ARMY MEDICAL LIBRARY FOUNDED 1836 WASHINGTON, D.C ,------—.-a-,«,-,-r----.- - ..j^, -•m»^t* it>E >"...»■'<. T*H£ DROPSY. '-•» lfiOtn.if.iii «>f ilia S^.1); <,f Tobac- I en \a •) !m(Ic v/anh jji-t and wj'tfr, ^hy a f»ill) K:iyht i'ui nifniiinj?. r'.< d i adult p.-iloM ; the fedoiV t>> 6>C en.' t -f ^t or dec<'P.«Ud, dCt.,..i iifjtf Bk> cttC'imiliitccs ; tor atKi'd hdjf (he u/dnil- , tv J#til anfwf, to be co -.ittuacd utitt! a oprt a'.es t- ifjttbdily by urim ,ll<.i is the me'hii framing ?he Sal's :—lake one pomvi of t'/»od Leaf I"o- Utc\ n, aiid pui it in a it wilt tc fit for uie. ___k > • DOMESTIC MEDICINE: O R, A TREATISE ON THE PREVENTION AND CURE O 5 DISEASES, BY REGIMEN AND SIMPLE MEDICINES: WITH AN APPENDIX, CONTAINING A DISPENSATORY TOR THE USE 01 PRIVATE PRACTITIONERS. BY WILLIAM BUCHAN, M. D. FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS, "^^ EDINBURGH. / ',-? ----—fc----- ■;' */o2 * 7 / ? / ADAPTED TO THE \\ >uV^ v. Si/.., ^^^~-^.^^S- ■ ■ Climate and Difeafes of America, ;J^j^> BY ISAAC CATHRALL. PHIL ADEL P HI A: PRINTED BT RICHARD FOLWELL, FOR HENRY SWEITZERi No. 86, Race-fireet, 1797. *»■*& PREFACE- /\MONG the motives which have induced me to re* pubjifli Dr. Buchan's book on Domestic Medicine, is that of 'rendering it more extenfively ufeful to the inhabitants of the United States of America, by accom- modating it to their difeafes. Although it contains a comprehenfive description of the difeafes incident to the,nations of Europe, and is too well known by its celebrity to the world, to require any encomium from me, yet the variety to which Hifeafes are fubjecl from climate, makes it fomewhat deficient when applied to thofe of America : To fupplv that defecT: is the object of this publication. How far I have fucceeded in the accomplifhment of my defign, mud be decided by the candour of the public, to whofe judgment it is now with diffidence fubmiited, without any farther apology than a concioufnefs of meaning well, and a defire of folia- ting that portion of indulgence, which is due to every attempt to promote the good of mankind. Ifaac CathralL Philadelphia, Augufl 20, 1797. o w CONTENTS PART I. Of the general Caufes of Difeafes. CHAPTER I. iF Children Page 23 F_Difeafed Parents 26 —Clothing of Children 28 —Food of do. 32 —Exercife of do. 36 —Effects of unwholefome Air upon do. —Nurfes . 89 ibid. 90 92 94 CHAPTER II. Of the Laborious, &c. —the Sedentary —the Studious CHAPTER III. Of Aliment CHAPTER IV. Of Air CHAPTER V. Of Exercife CHAPTER VI. Of Sleep —Clothing CHAPTER VII. Of Intemperance CHAPTER Mil. Of Cleanlinef* CHAPTER IS. Of Infection 41 43 45 5l 55 67, 71 75 76 79 82 86 CHAPTER X. Of the Paffiont -—Anger * —Fear —Grief —Love < —Religious Melancholy 95 CHAPTER XL Of common Evacuations 95 —Stool ibid. —Urine 97 —Perforation 98 Are affected by Changes in the Atmofphere ibid. —Wet Clothes 99 —Wet Feet ' ibid. —Night Air 100 —Damp Beds ibid, —EJamp 'Houfes 101 —Sudden Tranfitions from Heat to Cold 102 PART II. Of Difeafes. CHAPTER XII. Of the Knowledge and Cure of Difeafes CHAPTER XIII. Of Fevers in General CHAPTER XIV. Of Intermitting Fevers or Agues io5 10J 112 CONTENTS. CHAPTER XV. Of an Acute continual Fever i18 CHAPTER XVI. Of the Pleurify —Baftard do. —Paraphrenias CHAPTER XVII. Of a Peripneumony, or Inflammation of the Lungs *ic flammation of the Strain 192 CHAPTER XXIX. * Of the Opthalmia, or In- flammation of the Eyes 194 CHAPTER XXX. Of the Quinfey, or In- flammation of the Throat 198 —Malignant do. 202 126 —Cynanche Parotide; 122 125 126 205 208 2:0 CHAPTER XVIII. | or Mumps Of Confumptions 128 CHAPTER XX' CHAPTER XIX. j Of Colds and Coughs Of the Slow or Nervous i—Common Cough Fever 137—Hooping-Cough CHAPTER XX. CHAPTER XXXII. Of the Malignant, Putrid, Inflammation of the Sto- or Spotted Fever 141 j macn? & other Vifcera 213 CHAPTER XXI. Of the Miliary Fever 147 CHAPTER XXII. Of the Remitting Fever 150 CHAPTER XXIII. Of the Yellow Fever 152 CHAPTER XXIV. * Of the Small-Pox 167 —Inoculation 174 CHAPTER XXV. Of the Chkken-Pox 182 CHAPTER XXVI. Of the Mealies 18 3 -Scarlet Fever 186 —Vomiting —Of the Inteftines 215 GftheCholic 217 Inflammation of the Kid- nies 221 —Of the Bladder 223 —Of the Liver 224 CHAPTER XXXLII. Of the Cholera Morbus, and other excemveDif- charges from the Sto- mach and Bowels 2 25 —a Diarrhoea, or Loofe- nef3 228 330 —Bilious Fever \ CHAPTER ^VII. Of the Eryfipelas, or St. Anthony's Fire 1 CHAPTER XXVIII. Of the Phrenitis, or In- 187 CHAPTER XXXIV. Of the Diabetes, and other Difordeio of the Kid- nies and Bladder 232 —Suprjrefnon of Urine 234 —the Gravel »n.l Stone 236 C O N TENTS. chapter xxxv. Oj; Involuntary DiJ char- ges of Blood 23 —Bleeding at the Nofe 24 —in--. Bleedin:.*- and Blind Piles Spitting of Blood Vomiting of do. Bloody Urine Dyfentery, or Bloody Flux ' CcJhx PaiTion CHAPTER XXXVI. Of the Head-Ach ■—Tooth-Ach !—JVait of Appetite i—ITcurt J urn 29s :;u-l ^ikii 293 CHAPTER XLV. jNervou.s TC I Melancholy des 294 293 242|ThePa;;y 301 244Tetanus,orLockedjcivV 302 240 247 Of the Epilepfy, or Fal- nrp'-Sicknefs —Ear-Ach Pai;- of the Stomach, &c. 259 CHAPTER XXXVII. Of Worms 261 CHAPTER XXXVIII. Of the Jaundice 26 j. CHAPTER XXXIX. OftheDropfy 266 CHAPTER XL. Of the Gout —-Rheumatifm CHAPTER XLI. Of the Scurvy —Schroghula, or King's Evil —Itch CHAPTER. XLII. TbeAflhma 2*86 CHAPTER XLIII. Of the Apoplexy 288 CHAPTER XLIV. Of Co (tivenefs, and ojkgv. , /JMions of t-hevfS|p- * mach and Bowels """'391 3°* —Hiccup 306 248 —Cramp of theStomach 307 253 —Night-Mare 308 —Swoonings 309 253 —Flatulencies, or Wind311 256!—Low Spirits 313 2*:8 Of Hyfteric Affections ibid. 270 275 278 281 283 —Hypochondriac Affec tions *3*6 CHAPTER XLVI. Diforders of the Senfes 318 —of the Eye 319 A Gutta Serena 32a A Cataract. ibid. Short Sightednefs ibid. Seeing only at too great a Diftaijce ibkJ. Squinting ibid. ' • Blood-mot Eye 321 ^ Watery or weeping Eye ibid. Of the Ear ibid. —Tafle and Smell —Touch CHAPTER XLVII. OfaSchirrusandCanc?r "2 *r CHAJpTiiR XLV1IL OfPoifoS —i\4inefftl Poifons —Vegetable do. Bites of Poifonous Ani- mals 323 324 329 ibid. 33° 33i CO N T E N T S. 355 >f the Mad Dog 113 *—of the Viper 336 "-—of Poifonous Infects 337 CHAPTER XLIX. Of the Venereal Difeafe 337 —Virulent Gonorrhoea 338 i—Gleets' 342 —Swelled Teflicle 343 —Buboes 344 ' —Chancres 345 Confirmed Lues 348 General Obfervations 351 CHAPTER L. Difeafes of Women Of the Menftrual Dif- charge ^ 356 Or Pregnancy 360 —Child-Birth 362 —Barrennefs 368 CHAPTER LI. Difeafes of Children 369 Of the Meconium 370 —the Apths or Thrufh ibid. r—Acidities 371 -—Galling and Excoria- tion 372 —Stoppage at the Nofe 373 —Vomiting ibid. ►—a Loofenefs 374 «-r-the Vomiting and Purging of Children 375 —Eruptions * 377 —the Hives 378 •—the Spafmodic do.^ f/g —Teething ^f 380 —the Rickets ^ 3^2 —Convulfions 384 •—Water in the Head, or Dropfy of the Brain 385 CHAPTER LIE Of Surgery s 3$" —Bleeding ibid. —Inflammations and Abfcefles 389 —Wounds 391 —Burns 393 —Bruifcs 391; —Ulcers 396 CHAPTER LIU. Of Diflocations 397 Dillocations of the Jaw 398 -of the Neck 399 -----of the Ribs ibid. -----of the Shoulder 400 -----of the Elbow ibid. -----of the Wriil and Fingers 40 r -----of the Thigh ibid. -----of the Knees ibid. -----of the Ancles ibid. —---of the Toes ibid. CHAPTER LIV. Of Broken Bones, &c. 401 —Strains 404 —Ruptures ibiJ. CHAPTER LV. Of Cafualties —Subftances ftopt be- tween the Mouth and Stomach —Drowned Perfona-j- —Noxious Vapours' > Effects of extreme Cold 415 —------Heat 416 .--------Drinkieg cold Water in Warm Wea- tfie* 4^7 406 407 4M AIT, CONTENTS. CHAPTER LVL (JrFainting Fits, & other Cafes which require immediate Afiiftance 4*8 .—Intoxication 42 * —-Suffocation and Strangling 422 __Perfons falling into Con- vulfion Fits 424 CHAPTER LVII. Cautions concerning cold Bathing and Drinking the Mineral Waters, 426 CONTENTS OF THE APPENDIX. Introduction 437 Lid of Simples 441 Medical Preparations. Balfams- 443 Bolu fifes ibid. Cataplafms & Sinapifms 444 Clyfters 445 Co'iivria, or Eye-Voters 446 Confj&ions 447 Conferves and Preferves ibid. Decoctions 44^ Draughts 449 Electuaries 45° Emulfions 451 Extracts 452 Fomentations ibid. Gargles 45'3 Infufions Juleps Mixtures Ointments, Liniments, Cerates Pills, Plaifters, Powders Syrups, Tin6tures, Elixirs, &c. 454 455 45^ 457 459 461 462 464 465 468 Waters by Infufion, &c. 469 Simple Diftilled Waters ibid. Spiritous diftilled Waters 470 Wheys 471^ Wines ibid.' A Gloflary 473 Index 476 Vinegars Y ADVERTISEMENT. % SIXTEEN years hjave elapfed, Gnce the firft edition of this book appeared. Daring tb.at period, the author has taken oc- eafion to improve feveral articles, inferted in the more early im- preflions. For this he has been cenfured; but it would be unpar- donable in the writer, to fuffer an err>or in a book, on which health and life may depend, to ftand uncorrected^ or, to perceive an omiflion, and leave it unfupplied. His improvements are not the refult of mercenary views. The fame principle which prompted him to write the book, will ever induce him to improve it, to the ut- raoft of his power. The author regrets, that the limits of one volume preclude many interefting obfervations, and likewife deprive him of the pleafure of inferting a number of very ufeful remarks, made by do&or duplanil, of Paris, who publifhed an elegant tranflation of this work, in five volumes octavo, with a commentary. The improvements of the later editions are chiefly ififerted in the form of notes. Thefe are intended either to illuftrate. the text, or to put people on their guard in dangerous ficuations, and prevent fatal miftakes in the practice of medicine. Although the domestic medicine was never fended to fu- percede the ufe of a phyfician, but to fupply his place in fituations where medical afiiftance could noteafily be obtained ; yet the au- thor is forry to obferve, that the jealoufies and fears of the faculty, have prompted many of them to treat this work, in a manner un- becoming the profeflbrs of liberal fcience : notwithstanding their injurious treatment, he is determined to perfift in his plan, being fully convinced of its utility •, nor fhall intereft, or prejudice, ever deter him from exerting his beft endeavours to render the medical art more extenfively beneficial to mankind. But this treatment of the faculty, is not the only thing of which the author has caufe to complain. By fome of them his book has been ferved up mangled and mutiPited, and its title, type, fize, &.■:. fo clofely imitated, that purchafers are milled, and frequently buy thefe fpurious product-ions inftead of the real one. That a needy author, incapable himfelf of producing an original work, .(liould prey upon another, is a thing not at all to be wondered at: but that all this can be done with impunity, fhews, that the laws ©f this country, refpeding literary property, are (till in a very im- perfect Hate. London, Nov. 10, 1785. ^PREFACE. WHEN I firft fignified my intention of publifhrng the follow- ing fheets, I was told by my friends, that it would draw on me the refentment of the whole faculty. 1 refolved to make the experiment; which came out as might have been expected. Many whofe learning and liberality of fentiments do honour to medicine, received the book with indulgence, and the falfity of the opinion, that every phyfician wtihes to conceal his art; while the felfifh and narrow-minded, persecute both the book and its author, (hewed khe reception, however, which this work has met with from the public,merits my moft grateful acknowledgments. As the beft way of expreffmg thefe, 1 have endeavoured to render it more general- ly ufeful, by enlarging that part which treats of preventing difea- fes ; and by adding many articles which had been entirely omitted in the former impreflions. It is needlefs to enumerate thefe addi- tions: I hope that they will be found real improvements. This was fo apparent, as, with me, to amount to a proof of the following melancholy fact : That almoft one half of the human fpecies perifh in infancy, by improper management or neglect. No one, who has not. had an opportunity of obierving. them, can ima- gine what abfurd and ridiculous practices Hill prevail in the nurf- ing and management ofrinfants, and what numbers of lives are by that means loft to fociety. As thefe practices are chiefly owing to ignorance, it is to be hoped that when nurfes are better informed, their conduct will be very different. The obfervations relative to nurfing and the management of children, were chiefly fuggefted by an extenfive practice among infants, in a large branch of the Foundling Hofpital, where I had an opportunity not only of treating the difeafes incident to child- hood, but likewife of trying different plans of nurfing, andofob- ferving their effects. Whenever I had it in my power to place the children under the care of proper nurfes, to inftruct thefe nurfes in their duty, and to be fatisfied that they perform it, very few of them died ; but when, from diftance of place, and other unavoidable circumftances, the children were left to the fole care of mercenary nurfes, without any perfon to inftruct or fuperintend them, fcarce any of them lived. The application of medicine to the various occupations of life has been, in general, the remit of obfervation. An extenfive prac- tice for feveral years, in one of the largeft manufacturing towns in England, afforded me mfficient opportunities of obferving th« injuries which thofe ufeful people fuftain from their particular employments, and likewife of trying various methods of obviating PREFACE. fuch injuries. The fuccefs which attended thefe trials was fuffid- ent to encourage this attempt, which, I hope, will be of ufe to thofe who are under the necefiity of earning their bread by fuch employments as are unfavourable to health. I do not mean to intimidate men, far lefs to infinuate that even thofe arts, the practice of which is attended with fome degree of danger, fhould not be carried on j but to guard the lefs cautious and unwary againtt: thofe dangers which they have it in their pow- er to avoid, and which they often, through mere ignorance, in- cur. As every occupation in life, difpofes thofe who follow it, to fome particular difeafes more than to others, it is of importance to know thefe, that people may guard againft them. It is better to be warned of the approach of an enemy, than to be furprifed by him. The obfervations concerning diet, air, exercife, &c. are of a more general nature, and have not efcaped the attention of phyfi- cians in any age. They are fubjects of too great importance, how- ever, to be pafled over in an attempt of this kind, and can never be fafficiently recommended. The man who pays a proper atten- tion to thefe, will feldom need the phyfician ; and he who does not, will feldctn enjoy health, let him employ as many phyficians as he pleafes. Though I have endeavoured to point out the caufes of difeafes, and to put people upon their guard againft th^rh, yet they are of- ten of fuch a nature, as to be removed only by the diligence and ac- tivity of the public magiflrate. I am forry, indeed, to obferve, that the power of the magiftrate is feldom exerted in this country for the prefervation of health. The importance of a proper medical police is either not underftood, or little regarded. Many things highly injurious to the public health are daily practifed with impu- nity, while others, absolutely neceflary for its prefervation, arc entirely neglected. Some of the public means of preferving health are mentioned / in the general prophylaxis, as the infpection of provifions, widen- ing the ftreets of great towns, keeping them clean, fupplying the inhabitants with wholefome water, &c.; but they are palled over in a very curfory manner. A proper attention^to thefe, would have fwelled this volume to too large a fize; I have therefore referved them for the fubject of a future publication. In the treatment of difeafes, I have been peculiarly attentive to regimen. The generality of people lay too much itrefs upon medi- cine, and truft too little to their own endeavours. It is always in the power of the patient, or of thofe about him, to do as much towards his recovery as can be effected by the phyfician. By not attending to this, the defigns of medicine are often fruftrated; and the patient, by purfuing a wrong plan of regimen, not only defeats the doctor's endeavours, but renders them dangerous. I have often known patients killed by an error in regimen, when 12 PREFACE. they w-rc ufing very proper medicines. It will be laid, the phyfi- cian always orders the regimen when he prefcnbes a medicine. 1 with it were fo, both for the honour of the faculty and the fatety of their patients : but phyficians, as well as other people, are too little attentive to this matter. . Though many reckon it doubtful whether medicines are more beneficial or hurtful to mankind, yet all allow 'the neceffity and importance of a proper regimen in difeafes. Indeed, the very appe- tites of the fick prove its prorMety. No rnan in his fenfes ever ima- gined that a perfon in a fever, for example, could eat, drink, or conduct himfelf in the fame manner as one in perfed health. This part of medicine, therefore, is evidently founded* in nature, and is confident with reafon and common fenfe. Had men been more attentive to it, and lefs folicitous in hunting after fecret remedies, medicine had never become an object of ridicule. ^ * Indeed, this feems to have been the firfl idea of medicine. The ancient phyficians aded chiefly in the capacity of^ nurfes. They went very little beyond aliment in their*|>refcriptions; and even this they generally adminiftered themfelves, attending the fick, for that purpofe, through the whole courfc of the difeafe; which gave them an opportunity not only of marking the changes of difeafes with great accuracy, but likewife of obferving the effects of their different applications, and adapting them to the fymptoms. Dr. Arbuthnot afferts, that by a proper attention to thofe things, which are almoft within the reach of every body, more good and lefs mifchief will be done in acute difeafes, than by medicines im- properly and uhfeafonably adminiftered; and that great cures may be effeded in chronical diftempers, by a proper regimen of the di- et only. So entirely do the doctor's fentiments and mine agree*, that I would advife every perfon, ignorant of phyfic, to confine his practice folely to diet, and the other parts of regimen; by which means he may often do much good, and can feldom do any hurt. This feems alfo to have been the opinion of Dr. Huxham, who obferves, that we often feek from art what all-bountiful nature moft readily, and as effectually, offers us, had wc diligence and fagacity enough to obferve and make ufe of them; that the dietetic part of medicine is not fo much ftudied as it ought to be; and that, though lefs pompous, yet it is the moft natural method of curing difeafes. To render the book more generally ufeful, however, as well as more acceptable to the intelligent part of mankind, I have, in moft difeafes, befides regimen, recommended fome of the .moft fimple and approved forms of medicine, and added fuch cautions and di- rections as feemed neceflarj for their fafe adminiftration. .It -would no doubt have been more acceptable to many, had it abounded with pompous prefcriptions, and promifed great cures in confe- quence of their ufe; but this was not my plan : I think the ad- cniniftration of medicines always doubtfu^and often dangerous, PREFACE. and would much rather teach men how to avoid the neceffity of ■ufing them, than how they fhould'be ufqd. Several medicines, and thofe of confiderable efficacy, may be adminiftered with great freedom and fafety. Phyficians general- ly trifle a long time with medicines before they learn their proper ufe. Many peafants at prefent know better how to ufe fome of the moft important articles in the materia medica, than phyficians did a century ago ; and doubtlefs the fame obfervation will hold with regard to others fome time hence. Wherever I was convinced that medicine might be ufed with fafety, or where the cure de- pended chiefly upon it, I have taken care to recommend it; but where it was either highly dangerous, or not very neceffary, it is omitted. I have not troubled the reader with an ufelefs parade of quota- tions from different authors •, but have, in general, adopted their obfervafions where my own were either defective, or totally, want- ing. Thofe to whom I am moft obliged are, Ramazinj, Arbuth- not, and Tiflbt; the laft of which, in his Avis au Peuple, comes the neareft to my views of any author which I have feen. Had his plan been as complete as the execution is mafterly, we ftiould have had no occafion for any new treatife of this kindfooni but by confining himfelf to the acute difeafes, he has, in my opinion, omitted the moft ufeful part of his fubject. People in acute difeafes may fometimes be their own phyficians ; but in the chronic, the cure muft ever depend chiefly upon the patient's own endeavours. The doctor has alfo paffed over the Prophlyaxis, or preventive part of medicine, very nightly, though it is certainly of. the greateft importance in fuch a work. Several other foreign phyficians of eminence, have written on nearly the fame plan with Tiffot, as the baron Van Swietcn, phy- fician to their imperial magefties, M. Rofen, firft phyfician of the kingdom of Sweden, &c.; but their productions have never come to my hand. I with that fome of our diftinguifhed countrymen would follow their example. There ftill remains much to be done on this fubject, and no man could better employ his time or talents rhan in eradicating hurtful prejudices, and diffufing ufeful know- ledge among the people. Some of the faculty difapprove every attempt of this nature, ima- gining that ij: muft deftroy their influence.-But this notion appears to me to be as abfurd as it is illiberal. People in diftrefs will al- ways apply for relief to men of fuperior abilities, when they have it in their power; and they will do this with far greater confi- dence and readinefs, when they believe that medicine is a rational fcience, than when they take it to be only a matter of mere con- jecture. . Though I have endeavoured ft* render this treatife plain and ule- ful, yet I found it impoffible to avoid fome terms of art; but thofe are, in general, eidjfer explained, or are fuch as moft people un- PREFACE. derftand. In fhort,T have endeavoured to conform my ftile to the capacities of mankind in general; and, if my readers do not flatter either themfelves or me, with fome degree of fuccefs. On a medical fubject, this is not fo eafy a matter as fome may imagine. To make a fliow of learning, is eafier than to write plain fenfe, efpecially in a fcience, which has been kept at fuch a diftance from common ob- fervation. It would, however, be no difficult matter to prove, that every thing valuable in the practical part of medicine, is within the reach of common abilities. It would be ungenerous not to exprefs my warmeft acknowledg- ments to thofe gentlemen, who have endeavoured to extend the ufe- fulnefs of this performance, by tranflating it into the language of their refpective countries. Moft of them have not only given ele- gant tranflations of the book, but have alfo enriched it with many ufeful obfervations ; by which it is rendered more complete, and better adapted to the climate and the conftitutions of their country- men. To doctor Duplanil of Paris, phyfician to the count d'Artois, I lie under particular obligations; as this gentleman has not only confiderably enlarged my treatife; but, by his very ingenious and ufeful notes, has rendered it fo popular on the continent, as to oc- cafion its being tranflated into all the languages of modern Europe. The book has not more exceeded my expectations in its fuccefs, than in the effects it has produced. Some of the moft pernicious practices, with regard to the treatment of the fick, have already given place to a more rational conduct; and many of the moft hurtful prejudices, which feemed to be quite infurmo'untable, have, in a great meafure, yielded to better informatien. Of this, a ftron- ger inftance cannot be given, than the inoculation of the fmall- pox. Few mothers, fome years ago, would fubmit to have their children inoculated, even by the hand of a phyfician ; yet n«thing is more certain,-than that of late, many of them have performed this operation with their own hands; and as their fuccefs has been equal to that of the moft dignified inoculators, there is little rea- fon to doubt that the practice will become general. Whenever this fhall be the cafe, mere lives will be faved by inoculation alone, than are at prefent by all the endeavours of the faculty. INTRODUCTION. THE improvements in medicine, fince the revival of learning, have not kept pace with thofe of the other arts. The reafon is obvious. Medicine has been ftudied by few, except thofe who intended to live by it as a trade. Such, either from a miftaken zeal lor the honor of medicine, or to raife their own importance, have endeavoured to difguife and conceal the art. Medical authors have generally written in a foreign language ; and thofe who were une- qual to this tafk, have even valued themfelves upon couching, at leaft, their prefcriptions, in terms and characters, unintelligible to the reft of mankind. The contentions of the clergy, which happened foon after the reftoration of learning, engaged the attention of mankind, and pav- ed the way for that freedom of thought and enquiry, which has fince prevailed in moft parts of Europe, as to religious matters. Every man took a fide in thofe bloody difputes ; and every gentle- man, that he might diftinguifh himfelf on one fide or other, was in- ftructed in divinity. This taught people to think and reafon for themfelves in matters of religion, and at laft deftroyed that com- plete and abfolute dominion, which the clergy had obtained over the minds of men. The ftudy of law has likewife, in the moft civilized nations, been juftly deemed the neceffary part of the education of a gentleman. Every gentleman ought certainly to know at leaft the laws of his own country: And, if he were alfo acquainted with thofe of others, it might be more than barely an ornament to him. The different branches of philofophy have alfo of late been uni- verfally ftudied by all who pretended to a liberal education. The advantages of this are manifeft. It frees the mind from prejudice and fuperftition ; fits it for the inveftigation of truth; induces ha- bits ofreafoning and judging properly; opens an inexhauftible fource of entertainment; paves the way to the improvement of arts and agriculture ; and qualifies men for actinfe«with propriety in the moft important ftations of life. Natural Hiftory is likewife become an object of general atten- tion. And it well deferves to be fo. It leads to difcoveries of the greateft importance. Indeed, agriculture, the moft ufeful of all arts, is only a branch of natural hiftory, and can never arrive at a high degree of improvement, where the ftudy of that fcience is ne- glected. Medicine, however,has not been reckoned a neceffary part of the education of a gentleman. No fufficient reafon can be affigned for this omiJfion. No fcience lays open a more extenfive field of ufeful i6 INTRODUCTION. knowledge, or affords more ample entertainment to an lnquifitive* mind. Anatomy, Botany, Chemiftry, and the Materia Medica, are all branches of natural hiftory, and are fraught with fuch amuU- ment and utilitv, that the man who entirely neglects them, has but a forry claim, either to tafte or learning. If a gentleman has a turn for obfervation, fays an elegant and fenfible writer*, mreiy the natural hiftory of his own fpecies is a more interefting fub- jed, and prefents a more ample field for the exertion of gemus, than the natural hiftory of fpiders and cockle-fhells. # We do not mean that every man fhould become a phyfician. This would be an attempt as ridiculous as it is impoffible. All we plead for, is, that men of fenfe and learning, fhould be fo far ac- quainted with the general principles of medicine, as to be in a con- dition to derive from it fome of thofe advantages with which it is fraught; and at the fame time to guard themfelves againft the def- tructive influences of Ignorance, Superftition, and Quackery. _ As matters ftand at prefent, it is eafier to cheat a man out of J his life than of a fhilling, and almoft impoffible either to detect or punifh the offender. Nothwithftanding this, people will fhut their eyes, and take every thing upon truft that is adminiftered by any pretender to medicine, without daring to afk him a reafon for any part of his conduct. Implicit faith, every where elfe the object of ridicule, is ftill facrcd here. Many of the faculty are, no doubt, worthy of all the confidence that can be repofed in them; but as this can never be the character of every individual in any profef- iion, it would certainly be for the fafety, as well as. the honour of mankind, to have fome check upon the conduct of thofe to whom they intruft fo valuable a treafure as health. The veil of 'myftery, which ftill hangs over medicine, renders it not only a conjectural, but even a fufpicious art. This has been long ago removed from the other fciences, which induces many to believe that medicine is a mere trick, and that it will not bear a fair and candid examination. Medicine, however, needs only to be bet- ter known, in order to fecure the general efteem of mankind. Its precepts are fuch, as every wife man would chufe to obferve, and it forbids nothing, but what is incompatible with true happinefs. Difguifing medicine, not only retards its improvement as a fci- ence, but expofes the profeffion to ridicule, and is injurious to the true interefts of fociety. An art founded on obfervation never can arrive at any high degree of improvement, while it is confined to a few who make a trade of it. The united obfervations of all the ingenious and fenfible part of rrfankind, would do more in a few years towards the improvement of medicine, than thofe of the fa- culty alone in a great many. Any man can tell when a medicine gives him eafe, a§ well as a phyfician ; and if he only knows the name and dofe of the medicine, and the name of the difeaie, it is # Obfervations on the duties and offices of aphyfkisru INTRODUCTION. 1? fufficient to perpetuate the fact. Yet the man who adds one tingle fact to the flock of medical obfervations, does more real fervice to the art, than he who writes a volume in fupport of fome favourite hypothefis. Very few of the valuable difcoveries in medicine have been made by phyficians. They have, in general, either been the effeft of chance or of neceffity, and have been ufually oppofed by the facul- ty, till every one elfe was convinced of their importance. Ah im- plicit faith in the opinions of teachers, an attachment to fyftems and eftablifhed forms, and the dread of reflexions, will always operate upon thofe who follow medicine as a trade. Few improve- ments are to be expected from a man who might ruin his character; and family by even the fmalleft deviation from an eftablifhed rule. If men of letters, fays the author of the performance quoted above, were to claim their right of enquiry into a matter that fo nearly concerns them, the good effects on medicine would foon appear. Such men would have no feparate intereft from that of the art. They would detect and expofe affuming ignorance under the mafk of gravity and importance, and would be the judges and pa- trons of rhodeft merit. Not having their underftandings perverted in their youth by falfe theories, unawed by authority, and unbiaf- fed by intereft, they would canvafs with freedom the moft univer- fally received principles in medicine, and expofe the uncertainty of many of thofe doctrines, of which a phyfician dares not fo much as feem to doubt. No argument, continues he, can be brought againft laying open medicine, which does not apply with equal, if not greater force, to religion ; yet experience has fhown, that, fince the laity have af- ferted their right of enquiry into thcYe fubjects, theology, confider- ed as a fcience,has been improved, the interefts of real religion have been promoted, and the clergy have become a more learned, a more ufeful, and a more refpectable body of men, than'they ever wefe in the days of their greateft power and fplendour. Had other medical writers been as honeft as this gentleman, the art had been upon a very different footing at this day. Moft of them extol the merit of thqfe men, who brought philofophy out of the fchools, and fubjected it to the rools of common {en(c But they never confider that medicine, at prefent, is in nearly the fame lituation as philofophy was in at that time, and that it might be as much improved by being treated in the fame manner. In- deed, no fcience can either be rendered rational or ufeful, without being fubmitted to the common fenfe and reafon of mankind. Thefe alone ftamp a value upon fcience; and what will riot bear #he teft of thefe, ought to be rejected, 'It will be faid, that difFufing medical knowledge among the pss- ple, might induce them to tamper with medicine, and to truft ft> their own fkill initcad of calling a phyfician. Thereverfe of this b true. Perfons who have moft knowledge in thefe mar:ers sre i8 INTRODUCTION. commonly moft ready both to afk and to follow advice, when it if neceffary. The ignorant arc always moft apt to tamper with medi- cine, and have the leaft confidence in phyficians. Inftanccsof this are daily to be met with among the ignorant peafants, who, while they absolutely refufe to take a medicine which has been prefcri- bed by a phyfician, will fwallow, with greedinefs, any thing that is recommended to them by .their credulous neighbours. Where men will act even with knowledge, it is certainly more rational , to afford them all the light we can, than to leave them entirely in the dark. It may alfo be alleged, that laying medicine more open to manr kind would leffen their faith in it. This would indeed be the cafe with regard to fome; but it would have a quite contrary effect upon others. Many people who have the utmoft dread and horror of every thing prescribed by a phyfician, will readily take a medicine which they know, and whofe qualities they are in fome meafure acquainted with. Hence it is evident, that the dread arifes from. the doctor, not from the drug. Nothing ever can or will infpire mankind with an abfolute confidence* in phyficians, but an. open* frank, and undifguifed behaviour. While the leaft fhadovv of myf- tery remains in the conduct of the faculty, doubts, jealoufies, and fufpicions, will arife in the minds of men. Cafes will fometimes occur, where a prudent phyfician may find it expedient to difguife a medicine. The whims and humours of men muft be regarded by thofe who mean to do them fervice ; but this can never affect the general argument in favour of candour and opennefs. A man might as well allege, becaufe there are knaves and fools in the world, that he ought to take every one he meets for fuch, and to treat him accordingly. A fenfible phyfician will always know where difguife is neceffary ; but it ought never to appear on the face of his general conduct. The appearance of myftery in the conduct of phyficians not anly renders their art fufpicious, but lays the foundations of quack- ery. No two characters can be more different than that of the ho- neft phyfician and the quack; yet they have been much confound- ed. The line betwixt them is not fufficiently apparent; at leaft it is too fine for the general eye. Few perfons are able to diftinguifh fufficiently between the conduct of that man who adminifters a fecret medicine, and him who writes a prefcription in myftical cha- racters and in an unknown tongue. Thus the conduct of the honeft phyfician, which needs rio difguife, gives a fanction to that of the villain, whofe whole confequence depends upon fecrecy. No laws will ever be able to prevent quackery, while people believe that the quack is as honeft a man, and as well qualified, as the phyfician. A very fmall degree of medical knowledge, however^, would be fufficient to break' this fpell; and nothing elfe can effec- tually undeceive them. It is the ignorance- ancl credulity of the multitude, with regard to medicine, whieh render them fuch an INTRODUCTION. *9 tfeafy prey to every one, who has the hardinefs to attack them on this quarter. Nor can the evil be remedied by any other means but making them wifer. The moft effectual way to deftroy quackery in any art or fcience, is to diffufe the knowledge of it among mankind. Did phyficians write their prescriptions in the common language of the country, and explain their intentions to the patient, as far as he could under- ftand them, it would enable him to know when the medicine had the defired effect; would infpire him with confidence in the phyfi- cian ; and make him dread and deteft every man who pretended to cram a fecret-medicine down his throat. Men, in the different ftates of fociety, have very different views •f the fame object. Some time ago it was the practice of this coun- try, for every perfon to fay his prayers in Latin, whether he knew any thing of that language or not. This conduct, though facred in the eyes of our anceftors, appears ridiculous enough to us ; and fome parts of ours will feem as ftrange to pofterity. Among thefe, we may reckon the prefent mode of medical prefcription, which will fome time hence appear to have been completely ridiculous, and a very high burlefque upon the common fenfe of mankind. But this practice is not only ridiculous; it is likewife dangerous. However capable phyficians may be of writing Latin, apothecaries are not always in a condition to read it, and dangerous miftakes, in confequence of this, often happen. But fuppofe the apothecary ever fo able to read the phyfician's prefcription, he is generally otherwife employed, and the bufinefs of making up prefcriptions is left entirely to the apprentice. By this means, the greateft man in the kingdom, even when he employs a firft-rate phyfician, in re- ality trufts his life in the hands of an idle boy, who has not only the chance of being very ignorant, but likewife giddy and carelefs. Miftakes will fometimes happen in fpite of the greateft care ; but, where human lives are concerned, all poffibie methods ought cer- tainly to be taken to prevent them. For this reafon, the prefcrip- tions of phyficians, inftead of being couched in myftical characters, and a foreign language, ought, in my humble opinion, to be con- ceived in the moft plain and obvious terms imaginable. Diffufing medical knowledge among the people, would not only tend te improve the art, and to banifh quackery, but likewife to render medicine more univerfally ufeful. However long medicine may have been known as a fcience, many of its moft important purpofes to fociety have either been overlooked, or very little at- tended to. The cure of difeafes is a matter of great importance ; but the prefervation of health is ftill greater. This is the concern of every man, and furely what relates to it, ought to be rendered as plain and obvious to all as poffibie. Mei cannot be fufficiently on their guard againft difeafes, who are totally ignorant of their caufes. Nor can the legfflature, in whofe power it is to do much more for preferving the public health, than can ever be done by the faculty 2© INTRODUCTION. exert that power with propriety, and to die greateft advantage without fome degree of medical knowledge. Indeed, men of every occupation and condition in life^might avail themfelves of a degree of medical knowledge ; as it would teach them to avoid the dangers peculiar to their refpectiye fra-> tions; which is always eafier than to remove their effects. Medical knowledge, inftead of being a check upon the enjoyments of life, only teaches men how to make the moft of them. It has indeed been faid, that to live medically, is to live miferably : But it might with equal propriety be faid, that to live rationally, is to live mifera- bly. If phyficians obtrude their own ridiculo'us whims upon man- kind, or lay down rules inconfiftent with reafon or common fenfe, they will be defpifed. But this is not the fault of medicine. It pro- pofes no rules, but fuch as are perfectly confiftent with the true enjoyment of life, and conducive to the real happinefs of mankind. Medicine has hitherto hardly been confidered as a popular fci- ., ence, but as a branch of knowledge folely confined to a particular fet of men, while all the reft have been taught, not only to neglect, but even to dread and defpife it. But it will appear, upon a more • ftridt examination, that no fcience better deferves their attention, or is more capable of being rendered generally ufeful. People are told, that if they dip the leaft into medical know- ledge, it will render them fanciful,, and make them believe they have got every difeafe. of which they read. This, I am fatisfied, will feldom be the cafe with fenfible people : and, fuppofe it v/ere, they muft foon be undeceived. A ibort time will fhow their error, and a little moie reading will infallibly correct it. A fingle in- stance will fhow the abfurdity of this notion. A fenfible lady, rather than read a medical performance, which would inftruct her in the management of her children, muft leave them entirely to the care and conduct,of- the moft ignorant, credulous, and ftuper- flitiousparbof the human fpecies. Indeed, no part of medicine is of more general importance than that which relates to the nurfing and management of chil- dren. Yet few parents pay a proper attention to it. They leave the fole care of their tender offspring, at the very time when care and attention are moft neceffary, to hirelings, who are either too carelefs to dp their duly, or too ignorant to' knoV it. More fives are loft by the careleffnefs and inattention of parents'and nurfes, than are favecLby the faculty. The joint and well-conducted en- deavours of private perfons and the public, for the prefervation of infant lives, would be of more atk.mtage to fociety, than the . whole art of medicine, upon its prefent footing. The benefits cf medicine, as a trade, will ever be confined to . thofe who are able to pay for them ; and of courfe, the far greater part of mankind will be every where deprived of them. Phyfi- cians, like other people, muft live by their employment, and the ■.coor T/iufi either we-l advice altc>get*v*r, or t?.k-° up with tbI as to individual*, from mothers fuckling :heir own children. It would prevent the temp;..- tion which poor women urelaid under, of abandoning their c',i:dren, tu fuckle thofe of the r'ch, for the fake of gain : By which means, fociety lofes many of its moft ufeful members, aud mother-; become in frme fenfe the. murderers of their own oli'spring. I am fnre I fpeak w'.t'uin the truth, when I fay, that not one in twenty of thofe children live, who are thus abandoned by their mothers. For this reafon, no mother mould be allowed to fuckle-another's child, till her own is either dead, or fit !•;» be weaned.. A regulation of this kind would fave many lives among th* poorer fort', and could do no hurt to the rich, as moil: women who nu>k- good nurfes are able t« ftickl* two children in facceiiian upon rh.* (Ye** milk. OF CHILDREN. a$ It is indeed to be regretted, that more care is not bellowed in teaching the proper management of children to thofe whom nature has defigned for mothers. This, inftead of being made the princi- pal, is feldom confidered as any part of female education. Is it any wonder, when females fo educated come to be mothers, that they fhould be quite ignorant of the duties belonging to diat character?"' However ftrange it may appear, it is certainly true, that many mo- thers, and thofe of fafhion too, are as ignorant, when they have brought a child into the world, of what is to be dorte for it, as the infant itfelf. Indeed, the moft ignorant of the fex are generally rec- koned moft knowing in the bufinefs of nurfing..Hence, fenfible people become the dupes of ignorance and fuperftition ; and the nurfing of children, inftead of being conducted by reafon, is the refult of whim and caprice*. Were the time that is generally fpent by females, in the acquiG- tion of trifling accomplifhments, employed in learning how to bring up dieir children ; how to drefs them fo, as not to hurt, cramp, or confine their motions; how to feed them with wholefome and nou- jifhing food; how to exercife their tender bodies, fo as beft to pro- mote their growth and ftrength : Were thefe made the objects o£ female inftruction, mankind would derive the greateft advantages from it. But while the education of females, implies little more, than whaj relates to drefs and public fhow, we have nothing to ex- pect from them,but ignorance,even in themoft important concerns. Did mothers reflect on their own importance, and lay it to heart, they would embrace every opportunity of informing themfelves o£ the duties, which they owe to their infant offspring. It is their pro- vince, not only to form the body, but alfo to give the mind its moft early bias. They have it very much in their power, to make men; healthy or valetudinary, ufeful in life, or the pefts of fociety. But the morher is not the only perfon concerned in the manage- ment of children. The father has an equal intereft in their welfare, and ought to affift in every thing that refpects either the improve- ment of the body or mind. It is a pity that the men fhould be fo inattentive to this matter. Their negligence is one reafon why females know fo little of it. Women will ever be defirous to excel in fuch accomplifhments as recommend them to the other fex. But men generally keep at fuch a diftance from even the fmalleft acquaintance with the affairs of; the nurfery, that many would reckon it an affront, were they fup- -X- Tacitus, the celebrated Roman hiftcrian, complains greatly af'thc degeneracy of the Roman ladies in his time, with regard to the care of their offspring. He fays, that, in former times, the greateft women in Rome ufed to account it their chief glory to keep the home and attend their children; but that now the young infant was committed to the fole care of fome poor Grecian wench, or other menial fervant. We are afraid, wherever luxury and effeminacy prevail, there will be too much ground for this complaint. D ;g_ OF CHILDREN. y;ofcd to know any thing of ihem. Not fo, however, with the ken- nel or the ftables : A gentleman of the firft rank is not afhamed to give directions concerning the management of his dogs or horfes, yet would blufh, were he furprifed in performing the fame office for that being, who derived its exiftencc from himfelf, who is the heir of his fortunes, and the future hope of his country. Nor have phyficians themfelves been fufficiently attentive to the •management of children: This has been generally confidered as the fole province of old women, while men of the firit character in phy- fic, have refufed to vifit infants, even when fick. Such conduct in the faculty, has not only caufed this branch of medicine to be ne- glected, but has alfo encouraged the other fex to affume an abfolute title to'prefcribe for children, in the moft dangerous difeafes. The confequence is, that a phyfician is feldom called, till the good wo- men have exhaufted all their fkill; when his attendance can only ferve to divide the blame, and appeafe the difconfolate parents. Nurfes fhould do all in their power to prevent difeafes; but when a child is taken ill, fome perfon of fkill ought immediately to be confulted. The difeafes of children are generally acute, and the leaft delay is dangerous. Were phyficians moYe attentive to the difeafes of infants, they would not only be better qualified to treat them properly when fick, but likewife to give ufeful direct.ions for their management, when well. The difeafes of children are by no means fo difficult to be un- derftood as many imagine. It is true, children cannot tell their complaints; but the caufes of them may be pretty certainly difco-i vered, by obferving the fymptoms, and putting proper queftions tq the nurfes. Befides, the difeafes of infants, being lefs complicated, are eafier cured than thofe of adults*. Of Dikafcd Parents. ONE great fouvce of the difeafes of children is, the unhealthi- •nefs of parents. It would be as reafon*.ble to expect a rich crop from a barren foil, as that ftrotig and healthy children fhould be born of parents, whofe conftitutions have been worn out with in- temperance or difeafe. Rouffeau obferves, that on the conftitution of mothers depends originally that of their offspring. No one wh# believes this, will b? furprifed, on a view of the female world, to find difeafes and death fo frequent among children. A delicate female, brought up. within ■X- The common opiuion, that the difeafes of infants are hard to difco - ver, and ditiicultto cure, has deterred many phyficians from paying thuc attention to them which they deferve—I can, however, from experience, declare, that this opinion is without foundation, and that i hey are nei- ther fo difficult to diftover, nor L'n ill to cure, m thofe of adults. OF CHILDREN* iy doors, an utter ftranger to exercife and open air, who lives on tea and other flops, may bring a child into the wprld, but it will hardly be fit to live. The firft blaft of difeafe Will nip the tender plant in the bud : Or, fhould it ftruggle through a few years exifteuce, its feeble frame, fhaken with convulfions from every trivial caufe, will be unable to perform the common functions of life, and prove a burden to fociety. f If, to the delicacy of mothers, we add the irregular lives of fa- thers, we fhall fee further caufe to believe, that children are often hurt by the conftitution of their parents. A fickly frame may be originally induced by hardfhips or intemperance, but chiefly by the latter. It isvimpoffible that a courfe of vice fhould not fpoil the beft conftitution: and, did the evil terminate here, it would be a juft pu- nifhment for the folly of the fufferer ; but when once a difeafe is contracted"*and rivetted in the habit, it is entailed on pofterity. What a dreadful inheritance is the gout, the' fcurvy, or the king's evil, to .tranfmit to our offspring ! How happy had it been for the heir of many a great eftate, had he been born a beggar, rather than to inherit his father's fortunes at the expenfe of inheriting his difeafes ! No perfon who labours under any incurable malady ought to marry. He thereby not only fhortens his own life, but tranfmits mifery to others : but when both parties are deeply tainted with the fcrophula, the fcurvy, or the like, the effects muft be ftill worfe. If fuch have any iffue, they muft be miferable indeed. Want of attention to thefe things, in forming connexions for life, has rooted out more families than plague, famine, or the fword ; and as long as thefe connexions are formed from mercenary views, the evil will be continued*. In our matrimonial contracts, it is amazing fo little regard is had to the health and form of the object. Our fportfmen know, that the generous courfer cannot be bred out of the foundered jade, nor the fagaeious fpaniel out of the fnarling cur. This is fettled upon immutable laws. The man who marries a woman of a fickly conftitution, and defcended of unhealthy parents, what- ever his views may be, cannot be faid to act a prudent part. A difeafed woman may prove fertile ; fhould this be the cafe, the family muft become an infirmary: what profpect of happinefs the father of fuch a family has, we fliajl leave any one to judgef. ■X The Lacedemonians condemned their king Archidamus, for having married a v/eaic, puny woman ; becaufe, faid they, inftead of propa- gating a race of heroes, you will fill the throne with a progeny of chan^-'higs. t The Jews, by their la\v% were, in certainJcafes, forbid to have any manner of commerce with the difeafed; and indeed to this all wife legiflators ought to have a fpeual regard. In fome countries, dif- eafed perfons have actually been forbid to marry. This is an evil, of a complicated kind, a ni rural deformity, and political mifchief;- and therefore requires p public confideration. 28 OF CHILDREN. Such children as have the misfortune to be born of difeafed parents, require to be nurfed with greater care than others. This is the only way to make amends for the defects of conftitution ; and it will often go a great length. A healthy nurfe, wholefome air, and fufficient exercife, wili do wonders. But when thefe are neglected, little is to be expected from any other quarter. The defects of conftitution cannot be fuppliedby medicine. Thofe who inherit any family-difeafe ought to be very circum- fpea in their manner of living. They fhould confider well the nature of fuch difeafe, and guard againft it by a proper regimen. It is certain, that family difeafes, have often, by proper care, been kept off for one generation ; and there is reafon to believe, that by perfifting in the fame courfe, fuch difeafes might at length be wholly eradicated, this is a fubject very little regarded, though of the greateft importance. Tamily-conftitutions are as capable of improvement as family-eftates; and the libertine, who im- pares the one, does greater injury to his pofterity, than the prodi- gal, who fquanders away the other. Of the Clothing of Children. THE clothing of an infant, is fo fimple a matter, that it is fur- prifing how any perfon fhould err in it; yet many children lofe their lives, and others are deformed, by inattention to this article. Nature knows no ufe of clothes to an infant but to keep it warm. All that is neceffary for this purpofe, is to wrap it in a foft loofc covering. Were a mother left to the dictates of nature alone, fhe would certainly purfue this courfe. But the bufinefs of dreffing an infant has long been out of the hands of mothers, and has at laft become a fecret, which none but adepts pretend to underftand. From the moft early ages it has been thought neceffary, that a woman in labour, fhould have fome perfon to attend her. This, in time, became a bufinefs; and, as in all others, thofe who were em- ployed in it, ftrove to out-do one-another in the different branches of their profeffion. The dreffing of a child came of courfe to be confidered as the midwife's province, who, no doubt imagined, that the more dexterity fhe could fhow in this article, the more her fkill would be admired. Her attempts were feconded by the vanity of parents, who, too often defirous of making a fhow of the infant as foon as it was born, were ambitious to have as much finery heaped upon it as poffihle. Thus, it came to be thought as neceffary for a midwife to excel in bracing and dreffing an infant, as for a furgeon to be expert in applying bandages to a broken limb; and the1 poor child, as foon as it came into the world, had as many rollers and wrappers applied to its body, as if every bone had been fractur- ' OF CHILDREN. 29 ed in the birth; while thefe were often fo tight, as not only to gall and wound its'tender frame, but even to obftruct the motion of the heart, lungs, and other organs neceffary for life. In moft parts of Britain, the practice of rolling children, with fo many bandages, is now, in fome meafure, laid afide ; but it would ftill be a difficult tafk to purfuade the generality of mankind, that the (hape of an infant does not entirely depend on the midwife. So far, however, arc all her endeavours to mend the fhape, from being fuccefsful, that they conftantly operate the contrary way, and mankind become deformed juft in proportion to the means ufed to prevent it. How little deformity of body is to be found among uncivilized nations ? So little indeed, that it is vulgarly believed, they put all their deformed children to death. The truth is, they hardly know fuch a thing as a deformed child. Neither fhould we, if we followed their example. Savage nations never think of mana- cling their children. They allow them the full ufe of every organ, carry them abroad in the open air, wafh their bodies daily in cold water, &c. By this management, their children become fo ftrong and hardy, that, by the time our puny infants get out of the nurfe's arms, their's are able to fhift for themfelves*. Among brute animals, no art is neceffary to procure a fine fhape. Though many of them are extremely,delicate when they come in- to the world, yet we never find them grow crooked for want of iwaddling bands. Is nature lefs generous to the human kind? No : but we take the bufinefs out of nature's hands. Not only the analogy of other animals, but the very feelings of infants tell us, they ought to be kept eafy and free from ali pref- fure. They cannot indeed tell their complaints ; but they can fhow figns of pain ; and this they never fail to do, by crying, when hurt by their clothes. No fooner are they freed from their bracings, than they feem pleafed and happy; yet, firange infatuation! the moment they hold their peace, they are again committed to their chains. If we confider the body of an infant as a bundle of foft pipes, replenifhed with fluids in continual motion, the danger of preffure will appear in the ftrongeft light. Nature, in order to make way for the growth of children, has formed their bodies foft and'flexi- ble ; and left they fhould receive any injury from preffure in the womb, has furrounded the foetus every where with fluids. This f;,ows the care which nature takes, to prevent all unequal preffure on the bodies of infants, and to defend them againft every thing that might in the leaft cramp or confine their motions. Even the bones of an infant are fo foft and cartilaginous, that they readily yield to the flighteft preffure, and eafily aflume a bad ■K A friend of mine, who was feveral years on the coafl: of Africa, tells me, that the natives neither put any clothes upon their children, nor apply to their bodies bandages of any kind, but lay them on a pallet, and fuffer them to tumble about at pleafure ; yet they are all jftrait, and feldom have any difeafe, 30 OF CHILDREN. fhape, which can never after be remedied. Hence it is, that io many people appear with high fboulders, crooked fpines, and flac breafts, who were as well proportioned at their birth as others, but had the misfortune to be fqueezed out of fhape by the appli- cation of ftays and bandages. Preffure, by obftructing the circulation, likewife prevents the equal diftribution of nourifhment to the different parts of the bo- dy, by which means the growth becomes unequal. One part grows too large, while another remains too fmall; and thus in time the •whole frame becomes difproportioned and misfhapen. To this we muft add, that when a child is cramped in its clothes, it naturally (hrinks from the part that is hurt; and, by putting its body into un- natural pofturcs, it becomes deformed by habit. Deformity of body, may indeed proceed from weaknefs or dif- eafe ; but in general, it is the effcdl of improper clothing. Nine tenths, at leaft, of the deformity among mankind, muft be imputed to this caufe. A deformed body is not only difagreeable to the eye, but by a bad figure, both the animal and vital functions muft be impeded; and of courfe health impaired. Hence few people remark- ably misfhapen are ftrong or healthy. The new motions which commence at the birth, as the circula- tion of the whole mafs of blood through the lungs, refpira'tion, the periftaltic motion, &c. afford another ftrong argument for keeping the body of an infant free from all preffure. Thefe organs not hav- ing been accuftomed to move, are eafily flopped-; but when this happens, death muft enfue. Hardly any method could he devifed more effectually to flop thefe motions, than bracing the body too tight with rollcio* and bandages. Were thefe to be applied in the fame manner to the body of an adult, for an equal length of time, they could hardly fail to hurt the digeflion, and make him fick. How much more hurtful they muft prove to the tender bodies of infants, we fhali leave any one to judge. Whoever confiders thefe things, will not be* furprifed, that fo many children die of convulfions foon after the birth. Thefe fits are generally attributed to ibnie inward caufe ; but in fact, they ofterfer proceed from our own imprudent conduct. I have known a child feized with convulfion-fits foon after the midwife had done fwaddlingit, who, upon taking off the rollers and bandages, was immediately relieved, and never'had the difeafe afterwards. Numerous examples of this might be given, were they neceffary. It would be fiTer to fix on the clothes of an infant with fbrin'/s than pins, as thefe often gall and irritate their tender fkins, and * occafion diforders. Pins have been found flicking above half an inch into the body of a child, after it had died of convulfion fits, which, in all probability, proceeded from that caufe. ■Sf This is by no means inveighing againft a thing that doe:, not hap- pen' In ma«?y parts of Britain, at this day, a roller, eight or ten feet in length, is applied tightly round the child's body jis foon as it is bom. OF CHILDREN. 3r Children are not only hurt by the tight * fs of their clothes, but *alfo by the quantity. Every child has fome degree of fever after the birth; and if it be loaded with too many clothes, the fever muft be increafed. But this is not all; the child is generally laid in bed with the mother, who is often likewife feverifh ; to which we may add the heat of the bed-chamber, the wines, and other heating things, too frequently given to children, immediately after the birth. When all thefe are combined, which does not feldom happen, they muft increafe the fever to fuch a degree, as will en- danger the life of the infant. The danger of keeping infants too hot will further appear, if we confider, that after they have been for fometirh-e in the f/tuation mentioned above, they are often fent into the Country to be^urfed in a cold houfe. Is it any wonder, if a child, from fuch a tranfi- tion, catches a mortal cold, or contracts fome other fatal difeafe ? When an infant is kept too hot, its lungs, not being fufficiently expanded, are apt to remain weak and flaccid for life ; hence pro- ceed coughs, confumptions, and other difeafes of the breaft. It would anfwer little purpofe, to fpecify the particular pieces of drefs, proper for an infant. Thefe will always vary in different countries, according to cuftom and the humour of parents. The great rule to «e obferved is, that a child have no more clothes than are 'neceffary to keep it warm, and that they be quite eafy for its body. Stays are the very bane of infanfs. A volume would not fufficc to point out all the bad effects of this ridiculous piece of drefs, both on .children and adults. The madnefs in favour of ftaysj. feems however, to be fomewhat abated; and it is to be hoped that the world will, in time, become wife enough to know, that the human fhape does net folely depend upon whale-bone and bend- leather*. The clothes of children ought to be kept thoroughly clean. Children perfpire more than adults; and if their clothes be not frequently changed, they become very hurtful. Dirty clothes not only fret at id gall the tender fkins of infants, but likewife occafion ill fmells ; and what is worfe, tend to prcduce vermin and cuta- neous difi-ufes. Cleanlinefs is not only agreeable to the eye, but tends greatly to preferve the health of children. It promotes the perforation, and by that means, frees the body from fuperfluous humours, * Stays made of bend-leather, are worn by all the women of lower ftation/in many parts of* England. There are dill mothers mad enough, to lace their daughters very tight, in order to improve their fhape. As reafoning would be totally loft upon fuch people, I fliall beg leave, juft to afk them, Why there are ten deformed women for one man ? and likewife, to recommend to their perufal, a fliort moral precept, which forbids us to deform the hu- man body. I 32 OF CHILDREN. which, if retained, couV not fail to occafion difeafes. No mother or nurfe can have any excufe for allowing a child to be dirty. Po- verty may oblige her to give it coarfe clothes; but if fhe does not keep them clean, it muft be her own fault. Of the Food of Children. NATURE not only points out, the proper food for an infant, but actually prepares it. This does not prevent fome, who think themfelves wifer than nature, from attempting to bring up their children, without her provifion. Nothing can fhow the difpofition which mankind have to depart from nature, more, than their en- deavouring to bring up children without the breaft. The mother's milk, or that of a healthy nurfe, is unqueftionably the beft food for an infant. Neither art nor nature can afford a proper fubfti- tute for it. Children may feem to thrive for a few months with- out the breaft; but when teething, the fmall-pox*,and other difeafes, incident to childhood, come on, they generally perifh. A child, foon after birth, fhowj an inclination to fuck ; and it fhould be gratified. The mother's milk does not always come im- mediately after the birth; but this is the way to bring it: Befides, the firft milk that the child can fqueeze out of the breaft, anfwers the purpofe of cleanfing, bettcAhan all the drugs in the apotheca- ry's fhop,and at the fame time prevents inflammations of the breaft, fevers, and other difeafes incident to mothers. It is ftrange how people came to think, that the firft thing given to a child, fhould be drugs. This is beginning with medicine by times, and no wonder, if they generally end with it. It fometimes happens, indeed, that the child does not difcharge the meconium fo foon as could be wifhed ; this has induced phyficians, in fuch cafes, to give fomething of an opening nature, to cleanfe the firft paffages. Midwives have improved upon this hint, and never fail to give fyrups, oils, &c. whether they be neceffary or not. Cram- ming an infant with fuch indigeftible Muff, as foon as it is born, can hardly fail to make it fick, and is more likely to occafion dif- eafes, than to prevent them. Children are feldom long after fhe birth without having paffage both by ftool and urine ; though thefe evacuations may be wanting for fome time, without danger. But if children i»uft have fomething before they be allowed the breaft, let it be a little thin water-pap, to which may be added an equal quantity of new milk; or rather water alone, with the addi- tion of a little raw fugar. If this be given without any wines or fpiceries, it will neither heat the blood, load the ftomach, nor oc- cafion gripes. Upon the firft fight of an infant, almoft every perfon is ftruck with the idea of its being weak, feeble, and wanting fupport. This OF CHILDREN. 3? fuggefts the need of cdrdials. Accordingly, wines are universally mixed with the firft food of children. Nothing can be more falla* cious than this way cf reafoning, or mote hurtful to infants than the conduct founded upon it. Children require very little food for fome time after the birth ; and what they receive fhould be thin, weak, light, and of a cooling quality. A very fmall quantity of vAne is fufficient to heat and inflame the blood of an infant; but every perfon converfant in thefe matters, muft know, that moft of the difeafes of infants proceed from the heat of their humours. If the mother or nurfe has enough of milk, the child will need little or no other food, before the third or fourth month. It will then be proper to give it, once or twice a day, a little of fome food, that is eafy of digeftion, as water-pap, milk-pottage, weak broth, with bread in it, and fuch like. This will eafe the mother, will accuftom the child by degrees to take food, and wijl render the weaning both lefs difficult and lefs dangerous. All great and fud- den tranfitions are to be avoided in nurfing. For this purpofe, the food of children ought not only to be fimpie, but to refemble, aS nearly as poffibie, the properties of milk*, fndeed, milk itfelf, fhould make a principal part of their food, not only before they are weaned, but for a long time after. Next to milk, we would recommend good light bread. Bread may be given to a child as foon as it fhows an inclination to chew; and it may at-all times be allowed as, much plain bread, as it will eat. The very chewing of bread .will promote the cutting of the teeth, and the difcharge of faliva, while by mixing with the nurfe's milk in the ftomach, it will afford an excellent nourifhment. Chil- dren difcover an early inclination to chew whatever is put into their hands. Parents obferve the inclination, but generally miftake the object. Inftead of giving the child fomething, which may at once exercife its gums and afford it nourifhment, they commonly put into its hands apiece of hard metal, or impenetrable coral. A cruft of bread is the beft gum-flick. It anfwers the purpofe better than any thing elfe, and has the additional properties of nourifhing the child, and carrying the faliva down to the ftomach, which is too valuable a liquor to be loft. Bread, befides being ufed dry, may be many ways prepared in- to food for children. One of the beft methods is to boil it in water, afterwards pouring the water off, and mining with the bread* a * proper quantity of new milk unboiled. Milk is both more whole- fome and nourifhing this way than boiled, and is lefs apt to occa- fion coftivenefs. For a child farther, advanced, bread may be mixed in veal or chicken broth, made into puddings, or the like. Bread is ■a proper food for children at all times, provided it be plain, made -> A mixture of one-fourth milk, and three-fourths barley-water, with the addition of foniv ieaf-fugar, is a good fufeftitntefor. the rnilkof' the mother. (I. C) 34 OF CHILDREN. of wholefome grain, and well fermented; but when enriched wul fruits, fugars, or fuch things, it becomes very unwholefome. It is foon enough to allow children animal food, when they have got teeth to eat it. They fhould never tafle it till after they are weaned, and even-then they ought to ufe it fparingly. Indeed, when children live wholly on vegetable food, it is apt to four their ftomachs; but on the other hand, too much flefh heats the body, and occafions fevers and other inflammatory difeafes. This plainly points out a due mixture of animal and vegetable food, as the moft proper for children. Few things prove more hurtful to infants, than the common me- thod of fweetening their food. It entices them to take more than they ought to, which makes them grow fat and bloated. It is pret- ty certain, if the food of children were quite plain, that they would never take more than enough. Their exceffes are entirely owing to nurfes. If a child be gorged with food at all hours, and enticed to take it, by making it fweet and agreeable to the palate, is it any wonder, that fuch a child fhould in time be induced to crave more food than it ought to have ? Children may be hurt by too little as well as too much food*. After a child is weaned, it ought to be fed four or five times a day; but fhould never be accuftomed to eat in the night; neither fhould it have too much at a time. Children thrive beft with fmall quanti- ties of food frequently given. This neither overloads the ftomach, nor hurts the digeftion, and is certainly moft agreeable to nature. Writers on nurfing have inveighed with fuch vehemence againft giving children too much food, that many parents, by endeavour- ing to fhun that error, have run into the oppofite extreme, and ru- ined the conftitutions of their children. But the error of pinching children in their food is more hurtful than the other extreme. Na- ture has many ways of relieving herfelf when overcharged; but a child, who is pinched with hunger, will never become a ftrong or healthy man. That errors are frequently committed on both fides, we are ready to acknowledge; but where one child is hurt by the quantity of its food, ten fuffer from the quality. This is dre principal evil, and claims our ftricteil attention. Many people imagine that the food they themfelves love, can- not be bad for their children : but this notion is very abfurd. in the more advanced periods of life, we often acquire an inclination for food, which,\vhen children, we could not endure. Befides, ma- ny things may by habit, agree very well with the ftomach of a grown perfon, which would be hurtful to a child ; as high-feafon- ed, faked, and fmoke-dried provifions, &c. It would alfo be im- ' proper to feed children with fat meat, ftrong broaths, rich foups or the like. •* They mould be indulged in eating, as long as they eat with aviditv ; But as foon as that has fublided, the food fhould be withdrawn, cr tht v will be apt to overload their ftoiaachs.(I. G.) OF CHILDREN. 35 All ftrong liquors are hurtful to children. Some parents teach 'iieir chddren to guzzle ale, and other fermented liquors, at every meal. Such a practice cannot fail to do mifchief. Thefe children feldom efcape the violence of the fmall-pox, meafles, hooping- cough, or fome inflammatory diforder. Milk, water, butter-milk, or whey, are the moft proper for children to drink. If they have any thing ftronger, it may be fine fmall beer, or a little wine mix- ed with water. The ftbmachs of children can digeft well enough, without the afiiftance of warm ftimulants: Befides, being naturally hot, they are eafiiy hurt by every thing of a heating quality. Few things are more hurtful to children than unripe fruits. They weaken the powers of digeftion, and four and relax the fto- mach, by which means it becomes a proper nell for infects. Chil- dren fhow a great inclination for fruit, and I believe, that if good ripe fruit were allowed them in proper quantity, it would have no bad effects. We never find a natural inclination wrong, if proper- ly regulated. Fruits are generally of a cooling nature, and correct the heat and acrimony of the humours. This is what moft children require; only care fhould betaken left they exceed. The beft way to prevent children from going to excefs in the ufe of fruit, or eat- ing that which is bad, is to*allow them a proper quantity of what is good*. Roots which contain a crude vifcid juice fhould be fparingly given to children. They fill the body with grofs humours, and tend to produce eruptive difeafes. This caution is peculiarly'ne- ceffary for the poor ; glad to obtain at a fmall price, what will fill the bellies of their children, they fluff them two or three times a day, with greafy potatoes, or other crude vegetables. Children had better eat a fmaller quantity of food, which yields a wholefome nou- rishment, than be crammed with what their digeftive powers are unable properly to affimiiate. Butter ought likewife to be fparingly given to children. It both relaxes the ftomach, and produces grofs humours. Moft things that are fat or oily, have this effect. Butter, when faired, becomes ftill more hurtful. Inftead of butter, fo liberally given to children in moft parts of Britain, we would recommend honey. Honey is not only wholefome, but cooling, cleanfing, .and tends to fweeten the humours. Children who eat honey, are feldom troubled with worms : They are alfo lefs fubject to cutaneous difeafes, as itch, fcabbed-head, Sec. Many people err, in thinking that the diet of children ought to be altogether moift. When children live entirely upon flops, it re- #• Children are always fickly in the fruit-feafon, which may be thin accounted for : Two-thirds ol the fruit which comes to market in this country, is really unripe; and children not being in a condition to judge for themfelves, eat whatever they lay their hands upon, which often proves little better than a poitbn for their tender bowels. Servants and others who have the care of children, fhould be ffri&ly forbid to give them any fruit without t'.e knowled^ of their parents. ZS OF CHILDREN. laxes their folids, renders them weak, and difpofes them to the rickets, the fcrophula, and other glandular diforders. Relaxation is one of the moft general caufes of the difeafes of children. Every thing therefore which tends to unbrace their folids, ought to be carefully avoided. We would not be underftood by thefe obfervations, as confining children to any particular kind of food. Their diet may be fre- quently varied, provided always, that fufficient regard be had to fimplicity. Of the Exercife of Children. OF all the caufes which confpire to render the life of man fhort and miferable, none has greater influence than the want of proper exercife ; healthy parents, wholefome food, and proper clothing, will avail little, where exercife is neglected. Sufficient exercife will make up for feveral defects in nurfing ; but nothing can fupT ply the want of it. It is abfolutely neceffary to the health, the growth, and the ftrength of children. The defire of exercife is coeval with life itfelf. Were this prin- ciple attended to, many difeafes might be prevented. But, while indolence and fedentajy employments prevent two-thirds of manT kind from either taking fufficient exercife themfelves, or giving it to their children, what have we to expect, but difeafes and de- formity among their offspring ? The rickets, fo deftructive to children, never appeared in Britain, till manufactures began to flourifh, and people, attracted by the love of gain, left the country to folloyv fedentary employments in great towns. It is amongft thefe people that this difeafe chiefly prevails, and not only deforms, but kills many of their offspring. The conduct of other young animals, fhows the propriety of giving exercife to children. Every other animal makes ufe of its organs of motion a& foon as it can, and many of them, even when under no neceffity of moving in queft of food, cannot be reftrain- ed withput force. This is evidently the cafe with the calf, the lamb, and moft other young animals. If thefe creatures were not per- mitted to frifk abput and take exercife, they would foon die or be- come difeafed. The fame inclination appears very early in rhehu- rnan fpecies ; but as they are not able to take exercife themfelves, it is the bufinefs of their parents and nurfes to help them. Children may be exereifed various ways. The beft method while they are light, is to carry them about in the nurfe's arms*. This gives the nurfe an opportunity of taftcing to the child, and of ♦ The nurfe ought to be careful to keep the child in a proper pofition; as deformity is often the confequence of inattention to thit clrcumftance! OF CHILDREN. 37 pointing out every thing, that may pleafe and delight its fancy' Befides, it is much fafer than fwinging an infant in a machine, or leaving it to the care of fuch' as are not fit to take care of them- felves. Nothing can be more abfurd than to fet one child to keep another : This conduct has proved fatal to many infants, and has rendered others miferable for life. When children begin to walk, the fafeft and beft method of leading them about, is by the hands. The common way, of fwing- ing them in leading-firings fixed to their backs, has feveral bid confequences. It makes them throw their bodies forward, and prefs with their whole weight upon the ftomach and breaft ; by this means, the breathing is obftructed, the breaft flattened, and the bowels compreffed; which muft hurt the digeftion, and occa- fion confumptions of the lungs and other difeafes. It is a common notion, that if children be fet upon their feet too loon, their legs will become crooked. There is reafon to be- lieve, that the very reverfe of this is true. Every member acquires ftrength, in proportion as it is exercifed. The limbs of children are weak*indeed, but their bodies are proportionally light; and had they fkill to direct themfelves, they would foon be able to fupt* port their own weight. Whoever heard of any other animal that became crooked by ufing its legs too foon ? Indeed, if a child be not permitted to make any ufe of its legs till a confiderable time after the birth, and be then fet upon them with its whole weight at once, there may be fome danger; but this proceeds entirely from the child's not having been accuftomed to ufe its legs from the beginning. Mothers of the poorer fort think that they are great gainers by making their children lie or fit while they themfelves work. In this they are greatly rniftaken. By neglecting to give their chil- dren exercife, they are obliged to keep them a long-time before they can do any thing for themfelves, and to fpend more on medi- cine than would have paid for proper care. To take care of their children, is the moft ufeful bufinefs i'ft which even the poor can be employed; But, alas! it is not always m their power. Poverty often obliges them to neglect their off- fpring, in order to procure the neceffaries of life. When this is the cafe, it-becomes the intereft as well as the duty of the public to affift them. Ten thoufand times more benefit would accrue to the ftate, by enabling the poor to bring up their own children, than from all the hofpitals* that can be erected for that purpofe. ■* If it were made the intereft of the poor to keep their children alive, we fhould loofe very few of them. AJuiall premium given annually to each poor family, for every child t:iey have alive at the year's end, would fave more infant lives, than if the whole revenue */>f the crown were expended in hofpitals for this purpofe. This would-make the poo? cfteem fertility a blefling ; whereas many of them think it the greateft curfe that can befal thorn; and in place of wifhing their children to live, fo far does poverty get the better of natural affection, thct they are ofteu very li3ppy whenthe'y die. if OF CHILDREN. Whoever confiders the ftructure of the human body, will foo: be convinced of the neceffity of exercife for the health of children. The body is compofed of an infinite number of tubes, whofe fluids cannot be pufhedron without the action and preffure of the muf- cles.1 But if the fluidsTemain inactive, obftrudtions muft happen, which cannot fail to oceafion difeafes. Nature has furnifhed both the veffels which carry the blood and lymph with numerous valves, kt order that the action of every mufcle might pufh forward their contents ; but without action, this admirable contrivance carl have no .effect. This part of the animal ceconomy proves to a demon- ftratiojri the neceffity of exercife for the prefervation of health. Arguments to fhow the importance of exercife, might be drawn fjfom every part of the animal ceconomy: Without exercife, the circulation of the blood cannot be properly carried on, nor the dif- ferent fecretions duly performed ; without exercife, the fluids can- not be properly prepared,.nor the folids rendered ftrong or firm; The action of the heart, the motion of the lungs, and all the vital functions, are greatly aflifted by exercife. But to point out the manner in which thefe effects are produced, would leadus farther iato the ceconomy of the human body, than moft of thofe for whom this treatife is intended would be able to follow. We fhall there- fore only a'dd, that, where exercife is neglected, none of the ani- mal functions can be duly performed; and when that is the cafe, the whole conftitution muft go to wreck. A good conftitution ought certainly to be our firft object in the management of children. It lays a foundation for their being ufe- ful and happy in life ; and whoever neglects it, not only fails in his duty to his offspring, but to fociety. - One very common error of parents, by which they hurt the con- ftitutions of their children, is the fending them too young to fchool. This, is often done folely to prevent trouble. When the child is at fchool, he needs no keeper. Thus, the fchool-mafter is made the nurfe ; and the poor child is fixed to a feat feven or eight hours a day> which time ought to be fpent in exercife and diverfions. Sit- ting fo long cannot fail to produce the worft effects upon the body j nor is the mind lefs injured. Early application weakens the facul- ties, and often fixes in the mind an averfion to books, which con- tinues for life*. ,But, fuppofe this were the way to make children fcholars, it cer- tainly ought not' to be done at the expenfe of their conftitutions. Our anceitors, who feldom went to fchool very young, were not lefs learned than we. But we imagine the boy's education will be # It is undoubtedly the duty of parents to inftruft their children at leaft, till they are of an age proper to take care of themfelves. This would te:>d much to confirm the ties of parental tendernefs and filial af- fection, of the want of which, there are at prefent fo many deplorable inftances. Though few fathers have time to inftrucl their children, yet' niofl mollies have ; and furely, they cannot be better employed. OF CHILDREN. 39 quite marred, unlefs he be carried to fchool in the nurfe's armsTN^ wonder if fuch hot-bed plants feldom become either fcholars or men. Not only the confinement of children in public fchools, but their number, often proves hurtful. Children are much injured by be- ing kept in crowds within doors; their breathing not only renders the place unwhoiefome, but if any one of them happens to be dif- eafed, the reft catch the infeaion. A fingle child has been often known to communicate the bloody-flux, the hooping-cough, the itch, or other difeafes, to almofl every individual in a numerous fchool. But, if infants are to be fent to fchool, teachers, as they value the interefts of fociety, ought not to confine them too long at a time, but allow them to run about and pray at fuch active diver- fions as may promote their growth, and ftrengthen their confti- tutions. Were boys,inftead of being whipped for flealing an hour, to run, ride, fwim, or the like, encouraged to employ a proper part of their time in thefe manly and ufeful exercifes, it would have many excellent effects. An effeminate education will infallibly fpoil the beil natural conftitution ; and if boys are brought up in a more delicate man- ner than even girls ought to be, they never will be men. Nor is the common education of girls lefs hurtful to the con- ftitution than that of boys. Mifs is fet down to her frame before •ihe can put on her clothes ; and is taught to believe, that to er- cel at the needle is the only thing that can entitle her to genera* efteem. It is unneceffary here to infill upon the dangerous con- fequences of obliging girls to fit too much. They are pretty weM known, and are too often felt at z certain time of life. But fup- pofe this critical period be got over, greater dangers ftill await them when they come to be mothers. Women who have been early ao- cuitomed to a fedentary life, generally run great hazard in child- bed ; while thofe who have been ufed to romp about, and take fuf- ficient exercife, are feldom in any danger. One hardly meets with a girl who can at the fame time boaft of early performances by the needle, and a good conftitution. Clofe -md early confinement generally occafions indigeftions, head-ach3, pale-complexions, pain of the ftomach, lofs of appetite, coughs, \ confumptions of the lungs, and deformity of the body. Thelafto-f thefe indeed is not to be wondered at, considering the awkward pof- tures in which girls fit at many kinds of needle-woik, and the de- licate flexible ftate of their bodies in the early periods of life. Would mothers, inftead of having their daughters inftructed ia many trifling accomplifhments, employ them in plain woik and houfewifery, and allow them fufficient exercife in the open air, they would both make them more healthy mothers, ind more ufe- ful members of fociety. I am no enemy to genteel accomplifh- ments, but would have them only confidercd a; fecondaryy and al- w.-ysdijjreg'-.rdedj when they impair health. 40 OF CHILDREN. Many people imagine it a great advantage for children to be early taught to earn their bread. This opinion is certainly right, provided they were fo employed as not to hurt their health or growth; but, when thefe fuffer, fociety, inftead of being benefitted, is a real lofer by their labour. There are few employments, except fedcntary one*, by which children can earn a livelihood ; and if they be fet to thefe too foon, it ruins their conftitutions. Thus, by gaining a few years from childhood, we generally lofe twice as many in the latter period of life, and even render the perfon lefs ufeful while he does live. In order to be fatisfied of the truth of this obfervation, we need only look into the gneat manufacturing towns, where we fhall find a puny degenerate race of people, weak and fickly all their lives, feldom exceeding the middle period of life ; or if they do, being unfit for bufinefs, they become a burden to fociety. Thus, arts and manufactures, though they may increafe the riches of a country, are by no means favourable to the health of its inhabitants. Good policy would therefore require, that fuch people as labour during life, fhould not be fet too early to work. Every perfon converfant in the breed of horfes, or other working animals, knows, that if they be fet to hard labour too foon, they will never turn out to ad- vantage. This is equally true, with refpect to the human fpecies. There are nevertheless, various ways of employing young people without hurting their health. The eafier parts of gardening, huf- bandry, or any bufinefs carried on without doors, are moft proper. Thefe are employments which moft young people are fond of, and fome parts of them may always be adapted to their age, tafte, and ftrength*. Such parents as are under the neceffity of employing their chil- dren within doors, ought to allow them fufficient time for active di- verfions without. This would both encourage them to do more work, and prevent their conftitutions from being hurt. Some imagine, that exercife within doors is fufficient; but thev arc greatly miftaken. One hour fpent in running, or any other vxercife without doors, is worth ten within. When children can- not go abroad, they may indeed be exercifed at home. The beft method of doing this, is to make them run about in a long room, or dance. This laft kind of exercife, if not carried to excefs is of* excellent fervice to young people. It checr9 the fpirits, promotes perfpiration, ftrengthens the limbs, &c. I knew an eminent phyfi- cian, who ufed to fay, that he made his children dance, inftead of giving them phyfic. It we;: j well if more people followed his ex- ;1 nple. The cold-bath may he confidered a? an aid to exercife. By it the body is braced and lirength?ned, the circulation and fecvetions OF CHILDREN. 41 promoted, and, were it conducted with prudence, many difeafes, as the rickets, fcrophula, &c. might thereby be prevented. The ancients, who took every method to render children hardy and ro- buft, were no flrangers to the ufe of the cold bath ; and, if we may credit report, the practice of immerfing children daily in cold wa- ter muft have been very common among our anceflors. The greateft objection to the ufe of the cold bath arifes from the fuperftitious prejudices of nurfes. Thefe are often fo ftrong, that it is impoffible to bring them to make a proper ufe of it. I have known fome of them whe Would not dry a child's {kin after bathing it, left it fhould deftroy the effect of the water. Others will evea put cloths dipt in the water upon the child, and either put it to bed, or fuffer it to go about in that condition. Every child when in health,, fhould at leaft have its extremi- ties daily wafhed in cold water. This is a partial ufe of the cold- bath, and is better than none. In winter this may fuffiee; but in the warm feafon, if a child he relaxed, or feem to have a tendency to the rickets or fchrophula, its whole body ought to be frequently immerfed in cold water. Care however muft be taken not to do this when the body is hot, or the ftomach full. The child fhould be dipped only once at a time, fhould be taken out immediately, and have its fkin well rubbed with a dry cloth. The Effects of unwholefome Air upon Children, FEW things prove more deftructive to children, than confined er unwholefome air. This is one reafon why fo few of thofe infants, who arc put into hofpitals,or parifh work-houfes,live. Thefe places are generally crowded with old, fickly and infirm people; by which means the air is rendered fo extremely pernicious, that it becomes a poifon to infants. Want of wholefome air is likewife deftructive to many of the children born in great towns. There the poorer fort of inhabitants live in low, dirty, confined houfes, to which the frefti air has hardly any accefs. Though grown people, who are h^.r ly -nd robuft, may live in fuch fituations, yet they generally prove fatal to their ofK- fpring, few of whom arrive at maturity, and thofe who do, are weak and deformed. As fuch people are not in a condition to carry their children abroad in the open air, we muft lay our account with lofing the greater part of then'. But the rich have not this excufe. It is their bufinefs to fee that their children be daily carried abroad, and that they be kept in the open air for a fufficient time. This will always fucceed better if the mother goes along with them. Servants are often negligent in thefe matters, and allow a child to fit or lie on the damp ground, inftead of leading or carrying it about. The mother furely needs air as well as her children; and how can fhe he better employed than in attending them ? 42 OF CHILDREN. A very bad cuftom prevails, of making children fleep in fmall apartments, or crowding two or three beds into one chamber. In- ftead of this, the nurfery ought always to be the largeft and beft aired room in the houfe. When children are confined in fmall apartments, the air not only becomes unwholefome, but the heat relaxes their folids, renders them delicate, and difpofes them to colds and many other diforders. Nor is the cuftom of wrapping them up too clofe in cradles, lefs pernicious. One would think that nurfes were afraid left children fhould fuffer by breathing free air, as many of them actually cover the child's face while afleep, and others wrap a covering over the whole cradle, by which means, the child is forced to breathe the fame air over and over, all the time it fleeps. Cradles indeed are on many accounts hurtful to children, and it would be better if the ufe of them were totally laid afidef. A child is generally laid to fleep with all its clothes on ; and if a number of others are heaped above them, it muft be overheated ; by which means it cannot fail to catch cold on being taken out of the cradle, and expofed to the open air, with only its ufual clothing, which is too frequently the cafe. Children who are kept within doors all day, and fleep all night in warm clofe apartments, may, with great propriety, be compar- ed to plants, nurfed in a hot-houfe, inftead of the open air. Though fuch plants may, by this means, be kept alive for fome time, they will never arrive at that degree of ftrength, vigour and magnitude, which they would have acquired in the open air, nor would they be able to bear it afterwards, fhould they be expofed to it. Children, brought up in the country,who have been accuftomed to open air, fhould not be too early fent to great towns, where it is confined and unwholefome. This is frequently done with a view to forward their education, but proves very hurtful to their health. All fchools and feminaries of learning ought, if poffibie, to be fo fituated as to have frefh, dry, wholefome air, and fhould never be too much crowded. Without entering into a detail of the particular advantages of wholefome air to children, or of the bad confequences which pro- ceed from the want of it, I fhall only obfcrve, that, of feveral thou- fands of children that have been under my care, I do not remem- ber one inftance of a fingle child, who continued healthy in a clofe confined fituation; but have often known the moft obftinate difeafes cured by removing them from fuch a fituation to an open free air. t It is amazing how children efcape fiiffocation, confidering the man- ner in which they are often rolled up in flannels, &c. I lately attended an infant, whom I found muffled up over head and ears in many folds of flannel, though it was in the middle of June. I begged for a little free air to the poor babe ; but though this indulgence was granted during my flay, I found it always on my return in the fame fituation. Death foon freed the infant from all its miferies ; but it was not in my power to free the minds of its parents from thofe prejudices whk'h proved fatal to their uhild. OF CHILDREN. 43 Of Nurfes. IT is not here intended to lay down rules for the choice of nurfes. This would be wafting time. Common fenfe will direct every one to choofe a woman who is healthy, and has plenty of milk*. If fhe be at the fame time cleanly, careful, and good-natured, fhe can hardly fail to make a proper nurfef. After all, however, the only certain proof of a good nurfe, is a healthy child upon her breaft. But, as the mifconduct of nurfes often proves fatal to children, it will be of importance to point out a few of their moft baneful er- rors, in order to roufe the attention of parents, and to make them look more flrictly into the conduct of thofe to whom they commit the care of their infant offspring. Though it admits of fome exceptions, yet, we may lay it down as a general rule, that every woman who nurfes for hire ought to be carefully looked after, otherwife fhe will not do her duty. For this reafon, parents ought always to have their children nurfed un- der their own eye, if poffibie; and where this cannot be done, they fhould be extremely circumfpect in the choice of thofe perfons to whom they intruft them. It is folly to imagine that any woman, who abandons her own child to fuckle another for the fake of gain, fhould feel all the affections of a parent towards her nurfling ; yet fo neceffary are thefe affections in a nurfe, that, but for them, the human race would be extinct. One of the moft common faults of thofe who nurfe.for hire, is to dofe children with ftupefactives, or fuch things as lull them afleep. An indolent nurfe, who does not give a child fufficient ex- ercife in the open air to make it fleep, and does not choofe to be difturbed by it in the ifight, will feldom fail to procure for it a dofe of laudanum, diacodium, faffron, or, what anfwers the fame pur- pofe, a dram of fpirits, or other ftrong liquors. Thefe, though they be certain poifon to infants, are every day adminiftered by many who bear the character of very good nurfes:}:. A nurfe who has not milk enough, is apt to imagine that this de- fect may be fupplied by giving the child wines, cordial-waters, or other ftrong liquors. This is an egregious miftake. The only thing that has any chance to fupply the place of the nurfe's milk, muft be fomewhat nearly of the fame quality, as cow's milk, afs's milk, # I have'often known people fo impofed upon, as to give an infant to a nurfe to be fuckied who had not one drop of milk in her breaft. t I'i addition to thefe qualifications, fhe fhould be clear of any defor- mity about her eyes, fuch as fquinting, &c. as children are very liable to contract unpleafant habits from their nurfes. (I. C.) \ If a mother on vifiting her child at nurfe finds it always afleep, I would advife her to remoye it immediately; otberwife, it will foonfleep its laft. 44 OF CHILDREN. or the like, with good bread. It never can be done by the help of ftrong liquors. Thefe, inftead of nourifhing an infant, never fail to produce the contrary effect. Children are often hurt by nurfes fuffering them to cry long and vehemently. This flrains their tender bodies, and frequently oc- cafions ruptures, inflammations of the throat, lungs, Sec A child never continues to cry long without fome caufe, which might al- ways be difcovered by proper attention ; and the nurfe who can hear an infant cry till it has almoft fpent itfelf, without endeavour- ing to pleafe it, muft be cruel indeed, and is unworthy to be in- ■trufted with the care of an human creature. N;;rfes who deal much in medicine are always to be fufpected, TI.••/ truft to it, and neglect .their duty. I never knew a good nurfe who'had her Godfrey's cordials, Daffy's elixirs, &C. at hand. Such generally imagine, that a dofe of medicine will make up for ail de- fects in food, air, exerche and cleanlinefs. Allowing children to continue long wet, is another very perni- cious cuftom of indolent nurfes. This is not only difagreeable, but it galls and frets the infant, and by relaxing the folids, occafions fchrophulas, rickets, and other difeafes. A dirty nurfe is always to be fufpected. Nature often attempts to free the bodies of children from bad humours, by throwing them upon the fkin : By this means fevers and other difeafes" are .prevented. Nurfes are apt to miftake fuch critical eruptions for an itch, or fome other infectious diforder. Accordingly, they take every method to drive them in. In this way many children lofe their lives ; as nature is oppofed in the very method that fhe takes to relieve them. A nurfe fhould never flop any eruption without proper advice, or being well affured that it as not of a critical nature. At any rate, it is never to be done with- out previous evacuations. Loofc ftools are another method by which nature often prevents or carries off the difeafes of infants. If thefe proceed too far, they ought to be checked ; but never without great caution. Nurfes, upon the firft appearance of loofe ftools, frequently fly to the ufe of aftringents, or fuch things as bind the body. Hence inflammatory fevers, and other fatal difeafes, are occafi'oncd. A dofe of rhubarb, a gentle vomit, or fome other evacuation, fhould always precede the ufe of aflringent medicines*. One great fault of nurfes is, concealing the difeafes of children from their parents. This they are extremely ready to do, efpecially when the difeafe is the effect of their own negligence. Many in- 4f Some nurfes are fo extremely nice, that rather than take the trou- ble of ckanfing a child frequently, they will attempt to flop up the paf-' fage : Squeamifh maids have actually ufed corks for this purpofe. "What have not mothers to fear, who intruft their children to the care of fuch worthlefs drabs ? OF CHILDREN. 45 fiances tnight be given of perfons who have been rendered lame for life by a fall from their nurfe's arms,jwhich fhe through fear, concealed till the misfortune was paft cure. Every parent who in- trufts a nuirfe with the care of a child, ought to give her the ftrictefl charge not to conceal the moft trifling diforder or misfortune that may befal it. We can fee no reafon, why a nurfe, who conceals any mif- fortune which happens to a child under her care, till it lofes its life or limbs,fhould not be punifhed. Afew examples of this kind would fave the,lives of many infants ; but as there is little reafon to ex- pect that it will ever be the cafe, we would earneftly recommend it to all parents to look carefully after their children, and not to truft fo valuable a treafure entirely in the hands of an hireling. No perfon ought to imagine thefe things unworthy of his atten- tion. On the proper management of children depend not only their health and ufefulnefs in life, but likewife the fafety and profperity of the ftate to which they belong. Effeminacy ever will prove the ruin of any ftate where it prevails ; and, when its foundations arc laid in infancy, it can never arterwards be wholly eradicated. Pa- rents who love their offspring, and wifh well to their country,will, in the management of their children, avoid every thing that tends to make them weak or effeminate, and take every method in their power to render their conftitutions ftrong and hardy. -----By arts like thefe Laconia nurs'd of old her hardy fons; And Rome's unconquer'd legions urg'd their way, Unhurt, thro' every toil in every clime. Armfirong. «———i ■■ ■—........ii l.......■■■■■■■■■«■■......■■—^.....'"".....—' "■••••' — -■' " ■ mm CHAPTER II. Of the Laborious, the Sedentary, and the Studious. MEN arc expofed to particular difeafes from the occupations which they follow; but to remedy this evil is difficult. Moft people are under the neceffity of following thofe employments to which they have been bred, whether they be favourable to health or not. Inftead of inveighing, as fome authors have done, againft thofe occupations which are hurtful to health, we fhall endeavour to point out the circumflances in each of them from which the danger chiefly arifes, and to propofe the moft rational methods pf preventing it. Chemifts, founders, forgers, glafs-makers, and feveral other ar- tifts, are hurt by the unwholefome air which they are obliged to breathe. This air is not only loaded with the noxious exhalation p 46 OF THE LABORIOUS, THE SEDENTARY, arifingfrom metals and minerals, but is fo charged with phlogifton as* to be rendered unfit for expanding the lungs fufficiently, and anfwering the other important purpofes of refpiration. Hence pro- ceed aflhmas, coughs, and confumptions of the lungs, fo incident to perfons who follow thefe employments. • To prevent fuch confequences, 3S far as poffibie, the places where thefe occupations are carried on, ought to be conftructed in fuch a manner as to difchargc the fmoke and other exhalations, and admit a free current of frefh air. Such artifts ought never to con- tinue too long at work; and when they give over, they fhould fuffer'themfelves to cool gradually, and put on their clothes before they go into the open air. They ought never to drink large quanti- ties of cold, weak, or watery liquors, while their bodies are hot, nor to indulge in raw fruits, fallads, or any thing that is cold on the ftomach. » Miners, and all who work under ground, are likewife hurt by unwholefome air. The air, by its ftagnation in deep mines, not only lofes its proper fpring and other qualities neceffary for refpi- lation, but is often loaded with fuch noxious exhalations as to be- come a moft deadly poifon. The two kinds of air which prove moft deftructive to miners, are what they call the fire damp, and the choke damp. In both cafes the air becomes a poifon, by its being loaded with phlogifton. The danger from the former may be obviated by making it ex- plode before it accumulates in too great quantities; and the latter may be generally carried off by promoting a free circulation of air in the mine. Miners are not only hurt by unwholefome air, but likewife by the particles of metal which adhere to their fkin, clothes, &c. Thefe areabforbed, or .taken up into the body, and occafion palfies, ver- tigoes, and other nervous affections, which often prove fatal. Fal- lopius obferves, that thofe who work in mines of mercury, feldom live above three or four years. Lead, and feveral other metals, are likewife very pernicious to the health. Miners ought never to go to work fafting, nor to continue too long at work. Their food ought to be nourifhing, and their liquor generous: Nothing more certainly hurts them than living too low. They fhould by all means avoid coftivenefs. This mayeither.be done by chewing a little rhubart, or taking a fufficient quantity of fallad oil. Oil not only opens the body, but fheaths and defends the inteftines from the ill effects of the metals. All who work in mines or metals ought to wafh carefully, and to change their clothes as foon as they give' over working. Nothing would tend more to preferve the health of fuch people than a flrict regard to cleanlinefs. Plumbers, painters, gilders, fmeltcrs, makers of white-lead, and many others who work in metals, are liable to the fame difeafes as miners, and ought to obferve the fame directions for avoiding them. Tallow-chandlers, boilers of oil, and all who work in putrid ani- AND THE STUDIOUS. 4y mal fubftances, are likewife liable to'fuffer from the unwholefome fmells or effluvia of thefe bodies. They ought to pay the fame re- gard to cleanlinefs as miners; and when they are affeded with naufea, ficknefs, or indigeftion, we would advife them to take a vomit or a gentle purge. Such fubftances ought always to be ma- nufactured as foon as poffibie. When long kept, they not only be- come unwholefome to thofe who manufacture them, but likewife to people who live in the neighbourhood. It would greatly exceed the limits of this part of our fubject, to fpecify the difeafes peculiar to perfons of every occupation ; we fhall therefore confider mankind under the general claffes of Labo- rious, Sedentary, and Studious. The Laborious. THOUGH thofe who follow laborious employments are in ge- neral the moft healthy of mankind, yet the nature of their occupa- tions, and the places where they are carried on, expofe them more particularly to fome difeafes. Hufbandmcn, for example, are ex- pofed to ail the viciffitudes of the weather, which in America, arc often very great and fudden, and oocafion colds, coughs, quinfies, rheumatifms, fevers, and other acute diforders. They work hard, and often carry burden above their ftrength, which, by overftrain- ing the veffels, occafion afthmas, ruptures, pleurifies, &c. Thofe who labour without doors are aften afflicted with inter- mitting fevers or agues, occafioned by the frequent viciffitudes of heat and cold, poor living, bad water, fitting or lying on the damp ground, evening dews, night air, &c. to which they are frequently expofed. Such as bear heavy burdens, as porters, labourers, &c. are obli- ged to draw in the air with much greater force, arid alfo to keep their lungs diftended with more violence than is neceffary for com- mon refpiration : By this means the tender veffels of the lungs are over-ftretched, and often burft, infomuch that a fpitting of blood or fever enfues. Hippocrates mentions an inftance or a man, who, upon a wager, carried an afs ; but was foon after feized with a fever, a vomiting of blood, and a rupture. Carrying heavy burdens is generally the effect of mere lazinefs, which prompts people to do at once what fhould be done at twice. Sometimes it proceeds from vanity or emulation. Hence it is, that the ftrongeft men are moft commonly hurt by heavy burdens, hard labour, or feats of activity. It is rare to find one who boafts of his ftrength, without a rupture, a fpitting of blood, or fome other dif- eafe, which he reaps as the fruit of his felly. One would imagine the daily inflanccs we have of the fatal effects of carrying great 48 OF THE LABORIOUS, THE SEDENTARY, weights, running, wreftling, and the like, would be fufficient to prevent fuch practices. There are indeed fome employments which neceffanly require a great exertion of ftrength, as porters, blackfmiths, carpenters, &c. None ought to follow thefe but men of ftrong body ; and they fhould never exert their ftrength to the utmoft, nor work too long. When the mufcles are violently ftrained, frequent reft is neceffa- ry, in order that they may recover their tone; without this, the ftrength and conftitution will foon be worn out, and a premature old age be induced. The erifipelas, or St. Ajithony's fire, is a difeafe very incident to the laborious. It is occafioned by whatever gives a fudden check to the perfpiration, as drinking cold water when the body is warm, wet feet, keeping on wet clothes, fitting or lying on the damp ground, &c. It is impoffible for thofe who labour without doors always to guard againft thefe inconveniencies ; but it is known from experience, that their ill confequences might often be prevented by proper care. The iliac paffion, the cholic, and other complaints of the bowels, are often occafioned by the fame caufes as the erifipelas ; but they may likewife proceed from flatulent and indigeftible food. La- bourers generally eat unfermented bread, and great quantities of unripe fruits, baked, ftewed,.or raw, with various kinds of roots and herbs, upon which they often drink four milk, ftale fmall beer, or the like. Such a mixture cannot fail to fill the bowels with wind, and occafion difeafes of thofe parts. Inflammations, whitloes, and other difeafes of the extremities,are likewife common among thofe who labour without doors. Thefe difeafes are often attributed to venom, or fome kind of poifon; but they generally proceed either from fudden heat after cold, or the contrary. When labourers, milk-maids, &c. come from the field, cold or wet, they run to the fire, and often plunge their hands in warm water, by which means the blood and other humours in thofe parts, are fuddenly expanded, and, the veffels not yielding fo quickly, a ftrangulation happens, and an inflammation or morti- fication enfues. When fuch perfons come home cold, they ought to keep at a diftance from the fire for fome time, to wafh their hands in cold water, and to rub them well with a dry cloth. It fometimes hap- pens, that people are fo benumbed with cold, as to be quite de- prived of the ufe of their limU. In this cafe, the only remedy is to rub the parts affeded with fnow, or, where it cannot be had, with cold water. If they be held near the fire, or plunged into warm water, a mortification will generally enfue. Labourers in the hot feafon are apt to lie down and fleep in the fun. This practice is fo dangerous, that they often wake in a burn- ing fever. Thefe ardent fevers, which prove fo fatal about the end of fummer and beginning of autumn, are frequently occafiond by AND THE STUDIOUS. 49 this means. When labourers leave off work, which they ought al- ways to do during the heat of fhe day, they fhould go home, or, at leaft, get under fome cover, where they may repofe themfelves in fafety. Many people follow their employments in the fields fr:-»m morn- ing till night, without eating any thing. This cannot fail to hurt their health. However homely their fare be, they ought to have it at regular times ; and the harder they work, the more frequently they fhould eat. If the humours be not frequently replenifhed with frefh nourifhment, they foon become putrid, and produce fe- vers of the very worft kind. Many peafants are extremely carelefs with refpeet to what they eat or drink, and often, through mere indolence, ufe unwholefome food, when they might for the fame, expenfe have that which is wholefome. In fome parts of Britain, the peafants are too carelefs even to take the trouble of dreffing their own victuals. Such peo- ple would live upon one meal a-day in indolence, rather than la- bour, though it were to procure them the greateft affluence. Fevers of a very bad kind are often occafioned among labourers by poor living. When the body is not fufficiently nourifhed, the folids become weak; from whence the moft fatal confequences enfue. Poor living is likewife productive of many of thofe cuta- neous difeafes fo frequent among the lower clafs of people. It is^ remarkable that cattle, when pinched in their fodd, are generally affected with difeafes of the ikin, which feldom fail to difappear, when they are put upon a good pafture. This fliows how much a good ftate of the humours depends upon a fufficient quantity of pro- per nourifhment. Poverty not only occafions, but aggravates, many of the difeafes of the laborious. Few of them have much forefight; and, if they had, it is feldom in their power to fave any thing. They are glad to make a fhift to live from day to day; and, when any difeafe over- takes them, they are miferable indeed. Here, the godlike virtue of charity ought always to exert itfelf. To relieve theinduflrious poor in diftrefs, is furely the moft exalted act of religion and hu- manity, i hey alone, who are witneffes of thofe fcehes of calamity, can form an opinion of what numbers perifh in difeafes, for want of proper affiftance, and even for want of the neccffiries of life. Labourers are often hurt by an emulation, which prompts them to vie with one another, till they overheat themfelves to fuch a de- gree as to occafion a fever, or even to drop down dead. Such as wantonly throw away their lives in this manner, deftrve to be looked upon as felf-murderers. Soldiers fuffer many hardfhips from the inclemency of fcafohs, long marches, bad provifions, hunger, watching, unwholefome cli- mates, bad water, &c. Thefe occafion fevers, fluxes, rheumatifms, and other fatal difeafes, which generally do greater execution than the fword, efpecially when campaigns are continued too late in 5o ' OF THE LABORIOUS, THE SEDENTARY, thffeafon. A few weeks of cold rainy weather will often prove more fatal than an engagement. , Thofc who have the command of nrm.es fliould take care that their foldiers be well clothed and well fed. They ought alfo.o h- nilh their campaign* in due feafon, and to provide their men wnh drv and well-aired winter quarters. Thefe rules, taking care at the fame time, to keep the fick at a proper diftanee from thofe in health, wculd tend -ixatly to prcferve the lives of tne ioldicry. Sailors may be numbered among the laborious. Ihey undergo rreat hardships from change of climate, the violence of weather, hard labour, bad provifions, &c. Sailors arc of fo great impor- tance to the trade of a nation, that too much pains can never be bellowed in pointing out die means of prefcrving their lives. One rrreat fource of the difeafes of fea-faring people is excels. When they get on fhore, after having been long at lea, witnout re- gard to the climate, or their own conftitutions, they plunge nead- ioua into all manner of riot, and oftsn perfift till a fever puts an end°to thjir lives. Thus, intempcrance,and not the climate, is often the caufe why fo many of our .tailors die on foreign coafts. Luch people ought not to live too low ; but they will find moderation the Lv.-il defence againft fevers, and many other maladies. Sailors v.hen on duty, cannot avoid fometimes getting wet. When this happens, they fliould change their clothes as foon as they are relieved, and take every method to reftore the perfpira- tion. They fhould not in this cafe, make too free with fpnits or other ftrong liquors, but fhould rather drink them diluted with warm water, and go immediately to bed, where a found fleep and a gentle fweat would fet all to rights. But the health of failors fuffers moft from unwholefome food. The conftant ufe of faked provifions, with a fcant allowance of bad, water debilitate their conftitutions, occafions the fcurvy, and other obftinate maladies. It is no'eafy matter to prevent this dif- eafe in long voyages ; yet much might be done towards effecting fo definable an end, were due pains bellowed for that purpofe. For example, various roots, greens, and fruits, might be kept a long time at fea, as onions, potatoes, cabbages, lemons, oranges, tama- rinds, apples, &c. When fruits cannot be kept, the juice of them, either frefh or fermented, may. With thefe, all the drink, and even the food of the ihip's company, ought to be acidulated in long voyages. Stale bread and beer likewife contribute to vitiate the humours. Flour will keep for a long time on board, of which frefh bread might frequently be made. Malt, too, might be kept, and infufed with boiling water at any time. This liquor, when drank even in form of wort, is very wholefome, and is found to be an antidote againft the fcurvy. Small wines and cyder might like wife be plen- tifully laid in ; and fliould they turn four, they would ftill be ufe- ful as vinegar. Vinegar is a great antidote againft difeafes, and A^D THE STUDIOUS. 5i fliould be ufed by all travellers, efpecially at fea. It may either be mixed with the water they drink, or taken in their food. Such animals as can be kept alive, ought to be carried oh board, as hens, ducks, pig", &c. Frefh broths made of portable foup, and puddings made of peas, cr other vegetables, ought to be ufed plen- tifully. Many other things will readily occur to people converfant in thefe matters, which would tend to preferve the health of that brave and ufeful fet of men . We have reafon to believe, if due attention were paid to the diet, air, clothing, and above ail things, to the cleanlinefs of fea- faring people, they would be the moft healthy fet of men in the world ; but when thefe are neglected, the very reverfe will happen. The beft medical antidote that we can recommend to failers ov foldiers on foreign coafts, efpecially where 'dampriefs prevails, is the Peruvian bark. This will often prevent fevers and other fatal difeafes. About a drachm of it may be chewed every day, or if this fhould prove difagreeable, an ounce of bark, with half an ounce of orange-peel, and two drachms of fnake-root coarfely powdered, may be infufed two or three days in an Englifli quart of brandy, and half a wine-glafs of it taken twice or thrice a day, when the ftomach is empty. This has been found to be an excellent antidote againft fluxes,intermitting,and other fevers, in unhealthy climates. It is not material in what form this medicine is taken. It may ei- ther be infufed in water, wine, or fpirits, as recommended above, or made into an electuary with fyrup of lemons,oranges, or the like. The Sedentary. THOFJGH nothing can be more contrary to the nature of man than a fedentary life, yet this clafs comprehends by far the greater part of the fpecies. Almoft the whole female world, and in manu- facturing countries, the major part of the males, may be reckoned fedentaryf. ■)*• Captain Gook has mown how far, by proper care and attention, the direafes formerly fo fatal to feamen, may be prevented. In a voyage of three years and eighteen days, during which he was expofed to every climate, from the 520 north to the 710 of fouth latitude, of one hundred and eighteen men, compofing the* fhip's company, he loft only one, who died of a phthifis pulmonalis. The principal means he ufed were, to preferve aftri£t attention to cleanlinefs, to procure abundance of vege- tables and frefh provifions, efpecially good water, and to allow his peo- ple fufficient time for reft. + The appellation of fedentary has generally been given only to the ftudious; we can fee no reason, however, for reftricting it to them;done. Many artificers may, with" as much propriety, be denominated fedentary as the ftudious, with this particular difadvantage, that they are often obliged to fit in very awkward pofhires, which the ftudious ikj'.jU not un- lefs they pVeafe. 52 OF THE LABORIOUS, THE SEDENTARY, Agriculture, the firft and moft healthful of all employments, [i now followed by few who are able to carry on any other bufinefs. But thofe who imagine that the culture of the earth is not fuffici- ent to employ all its inhabitants, are .greatly mift.iken. An ancient Roman, we are told, could maintain his family from the produce of one acre of ground. So might a modern Briton, if he would be contented to live like a Roman. This fhows what an immenfe in- creafe of inhabitants Britain might admit of, and all of them live by the culture of the ground. Agriculture is the great fource of domeftic riches. Where it is neglected, whatever wealth may be imported from abroad, pover- ty and mifery will abound at home. Such is, and ever will be, the fluctuating ftate of trade and manufactures, that thoufands of peo- ple may be in full employment to-day, and in beggary to-morrow. This can never happen to thofe who cultivate the'ground. They can eat the fruit of their labour, and can always by induftry ob- tain, at leaft, the neceffaries of life. Though fedentary employments are neceffary, yet there feems to be no reafon why any perfon fhould be confined for life to thefe alone.. Were fuch employments intermixed with the more ac- tive and laborious, they would never do hurt. It is conflant con- finement that ruins the health. A man will not be hurt by fitting five or fix hours a-day; but if he is obliged to fit ten or twelve, he will foon become difeafed. , But it is not want of exercife alone which hurts fedentary peo- ple ; ' ey likswife fuffer from the confined air which they breathe. It is . ry common to fee ten or a dozen taylors*, or flaymakers, for e.ia.ripie, crowded into one fmall apartment, where there is harl.y ro^-n for one perfon to breathe freely. In this fituation th.-y generally continue for many hours at a time, often with the " . ition of fundry candles, which tend likewife to wafle the air r , I render it lefs fit for refpiration. Air that is breathed repeated- )) becomes unfit for expanding the lungs. This is one caufe of th phthifical coughs, and other complaints of thu breaft, fo inci- .- it to fedentary artificers. Even the perfpiration from a great number of perfons pent up together,renders the air unwholefome. The danger from this quar- ry will be greatly increafed, if any one of them happens to have .■ad lungs,'or 10 oe- jt.-r. '0* dif-afed. Thofe who fit near him, be- ,ng forced to breathe the fame air, can hardly fail to be infected It would be a rare thing to find a dozen fedentary people all in * A perfon oc obfervation in the: line of life to'd me, that moft tav- lo.,s die oi tor.iumptions ; which he attributed chiefly to the unfavoura- ble pollutes m wim h tiiey fit, and the unwholefomenefs of thofe nl^« whov du-ir bufimf> ,s carried on. if more attention was not oaid to proiu than to tne pre.trv,..o.. of human lives, this evil might b?eafi£ remedied ; out while iuaftero onlvmind their own intern* „„?i • Will be done for the fafety of their fervants. Interelt> nothing AND THE STUDIOUS. 53 good health. The danger of crouding them together muft there- fore be evident to every one. Many of thofe who follow fedentary employments are conftantly in a bending poflure, as fhoe-makers, taylors, cutlers, &c. Such a fituation is extremely hurtful. A bending poflure obftrufts all the vital motions, and of courfe muft deftroy the health. Accordingly, we find fuch artificers generally complaining of indigeftions, flatu- lences, heaJ-achs, pains of the breaft, &c, The aliment in fedentary people, inftead of being puflied for- wards by an erect poflure, and the aftion of the mufcles, is in a manner confined in the bowels. Hence, indigeftions, coftivenefs, wind,&other hypocondriachal affections, are the companions of the fedentary. No excretion can be duly performed where exereife is wanting ; and when the matter which ought to be difcharged in this way, js retained too long in the body, it muft have bad eftcds, as it is again taken up into the mafs of humours. A bending poflure is hurtful to the lungs. When this organ is compreffed, the air cannot have free accefs into all its parts, fo as to expand them properly. Hence tubercles, adhefions, &c. are formed, which oft on end in confumptions. Befides, the proper ac- tion of the lungs being abfolutely neceffary for making good blood, when that organ fails, the humours foon become univerfaliy de- praved, and the whole conftitution goes to wreck. Sedentary artificers are not only hurt by preffure on the bowels, but alfo on the inferior extremities, which obftructs .the circula- tion in thofe parts, and renders them weak and feeble. Thus, tay- lors, fhoe-makers, &c. frequently lofe the ufe of their legs altoge- ther ; befides, the blood and humours are, by ftagnation, vitiated, and the perfpiration is obftructed: From whence proceed the fcab, ulcerous feres, foul blotches, and other cutaneous difeafes, fo com- mon among fedentary artificers. A bad figure of body is a very common confequence of clofe ap- plication to fedentary employments. The fpine, for example, by Being continually bent, puts on a crooked fhape, and generally re- mains fo ever after. But a bad figure of body has already been ob- ferved to be hurtful to health, as the vital functions are thereby impeded. A fedentary life feldom fails to occafion an univerfal relaxation of the folids. This is the great fource from whence moft of the difeafes of fedentary people flow. The fchrophula, confumption, hyftencs, and nervous difeafes, now fo common, were very little known in this country before fedentary artificers became fo nume- rous : And they are very little known ftil] among fuchof our peo- ple as follow active employments without doors, though in great towns, at leaft two thirds of the inhabitants are afflicted with them. It is very difficult to remedy thofe evils, becaufe many who have been accuftomed to a fedentary life, like ricketty children, lofc all inclination for exercife; we fhall throw out a few hints with refpect 54 OF THE LABORIOUS,THE SEDENTARY, to the moft likely means for preferving the health cf this ufeful ff t of people. Sedentary artificers are often hurt by their bending poflure. They ou-»ht to ftand or fit as erect as the nature of their employ- ments will permit. They fhould'change their pofture frequently, and never fit too long at a time, hut leave off work, and walk, ride, run, or do any thing that will promote the viral functions. Sedentary artificers are generally allowed too little dme for ex- ercife; yet, fliort as it is, they feldom employ it properly. A jour- neyman taylor or weaver, for example, inftead of walking abroad for exercife and frefh air, at his hours of leifurc, choofes often to fpend them in a public-houi'e, or in playing at fome fedentary game, by which he generally lofes both his time and his money. The awkward poftures in which many fedentary artificers work, feem rather to be the effect of cuftom than neceffity. For example, a table might furely be contrived for ten or a dozen taylors to fit round, with liberty for their legs either to hang down, or reft upon a foot-board, as they fhould choofe. A place might be cut out for each perfon, in fuch a manner that he might fit as conveniently for working as in the prefent mode of fitting crofs-legged. All fedentary artificers ought to pay the moft religious regard to Cleanlinefs. Both'their fituation and occupation render this highly neceffary. Nothing would contribute more to preferve their health, than a ftridt attention to it; and fuch of them as neglect it, not onlv run the hazard of lofing health, but of becoming a nuifance to their neighbours. Sedentary people ought to avoid food that is windy, or hard of digeftion, and pay the ftrictefl regard to fobriety. A perfon who works hard without doors will foon throw off a debauch ; but one who fits has by no means an equal chance. Hence fedentary peo- ple are often feized wich fevers after hard drinking. When fuch per- fons feel their fpirits low, inftead of running to the tavern for re- lief, they fliould ride, or walk in the fields. This would remove the complaint more effectually than ftrong liquor, and would never hurt the conftitution. We fhall recommend the following general plan, viz. That eve- ry perfon who follows a fedentary employment fhould cultivate a piece of ground with his own hands. This he might dig, plant, fow, and weed at leifure hours, fo as to make it both an exercife and amufement, while it produced many of the neceffaries of life. After working an hour in a garden, a man will return with more keennefs to his employment within doors, than if he had been all the while idle. Labouring the ground is every way conducive to health. It not only gives exercife to every part of the body, but the very fmell of the earth and frefh herbs revives and cheers the fpirits, whilft the perpetual profpect of fomething coming to maturity, delights and entertains the mind. We are always pleafed with feme what in prof- AND THE STUDIOUS. 55 pect, however diftant or trivial. Hence the happinefs that molt men feel in planting, fowing, building, &c. Thefe feem to have been the chief employments of the more-early ages : And when kings and conquerors cultivated the ground, there is reafon to be- lieve, they knew as well wherein true happinefs confifted as we do. It may feem romantic to recommend gardeningto manufacturers in great towns; the plan is very practicable. In" Sheffield, where the great iron manufacture is carried on, there is hardly a journey- man cutler who does not poffefs a piece of ground, which he cul- tivates as a garden^ This practice has many falutary effects- It hot only induces thefe people to take exercife without doors, but alfo to eat many greens, roots, &c. of their own growth, which they would never think of purchafing. There can be no reafon why ma- nufacturers in any other towns of Britain fhould not follow the fame plan. In London, a plan of this kind is not practicable ; yet even there, fedentary artificers may find opportunities of taking air and exercife, if they choofe to embrace them. Mechanics are too much inclined to crowd into great towns. The fituation may have fome advantages; but it has many difad- vantages. All mechanics who live in the country have it in their power to cultivate a piece of ground ; "which, indeed, moft of them do. This not only gives them exercife, but enables them to live more comfortably. So far at leaft as my obfervation extends, me- chanics who live in the country are far more happy than thofe in great towns. They enjoy better health, live in greater affluence, and feldom fail to rear a healthy and numerous offspring. In a word, exercife without doors, in one fhape or another, is abfolutely neceffhry to health. Thofe who neglect it, though they may for a while drag out life, can hardly be faid to enjoy it. Weak and effeminate, they languifh for a few years, and foon drop into an untimely grave. The Studious. INTENSE'thinking is fo deftructive to health, that few inflan- ces can be produced of ftudious perfons who are ftrong and heal- thy. Hard ftudy always implies a fedentary life ; and when intenfc thinking is joined to the want of exercife, the confequence muft be bad. We have frequently known even a few months of clofe ap- plication to ftudy, ruin an excellent conftitution, by inducing a train of nervous complaints which could never be removed. Man is evidently not formed for continual thought more than for per- petual action, and would be as foon worn out by the one as by the other. So great is the power of the mind Over the body, that, by its in- fluence the whole vital motions may be accelerated or retarded3 •' 56 OF THE LABORIOUS, THE SEDENTARY, toalmoft any degree. Thus cheerfulnefs and mirth quicken the cir- culation, and promote all the fecretions; fadnefs and profound thought retard them. Hence, even a degree of thoughtleffiicis is, neceffary to health. The perpetual thinker feldom enjoys either health or fpirits ; while the perfon who can hardly be faid to think at all, generally enjoys both. Perpetual thinkers, as they are called, feldom think long. In a few years'they generally become quite flupid, and exhibit a melan- choly proof how readily the greateft bleffings may be abufed. Think- i? ing, like every thing elfe, when carried to an extreme, becomes a vice : nor can any thing afford a greater proof of wifdom, than for a man frequently and feafonably to unbend his mind. This may generally be done by mixing in cheerful company, active diverfions, or the like. ' Inftead of attempting to inveftigate the nature of that connexion which fubfifts between the mind and body, or to enquire into the manner in which they mutually affect each other, we fhall only mention thofe difeafes to which the learned are more peculiarly liable, and endeavour to point out the means of avoiding them. Studipus perfons are very fubject to the gout. This painful dif- eafe in a great meafure proceeds from indigeftion, and an obftruc- ted perfpiration. It is impoffible that the man who fits from morn- £ ing till night fhould either digeft his food, or have any of the fe- cretions in due quantity. But when that matter, which fhould be thrown off by the fkin, is retained in the body, and the humours are not duly prepared, difeafes muft enfue. The ftudious are likewife very liable to the ftone and gravel. Ex- eTcifs greatly promotes both the fecretion and difcharge of urine; a fedentary life muft have the contrary effect. Any one may be fatisfied of this by obferving, that he paffes much more urine by day than in the night, and alfo when he walks or rides, than when he fits. The circulation in the liver being flow, obftructions in that or- gan can hardly fail to be the confequence ©f inactivity. Hence, fe- dentary people .aae frequently afflicted with fchirrous livers. But the proper fecretion and difcharge of the bile is fo neceffary a part of the animal economy, that where thefe are not duly performed, the health muft foon be impaired. Jaundice, indigeftion, lofs of appe- tite, and a wafting of the whole body, feldom fail to be the confe- quences of a vitiated ftate of the liver, or obftructions of the bile. Few difeafes prove more fatal to the ftudious than confumptions of the lungs. This organ cannot be duly expanded in thofe vho do not take proper exercife; and where that is the cafe, obftructions 2nd adhefions will enfue. Not only want of exercife, but the pof- ture in which ftudious perfons generally fit, is very hurtful to the lungs. Thofe who read or write much are ready to contract a ha- bit of bending forwards, and often prefs with their breaft upon a fable or bench. This poflure hurts the lungs. AND THE STUDIOUS. 57 The functions of the heart may likewife by this means be in- jured. I remember to have feena man opened, whofe pericardium adhered to the breafl-bone, in fuch a manner, as to obftruct the mo- tion of the heart, and occafion his death. The only probable caufe that could be affigned for this fingular fymptom was, that the man, whofe bufinefs was writing, ufed conftantly to fit in a bending poflure, with his breaft prefling upon the edge of a flat table. No perfcm can enjoy health who does not properly digefl his food. But intenfe thinking and inactivity never fail to weaken the powers of digeftion. Hence the folids become weak and relaxed* and the whole conftitution goes to ruin. Long and intenfe thinking often occafions grievous head-achs, which bring on vertigoes, apoplexies, palfies, and other fatal dif- orders. The beft way to prevent thefe is, never to ftudy too long at one time, and to keep the body regular, either by proper food, or taking frequently a little of fome opening medicine. Thofe who read or write much are often afflicted with fore eyes. Studying by candle-light is peculiarly hurtful to the fight. This ought to be practifed as feldom as poffibie. When it is unavoid- able, the eyes fhould be fhaded, and the head fhould not be held too low. When the eyes are weak or painful, they fhould be bathed every night and morning in cold water, to which a little brandy may be added. The excretions are very defective in the ftudious. The dropfy is often occeafioned by the retention of thofe humours which outfit to be carried off in this way. Any perfon may obferve, that fit- ting makes his legs fivell, and that this goes offby exercife ; which clearly points out the method of prevention. Fevers, efpecially of the nervous kind, are often the effect o£ ftudy. Nothing affects the nerves fo much as intenfe thought. It in a manner unhinges the whole human frame, and not only hurts the vital motions, but diforders the mind itfelf. Hence a delirium, melancholy, and even madnefs, are often the effect of clofe appli- cation to ftudy. There is no difeafe which can proceed from a defect of the ufual fecretions, or a debility of the nervous fyftem, which may not be induced by intenfe thinking. But the moft afflicting of all the difeafes which attack the ftu- dious is the hypochondriac. This difeafe feldom fails to be the companion of deep thought. It may rather be called a complica- tion of maladies than a fingle one. To what a wretched condition arc the beft'of men often reduced by it! Their ftrength and appe- tite fail; a perpetual gloom hangs over their minds; they live in the conftant dread of death, and are continually in fearch of re- lief from medicine, where it is not to be found. Thofe who la- bour under this diforder, though they are often made the fubject of ridicule, juflly claim ourhigheft fympathy. Hardly any thing can be more prepofterous than for a perfon to make ftudy his fole bufinefs. A.mere ftudcnt is feldom an uf$* - H 58 OF THE LABORIOUS, THE SEDENTARY,- ful member of fociety. He often neglefts the moft important du- ties of life, in order to purfue ftudies of a very trifling nature. It rarely happens, that any ufeful invention is the effea of mere ftu- dy. The farther men dive into profound refearchce, they generally deviate the more from common fenfe, and too often lofe fight of it altogether. Profound fpeculations, inftead of making men wifer or better, generally render them abfolute fceptics, and overwhelm them with doubt and uncertainty. All that is neceffary for man to know, in order to be happy, is eafily obtained ; and the reft, like the forbidden fruit, ferves only to increafc his mifery. • Studious perfons, in order to relieve their minds, muft not only difcontinue to read and write, but engage in fome employment or diverfion, that will fo far occupy the thought as to make them for- get the bufinefs of the clofet. A folitary ride or walk arc fo far from relaxing the mind, that they rather encourage thought. Nothing can divert the mind, when it gets into a train of ferious thinking, but attention to fubjects of a more trivial nature, 'i hefe prove a kind of play to the mind, and eonfequently relieve it. Learned men often contract a contempt for what they call tri- fling company. They are afhamed to be fcen with any but philofo- ' phers. This is no proof of their being fo. No man deferves that, name who is afhamed to unbend his mind, by aflbciating with the cheerful and gay. Even the fociety of children will relieve the mind, r.nd expel the gloom which application to ftudy is too apt to occafion. ' As ftudious people are neceffarily much within doors, they fhould make choice ci a large r.nd well-aired place for ftudy. This would '.not only prevent the bad effects which attend confined air, but would cheer the fpirits, and have a moft happy influence both on the body and mind. It is faid of Euripides, that he ufed to retire to a dark cave to compofe his tragedies, and of Demoflhcnes, that he chofe a place for ftudy where nothing could be either heard or feen. With all deference to fuch venerable names, we cannot help condemning their tafte. A man may furely think to as good pur- pofe in an elegant apartment as in a cave ; and may have as happy conceptions where the all-cheering rays of the fun render the air wholefome, as in places where they never enter. Thofe who read or write much fhould be very attentive to thei? poflure. They ought to fit and fland by turns, always keeping a9 nearly in an erect poflure as poffibie.- Thofe who dictate may do it walking. It has an excellent effea frequently to read or fpeak aloud. This not only exercifes the lungs, but alrnoft the whole bo- dy. Hence ftudious people are greatly benefited by delivering dif- courfes in public. Public fpeakers, indeed, fometimes hurt them- felves by overawing theji part ; but this is their own fault. The martyr to mere vociferation merits no fympathy. The morning has been reckoned the beft time for ftudy. It is fo. But it is alfo the.moft proper feafon for exercife, while the fta^ AND THE STUDIOUS. ea ■j % L «-i^. ftxeh is empty, and the fpirits refrefhed with fleep. Studious peo- ple fhould fometimes fpend the morning in walking, riding, or fome manly diverfions without doors. This would make them re- turn to ftudy with greater alacrity, and would be of more fervice than twice the time after their fpirits are worn out with fatigue. It is not fufficient to take diverfion only when we can think no longer. Every ftudious perfon fhould make it a part of his bufinefs, and fhould let nothing interrupt his hours of recreation more than thofe of ftudy. Mufic has a very happy effea in relieving the mind when fa- tigued with ftudy. It would be well If every ftudious perfon were fo far acquainted withthat fcience as to amufe himfelf after fevere thought, by playing fuch airs as have a tendency to raife the fpi- rits, and infpire cheerfulnefs and good humour. It is a reproach to learning, that any of her votaries, to relieve the mind after ftudy, fhould betake themfelves to the ufe of ftropg liquors. This indeed is a remedy ; but it is a defperate one, and al- ways proves deftruaive. Would fuch perfons, when their fpirits are low, get on horfeback, and ride ten or a dozen miles, they would find it a more effeaual remedy, than any cordial medicine, or ftrong liquors. The following is my plan, and I cannot recommend a better to others. When my mind is fatigued with ftudy, or other ferious bu- finefs, I mount my horfe, and ride ten or twelve miles into th® country, where I fpend a day, and fometimes two, with a cheerful friend ; after which I never fail to return to town with new vigour, and to purfue my ftudies or bufinefs with frefh alacrity. It is to be regretted, that learned men, while in health, pay fo little regard to thefe things ! There is not any thing-more com- mon than to fee a miferable objea over-run with nervous difeafes, bathing, walking, riding," and doing every thing for health after it is gone ; yet, if any one had recommended thefe things to him by way of prevention, the advice would, in all probability, have been .treated with contempt, or at leaft, with neglea. Such is the weak- nefs and folly of mankind, and fuch the want of forefight, even in thofe who ought to be wifer than others. With regard to the diet of the ftudious, we fee no reafon why they fhould abftain from any kind of food that is wholefome, pro- vided they ufe it in moderation. They ought, however, to be fpa- ring in the ufe of every thing that is four, windy, rancid, or hard. of digeftion. Their fuppers fhould always be light, or taken foon in the evening. Their drink may be water, fine malt-liquor, not too ftrong, good cyder, wine and water, or, if troubled with acidities, water mixed with a little brandy, rum, or any other genuine fpirit. With regard to thofe kinds of exercife which are moft proper for the ftudious, they fhould not be too violent, nor carried to ex- ceffive fatigue. They ought to be frequently varied fo as to give aaion to all the different parts of the body; and fliould, as often as 60 OF ALIMENT. g poffibie, be taken in the open air. In general, riding on horfeTOck, walking, working in a garden, or playing at fome active diver/ions, are the beft. m '"" We recommend the ufe of the cold-bath to the ftudious. It will, ^ in fome meafure, fupply the place of exercife, and fliould not be negleaed by perfons of a relaxed habit, efpecially in a warm feafon. No perfon ought either to take violent exercife, or to ftudy im- mediately after a full meal. CHAPTER III. Of Aliment. UNWHOLESOME foodj and irregularities in diet, occafion many difeafes. There is no doubt but the whole conftitu- tion of body may be changed by diet alone. The folids may be braced or relaxed, have their fenfibility, motion, &c. greatly in- creased or diminifhed, by different kinds of aliment. A very fmall attention to thefe things will be fufficient to fhow, how much the prefervation of health depends upon a proper regimen of the diet. Nor is an attention to diet neceffary for the prefervation of health only: it is likewife of importance in the cure of difeafes. Every intention in the cure of many difeafes, may be anfwered by diet alone. Its effects, indeed, are not always fo quick as thofe of me- dicine, but they are generally more lafting : befides, it is neither fo difagreeable to the patient, nor fo dangerous as medicine, and is always more eafily obtained. Our intention is not to inquire minutely into the nature and properties of the various kinds of aliment in ufe among mankind; nor to fhow their effeas upon the different conftitutions of the hu- man body ; but to mark fome of the moft pernicious errors which •< people are apt to fall into, with refpea both to the quantity and qualities of their food, and to point out their influence upon health.' It is not eafy to afcertain the exaa quantity of food proper for every age, fex, and conftitution : but a fcrupulous nicety here is not neceffary. The beft rule is to avoid all extremes. Mankind were never intended to weigh and meafure their food. Nature teaches every creature when it has enough ; and the calls of thirll and hunger are fufficient to infdtm them when more is neceffary. | Though moderation is the chief rule with regard to the quantity, yet the quality of food merits a farther confideration. There are many ways by which provifions may be rendered unwholefome. Bad feafons may either prevent the ripening of grain, or damage it afterwards. Thefe, indeed, are aas of Providence, and we muft fubmit to them ; but no punifhment can be too fevere for thofe I ±_______________=-,__________________j OF ALIMENT. 61 wfio*fuffer provifions to fpoil by hoarding them, on purpofe to raife the price, or who promote their own intereft by adulterating the neceffaries of life*. Animal, as well as vegetable food, may be rendered unwhole- fome, by being kept too long. All animal fubftances have a con- flant tendency to putrefaaion ; and, when that has proceeded too far, they not only become offenfive to the fenfes, but hurtful to health. Difeafed animals, and fuch as die of themfelves, ought ne- ver to be eaten. It is a common praaice in fome grazing countries, for fervants and poor people to eat fuch animals as die of difeafe, or are killed by accident. Poverty may oblige people to do this; but they had better eat a fmaller quantity of what is found and wholefome : it would both afford a better nourifhment, and be at- tended with lefs danger. The injunaions given to the Jews, not to eat any creature which died of itfelf, feem to have a ftria regard to health; and ought to be obferved by Chriftians as veil as Jews. Animals never die of themfelves without fome previous difeafe ; but how a difeafed animal fhould be wholefome food, is inconceivable: even thofe which die by accident muft be hurtful, as their blood is mixed with the flefh, and food turns putrid. ' Animals which feed grofsly, as tame ducks, hogs, &c. are nei- ther fo eafily digefted, nor afford fuch wholefome nourifhment as others. No animal can be wholefome which does not take fufficient exercife Moft of our flailed cattle are crammed with grofs food, but not allowed exercife nor free air; by which means they indeed grow fat, but their juices, not being properly prepared or affimi- lated, remain crude, and occafion indigeftions, grofs humours and oppreffion of the fpirits, in thofe who feed upon them. Animals are often rendered unwholefome by being over-heated. Exceffive heat caufes a fever. For this reafon, butchers fhould be feverely reprimanded who over-drive their cattle. No perfon would choofe to eat the flefh of an animal which had died in a high fever; yet that is the cafe with all over-drove cattle ; and the fever is of- ten rajfed even to the degree of madnefs. But this is not the only way by which butchers render meat un- wholefome. The abominable cuftom of filling the cellular mem- brane of animals with air, in order to make them appear fat, is every day praaifed. This not only fpoils themeat, and renders it unfit for keeping, but is fuch a dirty trick/that the very idea of it is fufficient to difguft a perfon of any delicacy at every thing which * •K The poor are generally, the firft who fuffer by unfound provifions ; but the lives of the labouring poor are of great importance to the ftate ; hefides, difeafes occafioned by unwholefome food often^rovemfeftious, by which means they reach people in every ftation. It'is therefore the intereft of all to take care that no fpoilt provifions of any kind be ex- pofed to fale. 62 OF ALIMENT. comes from the fhambles. Who can bear the thought of eating meat which has been blown up with air from the lungs of a dirty fellow, perhaps labouring under the veryworft of difeafes? # Butchers have likewife a method of filling the cellular mem- branes of animals with blood. This makes the meat feem fatter, and likewife weigh more, but it is a very pernicious cuftom, as it both renders the meat unwholefome and unfit for keeping. I fel- dom fee a piece of meat from the fhambles, where the blood is not difi'nfed through the cellular texture. I fhall not fay that this is al- ways the effea of defign; but I am certain it is not the cafe''with animals that are killed for domeflic ufe, and properly blooded. Veal feems to be moft frequently fpoilt in this way. Perhaps that may in fome meafure be owing to the praaice of carrying calves from a great diftsmce to market, by which means their tender flefh is bruifed, and many of their veffels burft. No people in the world eat fuch quantities of animal food as the Englifli, which is one reafon why they are fo generally tainted with the fcurvy and its numerous train of confequences, indigeftion, low fpirits, hypochoudriacifm, &c. Animal food was furely defigned for man, and with a proper mixture of vegetables, it will be found the moft wholefome ; but to gorge beef, mutton, pork, fifh, and fowl, twice or thrice a day, is certainly too much. All who value. health oi\ght to be contented with making one meal of flefh in twenty-four hours, and this ought to confift of one kind only. The moft obftinate fcurvy has often been cured by a vegetable diet; n ay, milk alone will'frequently do more in that difeafe than any m edicine. If vegetables .and^milk were more ufed in diet, we fhoul d have lefs fcurvy, and likewife fewer putrid and inflammato- ry ff ;vers. Frefli vegetables, indeed, come to be daily more ufedin die* i; This laudable praaice we hope will continue to gain ground. Our aliment ought neither to be too moifl nor too dry. Moifl a1 liment relaxes the folids, and renders the body feeble. Thus, fe- r jiales, who live much on tea, and other watery diet, generally be- come weak, and unable to digeft folid food : Hence proceed hyfte- ^rics, and all their confequences. On the other hand, food that is r'too dry, renders the folids in a manner rigid, and the humours vif- •)*id, which difpofes the body to inflammatory fevers, fcurvics, and the like. Much has been faid on the ill effeas of tea in dietr They are, no doubt, numerous ; but they proceed rather from the imprudent ufe of it, than from any bad qualities in the tea itfelf. Moft delicate perfons, who are the greateft tea-drinkers, cannot eat any thing in the morning. If fuch perfons, after fafting ten or twelve hours, drink four or five cups of tea, without eating almoft any bread, it muft hurtthem. Good tea, taken in moder^e quantity, not too ftrong, nor too hot, nor drank upon an empty ftomach, will feldom do harm ; but if it be bad, or fubftituted in the room of folid food, it muft have many ill effeas. OF ALIMENT. £3 The arts of cookery render many things unwholefome, which ^re not fb in their own nature. By jumbling together a number ot different ingredients, in order to make a poignant f.uce or rich foup, the compofition proves almoft a poifon. All high feafoning, pickles, &c are only incentives to luxury, and hurt the ftomach. It were well, if cookery as an art were prohibited. Plain roaiting or boiling is all that the ftomach requires. Thefe alone are fufficient for people in health, and the fick have ftill lefs need of a cook. The liquid part of our aliment likewife claims our attention. Water is not only the bafis of moft liquors, but alfo compofes a great part of our folid food. Good water muft therefore be of the greateft importance in diet. The beft water is that which is moft pure, and free from any mixture of foreign bodies. Water takes up parts of moft bodies with which it comes into contaa ; by this means, it is often impregnated with metals or minerals of a hurtful or poifonous nature. Hence the inhabitants of fome hilly countries have peculiar difeafes, which in all probability proceed from the water. Thus the people who live near the Alps in Switzerland, and the inhabitants of the Peak of Derby, in England, have Inrge tumours or wens in their necks. This difeafe is generally imputed to the fnow-water ; but it is rather owing to the minerals in the mountains through which the waters pafs. When water is impregnated with foreign bodies, it generally appears by its weight, colour, tafte, fmell; heat, or fome othv. fenfible quality. Our bufinefs is to choofe fuch water, for common ufe, as is lighteft, and without any particular colour, tafte, or fmell. In moft places of Britain the inhabitants have their choice of wa- ter ; and few things would contribute more to health than a due attention to this article. Indolence often induces people to make 4 ufe of the water that is nearefl, without confidering its qualities. Before water be brought into great towns, the ftriaefl attentioa ought to be paid to its qualities, as many difeafes may be occ«- fioned or aggravated by bad water ; and when ©nee procured at a great expenfe, people are unwilling to give it up. The common methods of rendering water clear by filtration, or foft, by expofing it to the fun and air, &c. arc generally known. We fhall only advife all to avoid waters which flagnate long in fmall lakes, ponds, or the like; as fuch waters often become putrid, by the corruption of animal and vegetable bodies with which they abound. Even cattle frequently fuffer by drinking, in "dry feafons, water which has flood long in fmall refervoirs,, without being fupplied by fprings or frefhened with fhowers. All wells ought to be kept clean, and to have a free communication with the air. Fermented liquors, though exclaimed againft by many writers, continue to be the common drink of almoft every perfon who can afford them : We fhall rather endeavour to aflHi people in the1 choice of thofe liquors, thanpreteadtocondemm what cuftom has fo firmly eftablifhed. It i»not the moderate ufeiof found fernr*:*lqA 64 OF ALIMENT. Hc^cTrs which hurts mankind : It is excefs, and ufing fuch as arc ill prepared or vitiated. , ,. . .• Fermented liquors, which are too ftrong, hurt digeftion an*.. the body is fo far from being ftrengthened by them, that it s v, eak- ened and relaxed. Many imagine that hard labour could not be fupported without drinking ftrong liquors : 11ns is a very errone- ous notion. Men who never talk' ftrong liquors are not only able to endure more fatigue, but alfo live much longer, than thofe who ufe them daily. But, fuppofe ftrong liquors did enable a man to do more work, they muft neverthdefs wafte the powers of lite, and occafion premature old age. 'I hey keep up a conftant fever, which exhaufls the fyftem, and difpofes the body to numberlds difeafes. But fermented liquors may be too weak as v. ell as too itrong . when that is the cafe, they muft be either drank new, or they be- come four and dead ; when fuch liquors are drank new, the fer- mentation not being over, they generate air in the bowels, and oc- cafion flatulencies ; and, when kept till tlale, they four on the fto- mach, and hurt digeftion. For this reafon, all malt-liquors, cider, &c. ought to be of fuch ftrength, as to keen till they are ripe, and then they fhould be ufed. When fuch liquors are kept too long,_ though they fhould not become four, yet they generally contraa a hardnefs, which renders them unwholefome. All families, who can,ought to prepare their own liquors. Since preparing and vending of liquors became one of the moft general branches of bufinefs, every method has been tried to adulterate them. The great objea both to the makers and venders of liquor is, to render it intoxicating. But it is well known that this may be done by other ingredients than thofe which ought to be ufed for making it ftrong. It would be imprudent even to name thofe things which are daily made, ufe of to render liquors heady. Suf- fice it to fay, that the praaice is very common, and that all the ingredients ufed for this purpofe are of a narcotic or ftupefa£live quality. But as all opiates are poifonous, it is eafy to fee what muft be the confequence of their general ufe. Though they do not kill fuddenly, yet they hurt the nerves, relax and weaken the ftomach, and fpoil the digeftion. Were fermented liquors faithfully prepared, kept to a proper age, and ufed in moderation, they would prove real bleffings to mankind. But, while they are ill prepared, various ways adulte- rated, and taken to excefs, they muft have many pernicious effeas. We recommend it to families, not only to prepare their own liquors, but their bread. Bread is fo neceffary a part of diet, that too much care cannot be beftowed in order to have it found and wholefome. For this purpofe, it is not only neceffary that it be made of good grain, but likewife properly prepared, and kept free from all unwHolefome ingredients. This is not always the cafe with bread prepared by thofe who make a trade of vending it. Their objea is rather to pleafe the eye, than to confult the health; of aliment. 6^ The beft bread is that which is neither too coarfe nor too fine' well fermented, and made of wheat flour, or rather of wheat and rye mixed together. • To fpecify the different kinds/ff aliment, to explain their nature and properties, and to point out their effeas in different conftitu- tions would far exceed our defign. We fhall only mention the fol- lowing eafy rules with refpea to the choice of aliment. Perfons, Whofe folids are weak and relaxed, ought to avoid all vif- cid food, or fuch things as are hard of digeftion. Their diet ought to be nourifhing, and they fhould take fufficient exercife in the, open air. Such as abound with blood fhould be fparing in every thipg that is highly nourifhing, as fat meat, rich wines, ftrong ale, and fuch like. Their food fhould confift moftly of bread and other vegetable fubftances ; and their drink ought to be water, whey, or fmall-beer. Fat people fhould not cat ireely of oily nourifhing diet. They ought frequently to ufe radifh, garlic, fpices, or fuch things as are heating and promote perfpiration and urine. Their drink fhould be water, coffee, tea, Or the like ; they ought to take much exer- cife, and little fleep. Thofe who are too lean muft follow an op- pofite courfe. Such as are troubled with acidities, or whofe food is apt to four on the ftomach, fhould live much on animal food; and thofe afflia- ed with hot alkaline eruaations, ought to ufe a diet confifting chiefly of acid vegetables. People affeaed with the gout, low fpirits, hypochondriac or hyfleric diforders, ought to avoid all flatulent food, every thing thafc is vifcid, or hard of digeftion, all falted or fmoke-dried provifions^ and whatever is auftere, acid, or apt to four on the ftomach. Their food fhould be light, fpare, cool, and of an opening nature. The diet ought to be fuited to the age, conftitution, and manner of life: A fedentary or ftudious perfon fhould live more fparingly than one who labours hard without doors. Many kinds of food will nourifh a peafant very well, which would be almoft indigeflible to a citizen ; and the latter will live upon a diet on which the former would flarve. Diet ought not to be too uniform. 7 he conflant ufe of one kind of food might have fome bad effeas. Nature teaches us thH,n by the great variety of aliment which' fhe has provided for man, and likewife by giving him an appetite for different kinds of food. * Thofe: who labour under any particular difeafe, ought to avoid fuch aliments as have a tendency to increafe it: For example, a gouty perfon fhould not indulge in rich wines, ftrong foups or gra- vies, arid fliould avoid all acids. One who is troubled with the gravel oughtfto fhun all auftere and aftringent aliments; and thofe who are fcorbutic fhould be fparing in the ufe of falted provifions. In the firft period of life, our food ought to be light, nourifhing, and frequently taken. Food that is folid, with a fufficient degree I - •' ' 66 OF ALIMENT. of tenacity, is moft proper for the ftate of manhood. The diet Tinted to the laft period of life, when nature is upon the decline, " pproaches nearly to that of the firft. It fhould be lighter and more fucculent than that of vigorous age, and likewife more frequently" taken. It is not only -neceffary for health that our diet be wholefome, but alfo that it be taken at regular periods. Some imagine long fall- ing will atone for excefs ; but this, inftead of mending the matter, generally makes it worfe. When the ftomach and inteftines arc over-diftended with food, they lofe their proper tone, and, by long falling, they become w«..ak, and inflated with wind. Thus, either gluttony or falling deftroys the powers of digeftion. • The frequent repetition of aliment is not only neceffary for re- pairing the continual wafte of our bodies, but likewife to keep the fluids found and fweet. Our humours, even in the moft healthy ftate, have a conftant tendency to putrefaaion, which can only be prevented by frequent fupplies of frefh nourifhment: when that is. • wanting too long, the putrefaaion often proceeds fo far as to occa- fion very dangerous fevers. From hence we may learn the neceffi- / ty of regular meals. No perfon can enjoy a good ftate of health, whofe veffels are either frequently overcharged, or the humours long deprived of frefli fupplies of chyle. Long failing is extremely hurtful to young people ; it not only vitiates their humours, but prevents their growth. Nor is it lefs in- jurious to the aged. Moft perfons, in the decline of life, are afflia- ed with wind: This complaint is not only increafed, but rendered dangerous, and often fatal, by long faffing. Old people, when their ftomachs are empty, are frequently fei?ed with giddinefs, head- achs, and faintnefs. Thefe complaints may generally be removed by a piece of bread and a glafs of wine, or taking any other folid' food ; which plainly points out the method of preventing them. Many of the fudden deaths, which happen in the advanced pe- riods of life, are occafioned by falling too long, as it exhaufts the fpirits, and fills the bowels with wind ; we would therefore advife people in the declineof life, never to allow their ftomachs to be too long empty. Many people take nothing but a few cups of tea and »little bread, from nine o'clock at night till two or three next after- noon? Such may be faid to fall almoft three-fourths of their time. This can hardly fail to ruin the appetite, and fill the bowels with wind ; all which might be prevented by a folid breakfaft. It is very common to eat a light breakfaft and a heavy fupper. This cuftom ought to be reverfed. When people fup late, their , fupper fhould be very light; but the breakfaft ought always to be folid. If any one eats alight fupper, goes foon to bed, andTifes be- *.•' times in the morning, he will be fu.e to find an appetite for his breakfaft, and he may freely indulge it. The ftrong' and healthy do not fuffer fo much from fatting as the weak and delicate; but they run great hazard from its oppofite, N OF AIR. 6y -viz. repletion. Many difeafes, efpecially fevers, are the effea of a plethora, or too great fulnefs of the veffels. Strong people, in higbA health, have generally a great quantity of blood and other humours. When thefe are fuddenly increafed, by an overcharge of rich and nourifhing diet, the veffels become too much diftended, and ob- flruaions and inflammations enfue. Hence fo many people arefeiz- ed with inflammatory and eruptive fevers after a feaft or debauch. All great and fudden changes in diet are dangerous. What the ftomach has been long accuftomed to digeft, though lefs whole- fome, will agree better with it than food of a more falutary nature which it has not been ufed to. When a change becomes neceffary, it ought to be made gradually ; a fudden tranfition from a poor and low, to a rich and. luxurious diet, or the contrary, might fo difturb the funaions of the body, as to endanger health, or even to occafion death itfelf. When we recommend regularity in diet, we condemn not every fmall deviation. It is next to impoffible for people at all times to avoid fome degree of excefs, and living too much by rule might make even the fmalleft deviation dangerous. It may be prudent to vasy a little, fometimes taking more, fometimes lefs, than the ufual quantity of meat and drink, if due regard be had to modera- tion. CHAPTER IV. Of ^ in UNWHOLESOME air is a very common caufe of difeafes. Few are aware of the danger arifing from it. People gene- rally pay fome attention to what they eat and drink, but feldom regard what goes into the lungs, though .the latter often proves more fuddenly fatal than the former. Air, as well as water, takes up parts of moft bodies with which it comes into contaa, and is often fo replenifhed with thofe of a noxious quality, as to occafion immediate death. But fuch violent effeas feldom happen, as people are generally on their guard againft them. The lefs perceptible influences of bad air, prove more ge- nerally hurtful to mankind ; we fhall point out fome of thefe, and fhow" from whence the danger chiefly arifes. Air may become noxious many ways. Whatever greatly alters its degree of heat, cold, moifture, &c. renders it unwholefome. Ve- ry cold air obflruas the perfpiration, conftringes the folids, and occafions rheumatifms, coughs, and catarrhs, with other difeafes of the throat and breaft. Air that is too moift deftroys the elafti- " 6$ OF AIR. city or fpring of the folids, induces phlegmatic or lax conftitution*, ^and difpofes the body to agues; or intermitting fevers, dropfies, Sec. Wherever great numbers of people are crowded into one place, if the air has not a free circulation, it foon becomes unwholefome. Hence it is that delicate perfons are fo apt to turn fick or faint in crowded churches, affemblies, or any place where the air is in- jured by breathing, fires, candles, or the like. In great cities, fo many things tend to contaminate the air, that it is no wonder it proves fo fatal to the inhabitants. 'I he air in cities is not only breathed repeatedly over, but is likewife loaded with fulphur, fmoke, and other exhalations, befides the vapours continually arifing from innumerable putrid fubftances, as dung- hills, flaughter-houfes, &c. All poffibie care fhould be taken to keep the ftreets of large towns open and wide, that the air may have a free current through them. They ought likewife to be kept very clean. Nothing tends more to pollute the air of a city than dirty ftreets. It is very common in this country to have church.yards in the middle of populous cities. Whether this be the effea of ancient fuperftition, or owing to the increafe of fuch towns, is a matter of no confequence. Whatever gave rife to the cuftom, it is a bad one. Habit alone, reconciles us to thefe things ; by means of which the rooftridiculous,nay,perniciouscuftoms,oftenbecomefacred. Thou- fands of putrid carcaffes, fo near the furface of the earth, in a place where the air is confined, cannot fail to taint it; and fuch air, when breathed into the lungs, muft occafion difeafes*. Burying within churches is a praaice ftill more deteflable. The air in churches is feldom good, and the effluvia from putrid car- caffes muft render it ftill worfe. Churches are commonly old build- ings with arched roofs. They are feldom opened above once a week, are never ventilated by fires nor open windows, and rarely kept clean. This occafions that damp, mufty, unwholefome fmell which one feels upon entering a church, and renders it a very un- fafe place for the weak and valetudinary. Thefe inconveniences might, in a great meafure, be obviated, by prohibiting all perfons from burying within churches, by keeping them clean, and permit- ting a ftream of frefh air to pafs frequently through them, by open- ing oppofite doors and windows. Wherever air flagnates long, it becomes unwholefome. Hence perfons confined in jails not only contraa malignant fevers them- felves, but often communicate them to others. Nor are many cf the holes, for we cannot call them houfes, poffeffed by the poor in great towns, much better than jails. Thefe low dirty habitations * In moft eaftern countries, it was cuftomary to bury the dead at fom? diftancefrom any town. As this practice obtained among the Jews, the Greeks, and alfo the Romans, it is ftrange that the weftern parts of En- rope fhould not have followed their example in a cuftom fo truly laudable ©FAIR. £9 arc the very lurking-places of bad air and contagious difeafes. Such as live in them feldom enjoy good health; and their children com-* monly die young. In the choice of a houfe, thofe who have it in their power ought to pay the greateft attention to open free air. The various methods which luxury has invented to make houfe? clofe and warm, contribute to render them Unwholefome. No houfe can be wholefome unlefs the air has a free paffage through it. For which reafon, houfes ought daily to be ventilated, by opening op- pofite windows, and admitting a current of frefli air into every room. Beds, inftead of being made up as foon as people rife out of them, ought to be turned down, and expofed to ihe frefh air from the open windows through the day. This would expel any noxious vapour, and promote the health of the inhabitants. In hofpitals, jails, fhips, &c. where that cannot be conveniently done, ventilators fhould be ufed. The method of expetling foul, and introducing frefli air, by means of ventilators, is a moft falu- tary invention, and the moft ufeful of all modern medical improve- ments. It is capable of univerfal application, a:id is fraught with numerous advantages, both to thofe in health and ficknefs. In all places where numbers of people are crowded together, ventilation becomes abfolutely neceffary. Air which flagnates in mines, wells, cellars, &c. is extremely noxious, and ought to be avoided as the moft deadly poifon. It of- ten kills almoft as quickly as lightning. For this reafon, people fhould be very cautious in opening cellars that have been long fhut, or going down into deep wells or pits, efpecially if they have been kept clofe covered *. Many people who have fplendid houfes, choofe to fleep in fmall apartments. This is very imprudent. A bed-chamber ought always to be well aired ; as it is generally occupied in the night only, when all doors and windows are fhut. If a fire be kept in it, the danger from a fmall room becomes ftill greater. Numbers have been flifled whzn afleep by a fire in a fmall apartment, which is always hurtful. Thofe who are obliged, on account of bufinefs, to fpendthe day in clofe towns, ought, if poffibie, to fleep in the country. Breath- ing free air in the night will, in fome meafure, make up for the want of it through the day. This praaice would have a greater effea in preferving the health of citizens than is commonly ima- gined. Delicate perfons ought, as much as poffibie, to avoid the air of great towns. It is peculiarly hurtful to the aftmatic and confump- tive. Such perfons fhould avoid cities as they would the plague. •Jf We have frequent accounts of perfons who lofe their lives by going down into deep wells and other places where the air flagnates ; all thefe accidents might be prevented by only letting down a lighted candle be^ fore them, and flopping when they perceive it go out; yet this fimple precaution is feldom »fed. 7© OF AIR. The hypochondriac are likewife much hurt by it. Perfon.-, fo much ^effliaed with this malady while in town, that it feemed impoffible for them to live, have, upon removing to the country, been imme- diately relieved. The fame obfervation holds as to nervous and hy- fleric women. Many people have it not in their power to change their fituation in queft of better air. All we can fay to fuch perfons is, that they fhould go at-often abroad into the open air as they can, that they fhould admit frefh air frequently into their houfes, and take care to keep theni very clean. It was neceffary in former times, for fafety, to furround cities,. colleges, and even tingle houfes, with high walls. Thefe, by ob- ftruaing the free current of air, render fuch places damp and un- wholefome. Proper attention to air and cleanlinefs would tend more to preferve the health of mankind, than all the endeavours of the faculty. Surrounding houfes too clofely with planting, or thick woods, likewife tends to render the air unwholefome. Wood not only ob- ilruas the free current of air, but fends forth great quantities of moifl exhalations, which render it conflantly damp. Wood is ve- ry agreeable at a proper diftance from a houfe, but fhould never be planted too near it, efpecially in a flat country. Many gentle- men's feats in England are very unwholefome from the great quan- tity of wood which furrounds them. Houfes fituated in low "marfhy countries, or near large lakes of ftagnating water, are likewife unwholefome. Waters which ftag- iiate not only render the air damp, but load it with putrid exhala- tions, which produce the moft dangerous and fatal difeafes. Thofe obliged to inhabit marfhy countries, ought to make choice of the driefl fituation they can find, to live generoufly, and to pay the ftriaeft regard to cleanlinefs. If frefh air be neceffary for thofe in health, it is ftill more fo for the fick, who often lofe their lives for want of it. The notion that fick people muft be kept very hot, is fo common, that one can hard- ly enter the chamber where a patient lies, without being ready to faint, from the hot fuffocating fmell. How this muft affea the fick any one may judge. No medicine is fo beneficial to the fick as frefh air. It is the moft reviving of all cordials, if adminiftered with prudence. We are not to throw open doors and windows at random upon the fick. Frefh air is to be let into the chamber gradually, and, if poffibie, by opening the windows of fome other apartment. The air of a fick perfon's chamber may be greatly frefhened, and the patient much revived, by fprinkling the floor, bed, &c. frequently with vinegar, juice of lemon, or any other ftrone ve- getable acid. & Where numbers of fick are crowded into the fame houfe or into the fame apartment, the frequent admiffion of frefh ai/be- comes abfolutcly neceffary. Infirmaries, hofpitals, &c. are eften OF EXERCISE. s ;r rendered fo obnoxious, for want of proper ventilation, that the fick run more hazard from them than from the difeafe. This is particularly the cafe when putrid fevers, dyfenteries, and other' infeaious difeafes prevail. Phyficians, furgeons, and others who attend hofpitals,. ought* for their own fafety, to take care that they be properly ventilated*. Such perfons as are obliged to fpend moft of their time amongft the fick, run great hazard of being themfelves infeaed when the air is bad. All hofpitals, and places of reception for the fick, ought to have an open fituation, at fome diftance from any great town, and patients under an infeaious difeafe ought never to come near the reft. CHAPTER V. Of Exercife. ANT people look upon the neceffity man is under of earn- ing his bread by labour, as a curfe. But it is evident from .the ftruaure of the body, that exercife is not lefs neceffary than food for the prefervation of health: thofe whom poverty obliges to labour for daily bread, are not only the moft healthy, but gene- rally the moft happy part of mankind. Induftry feldom fails to place fuch above want, and aaivity ferves them inftead of phyfic. This is peculiarly the cafe with thofe who live by the culture of the ground. The great increafe of inhabitants in infant colonies, and the longevity of fuch as follow agriculture every where, prove it to be the moft healthful as well as the moft ufeful employment. The love of aaivity fliows itfelf very early in man. So ftrong is this principle, that a healthy youth cannot be reftrained from exercife, even by the fear of punifhrnent. Our love of motion is a ftrong proof of its utility. Nature implants no difpofition in vain. It feems to be a law throughout the animal creation, that no creature, without exercife, fhould enjoy health, or be able to find fubfiftenee. Every creature, except man, takes what is ne- ceffary. He alone, and fuch animals as are under his direaion, deviate from this original law, and they fuffer accordingly. Inaaivity never fails to induce an univerfal relaxation of the folids, which difpofes the body to innumerable difeafes. When the folids are relaxed, neither the- digeftion, nqr any of the fecre- tions, can be duly performed. In this Cafe, the worft confequen- ces muft enfue. How can perfons who loll all the day in eafy chairs, sad fleep all night on beds of down, fail to be relaxed ? M 74 OF EXERCISE. Nor do fuch greatly mend the matter, who never ftir abroad but in a coach, fedan, or fuch like. Thefe elegant pieces of luxury are become fo common, that the inhabitants of great towns feem to be in fome danger of lofing the ufe of their limbs altogether. It is now below any one to walk, who can afford to be carried. How ridiculous would it feem, to a perfon unacquainted with modern luxury, to behold the young and healthy fwinging along on the fhoulders of their fellow-creatures ! or to fee a fat carcafe, over- run with difeafes occafioned by inaaivity, dragged through the ftreets by half a dozen horfes* ! Glandular obflruaions, now fo common, generally proceed from ihaaivity. Thefe are the moft obftinate of maladies. So long as the liver, kidnies, and other glands, duly perform their func- tions, health is feldcm impaired ; but when they fail, nothing can reftore it. Exercife is almoft the only cure we know for glandular obftruaions ; indeed, it does not always fuccced as a remedy ; but there is reafon to believe that it would feldom fail to prevent thefe complaints, were it ufed in due time. One thing is certain, that, amongft thofe who take fufficient exercife, glandular difeafes are very little known ; whereas the indolent and inaaive are feldom free from them. Weak nerves are the conftant companions of inaaivity. Nothing but exercife and open air can brace and flrengthen the nerves, or prevent the endlefs train of difeafes which proceed from a relaxed ftate of thefe organs. We feldom hear the aaive or laborious com- plain of nervous difeafes; thefe are referved for the fons of eafe and „ affluence. Many have been completely cured of thefe diforders by being reduced from a ftate of opulence, to labour for their daily bread. This plainly points out the fources from whence nervous difeafes flow,-and the means by which they may be prevented. It is abfolutely impoffible to enjoy health, where the perfpin- tion is hot duly carried on; but that can never be the cafe where exercife is negleaed. When the matter which ought to be throwA off by perfpiration is retained in the body, it occafions fevers, rheu- matifm, &c. Exercife alone would prevent many of thofe difeafes which cannot be cured, and would remove others where medicine proves ineffeaual. Doaor Cheyne fays, that the weak and valetudinary ought to make exercife a part of their religion. We recommend this not only to the weak and valetudinary, but to all thofe whofe bufinefs does not oblige them to take fufficient exercife, as fedentary artifi- •* It is not neceffity, but fafhio'n, which makes the ufe of carriages fo common. Manyt people have not exercife enough to keep their humours from ftagaation, who yet dare not venture to make a vifit to their next neighbours, but inacoach or fedan, left they fhould be look- ed down upon. Strange, that men fhould be fuch fools as to be laughed t>ut of the ufe of their limbs, or to throw away their health, in order t\> gratify a piece of vanity, or to comply with a ridiculous fafhion ! OF EXERCISE. ^ cers*, fhop-keepers, ftudious perfons,' &c. Such ought to ufe ex- ercife as regularly as they take food. This might generally be done without any interruption to bufinefs or real lofs of time. No piece of indolence hurts the health mor? than the modem cuftonY of lying a-bcd too long in the morning. This is tliC general praaice in great towns,, The inhabitants of cities feldonVrife,be- fore eight or nine o'clock;'but the morning is undoubtedly the beft time for exercife, while the ftomach is empty, and* the body refrefhed with fleep. Befides, the morning-air braces and ftrength- ens the nerves,'and,in fome meafure,anfwers the purpofe of a cold- bath. Let any one who has been aceuftomed to lie a-bed till eight or nine o'clock, rife by fix or feven, fpend a Couple of hours in walking,; riding, or any aaive diverfion without doors, and he will find his fpirits cheerful and ferene'through the day, his appe- tite keen, and his body braced and ftrengthened. Cuftom foon renders early-rifing agreeable, and nothing contributes more to the prefervation of* health.4 .*""' The inaaive are Continually complaining of pains of the fto- mach, flatulencies, indigeftions, &c. Thefe complaints, which pave the way fc many others, a*re hot to be removed by medi- cines. They can only be cured by a vigorous courfe qf exercife, to which indeed they feldom fail to'yield. ":~ -"* Exercife, if poffibie;, ought always to he taken in the'open air. When that cannot be done, various;methods' may be contrived for exercifing the body-within doors,' as" the dumb-bell, dancing, fwing- ing,' Scci' It is hot lieceffary to adhere ftridtly to any particular kind of exercife.' .The beft way is to take them by turns, and to ufe that longeft which is moft fuitabfe to the ftrength and confti- tution. Thofe kinds of exercife which give aaion to rtiofl of the bodily organs, are always'to b'e preferred, as walking, running, riding, fencing, digging, fwimming, and fuch like. It is much to be regretted, that aaive and manly diverfions are now fo little jpractifed. Diverfions make people fake more ex*- eYcifi*'than th°y oth'erwilr would do, afld are of the greateft fer- vice jbTuch as are not under frid'necefljty OfTabourihg for their ■:o .• A'.:^\f ' . ylj ■ ' • a . * ""Sedentary occupation^ought chiefly to he1 followed by women. "liheybear confinement much bettef than men, and are fitter for evetf "\§ifi& t)f bufinefs which does not require much ftrength. It is ridiculous &&% -to feeaIufty f«How /flaking pins, needles, or watch, wheels, Whil truftive to the inhabitants, are owing to their imprudence in changing clothes. A few warm days in March or April induce them to throw off their winter garments, without confidering that our moft penetrating colds generally happen, in May. t We often fee perfons quite lame by the nails of their toes having grown into the flefh, and frequently hear of mortifications proceeding from this caufe. All thefe, and many other inconveniencies attending the feet, muft be imputed folely te the ufe of fliort and ftrait (hoes. ?8. OF SLEEP AND CLOTHING. ~The fi?e and figure of the fhoe ought certainly to be adapted to the foot. In children the feet are as well fhaped as the hands, and the motion of the toes as free and eafy as that of the fingers; yet few perfons in the advanced periods of life are abl* to make any ufe of their toes. They are generally, by narrow fhoes, fqueezed all-of-a-heap, and often laid over one-another in fuch a .^J^r^S to be rendered altogether incapable of motion. Nor is the MgR heel lefs hurtful than the narrow toe. A lady may feem taller for walking oh her tiptoes, but fhe will never walk well in' this man- ner. It ftrains her joints, diftorts her limbs, makes her ftoop, and utterly deftroys all her eafe and graccfulnefs of motion : It is^ entirely owing to fhoes with high heels and narrow toes, that not one female in ten can be faid to walk well. In fixing on the clothes, due care'fhould be taken to avoid all tight bandages. Garters, buckles, &c. when 'drawn too tight, fiot^ only prevent the free motion and ufe of the paits about which they are bound, but likewife obftrua the circulation of the blood, which prevents the equal nourifhment and growth of thefe parts, and oc- cafions various difeafes. Tight bandages about the neck, as flocks, cravats, necklaces, &c. are extremely dangerous. They obftf uct the blood in its courfe from the brain, by which means head-achs, ycr- tigos, apoplexies, and other fatal difeafes are often Occafioned. The perfeaion of drefs is to be eafy and clean. Nothing can be more ridiculous, than for any one to make himfelf a flave to fine clothes. Such an one, and many fuch there are, would rather re- main as fixt as a ftatue from morning till night, than difcompofe a fingle hair or alter the pofitibn of a pin. Were we to recommend any particular pattern for drefs, it would be that which is worn by thefociety of Friends, commonly called Quakers. They are always neat, clean, and often elegant, without any thing fuperfluous. „ What others lay out upon tawdry laces, ruffles arid ribbands, they beftow upon fuperior cleanlinefs. Finery is only the affeaationof drefs, and very often covers a great deal of dirt. Clothing ought not only to be fuited to the climate, the fekfon .. of the year, and the period of life ; but likewife to the temperature and conftitution. Robuft perfons are able to endure either cold or * heat better than the delicate ; confequently, may be lefs attentive '' to their clothing. But the precife quantity of clothes neceffary for any perfon cannot be determined by reafoning. It is entirely a mat- ter of experience, and every man is the beft judge for himfelf, what quantity of clothes is neceffary to keep him warm*. -i> nr . . #• Boerhaave ufed to fay, that no-body-"offered by cold, fave fools and be-gars ; the latter not being able toprocure clothes, and the for. rner no-; having fen:. :o wear them. In many cafes where the powers of zncd!tri?had been tried in vain, I have cured the patient by recom mendmir thick fiioes, a flannel waiftcoat.and drawers, a Dair of under flockin^jor afaofl! Lp^ttic 9«t. t» V? *.r?: 0\*\ "n« th* fold i-e ; the charaaer pf rational beings. The flave of appetite is the difgrace of human nature. T]j^Author of Nature hath endued us with various paffions, for the propagation of, the fpecies, the prefervation of the *rjd> visual, &c. Intemperance is the abufe of thefe - paffions } smd moderation confifts in the proper regulation of them. Men, not contented with fa-isfying-thp fimple calls of Nature, create arti- ficial wants, and are perpetually in fearch of fomething that may gratify them ; but imaginary .wants never can be gratified. Nature is content with little ; but luxury knows no bounds. Hence the cPlc#Tfi the drunkard, and the debauchee, feldom flop in theirca- reer, till their mpney or their cpnfjtitution fails: Then indeed they fee their error when too late. . . , It L irnpoffible to lay down fixtrjiles with regard tp diet, on ac- count of the different cor^f^imtions of mankind. The moft ignorant person,, however, certainly knows what is meant by excefs ; and every man,; if he choofes, can aypid it. The great rule of diet is to ftudy fimplicity. Nature delights in the .moft Mule food, and every animal, except man, follows her dictate* Mm alone riots atlajge, and ranfacjks the whole creation m q«eft of luxuries, tp hisown deftraaion. "For my part," fays te* So OF INTEMPERANCE difon, "when I behold a fafhionablc. table fef out in all itsmagnifi. cence, I fancy that I fee gouts'"and dropfiVs.Tevers and lethargies, with other innumerable diftempers, lying in ambufcade among the dimes.' ,Nor How quid abufe bf in^^i^aLi.i^ generally go hand in hand. Hence wefTo^ften behold the votaries -Of'Bacchus and Venus, even before they have .arrived at the prime of life, worh^out'whjr difeafes, and>:hafting_ with fwift'pacc fdan untimely grave.* Bid men reflect on the panful difeafes.^nd'pSmtJ. ture deaths, which are daily occafioned by in temper aJejgMjStJy "wouTd fhrink back with horror frofn theiridulgerice f&itim Taping 'pleaiVes. _" " ; - - ^i*^ ,«, -v j ' ■"« /<-;» ^' irfternperande does not hurt it's votarie^alcme: The^nnbcerft'too 'of Jen feel the effeas of it: How many Wretched orphans are-fo'bfe Teeri'embracing dunghill's, whofe parent^, re^;irdlefs of tKe-futtrre, fpent in riot' alVd debauch what might hive TervCtf td'^irrg^uj) their offspring m a decent manner ? How often do We behOfd the mother, with her infants', pining'in want, while the cruel father is indulging his infatiate appetites ?-;u"T * Families are not ohlyreduceffto mirery, but'even extirpated by intemperance. Nothing tends f6*much to*prevent propagation; and to fhorten the lives of children, as the intemperance, ofparents. The poor man who labours all day, and at night lies:;d'd'wrf conten- ted with his humble fare, can boaft a numerous offspring, while hfe pampered lord, funk in eafe and luxdry, often languifhes with- out an heir to his ample fortunes. Even ftates and-empires feel the influence of intemperance, and rife or fall as it prevails.1' *r »'c Inftead of mentioftiftg the different kinds of intemperance, and pointing out -their influence upon health, we fhall oiily, by way of example,-ma"*ge a few obfervations on one particular fpeetes of thai vice, viz. the abufe of intoxicating liquors. ",! * r^- • Every aa of intoxication puts Nature to the expenfe of a fever*, in order to difcharge the poifonous draught'. When this is repeat- ed almoft every day, it is eafy to forefee the confequences. That conftitution muft be ftrdng indeed, which is able long to hold out under a daily fever ! but fevers occafioned by drinkihg&o not always go (off in a day: They frequ^ritfy tM in an inflammation of the breaft, liver, or brain, and produce1 CatarefFeas. ^Though the drunkard fhould not fall by an acute difeafe, he feldom efcapes thofe of a chronic kind. Intoxicating liquors, when ufed to excefs, weaken the bowels*-and fpoil the digeftiOn ; tftef deftroy the power of the nerves, and occafion paralytic and cori* vuMive diforders. Hencebbftru&ioris, atrophies, drop fies," and con- sumptions of the lungs. Thefe-are the common ways" in whiolt drunkards make their exit. Difeafes of this kind, when brought on by hard drinking, feldom admit of a cure. ;i *u' 1 OF INTEMPERANCE. 8r Many people injure their health by drinking, who feldom get drunk. The habit of foaking, though its effeas be not fo violent, is not lefs pernicious. When the veffels are kept conffantly full and upon the ftretch,the different digeftions can neither be duly per* formed, nor the humours properly prepared. Hence, moft people ofuhis charaaer are affliaed with the gout ,the gravel, ulcerous fores in the le^s, &c. If thefe difor i.rs do not appear, they are feized with low fpirits, hypochondriacal affeaions, and other fymptoms of in- digeftion. Confumptions are now fo common, that it is thought one-tenth of the inhabitants of great towns die of that,difeafe. Hard drinking is no doubt one of the caufes to which we muft impute the increafe of confumptions. The great quantities of vifcid malt liquor drank by the common people of England, cannot fail to render the blood fizy and untie for circulation ; from whence proceed obftruaions, and inflammations of the lungs There are few great ale-frinkers who are not phthifical: nor is that to be wondered at, confidering the glutinous and almoft indigeftible nature of ftrong ale. Thofe who drink ardent fpirits or ftrong wines run ftill greater hazard ; thefe liquors heat and inflame the blood, and tear the tender veffels of the lungs to pieces ; yet fo great is the confump- tion of them in this country, that one would almoft be induced to thiriK fflfe inhabitants lived upon them *'. The habit of drinking proceeds frequently from misfortunes in life. The miferable fly to it for relief. It affords them indeed a temporary eafe. But, this folace is fhort-lived; and when it is over, the. Spirits fink as much below their ufual tone as they had before ^fceenjaifed above it. Hence, a repetition of the dofe becomes ne- ceffary, and every frefh dofe makes way for another, till the un- happy wretch becomes a flave to the bottle, and at length falls a Sacrifice to what at firft perhaps was taken only as a medicine. No man is fo dejeaed as the drunkard when his debauch is gone off. Thofe who have the greateft flow of fpirits while the glafs circu- lates freely, are of all others the moft melancholy when fober, and often put an end to their exiftence in a fit of fpleen or ill humour. Drunkennefs not only proves deftruaive to health, but likewife to tlie faculties of the mind. It is flrange that creatures who value themfelves on a fuperior degree of reafon to that of brutes, fhould take pleafure in finking fo far below them. Were fuch as volun- tarily deprive themfelves of the ufe of reafon, to continue ever *• We may form fome notion of the immenfe quantity of ardent fpL rits confumed in Britain from this circumftance, that in the city of Edin.. burgh and its environs, bffides the great quantity of foreign fpirits diily entered, and the ftill greater quantity jvhich is fuppofed to be fmnggled, it is computed that above twothoufimd private Kills are conftantly em- ployed in preparing a poifonous liquor called mobiles. The common people have got fa unlverfally into the habit of drinking' this bafe fpirit, that#vhen a porter or labourer is feen reeling along the ftreets, they fay, he has got raolafled. §2 OF .CLEANLINESS. after in that condition, it would feem but a juft pumflimenfc TlK.ugh this be not the confluence of one act of intoxication, it feldom fails to iueceed a courie of it. By a habit of drinking, the great ft genius is often reduced fo a mere idiot - IntoxiWjon is peculiarly hurtful ro young perfons. It heats their blood, impairs ttu-ir ftrength, and obftruas their growth ; befides, the frequent ufe of ftrong liquors in the eirly part or life deftroys any benefit that might arifc from them ,i;tcrwards. I hefe who make a practice of drinking generous liquors v. hen young, cannot expert to reap any benefit from them as a cordial in the decline of life. Drunkennefs is not only in itfelf amoft abominab1? vice, but is an inducement to many others. There is hardly any crime fc horrid that the drunkard will not perpetrate for the love of liquor. We have known mothers fell their children's clothes, the iood thit they fhould have ate, and afterwards even the infants themfelves, in order to purchafe the draught. CHAPTER VIII. Of Cleanlinefs. THE want of cleanlinefs admits of no excufe. Where water can be had for nothing, every perfon can be clean. The continual difcharge from our bodies by perfpiration, renders fre- quent change of apparel neceffary. changing apparel greatly pro- motes the fecretion from the fkin, fo neceffary for health. When that matter which ought to be carried off by perfpiration, is either retained in the body, or reforbed from dirty clothes, it muft occa- fion difeafes. Difeafes of the fkin are chiefly owing to want of eleanlinefs-h They may indeed be caught by iftfeaion, or brought on by poor 4f It is amazing that improvements in arts, learning, and politenefs, have not put the barbarous cuftom of drinking to excefs out of fafhion. It is indeed lefs common in South Britain, than it was formerly ; butit ftill prevails very much in the North, where this relic of barbarity is miftaken for hofpitality. There no man is fuppofed to entertain his guefts well, who does not make them drunk. Forcing people to drink, is certainly the greateft piece of rudenefs that any man can be guilty of. Manlinefs, compiaifance, or mere good-natin e may induce a man to take his glafs, if urged to it, at a time when he might as well take poifcii. The cuftom of drinking to excefs has long been out of fafhion in France; and, as it begins to lofe ground among the politer part of the Englifli, we hope it will foon be banifhed from every part of this ifland. f Mr. Pot, in. his furgical obfervations, mentions a difeafe which he cails the chimney-fweepers cancer, as it is almoft peculiar to that un- happy fet of people. 1 his he attributes to neglect of cleanlinefs, and with great.jullice. I am convinced, if that part of the body whichjs the feat of this cruel difeafe was kept clean by frequent warning, itwouW never happen. OF CLEANLINESS. 83 living, unwholefome food, &c. but they will feldom continue long where cleanlinefs prevails. To the fame caufe muft We impute the various kinds of vermin which infeft the human body, houfes, &c. lhefe may always be banifhed by cleanlinefs alone, and wherever they abound we have reafon to believe it is neglected. One common caufe of putrid and malignant fevers is the want of cleanlinefs. Thefe fevers commonly begin among the inhabi- tants of c'ofe dirty houfes, who breathe unwholefome air, take lit- tle exercife, and wear dirty clothes. There the infeaion is gene- rally hatched, which often fpreads far and wide, to the definition of many. Hence cleanlinefs may be con fidered as an objea of pub- lic attention. It is not fufficient that I be clean myfelf, while the want of it in my neighbour affects my health as well as his own. If dirty people cannot he removed as a common nuifance, they ought at leaft to be avoided as infeaious. All who regard their health fhould keep at a diftance even from their habitations. In places where great numbers of people are colleaed, cleanli- nefs becomes of the greateft importance.. It is well known that in- feaious difeafes are communicated by tainted air. Every thing, therefore, which tends to pollute the air, or fpread the infeaion, ought with the utmoft aire to be guarded againft. For this reafon, in great towns, no filth of any kind, fhould be permitted to lie up- on the ftreets. Nothing is more apt to convey infeaion than the excrements of the difeafed. In many great towns the ftreets are little better than dunghills, being frequently covered with afhes, dung, and naftinefs of every kind. Even flaughter-houfes, or killing-fhambles are ofjen to be feen in the very centre of great towns. The putrid blood, excre- ments, &c. with which thefe places are generally covered, cannot fail to taint the air, and render it unwholefome. How eafily nu^ht this be prevented by aaive magistrates, who have it always in their power to make proper laws relative to things of this nature; and to enforce the obfervance of them ! We are forry, that the importance of general cleanlinefs, does not feem to be fufficiently vnderftood by die magiftrates of moft great towns in Britain ; though health, pleafure, and delicacy, all confpire to recommend an attention to it. Nothing can be more agreeable to the fenfes, more to the honour of the inhabitants, or more conducive to their health, than a clean town ; nor can any thing imprefs a ftranger with a more difrefpeaful idea of any peo- ple, than its oppofite. Whatever pretentions people may make to learning, poiitenefs, or civilization, while they neglea cleanlinefs, they are in a ftate of barbarity*, * In ancient Rome the greateft men did not think cleanlinefs an flbjeft unworthy of their attention. Pliny fays, the Cloaca;, or com- mon fewer-, for the conveyance of filth and naftinefs from the city, were the greateft of all the public works ; and bellows higher encomiums up- ion Tarquinius, Agrippa, and others who made and improved them, than on thofe who atchieved the greateft conquefts, 84 OF CLEANLINESS. The peafants in moft countries hold cleanlinefs in contempt. Were it not for the open fituation of their houfes, they would often feel the bad effeas of this difpofition. One feldom fees a farm-houfe without a dunghill before the door, and frequently the cattle and their mailers lodge under the fame roof. 1 eafants are likewife extremely carelefs with refpea to change of apparel keep- ing their houfes, Sec. clean. This is merely the effea of indolence and a dirty difpofition. Habit may indeed render it lefs difagreea- ble to them, but no habit can ever make it falutary to wear dirty clothes or breathe unwholefome air. In camps, the ftriaeft regard fliould be paid to cleanlinefs. By negligence in this matter, infeaious difeafes are often fpsead . amongft a whole army ; and frequently more die of thefe, than by the fword. The Jews during their encampments in the wilder- nefs, received particular inftruaions with refpea to cleanlinefs*. The rules enjoined them ought to be obferved by all in the like fituation Indeed, the whole fyltem of laws delivered to that peo- ple, has a manifeft tendency to promote cleanlinefs. Whoever confiders the nature of their climate, the difeafes to which they were liable, and their dirty difpofition, will fee the proprietyof fuch laws. In moft eaftern countries, cleanlinefs makes a great part of their religion. The Mahometan, as well as the Jewifh religion, enjoins various bathings, wafhings, and purifications. Thefe might be de- fined to reprefent inward purity ; but they were at the far.re time calculated for the prefervation of health. However whimfical thefe v a dung* mav appear to fome, few things would tend more to pre- vent dileafes than a proper attention to many of them.' Were eve- 1 •-. perfon, for example, after vifiting the fick, handling a dead bo- dy, or touching any thi'»g that might convey infeaion, to wafh before he went into company, or fat down to meat, he would run lefs hazard either of catching the infeaion himfelf, or of commu- nicating it to others. Frequent w a fifing not only removes the filth and fordes which adhere to the fkin, but likewife promotes the perfpiration, braces the body, and enl-vens the fpirits. How refrefhed, how cheerful, and agreeable does one feel on being fhaved, wafhed, and fhifted; efpecially when thefe offices hrve been negleaed longer than ufual! The eaftern cuftom of wafhing the feet, though-lefs neceffary in this country, is a very agreeable piece of cleanlinefs, and contrir butes greatly to the prefervation of health* The fweat and dirt with which thefe parts are frequently covered, cannot fail to ob- ftrua the perfpiration. This piece of cleanlinefs would often pre* ■K '' Thou (halt have a place alfo without the camp, whither thou fhalt go forth abroad ; and thou fhalt have a padd'e upon thy weapon : and it fhall be \ hen thou lhalt eafe thy,felf abroad, thou fhalt dig therewith, and ihalt uirn back, and cover that whichcometh from thee, &G."DeuV Chap, xxiii. ver. 12, 13. OF CLEANLINESS. 85 vent colds and fevers. Were people careful to bathe their feet and legs in lukewarm water at night, after being expofed to cold or wet through the day, they would feldom experience the ill effeas which often proceed from thelc caufes. A proper attention to cleanlinefs is no where more neceffary than on fhipboard. If epidemic;:! diftempersbreakoutthere.no one can be fafe. The beft way to prevent them, is to take care that the whole cqmpany be cleanly in their clothes, bedding, &c. When infeaious difeafes do break out, cleanlinefs is the moft like- ly means to prevent their fpreading and to prevent their returning afterwards, or being convt yed to other places. For this purpofe, the clothes, bedding, &c. of the'fick ought to be carefully wafhed, and fumigated with bivnftone. Infeaion will lodge a long time in dirty clothes, and afterwards break out in the moft terrible man- ner. In places where great numbers of fick people are colleaed to- gether, cleanlinefs ought to be moft religioufly obferved. The very fmell in fuch places is often fufficient to make one fick. It is eafy to imagine what effea that is likely to have upon the difeaf- ed. In an hofpital or infirmary, where cleanlinefs is negleaed, a perfon in perfea health has a greater chance to beeome fick, than a fick perfon has to get well. Few things are more unaccountable than that neglea, or rather dread of cleanlinefs, which appears among thofe who have the care of the fick ; they think it almoft criminal to fuffer any thing that is clean to come near a perfon in a fever, for example, and would rather allow him to wallow in all manner of filth, than change the leaft bit of his linen. If cleanlinefs be neceffary for perfons in health, it is certainly more fofor the fick. Many dif- eafes may be cured by cleanlinefs alone : moft of them might be mitigated by it; and, where it is negleaed, the flighteft diforders are often changed into' the moft malignant. The fame miftaken care which prompted people to prevent the leaft admifhon of frefh air to the fick, feems to have induced them to keep them dirty. Both thefe deftruaive prejudices will, we hope, be foon entirely eradicated. Cleanlinefs is agreeable to our nature. We cannot help approv- ing it in others, even though we praaife it not ourfelves. It fooner attraas our regard than even finery itfeif, and often gains efteem where that fails. It is an ornament to the higheft as well as the lo \eft flation, and cannot be difpenfed with in either. Few vir- tues are of more importance to fociety than general cleanlinefs. It ought to be carefully cultivated every where ; but in populous cities, it fhould be almoft revered*'. ■X- As it is impoffible to be throughly clean without a fufficient quan- tity of water, the magiftrates of great towns mould be particularly at- tentive to this article. Moft great towns in Britain are fo fitnated as jto be eafily fupplied with water j and thofe perfons who w.ilnot make [ 86 ] CHAPTER IX. Of Infcclion. MANY difeafes are infeaious. Every perfon ought, therefore, as far as he can, to avoid all communication with the difeaf- ed. The common practice of vifiting the fick, though often well meant, has many ill confequences. We cannot help blaming fuch as endanger their own or their neighbours' lives by a miftaken friendfhp or an impertinent curiofity. The houfes of the fick, efpecially in the country, are generally crowded from morning till night with idle vintors. It is cuftoma- ry, in fuch places, for fervants and young people to wait upon the Jfick by turns, and even to fit up with them all night. It would be a miracle indeed fliould fuch always efcape. Experience teaches us the danger of this condua. People often catch fevers in this way, and communicate them to others, till at length they become epidemic. It would be thought highly improper, for one who had not had the fmall-pox, to wait upon a patient in that difeafe ; yet many other fevers are almoft as infeaious as the fmall-poxj and not lefs fatal. Some imagine that fevers prove more fatal in villages than in great* towns, for want of proper medical affiftance. This may fometimes be the cafe ; but we think it oftener proceeds from the caufe above-mentioned. Were a plan to be laid down for communicating infeaion, it could not be done more effeauallyfhan by the common method of vifiting the fick. Such visitors nbt only endanger themfelves and their conneaions, but likewife hurt the fick. By crowding the houfe, they render the air unwholefome, and by their private whifpers and difmal countenances disturb the imagination of the patient, and depress his fpirits. Perfons who are ill, efpecially in' fevers, ought to be kept as quiet as poffibie. The fight of ftrange faces, and every thing that diiturbs the mind, hurts them. The common praaice in country places of inviting great num- bers of people to funerals, and crowding them into the fame apart- ment where the corpfe lies, is another way of threading in- feaion. The infeaion does not always die with the patient. Eve- ry thing that comes into eontaa with his body while alive, receives the contagion, and fome of them, as clothes, blankets, &c. will re- tain it for a long time. Perfons who die of infeaious diforders,- a proper uCe of it, after it is brought to their hand, deferve to be punch- ed. The ftreets of great towns, where water can be had, ought to be wafhed every day. This is the only effectual method for keeping them thoroughly clean; and upon trial, we are perfuaded it will be fount* the cheapeft. OF INFECTION. Sy Ought not to lie long unburied ; and people fliould keep as much as poffibie at a diftance from them. it would tend greatly to prevent the fpreading of infeaious dif- fafes, if thofe in health were kept at a proper diftance from the lick. The Jewifh legiflator, among many other wife inftitution3 for preferving health, has been peculiarly' attentive to the means of preventing infeaion, or defilement as it is called, either from a difeafed perfon or a dead body. In many cafes the difeafed were to be feparated from thofe in health ; and it was deemed a crims even to approach their habitations. If a perfon only touched a difeafed or dead body, he was appointed to wafh himfelf in water, and to keep for fome time at a diftance from fociety. Infeaious difeafe&are often communicated by clothes. It is ex- tremely dangerous to wear apparel which h%s been worn by the deceafed, unlefs it has been well wafhed and fumigated, as infec- tion may lodge a long time in it, and afterwards produce very tra- gical effects. This fhows the danger of buying at random the clothes which have been worn by other people. Infeaious diforders are frequently imported. Commerce, toge- ther with the riches of foreign climes, brings their difeafes. Thefe do often more than counterbalance ail the advantages of that trad« by means of which they are introduced. It is to be regretted, that fo little care is commonly beftowed, either to prevent the intro- duaion or fpreading of infeaious maladies. Some attention in- deed is generally paid to the plague; but other difeafes pafs un- regarded*. Infeaion is often fpread through cities, by jails,, hofpitals, &c, Thefe are frequently fituated in the very middle of populous towns; and when infeaious difeafes break out in them, it is impoffible for the inhabitants to efcape. Did magiftrates pay any regard to the health of the people, this evil might be eafily remedied. Many are the caufes which tend to diffufe infeaion through populous cities. The whole atmofphere of a lar.:e town is one con- taminated mafs, abounding with various kinds of infeaion, and muft be pernicious to health. Such as are obliged to live in large cities, ought to choofe an open fituation ; to avoid narrow, dirty* * Were the tenth part of the care taken to prevent the importation of difeafes, that there is to prevent fmupgling, it would be attended with many happy confequences. This might eafily be done by appointing a phyfician at every confiderable fea-port, to infpect the fhip's company, pafrengers, &c. before they came afhore, and, if any fever or-other in- fectious diforder prevailed, to order the fhip to perform a fhort quaran- tine, and to fend the lick to fomehofpital or proper place to be cared. he might likewife order all the clothes, bedelingf &c. which had been nfed by the iick during the voyage, to be either deltroyed, or thoroughly cleanfed by fumigation, &c. before any of it were fent afliore. A fcheme of this kind, if properly conducted, would prevent many fevers, and other infectious difeafes, from being brought by failors into fea-port ipwns, and by this means diffufed ajl over the country. 88 OF INFECTION*. crowded ftreets; to keep their own houfes and offices clean ; and to be as much abroad in the open air as their time v ill' P«mlt* It would tend greatly to prevent the fpreading of infeaiousi du> cafes, were proper nurfes everywhere employed to take care of the fick. This might often fave a family, or even a whole town, from being infeaed by one perfon. Not that people fhould aoandon their friends or relations in diftrefs, but only be on their guard againft being too much in company with thofe who arc affhaed with difeafes of an infeaious nature. Such as wait upon the fick in infeaious difeafes run very great hazard. They fhould fluff their nofes with tobacco, or fome other ftrong fmelling herb, as rue, tanfy, or the like. They ought like- wife to keep the patient very clean, to fprinkle the room where he lies with vinegar, or other ftrong acids, frequently to admit a - ftream of frefh air into it, and to avoid the fmell of his breath as much as they can. They ought never to go into company without? having changed their clothes and wafhed their hands ; otberwife, if the difeafe be infeaious, they will in all probability carry the contagion along with them*. A due attention to thofe things which tend to diffufe infeaion would be of great importance in preventing difeafes. As moft dif- , cafes are in fome degree infeaious, no one fhould continue long with the fick, except the neceffary attendants. I mean not howe- ver, by this caution, to dete.r thofe whofe duty or office leads them to wait upon the fick, from fuch a laudable and neceffary employ- ment. Many things are in the power of the magistrate which would tend to prevent the fpreading of infeaion ; as the promoting of public cleanlinefs; removing jails, hofpitals, burying grounds, and other places where infeaion may be generated, at a proper dif- tance from great towns j ; widening the ftreets ; pulling down ufelefs walls, and taking all methods to promote a free circulation of air through every part of the town, &c. Public hofpitals, Qf proper places of reception for the fick, provided they were kept clean, well ventilated, and placed in an open fituation, would like- wife tend to prevent the -fpreading of infeaion. Such places of 4*. There is reafon to believe that infection is often conveyed froirt , •ne place to another by the carelelfaefs of the faculty themfelves. Many phyficians affect a familiar way of fitting upon ths patient's bedfide,ai5l holding his arm for a considerable time. If the patient has the fmallrpox, or any other infectious difeafe, there is no doubt but the doctor's hands, •iothes, &c will carry away fome of the infection; and, if he goes di- rectly to vifit another patient without wafh'mg his hands, changing his clothes, or being expofed to the open air, which is not feldom the cafe, is it any wonder that he fliould carry the difeafe along with him ? Phy- ficians not only endanger others, but alfo themfelves, by this practice. And indsed they fometimes fuffer for their want of care. t The ancients would not fuffer even the temples..of their gods whore theflck refold, to be built within the walls of at city. OF THE PASSIONS. S9 reception would prevent the poor, when fick, from being vifited by their idle or officious neighbours. They would likewife render it unneceflary for fick fervants to be kept in their matters houfes. Mafters had better pay for having their fervants taken care of in aii hofpital, than run the hazard of having an infeaious difeafe diffu- fed among a numerous family. Sick fervants and poor people; when placed in hofpitals, arc not only lefs apt to diffufe infec- tion among their neighbours, but have likewife the advantage o£ being well attended. We are not, however, to learn that hofpitals, inftead of pre- venting infeaion, may become the means of diffufing it. When they are placed in the middle of great towns ; when numbers of patients are crowded together into fmall apartments; when there is a constant communication kept up between the citizens and the patients ; and when cleanlinefs and ventilation are negleaed, they become nefls for hatching difeafes, and every one who goes into them, not only runs a rifk of receiving infeaion himfelf, but like- wife of communicating it to others. This is not the fault of hof- pitals, but of thofe who have the management of them. It were to be wifheff, that they were both more numerous, and upon a more refpeaable footing, a? that would induce people to go into them with lefs reluaance. f his is the more to be desired, becaufe i-noft of the putrid fevers and other infeaious diforders break out among the poor, and are by them communicated to the better fort. Were proper attention paid to the firft appearances of fuch diforders* and the patients early conveyed to an hofpital, we fhould feldom fee a putrid fever, which is almoft as infeaious as the plague, become epidemic. CHAPTER X. Of the Paffions. ripHE paffions have great influence both in the caufe and cure A of difeafes. How the mind affeas the body, will, in all proba- bility ever remain a fecret. It is fufficient for us to know, that there is eftablifhed reciprocal influence between the mental and corpo- real parts, and that whatever injures the one, diforders the other. Of Anger. THE paffion of anger ruffles the mind, diftorts the countenance, hurries on the circulation of the blood, and diforders.the whob vital and animal funaions. It often occafions fevers, and other acute difeafes ; and fometimes even fudden death. This paffion M - 9© OF THE PASSIONS. is peculiarly hurtful to the delicate, and thofe or weak nerves", Such perfon6 frequently lofe their lives by a violent fie of anger, and I would advife them to guard againft the excefs of this paffion with the utmoft care. It is not indeed always in our power to prevent being angryj but we may furely avoid harbouring refentment in our breaft. Re- fentmer.t preys upon the mind, and occafions the moft obftinate chronical diforders which gradually wafte the conftitution. Nothing fhows true greatnefs of mind more than to forgive injuries ; it promotes the peace of fociety, and greatly conduces to our own eafe, health, and felicity. Such as value health fliould avoid violent gufts of anger, as they would the moft deadly poifon. Neither ought they to indulge re- fentment, but to endeavour at all times to keep their minds calm and ferene. Nothing tends fo much to the health of "the body as a conftant tranquillity of mind. Of Fear. THE influence of fear, both in occafion ing and aggravating difeafes, is very great. No man ought to be blamed for a decent concern about life ; but too great a defire to preferve it is often the caufe o£ lofing it. Fear and anxiety, by depreffing the fpirits, not only difpofe us to difeafes, but often render thofe difeafes fatal which an undaunted mind would overcome. Sudden fear has generally violent effeas. Epileptic fits, and* other convulfive diforders, are often occafioned by it. Hence the danger of that praaice, fo common among young people, of frightening one another. Many have loft their lives, and others have been rendered mifeiable, by frolics of this kind. It is dange- rous 'to tamper with the human paffions. The mind may eafily be thrown into fuch diforder as never again to aa with regularity. But the gradual efleas of fear prove more hurtful. Thl con- ftant dread of fome future evil, by dwelling upon the, mind, often occafions the very evil itfelf. Hence it comes to pats, that fo many die of thofe very difeafes of which they long had a dread, or vi hich. had been impreffed on their minds by fome accident, or foolifh prediaion. '4 his, for example, is often the cafe with women in child-bed. Many of thofe who die in that fituation are impreffed with the notion of their death a long time before it happens ; and there is reafon to believe that this impreffion is often the caufe of it. The methods taken to imprefs the minds of women with ap- prehenfions of tlje great pain and peril of child-birth, are very hurtful. Fewv.'omen die in labour, though many lofe their lives after it; which may be thug accounted for. A woman after deli- OF THE PASSIONS. . / 91 very, finding hcrfelf weak and exhaufted, immediately apprehends fhe is in danger ; but this fear feldom fails to obftrucl the neceffa- ry evacuations, upon which her recovery depends. Thus, the fex often fall a facrifice to their own imaginations, when there would be no danger, did they apprehend none. It feldom happens that two or three women in a.great town die in child-bed, but their death is followed by many others. Every woman of their acquaintance who is with' child dreads the fame fate, and the difeafe becomes epidemical by the mere force of inva- gination. This fhculd indues pregnant women to defpife fear, end by all means to avoid thofe tattling goffips who are continually buzzing in their ears the misfortunes of others. Every thing that may in the leaft alarm a pregnant or child-bed woman, omdit with the greateft care to be guarded againft. Many women have loft their lives in child-bed by the old fu- perftitious cuftom, ftill kept up in moft parts of Britain, of tolling the parifh bell for every perfon who dies. People who think them- felves in danger are very incpfifitive .; and if they come to know that the bell tolls for one who died in the fame fituation with themfelves, what muft be the confequence ? At any rate they are apt to fuppofe that this is the cafe, and it will often be found a dif- ficult matter to peffuade them of the contrary. But this cuftom is not pernicious to'child-bed women only. It is hurtful in many other cafes. When low fevers, in which it is difficult to fupport the patient's fpirits, prevail, what muft be the effsct of a funeral peal founding five or fix times a day i"» his ears? No doubt his imagination will fu^gell that others died of the dif- eafe under which he labours. This apprehenfion will have a great- er tendency to deprefs his fpirits, than all the cordials of medicine will have to raife them. If we have not fenfe enough to abolifh this ufelefs piece of cere- mony, we ought to keep the fick as much from hearing it as poffibie, and from every other thing that may tend to alarm them. So far however is this from being generally attended to, that many make it their bufinefs tovifit the fick, on purpofe to whifper difmal ito- ries in their ears. Such may pafs for fympath;.zin;j; friends, but they are their enemies. All who with well to the fick ought to keep fuch perfons at the greateft diftance from them. A cuftom has long prevailed among phyficians, of prognofti- cating, or foretelling the iffue of the difeafe. Vanity introduced this praaice, and ftill fupports it in fpite of common fenfe and the fafety of mankind. I have known a ph fician barbarous enough to boaft, that he pronounced more fentences than all his Majefty's judges. Would to God that fuch fentences were not often equal- ly fatal ! It may indeed be alleged, that the doaor does not de- clare his opinion before the patient. So much the wcrfe. A fenfi- ,ble patient had better hear what the doaor fays, than learn it from )the difconfolate looks, the watery eyes, and the broken wh::peri 52 OF THE PASSIONS. of thofe about him. It feldom happens, when the d.aor gives an unfavourable opinion, that it C3n be concealed from the patient. The very embarraffment which the friends and attendants fhow in difguifing what he has faid, is generally fufficient to difcover the truth. Heaven has concealed from mortals their fate ; and we do not fee what right any man has to announce the death of another, ef- pecially if fuch a declaration has a chance to kill him. Mankind are indeed very fond of prying into future events, and feldom fail to folicit the phyfician for his opinion. A doubtful anfwer, or one that may tend rather to encourage the hopes of the fick, is lurely the moft fafe. This condua could neither hurt the patient nor the phyfician. Nothing tends more to deftroy the credit of phyfic than thofe bold prognofticators, who by fhe bye, are generally the moft ignorant of the faculty. The miftakes which daily happen in this way are fo many flanding proofs of human vanity, and the weak- nefs of fcience. There are cafes where the phyfician ought to give intimation of the patient's danger to fome of his near conneaions ; though even this ought always to be done with the greateft caution : but it ne- ver can be neceffary in any cafe that the whole town and country fhould know, immediately after the doaor has made his firft vifit, that he has no hopes of his patient's recovery. Perfons whofe im- pertinent curiofity leads them to queftion the phyfician with regard to the fate of his patient, deferve no anfwer. The vanity of foretelling the fate of the fick is not peculiar to the faculty. Others follow their example, and thofe who think themfelves wifer than their neighbours often do much hurt in this way. Humanity furely calls upon every one to comfort the fick, and not to add to their affliaion by alarming their fears. A friend, or even a phyfician, may often do more good by a mild and fym- pathizing behaviour than by medicine, and fhould never neglect to adminifter that greateft of all cordials, Hope. Of Grief. GRIEF is the moft deftruaive of all the paffions.- Its effeas arc permanent, and when it finks deep into the mind, it generally proves fatal. Anger and fear, being of a more violent nature, fel- ' dom laft long; but grief often changes into a fixed melancholy, which preys upon the fpirits, and waftes the conftitution. This paffion ought not to be indulged. It may generally be conqueied at the beginning; but when it has gained ftrength, all attempts to remove it are vain. No perfon can prevent misfortunes in life ; but it fhows true greatsefs of mind to bear them v.ith ftrenity. Many perfons make OF THE PASSIONS. 93 a merit of indulging grief, and when misfortunes happen, they obftinately refufe all confolation, till the mind, overwhelmed with melancholy, finks under the load. Such condua is not only de- ftruaive to health, but inconfiftent with reafon, religion, and com- mon fenfe. Change of ideas is as neceffary for health as change of poflure. When the mind dwells long upon one fubjea, efpecially of a dif- agreeable nature, it hurts the whole funaions of the body. Grief indulged fpoils the digeftion and deftroys the appetite ; hence the fpirits are depreffed, the nerves relaxed, the bowels inflated with" wind, and the humours, for want of frefh fupplies of chyle, vitia- ted. Many an excellent conftitution has been ruined by a family- misfortune, or any thing that occafions exceffive grief. It is utterly impoffible, that any perfon of a dejeaed mind fliould enjoy health. Life may indeed be dragged out for a few years : but whoever would live to a good old a^e, muft be good- humoured and cheerful. This indeed is not altogether in our own power; yu our temper of mind, as well as our aaions, de- pends greatly upon ourfelves. We can either affociate with cheer- ful or melancholy companions, mingle in the amufements and oifices of life, or fit ftill and brood over our calamities as we choofe. Thefe, and many fuch things, are certainly in our power, and from thefe the mind generally,takes its caft. The variety of fcenes which prefent themfelves to the fenfes, were certainly defigned to prevent our attention from being too long fixed upon any one objea. • Nature abounds with variety, and the mind, unlefs fixed down by habit, delights in contempla- ting new obje£s. This at once points out the method of reliev- ing the mind in diftrefs. Turn the attention frequently to new objeas. Examinp them for fome time. When the mind begins to recoil, fhift the fcene. By this means^a conftant fucceffion of _ new ideas may be kept up, till the difagreeable ones entirely difap- pear. Thus travelling, the ftudy of any art or fcience, reading or writing on fuch iubjeas as deeply engage the attention, will fooner expel grief than the moft fprightly amufements. As the body cannot be healthly unlefs it be exercifed; neither can the mind. Indolence nourifhes grief. When the mind has no- thing elfe to think of but calamities, no wonder that it dwells there. Few people who purfue bufinefs with attention are hurt by grief. Inftead therefore of abftraaing ourfelves from the world or bufi- nefs, when misfortunes happen, we ought to engage in it with more than ufual attention, to difcharge with double diligence the" funaions of our ftation, and to mix with friends of a cheerful and focial temper. Innocent amufements are not to be negleaed. Thefe, by lead- ing the mind infenfibly to the contemplation of agreeable objeas, help to difpe! the gloom which misfortunes caft over it. They make time fi^m lefs tedious, and have many other happy effeas. q4 OF THE PASSIONS. , "Some perfons, when overwhelmed with grief, betake themfclvos to drinking. This is m-.king the cure worfe than the dileau..it feldom fails to end in the ruin of fortune, charafter, and conlti- tutioa. Of Love. r LOVE is perhaps the ftrongeft of all the paffions; at leaft, when it becomes violent, it is lefs fubjea to the controul either of the underftanding or will, than any of the reft. Fear, anger, and feve- ral other paffions are neceffary for the prefervation of the indivi- dual, but love is neceffary for the continuation of the fpecies ltklt: It was therefore proper that this paffion fhould be deeply rooted in .the human breaft. . ' ...» Though love be a ftrong paffion, it is feldom fo rapid in its pro- grefs as feveral of the others. Few perfons fall defperately in love all-at-once. We would therefore advife eyery one, before he tam- pers with this paffion, to confider well the probability of his being able to obtain the objea of his love. When that is not likely, he fhould avoid every occafion of increasing it. He ought immediate- ly .to fly the c.ompany of the beloved objea ; to apply his mind attentively to bufinefs or ftudy ; to take every kind of amufement; and above all, to dndeavour, if poffibie, to find another objea which may engage his affeaions, and which it may be in his power to obtain. There is no paffion with which people is fo ready tatamper as love, although none is more dangerous. Some men make love for amufe- ment, others from mere vanity, or on purpofe to fhow their confe- quence with the fair. This is perhaps the greateft piece of cruel- ty, which any one can be guilty of. What we eagerly wifh for we eafily credit. Hence, the too credulous fair are often betrayed into a fituation wich is truly deplorable, before they are able to difcover that the pretended lover was only in jeft. But there is no jelling with this paffion. When love has got to a certain height, it admits of no other cure but the poffeffion of its objea, which in this, cafe ought always if poffibie to be obtained*. ■3f The conduct of parents with regard to the difpofal of their chil- dren in marriage is often very blameable,. An advantageous matchis the constant aim of parents ; while their children often fuflvr a real mar- tyrdom betwixt their inclinations and duty. The firll thing which pa- rents ought to confult in difpoling of their children in marriage, is cer- tainly their inclinations. Were due regard always paid to ihefe, there would be fewer unhappy couples, and parents would not have fo often caufe to repent the feverity of their conduct, after a ruined conftitution, a loft character, or a diftractcd mind, has fhown themth^'r inifhke. [ 95 ] Of Religious Melancholy. MANY perfons of a religious turn of mind behave as if they thought it a crime to be cheerful. They imagine the whole of re- ligion confifts in certain mortifications, or denying themfelves the fmalleft indulgence, even of the moft innocent* amufements. A perpetual gloom hangs over their countenances, while the deepest melancholy preys upon their minds. At length the faireft profpeas vanifh, every thing puts on a difmal appearance, and thofe very objeas, which ought to give delight, afford nothing but difguft. Life itfelf becomes a burden, and the unhappy wretch, perfuaded that no evil can equal what he feels, often puts an end to his own -exiltence. Perfons whofe bufinefs it is to recommend religion ,to others, fiiould beware of dwelling too much on gloomy fubjects. That peace and tranquillity of mind, which true religion is calculated to irifpire, is a more powerful argument in its favour, than all the ter- rors that can be uttered. Terror may indeed deter men from out- ward aa$ of wickednefi-, but can never infpire them with that love of God, and real goodnefs of heart, in which alone true religion confifts. The beft way to counteraa the violence of any paffion, is to keep the mind clofely engaged in fome ufeful purfuit. CHAPTER XI. Of the Common Evacu.iiisns. THE principal evacuations from th'e human body are thofe by ftool, urine and infeufible perfpiration. None of thefe can be long obftruaed without impairing health. When that which ought to be thrown out of the body is too long retained, it occa-j fions a plethora, or too great fulnefs of the veffels. Of the Evacuation by Stool. FEW things conduce more to health than keeping the body re- gular. When the- fceees lie too long in the bowels, they vitiate the humours; and when they are too foon difcharged, the body is not fufficiently nourifhed. A medium is to be defired, which" can only be obtained by regularity in diet, fleep and exercife. Whenever the body is not regular, there is reafon to fufpea a fault in onepr other of thefe. ' Perfons who eat and diink at irregular hours, and who eat vari- r}6 OF THE COMMON EVACUATIONS. ous kinds of food, and drink of feveral different liquors at every meal, have no reafon to expea either that their digeftion will be good, or their difcharges regular. Irregularity in eating and drink- ing, difturbs everv part of the animal ceconomy, and never tails to occafion difeafes. Either too much or too little food will have this effea. The former indeed generally occafions loofeneis, and the latter coftivenefs ; but both have a tendency to hurt the health. It wouldbe difficult to afcertain the exaa number of ftools which may be confifteiu with health, as thefe differ in the different pe- riods of life, in different conftitutions, and even in the fame con- ftitution under a different regimen of diet, exercife, &c. It is how- ever generally allowed, that one ftool a-day is fufficient for an adult, and that lefs is hurtful. But this, like moft general rules, admits of many exceptions. I have known perfons in perfea health who did not go to ftool above once a-week. Such a degree of cof- tivenefs is not fafe ; though the perfon who labours under it may for fome time enjoy tolerable health, yet at length it may occafion. difeafes. ' One method of procuring a ftool every day is to rife betin. -s, and go abroad in the open air. Not only the poflure in bed is unfavour- able, to regular ftools, but alfo the warmth, l his, by promoting the perfpiration, leffens all the other difcharges. The method recommended for this purpofe by Mr. Locke, is likewife very proper, viz. to folicit Nature, by going regularly to ftool, every morning whether one h^s a call or not. Habits of.this kind may be acquired, which will in time become natural. Perfons who have frequent recourfe to medicines for preventing coftivenefs, feldom fail to ruin their conftitutions. Purging medi« cines frequently repeated, weaken the bowels, hurt the digeftion,' and every dofe makes way for another, till at length they become as neceffary as daily bread. Thofe who are troubled with coftive- nefs, ought rather, if poffibie, to remove it by diet than drugs'. They fliould go thinly clothed, and avoid every thing of an aftrin- gent or heating nature. The diet and other regimen neceffary in this cafe, will be found under the article Coftivenefs, where thisf ftate of the bowels is treated as a difeafe. Such perfons as are troubled with a habitual loofenefs ought likewife to fuit their diet to the nature of their complaint. They fhould ufe.food which braces and strengthens the bowels, and. which is rather of an astringent quality, as wheat-bread made of the fineft flour, cheefe, eggs, rice boiled in milk, &c. Their. drink fhould be red-port, claret, brandy and water, in which toafted bread has been boiled, arid fuch like. As an habitual loofenefs is often owing to an obflruaed perfpi- ration, perfons affeaed with it ought to keep their feet warm, to wear flannel next their fkin, and take every other method to pro- mote the perfpiration. Further direaions, with regard to th« treatment of this complaint, will be found under the article Loofepfi C 97 .3 Of Urine. SO many things tend to change both the quantity and appear- ances of the urine, that it is very difficult to lay down any deter- mined rules for judging of either*. Dr. Cheyne fays, the Urine ought to be equal to three-fourths of the liquid part of our aliment. But fuppofe anyone were to take the trouble of meafiuing both, he would find, that every thing which altered the degree of per- fpiration, would alter this proportion, and likewife, that different kinds of aliment would afford very different quantities of urine. For thefe, and other reafons, no rule can be given for judging of the precife quantity of urine which ought to be difcharged, yet a perfon of common fenfe will feldom be at a lofs to know when it is in either extreme. As a free difcharge of urine not only prevents, but aaually cures', many difeafes, it ought, by all means, to be promoted ; and every thing that may obflrudt it fliould be carefully avoided. Both the fecretion and difcharge of urine are. leffencd by a fedentary life, fleeping on beds that arc too foft and warm, food of a dry and heating quality, liquors which are astringent and heating, as red- port, claret, and fuch like. Thofe who fufpea that their urine is in too, fmall quantity, or who have any fymptoms of the gravel, ought to avoid thefe things, and whatever elfe has a tendency to leffen the quantity of their urine. When the urine is too long retained, it is-not only re-abforbed or taken up again into the mafs of fluids, but, by ftagnating in the bladder, it becomes thicker, the more watry parts flying off firft, and the more grofs and earthy remaining behind. By the conftant tendency which thefe have to concrete, the formation of flones and gravel in the bladder is promoted. Hence, indolent and fedentary people are much more liable to thefe difeafes, than perfons of a more aaive life. •X- It has long been an obfervation among phyficians, that the ap- pearances of the urine are very uncertain, and very little to be depeii-. (led on. No one will be furprifed at this, who confiders how many ways it may be affected, and confequently have its appearance altered. The pallions, the ftate of the atmofphere, the quantity and quality of the food, the exercife, the clothing, the ftate of the other evacuations, and numberlefs other caufes, arefufficient to induce a change either in the quantity or appearance of the- urine. Any one who attends to this, will be aftoniflied at the impudence of thofe daring quacks, who pretend to find out difeafes, and prefcribe to patients from the bareinfpection of their urine. Thefe iinpoftors, however, are very common all over Britain, and by the amazing credulity of the populace, many of them arnafs con- liderable fortunes. Of all the medical prejudices which prevail in this country, that in favour of urine-doctors is theftrongeft. The common people have ftill an unlimited faith in their fkill, although it has been demonstrated that no one of them is able to diftingujfh. the urine of a horfe, or any other animal, from that ®f a man. N 93 OF THE COMMON EVACUATIONS. ~~Manv perfons have loft their lives, and others have brought on very tedious, and even incurable diforders, by retaining their urine too long, from a falfe delicacy. When the bladder has been over- diftended, it often loofes its power of aaion altogether, or be- comes paralytic, and is rendered unablo either to retain the urine, or expel it properly. The calls of nature on-ht never to be poft- ppned. Delicacy is a virtue ; but th.it can never be reckoned true delicacy, which induces anyone to rifle his health or hazard his life. Urine may be in too great as well as too fmall a quantity, by drinking large quantities of weak watery liquors, by the exceffivc ufe of alkaline falts, or any thing that ftimulates the kidnies, di- lutes the blood,' &c. This diforder very foon weakens the body, and induces a confumption. It is difficult to cure, but may be mitigated by ftrenghtening diet and aftringent medicines, fuch are recommended under the article Diabetes. Of the Perfpiration. INSENSIBLE perfpiration is generally reckoned the greateft of all the difcharges from the human body. It h of fo great impor- tance to health, that few difeafes attack us while it goes properly en; but when it is obftruacd, the whole frame is foon difordered. This difcharge, however, being lets perceptible than any of the reft, is confequently lefs attended to. Hence, acute fevers, rheu- matifms, agues, Z:c. often proceed from obftruaed perfpiration ^ before we are aware of its having taken place. On examining patients, we find moft of them impute their difeafes either to violent colds which they had caught, or to flight ones which had been negleaed. For this reafon, inftead of a cnticaiinquiryinto the nature of the perfpiration, its difference in different fcafons, climates, conftitutions, &c. we fhall endea- vour to point out the caufes which moft commonly obftrua it, and to fhow how far they may be either avoided, or have their influence counteraacd by timely care. The want of a dye ah tention to thefe, cofis Britain annually fome thoufands of ufeful lives. . \ Changes in the Atmofphere. ONE of the moft common caufes of obftruaed perfpiration, or catching cold, in this country, is the changeablenefs of the wea- ther, or ftate of the atmofphere. There is no place where fuch changes happen more frequently than in Britain. With us, the degrees of heat and cold are not only very different in the differ- ^ OF THE COMMON EVACUATIONS. 99 ciit feafons of the year, but often change almoft frqm one extreme to another in a fewdavs, and, fometimes even in the courfe of one day. That fuch changes muft affea the ftate of the perfpiration is obvious to every one*. The beft method of fortifying the body againft the change?, of the weather, is to be abroad every day. Thofe who keep moft withm doors are moft liable to catch cold- Such perfons generallv render them5 Ives fo delicate as to feel even the flighteft changes in the atmofphere, and by their pnns, coughs, and opprefilons of the breaft, &c. they become a kind of living barometers*. < JTet Clothes* WET clothes not only by inch- coldnefs obftrua the pcrfpiratiorr, •hut their moisture, by being aoforbed, or taken up into the body, greatly increafes the danger. The moft robuft conftitution is not proof againft the danger'arising from wet clothes ; they daily oc- cafion fevers, rheumatifms, and other fatal dilbrderc, even in the young and-beaky. / It is impoffible for people who go frequently abroad, to avoid fometimes being wet. But the danger might generally be leflened, if not wholly prevented* by chauging their clothes foon ; when this cannot be done, they fliould keep in motion till they be dry. So far are many from taking this precaution, that they often fit or lie down in the fiekh with their clothes wet, and frequently fleep even whole nights in this condition. The frequent inftances which we have of the fatal effeas of this condua, ouoht to deter others from being guilty of it. Wet Feel. EVEN wet feet often occafion fatal difeafes. The cholic, inflam- mations of the breaft and 6f the bowels, the iliac paffion, cholera. morbus, Sec. are often occafioned by wet feet. Habit will render this lefs dangerous; but it ought, as far as poflible, to be avoided. The delicate, and thofe who are not accuftomed to have their clothes or feet wet, fhould be peculiarly careful in this refpea. * I never knew a more remarkable inftance of the uncertainty of r'.e weather in this country, than happened while I was writing thefe- notes. This morning, Augult 14, 1783, the thermometer in the (hade was. down at fifty-three degrees, and a very few days ago it ftood above eighty. "No one who reflects on fuch great and fudden changes in the atmofphere, will be furprifed, to find colds, cough:?,' rheums, with other affections af the breaft and bowels, fo coinuioj*,' Ui this country. £ 103 ] Night Air. THE perfpiration is often obftruaed by night-air ; even in fum- mer, this ought to be avoided. The dews which fall plentifully af- ter the hotteft day, make the night more dangerous than when the weather is cool. Hence, in warm countries, the evening-dews are more hurtful than where the climate is more temperate. It is very agreeable after a warm day, to be abroad in the cool evening ; but this is a pleafure to be avoided by all who value their health. The effeas of evening-dews are gradual indeed, and almoft imperceptible ; but they are not the lefs to be dreaded: We therefore advife travellers, labourers, and all who are much heated by day, carefully to avoid them. When the perfpiration has been great, thefe become dangerous in proportion. By not at- tending to this, in flat marfhy countries, where the exhalations and dews are copious, labourers are often feized with intermitting fe- vers, quinfeys, and other dangerous difeafes. Damp Beds. BEDS become damp,either from their not being ufed, {landing in damp houfes, or in rooms without fire. Nothing is more to be dreaded by travellers than damp beds, which are very common in all places where fuel is fcarce. When a traveller, cold and-wet;' arrives at an inn, he may, by means of a good five, warm diluting liquor, and a dry bed, have the perfpiration restored ; but if he be put into a cold room, and laid on a damp bed, it will be more ob- ftruaed, and the worft confequences will enfue. Travellers fhould avoid inns which are noted for damp beds, as they would a houfe anfefted with the plague, as no man, however robuft, is proof againft the danger arising from them. But inns are not the only places where damp beds are to be met with. Beds kept in private families for the reception of flrangers are often equally dangerous. All kinds of linen and bedding, when 3iot frequently ufed, become damp. How then is it poffibie that beds, which are not flept in above two or three times a year, fhould ht Me ? Nothing is more common than to hear people complanl of having caught cold by changing their bed. The reafon is obvi- ous : Were they careful never to fleep in a bed but what was fre- quently ufed, they would feldom find any ill confequences from a change. Nothing is more to be dreaded by a delicate perfon, when on a vifit,than being laid in a bed which is kept on purpofe for flrangers. That ill-judged piece of complaifance becomes a real injury All OF THE COMMON EVACUATIONS. ior the bad confequences from this quarter might eafily be prevented in private families, by caufing their fervants to fleep in the fpare- heds, and refign them to ftrangers when they come. In inns, where the beds are ufed almoft every night, nothing elfe is neceffary than to keep the rooms well feafoned by frequent fires, and the linen dry. That baneful cuftom, faid to be praaifed in many inns, pf damping fheets, and preffing them, in order to fave waffling, and afterwards laying them on the beds, ought, when difcovered, to be punifhed with feverity. It is really a fpecies of murder, aild will often prove as fatal as poifon or gun-fhot. Indeed, no linen, efpecially if it has been waftied in winter, ought to be ufed until it has been expofed for fome-time to the fire ; nor is this opera- tion lefs neceffary for linen wafhed in fummer, if it has lain by for any length of time. This caution is the more needful, as gen- tlemen are often exceedingly attentive to what they eat or drink at an inn, yet pay little regard to a circumstance of more importance*. , Damp Houfes FREQUENTLY produce the like ill-confequences ; for this reafon, thofe who build,fliould be careful to choofe a dry fituation. A houfe which flands on a damp, marfhy foil or deep clay, will ne- ver be thoroughly, dry. All houfes, unlefs where the ground is ex- ceeding dry, fhould have the firft floor a little raifed. Servants and others, who are obliged to live in cellars and funk ftories, fel- dom continue long in health : Mailers ought furely to pa y fome regard to the health of their fervants, as well as to their own. Nothing is more common than for people, merely to avoid fome trifling inconveniency, to hazard their lives, by inhabiting a houfe almoft as foon as the mafons, plasterers, &c. have done with it': Such houfes are not only dangerous from their dampnefs, but like- wife from the fmell of lime, paint, &c. The afthmas, confump- tions, and other difeafes of the lungs, fo incident to people who work in thefe articles, are fufficient proofs of their being unwhok- fomq. Rooms are often rendered damp by an unfeafonable piece of cleanlinefs ; I mean the pernicious cuftom of wafbiug them imme- diately before company is put into them. Moft people catch cold, if they fit but a very fhort time in a room that has been lately wafh- * If a perfon fufpects that his bed is damp, the (imple precaution of taking oft the fheets and lying in the blankets, with all, or moft of his Clothes.on, will prevent all danger. I have praftiftd tlib for many years, and never have been hurt by damp beds ; though no conititution, without care, is proof a-gainft their baneful influence. ro:r OF THE COMMON EVACUATIONS. ed ; the delicate ought carefully to avoid fuch a fituation, and cve.i fclne robuft are not always proof againft its influence*. Sudden Tranfitions from Heat to Cold. , ' PERSPIRATION is frequently obftruaed by fudden tranfi- tions from heat to cold. Colds are feldom caught,unlefs when peo-* pie have been too much heated. Heat rarifies the blood, quickens the circulation, and increafes the perfpiration ; but when thefe are fuddenly checked, the confequences muft be bad. It is impoffible for labourers not to be too hot upon fome occafions ; but it is ge- nerally in their power to let themfelves cool gradually, to put on their clothes when they leave off work, to make choice of a dry- place to reft themfelves in, and to avoid flecping in the open fields. Thefe eafy rules, if obferved, would often prevent fevers and other fatal diforders. it is very common for people, when hot, to drink freely of cold water, or fmall liquors. This coudua is extremely dangerous. Thirft indeed is hard to bear, frequently gets tlie better of reafon, and makes us do what our judgment disapproves. Every peafant, however, knows, if his hori'e be permitted to drink 'his belly-full of s cold water after violent exercife, and be immediately put into the liable, or fuffercd to remain at reft, that it will kill him. This they take the utmoft care to prevent. It were well if they were equally attentive to their own fafety. Thirft may be c.uenched many ways without fwallowing large quantities of cold liquor. The fields afford a variety of acid fruits and plants, the very chewing of which would abate thirft. Water kept in the mouth for fome time, and fpit out again, if frequently, repeated, will have the fame effea. If a bit of bread beeaten along" with a few mouthfuls of water, it will both quench thirft mord effeaually, and make the danger lefs. When a perfon is extreme- ly hot, a mouthful of brandy, or other fpirits, if it can be obtained, ought to be preferred to any thing elfe. But if any one has been fo foohfh, when hot, a.s to drink freely" of cold liquor, he ought to continue his exercife at leaft, till what he drank be thoroughly warmed upon his ftomach. It would be tedious to enumerate aft the bad effeas which flow from drinking cold liquors when the body is hot. Sometimes this has occafioned immediate death. Hoarfeneis, quinfeys, and fevers of various kinds, are its common confequences. Neither is it fafc *n.P1°Pie.i"LaEin-e' if a S°od fire ^ made in a room, after it has been warned, that there » no danger from fitting in it V hut this increlfes the danger. 1 he evaporation excited by the fire generates cold, and rent' ders the damp more active. * • OF THE COMMON EVACUATIONS. 703 when warm, to eat freely of raw fruits, fallads, or the like. Thefe, indeed, have not fo fudden an effea on the body as cold liquors, but they are notwithilanding dangerous, and ought to be avoided. Sitting in a warm room, and drinking hot liquors till the pores are quite open, and immediately going into the cold air, is ex- tremely dangerous. Colds, coughs and inflammations of the breaft, are the ufua! effeas of this condua : Yet nothing is more com- mon than for people, after they have drank warm liquors for feve- ral hours, to walk or ride a number of miles in the coldeit night, or to ramble about in the ftreets*. People 'are very apt, when a room is hot, to throw open a win- dow, and to fit near it. This is a moft dangerous praaice. A per- fon had better fit without-doors than in fuch a fituation, as the current of air is' dircaed againft one particular part of the body. Inflammatory fevers and confumptions have often been occafioned by fitting or flanding thinly clothed near an open window. Nor is fleeping witn open windows lefs to be dreaded. That ought ne- ver to be done, even in the hotteft feafon, unlefs'ihe window is at a diftance. Mechanics frequently contraa fatal difeafes, by work- ing ftript at an open window, and I would advife ail of them to beware of fuch a praaice. Few things expofe people more to catch cold, than keeping their own houfes too warm ; fuch perfons may be faid to live in a fort of hot-houfes; they can hardly ftir abroad to visit a neighbour, but at the hazard of their lives. Were there no other reafon for keeping houfes moderately cool, that alone is fufficient: But no houfe that is too hot can be wholefome; heat destroys the fpring t and elafticity of the air, and renders it lefs fit for expanding the lunqs, and the other purpofes of refpiration. Hence confumptions and, other difeafes of the lungs prove fo fatal to people who work in forges, glafs-houfes, and the like. Some are even fo fool-hardy, as to plunge themfelves when hot in cold water. Not only fevers, but madnefs itfelf, has frequently been the effea of this condua. Indeed, it looks too like the aakm of a madman to deferve a ferious confederation. The refult of all thefe obfervations is, that every one ought to avoid, with the utmoft attention, all fudden tranfitions from heat to cold, and to keep the body in as uniform a temperature as pof- fibie ; or, where that cannot be done, to take care to let it cool gradually. People may imagine that too ftria an attention to thefe things * The tap-rooms in London and other great towns, where fuch num- bers of people fpend their evenings, are highly pernicious. The breath % ui'a number of people, crowded into alow apartment, with the addition of fires, candles, the fmoke of tobacco, and the fumes of hot liquor, &c. muft not only render it hurtful to continue in fuch places, but dan- gerous to go out vi them into a cold aud chilly atmofphere. io4 W THE COMMON EVACUATION'S. would tend to render them delicate. So far is this ftom being my defign, that the very firft rule propofed for preventing colds, is to harden the body, by enuring it daily to the open air. I fhall put an end to this part of my fubjea, by giving an ab- ftraa of the advice of Celfus, with refpea to the prefervation of health. "A man," fays he, "who is bleffed with good heffth,fhould « confine himfelf to no particular rules, either with refpea to re- « gimen or medicine. He ought frequently to diversify his man- " ner of living; to be fometimes in town, fometimes in thecoun- " try to hunt, fail, indulge himfelf in reft, but more frequently to " ufe exercife. He ought to refute no kind of food that is com- " monly ufed, but fometimes to eat more and fometimes lefs; " fometimes to make one at an entertainment, and fometimes to " forbear it; to make rather two meals a-day than one, and al- " ways to eat heartily, provided he can digeft it. He ought neither " too eagerly to purfue, nor too fcrupuloufly to avoid, intercourfe " with the fair fex ! Pleafures of this kind, rarely indulged, ren- " der the body alert and aaive ; but, when too frequently repea- " ted, weak and languid. He fliould be careful in time of health " not to deftroy, by exceffes of any kind, that vigour of conftitu- " tkon which fliould fupport him under ficknefe." PART II. OF DISEASE S- CHAPTER XII. Of the Knowledge and Cure of Difeafes. THE knowledge of difeafes does not depend fo much upori fcientific principles as many imagine. It is chiefly the re- fult of experience and obfervation. By attending the fick, and care- fully obferving the various occurrences in difeafes, a great degree of accuracy may be acquired, both in diftinguifhing their fymp- toms, and in the application of medicines. Hence, fenfible nurfes, and other perfons who wait upon the fick, often difcover a dif- eafe fooner than thofe who have been bred to phyfic. We. do not infinuate that a medical education is of no ufe : it is doubtlefs of the greateft importance ; but it never can fupply the place of ob- fervation and experience. Every difeafe may be confidered as an affemblage of fymptoms^ , and muft be diflinguifhed by thofe which are moft obvious and permanent. Inftead, therefore, of giving a classical arrangement o£ difeafes, according to the fyftematic method, it will be more fuit- able, in a performance of this nature, to give a full and accurate defcription of each particular difeafe as it occurs ; and, where any of the fymptoms of one difeafe have a near refemblance to thofe of another, to take notice of that circumftance, and at the fame: time to point out the peculiar or charaaeriftic fymptoms by which it may be diflinguifhed. By a due attention to thefe, the inveltigation of difeafes will be found lefs difficult than moft peo- ple would imagine. A proper attention to the patient's age, fex, temper of mind, con- ftitution, and manner of life, will greatly affift, both in the invelti- gation and treatment of difeafes. In childhood, the fibres are lax and foft, the nerves extremely irritable,and the fluids thin; whereas,in old age,the fibres are rigid, the nerves become almoft infenfible, and many of the veffels im- perviable. Thefe,and other peculiarities,render the difeafes of the young and aged very different, and of courfe, they muft require a different method of treatment. ro6 OF THE KNOWLEDGE "Females are liable to many difeafes which do not afflia the other fet: betules the nervous fyftem being more irritable in them than in men, their difeafes require to be treated with greater caution. They are lefs able to bsar large evacuations ; and all stimulating medicines ou-;ht to be adminiftered to them with a'fparmg hand. Particular conftitutions not only difpofe perfons to peculiar dif- eafes, but likewife render it neceffary to treat thefe difeafes in a peculiar manner. A delicate perfon, for example, with weak nerves, who lives moltly within doors, mult not be treated, under any dif- eafe, precifely in the fame manner as one who h> hardy and robuft, and who is much expofed to the open air. The temper of mind ought to be carefully attended to. Fear, anxiety, and a fretful temper, both occafion and aggravate difeafes. In vain do we apply medicines to the body to remove maladies which proceed from the mind. When it is affeaed, the beft me- dicine is to footh the paffions, to divert the mind from anxious thought, and to keep the patient as eafy and cheerful as poffibie. Attention ought likewife to be paid to the climate, or place where the patient lives, the air he breathes, his diet, &c. Such as live in low marfhy fituations are fubjea to many difeafes which are unknown to the inhabitants of high countries. Thofe who breathe the impure air of cities, have many maladies to which the more happy nifties are entire ftrangers. Perfons who feed grofsly, and indulge in ftrong liquors, are liable to difeafes which do not affea the temperate and abftemious, &c. It has already been obferved, that the different occupations and fituations in life difpofe men to peculiar difeafes. It is therefore neceffary to enquire into the patient's occupation, manner of life, &c. This will not only affill us in finding out the difeafe, but will likewife direa us in the treatment of it. It would be very impru- dent to treat the laborious and the fedentary precifely in the farm: manner, even fuppofing them to labour under the fame difeafe. It will be proper to enquire, whether the difeafe be conflitutfon- al or accidental; whether it has been of long or fhort duration-, whether it proceeds from any great and fudden alteration in the diet, manner of life, &c. The ftate of the patient's body, and of the other evacuations, ought alfo to be enquired into ; and whether he can with eafe perform all the vital and animal funaions, a* breathing, digeftion, &c Laftly, it will be proper to enquire what difeafes the patient has formerly been liable to, and what medicines were moft beneficia* to him ; if he has a ftrong averfion to any particular drug, Sec. As many of the indications of cure may be anfwered bV diet alone, it is always the firft thing to be attended to in the treatment of difeafes. Thofe who know no better, imagine that every thing which goes by the name of a medicine poffeffes fome wonderful power or fecret charm, and think, if the patient fwallows enough •f drugs, that he muft. do wclL This miftake has many ill confc- 1 AND CURE OF DISEASES. i-7 quences; it makes people truft-to drugs, and neglea their own en- deavours ; befides, it difcourages all attempts to relieve the fick where medicines cannot be obtained. Medicines are no doubt ufeful in their place, and, when admi- niftered with prudence, they may do much good ; but when they arc put in place of every thing elfe, or adminiftered at random, which is not feldom the cafe, they muft do mifchief. We therefore wifh to call the attention of mankind from the purfuit of fecret medicines, to fuch things as they are acquainted with. The .proper regulation of thefe may often do much good, and there is little danger of their ever doing hurt. Every difeafe weakens the digeftive powers. The diet ought, therefore, in all difeafes, to be light and of eafy digeftion. It would be as prudent for a perfon with a broken leg to attempt to walk, as for one in a fever to eat the fame kind of food, and in the fame quantity, as when he was in perfea health. Even abftinence alone will often cure a fever, efpecially when it has been occafioned by excefs in eating or drinking. In all fevers attended with inflammation, as pleurifies, peripneu- monies, &c. thin gruels, wheys, watery infusions of mucilaginous plants, roots, &c. are not only proper for the patient's food, but they are likewife the beft medicines which can be adminiftered. In fevers of a flow, nervous, or putrid kind, where there are no fymptoms of inflammation, and where the patient muft be fup- •ported with cordials, that intention can always be more effeaually anfwered by nourifhing diet and generous wines, than by any me- dicines yet known. Nor is a proper attention to diet of lefs importance in chronic than in acute difeafes. Perfons affliaed with low fpirits, wind, weak nerves, and other hypochondriacal affeaions, generally find ' more benefit from the ufe of folid food and generous liquors, than from all the cordial and carminative medicines which can be ad- miftered to them. The fcurvy will fooner yield to a proper vege- table diet, than to all the antifedrbutic remedies of the {hops. In confumptions, when the ftomach is fo much weakened as to be unable to digeft the folid fibres of aqimals, or even to affimilate the juice3 of vegetables,a diet confifting chiefly of milk will not only fupport the patient,but will often cure the difeafe after every other medicine has failed. Nor is an attention to other things of lefs importance than to diet. The ftrange infatuation which has long induced people to fhut up the fick from all communication with the external air, has done great mifchief. Not only in fevers but in many other difeafes, the patient will receive more benefit from having the frefh air, prudently admitted into his chamber, than from all the medicines which can be given him. Exercife may likewife in many cafes be confidered as a medicine. Sailing, or riding on horfeback, for example, will be of more fer- 168 OF FEVERS IN GENERAL. vice in the cure of confumptions, glandular obftruaions, Sec. than any medicine yet known. In difeafes which proceed from a relaxed •ftate of the folids, the cold bath, and other parts of the gymnaftic regimen, will be found equally beneficial. Few things are of greater importance in the cure of difeafes than cleanlinefs. When a patient is fuffered to lie in dirty clothes, •whatever perfpires from his body is again reforbed, or taken up into it, which ferves to nourifh the difeafe and increafe the danger. Many difeafes may be cured by cleanlinefs alone; moft of them may be mitigated by it, and in all of them it is highly neceffary hotti for the patient and thofe who attend him. Many other obfervations, were it neceffary, might be adduced to prove the importance of a proper regimen in difeafes. Regimen will often cure difeafes without medicine, but medicine will feldom fucceed where a proper regimen is negleaed. For this reafon, in the treatment of difeafes, we have always given the firft place to regi- men. Thofe who are ignorant of medicine may confine themfelves to it only. For others, who have more knowledge, we have recom- mended fome of the moft fimple but approved forms of medicine in every difeafe. Thefe, however, are never to be adminiftered but by people of better underftanding; nor even by them without the greateft precaution. CHAPTER XIII. Of Fevers in General. MORE than one half of mankind are faid to perifh by fevers, Their moft general caufes are infeclion, errors in diet, tin- ivholefome air, violent emotions of the mind, excefs or fuppreffion of ufual evacuations, external or internal injuries, and extreme degrees of heat »r £old. As moft of thefe have already been treated of at confiderablc length, and their effeas fhown, we fhall not now refume the conr iideration of them, but only recommend it to all, as they would wifh to avoid fevers and other fatal difeafes, to pay the moft punc- tual attention to thefe articles. Fevers arc not only the moft frequent of all difeafes, but they are likewife the moft complex. In the moft fimple fpecies of fever there is always a combination ef feveral different fymptoms. The diftinguifhing fymptoms of fevers are, increafed heat, frequency of pulfc, lofs of appetite, general debility, pain in the head, and a difficulty in performing fome of the vital or animal funEiions. The other fymp- toms, ufually attendant on fevers are, naufea, thirft, anxiety, de- lirium, wearinefs, wafting of the flefh, want of fleep, or the fleep difturbed and not refrefhing. When the fever comes on gradually, the patient generally com- OF FEVERS IN GENERAL. 109 plains firft of langour or liftleffnefs, forenefscf the flefh or the bones, heaviness of the head, lofs of appetite, ficknefs, with clamminefs of the mouth; after fome time come on exceffive heat, violent thirft, reftleffuefs, &c. When the fever attacks fuddenly, it always begins with an un- cafy fenfation of exceffive cold, accompanied with debility and lofs of appetite ; frequently the cold is attended with fhivering, oppreffion about the heart, and ficknefs at ftomach, or vomiting. Fevers are divided into continual, remitting, intermitting, and fuch as are attended with cutaneous eruption 01 topical inflam- mation, as the fmall-pox, eryfipelas, &c. By a continual fever is meant that which never leaves the patient during the whole courfe of the difeafe, or which fhows no remarkable increafe or abate- ment of the fymptoms. This kind of fever is likewife divided into acute, flow, and malignant. The fever is called acute when its pro- grefs is quick, and the fymptoms violent ; but when thefe are more gentle, it is generally denominated flow. When with livid or petechial fpot9, the fever is called malignant, putrid, or petechial. A remitting fever differs from a continual only in degree. It has frequent increafes and decreafes, or exacerbations and remif- fions, but never wholly leaves the patient during the courfe of the difeafe. Intermitting fevers or agues are thofe, which, during the time that the patient may be faid to be ill, have evident intervals or remiffions of the fymptoms. As a fever is only an effort of Nature to free herfilf from an offending caufe, it is the bufinefs of thofe who have the care of the fick, to obferve with diligence which way Nature points, and to endeavour to affift her operations. Our bodies are fo framed, as to have a conftant tendency to expel or throw off whatever is injurious to health. This is generally done by urine, fweat, ftool, cxpeaoration, vomit, or fome other evacuation. There is reafon to believe, that if the efforts of Nature, at the beginning of a fever, were duly attended to and promoted, it would feldom continue long; but when her attempts are either neglea- ed or counteraaed, it is no wonder if the difeafe proves fatal. There arc daily inftances of perfons, who after catching cold, have all the fymptoms of a beginning fever; but by keeping warm, drinking diluting liquors, bathing their feet in warm water, Sec. the fymptoms in a few hours difappear, and the danger is prevent- ed. When fevers of a putrid kind threaten, the beft method of ob- viating their effeas is by repeated vomits. Our defign is to mark the moft obvious fymptoms in fevers, and to point out the proper treatment of the patient with refpea to his diet, drink, air, Sec. in the different flagesof the difeafe. In thefe articles, the inclinations of the patient will, in a great meafure, direa our condua. Almoft every perfon in a fever complains of great thirft, and calls out for drink, efpecially of a cooling nature. This at once no OF FEVERS IN GENERAL. points out the ufe of water, and other cooling liquors. What is fo likely to abate the heat, remove fpafms and obftruaions, pro- mote perfpiration, increafe the quantity of urine, and, -in fhort, produce every hdutary effea, in an ardent or inflammatory fever, as drinking plentifully of water, thin gruel, or any other weak liquor, of which water is the bafis ? The neceffity of diluting li- quors is pointed out by the dry tongue, the parched fkin, and the burning heat as well as by the unquenchable thirft of the patient. Many cooling liquors, which are extremely grateful to patients in a fever, may be prepared from fruits ; as decodtions of tama- vinds, appie-tca, orangc-w hey, and the like. Mucilaginous liquors might alio he prepared from marfhmallow-rools, linfeed, lime- tree buds, and other mild vegetables. Thefe liquors, efpecially when acidulated, are highly agreeable to the patient, and fhould never be denied him. At the beginning of a fever, the patient generally complains of great lafiitude or wcarinefs, and has no inclination to move. This evidently fliows the propriety of keeping him eafy, and, if poffibie, in bed. Lying in bed relaxes the fpafms, abates the violence of the circulation, and gives Nature an opportunity of exerting all her force to overcome the difeafe. The bed alone would often remove a fever at the beginning ; but when the patient ftruggles with the difeafe, inftead of driving it off, he only fixes it the dee- per, and renders it more dangerous. This obfervation is too often verified in travellers, who happen, when on a journey, to be feized with a fever. Their anxiety to get home induces them to travel with the fever upon them, which condua feldom fails to render it fatal. In fevers, the mind as well as the body fhould be kept eafy. Company is feldom agreeable to the fick. Every thing that difturbs the imagination increafes the difeafe; for which reafon, every per- fon in a fever ought to be kept perfeaiy quiet, and neither allow- ed to fee nor hear any thing that may in the leaft affeft or difcom- pofe his mind. Though the patient in a fever haB the greateft inclination for drink, yet 'he feldom has any appetite for folid food ; hence, the impropriety of urging him to take viauals, is evident. Much folid food in a fever is every way hurtful: It oppreffes Nature, and in- ftead of nourifhing the patient, ferves only to feed the difeafe. What food the patient takes fhould b" in fmall quantity, light, and of eafy digeftion. It ought to be chiefly of the vegetable kind, as panada, roafted apples, gruels, and fuch like. Poor people, when any of their family are taken ill, run direaiy to their rich neighbours for cordials, and pour wine, fpirits, &e. into the patient, who, perhaps, never had been accuftomed to tafte fuch liquorg when in health. If there be any degree of fever/ this condua muft increafe it, and if there be none, this is the rea- lly way to raife one. Stuffing the patient with fwect-meats and OF FEVERS IN GENERAL. us other delicacies, is likewife very pernicious. Thefe are always r^ harder to digest than common food, and hurt the ftomach. Nothing is more defired by a patient in a fever, than frefli air. It not only removes his anxiety, but cools the blood, revives the lpirits, and proves every way beneficial. Many patients are in a manner flifled to death in fevers for want of frefh air ; yet fuch is the unaccountable infatuation of moft people, that the moment they think a perfon In a fever, they imagine he fliould be kept in ay clofe chamber, into which not one particle of frefh air muft be ad- mitted. Inftead of this, there ought to be a conftant ftream of frefi* air into a fick perfon's chamber, fo as to keep it moderately cool. Indeed, its degree cf warmth ought never to be grater than is agreeable to one in perfea health. Nothing fpoils the air of a fick perfon's chamber, or hurts the pa- tient more, than a number of people breathing in it. When the blood is inflamed, air that has been breathed repeatedly will great- ly increafe the difeafe. Such air not only lofes its fpring, and be- comes unfit for the purpofe of refpiration, but acquires a noxious quality, which renders it in a maimer poifonous to the fick. In fevers, when the patient's fpirits are low and deprtffed, he is not only to be fupported with cordials, but every method fhould be taken to cheer and comfort his mind. Many, from a miftakent< zeal, when they think a perfon in danger, inftead of folacing his mind with the hopes and confolations of religion, fright him with the views of hell and damnation. It would be unfuitable here to dwell upon the impropriety and dangerous confequences of this conduct. Among common people, the very name of a fever generally fug- gefts the neceffity of bleeding. 1 his notion feems to have taken its rife from moft fevers in this country having been formerly of an inflammatory nature ; but true inflammatory fevers are now feldom to be met with. Sedentary occupations, and a different manner of living, have fo changed the ftate of difeafes in Britain, that there is now hardly one fever in ten where the lancet is neceffary. In low, nervous fevers, which are now fo common, bleeding is really hurt- - ful, as it weakens the patient, finks his fpirits, Sec. We would re- commend this general rule, never to bleed at the beginning of a fever, unlets there be evident figns of inflammation. Bleeding is a^i excellent medicine when neceffary, but fhould never be wan- tonly performed. It is likewife a common notion, that fweating is always neceffary in the beginning of a fever. When the fever proceeds from an ob- ftruaed perfpiration, this notion is not ill-founded. If the patient only lies in bed, bathes his feet and legs in warm water, and drinks freely of water-gruel, or any other weak diluting liquor, he will fcldom fail to perfpire freely. The warmth cf the bed, and the diluting drink, will relax the univerfai fpafm, which generally af- fe6ts the fkin at the beginning of a fever; it wiilopeta the pjre-, 112 OF INTERMITTING FEVERS, and promote the perfpiration, by means of which the fever may often be carried off But inftead of this, the common practice is to heap clothes upon the patient, and to give him things of a hot nature, as fpirits, fpiceries, &c. which increafe the fpafms, and render the difeafe more dangerous. In all fevers, a proper attention fhould be paid to the patient's longings. Thefe are the calls of Nature, and often point out what may be of real ufe. Patients are not indeed to be indulged in every thing that the fickly appetite may crave ; but it is generally right to let them have a little of what they eagerly defire, though it may not feem altogether proper. What the patient longs for, his fto- mach will generally digeft; and fuch things have fometimes a very happy effea. When a patient is recovering from a fever, great care is necef- fary to prevent a relapfe. Many perfons, by too foon imagining themfelves well, have loft their lives, or cbntraaed other difeafes of an obftinate nature. As the body after a fever is weak and de- licate, it is neceffary to guard againft catching cold. Moderate exercife in the open air will be of ufe, but great fatigue is by all means to be avoided ; agreeable company will alfo have a good effea. The diet muft be light, but nourifhing. It fhould be taken frequently, but in fmall quantities. It is dangerous at fuch a time to eat as much as the ftomach may crave. CHAPTER XIV. Of Intermitting Fevers, or Agues. INTERMITTING fevers afford the beft opportunity both of obferving the nature of a fever, and alfo the effeas of medicine. No perfon can be at a lofs to diflinguifh an intermitting fever from any other, and the proper medicine for it is now almoft uni- verfally known. The feveral kinds of intermitting fevers take their names from the period in which the fit returns, as quotidian, tertian, quar- tan, &c. CAUSES.----Agues are occafioned by effluvia from putrid ftagnating water. This is evident from their abounding in rainy feafons, and being moft frequent in countries where the foil is marfhy. This difeafe may alfo be occafioned by eating too much ftone fruit, by a poor watery diet, damp houfes, evening dews, ly- ing upon the damp ground, watching, fatigue, depreffing paffionfc and the like. When the inhabitants of a high country remove to a low one, they are generally feized with intermitting fevers, and to fuch the difeafe is moft apt to prove fatal. In a word, whatever relaxes the folids, diminifhes the perfpiration^ or obftrua^ the OF INTERMITTING FEVERS. 113 ' v ■ . ' circulation in the capillary or fmall veffels, difpofes the body to agues. SYMPTOMS.----An intermitting fever generally begins with a pain of the head and loins, wearinefs of the limbs, coldnefs of the extremities, ftretching, yawning, with fometimes great ficknefs and vomiting; to which fucceed fhivering and violent fhaking. Afterwards the fkin becomes moift, and a prof ufe fweat breaks oat which generally terminates the fit or paroxyfm. Sometimes the difeafe comes on fuddenly, when the perfon thinks himfelf in perfea health; but it is more commonly preceded by liftleffnefs, lofs of appetite, and the fymptoms mentioned above. REGIMEN.----While the fit continues, the patient ought to drink freely of water-gruel, orange-whey, weak camomile tea ; or, if his fpirits be low, fmall wine-whey, fharpened with the juice of lemon. All his drink fhould be warm, as that will affift in bringing on the fweat, and confequently fhorten the paroxyfm*. Between the paroxyfms the patient muft be fupported with food that is nourifhing, but light and eafy of digeftion, as veal or chick- en broths, fago, gruel with a little wine, light puddings, and fuch- like. His drink may be fmall negus, acidulated with the ju,ice of lemons or oranges, and fometimes a little weak punch. He may likewife drir.k infusions of bitter herbs, as camomile, wormwood, or water-trefoil, and may now-and-then take a glafs of fmall wine, in which gentian root, centaury, or fome other bitter, has been in- fufed. As the chief intentions cf cure in an ague'are to brace the folids", and promote perfpiration. the patient ought to take as much exer- cife between the fits as he can bear. If he is able to go abroad, rid- ing on horfeback, or in a carriage, will be of great fervice. But if he cannot bear that kind of exercife, he ought to take fuch as his ftrength will permit. Nothing tends more to prolong an intermit- ting fever, than indulging a lazy, indolent difpofition. Intermitting fevers, under a proper regimen, will often go off without medicine ; and when the difeafe is mild, in an open dry country, there is feldom any danger from allowing it to take its courfe ; but when the patient's ftrength feems to decline, or the paroxyfms are fo violent that his life is in danger, medicine ought immediately to be adminiftered. This, however, fhould never be done till the difeafe be properly formed, that is to fay, till the pa- tient has had feveral fits of fhaking and fweating. MEDICINE.----The firft thing to be done in the cure of an intermitting fever, is to cleanfe the ftomach and bowels. This ren- ders the application of other medicines more fafe and efficacious. •# Dr. Lind fays, that twenty or twenty-five drops of laudanum put into a cup of the patient's drink, and given about half an hour after the eomtnencemeHtof the hot fit, promotes the fweat, Jhor'tens the lit, re- lieves the head, and tends greatly to remove the diftnfe, P OF INTERMITTING FEVERS. 114 IiTthis difeafe, the ftomach is generally loaded with cold vifcid phlegm, and frequently great quantities of bile are difeharged by vomit; which points out the neceffity of fuch evacuations. Vomits are therefore to be adminiftered before the patient takes any other medicine. A dofe of ipecacuanha will generally anfwer this pur- pofe very well. A fcruple or half a dram of the powder wi 1 be fufficient from an adult, and for a younger perfon the dofe muft be lefs in proportion. After the vomit begins to operate, the patient ought to drink plentifully of weak camomile-tea. The vomit fhould be taken two or three hours before the return of the fit, and may be repeated at the diftance of tuo or three days. Vomits not only cleanfe the ftomach, but increafe the perfpiration and all the other fecretions, which render them of fuch importance, that they of. ten cure intermitting fevers without the afiiftance of any other me- dicine. Purging medicines are ufeful and often neceffary in intermitting. fevers. A fmart purge has cured an obstinate ague,after the bark and other medicines had been ufed in vain. Vomits are more fuitabie in this difeafe, and render purging lefs neceffary ; but if the pa- tient be afraid to take a vomit, he ought to cleanfe the bowels by a dofe or two of Glauber's fait or jalap. Bleeding may fometimes be proper at the beginning of an inter- mitting fever, when excefftve heat, a delirium, &c. give reafon to fufpea an inflammation ; but as the blood is feldom in an inflam- matory ftate in intermitting fevers, this operation is rarely neceffary. When frequently repeated, it tends to prolong the difeafe. After proper evacuations, the patient may fafely ufe the Peruvian bark, which may be taken in any way that is moft agreeable to him. No preparation of the bark feems to anfwer better than the moft fimple form in which it can be given, viz. in powder. Two ounces of the beft bark, finely powdered, may be divided into twenty-four dofes. Thefe may either be made into boluffes as they are ufed, with a little fyrup of lemon, or mixed in a glafs of red wine, a cup of camomile-tea, water-gruel, or any other drink that is more agreeable to the patient*. In an ague which returns every day, one of the above dofes may be taken every two hours, or oftener during the interval of the fits. By this method, the patient will be able to take five or fix dofes between each paroxyfm. In a tertian or third-day ague, it will be fufficient to take a dofe every third hour during the interval, and in a,quartan every fourth. If the patient cannot take fo large a . dofe of the hark, he may divide each of the powders into two parts, and take one every hour, &c. For a young perfon, a fmaller •jf It has lately been obferved, that the red bark is more powerful than that which has for fome time been in common ufe. Its fuperior efficacy feems to arife from its being of a more perfeft growth than the quid bark, and confequently more fully impregnated with the medical properties-' of the plant. OF INTERMITTING FEVERS. 115 quantity of this medicine will be fufficient, and the dofe muft be adapted to the age, conftitution, and violence of the fymptoms*. The above quantity of bark will frequently cure an ague ; the patient, however, ought not to leave off taking the medicine as foon as the paroxyfms are flopped, but fhould continue to ufe it till there is reafon to believe the difeafe entirely overcome. Moft failures in the cure are owing to patients not continuing to ufe the medicine long enough. They are generally direaed to take it till the fits are flopped, then to leave it off, and begin again at fome diftance of time ; by which means the difeafe gathers ftrength, and often re- turns with as much violence as before. A rel-pfc may be prevented by the patient's continuing to take fmall dries-of the medicine for fome time after the fymptoms difappear. Tins is the moft fafe me- thod of cure. An ounce of gentian root, calamus aromaticus, and orange-peel, of each half an ounce, with three or four handfuls of camomile- flowers, and an handful of coriander-feed, all bruifed togeu er in a mortar, may be ufed in form or infufion of tea. About hal' 1 handful of thefe ingredients may be put into a tea-pot, and u<= Englifli pint of boiling water poured on them. A cup of this infu- fion, drank three or four times a day, will greatly promote the cure. Such patients as cannot drink the watery infufion, may put two handfuls of the fame ingredients into a bottle of white wine, and take a glafs of it twice or thrice a day. If patients drink freely of the above, or any other proper infufion of bitters, a fmaller quan- tity of bark than is generally ufed, will be fufficient to cure an aguef. Thofe who cannot fwallow the bark in fubftance, may take it in decoaion or infufion. An ounce of bark in powder may be in- fufed in a bottle of white wine for four or five days, frequently fhaking the bottle, afterwards let the powder fubfide, and pour off the clear liquor. A wine-ghfsful may be drank three or four ■y- In intermitting fevers of an obftinate nature, I have found it »r celfary to throw in the bark much faftcr. The benefits arifing from'th's medicine, depend chiefly upon a large quantity of it being adminiftered in a fhorttime. Several ounces of baric given in a few days wi'i do more than as many pounds taken in the courfe of fome weeks. When this medicine is intended either to stop a mortification, or cure an obftinate ague, it ought to be thrown in as fait as the ftomach can poflibly baar it. Inattention to this circumstance has hurt the reputation of one of the beft medicines of which we are in poffeffiou. f There is reafon to believe, that fundry of our own plants or barks, which are very bitter and astringent, would fucceed in the cure of in- termitting fevers, efpecially when aflifted by aromatics. But as Peruvian bark has been long approved in the cure of this difeafe, and is now to be obtained at a very reafonable rate, it is of lefs importance to fearch after new medicines. We cannot however omit taking notice, that Peru- vian bark is very often adulterated, and that it requires conliderable fkill to diftinguifli between the genuine and the falfe. This ought to make people very cauti«..u:s of whom they purchafe it. 116 OF INTERMITTING FEVERS. thnTs a day. or oftener, as there is occafion. If a deception be more agreeable, an ounce of the bark, and two drams of fnake- roct bruifed, with an equal quantity of fait of wormwood, may be boiled in a quart of water, into an Englifh pint. To the ftrained liquor may be added an equal quantity of red wine, and a glafs of it taken frequently. In obftinate agues, the bark will be found much more effica- cious when'aflifted by brandy, or other warm cordials, than taken alone. This I have had frequently occafion to obferve in a coun- try where intermitting fevers were endemical. The bark feldom fucceeds unlefs aflifted by fnake-root, ginger, canella alba, or fome other warm aromatic. When the fits are very frequent and violent, in which cafe the fever often approaches towards an inflamma- tory nature, it will be fafer to keep out the aromatics, and to add fait of tartar in their ftead. But in an obftinate tertian or quartan, in the .end of autumn or beginning of winter, warm and cordial medicines are abfolutely neceffary*. As autumnal and winter agues generally prove much more ob- ftinate than thofe which attack the patient in fpring or fummer, it wjll be neceffary to continue the ufe of medicines longer in the former than in the latter. A perfon who is feized with an inter- mitting fever in the beginning of winter, aught frequently, if the feafon proves rainy, to take a little medicine, although the'difeafe may feem to be cured, to prevent a relapfe, till the return of the warm feafon. He ought likewife to take care not to be much abroad in wet weather, efpecially in cold easterly winds. When agues are not properly cured, they often degenerate into obftinate chronical difeafes, as the dropfy, jaundice, &c. For this reafon, all poffibie care fliould be taken to have them radically cured, before the conftitution has been too much weakened. Though nothing is more rrtional than the method of treating intermitting fevers, yet, by fome flrange infatuation, more charms and whimfical remedies are daily ufed for removing this than any other difeafe. There is hardly an old woman who is not in poflef- fion of a nostrum for flopping an ague : and it is amazing with what readinefs their pretensions are believed. Thofe in diftrefs eagerly grafp at any thing that promifes fudden relief ; but the fhorteft way is not always the beft in the treatment of difeafes. The only method to obtain a fafe and lafting cure, is gradually to aflift Nature in removing the caufe of the diforder. Some, indeed, try bold, or, rather, fool-hardy experiments to *• In obfiinate ague, when the patient is ©Id, the habit phlegmatic, the l'Vsfon rainy, the fituation damp, or the like, it will be neceffary to sni:i with two ounces of the bark, half an ounee of Virginian fnake- root, and a quarter of an ounce of ginger, or fome other warm aromatic; but when the fymptoms are of an inflammatory nature, half an ounce of fait of wormwood, or fait of tartar, may be added to the above quan* iity of bark. OF INTERMITTING FEVERS. 117 cure agues, as drinking great quantities of ftrong liquors, jumping into a river, &c*. Thefe may fometimes have the defired effea, but muft always be attended with danger. When there is any de- gree of inflammation, or the leaft tendency to it, fueh experiments may prove fatal. The only patient whom I remember to have loft, in an intermitting fever, evidently killed himfelf by drinking ftrong liquor, which fome perfon had perfuaded him would prove an in- fallible remedy. I'lany dirty things are extolled for the cure of intermitting fe- vers, as fpiders, cobwebs, fnuffings of candles, Sec. Though thefe may fometimes fucceed, yet their very naftinefs is fufficient to fet them afide, efpecially w,hen cleanly medicines will anfwer the pur- pofe better. The only medicine that can be depended upon, for thoroughly curing an intermitting fever, is the Peruvian bark. It may always be ufed with fafety; and I can honeftly declare, that in all my praaice, I never knew it fail, when combined with the medicines mentioned above, and duly perfifted in' Where agues are endemical, even children are often affliaed with that difeafe. Such patients are very difficult to cure, as they can feldom be prevailed upon to take the bark, or any other difa- greeable medicinef. One method of rendering this medicine more palatable, is to make it into a mixture with diftilled waters andfy rup, and afterwards to give it an agreeable fharpnefs with the elix- ir or fpirit of vitriol. This both improves the medicine, and takes off the naufeous tafte. In cafes where the bark cannot be admini- ftered, the faline mixture may be given with advantage to children}:. Wine-whey is a very proper drink for a child in an ague; to half an Englifh pint of which, may be put a tea-fpoonful of the fpirit of hartfhorn. Exercife is likewife of considerable fervice ; and when the difeafe proves obftinate, the child ought, if poffibie, to be remo- ved to a warm, dry air. The food ought to be nourifhing, and fometimes a little generous wine fhould be allowed. To children, and fuch as cannot fwallowthe bark, or when the stomach will not bear it, it may be given by clyfter. Half an ounce of the extraa of bark, diffolved in four ounces of warm-water, with the addition of half an ounce of fweet-oil, and fix or eight drops of laudanum, is the form recommended by Dr. Lind for an adult, and this to be repeated every fourth hour, oroftener, as the occafion fhall require. For children, the quantity of extraa and ■* Arfnic is among the number of thefe bold, injudicious remedies; and ought never to be ufed in any cafe of intermitting fever what- ever. (I.C-) f When children cannot take the medicine recommended, they may • be frequently cured by giving ten or fifteen drops of laudanum, accor- ding to the age of the patient, about half an nour before the cold ftage commences. (I. C) | See Appendix, Saline mixture. 118 OF AN ACUTE CONTINUAL FEVER. laudanum muft be proportionally leffened. Children have been cured of agues by making them wear a waiftcoat with powdered bark quilted between the folds of it ; by bathing them frequently in a ftrong decoaion of the bark, and by rubbing the fpine with ftrong fpirits, or with a mixture of equal parts of laudanum, and the fa- ponaceous liniment. This difeafe is very common, and few patients in an ague apply to phyficians.unlefs in extremities. There are many cafes in which the difeafe is very irregular, being complicated with other difeaf- es, or attended with fymptoms which are both very dangerous and very difficult to underftand. All thefe we have purpofely pafled over, as they would only bewilder the generality of readers. When the difeafe is very irregular, or the fymptoms dangerous, the pa- tient ought immediately to apply to a phyfician, and ftriaiy to fol- low his advice. To prevent agues, people muft endeavour to avoid their caufes. Thefe have been already pointed out in the beginning of this fec- tion ; we fhall therefore only add one preventive medicine, which may be of ufe to fuch as are obliged to live in low marfhy coun- tries, or who are liable to frequent attacks of this difeafe. Take an ounce of the beft Peruvian bark ; Virginia fnake-root, and orange-peel, of each half an ounce; bruife them all together, and infufe for five or fix days in a bottle of brandy, Holland-gin, or any good fpirit; afterwards pour off the clear liquor, and take a wine glafs of it twice or thrice a-day. This is recommending a dram ; but the bitter ingredients in a great meafure take off the ill effeas of the fpirit. Thofe who do not choofe it in brandy, may infufe it in wine ; and fuch as can bring themfelves to chew the bark, will find that method fucceed very well. Gentian root, or calamus aromaticus may alfo he chewed by turns for the fame pur- pofe. All bitters feem to be antidotes to agues efpecially thofe that are warm and aftringent. C PI A P T E R XV. Of an Acute Continual Fever. THIS fever is termed acute, ardent, or inflammatory. It moft commonly attacks the young, or perfons about the prime or vigour of life, efpecially fuch as live high, abound with blood, and whofe fibres are ftrong and elaftic. It feizes people at all feafon s of the year ; but is moft frequent in the fpring and beginning of 'fummer. CAUSES.----An ardent fever may be occafioned by any thing that overheats the body, or produces plethora, as violent exercife, fleeping in the fun, drinking ftrong liquors, eating fpiceries, a full diet, with little exercife, &c. It may likewife be occafioned by OF AN ACUTE CONTINUAL FEVER. 119 whatever obftruas the perfpiration, as lying on the damp ground, drinking cold liquor when the body is hot, night watching, or the like. SYMPTOMS.——A rigour or chillnefs generally ufhers in this fever, which is foon fucceeded by great heat, a frequent and full pulfe, pain of the head, dry fkin, rednefs of the eyes, a florid countenance, pains in the back, loins, &c. To thefe fucceed dif- ficulty of breathing, ficknefs, with an inclination to vomit. The patient complains of great thirft, has no appetite for folid food, is reftlefs, and his tongue generally appears black and rough. A delirium, exceffive reftleffnefs, great oppreffion of the breaft, with laborious refpiration, flatting of the tendons, hickough, cold clammy fweats, and an involuntary difcharge of urine, are very dangerous fymptoms. As this difeafe is always attended with danger, the beft medi- cal afiiftance ought to be procured as foon as poffibie. A phyfician may be of ufe at the beginning, but his fkill is often of no avail afterwards. Nothing can be more unaccountable than the condua of thofe who have it in their power, at the beginning of a fever, to procure the beft medical affiftancr, yet put it off till things come to an extremity. When the difeafe, by delay or wrong treat- ment, has become incurable, and Ins exhaufted the ftrength of the patient, it is in vain to hope for relief from medicine. Phyfi- cians may indeed affift Nature ; but their attempts muft ever prove fruitlefs, when fhe is no longer able to co-operate with their endeavours. REGIMEN.----From the fymptoms of this difeafe, it is evi- dent, that the blood and other humours require to be diluted ; that the perfpiration, urine, faliva, and all the other fecretions, are in too fmall quantity ; that the veffels are rigid, and the heat of the whole body too great: all thefe clearly point out the neceffity of a regimen calculated to dilute the blood, allay the exceffive heat, remove the fpafmodic ftriaure of the veffels, and promote the fecretions. Thefe important purpofes may be greatly prompted by drinking plentifully of diluting liquors ; as water-gruel, or oatmeal-tea, clear whey, barley-water, balm-tea, apple-tea, Sec. Thefe may be fharpened with juice of orange, jelly of currants, rafpberries, and fuch-like : orange-whey is likewife an excellent cooling drink. It is made by boiling among milk and water a bitter orange fliced, till the curd fepafates. If no orange can be had, a lemon, a little cream of tartar, or a (e\v fpoonfuls of vinegar, will have the fame effea. Two or three fpoonfuls of white wine may be occafionally added to the liquor when boiling. If the pa'tient be coftive, an ounce of tamarinds, with two ounces of ftoned raifins of the fun, and a couple of figs, may be boiled in three Englifh pints of water to a quart. This makes a very plea- fant drink, and may be ufed at difcretion. The commoo pecloral fid OF AN ACUTE CONTINUAL FEVER. decoaion is likewife a very proper drink in this difeafe. A tea- cupful of it may be taken every two hours, or oftener, if the pa- tient's heat and thirft be very great*. The above liquids muft all be drank a little warm. They may be ufed in fmaller quantities at the beginning of a fever, but more freely afterwards, in order to affift in carrying off the difeafe, by promoting the different excretions. We have mentioned a variety of drinks, that the patient may have it in his power to choofe' thofe which arc moft agreeable ; and that, when tired of one, he may have recourfe to another. The patient's diet muft be very fpare and light. All forts of flefh-meats, and even chicken-broths, are to be avoided. He may be allowed groat-gruel, panado, or light-bread boiled in water; to which may be added a few grains of common fait, and a little fugar, which will render it more palatable. He may eat roafted apples with a little fugar, toafted bread with jelly of currants, boiled prunes, &c. It will greatly relieve the patient, efpecially in an hot feafon, to have frefh air frequently let into his chamber. This muft al- ways be done in fuch a manner as not to endanger his catchine cold. 6 It is too common in fevers to load the patient with bed-clothes 'under the pretence of making him fweat, or defending him from the cold. This cuftom has many ill effeas. It increafes, the heat of the body, fatigues the patient, and retards, inftead of promoting the perfpiration. ~ 6 Sitting up-right in bed, if the patient is able to bear it, will of- ten have a good effea. It relieves the head, by retarding the mo- tion or the hlood to the brain. But this poflure ought never to be •ontinued too long : and if the patient is inclined to fweat, it will low?0"6 ^ ^ nlm He> °nly raifmShis head aTittle with pil- Sprinkling the chamber with vinegar, juice of lemon, or vinegar andi rote-water, with a little nitre diffolved in it, will greatly re- frefh the patient. Ihis ought to be done frequently, efpecially if the weather is hot. ■ f*-^,"*,j The patient's mouth fliould be often wafhed with a mixture of sTcoal Tf ^ u "f* U Uttlc Vine*ar m^ be added i or -ith nt KKSl!'? ba,rI^-water- His feet and hand, ought fre- quently to be bathed in lukewarm water ; especially if theVad i, The patient fhould be kept as quiet and eafy as poffibie Com- pany noife, and every thing that difturbs the mi„T iWuT Even too much light or any thing that affeaS the fenfes ouS avoided. His attendants fhould be as few as nofflS a v cughtnottobetoooften changed. UvZ&Sg^^ * See Appendix, Peaoval Decoaion. OF AN ACUTE CONTINUAL FEVER. 121 fccToothed than contradiaed ; even the promife of what he craves will often fatisfy him as much as its reality. MEDICINE.----In all this and other fevers, attended with a hard, full, quick pulfe, bleeding is of the greateft importance. This operation ought always to be performed as foon as the fymp- toms of an inflammatory lever appear. The quantity of blood to he taken away, however, muft be in proportion to the ftrength of the patient and the violence of the difeafe. If, after the firft bleed- ing, the fever fliould rife, and the pulfe become more frequent and hard, there will be. a neceffity for repeating it a fecond, and per- haps a third, or even a fourth time, which may be done at the dif- tance of twelve, eighteen, or twenty-four hours from each other, as the fymptoms require*. If the heat and fever be very great, forty or fifty drops of the dulcified or fweet fpirit of nitre may be made into a draught, with an ounce of rofc-water, two ounces of com- mon water, and haif an ounce of fimple fyrup, or a bit of loaf-fu- gar. This draught may be given to the patient every three or four hours while the fever is violent; afterwards once in five or fix hours will be fufficient. If the patient be affliaed with reaching^ or an inclination to vomit, it will be right to affift Nature's attempts, by giving him weak camomile-tea, or lukewarm water to drink. If the body be bound, a clyfter of milk and water, with a little fait, and a fpoonful of fweet-ovl or frefh butter in it, ought daily to be adminiftered. Should this not have the defired effea, a tea- fpoonful of magnefia alba, or cream of tartar, may be frequently put into his drink. He may likewife eat tamarinds, boiled prunes, roafted apples, and the like. If about the tenth, eleventh, or twelfth day, the pulfe becomes more foft, the tongue moifter, and the urine begins to let fall a reddifti fettlement, there is reafon to expea a favourable iffue to the difeafe. But if, inftead of thefe fymptoms, the patient's fpirits grow languid, his pulfe finks, and his breathing becomes difficult, with a ftupor, trembling of the nerves, starting of the tendons, &c. there is reafon to fear that the confequences will be fatal. In this cafe, blifters muft be applied to the head, ancles, infideof the legs or thighs, as there may be occafion; poultices of wheat-bred, muftard, and vinegar, may likewife be applied to the foles of the feet, and the patient muft be fupported with cordials, as ftrong wine-whey, negus, fago-gruel with wine in it, and fuch like. A proper regimen is not only neceffary during the fever, but likewife after the patient begins to recover. By negleaing this, many relapfe, or fall into other difeafes, and continue valetudinary for life. Though the body is, weak after a fever, yet the diet for fome time ought to b~ rather cleanfing. than of too nourifhing a ■# During the time bleedings are employed, brisk purging with glau- b?r fahs fliou'd not be omitted. (I. C ) in OF THE rXEURISY. nature. Too much food,drink, exercife, company, &c. are careful- ly to be avoided. The mind ought to be kept eafy, and the patient fhould not purfue ftudy, or any bufinefs that requires intenfe thinking. . If the digeftion is bad, or the patient feized at times witn If vends heats, an infufion of bark in cold water will be of ufe. It will ftrengthen the ftomach, and help to fubdue the remains of thefever. When the patient's ftrength is pretty well recovered, he ought to take fome gentle laxative. An ounce of tamarinds and a dram of fena may be boiled for a few minutes in an Englifh pint of wa- ter, and an ounce of manna diffolveti in thedecoaion ; afterwards it may be {trained, and a tea-cupful drank every hour fill it ope- rates. This dofe may be repeated twice or thrice, five or fix days intervening betwixt each dofe. Thofe who follow laborious employments ought not to return too foon to their labour after a fever, but fliould keep eafy till their ftrength and fpirits are fufficiently recruited. C Ii APTE R XVI. Of the Pleurify. ripHE the pleurify is an inflammation of that nnembrance cal- JL led the pleura, which lines the in fide of the breaft. It is d>{- tinsuifhed into the moifl and dry. In the former, the patient fpits freely; in the latter, little, or none at all. There is likewife a fpecies of this difeafe, which is called the fpurious or bafiard pleurifyl in which the pain is more exterr'.-il, and chiefly affects the mufcles. between the ribs. Ihe pleurify prevails ;;mong labouring people, efpecially fuch as work without doors, and are of a fanguinc con- ftitution. It is moft frequent in the fpring feafon. CAUSES.---—The pleurify may be occafioned by whatever obftruas the perfpiration ; as cold northerly winds ; drinking cold liquors when the body is hot; fleeping without-doors on the damp ground ; wet clothes; plunging the body into cold water, or ex- pofing it to the cold air, when covered with fweat, &c. It may 'be occafioned by drinking ftrong liquors ; by the flqppage of ufual evacuations; as old ulcers, iflues, lweatiug of the feet or hands, &c. the fudden ftriking in of any eruption, as the itch, the mea- fles, or the fmall-pox. Thofe who have been accuftomed to bleed at a certain feafon of the year, are apt, if they neglea it, to be feized with a pleurify. Keeping the body too warm by means of fire, clothes, Sec. renders it more liable to this difeafe. A pleurify. may likewife be occafioned by violent exercife, as running, wreft- ling, leaping, or by fupporting great weight, blows on the breaft*;' >.*w; OF THE PLEURISY: 123 Sec. A bad comformation of the body renders perfons more liable •to this difeafe, fuch as a narrow cheft, &c. SYMPTOMS.----This, like moft other fevers, generally begins . with chil'inefs and fhivering, which are followed by heat, thirft, and reftleffnefs. To thefe fucceeds a violent pricking pain in one of the fides among the ribs*. Sometimes the pain extends towards the back-bone, fometimes towards the forepart of the breaft, and at other times towards the fhould-er blades. The pain is generally mod violent when the patient draws in his breath. - The pulfe in this difeafe is commonly quick and hard, the urine high-coloured ; and if biood be let, it is covered with a tough cruft, or buffy coat. The patient's fpiitle is at firft thin, but after- wards it becomes groffer, and is often ftreaked with blood. REGIMEN.----Nature generally endeavours to carry off this difeafe by a critical difcharge of blood .from fome part of the body, by expectoration, fweat, loofe ftools, thick urine, or the like. We ought therefore to fecond her intentions by lefiening the force of the circulation ; relaxing the veffels, diluting the humours, and promoting expeaoration. For thefe purpofes, thetiiet, as in the former difeafe, ought-to be cool, flender and diluting. The patient muft avoid all food that is vifcid, hard of digeftion, or that affords much nourifhment; as ' flefh, butter, cheefe, eggs, milk, and every thing that is of a heat- ing nature. His drink may be whey, or an infufion of peaoral and balfamic vegetablesf. Barley-water, with a little honey or jelly of currants mixed with it, is a very proper drink in this difeafe. ft is made by boiling an ounce of pearl-barley in three Englifh pints of water to two, which muft afterwards be ftrained. The decoaion of figs, raifins, barlev, recommended in the preceding difeafe, is here very proper. , Thefe and other diluting liquors are not to be drank in large quan- tities at a time, but the patient ought to keep continually tipping them, fo as to render his mouth and throat always moifl. All his food and drink fhouldbe taken a little warm. The patient fhould be kept quiet, cool, and every way eafy, as direaed under the foregoing difeafe. His feet and hands ought daily to be bathed in lukewarm water.; and he may fometimes fit "up in bed for a fhort fpace to relieve his head. MEDICINE.----Almoft every perfon knows, when a fever is attended with a violent pain of the fide, and a quick hard pulfe, ; that bleeding is neceffary. When thefe fymptoms come on, the i fooner this operation is performed the better.; and the quantity j at firft muft be pretty large if the patient is able to bear it. A large | quantity of blood let at once, in the beginning of a pleurify, has (.- a much* better, effea than repeated fmall bleedings. A man may i» ' •5f In fome cafes of pleurify, the pricking pain in the fideprecedes the .chiliinefs andftiivering. (I.C.) - ,f See Appendix, Pectoral infufion. 124 OF THE PLEURISY. lofetwelve or fourteen ounces of blood as foon as it is certainly known that he is feized with a pleurify. For a younger perfon, or one of a delicate conftitution, the quantity muft be lefs. _ If, after the firft bleeding, the flitch, with the other violent fymptoms, fhould ftill continue, it will be neceffary, at the diftance of twelve or eighteen hours*, to let eight or nine ounces more. If the fymptoms do not then abate, and the blood fhows a ftrong buffy coat, a third, or even a fourth bleeding may be requisite. If the pain of the fide abates, the pulfe becomes fofter, or the patient begins to fpit freely, bleeding ought not to be repeated. This opera- tion is feldom neceffary after the third or fourth day of the fever, and ought not then to be performed, unlefs in the moft urgent cir- cumftances. Topical bleeding has often a very good effea in this difeafe. It may be performed by applying a number of leeches to the part affeaed, or by cupping, which is a more certain and expeditious method. If the flitch continues after repeated bleedings, a blifter muft be applied over the part affeaed. This not only procures a dif- charge fsom the fide, but takes off the fpafm, and by that means affifts in removing the caufe of the difeafe. To prevent a ftrmgury when the blifter is on, the patient may drink freely of the Arabic emulsion * or flax-feed tea. If the patient is coftive, a clyster of thin water-gruel, or of barley- wacer, in which a handful of mallows, or any other emollient ve- getable has been boiled, may be daily adminiftered. This will not only empty the bowels, but have the effea of a warm fomentation appiied to the inferior vifcera, which will help to make a deriva- tion from the breaft. The expeaoration or fpitting may be promoted by fharp, oily, and mucilaginous medicines. For this purpofe, an ounce of the oxymel, or the vinegar of fquills, may be added to fix ounces of the peaoral decoaion, and two table-fpoonfuls of it taken every two hours. Should the fquill difagree with the ftomach, the oily emulfion may be administered! ; or, in place of it, two ounces of the oil of fweet-almonds, or oil of olives, and two ounces of the fyrup of violets may be mixed with as much fugar-candy powdered, as will make an eleauary of the confiftence of honey. The patient may take a tea-fpoonful of this frequently, when the cough is trouble- fome. Should oily medicines prove naufeous, which is fometimes the cafe, two table-fpoonfuls of the folution of gum-ammoniac in barley-water may be given three or four times a-day§. If the patient does not perfpire, but has a burning heat upon his flcin, and paffes very little water, fome fmall dofes of purified # See Appendix, Arabic Emulfion. + See Appendix, Oily Emnlfion. $ See Appendix, Solution of Gum Ammoniac. OF THE PLEURISY. 125 nitre and camphire will be of ufe. Two drams of the former may be rubbed with five or fix grains of the latter in a mortar, and the whole divided into fix dofes, one of which may be taken every five or fix hours, in a little of the patient's ordinary drink. There is one medicine which fome reckon almoft a fpecific in the pleurify, viz. the decoaion of the Seneka rattle-fnake root*. After bleeding and other evacuations have been premifed, the pa- tient may take two, three, or four table-fpoonfuls of this decoc- tion, according as his ftomach will bear it, three or four times a- day. If it fhould occafion vomiting, two or three ounces of fimple cinnamon-water may be mixed with the quantityof decoaion here direaed, or it may be taken in fmaller dofe.;. As this medicine promotes perfpiration and urine, and likewife keeps the body eafy, it may be of fome fervice in a pleurify, or any other inflammation of the breaft. No one will imagine that thefe medicines, are all to be ufed at the fame time. We have mentioned different things, on purpofe that people may have it in their power ,to choofe ; and likewife, that when one cannot be obtained, they may make ufe of another. Different medicines are no doubt neceffary in the different periods of a diforder ; and where one fails of fuccefs, or difagrees with the patient, it will be proper to try another. What is called the crifis, or height of the fever, is fometimes at- tended with very alarming fymptoms ; as difficulty of breathing, an irregular pulfe, convulfive motions, Sec. Thefe are apt tq frighten the attendants, and induce them to do improper things as bleeding the patient, giving him ftrong ftimulating medicines, or the like. But they are only the ftruggles of Nature to' overcome the difeafe, in which fhe ought to be aflifted byplenty of diluting drink, which is then peculiarly necefiary. If the patient's ftrengthjj however, be muchexhaufted by the difeafe, it will be neceffary at this time to fupport him with frequent fmall draughts of wine- whey, negus, or the like. When the pain and fever are gone, it will be proper, after the patient has recovered fufficient ftrength, to give him fome gentle purges, as thofe direaed towards the end of the acute continual fever. He ought likewife to ufe a light diet, of eafy digeftion, ar.d his drink fhould be butter-milk, whey, and other things of a cleanf- ing nature; The Baflard or Spurious Pleurify GENERALLY goes off by-keeping warm for a few days, drinking plenty of diluting liquors, and obferving a cooling re- gimen. It is known by a dry cough, a quick pulfe, and a difficulty # See Appendix, Decoction of feneka root. ia6 OF A PERIPNEUMONY. ofhTing on the affeaed fide, which laft does.not always happen, in the true pleurify. Sometimes indeed this difeafe proves obfti- nate, and requires bleeding, with cupping, =nd fcanncationsof the part affected. Thcff, together with the ufe of mtrou* and other cooling medicine.-,, feldom fail to effea a cure. The Pavaphrcnitis, OR inflammation of the diaphragm, h fo nearly conneaed with the pleurify, and refembles it lb much in the manner of treatment, ihat'it isfcarce neceffary to confider it as a feparate dileafe. It is attended with a very acute fever, and an extreme pain in the part affeaed, which is generally augmented by coughing, fneezing, drawing in the breath, taking food, going to ftool, mak- ing water, &c. Hence the patient breathes quick, and draws in his bowels to prevent the motion of the diaphragm ; is reftkfs, anxious, has a dry cough, a hickough and often a delirium. A con- vulsive laugh, or a kind of involuntary grin, is a common fymptom of this difeafe. Every method muft be taken to prevent a fuppuration, as it is impoffible to fave the patient's life when this happens. The regi- men and medicine are in all refpeas the fame as in the pleurify. Emollient clyfters are peculiarly ufeful, as they relax the"bowels, and by that means make a derivation from the part affeaed. CHAPTER XVII. Of a Peripneumony or Inf animation of the Lungs. AS this difeafe affects an organ which is abfolutely neceffary to life, it is always attended with danger. Perfons who abound with blood, whofe fibres are tenfe and rigid, who feed upon grofs aliment, and drink ftrong vifeid liquors, are moft liable to a perip- neumony. It is generally fatal to thofe who have a flat breaft,'or narrow cheft, and to fuch as are affliaed with an afthma, efpecial- ly in the decline of life. Sometimes the inflammation reaches to one lobe of the lungs only, at other times the whole'of the organ is affeaed; in which cafe the difeafe can hardly fail to prove fatal. When the difeafe proceeds from a vifeid matter obftruaing the veffels of the lungs, it is called zfpurious or bafiard peripneumony. When it arifes from a thin acrid defluxion on the lungs, it is de- nominated a catarrhal peripneumony, Sec. CAUSES.----An inflammation of the lungs is fometimes a primary difeafe, and fometimes it is the confequcnce of ether dit- * OF A PERIPNEUMONY. ,127 cafes, as a quinfey, a plcurifyy&c. It proceeds from the fame caufes as the pleurify, viz. an obftruaed perfpiration from cold, wet clothes, &c. or. from in increafed circulation of the blood, by vio- lent exercife, the ufe of fpiceries, ardent fpirits, and fuch like. The pleurify and peripneumony are often complicated ; in which cafe the difeafe is called a pleuroper ipiteumony. SYMPTOMS----Moft of the fymptoms of a pleurify likewife attend an inflammation of the lungs; only in the latter the puife is more foft and the pain lefs'acute ; but the difficulty of breathing, and oppreffron of the breaft, are generally greater. REGIMEN"----The regimen and medicine are in all refpeas the fame in the true peripneumony as in the pleurify, the aliment ought to be more flender and thin in this than in'any other inflam- matory difeafe. Dr. Arbuthnot afferts, that even common whey is fufficient to fupport the p-uient, and that decoctions of barley, and infusions of fennel roots in warm water with milk, are the moft proper both for drink and nourifhment. He recommends the fleam of warm water taken in by the breath, which ferves as a kind of internal fomentation, and nelps to"*attenuate the impaaed hu- mours. If the patient has loofc ftools, but is not weakened by them, they are not to be flopped, but rather promoted by emollient clyflers. The fpurious or bafiard peripneumony is occafioned by a vifeid matter obftruaing the veffels of the lungs. It commonly attacks the old, infirm, arid phlegmatic, in winter or wet feafons. The patient at the beginning is cold ami hot by turns, has a fmall quick pulfe, feels a fenfe of weight upon his breaft, breathes with. difficulty, and fometimes complains of a pain and giddinefsof his head. His urine is ufually pale, and his colour very little changed.. The diet in this, as well as in the true peripneumony, muft be very flender, as weak broths, fharpened with the juice' of orange or lemon, and fuch-like. His drink may be thin water-gruel Sweet- ened with honey, or a decoaion of the roots of fennel, liquorice, and quick grafs. An ounce of each of thefe may be boiled in three Englifh pints of water to a quart, and lharpened with a little cur- rant jelly, or the like. Bleeding and purging are generally proper at the beginning of this difeafe; but if the patient's fpittle is pretty thick, neither of them are neceffary. It will be fufficient to affift the expeaoratiort by fome of the fharp medicines recommended for that purpofe in the pleurify, as the folution of gum ammoniac with oxyinel of fquills, &c. Blifters have generally a good effect, and ought tc/be applied pretty early*. If the patient does not fpit, he muft be bled according as his ftrength will permit, and have a gentle purge adminiftered. Af- * Previous to the application of blifters,. cupping-glafTes fliould be applied to the puiuful part, which generally afford coufuLTabk' re- h\-f. . (i.e.; ,28 OF CONSUMPTIONS. terTards his body muft be kept open with clyfters, ^d^&}^^: ration promoted; by taking every four hours two table-fpoon.u,. of the foiution mentioned above. uifl„j;„„ When an inflammation of the breaft does not yield to bleeding, blifterinr, and other evacuations, it commonly ends in a iuppura- tion, which is more or lefs dangerous, according to the part where it is fituated. When this happens in the pleura, it fometimes oreaks outwardly, and the matter is difcharged by the wound. When the fuppuration happens within the fubftance or body of the lungs, the matter may be difcharged by expeaoration ; but if the matter floats in the cavitv of the breaft, between the pleura and the lungs, it can only be difcharged by an incifion made octwnct the ribs. . If the patient's ftrength does rot return after the inflammation is to all appearance removed ; if his pulfe continues quick though foft, his breathing difficult and oppreffed; if he has cold fhiverings at times, his cheeks flufhed, his lips dry; and if he complains of thirft, and want of appetite, there is reafon to fear a fuppurr.tion, and that a phthifis or confutation of the lungs will enfue*. W\ fhall therefore next proceed, to confider the proper treatment of that difeafe. CHAPTER. XVIII. Of Confumptions. ACOMSUMPTION is a wafting or decay of the whole bo- ' dy from an ulcer, tubercles, or concretions of the lungs, art empyema, an atrophy, or a cachexy. Dr. Arbuthnot obferves, that in his time confumptions made up above one-tenth part of the bills of mortality in and about t London. There is reafon to believe they have rather increafed fince ; and we know from experience, that they are not lefs fatal in fome other towns of England than in London. Z Young perfons, betwixt che age of fifteen and thirty, of a f!e:> der make, long neck, high fhoulders, and flat breafts, are moft lia- ble to this difeafe. Confumptions prevail more in England, than in any otheT part of the world, owing perhaps to the great ufe of animal food and malt liquors, the general application to fedentary employments, #■ In cafes of this kind, where feveral qinrts of pus or mattej have been difcharged from the mouth, the patient has been recovered by refl- ding, during fpring and fummer, in the country, aflifted by a nouriiV'i duet, exercife on horfe-back, and the t:itra,ct cf Link, (t. Q.) OF CONSUMPTIONS. 129 and the great quantity of pit-coal wvhich is there burnt; to which we may add the perpetual changes in the atmofphere, or variable- nefs of the weather. CAUSES.----It has already been okferved, that ari inflamma- tion in the breaft often ends in an impofthume ; Confequently, whatever difpofes people to this difeafe, muft likewife be consi- dered as a caufe of confumptions. - Other difeafes, by vitiating the habit, may likewife occafion con- fumptions ; as the fcurvy, the fcrophula, or king's evil, the vene- real difeafe, the afthma, fmall-pox, meafles, Sec. As this difeafe is feldom cured, we fhall endeavour the more particularly to point out its caufes, in order that people maybe ena- bled to avoid it. Thefe are : -----Confined or unwholefome air. When this fluid is impreg- nated with the fumes of metals or minerals, it proves extremely hurtful to the lungs, and often corrodes the tender veffels of that neceffary organ. —;—Violent paffions, exertions, or affeaions of the mind; as gpief, difappointment, anxiety, or clofe application to the ftudy of abftrufe arts or fciences. ----Great evacuations ; as fweating, diarrhoeas, diabetes, ex- ceffive venery, the fluor albus, an over difcharge of the menstrual flux, giving fuck too long, &c. * -----The fudden ftoppage of cuftomary evacuations; as the bleeding piles, fweating of the feet, bleeding at the nofe, the menfes, iffues, ulcers, or eruptions of any kind. -----Injuries done to the lungs, calculi, &c. I lately faw the fymptoms of a phthifis occafioned by a fmall bone flicking in the broncha. It was afterwards vomited along with a considerable quan- tity of purulent matter, and the patient, by a proper regimen, and the ufe of the Peruvian bark, recovered. ----Making a fudden transition from a hot to a very cold cli- mate, change of apparel, or whatever greatly leffens the perfpiration. ——Frequent and exceffive debaucheries. Late watching, and drinking ftrong liquors, which generally go together, can hardly fail to destroy the lungs. Hence, the bon companion generally falls a fac*rifice to this difeafe. ■*----Infeaion. It is fufpicious that Confumptions are caught by fleeping with the difeafed ; for which reafon, this fhould be carefully avoided. It cannot he of great benefit to the fick, and muft hurt thofe in health. -----Occupations in life. Thofe artificers who fit much, and are conftantly leaning forward, or preffing upon the ftomach and breaft, as cutlers, taylors, fhoe-makers, feamftreffes, &c. often die of confumptions. They likewife prove fatal to fingers, and all who have occafion to make frequent arid violent exertions of the lungs. -----Cold. More confumptive patients date the beginning of their diforders fj*om'wet feet, damp beds, night air? wet clothes, R , p OF CONSUMPTIONS. oTTatchirig cold after the body had been heated, than from ail other caufes. Sharp, faline, and arqmatic aliments, which heat and inflame the blood, are likewife frequently the caufe of confumptions. We fhall only add, that this difeafe is often o v. ing to an heredita- ry taint, or a- fcrophulous habit; in which cafe it is generally in- curable. SYMPTOMS.----This difeafe generally begins with a dry cough,which often continues for fome mouths. If a difpofition to vo- mit after eating be excited by it, there is ftill greater reafon to fear an approaching confumption. The patient complains of a more than ufual degree of heat, a pain and oppreffion of the breaft, ef- pecially after motion ; his fpittle is of a faltifh tafte, and fometimes mixed with blood. He is apt to be fad; his appetite is bad, and his thirft great. There is generally a quick, foft, fmall pulfe; though fometimes the pulfe is pretty full, and rather hard. Thefe are the common fymptoms of a beginning confumption. Afterwards the patient begins'to fpit a greenifh, white, or bloo- dy matter. His. body is extenuated by the heaic fever, and colli- quative fweats, which mutually fucceed one another, viz. the one towards night, and the other in the morning. A loofenefs, and an exceffive difcharge of urine, are often troublefome fymptoms at this time, and greatly weaken the patient. There is a burning heat in the palms of the hands, and the face generally flufhes after eat- ing ; the fingers become remarkably fmall, the nails are bent in- wards, and the hairs fall off. At laft the fwelling of the feet and legs, the total lofs of ftrength, the finking of the eyes, the difficulty of fwallowing, and the cold- nefs of the extremities, fhow the immediate approach of death, which the patient feldom believes to be fo near. Such is the ufu- al progrefs of this difeafe, which, if not early checked, commonly fets all medicine at defiance. REGIMEN.----On the firft appearance of a confumption, if the patient lives in a large town, or any place where the air is con- fined, he ought immediately to quit it, and to make choice of a-fituation in the country, where the air is pure and free. Here he muft not remain inaaive, but take every day as much exercife as he can bear. ""The beft method of taking exercife is to ride on horfeback, as this gives the body a great deal of motion without much fatigue. Such as cannot bear this kind of exercife, -muft make ufe of a carri- age. A long journey, as it amufes the mind by a continual change of objeas, is greatly preferable to riding the fame ground over and , over. Care however muft be taken to avoid catching cold from wet clothes, damp beds, or the like. The patient ought always to finifh his ride in the morning, or at leaft before dinner ; other wife it will oftener do harm than good. It is a pity that thofe who attend the fick feldom recommend OF CONSUMPTIONS. *3* riding in this difeafe, till the patient is either unable to hear it, or the malady has become incurable. Patients are likewife apt to tri- fle with every thing that is in their own power. They cannot fee how one of the common aaions of life fliould prove a remedy in an obftinate difeafe, and therefore they rejea it, while they gree- dily hunt after relief from medicine, merely becaufe they do not uhderftand it. Thofe who have ftrength and courage to undertake a pretty long voyage, may expea great advantage from it. This, to my knowledge, has frequently cured a confumption after the patient was, to all appearance, far advanced in that difeafe, and where me- dicine had proved ineffeaual. Hence it is reafonable to conclude, that if a voyage were undertaken in due time, it would feldom fail to perform a cure*. Such as try this method of cure ought to carry as much frefh provifions along with them as will ferve the whole time they are at fea. As milk is not eafily obtained in this fituation, they ought to live upon fruits, rye and Indian mufh, and die broth of chick- ens, or other young animals, which can be kept alive on board. Such voyages fhould be undertaken, if poffibie, in the mildefl fea- fon, and towards a warmer climatef. Thofe who have not courage for a long voyage may travel into a more fouthern climate, as the fouth of France, Spain or Portu- gal ; and if they find the air of thefe countries agree well with them, they fhould continue there, at leaft till their health be-con- firmed. Next to proper air and exercife, we would recommend a due attention to diet. The patient fhould eat nothing that is either heating or hard of digeftion, and his drink muft be of a foft and cooling nature. All the diet ought to be calculated to nourifh and fupport the patient. For this purpofe, he muft keep chiefly to the ufe of vegetables and milk. Milk alone is of more value in this dif- eafe than the whole materia medica. Affes' milk is commonly reckoned preferable to any other ; but it cannot'always be obtained; befides, it is generally taken in a very fmall quantity; whereas, to produce any effeas, it ought to make a confiderable part of the patient's diet. ]t is hardly to be expeaed, that a gill or two of affes' milk, drank in the fpace of * The greateft benefit derived to confumptive patients in going to fea, is in proportion to the time they are on the ocean, the temperature of the latitude they fail in, which fhould be agreeably w^rm. '1 herefore, a long voyage, commenced at an early period of this difeafe, or what would be more beneficial, a continuance for ten or twelve months, on the ocean, a patient in fuch a fituation, with tolerable accommoda- tion, would in all probability effeft a recovery. (I. C.) f Though I do not remember to have feen one inftance of a genuine qonfumption of the lungs cured by medicine, yet I have known a Weft- India voyage work wonders in that dreadful diforder. T -,2 OF CONSUMPTIONS. twenty-four hours, fhould be able to produce any confiderablc change in the humours of an adult; and when people do not per- ceive its effeas foon, they lofe hope, and fo leave it off. Hence, this medicine, however valuable, very feldom performs a cure^ The rea- fon is obvious ; it is commonly ufed too late, is taken in too fmall quantities, and is not duly perfifted in. I have known very extraordinary effeas from affes' milk in ob- ftinate coughs, which threatened a confumption of the lungs; and do verily believe, if ufed at this period, that it would feldom fail; but if it be delayed till an ulcer is formed, which is generally the cafe, how can it be expeaed to fucceed ? Affes' milk ought to be drank, if poffibie, in its natural warmth, and, by a grown perfon, in the quantity of half an Englifh pint at a time. Inftead of taking this quantity night and morning only, the patient ought to take it four times, or at leaft thrice a-day, and to eat a little light bread along with it, fo as to make it a kind of meal. If the milk fhould happen to purge, it may be mixed with old conferve of rofes. When that cannot be obtained, the powder of crabs' claws may be ufed in its flead. Affes' milk is ufually ordered to be'drank warm in bed; but as it generally throws the patient into a fweat when taken in this way, it would perhaps be better to give it after he rifes. Some extraordinary cures in comfumptive cafes have been per- formed by women's milk. Could this be obtained in fufficient quan- tity, we would recommend it in preference to any other. It is better if the patient can fuck it from the breaft, than to drink it after- wards. I knew a man who was reduced to fuch a degree of weak- nefs in a confumption, as not to be able to turn himfelf in bed. His wife was at that time giving fuck, and the child happening to die, he fucked her breafts, not with a view to reap any advantage from the milk, but to make her eafy. Finding himfelf greatly bene- ■ fited by it, he continued to fuck her till he became perfeaiy Well, and is at prefent a ftrong and healthy man. Sonie prefer butter-milk ; it is a very valuable medicine if th« ftomach be able to bear it. It does not agree with every perfon at firft; and is often laid afide without a fufficient trial. It fliould at firft be taken fparingly, and the quantity gradually increafed, until it comes to be almoft the fole food. I never knew it fucceed unlefs where the patient almoft lived upon it. Cows' milk is moft readily obtained of any, and though it be not fo eafily digefted as that of affes' or mares', it may be rendered ligh- ter by adding to it as equal quantity of barley-water, or allowing it to Hand for fome hours, and afterwards taking off the cream. If it fhould, notwithilanding, prove heavy on the ftomach, a fmall quantity of brandy or rum, with a little fugar, may be added, which will render it both more light and nourifhing. Milk may for fome time difagree with a ftomach that has not OF CONSUMPTIONS. 133 been accuftomed to digeft any thing but flefh and ftrong liquors, which is the cafe with many pf thofe who fall into confumptions. We do not however advife thofe who have been accuftomed to animal food and ftrong liquors, to leave them off all at once. This might be dangerous. It will be neceffary for fuch to eat a little once a day of the flefh of fome young-animal, or rather to ufe the broth made of chickens, veal, lamb, or fuch-like. They ought like- wife to drink a little wine made into negus, or diluted with twice or thrice its quantity of water, and to make it gradually weaker till they can leave it off altogether. Thefe muft be ufed only as preparatives to a diet confifting chiefly of milk and vegetables, which the fooner that the patient can be brought to bear, the better. Rice and milk or barley and milk, boiled with a little fugar, make very proper food. Ripe fruits roafted, baked, or boiled, are likewife proper, as goofe or currant berry tarts, apples roafled, or boiled in milk, &c. The jellies, con- ferves, and preferves, &c. of ripe fubacid fruits, ou^ht to be eaten plentifully, as the jelly of currants, conferve of rotes, preferved plums,'cherries, &c. Wholefome air, proper exercife, and a diet confifting chiefly of thefe and other vegetables, with milk, is thq only courfe that can be depended on in a beginning confumption. If the patient has ftrength and fufficient refolution to perfift in this courfe, he will feldom be difappointed of a cure. In the populous town of Sheffield, where confumptions are very common, I have frequently feen confumptive patients, who had been fent to the country with orders to ride, and live upon milk and vegetables, return, in a few months quite plump, and free from any complaint. This indeed was not always the cafe, efpecially when the difeafe was hereditary, or far advanced; but it was the only method in which fuccefa was to be expeaed : where it failed, I never knew medicine fucceed. If the patient's ftrength and fpirits flag, he muft be fupported by ftrong broths, jellies, and fuch-like. Some recommend fhell-fifh in this diforder, and with fome reafon, as they are nourifhing and restorative*. All the food and drink ought however to be taken in fmall quantities, left an overcharge of frefh chyle fhould opprefs the lungs*, and too much accelerate the circulation of the blood. The patient's mind ought to be kept as eafy and_ cheerful as poffibie. Confumptions are often occafioned, and always* aggrava- ted, by a melancholy caft of mind ; for which reafon, mufic, cheer- ful company, and every thing that infpires mirth, are highly be- neficial. The patient ought feldom to be left alone, as brooding over his calamities is fure to render them worfe. * I have often known perfons of a confumptive habit, where the fymptoms were not violent, reap great benefit from the ufe of oyfters. They generally ate-them raw, and drank the juice a)>opg with them. i u OF CONSUMPTIONS. "MEDICINE.-----Though the cure of this difeafe depends chief- ly upon regimen and rhe patient's own endeavours, yet we fhall mention a few things which may be of fervice in'relieving fome of the more violent fymptoms. In the f rft ftage of a confumption, the cough may fometimes be appeafed by bleeding ; and the expeaoration may be promoted by the following medicines. Take frefli fquills, gum-ammoniac, ar<^:t^ ^^^'££%>* re for ufing the Peruvian bff£^^t^ettdS&itW into the cavity •ofthebreaft, betwixt the pleura and the ^J^ » ^a^ rettinethe matter out but by an incifion, as has already been cu- rved8 As this operation muft always be performed by a furgeon t ifnof neceffar'y here to defcribe it. We fhall only add tha i is not fo dreadful as people are apt to imagine, and that it is the only chance the patient in this cafe has for his.lite. A NERVOUS CONSUMPTION, is a waiting or decay of the whole body, without any confutable degree of fever, cough or difficulty of breathing. It is attended with indigeftion, weaknefs, and want of appetite, Sec. ■ r • •* Thofe who are of a fretful temper, who indulge in fpirituous liquors, or who breathe an unwholefome air, are moft liable to L We'would chiefly recommend, for the cure of a nervous con- fumption, a li^ht and nourifhing diet, plenty of exercife m a free open air, and the ufe of fuch bitters as brace and ftrengthen the ftomach ; as the bark, gentian root, camomile, horehound, &c. Thefe may be infufed in water or wine, and a glafs of it drank frequently. It will greatly affift the digeftion, and promote the cure of this difeafe, to take twice a-day twenty pr thirty droops of the elixirof vitriol in a glafs of wine or water. The chalybeate wine is likewife an excellent medicine in this cafe. It ftrengthens the folids, and powerfully affifts Nature in the preparation of good blood*. Agreeable amufements, cheerful company, and riding about, are however preferable to all medicines in this difeafe. For which rea- fon, when the patient can afford it, we would recommend a long journey of pleafure, as the moft likely means to reftore his health. What is called zfymptomatic confumption cannot be cured without firft removing the difeafe by which it is occafioned. Thus, when a comfumption proceeds from the fcrophula or king's evil from the fcurvy, the afthma, the venereal difeafe, &c. a due attention muft be paid to the malady from whence it arifcs, and the regimen and medicine direaed accordingly. When exceffive evacuations of any kind occafion a confump- tion, they muft not only be reftrained, but the patient's ftrength muft be reftored by gentle exercife, nourishing diet, and generous cordials. Young and delicate mothers often fall into confumptions, by giving fuck too long. As foon as they perceive their ftrength and appetite begin to fail, they ought immediately to wean the child, or provide another nurfe, otherwife they cannot expea a cure;. * See* Appendix., Chalybeate wuie, OF THE NERVOUS FEVER. 137 Let all, as they wifh to avoid confumptions, take as much exer- cife without-doors as they can, avoid unwholefome air, and ftudy fobriety. Confumptions owe their prefent increafe not a little to the fafhicn of fitting up late, eating hot fuppers, and fpending every evening over a bowl of hot punch or other ftrong liquors. Thefe liquors, when too freely ufed, not only hurt the digeftbn, and fpoil the appetite, but Jseat and inflame the blood, and fet the whole conflitutipri on fire. CHAPTER XIX. Of the Slow or Nervous Fever, NERVOUS fevers have increafed greatly of late years in this country, owing, doubtlefs, to our different manner of living, and the increafe of fedentary employments; as they commonlv attack perfons of a weak, relaxed habit, who neglea exercife, eat little folid food, ftudy hard, or indulge in fpirituous liquors. CAUSES.----Nervous fevers may be occafioned by whatever depreffes the fpirits, or impoverifhes the blood; as grief, fear, anxiety, want of fleep, intenfe thought, living on poor watery diet, unripe fruits, cucumbers, melons, mufhrooms, &c. They may like- wife be occafioned by damp, confined, or unwholefome air. Hence they are very common in rainy feafons, and prove moft fatal to thofe who live in dirty low houfes, crowded ftreets, hofpitals, jails, or fuch-like places. Perfons whofe conftitutions have been broken by excefssVe vc- nery, frequent falivations, too free an ufe of purgative medicines, or any other exceffive evacuations, are moft liable to this difeafe. Keeping on wet clothes, lying on the damp ground, exceffive fatigue, and whatever obftrucls the perfpiration, or caufes a fpaf- modic ftriaure of the folids, may likewife occafion nervous fe- vers. We fhall only add, frequent and great irregularities in diet. Too great abflinence,as well as excefs, is hurtful. Nothing tends fo much to preferve the body in a found ftate as a regular diet; nor can any thing contribute more to occafion fevers of the worft kind thau its oppofite. SYMPTOMS.----Low fpirits, want of appetite, weaknefs, wearinefs after motion, watchfulnefs, deep fighing, and dejection of mind, are generally the forerunners of this difeafe. Thefe are fucceeded by a quick low pulfe, a dry tongue without any con- siderable thirft, chillnefs and flufhing in turns, Sec. After fome time, the patient complains of a giddinefs and pain of the head, has a naufea, with Teachings and vomiting ; the pulfe is quick, and fometimes intermitting ; the ufine pale; refembling i^ OF THE NERVOUS FEVER. dead"fmall beer, and the breathing is difficult, with oppreffionof the breaft, and flight alienations of mind. If towards the ninth, tenth, or twelfth day, the tongue become,-; more moifl, with a plentiful fpitting, a gentle purging, or a moisture upon the fkin ; or if a fuppuration happens in one or both ears, or large puftules break out about the lips and nofe, there u Teafonto hope for a favourable crifis. But if there is an exceffive loofenefs,or wafting fwcats, with fre- quent fainting fits ; if the tongue, when put out, trembles excef- fively, and the extremities feel cold, with a fluttering or flow creep- ing pulfe ; if there is a flatting of the tendon*, and almoft total lofs of fight and hearing, and an involuntary difcharge by ftool and urine, there is great reafon to fear that death is approaching. REGIMEN.'.----It is very neceffary in this difeaff to keep the patient cool and quiet. The leaft motion will fatigue him, and will be apt to occafion wearinefs and even faintings. His mind ought not only to be keptcafv, but toothed and comforted with hopes of a fpeedy recovery. Nothing is more hurtful in low fevers of this kind than prefenting'to the patient's imagination gloomy or fright- ful ideas. Thefe of themfelves often occafion nervous fevers, and* muft likewife aggravate them. The patient muft not be kept too low. His ftrength and fpirits ought to be fupport°d by nouiifhing diet and generous cordials. For this purpofe, his gruel,panado, or whatever food he takes, mud be mixed with wine, according as the fymptoms may require. Pretty ftrong wine-whey, or fmall negus, fharpened w ith-rfie juice of orange or lemon, will be proper for his ordinary drink. JVluftard- whey is likewife a very proper drink in this fever, and may be ren- dered an excellent cordial-medicine, by the addition, of a proper quantity of white-wine*. Wine, iti this difeafe, if it could be obtained genuine, is almoft the only medicine that would be neeeflhry. Good wine poffefles- all the virtues of the cordial medicines, while it'is free from ma- ny of their bad qualities. I fay good wine ; for, however com- mon this article of luxury is now become, it is rarely to be ob- tained genuine, efpecially by the poor, who are obliged to pur- chafe it in fmall quantities. I have often feen patients in low nervous fevers, where the pulfe could hardly be felt, with a constant delirium, coldnefs of the ex- tremities, and almoft every other mortal fyrnptom, recover, By ufmg in whey, gruel and negus, a bade or two of ftrong wine every day. Good old found claret is the beft, and may be made into negus, or given by itfelf, as circumftanccs require. In a word, the great aim in this difeafe is to fupport the pa- tient's ftrength, by giving him frequently fmall quantities of tile shove, or other drinks of a warm and cordial nature. He is not, * See Appendix, Mustard-whey.' OF THE NERVOUS FEVER; -*33 hewcver, to be over-heated either with liquor or clothes; and his food ought, to be light, and given in fmall quantities. MEDICINE-----Where a naufea, load, and ficknefs at fto- mach prevail at the beginning of the fever, it will be neceffary to give the patient a gentle vomit. Fifteen or twenty grains of ipecacuanha in fine powder, or a few fpoonfuls cf the vomiting- julepf, will generally anfwer this purpofe very well. This may be repeated any'time before the third or fourth day, if the above fymptoms continue. Vomits not only clean the ftomach, .but, bv fheygeneralfhock which they give, promote the perfpiration, and have many other excellent effeas in flow fevers, where there are no fignsof inflammation, and nature wants routing. Such as dare not venture upon a vomit, may clean the. bowels by an infufion of fenna and manna. In ..11 fevers, the great point is to regulate the fymptoms, fo as to prevent them from going to either extreme. '1 hus, in fevers ' of the inflammatory kind, where the force of the circulation is too great, or the blood denfe, and the fibres too rigid, bleeding and other evacuations are neceffary. But in nervous fevers, where nature*flags, and the folids relaxed, wine,'with other cordials fliould be plentifully adminiftered. It is neceffary to caution people againft bleeding in this difeafe, as there is generally at the beginning an univerftft ftriaure upon the veffels, and fometimes an opprefiion and difficulty of breath- ing, which fuggeft the idea of a plethora, or too great a quantity of blood. I have known even fome of the faculty deceived by their own feelings in this refpea, fo far as to infift upon being bled, when it was evident, from the confequences, that the opera- tion was improper. Though bleeding is generally improper in this difeafe, yet blif- tering is highly neceffary. Blifters may be applied at all times of the fever with great advantage. If the patient is delirious, he ought to be blistered on the neck or head, and it will be the fa- feft courfe, while the infenfibility continues, as foon as the dif- charge occafioned by one blifter abates, to apply another to fome other part of the body, and by that means, keep up a continual fucceffion of them till he be out of danger. I have been more fenfible of the advantage of bliltering in this than in any other difeafe. Blifters not only ftimulate the folids to aaion, but likewife occafion a continual difcharge, which may, in fome meafure, fupply the want of critical evacuations, which feldom happen in this kind of fever. They are moft proper, ei- ther towards the beginning, or after fome degree of flupor has come on ; in which laft cafe, it will always be proper to blifter the head. If the patient is coftive through the courfe of the difeafe, it will be neceffary to procure a ftool, by giving him every other day t Sec Appendix, Vomiting Julep. i4o OF THE NERVOUS FEVER. a clyfter of milk and water, with a little fugar, to which may be added a fpoonful of common fait, if the above does not operate. Should a violent loofenefs come on, it maybe checked by fmall quantities of Venice treacle or laudanum, giving the patient for hi3 ordinary drink the white decoaion *. A miliary eruption fometimes breaks out about the ninth or tenth day. As eruptions are often critical, great care fhould be taken not to retard Nature's operation in this particular. The eruption ought neither to be checked by bleeding nor other evacuations, nor pufhed out by a hot regimen ; but the patient fliould be fuppor- ted by gentle cordials, as wine-whey, fmall negus, fago-gruel, with a little wine in it, and fuch-like. He ought not to be kept too warm; yet a kindly breathing fweat fhould by no means be checked. Though blifters, and the-ufe of cordial liquors are the chief things to be depended on in this kind of fever; yet, for thofe who may choofe to ufe them, we fhall mention one or two of the forms of medicine which are commonly prefcribed in itf. In defperate cafes, where the hickough and flarting of the ten- dons have already come on, we have fometimes feen extraordinary effeas from large dofes of mufk frequently repeated. Mufk is doubtlefs an antifpafmodic, and may be given to the quantity of a fcruple three or four times a-day, or oftener if neceffary. Some- times it may be proper to add to the mufk a few grains of cam- phire, and fait of hartfhorn, as thefe tend to promote perfpiration and $e difcharge of urine. Thus, fifteen grains of mufk, with three grains of camphire, and fix grains of fait of hartfhorn, may be made into a bolus with a little fyrup, and given as above. If the fever fhould happen to intermit, which it frequently does towards the decline, or if the patient's ftrength fhould be wafted with colliquative fweats, &c. it will be neceffary to give him the Peruvian bark. Half a drachm, or a whole drachm, if the ftomach will bear it, of the bark in fine powder, may be given four or five times a-day in a glafs of red port or claret. Should the bark in fub- ftance not fit eafy on the ftomach, an ounce of it in powder may he infufed in a bottle of Lifbon or Rhenifh wine for two or three days, afterwards it may be {trained; and a glafs of it taken frequently!. * See Appendix, White Decoaion. f When the patient is low, ten grains of Virginian fnake root, and the fame quantity of contrayerva-root, with fiv; grains o£ Ruffian caftor, all in fine powder, may be made into a bolus with a little of the cordial confeaion or fyrup af faflron. One of thefe may be taken every four or five hours. J The following powder may be ufed with the fame intention • Take wild \ alenan-root in powder one fcruple, faflron 2nd caitor e->chfour grains. Mix thefe by rubbing them together in a mortar, and eive one in a cup of wine-whey three or four times a-day. 1 ThC *?} m-ay ^Tlf6 hf Very Pr°Per,y admimffered, alone with other cord.als, in the following manner : Of bark an ounce, "fan- peel half an ounce, Virgin.an fnake-root two drachma fuffron on- PUTRID OR SPOTTED FEVER. Some give the bark in this and other fevers, where there are no fymptoms of inflammation, without any regard to the remission or intermiffion of the fever. How far future obfervation may tend to eftablifh this praaice, we will not pretend to fay; but we have reafon to believe that the bark is a very univerfal febrifuge, and that it may be adminiftered with advantage in moft fevers where bleed- ing is not neceffary, or where there are no fymptoms of topical inflammation. CHAPTER XX. Of the Malignant Putrid or Spotted Fever. THIS may be called the peftilential fever of Europe, as, in many of its fymptoms, it bears a great refemblance to the plague. Perfons of a lax habit, a melancholy difpofition, and thofe whofe vigour has been wafted by long fafting, watching, hard la- bour, exceffive venery, frequent falivations, &c are moft liable to it. CAUSES.----This fever is occafioned by foul air, from a number of people being confined in a narrow place, not properly ventilated ; from putrid animal and vegetable effluvia, &c. Hence it-prevails is camps, jails, hofpitals, and infirmaries, efpecially where fuch places are.too much crowded, and cleanlinefs is ne- gleaed. A clofe conftitution of the air, with long rainy or foggy wea- ther, likewife occafions thefe fevers. They often fucceed great in- undations in low and marfliy countries, efpecially when thefe are preceded or followed by a hot 2nd fultry feafon. Living too much upon animal food, without a proper mixture of vegetables, or eating fifli or flefh that has been kept too long, are apt to occafion this kind of fever. Sailors on long voyages, and the inhabitants of befieged cities, are very often vifited with this dif- eafe. jCorn that has been greatly 'damaged by rainy feafons or long keeping, and water which has become putrid by ftagnation, &c. may likewife occafion this fever. Dead carcafes tainting the air, efpecially in hot feafons, are very apt to occafion thefe difeafes. Hence, this kind of fever often pre- vails in countries which are the fcenesof war and bloodfhed. This fho ws the propriety of removing burying-grounds, flaughter-houfes, &c. to a proper diftance from great towns. Want of cleanlinefs is a very general caufe of thefe fevers. Hence drachm. Let all of them be powdered, and infufed in an F.nglim pint of the beft brandy for three or four days. Afterwards the liquor may be {trained, and two tea-fpoonfuls of it given three or four times a day in a glafs of fmall wine oc negus. j 42 PUTRID OR SPOTTED FEVER, the7 prevail amongft the poor inhabitants of large towns, who breathe a confined, unwholefome air,and pcgleft cleanlinefs. oudi mechanics as carry on dirty employments, and arc conftantly con- fined within doors, arc very liable to this difeafe. _ We fhall only add, that malignant, or fpotted fevers are highly infeaious, and often communicated by contagion All perfons ought to keep, at a diftance from thofe affeaed with fuch difeafes, unlefs their attendance is abfolutcly ncceflary. SYMPTOMS.----The malignant fever is generally preceded by a remarkable weaknefs or lofs of ftrength, without any apparent caufe. This is fometimes fo^ve.it, that the patient can fcarce walk, ■or even fit upright, without being in danger of fainting away. His mind too is greatly dejected ; he fighs, and is full of dreadful npprehenfions. There is a naufea, ana fometimes a vomiting of bile; a violent pain of the head, with a ftrong pulfation or throbbing of thetemj- poral arteries ; the eyes often appear red and inflamed, with a pain at the bottom of the orbit; there is a noife in the ears, the breath- ing is laborious, and often interrupted with a figh ; the patien* complains of a pain about the region of the ftomach, and in his back and loins; his tongue is at firft white, but afterwards it ap> pears black and chsped ; and his teeth are covered with a black cruft. He fometimes paffes worms both upwards and downward*, is affeaed with tremors or fhaking, and often becomes delirious. If blood is let, it appears diflblved, or with a very fmall degree of coheficn, and foon becomes putrid : the ftools fmell extremely icctid, and are fometimes of a greenifli, black, or reddifti call. Spots of a pale purple, dun, or black colour, often appear upon the fkin, and fometimes there are violent haemorrhages, or dif- charges of blood from the mouth,.eyes, nofe, Sec. Thefe fevers may be diflinguifhed from the inflammatory, by the fniallnefs of the pulfe, the great dejeaion of mind, the diflbl- ved ftate of the blood, the petechias, or purple fpots, and the putrid fmell of the excrements. They may likewife be diflinguifhed from the low or nervous fever by the heat and thirft being greater, the urine of a higher colour, and the lofs of ftrength, dejeaion of mind, and all the other fymptom.-, more violent. Sometimes the inflammatory, nervous, and putrid fymptoms are fo blended together, as to render it very difficult to determine to vvhich clafs the fever belongs. In this cafe, the greateft caution and ikill are requisite. Attention muft be paid to thofe fymptoms which 2re moft prevalent, and both the regimen and medicines adapted to them. Inflammatory and nervous fevers may be converted into malig- nant and putrid, by too hot a regimen or improper medicines. The duration of putrid fevers is extremely uncertain ; fometimes they terminate between the feventh and fourteenth day, and at ether times they are prolonged for five or fix weeks. Their dura- I PUTRID OR SPOTTED FEVER. 14- tfon depends greatly upon the conftitution of the patient, and the ' manner of treating the difeafe. The moft favourable fymptoms are, a gentle loofenefs after the fourth or fifth day, with a warm, mild fweat. Thefe, when con- tinued for a considerable time, often carry off the fever, and fhouii/ never be imprudently flopped. Small miliary puftules appearing between the petechia:, or purple fpots, are likewife favourable, a.- alfo hot fcabby eruptions about the mouth and note. It is a good fign when the pulfe rifes upon the ufe of wine, or other cordials, and the nervous fymptoms abate ; deafnefs coming on towards the decline of the fever, is often a favourable fymptom'*, as arc; abfceflss in the groin or parotid glands. Among the unfavourable fymptoms,may be reckoned an exceffive loofenefs, with a hard fwelled belly; large black or livid blotches breaking out upon the fkin ; apthaj in^the mouthy cold clammy fweats ; blindnefs ; change of the voice; a wild flaring' of the eyes ; difficulty of fwallowing; inability to put out the tongue ; and a conftant inclination to uncover the breaft. When the fweat: and faliva are tinged with blood, aial the urine is black, or depofits a black footy fediment, the patient is in- great danger. Starting cf the tendons, and foetid, ichorous, involuntary ftools, attended with coldnefs of the extremities, are generally the fo*.-runners of death. REGIMEN.----In the treatment of this difeafe, we ought to endeavour as far as poffibie, to fupport the patient's ftrength aiul fpirits ; and to affift Nature in expelling the caufe of the difeafe, by gently promoting perfpiration and the other evacuations. Putrid fevers are often occafioned by unwholefome air, and of courfe they muft be aggravated b;,"it. Care fliould be taken to pre- vent air from ftagnating in the patient's chaiflber, to keep it cool, and renew it frequently, by opening the doors or windows of fome adjacent apartment. The breath and perfpiration of per- fons in perf a health loon render the air of a i'm..dl apartment: noxious ; but this will fooner happen from the perfpiration and' breath of a perfon in this difeaie. Befides the frequent ad million of frefli air, we recommend the ufe of vinegar, verjuice, juice of lemon, Seville orange, or any ve- getable acid- that can be moll readily obtained. Thefe ought fre- quently to be fprinkled upon the floor, the bed, and every part qf : . the room. They may alio be evaporated with a hot iron, or by boil- : ing, Sec. The frefli ileitis of lemons or oranges ought to be laid in % different parts of the room, 'and fhould be frequently held to the" i patient's nofe. '1 he ufe of acids in this manner would prove very refrefhing to the patient, and tend to prevent the infection from fpreading among thofe who attend him. Strong fcented herbs, as rue, tanfy, roternary, wormwood, &c. may be laid in different parts f of the houfe, and lmellcd to by thofe who go near the patient. * Deafnefs is not always a favourable fymptom in this difeafe. Per- "* ht'ps it is or.);- fo when o^r.'i'.aed by atfeclVs formed vitlfu the e:.rs» 144 PUTRID OR SPOTTED FEVER. " The patient muft be kept cool, quiet and eafy. The leaft noife will affea his head, and the fmalleft fatigue will be apt to make him faint. Few things are of greater importance in this difeafe than acids, which ought to be mixed with all the patient's food, as well as drink. Orange, lemon, or vinegar whey, are all very proper, and may be drank by turns, according to the patient's inclination. They may be rendered cordial by the addition of wine in fuch quantity as the patient's ftrength feems to require. When he is very low, he may drink negus, with only one half water, and fharpened with the juice of orange or lemon. In fome cafes, a glafs of clear wine may now and then be allowed. The moft proper wine is Rhenifh ; but if the body be open, red-port or claret is to be preferred. When the body is bound, a tea-fpoonful of the cream of tartar may be put into a cup of the patient's drink, as there is occafion; or he may drink a decoaion of tamarinds, which will both quench his thirft, and promote a difcharge by ftool. If camomile-tea will fit upon his ftomach, -it is a very proper drink. It may be fharpened by adding to every cup of the tea ten •r fifteen drops of the elixir of vitriol. The food muft be light, as panado or groat gruel; to which a little wine may be added, if the patient be weak and low ; and they ought all to be fharpened with the juice of orange, the jelly of cur- rants, or the like. The patient ought likewife to eat freely of ripe fruits, as roasted apples, currant or goofeberry tarts, preferved cherries, or plumbs, &c. Taking a little food or drink fupports the fpirits : for which rea- fon, the patient ought frequentir co be tipping fmall quantities of fome of the acid liquors mentioned above, or any that may be more agreeable to his palate or more readily obtained. If he is delirious, his feet and hands ought to be frequently fo- mented with a ftrong infufion of camomile flowers. This, or an infufion of the bark, to fuch as can afford it, cannot fail to have a good effea. Fomentations of this kind relieve the head, by relax- ing the veffels in the extremities. MEDICINE.----If a vomit be given at the beginning of this fever, it wiil hardly fail to have a good effea; but if the fever has gone on for fome days, and the fymptoms are violent, vomits are not quite fo fafe. The body however is always to be kept gently open by clyfters, or mild laxative medicines. Bleeding is feldom neceffary in putrid fevers. If there be fio:i!ei, in ta-'-consiiV of twenty-four hours. (I. C- ) 146 PUTRID OR SPOTTED FEVER. Thave known large ulcerous fores break out in ™^£<* the body, in the decline of this fever, of a livid gan|ien°^ pearance, and a moft putrid cadaverous fmell rhefe gradually healed ; and the patient recovered by the plentiful ufe of bark and wine, fharpened with the fpirits of vitriol. . For preventing putrid fevers, we would recommend a ftnfl re- gard to cleanlinefs; a dry fituation; fufficient exercife in the open air; wholefome food, and a moderate ufe of generous liquors. In- feaion ought above all things to be avoided. No conftitution t, proof aeainft it. I have known perfons feized with a putrid fever, by only"making a fingle vifit to a patient in it; others have caught it. by lodging for one night in a town where it prevailed; and fome by attending the funerals of fuch as died of it*. When a putrid fever feizes any perfon in a family, the greateft attention is neceffary to prevent the difeafe from fpreading. The fick ouFht to be placed in a large apartment, as remote from the. reft of the family as poffibie; to be kept extremely clean, and to have frefh air frequently let into his chamber; whatever comes from him fliould be immediately removed, his linen frequently changed, and thofeinhealthoughttoavoidallunncceffarycommunicationwithhim. Any one who is apprehensive of having caught the infeaion, ought immediately to take a vomit, and to work it off by drinking plentifully of camomile tea. This may be repeated in a day or two, if the apprehenfions ftill continue, or any unfavourable fymptoms appear. He ought likewife to take an infufion of the bark and camomile flowers for his ordinary drink ; and before he goes to bed, he may drink an Englifh pint of pretty ftrong negus, or a few glaffes of generous wine. I have frequently followed this courfe,, when malignant fevers prevailed, and have recommended it to others with conftant fuccefs. People generally fly to bleeding and purging as antidotes againft infeaion ; but thefe are fo far from fecuring them, that they often^ by debilitating the body, increafe the danger. Thofe who wait upon the fick in this difeafe ought always to have a piece of fpunge or a handkerchief dipt in vinegar, or juice of lemon, to fmell to while near the patient. They ought to wafh their hands, and, if poffibie, to change their clothes, before they go into company!- •5f The late Sir John Pringle exprefled a concern left thefe cautions fliould prevent people from attending their friends or relations when affli&ed with putrid fevers. I told him I meant only to difcourage unneceffarv^ attendance, and mentioned a number of inftances where putrid fevers had proved.fatal to perfons who were rather hurtful than beneficial to the fick. He agreed with me, that a good doftor and a care- ful nurfe were the only neceflury attendants ; and that all others not only endangered themfelves, but, generally, by their folicltude and ill— direfted care, hurt the lick. | Thefe are prudent precautions, particularly cle'anlinefs ; as to moft of the others, recommended by our judicious author, they feeaaed t»' C H7 J CHAPTER XXI. 'Of the Miliary Fever. THIS fever takes its name from the fmall puftules or bladders which appear on the fkin, refembling, in fhape and fize, the feeds of millet. The puftules are either red or white, and fre- quently both are mixed together. The whole body is fometimes covered with puftules ; but they are generally more numerous where the fweat is moft abundant, as on the breaft, the back, Sec. A gentle fweat, or moisture on the fkin, greatly promotes the eruption ; but, when the fkin is dry, the eruption is both more painful and dangerous. Sometimes this is a primary difeafe; but it is much oftener only a fymptom of fome other malady, as the fmall-pox, meafles, ardent, putrid, or nervous fevers, Sec. In all thefe cafes it is generally the effea of too hot a regimen or medicines. The miliary fever chiefly attacks the idle and the phlegmatic, or perfons of a relaxed habit. The young and the aged arc more liable to it than thofe in the vigour and prime of life. It is likewife more incident to women than men, efpecially the delicate and indolent, who keep continually within doors, and live upon weak watery diet. Such females are extremely liable to be feized with this difeafe in childbed, and often loofe their lives by it. CAUSES---—The miliary fever is fometimes occafioned by vio- lent paffions or affeaions of the mind ; as exceffive grief, anxiety, thoughtfulnefs, Sec. It may be occafioned by exceffive watching, great evacuations, a weak watery diet, rainy feafons, eating too freely of cold, crude unripe fruits, as plums, cherries, cucumbers, melons, Sec. Impure waters, or provifions which have been fpolied by rainy feafons, long keeping, &c. may caufe miliary fevers. They may alfo be occafioned by the ftoppage of any cuftomary evacuation, as iffues, fetons, ulcers, the bleeding piles in men, or the menftrual flux in women, &c. This difeafe in childbed-women is fometimes the effea of great coftivenefs during pregnancy ; it may likewife be occafioned by their exceffive ufe of green trafh, and other unwholefome things, in which pregnant women are too apt to indulge. But its moft ge- neral caufe is indolence. Such women as lead a fedentary life, ef- pecially during pregnancy, and at the fame time live grofsly, can hardly efcape this difeafe in childbed. Hence it proves extremely fatal to women of fafhion, and likewife to thofe women in manu- facturing towns, who, in order to affift their hufbands, fit clofe have little or no efFeft during the late yellow fever, which provailed in Philadelphia. We believe the beft prefervative, if it could be attained, is a cheerful and undifturbed ftate of mind. CI. C.) 148 OF THE MILIARY FEVER. within doors for almoft the whole of their trmc. But among wo- men who are aaive and l.-.boriou?, who live in the cuiatry, and take fufficient exercife' without doors, this tiifeafe is very little known. SYMPTOMS.----When this is a primary difeafe, it makes its attack like moft other eruptive fever?, with a flight fhivering, which is fuccecdedby.hear, lofs of ftrengtli, faintifhnefs, fighing, a low quick pulfe, difficulty of breathing, with great anxiety and oppref- fion of the breaft. The patient is rcftlefs, and fometimes delirious; •he tongue appears white, and the hards fhake, with often a burn- ing heat in the palms ; in childbed-women the milk generally goes away, and other difcharges flop. The patient feels an itching or prick Tig pain under the fkin, after which innumerable fmall puftules of a red or white colour begin to appear. Upon this the fymptoms generally abate, the pulfe be- comes more full and foft, the skin grows mcifter, and the fweat, as the difeafe advances, begins to have a peculiar fretid fmell; the great load on the breaft, and oppreffion of the fpirits, generally go off, and the cuftomary evacuatiens gradually return. About the fixth or feventh day from the eruption, the puftules begin to dry and fall off, which occafions a very difagreeable itching in the fkin. It is impoffible to afcertain the exaa time when the puftules will either appear or go off. They generally come out on the third or fourth day, when the eruption is critical; but when fympto-. matical, they may appear at any time of the difeafe. Sometimes the puftules appear and vaniih by turns. When that is the cafe, there is, always danger ; but when they go in all of a fudden, and do not appear again, the danger is very great. In childbed-women the puftules are commonly at firft filled with clear water, afterwards they grow yellowim. Sometimes they are intcrfperfed with puftules of a red colour. When thefe only appear the diffafe goes by the name of a rfj. REGIMEN----In all eruptive fevers, of whatever kind, the chief point is to prevent the fudden difappearing of the puftules, and to promote theif maturation. For this purpofe the patient muft be»kept in fuch a temperatuue, as neither to pufh out the eruption too fa ft, nor to caufe h to retreat prematurely. The diet and drink ought Therefore to be in a moderate degree nourifhing and cordial; but neither ftrong nor heating. The patient's chamber ought nei- ther to be kept too hot nor cold ; and he fhcnld not be too much cov.r.'ii with clothes. Above all, the mind is to be kept eafy and cheerful. Nothing fo certainly makes an eruption go in as fear, or the apprehension of clanger. Ihe food muft be weak chicken-broth with bread, panado, fago, or groat-gruel, &e. to a gill of which may be added a fpoonful or two of wine, as the patient's ftrength requires, with a few grains of fait and a little fugar. Good apples roaftcd or boiled, with ether ripe fruits of an^opening cooling nuuic, may be eaten. OF THE MILIARY FEVER. * 149 The'drink may be fuited to the ftate of the patient's ftrength and fpirits. If thefe be pretty high, the drink ought to be weak; as water-gruel, b.ilm-tea, or the decoclion.mei*-tioned below*. When the patient's fpirits are low, and the eruption does not rife fufficiently, his drink muft be a little more generous^ as wine- whey, or fmall negus, fharpened with the juice of orange or lemon, and made ftronger or weaker as circumflances may require. Sometimes the miliary fever approaches towards a putrid nature, in which cafe the patient's ftrength muft be fupported with gene- rous cordials, joined with acids; and, if the degree of putrefcence be greaf, the bark muft be given. If the head be much affeaed, the body muft be kept open by emollient clyfters-j-. MEDICINE.----If the food and drink be properly regulated, there will belittle occafion for medicine in this difeafe. Should the c ription, however, r,a rife, or the fpirits flag, it will be neceffary to fupport the patient with cordials, and fo apply blifters. The moft proper cordial, in this cafe, is good wine, which nay either be ta- ken in the patient's food or drink ; and if there be figns of putre- fcence, the bark and acids may be eai:;:d with wine, as direaed in the putrid lever. Some recommend blistering through the whole ccurfe of this difeafe; and where Nature flag-,, and the cTupiion comes arid goes, it may be neceffary to keep up a stimulus, by a continual fuefceffion of fmall blifters, but net above one at a time. I;" the pulfe finks re- markably, the puftules fall in, and'the head is affeaed, it will be- neceffary to a-p'.y fov-.ral bliiie-s to the mc ft fenfible parts, as the in fide of the legs and thighs, &c. .*• TaVe "v. o onus's or the fiVivlngs of hr.rtfacm, a-.id the fame quan- tity of farfd^rllii. b)":l tl-iem 'n two Kn^ifh quarts of water. To the (trained decoction add a.little walte fe^ar, ^net the patient <;:'.;e it ier h'-i ordinary drink. ' + In tV Coaunercivn I.'t-rar'vm for -he year T-35, we have the hif- tory of an epidemical niilla.7 'ever, which ra:>ed at Strai'bur»;h 111 the months of November, December, and J imeiry ; !rom which we lea-n the neceffity of a. temperate rczhven in tiiis malady, ;m«. likew (e-th.it plry.'icians are not always t'-e firil who di.eover i'lt: proper treatment f d ■•'eafes " Thr fevv made ter.llle havoclc even auiono; men ot -lobutt cWtitu'tions. and r.if-.acditiiie proved in vain. " They were (eiz■ d in an inilantwithfliivcring, yawning, irn:dii:tg and p;ms nnhe oat .c, luc- cecded bv a mo:: uiw* heat; at the (Vine time- there w.-i- a sreat. I^ls <-; Jlixnrili and appetite. On the fe-.entii or nuifh dav the miliary erup- tions appeared, or fpot.; like tlea bite-, with «rri',«t a i*u-,\ » «.t-m 1.'■ •;, r-'UeffH.e', and to'Imp-in bed. Bleeding was fatal. While matters were in thisiiiihanpv lunation, a midwife, of her own accord^''™ to .1 patient, in the height: of the dif an-, a ciyiter of rain-water and put'ee withowt fait, and Tor his ordinary drink a cpiaa t of fpring w;,t.:r, halt a._ pint ot jrencrous wine',- tke juice of a lemon and fix ommes <>) the wu.teltiu- rar, rrenfty boik-d tirl a farm arofe, and this with £rcat fncce's ; lor the bellv°v\ -■ -foon looi'encd, the-rievons fymptoms vanilhed, ard the W'}]?™ v. is'r eior. 1 t.« his f nfes, and faatched from the jaws of de..ui. 1 mi practice w as imitated by otherc with the like liappyefteftj. 15o • OF THE REMITTING FEVER. Bleeding is feldom neceffary in this difeafe, and fometimes it does much hurt, as it weakens the patient, and depreffes his fpirits. It is never to'be attempted unlefs by the advice of a phyfician. It has been cuftomary to treat this difeafe in childbed-women by plentiful bleeding, and other evacuations, as if it were highly in- flammatory. But this practice is generally very unfafe. Patients in this fituation bear evacuations very ill. And indeed the difeafe feems often to be more of a putrid than of an inflammatory nature. Though this fever is often occafioned in childbed-women by too hot a regimen, yet it would be dangerous to leave that off all of a fudden, and have recourfe to a very cool regimen, and large evacuations. Supporting the patient's fpirits, and promoting natural evacuations, is here much fafer than having recourfe to artificial, ones; as thefe by finking the fpirits, feldom fail to increafe the danger. , If the difeafe proves tedious, or the recovery flow, the bark may be taken in fubftance, or infufed in wine or water, as the patient inclines. The miliary fever, like other eruptive difeafes, requires gentle 1 purging, which fhould not be neglected as foon as the fever is gone off, and the patient's ftrength will permit. To prevent this difeafe, a pure dry air, fufficient exercife, and. wholefome food, are neceffary. Pregnant women fhould guard fcgainft coftivenefs, and take daily as much exercife as they can bear, avoiding all green trafhy fruits, and other unwholefome things; and when in childbed, they ought strictly to obferve a cool regimen. CHAPTER XXII. Of the Remitting Fever. THIS fever takes its name from a remiffion of the fymptoms, which happens fometimes fooner, and fometimes later, but generally before the eighth day. The remiffion is commonly pre- ceded by a gentle fweat, after which the patient feems greatly re- lieved, but in a few hours the fever returns. Thefe remiffions return at very irregular periods, and are fometimes of longer, fometimes of fhorter duration ; the nearer however that the fever approaches to a regular intermittent, the danger is the lefs. CAUSES.----Remitting fevers prevail in low marfhy countries abounding with wood and ftagnating water; but they prove moft fatal m places where great heat and moifture are combined, as in fome parts of Africa, Bengal in the Eaft Indies, &c. where remit- ting fevers are generally of a putrid kind, and prove very fatal. They are moft frequent in clofe calm weather, efpecially after rainy feafons, great inundations, or the like. No age,tex, or conftitution, OF THE REMITTING FEVER. i5i is exempted from the attack of this fever ; but it chiefly feizes per* ions of a relaxed habit, who live invlow dirty habitations, breathe an impure ftagnating air, take little exercife, and ufe unwholefome diet. SYMPTOMS-----The firft fymptoms of this fever are generally yawning, ftretching, pain, and giddinefs in the head, with alternate fits of heat and cold. Sometimes the patient is affected with a delirium at the very firft attack. There is a pain, and fometimes a fwelling, about the region of the ftomach, the tongue is white, the eyes and fkin frequently appear yellow, and the patient is often afflicted with bilious vomitings. The pulfe is fometimes a little hard, but feldom full, and the blood, when let, rarely fhows any figns of in- flammation. Some patients are exceedingly coftive, and others arc afflicted with a very troublefome loofenefs. It is impoffible to defcribe all the fymptoms of this difeafe,' as they vary according to the fituation, the feafon of the year, and the conftitution of the patient. They may be greatly changed by the method of treatment, and by many other circumftances. Some- times the bilious fymptoms predominate, fometimes the nervous and at other times the putrid. Nor is it uncommon to find a fuc- ceffion of each of thefe, or even a complication of them at the fame time, in the fame perfon. REGIMEN.----The regimen muft be adapted to the prevailing fymptoms. When there are any figns of inflammation, the diet muft be flender, and the drink weak and diluting. But when ner- vous or putrid fymptoms occur, it will be neceffary to fupport the patient with food and liquors of a more generous nature, fuch as are recommended in the immediately preceding fevers. We muft be very cautious in ufing things of a heating quality, as this fever is frequently changed into a continual by an hot regimen, and im- proper medicines. Whatever the fymptoms are, the patient ought to be kept cool, quiet, and clean. His apartment, if poffibie, fhould be large, and frequently ventilated by letting in frefh air at the doors or windows. It ought to be fprinkled with vinegar, juice of lemon, or the like. His linen, bed-clothes, &c. fliould be frequently changed, and all his excrements immediately removed. Thefe precautions are of more importance to the fick than practitioners are apt to imagine*. MEDICINE-----In order to cure this fever, we muft endeavour to bring it to a regular intermiffion. This intention may be pro- ■X- Dr. Lind, of Edinburgh, in his inaugural diflertation concerning, the putrid remitting fever of Bengal, has the following obfervation : 'l The patient's fliirt, bed-clothes, and bedding, ought frequently to be chan- ged, and expofed to the air, and all his excrements immediately remo- ved ; the bed-chamber fliould be well ventilated, and frequently fprin- kled with vinegar; infhort, every attention mou Id be paid to the patient. I can affirm, that a phyfician who puts thefe in practice will much oftener fucceed than one who i* even more flulful, but has not opportunity oi ufing thefe means." OF THE YELLOW FEVER. moted by bleeding*, if there be any figns of ' mfle.mmruion ; but when that >>not the cafe, bleed in,; ought by no means to beat- tempted, as it will weaken the patient and prolong the difeafe. A vomit however will feldom be improper, and is generally of great fervice. L'.venty or thirty grains bf ipecacuanha will anfwer this purpofe very well; but, where it can be obtained, werrather recom- mend a grain or two of tartar emetic, with five or fix grains of ipe- cacuanha, to be made into a draught and given for a vomit. "This may be repeated once or twice at proper intervals, if the fickneft or naufea continues. The body ought to be kept open either by clyfters or gentle hti. atives, as weak infufions of fenna and manna, frnall dofes of the lenitive elect nary, cream of tartar, tamarinds, ftewed prunes, or the like; but all ftrong or draflic purgatives are to be carefully avoided. By this courfe, the fever, in a few ;>avs, may generally he brought to a preity regular or diftinct intcrmiiiicm, in which cafe the bark may be adminiilered, and it will feldoin faii to per.feel the cure. It is needlefs here to repeat over again the methods of giving the bark. The mod likely way to avoid this fever is to ufe a wholefonrt and nourifhing diet, to pay the moft fcrupulous attention to clean- linefs, to keep the body warm, to take fufficient exercife, and in hot countries, to avoid damp fituations, night air, evening dews, and the like. In countries where it is endemical, the beft preventive medicine which we can recommend, is the Peruvian bark, which may either be chewed, or infufed in brandy or wine, Sec. Some recommend fmoking tobacco as very beneficial in snasfhv countries, both for the prevention of this and intermitting feveie. CHAPTER XXIII. Of the Telluw, Fever. r*¥*^IIlS fever differs materially from every other fpecies of fevet X.\ that has appeared in North-America. A minute Sefcription, therefore, of its fymptoms, and the moft effectual method of cure, may be an acceptable chapter to this work. No particular varia- ** tion fiom what appeared in Philadelphia in :he fummer and 'au- tumn of 1793, has fince been difcovered in its ravages in. other popular cities on the continent of America ; we therefore flail only detail the former, as being more generally deftruaive, and more within the reach of our immediate obfervatious. This yellow fever derives its appellation, from the vellmv * Blifters fliould be applied to the arms or lep-3 at an early ->criod of this difeafe, as they have .,: evident =ood effefc in procuring aa intermif- J;i>n of the iecer, [I. C.*] K2 OF THE YELLOW FEVER. •fuffufion, that often appeared in the eyes and on the fkin dur- ing the continuance of the difeafe. As it was not a general appear- ance, there may be an impropriety in the term. However, as it has been adopted, we will not contend for a word with thofe me- dical gentlemen who agree with us in ideas. Various caufes have been fuggefted for this difeafe; fome have fuppofed it to be indigenous, and the offspring of vegetable putrefaction ; others, that it was imported from the Weft-Indies, and highly contagious in its nature. The latter of thefe opinions, is fupported by more facts, and appears the moft probable. In its previous visitations in this country, which were in fix differ- ent periods, befides that cf 1793, it was always traced to have been imported from the Weft-Indies. It vifited CharJefton, in South-Carolina, four times, according to the accurate Dr. Lining, viz. in 1732, 1739, I745> and in 1748. It appears, alfo, from Dr. Lind*, that it was introduced in 1740, by a trunk of wearing ap- parel ; and from the notes of Dr. Redman, it feems to have been brought to this city in 1762, by a mariner, who arrived fick. From that period, it was not obferved in Philadelphia, till the afore- mentioned memorable year 1793. The 3d of August was the firft day it was difcovered'; which was in Water-street, between Mul- berry and Saflafras-ftreets, at a boarding-houfe, generally frequen- ted by feamen. Many of thefe people belonged to the zebec pri- vateer Sans Culottes of Nantz, which had juft entered the Delar ware from a cruize, with the fhip Flora, her prize. The voyage, of thefe veffels, from every circumftance that could be collected, ap- pears to have brought the difeafe indirectly from the Weft-Indies into this city, by exchanging part of her crew for that of the prize, who were from the Weft-India iflands, where this difeafe was raging with violence. The people moft generally affected, were the native inhabitants of Philadelphia, or of fome or other parts of the continent of Americaf. No condition or fituation in life was exempted from its violence. The timid of both fexes, the moft healthy, and thofe who feemed to have all the vigour of youth on their fide, fell vic- tims to it: No age fcarcely efcaped, from the child in the cradle up to confirmed manhood, and even from that to extreme old age. Women during geftation appeared to be generally fufceptible of it. In thefe, it often produced abortion or mifcarriage. It was, how- ever, more fatal to the male than the female fex ; but, the moft cheerful, fearlefs and gay, of both fexes, often efcaped it, as like- wife ideots, and thofe who had been deranged in their minds. ■Sf Lind on infection, page 293. t Strangers from the Weft-India Iflandr, were feldom attacked with rhis difeafe, and the negroes originally from the coalt of Africa, \vere fcarcely ever atfecled, but fome of thofe of our own country fell a faav i'ct to its violence. (I. C ) V i $4 OF THE YELLOW FEVER. ""SYMPTOMS.____This difeafe moft frequently attacked people in the coutff of the night, or early in the morning, with fome degree of general laflitudc, lofs of appetite, difagreeable tafte in the mouth, fudden prostration of ftrength, accompanied with univerfal pain and forenefs over the body, particularly about the large joints. Thefe were foon after fucceeded by fome degree of chilnefs, or alternate chills and ffufhes of heat, but very feldom a complete rigor. Du. ring the continuance of this ftate, the face appeared pallid, the fea- tures contracted, the whole countenance exhibiting a dejected af- peavwith a correfponding ftate of mind. After this, there was perceived a flight pain in the fore, or back part of the head, and fre- quently fome degree of vertigo, with a fenfe of fatigue commonly about the loins, often extending towards the iliae and pubes; to- gether with an uneafy fenfation between the fhoulders and back of the neck. Thefe fymptoms hourly increafed in violence, attended frequently with difagreeable eructations, naufea, and frequent retching to vomit, particularly after taking large draughts of warm or cool drinks, or upon motion of the body. The eyes were generally highly fuffufed, exhibiting the appear- ance of a painted eye or one minutely injected, accompanied with a fenfation as if irritated by fand, and generally an averfion to light. This I have often obferved to take place during the rigor, although generally at a more advanced period of the difeafe, or fometimes not at all during the whole courfe of it. After the rigor, the pulfe generally became frequent, tenfe, and tolerably even; at other times foft and irregular, the heat moftly a little higher than the healthy standard. The ftate of the fkin varia- ble, fometimes moift, but generally dry ; refpiration a little more frequent than ordinary, attended with sighing and oppreffion at the prsecordia, indicating great diftrefs. Thefe were obfervable even from the acceffion of the rigor ; at other times not until a more advanced period. The tongue was generally moift and white, efpecially in the middle, and red or of a purpiifh hue towards the edges and tip. The bowels were generally coftive, but fometimes had a diarrhoea, urine of a higher colour than natural, and fmall in quantity. As the evening approached, every fymptom became aggravated, the pulfe more frequent, full and ftrong, heat confiderably aug- mented, pain in the head and back excruciating ; in the former, fhooting from temple to temple, in the latter to the hips, and ex- tending down the-thighs; fkin dry and parched, fometimes a partial moifture, particularly when the bed-clothes were increafed, but without any abatement of the febrile fymptoms. The ficknefs and retching increafed, with an ejection of frothy ' or bilious^matter, or whatever fluid was laft received into the ftor mach, accompanied with pain and forenefs in the region of the ftomach, upon the leaft preffure, with a fenfation of inceffant burn* ling, and reftleffnefsj fo that no pofture afforded any relief. During L*S OF THE YELLOW FEVER. the exacerbation, the refpiration became more frequent, with an increafe of fighing, and flight pain and throbbing in one or other of'the hypochondriac regions, with ftrong beating in the moft con- fpicuous arterial trunks. The face was very much flufhed, and the features considerably diftcrted, with a flight hemorrhage from one or both nostrils, and an increafed fuffufion of the eyes. The intellectual faculties at times appeared confufed, but feldom in a complete delirium. In the intervals of reafon, the patient was very defponding, and under dreadful apprehensions for the. event. He complained much of thirft, which was almoft infatiable, for no foower did any fluid reach the ftomach, than it was instantly reject- ed with violence. Every morning the fymptoms fuffered fome abatement*, and the patient generally during the firft twenty-four or forty-eight hours complained of light fhivering, which became varied throughout the day, with viciffitudes of heat and partial moifture on the fkin. He feemed much inclined to doze, from which he was very often awaked by frightful dreams; after which he generally became very watchful. As the difeafe proceeded, the tongue was very little altered from a ftate of health, except appear- ing in furrows, or chopped and of a bluifh colour ; at other times yellow or brown in the middle, and bluifh at the edges and tip, but feldom dry. Stools, when procured, were generally fsetid and frothy, but feldom bilious. The urine was variable, generally of a higher colour than natural. Some of thefe fymptoms which mark- ed the firft ftage, proceeded rapidly to increafe, with a mitigation of others, and the rife of new ones, unlefs an intermiffion iuper- vened on or before the fourth day, and the patient recovered. But molt frequently, inftead of this intermiffion, a mere compofure ol fymptoms only took place, which was too often fallacious^ During this, the eyes and fkin fometimes became yellow, and the patient appeared fo placid to the attendants, that they often thought him out of danger. But this treacherous tranquillity foon vanifhed, and the feconoL,ftage commenced with a different train of fymptoms, and with redoubled violence. The vigour which before was ex- ceffive, now declined apace, and the difeafe put on a different com- plexion. The pain in the head and back, which was before excef- five, and almoft intolerable, frequently abated on a fudden, and the fever affumed more and more the fymptoms of the nervous kind; the pulfe became lefs frequent, foft, and feeble, and fome- times even flower than in a ftate of health ; the face much lefs flufhed, the features more tranquil, with a deadly afpect of the countenance, or fometimes it was but little altered. The fuffufion. of the eyes frequently increafed ; the heat became eonfiderably * It may not be improper to obferve, that for feveral weeks after the contagious fever .made its appearance in Philadelphia, intermitting and rem'tting fevers were met with at a ftiort diftance from the place where1 the malignant fever was fpreading its ravages, r56 OF THE YELLOW FEVER. oMmlnifhed, and in fome cafes, lefs than in a ftate of health; fkin cool, fometimes with a clammy moifture on the free, neck, and back of the hands ; the ficknefs at ftomach increafed with a burn- ing fenfation in the region of it, and continual vomiting of frothy matter; at other times it was bilious, streaked with blood In the fe- male fex, if the menfes did not flow at their ufual period, there was generally a quantity of blood brought up by vomiting, accompanied with violent stricture about the praecordia, and a fenfe of weight, with great flatulency in the'ftomach, and the inteftines, which was very diflreffing; for they were generally coftive, and had not ener- gy fufficient to expel the wind either upwards or downwards. The tongue in this ftage trembled much; and wifh refpcct to colour, it was variable ; in the former, often nearly natural, at other times covered over with mucus verging towards black, particularly in the middle; fometimes dry,but generally moift, and nofc unfrequently of a florid colour. It appeared as if rubbed over with the red particles of the blood, w:.»h deep furrows in it or chopped. When the patient was defired to put it out of the mouth, he would continue it until he was told to draw it in. The thirft was much augmented, with a continual drynefs of the lips and fauces. The confufion of the intellects increafed to a complete delirium ; the reftleffriefs became truly diftreffing, and the patient almoft outra- geous, and in-'fome cafes maniacal. The fkin and eyes affumed a deep yellow colour, with the fame appearance in the urine, which was fmall in quantity, and difchar- ged with difficulty. When the fkin was not fuffufed, the urine was turbid, depofiting a deep brown fediment. The refpiration was flower than natural, except when the body was much agitated by the extreme reftleffnefs, accompanied with heavy fighing, and much deb\lity in all the moving powers of the body. The patient gene- rally lay on his back, with his feet drawn up towards his body; ne- verthelefs, he had fufficient pewer, when urged by the call of Na- ture, to rife from his bed. ' In the decline of this ftage, the fkin was fometimes covered over with petechial eruptions, appearing like the flings of nettles, of a dark red colour, principally about the neck and breaft, accompa- nied fometimes with haemorrhages from different parts of the body; but thefe fymptoms more particularly belong to the'third and laft ftage. The duration of ths fecond ftage was various, generally ac- cording to the violence of the fymptoms or to the duration and feverity of the preceding ftage. It feldom lafted longer than fifty or fixty hours before death took place, and fometimes without the occurrence of many of the fymptoms of the laft ftage. This ftage generally commenced with the pulfe becoming very feeble intermitting, and almoft imperceptible at the wrift; fre- quently not more than thirty or thirty-five ftrokes in a minute. 'There was- alfo a great diminution of the heat of the whole body* except about the priccordia, which feemed, if the expreffion may OF THE YELLOW FEVER. l57 be ufed, to be more tenacious of its heat than any other part of the bo- dy, and was the laft part that furrendered it up after death. The fkin became much cooler, and covered univerfally with a dammy moifture ; the countenance exhibited a deadly afpect; the eyes lefs painful, but fo dreadfully fuffufed, as fometimes almoft to obliterate: the colour of the tunica albuginea, with great twitching of the mmcles of the face, and general ftartingsof the tendons through- out the body. The petechia; increafed, and became of a purplifh co- lour, between which the fkin was of a deep yellow; great delirium, with continual reftleflhefs fucceeded. The patient lying principally on his back, the powers not being fufficient to retain him on his fides j the feet were generally drawn up, the whole body frequently Ai- ding down in bed. The vomiting increafed, and the matter ejec- ted was of a*dark, colour, refembling coffee-grounds, fometime3 mixed with blood*. The following were ufual appearances j viz. great flatulency; haemorrhagies from the different parts of the body ; tongue frequently covered over with blood, and of a florid colour; at other times black and dry ; urine very offenfive; fome- times a total fuppreffion of it, and when iiools were procured, they were extremely black and foetid; livid ulcers in the mouth ; and the parts where blifters had been applied, affirmed a black afpect; laborious and deep refpiration, with heavy fighing and great op*. preffion at the prajcordia ; faultering in thefpeech ; cold and livid extremities; involuntary difcharges of the faeces; lofs of fwallow- ing; coma; eyes glazy. Startings and convulfions frequently clofed the fcene. Thefe were the appearances bf the malignant fever through its feveral ftages. Although in its firft attack it was frequently much varied. Sometimes the patients were feized of a fudden,. at other times in the manner above defcribed ; but often, in its different ftages, it was much diversified, according to the violence and du- ration of the fymptoms, to the age, fex, and conftitution of the patient. In fome, the difeafe terminated in death, during the inflammatory period; in others, it was hurried fo precipitately through the ftages, that they could hardly be discriminated by the moft accurate obferver, before the patient's fate was determined. > In- other cafes, it paffed with fome degree of regularity, as above marked; and the diffolution or recovery ,was protracted "to an un- common period. This was particularly the cafe in thofe peo- ple who laboured under a fevere falivation from the effects of mercury. In judging concerning the event of the malignant fever during its firft ftage, the danger was generally in proportion to the degree of inflammatory action. Of this an idea maybe formed from the violence and duration of the fymptoms. •if From the experiments I have made on the black matter or vomit, it feemed to have fcarce any of the properties of putrid bile or blood; but appeared to be a difeafed fecretion from the liver, poflefling but little ac- sivity when applied in any form to an healthy human fyftvm. (I. C.) 158 OF THE YELLOW FEVER. The febrile affection, when very considerable, was demonftra- ted by the violent pain in the head and back-, great fuffufion of the face and eyes, with obvious diftortion of the features^; nau- fea and vomiting, with a fenfe of univerfal forenefs, particularly in the limbs. The danger was then imminent. When the inflammatory ftage was of fhort duration and of great violence, accompanied with unufual quick refpiration, hea/yfigh- ing, and great oppreffion at the praecordia from the commence- ment, together with great reftlcfTnefsy confufion of the intellects and deep defpondency of mind, with a dread of fpeedy diflblu^ tion, they were to be considered as very unfavourable fymptoms. When very great prostration of ftrength, or a fpontaneous di- arrhoea, appeared after bleeding, without manifeft relief to the patient, they were generally unfavourable fymptoms ; indicating danger in proportion to their violence. Should a yellow tinge in the eyes and fkin appear, which is merely an accidental circumftance, although it has been consider- ed, by fome of the tropical writers, as an unfavourable appear^ ance j by others, as expreifive of the crifis of the difeafe ; my ex- perience does not corroborate either the one or the other, but I am induced to confider it as a favourable, rather than an unfavour-» able occurrence. Should the retching and vomiting be much in* creafed, with dark or coffee-coloured matter ejected, death gene- rally enfued. Fatality commonly happened on the fourth or fifth day; in-fome cafes, on the twelfth, and even on the twenty-fourth and. twenty-fifth day. But thefe patients, in addition to the difeafe, often had a fevere falivation from the adminiftration of large quantities of calomel during their indifpofition. The falivary dif* charge, in all probability, protracted life. A favourable prognosis may be formed in this ftage of the dif- eafe, from the febrile fymptoms being more moderate, together with the abfence of fome of thofe before-mentioned ones, parti- cularly the fuffufion of ths eyes, fighing and vomiting, efpeeialb/ if a flight haemorrhagy takes place from the noftrils, with erup- tions about the mouth, a flight cough, and an expectoration bf yellowifh matter, with hilious evacuations by ftool, particularly if they afford relief to the patient, together with the formation of abfeeffes indifferent parts of the body. Thgfe are frequently at- tended with an abatement of almoft every other fymptom, and the patient recovers. In the feeond ftage: If the pulfe became very feeble, fmall and intermitting,* with a confiderable diminution of heat below the natural standard, exceffive vomiting, with great burning in the region of tthe ftomach, particularly if the matter ejected be black, * In elderly people, I have found the pulfe intermitting in feveral caiesj ana they always recovered.^ . OF THE YELLOW FEVER. ,59 which was frequently the cafe, the patient had but a fhort time to live. There was little information to be acquired in any period of this difeafe^ from the appearance of the urine, but when it was dark and faetid, the patient delirious, troubled much wtth flatulency, great fuffufion of the eyes, a deadly afpect of the countenance, with vomiting of blood, which frequently occurred in the female fex, vhen their menfes did not flow at the ufual period, and when it happened to women at the period of life when they become extremely irrregular, and generally ceafe to flow, the prognosis will be found very unfavourable. At that time of life, the fyftem undergoes a very material change, being about to accommodate itfelf to a new mode of action. It is fcarce ever able to withftand this, with the violence of fo dreadful a difeafe. When the tongue was florid, appearing as if rubbed over with the red particles of the blood, accompanied with a clammy moif- ture on the different parts of the body, refpiration laborious, with fighing and livid petechia; generally fpread over the fkin, the-parts where blifters were applied becoming of a dark colour, together with the pofture of the patient's body indicating great debility, with difficulty in making water, although the pulfe be at the fame time tolerably even and ftrong, which is not unfrequent- ly the cafe, they are marks of extreme danger. A favourable prognosis in this ftage, as well as in the preced- ing, does not depend on a folitary favourable fymptom, but on feveral; therefore we fliould be guarded in giving an opinion. If the pulfe, from being extremely feebfe, fliould acquire mors ftrength, and the heat, which was before considerably diminifhed, becomes in general nearer the healthy standard, together with an abatement of the violent vomiting and burning fenfation in the re- gion of the ftomach and praecordia, the brain lefs confufed,* with a diminution of reftieffnefs and ceffation of fighing, gradual dis- appearance of petechias, with an enlargement in and about the parotid glands, disfiguring much the natural form of the vifage, occurring particularly in children, fometimes in adults, the tongue becoming cleaner from the middle and point, towards the edges, the patient capable of lying in any pofrtion with tolerable facility, with incipient formation of abfcefles in different parts of the bo- dy, and a flight return of appetite, although the fkin and eyes be of a deep yellow colour, we may prognofticate with fome degree of certainty, that the event will be favourable. In the laft ftage : This may be confidered as only a deeper fhade in the fymptoms of the latter part of the fecond, with thes addition of others, but replete with danger. Neverthelefs, with all the difagreeable fymptoms of fighing, yel- ■jf If the patients became manircalj the difeafe generally dtfappeared, and they frequently re .u red. i£o OF THE YELLOW FEVER. lownefs of the ikin, delirium, black vomiting, livid ulcers iji the mouth, fphacelation of bliftcred parts, bleedings from the nofe and mouth, black tongue, and almoft every other fymptom that this ftage can produce, excepting a remarkable feeble and' inter- mitting pulfi*, I have feen feveral patients perfectly recover. The change generally took place for the tetter on the ninth or tenth day, on which the pulfe became more full, ftrong and even, intellects lefs confufed, tongue more florid from the middle to- wards the edges, heat general, and more equally diffufed, ceffa- tion of vomiting and haemorrhagies, bowels more regular, with a flight return of appetite, and beginning abforption of the yellow- nefs and petechia;, with a capability in the patient of lying in any rpofition, with increafing ftrength and complete recovery. Thefe inftances were very rare, though few will deny their occurrence. REGIMEN.----The patient fliould abftain from animal food ; and when any thing is required, it fhould be gruel, panada, &c. He fhould ufe cool diluting drinks, fuch as barley-water, apple- water, with fmall quantities of ripe fruits, which tend to keep the bowels open. The chamber of the fick fhould be fpaciousand airy, kept cool, and frequently fprinkled with vinegar. Great attention fhould be paid to thefe circumftances, as they are of infinite im- portance to thofe who frequent the apartments of the fick, and are highly conducive to the cure of the difeafe. MEDICINE.----In the cure of the malignant fever, it appeared neceffary ; firft, to moderate the inflammatory action : fecondly, to remove or alleviate certain diftreffing fymptoms which generally occurred-, more or lefs, through the"feveral ftages of the difeafe: thirdly, to fupport the tone and vigour of the fvftem. ^ The inflammatory action was moft effectually moderated by the different claffes of evacuants; among the moft efficacious was bleeding in the arm. About the tenth of Auguft, 1793, which was fhdrtly after the difeafe made its appearance in Philadelphia, bleeding was not at- tended with fuccefs, at leaft among the fick under my care; there- fore, the pradice was difcontinued; and I trufted, with moft of my medical brethren, to the milder clafs of evacuants, until the 12th of September. Having found, on diffeetion, the ftomach and intef- tmes highly inflamed, I refumed the praaice of bleeding upon good grounds, and with evidently better effect. The quantity of blood to be taken away was regulated bv the violence of the fymptoms, age, fex, and habit of body'; for thofe who were very corpulent did not bear evacuations near fo well as thofe of a fpare make. No certain rule can be laid down, with refnea to ^ITf^f bI°°d t0be ^ Thc atteraPfc ™K ^ fubject to coniiderable error; yet the number of ounces to be abstracted has been dictated by fome authors. Dr. Williams, of lama ca who wrote » 1750, advifed plentiful bleeding. Dr. Hiihry of Barbaras, bled once or twice during the firft days of he d^ OF THE YELLOW FEVER. i(h i M_ eafe*. Dr. Mofely informs us, that bleeding fliould be perform- ed and repeated every fix or eight hours, and if the fymptoms be obftinate and do not abate, it fnould be executed even to faintingf. Dr. Blane obferves, that if the patient had not a throbbing pulfe, with violent pain in the head and back, it fhould not be perform- ed ; and that without the prefence cf thofe fymptoms it was ex- tremely dangerous. Dr. Warren', who had paffed aconfiderable time in Barbadoes, feems much averfe to bleeding in/ any ftage of this difeafe. Such are the different opinions of the tropical writers on this fubjea. But during the prevalence of the malig- nant fever in Philadelphia, which nearly refembled that defcribed under the appellation of the putrid bilious fever of the Weft-India iflands, I was influenced in the abftraaion of blood, by the ten- fion and fulnefs of the pulfe, the feafon of the year, and other circumftances previoufly obferved, together with the abatement which the fick experienced of the fymptoms during the flowing of the blood. But it was very feldom that one bleeding, however prof ufe it may have been, would put an end to this difeafe ; al- though the pains in the head and back were greatly mitigated. Yet they too often returned with additional violence. At this time, if the pulfe continued full and tolerably tenfe, and the ftr»ngth not much impaired, a fufficient quantity of blood may be taken away to procure an alleviation of the fymptoms. This fhould be repeated as often as they recur in the inflammatory ftage of the difeafe ; but it feldom appeared neceffary to be done later than the end of the third day. When it was employed at a more advan- ced period, particularly near the time when the difeafe was paffmg into its fecond ftage, it invariably increafed the train of terrible fymptoms which mark this period, with a finking in the pulfe that no human effort was able to fupport. The blood drawn in this ftage of the difeafe, very feldom perfeaiy feparated into the watery and grqffer parts. When it did, the former was of a na- tural colour, though fmall in quantity in proportion to the latter. The thicker part was generally of a florid arterial colour, tender in the courfe of the warm weather. As the cool weather advan- ced, and the difeafe became more inflammatory, it was fizy in fome cafes, with a proportionable degree of contraaion of its fu- perior circumference, exhibiting a cup-like appearance. Some- times, during the warm weather, there was a thick tender fizy coat on its upper furface, without this cup-like appearance. When blood was drawn during the yellow fuffufion of the fkin, the thin- ner part was of a corresponding colour, yet not in the leaft bitter to the tafte, that could be obferved in a variety of instances; and was, like healthy ferum, affeaed by heat and acids. To return to the cure : At the fame time that great attention was paid, to blood- letting, other remedies were not negleaed. Whatever contri- # Hillary's Obfervation?, page 157. t Mofely. pagr^o. t6i OF THE YELLOW FEVER. buted to diminifh the quantity of fluids in the fyftem, and carried off the redundant matter iij the firft paffages, was proportionably efficacious in diminifhing the inflammatory aaion. Purges, and other evacuants, were employed, as being fecondarily the moft powerful remedies, particularly when alternated with bleeding, which appeared to be the moft judicious way of ufing them— Thofe preferred were fuch, on whofe powerful aaion, reliance could' be had, and when the ftomach was fick, required but a fmall quantity to anfwer the purpofe, at the fame time being agreeable to the palate. Calomel poffeffes moft of thofe proper- ties, and under certain circumftances, could be adminiftered with the greateft advantage. It fhould be given in large dofes until it has the defired effea, and might be expedited in its operation by giving laxative clyfters. When the funaions of the ftomach were not much deranged, which was fometimes the cafe, the faT line purgatives were made ufe of, fuch as Glauber fait, which were powerful, lefs ftimulating than the calomel, and of courfe, better antiphlogiftics. Thefe anfwered the purpofe equally well, as the objea was merely to reduce the energy of the fyftem and carry off the bilious matter. To relieve the violent pain in the head, blifters were employed, after general evacuation had been ufed as far as appeared advisa- ble; but previous to their application to the neck, blood was clffewn by the part to be blistered. This mode of praaice generally afforded considerable relief. Having taken notice of remedies fuitable to'thejirft indication, I come now to the fecond, viz. to alleviate or remove certain dif- trefling fymptoms ; fuch as violent vomiting, coftivenefs, flatulen- cy, great reftleffnefs and want of fleep, and alfo to the means ufed to divert the defpondency of the patient. To moderate the exceffive vomiting, often baffled every prac- titioner. Various means were employed to effea it', which may be divided into external and internal. Among the former, was bliftering the different parts of the body, particularly the region of the ftomach. From repeated trials,.it feemed to have but little- influence on the latter. Blifters have been recommended to be' applied to the legs by Dr. Hume, of Jamaica* from which he ex- perienced very good effeas. This practice appeared here only to torture the patient's feelings, without the leaft abatement of the vomiting. Warm bathing was employed in this ftage of the difeafe, fometimes with a mitigation of the vomiting ; yet fre- quently ic increafed the ficknefs at the-ftomach, and produced tainting. Flannels wrung out of a warm and ftrong infufion of aro- matics, applied conftantly to the region of the ftomach, were fometimes ferviceable ; but external applications feldom promifed much advantage. With refpea to internal remedies, almoft every anti-emetic v as employed, that the experience cf phyficians had found ufcful, but OF THE YELLOW FEVER. 165 Frequently without having the defired effea ; fuch as the faline mixture injrhe ftate of effervefcence; the infufion of columboroot, cinnamon water with liquid laudanum; the peppermint julep with laudanum,as alfo barley-water, toaft-water, apple-water,lemonade, camomile tea, and a variety of other drinks during the inflamma- tory period. After thefe, fmall dofes of tinaure of Peruvian bark, with fpirit of lavender-compound, were adminiftered with a good effea, paticularly when the fymptoms of violent inflamma- tion of the ftomach did not contra-indicate its ufe. It was efpe- cially" ferviceable to fuch patients who had been accuftomed to ah irregular mode of life, and drank to excefs of fpirituous liquors ; for, \* hen every other article was immediately rejeaed, it generally continued on the ftomach. The mucilaginous vitriolic mixture*1 was ufed to advantage, and fmall quantities of wine, porter, cy- der, or brandy and water, was of fervice, by giving tone to the debilitated ftomach. Frefh buttermilk was Frequently found grateful to the fick, and very beneficial as an anti-emetic, even when from the fymptoms, it might be concluded, that the ftomach was highly inflamed. Like- wife, a tea-fpoonful of cream-tartar, diffolved in fugar and water, was known to ftay on the ftomach and pafs through the bowels, when every other medicine and drink was inftantly rejeaed Tiff.; medicine was adminiftered with a view to remove coftivenefs, which fhould always be guarded againft in this difeafe ; but the patient finding it fo effecWalln flopping vomiting, he frequently had recourfe to it without being costive, with the fame good effeet. In feveral other cafes it was made life of, but was too often in- ftantly rejeaed. Caflor-oil, adminiftered under similar circum- ftances, had the like effea ; but this was not often the cafe, al- though! have frequently known it to continue on the ftomachs of people violently fea-fick, and remove coftivenefs, when drink of every kind was immediately thrown up. During exceffive fick- nefs at the ftomach, the moft agreeable medicine and drinks were lefs frequently rejeaed than thofe of- an unoleafant quality. No fooner did a draught of any liquid reach the ftomach, than it was inftantly rejeaed. It is not to be apprehended that this arofe from the quality, but rather from the quantity. On this account, the pasient fliould not take more than a table-fpoonful at a time. His own feeling, with refpee'e to fulnefs and ficknefs at the ftomach, fhould determine the frequency and quantity of drink, however '. infatiably thirfey he may be. In conjunaion with thefe precau- tions, the body fhould be kept as quiet as poffibie ; for the leait accelerated motion of it, frequently brought on a fit of vomiting. Coftivenefs and flatulency were extremely diftrefling in this 'difeafe. To remove them was always very difficult, particularly ay hen there was much ficknefs at the ftomach, with vomiting; foi * \Y!;'.'.i hmt!/:'!1-.j-:- o*' M.:n, arable, acidulate! with ehxir-of vitrei 164 OF THE YELLOW FEVER. the inteltines were frequently very fluggifh in their aaion, and the ftomach generally rejeaed every clafs of purgative medicines. When this was the cafe, there was no alternative but that of keeping the bowels open by clyfters. Thefe were fubject to conf:- . derabls inconvenience, when they could be adminiftered ; but thij was not often the cafe. They frequently cleared but the lower part of the inteltines, whilft thofe approximating the ftomach, were generally diftended with fseces, and an inceffant fource pf irritation to the ftomach. Whenever, therefore, a chance of fuccefs in the adminiftration of purgative medicines occurred, they were always attempted. They generally cleared the whole traa of in- teftinal canal, and frequently procured a mitigation of the vomit- ing. If rejeaed, they were not frequently repeated, left they might exha-ift the ftrength of the patient without contributing to his relief. Keeping the inteftinal canal clear of faeces, in fome mea- fure, obviated flatulency. But in an advanced period of the dif- eafe, the ftomach and inteftines were fo much debilitated, that they frequently had not energv fufficient, when apparently clear of faeces, to expel the wind either upwards or downwards, but it continued, as it were,ftationary, and tormented ihepatient. Dur- ing this ftate, when the ftomach was tolerably tranquil, a ftrong in- fufion of fennel-feed was adminiftered, mixed in a fmall quan- tity of brandy, with advantage, particularly when alternated with iome agreeable tonic, fuch as the mucilaginous vitriolic mixture already recommended, if nothing contra-indicated its ufe, or a fmall quantity of a ftrong infufion of.fpices. They fometimes afforded relief; but thofe fymptoms too frequently baffled every attempt to remove them. Another circumftance was, the extreme reftleffnefs and want of fieep. Generally, by quieting the former, the fatigue from the long wakefulnefs will frequently induce the latter. This indi- cation was moft effeaually anfwered by opium. The propriety of employing it, has engaged the attention of many of the tropi- cal writers. By one it is much approved of ;* by another it is .condemned during the inflammatory period, as being highly fti- mulating and acrid. The ufe of it, fays one, muft be attended with imminent dangerf. In the fubfequent ftages, good effects have been experienced from*the ufe of opium, particularly in the fecend and hit ftages of the difeafe. In the former it induced fleep, refrefhing the patient, and enabling him, in fome meafure, to refill the extreme violence of the difeafe. In the latter, it afforded conf- lation by lulling the inquietude,and fmoothing the avenue to death. To divert die gloomy thoughts of the patient, was attended with almoft infurmcuntable difficulties. However, it ft culd be always__ attempted by the moft encouraging language *xd affur- ance ot a complete recovery; for on this, the favourable termi- nation cf the difeafe much depends. The patient fliould not be * HsLrVs ObrVrvatio'-."-, r.-s- x but if there was great defeft in thevigi ur cf the fyftem, Madeira was foon found neceffary. If wine could not be taken by the patient, brandy, diluted with wa- ter, porter, or cyder, was fubfiftuted. Thefe fhould be in- creafed in quantity, according to the ftate of the ftomach and de- gree of feeblenefs in the pulfe, at the fame time the elixir of vi- triol was employed as a tonic. The bark, the moft powerful of all tonics, was found to difagree with the ftomach, and was there- fore always omitted, except during the convalefcent ftate, and an entire dependence was placed in the medicine recommended, to- gether with the wine or its fubftitute. Thefe . fliould be adminif- tered in large quantities, and continued, until the pulfe, from be- ing fmall and finking, became full, round, and tolerably ftrong; the heat more equally diffufed, the delirium abating, and the pa- tient becoming mere cheerful. Such were frequently the effects of thofe ftimulants ; and even when the ftrength appeared almost exhaufted, they would revive and keep up the fpark .of fife, and fometimes in the moft deplorable cafes, reftore perfedt health and vigour. Great caution fhould be obferved in the administration of wine. When the moft urgent fymptoms are mitigated, and fome of them removed, the quantity maybe gradually diminifhed. Should the dangerous fymptoms return, it may be augmented with cau- tion. This practice was more expedient if the patient could take fome nourifhment that .was light and agreeable, fuch a» panada, 01 gruel; or if there was a flight return of appetite, fome preparation of animal food fhould be given, fuch as weak broth, and at times a few oyfters, if the ftomach would bear them. Great caution was to be obferved in making ufe of folid food. If any is advifable, oyf- ters certainly are the moft proper, as they are the moft eafy of di- gestion, and afford a fufficient quantity of nourifhment. It is proper to take noiice of the condua to be obferved by the patient during the convalefcent ftate. This was generally te- dious. When the difeafe had been remedied by profufe evacua- tions, the recovery was considerably protrafted and precarious. Ihe patient acquired ftrength but flowly, and fometimes had a tendency to afcites. During recovery, patients fliould be very circumfpea in their condua, for fear of a relapfe of fever They fhould choofe food moft eafy cf digeftion ; eer modentdv; and OF THE SMALL-POX. 1*67 take a dofe of bark, two or three times a-day, to affift digeftion, and invigorate the debilitated dropfy. A moderate quantity of wine may be allowed ; gentle exercife fhould be conjoined, the bowels kept open, and the night-air avoided. CHAPTER XXIV. Of the Small-Pox. THIS difeafe, which originally came from Arabia, is now be- come fo general, that very few efcape it at one time of life or another. It is a moft contagious malady ; and has for many years proved the fcourge of Europe. The fmall-pox generally appears towards the fpring. They are frequent in fummer, lefs fo in autumn, and leaft of all in winter. Children are moft liable to this difeafe ; and thofe whofe food i^ un- wholefome, who want proper exercife, and abound with grofs humours, run the greateft hazard from it. This difeafe is diflinguifhed into the diftina and confluent kind ; the latter of which is always attended with danger. There are like- . wife other diftinaions of the fmall-pox; as the cryftalline, the bloody, &c. CAUSES.----The fmall-pox is commonly caught by infeaion. Since the difeafe was firft brought into Europe, the infeaion has never been wholly extinguifhed, nor have any proper methods as far as I know, been taken for that purpofe ; fo that now it has be- come in a manner conftitutional. Children who have over-heated themfelves by running, wrestling, &c or adults after a debauch, are moft apt to be feized with the fmall-pox. SYMPTOMS.----This difeafe is fo generally known, that a minute defcription of it is unneceffary. Children commonly look a little dull, feem liftlefs *nd drowfy for a few days before the more violent fymptoms of the fmall-pox appear. They are more inclined to drink than ufual, have little appetite for folid food, com- plain of wearinefs. and, upon taking exercife, are apt to fweat. Thefe are fucceeded by, flight fits of cold and heat in turns, which, as the time of the eruption approaches, become more violent, and are accompanied with pains of the head and loins, vomiting, &c. The pulfe is quick, with a great heat of the fkin, and reftleffnefs. When the patient drops alleep, he wakes in a kind of horror, with a fudden ftart, which is a very common fymptom of the approach- ing eruption; as are alfo convulfion-fits in very young children. About the third or fourth day from the time of sickening, the fmall-pox generally begin to appear; fometimes they appear fooher, but that is no favourable fymptom. At firft they very nearly refem- ble flea-bites,andarefooncftdifcoveredon the face, arms, and breaft. The moft favourable fymptoms are a flow eruption, an^ an abate- jfJS OF THE SMALL-POX. ment of the fever as foon as the puftules appear. In the diftinch kind of fmall-pox, the puftules feldom appear before the fourth day' from the time of sickening, and they generally keep coming tfat gradual^ for feveral days after. Puftules which are diftma, witrV a florid red basis, and which fill with thick purulent matter, firft of a whitifh, wd afterwards of a yellowifh c6iour, are the beft. A livid brown colour of the puftules is an unfavourable fymp. torn ; as alfo when they are fmall and flat, with black fpecks in the middle. Puftules which contain a thin watery ichor are very bad. A great number of pox on the icce is always attended with danger. It is likewife a very bad fign when they run into one another. It is a moft unfavourable fymptom when petechia-;, or purple, brown or Mack foots are interfperfed among the puftules. Thefe are figns of great danger. Bloody ftools or urine, with a fwelled belly, are bad fymptoms; as is alfo a continual ftrangury. Pale urine and a violent throbbing of the arteries of the neck are figns of en approaching delirium, or of convulfion-fits. When the face does not fwejl, or falls before the pox come to maturity, it is very unfavourable. If the face begins to fall about the eleventh' or twelfth day, and, at the fame time,the hands and feet begin to swell, the patient generally does well : but when thefe do not fucceed to each other, there is danger. The tongue covered with a brown cruft,is an unfavourable fymptom. Cold fhivering fits coming on at the height of the difeafe are likewife unfavourable. Grinding of the teeth, when it proceeds from an affeaion of the nervous fyftem, is a bad fign; but fometimes it is occafioned by worms, or a difordered ftomach. REGIMEN.----When the firft fymptoms of the fmall-pox ap- pear, people are ready to be alarmed, and often fly to the ufe of medicine, to the great danger of the patient's fife. I have known children to be bled, bliftered and purged, during the fever which preceded the eiuption of the fmall-pox, to fuch a degree, that Nature was not only disturbed in her operation, but rendered un- able to fupport the puftules after they were out; fo that the pa- tient, exhauiled by mere evacuations, funk under the difeafe. ^ When convulfions appear, they give a dreadful alarm. Imme- diately fome noitrum is applied, as if this were a primary difeafe; whereas it is only a fymptom, and far from being an unfavourable one, of the approaching eruption. As the fits generally go offbe- fore the aaual appearance of the fmall-pox, it is attributed to the medjeine, which by this means-acquires a reputation without any merit' * Convulfion-fits are very alarmine;; but their effects are often fahitary. 7 Irw feem to be one of the means made ufe of by Nature, tor breaking the force oi a lever. I have always obferved the fever abated, and fome- times quite removed, after one or more convulfion-rks. This readily ac- r.'unt- forconvrrfions being, a favourable fymptom in \ he fever which -t>-- --•--—•••- vy'""1 lu L'l': lever wiuw« -recedes t.ie eruption of the fmall-pox/as every thing that negates tins fever lelfens the eruption. 6 °. OF THE SMALL-POX. 169 All that is, generally fpeaking, neceffary, during the eruptive fe- ver, is to keep the patient cool and eafy, allowing him to drink freely of fome weak diluting liquors ; as balm-tea, barley-water, clear whey, gruels, &c. He mould not be confined to bed, but fhould fit up as much as he is able, and fhould have his feet and legs frequently bathed in lukewarm water. His food ought to be very light; and he fhould be as little dilturbed with company as pof- fibie. Much mifchief is done at this period, by confining the patient too foon to his bed, and plying him with warm cordials or fudorific medicines. Every thing that heats and inflames the blood, increafes the fever, and pufhes out the puftules prematurely. This has nura- berHefs ill effeas. It not only increafes the number of puftules, but likewife tends to make them run into one another; and when they have been pufhed out with too great violence, they generally fall in before they come to maturity. Women, as foon as they fee the fmall-pox begin to appear, com- monly ply their tender charge with cordials, faffron, and marigold- teas, wine, punch, and even brandy itfelf. All thefe are given with a view, as they term it, to throw out the eruption from the heart. This, like moft other popular miftakes, is the abufe of a very juft obfervation, that when there is a moifture on the fkin, the pox rife better, and the patient is eafier, than when it continues dry and parched. But that is no reafon for forcing the patient into a fweat. Sweating never relieves unlefs where it comes fpontaneoufly, or is the effea of drinking weak diluting liquors. Children are often fo peevifh, that they will not lie a-bed with- out a nurfe conftantly by them. Indulging them in this, has many bad effeas both upon the nurfe and child. Even the natural heat of the nurfe augments the fever of the child; but if fhe, too, proves feverifh, which is often the cafe, the danger muft be increafed*. Lying feveral children, who have the fmall-pox, in the fame bed, has many ill confequences. They ought, if poffibie, never to be in the fame chamber, as the perfpiration, the heat, the fmell, &c. all tend to augument the fever, and to heighten the difeafe. It is com- mon among the poor, to fee two or three children lying in the fame bed, with fuch a load of puftules, that even their fkins ftick to- gether. One can hardly view a fcene of this kind, without being fickened by the fight. But how muft the effluvia aflea the poor patients, many of whom perifhed by this ufagef ? #-1 have known a nurfe, who had the fmall-pox before, fo infe£red by lying conftantly a-bed with a child, in a bad kind of fmall-pox, that fhe had not only a great number of puftules, which broke out all over her body, but afterwards a malignant fever, which terminated in a number of impofthumes or boils, and from which fhe narrowly efcaped with her life. We mention this, to put others upon their guard againft the danger of this virulent infecnon. f This obfervation is likewife applicable to hofpitals, work-houfes, &c. where numbers of children happen to have the fmall-pox at the fame time. I have feen above forty children cooped up in on« nparmieat, OF THE SMALL-POX. Tvery dirty cuftom prevails among ^'--cl^^ople^ left ?he Sn^omerhard by the moifture which it abforb's,and frets the tender (kin. It occafions a bed fmell, which is very pernicious both to the patient and thofe about him ; belide.', the filth and fordej; which adhere to the linen, being r."orbed/ or taken up again into the body, greatly augment the difeafe. _ _ A patient fhould not be fullered to be dirty in an internal difeafe, far lefs in the fmall-pox. Cutaneous diforders are often occafioned ' by naftinefs alone, and are always increafed by' it. Were the pa- tient's linen to be changed everyday, it would greatly refrefhlnm. Care, indeed, is to be "taken, that the linen be thoroughly dry. h outfit likewife to be put on when the patient is moft cool. So ftrong is the vulgar prejudice in this country, notwithfhnding all that has been faid againft the hot regimen in the fmall-pox, that numbers llill fall a f;icrifice to that error. 1 have feen poor women travelling in the depth of winter, and carrying their children along with them in the fmall-pox, and have frequently obferved others begging by the way-fide, with infants in their arms covered with the'puft'iles ; yet I could never learn that one of thefe children died by this fort, of treatment. This is certainly a fufficient proof of the fafety, at leaft, of expofing patients in the fmall-pox to the open air. There can be no reafon, however, for expofing them to public view. It is now very common in the environs of great towns to meet patients in the fmall-pox on die public walks. This padtice may suit the purpofes of boaiting inoculxtori, but is dangerous to the citizens, and contrary to the laws of humanity and found policy. The food in this difeafe ought to be very light, and o/a cooling nature, as panado, or bread boiled with equal quantities of milk and water, good apples roafted or boiled with milk and fweetened with a little fugar, or fuch-like. The drink may be equal parts of milk and water, clear fweet whey, barley-water, or thin gruel, Sec. Af- ter the pox are full, butter-milk? being of art Opening and cleanfing nature, is a very proper drink. MEDICINE.----This difeafe is generally divided into feurdif- ferent periods, viz. the fever which precedes the eruption, the crisp- tion itfelf, the fuppuration, or maturation of the puftules, and the fecondary fever. Little more is neceffary, during the primary fever, than to keep all the while they had this difeafe, without any of them beinr admitted to breathe "the freih air. No one can be at a lot's to fee the impropriety of fuch conduct. It ought to be a rule, not only in hofpitals far the finals pox, but, likewife, for other difeafes, that m> patient fliould be- with"* fight or hearing of another. This is a matter to which too little regard is- paid. In moft hofpitals and infirmaries, the fick, the'dyin^ and* the deal, are often to be feen in the fame apartment, OF THE SMALL-POX. i7r t"he patient cool nnd quiet, allowing him to drink diluting liquors, and bathing his feet frequently in warm water. Though this be' generally the fafeft courfe that can be taken with infants, yet adult's of a ftrong conftitution and plethoric habit fometimes require bleed- ing. \V hen a full pulfe, a dry fkin, and other fymptoms of inflam- mation render this operation neceffary, it ought to be performed ; but, unlefs thefe fymptoms are urgent, it is fafer to let it alone ; if » the body is bound, emollient clysters may be thrown in. If there is a great naufea,or inclination ta vomit, weak camomile- tea, or lukewarm water may be drank,in order to clean the ftomach. At the beginning of a fever, Nature generally attempts a difcharge, either upwards or downwards, which, if promoted by gentle means, would tend greatly to abate the violence of the difeafe. Though every method is to be taken during the primary fever, by a cool regimen, Sec. to prevent too gve^.t an eruption-, yet, after the puftules have made their appearance, our bufinefs is to promote the fuppuration, by diluting drink, light food, and, if Nature feems to flag, by generous cordials. When a low, creeping pulfe faintifh- nefs, and great lofs of ftrength, render cordials neceffary, we would recommend good wine, which may be made into negus, with an equal quantity of water, and iir-irpened with the juice of orange, the jelly of currants, or the like. Wine-whey, fharpened as above, is likewife a proper drink iu this cafe ; great care, however, muft be taken not to overheat the patient by any of thefe things. This, inftead of promoting, would retard the eruption. The rifing of the fmall-pox is oftac prevented by the violence of the fever. In this cafe, the cool regimen is ftrictly to be obfervui. The patient's chamber muft not only be kept cool, but he ought frequently to be taken out of bed, and to be lightly covered with clothes while in it. Exceffive rcftlefihefs often prevents the riling and filling of the fmall-pox. When this happens, gentle opiates "are neceffary. Thefe ought always to be adminiftered with a fparing hand. To an in- fant, a tea-fpoonful of the fyrup of poppies may be given eveiy five or fix hours tiil it has the defired effect. An adult w ill require a table-fpoQiiful to anfwer the fame purpofe. If the patient be troubled withaftrangury, or fuppreffion of urine, which often happens, in the fmall-pox, he fhould be frequently taken out of bed, and, if he be able, fliould walk aero is the room with his feet .bare. When he cannot do this, he may he frequently fet on his knees in bed, an-1 fhould endeavour to pafs his urine _j often as he can. When thefe do not fucceed, a tea-fpoonful of tiie fweet fpirits of "nitre may be occafionally mixed with liis drink. Nothing more certainly relieves the patient, or is more beneficial in the fmall-pox,than a plentiful difcharge of urine. If the.mouth be foul, and the tongue dry and chopped, it ought to be frequently wafhed, and the throat gargled with water and koney, fharpened with a little vinegtr or currant-jelly. XJ2 OF THE SMALL-POX. ^Durintr the rifine of the fmall-pox, it frequently happens, that the S b dgh^ten days without a ftool This not only tends o heat and inflame the blood, but the tec*bjMwgto*m the body, become acrid,and even putrid. From whence bad conf- quences muft unfue. It will, therefore, be proper, when the body is bound, to throw in an emollient clyfter every fecond or third day through the whole courfe of the difeafe. This will greatly cool and relieve the patient. . When petechia?, or purple, black, or livid fpots appear among the fmall-pox, the bark muft immediately be adminiftered in as large dofes as the patient's ftomach can bear. For a child, two drachms of the bark in powder may be mixed in three ounces of common water, one ounce of fimple cinnamon-water, and two ounces of the fyrup of orange or lemon. This may be fharpened with the fpirits of vitriol, and a table-fpoonful of it given every hour. If it be given to an adult in the fame form, he may take at leaft three or four fpoonfuls every hour. This medicine ought not to be trifled with, but muft be adminiftered as frequently as the ftomach can bear it; in which cafe, it will often produce very hap- py effeas. I have frequently feen the petechia? difappear,and fmall- pox, which had a very threatening afpea, rife and fill with laudable matter, by the ufe of the bark and acids. - The patient's drink ought, in this cafe,to be generous; as wine or ftrong negus acidulated with fpirits of vitriol, vinegar, the mice of lemon, jelly of currants, or fuch-like. His food muft confift of ap- ples roafted or boiled, prefervgd cherries, plumbs, and other fruits of an acid nature. The bark and acids are not only neceffary when the petechia appear, but likewife in the lymphatic or crystalline fmall-pox, where the matter is thin, and not duly prepared. The Peruvian bark feems to poffefs a fingular power of affifting Nature in preparing good matter; confequently, it muft be beneficial'both in this and other difeafes, where the crisis depends on a fuppuration. I have often obferved, where the fmall-pox were flat, and the matter contained in them quite clear and tranfparent, and where, at firft, they had the appearance of running into one another, that the bark, acidu- lated as above, changed the colour and confiftence of the matter, and produced the moft happy effeas. When the eruption fubfides fuddenly, or when the fmall-pox firike in, before they have arrived at maturity, the danger is very great. In this cafe, blifters muft be iixmediately applied to the wrifts and ancles, and the patient's fpirits fupported with cordials. Sometimes bleeding has a furprifing effea in raifing the puftules after they have fubfided ; but it requires fkill to know when this is proper, or to what length the patient can bear it. Sharp cata- plafms, however, may be applied to the feet and hands, as they tend to promote the fwelling of thefe parts. The moft dangerous period of this difeafe, is what we call the OF THE SMALL-POX. 17? ——A /econdary fever. This generally comes on when the fmall-pox be- gin to blacken, or turn on the face ; and moft of thofe who die of the fmall-pox, are carried off by this fever. Nature generally attempts, at the turn,of the fmall-pox, to re- lieve the patient by loofe ftools. Her endeavours, this way, are by no means to be counteraaed, but promoted, and the patient, at the fame time, fupported by food and drink of a nourifhing and cordial nature. , If, at the approach of the fecondary fever, the pulfe be very quick, hard and ftrong, the heat intenfe, and the breathing labori- ous, with other fymptoms of an inflammation of the breaft, the patient muft immediately be bled. The quantity of blood to be let, muft be regulated by the patient's ftrength, age, and the ur- gency of the fymptoms. But, in the fecondary fever, if the patient be faintifh, the puf- tules become fuddenly pale, and if there be great coldnefs of the extremities, blifters muft be applied, and the patient muft be fup- ported with generous cordials. Wine, and even fpirits, have fome- times been given, in fuch cafes, with amazing fuccefs. As the fecondary fever is, in great meafure, if not wholly, owing to the abforption of the matter, it would feem highly confonant to reafon, that the puftules, as foon as they come to maturity, fhould be opened. This is every day praaifed in other phlegmons which tend to fuppuration ; and there feems to be no caufe why it fhould be lefs proper here. On the contr?.:y, we have reafon to believe, that, by this means, the fecondary fever might always be leffened, and often wholly prewnted. The puftules fhould be opened when they begin to turn of a yellow colour. Very little art is neceffary for this operation. They may either be opened with a lancet or a needle, and the matter abforbed by a little dry lint. As the puftules are generally firft ripe on the face, it will be proper to begin with opening thefe, and the others in courfe as they become ripe. The puftules generally fill again, a fecond or even a third time ; for which caufe, the opera- tion muft be repeated, or rather continued as long as there is any confiderable appearance of matter in the puftules. This operation, rationales it is, has been negleaed from a piece of miftaken tendernefs in parents. They believe that it muft give great pain to the poor child; and, therefore, would rather fee it die than have it thus tortured. This notion is entirely without founda- tion. I have frequently opened the puftules, when the patient did not fee me, without his being in the leaft fenfible of it; but, fup- pofe it where attended with a little pain, that is nothing is compari- fon to the advantages which arife from it. ^ 1 Opening the puftules not only prevents the reforption of the matter into the blood, but likewife takes oft"the tenfion of the fkin, and, by that means, greatly relieves the patient. It likewife tends to prevent the pitting, which fs a matter of no fmall importance. ,74 OF THE SMALL-POX. Acrid matter, by lodging long in the puRules, cannot fail to eor- rode the tender fkin ; by which, many a handfome face becomes fo deformed as hardly to ber,r a refcmblance to the human figure*. It is generally neceffary, after the fmall-pox are gone of;, to purge the patient. If, however,'the body has been open through the whole courfe of the difeafe, or if bktterlmilk and other things of an open- ing nature have been drank fieely after the height of the- fmall-po:;, purging .becomes lefs neceffary ; but it ought never wholly to be negleaed. For very young children, an infufion of fenna and prunes, with a little rhubarb, may be fweetened with coarfe fugar, and given in fmall quantities till it operates. Thofe who are farther advanced, muft take medicines of a fharper nature. For example ; a child of five or fix years of age may take eight or ten grains ofjalap over night, and the fame quantity ofjalap in powder next morning. This may be wrought off with frefli broth or water-gruel, and may be repeated three or four times, five or fix clays intervening between each dofe. For children further advanced, and adults, the dofe muft be increafed in proportion to the age and conftitutionf. When impofthumes happen afier the fmall-pox, which is not feldom the cafe, they muft be brought to fuppuration as foon as poffibie, bv means of emollient poultices; and when they have been Opened, or have broke of their own accord, the patient muft be purged. The bark and a milk-diet will be ufeful in this cafe. When a cough, a difficulty of breathing, or other fymptoms of ^a confumption, fucceed to jhe fmall-pox, the patient muft be fent to a place where the air is goodjPnd put upon a courfe of affes' milk, with fuch exercife as he can bear. For further direajpns in this cafe, fee the article Confumptions. Of Inoculation. THOUGH no difeafe, after it is formed, baffles the powers of medicine more effeaually than the fmall-pox, yet more may be done before-hand, to render this difeafe favourable, than any one we know; as almoft all the danger from it may be prevented by inocu- lation. This falutary invention has been known in Europe above ■* Though this operation can never do harm, yet it is only neceffary when the patient has a great load of fiv.all-'pox, or when the matter which they contain is of fo thin and acrid a nature, that there is reafon to apprehend bad confequences from its being too quickly reforbed, or taken up again into the mafs of circulating humours. ^ t I have of late been accuftomed, after the fmall-pox, to give one, two, three, four, _or five grains of calomel, according to the age of the pa- tient, over night, and to work it off next morning with a fuitable dofe ot jalap. OF THE SMALL-POX. 175 half a century; but, like moft other ufeful difcoveries, it has till of late made buc flew pro-rrefs. To the honour of this country, ino- culation has met whh a more favourable reception Here, than among any of our neighbours. It is ftill, however, far from being general, which we have reafon to fear will be the cafe, as long as the prac- tice continues in the hands of the faculty. No difcovery can be of general utility, while the praaice of it is kept in the hands'of a few. Had the inoculation of the fmall- pox been introduced as a lafhion, and not as a medical difcovery, or had it been praaifed by the lame kind of operators here, as it is in thofe countries from whence we learned it, it had long ago been univerfal. The fears, jealousies, prejudices, and oopoiite interests of the faculty, are, and ever will be, the moft effeaual obftacies to the progrefs of any falutary diieovery. Hence, inoculation never became, in any meafure, general, even in England, till taken up by men not bred cophyilc. Thefe have not only rendered the practice more extenfive, but more fafe, and,by haing under leL feftfaint than regular praaitioners, have taught them that-the patienufs greateft danger arose, not fromthe want of care, but the excels of it. Tk_y know very lkcie of the matter, who impute the fuccess ©f modern inoculators to any fuperior fkill, either in preparing the patient or communicating the difeafe. Some of them, indeed, from a fordid defire of engroifing the whole praaice to themfelves, pre- tend to have extraordinary fecrets or noftrums for preparing perfons for inoculation, which never fail of fuccefs. But this is only a pretence to blind the ignorant. Common fenfe and prudence alone are fufficient both in the choice J| the fubjea and management of the operation. Whoever is poflefiea of thefe, may perform this office for his children,whenever he finds it convenient, if they be in a good ftate of health. This fentiment is not the refult of theory, but of obfervation. Though few phyficians have had more opportunities of trying in- oculation in all its different forms, fo little appears to me to de- pend on thofe, generally reckoned important circumftances, of preparing the body, communicating the infeaion by this or the other method, Sec. that, for feveral years paft, I have perfuaded the parents or nurfes, to perform the whole themfelves, and have found that method followed with equal fuccefs, while it is free from any inconveniences that attend the other.* * A critical fituation, too often to be met with, firft put me upon try- ing-this method. A gentleman who had loft all his children, except one fun, by the natural fmall-pox, was determined to have him inoculated. He told me his intention, and defired I would perfuadethe mother and grandmother, &c. of its propriety. But that was impoffible. They were not to be perfuaded ; and either could not get the better of their fears, or were determined againft conviction. It was always a point with me., not to perform the operation without the confent of the parties concern- ed. I therefore advifed the father, after giving his fon a doTe or two yf rhubarb, to so to a patient who had the finajl-pox u:' a g'^d .kind, 176 OF THE SMALL-POX. ^fhe fmall-pox may be communicated in a greafvariety of mi, with nearly the fame degree of fafety and fuccefs. In iurkey, from whence we learned the praaice, the women communicate the difeafe to children, by opening a bit of the fkin wrtha needle, and putting into the wound a little matter taken from a ripe pol- tule. On the coaft of Barbary, they pafs a thread wet with the matter through the fkin, between the thumb and fore-finger; and, in fome of the ftates of Barbary, inoculation is performed by rub- bing in the variolous matter between the thumb and fore-finger, or on other parts of the body. Rubbing the variolous matter upon the fkin, has been long known in many parts of Afia and Europe, as well as in Barbary, and has generally gone by the name of buf ing the fmall-pox. The prefent method of inoculating in Britain,* is to make two or three flanting incifions in the arm, fo fuperficial as not to pierce quite through the fkin, with a lancet wet with frefh matter taken from a ripe pnftule ; afterwards, the wounds are clofed up, and left without any dreffing. Some rriake ufe of a lancet covered with the dry matter ; but this is lefs certain, and ought never to- be ufed unlefs where frefh matter cannot be obtained : when this is the cafe, the matter ought to be moiftened by holding the lan- cet for fome time in the fteam of warm water. Indeed, if frefli matter be applied long enough to the fkirii there is no occafion for any wound at all. Let a bit of thread, about half an inch long, wet with the matter^ be applied to the arm, mid-way between the fhoulder and elbow, covered with a piece of common flicking plaiffcfc, and kept on for eight or ten days. This will feldom fail toTommunicate the difeafe. We mention this method, becaufe many people are afraid of a wound; and, doubtlefs, the more eafily the operation can be performed, it has the greater chance to become general. Some imagine, that Jthe difcharge from a wound leffens the eruption ; but there is no great ftrefs to be laid upon this notion ; befides,, deep wounds of- ten ulcerate, and become troublefome. 'i We do not find that inoculation is considered as a medical ope* ration in thofe countries from whence we learned it. In Turkey, it is performed by the women, and, in the Eaft-Indies, by thfc to open two or three of the puftules, taking up the matter with a little cotton, and, as foon as he came hoins, to take his fon apart, and give, hi* arm a flight fcratch with a pin, afterwards to rub the place well with the cotton, and take no farther notice of it. All this he punctually per.- formed; and, at the ufual period, the fmall-pox made their appearance which were of an exceeding good kind, andfomild,as not to confine the boy an hour ip his bed- None of the other relations knew but the difeafe had came in the natural way, till the boy was well. * The method pra&ifed in America, differ only in the number'of irt- «tfions : we find, that the matter inferted by one, is generally fufficient to produce the defired e&cr, without the trouble and inconvenienc* •f three. (I. C.) - .: . ,■ OF THE SMALL-POX. ' 177 Braehmins. In this country, the custom is ftill in its infancy', we make no doubt, but it will foon become fo familiar, that parents will think no more of inoculating their children, than at pre- ferut they do of giving them a purge. No fet of men have it fo much in their power to render the praaice of inoculation general, as the clergy, the greateft oppo- fition to it ftill arifing from fome fcruples of confidence, which they alone can remove. I would recommend it to them not only to endeavour to remove the religious objections which weak minds may have to this falutary praaice, but to enjoin it as a duty, and to point out the danger of negleaing to make ufe of a mean •^ hich Providence has put in our power for faving the lives of our offspring. Surely, fuch parents as wilfully neglea the means of faving their children's lives, are as guilty as thofe who put them to death. I wifh this matter were duly weighed. No one is more ready to make allowance for human weaknefs and religious pre- judices ; yet I cannot help recommending it, in the warmeft man- ner, to parents, to confider how greac an injury they do their children, by negleaing to give them this difeafe in the early pe- riod of life. The numerous advantages arifing from the inoculation of the fmall-pox, have been pretty fully pointed out by the learned Dr. M'Kenzie, in his Hiftory of Health.* To thofe mentioned by ■Jf " Many and great,1'fays this humane author, "are the dangers attending the natural infection, from all which the iiinoculationis quite fecure. The natural infection may invade weak or distempered bodies^ by no means difpofed for its kindly jpeception. It may attack them at a feafon of the year either violently hot or intenfely cold- It may be communicated from a fort of fmall pox impregnated with the utmoft virulence. It may lay hold of people unexpectedly, when a dangerous fort is imprudently imported into a maritime place. It may furprife us foon after exceifes committed in luxury, intemperance, or lewdnefs. It may likewife feize on the innocent after indifpenflble watchings, hard labour, or necejKaryjournies. And is it a trivial advantage, that all thefe unhappy circumftances can be prevented by inoculation ? By inocula^ tion, numbers are faved from deformity as well as from death. In the natural fmall-pox, how often are the fineft features, and the moft beau- tiful complexions miferably disfigured? Whereas, inoculation rarely leaves any ugly marks or fc3rs, even where, the number of puftules on the face has been very confiderable, and the fymptoms by no means fa- vourable. And many other grievous complaints, that are frequently fubfequent to the natural fort, feldom follow the artificial. ' Does not Inoculation alfo prevent thofe inexprefSble terrors, that perpetually harrafs perfons who never had this difeafe, infomuch, that when the fmall pox is epidemical, entire villages are depopulated, markets ruined, and the face of diftrefs fpread over the whole country ? From this ter- ror it arifes, that juftice is frequently poftponed, or difcouraged, at f>f- fions or aflizes where the fmall-pox rages. Witnefles and juries dare not Appear ; and by reafon of the neceffary abfence of fome gentlemen, our honourable and ufeful judges are not attended with that reverence and folendosr due to their office and merit. Does not inoculation, in like manner, prevent our brave failors from being feized with, this diftemper onfbipboard, where they muft quickly fpread tjje ijif^ftion among fudi 178 OF THE SMALL-POX. him, we (hall only add, that fuch as have not had the fmall-pox in the early period of life, are not only rendered unhappy, but like- wife, in a great meafure, unfit for fuftaining many of the moft ufeful and important ftations. Few people would choofe even to hire a fervant who had not had the fmall-pox, far lefs to purchafc a flave who had the chance of dying of this difeafe. How could a phyfician or a furgeon, who never had the fmall-pox himfelf, attend others under that malady ? How deplorable is the fitua- tion of females, who arrive at mature age without having had the fmall-pox ! A woman with-child feldom furvives this difeafe : and if an infant happen to be feized with the fmall-pox upon the mo- ther's breaft, who has not had the difeafe herfelf, the fcene mult be diftreffing ! If fhe continue to fuckle the child, it is at the peril ofjier own life ; and if fhe wean it, in all probability, it will perifh. How often is the affeaionate mother forced to leave her houfe, and abandon her children, at the very time when her care is moft neceffary ? Yet fhould parental affediion get the better of her fears, "the confequences would often prove fatal. 1 have known the mother and her infant laid in the fame grave, both viairrrs to this malady. Let parents who run-away with their children, to avoid the fmall-pox, or who refufe to inoculate them in infancy, confider to what deplorable fituations they may be reduced by this miftaken tendernefs ! As the fmall-pox is now become an epidemical difeafe in moft parts of the known world, no other choice remains, but to render the malady as mild as poffibie. This is the only manner of extir- pation now left in our power; and though it may feem paradoxical, the artificial method of communicating the difeafe, could it be rendered univerfal, would amount to nearly the fame thing as rooting it out. It is a matter of fmall confequence whether a dif- eafe be entirely extirpated, or rendered fo mild as neither to de- ftroy life nor hurt the conftitution ; but that this may be done by inoculation, does not now admit of a doubt. The numbers who jflie under inbculation hardly deferve to be named. In the natural way, one in four or five generally dies ; but by inoculation nc; one of a thoufand. Nay, fome can boaft of having inoculated ten thoufand without the lofs of a fingle patient. I have often wifhed to fee fome plan eftablifhed for rendering this falutary praaice univerfal. The difficulties are many; yet the thing is by no means impraaicable. The aim is great; no lefs than faving the lives of one-fourth part of mankind. What of the crew who never had it before, and where they have fcarce any chance to efcape, being half ftifled with the clofenefs of their cabinS, and but very indifferently nurfed ? Laftly, with regard to the fohlierv, the miferies attending thefe poor creatures, when attacked by the fmrul- pox on a march, are inconceivable—without attendance, withoutlodj^ ings, without any accommodation ; f0 that one of three cominoiiwr perifhes." : OF THE SMALL-POX. 179 ought not to be attempted in order to accomplifh fo defirable an end ?. The firft'ftep towards rendering the praaice univerfal, muft be to remove the religious prejudices againft it. This can only be done by the clergy. They muft not only recommend it as a duty to others, but likewife praaife it on their own children. Example will ever have more influence than precept. The next tlu'rig requisite is, to put it in the power of all. For this purpofe, let the faculty inoculate the children of the poorgn*- tis. It is hard that fo ufeful a part of mankind fhould, by their poverty, be excluded from fuch a benefit. - Should this fail, it is furely in the power of any ftate to render the praaice general^ at leaft as far as their dominion extends. We do not mean that it ought to be enforced by a law. The beft way to promote it, would be, to employ a fufficient number of operator* at the public expenfe, to inoculate the children of the poor. This would only be neceffary till the praaice became general ; after- wards, custom, the ftrongeft of all laws, would oblige every indi- vidual to inoculate his children to prevent refleaions. It may be objeaed to this fcheme, that the poor would refufe to employ the inoculators; this difficulty is eafily removed. A fmall premium to enable mothers to attend their children while under this difeafe; would be a fufficient inducement; befides, the fuccefs attending the operation would foon banifh all objeaions to it. Even confiderations of profit would induce the poor to embrace this plan. They often bring up their children to the age of ten or twelve, and when they come to be ufeful, they are fnatched away by this malady, to the great lofs of their parents, and detriment of the public. The Britifh legiflature has, of late years, fhown great attention. to the prefervation of infant lives, by fupporting the foundling hofpital, &c. Dnt if one-tenth part of the fums laid out in fup- porting that inftitution, had h«-**n beftowed towards promoting in- oculation of the fmall-pox among the poor, not only more ufeful lives had been faved, but the practice ere now rendered quite uni- verfal in this illand. It is sot to be imagined, what effea exam* pie and a little money will have upon the poor; yet,, if left to themfelves, they would go on fbr-ever in the old way, without thinking of any improvement. We only mean this as a hint to ths humane and public-fpirited : Should fuch a fcheme be approved^ a proper plan might eafily be laid down for the execution of it. But as public plans are very difficult to bring about, and often, by. fhe felfifh views and mifcondua cf thofe intrufted with the execution of them, fail ofanfwering the noble purpofes for which they were defigned; we fhall point out fome other method by which the benefits of inoculation may be extended to the poor* Then; is no doubt but inoculators will daily become more nume- rous* ,.We wou'd therefore have everv perifh iti Britain t© allow iSo OF THE SMALL-POX. one of them a fmall annual falary for inoculating all the child** of the parifh at a proper age. This might be done at a very tri- flingcxpenfe, and it would enable every one to enjoy the benefit of this falutary invention. . Two things chiefly operate to prevent the progress of inocula- tion. The one is a wifh to put the evil day as far oft as poffibie. This is a principle in our nature ; and as inoculation feems rather to be anticipating a future evil, mankind are averfe to it. But this objcaion is fufficiently anfwered by the fuccels. Who in his fenfe* would not prefer a lefier evil to-day, to a greater to-morrow, pro- vided they were equally certain ? The other obftacle is the fear of refteaions. This has very great weight with the bulk of mankind. Should the child die, they think the world would blame them. This they cannot bear. Here lies the difficulty ; and till that be removed, inoculation will make but fmall progrefs. Nothing, however, can remsve it but cuftom. Make the praaice fafhionable, and all objeaions will foon vanifh. It is fafhion alone that has led the multitude fince the beginning of the world, and will lead them to the end Wei muft, therefore, call upon the more enlightened part of mankind to iei a pattern to the reft. Their example, though it may for fome time meet with opposition, will at length prevail. I am aware of an obje£tion to this practice from the expenfe with which it may be attended : this is eafily obviated. We do not mean that every parifh ought to employ a Sutton or a Dimfdale as inoculators. Thefe have by their fuccefs already recommended themfelves to crowned heads, and are beyond the vulgar reach ; but have not others an equal chance to fucceed ? They certainly have. Let them make the fame trial, and the difficulties will foon vanifh. There is not a parifh, and hardly a village in Britain, delti- tute of fome perfon who can bleed. But this is a far more difficult operation, and requires more fkill and dexterity tl*£-n inoculation. The perfons to whom we would chiefly recommend the perfor- mance of this operation are the clergy. Moft of them know fome« thing of medicine. Almoft all of them bleed, and can order a purge which are all the qualifications neceffary .for the praclice of inocu- lation. The priefts among the lefs enlightened Indians perform this office; and why fhould a Chriftian teacher think himfelf above it ? Surely, the bodies of men, as well as their fouls, merit a part of the pastors care ; at leaft the greateft Teacher who ever appea- red among men feems to havethought fo. Should all other methods fail, we would recommend it to'pa* rents to perform the operation themfelves. Let them take any me- thod of communicating the difeafe they pleafe ; provided the^'fub- jefts be healthy, and of a proper age, they will^feldom fail to fuc- ceed to their wifh. I have known many inftances of mothers per- forming the operation, and never fo much as heard of one.bad eonfequence. A planter, in one of the Weft-India iflands.rh faid" OF THE SMALLPOX, i8x to have inoculated, with his own hand, in one year, three hun- dred of his flaves; who, notwithilanding the warmth of the cli- mate, and other unfavourable circumftances, all did well. Common mechanics have often, to mf knowledge, performed the operation with as good fuccefs as phyficians. We do not mean to difcourage thofe who have it in their power, from employing people of fkill to inoculate their children, and attend them while under the difeafe j but only to fhow, that where fuch cannot be had, the operation ought not uppnthat account to be negleaed. Inftead of multiplying arguments to recommend this praaice, i fhalljuft beg leave to mention the method which I took with my own fon, then an only child. After giving him two gentle purges, I ordered the nurfe to take a bit of thread, which had been pre- vioufty wet with frefh matter from a pock, and to lay it upon his arm, covering it with a piece of fticking-plaifter. 1 his remained on fix or feven days, till it was rubbed off by accident. At the Wual time, the fmall-pox made their appearance, and were exceed- ingly favourable. Surely, this, which is all that is generally necef- fary* may be done without any fkill in medicine. •We have been the more full upon this fubjea, becaufe the bene- fits of inoculation cannot be extended to fociety by any other means than making the praaice general. While it is confined to a few, it muft prove hurtful to the whole. By means of it,, the contagion is fpread, and is communicated to many who might otberwife never have had the difeafe. Accordingly, it is found, that more die of the fmall-pox now, than before inoculation was introduced ; and thi* important difcovery, by which alone more lives might be faved than by all the endeavours of the faculty, is in a great meafure loft by its benefits not being extended to thewhole community.* The fpring and autumn have been ufually reckoned the moft proper feafons for inoculation, on account of the weather being then moft temperate ; but it ought to be confidered that thefe are generally the moft unhealthy feafons of the whole year. Undoubt- edly, the. beft preparation for the difeafe is a previous good ftate of health. I have always obferved, that children, in particular, are more fickly towards the end of fpring and autumn, than at any other /time of the year. On this account, as well as for the advantage of eool air, I would propofe winter as the moft proper feafon for in- oculation. ; though, on every other confideration, the fpring would feem to be preferable. The moft proper age for inoculation is between three and five. Many approve of inoculating on the breaft, and where no circum- ftances forbid this praaice, I have no objeaion to it. Children, however,'are more liable to convulfions at this time than after- ♦ By a well-laid plan for extending inoculation, more lives might be fayed at a fmaft expence, than are atprefent preferred by all the hofp- t«i* in England, which colt the public fuen an junwLug fum 182 OF THE CHICKEN-POX. w^rTs; befides, the anxiety of the mother or nurfe, fhould-thi child be in danger, would not fail to heighten it by fpoiling the milk. Children who have conftitutional difeafes, muft neverthelefs be inoculated. It will often mend the habit of body ; but ought to be performed at a time when they are moft healthy. Accidental difeafes fliould always be removed before inoculation. ' It is generally thought neceffary to regulate the diet for fome time before the difeafe be communicated. In children, however, great alteration in diet is feldom neceffary, their food being com- monly of the moft fimple and wholefome kind, as milk, water-pap, weak broths, bread light-pudding, mild roots, and white meats. But children who have been accuftomed to a hotter diet, who are of grofs habit, ought to be put upon a fpare diet before they are inoculated. Their food fliould be of a light cooling nature, and their drink whey, butter-milk, and fuch-like. We recommend no other medical preparation but two or three mild purges, which ought to be fuited to the age and ftrength of the patient. The fuccefs of inoculators does not depend on the preparation of their patients, but on their management of them while under the difeafe. Their conftant care is to keep them cool, and their bodies gently open, by which means the fever is kept' low, and the eruption greatly leffened. The danger is feldom great when the puftules are few; and their number is generally in pro- portion to the fever which precedes and attends the eruption.— Hence, the chief fecret of inoculation confifts in regulating the eruptive fever, which generally may be kept fufficiently low by the methods mentioned above. The regimen during the difeafe is in all refpeas the fame as ,tmder the natural fmall-pox. The patient muft be kept cool, his diet fhould be light, and his drink weak and diluting, &c. Should any bad fymptoms appear, which is feldom the cafe, they muft be treated in the fame way as direaed in the natural fmall-pox. Purg- ing is not lefs neceffary after the fmall-pox, by inoculation than in the natural way, and ought bv no means to be negleaed. CHAPTER XXV. Of the Chicken-Pox. THIS difeafe is more incident to children than to grown peo- ple. It never affeasthe patient more than once in his life; and then it appears fo trifling as feldom to require the affiftance of a pnyfician. The chicken-pox is a contagious difeafe, and is ge- nerally caught by coming within the infected atmofphere of the patient or from the clothes of thofe who haye been yifiting the ficlf,. ' OF THE MEASLES. i§3 SYMPTOMS.----This difeafe comes on with moderate fymp- foms of fever, which generally on the, fecond day is followed by an eruption of red pimples over the whole body. They are foori filled with a thin whitifh fluid, which fometimes affumes a yellow Colour, with a light inflamed bafe, but the fluid contained in the puftules has not the property of pus or matter. After the eruption is on the fkin, the fever fubfides, and, in three or four days, the puf- tules dry, become of a brown colour, and fcale off. It is a matter of the moft ferious importance, to diftinguifli thii difeafe from the fmall-pox, as fome^'mes the moft dangerous con- fequences have enfued from the miftake. Children have been feiz- ed with the fmall-pox and have died, when their parents thought they had paft through the difeafe. This difeafe maybe diflinguifhed from the fmall pox, firft, by the eruptive fever being more moderate nnd of fhorter duration. Se- condly, by the puftules generally containing matter of the colour of milk. Thirdly, by the puftules filling quicker and continuing a fhorter time on the fkin, at fartheft not more than four or five days, before they become dry, of a brown colour, and fcale off. MEDICINE.-----The treatment of this difeafe fhould be, by cooling regimen, fimilar to that ufed in the fmall-pox. This muft be more particularly attended to, if the fymptoms of fever fhould be confiderable, which is rarely the cafe. After they empty, and become dry,the patient muft be purged with jalop and cream-tartar. CHAPTER XXVI. Of the Meafles. THE meafles appeared in Europe about the fame time with the fmall-pox, and have a great affinity to that difeafe. They both came from the fame quarter of the world, are both infec- tious, and feldom attack the fame perfon more than once. The meafles are moft common in the fpring feafon, and generally dif- appear in fummer. The difeafe itfelf, when properly managed, fel- dom proves fatal; bufits confequences are often very troublefome. CAUSE----This difeafe, like the fmall-pox, proceeds from infeaion, and is more or lefs dangerous, according to the confti- tution of the patient, the feafon of the year, the climate, Sec. SYMPTOMS____The meafles, like other fevers, are preceded by alternate fits of heat and cold, with ficknefs, and lofs of ap- petite. The tongue is white, but generally moift. There is a lhort cough, a heavinefs of the head and eyes, drowfinefs, and a running at the nofe. Sometimes, indeed, the cough does not come before the eruption has appeared. There is an inflammation and heat in the eyes, with a defluxion of fharp rheum, and great acute- nefs of fenfation; fo that they cannot bear the light without pain. 1&4 OF THE MEASLES. The eye-lids frequently fwell fo as to occafion blindnefs. The pa- tient generally complains of his throat; and a vomiting or loofe- nefs often precedes the eruption. The ftook in children are com- monly greenifh; they complain of an.itching of the fkin, and are remarkably peevifh. Bleeding at the nofe is common, both before and in the progrefs of the difeafe. About the fourth day, fmall fpots, refembling flea-bites, appear, firft upon the face, then upon the breaft, and afterwards on the extremities: thefe may be diftinguifhed from the fmall-pox by their fcarcely rifing above the fkin. The fever, cough, and.difficulty of breathing, inftead of being removed by the eruption as in the fmall-pox, are rather increafed : but the vomiting generally ceafes. About the sixth or feventhday from the time of sickening, the mea- fles begin to turn pale on the face, and afterwards upon the body; fo that by the ninth day they entirely difappe2r. The fever, however, and difficulty of breathing, often continue, efpecially if the pav tient has been kept upon too hot a regimen. Petechia, or purple fpots, may likewife be occafioned by this error. A violent loofenefs iometimes fucceeds the meafles; in which cafe, the patient's life is in imminent danger. - - Such as die of the meafles generally expire about the ninth day from the invafion, and are commonly carried offby a peripneumony, or inflammation of the lungs. The moft favourable fymptoms are, a moderate loofenefs, a moift fkin, and a plentiful difchare of urine, When the eruption fuddenly falls in, and the patient is feiaed with a delirium, he is in the greateft danger. If the meafles turn too foon of a pale colour, it is an unfavourable fymptom, as are alfo great weaknefs, vomiting, reftleflhefs, and difficulty of fwal- lowing. Purple or black fpots appearing among the meafles are very unfavourable. When a continual cough, with hoarfenefs, fuc- ceeds the difeafe, there is leafon to fufpea an approaching con- fumption of the lungs. Our bufinefs in this difeafe is to affift Nature, by proper cordials, an throwing put the eruption, if her efforts be too languid; but when they are too violent, they muft be ftrained by evacuations, and cool diluting liquors, &c. We ought likewife to endeavour to appeafe the moft urgent fymptoms, as the cough, reftlcffnefs, aud difficulty of breathing. REGIMEN.----The cool regimen is neceffary here as well as in the fmall-pox. The food muft be light, and the drink diluting, Acids do not anfwer fo well in the meafles as in the fmall-pox, as shey tend to exafperate the cough. Small beer, though a good drink in the fmall-pox, is here improper. The moft fuitable liquors are decoaions of liquorice with marfh-mallow roots and farfaparilla, infufions of linfeed, or of the'fiowers of elder, balm-tea, clarified whey, barley-water and fuch-like. Thefe, if the patient be coftivef may be fweetened with honey; or, if that fhould difagree with the ftomach, a little manna may occafionally be added to th«rn< OF THE MEASLES. 18: ■WWM»"« MEDICINE.<----The meafles being an inflammatory difeaie, without any critical difcharge of matter, as in the fmall-pox, bleed- ing is commonly neceffary, efpecially when the fever runs high, with difficulty of breathing, and great oppreffion of the breaft. But if the'difeafe be of a mild kind, bleeding may be omitted :. Bathing the feet and legs frequently in lukewarm water, both tends to abate the violence of the fever, and to promote the eruption. The patient is often greatly relieved by vomiting. When there iS a tendency this way, it ought to be promoted by drinking luke- warm water, or weak camomile-tea. When the cough is very troublefome, with drynefs of the threat, and difficulty of-breathing, the patient may hold his head over the fteam of warm water, and draw the fleam into his lungs. He may likewife lick a little fpermaceti and fugar-candy poun- ded together ; or take now-and-then, a fpoonful of the oil of fweet almonds, with fugar-candy diffolved in it. Thefe will foften the throat, and relieve the tickling cough. If,-at the turn of the difeafe, the fever afiumes new vigour, and there appears great danger of fuffocatipn, the'patient muft be bled according to his ftrength, and blifters applied, with a view to pre- vent fhe load from being thrown on the lungs; where, if an infl ani- mation fhould fix itfelf, the patient's life will be in imminent danger. In cafe the meafles fuddenly difappear, it will be neceffary to purfue the fame method recommended when the fmall-pox recede. The patient muft be fupported with wine and cordials. Blifters muft be applied to the legs and arms, and the body rubbed all over with warm flannels. Warm poultices may likewife be applied to the feet and palms of the hands. When purple or black fpots appear, the patient's drink fhould be fharpened with fpirits of vitriol ; and, if the fymptoms increafe, the bark muft be adminiftered in the fame manner, as direaed in the fmall-pox;-. Opiates are fometimes neceffary, but fhould never be given except in cafes of extreme reftlefliiefs, a violent loofenefs, or when the cough is very troublefome. For children, the fyrup of poppies.is fufficient. A tea-fpoonful or two may be occafionally given, ac- cording to the patient's age, or the violence of the fymptoms. After the meafles are gone off, the patient ought to be purged. This may be conduaed in the fame manner as direaed in the fmall-pox. If a violent loofenefs fucceeds the meafles, it may be checked by taking for fome days a gentle dofe of rhubarb in the morning, and •*■ I do not know any difeafe wherein bleeding is more neceffary than in the meafles, efpei-ially when the fever runs high : in this cafe, 1 have always found it relieve the patient. t Wine fhould be ah owed the patient, to co operate withthe bark, in fupportiiig the vigour of the fyltem. This fliould be theprartice in all cafes wheu there is a tendency, as it is commonly caiied, to putrefaction. (I.C.J A2 186 OF THE SCARLET FEVER. an opiate over night; but if thefe do not remove it, bleeding will lddom fail to have that effea. Patients recovering after the meafles fhould be careful what they cat or drink. Their food for fome time ought to be light, and in fmall quantities,, their drink diluting, and rather bf an opening na- ture, as butter-milk, whey, and fuch-like. They ought alfo to be- ware of expofing themfelves too foon to the cold air, left a fuffoca- ting catarrh, an afthma, or a confumption of the lungs fhould enfue. Should a cough, with a difficulty of breathing, and other fymp- toms of a confumption, remain after the meafles, fmall quantities- of blood may be frequently let, at proper intervals, as the patient's ftrength and conftitution will permit. He ought to drink afTes-milkj to remove to a free air, if in a large town, and to ride daily on horfeback. He muft keep clofe to a diet of milk arid vegetables; and, M thefe do not fucceedx let him remove to a warmer climate*. Of the Scarlet Fever. THE fcarlet fever is fo called from the colour of the patient's. fkin, which appears as if tinged with red wine. It happens at any feafon of the year, but is moft common towards the end of fum- mer ; when it often frizes whole families. Children- and youn^ perfons a*e moft fubje<9t to it. It begins, like other fevers, with coldnefs and fhiverings, without any violent ficknefs. Afterwards the fkin is covered with red fpots,, which are broader, more florid, and lefs uniform than the meafles. They continue two or three days, and then disappear ; after which the cuticle,, or fcarf-fkin, falls off. There is feldbm any occafion for medicine in this difeafe. The patient ought however to keep within doors, to ^l [tain from flefh, Attempts have been made to communicate the meafles, as well a» ftlif fmall-pox, by inoculation; and we make no doubt, but in time, the practice may fucceed. Dr. Home of Kdinburgh, fays, he cornmnnk.ited" the difeafe by the blood. Others have tried this method, and. have not found it fucceec. Some think the d'feafe would be more certainly com- municated, by rubbing the ikin of a patient, who^ has the meafles, with cotton, and- afterwards applying the cotton fo- a wound, as in the fmall- pox; while others recommend a bit of flann.,1 which had been applied to the patient's fkin, all the time of the difeafe, to be afterwards laid upon the am cr leg of the perfon to whom the infeaion, is to be com- municated. There is no doubt, but this difeafe, as well as the fmall-pox, may be cominun cated in various ways; the moft probable, however, is either from cotton rubbed upon the fkin, as mentioned above, or by introducing a little of the fharp humpur, which diftils from the eyes of the'patient into the blood It is agreed on all hands, that fuch patients as have been inoculated, had the difeafe very mildly;. we therefore wifh' 81* praftiee were mere general, ae the meafles have of late become verf OF THE BILIOUS FEVER. 187 ftrong liquors, and cordials, and to drink freely of cool diluting liquors. If the fever runs high, the body muft be kept gently open by emollient clysters, or cream of tartar and nitre, one or two drachms of the former, with eight or ten grains of the latter, may be taken two or three times a day. Children and young perfons are fometimes feized at the begin- ning of this difeafe with a kind of ftupor and epileptic fits. In this cafe, the feet and legs fhould be bathed in warm water*, a large blifter applied to the neck, and a dofe of the fyrup of poppies given every night till the patient recovers. The fcariet fever is not always fo mild. It is fometimes attended with putrid or malignant fymptoms, in which cafe; it is always dan- gerous. , In the malignant,fcariet fever the patient is not only af- fected with coldnefs and fhivering, but with languor, ficknefs, and great oppreflion ; to thefe fucceed exceffive heat, naufea and vomit- ing, with a forenefs of the throat; the pulfe is extremely quick, but fmall and depreffed ; the breathing frequent and laborious; the fkin hot, but ciot quite dry ; the tongue moift, and covered with a whitifh mucus; the tonfils inflamed and ulcerated. Wiien the eruption appears, it brings no relief; on the contrary, the fymp- toms generally grow worfe, and frefh ones come on, as purging, delirium, &c. "When this difeafe is miftaken for a fimple inflammation, and treated with repeated bleedings, purging and cooling medicines, it generally proves fatal. The only medicines that can be depended on in this cafe are cordials and antifeptics, as the bark, wine,fnake- root, and the like. The treatment muft be in general fimilar to that of the malignant ulcerous fore throatf. Of the Bilious Fever. WHEN a continual, remitting, or intermitting fever is accom- panied with a frequent or copious evacuation of bile, either by vomit, or ftool, the> fever is denominated bilious. In Britain, the bilious fever generally makes its appearance about the end of fummer, and ceafes towards the approach of winter. It is moft frequent and, fatal in warm countries, efpecially where the foil is marfhy, and / * if the pulfe'be full av.d hard, blood muft be takehfrorn the arm or jugular vein. (I. C.) t In the year 1774, during winter, a very bad fpecies of this fever prevailed in Edinburgh. It raged chiefly among young people. The erup- tion was generally accompanied with a quinfey, and the inflammatory fymptoms were fo blended with others, pf a putrid nature, as to render tlje treatment of the'd'ifeafe very difficult- Many of t,he patientsv towards the decline of the fever, were afflicted with large fwellings of the fub- maxillary glands, and not a few had a fuppuration in one or both ears. 188 OF THE ERYSIPELAS, when great rains are fucceeded by fultry heats. Perfons who work | without doors, lie in camps, or who are expofed to the night air, are moft liable to this kind of fever. ._ If there are fymptoms of inflammation at the beginning of this fever, it will be neceffary to bleed, and to put the patient upon the cool d.luting regimen recommended in the inflammatory fever. The fdine draught may be frequently adminiftered, and the pa;. tient's body kept open by clysters or mild purgatives. But if the fever fhould remit or intermit, bleeding will feldom be neceffary. In this cafe, a vomit may be adminiftered, and, if the body be bound, a gentle purge; afterwhich the bark willgenerally complete the cure. In cafe of a violent loofenefs, the patient muft be fupported with chicken broth, jellies of hartfhorn, and the like ; and he may ufe the white decoclion for his ordinary drink*. If a bloody flux fliould , accompany this fever, it muft be treated as recommended under the article Dyfiniery. When there is a burning heat, and the patient does not fweat, • that evacuation may be promoted by giving him, three or four times a day, a table-fpoonful of Mindererus's fpiritf mixed in a cup of his ordinary drink. If the bilious fever be attended with the nervous, malignant, or putrid fymptoms, which is fometimes the cafe, the patient muft be treated in the fame manner as directed under thefe difeafes. After this fever, proper care is neceffary to prevent a relapfe. For this purpofe, the patient, efpecially towards the end of autumn, ought to continue the ufe of the bark for fome-time after he is well. He fliould abft.iin from all trafhy fruits, new liquors, and every kind of flatulent aliment. CHAPTER XXVII. Of the Eryfipelas, or St. Anthony''s Fire. THIS difeafe, which in fome parts of Britain is called the rofe, attacks perfons at any period of life, but is moft common between the age of thirty and forty. Perfons of a sanguine or ple- thoric habit, are moft liable to it. It often attacks young people, and pregnant women ; and fuch as have once been afflicted with > it, are very liable to have it again. Sometimes it is a primary dif- eafe, and at other times only a fymptom of fome other malady. Every part of the body is liable to be attacked by an eryfipelas, but . it moft frequently feizes the legs or face, efpecially the latter. It is moft common in autumn, or when hot weather is fucceeded by fold and wet. ■* See Appendix, White Decoction. J ' f See Appendix, Spirit of Mindercrus.. ** ■ OR ST. ANTHONY'S FIRE. 189 CAUSES.-----The eryfipelas may be occafioned by violent paf- fions or affections of the mind; as fear, anger, &c. When the body has been heated to a great degree, and is immediately expofed to the cold air, fo that the perfpiration is fuddenly checked, an ery- fipelas will often enfue*. It may alfo be occafioned by drinking to excefs, bv continuing too long in a warm bath, or by any thing that overheats the blood. If any of.the natural evacuations be ob- structed, or in too fmall quantity, it may caufe an eryfipelas. The fame effect will follow from the ftoppage of artificial evacuations J as iffues, fetons, or the like.- SYMPTOMS.----The eryfipelas attacks with fhivering, thirft, lofs of ftrength, pain in the head and back, heat, reftleffnefs, a quick pulfe, vomiting, and fometimes a delirium. On the fecond, third, or fourth dAy, the part fw'ells, becomes red, and fmall puftules ap- pear ; at which time the fever generally abates. When the erysipelas feizes the foot, the parts contiguous fwell, the fkin fhines ; and, if the pain be violent, it will afcend to the leg, and will not bear to be touched. When it attacks the face, it fwells, appears red, and the fkin is covered with fmall puftules filled with clear water. One, or both eyes are generally clofed with the fwelling ; and there is a difficulty of breathing. If the mouth and nostrils be very dry, and the pa- tient drowfy, there is reafon to fufpept an inflammation of thehrain. If the eryfipelas affects the breaft, it fwells and becomes exceed- ingly hard, with great pain, and is apt to fuppurate. There is a vio- lent pain in the arm-pit, on the fide affected, where an abfeefs is of- ten formed. If in a day or two, the fwelling fubfides, the heat and pain abate, the colour of the part turns yellow, and the cuticle breaks and falls off in fcales, the danger is over. When the eryfipelas is large, deep, and affects a very fenfible part of the body, the danger is great. If the red colour changes into a livid or black, it will end in a mortification. Sometimes the inflammation cannot be difcuffed, but comes to a fuppuration ; in which cafe, fiftulas, gangrene, or mortification, often enfue. Such as die of this difeafe, are commonly carried offby the fever, which is attended with difficulty of breathing, and fometimes with -a delirium and great drowfinefs. They generally die about the fe- venth or, eighth day. REGIMEN.----In the eryfipelas the patient muft neither be kept too hot nor too cold, as either of thefe extremes will tend to * The country people in many parts of Britain call this dlf-aft a blaft, and imagine it proceeds from foul air, or iU wind, as they term it. The truth is, they often lie down to reft them, when warm and fatigued, upo-i thedamp ground, where they fall afleep, and lie fo long as to catch cold, wh'ch occafions the erfiypelas. This difeafe may indeed P**»«?ed from other caufes, but nine, times out of ten it is occahoned by cold caught after the body has been greatly heated or fatigued. rep OF THE ERYSIPELAS, S it retreat, which is always to be guarded againft. When the difeafe is mild, it will be fufficient to keep the patient within doors, without confining him to his bed, and to promote the perfpiration by diluting lienors, Sec. The diet ought to be flender, and of a moderately cooling and moiftenjng quality, as groat-gruel, panado, chicken or barley-broth, with cooling herbs and fruits, &c. avoiding flefh, fifh, ftrong drink, fpices, pickles, and all other things that may heat and inflame the blood ; the drink may be, barley-water, an infufion of elder-flowers, common whey, and fuch like. ' But if the pulfe be low, and the fpirits funk, the patient muft be fupported with negus, and other things of a cordial nature. His food may be fago gruel, with a little wine, and nourifhing broths, taken in fmall quantities, and often repeated. Great care muft be . taken not to overheat him. MEDICINE----In this difeafe much mifchief is often done by medicine, efpecially by external applications. People, when they fee an inflammation, immediately think that fomething ought,to be applied to it. I his indeed is neceffary in large phlegmons-, but in an eryfipelas, the fafer courfe is to apply nothing. Almoft all ointments, falves, and plasters, being of a greafy nature, tend ra- ther to obstruct and repel, than promote and difcharge from the part. At the beginning of this difeafe, it is neither fafe to promote a fuppuration, nor to repel the matter too quickly. The eryfipelas in many refpectfe refembles the gout, and is to be treated with the greateft caution. Fine wool, or very foft flannel, are the fafeft ap- plications to the-part. Thefe not only defend it from the external air, but fikewife -promote the perfpiration, which has a great ten- dency to carry off the difeafe. In Scotland, the common people generally apply a mealy cloth to the parts affected, which is not improper. it is common to bleed in the eryfipelas ; but this requires cau- tion. If the fever be high, the pulfe hard and ftrong, and the pa- tient vigorous, it will be proper to bleed ; but the quantity muft be regulated by thefe circumftances, and the operation repeated^ as the fymptoms may require. If the patient has been accuftomed to ftrong liquors, and the difeafe attacks his head, bleeding is abfo-. lufely iiecefTary. Bathing the feet and legs frequently in lukewarm water, when the difeafe attacks the face or brain, has an excellent effect. It tends to make a derivation from the head, and feldom fails to re- lieve the patient. When bathing proves ineffectual., poultices, or {harp fynapifms, may be applied to the foles of the feet, for the fame purpofe. In cafes where bleeding is requisite, it is likewife necefiary to keep the body open. This may be effected by emollient clyfteTS, or fmali dofes of nitre and cream of tartar. Some recommend very large dofei of nitre in the eryfipelas 5 but nitre feldom fits eafy ob , OR ST. ANTHONY'S FIRE. i9t the ftomach, when taken in large dofe6. It is>>ne of the beft me- dicines when the fever and inflammation run high. Haifa drachm of it, with one or two drachms of cream of tartar, may be given in the patients ordinary drink, four times a day. - When the eryfipelas leaves the extremities, and feizes the head, fo as to occafion a delirium or ftupor, it is abfolutely neceffary to open the body. If clyfters and miW purgatives fail to have this ek feet, ftronger ones muft be given. Blifters muft likewife be applied to the neck, or behind the ears, and fharp cataplafms laid to the foles of the feet. When the inflammation cannot be difcuffed, and the part has z tendency to ulcerate, it will then be proper to promote fuppura- tion, which may be done by the application of emollient poultices, fuch as bread and milk, or thofe made with flaxfeed flower. When the black, livid, or blue colour cf the part fhows a ten- dency to mortification, the bark muft be adminiftered. It may be taken along with acids, as recommended in the fmall pox, or.in any other form, more agreeable to the patient. It muft not however be trifled with, as the patient's life is at ftake. A drachm may be give». every two hours, if the fymptoms be threafening.,~and cloths dipped in warm camphorated fpirits of wine, of the tincture of myrrh and aloes, may be applied to the part, and frequently renewed. It may, likewife be proper in this cafe to apply poultices of the bark, or to foment the part affected with a ftrong decoction of it. In what is commonly called the fcorbutie eryfipelas, which con- forinues at confiderable time, it will only be neceffary to give gentle laxatives, and fuch things as promote the perfpiration. Thus, after the inflammation has been checked by opening medicines, the decoction of woods* may be drank, after which a courfe of bitters. will be proper. Such as are liable to frequent attacks of the eryfipelas, ought carefully to guard againft all violent paffions j. to abftain from ftrong liquors, and all fat, vifeid, and highly nourifhing food. They fhould likewife take fufficient exercife, carefully avoiding the extremes of, heat or cold. Their food fhould confift chiefly of milk, and fuch fruits, herbs and roots, as are of a cooling quality; and their drink ought to be fmall-beer, whey, butter-milk, and fuch like. They fhould never fuffer themfelves to be long coftive. If that cannot be prevented by fuitable diet, it will be proper to take frequently a gentle dofe of cream of tartar, the lenitive electuary, or fome other mild purgative. ♦ See Appendir, Decoction of Woods. [ i92 ] CHAPTER XXVIII. Of the Phrenitis ; or, Inflammation of the Brain. THIS is fometimes a primary difeafe, but oftener only a fymp- tom of fome other malady ; as the inflammatory, eruptive, or fpotted fever, &c. It is very common, as a primary difeafe, in warm climates, and is moft incident to perfons about the prime or vigour of life. The paffionate, the ftudious, and thofe whofe ner- vous fyftem is irritable in a high degree, are moft liable to it. - CAUSES_____This difeafe is often occafioned by night-watch- ing, efpecially when joined with hard ftudy : it may likewife pro- ceed from hard drinking, anger, grief or anxiety. It is often occa- fioned by the ftoppage of ufual evacuations ; as the bleeding piles in men, the cuftomary difcharges of women, Sec. Such as impru- dently expofe themfelves to the heat of the fun, efpecially by fleep- ing without doors in a hot feafon with their heads uncovered, are often fuddenly feized with an inflammation of the brain, fo as to awake quite delirious. When repellants are imprudently ufed in an eryfipelas, an inflammation of the brain is fometimes the con- fequence. It m?jj be occafioned by external injuries, as blows or bruifes upon the head, &c. SYMPTOMS.----The fymptoms which ufually precede a true inflammation of the brain are pain of the head, rednefs of the eyes, -a violent flufhing of the face, disturbed' fleep, or a total want of it, great drynefs of the fkin, coftivenefs, a retention of urine, a fmall dropping of bliod from the nofe, fingingofthe ears, and extreme fenlibility of the nervous fyftem. When the inflammation is formed, the fymptoms in general are similar to thofe of the inflammatory fever. The pulfe indeed is often weak, irregular, and trembling •, but fometimes hard and contracted. When the brain itfelf is inflamed, the pulfe is always foft and low ; but when the inflammation only aff dts the integu- ments of the brain, viz. the dura and pia mater, it is hard. A re- markable quicknefs of hearing is, a common fymptom of this dit eafe ; but that feldom continues long. Another ufual fymptomis a great throbbing or pulfinion in the arteries of the neck and tem- ples. Though the tongue is often black and dry, yet the patient feldom complains of thirft, and bven refufes drink, t he mind chiefly runs upon fuch objects as have before made a deep impref- fion on it; and fometimes, from a fullen filence, the patient be- comes all of a fudden quite outrageous. A conftant trembling and starting of the tendons is an unfavour- able fymptom, as are alfo a fuppreffion of urine; a total want of fleep -, a conftant fpitting ; a grinding of the teeth, which laft-may be confidered as a kind of convulfion. When a phrenitis fucceed* OF THE PHRENITIS, &c. 193 an inflammation of the lungs, of the inteltines, or of the throat, &c. it is owing to a tranflation of the difeafe from thefe parts to the brain, and generally proves fatal. This fhews the neceffity of pro- per evacuations, and the danger of repellents in all'inflammatory difeafes. The favourable fymptoms are, a free perfpiration, a copious dif- charge of blood from the nofe, the bleeding piles, a plentiful dif- charge of urine, which lets fall a copious fediment. Sometimes the difeafe is carried off by a loofenefs, and in women by an exceffive flow of the menfes. As this difeafe often proves fatal in a few days, it requires the moft fpeedy applications. When prolonged, or improperly treated, it fometimes ends in madnefs, or a kind of ftupidity, which conti- nues for life. In the cure, two things are chiefly to be attended to, viz. to leffen the quantity of blood in the brain, and to retard the circula- tion towards the head. REGIMEN.----The patient ought to be kept very quiet. Com - pany, noife, and every thing that affects the fenfes, or disturbs the imagination, increafes the difeafe. Even too much light is hurtful: for which reafon, the patient's chamber ought to be a little darken- ed, and he fliould neither be kept too hot nor cold. It is not necef- fary to exclude the company of an agreeable friend, as this has a tendency to footh and quiet the mind. Neither ought the patient to be kept too much in the dark, left it fhould occafion a gloomy melancholy, which is too often the confequence of this difeafe. The patient muft, as far as poffibie, be foothed and humoured in every thing. Contradiction will ruffle his mind, and increafe his malady. Even when he calls for things which are not to be ob- tained, or which might prove hurtful, he is not to be positively denied them, but rather put off with the promife of having them as foon as they can be obtained, or by fome other excufe. A little of any thing that the mind is fet upon, though not quite proper, will hurt the patient lefs than a pofitive refufal. Whatever he was delighted with when in health, may here be tried; as pleafing ftories, foft mufic, or whatever has a tendency to footh the paffions and compofe the mind. Boerhaave propofes feveral mechanical experiments for this purpofe •, as the foft noife of water diftilling by drops into a bafon, and the patient trying to reckon them, Sec. Any uniform found, if low and continued, has a tendency to pro- cure fleep, and confequently may be of fervice. The aliment ought to be light, confifting chiefly of farinaceous fubftances; as panado, and water-gruel, fharpened with jelly of currants, or juice of lemons, ripe fruits, roafted or boiled, jellies, preferves, &c. The drink, fmall, diluting, and cooling ; as whey, barley-water, or decoction of barley and tamarinds, which latter not only render the liquor more palatable, but likewife more bene- ficial, as they are of an opening nature. 194 OF THE OPHTHALMIA; OR, MEDICINE.----Nothing more certainly relieves the patient than a free difcharge of blood from the nofe. When this comes of its own accord, it is by no means to be flopped, but rather pro- moted, by applying cloths dipped in warm water to the part. Bleeding in the temporal arteries greatly relieves the head : but as this operation cannot always be performed, wc recommend in its ftead, bleeding in the jugular veins. When the patient's pulfe and fpirits are fo low, that he cannot bear bleeding with the lancet, leeches maybe applied to the temples. Thefe not only draw off the blood more gradually, but by being applied nearer to the part af- fected, generally give more immediate relief. A difcharge of blood from the ruemorrhoidal veins is of great fervice, and ought by all means to be promoted. If the patient has been fubject to the bleeding piles, and that difcharge has been flopped, every method muft be tried to reftore it; as the applica- tion of leeches to the parts, fitting over the fleams of warm watery fharp clyfters, or fuppofitories made of honey, aloes, and rock-falt. If the inflammation of the brain be occafioned by the ftoppage of evacuations either natural or artificial, as the menfes, ihues, fetons, or fuch like, all means muft be ufed to reftore them as foon as poffibie, or to fubftitute others in their ftead. The patient's body muft be kept open by ftimulating clyfters or fmart purges ; and fmall quantities of nitre ought frequently to be mixed with his drink. Two or three drachms, or more, if the cafe be dangerous, may be ufed in the fpace of twenty-four hours. The head fhould be fhaved and frequently rubbed with vinegar and rofe-water. Cloths dipped in this mixture may likewife be ap- plied to the head*. The feet ought frequently to be bathed in luke- warm water, and foft poultices of bread and milk may be kept conftantly applied to them. If the difeafe proves obftinate, and does not"yield to thefe medi- cines, it will be neceffary to apply a blifter to the whole head. CHAPTER XXIX. Of the Ophthalmia ; or, Inflammation of the Eyes. THIS difeafe may be occafioned by external injuries; as blows, burns, bruifes, and the like. It may likewife proceed from duft, quick-lime, or other fubftances getting into the eyes. It is of- ten caufed by the ftoppage of cuftomary evacuations ; as the heal- ing of old fores, drying up of ihues, the fuppreffing of gentle morn- ing fweats, or of the fweatin;; of the feet, Sec. Long expofure to the night air, efpecially in cold northerly winds, or whatever fud- ■jf Even ice, when It tan be procured, may be employed with advan- tage. (I. C) INFLAMMATION OF THE EYES. '95 denly checks the perfpiration, efpecially after the body has been much heated, is very apt to caufe it. Viewing fnow or other white bodies for a long time, or looking ftedfaftly at the fun, a clear fire, or any bright object, will occafion this malady. A fudden tranfition from darknefs to very bright light, will often have the fame effect. Nothing more certainly occafions an inflammation of the eyes than night-watching, efpecially reading or writing by candle-light. Drinking fpirituous liquors, an excefs of venery, are very hurtful to the eyes. The acrid fumes of metals, and of feveral kinds of fuel, are alfo pernicious. Sometimes an inflammation of the eyes pro- ceeds from a venereal taint, and often from a fcrophulous or gouty habit. It maylikewife be occafioned by the hairs in the eye-lids turn- ing inwards, and hurting the eyes. Sometimes the difeafe is epide- mic, efpecially after wet feafons ; and I have frequently known it prove infectious, particularly to thefe who lived in the fame houfe with the patient. It may be occafioned by moift air, or living in low damp houfes, efpecially in perfons who are not accuftomed to fuch fituations. In children it often proceeds from imprudently dry- ing up of fcabbed heads, a running behind the ears, or any other difcharge of that kind. Inflammations of the eyes often fucceed the fmall-pox or meafles, efpecially in children of a fcrophulous habit. SYMPTOMS.----An inflammation of the eyes is attended v. ith an acute pain, heat, rednefs, and fwelling. The patient is not abh» to bear the light, and fometimes he feels a pricking pain, as if his eyes were pierced with a thorn. Sometimes he imagines his eyes are full of motes, or thinks he fees flies dancing before him. The eyes are filled with a fcalding rheum, which rufhes forth in great quan- tities, whenever the patient attempts to look up. The pulfe is ge- nerally quick and hard, with fome degree of fever. When the dif- eafe is violent, the neighbouring parts fweil, and there is a throbbing or puliation in the temporal arteries, Sec. A flight inflammation of the eyes, efpecially from an external caufe, is eafily cured ; but when the difeafe is violent, and con- tinues long, it often leaves fpecks upon the eyes, or dimnefs of fight, and fometimes total bliudnefs. If the patient be feized with a loofenefs, it has a good effect.; and when the inflammation panes from one eye to another, as it were by infection, it is no unfavourable fymptom. But when the difeafe is accompanied with a violent pain of the head, and conti- nues long, the pi dent is in danger of lofing Ins fight. REGIMEM-----The diet unlefs in fcrophulous cafes, can hard- ly be too fpare, efpecially at the beginning. The patient muft ab- ftain from every thing of a heating nature. His food fliould confift chiefly of mild vegetables, weak broths, and gruels. His drink may be barley-water,balm-tea,common whey,and fuch-like. His cham- ber muft be darkened, or his eyes fhaded by a cover,fo as to exclude the light, but not to prefs upon the eyes. He fhould not look at a tandl-', the fire, or any !■? minors cbjeO; and ought to avoid all 196 OF THE OPHTHALMIA; OR, fmoke, as the fumes of tobacco, or any thing that may caufe cough- ing, fneezing, or vomiting. He fhould be kept quiet, avoiding all violent efforts, either of body or mind, and encouraging fleep as much as poffibie. MEDICINE.----This is one of thofe difeafes wherein great hurt is often done by external applications. Almoft every perfon pre- tends to be poffeffed of a remedy for the cure of fore-eyes. Thefe remedies generally confift of eye-waters and ointments, with other external applications, which do mifchief twenty times for once they do good. People ought to be very cautious how they ufe fuch things, as even the preffure upon the eyes often increafes the malady. Bleeding, in a violent inflammation of the eyes, is always necef- fary. This fhculd be performed as near the part affected as poffibie. An adult may loofe ten or twelve ounces of blood from the jugular vein, and the operation may be repeated according to the urgency of the fymptoms. If not convenient to bleed in the neck, the fame quantity may be let from the arm, or any other part of the body. Leeches are often applied to the temples, or under the eyes, with good effect*. The wounds muft be fuffered to bleed for fome hours, and if the bleeding flop foon, it may be promoted by the application of cloths dipt in warm water. In obftinate cafes, it will be necef- fary to repeat this operation feveral times. Brifk purging with glauber fait, fhould be produced, during the time bleeding is ufed; after that, the bowels may be kept open every other day, with a decoction of tamarinds with fenna. A gentle dofe of cream of tartar, caftor-oil, or any other laxative, will anfwer the fame end. If the inflammation does not yield to thefe evacuations, blifters muft be applied to the temples, behind the ears, or upon the neck, and kept open for fome time by the mild bliftering ointment. I have feldom known thefe, if long enough kept open, fail to remove the moft obftinate inflammation of the eyes ; but for this purpofe, it is often neceffary to continue the difcharge for feveral weeks. When the difeafe has been of long ftanding, I have feen very extraordinary effects from a feton in the neck, or between the fhoulders, efpecially the latter. It fhould be put upwards and downwards, or in the direction of the fpine, and in the middle, be- tween the fhoulder blades. It may be dreffed twice a day with yel- low bafilicon. I have known patients, who had been blind for a confiderable time, recover fight by means of a feton placed as above. When the feton is put acrofs the neck, it foon wears out, and is both more painful and troublefome than between the fhoul- ders ; befides, it leaves a difagreeable mark, and does not difcharge fo freely. When the heat and pain of the eyes are very great, a poultice of bread and milk; foftened with fweet oil or frefh butter, may be •*■ If leeches cannot be procured, blood may be drawn from the tern* pie by cupping. (1. C.) INFLAMMATION OF THE EYES. 197 applied to them, at leaft all night; and they may be bathed with lukewarm milk and water in the morning. If the patient cannot fleep, which is fometimes the cafe, he may take twenty or thirty drops of laudanum, or two fpoonfuls of the fyrup of poppies, over night, more or lefs according to his age, or the violence of the fymptoms. After the inflammation is gone off, if the eyes remain weak and tender, they may be bathed every night and morning with cold water and a little brandy, fix parts of the former to one of the lat- ter. A method fliould be contrived by which the eye can be quite immerfed in the brandy and water, where it fliould be kept for fome time. I have generally found this, or cold water and vine- gar, as good a ftrengthener cf the eyes as any of the moft celebra- ted collyriums. When an inflammation of the eyes proceeds from a fchrophu- lous habit, it generally proves very obftinate. In this cafe, the pa- tient's diet muft not be too low, and he may be allowed to drink fmall negus, or now-and-then a glafs of wine. The moft proper medicine is the bark, which may be given in fubftanqe, or prepared as follows : Take an ounce of the bark in powder, with two drachms of Winter's bark, and boil them in an Englifh quart of water to a pint; when it has boiled nearly long enough, add half an ounce of liquorice root, fliced. Let the liquor be {trainee. Two, three, or four table-fpoonfuls, according to the age of the patient, may be taken three or four times a-day. It is impoffible to fay how long this medicine fhould be continued, as the cure is fconer performed in fome than in others ; but, i.i general, it requires a confiderable time to produce any lafting effects. Preparations of mercury may be 'of Angular fervice in opthal- rnias of long continuance, but they ought always to be adminifter- ed with the greateft caution, or by perfons of ikill in phyfic. It will be proper frequently to look into the eyes, to fee if any hairs be turned inwards, or preffing upon them*. Thefe ought to be plucked out with a pair of fmail pincers. Thofe who are liable to frequent returns of this difeafe, ought conftantly to have an iffue in one or both arms. Bleeding or purg- ing in fpring and autumn, will be very beneficial to fuch perfons. They ought likewife to live with the greateft regularity, avoiding ftrong liquor, and every thing of a heating quality. Above all, let them avoid the night air and late ftudiesf. •* Any foreign body lodged in the eye may be expeditioufly removed bypafling a fmall hair-pencil between the eye-lid and thebali of the eye. In fome "places, the peafants do this very effectually, by ufing their tongue in the fame manner. f As moft people arc fond of ufing eye-waters and ointments in this and other difeafes of the creafe, the breathing and fwallowing become more difficult; the pain affects the ears ; the eyes generally appear red ; and the face fwells. The patient is often obliged to keep himfelf in an erect 1 pofture, being in danger of fuffocation; there is a conftant naufea, J or inclination to vomit; and the drink, inftead of paifing into the * ftomach, is often returned by the nofe. The patient is fometimes ftjvvol at laft,merely from an inability tofwallow any kind of food. 1 V.'heu the breathing is laborious, whh ftraitnefs of the breaft, OF THE QUINSEY. 19g and anxiety, the danger is great. Though the pain in fwallowing be very great, yet while the patient breathes eafy, there is not fo much danger. An external fwelling is no unfavourable fymptom; but if it fuddenly falls, and the difeafe affeas the breaft, the danger is very great. When a quinfey is the confequcnce of fome other difeafe, which has already weakened the patient, his fituation is dangerous. A frothing at the mouth, with^ a fwelled tongue, a pule, ghaftly countenance, and coldnefs of tnc extremities, are fatal fymptoms. REGIMEN.-----The regimen in this difeafe is in all refpe&s the fame as in the pleurify, or peripneumony. The food muft be light, and in fmall quantity, and the drink plentiful, weak and di- luting, mixed with acids. It is highly neceffary that the patient be kept eafy and quiet. Vi- olent affections of the mind, or great efforts of the body, may prove fatal. He fhould not even attempt to fpeak but in a low voice. Such a degree of warmth as to promote a conftant, gentle fweat, is proper. When the patient is in bed, his head ought to be rail- ed a little higher than ufual. It is peculiarly neceffary that the neck be kept warm ; for which purpofe, feveral folds of foft flannel may be wrapt round it. That alone will often remove, a flight complaint of the throat, if appli- ed in due time. A judicious cuftom prevails among the peafants of Scotland : When they feel any uneafinefs of the throat, they wrap a flocking about it all night. So effectual is this remedy, that '"many places it paffes for a charm, and the flocking is applied v/ith particular ceremonies: this cuftom fhould never be neglec- ted. When the throat has been thus wrapt up all night, it muft not be expofed to the cold air through the day, but a handkerchief or a pieceof flannel kept about it till the inflammation be removed. The jelly of black currants is a medicine very much in efteem for complaints of jte throat; and is of fome ufe. It fhould be al- moft conftantly key in the mouth, and fwallowed down leifurelv. It may be mixed in the patient's drink, or taken any other way. When it cannot be obtained, the jelly of red currants, or of mul- berries, may be ufed in its ftead. Gargles for the throat are very beneficial. They may be made of fage-tea, with a little vinegar and honey, or by adding to half an Englifh pint of the pectoral decoaion, two or three fpoonfuls of honey, and the fame quantity of currant jelly. This may be ufed three or four times a-day ; and if the patient be troubled with tough vifeid phlegm, the gargle may be rendered more fharp and cleanfing, by adding to it a tea-fpoonful of the fpirit of fal ammo- niac. Some recommend gargles made of a decoction of the leaves or bark of the black-currant-bufli ; but where jelly can be had, thefe are unneceffary. In no difeafe is the benefit of bathing the feet and ler;s in luke- warm water more apparent : that practice ougnt therefore never to L» negheted. If people were easeful to keep warm, to wr^p rp 200 OF THE QUINSEY \ OR, their throats with flannel, to bathe their feet and legs in warm wa- ter, and to ufe a fpare diet, with diluting liquors, at the beginning of this difeafe, it would feldom proceed to a great height, or be at- tended with any danger : but when thefe precautions are neglec- ted, and it becomes violent, more powerful medicines are neceffary. MEDICINE.----An inflammation of the throat being a moft acute and dangerous diftemper, which fometimes takes off the pa- tient very fuddenly, it will be proper, as foon as the fymptoms ap- pear, to bleed in the arm, or rather in the jugular vein, and to re- peat the operation if circumftances require. The body fhould be kept gently open by giving the patient for his ordinary drink, a decoaion of figs and tamarinds, or fmall dofes of cream of tartar and nitre, as recommended in the eryfipelas. Thefe may be increafed according to the age of the patient, and repeated till they have the defired effea. I have often known very good effeas from a bit of fal prunel, or purified nitre, held in the mouth, and fwallowed down as it melted. This promotes the difcharge of faliva, anfwers the end of a gargle, while at the fame time it abates the fever, by promoting the difcharge of urine, &c. The throat ought to be rubbed twice or thrice a-day with a little of the volatile liniment. This feldom fails to produce fome good effeas. At the fame time the neck ought to be carefully covered with wool or flannel, to prevent the cold from penetrating the fkin, as this application renders it very tender. Many other external applications are recommended in this difeafe, kut there is none preferable to a common poultice of bread and milk. Some recommend the gum guaiacum as a fpecific in this difeafe. Half a drachm of the gum in powder may be made into an eketuary with the rob of elder-berries, or the jelly of currants for a, "dofe, and repeated occafionally. » Blisters upon the neck or behind the ears irrSviolent inflamma- tions of the throat are very beneficial ; and in*oadcafes it will be neceffary to lay a blifter quite acrofs the throat, fo as to reach from ear to ear. After the plafters are taken off, the parts ought to be kept running by the application of iffue ointment, till the inflam- mation is gone ; otherwifc, upon their drying up, the patient will be in danger of a relapfe. When the patient has been treated as above, a fuppuration fel- dom happens. This, however,is fometimes the cafe, in fpite of all endeavours to prevent it. When the inflammation and fwelling continue, and it is evident that a fuppuration will enfue, it ought to be promoted by drawing the fleam of warm water into the throat through a tunnel, or the like. Soft poultices ought to be applied outwardly, and the patient may keep a roafted fig con- ftantly in his mouth. It fometimes happens, before the tumour breaks, that the fwel- ling is fo great, as entirely to prevent any thing from getting down INFLAMMATION OF THE THROAT. aor into the ftomach. In this cafe, the patient muft inevitably perifli, unlefs he can be fupported in fome other way. This can only be done by nourifhing clyfters of broth, or gruel with milk, &c. Pa- tients have often been fupported by thefe for feveral days, till the tumour has broke ; and afterwards they have recovered. Not only the fwallowing, but the breathing, is often prevented by the tumour. In this cafe, nothing can fave the patient's life, but opening the trachea, or windpipe. As that has been often done with fuccefs, no perfon, in fuch defperate circumftances, ought to hesitate a moment about the operation; but as it can only be performed by a furgeon, it is not neceffary here to give any direc- tions about it. When a difficulty of fwallowing is not attended with an acute pain or inflammation, it is generally owing to an obftruaion of the glands about the throat, and only requires that the part be kept warm, and the throat frequently gargled with fomething that may gently ftimulate the glands, as a decoaion of figs with vine- gar and honey ; to which may be added a little muftard, or a fmall quantity of fpirits. But this gargle is never to be ufed where there are figns of an inflammation. This fpecies of angina has va- rious names among the common people, as the pap of the throat, the falling down of the almonds of the ears, Sec. Accordingly, to remove it, they lift the patient up by the hair of the head, and thruft their fingers under his jaws, &c. all which praaices are at beft ufelefs, and often hurtful. Thofe who are fubjea to inflammations of the throat, in order to avoid that difeafe, ought to live temperate. Such as do not choofe to obferve this rule, muft have frequent recourfe to purging and other evacuations, to difcharge the fuperfluous humours. They ought likewife to beware of catching cold, and fliould abftain from aliment and medicines of an astringent or ftimulating nature. Violent exerckB| by increafing the motion and force of the blood, is apt to oosafion an inflammation of the throat, efpecially if cold liquor be drank immediately after it, or the body fufferea fuddenly to cool. Thofe who would avoid this difeafe, ought, therefore, after fpeaking aloud, finging, running, drinking warm liquor, or doing any thing that may ftrain the throat, or increafe the circulation of the blood towards it, to take care to cool gradu- ally, and to wrap fome additional coverings about their necks. I have often known perfons, who had been fubjea to fore throats, entirely freed from that complaint by only wearing a ribband, or a bit of flannel conftantly round their necks, or by wearing thick- er fhoes, a flannel waiftcoat, or the like. Thefe may feem trifling, but they have great effea. There is danger indeed in leaving them off after perfons have been accuftomed to them ; but furely the inconveniency of ufing fuch things for life, is not to be compar- ed with the danger which mny attend the neglea of them. ao2 OF THE MALIGNANT QUINSEY ; OR, Sometimes, after an inflammation, the glands of the throat con- tinue fwelled, and become hard and callous. This complaint is not eafily removed, and is often rendered dangerous by the too frequent application of ftrong ftimulating and ftyptic medicines. The beft method is to keep it warm, and to gargle it twice a-day with a decoaion of figs, fharpened a little with the elixir or fpirit of vitriol. Of the Malignant Quinfey; Or, Putrid, Ulcerous Sore Throat:. THIS kind of quinfey is but little known in the north of Britain, though, for fome time paft, it has been fatal in the more fouthern counties : It is frequently to be met with in America. Children are more liable to it than adults, females than males, and the de- licate than thofe who are hardy and robuft. It pre*ails chiefly in autumn,.and. is moft frequent after a long courfe of damp or fultry weather. CAUSES.----This is a contagious diftemper, and generally communicated by infeaion. Whole families, and even entire vil- lages, often receive the infeaion from one perfon. This ought to put people on their guard againft going near fuch patients as la- bour under the diforder; as they endanger their own lives, and thofe of their friends and connexions. Whatever tends to produce putrid or malignant fevers, may occafion the putrid ulcerous for« throat, as unwholefome air, damaged provifions, neglea of clean- linefs, Sec. SYMPTOMS.----It begins with alternate fits of fhivering and heat. The pulfe is quick, but low and unequal, and generally continues fo through the whole courfe of the difeafe. The patient complains greatly of weaknefs and oppreffior^f the breaft; his fpirits are low, and he is apt to faint away wherPTet upright; he is troubled with a naufea, and often with a vomiting or purging. The two latter are moft common in children. The eyes appear red and watery, and the face fwells. The urine is at firft pale and crude ; but, as the difeafe advances, it turns more of a yellowifh colour. The tongue is -white, and generally moift, which diftin- guifhes this from, an inflammatory difeafe. Upon looking into the throat, it appears fwelled, and of a florid red colour. Pale or afh- coloured fpots, are here and there interfperfed, and fometimes one feroad patch or fpot, of an irregular figure, and pale white colour, furrounded with florid red, only appears. Thefe whitifh fpots or floughs cover fo many ulcers. An efflorefccnce, or eruption upon the neck, arms, breaft,. and fingers, about the fecond or third day, is a common fymptom of this difeafe. When it appears, the purging and vomiting generally, ceafe. PUTRID, ULCEROUS SORE THROAT. 203 There is often a flight degree of delirium ; the face frequently appears bloated, and the infide of the noftrils red and inflamed. The patient complains of a difagreeable putrid fmell, and his breath is very offenfive. The putrid, ulcerous fore throat may be diftinguifhed from the inflammatory by the vomiting and loofenefs with which it is gene- rally ufhertd in ; the foul ulcers in the throat covered with a white or livid coat ; and hy the exceffive -weaknefs of the patient; with other fymptoms of a putrid fever. Unfavourable fymptoms are, an obftinate purging, extreme weaknefs, dimnefs of the fight, a livid or black colour of the fpots, and frequent fhiverings, with a weak, fluttering pulfe. If the erup- tion upon the fkin fuddenly difappears, or becomes of a livid co- lour, with a difcharge of blood from the nofe or mouth, the dan- ger is very great. If a gentle fweat break out about the third or fourth day, and continue with a flow, firm, and equal pulfe ; if the floughs caft off in a kindly manner, and appear clean and florid at the bottom *, and if the breathing is foft and free, with a lively colour of -the eyes, there is reafon to hope for a falutary crifis* REGIMEN.----The patient muft be kept quiet, and for the moft part in bed, as he will be apt to faint when taken out of it. His food muft be nourifhing and restorative ; as fago-gruel with red wine, jellies, ftrong broths, &c. His drink ought to be gene- rous, and of an antifeptic quality j as red wine negus, white wine whey, and fuch like. MEDICINE.----The medicine in this kind of quinfey is en- tirely different from that which is proper in the inflammatory. All evacuations, as bleeding, purging, &c. which weaken the patient, muft be avoided. Cooling medicines, as nitre and cream of tartar, are likewife'hurtf»l. Strengthening cordials alone can be ufed with fafety ; and thefe ought never to be negleaed. If at the beginning there is a great naufea, or inclination to vomit, the patient muft drink an infufion of green tea, camomile flowers, or carduus benediElus, in order to cleanfe the ftomach. If thefe are not fufficient, he may take a few grains of the powder of ipecacuanha, or any other gentle vomit. If the difeafe is mild, the throat may be gargled with an infufion of fage and rofe leaves, to a gill of which may be added a fpoonful or two of honey, and as much vinegar as will make it agreeably acid ; but when the fymptoms are urgent, the floughs" large and thick, and the breath very offenfive, the following gargle may be nfed : To fix or feven ounces of the peaoral decoaion, when boiling, add half an ounce of contrayerva-root; let it boil for fome time, and afterwards ftrain the liquor ; to which add two ounces of white wine vinegar, an ounce of fine honey, and an ounce of the «o4 OF THE MALIGNANT QUINSEY, &c. tinaure of myrrh. This ought to be ufed as a gargle, and a little of it fhould frequently be injeaed, with a fyringe to clean the throat, before the patient takes any meat or drink. This method is peculiarly neceffary for children, who cannot ufe a gargle. It will be of great benefit if the patient frequently receives into his mouth, through an inverted funnel, or proper inhaler, the fleams of warm vinegar, myrrh, and honey. But when the putrid fymptoms run high, and the difeafe is at- tended with danger, the only medicine that can be depended up- on is the Peruvian bark. It may be taken in fubftance, if the pa- tient's ftomach will bear it. If not, an ounce of bark grofsly pow- dered, with two drachms of Virginian fnake-root, may be boiled in an Englifh pint and a half of water, to half a pint; to which a tea-fpoonful of the elixir of vitriol may be added, and an ordinary tea-cupful of it taken every three or four hours. Blifters are very beneficial in this difeafe, efpecially when the patient's pulfe and fpirits are low. They may be applied to the throat, behind the ears, or upon the back part of the neck. Should the vomiting prove troublefome, it will be proper to give the patient two table-fpoonfuls of the faline julep every hour. Tea made of mint and a little cinnamon will be very proper for his ordinary drink, efpecially if an equal quantity of red wine be mixed with it. In cafe of a violent loofenefs, the fize of a nutmeg of diafeordium or fix or eight drops of laudanum, according to the age of the pa- tient, may be taken in cinnamon water two or three times a-day ; the japonic confeaion may be taken two or three times a-day, or oftener if neceffary. If a difcharge of blood from the nofe happens, the fleams of warm vinegar may be received up the noftrils frequently ; and the drink muft be fharpened with fpirits of vitriol, or tincture of rofes. In cafe of a ftrangury, the belly muft be fomented with warm water, and emollient anodyne clyfters given three or four times a-day. After the violence of the difeafe is over, the body fhould ftill be kept open with mild purgatives ; as manna, fenna, rhubarb, or the like. If great weaknefs and dejeaion of fpirits, or night-fweats, with other fymptoms of a confumption, fhould enfue, we advife the patient to continue the ufe of the bark, with the elixir of vitriol, and take frequently a glafs of generous wine. Thefe, together with a milk-diet', and riding on horfeback, are moft likely for recover: jng his ftrength. C 2°5 3 The Cynanche Parotidaa ; Or, the Mumps. THIS difeafe is known, in America, under the appellation of che mumps : It is more particularly incident to children than to grown people ; and afflias the patient but once in his life : It is thought to be produced by contagion. SYMPTOMS.----It comes on with a moderate fever : this is foon followed with a ftiffnefs in the neck, and a fwelling about the angle of the lower jaw. In a fhort time, the fwelling increafes, and affeas the whole neck ; fometimes one fide only is affeaed, but generally both. It is not unfrequently attended with a lligtk: difficulty in fwallowing. Thofe fymptoms continue to increafe until the third or fourth day. At length the fever fubfides, the fwel- ling recedes from the throat and neck ; and the tefticles in men, and the breafts in women, become afledted in a similar manner : for the moft part, this gradually difappears without much inconve- nience ; but when the fwelling does not come on after that of the throat and neck, the fever often becomes confiderable. REGIMEN.----This complaint feldom requires much atten- tion ; the patient muft confine himfelf to the houfe. The neck fhould be defended from cold, by the application of flannel. The diet fhould be fpare, and the drink diluting. MEDICINE.----The parts about the neck may be bathed with a mixture, confifting of half a table-fpoonful of fweet-oil, and fixty drops of laudanum. The bowels muft be kept open with cream of tartar and flower of fulphur : but when the tumour has fuddenly receded from the throat, in confequence of cold, or any other caufe, and the fever becomes confiderable, with pain in the head, a full and hard pulfe, blood muft be taken from the arm, and repeated as the fymptoms may demand. A blifter may alfo be applied to the fore or back part of the neck. CHAPTER XXXI. Of Colds and Coughs. COLDS are the effea of an obftruaed perfpiration : Almoft every cold is a kind of fever, which only differs in degree from fome of thofe already treated of. No age, fex, or conftitution, is exempted from this difea fe neither can any medicine or regimen prevent it. The inhabitants; pf every climate are liable to catch cold, nor can the greateft cir- (cumfpeaion defend them at all times from its attacks. Indeed, 206 OF COUGHS AND COLDS. if the human body could be kept conftantly in an uniform degree of warmth, catching cold would be impoffible : but as that cannbt be effeaed by any means, the perfpiration muft be liable to many changes. Such changes, when fmall, do not affea the health ; but, when great, they muft prove hurtful. When opprefJion of the breaft, a fluffing of the nofe, unufual wearinefs, pain of the head, &c. give ground to believe that the pe|*^iration is obftruaed, or, in other words, that the perfon has caught cold, he ought immediately to leffen his diet, at leaft the ufual quantity of his folid food, and to abftain from all ftrong li- quors. Inftead of flefh, fifh, eggs, milk, and other nourifhing diet, l$p may eat light bread-pudding, veal or chicken broth, panado, gruels, and fuch-like. His drink may be water-gruel fwtetened with a little honey; an infufion of balm or linfeed, fharpened with the juice of orange or lemon ; a decoaion of barley and liquorice, with tamarinds, or any other cool, diluting, acid liquor. His fup- per fhould be light; as fmall poffet or water-gruel, fweetened with honey, and a little toafted bread in it. If honey difagrees with the ftomach, the gruel may be fweetened with treacle or coarfe fugar, and fharpened with the jelly of currants. Thofe who have been accuftomed to generous liquors, may take wine-whey inftead of gruel, which may be fweetened as above. The patient ought to lie longer than ufual a-bed, and to encou- rage a gentle fweat, which is eafily brought on towards morning, by drinking tea, or any warm diluting liquor. I have often known this praaice carry off a cold in one day, which, in all probability, had it been negleaed, would have coft the patient his life, or have confined him for fome months. Would people facrifice a little time to eafe and warmth, and praaife a moderate degree of abfti- nence when the firft fymptoms of a cold appear, moft of the bad effeas which flow from an obftruaed perfpiration might be pre- vented. But, after the difeafe has gathered ftrength by delay, all attempts to remove it often prove vain. A pleurify, a peripneu- mony, or a fatal confumption of the lungs, are the common effeas of colds, which have either been totally negleaed or treated im- properly. Many attempt to cure a cold, by getting drunk. But this, to fay no worfe of it, is a very hazardous experiment. No doubt it may fometimes fucceed, by fuddenly reftoring the perfpiration ; but when there is any degree of inflammation, which is frequently the cafe, ftrong liquors, inftead of removing the malady, increafe it. By this means, a common cold may become an inflammatory fever. When thofe who labour for their daily bread catch cold, they cannot afford to lofe a day or two, in order to keep themfelves warm, and take a little medicine ; by which means, the diforder is often fo aggravated, as to confine them for a long time, or even to render them ever after unable to fuftain hard labour. But even OF COUGHS AND COLDS. 207 fuch of the labouring poor as can afford to take care of themfelves, are often too hardy to do- it: they affea to difpife colds, and as long as they can crawl about, fcorn to be confined by what they call a common cold- Hence, colds destroy fuch numbers of man- kind. Like an enemy defpifed, they gather ftrength from delay, till they become invincible. Often travellers, rather than lofe a day in the profecution of their bufinefs, throw away their lives by pur- fumg their journey, even in the fevereft weather, with this difeafe upon them. Colds may alfo be too much indulged. When a perfon, for eve- ry flight cold, fhuts himfelf up in a warm room, and drinks great quantities of warm liquor, it may occafion fuch a general relax- ation of the folids as will not be eafily removed. It is, therefore, proper, when the difeafe will permit, and the weather is mild, to join to the regimen mentioned above, gentle exercife ; as walking, riding on horfeback, or in a carriage, &c. An obftinate cold, which no medicine can remove, will yield to gentle exercife and a pro- per regimen of die diet. Bathing the feet and legs in warm water has a great tendencv to reftore perfpiration. But care muft be taken that the water be not too warm, otherwife it will do hurt. It fliould never be much warmer than the blood, and the patient fhould go immediately to bed after ufing it.. Bathing the feet in warm water, lying in bed, and drinking warm water-gruel, or other weak liquors, will foon- er take off a fpafm, and reftore the perfpiration, than all the hot fu- dorific medicines in. the world. This is all that is neceffary for re- moving a common cold ; and if this courfe be taken at the begin- ning, it will feldom fail. But when the fymptoms do not yield to abftinence, warmth, and diluting liquors, there is reafon to fear the approach of fome other difeafe ; as an inflammation of the breaft, an ardent fever, or the like. If the pulfe, therefore, be hard and frequent, the fkin hot and dry, and the patient complains of his head or breaft, it will be neceffary to bleed, and to give the cooling powders recommended in the fcariet fever, every three or four hours, till they give a ftooL It will likewife be proper to put a blifter on the back, to give two table-fpoonfuls of the faline mixture every two hours, and* in fhort, to treat the patient in all refpeas as for a flight fever. I have often feen this courfe, when obferved at the beginning, re- move the complaint in two or three day, when the patient had all the fymptoms of an approaching ardent fever, or an inflammation of the breaft. The chief fecret of preventing colds, lies in avoiding, as far as poffibie, all extremes either of heat or cold, and in taking care, when the body is heated, to-let it cool gradually. Thefe and other circumftances. relating to. this, important fubjea, are fully treated af, under the article ObfirucledPerfpiration, 208 Of a Common Cough. A cough is generally the effea of a cold, which has either been improperly treated, or entirely negleaed. When it proves obfti- nate, there is always reafon to fear the confequences, as this fhows a weak ftate of the lungs, and is often the forerunner of a con- fumption. If the cough be violent, and the patient young and ftrong, with a hard quick pulfe, bleeding will be proper; but in weak and relaxed habits, bleeding rather prolongs the difeafe. When the patient fpits freely, bleeding is unneceffary, and fometimes hurtful, as it tends to leffen that difcharge. When the cough is not attended with any degree of fever, and the fpittle is vifeid and tough, fharp peaoral medicines are to be adminiftered ; as gum ammoniac, fquills, &c. Two table-fpoon- fuls of the folution of the gum ammoniac may be taken two or three times a-day, more or lefs, according to the age and conftitu- tion of the patient. Squills may be given various ways : two oun- ces of the vinegar, the oxymel, or the fyrup, may be mixed with the fame quantity of fimple cinnamon-water, to which may be ad- ded, an ounce of common water and an ounce of balsamic fyrup. Two table-fpoonfuls of this mixture may be taken three or four times a-day. A fyrup made of equal parts of lemon-juice, honey, and fugar- candy, is likewife very proper in this kind of cough. A table fpoonful of it may be taken at pleafure. When the defluxion is fharp and thin, thefe medicines rather 60 hurt. In this cafe, gentle opiates, oils, and mucilages, are more proper. A cup of an infufion of wild poppy leaves, and marfli- mallow roots, or the flowers of colts-foot, may be taken frequent- ly ; ©r a tea-fpoonful of the paregoric elixir may be put into the patient's drink twice a-day. When a cough is occafioned by acrid humours, tickling the throat and fauces, the patient fhould keep fome foft peaoral lo- zenges almoft conftantly in his mouth ; a: the liquorice cakes, bar- ley-fugar, the common balfmatic lozenges, Spanifh juice, Sec. Thefe biunt the acrimony of the humours, and, by taking off their ftimulating quality, help to appeafe the cough*. * In a former edition, I recommended, for an obftinate tickling cough, an oily emulfion, made with rhi1 paregoric elixir of the Edinburgh Dif- penfatory, inftead of the common alkaline fpirit. I have (ince been told by feveral practitioners, that they found it to bean excellent medicine in this diforder, and every way deferving of the character which I had nlies and China, where inflammations of the liver are .■ acute pain about the region of the navel. As the difeafe advances, the pulfe often finks fo low as to become quite imperceptible, the extremities grow cold, or cramped, and are often covered with a clammy fweat, the urine is obftruaed, and there is a palpitation • of the heart. Violent hiccuping, fainting, and convulfions, are the figns of approaching death. MEDICINE.----At the beginning of this difeafe, the efforts of Nature to expel the offending caufe fhould be aflifted,by promoting , the purging and vomiting. For this purpofe, the patient muft drink freely of diluting liquors; as whey, butter-milk, warm water, thin water-gruel, fmall poffet, or, what is perhaps preferable to any of them, very weak chicken broth. This fhould not only be drank . plentifully to promote the vomiting, but a clyfter of it given every hour to promote the purging. After thefe evacuations have been continued for fome time, a de- coaion of toafted oat-bread may be drank to flop the vomiting. The bread fhould be toafted till it is of a brown colour, and af- terwards boiled in fpring water. If oat-bread cannot be had, wheat- bread, or Oat-meal well toafted, may be ufed in its ftead. If this does not put a flop to the vomiting, two table-fpoonfuls ofthe faline julep, with ten drops of laudanum, may be taken every hour till it ceafes. The vomiting and purging ought never to be flopped too foon. As long as thefe difcharges do not weaken the patient, they are falu- tary, and may be allowed to go on, or rather ought to be promoted. But when the patient is weakened by the evacuations, which may be known from the finking of his pulfe, &c. recourfe muft imme- diately be had to opiates, as recommended above; to which may- be added ftrong wines, with fpirituous cinnamon-waters, and other generous cordials. Warm negus, or ftrong wine-whey, will" likewife be neceffarjyro fupport the patient's fpirits, and promote the perfpiration. His legs fhould be bathed in warm water, and I havevbeen twice brought to the gates of death by this difsafe, and both times it was occafioned by eating rancid bacon. 22? DIARRHCEA, OR LOOSENESS. afterwards rubbed with flannel cloths, or wrapped in warm Man-. kets, and warm bricks applied to the foles of his feet. FiauneL wrung out of warm fpirituous fomentations fhould likewife be ap- plied to the region of the ftomach. * When the violence of the difeafe is over, to prevent a relnpfe, it will be neceffary for fome time to continue the ufe of fmall do- fes of laudanum. Ten or twelve drops may be taken in a glafs ot wine, at leaft twice a day, for eight or ten days. The patient's food ought to be nourifhing, but taken in fmall quantities, and he fhould ufe moderate exercife. As the ftomach and inteltines are generally much weakened, an infufion of the bark, or other bit- ters, in fmall wine, fharpened with the elixir vitriol, may be drank for fome time. Though phyficians are feldom called in due time in this difeafe, they ought not todefpair of relieving the patient even in the moft defperate circumftances. Of this, I lately faw a very ftriking proof in an old man and his fon, who had been both feized with it a- bout the middle of the night. I did not fee them till next morning, when they had much more the appearance of dead than of living men. No pulfe could be felt; the extremities were cold and rigid ; the countenance was ghaftly, and the ftrength almoft quite e.\- haufted. Yet, from this deplorable condition, they were both recor vered by the ufe of opiates and cordial medicines. Of a Diarrhoea, or Loofenefs. A LOOSENESS, in many cafes, is not to be considered as a dif- eafe, but rather as a falutary evacuation. It ought therefore never to be flopped, unlefs when it continues too long, or evidently weakens the patient. As this fometimes happens, we fhall point out the moft common caufes of a loofenefs, with the proper method of treatment. When a loofenefs is occafioned by catching cold, or an obftruc- ted perfpiration, the patient ought to keep warm, to drink freely of weak diluting liquors, to bathe his feet and legs in lukewarm water, to wear flannel next his fkin, and to take every other me- .thod to reftore the perfpiration. In a loofenefs which proceeds from excefs or repletion, a vomit "is the proper medicine. Vomits not only cleanfe the ftomach, but promote all the fecretions, which render them of great impor- tance in carrying off a debauch. Haifa drachm of ipecacuanha in powder will anfwer this purpofe very well. A day or two after the vomit, the fame quantity of rhubarb may |>e taken, andrepea- * Should the vomiting continue obftinate, a blifter or poultice conipo- f«?d of rye meal, flower of muftard, and vinegar, applied to the region qf the ftomach, and continued until it gives pain, or even forms a blif per; is frequently attended with the beft effecls. (I. C.) DIARRHCEA, OR LOOSENESS. 229 trd two or three times, if the loofenefs continues. The patient ought to live upon light vegetable food, of eafy digeftion, and to diis.k whey, thin gruel, or bailey-water. A loofenefs occafioned by the obftruaion of any cuftomary eva- cuation, generally requires bleeding. If that does not fucceed, other evacuations may be fubftituted in the room of thofe which are obftruaed. At the fame time, every method is to be taken to re- ftore the ufual difcharges, as not only the cure of the difeafe, but the patient's life, nuy depend en this. A periodical loofenefs ought never to be flopped. It is always an effort of Nature to carry off fome offending matter, which, if retained in the body, might have fatal effeas. Children are very liable to this kind of loofenefs, efpecially while teething. It is, however, fo far from being hurtful to them, that fuch children generally get their teeth with leaft trouble. If thefe loofe ftools fhould at any time prove four or griping, a tea-fpoonful of mag- nesia alba, with four or five grains of rhubarb, may be given to the child in a little panado, or any other food.' '1 his, if repeated three or four times, will generally correa the acidity, and carry off the griping ftools. A loofenefs which proceeds from violent paffions or affeaions of the mind, muft be treated with the greateft caution. Vomits in this cafe are highly improper. Nor are purges fafe, unlefs they be very mild, and given in fmall quantities. Opiates, and other antifpafmodic medicines are moll proper. Ten or twelve drops of laudanum may be taken in a cup of valerian or penny-royal tea, every eight or ten hours, till the fymptoms abate. Eafe, cheerful- nsfs and tranquillity of mind, are here of the greateft importance. When a loofenefs proceeds from acrid or poifonous fubftances, taken into the ftomach, the patient muft drink large quantities of diluting liquors, with oil or fat broths, to promote vomiting and purging. Afterwards, if there be reafon to fufpea that the bowels are inflamed, bleeding will be neceffary. Small dofes of laudanum may likewife be taken to remove their irritation. When the gout, repelled from the extremities, occafions a loofe- nefs, it ought to be promoted by gentle dofes of rhubarb, or other mild purgatives. The gouty matter is likewife to be folicited to- wards the extremities by warm fomentations, cataplafms,&c. The perfpiration ought at the fame time to be promoted by warm di- luting liquors ; as wine-whey, with fpirits of hartftiorn, or a few drops of laudanum in it. When a loofenefs proceeds from worms, which may be known from the fliminefs of the ftools mixed with pieces of decayed worms, &c. medicines muft be given ;o kill and carry off thefe vermin, as the powder of tin, with purges cf rhubarb and calomel. Afterwards lime-water, either alone, or with a fmall quantity of rhubarb infufed, will be proper to ftrengthen the bowels, and pre- vent the new generation of worms. t%& VOMITING. A loofenefs is often occafioned by drinking bad water. When this is the cafe, the" difeafe generally proves epidemical. When there is reafon to believe that this, or any other difeafe proceeds from the ufi of unwholefome water, it ought immediately to be changed, or if that cannot be done, it may be correaed by mixing with it quick-lime, chalk, or the. like. In people, whofe ftomachs are weak, violent exercife immedi- ately after eating, will occafion a loofenefs. The cure of this is obvious; yet it will be proper, befides avoiding violent exercife, to ufe fuch medicines as tend to brace and ftrengthen the ftomach, as infufions of the bark, with other bitter and aftringent ingredi- ents, in white wine. Such perfons ought likewife to take frequent- ly a glafs or two of old red port, or good claret.* From whatever caufe a loofenefs proceeds, when it is found ne- ceffary to check it, the diet ought to confift of rice boiled with milk, and flavoured with cinnamon ; rice-jelly ; fago, with red port; and the lighter forts offlefh-meat roafted: The drink may be thin water-gruel, rice-water, cr weak broth, made from lean veal, or with a fheep's head, as being more gefatinous than mut- ton, beef, or chicken-broth. Perfons, who from a peculiar weaknefs, or too great an irrita- bility of the bowels, .are liable to frequent returns of this difeafe, fhould live temperately, avoiding crude fummer fruits, all un- wholefome food, and meats of hard digeftion. They ought like- wife to beware of cold, moifture, or whatever may obftrua the perfpiration, and fliould wear flannel next their'fkin. All violent paffions, as fear, anger, &c. are carefully to be guarded againft. Of Vomiting. VOMITING may proceed from various caufes ; as excefs in eating and drinking ; fculnefs of the ftomach ; the acrimony of the aliments ; a tranflation of the morbific matter of ulcers, of the gout, the eryfipelas, or other difeafes, to the ftomach. It may like- wife proceed from a loofenefs having been too fuddenly flopped ; from the ftoppage of any cuftomary evacuation, as the bleeding piles, the menfes, &c. from a weaknefs of the ftomach, the colic, the iliac paffion, a rupture, a fit of the gravel, worms; or from any kind of poifon aken into the ftomach. It is an ufual fymptom of injuries done to the brain ; as contufions, compreffions, &c. It is likewife a fymptom of wounds or inflammations of the dia- phragm, inteflines, fpleen, liver, kidneys, &c. Vomiting may be occafioned by unufual motions ; as failing, being drawn backwards hi a cart or coach, &c. by violent paffions, * After every aftringent and tonic medicine has failed in the chronic diarrhoea of warm climates, a long voyage to fea has entirely removed the cumpLint. (I. C. ) VOMITING. 231 or by the idea of naufeous or difagreeable objeas, efpecially of fuch things as have formerly produced vomiting. Sometimes it proceeds from a regurgitation of the bile into the ftomach ; in this cafe, what the patient vomits, is generally of a yellow or greenifh colour, and has a bitter tafte. Perfons who are fubjea to nervous affeaions, are often fuddenly feized with violent fits of vomiting. Laftly, vomiting is a common fymptom of pregnancy. In this cafe, it generally comes on about two weeks after the ftop- page of the menfes, and continues during the firft three or four months. When vomiting proceeds from a foul ftomach or indigeftion, it is not a difeafe, but the cure of a difeafe. It ought therefore to be promoted by drinking lukewarm water, or thin gruel. If this does not put a flop to the vomiting, a dofe of ipecacuanha may be taken, and worked off with weak camomile tea. When the retroceffion of the gout, or the obftruaion of cufto- mary evacuations, occafion vomiting, all means muft be ufed to re- ftore thefe difcharges; or, if that cannot be effeaed, their place muft be fupplied by others, as bleeding, purging, bathing the extre- mities in warm water, opening iffues, fetons, perpetual blifters, &c. When vomiting is the effea of pregnancy, it may generally be mitigated by bleeding, and keeping the body gently open. The bleeding however ought to be in fmall quantities at a time, and the purgatives fhould be of the mildest kind, as figs, fie wed prunes, manna, or fenna. Pregnant women aremoft apt to vomit in the morning, immediately after getting opt of bed, which is owing parflyr£p the.change of pofture, but more to the emptinefs of the ftomach. It may generally be prevented by taking a difh of coffee, tea, or fome light breakfaft in bed. Pregnant women who are af- fliaed with vomiting, ought to be kept eafy both in body and mind. They fhould neither allow their ftomachs to be quite emp- ty, nor fliould they eat muchat once. Cold water is a very proper drink in this cafe ; if the ftomach be weak, a little brandy may be added to it. If the fpirits are low, and the perfon apt to faint, a fpoonful of cinnamon water, with a little marmalade of quinces or oranges may be taken. If vomiting proceeds from weaknefs of the ftomach, bitters will be of fervice. Bark infufed in wine or brandy, with as much rhubarb as will keep the body gently open, is an excellent medi- cine in this cafe. The elixir of vitriol is alfo good. It may be taken in the dofe of fifteen or twenty drops, twice or thrice a-day, in a glafs of wine or water. Habitual vomitings are fometimes alle- viated by making oyfters a principal part of diet. A vomiting, which proceeds from acidities in the ftomach, is relieved by alkaline purges. The beft medicine of this kind is the? magnefia alba, a tea-fpoonful of which may be taken in a difh of tea or a little milk, three or four times 3 or rime hours, with oi»c or two drachms of laudanum in each. (I. C-) C 236 ] Of the Gravel and Stone. WHEN fmall ftones are lodged in the kidneys, or difcharged along with the urine, the patient is faid to be affliaed with the gravel. If one of thefe ftones happens to make a lodgement in the bladder for fome time, it accumulates frefli matter, and at length becomes too large to pafs off with the urine. In this cafe the patient is faid to have the ftone. CAUSES.----The ftone and gravel may be occafioned by high living ; the ufe of ftrong aftringent wines ; a fedentary life ; lying too hot, foft, or too much on the back ; the conftant ufe of water impregnated' with earthy or ftony particles ; aliments of an aftrin- gent or windy nature, &c. It may likewife proceed from an he- reditary difpofition. ..Perfons in the decline of life, and thofe who have been much affliaed with the gout or rheumatifm, are moft liable to it. SYMPTOMS.----Small ftones or gravel in the kidneys occa- fion pain in the ioins ; ficknefs $ vomiting ; and fometimes bloody urine. When the ftone defcends into the ureter, and is too large to pafs along with eafe, all the above fymptoms are increafed ; the pain extends towards the bladder ; the thigh and leg of the affeaed fide are benumbed ; the tefticles are drawn upwards, and the urine is obftruaed. A ftone in the bladder is known from a pain, at the time, as well as before and after making water ; from the urine coming away by drops, or flopping fuddenly when it was running in a full ftream ; by a violent pain in the neck of the bladder upon motion, efpecially on horfeback, or in a carriage on a rough road ; from a white, thick, copious, (linking, mucous fediment in the urine ; from an itching in the top of the penis ; from bloody urine; from an inclination to go to ftool during the difcharge of urine ; from the patient's paffing his urine more eafily when lying than in an creel: pofture ; from a kind of convulfive motion occafioned by the fharp pain in difcharging the laft drops of the urine; and lastly, from founding or fearching with the catheter. REGIMEN.----Perfons affliaed with the gravel or ftone fhould avoid aliments of a windy or heating nature, as fait meat?, four fruits, &c. Their diet ought chiefly to confift of fuch things as promote the fecretion of urine, and keep the body open. Arti- chokes, afparagus, fpinnage, lettuce, parfley, fuccory, purflane, turnips, potatoes, carrots, and radifhes, may be faftly eaten. Oni- ons, leeks, and celery, are, in this cafe, reckoned medicinal. The moit proper drinks are whey, butter-milk, milk and water, barley- water; decoaions or infufions of the roots of marfh-mallows, parfley, liquorice, or of other mild mucilaginous vegetables, as lin- leed. If the patient has been accuftomed to generous liquors, Ire pay drink fmall gin punch. THE GRAVEL AND STONE. 237 Gentle exercife is proper ; but violent motion is apt to occrf.on bloody urine. Wc advife that it fliould betaken in mod<-r>ricn. Perfons affliaed with gravel, often pafs a great number of Itones after riding on horfeback, or in a carriage ; but thofe wh.; have a ftone in the bladder, are feldom able to bear thefe kinds of extrelit, Where there is a hereditary tendency to this difeafe, a fedentary -life ought never to be indulged. Were people careful, upo.i the firft fymptoms of gravel, to obferve a proper regimen of diet, and to take fufficient exercife, it might often be carried off, or at Ivraft prevented from increafing; but if the fame courfe which occafion- ed the difeafe is perfifted in, it muft be aggravated. , MEDICINE_____In what is called a fit of the gravel, which is commonly occafioned by a ftone flicking in the ureter or fome part of the urinary paffages, the patient muft be bled, warm.fo- mentations fliould likewife be applied to the part affeaed, emolli- ent anodyne clyfters adminiftered, and diluting mucilaginous li- quors drank, &c. The treatment of this cafe has been fully point- ed out under the articles, inflammation of the kidneys and bladder, to which we refer. Dr. Whyte advifes patients, who are fubjea to frequent fits of gravel in the kidneys, but have no ftone in the bladder, to drink, every morning, two or three hours before breakfaft, an Englifh pint of oyfter or cockle-fhell lime-water. The Doaor very juftly obferves, that though this quantity might be too fmall to have any fenfible effea in diffolving a ftone in the bladder, yet it may very probably prevent its growth. When a ftone is formed in the bladder, the Doaor recommends Alicant foap, and oyfter, or cockle-fhell lime-water,* to be taken in the following manner : The patient muft fwallow, every day, in any form that is leaft difagreeable, an ounce of the internal part of Alicant foap, and drink three or four Englifh pints of oyfter, or cockle-fhell lime-water. The foap is to be divided into three do- fes ; the largeft to be taken fading in the morning early ; the fe- cond at noon; and the third at feven in the evening; drinking, above each dofe, a large draught of the lime-water; the remainder of which he may take any time betwixt dinner and fupper, inftead of other liquors. The patient fhould begin with a fmaller quantity of the lime-wa- ter and foap, than that mentioned above ; at firft an Englilli pint of the former, and three drachms of the latter, may be taken daily. This quantity, however, he may increafe by degrees, and ought to perfevere in the ufe of thefe medicines, efpecially if he finds any abatement of his complaints, for feveral months ; nay, if the flone be very large,- for years. It may likewife be proper for the patient, if feverely pained, not only to begin with the foap and lime-water in fmal! quantities, but to take the fecond or third lime-water in- # See Appendix, Lime- water. 238 INVOLUNTARY DISCHARGES ftead of the firft. However, after he has been for fome time ac- cuftomed to thefe medicines, he may not only take the firft water, but, if he finds he can eafily bear it, heighten its diffolving power ftill more by pouring it a fecond time on frefh calcined fhells. The caultic alkali, or foap Ills, is the medicine chiefly in vogue, at prefent, for the ftone. It is of a very acrid nature, and ought, therefore, to be given in fome gelatinous or mucilaginous liquor ; as veal-broth, new milk, linfeed tea, a folution of gum-arabic, or a decoaion of marfh-mullow roots. 1 he patient muft begin with fmall dofes of the lees, as thirty or forty drops, and increafe by degrees, as far as the ftomach can bear it.* Though the foap-lees and lime-water are the moft powerful medicines which have hitherto been difcovered for the ftone ; yet there are fome things of a more fimple nature, which in certain cafes are found to be beneficial, and therefore deferve a trial. An infufion of the feeds of wild carrot, fweetened with honey, has been found to give confiderable eafe in cafes wdiere the ftomach could not bear any thing of an acrid nature. A decoaion of raw coffee-berries taken morning and evening, to the quantity of eight or ten ounces, with ten drops of fweet fpirit of nitre, has, likewife, been found very efficacious in bringing away large quantities of earthy matter in flakes. Honey is likewife found to be of confi- derable fervice, and may be taken in gruel, or in any other form that is more agreeable. The only other medicine which we fhall mention is the uva urfi. It has been greatly extolled of late, both for the gravel and ftone. It feems, however, to be, in all refpeas, inferior to the foap and lime-water; but it is lefs difagreeable, and has frequently, to my knowledge, relieved gravelly complaints. It is generally taken in powder from half a drachm to a whole drachm, two or three times a-day. It may, however, be taken to the quantity of feven. or eight drachms a-day, with great fafety and good effea. C II A P T E R XXXV. Of involuntary Difcharges of Blood. INVOLUNTARY difcharges of blood often happen from va- rious parts of the body. 'Thefe are fo far from being always dangerous, that they prove often falutary. When fuch difcharges are critical, which is frequently the cafe in fevers, they ought not to be ftop-'tri. Nor is it proper at any time to Hop them, unlefs ■* The c-iuftic alkali may be prepared by mixing two parts of quick- lime with one of potallies, and Umering them to Hand till the lixivium be formed, which muft be carefully fiitrated before it be ufed. If the folution does not hippcn readily, a 1 mail quantity of water may be ad dec! to the mixiirr;. OF BLOOD. 239 they be fo great as to endanger the patient's life. Moft people, afraid of the fmalleft difcharge of blood from any part of the bo- dy, fly immediately to the ufe of flyptic and aftringent medicines, by which means an inflammation of the brain, or fome other fatal difeafe, is occafioned, which had the difcharge been allowed to go on, might have been prevented. Periodical difcharges of blood, from whatever part of the body, muft not be flopped. They are always the efforts of Nature to relieve herfelf; and fatal difeafes have often been the confequence of obftruaing them. It may indeed be fometimes neceffary to check the violence of fuch difcharges ; but even this requires the greateft caution. Inftances might be given where the ftopping of a fmall periodical flux of blood from one of the fingers, has proved fatal. In the early period of life, bleeding at the nofe is very common. Thofe who are farther advanced in years, are more liable to hie- moptoe, or difcharge of blood from the lungs. After the m iddle period of life, hemorrhoidal fluxes are moft common; and in the decline of life, difcharges of blood from the urinary paflhges. Involuntary fluxes of blood may proceed from very different, and often from quite opposite caufes. Sometimes they are owing to a particular construction of the body, as a fanguine tempera- ment, a laxity of the veffels, a plethoric habit, &c At other times they proceed from a determination of the blood towards one par- ticular part, as the head, the hsemorrhoidal veins, &c. They may proceed from ah inflammatory difpofition of the blood, in which cafe there is generally fome degree of fever : this likewife hap- pens when the flux is occafioned by an obftruaed perfpiration, or a ftriaure upon the fkin, the bowels, or any particular parfcof the fyftem. Haemorrhages occur in malignant fevers, dyfentery, fcurvy, ma- lignant fmall pox. Sec. In thefe difeafes, there are great difcharges of blood from different parts of the body. They may likewife be brought on by too liberal a ufe of medicines, fuels as cantharides, &c. Food of an acrid or irritating quality may occafion hemor- rhages ; as alfo ftrong purges and vomits, or any thing that greatly ftimulates the bowels. Violent paffions or agitations of the mind may have this effea. Thefe often caufe bleeding at the nofe ; fometimes an haemorrhage in the brain. Violent efforts of the body, by overftraining or hurt- ing the veffels, may have the fame effea, efpecially when the body is long kept in an unnatural pofture, as hanging the head very low, &c The cure of an haemorrhage muft be adapted to its caufe- When it proceeds from too much blood, or a tendency to inflam- mation, bleeding, with gentle purges and other evacunions, will be neceffary. It wiil likewife be proper for the patient in this cafe to live chiefly upon a vegetable diet, to avoid all ftrong liquors, 240 OF BLEEDING AT THE NOSE. and food that is of an acrid, hot or ftimulating quality. The body fhould be kept cool and the mind eafy. When haemorrhage comes on in malignant fevers, fcurvy, &c the patient ought to live chiefly upon acid fruits with milk, and vegetables of a nourifhing nature, as fago, falop, &c. His drink may be wine diluted with water, and fharpened with the juice of lemon, vinegar, or fpirits of vitriol. The beft medicine in this cafe is the Peruvian bark, which may be taken according to the urgen- cy of the fymptoms. When a flux of blood is the effea of acrid food, or of ftrong ftimulating medicines, the cure is to be effeaed by foft and mu- cilaginous diet. The patient may likewife take frequently about the bulk of a nutmeg of Locatelli's balfam, or the fame quantity of fpermaceti. When an obftruaed perfpiration, or a ftriaure upon any part of the fyftem, is the caufe of an haemorrhage, it may be removed by drinking warm diluting liquors, lying a-bed, bathing the extre- mities in warm water, &c. Of Bleeding at the Nofe. THIS is commonly preceded by fome degree of quicknefs of the pulfe, fluihing in the face, pulfation of the temporal arteries, heavinefs in the head, dimnefs of the fight, heat and itching of the noftrils, &c To perfons who abound with blood, this difcharge is very falu- tary. It often cures a vertigo, the head-ach, a phrenzy, and even an epilepfy. In fevers, where there is a great determination of blood towards the head, it is of the utmoft fervice. It is beneficial for inflammations of the liver and fpleen, and often in the gout and rheumatifm. In all difeafes where bleeding is neceffary, a fpon- tanecus difcharge of blood from the nofe is of more fervice than the fame quantity let with a lancet. In a difcharge of blood from the nofe, the great point is to de- termine whether it ought to be flopped or not. It is a common praaice to flop the bleeding, without considering weather it be a difeafe, or the cure of a difeafe. This condua proceeds from fear; but it has often bad, and fometimes fatal confequences. \vhen a difcharge of blood from the nofe happens in an inflam- matory difeafe, there is always reafon to believe that it may prove falutary; and therefore it fhould be fuiTered to go on, at leaft as long as the patient is not weakened by it. When it happens to perfons in perfea health who are full of blood, it ought not to be fuddenly flopped, efpecially if the fymp- OF BLEEDING AT THE NOSE* 241 toms of plethora, mentioned above, have preceded it. In this cafe, ic cannot be flopped without rifking the patient's life. In fine, whenever bleeding at the nofe relieves any bad fymp- tom, and does not proceed fo far as to endanger the patient's life, itought not to be flopped. But when it returns frequently, or continues till the pulfe become? low, the extremities begin to grow - cold, the lips pale, or the patient complains of being fick or faint, it muft immediately be flopped. For this purpofe, the patient fhould be fet nearly upright, witli his head reclining a little, and his legs immerfed in water about the warmth of new milk. His hands ought likewife to be put in lukewarm water, and his garters may be tied a little tighter than ufual. Ligatures may be applied to the arms, about the plac£ where they are ufually made for bleeding, and with nearly the fame degree of tightnefs. Thefe muft be gradually flackened as the blood begins to flop, and removed entirely as foon as it gives over. Sometimes dry lint put up the nostrils will flop the bleeding. When this does not fucceed, doffils of lint dipped in ftrong fpi- rits of wine, may be put up the noftrils, or if that cannot be had, they may be dipped in brandy. Blue vitriol diffolved in water may likewife be ufed for this purpofe, or a tent dipped in the white of an egg, well beat up, may be rolled in a powder made of equal parts of white fugar, burnt allum, and white vitriol, and put up the noltril from whence the blood iffues*. Internal medicines can hardly be of ufe here, as they have fel- dom time to operate. It may not however be amiss to give the pa- tient half an ounce of Glauber's fait, and the fame quantity of manna, diffolved in four or five ounces of barley-water. This may be taken at a draught, and repeated, if it does not operate, in a few hours. Ten or twelve grains of nitre may be taken in a glafs of cold water and vinegar every hour, or oftener, if the ftomach will bear it. If a ftronger medicine be neceffary, a tea-cupful of the tinaure of rofes, with twenty or thirty drops of the weak fpi- rit of vitriol, may be taken every hour. When thefe things cannot be had, the patient may drink water, with a little common fait in it, or equal parts of water and vinegar. If the genitals be immerfed for fome time in cold water, it will generally flop a bleeding at the nofe. I have not known this fail. Sometimes, when the bleeding is flopped outwardly, it continued inwardly. This is very troublefome, and requires particular atten- tion, as the patient is apt to be fuffocated with the blood, efpeci- ally if he falls afleep, whicu he is very ready to do after lofing a $reat quantity of blood. * This intention is more effectually anfwered by palling a bbugeejip the bleeding noitril,'with a piece of fpunge tied near the middle of it. This may be drawn up fo as to comprefs the bleeding veffel, bvbringing the inner end of the bougee out of the mouth. d. C) H 2 BLEEDING AND BLIND PILES. When the patient is in danger of fuffocation from the blood getting, into his throat, the paffa^es may be flopped by drawing threads up the noftrils, and bringing them out at the mouth, then fattening pieces of fpungc, or fmall rolls of linen cloth to their ex- tremities; afterwards drawing them back, and tying them on the outfide with a fufficient degree of tightnefs. After the bleeding is flopped, the patient ought to be kept as eafy and quiet as poffibie. He fhould not pick his nofe, nor take away the tents or clotted blood, till they fall off of their own ac- cord, and fhould not lie with his head low. Thofe who are affeaed with frequent bleeding at the nofe, •ought to bathe their feet often in warm water, and to keep them warm and dry. They ought to wear nothing tight about their necks, to keep their body as much in an erea poflure as poffibie, and never to view any objea obliquely. If they have too much blood, a vegetable diet, with now and then a cooling purge, is the fafeft way to leffen it. ■ But when the difeafe proceeds from a relaxed ftate of the veffels, the diet fhould he rich and nourifhing, as ftrong broths and jel- lies, fago-gruel with wine and fugar, &c. Infufions of the bark in wine ought to be taken and perfilted in for a confiderable time. Of the Bleeding and Blind Piles. A difcharge of blood from the haemorrhoidal veffels is called the Heeding piles. When the veffels only fwell, and difcharge no blood, but are exceeding painful, the difeafe is called the blind piles. Perfons of a loofe fpungy fibre, of a bulky fize, who live high, and lead a fedentary inactive life, are moft fubjea to this difeafe. It is often owing to a hereditary difpofition. Where this is the cafe, it attacks perfons more early in life than when it is accidental. Men are more liable to it than women, efpecially thofe of a fan- guine, plethoric, or fcorbutic habit, or of a melancholy difpofition. . The piles may be occafioned by an excefs of blood, by ftrong aloetic purges, high-feafoned food, drinking great quantities of fweet-wines, the neglea of bleeding, or other cuftomary evacua- tions, much riding, great coftivenefs, or any thing that occafions hard or difficult ftools. Anger, grief, or other violent paffions, will likewife occafion the piles, or fitting on the damp ground. A pair of thin breeches will excite the diforder in a perfon who is fubjea to it, and fometimes even in thofe who never had it before. Preg- nant women are often affliaed with it. A flux of blood, from the anus, is not always to be treated as a difeafe. It is even more falutary than bleeding at the nofe, and of- ten prevents or carries off difeafes. It is peculiarly beneficial in the BLEEDING AND BLIND PILES. ^243 gout, rheumatism, afthma, and hypochondriacal complaints, and often proves critical in colics, and inflammatory fevers. In the management of the patient, regard muft be had to his habit of body, his age, ftrength, and manner of living. A difcharge which might be exceffive, and prove hurtful to one, may be very moderate, and even falutary to another. That only is to be efleem- ed dangerous which continues too long, and is in fuch quantity as to wafte the patient's ftrength, hurt the digeftion, nutrition, and, other funaions neceffary to life. When this is the cafe, the difcharge muft be checked by a pro- per regimen, and aftringent medicines. The DIET muft be cool but nourifhing, confifting chiefly of bread, milk, cooling vegeta- bles and broths. The drink may be chalybeate water, orange- whey, decoaions or infufions of the aftringent and mucilaginous plants, as the tormentil root, biflort, the marfhmallow-roots, &c. Old conferve of red rofes is a very good medicine in this cafe. It may be mixed with new milk, and taken in the quantity of an ounce three or four times a-day. '1 his medicine is in no great re- pute, owing to its being feldom taken in fuch quantity as to pro- duce any effeas ; but when taken a? here direaed, and duly per- fifted in, I have known it perform very extraordinary cures in violent haemorrhages, efpecially when aflifted by the tinaure of rofes ; a tea-cupful of which may be taken about an hour after eve- ry dofe of the conferve. The bark is likewife proper in this cafe, both as a ftrengthener and aftringent. Half a drachm may be taken in a glafs of red wine, fharpened with a few drops of the elixir of vitriol, three or four times a-day. The bleeding piles are fometimes periodical, and return regu- larly once a-month, or once in three weeks. In this cafe, they are always to be confidered as a falutary difcharge, and by no means to be flopped. Some have entirely ruined their health by flopping a periodical difcharge of blood from the hemorrhoidal veins. In the blind piles, bleeding is generally of ufe. The diet muft be light and thin, and the drink cool and diluting. The body muft be kept gently open. This may be done by fmall dofes of the flowers of brimftone and cream of tartar. Thefe may be mixed in equal quantities, and a tea-fpoonful taken two or three times a-day, or oftener if neceffary. Or an ounce of the flours of brimftone, and half an ounce of purified nitre, may be mixed with three or four ounces of the lenitive ekauary, and a tea-fpoonful of it taken three or four times a-day. Emollient clyfters are here likewife beneficial; but there is iome- times fuch an 'aftriaion of the anus, that they cannot be thrown up. In this cafe, a vomit has had a very good effea. When the piles are exceeding painful and fwelled, but difcharge nothing, the patient muft fit over the fleams of warm water. He niay likewife apply a linen cloth dipped,in \yarm fpirits^of wine.to g44_ SPITTING OF BLOOD. the part, or poultices of bread and milk. If thefe do not produce a difcharge, and the piles appear large, leeches muft be applied ai near them as poffibie, or, if they will fix upon the piles themfelves, fo much the better. When leeches will not fix, the piles mayt>c opened with a lancet. The operation is very eafy, and is attended with do danger. Various ointments, and other external applications, are rccom mended in the piles ; but I do not remember any effeas from thefe worth mentioning. Their principal ufe is to keep the part moift, which may be done as well by a foft poultice, or an emollient ca- taplafm. When the pain however is very great, a liniment made of two ounces of emollient ointment, and half an ounce of lauda- num, beat up with the yolk of an egg, may be applied. Spitting of Blood, WE mean here to treat of the difcharge of blood from the lungs only which is called an hcemoptoe, ox fpitting af blood. Perfons of a flender make, and a lax fibre,who have long necks and ftrait breads, are moft liable to this difeafe. It is moft common in the fpring, and generally attacks people before they arrive at the prime or middle period of life. It is a common obfervation, that thofe who have been fubjea to bleeding at the nofe when young, are afterwards moft liable to an haemoptoe. CAUSES.----An haemoptoe may proceed from excefs of blood, from a peculiar weaknefs in the lungs, or a bad conformation of the breaft, exceffive drinking, running, wrefthng, finging, or fpeak- ing aloud. Such as nave weak lungs ought to avoid all violent ex- ertions of that organ, as they value life. They fhould likewife guard againft violent paffions, exceffive drinking, and every thing that occafions a rapid circulation of the blood. This difeafe may proceed from wounds of the lungs. Thefe may either be received from without, or they may be occafioned by hard bodies getting.into the wind-pipe, and fo falling down upon the lungs, and hurting the tender organ. The obftruaion of any cuftomary evacuation may occafion a fpitting of blood; as ne- glea of bleeding or purging at the ufual feafons, the ftoppage of the bleeding piles in men, or the menfes in women, &c. It may likewife proceed from a polypus, fchirrous concretions, or any thing that obftruas the circulation of the blood in the lungs. It is often the effea of a long and violent cough ; in which cafe, it is generally the forerunner of a confumption. A violent degree of cold fuddenly applied to the external parts of the body, will occa- fion an haemoptoe. It may likewife be occafioned by breathing air which is too much rarified to be able properly to expand the lungs. This is often the cafe with thofe who work in hot places, as fur- SPITTING OF BLOOD. naces, glafs-houfes, or the like. It is likewife faid to happen to fuch as afcend to the top of very high mountains, as the Peak of Teneriffe, Sec. Spitting of blood is not always a primary difeafe. It is often only a fymptom, and in fomcdifeafes not an unfavourable one. This is the cafe in pleurisies, peripneumonies, and fundry other fevers. In a dropfy, fcurvy, or confumption, it is a bad fymptom, and (hows that the lungs are ulcerated. SYMPTOMS-----Spitting of blood is generally preceded by a fenfe of weight, and oppreffion of the breaft, a dry tickling cough, hoarfenefs, and a difficulty of breathing. Sometimes it is ufhered in with fhivering, coldnefs of the extremities, coftivenefs, great laffitude, flatulence, pain of the back and loins, &c. As thefe fhow a general ftriaure upon the veffels, and a tendency of the blood to inflammation, they are commonly the forerunners of a very copious difcharge. The above fymptoms do not attend a dif- charge of blood from the gums or fauces, by which means thefe may always be diftinguifhed from an haemoptoe. Sometimes the blood that is fpit up is thin, and of a florid red colour ; and at other times it is thick, and of a dark or blackifh colour; nothing can be inferred from this circumstance, but that the blood has lain a longer or fhorter time in the breaft before it was difcharged. Spitting of blood, in a ftrong, healthy perfon, of a found con- ftitution, is not very dangerous; but when it attacks the tender and delicate, or perfons of a weak lax fibre, it is with difficulty re- moved. When it proceeds from a fchirrus of the lungs, it is bad. The danger is greater when the difcharge proceeds from the rup- ture of a large veffel than of a fmall one. When the extravafated blood is not fpit up, but lodges in the breaft, it corrupts, and great- ly increafes the danger. When the blood proceeds from an ulcer in the lungs, it is generally fatal. REGIMEN.----The patient ought to be kept cool and eafy. Every thing that heats the body or quickens the circulation, in- creafes the danger. The mind ought likewife to be foothed, and every occafion of exciting the paffions avoided. The diet fnould be foft, cooling, and flender; as rice boiled with milk, fmall broths, barley-gruels, panado, &c. The diet, in this cafe, can fcarce be too low. Even water-gruel is fufficient to fupport the patient for fome days. All ftrong liquors muft be avoided, the patient may drink milk and water, barley-water, whey, but- ter-milk, and fuch-like. Every thing fliould be drank cold, and in fmall quantities at a time. He fliould obferve the ftriaeft filence, or at leaft fpeak with a very low voice. MEDICINE.____This, like the other involuntary difcharges of blood, ought not to be fuddenly flopped by aftringent medicines. More mifchief is often done by thefe, than if it were fuffered to go on. It may, however, proceed fo far as to weaken the patient, 246 VOMITING OF BLOOD, and even endanger his life; in which cafe, proper means muft be ufed for reftraining it. The body fliould be kept gently open by laxative diet ; as roaf- ted apples, ftewed prunes, and fuch-like. If thefe fhould not have the defired effea, a tea-fpoonful of the lenitive ekauary may be taken twice or thrice a-day, as is found neceffary. If the bleeding proves violent, ligatures maybe applied to the extremities, as di- reaed for a bleeding at the nofe. If the patient behot or feverifh, bleeding and fmall dofes of nitre will be of ufe; a fcruple or half a drachm of nitre may be taken in a cup of his ordinary drink, twice or thrice a-day. His drink may be fharpened with acids, as juice of lemon, or a few drops of the fpirit of vitriol; or he may take frequently a cup of the tinc- ture of rofes. Bathing the feet and legs in lukewarm water, has a very good effea in this difeafe. Opiates are fometimes beneficial ; but muft he adminiftered with caution. Ten or twelve drops of laudanum may be given in a cup of barley-water twice a-day, and continu- ed for fome time, provided they be found beneficial. The conferve of rofes is a very good medicine in this cafe, if taken in fufficient quantity, and long enough perfifted in. It may be taken to the quantity of three or four ounces a-day ; and, if the patient be troubled with a cough, it fliould be made into an elec- tuary with balfamic fyrup, and a little of the fyrup of poppies. If stronger astringents be neceffary, fifteen or twenty drops of the elixir of vitriol may be given in a glafs of water, three or four times a-day. Thofe who are fubjea to frequent returns of this difeafe, fhould avoid all excefs. Their diet fhould be light and cool, confifting chiefly of milk and vegetables. Above all, let them beware of vi- gorous efforts of the body, and violent agitations of the mind. Vomiting of Blood. THIS is not fo common as the other difcharges of blood alrea- dy mentioned j but it is very dangerous, and requires particular attention. Vomiting of blood is generally preceded by pain of the ftomach, ficknefs, and naufea; and is accompanied with great anxiety, and frequent fainting fits. This difeafe is fometimes periodical; in which cafe, it is lefs dangerous. It often proceeds from an obftruaion of the menfes in women ; and fometimes from the ftopping of the haemorrhoidal flux in men. It may be occafioned by any thing that greatly ftimu- lates or wounds the ftomach, as ftrong vomits or purges, acrid poifons, fharp or hird fubftances taken into the ftomr.ch, Sec. It is BLOODY URINE. 247 often the effea of obftruaions in the liver, the fplcen, or fome of the other vifcera, or external violence, as blows or bruifes, or any of the caufes which produce inflammation. In hyfleric wo- men, vomiting of blood is a very common, but no dangerous fymp- tom. A great part of the danger in this difeafe arifes from the ex- travafated blood lodging in the bowels, and becoming putrid, by which a dyfentery or malignant fever may be occafioned. The beft: Way of preventing this, is to keep the body gently open, by fre- quently exhibiting emollient clyfters. Purges muft not be given till the difcharge is ftopt, otherwife they will irritate the ftomach, and increafe the diforder. AH the food and drink muft be of a mild cooling nature, and taken in fmall quantities. Even drink- ing cold water has fometimes proved a remedy, but it will fucceed better when fharpened with the weak fpirits of vitriol*. When there are figns of an inflammation, bleeding may be neceffary ; but the patient's weaknefs will feldom permit it. Opiates may be of ufe ; but they muft be given in very fmall dofes, as four or five drops of laudanum twice or thrice a-day. After the difcharge is over, as the patient is generally troubled with gripes, occafioned by the acrimony of the blood lodged in the inteflines, gentle purges will be neceffary. Of Bloody Urine. THIS is a difcharge of blood from the veffels of the kidneys or bladder, occafioned by their being either enlarged, broken, or eroded. It is more or lefs dangerous according to the different cir- cumftances which attend it. When pure blood is voided fuddenly without interruption and without pain, it proceeds from the kidneys ; but if the blood be in fmall quantity, of a dark colour, arid emitted with heat and pain about the bottom of the belly, it proceeds from the bladder. When bloody urine is occafioned by a rough ftone descending from the kidneys to the bladder, which wounds the ureters, it is attended with a fharp pain in the back, and difficulty of making water. If the coats of the bladder are hurt by a ftone, and the bloody urine follows, it is attended with the moft acute pain, and a previous ftoppage of urine. Bloody urine may likewife be occafioned by falls, blows, the lifting or carrying of heavy burdens, hard riding, or any violent motin. It may alfo proceed from ulcers of the bladder, from a ftone * Clyfters of cold water, with forty or fifty drops of laudanum in each, fliould be injected, and ftillnefs Urictly enjoined. (I. C J 248 THE DYSENTERY, lodged in the kidneys, or from Violent purges, or fharp diuretic medicines, efpecially cantharides. Bloody urine is always attended with fome degree of danger : but peculiarly fo when mixed with purulent matter, as this fliows an ulcer fome where in the urinary paffages. Sometimes this dif- charge proceeds from excefs of blood, in which cafe it is rather a falutary evacuation than a difeafe. If the difcharge however be very great, it may wafte the patient's ftrength, and occafion an ill habit of body, a dropfy, or a confumption. The treatment of this diforder muft be varied, according to the different caufes from which it proceeds. When it is owing to a ftone in the bladder, the cure depends upon an operation ; a defcription of which would be foreign to our purpofe. If attended with a plethora, and fymptoms of inflam- mation, bleeding will be neceffary. The body muft likewife be kept open by emollient clyfters, or cooling purgative medicines; as cream of tartar, manna, or fmall dofes of lenitives ekauary. When bloody urine occurs in malignant difeafes, as the fmall- pox, fevers, or the like, the patient's life depends oil the liberal ufe of the bark and acids, as already fhown. When there is reafon to fufpea an ulcer in the kidneys or blad- der, the patient's diet mull be cool, and his drink of a foft, heal- ing, balfamic quality, as decoaions of marfh-mallow roots with liquorice, folutions of gum-arabic, &c. Three ounces of marfh- mallow roots, and half an ounce of liquorice, may be boiled in two Englifh quarjs of water to one; two ounces of gum-arabic may be diffolved in the ftrained liquor, and a tea-cupful of it taken four or five times a-day. The early ufe of aftringents in this difeafe has often bad con- fequences. When the flux is flopped too foon, the grumous blood, confined in the veffels, may produce inflammations, abfcefs, and ulcers. If the caufe be urgent, or the patient feems to fuffer from the lofs of blood, gentle aftringents may be neceffary. In this cafe, the patient may take three or four ounces of lime-water, with half an ounce of the tinaure of bark, three times a-day, or more frequent if neceffary. Of the Dyfentery, or Bloody Flux. THIS difeafe prevails in the fpring and autumn. It is moft com- mon in marfhy countries, where, after hot and dry fummers, it is apt to become epidemic. Perfons are moft liable to it, who are much expofed to the night air, or who live in places where the air is confined and unwholefome. Hence, it often proves fa- tal in camps, on fh'spboard, in gaols, hofpitals, and fuch-like places. OR BLOODY FLUX. 249 CAUSES----The dyfenterymay be occafioned by any thing that obftruas the perfpiration ; as damp beds, wet clothe ,, un- wholefome diet, air, &c. But it is moft frequently communicated by infeaion. This ought to make people extremely cautiouo, in going near fuch perfons as labour under the difeafe. Even the fmell of the patient's excrements has been known to communi- cate it. SYMPTOMS.^—Tt is known by a flux ot 0 < ^ily, attended with violent pain of the bowels, a confix • : hiciination to goto ftool, and generally more or lefs blood in the ftools. It begins, like other fevers, with chilinefs, lofs of ftrength, a quick pulfe, great thirft, and an inclination to vomit. The ftools are at firft greafy and frothy, afterwards they are ftreaked with blood, and at laft, have frequently the appearance of pure blood, mixed with fmall filaments refembling bits of fkin. Worms are fometimes paf- fed both upwards and downwards through the whole courfe of the difeafe. When the patient goes to ftool, he feels a bearing down, as if the whole bowels were falling out, and fometimes a part of the inteftine isaaually protruded, which proves exceeding troublefome, efpecially in children. Flatulency is a troublefome fymptom, efpecially towards the end of the difeafe. This difeafe may be diftinguifhed from a diarrhoea or loofe- nefs, by the acute pain of the bowels, and the blood which ge- nerally appears in the ftools; and from the cholera morbus, by its not being attended with fuch violent and frequent fits of vomit- ing, &c When the dyfentery attacks the old, the delicate, or fuch as have been wafted by the gout, the fcurvy, or other lingering dif- eafes, it generally proves fatal. Vomiting and hiccuping are bad figns, as they fhow an inflammation of the ftomach. When the ftools are green, black, or have an exceeding difagreeable cadave- rous fmell, the danger is very great, as it fhows the difeafe to be of the putrid kind. It is an unfavourable fymptom when clyfters are immediately returned ; but ftill more fo, when the paffage is fo obftinately fhut, that they cannot be injeaed. A feeble pulfe, coldnefs of the extremities, with difficulty of fwallowing, and con- vulfions, are figns of approaching death. REGIMEN.----Cleanlinefs contributes greatly to the reco- very of the patient, and the fafety of fuch as attend him. In all contagious difeafes, the danger is increafed, and the infeaion fpread, by the negka of cleanlinefs ; 'but in no one more than this. Every thing about the patient fhould be frequently changed. The excrements fhould never be fuffered to continue in his cham- ber, but removed immediately, and buried under ground. A con- ftant ftream of frefh air fhould be admitted into the chamber ; and it ought frequently to be fprinkled with vinegar, juice of lemon, or fome other ftrong acid. The patient muft not be difcouraged, but his fpirits kept up in I 2 THE DYSENTERY, hopes of a cure. Nothing tends^more to render any difeafe mor» tal, than the fears and apprehensions of the fick. AH difeafes of this nature have a tendency to fink and deprefs the fpirits, and when that is increafed by fears and alarms, from thofe whom the pa- tient believes to be perfons of fkill, it cannot fail to have the worft effeas. A flannel waiftcoat worn next the fkin has often a very good effea in the dyfentery. This promotes the perfpiration without over-heating the body. Great caution is neceffary in leaving it off. I have often known a dyfentery brought on by imprudently throw- ing off a flannel waiftcoat before t*»e feafon was fufficiently warm. For whatever purpofe this piece of drefs is worn, it fliould never be left off but in a warm feaibn. In this difeafe, the greatest attention muft be paid to the pa- tient's diet. Flefh, fifh, and every thing that has a tendency to turn putrid or rancid on the ftomach, muft be abftained from. Apples boiled in milk, water-pap, and plain, light pudding, with broth made cf the gelatinous parts of animals, may conftitute the prin- cipal part of the patient's food. Gelatinous broth not only anfwers the purpofe of food, but likewife cf medicine. I have often known dyfenteries, which were not of a putrid nature, cured by it after pompous medicines had proved ineffeaual*. Another kind of food very proper in the dyfentery, which may be ufed by fuch as cannot take the broth mentioned above, is made by boiling a few handfuls of fine flour, tied in a cloth, for fix or feven hours, till it becomes as hard as {larch. Two or three table-fpoonfuls of this may be grated down, and boiled in fuch a quantity of new mi%pnd water, as to be of the thicknefs of pap. This may be fweetened to the patient's tafte, and taken for his or- dinary foodf; * The manner of making this broth is, to take a fheep's-head and feet^ with the Ikin upon them, and to burn the wool off with a hot iron; afterwards to boil them till the broth is quite a jelly. A little cinna- mon or mace may be added, to give the broth an agreeable flavour, and the patient may take a little of it warm with toafted bread, three or four times a-day. A clyfter of it may likewife be given twice a-day. Such as cannot ufe the broth made in this way, may have the head and feet fkinned ; but we have reafon to believe, that this hurts the medi- cine. It is not our bufinefs here to reafon upon the nature and qualities of medicine, otherwise this might be fhown topoffefs virtues everyway fuited to the cure of a djfentery which does not proceed from a putrid ftate of, the humours. Whole families have often been cured by it, af- ter they had ufed many other medicines in vain. It will, however, be proper that the patient take a vomit, and a dofe^ or two of rhubarb, before he begins to ufe the brdth. It will likewife be neceffary to con- tinue the Ufe of it for a confiderable time, and to make it the principal food. _ t The learned and humane Dr. Rutherford, late profeffor of medi- cine in the univerfity of Edinburgh, ufed to mention this food in hi* public lectures with great encomiums. He directed it to be made by tying a pound or two of the fiiiert flour, as tight as poffibie, in a linen OR BLOODY FLUX. *5* In dyfentery, the patient may he allowed to eat freely of moft kinds of ripe fruit; as apples, grapes, goofeberries, currant-ber- ries, ftrawberrks, &c. Thefe may either be eaten raw or boiled, with or without milk, as the patient choofes. The prejudice againft fruit in this difeafe, is fo great, that many believe it to be the common caufe of dyfenteries. This is an egregious miftake. Both reafon and experience fhow, that good fruit is one of the beft medicines, both for the prevention and cure of the dyfentery. Good fruit is in every refpea calculated to counteraa that ten- dency to putrefaaion, from whence the moft dangerous kind of dyfentery proceeds. The patient, in fuch a cafe, ought to be al- lowed to eat as much fruit as he pkafes, provided it be ripe*. The moft proper drink in this diforder, is whey or flaxfeed tea. , The dyfentery has often been cured by the ufe of clear whey alone. It may be taken both for drink and in form of clyfter. When whey cannot be had, barley-water fharpened with cream of tartar may be drank, or a decoaion of barley and tamarinds ; two ounces of the former and one of the latter, may be boiled in two Englifh quarts of water to one. Warm water, water-gruel, or water wherein hot iron has been frequently quenched, ar,e all very proper, and may be drank in turns. Camomile-tea, if the ftomach will Wear it, is an exceeding proper drink. It both strength- ens the ■ftomach, and by its mitifeptic quality, tends to prevent a mortification of the b: trvels. MEDICINE.----At the beginning of this difeafe, it is always neceffary to cleanfe the firft paffages. For this purpofe, a vomit of ipecacuanha muft be given, and wrought off with weak camo- mile tea. Strong vomits are feldom neceffary here. A fcruple, or at moft, half a drachm of ipecacuanha,Us generally fufficient for an adult, and fometimes a few grains will fuffice. The day after the rag. afterwards to dip it frequently in water, and to dridge fheoutfide with flour, till a cake or cruft was formed around it, which prevents the water from foaking into it while boiling. It is then to be boiled till it becomes a hard, dry inafs, as directed above. This, when mixed with milk and water, will not only anfwer the purpofe of food, but may likewife be given in clyfters. * I lately faw a young man who had been feized with a dyfentery in North-America. Many things had been tried there for his relief, but to no purpofe. At length, tired out with difappointments from me- dicine, and reduced to fkin and bone, he came over to Britain, rather with a view to die among his relations, than with any hopes of a cure. After taking fundry medicines here with no better fuccefs than abroad, I advifed him to leave off the ufe of drugs, and to truft entirely to a diet of milk and fruits, with gentle exercife. Strawberries was.the only fruit he could procure at that feafon. Thefe he ate with milk twice, and fometimes thrice a-day. The confequence was, that in a (hort time his ftools Were reduced from upwards of twenty in a-dny, to three or four, and fometimes not fo many. He ufed the other fruits as they came in, and was in a few weeks fo well as to leave that part •i' the country wfewe I was, with* view t» return to America. THE DYSENTERY, &c. vomit, half a drachm, or two fcruples of rhubarb muft be taken ; or, what will anfwer the purpofe rather better, an ounce or an ounce and a half of Epfom falts. This dofe may be repeated every other day, for two or three times. Afterwards fmall dofes of ipe- cacuanha maybe taken for fome time. Two or three grains of the powder may be mixed in a table-fpoonful of the fyrup of poppies, and taken three times a-day. Thefe evacuations, and the regimen prefcribed above, will of- ten be fufficient to effea a cure. Should it, however, happen other- wife, the following aftringent medicines may be ufed. A clyfter of flarch or fat mutton-broth, with thirty or forty drops of liquid laudanum in it, may be adminifterd twice a-day. At the fame time an ounce of gum-arabic, and half an ounce of gum-tragacanth, may be diffolved in an Englifh pint of barley- water, over a flow fire, and a tabk-fpoonful of it taken every hour.* If thefe have not the defired effea, the patient may take i four times a day, about the bulk of a nutmeg of the Japonic confection, drinking after it a tea-cupful of the decoaion of logwoodf. Perfons who have been cured of this difeafe are very liable to a relapfe; to prevent which, great circumfpeaion as to diet is neceffary. The patient muft abftain from all fermented liquors, except now-and-then a glafs of good wine ; but he muft drink no kind of malt liquor. He fhould likewife abftain from animal food, as fifh and flefh, and live principally on milk and vegetables. Gentle exefcife and wholefome air are likewife of importance. The patient fhould go to the country as foon as his ftrength will permit, and take i xercife daily on horfeback, or in a carriage. He may likewife ufe bitters infufed in wine or brandy, and may drink twice a-day a gill of lime-water mixed with an equal quantity of new milk. When dyfenteries prevail, we would recommend a ftria atten- tion to cleanlinefs, a fpare ufe of animal food, the free ufe of found ripe fruits and other vegetables. The night air is to be carefully * The indications of cure in this difeafe are more effectually anfwer- ed, by giving i drachm of Glauber falts every hour, fo as to clear the boweis of hardenede cerement, by exciting brifk purging. This plan fliould be continued until the griping and teneiinus fublide, interpofing every night at bed-time one or two grains of opium, combined with two or three of ipecacuanha to quiet the bowels and promote perfpiration. I It" the patient cannot take falts, one table fpoonful of caftor oil fliould ' be given, and repeated every two or three hours, until it produces the defired effect of rendering the ftools more copious; and after they ap- pear in lumps or balls, the cure muft be followed up, by giving infufion of bark, as frequent and in as firge dofes as the iloniach will bear. This, praclice is equally applicable to children, by accommodating the* ! dofes of medicin to their age- (I. C.) , t See Appendix, Decoction of Logwoed. THE HEAD-ACH. 253 avoided, and all communication with the fick. Bad fmells are to be fhunned, efpecially thofe which arife from putrid animal fub- ftances. The neceffaries where the fick go fhould be carefully avoided by thofe in health. Sundry other fluxes of the belly, as the LIENTERY and CCE- LIAG PASSION, though lefs dangerous than the dyfentery, yet merit confideration. Thefe difeafes generally proceed from a re- laxed ftate of the ftomach and inteflines, which is fometimes fo great, that the food paffes through them without almoft any fen- fible alteration; and the patient dies merely from the want of nourifhment. When the lientery or cceliac paffion fucceeds to a dyfentery,' the cafe is bad. They are always dangerous in old age, efpecially when the conftitution has been broken by excefs or acute difeafes. If the ftools be very frequent, and quite crude, the thirft great, with little urine, the mouth ulcerated, and the face marked with fpots of different colours, the danger is very great. The treatment of the patient is in general the fame as in the dyfentery. In all obftinate fluxes of the belly, the cure mull be attempted, by firft cleanfing the ftomach and bowels with gentle vomits and purges ; afterwards, fuch diet as has a tendency to heal and strengthen the bowels, with opiates and aftringent medi- cines, will generally perfea the cure. The fame obfervation holds with refpea to a TENESMUS, or frequent defire of going to ftool. This difeafe refembks the dy- fentery fo much, both in its fymptoms and method of cure, thtft we think it needlefs to infift upon it. CHAPTER XXXVI. Of the Head-Ach. AC H S and pains proceed from very different caufes, and may affea any part of the body ; but we fhall point out thofe only which occur moft frequently, and are attended with the greateft danger. When the head-ach is flight, and affeas a particular part of the head only, it is called cephalalgia ; when the whole head is affeaed, cephalaa; and when on one fide only, hemicrania. A fixed pain in the forehead, which may be covered with the end of the thumbs is called the clavis hyfiericus. There are alfo other diftinaions. Sometimes the pain is Inter- nal, fometimes external; fometimes it is an original difeafe, and at other times only fymptomatic. When the head-ach proceeds from a hot bilious habit, the pain is very acute and throbbing, with a confiderable heat of the part affeaed. When from a cold *54 THE HEAD-ACH. phlegmatic habit, the patient complains of a dull heavy pain, and has a fenfe of coldnefs in the part. This kind of head-ach is fometimes attended with a degree of flupidity or folly. Whatever obftruas the free circulation of the blood through the veffels of the head, may occafion a head-ach. In perfons of a full habit, who abound with blood, or other humours, the head- ach often proceeds from the fuppreffion of cuftomary evacuations; as bleeding at the nofe, fweating of the feet, &c. It may likewife proceed from any caufe that determines a great flux of blood to- wards the head ; as coldnefs of the extremities, or hanging down the head for a long time. Whatever prevents the return of the blood from the head will occafion a head-ach ; as looking long obliquely at any objea, wearing any thing tight about the neck, or the like. When a head-ach proceeds from the ftoppage of a running at the nofe, there is a heavy, obtufe, preffing pain in the fore-part of the head, in which there feems to be fuch a weight, that the pa- tient can fcarce hold it up. When it is occafioned by the cauftic matter of the veneral difeafe, it generally affeas the flcull, and of- ten produces a caries of the bones. Sometirr.es the head-ach proceeds from the repulsion or retro- teffion of the gout, the eryfipelas, the fmall pox, meafles, itch, or other eruptive difeafes. What is called a hemicrania generally proceeds from crudities or indigeftion. Inanition, or emptinefs, will alfo occafion head-achs, as in nurfes who gave fuck too long, or who did not take a fufficient quantity of folid food. There is likewife a moft violent, fixed, conftant, and almoft in- tolerable head-ach, which occafions great debility both of body and mind, prevents fleep, deftroys the appetite, caufes a vertigo, dimnefs of fight, a noife in the ears, convulfions, epileptic fits, and fometimes vomiting, coftivenefs, coldnefs of the extremities, Sec. The head-ach is often fymptomatic in continual and intermit- ting fevers, efpecially quartans. It is likewife a very common fymptom in hyfteric and hypochondriac complaints. When a head-ach attends an acute fever, with pale urine, it is an unfavourable fymptom. In exceffive head-achs, coldnefs of the extremities is a bad fign. When the difeafe continues long, and is very violent, it often terminates in blindnefs, an apoplexy, deafnefs, a vertigo, the palfy, epikpfy, &c. The cool regimen in general is to be obferved. The diet ought to confift of fuch emollient fubftances as will correa the acrimo- ny of the humours, and keep the body open ; as apples boiled in milk, fpinage, turnips, and fuch-like. The drink ought to be di- luting ; as barley-water, infufions of mild mucilaginous vegeta- bles, decoaions of the fudorific woods, &c. The feet and leg3 ought to be kept warm, and frequently bathed in lukewarm wai- ter ; the head fhould be fhaved, and bathed with water and viner THE HEAD-ACH. z5S •gar. The patient ought as much as poffibie to keep in an erecTt pofture, and not to lie with his head too low. When the head-ach is owing to excefs of blood, or a bilious conftitution, bleeding is neceffary. The patient may be bled in the jugular vein, and the operation repeated if there be occafion. Cupping alfo, or the application of leeches to the temples, and behind the ears, will be of fervice. Afterwards a blifter may be applied to the neck, behind the ears, or to any part of the head that is moft affeaed. In fome cafes it will be proper to blifter the whole head. In perfons of a grofs habit, iffues or perpetual blifters will be of fervice. The body ought likewife to be kept open by gentle laxatives. But when there is a dull, heavy, continual pain in the head, which will neither yield to bleeding nor gentle laxatives, then more powerful purgatives are neceffary, as pills made of aloes, refinof jalap, or the like. It will alfo be neceffary in this cafe to blifter the whole head, and to keep the back part of the neck open for a confiderable time by a perpetual blifter. When the head-ach is occafioned by the ftoppage of a running at the nofe, the patient fhould frequently fmell to a bottle of volatile falts; he may likewife take fnuff, or any thing that will irritate the nofe, fo as to promote a difcharge from it; as the herb maftich, ground-ivy, &c. A hemicrania, efpecially a periodical one, is generally owing to a foulnefs of the ftomach, for which gentle vomits muft be adminiftered, as alfo purges of Glauber falts or jalap. After the bowels have been fufficiently cleared, chalybeate waters, and fuch bitters as ftrengthen the ftomach, will be neceffary. When the head-ach is fo intolerable as to endanger the pa- tient's life, or is attended with continual watching, delirium, &c. recourfe muft be had to opiates. Thefe, after proper evacua- tions by clyfters or mild purgatives, may be applied both exter- nally and internally. The affeaed part may be rubbed with Bate's anodyne balfam, or a cloth dipped in it may be applied to the part. The patient may, at the fame time, take twenty drops of laudanum, in a cup of valerian or penny-royal tea, twice or thrice a-day. This is only to be done in cafe of extreme pain. Proper evacuations ought always to accompany and follow the ufe of opiates*. When the patient cannot bear the lofs of blood, his feet ought frequently to be bathed in lukc-warm water, and well rubbed with a coarfe cloth. Cataplafms with muftard or horferadifh ought likewife to be applied to them. This courfe is peculiarly neceffary when the pain proceeds from a gouty humour affeainj* the head. * • When the pain is very violent, and does not yield to fmall dofes of laudanum, the quantity may be increafed. I have known a patient in extreme pain take three hundred drops in twenty-four hours j but fuch dofes ought only to be adminiftered by perfons of fkill.-. 256" THE TOOTH-ACH. When the head-ach is occafioned by great heat, hard labour, or violent exercife of any kind, it may be allayed by cooling me- dicines ; as the faline draughts with nitre, and the like. A little of Ward's effence, dropt into the palm of the hand, and applied to the forehead, will fometimes remove a violent head- ach ; and fo will aether, when applied in the fame manner. Of the Tooth-Ach. THIS difeafe needs no defcription. It has great affinity with the rheumatifm, and often fucceeds pains of the flioulders and other parts of the body. It may proceed from obftruaed perfpiration, or any of the other caufes of inflammation, from negleaing fome part of the ufual coverings of the head ; or "from fitting with the head bare near an open window, or expofing it any how to a draught of cold air. Food or drink taken either too hot or too cold is very hurtful to the teeth. Great quantities of fugar, or other fweet- meats, are likewife hurtful. Nothing \z more deftruaive to the teeth than cracking nuts, or chewing any kind of hard fubftances. Picking the teeth with pins, needles, or any thing that may hurt the enamel with which they are covered, does great mifchief, as the tooth is fure to be fpoikd whenever the air gets into it. Breeding women are very fubjea to the tooth-ach, efpecially dur- ing the firft three or four months of pregnancy. The tooth-ach often proceeds from fcorbutic humours affeaing the gums. In this cafe, the teeth are fometimes wafted, and fall out without any confiderable degree of pain. The more immediate caufe of the tooth-ach is a rotten or carious tooth. In order to relieve the tooth-ach, we muft firft endeavour to leffen the flux of humours to the part affeaed. This may be done by mild purgatives, fcarifying the gums, or applying leeches to them, and bathing the feet frequently with warm water. The perfpiration ought likewife to be promoted, by drinking freely of weak wine-whey, or other diluting liquors, with fmall dofes of nitre. Vomits, too, have often an exceeding good effea in the tooth-ach. It is feldom fafe to adminifter opiates, or any kind of heating medicines, or even to draw a tooth, till proper evacu- ations have been premifed; and thefe alone will often effea the cure. If this fails, and the pain and inflammation ftill increafe, a fup- puration may be expeaed ; to promote which, a toafted fig fhould be held between the gum and the cheek ; bags filled with boiled camomile flowers, flowers of elder, or the like, may be applied near the part affeaed, with as great a degree of warmth as the patient can bear, and renewed as they grow cool: the patient THE fOOTH-ACH. jjf may likewife receive the fleams of warm water into his mouth, through an inverted funnel, or by holding his head over the mouth of a porringer filled with warm water, &c. Such things as promote the difcharge of faliva, or caufe the patient to fpit, are generally of fervice. For this purpofe, bitter, hot, or pungent vegetables may be chewed ; -as gentian, calamus aromaticus, or pellitory of Spain. Allen recommends the root of yellow water flour-de-luce in this cafe. This root may either be rubbed upon the tooth, or a little of it chewed. Brookes fays he hardly ever knew it fail to eafe the tooth-ach. It ought how- ever to be ufed with caution. Many other herbs, roots and feeds, are recommended for cur- ing the tooth-ach; as the leaves or roots of milkfoil or yarrow chewed, tobacco fmoked or chewed, flaves acre, or the feeds of muftard chewed, Sec. 1 hefe bitter, hot, and pungent thi igs, by occafioning a greater flow of faliva, frequently give eafe in the tooth-ach. Opiates often relieve the tooth-ach. For this purpofe, a little cotton wet with laudanum may be held between the teeth ; or a piece of flicking-plaifter, about the bignefs of a fhilling, with a bit of opium in the middle of it, of a fize not to prevent the flicking of the other, may be laid on the temporal artery, where the pulfation is moft fenfible. De la Motte affirms, that there • are fewr cafes wherein this will not give relief. If there be a hol- low tooth, a fmall pill made of equal parts of camphire and opi- um, put into the hollow, is often beneficial. When this cannot be had, the hollow tooth may be filled with gum maftich, wax* lead, or any fubftance that will flick in it, and keep out the ex- ternal air. Few applications give more relief in the footh-ach than a blifter applied between the fhoulders; or rather put behind the ears, and made fo large as to cover a great part of the lower jaw. When a tooth is carious, it is often impoffible to remove the pain without extraaing it; and, as a fpoilt tooth never becomes found again, it is prudent to draw it foon, left it fhould affea the reft. Tooth-drawing, like bleeding, is very much praaifed by mechanics ; the operation is not without danger, and ought al- ways to be performed with care. A perfon unacquainted with the ftruaure cf the parts will be in danger of hurting the jaw- bone, or of drawing a found tooth inftead of a rotten one*. When the tooth-ach returns periodically, and the pain chiefly affeas the gums, it may be cured by the bark. Some pretend to have found great benefit from the application of an artificial magnet. If it be found to anfwer, though only iri particular cafes, it certainly deferves a trial, as it is attended with • This imy always be prevented by the operator ftriking upon the teeth with any j.iece of metal, as this never fails to excite pain in the carious tooth-. •* K % 258 THE EAR-ACH. "* ' no expence, and no harm. Ekaricity has likewife been recom- mended, and particular instruments have been invented for fend- ing a fhock through the affeaed tooth. Perfons who have returns of the tooth-ach at certain feafons, as fpring and autumn, might often prevent it by taking a purge at thefe times. Keeping the teeth clean tends to prevent the tooth-ach. The beft method is to wafh them daily with fait and water, a decoaion of the bark, or with cold water alone. All brufhing and fcrap- ing of the teeth is dangerous^ and unlefs it be performed with great care, does mifchief. Of the Ear-Ach. THIS diforder chiefly affeas the membrane which lines the in- ner cavity of the ear called the meatus auditorius. It often occa- j fions great reflkffnefs, anxiety, and even delirium. Epileptic fits,. • '' and other convulfive diforders, have been brought on by extreme i pain in the ear. . * The ear-ach may proceed from any of the caufes which p"ro- | duce inflammation. It often proceeds from a fudden fuppreffion * of perfpiration, or from the head being expofed to cold when co- 1 vered with fweat; or from worms, or other infeas getting into the ear, or being bred there; or from any hard body flicking in the ear. Sometimes it proceeds from the tranflation of morbific matter to the ear. This often happens in the decline of malig- nant fevers, and occafions deafnefs, which is generally reckoned a favourable fymptom. When the ear-ach proceeds from infeas, or any hard body flicking in the ear, every method muft be taken to remove them as foon as poffibie. The membranes may be relaxed by dropping into the ear, oil of fweet almonds, or olive oil. Afterwards the patient fhould be made to fneeze, by taking fnuff, or fome ftrong fternutatory. If this fhould not force out the body, it muft be extraaed by art. I have feen infeas, which had got into the ear, come out of their own accord upon pouring in oil, which they cannot bear. When the pain of the ear proceeds from inflammation, it muft be treated like other topical inflammations, by a cooling regimen, and opening medicines. Bleeding at the beginning, either in the arm or jugular vein, or cupping in the neck, will be proper. The ear may likewife be fomented with fleams of warm water; or flannel bags filled with boiled mallows and camomile flowers may be applied to it warm; or bladders filled with warm milk and water. An exceeding good method of fomenting the PAIN OF THE STOMACH, fcrV. 259 ear is to apply it clofe to the mouth of a jug filled with warm wa- ter, or a ftrong decoaion of camomile-flowers. The patient's feet fhould be frequently bathed in lukewarm water, and he ought to take fmall dofes of nitre and cream tartar, half a drachm of the latter, and ten grains of the former three times a-day. His drink may be whey, or a decoaion of barley and liquorice with figs or raifins. The parts behind the ear ought frequently to be rubbed with-camphorated oil, or a little of the vo- latile liniment. When the inflammation cannot be difcuffed, a poultice of bread and milk, or roafted onions, may be applied to the ear, and frequently renewed, till the abfcefs breaks, or can be opened. Af- terwards the humours may be diverted from the part by gentle laxatives, blifters, or iffues; but the difcharge muft not be fud- ' denly dried up by any external application. Pain of the Stomach, &c. THIS may proceed from various caufes ; as indigeftion ; wind ; ' the acrimony of the bile ; fharp, acrid, or poifonous fubftances ta- • ken into the ftomach, &c. It may like vife be occafioned by worms ; the ftoppage of cuftomary evacuations; a tranflation of , gouty matter to the ftomach, the bowels, &c. Women in the decline of life are very liable to pains of the fto- mach and bowels, efpecially fuch as are aflliaed with hyfleric complaints. It is likewife very common to hypochondriac men of a fedentary and luxurious life. In fuch perfons, it often proves fo extremely obftinate as to baffle medicine. When the pain of the ftomach is moft violent after eating, there is reafon to fufpea that it proceeds from fome fault either in the digeftion or the food. In this cafe, the patient ought to change his diet, till he finds what kind of food agrees beft with his ftomach, and fhould continue chiefly to ufe it. If a change of diet does not remove the complaint, the patient may take a gentle vomit, and afterwards a dofe or two of rhubarb. He ought likewife to take an infufion of camomile flowers, or fome other ftomachic bitter, either in wine or water. I have often known exercife remove this complaint, efpecially failing, or a long journey on horfeback, or in a carriage. When a pain of the ftomach proceeds from flatulency, the pa- „ tient is conftantly belching up wind, and feels an uneafy diften- tion of the ftomach after meals. This is the moft deplorable dif- eafe, and is feldom thoroughly cured. In general, the patient ought to avoid all windy diet, and every thing that fours on the ftomach, a- greens, roots, &c. This rule admits of fome exceptions. Ma- 26*a PAIN OF THE STOMACH, &c. ny perfons very much troubled with wind, have received great be- nefit from eating parched peafe, though that grain is generally fuppofed to be of a windy nature* This complaint may likewife be greatly relieved by labour, ef- pecially digging, reaping, mowing, or any kind of active employ- ment by which the bowels are alternately compreffed and dilated. The moft obftinate cafe of this kind I ever met with, was in a per- fon of a fedentary occupation, whom I advifed, after he had tried every kind of medicine in vain, to turn gardener ; which he did, and has ever fince enjoyed good health. When a pain of the ftomach is occafioned by the fwallowing of acrid or poifonous fubftances, they muft be difcharged by vo- mit ; this may be excited by butter, oils, or other foft things, which fheath and defend the ftomach from the acrimony of its contents. When a pain of the ftomach proceeds from a tranflation of gouty matter, warm cordials are neceffary, as generous wines, French brandy, &c. Some in this cafe have drank a whole bottle of bran- dy or rum in a few hours, without being in the leaft intoxica-' ' ted, or even feeling the ftomach warmed by it. It is impoffible to afcertain the quantities neceffary upon thefe occafions. This muft be left to the feelings and difcretion of the patient. The fafer way, however, is, not to go too far. When there is an inclination to vomit, it may be promoted by drinking an infufion of camomile flowers, or carduus benediclus. If a pain of the ftomach proceeds from the ftoppage of cuftoma- ry evacuations, bleeding will be neceffary, efpecially in fanguine and very full habits. It will likewife be of ufe to keep the body gently open by mild purgatives; as caftor oil, fenna, &c. When this difeafe affeas women, in the decline of life, after the ftop- page of the menfes, making an iffue in the kg or arm \\ ill be of pe- culiar fervice. When the difeafe is occafioned by worms, they muft be deftroy- ed, or expelled by means recommended in the following fbaion : When the ftomach is greatly relaxed, and the digeftion bad, which often occafion flatulencies, the elixir of vitriol will be of Angular fervice. Fifteen or twenty drops of it may be taken in a glafs of wine or water twice or thrice a- day. Perfons affliaed with flatulency are generally unhappy unlefs they be taking fome purgative medicines ; thefe, though they may give immediate eafe, weaken and relax the ftomach and bowels, and cqnfequently increafe the diforder. Their beft method" is to mix, purgatives and flomachics together. Equal parts of bark and rhubarb may be infufed in brandy or wine, and taken in fuch quan-i tity as to keep the body gently open. •' Thefe are prepared by Iteeping or foakiag peafecin water, and af- terwards drying them in a ^ot, op kiln tiil they b^couie quite hard. They- •rpay be ufed at pleafure. C 261 ] CHAPTER XXXVIL Of Worms. THESE are chiefly of three kinds, viz. the tania, or tape- worm ; the teres, or round and long worm ; and the afca- rides, or round or fhort worm. There are many other kinds of worms found in the human body ; but as they proceed, in a great meafure, from fimilar caufes, have nearly the fame fymptoms, and require almoft the fame method of treatment as thefe already men- tioned, we fhall not fpend time in enumerating them. The tape-worm is white, very long, and full of joints. It is ge- nerally bred either in the ftomach or fmall inteflines. The round and long worm is likewife bred in the fmall guts, and fometimes in the ftomach. The round and fhort worms commonly lodge in the rectum, or what is called the end gut, and occafion a difagreeable itching about the feat. The long round worms occafion fqueamifhnefs, vomiting, a dif- agreeable breath, gripes, loofenefs, fwelling of the belly, fwoon- ings, loathing of food, and at other times a vorueious appetite, a dry cough, convulfions, epileptic fits, and fometimes a privation of fpeech. Thefe Worms have been known to perforate the intpf- tines, and get into the cavity of the belly. The effeas of the tape- worm are nearly the fame with thofe of the long and round, but rather more violent. Andry fays, the following fymptoms particularly attend the fo- lium, which is a fpecies of the tape-worm, viz. fwoonings, priva- tion of fpeech and a voracious appetite. The round worms called afcarides, befides an itching of the anus, caufe fwoonings, and te- nefmus, or an inclination to go to ftool. CAUSES.----Worms may proceed from various caufes, but they are feldom found except in relaxed ftomachs, where the di- geftion is bad. Sedentary perfons are more liable to them than the aaive and laborious. Thofe who eat great quantities of unripe fruit, or who live much on raw herbs and roots, are generally fub- jea to worms. There feems to be a hereditary difpofition in fome. perfons to this difeafe. I have often feen all the children of a fami- ly fubjea to worms of a particular kind. They feem likewife fre- quently to be owing to the nurfe. Children of the fame family, nurfed by one woman, have often worms, when thofe nurfed by another have none. SYMPTOMS.---The common fymptoms of worms are, paknefs of the countenance, and at other times, an univerfal flufliing of the face ; itching of the nofe ; this however is doubt- ful, as children pick their nofes in ail difeafes; flarting, and grind- ing of the teeth in fleep ; fwelling of the upper lip ; the appetite 262 OE WORMS. fom--times bad, at ether times quite voracious; loofenefs; a four of {linking breath; a hard fwJkd belly; great thirft; the urine frothy, and fometimes of a whitifh colour; griping, or colic pains; an involuntary difcharge of faliva, efpecially when afleep; frequent pains of the fide, with a dry coujvards night, and eafier in the morning. The paroxyfms generally grow milder every day, till at length the difeafe is carried off by perfpiration, urine, and the other evacuations. In fome patients, a few days; in others, weeks, and in fome, months are required to finifh the fit. Thofe whom age and frequent fits of the gout have greatly debilitated, feldom get free from it before the approach of fummer, and fometimes not till it be pretty far advanced. REGIMEN.----No medicines yet known will cure the gout; we fhall confine our obfervations chiefly to regimen, both in and out of the fit. In the fit, if the patient be young and ftrong, his diet ought to be thin and cooling, and his drink of a diluting nature ; but where the conftitution is weak, and the patient has been accuftomed to live high, this is not a proper time to retrench. In this cafe, hi muft keep nearly to his ufual diet, and fhould take frequently a cup of ftrong negus, or a glafs of generous wine. Wine-whey is a very proper drink in this cafe, as it promotes the perfpiration without -ready heating the: patient. It will anfsver this purpofe 272 THE GOUT. better, if a tea-fpoonful offal volatile oleofum, or fpirits of hartf- horn, be put into a cup of it twice a-day. It will likewife be pro- per, to give at bed-time, a tea-fpoonful of the volatile tinaure of guaiacum in a large draught of warm wine-whey. This will great- ly promote perfpiration thropgh the night. As the moft fafe and efficacious method of difcharging the gou- ty matter is by perfpiration, this ought to be kept up by all means, efpecially in the affeaed part. For this purpofe, the leg and foot fhould be wrapt in flannel, fur, or wool. The laft feems to anfwer the purpofe Letter than any thing elfe. The people of Lancafhire look upon wool as a kind of fpecific in the gout. They wrap a great quantity of it about the leg and foot affeaed, and cover it with a fkin of foft dreffed leather. This they fuffer to continue for eight or ten days, and fometimes for a fortnight or three weeks, or longer, if the pain does not ceafe. I never knew any ex* ttrnal application anfwer fo well in the gout. I have often feen it applied when the fwelling and inflammation were very great, with violent pain, and have found all thefe fymptoms relieved by it in a few days. The wool is generally greafed, and carded or combed. They choofe the fofteft which can be had, and feldom or never remove it till the fit be entirely gone off. The patient ought to be kept quiet and eafy during the fit. Eve- ry thing that affects the mind disturbs the paroxyfm, and tends to throw the gout upon the nobler parts. All external applications that repel the matter are to be avoided as death. They dp not cure the difeafe, but remove it from a fafer to a more dangerous part of the bodjr, where it often proves fatal. A fit of the gout is Na- ture's method of removing fomething that might prove dirtruc- tive to the body, and all that we can do, with fafety, is to promote her intentions, and affilt her in expelling the enemy in her own way. Evacuations by bleeding, ftool, &c. are likewife to be ufed with caution ; they do not remove the caufe of the difeafe, and fometimes by weakening the patient, prolong the fit: but, where the conftitution is able to bear it, it will be of ufe to keep the bo- dy gently open by diet, or even mild laxative medicines. Many things will indeed fhorten a fit of the gout, and fome will drive it off altogether; but nothing has yet been found which will do this with fafety to the patient. In pain, we eaflrly grafp at any thing that promifes immediate eafe, and even hazard life itfelf for a temporary relief. This is the true reafon why fo many infallible remedies have been propofed for, the gout, and why • fuch numbers have loft th.eir lives by the ufe of them. It would be as prudent to flop the fmall-pox from rifing, and to drive them in- to the blood, as to attempt to repel the gouty matter after it has been thrown upon the extremities. The latter is as much an ef- fort of Nature to free herfelffrom an offending caufe as the for- mer, and ought equally to be promoted. When the pain is very great, and the patient reftlefs, thirty or THE GOUT. 273 forty drops of laudanum, more or lefs, according to the violence of the fymptoms, may ta taken at bed-time. This will eafe the pain,' procure reft, promote perfpiration, and forward the crifes of the difeafe. After the fit is over, the patient ought to take a gentle dofe or two of the bitter tinaure of rhubarb, or fome other warm flo- m'achic purge. He fhosild alfo drink a weak infufion of ftomachic bitters in fmall wine or ale, as the bark with cinnamon, Virginian fnake-root, and orange-peel. The diet at this time fhould be li,;ht, but nourifhing, and gentle exercife ought to be taken on horfeback, or in a carriage. Out of the fit, it is in the patient's power to do many things towards preventing a return of the diforder, or rendering the fit, if it fhould return, lefs fevere. This, however, is not to be attempted bv medicine. I have frequently known the gout kept off for feveral years by the bark and other aftringent medi- cines ; but, in all the cafes, where I had occafion to fee this tried, the perfon.- died fuddenly, and, to all appearance, for want of a re- gular fit of the gout, which, to fome conftitutions, in the decline of life^is rather falutary than hurtful. Though it may be dangerous to flop a fit of the gout by me^ diclne, yet if the conftitution can be fo changed by diet and ex- ercife, as to leffcn or totally prevent its return, there certainly can be no dan-jcr in following fuch a courfe. The' whole habit may be altered by a proper regimen, as quite to eradicate this difeafe 3 and thbfe only who have fufficient refolution to perfift in fuch a courfe, have reafon to expea a cure. The courfe which we w mid recommend for preventing the gout, is as follows : In the firft place, univerfal temperance. In the next place, fufficient exercife*. By this we do not mean fauntering about in an indolent manner, but labour, fweat, 2nd toil. Thefe only can render the humours wholefome, and keep them fo. Go- ing early to bed, and rifing betimes, are alfo of great importance. It is likewife proper to avoid night-ftudies, and all intenfe thought* The fupper fhould be light, and taken early. All ftrong liquors, efpecially generous wines and four punch, are to be avoided. We would likewife recommend fome dofes of magnefi'■>■ alba and rhubarb to,, be taken every fpring and autumn ; and afterwards a courfe of itomachic bitters, as tan fey'or water-trefoil tea, an in- fufion of gentian and camomile flowers, or a decoaion of burdock root, &c. Any of thefe, or an infufun of any wholefome bitter that is more agreeable to the patient, may be drank for two or three weeks in March and Oaober twice a-day. An iffue or per- petual blifter has a great tendency to prevent the gout. If thefe. * Some make a fecret of curing the gout by mufcular exercife This fecret, however, is as old as Celfus, who ftrongly recommend- that mode of cure ; anj^thoever will fubmit co it, in the f u Heft extent, may expect to reap folKiffldpermanent advantages. • *~ M 2 274 THE GOUT. were more generally ufed in the decline of life, they would not only often prevent the gout, but tifo other chronic maladies. Such as can afford to go to Bath, will find great benefit from bathing and drinking the water. It both promotes digeftion, and invigo- rates the habit. Though there is little room for medicine during a regular fit of the gout, yet when it leaves the extremities, and falls on fome of the internal parts, proper applications to recal and fix it become abfolutely neceffary. When the gout affeas the head, the pain of the joints ceafes, and the fwelling difappears, while either fevere head-ach, drowfinefs, trembling, giddinefs, convulfions, or deli- rium come on. When it feizes the lungs, great oppreffion, with cough and difficulty of breathing, enfue. If it attacks the ftomach, extreme ficknefs, vomiting, anxiety, pain in the epigastric region, and total lofs of ftrength will fucceed. When the gout attacks the head or lungs, every method muft be taken to fix it in the feet. They muft be frequently bathed in warm water, and acrid cataplafms applied to the foles. Blifters ought likewiie to be applied to the ancles or calves cf the legs. Bleeding in the feet or ancles is alfo neceffary, and warm ftoma- chic purges. The patient ought to keep in bed for the molt part, if there be any figns of inflammation, and fliould be very careful not to catch cold. If it attacks the ftomach with a fenfe of cold, the moft warm cordials are neceffary ; as ftrong wine boiled up wich cinnamon or other fpices ; cinnamon water; peppermint-water ; and even brandy or rum. The patient fhould keep his bed, and endeavour to promote a fweat by drinking warm liquors ; and if he fhould be troubled with a naufea, or inclination to vomit, he may drink camomile tea, or any thing that will make him vomit freely. When the gout attacks the kidneys, and imitates gravel-pains, the patient ought to drink freely of a decoaion of marfh-mallows, and to have the parts fomented with warm water. An emollient clyfter ought likewife to be given, and afterwards an opiate. If the pain be very violent, twenty or thirty drops of laudanum may be taken in a cup of the decoaion. Perfons who have had the gout fhould be very attentive to any complaints that may happen to them about the time when they have reafon to expea a return of the fit. The gout imitates many other diforders, and by being miftaken for them, and treated im- properly, is often diverted from its regular courfe, to the great danger of life. Thofe who never had the gout, but who, from their conftitution or manner of living, have reafon to expea it, ought to be very circumfpea with regard to its firft approach. If the difeafe, by wrong condua or improper medicines, be divtrted from its pro- per courfe, the patient has a chance to be ever after tormented C J** THE RHEUMATISM. 075 with head-achs, coughs, pains of the ftomach and inteftines ; and *o fall at laft a viaim to its attack upon fome of the more noble parts. Of the Rheumatifm. THIS difeafe has often a refemblance to the? gout. It generally attacks the joints with exquifite pain, and is fometimes attended with inflammation and fwelling. It is moft common in the fpring, and towards the end of autumn. It is ufually diftinguifhed i> to acute and chronic ; or the rheumatifm with and without a fever. 1 CAUSES----The caufes of a rheumatifm are frequently the fame as thofe of an inflammatory fever, viz. an obftruaed perfpi- ration, the immoderate ufe of ftrong liquors, and the like. Sud- den changes of the weather, and all quick tranfitions from heat to cold, are very apt to occafion the rheumatifm. The moft extraor- dinary cafe of a rheumatifm that I ever faw, where almoft every joint of the body was diftorted, was a man who ufed to work one part of the day by the fire, and the other part of it in the water. Very obftinate rheumatifms have likewife been brought on by per- fons not accuftomed to it, allowing their feet to continue long wet. The fame effeas are produced by wet clothes, damp beds, fitting or lying on the damp ground, travelling in the night, by exceffive evacuations, or the ftoppage of cuftomary difcharges. It is often the effea of chronic difeafes, as the fcurvy, the lues venerea, obfti- nate autumnal agues, &c. The rheumatifm prevails in cold, damp, marfhy countries. It is moft common among the poorer fort of peafants, who are ilf clothed, live in low damp houfes, and eat coarfe unwholefome food, which contains but little nourifhment, and is not eafily di- gefted. SYMPTOMS.----The acute rheumatifm commonly begins with wearinefs, fhivering, a quick pulfe, reftleffnefs, thirft, and other fymptoms of fever. Afterwards the patient complains of flying pains, which increafe by the leaft motion. Thefe at length fix in the joints, which are often affeaed with fwelling and in- flammation. If blood be let in this difeafe, it has generally the fame appearance as in the pleurify. In this kind of rheumatifm, the treatment of the patient is near- ly the fame as in an acute or inflammatory fever. If he be young and ftrong, bleeding is neceffary, which may be repeated accord- ing to the exigencies of the cafe. The body ought to be kept open by emollient clyfters, or cool opening liquors ; as decoaions of tamarinds, cream of tartar whey, fenna tea, and the like. The di- et fhould be light, and in fmall quantity, confifting chiefly of 176 THE RHEUMATISM. rcafted apples, groat-gruel, or weak chicken broth. After the fe- verifh fymptoms have abated, if the p;.in ftill continues, the patient muft keep his bed, and take fuch things :s piomote perfpiration ; as wine-whey, with fpiritus Mindereri, Sec He may likewife take, -i for a few nights, at bed-time, in a cup of wine-v hey, a drachm of the cream of tartar, and half a drachm of gum guaiacum in powder. Warm bathing, after proper evacuations, has often an exceed- ing good effea. The patient may either be put into a bath of warm water, or have cloths wrung out of it applied to the parts affeaed. Great care muft be taken that he do not catch cold after bathing. The chronic rheumatifm is feldom attended with any confider- able degree of fever, and is generally confined to fome particular part of the body, as the fhoulders, the back, or the loins. There is feldom any inflammation or fwelling in this cafe. Perfons in the decline of life are moft fubjea to the chrcnic rheumatifm. In fuch patients, it often proves extremely obftinate, and fometimes incurable. In this kind of rheumatifm the regimen fhould be nearly the - fame as in the acute. Cool and diluting diet, as ftewed prunes, ' coddled apples, currants or goofeberries boiled in milk, is moft < •proper. Arbuthnot fays, " If there be a fpecific in aliment for the ' ;; rheumatifm, it is cert;.i dy whey ;:' and adds, " that he knew a perfon fubjea to this difeafe, who could never be cured by. any , other method but a diet of whey and bread." He fays, " that | cream of tartar in water-gruel, taken for feveral days, will eafe j rheumatic pains confiderably." This I have often experienced, but found it always more efficacious when joined with gum guaU acum as already direaed. In this cafe, the patient may t.ke the dofe formerly mentioned twice-a-day, and likewife.a tea-fpoonful of the volatile tinaure of gum guaiacum, at bed time, in wine- whey. This courfe may be continued for a week, or longer, if the cafe proves ohftinat*, and the patient's ftrength will permit. It ought 1 -then to be omitted for a few days, and repeated again. At the 1 fame time leeches or a blifter may be applied to the part affeaed. 1 What I have generally found anfwer better than either of thtfe, in obftinate fixed rheumatic pains, is the warmplaifier *. I have ' likewife known a plaifter cf Burgundy pitch worn for fome time on the part affeaed, give great relief in rheumatic pains. Dr. Alex- ander, of Edinburgh, fays he has frequently cured very obftinate rheumatic pains, by rubbing the part affeaed with tinaure of can- tharides. When the cemmen tinaure did not fucceed, hemfed \ it of a double cr treble ftrength. Cupping upen the part ^fiefled *■ See appendix, Warm Plaifter. THE RHEUMATISM. 2/7 16 often very beneficial, and is greatly preferable to the application of leeches. Though this difeafe may not feem to yield to medicines for fome time, yet they ought ftill to be perfilted in. Perfons fubjea io fre- quent returns of rheumatifm, will often find their account in ufing medicines, whether they be immediately affeatd with the difeafe or not. The chronic rheumatifm is fimilar to the gout in this refpea, that the moft proper time for ufing medicines to ex- tirpate it, is when the patient is moft free from the diforder. To thofe who can afford the expenfe, I recommend the warm baths of Buxton or Matlock in Derbyfhire. Thefe have often, to my knowledge, cured very obPinate rheumatifms, and are always fufe either in or out of the fit. When the rheumatifm is compli- cated with fcorbutic complaints, which is not feldom the cafe, the Ilarrowgate waters, and thofe of Moffat, are proper. They fliould both be drank and ufed as a warm bath. Several of our own domeftic plants may be ufed with advan- tage in the rheumatifm. One of the beft is wnite mufiard. A table- fpoonful of the feed of this plant may be taken twice or thrice a-day, in a glafs of water or fmall wine. The watt;r-trefoil is like- wife of great ufe in this complaint. It may be infufed in wine or ale, or urank in form of tea. The ground-ivy, camomile, .nd feve- ral other bitters arc beneficial, and may be ufed in the i me way. No benefit is to be expeaed from thefe, unlefs they be : ken for a confiderable time. Excellent medicines are often defpik in this difeafe, becaufe thev do not perform an immedLte cure; wnereas, nothing would be more certain than their effea, were they duly perfifted in. Want of perfeverance in the ufe of medicines is one reafon why chronic difeafes are fo feldom cured. Cpld bathing, efpecially in fait water, often cures the rheuma- tifm. We alfo recommend riding on horfeback, and wearing flan- nel next the fkin. Iffues are very proper, efpecially in chronic cafes. If the pain affeas the fhoulders, an iffue may be made in the arm ; but if it alleas the loins, it fhould be put in the leg or thigh. Perfons affliaed with the fcurvy are very fubjea to rheumatic complaints. The beft medicines in this cafe are bitters and mild purgatives. Thefe may either be taken feparately or together, as the patient inclines. An ounce of bark, and half an ounce of rhu- barb in powder, may he infufed in a bottle of wine ; and one, two, or three wine glaffes of ,t taken daily, as fhall be found necef- rary for keeping the body gently open. In cafes where the bark felf proves fufficiently purgadve, the rheubarb may be omitted. Such as are fubjea to frequent attacks of the rheumatifm ought t°nake choife of a dry, warm fituation: to avoid the night-air, w^clothes, and wet feet, as much as poffibie. Their clothing {ho'j be warm ; they fhould wear flanne) next their fkin, and ma-kfreqUent ufe of the flefh-brufh. 278 CHAPTER XLI. The Scurvy PREVAILS chiefly in cold northern countries, efpeeially in low, damp fituations, near large marfhes, or great quantities of ftagnating water. Sedentary people, of a dull, melancholy dif- pofition, are moft fubjea to it. It proves often fatal to failors on long voyages, particularly in fhips that are not properly ventila- ted, have many people on board, or where cleanlinefs is neglec- ted. It is not neceffary to mention the different fpecies into which this difeafe has been divided, as they differ from one another chief- ly in degree. What is called the land fcurvy, however, is feldom attended with thofe highly putrid fymptoms which appear in pa- tients who have been long at fea, and which, we prefume, are rather owing to confined air, want of exercife, fcarcity of water, and the unwholefome food eaten by failors on long voyages, than to any fpecific difference in the difeafe. CAUSES-----The fcurvy is occafioned by cold, moift air ; by the long ufe of falted or fmoke-dried provifions, or any kind of food that is hard of digeftion, and affords little norifhment. It may alfo proceed from the fuppreffion of cuftomary evacuations; as the menfes, the haemorrhoidal flux, Sec. It is fometimes owing to a hereditary taint, in which cafe, a very fmall caufe will excite the latent diforder. Grief, fear, and other depreffing paffions, have a great tendency both to excite and aggravate this difeafe. The fame obfervation holds with regard to negka of cleanlinefs; badcloth- ing ; the want of proper exercife ; confined air; unwholefome food ; or any difeafe which greatly weakens the body. SYMPTOMS----This difeafe may be known by unufual wea- rinefs, heavinefs, and difficulty of breathing, efpecially after mo- tion ; rotcennefsof the gums, which are apt to bleed on the flight- eft touch; a ftinking breath ; frequent bleeding at the nofe; crackling of the joints ; difficulty of walking ; fometimes a fwel- ling, and fometimes a falling away of the legs, on which/there are livid, yellow, or violet-coloured fpots ; the face k generally of a pale or leaden colour. As the difeafe advances, other fymptoms come on ; as rottennefs of the teeth, haemorrhages, or difchar- ges of blood from different parts of the body, foul obftinate ulcers pains in various parts, efpecially about the breaft, dry, fcaly eruj tions all over the body, Sec. At laft, a wafting or heaic ftv* comes on, and the patient is often carried off by a dyfenten a diarrhoea, a dropfy, the palfy, fainting fits, or a mortificatior0^ fome of the bowels. CURE.----We know no way of curing this difeafe K ty THE SCURVY. , 279 purfuing a plan direaiy opposite to that which brings it on. It is occafioned by errors in diet, air, or exercife ; and this cannot be removed but by a proper attention to thefe important articles. If the patient has been obliged to breathe a cold, damp, or con- fined air, he fhould be removed, as foon as poffibie, to a dry, open, and moderately warm one. If there is reafon to believe that the difeafe proceeds from a fedentary life, or depreffing paffions, as grief, fear, &c. he muft take, daily, as much exercife in the open air as he can bear, and his mind fhould be diverted by cheerful company and other amufements. Nothing has a greater tendency either to prevent or remove this difeafe, than conftant cheerful- nefs and goed humour. But perfons affliaed with the fcurvy, are generally furly, peevifh, and morofe. When the fcurvy comes on by a long ufe of falted provifions, the proper medicine is a diet confifting chiefly of frefh vegetables; as oranges, apples, lemons, limes, tamarinds, water-criffes, fcurvy- grafs, brook-lime, &c. The ufe of thefe, with milk, pot-herbs, new-bread, and frefh beer or cyder, wiil feldom fail to remove a fcurvy of this kind, if taken before it be too far advanced ; but to have this effea, they muft be perfifted in for a confiderable time. When frefh vegetables cannot be obtained, pickled or preferved ones may be ufed ; and where thefe are wanting, recourfe muft be had to the chemical acids. All the patient's food and drink, fhould, in this cafe, be fharpened with cream of tartar, elixir of vitriol, vinegar, or the fpirit of fea-falt. Thefe things, however, will more certainly prevent than cure the fcurvy ; for which reafon, fea-faring people, efpecially on long voyages, ought to lay in plenty of them. Cabbages, onions,goofe- berries, and many other vegetables, may be kept a long time by pickling, preferving, Sec. and when thefe fail, the chemical acids, recommended above, which will keep for any length of time, may be ufed. We have reafon to believe, if fliips were well ventilated, had good ftore of fruits, greens, cyder, &c. laid in, and if proper regard were paid to cleanlinefs and warmth, that failors would be the moft healthy people in the world, and would feldom fuffer either from the fcurvy or malignant fevers, which are fo fatal to that ufeful fet of men ; but it is too much their temper to defpife all precaution ; they will not think of any calamity till it overtakes them, when it is too late to ward off the blow. It muft indeed be owned, that many of them have it not in their power to make the provifion we are fpeaking of; but in this cafe it is the duty of their employers to make it for them ; and no man ought to engage in along voyage without having thefe articles fecured. I h vve often feen very extraordinary effeas in the land-fcurvy from a milk diet. This preparation of nature, a mixture of ani- mal and vegetable properties, is the moft fit for reftoring a decay- ed conftitution. But people defpife this wholefome and nourifhing 280 THE SCURVY. food, becaufe it is cheap, and devour ,\ hh grcedinefs, flefli, and fermented ic.uors, while milk iscnly deemed fit for hogs. The moft proper drink in the f-irvy is whey or butter-milk. When thefe cannot be had, fou::d cyder, perry, porter or fprucc- beer, may be ufed. Wort has been found a proper drink in the fcurvy, and may be ufed at fea, as malt will lceep during the longeft voyage A decoaion of the tops of the fpruce fir is likewife pro- per. It may be drank in the' quantity of an Englifli pint twice a- day. Tar-water may be ufed for the fame purpofe, or decoaions of any of the mild mucilaginous vegetables ; as farfaparilla, marfh- mallow ror»ts, Sec. Infufions of the bitter plants, as ground-ivy, the kffer centaury, marfh-trefoil, &c. are beneficial. The peafants in fome parts of Britain, exprefs the juice of the laft-mentioned plant, and drink it with good effea in thofe foul, fcorbutic erup- tions with which they are often troubled in the fpring feafon. Harrowgate-water is certainly an excellent medicine in the larid-fcurvy. I have often feen patients who had been reduced to the moft deplorable condition by this difeafe, greatly relieved by drinking the fulphur-water, and bathing in it. The chalybeate- water may alfo be ufed with advantage, efpecially with a view to brace the ftomach after drinking the fulphur-water, which, though it ftiarpens the appetite, never fails to weaken the powers of digeftion. A flight degree of fcurvy may be carried off by frequently fuck- ing a little of the juice of a bitter or?.nge, or a lemon. When the difeafe affeas the gums only, this praaice, if continued for fome ti ne, will generally carry it off. We recommend the bitter orange as jrtjtly preferable to lemon ; it feems to be as good a medicine, and is not nearfo hurcfulto the ftomach. Perhaps our own forrel nvy be little in^erio^- to either of them. All kinds of fallad arc good in the fcurvy, and ought to be eaten very plentifully, as fpinage, lettuce, parfley, celery, endive, rad- ifh, dandelion, &c. It is amazing t., fee how foon frefli vegeta- bles in the fpring cure the brute animals of any fcao or foulnefs which is upon their fkins. It is reaf ^..oie to fuppofe that their effeas would be as great upon the h.'-nan fpc ies, were they ufed in proper quantity for a ruuicie- cngth of time. I ha>-e Sometimes feen good eff-as in frorbutic complaints of very lor Handing, from the ule of a decc Lion of the roots of wa- ter-dock. It is ufually made by boiling a pound of the frefh root in fix Englifh pints of water, till about on: -third of it be confum- ed. The dofe is from half a pint io-a whoie pint of the docoaion every day. But in all the cafes where I have feen it prove benefi- cial, it was made much ftronger, and drank in larger quantities. The fafeft way is, for the patient to begin with fmall dofes, and increafe them both in ftrength and quantity as he finds his fto- mach will bear it. It muft be ufed for a confiderable time I h.'vc known fome take it for many months, and have been told of others THE SCROPHULA, OR KING's EVIL. a$t who had ufed it for feveral years, before they were fenfible of any; benefit, but who neverchekfs were cured by it at length. j ho leprofy, which was fo common in this country long ago, feems to have been near a-kin to the fcurvy. Perhaps its appear- ing fo feldom now, may be owing to the inhabitants of Britain eat- ing more vegetable food than formerly, living more upon tea, and other diluting diet, ufing lefs falted meat, being more cleanly, bet- ter lodged and clothed, Sec.—For the cure of this difeafe, we re- commend the fame courfe of diet and medicine as in the fcurvy* The Scrophula, or King's Evil CHIEFLY affeas the glands, efpecially thofe of the neck. Chil- dren, and young perfons of a fedentary life, are very fubjea to it. It is one of thofe difeafes which may be removed by proper regimen, but feldom yields to medicine. The inhabitants of cold* damp, marfhy countries are moft liable to the fcrophula. CAUSES.----This difeafe may proceed from a hereditary taint, from a fcrophulous nurfe, &c. Children who have the mis- fortune to be born of fickly parents, whofe conftitutions have been greatly injured by the pox, or other chronic difeafes, are apt to be affeaed with it. It may proceed from fuch difeafes as weaken the habit, as the fmall-pox, meafles, &c External injuries, as blows* bruifes, and the like, fometimes produce fcrophulous ulcers ; but we believe, when this happens, that there has been a predifpofi- tion in the habit to this difeafe. In fhort, whatever tends to relax? the folids, paves the way to the fcrophula ; as the want of proper exercife, too much heat or cold, confined air, unwholefome food* bad water, the long ufe of poor, weak, watery aliments, the ne- gka of cleanlinefs, &c. Nothing tends more to induce this dif- eafe in children, than allowing them to continue long wet** SYMPTOMS----At firft, fmall knots appear under the chirt or behind the ears, which gradually increafe in number and fize, till they form one large hard tumour. This often continues for a long time without breaking, and when it does break, it only dif- charges a thinfanies, or watery humour. Other parts of the body are likewife liable to its attack, as the arm-pits, groins, feet, hands, eyes, breafts, &c. Nor are the internal parts exempt from it. It often affeas the lungs, liver, or fpleen ; and frequently the glands of the myfentery are greatly enlarged by it; Thofe obftinate ulcers which break out upon the feet and hands with fwelling, and little or no rednefs, are of the fcrophulous kind. They feldom difcharge good matter, and are exceedingly difficult ■¥■ The fcrophula, as well as the rickets, prevails in large manufaC' luring towns, where people liv-.- grofs, and le.id fedentary fives. N 2 2%2 THE SCROPHULA, OR KING's EVIL. to cure. The white fwelling of the joints feems to be of this kind. They are with difficulty brought to a fuppuration, and when open- ed, they only difcharge a thin ichor. There is not a more general fymptom of the fcrophula than a fwelling of the upper lip and nofe. REGIMEN.----As this difeafe proceeds, in a great meafure, from relaxation, the diet ought to be generous and nourifhing, but at the fame time, light and of eafy digeftion ; as well fermented bread, made of found grain, the flefh and broth of young animals, with a glafs of generous wine, or good ale. The air ought to be open, dry, and not too cold, and the patient fhould take as much exercife as he can bear. This is of the utmoft importance. Chil- dren who have fufficient exercife are feldom troubled with the fcrophula. MEDICINE.----The vulgar are remarkably credulous with fegard to the cure of the fcrophula ; many of them believing in the virtue of the royal touch, that of the feventh fon, &c. We know but little of the nature or cure of this difeafe, and where reafon or medicines fail, fuperftition always comes in their place. Hence, in difeafes which are the moft difficult to underftand, we generally hear of the greateft number of miraculous cures being j>erformed. Here, however, the deception is eafily accounted for. The fcrophula, at a certain period of life, often cures of itfelf; and, if the patient happens to be touched about this time, the cure is imputed to the touch, and not to Nature. In the fame way, the infignificant nostrums of quacks and old women often gain ap- plaufe when they deferve none. ' Nothing is more pernicious than the cuftom of plying children in the fcrophula with ftrong purgative medicines. People imagine it proceeds from humours which muft be purged off, without con- fidering that thefe purgatives increafe the debility and aggravate the difeafe. It has indeed been found, that keeping the body gen- tly open for fome time, efpecially with fea-water, has a good ef- fea ; but this fliould only be given in grofs habits, and in fuch quantity, as to procure one, or at moft, two ftools every day. Bathing in the fait water has likewife a very good effea ; efpe- cially in the warm feafon. I have often known a courfe of bathing in fait water, and drinking it in fuch quantities as to keep the bo- dy gently open, cure a fcrophula, after many other medicines had been tried in vain. When fait water cannot be obtained, the pa- tient may be bathed in frefh water, and his body kept open by fmall quantities of fait and water, or fome other mild purgative. Next to cold bathing, and drinking the fait water, we recom- mend the bark. The cold bath may be ufed in fummer, and the bark in winter. To an adult, half a drachm of the bark in powder may be given in a glafs of red wine four or five times a-day. Chil- dren, and fuch as cannot take it in fubftance, may ufe the decoc- tion made in the following manner. THE ITCH. 283 Boil an ounce of Peruvian bark and a drachm of Winter s bark, both grofsly powdered, in an Englifh quart of water to a pint: towards the end, half an ounce of fliced liquorice-root, and a hand- ful of raifins may be added, which will both render the decoaion lefs difagreeable, and make it take up more of the bark, i he li- quor muft be ftrained, and two, three, or four tabk-fpoonfuts, a» cording to the age of the patient, given three times a-day. The Moffat and Harrowgate waters, efpecially the latter, are likewife very proper medicines in the fcrophula. They ought not to be drank in large quantities, but fo as to keep the body gently open, and muft be ufed for a confiderable time. Hemlock may fometimes be ufed with advantage in the fcrophu- la. Some lay it down as a general rule, that the fea-water is moft proper before there are any fuppuration or fymptoms of tabes \ the Peruvian bark, when there are running fores, and a degree ot hec- tic fever; and the hemlock in old inveterate cafes, approaching to the fchirrous or cancerous ftate. Either the extract or the f rein juice of this plant may be ufed. The dofe mud be imall at hrlt, and increafed gradually as far as the ftomach can bear it. External applications are of little ufe. Before the tumour breaks, nothing ought to be applied to it, unlefs a piece of flannel or fome- thing to keep it warm. After it breaks, the fore may be dreffed with fome digeftive ointment. As the vellowbafilicon mixed with about a fixth or eighth part of its weight of red precipitate of mer- cury The fore may be dreffed with this twice a-day ; and if it be very fungous, and does notdig.lt well, a larger proportion of the precipitate may be added. Medicines which mitigate this difeafe, though they do not cure it, are not to be defpifed. If the patient can be kept alive by any means till he arrives at the age of puberty, he has a great chance to get well; but if he does not recover at this time, in all probabi- lity, he never will. There is no malady which parents are fo apt to communicate to their offspring as the fcrophula, for which reafon, people ought to beware of marrying into families affeaed with this difeafe. For the means of preventing the fcrophula, we muft refer the reader to the obfervations on nurfing at the beginning of the book. The Itch IS commonly communicated by infeaion yet it feldom pre- lc !h due regard is paid to cleanlinefs, frefh air, and wholefomedift It generally appears in form of fmall watery put Uks firft about the wrists! or between the fingers ; afterwards 284 THE ITCH. it affeas the arms, legs, thighs, &c. Thefe puftules are attended with-an intolerable itching, efpecially when the patient is warm a- bed, or fits by the fire. Sometimes, indeed, the fkin is covered with large blotches or fcabs, and at other times with a white fcurf, or fcaly eruption. This laft is called the dry itch, and is the moft dif- ficult to cure. The itch is feldom a dangerous difeafe, unlefs when rendered fo by negka, or improper treatment. If fuffered to continue too long, it may vitiate the whole mafs of blood, and, if fuddenly drove in, without proper evacuations, it may occafion fevers, in- flammations of the vifcera, or other internal diforders. The beft medicine for the itch is fulphur, ufed both externally and internally. The parts moft affeaed may be rubbed with an ointment made of the flowers of fulphur, two ounces ; crude fal ammoniac finely powdered, two drachms ; hog's lard, or butter, four ounces. If a fcruple or half a drachm of the eflence of lemon be added, it will entirely take away the difagreeable fmell. About the bulk of a nutmeg of this may be rubbed upon the ex- tremities at bed time twice or thrice a-week. It is feldom necef- fary to rub the whole body ; but when it it, it ought not to be done all at once, but by turns, as it is dangerous to flop too ma- ny pores at the fame time. Before the patient begins to ufe the ointment, he ought, if he be of a full habit, to bleed or take a purge or two. It will likewife be proper, during the ufe of it, to take every night and morning as much of the flour of brimftone and cream of tartar, in a little treacle or new milk, as will keep the body gently open. He fhould beware of catching cold, fliould wear more clothes than ufual, and take every thing warm. The fame clothes, the linen excepted, ought to be worn all the time of ufing the ointment; and fuch clothes as have been worn while the patient was under the difeafe, are not to be ufed again, unlefs they have been fumigated with brimftone, and thoroughly cleaned ; otherwife, they will commu- nicate the infeaion anew '. I never knew brimftone, when pfed as direaed above, fail to cure the itch ; and I believe that if duly pcrfilled in, it never will fail; but if it be only ufed once or twice, and cleanlinefs neglec- ted, it is no wonder if the diforder returns. The quantity of oint- ment, mentioned above, will generally be fufficient for the cure of one perfon ; but if any fymptoms of the difeafe fhould appear a- gam, the medicine may be repeated. It is both more fafe and effi- * Sir John Pringle obferve, that though this difeafe may feem rriflinsr, ..there is no,one in tjic ;.r:ny tiiatis more f.roublefome to cure, as the in- fection often lurks in clothes. Sec. and breaks out a feem d or even a third time The f.ime inconveniency occurs in private famii: ,, unlefs pnrtlcwiar regard is paid to the changing or cleaning of their clothes v. Inch '^11: is by no means an eafy operation. THE ITCH. 285 cacious when persisted in for a confiderable time, than when a large quantity is applied at once. As moft people diflike the fmell of fulphur, they may ufe in ks place the powder of white hellebore root made up into an ointment, in the fame manner, which will feldom fail to cure the itch. People ought to be extremely cautious left they take other erup- tions for the itch ; as the ftoppage of thefe may be attended with fatal confequences. Many of the eruptive diforders to which chil- dren are liable, have a near refemblance to this difeafe; and I have often known infants killed by being rubbed with greafy oint- ments that made thefe- eruptions strike fuddenly in, which Nature had thrown out to preferve the patient's life, or prevent fome other malady. Much mifchief is likewife done by the ufe of mercury in this difeafe. Some perfons wafh the parts affeaed with a ftrong folu- tion of the corrofive fublimate. Others ufe the mercurial ointment, without raking the leaft care either to avoid cold, keep the body open, or obferve a proper regimen. The confequences may be ea- fily gueffed. Mercurial girdles have produced bad effeas, and I would advice every perfon, as he values his health, to beware how he ufes them. Mercury ought never to be ufed as a medicine without the greateft care. Ignorant people look upon thefe gir- dles as a kind of charm, without confidering that the mercury en- ters the body. It is not to be told what mifchief is done by ufing mercurial ointment for curing the itch and killing vermin ; yet it is unne- ceffary for either : the former may be always more certainly cured by fulphur, and the latter will never be found where due regard *ts paid to cleanlinefs. "Thofe who wifh to avoid this deteftable difeafe, ought to beware of infeaed perfons, to ufe wholefoaie food, and to ftudy univerfal (Cleanlinefs*. * The itch is now by cleanlinefs banifhed from every genteel family in Britain. It ftill prevails among the poorer fort of peafants in Scot- land, and among the manufaaurers in England. Thefe are not only fuf- ficient to keep the feeds of the difeafe aiive, but to fpread theinfschon among others. It were to be wiihed, that fome effectual method could be devifed for extirpating it altogether. Several country clergymen have told me, that by getting fuch as were infected cured, and ftrongly recommending an attention to cleanlinefs, they have banished the itch entirely out of their panlhes. Why might not others do the iume ? 286 CHAPTER XLII. The Afthrna IS a difeafe of the lungs, which feldom admits of a cure. Per- fons in the decline of life are moft liable to it. It is diftinguifh- ed into the mcift and dry, or humoural and nervous. The for- mer is attended with expeaoration or fpitting ; but in the latter, the patient feldom fpits, unlefs fometimes a little tough phlegm . by the mere force of coughing. CAUSES.----The afthrna is fometimes hereditary. It may likewife proceed from a bad formation of the breaft; the fumes of metals or minerals taken into the lungs ; violent exercife, ef- pecially running ; the obftruaion of cuftomary evacuations, as the menfes, haemorrhoids, Sec. the fudden retroceffion of the gout, or ftriking in of eruptions, as the fmall-pox, meafles, &c. vi- olent paffions of the mind, as fudden fear or furprife. In a word, i the difeafe may proceed from any caufe that either impedes the circulation of the blood through the lungs, or prevents their being duly expanded by the air. SYMPTOMS____An afthrna is known by a quick laborious breathing, which is generally performed with a kind of wheezing noife. Sometimes the difficulty of breathing is fo great, that the patient is obliged to keep in an erea pofture, otherwife he is in danger of being fuffocated. A fit or paroxyfm of the afthrna ge- nerally happens after a perfon has been expofed to cold easterly winds, or has been abroad in thick foggy weather, or has got wet, or continued long in a damp place under ground, or has taken fome food which the ftomach could not digeft, as paftries, toaft- ed cheefe, or the like. The paroxyfm is commonly ufhered in with liftleffnefa, want of fleep, hoarfenefs, a cough, belching of wind, a fenfe of heavi- nefs about the breaft, and difficulty of breathing. To thefe fuc- ceed heat, feter, pain of the head, ficknefs and naufea, great op- preflion of the breaft, palpitation of the heart, a weak and fome- times intermitting pulfe, an involuntary flow of tears, bilious vo- mitings, &c. All the fymptoms grow worfe towards night; the patient is eafier when up than in bed, and is very defirous of cool air. REGIMEN----The food ought to be light and of eafy digef- tion. Boiled meats are to be preferred to roafted, and the flefh of young animals to that of old. All windy food, and whatever is apt to fwell in the ftomach, is to be avoided. Light puddings, white broths, and ripe fruits, baked, boiled, or roafted, are proper. Strong liquors, of all kinds, efpecially malt liquor, are hurtful. The patient flicnld est a very light f.-:pper, or rather none at all, THE ASTHMA. 287 and fhould never fuffer himfelf to be long coftive. His clothing fhould be warm, efpecially in the winter-feafon. As aft diforders of the breaft are much relieved by keeping the feet warm, and promoting the perfpiration, a flannel fhirt or waiftcoat, and thick fhoes, will be of Angular fervice. But nothing is of fo great importance in the afthrna as pure and moderately warm air. Afthmatic people can feldom bear cither the clofe heavy air of a large town, or the fharp, keen atmof- phere of a bleak hilly country ; a medium therefore between thefe is to be chofen. The air near a large town is often better than at a diftance, provided the patient be removed fo far as not to be af- feaed by the fmoke. Some afthmatic patients breathe eafier in town than in the country; but this is feldom the cafe, efpecially in towns where much coal is burnt. Afthmatic perfons who are obliged to be in town all day, ought at leaft to fleep out of it. This will often prove of great fervice. Thofe who can afford it,. ought to travel into a warmer climate. Many afthmatic perfons, who cannot live in Britain, enjoy very good health in the fouth of France, Portugal, Spain, or Italy. Exercife is of very great importance in the afthrna, as it promotes the digeftion, preparation of the blood, &c. The blood of afthma- tic perfons is feldom duly prepared, owing to rhe proper aaion of the lungs being impeded. For this reafon, fuch people ought daily to take as much exercife, either on foot, horfeback, or in a carriage, as they can bear. MEDICINE.---Almoft all that can be done by medicine in this difeafe, is to relieve the patient when feized with a violent fit. This, indeed, requires the greateft expedition, as the difeafe of- ten proves fuddenly fatal. In the paroxyfm or fit, the body is ge- nerally bound ; a purging clyfter, with a folution of afafcetida, ought therefore to be adminiftered, and if there be occafion, it may be repeated two or three times. The patient's feet and legs ought to be immerfed in warm water, and afterwards rubbed with a warm hand, or dry cloth. Bleeding, unlefs extreme weaknefs or old age fhould forbid it, is highly proper. If there be a violent fpafm about the breaft or ftomach, warm fomentations, or blad- ders filled with warm milk and water, may be applied to the part affeaed, and warm cataplafms to the foles of the feet. The pa- tient muft drink freely of diluting liquors, and may take a tea- fpoonful of the tinaure of caftor and of faffron mixed together, in a cup of valerian-tea, twice or thrice a-day. Sometimes a vo- mit has a very good effea, and fnatches the patient from the jaws of death. This, however, will be more fafe after other evacuations have been premifed. A very ftrong infufion of roafted coffee is faid to give eafe in an afthmatic paroxyfm. In the moift afthrna, fuch things as promote expeaoration or fpitting ought to be ufed ; as the fyrup of fquills, gum ammoniac, and fuch-hke. A common fpoonful of the fyrup, or oxymel of 288 THE APOPLEXY. fqudls, mixed w:rh an equal quantity of cinnamon-water, may be t;dcen three or four times through the day, ami four or five pills, made of equ^l parts of afafcetida and gum-ammoniac, at bed time*. For the convulsive or nervous afthrna, antifpifmodics and bra- cers are the moft proper medicines. The patient may take a tea- fpoonful of the paregoric elixir twice a-day. Thebark is fomttiraes of ufe in this cafe. It may be taken in fubftance, or infufed in winef. In fhort, every thing that braces the nerves, or takes off fpafm, may be of ufe in a nervous afthrna. It is often relieved by the ufe of affes' milk. I have likewife known cow's milk, drank warm in the morning, have a very good effea in this cafe. In every fpecies of afthrna, fetons and iffues have a good effea. They may either be fet in the back or fide, and fhould never be al- lowed to dry up. Not only in the afthrna, but in moft chronic difeafes, iffues are extremely proper. They are a fife and effica- cious remedy; and though they do not always cure the difeafe, yet they will often prolong the patient's life. CHAPTER XLIII. Of the Apoplexy. THE apoplexy is a fudden lofs of fenfe and motion, wherein the patient is to all appearance dead. The heart and lungs however ftill continue to move. This difeafe proves often fatal; yet it may fometimes be removed by proper care. It chiefly attacks fe- dentary perfons, of a grofs habit, who ufe a rich and plentiful diet, and indulge in ftrong liquors. People in the decline of life are moft fubjea to the apoplexy. It prevails moft in winter, efpecial- ly in rainy feafons, and very low flutes of the barometer. CAUSES-----The immediate caufe of an apoplexy is a com- preffion of the brain, occafioned by an excefs of blood, or a collec- jion of watery humours. The former is called a fanguine, and the latter, a ferous apoplexy. It m:*y be occafioned by any thing that increafes the circulation towards the brain, or prevents the return ■if After copious evacuations, large dofes of xther have been found very efficacious in removing afk of the a'.rhma I have likewife known the following mixture produce very happy effects : To four or five ounces of the folution of gum-ammoniac, add two ounces of fimple cinnamon-water, the iam^ quantity of balfamic fyrup, and half an ounce of the paregoric elixir. Of this, two table-fpoonluis may be taken eve- ry three hours. t When aparoxyfii or fit of a ft Inn a has gone off, cold bathing may be employed, to co-operate with the tonic medicines recommended, tu prevent a return of the pun.-y.yfm, (I. C; THE APOPLEXY. 289 jf the blood from the head ; as intenfe ftudy; violent paffions* ; viewing objeas for a long time obliquely ; wearing any thing too light about the neck ; a rich and luxurious diet; fuppreffion of urine ; fuffering the body to cool fuddenly after having been great- ly- leated ; continuing long in a warm or a cold bath; the excef- five ufe of fpiceries, or high-feafoned food ; excefs of venery ; the fuuden ftriking in of any eruption ; fuffering iffues, fetons, &c. m ■'• enly to dry up, or the ftoppage of any cuftomary evacuation ; . mercurial falivation pufhed too far, or fuddenly checked by cold ; •.voands or bruifes on the head ; long expofure to exceffive cold ; poifonous exhalations, &c. SYMPTOMS, and method of cure.-----The ufual forerunners er an apoplexy are giddinefs, pain and fwimming of the head j lofs of memory; drowfinefs ; noife in the ears ; the night-mare ; a fpontaneous flux of tears, and laborious refpiration. When per- fons of an apopkaic make obferve thefe fymptoms, th-.y ,'iave rea- fon to fear the approach of a fit, and fhould endeavour to prevent it by bleeding, a flender diet, and opening medicines. - In the fanguine apoplexy, if the patient does not die fuddenly, the countenance appears florid, the face is fwelled or puffed up, and the blood-veffeis, efpecially about the neck and temples, are turgid ; the pulfe beats ftrong; the eyes are prominent and fix. d, and the breathing is difficult, and performed with a fnorting noife. The excrements and urine are often voided fpontaneoufly, and the patient is fometimes feized with vomiting. In this fpecies of apoplexy, every method muft be taken to leffen the force of the circulation towards the head. The patient fhould be kept perfeaiy eafy and cool. His head fhould be raifed pretty high, and his feet fuffered to hang down. His clothes ought to be loofened, efpecially about the neck, and frefh air admitted into his chamber. His garters fhould be tied pretty tight, by which means the motion of the blood from the lower extremities will be retarded. As foon as he is placed in a proper pofture, he fhould be bled freely in the neck or arm, and, if there be occafion, the ope- ration may be repeated in two or three hours. A laxative clyfter, with plenty of fweet oil, or frefh butter, and a fpoonful or two of common fait in it may be adminiftered every two hoursf, and a * I knew a woman, who, in a violent fit of anger, was feized with a fanguine apoplexy. She at firft complained of extreme pain, as if dag- gers had been thruft through her head, as fhe expreffed it. Afterwards Ihe became comatofe, her pulfe funk very low, and was exceeding flow- By bleeding, blillering, and other evacuations, fhe was kept alive about a fortnight. When her head was opened, a large quantity of extravafa- ted blood, was found in the left venteicle of the brain. f A clyfter, confifting of three ounces of glauber falts diffolved in a pint of warm water, with an ounce of antimonial wine, and afuitable quan- tity of oil, would have a more powerful effea in relieving the head. (I. d.j 29o... n THE APOPLEXY. blifter a'ppplied between the fhoulders, and to the calves of the legs. ■> As foon as the fymptoms are a little abated, and the patient is . able to fwallow, he ought to drink freely of fome diluting opening ' liquor, as a decoaion of tamarinds and liquorice, cream-tartar whey, or common whey with cream of tartar diffolved in it. Or he may take any cooling purge, as Glauber's falts, manna diffolved in an infufion of fenna, or the like. All fpirits and other .ftrong liquors are to be avoided. Even volatile falts held to the nofe do mifchief. Vomits, for the fame reafon, ought not to be,given, nor any thing that may increafe the motion of the blood towards, the head. In the ferous apoplexy, the fymptoms are nearly the fame, only the pulfe is not fo ftrong, the countenance is lefs florid, ainfthe breathing lefs difficult. Bleeding is notfo neceffary here as in the former cafe. It may generally be performed onqe with fafety and advantage, but fhould not be repeated. The patient fhould be placed in the fame pofture as diread above, and fliould have blif- ters applied, and receive opening clyfters in the fame manner. Purges are likewife neceffary, and tiis .patient may drink'ftrong j balm-tea. If he be inclined to fweat, it ought to be promoted by drinking fmall wine-whey, or an infufion of carduus benediaus. • A plentiful fweat kept up for a confiderable time has often carried off a ferous apoplexy. . , When apopkaic fymptoms proceed from, opium, or other :nar- cotic fubftances taken into the ftomach, vomits are neceffary. The patient is generally relieved as foon as he has difcharged the ( poifon in this way. Perfons of an apopkaic make, or thofe who have been, attack- ed by an apoplexy, ought 10 ufe a very fpare and flender diet, avoiding all ftrong liquors, fpiceries, and high feafoned food. ) They ought likewife to guard againft all violent paffioris,- and to avoid the extremes of heat and cold. The head fhould be fhaved; ; and daily wafhed with cold water. The feet ought to be kept , warm, and never fuffered to continue long wet. The body muft j be kept open either by food or medicine, and a little blood may { be let every fpring and fall. Exercife fliould by no means be ne- gleaed"; but it ought to be taken in moderation. Nothing has a more happy effea in preventing an apoplexy than perpetual iffues ; or fetops ; great care however muft be taken not to fuffer them to dry up, without opening others in their ftead. Apopkaic per- fons ought never to go to reft with a full ftomach, or to lie with 1 their heads low, or wear any thing too tight about their necks. 291 T = C H A P T E R XLIV. 6f Coftivenefs, and other AffeeTkns of the Stomach and ■ ' Bowels. W TE do not here mean to treat of thofe aftriaions of the bow- Vy els which are the fymptoms of difeafes, as of the cholic, the iliac paffion, &c. bat only to take notice of that infrequency of ftools which fometimes happens, and which in fome particular conftitutions may occafion difeafes. '' Coftivenefs may proceed from drinking rough'red wines, or other aftringent liquors ; too much exercife, efpecially on horfe- back, or from a long ufe of cold infipid foody which does not fuffi- ciently ftimulate the inteftines. Sometimes it is owing to the 'bite not defcending to the inteflines, as in the jaundice ; and at'Other 'times it proceeds from difeafes of the inteftines themfelves, as a palfy,' fpafms, torpor, tumours of the inteftines, &c. Exceffive coftivenefs is apt to occafion pains of the head, vomit- ing, colics, and other complaints of the bowels. It is peculiarly hurtful to hypochondriac and hyfleric perfon?, as it generates wind and other grievous fymptoms. Some people can bear coftive- nefs to a great degree. I know perfons Who enjoy pretty good health, yet do not go to ftool above once a-week, and others not ' above once a-fortnight. I have heard of fome who do nof.go above once a-'month. Perfons who are generally coftive fhould live upon a moiften- ing and laxative diet, as roafted or boiled apples, pears, {tewed prunes, raifins, gruels with currants, butter, honey, fugar, and fuch-like. Broths with fpinage, leeks, and other foft pot-hcrhs, are likewife proper. Rye-bread, or that which is made of .a mix- ture of wheat and rye together, ought to be eaten. No perfon troubled with coftivenefs fliould eat white bread alone; efpecialiy that which is made of fine flour. The beft, bread for keeping the body foluble is what in fome parts of England they call mefiin. It is made of a mixture of wheat and rye, and is very agreeable to thofe accuftomed to it. Coftivenefs is encreafed by keeping the body too warm, and by every thing that promotes the perfpiration ; as wearing flannel, lying too long a-bed, &c. Intenfe thought and a fedentary life, are likewife hurtful. All the fecretions and excretions are promo- ted by moderate exercife without doors, and by a gay, cheerful, fprightly temper of mind. m The drink fhould be of an opening quality. Ardent fpirits, attf- tere and aftringent wines, as port, claret, &c. ought to be avoi- ded. Malt-liquor that is fine, and of a moderate ftrength, is TCiy 292 WANT OF APPETITE. •prober. Butter-milk, whey, and other watery liquors, ate likewife proper, and may be drank in turns, as inclination direas. Thofe troubled with coftivenefs, ought, if poffibie, to remedy it by'diet, as the conftant ufe of medicines for that purpofe is at- tended with many inconveniencies, and often with bad confequen- cs*. I never knew any one get into a habit of taking medicine for keeping the body open, who could leave it off. In time, the cuftom becomes neceffary, and generally ends in a total relaxation of the bowels, indigeftion, lofs of appetite, wafting of the strength, and death. When the body cannot be kept open without medicine, we re- commend gentle dofes of caftor-oil, flour of fulphur, and cream of tartar, to be taken twice or thrice a-week. This is not near fo injurious to the ftomach as aloes, jalap, or the other draftic pur- jM-ives fo much in ufe. Infufions of fenna and manna may like- wife be taken, or half an ounce of foluble tartar diffolved in water- gruel. Aiout the fize of a nutmeg of lenitive ekauary taken twice or thrice a-day generally anfwers the purpofe very well. Want of Appetite. THIS may proceed from a foul ftomach; indigeftion ; the want of free air and exercife ; grief; fear ; anxiety ; or any of the de- preffing paffions; exceffive heat; the ufe of ftrong broths, fat meats, or any thing that palls the appetite, or is hard of digeftion; xhe immoderate ufe of ftrong liquors, tea, tobacco, opium, &c The patient ought, if impoffible, to make choice of an open dry air ; to take exercife daily on horfeback or in a carriage; to rife #■ Dr- Arbuthnot advifes thofe who are troubled with coftivenefs t9 life animal oils, as frelh butter, cream, marrow, fat broths, efpecially thofe madeof internal parts of animals, as the liver, heart, midriff, &c. the expreffed oils of mild vegetables, as olives, almonds, paftaches, and the fruits themfelves; all oily and mild fruits, as figs ; decoctions of mealy vegetables; thefe lubricate the inteftines ; fjme faponaceous fubftances which ftimulate gently, as honey, hydromel, or boiled honey and water, unrefined fugar, &c. He obferves, that fuch lenitive fubftances are proper for perfons of dry atrabilarian conftitutions, who are fubject to aftricVion of the belly, and the piles, and will operate when ftronger medicinal fubftances are fometimes ineffectual ; but that fuch lenitive diet hurts thofe whofe bowels are weak and lax. He obfyrves, that all watery fnbftadces are lenitive, and that even common water, whey, four milk,'arra butter jnilk have that effect;—that new milk, efpecially alfes'mnft'/ftimulates ftill more when it fours on the ftomach ; and that whey turned four will purge ftrongly ;—that moft garden fruits are likewife laxative; and that fome of them, as grapes, will throw fuch as take them immo- deratrl* into a cholera morbus, or incurable diarrhoea. THE HEART-BURN. 2£3 betimes ; and to avoid all intenfe thought. He fhould ufe a diet of eafy digeftion ; and avoid exceffive heat and fatigue. • If want of appetite proceeds from errors in diet, or any other part of the patient's regimen, it ought to be changed. If naufea and Teachings fhew that the ftomach is loaded with crudities, a vo- mit will be of fervice. After this a gentle purge or two, of any of the bitter purging falts, may be taken. The patient ought next to ufe fome of the ftomachic bitters infufed in wine. Though gentle evacuations be neceffary, yet ftrong purges and vomits are to be avoided, as they weaken the ftomach, and hurt digeftion. Elixir of vitriol is an excellent medicine in moft cafes of indigef- tion, weaknefs of the ftomach, or want of appetite. From twenty to thirty drops of it may be taken twice or thrice a-day in a glafs of wine and water. It may likewife be mixed with the tinaure of the bark, one drachm of the former to an ounce of the latter, and two tea-fpoonfuis of it taken in wine or water, as above. The chalybeate waters, if drank in moderation, are generally of confiderable fervice in this cafe. The fait water has likewife good effeas, but muft not be ufed too freely. The waters of Haf- rowgate, Scarborough, Moffat, and moft other Spas in Britain, may be ufed with advantage. All who are affliaed with indigef- tion and want of appetite, fhould repair to thefe places of public rendezvous. The very change of air, and the cheerful company, will be of fervice; not to mention the exercife, diffipation, amufe- ments, &c. The Heart-Burn, AS it is commonly calkd, is not a difeafe of that organ, but aa uneafy fenfation of heat or acrimony about the pit of" the fto- mach, which is fometimes attended with anxiety, naufea, and vo- miting. It may proceed from debility of the ftomach, indigeftion, bile, the abounding of an acid in the ftomach, &c. Perfons liable to this complaint ought to avoid flak liquors, acids, windy or greafy aliments, and fhould never ufe violent exercife foon after a plen- tiful meal. Many perfons have the heart-burn if they ride foon af- ter dinner, provided they have drank ale, wine, or any fermented liquor; but are never troubled with it when they have drank rum, or brandy and water without any fugar or acid. When the heart-burn proceeds from debility of the ftomach^or indigeftion, the patient ought to take a dofe or two of rhubarb ; afterwards he may ufe infufions of the bark, or any other of the ftomachic bitters, in wine or brandy. Exercife in the open air will be of ufe, and every thing that promotes digeftion, 294 NERVOUS DISEASES. When bilious humours occafion the heart-burn, a tea-fpoonful of the fweet fpirit of nitre in a glafs of water, or a cup of tea, witf generally give eafe. If it proceeds from the ufe of greafy aliments, a drachm of brandy or rum may be taken. •'» 'If acidity or fournefs of the ftomach occafions the heart-bum, abforbents are the proper medicines. In this cafe, an ounce of pow- dered chalk,half an ounce of fine fugar, and a quarter of an ounce of gum-arabic, may be mixed in an Englifh quart of water, and a tea-cupful of it taken as often as is neceffary. Such as do not cho**>fe chalk may take a tea-fpoonful of prepared oyfter-fhells, or of the powder called crabs-eyes, in a glafs of cinnamon or pepper-mint water. But the fafeft and beft abforbent is magnefia elbd'. This not only aa.s as an abforbent, but likewife as a purgative ; whereas chalk and other abforbents of that kind, are ape to lie in the intef- itines and occafion obftruaions. This powder is not difagrefeabk, and may be taken in a cup of tea, or a glafs of mint-water. A large tea-fpoonful is the ufual dofe ; but it may be taken in a much great- er quantity when there is occafion. Thefe things are now generally made up into lozenges for the conveniency of being carried in the j pocket, and taken at pleafure.'. If wind caufes this complaint, the moft proper medicines are carminatives; as annifeeds, juniper-berries, ginger, cahella alba, cardamon feeds, &c. Thefe may either be chewed, or infufed in wine, brandy, or other fpirits. One of the fafeft medicines of this kind is the tinaure made by infufing an ounce of rhubarb, and a quarter of an ounce of the leffer cardamon feeds, in an Englifh pint of brandy. After this has digefted for two or three days, it ought to be ftrained, and four ounces of white fugar-candy added to it. It muft ftand to digeft a fecond time till the fugar be diffolv- ed. A tabk-fpooful of it may be taken occafionally for a dofe. I have frequently known the heart-burn cured, particularly in pregnant women, by chewing green tea. CHAPTER XLV. Nervous Difeafes ARE, of all thpfe incident to mankind, the moft complicated and difficult to cure. A volume would not be fufficient to point out their various appearances. They imitate almoft every dif- eafe ; and are feldom alike in two different perfons, or even in the fame perfon at different times.They arecontinually changing fhape; and upon every frefh attack, the patient thinks he feels fymp- toms which he never experienced before. Nor do they only affea the. body; the mind likewife fuffers, and is often rendered extreme- ly weak aud peevifh. The low fpirits, timoroufnefs, melancholy, Nervous diseases. 2,c# ""•***^"**P and ficklenefs of temper, which generally attend nervous difor- ders, induce many to believe that they are entirely difeafes of the mind; but this change of temper is rather a confequence, than the caufe of nervous difeafes. CAUSES.----Every thing that tends to relax_or weaken the body, difpofes it to nervous difeafes, as indolence, exceflive vene- ry, drinking too much tea, or other weak watery liquors warm* frequent and.copjous bleeding, purging, vomiting, &c. Whatever hurts the digeftion, or prevents the proper affimilation of the food has likewife this effea ; as long falling, excefs in eating or drink- ing, the ufe o.f windy, crude, or unwholefome aliments, an. uufa- vpurabk pofture of the body, &c. Nervous diforders often proceed from intenfe application tc» ftudy. Few ftudious perfons are entirely free from them. Nor is this.to be wondered at; intenfe thinking not only preys upon tho fpirijts, but prevents tj;e perfon from taking proper exercife, by* which means the digeftion is impaired, the nourifhment preven- ted, aniveii in a clyfter of warm water. Thu, is much more cer- SOO- THE NIGHT-MARE. tain than laudanum given by the mouth, which is often vomited, and in fome cafes, increafes the pain and fpafms in the ftomach*. If the pain and cramps return with great violence, after the effeas of the anodyne clyfter are over, another, with an equal or a larger quantity of opium, may be given ; and every four or five hours a bolus, with ten or twelve grains of mufk, and half a drachm of the Venice treacle. In the mean time, the ftomach ought to be fomented with cloths dipped in warm water, or bladders, filled with warm milk and wa- ter, fliould be conftantly applied t; itf. I have often feen thefe pro- duce the moft happy effeas. The anodyne balfam may alfo be rub- bed on the part affeaed; and an antihyfteric plaifter worn upon it for fome time after the cramps are removed, to prevent their re- turn. In very violent and lafting pains of the ftomach, fome blood ought to be let, unlefs the weaknefs of the patient forbids it. When the pain or cramps proceed from a fuppreffion of the menfes, bleeding is of ufe. If they be owing to the gout, recourfe muft be had tp lpirits, or fome of the warm cordial waters. Blifters ought likewife, in this cafe, to be applied to the ancles. I have often feen violent cramps and pains of the ftomach removed, by covering it with a large plaifter of Venice treacle. Of the Night-Mare. IN this difeafe, the patient, in time of fleep, imagines he feels an un- common oppreffion or weight about his breaft or ftomach, which he *. an byno means fhake off. He groans,and fometimes cries out,though oftner he attempts to fpeak in vain. Sometimes he imagines him- leif engaged with an enemy, and in danger of being killed, attempts to run away, but finds he cannot. Sometimes he fancies himfelf in a houfe that is on fire, or that he is in danger of being drowned in a river. He often thinks he is falling over a precipice, and the dread of being dafhed to pieces fuddenly awakes him. This diforder has been fuppofed to proceed from too much blood-: from a ftagnation of blood in the brain, lungs, &c. But it is rather a nervous affea ion, and arifes chiefly from indigeftion. Perfons of \/eak nerves, who lead a fedentary life, and live full, are moft comr monly affliaed with the night-mare. Nothing tends more to pro- duce it than heavy fuppers, efpecially when eaten late, or the pa- tient goes to bed foon after. Wind is a very frequent caufe of this *• Laudanum fliould always be tried by the mouth in large dofes, a? it can be given without delay; which is of the utnioft coafequenco in fo dangerous a difeafe. (I. C.) ^ i The put'.e it may go into the warm bath, which is more efEca- elim. -(!• **^h SWOONINGS. 50$ difeafe; for which reafon, thofe who are affliaed with it, ought to avoid all flatulent food. Deep thought, anxiety, or any thing that ©ppreffes the mind, ought to be avoided. As perfons affliaed with the night-mare generally moan, or make fome noife in the fit, they fhould be waked, or fpoken to by fuch as hear them, as the uneafinefs generally goes off as foon as the patient is awake. Dr. Whytt fays, he generally found a dram of brandy, taken at bed-time, prevent this difeafe. That, however, is a bad cuftom, and in time lofes its effea. The patient fhould rather de- pend upon the ufe of food of eafy digeftion, cheerfulness, exercife through the day, and a light fupper taken early, than accuftom him- felf to drams. A glafs of peppermint-water will often promote di- geftion as much as a glafs of brandy, and is much fafer. After a per- fon of weak digeftion, however, has eaten flatulent food, a drara may be neceffary ; in this cafe, it is the moft proper medicine. Of Swoonings. PEOPLE of weak nerves or delicate conftitutions, are liable t« fwoonings or fainting fits. Thefe are feldom dangerous when duly attended to; but when wholly negkaed, or improperly treated, they often prove hurtful, and fometimes fatal. The general caufes pf fwoonings are, fudden transition from cold to heat; breathing air that is deprived of its proper fpring or elaf- ticity; great fatigue ; exceffive weaknefs ; lofs of blood; long falling ; fear, grief, and other violent paffions or affeaions of the mind. Perfons who have been long expofed to cold, often faint or fall into a fwoon, upon coming into the houfe, efpecially if they drink hot liquor, or fit near a large fire. This might eafily be prevented by people taking care not to go into a warm room immediately af- ter they have been expofed to the cold air, to approach the fire gra- dually, and not to eat or drink any thing hot, till the body has been gradually brought into a warm temperature. When any one, in confequence of negleaing thefe precautions, falls into a fwoon, he ought immediately to be removed to a cooler apartment, to have* ligatures applied above his knees and elbows, and to have his hands and face fprinkled with vinegar or cold water. He fhould likewife be made to fmell to vinegar, and fhould have a fpoonful or two of water, if he can fwallow, with about a third- part of vinegar mixed with it, poured into his mouth. If thefe fhould pot remove the complaint, it will be neceffary to bleed the patient, ■and afterwards to give him a clyfter. As air that is breathed frequently lofes its elafticity or fpring, it is Mwonder, if perfons who lvfpire in it, often fall into a fwoon or iainthig fit. They are, in this cafi', deprived of the very principle 3io SWOONINCS. of life. Hence it is, that fainting fits are fo frequent in all crowded affemblies, efpecially in hot feafons. Such fits, however, muft be considered as a kind of temporary death; and, to the weak and de- licate, they fometimes prove fatal. They ought, with the utmoft care, to be guarded againft. The method of doing this is obvious. Let affembly-rooms, and all other places of public refort, be large and well ventilated ; and let the weak and delicate avoid fuch places, particularly in warm feafons. A perfon who faints, in fuch a fituation, ought immediately to be carried into the open air ; his temples fhould be rubbed with ftrong vinegar or brandy, and volatile fpirits or falts held to his nofe. He fliould be laid upon his back with his head low, and have a little wine, or fome other cordial, as foon as he is able to fwallow it, poured into his mouth. If the perfon has been fubjea to hyfleric fits, "caftor or afafoetida fhould be applied to the nofe, or burnt feathers, horn, or leather, &c. When fainting-fits proceed from mere weaknefs or exhauftion, which is often the cafe after great fatigue, long falling, lofs of blood, or the like, the patient muft be fupported v/ith generous cor- dials, as jellies, wines, fpirituous liquors, Sec. Thefe, however, muft be given at firft in very fmall quantities, and increafed gradually as the patient is able to bear them. He ought to be allowed to lie quite ftill and eafy upon his back, with his head low, and fliould have frefh air admitted into his chamber. His food fhould cor. lift of nourifhing broths, fago-gruel with wine, new milk, and other things of a light and cordial nature. Thefe thing are to be given out of the fit. All that can be done in the fit is, to let him fmell to a bottle of Hungary-water, eau de luce, or fpirits of hartfhorn, and to rub his temples with warm brandy, or to lay a comprefs dipped in it to the pit of the ftomach. In fainting-fits that proceed from fear, grief, or other violent paf- fions or affeaions of the mind, the patient muft be very cautioufly managed. He fhould be fuffered to remain at reft, and only made to fmell fome vinegar. After he is come to himfelf, he may drink freely of warm lemonade, or balm-tea, with fome orange or lemon- peel in it. It will likewife be proper, if the fainting-fits have been long and fevere, to clean the bowels by throwing in an emollient "clyfter. It is common in fainting-fits, from whatever caufe they proceed, to bleed the patient. This praaice may be very proper in ftrong perfons of a full habit; but in thofe who are weak and delicate, or fubjea to nervous diforders, it is dangerous. The proper method with fuch people is, to expofe them to the free air, and to ufe cor- dial and ftimulating medicines, as volatile falts, Hungary-water, fpirits of lavender, tinaure of caftor, and the like. m 3" Of Flatulencies, or Wind. ALL nervous patients, without exception, are affliaed with wind or flatulencies in the ftomach and bowels, which arife chiefly from the want of tone or vigour in thefe organs. Crude, flatulent ali- ment, as green peafe, beans, cokworts, cabbages, and fuch-like, may increafe this complaint; but ftrong and healthy people are feldom troubled with wind, unlefs they either overload their ftomachs, or drink liquors that are in a fermenting ftate, and confequently full of elaftic air. While, tlierefore, the matter of flatulence proceeds from our aliments, the caufe which makes air feparate from them, in fuch quantity as to occafion complaints, is almoft always a fault of the bowels themfelves, which are too weak either to prevent the produaion of elaftic air, or to expel it after it is produced. To relieve this complaint, fuch medicines ought to be ufed as have a tendency to expel wind, and by ftrengthening the alimen- tary canal, to prevent its being produced there*. The lift of medicines for expelling .wind is very numerous; they often difappoint the expeaations of both the phyfician and his pa- tient. The moft celebrated among the*clafs of carminatives are ju- nipar-berries; the roots of ginger and zedoary ; the feeds of anife, caraway, and coriander; gum afafcetida and opium ; the warm wa- ters, tinaures, and fpirits, as the aromatic water, the tinaure of woodfoot, the volatile aromatic fpirit, aether, &c. Dr. Whytt fays, he found no medicines more efficacious in ex- pelling wind than rather and laudanum. He generally gave the lau- danum in a mixture with peppermint-water and tincture of caftor, or fweet fpirits of nitre. Sometimes, in place of this, he gave opi- um in pills with afafcetida. He obferves, that the good effeas of opiates are equally confpicuous, whether the flatulence he contain- ed in the ftomach or inteftines; whereas, thofe warm medicines, commonly called carminatives, do not often give immediate relief, except when the wind is in the ftomach. With regard to aether, the Doaor fays, he has often feen very good effeas from it in flatulent complaints, where other medicines failed. The dofe is a tea-fpoonful mixed with two table-fpoonfuls of waterf. In gouty cafes, he obferves, that aether, a glafs of French brandy, or of the aromatic water, or ginger, either taken in fub- 4 Many nervous people find great benefit from eating a dry bifaiit, efpecially when the ftomach i. empty. This is one of the h.lt carmina- tive medicines in ad complaints of the ftomach, arifing from flatulence, indigeliioii, &c. t Though the patient may begin with this quantity, it will be necef- fary ^Mncreafe the dole gradually as the ftomach can bear it. /hither is mflBiven in conhderably greater dofeu than it was in Dr. Whyu** time, 3«* FLATULENCIES, OR WIND. ftance or infufed in boiling water, are among the beft medicines for expelling wind. Whm the cafe of flatulent patients is fuch as fnakes it impro- per to give them warm medicines inwardly, he recommends exter- nal applications, which are fometimes of advantage. Equal parts of the anti hyfleric and ftomach plaifter may be fpread upon a pi. ce of loft leather, of fuch fize as to cover the greater part of the belly. This fhould be kept on for a confiderable time, provi- ded the patient be able to bear it; if it fhould give great uneafi- nefs, it may be taken off, and the following liniment ufed in its ftead : Take of Bates's anodyne balfam an ounce; of the expreffed oil of mace half an ounce ; oil of mint two drachms. Let thefe be mixed together, and about a table-fpoonful well rubbed on the parts at bed-time. For strengthening the ftomach and bowels, and leffening the produaion of flatulence, the Doaor recommends the Peruvian bark, bitters, chalybeates, and exercife. In flatulent cafes, he thinks fome nutmeg or ginger fhould be added to the tinaure of the bark and bitters, and that the aromatic powder fhould be joined with the filings of iron. , When windy complaints' are attended with coftivenefs, which is often the cafe, few things will be found to anfwer better than four or five of the following pills taken every night at bed-time. Take of afafcetida, two drachms ; fuccotrine aloes, fait of iron, and powdered ginger, of each one drachm ; as much of the elixir proprietatis as will be fufficient to form them into pills. On the other hand, when the body is too open, twelve or fifteen grains of rhubarb, with half a drachm, or two fcruples of the Japo- nic confeaion, given every other evening, will have very good ef- feas. In thofe flatulent complaints which come on aboujt the time the menfes ceafe, repeated fmall bleedings often give more relief than any other remedy. With regard to diet, the Doaor obferves, that tea, and all flatu- lent aliments, are to be avoided; and that for drink, water with a little brandy or rum is preferable to malt liquor, and in moft cafes to wine. Dr. Whytt has paid great attention to this fubjea ; his fenti- ments upon it, in a great meafure, agree with mine. I fhall only add to his obfervation, that exercife is, in my opinion, fuperior t# all medicine, both for preventing the produaion and hkewife for ex- pelling of flatulencies. Thefe effeas are not to be expeaed from fau: tering about, or lolling in a carriage; but from labour, or fuch aaive amufements as give exercife to every part of the body. • I 313 ] Of Low Spirits. ALL who have weak nerves are fubjea to low fpirits in a grea* icy or lefs degree. Generous diet, the cold bath, exercife, and amufements are the moft likely means to remove this complaint. It is greatly increafed by folitude and indulging gloomy ideas ; but may often be relieved by cheerful company and fprightly amufe- ments. When low fpirits are Owing to a weak relaxed ftate of the fto>- mach and bowels, an infufion of the bark with cinnamon or nut- meg will be proper. Steel joined with aromatics may be ufed with advantage; but riding,and a proper diet, are moft to be depended on. When they arife from a foulnefs of the ftomach and inteftines, or obftruaion in the hypochondriac vifcera, aloetic purges will be proper. I have known the Harrowgale fulphur-water of fervice iri this cafe. When low fpirits proceed from a fuppreffion of the menftrual or of the hemorrhoidal flux, thefe evacuations may either be reftored, or fome others fubftituted in their place, as iffues, feton s, or the like. Dr. Whytt obferves, that nothing has fuch fudden good effeas in this eafe as bleeding, if the ftrength of the patient will admit o£ it. When low fpirits have been brought on by long continued grief, anxiety, or other diftrefs of mind, agreeable company, variety of amufements, and change of place, efpecially travelling into foreign countries, will afford die moft certain relief. Perfons affliaed with low fpirits fhould avoid all kinds of excefs, efpecially of venery and ftrong liquors. The moderate ufe of wine and other ftrong liquors is by no means hurtful; but when taken to excefs, they weaken the flomaoh, and deprefs the fpirits. This cau- tion is the more neceffary, as the unfortunate and melancholy often fly to ftrong liquors for relief, by which means they, never fail t# precipitate their own deftruaion. Of Hyfleric Affeaions. THESE likewife belong to the numerous tribe of nervous difea- fes, which may be juftly reckoned the reproach of medicine. Wo<> men of a delicate habit, whofe ftomach and inteftines are relaxed, and whofe nervous fyftem is extremely fenfible, are moft fubjea to hyfleric complaints. In fuch perfons, an hyfleric fit, as it is called, may hebrought on by an irritation of the nerves of the ftomach or inteliK, by wind, acrid humour, or the like. A fudden fuppref- fion of the menfes often gives rife to hyfleric fits. They may likewife R 2 3*4 * HYSTERIC AFFECTIONS. be excited by violent paffions or affeaions of the mind, as fear, grief, anger, or great difappointments. Sometimes the hyfleric fits refemble a fwoon or fainting fit, du- ring which the patient lies as in a fleep, only die breathing is fo low as fcarce to be perceived. At other times the patient ii affeaed with catchings and ftrong convulfions. The fymptoms which pre- cede hyfleric fits are likewife various in different perfons. Some- times the fits come on with coldnefs of the extremities, yawning and ftretching, lownefs of fpirits, oppreffion and anxiety. At other times the approach of the fit is foretold by a feeling, as if there were a ball at the lower part of the belly, which gradually rifes towards the ftomach, where it occafions inflation, ficknefs, and fometimes vomiting ; afterwards it rifes into the gullet, and occa- fions a degree of fuffocation, to which quick breathing, palpitation of the heart, giddinefs of the head, dimnefs of the fight, lofs of hear- ing, with convulfive motions of die extremities and other parts of the body, fucceed. The hyfleric paroxyfm is often introduced by an immoderate fit of laughter, and fometimes it goes off by crying. Indeed, there is not much difference between the laughing and cry- ing of an highly hyfleric lady. , Our aim in the treatment of this difeafe muft be mation of the ear itfelf. When this is the cafe, it admits of no cure; and the perfon not only continues deaf, but generally likewife dumb for life*. When deafnefs is the effea of wounds or ulcers of the ears, or of old age, it is not eafily removed. When it proceeds from cold ■* Though thofe born deaf are generally fuffered to continue dumb, andconfequefltly are, in a great rrieafure, loft to fociety, yet nothing is more certain than that fuch perfons may be taught not only to read and write, but alfo to fpeak, and to underftand what others fay to them. Teaching the dumb to fpeak will appear paradoxical to thofe who do not confider that the formation of founds is merely mechanical, and way be taught without the affiftance of the ear. This is not only capa- S 3 322 THE EAR. of the head, the patient muft be careful to keep his head warm, es- pecially in the night; he fhould likewife take fome gentle purges, and keep his feet warm, and bathe them frequently in lukewarm water at bed-time. When deafnefs is the effea of a fever, it gene- rally goes off after the patient recovers. If it proceeds from dry wax flicking in the ears, it may be foftened by dropping oil into them* ; afterwards they muft be fyringed with warm milk and water. If deafnefs proceeds from drynefs of the ears, which may be known by looking into them, half an ounce of the oil of fweet al- monds, and the fame quantity of liquid apodeldoch, or tinaure of afafcetida, may be mixed together, and a few drops of it put into the ear every night at bed-time, ftopping them afterwards with a little wool or cotton. Some, inftead of oil, put a fmall flice of the fat of bacon into each ear, which is faid to anfwer the purpofe ve- ry well. When the ears abound with moifture, it may be drained off by an iffue or feton, which fhould be made as near the affeaed parts as poffibie.. Some, for the cure of deafnefs, recommend die gall of an eel mixed with fpirit of wine, to be dropped into the ear; others, equal narts of Hungary-water and fpirit of lavender. Etmuller ex- tols amber and mufk; and Brookes fays, he has often known hard- fiefs of hearing cured, by putting a grain or two.of mufk into the ear with cotton-wool. But thefe and other applications muft be va- ried, according to the caufe of the diforder. Though fuch applications may fometimes be of fervice, yet they much oftener fail, and frequently they do hurt. Neither the eyes nor ble of demonstration, but "13 actually reduced to practice by Mr. Thomas Braidwood, of Edinburgh. This gentleman has, by the mere force of genius and application, brought the teaching of dumb perfons to fuch a degree of perfection, that his fcholars are generally more forward in their education than thofe of the fame age who enjoy all their fatuities. They net only read and write with the utmoft readinefs, but likewife fpeak, and are capable of hftldlng converfation with any perfon in the light. vVhat a pity any of the human fpecies fliould remain in a ftate of idi- otifm who are eapable of being rendered ufeful and intelligent. "Yv'e mention this not only from humanity to thofe who have the misfor- tune to be born deaf, but alfo in juftice to Mr. Braidwood, whofe fuc- cefs has far exceeded all former attempts this way ; and indeed it ex- ceeds imagination itfelf fo far, that no perfon who has not feen and ex- amined his pupils, can believe whatHhey are capable of. As this gentle- man, however willing, is only able to teach a few, and as the far great- er part of thofe who are born deaf cannot afford to attend him, it would be an act of great humanity, as well asr of public utility, to erett an academy for their benefit. ■5fr Good'effe0.s have been derived from wearing a conical plug in the ear, madeof the ftalk of a green cabbage, which will, after awhile, give out its water, and be more conftantly applied in diffolving the wax,foas to prepare it for fyringing with milk and water, (I. G. *t TASTE AND SMELL. jm «ar$ ought to be tampered with; they are tender organs, and re- quire a very.delicate touch. I chiefly recommend in deafnefs to keep the head warm. From whatever caufe the diforder proceeds this is always proper; and I have known more benefit from it alone, in ;the moft obftinate cafes of deafnefs, than from all the medicines I ever ufed. The Tafte and $meH ARE not of fo great importance to man in a ftate of fociety, as fthe fight and hearing ; yet, as the lofs of them is attended with in- conveniency, they deferve our notice. They are feldom to be re- ftored when loft ; which ought to make us very attentive to .their prefervation, by carefully avoiding whatever may injure them. As there is a very great affinity between the organs of tailing and fmel- ling, whatever hurts the one generally affeas the other. Luxury is highly injurious to thefe organs. When the nofe and palate are frequently ftimulated by fragrant and poignant difhes, . .they foon lofe the power of difting.uifhing taftes and odours with any degree of nicety. Man, in a ftate of nature, may perhaps have „ thefe faculties as acute as any other animal. The fenfe of fmelling may be diminifhed or deftroyed by difeafe; as, the moifture, drynefs, inflammation or fuppuration of thafrmem- bvane which lies the infide of the nofe, commonly called the olfac- tory membrane ; the compreffion of the nerves which fupply this membrane, or fome fait in the brain itfelf at their origin. A defea, or too great a degree of folidity, of the fmall fpungy bones of the ..upper jaw, the caverns of the forehead, &c. may impair the fenfe offmelling. It may be injured by a colkaion of foetid matter in thofe caverns, which keeps conftantly exhaling from them. Few things are more hurtful to the fenfe of fmelling than quantities of fnuff. When the nofe abounds with moifture, after gentle evacuations, fuch things as tend to take off irritation, and coagulate the thin, fharp ferum, may be applied ; as the oil of anife mixed with fine flour; qpmphire diffolved in oil of almonds, &c. (The vapours of amber, frankincenfe, gum-maftic, and benjamin, may likewife be received into the nofe and mouth. * For moiftening the mucus when it is too dry, fome recommend fnuff made of the leaves of marjoram, mixed with the oil of amber, marjoram and anifeed ; or a flernutatory of calcined white vitriol; twelve grains of which may be mixed with two ounces of marjoram- ^ater, and filtrated^ The fteam or vapourtff vinegar upon hot iron 324 THE TOUCH. received up the noftrils, is of ufe for foftening the mucus, opening obftruaions, &c. If there is an ulcer in the nofe, it ought to be dreffed with fome emollient ointment, to which, if the pain be very great, a little lau- danum maybe added. If a venereal ulcer, it is not to be cured with- out mercury. In that cafe, the folution of the corrosive fublimate in brandy, may be taken, as direaed in the gutta ferena. The ulcer ought likewife to be wafhed with it; and the fumes of cinnabar may be received up the noftrils. If there be reafon to fufpea that the nerves which fupply the or- gans of fmelling, are inert, or want ftimulating, volatile fa!ts, ftrong fnuffs, and other things which occafion fneezing, may be applied to the nofe. The forehead may likewife be anointed with balfam of Peru, to which may be added a little of the oil of amber. The tafte may be diminifhed by crufts, filth, mucus, aphthae, pellicles, warts, &c. covering the tongue: it may be depraved by a fault of the faliva, which, being difcharged into the mouth, gives the fame fenfation, as if the food, which the perfon takes, had real- , ly a bad tafte; or it may be entirely deftroyed by injuries done to the nerves of the tengue and palate. Few things prove more hurt- ful either to the fenfe of tailing or fmelling than obftinate colds, ef- pecially thofe which affea the head. When the tafte is diminifhed by filth, mucus, &c. the tongue •ought to be fcraped and frequently wafhed with a mixture of water, vinegar, and honey, or fome other detergent. When the faliva is vitiated, which feldom happens unlefs in fevers or other difeafes, the coring of the diforder is the cure of this fymptom. To leave it in the mean time, if there be a bitter tafte, it may be taken away by -vomits, purges, and other things which evacuate bile. What is cal- led a nidorous tafte, arifing from putrid humours, is correaed by the juice of citrons, oranges, and other acids. A fait tafte is cured by plentiful dilution with watery liquors. An acid tafte is deftroyed hy abforbents, and alkaline falts, as powder of oyfter-fhells, fait of worm-wood, &c. When the fenfibility pf the nerves which fupply the organs of tafte is diminifhed, the chewing of horfe-radifh, or other ftimulating "fubftances, will help to recover it. Of the Touch. THE fenfe of touching may be hurt by any thing .that obftrua* the nervous influence, or prevents its being regularly conveyed to the organs of touching; as preffure, extreme cold, &c. It may like- wife be hurt by too great a degree of fenfibility, when the nerve is . j( fufiiciendy covered by the cuticle or fcarf-flcin, or where there SCHIRRUS AND CANCER. 325 Is too great a tenfion of it, or it is too delicate. Whatever diforders the funaions of the brain and nerves, hurts, the fenfe of touching. Hence it appears to proceed from the fame general caufes as palfy and apoplexy, and requires nearly the fame method of treatment. In z flupor, or defea of touching, which arifes from an obftruc- tion of the cutaneous nerves, the patient muft firft be purged; afte- wards fuch medicines as excite the aaion of the nerves, or ftimu- late the fyftem, may be ufed. For this purpofe, the fpirits of hartf- horn, fat volatile oleofum, horfe-radifh, &c. may be taken inwardly; the difordered parts, at the fame time, may be frequently rubbed with frefh nettles or fpirit offal ammoniac. Blifters and finapifms applied to the parts will likewife be of ufe, as alfo warm bathing, efpecially in the natural hot baths. CHAPTER XL VII. Of a Schirrus and Qancer. \ SCHIRRUS is a hard indolent tumour feared in fome of /\. the glands; as- the breafts, the arm-pits, &c. If die tumour becomes large, unequal, of a livid, blackifh, or leaden colour, and is attended with violent pain, it gets the name of an occult cancer. When the fkin is broken, and zfanies or ichorous matter, of an abominably foetid fmell is difcharged from the fore, it is called an open or ulcerated cancer. Perfons after the age of forty-five, par- ticularly women, and thofe who lead an indolent fedentary life, are moft fubjea to this difeafe. CAUSES.-----It is often owing to fuppreffed evacuations; hence it proves frequently fatal to women of a grofs habit, particularly old maids and widows, about the time when the menftrual flux; ceafes. It may be occafioned by exceffive fear, grief, anger, religious melancholy, or any of the depreffing paffions. Hence, the unfortu- nate, the choleric, and thofe perfons who devote themfelves to a religious life in convents or monafteries, are often affliaed with it. It may be occafioned by the long-continued ufe of food that is too hard of digeftion, or of an acrid nature; bybarrennefs; celibacy; indolence; cold ; blows; friaion ; preffure, or the like. Women often fuffer from the laft of thefe, by means of their flays, which fqueeze and comprefs their breafts fo as to occafion great mifchief. Sometimes the difeafe is owing to an hereditary difpofition. SYMPTOMS.----This diforder feems often very trifling at the beginning. A hard tumour about the fize of a hazle-nut, or per- haps fmaller, is generally the firft fymptom. This will often con- tinue for a long time without feeming to increafe, or giving the pa- rent great uneafinefs; but if the conftitution be hurt, or the tu- 326 SCHIRRUS AND CANCER. mour irritate^ by preffure, or improper treatment of any kind, it \ begins to extend itfelf towards the neighbouring parts, by pufhing out a kind of roots or limbs. It then gets the name of cancer, from a fancied refemblance between the limbs and the claws of a crab. The colour of the fkin begins to change, which is firft red, afterwards .purple, then bluifh, livid, and at laft black. The patient complains of heat, with a burning, gnawing, fhooting pain. The tumour is very hard, rough, and unequal, with a protuberance, or rifing, in the middle; its fize increafes daily, and the neighbouring veins be- come thick, knotty, and of a blackifh colour. The fkin at length gives way, and a thin, fharp ichor begins to flow, which corrodes the neighbouring parts till it forms a large unfighdy ulcer. More occult cancers arife, and communicate with the neighbouring glands. The pain and flench become intolkrable ; the appetite fails ; the ftrength is exhaufted by a continual heaic fever; at laft, a violent haemorrhage, or difcharge of blood, from fome part of the body, with faintings, or convulsion fits, generally put an end to life. REGIMEN.----The diet ought to be light, but nourifhing. All ftrong liquors, and high-feafoned or falted provifions, are to be avoided. The patient may take as much exercife as he can eafily bear; and fhould ufe every method to divert thought, and amufe his fancy. All kinds of external injury are carefully to be guarded againft, particularly of the affeaed part, which ought to be defen- ded from all preffure, and even from the external air, by covering it with fur or foft flannel. MEDICINE.-----For this difeafe no certain remedy is known. Its progrefs may fometimes be retarded, and fome of its moft dif- agreeable fymptoms mitigated, by proper applications. One misfor- tune attending the difeafe is, that the patient often conceals it to» long. Were proper means ufed in due time, a cancer might often be cured ; but after the diforder has arrived at a certain height, it generally fets all medicine at defiance. When a fchirrous tumour is firft difcovered, the patient ought to obferve a proper regimen, and to take twice or thrice a-week, a dofe of common purging mercurial pills. Some blood may alfo be let, and the part affeaed may be gently rubbed tvyice a-day with a little of cancers of the breafts. The medicine moft in repute for this difeafe is hemlock. Dr- Stork, phyfician at Vienna, has of late recommended the extraa of this plant as very efficacious in cancers of every kind. The Doaor fays, he has given fome hundred weights of it without ever hurting any body^and often .with manifeft advantage. He advifes the patient, however, to begin widi very fmall dofes, as. two or three grains, and to increafe the dofe gradually till fome good effea be perceived, and there to reft without further increafe. From two orvthree grains at firft, he fays he has increafed the dofe to two, three, or four drachms a-day, and finds that fuch dofes may be continued for fe- veral weeks without any bad confequences. . ~ The regimen which he recommends during the ufe of the medi- cine, is to avoid farinaceous fubftances not fermented, and too acrid aromatics. He fays, good wine will not be hurtful to thofe who are accuftomed to it, nor a morderate ufe of acids ; and adds, that the patient fhould live in a pure, free air, and keep his mind as quiet and cheerful as poffibie. He- does not pretend to fix the time in which a cancer may be re- folved by the ufe of hemlock, but fays, he has given it for above two years in large dofes without any apparent benefit; neverthekfs* the patient has been cured by perfifting in the ufe of it for half a- year longer. This is, at leaft encouragement, to give it a fair trial- Though we are far from thinking hemlock merits thofe extravagant encomiums which he has beftowed upon it, yet, in a difeafe which has fo long baffled the boafted powers of medicine, ought always to be tried. The powder of hemlock is by fome preferred to the extraa. They are both made of the frefh leaves, and may be ufed nearly in the fame manner. Dr. Nicholfon of Berwich, fays, he gradually in- creafed the dofe of the powder from a few grains to 'half a drachm, ,and gave near four drachms of it in the day, with remarkably good , effeas. The hemlock may alfo be ufed externally either as a poul- tice or fomentation. The fore may likewife be kept clean by injea- . ing daily a ftrong decoaion of the tops and leaves into it. Few things contribute more to the healing of foul fordid ulcers of any kind than keeping them thoroughly clean. This ought never to 328 SCHIRRUS AND CANCER. be negleaed. The beft applkation for this purpofe feems to be the carrot poultice. The root of the common carrot may be grated, and moiftened with as much water as will bring it to the confif- tence of a poultice or cataplafm. This muft be applied to the fore, and renewed twice a-day. It generally cleans the fore, eafes the pain, and takes away the difagreeable fmell, which are objeas of no fmall importance*. Wort, or an infufion of malt, has been recommended, not only as a proper drink, but as a powerful medicine, in this difeafe. It muft be frequently made frefh, and the patient may take it at pleafure. Two, three, or even four Englifh pints of it may be drank every disy for a confiderable time. No benefit can be expeaed from any medicine in this difeafe, unlefs it be perfifted in for a long time. It is of too obftinate a nature to be foon removed; and, when it admits of a cure at allj it muft be brought about by inducing an almoft total change of the habit, which muft always be a work of time. Setons or iffues in the neighbourhood of the cancer have fometimes good effeasf. When all other medicines fail, recourfe muft be had to opium, as a kind of folace. This will not indeed cure the difeafe, but it will eafe the patient's agony, and render life more tolerable while it continues. To avoid this diforder, people ought to ufe wholefome food ; to take fuffkient'exercife in the open air; to be as eafy and cheerful as poffibie; and carefully to guard againft all blows, bruifes, and every kind of preffure upon the breafts or other glandular parts}. # London Medical Eflay*. t In a cancer which had fet all medicines, and even furgery, at de- fiance, I lately faw remarkable effects from an obftinate perfeverance In a courfe of antifeptics. I ordered the deep ulcers to be wafhed to the bottom, by means of a fyringe, twice or thrice a-day, either with an infufion of the bark, or a decoction of carrot, and that the patient fhould take, four or five times a-day, a glafs of good wine, with half a drachm of the beft powdered bark in it. The fores, after being wafh- ed, were likewife fprinkled with the fame powder. When the patient began this courfe, her death was daily expected. She continued it for above two years, with manifeft advantage; but being told by an emi- nent furgeon, that the bark would not cure a cancer, antl that the fores ought not to be wafhed, fhe discontinued the practice, and died io a few weeks. This courfe was not expected to cure the cancer, but fo prolong the patient's life, which it evidently did almoft to a miracle. $ As hemlock is the principal medicine recommended in this difeafe, we would have given fome direaions for the gathering and preparing of that plant; but as its different preparations are now kept in the fhop*, it is much fafer for people to get them there, with proper direaions for ufing them. [ 3-3$ 3 CHAPTER xlviii; ^ Of Poifions. EVERY perfon ought, in fome meafure, to be acquainted with the nature and cure of poifons. They are generally taken un- awares, and their effeas are often fo fudden and violent, as not to admit of delay, or time to procure the affiftance of phyficians. Hap- pily no great degree of medical knowledge is here neceffary ; the remedies for moft poifons beings generally at hand, or eafily obtain-' ed, and nothing but common prudence needful in the application bf them. The vulgar notion, that every poifon is cured by fome tounter- poifon, as a fpecific, has done much hurt. People believe they can do nothing for the patient, unlefs they know the particular antidote: to that kind of poifon which he has taken. Whereas the cure of all poifons taken into the ftomach, without exception, depends chief- ly on discharging them as foon as poffibie. , >..; ... There is no cafe wherein the indications of cure are more obvious. Poifon is feldom long in the ftomach before it occafions ficknefs, with an inclination to vomit. This fhews plainly what ought to be done. Indeed common fenfe diaates to every one, that, if any thing has been taken into the ftomach which endangers life, it ought im- mediately to be difcharged. Were this duly regarded, the danger arifing frohi poifons might generally be avoided. The method of prevention is obvious, and the means are in the hands of every one. We fhall not take up the reader's time with a detail of the ridi- culous notions which have prevailed among ignorant people in dif- ferent ages with regard to poifons; neither fhall we mention the boafted antidotes, which have been recommended either for pre- venting or obviating their effeas; but fhall point out the poifons ihoft common in this country, and the means of avoiding their dan- gerous confequences. Poifons_ either belong to the mineral, the vegetable, or die animal kingdom. Mineral poifbhs are commonly of an acrid or corrofive quality ; as arfenic, cobalt, the corrofive fublimate of mercury, &c. Thofe of the vegetable kind are generally of a narcotic or ftu- J&efaaive quality; as poppy, hemlock, henbane, berries of the dead- ly night-fhade, &c. , Poifonous animals communicate their infaaion either by the bite or fling. This poifon is very different from the former, and only produces its effeas when received into the body by a wound. MINERAL POISONS.---Arfenic is the moft common of this plafs; and, as the whole of them are pretty fimilar both in thei* 3$o POISONS. effeas and method of cure, what is faid with refpea to it wilr br applicable to every other fpecies of corrofive poifon*. When a perfon has taken arfenic, he foon perceives a burning heat, and a violent pricking pain in his ftomach and bowels, with an intolerable thirft, and an inclination to vomit. The tongue and throat feel rough and dry ; and, if proper means be not foon adminif- tered, the patient is feized with great anxiety, hiccupping, faintings, and coldnefs of the extremities. To thefe fucceed black vomits, 'foetid ftools, with a mortification of the ftomach and inteftines, which are the immediate forerunners of death. On the firft appearance of thefe fymptoms, the patient fhould drink large quantities of new milk and fallad-oil till he vomits ; or he may drink warm water mixed with oil. Fat broths are likewife proper, provided they can be got ready in time. Where no oil is to be had, frefh butter may be melted and mixed with the milk or wa- ter. Thefe thing are to be drank as long as the inclination to vomit continues. Some have drank eight or ten Englifh quarts before the vomiting ceafed; and it is never fafe to leave off drinking while one particle of the poifon remains in the ftomach. Thefe oily or fat fubftances not only provoke vomiting? but like- wife blunt the acrimony of the poifon, and prevent its wounding, the bowels ; but if they fhould not make the perfon vomit,, half a drachm, or two fcruples of the powder of ipecacuanha muft be given, or a few fpoonfuls of the oxymel or vinegar of fquills may be mixed with the water which he drinks. Vomiting may likewife be excited, by tickling the infide of the throat with a feather. Should thefe methods, however, fail, half a drachm of white vitriol, or five or fix grains of emetic tartar, muft be adminiftered. If tormenting pains are felt in the lower belly, and there is reafon to fear that the poifon has got down to the inteftines, clyfters of milk and oil muft be very frequently thrown up ; and the patient muft drink emollient decoaions of barky, oat-meai, marfh-mallows, and fuch-like. He muft likewife take an infufion of fenna and man- na, a folution of Glauber's falts, or fome other purgative. After the poifon has been evacuated, the patient ought, for fome time, to live upon fuch things as are of a healing and cooling quality; to abstain from flefh and all ftrong liquors, and to live upon milk, broth, gruel, light puddings, and other fpoon-meats of eafy digeftion. His drink fhould be barley-water, linfeed-tea-, or infufions of any of the mild mucilaginous vegetables. VEGETABLE POISONS, befides heat and pain of the fto- mach, commonly occafion fome degree of giddinefs, and often a kind of flupidity or folly. Perfons who have taken thefe poifons muft be treated in the fame manner as for the mineral or corrofive. # Corrofive sublimate is an exception when this poifon has been tak- en, the patient ought to drink large quantities of pot-afh or fait of tar- tar, diffolved in water to re-compofe the poifon and render it inactive. (I. C) BITES OF POISONOUS ANIMALS. 331 Though the vegetable poifons, when allowed to remain in the fto- **nach, often prove fatal; yet the danger is generally over as foon aS they are difcharged. N6t being of fuch a cauftic or corrofive nature, they are lefs apt to wound or inflame the bowels than mineral fub- ftances : no time ought to be loft in having them difcharged. * Opium, bping frequently taken by miftake, merits particular at- tention. It is ufed as a medicine bpth in a folid and liquid form, which latter commonly goes by the name of laudanum. It is, in- deed, a valuable medicine when taken in proper quantity; but as an over-dofe proves a ftrong poifon, we fhall point out its common effeas, together with the method of cure. An over-dofe of opium generally occafions great drowfinefs, with ftupor and other apoplcaic fymptoms. Sometimes the perfon has fo great an inclination to fleep, that it is almoft impoffible to keep him awake. Every method muft, however, be tried for this purpofe. He fhould be tofftd, fhaked, and moved about. Sharp blifters fhould be applied to his legs or arms, and ftimulating medicines, as falts of hartfhorn, &c. held under his nofe. It will alfo be proper to let blood. At the fame time, every method muft be taken to make him ' dicharge the poifon. This may be done in the manner direaed above, viz. by the ufe of ftrong vomits, drinking plenty of warm water with oil, &o ' Mead, befides vomits in this cafe, recommends acid medicines with lixivial falts. He fays, that he has often given fait of worm- wood mixed with juice of lemon' in repeated dofes with great fuccefs. If the body fhould remain weak and languid after the poifon has been difcharged, nourifhing diet and cordials will be proper; but when there is reafon to fear that the ftomach or bowels are in- flamed, the greateft circumfpeaion is neceffary, both with regard to food and medicine. Of the Bites, of Poifonous Animals. 1 WE fhall begin with the bite of a mad dog, as it is both the moft common and dangerous animal-poifon in this country. The creatures naturally liable to contraa this difeafe are, as far as we yet know, all of the dog kind, viz. foxes, dogs, and wolves.— Hence it is called the rabies canina, or dog madnefs. It fo feldom happens that any perfon is bit by the firft, that-they fcarce deferve to be taken notice of. If fuch a thing fliould happen, the method of treatment is precifely the fame as for the bite of a mad dog. The fymptoms of madnefs in a dog are as follow: At firft he looks dull, ftiews an averfion to food and company: he does not bark as ufual, but feems to murmur, i» peevifh, and apt to. bite 3j* BITES OF POISONOUS ANIMALS. ftrangers: his ears and tail droop more than ufual, and he appears drowfy: afterwards he begins to loll out his tongue, and froth at the mouth, his eyes feeming heavy and watery : he now, if not Confined, take6 off, runs panting along with a kind of dejeaed air, and endeavours to bite every one fie meets. Other dogs are faid to jBy from him. Some think this a certain fign of madnefs, fuppofing that they knew him by the fmell; but it is not to be depended on. If he efcapes being killed, he feldom runs above two or three days, till he dies exhaufted with heat,' hunger, and fatigue. This difeafe is moft frequent after long, dry, hot feafons ; and fuch dogs as live upon putrid, stinking carrion, without having enougrh of frefh-water, are moft liable to it. Wnen any perfon has been bit by a dog, the ftri6"teft inquiry ought to be made, whether the animal was really mad. Many difagreeable confequences arife from negkaing to afccrtain this point. Some people have lived in continual anxiety for many years, becaufe they had been bit by a dog which they believed to be mad; but as he had been killed on the fpot, it was impoffible to afcertain the faa. This fhould induce us, inftead of killing a dog the moment he has bit any perfon, to do all in our power to keep him alive, at leaft till we can be certain whether he be mad or not. Many circumftances may contribute to make people imagine a dog mad. He loofes his mafler, runs about in queft of him, is fet upon by other dogs, and perhaps by men. The creature thus frigh- tened, beat and abufed, looks wild, and lolls out his tongue as he runs along. Immediately a crowd is after him ; while he, finding himfelf clofely purfued, and taking every one he meets for an ene- my, naturally attempts to bite him in felf-defence. He foon gets knocked on the head, and it paffes currently that he was mad, as it is then impoffible to prove the contrary. This being the true hiftory of, by far, the greater part of thofe dogs which pafs for mad, is it any wonder that number lefs whim- fical medicines have been extolled for preventing the effeas of their bite ? This readily accounts for the great variety of infallible re- medies for the bite of a mad dog, which are to be met with in al- moft every family. Though not ope in a thoufand has any claim to merit, yet they are all fupported by numbcrlefs vouchers. No won- der that imaginary difeafes fhould be cured by imaginary remedies^ In this way, credulous people' firft impo'fe upon themfelves, and then deceive Others. The fame medicine which was fhppofcd to pre- vent the effeas of the bite; when the dog was not mad, is recom- mended to a perfon who has had the misfortune to be bit by a dog that was really mad. He takes it, trulls to it, and is undone. To thefe miftakes we muft impute the frequent ill fuccefs of the medicines, ufed for preventing the effeas of the bite of a mad dog. It is not owing fo much to a defea in medicine, as to wrong appli- cations. If proper medicines were adminiftered immediately after the bite is received, and continued for a fufficient length of time, we fliould not lofe one 'in a thoufand of thofe bit hy a mad dog. BITES OF POISONOUS ANIMALS. ^35 . This poifon is generally communicated hy a wound, which, never- thelefs, heals as foon as a common wound : but afterwards it begins to feel painful, and as the pain fpreads towards the neighbouring parts, the perfon becomes heavy and liftlefs. His fleep is unquiet, with frightful dreams-, he fighs, looks dull, and loves folitude. Thefe ^are the forerunners, or rather the firft fymptoms of that dreadful difeafe, occafioned by the bite of a mad dog. But as we do not pro- pofe to treat fully of the difeafe itfelf, but to point out the methodof preventing it, we fhall not take up time in fhowing its progrefs from the firft invafion to its commonly fatal end. The common notion, that this poifon may lie in the body for many years, and afterwards prove fatal, is both hurtful and ridicu- lous. It muft render perfons bit, very unhappy, and can have no good effeas. If the perfon takes proper medicines for forty days after the time of his being bit, and feels no fymptoms of the difeafe, there is reafon to believe him out of danger. The medicines recommended for preventing the effeas of the bite of a mad dog, are chiefly fuch as promote the different fecre^ tions, and antifpafmodics. Dr. Mead recommends a preventative medicine, which he fays he never knew fail, though in the fpace of-thirty years he had ufed it a thoufand times. It is as follows : " Take afh-coloured ground liver-wort, cleaned, dried, and pow- dered, half an ounce ; of black pepper powdered, a quarter of an ounce. , Mix thefe well together, and divide the powder into four dofes; one of which muft be taken every morning failing, for four mornings fucceffively, in half an Englifh pint of cows mill; warm. " After thefe four dofes are taken, the patient muft go into the cold bath, or a cqld fpring or river, every morning failing, for a month ; he muft be dipped all over, but not flay in (with his head above water) longer than half a minute, if the water be very cold. After this hfc muft go in three times a-week for a fortnight longer. " The perfon muft be bled before he begins to ufe the medicine*." We fhall next mention the famous Eaft-India fpecific, as it is cal- led. This medicine is compofed of cinnabar and mufk. It is efteem- ed a great antifpafmodic; and, by many, extolled as an infallible remedy for preventing the effeas of the bite of a mad dog. " Take native artd faaitious cinnabar, of each twenty-four grains, mufk fixteen grains. Let thefe be made into a fine powder, and taken in a glafs of arrack or brandy." This fingle dofe is faid to fecure the perfon for thirty days, at the end of which it muft be repeated ; but if he has any fymptoms of the difeafe, it muft be repeated in three hours. #■ Though we give this prefcription on the credit of Dr. Mead, )'et we would not advife any perfon, who, has reafon to believe that he-has been bit by a dog which was-really mad, to trull to it alone. Mead was an able phyfician, but he feems to have been no great phylofopher,« and was fometimes the dupe of his own credulity. 334 BITES OF POISONOUS ANIMALS. The following is likewife reckoned a good antifpafmodic medicine; " Take of Virginian fnake-root in powder, half a drachm j gum •afafcetida twelve grains, gum camphire feveh grains ; make thefe into a bolus with a little fyrup of fatfron." Camphire may alfo be given in the following manner: " Take purified nitre, half an ounce, Virginian fnake-root in powder, two drachms, camphire, one drachm ; rub them together in a mortar, and divide the whole into ten dofes." Mercury is likewife recommended as of great efficacy, both in the prevention and cure cf this kind of madnefs. When ufdd as a preventative, it will be fufficient to rub daily a drachm of the oint- ment into the parts about the wound. Vinegar is likewife of confiderable fervice, and fhould be taken freely, either in the patient's food or drink. Thefe are the principal medicines recommended for preventing the effeas of die bite of a mal dog. We would not advife people to truft to any one of them ; but from - proper combination of their different powers, there is the greateft reafon to hope for fuccefs. The great trior in die ufe of thefe medicines lies, in not taking them for'a fufficient length cf time. They are ufed more like charms, than medicine: hit *rx\~d toproduc', any change in the body. To this, and not to the inf utfickncy of the medicines, ,we muft impute their frequent want of h:c< eis. Dr. Mead ft:ys, that the virtue of his medicine confifts in promo- ting urine. But how a poifon fliould be-expelled by urine, with ohly'/ three or four dofes cf any medicine, however powerful, it is not eafy to conceive. More time is certainly mceflhry, even though the me- dicine wer.j more powerful than that which the Doaor prefcribes. The Eaft-India fpecific is ftill more exceptionabk on this ac- • count. As thefe and moft other medicines, taken singly, have frequent- lybeen found to fail, we fhall recommend the following courfe : If a perfon be bit in a fiefhy part, where there is no hazard of hurting any large blood-vefiel, the parts adjacent to the wound may, be immediately cut away*. But if this be not done foon after the bite has been received, it will be better to omit it. 1 he wound may be wafhed with, fait and water, or a pickle made of vinegar aid fait, and afterwards dreffed twice a-day with yellow bafiheon, mixed *vith the red precipitate of mercury. The patient fliould begin to 'ffe either Dr. Mead's medicine, or fome cf the others mentioned above. If "ho takes Mead's medicine, he may ufe it as the Doaor direas for four days fucceffively. Let him then emit it for two or three days, and again repeat the fame number cf doles as-before. During this courfe, he muft rub into the parts about the wound * Caulk his been recommended to be applied to the parr,- but jhir 'honl.l n?ver b^ employed when the knife can be ufed, for it is i;able t> frnilrate the intention by r.ut deitroyn^ the v, hok of the v. omid.d part. (I. Cj BITES OF POISONOUS ANIM1LS. 335 daily, one drachm of the mercurial ointment. This may be done for ten or twelve days at leaft. When this courfe is over, he may take a purge or two, and wait a few days till the effea of the mercury be gone off. He muft the» begin to ufe the cold bath, into which he may go every morning for five or fix weeks. If he fhould feel cold and chilly for a long time after coming out of the cold bath, it will be better to ufe a te- pid one, or to have the water a little warmed. Li the mean time, we would advife him not to leave off all in- ternal medicines, but to take either one of the bolufes of fnake-root, afafcetida, and camphire ; or one of the powders of nitre, camphire, and fnake-root, twice a-day. Thefe may be ufed during the whok time he is bathing. During the ufe of the mercurial ointment, the patient muft keep within doors, and take nothing cold. A proper regimen muft be obferved throughout the whole courfe. The patient fhould abftain from flefh, and all falted and high-fea- foned provifions. He muft avoid ftrong liquors, and live mostly up~ on a light and rather-fpare diet. His mind fhould be kept as eafy and cheerful as poffibie, and all exceffive heat and vioknt paffions avoided with the utmoft care. I have never feen this courfe of medkine, with proper regimen,. fail to prevent the hydrophobia, and cannot help again obferving, that the want of fuccefs muft generally be owing either to the ap- plication of improper medicines, or not ufing proper ones for a fuf- ficient length of time.. Mankind are extremely fond of every thing that prdmifes a fud- den or miraculous cure. By trufting to thefe, they often lofe their lives, when a regular courfe of medicine would have rendered them abfolutely fafe. This holds remarkably in the prefent cafe. Num- bers of people, for example, believe if they or their cattle be once dipped in the fea, it is fufficient; as if the fait water were a charm againft the effeas of the bite. This, and fuch like whims, have proved fatal to many. It is a common notion, if a perfon be bit by a dog which is not mad, that, if he fhould go mad afterwards, the perfon would be af- feaed with the diforder at the fame time; but this notion is too ridiculous to deferve a ferious confideration. It is a good ruk, how- ever, to avoid dogs as much as poffibie, as the difeafe is often upon them for fome time before its violent fymptoms appear. The hydro-* phobia has been occafioned by the bite of a dog which fhewed no other fymptoms of the difeafe but liftleffnefs and a fullen difpofition. Though we do not mean to treat fully of the cure of the hydro- phobia, yet we are far from reckoning it incurable. Tfie notion that this difeafe could not be cured, has been produaive of horrid con- fequences. It was ufual either to abandon the unhappy perfons, as foon as they were feized with the difeafe, to their fate, to bleed them to death,, or to fuffocate them between matraffes or feather beds, &c. 336 BITES OF POISONOUS ANIMALS. This coriduci: certainly dcferved the fevereft punifhment 1 We hopc^ for the honour of human nature, it will never again be heard of.. I have never had an opportunity of treating this difeafe, and therefore can fay nothing of it from my own experience; but Dr. •Tiffot fays, it may be cured in the following manner : i. The patient muft be bled to a confiderable quantity; and khis may be repeated twice, thrice, or even a fourth time, if circum- ftances require it. 2. The patient fhould be put, if poffibie, into a warm bath ; and -this fhould be ufed twice a-day. 3. He fhould every day receive two, ot even three emollient Clyfters. 4. The wound, and die parts adjoining to it, fhould be rubbed with the mercurial ointment twice a-day. 5. The whole limb which contains the wound mould be rubbed with oil, and be wrapped up in an oily flannel. 6. Every three hours a dofe of Cob's powder fhould be taken in a cup of the infufiort of lime-tree and elder-flowers. This powder is made, by rubbing together in a mortar, to a very fine powder, of native and faaitious cinnabar, each twenty-four grains; of mufk, fixteen grains*. 7. The following bolus is tbbe given every night, and to be re- peated in the morning, if the patient is not eafy, wafhing it down with the infufion mentioned above : Take one drachm of Virginian fnake-root in powder ; of camphire and afafcetida, ten grains each; of opium, one grain; and, with a fufficient quantity of conferve^ or rob of elder, make a bolus. 8. If there be a great naufea at the ftomach, with a bittemefs 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, mifft be light; as pana- do, foiips made of farinaceous or mealy vegetables, &c. l o. If the patient fhould long continue weak, and fubjea to ter- rors, he may take half a drachm of the Peruvian bark thrice a-day. The next poifonous animal which we fhall mention is the VIPER, The greafe of this animal rubbed into the wound is faid to cure the bite. Though that is all the viper-catcherS generally do when bit,; we fhould not think it fufficient for the bite of an enraged viper. It would surely be more fafe to have the wound well fuckedf, and af- * The Qrm'kirk medicine, as it is called, feems to me to confift chef-, ly of cinnabar. Though it is faid to be infallible, as a preventative; yet 1 would not advife any one to trull to italone. Indeed, it is ordered t» be taken in a manner which gives it more the appearance of a charm than of a medicine, burely. if a medicine is to produce any change in the body, it muft be taken for fome confiderable time, and in fufficient quantity. *t The practice of fucking out poifons is very ancient ; and indeed nothing can be more rational. Where the' bite cannot be cut out, thii is the moft likely way for extraaing the poifon. There can be no dan- ger in performing this office*, as the poifon docs n» harm, unlefs it be VfcNEfeEAL DISEASE. 33? lerwards rubbed with warm fallad-oil. A poultice of bread and milk, foftened with fallad-oil, fhould likewife 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 fweat. Vinegar is one of the beft medicines which can be ufed in any kind of poifon, and ought to be taken very liberally. If the patient be fick, he may take a vo^ mit- This courfe will be fumcient to cure the bite of any of the poifonous animals of this country. With regard to poifonous infeas, as the bee, the wafp, the hornet, &c. their ftings are feldom attended with danger, unlefs when a perfon happens to be flung by a great number of them at the fame time ; in which cafe fomething fhould be done to abate the inflam- mation and fwelling. Some, for rjiis purpofe, apply honey, others lay pounded parfley to the part. A mixture of vinegar and Venice treacle is likewife recommended ; but I have always found rubbing the part"with warm fallad-oil fucceed very well. Indeed, when the : ftings are fo numerous as to endanger the patient's life, which is fometimes the cafe, he muft not only have oily poultices applied to the part, but fliould likewife be bled, and take fome cooling medi- cines, as nitre, or cream of tartar, and fhould drink plentifully of diluting liquors. It is'the happinefs of this ifland to have very few poifonous ani- mals,, and thofe which we havei are by no means of the moft virulent kind. Nine-tenths of the effeas attributed to poifon or venom in this country, are really other difeafes, and proceed from quite dif- ferent caufes. ., We cannot, however, make the fame obfervation with regard to poifonous vegetables* Thefe abound every where, and prove often fatal to the ignorant and unwary. This, indeed, is chiefly owing to carelcflhefs. Children ought early to be cautioned againft eating any kind of fruit, roots, or berries, which they do not know, and all poi- fonous plants to which they can have accefs, ought, as far as poffibie, to be deftroyed. This would not be fo difficult a tafk as fome peo- ple imagine. CHAPTER XLIX* Of the Venereal Difeafe. IT is unfortunate for the unhappy perfons who contraa this dif- eafe, that it lies under a fort of difgrace. This renders difguife neceffary, and makes the patient either conceal his diforder altoge- taken into the body by a wound. The perfon1 who fucks the w»nr»d ought however to wafli his mouth frequently with falad-oil, which will fecure him from even the leaft inconveniency. The Pfylli in Africa, and-the Marfi in Italy, were famed for curing the bites of poifonous animals by fucking the wound; and we are told-that the Indians in North-America pradfife the famte at this day. 33S VIRULENT GONORRHCEA. ther, or apply to thofe who promife a fudden and fecret cure ; bi!t who in faa only remove the fymptoms for a time, while they fix the difeafe deeper in the habit. By this means, a flight infeaion, which might have been eafily removed, is often converted into an obftinate and fometimes incurable malady. Another unfavourable circumftance attending this difeafe is, that ft affumes a variety of different fhapes, and may with more propri- ety be called an affemblage of difeafes than a fingle one. No two difeafes can require a more different method of treatment than this does in its different ftages. Hence, the folly and danger of trufting to any particular nostrum for the cure of it. Such noftrums are however generally adminiftered in the fame manner to all who ap- ply for them, without the leaft regard to the ftate of the difeafe, the conftitution of the patient, the degree of infeaion, and a thoufand other circumftances of the utmoft importance. The venereal difeafe may be communicated to the innocent as well as the guilty. Infants, nurfes, midwivesr and married women whofe hufbands lead diffolute lives, are often affeaed with it, and frequently lofe their lives by not being aware of their danger in due time. The condition of fuch perfons will certainly plead our excufe, if any excufe be neceffary, for endeavouring to point out the fymp- toms and cure of this too common difeafe. To enumerate all its different fymptoms, and to trace the difeafe minutely through its various ftages, would require a much larger „ fpace than falls to this part of my fubjea. I therefore confine my obfervations chiefly to circumftances of importance, omitting j fuch as are trifling, or which occur but feldom. The Virulent Gonorrhoea IS an involuntary difcharge of infeaious matter from the parts 6f generation in either fex. It generally makes its appearance within eight or ten days after'the infeaion has been received : fometimes in two or three days, and at other times not for four or five weeks. Previous to the difcharge, the patient feels an itching, with a fmall degree of pain in the genitals. Afterwards a thin glary matter be- gins to diftil from the urinary paffage, which flains the linen, and occafions a fmall degree of titillation, particularly in the time of making water; this arifes at length to a degree of heat and pain, which are chiefly perceived about the extremity of the urinary paf- fage, where a flight degree of rednefs and inflammation likewife be- gin to appear. As the diforder advances, the pain, heat of urine, and running increafe, while frqfh fymptoms daily enfue. In men, the ereaions become painful and involuntary, and are more frequent and lafting VIRULENT GONORRHOEA. 333 fhan when natural. This fymptom is moft troublefome when the patient is warm in bed. The pain which was at firft only perceived towards the extremity, now begins to reach .-11 up the urinary paf- fage, and is moft intenfe juft after the patient has done making wa- ter. The running gradually grows yellow, and at length puts on the appearance of matter. When the diforder has arrived at its height, all the fymptoms are more intenfe; the heat of urine is fo great, that the patient dreads the making water; and, though he feels a conftant inclination this way, yet it is rendered with the greateft difficulty, and often only by drops : the involuntary ereaions now become extremely pain- ful and frequent; there is alfo a pain, heat, and fenfe of fulnefs about the feat, and the running is plentiful and fharp, of a brown, greenifh, and fometimes of a bloody colour. By a proper treatment, the violence of the fymptoms gradually abate ; the heat of urine goes off; the involuntary and painful erec- tions, and the heat and pain about the feat* become eafier; the Bin- ning alfo gradually decreafes, grows whiter and thicker, till at laft it entirely difappears. By attending to thefe fymptoms, the gonorrhoea may be general- ly diftinguifhed from any other difeafe. There are however fome few diforders for which it may hi miftaken, as an ulcer in the kid- hies or bladder, the fluor albus, or whites in women, &c. But in the former of thefe, the matter comes away only with the urine, or • when theTphinaer of the bladder is open ; whereas, in a gonorr- hoea, the difcharge is conftant. The latter muft be known chiefly from its effeas, as pain, communicating the infeaion, &c. REGIMEN.----When a perfon fufpeas that he has caught the 'venereal infeaion, he ought moft ftriaiy to obferve a cooling re-. gimcn, to avoid every thing of a heating nature, as wines, fpiritu-. ous liquors, rich fauces, fpiced, falted, high-feafoned and fmoke-. dried provifions, aromatic aud ftimulating vegetables, as onions, garlic, fliallot, nutmeg, muftard, cinnamon, mace, ginger, and fuch like. His food ovght chiefly to confift cf mild vegetables, milk, broths, light puddings, panado, gruels, &c. His drink maybe bar- ley-water, milk and water, decoctions of marfh-mallows and liquo-. rice, linfeed tea, or clear whey. Of thefe, he ought to drink plenti- fully. Violent exercife of all kinds, efpecially riding on horfeback, and venereal pleasures, are to be avoided. The patient muft beware of cold, and when the inflammation is violent, he ought to keep hisjjed. MEDICINE.-----A virulent gonorrhoea cannot always be cur- ed fpeedily and effeaually at the fame time. The patient ought not to expea, nor the phyfician to promife it. It will often continue for two or three weeks, and fometimes for five or fix, even where the treatment has been very proper- Sometimes a flight infeaion may be carried off in a few days by bathing the parts in warm milk and water, and injeaing frequent- 54o VIRULENT GONORRHOEA. Jy up the urethra a little fweet oil or linfeed-tea about the warmth pf new milk. Should thefe not fucceed in carrying off the infeaion, they will at leaft have f. tendency to teffen-its virulence. To effea a cure, however, aftringent injeaions will generally be found neceffary. Thefe may be various ways prepared, but I think thofe made with the white vitriol are both moft fafe and efficacious. They can be made ftronger or weaker as circumftances may require; but it is beft to begin with the more gentle, and increafe their power if neceffary. I generally order a drachm of white vitriol to be diffolved in eight or nine ounces of common or rofe-water, and an ordinary fyringe 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 dofe increafed*. Whedser injeaions be ufed or not, cooling purges are always proper in the gonorrhoea. They ought not however to be of the ftrong or draftic kind. Whatever raifes a violent commotion in the body increafes the danger, and tends to drive the difeafe deeper in- to the habit. Procuring two or three ftools every fecond or third day for the firft fortnight, and the fame number every fourth or fifth day for the fecond, will generally be fufficient to remove die inflammatory fymptoms, to diminifh the running, and to change the colour and confiftence of the matter, which gradually becomes more white and ropy as the virulence abates-)-. ■* Although it is now very common to cure the gonorrhoea by aflriii- gent injections, there are still, many practitioners who do not approve this mode of practice. I can, from much experience, affert, that it U both the inoll eafy and efficacious method of cure ; any bad confequences arifing from it muft be ojving to the ignorance or mifconduct of the prac- titioner himfelf, and hoc to the remedy. Many, for example, ufeHrong preparations of lead, all of which are dangerous when applied to the: in- ternal furfacej of the body ; others ufe efcharotics, which inflame and injur? the parts. I liave known a gonorrhoea actually cured by an in- jeclio:i made of green-tea, and would always recommend gentle me- thod;; where th?y will fucceed. t If the patient can fwallow a folution of falts and manna, he may lake fir. drachms, or, if his conftitution requires it, an ounce of the former, with h:t!f a:i ounce of the latter. Thefe may be difiblved in an Kuglifh pint pf boiling water, whey, or thin water-grv.el, and taken early in die morning. If an infufion of fenna and tamarinds be more agreeable, two drachm* of the former, and an ounce of the latter, maybe iniu'td all night in an Englifh pine of boiling water. The infufion may be /trained next morn- ing, and half an ounce of Glauber's faits diffolved in it. 4 Ua-uipful of r.h'i-> infufion may be taken every1 half hour till it operates. , yj Should the patient prefer an electuary, the following will be found to anfwer very well. Take of-the lenitive elei'tuary four ounces, cream of tartar two ounces, jalap in powder two drachms, rhubarb one drachm, and as much of the fyrup of pale rofes as will ferve to make up the whole into a foft electuary. Two or three tea-fpoonfuls of rhis may he taken over-night, and about the fame quantity next morning, every day that the patient choofes to take a purge. The dofes of the above medicines may be increafsd or diminiihtd ac- VIRULENT GONORRHOEA. When the inflammatory fymptoms run high, bleeding is always neceffary at the beginning. This operation, as in other topical in- flammations, muft be repeated according to the ftrengtli and confti- tution of the patient, and the vehemence and urgency of the fymp- toms. Medicines which promote the fecretion of urine, are proper in this ftage of the diforder. For this purpofe, two ounces of pounded arabic may be mixed with half an ounce of cream tartar, and di- \ ided into twenty-four dofes, one of which may be taken every morning and evening in a cup of the patient's drink. I have ge- nerally found this anfwer extremely well, both as to the diuretic, and for keeping the body gently open. When the pain and inflammation are feated high towards the neck of the bladder, it will be proper frequently to throw up an emollient clyfter, which, befides the benefit of procuring ftools; will ferve as a fomentation to the inflamed parts. Soft poultices, when they can conveniently be applied to the parts, are of great fervice. They may be made of the flour of fin- feed, or of wheat bread and milk, foftened with frefh butter or fweet oil. When poultices cannot be conveniently ufed, cloths wrung out of warm water, or bladders filled with warm milk and water, maybe applied. I have often known'the moft excruciating.pains, during the inflammatory ftate of the gonorrhoea, relieved by one or other of thefe applications. Few things tend more to keep off inflammation in the fpermatic • yeflels, thana proper trufs for the fcrctum. It ought to be fo con- trived as to fupport the tefticks, and fhould be worn from the firil appearance of the dife fe till it hasceafed fome weeks.. The above treatment will fometimes remove the , gonorrhoea f> quickly, that the perfon will be in doubt whether he really labour- ed under that difeafe. This, however, is too favourable a turn to be often expected, and ought never to be adopted. When the above treatment has removed the,heat of urine, and forenefs of the genital parts ; when the quantity of running is con- fiderably leffened, without any pain or fwelling in the groin or td- ticle fupervening ; when 'the patient is free from involuntary erec- tions; and laftly, when the running becomes pale, whidlh, duel:, void of ill fmell, and tenacious or rcpy ; when all or moil cf thefe fymptoms appear, the gonorrhoea is arrived at its lift ftage, and w; may gradually1 proceed to treat ft as a gleet wi:h .ilringent medi- cines. cordin- as the pr.t'ent finds it neceffary. We have ordered the falts to be diffolved in a large qua::::ry o: * uter, becaufe U renders the.r operation mere mild. [ 34* ] Of Gleets. A GONORRHCE A frequently repeated, or improperly treated, often ends in a gleet, which may either proceed from relaxation, or from fome remains of the difeafe. It is of the greateft importance in thccure, to know from which caufe the gleet proceeds. When the difcharge proves very obftinate, and receives little or no check, from aftringent medincines, there is ground to fufpe£t that it is owing to the latter j but if the drain is inconstant, and is chiefly obfervablt when the patient is ftimulated by lafcfvious ideas, or upon ftrain- ing to go to ftool, we may reafonably conclude that it is chiefly owing to the former. In the cure of a gleet, proceeding from relaxation, the principal defign is to brace, and reftore a proper degree of tension to the de- bilitated and relaxed yeffels. For this purpofe, befides the medi- cines recommended in the gonorrhoea, the patient may have re- courfe to ftronger and powerful astringents, as the Peruvian bark*, «llum, vitriol, galls, tincture of gum kino, Set. The injections may be rendered more aftringent by the addition of a few grains of al- lum, or increasing the quantity of vitriol as far as- the parts are able to bear it. The laft remedy which we fhall mention in this cafe is the cold bath,'than which, there is not perhaps a more powerful bracer in the whole compafs of medicine. It ought never to be omitted in this fpe- cies of gleet, unlefs there be'fomething in the conftitution of the patient which renders the ufe of it unfafe. The chief objections to the ufe of the cold bath are, a full habit, and an unfound ftate of the vifcera. The danger from theformer may always be leflened, if not re- moved, by purging and bleeding; but the latter is an infurmountable obftack, as the preffure of the water, and the fudSen contraction of the external veffels, by throwing the blood with too much force up- on the internal parts, are apt to occafion ruptures of the veffels, or a flux of humours upon the difeafed organs. But where no objection of this kind prevails, the patient ought to plunge over head in wa- ter every morning failing, for three or four weeks together. He fhould not flay long in the water, and fnould have his fkin dried as foon as he comes out. The regimen proper in this cafe is the fame as in die laft ftage of the gonorrhoea : the diet muft be drying and aftringent, and the drink, Spa, Pyrmont, or Bristol waters, with which a little clartt er red wine may fometimes be mixed. Any perfon may now afford -* The Peruviai bark may be combined with other astringents, and prepared in thefellowi/.ig manner : Take of Peruvian bark bruifed, fijcdrachm«, of frefh gal!'; bruifed, two drachms; boil tlit-m in a pound and an half of watpr to a pound : to the ltrained liquor add thrt-e ounces of the fi'iiple tincturi? of the bark. A Imall tea-cupful of th's m y be taken three times a-dsy, adding to each cup fifteen or twenty drops of the acid elb.ir of vitriol. THE SWELLED TESTICLE. 343 to drink thefe waters, as they can be every where prepared at almoft no expence, by a mixture of common chalk and oil of vitriol. When the gleet does not in the fmalleft degree yield to thefe me- dicines, diere is reafon to fufpect that it proceeds from ulcers*. In this cafe, recourfe muft be had to mercury, and fuch medicines as tend to Correct any predominant acrimony with which the juices may be affected, as the decoction of China, fafaparilla, (affafras, or the like. , Mr. Fordyce fays, he has feen many obftinate gleets of two, three, or four years Handing, .effectually cured by a mercurial inunction, when almoft every other medicine has been tried in vain. Dr. Chap- man feems to be of the fame opinion ; but fays, he has always found the'mercury fucceed beft in this cafe when joined with terebinthi- nate and other agglutinating medicines. For which reafon, he re- commends pills made of calomel and Venice turpentinef ; and:de- fires that their ufe may be accompanied with a decoction of guaiar cum or farfaparilla.' For the cure of ulcers in the urinary paffage, fuppurating can- dles or bougies are prepared various ways, and are generally to be bought ready made. It is needkfs to fpend time in enumerating the different ingredients of which they are compofed, or teaching the manner of preparing them. Before a bougie be introduced in- to the urethra, it fhould be fmeared all over with fweet oil, to pre- vent it from ftimulating too fuddenly ; it may be fuffered to conti- nue in from one to feven or eight hours, according as the patient can bear it. Obftinate ulcers are not only often healed, but tumours and excrefcences in the urinary paffages taken away, and an ob- ftruction of urine removed by means of bougies. Of the Swelled Teflicle. THE fwelled teflicle may proceed from infection lately contrac- ted, and may happen both in the firft and fecond ftages of a gonorr- hoea ; particularly when the running is unfeafonably checked, by * This conjecture fliould be well-founded, as the fame effect may be produced from different caufes, fuch as a ftriaure in the urethra or fim- ple relaxation of the excreting veffels of that canal; in both ot theie , cafes, mercury would be improper, pirticularly in the former, which ' can only be removed by a diligent ufe of bougies. (1. C.) t Take Venice turpentine, boiled to a fufficient degree of hardnefs, half an ounce, calomel, half a drachm. Let thefe be mixed and formed into fixty pills, of which five or fix may be taken night and morning. If, durinT the ufe of thefe pills, the mouth fhould groAv fere, or the breath become offensive, they muft be difcontinued till thefe fymptoms chfap- pear. 344 BI3JK>Er£^ coktyhattf-drinking, ftrong .draftk purges, vioknt exeseife,.-.thf^QB earlymfe of aftringent medicines,- or the like. ... ,„vv rraq. In the inflammatory ftage, .-bleeding is neceffary,. which.*nuft.,jbex: -rerJeated according to the urgency of the fymptoms*. The^tid i-. muft he light, aid the-drink diluting. High-feafoned^food,-flefh^j ■wifcev and every thing of a heating nature, are to b+avoided. Fo- mentations are of lingular fervice. Poultices-of bread and. milk* , foftened wids frefh butter or oil, are very proper, and ought of^n ftantly" to fee applied when the patient is in bed*, whert he is up, the teflicle fhould be kept warm, and fupported by a bag ortrufsi ; which-may «eafilK be contrived in fuch a manner as to prevent the weight of the teiucle from having any effect. . ,+i ■■■?- ..*■;- If if Arnold be found impracticable to clear the teflicle by-die*" cooling regimen ■now pointed out, and extended according to cir- cumftances, it will be neeeuary to lead die- patient through fueh .•*»..- complete-antivenc real courfe, as fhall enfure him againfk any future 2 uneafinefs. For this purpofe, befides rubbing the mercurial ointment .- on the part, if free from! paift, or on the-thighs, as directed'in* the gonorrhoea, the patient muft be confined to bed, if necefihry,- for; >v five or fix weeks, fufpending the teflicle all the.while, with a bag or trufs, and plying him inwardly with ftrong decoctions -of farfa*"*- parilla. > ■ -< Uk . When thefe means do not fucceed, and there is reafon tofuf-.- pect a fcropwdous or cancerous habit, either of which may. fup- port a fchirrhous-induration, after the venereal poifon is corrected, - the parts fhould be fomented daily with a decoction of hemlock,' the bruifed leaves'of which may likewife be added to the poultice,-*: and the extract at-the fame time taken in-wardlyf*' This --practice b\ ftrongly recommended by Doctor Stork in fchirrous and Cancerous- cafes ; and Mr. Fordyce affures us, that by this method he has cu- red difeafed tefticks of two or three years standing, even when ulce- rated, and when the fchirrous had begun to be affected with prick- ing and lancing pains. •jt aae--. <■; • " "*' : . . Buboes •.. ■ "'* .<>.'$ tei-'-'-i., .„'■'.. _■-..■■:.(•. fill'-; : -it ARE hard tumours feated in the groin, occafioned by the vene- real poifon lodged in this part. They are of two kinds-'*, viz.'fuch as proceed from a recent infection, and fuch as ac"company d, con- firmed lues. ... . - • ' ..... •.-.**; .; I f> t i - i- • ■'■'- -•■- ■■:■- 'xU«f .w fi;'j ft.-, * i have been accuftomed for fome time paft to npply leeches to rn-' fi*»e'd refticles, which practice .hasjdways'bettn fodlowcd **'ififtt':e-m«ft hippy effe&s. •..-'■••.'... .., ,». 4' l?ihe-.e«traft of hem lack, may. be made into pills,, and taken m the" uanser dirt Sled under theartrde. Cancer.. . . - v.-- „, . . .., ... Aku CHANCRES. 345 The cure of recent buboes, that is, fuch as appear foon after im- pure coition, may be firft attempted by difperfion, and, if that fhould not fucceed, by fuppuration. To promote the difperfion of a bubo, the fame regimen muft be obferved as was directed in the firft ftage of a gonorrhoea. The patient muft likewife be bled, and t^he fome cooling purges, as the decoction of tamarinds and fenna, Glauber'* falte, and the like*. If, by this courfe, the fwelfing and other in- flammatory fymptoms abate, we may fafely proceed to the ufe of mercury, which muft be continued till the venereal virus is quite fubduedf. But, if the bubo fhould, from the beginning, be attended with great heat, pain, and pulfation, it will be proper to promote its fup- puradon. For this purpofe, the patient may be allowed to ufe his ordinary diet, and to take now and then a glafs of wine. Emollknt cataplafms, confifting of bread and milki or flax-feed flour, foften- ed with oil or frefh butter, may be applied to the part; and, where the tumour advances flowly, white lily-roots boiled, or fliced onions raw, and a fufficient quantity of yellow bafilicon, may be added to the poultice. , When the tumour is ripe, which may be known by its conical figure, the foftnefs of the fkin, and a fluctuation of matter plainly lb be felt under the finger, it may he opened by either cauftic or a lancet^:, and afterwards dreffed with digeftive ointment. Sometimes buboes can neither be difperfed nor brought to a fup- puration, but remain hard, indolent tumours. In this cafe, the in- durated glands muft be confumed by cauftic. if they fhould be- come fchirrous, they muft be diflblved by the application of hem- lock, both externally and internally, as directed in the fchirrous tcf- tkrle, Chancres ARE fuperficial, callous, eating ulcers ; which may happen er» ther with or without a gonorrhoea. They are commonly feated about the glands, and make their appearance in the following man- ner : Firft a little red pimple arifes, which foon becomes pointed * During the continuance of this practice, one drachm of the mercu- rial ointment fliould be rubbed every night, into the infide of ;he thigs, below the bubo. (I- C.) t For the difperfion of the bubo, a number of leeches applied to the part affeaed, will b« found equally efficacious as in the inflamed tef- licle. t The latter is more advantageous than the former ; if the bubo be Amply punctured, and the matter difcharged gradually, foasto imitate Its fpontanious rilpturv-. This mode fhould always be prefered, wh«£ the patient cannot wait for it to break cf itfelf. % 2 346 CHANCRES. at top, and is filled with a whitifh matter inclining to'yellow. This pirn ik is hot, and itches generally before it breaks ; afterwards it degenerates intj an obftinate ulcer, the bottom of which is ufually covered with a vifeid mucus, and whofe edges gradually become hard and callous. Sometimes the firft appearance vefembles a fimple excoriation of the cuticle ; which, if the caufe be venereal, foon becomes a true chancre. A chancre is fometimes a primary affection, but it is much oft- ner fymptomatic, and is the mark of a confirmed lues. Primary chancres difcover themfelves foon after impure coition, and are ge- nerally feated in parts covered with a thin cuticle, as die lips, the nipples of women, the glaus penis of men, &c*. When a chancre appears foon after impure coition, its treatment is nearly fimilar to that of the virnicnt gonorrhoea. The patient muft obferve the cooling regimen, lofe a little brood, and take fome gentk dofes of falts and manna. The parts affected ought frequent- ly to be bathed, or rather foaked, in warm milk and water, and if i the inflammation be great, an emollient poultice or cataplafm may be applied to them. This courfe will, in moft cafes, be fufficient to abate the inflammation, and prepare the patient for the ufe of mer- cury. Symptomatic chancres are commonly accompanied with ulcers in the throat, nocturnal pains, fcurfy eruptions about the roots cf the hair, and other fymptoms of a confirmed lues." Though they may be feated in any of the parts mentioned above, they commonly appear upon the private parts, or the infide of the thigh. They are alfo lefs painful, but frequently much larger and harder than pri- mary chancres. As their cure muft depend upon that of the pox, of which they are only a fymptom, we fhall take no further notice of them tiil we come to treat of a confirmed lucsf. Thus we have related moft of the fymptoms which accompany or fucceed a virulent gonorrhoea, and have alfo given a fhort view of their proper treatment; feveral others fometimes attend this dif- eafe, as a firangury or obftruction of urine, a phymofts, paraphymt- fisjScc. . . A strangury may be occasioned either by a fpafmodic constric- tion, or an inflammation of die urethra and parts about the neck of * Wrieri venereal tilcers are feated in the lips, the infection may'be, communicated by k'fling- I have fc-en very obitinar.e venereal ulcers in the lips, which I had all the reafon in the world to believe were com- minu-att-d in thrS mariner. isitrfes ought to beware offuckling infected children, of having their brcaftsdrawn by perfons tainted with th? venereal difea'.e. This catt- t:o:i k peculiarly neceffary for nurfes who reiide in the neighbourhood oi"•grt-i- r towns. ■f I jiave found it anfwer extremely, well to fprinkle chancres twice a-day with calomel. This will often perform a cure without any othe application whatever, if the chancre* are upon theglaus, they may be wafhed with milk and water, a littie warm, and afterwards the caloin«l .; iy be applied as above. CHANCRES. - j347 ihe:-bladder. In die former cafe, the patientbegins to void his urine with tolerable eafe ; but, as foon as it touches the galled or inflat- ed urethra, a fudden conftriction takes place, and the urine is void- ed oy fpurts, and fometimes hydrops only. When .the strangury is owing to an inflammation about the neck of the bladder, there is a conftant heat and uneafinefs of the^part, a perpetual defire to make water, while the patient can only render a few drops, and a trouble- fome tensfnus, or conftant inclination to go to ftool. When the strangury is owing to fpafm, fuch medicine* as'tend to dilute and blunt the falts of the urine will be proper. For this purpose, befides the common diluting liquors, foft and cooling emulfions, fweetened with the fyrup of poppies, may be ufed. Should thefe not have the defired effect, bleeding, and emollient fomentations, will be neceffary. When the complaint is evidently owing to an inflammation about the neck of the bladder, bleeding muft be more liberally per- formed, and repeated according to the urgency of die fymptoms. t, After bleeding, if the ftrangury ftill continues, foft clyfters, with a \ jjroper quantity of laudanum in them, may be adminiftered, and emollient fomentations applied to the region of the bladder. At the fame time, the patient may take every four hours a tea-cupful of .barley-water, to an Englifh pint of wisich fix'ounces of the fyrup of r inarfh-mallows, ftuir ounces qi the oil of fweet almonds, and half ran ounce of nitre, may be added. If thefe remedies fhould not re- lieve the complaint, and a total fuppre fhon of urine.fhould come on, bleeding muft be repeated, and the patient fet in a warm bath up to. the middle. It will be proper in this cafe to discontinue the diu- retics, and to draw off the water with a catheter; bat as the patient is feldom able to bear its being introduced, we rather r-ecemmend die ufe of mild bougies.. Thefe cfcen lubricate the paffage; and greatly y, facilitate the difcharge of urine. When they begin to ftimulare or give any uneafinefs, they may be withdrawn. The phymfis is fuch a conftriction of the prepuce over the glans, ,a§ hinders it from being drawn backwards.; the paraphymfis, on k the cpntjary, is fuch a conftriction of the prepuce behind the glans, ashinders it from being brought forward. >. ;• , The treatment of thefe fymptoms is fo nearly jhe fame with that .' of the virulent gonorrhoea, that we have no occafion to c:.large up- on it. In general, bleeding, purging, poahkes, and emollient fo- mentations are fufficient. " Sometimes in fpite of all endeavours to the contrary, the infram- 1 mation goes on, and fymptoms of a Leginring mortification appear. When this is the cafe, the prepuce muft be fearified v.ith a lancet, •and, if neceffary, divided, iri order to prevent a ftr.mgukitiou, and let the imprifoned glans at liberty. We fhall not ddcribe thij ope- ration, as it ought always to be done by a furgeon. When a mor- tification has actually taken place, it will bj neeeuary, befides rfer- jfoimmg the above operations, to foment the parrs frecpe^dyrAV'.tn S*4§ A COOTTRMEB XTJES. *cloths"; wrung out of a ftrong decoction, of- cameunife-flo-tfcr*f. and '-few^and to give the patient* drachflurfthe bark.in powder ev#y -" two or three hours. . . .^ j; -*--' With regard to the priapifm, ehordee, and other, diftcrtions of die penis, their treatment is no way different from that of theg^or- -rhcea. When they prove very troublefome, the patient, may take a few drops of laudanum at night, efpecially after the. operation of a purgative through the day. Of a Confirmed Lues. WE have hitherto treated cf thofe affections, in which die vene- real poifon is fuppofed to be confined chiefly to the particularpan by which it was received, and fhall next take a view of the lues in in its confirmed ftate ; that is, when the pcik-n is actually received into the blood, and circulating with it through every p^rt of 'the body, mixes with the feveral fecretions, and renders the whole rfa- bit tainted. The fymptoms of a confirmed lues are, buboes in the groin, pains. of the head and joints, which are peculiarly troublefome in the night, or when the patient is warm in bed ; fcabs and fcurfs in va- rious parts of the body, efpecially on the head, of a yellowifh "co- lour, refembling a honey-comb; corroding ulceis in various parts' cf the body, which generally begin about the throat, from whence tisey creep gradually, by the palate, towards the cartilage of the nofe, which they deftroy ; excrefcences or exoftofes arife in the middle of the bones, and their fpongy ends become brittle, and break upon the leaft accident; at other times they are foft, arid bend like'wax; die conglobate glands become hard and callous, and form, in the ■■< neck, armpits, groin, and mefentery, hard moveable tumours, like the king's evil; tumours of different kinds are likewife formed in the lymphatic veffels, tendons, ligaments, and nerves, aj die gum- ' viata, ganglia, jiodcs, tophs, Sec. \ the eyes are affected with itching, pain, rednefs, and fometimes with total blindnefs, and the ears witii a,,finging noife, pain and deafnefs, whilft their internal fubftance is ekulcerated and rendered' cariouj j at length all the animal, vitah and natural functions are depraved; the face becomes pale and li- vid ; the body emaciated and unfit for motion, andthe patient falls into an atropfry or wafting confumption. Women have fvrnpteros peculiar to the fex; ?.s co-Hirers of the' breaft ; a fuoDi'efnon or overflowing of the menfes ; the wliites; hyfxeric affL^ions; an inflammation, abfcefs, fchirrus, gangrene, cancer, or uieer of the womb j they are generally either barren or fubject to abortion ; or, if they bring children into the world, they have an univerfid eryfipelr.o, are h : vc- tm\ the mercury in the 'bowel's. y This practice muft be ronrhuied until '■'■•c fvmp:omi:"c!i'f;'i)pcirj a.itf iW sen br'llftre.'-dxyi rf erwr-rd-: --'I.-C. 350 A CONFIRMED LUE§. ?= - - - -v ■ ■ ' , * not lefs than two ounces of the ftrong mercurial ointment is fuffi. cient, and not more than three or four ounces neceffary. ' ' ~'J- The only other preparation of mercury which we fhall take no- tice-of, is the corrofive-fublimate*. This was fome time ago brought into ufe for the venereal difeafe, in Germany, by Baron Vart Swk- *ten ;jand was foon after introduced into Britain by Sir John Prin- gk. The method of giving it is as follows : One grain of corfofiye fublimate is difiblved in two ounces of French brandy or malt fpi- rits ; and of this folution, an ordinary table-fpoonful, or the quan- tity of half an oifhce, is to be taken twice a-day, and to be conti- nued as long as any fymptoms of die diforder remain. To thofe whofe ftomach cannot bear- the folution, die fublimate may be gi- ven in form of pillf. "**" Several roots, woods, and barks, have been recommended for curing the venereal difeafe; but none have upon experience.an- fwered the high encomiums bellowed upon them. Though no one of thefe is to be depended upon alone, yet, when joined with mer- cury, fome of them are found to be very beneficial in promoting a cure. One of the beft,is farfapafilla,.which may be prepared and taken according to the directions in the r.ppendixj. The mezereon-root is found to be a powerful aiTiftantt© the fub- limate, or any other-mercurial. It may be ufed along with the far- faparilla, as directed in the appendix, or by itfelf. Thofe who choofe the mezereonby itfelf, may boil an ounce of the frefh bark, talcett from the root, in twelve English pints of water to eight, adding to". wards the end an ounce of liquorice. The defe cf this hi the lame as of the decoction of farfapariha. .\,vi ,:li.. We have been told that the natives of America cure tbcevene- real difeafe, in every ftage, by a decoction of the root of a plant called the Lobelia. It is ufed either frefh or dried; but we have no certain accounts with regard to the proportion. Sometimes they mix other roots with it, as thofe of the ranunculus, the ceanothus, &c.; but whether thefe are designed to difguife cr affift it, is doubt- fjul. The patient takes a large draught of the decoclxn early in the morning, and continues to ufe it for his ordinary drink through the day§. v :, * This preparation of mercury is thought to be more efficacious than any oth'e'r, In venereal affections of the fl.in. I. C. t The fublimate may be given in diftilled water, or any^other li- quor that dv: patient choofes. I commonly order ten grains to be diffolv- ed in an ounce of the fpirit of wine, for the convee.iency of carriage, and lei. the patient take twenty or thirty drops of it night .-ilfi morning irk half a glafs. of brandy or other fpirits Mr. :>ebfa-v, r.n ingenious chemitt -of this place., prepares a fait of mercury much more mi H ti nd gentle in its;operiitioa than the fublimate, though equally. Cffic^c. j.ui. | See -.Appendix, Decott. t.fSarfaparilla'.- '§ Though; \vl are ftill very miu:h in the darlt, with reg.-.rd to the rne- thcrf'ofcurirtg'this'difeafe among the natives' of Anxr'ua, yet it is ge- neral'y afHrmctf, that they do cure it with fpced, fa.\.'r,yv -..\d ficcefsj and that Without fnc'leafr knowledge'of mercury. .Hence it heior.u-s a:: o"j'e"*t 6f conli\icT:!b,.e'imp<>r::a:i .'c- 't'J uif.-orcr th.ir merhu-.f ci'.urc . A COWfRMED LUES. 351 . Many other roots and woods might be mentioned which havs .been' extolled for curing the venereal difeafe, as the chinaHtoot, die roots of foap-wort, burdock, &Ci as alfo the wood of guaiacum and^faffafras ; but, as none of thefe poffefs virtues fuperior to, thofe already mentioned, We fhall pafs them over, and fhall conclude our obfervations on this difeafe, with a few general remarks concerning , the proper management of the patient, and the nature of the infec- tion. General Obfervations. THE condition of the patient ought always to be consideredpre- vious to his entering upon a courfe of mercury in any form. It would be.rafh and dangerous to adminifter mercury to a perfon la- bouring under any vioknt acute difeafe, as fevers, pleurify, perip- neumony, or the like. It would be dangerous in fome chronic ca- fes ; as a flow hectic fever, or the laft ftage of a confumption. Sometimes, however, thefe difeafes proceed from a confirmed lues; in which cafe, it will be neceffary to give mercury. In chronic dif- eafes of a lefs dangerous nature, as the afth'Aia, the gravel, and fuch like, mercury, if neceffary, may be fafely adminiftered, If the