, or the inside of the thigh. They are also less painful, but frequently much larger and harder than primary chancres. As their cure must depend upon that of the pox, of which they are only a symptom, we shall take no further notice of them, till we come to treat of a confirmed lues[173].

Thus we have related most of the symptoms which accompany or succeed a violent gonorrhœa, and have also given a short view of their proper treatment; there are, however, several others which sometimes attend this disease, as a strangury or obstruction of urine, phymosis, paraphymosis, &c.

A strangury may be occasioned either by a spasmodic constriction, or an inflammation of the urethra and parts about the neck of the bladder. In the former case, the patient begins to void his urine with tolerable ease; but, as soon as it touches the galled or inflamed urethra, a sudden constriction takes place, and the urine is voided by spurts, and sometimes by drops only. When the strangury is owing to an inflammation about the neck of the bladder, there is a constant heat and uneasiness of the part, a perpetual desire to make water, while the patient can only render a few drops, and a troublesome tenesmus, or constant inclination to go to stool.

When the strangury is owing to spasm, such medicines as tend to dilute and blunt the salts of the urine will be proper. For this purpose, besides the common diluting liquors, soft and cooling emulsions, sweetened with the syrup of poppies, may be used. Should these not have the desired effect, bleeding, and emollient fomentations, will be necessary.

When the complaint is evidently owing to an inflammation about the neck of the bladder, bleeding must be more liberally performed, and repeated according to the urgency of the symptoms. After bleeding, if the strangury still continues, soft clysters, with a proper quantity of laudanum in them, may be administered, and emollient fomentations applied to the region of the bladder. At the same time, the patient may take every four hours a tea-cupful of barley-water, to an English pint of which six ounces of the syrup of marsh-mallows, four ounces of the oil of sweet almonds, and half an ounce of nitre, may be added. If these remedies should not relieve the complaint, and a total suppression of urine should come on, bleeding must be repeated, and the patient set in a warm bath up to the middle. It will be proper in this case to discontinue the diuretics, and to draw off the water with a catheter; but as the patient is seldom able to bear its being introduced, we would rather recommend the use of mild bougies. These often lubricate the passage, and greatly facilitate the discharge of urine. Whenever they begin to stimulate or give any uneasiness, they may be withdrawn.

The phymosis is such a constriction of the prepuce over the glans, as hinders it from being drawn backwards; the paraphymosis, on the contrary, is such a constriction of the prepuce behind the glans, as hinders it from being brought forward.

The treatment of these symptoms is so nearly the same with that of the virulent gonorrhœa, that we have no occasion to enlarge upon it. In general, bleeding, purging, poultices, and emollient fomentations are sufficient. Should these, however, fail of removing the stricture, and the parts be threatened with a mortification, twenty or thirty grains of ipecacuanha, and one grain of emetic tartar, may be given for a vomit, and may be worked off with warm water or thin gruel.

It sometimes happens, that, in spite of all endeavours to the contrary, the inflammation goes on, and symptoms of a beginning mortification appear. When this is the case, the prepuce must be scarified with a lancet, and, if necessary, divided, in order to prevent a strangulation, and set the imprisoned glans at liberty. We shall not describe the manner of performing this operation, as it ought always to be done by a surgeon. When a mortification has actually taken place, it will be necessary, besides performing the above operations, to foment the parts frequently with cloths wrung out of a strong decoction of camomile-flowers and bark, and to give the patient a drachm of the bark in powder every two or three hours.

With regard to the priapism, chordee, and other distortions of the penis, their treatment is no way different from that of the gonorrhœa. When they prove very troublesome, the patient may take a few drops of laudanum at night, especially after the operation of a purgative through the day.

OF A CONFIRMED LUES.

We have hitherto treated of those affections in which the venereal poison is supposed to be confined chiefly to the particular part by which it was received, and shall next take a view of the lues in its confirmed state; that is, when the poison is actually received into the blood, and, circulating with it through every part of the body, mixes with the several secretions, and renders the whole habit tainted.

The symptoms of a confirmed lues are, buboes in the groin, pains of the head and joints, which are peculiarly troublesome in the night, or when the patient is warm in bed; scabs and scurfs in various parts of the body, especially on the head, of a yellowish colour, resembling a honey-comb; corroding ulcers in various parts of the body, which generally begin about the throat, from whence they creep gradually, by the palate, towards the cartilage of the nose, which they destroy; excrescences or exostoses arise in the middle of the bones, and their spongy ends become brittle, and break upon the least accident; at other times they are soft, and bend like wax; the conglobate glands become hard and callous, and form, in the neck, armpits, groin, and mesentery, hard moveable tumours, like the king’s evil; tumours of different kinds are likewise formed in the lymphatic vessels, tendons, ligaments, and nerves, as the gummata, ganglia, nodes, tophs, &c.; the eyes are affected with itching, pain, redness, and sometimes with total blindness, and the ears with a singing noise, pain, and deafness, whilst their internal substance is exulcerated and rendered carious; at length all the animal, vital, and natural functions are depraved; the face becomes pale and livid; the body emaciated and unfit for motion, and the miserable patient falls into an atrophy or wasting consumption.

Women have symptoms peculiar to the sex; as cancers of the breast; a suppression or overflowing of the menses; the whites; hysteric affections; an inflammation, abscess, scirrhus, gangrene, cancer, or ulcer of the womb; they are generally either barren or subject to abortion; or, if they bring children into the world, they have an universal erysipelas, are half rotten, and covered with ulcers.

Such is the catalogue of symptoms attending this dreadful disease in its confirmed state. Indeed they are seldom all to be met with in the same person, or at the same time; so many of them, however, are generally present as are sufficient to alarm the patient; and if he has reason to suspect the infection is lurking in his body, he ought immediately to set about the expulsion of it, otherwise the most tragical consequences will ensue.

The only certain remedy hitherto known in Europe, for the cure of this disease, is mercury, which may be used in a great variety of forms, with nearly the same success. Some time ago it was reckoned impossible to cure a confirmed lues without a salivation. This method is now however pretty generally laid aside, and mercury is found to be as efficacious, or rather more so, in expelling the venereal poison, when administered in such a manner as not to run off by the salivary glands.

Though many are of opinion, that the mercurial ointment is as efficacious as any other preparation of that mineral; yet experience has taught me to think otherwise. I have often seen the most obstinate venereal cases, where great quantities of mercurial ointment had been used in vain, yield to the saline preparations of mercury. Nor am I singular in this opinion. My ingenious friend, Mr. Clare, an eminent surgeon of this city, assures me, that for some time past he has employed, in venereal cases, a saline preparation of mercury with most happy success. This preparation, rubbed with a sufficient quantity of any mild powder, he applies, in small portions, to the tongue, where, with a gentle degree of friction, it is immediately absorbed, and produces its full effect; upon the system, without doing the least injury to the stomach or bowels; a matter of the greatest importance in the application of this most active and powerful remedy.

It is impossible to ascertain either the exact quantity of medicines that must be taken, or the time they ought to be continued, in order to perform a cure. These will ever vary according to the constitution of the patient, the season of the year, the degree of infection, the time it has lodged in the body, &c. But though it is difficult, as Astruc observes, to determine à priori, what quantity of mercury will, in the whole, be necessary to cure this distemper completely; yet it may be judged of à posteriori, from the abatement and ceasing of the symptoms. The same author adds, that commonly not less than two ounces of the strong mercurial ointment is sufficient, and not more than three or four ounces necessary.

The only chemical preparation of mercury which we shall take notice of, is the corrosive sublimate. This was some time ago brought into use for the venereal disease, in Germany, by the illustrious Baron Van Swieten; and was soon after introduced into Britain by the learned Sir John Pringle, at that time physician to the army. The method of giving it is as follows: One grain of corrosive sublimate is dissolved in two ounces of French brandy or malt spirits; and of this solution, an ordinary table-spoonful, or the quantity of half an ounce, is to be taken twice a-day, and to be continued as long as any symptoms of the disorder remain. To those whose stomach cannot bear the solution, the sublimate may be given in form of pill[174].

Several roots, woods, and barks, have been recommended for curing the venereal disease; but none of them have been found, upon experience, to answer the high encomiums which had been bestowed upon them. Though no one of these is to be depended upon alone, yet, when joined with mercury, some of them are found to be very beneficial in promoting a cure. One of the best we know yet is sarsaparilla, which may be prepared and taken according to the directions in the Appendix[175].

The mezereon root is likewise found to be a powerful assistant to the sublimate, or any other mercurial. It may either be used along with the sarsaparilla, as directed in the Appendix, or by itself. Those who chuse to use the mezereon by itself, may boil an ounce of the fresh bark, taken from the root, in twelve English pints of water to eight, adding towards the end an ounce of liquorice. The dose of this is the same as of the decoction of sarsaparilla.

We have been told that the natives of America cure the venereal disease, in every stage, by a decoction of the root of a plant called the Lobelia. It is used either fresh or dried; but we have no certain accounts with regard to the proportion. Sometimes they mix other roots with it, as those of the ranunculus, the ceanothus, &c.; but whether these are designed to disguise or assist it, is doubtful. The patient takes a large draught of the decoction early in the morning, and continues to use it for his ordinary drink through the day[176].

Many other roots and woods might be mentioned which have been extolled for curing the venereal disease, as the china-root, the roots of soap-wort, burdock, &c. as also the wood of guaiacum and sassafras; but as none of these have been found to possess virtues superior to those already mentioned, we shall, for the sake of brevity, pass them over, and shall conclude our observations on this disease with a few general remarks concerning the proper management of the patient, and the nature of the infection.

GENERAL OBSERVATIONS.

The condition of the patient ought always to be considered previous to his entering upon a course of mercury in any form. It would be equally rash and dangerous to administer mercury to a person labouring under any violent acute disease, as a putrid fever, pleurisy, peripneumony, or the like. It would likewise be dangerous in some chronic cases; as a slow hectic fever, or the last stage of a consumption. Sometimes, however, these diseases proceed from a confirmed lues; in which case it will be necessary to give mercury. In chronic diseases of a less dangerous nature, as the asthma, the gravel, and such like, mercury, if necessary, may be safely administered. If the patient’s strength has been greatly exhausted by sickness, labour, abstinence, or any other cause, the use of mercury must be postponed, till by time, rest, and a nourishing diet, it can be sufficiently restored.

Mercury ought not to be administered to women during the menstrual flux, or when the period is near at hand. Neither should it be given in the last stage of pregnancy. If, however, the woman be not near the time of her delivery, and circumstances render it necessary, mercury may be given, but in smaller doses, and at greater intervals than usual: with these precautions, both the mother and child may be cured at the same time; if not, the disorder will at least be kept from growing worse, till the woman be brought to bed, and sufficiently recovered, when a more effectual method may be pursued, which, if she suckles her child, will in all probability be sufficient for the cure of both.

Mercury ought always to be administered to infants with the greatest caution. Their tender condition unfits them for supporting a salivation, and makes it necessary to administer even the mildest preparations of mercury to them with a sparing hand. A similar conduct is recommended in the treatment of old persons, who have the misfortune to labour under a confirmed lues. No doubt the infirmities of age must render people less able to undergo the fatigues of a salivation; but this, as was formerly observed, is never necessary; besides, we have generally found, that mercury had much less effect upon very old persons than on those who were younger.

Hysteric and hypochondriac persons, and such as are subject to an habitual diarrhœa or dysentery, or to frequent and violent attacks of the epilepsy, or who are afflicted with the scrophula, or the scurvy, ought to be cautious in the use of mercury. Where any one of these disorders prevails, it ought either, if possible, to be cured, or at least palliated, before the patient enters upon a course of mercury. When this cannot be done, the mercury must be administered in smaller doses, and at longer intervals than usual.

The most proper seasons for entering upon a course of mercury, are the spring and autumn, when the air is of a moderate warmth. If the circumstances of the case, however, will not admit of delay, we must not defer the cure on account of the season, but must administer the mercury; taking care at the same time to keep the patient’s chamber warmer or cooler, according as the season of the year requires.

The next thing to be considered is the preparation necessary to be observed before we proceed to administer a course of mercury. Some lay great stress upon this circumstance, observing, that by previously relaxing the vessels, and correcting any disorder which may happen to prevail in the blood, not only the mercury will be disposed to act more kindly, but many other inconveniencies will be prevented.

We have already recommended bleeding and gentle purges, previous to the administration of mercury, and shall only now add, that these are always to be repeated according to the age, strength, constitution, and other circumstances of the patient. Afterwards, if it can be conveniently done, the patient ought to bathe once or twice a-day, for a few days, in lukewarm water. His diet in the mean time must be light, moist, and cooling. Wine, and all heating liquors, also violent bodily exercise, and all great exertions of the mind, are carefully to be avoided.

A proper regimen is likewise to be observed by such as are under a course of mercury. Inattention to this not only endangers the patient’s life but often also disappoints him of a cure. A much smaller quantity of mercury will be sufficient for the cure of a person who lives low, keeps warm, and avoids all manner of excess, than of one who cannot endure to put the smallest restraint upon his appetites: indeed it but rarely happens that such are thoroughly cured.

There is hardly any thing of more importance, either for preventing or removing venereal infection than cleanliness. By an early attention to this, the infection might often be prevented from entering the body; and, where it has already taken place, its effects may be greatly mitigated. The moment any person has reason to suspect that he has received the infection, he ought to wash the parts with water and spirits, sweet oil, or milk and water; a small quantity of the last may likewise be injected up the urethra, if it can be conveniently done. Whether this disease at first took its rise from dirtiness is hard to say; but wherever that prevails, the infection is found in its greatest degree of virulence, which gives ground to believe that a strict attention to cleanliness would go far towards extirpating it altogether[177].

When the venereal disease has been neglected, or improperly treated, it often becomes a disorder of the habit. In this case the cure must be attempted by restoratives, as a milk diet, the decoction of sarsaparilla, and such like, to which mercury may be occasionally added. It is a common practice in North Britain to send such patients to drink goat-whey. This is a very proper plan, provided the infection has been totally eradicated before-hand; but when that is not the case, and the patient trusts to the whey for finishing his cure, he will often be disappointed. I have frequently known the disease return with all its virulence after a course of goat-whey, even when that course had been thought quite sufficient for completing the cure.

One of the most unfortunate circumstances attending patients in this disease, is the necessity they are often laid under of being soon well. This induces them to take medicine too fast, and to leave it off too soon. A few grains more of medicine, or a few days longer confinement, would often be sufficient to perfect the cure; whereas, by neglect of these, a small degree of virulence is still left in the humours, which gradually vitiates, and at length contaminates the whole mass. To avoid this, we would advise, that the patient should never leave off taking medicine immediately upon the disappearing of the symptoms, but continue it for some time after, gradually lessening the quantity, till there is sufficient ground to believe that the disease is entirely eradicated.

It is not only difficult, but absolutely impossible, to ascertain the exact degree of virulence that may attend the disease; for which reason it will always be a much safer rule to continue the use of medicine too long, than to leave it off too soon. This seems to be the leading maxim of a modern practitioner of some note for the venereal disease, who always orders his patient to perform a quarantine of at least forty days, during which time he takes forty bottles of, I suppose, a strong decoction of sarsaparilla, or some other antivenereal simple. Whoever takes this method, and adds a sufficient quantity of corrosive sublimate, or some other active preparation of mercury to the decoction, will seldom fail to cure a confirmed lues.

It is peculiarly unfortunate for the cure of this disease, that not one in ten of those who contract it, are either able or willing to submit to a proper plan of regimen. The patient is willing to take medicine; but he must follow his business, and, to prevent suspicions, must eat and drink like the rest of the family. This is the true source of nine-tenths of all the mischief arising from the venereal disease. I never knew the cure attended with any great difficulty or danger where the patient strictly followed the physician’s advice: but a volume would not be sufficient to point out the dreadful consequences which proceed from an opposite conduct. Scirrhous testicles, ulcerous sore throats, madness, consumptions, carious bones, and a rotten progeny, are a few of the blessings derived from this source.

There is a species of false reasoning, with regard to this disease, which proves fatal to many. A person of a sound constitution contracts a slight degree of the disorder. He gets well without taking any great care, or using much medicine, and hence concludes that this will always be the case. The next time the disease occurs, though, ten times more virulent, he pursues the same course, and his constitution is ruined. Indeed, the different degrees of virulence in the small-pox are not greater than in this disease, though, as the learned Sydenham observes, in some cases the most skilful physicians cannot cure, and in others the most ignorant old woman cannot kill the patient in that disorder. Though a good constitution is always in favour of the patient, yet too great stress may be laid upon it. It does not appear from observation, that the most robust constitution is able to overcome the virulence of the venereal contagion, after it has got into the habit. In this case a proper course of medicine is always indispensably necessary.

Although it is impossible, on account of the different degrees of virulence, &c. to lay down fixed and certain rules for the cure of this disease, yet the following general plan will always be found safe, and often successful, viz. to bleed and administer gentle purges with diuretics during the inflammatory state, and as soon as the symptoms of inflammation are abated, to administer mercury, in any form that may be most agreeable to the patient. The same medicine, assisted by the decoction of sarsaparilla, and a proper regimen, will not only secure the constitution against the further progress of a confirmed pox, but will generally perform a complete cure.

CHAP. XLVIII. DISEASES OF WOMEN.

Women, in all civilized nations, have the management of domestic affairs, and it is very proper they should, as Nature has made them less fit for the more active and laborious employments. This indulgence, however, is generally carried too far; and females, instead of being benefited by it, are greatly injured, from the want of exercise and free air. To be satisfied of this, one need only compare the fresh and ruddy looks of a milk-maid, with the pale complexion of those females whose whole time is spent within doors. Though Nature has made an evident distinction between the male and female with regard to bodily strength and vigour, yet she certainly never meant, either that the one should be always without, or the other always within doors.

The confinement of females, besides hurting their figure and complexion, relaxes their solids, weakens their minds, and disorders all the functions of the body. Hence proceed obstructions, indigestion, flatulence, abortions, and the whole train of nervous disorders. These not only unfit women for being mothers and nurses, but often render them whimsical and ridiculous. A sound mind depends so much upon a healthy body, that where the latter is wanting the former is rarely to be found.

I have always observed, that women who were chiefly employed without doors, in the different branches of husbandry, gardening, and the like, were almost as hardy as their husbands, and that their children were likewise strong and healthy. But as the bad effects of confinement and inactivity upon both sexes have been already shewn, we shall proceed to point out those circumstances in the structure and design of females, which subject them to peculiar diseases; the chief of which are, their monthly evacuations, pregnancy, and child-bearing. These indeed cannot properly be called diseases, but from the delicacy of the sex, and their being often improperly managed in such situations, they become the source of numerous calamities.

OF THE MENSTRUAL DISCHARGE.

Females generally begin to menstruate about the age of fifteen, and leave it off about fifty, which renders these two periods the most critical of their lives. About the first appearance of this discharge, the constitution undergoes a very considerable change, generally indeed for the better, though sometimes for the worse. The greatest care is now necessary, as the future health and happiness of the female depends in a great measure upon her conduct at this period[178].

If a girl about this time of life be confined to the house, kept constantly sitting, and neither allowed to romp about, nor employed in any active business, which gives exercise to the whole body, she becomes weak, relaxed, and puny; her blood not being duly prepared, she looks pale and wan; her health, spirits, and vigour decline, and she sinks into a valetudinarian for life. Such is the fate of numbers of those unhappy females, who, either from too much indulgence, or their own narrow circumstances, are, at this critical period, denied the benefit of exercise and free air.

A lazy indolent disposition proves likewise very hurtful to girls at this period. One seldom meets with complaints from obstructions amongst the more active and industrious part of the sex; whereas the indolent and lazy are seldom free from them. These are in a manner eaten up by the chlorosis, or green-sickness, and other diseases of this nature. We would therefore recommend it to all who wish to escape these calamities, to avoid indolence and inactivity, as their greatest enemies, and to be as much abroad in the open air as possible.

Another thing which proves very hurtful to girls about this period of life, is unwholesome food. Fond of all manner of trash, they often indulge in it, till their whole humours are quite vitiated. Hence ensue indigestions, want of appetite, and a numerous train of evils. If the fluids be not duly prepared, it is utterly impossible that the secretions should go properly on. Accordingly we find, that such girls as lead an indolent life, and eat great quantities of trash, are not only subject to obstructions of the menses, but likewise to glandular obstructions; as the scrophula, or king’s evil, &c.

A dull disposition is also very hurtful to girls at this period. It is a rare thing to see a sprightly girl who does not enjoy good health, while the grave, moping, melancholy creature, proves the very prey of vapours and hysterics. Youth is the season for mirth and cheerfulness. Let it therefore be indulged. It is an absolute duty. To lay in a stock of health in time of youth, is as necessary a piece of prudence, as to make provision against the decays of old age. While, therefore, wise Nature prompts the happy youth to join in sprightly amusements, let not the severe dictates of hoary age forbid the useful impulse, nor damp, with serious gloom, the season destined to mirth and innocent festivity.

Another thing very hurtful to females about this period of life is strait clothes. They are fond of a fine shape, and foolishly imagine that this can be acquired by lacing themselves tight. Hence, by squeezing the stomach and bowels, they hurt the digestion, and occasion many incurable maladies. This error is not indeed so common as it has been; but, as fashions change, it may come about again: we therefore think it not improper to mention it. I know many females who, to this day, feel the direful effects of that wretched custom which prevailed some years ago, of squeezing every girl into as small a size in the middle as possible. Human invention could not possibly have devised a practice more destructive to health.

After a female has arrived at that period of life when the menses usually begin to flow, and they do not appear, but, on the contrary, her health and spirits begin to decline, we would advise, instead of shutting the poor girl up in the house, and dosing her with steel, asafœtida, and other nauseous drugs, to place her in a situation where she can enjoy the benefit of free air and agreeable company. There let her eat wholesome food, take sufficient exercise, and amuse herself in the most agreeable manner; and we have little reason to fear, but Nature, thus assisted, will do her proper work. Indeed she seldom fails, unless where the fault is on our side.

This discharge in the beginning is seldom so instantaneous as to surprise females unawares. It is generally preceded by symptoms which foretel its approach; as a sense of heat, weight, and dull pain in the loins; distension and hardness of the breasts; head-ach; loss of appetite; lassitude; paleness of the countenance; and sometimes a slight degree of fever. When these symptoms appear about the age at which the menstrual flux usually begins, every thing should be carefully avoided which may obstruct that necessary and salutary evacuation; and all means used to promote it; as sitting frequently over the steams of warm water, drinking warm diluting liquors, &c.

After the menses have once begun to flow, the greatest care should be taken to avoid every thing that may tend to obstruct them. Females ought to be exceeding cautious of what they eat or drink at the time they are out of order. Every thing that is cold, or apt to sour on the stomach, ought to be avoided; as fruit, butter-milk, and such like. Fish, and all kinds of food that are hard of digestion, are also to be avoided. As it is impossible to mention every thing that may disagree with individuals at this time, we would recommend it to every female to be very attentive to what disagrees with herself, and carefully to avoid it.

Cold is extremely hurtful at this particular period. More of the sex date their disorders from colds, caught while they are out of order, than from all other causes. This ought surely to put them upon their guard, and to make them very circumspect in their conduct at such times. A degree of cold that will not at the least hurt them at another time, will at this period be sufficient entirely to ruin their health and constitution.

The greatest attention ought likewise to be paid to the mind, which should be kept as easy and cheerful as possible. Every part of the animal economy is influenced by the passions, but none more so than this. Anger, fear, grief, and other affections of the mind, often occasion obstructions of the menstrual flux, which prove absolutely incurable.

From whatever cause this flux is obstructed, except in the state of pregnancy, proper means should be used to restore it. For this purpose we would recommend sufficient exercise, in a dry, open, and rather cool air; wholesome diet, and, if the body be weak and languid, generous liquors; also cheerful company and all manner of amusements. If these fail, recourse must be had to medicine.

When obstructions proceed from a weak relaxed state of the solids, such medicines as tend to promote digestion, to brace the solids, and assist the body in preparing good blood, ought to be used. The principal of these are iron and the Peruvian bark, with other bitter and astringent medicines. Filings of iron may be infused in wine or ale, two or three ounces to an English quart, and after it has stood for two or three weeks it may be filtered, and about half a wine-glass of it taken twice a-day: or prepared steel may be taken in the dose of half a drachm, mixed with a little honey or treacle, three or four times a-day. The bark and other bitters may either be taken in substance or infusion, as is most agreeable to the patient.

When obstructions proceed from a viscid state of the blood; or for women of a gross or full habit, evacuations, and such medicines as attenuate the humours, are necessary. The patient in this case ought to be bled, to bathe her feet frequently in warm water, to take now and then a cooling purge, and to live upon a spare thin diet. Her drink should be whey, water, or small beer, and she ought to take sufficient exercise. A tea-spoonful of the tincture of black hellebore may also be taken twice a-day in a cup of warm water.

When obstructions proceed from affections of the mind, as grief, fear, anger, &c. every method should be taken to amuse and divert the patient. And that she may the more readily forget the cause of her affliction, she ought, if possible, to be removed from the place where it happened. A change of place, by presenting the mind with a variety of new objects, has often a very happy influence in relieving it from the deepest distress. A soothing, kind, and affable behaviour to females in this situation is also of the last importance.

An obstruction of the menses is often the effect of other maladies. When this is the case, instead of giving medicines to force that discharge, which might be dangerous, we ought by all means to endeavour to restore the patient’s health and strength. When that is effected, the other will return of course.

But the menstrual flux may be too great as well as too small. When this happens, the patient becomes weak, the colour pale, the appetite and digestion are bad, and œdematous swellings of the feet, dropsies, and consumptions often ensue. This frequently happens to women about the age of forty-five or fifty, and is very difficult to cure. It may proceed from a sedentary life; a full diet, consisting chiefly of salted, high-seasoned, or acrid food; the use of spirituous liquors; excessive fatigue; relaxation; a dissolved state of the blood; violent passions of the mind, &c.

The treatment of this disease must be varied according to its cause. When it is occasioned by any error in the patient’s regimen, an opposite course to that which induced the disorder must be pursued, and such medicines taken as have a tendency to restrain the flux, and counteract the morbid affections of the system from whence it proceeds.

To restrain the flux, the patient should be kept quiet and easy both in body and mind. If it be very violent, she ought to lie in bed with her head low; to live upon a cool and slender diet, as veal or chicken broths with bread; and to drink decoctions of nettle-roots, or the greater comfrey. If these be not sufficient to stop the flux, stronger astringents may be used, as Japan earth, allum, elixir of vitriol, the Peruvian bark, &c.[179]

The uterine flux may offend in quality as well as in quantity. What is usually called the fluor albus, or whites, is a very common disease, and proves extremely hurtful to delicate women. This discharge, however, is not always white, but sometimes pale, yellow, green, or of a blackish colour; sometimes it is sharp and corrosive, sometimes foul and fœtid, &c. It is attended with a pale complexion, pain in the back, loss of appetite, swelling of the feet, and other signs of debility. It generally proceeds from a relaxed state of the body, arising from indolence, the excessive use of tea, coffee, or other weak and watery diet.

To remove this disease, the patient must take as much exercise as she can bear without fatigue. Her food should be solid and nourishing, but of easy digestion; and her drink rather generous, as red port or claret, mixed with Pyrmont, Bristol, or lime-water. Tea and coffee are to be avoided. I have often known strong broths have an exceeding good effect, and sometimes a milk diet alone will perform a cure. The patient ought not to lie too long a-bed. When medicine is necessary, we know none preferable to the Peruvian bark, which in this case ought always to be taken in substance. In warm weather, the cold bath will be of considerable service.

That period of life at which the menses cease to flow, is likewise very critical to the sex. The stoppage of any customary evacuation, however small, is sufficient to disorder the whole frame, and often to destroy life itself. Hence it comes to pass, that so many women either fall into chronic disorders, or die about this time. Such of them, however, as survive it, without contracting any chronic disease, often become more healthy and hardy than they were before, and enjoy strength and vigour to a very great age.

If the menses cease all of a sudden, in women of a full habit, they ought to abate somewhat of their usual quantity of food, especially of the more nourishing kind, as flesh, eggs, &c. They ought likewise to take sufficient exercise, and to keep the body open. This may be done by taking, once or twice a-week, a little rhubarb, or an infusion of hiera picra in wine or brandy.

It often happens that women of a gross habit, at this period of life, have ulcerous sores break out about their ancles, or in other parts of the body. Such ulcers ought to be considered as critical, and should either be suffered to continue open, or have artificial drains substituted in their stead. Women who will have such sores dried up, are often soon after carried off by acute diseases, or fall into those of a chronic nature.

OF PREGNANCY.

Though pregnancy is not a disease, yet that state is often attended with a variety of complaints which merit attention, and which sometimes require the assistance of medicine. Some women indeed are more healthy during their pregnancy than at any other time; but this is by no means the general case: most of them breed in sorrow, and are frequently indisposed during the whole time of pregnancy. Few fatal diseases, however, happen during that period; and hardly any, except abortion, that can be called dangerous. We shall therefore pay particular attention to it, as it proves generally fatal to the child, and sometimes so to the mother.

Pregnant women are often afflicted with the heart-burn. The method of treating this complaint has been already pointed out. They are likewise, in the more early periods of pregnancy, often harassed with sickness and vomiting, especially in the morning. The method of relieving these complaints has also been shewn. Both the head-ach and tooth-ach are very troublesome symptoms of pregnancy. The former may generally be removed by keeping the body gently open, by the use of prunes, figs, roasted apples, and such like. When the pain is very violent, bleeding may be necessary. For the treatment of the latter, we must refer to that article. Several other complaints incident to pregnant women might be mentioned, as a cough and difficulty of breathing, suppression and incontinency of urine, &c.; but as all of these have been taken notice of before, it is needless to repeat them.

Every pregnant woman is more or less in danger of abortion. This should be guarded against with the greatest care, as it not only weakens the constitution, but renders the woman liable to the same misfortune afterwards[180]. Abortion may happen at any period of pregnancy, but it is most common in the second or third month. Sometimes, however, it happens in the fourth or fifth. If it happens within the first month, it is usually called a false conception; if after the seventh month, the child may often be kept alive by proper care.

The common causes of abortion are, the death of the child; weakness or relaxation of the mother; great evacuations; violent exercise; raising great weights; reaching too high; jumping, or stepping from an eminence; vomiting; coughing; convulsion fits; blows on the belly; falls; fevers; disagreeable smells; excess of blood; indolence; high living; or the contrary; violent passions or affections of the mind, as fear, grief, &c.

The signs of approaching abortion are, pain in the loins, or about the bottom of the belly; a dull heavy pain in the inside of the thighs; a slight degree of coldness, or shivering; sickness, palpitation of the heart; the breasts become flat and soft; the belly falls; and there is a discharge of blood or watery humours from the womb.

To prevent abortion, we would advise women of a weak or relaxed habit to use solid food, avoiding great quantities of tea, and other weak and watery liquors; to rise early and go soon to bed; to shun damp houses; to take frequent exercise in the open air, but to avoid fatigue; and never to go abroad in damp foggy weather, if they can shun it.

Women of a full habit ought to use a spare diet, avoiding strong liquors, and every thing that may tend to heat the body, or increase the quantity of blood. Their diet should be of an opening nature, consisting principally of vegetable substances. Every woman with child ought to be kept cheerful and easy in her mind. Her appetites, even though depraved, ought to be indulged as far as prudence will permit.

When any signs of abortion appear, the woman ought to be laid in bed on a mattrass, with her head low. She should be kept quiet, and her mind soothed and comforted. She ought not to be kept too hot, nor to take any thing of a heating nature. Her food should consist of broths, rice and milk, jellies, gruels made of oatmeal, and the like, all of which ought to be taken cold.

If she be able to bear it, she should lose at least half a pound of blood from the arm. Her drink ought to be barley-water sharpened with juice of lemon; or she may take half a drachm of powdered nitre, in a cup of water-gruel, every five or six hours. If the woman be seized with a violent looseness, she ought to drink the decoction of calcined hartshorn prepared. If she be affected with vomiting, let her take frequently two table-spoonfuls of the saline mixture. In general, opiates are of service; but they should always be given with caution.

Sanguine robust women, who are liable to miscarry at a certain time of pregnancy, ought always to be bled a few days before that period arrives. By this means, and observing the regimen above prescribed, they might often escape that misfortune.

Though we recommend due care for preventing abortion, we would not be understood as restraining pregnant women from their usual exercises. This would generally operate the quite contrary way. Want of exercise not only relaxes the body, but induces a plethora, or too great a fulness of the vessels, which are the two principal causes of abortion. There are, however, some women of so delicate a texture, that it is necessary for them to avoid almost every kind of exercise during the whole period of pregnancy.

OF CHILD-BIRTH.

Many diseases proceed from the want of due care in child-bed; and the more hardy part of the sex are most apt to despise the necessary precautions in this state. This is peculiarly the case with young wives. They think, when the labour-pains are ended, the danger is over; but in truth it may only then be said to be begun. Nature, if left to herself, will seldom fail to expel the fœtus; but proper care and management are certainly necessary for the recovery of the mother. No doubt mischief may be done by too much as well as by too little care. Hence females who have the greatest number of attendants in child-bed generally recover worst. But this is not peculiar to the state of child-bed. Excessive care always defeats its own intention, and is generally more dangerous than none at all[181].

During actual labour, nothing of a heating nature ought to be given. The woman may now and then take a little panado, and her drink ought to be toast and water, or thin groat-gruel. Spirits, wines, cordial waters, and other things which are given with a view to strengthen the mother, and promote the birth, for the most part tend only to increase the fever, inflame the womb, and retard the labour. Besides, they endanger the woman afterwards, as they often occasion violent and mortal hæmorrhages, or dispose her to eruptive and other fevers.

When the labour proves tedious and difficult, to prevent inflammations, it will be proper to bleed. An emollient clyster ought likewise frequently to be administered; and the patient should sit over the steams of warm water. The passage ought to be gently rubbed with a little soft pomatum or fresh butter, and cloths wrung out of warm water applied over the belly. If nature seems to sink, and the woman is greatly exhausted with fatigue, a draught of generous wine, or some other cordial, may be given, but not otherwise. These directions are sufficient in natural labours; and in all preternatural cases, a skilful surgeon, or man-midwife, ought to be called as soon as possible.

After delivery, the woman ought to be kept as quiet and easy as possible[182]. Her food should be light and thin, as gruel, panado, &c. and her drink weak and diluting. To this rule, however, there are many exceptions. I have known several women, whose spirits could not be supported in child-bed without solid food and generous liquors; to such, a glass of wine and a bit of chicken must be allowed.

Sometimes an excessive hæmorrhage or flooding happens after delivery. In this case the patient should be laid with her head low, kept cool, and be in all respects treated as for an excessive flux of the menses. If the flooding proves violent, linen cloths, which have been wrung out of a mixture of equal parts of vinegar and water, or red wine, should be applied to the belly, the loins, and the thighs: these must be changed as they grow dry; and may be discontinued as soon as the flooding abates[183].

If there be violent pains after delivery, the patient ought to drink plentifully of warm diluting liquors, as groat-gruel, or tea with a little saffron in it; and to take small broths, with carrawayseeds, or a bit of orange-peel in them; an ounce of the oil of sweet almonds may likewise be frequently taken in a cup of any of the above liquors; and if the patient be restless, a spoonful of the syrup of poppies may now and then be mixed with a cup of her drink. If she be hot or feverish, one of the following powders may be taken in a cup of her usual drink every five or six hours[184].

An inflammation of the womb is a dangerous and not unfrequent disease after delivery. It is known by pains in the lower part of the belly, which are greatly increased upon touching; by the tension or tightness of the parts; great weakness; change of countenance; a constant fever, with a weak and hard pulse; a slight delirium or raving; sometimes incessant vomiting; a hiccup; a discharge of reddish, stinking, sharp water from the womb; an inclination to go frequently to stool; a heat, and sometimes total suppression of urine.

This must be treated like other inflammatory disorders, by bleeding and plentiful dilution. The drink may be thin gruel or barley-water; in a cup of which half a drachm of nitre may be dissolved, and taken three or four times a-day. Clysters of warm milk and water must be frequently administered; and the belly should be fomented by cloths wrung out of warm water, or by applying bladders filled with warm milk and water to it.

A suppression of the lochia, or usual discharges after delivery, and the milk-fever, must be treated nearly in the same manner as an inflammation of the womb. In all these cases, the safest course is plentiful dilution, gentle evacuations, and fomentations of the parts affected. In the milk-fever, the breads may be embrocated with a little warm linseed oil, or the leaves of red cabbage may be applied to them. The child should be often put to the breast, or it should be drawn by some other person.

Nothing would tend more to prevent the milk-fever than putting the child early to the breast. The custom of not allowing children to suck for the first two or three days, is contrary to Nature and common sense, and is very hurtful both to the mother and child.

Every mother who has milk in her breasts, ought either to suckle her own child, or to have her breasts frequently drawn, at least for the first month. This would prevent many of the diseases which prove fatal to women in child-bed.

When an inflammation happens in the breast, attended with redness, hardness, and other symptoms of suppuration, the safest application is a poultice of bread and milk, softened with oil or fresh butter. This may be renewed twice a-day, till the tumour be either discussed or brought to suppuration. The use of repellents, in this case, is very dangerous; they often occasion fevers, and sometimes cancers; whereas a suppuration is seldom attended with any danger, and has often the most salutary effects.

When the nipples are fretted or chapt, they may be anointed with a mixture of oil and beeswax, or a little powdered gum-arabic may be sprinkled on them. I have seen Hungary water applied to the nipples have a very good effect. Should the complaint prove obstinate, a cooling purge may be given, which generally removes it.

The miliary fever is a disease incident to women in child-bed; but as it has been treated of already, we shall take no further notice of it. The celebrated Hoffman observes, That this fever of child-bed women might generally be prevented, if they, during their pregnancy, were regular in their diet, used moderate exercise, took now and then a gentle laxative of manna, rhubarb, or cream of tartar; not forgetting to bleed in the first months, and avoid all sharp air. When the labour is coming on, it is not to be hastened with forcing medicines, which inflame the blood and humours, or put them into unnatural commotions. Care should be taken, after the birth, that the natural excretions proceed regularly; and if the pulse be quick, a little nitrous powder, or some other cooling medicines, should be administered.

The most fatal disorder consequent upon delivery is the puerperal, or child-bed fever. It generally makes its attack upon the second or third day after delivery. Sometimes indeed it comes on sooner, and at other times, though rarely, it does not appear before the fifth or sixth day.

It begins, like most other fevers, with a cold or shivering fit, which is succeeded by restlessness, pain of the head, great sickness at stomach, and bilious vomiting. The pulse is generally quick, the tongue dry, and there is a remarkable depression of spirits and loss of strength. A great pain is usually felt in the back, hips, and region of the womb; a sudden change in the quantity or quality of the lochia also takes place; and the patient is frequently troubled with a tenesmus, or constant inclination to go to stool. The urine, which is very high-coloured, is discharged in small quantity, and generally with pain. The belly sometimes swells to a considerable bulk, and becomes susceptible of pain from the slightest touch. When the fever has continued for a few days, the symptoms of inflammation usually subside, and the disease acquires a more putrid form. At this period, if not sooner, a bilious or putrid looseness, of an obstinate and dangerous nature, comes on, and accompanies the disease through all its future progress.

There is not any disease that requires to be treated with more skill and attention than this; consequently the best assistance ought always to be obtained as soon as possible. In women of plethoric constitutions, bleeding will generally be proper at the beginning; it ought however to be used with caution, and not to be repeated unless where the signs of inflammation rise high; in which case it will also be necessary to apply a blistering-plaster to the region of the womb.

During the rigour, or cold fit, proper means should be used to abate its violence, and shorten its duration. For this purpose the patient may drink freely of warm diluting liquors, and, if low, may take now and then a cup of whine-whey; warm applications to the extremities, as heated bricks, bottles or bladders filled with warm water, and such like, may also be used with advantage.

Emollient clysters of milk and water, or of chicken water, ought to be frequently administered through the course of the disease. These prove beneficial by promoting a discharge from the intestines, and also by acting as a kindly fomentation to the womb and parts adjacent. Great care however is requisite in giving them, on account of the tenderness of the parts in the pelvis at this time.

To evacuate the offending bile from the stomach, a vomit is generally given. But as this is apt to increase the irritability of the stomach, already too great, it will be safer to omit it, and to give in its stead a gentle laxative, which will both tend to cool the body, and to procure a free discharge of the bile[185].

The medicine which I have always found to succeed best in this disease is the saline draught. This, if frequently repeated, will often put a stop to the vomiting, and at the same time lessen the violence of the fever. If it runs off by stool, or if the patient be restless, a few drops of laudanum, or some syrup of poppies, may occasionally be added.

If the stools should prove so frequent as to weaken and exhaust the patient, a starch clyster, with thirty or forty drops of laudanum in it, may be administered as occasion shall require; and the drink may be rice-water, in every English pint of which half an ounce of gum-arabic has been dissolved. Should these fail, recourse must be had to Columbo-root, or some other strong astringent.

Though in general the food ought to be light, and the drink diluting, yet when the disease has been long protracted, and the patient is greatly spent by evacuations, it will be necessary to support her with nourishing diet and generous cordials.

It was observed that this fever, after continuing for some time, often acquires a putrid form. In this case the Peruvian bark must be given, either by itself, or joined with cordials, as circumstances may require. As the bark in substance will be apt to purge, it may be given in decoction or infusion mixed with the tincture of roses, or other gentle astringents; or, a scruple of the extract of bark with half an ounce of spirituous cinnamon-water, two ounces of common water, and ten drops of laudanum, may be made into a draught, and given every second, third, or fourth hour, as shall be found necessary.

When the stomach will not bear any kind of nourishment, the patient may be supported for some time by clysters of beef tea, or chicken water.

To avoid this fever, every woman in child-bed ought to be kept perfectly easy; her food should be light and simple, and her bed-chamber cool, and properly ventilated. There is not any thing more hurtful to a woman in this situation than being kept too warm. She ought not to have her body bound too tight, nor to rise too soon from bed, after delivery; catching cold is also to be avoided; and a proper attention should be paid to cleanliness.

To prevent the milk-fever, the breast ought to be frequently drawn; and if they are filled previous to the onset of a fever, they should, upon its first appearance, be drawn, to prevent the milk from becoming acrid, and its being absorbed in this state. Costiveness is likewise to be avoided. This will be best effected by the use of mild clysters and a laxative diet.

We shall conclude our observations on child-bed women by recommending it to them, above all things, to beware of cold. Poor women, whose circumstances oblige them to quit their bed too soon, often contract diseases from cold, of which they never recover. It is pity the poor are not better taken care of in this situation.

But the better sort of women run the greatest hazard from too much heat. They are generally kept in a sort of bagnio for the first eight or ten days, and then dressed out to see company. The danger of this conduct must be obvious to every one.

The superstitious custom of obliging women to keep the house till they go to church, is likewise a very common cause of catching cold. All churches are damp, and most of them cold; consequently they are the very word places to which a woman can go to make her first visit, after having been confined in a warm room for a month.

OF BARRENNESS.

Barrenness may be very properly reckoned among the diseases of females, as few married women who have not children enjoy a good state of health. It may proceed from various causes, as high living, grief, relaxation, &c. but it is chiefly owing to an obstruction or irregularity of the menstrual flux.

It is very certain that high living vitiates the humours, and prevents fecundity. We seldom find a barren woman among the labouring poor, while nothing is more common among the rich and affluent. The inhabitants of every country are prolific in proportion to their poverty; and it would be an easy matter to adduce many instances of women, who, by being reduced to live entirely upon a milk and vegetable diet, have conceived and brought forth children, though they never had any before. Would the rich use the same sort of food and exercise as the better sort of peasants, they would seldom have cause to envy their poor vassals and dependants the blessing of a numerous and healthy offspring, while they pine in sorrow for the want of even a single heir to their extensive domains.

Affluence begets indolence, which not only vitiates the humours, but induces a general relaxation of the solids; a state, highly unfavourable to procreation. To remove this, we would recommend the following course: First, sufficient exercise in the open air; secondly, a diet consisting chiefly of milk and vegetables[186]; thirdly, the use of astringent medicines, as steel, allum, dragon’s blood, elixir of vitriol, the Spaw or Tunbridge waters, Peruvian bark, &c.; and lastly, above all, the cold bath.

Barrenness is often the consequence of grief, sudden fear, anxiety, or any of the passions which tend to obstruct the menstrual flux. When barrenness is suspected to proceed from affections of the mind, the person ought to be kept as easy and cheerful as possible; all disagreeable objects are to be avoided, and every method taken to amuse and entertain the fancy.

CHAP. XLIX. DISEASES OF CHILDREN.

Miserable indeed is the lot of man in the state of infancy! He comes into the world more helpless than any other animal, and stands much longer in need of the protection and care of his parents; but, alas! this care is not always bestowed upon him; and when it is, he often suffers as much from improper management as he would have done from neglect. Hence the officious care of parents, nurses, and midwives, becomes one of the most fruitful sources of the disorders of infants[187].

It must be obvious to every attentive person, that the first diseases of infants arise chiefly from their bowels. Nor is this in the least to be wondered at, as they are in a manner poisoned with indigestible drugs and improper diet as soon as they come into the world. Every thing that the stomach cannot digest may be Considered as a poison; and unless it can be thrown up, or voided by stool, it must occasion sickness, gripes, spasmodic affections of the bowels, or what the good women call inward fits, and at last convulsions and death.

As these symptoms evidently arise from somewhat that irritates the intestines, doubtless the proper method of cure must be to expel it as soon as possible. The most safe and effectual method of doing this is by gentle vomits. Five or six grains of the powder of ipecacuanha may be mixed in two table-spoonfuls of water, and sweetened with a little sugar. A tea-spoonful of this may be given to the infant every quarter of an hour till it operates; or, what will more certainly answer the purpose, a grain of emetic tartar may be dissolved in three ounces of water, sweetened with a little syrup, and given as above. Those who are unwilling to use the emetic tartar, may give six or seven drops of the antimonial wine, in a tea-spoonful of water or thin gruel. Small doses of the ipecacuanha wine will be found more gentle than any of the above, and ought to be preferred.

These medicines will not only cleanse the stomach, but will generally likewise open the body. Should this however not happen, and if the child be costive, some gentle purge will be necessary: for this purpose, some manna and pulp of cassia may be dissolved in boiling water, and given in small quantities till it operates; or, what will answer rather better, a few grains of magnesia alba may be mixed in any kind of food that is given to the child, and continued till it has the desired effect. If these medicines be properly administered, and the child’s belly and limbs frequently rubbed with a warm hand before the fire, they will seldom fail to relieve those affections of the stomach and bowels from which infants suffer so much.

These general directions include most of what can be done for relieving the internal disorders of infants. They will likewise go a considerable way in alleviating those which appear externally, as the rash, gum, or fellon, &c. These, as was formerly observed, are principally owing to too hot a regimen, and consequently will be most effectually relieved by gentle evacuations. Indeed, evacuations of one kind or other constitute a principal part of the medicine of infants, and will seldom, if administered with prudence, in any of their diseases, fail to give relief.

OF THE MECONIUM.

The stomach and bowels of a new-born infant are filled with a blackish-coloured matter of the consistence of syrup, commonly called the meconium. This is generally passed soon after the birth, by the mere effort of Nature; in which case it is not necessary to give the infant any kind of medicine. But if it should be retained, or not sufficiently carried off, a little manna or magnesia alba may be given, as mentioned above; or, if these should not be at hand, a common spoonful of whey, sweetened with a little honey, or raw sugar, will answer the purpose.

The most proper medicine for expelling the meconium is the mother’s milk, which is always at first of a purgative quality. Were children allowed to suck as soon as they shew an inclination for the breast, they would seldom have occasion for medicines to discharge the meconium; but even where this is not allowed, they ought never to have daubs of syrup, oils, and other indigestible stuff, crammed down their throats.

THE APHTHÆ OR THRUSH.

The aphthæ are little whitish ulcers affecting the whole inside of the mouth, tongue, throat, and stomach of infants. Sometimes they reach through the whole intestinal canal; in which case they are very dangerous, and often put an end to the infant’s life.

If the aphthæ are of a pale colour, pellucid, few in number, soft, superficial, and fall easily off, they are not dangerous; but if opake, yellow, brown, black, thick, or running together, they ought to be dreaded.

It is generally thought that the aphthæ owe their origin to acid humours; we have reason however to believe, they are more frequently owing to too hot a regimen both of the mother and child. It is a rare thing to find a child who is not dosed with wine, punch, cinnamon-waters, or some other hot and inflaming liquors, almost as soon as it is born. It is well known that these will occasion inflammatory disorders even in adults; is it any wonder then that they should heat and inflame the tender bodies of infants, and set as it were the whole constitution on a blaze?

The most proper medicines for the aphthæ are vomits, such as have been already recommended, and gentle laxatives. Five grains of rhubarb and half a drachm of magnesia alba may be rubbed together, and divided into six doses, one of which may be given to the infant every four or five hours till they operate. These powders may either be given in the child’s food, or a little of the syrup of pale roses, and may be repeated as often as is found necessary to keep the body open. It is common in this case to administer calomel; but as that medicine sometimes occasions gripes, it ought always to be given to infants with caution.

Many things have been recommended for gargling the mouth and throat in this disease; but it is not easy to apply these in very young infants; we would therefore recommend it to the nurse to rub the child’s mouth frequently with a little borax and honey; or with the following mixture: Take fine honey an ounce, borax a drachm, burnt alum half a drachm, rose-water two drachms; mix them together. A very proper application in this case, is a solution of ten or twelve grains of white vitriol in eight ounces of barley-water. These may be applied with the finger, or by means of a bit of soft rag tied to the end of a probe.

OF ACIDITIES.

The food of children being for the most part of an acescent nature, it readily turns sour upon the stomach, especially if the body be any way disordered. Hence most diseases of children are accompanied with evident signs of acidity, as green stools, gripes, &c. These appearances have induced many to believe, that all the diseases of children were owing to an acid abounding in the stomach and bowels; but whoever considers the matter attentively, will find that these symptoms of acidity are oftner the effect than the cause of their diseases.

Nature evidently intended, that the food of children should be acescent; and unless the body be disordered, or the digestion hurt, from some other cause, we will venture to say, that the acescent quality of their food is seldom injurious to them. Acidity, however, is often a symptom of disorders in children, and, as it is sometimes a troublesome one, we shall point out the method of relieving it.

When green stools, gripes, purgings, sour smells, &c. shew that the bowels abound with an acid, the child should have a little small broth, with light white bread in it; and should have sufficient exercise in order to promote the digestion. It has been customary in this case to give the pearl-julep, chalk, crabs eyes, and other testaceous powders. These, indeed, by their absorbent quality, may correct the acidity; but they are attended with this inconvenience, that they are apt to lodge in the bowels, and occasion costiveness, which may prove very hurtful to the infant. For this reason they should never be given unless mixed with purgative medicines; as rhubarb, manna, or such like.

The best medicine which we know, in all cases of acidity, is that fine insipid powder called magnesia alba. It purges, and at the same time corrects the acidity: by which means it not only removes the disease, but carries off its cause. It may be given in any kind of food, or in a mixture, as recommended in the Appendix[188].

When an infant is troubled with gripes, it ought not at first to be dosed with brandy, spiceries, and other hot things, but should have its body opened with an emollient clyster, or the medicine mentioned above; and at the same time a little brandy may be rubbed on its belly with a warm hand before the fire. I have seldom seen this fail to ease the gripes of infants. If it should happen, however, not to succeed, a little brandy or other spirits may be mixed with thrice the quantity of warm water, and a tea-spoonful of it given frequently till the infant be easier. Sometimes a little peppermint-water will answer this purpose very well.

GALLING AND EXCORIATION.

These are very troublesome to children. They happen chiefly about the groin and wrinkles of the neck, under the arms, behind the ears, and in other parts that are moistened by the sweat or urine.

As these complaints are, in a great measure, owing to want of cleanliness, the most effectual means of preventing them are, to wash the parts frequently with cold water, to change the linen often, and, in a word, to keep the child in all respects thoroughly clean. When this is not sufficient, the excoriated parts may be sprinkled with absorbent or drying powders; as burnt hartshorn, tutty, chalk, crabs claws prepared, and the like. When the parts affected are very sore, and tend to a real ulceration, it will be proper to add a little sugar of lead to the powders; or to anoint the place with the camphorated ointment. If the parts be washed with spring water, in which a little white vitriol has been dissolved, it will dry and heal them very powerfully. One of the best applications for this purpose, is to dissolve some fuller’s earth in a sufficient quantity of hot water; and after it has stood till it is cold, to rub it gently upon the galled parts once or twice a-day.

STOPPAGE OF THE NOSE.

The nostrils of infants are often plugged up with a gross mucus, which prevents their breathing freely, and likewise renders it difficult for them to suck or swallow.

Some in this case order, after a suitable purge, two or three grains of white vitriol dissolved in half an ounce of marjoram-water, and filtered, to be applied now and then to the nostrils with a linen rag. Wedelius says, If two grains of white vitriol, and the same quantity of elaterium, be dissolved in half an ounce of marjoram-water, and applied to the nose, as above directed, that it brings away the mucus without sneezing.

In obstinate cases these medicines may be tried; but I have never found any thing necessary, besides rubbing the nose at bed-time with a little sweet oil, or fresh butter. This resolves the filth, and renders the breathing more free[189].

OF VOMITING.

From the delicate state of children, and the great sensibility of their organs, a vomiting or looseness may be induced by any thing that irritates the nerves of the stomach or intestines. Hence these disorders are much more common in childhood than in the more advanced periods of life. They are seldom however dangerous, and ought never to be considered as diseases, unless when they are violent, or continue so long as to exhaust the strength of the patient.

Vomiting may be excited by an over-quantity of food; by food that is of such a nature as to irritate the nerves of the stomach too much; or by the sensibility of the nerves being so much increased as to render them unable to bear the stimulus of even the mildest element.

When vomiting is occasioned by too much food, it ought to be promoted, as the cure will depend upon cleansing the stomach. This may be done either by a few grains of ipecacuanha, or a weak solution of emetic tartar, as mentioned before. When it is owing to food of an acrid or irritating quality, the diet ought to be changed, and aliment of a milder nature substituted in its stead.

When vomiting proceeds from an increased degree of sensibility, or too great an irritability of the nerves of the stomach, such medicines as have a tendency to brace and strengthen that organ, and to abate its sensibility, must be used. The first of these intentions may be answered by a slight infusion of the Peruvian bark, with the addition of a little rhubarb and orange-peel; and the second by the saline draughts, to which a few drops of liquid laudanum may be occasionally added.

In obstinate vomitings the operation of internal medicines may be assisted by aromatic fomentations made with wine, applied warm to the pit of the stomach; or the use of the stomach plaster, with the addition of a little Theriaca.

OF A LOOSENESS.

A looseness may generally be reckoned salutary when the stools are sour, slimy, green, or curdled. It is not the discharge, but the production of such stools, which ought to be remedied. Even where the purging is thin and watery, it ought not to be checked too suddenly, as it often proves critical, especially when the child has caught cold, or an eruption on the skin has disappeared. Sometimes an evacuation of this kind succeeds a humid state of the atmosphere, in which case it may also prove of advantage, by carrying off a quantity of watery humours, which would otherwise tend to relax the habit.

As the principal intention of the cure of a looseness is to evacuate the offending matter, it is customary to give the patient a gentle vomit of ipecacuanha, and afterwards to exhibit small and frequent doses of rhubarb; interposing absorbent medicines, to mitigate the acrimony of the humours. The best purge, however, in this case, is magnesia alba. It is at the same time absorbent and laxative, and operates without exciting gripes.

The antimonial wine, which acts both as an emetic and purge, is also an excellent medicine in this case. By being diluted with water, it may be proportioned to the weakest constitution; and, not being disagreeable to the palate, it may be repeated as often as occasion requires. Even one dose will frequently mitigate the disease, and pave the way for the use of absorbents. If, however, the patient’s strength will permit, the medicine ought to be repeated every six or eight hours, till the stools begin to assume a more natural appearance; afterwards a longer space may be allowed to intervene between the doses. When it is necessary to repeat the medicine frequently, the dose ought always to be a little increased, as its efficacy is generally diminished by use.

Some, upon the first appearance of a looseness, fly immediately to the use of absorbent medicines and astringents. If these be administered before the offending humours are discharged, though the disease may appear to be mitigated for a little time, it soon afterwards breaks forth with greater violence, and often proves fatal. After proper evacuations, however, these medicines may be administered with considerable advantage.

Should any gripings or restlessness remain after the stomach and bowels have been cleansed, a tea-spoonful of the syrup of poppies may be given in a little simple cinnamon-water, three or four times a-day till these symptoms have ceased.

OF ERUPTIONS.

Children, while on the breast, are seldom free from eruptions of one kind or other. These, however, are not often dangerous, and ought never to be dried up but with the greatest caution. They tend to free the bodies of infants from hurtful humours, which, if retained, might produce fatal disorders.

The eruptions of children are chiefly owing to improper food and neglect of cleanliness. If a child be stuffed at all hours with food that its stomach is not able to digest, such food, not being properly assimilated, instead of nourishing the body, fills it with gross humours. These must either break out in form of eruptions upon the skin, or remain in the body, and occasion fevers and other internal disorders. That neglect of cleanliness is a very general cause of eruptive disorders, must be obvious to every one. The children of the poor, and of all who despise cleanliness, are almost constantly found to swarm with vermin, and are generally covered with the scab, itch, and other eruptions.

When eruptions are the effect of improper food, or want of cleanliness, a proper attention to these alone will generally be sufficient to remove them. If this should not be the case, some drying medicines will be necessary. When they are applied, the body ought at the same time to be kept open, and cold is carefully to be avoided. We know no medicine that is more safe for drying up cutaneous eruptions than sulphur, provided it be prudently used. A little of the flour of sulphur may be mixed with fresh butter, oil, or hog’s lard, and the parts affected frequently touched with it.

The most obstinate of all the eruptions incident to children are, the tinea capitis, or scabbed head, and chilblains. The scabbed head is often exceeding difficult to cure, and sometimes indeed the cure proves worse than the disease. I have frequently known children seized with internal disorders, of which they died soon after their scabbed heads had been healed by the application of drying medicines[190]. The cure ought always first to be attempted by keeping the head very clean, cutting off the hair, combing and brushing away the scabs, &c. If this is not sufficient, let the head be shaved once a-week, washed daily with soap suds, and gently anointed with a liniment made of train oil eight ounces, red precipitate, in fine powder, one drachm. And if there be proud flesh, it should be touched with a bit of blue vitriol, sprinkled with a little burnt allum. While these things are doing, the patient must be confined to a regular light diet, the body should be kept gently open; and cold, as far as possible, ought to be avoided. To prevent any bad consequences from stopping this discharge, it will be proper, especially in children of a gross habit, to make an issue in the neck or arm, which may be kept open till the patient becomes more strong, and the constitution be somewhat mended.

Chilblains commonly attack children in cold weather. They are generally occasioned by the feet or hands being kept long wet or cold, and afterwards suddenly heated. When children are cold, instead of taking exercise to warm themselves gradually, they run to the fire. This occasions a sudden rarefaction of the humours, and an infarction of the vessels; which being often repeated, the vessels are at last over-distended, and forced to give way.

To prevent it, violent cold and sudden heat must be equally avoided. When the parts begin to look red and swell, the patient ought to be purged, and to have the affected parts frequently rubbed with mustard and brandy, or something of a warming nature. They ought likewise to be covered with flannel, and kept warm and dry. Some apply warm ashes between cloths to the swelled parts, which frequently help to reduce them. When there is a sore, it must be dressed with Turner’s cerate, the ointment of tutty, the plaster of cerus, or some other drying ointment. These sores are indeed troublesome, but seldom dangerous. They generally heal as soon as the warm weather sets in.

OF THE CROUP.

Children are often seized very suddenly with this disease, which, if not quickly relieved, proves mortal. It is known by various names in different parts of Britain. On the east coast of Scotland it is called the croup. On the west they call it the chock or stuffing. In some parts of England, where I have observed it, the good women call it the rising of the lights. It seems to be a species of asthma, attended with very acute and violent catarrhal symptoms.

This disease generally prevails in cold and wet seasons. It is most common upon the sea-coast, and in low marshy countries. Children of a gross and lax habit are most liable to it. I have sometimes known it hereditary. It generally attacks children in the night, after having been much exposed to damp cold easterly winds through the day. Damp houses, wet feet, thin shoes, wet clothes, or any thing that obstructs the perspiration, may occasion the croup.

It is attended with a frequent pulse, quick and laborious breathing, which is performed with a peculiar kind of croaking noise, that may be heard at a considerable distance. The voice is sharp and shrill, and the face is generally much flushed, though sometimes it is of a livid colour.

When a child is seized with the above symptoms, his feet should immediately be put into warm water. He ought likewise to be bled[191], and to have a laxative clyster administered as soon as possible. He should be made to breathe over the steams of warm water and vinegar; or an emollient decoction, and emollient cataplasms or fomentations may be applied round his neck. If the symptoms do not abate, a blistering plaster must be applied round the neck, or between the shoulders, and the child may take frequently a table-spoonful of the following julep: Take penny-royal water three ounces, syrup of althea and balsamic syrup, each one ounce, mix them together.

Asafœtida is found to have a good effect in this case. It may be both given in form of clyster, and taken by the mouth. Two drachms of asafœtida may be dissolved in one ounce of Mindererus’s spirit, and three ounces of penny-royal water. A table-spoonful of this mixture may be given every hour, or oftner, if the patient’s stomach be able to bear it. If the child cannot be brought to take this medicine, two drachms of the asafœtida may be dissolved in a common clyster, and administered every six or eight hours, till the violence of the disease abates[192].

To prevent a return of the disorder, all those things which occasion it must be carefully avoided; as wet feet, cold, damp, easterly winds, &c. Children who have had frequent returns of this disease, or whose constitutions seem to dispose them to it, ought to have their diet properly regulated; all food that is viscid or hard of digestion, and all crude, raw, trashy fruits, are to be avoided. They ought likewise to have a drain constantly kept open in some part of their body, by means of a seton or issue. I have sometimes known a Burgundy-pitch plaster, worn continually between the shoulders for several years, have a very happy effect in preventing the return of this dreadful disorder.

OF TEETHING.

Dr. Arbuthnot observes, that above a tenth part of infants die in teething, by symptoms proceeding from the irritation of the tender nervous parts of the jaws, occasioning inflammations, fevers, convulsions, gangrenes, &c. These symptoms are in a great measure owing to the great delicacy and exquisite sensibility of the nervous system at this time of life, which is too often increased by an effeminate education. Hence it comes to pass, that children who are delicately brought up, always suffer most in teething, and often fall by convulsive disorders.

About the sixth or seventh month the teeth generally begin to make their appearance; first, the incisores, or fore-teeth; next, the canini, or dogteeth; and, lastly, the molares, or grinders. About the seventh year, there comes a new set; and about the twentieth, the two inner grinders, called dentes sapientiæ, the teeth of wisdom.

Children, about the time of cutting their teeth, slaver much, and have generally a looseness. When the teething is difficult, especially when the dogteeth begin to make their way through the gums, the child has startings in his sleep, tumours of the gums, watchings, gripes, green stools, the thrush, fever, difficult breathing, and convulsions.

Difficult teething requires nearly the same treatment as an inflammatory disease. If the body be bound, it must be opened either by emollient clysters or gentle purgatives; as manna, magnesia alba, rhubarb, senna, or the like. The food should be light, and in small quantity; the drink plentiful, but weak and diluting, as infusions of balm, or of the lime-tree flowers; to which about a third or fourth part of milk may be added.

If the fever be high, bleeding will be necessary; but this in very young children ought always to be sparingly performed. It is an evacuation which they bear the worst of any. Purging, vomiting, or sweating, agree much better with them, and are generally more beneficial. Harris, however, observes, that, when an inflammation appears, the physician will labour in vain, if the cure be not begun with applying a leech under each ear. If the child be seized with convulsion-fits, a blistering-plaster may be applied between the shoulders, or one behind each ear.

Sydenham says, that in fevers occasioned by teething, he never found any remedy so effectual as two, three, or four drops of spirits of hartshorn in a spoonful of simple water, or other convenient vehicle, given every four hours. The number of doses may be four, five, or six. I have often prescribed this medicine with success, but always found a larger dose necessary. It may be given from five drops to fifteen or twenty, according to the age of the child, and, when costiveness does not forbid it, three or four drops of laudanum may be added to each dose.

In Scotland, it is very common, when children are cutting their teeth, to put a small Burgundy-pitch plaster between their shoulders. This generally eases the tickling cough which attends teething, and is by no means an useless application. When the teeth are cut with difficulty, it ought to be kept on during the whole time of teething. It may be enlarged as occasion requires, and ought to be renewed at least once a fortnight.

Several things have been recommended for rubbing the gums, as oils, mucilages, &c.; but from these much is not to be expected. If any thing of this kind is to be used, we would recommend a little fine honey, which may be rubbed on with the finger three or four times a-day. Children are generally at this time disposed to chew whatever they get into their hands. For this reason they ought never to be without somewhat that will yield a little to the pressure of their gums, as a crust of bread, a wax-candle, a bit of liquorice-root, or such like.

With regard to cutting the gums, we have seldom known it of any great benefit. In obstinate cases, however, it ought to be tried. It may be performed by the finger-nail, the edge of a six-penny piece that is worn thin, or any sharp body which can be with safety introduced into the mouth; but the lancet, in a skilful hand, is certainly the most proper.

In order to render the teething less difficult, parents ought to take care that their children’s food be light and wholesome, and that their nerves be braced by sufficient exercise without doors, the use of the cold bath, &c. Were these things duly regarded, they would have a much better effect than teething necklaces, or other nonsensical amulets worn for that purpose.

OF THE RICKETS.

This disease generally attacks children between the age of nine months and two years. It appeared first in England about the time when manufactures began to flourish, and still prevails most in towns where the inhabitants follow sedentary employments, by which means they neglect either to take proper exercise themselves, or to give it to their children.

CAUSES.——One cause of the rickets is diseased parents. Mothers of a weak relaxed habit, who neglect exercise, and live upon weak watery diet, can neither be expected to bring forth strong and healthy children, or to be able to nurse them, after they are brought forth. Accordingly we find, that the children of such women generally die of the rickets, the scrophula, consumptions, or such like diseases. Children begotten by men in the decline of life, who are subject to the gout, the gravel, or other chronic diseases, or who have been often affected with the venereal disease in their youth, are likewise very liable to the rickets.

Any disorder that weakens the constitution, or relaxes the habit of children, as the small-pox, measles, teething, the hooping-cough, &c. disposes them to this disease. It may likewise be occasioned by improper diet, as food that is either too weak and watery, or so viscid that the stomach cannot digest it.

Bad nursing is the chief cause of this disease. When the nurse is either diseased, or has not enough of milk to nourish the child, it cannot thrive. But children suffer oftner by want of care in nurses than want of food. Allowing an infant to lie or sit too much, or not keeping it thoroughly clean in its clothes, has the most pernicious effects.

The want of free air is likewise very hurtful to children in this respect. When a nurse lives in a close small house, where the air is damp and confined, and is too indolent to carry her child abroad into the open air, it will hardly escape this disease. A healthy child should always be in motion, unless when asleep; if it be suffered to lie, or sit, instead of being tossed and dandled about, it will not thrive.

SYMPTOMS.——At the beginning of this disease the child’s flesh grows soft and flabby; its strength is diminished; it loses its wonted cheerfulness, looks more grave and composed than is natural for its age, and does not chuse to be moved. The head and belly become too large in proportion to the other parts; the face appears full, and the complexion florid. Afterwards the bones begin to be affected, especially in the more soft and spungy parts. Hence the wrists and ancles become thicker than usual; the spine or backbone puts on an unnatural shape; the breast is likewise often deformed; and the bones of the arms and legs grow crooked. All these symptoms vary according to the violence of the disease. The pulse is generally quick, but feeble; the appetite and digestion for the most part bad; the teeth come slowly and with difficulty, and they often rot and fall out afterwards. Ricketty children generally have great acuteness of mind, and an understanding above their years. Whether this is owing to their being more in the company of adults than other children, or to the preternatural enlargement of the brain, is not material.

REGIMEN.——As this disease is always attended with evident signs of weakness and relaxation, our chief aim in the cure must be to brace and strengthen the solids, and to promote digestion and the due preparation of the fluids. These important ends will be best answered by wholesome nourishing diet, suited to the age and strength of the patient, open dry air, and sufficient exercise. If the child has a bad nurse, who either neglects her duty, or does not understand it, she should be changed. If the season be cold, the child ought to be kept warm; and when the weather is hot, it ought to be kept cool; as sweating is apt to weaken it, and too great a degree of cold has the same effect. The limbs should be rubbed frequently with a warm hand, and the child kept as cheerful as possible.

The diet ought to be dry and nourishing, as good bread, roasted flesh, &c. Biscuit is generally reckoned the best bread; and pigeons, pullets, veal, rabbits, or mutton roasted or minced, are the most proper flesh. If the child be too young for flesh-meats, he may have rice, millet, or pearl-barley boiled with raisins, to which may be added a little wine and spice. His drink may be good claret, mixed with an equal quantity of water. Those who cannot afford claret, may give the child now and then a wine-glass of mild ale, or good porter.

MEDICINE.——Medicines are here of little avail. The disease may often be cured by the nurse, but seldom by the physician. In children of a gross habit, gentle vomits and repeated purges of rhubarb may sometimes be of use, but they will seldom carry off the disease; that must depend chiefly upon such things as brace and strengthen the system: for which purpose, besides the regimen mentioned above, we would recommend the cold bath, especially in the warm season. It must however be used with prudence, as some ricketty children cannot bear it. The best time for using the cold bath is in the morning, and the child should be well rubbed with a dry cloth immediately after he comes out of it. If the child should be weakened by the cold bath, it must be discontinued.

Sometimes issues have been found beneficial in this disease. They are peculiarly necessary for children who abound with gross humours. An infusion of the Peruvian bark in wine or ale would be of service, were it possible to bring children to take it. We might here mention many other medicines which have been recommended for the rickets; but as there is far more danger in trusting to these than in neglecting them altogether, we chuse rather to pass them over, and to recommend a proper regimen as the thing chiefly to be depended on.

OF CONVULSIONS.

Though more children are said to die of convulsions than of any other disease, yet they are for the most part only a symptom of some other malady. Whatever greatly irritates or stimulates the nerves, may occasion convulsions. Hence infants whose nerves are easily affected, are often thrown into convulsions by any thing that irritates the alimentary canal; likewise by teething; strait clothes; the approach of the small-pox, measles, or other eruptive diseases.

When convulsions proceed from an irritation of the stomach or bowels, whatever clears them of their acrid contents, or renders these mild and inoffensive, will generally perform a cure: wherefore, if the child be costive, the best way will be to begin with a clyster, and afterwards to give a gentle vomit, which may be repeated occasionally, and the body in the mean time kept open by gentle doses of magnesia alba, or small quantities of rhubarb mixed with the powder of crabs claws.

Convulsions which precede the eruption of the small-pox or measles generally go off upon these making their appearance. The principal danger in this case arises from the fears and apprehensions of those who have the care of the patient. Convulsions are very alarming, and something must be done to appease the affrighted parents, nurses, &c. Hence the unhappy infant often undergoes bleeding, blistering, and several other operations, to the great danger of its life, when a little time, bathing the feet in warm water, and throwing in a mild clyster, would have set all to rights.

When convulsion fits arise from the cutting of teeth, besides gentle evacuations, we would recommend blistering, and the use of antispasmodic medicines, as the tincture of soot, asafœtida, or castor. A few drops of any of these may be mixed in a cup of white-wine whey, and given occasionally.

When convulsions proceed from any external cause, as the pressure occasioned by strait clothes or bandages, &c. these ought immediately to be removed; though in this case taking away the cause will not always remove the effect, yet it ought to be done. It is not likely that the patient will recover, as long as the cause which first gave rise to the disorder continues to act.

When a child is seized with convulsions without having any complaint in the bowels, or symptoms of teething; or any rash or other discharge which has been suddenly dried up; we have reason to conclude that it is a primary disease, and proceeds immediately from the brain. Cases of this kind, however, happen but seldom, which is very fortunate, as little can be done to relieve the unhappy patient. When a disease proceeds from an origial fault in the formation or structure of the brain itself, we cannot expect that it should yield to medicine. But as this is not always the cause, even of convulsions which proceed immediately from the brain, some attempts should be made to remove them. The chief intention to be pursued for this purpose, is to make some derivation from the head, by blistering, purging, and the like. Should these fail, issues or setons may be put in the neck, or between the shoulders.

OF WATER IN THE HEAD.

Though water in the head, or a dropsy of the brain, may affect adults as well as children, yet, as the latter are more peculiarly liable to it, we thought it would be most proper to place it among the diseases of infants.

CAUSES.——A dropsy of the brain may proceed from injuries done to the brain itself by falls, blows, or the like; it may likewise proceed from an original laxity or weakness of the brain; from scirrhous tumours or excrescences within the skull; a thin watery state of the blood; a diminished secretion of urine; and, lastly, from tedious and lingering diseases, which waste and consume the patient.

SYMPTOMS.——This disease has at first the appearance of a slow fever; the patient complains of a pain in the crown of his head, or over his eyes; he shuns the light; is sick, and sometimes vomits; his pulse is irregular and generally low: though he seems heavy and dull, yet he does not sleep: he is sometimes delirious, and frequently sees objects double; towards the end of this commonly fatal disease, the pulse becomes more frequent, the pupils are generally dilated, the cheeks flushed, the patient becomes comatose, and convulsions ensue.

MEDICINE.——No medicine has hitherto been found sufficient to carry off a dropsy of the brain. It is laudable, however, to make some attempts, as time or chance may bring many things to light, of which at present we have no idea. The medicines generally used are, purges of rhubarb or jalap with calomel, and blistering-plasters applied to the neck or back part of the head. To which we would beg leave to add diuretics, or medicines which promote the secretion of urine, such as are recommended in the common dropsy. A discharge from the nose ought likewise to be promoted by causing the patient to snuff the powder of asarum, white hellebore, or the like.

Some practitioners have of late pretended to cure this disease by the use of mercury. I have not been so happy as to see any instances of a cure being performed in a confirmed dropsy of the brain; but in so desperate a malady every thing deserves a trial[193].

CHAP. L. OF SURGERY.

To describe all the operations of surgery, and to point out the different diseases in which these operations are necessary, would extend this article far beyond the limits allotted to it: we must therefore confine our observations to such cases as most generally occur, and in which proper assistance is either not asked, or not always to be obtained.

Though an acquaintance with the structure of the human body is indispensably necessary to qualify a man for being an expert surgeon; yet many things may be done to save the lives of their fellow-men in emergencies by those who are no adepts in anatomy. It is amazing with what facility the peasants daily perform operations upon brute animals, which are not of a less difficult nature than many of those performed on the human species; yet they seldom fail of success.

Indeed every man is in some measure a surgeon whether he will or not. He feels an inclination to assist his fellow-men in distress, and accidents happen every hour which give occasion to exercise this feeling. The feelings of the heart, however, when not directed by the judgment, are apt to mislead. Thus one, by a rash attempt to save his friend, may sometimes destroy him; while another, for fear of doing amiss, stands still and sees his bosom-friend expire without so much as attempting to relieve him, even when the means are in his power. As every good man would wish to steer a course different from either of these, it will no doubt be agreeable to him to know what ought to be done upon such emergencies.

OF BLEEDING.

No operation of surgery is so frequently necessary as bleeding; it ought therefore to be very generally understood. But though practised by midwives, gardeners, blacksmiths, we have reason to believe that very few know when it is proper. Even physicians themselves have been so much the dupes of theory in this article, as to render it the subject of ridicule. It is however an operation of great importance, and must, when seasonably and properly performed, be of singular service to those in distress.

Bleeding is proper at the beginning of all inflammatory fevers, as pleurisies, peripneumonies, &c. It is likewise proper in all topical inflammations, as those of the intestines, womb, bladder, stomach, kidnies, throat, eyes, &c. as also in the asthma, sciatic pains, coughs, head-achs, rheumatisms, the apoplexy, epilepsy, and bloody flux. After falls, blows, bruises, or any violent hurt received either externally or internally, bleeding is necessary. It is likewise necessary for persons who have had the misfortune to be strangled, drowned, suffocated with foul air, the fumes of metal, or the like. In a word, whenever the vital motions have been suddenly stopt from any cause whatever, except in swoonings occasioned by mere weakness or hysteric affections, it is proper to open a vein. But in all disorders proceeding from a relaxation of the solids, and an impoverished state of the blood, as dropsies, cacochymies, &c. bleeding is improper.

Bleeding for topical inflammations ought always to be performed as near the part affected as possible. When this can be done with a lancet, it is to be preferred to any other method; but where a vein cannot be found, recourse must be had to leeches or cupping.

The quantity of blood to be let must always be regulated by the strength, age, constitution, manner of life, and other circumstances relating to the patient. It would be ridiculous to suppose that a child could bear to lose as much blood as a grown person, or that a delicate lady should be bled to the same extent as a robust man.

From whatever part of the body blood is to be let, a bandage must be applied between that part and the heart. As it is often necessary, in order to raise the vein, to make the bandage pretty tight, it will be proper in such cases, as soon as the blood begins to flow, to slacken it a little. The bandage ought to be applied at least an inch, or an inch and half from the place where the wound is intended to be made.

Persons not skilled in anatomy ought never to bleed in a vein that lies over an artery or a tendon, if they can avoid it. The former may easily be known from its pulsation or beating, and the latter from its feeling hard or tight like a whipcord under the finger.

It was formerly a rule, even among those who had the character of being regular practitioners, to bleed their patients in certain diseases till they fainted. Surely a more ridiculous rule could not be proposed. One person will faint at the very sight of a lancet, while another will lose almost the whole blood of his body before he faints. Swooning depends more upon the state of the mind than of the body; besides, it may often be occasioned or prevented by the manner in which the operation is performed.

Children are generally bled with leeches. This, though sometimes necessary, is a very troublesome and uncertain practice. It is impossible to know what quantity of blood is taken away by leeches; besides, the bleeding is often very difficult to stop, and the wounds are not easily healed. Would those who practice bleeding take a little more pains, and accustom themselves to bleed children, they would not find it such a difficult operation as they imagine.

Certain hurtful prejudices with regard to bleeding still prevail among the country people. They talk, for instance, of head-veins, heart-veins, breast-veins, &c. and believe that bleeding in these will certainly cure all diseases of the parts from whence they are supposed to come, without considering that all the blood-vessels arise from the heart, and return to it again; for which reason, unless in topical inflammations, it signifies very little from what part of the body blood is taken. But this, though a foolish prejudice, is not near so hurtful as the vulgar notion that the first bleeding will perform wonders. This belief makes them often postpone the operation when necessary, in order to reserve it for some more important occasion, and, when they think themselves in extreme danger, they fly to it for relief, whether it be proper or not. Bleeding at certain dated periods or seasons has likewise bad effects.

It is a common notion that bleeding in the feet draws the humours downwards, and consequently cures diseases of the head and other superior parts: but we have already observed that, in all topical affections, the blood ought to be drawn as near the part as possible. When it is necessary, however, to bleed in the foot or hand, as the veins are small, and the bleeding is apt to stop too soon, the part ought to be immersed in warm water, and kept there till a sufficient quantity of blood be let.

We shall not spend time in describing the manner of performing this operation: that will be better learned by example than precept. Twenty pages of description would not convey so just an idea of the operation as seeing it once performed by an expert hand. Neither is it necessary to point out the different parts of the body from whence blood may be taken, as the arm, foot, forehead, temples, neck, &c. These will readily occur to every intelligent person, and the foregoing observations will be sufficient for determining which of them is most proper upon any particular occasion. In all cases where the intention is merely to lessen the general mass of blood, the arm is the most commodious part of the body in which the operation can be performed.

OF INFLAMMATIONS AND ABSCESSES.

From whatever cause an inflammation proceeds, it must terminate either by dispersion, suppuration, or gangrene. Though it is impossible to foretel with certainty in which of these ways any particular inflammation will terminate, yet a probable conjecture may be formed with regard to the event, from a knowledge of the patient’s age and constitution. Inflammations happening in a slight degree upon colds, and without any previous indisposition, will most probably be dispersed; those which follow close upon a fever, or happen to persons of a gross habit of body, will generally suppurate; and those which attack very old people, or persons of a dropsical habit, will have a strong tendency to gangrene.

If the inflammation be slight, and the constitution sound, the dispersion ought always to be attempted. This will be best promoted by a slender diluting diet, plentiful bleeding, and repeated purges. The part itself must be fomented, and, if the skin be very tense, it may be embrocated with a mixture of three-fourths of sweet oil, and one-fourth of vinegar, and afterwards covered with a piece of wax plaster.

If, notwithstanding these applications, the symptomatic fever increases, and the tumour becomes larger, with violent pain and pulsation, it will be proper to promote the suppuration. The best application for this purpose is a soft poultice, which may be renewed twice a day. If the suppuration proceeds but slowly, a raw onion cut small or bruised may be spread upon the poultice. When the abscess is ripe or fit for opening, which may easily be known from the thinness of the skin in the most prominent part of it, a fluctuation of matter which may be felt under the finger, and, generally speaking, an abatement of the pain, it may be opened either with a lancet or by means of caustic.

The last way in which an inflammation terminates, is in a gangrene or mortification, the approach of which may be known by the following symptoms: the inflammation loses its redness, and becomes duskish or livid; the tension of the skin goes off, and it feels flabby; little bladders filled with ichor of different colours spread all over it; the tumour subsides, and from a duskish complexion becomes black; a quick low pulse, with cold clammy sweats, are the immediate forerunners of death.

When these symptoms first appear, the part ought to be dressed with London treacle, or a cataplasm made of lixivium and bran. Should the symptoms become worse, the part must be scarified, and afterwards dressed with basilicum softened with oil of turpentine. All the dressings must be applied warm. With regard to internal medicines, the patient must be supported with generous cordials, and the Peruvian bark exhibited in as large doses as the stomach will bear it. If the mortified parts should separate, the wound will become a common ulcer, and must be treated accordingly.

This article includes the treatment of all those diseases, which, in different parts of the country, go by the names of biles, imposthumes, whitloes, &c. They are all abscesses in consequence of a previous inflammation, which, if possible, ought to be discussed; but when this cannot be done, the suppuration should be promoted, and the matter discharged by an incision, if necessary; afterwards the sore may be dressed with yellow basilicum, or some other digestive ointment.

OF WOUNDS.

No part of medicine has been more mistaken than the treatment or cure of wounds. Mankind in general believe that certain herbs, ointments, and plasters are possessed of wonderful healing powers, and imagine that no wound can be cured without the application of them. It is however a fact, that no external application whatever contributes towards the cure of a wound, any other way than by keeping the parts soft, clean, and defending them from the external air, which may be as effectually done by dry lint, as by the most pompous applications, while it is exempt from many of the bad consequences attending them.

The same observation holds with respect to internal applications. These only promote the cure of wounds as far as they tend to prevent a fever, or to remove any cause that might obstruct or impede the operations of Nature. It is Nature alone that cures wounds. All that Art can do is to remove obstacles, and to put the parts in such a condition as is the most favourable to Nature’s efforts.

With this simple view we shall consider the treatment of wounds, and endeavour to point out such steps as ought to be taken to facilitate their cure.

The first thing to be done when a person has received a wound, is to examine whether any foreign body be lodged in it, as wood, stone, iron, lead, glass, dirt, bits of cloth, or the like. These, if possible, ought to be extracted, and the wound cleaned, before any dressings be applied. When that cannot be effected with safety, on account of the patient’s weakness, or loss of blood, they must be suffered to remain in the wound, and afterwards extracted when he is more able to bear it.

When a wound penetrates into any of the cavities of the body, as the breast, the bowels, &c. or where any considerable blood-vessel is cut, a skilful surgeon ought immediately to be called, otherwise the patient may lose his life. But sometimes the discharge of blood is so great, that if it be not stopt, the patient may die even before a surgeon, though at no great distance, can arrive. In this case, something must be done by those who are present. If the wound be in any of the limbs, the bleeding may generally be stopt by applying a tight ligature or bandage round the member a little above the wound. The best method of doing this is to put a strong broad garter round the part, but so slack as easily to admit a small piece of stick to be put under it, which must be twisted, in the same manner as a countryman does a cart-rope to secure his loading, till the bleeding stops. Whenever this is the case, he must take care to twist it no longer, as straining it too much might occasion an inflammation of the parts, and endanger a gangrene.

In parts where this bandage cannot be applied, various other methods may be tried to stop the bleeding, as the application of styptics, astringents, &c. Cloths dipped in a solution of blue vitriol in water, or the styptic water of the Dispensatories, may be applied to the wound. When these cannot be obtained, strong spirits of wine may be used. Some recommend the agaric[194] of the oak as preferable to any of the other styptics; and indeed it deserves considerable encomiums. It is easily obtained, and ought to be kept in every family, in case of accidents. A piece of it must be laid upon the wound, and covered with a good deal of lint, above which a bandage may be applied so tight as to keep it firmly on.

Though spirits, tinctures, and hot balsams may be used, in order to stop the bleeding when it is excessive, they are improper at other times. They do not promote but retard the cure, and often change a simple wound into an ulcer. People imagine, because hot balsams congeal the blood, and seem, as it were, to solder up the wound, that they therefore heal it; but this is only a deception. They may indeed stop the flowing blood, by searing the mouths of the vessels; but, by rendering the parts callous, they obstruct the cure.

In slight wounds, which do not penetrate much deeper than the skin, the best application is a bit of the common black sticking-plaster. This keeps the sides of the wound together, and prevents the air from hurting it, which is all that is necessary. When a wound penetrates deep, it is not safe to keep its lips quite close: this keeps in the matter, and is apt to make the wound fester. In this case the best way is to fill the wound with soft lint, commonly called caddis. It however must not be stuffed in too hard, otherwise it will do hurt. The lint may be covered with a cloth dipped in oil, or spread with the common wax plaster[195]; and the whole must be kept on by a proper bandage.

We shall not spend time in describing the different bandages that may be proper for wounds in different parts of the body; common sense will generally suggest the most commodious method of applying a bandage; besides, descriptions of this kind are not easily understood or remembered.

The first dressing ought to continue on for at least two days; after which it may be removed, and fresh lint applied as before. If any part of the first dressing sticks so close as not to be removed with ease or safety to the patient, it may be allowed to continue, and fresh lint dipped in sweet oil laid over it. This will soften it, so as to make it come off easily at next dressing. Afterwards the wound may be dressed twice a-day in the same manner till it be quite healed. Those who are fond of salves or ointments, may, after the wound is become very superficial, dress it with the yellow basilicum[196]; and if fungous, or what is called proud flesh, should rise in the wound, it may be checked, by mixing with the ointment a little burnt alum or red precipitate of mercury.

When a wound is greatly inflamed, the most proper application is a poultice of bread and milk, softened with a little sweet oil or fresh butter. This must be applied instead of a plaster, and should be changed twice a-day.

If the wound be large, and there is reason to fear an inflammation, the patient should be kept on a very low diet. He must abstain from flesh, strong liquors, and every thing that is of a heating nature. If he be of a full habit, and has lost but little blood from the wound, he must be bled; and, if the symptoms be urgent, the operation may be repeated. But when the patient has been greatly weakened by loss of blood from the wound, it will be dangerous to bleed him, even though a fever should ensue. Nature should never be too far exhausted. It is always more safe to allow her to struggle with the disease in her own way, than to sink the patient’s strength by excessive evacuations.

Wounded persons ought to be kept perfectly quiet and easy. Every thing that ruffles the mind or moves the passions, as love, anger, fear, excessive joy, &c. are very hurtful. They ought above all things to abstain from venery. The body should be kept gently open, either by laxative clysters, or by a cool vegetable diet, as roasted apples, stewed prunes, boiled spinage, and such like.

OF BURNS.

In slight burns which do not break the skin, it is customary to hold the part near the fire for a competent time, to rub it with salt, or to lay a compress upon it dipped in spirits of wine or brandy. But when the burn has penetrated so deep as to blister or break the skin, it must be dressed with some of the liniment for burns mentioned in the Appendix, or with the emollient and gently drying ointment, commonly called Turner’s cerate[197]. This may be mixed with an equal quantity of fresh olive oil, and spread upon a soft rag, and applied to the part affected. When this ointment cannot be had, an egg may be beat up with about an equal quantity of the sweetest salad-oil. This will serve very well till a proper ointment can be prepared. When the burning is very deep, after the first two or three days, it should be dressed with equal parts of yellow basilicum and Turner’s cerate mixed together.

When the burn is violent, or has occasioned a high degree of inflammation, and there is reason to fear a gangrene or mortification, the same means must be used to prevent it as are recommended in other violent inflammations. The patient, in this case, must live low, and drink freely of weak diluting liquors. He must likewise be bled, and have his body kept open. But if the burnt parts should become livid or black, with other symptoms of mortification, it will be necessary to bathe them frequently with warm camphorated spirits of wine, tincture of myrrh, or other antiseptics, mixed with a decoction of the bark. In this case the bark must likewise be taken internally, and the patient’s diet must be more generous.

As example teaches better than precept, I shall relate the treatment of the most dreadful case of this kind that has occurred in my practice. A middle-aged man, of a good constitution, fell into a large vessel full of boiling water, and miserably scalded about one half of his body. As his clothes were on, the burning in some parts was very deep before they could be got off. For the first two days the scalded parts had been frequently anointed with a mixture of lime-water and oil, which is a very proper application for recent burnings. On the third day, when I first saw him, his fever was high, and his body costive, for which he was bled, and had an emollient clyster administered. Poultices of bread and milk, softened with fresh butter, were likewise applied to the affected parts, to abate the heat and inflammation. His fever still continuing high, he was bled a second time, was kept strictly on the cooling regimen, took the saline mixture with small doses of nitre, and had an emollient clyster administered once a-day. When the inflammation began to abate, the parts were dressed with a digestive composed of brown cerate and yellow basilicum. Where any black spots appeared, they were slightly scarified, and touched with the tincture of myrrh; and, to prevent their spreading, the Peruvian bark was administered. By this course, the man was so well in three weeks as to be able to attend his business.

OF BRUISES.

Bruises are generally productive of worse consequences than wounds. The danger from them does not appear immediately, by which means it often happens that they are neglected. It is needless to give any definition of a disease so universally known; we shall therefore proceed to point out the method of treating it.

In slight bruises it will be sufficient to bathe the part with warm vinegar, to which a little brandy or rum may occasionally be added, and to keep cloths wet with this mixture constantly applied to it. This is more proper than rubbing it with brandy, spirits of wine, or other ardent spirits, which are commonly used in such cases.

In some parts of the country the peasants apply to a recent bruise a cataplasm of fresh cow-dung. I have often seen this cataplasm applied to violent contusions occasioned by blows, falls, bruises, and such like, and never knew it fail to have a good effect.

When a bruise is very violent, the patient ought immediately to be bled, and put upon a proper regimen. His food should be light and cool, and his drink weak, and of an opening nature; as whey sweetened with honey, decoctions of tamarinds, barley, cream-tartar-whey, and such like. The bruised part must be bathed with vinegar and water, as directed above; and a poultice made by boiling crumb of bread, elder-flowers, and camomile-flowers, in equal quantities of vinegar and water, applied to it. This poultice is peculiarly proper when a wound is joined to the bruise. It may be renewed two or three times a-day.

As the structure of the vessels is totally destroyed by a violent bruise, there often ensues a great loss of substance, which produces an ulcerous sore very difficult to cure. If the bone be affected, the sore will not heal before an exfoliation takes place; that is, before the diseased part of the bone separates, and comes out through the wound. This is often a very slow operation, and may even require several years to be completed. Hence it happens, that these sores are frequently mistaken for the king’s evil, and treated as such, though in fact they proceed solely from the injury which the solid parts received from the blow.

Patients in this situation are pestered with different advices. Every one who sees them proposes a new remedy, till the sore is so much irritated with various and opposite applications, that it is often at length rendered absolutely incurable. The best method of managing such sores is, to take care that the patient’s constitution does not suffer by confinement, or improper medicine, and to apply nothing to them besides simple ointment spread upon soft lint, over which a poultice of bread and milk, with boiled camomile-flowers, or the like, may be put, to nourish the part, and keep it soft and warm. Nature, thus assisted, will generally in time operate a cure, by throwing off the diseased parts of the bone, after which the sore soon heals.

OF ULCERS.

Ulcers may be the consequence of wounds, bruises, or imposthumes improperly treated; they may likewise proceed from an ill state of the humours, or what may be called a bad habit of body.

In the latter case, they ought not to be hastily dried up, otherwise it may prove fatal to the patient. Ulcers happen most commonly in the decline of life; and persons who neglect exercise, and live grossly, are most liable to them. They might often be prevented by retrenching some part of the solid food, or by opening artificial drains, as issues, setons, or the like.

An ulcer may be distinguished from a wound by its discharging a thin watery humour, which is often so acrid as to inflame and corrode the skin; by the hardness and perpendicular situation of its sides or edges, by the time of its duration, &c.

It requires considerable skill to be able to judge whether or not an ulcer ought to be dried up. In general, all ulcers which proceed from a bad habit of body, should be suffered to continue open, at least till the constitution has been so far changed by proper regimen, or the use of medicine, that they seem disposed to heal of their own accord. Ulcers which are the effect of malignant fevers, or other acute diseases, may generally be healed with safety after the health has been restored for some time. The cure ought not however to be attempted too soon, nor at any time without the use of purging medicines and a proper regimen. When wounds or bruises have, by wrong treatment, degenerated into ulcers, if the constitution be good, they may generally be healed with safety. When ulcers either accompany chronical diseases, or come in their stead, they must be cautiously healed. If an ulcer conduces to the patient’s health, from whatever cause it proceeds, it ought not to be healed; but if, on the contrary, it wastes the strength, and consumes the patient by a slow fever, it should be healed as soon as possible.

We would earnestly recommend a strict attention to these particulars, to all who have the misfortune to labour under this disorder, particularly persons in the decline of life; as we have frequently known people throw away their lives by the want of it, while they were extolling and generously rewarding those whom they ought to have looked upon as their executioners.

The most proper regimen for promoting the cure of ulcers, is to avoid all spices, salted and high-seasoned food, all strong liquors, and to lessen the usual quantity of flesh meat. The body ought to be kept gently open by a diet consisting chiefly of cooling laxative vegetables, and by drinking butter-milk, whey sweetened with honey, or the like. The patient ought to be kept cheerful, and should take as much exercise as he can easily bear.

When the bottom and sides of an ulcer seem hard and callous, they may be sprinkled twice a-day with a little red precipitate of mercury, and afterwards dressed with the yellow basilicum ointment. Sometimes it will be necessary to have the edges of the ulcer scarified with the lancet.

Lime-water has frequently been known to have very happy effects in the cure of obstinate ulcers. It may be used in the same manner as directed for the stone and gravel.

My late learned and ingenious friend, Dr. Whytt, strongly recommends the use of the solution of corrosive sublimate of mercury in brandy, for the cure of obstinate ill conditioned ulcers. I have frequently found this medicine, when given according to the Doctor’s directions, prove very successful. The dose is a table-spoonful night and morning; at the same time washing the sore twice or thrice a-day with it. In a letter which I had from the Doctor a little before his death, he informed me, “That he observed washing the sore thrice a-day with the solution of a triple strength was very beneficial[198].”

A fistulous ulcer can seldom be cured without an operation. It must either be laid open so as to have its callous parts destroyed by some corrosive application, or they must be entirely cut away by the knife: but as this operation requires the hand of an expert surgeon, there is no occasion to describe it. Ulcers about the anus are most apt to become fistulous, and are very difficult to cure. Some indeed pretend to have found Ward’s Fistula paste very successful in this complaint. It is not a dangerous medicine, and being easily procured, it may deserve a trial; but as these ulcers generally proceed from an ill habit of body, they will seldom yield to any thing except a long course of regimen, assisted by medicines, which are calculated to correct that particular habit, and to induce an almost total change in the constitution.

CHAP. LI. OF DISLOCATIONS.

When a bone is moved out of its place or articulation, so as to impede its proper functions, it is said to be luxated or dislocated. As this often happens to persons in situations where no medical assistance can be obtained, by which means limbs, and even lives, are frequently lost, we shall endeavour to point out the method of reducing the most common luxations, and those which require immediate assistance. Any person of common sense and resolution, who is present when a dislocation happens, may often be of more service to the patient, than the most expert surgeon can after the swelling and inflammation have come on. When these are present, it is difficult to know the state of the joint, and dangerous to attempt a reduction; and by waiting till they are gone off, the muscles become so relaxed, and the cavity filled up, that the bone can never afterwards be retained in its place.

A recent dislocation may generally be reduced by extension alone, which must always be greater or less according to the strength of the muscles which move the joint, the age, robustness, and other circumstances of the patient. When the bone has been out of its place for any considerable time, and a swelling or inflammation has come on, it will be necessary to bleed the patient, and, after fomenting the part, to apply soft poultices with vinegar to it for some time before the reduction is attempted.

All that is necessary after the reduction, is to apply cloths dipt in vinegar or camphorated spirits of wine to the part, and to keep it perfectly easy. Many bad consequences proceed from the neglect of this rule. A dislocation seldom happens without the tendons and ligaments of the joint being stretched and sometimes torn. When these are kept easy till they recover their strength and tone, all goes on very well; but is the injury be increased by too frequent an exertion of the parts, no wonder if they be found weak and diseased ever after.

DISLOCATION OF THE JAW.

The lower jaw may be luxated by yawning, blows, falls, chewing hard substances, or the like. It is easily known from the patient’s being unable to shut his mouth, or to eat any thing, as the teeth of the under jaw do not correspond with those of the upper; besides, the chin either hangs down, or is thrown toward one side, and the patient is neither able to speak distinctly, nor to swallow without considerable difficulty.

The usual method of reducing a dislocated jaw, is to set the patient upon a low stool, so as an assistant may hold the head firm by pressing it against his breast. The operator is then to thrust his two thumbs, being first wrapped up with linen cloths that they may not slip, as far back into the patient’s mouth as he can, while his fingers are applied to the jaw externally. After he has got firm hold of the jaw, he is to press it strongly downwards and backwards, by which means the elapsed heads of the jaw may be easily pushed into their former cavities.

The peasants in some parts of the country have a peculiar way of performing this operation. One of them puts a handkerchief under the patient’s chin, then turning his back to that of the patient, pulls him up by the chin so as to suspend him from the ground. This method often succeeds, but we think it a dangerous one, and therefore recommend the former.

DISLOCATION OF THE NECK.

The neck may be dislocated by falls, violent blows, or the like. In this case, if the patient receives no assistance, he soon dies, which makes people imagine the neck was broken; it is, however, for the most part only partially dislocated, and may be reduced by almost any person who has resolution enough to attempt it. A complete dislocation of the neck is instantaneous death.

When the neck is dislocated, the patient is immediately deprived of all sense and motion; his neck swells, his countenance appears bloated; his chin lies upon his breast, and his face is generally turned towards one side.

To reduce this dislocation, the unhappy person should immediately be laid upon his back on the ground, and the operator must place himself behind him so as to be able to lay hold of his head with both hands, while he makes a resistance by placing his knees against the patient’s shoulders. In this posture he must pull the head with considerable force, gently twisting it at the same time, if the face be turned to one side, till he perceives that the joint is replaced, which may be known from the noise which the bones generally make when going in, the patient’s beginning to breathe, and the head continuing in its natural posture.

This is one of those operations which it is more easy to perform than describe. I have known instances of its being happily performed even by women, and often by men of no medical education. After the neck is reduced, the patient ought to be bled, and should be suffered to rest for some days, till the parts recover their proper tone.

DISLOCATION OF THE RIBS.

As the articulation of the ribs with the backbone is very strong, they are not often dislocated. It does however sometimes happen, which is a sufficient reason for our taking notice of it. When a rib is dislocated either upwards or downwards, in order to replace it, the patient should be laid upon his belly on a table, and the operator must endeavour to push the head of the bone into its proper place. Should this method not succeed, the arm of the disordered side may be suspended over a gate or ladder, and, while the ribs are thus stretched asunder, the heads of such as are out of place may be thrust into their former situation.

Those dislocations wherein the heads of the ribs are forced inwards, are both more dangerous and the most difficult to reduce, as neither the hand nor any instrument can be applied internally to direct the luxated heads of the ribs. Almost the only thing that can be done is, to lay the patient his belly over a cask, or some gibbous body, and to move the fore-part of the rib inward towards the back, sometimes shaking it; by this means the heads of the luxated ribs may slip into their former place.

DISLOCATION OF THE SHOULDER.

The humerus or upper bone of the arm may be dislocated in various directions: it happens however most frequently downwards, but very seldom directly upwards. From the nature of its articulation, as well as from its exposure to external injuries, this bone is the most subject to dislocation of any in the body. A dislocation of the humerus may be known by a depression or cavity on the top of the shoulder, and an inability to move the arm. When the dislocation is downward or forward, the arm is elongated, and a ball or lump is perceived under the arm-pit; but when it is backward, there appears a protuberance behind the shoulder, and the arm is thrown forwards toward the breast.

The usual method of reducing dislocations of the shoulder is to seat the patient upon a low stool, and to cause an assistant to hold his body so that it may not give way to the extension, while another lays hold of the arm a little above the elbow, and gradually extends it. The operator then puts a napkin under the patient’s arm, and causes it to be tied behind his own neck: by this, while a sufficient extension is made, he lifts up the head of the bone, and with his hands directs it into its proper place. There are various machines invented for facilitating this operation, but the hand of an expert surgeon is always more safe. In young and delicate patients, I have generally found it a very easy matter to reduce the shoulder, by extending the arm with one hand, and thrusting in the head of the bone with the other. In making the extension, the arm ought always to be a little bent.

DISLOCATION OF THE ELBOW.

The bones of the fore-arm may be dislocated in any direction. When this is the case, a protuberance may be observed on that side of the arm towards which the bone is pushed, from which, and the patient’s inability to bend his arm, a dislocation of this joint may easily be known.

Two assistants are generally necessary for reducing a dislocation of the elbow; one of them must lay hold of the arm above, and the other below the joint, and make a pretty strong extension, while the operator returns the bones into their proper place. Afterwards the arm must be bent, and suspended for some time with a sling about the neck.

Luxations of the wrist and fingers are to be reduced in the same manner as those of the elbow, viz. by making an extension in different directions, and thrusting the head of the bone into its place.

DISLOCATION OF THE THIGH.

When the thigh-bone is dislocated forward and downward, the knee and foot are turned out, and the leg is longer than the other; but when it is displaced backward, it is usually pushed upward at the same time, by which means the limb is shortened, and the foot is turned inwards.

When the thigh-bone is displaced forward and downward, the patient, in order to have it reduced, must be laid upon his back, and made fast by bandages, or held by assistants, while by others an extension is made by means of slings fixed about the bottom of the thigh a little above the knee. While the extension is made, the operator must push the head of the bone outward, till it gets into the socket. If the dislocation be outward, the patient must be laid upon his face, and, during the extension, the head of the bone must be pushed inward.

Dislocations of the knees, ancles, and toes, are reduced much in the same manner as those of the upper extremities, viz. by making an extension in opposite directions, while the operator replaces the bones. In many cases, however, the extension alone is sufficient, and the bone will slip into its place merely by pulling the limb with sufficient force. It is not hereby meant, that force alone is sufficient for the reduction of dislocations. Skill and address will often succeed better than force. I have known a dislocation of the thigh reduced by one man, after all the force that could be used by six had proved ineffectual.

CHAP. LII. OF BROKEN BONES, &c.

There is, in most country villages, some person who pretends to the art of reducing fractures. Though in general such persons are very ignorant, yet some of them are very successful; which evidently proves, that a small degree of learning, with a sufficient share of common sense and a mechanical head, will enable a man to be useful in this way. We would, however, advise people never to employ such operators, when an expert and skilful surgeon can be had; but when that is impracticable, they must be employed: we shall therefore recommend the following hints to their consideration:

When a large bone is broken, the patient’s diet ought in all respects to be the same as in an inflammatory fever. He should likewise be kept quiet and cool, and his body open by emollient clysters; or, if these cannot be conveniently administered, by food that is. of an opening quality; as stewed prunes, apples boiled in milk, boiled spinage, and the like. It ought however to be here remarked, that persons who have been accustomed to live high, are not all of a sudden to be reduced to a very low diet. This might have fatal effects. There is often a necessity for indulging even bad habits, in some measure, where the nature of the disease might require a different treatment.

It will generally be necessary to bleed the patient immediately after a fracture, especially if he be young, of a full habit, or has at the same time received any bruise or contusion. This operation should not only be performed soon after the accident happens, but if the patient be very feverish, it may be repeated next day. When several of the ribs are broken, bleeding is peculiarly necessary.

If any of the large bones which support the body are broken, the patient must keep his bed for several weeks. It is by no means necessary, however, that he should lie all that time, as is customary, upon his back. This situation sinks the spirits, galls and frets the patient’s skin, and renders him very uneasy. After the second week he may be gently raised up, and may sit several hours, supported by a bed-chair, or the like, which will greatly relieve him. Great care, however, must be taken in raising him up, and laying him down, that he make no exertions himself, otherwise the action of the muscles may pull the bone out of its place[199].

It is of great importance to keep the patient dry and clean while in this situation. By neglecting this, he is often so galled and excoriated, that he is forced to keep shifting places for ease. I have known a fractured thigh-bone, after it had been kept straight for above a fortnight, displaced by this means, and continue bent for life, in spite of all that could be done.

It has been customary when a bone was broken, to keep the limb for five or six weeks continually upon the stretch. But this is a bad posture. It is both uneasy to the patient, and unfavourable to the cure. The best situation is to keep the limb a little bent. This is the posture into which every animal puts its limbs when it goes to rest, and in which fewest muscles are upon the stretch. It is easily effected, by either laying the patient upon his side, or making the bed so as to favour this position of the limb.

Bone-setters ought carefully to examine whether the bone be not shattered or broken into several pieces. In this case it will sometimes be necessary to have the limb immediately taken off, otherwise a gangrene or mortification may ensue. The horror which attends the very idea of an amputation often occasions its being delayed in such cases till too late. I have known this principle operate so strongly, that a limb, where the bones were shattered into more than twenty pieces, was not amputated before the third day after the accident, when the gangrene had proceeded so far as to render the operation useless.

When a fracture is accompanied with a wound, it must be dressed in all respects as a common wound.

All that art can do towards the cure of a broken bone, is to lay it perfectly straight, and to keep it quite easy. All tight bandages do hurt. They had much better be wanting altogether. A great many of the bad consequences which succeed to fractured bones are owing to tight bandages. This is one of the ways in which the excess of art, or rather the abuse of it, does more mischief than would be occasioned by the want of it. Some of the most sudden cures of broken bones which were ever known, happened where no bandages were applied at all. Some method however must be taken to keep the member steady; but this may be done many ways without bracing it with a tight bandage.

The best method of retention is by two or more splints made of leather or pasteboard. These, if moistened before they be applied, soon assume the shape of the included member, and are sufficient, by the assistance of a very slight bandage, for all the purposes of retention. The bandage which we would recommend is that made with twelve or eighteen tails. It is much easier applied and taken off than rollers, and answers all the purposes of retention equally well. The splints should always be as long as the limb, with holes cut for the ancles when the fracture is in the leg.

In fractures of the ribs, where a bandage cannot be properly used, an adhesive plaster may be applied over the part. The patient in this case ought to keep himself quite easy, avoiding every thing that may occasion sneezing, laughing, coughing, or the like. He ought to keep his body in a straight posture, and should take care that his stomach be constantly distended, by taking frequently some light food, and drinking freely of weak watery liquors.

The most proper external application for a fracture is oxycrate, or a mixture of vinegar and water. The bandages should be wet with this at every dressing.

OF STRAINS.

Strains are often attended with worse consequences than broken bones. The reason is obvious; they are generally neglected. When a bone is broken, the patient is obliged to keep the member easy, because he cannot make use of it; but when a joint is only strained, the person, finding he can still make a shift to move it, is sorry to lose his time for so trifling an ailment. In this way he deceives himself, and converts into an incurable malady what might have been removed by only keeping the part easy for a few days.

Country people generally immerse a strained limb in cold water. This is very proper, provided it be done immediately, and not kept in too long. But the custom of keeping the part immersed in cold water for a long time is certainly dangerous. It relaxes instead of bracing the part, and is more likely to produce a disease than remove one.

Wrapping a garter, or some other bandage, pretty tight about the strained part, is likewise of use. It helps to restore the proper tone of the vessels, and prevents the action of the parts from increasing the disease. It should not however be applied too tight. I have frequently known bleeding near the affected part have a very good effect: but what we would recommend above all is ease. It is more to be depended on than any medicine, and seldom fails to remove the complaint[200].

OF RUPTURES.

Children and old people are most liable to this disease. In the former it is generally occasioned by excessive crying, coughing, vomiting, or the like. In the latter, it is commonly the effect of blows or violent exertions of the strength, as leaping, carrying great weights, &c. In both, a relaxed habit, indolence, and an oily or very moist diet, dispose the body to this disease.

A rupture sometimes proves fatal before it is discovered. Whenever sickness, vomiting, and obstinate costiveness give reason to suspect an obstruction of the bowels, all those places where ruptures usually happen ought carefully to be examined. The protrusion of a very small part of the gut will occasion all these symptoms; and, if not returned in due time, will prove mortal.

On the first appearance of a rupture in an infant, it ought to be laid upon its back, with its head very low. While in this posture, if the gut does not return of itself, it may easily be put up by gentle pressure. After it is returned, a piece of sticking-plaster may be applied over the part, and a proper truss or bandage must be constantly worn for a considerable time. The method of making and applying these rupture-bandages for children is pretty well known. The child must, as far as possible, be kept from crying, and from all violent exertions, till the rupture is quite healed.

In adults, when the gut has been forced down with great violence, or happens from any cause to be inflamed, there is often great difficulty in returning it, and sometimes the thing is quite impracticable without an operation; a description of which is foreign to our purpose. As I have been fortunate enough, however, always to succeed in my attempts to return the gut, without having recourse to any other means than what are in the power of every man, I shall briefly mention the method which I generally pursue.

After the patient has been bled, he must be laid upon his back, with his head very low, and his breech raised high with pillows. In this situation flannel cloths wrung out of a decoction of mallows and camomile-flowers, or, if these are not at hand, of warm water, must be applied for a considerable time. A clyster made of this decoction, with a large spoonful of butter and an ounce or two of salt, may be afterwards thrown up. If these should not prove successful, recourse must be had to pressure. If the tumour be very hard, considerable force will be necessary; but it is not force alone which succeeds here. The operator, at the same time that he makes a pressure with the palms of his hand, must with his fingers artfully conduct the gut in by the same aperture through which it came out. The manner of doing this can be much easier conceived than described. Should these endeavours prove ineffectual, clysters of the smoke of tobacco may be tried. These have been often known to succeed where every other method failed.

There is reason to believe that, by persisting in the use of these, and such other means as the circumstances of the case may suggest, most hernias might be reduced without an operation. Cutting for the hernia is a nice and difficult matter. I would therefore advise surgeons to try every method of returning the gut before they have recourse to the knife. I have once and again succeeded by persevering in my endeavours, after eminent surgeons had declared the reduction of the gut impracticable without an operation[201].

An adult, after the gut has been returned, must wear a steel bandage. It is needless to describe this, as it may always be had ready made from the artists. Such bandages are generally uneasy to the wearer for some time, but by custom they become quite easy. No person who has had a rupture after he arrived at man’s estate should ever be without one of these bandages.

Persons who have a rupture ought carefully to avoid all violent exercise, carrying great weights, leaping, running, and the like. They should likewise avoid windy aliment and strong liquors; and should carefully guard against catching cold.

CHAP. LIII. OF CASUALTIES.

It is certain that life, when to all appearance lost, may often, by due care, be restored. Accidents frequently prove fatal, merely because proper means are not used to counteract their effects, No person ought to be looked upon as killed by any accident, unless where the structure of the heart, brain, or some organ necessary to life, is evidently destroyed. The action of these organs may be so far impaired as even to be for some time imperceptible, when life is by no means gone. In this case, however, if the fluids be suffered to grow cold, it will be impossible to put them again in motion, even though the solids should recover their power of acting. Thus, when the motion of the lungs has been stopt by unwholesome vapour, the action of the heart by a stroke on the breast, or the functions of the brain by a blow on the head, if the person be suffered to grow cold, he will in all probability continue so; but, if the body be kept warm, as soon as the injured part has recovered its power of acting, the fluids will again begin to move, and all the vital functions will be restored.

It is a horrid custom immediately to consign over to death every person who has the misfortune, by a fall, a blow, or the like, to be deprived of the appearance of life. The unhappy person, instead of being carried into a warm house, and laid by the fire, or put to a warm bed, is generally hurried away to church, or a barn, or some other cold damp house, where, after a fruitless attempt has been made to bleed him, perhaps by one who knew nothing of the matter, he is given over for dead, and no further notice taken of him. This conduct seems to be the result of ignorance, supported by an ancient superstitious notion, which forbids the body of any person killed by accident to be laid in an house that is inhabited. What the ground of this superstition may be, we shall not pretend to inquire; but surely the conduct founded upon it is contrary to all the principles of reason, humanity, and common sense.

When a person seems to be suddenly deprived of life, our first business is to inquire into the cause. We ought carefully to observe whether any substance be lodged in the wind-pipe or gullet; and, if that is the case, attempts must be made to remove it. When unwholesome air is the cause, the patient ought immediately to be removed out of it. If the circulation be suddenly stopped, from any cause whatever, except mere weakness, the patient should be bled. If the blood does not flow, he may be immersed in warm water, or rubbed with warm cloths, &c. to promote the circulation. When the cause cannot be suddenly removed, our great aim must be to keep up the vital warmth, by rubbing the patient with hot cloths, or salt, and covering his body with warm sand, ashes, or the like.

I should now proceed to treat more fully of those accidents, which, without immediate assistance, would often prove fatal, and to point out the most likely means for relieving the unhappy sufferers; but as I have been happily anticipated in this part of my subject by the learned and humane Dr. Tissot, I shall content myself with selecting such of his observations as seem to be the most important, and adding such of my own as have occurred in the course of practice.

OF SUBSTANCES STOPT BETWEEN THE MOUTH AND STOMACH.

Though accidents of this kind are very common, and extremely dangerous, yet they are generally the effect of carelessness. Children should be taught to chew their food well, and to put nothing into their mouths which it would be dangerous for them to swallow. But children are not the only persons guilty of this piece of imprudence. I know many adults who put pins, nails, and other sharp-pointed substances in their mouths upon every occasion, and some who even sleep with the former there all night. This conduct is exceedingly injudicious, as a fit of coughing, or twenty other accidents, may force over the substance before the person is aware[202].

When any substance is detained in the gullet, there are two ways of removing it, viz. either by extracting it, or pushing it down. The safest and most certain way is to extract it; but this is pot always the easiest; it may therefore be more eligible sometimes to thrust it down, especially when the obstructing body is of such a nature, that there is no danger from its reception into the stomach. The substances which may be pushed down without danger are, all common nourishing ones, as bread, flesh, fruits, and the like. All indigestible bodies, as cork, wood, bones, pieces of metal, and such like, ought if possible to be extracted, especially if these bodies be sharp pointed, as pins, needles, fish-bones, bits of glass, &c.

When such substances have not passed in too deep, we should endeavour to extract them with our fingers, which method often succeeds. When they are lower, we must make use of nippers, or a small pair of forceps, such as surgeons use. But this attempt to extract rarely succeeds, if the substance be of a flexible nature, and has descended far into the gullet.

If the fingers and nippers fail, or cannot be duly applied, crotchets, a kind of hooks, must be employed. These may be made at once, by bending a piece of pretty strong iron wire at one end. It must be introduced in the flat way; and for the better conducing it, there should likewise be a curve or bending at the end it is held by, to serve as a kind of handle to it; which has this further use, that it may be secured by a string tied to it, a circumstance not to be omitted in any instrument employed on such occasions, to avoid such ill accidents as have sometimes ensued from these instruments slipping out of the operator’s hand. After the crotchet has passed below the substance that obstructs the passage, it is drawn up again, and hooks up the body along with it. The crotchet is also very convenient, when a substance somewhat flexible, as a pin or fish-bone, sticks across the gullet, the hook, in such cases, seizing them about their middle part, crooks and thus disengages them; or, if they are very brittle substances, serves to break them.

When the obstructing bodies are small, and only stop up a part of the passage, and which may either easily elude the hook, or straiten it by their resistance, a kind of rings, made either of wire, wool, or silk, may be used. A piece of fine wire of a proper length may be bent into a circle, about the middle, of about an inch diameter, and the long unbent sides brought parallel, and near each other: these are to be held in the hand, and the circular part or ring introduced into the gullet, in order to be conduced about the obstructing body, and so to extract it. More flexible rings may be made of wool, thread, silk, or small pack-thread, which may be waxed for their greater strength and consistence. One of these is to be tied fast to a handle of iron wire, whale-bone, or any kind of flexible wood, and by this means introduced, in order to surround the obstructing substance, and to draw it out. Several of these rings passed through one another may be used, the more certainly to lay hold of the obstructing body, which may be involved by one, if another should miss it. These rings have one advantage, which is, that when the substance to be extracted is once laid hold of, it may then, by turning the handle, be retained so strongly in the ring thus twitted, as to be moved every way, which must in many cases be a considerable advantage.

Another material employed on these unhappy occassions is the sponge. Its property of swelling considerably on being wet is the principal foundation of its usefulness here. If any substance is stopt in the gullet, but without filling up the whole passage, a bit of sponge may be introduced into that part which is unstopt, and beyond the substance. The sponge soon dilates, and grows larger in this moist situation; and indeed the enlargement of it may be forwarded by making the patient swallow a few drops of water. Afterwards it is to be drawn back by the handle to which it is fastened; and as it is now too large to return through the small cavity by which it was conveyed in, it draws out the obstructing body along with it.

The compressibility of sponge is another foundation of its usefulness in such cases. A pretty large piece of sponge may be compressed or squeezed into a small size, by winding a string of tape closely about it, which may be easily unwound, and withdrawn, after the sponge has been introduced. A bit of sponge may likewise be, compressed by a piece of whale-bone split at one end; but this can hardly be introduced in such a manner as not to hurt the patient.

I have often known pins and other sharp bodies, which had stuck in the throat, brought up by causing the person to swallow a bit of tough meat tied to a thread, and drawing it quickly up again. This is safer than swallowing sponge, and will often answer the purpose equally well.

When all these methods prove unsuccessful, there remains one more, which is, to make the patient vomit: but this can scarcely be of any service, unless when such obstructing bodies are simply engaged in, and not hooked or stuck into the sides of the gullet, as in this case vomiting might sometimes occasion further mischief. If the patient can swallow, vomiting may be excited by taking half a drachm or two scruples of ipecacuanha in powder made into a draught. If he is not able to swallow, an attempt may be made to excite vomiting, by tickling his throat with a feather; and, if that should not succeed, a clyster of tobacco may be administered. It is made by boiling an ounce of tobacco in a sufficient quantity of water: this has often been found to succeed, when other attempts to excite vomiting had failed.

When the obstructing body is of such a nature that it may with safety be pushed downwards, this may be attempted by means of a wax-candle oiled, and a little heated, so as to make it flexible; or a piece of whale-bone, wire, or flexible wood, with a sponge fastened to one end.

Should it be impossible to extract even those bodies which it is dangerous to admit into the stomach, we must then prefer the least of two evils, and rather run the hazard of pushing them down than suffer the patient to perish in a few minutes; and we ought to scruple this resolution the less, as a great many instances have happened, where the swallowing of such hurtful and indigestible substances has been followed by no disorder.

Whenever it is manifest that all endeavours either to extract or push down the substance must prove ineffectual, they should be discontinued; because the inflammation occasioned by persisting in them might be as dangerous as the obstruction itself. Some have died in consequence of the inflammation, even after the body which caused the obstruction had been entirely removed.

While the means recommended above are making use of, the patient should often swallow, or, if he cannot, he should frequently receive by injection through a crooked tube or pipe that may reach down to the gullet, some emollient liquor, as warm milk and water, barley-water, or a decoction of mallows. Injections of this kind not only soften and sooth the irritated parts, but, when thrown in with force, are often more successful in loosening the obstruction than all attempts with instruments.

When, after all our endeavours, we are obliged to leave the obstructing body in the part, the patient must be treated as if he had an inflammatory disease. He should be bled, kept upon a low diet, and have his whole neck surrounded with emollient poultices. The like treatment must also be used, if there be any reason to suspect an inflammation of the passages, though the obstructing body be removed.

A proper degree of agitation has sometimes loosened the inhering body more effectually than instruments. Thus, a blow on the back has often forced up a substance which stuck in the gullet; but this is still more proper and efficacious when the substance gets into the wind-pipe. In this case, vomiting and sneezing are likewise to be excited. Pins, which stuck in the gullet, have been frequently discharged by riding on horseback, or in a carriage.

When any indigestible substance has been forced down into the stomach, the patient should use a very mild and smooth diet, consisting chiefly of fruits and farinaceous substances, as puddings, pottage, and soups. He should avoid all heating and irritating things, as wine, punch, pepper, and such like; and his drink should be milk and water, barley-water, or whey.

When the gullet is so strongly and fully closed, that the patient can receive no food by the mouth, he must be nourished by clysters of soup, jelly, and the like.

When the patient is in danger of being immediately suffocated, and all hope of freeing the passage is vanished, so that death seems at hand, if respiration be not restored; the operation of bronchotomy, or opening of the wind-pipe, must be directly performed. As this operation is neither difficult to an expert surgeon, nor very painful to the patient, and is often the only method which can be taken to preserve life in these emergencies, we thought proper to mention it, though it should only be attempted by persons skilled in surgery.

OF DROWNED PERSONS.

When a person has remained above a quarter of an hour under water, there can be no considerable hopes of his recovery. But as several circumstances, may happen to have continued life, in such an unfortunate situation, beyond the ordinary term, we should never too soon resign the unhappy object to his fate, but try every method for his relief, as there are many well attested proofs of the recovery of persons to life and health who had been taken out of the water apparently dead, and who remained a considerable time without exhibiting any signs of life.

The first thing to be done, after the body is taken out of the water, is to convey it as soon as possible to some convenient place where the necessary operations for its recovery may be performed. In doing this, care must be taken not to bruise or injure the body by carrying it in any unnatural posture with the head downwards, or the like. If an adult body, it ought to be laid on a bed, or on straw, with the head a little raised, and carried on a cart or on men’s shoulders, and kept in as natural and easy a position as possible. A small body may be carried in the arms.

In attempting to recover persons apparently drowned, the principal intention to be pursued is, to restore the natural warmth, upon which all the vital functions depend; and to excite these functions by the application of stimulants, not only to the skin, but likewise to the lungs, intestines, &c.

Though cold was by no means the cause of the person’s death, yet it will prove an effectual obstacle to his recovery. For this reason, after stripping him of his wet clothes, his body must be strongly rubbed for a considerable time with coarse linen cloths, as warm as they can be made; and, as soon as a well-heated bed can be got ready, he may be laid in it, and the rubbing should be continued. Warm cloths ought likewise to be frequently applied to the stomach and bowels, and hot bricks, or bottles of warm water, to the soles of his feet, and to the palms of his hands.

Strong volatile spirits should be frequently applied to the nose; and the spine of the back and pit of the stomach may be rubbed with warm brandy or spirit of wine. The temples ought always to be chafed with volatile spirits; and stimulating powders, as that of tobacco or marjoram, may be blown up the nostrils.

To renew the breathing, a strong person may blow his own breath into the patient’s mouth with all the force he can, holding his nostrils at the same time. When it can be perceived by the rising of the chest or belly that the lungs are filled with air, the person ought to desist from blowing, and should press the breast and belly so as to expel the air again; and this operation may be repeated for some time, alternately inflating and depressing the lungs so as to imitate natural respiration.

If the lungs cannot be inflated in this manner, it may be attempted by blowing through one of the nostrils, and at the same time keeping the other close. Dr. Monro for this purpose recommends a wooden pipe fitted at one end for filling the nostril, and at the other for being blown into by a person’s mouth, or for receiving the pipe of a pair of bellows, to be employed for the same purpose, if necessary.

When air cannot be forced into the chest by the mouth or nose, it may be necessary to make an opening into the wind-pipe for this purpose. It is needless, however, to spend time in describing this operation, as it should not be attempted unless by persons skilled in surgery.

To stimulate the intestines, the fume of tobacco may be thrown up in form of clyster. There are various pieces of apparatus contrived for this purpose, which may be used when at hand; but where these cannot be obtained, the business may be done by a common tobacco-pipe. The bowl of the pipe must be filled with tobacco well kindled, and, after the small tube has been introduced into the fundament, the smoke may be forced up by blowing through a piece of paper full of holes wrapped round the mouth of the pipe, or by blowing through an empty pipe, the mouth of which is applied close to that of the other. This may also be done in the following manner: A common clyster-pipe with a bag mounted upon it may be introduced into the fundament, and the mouth of the bag may be applied round the small end of a tobacco-pipe, in the bowl of which tobacco is to be kindled, and the smoke blown up as directed above. Should it be found impracticable to throw up the smoke of tobacco, clysters of warm water, with the addition of a little salt and some wine or spirits, may be frequently administered. This may be done by a common clyster-bag and pipe; but, as it ought to be thrown well up, a pretty large syringe will answer the purpose better.

While these things are doing, some of the attendants ought to be preparing a warm bath, into which the person should be put, if the above endeavours prove ineffectual. Where there are no conveniencies for using the warm bath, the body may be covered with warm salt, sand, ashes, grains, or such like. Tissot mentions an instance of a girl who was restored to life, after she had been taken out of the water, swelled, bloated, and to all appearance dead, by laying her naked body upon hot ashes, covering her with others equally hot, putting a bonnet round her head, and a stocking round her neck stuffed with the same, and heaping coverings over all. After she had remained half an hour in this situation, her pulse returned, she recovered speech, and cried out, I freeze, I freeze; a little cherry-brandy was given her, and she remained buried as it were under the ashes for eight hours; afterwards she was taken out, without any other complaint except that of lassitude or weariness, which went off in a few days. The Doctor mentions likewise an instance of a man who was restored to life, after he had remained six hours under water, by the heat of a dunghill.

Till the patient shews some signs of life, and is able to swallow, it would be useless and even dangerous to pour liquors into his mouth. His lips, however, and tongue, may be frequently wet with a feather dipt in warm brandy or other strong spirits; and, as soon as he has recovered the power of swallowing, a little warm wine, or some other cordial, ought every now and then to be administered.

Some recommend a vomit after the patient is a little re-animated; but if he can be made to puke without the sickening draught, it will be more safe: this may generally be done by tickling the throat and fauces with an oiled feather, or some other soft substance, which will not injure the parts. Tissot in this case recommends the oxymel of squills, a table-spoonful of which, diluted with water, may be given every quarter of an hour, till the patient has taken five or six doses. Where that medicine is not at hand, a strong infusion of sage, camomile-flowers, or carduus benedictus, sweetened with honey, or some warm water, with the addition of a little salt, may, he says, supply its place. The Doctor does not intend that any of these things should be given in such quantity as to occasion vomiting. He thinks emetics in this situation are not expedient.

We are by no means to discontinue our assistance as soon as the patients discover some tokens of life, since they sometimes expire after these first appearances of recovering. The warm and stimulating applications are still to be continued, and small quantities of some cordial liquor ought frequently to be administered. Lastly, though the person should be manifestly re-animated, there sometimes remain an oppression, a cough, and feverishness, which effectually constitute a disease. In this case it will be necessary to bleed the patient in the arm, and to cause him to drink plentifully of barley-water, elder-flower-tea, or any other soft pectoral infusions.

Such persons as have the misfortune to be deprived of the appearances of life, by a fall, a blow, suffocation, or the like, must be treated nearly in the same manner as those who have been for some time under water. I once attended a patient who was so stunned by a fall from a horse, that for above six hours he scarcely exhibited any signs of life; yet this man, by being bled, and proper methods taken to keep up the vital warmth, recovered, and in a few days was perfectly well. Dr. Alexander gives an instance to the same purpose, in the Edinburgh Physical and Literary Essays, of a man who was to all appearance killed by a blow on the breast, but recovered upon being immersed for some time in warm water. These, and other instances of a similar nature, which might be adduced, amount to a full proof of this fact, that many of those unhappy persons who lose their lives by falls, blows, and other accidents, might be saved by the use of proper means duly persisted in.

OF NOXIOUS VAPOURS.

Air may be many ways rendered noxious, or even destructive to animals. This may either happen from its vivifying principle being destroyed, or from subtle exhalations with which it is impregnated. Thus air that has passed through burning fuel is neither capable of supporting fire nor the life of animals. Hence the danger of sleeping in close chambers with charcoal fires. Some indeed suppose the danger here proceeds from the sulphureous oil contained in the charcoal, which is set at liberty and diffused all over the chamber; while others imagine it is owing to the air of the room being charged with phlogiston. Be this as it may, it is a situation carefully to be avoided. Indeed, it is dangerous to sleep in a small apartment with a fire of any kind. I lately saw four persons who had been suffocated by sleeping in an apartment where a small fire of coal had been left burning.

The vapour which exhales from wine, cyder, beer, or other liquors, in the state of fermentation, contains something poisonous, which kills in the same manner as the vapour of coal. Hence there is always danger in going into cellars where a large quantity of these liquors is in a state of fermentation, especially if they have been close shut up for some time. There have been many instances of persons struck dead on entering such places, and of others who have with difficulty escaped.

When subterraneous caves, that have been very long shut, are opened, or when deep wells are cleaned, which have not been emptied for several years, the vapours arising from them produce the same effects as those mentioned above. For this reason, no person ought to venture into a well, pit, cellar, or any place that is damp, and has been long shut up, till the air has been sufficiently purified, by burning gunpowder in it. It is easy to know, as has been observed in a former part of this work, when the air of such places is unwholesome, by letting down a lighted candle, throwing in burning fuel, or the like. If these continue to burn, people may safely venture in; but where they are suddenly extinguished, no one ought to enter till the air has been first purified by fire.

The offensive smell of lamps and of candles, especially when their flames are extinguished, operate like other vapours, though with less violence, and less suddenly. There have however been instances of people killed by the fumes of lamps which had been extinguished in a close chamber, and persons of weak delicate breasts generally find themselves quickly oppressed in apartments illuminated with many candles.

Such as are sensible of their danger in these situations, and retreat seasonably from it, are generally relieved as soon as they get into the open air, or, if they have any remaining uneasiness, a little water and vinegar, or lemonade, drank hot, affords them relief. But when they are so far poisoned, as to have lost their feeling and understanding, the following means must be used for their recovery:

The patient should be exposed to a very pure, fresh, and open air; and volatile salts, or other stimulating substances, held to his nose. He should next be bled in the arm, or if that does not succeed, in the neck. His legs ought to be put into warm water, and well rubbed. As soon as he can swallow, some lemonade, or water and vinegar, with the addition of a little nitre, may be given him.

Nor are sharp clysters by any means to be neglected; these may be made, by adding to the common clyster, syrup of buckthorn and tincture of senna, of each two ounces; or, in their stead, half an ounce of Venice turpentine dissolved in the yolk of an egg. Should these things not be at hand, two or three large spoonfuls of common salt may be put into the clyster. The same means, if necessary, which were recommended in the former part of this chapter, may be used to restore the circulation, warmth, &c.

Mr. Tossach, surgeon at Alloa, relates the case of a man suffocated by the steam of burning coal, whom he recovered by blowing his breath into the patient’s mouth, bleeding him in the arm, and causing him to be well rubbed and tossed about. And Dr. Frewen, of Sussex, mentions the case of a young man who was stupified by the smoke of sea-coal, but was recovered by being plunged into cold water, and afterwards laid in a warm bed.

The practice of plunging persons suffocated by noxious vapours in cold water, would seem to be supported by the common experiment of suffocating dogs in the grotto del cani, and afterwards recovering them, by throwing them into the neighbouring lake.

EFFECTS OF EXTREME COLD.

When cold is extremely severe, and a person is exposed to it for a long time, it proves mortal, in consequence of its stopping the circulation in the extremities, and forcing too great a proportion of blood towards the brain; so that the patient dies of a kind of apoplexy, preceded by great sleepiness. The traveller, in this situation, who finds himself begin to grow drowsy, should redouble his efforts to extricate himself from the imminent danger he is exposed to. This sleep, which he might consider as some alleviation of his sufferings, would, if indulged, prove his last.

Such violent effects of cold are happily not very common in this country; it frequently happens, however, that the hands or feet of travellers are so benumbed or frozen, as to be in danger of a mortification, if proper means are not used to prevent it. The chief danger in this situation arises from the sudden application of heat. It is very common, when the hands or feet are pinched with cold, to hold them to the fire; yet reason and observation shew that this is a most dangerous and imprudent practice.

Every peasant knows, if frozen meat, fruits, or roots of any kind, be brought near the fire, or put into warm water, they will be destroyed, by rottenness, or a kind of mortification; and that the only way to recover them, is to immerse them for some time in very cold water. The same observation holds with regard to animals in this condition.

When the hands or feet are greatly benumbed with cold, they ought either to be immersed in cold water, or rubbed with snow, till they recover their natural warmth and sensibility: after which the person may be removed into an apartment a little warmer, and may drink some cups of tea, or an infusion of elder flowers sweetened with honey. Every person must have observed, when his hands were even but slightly affected with cold, that the best way to warm them was by washing them in cold water, and continuing to rub them well for some time.

When a person has been so long exposed to the cold, that all appearances of life are gone, it will be necessary to rub him all over with snow or cold water; or, what will answer better, if it can be obtained, to immerse him in a bath of the very coldest water. There is the greatest encouragement to persist in the use of these means, as we are assured that persons who had remained in the snow, or had been exposed to the freezing air during five or six successive days, and who had discovered no marks of life for several hours, have nevertheless been revived.

I have always thought, that the whitloes, kibes, chilblains, and other inflammations of the extremities, which are so common among the peasants in the cold season, were chiefly occasioned by their sudden transitions from cold to heat. After they have been exposed to an extreme degree of cold, they immediately apply their hands and feet to the fire, or, if they have occasion, plunge them into warm water, by which means, if a mortification does not happen, an inflammation seldom fails to ensue. Most of the ill consequences from this quarter might be easily avoided, by only observing the precautions mentioned above.

EFFECTS OF EXTREME HEAT.

The effects of extreme heat, though not so common in this country, are no less fatal, and much more sudden than those of cold. In hot countries people frequently drop down dead in the streets, exhausted with heat and fatigue. In this case, if any warm cordial can be poured into the mouth it ought to be done. If this cannot be effected, they may be thrown up in form of a clyster. Volatile spirits, and other things of a stimulating nature, may be applied to the skin, which should be well rubbed with coarse-cloths, whipped with nettles, or other stimulating things. Some of the ancient physicians are said to have restored to life persons apparently dead, by beating them with rods.

CHAP. LIV. OF FAINTING FITS, AND OTHER CASES WHICH REQUIRE IMMEDIATE ASSISTANCE.

Strong and healthy persons, who abound with blood, are often seized with sudden fainting fits, after violent exercise, drinking freely of warm or strong liquors, exposure to great heat, intense application to study, or the like.

In such cases the patient should be made to smell to some vinegar. His temples, forehead, and wrists ought at the same time to be bathed with vinegar mixed with an equal quantity of warm water; and two or three spoonfuls of vinegar, with four or five times as much water, may, if he can swallow, be poured into his mouth.

If the fainting proves obstinate, or degenerates into a syncope, that is, an abolition of feeling and understanding, the patient must be bled. After the bleeding, a clyster will be proper, and then he should be kept easy and quiet, only giving him every half hour a cup or two of an infusion of any mild vegetable, with the addition of a little sugar and vinegar.

When swoonings, which arise from this cause, occur frequently in the same person, he should, in order to escape them, confine himself to a light diet, confiding chiefly of bread, fruits, and other vegetables. His drink ought to be water or small beer, and he should deep but moderately, and take much exercise.

But fainting fits proceed much oftner from a defect than an excess of blood. Hence they are very ready to happen after great evacuations of any kind, obstinate watching, want of appetite, or such like. In these an almost directly opposite course to that mentioned above must be pursued.

The patient should be laid in bed, with his head low, and being covered, should have his legs, thighs, arms, and his whole body rubbed strongly with hot flannels. Hungary water, volatile salts, or strong smelling herbs, as rue, mint, or rosemary, may be held to his nose. His mouth may be wet with a little rum or brandy; and, if he can swallow, some hot wine, mixed with sugar and cinnamon, which is an excellent cordial, may be poured into his mouth. A compress of flannel dipt in hot wine or brandy must be applied to the pit of his stomach, and warm bricks, or bottles filled with hot water, laid to the feet.

As soon as the patient is recovered a little, he should take some strong soup or broth, or a little bread or biscuit soaked in hot-spiced wine. To prevent the return of the fits, he ought to take often, but in small quantities, some light yet strengthening nourishment, as panado made with soup instead of water, new laid eggs lightly poached, chocolate, light roast meats, jellies, and such like.

Those fainting fits, which are the effect of bleeding, or of the violent operation of purges, belong to this class. Such as happen after artificial bleeding are seldom dangerous, generally terminating as soon as the patient is laid upon the bed; indeed persons subject to this kind should always be bled lying, in order to prevent it. Should the fainting however continue longer than usual, volatile spirits may be held to the nose, and rubbed on the temples, &c.

When fainting is the effect of too strong or acrid purges or vomits, the patient must be treated in all respects as if he had taken poison. He should be made to drink plentifully of milk, warm water, and oil, barley-water, or suck like; emollient clysters will likewise be proper, and the patient’s strength should afterwards be recruited, by giving him generous cordials, and anodyne medicines.

Faintings are often occasioned by indigestion. This may either proceed from the quantity or quality of the food. When the former of these is the cause, the cure will be best performed by vomiting, which may be promoted by causing the patient to drink a weak infusion of camomile-flowers, carduus benedictus or the like. When the disorder proceeds from the nature of the food, the patient, as in the case of weakness, must be revived by strong smells, &c. after which he should be made to swallow a large quantity of light warm fluid, which may serve to drown, as it were, the offending matter, to soften its acrimony, and either to effect a discharge of it by vomiting, or force it down into the intestines.

Even disagreeable smells will sometimes occasion swoonings, especially in people of weak nerves. When this happens, the patient should be carried into the open air, have stimulating things held to his nose, and those substances which are disagreeable to him ought immediately to be removed. But we have already taken notice of swoonings which arise from nervous disorders, and shall therefore say no more upon that head.

Fainting fits often happen in the progress of diseases. In the beginning of putrid diseases they generally denote an oppression at stomach, or a mass of corrupted humours, and they cease after evacuations either by vomit or stool. When they occur at the beginning of malignant fevers, they indicate great danger. In each of these cases, vinegar used both externally and internally is the best remedy during the paroxysm, and plenty of lemon-juice and water after it. Swoonings which happen in diseases accompanied with great evacuations, must be treated like those which are owing to weakness, and the evacuations ought to be restrained. When they happen towards the end of a violent fit of an intermitting fever, or at that of each exacerbation of a continual fever, the patient must be supported by small draughts of wine and water.

Delicate and hysteric women are very liable to swooning or fainting fits after delivery. These might be often prevented by generous cordials, and the admission of fresh air. When they are occasioned by excessive flooding, it ought by all means to be restrained. They are generally the effect of mere weakness or exhaustion. Dr. Engleman relates the case of a woman “in child-bed, who, after being happily delivered, suddenly fainted, and lay upwards of a quarter of an hour apparently dead. A physician was sent for; her own maid, in the mean while, being out of patience at his delay, attempted to assist her herself, and extending herself upon her mistress, applied her mouth to her’s, blew in as much breath as she possibly could, and in a very short time the exhausted woman awaked as out of a profound sleep; when proper things being given her, she soon recovered.

“The maid being asked how she came to think of this expedient, said she had seen it practised at Altenburgh, by midwives, upon children with the happiest effect.”

We mention this case chiefly that other midwives may be induced to follow so laudable an example. Many children are born without any signs of life, and others expire soon after the birth, who might, without all doubt, by proper care, be restored to life.

From whatever cause fainting fits proceed, fresh air is always of the greatest importance to the patient. By not attending to this circumstance, people often kill their friends while they are endeavouring to save them. Alarmed at the patient’s situation, they call in a crowd of people to his assistance, or perhaps to witness his exit, whose breathing exhausts the air, and increases the danger. There is not the least doubt but this practice, which is very common among the lower sort of people, often proves fatal, especially to the delicate, and such persons as fall into fainting fits from mere exhaustion, or the violence of some disease. No more persons ought ever to be admitted into the room where a patient lies in a swoon than are absolutely necessary for his assistance, and the windows of the apartment should always be opened, at least as far as to admit a stream of fresh air.

Persons subject to frequent swoonings, or fainting fits, should neglect no means to remove the cause of them, as their consequences are always injurious to the constitution. Every fainting fit leaves the person in dejection and weakness; the secretions are thereby suspended, the humours disposed to stagnation, coagulations and obstructions are formed, and, if the motion of the blood be totally intercepted, or very considerably checked, polypuses are sometimes formed in the heart or larger vessels. The only kind of swoonings not to be dreaded are those which sometimes mark the crisis in fevers; yet even these ought, as soon as possible, to be removed.

OF INTOXICATION.

The effects of intoxication are often fatal. No kind of poison kills more certainly than an over-dose of ardent spirits. Sometimes, by destroying the nervous energy, they put an end to life at once; but in general their effects are more slow, and in many respects similar to those of opium. Other kinds of intoxicating liquors may prove fatal when taken to excess, as well as ardent spirits; but they may generally be discharged by vomiting, which ought always to be excited when the stomach is overcharged with liquor.

More of those unhappy persons, who die intoxicated, lose their lives from an inability to conduct themselves than from the destructive quality of the liquor. Unable to walk, they tumble down, and lie in some awkward posture, which obstructs the circulation or breathing, and often continue in this situation till they die. No drunken person should be left by himself, till his clothes have been loosened, and his body laid in such a posture as is most favourable for continuing the vital motions, discharging the contents of the stomach, &c. The best posture for discharging the contents of the stomach is to lay the person upon his belly; when asleep he may be laid on his side, with his head a little raised, and particular care must be taken that his neck be no way bent, twisted, or have any thing too tight about it.

The excessive degree of thirst occasioned by drinking strong liquors, often induces people to quench it by taking what is hurtful. I have known fatal consequences even from drinking freely of milk after a debauch of wine or sour punch; these acid liquors, together with the heat of the stomach, having coagulated the milk in such a manner that it could never be digested. The safest drink after a debauch is water with a toast, tea, infusions of balm, sage, barley-water, and such like. If the person wants to vomit, he may drink a weak infusion of camomile-flowers, or lukewarm water and oil; but in this condition vomiting may generally be excited by only tickling the throat with the finger or a feather.

Instead of giving a detail of all the different symptoms of intoxication which indicate danger, and proposing a general plan of treatment for persons in this situation, I shall briefly relate the history of a case which lately fell under my own observation, wherein most of those symptoms usually reckoned dangerous concurred, and where the treatment was successful.

A young man, about fifteen years of age, had, for a hire, drank ten glasses of strong brandy. He soon after fell fast asleep, and continued in that situation for near twelve hours, till at length his uneasy manner of breathing, the coldness of the extremities, and other threatening symptoms, alarmed his friends, and made them send for me. I found him still sleeping, his countenance ghastly, and his skin covered with a cold clammy sweat. Almost the only signs of life remaining were, a deep laborious breathing, and a convulsive motion or agitation of his bowels.

I tried to rouse him, but in vain, by pinching, shaking, applying volatile spirits, and other stimulating things to his nose, &c. A few ounces of blood were likewise taken from his arm, and a mixture of vinegar and water was poured into his mouth; but, as he could not swallow, very little of this got into the stomach. None of these things having the least effect, and the danger seeming to increase, I ordered his legs to be put into warm water, and a sharp clyster to be immediately administered. This gave him a stool, and was the first thing that relieved him. It was afterwards repeated with the same happy effect, and seemed to be the chief cause of his recovery. He then began to shew some signs of life, took drink when it was offered him, and came gradually to his senses. He continued, however, for several days weak and feverish, and complained much of a soreness in his bowels, which gradually went off, by means of a slender diet, and cool mucilaginous liquors.

This young man would probably have been suffered to die, without any assistance being called, had not a neighbour, a few days before, who had been advised to drink a bottle of spirits to cure him of an ague, expired under very similar circumstances.

OF SUFFOCATION AND STRANGLING·

These may sometimes proceed from an infarction of the lungs, produced by viscid clammy humours, or a spasmodic affection of the nerves of that organ. Persons who feed grossly, and abound in rich blood, are very liable to suffocating fits from the former of these causes. Such ought, as soon as they are attacked, to be bled, to receive an emollient clyster, and to take frequently a cup of diluting liquor with a little nitre in it. They should likewise receive the steams of hot vinegar into their lungs by breathing.

Nervous and asthmatic persons are most subject to spasmodic affections of the lungs. In this case the patient’s legs should be immersed in warm water, and the steams of vinegar applied as above. Warm diluting liquors should likewise be drank; to a cup of which a tea-spoonful of the parygoric elixir may occasionally be added. Burnt paper, feathers, or leather, may be held to the patient’s nose, and fresh air should be freely admitted to him.

Infants are often suffocated by the carelessness or inattention of their nurses[203]. An infant when in bed should always be laid so, that it cannot tumble down with its head under the bed-clothes; and when in a cradle, its face ought never to be covered. A small degree of attention to these two simple rules would save the lives of many infants, and prevent others from being rendered weak and sickly all their days by the injuries done to their lungs.

Instead of laying down a plan for the recovery of infants who are suffocated, or overlaid, as it is termed by their nurses, I shall give the history of a case related by Monsieur Janin, of the Royal College of Surgery at Paris, as it was attended with success, and contains almost every thing that can be done on such occasions.

A nurse having had the misfortune to over-lay a child, he was called in, and found the infant without any signs of life; no pulsation in the arteries, no respiration, the face livid, the eyes open, dull, and tarnished, the nose full of snivel, the mouth gaping, in short it was almost cold. Whilst some linen clothes and a parcel of ashes were warming, he had the boy unswathed, and laid him in a warm bed, and on the right side. He then was rubbed all over with fine linen, for fear of fretting his tender and delicate skin. As soon as the ashes had received their due degree of heat, Mr. Janin buried him in them, except the face, placed him on the side opposite to that on which he had been at first laid, and covered him with a blanket. He had a bottle of eau de luce in his pocket, which he presented to his nose from time to time; and between whiles some puffs of tobacco were blown up his nostrils: to these succeeded the blowing into his mouth, and squeezing tight his nose. Animal heat began thus to be excited gradually; the pulsations of the temporal artery were soon felt, the breathing became more frequent and free, and the eyes closed and opened alternately. At length the child fetched some cries expressive of his want of the breast, which being applied to his mouth, he catched at it with avidity, and sucked as if nothing had happened to him. Though the pulsations of the arteries were by this time very well re-established, and it was hot weather, yet Mr. Janin thought it advisable to leave his little patient three quarters of an hour longer under the ashes. He was afterwards taken out, cleaned and dressed as usual; to which a gentle sleep succeeded, and he continued perfectly well.

Mr. Janin mentions likewise an example of a young man who had hanged himself through despair, to whom he administered help as effectually as in the preceding case.

Mr. Glover, surgeon in Doctors Commons, London, relates the case of a person who was restored to life after twenty-nine minutes hanging, and continued in good health for many years after.

The principal means used to restore this man to life were, opening the temporal artery and the external jugular; rubbing the back, mouth, and neck, with a quantity of volatile spirits and oil; administering the tobacco clyster by means of lighted pipes, and strong frictions of the legs and arms. This course had been continued for about four hours, when an incision was made into the wind-pipe, and air blown strongly through a canula into the lungs. About twenty minutes after this, the blood at the artery began to run down the face, and a slow pulse was just perceptible at the wrist. The frictions were continued for some time longer; his pulse became more frequent, and his mouth and nose being irritated with spirit of sal ammoniac, he opened his eyes. Warm cordials were then administered to him, and in two days he was so well as to be able to walk eight miles.

These cases are sufficient to shew what may be done for the recovery of those unhappy persons who strangle themselves in a fit of despair.

OF PERSONS WHO EXPIRE IN CONVULSION FITS.

Convulsion fits often constitute the last scene of acute or chronic disorders. When this is the case, there can remain but small hopes of the patient’s recovery after expiring in a fit. But when a person, who appears to be in perfect health, is suddenly seized with a convulsion fit, and seems to expire, some attempts ought always to be made to restore him to life. Infants are most liable to convulsions, and are often carried off very suddenly by one or more fits about the time of teething. There are many well-authenticated accounts of infants having been restored to life, after they had to all appearance expired in convulsions; but we shall only relate the following instance mentioned by Dr. Johnson in his pamphlet on the practicability of recovering persons visibly dead.

In the parish of St. Clemens in Colchester, a child of six months old, lying upon its mother’s lap, having had the breast, was seized with a strong convulsion fit, which lasted so long, and ended with so total a privation of motion in the body, lungs, and pulse, that it was deemed absolutely dead. It was accordingly stripped, laid out, the passing-bell ordered to be tolled, and a coffin to be made; but a neighbouring gentlewoman who used to admire the child, hearing of its sudden death, hastened to the house, and upon examining the child found it not cold, its joints limber, and fancied that a glass she held to its mouth and nose was a little damped with the breath; upon which she took the child in her lap, sat down before the fire, rubbed it, and kept it in gentle agitation. In a quarter of an hour she felt the heart begin to beat faintly; she then put a little of the mother’s milk into its mouth, continued to rub its palms and soles, found the child begin to move, and the milk was swallowed; and in another quarter of an hour she had the satisfaction of restoring to its disconsolate mother the babe quite recovered, eager to lay hold of the breast, and able to suck again. The child throve, had no more fits, is grown up, and at present alive.

These means, which are certainly in the power of every person, were sufficient to restore to life an infant to all appearance dead, and who, in all probability, but for the use of these simple endeavours, would have remained so. There are however many other things which might be done in case the above should not succeed; as rubbing the body with strong spirits, covering it with warm ashes or salt, blowing air into the lungs, throwing up warm stimulating clysters, or the smoke of tobacco, into the intestines, and such like.

When children are dead born, or expire soon after the birth, the same means ought to be used for their recovery, as if they had expired in circumstances similar to those mentioned above.

These directions may likewise be extended to adults, attention being always paid to the age and other circumstances of the patient.

The foregoing cases and observations afford sufficient proof of the success which may attend the endeavours of persons totally ignorant of medicine, in assisting those who are suddenly deprived of life by any accident or disease. Many facts of a similar nature might be adduced, were it necessary; but these, it is hoped, will be sufficient to call up the attention of the public, and to excite the humane and benevolent to exert their utmost endeavours for the preservation of their fellow-men.

The society for the recovery of drowned persons, instituted at Amsterdam in the year 1767, had the satisfaction to find that not fewer than 150 persons in the space of four years had been saved by the means pointed out by them, many of whom owed their preservation to peasants and people of no medical knowledge. But the means used with so much efficacy in recovering drowned persons are, with equal success, applicable to a number of cases where the powers of life seem in reality to be only suspended, and to remain capable of renewing all their functions, on being put into motion again. It is shocking to reflect, that for want of this consideration many persons have been committed to the grave, in whom the principles of life might have been revived.

The cases wherein such endeavours are most likely to be attended with success, are all those called sudden deaths from an invisible cause, as apoplexies, hysterics, faintings, and many other disorders wherein persons in a moment sink down and expire. The various casualties in which they may be tried are, suffocations, from the sulphureous damps of mines, coal-pits, &c.; the unwholesome air of long unopened wells or caverns; the noxious vapours arising from fermenting liquors; the steams of burning charcoal; sulphureous mineral acids; arsenical effluvia, &c.

The various accidents of drowning, strangling, and apparent deaths, by blows, falls, hunger, cold, &c. likewise furnish opportunities of trying such endeavours. Those perhaps who to appearance are killed by lightning, or by any violent agitation of the passions, as fear, joy, surprise, and such like, might also be frequently recovered by the use of proper means, as blowing strongly into their lungs, &c.

The means to be used for the recovery of persons suddenly deprived of life are nearly the same in all cases; they are practicable by every one who happens to be present at the accident, and require no great expence, and less skill. The great aim is to restore the warmth and vital motions. This may in general be attempted by means of heat, frictions, bleeding, blowing air into the lungs, administering clysters and generous cordials. These must be varied according to circumstances. Common sense, and the situation of the patient, will suggest the proper manner of conducting them. Above all we would recommend perseverance. People ought never to despair on account of discouraging circumstances, or to leave off their endeavours as long as there is the least hope of success. Where much good and no hurt can be done, no one ought to grudge his labour.

It were greatly to be wished, that an institution, similar to that of Amsterdam, was established, upon a more extensive plan, in Great Britain; and that a reward was allowed to every one who should be instrumental in restoring to life a person seemingly dead[204]. Men will do much for fame, but still more for money. Should no profit, however, be annexed to those benevolent offices, the heartfelt pleasure which a good man must enjoy, on reflecting that he has been the happy instrument of saving one of his fellow-creatures from an untimely grave, is itself a sufficient reward.

CHAP. LV. CAUTIONS CONCERNING COLD BATHING, AND DRINKING THE MINERAL WATERS.

As it is now fashionable for persons of all ranks to plunge into the sea, and drink the mineral waters, I was desirous of rendering this work still more extensively useful, by the addition of some practical remarks on these active and useful medicines. Finding it impossible to bring these observations within so narrow a compass as not to swell the book, already too large, into an enormous size, I resolved to confine myself to a few hints or cautions; which may be of service to persons who bathe, or drink the mineral waters, without being able to put themselves under the care of a physician.

No part of the practice of medicine is of greater importance, or merits more the attention of the physician, as many lives are lost, and numbers ruin their health, by cold bathing, and an imprudent use of the mineral waters. On some future occasion I may probably resume this subject, as I know not any work that contains a sufficient number of practical observations to regulate the patient’s conduct in the use of these active and important medicines.

We have indeed many books on the mineral waters, and some of them are written with much ingenuity; but they are chiefly employed in ascertaining the contents of the waters by chymical analysis. This no doubt has its use, but it is by no means of such importance as some may imagine. A man may know the chymical analysis of all the articles in the materia medica, without being able properly to apply any one of them in the cure of diseases. One page of practical observations is worth a whole volume of chymical analysis. But where are such observations to be met with? Few physicians are in a situation to make them, and fewer still are qualified for such a task. It can only be accomplished by practitioners who reside at the fountains, and who possessing minds superior to local prejudices, are capable of distinguishing diseases with accuracy, and of forming a sound judgment respecting the genuine effects of medicines.

Without a proper discrimination with regard to the disease and the constitution of the patient, the most powerful medicine is more likely to do harm than good. Every one knows that the same physician who, by cold bathing, cured Augustus, by an imprudent use of the same medicine killed his heir. This induced the Roman senate to make laws for regulating the baths, and preventing the numerous evils which arose from an imprudent and promiscuous use of those elegant and fashionable pieces of luxury. But as no such laws exist in this country, every one does that which is right in his own eyes, and of course many must do wrong.

People are apt to imagine that the simple element of water can do no hurt, and that they may plunge into it at any time with impunity. In this, however, they are much mistaken. I have known apoplexies occasioned by going into the cold bath, fevers excited by staying too long in it, and other maladies so much aggravated by its continued use, that they could never be wholly eradicated. Nor are examples wanting, either in ancient or modern times, of the baneful consequences which have arisen also from an injudicious application of the warm bath; but as warm baths are not so common in this country, and are seldom used but under the direction of a physician, I shall not enlarge on that part of the subject.

Immersion in cold water is a custom which lays claim to the most remote antiquity: indeed it must have been coëval with man himself. The necessity of water for the purpose of cleanliness, and the pleasure arising from its application to the body in hot countries, must very early have recommended it to the human species. Even the example of other animals was sufficient to give the hint to man. By instinct many of them are led to apply cold water in this manner; and some, when deprived of its use, have been known to languish, and even to die. But whether the practice of cold bathing arose from necessity, reasoning, or imitation, is an inquiry of no importance; our business is to point out the advantages which may be derived from it, and to guard people against an improper use of it.

The cold bath recommends itself in a variety of cases, and is peculiarly beneficial to the inhabitants of populous cities, who indulge in idleness, and lead sedentary lives. In persons of this description the action of the solids is always too weak, which induces a languid circulation, a crude indigested mass of humours, and obstructions in the capillary vessels and glandular system. Cold water, from its gravity as well as its tonic power, is well calculated either to obviate or remove these symptoms. It accelerates the motion of the blood, promotes the different secretions, and gives permanent vigour to the solids. But all these important purposes will be more essentially answered by the application of salt-water. This ought not only to be preferred on account of its superior gravity, but likewise for its greater power of stimulating the skin, which promotes the perspiration, and prevents the patient from catching cold.

It is necessary, however, to observe, that cold bathing is more likely to prevent, than to remove obstructions of the glandular or lymphatic system. Indeed, when these have arrived at a certain pitch, they are not to be removed by any means. In this case the cold bath will only aggravate the symptoms, and hurry the unhappy patient into an untimely grave. It is therefore of the utmost importance, previous to the patient’s entering upon the use of the cold bath, to determine whether or not he labours under any obstinate obstructions of the lungs or other viscera; and where this is the case, cold bathing ought strictly to be prohibited[205].

In what is called a plethoric state, or too great a fulness of the body, it is likewise dangerous to use the cold bath, without due preparation. In this case there is great danger of bursting a blood-vessel, or occasioning an inflammation of the brain, or some of the viscera. This precaution is the more necessary to citizens, as most of them live full, and are of a gross habit. Yet, what is very remarkable, these people resort in crowds every season to the sea-side, and plunge in the water without the least consideration. No doubt they often escape with impunity, but does this give a sanction to the practice? Persons of this description ought by no means to bathe, unless the body has been previously prepared by suitable evacuations.

Another class of patients, who stand peculiarly in need of the bracing qualities of cold water, is the nervous. This includes a great number of the male, and almost all the female inhabitants of great cities. Yet even those persons ought to be cautious in using the cold bath. Nervous people have often weak bowels, and may, as well as others, be subject to congestions and obstructions of the viscera; and in this case they will not be able to bear the effects of the cold water. For them, therefore, and indeed for all delicate people, the best plan would be to accustom themselves to it by the most pleasing and gentle degrees. They ought to begin with the temperate bath, and gradually use it cooler, till at length the coldest proves quite agreeable. Nature revolts against all great transitions; and those who do violence to her dictates, have often cause to repent of their temerity.

Wherever cold bathing is practised, there ought likewise to be tepid baths for the purpose mentioned above. Indeed it is the practice of some countries to throw cold water over the patient as soon as he comes out of the warm bath; but though this may not injure a Russian peasant, we dare not recommend it to the inhabitants of this country. The ancient Greeks and Romans, we are told, when covered with sweat and dust, used to plunge into rivers, without receiving the smallest injury. Though they might often escape danger from this imprudent conduct, yet it was certainly contrary to sound reason. I have known many robust men throw away their lives by such an attempt. We would not however advise patients to go into the cold water when the body is chilly; as much exercise, at least, ought to be taken, as may excite a gentle glow all over the body, but by no means so as to overheat it.

To young people, and particularly to children, cold bathing is of the last importance. Their lax fibres render its tonic powers peculiarly proper. It promotes their growth, increases their strength[206], and prevents a variety of diseases incident to childhood. Were infants early accustomed to the cold bath, it would seldom disagree with them; and we should see fewer instances of the scrofula, rickets, and other diseases, which prove fatal to many, and make others miserable for life. Sometimes, indeed, these disorders render infants incapable of bearing the shock of cold water; but this is owing to their not having been early and regularly accustomed to it. It is however necessary here to caution young men against too frequent bathing; as I have known many fatal consequences result from the daily practice of plunging into rivers, and continuing there too long.

The most proper time of the day for using the cold bath is no doubt the morning, or at least before dinner; and the best mode, that of quick immersion. As cold bathing has a constant tendency to propel the blood and other humours towards the head, it ought to be a rule always to wet that part as soon as possible. By due attention to this circumstance, there is reason to believe, that violent head-achs, and other complaints, which frequently proceed from cold bathing, might be often prevented.

The cold bath, when too long-continued in, not only occasions an excessive flux of humours towards the head, but chills the blood, cramps the muscles, relaxes the nerves, and wholly defeats the intention of bathing. Hence, by not adverting to this circumstance, expert swimmers are often injured, and sometimes even lose their lives. All the beneficial purposes of cold bathing are answered by one immersion at a time; and the patient ought to be rubbed dry the moment he comes out of the water, and should continue to take exercise for some time after.

When cold bathing occasions chillness, loss of appetite, listlessness, pain of the breast or bowels, a prostration of strength, or violent head-achs, it ought to be discontinued.

Though these hints are by no means intended to point out all the cases where cold bathing may be hurtful, nor to illustrate its extensive utility as a medicine; yet it is hoped they may serve to guard people against some of those errors into which, from mere inattention, they are apt to fall, and thereby not only endanger their own lives, but bring an excellent medicine into disrepute.

Of drinking the Mineral Waters.

The internal use of water, as a medicine, is no less an object of the physician’s attention than the external. Pure elementary water is indeed the most inoffensive of all liquors, and constitutes a principal part of the food of every animal. But this element is often impregnated with substances of a very active and penetrating nature; and of such an insidious quality, that, while they promote certain secretions, and even alleviate some disagreeable symptoms, they weaken the powers of life, undermine the constitution, and lay the foundation of worse diseases than those which they were employed to remove. Of this every practitioner must have seen instances; and physicians of eminence have more than once declared that they have known more diseases occasioned than removed by the use of mineral waters. This doubtless has proceeded from the abuse of these powerful medicines, which evinces the necessity of using them with caution.

By examining the contents of the mineral waters which are most used in this country, we shall be enabled to form an idea of the danger which may arise from an improper application of them either externally or internally, though it is to the latter of these that the present observations are chiefly confined.

The waters most in use for medical purposes in Britain, are those impregnated with salts, sulphur, iron, and mephitic air, either separately, or variously combined. Of these the most powerful is the saline sulphureous water of Harrowgate, of which I have had more occasion to observe the pernicious consequences, when improperly used, than of any other. To this, therefore, the following remarks will more immediately relate, though they will be found applicable to all the purging waters in the kingdom which are strong enough to merit attention[207].

The errors which so often defeat the intention of drinking the purgative mineral waters, and which so frequently prove injurious to the patient, proceed from the manner of using them, the quantity taken, the regimen pursued, or using them in cases where they are not proper.

A very hurtful prejudice still prevails in this country, that all diseases must be cured by medicines taken into the stomach, and that the more violently these medicines operate, they are the more likely to have the desired effect. This opinion has proved fatal to thousands, and will, in all probability, destroy many more before it can be wholly eradicated. Purging is often useful in acute diseases, and in chronical cases may pave the way for the operation of other medicines; but it will seldom perform a cure; and by exhausting the strength of the patient, will often leave him in a worse condition than it found him. That this is frequently the case with regard to the more active mineral waters, every person conversant in these matters will readily allow.

Strong stimulants applied to the stomach and bowels for a length of time, must tend to weaken and destroy their energy; and what stimulants are more active than salt and sulphur, especially when these substances are intimately combined, and carried through the system by the penetrating medium of water? Those bowels must be strong indeed, which can withstand the daily operation of such active principles for months together, and not be injured. This however is the plan pursued by most of those who drink the purging mineral waters, and whose circumstances will permit them to continue long enough at those fashionable places of resort.

Many people imagine that every thing depends on the quantity of water taken, and that the more they drink they will the sooner get well. This is an egregious error; for, while the unhappy patient thinks he is by this means eradicating his disorder, he is often in fact undermining the powers of life, and ruining his constitution. Indeed nothing can do this so effectually as weakening the powers of digestion by the improper application of strong stimulants. The very essence of health depends on the digestive organs performing their due functions, and the most tedious maladies are all connected with indigestion.

Drinking the water in too great quantity, not only injures the bowels and occasions indigestion, but generally defeats the intention for which it is taken. The diseases for the cure of which mineral waters are chiefly celebrated, are mostly of the chronic kind; and it is well known that such diseases can only be cured by the slow operation of alteratives, or such medicines as act by inducing a gradual change in the habit. This requires length of time, and never can be effected by medicines which run off by stool, and operate chiefly on the first passages.

Those who wish for the cure of any obstinate malady from the mineral waters, ought to take them in such a manner as hardly to produce any effect whatever on the bowels. With this view a half-pint glass may be drank at bed-time[208], and the same quantity an hour before breakfast, dinner, and supper. The dose, however, must vary according to circumstances. Even the quantity mentioned above will purge some persons, while others will drink twice as much without being in the least moved by it. Its operation on the bowels is the only standard for using the water as an alterative. No more ought to be taken than barely to move the body; nor is it always necessary to carry it this length, provided the water goes off by the other emunctories, and does not occasion a chillness, or flatulency in the stomach or bowels. When the water is intended to purge, the quantity mentioned above may be all taken before breakfast.

I would not only caution patients who drink the purging mineral waters over night to avoid heavy suppers, but also from eating heavy meals at any time. The stimulus of water, impregnated with salts, seems to create a false appetite. I have seen a delicate person, after drinking the Harrowgate waters of a morning, eat a breakfast sufficient to have served two ploughmen, devour a plentiful dinner of flesh and fish, and, to crown all, eat such a supper as might have satisfied a hungry porter. All this, indeed, the stomach seemed to crave; but this craving had better remain not quite satisfied, than that the stomach should be loaded with what exceeds its powers. To starve patients was never my plans; but I am clearly of opinion, that, in the use of all the purging mineral waters, a light and rather diluting diet is the most proper; and that no person, during such a course, ought to eat to the full extent to what his appetite craves.

To promote the operation of mineral waters, and to carry them through the system, exercise is indispensably necessary. This may be taken in any manner that is most agreeable to the patient; but he ought never to carry it to excess. The best kinds of exercise are those connected with amusement. Every thing that tends to exhilarate the spirits, not only promotes the operation of the waters, but acts as a medicine. All who resort to the mineral waters ought therefore to leave every care behind, to mix with the company, and to make themselves as cheerful and happy as possible. From this conduct, assisted by the free and wholesome air of those fashionable places of resort, and also the regular and early hours which are usually kept, the patient often receives more benefit than from using the waters.

But the greatest errors in drinking the purging mineral waters arise from their being used in cases where they are absolutely improper, and adverse to the nature of the disease. When people hear of a wonderful cure having been performed by some mineral water, they immediately conclude that it will cure every thing, and accordingly swallow it down, when they might as well take poison. Patients ought to be well informed, before they begin to drink the more active kinds of mineral waters, of the propriety of the course, and should never persist in using them when they are found to aggravate the disorder.

In all cases where purging is indicated, the saline mineral waters will be found to fulfil this intention better than any other medicine. Their operation, if taken in proper quantity, is generally mild; and they are neither found to irritate the nerves, nor debilitate the patient so much as the other purgatives.

As a purgative, these waters are chiefly recommended in diseases of the first passages, accompanied with, or proceeding from, inactivity of the stomach and bowels, acidity, indigestion, vitiated bile, worms, putrid sordes, the piles, and jaundice. In most cases of this kind they are the best medicines that can be administered. But when used with this view, it is sufficient to take them twice, or at most three times a-week, so as to move the body three or four times; and it will be proper to continue this course for some weeks.

But the operation of the more active mineral waters is not confined to the bowels. They often promote the discharge of urine, and not unfrequently increase the perspiration. This shews that they are capable of penetrating into every part of the body, and of stimulating the whole system. Hence arises their efficacy in removing the most obstinate of all disorders, obstructions of the glandular and lymphatic system. Under this class is comprehended the scrofula or King’s evil, indolent tumours, obstructions of the liver, spleen, kidnies, and mesenteric glands. When these great purposes are to be effected, the waters must be used in the gradual manner mentioned above, and persisted in for a length of time. It will be proper however now and then to discontinue their use for a few days.

The next great class of diseases where mineral waters are found to be beneficial, are those of the skin, as the itch, scab, tetters, ringworms, scaly eruptions, leprosies, blotches, foul ulcers, &c. Though these may seem superficial, yet they are often the most obstinate which the physician has to encounter, and not unfrequently set his skill at defiance: but they will sometimes yield to the application of mineral waters for a sufficient length of time, and in most cases of this kind these waters deserve a trial. The saline sulphureous waters, such as those of Moffat in Scotland, and Harrowgate in England, are the most likely to succeed in diseases of the skin; but for this purpose it will be necessary not only to drink the waters, but likewise to use them externally.

To enumerate more particularly the qualities of the different mineral waters, to specify those diseases in which they are respectively indicated, and to point out their proper modes of application, would be an useful, and by no means a disagreeable employment; but as the limits prescribed to these remarks will not allow me to treat the subject at more length, I shall conclude by observing, that whenever the mineral waters are found to exhaust the strength, depress the spirits, take away the appetite, excite fevers, distend the bowels, or occasion a cough, they ought to be discontinued.

⁂ These Cautions having been printed and sold separately for the accommodation of those who had purchased the former editions of this book, has induced some persons to consider them as a Treatise on sea-bathing and drinking the mineral waters; whereas the author’s sole intention was to furnish a few general hints to persons who frequent those fashionable places of resort, without putting themselves under the care of a physician. As he looks upon this subject however to be of the greatest importance to the sick, he pledges himself to treat it at more length on a future occasion.

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