*x •094 t. :u ARMY MEDICAL LIBRARY FOUNDED 1836 WASHINGTON, D.C. * ^4 fl'- DOMESTIC MEDICINE. OR, A TREATISE ON The Prevention and Cure of Diseases, BY REGIMEN AND SIMPLE MEDICINES. WITH AN APPENDIX, CONTAINING A DISPENSATORY FOR THE USE OF PRIVATE PRACTITIONER* BY WILLIAM BUCHAN, M. D. Fellow of the Royal College of Physicians, Edinburgh. ^ Revised, and adapted to the Diseases and Climate of the United States of America. BY SAMUEL POWEL GRIFFITTS, M. D. Late Professor of Materia Medica in the University of Pennsylvania. ^/1^/tJU^) PHILADELPHIA: Published by Thomas Dobson, at the Stone House, No. 41, S. Second street, Fry and Kammerer, Printers 1809. ubliming the following meets, I was told by my friends it would draw on me the refentment of the whole faculty* As I never could entertain fuch an unfavourable idea, I was refolved to make the ex- periment, which indeed came out pretty much as might have been expected. Many whofe learning and li- berality of fentiments do honour to medicine, received the book in a manner which at once mewed their in- dulgence, and the falfity of the opinion that every phy- fician ivijhes to conceal his art; while the more felfiih and narrow-minded, generally the mod numerous in every profeffion, have not failed to perfecute both the book and its author* The reception, however which this work has met with from the public merits my mod grateful ac- knowledgments. As the bed way of expf effing thefe, I have endeavoured to render it more generally ufe- ful, by enlarging the prophylaxis, or that part which treats of preventing difeafes ; and by adding many articles which had been entirely omitted in the former impreilions. It is needlefs to enumerate thefe addi- tions ; I ihall only fay, that I hope they will be found real improvements. a * The it PREFACE. The obfervations relative to Nurfmg and the Ma- nagement of Children, were chiefly fuggefted by art exteniive practice among infants, in a large branch of the Foundling Hofpital, where I had an oppor- tunity not only of treating the difeafes incident to childhood, but likewife of trying different plans of nurfmg, and obferving their effects. Whenever I haif 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 performed it, very few of them died ; but when, from diltance of place, and other unavoidable circumftances, the children were left to the fole care of mercenary nurfes, with- out any perfon to inftruct or fuperimtend them, fcarce any of them lived- This was fo apparent, as with me to amount to a proof of the following melancholy fact : That aU mojl one half of the human fpecies perijh in infancy, by improper management or negleel. This reflection has made me often wifh to be the happy inftrument of alleviating the miferies of thofe differing innocents, or of rtfcuing them from an untimely grave. No one, who has not had an opportunity of obferving them, can imagine what abfurd and ridiculous practices ilill prevail in the nurfmg and manage- ment of infants, and what numbers of lives are by that means loll 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 more proper. The application of medicine to the various occu- pations of life has been in general the refult of ob- servation. An extenftve practice for feveral years; in one of the. larged manufacturing towns in Eng- land, afforded me fufficient opportunities of ob- ferving the injuries which thofe ufeful people fuffain ii-oia their particular employments, and likewife of * -trying PREFACE. v!i trying various methods of obviating fuch injuries* The fuccefs which attended thefe trials was fuffi- cient to encourage this attempt, which I hope will be of ufe to thofe who are under the neceflity of earning their bread by fuch employments as are unfavourable to health* I do not mean to intimidate men, far lefs to in-s- finuate that even thofe arts, the practice of which is attended with fome degree of danger, (hould not be carried on ; but to guard the lefs cautious and unwary agaihft thofe dangers wich they have it in their power to avoid, and which they often, through mere ignorance, incur. As every occupation in life difpofes thofe who follow it to fome. particular dif- eafes more than to others, it is certainly of impor- tance to know thefe, in order that people may be up- on their guard againfl them. It is always better to be warned of the approach of an enemy, than to be furprifed by him, efpecially where there is a poflibility of avoiding the danger. The obfervations concerning Diet, Air, Exercife, &c. are of a more general nature, and have not efcaped the attention of phyficians in any age. They are fubjects of too great importance, however, to be pafled over in an attempt of this kind, and can never be fufficiently recommended. The man who pays a proper attention to thefe, will feldom need the phyfician ; and he who does not, will feldom en- joy health, let him employ as many phyficians as he pleafes. Though we have endeavoured to point out the caufes of difeafes, and to put people upon their guard againfl them, yet it muff be acknowledged, that they are often of fuch a nature as to admit of being removed only by the diligence and activity of the public magiflrate. We are forry, indeed, to obferve, that the power of the magiflrate is feh a 4 dom © rm PREFACE. dom exerted in this country for the pjrefervation of health. The importance of a proper medical po- lice is either not underflood, or little regarded. Many things highly injurious to- the public health are daily practifed with impunity, while others, ab- folutely neeefiary for its prefervation, are entirely neglected. Some of the public means of preferving health are mentioned in. the general prophylaxis^ as the inflection of provifions, widening the flreets of great towns, keeping them clean* fupplying the inhabitants with wholefome water, &c. j but they are pafled over in a very curfory manner. A proper attention to thefe would have fwelied 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 peculiar- ly attentive to- regimen. The generality of people lay too much flrefs upon Medicine, 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 de- figns of Medicine are often fruflrated ; and the pa- tient, 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 they were ufmg very proper medicines. It will be faid, the phyfician always orders the regimen when he prescribes a medicine. I wifli'it were fo, both'for the honour of the Faculty and the fafety of their patients : but phy- ficians, as well as other people, are too little attentive to this matter. Though many reckon it doubtful whether phy- fic is more beneficial or hurtful to mankind, yet all *l!ow the neccflity and importance of a proper regi- men PREFACE- U men in difeafes. Indeed the very appetites of the fick prove its propriety. No man in his fenfes ever imagined that a perfon in a fever, for example, could eat, drink, or conduct himfelf in the fame manner as one in perfect health. This part of medicine, there- fore, is evidently founded in Nature, and is every way confident with reafon and common fenfe. Had men been more attentive to it, and lefs felicitous in hunting after fecret remedies, Medicine had never be- come an object of ridicule. This feems to have been the fird idea of Me- dicine. The ancient phyficians acted chiefly in the capacity of nurfes. They went very little beyond aliment in their prefcriptions; and even this they generally adminidered themfelves, attending the fick for that purpofe through the whole courfe of the difeafe ; which gave them an opportunity not only of marking the changes of difeafes with great ac- curacy, but likewife of obferving the effects of their diiferent applications, and adapting them to the fymptons. The learned Dr Arbuthnot afferts, that by a pro- per attention to thofe things which are almofl within the reach of every body, more good and lefs mif- chief will be done in acute difeafes, than by medi- cines improperly and unfeafonably adminidered ; and that great cures may be effected in chronic didem- pers, by a proper regimen of the diet only. So en- tirely do the Doctor's fcntimcnts and mine agree, that I would advife every perfon, ignorant of phyfic, to con- fine 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 the ingenious Dr Huxham, who obferves, that we often feek from Art what all-bountiful Nature mod rea- dily, and as effectually, offers u«, had we dlfcnce " and x PREFACE. and fagacity enough to obferve and make ufe of it ; that the dietetic part of Medicine is not fo much dudied as it ought to be ; and that, though lefs pompous, yet it is the mod natural method of curing difeafes. To render he book more generally ufeful, how- ever, as well as more acceptable to the intelligent part of mankind, I have in mod difeafes, befides re- gimen, recommended fome of the mod fimple and approved forms of medicine, and added fuch cau- tions and directions as feemed neceflary for their fafe adminidration. It would no doubt have been more acceptable to many, had it abounded with pompous prefcriptions, and promifed great cures in confequence of their ufe ; but this was not my plan ; I think the adminidration of medicines always doubtful, and often dangerous, and would much rather teach men how to avoid the neceffity of ufing them, than how they fhould be ufed. Several medicines, and thofe of confiderable ef- ficacy, may be adminidered with great freedom and fafety. Phyficians generally trifle a long time with medicines before they learn their proper ufe. Many peafants at prefent know better how to ufe fome of the mod important articles in the materia medica, than phyficians did a century ago ; and doubtlefs the fame observation will hold with regard to others fome time hence.' Wherever I was convinced that medicine might be ufed with fafety, or where the cure depend- ed chiefly upon it, I have taken care to recommend it; but where it was either highly dangerous, or not very neceflary, it is omitted. I have not troubled the reader with an ufelefs parade of quotations from different authors, but have in general adopted their obfervations where my own were either defective, or totally wantinp. Thofe to whom I am mod obliged are, Ramizini, Arbuthnor* PREFACE. xi Arbutfinot, and TilTot ; the lad of which, in his Avis au Peuple, comes the neared to my views of any author that I have feen. Had the Doctor's plan been as complete as the execution is maflerly, we fhould have had no occafion for any new trea- tife of this kind foon ; but by confining himfelf to the acute difeafes, he has in my opinion omitted the mod ufeful part of his fubject. People in acute difeafes may fometimes be their own phyficians ; but in the chronic, the cure mud ever depend chiefly upon the patient's own endeavours. The Doctor has alfo paflfed over the Prophylaxis, or pre- ventative part of Medicine, very flightly, though k is certainly of the greated importance in fuch a work. He had no doubt his reafons for fo doing, and I am fo far from finding fault with him, that I think his performance docs great honour both to his head and to his heart. Several other foreign phyficians of eminence have written on nearly the fame plan with Tiffot, as the Baron Van Swieten, phyfician to their Imperial Ma- kefiles, M. Rofen, fird phyfician of the kingdom of Sweden, &c. ; but thefe gentlemen's productions have never come to my hand. I cannot help wifli- ing, however, that fome of our diflinguifhed coun- trymen would follow their example. There dill re- mains much to be done on this fubject, and it does not appear to me how any man could better employ his time or talents, than in eradicating hurtful pre- judices, and diffufing ufeful knowledge among- the people. I know fome of the Faculty difapprove of every attempt of this nature, imagining that it mud totally dedroy their influence. But this notion appears to me to be as abfurd as it is illiberal. People in dif- trefs will always apply for relief to men of fupe- rior xii PREFACE. l-ior abilities, when they have it in their power ; and they will do this with far greater confidence and rea- dinefs when they believe that medicine is a rational fcience, than when they take it to be only a matter of mere conjecture. Though I have endeavoured to render this Trea- tife plain and ufeful, yet I found it impoffible to avoid fame terms of art; but thofe are in general either explained, or are fuch as mod people under- hand. In fhort, I have endeavoured to conform"my dyle 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 diew of learning is eafier than to write plain fenfe, efpecially in a fcience which has been kept at fuch a didance from common obfervation. 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 warm- ed acknowledgments to thofe gentlemen who have endeavoured to extend the ufefufnefs of this Per- formance, by tranflating it into the language of their refpective countries. Mod of them have not only given elegant 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 conditutions of their countrymen. To the learned Dr Duplanil of Paris, phyfician to the Count d'Artois, I lie under particular obligations ; as this gentleman has not only coniiderably enlarged my Treatife, but, by his very ingenious and ufeful notes, has rendered it fo popular on the Continent, as to occafion its being tranflated into all the langua- ges of modern Europe. I have PREFACE. xill I have only to add, that the book has not more exceeded my expectations in its fuccefs, than in the effects it has produced. Some of the mod pernici- ous practices, with regard to the treatment of the fick have already given place to a more rational conduct; and many of the mod hurtful prejudices, which feemed to be quite infurmountablc, have in a great meafure yielded to better information. Of this a dronger indance cannot be given than in the inoculation of the fmall-pox. Few mothers, fome years ago, would fubmit to have their children ino- culated, even by the hand of a phyfician ; yet no- 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 mod dignified inoculators, there is little reafon to doubt that the practice will become general. Whenever this fliall.be the cafe, more lives will be faved by ino- culation alone, than are at prefent by all the endea- vours of the Faculty. s INTRODUCTION. X HE improvements in Medicine, fince the revival of learning, have by no means kept pace with thofe of the other arts. The reafon is ob- vious. Medicine has been dudied by few, except thofe who intended to live by it as a trade. Such, ehher from a midaken zeal for the honour of Medi- cine, or to raife their own importance, have endea- voured to difguife and conceal the art. Medical au- thors have too generally written in a foreign lan- guage ; and thofe who were unequal to this talk, have even valued themfelves upon couching, at lead, their prefcriptions, in terms and characters unintelligible to the red of mankind. The contentions of the clergy, which happened foon after the redoration of learning, engaged the attention of mankind, and paved the way for that freedom of thought and inquiry, which has fince prevailed in mod parts of Europe with regard to religious matters. Every man took a fide in thofe dilutes; and every gentleman, that he might dif- tinsuifh himfelf on one fide or other, was indruc- ted in Divinity. This taught people to think and reafon for themfelves in matters of religion, and at lad, in a degree, dedroyed that complete- and abfo- lute dominion which the clergy had obtained over the minds of men. The fludy of Law has likewife, in mod civilized nations, been judly deemed a neceflary part of edu- cation. Every man ought certainly to know at lead the laws of his own country; and, if he were alio, acquainted ivi 1NTR0DUCTI0 N. 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 very univerfally dudied by all who pretend- ed to a liberal education. The advantages of this are manifed. It frees the mind from prejudice and fuperdition ; fits it for the invedigation of truth; induces habits of reafoning and judging properly; opens an inexhaudible fource of entertainment; paves the way to the improvement of arts and agriculture ; and qualifies men for acting with propriety in the mod important dations of life. Natural Hidory is likewife become an object of general attention ; and it well deferves to be fo. It leads to difcoveries of the greated importance. In- deed agriculture, the mod ufeful of all arts, is only a branch of Natural Hidory, and can never arrive at a high degree of improvement where the dudy of that fcience is neglected. Medicine however has not, as far as I know, in any country, been reckoned a neceflary part of edu- cation. But furely no diffident reafon can be aflign- ed for this, omiffion. No fcience lays open a more extenfivc field of ufeful knowledge, or affords more ample entertainment to an inquiiitive mind. Anato- my, Botany, Chemidry, and the Materia Medica, are all branches of Natural Hidory, and are fraught with fuch aniufement and utility, that the man who entirely neglects them has but a forry claim either to tade or learning. If a man has a turn for obfervation, fays an excellent and fenfible writer*, furely the na- tural hidory of his own fpecies is a more intereilin^ fubject, and prcfents a more ample field for the exert tion of genius, than the natural hidory of fpiders and cockle-fhells. * Obfervations on the Duties and Offices of a Phyfician. 4 Wc INTRODUCTION. xvii We do not mean that every man fhould become a phyfician. This would be an attempt as ridiculous as it is impoflible. All we plead for is, that men of fenfe and learning fhould be fo far acquainted with the general principles of Medicine, as to be in a condition to derive from it fome of thofe advantages with which it is fraught ; and at the fame rime to guard themfelves againd the definitive influences of Ignorance, Superdition, and Quackery. As matters dand at prefent, it is eafier to cheat a man out of his life than of a fhilling, and almod impoflible either to detect or punifli the offender. Notwithdanding this, people dill fhut their eyes, and take every thing upon trud that is adminidered 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 dill facred here. Many of the faculty are no doubt worthy of all the confidence that can be repofed m them ; but as this can never be the character of every individual in any profeffion, it would certainly be for the fafety, as well as the honor of mankind, to have fome check upon the conduct of thofe to whom they entrud fo valuable a treafure as health. Medicine, however, needs only to be better known, in order to fecure the general edeem of mankind. Its precepts are fuch as every wife man would chufe to obferve, and it forbids nothing but what is incompatible with true happinefsi.. Difguifing Medicine not only retards its improve- ment as a fcience, but expofes the profeffion to ridi- cule, and is injurious to the true interefls 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 ob- fervations of all the ingenious and fenfible part of mankind, would do more in a few years towards the b improve * v'ii INTRODUCTION.' improvement of Medicine, than thofe of the Faculty alone in a great many. Any man can tell when kt medicine gives him eafe as well as a phyfician ; and if he only knows the name and dofe of the medicine, and the name of the difeafe, it is fuflicient to perpe- tuate the fact. Yet the man who adds one fingle fact to the dock 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 discoveries in Medicine have been made by phyficians. They have in gene- ral either been the effect of chance or of neceflity, and have leen often oppofed by the Faculty, till every one elfe was convinced of their importance. An implicit faith in the opinions of teachers, an at- tachment to fydems and edabliflied forms, and the dread of reflections, will always operate upon thofe who follow Medicine as a trade. Few improvements are to be expected from a man who might ruin his character and family by even the fmalled deviation from an edablifhed rule. If men of letters, fays the author of the perform- ance quoted above, were to claim their right of inquiry into a matter that fo nearly concerns them, the good effects on Medicine would foon appear. Such men would have no feparate intered from that of the art. They would detect and expofe afluming Ignorance under the mafic of Gravity and Import- ance, and would be the judges and patrons of moded merit. Not having their underdandings perverted ift their youth by falfe theories, unawed by authori-, ty, and unbiased by intered, they would canvafs with freedom the mod universally received principles in Medicine, and expofe the uncertainty of many of thofe doarines, of which a phyfician dares not fo much as fcem to doubt. i No INTRODUCTION. xh No argument, continues he, can be brought againfl laying open Medicine, which does not apply with equal, if not greater, force to religion ; yet expe- rience has fliewn, that fince the laity have afferted their right of inquiry into thefe fubjects, Theology, confidered as a fcience, has been improved, the intereds 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 were in the days of their greated power and fplendor. Had other medical writers been as honed as this gentleman, the art had been upon a very different footing at this day. Mod of them extol the merit of thofe men who brought Philoibphy out of the fchools, and fubjected it to the rules of common fenfe. But they never confider that Medicine, at prefent, is in nearly the fame fituation as Philofophy was at that time, and that it might be as much im- proved by being treated in the fame manner. In- deed, no fcience can be rendered either rational or ufeful, without being fubmitted to the common fenfe and reafon of mankind. Thefe alone damp a value upon fcience; and what will not bear the ted of thefe ought to be rejected. I know it will be faid, that diffufing medical knowledge among the people might induce them to tamper with Medicine, and to trud to their own ikill indead of calling in a phyfician. The reverfe of this however is true. Perfons who have molt knowledge in thefe matters, are commonly mod ready both to afk and to follow advice, when it is necelfary. The ignorant are always mod apt to tamper with Medicine, and have the lead confidence in phyficians. Indances of this are daily to be met, with among the ignorant, who, while they abfo- lutely refui" to take a medicine which has been b 2 rrefcibe.l *x INTRODUTION. prefcribed by a phyfician, will fwallow with greedj- nefs any thing that is recommended to them by their credulous neighbours. Where men will act even without knowledge, it is certainly mere rational to afford them all the light we caji, than to leave them entirely in the dark. It may alfo be alleged, that laying Medicine more open to mankind would lefien their faith in it. This would indeed be the cafe with regard to fome ; but it would have a quite contrary effect upon others. I know many people who have the utmod dread" and horror of every thing prefcribed by a phyfician, but who will neverthelefs very 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 lead fhadow of mydery remains in the conduct of the Faculty, doubts, jealoufies, and fufpicions, will arife in the minds of men. No doubt cafes will fometimes occur, where a prudent phyfician may find it expedient to difguife a medicine. The whims and humors of men mud 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 necef- lary ; but it ought never to" appear on the face of his general conduct. The appearance of mydery in the conduct, of phyficians not only renders their art fufpicious, but lays the foundations of Quackery, which is the dis- grace INTRODUCTION. xxi grace of Medicine. No two characters can be more different than that of the honed phyfician and the quack; yet they have generally been very much confounded. No laws will'ever be able to prevent quackery, while people believe that the quack is as honed 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 effectually undeceive them. It is the ignorance and credulity of the multitude, with regard to medicine, which renders them fuch an eafy prey to every one who has the hardinefs to attack them in this quarter. Nor can the evil be remedied by any other means but by making them wifer. The mod effectual way to dedroy quackery in any art or fcience, is to diflufe the knowledge of thefe among mankind. DiiFufing medical knowledge among the people would not only tend to improve the art, and to banifh quackery, but likewife to render Medicine more univerfally ufeful, by extending its benefits to fociety. However long Medicine may have been known as a fcience, we will venture to fay, that many of its mod important purpofes to feciety have either been over- looked, or very little attended to. The cure of difea- fes is doubtlefs a matter of great importance ; but the prefervation of health is of dill 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 pofiible. It is not to be luppofed, that men can be fufliciently upon their guard againd difeafes, who are totally ignorant of their caufes. Neither can the legiflature, in whofe power it is to do much more for preferving the public health than can ever be done by the Faculty, exert that power with pro- b i prietv*, *Xll INTRODUCTION. priety, and to the greated advantage, without fome degree of medical knowledge. 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 refpective dations ; which is always ealier than to remove their effects. Me- dical knowledge, inflead of being a check upon the enjoyments of life, only teaches men how to make the mod of them. It has indeed been faid, that to live medically is to live inferably : but it might with equal propriety be faid, that to live rationally is to live miferably. If phyficians obtrude their own ridiculous whims upon mankind, or lay down rules inconfident with reafon or common fenfe, no doubt they will be defpifed. But this is not the fault of Medicine. It propofes no rules that I know, but fuch as are perfectly confident with the true enjoy- ment of life, and every way conducive to the real liappinefs of mankind. We are forry indeed to obferve, that Medicine has hitherto hardly been confidered as a popular fcience, but as a branch of knowledge folely con- fined to a particular fet of men, while all the red have been taught not only to neglect, but even to dread and defpife it. It will however appear, upon u more drict examination, that no fcience better de- ferves their attention, or is more capable of being rendered generally ufeful. People are told, that if they dip the lead into medical knowledge, it will render them fanciful, and make them believe they have every difeafe of which they read. This I am fatisfied will feldom be the cafe with fenfible people; and, fuppofe it were, they mud foon be undeceived. A fliort time will Ihew them their error, and a little more reading will infallibly INTRODUCTION. JoTi infallibly correct it. A fingle inffance will (hew the abfurdity of this notion. A fenfible woman, rather than read a medical performance which would k- llrucl her in the management of her children, mud leave them entirely to the care and conduct of the mod ignorant, credulous, and fuperftitious part of the human fpecies. No part of Medicine is of more general import- ance than that which relates to the nurfmg and ma- nagement of children. Yet few parents pay a pro- per attention to it. They leave the fole care of their tender offspring, at the very time when care and attention are mod neceflary, to hirelings, who are either too carelefs to do their duty, or too igno- rant to know it. We will venture to affirm, that more human lives are lod by the carcleflhefs and in- attention of parents and nurfes, rhan are faved by the Faculty ; and that the joint and well-condufted en. deavours, boch of private perfons and the public, for the prefervation of infant lives, would be of more advantage to fociety, than the whole art of Medi-, cine, upon its prefent footing. The benefits of 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. Phyficians, like other people, mufl live by their employment, and the poor mud either want advice altogether, or take up with that which is worfe than none. There are not, however, any where wanting well-difpof-i people, of better fenfe, who are willing to fupply the defect of medical advice to the poor, did not their fear of doing ill often fupprefs their inclination to do good. Such people a-e often deterred from the mod noble and praife-worthy actions, br the fooiifli alarms founded in their ears by a let of men M-ho to -life their own importance, magnify the •'- ' , .1:0:.,..i.:..,. xx;v INTRODUCTION. difficulties of doing good, find fault with what is truly commendable, and fleer at every attempt to relieve the fick, which is not conducted by the pre- cife rules of Medicine. Thefe gentlemen mud, how- ever excufe me for faying, that I have often known fuch well-difpofed perfons do much good ; and that their practice, which is generally the refult of good fenfe and obfervation, aflifled by a little medical read- ing, is frequently more rational than that of the ig- norant retainer to phyfic, who defpifes both reafon and obfervation, that he may go wrong by rule:^and wiio, while he is dofing his patient with medicines, often neglects other things of far greater importance. Many things are neceflary for the fick befides me- dicine. Nor is the perfon who takes care to procure thofe for them, of lefs importance than a phyfician. The poor oftener perifli in difeafes for want of pro- per nurfmg than of medicine. They are frequently in want of even the neceffaries of life, and dill more fo of what is proper for a fick-bed. No one can imagine, who has not been a witnefs of thefe fixa- tions, how much good a well-difpofed perfon may do, by only taking care to have fuch wants fupplied. There certainly cannot be a more neceflary, a more noble, or a more gcd-like action, than to admmider to the wants of our fellow-creatures in dillrefs. While virtue or religion are known among mankind, this conduct will be approved ; and while Heaven is jud. it mud be rewarded ! Perfons who do not chufe to adminider medi- cine to the fick, may neverthelefs direct their regi- men. An eminent medical author has faid, That by diet alone all the intentions of Medicines may be an- fwered*. No doubt a great many of them may ; but there are other things befide diet, which ought 4 * Aibuihr.ot. by INTRODUCTION. XXV by no means to be neglected. Many hurtful and de- dructive prejudices, with regard to the treatment of the fick, dill prevail among the people, which per- fons of better fenfe and learning only can eradicate. To guard the poor againd the influence of thefe pre- judices, and to indil into their minds fome jud ideas of the importance of proper food, frefh air, cleanli- nefs, and other pieces of regimen neceflary in dif- eafes, would be a work of great merit, and produc- tive of many happy confequences. A proper regi- men, in mod difeafes, is at lead equal to medicine, and in many of them it is greatly fuperior. To affifl the well-meant endeavours of the humane and benevolent in relieving didrefs ; to eradicate dan- gerous and hurtful prejudices ; to guard the ignorant, and credulous againd the frauds and impofitions of quacks and impodors ; and to fliew men what is in their own power, both with regard to the preven- tion and cure of difeafes, are certainly objects worthy of the phyfician's attention. Thefe were the leading views in compofing and publifhing the following flieets. They were fuggeded by an attention to the conduct of mankind, with regard to Medicine, in the courfe of a pretty long practice in different parts of this ifland, during which the author has often had occafion to wifli that his patients, or thofe about them, had been poflfefled of fome fuch plain directory for regulating their conduct. How far he has fuc- ceeded in his endeavours to fupply 'this deficiency, mud be left for others to determine ; but if they be found to contribute in any meafure towards alleviat- ing the calamities of mankind, he will think his la- bour very well bedowed. CONTENTS. PART I. •Of the General Causes Of Diseases. CHAP. X PAGE. /^VF Children 1 V-/ — Diseased Parents 7 Clothing of Children 10 — Food of ditto . 16 — Exercise of ditto 22 —Bad Effects of unwholesome Air upon ditto . 32 —■Nurses . , 34 CHAP. II. Of the Laborious, Ike. —the Sedentary —•the Studious , 39 48 $5 CHAP. III. Of Aliment 63 CHAP. XV. Of Air 76 CHAP. V. Of Exercise . 82 CHAP. VI, Of sleep > . • —Clothing. CHAP. VII. Of Intemperance 89 ibid. 96 p«& CHAP. VIII. Of Cleanliness . 102 CHAP. IX. Of Infection 108 CHAP. X. Of the Passions 114 —Anger ibid. —Fear . 115 —Grief 119 —Love 121 —Religious Melancholy 122 CHAP. XI. Of the common Evacuations 124 —Stool . ibid. —Urine 126 —Perspiration 128 —being affected by changes in the atmosphere 129 —Wet clothes 130 —Wet feet ib. —&ight Air 131 —Damp Beds ibui. —Damn Houses 133 —Sudden Transitions from Heat to Cold 134 xxviii CONTENTS. PART. II. Of Diseases. CHAP. XII. Of the Knowledge and Cure of Diseases . 139 CHAP. XIII. Fevers in general 145 CHAP. XIV. . Of Intermitting Fjeveji or- Agues . 152 CHAP. XV. Of an Accute Continual Fever 162 CHAP. XVI. Of the Pleurisy - 168 ------Bastard ditto 173 ——— Paraphrenias 174 CHAP. XVII. Inflammation of the Lungs 175 CHAP. XVIII. Of Consumptions 178 CHAP. XIX. Of the slow or Nervous Fever 192 CHAP. XX. Malignant, Putrid, or Spotted JFever 199 CHAP. XXI. Miliary Fever . 209 CHAP. XXII. Remitting Fever .214 CHAP. XXIII. . - Yellow Fever 218 CHAP. XXIV. The Small pox . 225 Inoculation . $37 Vaccination 24] CHAP. xxv. The Measles . 249 —Scarlet Fever 254 —Bilious Fever 25J CHAP. xxvr. St. Anthony's Fire ^"57 «HAP. XXVlI. Inflammation of the Brain 262 CHAP. xxvm. Inflammation of the Eyes 266 Page CHAP. XXIX. The Quinsey . 272 —Malignant ditto 279 CHAP. XXX. Colds and Coughs 283 A Common Cough 287 Whooping Cough 291 CHAP. XXXI. Inflammation of the tomach „ V. 296 ■ ■ ■ ■ ■■ of the intestines 298 Of the Cholic . 302 Inflammation of the Kidneys •.___ 309 ------------of the Bladder 311 Of the Liver 313 CHAP' XXXII.' Of the Cholera Morbus, and other excessive Discharges from the Stomach and Bowels ■■"■';'' . 316 ■■—a Diarrhoea,orlooseness 319 —Vomitting '":."' 322 —the-Vdmitrng/and Purging of Children '- 325 CHAP. XXXIII. Disorders of the Kidneys and Bladder . 328 Of the-Diabetes or excessive discharge of Urine ib. —Suppression of ditto 331 —the Gravel and Stone 333 CHAP.'XXXIv. Involuntary discharges- of Blood ' V 337 Bleeding at the Nose 340 --------and Blind Piles 343 Spitting of Blood 346 Vomiting of ditto 350 Bloody Urine . 351 V . -Flux . • - 353 (-celiac Passion , 359 CHAP. XXXV, Of the Head-ache 360 —Tooth ache 364 CONTENTS. XXIX Page Of the Ear-ach - 368 Pain of the Stomach, &c. 369 CHAP, xxxvi. Of Worms . 372 CHAP. XXXVII. Of the Jaundice 37S CHAP. XXXVIII. OfiheDropfy • 381 CHAP. XXXIX. Of the Gout . 3^7 ------Rheumatiftn 395 CHAP.'XL. Oft the Scurvy . 400 ------Scrophula 405 ------Itch . 410 CHAP. XLI. Of the Afthma . 413 CHAP. XL1I. Of*the Apoplexy 418 CHAP. XLIII. Of Coftivenefs . 421 —Want of Appetite 424 —Heartburn . 425 CHAP. XLIV. Of Nervous Difeafes 427 —Melancholy . 433 —the Palfy . 438 —the Epilepfy, or Falling Sickncfs . 440 —the Hiccup . 444 —Cr.imp of the Stomach 446 —the Night-mare 447 —Swoonings 448 —Flatulencies, or Wind 451 —Low Spirits . 454 —Hy It eric Affections 455 —Hypochondriac Affections 459 CHAP. XLV. Diforders of the Senfes 464 __.------of the Eye ib. A Gutta Serena 466 A Cataract . . ib. Short Sightednefs 467 Page Seeing only at too great a Diftance . 467 Squinting . . ib. Spots or Specks . ib. Blcodfhot Eye . ib. Watery or Weeping Eye 4^8 Of the Ear ib. ------Tafte and Smell 471 ------Touch . 473 CHAP. XLVI. Of a Schirrus and Cancer 474 CHAP. XLVII. Of Poifons . 48D —Mineral Poifons 481 —Vegetable ditto 483 Bitesof poifonousAnimals484 ----of the Mad Dog ib. ----of the Viper 493 ----of poifonous Infects ib. ----of the Rattle-Snake 495 CHAP. XLVIII. Of the Venereal Difeafe 496 ----Virulent Gonorrhoea 498 —Gleets . . 504 —Swelled Tefticle 507 —Buboes . . 50S —Chancres . 509 —A Confirmed Lues Or iJi x 513 General Obfervataons 51S CHAP. XLIX. Difeafes of Women 524 Of the Menftrual Difcharge —Pregnancy . 534 —Child-Birth . 537 —Barrennefs . 545 CHAP. L. Difeafes of Children 546 Of the Meconium 548 —the Apthar or Thrufh 549 —Acidities . 550 —Galiingand Excoriation 551 —Stoppage of the Nofe 553 XXX C O TsT £ 17 T 5- Of Vomiting 553 —a Loofenefs . 554 —Eruptions . $$$ —the Croup or Hives 558 —Teething . 561 —the Rickets . 564 —Convulfions . 567 —Water in the Head, or Dropfy of the Brain 569 chap. ti. Of Surgery . 571 —Bleeding . 572 —Inflammations and Ablcef- fes . . . 575 —Wounds . 577 —Burns . . 581 —Bruifes . . 583 —Ulcers . . 585 chap. lit. Of Diflocations - 589 Diflocation cf the Jaw 590 —------of the Neck 591 --------of the Ribs 592 --------of the Shoulder 593 <■ ----of the Elbow 594 <--------of the Wrift and Fingers ib. --------of the Thigh ib. --------of the Knees 595 INTRODUCTION 657 Lift of Simples 662 medical preparations. Balfams . . 664 Bolulfes . . ib. Cataplafms and Siaapifms 666 Page Diflocation of the Ankles 595 ________of the Toes ib. chap. liii. Of Broken Bones, &c. 595 —Strains . . S9{) —Ruptures . 6co CHAP. LIV. OfCafualties . 603 —Subftances ftoptbetweenthc Mouth and Stomach 604 —Drowned Perfons 610 —Noxious Vapours 614 Effects of Extreme Cold 616 ----------,-----Heat 618 CHAP. LV. • Of Fainting Fits, and other Cafes which require imme- diate Affiftance 619 —Intoxication . 624 —Suffocation and Strangling 626 —Perfons who expire in Con- vulficn Fits . 629 Directions for Recovering per- fons fuppofed Dead 634 CHAP. LVI. Cautions concerning Cold Bathing, and drinking the Mineral Waters 64J Clyfters . . 66G Collyria, or Eye-waters 663 Confections . 669 Conferves and Preferves 670 Decoction* . . 671 Draughts . . 674 Electuaries . 6-5 CONTENTS of the APPENDIX. CONTENTS. XXXJ Page Emulfions 676 Extracts 677 Fomentations 678 Gargles 679 Infufions 680 Juleps . . 683 Mixtures 684 Ointments, Liniments, and Cerates 686 Pills 689 A GLOSSARY INDEX Plafters ii 693 Powders . * 69^ Syrups . . . 69$ Tinctures, Elixirs, &c. 699 Vinegars . . 7.04 Waters by Infufion, &c. 705 Simple diftilled Waters 70S Spirituous diftilled Waters 70S Wheys . . ib. Wines . . . 709 Page 712 717 PART PART I. OF THE GENERAL CAUSES OF DISEASES. CHAPTER L Of Children* 1 HE better to trace difeafes from" their original caufes we fhall take a view of the common . treatment of mankind in the ftate of infancy. In this period of our lives, the foundations of a good or bad conftitution are generally laid ; it is therefore of importance, that parents be well acquainted with the various caufes which may injure the health of their offspring. It appears from the annual regiflers of the dead, that almoft one half of the children born in Great Britain die under twelve years of age. To many, indeed, this may appear a natural evil; but, on due examination, it will be found to be one of our own creating. Were the death of infants a natural evil, other animals. would be as liable to die young as man ; but this we find is by no means the cafe. It may feem flrange that man, notwithftanding his fuperior reafon, fhould fall fo far fhort of other B animals 2 OF CHILDREN. animals in the management of his young : But our furprife will foon ceafe, if we confider that brutes, guided by inftincl:, never err in this refpec*t j while man, trufting folely to art, is feldom right. Were a catalogue of thofe infants who perifli annually by art alone exhibited to public viewy it would aftonifh mofl people. If parents are above taking care of their children, others mufl be employed for that purpofe : thefe will always endeavour to recommend themfelves by the appearance of extraordinary fkill and addrefs. By this means fuch a number of unneceffary and de- ftru&ive articles have been introduced into the diet, clothing, &c. of infants, that it is no wonder fo many of them perifh. Nothing can be more prepoflerous than a mother who thinks it below her to take care of her own child, or who is fo ignorant as not to know what is proper to be done for it. If we fearch Nature throughout, we cannot find a parallel to this. Every other animal is the nurfe of its own offspring, and they thrive accordingly. Were the brutes to bring up their young by proxy, they would fhare the fame fate with thofe of the human fpecies. We mean not, however, to impofe it as a talk upon every mother to fuckle her own child. This, whatever fpeculative writers may allege, is in fome cafes impracticable, and would inevitably prove de* flruclive both to the mother and child. Women of delicate conftitutions, fubject to hyfteric fits, or other nervous affections, make very bad nurfes : and thefe complaints are now fo common, that it is rare to find a woman of fafhion free from them ; fuch women, therefore, fuppofmg them willing, are often unable to fuckle their own children. Almoft every mother would be in a condition to give fuck, did mankind live agreeably to Nature: but or CHILDREN. 3 but whoever confiders how far many mothers deviate from her dictates, will not be furprifed to find fome of them unable to perform that neceffary office. Mothers who do not eat a fufficient quantity of folid food, nor enjoy the benefit of free air and exercife* can neither have wholefome juices themfelves, nor afford proper nourifhment to an infant. Hence chil- dren who are fuckled by delicate women, either die young, or continue weak and fickly all their lives. When we fay that mothers are not always in a condition to fuckle their own children, we would not be underflood as difcouraging that practice. Every mother who can, ought certainly to perform fo tender and agreeable an office *. But, fuppofe it to be out of her power, fhe may, neverthelefs, be of great fervice to her child. The bufinefs of nurfmg is by no means confined to giving fuck. To a woman who abounds with milk, this is the eafieft part of it. Numberlefs other oifices are neceffary for a child, which the mother ought at leafl to fee done. A mother who abandons the fruit of her womb, as foon as it is born, to the fole care of an hireling, hardly deferves that name. A child, by being brought up under the mother's eye, not only fecures her affection, but may reap all the advantages of a * Many advantages would arife to fociety, as well as to in- dividuals, from mothers fuckling their own children. It would prevent the temptation which poor women are laid under of abandoning their children to fuckle thofe of the rich for the fake of gain : by which means fociety lofes many of its molt ufeful members, and mothers become in fome fenfe the mur- derers of their cwn offspring. I am fure I fpeak within the truth when I fay; that not one in twenty of thofe children live, who are thus abandoned by their mothers. For this retfon no mother fhould be allowed to fuckle another's child, till her own is either dead, or fit to be weaned. A regulation of this kind would iave many lives among the poorer fort, and could do no hurt to the rich. B 2 parent's 4 OF CHILDREN. parent's care, though it be fuckled by another. How can a mother be better employed than in fuper- intending the nurfery ? This is at once the moft de- lightful and important office; yet the moft trivial bufinefs or infipid amufements are often preferred to it! A ftrong proof both of the bad tafte and wrong education of modern females. It is indeed to be regretted, that more care is not beftowed in teaching the proper management of chil- dren to thofe whom nature has defigned for mothers. This, inftead of being made the principal, 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 that character ? However ftrange it may appear, it is certainly true, that many mothers, and thofe of fafhion too, are as ignorant, when they have brought a child into the world, of what is to be done for it, as the infant itfelf. Indeed, the moft ignorant of the fex are generally reckoned moft knowing in the bufinefs of nurfing. Hence, fenfible people become the dupes of ignorance and fuper- ftition ; and the nurfmg of children, inftead of being conducted by reafon, is the refult of whim and ca- price *. AVere the time that is generally fpent by females in the acquifition of trifling accomplifhments, em- ployed in learning how to bring up their children; * Tacitus, the celebrated Roman Hiftorian, complains greatly of the 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 houfe 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 loo much ground for this complaint. how ©F CHILDREN. 5 how to drefs them fo as not to hurt, cramp, or con- fine their motions; how to feed them with whole- fome and nourifhing food ; how to exercife their tender bodies, fo as befl to promote their growth and ftrength : were thefe made the objects of female inftruction, mankind would derive the greateft ad- vantages from it. But while the education of fe- males implies little more than what relates to drefs an|d public fhew, we have nothing to expect from them but ignorance, even in the moft important concerns. Did mothers reflect on their own importance, and lay it to heart, they would embrace every opportu- nity of informing themfelves of the duties which they owe to their infant offspring. It is their province, not only to form the body, but alfb 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 mother is not the only perfon concerned in the management of children. The father has an equal intereft in their welfare, and ought to affift in every thing that refpects either the improvement 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 recom- mend them to the other fex. But men generally keep at fuch a diftance from even the fmalleft ac- quaintance with the affairs of the nurfery, that many would reckon it an affront, were they fuppofed to know any thing of them. Not fo, however, with the kennel or the ftables : a gentleman of the firft rank is not afhamed to give directions concerning the ma- nagement of his dogs or horfes, yet would blufli were he furprifed in performing the fame office for B 3 that 6 OF CHILDREN. that being who derived its exiftence 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. Such conduct has not only caufed this branch of medicine to be neglected, but has alfo en- couraged the other fex to affume an abfolute title to prefcribe for children in the moft dangerous difeafes. The confequence is, that a phyfician is too feldom called till the good women have exhaufted all their /kill; when his attendance can only ferve to divide the blame, and appeafe the difconfolate parents. Nurfes mould do all in their power to prevent difeafes; but when a child is taken ill, fome perfon of fkill ought immediately to be confultcd. The difeafes of children are generally acute, and the leafl delay is dangerous. Were phyficians more attentive to the difeafes of infants, they would not only be better qualified to treat them properly when fick, but likewife to give ufeful directions for their management when well. The difeafes of children are by no means fo diffi- cult to be understood as many imagine. It is true, children cannot tell their complaints; but the caufes of them may be pretty certainly difcovered by ob- ferving the fymptoms, and putting proper queftions to the nurfes. Befide-, the difeafes of infants be» ing lefs complicated, are eafier cured than thofe of adults. * * The common opinion that the difeafes of infants are hard to difcover and difficult to cure, has de erred many phyficians from paying that attention, to them which they deferve. I can, however, from experience decLre, that this opinirn is without foundation ; and that the di'eafes of in'antsare neither fo diffi- cult to difcoyer, nor fo ill to ewe, as thofe of adults. ft OF CHILDREN. 7 It is really aftonifhing, that fo little attention mould in general be paid to the prefervation of in- fants. What labour and expence are daily beftowed, to prop an old tottering carcafe for a few years, while thoufands of thofe who might be ufeful in life, perifli without being regarded! Mankind are too apt to value things according to their prefent, not their future, ufefulnefs. Though this is, of all others, the moft erroneous method of eftimation ; yet, upon no other principle, is it poffible to account for the general indifference, with refpect to the death of infants. Of Difeafed Parents. One great fource of the difeafes of children is, the unhealthiness of Parents. It would be as unreafonable to expect i. rich crop from a barren foil, as that ftrong and healthy children fhould be born of parents whofe conftitutions have been worn out with intemperance or difeafe. An ingenious writer * obferves, that on the con- ftitution of mothers depends originally that of their offspring. No one, who believes this, will be fur- prifed, on a view of the female world, to find difeafes and death fo frequent among children. A delicate female, brought up within doors, an utter ftranger to exercife and open air, who lives on tea and other flops, may bring a child into the world, but it will hardly be fit to live. The firfl blaft of difeafe will nip the tender plant in the bud : or, fhould it ftrug- gle through a few years exiftence, its feeble frame, fliaken with convulfions from every trivial caufe, will be unable to perform the common functions of life, and prove a burden to fociety. * RoufTeau. B4 V 8 OF CHILDREN. If to the delicacy of mothers, we add the irregular lives of fathers, we fhall fee farther caufe to believe, that children are often hurt by the conftitutions of their parents. A fickly frame may be originally induced by hardfhips or intemperance, but chiefly by the latter. It is impoffible that a courfc of vice fhould not fpoil the beft conftitution: and, did the evil terminate here, it would be a juft punifhment for the folly of the fufferer. What a dreadful inhe- ritance 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 expenee of inheriting his difeafes! "' A perfon labouring under any incurable malady, ought not to-marry. He thereby not only fhortens his own life, but tranfmits mifery to others: but, when both parties are deeply tainted with the fcro- phula, the fcurvy, or the like, the effects muft be miferable indeed. Want of attention to thefe things, in forming connections for life, has rooted out more families than plague, famine, or the fword ; and, as long as thefe connections 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 fagacious fpaniel out of the fnarling cur. This is fettled upon immutable laws. The man who marries a woman of a fickly conftitution, and de- scended of unhealthy parents, whatever his views * The Lacedemonians condemned their king Archidamus, for having married a weak, puny woman : becaufe, faid they, inftead of propagating a race of heroes, you will fill the throne wllh a progeny of changelings. may OF CHILDREN. 9 may be, cannot be faid to act a prudent part. A difeafed woman may prove fertile ; fhould this be the cafe, the family mufl become an infirmary: what profpect of happinefs the father of fuch a family has, we fhall leave any one to judge. * Such children as have the misfortune to be born of difeafed parents, will 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. An healthy nurfe, whole- fome air, and fufficient exercife, will do wonders. But when thefe are neglected, little is to be expected from any other quarter. The defects of conftitution cannot be fupplied by medicine. Thofe who inherit any family difeafe, ought to be very circumfpect in their manner of living. They fhould confider well the nature of fuch difeafe, and guard againfl 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 greatefl importance. Family conftitutions are as capable of improvement as family eftates; and the libertine, who impairs the one, does greater injury to his pofterity, than the prodigal, who fquanders away the other. * The Jews, by their laws, were, in certain cafes, forbid to have any manner of commerce with the difeafed ; and indeed to this all wife legiflators ought to have a fpecial regard. In -fome countries, difeafed perfons have actually been forbid to marry. This is an evil of a complicated kind, a natural de- formity, and political mifchief; and therefore requires a public confideration. 10 OF CHILDREN. Of the Clothing of Children. The clothing of an infant is fo fimple a matter, that it is furpriling how any perfon fhould err in it j 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 pur- pofe, is to wrap it in a foft loofe 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 lafl become a fecret which none but adepts pretend to underfland. From the moil early ages, it has been thought neceffary, that a woman in labour fhould have fome perfon to attend her. This in time became a bufi- nefs ; and, as in all others, thofe who were employed in it, flrove to outdo 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 poffible. Thus it came to be thought as necef- fary 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 the 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 fractured in the birth ; while thefe were often fo tight, as not only to gall and wound its tender OF CHILDREN. u tender frame, but even to obflrudt 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 mea- fure, laid afide; but it would flill be a difficult talk to perfuade the generality of mankind, that the fhape of an infant does not entirely depend on the care of the midwife. So far, however, are all her endea- vours to mend the fhape from being fuccefsful, that they conflantly operate the contrary way, and man- kind become deformed 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 manacling their chil- dren. 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 flrong and hardy, that, by the time our puny infants get out of the nurfe's arms, theirs are able to fhift for themfelves. * Among brute animals, no art is neceffary to pro- cure a fine fhape. Though many of them are ex- tremely delicate, when they come into the world, yet we never find them grow crooked for want of Twaddling bands. Is nature lefs generous to the * A friend of mine, who was feveral years on the coaft 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 ftrait, and feldom have any difeafe. An American need go no further, for examples of the truth of this afTeition, than in our own country. The ihapes of the In- dians are proverbial, human 12 OF CHILDREN. 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 all preffure. They cannot indeed tell their complaints; but they can fhew 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, ftrange 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 flexible ; and, left they fhould receive any injury from preffure in the womb, has furrounded thefztus every where with fluids. This fhews the care which Nature takes to prevent all unequal preffure on the bodies of infants, and to defend them againfl every thing that might in the leafl cramp or confine their motions. Even the bones of an infant are fo foft and car- tilaginous, that they readily yield to the flightefl preflurej and eafily affume a bad fhape, which can never after be remedied. Hence it is, that fo many people appear with high fhoulders, crooked fpin.es, and flat breafls, who were as well proportioned at their birth as others, but had the misfortune to be fqueezed out of fhape, by the application of flays and bandages. Preffure, by obflrudting the circulation, likewife prevents the equal diflribution of nourifhment to the different parts of the body, by which means the growth becomes unequal. One part grows too large, OF CHILDREN. 13 large, while another remains too fmall; and thus, in time, the whole frame becomes difproportioned and misfhapen. To this we mufl add, that when a child is cramped* in its clothes, it' naturally fhrinks from the part that is hurt; and, by putting its body into unnatural poflures, it becomes deformed by habit. Deformity of body may indeed proceed from weaknefs or difeafe; but, in general, it is the effect of improper clothing. Nine-tenths, at leafl, of the deformity among mankind, mufl 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 mufl be impeded, and, of courfe, health impaired. Hence, few people remarkably misfhapen are ftrong or healthy. ^ The new motions which commence at the birth, as the circulation of the whole mafs of blood through the lungs, refpiration, the periflaltic motion, &c. afford another ftrong argument for keeping the body of an infant free from all preffure. Thefe organs, not having been accuftomed to move, are eafily flopped ; but when this happens, death mufl enfue. Hardly any method could be devifed more effectually to flop thefe motions, than bracing the body too tight with rollers * and bandages. Were thefe to be applied in the fame manner to the body of an adult, for an equal length of time, they would hardly fail to hurt the digeflion and make him fick. How much more hurtful they mufl prove to the tender bodies of infants, we ihall leave any one to judge. Whoever confiders thefe things, will not be fur- prifed, that fo many children die of convulfions foon * This is by no means inveighing againfl a thing that does not happen. In many parts of Britain, and in France, at this day, a roller, eight or ten feet in length, is applied tightly s-eujid the child's body, as foon as it is born. after H OF CHILDREN. after the birth. Thefe fits are generally attributed to fome inward caufe ; but in fact, they oftener proceed from our own imprudent conduct. I have known a child feized with convulfion-fitsp foon after the midwife had done fwaddling it, who, upon taking, off the rollers and bandages, was immediately relieved, and never had the difeafe afterwards. Nu- merous examples of this might be given, were they neceffary. It would be far fafer to faflen the clothes of an infant with firings than pins, as thefe often gall and irritate their tender ikins, and occafion diforders. Pins have been found flicking above half an inch into the body of a child, after it had died of convul- fion fits, which, in all probability, proceeded from that caufe. Children are not only hurt by the tightnefs 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 mufl be in- creafed. 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 mufl increafe the fever to fuch a degree as will endanger the life of the infant. The danger of keeping infants too hot will further appear, if we confider that, after they have been for fome time in the fituation mentioned above, they are often fent into the country to be nurfed in a cold houfe. Is it any wonder, if a child, from fuch a tranfition, 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 j hence pro- ceed OF CHILDREN. 15 ceed coughs, confumptions, and other difeafes of the breaft. It would anfwer little purpofe, to fpecify the par- ticular fpecies of drefs proper for an infant. Thefe will always vary in different countries, according to cuflom and the humour of parents. The great rule to be 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 infants. A volume would not fuffice to point out all the bad effects of this ridiculous piece of drefs both on children and adults. The madnefs in favour of flays feems, how- ever, to be fomewhat abated ; and it is to be hoped the world will, in time, become wife enough to know, that the human fhape does not folely depend upon whale-bone and bend-leather. * I fhall only add, with refpedt to the clothes of children, that they ought to be kept thoroughly clean. Children perfpire more than adults; and if their clothes be not frequently changed, they be- come very hurtful. Dirty clothes not only gall and fret the tender fkins of infants, but likewife occafion ill fmells ; and, what is worfe, tend to produce ver- min and cutaneous difeafes. Cleanlinefs is not only agreeable to the eye, but tends greatly to preferve the health of children. It promotes the perfpiration, and, by that means, frees * Stays made of bend-leather, are worn by all the women of lower ftation, in many parts of England. I am forry to underftand, that there are ftill 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 fhall beg leave juft to afk them, why there are ten deformed women for one man ? and likewife to recommend to their perufal a (hort moral precept, which forbids us to deform the human body. fhe 16 OF CHILDREN. the body from fuperfluous humours,, which, it re-' tained, could not fail to occafion difeafes. No mo- ther or nurfe can have any excufe for allowing a child to be dirty. Poverty may oblige her to give it coarfe clothes; but if fhe does not keep them clean, , it mufl be her own fault. Of the Food of Children. Nature not only points out the food proper for an infant, but actually prepares it. This, however, is not fufficient to prevent fome who think themfelves wifer than Nature, from attempting to bring up their children without her provifion. Nothing can fhew the difpofition which mankind have to depart from Nature more, than their endeavouring to bring up children without the breafl. The mother's milk, or that of an healthy nurfe, is unqueftionably the befl food for an infant. Neither art nor nature can afford a proper fubftitute for it. Children may feeiri to thrive for a few months without the breafl; but, when teething, the fmall-pox, and other difeafes in- cident to childhood, come on, they generally perifh. A child, foon after the birth, fhews an inclination to fuck ; and there is no reafon why it fliould not be gratified. It is true, the mother's milk does not always come immediately after the birth ; but this is the way to bring it: befides, the firfl milk that the child can fqueeze out of the breafl anfwers the pur- pofe of cleanfing,' better than all the drugs in the apothecary's fhop, and at the fame time prevents in- flammations of the breafl, fevers, and other difeafes incident to mothers. It is itrange how people came to think that the firfl thing given to a child fliould be drugs. This is beginning with medicine betimes, and no wonder if they generally ended with it. It fometimes happens, l indeed, OF CHILDREN. 17 Indeed, that a child does not difcharge the meconium fo foon as could be wifhed ; this has induced phy- ficians, in fuch cafes, to give fomething of an ooen- ing nature to cleanfe the firfl paffages. Midwives have improved upon this Vint, and never fail to give fyrups, oils, &c. whether they be neceffary or not.- Cramming an infant with fuch indigeftible fluff as foon as it is born, can hardly fail to make it fick, and is more likely to occafion difeafes than to pre- vent them. Children are feldom loner after the birth without having paffage both by ftool and urine ; though thefe evacuations may be wanting for fome time without any danger. But if children mufl have fomething before they be allowed the breafl, 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 addition of a little raw fugar. If this be given without any wines or fpiceries, it will neither heat the blood, load the flomach, nor occafion gripes. Upon the firft fight of an infant, almofl every perfon is flruck with the idea of its being weak, feeble, and wanting fupport. This naturally fuggefts the idea of cordi: . Accordingly wines are univer- fally mixed with tne firfl food of children. Nothing can be more fallacious than this way of reafoning, or more 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 wine is fufficient to heat and inflame die blood of an infant; but every perfon converfant in thefe matters mufl 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 C that iS OF CHILDREN. that is «=afy of digeflion, as water-pap, milk pottage* weak 1. roth with bread in it, and fuch like. This will eafc the mother, will accuflom the child by de- grees to take food, and will render the weaning both lefs difficult and lefs dangerous. All great and hid- den tranfitions are to be avoided in nurfmg. For this purpofe, the food of children ought not only to be fimple, but to refemble, as nearly as poffible, the properties of milk. Indeed milk itfelf mould make a principal part of their food, not only before they are weaned, but for fome time after*. Next to milk we fhould recommend good light bread. Bread may be given to a child as foon as it fhews 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 oi faliva, while, by mixing with the nurfe's milk in the flomach, it will afford an excellent nourifliment. Children difcover an early inclination to chew whatever is put into their hands. Parents obferve the inclination, but generally miflake the object. Inftead of giving the child fomething which may at once e^ercife its gums and afford it nourifliment, they con^nonly put into its hands a piece of hard metal, or impenetrable coral. A crufl of bread is the belt gum-flick. It not only anfwers the purpofe better than any thing elfe, but has the additional properties of nourifhing the child and carrying the faliva down to the flomach, which is too valuable a liquor to be loft. * I do not wifli to differ from the judicious author, but I am well perfuaded, that it is in general bed to learn children to feed a little when very young, and I believe there is no food fo proper f)r them as the hard water bifcuit pounded and boiled in water, and afterwards adding milk and futrar. Bread, OF CHILDREN. i? feread, befides being ufed dry, may be many ways prepared into food for children. One of the befl methods is to boil it in water, afterwards pouring the water off, and mixing with the bread a proper quantity of new milk unboiled. Milk is both more wholefome and nourifhing this way than boiled, and is lefs apt to occafion 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 of wholefome grain, and well ferment- ed ; but when enriched with 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 on their flomachs ; but, on the other hand, too much flefli heats the body, and occafions fevers and other inflammatory difeafes. This plainly points out a due mixture of animal and vegetable food as mofl proper for children. Few things prove more hurtful to infants, than the common method of fweetening their food. It entices them to take more than they ought to do, which makes them grow fat and bloated. It is pretty certain, if the food of children were quite plain, that they would never take more than enough. Their exceflfes 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 pa- late 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 ac too much food. After a child is weaned, it ought to be C 2 fed 2« OF CHILDREN. fed four or five times a day ; but fhould never be accuftomed to eat in the night; neither fliould it have too much at a time. Children thrive belt with fmall quantities of food frequently given. This nei- ther overloads1 the flomach nor hurts the digeftion, and is certainly moft agreeable to nature. Writers on nurfing have inveighed with fuch ve- hemence againfl giving children too much food, that many parents, by endeavouring to fhun that error, have run into the oppofite extreme, and ruined the conftitutions of their children. But the error of pinching children in their food is more hurtful than the other extreme. Nature has many ways of re- lieving herfelf when overcharged; but a child who is pinched with hunger will never become a flrong or healthy man. That errors are frequently com- mitted 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 the prin- cipal evil, and claims our ftricteft attention. Many people imagine that the food which they themfelves love cannot be bad for their children : but this notion is very abfurd. In the more advan- ced period of life we often acquire an inclination for food, which when children we could not endure. Befides, there are many things that by habit may agree very well with the flomach of a grown perfon, which would be hurtful to a child ; as high-feafoned, falted, and fmoke-dried provifions, &c. It would alfo be improper to feed children with fat meat, flrong broths, rich foups, or the like. All ftrong liquors are hurtful to children. Seme parents teach their children 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, whoop- ing cough, or fome inflammatory diforder. Milk, water. OF CHILDREN. 21 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 mixed with water. The flomachs of children can digefl well enough without the afiiflance of warm ftimulants: befides, being naturally hot, they are eafily hurt by every thing of, a heating quality. Few things are more hurtful to children than un- ripe fruits. They weaken the powers of digeftion, and four and relax the flomach, by which means it becomes a proper neft for infects. Children indeed fhew a great inclination for fruit, and I am apt to 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 properly regulated. Fruits are generally of a cooling nature, and correct the heat and acrimony of the humours. This is what mofl children require ; only care fhould be taken left they exceed. Indeed the befl way to prevent children from going to excefs in the ufe of fruit, or eating that which is bad, is to allow them a proper quantity of what is good*. Roots which contain a crude vifcid juice fliould be fparingly given to children. They fill the body with grofs humours, and tend to produce eruptive difeafes. This caution is peculiarly neceffary for the f poor ; glad to obtain at a fm.ali price what will fill the bellies of their children, they fluff them two or three times a day with crude vegetables. Children * Children are always fickly in the fruit fcafbn, which may be thus accounted f >r:. Two thirds of the fruit which comes to market in this country is really unripe ; and children not being in a condition to judge for them'elves, eat whatever they can lay their hands upon, which often proves little better than a poifon t» rheir tender bowels. Servants, and others who have the care of chddren fliould be ftriclly forbid to give them any fruit without the knowledge of their parents. C 3 had It OF CHILDREN. had better eat a fmaller quantity of food which yields a wholefome nourifliment, than be crammed with what their digeflive powers are unable properly to. affimilate. Butter1 ought likewife to be fparingly given to children. It both relaxes the flomach, and produces grofs humours. Indeed, moft things that are fat or oily, have this effect. Butter, when falted, be- comes flill more hurtful. Inftead of butter, fo libe- rally given to children in moft parts of Britain, we would recommend honey. Honey is not only whole- fome, 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, &c. Many people err in thinking that the diet of chil- dren ought to be altogether moifl. When children live entirely upon flops, it relaxes their folids, ren- ders them weak, and difpofes them to the rickets, the fcropula, and other glandular diforders. Re- laxation is one of the moft general caufes of the dif- eafes of children. Every thing therefore which tends to unbrace their folids, ought to be carefully avoided. 1 We would not be underflood by thefe obfervations as confining children to any particular kind of food. | Their diet may be frequently 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 influ- ence than the want of proper exercise : healthy parents, wholefome food, and proper cloathing, will avail little, where exercife is neglected. Sufficient exercife will make up for feveral defects in nurfing; but OF CHILDREN. 23 but nothing can fupply the want of it. It is abfo- lutely neceffary to the health, the growth, and the ftrength of children. The defire of exercife is coeval with life itfelf. Were this principle attended to, many difeafes might be prevented. But, while indolence and fedentary employments prevent two-thirds of mankind from either taking fufficient exercife themfelves, or giving it to their children, what have we to expect but dif- eafes and deformity among their offspring ? The rickets, fo destructive to children, never appeared in Britain till manufactures began to flourifh, and people, attracted by the love of gain, left the coun- try to follow fedentary employments in great towns. It is amongfl thefe people that this difeafe chiefly prevails, and not only deforms, but kills many of their offspring. The conduct of other young animals fhews the propriety of giving exercife to children. Every other animal makes ufe of its organs of motion as foon as it can, and many of them, even when under no neceffity of moving in quefl of food, cannot be reflrained without force. This is evidently the cafe with the calf, the lamb, and moft other young ani- mals. If thefe creatures were not permitted to frifk' about and take exercife, they would foon die or be- come difeafed. The fame inclination appears very- early in the human fpecies; but as they are not able to take exercife themfelves, it is the bufinefs of their parents and nurfes to affifl them. Children may be exercifed various ways. The belt method, while they are light, is to carry them about in the nurfe's arms*. This gives the nurfe * The nurfe ought to be careful to keep the child in a proper pofition; as deformity is often the confequence of inattention to this circumfhnce. Its fituation ought alfo to be frequently C 4 <>D 24 OF CHILDREN. an opportunity of talking to the child, and of point- ing 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 themfelves. Nothing can be more abfurd than to fet one child to keep another : this conduct has proved fatal to many in- fants, and has rendered others miferable for life. W hen children begin to walk, the fafefl and belt method of leading them about, is by the hands. The common way, of fwinging them in leading • firings fixed to their backs, has feveral bad confequenees. It makes them throw their bodies forward, and prefs with their whole weight upon the flomach and bread; by this means the breathing is obflructed, the breafl flattened, and the bowels compreffed ; which mufl hurt the digeftion, and occafion confumptions of .the lungs, and other difeafes. It is a common notion, that if children are fet upon their feet too foon, their legs will become crooked. There is reafon to believe, that the v.ery reve,rie of this ,is true. Every member acquires flrength in proportion as it is exercifed. The limbs of children are weak indeed, but their bodies are proportionably light $ and had they ijdll to dire# themfelves, they would foon be able to fupport their own weight. Who ever heard of any other animal that became crooked by ufing its legs too foon ? In- deed, if a child is not permitted to make any ufe of its iegs 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 haying })een accuftomed to ufe its legs from the beginning. changed. I have known a child's leg bent all on one fide, by j&e nurjfe carrying it conftantly on one arm. Mothers OF CHILDREN. 25 Mothers of the poorer fort think they are great gainers by making their children lie or fit while they themfelves work. In this they are greatly miflaken. By neglecting to give their children exercife, they are obliged to keep them a long time before they can do any thing for themfelves, and to fpend more on medicine than would have paid for proper care. To take care of their children, is the moft ufe- ful bufinefs in which even the poor can be em- ployed : but alas ! it is not always in their power. Poverty often obliges them to neglect their offspring, 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 flate, by enabling the poor to bring up their own children, than from all the hofpitals* that ever can be erected for that purpofe. Whoever confiders the flructure of the Iranian body will foon be convinced of the neceffity of exer- cife for the health of children. The body is com- pofed of an infinite number of tubes, whofe fluids cannot be pufhed on without the action and preffure of the mufcles. But, if the fluids remain inactive, obflrudtions mufl happen, and the humours will of courfe be vitiated, which cannot fail to occafion difeafes. Nature has furniflied both the veffels * If it were made the intereft cf the poor to keep their chil- dren alive, we fhould lofe very few of them. A fmall premium given annually to each poor family, for every child they have alive at the year's end, would fave more infant lives than if the whole revenue were expended on hofpitals for this purp je. This would make the poor efteem fertility a bleffing ; whereas many of them tfcink it the greateft curfe that can befal them; and in the place of wifh'ng their children to live; fo far doei poverty get the better of natural affechoa, that they are oftet very happy when they die. which 26 OF CHILDREN. which carry the blood and the lymph with nume- rous valves, in order that the action of every mufcle might pulh forward their contents ; but without action, this admirable contrivance can have no ef- fect. This part of the animal oeconomy proves to a demonftration the neceffity of exercife for the pre- fervation of health. Arguments to fhew the importance of exercife might be drawn from every part of the animal ceco- nomy ; without exercife, the circulation of the blood cannot be properly carried on, nor the different fe- cretions duly performed ; without exercife, the fluids cannot be properly prepared, nor the folids rendered flrong or firm. The action of the heart, the motion of the lungs, and all the vital functions, are greatly affifled by exercife. But to point out the manner in which thefe effects are produced, would lead us farther into the oeconomy of the human body, than molt of thofe for whom this treatife is intend- ed would be able to follow. We fhall therefore only add, that, where exercife is neglected, none of the animal functions can be duly performed ; and when this is the cafe, the whole conftitution mufl go to wreck. A good conftitution ought certainly to be our firfl object in the management of children. It lays a foundation for their being ufeful 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 conftitutions 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- mafler 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. Sitting OF CHILDREN. 27 Sitting fo long cannot fail to produce the wOrft ef- fects upon the body ; nor is the mind lefs injured. Early application weakens the faculties, and often fixes in the mind an averfion to books, which conti- nues for life*. But fuppofe this were the way to make children fcholars, it certainly ought not to be done at the ex- pence of their conftitutions. Our anceftors, who feldom went to fchool very young, were not lefs learned than we. But we imagine the boy's edu- cation will be quite marred, unlefs he be carried to fchool in his nurfe's arms. No 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 being kept in crowds within doors ; their breathing not only renders the place unwholefome, but if any one of them happens to be difeafed, the reft catch the infection. A An- gle child has been often known to communicate the bloody flux, the whooping-cough, the itch, or other difeafes, to almoft every individual in a numerous fchool. But, if fafhion mufl prevail, and infants are to be fent to fchool, we would recommend it to teachers, as they value the interefls of fociety, not to con- fine them too long at a time, but allow them to run about and play at fuch active diverfions as may promote their growth, and ftrengthen their conftitu- tions. Were boys, inftead of being prevented from * It is undoubtedly the duty of parents to inftrucl their chil- dren, at leaft till they are of an age proper to take fome care of themfelves. This would tend much to confirm the ties of pa- rental tendernefs and filial affection, of the want of which there are at prefent fo many deplorable inftances. Though few fa- thers have time to inftruct their children, yet moft mothers have ; and furely they cannot be better employed. running, 2$ ©F CHILDREN. running, riding, fwimming, 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 belt natural conftitution ; and if boys are brought up in a more delicate manner than even girls ought to be, they never will be men. Nor is the common education of girls lefs hurt- ful to the conftitution than that of boys. Mifs is fet down to her frame before fhe can put on her clothes; and is taught to believe, that to excel at the needle is the only thing that can entitle her to general efteem. It is unneceflary here to infifl upon the dangerous confequences of obliging girls to fit too much. They are pretty well known, and are 'too often felt at a certain time of life. But fup- pofing this critical period to be got over, greater dangers ftill await them when they come to be mo- thers. Women who have been early accuftomed to a fedentary life, generally run great hazards in child- bed ; while thofe who have been ufed to take fuffi- cient 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 and early confinement generally occafions indigeftions, head-achs, pale com- plexions, pain of the flomach, lofs of appetite, coughs, confumptions of the lungs, and deformity of body. The laft of thefe indeed is not to be won- dered at, confidering the aukward poftures in which girls fit at many kinds of needle-work, and the de- licate flexible ftate of their bodies in the early pe- riods of life. Would mothers, inftead of having their daugh- ters inftructed in many trifling accomplifhments em- ploy them in plain work and houfewifery, and ah low OF CHILDREN. ?9 low them fufficient exercife in the open air, they would both make them more healthy mothers, and more ufeful members of fociety. I am no enemy to genteel accomplifliments, but would have them only confidered as fecondary, and always dilregarded when they impair health. 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 be- nefited, is a real lofer by their labour. There are few employments, except fedentary ones, by which children can earn a livelihood; and if they be kt to thefe too foon, it ruins their conftitutions. Thus, by gaining a few years from childhood, we gene- rally Iofe 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 obfer- vation, we need only look into the great manufac- turing towns, where we fhall find a puny degene- rate 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 in- habitants. 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 never will turn out to advantage. This is equally true with refpect to the human fpecies.— Weakly children fhould always be put apprentices to trades which require their being moftly out of doors; a OF CHILDREN. doors; the contrary practice is, however, too com- mon. There are neverthelefs various ways of employ- ing young people without hurting their health. The eafier parts of gardening, hufbandry, 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, however, as are under the necef- fity of employing their children within doors, ought to allow them fufficient time for active diverfions without. This would both encourage them to do more work, and prevent their conftitutions from being hurt. Some imagine, that exercife within doors is fuf- ficient ; but they are greatly miftaken. One hour fpent in running, or any other exercife without doors, is worth ten within. When children cannot 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 ex- cellent fervice to young people. It cheers the fpi- rits, promotes perfpiration, ftrengthens the limbs, &c. I know an eminent phyfician who ufed to fay, that he made his children dance, inftead of giving them phyfic. it were well if more people followed his example. The cold bath may be confidered as an aid to exercife. By it the body is braced and ftrengthen- ed ; the circulation and lecretions promoted ; and, * 1 hive been told thu in China, where the police is the beft in the world, all the children are employed in the eafier part of gardening and hufoandry ; a* weeding, gathering ftones off the land, and h:ch like. % were OF CHILDREN. 31 were it conducted with prudence, many difeafes, as the rickets, fcrophula, &c. might thereby be pre- vented. The ancients, who took every method to render children hardy and robuft, were no ftrangers to the ufe of the cold bath ; and, if we may credit report, the practice of immerfing children daily in cold water mufl have been very common among our anceftors. The greateft objection to the ufe of the cold bath arifes from the fuperflitious prejudices of nurfes. Thefe are often fo ftrong, that it is impoflible to bring them to make a proper ufe of it. I have known fome of them who would not dry a child's fkin after bathing it, left it fliould deftroy the effect of the water. Others will even put cloths dipt in the water upon the child, and either put it to bed, or fuffer it to go about in that condition. Some believe that the whole virtue of the water depends upon its being dedicated to a particular faint: while others place their confidence in a certain number of dips, as three, feven, nine, or the like ; and the world could not perfuade them, if thefe do not fucceed, to try it a little longer. Thus, by the whims of nurfes, children lofe the benefit of the cold bath, and the hopes of the phyfician from that medicine are often fruftrated. We ought not, however, entirely to fet afide the cold bath, becaufe fome nurfes make a wrong ufe of it. Every child, when in health, fhould at leafl have its head and extremities daily wafhed in cold water. This is a partial ufe of the cold bath, and is better than none. In winter, this may fuffice ; but, in the warm feafon, if a child be relaxed, or feem to have a tendency to the rickets or fcrophula, its whole body ought to be frequently immerfed in cold wa- ter. Care, however, mufl be taken not to do this when the body is hot, or the flomach full. The child 32 OF CHILDREN. child fliould be dipt only once at a time, fhould be taken out immediately, and have its fkin well rubbed with a dry clorh. The bad Efeels of unwholefome Air upon Children. Few things prove more definitive to children than confined or unwholefome air. This is one reafon why fo few of thofe infants, who are put into hofpitals, or parifh workhoufes, 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 deflructive to many of the children born in great towns. There the poorer fort of inhabitants live in low, dirty, confined houfes, to which the frefh air has hardly any accefs. Though grown people, who are hardy and robuft, may live in fuch fituations, yet they generally prove fatal to their offspring, 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 into the ©pen air, we mufl lay our account with lofing the greater part of them. But the rich have not this excufe. It is their bufinefs to fee that their chil- dren be daily carried abroad, and that they be kept in the open air for a fufficient time. This will al- ways fucceed better if the mother goes along with them. Servants are often negligent in thefe mat- ters, and allow a child to fit or lie on the damp ground, inftead of leading or carrying it about. The mother certainly needs air as well as her chil- dren ; and how can fhe be better employed than io. attending them ? r A very OF CHILDREN. 33 A very bad cuftom prevails, of making children. fleep in fmall apartments, or crowding two or three beds into one chamber. Inftead of this, the nurfery ought always to be the largeft and belt 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 de- licate, and difpofes them to ctffas 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 ac-» tually 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 afide. * A child is generally laid to fleep with all its clothes en ; and if a number of others are heaped above them, it mufl be overheated ; by which means it can- not fail to catch cold on being taken out of the * It is amazing how children efcape fuffocation, confidering the manner in which they are of en 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 ftay, I found it always on my return in the fame fituation. Death, as might be expected, 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 which ptrfyed fatal to their child. I was very lately called to fee an infant which was faid to be expiring in convulfion fits. I defired the mother to ftrip the child, and wrap it in a loofe covering. It had no more con- /njfton fit*. D cradle. 34. OF CHILDREN. cradle, and expofed in 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 compared 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, vi- gour, and magnitude, which they would have ac- quired 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 learn- ing ought, if poflible, 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 particularS advantages of wholefome air to children, or of the I bad confequences which proceed from the, want of it, I fhall only obferve, that, of feveral thoufands \ of children which have been under my care, I do not remember one inftance of a fingle child who continued healthy in a clofe confined fituation ; but have often known the moft obflinate difeafes cured by removing them from fuch a fituation to an open free air. Of Nurfes. @ It is not here intended to lay down rules for the *..;j choice of nurfes. This would be wafting time. | Common fenfe will direct every one to chufe a wo- ^ man OF CHILDREN. 55 man who is healthy, and has plenty of milk. * If (he be at the fame time cleanly, careful, and good- natured,'fhe can hardly fail to make a proper nurfe. After all, however, the only certain proof of a good nurfe is an healthy child upon her breafl. But, as the mffconduct of nurfes often proves fatal to children, it will be of importance to point out a few of their moft baneful errors, 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 Jhould be carefully looked after', otherwifejhe will not do her duty. For this reafon parents ought always to have their children nurfed under their own eye, if poffible; and where this cannot be done, they fhould be extremely circum- fpect in the choice of thofe perfons to whom they intrufl them. It is folly to imagine that any wo- man, who abandons her own child to fuckle an- other for the fake of gain, fhould feel all the affec- tions of a parent towards her nurfling ; yet fo necef- fary are thofe affections in a nurfe, that, but for them, the human race would foon be extinct. One of the moft common faults of thofe who nurfe for hire, is to dofe children with flupefac- tives, or fuch things as lull them afleep. An in- dolent nurfe, who does not give a child fufficient exercife in the open air to make it fleep, and does not chufe to be difturbed by it in the night, will feldom fail to procure for it a dofe of laudanum, diacodium, faffron, or what anfwers the fame pur- * I have often known people fo impofed upon, as to give an infant to a nurfe to be fuckled, who had not one drop of milk in her bre;ift. D z pofe. -6 OF CHILDREN. ' 1 pofe, a dofe of fpirits, or other ftrong hquort; \ Thefe, though they be certain poifon to infants, are ; every day adminiftered by many who bear the cha- j raeter of very good nurfes. * _ a A nurfe who has not milk enough is ant to ima- *l gine that this defe& may be fupplied by*giving ths child wines, cordial waters, or other ftrong liquors* I This is an egregious miftake. The only thing that' has any chance to fupply the place of the nurfe^ milk, mufl be fomewhat nearly of the fame quality, as cow's milk, afs's milk, or beef tea, with good bread. It never can be tlone by the help of flrong liquors. Thefe, inftead of nourifhing an infant, never fail to produce the contrary effect. Children are often hurt by nurfes fuffering them *ci to cry long and vehemently. This flrains their tender bodies, and frequently occafions ruptures, inflammations of the throat, lungs, &c. A child never continues to cry long without fome caufe, which might always be difcovered by proper atten-" tion ; and the nurfe who can hear an infant cry tillx' it has almoft fpent itfelf, without endeavouring to pleafe it, mult be cruel indeed, and is unworthy to be entrufled with the care of an human creature. Nurfes who deal much in medicine are always to be fufpected. They trufl to it, and neglect their duty. 1 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 all defects in food, air, exercife, and cleanlinefs. By errors of this kind, I will venture to fay, that one half of the children who die annu- ally in London, lofe their lives. * If a mother, on vifking her child at nurfe, find it always afleep, I would advife her to remove it immediately, otherwiffc] it will foon fleep its laft. Allowing OF CHILDREN. 37 Allowing children to continue long wet, is another very pernicious cuftom of indolent nurfes. This is not only difagreeable, but it galls and frets the in- fant, and, by relaxing the folids, occafions fcrophu- las, rickets, and other difeafes. A dirty nurfe is always to be fufpected. Nature often attempts to free the bodies of chil- dren from bad humours, by throwing them upon the fkin: by this means fevers and other difeafes are prevented. Nurfes are apt to miftake fuch cri- tical 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; and no wonder, as Nature is oppofed in the very method fhe takes to relieve them. It ought to be a rule, which every nurfe fhould obferve, never to ftop any eruption without proper advice, or being well affured that it is not of a critical nature. At any rate, it is never to be done without previous evacuations^ Loofe flools is another method by which Nature often prevents or carries off the difeafes of infants. If thefe proceed too far, no doubt they ought to be checked ; but this is never to be done without the greateft caution. Nurfes, upon the firfl appearance of loofe ftools, frequently fly to the ufe of aftrin- gents, or fuch things as bind the body. Hence in* flammatory fevers, and other fatal difeafes, are oc- cafioned. A dofe of rhubarb, a gentle vomit, or fome other evacuation, fhould generally precede the . ufe of aftringent medicines. One of the greateft faults of nurfes is, concealing the difeafes of children from their parents. This they are extremely ready to do, especially when the difeafe is the effect of their own negligence. Many inftances might be given of perfons who have been rendered lame for life by a fall from their nurfe's D 3 arms, 38 OF CHILDREN. arms, which fhe, through fear, concealed till the misfortune was paft cure, Every parent who in* trufts a nurfe with the care of a child, ought to give her the ftricteft 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 misfortune which happens to a child under her care, till it lofes its life or limbs, fhould not be punifhed. A few examples of this would fave the lives of many infants; but as there is little reafon to expect that it ever will be the cafe, we would earneftly recommend it to all parents to look care- fully after their children, and not to truft fo valu- able a treafure entirely to the hands of an hireling. No perfon ought to imagine thefe-4hings unwor* thy of his attention. On the proper management of children depend not only their health and ufeful- nefs in life, but likewife the fafety and profperity of the flate to which they belong, Effeminacy ever will prove the ruin of any flate where it prevails; and, when its foundations are laid in infancy, it can never afterwards be wholly eradicated. Parents who love their offspring, and wifli well to their country, ought therefore, in the management of their chil- dren, to avoid every thing that may have a tendency to make them weak or effeminate, and to take every method in their power to render their conftitution^. ftrong and hardy. -By arts like thefe Laconia nurs'd of old her hardy fons; And Rome's unconquei'd legions urg'd their way Unhurt, thro' every toil and every clime. * ? Armftrong. CHAR [ 39 ] CHAP. II. Of the Laborious, the Sedentary, and the Studious. 1 HAT men are expofed to particular difeafes from the occupations which they follow, is a fact well known ; but to remedy this evil is a mat- ter of fome difficulty. Molt people are under the neceffity of following thofe employments to which they have been bred, whether they be favourable to health or not. For this reafon, inftead of in- veighing, in a general way, as fome authors have done, againfl thofe occupations which are hurtful to health, we fhall endeavour to point out the cir- cumflances in each of them from which the danger chiefly arifes, and to propofe the molt rational me- thods of preferving it. Chemifts, founders, forgers, glafs-makers, and feveral other artifts, are hurt by the unwholefome air which they are obliged to breathe. This air is not only loaded with the noxious exhalations arifing from metals and minerals, but is fo charged with ■phlogifton as to be rendered unfit for expanding the lungs fufficiently, and anfwering the other im- portant purpofes of refpiration. Hence proceed aflhmas, coughs and confumptions of the lungs, fo incident to perfons who follow thefe employments. To prevent fuch confequences, as far as poffible, the places where thefe occupations are carried on, ought to be constructed in fuch a manner as to dif- charge the fmoke and other exhalations, and admit a free current of frefh air. Such artifts ought never D 4 to 40 OF THE LABORIOUS, THE SEDENTARY, to continue too long at work ; and when they give over, they fliould furfer themfelves to cool gradually, and put on their clothes before they go into the open air. They ought never to drink large quantities 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 flomach. * Miners, and all who work under ground, are like- wife hurt by unwholefome air. The air, by its flag* nation in deep mines, not only lofes its proper fpring and other qualities neceffary for refpiration, b»t is often loaded with fuch noxious exhalations as tp be- come a moft deadly poifon. . ±jM The two kinds of air which prove moft deftructHtt ''19 to miners, are what they call the fi're damp, and the choke damp. In both cafes the air becomes a poifon, The danger from the former may be obviated by making it explode before it accumulates in too great quantities ; and the latter may be generally carrie4 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, &e. Thefe are abforbed, or taken up into the body, and occafion palfies, verti- goes, and other nervous affections, which often prove fatal. Fallopius 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 faffing, nor to continue too long at work. Their food ought to be nourifhing, and their liquor generous : no- thing more certainly hurts them than living too low, * When perfons heated with labour have drunk cold liquor tkey ought to continue at work for fome time after. They © AND THE STUDIOUS. At They fliould by all means avoid coftivenefs. This may either be done by chewing a little rhubarb, or taking a fufficient quantity of faliad 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 ftrict, and almoft reli- gious regard to cleanlinefs. Plumbers, painters, gilders, fmelters, makers of white lead, and many others who work in metals, are liable to the fame difeafes as miners, and ought to obferve the fome directions for avoiding them. Tallow-chandlers, boilers of oil, and all whd work in putrid animal fubftances, are likewife liable to fuffer from the unwholefome fmells or effluvia of thefe bodies. They ought to pay the fame regard to cleanlinefs as miners; and when they are affected with naufea, ficknefs, or indigeftion, we would ad- vife them to take a vomit or a gentle purge. Such fubftances ought always to be manufactured as foon as poffible. When long kept, they not only become unwholefome to thofe who manufacture them, but likowife 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 Laborious, Se- dentary, and Studious. THE LABORIOUS. Though thofe who follow laborious employnieme are in general the moft healthy of mankind, yet the nature of their occupations, and the places where they 4z OF THE LABORIOUS, THE SEDENTARY, they are carried on, expofe them more particularly -j to fome difeafes. Hufbandmen, for example, are expofed to all the viciflitudes of the weather, which, in this country, are often very great and hidden, and occafion colds, coughs, quinfies, rheumatifms, fevers, and other acute diforders. They are likewife forced to work hard, and often to carry burden* % above their ftrength, which, by overftraining the veifels, occafion' afthmas, ruptures, pleurifies, &c. Thofe who labour without doors are often afflict- ed with intermitting fevers or agues, occafioned by the frequent viciflitudes of heat and cold, poor living, bad water, fitting or lying on the damp ground, evening dews, night air, &c. to which they are fre- quently expofed. Such as bear heavy burdens, as porters, labourers', &c. are obliged to draw in the air with much greate^ force, and alfo to keep their lungs diftended with^ more violence than is neceffary for common refpira- tion : by this means the tender veifels of the lungs.' are overftretched, and often burft, infomuch that a fpitting of blood or fever enfues. Hippocrates men- ' tions an inftance to this purpofe, of 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 difeafe, which he reaps as the fruit of his folly. One would imagine, the daily inflances we have, of the fatal effects r AND THE STUDIOUS. 43 effects of carrying great weights, running, wreft- ling, and the like, would be fufficient to prevent fuch practices. There are indeed fome employments which ne- ceflarily require a great exertion of ftrength, as por- ters, blackfmiths, carpenters, &c. They fhould never exert their ftrength to the utmoft, nor work too long. When the mufcles are violently ftrained, frequent reft is neceffary, 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 eryfipelas, or St. Anthony's fire, is a difeafe very incident to the laborious. It is occafioned by whatever gives a hidden 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 impoflible for thofe who labour without doors always to guard againfl thefe inconveniences ; but it is known from expe- rience, 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 eryfipelas; but they may likewife proceed from flatulent and indigeftible food. Labourers frequently eat unfermented bread, made of peas, beans, rye, and other windy ingredients. They alfo devour great quantities of unripe fruits, baked, ftewed, or raw, with various kinds of roots and herbs, upon which they often drink four milk, flale 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 at- tributed to venom, or fome kind of poifon ; but they gene- 44 OF THE LABORIOUS, THE SEDENTARY, 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 veflels not yielding fo quickly, a ftrangulation happens, and an inflammation or a mortification 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 happens, that people' I arefo benumbed with cold, as to be quite deprived?)" of the ufe jof their limbs. In this cafe, the only re- medy is to rub the parts affected with fnow, or where it cannot be had, with cold water. If they be held near the fire* or plunged into warm water, a morti- fication will generally enfue. Labourers in the hot feafon are apt to lie dow% and fleep in the fun. This practice is fo dangerous, * that they often wake in a burning fever. Thefe ar- dent fevers, which prove fo fatal about the end of fummer and beginning of autumn, are frequently occafioned by this means. When labourers leave off work, which they ought always to do during the heat of the day, they fhould go home, or, at leafl, get under fome cover, where they may repofe them* felves in fafety. Many people follow their employments in the fields from morning till night, without eating any thing. This cannot fail to hurt their health. How- ever 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 nourifliment, they foon produce fevers of the very worft kind Many 1 0 AND THE STUDIOUS. 45 Many peafants are extremely carelefs with refpect to what they eat or^irink, and often, through mere indolence, ufe unwnolefome food, when they might for the fame expence have that which is wholefome. In fome parts of Britain, the peafants are too care- lefs even to take the trouble of dreffing their own victuals. Such people would live upon one meal a-day in indolence, rather than labour, 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 humours become vi- tiated, and the folids weak ; from whence the moft fatal confequences enfue. Poor living is likewife productive of many of thofe cutaneous difeafes fo frequent among the lower clafs of people. It is re- markable that cattle, when pinched in their food, are generally affected with difeafes of the fkin, which feldom fail to difappear, when they are put upon a good pafture. This fhews how much a good flate of the humours depends upon a fufficient quantity of proper nourifliment. 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 overtakes them, they are miferable indeed. Here the god-like virtue of charity ought always to exert itfelf. To relieve the induflrious poor in dif- trefs, is furely a moft exalted act of religion and humanity. They alone, who are witnefles of thofe fcenes of calamity, can form an idea of what num- bers perifli in difeafes, for want of proper afliftance, and even for want of the necelfaries of life. Labourers are often hurt by a foolifh. emulation, which prompts them to vie with one another, till they 46 OF THE LABORIOUS, THE SEDENTA RY, they overheat themfelves to fuch a degree as to oc- cafion a fever, or even to drop &>wn dead. Such as wantonly throw away their lives in this manner, de- ferve to be looked upon in no better light than felf- murderers. Sailors may alfo be numbered among the laborious. They undergo great hardfhips from change of cli- mate, the violence of weather, hard labour, bad pro- vifions, &c. Sailors are of fo great importance, that too much pains can never be beflowed in pointing out the means of preferving their lives. One great fource of the difeafes of fea-faring peo- ple is excefs. When they get on fhore, after hav- ing been long at fea, without regard to the climate, ,ft or their own conftitutions, they plunge headlong in-' '"'* to all manner of riot, and often perfift till a fever!'^ puts an end to their lives. Thus intemperance, and not the climate, is often the caufe why fo many of our brave failors die on foreign coafts. Such peo- ple ought not to live too low; but they will find moderation the beft defence againft fevers, and many other maladies. Sailors, when on duty, cannot avoid fometimes getting wet. When this happens they fhould change their clothes as foon as they are relieved, and take every method to reftore the perfpiration. They fliould not, in this cafe, make too free with fpirits or other ftrong liquors, but fliould rather drink warm teas, 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 un- wholefome food. The conftant ufe of falted provi- fions vitiates their humours, and occafions the fcurvy, and other obftinate maladies. It is no eafy matter to prevent this difeafe in long voyages; yet much might be done towards effecting fo defirable an end, were AND THE STUDIOUS. 47 were due pains beftowed for that purpofe. For ex- ample, various roots, greens, and fruits might be kept a long time at fea, as onions, potatoes, cabba- ges, lemons, oranges, tamarinds, apples, &c. When fruits cannot be kept, the juices of them, either frefh or fermented, may. With thefe all the drink, and even the food of the (hip'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 againfl the fcurvy. Small wines and cyder might likewife be plentifully laid in; and fhould they turn four, they would flill be ufeful as vinegar. Vinegar is a great antidote againft difeafes, and fhould be ufed by all travellers, espe- cially 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 likewife to be carried on board, as hens, ducks, pigs, &c. Frefh broths made of portable foup, and puddings made of peas, or other vegetables ought to be ufed plentifully. 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. * * The celebrated Captain Cook, has fliewn how far, by proper care and attention, the difeafes formerly fo fatal to fca- men may be prevented. In a voyage of three years and eighteen days, during which he was expofed to every climate, from the 52° 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 phthifts pulmonalis. The principal means he ufed were, to prefe-rre a firift attention to cleanlinefs, to procure abundance • ' 4S OF THE LABORIOUS, THE SEDENTARY, We have reafon to believe, if due attention were paid to the diet, air, clothing, and above all things to the cleanlineft 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. v The beft medical antidote that we can recommend' , to failors. or foldiers, on foreign coafts, efpecially where dampriefs prevails, is the Peruvian bark. This will often prevent fevers, and other fatal dif- eafes. 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 for two or three days in an Englifh quart of brandy, and half a wine glafs of it taken twice or thrice a- fons may either prevent the ripening of grain, or damage it afterwards. Thefe, indeed, are acts of Providence, and we mufl fubmit to them ; but fure- ly no punifhment can be too fevere for thofe who fuffer provifions to fpoil by hoarding them, on pur* pofe to raife the price, or who promote their own fuppofed intereft by adulterating the neceffaries of life. * Animal, as well as vegetable food, may be render- ed unwholefome, by being kept too long. All ani- mal fubftances have a conftant tendency to putre- faction ; and, when that has proceeded too far, they * The poor, indeed, are generally the firfl who fuffer by unfound provifions ; but the lives of the labouring poor are of great importance to the ftate : befides, difeafes occafioned by unwholefome food often prove infectious, by which means they reach people in every ftation. It is therefore the intereft of all to take care that no fpmlt provifions of any kind be ex- pofed tc fale. 4 no OF ALIMENT. 65 not only become offenfive to the fenfes, but hurtful to health. Difeafed animals, and fuch as die of themfelves, ought never to be eaten. It is a com- mon practice, however, in fome grazing countries, for fervants and poor people to eat fuch animals as die of any difeafe, or are killed by accident. Pover- ty, indeed, 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 nourifli- inent7 and be attended with lefs danger. The injunctions given to the Jews, not to eat any creature which died of itfelf, feemed to have a ftrict regard to health ; and ought to be obferved by Chrif- tians as well as Jews. Even thofe which die by acci- dent mufl be hurtful, as their blood is mixed with the flefh, and foon turns putrid. Animals which feed grofsly, as tame ducks, hogs, &c. are neither fo eafily digefted, nor afford fuch wholefome nourifliment as others. No animal can be wholefome which does not take fufficient exercife. Moft of our flailed cattle are crammed wiih.grofs food, but not allowed exercife nor free air; by which means they indeed grow fat, but their juices not being properly prepared or aflimilated, 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, exalts the animal falts, and mixes the blood fo intimately with the flefli that it cannot be feparated. For this reafon, butchers fhould be feverely punifhed who over-drive their cattle. No perfon would chufe to eat the flefli of an animal which had died in a high fever ; yet that is the cafe with all over-drove cattle ; and the fever is often raifed to the degree of mad- nefs. F Bur 66 OF ALIMENT. But this is not the only way by which butchers render meat unwholefome. The abominable cuf- tom of filling the cellular membrane of animals with air, in order to make them appear fat, is every day practifed. . This not only fpoils the meat and ren- ders it unfit for keeping, but is fuch a dirty trick,4 that the very idea of it is fufficient to difguft a perfon of any delicacy, at every thing which comes from the fliambles. Who can bear the thought of eat- ing meat which has been blown up with air from thdl tongs of a dirty fellow, perhaps labouring under the very worft of difeafes ? Butchers have likewife a method of filling the cellular membranes of animals with blood. This makes the meat feem fatter, and likewife weigh more, but is notwithftanding a very pernicious cuf- tom, as it both renders the meat unwholefome and >lmfit for keeping. I feldom fee a piece of meat from the fliambles, where the blood is .not dilfufed through the cellular texture. I fhall not fay that this is always the effect of defign ; but I am certain . J it is not the cafe with animals that are killed for domeftic ufe, and properly blooded. Veal feems to be moft frequently fpoilt in this way. Perhaps ] that may in fome meafure be owing to the practice ] of carrying calves from a great di fiance to market, by which means their tender flefli is bruifed, and . many of their veifels burft. No people in the world eat fuch quantities of ani- mal food as the Englifh, which is one reafon why they are fo generally tainted with the fcurvy and its numerous train of confequences, indigeftion, low fpirits, hypochondriacifm, &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, fifli, and fowl, j twice or thrice a day, is certainly too much. All 1 who OF ALIMENT. £7 who value health ought to be contented with making one meal of flefli in the twenty-four hours, and this ought to confift of one kind only. The moft obftinate fcurvy has often been cured t by a vegetable diet ; nay, milk alone will frequently do more in that difeafe than any medicine. Hence it is evident, that if vegetables and milk were more ufed in diet, we fhould have lefs fcurvy, and like- wife fewer putrid and inflammatory fevers. Frefh vegetables, indeed, come to be daily more ufed in diet; this laudable practice we hope will continue to gain ground* . Our aliment ought neither to be too moift nor too dry. Moift aliment relaxes the folids, and ren- ders the body feeble. Thus we fee females, who live much on tea and other watery diet, generally become weak, and unable to digeft folid food : hence proceed hyfterics, and all other dreadful confequences. On the other hand, food that is too dry, renders the folids in a manner rigid, and the humors vifcid, which difpofes the body to inflammatory fevers, fcur- vies, and the like. Much has been faid on the ill effects of tea in diet. They are, no doubt, numerous; but they proceed rather from the imprudent ufe of it, than from any bad qualities in the tea itfelf. Tea is now the uni- versal breakfaft in Great Britain ; but the morning is furely the moft improper time of the day for drink- ing it. Moft delicate perfons, who, by the bye, are the greateft tea-drinkers, cannot eat any thing in the morning. If fuch perfons, after failing ten or twelve hours, drink four or five cups of tea with- out eating almolt any bread, it mufl hurt them. Good tea, taken in moderate quantity, not too ftrong nor too hot, nor drank upon an empty flo- mach, will feldom do harm ; but if it be bad, which 68 OF ALIMENT. is often the cafe, or fubftituted in the room of folid food, it mufl have many ill effects. The arts of cookery render many things unwhole- ■{ fome, which are not'fo in their own nature. By jumbling together a number of different ingredients^ in order to make a poignant fauce,^ or rich foup, the compofition proves almoft a poifon. All high feafoning, pickles, &c. are only incentives to lux- ury, and never fail to hurt the flomach. It were well for mankind, if cookery, as an art, were en- tirely prohibited. Plain roafting or boiling is all that the flomach requires. Thefe alone are fufficient for people in health, and the fick have ftiil lefs need of a cook. The liquid part of our aliment likewife claims our attention. Water is not only the bafis of moft li- quors, but alfo compofes a great part of our folid food. Good water mufl 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 j which it comes into contact ; 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 Eng- land, have large tumors or wens on their necks. This difeafe is generally imputed to the fnow-water; but there is more reafon to believe it is owing to the minerals in the mountains through which the waters I pafs. When water is impregnated with foreign bodies, it generally appears by its weight, colour, tafte, fmell, heat, or fome other fenfible quality. Our I bufinefs OF ALIMENT. 60 bufinefs therefore is to chufe fuch water, for com- mon ufe, as is lighteft, and without any particular colour, tafte, or fmell. In moft places of Britain the inhabitants have it in their power to make choice of their water ; and few things would contribute more to health than a due attention to this article. But mere indolence often induces people to make ufe of the water that is neareft to them, without con- fidering its qualities. Before water is brought into great towns, the ftrictefl attention ought to be paid to its qualities, as many difeafes may be occafioned or aggravated by bad water ; and when once it has been procured at a great expence, people are unwilling to give it up. The common method of rendering water clear by filtration, or foft, by expofing it to the fun and air, &c. are fo generally known, that it is unnecef- fary to fpend time in explaining them. We fhall only, in general, advife all to avoid waters which ftagnate 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. As fermented liquors, notwithftandihg they have been exclaimed againft by many writers,flill unhappily continue to be the common drink of almoft every perfon who can afford them ; we fhall rather endea- vour to affift people in the choice of thefe liquors, than to pretend to condemn what cuftom has fo firmly eftabliflied. It is not the moderate ufe of found fermented liquors which hurts mankind : it is excefs, and ufing fuch as are ill prepared or vitiated. F 3 Fermented i 7o OF ALIMENT. Fermented liquor?, which are too ftrong, hurt digeftion ; and the body is fo far from being ftrength. ened by them, that it is weakened and relaxed. Many imagine that hard labour could not be fup- ported without drinking ftrong liquors ; this is a very erroneous notion. Men who never tafle ftrong liquors are not only able to endure more fatigue, # but alfo live much longer, than thofe who ufe thera daily. But, fuppofe ftrong liquors did enable a man to do more work, they mufl neverthelefs waite the powers of life, and occafion premature old age. They keep up a conftant fever, which exhaufts the fpirits, inflames the blood, and difpofes the body to number- lefs difeafes. But fermented liquors may be too weak as well as too ftrong: when that is the cafe, they mufl ei. ther be drank new, or they become four and dead: when fuch liquors are drank new, the fermentatioa. r not being over, they generate air in the bowels, and occafion flatulencies; and, when kept till ftale, they -)M turn four on the flomach, and hurt digeftion. For this reafon, all malt liquors, cider, &:c. ought to be of fuch ftrength as to keep till they be ripe, and then they fhould be ufed. When fuch liquors are kept too long, though they fliould not become four, yet they generally contract a hardnefs, which renders ' them unwholefome. All familiesj who can, ought to prepare their own liquors. • Since preparing and vending of li- , i quors become one of the moft general branches of I bufinefs, every method has been tried to adulterate ,9 them. The great object both to the makers and I venders of liquor is, to render it intoxicating, and give it the appearance of age. But it is well known m that it may be done by other ingredients than thofe | which ought to be ufed for making it ftrong. It y/ould be imprudent even to name thofe things which I A are OF ALIMENT. 71 are daily made ufe of to render liquors heady. Suf- fice it to fay, that the practice is very common, and that all the ingredient-s ufed for this purpofe are of a narcotic or ftupefactive quality. But as all thefe drugs are poifonous, it is eafy to fee v. hat mufl be the con- fequence of their general ufe. Though they do not kill fuddenly, yet they hurt the nerves, relax and weaken the flomach, and fpoil the digeftion. Were fermented liquors faithfully prepared, kept to a proper age, and ufed in moderation, they would prove real bleffmgs to mankind. But, while they are ill prepared, various ways adulterated, and taken to excefs, they mufl have many pernicious effects. We would recommend it to families, not only to prepare their own liquors, but like-wife their bread. Bread is fo neceffary a part of diet, that too much care cannot be bellowed in order to have it found and wholefome. For this purpofe, it is not only neceflary that it be made of good grain, but like- wife properly prepared, and kept free from all un- wholefome ingredients. This, however, we have reafon to believe is not always the cafe with bread prepared by thofe who make a trade of vending it. Their object is rather to pleafe the eye, than to con- fult the health. The belt bread is that which is nei- ther too coarfe nor too fine ; well fermented, and made of wheat flour, or rather of wheat and rye mixed together. Notwithftanding the general idea of the fuperiority of fermented bread, it is certain that unfermented bread is more wholefome ; witnefs, the oat-cakes of the Scotch, the rice of the Eaft-In- dians, the indian meal of the Indians of America, the hard bifcuit of wheaten flour. To fpecify the different kinds of aliment, to ex- plain their nature and properties, and to point out their effects in different conftitutions, would far ex- F 4 ce«d ?2 OF ALIMENT. I ceed the limits of our defign. Inftead of a detail of 'I this kind, which would not be generally underftood, ,v» and of courfe little attended to, we fhall only men- | tion the following eafy rules with refpect to the choice of aliment. . a Perfons, whofe folids are weak and relaxed, ought | to avoid all vifcid food, or fuch things as are hard of I digeftion. Their diet, however, ought to be nou- 1 rifliing ; and they fhould take fufficient exercife in the open air. Such as abound with blood fhould be fparing in the ufe of every thing that is highly nourifhing, as fat meat, rich wines, ftrong ale, and fuch like. Their food fliould confift chiefly of bread and other vege- table fubftances; and their drink ought to be water, whey, or fmall beer. Fat people fhould not eat freely of oily nourifh- ing diet. They ought frequently to ufe horfe-radifh, garlic, and fuch things as promote perfpiration and urine. Their drink fhould be water, coffee, tea, or the like ; and they ought to take much exercife and little fleep. Thofe who are too lean mufl follow an oppofite courfe. Such as are troubled with acidities, or whofe food is apt to four on the flomach, fhould live much on animal food ; and thofe who are afflicted with hot bilious eructations, ought to ufe a diet confuting chiefly of acid vegetables. People who are affected with the gout, low fpirits, ": hypochondriac or hyfteric diforders, ought to avoid all flatulent food, every thing that is vifcid, or hard of digeftion, all falted or fmoke-dried provifions, and whatever is auftere, acid, or apt to turn four on the flomach. Their food fliould be light, fpare, cool, and of an opening nature. The OF ALIMENT. 73 The diet ought not only to be fuited to the age and conftitution, but alfo to the manner of life : a fedentary or ftudious perfon fhould live more fparing- ly than one who labours hard without doors. Many kinds of food will nourifli a peafant very well which would be almoft indigeftible to a citizen ; and the latter would live upon a diet on which the former would flarve. Diet ought not to be too uniform. The conftant ufe of one kind of food might have fome bad effects. Nature teaches, us this by the great variety of ali- ment 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 fliould not indulge in rich wines, ftrong foups, or gravies, and fliould avoid all acids. And thofe who are fcor- butic, fhould be fparing in the ufe of falted pro- vifions, &c. In the firfl period of life, our food ought to be light, but nourifliing, and frequently taken. Food that is folid, with a fufficient degree of tenacity, is moft proper for the flate of manhood. The diet fuited to the laft period of life, when nature is upon the decline, approaches nearly to that of the firfl. It fhould be lighter and more fucculent than that of vigorous age, and likewife more frequently taken. The beft general rule in the choice of diet is to eat fuch food as is agreeable to the tafte, and is found by experience to be eafy to the flomach. No one who is honeft to himfelf need ever be deceived in this particular. It is not only neceffary for health that our diet be wholefome, but alfo that it be taken at regular pe- riods. Some imagine long fafting will atone for ex- cefs j 74 . 07 ALIMENT. cefs ; but this, inftead of mending the matter, gene- rally makes it worfe. When the flomach and in- teftines are over-diftended with food, they lofe their i proper tone ; and, by long fafting, they become weak, and inflated with wind. Thus, either gluttony or fafting deftroys the powers of digeftion. The frequent repetition of aliment is not only ne- ceffary for repairing the continual wafle of our bo- dies, but likewife to keep the fluids found and fweet. Our humors, even in the moft healthy flate, have a conftant tendency to putrefaction, which can only be prevented by frequent fupplies of frefh nourifli- ment : when that is wanting too long the putrefac- ,. tion often proceeds fo far as to occafion very danger; . ; ous fevers. From hence we may learn the neceffity of regular meals. No perfon can enjoy a good flate of health, whofe veifels are either frequently over- charged, or the humors long deprived of frefh fup- plies of chyle. Long fafting is extremely hurtful to young peo- ple ; it not only vitiates their humors, but prevents ',, their growth. Nor is it lefs injurious to the aged. Many perfons, in the decline of life, are afflicted with wind : this complaint is not only increafed, but even rendered dangerous, and often fatal, by long fafting. Old people, when their ftomachs are empty, are fre- quently feized with giddinefs, head-achs, and fainti- nefs. Thefe complaints may generally be removed vfl by a piece of bread and a glafs of wine, or by taking ■ any other folid food ; which plainly points out the 1 method of preventing them. It is more than probable that many of the hid- den deaths, which happen in the advanced periods of life, are occafioned by fafting too long, as it ex- haufts the fpirits, and fills the bowels with wind ; we would therefore advife perfons, in the decline of life, 4 never to allow their ftomachs to be too long empty. i Many « OF ALIMENT. 75 Many people take nothing but a few cups of tea and a little bread, from nine o'clock at night till two or three next afternoon. Such may be faid to faff al- moft three fourths of their time. This can hardly fail to ruin the appetite, vitiate the humors, and fill the bowels with wind ; all which might be prevented by a folid breakfaft. It is a very common practice to eat a light break- faft and a heavy fupper. This cuftom ought to be reverfed. When people fup late, their fupper fhould be very light j but the breakfaft ought always to be folid. If any one eats a light fupper, goes foon to bed, and rifes betimes in the morning, he will be fure to find an appetite for his breakfaft, and he may freely indulge it. The ftrong and healthy do not indeed fuffer fo much from fafting as the weak and delicate ; but they run great hazard from its oppofite, viz. reple- tion. Many difeafes, efpecially fevers, are the effect of a plethora, or too great a fulnefs of the veifels. Strong people, in high health, have generally a great quantity of blood and other humors. When thefe are fuddenly increafed, by an over-charge of rich and nourifhing diet, the veffels become too much dif- tended, and obftructions and inflammations enfue. Hence fo many people are feized with inflammatory and eruptive fevers after a feaft or a debauch. All great and fudden changes in diet are danger- % ous. What the flomach has been long accuftomed to digeft, though lefs wholefome, will agree better with it than food of a more falutary nature which it has not been ufed to. When therefore a change be- comes neceflary, it ought always to be made gra- dually ; a fudden tranfition from a poor and low, to a rich and luxurious diet, or the contrary, might fo difturb the functions of the body, as to endanger fcealth, or even to occafion death itfelf. When 76 OF AIR. When we recommend regularity in diet, we would not be underftood as condemning every fmall devia- tion from it. It is next to impoflible 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 therefore be prudent to vary a little, fometimes taking more, fometimes lefs, than the ufual quantity of meat and drink, provided always that a due regard be had to moderation. CHAP. IV. Of Air. UNWHOLESOME air is a very com- mon caufe of difeafes. Few perfons are aware of the danger ariling from it. People generally pay fome attention to what they eat and drink, but fel- » dom regard what goes into the lungs, though the latter proves often more fuddenly fatal than the for- mer. Air, as well as water, takes up parts of moft bo- dies with which it comes in contact, and is often fo replenifhed with thofe of a noxious quality, as to oc- cafion immediate death. But fuch violent effects feldom happen, as people are generally on their guard againft them. The lefs perceptible influences of bad air prove more generally hurtful to mankind ; we fliall therefore endeavour to point out fome of thefe, and to fhew from whence the danger chiefly arifes. Wherever OF AIR. 77 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, aflemblies, or any place where the air is injured by breathing, fires, candles, or the like. In great cities fo many things tend to contami- nate the air, that it is no wonder it proves fo fatal to the inhabitants. The 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 dunghills, flaughter-houfes, &c. All poffible 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 likewife ought • to be kept very clean. Nothing tends more to pol- lute and contaminate 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 effect of ancient fuperftition, or owing to the increafe of fuch towns, is a matter of no confe- quence. Whatever gave rife to the cuftom, it is a bad one. It is habit alone, which reconciles us to thefe things ; by means of which the moft ridiculous, nay, pernicious cuftoms, often become facred*. Burying within churches is a practice flill more deteftable. The air in churches is feldom good, and the effluvia from putrid carcafes mufl render it flill worfe. Churches are commonly old buildings * In moft eaftern countries, it was cuftomary to bury the dead at fome diftance from any town. As this pra&ice ob- tained among the Jews, the Greeks, and alfo the Romans, it is ftrange that the weftern parts of Europe, fliould not have followed their example in a cuftom fo truly laudable. with 78' OF AIR. with arched roofs. They are feldom open above* once a week, are never ventilated by fires nor opeii windows, and rarely kept clean. This occafions that damp, mufty, unwholefome fmell which one feels upon entering a church, and renders it a'very unfafe place for the weak and valetudinary. Thefe incon< veniences might, in a great meafure, be obviated, by prohibiting all perfonsVrom burying within churches^ by keeping them clean, and permitting a ftream of | frefh air to pafs frequently through them, by opening oppofite doors and windows*. Wherever air ftagnates long, it becomes unwhole- fome. Hence the unhappy perfons confined in jails, not only contract malignant fevers themfelves, but often communicate them to others* Nor are many j of the holes, for we cannot call them houfes, poffefTed by the poor in great towns, much better than jails* Thefe low, dirty habitations, are the very lurking-* places of bad air and contagious difeafes. Such as live in them feldom enjoy good health ; and their children commonly die young. In the choice of a houfe, thofe who have it in their power ought always to pay the greateft attention to open free air. The various methods which luxury has invented to make houfes clofe and warm, contribute not a little 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 oppofite windows and admitting a current of frefh 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 the frefh air, from the open windows, through the day. This would expel any noxious * One cannot pafs through a large church or cathedral, even in fummer, without feeling quite chilly. vapour OF AIR. n vapour, and could not fail to promote the health of the inhabitants. In hofpitals, jails, fhips, &c. where that cannot be conveniently done, ventilators fliould be ufed. The method of expelling foul, and introducing frefh air, by means of ventilators, is a moft falutary invention, and is indeed the moft ufeful of all our modern me- dical improvements. It is capable of univerfal appli- cation, and is fraught with numerous advantages, both to thofe in health and ficknefs. In all places, where numbers of people are crowded together, venti- lation becomes abfolutely neceffary. Air which ftagnates in mines, wells, cellars, &c. is extremely noxious. That kind of air is to be avoided, as the moft deadly poifon. It often 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 conduct 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 be- comes flill greater. Numbers have been flifled when afleep by a fire in a fmall apartment, which is always hurtful. Thofe who are obliged, on account of bufinefs, to fpend the day in clofe towns, ought, if poffible, to * We have daily accounts of perfons who lofe theirs lives, by going down into deep wells, and other places where the air ftagnates ; all thefe accidents might be prevented, by only letting down a lighted candle before them, and flopping when they perceive it go out; yet this precaution, fimple as it is, is t^» ftldcm x.fsd. t fleep 80 OF AIR. fleep in the country. Breathing free air in the night, , will, in fome meafure make up for the want of it ;-, through the day. This practice would have a greater effect in preferving the health of citizens than is com- ■ monly imagined. Delicate perfons ought, as much as poffible, to avoid the air of great towns. It is peculiarly hurtful to the afthmatic and confumptive. Such perfons fhould avoid cities as they would the plague. The hypochondriac are likewife much hurt by it. I have often feen perfons fo much afflicted with this malady, while in town, that it feemed impoflible for them to live, who, upon being removed to the country, were immediately relieved. The fame obfervation holds with regard to nervous and hyfteric women*. Many people, indeed, have it not in their power to change their fituation in quefl of better air. All we can fay to fuch perfons is, that they fliould go as often abroad into the open air as they can, that they fhould admit frefh air frequently into their houfes, and take care to keep them very clean. It was neceffary in former times, for fafety, to furround cities, colleges, and even fingle houfes, with high walls. Thefe, by obftructing the free current of air, never fail to render fuch places damp and unwholefome. As fuch walls are now become ufelefs, they ought to be pulled down, and every method taken to admit a free free palfage to the air. Proper attention to Air and Cleanliness, would tend more to preferve the health of mankind, than all the endeavours of the faculty. * And yet we often find thefe difeafes to prevail in the country, where a retired life gives rife to them. The beft rule in thefe cafes is, to ufe exercife, whether in town or country; and to exchange the one for the other, according to circum- ftances. A 4 Surrounding OF AIR. Si Surrounding houfes too clofely with planting, or thick woods, likewife tends to render the air un- wholefome. Wood not only obftructs the free cur- rent of the air, but fends forth great quantities of moift exhalations, which render it conftantly damp. Wood is very agreeable at a proper diftance from a houfe, but fliould never be planted too near it, efpe- cially in a flat country. Many of the gentlemen's feats in England are rendered very unwholefome, from the great quantity of wood which furrounds them. Houfes fituated in low marfliy countries, or near large lakes of flagnating water, are likewife unwhole- fome. Waters which ftagnate, not only render the air damp, but load it with putrid exhalations, which produce the moft dangerous and fatal difeafes. Thofe who are obliged to inhabit marfliy countries, ought to make choice of the drieft fituations they can find, and to the windward, as the failors fay, of any pond or marfh, to live generoufly, and to pay the ftrictefl regard to cleanlinefs. If frefh air be neceffary for thofe in health, it is flill more fo for the fick, who often lofe their lives for want of it. The notion that fick people mufl be kept very hot, is fo common, that one can hardly enter the chamber where a patient lies without being ready to faint, by reafon of the hot fuffocating fmell. How this may affect the fick any one may judge. No medicine is fo beneficial to them as frefh air. It is the moft reviving of all cordials, if it be admi- niftered with prudence. We are not, however, to throw open doors and windows at random upon the fick. Frefh air is to be let into the chamber gradu- ally, and, if poffible, 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 fprink- G • ling 82 OF EXERCISE. ling the floor, bed, &c. frequently with vinegar, juice of lemon, or any other ftrong vegetable acid. In places where numbers of fick are crowded into the fame houfe, or, which is often the cafe, into the fame apartment, the frequent admiflion of frefh air becomes abfolutely neceffary. Infirmaries, hofpitals, &x. are often rendered fo noxious, for want of pro- per ventilation, that the fick run more hazard from them than from the difeafe. This is particularly the cafe when fevers, dyfenteries, and other infectious difeafes prevail. Phyficians, furgeons, and others who attend hof- pitals, ought, for their own fafety, to take care that they be pr&perly ventilated. Such perfons as are obliged to fpend moft of their time amongft the fick, run a hazard of being themfelves infected when the air is bad. All hofpitals, and places of recep-' tion for the fick, ought to have an open fituation, at fome diftance from any great town, and fuch patients as labour under any infectious difeafe ought never to be fuffered to come near the reft. CHAP. V. Of Exercife. 1VI ANY people look upon the neceffity man is under of earning his bread by labour, as a curfe. Be this as it may, it is evident from the tructure of the body, that exercife is not lefs necef. fary than food for the prefervation of health • thofe whom poverty obliges to labour for daily bread, are not only the moft heaithy, but generally the molt happy OF EXERCISE. 83 iiappy part of mankind. Induflry feldom fails tp place them above want, and activity ferves them in- ftead 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, evidently prove it to be the moft healthful as well as the moft ufeful employment. The love of activity fhows itfelf very early in man. So ftrong is this principle, that an healthy youth can- not be reftrained from exercife, even by the fear of punifhment. Our love of motion is furely a ftrong proof of its utility. Nature implants no difpofition in vain. It feems to be a general law throughout the whole animal creation, that no creature, without exercife, fliould enjoy health, or be able to find fub- fiftence. Every creature, except man, takes as much of it as is neceffary. He alone, and fuch animals as are under his direction, deviate from this original law, and they fuffer accordingly. Inactivity feldom fails to induce an univerfal relax- ation of the folids, which difpofes the body to innu- merable difeafes. When the folids are relaxed, nei- ther the digeftion, nor any of the fecretions, can be duly performed. In this cafe the worft confequences mufl enfue. How can perfons, who loll all day in eafy chairs, and fleep all night on beds of down, fail to be relaxed ? 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 alto- gether. It is now below any one to walk, who can af- ford 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 fhoiil- 'lers of their fellow-creatures! or to fee a fat car- G 2 , cafe_i ?4 ' OF EXERCISE. I cafe, over-run with difeafes occafioned by ina * We often fee perfons who are rendered quite lame by the nails of their toes having grown into the ftefh, and frequently hear d mortifications proceeding fiom this caufe. All thefe ?.nd many other inconveniences attending the feet, muft be imputed folely to the ufe of fhort and ftrait fhoes. ftruct OF SLEEP AND CLOTHING. 95 ftruct the blood in its courfe from the brain, by which means headachs, vertigoes, apoplexies, and other fatal difeafes are often occafioned. The perfection of drefs is to be eafy and clean. Nothing can be more ridiculous, than for any one to make himfelf a Have to fine clothes. Such an one, and many fuch there are, would rather remain as fixt as a flatue from morning till night, than difcom- pofe a fingle hair, or alter the pofition of a pin. Were we to recommend any particular pattern for drefs, it would be that which is worn by the people called Quakers. They are always neat, clean, and often elegant, without any thing fuperfluous. What others lay out upon tawdry" laces, ruffles, and rib- bands, they beftow upon fuperior cleanlinefs. Finery is only the affectation of drefs, and very often covers a great deal of dirt. We fliall only add, with regard to clothing, that it ought, not only to be fuited to the climate, the feafon of the year, and the period of life, but like- wife to the temperature and conftitution. Robuft perfons are able to endure either cold or heat better than the delicate ; confequently *may be lefs atten- tive to their clothing. But the precife quantity of clothes neceffary for any perfon cannot be deter- mined by reafoning. It is entirely a matter of expe- rience, and every man is the beft judge for himfelf what quantity of clothes is neceffary to keep him warm *. * The celebrated Boerhaave ufed to fay, that no body fuf- fered by cold fave fools and beggars ; the latter not being able to procure clothes, and the former not having fenfe to wear them. Be this as it may, I can with the itriftelt truth declare. that in many cafes where the powers of medicine had been tried in vain, I have cured the patient by recommending thick fhoes, a flannel waiftcoat and drawers, a pair of under (lockings, or a flannel petticoat, to be worn during the cold feafon at leaft. I have known feveral inftanccs of fore throat from thin flioes. CHAP 96 OF INTEMPERANCE. CHAP. VII. Of Inte?nperance. A MODERN author* obferves, that' temperance and exercife are the two beft phyficians^ in the world. Temperance may juftly be called the parent of health ; yet numbers of mankind act as if they thought difeafes and death too flow in their progrefs, and, by intemperance and debauch, feem, as it were, to folicit their approach. The danger of intemperance appears from the very conftruction of the human body. Health de- pends on that flate of the folids and fluids which fits them for the due performance of the vital functions; and, while thefe go regularly on, we are found and well; but whatever difturbs them, neceffarily impairs health. Intemperance never fails to diforder the whole animal oeconomy; it hurts the digeftion, re-' laxes the nerves, renders the different fecretions irre- gular, vitiates the humors, and occafions numberlefs difeafes. The analogy between the nourifliment of plants and animals affords a ftriking proof of the danger .j of intemperance. Moifture and manure greatly pro- mote vegetation ; yet an over quantity of either will entirely deftroy it. The beft things become hurt- ful, nay deftructive, when carried to excefs. Hence we learn, that the higheft degree of human wifdom confifts in regulating our appetites and paffions fo as to avoid all extremes. It is that chiefly which en- * Roffeau. 2 titles. OF INTEMPERANCE. 97 titles us to the character of rational beings. The flave of appetite will ever be the difgrace of human nature. The Author of Nature hath endued us with vari- rious paffions, for the propagation of the fpecies, the prefervation of the individual, &c. Intemperance is the abufe of thefe paffions; and moderation confifts in the proper regulation of them. Men, not con- tented with fatisfying the Ample calls of Nature, create artificial wants, and are perpetually in fearch of fomething that may gratify them ; but imaginary wants can never be gratified. Nature is content with little ; but luxury knows no l^unds. Hence the epicure, the drunkard, and the debauchee, fel- dom ftop in their career, till their money or their conftitution fails : then, indeed, they generally fee their error, when too late. It is impoflible to lay down fixt rules with regard to diet, on account of the different conftitutions of mankind. The moft ignorant perfon, however, cer- tainly knows what is meant by excefs ; and it is in the power of every man, if he choofes, to avoid it. The great rule of diet is to ftudy fimplicity. Na- ture delights in the moft plain and fimple food, and every animal, except man, follows her dictates. Man, alone, riots at large, and ranfacks the whole creation in quefl of luxuries, to his own deftruction. An ele- gant writer* of the laft age, fpeaks thus of intemper- ance in diet: " For my part, when I behold a fafhion- " able table fet out in all its magnificence, I fancy " that I fee gouts and dropfies, fevers and lethargies, " with other innumerable diflempers, laying in am- " bufcade among the difhes." Nor is intemperance in other things lefs deftruc- tive than in diet. How quickly does the immode- * Addifon, H rate 93 OF INTEMPERANCE. rate purfuit of carnal pleafures, or the abufe of in- toxicating liquors, ruin the beft conftitution ! Indeed thefe vices generally go hand and hand. Hence it rs that we fo often behold the votaries of Bacchus and Venus, even before they have arrived at the prime of life, worn out with difeafes, and haftening with fwift pace to an untimely grave. Did men reflect on the painful difeafes and premature deaths, which are daily occafioned by intemperance, it would be fuffi- cient to make them fhrink back with horror from the indulgence even of their darling pleafures. , Intemperance does not hurt its votaries alone ; the \t innocent too often feel the direful effects of it. How ^ many wretched orphans are to be feen embracing^,.- dunghills, whofe parents, regardlefs of the future, fpent in riot and debauch what might have ferved to bring up their offspring in a decent manner ? How Often do we behold the miferable mother,, with her helplefs infants, pining in want, while the cruel father , is indulging his infatiate appetites ? Families are not only reduced to mifery, but,event ft ^ extirpated, by intemperance. Nothing tends fo much to prevent propagation, and to fliorten the lives of children, as the intemperance of parents. The poor man who labours all day, and at night lie* down contented with his humble fare, can boafl a numerous offspring, while his pampered lord, funk. in eafe and luxury, often languifhes without an heir to his ample fortunes. Even ftates and empires'feel the influence of intemperance, and rife or fall as it prevails. Inftead of mentioning the different kinds of in- temperance, and pointing out their influence upon health, we fliall only, by way of example, make a few obfervations on one particular fpecies of that vice, viz. the abufe of intoxicating liquors. Every OF INTEMPERANCE. $9 Every act of intoxication puts Nature to the ex- pence of a fever, in order to difcharge the poifonous draught. When this is repeated almoft every day, it is eafy to forefee the confequences. That confti-v tution mufl be ftrong indeed, which is able long to hold out under a daily fever! but fevers occafioned by drinking do not always go off in a day; they fre-> quently end in an inflammation of the breaft, liver $ or brain, and produce fatal effects- Though the drunkard fhould not fall by ah acute difeafe, he feldom efcapes thofe of a chronic kind. Intoxicating liquors, when ufed to excefs, weaken the bowels, and fpoil the digeftion ^1 they deftroy the power of the nerves, and occafion paralytic and eon- vulfive diforders; they likewife heat and inflame th« blood, deftroy its balfamic quality, render it unfit for circulation, and the nourifhment of the body. Hence obftructions, atrophies, dropfies, and con- fumptions of the lungs. Thefe are the common ivays in which drunkards make their exit. Difeafes of this kind, when brought on by hard drinking, fel- dom admit of a cure** Many people injure their health by drinking, who feldom get drunk. The continual habit of foaking, as it is called, though its effects be not fo violent, is not lefs pernicious. When the veffels are kept con- flantly full and upon the ftretch, the different digef- tions can neither be duly performed, nor the hu- mors properly prepared. Hence moft people of this character are afflicted with the gout, the gravel, fores in the legs, &c. If thefe diforders do not ap- pear, they are feized with low fpirits, hypochondri- acal affections, and other fymptoms of indigeftion. * It is much to be feared that phyficians have too often h> #.iuti<>ufly m-.ide drunkards of their patients, by prescribing fpirits,or trendy and water, for their drink; which, however, are r-evtr r.ccefutry. H z Confump- lco OF INTEMPERANCE. 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 4f>f the caufes to which we muft impute the increafe of confumptions. The great quantities of ftrong vif- cid malt liquor drank by the common people of Eng: land, cannot fail to render the blood fizy and unfit for circulation ; from whence proceed obstructions^ . and inflammations of the lungs. There are few great ale-drinkers who are not phthifical: nor is that to be wondered at, confidering the glutinous and al- moft indigeftible nature of ftrong ale. Thofe who drpk ardent fpirits or ftrong wines run flill greater hazard ; thefe liquors heat and inflame > the blood, and tear the tender veffels of the lungs to pieces ; yet fo great is the confumption of them in this country, that one would almoft be induced to think that the inhabitants lived upon them*. The habit of drinking proceeds frequently from misfortunes in life. The miferable fly to it for re- lief. It affords them indeed a temporary eafe. But, alas! this folace is fliort-lived; and when it is over, the fpirits fink as. much below their ufual tone as they had before been raifed above it. Hence a re- petition of the dofe becomes neceffary, and every frefli dofe makes way for another, till the unhappy- wretch becomes a Have to the bottle, and at length falls a facrifice to what at firfl perhaps was taken only as a medicine. No man is fo dejected as the * We may form fome notion of the immenfe quantity of ar- dent fpirits cor.fumed in Great-Britain from this circumftance, that in the city of Edinburgh and its environs, befides the great quantity of foreign fpirits duly entered, and the flill greater quantity which is fuppofed to be fmuggled, it is computed that above two thoufand private (tills are conftaritly employed in preparing a poifonous liquor called Mola([es. The common people have got fo univerfally into the habit of drinking this bafe fpirit, that when a porter or labourer is feen reeling along the ftreets, they fay, he has got molajfed. drunkard OF INTEMPERANCE. ICI drunkard when his debauch is gone off. Hence it is, that thofe who have the greateft flow of fpirits when the glafs circulates freely, are of all others the moft melancholy when fober, and often put an end to their own miferable exiftence in a fit of fpleen or* ill humor. Drunkennefs not only proves deftructive to health, but likewife to the faculties of the mind. It is flrange that creatures who value themfelves on account of a fuperior degree of reafon to that of brutes, fliould take pleafure in finking fo far below them. Were fuch as voluntarily deprive themfelves of the ufe of reafon, to continue ever after in that condition, it would feem but a juft punifhment" Though this be not the confequence of one act of intoxication, it feldom fails to fucceed a courfe of it. By a habit of drinking, the greateft genius is often reduced to a mere idiot*. Intoxication is peculiarly hurtful to young perfons. It heats their blood, impairs their ftrength, and ob- ftructs their growth ; befides, the frequent ufe of ftrong liquors in the early part of life deftroys any benefit that might arife from them afterwards. Thofe who make a practice of* drinking generous liquors when young, cannot expect to reap any benefit from them as a cordial in the decline of life. * It is amazing that our improvements in arts, -learning, and politenefs, have not put the barbarous cuftom of drinking to excefs out of falhion. It is indeed lefs common in South-Bri- tain than it was formerly ; but it ftill prevails very much in the North, where this relic of barbarity is miftaken for hofpitality. There no man is fuppofed to entertain his guells well, who does not make them drunk. Forcing pecple to drink, is certainly the greateft piece of rudenel's that any man can be guilty of. Suppofed manlinefs, complaifance, or n.eer good nature, may induce a man to take his glafs, if urged to it, at a time when he might as well take poifon. The cuftom of drinking to excefs has long been out of falhion in France ; and, as it begins to lofe ground among the politer part of the Englifh, we hope it will foon be banilhed from every pan of this iiland. H 3 Drunk. tea 07 CLEANLINESS. Dnmkennefs is not only in itfelf a moft abomina- ble vice, but is an inducement to many, others. There is hardly any crime fo horrid that the drunk- ard will not perpetrate for the love of liquor. Wc , have known mothers fell their children's clothes, the food that they would have ear, and afterwards even the infants themfelves, in order to purchafe the ac- eurfed draught. A very abfurd argument in favour of fpirits has; been ufed, from obferving, that fome- perfons who made a very free ufe of them have lived to old age: we fometimes fee an old foldier, and an old failor; but no one v/ill fuppofe that a military or a fea-faring life, are favourable to longevity. CHAP. VIII. Of Cleanlinefs. 1 HE want of cleanlinefs is a fault which admits of no excufe. Where water can be had for nothing, it is furely in the power of every perfon to be clean. The continual difcharge from our bodies by perfpiration, renders frequent change of apparel ■* neceffary. Changing apparel greatly promotes 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 re- forbed from dirty clothes, it muft occafion difeafes. Difeafes of the fkin are, in a great meafure owing jto want of cleanlinefs. They may indeed be caught by infectiou, or brought on by poor living, unwhole-* fome food, &c. but they will feldom continue long where OF CLEANLINESS. 103 wliere cleanlinefs prevails. To the fame caufe muft we impute the various kinds of vermin which infefl the 'human body, houfes, &c. Thefe may always be banifhed by cleanlinefs alone, and wherever they abound, we have reafon to believe it is neglected. One common caufe of malignant fevers, is the want of cleanlinefs. Thefe fevers commonly begin among the inhabitants of clofe dirty houfes, who breathe unwholefome air, take little exercife, and wear dirty clothes. There the infection is generally hatched, which often fpreads far and wide, to the definition of many. Hence cleanlinefs may be con- fidered as an object of public attention. It is not fuf- ficient that I be clean myfelf, whilethe want of it in my neighbour affects ray health as well as his own. If dirty people cannot be removed as a common nui- fance, they ought at leafl to be avoided as infectious. All who regard their health fhould keep at a diftance even from their habitations. In places where great numbers of people are col- lected, cleanlinefs becomes qf the utmoft importance. It is well known that infectious difeafes are commu- nicated by tainted air. Every thing, therefore, which tends to pollute the air, or fpread the infection, ought with the utmoft care to be guarded againft. For this reafon, in great towns, no filth of any kind, fliould be permitted to lie upon the ftreets. In many great towns the ftreets are little better than dunghills, being frequently covered with allies, dung, and naflinefs of every kind. Even flaughter- houfes, or killing fhambles, are often to be feen in the very centre of great towns. The putrid blood, excrements, &c. with which thefe places are gene- rally covered, cannot fail to taint the air, and render it unwholefome. How eafily might this be prevented by active magiftrate-, who have it always it their * H 4 power V*t 104 OF CLEANLINESS. power to make proper laws relative to things of this nature, and to enforce the obfervance of them !' We are forry to fay, that the importance of gene- • ral cleanlinefs does not feem to be fufficiently under- flood by the 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 ho- nour of the inhabitants, or more conducive to their health, than a clean town ; nor can any thing imprefs ' a ftranger with a more difrefpectful idea of any peo- ple than its oppofite. Whatever pretenfiojis people may make to learning,-politenefs, or civilization, we will venture to affirm, that while they neglect clean- linefs,they are in a flate of barbarity*. The peafants in moft countries feem to hold clean- linefs in a fort of centempt. Were it not for the open fituation of their houfes, they would often feel the bad effects 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. Peafants are likewife extremely care- lefs with refpect to change of apparel, keeping their houfes, &c. clean. This is merely the effect of in- dolence and a dirty difpofition. Habit may indeed ' render it lefs difagreeable to them, but no habit, can • * In ancient Rome the greateft men did not think cleanlinefs^ an objetf unworthy of their attention. Pliny fays, the Cloaca, I or common fewers for the conveyance of filth and naftinefs from I the city, were the greateft of all the public works ; and beftowi ) higher tncomiums upon Tarquinus, Agrippa, and others who made and improved them, than on thofe who atchieved the greateft conquefts. How truly great does the emperor Trajan appear, when giving directions to Pliny his proconful, concerning the making of a common fewer for the health and convenience of a con- quered city ? ■ * ~. ever OF CLEANLINESS. io5 ever make it falutary to wear dirty clothes or breathe' unwholefome air. As many articles of diet come through the hands of peafants, every method fliould be taken to encou- rage and promote habits of cleanlinefs among them* This, forbxample, might be done by giving a fmall premium to the perfon who brings the cleaneft and beft article of any kind to market, as butter, cheefe, &c. and by punifhing feverely thofe who bring it dirty. The fame method fhould be taken with butchers, bakers, brewers, and all who are employed in preparing the neceffaries of life. In camps the ftricteft regard fhould be paid to cleanlinefs. By negfigence in this matter, infectious difeafes are often fpread amongft a whole army; and frequently more die of thefe than by the fword. The Jews during their encampments in the wildernefs, received particular mftrudtions with refpect to clean- linefs*. The rules enjoined them ought to be ob- ferved by all in the like fituation. Indeed the whole fyftem of laws delivered to that people 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 propriety of fuch laws. It is remarkable that in moft eaftern countries, cleanlinefs makes a great part of their religion. 4 Tfce Mahometan, as well as the Jewifh religion, en- joins various bathings, wafliings, and purifications. No doubt thefe might be defigned to reprefent in- ward purity ; but they were at the fame time cal- culated for the prefervation of health. However * Thou Ihalt have a place alfo without the camp, whither thou fhalt go forth abroad ; and thou Ihalt have a paddle upon thy weapon: and it Ihall be when thou fhalt eale thyfelf abroad, thou (halt dig therewith, an^ ihalt turn bad;, and cover that which cometh from thee, ^T''i)euter. chap. xxii. ver. 12, 1?. whimfical io6 OF CLEANLINESS. whimfical thefe wafhmgs may appear to fome, few ; things would tend more to prevent difeafes than a proper attention to many of them. Were every per- fon for example, after vifiting the fick, handling a . dead body, or touching any thing that might convey infection, to wafh before he went into company, or fat down to meat, he would run lefs hazard either of Catching the infection himfelf, or of communicating it to others*. Frequent wafliing not only removes the filth and fordes which adhere to the fkin, but likewife pro- motes the perfpiration, braces the body, an/l enliveur the fpirits. How refreflied, how cheerful, and agreev able does one feel on being Hfhaved, waflied, and fhifted ; efpecially when thefe offices have been ne- glected longer than ufual. ' - The eaftern cuftom of wafliing the feet, thougfrt lefs neceffary in this country, is neverthelefs atvery agreeable piece of cleanlinefs, and contributes grea$-# \y to the,prefervation of health. The fweat and di$3 ;■ with which thefe parts are frequently covered, can- not fail to obftruct the perfpiration. This piece of cleanlinefs would often prevent colds and fevers. Were people careful to bathe their feet and legs in lukewarm water at night, after being expofed to coM ' or wet through the day, they would feldom experi-'l' ence the ill effects which often proceed from thefe ■ caufes. A proper attention to cleanlinefs is no where more neceffary than on fhipboard. If epidemical diftem- pers break out there, no one can be fafe. The beft way to prevent them, is to take care that the whole company be cleanly in their clothes, bedding, &c. When infectious difeafes do break out, cleanlinefs is * I know a phyfician, who from habit, fddcm or never en- ter? hi? houfe without wafhing his^ands. the _ OF CLEANLINESS. 107 the moft likely means to prevent their fpreading : it is likewife neceffary to prevent their returning after- wards, or being conveyed to other places. For this purpofe, the clothes, bedding, &c. of the fick ought to be carefully waflied, and' fumigated with brim- ftone. Infection will lodge a long time in dirty clothes, and afterwards break out in the moft terrible manner*. In places where great numbers of fick people are collected together, cleanlinefs ought to be moft reli- gioufly obferved. The very fmell in fuch places k often fufficient to make one fick. It is eafy to ima- gine what effect that is likely to have upon the dif- eafed. In an hofpital or infirmary, where cleanlinefs is neglected, a perfon in perfect health has a greater chance to become fick, than a fick perfon has to get well. Few things are more unaccountable than that neglect, 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 leafl bit of his linen. If cleanlinefs be neceffary for perfons in health, it is certainly more fo for the fick. Many difeafes may be cured by cleanlinefs alone ; moft of them might be mitigated by it; and, where it is neglected, the fliighteft diforders are often changed into the moft malignant. The fame miftaken care which prompted people to prevent the leaft admiflion of frefli air to the fick, feems to have induced them to keep them * The beft mode of purifying a bed is to expofe it to an heavy rain, then dry it; thi^ does not in the leaft injure the bed. iirtv. ic8 OF INFECTION. J dirty. Both thefe deftructive prejudices will, we hope; | be in time entirely eradicated. I Cleanlinefs is certainly agreeable to our nature, I We cannot help approving it in others, even thougfc^fl we fliould not practife it ourfelves. It fooner attraftrH our regard than even finery itfelf, and often gains i efteem where that fails. It is an ornament to the higheft as well as the loweft flation, and cannot be difpenfed with in either. Few virtues 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*. CHAP. IX. Of Infeclion. IVl ANY difeafes are infectious. Every. perfon ought, therefore, as far as he can, to avoid all communication with the difeafed. The common practice of vifiting the fick, though often well meant, has many ill confequences. Far be it from us to dif- courage any act of charity or benevolence, efpecially towards thofe in diftrefs; but we cannot help blaming \\ fuch as endanger their own or their neighbour's lives by a miftaken friendfliip or an impertinent curiofity. j * The ftreets of great towns, where water can be had, ought':' to be walhed every day. This is the only effectual method for keeping them thoroughly clean ; and, upon trial, we are per- fuaded it will be found the cheapeft. Some of the moft dreadful difeafes incident to human nature '» might, in my opinion, bs entirely eradicated by cleanlinefs. ' The OF INFECTION. ro9 The houfes of the fick, efpecially in the country, are generally crowded from morning 'till night with idle vifitors. It is cuftomary, in fuch places, for fervants and young people to wait upon the fick by turns, and even to fit up with them all night. It would be a miracle indeed fhould fuch always efcape. Experience teaches us the danger of this conduct. People often catch fevers in this way, and commu- nicate 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 pa- tient in that difeafe; yet many other fevers are al- moft as infectious as the fmall-pox, and not lefs fatal. Some imagine, that fevers prove more fatal in vil- lages than in great towns, for want of proper me- dical afliftance. This may fometimes be the cafe; but we are inclined to think it oftener proceeds from the cafe above mentioned. Were a plan to be laid down for communicating infection, it could not be done more effectually than by the common method of vifiting the fick. Such vifitors, not only endanger themfelves and their con- nections, but likewife hurt the fick. By crowding the houfe, they render the air unwholefome, and by their private whifpers and difmal countenances, difturb the imagination of the patient, and deprefs his fpirits. Perfons whb are ill, efpecially in fevers, ought to be kept as quiet as poffible. The fight of ftrange faces, and every thing that difturbs the mind, hurts them. The common practice in country places of in- viting great numbers of people to funerals, and crowding them into the fame apartment where the corpfe lies, is another way of fpreading infection. The infection does not always die with the patient. Everv 110 OF INFECTION. Every thing that comes into contact with his body while alive, receives the contagion, arid fome of : thefe things, as clothes, blankets, &e. WhU retain it for a long time. Perfons who die of infectious dif- orders, ought not to lie long unburied ; and people fhould keep as much as poffible at a diftance from. them. It would tend greatly to prevent the fpreading of infectious difeafes, if thofe in health were kept at a proper diftance from the fick. The Jewifh Le- giflator, among many other wife inftitutions for pre- ferving health, has been peculiarly attentive to the means of preventing infection, 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 crime, even to approach their habitations, If a perfon only touch-.' ed a difeafed or dead body, he was appointed to wafli himfelf in water, and to keep for fome time at a dif- tance from fociety. Infectious difeafes are often communicated by clothes. It is extremely dangerous to wear apparel which has been worn by the difeafed, unlefs. it ha? been well wafhed and fumigated, as infection may, lodge a long time in it, and afterwards produce very ' tragical effects. This fliews the danger of buying at random, the clothes which have been worn by other people. Infectious diforders- are frequently imported. Com- I merce, together with the riches of foreign climes, ' brings us alfo their difeafes. Thefe do often more : I than counterbalance all the advantages of that trade;: 1 by means of which they are introduced. It is to be regretted, that fo little care is commonly bellowed; ^" eitacr to prevent the introduction or fpreading. of miccma^i isahdies. Some attention, indeed, is ge«« rally 1 i OF INFECTION. in ■erally paid to the plague j but other difeafes pafs unregarded*. Infection is often fpread through cities, by jails, hofpitals, &c. Thefe are frequently fituated in the very middle of populous towns; and when infectious difeafes break out in them, it is impoflible for the in- habitants 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 infection through populous cities. The beft advice that we can give to fuch as are obliged to live in large cities is, to choofe an open fituation ; to avoid narrow, dirty, crowded ftreets ; to keep their own houfe and offices clean ; and to be as much abroad in the open air as their time will permit. It would tend greatly to prevent the fpreading of infectious difeafes, were proper nurfes every where employed to take care of the fick. This might often fave a family, or even a whole town, from being infected by one perfon. We do not mean that people fhould abandon their friends or rela- tions, in diftrefs, but only to put them on their * Were the tenth part of the care taken to prevent the importation of difeafes, that there is to prevent fmuggling, it would be attended with many happy confequences. This might eafily be done, by appointing a phyfician at every con- fiderable fea-port, to inlpeft the fhip's company, paffengers, &c. before they came alhore, and, if any fever or other in- fectious diforder prevailed, to order the Ihip to perform a fhort quarantine, and to fend the fick to fome holpital or proper place to be cured. He might likewife order all the clothes, bedding, &c. which had been ufed by the fick during the voyage, to be either deftroyed, or thoroughly cleanfed by fumigation, &c. before any of it were fent a-lhore. A fcheme of this kind, if properly conduced, would prevent many fe- vers, and other infectious difeafes, from being brought by failors into fea-port towns, and, by this means diffufed all over the country. guard ii2 OF INFECTION. guard againft being too much in company with thofe who are afflicted with difeafes of an infectious nature. ^ Such as wait upon the fick in infectious difeafes, . j fhould fluff their nofes with tobacco, or fome other flrong fmelling herb, as rue, tanfy, or the like. They ought likewife to keep their patient very clean, • to fprinkle the room where he lies with vinegar, or other flrong acids, frequently to admit a ftream of frefli 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 waflied their hands ; other wife, if the difeafe be in- . fectious, they will in all probability carry the conta- gion along with them. However trifling it may appear to inconfiderate perfons, we will venture to affirm, that a due atten- tion to thofe things which tend to diffufe infection, would be of great importance in preventing difeafes. As moft difeafes are in fome degree infectious, no one fliould continue long with the fick, except the neceffary attendants. I mean not, however, by this caution, to deter thofe whofe duty or office leads them. to wait upon the fick, from fuch a laudable and ne- ceffary employment. .» < Many things are in the power of the magiftrate, which, would tend to prevent the fpreading of infec- tion ; as the promoting of public cleanlinefs; re- moving jails, hofpitals, burying-grounds, and other places where infection may be generated, at a proper I diftance from great towns*; widening the ftreets; pulling down ufelefs walls, and taking all methods to promote a free circulation of air, through every part * The ancients would not fuffer even the temples of their I gods, where the fick reforted, to be built within the walls of J a city. A 4 of OF INFECTION. 113 of the town, &c. Public hofpitals, or proper places of reception for the fick, provided they were kept clean, well ventilated, and placed in an open fitua- tion, would likewife tend to prevent the fpreading of infection. Such places of reception would pre- vent the poor, when fick, from being vifited by their idle or officious neighbours. We are not, however, to learn, that hofpitals, in- ftead of preventing infection, may become the means of diffufing it. When they are placed in the mid- dle of great towns; when numbers of patients are crowded together in fmall apartments; when there is a conftant communication kept up between the citizens and the patients, and when cleanlinefs and ventilation are neglected, they become nefts for hatching difeafes, and every one who goes into them, not only runs a riik of receiving infection himfelf, but likewife of communicating it to others. This, however, is not the fault of the hofpitals, but of thofe who have the management of them. It were to be wilhed, that they were both more numerous, and upon a more refpectable footing, as that would induce people to go into them with lefs reluctance. This is the more to be defired, becaufe moft of the putrid fevers, fo called, and other infectious difor- ders break out among the poor, and are by them communicated to thofe in better circumftances. Were proper attention paid to the firfl appearances of fuch diforders, and the patients early conveyed to an hof- pital, we fliould feldom fee thofe malignant fevers, which are almoft as infectious as the plague, become epidemic. I CHAP, t "4 •] CHAP. X. Of the Pajfions. 1 I IE paffions have great influence, both in the caufe and cure of difeafes. How the mind affects the body, will, in all probability, ever remain a fecrct. It is fufficient for us to know, that there is eftabliflied a reciprocal influence between the mental and corporeal parts, and that whatever in- jures the one, diforders the other. Of Anger. The paflion of anger ruffles the mind, diftorts the countenance, hurries on the circulation of the blood, and diforders the whole vital and animal functions. It often occafions fevers, and other acute difeafes; and fometimes even fudden death. This paflion is peculiarly hurtful to the delicate, and thofe of weak nerves. I have known fuch perfons frequently lofe their lives by a violent fit of anger, and would ad- vife them to guard againft the excefs of this paflion, with the utmoft care. It is not indeed always in our power to prevent being angry; but we may furely avoid harbouring refentment in our breaft. Refentment preys upon the mind, and occafions the moft obftinate chronical diforders, which gradually wafle the conftitution. Nothing fliews 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 OF THE PASSIONS. 115 Such as value health, fliould avoid violent gufts of anger, as they would the moft deadly poifon. Neither ought they to indulge refentment, but to endeavour at all times to keep their minds calm and ferene. Nothing tends So much to the health of the body, as a conftant tranquillity of the mind. Of Fear. The influence of fear, both in occafioning 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 of 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 over- come. * Sudden fear has generally violent effects. Epi- leptic fits, and other convulfive diforders, are often occafioned by it. Hence the danger of that practice, fo common among young people, of frightening one another. Many have loft their lives, and others have been rendered miferable by frolics of this kind. It is dangerous to tamper with the human paffions. The mind may eafily be thrown into fuch diforder, as never again to act with regularity. But the gradual effects of fear prove moft hurtful. The conftant dread of fome future evil, by dwelling upon the mind, often occafions the very evil itfelf. Hence it comes to pafs, that fo many die of thofe very difeafes, of which they long had a dread, or which had been impreffed on their minds by fome accident or foolifli prediction. This, for example, is * It were to be wifhed, that epidemics might alarm without caufing terror. And great advantages would reiult, from accuftoming young perfons to a fick room ; thus every family would afford nurfes. I 2 often Il6 CF THE PASSIONS. often the cafe with women in childbed. Many of thofe who die in that fituation, are impreffed with the notion of their death, a long time before it hap- pens ; and there is reafon to believe, that this im- preflion is often the caufe of it. The methods taken to imprefs the minds of wo- men with the apprehenfions of the great pain and peril of child-birth, are very hurtful. Very few women die in labour, though many lofe their lives after it ; which may be thus accounted for. A wo- man, after delivery, finding herfelf weak and ex- haufted, immediately apprehends fhe is in danger; but this fear feldom fails to obftruct the neceffary .j evacuations, upen which her recovery depends. Thus .< the fex frequently fall a facrifice to their own imagi- nations, 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 fol- lowed by many others. Every woman of their ac- quaintance who is with child, dreads the fame fate, and the difeafe becomes epidemical by the mere force of imagination. This fliould induce pregnanfc" women to defpife fear, and by all mean, to avoid thofe tattling goi!!;..-,, 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, ought with the greateft care to be guarded againft. Many women h?.ve loft their lives in child-bed, by the old fuperftitious cuftom, ftiil kept i:p in mofl parts of Britain, ^:d far too much in America, of toiling the parifh bell for every perfon who dies. People v.'ho think themfelves in danger, are very inquiiitive ; and if they come to know, that the bell tolls for 0:1c who died in the fame fituation with themfelves, v.h:-t muft be the confequence ? At any rate, OF THE PASSIONo. :: 7 rate, they are apt to fuppofe that this is the cafe, and it will often be found a very difficult matter to per- fuade 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 rruf: be the effect of a funeral peal founding five or fix limes a-day in his ears ? No doubt his imagination will fuggeft that others died of the fame difeafe under which he la- bours. This apprehenfion will have a greater ten- dency to deprefs his fpirits, than all the cordials of which medicine can boaft will have to raife them. If this ufelefs piece of ceremony cannot be abo- lifhed, we ought to keep the fick as much from hearing it as poffible, 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 to vifit the fick, on purpofe to whifper difmal ftories in their ears. Such may pafs for fympathizing friends, but they ought rather to be confidered as enemies. All who wifli well to the fick ought to keep fuch perfons at the greateft dif- tance from them. A cuftom has long prevailed among phyficians, of prognofticating, as they call it, the patient's fate, or foretelling the iffue of the difeafe. Vanity no doubt introduced this practice, and flill fupports it, in fpite of common fenfe and the fafety of mankind. It may indeed be alleged, that the doctor does not declare his opinion before the patient. So much the worfe. A fenfible patient had better hear what the doctor fays than learn it from the difconfolate looks, the watery eyes, and the broken whifpers of thofe about him. It feldom happens, when the doctor gives an unfavourable opinion, that it can be con- cealed from the patient. The very cnibanTifiment I 3 which *s ii8 OF THE PASSIONS. which the friends and attendants fhew in difguifing Vhat he has faid, is generally fufficient to difcover the truth. Kind Heaven has, for the wifeft ends, concealed from mortals their fate; and we do not fee what right any man has to announce the death of another, efpecially 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, however, or one that may tend rather to encourage the hopes of the fick, is furely the moft fafe. This conduct could neither hurt the patient nor the phyfician. Nothing tends more to deftroy the credit of phyfic than thofe bold prognofticators, who, by the by, are gene- rally the moft ignorant of the faculty. The miftakes which daily happen in this way are fo many Handing proofs of human vanity, and the weaknefs of fcience. We readily admit that there are cafes where the phyfician ought to give intimation of the patient's danger to fome of his near connections ; though even this ought always to be done with the greateft caution : but it never can be neceffary in any cafe that the whole town and country fliould know, im- mediately after the doctor has made his firfl vifit, that he has no hopes of his patient's recovery. Perfons whofe impertinent curiofity leads them to queflion the phyfician with regard to the fate of his patient, certainly deferve no other than an evafive 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 affliction by alarming their fears. A friend, or even a phyfician, may often do more good by a mild and fympathizing be- haviour OF THE PASSIONS. 119 haviour than by medicine, and fliould never neglect to adminifter that greateft of all cordials, Hope, when he can do it with confiftency. Of Grief. Grief is the moft deftrudtive of all the paffions. Its effects are permanent, and when it finks deep into the mind, it generally proves fatal. Anger and fear, being of a more violent nature, feldom laft long ; but grief often changes into a fixed melancholy, which preys upon the fpirits, and waftes the confti- tution. This paflion ought not to be indulged. It may generally be conquered at the beginning; but when it has gained ftrength, all attempts to remove it are vain. No man can prevent misfortunes in life; but it fliews true greatnefs of mind to bear them with fe- renity. Many perfons make 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 con- duct is not only deftructive to health, but utterly inconfiftent with reafon, religion, and common fenfe. Change of ideas is as neceffary for health as change of pofture. When the mind dwells long upon one fubject, efpecially of a difagreeable nature, it hurts the whole functions of the body. Hence grief indulged fpoils the digeftion and deftroys the appetite ; by which means the fpirits are depreffed, the nerves relaxed, the bowels inflated with wind, and the humors, for want of frefli fupplies of chyle, vitiated. Thus many an excellent conftitution has been ruined by a family misfortune, or any thing which occafions exceffive grief. I 4 It 120 OF THE PASSIONS. It is not probable, that any perfon of a dejected mind fliould enjoy health. Life may indeed be dragged out for a few years ; but whoever would live to a good old age, muft be good-humored and cheer- ful. Th»s indeed is not altogether in our own power ; yet our temper of mind, as well as our ac- tions, depend greatly upon ourfelves. We can either affociate with cheerful or melancholy companions, mingle in the amufements and offices of life, or fit flill and brood over our calamities as we chufe. Thefe, and many fuch things, are certainly in our power, and from thefe the mind generally takes its call. 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 object. Nature abounds with variety, and the mind, unlefs fixed down by habit, delights in contemplating new objects. This at once points out the method of relieving the mind in diftrefs. Turn the attention frequently to new objects. Examine 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 en- tirely difappear. Thus, travelling, the ftudy of any art or fcience, reading or writing on fuch fubjects as deeply engage the attention, will fooner expel grief than the moft fprightly amufements. It has already been obferved that the body can- not be healthy unlefs it be exercifed ; neither can the mmd. Indolence nourifhes grief. When the mind has nothing elfe to think of but calamities, no won- der that it dwells there. Few people who purfue bufinefs with attention, are hurt by grief. Inftead therefore of abftracting ourfelves from the world or bufinefs, when misfortunes happen, we ought to engage in it with more than ufual attention, to dif- charee OF THE PASSIONS. 121 charge with double diligence the functions of our ftation, and to mix with friends of a cheerful and focial temper. Innocent amufements are by no means to be ne- glected. Thefe, by leading the mind infenfibly to the contemplation of agreeable objects, help to dif- pel the gloom which misfortunes call over it. They make time feem lefs tedious, and have many other happy effects. * Some perfons, when overwhelmed with grief, be- take themfelves to drinking. This is making the cure much worfe than the difeafe. It feldom fails to end in the ruin of fortune, character, and conftitution. Of Love. Love is perhaps the ftrongeft of all the pa/lions; at leaft, when it becomes violent, it is lefs fulj^ct to the control either of the underflanding or will, than any of the reft. Fear, anger, and feveral other paf- fions, are neceffary for the prefervation of the indi- vidual, but love is neceffary for the continuation of the fpecies itfelf: it was therefore proper that this paflion fhould be deeply rooted in the human breaft. Though love be a ftrong paflion, it is feldom fo rapid in its progrefs as feveral of the others. Few perfons fall defperately in love all at once. We would therefore advife every one, before lie tam- pers with this paflion, to confider well the probabi- lity and propriety of his being able to obtain the ob- ject of his love. When that is not likely, he fhoald avoid every occafion of iucreafing it. He ought im- mediately to fly the company of the beloved oblect * * After ;i!< that has been fiid, there is nothing vr.ich cm relieve the mind fiom grief with fo much certa!;:,tv as a c mate 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 effects of evening dews are gradual indeed, and al- moft imperceptible ; but they are nol the lefs to be dreaded : we would therefore 'advife travellers, la- bourers, and all who are much heated by day, carefully to avoid them. When the perfpiration has been great, thefe become dangerous in propor- tion. By not attending to this, in flat marfliy countries, where the exhalations and dews are co- pious, labourers are often feized with intermitting fevers, quinfeys, and other dangerous difeafes. Damp Beds. Beds become damp, either from their not beLg ufed, ftanding 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 :md wet, arrives at an inn, he may, by irleans of a good fire, warm diluting liquor, and a; dry bed, IJ2 OF THE EVACUATIONS. have the perfpiration reftored ; but if he be put into a cold room, and laid on a damp bed, it will be more obftruaed, and the worft confequences will enfue. Travellers fhould avoid inns which are noted for damp beds, as they would a houfe infected with the plague, as no man, however robuft, is proof againft the danger arifing 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 ftrangers are often equally dan- gerous. All kinds of linen and bedding, when not frequently ufed become damp. How then is it pof- fible, that beds, which are not flept in above two or three times a-year, fhould be fafe ? Nothing is more common than to hear people complain of having caught cold by changing their bed. The reafon is obvious: were they careful never to fleep in a bed but what was frequently ufed, they would feldom find any ill confequences from a change. Nothing is more to be dreaded by a delicate per- fon when on a vifit, than being laid in a bed which is kept on purpofe for ftrangers. That ill-judged ' , piece of complaifance becomes a real injury. All the bad confequences from this quarter might eafily be prevented in private families, by caufing their fervants to fleep in the fpare beds, 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 practifed in many I inns, of damping fheets, and prefling them in order I to fave wafhing, and afterwards laying them on the beds, ought, when difcovered, to be punifhed with the utmoft feverity. It is really a fpecies of murder, . and will often prove as fatal as poifon or gun-fhot. Indeed, no linen, efpecially if it has been wafhed " in OF THE EVACUATIONS. 133 in winter, ought to be ufed till it has been expofed for fome time to the fire ; nor is this operation lefs neceffary for linen wafhed in fummer, provided it has lain by for any length of time. This caution is the more needful, as gentlemen are often exceedingly attentive to what they eat or drink at an inn, yet pay no regard to a circumftance of much more im- portance*. Damp Houfes. Damp Houfes frequently produce the like ill con- fequences ; for this reafon thofe who build fhould be careful to chufe a dry fituation. A houfe which ftands on a damp marfliy foil or deep clay, will nevier be thoroughly dry. All houfes, unlefs where the ground is exceedingly dry, fhould have the firfl floor a little raifed. Servants and others, who are obliged to live in cellars and funk ftories, feldom continue long in health: mailers ought furely to pay 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, plafterers, &c. have done with it: fuch houfes are not only dangerous from their dampnefs, but likewife from the fmell of lime, paint, &c. The afthmas, confumptions, and other difeafes of the lungs, fo incident to people who work in $hefe arti- * If a perfon fufpe&s that his bed is damp, the fimple pre- caution of taking off the ftieets, and lying in the blankets, with all or moft of his clothes on, will prevent all the danger. I have pratfifed this for many years, and never have been hurt by damp beds, though no conftitution, without care, is proof againft their baneful influence. K 3 cles, ,34 OF THE EVACUATIONS. cles, are fufficient proofs of their being unwhole- fome. Rooms are often rendered damp by an able piece of cleanlinefs ; I mean the pernicious cuftom of wafliing them immediately before com, pany is put into them. Moft people catch cold, if they fit but a very fhort time in a room that has been lately waftied ; the delicate ought carefully to avoid fuch a fituation, and even the robuft are not always proof againft its influence*. Sudden Tranftions from Heat to Cold. The perfpiration is commonly obftrudted by sud« qen transitions from heat to cold. Colds are feldom caught, unlefs when people have been too much heated. Heat rarities the blood, quickens the circulation, and increafes the perfpiration; but when thefe are fuddenly checked, the confequences muft be bad. It is indeed impoflible for labourers not to be too hot upon fome occafions ; but it is generally in their power to let themfelves cool grar dually,- to put on their clothes when they leave off work, to make choice of a dry place to reft them- felves in, and to avoid fleeping 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 con- duct is extremely dangerous. Thirft indeed is hard to bear, and the inclination to gratify that appetite * People imagine if a good fire is made in a room after it has been waftied, that there is no danger from fitting in it; but they muft give me leave to fay that this increafes the danger. The evaporation excited by the fire generates cold, and renders the damp more active, frequently OF THE EVACUATIONS. 135 frequently gets the better of reafon, and makes us do what our judgment disapproves. Every peafant, however, knows, if his horfe be permitted to drink his bellyful of cold water after violent exercife, and be immediately put into the liable, or fuffered 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. This may be quenched many ways without fvval- lowing large quantities of cold liquor. The fields afford 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, would have the fame effect. If a bit of bread be eaten along with a few mouthfuls of water, it will both quench thirft more effectually, and make the danger lefs. When a perfon is extremely hot, a mouthful of wine and water, if it can be obtained, ought to be preferred to any tMng elfe. But if any one has been fo foolifli, when hot, as to drink freely of cold liquor, he ought to continue his exercife at leaft till what he drank be thoroughly warmed upon his flomach. It would be tedious to enumerate all the bad ef- fects which flow from drinking cold liquors when the body is hot. Sometimes this has occafioned immediate death. Hoarfenefs, quinfeys, and fevers of various kinds, are its common confequences. Neither is it fafe when warm to eat freely of raw fruits, fallads, or the like. Thefe indeed have not fo fudden an effect on the body as cold liquors, but they are notwithftanding 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 extremely dangerous. Colds, coughs, and inflammations of the breaft, are the K 4 ufual 136 OF THE EVACUATIONS. ufual effects of this conduft: yet nothing is more ' common than for perfons who have drank warm li- quors for feveral hours, to walk or ride a number of miles in the coldeft night, or to ramble about in the ftreets*. People are very apt, when a room is hot, to throw open a window, and to fit near it. This is a moft dangerous practice. Any perfon had better fit with- out doors than in fuch a fituation, as the current of air is directed againft one particular part of the body. Inflammatory fevers and confumptions have often ■ been occafioned by fitting or ftanding thinly clothed near an open window. Nor is fleeping with open windows lefs to be dreaded. That ought never to be done, even in the hotteft feafon, unlefs the win- dow is at a diftance. I have known mechanics fre- quently contract fatal difeafes, by working ftript at an open window, and would advife all of them to beware of fuch a practice. Few things expofe people more to catch c#b than keeping their own houfes too warm; fuch per- fons may be faid to live in a fort of hot-houfes; they can hardly ftir abroad to vifit 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 deftroys the fpring and elafticity of the airv and renders it lefs fit for expanding the lungs, and for the other purpofes of refpiration. Hence it is, that confumptions and other difeafes of * The beer houfes in great towns, where fuch numbers of people fpend their evenings are highly pernicious. The breath of a number of people crowded into a low 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 dangerous to go out of them into S cold and chilly atmofphere. the OF THE EVACUATIONS. 137 the lungs prove fo fatal to thofe who work in forges, glafs-houfes and the like. Some are even fo fool-hardy, as to plunge them- felves when hot into cold water. Not only fevers, but madnefs itfelf has frequently been the effect of this conduct. Indeed it looks too like the action of a madman to deferve a ferious confideration. 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 poffible ; or where that cannot be done, to take care to let it cool gradually. People may imagine that too ftrict an attention to thefe things would tend to render them delicate. So far, however, is this from beijig my defign, that the very firfl rule propofed for preventing colds, is to harden the body, by inuring it daily to the open air. I fhall put at end to what relates to this part of my fubject, by giving an abftract of the juftly cele- brated advice of Celfus, with refpect to the prefer- vation of health. " A man," fays he, " who is " bleffed with good health, fliould confine himfelf " to no particular rules, either with refpect to regi- always neceffary in the beginning of a fever. When the fever proceeds from an obftructed 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 feWom fail to perfpire freely. * The warmth of the bed, and the .diluting drink, will relax the univerfal fpafm, which generally affects the ikin at the beginning of a fever; it will open the m pores, and promote the perfpiration, by means of which the fever may often be carried off: But, in- ftead 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 fire his blood, 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 fometimes the calls of Nature, and 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 altoge- ther proper. What! the patient longs for, his fto> mach will generally digeft;. and, fuch things have fometimes a very happy effect, We fhould, how- ever, be careful to diftinguifh between a rational longing for any thing, and the incoherent wifhes of perfons in a delirium. When a patient is recovering from a fever, great care is neceffary to prevent a .relapfe. Many per- fons, by too foon imagining themfelves well, have loft their lives,, or contracted other difeafes of an obflinate nature. As the body, after a fever, is weak and delicate, it is neceflary to guard againfl catching cold. Moderate exercife in the open air • L 4 vill • ,52 OF INTERMITTING FEVERS. will be of ufe, but great fatigue is, by all means, to be avoided; agreeable company will alfo have a good effect. The diet muft be light, but nourifhing. • It fhould be taken frequently, but upon to take the bark, or any other difagreeable medicine. One method of rendering this medicine more palatable, is to make it into a mixture with, diftilled waters and fyrup, and afterwards to give it an agreeable fharpnofs with the elixir or fpirit of vi- triol. This both improves the medicine, and takes off the naufeous tafte. In cafes where the bark can- not be adminiftered, the faline mixture may be givea^ with advantage to children. * Wine-whey is a very proper drink for a' child' ia the cold fit of an ague ; to half a pint of which may be put a teafpoonful of the fpirit of hartfhoyfi. Ex. ercife is likewife of confiderable fervice ; and when; the difeafe proves obftinate, the child ought, if pof- fible, to be removed to a warm dry air. The food. ought to be nourifhing, and fometimes a little gene- rous wine fliould be allowed. To children, and fuch as cannot fwallow the bark, or when the ftomach will not bear it, it may be given by clyfter. Half an ounce of the powder of bark, fufpendcd in four ounces of warm water, by the help of two teafpoonsful of gum arabic, with fix or eight drops of laudanum, in the form recommended. by Dr. Lind for an adult, and this to be repeated * Ses Appendix-, Saiir.e I'.lLfure. \ i every OF INTERMITTING FEVERS. 161 every fourth hour, or oftener, as the occafion fhall require. For children, the quantity of powder and laudanum muft be proportionably leflened. 'Children have been cured of agues, by making them wear a waiftcoat with powdered bark quilted between Jie folds of it; by bathing them frequently in a ftrong decodtion of the bark, and by rubbing the fpine with ftrong fpirits, or with a mixture of equal parts of laudanum and the faponaceous liniment. We have been the more full upon this fubject, be- caufe it is very common, and becaufe few patients in an ague apply to phyficians, unlefs in extremities. There are, however, many cafes in which the difeafe is very irregular, being complicated with other dif- eafes, 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 flri&ly to follow his advice. To prevent agues, people mufl endeavour to avoid their caufes. Thefe have been already pointed out in the beginning of this fedYion ;* we fhall therefore only add one preventive medicine, which may be of ufe to fuch as are obliged to live in low marfliy countries, or who are liable to frequent attacks of this difeafe. Take a large tea-fpoonful of good Peruvian bark three times a-day, in a little water, or wine and water. 3 M CHAP. t 16* ] CHAP. XV. Of an Acute Continual Fever. 1 HIS fever is denominated acute, ardeny " or inflammatory. It moft commonly attacks the^ young, or perfons about the prime or vigour of life,^f efpecially fuch as live high, abound with blood, and whofe fibres are ftrong and elaftic. It feizes people at all feafons of the year ; but is moft frequent in the fpring. CAUSES.—An ardent fever may be occafioned. by any thing that overheats the'body, or produce^ plethora, as violent exercife, fleeping in the fun,' drinking ftrong liquors, eating fpiceries, a full diet, with little exercife, &c. It may likewife be occa- fioned by whatever obftrufts 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 chillinefs geMly ufhers in this fever, which is foon fucceeded by pfat< 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 difficulty of *j breathing, ficknefs, with an inclination to vomit. The^ patient complains of great thirft, has no appetite for fqjid foo4, and is reftlefs ; and the tongue', at the beginning is generally clean. A delirium, ej I with milk are the moft proper both for drink and J nourifliment. He likewife recommends the fleam of 1 warm water taken in by the breath, which ferves as I a kind of internal fomentation. If the patient Jias . */J loofe ftools, but is not weakened by them, they are ' j not to be flopped, but rather promoted by the ufe of emollient clyfters. It has already been obferved, that the fpurioits or bqftard peripneumony is occafioned by a vifcid pitui- tous matter' obftructing the veffels of the lungs. It commonly attacks the old, infirm, and phlegmatic^ in winter and wet feafons. The patient at the beginning is cold and hot by turns, has a fmall quick pulfe, feels a fenfe of weight upon his breaft, breathes with difficulty, and fome- times complains of a "pain and giddinefs of his head. His urine is ufually pale, and his colour very little • changed. The diet in this, as well as in the true pcripneu- ' ( mony, muft he very flender, as weak broths, fharp-. ' *ned with the juice of orange or lemon, and fuch ' like. OF A PERIPNEUMONY. 177 like* His drink may be thin water-gruel, fweetened with honey, or a decoction of the roots of fennel and liquorice. An ounce of each of thefe may be boiled in three pints of water to a quart, and fharpened with a little currant-jelly or the like. Bleeding and purging are generally proper at the beginning of this difeafe. It will be fufficient to affift the expectoration, by fome of the medicines re- commended for that purpofe in the pleurify, as the folution of gum ammoniac with oxymel of fquills, &c. Bliftering plafters have generally a good effect, and ought to 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. Afterwards his body may be kept open by clyfters, and the expectoration promoted, by taking every four hours two table- fpoonfuls of the folution mentioned above. When an inflammation of the breaft does not yield to bleeding, bliftering, and other evacuations, it commonly ends in a fuppuratidn, which is more or lefs dangerous, according to the part where it is Jituated. When this happens in the pleura, it fome- times breaks outwardly, and the matter is difcharged by the wound. When the fuppuration happens within the fub- flance or body of the lungs, the matter may.be dif- charged by expectoration ; but if the matter floats in the cavity of the breaft, between the pleura and the lungs, it can only be difch^gyed by an incifion made betwixt the ribs. If the patient's ftrength does not return, after the inflammation is, to all appearance, removed j 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 N reafon i78 OF CONSUMPTIONS. reafon to fear a fuppuration, and that a phthifis, or confumption of the lungs will enfue. We fhal$ therefore, next proceed to confider the proper treat- ment of that difeafe. CHAP. XVIII. Of Confumptions. A CONSUMPTION is a wafting or decay of the 'whole body, from an ulcer, tubercles* or concretions of the lungs, or an empyema. Dr. Arbuthnot obferves that, in his time, con- fumptions made up above one-tenth part of the bills of mortality, in and about 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. Young perfons, between the age of fifteen and thirty, of a flender make, long neck, high fhoulclers, and flat breafts, are moft liable to this difeafe. Confumptions prevail more in England than in any other part of the ^gprld, owing, perhaps, to the great ufe of animal food, and the general application to fedentary employments. To which we may add, the perpetual changes in the atmofphere, or varia- blenefs of the weather. CAUSES.—It has already been obferved, that an inflammation of the breafl often ends in an im- pofthume: confequently, whatever difpofes to this difeafe, ^ OF CONSUMPTIONS. i7g difeafa, muft likewife be confidered as a caufe of confumption. Other difeafes, by vitiating the habit, may like- wife occafion confumptions ; as the fcurvy, the fcro- phula, or kiiig's evil, the venereal difeafe, the afthma, fmall-pox, mealies, &c. As this difeafe* is too feldom cured, we fliall en- deavour the more particularly to point out its caufes, in order that people may be enabled to "avoid it. Thefe are : -----Confined or unwholefome air. When this fluid is impregnated with the fumes of metals, or minerals, it proves extremely hurtful to the lungs, and often corrodes the tender veffels of that necef- fary organ. -----Violent paffions, exertions or affections of the mind; as grief, difappointment, anxiety, or clofe application to the ftudy of abftrufe arts or fciences. ——Great evacuations; as fweating, diarrhoeas, diabetes, exceffive venery, the fluor albus, an over- difcharge of the menftrual flux, giving fuck too long, &c. -----The fudden floppage of cuftomary evacua- tions ; as the bleeding piles, fweating of the' feet, bleeding at thenofe, 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 bronchia. It was afterwards vomited along with a confiderable quan- tity of purulent matter, and the patient, by a pro- per regimen^ and the ufe of the Peruvian bark, recovered. -----Making a fudden tranfition from a hot to a very cold climate, change of apparel, or whatever greatly leffens the perfpiration. N 2, ----Ere-' 180 OF CONSUMPTIONS. -----Frequent and exceffive debaucheries* Late watching, and drinking ftrong liquors, which geneU rally go together, can hardly fail to deftroy the lungs; j Hence the bon compagnon generally falls a facrifice to' this difeafe. ° -----Infection. Confumptions are likewife caught by fleeping with the difeafed ; for which reafon, ft fhould be carefully avoided. It cannot be 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 pref- fing upon the ftomach and breaft, as cutlers, taylorsj, i; fhoe-makers, feamftreffes, &c. often die of confunny * tions. They likewife prove fatal to fingers, and aH, " who have occafion to make frequent and violent exertions of the lungs. * -----Cold. More confumptive patients date the beginning of their diforde/s from wet feet, damp beds, night air, wet clothes, or catching cold after the body had been heated, than from all other caufes. Sharp, faline, and aromatic aliments, which heat and inflame the blood, are likewife frequently the caufe of confumptions. We fhall only add, that this difeafe is often owing to an hereditary taint, or a fcrophulous habit. SYMPTOMS.—This difeafe generally begins with a dry cough, which often continues for fome months. If a difpofition to vomit after eating be excited by it, there is ftill greater reafon to fear an approaching confumption. The patient complains of a more tfyan ufual degree of heat, a pain and op- preffion of the breafl, efpecially after motion; his * An eminent phyfician of our country (Dr. Rufh) is, however, of a different opinion, and recommends ringing as a cure for this dife ife. See his Medical Inquiries and Obferva* tion% fpittle OF CONSUMPTIONS. 181 fpittlc is of a faltifli tafte, and fometimes mixed with blood. He is apt to be fad ; his appetite is bad, and his thirft great. There is often a quick, foft, fmall pulfe; though fometimes the pulfe is pretty full, and rather hard. Sometimes it is fmall and hard. Thefe are the common fymptoms of a begin- ning confumption. Afterwards, the cough increafes, the patient begins to fpit a greenifh, white, or bloody matter. His body is extenuated by the hectic fever, and colliquative fweats, which mutually fucceed one an- other, 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 eating j the fingers become remarkably fmall, the nails are bent inwards, and the hairs fall off. At laft a diarrhoea, the fwelling of the feet and legs, the total lofs of ftrength, the finking of the eyes, the difficulty of fwallowing, and the coldnefs of the extremities, fhew the immediate approach of death, which, however, the patient feldom believes to be fo near. Such is the ufual progrefs of this fatal difeafe, which, if not early checked, commonly fets all medicine at defiance. REGIMEN.—On the firft appearance of a con- fumption, if the patient lives in a large town, or any place where the air is confined, he ought immediately to quit it, and to make choice of a fituation in the country, where the air is pure and free. Here he muft not remain inactive, 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 N 3 this 182 OF CONSUMPTIONS. ^ 'this kind of exercife, mufl make.ufe of a carriage, A long journey, as it amufes the mind by a continu; change of objects, 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 leafl before dinner -, otherwife it will oftener do harm than good.' It is a pity that thofe who attend the fick feldom recommend riding in this difeafe, till the patient it either unable to bear it, or the malady has become incurable. Patients are likewife apt to trifle with every thing that is in their own power. They can-; not fee how one of the common actions of life fhouldr prove a remedy in an obftinate difeafe, and therefore !; they reject it, while they greedily hunt after relief from medicine, merely becaufe they do not under- flahd it. , Thofe who have ftrength and courage to under- take a pretty long voyage, may expect great advan- tage from it. This, to my knowledge, has fre- quently cured a confumption after the patient was, to all appearance, far advanced in that difeafe, and where medicine had proved ineffectual. Hence it is reafonable to conclude, that if a voyage were under- taken 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 * Two things chiefly ©perate to prevent the benefits which would arife from failing. The one is, that phyficians feldom order it till the difeafe is too far advanced ; and the other is, that they feldom order a voyage of fufficient length. A patient may receive no benefit by crofimg the channel, who, fliould he- crofs the Atlantic, might be completely cured. Indeed,' we have reafon to believe, that a voyage of this kind, if taken >n due time, would feldom fail to cure a confumptioa. for OF CON&JMPTIONS. 183 for the whole time they are at fea. When milk is not eafily to be obtained in this fituation, they ought to live upon fruits, and the broth of chickens or other young animals which can be kept alive on board. It is fcarcely neceffary to add, that fuch voyages fliould be undertaken, if poffible, in the mildeft feafon, and that they ought to be towards a warmer climate. * Thofe who have not courage for a long voyage, may travel into a more fouthern climate, as the fouth of France, Spain, or Portugal; and if they find the air of thefe countries agree with them, they fliould continue there, at leaft till their health be confirmed, f Next to proper air and exercife, we would re- commend 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 cool- ing nature. All the diet ought to be calculated to leffen the inflammatory ftate of the fyftem, and 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 difeafe, than the whole materia medica. Affes milk is commonly reckoned preferable to any other ; but it cannot always be obtained; be- fides, it is generally taken in a very fmall quantity ; whereas, to produce any effects, it ought to make a confiderable part of the patient's diet. It is hardly to be expected, that a gill or two of affes milk, drank * Though I did not remember to have feen one inftance of a genuine confumption of the lungs cured by medicine, yet I have known a Weft India voyage work wonders in that dreadful diforder. f For Americans, we may recommend the fame voyage, if practicable. If not, they may go to the fouthern ftates in win- ter, and to the eaftern ftates in fummer. If a journey by land is preferred, the back parts of our country are the beft. N 4 in \ 184 OF CONSUMTTIONS. in the ^>ace of twenty-four hours, fhould be able to , produce any confiderable change in an adult; and when people do not perceive its effects foon, they J ' lofe hope, and fo leave it off. Hence it happens, that this remedy, however valuable, very feldom per- I forms a cure. The reafon is obvious; it is com. J monly ufed too late, is taken in too. fmall quantities, ] and is not duly perfifted in. J I have known extraordinary effects from aflcs 1 milk in obftinate coughs, which threatened a con- fumption 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 expected to fucceed ? Affes milk ought to be drank, if poffible, in its na- tural warmth, and, by a grown perfon, in the quan- tity of half a 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 fliould happen to purge, it may be mixed with old conferve of rofes. When that can- not 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 1 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 confumptive cafes have been performed by women's milk. Could this be obtained in fufficient quantity, we would recom- mend it in preference to any other. It is better if the patient can fuck it from the breaft, than to drink it afterwards. I knew a man who was reduced to fuch a degree of weaknefs 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 OF CONSUMPTIONS. 185 die, he fucked her breaft, not with a view to reap any advantage from the milk, but to make her eafy. ' Finding himfelf, however, greatly benefited by it, he continued to fuck her till he became perfectly well and is at prefent a ftrong and healthy man. Some prefer butter-milk.to any other, and it is in- deed a very valuable medicine, if the ftomach be able to bear it. It does not agree with every perfon at- firfl; and is therefore often laid afide without a fuffi- cient trial. It fhould at firft be taken fparingly, and the quantity gradually increafed, until it comes «to be almoft the fole food. I never knew it fucceed un- lefs 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 lighter by adding to it an equal quantity of water, or allowing it to ftand for fome hours, and afterwards taking off the cream. If it fhould, notwithftanding, prove heavy on the ftomach, a fmall quantity of brandy, with a little fugar, may be added, which will render it both more light and nourifhing. It is not to be wondered at, that milk fhould for fome time difagree with a ftomach that has not been accuftomed to digefl any thing but flefli and ftrong liquors, which is the cafe with many of 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 likewife 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 186 OF CONSUMPTIONS. M Thefe muft be ufed only as preparatives to a diet m confifting chiefly of milk and vegetables, which the m fooner the patient can be brought to bear, the better. '!■ Rice and milk, or barley and milk, boiled with a J little fugar, is very proper food. Ripe fruits roafted, .jjm baked, or boiled, are likewife proper, as gooieberry 9 or currant tarts, apples roafted, or boiled in milk, iU &c. The jellies, conferves and preferves, &c. of *■ ripe fubacid fruits, ought to be eaten plentifully, as' 'nP the jelly of currants, conferve of rofes, preferved ; "■ . plums, cherries, &c. Wholefome air, proper exercife, and a diet con- fifting chiefly of thefe and other vegetables, with | milk, is the only courfe that can be depended on in • a beginning confumption. In a populous town in England, # where con- fumptions 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 al- ways the cafe, efpecially when the difeafe was here- ditary, or far advanced ; but it was the only method j in which fuccefs was to be expected: where it failed, I never knew medicine fucceed. If the patient's ftrength and fpirits flag, he mufl be fupported by ftrong broths, jellies, and fuch like.' Some recommend fhell-fifh in this diforder, 'A and with fome reafon, as they are nourifliing and reftorative. f All the food and drink ought, how- ever, to be taken in fmall quantities, left an over-. charge of frefli chyle fhould opprefs the lungs, * Sheffield. j ^ f I have often known perfons of a confumptive habit, where 1 t.ie fymptoms were not violent, reap great benefit from the ufe cf oyfters. They generally ate them raw, and drank the juice along with them. J and OF CONSUMPTIONS. 187 and too much accelerate the circulation of the blood. The patient's mind ought to be kept as eafy and cheerful as poffible. Confumptions are often occa- fioned, and always aggravated, by a melancholy caft of mind ; for which reafon mufic, cheerful company, and every thing that infpires innocent mirth, are highly beneficial. The patient ought feldom to be left alone, as brooding over his calamities is fure to render them worfe. MEDICINE.—Though the cure of this difeafe depends, in a great meafure, upon regimen and the patient's own endeavours, yet we fliall mention a few things which may be of fervice in relieving fome of the more violent fymptoms. In the firft flage of a confumption, the cough may often be appeafed by bleeding, to be ufed in fmall quantities, and repeated, occafionally, while the pulfe requires it: at the fame time the patient fliould live on a milk and vegetable diet, take gen- tle exercife, ufe country air, and apply a blifter to any part of the breaft where there is moft pain, take cooling laxatives; in fhort, ufe all the means to leffen inflammation. It is too common in this flage of the difeafe to load the patient's ftomach with oily and balfamic medi- cines. Thefe, inftead of removing the caufe of the difeafe, tend rather to increafe it, by heating the blood, while they pall the appetite, relax the folids, and prove every way hurtful to the patient. What- ever is ufed for removing the cough, befides riding, and other proper regimen, ought to be medicines of a calming nature, as, for example, the paregoric mixture. (Vide Appendix.) Acids feem to have peculiarly good effects in this difeafe; they both tend to quench the patient's thirft, and to cool the blood. The vegetable acids, as 188 OF CONSUMPTIONS.' as apples, oranges, lemons, &c. appear to be the moft proper. I have known patients fuck the juice of feveral lemons and oranges every day with mani- feft advantage, and would for this reafon recommend acid vegetables to be taken in as great quantity as the ftomach will bear them. For the patient's drink, we- fhould recommend barley-water, rennet-whey, toaft and water, &c. Thefe may be drunk at pleafure. They at the fame time anfwer all the purpofes of dilution, and quench thirft much better than things that are lufcious and fweet. If the patient fpits blood, the fame are pro- per for his ordinary drink. There are many other mucilaginous plants and feeds, of an healing and agglutinating nature, from which decoctions or infufions may be prepared with the fame intentions; as the orchies, the qumce- feed, coltsfoot, lintfeed, farfapariila, &c. It is not neceflary to mention the different ways in which thefe may be prepared. Simple infufion or boiling is all that is neceffary, and the dofe may be at dif- cretion. The conferve of rofes is here peculiarly proper. It may either be put into the decoction above de- fcribed, or eaten by itfelf. No benefit is to be ex« pected from trifling dofes of this medicine. I never knew it of any fervice, unlefs where three or four ounces at leaft were ufed daily for a confiderable time. In this way I have feen it produce very happy effects, and would recommend it wherever there is a> difcharge of blood from the lungs. When the fpitting up of grofs matter, oppreffion of the breaft, and the hectic fymptoms, fhew that an impofthume is formed in the lungs, fix grains of ipecacuanha taken every other morning before rifing, and continued for about a week, will be of great fervice j it will vomit gently. The vitriolic mucila- ginous OF CONSUMPTIONS. x89 ginous mixture (fee Appendix) is alfo now of great fervice, and the paregoric mixture is to be continued, and Peruvian bark. An ounce of the bark in powder may be divided into eighteen or twenty dofes, of which one may be taken every three hours through the day, in a little fyrup, or a cup of horehound tea. If the bark fhould happen to purge, it may be made into an electuary, with the conferve of rofes, thus, Take old conferve of rofes a quarter of a pound, Peruvian bark in powder an ounce, fyrup of orange or lemon, as much as will make it of the confiftence of honey. This quantity will ferve the patient.four or five days, and may be repeated as there is occafion. Such as cannot take the bark in fubftance, may infufe it in cold water. Half an ounce of bark in powder may be infufed for twenty-four hours in half a pint of water. Afterwards let an ordinary tea- cupful of it be taken three or four times a-day. We would not recommend the bark while there are any fymptoms of an inflammation of the breafl; but when it is certainly known that matter is collect- ed there, it is one of the beft medicines which can be ufed. Few patients indeed have refolution enough to give the bark a fair trial at this period of the difeafe, otherwife we have reafon to believe that fome benefit might be reaped from it. As long as the bark occafions no difficulty of breathing it may- be taken to advantage. The tar water and tar pills (fee Appendix J are very ufeful medicines. If the patient has a fixed pain about the fleraum very con- fiderable benefit will be derived by a cauftic to the part. After the matter is formed, and the expecto- ration has come on, the vitriolic and paregoric mix- tures and bark are to be continued to the clofe of the- difeafe. When ,9o OF CONSUMPTIONS. When it is evident that there is an impofthume in 'the breaft, and the matter can neither be fpit up nor carried off by abforption, the patient may draw "-f in the fleams of warm water or vinegar with his breath, &c. When it happens to burft within the lungs, the matter may be difcharged by the mouth. -\ Sometimes indeed the burfting of the vomica oc- J cafions immediate death, by fuffocating the patient. ' <■ When the quantity of matter is great, and the pa- J tient's ftrength exhaufted, this is commonly the cafe. 1 At any rate the patient is ready to fall into a fwoon, I and fhould have volatile falts or fpirits held to his nofe. If the matter difcharged be thick, and the cough and breathing become eafier, there may be fome hopes of a cure. The diet at this time ought to be light, but reftorative, as chicken-broths, fago-gruel, rice-milk, &c. the drink, butter-milk, or whey, fweetened with honey. This is likewife a proper time for ufmg the Peruvian bark, which may be taken as directed above. If the vomica or impofthume fhould difcharge it- felf into the cavity of the breaft, betwixt the pleura t, 1j and the lungs, there is no way of getting the matter out but by an incifion, as has already been obferved. As this operation muft always be performed by a furgeon, it is not neceffary here to defcribe it. We fliall only add, that it 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 life. A NERVOUS CONSUMPTION is a wafting or decay of the whole body, without any confider. m able degree of fever, cough, or difficulty of breathing. B 1 It is attended with indigeftion, weaknefs, and want of appetite, &c. I , Thofe , OF CONSUMPTIONS. 191 Thofe who are of a fretful temper, who indulge in fpirituous liquors, or who breathe an unwholefome air, are moft liable to this difeafe.^ We would chiefly recommend, for the cure of a nervous confumption, a light and nourifliing diet, plenty of exercife in a free open air, and the ufe of fuch bitters as brace and ftrengthen the ftomach; as the Peruvian bark, gentian root, camomile, hore- hound, &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 or thirty drops of the elixir of vitriol in a glafs of wine or water. The chalybeate wine is likewife an ex- cellent medicine in this cafe. It ftrengthens the fo-' lids, and powerfully aflifts nature in the preparation of good blood. * Agreeable amufements, cheerful company, and riding about, are, however, preferable to all medi- cines in this difeafe. For which reafon, when the patient can afford it, we would recommend a long journey of pleafure, as the moft likely means to re- ftore his health. What is called a fymptomatic confumption cannot uc cured without firft removing the difeafe by which it is occafioned. Thus, when a confumption 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 arifes, and the regimen and medicines directed accordingly. When exceffive evacuations of any kind occafion a confumption, they muft not only be reftrainc 1, but the patient's ftrength muft be reftored by gentle ex- ercife, nourifliing diet, and generous cordials. Young and delicate mothers often fall into confumptions by * See Appendix, Chalybeate nuine. eivlnr 192 OF THE NERVOUS FEVER. giving fuck too long. As foon as they perceive their' ftrength and appetite begin to fail, and are troubled with chills and fevers, or a pain or weaknefs of the breaft, they ought "immediately to wean the child, or provide another nurfe, otherwife they cannot expefi a cure. Before we quit this fubject, we would earnefUy recommend it to all, as they wifh to avoid confump. tions, to take as much exercife without doors as they can, to avoid unwholefome air, and to ftudy fo- briety. Confumptions owe their prefent increafe not a little to the fafhion 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 digeftion, and fpoil the appetite, but heat and inflame the blood, and fet the whole conftitution on fire. CHAP. XIX. Of the Slow or Nervous Fever. N Si ERVOUS fevers have increafed greatly of late years amongft us, owing doubtlefs to our dif- ferent manner of living, and the increafe of fedentary employments; as they commonly attack perfons of a weak relaxed habit, who neglect exercife, eat little fo- lid food, ftudy hard, or indulge in fpirituous liquors. CAUSES.—Nervous fevers may be occafioned by whatever depreffes the fpirits, or impoveriflifis the blood ; as grief, fear, anxiety, want of fleep, in- tenfe thought, living on poor watery diet, unripe ° 4 fruits, OF THE NERVOUS FEVER. 193 fruits, cucumbers, melons, Sec. They may likewife be occafioned by damp, confined, or unwholefome air. Hence they 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 ■ exceffive venery, frequent falivations, too free an ufe of purgative medicines, or by any other exceffive evacuations, are moft liable to this difeafe. Keeping on wet clothes, lying on the damp ground, expofure to the night air, exceffive fatigue, and whatever obftructs the perfpiration, may likewife occafion nervous fevers. We fhall only add, fre- quent and great irregularities in diet. Too great abftinence 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 than its oppo- fite. 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 confi- derable thirftx chillinefs, and fiufhing in turns, &c. After fome time the patient complains of a gidd:- nefs and pain of the head, has a naufea, with retch- ings and vomiting ; the pulfe is quick, and fometir es intermitting ; the urine pale, refembling dead fmad beer, and the breathing is difficult, with oppreffiou of the breaft, and flight alienations of mind. If towards the ninth, tenth, or twelfth cliy, the tongue becomes more moift, with a plentiful fpittinr, a gentle purging, or a moifture upon the ikin ; or it a fuppuration happens in one or both cars, or ian.e puftules break out about the lips and i\oi\\ thcrt\s reafon to hoDe for a favourable crifis. O . . B.it 194 OF THE NERVOUS FEVER. But if there is an exceffive loofenefs, or wafting fweats, with frequent fainting fits j if the tongue, when put out trembles exceffively, and the extre- mities feel cold, with a fluttering or flow creeping pulfe ; if there is a flarting of the tendons, an almoft total lofs of fight and hearing," and an involuntary difcharge by flool and urine, there is reafon to ap- prehend confiderable danger. REGIMEN.—It is very neceffary hi this difeafe to keep the patient cool and quiet. The leafl mo- tion would fatigue him, and will be apt to occafion wearinefs, and even faintings. His mind ought not only to be kept eafy, but foothed and comforted. Nothing is more hurtful in low fevers of this kind than prefenting to the patient's imagination gloomy or frightful ideas. Thefe of themfelves often occa- fion nervous fevers, and it is not to be doubted but they will likewife aggravate them. The patient muft not be kept too low. His ftrength and fpirits ought to be fupported by nourifliing diet, and generous cordials. For this purpofe his gruel, panada, or whatever food he takes, mufl be mixed with wine according as the fymptoms may require. Pretty ftrong wine-whey, or fmall negus, fliarpened with the juice of orange or lemon, will be proper for his ordinary drink. Muftard-whey is likev/ife a very proper drink in this fever, and may be rendered an excellent cordial medicine by the addition of a proper quantity of white-wine*. Wine in this difeafe, when genuine, is often.al- moft the only medicine that is neceffary. Good wine poffeffes all the virtues of the cordial medicines, while it is free from many of their bad qualities. I fay good wine, for however common this article of luxury is now become, it is too feldom to be ob- * See Appendix, Muflard-ivhey. tained OF THE NERVOUS FEVER. 195 tained genuine, efpecially by the poor, who are ob- liged to purchafe it in fmall quantities. I have often feen patients in low nervous fevers where the pulfe could hardly be felt, with a conftant delirium, coldnefs of the extremities, and almoft every other mortal fymptom, recover by ufing in whey, gruel, and negus, a bottle or two of ftrong wine every day. Good old found Madeira, or Sherry, are the beft, and may be made into negus, or given alone, as circumftances require. In a word, the great aim in this difeafe is to fup- port the patient's ftrength, by giving him frequently fmall quantities of the above, or other drinks of a warm and cordial nature. He is not, however, 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 fick- nefs at ftomach, 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 pow- der, or a few fpoonfuls of the vomiting julep *, 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, by the general fhock which they give, promote the perfpiration, and have many other excellent effects in flow fevers, where there are no figns of inflammation. Such as dare not venture upon a vomit, may clean the bowels by a fmall dofe of Turkey rhubarb, or an infufion of fenna and manna. In all fevers, the great point is to regulate the fymptoms, fo as to prevent them from going to ei- ther extreme. Thus, in fevers of the imlimmatory * See Aprendix, Vomilln? Jul-!*. l9g OF THE NERVOUS FtVER. kind, where the force of the circulation is too great, and the fibres too rigid^ bleeding and other evacua- tions are neceflary. But in nervous fevers, where nature flags, where the folids are relaxed, the lancet muft be fpared, and wine, with other cordials, plenti- fully adminiftered. Though bleeding is often improper in this dif. eafe, yet bliftering is highly neceffary. Bliftering. plaflers may be applied at all times of the fever with great advantage. If the patient is delirious, he ought to be bliftered on the neck or head, and it will be the fafeft courfe, when the infenfibility continues, as foon as the difcharge occafioned by one bliftering-plafter 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 clanger. I have been more fenfible of the advantage of bliftering in this than in any other difeafe. Blilter- ing-piafters not only flimulate the folids to action, 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, however, either to- wards the beginning, or after fome degree of ftupor 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 flool, by giving him every other day 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 may be checked by fmall quantities of laudanum, or giving the patient for his ordinary drink the white decoction*. * See Append; k, White doic-froi. A mili- OF THE NERVOUS FEVER, 197 A miliary eruption fometimes breaks out about the ninth or tenth day. As eruptions are often cri- tical, great care fhould be taken not to retard Na- ture's operation in this particular. The eruption ought neither to be checked by evacuations, nor pufhed out by a hot regimen ; but the patient fhould be fupported 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 fliould by no means be checked. Though bliftering and the ufe of cordial liquors are the chief things to be depended on in this kind of fever ; yet, for thofe who may chufe to ufe them, we fliall mention one or two of the forms of medi- cine which are commonly prefcribed in it; centaury and fnake-root tea, volatile boluffes. In defperate cafes, where the hiccup and flarting of the tendons have already come on, we have fometisies feen extraordinary effects from large dofes of mufk frequently repeated. Muflc is doubt- lefs an antifpafmodic, and may be given to the quantity of a fcruple three or four times a-day, or oftener, if neceffary. Sometimes it may be proper to add to the mufk a few grains of camphire, and fait of hartfliorn, as thefe tend to promote perfpi- ration and the difcharge of urine. Thus fifteen grains of muflc, with three grains of camphire, and fix grains of fait of hartfliorn, may be made into a bolus with a little fyrup, and given as above. If the fever fliould happen to intermit, which it frequently does towards the decline, or if the pa- rent's ftrength fliould be wafted with colliquative fweats, Sec. it will be neceflary to give him the Pe- ruvian bark. Half a drachm, or a whole drachm, if the ftomach will bear it, of the bark in fine powder, may be tjiven four or five times a-day in a O 3 glafs i98 OF THE NERVOUS FEVER. glafs of red Port or claret. Should the bark in fubftance not fit eafily on the ftomach, an ounce of it in powder may be infufed in a bottle of Lifbon or Rhenifh wine for two or three days, afterwards it may be ftrained, and a glafs of it taken frequently.* Some give the bark in this and other fevers, where there are no fymptoim of inflammation, without any regard to the remiffion or intermiffion of the fever. How far future obfervations may tend to eftablifli this practice, 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 bleeding is not neceffary, or where there are no fymptoms of topical inflammation. * The hark may likewife be very properly adminiftered, along with other cordials, in the following manner: Take an ounce of Peruvian bark, orange-peel half an ounce, Virginian fnake-root two drachms. Let all of them be powdered, and infufed in a pint of the beft brandy for three or four days. Afterwards the liquor may be ftrained, and two tea-fpoonfuls of it given three or four times a-day in a glafs of a fmall wins pr wine and water. CHA1\ I l09 1 CHAP. XX. Of the Malignant, Putrid, or Spotted Fever. 1 HIS may be called the peftilentialfeve? of Europe, as in many of its fymptions it bears a great refemblance to that dreadful difeafe, the plague. Perfons of a lax habit, a melancholy difpofition, and thofe whofe vigour has been wafted by long falling, watching, hard labour, exceffive venery, frequent falivations, &c. are moft liable to it. CAUSES.—This fever is occafioned by foul ain, from a number of people being confined in a narrow place, not properly ventilated ; from putrid animal and vegetable effluvia, &c. Hence it prevails in camps, jails, hofpitals, and infirmaries, efpecially where fuch places are too much crowded, and clean- linefs is neglected. Thefe fevers often fucceed great inundations in low and marfliy countries, efpecially when thefe are pre- ceded or followed by a hot and 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 likewife apt to oc- cafion this kind of fever. Hence failors on long voyages, and the inhabitants of befieged cities, are very often vifited with putrid fevers. Corn that has been greatly damaged by rainy fea- fons, or long keeping, and water which has become putrid by ftagnation, &c, may likewife occafion this i'ever. 04 Dea £Oo PUTRID OR SPOTTED FEVER. Dead carcafes tainting the air, efpecially in hot feafons, are very apt to occafion putrid difeafes. j Hence this kind of fever often prevails in countries which are the fcenes of war and bloodfhed. This ' r'hcv," the propriety of removing burying-grounch, iLiughier-houfes, &c. to a proper diftance from great towns. Want of cleanlinefs is a very general caufe of pu- trid fevers. Hence they prevail amongfl- the poor inhabitants of large towns, v/ho breathe a confined ■ nnwholefome air, ard neglect cleanlinefs. Such mechanics as carry on dirty employments, and arc conftantly confined within doors, are likewife veri- fiable to this difeafe. We fliall only add, that putrid, malignant, cr fpottcd fevers, are highly infectious, and are there* for? often cc-EmuTMcarc-d by contagion. SYMPTOMS.—The malignant fever is generally preceded by a remarkable weaknefs, or lofs of ftreng':h, withoat ar.y apparent caufe. This is feme- times fo great, that the patient can fcarcely walk, or ever, fit upright, vkhout being in danger of fainting away. His mind too is greatly dejected; he fighs, and is full of dreadful apprehenfanas. ^ There is a naufea, and fometimes a vomiting of bile ; a violent pain of the head, v/ith a ftrong pul- iation or LhroVbinev of the temporal arteries; the eyes often appear red and inflamed, with a pain at t;ie bottom of the orbit; there is a noife in the ears, the breathing is laborious, ,-ad often interrupted with a figh ; the patient complains of a pain about the region of the ftomach, raid in his back and loins ; his tongue is at firft whiv, but afterwards it appears hhek and chapped ; and his teeth are covered witn a back cruft. lie fometimes paffes worms both upwards and downwards, is afrected with tremors or foaming, and oltcn becomes delirious. If PUTRID OR SPOTTED FEVER. a6t If blood is let, it appears difiblved, or with a very fmall degree of cohefion, and foon becomes putrid; the ftools fmell extremely foetid, and are fometimes of a greenifli, black, or reddifh caft. Spots of a pale purple, dun, or black colour, often appear upon the ikin, and fometimes there are violent ha?morrha?es. or difcharges of blood from the mouth, eyes, nofe, &c. It fometimes happens, that the inflammatory, nervous, a1.: J putrid fymptoms are fo blended to- gether, as to render it very difficult to determine to which clafs the fever belongs. In this cafe the greateft caution and fkill are requifite. Attention muft be paid to thofe fymptoms which are moft pre- valent, and both the regimen and medicines mufl be adapted to them*. Inflammatory and nervous fevers may be converted into malignant and putrid, by too hot a regimen, or improper medicines. The duration of putrid fevers is extremely uncer- tain ; .fometimes they terminate between the feventh and fourteenth day, and at other times they are pro7" longed for five or fix weeks. Their duration de- pends greatly upon the conftitution of the patient, and the manner of treating the difeafe. The moft favourable fymptoms are, a "gentle loofe- nefs after the fourth or fifth day, with* a-warm mild fweat. Thefe, when continued fo,r a confiderable time, often carry off the fever, and fliould never be imprudently flopped. Small miliary puftules ap- pearing between the petechia', or purple fpots, are likewife favourable, as alfo hot fcabby eruptions about the mouth and nofe. It is a good fign when * After all that lias been faid upon this fubjeft.^t is net at all probable, that any fever can with propriety be called pu- trid. They are alwv.yc infl.m.niutory at firfl:. the 202 PUTRID OR SPOTTED FEVER. fhe pulfe rifes upon the ufe of wine, or other cor- foals, and the nervous fymptoms abate ; deafnefs coming on towards the decline of the fever, is likewife often a favourable fymptom*, as are ab- fceffes in the groin or parotid glands. Among the unfavourable fymptoms may be reck- oned an exceffive loofenefs, with a hard fwelled belly -, large black or livid blotches breaking out upon the fkin ; aphthae in the mouth ; cold clammy fweats ; blindnefs ; change of the voice ; a wild ftar- ing 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, and the urine is black, or depofites a black footy fediment, the patient is in great danger. Starting of the tendons, and fcefid, ichorous, involuntary ftools, attended with coldnefs of the extremities, are moft generally the forerun- ners of death. REGIMEN.—In the treatment of this difeafe, we ought to endeavour, as far as poffible, to coun- 'teract the putrid tendency of the humors,! to fup- port the patient's ftrength and fpirits; and to affift nature in expelling the caufe of this difeafe, by gently promoting perfpiration and the other evacu- ations. It has been obferved, that putrid fevers are often occafioned by unwholefome air, and of courfe they muft be aggravated by it. Care fhould therefore be taken to prevent the air from ftagnating in the pa- tient's chamber, to keep it cool, and renew it fre- 'ife pV*18 -5 not aIwa)*s a favourable fymptom in this dif- with'in th" cPt!t " °uly f° whenoccafioned by abfeefles formed f It * quently. PUTRID OR SPOTTED FEVER. 203 quently, by opening the doors or windows of fome adjacent apartment. The breath and perfpiration of perfons in perfect health, foon render the air of a fmall apartment noxious ; but this will fooner happen from the perfpiration and breath of a perfon whofe whole mafs of humors are in a difeafed flat . * Befides the frequent acfsiiffien of fr.ih air, we would recommend the ufe of vinegar, verjuice, juice of lemon, Seville orange, or any kind of vegetable acid that can be moft readily obtained. Thefe ought frequently to be fprinkled upon the floor, the bed, and every part of the room. They may alfo be evaporated by pouring them on an hot iron, or by boiling, &:c. The frefli fkins of lemons or oranges, ought likewife to be laid in different parts of the room, and they fhould be frequently held to the patient's nofe. 7'he ufe of acids in this manner, would not only prove very refrefhing to the patient, but would likewife tend to prevent the infection from fpreading among thofe who attend him. Strong fcented herbs, as rue, tanfy, rofemary, wormwood, &c. may likewife be laid in diiferent parts of the houfe, and fmelled to by thofe who go near the patient. The patient muft not only be kept cool, but like- wife quiet and eafy. The ieaft noife will affect his head, and the fmalleft fatigue will be apt to make him faint. Few things are of greater importance in this dif- eafe 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 inclina- * It is of the utmofl: importance to change the patient's linen, bed-clothes, and bed da;ly, and, when practicable, to remove him into another room. A matrafs is far preferable jo a hcd. tion. 2c4 PUTRID OR SPOTTED I'EVER. tion. They may be rendered cordial, by the addi- tion 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 fliarp- ened with the juice of orange or lemon. In fome cafes, a glafs of wine may now and then be allowed. The moft proper wine is good Madeira, or Sherry; 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 decoction of tamarinds, which will both quench his thirft, and promote a difcharge by flool. If camomile-tea will fit upon his ftomach, it is a very proper drink in this difeafe. It may be fliarp- ened by adding to every cup of the tea t£n or fifteen drops of the elixir of vitriol. The food muft be light, as panada or oatmeal gruel, to which wine may be added, if the patient be weak and low; and they ought all to be fharp- ened with the juice of orange, the jelly of currants, or the like. The patient ought likewife to eat freely of ripe fruits, as roafted apples, currant or goofe- feerry tarts, preferved cherries, or plums, &c. Taking a little food or drink frequently, not only fupports the fpirits, but counteracts the putrid ten- dency of the humors ; for which reafon, the patient aught frequently to be fipping 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 he frequently fomented with a ftrong infufion of camo- mile flowers. This, or an infufion of the bark, to fuch as can afford it, cannot fail to have a good efFect. Fomentations of this kind not only relieve the PUTRID OR SPOTTED FEVER. 225 the head, by relaxing the veffels in the extremities, but as their contents are abforbed, and taken into the fyftem, they may affift in preventing the pu- trefcency of the humors. MEDICINE.—If a vomit be given at the begin- ning of this fever, it will hardly fail to have a good effect; but if the fever has gone on for fome days, and the fymptoms are violent, vdmits are not quite fo fafe. The body, however, is always to be kept open by clyfters, or laxative medicines. Bleeding is neceflary in putrid fevers to be regu- ' lated by the figns of inflammation. Bliftering plafters are to be ufed, according to circumftances. If the petechias or fpots fliould fud- denly difappear, the patient's pulfe fink remarkably, and a delirium, with other bad fymptoms come on, bliftering may be permitted. In this cafe, the blifter- ing plafters are to be applied to the head, and infidc of the legs or thighs. It is common, in the beginning of this fever, to give the emetic tartar in fmall dofes, repeated every fecond or third hour, till it fliall either vomit, purge, or throw the patient into a fweat. This practice is very proper, provided it be not pufhed fo far as to ^ weaken the patient. A very ridiculous notion has long prevailed, of expelling the poifonous matter of malignant difeafes, by trifling dofes of cordial or alexipharmic medicines. In confequence of this notion, the contrayerva-root, the cordial confection, the mithridate, &c. have been extolled as infallible remedies. There is reafon, however, to believe that thefe feldom do much good, Where cordials are neceffary, we know ncr.s that 1. fuperior to good wine, and therefore again recommend it, both as the fof eft and beft. Wine, with acids .and afitifeptics, are the only cordials ty be relied ov3 in the cure of malignant fevers.' 206 PUTRID OR SPOTTED FEVER. In the moft dangerous fpecies of this difeafe, when it is attended with purple, livid or black fpots, the Peruvian bark muft be adminiftered. 1 have feen it, when joined with acids, prove fuccefsful, even in cafes where the petechice had the moft threatening afpect. But, to anfwer this purpofe, it muft not only be given in large dofes, but duly perfifted in. 'The beft method of adminiftering the bark is cer- tainly in fubftance. An ounce of it in powder, may be mixed with half a pint of water, and the fame quantity of red wine, and fliarpened with the elixir or the fpirit of vitriol, which will both make it fit eafier on the ftomach, and render it more benefical. Two or three ounces of the fyrup of lemons may be added, and two tabie-fpoonfuls of the mixture taken every two hours, or oftener, if the ftomach is able to bear it. Thofe who cannot take the bark in fubftance, may infufe it in wine, as recommended in the preceding difeafe. If there be a violent loofenefs, the bark mufl be boiled in red wine with a little cinnamon, and fliarp- ened with the elixir of vitriol, as above. Nothing can be more beneficial, in this kind of loofenefs, than plenty of acids, and fuch things as promote a gentle perfpiration. If the patient be troubled with vomiting, a dram of the fait of wormwood, diffolved in an ounce and a half of frefli lemon juice, and made into a draught with an ounce of fimple cinnamon water, and a bit of fugar, may be given and repeated as often as it is neceflary. A tabie-fpoonful of milk every half hour will often ftop the Vomiting. If iwelling? of the glands appear, their fuppura- tion is to be promoted by the application of poulti- ces, ripening cataplafms, cee. And as foon as there is any appearance of matter in them, they ought to be opened, and the poultices, continued. I have PUTRID OR SPOTTED FEVER. 207 I have known large ulcerous fores break out in various parts of the body, in the decline of this fever, of a livid gangrenous appearance, and a moft putrid cadaverous fmell. Thefe gradually healed, and the patient recovered, by the plentiful ufe of Peruvian bark and wine, fharpened with the fpirits of vitriol. For preventing putrid fevers we would recommend a ftrict regard to cleanlinefs ; a dry fituation ; fufficient exercife in the open air; wholefome food, and a mo- derate ufe of generous liquors. Infection ought above all things to be avoided. No conftitution is proof againft it. I have known perfons feized with a putrid fever, by only making a fingle vifit to a pa- tient 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 neceflary to prevent the dif- eafe from fpreading. The fick ought to be placed in a large apartment, as remote from the reft of the family as poffible j he ought likewife to be kept ex- tremely clean, and fliould have frefh air conftanfiy let into his chamber; whatever comes from him fliould be immediately removed-, his linen fliould be * The late Sir John Pi ingle exprefled a concern left thefe cautions fhonld prevent people from attending thtir friends or relations when afflicted with putrid fevers. I told him I meant only to difcourage unneceflary attendance, and mentioned a number of inftances where putrid fevers had proved i.e.al t« perfons, who were rather hurtful than beneficial to the iicL This fagacious phyfician agreed with me, in thinki.ig that a good doctor and a careful mine were the only neceflary attend- ants ; and that all others, by their folicitude and iil-directej care, hurt the fick. If perfons attendant on the lick would pay fafneient atten- tion to cleanlinefs, and not lit near the patient unnece:;.jri:y, ;:,ey vwald fdJom be infected. fre^uei::.^. 208 PUTRID OR SPOTTED FEVER. frequently changed, and thofe in health ought to avoid all unneceflary communication with him. Any one who is apprehenfive of having caught the infection, ought immediately to take a vomit, and to work it off by drinking plentifully of chamo- mile tea. This may be repeated in a day or two, if the apprehenfions ftill continue, or any unfavourable fymptoms appear. The perfon ought likewife to take an infufion of the bark and chamomile flowers for his ordinary drink; and before he goes to bed, he may drink a pint of pretty ftrong negus, or a few glaffes of generous wine. I have been frequently obliged to follow this courfe, when malignant fevers prevailed, and have likewife recommended it to others with conftant fuccefs. People generally fly to bleeding and purging as antidotes againft infection ; but thefe are fo tar from fecuring them, that by debilitating the body they increafe the danger*. Thofe who wait upon the fick in putrid fevers, ought always to have a piece of fpunge or a hand- kerchief dipt in vinegar, or juice of lemon, to fme§ to while near tee patient. They ought likewife to wafli] their hands, and, if poffible, to change their clothes, before they go into company. * This may be true in many cafes, but where fymptoms cf inflammation occur, bleeding and purging arc conftantly th; chief and only remedies. CHAP. L *'C9 j" CHAP. XXI. 0/* /fo Miliary Fever. 1 HIS fever takes its name from the fmall puflules or bladders which appear on the fkin, refembling, in fliape and fize, the feeds of millet The puflules are either red or white, and fometimes both are mixed together. The whole body is fometimes covered with puf- tules ; but they are generally more numerous where the fweat is moft abundant, as on the breaft, the back, &c. A gentle fweat or moifture on the fkin, greatly promotes the eruption; but, when the fkin is dry, the eruption is both more painful and dan- gerous. Sometimes this is a primary difeafe; but it is much oftener only a fymptom of fome other malady, as the fmall-pox, mealies, ardent or nervous fever, &c. In all thefe cafes it is generally the effect of too hot a regimen or medicines. The young and the aged are more liable to it than thofe in the vigour and prime of life. It is likewife more incident to women than men, efpecially the de- licate and the indolent, who, neglecting exercife, keep continually within doors, and live upon weak watery diet. Such females are extremely liable to be feized with this difeafe in child-bed. CAUSES.—The miliary fever is fometimes occa- fioned by violent paffions or affections of the mind ; as exceffive grief, anxiety, thoughtfulnefs, Sec. It may likewife be occafioned by exceffive watching, great evacuations, a weak watery diet, eating too freely of cold, crude, unripe fruits, as plumbs, cher- P ries, no OF THE MILIARY FEVER. ries, cucumbers, melons, &c. Impure waters, or provifions which have been fpoiled by rainy feafons, long keeping, &c. may likewife caufe miliary fevers. This difeafe in childbed-women is fometimes the effect of great coflivenefs during pregnancy ; it may likewife be occafioned by their exceffive ufe of green trafh, and other unwholefome things, in which preg- nant women are too apt to indulge. But its mofl general caufe is indolence. Such women as lead a fedentary life, efpecially during pregnancy, and at the fame time live grofsly, can hardly efcape this difeafe in childbed. Hence it proves extremely fatal to women of faflion, and likewife to thofe women in manufacturing towns, who, in order to affift their hufbands, fit clofe within doors for almoft the whole of their time. But amongft women who are active and laborious, who live in the country, and take fufficient exercife without doors, this difeafe is very little known. SYMPTOMS.—When this is a primary difeafe, it makes its attack, like molt other eruptive fevers, with a flight fliivering, which is fucceeded by heat, lofs of ftrength, faintnefs, fighing, a low quick pulfe, difficulty of breathing, with great an.xiety and op- preffion of the breaft. The patient is reftlefs, and fometimes delirious; the tongue appears white, and the hands fhake, with often a burning heat in the palms; and in childbed-women the milk generally goes away, and the other difcharges ftop. The patient feels an itching or pricking pain un- der the fkin, after which innumerable fmall puflules of a red or white colour begin to appear. Upon this the fymptoms generally abate, the pulfe becomes more full and foft, the fkin grows moifter, and the fweat, ') ■ate the difeafe advances, begins to have a peculiar foetid 'fmell; the great lead on the breaft and oppreffion of the fpirit^ generally go off, and the cuftomary eva- } - cuations OF THE MILIARY FEVER. 211 cuations gradually return. About the fixth or feventh day from the eruption, the puflules begin to dry and fall off, which occafions a very difagreeable itching in the fkin. It is impoflible to afcertain the .exact time when the puflules will either appear or go off. They gene- rally come out on the third or fourth day,* when the eruption is critical; but, when fymptomatical, they may appear at any time of the difeafe. Sometimes the puflules appear and vanifh 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 great. In child-bed women the puflules are commonly at firft filled with clear water, afterwards they grow yellowifh. Sometimes they are interfperfed with puf- tules of a red colour. When thefe only appear the difeafe goes by the name of a rajh. REGIMEN.—In all eruptive fevers, of whatever kind, the chief point is to prevent the fudden difap- pearing of the puflules, and to promote their matu- ration. For this purpofe the patient muft be kept in fuch a temperature, as neither to pufh out the eruption too fall, nor to caufe it to retreat prema- turely. The diet and drink ought therefore to be in a moderate degree nourifliing and cordial; but neither ftrong nor heating. The patient's chamber ought neither to be kept too hot nor too cold ; and he fhould not be too much covered 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 apprehenfion of danger. The food muft be weak chicken-broth with bread, panada, fago, or oatmeal-gruel, &c. 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 roafted or boiled, P 2 with 2ia OF THE MILIARY FEVER. with other ripe fruits of an opening cooling nature, may be eaten. 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 j as water-gruel, or balm tea. When the patient's fpirits are low, and the erup- tion does not rife fufficiently, his drink muft be a little more genereua; as wine-whey, or fmall negus, fharpened with the juiee of orange or lemon, and made ftronger or weaker as circumftances may re- quire. Sometimes the miliary fever approaches towards a putrid nature, in which cafe the patient's ftrength mufl be fupported with generous cordials, joined with acids; and, if the degree of putrefcence be great, the Peruvian bark muft be adminiftered. If the head be much affected, the body mufl be kept open by emol- lient clyfters. MEDICINE.—If the food and drink be properly regulated, there will be little occafion for medicine in this difeafe. Should the eruption, however, not rife, or the fpirits flag, it will not only be neceffary to fupport the patient with cordials, but likewife to apply bliftering-plafters. The moft proper cordial, in this cafe, is good wine, which may either be taken in the patient's food or drink ; and if there be figns of putrefcency, the bark and acids may be mixed with wine, as directed in the putrid fever. Some recommend bliftering through the whole courfe" of this difeafe ; and where nature flags, and the eruption comes and goes, it may be neceffary to keep up a ftimulus, by a continual fucceffion of fmall bliftering-plafters ; but we would not recommend above one at a time, if, however, the pulfe fliould fink remarkably, the puflules fall in, and the head be affected, it will be neceflary to apply feveral bliftering- plafters OF THE MILIARY FEVER. 213 plafters to the moft fenfible parts, as the infide of the legs and thighs, Sec. Bleeding is feldom neceflary in this difeafe, and fometimes it does much hurt, as it weakens the pa- tient, and depreffes his fpirits. It is therefore never to be attempted, unlefs by the advice of a phyfician. We mention this, becaufe it has been cuftomary to treat this difeafe in childbed-women by plentiful bleeding, and other evacuations, a8 if it were highly inflammatory*. If the difeafe proves tedious, Or the recovery flow, we would recommend the Peruvian bark, which may either be taken in fubftance, or infufed in wine or water» as the patient inclines. The miliary fever, like other eruptive difeafes, re- quires gentle purging when the fever is gone off, and thepatient's ftrength will permit. To prevent this difeafe, a pure dry air, fufficient exercife, and wholefome food, are neceflary. Preg- nant women fhould guard againft coflivenefs, and take daily as much exercife as they can bear, avoid- ing all green fruits, and other unwholefome things; and when in childbed they ought ftrictly to obferve a cool regimen. * The only rule to go by here is the Itate of the pulfe and violence of the fymptoms. If thefe require bleeding, it cannot be improper. P3 CHAP. [ 2'4 ] CHAP. XXII. Of the Remitting Fever. 1 HIS fever takes its name from a re. million of the fymptoms, which happens fometimes fooner, and fometimes later. The remiffion is com- monly preceded by a gentle fweat, after which the patient feems greatly relieved, but in a few hours the fever returns. Thefe remiflions return at very irregular periods, and are fometimes of longer, fome- .times 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 marfliy countries, abounding with wood and ftagnat. ing water; but they prove moft fatal in places where great heat and moifture are combined, as in fome parts of Africa, the province of Bengal in the Eaft Indies, &c. where remitting fevers are generally very fatal. They are moft frequent in clofe calm wea- ther, efpecially after rainy feafons, great inundations, or the like*. No age, fex, or conftitution, is ex- empted from the attack of this fever; but it chiefly feizes perfons of a relaxed habit, who live in low dirty habitations, breathe an impure flagnating air, take little exercife, and ufe unwholefome diet. SYMPTOMS.—The firft fymptoms of this fever are generally yawning, ftretching, pain and giddinefs of the head and limbs, with alternate fits of heat and * In America, they are often moft prevalent after dry fummers. cold. OF THE REMITTING FEVER. 21/, cold. Sometimes the patient is affected with a de- lirium at the very firft attack. There is a pain, and fometimes a fwelling, about the region of the fto- mach, the tongue is white, the eyes and fkin frequent- ly 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 fliews any figns of inflammation. Some pan tients are exceedingly coftive, and others are afflicted with a very troublefome loofenefs. It is impoflible 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 likewife be greatly changed by the method of treatment, and by many other cir- cumftances too tedious to mention. Sometimes the bilious fymptoms predominate, fometimes the ner- vous, and at other times the putrid. Nor is it at all uncommon to find a fucceffion of each of thefe, or even a complication of them at the fame time, in the fame perfon. This fever in its common appearance, approaches neareft to an intermittent with protracted paroxyfms. REGIMEN.—The regimen mufl be adapted to the prevailing fymptoms. When there are a»ny figns of inflammation, the diet muft be flender, and the drink weak and diluting. But when nervous fymp- toms 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 pre- ceding fevers. We muft, however, be very cautious in the ufe of things of a heating quality, as this fever is frequently changed into a continual one by ain hot regimen, and improper medicines. Whatever the fymptoms are, the patient ought to be kept cool, quiet, and clean. His apartment, if poffible, fhould be large, and frequently ventilated P4 VS 216 OF THE REMITTING FEVER. by letting in frefh air at the doors or windows. It ought likewife 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. Though thefe things have been recommended before, we think neceffary to re- peat them here, as they 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 interraifEoa. This intention may be promoted by bleeding, if there be figns of inflammation ; but, when that is not the cafe, bleeding ought not to be attempted, as it will weaken the patient, and prolong the difeafe. A vomit, however, will feldom be improper, and is generally of great fervice. Fifteen or twenty grains of ipecacuanha will anfwer this purpofe very well; but, where it can be obtained, we would rather re- commend a grain or two of tartar emetic, with five or fix grains of ipecacuanha, to be made into a draught, and given for a vomit. This may he repeated once or twice, at proper intervals, if the ficknefs car »aufea continues. Sometimes the naufea and vomiting arc very troublefome. To remove this we bleed, if the pulfe will bear it: if not, we apply hliftexs to the wrifts or ancles. * The ingenious Dr. Liral, of Edinburgh in his inaugural diflertatio© concerning the putrid remitting fever of Bengal, has the following obfervation; " The patient's ftutt, bed- " clothes, and bedding, ought frequently to be changed, and " expofed to the air, and all his excrements immedfately re- " moved ; the bed-chamber fliould1 be made pure and whole- " fome, and frequently fprinkled with vinegar ; in fhort every " attention fhould be paid to the patient. I can ajKrsa»thaia " phyfician who puts thefe in practice, will much ofteowruc- " ceed than one who is even more fkilful, but has not oppor- ". tunity of ufmg thefe means," The OF THE REMITTING FEVER. 217 The body ought to be kept open either by laxa- tives, as infufions of fenna and manna, fmall dofes of cream of tartar, tamarinds, ftewed prunes, or the like. The ftronger purgatives, as calomel with jalap or rhubarb, are often neceffary. By this courfe the fever, in a few days, may f\ - rally be brought to a pretty regular or diftincl: ■ „t- miffion ; and if the intermiffion is not complete. 0:e faline julep, and blifters to the wrifts,will mc'. com- monly produce one; in which cafe the Peruvian ba> ■; may be adminiftered, and, if the ftomach will bear it, it will feldom fail to perfect the cure. Wherever the bark is proper in fevers, the beft method is to give as much as the ftomach will bear, and continue it for one or two days in thefe dofes. It is needlets here to repeat the methods of giving the bark, as we have already had occafion frequently to mention them*. The moft likely way to avoid this fever, is to ufe a wholefome and nourifhing diet, to pay the moft fcrupulous attention to cleanlinefs, to keep the body warm, to take fufficient exercife, and, in hot coun- tries 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 wine. Some recommend fmoking tobacco, as very beneficial in marfhy countries, both for the prevention of this and intermitting fevers., * It often happens that the ftomach will not bear the bark, or perhaps the intermiffion is not fufficiently evident to give it. In fuch cafes, a (trong tea, made of three fourths centuary and one fourth Virginia fnake root, may be drank cold, a tea-cup full every hour. CHAP. C 218 ] CHAP. XXIII. Of the Yellow Fever. XEVERS have already been divided and fubdivided into too many fpecies; and, it is by no means from a wifli to add to the number, that I in- fert this chapter on, what is commonly called, the Yellow Fever. But, as there are fome particulars in it, which feem to diftinguifli it from other fevers, al- though the difcriminating fhades between fevers are difficult to mark, and as the practice does certainly vary from that which is proper in others, to which it has a confiderable refemblance, I thought it might be ufeful to give a general account of it; more efpe- cially, as there are but few, even of the phyficians in the United States, who have had an opportunity of feeing this difeafe. To thefe I would particularly recommend a careful perufal of Dr. RufiVs book op the fubject:. I need hardly remark, that a more full account, than that which is here given, would be improper in the prefent work. This fever is fo called from a yellownefs of the whole furface, which takes place, generally, from the fecond and third to the fixth and feventh days: it does not, however, occur in every inftance. It would feem, from the defcriptions given by various authors, that this difeafe appears in different forms : fome tell us of its appearance with fuch fymp- toms as indicate great debility ; others place it among the moft violent inflammatory fevers; and it is cer- tain, that this laft was the form it generally affirmed at Philadelphia, in the fummer and autumn of 1793 \ although OF THE YELLOW FEVER. 219 although it fuffered all the varieties produced by age, conftitution, the ftate of the atmofphere, feafon of the year, together with a number of other caufes, fuch as fear, grief, and defpondency, which power- fully operated on the mind. The young and plethoric were moft fubject: to this difeafe, efpecially at the beginning ; but, during its progrefs, no age nor conftitution were exempt from its attacks. The danger was, in general, to be eftimated by the violence of the attack, and age of the patient. It ofteneft proved mortal from the third to the feventh day,: a yellownefs on the fixth day, was not an un- favourable fymptom. CAUSES.—It remains a matter of difpute, whe- ther this difeafe is always imported, or whether it ever originates in this country. But, as it is agreed that it may be imported, the ftrifteft vigilance fhould be exercifed at every port of the United States during, at leaft, the months of July, Auguft, and September, when this difeafe is known to prevail in the Weft Indies and South America, and more efpecially in a time of war there. Perhaps it would not be too ftric"f. to fubject every vefiel, coming from a fickly or fufpected place, to a delay of at leaft thirty days, in fome port, at a convenient diftance from any town. Though it may not be an eafy matter to determine the queftion concerning the origin of the difeafe, it is by no means difficult to trace the caufes of its fpreading, when once amongft us. Thefe are, dry, or moift and hot weather, dirty ftreets or houfes, want of cleanlinefs in general, fcarcity of gooVi ripe fruit, intemperance, expofure to the fun or night air, fatigue, and fear. And, as thofe who fuppofe the difeafe to be always imported, regard the caufes juft mentioned to be the nu.i :;o OF THE YELLOW FEVER. moft probable ones of fpreading the difeafe, and thofe who fuppofe it to be an original diforder, be- iieve thefe to be the caufes of the difeafe ; it is, in either cafe, ftrictly incumbent on the magiftrates and citizens of every city to have the ftreets kept per- fe&ly clean, as well as to have them properly watered in dry feafons. SYMPTOMS.—Thefe are various ; generally, however, after a previous laffitude, the fever attacks with a chill more or lefs violent, followed by heat, fevere pains in the head, back, and hips, oppreflion at the breaft, naufea and vomiting, delirium, and watchfulnefs. The eyes are muddy, fometimes fpark- ling, fometimes dull, the pupil dilated, the tongue is moift, the fkin dry, the bowels generally very coftive, the pulfe fometimes opprcfied and fmall, ge- nerally hard, the fever has irregular exacerbations, but moftly one in the evening or during the night; thefe are not followed by fweat as in the remittent fever. The urine is in fmall quantity and high co- loured; eruptions fometimes appear, particularly about the breaft. In the moft fatal cafes thefe fymptoms continue with violence till the third or fourth day, when the pulfe fails, the fkin turns yellow, hlrmor- rhagies from different parts come on, the vomiting increafes, and, inftead of bile and the contents of the ftomach, a dark coloured liquor is thrown up, ex- actly refembling coffee grounds diffolvcd in water; this vomiting is often accompanied with a diftrefung noife and exceffive reftleflhefs, the extremities be- come cold, the debility increafes, and the patient is foon relieved by death from all his agonies. When the difeafe terminates favourably, the fymp- toms of attack are much the fame at firft, and of dif- ferent degrees of violence ; by proper remedies they often abate on the firft or fecond day, and when they continue longer, the exacerbations are lefs violent, OF THE YELLOW FEVER. 221 violent, there is lefs vomiting, pain, &c. If the pa- tient lives over the eighth or ninth day, there is more reafon to hope a favourable iffue. REGIMEN.—The fame regimen is proper here as in moft fevers; but we muft be particularly care- ful to place the fick in as large and airy a room as poffible, to change his linen and bed clothes every day, and to carry the cooling plan to its greateft ex- tent ; the bed clothes fliould be very light, the win- dows and doors fhould be kept open conftantly, linen cloths dipt in cold water fliould be applied often to the forehead and hands, efpecially where the pain in the head is violent. Every attention fliould be paid to leffen the exertions of the fick ; the forces fhould be removed immediately, and fugar and falt- petre burnt in the chamber on coals—the floor may be often fprinkled with vinegar. The diet muft be very light, and confifting chiefly of vegetables, indeed moftly of drinks, fuch as thin fago-gruel, lemonade, toaft and water, tamarind- water, molaffes and water : a fmall quantity of thefe muft be taken at a time to prevent vomiting. This is a moft troublefome and dangerous fymptom, and will often yield to a few table-fpoonfuls of milk every hour, or a table-fpoonful of good olive oil occafionally. The fick perfon fliould drink very freely of any ct the mild diluents above mentioned if his ftomach will bear it, and the drink muft be offered to him. MEDICINES.—The chief remedies in this dif- eafe are bleeding and purging: and were thefe timelv adminiftered and repeated in fufficient quantity, with proper nurfing and accommodations there is no cafe of fever that would become lefs fatal than this terri- ble one. The bleeding fliould be performed on the firft at- *ack, and repeated two, fV.ree. or four times a-day, according 222 OF THE YELLOW FEVER. according to the violence of the fymptoms, in the quantity of from eight and ten to fourteen and twenty ounces, until the fymptoms are fubdued, or in com- mon language, until the fever is broken. Every new exacerbation of fever calls for another bleeding, and this may be repeated commonly until the feventfl 'M and eighth day if neceffary, or longer if there isfany local determination to the head, breaft, or bowels. The pulfe will direct: us greatly here ; we are not always to look for the ftrong, hard pulfe, it is often a fmall, tenfe, or, as it may be ftiled, chorded pulfe, which requires bleeding ; where there is fuch a pulfe we are not to be reftrained by haemorrhagies from the ufe of the lancet. The blood drawn firft appears of a fcarlet colour, without much feparation ; it will afterwards generally put on the appearance of blood in other inflammatory diforders, or what is commonly called buffy blood. Purging is alfo abfolutely neceffary. As the cof- tivenefs is obftinate we are obliged to ufe fuch cathartics as will overcome it. Nothing has been found more effectual for this purpofe than calo- mel, and as it is flow, though fure in its effects, we add fome jalap or rhubarb to quicken its opera- tion. From eight to twelve grains of calomel with the fame, or rather a larger, quantity of jalap or rhubarb may be given every four or fix hours until they operate. It is, however, often neceffary alfo to give feveral purgative glyfters before the bowels can be opened. After fix or eight large dark coloured or black ftools have been procured, we may give, perhaps, a fingle dofe of this medicine daily, and when the fymptoms abate, any other purgative may be ufed, a* caitor-oil, Glauber falts, &c. and fometimes it is neceflary, efpecially after the difeafe has continued for fome days, and the coflivenefs remains obftinate,- to OF THE YELLOW FEVER. 223 to combine the calomel with aloes or gamboge, in the form of pills, two of which, containing equal parts of each, may be given every three or- four hours until they operate. Confiderable advantages arife from giving a few grains of calomel daily until the difeafe is fubdued. It will often vomit as well as purge when firft admi- niftered. It will bring on perfpiration, and it feems to increafe the fecretion and excretion of the bile, which appears to be deficient in this difeafe. The fears which fome entertain refpecting the rough and inflammatory nature of this mercurial purge are totally groundlefs. Indeed, when we confider that it is the cathartic almoft univerfally employed in the difeafes of children, we furely cannot fuppofe it to be too heating in thofe of adults. The difeafe has fometimes been fuddenly refolved by a general perfpiration. It will not, however, be fafe to lofe time by attempting to procure this eva- cuation, more efpecially as the means made ufe of to bring it on, would increafe the inflammatory ftate of the fyftem, if they failed of producing their defirtd effea. Having faid thus much of bleeding and purging, little need be added concerning any other remedies, as the whole cure depends on the ufe of thefe and of a proper regimen. It fometimes happens, in the ad- vanced flage of this difeafe, when bleeding is no longer proper, that pain of any particular part, coma, vomiting, or a continuance of fever, require the ap- plication of blifters. In this ftate only, laudanum may be of fervice, efpecially if there is any delirium. Sinapifms to the ancles may be ufed if there is much flupor, as well as wine and other cordials ; but thefe are only admiflible in that flage of the difeafe when the pulfe is too weak to bear bleeding, and there is no appearance cf fever. The 224 OF THE YELLOW FEVER. The efficacy of the above remedies depends upon their being early applied. To prevent infection, the bowels fhould be kept open by gentle laxatives ; a temperate diet, confifting of broths, milk, vegetables, and ripe fruits of all kinds fhould be ufed, and the exciting caufes of un- ufual heat, cold, and fatigue, fhould be carefully avoided. During the convalefcence, light food, ripe fruit, beer and water, wine and water, the elixir of vitriol, and centaury-tea, may be ufed ; and, when able, the patient fhould ufe exercife in a carriage. But there is great danger of a relapfe, and much caution is ne* ceffary not to be expofed to fatigue, the rays of the fun, or night air. It does no f appear that this difeafe is communicable in the country, and we are told by Dr. Lining of Charlefton, where it has often prevailed, that no perfon can have it twice, though this is doubted. The black people, and perfons from the Weft Indies, are lefs fubject to it than others. The treatment above recommended applies to the yellow fever as it appeared here in 1793 and 1794. If it fliould hereafter appear in a different form, a different mode of practice may be requifite. This, however, can eafily be afcertained by the fymptoms. If they are inflammatory, they will undoubtedly re» quire the fame treatment, and at any rate cathartics cannot be improper. 4 CHAP. [ 235 ] CHAP. xxrv. Of the Small-Pox. 1 HIS difeafe, which originally came from Arabia, is now become 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 and America. The fmall-pox generally appear towards the , fpring. They are very frequent in fummer, lefs fo in autumn, and leaft of all in winter. Children are moft liable to this difeafe ; and thofe whofe food is unwholefome, who want proper exercife, or who ufe too much exercife, or drink diftilled fpirits, run the greateft hazard from it. The difeafe is diftinguifhed into the diftinct and confluent kind ; the latter of which is always at- tended with danger. There are likewife other dif- tin&ions of the fmall-pox ; as the cryftalline, the bloody, &c. CAUSES.—The fmall-pox is commonly caught by infection. Since the difeafe was firft brought into Europe, the infection 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 become in a manner conftitutional. Children who have over-heated themfelves by running, wreft- ling, &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 unnecef- fary. Children commonly look a little dull, feem lift lefs and drowfy for a few days before the more Q^ violent 226 OF THE SMALL-POX. violent fymptoms of the fmall-pox appear They * are likewife more inclined to drink than ufual, have little appetite for folid food, complain of wearinefs, j 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, be- come more violent, and are accompanied with pains : of the head and loins, vomiting, &c. The pulfe is quiclc, with a great heat of the fkin, and reflijeflhels. When the patient drops afleep, he wakes in a kind of horror, with a fudden flart, which is a very com* mon fymptom of the approaching eruption; as are alfo convujfion-fits in young children. We may remark, however, that all the feverifh fymptoms of fmall-pox are greatly relieved by waljking about is tjhe cool air, and often intermit. About the third or fourth day from the time of fickening, the fmall-pox generally b^gin to appear j fometimes indeed they appear fooner. At firfl they very nearly refemble flea-bites, and are fqpneft dif- covered on the face, arms, and breafl. The moft favourable fymptoms are a flosjr erup- tion, and an abatement of vthe fever as foon as w; puflules appear. In a mild diftinct kin4 of finall- pox the puflules feldom appear before the third or fourth day from the time of fickening, and they generally keep coming out gradually for feveral days after, Puflules which are diftind, with a florid retf bafis, and whicji fill with thick purulent matter, are the beft. A livid brown colour of the puflules is an unfa- vourable fymptom j a^s alfo when they are (mal) and flat, with black fpecks in the middle. Puflules which contain a thin watery ichor are very bad. A great number of pock on tlie face is always attended with danger. It is likewife a bad fign when they run intp one another. It OF THE 8MALL.POX. 227 tt is a moft unfavourable fymptoHi when petechice, jor purple, brown, or black fpots are interiperfed among the puflules. * Bloody ftools or urine, with a fwelled belly, are bad fymptoms; as is alfo a con- tinual ftrangury. Pale urine, and a violent throb- bing of the arteries of the neck, are figns of an ap- proaching delirium, or of convulfion-fits. When .the face does not fwell, or falls before the pock come to maturity, it is very unfavourable. If the face begins to fall about the eleventh or twelfth day, and at theiarae time the hands and feet begin to fwell, *he patient generally does well; but when thefe do •not fucceed to «ach other, there is .reafon to appre- hend danger. A continual fpitting is now very fa- vourable. When the tongue is covered with a brown crirft, it is an unfavourable fymptom. Grind- ing of the teeth, when it proceeds from an affe&ion of the nervous fyftem, is a bad fign j but fometimes it is occafioned by worms, or a difordered ftomach. REGIMEN.—When convulfions appear, they give a dreadful alarm; immediately fome noftrum is applied, as if this were a primary difeafe ; whereas it is.only a fymptom, and far from being an unfa- vourable, one, of the approaching eruption. As the fits generally go off before the actual appearance of the fmalhpox, it is attributed to the medicine, which, by this means, acquires a reputation without any merit. + * And y«t we often fee a few purple pock fcattered amongft a very good diftincl kind }-here there is no danger. f Convulfion-fits are no doubt very alauping.but their effefls are often falutary. They feem to be one of the means made ufe of by Nature for breaking the force of a fever. I have al- ways obferved the fever abated, and fometimes quite removed, after one or more convulfion-fits. This readily accounts for convulfions being a favourable fymptom in the fever which pre- cede, the eruption of the fmall-pox, as every thing thatmtti- v In 1768, the Abbe Chappe informs us, that this same scourge destroyed at Naples sixteen thousand persons in a few weeks. In Russia, the annual de- struction of human beings thereby, is estimated by Baron Dimsdale, at two millions. In China, says Dr. Clark, where the population is immense, the number who annually die of the Small- Pox, the most loathsome of all diseases, next to the leprosy, is incalculable. The fatality is still more remarkable amongst unci- vilized people, who are wholly ignorant of the means of prevention, and of the methods of cure. About fifty years after the discovery of Peru, the Small-Pox was carried from Europe to America, by OF VACCINATION. 243 way of Carthagena, when it overran the continent of the New World, and destroyed upwards of one hun- dred thousand Indians, in the single province of Qui- to. This account was found by M. de la Condamine in an ancient manuscript preserved in the cathedral of that city. This author also observes, that in the Portuguese settlements, bordering upon the river of the Ama- zons, the Small-Pox proved fatal to nearly all the na- tives. Mackenzie, in his travels over the continent of North America, gives an affecting account of the de- struction occasioned amongst the Indians by the Small- Pox. The fatal infection, says he, spread around with a baneful rapidity, which no flight could escape, and with a fatal effect that nothing could resist. It de- stroyed, with its pestilential breath, whole families and tribes, and the horrid scene presented to those who had the melancholy and afflicting opportunity of beholding it, a combination of the dead, the dying, and of such as to avoid the horrid fate of their friends around them, prepared to disappoint the plague of its prey, by terminating their own existence. In an account of the travels of Captains Lewis and Clarke, byway of the Missouri and Columbia rivers, to the pacific Ocean, in 1804, 1805, and 1806, we are informed that the Sioux Indians had threatened to murder their party, but were prevented by the threat of spreading the Small-Pox amongst them. The Indians having severely suffered by mis disease, and knowing it came from the white people, were deterred by the bare threat, from putting their bloody purposes into execution. In 1767, we are informed in Cook's Voyage, a soldier introduced the Small-Pox for the first time into Kamtschatka, and twenty thousand persons per- ished by that disease, leaving whole villages nearly desolate. 244 OF VACCINATION. Crantz, in his history of Greenland, says, that the Small-Pox was first introduced into that frozen re- gion in 1733, when the mortality of this disease was so great that it almost depopulated the whole coun- try. Even so late as the year 1793, when the Small Pox was conveyed to the Isle of France in the East Indies, by a Dutch ship, five thousand four hundred persons perished there widi this distemper in six weeks. From the above statement, it is evident, that all the wars throughout the whole world, have never destroy- ed so many lives as have been cut off by this awful scourge. To lessen in some degree this destruction of the human race, inoculation was introduced, by which the mortality of the disease was obviated, as far as it respected those who submitted to the operation. But as the benefit of inoculation cannot be extend- ed .to society, as is observed by a popular writer, by any other means than by making the practice gener- al ; while it is confined to a few, it must prove hurtful to the whole. By means of it the contagion is spread and is communicated to many, who might otherwise have never had the disease. Accordingly it is found that more persons die of the Small Pox now, than before inoculation was introduced; and this import- ant discovery, by which alone more lives might be saved than by all the other endeavors of the faculty, is in a great measure lost by its benefit not being ex- tended to the whole community. Dr. Heberden, in his observations on the increase and decrease of dif- ferent diseases, observes, that he examined carefully the bills of mortalitv, and comparing the destruction occasioned by the Small Pox in Great Britain before and since inoculation, reluctantly was brought to this melancholy conclusion, that at the present period, the proportional increase of deaths from this disease was m five to four. OF VACCINATION. 245 Hence it would appear that inoculation has done a great injury to society at large, and the difficulty of extending it generally, so as to convert it truly into a public benefit, is attended with almost insuperable objections. For, to make a law that inoculation shall be geneial and periodical, appears both cruel and ar- bitrary, w here security of life cannot be given to all, and is what no government, grounded on the basis of general liberty, would venture to adopt. But through the kindness of Divine Providence, the means of obviating all these difficulties and dan- gers have at length been placed within our power, by the invaluable discovery made public by Dr. Edward Jenner, that the Cow Pock, which has never been known to prove fatal, effectually secures the constitu- tion from the attacks of either the natural or. inocu- lated Small Pox* The following annual statement of deaths by the Small-Pox within the London bills of mortality, in the present century, has lately been published by the Jennerian Society of that city: A. D. 1800............2409 deaths, 1801............1461 1802............1579 1803............1173 1804............ 622 As the society remarks, it is hoped the knowledge f these facts will be strongly promotive of the ben- eficial practice- of Vaccine inoculation ; it appealing that the fatal disease of Small-Pox has progressively declined as the inestimable discovery of Dr. Jenner has been introduced. Vaccination was introduced into Vienna in 1801. Its effects in decreasing the deaths by Small-Pox are 246 OF VACCINATION. evident from comparing the deaths since that period with those of the preceding years. In 1800........835 died of Small-Pox. 1801.........164 1802......... 61 1803......... 27 1804......... 2 only. A Comparative View of the Natural Small-Pox, Inoculated Small-Pox, and Vaccination, in their Effects on Individuals and Society. NATURAL SMALL POX. For twelve centuries this disorder has been known to continue its ravages, destroying every year an im- mense proportion of the population of the world. It is in some few instances mild, but for the most part violent, painful, and loathsome, dangerous to life, and always CONTAGIOUS. One case in three, dangerous—one in six dies. At least half of mankind have it,consequently one in twelve of the human race perish by this disease. In London three thousand die annually—forty thou- and in Great Britain and Ireland. The eruptions are numerous,painful and disgusting. Confinement,loss of time,and expense are certain, and more or less considerable. Precautions are for the most part unavailing. Medical treatmentnecessary,both du- ring the disease, and afterwards. It occasions pitts, scars, seams, Sec. disfiguring the skin, particularly ;he face. The subsequent diseases are scrophula in its worst forms ; diseases of the skin, glands, joints, Sec. ^nd loss of sense, sight or hearing, frequently follow. It is attempting to cross a large and rapid stream oy swimming, -when one jn six perish. INOCULATED SMALL-POX. For the most part mild* but some- times violent, painful, loathsome and dan- gerous to life ; always Contagious, and therefore gives rise to the Natural Small- Pox, and has actually, by spreading the disease, increased the general mortality, seventeen in every thousand. One in forty has a dangerous disease, one in three hundred dies. And in Lon- don, one in an hundred. Eruptions are sometimes very consi- derable, confinement, loss of time, and ex- pense certain, and more or less consider- able ; preparation by diet and medicine ne- cessary, extremes of heat and cold, dan- gerous : during -ill-health, teething, and pregnancy, to be avoided, medical treat- ment usually necessary. When the disease is severe, deformity probable, and subse- quent disorders as in the natural smallpox. It is passing the river in a boat subject to accidents, where one in three hundred perish, and one in forty suffer partially. VACCINATION. Is an infallible pre- ventive of the Small- Pox,always mild, free from pain or danger, never fatal, nor con- tagious. No eruption but where Vaccinated.No confinement, loss of time, or expense ne- cessary. No precau- tion, no medicine re- quired, no consequent deformity. No sub- sequent disease. © g O M It is passing over a safe bridge. 248 OF VACCINATION. After a mature consideration of the preceding statement of facts, we would seriously ask every person of reflection, xvhether or not it is justifiable to continue to inoculate for the Small Pox? THE following concise instructions it is hoped will be found sufficient for conducting the VACCINE INOCULATION. Which effectually prevents the small-pox, is never dangerous, requires no particular diet nor medicine, and may be practised at all ages, and at every sea- son of the year. TO COLLECT THE VACCINE MATTER. The matter may be taken from a pustule that is making its progress regularly, and which possesses the true vaccine character, by puncturing with a lan- cet in several points, and charging small square pieces of glass with it, by gently pressing them on the open- ed puncture, and putting two of them together, with the sides containing the matter in contact; wrap them up in a piece of paper, and preserve them from heat and moisture. The best time for taking the vaccine matter is from the seventh to the ninth day, before the efflorescence or red appearance takes place. An unnecessary ir- ritation of the pustule is thereby avoided: and it is al- so adviseable not to take a great deal of fluid from one pustule. Or, the internal, central part of the first scab that falls off, which is the true vaccine scab, may be used: and this I have in general found to be the most cer- tain mode of communicating the infection. The scab of a vigorous pustule, which has not been opened, should be chosen, and may be kept OF VACCINATION. 249 in a cool dry place for a twelve month; so that vaccin- ation may be performed from it at any time: But it is well known that the most recent scabs are the most powerful. TO INTRODUCE THE MATTER. The proper place for introducing the matter is on the arm, about midway between the shoulder and the elbow. The mode of doing it is by impregnating the point of a clean sharp lancet with the matter, and inserting it by means of a very slight scratch or small puncture, and wiping the point of the lancet on the part where the blood is drawn. Fluid matter taken from a pustule and immediately inserted, is the most certain. But to use the matter on the glasses, we restore it to a fluid state by dissolving it in a small portion of cold water taken upon the point of a lan- cet; and to use the scab, we scrape off some of the dark, internal, central part, and mix it with a little cold water on a piece of glass; taking care to moisten on- ly the part we use. SIGNS OF TRUE VACCINE INOCULATION. A little red spot will appear on the punctured part on the third day, which, on the fourth or fifth day, be- comes a watery or vesicated pimple: It goes on in- creasing, with a depression in the middle of the pus- tule, until the ninth day, when it is generally surroun- ded by a rose-coloured circumscribed appearance or efflorescence, which remains nearly stationary for a day or two. The efflorescence then fades away, and the pustule gradually becomes a hard, glossy scab, of a dark ma- hogany colour. This efflorescence is also called the areola, and the vaccine rixg, from its being circumscribed. It is most commonly in size rather •argrr than a dollar. 250 OF VACCINATION. These progressive stages of the pustule are com- monly completed in sixteen or seventeen days. One pustule only is pi oduced. On the eighth or ninth day, when the efflorescence is forming, some fever often oc- n.ro m children, and lassitude in adults. SIGNS OF UNSUCCESSrUL VACCINATION. The most frequent deviation from the perfect pus, tulc is that which finishes its progress much within th i time limited by the true. Its commencement is marked by a troublesome itching; and it forms a premature efflorescence, sometimes extensive, but seldom circumscribed or of so vivid a tint as that which surrounds the complete pustule; and it exhibits one peculiar characteristic of degeneracy, by appearing more like a common fes- tering, produced by any small extraneous body stick- ing in the skin, than a pustule excited as before des- cribed, by the vaccine virus. The successful pro- gress of the vaccine pustule is frequently rendered uncertain by being rubbed. An attention to the progress of the true vaccine in- oculation impresses on the mind of a practitioner the perfect character of the vaccine pustule. Therefore, when a deviation of any kind arises, common pru- dence points out the necessity of re-inoculation with vaccine virus of the most active kind, and, if possi- ble, taken fresh from the pustule or from a fresh scab. CAUTIONS RESPECTING THE VACCINATED PART. To preserve the patient from suffering inconve. nience in the vaccinated, part it is necessary that it should not be rubbed; that it should be entirely loose and exposed to the air, and during the time of the ef- florescence should be constantiy dusted with rye or buck-wheat meal. The arms of adults are often in- flamed from th^h wearing tight clothes or using too OF THE MEASLES. **l much exercise at the period of the inflammation's ta* king place—this might easily be prevented by avoid- ing the cause. If the pustule is rubbed and becomes a sore, the part should be covered with Goulard's cerate or a salve composed of sweet-oil and bees-wax melted to- gether, spread upon a clean linen rag, and kept in, its place by a piece of soft linen sewed round the arm; the same application should be made if any sore remains after the scab has dropped off. CHAP. XXV. OF THE MEASLES.. THE measles appeared in Europe about the same time with the small-pox, and have a great affinity to that disease. They both come from the same quar- ter of the world, are both contagious, and do not at- tack the same person more than once. The measles are most common in the spring season, and generally dis- appear in summer. The disease, itself, when prop- erly managed, seldom proves fatal; but its conse- quences are often very troublesome. CAUSE.—-This disease, like the small-pox, pro- ceeds from infection, and is more or less dangerous according to the constitution of the patient, the sea- son of the vear, the climate, &c. SYMPTOMS.—The measles, like other fever- ish complaints, are preceded by alternate fits of heat 25ii OF THE MEASLES. and cold, with sickness, and loss of appetite. The tongue is white, but generally moist. There is ? short cough, a heaviness of the head and eyes, drow- siness, and a running at the nose. Sometimes in- deed the cough does not come before the eruption has appeared. There is an inflammation and heat in the.eyes, accompanied with a defluxion of sharp rheum, and great acuteness of sensation, so that they cannot bear the light without pain. The eye-lids frequently swell so as to occasion blindness. The patient gen- erally complains of his throat; and a vomiting or looseness often precedes the eruption. The stools in children are commonly greenish; they complain of an itching of the skin, and are remarkably peevish. Bleeding at the nose is common, both before and in the progress of the disease. About the fourth day, small spots, resembling flea-bites, appear, first upon the face, then upon the breast, and afterwards on the extremities: these may be distinguished from the small-pox by their scarcely rising above the skin. The fever, cough, and diffi- culty of breathing, instead of being removed by the eruption, as in the small-pox, are rather increased; but the vomiting generally ceases. About the sixth or seventh day from the time of sickening the measles begin to turn pale on the face, and afterwards upon the body; so that by the ninth day they entirely disappear, leaving furfuraceous or branny appearances of the skin. The fever, how- ever, and difficulty of breathing, often continue, especially if the patient has been kept upon too hot a regimen. Petechiae, or purple spots, may likewise be occasioned by this error. A violent looseness sometimes succeeds the mea- sles ; in which .case the patient's life is in imminent danger. Such as die of the measles generally expire about ?hc ninth day from the infection, and are commonly OF THE MEASLES. 251 carried off by the peripneumony, or inflammation of the lungs. The moft favourable fymptoms are a moderate loofenefs, a moift fkin, and a plentiful difcharge of urine. When the eruption fuddenly ftrikes in, and the patient is feized with a delirium, he is in the greateft danger. If the meafles turn too foon of a pale co- lour, it is an unfavourable fymptom, as are alfo great weaknefs, vomiting, reftleffnefs, and difficulty of fwallowing. Purple or black fpots appearing among the meafles are very unfavourable. When a continual cough, with hoarfenefs, fucceeds the dif- eafe, there is reafon to fufpeft an approaching con- fumption of the lungs. Our bufinefs in this difeafe is to affift Nature, by proper cordials, in throwing out the eruption, if her efforts be too languid ; this, however, is feldom the cafe: but when they are too violent they muft be reftrained by evacuations, and cool diluting liquors, Sec. We ought likewife to endeavour to appeafe the moft urgent fymptoms, as the cough, reftleffnefs, and difficulty of breathing. REGIMEN.—The cool regimen is neceffary here as well as in the fmall-pox. The food too muft be light, and the drink diluting. Small-beer likewife, though a good drink in the fmall-pox, is here impro- per. The moft fuitable liquors are decodfions of liquorice with marfhmallow roots, infufions of flax- feed, or the flowers cf elucr, balm-tea, whey, barley- water, bran-tea, and fuch like. Thefe, if the pa- tient be coftive, may be fweetened with honey ; or, if that fliould difagree with the ftomach, a little brown-fugar may occafionaily be acioi to them. MEDICINE.—The mealies being an inflammatory difeafe, without any crkiral difcharge of matter, as »u the fma!i-pG.\, i,!cefih"!g is commonly neceffary, efpecially 252 OF THE MEASLES. 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. The patient is often greatly relieved by vomiting. When there is a tendency this way, it ought to be promoted by drinking lukewarm water, or weak ca- momile-tea. When the cough is very troublefome, with dry- rrefs of the throat, and difficulty of breathing, the patient may hold his head over the fteam of warm water, and draw the fteam into his lungs. He may likewife lick a little fpermaceti and fugar- candy pounded 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 afmmes new vigour, and there appears great danger of fuffoca- tion, the patient muft be bled according to his pulfe, and bliftering-plafters applied, with a view to prevent the load from being thrown on the lungs, where if an inflammation fhould fix itfelf, the patient's life will be in danger. In cafe the meafles fliould fuddenly difappear, it will be neceflary to purfue the fame method'which we have recommended when the- fmall-pox recede. The patient muft be fupported with wine and'cordials. Bliftering-plafters muft- be applied to the legs and arms, and the body rubbed all over with warm flannels. 'Warm poultices may be likewife applied to the feet and palms of the hands. When purple or black fpots appear, the patient's drink'fhould be fliarpened with fpirits of vitriol - and if thefe fymptoms increafe, the Peruvian bark mufl be adminiftered in the fame manner as directed in the fmrdi-rox. ♦ Opiates OF THE MEASLES. 253 Opiates are fometimes neceflary, but fhould never be given except in cafes of extreme reftleffnefs, a violent loofenefs, or when the cough b very trouble- fome. For children, a tea-fpoonful of afthmatic elixir may be occafionally given, according to the patient's age, or the violence of the fymptoms. Whenever opiates are given in this difeafe, antimonial wine fhould be added. One or two tea-fpoonsful of the paregoric mixture (fee Appendix) may be given every two or three hours, if neceffary. After the meafles are gone off, the patient ought to be purged. This may be conducted in the fame manner as directed 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 an opiate over night; but if thefe do not remove it, and the pulfe is hard, bleeding will feidom fail to have that effect. Patients recovering after the meafles fhould be careful what they eat or drink. Their food for ■ fome time ought to be light, and in fmall quantities, and their drink diluting, and rather of an opening nature, as butter-milk, whey, and fuch like. They ought alfo to beware of expofmg themfelves too foon to the cold air, leaft a fuffocating catarrh, an afthrna, or a confumption of the lungs, fhould enfue. Should a cough, with difficulty of breathing, and other fymptoms of a confumption, remain after the meafles, fmall quantities of blood may be frequently let at proper intervals, as the patient's ftrength and confti- tution will permit. He ought likewife to drink milk, to remove to a free air, if in a large town, and to ride daily on horfeback. He muft keep clofe to a diet con- fifting of milk and vegetables - and laftly, if thefe do not fucceed, let him remove to a warmer climate. * * Attempts have been made to communicate the meafles, as well as the fmall-po.?, by inoculation, and we make no doubt L 254 3 OF THE SCARLET FEVER. The fcarlet fever is fo called from the colour of the patient's fkin, which appears, as if it were, tinged with red wine. It happens at any feafon of the year, but is moft common towards the end of fummer ; at which time it often feizes whole families j children and young perfons are moft fubject to it. It begins, like other fevers, with coldnefs and fliivering, without any violent ficknefs. Afterwards the fkin is covered with red fpotr, which are broader, more florid, and lefs uniform than the meafles. They continue two or three days, and then difappear ; after which the cuticle or fcarf-fkin falls off. There is feldom any occafion for medicine in this difeafe. The patient ought, however, to keep with- in doors, to abftain from flefli, 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 clyfters, or fmall dofes of flowers of fulphur and cream of tartar. but in time the practice may fucceed. Dr. Home of Edin- burgh fays, he communicated the difeafe by the blood. Others have tried this method, and have not found it fucceed. Some think the difeafe would be more certainly communicated, by rubbing the fkin of a patient who has the meafles with cotton, and afterwards applying the cotton to a wound, as in the fmall- pox ; while others recommend a bit of flannel, which had been applied to the patient's fkin all the time of the difeafe, to be afterwards laid upen the arm or leg of the perfon, to whom the infection is to be communicated. There is no doubt but this difeafe, as well as the fmall-yox, may be communicated various ways ; the moll probable, however, h either from cotton rubbed upon the fkin, as mentioned above, or by intro- ducing a little of the fharp liumor, which dillils from the eyes of the patient into the blood. It is agreed on all hands, that fuch patients as have been inoculated had the diicuic very mildly; we therefore wifli the practice were m,re g:n:ra!, as the meafles are olten '.'.»: d. * Children OF THE BILIOUS FEVER. 255 Children and young perfons are fometimes feized at the beginning of this difeafe, with a kind of fhu por and epileptic fits. In this cafe, the feet and legs fhould be bathed in warm water, a large bliftering- plater applied to the neck, and the patient bled, if the pulfe is ftrong and hard. The fcarlet fever, however, is not always of fo mild a nature. It is fometimes .attended with putrid or malignant fymptoms, in which" cafe it is always dangerous. In the malignant fcarlet fever, the pa- tient is not only arfecfed with coldnefs and fhivering, but with languor, ficknefs,-and great opprefhon ; to theie fucceed exceffive heat, naufea and vomiting, with a foreneis of the throat; the pulfe is extremely quick, but fmall and depreffed; the breathing fre- quent' and laborious; the fkin hot, but not quite dry ; the tongue moift, and covered with a whitifh mucus ; the toni.Is inflamed and ulcerated. When the eruption appears, it brings no relief: on the contrary, the fymptoms generally grow worfe, and frefh ones come on, as purging, delirium, &c. * OF THE BILIOUS FEVER. When a continual, remitting, or intermitting fever is accompanied with a frequent or "copious evacua- tion of bile, either by vomit or ftool, the fever is denominated bilious. The bilious fever generally makes its appearance about the end of fummer,/-nd ceafes towards the approach of winter. It i^ .ioit frequent and fatal in warm countries, efpecially where the foil is marfhy, and when great rains are fucceeded by fultry heats. Perfons who work without doors, * For the treatment of this malignant fcarlet fever, as it is here called, fee putrid ulcerous fore-throat, as there is every reafon to idieve they are the fame difeafes, differing only in the violence of the fymptoms. lie 25^5 .OF THE BILIOUS FEVER. .lie in camps, or who .are expofed rto the night ,air, are moft liable-to this kind of fever. Tf; there .are fymptoms of inllamaution at the begsjuaingof this fever,-it-will be neceffary to bleed, .and: touput-the patient upon the cool diluting reginien recommended in the inflammatory-fever. The,fa. line draught may likewife be frequently, adminiftered, ;.andthe patient- s body kept open by clyfters or mild «piirgatives. ..But if the fever fliould,- remit or irit^r- mit,\bleeding'Wiil,feWom be;ut;ceifary. In-this cafe, a -.vomit t may be adminiftered,. and, if t^e - body be cbonnd, .a gentle purge ; after which the Peruvian barkissrUl generally complete the cure. .in cafe .of. a violent loofenefs, the jaatj^it mipft he -fupported with chicken-broth, jellies of .ttartfljpjn, and- theJike ; and he may ufe the white decoclim f§r his. ordinary drink. * If a bloody flu:: mould, aeoop- :pany this ^fever,;it muft -]pe, treated ;in- the mafljigr .•recoKimeiideii under the article D fent cry. :When there .is..a burning heat, and the patient does not fweat, tihat evacuation may be promoted by giving him, three or four times a-day, a table- fpoonful of Miudererus's fpirit, f mixed in a cup of his ordinary drink. If' the bilious fever be attended..with die nervous, malignant, or putrid fymptoms,: which .is .ibmefcimes the cafe,ithe-patient muft be treated in the ime manner.as dire&edunder thefe.difeafes. Vrrer this fever, proper care is.neceflary to.-.pre- vent a relapfe. For this purpofe, the patient, efpe- cially towards; the end of autumny ought to continue the ufe of the Peruvian bark, for fome time after;he : is well. He fhould likewife abftain from all trafhy fruits, new liquors, and every kind of flatulent aliment. * -See Appendix,: White DccoSlon. t See Appendix, Spirit of Mi:.d.re:us. i CHAP- C *57 ] CHAP. XXVI. Of the Eryfipelas, or St. Anthony*s Fire. 1 HIS difeafe, whiclj 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 fanguine or ple- thoric habit are moft liable to it. It often attacks young people, and pregnant women ; and fuch as have once been affli&ed with it are very liable to have it again. Sometimes it is a primary difeafe, and at other times only a fymptom of fome other malady. Every part of the body is liable to be at- tacked by an eryfipelas, but it moft frequently feizes the legs or face, efpecially the latter. It is moft com? mon in autumn, or when hot weather is fucceeded by cold and wet. CAUSES.—The eryfipelas may be occafioned by violent paffions or affections of trie 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 eryfipelas will often enfue*. It may alfo be occafioned by drinking to excefs, by continuing too long in a warm bath, by vegetable and mineral poifons, or by * The country people in many parts cf Britain c. 11 this dif- eafe a blajl, and imagine it proceeds from foul ai, cr ill wind, as rhey term it. The truth is, they often lie down to reft them, when warm and fatigued, upon the damp ground, where they fall afleep, and lie fo long as to catch cold, which rcca- fi ns the eryfipehis. 'this difeafe may indeed proceed from other caufes, but we may venture to fay, that nine times out of ten it is occafioned by cold caught after the body has been greatly healed or fatigued. S any 25S OF THE ERYSIPELAS, any thing that overheats the blood. If any cf the natural evacuations be obftru&ed, or in too fmall quantity, it may caufe an eryfipelas. The fame effeft will follow from the ftoppage of artificial evacuations; as iffues, fetons, or.the like. SYMPTOMS.—The eryfipelas attacks with fliiver- ing, thirft, lofs of ftrength, pain in the head and back, heat, reftleffnefs, and a quick pulfe ; to which may be added vomiting, and fometimes a delirium. On the fecond, third, or fourth day, the part fwells, becomes red, and fmall puflules appear ; at \\ hich time the fever generally abates. When the eryfipelas feizes the foot, the parts con- tiguous fwell, the ikin fhines ; and, if the pain be vio- lent, it will afcend to the leg, and will not bear to be touched. .r;When it attacks the face, it fwells, appears red, and the Ikin is often covered with fmall puflules, filled with; clear water. One or both eyes are generally cldfdd'with the fweliing ; and there is a dii&culty of breathing:. ' " If the eryfipelas affe&s'the breaft--, it fwells and becomes exceedingly hard, with great pain, and may fuppurate. There is fometimes a violent pain in the arm-pit on the fide affe&ed, wherei an abfeefs is often formed. If in a day or two the fweliing fubfides, the heat and pain abate, the colour of the part turns yellow, and the cuticle breaks and falls off in fcales, the dan- ger is over. "When the eryfipelas is large, deep, and arTe&s a very fenfible part of the body, the danger is great. If the red colour changes into a livid or black, it may end in a mortification. Sometimes the inflam- mation cannot be difcuffed, but comes to a fuppura- tion ; in which cafe, fiftulas, a gangrene, or mortifi- cation, often enfue. Such OR ST. ANTHONY'S FIRE. 259 Such as die of this difeafe are commonly carried off by the fever, which is attended with difficulty of breathing, and fometimes with a delirium and great drowfinefs. They generally die about the feventh 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 make 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 pro- mote the perfpiration by diluting liquors, &c. The diet ought to be flender, and of a moderately cooling and moiftening quality, as oatmeal-gruel, pa- nada, chicken or barley-broth^ with cooling herbs and fruits, Sec. avoiding flefh, fifli, 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 however muft be taken not to overheat him. MEDICINE.—In this difeafe much mifchief is often done by medicine, efpecially by external ap- plications. People, when they fee an inflammation, immediately think that fomething ought to be applied to it. This indeed is neceffary in large phlegmons ; but in an eryfipelas the fafer courfe is to apply no- thing. All ointments, falves, and plafters, being of a greafy nature, tend rather to obftruct and repel, than promote any 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. S 2 The 263 OF THE ERYSIPELAS, The" eryfipelas in many refpecls refembles the gout, and is to be treated with the greateft caution. The inflamed parts fhould be kept conftantly powdered with rye-meal. It is common to bleed in the eryfipelas ; but this likewife requires caution. If, however-, the fever be high, the pulfe hard and ftrong, and the patient vigorous, it will be proper to bleed ; but the quan- tity muft be regulated by thefe circumftances, and the operations repeated as the fymptoms may require. If the patient has been accuftomed to ftrong liquors, and the difeafe attacks his head, bleeding is abfolute- ly neceffary. 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 deriva- tion from the head, and feldom fails to relieve the patient. When bathing proves ineffectual poultices, or fliarp finapifms, may be applied to the foles of the feet, for the fame purpofe. In cafes where bleeding is requifite, it is likewife neceffary to keep the body open. This may be ef- fected by emollient clyfters, or fmall dofes of nitre and rhubarb. Some indeed recommend very large dofes of nitre in the eryfipelas ; but nitre feldom fits eafy on the ftomach when taken in large dofes. It is, however, one of the beft medicines when the fever and inflammation run high. Half a drachm of it, with four or five grains of rhubarb, may be taken in the patient's ordinary drink four times a-day. When the 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 mild purgatives fail to have this effect, ftronger ones muft be given. Bliftering plafters muft likewife be applied to the neck, or behind the ears, and fharp cataplafms laid on the foles of the feet. OR ST. ANTHONY'S FIRE. 261 When the inflammation cannot be difcuffed, and the part has a tendency to ulcerate, it will then be proper to promote fuppuration. When the black, livid, or blue colour of the part fliews a tendency to mortification, the Peruvian bark muft be adminiftered. It may be taken along wiih 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 given every two hours, if the fymptoms be threatening, and cloths dipped in warm camphorated fpirits of wine, or 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 de- coction of it. In what is commonly called the fcorbutic .eryfipelas, which continues for a confiderable Lime, it will only be neceffary to give gentle laxatives, and fuch things as purify the blood, and promote the perfpiration. Thus, after the inflammation has been checked by opening medicines, the decoction of farfaparilla* may be drank ; after which a courfe of bitters would be proper. Such as are liable to frequent attacks of the ery- fipelas ought carefully to guard againft all violent paffions ; to abftain from ftrong liquors, and all fat, vifcid, and highly nourifliing food. They fliould likewife take fufficient exercife, carefully avoiding the extremes of heat or cold. Their food fliould 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 fliould never fuffer themfelves to be S»c Appendix, DccoSion of Sarfapari'Ia. S j long 26z OF THE PHRENITIS,. OR long coftive. If that cannot be prevented by fuitable diet, it wi.l be proper to take frequently a gentle dofe of rhubarb, cream of tartar, the lenitive electuary, or fome other mild purgative. CHAP. XXVII. Of the Phrenitis, or Inflammation of the Brain. 1 HIS is fometimes a primary difeafe, but oftener only a fymptom of fome other malady ; as the inflammatory, eruptive, or fpotted fever, Sec. It is very common, however, 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 nervous fyftem is irritable in a high degree, are moft liable to it. CAUSES.—This difeafe is often occafioned by night-watching, efpecially when joined with hard ftudy : it may likewife proceed from hard drinking, anger, grief, or anxiety. It is often occafioned by the ftoppage of ufual evacuations ; as the bleeding piles in men, the cuftomary difcharges of women, Sec. Such as imprudently expofe themfelves to the heat of the fun, efpecially by fleeping 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 repellents are imprudently ufed in an eryfipelas, an inflammation of the brain is fometimes the confequence. It may likewife be occafioned by external injuries, as blows or bruifes upon the head, Sec. SY-V1P- INFLAMMATION OF THE BRAIN. 263 SYMPTOMS.----The fymptoms which ufually precede a true inflammation of the brain, are, pain of the bead, rednefs of the eyes, a dilated pupil, a violent Unfiling of the face, difturbed fleep, or a total want of it, great drynefs of the fkin, coflivenefs, a retention of urine, fometimes a fmall dropping of blood from the nofe, finging of the ears, and extreme fenfibility of the nervous fyftem. When the inflammation is formed, the fymptoms in general are fimilar to thofe of the inflammatory fever. The pulfe indeed is often weak, irregular, and trembling ; but fometimes it is hard and con- tracted. When the brain itfelf is inflamed, the pulfe is always low ; but when the inflammation only affects the integuments of the brain, viz. the dura and pia matter, it is hard. A remarkable quicknefs of hearing is a common fymptom of this difeafe ; but that feldom continues long.' Another ufual fymptom is a great throbbing or pulfation in the arteries of the neck and temples. The patient feldom complains of thirft, and even refufes drink. The mind chiefly runs upon fuch objects as have before made a deep impref- fion on it; and fometimes, from a fullen filence, the patient becomes all of a fudden quite outrageous. A conftant trembling and ftartin^ of the tendons is an unfavourable fymptom, as are alfo a fuppreflion of urine ; a total want of fleep ; a conftant fpitting and a grinding of the teeth. When a phrenitis fuc- ceeds an inflammation of the lungs, of the inteftines, or of the throat, Sec. it is owing to a tranflation of the difeafe from thofe parts to the brain, and often proves fatal. This fliews the neceflity of proper evacuations, and the danger of repellents in all in- flammatory difeafes. The favourable fymptoms are, a free perfpiration, a copious difcharge of blood from- the nofe, the b'eeding piles, ;i plentiful difcharge of urine, which S 4 264 OF THE PHRENITIS, OR 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 it is prolonged, or improperly treated, it fometimes ends in madnefs, or a kind of ftupidity, which may con- tinue 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 circulation towards the head. REGIMEN.—The patient ought to be kept very quiet. . Company, noife, and every thing that affects the fenfes, or difturbs the imagination, increafes the difeafe. Even too much light is hurtful; for which reafon the patient's chamber ought to be a little darkened, and he fhould neither be kept too hot nor too cold. It is not however neceffary to exclude the company of an agreeable friend, as this has a tendency to foothe and quiet the mind. Neither ought the pa- tient to be kept too much in the dark, left it fliould occafion a gloomy melancholy, which is too often the confequence of this difeafe. The patient muft, as far as poffible, 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 obtained, or which might prove hurtful, he is not to be pofitively' denied them, but rather put off with the prcmife 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. In a word, whatever he was fond of, or ufed to be delighted with when in health, may here be tried, as pleafing /lories, foft mufic, or whatever has a tendency to fcothc the paffions' and compofe the mind. Boerhaave propofes INFLAMMATION OF THE BRAIN. 265 propofes feveral mechanical experiments for this pur- pofes ; 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 procure fleep, and confequently may be of fervice. The aliment ought to be light, confifting chiefly of farinaceous fubftances ; as panada, and water- gruel fliarpened with jelly of currants, or juice of lemons, ripe fruits roafted or boiled, jellies, pre- ferves, &c. The drink fmall, diluting, and cooling; as whey, barley-water, or decoctions of barley and tamarinds, which latter not only render the liquor more palatable, but likewife more beneficial, as they are of an opening nature. MEDICINE.—In an inflammation of the brain, nothing more certainly relieves the patient than a free difcharge of blood from the nofe. When this comes of its own accord, it is by no means to be flopped, but rather promoted, by applying cloths dipped in warm water to the part. The chief remedy is frequent and -copious bleeding. Bleeding in the temporal arteries alfo greatly re- lieves the head : but as this operation cannot always be performed, we would recommend in its flead bleed- ing in the jugular veins. When the patient's pulfe and fpirits are fo low, that he cannot bear bleeding with the lancet, leeches may be applied to the temples. Thefe not only draw off the blood more gradually, but by being applied nearer to the part affected, ge- nerally give more immediate relief. Cupping is alfo' of effential fervice in this cafe. A difcharge of blood from the hemorrhoidal veins is likewife of great fervice, and ought by all means to be promoted. If the patient has been fubject to the bleeding piles, and the difcharge has been flopped, p-ery method muft be tried to reftore it; as the ap- plication zr/o OF THE OPHTHALMIA, OR plication of leeches to the parts, fitting over the fteams of warm water,1 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, iffues, fetons, or fuch like, all means muft be ufed to reftore them as foon as poffible, or to fubftitute others in their flead. The patient's body muft be kept open by flimu- lating 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 danger- ous, may be ufed in the fpace of twenty-four hours. The head fliould be fhaved and cloths dipped in cold water frequently applied to it. If the difeafe proves obftinate and does not yield to thefe medicines, it will be neceffary to apply a bliftering-plafter to the whole head. Blifters to the ancles are alfo very ufeful. CHAP. XXVIII. Of the Ophthalmia, cr Inflammation of the Eyes. 1 HIS difeafe may be occafioned by ex- ternal injuries ; as blows, burns, bruifes, and the like. It may likewife proceed from dull, quick-lime, cr other fubftances, getting into the eyes. It is often caufed by the ftoppage of cuftomary evacua- tions ; as the -healing of old fores, drying up of iffues, the fupprefling of. gentle morning fweats, or of the fweating of the feet, Sec. Long expofure to the night air, efpecially in cold northerly winds, 'er whatever INFLAMMATION OF THE EYES. 26j whatever.fuddenly checks the perfpiration, efpecially after the body has been much heated, is very apt to caufe an inflammation of the eyes. Viewing fnow or other white bodies for a long time, or looking fleadfaftly at the fun, -a clear fire, or any bright ob- ject, will likewife 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, and excefs of vencry are likewife very hurtful to the eyes. The acrid fumes of metals, and of feveral kinds of fuel, are alfo pernicious. Sometimes an inflamma- tion of the eyes proceeds from a venereal taint, and often from a fcrophulous or gouty habit. It may like- wife be occafioned by hairs in the eye-lids turning in- wards, and hurting the eyes. Sometimes the difeafe is epidemic, efpecially after wet feafons, and often in dry feafons ; and I have frequently known it to prove infectious, particularly to thofe Mho lived in the fame houfe with the patient. It may be occafioned by moift air, or living in low damp houfes, efpecially in per- fons who are not. accuilomrd to fuch fituations. In children it often proceeds from imprudently drying 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 with acute pain, heat, rednefs, and fwel- iing. The patient is not able 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 fraiding rheum, which rallies forth in great quantities, whenever 263 OF THE OPHTHALMIA, OR whenever the patient attempts to look up. The pulfe is generally quick and hard, with fome degree of fever. When the difeafe is violent, the neigh- bouring parts fwell, and there is a throbbing or pul- fation in the temporal arteries, &c. A flight inflammation of the eyes, efpecially from an external caufe, is eafily cured ; but when the dif- eafe is violent, and continues long, it often leaves fpecks upon the eyes, or dimnefs of fight, and fome- times total blindnefs. If the patient be feized with a loofenefs, it has«a good effect; and when the inflammation paffes from one eye to another, as it were by infection, it is no unfavourable fymptom. But when the difeafe is ac- companied with a violent pain of the head, and con- tinues long, the patient is in danger of lofing his fight. REGIMEN.----The diet, unlefs in fcrophulous cafes, can hardly be too fpare, efpecially at the be- ginning. The patient muft abftain from every thing of a heating nature. His food fhould confift chiefly of mild vegetables, weak broths, and gruels. His drink may be barley-water, balm-tea, common whey, and fuch like. x The patient's chamber muft be darkened, or his eyes fliaded by a cover, fo as to exclude the light, but not to prefs upon the eyes. He fhould not look at a candle, the fire, or any luminous object; and ought to avoid all fmoke, as the fumes of tobacco, or any thing that may caufe coughing, fneezing, or vomiting. He fliould be kept quiet, avoiding all vio- lent efforts, either of body or mind, and encouraging fleep as much as poffible. MEDICINE.----This is one of thofe difeafes wherein great hurt is often done by external appli- cations. Almoft every perfon pretends to be pof- feffed of a remedy for the cure of fore eyes. Thefe remedies generally confift of eye-waters and oint- ments, INFLAMMATION OF THE EYES. 269 ments, with other external applications, which do mifchief twenty times for once they do good. People ought therefore to be very cautious how they ufe fuch things, as even the preflfure upon the eyes often increafes the malady. Bleeding, in a violent inflammation of the eyes, is always neceffary. This fliould be performed as near the part affected as poffible. An adult may lofe ten or twelve ounces of blood from the jugular vein, and the operation may be repeated according ttfbthe urgency of the fymptoms. If it fhould not be convenient to bleed in the neck, the fame quantity may be let from the arm, or any other part of the body, efpecially from the temples and behind tiie ears by cupping. Leeches are often applied to the temples, or un- der the eyes, with good effect. The wounds muft be fuffered to bleed for fome hours, and' if the bleeding ftop foon, it may be promoted by the ap- plication of cloths dipt in warm water. In obftinate cafes, it will be neceffary to repeat this operation fe- veral times. Opening and diluting medicines are, by no means, to be neglected. The patient may take a fmall dofe of Glauber's falts, and cream of tartar, every fecond or third day, or a decoction of tamarinds with fenna. If thefe be not agreeable, gentle dofes of rhubarb and nitre, a little lenitive electuary, or any other mild purgative will anfwer the fame end. The pa- tient, at the fame time, muft drink freely of water- gruel, tea, whey, or any other weak diluting liquor. The Collyrium of lead, (fee Appendix,,) fliould be dropped into the eyes, often in a day. If the inflammation does not yield to thefe evacua- tions, bliftering-plafters 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 2;o OF THE OPHTHALMIA, OR feldom known thefe, 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 between the flioulder-blades. It may be dreffed twice a-day with yellow 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 a- crofs the neck, it foon wears out, and is both more pain- ful and troublefome than between the fhoulders; he- fides, it leaves a difagreeable mark, and does not dif- charge fo freely. An iffue in each arm made by a cauftic is alfo very beneficial. When the heat and pain of the eyes are very great, a poultice of bread and milk, foftened with fweet oil or frefli butter, may be applied to them, at leaft all night; and they may be bathed with milk and water in the morning. If the patient cannot fleep, which is fometimes the cafe, he-may take twenty or thirty drops of lau- danum, or two tea-fpoonfuls of the paregoric elixir, over night, more or lefs, according to his age, or the violence of the fymptoms. After the inflammation is gone off, if the eyes flill 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 latter. A method fhould be contrived by which the eye can be quite im- merfed in the brandy and water, where it flioiild be kept for fome time. I have generally found this, or cold water and vinegar, as good a "ftrengthener of the eyes, as many of the moft celebrated collyriums. When INFLAMMATION OF THE EYES. 271 ' When an inflammation of the eyes proceeds from a fcrophulous habit, it generally proves very obfti- nate. The moft proper medicine is the Peruvian bark, which may either be given in fubftance, or prepared iii the following manner : Take, an ounce' of the bark in powder, with two drachms of Winter's bark, and boil them in a quart of water to a pint; when it has boiled nearly long enough, add half an ounce of liquorice-root fiiced. Let the liquor be ftrained. Two, three, or four .table fpoonfuls, according to the age of the patient, may be taken three or four times a-day. It is im- poflible to fay how long this medicine fliould be con- tinued, as the cure is fooner performed in fome than in others; but, in general, it requires a confiderable time to produce any lafting effects. Dr. Cheyne fays, " That iEthiops mineral never " fails in obftinate inflammations of the eyes, even "fcrophulous ones, if given in a fuflicient dofe, and *' duly perfifted in." There is no doubt but. this, and other .preparations of mercury, may be of lingu- lar fervice-.ni' ophthalmias of long continuance, but they ought always to be adminiftered with the greatefi caution, or by perfons of fkill in phyfic. In obftinate ophthalmias, a grain of calomel every night, for one or two weeks, is of great fervice; and, when fpecks or films, are formed on the fight, this medicine, with a blifter or iffue, is of the greateft fervice. 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 removed by plucking them otut with a pair of fmall pincers. * Any foreign body lodged in the eye, may be expeditiously removed, by paffing a fmall hair pencil between the eye-iid and the ball of the eye. In fome places, the peafants do this very effectually, by uiing their tongue in the fdiae manner. Thofe 272 OF THE QUINSEY, OR Thofe who are liable to frequent returns of this difeafe, ought conftantly to have an iffue on one or both arms. Bleeding or purging, in the fpring and autumn, will be very beneficial to fuch perfons. They ought likewife to live with the greateft regu- larity, avoiding ftrong liquor, and every thing of a heating quality. Above all let them avoid the night- air and late fludies. CHAP. XXIX. Of the Shtinfey, or Inflammation of the Throat. 1 HIS difeafe is very common, and is frequently attended with great danger. It prevails in the winter and fpring, and is moft fatal to young people of a fanguine temperament. CAUSES.—In general it proceeds from the fame caufes as other inflammatory diforders, w'z* an ob- ftructed perfpiration, or whatever heats or inflames the blood. An inflammation of the throat is often occafioned by omitting fome part of the covering ufually worn about the neck, by drinking cold liquor when the body is warm, by riding or walking againfl a cold northerly wind, or any thing that greatly cools the throat, and parts adjacent. It may likewife pro- ceed from the neglect of bleeding, purging, or any cuftomary evacuation. Singing, fpeaking loud and long, or whatever flrains the throat, may likewife caufe an inflamma- tion of that organ. I have often known the quinfey prove fatal to jovial companions, who, after fitting Jong in a warm room, drinking hot liquors, and i finging INFLAMMATION OF THE THROAT. 273 finging with vehemence, were fo imprudent as to gd abroad in the cold night-air. Wearing thin fhoes, fitting with wet feet, or keeping on wet clothes, are very apt to occafion this malady. It is likewife fre- quently occafioned by continuing long m a moift place, fitting near an open window,, fleeping in a damp bed, fitting in a room that has been newty plaftered, Sec. I know people who never fail to have a fore throat if they fit even but a fhort time in a room that has been lately waftied. Acrid or irritating food may likewife inflame the throat, and occafion a quinfey. It may alfo proceed from bones, pins", or other fliarp fubftances, flicking in the throat, or from the cauftic fumes of metals or minerals, as arfenic, antimony, &c. taken in by the breath. SYMPTOMS.—The inflammation of the throat is evident from infpection, the parts appearing red arid fwelled; befides, the patient complains of pain in fwallowing. His pulfe is quick and hard, with other fyrmbtoms of a fever. If blood be let, it is generally covered with a tough coat of a whitifh colour, and the patient fpits a tough phlegm. As the fweliing and inflammation increafe, the breath- iflg aiid fwallowing become more difficult j the pain affects the ears ; the eyes generally appear red j and the face fwells. The patient is often obliged to keep hSmfelf in an erect pofture, being in danger of fuffo- cation ; there is a cortftant naufea, or inclination to vonlit, and the drinkj inftead of pafTing ititd the flomach, is often returned by the nofe. The patierit is fometimes flarve'd at laft, merely from an inability tofwallow any kind of food. When the breathing is laborious, with ftrartnefs of the breaft, and anxiety, the danger is great. Though the pain in fw allowing be very great, yet while the patient bre-.thes eafy, there h not fb ir.utife danger^ T An 274 OF THE QUINSEY, OR An external fweliing is no unfavourable fymptom • but if it fuddenly falls, and the difeafe affects the breaft, the danger is very great. When a quinfey is the confequence of fome other difeafe, which has already weakened the patient, his fituation is dan- gerous. A frothing at the mouth, with a fwelled tongue, a pale ghaftly countenance, and coldnefs of the extremities, are fatal fymptoms. REGIMEN.—The regimen in this difeafe is in all refpects the fame as in the pleurify, or peripnen- mony. The food muft be light, and in fmall quan- tity, and the drink plentiful, weak, and diluting, mixed with acids. It is highly neceffary that the patient be kept eafy and quiet. Violent 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, gende fweat, is proper. When the patient is in bed, his head ought to be raifed 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, efpecially if applied in due time. We cannot here omit ob- ferving the propriety of a cuftom which 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 in many places it paffes for a charm, and the flocking is applied with particular ceremonies: the cuftom, however, is undoubtedly a good one, and fhould never be neglected. When the throat has been thus wrapped up all night, it muft not be expofed to the cold air through the day, but a handkerchief or a piece of flannel kept about if, till the inflammation be removed. a The INFLAMMATION OF THE THROAT. '275 The jelly of black currants is a medicine very much in efteem for complaints of the throat; and indeed it is of fome ufe. It fhould be almoft con- ftantly kept in the mouth, and fwallowed down leifurcly. It may likewife 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 or alum and honey, or by adding to half an Englifh pint of the pectoral decoction 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 vifcid phlegm, the gargle may be rendered more fliarp and clean- fing, by adding to it a tea-fpoonful of the fpirit of fal ammoniac. Some recommend gargles made of a decoction of the leaves or bark of the black currant- bufh ; but where the jelly can be had, thefe are un- neceflary. Two tea-fpoonfuls of the crude fal am- moniac powdered, in a full pint of water, makes an excellent gargle. There is no difeafe wherein the benefit of bathing the feet and legs in lukewarm water is more appa- rent : that practice ought therefore never to be neg- lected. If people were careful to keep v.arm, to wrap up their throats with flannel, to bathe their feet and legs in warm water, and to ufe a fpare diet, with diluting liquors, at the beginning of this dif- eafe, it would feldom proceed to a great height, or be attended with any danger ; but when thefe pre- cautions are neglected, and the difeafe becomes vio- lent, more powerful medicines are neceffary. MEDICINE.-----An inflammation of the threat being a moft acute and dangerous diftempery which fometimes tikes off the patient very fuddenly. it T z will if& OF THE QUINSEY, OR will be proper, as foon as the fymptoms appear, -■; bleed in the arm, and to repeat the operation if cir- ctfrriftances require. The body fliould likewife be kept gently open; 'this may either be done by giving the patient for his ordinary drink a decoction of figs and^tamarindj, or fmall dofes of rrmbarb and nitre, as recommended in the eryfipelas, or of Glauber's fait. Thefe maybe increafed according to the age of the patient, and re- pea ted till they have the defired effect. 1 have often known very good effects from a bit of falprunel, or purified nitre, held in the mouth, and fwallowed down as it melted. This promoted the'difcharge of faliva, by which means it anfwers the end of a gargle, while at the fame time it abates the fever, by promoting the difcharge of urine, Sec. The throat oaght likewife to be rubbed twice or thrice a-day with a little of the volatile liniment. This feldom fails to produce fome good effects'. At the fame time the neck ought to be carefully covered with wool or flannel, to prevent the cold from penetrating the flcin, as this application rea- ders it very tender. Bliftering upon the neck or behind the ears in violent inflanrmations of the throat is very benefi- cial ; and in bad cafes it will be neceffary to lay a bljftermg-plafter 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 ap- plication of iffue ointment, till the inflarnimttisfl-'ft gone. When the patient has been treated as above, a fuppuration feldom happens. This, however, is fometimes the cafe, in fpite of all endeavours to prevent it. When the inflammation and fweliing continue* and it is evident that a fuppuration Vi» enfuei INFLAMMATION OF THE THROAT. , 277. enfue, it ought to be promoted by drawing the. fteam of warm water into the throat through a fun- nel, or the like. Soft poultices -ought likewife to be applied outwardly, and the patient may keep a roafted fig conftantly in his mouth. It fometimes happens, before the tumor breaks, that the fweliing is fo great, as entirely to prevept any thing from getting into the flomach. In this cafe the patient muft inevitably perifh, Uiijefs he can be fupported in fome other way. This can only be done by nourifhing clyfters of broth, or gruel with milk, Sec Patients have often been fupported by thefe for feveral days, till the tumor has broke; -and afterwards they fyave recovered. Not only the fwallowing^ but the breathing, is ©ften prevented by the tumor. In this cafe no- thing can fave the patient's life but opening the trachea or wind-pipe. As that has been often done with fuccefs, no perfon, in fuch defperate circum- ftances, ought to hefitate a moment about the ope- ration ; but as it can only be performed by a fur- geon, it is not neceffary here to give any directions about it. When a difficulty of fwallowing is not attended with an acute pain or inflammation,' it is generally uwing to an obftruction of the glands alx>ut the throat, and only requires that the part be kept warm, and the throat frequently gargled with fome- thing that may gently ftimulate the glands, as a iecoction of figs with vinegar and honey; to which nay be added a little muftard, or a fmall quantity ff fpirits. But this gargle is never tp be ufed where here are figns of an inflammation. This fpecies )f angina has various names &aiong the common )eon!e, .as the failing down of the almonds of the ears, kc. Accordingly, to remove it, they lift the patient 'o by the hair of ike head, and thruft their fingers T 1 under •.' ■** - i, .*:/ 278 OF THE QUINSEY, 5cc. ~* under his jaws, Sec. all which practices are at bell ufelefs, and often hurtful. Thofe who are fubject to inflammations of the throat, in order to avoid that difeafe, ought to live temperately. Such as do not chufe to obferve this rule, muft have frequent recourfe to purging and other evacuations, to difcharge the fuperfluous hu- mors. They ought likewife to beware of catching cold, and fhould abftain from aliment and medicines of an aftringent or flimulating nature. Violent exercife, by increafing the motion and force of the blood, is apt to occafion an inflamma- tion of the throat, efpecially if cold liquor be drank immediately after it, or the body fullered fuddenly to cool. Thofe who would avoid this difeafe, ought therefore, after fpeaking aloud, fing- ing, running, drinking warm liquor, or doing any thing that may ftrain the throat, or increafe the cir- culation of the blood towards it, to take care to cool gradually, and to wrap fome additional cover- ings about their necks. I have often known perfons who had been fub- ject to fore throats, entirely freed from that com- plaint by only wearing a ribband, or a bit of flannel, conftantly about their necks, or by wearing thicker fhoes, a flannel waiftcoat, or the like. Thefe may feem trifling, but they have great effects. There is danger indeed in leaving them off after perfons have been accuftomed to them ; but furely the in- conveniency of ufing fuch things for life, is not to be compared with the danger which may attend the neglect of them. Sometimes, after an inflammation, the glands of the throat continue dwelled, and become hard and callous. This complaint is not eafily removed, and is often rendered dangerous by the too fre- quent application of ftrong ft mulating and ftyptic. medicines. OF THE MALIGNANT QUINSEY, *c. 279 medicines. The beft method is to keep it warm, and to gargle it twice a-day with a decoction of figs fharpened a little with the elixir or fpirit of vitriol. OF THE MALIGNANT OUINSEY, OR PUTRID ULCEROUS SORE THROAT. This kind of quinfey is but little known in the northern parts of Britain, though, for fome time paft, it has been fatal in the more fouthern coun- ties. Children are more liable to it than adults, females than males, and the delicate than thofe who are hardy and robuft. It prevails chiefly in autumn, and is moft frequent after a long courfe of damp or fultry weather. CAUSES.—This is evidently a contagious dis- temper, and k generally communicated by infection. Whole families, and even entire villages, often re- ceive the infection from one perfon. Whatever ■tends to produce putrid or malignant fevers, may likewife occafion the putrid ulcerous fore throat, as unwholefome air, damaged provifions, neglect of cleanlinefs, &c. SYMPTOMS.—It begins with alternate fits of fliivering and heat. The pulfe is quick, but low and unequal, and generally continues fo through the whole courfe of the difeafe. The patient com- plains greatly of weaknefs and oppreffion of the breaft; his fpirits are low, and he is apt to faint away when fet upright; he is troubled with a nau- fea, 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- T 4 guifhes aSp OF THE MALIGNANT FEVER, OR guifhes this difeafe. Upon looking into the throat it appears fwellecf, and of a florid red colour. Pale or afh-cobured fpots, however, are here and there interfperfcd, and fometimes one broad patch or foot, of an irregular figure, and pale white co- lour, furrounded with florid red, only appears, Thefe wH-ifti fpots or floughs cover fo many ulcers. An efflorefcence, or eruption upon the neck, arms, breaft, and fingers, about the fecond or third day, is a common 'ymptom of this difeafe. When it appears, the purging and vomiting generally ceafe. There is often a flight degree of delirium, and. the face frequently appears bloated, and the in fide of the ■noftrils red and inflamed. The patient complains of a difagreeable putrid fmell, and his breath is very often five. .. The putrid, ulcerous fore throat may be 4iflm- guifhed from the inflammatory by the vomiting and ioofjsaefs, with wt)ich it is generally ufhered in; the foul ylcers in the throat covered with a white or livid coat j and by the exceflave weajknef? of the patient. Unfavourable fymptoms are, an obftinate purging, extreme weaknefs, dimnefs cf the fight, a livid or black colour of the fpots, and frequent fhiverings, with a weak fluttering pulfe. If the eruption upon ■the Ikin fuddenly difappears, or becomes of a livid .colour, with a difcharge of blood from the nofe or mouth, the danger is very great. If a gentle fwe&t 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 man- ner, apd 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, or on the bed. His foo,d PUTRID ULCEROUS SORE THROAT. a$i food muft be nourifhing and reftorative; as fago-. gruel with red wine, jellies, ftrong broths, &e. His drink ought to be generous, and of an antifeptic quality; as red-wine negus, white-wine whey, and Inch like. MEDICINE.-----The medicine in this kind of quinfey is rather different from that which is pror per in the inflammatory, fjowever, if the pulfe re- quires it, bleeding muft be performe4 and repeated, but if the pulfe is very wealc, all evacuations, as bleed- ing, purging, Sec. which weaken the patient, muft be avoided. Cooling medicines, as nitre and cream of tartar, are then likewife hurtful. Strengthening cor- dials alone can be ufed with fafety 5 and thefe ought never to be neglected. If at the beginning there is a great naufea, pr in- clination to vomit, the patient muft drink an infufion of green tea, camomile flowers, or carduus benedic-, tus, in order to cleanfe tjie ftomach. If thefe are not fufficient, he may take a few grains of the pow- der of ipecacuanha, or any other gentle vomit. II the difeafe is mild, the throat may be gargled with an infufion of fage and rpfe leaves, to a gill of which may be added a fpoonful P*" two of honey, and as much vinegar as will make it agreeably acid j but when the fymptoms are urgent, the floughs large and thick, and the breath very pifenfive, the following gargle may be ufed : To fix or feven ounces of the pectoral decoction, when boiling, add half an ounce of Contrayerva- root; let it boil for fome time, and afterwards ftrain the liquor j to which ad4 two ounces of white-wine vinegar, an ounce of fine honey, and an ounce of the tincture of myrrh. This ought not only to be ufed as a gargle, but a little of it fhould frequently be injected with a fyringe to clean the throat, before the patient takes any meat or drink. This method is **£ OF THE MALIGNANT QUINSEY, Sec. 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, the fteams of warm vinegar, myrrh, and honey. But when the putrid fymptoms run high, and the difeafe is attended with danger, the only medicine that can be depended upon is the Peruvian bark. It may be taken in fubftance, if the patient'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 a pint and a half of water to half a pint; to which a tea-fpoonful of the elixir of vi- triol may be added, and an ordinary tea-cupfull of it taken every three or four hours. Bliftering-plafters 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 troublefbme, it will be proper to give the patient two table-fpoonfuls of the faline julep every hour. Tea made of mint and a. Kttle 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 nut- meg of diafcordium, or the japonic confection, may be taken two or three times a-day, or oftener if necefTary. If a difcharge of blood from the nofe happens, the fteams 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 cafes of a ftrangury, the belly mu(l be fomented with warm water, and emollient clyfters given three by four times a-dav. After OF COLDS AND COUGHS. 283 After the violence of the difeafe is over, the body fhould be kept open with mild purgatives; as manna, fenna, rhubarb, or the like. If great weaknefs and dejection of fpirits, or night-fweats, with other fymptoms of a confump- tion, fliould enfue, we would advife the patient to continue the ufe of the Peruvian bark, with the c'ixir of vitriol, and to take frequently a glafs of generous wine. Thefe, together with a milk-diet, and riding on horfeback, are the moft likely means for recovering his ftrength*. CHAP. XXX. Of Colds and Coughs. 1T has already been obferved, that colds are the effect of an obstructed perfpiration ; the com- mon caufes of which we have likewife endeavoured to point out, and fliall not here repeat them. Nei- ther fhall we fpend time in enumerating all the va- rious fymptoms of colds, as they are pretty gene- rally known. It may not however be amifs to ob- ferve, that almoft every cold is a kind of fever, which only differs in degree from fome of thofe which have been already treated of. * This difeafe, in reality, fliould be treated, according to the fymptoms—if highly inflammatory we bleed, purge, &c. and it is always more or lefs fo at its firft onfet. The inge- nious author feems to have regarded it as a difeafe of debility, or, as he ililes it, putridity. In America, the moft fuccefsful mode of treatment is, to ufe the cooling or cordial regimen ac- cording to the fymptoms ; and with this generally to give, firft an emetic of ipecacuanha, and afterwards a few grains of calo- mel twice every dav until the Houghs come off. No atf* OF COLDS AND COUGHS. No age, fex, or conftitution, is exempted from this difeafe; neither is it in the power of any medi- cine or regimen to prevent it. The inhabitants of every climate are liable to catch cold, nor can even the greateft circumfpection defend them at all times from its attacks. Indeed, if the human body could be kept conftantly in an uniform degree of warmth, fuch a thing as catching cold would be impoflible : but as that cannot be effected by any means, the perfpiration muft be liable to many changes. Such changes, however, when fmall, do not affect the health ; but, when great, they muft prove hurtful. When oppreffion of the breaft, a fluffing of the nofe, unufual wearinefs, pain of the head, &c. give ground to believe that the perfpiration is obftructed, 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 liquors. Inftead of flefh, fifli, eggs, milk, and other nourifliing diet, he may eat light bread- pudding, veal or chicken broth, panada, gruels, and fuch like. His drink may be water-gruel fweet- ened with a little honey; an infufion of balm, or flaxfeed fharpened with the juice of limes or lemon ; a decoction of barley and liquorice, with tamarinds, or any other cool, diluting, acid liquor. Above all, his fupper fhould be light; as fmall poffet, or water-gruel fweetened with honey, and a little toafted bread in it. If honey fliould difagree with the ftomach, the gruel may be fweetened with molaflcs 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 bathe his feet, to lie longer than ufual a-bed, and to encourage a gentle fweat, which is eafily brought on towards morning, by drinking OF COLDS AND COUGHS. 2S5 drinking tea, or any kind of warm diluting liquor. I have often known this practice carry off a cold in one day, which in all probability, had it been neg- lected, would have coft the patient his life, or have confined him for fome months. Would people facri- fice a little time to eafe and warmth, and practife a moderate degree of abilinenee when the firft fymp- toms of a cold appear, we have reafon to believe, that moft of the bad effects which flow from an ob- ftructed perfpiration might be prevented. But, after the difeafe has gathered ftrength by delay, all attempts to remove it often prove vain. A pleurify, a perip- neumony, or a fatal confumption of the lungs, are the common effects of colds which have either been totally neglected or treated improperly. Many attempt to cure a cold, by getting drunk. But this, to 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 fre- quently the cafe, ftrong liquors, inftead of removing fhe malady will increafe it. By this means a com- mon cold may be converted into an inflammatory fever. When thofe who labour for their daily bread have the misfortune to 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 dif- order is often fo aggravated as to confine them for a long time, Or even to render them ever after un- able to fuftain hard labour. But even fuch of the labouring poor as can afford to take care of them- felves, are often too hardy to do it j they affect to defpife colds, and as long as they can crawl about,. fcorn to be confined by what they call a common cold. Hence it is, that colds deftroy fuch numbers of man- kind. Like an enemy defpifed, they gather ftrength from 2B6 OF COLDS AND COUGHS. from delay ; till at length they become invincible. We often fee this verified in travellers, who, rather than lofe a day in the profecution of their bufinefs, throw away their lives by purfuing their journey, even in the fevereft weather, withu this difeafe upon them. It is certain, however, that colds may be too much indulged. When a perfon, for every flight cold, fhuts himfelf up in a warm room, and drinks great quantities of warm liquor, it may occafion fuch a general relaxation of the folids as will not be eafily removed. It will therefore be proper, when the difeafe will permit, and the weather is mild, to join to the regimen mentioned above, gentle exer- cife ; as walking, riding on horfeback, or in a car- riage, &c. An obftinate cold, which no medicine can remove, will yield to gentle exercife and a pro- per regimen of the diet. Bathing the feet and legs in warm water has a great tendency to reftore the perfpiration. But care muft be taken that the water be not too warm, otherwife it will do hurt. It flipuld never be warmer than is agreeable to the hand of a perfon in health, and the patient fliould 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 fooner take off a fpafm, and reftore the perfpiration, than all the hot fudorific medicines in the world. This is all that is neceffary for removing a common cold; and if this courfe be taken at the beginning, it will feldom fail. But when the fymptoms do not yield to abfti- nence, 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, rhe fkin hot and dry, and the patient complains of his. OF COLDS AND COUGHS. 2S7 his head or breaft, it will be neceffary to bleed, and to give the cooling powders recommended in the fcarlet fever every three or four hours, till they give a flool. It will likewife be proper to give two table-fpoon- fuls of the faline mixture every two hours, and m fhort to treat the patient in all refpects as for a flight fever. I have often feen this courfe, when obferved at the beginning, remove the complaint in two or three days, 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 poffible, 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 fubject, are fo fully treated of under the article Objlrucled Perfpiration, that it is needlefs here to rename the confideration of them. OF A COMMON COUGH. A cough is generally the effect of a cold, which has either been improperly treated, or entirely neg- lected. When it proves obftinate, there is always reafon to fear the confequences, as this fhews a weak ftate of the lungs, and is often the forerunner of a confumption. If the cough be violent, and the patient young and ftrong, with a hard quick pulfe, bleeding will be proper. When the patient fpits freely, and the pulfe is not hard, bleeding is unneceflary, and fome- times hurtful, as it tends to leffen that difcharge. When the cough is not attended with any "degree of fever, and the fpittle is vifcid and tough, fharp pectoral medicines are to be adminiftered ; as gum ammoniac, fquiils, &c. Two table-fpconfuis of the folutiott 288 OF A COMMON COUGH. folution of gum ammoniac may be taken three or four times a-day, more or lefs, according to the age and conftitution of the patient. Squills may be given various ways : two ounces of the vinegar, the oxyrnel, or the fyrup, may be mixed with the fame quantity of fimple cinnamon-water, to which may be be added an ounce of common water, and an ounce of 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. But when the defluction is fharp and thin, thefe medicines rather do hurt. In this cafe gentle opiates, oils, and mucilages are more proper. A cup of an infufion of wild poppy leaves, and marfh-mallow roots, or the flowers of colts-foot, may be taken frequently; or 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 humors tick- ling the throat and fauces, the patient fliould keep fome foft pectoral lozenges almoft conftantly in his mouth ; as the liquorice cakes, barley-fugar, the com- mon balfamic lozenges, Sec. Thefe blunt the acri- mony of the humors, and by taking off their flimula- ting quality, help to appeafe the cough*. * In a former ed-ition of th;s book 1 recommended, fcr an obftinate tickling cough, an oily emulfion, made with the pare- goric elixir of the Edinburgh Difpenfatory, inftead of the com- mon alkaline fpirit, 1 have fince been told by feveral prafti'-' tioners, that they found it to be an excellent medicine in this disorder, and every way d-fn ving of the character which I had given of it. Where this elixir is not kept, its phce may be Supplied by adding to the common oily emulfion an adequate proportion of the 7' elaio tinO^re, c,t liquid laudaimm. I I* OF A COMMON COUGH. i$g In obftinate coughs, proceeding from a flux of humors upon the lungs, it will often be neceffary, befides expectorating medicines, to have recourfe fo iffues, fetons, or lome oiher drain. In this cafe I have often obferved the moft happy effects from a Burgundy-pitch plaflcr applied between the fhoul- ders. I have ordered this fimple remedy in the moft: obftinate coughs, in a great number of cafes, and in many different conftitutions, without ever know- ing it fail to give relief, unlefs where there were evident figns of an ulcer in the lungs. About the bulk of a nutmeg of Burgundy pitch may be fpread thin upon a piece of foft leather, about the fize of the hand, and laid between the fhoulder- blades. It may be taken off and wiped every three or four days, and ought to be renewed once a fort- night or three weeks. This is indeed a cheap and fimple medicine, and confequently apt to be de- fpifed ; but we will venture to affirm, that it is effi- cacious in almoft every kind of cough. It has not indeed always an immediate effect; but, if kept on for fome time, it will fucceed where many other me- dicines fail. The only inconveniency attending this plafter is the itching which it occafions ; but furely this may be difpenfed with, confidering the advantage which the patient may expect to reap from the application ; befides, when the itching becomes very uneafy, the plafter may be taken off, and the part rubbed with a dry cloth, or wafhed with a little warm milk and water. Some caution indeed is neceffary in dif- continuing the ufe of fuch a plafter ; this, however, may be fafely done by making it fmaller by de- grees, and at length quitting it altogether in a warm feafon. * * Some complain diat the pitch plafter adheres too fail, while others find difficulty in keeping it on. This proceeds.. V i'ra.-n OF A COMMON COUGH. But coughs proceed from many other caufes be- f des deflations upon the lungs. In thefe cafes the cure is not to be attempted by peaoral medicines. Thus, in a cough proceeding from a foulnefs and debility of the ftomach, fyrups, oils, mucilages, and all kinds of balfamic medicines do hurt. The ftomach cough may be known from one that is owing to a fault in the lungs by this, that in the latter the patient coughs whenever he infpires, or draws in his breath fully ; but in the former that does not happen. The cure of this cough depends chiefly upon cleanfing and ftrengthening the ftomach ; for which purpofe gentle vomits and bitter purgatives are moft proper. Thus, after a vomit or two, the tincture of aloes * may be taken for a confiderable time in the dofe of one or two tea-fpoonfuls twice a-day, or as often as it is found neceffary, to keep the body gently open. In coughs which proceed from a debility of the ftomach, the Peruvian bark is likewife of confider- able fervice. It may either be chewed, taken in powder, or made into a tincture along with other flomachic bitters. A nervous cough can only be removed by change of air and proper exercife ; to which may be added the ufe of gentle opiates. Inftead of the fapona- ceous pill, the paregoric elixir, &c. which are only opium difguifed, ten, fifteen, twenty, or twenty- five drops of liquid laudanum, more or lefs, as cir- cumftances require, may be taken at bed-time, or when the cough is moft troublefome. Irnmerfing from the different kinds of pitch made ufe of, and likewife from the manner of making it. I generally find it anfwer beft when mixed with a little bees-wax, and fpread as cool as poffible. The clear, hard, tranfparent pitch anfwers the purpofe beft. * See Appendix, ThcJure of Afa:.. the OF THE WHOOPING-COUGH, &c. 291 the feet and hands in warm water will often appeafe the violence of a nervous cough. When a cough is only the fymptom of fome other malady, it is in vain to attempt to remove it with* out firft curing the difeafe from which it proceeds* Thus when a cough is occafioned by teething, keep- ing the body open, fcarifying the gums, or whatever facilitates the cutting of the teeth, likewife appeafes the cough. In like manner, when worms occafion a cough, fuch medicines as remove thefe vermin, will generally cure the cough ; as bitter purgatives, oily clyfters, and fuch like. Women, during the laft months of pregnancy, are often greatly afflicted with a cough,' which is gene- rally relieved by bleeding, and keeping the body gently open. They ought to avoid all flatulent food, and to wear a loofe eafy drefs. A cough is not only a fymptom, but is often-like- wife the forerunner of difeafes. Thus, the gout is frequently ufliered in by a very troublefome cough, which affects the patient for fome days before the coming on of the fit. This cough is generally re- moved by a paroxyfm of the gout, which fhould therefore be promoted, by keeping the extremities warm, drinking warm liquors, and bathing the feet and legs frequently in lukewarm water. OF THE WHOOPING COUGH, OR CHIN-COJJGH, This cough feldom affects adults, but proves often fatal to children. Such children as live upon thin watery diet, who breathe unwholefome air, and have too little exercife, are moft liable to this difeafe, and generally fuffer moft from it. The chin-cough is fo well known, even to nurfes, that a defcription of it is unneceffary. Whatever hurts the digeftion, obftructs the perfpiration, or U 2 relaxes i9z OF THE WHOOPING-COUGH, relaxes the folids, difpofes to this difeafe : confe- quently its cure muft depend upon cleanfing and ftrengthening the ftomach, bracing the folids, and at the fame time promoting perfpiration and the dif- ferent fecretions. The diet muft be light, and of eafy digeftion; for children, good bread made into pap or pudding, chicken-broth, with other light fpoon-meats, are proper ; but thofe who are farther advanced may be allowed fago-gruel, and if the fever be not high, a little boiled chicken, or other white meats. The drink may be hyffop, or penny-royal tea, fweetened with honey or fugar-candy, fmall wine-whey; or, if the patient be weak, he may fometimes be allowed a little negus. One of the moft effectual remedies in the chin- cough is change of air. ' This often removes the malady, even when the change feems to be from a purer to a lefs wholefome air. This may in fome meafure depend on the patient's being removed from the place where the infection prevails. Moft of the difeafes of children are infectious ; nor is it at all uncommon to find the chin-cough prevailing in one town or village, when another, at a very fmall diftance, is quite free from it. But whatever be the caufe, we are fure of the fact. No time ought therefore to be loft in removing the patient at fome diftance from the place where he caught the difeafe, and, if poffible, into a more pure and warm air. * When the difeafe proves violent, and the patient is in danger of being fuffocated by the cough, he * Some think the air ought not to be changed till the difeafe is on the decline ; but there feems to be no fufficient reafon for this opinion, as patients have been known to reap benefit from a change of air at all periods of the difeafe. It is not fufficient to take the patient: ^.t daily in a carriage. ought OR CHIN-COUGH. 293 ought to be bled, efpecially if there be a fever with a hard full pulfe. But as the chief intention of bleeding is to prevent an inflammation of the lungs, and to render it more fafe to give vomits, it will fel- dom be neceffary to repeat the operation ; yet if there are fymptoms of an inflammation of the lungs, a fecond, or even a third bleeding may be requifite. It is generally reckoned a favourable fymptom when a fit of coughing makes the patient vomit. This cleanfes the ftomach, and greatly relieves the cough. It will therefore be proper to promote thi-: difcharge, either by fmall dofes of ipecacuanha, or the vomiting julep, recommended in the Appendix. * It is very difficult to make children drink after a vomit. I have often feen them happily deceived, by infufmg a fcruple or half a drachm of the powder of ipecacuanha in a tea-pot, with half an Englifh pint of boiling water. If this be difguifed with a few drops of milk, and a little fugar, they will ima- gine it tea, and drink it very greedily. A fmall tea-cupful of this may be given every quarter of an hour, or rather every ten minutes, till it operates. When the child begins to puke, there will be ne occafion for drinking any more, as the water already on the ftomach will be fufficient. Vomits not only cleanfe the ftomach, which in this difeafe is generally loaded with vifcid phlegm, but they likewife promote the perfpiration and other fecretions, and ought therefore to be repeated ac- cording to the obftinacy of the difeafe. They fhould not however be ftrong ; gentle vomits frequently re- peated, are both lefs dangerous, and more beneficial, than ftronp- ones. The body ought to be kept gently open. The beft medicines for this purpofe are rhubarb and its * See Appendix, Vomiting Julep. U 3 prepara- 294 OF THE WHOOPING-COUGH, preparations, as the fyrup, tincture, &c. Of thefe a tea-fpoonful or two may be given to an infant twice or thrice a-day, as there is occafion. To fuch as are farther advanced, the dofe muft be propor- tionally increafed, and repeated till it has the de- fired effect. Thofe who cannot be brought to take the bitter tincture, may have an infufion of fenna and prunes, fweetened with manna, coarfe fugar, or honey ; or a few grains of rhubarb mixed with a tea-fpoonful or two of fyrup, or currant-jelly, fo as to difguife the tafte. Moft children are fond of fyrups and jellies, and feldom refufe even a dif- agrceable medicine when mixed with it. Many people believe that oily, pectoral, and bal- famic medicines poflefs wonderful virtues for the cure of the chin-cough, and accordingly exhibit them plen- tifully to patients of every age and conftitution, with- out confidering that every thing of this nature mufl load the ftomach, hurt the digeftion, and of courfe aggravate the diforder. * , Opiates are fometimes neceffary to allay the vio- lence of the cough. For this purpofe five, fix, or feven drops of laudanum, according to the age of the patient, may be taken in a little fugar or water, and repeated occafionally. f * Dr. Duplanil fays he has feen many good efFe&s from the kermes mineral in this complaint, the cough being fre- quently alleviated even by the firfl dofe. The dofe for a child of one year old, is a quarter of a grain diffolved in a cup of any liquid, repeated two or three times a-day. For a child of two years the dofe is half a grain ; and the quantity muft be thus increafed in proportion to the age of the patient. f Some recommend the extract of hemlock as an extraordi- nary remedy in the whoeping-cough ; but fo far as I have been able to obferve, it is no way fuperior to opium, which, when pro- perly adminiftered, will often relieve fome of the mod trouble- iome fymptoms of this diforder ; but opium fhould be given very cautioufly, if there is any difficulty of breathing from phlegm, The OR CHIN-COUGH. 295 The garlic-ointment is a well known remedy in North-Britain for the chin-cough. It is made by beating in a mortar garlic with an equal quantity of hog's lard. With this the foles of the feet may be rubbed twice or thrice a-day; but the beft method is to fpread it upon a rag, and apply it in the form of plafter. It fhould be renewed every night and morning at leaft, as the garlic foon lofes its virtue. This is an exceeding good medicine, both in the chin-cough, and in moft other coughs of an obftinate nature. It ought not, however, to be ufed when the patient is very hot or feverifli, left it fliould in- creafe thefe fymptoms. The feet fliould be bathed once every two or three days in lukewarm water ; and a Burgundy- pitch plafter kept conftantly between the fhoulders. But when the difeafe proves very violent, it will be neceffary, inftead of it, to apply a bliftering-plafter, and to keep the part open for fome time with iflue- ointment. When the difeafe is prolonged, and the patient is free from a fever, the Peruvian bark, and other bit- ters, are the moft proper medicines. The bark may either be taken in fubftance, or in a decoction or in- fufion, as is moft agreeable. For a child, ten, fifteen, or twenty grains, according to the age of the patient, may be given three or four times a-day. For an an adult, half a drachm or two fcruples will be pro- per. Some give the extract of the bark with cantha- rides; but to manage this requires a confiderable at- tention. It is more fafe to give a few grains of caftor along with the bark. A child of fix or feven years of age may take feven or eight grains of caftor, with fifteen grains of powdered bark, for a dofe. This may be made into a mixture, with two or three ounces of a fimple diftilled water, and a little fyrup, and taken three or four times a-day. U .1 CHAP [ 296 ] CHAP. XXXI. Inflammation of the Stomach, and other Vifcera. r\LL inflammations of the bowels arc dangerous, and require the moft fpeedy affiftance; as they frequently end in a fuppuration, and fometimes in a mortification, which is certain death. CAUSES.—An inflammation of the ftomach may . proceed from any of the caufes which produce an inflammatory fever ; as cold liquor drank while the body is warm, obftructed perfpiration, or the fudden ftriking in of any eruption. It may likewife.proceed from the acrimony of the bile, or from acrid and flimulating fubftances taken into the ftomach ; as ftrong vomits or purges, corrofive poifons, and fuch like. When the gout has been repelled from the extremities, either by cold or improper applications, it often occafions an inflammation of the ftomach. Hard or indigeftible fubftances taken into the fto- mach, as bones, the flones of fruit, &c. may likewife have that effect. SYMPTOMS.—It is attended with a fixed pain and burning heat in the ftomach; great fejlleflhefs and anxiety j a fmall, quick, and hard pulfe ; vomit- ing, or, at leaft, a naufea and ficknefs; exceffive thirft; coldnefs of the extremities ; difficulty' of breathing ; cold clammy fweats ; and fometimes con- vulfions and fainting fits. The ftomach is fwelled, and often feels hard to the touch. One of the moft certain figns of this difeafe is the fenfe of pain, which the patient feels upon taking any kind of food or drink, efpecially if it be either too hot or too cold. When INFLAMMATION OF THE STOMACH, &c. 297 When the patient vomits every thing he eats or drinks, is extremely reftlefs, has a hiccup, with an intermitting pulfe, and frequent fainting fits, the danger is very great. REGIMEN.—All acrimonious, heating, and irri- tating food and drink are carefully to be avoided. The weaknefs of the patient may deceive the by- ftanders, and induce them to give him wines, fpi- rits, or other cordials ; but thefe never fail to in- creafe the difeafe, and often occafion fudden death. The inclination to vomit may likewife impofe on the attendants, and make them think a vomit necef- fary ; but that too is almoft certain death. The food muft be light, thin, cool, and eafy of digeftion. It muft be given in fmall quantities, and fhould neither be quite cold nor too hot. Thin gruel made of barley or oatmeal, light toafted bread diflblved in boiling water, or very weak chicken-broth, are the moft proper. The drink fhould be clear whey, barley-water, water in which toafted bread has been boiled, or decoctions of emol- lient vegetables ; as liquorice and marfhmallow roots, &c. MEDICINE.—Bleeding in this difeafe is abfo- lutely neceffary, and is almoft the only thing that can be depended on. When the difeafe proves ob- ftinate, it will often be proper to repeat this opera- tion fevcry.l times, nor muft the low ftate of the pulfe deter us from doing fo. The pulfe indeed generally rifes upon bleeding, and as long as that is the c?Ac, the operation is fafe. Frequent fomentations with lukewarm water, or a decoction of emollient vegetables, are likewife beneficial. Flannel cloths dipped in thefe muft be applied to the region of the flomach, and removed as they grow cool. They muft neither be applied too warm, nor be fuffered to continue till they be- come 298 INFLAMMATION OF THE INTESTINES. come quite cold, as either of thefe extremities would aggravate the difeafe. The feet and legs ought likewife to be frequently bathed in lukewarm water, and warm bricks or poul- tices may be applied to the foles of the feet. The warm bath,, if it can be conveniently ufed, will be of great fervice. In this, and all other inflammations of the bowels, an epifpaftic, or bliftering-plafter, applied over the part affected, is one of the beft remedies I know. I have often ufed it, and do not recollect one inftance wherein it did not give relief to the patient. The only internal medicines which we fhall ven- ture to recommend in this difeafe, are mild clyfters. Thefe may be made of warm water, or thin water- gruel ; and if the patient is coftive, a little fweet oil, honey, or manna, may be added. Clyfters anfwer the purpofe of an internal fomentation, while they keep the body open, and at the fame time nourifh the patient, who is often in this difeafe unable to retain any food upon his ftomach. For thefe rea- fons they muft not be neglected, as the patient's life may depend on them. INFLAMMATION OF THE INTESTINES. -This is one of the moft painful and dangerous difeafes that mankind is liable to. It generally pro- ceeds from the fame caufes as the inflammation of the ftomach ; to which may be added coflivenefs, worms, eating unripe fruits, or great quantities of nuts, drinking hard windy malt liquors, as ftale bottled beer or ale, four wine, cyder, &c. It may likewife be occafioned by a rupture, by fcirrhous tumors of the inteftines, or by their oppofite fides growing together. The INFLAMMATION OF THE INTESTINES. 299 The inflammation of the inteftines is denominated Iliac paffion, Enteritis, effr. according to the names of the parts affected. The treatment, however, is nearly the fame whatever part of the inteftinal canal be the feat of the difeafe ; we fhall therefore omit thefe diftinctions left they fliould perplex the reader. The fymptoms here are nearly the fame as in the foregoing difeafe ; only the pain, if poffible, is more acute, and is fituated lower. The vomiting is like- wife more violent, and fometimes even the excre- ments, together with the clyfters, are difcharged by the mouth. The patient is continually belching up wind, and has often an obftruction of his urine. While the pain fliifts, and the vomiting only re- turns at certain intervals, and while the clyfters pafs downwards, there is ground for hope; but when the clyfters and feces are vomited, and the patient is exceedingly weak, with a low fluttering pulfe, a pale countenance, and a difagreeable or flanking breath, there is great reafon to fear that the confe- quences will prove fatal. Clammy fweats, btack fectid ftools, with a fmall intermitting pulfe, and a total ceffation of pain, are figns of a mortification already begun, and of approaching death. REGIMEN.—The regimen in this difeafe is in general the fame as in an inflammation of the ftomach. The patient muft be kept quiet, avoiding cold, and all violent paffions of the mind. His food ought to be very light, and given in fmall quantities; his drink weak and diluting ; as clear whey, barley-wa- ter, and fuch like. * MEDICINE.—Bleeding in this, as well as in the inflammation of the ftomach, is of the greateft im- * Indeed we can give very little food, ether liquid or fo- lid, in this difeafe, until the molt dangerous fymptoms, ef- prriaUy vomiting, are iubdueJ. rortance. 300 INFLAMMATION OF THE INTESTINES. portance. It fhould be performed as foon as the fymptoms appear, and muft be repeated according to the ftrength of the patient, and the violence of the difeafe. A bliftering-plafier is here likewife to be applied immediately over the part where the moft violent pain is. This not only relieves the pain of the bowels, but even clyfters and purgative medicines, which before had no effect, will operate when the blifter be?ins to rife. Fomentations and laxative clyfters are by no means to be omitted. The patient's feet and legs fhould frequently be bathed in warm water; and cloths dipped in it applied to his belly. Bladders filled with warm water may likewife be applied to the region of the navel, and warm bricks, or bottles filled with warm water, to the foles of the feet. The clyfters may be made of barley-water or thin gruel with fait, and foftened with fweet oil or frefh butter. Thefe may be adminiftered every two or three hours, or oftener, if the patient continues coftive. If the difeafe does not yield to clyfters and fomen- tations, recourfe muft be had to pretty ftrong pur- gatives ; but as thefe, by irritating the bowels, often increafe their contraction, and by that means fruflrate their own intention, it will be neceffary to join them with opiates, which, by allaying the pain, and re- laxing the fpafmodic contractions of the guts, greatly affift the operation of purgatives in this cafe. What anfwers the purpofe of opening the body very well, is a folution of the bitter purging falts. Two ounces of thefe may be diffolved in a pint of warm water, or thin gruel, and a tea-cupful of it taken every half hour till it operates. At the fame time fifteen, twenty, or twenty-five drops of lauda- num may be given iv. a glafs of peppermint or fimple cinnamon- INFLAMMATION OF THE INTESTINES. 301 cinnamon-water, to appeafe the irritation, and pre- vent the vomiting, &c. Acids have often a very happy effect in flaying the vorriting, and appeafmg the other violent fymp- toms of this difeafe. It will therefore be of ufe to fharpen the patient's drink with cream of tartar, juice of lemon , or, when thefe cannot be obtained, with vinegar. But it often happens that no liquid whatever will flay on the ftomach. In this cafe the patient muft take purging pills. I have generally found the fol- lowing anfwer very well: Take jalap in powcer, and vitriolated tartar, of each half a drachm, opium one grain, Caftile foap as much as will make the mais fit for pills. Thefe muft be taken at one dofe, and if they do not operate in a few hours, the dofe may be repeated. If a flool cannot be procured by any of the above means, it will be neceffary to immerfe the patient in warm water up to the breaft. I have often feen this fucceed when other means had been tried in vain. The patient muft continue in the water as long as he can eafily bear it without fainting, and if one immerfion has not the defired effect, it may be repeated as foon as the patient's ftrength and fpirits are recruited. It is more fafe for him to ; been experienced from tra- velling in this, and every other preternatural difcharge of blood. and OF BLOODY URINE. 351 and taken in fmall quantities. Even drinking cold water has fometimes proved a remedy, but it will' fucceed better when fliarpened with the weak fpirits of vitriol. When there are figns of an inflammation, bleeding is neceffary. Opiates may be of ufe ; but they muft be given in very fmall dofes, as four or five drops of liquid laudanum twice or thrice a-day. After the difcharge is over, as the patient is ge- nerally troubled with gripe3, occafioned by the acri- mony of the blood lodged in the inteftine3, 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 cither enlarged or eroded. It is more or lefs dan- gerous according to the different circumftances which attend it. When pure blood is voided fuddenly without in- terruption and without pain, it proceeds from the kidneys ; but if the bl^od be in fmall quantity, of a dark colour, and emitted with heat and pain about the bottom, of the belly, it proceeds from the blad- der. When bloody urine is occafioned by a rough ftone defcending from the kidneys to the bladder, which wounds the ureters, it is attended with a {harp 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 utmoft 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 motion. It may alfo proceed from ulcers of the bladder, from a ftone lodged in the kidneys, or from violent purges, or lharp medicines, efpecially cantharides. Bloody S52 OF BLOODY URINE. Bloody urine is always attended with fome de- gree of danger : but it is peculiarly fo when mixed with purulent matter, as this fliews an ulcer fome- where in the urinary paffages. Sometimes this dif- charge proceeds from excefs of blood, in which cafe it is rather to be confidered as a falutary eva- cuation 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 con- fumption. The treatment of this diforder muft be varied ac- cording 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 it be attended with a plethora* and fymptoms of inflammation, bleeding will be neceffary. The body muft likewife be kept open by emollient clyf- ters, or cooling purgative medicines; as cream of tartar, rhubarb, manna, or fmall dofes of lenitive electuary. When bloody urine proceeds from the fmall-pox, a fever, or the like, the patient's life depends on the liberal ufe of the Peruvian bark and acids, as has already been fliewn. When there is reafon to fufpect an ulcer in the kidneys or bladder, the patient's diet muft be cool, and his drink of a foft, healing, balfamic quality, as decoctions of marfli-mallow roots with liquorice, folutions of gum-arabic, &c. Three ounces of marfli-mallow roots, and half an ounce of liquorice, may he boiled in two quarts of water to one; two- ounces of gum-arabic, and half an ounce of purified nitre, may be diflolvcd in the ftrained liquor, and a tea-cupful of it taken four or five times a-day, and a continued courfe of mercurial medicines will be of- ten found of fervice. 2 The OF THE DYSENTERY, &c. 3^-3 The early ufe of aftringents in this difeafe has often bad confequences. When the flux is flopped too foon, the grumous blood, by being confined in the veffels, may produce inflammations, abfcefs, and ulcers. If, however, the cafe be urgent, or the patient feems to fuffer from the lofs of blood, gentle aftrin- gents may be neceffary* In this cafe the patient may take three or four ounces of lime-water, with half an ounce of the tincture of Peruvian bark, three times a-day, or twenty drops of elixir of vitriol in a tea*cup- ful of water four or five times a*day« OF THE DYSENTERY, OR BLOODY FLUX. This difeafe prevails chiefly in the fpring*. fummer, and autumn. It is moft common in marfliy countries, where, after hot arfd dry fummers, it is apt to be- come 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 or unwholefome. Hence it often proves fatal in camps, on fhipboard, in jails, hof* pitals, and fuch like places. CAUSES.—The dyfentery may be occafioned by. • any thing that obftructs the perfpiration, as damp beds? wet clothes, unwholefome air, &c. But it is moft fre- quently communicated by infection. SYMPTOMS.—It is known by a flux of the belly, attended with violent pain of the bowels, a con- ftant inclination to go to ftool, and generally more or lefs blood in the ftools. It begins, like other fevers, with chillinefs, 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 pafled both up- wards and downwards through the whole courfe of A a the 3*4 OF THE DYSENTERY, the difeafe. When the patient goes to ftool, hs keh a bearing down, as if the whole bowels were falling out, and fometimes a part of the inteftine is actually protruded, which proves exceedingly troublefome, efpecially in children. Flatulency is likewife a trouble* fome fymptom, efpecially towards the end of thedifeafc. This difeafe may be diftinguiflied from a diarrhoea or loofenefs, by the acute pain of the bowels, by the bearing down, and the blood which generally appears in the ftools. It may be diftinguiflied from the cholera morbus by its not being attended with fuch violent and frequent fits of vomiting, Sec. When the dyfentery attacks the old, the delicate, or fuch as have been wafted by the gout, the fcurvy, or other lingering difeafes, it often proves fatal. Vo- miting and hiccuping are bad figns, „as they fhew an inflammation of the ftomach. When the ftools arc green, black,or have an exceedingly difagreeable cada- verous fmell, the danger is very great. It is an unfa- vourablc fymptom when clyfters are immediately re- turned ; but flill more fo, when the paffage is fo ob- flinately fhut that they cannot be injected. A feeble pulfe, coldnefs of the extremities, with difficulty of fwallowing, and convulfions, are figns of approaching death. REGIMEN.—Nothing is of more importance in this difeafe than cleanlinefs. It contributes greatly to the recoveryxof the patient, and no lefs to the fafety of fuch as attend him. In all contagious difeafes the danger is increafed, and the infection fpread, by the neglect 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 chamber,but removed immediately,and buried under ground A conftant ftream of frefh air fhould be admitted into che chamber : and it ought frequent :.y to be fpr-r.^led with vinegar, juiec cf lemon, or OR BLOODY FLU*. 3*5 •r fome other ftrong acid. It is often or" ^rea* nine • tance in the cure of this difeafe, 'or die fick to ciun^c no: only thc;r bed, but al'b their bed-chamber. The patient muft not be difcouraged. Nothing tends more to render any difeafe morcal, than tho fears and apprehenfions of the fick. Ail diicales of this nature have a tendency to fink and deprefs the fpirits, and when that is. increafed by fears aud alarms from thofe whom the patient believes to be perfons of ikill, it cannot fail to have the worft effects. A flannel waiftcoat worn next the ikin has often a very good effect in the dyfentery. This promotes the perfpiration without over-heating the body. Great caution, however, is neceffary in leaving it off. I have often known a dyfentery brought on by imprudently throwing off a flannel waiftcoat before the feafon was fufficiently warm. For whatever purpofe this piece of drefs is worn, it fhould never be left off but in a warm feafon. In this difeafe the greateft attention muft be paid to the patient's diet. Flefli, fifli, 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 of the gelatinous parts of animals, fago-gruel, may conftitute the principal part of the patient's food. 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 ftarch. Two or three table- fpoonfuls of this may be grated down, and boiled in fuch a quantity of new milk and water as to be of the thicknefs of pap. This may be fweetened to the pa- tient's tafte, and taken for his ordinary food*. * The learned and humane Dr R j herford, late profefTor of medicine in th« univerfity of Edinburgh, ufed to location this A a a food 35$ OF THE- DYSENTEgr, In a dyfntery the patient may be allowed to eat freely of mpft kinds -of good ripe fruit; as grapes, ftrawberries, rafpberries, blackberries, Sec. Thefe *. tnay either be eaten raw or boiled, with or without milk, as the patient chufes. The prejudice againft fruit in this difeafe is fo great, that many believe it to be the common caufe of dyfenteries. This, how- ever, is an egregious miftake. Both reafon and ex- perience fhew, that good fruit is one of the heft mcr dicines, both for the prevention and cure of the dyfea. fiery. Good fruit is in every refpect calculated to counteract that tendency to putrefaction, from whence the moft dangerous kind of dyfentery proceeds. Thp patient in fuch a cafe ought therefore to be allowed . to eat as muck fruit as he pleafes, provided it be • ripe ^. food in his public knftures with great encomiums. He dire&etf it to be made by tying a pound or two of the fineft flour, as tight as poffible, in a linen rag, afterwards to dip it frequently jn water, and to dredge the outfide with flour, till a ca,ke °r eruft was for-rned around it, which prevents the water fr.on> \ fbaking into it while bailing. It is then to be boiled till it be- comes a hard dry mafs, as directed above. This, when mixed v/jth milk and water, will not only anfwer the purpofe of food> but may likewife be given in •lyftcrs. * I lately faw a young man who had been feized with a dy« fentery in North-America. Many tnings'had been tried there for his relief, but to no purpofe. At length, tired out with ^ifappointnocnts from medicine, and reduced to fkin and bone, ^ie came over to Britain, rather with a view to die among his relations, than with any hopes of a. cure.- After taking fundrjj medicines here with no better fuccefs than abroad, I adviled; him to leave off the ufe of drugs, and to truft entirely to a diet- of milk and fruits, with ger.tl* exercife. Strawberries was the- prjly fruit he could procure at that feaibn. Thefe he ate with milk twice, and fcmetimes thrice a-day. The cpnfequenc* \ was, that in a fhort time his ftuols were reduced from upward* of twenty in a-day, to three or fpur, and fometimes notfo many^ He ufed the other fruits as they came in, and was in a few weeks . &> well as to leave that part of til? country where J was; with a view to remro to America. OR BLOODY FLUX. 3J7 The moft proper drink in this difordey is whey* 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, fliarpened with cream of tartar, may be drank, or a decoction of barley and tamarinds; two ounces of the former and One of the latter, may be boiled in two quarts of water to one. Warm water, water-gruel, or water Vherein hot iron has been frequently quenched, are all very proper, and may be drank m turns. Camomile-tea, if the fto- mach will bear it, is a very proper drink. It both {rrengthens the ftomach, and tends to prevent a mor- tification of the bowels. MEDICINE.—At the beginning of this difeafe it is always neceffary to cleanfe the firft paffages. For this purpofe, if there is any fever or ficknefs at fto- mach, a vomit of ipecacuanha muft be given, and Wrought off with weak camomile-tea. Strong vo- mits are feldom neceffary here. A fcruple, or fifteen grains of ipecacuanha, is generally fufficient for an adult, and fometimes a very f^w grains will fuffice. The day after the vomit, an ounce or an ounce and a half of Glauber's falts or a table-fpoonful of caftor oil. This dofe may be repeated every other day, for two or three times. A fterWards fmall dofes of ipeca- cuanha may be taken for fome time. Two or three grains of the powder may be mixed in a table-fpoon- nrl of the fyrup of poppies, ?.nd taken three times a- day. This difeafe generally yields to the following plan : A dofe of Glauber's falts or caftor-oil in the morning, and one or two grains of opium at night, to be repeated until the difeafe is conquered. In children, from five to feven grains of calomel, with a little magnefia or rhubarb, anfwer much better than any other purgative. Fever is fo very common an attendant on dyfentery that the judicious Sydenham A a 3 calls s?8 OF THE DYSENTERY, calls it fever of the bowels. It is always neccfTary t» treat it as fever, and according to the ftate of the pulfe, to bleed, purge, blifter, Sec. until the fever is removed.—The truth is, that here, as in all other cafes, we muft direct our practice according to the difeafes of the feafon, or reigning epidemic. Thefe evacuations, and the regimen prefcribed above, will often be fufficient to effect a cure. Should it, however, happen otherwife, the following addi- tional aftringent medicines may be ufed. A clyfter of ftarch, or fat mutton-broth, with thirty or forty drops of liquid laudanum in it, may be ad- miniftered twice a-day. At the fame time on ounce of gum-arabic, and half an ounce of gum-tragacanth, may be diflblved in a pint of barley-water, over a flow, iire, and a table-fpoonful of it taken every hour. If thefe have not the defired effect, the patient may take, four times a-day, about the bulk of a nutmeg of the faponic confection, drinking after it a tea-cupful of the decoction of logwood* ; or, the Columbo root may be given in infufion or decoction. Two drachms of the root fii.ced may be put to a pint of boiling-water, half a drachm .of .cinnamon bark may be added; a wine glafs full for a dofe four or five times a-day. Perfons who have been cured of this difeafe arc very liable to fuffer a relapfe; to prevent which, great circumfpection with refpect 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 fliould like- wife abftain from ftrong animal food, and live prin- cipally on milk and vegetables. Gentle exercife and wholefome air are likewife of importance. The patient fhould go to the country asibon as his ftrength will permit, and fliould take ex,- * See Appendix, Deceflion of Logwood. OR BLOODY FLUX. 35* ercife daily on horfeback, or in a carriage. He may likewife ufe bitters, 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 ftrict attention to cleanlinefs,a fpare ufe of animal food, and a free ufe of found ripe fruits, and other vege- tables. The night air is to be carefully avoided, and all communication with tho fick. Bad fmells are like- wife to be fhunned, efpecially thofe which arife from putrid animal fubftances. The neceffaries where the lick go, are carefully to be avoided. There are fundry other fluxes of .the belly, as the LIENTERY and CCELIAC PASSION, which, though lefs dangerous than the dyfentery, yet merit confideration. Thefe difeafes generally proceed from a relaxed ftate of the ftomach and inteftines, which is fometimes fo great that the food paffes through them without almoft any fenfible alteration ; and the patient dies merely from the want of nourifliment. When the lientery or ccrliac 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 .^reat. The treatment of the patient, is in general the fame as in the dyfentery. In all obftinate fluxes of the belly, and efpecially in the diarrhoea which often follows dy- fentery, the cure muft be attempted, firft by cleanfing the ftomach and bowels with gentle vomits and pur- ges ; afterwards, fucli a diet as has a tendency to heal and ftrengthen the bowels, with opiates and aftringent ljudicinc>, will generally perfed die cure. A a 4 CHAP* I 360 J CHAP. XXXV. Of the Head-ach. ACHES and pains proceed from very different caufes, and may affect any part of the body ; but we fliall point-out thofe only which occur moft frequently, and are attended with the greateft danger. When the head-ach is flight, and affects a parti. cular part of the head only, it is called cephalalgia; when the whole head is affefted, cephalaa; and when on one fide only, hemicrania. A fixed pain in the fore- head, which may be covered with the end of th$ thumb, is called the clavis hyliericus. There are alfo other diftindtions. Sometimes the pain is internal, fometimes external ; fometimes it is an original defeafe, and at other times only fympto* matic, When the head-ache proceeds from a hot bilious habit, the pain is very acute and throbbing, with a confiderable heat of the part affected, When from a cold phlegmatic habit, the patient complains. of a dull heavy pain, and has a fenfe of coldnefs in the part. Whatever obftructs 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 humors, the head-ach often proceeds from the fuppreffion pf cuftomary evacua* tions ; as bleeding at the nofe, fweating of the feet, Sec. It may likewife -proceed from any caufe that determines a great flux of blood towards the head; &s coldnefs of the extremities, or hanging down the OF THE HEAD-ACH. 3$c Ticad for a long time. Whatever prevents the re- turn of the blood from the head will likewife occa- fion a head-ach; as looking long obliquely at any object, wearing any thing tight about the netfk, or the like. When a head-ach proceeds from a ftoppage of a running at the nofe, there is a heavy, obtufe, prefling pain in the fore part of the head, in which there feems to be fuch a weight, that the patient can fcarcely hold it up. When it is occafioned by the venereal difeafe, it generally affects the ikull, and often produces a caries of the bones. Sometimes the head-ach proceeds from the repul- fion or retroceflion of the gout, the eryfipelas, the fmall-pox, meafles, itch, or other eruptive difeafes. What is called hemicrania generally proceeds from crudities or indigeftion. Inanition, or emptinefs^ will often alfo occafion head-achs, I have often feea . inflances of this 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, conftan/„ and almoft intolerable head-ach, which occafiona 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 intermitting 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 ex* ceftive head-achs, coldnefs of the extremities is a bad Whea tfs OF THE HEAD-ACH. Wlien the difeafe continues long, and is very vio- lent, it may terminate in blindnefs, an apoplexy, deafhefs, a vertigo, the palfy, epilepfy, Sec. In this difeafe the cool regimen in general is to be obferved. The diet ought to confift of fuch emol- lient fubftances as will correct the acrimony of the humors, and keep the body open ; as apples boiled in milk, fpinage, turnips, and fuch like. The drink ought to be diluting; as barley-water, infufions of mild mucilaginous vegetables, decoctions of the fudorific woods, &c. The feet and legs ought to be kept warm, and frequently bathed in lukewarm water; the head fhould be fhaved,, and bathed with water and vinegar. The patient ought as much as poffible to keep in an erect pofture, and not to lie with his head too low. When the head-ach is owing to excefs of blood, or an hot bilious conftitution, bleeding is neceffary. Cupping alfo, or the application of leeches to the temples, and behind the ears, will be of fervice. Afterwards, a bliftering-plafter may be applied to the neck, behind the ears, or to any part of the head that is moft affected. 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 fer- vice. The body ought likewife to be kept open by gentle laxatives. But when the head-ach continues with a dull, heavy, continual pain, which will neither yield to bleeding nor gentle laxatives, then more powerful purgatives are neceffary, as pills made of aloes, refin of jalap, or the like. It will alfo be neceflary in this cafe to blifter the whole head, and to keep on the back part of the neck, for a confiderable time, a perpetual blifter, When OF THE HEAD-ACH. 3*1 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 j as the herb maftich, ground-ivy, &c. A hemicrania, efpecially a periodical one, is gene- rally owing to a foulnefs of the ftomach, for which gentle vomits muft be adminiftered, as alfo purges of rhubarb. After the bowels have been fufficiently cleared, chalybeate waters, and fuch bitters as ftrengthen the ftomach, will be neceflary. A peri- odical head-ach has been cured by wearing a piece of flannel over the forehead during the night. When the head-ach arifes from a vitiated ftate of the humors, as in the fcurvy and venereal difeafe, the patient, after proper evacuations, muft drink freely of the decoction of woods, or the decoction of farfaparilla, with raifms and liquorice*. Thefe pro- mote perfpiration, fweeten the humors, and, if duly perfifted in, will produce very happy effects. When a collection of matter is felt under the fkin, it muft be difcharged by an incifion, otherwife it will render the bone carious. When the head-ach is fo intolerable as to endan- ger the patient's life, or is attended with continual watching, delirium, &c. recourfe muft be had to opiates. Thefe, after proper evacuations by clyfters or mild purgatives, may be applied both externally and internally. The affected 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 ji-day. This is only to be' done in cafe of extreme ^ Sec Appendix, DecoQion of Sarfaparilla. jS+ Or THE TOOTH-ACH. pain. Proper evacuations ought always to accom- pany, and follow the ufe of opiates*. When the patient cannot bear the lofs of bloorJ, bis feet ought frequently to be bathed in lukewann water, and well rubbed with a coarfe cloth. Cata- plafms with mirftard or horferadifh Ought likewife to be applied to them. This courfe is peculiarly necef- fary when the pain proceeds from a gouty humor affecting the head. When the head-ach is occafioned by great heat, feard labour, or violent exercife of any kind,- it may be allayed by cooling medicines; as the faline draughts with nitre, and the like. A little of Ward's eflence, dropt into* the palm a£ the hand, and applied to the forehead, will fome- times remove a violent heacf~ae& ; and fo will aether, when applied in the fame manner. OF THE TOOTH-ACH. This difeafe is fo well-known that it needs no de* fcription. It has great affinity with the rheumatifra, and often fucceeds pains of the fhoulders and other parts of the body. It may proceed from; obftructed perfpiration, or any of the other caufes of inflammation. 1 have often known the tooth-ach occafioned by neglecting fcrae part of the ufual covering of the head, by fit- * 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 drnps in twenty-four hours ; but fuch dofes ought only to be adminif- tered by a perfon of (kill. What is called the nervous head-ach, which comes on perio- dically, beginning with a dimnefs of fight, followed bv violent pain, may be very effectually relieved for the time, by giving from twenty to thirty drops of laudanum. ting OF THE TOOTH-ACH. 365 ling with the head bare near an open window, or • expofing it any how to a draught of cold air. Food or drink taken cither too hot or too cold is verjr hurtful to the teeth. Great quantities of fugar, or other fweet-meats, are likewife hurtful. Nothing is more deftructive 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 js fure to be fpoiled whenever the air gets into it. Breeding women are very fubject to the tooth-ach, efpecially during the firft three or four months of pregnancy. The tooth- ach often proceeds from fcorbutic humors affecting the gums. In this cafe the teeth are fometimes wafted, and fall out without any confiderable degree ©fpain. The more immediate caufe of the tooth- ach is a rotten or carious tooth. In order to relieve the tooth-ach, we mufl firll endeavour to leffen the flux of humors to the part affe&ed. 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 diluting liquors, with fmall dofes of nitre. If this fails, and the pain and inflammation {Kit increafes, a fuppuration may be expected; to promote which a toafted fig fhould be held between the gum and the cheeks ; bags filled with boiled camomile- flowers, flowers of elder, or the like, may be applied near the part affected, with as great a degree of warmth as the patient can bear, and renewed as they grow cool: the patient may likewife receive the ieams of warm water into his mouth, through an inverted funnel, or by holding his head over the E&outh of a porringer filled with warm water, &c. Such £6* OP THE TOOTH-ACH. Such things as promote the difcharge of faliva, or jpaufe the patient to fpit, are fometimes of fervice. For this purpofe, bitter, hot, or pungent vegetable! may be chewed; as gentian, calamus aromaticus. Many other herbs, roots, and feeds, are recom- mended for curing the tooth-ach; as the leaves or roots of millefoil or yarrow chewed, tobacco fmoaked or chewed, ftaves-acre, or the feeds of muftard chewed, &c. Thefe bitter, hot, and pun- gent things, 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 plafter, about the bignefs of a fhilling, with a bit of opium in the middle of it, of a fize not to pre- vent the flicking of the other, may be laid on the temporal artery, where the pulfation is moft fenfi- ble*. De la Motte affirms, that there are few cafes wherein this will not give relief. If there be a hol- low tooth, a fmall pill made of equal parts of cam- phire and opium, put into the hollow, is often bene- icial. 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 tooth-ach than bliftering-plafters. Thefe may be applied be- tween the fhoulders; but they have the beft effect when put behind the ears, and made fo large as to cover a great part of the lower jaw. After all, when a tooth is carious, it is often ira- poflible to remove the pain without extracting it; and, as a fpoilt tooth never becomes found again, it is prudent to draw it foon, left it fhould affeel * Or what is much better,, a plafter made oflaudanum and common wheat flour. the ! OF THE TOOTHvACH. 3 5 7 ■Phe reft. Tooth-drawing, like bleeding, is very much practifed by mechanics, as well as perfons of tjie medical profeffion. The operation, however, is not without danger, and ought always to be performed with care. A perfon unacquainted with the ftructurc of 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 affects the gums, it may be cured by the bark. Some pretend to have found great benefit in the tooth-ach, from the application of an artificial mag- net to the affected tooth. We fhall not attempt to account for its mode of operation; but, if it be found to anfwer, though only in particular cafes, it cer- tainly deferves a trial, as it is attended with no ex- pence, and cannot do any harm. Electricity has like- wife been recommended, and particular inftrumenta have been invented for fending a fhock through the affected tooth. The tooth-ach may very often be prevented by the ufe of a flannel night cap. Perfons who have returns of the tooth-ach at cer- tain feafons, as fpring and autumn, might often pre*. vent it by taking a purge at thefe times. Keeping the teeth clean has no doubt a tendency to prevent the tooth-ach. The beft method of do- ing this is to rub the gums daily with the bark, and to have the tartar taken off when it collects in anf quantity. And inftead of a tooth pick to clean the- teeth by paffing a bit of thread between them. * This may always be prevented by tht operator linking wpon the teeth with any piece of metal, as this never fails t« excitt (he pain in the carious, tooth. OF C s«* 3 j OF THE EAR-ACH. This diforder chiefly affects the membrane which Enes the inner cavity of the ear, called the meatus cuditorius. It is often fo violent as to occafion great reftleffnefs, anxiety, and even delirium. The ear-ach may proceed from any of the caufes which produce inflammation. It often proceeds from a fudden fuppreffion of perfpiration, or from the head being expofed to cold when covered with fweat. It may alfo be occafioned by worms, or other infects getting into the ear, or being bred there; or from any hard body flicking in trie ear. Sometimes it proceeds from the .tranflation of matter to the ear. This oJften happens in the decline of malignant fevers, and occafions deafnefs. When the ear-ach proceeds from infe&s, or any hard body flicking in the ear, every method muft be taken to remove them as foon as poffible. The membranes may be relaxed by dropping into the ear oil of fweet almonds, or olive oil. If this fhould not force out the body, it muft be extracted by art. I have feen infects, which had got into the ear, come out of their own accord upon pouring in oil, which is a thing they cannot bear. The pain in the ear is fometimes fo violent, as to make it abfolutely necef- fary to give twenty-five drops of liquid laudanum in a little water every hour, until the,pain abates. When the pain of the ear proceeds from inflam- mation, it muft be treated like other topical inflam- mations, by a cooling regimen, and opening medi- cines. Bleeding at the beginning, either in the arm or jugular vein, or cupping in the neck, will be pro- per. ( The ear may likewife be fomented with fteams of warm water; or flannel bags filled with boiled mallows and camomile flowers may be applied to it N i warm j PAIN OF THE STOMACH, Sec. 369 warm ; or bladders filled with warm milk and water. A very good method of fomenting the ear is to ap- ply it clofe to the mouth of a jug filled with warm wafer, on a ftrong decoction of camomile-flowers. The patient's feet fhould be frequently bathed in lukewarm water, and he ought to take fmall dofes of nitre and rhubarb, viz. a fcruple of the former, and ten grains of the latter, three times a-day. His drink may be whey, or a decoction of barley and liquorice, with figs or raifins. The parts behind the ear ought frequently to be rubbed with campho- rated oil, or a little of the volatile liniment ; or what perhaps is far preferable, a blifter applied be- hind the ear. When the inflammation cannot be difcuffed, a poul- tice of bread and milk, or roafted onions, may be ap- plied to the ear, and frequently renewed, till the ab- fcef§ breaks, or can be opened. Afterwards the hu- mors may be diverted by gentle laxatives, blifters, or iffues; but the difcharge muft not be fuddenly dried up by any external application. PAIN OF THE STOMACH, &c. This may proceed from various caufes; as indi- geftion, wind, the acrimony of the bile, fharp, acrid, or poifonous fubftances taken into the ftomach, &c It may likewife be occafioned by worms, the ftop- page of cuftomary evacuations, a tranflation of gouty matter to the ftomach, the bowels, Sec. Women in the decline of life are very liable to pains in the ftomach and bowels, efpecially fuch as are afflicted with hyfteric complaints. It is like- wife very common to hypochondriac men of a feden- tary and luxurious life. In fuch perfons it fometimes proves fo extremely obftinate as to baffle all the pow- ' ers of medicine. B b When 37o PAIN OF THE STOMACH, &c. >> When the pain of the ftomach is moft violent after eating, there is reafon to fufpecV that it pro- ceeds 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 after- wards a dofe or two of rhubarb. He ought like- wife to take an infufion of camomile-flowers, or fome; other flomachic 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 flatu- lency, the patient is conftantly belching up wind, and feels an uneafy diftention of the ftomach after meals. In general, the patient ought to avoid all windy diet, and every thing that fours on the ftomach, as greens, roots, &c. This rule, however, admits of fome ex- ceptions. There are many inftances of perfons very much troubled with wind, who have received great benefit from eating parched peafe, though that grain is generally fuppofed to be of a windy nature*. This complaint may be likewife greatly relieved by labour, efpecially digging, reaping, mowing, or any kind of active employment by which the bowels are alternately comprefied and dilated. The moft obftinate cafe of this kind I ever met with was in a perfon 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, * Thefe are prepared by (teepiiv* or {baking peafe in water, and afterwards drying them in a pot cr kiln till they be quite 1iard. They may be ufed at plcafure. This preparation rnoft probably expels the wind. they I i PAIN OF THE STOMACH, &c. , 371 they muft be difcharged by vomit ; this may be excited by butter, oils, or other foft things, which flieath and defjend the flomach from the acrimony of its contents. When pain of the ftomach proceeds from a tranf- lation of gouty matter, warm cordials are neceffary, as generous wines, French brandy, &c. Some have drank a whole bottle of brandy or rum, in this cafe, in a few hours, without being in the leaft intoxi- cated, or even feeling the ftomach warmed by it. It is impofiible 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*. If a pain of the ftomach proceed from the ftoppage of cuftomary 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 rhubarb or fenna, Sec. When this difeafe affects women, in the decline of life, after the ftoppage of the menfes, making an iffue in the leg o. arm will be of peculiar fervice. When the difeafe is occafioned by worms, they muft be deftroyed, or expelled by fuch means as are recom- mended in the following fection. When the ftomach is greatly relaxed, and the di- geftion bad, which often occafions flatulencies, the •elixir of vitriol will be of fingular fervice. Fifteen or twenty drops of it may be taken in a glafs of wine or water twice or thrice a-day, or a glafs of the de- coction of Columbo, as recommended in the dyfentery, may be taken three or four times a-day. Perfons afflicted with flatulency are generally un- happy unlefs they be taking fome purgative medi- * A tea-fpocnful of ether, with ten drops of laudanum, in a litil: water, rep.-ated every half hour if neceflary, will do more good in thefe cafes than a gallon of brandy. B b 2 cines 5 •■'' wg 372 O F W 0 R M S. ?£, cines ; thefe, though they may give immediate eafe tend to weaken and relax the ftomach and bowels and confequently increafe the diforder. Their beft method is to mix purgatives and ftomachics together. Equal parts of Peruvian bark and rhubarb may be ufed in wine, and taken in fuch quantity as to keep the body gently open. CHAP. XXXVI. Of Worms. 1 HESE are chiefly of three kinds, viz. the tania, or tape-worm ; the teres, or round and long worm; and the afcarides, or round and fhort worms. There are many other kinds of worms found in the human body ; but as they proceed, in 3. great meafure, from fimilar caufes, have nearly the fame fymptoms, and require almoft the fame method of treatment as thefe already mentioned, we fliall not fpend time in enumerating them. The tape-worm is white, very long, and full of joints. It is generally bred either in the ftomach or fmall inteftines. The round and long worm is like- wife bred in the fmall guts, and fometimes in the flomach. The round and fhort worms commonly lodge in the retlum, or what is called the end gut, and occafion a difagreeable itching about the feat. The long round worms occafion fqueamifhnefs, vomiting, a difagreeable breath, gripes, loofenefs, fwellings of the belly, fwooning, loathing of food, and at other times a voracious appetite, a dry cough, convulfions, epileptic fits, and fometimes a privation of t 0 F W O R M S. 573 of fpeech. The effects of the tape-worm are nearly the fame with thofe of the long and round, but ra- ther more violent. Andry fays, the following fymptoms particularly attend the folium, which is a fpecies of the tape-worm, viz. fwoonings, privation of fpeech, and a voracious appetite. The round worms called afcarides, befides an itching of the anus, caufe fwoonings, and tenefmus, or an inclination to go to ftool. CAUSES.—Worms may proceed from various caufes; but they are feldom found to be trouble- fome, except in weak and relaxed ftomachs, where the digeftion is bad. Sedentary perfons are more liable to them than the active and laborious. Thofe who eat great quantities of unripe fruit, or who live much on raw herbs and roots, are generally fubject to worms. There feems to be an hereditary difpofi- tion in fome perfons to this difeafe. I have often feen all the children of a family fubject to worms of a par- ticular kind. SYMPTOMS.—The common fymptoms of worms are, palenefs of the countenance, and at other times, an univerfal flufhing of the face ; itching of the nofe ; this, however, is doubtful, as children pick their nofes in many difeafes ; ftarting, and grinding of the teeth in fleep ; fweliing of the upper lip ; the appetite fometimes bad, at other times quite vora- cious ; loofenefs ; a four or flinking breath ; a hard fwclled 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 cough, and unequal pulfe j palpitations of the heart; fwoon- ings ; drowfmefs ; cold fweats ; palfy ; epileptic fits, with many other unaccountable nervous fymptoms, which were formerly attributed to witchcraft, or the influence of evil fpirits. Small bodies in the excre- B b 3 ments, 374 OF WORMS. ments, refembling melon or cucumber feeds, are fymp- toms of the tape-worm. I lately faw fome very furprifing effects of worrm in a girl about five years of age, who ufed to lie for whole hours as if dead. She at laft expired, and, upon opening her body, a number of the teres, or long round worm, were found in her guts, which were confiderably inflamed ; and what anatomifts call an intus fufceptio, or involving of one part of the gut within another, had taken place in no lefs than four different parts of the inteftinal canal*. MEDICINE.—Though numberlefs medicines are extolled for expelling and killing wormsf, yet no dif- eafe more frequently baffles the phyfician's fkill. In general, the moft proper medicines for their expulfion are flrong purgatives; and to prevent their breeding, ftomachic bitters. The beft purge is jalap and calomel. Five and twenty or thirty grains of the former with fix or feven of the latter, for an adult, mixed in fyrup, may be taken early in the morning, for a dofe. It will be proper that the patient keep the houfe all day, and drink nothing cold. The dofe may be repeated once or twice a week, for a fortnight or three weeks. On the intermediate days, the patient may take a ' ""* That worms exift in the human body, there can be no doubt; and that they muft fometimes be confidered as a difeafe, is equally certain: but this is not the cafe fo often as people imagine. The idea that worms occafion many difeafes, gives an opportunity to the profefted worm doctors of impofingon the credulity of mankind, and doing much mifchief. They find worms in every cafe, and liberally throw in their antidotes, which generally confift of ftrong, draftic purges. I have known thefe given, in delicate conftitutions, to the deftruction of ths patient, where there was not the leaft fymptom of wormy. f A medical writer of the prefent age, has enumerated up- wards of fifty Brit:fh plants, all celebrated for killing and ex- polling worms. drachm 0 F W O R M S. 375 drachm of the powder of tin, twice or thrice a-day, mixed with fyrup, honey or molaffes. Thofe who do no chufe to take calomel, may make ufe of the bitter ourgatives; as aloes, hiera picra, tinc- ture of fenna, rhubarb, Sec. Oily medicines arc fometimes found beneficial for expelling worms. An ounce of fallad oil, and a table-fpoonful of common fait may be taken in a glafs of red port wine thrice a-day, or oftener, if the fto- mach will bear it. But the more common form of ufing oil is in clyfters. Oily clyfters, fweetened with fugar or honey, are very efficacious in bringing away the fhort round worms called afcarides, and likewiie the teres. The Harrowgate water is an excellent medicine for expelling worms, efpecially the afcarides. As this water is impregnated with fulphur, we may hence infer, that fulphur alone muft be a good medicine in this cafe; which is found to be a fact. Many practitioners give flour of fulphur in very large dofes, and with great fuccefs. It fhould be made into an electuary with honey or molaffes, and taken in fuch quantity as to purge the patient. Where Harrowgate water cannot be obtained, fea-water may be ufed, which is far from being a contemptible medicine. in this cafe. If fea-water cannot be had, common fait diflblved in water may be drank. I have often feen this ufed by country nurfes, with very good effect. Some flour of fulphur may be taken over night, and the falt-water in the morning. But worms, though expelled, will foon breed again, if the ftomach remains weak and relaxed ; to prevent which, we would recommend the Peruvian bark. Half a drachm of bark in powder may be taken in a glafs of red port wine three or four times a-day, after the above medicines have been ufed. hme-water is likewife good for this purpofe, or a B b 4 table- 376 OF WORMS. t table-fpoonful of the chalybeate wine taken twice or thrice a-day. Infufions or decoctions of bitter herbs, f may likewife be drank ; as the infufion of tanfy, water trefoil, camomile-flowers, tops of wormwood, .1 centaury, &c. ■ For a child of four or five years old, fix grains of ^ rhubarb, five of jalap, and fix of calomel, may be mixed in a fpoonful of fyrup or honey, and given in ^ the morning. The child mould keep the houfe all day, and take nothing cold. This dofe may he repeated twice a-week for three or four weeks. On "•'.■ the intermediate days the child may take a fcruplc of powdered tin and ten grains of asthiops mineral in a fpoonful of molaffes twice a-day. This dofe mull * be increafed or diminifhed according to the age of the M patient. ^ Biflet fays, the great baftard black hellebore, or bear*s foot, is a moft powerful vermifuge for the long round worms. He orders the decoction of about a drachm of the green leaves, or about fifteen , ^ grains of the dried leaves in powder for a dofe to i child between four and feven years of age. This dofe is to be repeated two or three times. He adds, *k that the green leaves made into a fyrup with coarfc '1 fugar, is almoft the only medicine he has ufed for round worms for three years paft. Before preffing out the juice, he moiftens the bruifed leaves with vinegar, which corrects the medicine. The dofe is a tea-fpoonful at bed-time, and one or two next morning. 1 have frequently known thofe big bellies, which in children are commonly reckoned a fign of worms, quite removed by giving them white foap in their pottage, or other food. Tanfy, garlic, and rue, are all good againft worms, and may be ufed various ways. We might here mention many other plants, both for external and internal ufe, as the cabbage- »J bark, Sec. but think the powder of tin with anhiops mineral, OF WORMS. 377 mineral, and the purges of rhubarb and calomel, are more to be depended on. Perhaps there is no me- dicine more powerful, in thefe cafes, and at the fame time more fafe, than from two to eight grains of fal martis, with five grains of iron filings, twice a-day, for feveral days, in a little fyrup or molaffes. Ball's purging vermifuge powder is a very power- ful medicine. It is made of equal parts of rhubarb, fcammony, and calomel, with as much double refined fugar as is equal to the weight of all the other ingre- dients. Thefe muft be well mixed together, and re- duced to a fine powder. The dofe for a child is from ten grains to twenty, once or twice a-week. An adult may take a drachm for a dofe*. Parents who would preferve their children from worms, ought to allow them plenty of exercife in the open air; to take care that their food be wholefome and fufficiently folid ; and, as far as poffible, to pre- vent their eating raw herbs, roots, or green trafhy fruits. It will not be amifs, fometimes, to allow a child who is fubject to worms, a glafs of red wine after meals ; as every thing that braces and ftrength- ens the ftomach is good both for preventing and ex- pelling thefe verminf. * A powder for the tape-worm, was long kept a fecret on the Continent; it was lately purchafed by the French king, and will be found under the article Powder, in the Appendix. ■j- We think it neceffary here to warn people of their danger who buy cakes, powders, and other worm medicines, at ran- dom from quacks, and give them to their children without proper care. The principal ingredients in moft of thefe medi- cines is mercury, which is never tokbe trifled with. I lately faw a (hocking inftance of the danger of this conduct. A girl who had taken a dofe of worm powder, bought of a travelling quack, went out, and perhaps was fo imprudent as to drink cold water, during its operation. She immediately fwelled, and died on the following Juy, with all the fymptoms of having been poifoned. CHAP- C 378 1 CHAP. XXXVII. Of the 'Jaundice. 1 HIS difeafe is firft obfervable in the white of the eye, Which appears yellow. Afterwards the whole fkin puts on a yellow appearance. The urine, too, is of a faffron hue, and dies a white cloth of the fame colour. There is likewife a fpecies of this difeafe called the Black Jaundice. CAUSES.—The immediate caufe of the jaundice is an obftruction of the bile. The remote or occa- fional caufes are, the bites of poifonous animals, as the viper, the mad dog, &c. the bilious or hyfleric colic ; violent paffions, as grief, anger, &c. Strong purges or vomits will likewife occafion the jaundice. Sometimes it proceeds from obftinate agues, or from that difeafe being prematurely flopped by aftringent medicines ; alfo from affections of the liver and biliary ducts. In infants it is often occafioned by the meconium not being fufficiently purged off. Pregnant women are very fubject to it. It is likewife a fymptom in feve- ral kinds of fever. Catching cold, or the ftoppage of cuftomary evacuations, as the menfes, the bleed-* ing piles, iffues, &c. will occafion the jaundice. ^SYMPTOMS.—The patient at firft complains of exceffive wearinefs, and has great averfion to every kind of motion. His fkin is dry, and he generally feels a kind of itching or pricking pain over the whole body. The ftools are of a whitifh or clay co- lour, and the urine, as was obferved above, is yel- low. The breathing is difficult, and the patient com- plains of an unufual load or oppreffion on his breaft, often attended with great defpondency. There is a heat. OF THE JAUNDICE. 379 is a heat in the noftrils, a bitter tafte in the mouth, loathing of food, ficknefs at the ftomach, vomiting, flatulency, and other fymptoms of indigeftion. If the patient be young, and the difeafe compli- cated with no other malady, it is feldom dangerous; but in old people, where it continues long, returns frequently, or is complicated with the dropfy or hy- pochondriac fymptoms, it often proves fatal. The black jaundice, or vomiting of a dark coloured fluid, is more dangerous than the yellow. REGIMEN.—The diet fliould be cool, light, and diluting, confifting chiefly of ripe fruits and mild vegetables ; as apples boiled or roafted, ftewed prunes, preferved plums, boiled fpinage, &x. Veal or chick- en-broth, with light bread, are likev/ife very proper. Many have been cured by living almoft wholly for fome days on raw eggs. The drink fliould be butter- milk, vhey fweetened with honey, or decoctions of cool opening vegetables; or marfli-mallow roots, with liquorice, Sec. The patient fliould take as much exercife as he can bear, either on horfeback or in a carriage; walking, running, and even jumping, are likewife proper, pro- vided he can bear them without pain, and there be no fymptoms of inflammation. Patients have been often cured of this difeafe by a long journey, after medicines had proved ineffectual. Amufements are likewife of great ufe in the jaun- dice. The difeafe is often occafioned by a fedentary life, joined to a dull melancholy difpofition. What- ever therefore tends to promote*the circulation, and to cheer the fpirits, muft have a good effect, as danc- ing, laughing, finging, Sec. MEDICINE.—If the patient be young, of a full fanguine habit, and complains of pain in the right fide about the region of the liver, bleeding will be necef- fary. If bleeding does not relieve, a blifter fliould be 380 OF THE JAUNDICE. be applied directly to the painful part. The body muft likewife be kept open by taking a fufficient quan- tity of Caftile foap, or the pills for the jaundice re- commended in the Appendix. Fomenting the parts about the region of the flo- mach and liver, and rubbing them with a warm hand or flefh-brufh, are likewife beneficial; but it is < ] ftill more fo for the patient to fit in a bath of warm water up to the breaft. He ought to do this fre- j quently, and fhould continue in it as long as his ftrength will permit; but if the pain continues vio- lent, it will be neceffary to have recourfe to the liquid laudanum. I Many dirty things are recommended for the cure m\ of the jaundice ; as lice, millepedes, &c. But thefe do more harm than good, as people truft to them, and neglect more valuable medicines; befides, they are feldom taken in, fufficient quantity to produce . any effects. People always expect that fuch things fhould act as charms, and confequently feldom per- fift in the ufe of them. Bleeding, purges, fomen- tations, and exercife, will feldom fail to cure the • jaundice when it is a fimple difeafe, and when com- plicated with the dropfy, a fchirrous liver, or other1 | chronic complaints, it requires a more particular treatment. Numberlefs Britifh herbs are extolled for the curu of this difeafe. The author of the Medicina Britan- nica mentions near an hundred, all famous for cur- ing the jaundice. The fact is, the difeafe often goes off of its own accord ; in which cafe the laft medicine is always faid to have performed the cure. I have fometimes however feen confiderable benefit, | in a very obftinate jaundice, from a decoction of ' f hempfeed. Four ounces of the feed may be boiled in two Englifh quarts of ale, and fweetened with % coarfe fugar. The dofe is half an Englifh pint every ' OF THE DROPSY. 381 every morning. It may be continued for eight or nine days. I have likewife known Harrowgate fulphur-water cure a jaundice of very long ftanding. It fhould be ufed for fome weeks, and the patient muft both drink and bathe. The foluble tartar is a very proper medicine in the jaundice. A drachm of it may be taken every night and morning in a cup of tea or water-gruel. If it does not open the body, the dofe may be in- creafed. Perfons fubject to the jaundice ought to take as much exercife as poffible, and to avoid all heating and aftringent alinaents. CHAP. XXXVIII . Of the Dropfy. E dropfy is a preternatural fweliing of the whole body, or fome part of it, occafioned by a collection of watery liumor. It is diftinguiflied by different names, according to the part affected, as the anafarca, or a collection of water under the fkin ; the afcites or a collection of water in the belly ; the hydrops pecloris, or dropfy of the breaft j the hydro- cephalus, or dropfy of the brain, &c. CAUSES.—The dropfy is often owing to an he- reditary difpofition. It may likewife proceed from drinking ardent fpirits, or other ftrong liquors. It i;i true almoft to a proverb, that great drinkers die of a dropfy. The want of exercife is alfo a very common caufe of the dropfy. Hence it is juftly reckoned Th -?2 OF THE DROPSY. reckoned among the difeafes of the fedentary. It fometimes proceeds from exceffive evacuations, as fre- quent and copious bleedings, ftrong purges often re- peated, frequent falivations, Sec. The fudden ftop- page of cuftomary or neceffary evacuations, as the 4 menfes, the haemorrhoids, fluxes of the belly, &c. may likewife caufe a dropfy. I have known the dropfy occafioned by drinking large quantities of cold, weak, watery liquor, when the body was heated by violent exercife. A low, damp, or marfliy fituation is likewife a frequent caufe of it. Hence it is a common difeafe in moift, flat, fenny countries. It may alfo be brought on by a long ufe of poor watery diet, or of vifcous aliment that is hard of digeftion. It is very often the effect of other difeafes, as the jaundice, a fchirrus of the liver, a violent ague of long continuance, a diarrhoea, a dy- fentery, an empyema, or a confumption of the lungs. In fhort, whatever obftructs the perfpiration, or pre- vents the blood from being duly prepared, may occa- 1 fion a dropfy. SYMPTOMS.—The anafarca generally begins .: with a fweliing of the feet and ancles towards night, j which for fome time disappears in the morning. In the evening, the parts, if preffed with the finger, will pit. The fweliing gradually afcends, and occu- pies the trunk of the body, the arms, and the head. Afterwards the breathing becomes difficult, the urine is in fmall quantity, and the thirft great; the body is i bound, and the perfpiration is greatly obftructed. To thefe fucceed torpor, heavinefs, a flow wafting fever, and a troublefome cough. This laft is gene- rally a bad fymptom, as it fliows that the lungs are affected. i In an afcites, befides the above fymptoms, there | is a fweliing of the be-ly, and often a fluctuation, which may be perceived by ftriking the belly on 4 one OF THE DROPSY. 383 one fide, and laying the palm of the hand on the op- pofite. This may be diftinguiflied from a tympany by the weight of the fweliing, as well as by the fluctuation. When the anafarca and afcites are com- bined, the cafe is more dangerous. Even a fimple afcites too feldom admits of a radical cure. When the difeafe comes fuddenly on, and the pa- tient is young and ftrong, there is reafon, however, to hope for a cure, efpecially if medicine be given early. But if the patient be old, has led an irregular or a fedentary life, or if there be reafon to fufpect that the liver, lungs, or any of the vifcera are un- found, there is great reafon to fear that the confe- quences will prove fatal. REGIMEN.—The patient muft abftain as much as poffible from all drink, efpecially weak and watery liquors, and muft quench his thirft with muftard- whey, or acids, as juice of lemons, oranges, forrel, or fuch like. His aliment ought to be dry, of a ftimulating and diuretic quality, as toafted bread, the flefh of birds, or other wild animals, roafted; pungent and aromatic vegetables, as garlic, muftard, onions, creffcs, horfe-radifh, rocambole, flialot, &c. He may alfo eat fea-bifcuit, dipped in wine. This is not only nourifliing, but tends to quench thirft. Some have been actually cured of a dropfy from a total abftinence from all liquids, and living entirely upon fuch things as are mentioned above. If the patient muft have drink, the Spa-water, or Rhenifh wine, with diuretic medicines infufed in it, are the beft. There are, however, many diuretic medicines which require a large quantity of drink to make -them ope- rate. Exercife is of tne gj-eateft importance in a dropfy. If the patient be able to walk, dig, or the like, he ought to continue thefe exercifes as long as he can. If he is not able to walk or labour, hie muft ride on horfeback, 3$4 OF THE DROPSY. horfeback, or in a carriage ; and the more violent the motion fo much the better, provided he can bear it. His bed ought to be hard and the air of his apartments warm and dry. If he lives in a damp country, he ought to be removed into a dry one, and, if poffible, into a warmer climate. In a word, every method fhould be taken to promote the per- fpiration, and to brace the folids. For this purpofe it will likewife be proper to rub the patient's body, two or three times a-day, with a hard cloth, or the flefh-brufh ; and he ought conftantly to wear flannel next his fkin. Thefe obfervations apply to the cure of dropfy, attended with the common fymptoms of weaknefs. For there are many cafes of dropfy in which the pulfe evidently indicates bleeding and the remedies proper for inflammatory difeafes. MEDICINE.—If the patient be young, his confti- tution good, and the difeafe has come on fuddenly, it may generally be removed by bleeding,brifk purges, aud fuch medicines as promote a difcharge by fweat and urine. The patient may take the following purge : Jalap in powder half a drachm, cream of tartar, two drachms, calomel fix grains. Thefe may be made into a bolus with a little fyrup of pale rofes, and taken early in the morning. The patient may likewife take every night at bed- time the following bolus: To four or five grains of camphor add one grain of opium, and as much fyrup of orange-peel as is fufficient to make them into a bolus. This will generally promote a gentle fweat, which fhould be encouraged by drinking now and then a fmall cup of wine-whey, with a tearfpoonful of the fpirits of hartfliorn in it. A tea-cupful of the follow- ing diuretic infufion may likewife be taken every four or five hours through the day : Take OF THE DROPSY". $t$ Take juniper berries, mustard-feed, and horfe- radifti, of each half an ounce, aihes of broom half a pound; infufethem in a quart of Rhenish wine or flrong lie, for a few days, and afterwards ftrain oif the liquor. Such as cannot take this infufion, may ide the docoction of feneka-root, which is both diu- retic and fudorific. I have known an obftinate anafarca cured by an infufion of the allies of broom in wine. The above courfe will often cure an incidental dropfy, if the conftitution be good ; but when the difeafe proceeds from a bad habit, or an unfound ftate of the vifcera, ftrong purges are not to be ven- tured upon. In this cafe, the fafer courfe is to pal- liate, the fymptoms, by the ufe of fuch medicines as. promote the fecretions, and to fupport the patient's ftrength by warm and nourifliing cordials. The fecretion of urine may be greatly promoted by nitre. Brookes fays, he knew a young woman who was cured of a dropfy by taking a drachm of nitre every morning in a draught of ale, after fhe had been given over as incurable. The powder of fquills is likewife a good diuretic. Six or eight grains of it, with a fcruple of nitre, may be given twice a-day in a glafs of ftrong cinnamon-water. lx.ll fays, a large fpoonful of unbruifed muftard- fcrd tiia.n every night and morning, and-drinking half a pint of the decoction of the tops of green broom after it, has performed a cure after other powerful medicines had proved ineffectual. 1 have often feen good effects from cream of tarrar in this difeafe. It promotes the difcharges by ftool and urine, it will at least palliate, and often perform a cure. The patient may begin by taking an ounce every feeond or third day, and may in- creafe the quantity to two, or even to three ounces, if the flomach will bear it. This quantity ' is nor, however, to Le taken at once, but divided Liic thies C c cr 3*6 OF THE DROPSY. or four dofes, and drink freely of camomile tea, or any diluting liquor. The fox-glove, taken in dofes of two or three grains, night and morning, for five or fix days, will prove more diuretic than moft other re- medies. It will be neceffary to drink very freely of camomile-tea, weak wine and water, or any other drink of this kind, to promote its operation. Indeed, this is neceffary, when we ufe any kind of diuretics. If the fox-glove either does not prove diuretic in a few days, or if it produces a flownefs in the pulfe, its ufe muft be difcontinued. In pure afcites diuretics do no good. To promote perfpiration, the patient may ufe the decoction of feneka-root, as directed above; or he may take two table-fpoonfuls of Mindererus*s fpirit, in a cup of wine-whey, three or four times a-day. To promote a difcharge of urine, the following infu- fion of the London hofpitals will likewife be beneficial: Take of zedoary root two drachms; dried fquills, rhubarb, and juniper-berries bruifed,of each adrachmj cinnamon in powder, three drachms; fait of worm- wood, a drachm and a half; infufe in a pint and a half of old hock wine, and when fit for ufe, filter the liquor. A wine-glafs of it may be taken three or four times a-day. In an afcites, when the difeafe does not evidently and fpeedily give way to puagative and diuretic medi- cines, the water ought to be let off by tapping. This is a very fimple and fafe operation, and would often fucceed, if it were performed in due time -f but if k be delayed till the humors are vitiated, or the bowels fpoiled, by long foaking in water, it can hardly be expected that any permanent relief will be procured*. Afcites is often relieved, and fometimes cured, by rubbing the belly with fweet-oil. * The very name of an operation is dreadful to moft peo- ple, and they vifh to try every thing before they have recourfe to it. This is the reafon why tapping feldom fiicceeds to our wifli i OF THE GOUT. S&? After the evacuation of the water, the patient is to be put on a courfe of {lengthening medicines; as the Peruvian bark; the elixir of vitriol; preparations of iron; warm aromatics, with a due proportion of rhubarb, infufed in wine, and fuch like. His diet ought to be dry and nourifhing, fuch as is recom- mended in the beginning of the Chapter ; and he fliould take as much exercife as he can bear with- out fatigue. He fhould wear flannel next his fkin, and.make daily ufe of the flefh-brufh. CHAP. XXXIX. Of the Gout. .1 HERE is no difeafe which fets the advantages of temperance and exercife in a ftronger light, than the gout. Excefs and idlenefs are the true fources from whence it originally fprung, and all who would avoid it muft be aclive and temperate Though idienefs and intemperance are the princi- pal cuules of the gout, yet many other things may contribute to bring on the diforder in thofe who are not, and to induce a paroxyfm in thofe who are fub- ject to it; as intenfe ftudy ; too free an ufe of acidv> lated liquors ; night-watching; grief or uneafinefs of the mind ; an obstruction or defect of any of the cuftomary difcharges, as the menfes, fweating of the feet, perfpiration, Sec. wi(h. I have had a pa :ent who v.-as reeularly tapped, once a momh, for {Vvernl years, and who ufed tn eat her dinner its well after the opjratinn, as if nothing ha.l happened. She died at lait, radicr worn out J>v age than by the dif^iP* C c 2 SYMP- 3&S OF THE GOUT. SYMPTOMS.—A fit of the gout is generally preceded by indigeftion, drowllnefs, belching of wind, a flight head-ach, ficknefs, and fometimes vo- miting. The patient complains of wearinefs and detection of fpirits, and has often a pain in the limbs, witii a fenfation as if wind cr cold water were palling down the thigh. The appetite is often remarkably keen a day or two before the fit, and there is a ilight pain in paffing urine, and fometimes an involuntary fhedding of tears. Sometimes thefe fymptoms are much more violent, efpecially upon the near approach of the fit; and fome obferve, that as is the fever which ufhers in the gout, fo will the fit be; if the fever be fhort and fharp, the fit will be fo likewife; if it be feeble, long, and lin- gering, the fit will be fuch alfo. But this obfervation can only hold with refpect to very regular fits of the gout. The regular gout generally makes its attack in the fpring, or beginning of winter, in the follow- ing manner: About two or three in the morning, the patient is feized with a pain in his great toe fometimes in the heel, and at other times in the an- kle or calf of the leg. This pain is accompanied with a fenfation as if cold water were poured upon the part, which is fueceeded by a fliivering, with fome degree of fever. Afterwards the pain in- creafes, and fixing among the fmall bones of the foot, the patient feels all the different kinds of torture, as if the part were ftretched, burnt, fqueezed, gnaw- ed, or torn in pieces, &c. The part at length be- comes fo cxquifttely fenfible, that the patient cannot bear to have it touched, or even fuffer any perfon to walk acrofs the room. Tlie patient is generally in exquifite torture for twenty-four hours, from the time of the coming on ©f the fit : he then becomes eafier, the part begins to OF THE GOUT. 3?$ to fwell, appears red, and is covered with a little moifture. Towards morning he drops afleep, and generally falls into a gentle breathing fweat. This terminates the firft paroxyfm, a number of which conftitute' a fit cf the gout; which is longer or fhorter according to the patient's age, ftrength, the feafon of the year, and the difpofition of the body to this difeafe. The patient is always worfe towards night, and eafier in the morning. The paroxyfms however ge- nerally grow milder every day, till at length the dif- eafe is carried off by perfpiration, urine, and the other evacuations. In fome patients this happens in a few days; in others, it requires weeks, and in fome, months, to fmifh the fit. Thole whom age and frequent fits of the gout have greatly debili- tated, feldom cret free from it before the aerroach of fummer, and fometimes not till it be pretty far ad- vanced. REGIMEN.—As there are no medicines yet known that will certainly cure the gout, we fliall con- fine 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 conftitudon is weak, and the patient has been accuftomed to live high, this is not a proper time to retrench. In this cafe he muft keep nearly to his ufual diet, and fliould take frequently a cup of flrong negus, or a glafs of generous wine. Wine-whey is a very proper drink in this cafe, as it promotes the per- fpiration without greatly heating the patient. It w ill anfwer this purpofe better if a tea-fpoonful of fil volatile oleofum, or fpirits of hartfliorn, be put into a cup of it tv. ice a-day. It will likewife be proper to give at bed-time two or three tea-fpoonfuls C c 3 of S9© OF THE GOUT. ©f the volatile tinfture of guaiacum in a large draught of warm wine-whey. This will greatly promote perfpiration through the night. As the moft fafe and efficacious method of dis- charging the gouty matter is by perfpiration, this ought to be kept up by all means, efpecially in the affected part. For this purpofe the leg and foot fhould be wrapt in foft flannel, fur, or wool. The laft is moft readily obtained, and feems to anfwer the purpofe better than any thing . elfe. The peo- ple 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 affected, 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 external applica- tion anfwer fo well in the gout. I have often feen it applied when the fweliing and inflammation were "very great, with violent pain, and have found all thefe fymptoms relieved by it in a few days. The wool which they ufe is generally greafed, and carded or combed. They chufe the fofteft which can be had, and feldom or never remove it till the fit be en- tirely gone off. It is, however, neceffary to obferve, that too much heat is always hurtful, When flannel or wool produce perfpiration and give eafe they are ufeful; but when they have not this effect, and in* creafe the heat, they are improper. The patient ought likewife to be kept quiet and eafy during the fit. Every thing that affects the mind difturbs the paroxyfm, and tends to throw the gout upon the nobler parts, /ill external applica- tions that repel the matter, are to be avoided as death. They do not cure the difeafe, but remove it from a fafer to a more dangerous part of the body, where it often proves fatal, A fit of the gout is to be confidered OF THE GOUT. 391 fonfidered as Nature's method of removing fome- thing that might prove deftructive to the body, and all that we can do, with fafety, is to promote her intentions, and to affift her in expelling the enemy in her own way. Evacuations by bleeding, ftool, Sec. are likewife to be ufed with caution ; they do not remove the caufp 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 body gently open by diet, or very mild lax- ative medicines. It may, however, be laid down as a general rule, that, where the pulfe is ftrong or tenfe, bleeding is abfolutely neceffary, as well as purging, in thofe cafes where the gout affumes the form of apolepxy, pleurify, ftrangury, &c. Many things will indeed fliorten 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 eagerly grafp at any thing that promifes immediate eafe, and even hazard life itfelf for a temporary relief. This is the true rea- fon why fo many infallible remedies have been pro- pofed for the gout, and why fuch numbers have loft their lives by the ufe of them. It would be as prudent to ftop the fmall-pox from rifing, and to drive them into the blood, as to attempt to re- pel the gouty matter after it has been thrown upon the extremities. The latter is as much an effort of Nature to free herfelf from an offending caufe, as the former, and ought equally to be promoted. When the pain, however, is very great, and the patient is reftlefs, thirty or forty drops of laudanum, more or lefs, according to the violence of the fymp- toms, may be taken at bed-time, This will eafe the pain, procure reft, promote perfpiration, and forward the crilis of the difeafe. After the fit is over, the patient, if he is in a weak ftate, ought to take a gentle dofe or two of the bitter -Cc 4 tincture 393 OF THE GOUT. tincture of rhubarb, or fome other warm ftoirrachic pur^e. He fliould alfo drink a weak infufion of itomachic bitters in fmall wine, as the Peruvian bark, with cinnamon, Virginian fnake-root, and orange- peel. The diet at this time fhould be light, but nourifliing, 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 dif- order, or rendering the fit, if it fliould return, lefs fevcre. This, however, is not to be attempted by medicine. I have frequently known the gout kept off for feveral years by the Peruvian bark and other aftringent medicines; but in all the cafes where I had occafion to fee this tried, the perfons died fuddenly, and, to all appearance, for want of a regular fit of the gout. One would be apt, from hence, to conclude, that a fit of the gout, to 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 medicine, yet if the conflitution can be fo changed by diet and exercife, as to Icffin or totally prevent its return, there- certainly can be no danger in following fuch a courfe. It is well known thai the whole habit may be fo altered by a proper regimen, as quite to eradicate this difeafe ; and thofe only who have fuffi- cient reflution to perfid in fuch a courfe, have reafon to expeel a cure. The courfe which we would recommend for pre- venting the gout, is as follows : In the firft place, univerfal temperance. In the next phice fufficient ex- ercife*. By this we do not mean fauntering about * S^me make a fecret of curing the gout by mufcuhr exer- c'ife. This fecrer, however, is ;>.s old as CVifus, who ttrorgly recommenced that mode of cure ; and whoever will fubrnit to t, in th? fulleft exttr.t, nny expect to reap folid and perm:- *»:nf advantages. OF THE COUT. 393 in an indolent manner, but labour, fweat, and toil. Thefe onlv ca i render the humors wholefome, and keep them io. Going early to bed, and rifing be- times, are alio 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 mag- nefia alba and rhubarb to be taken every fpring and autumn ; and afterwards, if the ftomach is weak, a courfe of ftomachic bitters, as tanfey or water-tre- foil tea, an infufion of gentian and camomile flowers, or a decoction of burdock root, &c. Any of thefe, or an infufion of any wholefome bitter that is more agreeable to the patient, may be drank for two or three weeks in March and October twice a-day. An iffue or perpetual blifter has a great tendency to prevent the gout. If thefe were more generally ufed in the decline of life, they would not only often prevent the gout, but alfo 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 invigorates the habit. Though there is little room for medicine during a regular fit of the gout, yet when it leaves the extre- mities and falls on fome of the internal parts, proper applications to recal and fix it, become abfolutely neceffary. When the gout affects the head, the pain of the joints ceates, and the fweliing difappears, while either fevere head-ach, drowllnefs, trembling, gid- dinefs, convullions, or delirium come on. When it feizes the lungs, great opprcifion, with cough and difficulty of breathing, en tie. If it attacks the fto- mach, extreme fickneis, vomiting, anxiety, pain in the epigaftric region, and total lofs of ftrength, will luccecd. Whet 394 OF THE GOUT. 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 tataplafms made of equal parts of the flour of muflard and rye-meal, mixed with hot vinegar, applied to the foles. Bliftering-plafters may likewife be applied to the ankles or calves of the legs. Bleeding is alfo ne- ceffary, and purges. The patient ought to keep in bed for the moft part, if there be any figns of inflam- mation, 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 with cinnamon or other fpices ; cinnamon- water ; peppermint-water, or a tea-fpoonful of ether every hour in a little water, with the addition of fif- teen or twenty drops of laudanum to every dofe if there is much pain. The patient fhould keep his bed, and endeavour to promote a fweat by drinking warm liquors. When the gout attacks the kidneys, and imitates gravel pains, the patient ought to drink freely of a decoction 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 maybe taken in a cup of the decoction. Perfons who have had the gout fhould be very at- tentive to any complaints that may happen to them about the time when they have reafon to expect a return of the fit. The gout imitates many other diforders, and by being miftaken for them, and treated improperly, is often diverted from its regular courfe, to the great danger of the patient's life. Thofe who never had the gout, but who, from their conftitution or manner of living, have reafon to expect it, ought likewife to be very circumfpect with regard to its firft approach. If the difeafe, by wrong OF THE RHEUMATISM. 39$ wrong conduct or improper medicines, be diverted from its proper courfe, the miferable patient has a chance to be ever after tormented with head-achs, coughs, pains of the ftomach and inteftines ; and to fall at laft a victim to its attack upon fome of the more noble parts. When the gout attacks any part befides the feet, without fymptoms. of inflammation, unlefs indeed it is in the ftomach, the tincture of guaiacum will be found of great fervice. OF THE RHEUMATISM. This difeafe has often a refemblance to the gout. It generally attacks the mufcles and large joints with exquifite pain, and is fometimes attended with inflam- mation and fweliing. It is moft common in the fpring, and towards the end of autumn. It is uftialiy diftin- guiflied into acute and chronic ; or the rheumatifm with and without a fever. CAUSES.—The caufes of a rheumatifm are fre- quently, the fame as thofe of an inflammatory fever, viz. an obftructed perfpiration, the immoderate ufe of ftrong liquors, and the like. Sudden changes of the weather, and all quick tranfitbns from heat to cold, are very apt to occafion the rheumatifm. The moft extraordinary cafe of a rheumatifm that I ever faw, where almoft every joint of the body was dif- torted, was that of a man v/ho 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 peru.ns not accuftomed to it, allowing their^et to continue long wet. The fame effects are often produced by wet clothes, damp beds, fit- ting or lying on the damp ground, travelling in the night, Sec. The rh.-umatifm may likewife be occafioned by ocelli- e . \w,(aiious, or the ftoppage of cuftomary difcharges, 596 OF THE RHEUMATISM. difcharges. It is often the effect of chronic difeafes, which vitiate the humors; as the fcurvy, the lues venerea, obftinate autumnal agues, &c. The rheumatifm prevails in cold, damp, marfliy countries. It is moft common among the poorer fort of peafants, who are ill cloathed, live in low damp houfes, and eat coarfe unwholefome food, which contains but little nouriihment, and is not eafily di- gged. SYMPTOMS.—The acute rheumatifm commonly beeirr with wearinefs, fliivering, a quick pulfe, rell- lelihefs, thirft, and other fymptoms of fever. After- wards the patient complains of flying pains, which are increafed by the leaft motion. Thefe at length fix in the joints, which are often affected with fwel- iing ar.d inflammation. If blood be let in this dif- eafe, it has generally the fame appearance as in the pleurify. In this kind of rheumatifm the treatment of the patient is nearly the fame as in an acute or inflam- matory fever. If he be young and ftrong, bleeding is neceflary, which may be repeated according to the exigencies of the cafe. The body ought likewife to be kept open by emollient clyfters, or cool opening liquors ; as decoctions of tamarinds, cream of tartar whey, fenna-tea, and the like. The diet fliould be light and in fmall quantity, confifting chiefly of roafted apples, oatmeal-gruel, or weak chicken-broth. After the feverifli fymptoms have abated, if the pain ftill ccntinr.es the patient muft keep his bed, and take fuch things as promote perfpiration ; as wine-whey with fiiritus Mindcreri, Sec. He may likewife take, for a few nights, at bed-time, in a cup of weak wine- whey, a drachm of the cream of tartar, and half a drachm of gum guaiacum in powder*. * g^art purging in rheumatifm is generally of v.ery efTen- ti5 which will keep for any length of time, may be ufed. We have reafon to believe, if fliips were well venti- lated, had good flore 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 putrid fevers, which are fo fatal to that ufeful fet of men, but it is too much the temper of fuch people 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 do it for them; and no man ought to engage in a long voyage, without having thefe arti- cles fecured. I have often feen very extraordinary effects in the land-fcurvy from a milk diet. This preparation of Nature, is a mixture of animal and vegetable proper- ties, which, of all others, is the moft fit for reftor- ing a decayed conftitution. But, people defpife this wholefome and nourifliing food, becaufe it is cheap, and devour with greedinefs, flefh, and fermented li- quors, while milk is only deemed fit for their hogs. The moft proper drink in the fcurvy is whey, or butter-milk. When thefe cannot be had, found cyder, perry, or fpruce-beer, may be ufed. Wort has likewife been found to be a proper drink in the fcurvy, and may be ufed at fea, as malt will keep during the longeft voyage. A decoction of the tops of the fpruce fir, is likewife proper. It may be drank in the quantity of a pint, twice a-day. Tar-water may be ufed for the fame purpofe, or decoctions o£ any of the mild mucilaginous vegetables; as farfapa- rilla, marlh'mallow roots, &c. Infufions of the bitter plants, as ground ivy, the leffer centaury, D d 2 marfli- 404 OF THE SCURVY. marfh-trefoil, Sec. are likewife beneficial. I have feen the peafants, in fome parts of Britain, exprefs the juice of die laft-mentioned plant, and drink it with good effect in thofe foul fcorbutic eruptions with which they are often troubled in the fpring feafon. Harrowgate-water is certainly an excellent medi- cine in the land fcurvy. I have often feen patients who had been reduced to the moft deplorable con- dition by this difeafe, greatly relieved by drinking the fulphur-water, and bathing in it. The chaly- beate-water may alfo be ufed with advantage, efpe- cially with a view to brace the ftomach after drinking the fulphur-water, which, though it, fliarpens the appetite, never fails to weaken the powers of di- geftion. A flight degree .of fcurvy may be carried off, by frequently fucking a little of the juice of a bitter orange, or a lemon. When the difeafe affects the gums only, this practice, if continued for fome time, will generally carry it off". We would, however, re- commend the bitter orange as greatly preferable to lemon ; it feems to be as good a medicine, and is not near fo hurtful to the ftomach. Perhaps our own forrel may be little inferior to either of them. All kinds of fallad are good in the fcurvy, and ought to be eaten very plentifully, as fpinnage, let- tuce, parfley, cellery, endive, radifh, dandelion, &c. It is amazing to fee how foon frefli vegetables in the fpring, cure the brute animals of any fcab or foul- nefs which is upon their fkins. It is reafonable to fuppofe, that their effects would be as great upon the human fpecies, were they ufed in proper quan- tity, for a fufficient length of time. 1 have fometimes feen good effects/ in fcorbutic complaints of very long ftanding, from the ufe of-,a decoction of the roots of water dock. It is ufually made by boiling a pound of the frefli root in fix pin*; OF THE SCROPHULA, ftc. 4»,5 pints of water, 'till about one-third of it be confumed. The dofe is from half a pint to a whole pint of the decoction every day. But in all the cafes where I have feen it prove beneficial, it was made much ftronger, and drank in larger quantities. The fafeft way,'however, is for the patient to begin with fmall dofes, and increafe them both in ftrength and quan- tity as he finds his ftomach will bear it. It muft be ufed for a confiderable time. I have known fome take it for many months, and have been told of others who had ufed it for feveral years, before they were fenfible of any benefit, but who nevertheless were cured by it at length. The leprofy, which was fo common in this coun- try long ago, feems to have been near a-kin to the fcurvy. Perhaps its appearing fo feldom now, maybe owing to the inhabitants of Britain eating more vege- table food than formerly, living more upon tea and other diluting diet, ufing lefs falted meat, being more cleanly, better lodged and cloathed, &c.—For the cure of this difeafe we would recommend the fame courfe of diet and medicines as in the fcurvy. OF THE SCROPHULA, OR KTNG's EVIL. This difeafe chiefly affects the glands, efpecially thofe of the neck. Children and young perfons of a fedentary life are very fubject to it. It is one of thofe difeafes which may be removed by proper regi- men, but too feldom yields to medicine. The inhabi- tants of cold, damp, marfliy countries are moft liable to the fcrophula. CAUSES.—This difeafe may proceed from an hereditary taint. Children who have the misfortune to be born of fickly parents, whofe conftitutions h- re been greatly injured by the pox, or other chronic difeafes, are apt to be affected with the fcrophula. . D d 3 k 4©6 OF THE SCROPHULA, It may likewife proceed from fuch difeafes as weaken the habit or vitiate the humors, as the fmall-pox, meafles, &c. External injuries, as blows, bruifes, and the like, fometimes produce fcrophulous ulcers; but we have reafon to believe, when this happens, that there has been a prcdifpofition in the habit to this difeafe. In fhort, whatever tends to vitiate the humors or 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 neglect of cleanlinefs, &c. Nothing tends more to induce this difeafe in children, than allowing them to continue long wet*. SYMPTOMS.—At firft fmall knots appear under the chin or behind the ears, which gradually increafe in number and fize, till they form one large hard tumor. This often continues for a long time without breaking, and when it does break, it only difcharges a thm fanies, or watery humor. Other parts of the body are likewife liable to to its attack, as the arm-pits, groins, feet, hands, eyes, breafts, &c. Nor are the internal parts exempt from it. It often affects the lungs, liver, or fpleen ; and I have frequently feen the glands of the mefentery greatly enlarged by it. Thofe obftinate ulcers which break out upon the legs, feet, and hands, and indeed every part of the body, with fweliing and little or no rednefs, arc of the fcrophulous kind. They feldom difcharge good matter, and are exceedingly difficult to cure, The white fwellings of the joints feem likewife to be of this kind. They are with difficulty brought to a fuppuration, and when opened they only difcharge a . * i he fcrophula, as well as the rickets, is found to prerail in large manufacturing towns, where people live grofs, and Jipa.d iedentary lives. thin OF KING'S EVIL. 407 thin ichor. There is not a more general fymptom of the fcrophula, than a fweliing of the upper lip and nofe, and, often, a dilated pupil. REGIMEN.—As this difeafe proceeds, in a great meafure, from relaxation, the diet ought to be gene- rous 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 now and then a glafs of generous wine, or good porter. 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. Children who have fufficient exercife are feldom troubled with the fcrophula. MEDICINE.—The vulgar are remarkably cre- dulous with regard to the cure of the fcrophula; many of them believing in the virtue of the royal touch, that of the feventh fon, Sec. The truth is, where reafon or medicines fail, fuperftition always comes in their place. Hence it is, that in difeafes which are the moft difficult to underftand, we gene- rally hear of the greateft number of miraculous cures being performed. Here, however, the deception is eafily accounted for. The fcrophula, at a certain period of life, is often cured of itfelf; and, if the patient happens to be touched about this time, the cure is imputed to the touch, and not to Nature, who is really the phyfician. In the fame way the infignificant noftrums of quacks and old women often gain applaufe when they deferve none. There is nothing more pernicious than the cuftom of plying children in the fcrophula with ftrong pur- gative medicines. People imagine it proceeds from humors which muft be purged off, without confi- dering that thefe purgatives increafe the debility and aggravate the difeafe. It has, indeed, been found, that keeping the body gently open for fome time, D d 4 efpecially 4o& OF THE SCROFHULA, efpecially with fea-water, has a good effect; but this fhould 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 effect, efpecially in the warm feafon. I have often known a courfe of bathing in fait water, and drink- ing it in fuch quantities as to keep the body gently open, cure a fcrophula, after many other medicines had been tried in vain. When falt-watcr cannot be obtained, the patient may be bathed in frefli 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 falt-water, we would recommend the Peruvian 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. Children and fuch as cannot take it ia f bftance, may ufe the decoction made in the follow- ing manner: Boil an ounce of Peruvian bark and a drachm of Winter's bark, both grofsly powdered, in a quart of water to a pint; towards the end half an ounce of fliced liquorice-root, and a handful of raifins may be added, which will both render the decoction lefs difagreeable, and make it take up more of the barkT The liquor muft be ftrained, and two, three, or four table-fpoonfuls, according 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, however, to be drank in large quantities, but fhould be taken fo as to keep the body gently open, and muft be ufed for a con- §derable time. The OR. KING'S EVIL. 4cj The hemlock may fometimes be ufed with advan- tage in the fcrophula. Some lay it down as a gene- ral 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 of hectic fever ; and the hemlock in old inveterate cafes, approaching to the fchirrous or cancerous ftate. Either the extract or the frefh juice of this plant may be ufed. The dofe muft bo fmall at firft, and increafed gradually as far as the ftomach is able to 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 fomething to keep it warm. After it breaks, the fore may be dreffed with fome digeftive ointment. What I have always found to anfwer beft, was the yellow bafilicon mixed with about a fixth or eighth part of its weight of red precipitate of mercury. The fore may be dreffed with this twice a-day ; and if it be very fungous, and does not digeft well, a larger proportion of the pre- cipitate 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. 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 affected with this difeafe. * We often find fcrophula, efpeciallv when i> firft appears, attended with a confiderable degree of fever: H:re repeated fmall bleedings, gentle purging, and low diet, will do moft good; after this fmall dofes of corrofire fublimate and bark, w;h wort for drink, will be found of the greateft ervice. For 4*» OF THE ITCH. For the means of preventing the fcrophula, wc muft refer the reader to the obfervations on nurfing, at the beginning of the book. OF THE ITCH. Though this difeafe is commonly communicated by infection, yet it feldom prevails where due regard Js paid to cleanlinefs, frefh air, and wholefome diet. It generally appears in form of fmall watery puflules, firft about the wrifts or between the fingers; after- wards it affects the arms, legs, thighs, Sec. Thefe puflules 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 difficult to cure. The itch is feldom a dangerous difeafe, unlefs when it is rendered foby neglect, or improper treat- ment. If it be fuffered to continue too long, it may vitiate the whole mafs of humors; and, if it be fud- denly drove in, without proper evacuations, it may occafion fevers, inflammations of the vifcera, or other internal diforders. The beft medicine yet known for the itch is ful- phur, which ought to be ufed both externally and internally. The parts moft affected may be rubbed with an ointment made ©f the flower of fulphur, two ounces ; crude fal ammoniac, finely powdered, two drachms; hog's lard, or butter, four onces. If a fcruple or half a drachm of the effence of lemon be added it will entirely take away the difagreeable fmell. About the bulk of a nutmeg of this may be rubbed cpon the extremities every night at bed time. It is fel- dom neceffary to rub the whole body ; but when it is, it ought not to be done all at once, but by turns, as OF THE ITCH. 411 it is dangerous to ftop too many 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 flower of brimflone and cream of tartar, in a litle molaffes, as will keep the body gently- open. He fliould beware of catching cold, fhould wear more clothes than ufual, and take every thing juft warm. It will alfo be proper daily to wafh off the ointment with warm water and a little Caftile foap, fome hours before anointing afrefh. 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 brimflone, and tho- roughly cleaned, otherwife they will communicate the infection anew*. I never knew brimflone, when ufed as directed above, fail to cure the itch; and I have reafon to believe, that, if duly perfifted in, it never will fail; but if it be only ufed once or twice, and cleanlinefs neglected, it is no wonder if the diforder returns. The quantity of ointment mentioned above will generally be fufficient for the cure of one perfon; but, if any fymptoms of the difeafe fliould appear again, the medicine may be repeated. It is both * Sir John Pringle obferves, that though this difeafe may feem trifling, there is no one in the army that is moretrouble- fome to cure, as the infection often lurks in clothes, &c. and breaks out a fecond, or even a third time. The fame inconve- niency occurs in private families, unlefs particular regard is paid to the changing or cleaning cf thsir clothes, which laft is by no m^ansin eafy operation. more 412 OF THE ITCH. more fafe and efficacious when perfifted in for a cos- / fiderable time, than when a large quantity is applied "at once. As moft people diflike the fmell of ful- phur, they may ufe in its 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 miftake other eruptions for the itch ; as the ftoppage of thefe may be attended with fatal confequences. Many of the eruptive diforders to which children are liable, have a near refemblance to this difeafe; and I have often known infants killed by being rub- bed with greafy ointments that made thefe eruptions itrike 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 mer- cury in this difeafe. Some perfons are fo fool-hardy as to wafli the parts affected with a ftrong folution of the corrofivc fublimate. Others ufe the mercu- rial ointment, without taking the leaft care either to avoid cold, keep the body open, or obferve a pro- per regimen. The confequences of fuch conduct may be eafily gueffed. I have known even the mer- curial girdles produce bad effects, and would advife 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 girdles as a kind of charm, without confidering that the mercury enters 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 unneceffary for either : the former may be always more certainly cured by fulphur, and the OF THE ASTHMA. 413 the latter will never be found where due regard is paid to cleanlinefs*. Thofe who would avoid the deteftable difeafe ought to beware of infected perfons, to ufe whole- fome food, and to ftudy univerfal cleaulinefsf. CHAP. XLI. Of the Aflhma. 1 HE aflhma is a difeafe of the lungs, which rarely admits of a perfect cure. Perfons in the decline of life are moft liable to it. It is diftin- guiflied into the moift and dry, or the humoral and nervous. The former is attended with expectoration or fpitting; but in the latter the patient feldom fpits, unlefs fometimes a little tough phlegm by the mere force of coughing. * If Mercury is ufed, the unguentum citrinum is the moft powerful form of it. The moft inveterate itches are cured by an ointment made by mixing from fifty to one hundred drops ef fpirits of vitriol with an ounce of hog's lard. f The itch is now, by cleanlinefs, baniihed from every genteel family in Britain. It ftill, however, prevails among the poorer fort of peafants in Scotland, and among the manufacturers in England. Thefe are not only fufficient to keep the feeds of the difeafe alive, but to fpread the infection among others. It were to be wifhed that fome effectual method could be devifed for extirpating it altogether. Several country clergymen hav= t"ld me, that by petting fuch as were infected cured, and ftrongly recommending an attention to cleanlinefs, they have baniihed the itch entiiely out of their pariftics. Why might not others do the fame ? CAUSES. 4*f OF THE ASTHMA. CAUSES.—The aflhma 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, efpecially running; the obftruction of cuftomary evacuations, as the menfes, haemorrhoids, &c. the fudden retroceffion of the gout, and ftriking in of eruptions, as the fmall-pox, meafles, &c. violent paffions of the mind, as fudden fear or furprife. In a word, 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 aflhma is known by a quick laborious breathing, which is generally performed with a kind of wheezing noife. Sometimes the diffi- culty of breathing is fo great, that the patient is ob- liged to keep in an erect pofture, otherwife he is in danger of being fuffocated. A fit or paroxyfm of the aflhma generally happens after a perfon has been expofed to cold eafleriy winds, or has been abroad in thick foggy weather, or has got wet, or continued long in a damp place, or has taken food which the ftomach could not digeft, as paftries, toafted cheefe, or the like. The paroxyfm is commonly ufhered in with lift- leffncfs, want of fleep, hoarfenefs, a cough, belch- ing of wind, a fenfe of heavinefs about the breafl, and difficulty of breathing. To thefe fucceed heat, fever, pain of the head, ficknefs and naufea, great oppreffion of the breaft, palpitation of the heart, a weak, and fometimes intermitting pulfe? an involun- tary flow of tears, bilious vomitings, Sec. All the fymptoms grow worfe towards night; the patient i* eafier when up than in bed, and is very defirous ol" cool air. REGIMEN.----The food ought to be light, and ©f eafy digeftion. Boiled meats are to be preferred to OF THE ASTHMA. 4i* to roafted, and the flefh of animals come to their full growth, to that of old. All windy food, and what- ever is apt to fwell in the ftomach, is to be avoided. Light puddings, broths, and ripe fruits baked, boiled, or roafted, are piroper. Strong liquors of all kinds, efpecially malt-liquors, are hurtful. The patient fhould eat a very light fupper, or rather none at all, and fhould never fuffer himfelf to be long coftive. His cloathing fhould be warm, efpecially in the win- ter-feafon. As all diforders of the bretfft arc much relieved by keeping the feet warm, and promoting the perfpiration, a flannel fhirt or waiftcoat, and thick fhoes will be of fingular fervice. But nothing is of fo great importance in the aflh- ma as pure and moderately warm air. Afthmatic people can feldom bear either the clofe heavy air of a large town, or the fharp, keen atmofphere 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 be affected by the fmoke. Some afthmatic patients indeed 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. Even 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 likewife of very great importance in the afthma, as it promotes the digeftion, preparation of the blood, Sec. The blood of afthmatic perfons is feldom duly prepared, owing to the proper action if the lungs bring impeded. For this reafon fuch people cnght daily to t ike as much exercife, either ci* 4i« OF THE ASTHMA. on foot, horfeback, or in a carriage, as they cai 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 fometimes proves fuddenly fatal. In the paroxyfm or fit, the body is generally 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 weaknefs or old age, fliould forbid it, is highly pro- per. If there be a violent fpafm about the breaft or flomach, warm fomentations, or bladders filled with warm milk and water, may be applied to the part affected, and warm cataplafms to the foles of the feet. The patient muft drink freely of diluting liquors, and may take a tea-fpoonful of the tincture of caftor, in a cup of valerian-tea, twice or thrice a-day. Sometimes a vomit has a Very good effect, and fnatches the patient, as it were, from the jaws of death. This however will be more fafe after other evacuations have been premifed. A very ftrong in- fufion of roafted coffee is faid to give eafe in an afth- matic paroxyfm. In the moift aflhma, fuch things as promote expec- toration or fpitting ought to be ufed; as the fyrup of fquills, gum ammoniac, and fuch like. A com- mon fpoonful of the fyrup, or oxymel of fquills, mixed with an equal quantity of cinnamon-water, may be taken three or four times through the day, and four or five pills made of equal parts of afafcetida und gum-ammoniac, at bed-time*. * After copious evacuations, large dofes of rther have been found very efficacious in removing a fit of the all!nia. I have i like.-.i:e OF THE ASTHMA. 4»7 For the convulfive or nervous aflhma, antifpaf- modics and bracers are the moft proper medicines. The patient may take a tea-fpoonful of the parego- ric elixir twice a-day. The Peruvian bark is fome-. times found to be of ufe in this cafe. It may be taken in fubftance, or infufed in wine. In fhort, every thing that braces the nerves, or takes off fpafm, may be of ufe in a nervous aflhma. It is often re- lieved by the ufe of affes milk ; I have likewife known cows milk, drawn warm in the morning, have a very good effect in this cafe. In every fpecies of aflhma, fetons and iffues have a good effect; they may either be fet in the back or fide, and fliould never be allowed to dry up. We fliall here, once for all, obferve, that not only in the aflhma, but in moft chronic difeafes, iffues are extremely proper- They are both a fafe and effica- cious remedy ; and though they do not always cure the difeafe, yet they will often prolong the patient's life. Blifters to the breaft are often highly neceffary, and fometimes a very large warm plafler, conftantly worn on the breaft, has been found of effential fer- vice. likewife known the following mixture produce very happy ef- fects : To four or five ounces of the folution of gum-ammoniac add two ounces of fimple cinnamon-water, and half an ounce of paregoric eiixir. Of this two table-fpoonfuls may be taken every three hours. E c CHAP. [ 4*8 j CHAP. XLII. Of the Apoplexy. 1 HE 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. Though this difeafe proves often fatal, yet it may fometimes be removed by proper care. It chiefly attacks fedentary 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 fubject to the apoplexy. It prevails moft in winter, efpecially in rainy feafons, and very low ftates of the barometer. CAUSES.—The immediate caufe of ait apoplexy is a compreffion of the brain, occafioned by an excels of blood, or a collection of watery humors. The former is called a fanguine, and the latter a from apoplexy. It may be occafioned by any thing that increafes the circulation towards the brain, or pre- vents the return of the blood from the head ; as in- tenfe ftudy ; violent paffions*; viewing objects for a long time obliquely ; or much flooping ; wearing any thing too tight about the neck; a rich and luxurious diet; fuppreffion of urine ; fuffering the body to cool * I knew a woman who in a violent fit of anger was feized ,v?ith a fanguine apoplexy. She at fiift complained of extreme pafn, a\ if daggers had been thrvfl through her head, as (he expref- /ed it. Afterwards (lie became comatofe, her pulfe funk very }ow, and it was exceeding (low. By bleeding, bliftering, and other evacuations, fhe was kept alive for about a fortnight. When her head was opened, a large quantity of extravafated blood '.vas found in.die left ventricle of the brain. fuddenly OF THE APOPLEXY. 4.1$ fiiddenly after having been greatly heated ; continuing too long in a warm or a cold bath ; the exceffive uf« of fpiceries, or high feafoned-.'ood; excefs ofvenery; the fudden finking in of any eruption ; fuffering iffues, fetons, &c. fuddenly to dry up, or the ftoppage of any , • cuftomary evacuation ; a mercurial falivation pufhed too far, or fuddenly checked by cold ; wounds or bruifes on the head ; long expofure to exceffive cold; poifonous exhalations, &c. SYMPTOMS, and method of cure. The ufual forerunners of an apoplexy are giddinefs, pain and fwimming of the head ; lofs of memory ; drowfinefs ; noife in the ears ; the night mare ; a fpontaneous Auk of tears, and laborious refpiration. When per- fons of an apoplectic make obferve thefe fymptoms, they have reafon 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 fwclled or puffed up, and the blood-veffel?, .efpecially about the neck and temples, are turgid ; the pulfe beats flrong ; the eyes are prominent and fixed, and the breathing is difficult, and performed with a fnorting noife. The excrements and urine are . ©ften voided fpontaneoufly, and the patient is fome- times 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 fliould be kept perfectly eafy and cool. His head fliould be raifed pretty high, and his feet fuffered to hang down. His clothes ought to be loofened, efpecially about the neck, and freih air admitted into his chamber. His garters fhould be tied pretty tight, by which means the mo- tion of the blood from the lower extremities will be retarded. As foon as the patient is placed in a proper E e 2 pofture, 42e> OF THE APOPLEXY. pofture, he fhould be bled freely in the neck or arm, and, if there be occafion, the operation may be re- peated in two or three hours. A laxative clyfter, v.ith plenty of fweet oil, or frefli butter, and a fpoonful or two of common fait in it, may be adminiftered every two hours; and bliftering-plafters applied between the fhoulders, and to the calves of the legs. As foon as the fymptoms are a iittlc abated, and the patient is able to fwal!ow,he ought to drink freely of fome diluting opening liquor, as a decoction of ta- marinds and liquorice, cream of tartar-whey, or com- mon whey with cream of tartar diflblved in it. Or he may take any cooling purge, as Glauber's fait, manna diflblved 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 to- wards the head. In the ferous apoplexy, the fymptoms are nearly the fame, only the pulfe is not fo ftrong, the coun- tenance is lefs florid, and the breathing lefs difficult. Bleeding is not fo neceffary here as in the former cafe. It may, however, generally be performed once with fafety and advantage, but fhould not be repeated. The patient fliould be placed in the fame pofture as directed above, and fhould have blifteriiig-plaflers ap- plied, and receive opening clyfters in the fame manner. Purges here are likewife neceffary, and the patient may drink ftrong balm-tea. If he be inclined to fweat, it ought to be promoted by drinking fmall wine-whey, or an infufion of carduus benedictus. A plentiful fweat kept up for a confiderable time has often carried off a ferous apoplexy. When apoplectic fymptoms proceed from opium, or other narcotic fubftances taken into the ftomach, * vomits are neceflary. The patient is generally re- lieved OF COSTIVENESS, See. lieved as foon as he has difcharged the poifon in this way. Perfons of an apoplectic make, or thofe who have been attacked by it, ought to ufe a very fpare and flender diet, avoiding all ftrong liquors, fpiceries, and * high feafoned food. They ought likewife to guard againft all violent paffions, and to avoid the extremes - of heat and cold. The head fliould be fhaved, and daily waflied with cold water. The feet ought to be kept warm, and never fuffered to continue long wet. The body muft be kept open either by food or medi- cine, and a little blood may be let every fpring and fall. Exercife fhould by no means be neglected ; but it ought to be taken in moderation. Nothing has a more happy effect, in preventing an apoplexy than per- . petual iffues or fetons ; great care, however, mufl be taken not to fuffer them to dry up, without opening others in their flead. Apoplectic perfons ought never to go to reft with a full ftomach, or to lie with their heads low, or wear any thing tight about their necks. CHAP. XLIII. Qf Coflivenefs, and other Affeclions of the Stomach and Bowels. W E do not mean here to treat of thofe aftrictions of the bowels which are the fymptoms of difeafes, as of the colic, the iliac paffion, &c. but only to take notice of that infrequency of ftools which fome- times happens, and which, in fome particular confti- tutions may occafion difeafes. Coftivi in fs may proceed from drinking rough red whifs, or other aftringent liquors j too much exer- E c 3 » cife, 422 OF COSTIVENESS, &c. cife, efpecially on horfeback. It may likewife pre- ceed from a long ufe of cold infipid food, which doe* not fufficiently ftimulate the inteflines. Sometimes it is owing to the bile not defccnding to the inteflines, as in the jaundice ; and at other times it proceeds from difeafes of the inteflines themfelves, as a palfy, fpafms, torpor j tumors, a cold dry ftate of the inteflines, Sec. Exceffive coftivenefs is apt to occafion pains of the head, vomiting, colics, and other complaints of ihe bowels. It is peculiarly hurtful to hypochondriac and hyfteric perfons, as it generates wind and other grievous fymptoms. Some people, however, can bear coftivenefs to a great degree. I know neriims who enjoy pretty good health, yet do not go to ftool above once a-week, and others not above once a-fortmght. Indeed I have heard of fome who -do not go above once a-month. Perfons who are generally coftive fhould live upo» a moiftening and laxative diet, as roafted or boiled, apples, pears, ftewed prunes, raifins, gruels with cur- rants, butter, honey, fugar, and fuch like. Broths with fpinage, leeks, and other foft pot-herbs, arc likewife proper. Rye-bread, or that which is made of a mixture of wheat and rye together, ought to be eaten. No perfon, troubled with coftivenefs, fhould pat white bread alone, efpecially that which is made of fine flour. The beft bread for keeping the body foluble is what, in fome parts of England, they call ineflin. It is made of a mixture of wheat and rye, and is very agreeable to thofe who are accuftomed to it, Coftivenefs is increafed by keeping the body too warm, and by every thing that promotes the perfpi- ration ; as wearing flannel, laying too long a-bed, &c. Intenfe thought, and a fedentary life, are likewife hurtful. AH the fecretions and excretions are pro- moted by moderate exercife without doors, and by a gay, cheerful, and fprightly temper of mind. OF COSTIVENESS, &c. 4*$ The drink fhould be of an opening quality. All ardent fpirits, auftere and aftrmgent wines, as port, claret, &c. ought to be avoided. Malt-liquor that is fine, and of a moderate ftrength, is very proper. Butter-milk, wh«y, and other watery liquors, are likewife proper, and may be drank in turns, as the patient's inclination directs. Thofe who are troubled with coftivenefs, ought, if poffible, to remedy it by diet, as the conftant ufe of medicines for that purpofe, is attended with many inconveniences, and often with bad confequences*. 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 ftrength, and death. . When the body cannot be kept open without medicine, we would recommend gentle dofes of rhu- * The learned Dr Arbuthnot advifes thofe who are troubled with coftivenefs to ufe animal oils, as frefh butter, cream, mar- row, fat broths, &c. He likewife recommends the expreffed •ils of mild vegetables, as olires, almonds, piftaches, and the fruits themfelves ; all oily and mild fruits, as figs; deco&ions of mealy vegetables; thefe lubricate the inteflines; fome fa- ponaceous fubftances which ftimulate gently, as honey, hydro- mel, or boiled honey and watCT, unrefined fugar, &c. The Do&wr obferves, that fuch lenitive fubftances are proper for perfons of dry atrabilarian conftitutions, who are fubjecl: to junction of the belly, and the piles, and will operate when ftronger medicinal fubftances are f. metimes ineffectual; but that fuch lenitive diet hurts thofe whofe bowels are weak and lax. He likewife obferves, that all watery fubftances are lenitive, and thut even common water, whey, four milk, and butter- milk, have that efFecl:;—That new milk, efpecially afTes milk, iliraulates ftill more when it fours on the ftomach ; and that whej 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 immoderately into a cholera morbus, or incurable diarrhoea. E e 4 ' Wi 4*4 WANT OF APPETITE. barb to be taken twice or thrice a-week. A very good practice in thefe cafes is to chew a piece of the root of rhubarb, about the fize of an hazehnut every morn- ing. This is not near fo injurious to the ftomach as aloes, jalap, or the other draftic purgatives fo much in ufe. Infufions of fenna. and manna may likewife be taken, or half an ounce of foluble tartar diflolvcd in water-gruel. About the fize of a nutmeg of lenitive electuary taken twice or thrice a-day generally anfwers the pnrpofe very well. Perhaps there is no purga, tive fo fafe for thofe who arc troubled with habitual coftivenefs as caftor oil. A table-fpoonful. maybe taken for a dofe, and the quantity need not be in- creafed. Eight or twelve grains of the extracl of the butter nut, is an excellent cathartic in thefe cafes. A large lump of brown fugar eaten at bed-time, will generally prove laxative. WANT OF APPETITE. This may proceed from a foul ftomach; indigef- tion ; the want of free air and exercife ; grief; fear; anxiety ; or any of the depreffing paffions; exceffive heat; the ufe of ftrong broths, fat meats, or any thing that palls the appetite, or is hard of digeftion, the immoderate ufe of ftrong liquors, tea, tebacco, opium, Sec. The patient ought, if poffible, to make choice of an open dry air ; to take exercife daily on horfeback or in a carriage; to rife betimes; and to avoid all in- tenfe thought. He fhould take a diet of eafy digeftion; and fhould avoid exceffive heat and great fatigue. If want of appetite proceeds from errors in dier^ or any other part of the patient's regimen, it ought to be changed. If naufea and retchings fliew that the ftomach is loaded with'crudities, a vomit will be of fervice. After this a gentle purge or two of rhn-. ;p, OF THE IIE/iP-T-iaRN. 42$ barb, may be taken. The patient ought nex. ic ufe fome of the flomachic bitters infufed in w inc. Though- gentle evacuations be neceflary. yet ftrong purges and vomits arc to be avoided,as they weaken the itomacu and hurt digeftion. Elixir of vitriol is an excellent medicine in moft: cafes of indi'-e-ftion, 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 or Water. It may likewife be mixed with the tincture of the bark, one drachm of the former to an ounce of the kitter, and two tea-fpoonf uls 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 effects ; but it muft not be ufed too freely. The waters of Harrowgate, Scarborough, Moffat, and moft other Spas in Bri- tain, may be ufed with advantage. We would ad- vife all who are afflicted with indigeftion and want of appetite, to repair to thofe places of public rendez- vous. The very change of air, and the cheerful com* pany, will be of fervice ; not to mention the exercife, amufements, &c. OF THE HEARTBURN. What is corr.V: