DOMESTIC MEDICINE, OR, A TREATISE PREVENTION AND CURE OF DISEASES] REGIMEN AND SIMPLE MEDICINE^: % nv AtfY WITH OBSERVATIONS Olf ■ *. . . ". SEA-BATHING, AND THE USE OF THE MINERAL WATERS LJ..7 £f-k'7 Y~^ NNEXlft). / / I TO WHICH IS ANNEXE^, / / A DISPENSATORY FOB THE USE OP PRIVATE PRACTITIONERS, BY WILLIAM BITCHAN, M..D. FROM THE TWENTY-SECOND ENGLISH EDITION, WITH CONSIDERABLE ADDITIONS, AND NOTES. 3B*tter: J. & B. WILLIAMS. 1834. vvz 2*30 t?34- Omnes homines artem medicam nosse oportet. — Sapientiae cognitionem medicinal sororem ac contubernalem esse puto. Hippocrates. Primoque medendi scientia, sapientiae pars habebatur. — Rationalem quidem puto medicinam esse debere. Celsus. Quemadmodum sanitas omnium rerum pretium excedit, omnisque felicitatis fundamen- tum est, ita scientia vitae ac sanitatis tuendae omnium nobilissima, omnibusqae I hominibus commendatissima esse debet. Hoffman. All men ought to be acquainted with the medical art. — I believe knowledge of medi- cine is the sister and companion of wisdom. In early times skill in healing was esteemed a part of wisdom. — I believe the practice of medicine should be agreeable to reason. As health is the most preeious of all things, and is the foundation of all happiness, the science br protecting life and health is the noblest of all, and most worthy the at- tention of all mankind. PREFACE. This New Edition of the Domestic Medicine, comes before the public with fresh claims upon their attention. It has undergone a thorough revision, with considerable additions and improvements. The little obsolete or irrelevant matter, scattered here and there in the preceding edition, has been expunged, and its place supplied with information of a more useful and more recent nature, which it was deemed essentially necessary not to omit, in order that a book so familiar to all ranks of society, might keep pace with the various improvements and opinions which have taken place of late years in medical science. In addition to the variety of new and interesting subjects above alluded to, numerous prescriptions, in English, with the Latin translation, selected from the practice of eminent medical practi- tioners, have been added, though in such a manner as not to inter- fere with the text of the author, being appended at the bottom of the page, where they are referred to from the body of the work. It ought, however, to have been previously mentioned, that, witb the introduction of the prescriptions, and some additional histories of disease, an important alteration has been made in the distribu- tion of the original matter, in order to give it more an appearance of method, conformable with modern nosological arrangement. To the diseases of children, which, instead of commencing the work, as in the older, and still in the spurious editions extant, stand towards the end, is added much valuable medical instruction. The diseases of women are treated of at large, as well as those which oc- cur during pregnancy ; to these is added the management of lying- in women, as well as the necessary treatment to be adopted during the piocess of a natural labour, than which a more useful feature, for various assignable and obvious reasons, could not possibly have been introduced into a work that professes to treat of Domestic Medicine in a simple and comprehensive manner. The dietetic, or that branch of medicine which lias the regula- tion of diet for object, either in health or disease, as will readily be perceived, is placed at the commencement of the work; then fol- low the various diseases, nearly in the same succession as first laid down by the author. Another most important feature to those already mentioned, will be found in the toxicological, or that part which treats of the dif- ferent classes of poisons, (mineral, vegetable, aerial, and animal,)* a subject every person ought, in some measure, to be acquainted with; as these deleterious substances are not unfrequcntly taken by accident, as well as designedly; and their effects are often so sudden and violent, as not to admit of delay, or allow time to pro- cure the assistance of medical men. PREFACE. The surgical department of this popular work has also expen- enced several very useful additions and alterations. Under the head of casualties will be found many useful direc- tions how to proceed in all cases of suspended animation, with the treatment laid down by the Royal Humane Society, as well as that recommended by writers in every department of medical jurisprudence, for the restoration of life. The Appendix has also undergone some considerable improve- ment. To the list of drugs, with their lowest and greatest doses, has been added, the medicinal properties of each ; thus presenting to the reader, at one view, the respective article, its virtues, withf the smallest and largest quantity of it that may be taken at one time. The prescriptions of the author have also been slightly touched, without, however, causing them to vary much from their original form. The additions, with the notes introduced in the preceding edi- tion of this work, by the late Dr. A. P. Buchan, (1813) the highly respected and much lamented son of the Author, will be distin- guished from those of the present edition, by the initials of his name. And the reason given for these additions, cannot be better explained than in his (Dr. A. P. Buchan's) own words : " Of some complaints," says he, " hitherto omitted, I know it was my father's intention to have inserted an account in a future edition. From notes found among his papers, combined with the result of my own observations, I have drawn up a history of the symptoms, and most approved treatment of Chorea or St. Vitus's Dance, Fistu- la in Ano and a peculiar kind of epidemic sore throat, named the mumps, which occasionally makes its appearance in this country, at distant intervals of time. " Various affections of the lungs, comprised under the general denomination of consumption, too frequently prove fatal to'the youth of this country, at an age when life is, for many reasons, peculiarly valuable. The remarks which I have ventured to intro- duce, on the means of detecting and counteracting the early ten- dencies to this complaint, originated in some apprehensions enter- tained concerning my own health at a former period of life, and they have since been matured by most extensive experience. . " It is not unreasonable to suppose, that the extensive circula- tion of so popular a work, must have had some influence on the state of public opinion. This influence may, I think, be distinctly traced in the generally improved treatment of children, respecting their clothing and diet, and the consequent amelioration of their health. Nor let it be forgotten, that the utility of those noble, and now flourishing charities, the Humane Society, for the recovery of persons apparently drowned; an institution for teaching the Deaf and Dumb to read and speak ; and a school for the Indigfnt Bund, was pointed out, and their establishment strongly recom- mended on the score of humanity, more than forty years ago, in the.early editions of the Domestic Medicine." The instances, if not without a parallel in the annals of litera- ture, are, at least, extremely rare, of a work on the science of med- icine having attained its twenty-second Edition of a series oflarov impressions. The Editor ofthe present Edition, by every pos^ PREFACE. v ble means, has endeavoured to maintain the claim of this Work to a continuance of that general approbation with which, for upwards of fifty years, it has been so eminently distinguished. J. S. F. London, May 1826 [vi] AUTHOR'S PREFACE When I first signified my intention of publishing the following sheets, I was told by my friends it would draw on me the resent- ment of the whole Faculty. As I never could entertain such an unfavourable idea, I was resolved to make the experiment, which indeed came out pretty much as might have been expected. Many whose, learning and liberality of sentiments do honour to medi- cine, received the book in a manner which at once showed their in- dulgence, and the falsity of the opinion that every Physician wish- es to conceal his art; while the more selfish and narrow-minded, generally the most numerous in every profession, have not failed to persecute both the book and its author. The reception, however, which this work has met with from the Public, merits my most grateful acknowledgments. As the best way of expressing these, I have endeavoured to render it more generally useful, by enlarging the prophylaxis, or that part which treats of preventing diseases ; and by adding many articles which had been entirely omitted in the former impressions. It is needless to enumerate these additions ; I shall only say, that I hope they will be found real improvements. The observations relative to Nursing and the Management of Children were chiefly suggested by an extensive practice among in- fants, in a large branch of the Foundling Hospital, were I had an opportunity not only of treating thte diseases incident to childhood, but likewise of trying different plans of nursing, and observing their effects. Whenever I had it in my power to place the children under the care of proper nurses, to instruct these nurses in their duty, and to be satisfied that they performed it, very few of them died ; but when, from distance of place, and other unavoidable cir- cumstances, the children were left to the sole care of mercenary nurses, without any person to instruct or superintend them, scarce- ly any of them lived. This was so apparent, as with me to amount to a proof of the following melancholy fact; that almost one half of the human spe- cies perish in infancy, by improper management' or neglect. This re- flection has made me often wish to be the happy instrument of alle- viating the miseries of those suffering innocents, or of rescuing them from an untimely grave. No one, who has not had an opportunity of observing them, can imagine what absurd and ridiculous prac tices still prevail in the nursing and management of infants, and what numbers of lives are by that means lost to society. As these practices are chiefly owing to ignorance, it is to be hoped, that when nurses are better informed, their conduct will be more proper. The application of medicine to the various occupations of life has been in general the result of observation. An extensive prac- PREFACE. vii tice for several years, in one of the largest manufacturing towns in England, afforded me sufficient opportunities of observing the injuries which those useful people sustain from their particular em- ployments, and likewise of trying various methods of obviating such injuries. The success which attended these trials was sufficient to encourage this attempt, which I hope will be of use to those who are under the necessity of earning their bread by such employ- ments as are unfavourable to health. I do not mean to intimidate men, far less to insinuate that ever those arts, the practice of which is attended with some degree of danger, should not be carried on ; but to guard the less cautious and unwary against those dangers which they have it in their pow- er to avoid, and which they often, through mere ignorance, incur. As every occupation in life disposes those who follow it to some particular diseases more than to others, it is certainly of impor- tance to know these, in order that people may be upon their guard against them. It is always better to be warned of the approach of an enemy, than to be surprised by him, especially where there is a possibility of avoiding the danger. " The observations concerning Diet, Air, Exercise, &c. are of a more general nature, and have not escaped the attention of Phy- sicians in any age. They are subjects of too great importance, however, to be passed over in any attempt of this kind, and can never be sufficiently recommended. The man who pays a proper attention to these, will seldom need the physician; and he who does not will seldom enjoy health, let him employ as many physi- cians as he pleases. Though we have endeavoured to point out the causes of diseas- es, and to put people upon their guard against them, yet it must be acknowledged that they are often of such a nature as to admit of being removed only by the diligence and activity of the public ma- gistrate. We are sorry, indeed, to ob^rve, that the power of the magistrate is seldom exerted in this country for the preservation of health. The importance of a proper medical police is either not understood, or little regarded. Many things highly injurious to the public health are daily practised with impunity, while others, absolutely necessary for its preservation, are entirely neglected. Some of the public means of preserving health are mentioned in the general prophylaxis, as the inspection of provisions, widen- ing the streets of great towns, keeping them clean, supplying the inhabitants with wholesome water, &c.; but they are passed over in a very cursory manner. A proper attention to these would have swelled this volume to too large a size ; I have, therefore, reserved them for the subject of a future publication. In the treatment of diseases, I have been peculiarly attentive to reffimen. The generality of people lay too much stress upon Medi- cine, and trust too little to their own endeavours. It is always in the power of the patient, or of those about him, to do as much towards his recovery as can be effected by the physician. By not attending to this, the designs of Medicines are often frustrated, and the patient, by pursuing a wrong plan of regimen, not only de- feats the doctor's endeavours, but renders them dangerous. I have often known patients killed by an error in regimen, when they viii PREFACE. were using very proper medicines. It will be said the physician always orders the regimen, when he prescribes a medicine. 1 wish il were so, both for the honour of the Faculty and the satety of their patients; but physicians, as well as other people, are too little attentive to this matter. Though many reckon it doubtful whether physic is more benefi- cial or hurtful to mankind, yet all allow the necessity and importance of a proper regimen in diseases. Indeed, the very appetites of the sick prove its propriety. No man in his senses ever imagined that a person in a fever, for example, could eat, drink, or conduct him- self in the same manner as one in perfect health. This part of medicine, therefore, is evidently founded in Nature, and is every way consistent with reason and common sense. Had men been more attentive to it, and lesa solicitous in hunting after secret remedies, Medicine had never become an object of ridicule. This seems to have been the first idea of Medicine. The ancient physicians acted chiefly in the capacity of nurses. They went very little beyond aliment in their prescriptions ; and even this they gen- erally administered themselves, attending the sick for that purpose through the whole course of the disease ; which gave them an op- portunity, not only of marking the changes of diseases with great accuracy, but likewise of observing the effects of their different applications, and adapting'them to the symptoms. The learned Dr. Arbuthnot asserts, that by a proper attention to those things which are almost within the reach of every body, more good and less mischief will be done in acute diseases, than by medicines improperly and unseasonably administered; and that great cures may be effected in chronical distempers by a proper regimen of the diet only. So entirely do the Doctor's sentiments and mine agree, that I would advise every person, ignorant of physic, to confine his practice solely to diet, and the other parts of regimen; by which means h© May often do much good, and can seldom do any hurt. This seems also to have been the opinion of the ingenious Dr. Huxham, who observes, that we often seek from art, what all-boun- tiful Nature most readily, and as effectually, offers us, had we dil- igence and sagacity enough to observe and make ast of them ; that the dietetic part of medicine is not so much studied as it ought to be ; and that, though less pompous, yet it is the most natural meth- od of curing diseases. To render this book more generally useful, however, as well as more acceptable to the intelligent part of mankind, I have in most diseases, besides regimen, recommended some of the most simple and approved forms of medicine, and added such cautions and directions as seemed necessary for their safe administration. It would no doubt have been more acceptable to many, had the book abounded with pompous prescriptions, and promised great cures in consequence of their use ; but this was not my plan: I think the administration .of medicines always doubtful, and often dangerous, and would much rather teach men how to avoid the necessity of using them, than how they should be used. Several medicines, and those of considerable efficacy, may be administered with great freedom and safety. Physicians generally PREFACE. trifle a long time with medicines before they learn their proper use. Many peasants at present know better how to use some of the most important articles in the Materia Medica, than physicians did a century ago; and doubtless the same observation will hold with regard to others for some time hence. Wherever I was convinced that medicine might be used with safety, or where the cure de- pended chiefly upon it, I have taken care to recommend it; but where it was either highly dangerous, 'or not very necessary, it is omitted. I have not troubled the reader with a useless 'parade of quota- tions from different authors, but have generally adopted their ob- servations where my own were either defective or totally wanting. Those to whom I am most obliged are, Ramazina, Arbuthnot, and Tissot; the last of which, in his Avis au Peuple, comes the near- est to my views of any author which I have seen. Had the Doc- tor's plan been as complete as the execution is masterly, we should have had no occasion for any new treatise of this kind soon; but by confining himself to the acute diseases, he has in my opimon omitted the most useful part of the subject. People in acute diseases may sometimes be their own physicians; but in chronic cases, the cure must ever depend chiefly upon the patient's own en- deavours. The Doctor has also passed over the Prophylaxis, or pre- ventive part of medicine, very slightly, though it is certainly of the greatest importance in such a work. He had no doubt his reasons for so doing, and I am so far from finding fault with him, that I think his performance does great honour both to his head and to his heart. Several other foreign physicians of eminence have written on nearly the same plan with Tissot, as the Baron Van Swieten, physi- cian to Their Imperial Majesties; M. Rosen, first physician of the kingdom of Sweden, &c.; but these gentlemen's productions have never come to my hand. I cannot help wishing, however, that some of our distinguished countrymen would follow their example. There still remains much to be done on this subject, and it does not appear to me how any man could better employ his time or tal- ents, than in eradicating hurtful prejudices, and diffusing useful knowledge among the people. I know some of the Faculty disapprove of every attempt ot this nature, imagining that it must totally destroy their influence. But this notion appears to me to be as absurd as it is illiberal. People in distress will always apply for relief to men of superior abilities, when they have it in their power ; and they will do this with greater confidence and readiness when they believe that Med- icine is a rational science, than when they take it to be only a mat- ter of mere conjecture. ... , Though 1 have endeavoured to render this Treatise plain and use- ful, yet I found it impossible to avoid some terms of art; -but those are in general either explained, or are such as most people un- derstand. In short, I have endeavoured to conform my style to fhe capacities of mankind in general; and imy J«j£ *> ™ flatter either themselves or me, with some degree ot success, un a medical subject, this is not so easy a matter as some may ima- gine To make a show of learning, is easier than to wnte plain PREFACE. sense, especially in a science which has been kept at such a^dis- tance from common observation. It would, however, be no diffi- cult 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 express my warmest acknowledg- ments to those Gentlemen who have endeavoured to extend the usefulness of this Performance, by translating it into the language of their respective countries. Most of them have not only given el- egant translations of the Book, but have also enriched it with many useful observations ; by which it is rendered more complete, and better adapted to the climate and the constitutions of their coun- trymen. To the learned Dr. Duplanil of Paris, physician to the Couni d'Artois, I lie under particular obligations ; as this Gentle- mau has not only enlarged my treatise, but by his very ingenious and useful notes, has rendered it so popular on the Continent, as to occasion its being translated into all the languages of modern Europe. • I have only to add, that the book has not more exceeded my ex- pectation in its success than in the effects it has produced. Some of the most pernicious practices, with regard to the treatment of the sick, have already given place to a more rational conduct; and many of the most hurtful prejudices, which seemed to be quite insur- mountable, have in a great measure yielded to better information. Of this a stronger instance cannot be given than in the inocula- tion of the small-pox. Few mothers, some years ago, would sub- mit to have their children inoculated even by the hand of a Physi- cian ; yet nothing is more certain, than that of late many of them have performed this operation with their own hands ; and as their success has been equal to that of the most dignified inoculators, there is little reason to doubt that the practice will become gener- al. Whenever this shall be the case, more lives will be saved by inoculation alone, than are at present by all the endeavours of the Faculty.* * Allowance must here be made for the unacquaintance of the Author, at the time he wrote, with the blessings since derived from the inestimable discovery of vaccina- tion. The above observations nevertheless, will be equally good and applicable at the present day, by the simple substitution of one word for another, viz.—for Inoculation, to read Vacoiration. Ed. [»] INTRODUCTION. The improvements in medicine, since the revival of learning, have by no means kept pace with those of the other arts. The reason is obvious. Medicine has been studied by few, except those who in- tended to live by it as a business. Such, either from a mistaken zeal for the honour of medicine, or to raise their own importance, have endeavoured to disguise and conceal the art. Medical authors have generally written in a foreign language ; and those who are unequal to this task, have even valued themselves upon couching, at least, their prescriptions, in terms and characters unintelligible to the rest of mankind. The contentions of the clergy, which happened soon after the restoration of learning, engaged the attention of mankind, and paved the way for that freedom of thought and inquiry, which has since prevailed in most parts of Europe with regard to religious matters. Every man took a side in those bloody disputes; and every gentleman, that he might distinguish himself on one side or other, was instructed in Divinity. This taught people to think and reason for themselves in matters of religion, and at last totally destroyed that complete and absolute dominion which the clergy had obtained over the minds of men. The study of law has likewise, in most civilized nations, been justly deemed a necessary part of the education of a gentleman. Every gentleman ought certainly to know at least the laws of his own country : and, if he were also acquainted with those of oth- ers, it might be more than barely an ornament to him. The different branches of philosophy have also of late been very universally studied by all who pretended to a liberal education. The advantages of this are manifest. It frees the mind from preju- dice and superstition; fits it for the investigation of truth; indu- ces habits of reasoning and judging properly; opens an inexhaust- ible source of entertainment; paves the way to the improvement of arts and agriculture ; and qualifies men for acting with propriety in the most important stations of life. Natural History has likewise become an object of general atten- tion ; and it well deserves to be so. It leads to discoveries of the greatest importance. Indeed agriculture, the most useful of all arts, is only a branch of Natural History, and can never arrive a^ a high degree of improvement where the study of that science neglected. Medicine, however, has not, as far as I know, in any countr, been reckoned a necessary part of the education of a gentleman. But surely no sufficient reason can be assigned for this omission. No science lays open a more extensive field of useful knowledge, or affords more ample entertainment to an inquisitive mind. Anat- xii INTRODUCTION. omy, Botany, Chemistry, and the Materia Medica, are all branches of Natural History, and are fraught with such amusement and utility, that the man who entirely neglects them has but.a sorry claim either to taste or learning. If a gentleman has a turn for observation, says an excellent and sensible writer,* surely the nat- ural history of his own species is a more interesting subject, and presents a more ample field for the exertion of genius, than the natural.history of spiders and cockle-shells. We do not mean that every man should become a physician. This would be an attempt as ridiculous as it is impossible. All we plead for is, that men of sense and learning should be so far ac- quainted with the general principles of medicine as to be in a con- dition to derive from it some of those advantages with which it is fraught; and at the same time to guard themselves against the de- structive influence of Ignorance, Superstition, and Quackery. As matters stand at present, it is easier to cheat a man out of his life than of a shilling, and almost impossible either to detect or punish the offender. Notwithstanding this, people still shut their eyes, and take everything upon trust that is administered by any pretender to medicine, without daring to ask him a reason for any part of his conduct. Implicit faith, everywhere else the object of ridicule, is still sacred here. Many of the Faculty are no doubt worthy of all the confidence that can be reposed in them ; but as this can never be the character of every individual in any profes- sion, it would certainly be for the safety, as well as the honour of mankind, to have some check upon the conduct of those to whom they entrust so valuable a treasure as health. The veil of mystery, which still hangs over Medicine, renders it not only a conjectural, but even a suspicious art. This has been long ago removed from the other sciences, which induces many to believe that Medicine is a mere trick, and that it will not bear a fair and candid examination. Medicine, however, needs only to be better known, in order to secure the general esteem of mankind. Its precepts are such as every wise man would choose to observe, and it forbids nothing but what is incompatible with true happiness. Disguising Medicine not only retards its improvement as a sci- ence, but exposes the profession to ridicule, and is injurious to the true interests of society. An art, founded on observation, can never arrive at any high degree of improvement, while it is confined to a few who make a trade of it. The united observations of all the ingenious and sensible part of mankind, would do more in a few years towards the improvement of Medicine, than those of the Faculty alone in a great many. Any man can tell when a medi- cine gives him ease as well as a physician ; and if he only knows the name and dose of the medicine, and the name of the disease, it is sufficient to perpetuate the fact. Yet the man who adds one single fact to the stock of Medical observations, does more real service to the art than he who writes a volume in support of some favourite hypothesis. Very few of the valuable discoveries in Medicine have been made by physicians. They have in general either been the effect of * Observations on the Duties and Offices of a Physician. INTRODUCTION. ami chance or of necessity, and have been usually opposed by the Fac- ulty, till every one else was convinced of their importance. An implicit faith in the opinions of teachers', an attachment to systems and established forms, and the dread of reflections, will always op- erate upon those who follow Medicine as a trade. Few improve- ments are to be expected from a man who might ruin his charac- ter and family by even the smallest deviation from an established rule. If men of letters, says the author of the performance quoted above, were to claim their right of inquiry into a matter that so nearly concerns them, the good effects in Medicine would soon ap- pear. Such men would have no separate interest from that of the art. They would detect and expose assuming Ignorance under the mask of Gravity and Importance, and would be the judges and patrons of modest merit. Not having their understandings per- verted in their youth by false theories, unawed by authority, and unbiassed by interest, they would canvass with freedom the most universally received principles in Medicine, and expose the uncer- tainty of many of those doctrines, of which a physician dares not so much as seem to doubt. No argument, continues he, can be brought against laying open Medicine, which does not apply with equal, if not greater force, to religion ; yet experience has shown, that since the laity have assert- ed their right of inquiry into these subjects, Theology, considered as a science, has been improved, the interests-of real religion have been promoted, and the clergy have become a more learned, a more use- ful, and a more respectable body of men, than they ever were in the days of their greatest power and splendour. Had other medical writers been as honest as this gentleman, the art had been upon a very different footing at this day. Most of them extol the merit of those men who brought Philosophy out of the schools, and subjected it to the rules of common sense. But they never consider that Medicine, at present, is in nearly the same situation that Philosophy was at that time, and that it might be as much improved by being treated in the same manner. Indeed, no science can either be rendered rational or useful, without being submitted to the common sense and reason of mankind. These alone stamp a value upon science ; and what will not bear the test of these ought to be rejected. I know it will be said, that diffusing medical knowledge among the people might induce them to tamper with Medicine, and to trust to their cfwn skill, instead of calling a physician. The reverse of this, however, is true. Persons who have most knowledge in these matters, are commonly most ready both to ask and follow advice, when it is necessary. The ignorant are always most apt to tam- per with Medicine, and have the least confidence in physicians. Instances of this are daily to be met with among the ignorant peas- ants, who, while they absolutely refuse to take a metheme which has been prescribed by a physician, will swallow with greediness any thing that is recommended to them by their credulous neigh- bours Where men will act even without knowledge, it is certain- ly more rational to afford them all the light we can, than to leave them entirely in the dark. xiv INTRODUCTION. It may also be alleged, that laying Medicine more open to man- kind, would lessen their faith in it. This indeed would be the case with regard to some ; but it would have a quite contrary effect upon others. I know many people who have the utmost dread and hor- ror of every thing prescribed by a physician, but who will never- theless readily take a medicine which they know, and whose qual- ities they are in some measure acquainted with. Hence it is evident, that the dread arises from the Doctor not from the drug. Noth- ing ever can or will inspire mankind with an absolute confidence in physicians, but an open, frank, and undisguised behaviour. Whilst the least shadow of mystery remains in the conduct of the Faculty, doubts, jealousies, and suspicions, will arise in the minds of men. No doubt cases will sometimes occur, where a prudent physi- cian may find it expedient to disguise a medicine. The whims and humours of men must be regarded by those who mean to do them service ; but this can never affect the general argument in favour of candour and openness. A man might as well allege, because there are knaves and fools in the world, that he ought to take every one he meets for such, and to treat him accordingly. A sensible physician will always know where disguise is necessary; but it ought never to appear on the face of his general conduct. The appearance of mystery in the conduct of physicians not only renders their art suspicious, but lays the foundations of Quack- ery, which is the disgrace of Medicine. No two characters can be more different than that of the honest physician and the quack; yet they have generally been very much confounded. The line between them is not sufficiently apparent; at least it is too fine for the general eye. Few persons are able to distinguish sufficiently between the conduct of that man who administers a secret medi- cine, and him who writes a prescription in mystical characters and an unknown tongue. Thus the conduct of the honest physician, which needs no disguise, gives a sanction to. that of the villain, whose sole consequence depends upon secrecy. No laws will ever be able to prevent quackery, while people be- lieve that the quack is as honest a man, and as well qualified as the physician. A very small degree of medical knowledge, however, will be sufficient to break this spell ; and nothing else can effectu- ally undeceive them. It is the ignorance and credulity of the mul- titude, with regard to Medicine, which renders them such an easy prey to every one who has the hardiness to attack them on this quarter. Nor can the evil be remedied by any other means but by making them wiser. The most effectual way to destroy quackery in any art or sci- ence, is to diffuse the knowledge of it among mankind. Did phy- sicians write their prescriptions in the common language of the country, and explain their intentions to the patient, as far as he could -understand them, it would enable him to know when the medicine had the desired effect; would inspire him with absolute confidence in the physician ; and would make him dread and de- test every man who pretended to cram a secret medicine down his throat. Men in the different states of society, have very different views of INTRODUCTION. XV the same object. Some time ago it was the practice of this coun- try for every person to say his prayers in Latin, whether he knew any thing of that language or not. This conduct, though sacred in the eyes of our ancestors, appears ridiculous enough to us ; and doubtless some parts of ours will seem as strange to posterity. Among these we may reckon the present mode of medical pre- scription, which, we venture to affirm, will sometime hence appear to have been completely ridiculous, and a very high burlesque upon the common sense of mankind. 1- But this practice is not only ridiculous, it is likewise dangerous. However capable physicians may be of writing Latin, I am certain apotb.ecaries.are not always in a condition to read it, and that dan- gerous mistakes, in consequence of this, often happen. But sup- pose the apothecary ever so able to read the physician's prescrip- tion, he is generally otherwise employed, and the business of mak- ing up prescriptions is left entirely to the apprentice. By this means the greatest man in the kingdom, even when he employs a first-rate physician, in reality trusts his life in the hands of an idle boy, who has not only the chance of being very ignorant, but likewise giddy and careless. Mistakes will sometimes happen in spite of the greatest care ; but, where human lives are concerned, all possible methods ought certainly to be taken to prevent them. For this reason, the prescriptions of physicians, instead of being couched in mystical characters and a dead language, ought, in my humble opinion, to be conceived in 'the most plain and obvious terms imaginable. . Diffusing medical knowledge among the people would not only tend to improve the art, and to banish quackery, but likewise to •render Medicine more universally useful, by extending its benefits to society. However long Medicine may have been known as a science, we will venture to say, that many of its most important purposes to society have either been overlooked, or very little at- tPnded to The c»ro of diseases is doubtless a matter of great im- nortance but the preservation of health is of still greater. This is the concern of every man, and surely what relates to- it ought to be rendered as plain and obvious to all as possible. It is not to be supposed that men can be sufficiently upon their guard against dis- eases who are totally ignorant of their causes. Neither can the Wislalure in whose power it is to do much more for preserving KSk^health thai/can ever be done by the Faculty, exert that power with propriety, and to the greatest advantage, without some ^MTn ^^t^SSSad condition in life might avail them- selves of^^^^^^ medical knowledge; as it would teach them to avoTd the dangers peculiar to their respective stations; which is Xays easier fhan to remove their effects. Medical, knowledge,,jn- stead^f being a check upon the enjoyments of ^^J^ be said, that to live rationally is to live miserably. If WJJn^S SeTp?^ But «hi» Unot the fault of Medtetne. It proposes no xvi INTRODUCTION. rules that I know, but such as are perfectly consistent with the true enjoyment of life, and every way conducive to the real happiness of mankind. We are sorry indeed to observe, that Medicine has hitherto hardly been considered as a popular science, but as a branch of knowledge solely confined to a particular set of men, while all the rest have been taught not only to neglect, but even to dread and despise it. It will however appear, upon a more strict examina- tion, that no science better deserves their attention, or is more ca- pable of being rendered generally useful. People are told, that if they dip the least into medical knowl- edge, it will render them fanciful, and make them believe they have every disease of which they read. This I am satisfied will seldom be the case with sensible people; and suppose it were*, they must soon be undeceived. A short time will show them their error, and a little more reading will infallibly correct it. A single instance will show the absurdity of this notion. A sensible lady, rather than read a medical performance, which would instruct her in the management of her children, generally leaves them entirely to the care and conduct of the most ignorant, credulous, and superstitious part of the human species. No part of Medicine is of more general importance than that which relates to the nursing and management of children. Yet few parents pay a proper attention tp it. They leave the sole care of their tender offspring, at the very time when care and attention are most necessary, to hirelings, who are either too negligent to do their duty or too ignorant to know it. We will venture to affirm, that more human lives are lost by the carelessness and inattention of parents and nurses, than are saved by the Faculty; and that the' joint and well-conducted endeavours, both of private persons and the public, for the preservation of infant lives, would be of more advantage to society than the whole art of Medicine, upon its pres- ent footing. r The benefits of Medicine, as a trade, will ever be confined to those who are-able to pay for them ; and of course, the far greater part of mankind will be everywhere deprived of them. Physicians, like other people, must live by their employment, and the poor must either want advice altogether, or take up with that which is worse than none. There are not, however, anywhere wanting well-disposed people, of better sense, who are willing to supply the defect of medical advice to the poor, did not their fear of doin«- ill often suppress their inclination to do good. Such people are often deterred from the most noble and praise-worthy actions, by the foolish alarms sounded in their ears by a set of men, who, to raise their own importance, magnify the difficulties of doing good, find fault with what is truly commendable, and fleer at every attempt to relieve the sick which is not conducted by the precise rules of Med- ?h!L J^i! gentlemen m"f' however, excuse me for saying, that ha? tt 7™ 8»?h^eU^"Po.ed persons do much good; and Uiat their practice, which is generally the result of good sense and observation, assisted by a little medical reading, is frequently more rational than that of the ignorant retainer to physic, who desSses both reason and observation, that he may go Jong by rafc^and INTRODUCTION. xvii who, while he is dosing his patient with Medicines, often neglects other things of far greater importance. Many things are necessary for the sick besides Medicine. Nor is the person who takes care to procure these for them, of less im- portance than a physician. The poor oftener perish in diseases for want of proper nursing than of Medicine. They are frequent- ly in want of even the necessaries of life, and still more so of what is proper for a sick-bed. No one can imagine, who has not been a witness of these situations, how much good a well-disposed per- son may do, by only taking care to have such wants supplied. There certainly cannot be a more necessary, a more noble, or a more godlike action, than to administer to the wants of our felkwv- creatures in distress. While virtue or religion are known among mankind, this conduct will be approved; and while heaven is just, it must be rewardc ! Persons who do i ot choose to administer Medicine to the sick, may nevertheless direct their regimen. An eminent medical au- thor has said, That by diet alone all the intentions of Medicine may be answered.* No doubt a great many of them way; but there are other things besides diet, which ought by no means to be neglected. Many hurtful and destructive prejudices, with regard to the treatment of the sick, still prevail among the people, which persons of better sense and learning alone can eradicate. To guard the poor against the influence of these prejudices, and to instil into their minds some just ideas of the importance of proper food, fresh air, cleanliness, and other pieces of regimen necessary in diseases, would be a work of great merit, and productive of many happy con- sequences. A proper regimen, in most diseases, is at least equal to Medicine, and in many of them it is greatly superior. To assist the well-meant endeavours of the humane and benevo- lent in relieving distress; to eradicate dangerous and hurtful pre- judices; to guard the ignorant nnJ credulous against the frauds and impositions of quacks and imposters; and to show men what is in their own power, both with regard to the prevention and cure of diseases, are certainly objects worthy of the physician's attention. These were the leading views in composing and publishing the fol- lowing sheets. They were suggested by an attention to the con- duct of mankind, with regard to Medicine, in the course of a pretty long practice in different parts of this island, during which the au- thor has often had occasion to wish that his patients, or those about them, had been possessed of some such plain directory for reg- ulating their conduct. How far he has succeeded in his endeavours to supply this deficiency, must be left to others to determine: but if they be found to contribute in any measure towards alleviating the calamities of mankind, he will think his labour very well be- stowed. * Arbuthnot. TABLES OF WEIGHTS AND MEASURES USED IN WEIGHING MEDICINE, &C. The Pound } C twelve Ounces. Ounce f I eight Drachms. Drachm \ containS \ three Scruples. Scruple J I twenty Grains. The liquid measure also differs, one being 'proper for ale, the other for wine; the latter of which is adopted. The wine gallon is defined |by the laws of the kingdom, which is thus divided for medicinal purposes:— The Gallon. C. \ Fluid Onaee [ contains Fluid Drachm J %* Acid, alkaline, earthy, and metalic preparations, and salts of all kinds, should be kept in glass-stopped bottles. The degree of heat is measured by Fahrenheit's thermometer, and when a boiling heat is prescribed, it is that which is marked by the 212th degree. A gentle beat is between the ninetieth and hundredth. eight Pints. sixteen Fluid Ounces. eight Fluid Drachms. sixty Minims.* A TABLE OF PROPORTIONATE DOSES, REGULATED FOR ALL AGES. Ages. Suppose the common dose 1 Drachm. Proportionate Dose. Weeks 7 1-15 4 grains. Months 7 14 S8 1-12 1-8 1-6 5 grains. 8 grains. 12 grains. Years 3£ 7 S 14 21 63 77 100 1-4 1-3 1-2 2-3 i* 5-6 4-5 25 grains. 1 scruple. h drachm. 2 scruples. 1 drachm. 55 grains. 2£ scruples. 2 scruples. •■\H UTENSILS NECESSARY FOR THE FAMILY MEDICINE CHEST. 1. A two or three ounce graduated measure. *•' ^"f6 and email spatula for spreading ointments, plasters, &c. 3. Weights and scales; — a larger set to weigh ounces; —a smaller for grains,sera pies, and drachms. 4. A clyster syringe. 5. A pint marble mortar and pestle. 6. A half-pint glass do. 7. A slab of marble, or of Wedgewood's composition, for sundry purposes. 8. A minim glass, &c. &c. r uZ^n»"h51j,'!!i.i US8d for. measuring the smallest portions of liquids, marked at regular intervals J^SSnH'nnLlj ^ " 8°meti™>» deceiving, according to the nect of the vehicle whence they fall Sf«.n«»BUr",a,ni M J«"t twice as many drop, of L, tincture is required for fillip th/same measure as water. DOMESTIC MEDICINE, &c. &c. CHAP. I. OBSERVATIONS ON DIET, PARTICULARLY THAT OF THE COMMON PEOPLE. Experience proves, that not a few of the diseases incident to the inhabitants of this country, are owing to their mode of living. The vegetable "productions they consume fall considerably short of the proportion they ought to bear to the animal part of their food. The constant use of bread and animal substances excites an unnat- ural thirst, and leads to the immoderate use of beer and other stim- ulating Liquors, which generate disease, and reduce the lower orders of the people to a state of indigence. To teach the poor man how to live cheaper and better, is the design of the following pages. Though the common people of this country live at a greater expense than any where else, it does not follow that they live better. They are strong indeed, but by no. .means healthy * and it is found that, from an attach*™©*** «*» a particular mode of living, they are more liable to disease and death in foreign climates, than the inhabitants of any other country. It is certainly proper that the poor man should be instructed in every thing that can make his little earnings go as far as possible, or which can add to the comfort of himself and family. Nor can economy in living be deemed a trivial virtue, in a country where the richer depend on the cheapness of labour. It is alleged that the English are so much attached to their own modes of living, that no argument will induce them to make the smallest change. Habits are indeed obstinate things, especially those which relate to diet; but there are proofs that the English are not inflexible even in this matter. The mode of hving among the lower orders has been greatly changed in my time, and I am sorry to say, not for the better. Tne people of England have too much good sense not to listen to reason, provided due care were taken to instruct them. But here the people may be truly said "to perish for want of knowledge." No means have been used to give them proper instruction. Hurt- ful customs have been suffered to prevail, till they have struck such deep roots that it will not be an easy matter to eradicate them. The difficulty, however, is not insurmountable. A few experi- 20 OBSERVATIONS ON ALIMENT. ments of reform would have the effect to render it as agreeable as it is salutary. Adults have many old prejudices to overcome, but the case is different in regard to children. They may be taught to use any kind of food, and what they use when young, they mil love when old. If I can introduce a different method of feeding children, my purpose will be answered. This alone will, in time, effect a total change in the general mode of living. Particular attention has been paid to the substitutes for bread, as the scarcity of this article proves peculiarly distressing to the poor. It will appear from the following pages, that bread is by no means so much a necessary of life as is generally imagined, and that its place may, in many instances, be supplied by a variety of other farinaceous substances. GENERAL OBSERVATIONS ON ALIMENT. No creature eats such a variety of food as man. Intended for an inhabitant of every climate, he devours the productions of them all; and if they do not suit his palate, or agree with his stomach, he calls in the aid of cookery, an art peculiar to himself; by which many things that, in a crude state, would prove hurtful, or even poisonous, are rendered wholesome and salutary. The obvious division of food is into animal and vegetable. To say that man was intended by nature for using either the one or the other alone, would be absurd. His structure and appetite prove that he was formed for both. Judgment, however, is requi- site in adjusting the due proportion of each, so as to avoid the inconveniences arising from an extreme on either hand. Though animal food is more nourishing than vegetable, it is not safe to live on that alone. Experience has shown that a diet, consisting solely of animal food, excites thirst and nausea, occa- sions putrescence in the stomach and bowels, and finally brings on violent griping pains, with cholera and dysentery. Animal food is less adapted to the sedentary than the laborious, and least of all to the studious, whose diet ought to consist chiefly of vegetables. Indulging in animal food renders men dull, and unfit for the pursuits of science, especially when it is accompanied with the free use of strong liquors. The plethoric, or persons of a full habit, should eat sparingly of animal food. It yields far more blood than vegetables taken in the same quantity, and, of course, may induce inflammatory disor- ders. 1% acts as a stimulus to the whole system, by which means the circulation of the blood is greatly accelerated. I am inclined to think that consumptions, so common in England, are in part owing to the great use of animal food. Though pul- monary consumption is not, properly speaking, an inflammatory disease, yet it generally begins with symptoms of inflammation, and is often accompanied with them through its whole progress, But the disease most common to this country is the scurvy. One finds a taint of it in almost every family, and in some the taint is very deep. A disease so general must have a general cause, and there is none so obvious as the great quantity of salted BREAD. 21 animal food devoured by the natives. As a proof that scurvy arises from this cause, we are in possession of no remedy for that disease equal to the free use of vegetables. By the uninterrupted use of animal food, a putrid diathesis is induced in the system, which predisposes to a variety of disorders. I am fully convinced, that many of those obstinate complaints for which we are at a loss to account, and find it still more difficult to cure, are the effects of a scorbutic taint lurking in the habit. Improper diet affects the mind as well as the body. The choleric disposition of the English is almost proverbial. Were I to assign cause, it would be, their living so much on animal food. There is no doubt but this induces a ferocity of temper unknown to men whose food is chiefly taken from the vegetable kingdom. Though these and similar consequences may arise from the excess of animal diet, we are far from discouraging its use in mod- eration. In all cold countries it is certainly necessary; but the major part of the aliment ought, nevertheless, to consist of vegeta- ble substances. There is a continual tendency in animal food, as well as in the human body itself, to putrefaction, which can only be counteracted by the free use of vegetables. With regard to the proportion of vegetable food to that of ani- mal, great nicety is by no means required. It must vary according to circumstances, as the heat of the weather, the warmth of the climate, and the like. The vegetable part, however, where no- thing forbids, ought certainly to preponderate, and I think in the proportion at least of two to one. The excessive consumption of animal food is one great cause of the scarcity of grain. The food that a bullock iffords bears but a small proportion to the quantity of vegetable ma..er he consumes. I am no enemy to good fruit, as an article of diet; but the greater part of what is used in this country, by the lower orders of the people, is mere trash. Fruit should bo eaten in the early part of the day, when the stomach is not loaded with food, and it never ought to be eaten raw till it is thoroughly ripe. OF BREAD. Bread, or something resembling it, makes a part of the diet of all nations. Hence it is emphatically denominated the staff of life. It may, however, be used too freely. The late Dr. Fothergill was rf opinion, and I perfectly agree with him, that most people eat nore bread than is conducive to their health. I do not mean to ir sinuate that bread is unwholesome, but that the best things may prove hurtful when taken to excess. A surfeit of bread is more dan- gerous than one of any other food. Omnis rcpletio mala, repletio panis pessima. The French consume vast quantities of bread; but its bad effects are prevented by their copious use of soups and fruits, which have little or no share in the diet of the common people of England. One important use of bread is to form a mass fit for falling up the alimentary canal, and carrying the nutritious juices along that passage in such a state, as to render them fit to be acted upon by the lacteal absorbentsfVhich take up the nourishment, and convey 22 BREAD. it to the blood. In this light, bread may be considered as a soil from whence the nourishment is drawn. I do not say that bread contains no nourishment, but that its use, as an article of diet, does not solely depend on the quantity of nutriment it contains, but in some measure on its fitness as a vehicle for conveying the nutri- tious particles through the intestinal tubes. Hence it follows, that the finest bread is not always the best adapted for answering the purposes of nutrition. The richest food will not nourish an animal, unless the aliment- ary canal is sufficiently distended. A dog has been fed on the richest broth, yet could not be kept alive ; while another, which had only the meat boiled to a chip, and water, throve very well. This shows the folly of attempting to nourish men on alimentary powders and other concentrated food. The great art, therefore, of preparing food, is to blend the nutri- tive part of the aliment with a sufficient quantity of some light far- inaceous substance, in order to fill up the canal, without overcharg- ing it with more nutritious particles than are necessary for the support of the animal. This may be done either by bread, or oth- er farinaceous substances, of which there is a great variety, as will appear from the sequel. Bread is one of the most expensive modes of using grain, and not adapted to the narrow circumstances of the lower orders of the people, as it is burthened with two heavy additional charges, in passing through the hands of both the miller and the baker. Besides, the former often grinds down extraneous matter with the wheat, and the latter as frequently bakes it up with the addition of lime, chalk, alum, and other pernicious substances. Since the articles of diet have become branches of manufacture, the public neither know what they eat, nor what they drink. People imagine, as the finest flour contains the greatest quantity ot nourishment, that it must therefore be the most proper for making into bread; but this by no means follows. The finest flour comes the nearest to starch, which, though it may occasionally prove a good medicine, makes bad bread. Household bread, which is made by grinding down the whole grain, and only separating the coarser bran, is, without doubt, the most wholesome. The best household bread I ever remember to have eaten was in the county of York. It was what they call meslin bread, and con- sisted of wheat and rye ground together. I am not quite certain as to the proportion, but I think there might be two parts of the former to one of the latter. This bread, when well fermented, eats light, is of a pleasant taste, and soluble to the bowels. After usinir nJ£ S°me ?ears' * found that b'ead, made entirely of flour, was neither so agreeable to the palate, nor so conducive to health. whitened 'd™ " SD°iled to Plea«e the eye. The artificially wheat t' fnStv"^ bread'tho»gh ™de of the heart of the most De0;i^"nrefer7'ath/X°rSt °f *»?'> ?« this is the bread wh^h A lPrhT iff : , d]he P.°°rer sort wil1 eat no other. All the different kinds of grain are occasionally made into bread, some giving the preference to on* anj y "i b«t the dupe of prejudice, has, fLS fdT def mtT' favoured to represent oats as proper food for horses only. I wish the horses in England devoured a smaHer quantity of that grain, and the people more Few tWs would have a greater tendency to lessen the expense of livinl The oats in North Britain are of a superior qualfty, and I Zfe ^people will long have the sense to use them as^'an article oV fWnfp ^"i3 liukewise said to make the best food when boiled Snrano'tfaiTn.tSeiVeS,' **£ °f &U thl"^s " raakes the best pud tegferth'ni wLT^ h heart>\meal of h' sauce »cludedf for dumpWs fnd tZlliU tCS g°°d puddinSS wiI1 make g^d TheCount alsoremaps t T*^ SU?ply the PIace of bread- Indian com to^rL andt'h.tt ^ N^r°eS in Americ* Prefer wheat; that it Shit * ,Bavaria" Peasants prefer it to four or five shillTnls'pt ST'tha?™ h^ ^T™ at ab°Ut would cost only Tne nennv f Vk ' When made into flour' il highly nutritious7, and ST^S^oTi P°Und' and that it is scarcity, a large quantitv of th?c • known- During the late 'the aveVsion ^F^^^?^™ imPorted ■ *>St such is food to which theyTW 5 thls/o"ntry to every sort of tney are not accustomed, that they refused to BUTTER. 27 purchase it, and the merchants were very great losers by the importation. On the same principle the Germans, till within these few years, could not be induced to eat potatoes, though now they are become extremely fond of them. The American, the Italian, and the-German, all cook Indian corn, in the same way as the North Britain does his oatmeal, by making it into hasty-pudding. It may be eaten in a variety of ways. Some eat it with a sauce composed of butter and brown sugar, or butter and molasses. Others eat it with milk only. In either way it makes a good, cheap, and wholesome diet, by no means disagreeable to those who are accustomed to it. The only other grain we shall mention, as best when boiled, is buck-wheat: it is of a very mucilaginous nature, and, of course, highly nutritious. In several parts of Europe it constitutes a principal part of the food of the lower people. In former times it was eaten in Russia; not by the lower classes only; even the nobility made use of it. Boiled, and then buttered, it was such a favourite of the great Czar Peter, that he is .said seldom to have supped on any thing else. BUTTER. It has been said, that the English have a thousand religions, and but one sauce. It must be allowed that they use butter with almost every kind of food. Butter, though a good artiple of diet, may be used too freely, and in this country, I am convinced, that is the case. To weak stomachs it is hurtful, even in small quantities, and when used freely it proves prejudicial to the strongest. . Butter, like other things of an oily nature, has a constant tendency to turn rancid. This proc*-, by the heat of the stomach, is greatly accelerated, insomuch that many people, soon after eatins butter, complain of its rising in their stomachs, in a state SI d?8agreeableP Oils of every kind are with difficulty mixed with watery fluids. This is the reason why butter floats m the stomach, and rises in such an unpleasant manner. Persons afflicted with bile should use butter very sparingly. Some sceptical authors doubt whether or not aliment of any kind haTan effect on the bile. One thing, however, is certain, that many patients, afflicted with complaints which were supposed to b? occasioned by bile, have been completely cured by a total ^Sros^olerbilious complaints that I ever met with, were evidently occasioned by food that became rancid on the stomach as the cholera morbus, and the like. Nor can such complaints be cured, till the rancid matter is totally evacuated by vomiting and PUBu"§supposing butter did not possess the quality of becoming randd oT the ftomach, it may, nevertheless, prove hurtful ., dt": ton Oils of all kinds are of a relaxing quahty and tend to SlTthe action of digestion. Hence tte custom of giving rich Ss and fat meats to'persons who have a voracious appetite. 28 BUTTER. The free use of butter, and other oily substances, not only tendi t > relax the stomach, and impede its action, but to induce a debility of the solids, which paves the way to many maladies. In a country where two-thirds of the inhabitants lead sedentary lives, a debility of fibre must predominate. Whatever increases that debility ought to be avoided. Children, without exception, are disposed to diseases arisin* from relaxation. Butter, of course, ought to be given to them with a sparing hand. But is this the case 1 By no means. Bread and butter constitute a great part of the food of children, and I am convinced that the gross humours with which they are frequently U-oubled are partly owing to this food. As children abound with bTeaTaTid"buTterr10116 "' ^^ •*"*■* better *» tbem tba* I have been astonished to see the quantities of butter eaten by grosS women h0 Iead sedent hyel T tea-bread is gene* rally contrived so as to suck up butter like a spunge. What ZZZt^mmr8 and,muffinS ^ ™» devourPin a* mor^ng soaked with this oil; and afterwards complain of indigestion, when Dr^FnT CaT Whf WOUld °Verload *e stomach of a%loughman° ^ckheadTh " °f °Pimon» that b«"er produces thene/vous or a nroof „"f J-' S° ^T™ amonS the women of ^ country. As a proof of this it is often cured by an emetic. ' They munstCofta,Xn quantities' «cite nau«ea, and even vomiting. ■ Atiey must, of course, prove unfriendly to digestion. A DunS, ■ai or, we are told, can digest train oil. So may aa En£ t\oTo7T?e ^proper food for a ZldoT^ andthehTe bLtSr iT" fannaceous Stance., as the potato, flesh andI fiifc, «? ? * Vei*7 pi'°per addition' but eating it to The JSJ ♦ ' °f *l™°St GVGry description, is certainly wronL herrings, are ilht'er on the T^7 ^ °f fish' as salmon °* eaten without it. ** St°mach' and easier <%«ed, when I-ffi.^*^ atWetic ™« aten fresh than sahed^ S ahadde}lc*te' ^ less hurtful when £rtrr:d£H? ?5SOTS.» i !-= de.Lc.ive Hnr brave Lori S^eT """ ^^ malad^ s« Them ;- , , fanois, the sea-scurvy. -eel^o 8toa bTknow0/ Xl" T^T^ h"^ ** * with an equal quantity of hon^nd i, W ^ ' Wean is' to mix *« * may be given to childZ 7*-5? keGp rt for use' In this way Britain, this method of 5 ^ greater freedom. In North and, fromVc^mof p'S'T^kfth ^^ is ™» k-wn; ancient. provero, i take the custom to be very c^'itor^" nF0orn:?anlh;rtKU,' as When c^b-ed with «*■«« indigestible^ and pasS^* e&d, made with butte' » ---m* tr £5? ;r- - - "--; FRUITS AND ROOTS. 29 pass a pastry-shop, without treating her darling boy with some of. the dainties, and then wonders how he got the cough, or colic. I have known a man seemingly in perfect health, who, by eating a pennyworth of pastry, as he passed along the street, was seized with such an asthmatic-fit, that he was obliged to be carried home, and had nearly lost his life. This occurred whenever he inadver- tently ate any thing baked with butter. Every thing that proves very injurious to health, ought, as far as possible, to be prohibited, by laying a high duty upon it. A duty on pastry would be serving the public in more respects than one. It would save many lives, and lessen some tax on neces- saries. Cheese, as a diet, is likewise injurious to health. It should never be eaten but as a dessert. It occasions constipation, fires the blood, and excites a constant craving for drink. It is very improper for the sedentary, and hardly to be digested even by the athletic. If men will live on dry bread, poor cheese, salt butter, broiled bacon, and such like parching food, they will find their way to the ale-house, the bane of the lower orders, and the source of half the beggary in the nation. FRUITS AND ROOTS. Fruits and roots form a large class of the substit ites for bread. The latter, being produced under-ground, are less lial 'e to suffer from the inclemency of the seasons than grain. Men who wish to inflame the minds of the midtitude may inveigh against the substi- tutes for bread; but reason and sound sense say, the nore substi- tutes for bread, the better. When one fails, recourse can be had to another. In warm climates the inhabitants have many substitutes for bread: and as their seasons are more uniform than ours, they can generally depend on the plant, or whatever it is, proving product- ive. The plantain-tree, commonly called the Indian fig, which has from time immemorial been cultivated in South America, bears fruit of a sweetish taste, which will dissolve in the mouth without chewing. It is eaten either raw, fried, or roasted. When intended to supply the place of bread, it is gathered before it is ripe, and eaten either boiled or roasted. The banana is nearly of the same nature, but its fruit is greatly superior both in taste and flavour. The inhabitants of the South Sea, or Ladrone islands, are sup- plied with bread from a tree, which has been lately imported into our West India islands, and will, it is hoped, be found to answer the same purpose there. It has a slight degree of sweetness, but not much flavour. It resembles new bread, and requires to be roasted before it is eaten. Those who have tasted it, say, that it is in no respect superior to the potato. In some of the West India islands the inhabitants supply the place of grain by making bread from the root of a shrub, called the cassada, or cassava. Though, to my taste, this bread is very insipid, yet the natives are fond of it, to such a degree, that I have known some of them eat it, during their residence in England, in preference to the finest London bread. 30 FRUITS AND ROOTS. But the most general substitutes for bread in the West Indies * are the yams. There are three different species of this plant, the roots of which are promiscuously used for bread. They are said to be very nutritious, of easy digestion, and when properly dressed, are by some preferred to the best wheaten bread. The taste is somewhat like the potato, but more luscious. The negroes gene- rally eat them boiled, and beaten into a mash. The white people have them ground into flour, and make bread and puddings of them. They can be preserved for several seasons, without losine any of their primitive goodness. Of all the substitutes for bread in Europe, the potato is the most extensively useful. This plant is a native of Peru, and has been m Europe above two hundred years. Like most other importam discoveries, it made but slow progress, and is still far frorTbetng so generally cultivated as it deserves to be. It is indeed known"? most parts of Europe, but its culture is best understood in Ireland and the northern parts of England. At Harwich, however, "he SrIeLenCh/S glVCu l° ,the Dutch P°tatoes' brought over by^he packets between that place and Helvoet-Sluys. There is alight rn^bt root!" aDd "^ faV°Urable t0 the C"ltUre of that ™£ inrWnl™ P1T thrivCS in ever^ soi1' and seldom suffers from an inclemency of seasons, wo must blame ourselves if we suffer a famine to ex,st. Indeed no such thing ever can be, where due attention is paid to the culture of potatoef. A far grea er quanrity of farinaceous food can be raised on an acre of ground planted with potatoes, than sown with any kind of grfin It s not Kty7food0ahave Yeturnof forty for one- ™*ya--"o caTnlve ^tatoes"^ ' "° "** ** "" ^ f°r h™Z" who thiS^tha? tteTar.^ an insipid juice' which induces so™ to imnK mat they are not very nutritious. Facts, however are against this opinion. Some of the stoutest men we Tnow »™ brought up on milk and potatoes. Dr. PearsonTwho has besTowed some pains in analyzing this root, says, that potatoes and wZr dlffer'inT1? "T S&h' C&n " men compfete^ They ^^^^^T^ but n0t --eriallyUVX7 wh^must^elood6- klnd arC !he m°St nutritious; but the Irish, £flLm u g °d JUQSes' Slve the preference to the mealy The ^rthanTaT/the'^r?8 "^ °" the m°de of i3S$'J? Jl^r tbe s«hstance of potatoes consists of water, and tZTZertoiZethfs t ^ °f, CO°,king' Which -ost d5rn. ^nch5in^^;nd8j;I1b!1Hfe,Teud- In London' ther aie which accou^s m ^ J-t Cd bef°re ?°7 are brou^ht to mark<*. London potatoes g &t me&SUre for the bad a"d a variety of 0"he? things,) and during the summer, after their day's labour is donl the ensuing winter.—Were this „.»„ 1 rms'IIvhlcb 1S to serve them ers would fonsume b^SS^T,^^^ tbe Iab™'- facturing towns, and we shm,U L . supP^ the manu- four acres are sufficient for Wnv fnm°l^^^ '°,import- A« small quantity of land^m^g^ft £^ take but * practised here is to plant the notatoefin fi kingd°m- The way apart, and a foot apa?inTe ro* tZT'^6™ inches different qualities; on the Mis rather ii J in^ ab?Ut Me is °f parish, inclining to clay; but all fit fnX ' • heLVaIe'near the Planted in the hfw landf being S^M^EL*8 P°tat°eS *** will not live entirely without h~«? , e poor at Presem potatoes daily get„^us"mo,^'d J™"7 d° nTIreland» though were my »]«£ Jenerallv ad-S . m°re;,and J am Persuaded, ers in thVcounfr^Zolld l^fM,*™ Jm the labou- years age che poor in thisDat «? th le °r no corn« Th"ty "OJJ. if V co'uld ge" ^S£^a^ ^ Cat ^ ^?ffTS|^t M>r—™ this letter, every by liberal and^UgZned\lZi Tf!, huma*»ty, as well S ^^.thattheexaml^tte^J^.^^ add an earnest may be followed by every ma„7l2 fC and benevolent writer considerable farmed in S^X^ PlDpeTt7' and by every ~X^^tt^* b-adeinto bread, wi,l a friend of mine sent me a g« ta™e afte'rh hTh ^ ^i 4» oven, on account of its singulafiLe T S ♦ ^ r°asted in « some other things of the like kinK J Imd ll on a shetf amon* them many yeL after,tTfinJ"^^ ""l^^ ™«i3 dry as a bone. On crating ? ,hT P ® qmte fresh> though a! as fit for making soupa?h2™> W&S perfectI^ ^eetfand that nothing made into bread would h* *? r°aSted* * aPPrehend Posterity will hardly beheve th«t kept S° lon& felt m Britain, at a tii/e when it w i SCamty °f br^ad c™™ be itv of farinaceous food could I kn™nthat a sufficie*t quan! inhabitants of the whole island b%laised " one county forTe does ne, *.. a M ,£ X ^^^JJ^l!^ FRUITS AND ROOTS. 03 The Jerusalem artichoke is a native of Brazil, but having been long cultivated in this country, it is too well known to need any description. From its taste, which is like that of artichoke-bot- toms, it would seem to be nutritious, and is far from being unpleas- ant to the palate. Some reckon it windy, but this may be cor- rected in the cooking, by warm spices; and as the plant is very productive, we would recommend it to be used in the same man- ner as potatoes, and the other farinaceous roots. Of the esculent roots in this country, the parsnip is reckoned the most nourishing. It is likewise of easy digestion, and is agreeable to most palates. Some, indeed, dislike it on account of its sweetness; but that is a proof of its nutritive quality, sugar being the most nourishing thing in nature. We are told that, in the north of Ireland, the poor people make beer from this root. There is not any plant that affords a more striking proof of the benefits of culture than the turnip. In its wild state it is good for little or nothing; but when properly cultivated, it not only affords wholesome nourishment for man, but furnishes the principal win- ter-food for cattle. There is a species of this plant which grows in North Britain, called the yellow turnip, which is sweet, and of a superior quality to those produced in the south, particularly about London, which are bitter and stringy. The yellow turnip is the most nourishing, and also the most hardy in sustaining the winter. It is eaten with milk to cure the consumption and scurvy. Margraaf says, he could extract no sugar from the turnip, which affords ground to conclude, that it is not so nutritiye as certain' other roots. Not only the root of the turnip, but the tops, when young, make very pleasant greens. The sprouts, if gathered when very tender, make an excellent salad. The carrot, like the turnip, is good for little in its natural state, being small, tough, and stringy. Manured, it grows large, succu- lent, and of a pleasant flavour. It ought, however, to be eaten young, otherwise it lies on the stomach, and is hard of digestion. It is an ingredient in several soups, and, being solid, may in some measure supply the place of bread. Salsafy, skirrets, and the several kinds of beets, are all pleasant and nourishing. They are likewise of easy digestion, and may be dressed in a variety of ways. Margraaf has, by experiments, discovered, that both skirrets and beets contain a considerable quantity of sugar. Though the extracting a saccharine salt from these plants may be no object while we possess the West India islands, yet it serves to show that they possess a quantity of nutri- tious matter, sufficient to give them a rank among the articles cal- culated to supply the place of bread. The onion, we are told, was a great favourite in Egypt four thousand years ago, and Dr. Hasselquist says, it is not to be Won- dered at, for whoever has tasted the onions of Egypt must allow that none can be better in any part of the globe. There, he says, they are sweet, though in many countries they are strong and nau- seous. There they are soft, whereas in northern countries, they are hard, and their coats so compact, that they are difficult to digest. This very quality may, however, recommend them in countries where food is scarce. The Doctor observes, that the B2 34 BROTHS AND SOUPS. Turks eat them roasted with their meat as we do bread, aad are so fond of them that they wish to be indulged with this dish in Paradise. From the Doctor's account one would be induced to believe that the onion used in Egypt was of a different species from ours; but I am rather inclined to think it may depend on the mode of cul- ture, as well as on the warmth of the climate and the difference of so,!, as we find in the southern parts of Europe they are mflder han in the more northerly. In Spain they are very mild and a be remedied, by eatinz a few ,,» Z t i Br^ant aVs< 'his may whieh will ek/ctlXlylZmZ^ltZ ^f^^^ly-Ael " ThiTV1'61" W "" ™" ^^ 0?,^s,0mach.0m0nS• a"d llke- ro„Tl%t6U ereflyalSeaeC,kh0e°e,d T* J"**-*-1 but « *• the present iheado& iST™ of " c°mes »"^' with a large qu££5^fl££" i P1T °f Salt beef, stewed opinion the leek i no L ' \s, a Ver^ favourite dish. In my toV The^lsTo^fS1 ir' "*• whe" aS * dese™ wholesome, or that gives it a betted fl» g°GS T° TUV that is '"ore m many respects Ih^^^^^^- They are SeVe^ ^ ^ "» «» ^Tnr:; rny^thTp^eJo ^^^^.t^assi dhat the ^"g °f « a considerable quLtity of^SdlZt^T ^^ extricat«« duce flatulency. ' d makes them less liable to pro- «™«^^ PJ-ts which might sufficient to show how liberal nn?,f• • • * above sPecimen is ood, provided he will take the troublf nf W, SUpp1^ man ™h it. Mr. Bryant, in his hisTorvo■! °f, CUltlVatinS and coking ief« hundred and fifty eih of w.f S""18' e"u™ratef nourishment, and may -ce^,?^^ ^ol.ome BROTHS AND SOUPS extremely dehaous, yet it ig not 1^^ in"^ * considered Is vourite ,n th« country. Here BROTHS AND SOUPS. 35 the people are fond of what they call solids; yet those very solids, they make into broth, by swallowing as much drink after them as they can get. The only difference is, the foreigner makes his broth in a pot, and the Englishman makes his in the stomach. A very sensible anonymous writer observes, that in England a pound of meat makes simply a pound of food; whereas in any other country in Europe, that quantity of animal food, when stewed down with vegetables and Scotch barley, will produce an ample meal for half a dozen people. Hence he justly infers that, among the variety of schemes which may have been devised by the humane for relieving the distresses of the poor, a better and more extensive charity cannot be devised than that of instructing them in a new mode of cookery. The same author adds, that the result of his experiments on this subject had exceeded his most sanguine expectations, and that each day gave him fresh proofs of the excellency of his plan for teaching the poor and needy to find themselves in a wholesome and palatable diet, at the cheapest rate, in which little or no bread was required. He concludes by asserting, that there is scarcely a place in this kingdom, where twenty persons may not have a wholesome, hearty, palatable meal, for three shillings. This anonymous letter is followed by one from Colonel Poynter, two from Dr. Johnson, of the royal hospital at Haslar, addressed to Admiral Waldegrave, and one from the Admiral himself, written- for insertion in a public paper. They contain a variety of receipts for making cheap, wholesome, and nourishing dishes for the poor. These dishes consist chiefly of broths, soups, and stews, or what they call pottage, and are calculated to make a hearty and plenti- ful meal without bread or drink. I am inclined to pay the more attention to these letters, as they seem all to have been written by gentlemen of observation. The pamphlet is sold by Longman and Debrett, for a charitable purpose, at the small price of three-pence. The writer who has paid most attention to the improvement of cookery, for the benefit of the poor, is Count Rumford. In his economical and philosophical essays, he has given such a variety of forms for making wholesome, cheap, and nourishing soups, stews, and other dishes for common use, that little more seems necessary to be said on the subject. I shall only observe, that the mode of living on broths, soups, hasty-pudding, and such like, so warmly and justly recommended by the Count, has been prac- tised in the northern parts of this kingdom from time immemorial. There the food of the common people is hasty-pudding, with milk, for breakfast and supper, and broth, with vegetables and meat, for dinner The poorer sort often make broth without meat; but they all use vegetables in great abundance, and sometimes they supply the place of meat with butter. As the hasty-pudding and milk make a complete meal, no bread is necessary either at supper or breakfast; nor is much required at dinner, as the broth is made thick with barley, cabbage, and a variety of other vegetables or oot-herbs. Cabbage is a favourite ingredient ma Scotchman s Kroth It is seldom made without this article, which is not eaten Jo early as in England. It is there suffered to grow to maturity, 36 BROTHS AND SOUPS. and, when that is the case, there is no plant more productive. This the Germans know well, and make it into saur kraut, one of the best antidotes against the scurvy with which we are ac« quaint ed. This kind of diet not only saves bread but drink. The labourer who lives on hasty-pudding and soups, seldom has occasion for drink; while he who is burnt up with dry bread and cheese, or salt meat boiled, has a continual thirst, and spends the greater part of his earnings in liquor. This, by acting as a powerful stim- ulus, may make him do more work for some time, but it generally cuts him off in the middle of his days. The English labourer. who works hard and drinks hard, seldom lives long, and is an old man when he should be in his prime. The roasting of meat is a wasteful mode of cookery, which ought to be avoided by the poorer sort of people, as much of the substance, and the most nutritive parts, are lost by scorching and what flies off by evaporation. 6 I know it will be said, that I recommend slops in place of solid rood. 1 hey are such slops, however, as the greatest heroes of antiquity lived upon; and though I have visited most parts of the island, I know of no better men than those who live in the manner longer lived ^ *" ^ PG.ple any where more healtty, or Broth is not only a dish of great antiquity, but one that can bf a^mJ11 &frGat Vau?ty °fLWa^s' II receives into its compositior animal and vegetable substances of every kind that are used ii met, and it may be seasoned so as to suit every palate. Indeed SlJfonH rl£ accus,tomed to eat broths properly made, are gene rally fond of them for their whole lives. SouthTrilin6 diffi?ult t° assign a reason why the inhabitants of nadons T t should ^J*6 a dish so much relished by other nations. Custom, no doubt, settles all these things ; but hoW cus- toms arise, is not so clear a matter. If an alteration in diet is to be introduced with effect, it must begin with children Whatever men are accustomed to eat when young, they generally mefel 21 he rest of their lives. Were the cMldfen in^outhKktug„ to eat hasty-pudding, with milk, for breakfast and supper and What parents love themselves, they generally eive to their M..1 dren, without any regard to its being proper fo^hem or not i inTjez:J:te:t :ho was f?nd of/tr°^beer* ™s £ son,* J tea? doef not mil tl^ Tf'L "!? the mother' who flights in herself! By thL co/dTct th°P ^ ^^ Whenever she takes * 4 daughter sips tea in placfo^soirf^0"168, I tippler' and th« -pours andP other ne^voirdisorders^' ^ She is Caten Up ™th ^BS£^LSS' tor0wnichUtPhiS ^ C°mmon breakfa* Of This he avers £ SSly D«feS.lP * T™'10™11* add bread. «.. wash, tea, .ith &?£*£% S^^££S^i REMARKS. 37 this island, drench their stomachs, and ruin their constitutions. He adds, that a simple infusion of this drug, drank boiling hot, as the poor generally drink it, is certainly a poison, which, though it be sometimes slow in its operation, never fails to produce fatal effects, even in the strongest constitution, where the free use of it is continued for a considerable length of time. The German on his polenta, the American on his mush, and the North Britain on his hasty-pudding, can make a hearty breakfast for a tenth part of what a tea-breakfast would cost, while it is infinitely more wholesome. It has likewise the advantage that no bread is necessary. I have been often told, when recommending soups to the poor, that they had not time to make them, and that they could not afford fuel on account of its price, as it is dear in great towns. They can, however, find fuel twice a-day to boil a tea-kettle, and time to make the tea, which is a more tedious operation, by far, than making a mess of hasty-pudding. For a great part of the year even the poorest person must have a little fire ; and it would require no more to make a comfortable mess of soup, which is always best when made with a slow fire. The mode of living that I would recommend to the lower orders of the people, with a view to save expense and improve their health, is to substitute occasionally other farinaceous substances in the place of bread, as potatoes, &c. to give up in a great meas- ure the use of roasted, baked, and broiled meats, and to supply their place with broths, soups, stews, and such like, made with a little meat and plenty of vegetables; to give it to children, and to grown people who will eat it for breakfast, milk-porridge, or hasty- pudding with milk, small-beer, or molasses. This will be found a more wholesome breakfast than tea, while it is much cheaper and requires no bread.* REMARKS. Although the place of bread may be occasionally supplied by farinaceous roots and other vegetables, yet wewould by 1.0 means wish to discourage the culture of grain. The culture of grain is the culture of men. While the husbandman is raising few minutes a kind,of warm soup m the stomacn. ana a e in too Bame temperature during the whole day ? Be ""JJ^1 J^wllh great advantages. great quantity at one time, or two watery. It 1' a™."^ a^°men ^d all those who ft supplies the place of drink, particularly to ™«» ^.le'if0n'Xn thiy give over soup, do not drink, or drink very little except at ^ *"d. ^^ remarked, that fluiS receive into their blood too little m^^„^^l^^^^Zic^i^i when used in the form of soups unite much better and ■«»"« £™ °"f ^ ss and rigid. drunk cold and raw. On this account soup is a great pre Tentative ot drynessa g ity in the body, and, therefore, the best nourish ™nt forold P^|nd «io ^ of\n arid temperament It even suppliesthe.place of a ^'£B£e ^macb.waro cold, in nervous head-aches, colics, and different kinds of crampm least'hanB_ .-oup is of excellent service. It may serve " ■ P™ofX* r^Snly nad more strength lesLss of soup, when I remark hat our forefathers who ^J^ ^ ^ d^li'e ,S°anPd' thS Sthe' o^A with Whom I ever was acquainted than we have, thos« in refined were great friends to it 38 REMARKS. food for his fellow-creatures, he is laying the foundation of health and longevity to himself and his offspring. Innumerable benefits are connected with the culture of grain. While the artificer is sit- ting in some awkward posture, breathing confined, and, perhaps, contaminated air, the cultivator of the soil rises with the sun, eats his wholesome meal of milk and farinaceous food, hies him to the field, where he spends the day in useful labour, inhales the fresh breezes, and at eve returns home with a keen appetite, to enjoy his simple repast and sound repose. It has been said, as artificers can earn more money than those who cultivate the ground, that arts ought to be encouraged, and grain, if necessary, imported. No manufacture is equal to the manufacture of grain. It supplies food for man and beast, while the surplus, by being exported, enriches the nation. Nor is it subject to the uncertainty of other manufactures. They often de- pend on fashion and caprice, but the necessaries of life will always find their value somewhere. Though I am convinced that some regulations are wanting for the encouragement of agriculture, I do not consider it as my province to dictate to the wisdom of the le- gislature. They know their duty, and I have reason to believe that they are inclined to pay it all due attention. I will venture, however, to assert, that if proper encouragement were given to agriculture, Britain would at all times not only have a sufficiency of grain for her own consumption, but a surplus for exportation. This would contribute more to her real wealth, the happiness of her people, and the stability of her government, than either the increase of her trade, the flourishing of her manufac- tures, or the extension of her territory. It is a matter of real regret and wonder that Britain, at a time when agriculture is cultivated as a science, should not be able to raise grain for the supply of her own inhabitants, but become every year more dependent on foreign states for even the necessaries of life. Until an adequate remedy can be found for this growing evil, the free use of the various substitutes for bread, cannot fail to alleviate the calamities of the poor, and to reduce the price of labour. The great consumption of animal food, and the immense num- ber of horses kept in this country, are to be reckoned among the causes of the scarcity of grain. Mr. Mackie computes the number of horses in this country to be about two millions, and that every horse, on an average, consumes the produce of three fertile acres, consequently the produce of six millions of fertile acres is annually consumed by horses. These would produce a quantity of grain more than sufficient to maintain half the inhabitants of Great Britain. 1 wo hundred and sixty thousand of these animals are kept for pleasure. I shall be told that they contribute to health. That I ?uny'v u °Ur ladjes of fashion and fine gentlemen make use of le'u SunStfdu0f bfing dra^ed about in carriages, they would both benefit themseves and the public. I shall conclude these remarks with the advice of the humane and benevolent Thorn- son :— FOOD CONSIDERED. 39 " Ye gen'rous Britons ! venerate the plough, And o'er your hills and long withdrawing vales Let Autumn spread her treasures to the eun. Luxuriant ana unbounded. As the sea Far through his azure turbulent domain Your empire owns, and from a thousand shores Wafts all the pomp of life into your ports 3 So with superior boon may your rich soil Exub'rant Nature's better blessings pour O'er ev'ry land, the naked nations clothe, And be the exhaustless gran'ry of a world." POOD CONSIDERED IN A MEDICAL POINT OF VIEW. Under this point of consideration, the most remarkable distinc- tion of foods is into those which are already assimilated with the animal nature, and into those that are not. Animal substances, generally, are of the first kind, which, although not entirely simi- lar, are nearly so to our nature. Of the second kind are vegetables, which, with much more difficulty are assimilated. But as the nourishment of all animals can be originally traced to the vegeta- ble kingdom, it becomes evident that the principle of all nutrition exists in vegetables. In the first edition of his Materia Medica, Dr. Cullen observes, that though there is, perhaps, no vegetable which does not afford nourishment to some species of animals or other, yet, with regard to mankind, a very considerable distinction is to be made. Those vegetables that are of a mild, bland, agreeable taste, are proper nourishment, while those of an acrid, bitter, and nauseous nature, are improper. We use, indeed, several acrid substances as food, but as spices or condiments, which answer the purpose of medi- cines, rather than any thing else; although, not unfrequently, acrid and bitter acrid vegetables are admitted as food. For instance, celery and endive are used in common food, though both are substances of considerable acrimony ; but it must be observed, that wnen we use them, they are previously blanched, which almost totally destroys their acrimony. Or, if we employ other acrid substances, we generally, in a great measure, deprive them of their acrimony by boiling. In different countries the same plants grow with different degrees of acrimony. Garlic, for example, seldom, in this country, enters our food ; but in southern countries, where this plant grows more mild, it is frequently used. The plant which furnishes casada, which, in its recent state, is of a very poisonous and acrimonious nature, affords an instance of the necessity of preparing acrid substances, even in hot countries ; and there are other plants, such as the wake-robin, which, in their natural state, are so acrimonious, that they cannot be swallowed with safety ; yet, when deprived of that acrimony by boiling, afford good nourishment. DIFFERENCES BETWEEN VEGETABLE AND ANIMAL FOOD. Vegetable differs from animal food in several respects. 1st, It has a greater tendency to acidity; whilst animal food of all kinds inclines more to alkalescency and putrefaction. 2d, With regard to their difference of solution in the stomach, heaviness, a« 40 ON SEDENTARY, STUDIOUS, it is called, is seldom felt from vegetables, except from tough far- inaceous paste, or the most viscid si.ostances ; while heaviness from animal food is more frequently ngticed, especially when taken in any great quantity. 3d, With regard to mixture, there is no instance of difficult mixture in vegetables, except in vegetable oils; while animal food, especially the fatter meats, both from viscidity and oiliness, are in this respect refractory. 4th, When the putrescency of animal food has proceeded so far, it produces an active stimulus, causing diarrhoea, and dysentery. These effects are, however, but of rare occurrence ; whereas from vegeta- ble food and its acid, which, united with bile, proves a pretty strong stimulus, they more frequently occur ; fortunately, however, they are of less consequence, if the degree of refrigeration be not very great. 5th, Wherever neither putrefaction nor acidity has gone to any great length, animal food keeps the belly more regu- lar, &c. 6th, Vegetable food gives a greater proportion of succu- lent matter, and, when exsiccated by the stomach and intestines, is more apt to stagnate and produce slow belly and costiveness, than stimulating animal food, which, before it reaches the large intestines, where stoppage is made, it has obtained a putrefactive tendency, and gives a proper stimulus; thus, those who are cos- tive from the'use of vegetables, when they return to animal food, are considerably ameliorated in their natural bodily health. See " Natural and Medical Dieteticon, or Practical Rides for eating and drinking, fyc." By J. S. Forsyth, fyc, p. 63—67. Independent of the preceding observations, it is generally pretty well known, that animal food is far more nutritive than vegetable, although they both produce a blood of the same kind but different in quality. The former affords a more dense stimulating elastic blood than the latter, which stretches and causes a greater degree of resistance in the solids, as well as excites them to stronger action. CHAP. II. REMARKS ON SEDENTARY, STUDIOUS, AND LABO- RIOUS OCCUPATIONS, * ^ * AND LABORIOUS OCCUPATIONS, &c. 41 rendered unfit for expanding the lungs sufficiently, and answering the other important purposes of respiration. Hence proceed asth- mas, coughs, and pulmonary complaints, so incident to persons who follow these employments. To prevent such consequences as far as possible, the places where these occupations are carried on ought to be constructed in such a manner as to discharge the smoke and other exhalations, and admit a free current of fresh air. Such artists ought never to continue long at work ; and when they give over, they should suffer themselves to cool gradually, and put on their clothes before they go into the open air. They ought never to drink large quan- tities of cold, weak, or watery liquors while their bodies are hot, nor to indulge in raw fruits, salads, or any thing that is cold on the stomach.* Miners, and all who work under-ground, are likewise hurt by unwholesome air. The air, by its stagnation in deep mines, not only loses its proper elasticity, and other qualities necessary for respiration, but is often charged with such noxious exhalations as to become a most deadly poison. The two kinds of air which prove most destructive to miners, are what they call the fire-damp, and the choak-damp.i In both cases the air becomes a poison by its being loaded with noxious gas.t 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 carried off by promoting a free circulation of air in the mine. . Miners are not only hurt by unwholesome air, but likewise Dy the particles of metal which adhere to their skin, clothes, &c. These are absorbed, or taken up into tl i body, and occasion pal- eies, vertigoes, and other nervous affections, which often prove fatal. Lead, and several other metals, are likewise very perni- cious to the health. Miners ought never to go to work fasting, nor to continue too long at work. Their food ought to be nourishing, and their liquor generous : nothing more certainly hurts them than living too low. They should by all means avoid costiveness. This may either be dene by chewing a little rhubarb, or taking a sufficient quantity of salad oil. Oil not only opens the body, but sheathes and de- fends the intestines from the ill effects of the metals. All who work in mines or metals ought to wash carefully, and to change their clothes as soon as they give over working. Nothing would » When persons heated with labour, have drunk cold liquor, they ought to continue Vn£ a^'EnS'-V which miners distinguish damps. The choak-damp «. 42 ON SEDENTARY STUDIOUS, tend more to preserve the health of such people than a strict, and almost religious, regard to cleanliness. Plumbers, painters, gilders, smelters, makers of white lead, and many others who work in metals, are liable to the same diseases as miners ; and ought to observe the same directions for avoiding them. Tallow-chandlers, boilers of oil, and all who work in putrid ani- mal substances, are likewise liable to suffer from the unwholesome smells or effluvia of these substances. They ought to pay the same regard to cleanliness as miners ; and when they are affected with nausea, sickness, or indigestion, we would advise them to take an emetic or a gentle purge. Such substances ought always to be manufactured as soon as possible. When long kept, they not only become unwholesome to those who manufacture them, but likewise to people who live in the neighbourhood. It would greatly exceed the limits of this part of our subject to specify the diseases peculiar to persons of every occupation ; we shall, therefore, consider mankind under the general classes of Laborious, Sedentary, and Studious. ON VARIOUS EMPLOYMENTS, &C. Though the working classes are in general the most healthy of all mankind, yet the nature of their occupations, and the places where they are carried on, expose them more particularly to some diseases. Husbandmen, for example, are exposed to all the vicis- situdes of the weather, which, in this country, are often very great and sudden, and occasion colds, coughs, quinsies, rheumatisms, fevers and other acute disorders. They are likewise forced to work hard, and often to carry burdens above their strength, which, by overstraining the vessels, occasion asthmas, ruptures, pleuri- sies, &c. Those who labour without doors are often afflicted with inter- mitting fevers or agues, occasioned by the frequent vicissitudes of heat and cold, poor living, bad water, sitting or lying on the damp ground, evening dews, night air, i. ing will be done for the safety'ofuJir se "ante ' °WD intere8t' "otb' INCLINED POSTURE INJURIOUS. 47 addition of several candles, which tend to waste the air, and render it less fit for respiration. Air that is breathed repeatedly, becomes unfit for expanding the lungs. This is one cause of the phthisical coughs, and other complaints of the breast, so frequent among sedentary artificers. Even the perspiration from a great number of persons pent up together, renders the air unwholesome. The danger from this quarter will be greatly increased, if any of them happen to have bad lungs, or to be otherwise diseased. Those who sit near the person so affected, being forced to breathe the same air, can hardly fail to be infected. It would be a rare thing, however, to find a dozen of sedentary people all in good health. The danger of crowding them together must, therefore, be evident to every one. INJURIOUS EFFECT OF LONG INCLINED POSTURE, &.C. Many of those who follow sedentary employments are constantly in a bending posture, as shoemakers, tailors, cutlers, &c. Such a situation is extremely hurtful. A bending posture obstructs all the vital motions, and of course must destroy the health. Accordingly we find such artificers generally complaining of indigestions, flatu- lences, head-achs, pains of the breast, &c. The aliment in sedentary people, instead of being pushed for- wards by an erect posture, and the action of the muscles, is in a manner confined in the bowels. Hence indigestions, costiveness, wind, and other hypochondriacal affections, are the constant com- panions of the sedentary. Indeed none of the excretions can be duly performed where exercise is wanting; and when the matter which ought to be discharged in this way is retained too long in the body, it must have bad effects, as it is again taken up in the mass of humours. A bending posture is likewise hurtful to the lungs. When this organ is compressed, the air cannot have free access into all its parts, so as to expand them properly. Hence tubercles, adhesions, &c. are formed, which often end in consumptions. Besides, the proper action of the lungs being absolutely necessary for making good blood, when that organ fails, the humours soon become uni- versally depraved, and the whole constitution goes to wreck. Being of a soft texture, and in continual action, their functions are easily obstructed by pressure. The sedentary are not only hurt by pressure on the bowels, but also on their inferior extremities, which obstructs the circulation in these parts, and renders them weak and feeble. Thus tailors, shoemakers, &c. frequently lose the use of their legs altogether: besides, the blood and humours are, by stagnation, vitiated, and the perspiration is obstructed; whence proceed the scab, ulcerous sores, foul blotches, and other cutaneous diseases, so common among sedentary artificers. A bad figure of body is a very common consequence of close application to sedentary employments. The spine, for example, by being continually bent, puts on a crooked shape, and generally remains so ever after. But a bad figure of body has already been observed to be hurtful to health, as the vital functions are thereby impeded. 48 SEDENTARY HABITS, See. A sedentary life seldom fails to occasion an universal relaxation of the solids. This is the great source whence most of the diseases of sedentary people flow. Scrophula, (king's evil,) consumption, hysterics, and other nervous diseases, now so common, were very little known in this country before sedentary artificers became so numerous; and they are very little known still among such of our people as follow active employments without doors, though in large towns at least two thirds of the inhabitants are afflicted with them. It is very difficult to remedy those evils, because many who have been accustomed to a sedentary life, like rickety children, lose all inclination for exercise: we shall, however, throw out a few hints with respect to the most likely means for preserving the health of this useful set of people, which some of them, we hope, will be wise enough to take. It has been already observed, that sedentary artificers are often hurt by their bending posture. They ought, therefore, to stand or sit as erect as the nature of their employments will permit. They should likewise change their posture frequently, and should never sit too long at a time, but leave off work, and walk, ride, run, or do any thing that will promote the vital functions. Sedentary artificers are generally allowed too little time for exercise ; yet, short as it is, they seldom employ it properly. A journeyman tailor or weaver, for example, instead of walking abroad for exercise and fresh air, at his hours of leisure, chooses often to spend them in a public house, or in playing at some sed- entary game, by which he generally loses both his time and his money. The awkward postures in which many sedentary artificers work, seem rather to be the effect of custom than necessity. For exam- ple, a table might surely be contrived for ten or a dozen tailors to sit round, with liberty for their legs either to hang down, or rest upon a footboard, as they should choose. A place might like- wise be cut out for each person in such a manner that he might sit as conveniently for working as in the present mode of sitting cross-legged. 8 All sedentary artificers ought to pay the most religious regard to eleanlmess. Both their situation and occupations render this highly necessary. Nothing would contribute more to preserve their health, than a strict attention to it; and such of them as neglect l;!!^ r"nthe haTrd of losinS health> ««t of becoming a nuisance to their neighbours. Sedentary people ought to avoid food that is windy or hard of tin Z\ald s\ouldJay^ diciest regard to sobriety. A person ot ZZKhard™thout doors will soon throw off a debauch; but TlZl, *fc ?' fS y "° means an emjal chance- Hence it often to^t^men11^ Pe°Ple ^ S6"ed With fevers after hard drinking. When such persons feel their spirits low, instead of ne^ThiwoT ^ relif' they should **°<^walk?„the •SSrltaS; Tndi Tr™ thS coTlaint more effectually than «rong uquor, and would never hurt the constitution. ADVICE TO THE SEDENTARY, &c7 49 ADVICE TO THE SEDENTARY, &C. Instead of multiplying rules for preserving the health of the sedentary, we shall recommend them to the following general plan, viz. That every person who follows a sedentary employment should cultivate a piece of ground with his own hands. This he might dig, plant, sow, and weed at leisure hours, so as to make it both an exercise and amusement, while it produced many of the neces- saries of life. After working an hour in a garden, a man will re- turn with more ^keenness to his employment within doors, than if he had been all the while idle. Cultivating the ground is every w.ay conducive to health. It not only gives exercise to every part of the body, but the very smell of the earth and fresh herbs revives and cheers the spirits, whilst the perpetual prospect.of something coming to maturity delights and entertains the mind. We are so formed as to 03 always pleased with somewhat in perspective, however distant or however trivial; hence the happiness that most men feel in planting, sow- ing, building, &c. These seem to have been the chief employ- ments of the more early ages ; and, when kings and conquerors cultivated the ground, there is reason to believe that they knew as well wherein true happiness consisted as we do. It may seem romantic to recommend gardening to manufactur- ers in great, towns; but observation proves that the plan is very practicable. In the town of Sheffield, in Yorkshire, where the great iron manufacture is carried on, there is hardly a journeyman cutler who does not possess a piece of ground, which he cultivates as a garden. This practice has many salutary effects. It not only induces these people to take exercise without doors, but also to eat many greens, roots, &c, of their own growth, which they would never think of purchasing. There can be no reason why manufacturers in any other town in Great Britain should not fol- low the same plan. It is indeed to be regretted, that in such a place as London a plan of this kind is not practicable : yet, even there, sedentary artificers may find opportunities of taking air and exercise, if they choose to embrace them. Mechanics are too much inclined to crowd into great towns. The situation may have some advantages; but it has likewise ma- ny disadvantages. All mechanics who live in the country have it in their power to cultivate a piece of ground; which, indeed, most of them do. This not only gives them exercise, but enables them to live more comfortably. So far at least as my observation extends, mechanics who live in the country are far more Ivappy than those in great towns. They enjoy better health, live in greater affluence, and seldom fail to rear a healthy and numerous offspring.* * Watchmakbrs, in consequence of their sedentary habits, are liable to a pecul- iar species of disease, to which I have witnessed many of them fall victims. Its commencement is indicated by deficient appetite and eructations of wind from the stomach. There is also sallowness of complexion, and a muddy yellow appearanee of the eyes. In the progress of the disease great quantities of black coagulated blood is discharged by stool, and occasionally by vomit. On dissection, the whole intestinal canal is found replete with blood either fluid or black and coagulated. The liver and the spleen appear soft, and as it were rotten. In its more early stages, this disease admits of being checked by active purgatives, exercise, and country air. 50 DISEASES PECULIAR TO In a word, exercise without doors, in one shape or another, is absolutely necessary to health. Those who neglect it, though they may for a while drag out life, can hardly be said to enjoy it. Weak and effeminate, they languish for a few years, and soon drop into an untimely grave. THE SEDENTARY STUDIOUS. Intense thinking is so destructive to health, that few instances can be produced of studious persons who are stro*ng and healthy. Hard study always implies a sedentary life ; and when intense thinking is joined to the want of exercise, the consequences must be bad. We have frequently known even a few months of close appli- cation to study, ruin an excellent constitution, by inducing a train of nervous complaints which could never be removed. Man is evidently not formed for continual thought more than for per- petual action, and would be as soon worn out by the one as by the other. So great is the power of the mind over the body, that, by its influence, the whole vital motions may be accelerated or retarded to almost any degree. Thus, cheerfulness and mirth quicken the circulation, and promote all the secretions ; whereas sadness and profound thought never fail to retard them. Hence it would appear, that even a degree of thoughtlessness is necessary to health. In- deed the perpetual thinker seldom enjoys either health or spirits; while the person who can hardly be said to think at all, generally enjoys both. Perpetual thinkers, as they are called, seldom think long. In a few years they generally become quite stupid, and exhibit a mel- ancholy proof how readily the greatest blessings maj be abused. Thinking, like every thing else, when carried to extreme, be- comes a vice ; nor can any thing afford a greater proof of wisdom, than for a man frequently and seasonably to unbend his mind. This may generally be done by mixing in cheerful company, active diversions, or the like. DISEASES TO WHICH STUDIOUS PEOPLE ARE MORE PECULIARLY LIABLE, &C. Studious persons are very subject to the gout. This painful dis- ease in a great measure proceeds from indigestion, and an obstruct- ed perspiration. It is impossible that the man who sits from morn- ing till night should either digest his food, or have any of the se- cretions m due quantity. But when that matter which should be thrown off by the skin, is retained in the body, and the humours are not duly prepared, diseases must ensue. Gravel.— The studious are likewise very liable to the stone and gravel. Exercise greatly promotes both the secretion and discharge of urine; consequently a sedentary life must have a contrary ef- 2. mntZLZt m&y k Sf Sfild °fthis hy observing, that he pas- walS or ridl! X™ b{daVhan in the niSht' and8also when he o^ly DrevenSth^h!" Wlfen .he Slts' x The n, in either sex, somewhat dfcease ^/^n^LZ^fottnlZZ^^ ™d a finD ind figid hal/it' that tha ADVICE TO THE STUDIOUS. 53 air, but would cheer the spirits, and have a most happy influence both on the body and mind. It is said of Euripides the tragedian, that he used to retire to a dark cave to compose his tragedies ; and of Demosthenes the Grecian orator, that he chose a place for study where nothing could be either heard or seen. With all def- erence to such venerable names, we cannot help condemning their taste. A man may surely think to as good purpose in an elegant apartment as in a cave ; and may have as happy conceptions where the all-cheering rays of the sun render the air wholesome, as in places where they never enter. DESK OCCUPATIONS, &C. Those who read or write much should be very attentive to their posture. They ought to sit and stand by turns, always keeping as nearly in an erect posture as possible. Those who dictate, may do it walking. It has an excellent effect frequently to read or speak aloud. This not only exercises the lungs, but almost the whole body. Hence studious people are greatly benefitted by de- livering discourses in public. Public speakers, indeed, sometimes hurt themselves, by over-acting their part; but this is their own fault. The martyr to mere vociferation merits not our sympathy. MORNING BEST ADAPTED FOR STUDY AND EXERCISE, &C, The morning has, by all medical writers, been reckoned the best time for study. It is so. But it is also the most proper sea- son for exercise, while the stomach is empty, and the spirits re- freshed with sleep. Studious people should, therefore, sometimes spend the morning in walking, riding, or some manly diversions without doors. This would make them return to study with great- er alacrity, and would be of more service than twice the time after their spirits are worn out with fatigue. It is not sufficient to take diversion only when we can think no longer. Every studious person should make it part of his business, and should let nothing interrupt his hours of recreation more than those of study. effects of music on the mind, &c. Music has a very happy effect in relieving the mind when fatigu- ed with study. It would be well if every studious person were so far acquainted with that science as to amuse himself after severe thought by playing such airs as have a tendency to raise the spir- its, and inspire cheerfulness and good humour. It is a reproach to learning, that any of her votaries, to relieve the mind after study, should betake themselves to the use of strong liquors. This indeed is a remedy; but it is a desperate one, and always proves destructive. Would such persons, when their spir- its are low, get on horseback, and ride ten or a dozen miles, they would find it a more effectual remedy than any cordial medicine in the apothecary's shop, or all the strong liquors in the world. 54 DIET AND EXERCISE RECOMMENDED, &c. DR. BUCHAN's PLAN, &C The following is my plan, and I cannot recommend a better to others. When my mind is fatigued with study or other serious business, I mount my horse, and ride ten or twelve miles into the country, where I spend a day, and sometimes two, with a cheerful friend ; after which I never fail to return to town with new vigour, and to pursue my studies or business with fresh alacrity. It is much to be regretted, that learned men, while in health, pay so little regard to these things ! There is not any thing more common than to see a miserable object over-run with nervous dis- eases, bathing, walking, riding, and, in a word, doing every thing for health after it is gone; yet, if any one had recommended these things to him by way of prevention, the advice would, in all proba- bility, have been treated with contempt, or at least with neglect. Such is the weakness and folly of mankind, and such the want of foresight, even in those who ought to be wiser than others! t' DIET OF THE STUDIOUS, &C. With regard to the diet of the studious, we see no reason why they should abstain from any kind of food that is wholesome, pro- vided they use it in moderation. They ought, however, to be sparing in the use of every thing that is windy, rancid, or hard of digestion. Their suppers should always be light, or taken soon in the evening. Their drink may be water, fine malt liquor, not too strong, good cider, wine and water, or, if troubled with acidities, water mixed with a little brandy, rum, or any other gen- uine spirit. THE KIND OF EXERCISE RECOMMENDED TO PEOPLE OF STUDIOUS HABITS, &C. We shall only observe, with regard to those kinds of exercise which are most proper for the studious, that they should not be too violent, nor ever carried to the degree of excessive fatigue. They ought likewise to be frequently varied, so as to give action to all the different parts of the body ; and should, as often as pos- sible, be taken in the open air. In general, riding on horseback, walking, working in a garden, or playing at some active diversions, are the best. We would likewise recommend the use of the cold bath to the studious. It will, in some measure, supply the place of exercise, and should not be neglected by persons of a relaxed habit, espe- cially in the warm season. No person ought either to take violent exercise, or to study im- mediately after a full meal. In the above remarks on the usual diseases of the studious, my chief object was to warn them of the evil consequences of painful and intense thinking. But I should be sorry to damp the ardour 01 their literary pursuits, which are injurious to health only when valsoTtZ VnCTant t0iI' at late hours' and without d«e inter- vals ot rest, refreshment, relaxation, and exercise. It is not thought, says the medical poet, 'tis painful thinking, that corloSes OBSERVATIONS ON DIET, ,0^ia^tL?dKed,are 8enerallythe first who suffer by unsound provisions- but the hyee of the labouring poor are of great importance to the state • b^sides disease. occasioned by unwholesome food often prove infectious bv whirl, „.!?{.d,eeasea people in every station. It is, therefore,Te Lterest of afl to take LTH * T$ provisions of any kind be exoosed to sale. " Care *hat n0 sP0i,ed VEGETABLE DIET, COOKERY, &c 57 VEGETABLE DIET. The most obstinate scurvy has often been cured by a vegetable diet; nay, milk alone will frequently do more in that disease than any medicine. Hence it is evident, that if vegetables and milk were more used in diet, we should have less scurvy, and likewise fewer putrid and inflammatory fevers. Fresh vegetables, indeed, come to be daily more used in diet; this laudable practice we hope will continue to gain ground. Aliments.—Our aliment ought neither to be too moist nor too dry. Moist aliment relaxes the solids, and renders the body fee- ble. Thus we see females, who live much on tea and other watery diet, generally become weak and unable to digest solid food : hence proceed hysterics, and all their dreadful consequences. On the other hand, food that is too dry, renders the solids in a man- ner rigid, and the humours viscid, which disposes the body to in- flammatory fevers, scurvies, and the like. Tea.—Much has been said on the ill-effects of tea in diet. They are, no doubt, numerous ; but they proceed rather from the imprudeut use of it, than from any bad qualities in the tea itself. Tea js now the universal breakfast in this part of the world ; but the morning is surely the most improper time of the day for drink- ing it. Most delicate persons, who, by the bye, are the greatest tea-drinkers, cannot eat any thing in the morning. If such per- sons, after fasting ten or twelve hours, drink four'or five cups of green tea without eating almost any bread, it must hurt them. Good tea, taken in a moderate quantity, not too strong, nor too hot, nor drank upon an empty stomach, will seldom do harm; but if it be bad, which is often the case, or substituted in the room of solid food, it must have many ill effects. Cookery.— The arts of cookery render many things unwholesome, which are not so in their own nature. By jumbling together a num- ber of different ingredients, in order to make a poignant sauce, or rich soup, the composition proves almost a poison. All high sea- soning, pickles, and although she may be SUPPERS AND BREAKFASTS CONTRASTED. 61 fasting will atone for excess; but this, instead of mending the matter, generally makes it worse. When the stomach and intes- tines are over distended with food, they lose their proper tone, and by long'fasting, they become weak, and inflated with wind. Thus either gluttony or fasting destroys the powers of digestion. Long fasting is extremely hurtful to young people; it not only vitiates their humours, but prevents their growth. Nor is it less injurious to the aged. Most persons in the decline of life, are af- flicted with wind : this complaint is not only increased, but even rendered dangerous, and often fatal, by long fasting. ' Old people, when their stomachs are empty, are frequently seized with giddi- ness, head-achs, and faintness. These complaints may generally be removed by a piece of bread and a glass of wine, or taking any other solid food; which plainly points out the method of prevent- ing thein. It is more than probable, that many of the sudden deaths, which happen in the advanced periods of life, are occasioned by fasting too long, as it exhausts the spirits, and fills the bowels with wind: we would, therefore, advise people, in the decline of-life, never to allow their stomachs to be too long empty. Many people take nothing but a few cups of tea and a little bread, from nine o'clock at night till two or three the next afternoon. Such may be said to fast almost three fourths of their, time. This can hardly fail to ruin the appetite, vitiate the humours, and fill the bowels with wind; all which might be prevented by a solid breakfast. SUPPERS AND BREAKFASTS CONTRASTED, &C. It is a very common practice to eat a light breakfast and a heavy supper. This custom ought to be reversed. When people sup late, their supper should be very light; but the breakfast ought al- ways to be solid. If any one eats a light supper, goes soon to bed, and rises betimes in the morning, he will be sure to find an appe- tite for his breakfast, and he may freely indulge it. The strong and healthy do not indeed suffer so much from fast- ing as the weak and delicate ; but they run great hazard from its opposite, viz. repletion. Many diseases, especially fevers, are the effect of plethora, or too great fulness of the vessels. Strong peo^ pie, in high health, have generally a great quantity of blood and other humours. When these are suddenly increased by an over- charge of rich and nourishing diet, the vessels become too much distended, and obstructions and inflammations ensue. Hence so many people are seized with inflammatory and eruptive fevers, ap- oplexies, &c. after a feast or debauch. ft All great and sudden changes in diet are dangerous. What the stomach has been long accustomed to digest, though less whole- some, will better agree with it than food of a more salutary nature to which it has not been used. When, therefore, a change becomes necessary, it ought always to be made gradually; a sudden tran- sition from a poor and low to a rich and luxurious diet, or the con- trary, might so disturb the functions of the body as to endanger health, or even to occasion death itself. When we recommend regularity in diet, we would not be under- 62 UNWHOLESOME AIR. stood as condemning every small deviation from it. It is next to impossible for people at all times to avoid some degree of excess, and living too much by rule might make even the smallest devia- tion dangerous. It may, therefore, be prudent to vary a little, sometimes taking more, sometimes less, than the usual quantity of meat and drink, provided always that a due regard be had to mod- eration. The details which some writers have entered into respecting the supposed qualities of every article of food and drink, as well as the proper quantifies of each, appear to me just as trifling as the minute- ness of the physician who inserted in his prescription how many grains of salt should be eaten with an egg. Every man's experi- ence of what he has found to agree or disagree with hirn, is a much more unerring guide than whimsical calculations of the difference between the mucilage of a carrot and a parsnip, or between the jelly contained in a leg and a shoulder of mutton. But while I point out the folly of extreme solicitude in such matters, I am far from advising people to eat and drink, without any choice or re- straint, whatever falls in their way. This would be inconsistent with the rules I have already laid down. Rational enjoyment of the gifts of nature, is the happy medium between boundless indul- gence and frivolous or unnecessary self-denial. Such as have a faulty circulation through the lungs, the conse- quence of pulmonary or other complaints, ought to eat very little at a time, because the quantity of chyle being increased must obvi- ously render that circulation still more uneasy. The great secret then for consumptive and asthmatic patients in particular, and up- on which their cure principally depends, is to take their food in small quantities at a time. It happens, however, rather unfortun- ately for asthmatic patients, that their desire for food is consider- ably increased ; in consequence of which, sanguification is but im- perfectly performed, they become what is termed leucophlegmatic, that is, they acquire a dropsical tendency. The choice, therefore, as well as the quantity, of diet, is of great importance to those who have weak lungs, as well as to persons generally who are of deli- cate constitutions. CHAP. IV- AIR. Unwholesome air is a very common cause of diseases. Few are aware of the danger arising from it. People generally pay some attention to what they e*at or drink, but seldom regard what goes into the lungs, though the latter proves often more suddenly fatal than the former. Air, as well as water, takes up parts of most bodies with which it comes in contact, and is often so replenished with those of a noxious quality, as to occasion immediate death. But such vio- BURYING WITHIN CHURCHES. 63 lent effects seldom happen, as people are generally on their guard against them. The less perceptible influences of bad air prove more generally hurtful to mankind; we shall, therefore, endeav- our to point out some of these, and to show whence the danger chiefly arises. Airs may become noxious many ways. Whatever greatly alters its degrees of heat, cold, moisture, &c. renders it unwholesome : for example, that which is too hot dissipates the watery parts of the blood, exalts the bile, and renders the whole humours adust and thick. Hence proceed bilious and inflammatory fevers, cholera morbus, &c. Very cold air obstructs the perspiration, constrin- ges the solids, and condenses the fluids. It occasions rheumatisms, coughs, and catarrhs, with other diseases of the throat and breast. Airlhat is too moist destroys the elasticity or spring of the solids, induces phlegmatic or lax constitutions, and disposes the body to intermitting fevers, dropsies, &c. Wherever great numbers of people are crowded into one place, if the air has not a free circulation it soon becomes unwholesome. Hence it is that delicate persons are so apt to turn sick or faint in crowded churches, assemblies, or any place where the air is injur- ed by breathing, fires, candles, or the like. In great cities, so many things tend to contaminate the air, that it is no wonder it proves so fatal to the inhabitants. The air in cities is not only breathed repeatedly over, but is likewise loaded with sul- phur, smoke, and other exhalations, besides the vapours contin- ually arising from innumerable putrid substances, as dunghills, slaughter-houses, &c. All possible care should be taken to keep the streets of large towns open and wide, that the air may have a free current through them. They ought likewise to be kept very clean. Nothing tends more to pollute and contaminate the air of a city than dirty streets. It is very common in this country to have churchyards in the middle of populous cities. Whether this be the effect of ancient superstition, or owing to the increase of such towns, is a matter of no consequence. Whatever gave rise to the custom, it is a bad one. It is habit alone which reconciles us to these things; by means of which the most ridiculous, nay pernicious customs, often become sacred. Certain it is, that thousands of putrid carcasses, so near the surface of the earth, in a place where the air is confin- ed, cannot fail to taint it; and that such air, when breathed into the lungs, must occasion diseases.* Burying within churches is a practice still more detestable. The air in churches is seldom good, and the effluvia from putrid car- casses must render it still worse. Churches are commonly old buildings with arched roofs. They are seldom open above once a week, are never ventilated by fires nor open windows, and rarely kept clean. This occasions that damp, musty, unwholesome smell which one feels upon entering a church, and renders it a very un- safe place for the weak and valetudinary. These inconvemencies - In most eastern countries it was customary to bury the dead at some distance from »nv town As this practice obtained among the Jews, the Greeks, and also the Ro- m7ns!7tis sfra,!ge that the western parts of Europe should not have followed thetr •* »mple in a custom so truly laudable. (M STAGNATED AIR. might, in a great measure, be obviated by prohibiting all persons from burying within churches, by keeping them clean, and per- mitting a stream of fresh air to pass frequently through them, by opening opposite doors and windows.* Wliercvcr air stagnates long, it becomes unwholesome. Hence the unhappy persons confined in jails not only contract malignant fe- vers themselves, but often communicate them to others. Nor are many of the holes, for we cannot call them houses, possessed by the poor in great towns, much better than jails. These low dirty habitations are the very lurking places of bad air and contagious diseases. Such as live in them seldom enjoy good health ; and their children commonly die young. In the choice of a house, those who have it in their power ought always to pay the greatest attention to open free air. The various methods which luxury has invented to make houses close and warm, contribute not a little to render them unwholesome. No house can be wholesome, unless the air has a free passage through it. For which reason, houses ought daily to be ventilated by opening opposite windows, and admitting a current of fresh air into every room. Beds, instead of being made up as soon as peo- ple rise out of them, ought to be turned down, and exposed to the fresh air from the open windows through the day. This would ex- pel any noxious vapour, and could not fail to promote the health of the inhabitants. In hospitals, jails, ships, &c. where that cannot be conveniently done, ventilators should be used. The method of expelling foul, and introducing fresh air, by means of ventilators, is a most saluta- ry invention, and is, indeed, the most useful of all our modern med- ical improvements. It is capable of universal application, and is fraught with numerous advantages, both to those in health and sick- ness. In all places, where numbers of people are crowded togeth- er, ventilation becomes absolutely necessary. Air which stagnates in mines, wells, cellars, tyc. is extremely delete- rious and fatal to life; and ought to be avoided as the most deadly poison. It often kills almost as quickly as lightning. For this reason people should be very cautious in opening cellars that have been long shut, or going down into deep wells or pits, especially it they have been kept closely covered.! Many people who have splendid houses, choose to sleep in small apartments. This conduct is very imprudent. A bedchamber ought always to be well aired; as it is generally occupied in the night only, when all doors and windows are shut. If a fire be kept in it, the danger from a small room becomes still greater. Numbers have been stifled when asleep by a fire in a small apartment, which is always hurtful. Those who are obliged, on account of business, to spend the day in close towns, ought, if possible, to sleep in the country. Breath- feelSgeq"tenchiny8 thr°Ugh * large ChUrCh °r cathedral> even in summer, without AIR OF GREAT TOWNS, &c. 65 ing free air in the night will, in some measure, make up for the want of it through the day. This practice would have a greater effect in preserving the health of citizens than is commonly ima- gined. Delicate persons ought, as much as possible, to avoid the air of great towns. It i.s peculiarly hurtful to the asthmatic and consumptive. Such persons should avoid cities as they would the plague. The hypochondriac are likewise much hurt by it. I have often seen persons so much afflicted with this malady while in town, that it seemed impossible for them to live, who, upon being removed to the country, were immediately relieved. The same observation holds with regard to nervous and hysteric women. Many people, indeed, have it not in their power to change their situation in quest of bet- ter air. All we can say to such persons is, that they should go as often abroad into the open air as they can, that they should admit fresh air frequently into their houses, and take care to keep them very clean. It was necessary in former times, for safety, to surround cities, colleges, and even single houses, with high walls. These, by ob- structing the free current of air, never fail to render such places damp and unwholesome. As such walls are now, in most parts of this country, become useless, they ought to be pulled down, and every method taken to admit a free passage to the air. Proper at- tention to Air and Cleanliness would tend more to preserve the health of mankind, than all the prescriptions of the faculty. Surrounding houses too closely with plantations or thick woods, likewise tends to render the air unwholesome. Wood not only ob- structs the free current of the air, but sends forth great quantities of moist exhalations, which render it constantly damp. Wood is .very agreeable at a proper distance from a house, but should never be planted too near it, especially in a flat country. Many of the gentlemen's seats in England are rendered very unwholesome from the great quantity of wood which surrounds them. Houses situated in low marshy countries, or near large lakes of stagnating water, are likewise unwholesome. Waters which stag- nate not only render the air damp, but load it with putrid exhala- tions, which produce the most dangerous and fatal diseases. Those who are obliged to inhabit marshy countries, ought to make choice of the dryest situations they can find, to live generously, and to pay the strictest regard to cleanliness. If fresh air be necessary for those in health, it is still more so for the sick, who often lose their lives for want of it. The notion that sick people must be kept very hot, is so common, that one can hardly enter the chamber where a patient lies, without being ready to faint, by reason of the hot suffocating smell. How this must af- fect the sick any one may judge. No medicine is so beneficial to the sick as fresh air. It is the most reviving of all cordials, if it be administered with prudence. We are not, however, to throw open doors and windows at random upon the sick. Fresh air is to be let into the chamber gradually, and, if possible, by opening the win- dows of some other apartment. The air of a sick person's chamber may be greatly freshened, and the patient much revived, by sprinkling the floor, bed, &c. fre- 66 EXERCISE. quently with vinegar, juice of lemon, or any other strong vegeta- ble acid. In places where numbers of sick are crowded into the same house, or, which is often the case, into the same apartment, the frequent admission of fresh air becomes absolutely necessary. In- firmaries, hospitals, &c. are often rendered so noxious, for want of proper ventilation, that the sick run more hazard from them than from the disease. This is particularly the case when putrid fevers, dysenteries, and other infectious diseases prevail. CHAP. V. EXERCISE. Many people look upon the necessity man is under, of earning his bread by labour, as a curse. Be this as it may, it is evident from the structure of the body, that exercise is not less necessary than food for the preservation of health : those whom poverty obliges to labour for daily bread, are not only the most healthy, but generally the most happy part of mankind. Industry seldom fails to place them above want, and activity serves them instead of phys- ic. This is peculiarly the case with those who live by the culture of the ground. The great increase of inhabitants in infant colo- nies, and the longevity of such as follow agriculture every where, evidently prove it to be the most healthful as well as the most use- ful employment. The love of activity shows itself very early in man. So strong is this principle, that a healthy youth cannot be restrained from ex- ercise, even by the fear of punishment. Our love of motion is sure- ly a strong proof of its utility. Nature implants no disposition in vain. It seems to be a catholic law throughout the whole animal creation, that no creature without exercise, should enjoy health, or be able to find subsistence. Every creature, except man, takes as much of it as is necessary. He alone, and such animals as are under his direction, deviate from this original law, and they suffer accordingly. Inactivity «ever fails to induce an universal relaxation of the sol- ids, which disposes the body to innumerable diseases. When the solids are relaxed, neither the digestion nor any of the secretions can be duly performed. Glandular obstructions, now so common, generally proceed from inactivity. These are the most obstinate of maladies. So long as the liver, kidneys, and other glands, duly perform their functions, health is seldom impaired : but when they fail, nothing can restore it. Exercise is almost the only cure we know for glandular ob- structions : indeed, it does not always succeed as a remedy ; but there is reason to believe that it would seldom fail to prevent these complaints, were it used in due time. One thing is certain, that amongst those who take sufficient exercise, glandular diseases are INACTIVITY, ITS CONSEQUENCES, &c 67 very little known ; whereas the indolent and inactive are very sel- dom free from them. Weak nerves are the constant companions of inactivity. Nothing but exercise and open air can brace and strengthen the nerves, or prevent the endless train of diseases which proceed from a relaxed state of these organs. We seldom hear the active or laborious com- plain of nervous diseases ; these are reserved for the sons of ease and affluence. Many have been completely cured of these disor- ders by being reduced, from a state of opulence, to labour for their daily bread. This plainly points out the sources from whence nervous diseases flow, and the means by which they may be pre- vented. It is absolutely impossible to enjoy health where the perspiration is not duly carried on; but that can never be the case where ex- ercise is neglected. When the matter which ought to be thrown off by perspiration is retained in the body, it vitiates the humours, and occasions the gout, fevers, rheumatisms, &c. Exercise alone would prevent many of those diseases which cannot be cured, and would remove others where medicine proves ineffectual. A late author,* in his excellent treatise on health, says, that the weak and valetudinary ought to make exercise a part of their re- ligion. We would recommend this, not only to the weak and vale- tudinary, but to all whose business does not oblige them to take sufficient exercise, as sedentary artificers,t shopkeepers, studious persons, &c. Such ought to use exercise as regularly as they take food. This might generally be done without any interruption to business or real loss of time. No piece of indolence hurts the health more than the modern custom of lying a-bed too long in the morning. This is the gene- ral practice in great towns. The inhabitants of cities seldom rise before eight or nine o'clock ; but the morning is undoubtedly the best time for exercise, while the stomach is empty, and the body refreshed with sleep. Besides, the morning-air braces and strengthens the nerves, and, in some measure, answers the purpose of a cold bath. Let any one who has been accustomed to lie a-bed till eight or nine o'clock, rise by six or seven, spend a couple of hours in walking, riding, or any active diversion without doors, and he will find his spirits cheerful and serene through the day, his ap- petite keen, and his body braced and strengthened. Custom soon renders early rising agreeable, and nothing contributes more to the preservation of health. /../•» * The inactive are continually complaining of pains of the stomacn, i Sedentary occupations ought chiefly to be followed by women. They bear con- finement S better than meS, and are fitter for every kind of business which does not raaato? much strength. It is ridiculous enough to see a lusty fellow making pins needles or^tS^wEeel., while many of the laborious parts of husbandry are earned on bv the other sex. The fact is, we want men for laborious employments, while one halfof the other seYare rendered useless for want of occupations suited to their strength, &c wire gms bred" to mechanical employments, we should not see such numbers of them prostitute themselves for bread, nor find such a want of men for the^portant S navigation, agriculture, &c. An eminent silk m^KXadtte™v'4en a found women answer better for that business than men ; and that he had lately takeni a peat many'glri, apprentices as silk-weavers. I hope his example will be followed by many others. 68 EXERCISE IN THE OPEN AIR, &c. flatulencies, indigestions, Spc. These complaints, which pave the way to many others, are not to be removed by medicines. They can only be cured by a vigorous course of exercise, to which indeed they seldom fail to yield. Exercise, if possible, ought always to be taken in the open air. When that cannot be done, various methods may be contrived for exercising the body within doors, as the dumb bell, dancing, fenc- ing, &c. It is not necessary to adhere strictly to any particular kind of exercise. The best way is to take them by turns, and to use that longest which is most suitable to the strength and con- stitution. Those kinds of exercise which give action to most of the bodily organs, are always to be preferred, as walking, running, riding, digging, rubbing furniture, and such like. It is much to be regretted, that active and manly diversions are now so little practised. Diversions make people take more exer- cise than they otherwise would do, and are of the greatest service to such as are not under the necessity of labouring for their bread. As active diversions lose ground, those of a sedentary kind seem to prevail. Sedentary diversions are of no other use but to con- sume time. Instead of relieving the mind, they often require more thought, than either study or business. Every thing that in- duces people to sit still, unless it be some necessary employment, ought to be avoided. The diversions which afford the best exercise are, hunting, shooting, playing at cricket, hand-ball, golff,* &c. These exer- cise the limbs, promote perspiration, and the other secretions. They likewise strengthen the lungs, and give firmness and agility to the whole body. J Such as can, ought to spend two or three hours a day on horse- back ; those who cannot ride, should employ the same time in walking. Exercise should never be continued too long. Over- fatigue prevents the benefit of exercise, and instead of strengthen- ing the body tends to weaken it. Every man should lay himself under some sort of necessity to take exercise. Indolence, like other vices, when indulged, ffains ground, and at length becomes agreeable. Hence many who were fond of exercise in the early part of life, become quite averse from it afterwards. This is the case of most hypochondriac and fumble 6' *GnderS th(?ir diseases in a Sreat measure in- In some countries laws have been made, obliging every man, of whatever rank, to learn some mechanical employment. Whether such laws were designed for the preservation of health, or the en- Certafn^r? M ,TnUfarUre' i8 a *uestion of no importance. erefse til gentlemen were frequently to amuse and ex Thev vvouST m ihlS W&y'^ misht have man7 g°od effects. ScLens J-\leaStdCnVe af much honour from a few masterly havina^n^ f 71 workmanshiP> a* from the character of havingnnned most of their companions by gaming or drinking. cUin^Udy ^ZZfllZZZ^ N of tho"^ gale. BENEFITS OF SLEEP. 69 Besides, men of leisure, by applying themselves to the mechanic- al arts, might improve them, to the great benefit of society. Indolence not only occasions diseases, and renders men useless to society, but promotes all manner of vice. To say a man is idle, is little better than to call him vicious. The mind, if not engaged in some useful pursuit, is constantly in quest of ideal pleasures, or impressed with the apprehension of some imaginary evil. From these sources proceed most of the miseries of mankind. Certain- ly man was never intended to be idle. Inactivity frustrates the very design of his creation ; whereas an active life is the best guar- dian of virtue, and the greatest preservative of health. It is indeed evident, that the love of motion, as well as the love of food, so observable in every living creature from the moment of its birth, are wisely designed by nature as the means of its pre- servation. The indolent man is therefore a rebel to her laws, and will certainly provoke her severest punishment. In vain does he hope for enjoyment in the lap of sloth ; its chilling influence poi- sons the source of every pleasure, and not only invites disease, but renders it almost incurable. CHAP. VI. SLEEP. The benefits resulting from sleep are sufficiently obvious, from the effects it produces. It restores both the powers of the mind and body, when exhausted by exercise, giving vigour to the one, and restoring the other to its accustomed alacrity. By means of sleep, the muscles are again rendered active and moveable ; after they have become wearied, rigid, painful, and trembling, from hard labour and severe exercise. It moderates the quickness of the pulse, which usually increases at night, and brings it back to its morning standard. It seems also to assist digestive of aliment— it diminishes both excretions and secretions; and renders the fluids thicker than otherwise they would be, particularly in a body endowed with much sensibility or mobility. Sleep, therefore, is not only useful, but absolutely indispensable, for the preservation of life and health; and it contributes most essentially to the alle- viation, as well as to the total removal of disease. The want of it is equally hurtful, and in many different ways, to the nervous sys- tem. Its absence renders the external as well as internal organs of sense, and those of every kind of motion, unfit for the perform- ance of their offices. Sleep, therefore, like diet, ought to be duly regulated. Too little sieep weakens the nerves, exhausts the spirits, and occasions dis- eases ; and too much renders the mind dull, the body gross, and disposes to apoplexies, lethargies, and other complaints of a simi- lar nature. A medium ought therefore to be observed; but this is not easy to fix. Children require more sleep than grown persons, 70 TO PROCURE REFRESHING SLEEP. the laborious than the idle, and such as cat and drink freely, than those who live abstemiously. Besides, the real quantity of sleep cannot be measured by time ; as one person will be more refreshed by five or six hours sleep than another by eight or ten. Children may always be allowed to take as much sleep as they please ; but for adults, six or seven hours is certainly sufficient, and no one ought to exceed eight. Those who lie in bed more than eight hours may slumber, but they can hardly be said to sleep; such generally toss and dream away the fore part of the night, sink to rest towards morning, and dose till noon. The best way to make sleep sound and refreshing is to rise betimes. The cus- tom of lying in bed for nine or ten hours, not only makes the sleep less refreshing, but relaxes the solids, and greatly weakens the constitution. Nature points out night as the proper season for steep. Nothing more certainly destroys the constitution than night-watching. It is a great pity that a practice so destructive to health should be so much in fashion. How quickly the want of rest in due season will blast the most blooming complexion, or ruin the best constitution, is evident from the ghastly countenances of those who, as the phrase is, turn day into night, and night into day. TO PROCURE REFRESHING SLEEP, &C. To make sleep refreshing, the following things are requisite : First, to take sufficient exercise in the open air; to avoid strong tea or coffee ; next, to eat a light supper; and, lastly, to lie down with a mind as cheerful and serene as possible. It is certain that too much exercise will prevent sleep, as well as too little. We seldom, however, hear the active and laborious com- plain of restless nights. It is the indolent and slothful who gener- ally have these complaints. Is it any. wonder that a bed of down should not be refreshing to a person who sits all day in an easy chair 1 A great part of the pleasure of life consists in alternate rest and motion; but they who neglect the latter can never relish the former. The labourer enjoys more true luxury in plain food and sound sleep, than is to be found in sumptuous tables and downy pillows, where exercise is wanting. That light suppers cause sound sleep, is true even to a proverb. Many persons, if they exceed the least at that meal, are sure to have uneasy nights; and, if they fall asleep, the load and oppres- sion on their stomach and spirits occasion frightful dreams, broken and disturbed repose, the night-mare, &c. Were the same per- sons to go to bed with a light supper, or sit up till that meal was pretty well digested, they would enjoy sound sleep, and rise refresh- ed and cheerful. There are indeed some people who cannot sleep unless they have eat some solid food at night; but this does not imply the necessity of a heavy supper: besides, these are general- ly persons who have accustomed themselves to this method, and who do not take a sufficient degree of exercise. Nothing more certainly disturbs our repose than anxiety. When the mind is not at ease, one seldom enjoys sound sleep. This greatest of human blessings flies the wretched and visits the hap- CLOTHING, HOW TO BE REGULATED, &c. 71 py, the cheerful, and the gay. This is a sufficient reason why ev- ery man should endeavour to be as easy in his mind as possible when he goes to rest. Many by indulging grief and anxious thought, have banished sound sleep so long, that they could never afterwards enjoy it. Sleep, when taken in the fore part of the night, is generally reckoned most refreshing. Whether this be the effect of habit or not, is hard to say ; but as most people are accustomed to go early to bed when young, it may be presumed that sleep, at this season, will prove most refreshing to them ever after. Whether the fore part of the night be best for sleep or not, surely the fore part of the day is fittest both for business and amusement. I hardly ever knew an early riser who did not enjoy a good state of health.* Early rising is the natural consequence of going to bed early ; and this habit implies sobriety, good order, and an exemption from many fashionable follies extremely prejudicial to health. The man, who accustoms himself to go to bed at an early hour, can seldom join the revels of Bacchus, or what are improperly called the amusements of the gay world. His rest is not disturbed by the effects of unseasonable luxury. He knows, that temperance, mod- erate exercise, composure of mind, and external tranquillity, are the best opiates. His slumbers are sound and refreshing. The waste of spirits on the preceding day is fully repaired. Every muscle, every fibre, every nerve has regained its proper tone. He rises with cheerfulness and vigour to breathe the morning air, and to enter upon the duties of the day. In short, an attention to this sino-le point of going to bed early, and of rising betimes, will be found to supersede a variety of other precepts, and may be justly called the golden rule for the attainment of health and long life. CHAP. VII. CLOTHING. The clothing ought to be suited to the climate. Custom has, no doubt a very great influence in this article ; but no custom can ever change the nature of things ^o far, as to render the same clothing fit for an inhabitant of Nova Zembla and the Island of Ja- maica.* It is not indeed necessary to observe an exact propor- tion between the quantity of clothes we wear, and the degree of latitude which we inhabit; but, at the same time, proper attention ought to be paid to it, as well as to the openness of the country, the frequency and violence of storms, &c. In youth, while the blood is hot ami the perspiration free, it is le»s necessary to cover the body with a great quantity of clothes ; • Men of every occupation, and in every situation of life, have lived to a good old CLOTHING. but in the decline of life, when the skin becomes rigid and the hu- mours more cool, the clothing should be increased. Many diseas- es in the latter period of life proceed from a defect of perspira- tion : these may, in some measure, be prevented by a suitable ad- dition to the clothing, or by wearing such as are better calculated for promoting the discharge from the skin, as clothes made of cot- ton, flannel, &c. The clothing ought likewise to be suited to the season of the year. Clothing may be warm enough for summer, which is by no means sufficient for winter. The greatest caution, however, is necessary in making these changes. We ought neither to put off our winter clothes too soon, nor to wear our summer ones too long. In this country, the winter often sets in very early with great rigour, and we have frequently cold weather even after the commencement of the summer months. It would likewise be prudent not to make the change all at once, but to do it gradually; and indeed the changes of apparel in this climate ought to be very inconsiderable, especially among those who have passed the meridian of life.* Clothes often become hurtful to the ivearer by their being made sub- servient to the purposes of pride or vanity. Mankind in all ages seem to have considered clothes in this view ; accordingly their fashion and figure have been continually varying, with very little regard either to health, the climate, or conveniency : a farthingale, for example, may be very necessary in hot southern climates, but surely nothing can be more ridiculous in the cold regions of the north. Even the human shape is often attempted to be mended by dress, and those who know no better believe that mankind would be mon- sters without its assistance. All attempts of this nature are highly pernicious. The most destructive of them in this country is that of squeezing the stomach and bowels into as narrow a compass as possible, to procure what is falsely called, a fine shape.t By this practice, the action of the stomach and bowels, the motion of the heart and lungs, and almost all the vital functions, are obstructed. Hence proceed indigestions, syncopes or fainting fits, coughs, consumptions of the lungs, and other complaints so common among females. The feet likewise often suffer by pressure. How a small foot came to be reckoned genteel, I will not pretend to say ; but certain it is, that this notion has made many persons lame. Almost nine tenths of mankind are troubled with corns; a disease that is seldom or never occasioned but by strait shoes. Corns are not only very troublesome, but by rendering people unable to walk, they may likewise be considered as the remote cause of other diseases.f * That colds kill more than plagues is an old observation ; and, with regard to this country, it holds strictly true. Every person of discernment, however, will perceive, that most of the colds which prove so-destructive to the inhabitants of Britain, are ow- ing to their imprudence in changing clothes. A few warm daya in March or April in- duce them to throw off their winter garments, without considering that our most pene- trating colds generally happen in the spring. t This madness seems to have pervaded the minds of mothers in every age and coun- try. Terence, in his comedy of the Eunuch, ridicules the Roman matrons for at tempting to mend the shape of their daughters. t We often see persons, who are rendered quite lame by the nails of their toes hav- CLOTHING. 73 The size and figure of the shoe ought certainly to be adapted to the foot. In children the feet are as well snaped as the hands, and the motion of the toes as free and easy as that of the fingers ; yet few persons in the advanced period of life are able to make any use of their toes ; they are generally, by narrow shoes, squeezed all of a heap, and often laid over one another in such a manner as to be rendered altogether incapable of motion. Nor is the high heel less hurtful than the narrow toe. A lady may seem taller for walking on her tiptoes, but she will never walk well in this man- ner. It strains her joints, distorts her limbs, makes her stoop, and utterly destroys all her ease and gracefulness of motion; it is en- tirely owing to shoes with high heels and narrow toes, that not one female in ten can be said to walk well. Infixing on the clothes, due care should be taken to avoid all tight bandages. Garters, buckles, &c. when drawn too tight, not only prevent the free motion and use of the parts about which they are bound, but likewise obstruct the circulation of the blood, which prevents the equal nourishment and growth of these parts, and oc- casions various diseases. Tight bandages about the neck, as stocks, cravats, necklaces, &c. are extremely dangerous. They obstruct the blood in its course from the brain, by which means head-achs, vertigoes, apoplexies, and other fatal diseases, are often occa- sioned. The perfection of dress is to be easy and clean. Nothing can be more ridiculous, than for any one to make himself a slave to fine clothes. Such a one, and many such there are, would rather re- main as fixed as a statue from morning till night, than discompose a single hair, or afcer the position of a pin. Were we to recom- mend any particular pattern for dress, it would be that which is worn by the people called quakers. They are always neat, clean, and often elegant, without any thing superfluous. What others lay out upon tawdry laces, ruffles, and ribands, they bestow upon superior cleanliness. Finery is only the affectation of dress, and very often covers a great deal of dirt. We shall only add, with regard to clothing, that it ought not only to be suited to the climate, the season of the year, and the pe- riod of life, but likewise to the temperature and constitution. Ro- bust persons are able to endure either cold or heat better than the delicate, consequently may be less attentive to their clothing. But the precise quantity of clothes necessary for any person cannot be determined by reasoning. It is entirely a matter of experience, and every man is the best judge for himself what quantity of clothes is necessary to keep him warm.* ing grown into the flesh, and frequently hear of mortifications proceeding from this cause. All these, and many other inconveniences attending the feet, must be impu- ted solely to the use of short and tight shoes. Though we hear frequently of plasters, salves, ointments, &c. for eradicating corns, vet they are never known to produce, that effect. The only rational mode of proceed- in" is to soften the corn a little by immersion in warm water, and then to cut it care- fuflv and to renew this operation every week, till the scarf skin is reduced to its origi- nal or natural thinness, after which it must be preserved from the irritating pressure of strait shoes, which had at first occasioned the painful callosity ... . . •The celebrated Boerhaave used to say, that nobody suffered by cold, save fools and beggars : the latter not being able to procure clothes, and the former not having sense to wear them. Be this as it may, I can with the strictest truth declare, that in D 74 CLOTHING. S:nce the first publication of the preceding remarks, very im- portant changes have taken place in the dress of our fair country- women, which afford the strongest proofs of their good sense and taste. The shape is no longer distorted, nor is growth check- ed and the vital functions impeded by a whalebone press. Easy, safe, and graceful motion in a flat-heeled shoe has completely abol- ished the awkwardness and danger of former attempts to totter about, as it were upon stilts. In a word, a becoming regard to health, simplicity, and elegance, seems now to have more influence over female fashions than absurdity, caprice, or the desire of con- cealing any personal deformity. I wish I could pay my own sex the same compliment which the ladies have so well deserved. But an affectation of what is called military smartness seems to have converted their whole apparel into a system of bandages. The hat is as tight as if it was intend- ed for a helmet, and to defy the fury of a hurricane. Its form al- so being by no means suited to the natural shape of the head, it must be worn for a considerable time with very painful and une- qual pressure, before it can be made to fit its new block. The neck is bolstered up and swathed with the most unnatural stiff- ness. Easy motion without, and free circulation within, are alike obstructed. Blotches and eruptions in the face, head-achs, apo- plexies, and sudden deaths, may be often traced to this cause ; and if we view its effects in another light, we shall not be surprised at any inconsistency in the language or conduct of persons who take so much pains to suspend all intercourse between the head and the heart. The close pressure of the other articles of d/ess is equally re- prehensible. Narrow sleeves are a great check upon the muscular exercise of the arms. The waistcoat in its present fashionable form, may be very properly termed a strait one ; and, no doubt, is in many instances an indication of some mental derangement. The wrists and knees, but more particularly the latter, are braced with ligatures, or tight buttoning; and the legs, which require the utmost freedom of motion, are screwed into leathern cases, as if to convey an idea that the wearer is sometimes mounted on horse- back. To complete the whole, and in order that the feet mav be kept in as tight a press as the head, when shoes are to be worn, the shape of the foot, and the easy expansion of the toes are never con- sulted, but fashion regulates the form of the shoe, sometimes square- toed, more frequently pointed, and always sure to produce cramps and corns, the keen, the sensible announcers of every change of the weather. I have so long employed serious argument upon these subjects in vain, that I am now accustomed to view them with pleasantry; and when I meet with such figures, disguised, and rendered truly awkwa/d both in their motions and appearance, I cannot help thinking with Shakspeare, " that some of Nature's journeymen had made them and not made them well; they imitate humanity so abominably !" many cases, where the powers of medicine had been tried in vain, I have cured the patient by recommending thick shoes, a flannel waistcoat and drawers, a pair of und°r- stockings or a flannel petticoat, to be worn during the cold season at least. Where warmer clothing is wanted, I would recommend the fleecy hosiery to be worn next INTEMPERANCE. 75 CHAP. VIII. OF INTEMPERANCE. • A modern author* observes, that temperance and exercise are the two best physicians in the world. He might have added, that if these were duly regarded, there would be little occasion for any other. Temperance may justly be called the parent of health ; yet numbers of mankind act as if they thought diseases and death too slow in their progress, and, by intemperance and debauch, seem as it were to solicit their approach. # The danger of intemperance appears from the very construction oj the human body. Health depends on that state of the solids and fluids which fits them for the due performance of the vital func- tions; and while these go regularly on, we are sound and well; but whatever disturbs them necessarily impairs health, intem- perance never fails to disorder the whole animal economy; it hurts the digestion, relaxes the nerves, and renders the different secre- tions irregular, vitiates the humours, and occasions numberless fllSPfi.SGS « * The analogy between the nourishment of plants and animals af- fords a striking proof of the danger of intemperance. Moisture and manure greatly promote vegetation ; yet an over-quantity ot either will entirely destroy it. The best things become hurtful, nay destructive, when carried to excess. Hence we learn, that the highest degree of human wisdom consists in reguat'"f our a£ petites and palsions so as to avoid all extremes 1ts that^clnefly which entitles us to the character of rational beings. The slave of annetite will ever be the disgrace of human nature. 0tThPe author of nature hath endued us with various' P^J^' the propagation of the species, the preservation of the individual, &c Intemperance is the abuse of these passions ; and modera- tion consisTs in the proper regulation of them. Men, not content- and are perpetually in "arch aft eraom ettoig £ g^ / them; but imaginary wants can never begraun h • content with little; but luxury knows^no bounds. Hence^ p icure, the drunkard, and the debauchee seldom stop in reer till their money or their constitution fails, then ina generally see their error when too late. g It is impossible to lay down fixed rules ^gjj*11^"^ ig. account of the different constitutions of nrankind^l he J norant person, however certainly knXchoOSes to avoid it. and it is in the power of every man, rfhechooses, to a ^ The great rule of diet is to study smphaty Natu e g ^ ^o^lJZ^ ^ai^tsttla^and ransacksthe * Rousseau. 70 INTEMPERANCE. whole creation in quest of luxuries, to his own destruction. An el egant writer* of the last age speaks thus of intemperance in diet : " For my part, when I behold a fashionable table set out in all its " magnificence, I fancy that I see gouts and dropsies, fevers and " lethargies, with other innumerable distempers, lying in ambus- " cade among the dishes." Nor is intemperance in other things less destructive than in diet. How quickly does the immoderate pursuit of carnal pleasures, or the abuse of intoxicating liquors, ruin the best constitution ! In- deed these vices generally go hand in hand. Hence it is that we so often behold the votaries of Bacchus and Venus, even before they have arrived at the prime of life, worn out with diseases, and hastening with swift pace to an untimely grave. Did men reflect on the painful diseases and premature deaths which are daily oc- casioned by intemperance, it would be sufficient to make them shrink back with horror from the indulgence even of their darling pleasures. Intemperance does not hurt its votaries alone; the innocent too of- ten feel the direful effects of it. How many wretched orphans are to be seen embracing dung-hills, whose parents, regardless of the future, spent in riot and debauch what might have served to bring up their offspring in a decent manner ! How often do we behold the miserable mother, with her helpless infants, pining in want, while the cruel father is indulging his insatiate appetites ! Families are not only reduced to misery, but even extirpated, by in- temperance. Nothing tends so much to prevent propagation, and to shorten the lives of children, as the intemperance of parents. The poor man who labours all day, and at night lies down con- tented with his humble fare, can boast a numerous offspring, while his pampered lord, sunk in ease and luxury, often languishes with- out an heir to his ample fortunes. Even states and empires feel the influence of intemperance, and rise or fall as it prevails. Instead of mentioning the different kinds of intemperance, and pointing out their influence upon health, we shall only, by way of example, make a few observations on one particular species of that vice, viz. the abuse of intoxicating liquors. Every act of intoxication puts nature to the expense of a fever, in order to discharge the poisonous draught. When this is repeated almost every day, it is easy to foresee the consequences. That constitution must be strong indeed which is able long to hold out under a daily fever; but fevers occasioned by drinking do not al- ways go off in a day ; they frequently end in an inflammation of the breast, liver, or brain, and produce fatal effects. Though the drunkard should not fall by an acute disease, he seldom escapes those of a chronic kind. Intoxicating liquors, when used to excess, weaken the bowels and spoil the digestion ; they destroy the power of the nerves, and occasion paralytic and convulsive disorders ; they likewise heat and inflame the blood, destroy its balsamic quality, render it unfit for circulation and the nourish- ment of the body. Hence obstructions, atrophies, dropsies, and diseases of the lungs. These are the common ways in which * Addison. INTEMPERANCE. 77 drunkards make their exit. Disorders of this kind, when brought on by hard drinking, seldom admit of a cure. Many people injure their health by drinking, who seldom get drunk. The continual habit of soaking, as it is called, though its effects be not so violent, is not less pernicious. When the vessels are kept constantly full and upon the stretch, the different digestions can neither be duly performed, nor the humours properly' prepared. Hence most people of this character are afflicted with the gout, the gravel, ulcerous sores in the legs, &c. If these disorders do not appear, they are seized with low spirits, hypochondriacal affec- tions, and other symptoms of indigestion. Hard drinking is no doubt one of the causes to which we must im- pute the increase of consumptions. The great quantities of viscid malt liquor drank by the common people of England, cannot fail to render the blood sizy and unfit for circulation; from whence proceed obstructions, and inflammations of the lungs. There are few great ale-drinkers who are not phthisical: nor is that to be wondered at, considering the glutinous and almost indigestible nature of strong ale. Those who drink ardent spirits or strong wines run still greater hazard; these liquors heat and inflame the blood, and tear the ten- der vessels of the lungs to pieces; yet so great is the consump- tion of them in this country, that one would almost be induced to think that the inhabitants lived upon them. The habit of drinking proceeds frequently from misfortunes in life. The miserable fly to it for relief. It affords them, indeed, a temporary ease. But, alas! this solace is short-lived; and when it is over, the spirits sink as much below their usual tone as they had before been raised above it. Hence a repetition of the dose becomes necessary, and every fresh dose makes way for another, till the unhappy wretch becomes a slave to the bottle, and at length falls a sacrifice to what at first perhaps was taken only as a med- icine. No man is so dejected as the drunkard when his debauch is gone off. Hence it is, that those who have the greatest flow of spirits while the glass circulates freely, are of all others the most melancholy when sober, and often put an end to their own miser- able existence in a fit of spleen or ill-humour. Drunkenness not only proves destructive to health, but likewise to the faculties of the mind. It is strange that creatures, who value themselves on account of a superior degree of reason to that of brutes, should take pleasure in sinking so far below them. Were such as voluntarily deprive themselves of the use of reason to con- tinue ever after in that condition, it would seem but a just punish- ment. Though this be not the consequence of one act of intoxica- tion, it seldom fails to succeed a course of it. By a habit of drink- ing, the greatest genius is often reduced to a mere idiot. « Tt U amaiinff that our improvements in arts, learning, and politeness, have not put the Parous Xom tf drifting to excess out of fashion It Is indeed less common i« «nf,th Britain than it was formerly; but it still prevails very much in the North where this «lic o" ^rbarTty is mistaken for hospitality. There no man is supposed ^„?^L his wests well! who does not make them drunk. Forcing people to drink » «£Srf»th«^Catest piece of rudeness that any man can be guilty of. Manliness SS^r^n^^natnr., may induce a'man to take his glass, if urged to it 78 CLEANLINESS. Intoxication is peculiarly hurtful to young persons. It heats their blood, impairs their strength, and obstructs their growth; besides, the frequent use of strong liquors in the early part of life destroys any benefit that might arise from them afterwards. Those 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. Drunkenness is not only in itself a most abominable vice, but it is an inducement to many others. There is hardly any crime so horrid that the drunkard will not perpetrate for the love of liquor. We have known mothers sell their children's clothes, the food that they should have eat, and afterwards even the infants themselves, in or- der to purchase the accursed draught. It is of the utmost importance to check the first propensities to glut- tony and intoxication, or they soon become uncontrollable. With re- spect to eating, the stomach, being often put upon the full stretch, feels uneasiness from the least vacuity, and acquires by degrees a sort of unnatural craving, the gratifications of which are sure to be attended with a stupor, debility, and disease. The same remark is applicable to drinking. After frequent indul- gence in excess, the smallest self-denial causes a faintness and de- pression of spirits, which nothing can remove but the favourite dram or pretended cordial. Nay more, the repetition of the last night's debauch is looked upon as the best remedy for the sickness of the ensuing day. Mild diluting liquors are rejected as insipid, and some hot stimulant is required for the palate and stomach, without considering, that by such means the action of the heart and arteries is stimulated also ; that the lungs are inflamed ; and the whole system is relaxed and enfeebled. CHAP. IX. CLEANLINESS. The want of cleanliness is a fault which admits of no excuse. Where water can be had for nothing, it is surely in the power of every person to be clean. The continual discharge from our bod- ies by perspiration, renders frequent change of apparel necessary. Changing apparel greatly promotes the secretion from the skin, so necessary for health. When that matter which ought to be carried off by perspiration is either retained in the body or re-absorbed from dirty clothes, it must occasion diseases. Diseases of the skin are chiefly owing to want of cleanliness.* They at a time when he might as well take poison. The custom of drinking to excess has long been out of fashion in France ; and, as it begins to lose ground among the polite #iSr d EDg«sh, we hope it will soon be banished from every part of this island Mii»T;u !'•ln hl8 sur8ical observations, was the first to notice a disease which he nnil!^„ c,h,5»ney-8weeper's cancer, now well known, as it is almost peculiar to that unhappy set of people, and of which he has left us a concise and accurate history! CLEANLINESS. 79 may, indeed, be caught by infection, or brought on by poor living, unwholesome food, &c.; but they will seldom continue long where cleanliness prevails. To the same cause must we impute the va- rious kinds of vermin which infest the human body, houses, &c. These may always be banished by cleanliness alone, and where- ever they abound, we have reason to believe it is neglected. One common cause of putrid and malignant fevers is the want of cleanliness. These fevers commonly begin among the inhabitants of close, dirty houses, who breathe unwholesome air, take little exercise, and wear dirty clothes. There the infection is general- ly hatched, which often spreads far and wide, to the destruction of many. Hence cleanliness may be considered as an object of pub- lic attention. It is not sufficient that I be clean myself, while the want of it in my neighbour affects my health as well as his. If dirty people cannot be removed as a common nuisance, they ought at least to be avoided as infectious. All who regard their health should keep at a distance even from their habitations. In places where great numbers of people are collected, cleanliness be- comes of the utmost importance. It is well known that infectious dis- eases are communicated by tainted air. Every thing, therefore, which tends to pollute the air, or spread the infection, ought with the utmost care to be guarded against. For this reason, in great towns, no filth, of any kind, should be permitted to lie upon the streets. Nothing is more apt to convey infection than the excre- ments of the diseased. In many great towns the streets are little better than dung-hills, being frequently covered with ashes, dung, and nastiness of every kind. Even slaughter-houses, or killing-shambles, are often to be seen in the very centre of great towns. The putrid blood, excre- ments, &c. with which these places are generally covered, cannot fail to taint the air, and render it unwholesome. How easily might this be prevented by active magistrates, who have it always in their power to make proper laws relative to things of this na- ture, and to enforce the observance of them ? Whatever pretensions people may make to learning, politeness, or civilization, we will venture to affirm, that while they neglect cleanliness, tbey are in a state of barbarity.* The peasants in most countries seem to hold cleanliness in a sortoj contempt. Were it not for the open situation of their houses, they MSa^s^saa ience of a conquered city! HO CLEANLINESS. would often feel the bad effects of this disposition. One seldom sees a farm-house without a dung-hill be/ore the door, and fre- quently the cattle and their masters lodge under the same roof. Peasants are likewise extremely careless with respect to change of apparel, keeping their houses, &c. clean. This is merely the ef- fect of indolence and a dirty disposition. Habit may, indeed, ren- der it less disagreeable to them, but no habit can ever make it sal- utary to wear dirty clothes, or breathe unwholesome air. As many articles of diet come through the hands of peasants, every method should be taken to encourage and promote habits of cleanliness among them. This, for example, might be done, by giving a small premium to the person who brings the cleanest and best article of any kind to market, as butter, cheese, &c, and by punishing severely those who bring it dirty. The same method should be taken with butchers, bakers, brewers, and all who are employed in preparing the necessaries of life. In camps the strictest regard should be paid to cleanliness. By neg- ligence in this matter, infectious diseases are often spread amongst a whole army ; and frequently more die of these than by the sword. The Jews, during their encampments in the wilderness, received particular instructions with respect to cleanliness.* The rules en- joined them ought to be observed by all in the like situation. In- deed the whole system of laws delivered to that people has a man- ifest tendency to promote cleanliness. Whoever considers the na- ture of their climate, the diseases to which they were liable, and their dirty disposition, will see the propriety of such laws. It is remarkable, that in the most eastern countries, cleanliness makes a great part of their religion. The Mahometan, as well as the Jewish religion, enjoins various bathings, washings, and purifi- cations. No doubt these might be designed to represent inward purity, but they were at the same time calculated for the preserva- tion of health. However whimsical these washings may appear to some, few things would tend more to prevent diseases than a proper attention to many of them. Were every person, for example, after visiting the sick, handling a dead body, or touching any thing that might convey infection, to wash before he went into company, or sat down to meat, he would run less hazard either of catching the infection himself, or of communicating it to others. NECESSITY OF FREQUENT ABLUTIONS, &C. Frequent washing not only removes the filth and sordes which adhere to the skin, but likewise promotes the perspiration, braces the body, and enlivens the spirits. How refreshed, how cheerful, and agreeable does one feel on being shaved, washed, and shifted) especially when these offices have been neglected longer than usual! The eastern custom of washing the feet, though less necessary in this country, is nevertheless a very agreeable piece of cleanli- ness, and contributes greatly to the preservation of health. The sweat and dirt with which these parts are frequently covered, can- not fail to obstruct the perspiration. This piece of cleanliness * See Deuteron. chap. xxii. ver. 12, 13. CLEANLINESS. 81 would often prevent colds and fevers. Were people careful to bathe their feet and legs in lukewarm water at night, after being exposed to cold or wet through the day, they would seldom expe- rience the ill effects which often proceed from these causes. A proper attention to cleanliness is no where more necessary than on shipboard. If epidemical distempers break out there, no one can be safe. The best way to prevent them is to take care that the whole company be cleanly in their clothes, bedding, &c. When infectious diseases do break out, cleanliness is the most likely means to prevent their spreading : it is likewise necessary to pre- vent their returning afterwards, or being conveyed to other places. For this purpose the clothes, bedding, &c. of the sick ought to be carefully washed, and fumigated with brimstone. Infection will lodge a long.time in dirty clothes, and afterwards break out in the most terrible manner. In places where great numbers of sick people are collected to- gether, as jails, hospitals, &c. cleanliness ought to be most reli- giously observed. The very smell in such places is often sufficient to make one sick. It is easy to imagine what effect that is likely to have upon the diseased. In an hospital or infirmary where clean- liness is neglected, a person in perfect health has a greater chance to become sick than a sick person has to get well. Few things are more unaccountable than that neglect, or rather dread of cleanliness, which appears among those who have the care of the sick : fhey think it almost criminal to suffer any thing that is clean to come near a person in a fever, for example, and would rather allow him to wallow in all manner of filth than change the least bit of his linen. If cleanliness be necessary for persons in health, it is certainly more so for the sick. Many diseases may be cured by cleanliness alone ; most of them might be mitigated by it; and where it is neglected, the slightest disorders are often changed into the most malignant. The same mistaken care which prompted people to prevent the least admission of fresh air fb the sick, seems to have induced them to keep them dirty. Both these destructive prejudices will, we hope, be soon entirely eradi- Cleanliness is certainly agreeable to our nature. We cannot help approving it in others, even though we should not practise it our- selves. It sooner attracts our regard than even finery itself, and often gains esteem where that fails. It is an ornament to the high- est as well as the lowest station, and cannot be dispensed with in either. Few virtues are of more importance to society than gene- ral cleanliness. It ought to be carefully cultivated every where; but in populous cities it should be almost revered.* * As it is impossible to be thoroughly clean without a ™?™*\*^V%^1>™ would earnestly recommend it to the magistrates of great towns to be V^^fft ** tenti ve to this article. Most great towns in Britain are so situated as t.be easily sup. nlied with water : and those persons who will not make a proper use of »«»«"«•• I ought to their hand, certainly deserve to be severely punished. The streets of area i«.»!.. ™hpre water can be had, ought to be washed every day. This is me oniy ei fectullmeth^of keeping them thoroughly clean ; and, upon trial, we are persuaded * Smebeof°thedmtosetCd,reS'diseases incident to human nature might, in my opinion, be entirely eradicated by cleanliness. D2 INFECTION AND CONTAGION. CHAP. X. INFECTION AND CONTAGION. Infection is designated a febrific agent, produced by the de- composition of animal and vegetable substances. It usually exists in the state of miasm or gas, and, in this form, occurs in filthy houses, ships, jails, hospitals, and cities ; and also in marshes, and fenny and low districts of country. Under the denominations of marsh, or paludal miasmata, exhalations of the soil, vegeto-animal ef- fluvium, malaria, human effluvia, febrile and putrid contagion, its va- rious specific effects are detailed in the works of practical writers, as having a decided influence on the human body.* Contagion is a poison generated by morbid animal secretion, possessing the power of inducing a similar morbid action in healthy bodies, whereby it is reproduced, and indefinitely modified. This contagion can only be known by its effects, and can only be divi- ded into genera by classifying it with the diseases it produces : e.g. 1st, Contagion communicable exclusively by contact, the spe- cies of which are as follows : itch, syphilis, sibbens, loanda of Afri- ca, frambesia or yaws, elephantiasis, hydrophobia, and small-pox.i These diseases cannot be conveyed through the medium of the air, but require actual contact. Hence they are strictly contagious, in the etymological sense of the word. 2d, Contagion communica- ble both by contact and by the atmosphere. These are liable to become epidemic, in contradistinction to those of the first genera. In this the species are, small-pox, measles, chicken-pox, scarlet fever, hooping-cough, &c. One of the laws which govern these contagions is, that they are #oramunicable in every season, in the heat of summer as well as in the cold of winter, in a pure as well as an impure air. An- other law is, general insusceptibility to future attacks of the same disease, but with exceptions. Many diseases are infectious. Every person ought, therefore, as far as he can, to avoid all communication with the diseased.' The com- mon practice of visiting the sick, though often well meant, has many ill consequences. Far be it from me to discourage any act of charity or benevolence, especially towards those in distress ; but I cannot help blaming such as endanger their own or their neigh- bours' lives, by a mistaken friendship, or an impertinent curiosity. The houses of the sick, especially in the country, are generally crowded from morning till night with idle visiters. It is custom- ary in such places, for servants and young people to wait upon the * It has erroneously, we conceive; been denied that animal substances have any thing to do in the production of febrific miasmata. An unequivocal proof, however, has lately been exhibited of the contrary opinion, or rather fact, produced by opening a grave in the island of Lenten. See Med. Chirurg. Review tri^T° th.tSC' Dr. Hossack of New York, adds influenza, and cynancha maligna, or pu- have %Lthroat' al'h°u?h Dr- Smith; wh°se modification ofi Dr. H.'s classification we that tie Tt',!!**' ^Ugh w,th,°cut Pf00^- *hat the former is evidently not contagious, and Uiat the latter is either a modification of scarlatina, or an atmospheric disease INFECTION AND CONTAGION. S3 sick by turns, and even to sit up with them all night. It would be a miracle indeed should such always escape. Experience teaches us the danger of this conduct. People often catch fevers in this way, and communicate them to others, till at length they become epidemic. It would be thought highly improper for one who had not had the small-pox, to wait upon a patient in that disease ; yet many other fevers are almost as infectious as the small-pox, and not less fatal. Some imagine that fevers prove more fatal in villages than in great towns, for want of proper medical assistance. This may sometimes be the case; but I am inclined to think it oftener pro- ceeds from the cause 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 visiting the sick. Such visiters not only endanger themselves and their connexions, but likewise hurt the sick. By crowding the house, they render the air unwholesome, and by their private whispers and dismal countenances, disturb the imagination of the patient, and depress his spirits. Persons who are ill, especially in fevers, ought to be kept as quiet as possible. The sight of strange faces, and every thing that disturbs the mind, hurts them. The common practice in country-places, of inviting great num- bers of people to funerals, and crowding them into the same apart- ment where the corpse lies, is another way of spreading infection. The infection does not always die with the patient. Every thin<; that comes into contact with his body while alive, receives the con- tagion, and some of them, as clothes, blankets, &c. will retain it for a long time. Persons who die of infectious disorders ought not to lie long unburied; and people should keep as much as pos- sible at a distance from them. It would tend greatly to prevent the spreading of infectious dis- eases, if those in health were kept at a proper distance from the sick. The Jewish Legislator, among many other wise institutions for preserving health, has been peculiarly attentive to the means of preventing infection, or defilement, as it is called, either from a diseased person or a dead body. In many cases the diseased were to be separated from those in health ; and it was deemed a crime even to approach their habitations. If a person only touched a diseased or dead body, he was appointed to wash himself in water, and to keep for some time at a distance from society. Infectious diseases are often communicated by clothes. It is ex- tremely dangerous to wear apparel which has been worn by a per- son who died of an infectious disease, unless it has been well washed and fumigated, as infection may lodge a long time in it, and afterwards produce very tragical effects. This shows the danger of buying at random the clothes which have been worn by other people. Infectious disorders are frequently imported. Commerce, togeth- er with the riches of foreign climes, brings us also their diseases. These do often more than counterbalance all the advantages of that trade by means of which they are introduced. It is to be re- gretted, that so little care is commonly bestowed, either to prevent the introduction or spreading of infectious maladies. Some atten- 84 * INFECTION AND CONTAGION. tion indeed is generally paid to the plague ; but other diseases pass unregarded. Infection is often spread through cities, by jails, hospitals, fyc. These are frequently situated in the very middle of populous towns ; and when infectious diseases break out in them, it is impossible for the inhabitants to escape. Did magistrates pay any regard to the health of the people, this evil might be easily remedied. Many are the causes which tend to diffuse infection through populous cities. .The whole atmosphere of a large town is one contaminated mass, abounding with various kinds of infection, and must be pernicious to health. The best advice that we can give to such as are obliged to live in large cities, is to choose an open sit- uation ; to avoid narrow, dirty, crowded streets; to keep their own house 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 spreading of infectious dis- eases, were proper nurses every where employed to take care of the sick. This might often save a family, or even a whole town, from being infected by one person. We do not mean that people should abandon their friends or relations in distress, but only to » put them on their guard against being too much in company with those who are afflicted with diseases of an infectious nature. Such as wait upon the sick in infectious diseases, run very great haz>- ard. Tljey should stuff their noses with tobacco, or some other strong-smelling herb, as rue, tansy, or the like. They ought like- wise to keep the patient very clean, to sprinkle the room where he lies with vinegar or other strong acids, frequently to admit a stream of fresh air into it, and to avoid the smell of his breath as much as they can. They ought never to go into company without having changed their clothes and washed their hands ; otherwise, f the disease be infectious, they will in all probability carry the contagion along with them. However trifling it may appear to inconsiderate persons, we will venture to affirm, that a due attention to those things which tend to diffuse infection would be of great importance in preventing dis- eases. As most diseases are in some degree infectious, no one should continue long with the sick, except the necessary attend- ants. I mean not, however, by this caution to deter those whose duty or office leads them to wait upon the sick, from such a lauda* ble and necessary employment. As a disinfecting agent, either of the following simple and easily obtained fumigations, may be carried at least once a-day through the apartments of the sick ; or for the purpose of fumigating apart- ments where sick people have been lodged : Take nitrate of potash, (nitre,) four drachms. Sulphuric acid, (oil of vitriol,) two drachms. Place them in a saucer upon hot sand ; or, Take muriate of soda, (common salt,) three ounces. Black oxide of manganese, one ounce. AFFECTIONS OF THE MIND. 85 Sulphuric acid, one ounce. Water, two ounces. Mix the three first ingredients, and pour in the water gradually, when visible streams of gas will be elicited, capable of destroying the contagious effluvia generated in the apartment, or about the furniture, bed-clothes, &c. The saucer, or other earthenware vessel, containing either of these, may be placed in the middle of the room, observing to have, during its use, the doors and windows closely shut. In a conversation with the late Sir John Pringle, for whom I had a great regard, he expressed some apprehension that the con- tents of this chapter might deter people from attending their friends and relations in fevers. I told Sir John that was the very evil I meant to cure, having always found the country-people too apt to visit their friends and neighbours in fever, even so as to crowd the house, and incommode the sick. Nor could I impute this to hu- manity, but to an inquisitive disposition to learn what was likely to be the patient's fate, and to ask improper questions of those about him, or of the doctor himself, were he weak enough to an- swer them. In this case, his answer would be sure to come back to the patient, and if unfavourable, greatly magnified; so strong is the inclination which some men feel to spread terror, even at the risk of another's life. Sir John, not having practiced in the country, was not immedi- ately struck with the force of my reasoning, till I told him what had happened to a family of his own name who lived near Edin- burgh, who had nearly all perished in a fever. The family con- sisted of a father and mother, with nine or ten children, most of them grown up and in place. The mother was seized with a fever of the putrid kind, and the children came in turns to nurse her. They all caught the fever : some died ; and others narrowly escap- ed with their lives. The evil did not end there. They carried the fever into the families where they lived, and spread the infec- tion far and wide. This I have often known to happen in the country, and would advise masters and mistresses never to suffer their servants to act as nurses or attendants on the sick, even though the latter should be their nearest relations. They had much bet- ter hire nurses, than allow their servants to act in that dangerous capacity. CHAP. XI. AFFECTIONS OF THE MIND. Mental affections have great influence both in the cause and cure of diseases. How the mind affects the body, will, in all prob- ability, ever remain a secret. It is sufficient for us to know, that there is established a reciprocal influence between the mental and 66 ANGER AND FEAR. corporeal parts; and that whatever injures the one, disorders the other. ANGER. The passion of anger ruffles the mind, distorts the countenance, hurries on the circulation of the blood, and disorders the whole vital and animal functions. It often occasions fevers, and other acute diseases; and sometimes even sudden death. This passion is peculiarly hurtful to the delicate, and those of weak nerves. I have known such persons frequently lose their lives by a violent fit of anger, and would advise them to guard against the excess of this passion with the utmost care. It is not, indeed, always in our power to prevent being angry ; but we may surely avoid harbouring resentment in our breast. Re- sentment preys upon the mind, and occasions the most obstinate chronical disorders, which gradually waste the constitution. No- thing shows true greatness of mind more than to forgive injuries ; it promotes the peace of society, and greatly conduces to our own ease, health, and felicity. Such as value health should avoid violent gusts of anger, as they would the most deadly poison. Neither ought they to indulge re- sentment, but to endeavour at all times to keep their minds calm and serene. Nothing tends so much to the health of the body as a constant tranquillity of mind. FEAR. The influence of fear, both in occasioning and aggravating dis- eases, is very great. No man ought to be blamed for a decent con- cern about life ; but too great a desire to preserve it, is often the cause of losing it. Fear and anxiety, by depressing the spirits, not only dispose us to diseases, but often render those diseases fa- tal which an undaunted mind would overcome. Sudden fear has generally violent effects. Epileptic fits, and other convulsive disorders, are often occasioned by it. Hence the danger of that practice, so common among young people, of fright- ening one another. Many have lost their lives, and others have been rendered miserable by frolics of this kind. It is dangerous to tamper with the human passions. The mind may easily be thrown into such disorder as never again to act with regularity. THE EFFECTS OF FEAR ON CHILD-BED WOMEN. But the gradual effects of fear prove most hurtful. The con- stant dread of some future evil, by dwelling upon the mind, often occasions the very evil itself. Hence it comes to pass, that so many die of those very diseases of which they long had a dread, or which had been impcessed on their minds by some accident, or foolish prediction. This, for example, is often the case with wo- men in child-bed. Many of those who die in that situation, are impressed with the notion of their death, a long time before it hap- REPREHENSIBLE CUSTOMS, &c. 87 pens ; and there is reason to believe that this impression is often the cause of it. The methods taken to impress the minds of women with the apprehensions of the great pain and peril of child-birth, are very hurtful. Few women die in labour, though many lose their lives after it ; which may be thus accounted for. A woman after deliv- ery, finding herself weak and exhausted, immediately apprehends she is in danger; but this fear seldom fails to .obstruct the neces- sary evacuations, upon which her recovery depends. Thus the sex often fall a sacrifice to their own imagination, when there would be no danger, did they apprehend none. It seldom happens, that two or three women in a great town die in child-bed, but their death is followed by many others. Every woman of their acquaintance who is with child dreads the same fate, and the disease becomes epidemical, by the mere force of im- agination. This should induce pregnant women to despise fear, and by all means to avoid those tattling gossips who are continu- ally buzzing in their ears the misfortunes of others. Every thing that may in the least alarm a pregnant or child-bed woman, ought with the greatest care to be guarded against. Many women have lost their lives in child-bed by the old super- stitious custom, still kept up in most parts of Britain, of tolling the parish-bell for every person who dies. People who think them- selves in danger, are very inquisitive ; and if they come to know that the bell tolled for one who died in the same situation with themselves, what must be the consequence 7 At any rate they are apt-to suppose that this is the case, and it will often be found a very difficult matter to persuade them of the contrary. But this custom is not pernicious to child-bed women only. It is hurtful in many other cases. When low fevers, in which it is difficult to support the patient's spirits, prevail, what must be the effect of a funeral peal sounding five or six times a-day in his ears 7 No doubt his imagination will suggest that others died of the same disease under which he labours. This apprehension will have a greater tendency to depress his spirits, than all the cordials of which medicine can boast will have to raise them. The only town which has abolished this custom is Bath. If this useless piece of ceremony cannot be abolished we ought to keep the sick as much from hearing it as possible, 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 business to visit the sick, on purpose to whisper dismal stories in their ears. Such may pass for sympathizing friends, but they ought rather to be considered as enemies. All who wish well to the sick, ought to keep sucli persons at the greatest distance from them. REPREHENSIBLE CUSTOMS, &C. ' A custom has long prevailed among physicians, of prognostica- ting, as they call it, the patient's fate, or foretelling the issue of tlufdisease. Vanity, no doubt, introduced this practice, and still supports it, in spite of common sense, and the safety of mankind. 88 GRIEF. I have known a physician barbarous enough to boast, that he pro- nounced more sentences than all His Majesty's judges. Would to God that such sentences were not.often equally fatal! It may, in- deed, be alleged, that the doctor does not declare his opinion be- fore the patient. So much the worse. A sensible patient had bet- ter hear what the doctor says, than learn it from the disconsolate looks, the watery eyes, and the broken whispers of those about him. It seldom happens, when the doctor gives an unfavourable opinion, that it can be concealed from the patient. The very embarrass- ment which the friends and attendants show in disguising what he has said, is generally sufficient to discover the truth. Kind heaven has, for the wisest ends, concealed from mortals their fate ; and we do not see what right any man has to announce the death of another, especially if such a declaration has a chance to kill him. Mankind are, indeed, very fond of prying into future events, and seldom fail to solicit the physician for his opinion. A doubtful answer, however, or one that may tend rather to encour- age the hopes of the sick, is surely the most proper. This conduct could neither hurt the patient nor the physician. Nothing tends more to destroy the credit of physic than those bold prognostica- tors, who, by-the-by, are generally the most ignorant of the facul- ty. The mistakes which daily happen in this way are so many standing proofs of human vanity, and the. weakness of science. We readily admit, that there are cases where the physician ought to give intimation of the patient's danger to some of his near connections ; though even this ought always to be done with the greatest caution: but it never can be necessary in any case that the whole town and country should know, immediately after the doctor has made his first visit, that he has no hopes. of his patient's recovery. Persons whose impertinent curiosity leads them to ques- tion the physician with regard to the fate of his patient, certainly deserve no other than an evasive answer. The vanity of foretelling the fate of the sick is not peculiar to the faculty. Others follow their example, and those who think themselves wiser than their neighbours often do much hurt in this way. Humanity surely calls upon every one to comfort the sick, and not add to their affliction by alarming their fears. A friend, or even a physician, may often do more good by a mild and sympa- thizing behaviour than by medicine, and should never neglect to ad- minister that greatest of all cordials, Hope. grief. Grief is the most destructive of all the passions. Its effects are permanent; and when it sinks deep into the mind, it generally proves fatal. Anger and fear, being of a more violent nature, sel- dom last long; but grief often changes into a fixed melancholy, which preys upon the spirits, and wastes the constitution. This, passion ought not to be indulged. It may generally be conquered at the beginning; but when it has gained strength, all attempts to remove it are vain. No person can prevent misfortunes in life; but it shows true greatness of mind to bear them with serenity. Many persons GRIEF. S9 make a merit of indulging in grief, and when misfortunes happen, they obstinately refuse all consolation, till the mind, overwhelmed with melancholy, sinks under the load. Such conduct is not only destructive to health, but inconsistent with reason, religion, and common sense. Change of ideas is as necessary for health as change of posture. When the mind dwells long upon one subject, especially of a disa- greeable nature, it hurts the whole functions of the body. Hence grief, indulged, spoils the digestion and destroys the appetite; by which means the spirits are depressed, the nerves relaxed, the bow- els inflated with wind, and the humours, for want of fresh supplies of chyle, vitiated. Thus many an excellent constitution has been ruined by a family misfortune, or any thing that occasions excess- ive grief. It is utterly impossible that any person of a dejected mind should en- joy health. Life may, indeed, be dragged out for a few years; but whoever would live to a good old age, must be good-humoured and cheerful. This, indeed, is not altogether in our own power; yet our temper of mind, as well as our actions, depend greatly upon ourselves. We can either associate with cheerful or melancholy companions, mingle in the amusements and offices of life, or sit still and brood over our calamities as we choose. These, and ma- ny such things, are certainly in our power, and from these the mind generally takes its cast. The variety of scenes which present themselves to the senses, were certainly designed to prevent our attention from being too long fixed upon any one object. Nature abounds with variety, and the mind, unless fixed down by habit, delights in contemplating new objects. This at once points out the method of relieving the mind in distress. Turn the attention frequently to new objects. Examine them for Borne time. When the mind begins to recoil, shift the scene. By this means a constant succession of new ideas may be kept up, till the disagreeable ones entirely disappear. Thus, travelling, the study of any art or science, reading or writing on such subjects as deeply engage the attention, will sooner expel grief than the most sprightly amusements. It has already been observed, that the body cannot be healthy unless it be exercised; neither can the mind. Indolence nourishes erief. When the mind has nothing else to think of but calamities, no wonder that it dwells there. Few people who pursue business with attention are hurt by grief. Instead, therefore, of abstract- ing ourselves from the world or business when misfortunes hap- pen, we ought to engage in it with more than usual attention, to discharge with double diligence the functions of our station, and to mix with friends of a cheerful and social temper. Innocent amusements are by no means to be neglected. Inese, oy leading the mind insensibly to the contemplation of agreeable ob- jects help to dispel the gloom which misfortunes cast over it. 'They make time seem less tedious, and have many other happy ^Some persons, when overwhelmed with grief, betake themselves to drSkimi This is making the cure worse than the disease. It seldom fa"l to end in the rmn of fortune, character, and consti- tutioii. 90 LOVE, AND RELIGIOUS MELANCHOLY. LOVE. Love is perhaps the strongest of all the passions. At least when it becomes violent, it is less subject to the control either of the un- derstanding or will, than any of the rest. Fear, anger, and sever- al other passions, are necessary for the preservation of the indi- vidual, but love is necessary for the continuation of the species it- self: it was therefore proper that this passion should be deeply rooted in the human breast. Though love be a strong passion it is seldom so rapid in its prog- ress as several of the others. Few persons fall desperately in love all at once. We would therefore advise every one, before he tam- pers with this passion, to consider well the probability of his being uble to obtain the object of his wishes. When that is not likely, he should avoid every occasion of increasing it. He ought imme- diately to flee the company of the beloved object; to apply his mind attentively to business or study ; to take every kind of amuse- ment ; and above all, to endeavour, if possible, to find another ob- ject which may engage his affections, and which it may be in his power to obtain. There is no passion with which people are so apt to tamper as love, although none is more dangerous. Some men make love for amuse- ment, others from mere vanity, or on purpose to show their conse- quence with the fair. This is perhaps the greatest piece of cruelty which any one can be guilty of. What we eagerly wish for, we easily credit. Hence the too credulous fair are often betrayed into a situation which is truly deplorable, before they are able to discover that the pretend- ed lover was only in jest. But there is no jesting with this passion. When love has got to a certain height, it admits of no other cure but the possession of its object, which in this case ought always, if possible, to be obtained. religious melancholy. Many persons of a religious turn of mind behave as if they thought it a crime to be cheerful. They imagine the whole of religion con- sists in certain mortifications, or denying themselves the smallest indulgence, even in the most innocent amusements. A perpetual gloom hangs over their countenances, while the deepest melan- choly preys upon their minds. At length the fairest prospects van- ish, every thing puts on a dismal appearance, and those,very ob- jects which ought to give delight, afford nothing but disgust. Life itself becomes a burden, and the unhappy wretch, persuaded that no evil can equal what he feels, often puts an end to his miserable existence. It is great pity that ever religion should be so far perverted, as to become the cause of those very evils which it was designed to cure. Nothing can be better calculated than True religion to raise and support the mind of its votaries under every affliction that can befal them. It teaches that even the sufferings of this life are pre- paratory to the happiness of the next; and that all who persist in a course of virtue shall at length arrive at complete felicity. Persons whose busmess it is to recommend religion to others, should THE FiECAL EVACUATIONS. 91 beware of dwelling too much on gloomy subjects. That peace and tranquillity of mind, which true religion is calculated to inspire, is a more powerful argument in its favour, than all the terrors that can be uttered. Terror may indeed deter men from outward acts of wickedness, but can never inspire them with that love of God, and real goodness of heart, in which alone true religion consists. To conclude ; the best way to counteract the violence of any passion, is to keep the mind closely engaged in some useful pur- suit. , , , I have often heard that the late Lord Kaimes, when he saw any literary friend sinking under the pressure of melancholy, or some other corroding passion, always gave this advice in a few emphat- ical words, "Write a book ;" which he believed to be an infallible remedy. I also knew the author of a very beautiful elegy cured ofhisffriefforawife,whomhe tenderly loved, by studying how to express the greatness of his loss, and the pungency of his sor- rows in the most plaintive and affecting strains. Indeed, the ear- nest direction of our thoughts to some important object is, as I be- fore hinted, the surest method of subduing passions which may stubbornly resist the control of reason. CHAP. XII. THE NATURAL EVACUATIONS. 1 The principal evacuations from the human body are those by stool urine, and insensible perspiration. None of these can be long SSiSSd without impair^e health. When that which,c»ugh to be thrown out of the body is too long retained, it not only occa sions a vhLm, or too grekt fulness of the vessels, but acquires quSLes which are hurtful to the health, as acrimony, putrescence, &c. THE F^CAL EVACUATION, &C. r Fsw things conduce more to health *;»££££ »•£»£- lar. When the faces lie too long inthe «£«* y humours , and when they "J^^J&Eta iesir/d which sufficiently nourished. A medium is .">•>• a exeroise. WhetvCrtt Is^O^ «»->" to suspect a fault in one or other-of these. h and who eat va- ££JS£Z?£tS-KT. •e'ndency ,o hurt the heaHh. 92 URINE. It would be difficult to ascertain the exact number of stools which may be consistent with health, as these differ in the different periods of life, in different constitutions, and even in the same con- stitution under a different regimen of diet, exercise, &c. It is, however, generally allowed, that one stool a-day is sufficient for an^adult, and that more or less is hurtful. But this, like most gen- eral rules, admits of many exceptions. I have known persons in perfect health who did not go to stool above once a week.* Such a degree of costiveness, however, is not safe ; though .the person who labours under it may for some time enjoy tolerable health, yet at length it may occasion diseases. One method of procuring a stool every day is to rise betimes, and go abroad in the open air. Not only the posture in bed is un- favourable to regular stools, but also the warmth. This, by pro- moting perspiration, lessens all the other discharges. The method recommended for this purpose, by Mr. Locke, is likewise very proper, viz. to solicit nature, by going regularly to stool every morning whether one has a call or not. Habits of this kind may be acquired, which will in time become natural. Persons who have frequent recourse to medicines for preventing costiveness seldom fail to ruin their constitution. Purging medi- cines frequently repeated weaken the bowels, hurt the digestion, and every dose makes way for another, till at length they become as necessary as daily bread. Those who are troubled with cos- tiveness ought rather, if possible, to remove it by diet than drugs. They should likewise go thinly clothed, and avoid every thing of an astringent or of an heating nature. The diet and other regi- men necessary in this case will be found under the article Costive- ness, where this state of the bowels is treated as a disease. Such persons as are troubled with an habitual looseness ought likewise to suit their diet to the nature of their complaint. They should use food which braces and strengthens the bowels, and which is rather of an astringent quality, as wheat-bread made of the finest flour, cheese, eggs, rice boiled in milk, &c. Their drink should be red port, claret, brandy and water, in which toasted bread has been boiled, and such like. As an habitual looseness is often owing to an obstructed perspi- ration, persons affected with it ought to keep their feet warm, to wear flannel next their skin, and take every other method to promote the perspiration. Further directions with regard to the treatment of this complaint will be found under the article Looseness. URINE. So many things tend to change both the quantity and appear- ances of the urine, that it is very difficult to lay down any deter- mined rules for judging of either.t Dr. Cheyue says, the urine • Some persons have told me that they did not go to stool above once a month. t f It has long been an observation among physicians, that the appearances of the urine are very uncertain, and very little to be depended on. No one will be surprised at this, who considers how many ways it may be affected, and, consequently, have its appearance altered. The passions, the state of the atmosphere, the quantity and quali- ty of the food, the exercise, the clothing, the state of the other evacuations, and num.- URINE. 03 ought to be equal to three-fourths of the liquid part of our aliment. But suppose any one were to take the trouble of measuring both, he would find that every thing which altered the degree of perspi- ration would alter this proportion, and likewise that different kinds of aliment would afford very different quantities of urine. Though for these, and other reasons, no rule can be given forjudging the pre- cise quantity of urine which ought to be discharged, yet a person of common sense will seldom be at a loss to know when it is in either extreme • As a free discharge of urine not only prevents but actually cures many diseases, it ought by all means to be promoted; and every thine that may obstruct it should be carefully avoided. Both the secretion and discharge of urine are lessened by a sedentary life, sleeping: on beds that are too soft and warm, food of a dry and heatinff quality, liquors which are astringent and heating, as red ort flaret, aAd such like. Those who have reason to suspect hat their urine is in too small quantity, or who have any symp- toms of the gravel, ought not only to avoid these things, but what- ever else the? find has a tendency to lessen the quantity of their ""when the urine is too long retained, it is not only resorbed, or taken up again into the mass of fluids, but by stagnating in thei blad- der it becomes thicker, the more watery parts flying off first, and The more gross and earthy remaining behind. By the constant endency which these have to concrete, the formation of stones and gSvel in the bladder is promoted. Hence it conies to pass that indolent and sedentary people are much more liable to these diseases than persons of a more active life. Many persons have lost their lives,'and others have brought on ve v tedious, and even incurable disorders, by retaining their urine oofong from a false delicacy. When the bladder has been over- distended it often loses its power of action altogether, or become* iTrZZf'by which means it is rendered unable either to retain paralytic, oy «' nrODeriv. The calls of nature ought never ^beTo^p^ned^D elicaTifdoubtless a virtue, but that can nev- er be ?eckoned true delicacy which induces any one to risk his ^But'the S may bfm too great, as well as too small aquau- titv This may be occasioned by drinking large quantities of weak nty. ±nis may ue ■ J of alkaline salts, or any thing SSTS X s S Wn™u«es the hlood, &c. ThU.disorder mat stimulate j induces a consumption. It is TJ *u2ZtZ ma, be^mMgated b, strengthening diet and 'ifringlnt roedicinl s%u„h as J recomLnded under the article Diabetes, or excessive discharge of urine.___________________ Mce of t e anne Any on « '^ \ diseases, and prescribe to patients, ot those daring quacks, who pre»Mi to irnpostor8' however, are very com- from the bare, nspeat.on of their urme z * ^^y *f the populace, many of them mon all over,BnthY;'foarniebsy Of T hi medical* prejudices which prevail in this amass considerable ">*""«?• VV^ lis the strongest The common people have country, that in favour of am *»«*°™ £jg it hasgbeen demonstrated that no one of ^^^^^^^^"WB-°' a"y °thCr an'ma1' fr0mlhat°fa man. 94 PERSPIRATION. THE PERSPIRATION. Insensible perspiration is generally reckoned the greatest of all the discharges from the human body.* It is of so great impor- tance to health, that few diseases attack us while it goes properly on ; but when it is obstructed, the whole frame is soon disordered. This discharge, however, being less perceptible than any of the rest, is, consequently, less attended to. Hence it is that acute fe- vers, rheumatisms, agues, &c. often proceed from obstructed per- spiration, before we are aware of its having taken place. On examining patients, we find most of them impute their dis- eases either to violent colds which they had caught, or to slight ones which had been neglected. For this reason, instead of a crit- ical inquiry into the nature of the perspiration, its difference in dif- ferent seasons, climates, constitutions, &c. we shall endeavour to point out the causes which most commonly obstruct it, and to show how far they may be either avoided, or have their influence coun- teracted by timely care. The want of a due attention to these, costs Britain annually some thousands of useful lives. CAUSES OF OBSTRUCTED PERSPIRATION, &C. One of the most common causes of obstructed perspiration,t or catching cold, in this country, is the changeableness of the weath- er, or state of the atmosphere. There is no place where such changes happen more frequently than in Great Britain. With us the degrees of heat and cold are not only very different in the dif- ferent seasons of the year, but often change almost from one ex- treme to another in a few days, and sometimes even in the course of one day. That such changes must affect the state of the per- spiration is obvious to every one. The best method of fortifying the body against the changes of the weather is, to be abroad every day. Those who keep most within doors, are most liable to catch cold. Such persons gener- ally render themselves so delicate, as to feel even the slightest ' Sanctorius, an Italian physician, was the first that directed the attention of the faculty to the cutaneous and pulmonary transpiration, which he proved to exceed the other secretions considerably in weight; and he maintained that this function must have a considerable influence on the system, and was deserving of great considera- tion in the treatment of diseases. There is, doubtless, much of truth in this general observation ; but in its application to practice, he appears to have gone to an extrava- gant length, and to have considerably contributed to prolong the humoral pathology, which referred all diseases to a vitiated state of the fluids, which is now well known to be the effect instead of the cause. Ed. t From the time of Sanctorius, colds, coughs, fevers, and other diseases, have been attributed, by many, to the suppression of perspiration, although there was no direct experiment to prove it. That this may sometimes act as a cause there can be little doubt, but not so frequently as has been imagined ; for we see people perspiring some- times a great deal, at other times not at all, and without any baa effect. A man, in fine,enjoy8 as good health ifn winter as in summer; in cold as in hot countries; and, besides that perspiration is carried on to a great extent by thelungs, nature has also taken care to guard against obstructed perspiration, by making it a vicarious secretion with the urine ; for when the former is increased the latter is diminished, and vice versa. The matter of perspiration, nevertheless, appears to be useless to the human frame, and perhaps contains materials that might prove hurtful if retained; hence, when obstructed, it may produce some complaints and aggravate others ; although ma- ny of the diseases attributed to retained perspiration arise from mere torpor of the skin ; and the effect is here taken for the cause. See Diaphoretics, Cold Bath, &c. Co. WET CLOTHES.—WET FEET.—NIGHT AIR, &c. 95 changes in the atmosphere, and by their pains, coughs, and oppres- sions of the breast, &c. they become a kind of living barometers. WET CLOTHES. Wet clothes not only by their coldness obstruct the perspira- • I ,t!w moisture by being absorbed, or taken up into the bod"; " grtTly^rrSs The danger. The most robust,consti- Douy, sicai / „„oiwiat thp danger arising from wet clothes; ^'dad^aslltr, riTeut .fsms, and other fatal disorders, T i" STpSa! for pe^vho go frequenUy abroad to avoid It is impossiuic i ii o. generally be lessen- STf no? whoilf ^e'venfed by £& '"eirl.othes loon; when ed, it notJ"°"y P . h ■" w keep in motion till they be dry. S^fLTe manyTom taking this precaution, that they often si. or £ Ml-^J^jfclSS: ^r re^t^tatce': Xch;hetav:,5nhe,fa,,.l':ffrc,nsdof°,his eonduc,,qought cer.ai.dy to deter all from being guilty of it. WET FEET. iv w nftPn occasion fatal diseases. The colic, inflam- rET If he breast and of the bowels, the iliac passron, cholera mations ot the oreasi anu ui i» Habit will, no doubt, morbus, &c. are often occasioned by wet feet. Habitwii render this less dangerous ; but it J^ «bJ^ P-s^ ^ ^ l^ltl^"^ ireful in this re- spect. NIGHT AIR. the weather is cool &nnn™ climate is more temperate. dews are more *™™1 ™™*neie ^ .n & cqo1 It is very agreeable aftei a«airai nay yalue their ning ; but this is a pleasure to be avoided oy ^ ^ health. The effects c, evening dews ^ grad ^ ^ ^^ = most imperceptible ; but they_ae d u who are much would therefore adyisc traveller , labourers^am iration heated by day, ^^J^^t^^V^on. By not has been great, these becon J ^^ wge« the exhalations attending to this, m flat marshy com , intermitting ind dews are copious, labourers are oiten «w frverl!^.inseys, and other dangerous diseases. DAMP BEDS. BE„s become damp, either^, their no, being^ ^.andij-g ;n/r;wtrtJonrredW'thr«hi„S ,s more tobe dreaded by 96 DAMP HOUSES. travellers than damp beds, which are very common in all places where fuel is scarce. When a traveller, cold and wet, arrives at an inn, he may, by means of a good fire, warm diluting liquor, and a dry bed, have the perspiration restored ; but if he be put into a cold room, and laid in a damp bed, it will be more obstructed, and the worst consequences will ensue. Travellers should avoid inns which are noted for damp beds, as they would a house infected with the plague, as no man, however robust, is proof against the danger arising from them. But inns are not the only places where damp beds are to be met with. Beds kept in private families for the reception of strangers are often eqaally dangerous. All kinds of linen and bedding, when not frequently used, become damp. How then is it possible that beds which are not slept in above two or three times a-year, should be safe ? Nothing is more common than to hear people complain of having caught cold by changing their bed. The reason is ob- vious : were they careful never to sleep in a bed but what was fre- quently used, they would seldom find any ill consequences from ;i change. Nothing is more to be dreaded by a delicate person when on a visit, than being laid in a bed which is kept on purpose for stran- gers. That ill-judged piece of complaisance becomes a real inju- ry. All the bad consequences from this quarter might easily be prevented in private families, by causing their servants to sleep in the spare beds, and resign them to strangers when they come. In inns, where the beds are used almost every night, nothing else is necessary than to keep the rooms well seasoned by frequent fires, and the linen dry. That baneful custom, said to be practised in many inns, of damping sheets, and pressing them, in order to save washing, and afterwards laying them on the beds, ought, when discovered, to be punished with the utmost severity. It is really a species of mur- der, and will often prove as fatal as poison or gun-shot. Indeed no linen, especially if it has been washed in winter, ought to be used till it has been exposed for some time to the fire ; nor is this operation less necessary for linen washed in summer, provided it has lain 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 circumstance of much more importance.* DAMP HOUSES. Damp houses frequently produce the like ill consequences ; for this reason those who build should be careful to choose a dry situa- tion. A house which stands on a damp marshy soil or deep clay, will never be thoroughly dry. All houses, unless where the ground is exceedingly dry, should have the first floor a little raised. Ser- vants and others, who are obliged to live in cellars and sunk sto- ries, seldom continue long in health : masters ought surely to pay * If a person suspect that his bed is damp, the simple precaution of taking off lh« sheets and lying in the blankets, with all, or most of his clothes on, will prevent all tha danger. I have practised this for many years, and never have been hurt by damp beds, though no constitution, without care, is proof against their baneful influence. SUDDEN TRANSITIONS, &c. 97 some regard to the health of their servants, as well as to their own. Nothing is more common than for people, merely to avoid some trifling inconveniency, to hazard their lives by inhabiting a house almost as soon as the masons, plasterers, &c. have done with it; such houses are not only dangerous from their dampness, but like- wise from the smell of lime, paint, &c. The asthmas, consump- tions, and other diseases of the lungs, so incident to people who work among these articles, are sufficient proofs of their being un- wholesome. , e Rooms are often rendered damp by an unseasonable piece ot cleanliness ; I mean the pernicious custom of washing them imme- diately before company is put into them. Most people catch cod if thev sit but a very short time in a room that has been lately washed ; the delicate ought carefully to avoid such a situation, and even the robust are not always proof against its influence.* SUDDEN TRANSITIONS FROM HEAT TO COLD. The perspiration is commonly obstructed by sudden transi- tions from heat to cold. Colds are seldom caught, unless when people ha^e been too much heated. Heat ranfies the blood, quick- ens the circulation, and increasesthe perspiration; butwhen the* are suddenly checked, the consequences must be bad. It is, in- deed impossible for labourers not to be ^ hot upon some occa- sions ; but it is generally in their power to let themselves cool arTdually, to put on their clothes when they leave off work, to make choice of a dry place to rest themselves in, and to avoid sleep- ^Yn the open field's.1 These easy rules, if observed, would often prevent fevers and other fatal disorders. 1 Trl; verv common for people, when hot, to drink freely of cold our judgment .^»PPr^;k £ tally-full of cold water after vio- own safety. ftA f swallowing large quan- Thirst may be quenched many lay^ ^ ^^ &nd titles of cold ^M0;-Jnh;of;dhich would abate thirst. Water kept plants, the very chewing ot wnicn > frequently re- in the mouth for some time and spit on again, 4 y peated, will have the same effect Ifa £ tot or ^ rf_ the u* dangerous to go out of them into a cold and chilly atmosphere P -i V£UhouSh this long uncontradicted opinion, which daily observation confirms ha, akobeen contradicted by Sir Arthur eiarke, the analogies' are too wide £Km com parison It will, we believe, be universally admitted that a current of ,;! „« ■ an overheated body, although it might not |prove ^^itaUflrfd » £, ™P,h ngUp°.n SUDDEN TRANSITIONS, &c. 99 ly been the effect of this conduct. Indeed it looks too like the ac- tion of a madman to deserve a serious consideration. The result of all these observations is, that every one ought to avoid, with the utmost attention, all sudden transitions from heat to cold, and to keep the body in as uniform a temperature as pos- sible ; or where that cannot be done, to take care, when heated, to let it cool gradually. People may imagine that too strict an attention to these things would tend to render them delicate. So far, however, is this from being my design, that the very first rule proposed for preventing colds is, to harden the body, by inuring it daily to the open air. I shall put an end to what relates to this part of my subject, by giving an abstract of the justly celebrated advice of Celsus, with respect to the preservation of health: "A man, says he, » who is blessed with good health, should confine himself to no " particular rules either with respect to regimen or medicine. He "ouo-ht frequently to diversify his manner of living ; to be some- " times in town, sometimes in the country ; to hunt, sail, indulge " himself in rest, but more frequently to use exercise. He ought » to refuse no kind of food that is commonly used, but sometimes » to cat more and sometimes less ; sometimes to make one at an en- tertainment, and sometimes t6 forbear it; to make rather two « meals a-day than one, and always to eat heartily, provided he " can digest it. He ought neither too eagerly to pursue, nor too » scrupulously to avoid intercourse with the fair sex : pleasures or « this kind, rarely indulged, render the body alert and active,; but '-when too frequently repeated, weak and languid. He should « be careful in time of health not to destroy, by excesses of any " kind, that vigour of constitution which should support him un- Thirplafnf'yet elegant and judicious summary of the most useful niax!msPof helh, confirms tlJ justness of my former «^*J« enlightened Medicine breathes the true spirit of liberal indulgence Lying down no rules but such as a man of sense would cheerfully Vt has been ^^^^^£^^^^S^ rcTSK K ~ ^ce 5 and^ccordingiy ^^nera cu= wit bathers who find themselves overheated^to wait tUl^ thej>oe m ov'erted b the plunge into the bath. This W*™™**™£™ and experience, that the opinion is late Dr. Currie, who has shown both from thjBory ana exp ^ ^^ ^ ^ erroneous and the practice««njudjc.ou.. Th« i. • ^^ Version, a8 £ay produce directed infirm I>enonB to use a degreeot exerc f heat and thus BeCure a an increased action of the vascular, wUh«ome in not always take place." force of re-action under the shocK, wniou £ rather untimely ; for it is evident We think Sir Arthur ha. brought Dr. Come forward ratoer^numy^ invariabl the the latter alludes to «fi™» P"™"' £™ofchimesis below the natural standard: heat of the body, accompanied with a sens ;™ «J "™0iud use a d€gjee of exercise to it is judicious, therefore, enough that such geomea ^ re-action under it, enable them to resist the shock of thecold Dan. an however> >ppUei equally which otherwise they could no\™"*Kd- {|™8 never to use the cold-bath at a time to persons in health, whom we would^caution "°*e h t0 pUinge into it at a when a cold sensation pervades the whole body^ any more^^j^ns may admit of time when the body is overheated ; although Dotnoiu,«»c popular opinion, proved the reverse. Ed. 100 THE KNOWLEDi.L, (TRE, AND follow and forbidding nothing but what is incompatible with reul hap- piness. Here the votaries of fashion and folly may learn to correct their own mistaken ideas of enjoyment; the epicure may acquire a relish for rational gratification ; and the man of pleasure may be taught the economy of love. PART II. CHAP. I. THE KNOWLEDGE AND CURE OF DISEASE-. The eure of diseases does not depend so much upon scientific principles as many imagine. It is chiefly the result of experience and observation. By attending the sick, and carefully observing the various occurrences in diseases, a great degree of accuracy may be acquired, both in distinguishing their symptoms, and in the application of medicines. Hence sensible nurses, and other persons who wait upon the sick, often foresee the patient's fate sooner than many who have been bred to physic* We do not, however, mean to insinuate that a medical education is of no use : it is doubtless of the greatest importance, but it never can supply the place of observation and experience. Definition of diseases, &c.—Every disease may be considered as an assemblage of symptoms, and must be distinguished by those which are most obvious and permanent. Instead, therefore, of giving a classical arrangement of diseases, according to the sys- tematic method, it will be more suitable, in a performance of this nature, to give a full and accurate description of each particular disease as it occurs ; and, where any of the symptoms of one dis- ease have a near resemblance to those of another,t to take notice of that circumstance, and at the same time to point out the pecul- iar or characteristic symptoms by which it may be distinguished. By a due attention to these, the investigation of diseases will be found to be a less difficult matter than most people would at first be ready to imagine. A proper attention to the patient's age, sex, temper of mind, constitution, and manner of life, will likewise greatly assist, both in the investigation and treatment of diseases. In childhood the fibres are lax and soft, the nerves extremely irritable, and the fluids thin : whereas in old age the fibres are rigid, the nerves become almost insensible, and many of the vessels •Physicians express this prescLnce by the term Prognosis, or the art of predicting the event of diseases from particular symptoms. t Physicians express these symptomatic characters by the word Diagnosis; via the signs by which one disease may be distinguished from another disease. Hence those symptoms which distinguish such affections are termed diagnostic signs DEFINITION OF DISEASES, &c. 101 imperviable. These and other peculiarities render the diseases of the young and aged very different, and of course they must re- quire a different method of treatment. See Diseases of Chil- dren. Females are liable to many diseases which do not afflict tlie other sex : besides, the nervous system being more irritable in them than in men, their diseases require to be treated with greater caution. They are less able to bear large evacuations; and all stimulating medicines ought to be administered to them with a sparing hand. See Diseases of Females. Particular constitutions not only dispose persons to peculiar diseas- es, but likewise render it necessary to treat these diseases in a peculiar maimer. A delicate person, for example, with weak nerves, who lives mostly within doors, must not be treated, under any disease, precisely in the same manner as one who is hardy and robust, and one who is much exposed to the open air. The temper and mind ought to be carefully attended to in diseases. Fear, anxiety, and a fretful temper both occasion and aggravate diseases. In vain do we apply medicines to the body to remove maladies which proceed from the mind. When that is affected, the best medicine is to soothe the passions, to divert the mind from anxious thought, and to keep the patient as easy and cheerful as possible. See affections of the mind. Attention ought likewise to be paid to the climate, or place where the patient lives, the air he breathes, his diet, &c. Such as live in low marshy situations are subject to many diseases which are unknown to the inhabitants of high countries. Those who breathe the im- pure air of cities have many maladies to which the more happy rustics are entire strangers. Persons who feed grossly, and in- dulge in strong liquors, are liable to diseases which do not affect the temperate and abstemious, &c. It has already been observed, that the different occupations and situations in life dispose men to peculiar diseases. (See p. 47.) It is therefore necessary to enquire into the patient's occupation, manner of life, &c. This will not only assist us in finding out the disease, but will likewise direct us in the treatment of it. It would be very imprudent to treat the laborious and the sedentary precisely in the same manner, even supposing them to labour un- der the same disease. It will likewise be proper to enquire, whether the disease be constitutional or accidental; whether it has been of long or short duration ; whether it proceeds from any great and sudden altera ■ tion in the diet, manner of life, &c. The state of the patient's body, and of the other evacuations, ought also to be enquired into ; and likewise whether he can with ease perform all the vital and animal functions, as breathing, digestion, &-c. Lastly, it will be proper to enquire to what diseases the patient has formerly been liable, and what medicines were most beneficial to him; if he has a strong aversion to any particular drug, &c. As many of the indications of cure may be answered by diet alone, it is always the first thing to he attended to in the treat- ment of diseases. Those who know no better, imagine that every thin"- which goes by the name of a medicine possesses some won- 102 DEFINITION OF DISEASES, &c. derful power or secret charm, and think, if the patient swallows enough of drugs, that he must do well. This mistake has many ill consequences ; it makes people trust to drugs, and neglect their own endeavours; besides, it discourages all attempts to relieve the sick where medicines cannot be obtained. Medicines are no doubt useful in their places; and when admin- istered with prudence, may do much good; but when they are put in place of every thing else, or administered at random, which is not seldom the case, they must do mischief. We wouM, therefore, wish to call the attention of mankind from the pursuit of secret medicines, to such things as they are acquainted with. The prop- er regulation of these may often do much good, and there is little danger of their ever doing hurt. Every disease weakens the digestive powers. The diet ought, therefore, in all diseases, to be light and of easy digestion. It would be as prudent for a person with a broken leg to attempt to walk, as for one in a fever to eat the same kind of food, and in the same quantity, as when he was in perfect health. Even absti- nence alone will often cure a fever, especially when it has been occasioned by excess in eating or drinking. In all fevers attended with inflammation, as pleurisies, pcri- pneumonies, &c. thin gruels, wheys, watery infusions of mucilagi- nous plants, roots, &c. are not only proper for the patient's food, but they are likewise the best medicines that can be administered. In fevers of a slow, nervous, or putrid kind, where there are no symptoms of inflammation, and where the patient must be sup- ported with cordials, that intention can always be more effectually answered by nourishing diet and generous wines, than by any medicines yet known. Nor is a proper attention to diet of less importance in chronic than in acute diseases. Persons afflicted with low spirits, wind, weak nerves, and other hypochondriacal affections, generally find more benefit from the use of solid food, and generous liquors, than from all the cordial and carminative medicines which can be ad- ministered to them. The scurvy, that most obstinate malady, will sooner yield to a proper vegetable diet than to all the boasted antiscorbutic remedies of the shops. In consumptions, when the humours are vitiated, and the stom- ach so much weakened as to be unable to digest the solid fibres of animals, or even to assimilate the juices of vegetables, a diet con- sisting chiefly of milk will not only support the patient, but will often cure the disease after every other medicine has failed. Nor is the attention to other things of less importance than diet. The strange infatuation which has long induced people to shut up the sick from all communication with the external air, has done great mischief. Not only in fevers, but in many other diseases, the patient will receive more benefit from having the fresh air pru- dently admitted into his chamber, than from all the medicines which can be given him. See Air, p. 65. Exercise may likewise in many cases be considered as a medicine : sailing, or riding on horseback, for example, will be of more ser- vice in the cure of consumptions, glandular obstruc ions, &c. than DEFINITION OF DISEASES, &c. 103 any medicines yet known. In diseases which proceed from a re- laxed state of the solids, the cold bath, and other parts of the gym- nastic regimen, will be found equally beneficial. See Exercise, p. 66. Few things are of greater importance in the cure of diseases than cleanliness. When a patient is suffered to lie in dirty clothes, whatever perspires from his body is again resorbed, or taken up into it, which serves to nourish the disease and increase the dan- ger. Many diseases may be cured by cleanliness alone ; most of them may be mitigated by it, and in all of them it is highly neces- sary both for the patient and those who attend him. See Clean- liness, p. 78. Many other observations, were it necessary, might be adduced to prove the importance of a proper regimen in diseases. Regi- men will often cure diseases without medicine, but medicine will seldom succeed where a proper regimen is neglected. For this reason, in the treatment of diseases, we have always given the first place to regimen. Those who are ignorant of medicine may con- fine themselves to it only. For others who have more knowledge, we have recommended some of the most simple but approved forms of medicine in every disease. These, however, are never to be administered but by people of better understanding ; nor even by them without the greatest precaution. The clearness and simplicity with which I took care to express myself on these points, would, I thought, have prevented the pos- sibility of any misrepresentation. Yet I find that a certain low class of self-aj pointed practitioners, who call themselves of the faculty, take no small pains to insinuate, that my observations on the prevention and cure of diseases serve only to encourage the fatal practice of domestic quackery. This is equally inconsistent with candour and truth. . The obvious tendency of all my remarks is to enlighten the minds of the people on a subject of such imme- diate concern as their health, and thus to guard them against the bad effects of ignorance and rashness on their own part, and of impudence and deceit on the part of others. I should rather have expected to be blamed for teaching people to place very little reliance on the efficacy of any medicine; which was, indeed, one of tke objects I had in view, for the express pur- pose of directing general attention to the far more assured means of preserving health, namely, air, cleanliness, diet, exercise, and the management of the passions. Upon these subjects I enlarged with peculiar earnestness, well knowing how much easier it is to prevent disorders before-hand than to cure them afterwards. . Even in cases of actual infirmity and disease, I have intimated a wish, that those who are ignorant of physic would confine them- selves to regimen only, and leave the medical treatment of their complaints to persons of better information. The remedies which I have prescribed may be entrusted to such hands with perfect safety; and if the directions I give do not operate as a check upon rashness, I know of no words strong enough to produce that effect. 104 GENERAL OBSERVATIONS ON FEVERS, &c. CHAP. II- GENERAL OBSERVATIONS ON FEVERS, &c. Fevers, though the most common complaints, are those in which mankind, whether professional or laical, are those by which they are most apt to be misled. It has been well observed, that " in reality, no writer seems to have been fully satisfied with his own definition, and it is not extraordinary, therefore, that he should have seldom given satisfaction to others." This difficulty proceeds from the complexity of the symptoms that enter into the charac- ter of a fever; the contrariety of many of them to each other in different stages of it; and the occasional absence of some, that, in other instances, appear to constitute its leading features. There are also two other difficulties of no inconsiderable magnitude, which the nosologist has to contend with in laying down a clear and per- spicuous survey of fevers; namely, their division or collocation, and their generic names,—a province, on which, however, it is not our intention now to discuss. The remote cause of fever can frequently be traced; but we are too little acquainted with the nature of several of them to be able to restrict them to a specific mode of action : of the proximate cause, but very little is at present known, and will probably be long before we know much more. The usual division of fevers is into intermittents, and continu- ed, on account of their taking up different times in their natural duration ; some being compounded of a number of paroxysms, fol- lowing each other in a regular succession, at some distance of time, as happens in intermittents or agues ; in others, a fresh paroxism comes in, immediately as the crisis of the former, so as hardly to leave the patient wholly free from fever, as occurs in remittents ; and in others, there is such a quick succession of paroxysms, that the one comes on before there is any visible abatement of the fe- brile symptoms as in continued fevers. Causes of fevers, &c.—As more than $ne half of mankind is said to perish by fevers, it is of importance to be acquainted with their causes. The most general causes of fevers are, infection, rors in diet, unwholesome air, violent emotions of the mind, excess or suppression of usual evacuations, external or internal injuries, and ex- treme degrees of heat or cold. As most of these have already been treated of at considerable length, and their effects shown, we shall not now resume the consideration of them, but shall only recom- mend it to all, as they would wish to avoid fevers and other fatal diseases, to pay the most punctual attention to these articles. Fevers are not only the most frequent of all diseases, but they are likewise the most complex. In the most simple species of fever there is always a combination of several different symptoms. The dis- tinguishing symptoms of fever are, increased heat, frequency of pulse, loss of appetite, general debility, pain in the head, and a difficulty in erforming some of the vital or animal functions. The other symp- CAUSES OF FEVERS, &c. 105 toms usually attendant on fevers, are nausea, thirst, anxiety, de- lirium, weariness, wasting of the flesh, want of sleep, or the sleep disturbed and not refreshing. When the fever eoines on gradually, the patient generally com- plains first of languor or listlessness, soreness of the flesh or the bones, as the country people express it, heaviness of the head, loss of appetite, sickness, with clamminess of the mouth; after some time come on excessive heat, violent thirst, restlessness. Slc. When the fever attacks suddenly, it always begin* with *m un- easy sensation of excessive cold, accompanied wi-'n debility and loss of appetite; frequently the cold is attended with shivering, oppression about the heart, and sickness at st^ach, or vomiting. Fever considered as an effort of n;™re, &%~fs a fever ^ only an effort of Nature to free fcerseir from an offending cause, it is^be business of those who have the care of the sick to observe with diligence which way Nature points and ^ endeavour to as- sist her operations. Our bodies are so framed, as to ^ve a con- stant tendency to expeJor throw off whatever is injurious to health. This is generally do»e by urine, sweat, stool, expectoration, vomit, "ThTrVil^scrtTb^ve, if the efforts of Nature, at the begin- nino; of a fever, were duly, attended to and prornoted, it would sel- dom continue long ; but when her attempts are either neglected „, counteracted, it is no wonder if the disease prove fatal. There are daily instances of persons, who, after catching cold, have al the symyoms of a beginning fever; but by keeping warm, drinking dlEThquors, bathing their feet in warm water, &c. the symp- tomsn? a few hours disappear, and the danger is prevented. When fevers of a putrid kind threaten, the best method of obviating their 6ffotr o^u^ "'into a critical inquiry into the nature andhnmediate causes of fevers, but to mark their most obvious svmi oms and to point out the proper treatment of the patient with reject "o his diet, dnnk, air, &c. in the different stages of Thf diiases- In these articles the inclinations of the patient will in o »,.0/it measure direct our conduct. . gJJno£ eyery person in a fever complains of great thirst, and calls out for drhl especially^ofacooling nature. This at once "7^ thc opinion of ^^^'^^S^^t^^^^^^ thing noxious to the ^dv eit&er .ngenera^d « «tr^wed Jom ^ ^ ^ ^ ^ a violent commouon in the system, touowea Dy »J»« commotion to a fermenta- neys, with which the paroxysm terminatedhe^enbed the ^ d from the tion, concoction, or ebullition, by w^icn .^nnmation mscum which such separation sound humours; and the evacuation to f. J"PXd°KumXm The emunctorles that produces, or rather to the discharge of f'■ "O'bid ?cum t °m ln rfh-B d and open externally. Galen supported this hypothesis w^u.j writing8j thr0ugh the it is the only explanation of fever to to me™{J ™ °» ™e|Xnh8nif 4o still Idher- long course of three thousand veara; in fact till the nme 01 YQ«'h d it was fffo it, and whose pages areju 1 of he anguage to which t gave^rth,^ ^ blended almost insensibly with the dialect of the "J™ but'highly ingenious doctrine, considered merely hypothetical^, is not onij mnu'.. g diseases ; depuration of the system. F.d. 106 SYMPTOMS OF FEVER. points out the use of water, and other cooling liquors. What is so likely to abate the heat, attenuate the humours, remove spasms 3nd obstructions, promote perspiration, increase the quantity of urune> an<*» *n shoit, produce every salutary effect in an ardent or inflaiL?matory fever, as drinking plentifully of water, thin gruel, or any v°ther weak liquor, of which water is the basis ? The ne- cessity of diluting liquors is pointed out by the dry tongue, the parched skh?> and tne burning heat, as well as the unquenchable thirst of the parent. In innammatoi "v fevers, where the thirst is great, the following forms a grateful an J cooling beverage : Take cream of tartar half an ounce. White sugar four ouirees. Fresh confection of orange ^ree ounces. Hot water three pints. Half a pint or more may be drunk as otxcas^on requires. Many other cooling liquors, which are extremity grateful to pa- tients in a fever, may be prepared from fruits, i?s decoctions of tamarinds, apple-tea, orange whey, and the like. Mucilaginous liquors might also be prepared from marshmallow repots, linseed, lime-tree buds, and other mild vegetables. These liquors, espe- cially when acidulated, are highly agreeable to the patient, and should never be denied him. Symptoms of fever.—At the beginning of a fever, the p*atient generally complains of great lassitude or weariness, and has no in- clination to move. This evidently shows the propriety of keeping him easy, and if possible, in bed. Lying in bed relaxes the spasms,* abates the violence of the circulation, and gives nature an oppor- tunity of exerting all her force to overcome the disease. Confine- ment to bed alone would often remove a fever at the beginning; but when the patient struggles with the disease instead of driving it off, he only fixes it the deeper, and renders it more dangerous. This observation is too often verified in travellers, who happen when on a journey to be seized with a fever. Their anxiety to get home, induces them to travel with the fever upon them ; which con- duct seldom fails to render it fatal. In fevers, the mind as well as the body should be kept easyv Company is seldom agreeable to the sick. Indeed every thing that * The hypothesis of Stahl, Hoffman, and Cullen, is founded on the doctrine of a spasm on the extremities of the living fibre. According to the more elaborate princi- ples of this system, as improve J by Cullen, the human body is a congeries of organs, regulated by the laws not of inanimate matter, but of life, and superintended by a mo- bile and conservative power or energy, seated in the brain, but distinct from the mind or soul, acting wisely butnecessarily for the general health ; correcting deviations, and supplying defects, not from a knowledge and choice of the means, but by a pre-estab- lished relation between the changes produced, and the motions required for the resto- ration of health; and operating, therefore, through the medium of the moving fibres, upon whose healthy or unhealthy state depends the health or unhealthiness of the general frame, which fibres he regarded with Stahl, as simple nerves, the muscular filaments being nothing more than their extremities, and by no means possessed of an independent vis insita. Ed. SYMPTOMS OF FEvER. 107 disturbs the imagination increases the disease: for which reason every person in a fever ought to be kept perfectly quiet, and nei ther allowed to see nor hear any thing that may in the least affect or discompose his mind. Though the patient in a fever has the greatest inclination for drink, yet he seldom has any appetite for solid food : hence the impropriety of urging him to take victuals is evident. Much solid food in a fever is every way hurtful. It oppresses nature, and, in- stead of nourishing the patient, serves only to feed the disease. What food the patient takes, should be in small quantity, light, and of easy digestion. It ought to be chiefly of the vegetable kind, as panada, roasted apples, gruels, and such like. Nothing is more desired by a patient in a fever, than fresh air. It not only removes his anxiety, but cools the blood, revives the spirits, and proves every way beneficial. Many patients are in a manner stifled to death in fevers for want of fresh air; yet such is the unaccountable infatuation of most people, that the moment they think a person in a fever, they imagine he should be kept irt a close chamber, into which not one particle of fresh air must be admitted. Instead of this, there ought to be a constant stream of fresh air into a sick person's chamber, so as to keep it moderately cool. Indeed, its degree of warmth ought never to be greater than is agreeable to one in perfect health. Nothing spoils the air of a sick person's chamber, or hurts the patient more, than a number of people breathing in it. When the blood is inflamed, or the humours in a putrid state, air that has been breathed repeatedly will greatly increase the disease. Such air not only loses its spring, and becomes unfit for the purpose of respiration, but acquires a noxious quality, which renders it in a manner poisonous to the sick. In fevers, when the patient's spirits are low and depressed, he is not only to be supported with cordials, but every method should be taken to cheer and comfort his mind. Many, from a mistaken zeal, when they think a person in danger, instead of solacing his mind with the hopes and consolations of religion, frighten him with the views of hell and damnatibn. It would be unsuitable here to dwell upon the impropriety and dangerous consequences of this conduct; it often hurts the body, and there is reason to believe seldom benefits the soul. Among common people, the very name of a fever generally sug- gests the necessity of bleeding. This notion seems to have taken its rise from most fevers in this country having been formerly of an inflammatory nature ; but true inflammatory fevers are now seldom to be met with. Sedentary occupations, and a different manner of living, have so changed the state of diseases in Britain, that there is now hardly one fever in ten where the lancet is ne- cessary. In most low, nervous, and putrid fevers, which are now so common, bleeding is really hurtful, as it weakens the patient, sinks his spirits, &c. We would recommend this general rule, never to bleed at the beginning of a fever, unless there be. evident signs of inflammation. Bleeding is an excellent medicine when ne- cessary, but should never be wantonly performed. It is likewise a common notion, that sweating is always neces- 108 SYMPTOMS OF FEVER. sary in the beginning of a fever. When the fever proceeds from an obstructed perspiration, this notion is not ill-founded. If the .patient only lie in bed, bathe his feet and legs in warm water, and drink plentifully of warm water-gruel, or any other weak, diluting liquor, he will seldom fail to perspire freely. The warmth of the bed, and the diluting drink, will relax the universal spasm, which generally affects the skin at the beginning of a fever; it will open the pores, and promote the perspiration, by means of which the fever may often be carried off. But instead of this, the common practice is to heap clothes upon the patient, and to give him things of a hot nature, as spirits, spiceries, &c., which fire his blood, in- crease the spasms, and render the disease more dangerous. In all fevers, a proper attention should be paid to the patient's longings. These are the calls of Nature, and often point out what may be of real use. Patients are not indeed to be indulged in ev- ery thing that the sickly appetite may crave ; but it is generally right to let them have a little of what they eagerly .desire, though it may not seem altogether proper. When a patient is recovering from a fever, great care is neces- sary to prevent relapse. Many persons, by too soon imagining themselves well, have lost their lives, or contracted other diseases of an obstinate nature. As the body after a fever is weak and del- icate, it is necessary to guard against catching cold. Moderate exercise in the open air will be of use, but great fatigue is by all means to be avoided ; agreeable company will also have a good effect. The diet must be light, but nourishing. It should be tak- •n frequently, but in small quantities. It is dangerous, at such a time, to eat as much as the stomach may crave. From the great variety of fevers that afflict the human body, it is impossible to find any medicine adapted to them all, or, in- deed, to all the symptoms of any one of them. Notwithstanding this, the people of England have, for half a century, been swal- lowing a powder said to possess wonderful virtues in the cure of feversr Nor has the use of this powder been confined to England ; it has been carried to every part of the globe ; and great cures have been attributed to it, with what truth I will not pretend to say. I remember bleeding to have been as much in vogue in fe- vers, though now it is seldom prescribed, unless in local inflam- mations. But there is a fashion in physic, as well as in other things ; and it is always heresy to talk against the doctrine of the day. This fever-powder, like other quack medicines, is said to be good in a variety of complaints, and is used by some people in ev- ery disorder, real or imaginary. I knew a lady, who not only ad- ministered it to all the poor of the parish when ill, but likewise gave it to her dogs and horses ; and never failed to take it daily herself, till she destroyed her constitution. Many persons look upon it as panacea, or universal remedy, and keep it continually by them in case of emergencies. The fatal consequences of such credulity must be often irreparable. This, at least, was the situa- tion of an old General of my acquaintance, whom no argument could dissuade from taking the powder, till he lost the use of all his extremities. INTERMITTENT FEVERS, &c. There is not a greater solecism in language, nor a greater ab- surdity in real practice, than to pretend that any one medicine is of certain efficacy in fevers. The most skilful physicians that ever existed have always found it necessary to watch attentively the progress of a fever ; and to adapt both the regimen and medicines to the different changes and symptoms as they occurred. CHAP. III. INTERMITTENT FEVERS, OR AGUES. The generic character of an intermittent fever consists of peri- ods or paroxysms, between each of which there is a perfect inter- val when no fever is present. They admit of several distinctions, as true, spurious, perfect, and imperfect. The true and perfect intermittents which occur are ; 1. The quotidian or daily—having an intermission of 24 hours. 2. Tertian, or third-day, 48 hours. 3. Quartan, or fourth-day, 72 hours. When the return of an intermittent exceeds the latest of these times, it is called erratic or wandering. The other distinctions are of no practical utility, the means of cure being the same. The paroxysm of an intermittent consists of three successive stages, viz. a hot, a cold, and a sweating stage. Intermitting fevers afford the best opportunity both of observing the nature of a fever, and also the effects of medicine. No person can be at a loss to distinguish an intermitting fever from any other, and the proper medicine for it is now almost universally "The several kinds of intermittent fevers take their names from the period in which the fit returns, as quotidian, tertian, quartan, &It appea7s~to~be generally acknowledged, iiiat "^f^^ or a! effluvia arising from stagnant water, or marshy ground, wVen acted upon by heat, are the most frequent exciting cause of this fever. Exciting CAUSES.-This is evident from their abounding in rainy seasons, and being most frequent in countries where the soi s marshy, as in Holland, the fens of Cambridgeshire, the hundreds of Essex, &c, although we are not yet f^^^y.^"1""^^ all the circuinstances which are requisite to render ™r* ""** mata productive of intermittents. In acknowledging, however The influence of marsh effluvia to produce intermittents, they must not at the same time, be considered as their universal cause, since ^ found that persons residing constantly in the most healthy 110 INTERMITTENT FEVERS, &c. part of cities, and far remote from marshes, are not unfrequently attacked by them. Predisposing.—This disease may also be occasioned by debility, however induced, by a poor watery diet, damp houses, evening dews, lying upon the damp ground, watching, fatigue, depressing passions of the mind, &c. When the inhabitants of a high country remove to a low one, they are generally seized with intermittent fevers, and to such the disease is most apt to prove fatal. In a word, whatever relaxes the solids, diminishes the perspiration, or obstructs the circula- tion in the capillary or small vessels, disposes the body to agues. Symptoms of the cold stage.—An intermitting fever generally begins with pain of the head and loins, weariness of the limbs, coldness of the extremities, stretching, yawning, with sometimes great sickness and vomiting; to which succeed shivering and vio- lent shaking. Of the hot stage.—After a longer or shorter continuance of shivering, the heat of the body gradually returns ; irregularly at first, and by transient flushes, soon, however, succeeded by a steady, dry, and burning heat, considerably augmenting above the natural standard. The skin which before was pale and constricted, be- comes now swollen, tense, and red ; and is remarkably sensible to the touch. The sensibility, diminished in the cold stages, is now preternaturally acute ; pains attack the head, and flying pains are felt over various parts of the body. The pulse is quick, strong, and hard; the tongue white, the thirst is great, and the urine is high coloured. Of the sweating stage.—A moisture is at length observed to break out upon the face and neck, which soon becomes universal and Uniform. The heat falls to its ordinary standard; the pulse diminishes in frequency, and becomes full and free ; the urine de- posits a sediment; the bowels are no longer confined ; respiration is free and full; all the functions are restored to their natural or- der ; when, after a specific interval, the paroxysm returns, and performs the same successional evolutions. Between the paroxysms, the patient must be supported with food that is'nourishing, but light and easy of digestion, as veal or chicken broths, sago, gruel with a little wine, light puddings, and such like. His drink may be small negus, acidulated with the juice of lemons or oranges, and sometimes a little weak punch. He may likewise drink infusions of bitter herbs, as camomile, wormwood, or water-trefoil, and may now and then take a glass of small wine, in which gentian root, centaury, or some other bit- ter, has been infused. As the chief intentions of cure in an ague are to brace the sol- ids, and promote perspiration, the patient ought to take as much exercise between the fits as he can bear. If he be able to go abroad, riding on horseback, or in a carriage, will be of great service. But if he cannot bear that kind of exercise, he ought to take such as INTERMITTENT FEVERS, &c. Ill his strength will permit. Nothing tends more to prolong an in- termitting fever, than indulging a lazy indolent disposition. Intermitting fevers, under a proper regimen, will frequently go off without medicine : and when the disease is mild, in an open dry country, there is seldom any danger from allowing it to take its course ; but when the patient's strength seems to decline, or the paroxysms are so violent that his life is in danger, medicine ought immediately to be administered. This, however, should never be done till the disease be properly formed, that is to say, till the pa- tient has had several fits of shaking and sweating. Medical treatment.—1. This consists during the cold stage, in endeavouring to bring on the hot, by means of artificial warmth ; putting the feet in warm water ; giving mild diluent liquids ; dia- phoretic cordials ;* opiates, &c. 2. During the hot stage, to promote perspiration, by means of cordial diaphoretics, with the means recommended in the cold stage. The principal object, therefore, in the treatment of intermittents, is to put a period to the stage which is present, by hastening that which naturally succeeds it. The first thing to be done in the cure of an intermitting fever, is to cleanse the stomach and bowels. This not only renders the application of other medicines more safe, but likewise more effica- cious. In this disease the stomach is generally loaded with cold viscid phlegm, (sordes,) and frequently great quantities of bile are discharged by vomit; which plainly points out the necessity of such evacuations. Emetics are, therefore, to be administered be- fore the patient takes any other medicine, which may be adminis- tered just before the accession of the cold fit. A dose of ipecacu- anha will generally answer this purpose very well. A scruple or half a drachm of the powder will be sufficient for an adult,t and for a younger person the dose must be less in proportion. After it begins to operate, the patient ought to drink plentifully of weak camomile-tea; and it may be repeated at the distance of two or three days. Emetics not only cleanse the stomach, but increase the perspiration, and all the other secretions, which render them of * Take Spirits of Nitric iEther, 2 drachms. Camphor mixture, 4 ounces. Liquor of acetated Ammonia, 1 ounce. Syrup of Roses, 3 drachms. Mix": and take two table-spoonsful every fifteen minutes. t Take Powder of Ipecacuanha, 15 grains. Tartarised Antimony, 1 grain. Make an Emetic powder. or Powder of Ipecacuanha, 15 grains. Tartarixed Antimony, 1 grain. Spearmuch water, l£ ounce. Syrup of Saffron, 1 ounce. Make an Emetic draught. or Take Peruvian Bark, 1 ounce. Divide into twelve equal parts, of which take one every hour, or every second or third hour, in a small cupful of new milk, during the absence of the fever. or Take Peruvian Bark, 1 ounce. Compound Cinnamon powder, £ drachm. Mix, and divide into twelve equal parts or Take Peruvian Bark, 1 ounce. Confection of Opium, 1 drachm. Mix, and divide into twelve equal parU. or Take Peruvian Bark, I ounce. Powdered Rhubarb, 2 scruples. Mix, and divide in twelve equal parts; to be taken as above. 112 INTERMITTENT FEVERS, &c. such importance, that they often cure intermitting fevers without the assistance of any other medicine. Purgative medicines are likewise useful and often necessary in intermitting fevers. Emetics, however, are more suitable in this disease, and render purging less necessary ; but if the patient be afraid to take a vomit, he ought in this case to cleanse the bow- els by a dose or two of Epsom salts, jalap, or rhubarb, as may ap- pear best adapted to the constitution. Bleeding may sometimes be proper at the beginning of an in- termitting fever, when excessive heat, delirium, &c. give reason to suspect an inflammation or congestion of blood in the external ves- sels of the head; but as the blood is seldom in an inflammatory state in intermitting fevers, this operation is rarely necessary. When frequently repeated, it tends to prolong the disease. After proper evacuations, the patient may safely use the Peruvi- an bark, which may be taken in any way that is most agreeable to him. No preparation of the bark seems to answer better than the most simple form in which it can be given, viz. in powder. It may also, as required, be advantageously combined with other sub- stances,-as, confection of opium, rhubarb, cinnamon also, in any form ; e. g. in powder, electuary, tincture, decoction, extract, &c. Two ounces of the best Peruvian bark, finely powdered, may be divided into twenty-four doses. These may either be made into boluses, as they are used, with a little syrup of lemon, or mixed in a glass of red wine, a cup of camomile-tea, water-gruel, or any other drjnk that is more agreeable to the patient.* In an ague which returns every day, one of the above doses may be taken every two hours during, the interval of the fits. By this method, the patient will be able to take five or six doses between each paroxysm. In a tertian, or third day, ague, it will be suffi- cient to take a dose every third hour, during the interval, and in a quartan every fourth. If the patient cannot take so large a dose of the bark, he may divide each of the powders into two parts, and take one every hour, &c. For a young person, a smaller quantity of this medicine will be sufficient, and the dose must be adapted to the age, constitution, and violence of the symptoms.f The above quantity of bark will frequently cure an ague; the patient, however, ought not to leave off taking the medicine as soon as the paroxysms are stopped, but should continue to use it till there is reason to believe the disease is entirely overcome. Most of the failures in the cure of this disease are owing to pa- tients not continuing to use the medicine long enough. They are generally directed to take it till the fits are stopped, then to leave * It has lately been observed, that the red bark is more powerful than that which has for some time been in common use. Its superior efficacy seems to arise from its be- ing of a more perfect growth than the quill-bark, and consequently more fully impreg- nated with the medical properties of the plant. \ In intermitting fevers of an obstinate nature, I have found it necessary to throw in the bark much faster. Indeed, the benefits arising from this medicines-depend chiefly upon a large quantity of it being administered in a short time. Several ounces of bark given in a few days, will do more than as many pounds taken in the course of some weeks. When this medicine is intended either to stop a mortification, or cure an obstinate ague, it ought to be thrown in as fast as the stomach can possibly bear it. Inattention to this circumstance has hurt the reputation of one of the best medicines of which we are in possession. INTERMITTENT FEVERS, y be given to the patient every three or four hours while the fevej? is violent; afterwards once in five or six hours will be sufficient, using some diluent drink. If the body be bound, a clyster of milk and water, with ^ httle salt, and a spoonful of sweet oil or fresh butter in it, ought daily to be administered. Should this not have the desired effect, a tea- spoonful of magnesia alba, or cream of tartar, may be frequently put into his drink, or some gentle aperient may be given.* He may likewise eat tamarinds, boiled prunes, roasted apples, and the like. If there be pain in the head with delirium, oppressed breathing, or determination to any organ, leeches should be applied to the temples, or other parts, blisters, fomentations, &c. and the treat- ment laid down for the particular organ affected should be adopted- If about the tenth, eleventh, or twelfth day, the pulse becomes more soft, the tongue moister, and the urine begins to let fall a reddish sediment, there is reason to expect a favourable issue to the disease. But if, instead of these symptoms, the patient's spir- its grow languid, his pulse sinks, and his breathing becomes, diffi- • Take Pulp of Tamarinds, i ounce. Cream of Tartar, 2 drachms. Boiling Water, 5 ounces. Strain off the liquor and add, Cinnamon Water, 1 ounce. Tartarised Antimony, 1 grain. Four table spoonsful to be taken for a dose, to be repeated in three hours, should no motions in that time have been obtained. or Take Sulphate of Soda, 6 drachms. Infusion of Senna, 1£ ounce. Syrup of Oranges, 1 drachm. Make a purging draught. or Take powdered Rhubarb, 25 grains. Cream of Tartar, 1 drachm. Make a powder, to be taken out of some appropriate vehicle. 126 INFLAMMATORY FEVER. cult, with a stupor, trembling of the nerves, starting of the ten- dons, &c. there is reason to fear that the consequences will be fa- tal. In this case blistering-plasters must be applied to the head, ancles, inside of the legs or thighs, as there may be occasion ; poul- tices of wheat-bread, mustard, and vinegar, may likewise be ap- plied to the soles of the feet, and the patient must be supported with cordials, as strong wine-whey, negus, sago-gruel, with wine in it, and such like, especially camphor and a?ther.* A proper regimen is not only necessary during the fever, but likewise after the patient begins to recover. By neglecting this, many relapse, or fall into other diseases, and continue valetudinary for life. Though the body be weak after a fever, yet the diet for some time ought to-be rather light than of too nourishing a nature. Too much food, drink, exercise, company, &c. are carefully to be avoided. The mind ought likewise to be kept easy, and the pa- tient should not attempt to pursue study, or any business that re- quires intense thinking. If the digestion be bad, or the patient be seized at times with feverish heats, an infusion of Peruvian bark in cold water will be of use. It will strengthen the stomach, and help to subdue the re- mains of the fever. When the patient's strength is pretty well recovered, he ought to take some gentle laxative. An ounce of tamarinds and a dram of senna may be boiled for a few minutes in an English pint of water, and an ounce of manna dissolved in the decoction; after- wards it may be strained, and a tea-cupful drank every hour till it operates. This dose may be repeated twice or thrice, five or six days intervening. Those who follow laborious employments ought not to return too soon to their labour after a fever, but should keep easy till their strength and spirits are sufficiently recruited. It requires very little argument to prove, that the body, as well as the mind, must require indulgence after the severity of such a disease. But I find it more difficult to prevent people from carry ing this indulgence to excess in what relates to eating and drink- ing. The appetite is usually voracious upon recovering from most fevers, and to say, that its cravings are not to be satisfied, is cer- tainly an unpalatable doctrine. Yet self-command is necessary in such cases, us there will be great danger, not only of a relapse, but of other disagreeable consequences, such as biles, ulcers, and settled swellings in particular limbs. These may be obviated by a light and principally vegetable diet, not however totally exclud- ing animal food of easy digestion. Sudorifics do not appear to be advisable in this fever, from their aptitude to bring on profuse perspiration ; and it is not possible to keep the body warm without producing a considerable increase of heat. Epsom, or any of the other neutral salts, may be given in some simple form, every two or three hours, joined with small ► Take camphor mixture, 6 ounces. each, 2£ drachms. Spirits of compound ether. Mix, and give the patient two table spoons- Aromatic stunts of ammonia, of ful every hour. NERVOUS FEVER. 127 nauseating doses of tartarized antimony,* or the like, or so as to act on the bowels as occasion may require. A bath for the feet, at night, may assist the effect. In this fever, as in most others, sleep is much interrupted and from a want of it delirium often ensues. Opium here would be an uncertain remedy, for should it fail to procure rest, the deliri- um would be considerably increased by it. It should, therefore, only be given in cases of imminent danger, and even then in small doses, frequently repeated, paying strict attention to the state it produces. Throughou* the whole disease the patient must be strictly en- joined to pay the greatest attention to the diet here laid down, and to abstain from solid food, and animal broths of any kind. Fresh air, exercise of a gentle kind, on horseback or in a car- riage, agreeable society, and a moderate use of wine, will greatly contribute to the recovery of convalescents. Should the digestive organs prove weak, which will be indicated by the appetite not readily returning, stomachic bitters, as advised under the head of indigestion, may be taken with advantage, &c. CHAP. VII. SLOW OR NERVOUS FEVER. (Typhus Mitior.) Nervous fevers have increased greatly of late years in this isl- and, owing doubtless to our different manner of living, and the in- crease of sedentary employments ; as they commonly attack per- sons of a weak relaxed habit, who neglect exercise, eat little solid food, study hard, or indulge in spirituous liquors. • Causes.—Nervous fevers may be occasioned by whatever de- presses the spirits, or impoverishes the»blood; as grief, fear, anxi- ety, want of sleep, intense thought, living on poor watery diet, as nnripe fruits, cucumbers, melons, mushrooms, &c. They may likewise be occasioned by damp, confined, or unwholesome air. Hence they are very common in rainy seasons, and prove most fa- Jtl to those who live7 in low dirty houses, crowded streets, hospitals, iails manufacturing or large towns, or such like places. J It p^c pally attacks those of weak lax fibres, and persons whose'consAtutfons have been broken by e«e«iye vene^y, freq^t salivations, too free an use of purgative medicines, or any other excessive evacuations, are most liable to this disease. ' KeepUi- on wet clothes, lying on the damp ground, excessive fatigue, and whatever obstructs the perspiration, or causes a spas- modic stricture of the solids, may likewise occasion nervous fevers We shall only add, frequent and great irregularities in diet, aoo gleat abstinence, as well as excess, is hurtful. jy^hmg tends so AnurTny Vvfne, ' 20 drops. occasion may require. 128 NERVOUS FEVER. much to preserve the body in a sound slate as a regular diet ; nor can any thing contribute more to occasion fevers of the worst kind than its opposite. The most general cause of this fever is contagion,* communi- cated through the medium of an impure or heated atmosphere, by concentrated effluvia arising from the body of a person labouring under this specific disease ; but whatever debilitates the system or oppresses the mind may induce a state of pre-disposition more readily to be influenced by its operations ; and although in the origin and progress of typhus and such like fevers, it is undenia- ble that contagion is the most powerful agent in propagating the disease, still many of these fevers, though not contagious at their origin, become so in their progress and decline, and, in some in- stances, generate others of a much worse description than the ori- ginal one ; and this, in all probability, is the way in which epidem- ics appear and spread. In warm climates typhus sometimes occurs, and continued fe- vers of most kinds are apt to degenerate into fever of a typhus type. It is, however, most prevalent in temperate and cold cli- mates. In Great Britain typhus is favoured by a low temperature, being most prevalent in the cold months of winter, generally abat- ing or disappearing as the summer-heat advances, and often pre- vailing, in a considerable degree, in cool wet autumns. Symptoms.—Typhus Mitior generally sets in with remarkable mildness in its symptoms ; and although the patient experiences some trifling indisposition for several days, still he lias no reason to suspect the approach of any severe disease. There is dejection of spirits; want of appetite, weakness, weariness after motion, watchfulness, deep sighing, and dejection of mind, are generally the forerunners of this disease. These are succeeded by a quick low pulse, a dry tongue without any considerable thirst, chilliness and flushings in turns, &c. * After some time the patient complains of a giddiness and pain of the head, has a nausea, with retchings and vomiting ; the pulse is quick, and sometimes intermitting; the urine pale, resembling dead small-beer, and the breathing is difficult, with oppression of the breast, and slight alienation of the mind. If, towards the ninth, tenth, or twelfth day, the tongue becomes more moist, with a plentiful spitting, a gentle purging, or a moist- ure upon the skin ; or if a suppuration happen in one or both ears, or large pustules break out about the lips and nose, there is reason to hope for a favourable crisis. But if there be an excessive looseness or wasting sweats, with frequent fainting fits ; if the tongue when put out trembles ex- * Dr. Haygarth, who devoted considerable attention to the consideration of the con- K™tUre °f,tyPrU- feVeT' 3tVd the manner m which Jt is Propagated^? deduct therefrom a variety of important facts, of very great importance For the prevention of ^Sv^V116 Pr.efvat'on «f human life /whence he concludes, thaf t7phus mav oe easily and certainly prevented by ventilation; (in large, airy, and clean rooms Tor S.Sh£r (,Dt0 a,r.TPitals: °\into an adjoining room of the same house, wh'ere ever t oiLL^JfPwaIly by cl"nhn<»". which entirely destroys the poison/where- pp 72 89 ) comPletely accomphshed. (See Dr. Haygarth'* letter to%. Ptrcival, NERVOUS FEVER. 129 rosively, and the extremities feel cold, with a fluttering or slow creeping pulse; if there be a starting of the tendons, and almost total loss of sight and hearing, and an involuntary discharge of Stool and urine, there is great reason to fear that death is ap- proaching. Diet.—It is very necessary, in this disease, to keep the patient cool and quiet. The least motion would fatigue him, and will be apt to occasion weariness, and even faintings. His mind ought not only to be kept easy, but soothed and comforted with the hopes of a speedy recovery. Nothing is more hurtful in low fevers of this kind than presenting to the patient's imagination gloomy or frightful ideas. These of themselves but often occasion nervous fevers, and it is not to be doubted but they will likewise aggravate The patient must not be kept too low. His strength and spirits ought to be supported by nourishing diet and generous cordials. For this purpose his gruel, panado, or whatever food he takes, must be mixed with wine according as the symptoms may require. Pretty strong wine-whey, or negus sharpened with the juice of or- ange or lemon, will be proper for his ordinary drink. Mustard- whey is likewise a very proper drink in this fever, and may be rendered an excellent cordial medicine by the addition of a propel quantity of white-wine.* Wine in this disease, if it could be obtained genuine, is almost the only medicine that would be necessary. Good wine possesses all the virtues of the cordial medicines, while it is free from any of their bad qualities; I say good wine; for however common this article of luxury is now become, it is rarely to be obtained genuine, especially by the poor, who are obliged to purchase it in small quantities. , I have often seen patients in low nervous fevers where the pulse could hardly be felt, with a constant delirium, coldness of the ex- tremities, and almost every other mortal symptom, recover by us- ing, in whey, gruel, and negus, a bottle or two of strong wine eve- y. Good old sound claret is the best, and may be made into or given by itself, as circumstances require.t word, the great aim in this disease is to support the pa- tient's strength, by giving him frequently small quantities of the above, or other drinks of a warm and cordial nature. He is not however, to be overheated either with liquor or clothes ; and his food ought to be light, and given in small quantities. Medical treatment.—Where a nausea, load, and sickness at stomach, prevail at the beginning of the fever, it will be necessary J vV^e^wmfca^ofbl JSred, eoually beneficial effects.have,*«i pjoJ^J bv drinking sound porter or ale with a lemon or orange sliced into it and f«naerea agreeable fo the pafate of the patient by^ the addition of ^^^J^S^Sa low fevers ofqthis country may with safety be confided. Ep. k '2 ■ 130 NERVOUS FEVER. to give the patient a gentle vomit.* This may be repeated any time before the third or fourth day, if the above symptoms contin- ue. Emetics not only clean the stomach, but, by the general shock which they give, promote the perspiration, and have many other excellent effects in slow fevers, where there are no signs of inflammation, and nature wants rousing. Such as dare not venture upon an emetic, may clear the bowels by a small dose of Turkey rhubarb, or an infusion of senna and manna, or sublimate of mercury.t In all fevers, the great point is to regulate the symptoms, so as to prevent them from going to either extreme. Thus, in fevers of the inflammatory kind, where the force of the circulation is too great, or the blood dense, and the fibres too rigid, bleeding and other evacuations are necessary. But in nervous fevers, where nature flags, where the blood is vapid and poor, and the solids re- laxed, the lancet must be spared, and wine, with other cordials, plentifully administered. It is the more necessary to caution people against bleeding in this disease, as there is generally, at the beginning, an universal stricture upon the vessels, and sometimes an oppression and diffi- culty of breathing, which suggest the idea of a plethora, or too great a quantity of blood. I have known even some of the faculty deceived by their own feelings in this respect, so far as to insist upon being bled, when it was evident, from the consequences, that the operation was improper. Though venesection is generally improper in this disease, yet topical bleeding from the temples, at the commencement, to re- lieve cerebral congestion, will be advisable, in persons of delicate constitutions ; although in full plethoric habits it may be more proper to draw off six or eight ounces of blood from the arm, or jugular vein, on the first day of the attack. Cold affusions is one of the most powerful and efficacious means that can be resorted to in typhus fever ; but its effects will be more salutary in propor- tion as it is adopted early, or during the first stage of the disease. The affusion may be repeated four or five times in the course of the twenty-four hours, using spring water impregnated with com- mon salt, when sea water is not at hand. At the same time the patient's feet may be placed in a warm bath. This operation be- ing over, the feet dried, and the patient put to bed, some tepid bland fluid may be given to promote perspiration. In the more advanced stage a tepid affusion may be substituted for the cold, to which a small portion of ardent spirit may be added to the wa- ter, with the view of increasing the evaporative process. Vinegar is usually substituted, although the former is preferable. Blister- ing is also highly necessary. Blistering plasters may be applied, at all times of the fever, with great advantage. If the patient be delirious, he ought to be blistered on the neck or head, and it will be the safest course, when the insensibility continues, as soon as * See Simple continued Fever. t Take Powdered Jalap, 10 grains. Submuriate of Mercury, 3 grains. Syrup of Buckthorn, enough to make the mass, which divide into three pills for a dose. NERVOUS FEVER. 131 the discharge occasioned by one blistering-plaster abates, to apply another to some other part of the body, and by that means keep up a continual succession of them till he be out of danger. I have been more sensible of the advantage of blistering in this, than in any other disease. Blistering-plasters not only stimulate the solids to action, but likewise occasion a continual discharge, which may in some measure supply the want of critical evacua- tions, which seldom happen in this kind of fever. They are most proper, however, either towards the beginning, or after some de- gree of stupor has come on, in which last case it will always be proper to blister the head. If the patient be costive through the course of the disease, it will be necessary to procure a stool, by giving him every other day a clyster of milk and water, with a little sugar, to which may be added a spoonful of common salt, if the above does not op- Should a violent looseness come on, it may be checked by hav- ing recourse to astringents;* but, in the progress of the disease, if a gentle diarrhoea occur, and seem likely to prove critical, it should by no means be checked. A miliary eruption sometimes breaks out about the ninth or tenth day. As eruptions are often critical, great care should be taken not to retard Nature's operation in this particular. The eruption ought neither to be checked by bleeding nor other evacuations, nor pushed out by a hot regimen ; but the patient should be sup- ported by gentle cordials, as wine-whey, small negus, sago-gruel with a little wine in it, and such like. He ought not to be kept too warm, yet a kindly-breathing sweat should by no means be checked. ..... . , -c Though blistering and the use of cordial liquors are the chief things to be depended on in this kind of fever ; yet for those who may choose to use them, we shall mention one or two of the forms of medicine which are commonly prescribed in it. In desperate cases, where the hiccup and starting of the tendons have already come on, we have sometimes seen extraordinary ef- fects from large doses of musk, ether, camphor, ammonia, opium, frequently repeated. Musk is doubt'.ess an antispasmodic, and may be given to the quantity of a scruple three or four times a-day, or oftener if necessary. Sometimes it may be proper to add to the musk a few grains of camphor, and salt of hartshorn as these tend to promote perspiration and the discharge of urine. Thus, fifteen grains of musk, with three grains of camphor, and six grains „, ,, ... , „ 9nnnrps Svruo of Saffron, enough to make the ^^TSre'o'f&hu, t~ ^ss into a i, t0gbe taken every Tincture of Opium, 30 drops. four or five hours. ^ Make a^Uture: J^h'ich give two table Take powdered Valerian, I sple. spoonsful every»iiho«™. » ^ Q of eacb> 4 g^ 132 NERVOUS FEVER. of salt of hartshorn, may be made into a bolus with a little syrup, and given as above ; or in any of the subjoined forms.* If the fever should happen to intermit, which it frequently does towards the decline, or if the patient's strength should be wasted with colliquative sweats, &c. it will be necessary to give him the Peruvian bark. Half a drachm, or a whole drachm, if the stom- ach will bear it, of the bark in fine powder, may be given four or five times a-day in a glass of red port or claret. Should the bark in substance not sit easy on the stomach, an ounce of it in pow- der may be infused in a bottle of Lisbon or Rhenish wine for two or three days, afterwards it may be strained, and a glass of it tak- en frequently. The bark may likewise be very properly administered, along with other cordials, in the following manner —Take an ounce of Peruvian bark, orange-peel half an ounce, Virginian Snake-root two drachms, saffron one drachm. Let all of them be powdered, and infused in an English pint of the best brandy for three or four days. Afterwards the liquor may be strained, and two tea-spoon- fuls of it given three or four times a-day in a glass of small wine or negus. I now generally administer Huxham's tincture. Some give the bark in this and other fevers, where there are no symptoms of inflammation, without any regard to the remission or intermission of the fever. How far future observations may tend to establish this practice, we will not pretend to say; but we have reason to believe, that the bark is a very universal febrifuge, and that it may be administered with advantage in most fevers, where bleeding is not necessary, or where there are no symptoms of top- ical inflammation. There is no fever that requires to be watched with more care and attention than this. If the actions of the system are not kept up by stimulating applications, and the patient's strength support- ed by cordial medicines and nourishing diet, he will sink under the disease ; and it frequently happens, that, when the attendants think him better, he is actually dying. Mulled port wine, or pure port wine, or diluted brandy, should be frequently administered ; profuse perspirations may be restrain- ed by the use of some of the vegetable acids.f Should the extrem- ities become cold, direct senapisms J to the feet, blisters to the in- side of the ancles, and give camphor and ether. I wish to inspire not only patients in this fever, but their physi- cians also, with unceasing, unabated hope till the very last extrem- * Take musk mixture, 6 oz. Compound Tincture of Cardamoms, 1 oz. Make a mixture, of which let two table spoonsful be taken every two hours. or Take Musk mixture, 7 oz. Compound Spirit of Ether, 2 drs. Syrup of Roses, 3 drs. Of which, make*a mixture, and let the pa- tient take a table spoonful often. t Take of the strongest Camphor Mixture, 7oz. Diluted Sulphuric Acid, A drm. Three table spoonsful to be taken often. or Take of infusion of Roses. Port Wine, of each equal parts ; mix for the ordinary drink. t Take strongest Camphor mixture, r, . . 7 °z- Spirit of Compound Ether, 2 drs. Make a mixture—twp table spoonsful eve ry two hours. PUTRID FEVER. 133 ity. The changes for the better are often as sudden, and unfore- seen, as those for the worse. The last gasp alone should induce us to give over the patient. I have left a patient twenty times and more, little expecting to see him alive next day. Yet I did not lose courage, but ordered a bottle, or perhaps two, of generous wine to be given in the course of twenty-four hours ; and that pa- tient, to my great satisfaction, recovered, and enjoyed health for many years after. CHAP. VIII. MALIGNANT AND PUTRID, OR SPOTTED FEVER, ( Typhus gravior.) This fever, which takes its name from the malignancy of its na- ture, and the symptoms of putrefaction observed towards its close, may'be called the pestilential fever of Europe, as in many of its symptoms it bears a great resemblance to that dreadful disease the plague. Persons of a lax habit, a melancholy disposition, and those whose vigour has been wasted by long fasting, watching, hard labour, excessive venery, frequent salivations, . u Tinct. of Bark, 3 drachms. t Take Oxygenated Muriate of Potash, M k draught t0 be taken as above. 1 scrup. to 1 drm. 6 ' Tinct. of Orange-peel, 1 drachm. t Take Common Vinegar, 3 drachms. Cinnamon-water, 1£ ounce. Infusion of Camomile, 5 ounces. Syrup of Saffron, 1 drachm. Mix for a clyster. Make a draught. To be taken every third or nour- Take Common Salt, $ ounce. Of Vinegar, 2 ounces. Take Oxymuriatic Acid, 20 minims. Infqsion of Camomile, 6 ounces, Decoction of Bark, 1$ ounce. Make a clyster. 140 MILIARY FEVER. In typhus, whatever may be the mode of action of yeast, it ap- pears to be indisputable that fixed air takes off that extreme debil- ity of the stomach, so conspicuously marked in disorders of this nature ; and in proportion as that subsides, the pulse rises, becomes slower and fuller, the burning heat on the skin disappears, and a truce is gained for the reception of nutrition. CHAP. IX. MILIARY FEVER. Tris fever takes its name from the small pustules or bladders which appear on the skin, resembling, in shape and size, the seeds of millet. The pustules are either red or white, and sometimes both are mixed together. The whole body is sometimes covered with pustules ; but they are generally more numerous where the sweat is most abundant, as on the breast, the back, &c. A gentle sweat, or moisture on the skin, greatly promotes the eruption ; but when the skin is dry, the eruption is both more painful and dangerous. Sometimes this is a primary disease ; but it is much oftener only a symptom of some other malady, as the small-pox, measles, ar- dent, putrid, or nervous fever, &c. In all these cases it is gener- ally the effect of too hot a regimen or medicines. The miliary fever chiefly attacks the idle and the phlegmatic, or persons of a relaxed habit. The young and the aged are more liable to it than those iii the vigour and prime of life. It is like- wise more incident to women than men, especially the delicate and the indolent, who, neglecting exercise, keep continually within doers, and live upon weak watery diet. Such females are ex- tremely liable to be seized with this disease in childbed, and often lose their lives by it. Causes.—The miliary fever is sometimes occasioned by violent passions or affections of the mind; as excessive grief, anxiety thoughtfulness, &c. It may likewise be occasioned by excessive watching, great evacuations, a weak watery diet, rainy seasons eating too freely of cold, crude, unripe fruit, as plums, cherries,' cucumbers, melons, , If the milk should happen to purge, it may be mixed with old conserve of roses. When that cannot be obtained, the powder of crabs' claws may be used in its stead. Asses'- milk is usually or- dered to be drunk warm in bed; but as it generally throws the patient into a sweat when taken in this way, it would perhaps be better to give it after he rises. Some extraordinary cures in consumptive cases have been per* formed by women's milk. Could this be obtained in sufficient quantity, we would recommend it in preference to any other. It is better if the patient can suck it from the breast, than to drink it afterwards. I knew a man who was reduced to such a degree of weakness in a consumption, as not to be able to turn himself in bed. His wife was at that time giving suck, and the child hap- pening to die, he sucked her breasts, not with a view to reap any advantage from the milk, but to make her easy. Finding himself, however, greatly benefited by it, he continued to suck her till he became perfectly well, and is at present a strong and healthy man. Some prefer butter-milk to any other, and it is indeed a very valuable medicine, if the stomach be able to bear it. It does not agree with every person at first; and is, therefore, often laid aside without a sufficient trial. It should at first be taken sparingly, and the quantity gradually increased, until it comes to be almost the sole food. I never knew it succeed, unless where the patient almost lived upon it. Cows' milk is most readily obtained of any, and though it be not 156 PULMONARY CONSUMPTION. so easily digested as that of asses or mares, it may be rendered lighter, by adding it to an equal quantity of barley-water, or allow- ing it to stand for some hours, and afterwards taking off the cream. If it should, notwithstanding, prove heavy on the stomach, a small quantity of brandy or rum, with a little sugar, may be added, which will render it both more light and nourishing.* It is not to be wondered, that milk should for some time disa- gree with a stomach that has not been accustomed to digest any thing but flesh and strong liquors, which is the case with many of those who fall into consumptions. We do not, however, advise those who have been accustomed to animal food and strong liquors, to leave them off all at once. This might be dangerous. It will be necessary for such to eat a little once a-day of the flesh of some young animal, or rather to use the broth made of chickens, veal, lamb, or such like. They ought likewise to drink a little wine made into negus', or diluted with twice or thrice its quantity of water, and to make it gradually weaker till they can leave it off altogether. These must be used only as preparatives to a diet consisting chiefly of shell-fish, of milk and vegetables, which the sooner the patient can be brought to bear, the better. Rice and milk, or bar- ley and milk, boiled with a little sugar, is very proper food. Ripe fruits, roasted, baked, or boiled, are likewise proper, as goose or currant-berry tarts, apples roasted, or boiled in milk, &c. The jellies, conserves, and preserves, &c. of ripe subacid fruits, ought to be eaten plentifully, as the jelly of currants, conserve of roses, preserved plums, cherries, Sec. Wholesome air, proper exercise, and a diet consisting chiefly of these and other vegetables, with milk, is the only course that can be depended on in a beginning consumption. If the patient has strength and sufficient resolution to persist in this course, he will seldom be disappointed of a cure. In a populous town of England,t where consumptions are very common, I have frequently seen consumptive patients, who had been sent to the country with orders to ride and live upon milk and vegetables, return in a few months quite plump, and free from any complaint. This indeed was not always the case, especially when the disease was hereditary, or far advanced; but it was the only method in which success was to be expected; where it failed, I never knew medicine succeed. If the patient's strength and spirits flag, he must be supported by strong broths, jellies, and such like. Sorae-recommend shell- fish in this disorder, and with some reason, as they are nourishing and restorative.:}: All the food and drink ought, however, to be taken in small quantities, lest an overcharge of fresh chyle should oppress the lungs, and too much accelerate the circulation of the blood. * In Russia, it is common for consumptive persons to migrate into Tartary, where, by living wholly on a fermented preparation of mares' milk, termed koumiss, they very generally recover even from the last stages of this disease. t Sheffield. _ 11 have oflen known persons of a consumptive habit, where the symptoms were no violent, reip great benefit from the use of oysters. They generally ate them raw, and drank the juice along with them. PULMONARY CONSUMPTION. 157 The patient's mind ought to be kept as easy and cheerful as possible. Consumptions are often occasioned, and always aggra- vated, by a melancholy cast of mind ; for which reason, music, cheerful company, and every thing that inspires mirth, are highly beneficial. The patient ought seldom to be left alone, as brooding over his calamities is sure to render him worse. Medicine.—Though the cure of this disease depends chiefly upon regimen and the patient's own endeavours, yet we shall men- tion a few things which may be of service in relieving some of the more violent symptoms.* In the first stage of a consumption, the cough may sometimes be appeased by local and general purging and bleeding, which may be occasionally repeated ; and the expectoration may be promoted by the following medicines; Take fresh squills, gum ammoniac, add powdered cardamom seeds, of each a quarter of an ounce; beat them together in a mortar, and if the mass prove too hard for pills, a little of any kind of syrup may be added to it. This may be formed into pills of a moderate size, and four or five of them taken twice or thrice a-day, according as the patient's stomach will bear them. The mixture of ammoniacum, or milk of gum ammoniac, as it is called, is likewise a proper medicine in this stage of the disease. It may be used as directed in the pleurisy, or in the subjoined form, &c.t A mixture made of equal parts of lemon-juice, fine honey, and syrup of poppies, may likewise be used. Four ounces of each of these may be simmered together in a sauce-pan, over a gentle fire, and a table spoonful of it taken at any time when the cough is troublesome. , It is common in this stage of the disease to load the patients stomach with oily and balsamic medicines. These, instead of removing the cause of the disease, tend rather to increase it by heating the blood, while they pall the appetite, relax the solids, md prove every way hurtful to the patient. Whatever is used for removing the cough, besides riding and other proper regimen, ought to be medicines of a sharp and cleansing nature; as oxymel, syrup of lemon, Slc. . Acids seem to have peculiarly good effects in this disease; they both tend to quench the patient's thirst and to cool the blood. The vegetable acids, as apples, oranges, lemons, &c. appear to be the most proper. I have known patients suck the juice of several lem- ons every day with manifest advantage, and would for this reason • Take Submuriate of Mercury, 5 grains. Camphorated Tincture £ Opium, Make a^ot^rmmediafefr^ M*. * draught, of which the dose may the following draught. be a table spoonful during the urgency Take Tartrate of Potash, 1 drachm. of the cough. Infusion of Senna. 15 drachms. or - Make a Draught. Camphorated Tincture of Opium, »Take Mixture *^P™0^'1™ZI Tincture of Foxglove, 20 minims.' SyJuTofTolu ' ISZ. Mia and take a table spoonful often. ,:>9 PULMONARY CONSUMPTION. "ecommend acid vegetables to be taken in as great quantity as the stomach will bear them. During the first or inflammatory stage of the complaint, it will be advisable, in conformity with the antiphlogistic plan, to employ gentle laxatives, should the bowels be costive, with occasional gen- tle emetics, &c. When there is any febrile heat, with a cough or pain in the chest, diaphoretics may be given, such as a small dose (one eighth of a grain) of tartarized antimony, or the powder of antimony, two or three times a-day, together with the saline mix- ture and nitre, as recommended iu peripneumony. For the patient's drink, we would recommend demulcent drinks ;* infusions of the bitter plants, as ground-ivy, the lesser centaury, camomile flowers, or water trefoil.! These infusions may be drank at pleasure. They strengthen the stomach, promote diges- tion, and at the same time answer all the purposes of dilution, and quench thirst much better than things that are luscious or sweet. But if the patient spit blood, he ought to use, for his or- dinary drink, infusions or decoctions of the vulnerary roots, plants, &c.J There are many other mucilaginous plants and seeds, of a heal- ing and agglutinating nature, from which decoctions or infusions may be prepared with the same intention ; as the orches, the quince-seed, coltsfoot, linseed, sarsaparilla, Sec. It is not neces- sary to mention the different ways in which these may be prepar- ed. Simple infusion or boiling is all that is necessary, and the dose may be at discretion. The confection of roses is here peculiarly proper. It may either be put into the decoction above prescribed, or eaten by itself. No benefit is to be expected from trifling doses of this medicine. I never knew it of any service, unless when three or four ounces at least were used daily for a considerable time. In this way I have seen it produce very happy effects, and would recommend it wherever there is a discharge of blood from the lungs. Where a disposition to consumption arises in consequence of any enfeebling evacuation, such as a considerable abscess, fluor albus, or the like, without any inflammation of the lungs having yet taken place, cinchona will be serviceable, and may be given as advised below.§ After inflammation has come on, or ulceration has commenced, it would not fail to prove injurious, by increasing the cough with the tightness at the chest and oppressive breathing. When it is evident that there are vomicae or tubercles in the lungs, and the matter can neither be spit up nor carried off by ab- borption, the patient must endeavour to make it break inwardly, • Take Decoction of Barley, 2 pints. Syrup of Lemons, 1& ounce. Gum Arabic, 3 drachms. Mix them for an ordinary drink. t The decoction of lichen Islandicus may be used with great advantage as a drink ; its bitterness strengthens the stomach, while the mucilage it contains, renders it high- ly nutritious. Ed. t Take Decoction of Bark, 5 ounces. Decoction of Bark, 5 ounces. Solution of acetated Ammonia. Lemon Juice, 1 ounce. 1 ounce. Make a mixture; of which two table Make a mixture. spoonsful may be given two 6r three or times a-day. Take Subcarbonate of Potash, 2 scruples. PULMONARY CONSUMPTION. 159 by drawing in the steams of warm water or vinegar with his breath, coughing, laughing, or bawling aloud, &c. When it happens to burst within the lungs, the matter may be discharged by the mouth. Sometimes, indeed, the bursting of the vomica? occasions immedi- ate death, by suffocating the patient. When the quantity of mat- ter is great, and the patient's strength exhausted, this is commonly the case. At any rate, the patient is ready to fall into a swoon, and should have volatile salts or spirits held to his nose. If the matter discharged be thick, and the cough and breathing become easier, there may be some hopes of a cure. The diet at this time ought to be light, but restorative, as chicken-broths, sago-gruel, rice-milk, &c, the drink, butter-mdk or whey, sweetened with honey. In the second, or tuberculated stage of the disease, the employ- ment of emetics might be regularly persisted in every second or third morning; the sulphate of zinc is preferred ; and the sulphate of copper is recommended by Senter, in the transactions of the college of Philadelphia, and by Adair, in the medical commenta- ries, in doses from seven to ten grains each, made into pills, &c. As detergents, balsamics of different kinds have been much used in the ulcerated stage. Balsam of Copaiva, in the dose of twenty to thirty drops, twice or thrice a day, may be tried. Myrrh, how- ever, is the medicine employed with the greatest success in those cases of hectic fever which are unattended by any great degree of heat or thirst, and which do not show manifest signs of inflamma- tion. The preparation used by the late Dr. Moses Griffiths* seems to be preferable to all others. If at any time it should be thought too heating, the spirituous water may be omitted, as the solution may be made without it; although it is doubted whether it will agree so well with the stomach in general. A proper dose, (ten to fifteen drops of the tincture of foxglove,) may be added to each of the draughts, and to be given together. If the vomicae or tubercles should discharge themselves into the cavity of the breast, between the pleura and the lungs, there is no way of getting the matter out, but by an incision, as has already been observed. As this operation must always be performed by a Burgeon, it is not necessary here to describe it. We shall only add, that it is not so dreadful as people are apt to imagine, and that it is the only chance the patient in this case has for his life. With regard to the remedies usually employed in the treatment of phthisis, Dr. Ferriar has observed that the digitalis (fox-glove,) with the sulphate of iron, myrrh, bark, and other tonics, may be most proper in those cases of consumption which arise from scro- phula ; while the digitalis with opium, mucilaginous medicines, and diuretics, may be opposed to the floria consumption. Dr. Crichton, of Petersburgh, in the tuberculous or true scro- phulous phthisis, has seen much benefit derived from the use of the tar fumigations. » Take Myrrh, I drachm. Dissolve in a mortar with Spirit of Pimento, 6 drachms. Distilled Water, 6£ drachms. Then add, Subcarbonate of Potash, J drm Sulphate of Iron, 12 grains. Syrup, 2 drachms. Mix, and divide into four draughts, one of which is to be taken every morning, another at five in the evening, and an- other at bed time 160 NERVOUS CONSUMPTION, &c. It would serve little purpose here to recapitulate the many arti- cles recommended by various practitioners in the treatment of pul- monary consumptions, such as fixed airs, Prussic acid, conium, foxglove, uva, ursi, &c. It does not follow that any of them have any decided influence over the disease, and are more embarrassing to the practitioner than beneficial to the patient. If confirmed phthisis were to be cured, it must be effected principally, if not solely, by dietetic means and change of climate. A nervous consumption, or atrophy, is a wasting or decay of the whole body, without any considerable degree of fever, cough, or difficulty of breathing. It is attended with indigestion, weak- ness, want of appetite, &c. Those who are of a fretful temper, who indulge in spirituous liquors, or who breathe an unwholesome air, are most liable to this disease. We would chiefly recommend, for the cure of a nervous con- sumption, a light and nourishing diet, plenty of exercise in a free open air, and the use of such bitters as brace and strengthen the stomach ; as the Peruvian bark, gentian-root, camomile, hore- hound, &c. These may be infused in water or wine, and a glass of it drank frequently. It will greatly assist the digestion, and promote the cure of this disease, to take, twice a-day, twenty or thirty drops of the elixir of vitriol in a glass of wine or water.* The chalybeate wine is likewise an excellent medicine in this case; it strengthens the solids, and powerfully assists Nature in the preparation of good blood. Agreeable amusements, cheerful company, and riding about, are, however, preferable to all medicines in this disease. For which reason, when the patient can afford it, we would recom- mend a long journey of pleasure, as the most likely means to re- store his health. What is called a symptomatic consumption, cannot be cured with- out first removing the disease by which it is occasioned. Thus when a consumption proceeds from the scrophula, or king's evil, from the scurvy, the asthma, the venereal disease, Sec. a due atten- tion must be paid to the malady from whence it arises, and the regimen and medicine directed accordingly. When excessive evacuations of any kind occasion a consumption, they must not only be restrained, but the patient's strength must be restored by gentle exercise, nourishing diet, and generous cor- dials. Young and delicate mothers often fall into consumptions, by giving suck too long. As soon as they perceive their strength and appetite begin to fail, they ought immediately to wean the child, or provide another nurse, otherwise they cannot expect a cure. Before we quit this subject, we would earnestly recommend it to all, as they wish to avoid consumptions, to take as much exer- cise without doors as they can, to avoid unwholesome air, and to study sobriety. Consumptions owe their present increase not a * See Appendix, Chalybeate Wine. PREVENTION OF CONSUMPTION. 161 little to the fashion of sitting up late, eating hot suppers, and spending every evening over a bowl of punch, or other strong liquors. These liquors, when too freely used, not only hurt the digestion, and spoil the appetite, but heat and inflame the blood, and set the whole constitution on fire. In tracing the various causes of consumption, I entered into minute details, to put people more upon their guard, as the disease, when deeply seated, seldom admits of a cure. Not but there are plonty of persons in London who confidently undertake to perform cures in the most hopeless stages of the complaint, though physi- cians have not been so happy as to find out the art. Perhaps the only art which the others have discovered, or which they have ever studied, is the art of impudence and deception. But to return to my former argument: as consumptions seldom admit of a cure, the utmost care should be exerted to avoid them. The best general caution I can give is to guard against catching cold, the fruitful mother of consumptions, and of many other dis- orders. How this is to be done, will be more fully explained when I come to treat of colds and coughs, the bane of this island, and the source of numberless diseases, especially among the young, gay, and thoughtless part of the community, who have no fear of any ill until it overtakes thorn, when it is generally too late to pre- vent the fatal consequences. on the means of preventing pulmonary consumption. Human beings are so constituted that they can exist but for a very short space of time without inhaling a fresh portion of atmos- pheric air. The uninterrupted repetition of this process, which is absolutely requisite for the support of life, implies a perpetual state of activity in the organs by means of which it is carried on. This alternate state of dilatation and contraction of the lungs necessarily forms a great impediment to the cure of any wound or ulceration taking place in their substance, by the same process employed by Nature to heal injuries in other parts of the living body, which admit of a temporary state of quietude and repose. The slightest degree of diseased action occurring in an organ so essentially important to the maintenance of existence, is sufficient to create alarm, which our melancholy experience of the inefneacy of the art of medicine to remove chronic affections of the organs of respiration has no tendency to diminish. A single opportunity of inspecting the state of the lungs of a person dead of pulmonary consumption, might, I have frequently thought, suffice to correct the pretensions of those who propose to cure the disease after it is confirmed, by the administration of medicine. But the impracti- cability of a cure ought to render us proportionality more attentive to the means of prevention, from which much may be expected, provided they are employed at a sufficiently early period. Pulmonary consumption may be divided into two kinds, which it is of importance, even in a prophylactic point of view, to dis- criminate from each other.—The lungs may be injured by a blow, or pierced by a wound. Inflammation may take place in them from over-exertion, in consequence of the stoppage of some custom- 162 PREVENTION OF CONSUMPTION. ary evacuation, or from exposure to cold, giving rise to pleurisy or peripneumony; and these diseases may terminate in consumption in persons who have no natural predisposition to that complaint. This species of the disease may be termed symptomatic, and occa- sionally admits of being cured, by removing the cause from whence it originated. Sometimes, when an abscess is formed in the lungs, which is termed a vomica, and produces all the symptoms of phthisis, it will at length break either internally, when the matter is coughed up, or point externally, and admit of being opened; and, after its contents are evacuated, it will heal up, and the patient completely recover. The other species of consumption may be denominated heredi- tary, as being derived either from a parent, or occasionally from some more distant relative. As we perceive children to resemble their parents in the features of their face, and in the disposition of their minds, so there can be no doubt but they also resemble them in the internal organization of the body, on the peculiar structure of which a predisposition to future disease must necessarily depend; and that children are, in fact, liable to the diseases of their parents, we have manifold and decisive proofs. How fre- quently do we see a person, at a certain time of life, so much re- semble what a father was at the same period, that he seems to fill the identical place in society that the former occupied. In like manner, at certain periods of life, do children become liable to the diseases of their parents, and consumption, gout, or dropsy makes its appearance, the germs of which must have lain in the system from the earliest period of existence, although they did not disclose themselves till their due season. Not only do we see that children are peculiarly prone to the diseases of that parent to whom they bear the greatest personal similarity, but as we occasionally per- ceive the resemblance of some more remote ancestor break forth, as it were, in a family, so we shall find the constitution and dis- eases of that child differ from those of its immediate parents, and partake rather of the nature of the progenitor whom it most re- sembles. These circumstances are thus particularly noted, because it is only in cases where the predisposition to this disease is suspected at a very early period of life, that the means of prevention can be employed with any reasonable prospect of success. For the same reason, also, I am desirous of attracting the attention to a point of similarity between parents and children which has not hitherto been sufficiently attended to. The form and structure of the nails of both extremities afford an excellent criterion to enable us to judge which of the parents the offspring most resembles in consti- tution. I have known the peculiar structure of a toe-nail designate certain individuals of a family for several successive generations. Although these parts of the human body do not make their appear- ance earlier than about the sixth month of the foetal age, they in- dicate very decidedly the predominant influence of the parent whom the child most resembles in constitution. It is also a curi- ous fact that the horns of animals, which often do not appear till several months after birth, afford the best criterion for distinguish- ing the peculiar breed or race, to those who are conversant with such subjects. PREVENTION OF CONSUMPTION. 163 But certain peculiarities in the structure of the nails afford also a strong indication of the propensity to phthisis. In forming an opinion concerning the probable future occurrence of this disease, the nails ought always to be carefully examined, and compared with those of the parents. If these parts of the body are large, of an oblong shape, of a smooth texture, and a pink colour, curling over the tips of the fingers, the last joint of which is commonly somewhat enlarged, there is much reason to suspect a phthisical tendency. If, moreover, we find a slender conformation of the body, fine skin and hair, a shrill voice easily rendered hoarse, hollowness of the temples, sound teeth, and an expanded pupil of the eye, there is little doubt but a person so constituted will, at some future period of life, become the victim of pulmonary con- sumption. The aggregate of these appearances constitute what is termed delicacy of constitution. T,his habit of body is frequently accom- panied by superior powers of mind. Individuals, indeed, who seem almost to approach the perfection of our species, are pecul- iarly marked as the victims of pulmonary consumptions. This fact not only furnishes a strong motive for endeavouring to prevent the first attack of affections of the lungs, but affords also some grounds to encourage the expectation of success. Soundness of teeth, a marked concomitant of the phthisical habit, is commonly considered as one of the surest signs of a sound constitution. A variety of examples might also be adduced of persons who, after having subdued, by regimen and medicine, phthisical symptoms with which they were threatened in their youth, have protracted existence to a very advanced period of life. As the propensity to this disease must necessarily be the result of a certain combination of habits, continued, perhaps, from one generation to another, combined with the peculiar circumstances in which the individual is placed, it is reasonable to suppose that, by altering the former, and counteracting the latter, the general constitution might be changed. Pulmonary consumption is a disease almost peculiar to a certain zone of northern latitude, in which the British Isles are included. A little farther to the north, or to the south, the ravages of these complaints are comparatively trifling. The only natural cause to which this can with propriety be attributed, is the fluctuation of our atmospheric temperature between the confines of heat and cold. The increased frequency of pulmonic complaints, which has accompanied the more general diffusion of wealth, and consequert habits of luxurious living in this country, affords, I think, sufficient proof that tender and indulgent treatment is not the best means of obviating them. What are the classes of mankind most suscep- tible of, and most injured by the impressions of heat and cold 1 Precisely those who are least exposed to their influence. Seden- tary^artificers, who necessarily pass their days in close and heated chambers, are swept off in unaccountable numbers by pulmonary consumption; while sailors, ploughmen, butchers, and all persons whose occupations lead them to be much in the open air, enjoy a comparative immunity from the attack of this disease. Among the native inhabitants of America, Doctor Rush informs us, that pul- 164 PREVENTION OF CONSUMPTION. monary consumption is unknown ; but in proportion as they adopt the arts and manners of civilized life, do they beoome liable to the fatal influence of this complaint. When a wealthy parent sees a delicate child shiver at the fresh- ness of the breeze, a natural tenderness leads him to avert this unpleasant feeling by the means he can most readily command, close apartments and warm clothing. But he thus augments that very delicacy of constitution he should endeavour to counteract. The variations of atmospheric temperature are most sensibly felt by those who are cased in the thickest clothing; as plants reared in the hot-house are least able to bear the blasts of winter. Con- trast the leaden-coloured visage, and the chilblain toes and fingers of the puny schoolboy, shivering and crawling along the street in a winter's day, with the appearance of the country lad of equal years employed all day in following the plough ; the surface of his body, in place of being chilled by the cold, is roused to a state of increased vascular action, his countenance glows with the genuine hue of health, and his whole frame bespeaks elasticity and vigour. Surely from this example we might be taught the most effectual method of averting delicacy of constitution, being careful to mod- ify the means according to the object we have to operate upon. Let the child whose wealth can command, and whose future exist- ence is of sufficient importance to justify such attention, reside in a part of the country where the soil is chalk or limestone, and the air pure. Let him be abroad all day, and during every kind of weather, provided he is employed in active exercise ; let him be guarded against suddenly approaching, or sitting much over the fire, even in winter. Let the habit of retiring early to bed, and leaving it early in the morning, be strictly enforced. Let him wear no more clothes than are requisite to guard against cold, and plunge into the sea, or a river, for a moment, daily, during the three warmest months of summer. The phthisical habit is, in gen- eral, attended by a precocity of intellect, which it is of more impor- tance to check than to encourage. In such instances the improve- ment of the mind should be considered as a secondary object, and may well be postponed till a certain share of robustness of consti- tution has been ensured. This kind of corporeal education is obviously incompatible with the usual discipline of schools, wheth- er private or public, and can only be advisable where the impor- tance of the object justifies the various sacrifices that must be made in order to attain it. I very recently had occasion to see the success of this plan completely exemplified. Every possible attention was paid to the health of a delicate child by its anxious parents. He lived in spa- cious apartments in an open and airy part of London ; was carri- ed abroad several times every day when it did not rain ; and the diet was regulated with every attention to propriety. Notwith- standing all this care the flesh of this child was flabby, he was averse to exercise, the belly became prominent, and the gland* on each side of the neck were very considerably enlarged. In this state the child was removed the beginning of last summer to a dry and healthy situation in the neighbourhood of the sea. There it ran about and bathed along with other children of a similar age. PREVENTION OF CONSUMPTION. 165 No particular attention was paid to dress or diet. In the course of a few months the tumid abdomen subsided, the swellings of the neck disappeared, the flesh became firm, and this child, whose life had been despaired of, and was sent from home as on a forlorn hope, returned vigorous, active, and healthy. But precautions against this insidious disease are rarely had re- course to at so early a period of life. The buoyant spirits and ac- tive propensities of its destined victims rarely excite suspicion either in themselves or their friends of the approaching mischief. As the age of puberty approaches, other indications of the propen- sity to phthisis are developed. The narrow and elongated form of the chest becomes more apparent, and is chiefly indicated bv the prominence of the shoulders, which stand out from it on each side somewhat like wings. A broad deep chest, the transverse section of which approaches the circle, affords the best criterion of a healthy and vigorous conformation of the body, not only in man but in all kinds of quadrupeds which are subservient to his wants. For the support of life it is necessary that nearly one half of the blood should circulate through the lungs in the same time that the remainder passes through the rest of the body. But if the lungs are prevented from expanding to their proper magnitude in consequence of being confined within the limits of a narrow thorax, their proper blood-vessels must be proportionally dimin- ished in number as well as in dimensions, and on any sudden push of blood, their coats, already over-distended, must be prone to rup- ture. At this period of life, too, there is evidently an effort of the constitution endeavouring to expand every part to a state of full perfection. This is evinced by frequent discharges of blood from the nose. The vessels of that part readily heal, but an accident of the same kind taking place in the lungs, not unfrequently lays the foundation of consumption. This temporary fulness of blood should be counteracted, bv strictly adhering to a diet of the farinacea and ripe fruits. Ani- mal food and fermented liquors ought to be rigidly prohibited. Even milk often proves too nutritious. Exercise should h^ regu- lar but gentle. Sudden and violent exertions are extremely haz- ardous. Riding on horseback is preferable to any other kind of exercise. Such efforts of the voice as are required in singing or, playing on any wind-instrument of music, frequently produce dis- charges of blood from the lungs ; but the practice of reading or reciting for some time together in a moderate tone of voice, tends to strengthen these organs, and to diminish the danger of pulmo- nary hemorrhage from any sudden exertion. During the circulation of the blood through the lungs, ^ princi- ple necessary to the support of life is absorbed from the air; and various matters, the longer continuance of which in the body would be noxious, are also discharged in the form of vapour or gas. That there is, besides, no inconsiderable quantity of aqueous fluid se- creted and discharged from the lungs, every person must be con- vinced, who has attended to the deposition of watery particles that takes place from the breath in a frosty day. Of the whole quanti- ty of perspirable matter discharged from the surface of the body in any given portion of time, that exhaled from the surface of the 166 • PREVENTION OF CONSUMPTION. luh. turbid, that the t Take Ointment of the Nitrate of Mer- cury ®T Prepared Lard, of each, A ounce. Take Vrl^A f ZJDC' J scruPte- Make an ointment. * MakeaSe^' ' °UDCe- peasants do this very effectually, bfulrthe^^gl^y^e^me^arer ^K" L QUfNSEY, Sec. 19H Those who are liable to frequent returns of this disease ought constantly to have an issue in one or both arms. Bleeding or purg- ing in the spring and autumn will be very beneficial to such per- sons. They ought likewise to live with the greatest regularity avoiding strong liquor, and every thing of a heating quality. Above all, let them avoid the night air and late studies.* It may also be necessary, to prevent a return of ophthalmia, to continue the use of blisters behind the ears, or an issue or seton. The cold bath, employed by immersing the whole body, or by washing the head in cold water once or twice a-day, is also a powerful means of prevention. Also the application of cold water to the eyes themselves, or of any astringent collyrium, by means of an eye- cup, two or three times a-day, may likewise be serviceable in pre- venting its return, or removing it after it has become habitual. Tonics have also been adopted with this intention, and with the best effects. CHAP. XX. QUINSEY, OR INFLAMMATORY SORE THROAT. (Cynanche Tonsillaris.) This disease is very common in Britain, and is frequently at- tended with great danger, occupying the glands, such as the ton- sils, but frequently extending throughout the whole mucous mem- brane of the fauces, so as essentially to interrupt the speech, respi- ration, and deglutition »f the patient. It prevails in the winter and spring, and is most fatal to young people of a sanguine tem- perament. Causes.—In general it proceeds from the same causes as other inflammatory disorders, viz. exposure to cold, an obstructed per- spiration, or whatever heats or inflames the blood. An inflamma- tion of the throat is often occasioned by omitting some part of the covering usually worn about the neck, by drinking cold liquor when the body is warm, by riding or walking against a cold north- erly wind, or any thing that greatly cools the throat and parts ad- jacenL It may likewise proceed from the neglect of bleeding, purging, or stoppage of any customary evacuation. Singing, speaking loud and long, or whatever strains the throat, may likewise cause an inflammation of that organ. I have often known the quinsey prove fatal to jovial companions, who, after sitting long in a warm room, drinking hot liquors, and singing with vehemence, were so imprudent as to go abroad in the cold night air. Sitting with wet feet, or keeping on wet clothes, are very apt to occasion this malady. It is likewise frequently occa- sioned by continuing long in a moist place, sitting near an open window, sleeping in a damp bed, sitting in a room that has been * As most people are fond of using eye-waters and ointments in this and other dis- eases of the eyes, we have inserted some of the most approved form of these medi- rincs in the Appendix. See Appendix, Eye-water and Eye-salve 194 quinsey; or newly plastered, Sec. I know people who never fail to have a sore throat if they sit even but a short time in a room that has been lately washed. Acrid or irritating food may likewise inflame the throat, and occasion a quinsey. It may also proceed from bones, pins, or other sharp substances sticking in the throat, or from the caustic fumes of metals or minerals, as arsenic, antimony, Sec. taken in by the breath. This disease is sometimes epidemical and infec- tious. Symptoms.—The inflammation of the throat is evident from in- spection, the parts appearing red and swelled; besides, the patient complains of pain in swallowing. His pulse is quick and hard, with other symptoms of a fever. If blood be drawn, it is generally covered with a tough coat of a whitish colour, and the patient spits a viscid phlegm. As the swelling and inflammation increase, the breathing and swallowing become more difficult; the pain affects the ears ; the eyes generally appear red, and the face swells. The patient is often obliged to keep himself in an erect posture, being in danger of suffocation; there is a constant nausea, or inclination to vomit, and the drink, instead of passing into the stomach, is often returned by the nose. The patient is sometimes starved at wTC Y fr°m &n inabilit)r to swallow any kind of food. When the breathing is laborious, with straitness of the breast and anxiety, the danger is great. Though the pain in swallowing be very great, yet while the patient breathes easy there is not so much danger. An external swelling is no unfavourable symptom; but if it suddenly falls, and the disease affects the breast, the dan- otL'r^7^^ J?6" a quinSey isthe consequence of some other disease, which has already weakened the patient, his situa- tion is dangerous. A frothing at the mouth, with a swelled tongue, k&^ft^™"1"*™*' ^ C°IdneSS °f the e*tren,ities/are 8ameErsT*treTn.7^imen in this disease is in a» aspects the ^■S^'i^^^?.^ --ance'o^'an^ yoice. Such a degree of warmth as to nTl ? SpCak but ,n a low perspiration, is proper When ?L Pfromote a constant, gentle TO^^Hr^1!!^ ^i^ kGpt Wa™ > *>' which alone will often remove a slight 1 7* be Wrapt round *• That if applied in due time witnnT&T °r ^ thr°at' CSpeciaI1' ety of a custom which p7evaih^m„nJ fU °bserv,nS the propri- INFLAMMATORY SORE THROAT. 19o ticular ceremonies: the custom, however, is undoubtedly a good one, and should never be neglected. When the throat has been thus wrapped up all night, it must not be exposed to the cold air through the day, but a handkerchief, or a piece of flannel, kept about it till the-inflammation be removed. The jelly of black currants is a medicine very much in esteem for complaints of the throat; and, indeed, it is of some use. It should be almost constantly kept in the mouth, and swallowed down leisurely. It may likewise be mixed in the patient's drink, or taken any other way. When it cannot be obtained, the jelly of red currants, or of mulberries, may be used in its stead. Gargles for the throat are very beneficial. They may be made of sage-tea, with a little vinegar and honey, or by adding to half an English pint of the pectoral decoction two or three spoonsful of honey, and the same quantity of currant jelly. This may be used three or four times a-day; and if the patient be troubled with tough viscid phlegm, the gargle may be rendered more sharp and cleans- ing, by adding to it a tea-spoonful of sal volatile, or any of the an- nexed forms:* There is no disease in which the benefit of bathing the feet and legs in lukewarm water is more apparent: that practice ought, therefore, never to be neglected. If people were careful to keep warm, to wrap up their throats with flannel, to bathe their feet and legs in warm water, and to use a spare diet, with diluting liquors, at the beginning of this disease, it would seldom proceed to a great height, or be attended with any danger; but when these precautions are neglected, and the disease becomes violent, more powerful medicines are necessary. Medicine.—An inflammation of the throat being a most acute and dangerous distemper, which sometimes takes off the patient very suddenly, it will be proper, as soon as the symptoms appear, to bleed in the arm, or rather in the jugular vein, and to repeat the operation if circumstances require. The body should likewise be kept gently open. This may either be done by giving the patient for his ordinary drink a decoction of saline aperients, figs, and tamarinds, or small doses of rhubarb and nitre, as recommended in the erysipelas. These may be in- creased according to the age of the patient, and repeated till they have the desired effect. I have often known very good effects from a bit of sal prunel, or purified nitre, held in the mouth and swallowed down as it melted. This promotes the discharge of saliva, by which means it answers the end of a gargle, while at the same time it abates the fever, by promoting the discharge of urine, &c. At the commencement of inflammatory sore throat, and befbre the febrile symptoms have become any way violent, an early emetic is often of great benefit, and not unfrequently checks its formation. » Take Confection of the Red Rose, 1 oz. Boiling Water, £ pint. Diluted Sulphuric Acid, 1 drra. Mis for a gargle. or Take Barley-water, 6 oz. Honey of Roses, 1 07,. Dili led Sulphuric Acid, 1 drm. Make a gargle. 196 QUINSEV, M Fhe throat ought likewise to be rubbed twice or tin ioe a-day with a little of the volatile liniment. This seldom Jails to produce some good effects. At the same time the neck ought to be care- fully covered with wool or flannel, to prevent the cold from pene- trating1 the skin, as this application render- it very tender. Many other external applications are recommended in this disease, as a swallow's nest, poultices made of the fungus called Jew's ears, album Graecum, - It sometimes happens, before the tumour breaks that the sw*l Patients have often been suDnorted ul tuatT J"1,' &c' opening the trachea or windp ipe I" "Z'le T*"" V'fe' bu' •M. soceess, no person, in suTdesperae e^ul,?" °f'Cn t™ hes.tate a moment about the operation rbut a, U ean o, ,*v hf '° formed br . surgeon, ft is not nec?ssary he,, ,„ J^^!- When a difficulty Q^alWmgJs^^^ an ^ * Take Infusion of Roses, 602 « "~—~----- Tincture of Myrrh, , oz. Mu for^er|,e°f B°"X * *■■ t Dr. Home. MALIGNANT QUINSEY, Sec. 197 pain or inflammation, it is generally owing to an obstruction of the glands about the throat, and only requires that the part be kept warm, and the throat -frequently gargled with something that may gently stimulate the glands, as a decoction of figs with vinegar and honey; to which may be added a little mustard, or a small quantity of spirits. But this gargle is never to be used where there are signs of an inflammation. This species of angina has various names among the common people, as the pap of the throat, the falling down of the almonds of the ears, Sec. Accordingly, to remove it, they lift the patient up by the hair of the head, and thrust their fingers under his jaws, &c.; all which practices are at best use- less, and often hurtful. Those who are subject to inflammations of the throat, in order to avoid that disease, ought to live temperate. Such as do not choose to observe this rule, must have frequent recourse to purging and other evacuations, to discharge the superfluous humours. They ought likewise to beware of catching cold, and should abstain from aliment and medicines of an astringent or stimulating nature. Violent exercise, by increasing the motion and foree of the blood, is apt to occasion an inflammation of the throat, especially if cold liquor be drank immediately after it, or the body suffered suddenly to cool. Those who would avoid this disease ought, therefore, after speaking aloud, singing, running, drinking warm liquor, or doing any thing that may strain the throat, or increase the circu- lation of the blood towards it, to take care to cool gradually, and to wrap some additional covering about their necks. I have often known persons who had been subject to sore throats, entirely freed from that complaint by only wearing a riband, or a bit of flannel, constantly about their necks, or by wearing thicker shoes, a flannel waistcoat, or the like. These may seem trifling, but they have great effect. There^is danger indeed in leaving them off after persons have been accustomed to them; but surely the inconveniency of using such things for life, is not to be com- pared with the danger which may attend the neglect of them. Sometimes, after an inflammation, the glands of the throat con- tinue swelled, and become hard and callous. This complaint is not easily removed, and is often rendered dangerous by the too frequent application of strong stimulating and styptic medicines. The best method is to keep it warm, and to gargle it twice a-day with a decoction of figs, sharpened a little with diluted sulphuric acid. Malignant Quinsey, or Putrid Ulcerous Sore Throat. (Cynanche Maligna.) This kind of sore throat is but little known in the northern parts of Britain, though for some time past it has been fatal in the more southern counties. Children are more liable to it than adults, females than males, and the delicate than those who are hardy and robust. It prevails chiefly in autumn, and is most frequent after a long course of damp or sultry weather. It is readily distinguished from the inflammatory quinsey by the soreness and white specks or aphthae covering ulcers which appear in the fauces, together with the great debility of the system, a 198 MALIGNANT QUINSEY, OR small fluttering" pulse, and an eruption on the skin of the same nature with that of scarlet fever, which are to be observed in the former; whereas in the latter there is always considerable difficulty of breathing, a considerable degree of swelling, with a tendency in the parts to suppurate, and a hard pulse. Also in the seat of the disease, which in the former is principally in the nervous mem- brane of the mouth and throat, and the accompanying fever is of the typhoid kind; whereas, in the latter, it chiefly occupies the glandular parts, and the fever is of the inflammatory type. Causes.—This is evidently a contagious distemper, and is gene- rally communicated by infection. Whole families, and even entire villages, often receive the infection from one person. This ought to pul people upon their guard against going near such patients as labour under the disorder; as by that means they endanger not only their own lives, but likewise those of their friends and connex- ions. Whatever tends to produce putrid or malignant fevers, may likewise occasion the putrid ulcerous sore throat, as unwholesome air, damaged provisions, neglect of cleanliness, &c. In some instances the symptoms of scarlet fever and putrid sore throat are so blended, that it is frequently difficult to pronounce of which the disease partakes most; this, however, is of little im- portance in a practical point of view, as both require the same mode of treatment. Symptoms.—It begins with alternate fits of shivering and heat. The pulse is quick, but low and unequal, and generally continues so through the whole course of the disease. The patient com- 'plains greatly of weakness and oppression of the breast; his spir- its are k>w, and he is apt to faint away when set upright; he is troubled with a nausea, and often with a vomiting or purging. The two latter are mcst common in children. The eyes appear red and watery, and the face swells. The urine is at first pale and crude ; but, as the disease advances, it turns more of a yellow- ish colour. The tongue is white, and generally moist, which dis- tinguishes this from an inflammatory disease. -Upon looking into the throat, it appears swelled, and of a florid red colour. Pale or ash-coloured spots, however, are here and there interspersed, and sometimes one broad patch or spot, of an irregular figure, and pale white colour, surrounded with florid red, only appears. These whitish spots or sloughs cover so many ulcers. An efflorescence, or eruption upon the neck, arms, breast, and fingers, about the second or third day, is a common symptom of this disease. When it appears, the purging and vomiting gener- ally cease. There is often a slight degree of delirium, and the face frequent- ly appears bloated, and the inside of the nostrils red and inflamed. The patient complains of a disagreeable putrid smell, and his breath is very offensive. The putrid, ulcerous sore throat may be distinguished from the inflammatory, by the vomiting and looseness with which it is gen- erally ushered in ; the foul ulcers in the throat covered with a white or livid coat; and by the excessive weakness of the patient; with other symptoms of a putrid fever. PUTRID ULCEROUS SORE THROAT. . 199 Unfavourable symptoms are, an obstinate purging, extreme weakness, dimness of the sight, a livid or black colour of the spots, and frequent shiverings, with a weak, fluttering pulse. If the eruption upon the skin suddenly disappears, or becomes of a livid colour, with a discharge of blood from the nose or mouth, the danger is very great. If a gentle sweat break out about the third, or fourth day; and continue with a slow, firm, and equal pulse; if the sloughs cast off in a kindly manner, and appear clean and florid at the bottom ; and if the breathing is soft and free, with a lively colour of the eyes, there is reason to hope for a salutary crisis. Regimen.—The patient must be kept quiet, and for the most part in bed, as he will be apt to be faint when taken out of it. His food must be nourishing and restorative ; as sago-gruel with red- wine, jellies, strong broths, flammatory fever. 204 COLDS AND COUGHS. When those who labour for their daily bread have the misfortune to catch cold, they cannot afford to lose a day or two, in order to keep themselves warm, and take a little medicine; by which means the disorder is often so aggravated as to confine them for a long time, or to render them ever after unable to sustain hard labour. But even such of the labouring poor as can afford to take care of themselves, are often too hardy to do it; they affect to despise colds, and as long as they can crawl about, scorn to be confined by what they call a common cold. Hence it is that colds destroy such numbers of mankind. Like an enemy despised, they gather strength from delay, till at length they become invincible. We often see this verified in travellers, who, rather than lose a day in the prosecution of their business, throw away their lives by pursu- ing their journey, even in the severest weather, with this disease upon them. It is certain, however, that colds may be too much indulged. When a person, for every slight cold, shuts himself up in a warm room, and drinks great quantities of warm liquor, it may occasion such a general relaxation of the solids as will not be easily remov- ed. It will, therefore, be proper, when the disease will permit, and the weather is mild, to join to the regimen mentioned above, gentle exercise ; as walking, riding on horseback, &c. An ohsti- . nate cold, which no medicine can remove, will yield to gentle ex- ercise and a proper regimen of diet. Bathing the feet and legs in warm water has a great tendency to restore the perspiration. But care must be taken that the water be not too warm, otherwise it will do hurt. It should never be much warmer than the blood, and the patient should go immediately to bed after using it. Bathing the feet in warm water, lying in bed, and drinking warm water-gruel, or other weak liquors, will sooner take off a spasm, and restore a perspiration, than all the hot sudo- rific medicines in the world. This is all that is necessary for removing a common cold ; and if this course be taken at the begin- ning, it will seldom fail. But when the symptoms do not yield to abstinence, warmth, and diluting liquors, there is reason to fear the approach of some other disease, as an inflammation of the breast, an ardent fever, or the like. If the pulse, therefore, be hard and frequent, the skin hot and dry, and the patient complains of his head or breast, it will be necessary to bleed, and to give the cooling powders recommend d in the scarlet fever, every three or four hours, till they give a stool. It will likewise be proper to put a blistering-plaster on the ba k to give two table-spoonsful of the saline mixture every two hours. and in short to treat the patient in all respects as for a slight fever. I have often seen this course, when observed at the beginning, re move the complaint in two or three days, when the patient had al the symptoms of an approaching ardent fever, or an inflammatior of the breast. The chief secret in preventing colds lies in avoiding, as far as possible, all extremes either of heat or cold, and in taking car wn«n the body is heated, to let it cool gradually. These and other circumstances relating to this important subject, are so fully treat- ed of under the article Obstructed Perspiration, that it is needless he:e to resume the consideration of them. COMMON COUGH. 205 Of a Common Cough. A cough is generally the effect of a cold, which has either been improperly treated, or entirely neglected. When it proves obsti- nate, there is always reason to fear the consequences, as this shows a weak state of the lungs, and is often the forerunner of con- sumption. If the cough be violent, and the patient young and strong, with a hard quick pulse, bleeding will be proper; but in weak and re- laxed habits, bleeding rather prolongs the disease. When the patient spits freely, bleeding is unnecessary, and sometimes hurt- ful, as it tends to lessen that discharge. When the cough is not attended with any degree of fever, and the spittle is viscid and tough, sharp pectoral medicines are to be ad- ministered ; as gum-ammoniac, squills, &c. Two table-spoonsful of the solution of gum-ammoniac may be taken three or four times a-day, more or less, according to the age and constitution of the patient. Squills may be given various ways :* two ounces of the vinegar, the oxymel, or the syrup, may be mixed with the same "quantity of simple cinnamon-water, to which may be added an ounce of common water and an ounce of balsamic syrup. Two table-spoonsful of this mixture may be taken three or four times a-day. A syrup made of equal parts of lemon-juice, honey, and sugar- candy, is likewise very proper in this kind of cough. A table- spoonful of it may be taken at pleasure. But when the defluxion is sharp and thin, these medicines rather do hurt. In this case, gentle opiates, combined with diaphoretics, oils, and mucilages,! are more proper. A cup of an infusion of poppy leaves, and marsh-mallow roots, or the flowers of colts-foot, may be taken frequently ; or a tea-spoonful of paregoric elixir may be put into the patient's drink twice a-day. Fuller's Spanish' infu- sion is also a very proper medicine in this case, and may be taken in the quantity of a tea-cupful three or four times a-day. In obstinate coughs, proceeding from a flux of humours upon the lungs, it will often be necessary, besides expectorating medi- cines, to have recourse to issues, setons, or some other drain. In this case I have often observed the most happy effects from a Bur- gundy-pitch plaster applied between the shoulders. I have ordered this simple remedy in the most obstinate coughs, in a great number of cases, and in many different constitutions, without ever knowing it fail to give relief, unless there were evident signs of an ulcer in the lungs. * Take Mixture of Ammonia, 54 oz. t Take Solution of the Acetate of Ammj- Oxymel of Squills, | oz. nia, 3 drs. Make a mixture ; of which take two des- Mucilage of G. Acacia, 1 oz. sert spoonsful often, or when the cough Syrup of Tolu, 1 dr. is troublesome. Tincture of Opium, 25 drps. or Make a draught; to be taken at bed-time. Take Mucilage of Gam Arabic, 5 oz. or Oil of Sweet Almonds, 1 oz. Take Compound Powder of Ipecacuanha, Syrup of Tolu, 4 oz. 10 grs. Solution of Subcarbonate of Ammo- Make a diaphoretic powder. nia, 4 drm. Make an emulsion, of which take one table-spoonful frequently. 20C COMMON COUGH. About the bulk of a nutmeg of Burgundy-pitch may be spread thin upon a piece of soft leather, about the size rf the hand, and itiid between the shoulder-blades. It may be taken off and wiped every three or four days, and ought to be renewed once a fortnight or three weeks. This is indeed a cheap and simple medicine, and consequently apt to be despised; but we will venture to affirm, that the whole materia medica does not afford an application more efficacious in almost every kind of cough. It has not indeed always an immediate effect; but, if kept on for some time, it will succeed where most other medicines fail. The only inconvenience attending this plaster is the itching which it occasions; but surely this may be dispensed with, consid- ering the advantage which the patient may expect to reap from the application; besides, when the itching becomes very uneasy, the plaster may be taken off, and the part rubbed with a dry cloth, or washed with a little warm milk and water. Some caution indeed is necessary in discontinuing the use of such a plaster; this how- ever, may be safely done by making it smaller by degrees, and at length quitting it altogether in a warm season.* But coughs proceed from many other causes besides defluxions upon the lungs. In these cases the cure is not to be attempted by pectoral medicines. Thus, in a cough proceeding from the foul- ness and debility of the stomach, syrups, oils, mucilages, and all kinds of balsamic do hurt. The stomach cough may be known from one that is owing to a fault in the lungs by this, that in the latter the patient coughs whenever he inspires, or draws in his breath fully; but in the former that does not happen. The cure of this cough depends chiefly upon cleansing and strengthening the stomach; for which purpose, gentle emetics and bitter purgatives are most proper. Thus, after a vomit or two, the sacred tincture, as it is called, may be taken for a considerable time in the dose of one or two table-spoonsful twice a-day, or as often as it is found necessary, to keep the body gently open. People may make this tincture themselves, by infusing an ounce of hiera picra in an English pint of white-wine, letting it stand a few days, and then straining it off for use.t In coughs which proceed from a debility of the stomach, the Peruvian bark is likewise of considerable service. It may either be chewed, taken in powder, or made into a tincture along with other stomachic bitters. A nervous cough can only be removed by change of air, and proper exercise; to which may be added the use of gentle opiates. Instead of the saponaceous pill, the paregoric elixir, Se.c. which are only opium disguised, ten, fifteen, twenty, twenty-five drops of liquid laudanum, more or less, as circumstances require, may be * Some complain that the pitch plaster adheres too fast, while others find difficult? in keeping it on. This proceeds from the different kinds of pitch made use of and hkewueifton the manner of making it. I generally find it anWer best when mixed J1S. LSers^rp:rapXoseanbdeSral " «* " *™M*' ^ «™> ^' ^ "nl effUta'JrV.W.Sii fhC 8tom^h, productive of this particular kind of cough, beneficial one Jr,f„ ,, d fr!5m 8mlU doses of ipecacuanha. A person may begin with takine ^e^reeno7nnauasneda.anS.er * »'«H*™*»«7 «.™»W the dose &l ,t occS HOOPING-COUGH, OR CHIN-COUGH. 207 taken at bed-time, or when the cough is most troublesome.* Im- mersing the ,feet and hands in warm water will often appease the violence of a nervous cough. When a cough is only a symptom of some other malady, it is in vain to attempt to remove it without first curing the disease from which it proceeds. Thus, when a cough is occasioned by teething, keeping the body open, scarifying the gums, or whatever facilitates the cutting of the teeth, likewise appeases the cough. In like manner, when worms occasion a cough, such medicines as remove these vermin will generally cure the cough; as bitter purgatives, oily clysters, and such like. Women, during the last month of pregnancy are often greatly afflicted with a cough, which is generally relieved by bleeding, and keeping the body gently open. They ought to avoid all flatulent food, and to wear a loose easy dress. A cough is not only a symptom, but is often likewise the fore- runner of diseases. Thus, the gout is frequently ushered in by a very troublesome cough, which affects the patient for some days before the coming on of the fit. This cough is generally removed by a paroxysm of the gout, which should therefore be promoted, by keeping the extremities warm, drinking warm liquors, and bathing the feet and legs frequently in lukewarm water. Hooping-cough, or Chin-cough. (Pertussis.) This cough seldom affects adults, but proves often fatal to chil- dren. Such children as live upon thin watery diet, who breathe unwholesome air, and have too little exercise, are most liable to this disease, and generally suffer most from it. The chin-cough is so well known, even to nurses, that descrip- tion of it is unnecessary. Whatever hurts the digestion, obstructs the perspiration, or relaxes the solids, disposes to this disease; consequently its cure must depend upon cleansing and strengthen- ing the stomach, bracing the solids, and at the same time promot- ing perspiration, and the different secretions. The diet must be light, and of easy digestion; for children, good bread made into pap or pudding, chicken-broth, with other light spoon-meats, are proper; but those who are farther advanced may be allowed sago-gruel, and if the fever be not high, a little boiled chicken, or other white meats. The drink may be hyssop, or penny-royal tea, sweetened with honey or sugar-candy, small wine- whey, or, if the patient be weak, he may sometimes be allowed a little negus. One of the most effectual remedies in the chin-cough is change of air. This often removes the malady, even when the change seems to be from a purer to a less wholesome air. This may in some measure depend on the patient's being removed from the place where the infection prevails. Most of the diseases of chil- dren are infectious; nor is it at all uncommon to find the chin- cough prevailing in one town or village, when another at a very small distance is quite free from it. But whatever be the cause, •Take Oxymel of Squills, A oz. Of which a table-spoonful maybe taken Paregoric Elixir, 2 drs. three or four times a-day. 208 HOOPING-COUGH, OR CHIN-COUGH. we arc sure of the fact. No time ought therefore to be lost in removing the patient at some distance from the place where he caught the disease, and, if possible, into a more pure and warm air.* When the disease proves violent, and the patient is in danger of being suffocated by the cough, he ought to be bled, especially if there be a fever with a hard full pulse. But as the chief intention of bleeding is to prevent an inflammation of the lungs, and to ren- der it more safe to give vomits, it will seldom be necessary to repeat the operation; yet if there are symptoms of an inflamma- tion of the lungs, a second or even a third bleeding may be re- quisite. It is generally reckoned a favourable symptom when a fit of coughing makes the patient vomit. This cleanses the stomach, and greatly relieves the cough. It will therefore be proper to pro- mote this discharge, either by small doses of ipecacuanha, or the emetic mixture here subjoined in doses of a table-spoonful every fifteen minutes till it operates.t Emetics not only cleanse the stomach, which in this disease is generally loaded with viscid phlegm, but they likewise promote the perspiration and other secretions, and ought therefore to be repeat- ed according to the obstinacy of the disease. They should not however be strong; gentle vomits frequently repeated are both less dangerous and more beneficial than strong ones. The body ought to be kept gently open. The best medicines for this purpose are rhubarb and its preparations, as the syrup, tinct- ure, or submuriate of mercury and rhubarb, &c. Of these former a tea-spoonful or two may be given to an infant, twice or thrice a-day, as there is occasion. To such as are further advanced, the dose must be proportionally increased, and repeated till it has the desired effect. Those who cannot be brought to take the bitter tincture, may have an infusion of senna and prunes, sweetened with manna, coarse sugar, or honey; or a few grains of rhubarb mixed with a tea-spoonful or two of syrup, or currant jelly, so as to disguise the taste. Most children are fond of syrups and jellies, and seldom refuse even a disagreeable medicine when mixed with them. Many people believe that oily, pectoral, and balsamic medicines possess wonderful virtues for the cure of the hooping-cough, and accordingly exhibit them plentifully to patients of every age and constitution, without considering that every thing of this nature must load the stomach, hurt the digestion, and of course aggravate the disorder.^ * Some think the air ought not to be changed till the disease is on the decline ; but there seems to be no sufficient reason for this opinion, as patients have been known to reap benefit from a change of air at all periods of the disease. It is not sufficient to take the patient out daily in a carriage. This seldom answers any good purpose ; but often does hurt, by giving him cold. f Take Tartarized Antimony, 3 grs. Make an emetic mixture; to be taken as Water, 6 oz. above. Simple Syrup, 2 drs. t Dr. Duplanil says, he has seen many good effects from the kermes mineral in this complaint, the cough being frequently alleviated even by the first dose. The dose for a child of one year old is a quarter of a grain dissolved in a cup of any liquid, repeated HOOPING-COUGH, OR CHIN-COUGH. 209 Opiates are sometimes necessary to allay the violence of the cough. For this purpose, a little of the syrup of poppies, or five, six, or seven drops of laudanum, according to the age of the patient, may be taken in a cup of hyssop or penny-royal tea, and repeated occasionally, or a hemlock has been recommended; they may be combined in the following form.* After the accumulated phlegm has been brought away by emet- ics, Dr. Pearson recommends a medicine composed of opium, ipe- cacuanha, and the carbonate of soda;t in the subjoined proportions to a child between two and three years old, to be repeated every fourth hour, for several days, taking care to remove costiveness whenever it may occur, by submuriate of mercury and rhubarb (one grain of the former to four of the latter.) The superacetate of lead is said to relieve speedily the exacer- bated symptoms of the disease, without producing any bad effects on the stomach and Bowels.J Stimulating or anodyne embrocations frequently afford relief; and may be rubbed along the spine, breast bone, or lower region of the stomach,^ and opium rubbed over the stomach and chest. Young children should be laid with their heads and shoulders raised, and should be cautiously watched, that, when the cough comes on, they may be held up, so as to stand upon their feet, bending a little forward to guard against suffocation. The feet should be frequently bathed in lukewarm water; and a Burgundy-pitch plaster kept constantly between the shoulders. But when the disease proves very violent, it will be necessary, in- stead of it, to apply a blistering-plaster, and to keep the part open for some time with issue-ointment. When the disease is protracted, and the patient is free from a fever, the Peruvian bark, and other bitters and antispasmodics, are the most proper medicines. The bark may either be taken in substance, or in a decoction or infusion, as is most agreeable. For a child, ten, fifteen, or twenty grains, according to the age of the patient, may be given three or four times a-day. For an adult half a drachm or two scruples will be proper. Some give the ex- tract of the bark with cantharides ; but to manage this requires a considerable attention. It is more safe to give a few grains of castor along with the bark. A child of six or seven years of age may take seven or eight grains of castor, with fifteen grains of powdered bark, for a dose. This may be made into a mixture, with two or three ounces of any simple distilled water, and a little syrup, and taken three or four times a-day. two or three times a-day. For a child of twp years, the dose is half a grain j and the quantity must be thus increased in proportion to the age of the patient. • Take Extract of Hemlock, 1 to 2 grs. Decoction of Bark, 1 oz. Tincture of Opium, 3 drps. Make a draught; to be taken three times a-day, t Take Ipecacuanha Wine, 5 drps. Carbonate of Soda, 2 grs. Tincture of Opium, 1 gr. Simple Syrup, 1 drm. Make a draught) to be taken as above. I Take Superacetate of lead, 2 to 5 grs. Rose Water, 2 ounces. Syrup of Violets, 2 drachms Make a mixture ; of which let a tea-spoon ful be taken every four or five hours. $ Take Tartarized Antimony, 1 scruple. Water, 2 ounces. Tincture of Spanish Flics, 4 ounce Make an embrocation. 210 INFLAMMATION OF THE STOMACH. CHAP. XXII. INFLAMMATION OF THE STOMACH. (Gastritis.) This disease is divided into two species, viz. the phlegmonous and erysipelatous ; but it is the former that is here alluded to, the latter arising, for the most part, towards the termination of other diseases, marking the certain approach to dissolution, and being unaccompanied with any marks of general inflammation, or by any burning pain in the stomach. Inflammations of the stomach are dangerous, and require the most speedy assistance, as they frequently end in a suppuration, and sometimes in a mortification, which is certain death. Causes.—Phlegmonous Inflammation of the stomach may pro- ceed from any of the causes which produce an inflammatory fever ; as cold liquor drank while the body is warm, obstructed perspira- tion, or the sudden striking-in of any eruption. It may likewise proceed from the acrimony of the bile, or from acrid and stimulat- ing substances taken into the stomach ; as strong vomits or purges, corrosive poisons, and such like. When the gout has been repel- led from the extremities, either by cold or improper applications, it often occasions e.n inflammation of the stomach. Hard or indi- gestible substances taken into the stomach, as bones, the stones of fruits, &c. may likewise have that effect. Symptoms.—It is attended with a fixed pain and burning heat in the stomach ; great restlessness and anxiety ; a small, quick, and hard pulse ; vomiting, or at least a nausea'and sickness ; excessive thirst; coldness of the extremities ; difficulty of breathing ; cold clammy sweats ; and sometimes convulsions and fainting fits. The stomach is swelled, and often feels hard to the touch. One of the most certain signs of this disease is the sense of pain, which the patient feels upon taking any kind of food or drink, especially if it be either too hot or too cold. When the patient vomits every thing he eats or drinks, is ex- tremely restless, has a hiccup, with an intermitting pulse, and fre- quent fainting fits, the danger is very great. Regimen.—All acrimonious, heating, and irritating food and drink are carefully to be avoided. The weakness of the patient may deceive the by-standers, and induce them to give him wines, spirits, or other cordials; but these never fail to increase the dis- ease, and often occasion sudden death. The inclination to vomit may likewise impose on the attendants, and make them think a vomit necessary ; but that too is almost certain death. The food must be light, thin, cool, and easy of digestion. It must be given in small quantities, and should neither be quite cold nor too hot. Thin gruel made of barley or oatmeal, light toasted bread dissolved in boiling water, or very weak chicken broth, are the most proper. The drink should be clear whey, barley-water, INFLAMMATION OF THE INTESTINES. 211 water in which toasted bread has been boiled, or decoctions of emollient vegetables, as liquorice, and marshmallow roots, sarsa- parilla, or the like. Medicine.—Bleeding in this disease, as in all other visceral in- flammations, is the sheet anchor, and the only thing that can be depended on. When the disease proves obstinate, it will often be proper to repeat this operation several times ; nor must the low state of the pulse deter us from doing so. The pulse, indeed, gen- erally rises upon bleeding, and as long as that is the case, the operation is safe. Frequent fomentations with lukewarm water, or a decoction of emollient vegetables, and leeching, are likewise beneficial. Flan- nel cloths dipped in these must be applied to the region of the stom- ach, and removed as they grow cool. They must neither be appli- ed too warm, nor be suffered to continue till they become quite cold, as either of these extremes would aggravate the disease. A number of leeches, not less than twenty, may be applied, and the warm fomentations continued to promote the bleeding when they fall off. The feet and legs ought likewise to be frequently bathed in lukewarm water, and warm bricks or poultices may be applied to the soles of the feet. The warm bath, if it can be conveniently used, will be of great service. In this and all other inflammations of the bowels, a large blister, applied over the part affected, is one of our best remedies. The only internal medicines which we shall venture to recom- mend in this disease, are mild clysters. These may be made of warm water, or thin water-gruel; and if the patient be costive, a little sweet oil, honey, or manna may be added. Clysters answer the purpose of an internal fomentation, while they keep the body open, and at the same time nourish the patient, who is often in this disease unable to retain any food upon his stomach. For these reasons they must not be neglected, as the patient's life may depend on them. Inflammation op the Intestines. (Enteritis.) This, like inflammation of the stomach, is of two species, viz. the phlegmonous and erysipelatous; the first only is here noticed, as the latter is invariably symptomatic of some other disease, and is one of the most painful and dangerous diseases to which man- kind are liable. It generally proceeds from the same causes as the inflammation of the stomach; to which may be added, costive- ness, worms, eating unripe fruits or great quantities of nuts, drink- ing hard windy malt liquors, as stale bottled beer or ale, sour wine, cider, Sec. It may likewise be occasioned by a rupture, by scir- rhous tumours of the intestines, or by their opposite sides growing together. The inflammation of the intestines is denominated Iliac passion, Enteritis, $fc. according to the name of the parts affected. The treatment, however, is nearly the same, whatever part of the in- testinal canal be the seat of the disease ; we shall therefore omit these distinctions, lest they should perplex the reader. 212 INFLAMMATION OF THE INTESTINES. The symptoms here are nearly the same as in the foregoing dis- ease only the pain, if possible, is more acute, and is situated lower in the abdomen. The vomiting is likewise more violent, and sometimes even the excrements, together with the clysters, are discharged by the mouth. The patient is continually belching up wind, and has often an obstruction of his urine. While the pain shifts, and the vomiting only returns at certain intervals, and while the clysters pass downwards, there is ground for hope ; but when the clysters and faeces are vomited, and the pa- tient is exceedingly weak, with a low fluttering pulse, a pale coun- tenance, and a disagreeable or stinking breath, there is great rea- son to fear the consequences will prove fatal. Clammy sweats, black foetid stools, with a small intermitting pulse, and a total ces- sation of pain, are the signs of a mortification already begun, and of approaching death. Regimen.—The regimen in this disease is in general the same as in an inflammation of the stomach. The patient must be kept quiet, avoiding cold, and all violent passions of the mind. His food ought to be very light, and given in small quantities ; his drink weak and diluting; as clear whey, barley-water, and such like. Medicine.—Bleeding in this, as well as in the inflammation of the stomach, is of the greatest importance. It should be perform- ed as soon as the symptoms appear, and must be repeated accord- ing to the strength of the patient, and the violence of the disease. Fomentations, laxative clysters, and leeches, are by no means to be omitted. The patient's feet and legs should frequently be bathed in warm water ; and cloths dipped in it applied to his belly. Bladders filled with warm water may likewise be applied to the region of the navel, and warm bricks, or bottles filled with warm water, to the soles of the feet. The clysters may be made of bar- ley-water, or thin gruel with salt, and softened with sweet oil or fresh butter. These may be administered every two or three hours, or oftener, if the patient continues costive. A blistering plaster is here likewise to be applied immediately over the part where the most violent pain is. This not only relieves the pain of the bowels, but even clysters* and purgative medicines,! which before had no effect, will operate when the blister begins to rise. If the disease does not yield to clysters and fomentations, re- course must be had to purgatives ; but as these, by irritating the bowels, often increase their contraction, and by that means frustrate their own intention, it will be necessary sometimes to join them with opiates, which, by allaying the pain, and relaxing • Take Infusion of Senna, 10 ounces. Tinct. of Jalap, 4 drachm. Sulphate of Soda. 1 ounce. Make a draught. Castor Oil, 4 ounce. or Make a clyster. Take Infusion of Senna;, 14 ounce. Tincture of the same, 1 drachm. t Take Castor Oil, 1 ounce. Epsom Salts, 3 drachms Mint Water, 4 ounce. Make a draught. INFLAMMATION OF THE INTESTINES. ^13 the spasmodic contractions of the guts, greatly assist the operation of purgatives in this case. Acids have often a very happy effect in staying the vomiting, and appeasing the other violent symptoms of this disease ; it will therefore be of use to sharpen the patient's drink, with cream of tartar, juice of lemon, or, when these cannot be obtained, with vinegar. But it often happens that no liquid whatever will stay on the stomach. In this case the patient must take purging pills. I have generally found the following answer very well:—Take jalap in powder, and vitriolated tartar, of each half a drachm, opium one grain, Castile soap as much as will make the mass fit for pills. These must be taken at one dose, and if they do not operate in a few hours, the dose may be repeated. If a stool cannot be procured by any of the above means, it will be necessary to immerse the patient in warm water up to the breast. I nave often seen this succeed when other means had been tried in vain. The patient must continue in the water as long as he can easily bear it without fainting, and if one immer- sion has not the desired effect, it may be repeated as soon as the patient's strength and spirits are recruited. It is more safe for him to go frequently into the bath than to continue too long at a time; and it is often necessary to repeat it several times before it has the desired effect. It has sometimes happened, after all other means of procuring a stool has been tried to no purpose, that this was brought about by immersing the patient's lower extremities in cold water, or making him walk upon a wet pavement, and dashing his legs and thighs with the cold water. This method, when others fail, at least merits a trial. It is, indeed, attended with some danger; but a doubtful remedy is better than none. In desperate cases it is common to give quicksilver. This may be given to the quantity of several ounces, or even a pound, but should not exceed that.* When there is reason to suspect a mor- tification of the intestines, this medicine ought not to be tried. In that case it cannot cure the patient, and will only hasten his death. But when the obstruction is occasioned by any cause that can be removed by force, quicksilver is not only a proper medicine, but the best that can be administered, as it is the fittest body we know for making its way through the intestinal canal. If the disease proceeds from a rupture, the patient must be laid with his head very low, and the intestines returned by gentle pressure with the hand. If this, with fomentations and clysters, should not succeed, recourse must be had to a surgical operation, which may give the patient relief. Such as would avoid this excruciating and dangerous disease, must take care never to be too long without a stool. Some who have died of it, have had several pounds of hard dry fauces taken out of their intestines. They should likewise beware of eating too * When quicksilver is given in too large quantities, it defeats its own intention, as it drags down the bottom of the stomach, which prevents its getting over the Pylorus. In this case the patient should be suspended by the heels, in order that the quicksil- ver may be discharged by his mouth. 211 COLIC. freely of sour or unripe fruits, or drinking stale windy liquors, Sec. I have known it bror.ght on by living too much on baked fruits, which are seldom goo»1. It likewise proceeds frequently from cold caught by wet clothes, &c. but especially from wet feet. Colic (Colica.) The colic has a great resemblance to the two preceding diseases, both in its symptoms and method of cure. It is generally attended with costiveness and acute pain of the bowels; and requires dilut- ing diet, evacuations, fomentations, &c. Colics are variously denominated according to their causes, as the flatulent, the bilious, the hysteric, the nervous, Sec. And as each of these requires a particular method of treatment, we shall point out their most general symptoms, with the means to be used for their relief. The flatulent, or wind colic, is generally occasioned by an indis- creet use of unripe fruits, meats of hard digestion, windy vegeta- bles, fermenting liquors, and such like. It may likewise proceed from an obstructed perspiration, ok catching cold. Delicate peo- ple, whose digestive powers are weak, are most liable to this kind of colic. The flatulent colic may either affect the stomach or intestines. It is attended with a painful stretching of the affected part. The patient feels a rumbling in his bowels, and is generally relieved by a discharge of wind, cither upwards or downwards. The pain is seldom confined to any particular part, as the vapour wanders from one division of the bowels to another, till it finds a vent. When the disease proceeds from windy liquor, green fruits, sour herbs, or the like, the best medicine on the first appearance of the symptoms is a dram of brandy, gin, or any good spirits, or aromatic cordials* combined with opiates. The patient should likewise sit with his feet upon a warm hearth-stone, or apply warm bricks to them; and warm clothes may be applied to his stomach and bowels. If costiveness prevail, some gentle laxative may be given. This is the only colic in which ardent spirits, spiceries, or any thing of a hot nature may be ventured upon. Nor indeed are they to be used here, unless at the very beginning, before any symptoms of inflammation appear. We have reason to believe that the colic occasioned by wind or flatulent food might always be cured by spirits and warm liquors, if they were taken immediately upon perceiving the first uneasiness; but when the pain has continued for a considerable time, and there is reason to fear an inflammation of the bowels is already begun, all hot things are to be avoided as poison, and the patient is to be treated in the same manner as for the inflammation of the intestines. Several kinds of food, as honey, eggs, &c. occasion colics in some particular constitutions. I have generally found the best method of cure for these was to drink plentifully of small diluting liquors, as water-gruel, small posset, toast and water, &c. * Take Mint Water, 1 oz. Spirit of Caraway, 4 oz- Compound Tincture of Lav- ender, 1 drm. Tincture of Opium, 20 drps Make a draught. COLIC. 215 Colics which proceed from excess andv indigestion, generally cure themselves by occasioning vomiting or purging. These dis- charges are by no means to be stopped, but promoted by drinking plentifully of warm water, or weak posset. When their violence is over, the patient may take a dose of rhubarb, or any other gen- tle purge, to carry off the dregs of his debauch. Colics which are occasioned by wet feet, or catching cold, may generally be removed at the beginning by bathing the feet and legs in warm water, and drinking such warm diluting liquors as will promote the perspiration, as weak wine-whey, or water-gruel with a small quantity of spirits in it. Those flatulent colics, which prevail so much among country- people, might generally be prevented, were they careful to change their clothes when they get wet. They ought likewise to take a dram, or to drink some warm liquor after eating any kind of green trash. We do not mean to recommend the practice of dram- drinking, but in this case ardent spirits prove a real medicine, and indeed the best that can be administered. A glass of good pepper- mint-water will have nearly the same effect as a glass of brandy, and in some cases is rather to be preferred. The bilious colic is attended with very acute pains about the region of the navel. The patient complains of great thirst, and is generally costive. He vomits a hot, bitter, and yellow-coloured bile, which, being discharged, seems to afford some relief, but is quickly followed by the same violent pain as before. As the dis- icmpcr advances, the propensity to vomit sometimes increases so as to become almost continual, and the proper motion of the intes- tines is so far perverted, that there are all the symptoms of an im- pending iliac passion. If the patient be young and strong, and the pulse full and fre- quent, it will be proper to bleed, after which clysters may be administered. Clear whey or gruel, sharpened with the juice of lemon, or cream of tartar, must be drunk freely. Small chicken- broth, with a little manna dissolved in it, or a slight decoction of tamarinds, is likewise very proper, or any other thin, acid, opening liquor. Besides bleeding and plentiful dilution, it will be necessary to foment the belly with cloths dipped in warm water, and if this should not succeed, the patient must be immersed up to the breast in warm water. In the bilious colic, the vomiting is often very difficult to restrain. When this happens, the patient may drink a decoction of toasted bread, or an infusion of garden-mint in boiling water. Should these not have the desired effect, the saline draught, with a few drops of laudanum in it, may be given, and repeated according to the urgency of the symptoms. A small quantity of Venice treacle may be spread in form of a cataplasm, and applied to the pit of the stomach. Clysters, with a proper quantity of Venice treacle or liquid laudanum in them, may likewise be frequently administered. The hysteric colic bears a great resemblance to the bilious. It is attended with acute pains about the region of the stomach, vom- iting, Sec. Sec. What the patient vomits in this case is commonly of a greenish colour. There is a great sinking of the spirits, with 216 COLIC. dejection of mind and difficulty of breathing, which are the char ncteristic symptoms of this disorder. Sometimes it is accompanied with the jaundice, but this generally goes off of its own accord in a few days. In this colic all evacuations, as bleeding, purging, vomiting, Sec. do hurt. Every thing that weakens the patient, or sinks the spirits, is to be avoided. If, however, the vomiting should prove violent, lukewarm water, or small posset, may be drank to cleanse the stomach. Afterwards the patient may take fifteen, twenty, or twenty-five drops of liquid laudanum in a glass of cinnamon-water. This may be repeated every ten or twelve hours, till the symptoms abate. The patient may likewise take four or five of the foetid pills every six hours, and drink a cup of penny-royal tea after them. If asa- foetida should prove disagreeable, which is sometimes the case, a tea-spoonful of the tincture of castor in a cup of penny-royal tea, or thirty or forty drops of the balsam of Peru dropped upon a bit of loaf-sugar, may be taken in its stead, or the subjoined form.* The nervous colic prevails among miners, smelters of lead, plumbers, the manufacturers of white lead, Sec. It is very com- mon in the cider countries of England, and is supposed to be occasioned by the leaden vessels used in preparing that liquor. It is likewise a frequent disease in the West Indies, where it is term- ed the dry belly-ache. No disease of the bowels is attended with more excruciating pain than this; nor is it soon at an end. I have known it continue eight or ten days with very little intermission, the body all the while, continuing bound in spite of medicine, yet at length yield. and the patient recover.! It generally, however, leaves the paticn' weak, and often ends in a palsy. The general treatment of this disease is so nearly the same with that of the iliac passion, or inflammation of the bowels, that we shall not insist upon it. The body is to be opened by mild purga- tives given in small doses, and frequently repeated, and their ope- ration must be assisted by soft oily clysters, fomentations, Sec. The castor oil is reckoned peculiarly proper in this disease. It may both be mixed with the clystersj and given by the mouth, in dose of one, two, or three table-spoonsful. The Barbadoes tar is said to be an efficacious medicine in this complaint. It may be taken to the quantity of two drachms three times a-day, or oftener, if the stomach will bear it. This tar, mixed with an equal quantity of strong rum, is likewise proper for • Take Dill Water, 64 oz. Tincture of Castor, A oz. Spirit of Sulphuric ^Ether, 1 drm. Make a mixture, of which let two table- *etid Spirit of Ammonia, A drm. spoonsful be given every three or four Tincture of Opium, 30 drps. hours. t As the smoke of tobacco thrown into the bowels will often procure a stool when all other mearts have failed, an apparatus for this purpose ought to be kept by every surgeon. It may be purchased at a small expense, and will be of service in several other cases. t Take Sulphate of Soaa, 6 drs. Mix them well togetner in a marble uior- 7?? J™' l oz- tar> tnen add gradually, v 1iiof T"rPentme>, 3 drs. ------Thin Water Gruel, 12 oz. \ elk of Egg, enough. Make a clyster. INFLAMMATION OF THE KIDNEYS. 217 rubbing the spine, in case any tingling, or other symptoms of the palsy are felt. When the tar cannot be obtained, the back may be rubbed with strong spirits, or a little oil of nutmeg, or of rose- mary. If the patient remain weak and languid after this disease, he must take exercise on horseback, and use an infusion of the Peru- vian bark in wine. When the disease ends in palsy, the Bath waters are found to be extremely proper. To avoid this kind of colic, people must shun all sour fruits, acid and austere liquors, Sec. Those who work in lead ought never to go to their business fasting, and their food should be oily or. fat. They may take a glass of salad oil, with a little brandy or rum, every morning, but should never take spirits alone. Liquid ali- ment is best for them ; as fat broths, &c, but low living is bad. They should frequently go a little out of the tainted air; and should never suffer themselves to be costive. In the West Indies, and on the coast of Guinea, it has been found of great use, for preventing this colic, to wear a piece of flannel round the waist, and to drink an infusion of ginger by way of tea. Sundry other kinds of this disease might be mentioned, but too many distinctions would tend only to perplex the reader. Those already mentioned are the most material, and should, indeed, be at- tended to, as their treatment is very different. But even persons who are not in a condition to distinguish very accurately in these matters, may nevertheless be of great service to patients in colics of every kind, by only observing the following general rules, viz. To bathe the feet and legs in warm water ; to apply bladders fill- ed with warm water, or clothes wrung out of it, to the stomach and bowels; to make the patient drink freely of diluting mucilaginous liquors ; and to give him an emollient clyster every two or three hours. Should these not succeed, the patient ought to be immers- ed in warm water. Inflammation of the Kidneys. (Nephritis.) Properly considered, inflammation of the kidneys appears to be of two kinds; one arising from the general causes of inflamma- tion, and seated principally in the external membrane of the kid- neys, the other occasioned by the stimulus of the gravel or stone in the pelvis or cavity of it, and the inflammation occupying the interior parts. It is the first that is here noticed; the other will be referred to under the head of Stone and Gravel. Causes.—This disease may proceed from any of those causes which produce an inflammatory fever. It may likewise be occa- sioned by wounds or bruises of the kidneys ; small stones or gravel lodging within them by strong diuretic medicines; as spirits of turpentine, tincture of cantharides, &c. Violent motion, as hard riding or walking, especially in hot weather, or whatever drives the blood too forcibly into the kidneys, may occasion this malady. It may likewise proceed from lying too soft, too much on the back, involuntary contractions, or spasms, in the urinary vessels, Sec. K 21S INFLAMMATION OF THE KIDNEYS. Symptoms.—There is a sharp pain about the region of the kid neys, with some degree of fever, and a stupor or dull pain in the thigh of the affected side. The urine is at first clear, and after- wards of a reddish colour ; but in the worst kind of the disease it generally continues pale, is passed with difficulty, and commonly in small quantities at a time. The patient feels great uneasiness when he endeavours to walk or sit upright. He lies with most ease on the affected side, and has generally a nausea or vomit- ing, resembling that which happens in the colic. This disease, however, may be distinguished from the colic by the pain being seated farther back, and by the difficulty of passing urine, with which it is constantly attended. Regimen.—Every thing of a heating or stimulating nature is to be avoided. The food must be thin and light; as panado, small broths, with mild vegetables, and the like. Emollient and thin liquors must be plentifully drunk ; as clear whey, or balm-tea sweetened with honey, decoctions of marshmallow roots, with bar- ley and liquorice, &c. The patient, notwithstanding the vomiting, must constantly keep sipping small quantities of these or other di- luting liquors. Nothing so safely and certainly abates the inflam- mation, and expels the obstructing cause, as copious dilution. The patient must be kept easy, quiet, and free from cold, as long as any symptoms of inflammation remain. Medicine.—Bleeding is generally necessary, especially at the beginning. Ten or twelve ounces may be let from the arm or foot with a lancet; and if the pain and inflammation continue, the op- eration may be repeated in twenty-four hours, especially if the pa- tient be of a full habit. Leeches may likewise be applied to the seat of pain, and to the heemorrhoidal veins, as a discharge from these will greatly relieve the patient. Cloths dipped in warm water, or bladders filled with it, must be applied as near as possible to the part affected, and renewed as they grow cool. If the bladders be filled with a decoction of mal- lows and camomile flowers, to which a little saffron is added, and mixed with about a third part of new milk, it will be still more beneficial. Oleaginous cathartics of castor oil,* manna, or oil of almonds, with emollient clysters, ought frequently to be adminis- tered ; and if the latter do not open the body, a little salt and hon- ey, or manna, may be added to them. The same course is to be followed where gravel or a stone is lodged in the kidney; but when the gravel or stone is separated from the kidney, and lodges in the ureter.t it will be proper, be- * Take Castor Oil, 1 ounce. or Mucilage of Gum Arabic, Take Manna, 1 ounce. Fennel Water, of each, 4 ounce. Tartrate of Potash, 3drachms. Tincture of Jalap, - J drachm. Warm Water, IA ounce Make an opening draught. Tincture of Senna, 1 drachm. Make a draught. t The Ureters are two long and slender canals, one on each side, which carry the urine from the basin of the kidneys to the bladder. They are sometimes obstructed by small pieces of gravel falling down from the kidneys, and lodging in them. INFLAMMATION OF THE BLADDER. 219 sides the fomentations, to rub the small of the back with sweet oil, and to give gentle diuretics ; as juniper-water sweetened with the syrup of marsh-mallows : a tea-spoonful of the sweet spirits of.nitre, with a few drops of laudanum, may now and then be put in a cup of the patient's drink ; or a decoction of the dried leaves of the peach tree. He ought likewise to take exercise on horseback, or in a carriage, if he be able to bear it. When the disease is protracted beyond the seventh or eighth day, and the patient complains of a stupor and heaviness of the part, has frequent returns of chilliness, shivering, &c, there is reason to suspect that matter is forming in the kidney, and that an ab- scess will ensue. When matter in the urine shows that an ulcer is already formed in the kidney, the patient must be careful to abstain from all acrid, sour, and salted provisions ; and to live chiefly upon mild mucilag- inous herbs and fruits, together "with the broth of young animals, made with barley and common pot-herbs, &c His drink may be whey, and buttermilk that is not sour. The latter is by some reckoned a specific remedy in ulcers of the kidneys. To answer this character, however, it must be drunk for a considerable time. Chalybeate waters have likewise been found beneficial in this dis- ease. This medicine is easily obtained, as it is found in every part of Great Britain. It must likewise be used for a considera- ble time, in order to produce any salutary effect. Those who are liable to frequent returns of inflammation, or obstructions of the kidneys, must abstain from wines, especially such as abound with tartar ; and their food ought to be light and easy of digestion. They should use moderate exercise, not lie too hot, nor too much on their back, and avoid costiveness. Inflammation of the Bladder. (Cystitis.) The inflammation of the bladder proceeds, in a great measure, from the same causes as that of the kidneys. It is known by an acute pain and tension towards the bottom of the belly, and diffi- culty of passing urine, with some degree of fever, a constant in- clination to go to stool, and a perpetual desire to make water, &c. This disease must be treated on the same principle, as the one immediately preceding. The diet must be light and thin, and the drink of a cooling nature. Bleeding is very proper at the begin- ning, and in robust constitutions it will often be necessary to re- peat it. The lower part of the belly should be fomented with warm water, or a decoction of mild vegetables; and emollient clysters ought frequently to be administered, &c. The patient should abstain from every thing that is of a hot, acrid, and stimulating quality; and should live entirely upon small broths, gruels, or mild vegetables. A stoppage of urine may proceed from other causes besides an inflammation of the bladder ; as a swelling of the hsemorrhoidal veins ; hardened fceces lodged in the rectum; a stone in the blad- der ; excrescences in the urinary passages, a palsy of the bladder, hysteric affections, &c. Each of these require* a particular treat- ment which does not fall under our present consideration. We 52-10 INFLAMMATION OF THE LIVER. shall only observe, that in all of them mild and gentle applications are the safest, as strong diuretic medicines, or things of an irritat- ing nature, generally increase the danger. I have known some persons kill themselves by introducing probes into the urinary pas- sages, to remove, as they thought, somewhat that obstructed the discharge of urine, and others bring on a violent inflammation of the bladder, by using strong diuretics, as oil of turpentine, &c. for that purpose. Inflammation of the Liver. The liver is less subject to inflammation than most of the other viscera, as in it the circulation is slower ; but when an inflamma- tion does happen, it is with difficulty removed, and often ends in suppuration or scirrhus. Causes.—Besides the common causes of inflammation, we may here reckon the following, viz. excessive fatness, a scirrhus of the liver itself, violent shocks, from strong vomits when the liver was before unsound, an adust or atrabiliarian state of the blood, any thing that suddenly cools the liver after it has been greatly heated, stones obstructing the course of ths bile, drinking strong wines and spirituous liquors, using hot spicy aliment, obstinate hypo- chondriacal affections, long-continued intermittent and remittent fevers, contusions, blows, and in five cases out of six the partial application of cold or wet when the body is heated or over fatigu- ed with exercise, Sec. Symptoms.—This disease is known by a painful tension of the right side under the false ribs, attended with some degree of fever, a sense of weight, or fulness of the part, difficulty of breathing, loathing of food, great thirst, with a pale or yellowish colour of the skin and eyes. The symptoms here are various, according to the degree of in- flammation, and likewise according to the particular part of the liver where the inflammation happens. Sometimes the pain is so inconsiderable, that an inflammation is not so much as suspected; but when it happens in the upper or convex part of the liver, the pain is more acute, the pulse quicker, and the patient is often troubled with a dry cough, a hiccup, and a pain extending to the shoulder, with difficulty of lying on the left side, Sec. This disease may be distinguished from the pleurisy, by the pain being less violent, seated under the false ribs, the pulse not so hard, and by the difficulty of lying on the left side. It may be distin- guished from Jhe hysteric and hypochondriac disorders by the de- gree of fever with which it is always attended. In warm climates* this viscus is more apt to be affected with in * Inflammation of trie liver, and the diseases consequent thereupon, are indeed affec tions more frequently to be met with in warm climates than in cold ones, particularly in the East and West Indies,-where few Europeans can reside for any length of time without being attacked by them. The liver in warm climates seems to be the seat of disease, nearly in the same proportion that the lungs are in Great Britain. Both acute and chronic hepatitis are frequently met with in persons who come to Europe from the East and West Indies; and in those who have been affected when in those climates, they *re very apt to recur by the application of causes which would be likely to havo ft different effect upon any one else. Ed. INFLAMMATION OF THE LIVER. 221 flammation than any o'.her part of the body, from, in all probabil- ity, the increased secretion of bile which takes place when the blood is thrown on the internal parts by an exposure to cold ; or from the bile becoming acrid, and thereby exciting an irritation of the part. This disease, if properly treated, is seldom mortal. A constant hiccuping, violent fever, and excessive thirst, are bad symptoms. If it ends in a suppuration, and the matter cannot be discharged outwardly, the danger is great. When a scirrhus of the liver en- sues, the patient, if he observes a proper regimen, may neverthe- less live a number of years tolerably easy ; but if he indulge in an- imal food and strong liquors, or take jnedicines of an acrid or irri- tating nature, the scirrhus will be converted into a cancer, which must infallibly prove fatal. Regimen.—The same regimen is to be observed in this as in other inflammatory disorders. All hot things are to be carefully avoided, and cool diluting liquors, as whey, barley water, &c. drank freely. The food must be light and thin, and the body, as well as the mind, kept easy and quiet. Medicine.—Bleeding from a large orifice is proper at the be- ginning of this disease, and it will often be necessary, even though the pulse should not feel hard, to repeat it. Topical bleeding by means of leeches applied over the seat of the pain, &c. All vio- lent purgatives are to be avoided; the body, however, must be kept gently open, and immediately after venesection, a proper dose of the submuriate of mercury and colocynth may be directed; or the bowels may be kept open with the neutral salts* or jalap, giving the submuriate of mercury from time to time.t A decoc- tion of tamarinds, with a little honey or manna, will answer this purpose very well. The side affected must be fomented in the manner directed i*n the foregoing diseases. Mild laxative clysters should be frequently administered; and, if the pain should notwith- standing continue violent, a blistering plaster may be applied over the part affected ; or rather a plaster made of gum ammoniac and vinegar of squills. Medicines which promote the secretion of urine have a very good effect here. For this purpose half a drachm of purified nitre, or a teaspoonful of the sweet spirits of nitre, may be taken in a cup of the patient's drink three or four times a-day. When there is an inclination to sweat, it ought to be promoted, but not by warm sudorifics. The only thing to be used fbr that purpose is plenty of diluting liquor drank about blood-warm. In- deed the patient in this case, as well as in all other topical inflam- mations, ought to drink nothing that is colder than this medium. If the stools should be loose, and even streaked with blood, no means must be used to stop them, unless they be so frequent as to Take Infusion of Senna, 14 oz. f Take Submuriate of Mercury, 3 grs. Fpsom Salts, 3 drs. Extract of Colocynth, 5 grs. Tincture of Jalap, Make a pill for* dose. Syrup of Buckthorn, of each 1 dr. Make a draught. 222 INFLAMMATION OF THE LIVER. weaken the patient. Loose stools often prove critical, and carry off the disease. Mercurial friction, should the disease resist the ordinary means, may be employed, in the proportion of a drachm of the blue oint- ment rubbed over and about the affected part every night until a slight degree of salivation is excited, or rather until some obvious effect in the constitution is produced; and this may be commenced at the end of the fourth or fifth day of the disease. Should the friction in this part be attended with any inconvenience, it may be applied to the groins, taking care, however, not to carry it much beyond the point bordering on salivation. If it be desirable to produce some speedy effect »f the mercury, it may also be inter- nally employed, combined with small doses of opium or antimony in the form of pills.* If the disease yields readily, a short course of mercury will be sufficient; but otherwise its use must be contin- ued for, perhaps, five or six weeks. This remedy has latterly been very extensively and beneficially employed; although in all cases it may not be necessary ; particularly at the commencement of acute inflammation of the liver, which, like other visceral inflammations in Great Britain, readily yields to the ordinary plan of depletion. If an abscess or imposthume is formed in the liver, methods should be tried to make it break and discharge^ itself outwardly, as fomentations, the application of poultices, ripening cataplasms, &c. Sometimes, indeed, the matter of an abscess comes away in the urine, and sometimes it is discharged by stool; but these are efforts of nature which no means can promote. When the abscess bursts into the cavity of the abdomen at large, death must ensue; nor will the event be more favourable when the abscess is opened by an incision, unless in cases where the liver adheres to the peri- tonaeum, so as to form a bag for the matter, and prevent it from falling into the cavity of the abdomen; in which case opening the abscess by a sufficiently large incision will probably save the patient's life.t If the disorder, in spite of all endeavours to the contrary, should end in a scirrhus, the patient must be careful to regulate his diet, &c. in such a manner as not to aggravate the disease. He must not indulge in flesh, fish, strong liquors, or any highly-seasoned or salted provisions; but should, for the most part, live on mild vege- tables, as fruits and roots, taking gentle exercise, and drinking whey, barley-water, or butter-milk. If he take's any thing strong- er, it should be fine mild ale, which is less heating than wines or spirits. . If the fomentations do not remove or abate the pain, recourse must be had to blisters, and the warm bath, in which the patient is to continue as long as his strength will permit. The want of a " Take Calomel, 1 drm. or Purified Opium, 1 scr. Take Submuriate of Mercury, 1 drm. Tartarized Antimony, 5 grs. Purified Oplam, Simple Syrup, enough to form the mass; Camphor, of each, 4 drm. which is to be divided into 30 pills; one Simple Syrup, enough to form the mass 5 to be taken night and morning. to be made into 30 equal pills. Dose, one or two. 11 know a gentleman who had several abscesses of the liver opened, and is now a strong and healthy man, though above eighty years of age. CHOLERA MORBUS, &c. 22:} proper warm bath may be supplied by some of the portable l;ath% filled with warm water. The most convenient of these contri- vances, which are to be had at the tin-shops, is commonly called the slipper bath, from its resembling a slipper in form. A cask, or a common tub, may be used for the purpose upon an emergency, though not so commodious. When hepatitis degenerates into, a chronic state, the common mode of cure is by mercury, which is the most effectual practice. It should be given in small doses and slowly, so as just to keep up a brassy taste in the mouth for a considerable time, as it promotes the secretion of bile, and excites the extreme vessels on the sur- face ; and to increase the latter effect, it has been found useful to combine it with small proportions of antimonial powder, as well as opium. To keep up the regular peristaltic motion, which is the next salutary process, and excite the mouths of the excretory ducts of the liver, one or two of the pills prescribed below may be taken occasionally at bed time.* General bleeding is never necessary in chronic inflammation of the liver; but in a few instances topical bleeding by means of leeches or scarifications (cupping) may be serviceable. When there is much local uneasiness, blisters may be advantageously applied. Inflammations of the stomach and bowels are-usually attended with obstinate costiveness, for the removal of which no small skill and perseverance are often necessary. Sometimes a very mild medicine will operate, where a powerful one has had no effect. I have known a few spoonsful of castor oil procure a stool, after the failure of strong drastic purges. The means, therefore, should be varied, not hastily discontinued. Where one thing does not suc- ceed, another may be happily employed; and instances are not wanting of the efficacy even of external applications, when the best internal remedies have proved unsuccessful. CHAP. XXIII. CHOLERA MORBUS, AND OTHER EXCESSIVE DIS- CHARGES FROM THE STOMACH AND BOWELS. The cholera morbus is a violent purging and vomiting of bdious matter, attended with gripes, sickness, and a constant desire to go to stool. It comes on suddenly, and is most common in autumn. There is hardly any disease that kills more quickly than this, when proper means are not used in due time for removing it. In warm climates it is met with at all seasons of the year, and its occurrences are very frequent; but in England and other cold climates, it is apt to prevail most during the autumnal months, when there is excessive heat, or sudden transitions from heat to cold; and the violence of the disease has usually been observed to •Take Compound Extract of Bitter Apple,- Oil of Caraway, 5 drpa. F 1 \irm! Simple Syrup, enough. Calomel, 1 scr. Make 30 pills; to be taken as directed Emetic Tartar, ' 4 grs above. 224 CHOLERA MORBUS, Sec. be greater in proportion to the intenseness of the heat,—circum- stances which induce the belief that cholera morbus is the effect of a warm atmosphere producing some change in the state of the bile, which may consist either in the matter of the bile being rendered more acrid, or its secretion being preternaturally increased. In some instances, the disease has been observed to proceed from an obstructed perspiration, and food that passes readily into the acetous fermentation, &c. though these causes might not give rise tcr*it without the predisposition acquired by preceding great heat, succeeded by sudden transitions of cold, particularly in the evenings. Causes.—It is occasioned by a redundancy and putrid acrimony of the bile; food that easily turns rancid or sour on the stomach; as butter, bacon, sweetmeats, cucumbers, melons, cherries, and other cold, unripe fruits.* It is sometimes the effect of strong acrid purges or vomits, or of poisonous substances taken into the stomach. It may likewise proceed from violent passions or affec- tions of the mind; as fear, anger, &c. Symptoms.—It is generally preceded by a cardialgia, or heart- burn, sour belchings, and flatulencies, with pain of the stomach and intestines. To these succeed nausea, excessive vomiting, and purging of green, yellow, or blackish-coloured bile, with a disten- tion of the stomach, and violent griping pains. There is likewise a great thirst, with a very quick and- unequal pulse, and often a fixed acute pain about the region of the navel. -As the disease advances, the pulse often sinks so low as to become quite imper- ceptible, the extremities grow cold or cramped, and are often cov- ered with a clammy sweat, the urine is obstructed, and there is a palpitation of the heart. Violent hiccuping, fainting, and convul- sions, are the signs of approaching death. Medicine.—At the beginning of this disease, the efforts of Na- ture to expel the offending cause should be assisted, by promoting the purging and vomiting. For this purpose the patient must drink freely of diluting liquors; as whey, butter-milk, warm water, thin water-gruel, barley-water, linseed tea, or, what is perhaps preferable to any of them, very weak chicken broth. This should not Only be drunk plentifully to promote the vomiting, but a clys- ter of it given every hour in order to promote the purging. In addition to these means, flannel cloths wrung out in a warm decoc- tion of poppy-heads slightly bruised, with the addition of about one fourth of the spirit of camphor, may be applied to the region of the stomach, renewing them as often as they become cold; or opium in the form of an external embrocation.t After these evacuations have been continued for some time, a decoction of toasted oat-bread may be drunk to stop the vomiting. • I have been twice brought to the gates of death by this disease, and both times it was occasioned by eating rancid bacon. r Take Spirit of Camphor, 4 oz. Make an embrocation, to be frequently Tincture of Opium. 1 oz. rubbed over the seat of the stomach. CHOLERA MORBUS, &c. 225 The bread should be toasted till it is of a brown colour, and af- terwards boiled in spring water. If oat-bread cannot be had, wheat-bread, or oat-meal well toasted, may be used in its stead. If this does not put a stop to the vomiting, two table-spoonsful of the saline julep, with ten drops of laudanum, may be taken every hour till it ceases. The vomiting and purging, however, ought never to be stopped too soon. As long as these discharges do not weaken the patient, they are salutary, and may be allowed to go on, or rather ought to be promoted. But when the patient is weakened by the evacu- ations, which may be known from the sinking of his pulse, &c. re- course must immediately be had to opiates, as recommended above ; to which may be added strong wines, with spirituous cinnamon- waters, and other generous cordials ; or large doses of diluted sul- phuric acid, which is said to abate the irritation of the stomach more readily than even opium. Warm negus, or strong wine- whey, will likewise be necessary to support the patient's spirits, and promote the perspiration. His legs should be bathed in warm water, and afterwards rubbed with flannel cloths, or wrapped in warm blankets, and warm bricks applied to the soles of his feet. The application of a blister to the stomach will sometimes put a stop to the vomiting. In very severe cases, the external appli- cation of nitric acid has been suggested, as a counter-irritant, as a considerable time may elapse before the blister begins to irritate, a practice that has been adopted in that aggravated form of the dis- ease which has lately been developed in Hindostan. When the violence of the disease is over, to prevent a relapse, it will be necessary for some time to continue the use of small doses of laudanum. Ten or twelve drops may be taken in a glass of wine, at least twice a-day for eight or ten days. The patient's food ought to be nourishing, but taken in small quantities, and he should use moderate exercise. As the stomach and intestines are generally much weakened, an infusion of the bark, or other bitter* in small wine, sharpened with the elixir of vitriol, may be drunk for some time. Though physicians are seldom called in due time in this dis- ease, they ought not to despair of relieving the patient even in the most desperate circumstances. Of this I lately saw a very strik- ing proof in an old man and his son, who had been both seized with it about the middle of the night. I did not see them till next morning, when they had much more the appearance of dead than of living men. No pulse could be felt; the extremities were cold and rigid, the countenance was ghastly, and the strength al- most quite exhausted. Yet from this deplorable condition they were both recovered by the use of opiates! and cordial medicines. •Take Tincture of Gentian, 1 drm. or Infusion of Cascarilla, 14. oz. Take Tincture of Columba, 1 drm. Make a draught, to be taken three times Mint Water, 1» <*• a-day Make a draught, to be taken three time* a-day. t In the Epidemic Cholera of India, the cases which may with most confidence be trused to opium, are those in which the primary symptoms, are seated- W^'" the stomach, as indicated by vomiting and spasmodic pain in that region; and in the K.2 226 DIARRHOEA, OR LOOSENESS. I have frequently had occasion to see this disease, and have sometimes felt it. Yet I never met with an instance, in my own practice, where it proved fatal, though we are told this often hap- pens. Whether so lamentable an issue be owing to improper treat- ment, or to the extreme weakness of the patient's bowels, 1 can- not pretend to say, without an exact knowledge of each particu- lar case ; but I am inclined to think, that when death is the con- sequence, the antidote, which is opium, has been too long delay- ed. No time should be lost in administering it, upon the first seri- ous alarm, and before the powers of Nature are exhausted. What I generally prescribe is laudanum, to. be taken in cinnamon or some other cordial water. Ten drops of laudanum may be added to two ounces of simple cinnamon water, and the draught repeated every two hours, or oftener if necessary. I have found opiates no less successful in diarrhoea, or loose- ness. Ten grains of the powder of bole compounded with opium, given in a glass of cordial water four or five times a-day, will sel- dom fail to check a recent diarrhoea, and if judiciously persisted in, will often cure the most obstinate. I would therefore advise, in such cases, a full reliance on its final efficacy, rather than a rash impatience to try other medicines far more uncertain, and perhaps dangerous. But as a looseness may arise from a great variety of causes, how to adapt the mode of medical treatment to each will be explained in the next section. Diarrhoea or looseness. Diarrhoea, in many cases is not to be considered as a disease, but rather as a salutary evacuation. It ought, therefore, never to be stopped, unless when it continues too long, or evidently weak- ens the patient. As this, however, sometimes happens, we shall point out the most common causes of a looseness, with the proper method of treatment. When a looseness is occasioned by catching cold, or an obstruct- ed perspiration, the patient ought to keep warm, to drink freely of weak diluting liquors, to bathe his feet and legs frequently in lukewarm water, to wear flannel next his skin, and to take every other method to restore the perspiration. In a looseness which proceeds from excess or repletion, an emetic is the proper medicine. Emetics not only cleanse the stomach, biit promote all the secretions, which renders them of great importance in carrying off a debauch. Half a drachm of ipecacuanha in powder will answer this purpose ve*ry well. A day or two after the emetic, the same quantity of rhubarb may be takz intestines, as indicated by violent pursing and painful contractions of the abdomen. Its effects arc more uncertain where the affection of the stomach is obscure; where there is moderate but insidious purging; where there is great sense of heat in the epi- gastrium, and in every case where collapse has come on. In conjunction with other remedies of the antispasmodic and stimulant kind, blood-letting has latterly been esti- mated as an important measure in the treatment of this terrific malady; and although brought forward in a late publication, was, we believe, first proposed by Dr. James Johnson, from observing its effects in one or two sporadic cases of cholera in the Isl- and of Ceylon, more than twenty years ago. Eu. See Report of the Epidemic cholera, &c. by William Scott, Burgeon, &c. 4tQ. Madras, IS'ii DIARRHOEA, OR LOOSENESS. 227 en, and repeated tv/o or three times,, if the looseness continues; castor oil, purging salts, or the subjoined draught.* The patient ought to live on light vegetable food of easy digestion, and to drink whey, thin gruel, or barley-water. A looseness occasioned by the obstruction of any customary evacuations generally requires bleeding. If that does not succeed, other evacuations may be substituted in the room of those which are obstructed. At the same time, every method is to be taken to restore the usual discharges, as not only the cure of the disease, but the patient's life, may depend on this. - A periodical looseness ought never to be stopped. It is always an effort of Nature to carry off some offending matter, which if retained in the body, might have fatal effects. Children are very liable to this kind of looseness, especially while teething. It is, however, so far from being hurtful to them, that such children gen- erally get their teeth with least trouble. If these loose stools should at any time prove sour or griping, a teaspoonful of magnesia alba, with four or five grains of rhubarb, may be given to the child in a lit- tle panada, or any other food, or the mixture advised below.t This, if repeated three or four times, will generally correct the acidity, and carry off the griping stools. The chalk mixture in the annex- ed forms may be administered in doses of two or three spoonsful after each evacuation, to suspend the inordinate action of the in- testinal canal ;\ or a tea-spoonful of fine powdered chalk may be mixed in a teacupful of water-gruel, and given occasionally. A diarrhoea, or looseness, which proceeds from violent passions or affections of the mind, must be treated with the greatest caution. Vomits in this case are highly improper; nor are purges safe, unless they be very mild, and given in small quantities. Opiates, and other antispasmodic medicines, are most proper. Ten or twelve drops of liquid laudanum may be taken in a cup of valerian or penny-royal tea, every eight or ten hours, till the symptoms abate. Ease, cheerfulness, and tranquillity of mind are here of the greatest importance. »Take Carbonate of Magnesia, 1 scr. Tincture of Catechu, I oz. Aromatic Confection, 4 drm. CBalk Mixture, 6 oz. Powdered Rhubarb, 15 grs. Syrup of Ginger, £ oz. Svrup of Ginger, 1 drm. Tincture of Opium 30 drps. Mint Water 14 oz. Make a mixture ; of which, let two table- Make an aperient antacid draught. spoonsful be taken after each liquid - v „ stool, previously shaking the bottle- Take Magnesia 2 scrs. or Powdered Rhubarb, 8 grs. Take Compound Powder of Chalk with Compound Powder of Cinnamon Opium, 1 scr. 10 grs. Extract of Catechu, 15 grs. Make a powder, to be taken morning and Make a powde>; to be taken after eack evening. Yl1aid st°o1- t Take Powdered Rhubarb, 15 grs. Take Compound Powder of Chalk, Carbonate of Magnesia, 4 drm. 64 oz. Dill Water, 2 oz. Opium in Powder, *■ sera. Aromatic Spirit of Ammonia, Dose, 1 to 2 scruples. 20 drps. or Tincture of Opium, 10 drps. Take Extract of Logwood, l* arm \ Take Aromatic Confection, 1 drm. 228 VOMITING. When a looseness proceeds from acrid or poisonous substances taken into the stomach, the patient must drink large quantities of diluting liquors, with oil or fat broths, to promote vomiting and purging. Afterwards, if there be reason to suspect that the bowels are inflamed, bleeding will be necessary. Small doses of laudanum may likewise be taken to remove their irritation. When the gout, repelled from the extremities, occasions a loose- ness, it ought to be promoted by gentle doses of rhubarb, or other mild purgatives. The gouty matter is likewise to be solicited towards the extremities by warm fomentations, cataplasms, &c. The perspiration ought at the same time to be promoted by warm diluting liquors; as wine-whey with spirits of hartshorn, or a few drops of liquid laudanum in it. When a looseness proceeds from worms, which may be known from the sliminess of the stools, mixed with pieces of decayed worms, &c, medicines must be given to kill and carry off these vermin, as the powder of tin, with purges of rhubarb and calomel. Afterwards lime-water, either alone, or with a small quantity of rhubarb infused, will be proper to strengthen the bowels, and pre- vent the new generation of worms. A looseness is often occasioned by drinking bad water. When this is the case, the disease generally proves epidemical. When there is reason to believe that this or any other disease proceeds from the use of unwholesome water, it ought immediately to be changed, or if that cannot be done, it may be corrected by mixing with it quick lime, chalk, or the like. In people whose stomachs are weak, violent exercise immediately after eating will occasion a looseness. Though the cure of this is obvious, yet it will be proper, besides avoiding violent exercise, to use such medicines as tend to brace and strengthen the stomach, as infusions of the bark, with other bitter and astringent ingredients, in white-wine. Such persons ought likewise to take frequently a glass or two of old red port, or good claret. From whatever cause a looseness proceeds, when it is found necessary to check it the diet ought to consist of rice boiled with milk, and flavoured with cinnamon; rice-jelly, sago with red port, and the lighter sorts of flesh-meat roasted. The drink may be thin water-gruel, rice-water, or weak broth made from lean veal, or with a sheep's head, as being more gelatinous than mutton, beef, 6r chicken-broth. Persons who, from a peculiar weakness, or too great an irrita- bility of the bowels, are liable to frequent returns of this disease, should live temperately, avoiding crude summer fruits, all unwhole- some foods, and meats of hard digestion. They ought likewise to beware of cold, moisture, or whatever may obstruct the perspira- tion, and should wear flannel next the skin. All violent passions, as few, anger, &c. are likewise carefully to be guarded against. Vomiting. Vomiting may proceed from various causes; as excess in eating and drinking; foulness of the stomach; the acrimony of the ali- ments ; a translation of the morbific matter of ulcers, of the gout, VOMITING. 229 the erysipelas, or other diseases, to the stomach. It may likewise proceed from a looseness having been too suddenly stopped; from the stoppage of any customary evacuations, as the bleeding piles, the menses, Sec. from a weakness of the stomach, the colic, the iliac passion, a rupture, a fit of the gravel, worms, or from any kind of poison taken into the stomach. It is an usual symptom of injuries done to the brain; as contusions, compressions, &c. It is likewise a symptom of wounds or inflammations of the dia- phragm, intestines, spleen, liver, kidneys, Sec. Vomiting may be occasioned by unusual motions, as falling, being: drawn back in a carriage, &c. It may likewise be excited by violent passions, or by the idea of nauseous or disagreeable objects, especially of such things as have formerly produced vom- iting. Sometimes it proceeds from a regurgitation of the bile into the stomach: in this case, what the patient vomits is generally of a yellow or greenish colour, and has a bitter taste. Persons who are subject to nervous affections are often suddenly seized with violent fits of vomiting. Lastly, vomiting is a common symptom of nreenancy. In this case it generally comes on about two weeks after the stoppage of the menses, and continues during the first three or four months. . When vomiting proceeds from a foul stomach or indigestion, it is not to be considered as a disease, but as the cure of a disease. It ought, therefore, to be promoted, by drinking lukewarm water, or thin jmiel. If this does not put a stop to the vomiting, a dose of ipecacuanha may be taken, and worked off with weak camomile ^When the retrocession of the gout, or the obstruction of custom- ary evacuations occasion vomiting, all means must be used to restore these discharges; or, if that cannot be effected their place must be supplied by others, as bleeding, purging, bathing the extremities in warm water, opening issues, setons, perpetual blis- teWhtn' vomiting is the effect of pregnancy, it may generally be mitigated by bleeding, and keeping the body gently open, lhe bleeding, however, ought to be in small quantities at a time, and the purgatives should be of the mildest kind, as figs, stewed prunes manPna,°or senna. Pregnant women are most: apt: to.vomit in he morning immediately after getting out orbed, which is ow ng oartlv to the change of posture, but more to the emptiness ot tne stomacl, It mayGenerally be prevented, by taking a dish of coffee tea or soml light breakfast, in bed. Pregnant women, "ho are afflicted with vomiting, ought to be kept easy both in body and mind. They should neither allow their stomachs to be quite empty nor should they eat much at once. Cold water is a very propel drink in this case; if the stomach be weak a lmto brandy may be added to it. If the spirits be low and the, p^ apt to faint, a spoonful of cinnamon-water, with a little marmalade of quinces or oranges, may be taken. u;tr«rs will "^SSas wD. keep ^.^X^T^ dicine in this case. Sulphuuc acia is tus« e m me 230 DIABETES, Sec. It may be taken in the dose of fifteen or twenty drops, twice or thrice a-day, in a glass of wine or water. Habitual vomitings are sometimes alleviated by making oysters a principal part of diet. A vomiting which proceeds from acidities in the stomach, is re- lieved by alkaline purges. The best medicine of this kind is the magnesia alba,, a teaspoonful of which may be taken in a dish of tea, or a little milk, three or four times a-day, or oftener if neces- sary, to keep the body open, or any of the cretaceous mixtures recommended in diarrhoea. When vomiting proceeds from violent passions, or affections of the mind, all evacuants must be carefully avoided, especially vomits. These are exceedingly dangerous. The patient in this case ought to be kept perfectly easy and quiet, to have the mind soothed, and to take some gentle cordial, as negus, or a little brandy and water, to which a few drops of laudanum may occasionally be added. When vomiting proceeds from spasmodic affections of the stom- ach, musk, castor, and other antispasmodic medicines are of use. Warm and aromatic plasters have likewise a good effect. Aro- matic medicines may likewise be taken inwardly, as cinnamon or mint-tea, wine with spiceries boiled in it, &c. The region of the stomach may be rubbed with aether, or if that cannot be had, with strong brandy, or other spirits. The belly should be fomented with warm water, or the patient immersed up to the breast in a warm bath. I have always found the saline draughts, taken in the act of ef- fervescence, of singular use in stopping a vomiting, from what- ever cause it proceeded. These may be prepared by dissolving a drachm of the subcarbonate of potash," in an ounce and a half of fresh lemon-juice, and adding to it an ounce of peppermint-water, the same quantity of simple cinnamon-water, and a little white sugar. This draught must be swallowed before the effervescence is quite over, and may be repeated every two hours, or oftener, if the vomiting be violent. A violent vomiting has sometimes been stopped by cupping on the region of the stomach, after all other means had failed. As the least motion will often bring on the vomiting again, even after it has been stopped, the patient must avoid all manner of ac- tion. The diet must be so regulated as to sit easy upon the stom- ach, and nothing should be taken that is hard of digestion. We do not, however, mean that the patient should live entirely upon slops. Solid food, in this case, often sits easier on the stomach than liquids. CHAP. XXIV. DIABETES, AND OTHER DISORDERS OF THE URIN- ARY ORGANS. The diabetes is a frequent and excessive discharge of urine. It is seldom to be met with among young people: but often attacks persons in the decline of life, especially those who follow the more violent employments, or have been hard drinkers in their youth. DIABETES, Sec. 231 Causes.—A diabetes is often the consequence of acute diseases, as fevers, fluxes, Sec, where the patient has suffered by excessive evacuations ; it may also be occasioned by great fatigue, as riding long journies upon a hard-trotting horse, carrying heavy burdens, running, Sec. It may be brought on by hard drinking, or the use of strong stimulating diuretic medicines, as tincture of cantharides, spirits of turpentine, and such like. It is often the effect of drink- ing too great quantities of mineral waters. Many imagine that these will do them no service unless they be drank in great quan- tities, by which mistake it often happens that they occasion worse diseases than those they were intended to cure. In a word, this dis- ease may either proceed from too great a laxity of the organs which secrete the urine, from something that stimulates the kidneys too much, or from a thin dissolved state of the blood, which makes too great a quantity of it run off by the urinary passages. Symptoms.—In a diabetes, the urine generally exceeds in quan- tity all the liquid food which the patient takes. It is thin and pale, of a sweetish taste, and an agreeable smell. The patient has a continual thirst, with some degree of fever; his mouth is dry, and he spits frequently a frothy spittle. The strength fails, the appetite decays, and the flesh wastes away till the patient is reduc- ed to skin and bone. There is a heat of the bowels ; and fre- quently the loins, testicles, and feet, are swelled. It has been remarked, that diabetes is often preceded or accom- panied with an affection of the lungs; and Dr. Bardsley informs us that he does not recollect an instance of the disease which was not attended with some affection of the chest. This disease may generally be cured at the beginning : but after it has continued long, the cure becomes very diflicult. In drunk- ards, and very old people, a perfect cure is not to be expected. Regimen.—Every thing that stimulates the urinary passages, or tends to relax the habit, must be avoided. For this reason, the patient should live chiefly on solid food. His thirst may be quench- ed with acids ; as sorrel, juice of lemon, or vinegar. The mucil- aginous vegetables, as rice, sago, and salop, with milk, are the most proper food. Of animal substances, shell-fish are to be pre- ferred ; as oysters, crabs, Sec. . The Bristol Hot-well waters, when drank at the fountain head, have long been celebrated for their good effects in this disease. When that cannot be obtained, lime-water, in which a due propor- tion of oak-bark has been macerated, may be used. The patient ought daily to take exercise, but it should be so gen- tle as not to fatigue him. He should lie upon a hard bed or mat- tress. Nothing hurts the kidneys more than lying too soft. A warm dry air, the use of the flesh-brush, and every thing that pro- motes perspiration, is of service. For this reason, the patient ought to wear flannel next his skin. A large strengthening-plae- termay be applied to the back; or, what will answer better, a great part of the body maybe wrapped in plaster. MEDiciNE.-Gentle purges, if the patient be not too much weak- ened by the disease, have a good effect. They may consist of 232 DIABETES, Sec. rhubarb, with cardainom-seeds, or any other spieeries, infused in wine, and may be taken in such quantities as to keep the body gen- tly open. The patient must next have recourse to astringents and corrobo- rants. Half a drachm of powder made of equal parts of alum and the inspissated juice, commonly called Terra Japonica, may be taken four times a-day, or oftener, if the stomach will bear it. The alum must first be melted in a crucible ; afterwards they may both be pounded together. Along with every dose of this powder, the patient may take a tea-cupful of the tincture of roses.* If the patient's stomach cannot bear the alum in substance, whey may be made of it, and taken in the dose of a tea-cupful three or four times a-day. The alum-whey is prepared by boiling two English quarts of milk over a slow fire, with three drachms of alum, till the curd separates. Opiates are of service in this disease, even though the patient rests well. They take off spasm and irritation, and at the same time lessen the force of the circulation. Ten or twelve drops of liquid laudanum may be taken in a cup of the patient's drink three or four times a-day. The best corroborants which we know, are the Peruvian bark and wine. A drachm of bark may be taken in a glass of red port or claret three times a-day. The medicine will be both more effi- cacious and less disagreeable, if fifteen or twenty drops of the acid elixir of vitriol be added to each dose. Such as cannot take the bark in substance, may use the decoction, mixed with an equal quantity of red wine, and sharpened as above. There is a disease incident to labouring people in the decline of life, called an INCONTINENCYof Urine. But this is very differ- ent from a diabetes, as the water passes off involuntarily by drops, and does not exceed the usual quantity. This disease is rather troublesome than dangerous. It is owing to a relaxation of the sphincter of the bladder, and is often the effect of a palsy. Some- times it proceeds from hurts, or injuries occasioned by blows, bruises, preternatural labours, &c. Sometimes it is the effect of a fever. It may likewise be occasioned by a long use of strong diu- retics, or of stimulating medicines injected into the bladder. This disease may be mitigated by the use of astringent and corroborating medicines, such as have been mentioned above; but we do not remember ever to have seen it cured.t * See Appendix, Tincture of Roses. 1 Dr. Ferriar informs us that he has cured three confirmed cases of this disease by a combination of cinchona, uva ursi, and opium, taken three times a-day, in the propor- tion of a scruple of each of the former to half a grain of the latter; and that, from the great success he had met with from this medicine, he found it unnecessary to try Dr. Rollo's plan, which is said to have performed a cure under very unpromising circum- stances. The indications to be attended to, Dr. Rollo supposes to be, to destroy the saccha- rine process going on in the stomach ; to promote a healthy assimilation ; to prevent a supposed increased absorption by the surface; to diminish the increased action; and to change the imagined derangement of the kidneys. To answer these indications, Dr. Rollo enjoins a diet consisting wholly of animal food, rigid abstinence from every kind of vegetable substance from which sugar may be produced. I " | &m< t Take Spermaceti Ointment, 2 «i. Mix for an ointment, 244 SPITTING Ol1 LiL'>OD. third finely powdered galls, and two-thirds hog's lard, is very useful. When the piles are seated high, relief may frequently be obtained from the injection of lime-water, or of an infusion of galls. The pain of the piles is very often removed by an emetic, or by taking twice a-day thirty drops of balsam of copaiva on a little moist sugar. When a pile has a narrow neck, it is best extirpated by the knife. If the pile be large, or has a broad basis, a double ligature may be passed through it, and tied on each side. When piles are neglected, they are very apt to produce a fistula. This complaint is discovered by a stain of matter on the linen, which, on examination, will be found to proceed from a small ori- fice in the neighbourhood of the anus. Various local remedies are recommended for this complaint. The utility of all of them de- pends on their power of stimulating the sides of the ulcer into more active inflammation, so as to make them cohere together. On this principle, I think I have seen advantage from taking a wine-glass of sea-water every night for a month or six weeks. Irritating injections have been used, with similar intentions, and have some- times, when duly persisted in, succeeded. The only certain radical cure for a fistula is a surgical operation, the object of which is to reduce the ulcer to the state of a simple wound, and as such to heal it. This should never be too long neglected. The disease gradually diffuses itself in various direc- tions through the cellular substance surrounding the rectum ; and new openings are formed, which render the complaint more diffi- cult to be removed. There are two ways of performing the operation. One is by passing a silk thread, or piece of flexible gold wire in at the exter- nal orifice of the fistula, and bringing it out at the anus, and then twisting the ends together, which is daily repeated till it cuts its way out. By some timid people this mode of cure is preferred to the knife: and, though kept a secret by some pretenders to medi- cal knowledge, it is as old as the history of surgery. The incision, however, is the more certain and effectual mode of eradicating the disease; and if suffering is to be estimated by duration, the°lc$s painful also. Spitting of Blood. (Hemoptysis.) We mean here to treat of that discharge of blood from the lung* only which is called an hamoptoe, or spitting of blood. Persons of a slender make, and a lax fibre, who have long necks and strait breasts, are most liable to this disease. It is most common in the spring, and generally attacks people before they arrive at the prime or middle period of life. It is a common observation that those who have been subject to bleeding at the nose when youn * W VOMITING OF BLOOD. 247 If stronger astringents be necessary, fifteen or twenty drops of sulphuric acid may be given in a glass of water, three or four times a-day These who are subject to frequent returns of this disease should avoid all excess. Their diet should be light and cool, consisting chiefly of milk and vegetables. Above all, let them beware of vig- orous efforts of the body, and violent agitations of the mind.* Vomiting of Blood. (Hamatemesis.) This is not so common as the other discharges of blood which have already been mentioned ; but it is very dangerous, and re- quires particular attention. Vomiting of blood is generally preceded by pain of the stomach, sickness, and nausea ; and is accompanied with great anxiety, and frequent fainting fits. This disease is sometimes periodical; in which case it is less dangerous. It often proceeds from an obstruction of the menses in women, and sometimes from the stoppage of the hemorrhoidal flux in men. It may be occasioned by any thing that greatly stim- ulates or wounds the stomach, as strong vomits or purges, acrid poison, sharp or hard substances taken into the stomr.ch, &c. It is often the effect of obstructions in the liver, the spleen, or some of the other viscera. It may likewise proceed from external vio- lence, as blows or bruises, or from any of the causes which pro- duce inflammation. In hysteric women, vomiting of blood is a very common, but by no means a dangerous symptom. A great part of the danger in this disease arises from the extrav- asated blood lodging in the bowels, and becoming putrid, by which means a dysentery or putrid fever may be occasioned. The best way of preventing this, is to keep the body gently open, by fre- quently exhibiting emollient clysters. Purges must not be given till the discharge is stopped, otherwise they will irritate the stom- ach, and increase the disorder. All the food and drink must be of a mild cooling nature, and taken in small quantities. Even drink- ing cold water has sometimes proved a remedy, but it will succeed better when sharpened with the weak spirits of vitriol. When there are signs of an inflammation, bleeding may be necessary; but the patient's weakness will seldom permit it. Opiates may be • Dr Rush of Philadelphia has published some interesting facts concerning the utility of common sa,^ in curing hemorrhage from the lungs. As this remedy may be ob- UinedTvery where without difficulty, its effects ought to be made generally known. The following art the Doctor's own words. "The mode of eivin^ it, is to pour down from a tea to a table-spoonful of clean fine .alt 1 .00 «.p£.!bre after thS hemorrhage begins from «h. lungs. This quantity generally stops it: but the dose must be repeated daily for three or four days, to pre- vent a return of the disorder. If the bleeding continues, the salt must be continued- till it is checked, but in larger doses. I have heard of several instances in which two table-spoonsful were taken at one time for several days. ____ « It sometime, excites a sickness at the stomach and never fails to produce a burn- ing sensation in the throat in its passage into the stomach, and considerable thirst ^< «r c\ ■ 7T~, DYSENTERY, OR BLOODY FLUX. 249 it is commonly the symptom of some malignant disease; as the small-pox, a putrid fever, or the like. In this case the patient's life depends on the liberal use of the Peruvian bark, wine, and acids, as has already been shown.* When there is reason to suspect an ulcer in the kidneys or blad- der, the patient's diet must be cool, and his drink of a demulcent, healing, balsamic quality, as decoctions of marsh-mallow roots with liquorice, solutions of gum-arabic, &c. Three ounces of marsh-mallow roots, and half an ounce of liquorice, may be boiled in two English quarts of water to one; two ounces of gum-arabic, and half an ounce of purified nitre, may be dissolved in the strained liquor, and a tea-cupful of it taken four or five times a-day. The early use of astringents in this disease has often bad conse- quences. When the flux is stopped too soon, the grumous blood, by being confined in the vessels, may produce inflammations, abscess, and ulcers. If, however, the case be urgent, or the patient 6eems to suffer from the loss of blood, gentle astringents may be necessary. In this case the patient may take three or four ounces of lime-water, with half an ounce of the tincture of Peruvian bark, three times a-day; or he may take an ounce or two of the conserve of roses three or four times a-day, drinking a tea-cupful of the tincture of roses after it; or, if stronger styptics be necessary, a dram of Armenian bole in a cup of whey may be taken three or four times a-day, or the annexed.t Dysentery, or Bloody Flux. (Dysenteria.) This disease prevails in the spring and autumn. It is most common in marshy counties, where, after hot and dry summers, it is apt to become epidemic. Persons are most liable to it who are much exposed to the night air, or who live in places where the air is confined and unwholesome. Hence it often proves fatal in camps, on shipboard, in jails, hospitals, and such like places. Causes.—The dysentery may be occasioned by any thing that obstructs the perspiration, or renders the humours putrid; as damp' beds, wet clothes, unwholesome diet, bad air, &c. But it is most frequently communicated by infection. This ought to make people extremely cautious in going near such persons as labour under the disease. Even the smell of the patient's excrements has been known to communicate the infection. Symptoms.—It is known by a flux of the belly, attended by vio- lent pain of the bowels, tenesmus, or a constant inclination to go to stool, and generally more or less blood in the stools. It begins, like other fevers, with chilness, loss of strength, a quick pulse, great thirst, and an inclination to vomit. The stools are at first • Take Confection of Red Roses, 1 oz. Make a mixture; to be taken three time* Infusion of Roses, Warm, 1 pint. a-day. Macerate for half an hour, and strain. or t Take Purified Alum, £ scr. Taki of this Strained Liquor, 13 drs. Kino in Powder, 6 gM. Diluted Sulphuric Acid, 10 drps. Make a powder; to be taken three tira*a a-day. L2 250 DYSENTERY, OR BLOODY FLUX. greasy and frothy, afterwards they are streaked with blood, and at last have frequently the appearance of pure blood, mixed with small filaments resembling bits of skin. Worms are sometimes passed both upwards and downwards, through the whole course of the disease. When the patient goes to stool, he feels a bearing down, as if the whole bowels were falling out, and sometimes a part of the intestine is actually protruded, which proves exceeding- ly troublesome, especially in children. Flatulency is likewise a troublesome symptom, especially towards the end of the disease. This disease may be distinguished from a diarrluea, or looseness, by the acute pain of the bowels, and the blood which generally appears in the stools. It may be distinguished from the cholera mor- bus by its not being attended with such violent and frequent fits of vomiting, Sec. When the dysentery attacks the old, the delicate, or such as have been wasted by the gout, the scurvy, or other lingering dis- eases, it generally proves fatal. Vomiting and hiccuping are bad signs, as they show an inflammation of the stomach. When the stools are green, black, or have an exceedingly disagreeable cadav- erous smell, the danger is very great, as it shows the disease to be of the putrid kind. It is an unfavourable symptom when clysters are immediately returned; but still more so when the passage is so obstinately shut that they cannot be injected. A feeble pulse, coldness of the extremities, with difficulty of swallowing, and con- vulsions, are signs of approaching death. Regimen.—Nothing is of more importance in this disease than cleanliness. It contributes greatly to the recovery of the patient, and no less to the safety of such as attend him. In all contagious diseases the danger is increased, and the infection spread, by the neglect of cleanliness, but in no one more than in this. Every thing about the patient should be frequently changed. The excre- ments should never be suffered to continue in his chamber, but removed immediately, and buried under ground. A constant ptream of fresh air should be admitted into the chamber, and it ought frequently to be sprinkled with vinegar, juice of lemon, or some other strong acids. The patient must not be discouraged, but his spirits kept up in hopes of a cure. Nothing tends more to render any putrid disease mortal than the fears and apprehensions of the sick. All diseases of this nature have a tendency to sink and depress the spirits, and when that is increased by fears and alarms from those whom the patient believes to be persons of skill, it cannot fail to have the worst effect. A flannel waistcoat worn next the skin has often a very good effect in the dysentery. This promotes the perspiration, without overheating the body. Great caution, however, is necessary, in leaving it off. I have often known a dysentery brought on by im- prudently throwing off a flannel waistcoat before the season was sufficiently warm. For whatever purpose this piece of dress it worn, it should never be left off but in a warm season. In this disease the greatest attention must be paid to the patient's diet; flesh, fish, and every thing that has a tendency to turn putrid DYSENTERY, OR BLOODY FLUX. 251 or rancid on the stomach, must be abstained from. Apples boiled in milk, water-pap, and plain light pudding, with broth made of the gelatinous parts of animals, may constitute the principal part of the patient's food. Gelatinous broth not only answers the pur- pose of food, but likewise a medicine. I have often known dysen- teries, which were not of a putrid nature, cured by it, after pom- pous medicines had proved ineffectual.* Another kind of food very proper in the dysentery, which may be used by such as cannot take the broth mentioned above, is made • by boiling a few handsful of fine flour, tied in a cloth, for six or seven hours, till it becomes as hard as starch. Two or three table- spoonsful of this may be grated down, and boiled in such a quantity of new milk and water as to be of the thickness of pap. This may be sweetened to the patient's taste, and taken for his ordinary food.t " «. , r In a putrid dysentery the patient may be allowed to eat freely of most kinds of good ripe fruit: as apples, grapes, gooseberries, cur- rant-berries, strawberries, «&c. These may either be eaten raw or boiled, with or without milk, as the patient chooses. The preju- dice against fruit in this disease is so great, that many believe it to be the common cause of dysenteries. This, however, is an egre- gious mistake. Both reason and experience show, that good fruit is one of the best medicines, both for the prevention and cure of the dysentery. Good fruit is in every respect calculated to coun- teract that tendency to putrefaction, from whence the most danger- ous kind of dysentery proceeds. The patient in such a case ought, therefore, to be allowed to eat as much fruit as he pleases, provid- ed it be ripe.J * The manner of making this broth is. to take a sneep s head and feet, with theskm upon them, and to burn the wool off with a hot iron ; afterwards to boil them till the broth is quite a jelly. A little cinnamon or mace may be added, to give the broth an agreeable flavour, and the patient may take a little of it warm, with toasted bread three or four times a-day. A clyster of it may likewise be given twice a-day. huch as cannot use broth made in this way, may have the head and feet skinned; but we have reason to believe that this injures the medicine It is not our business here to reason upon the nature and qualities of medicine, otherwise this might bi shown to possess virtues every way suited to the cure of a dysentery which.doe.not proceed from a putrid state of the humours. One thing we know, which is preferable to all reasoning, that whole families have often been cured by .after they had_ uae.l many other medicines in vain. It will however, be proper that^the patien take a vomit, and a dose or two of rhubarb, before he-begins to use the broth I: will like- wUe be necessary to continue the use of it for a considerable time, and to make it th« TTfiSn'ed and humane Dr. Rutherford, late professor of medicine in the univer- sal of Edinburgh^ used to mention this food in his public lectures with ^encomi- um. He directed it to be made by tying a pound or two of the finest flour as tight as Possible in a linen rag, afterwards to dip it frequently in water, and to dndge the ouSwUh flour till a fake or crust was formed around it, which prevents the water ftom soaking into it while boiling. It is then to be boiled till it becomes a hard dry mass, as d,>egcted above. This, when mixed with milk and water, will not only answer the purpose of food, but may likewise be given in clysters ,». »m«.;r« 11 lately saw a young man who had been seized with a dysentery in North America. Many things had been tried there for his relief but to no purpose. At length tired out with disappointments from medicine, and reduced to skin and bone I.came over to Britain, rather with a view to die among his relations, than W1* ^L^^V^ « After taking sundry medicines here with no better success than abroad I ^'»«d »»« u> leave off the use of drugs, and to trust entirely to a diet of milk «*£»»■»_*>™ £ntle Lercise Strawberries was the only fruit he could procure at that season. C he ate with mUk twice, and sometimes thrice a-day The consequence was, Jbaiiu a short time W. stools were reduced from upwards of twenty in a-day, to tf.r« 052 DYSENTERY, OR BLOODY FLUX The most proper drink in this disorder is whey. The dysentery has often been cured by the use of clear whey alone. It may be taken both for drink, and in form of clyster. When whey cannot be had, barley-water sharpened with cream of tartar may be drank, or a decoction of barley and tamarinds; two ounces of the former and one of the latter may be boiled in two English quarts of water to one. Warm water, water-gruel, or water wherein hot iron has been frequently quenched, are all very proper, and may* be drank ' in turns. Camomile-tea, if the stomach will bear it, is an exceed- ingly proper drink. It both strengthens the stomach, and by its antiseptic quality tends to prevent a mortification of the bowels. Medicine.—At the beginning of this disease it is always neces- sary to cleanse the first passages. For this purpose an emetic ipecacuanha must be given, and wrought off with weak ->momile tea. Strong vomits are seldom necessary here. A scrupie, or at most half a drachm of ipecacuanha, is generally sufficient for an adult, and sometimes a very few grains will suffice. The day after the vomit, half a drachm or two scruples of rhubarb must be taken; or, what will answer the purpose rather belter, an ounce, or an ounce and a half, of Epsom salts.* This dose may be repeated every other day for two or three times. Afterwards small doses of ipecacuanha may be taken for some time. Two or three grains of the powder may be mixed in a table-spoonful of the syrup of poppies, and taken three times a-day. Should the medicines here prescribed not procure copious stools, stronger purgatives must then be employed.t Some practition- ers are in the habit of combining emetic and purgative medicines; such as some of the mild neutral salts with tartarized, and often with very good effect.f These evacuations, and the regimen prescribed above, will often be sufficient to effect a cure. Should it, however, happen otherwise, the following astringent medicines may be used :— A clyster of starch or fat mutton-broth, with thirty or forty drops of liquid laudanum in it, may be administered twice a-day. At the same time an ounce of gum-arabic, and half an ounce of gum- tragacanth, may be dissolved in an English pint of barley-water, over a slow fire, and a table spoonful of it taken every hour. If these have not the desired effect, the patient may take, foui times a-day, about the bulk of a nutmeg of the extract of catechu, drinking after it a tea-cupful of the decoction of logwood. or four, and sometimes not so many. He used the other fruits as they came in, and was in a few weeks so well as to leave that part of the country where I was, with a Tiew to return to America. »Take Epsom Salts, 1 oz. Jalap, 1 §c,. Manna, £ oz. Syrup of Buckthorn, enough to form lbs Warm Water, mass into five pills for a dose. Peppermint Water, rv r °fufach' , , H °z- t Take Infusion of Senna, ft oa. Dose, four table-spoonsful occasionally. Tartrite of Potash, 1 uz. -, „ , .... .or „ , Tartarized Antimony, 2 grs. I ahe Castor Oil, 1 oz. for a dose. Make a mixture, of which take four table- ♦ T.v„c u /.», « spoonsful every three hours, until th« r t a*e Submuriate of Murcury, 3 grs. bowels are sufficiently moved. DYSENTERY, OR BLOODY FLUX. 253 The astringents best adapted for the cure of a dysentery are the different preparations of catechu, gum kino, logwood, &c, which may be given as below,* the patient at the same time taking port wine properly diluted with water for his ordinary drink. Lime- water mixed with an equal quantity of milk has been recommend- ed as a useful remedy towards the latter end of the disease. In the advanced and chronic state of the disease, at which time acidity of the stomach is apt to prevail, absorbents, as the chalk mixture, compound powder of chalk, lime-water, &c. conjoined with opiates, will be serviceable." Persons who have been cured of this disease are very liable to relapse ; to prevent which, great circumspection with respect to diet is necessary. The patient must abstain from all fermented liquors, except now and then a glass of good wine ; but he must drink no kind of malt liquor. He should likewise abstain from animal food, as fish and flesh, and live principally on milk and vegetables. Gentle exercise and wholesome air are likewise of importance. The patient should go to the country as soon as his strength will permit, and should take exercise daily on horseback, or in a car- riage. He may likewise use bitters infused in wine or brandy, and may drink twice a-day a gill of lime-water mixed with an equal quantity of new milk. When dysenteries prevail, we would recommend a strict atten- tion to cleanliness, a spare use of animal food, and the free use of sound ripe fruits, and other • vegetables. The night air is to be carefully avoided, and all communication with the sick. Bad smells are likewise to be shunned, especially those which arise from putrid* animal substances. The necessaries where the sick go are carefully to be avoided. There are various other fluxes of the belly, as the Lientery and Cozliac Passion, which, though less dangerous than the dysentery, yet merit consideration. These diseases generally proceed from a relaxed state of the stomach and intestines, which is sometimes so great, that the food passes through them with hardly any sensible alteration ; and the patient dies merely from the want of nourish- ment. When the lientery or coeliac passion succeeds to a dysentery, the case is bad. They are always dangerous in old age, especial- ly when the constitution has been broken by excess or acute dis- eases. If the stools be very frequent and quite crude, the thirst great, with little urine, the mouth ulcerated, and the face marked with spots of different colours, the danger is very great. The treatment of the patient is in general the same as in the * Take Extract of Logwood, 3 drs. Water, 7 oz. Spirit of Cinnamon, 1 oz. Tincture of Catechu, 2 drs. Mix, and give two table-spoonsful every four hours. or Take Extract of Logwood, 1 drm. Chalk Mixture, 4 oz. Tincture of Catechu, 2 drs Spirit of Nutmegs, 1 oz. Mix.—Dose, three table-spoonsful or more every hour. or Take Extract of Catechu, 15 grs. Pimenta Water, 1£ ox. iTinclure of Kino, 1 drm. -------of Opium, 10 drps. Make a draught to be taken every four hours. 254 HEAD-ACH. dysentery. In all obstinate fluxes of the belly, the cure must be attempted, by first cleansing the stomach and bowels with gentle vomits and purges; afterwards such a diet as has a tendency to heal and strengthen the bowels, with opiates and astringent medi- cines, will generally complete the cure. The same observation holds with respect to a Tenesmus, or fre- quent desire of going to stool. This disease resembles the dysen- tery so much, both in its symptoms and method of cure, that we think it needless to insist upon it. CHAP. XXVI. HEAD-ACH. (Cephalalgia.) Aches and pains proceed from very different causes, and may affect any part of the body; but we shall point out those only which occur most frequently, and are attended with the greatest danger. When the head-ach is slight, and affects a particular part of the head only, it is called cephalalgia; when the whole head is affect- ed, cephalaa; and when one side only, hemicrania. A fixed pain in the forehead, which may be covered with the end of the thumb, is called the clavis hystericus. There are also other distinctions. Sometimes the pain is inter- nal, sometimes external; sometimes it is an original disease, and at other times only symptomatic. When the head-ach proceeds from a hot bilious habit, the pain is very acute and throbbing, with a considerable heat of the part affected. When from a cold phlegmatic habit, the patient complains of a dull heavy pain, and has a sense of coldness in the part. This kind of head-ach it sometimes attended with a degree of stupidity or folly. Causes.—Whatever obstructs the free circulation of the blood through the vessels of the head, may occasion a head-ach. In persons of a full habit, who abound with blood, the head-ach often proceeds from the suppression of customary evacuations ; as bleed- ing at the nose, sweating of the feet, &c. It may likewise pro- ceed from any cause that determines a great flux of blood towards •the head ; as coldness of the extremities, or hanging down the head for a long time. Whatever prevents the return of the blood from the head, will likewise occasion a head-ach ; as looking long obliquely at any object, wearing any thing tight about the neck, a new hat, or the like. When a head-ach proceeds from the stoppage of a running at the nose, there is a heavy, obtuse, pressing pain in the fore-part of the head, in which there seems to be such a weight, that the pa- tient can scarcely hold it up. When it is occasioned by the caus- tic matter of the venereal disease, it generally affects the skull, and often produces a caries of the bones. Sometimes the head-ach proceeds from the repulsion or retro- cession of the gout, the erysipelas, the small-pox, measles, itch, or HEAD-ACH. 255 other eruptive diseases. What is called a hemicrania generally proceeds from crudities or indigestion. Inanition, or emptiness. will also occasion head-achs. I have often seen instances of this in nurses who gave suck too long, or who did not take a sufficient quantity of solid food. There is likewise a most violent, fixed, constant, and almost in- tolerable head-ach, which occasions great debility both of body and mind, prevents sleep, destroys the appetite, causes a vertigo, dim- ness of sight, a noise in the ears, convulsions, epileptic fits, and sometimes vomiting, costiveness, coldness of the extremities, &.c. The head-ach is often symptomatic in continual and intermitting fevers, especially quartans. It is likewise a very common symp- tom in hysteric and hypochondriac complaints. When a head-ach attends an acute fever, with pale urine, it is an unfavourable symptom. In excessive head-achs, coldness of the extremities is a bad sign. When the disease continues long, and is very violent, it often terminates in blindness, apoplexy, deafness, vertigo, odUsy, or epi- lepsy. In this disease the cool regimen in general is to be observed. The diet ought to consist of such emollient substances as will cor- rect the acrimony of the humours, and keep the body open ; as apples boiled in milk, spinnage, turnips, and such like. The drink ought to be diluting ; as barley-water, infusions of mild mu- cilaginous vegetables, decoctions of the sudorific woods, &c. The feet and legs ought to be kept warm, and frequently bathed in lukewarm water ; the head should be shaved, and bathed with wa- ter and vinegar. The patient ought, as much as possible, to keep in an erect posture, and not to lio with his head too low. When the head-ach is owing to excess of blood, or a hot bil- ious constitution, bleeding is necessary. The patient may be bled in the jugular vein, and the operation repeated if there be occa- sion. Cupping also, or the application of leeches to the temples, and behind the ears, will be of service; afterwards a blistering- plaster may be applied to the neck, behind the ears, or to any part of the head that is most affected. In some cases it will be proper to blister the whole head. In persons of a gross habit, issues, or perpetual blisters, will be of service. The body ought likewise to be kept open by gentle laxatives. But when the head-ach proceeds from a copious vitiated serum, stagnating in the membranes, either within or without the skull, with a dull, heavy, continual pain, which will neither yield to bleeding nor gentle laxatives, then more powerful purgatives are necessary, as pills made of aloes, resin of jalap, or the like. It will also be necessary in this case to blister the whole head, and to keep the back-part of the neck open for a considerable time by a perpetual blister. When the head-ach is occasioned by the stoppage of a running at the nose, the patient should frequently smell to a bottle of vola- tile salts ; he may likewise take snuff, or any thing that will irri- tate the nose, so as to promote a discharge from it ; as the herb mastich, ground ivy, &c. A hemicrania, especially a periodical one, is generally owing to 256 TOOTH-AC H. a foulness of the stomach, for which gentle vomits must be admin- istered, as also purges of rhubarb. After the bowels have been sufficiently cleared, chalybeate waters, and such bitters as strength- en the stomach, will be necessary. A periodical head-ach has been cured by wearing a piece of flannel over the forehead during the night. When the head-ach arises from a vitiated state of the humours, as in the scurvy and venereal disease, the patient, after proper evacuations, must drink freely of the decoction of woods, or the de- coction of sarsaparilla, with raisins and liquorice. These, if duly persisted in, will produce very happy effects. When a collection of matter is felt under the skin, it must be discharged by an incision, otherwise it will render the bone carious. When the head-ach is so intolerable as to endanger the patient's life, or is attended with continual watchiug and delirium, recourse must be had to opiates. These, after proper evacuations by clys- ters, or mild purgatives, may be applied both externally and in- ternally. The affected part may be rubbed with Bate's anodyne balsam, or a cloth dipped in it may be applied to the part. The patient may, at 'the same time, take twenty drops of the tincture of opium, in a cup of valerian or penny-royal tea, twice or thrice a-day. This is only to be done in case of extreme pain. Proper evacuations ought always to accompany and follow the use of opiates.* When the patient cannot bear the loss of blood, his feet ought frequently to be bathed in lukewarm water, and well rubbed with a coarse cloth. Cataplasms with mustard or horse-radish ought like- wise to be applied to them. This course is peculiarly necessary when the pain proceeds from a gouty humour affecting the head. When the head-ach is occasioned by great heat, hard labour, or violent exercise of any kind, it may be allayed by cooling medi- cines ; as the saline draughts with nitre, and the like. A little ffither, dropt into the palm of the hand, and applied to the forehead, will sometimes remove a violent head-ach. Of the Tooth-ach. (Odontalgia.) This disease is so well known, that it needs no description. It has great affinity with the rheumatism, and often succeeds pains of the shoulders and other parts of the body. It may proceed from obstructed perspiration, or any of the other causes of inflammation. I have often known the tooth-ach occa- sioned by neglecting some part of the usual coverings of the head, by sitting with the head bare near an open window, or exposing it to a draught of cold air. Food or drink taken either too hot or too cold, is very hurtful to the teeth. Great quantities of sugar, or other sweat-meats, are likewise hurtful. Nothing is more de- structive to the teeth than cracking nuts, or chewing any kind of hard substances. Picking the teeth with pins, needles, or any * When the pain is very violent, and does not yield to small doses of laudanum, the uantity may be increased. I have known a patient in extreme pain take three nun- red drops in twenty-four hours; but such doses ought only to be administered bv a person of skill. TOOTH-ACH. 257 thing that may h irt the enamel with which they are covered, does great mischief, as the tooth is sure to be spoiled whenever the air gets into it. Breeding women are very subject to the tooth-ach, especially during the first three or four months of pregnancy. The tooth-ach often proceeds from scorbutic humours affecting the gums. In this case the teeth are sometimes wasted, and fall out without any considerable degree of pain. The more immediate cause of the tooth-ach is a rotten or carious tooth. In order to relieve the tooth-ach, we must first endeavour to les- sen the flux of humours to the part affected. This may be done by mild purgatives, scarifying the gums, or applying leeches to them, and bathing the feet frequently with warm water. The per- spiration ought likewise to be promoted, by drinking freely of weak wine-whey, or other diluting liquors, with small doses of ni- tre. EmeJcs too have often an exceedingly good effect in the tooth-ach. It is seldom safe to administer opiates, or any kind of heating medicines, or even to draw a tooth, till proper evacuations have been premised ; and these alone will often effect the cure. If this fail, and the pain and inflammation still increase, a sup- puration may be expected, to promote which a toasted fig should be held between the gum and the cheek ; bags filled with boiled camomile flowers, flowers of elder, or the like, may be applied near the part affected, with as great a degree of warmth as the patient can bear, and renewed as they grow cool: the patient may likewise receive the steams of warm water into his mouth, through an inverted funnel, or by holding his head over the mouth of a porringer filled with warm water. Gargles are likewise of use to promote a discharge. Rob of elder dissolved in small beer makes a very proper gargle, or an infusion of sage or mulberry leaves. Such things as promote the discharge of saliva, or cause the pa- tient to spit, are generally of service. For this purpose, bitter, hot, or pungent vegetables may be chewed ; as gentian, calamus aromaticus, or pellitory of Spain. Allen recommends the root of yellow water flower-de-luce in this case. This root may either be rubbed upon the tooth, or a little of it chewed. Brookes says, he hardly ever knew it fail to cure the tooth-ach. It ought, however, to be used with caution. Many other herbs, roots, and seeds, are recommended for cur- ing the tooth-ach ; as the leaves or roots of millefoil or yarrow chewed, tobacco smoked or chewed, stavesacre, or the seeds of mustard chewed, &c. These bitter, hot, pungent things, by occa- sioning a greater flow of saliva, frequently give ease in the tooth-ach. Opiates often relieve the tooth-ach. For this purpose, a little cotton wet with laudanum may be held between the teeth ; or a piece of sticking-plaster, about the bigness of a shilling, with a bit of opium in the middle of it, of a size not to prevent the sticking of the other, may be laid on the temporal artery, where the pulsa- tion is most sensible. De la Motte affirms, that there are few cases wherein this will not give relief. If there be a hollow tooth, a small pill made of equal parts of camphor and opium, or a small piece of assafoetida, put into the hollow, is often beneficial. When this cannot be had, the hollow tooth may be filled with gum mas- tich, wax, lead, cork, or any substance that will keep in it, and keep out the external air. •>.-)3 EAR-AC II. Few applications give more relief in the tooth-ach than blister- ing-plasters. These may be applied between the shoulders ; but they have the best effect when put behind the ears, and made so large as to cover a great part of the lower jaw. Burning the nerve within the affected tooth with a hot iron, has frequently given ease ; but this operation ought to be performed with care. After all, when a tooth is carious, it is often impossible to re- move the pain without extracting it; and as a spoiled tooth never becomes sound again, it is prudent to draw it soon, lest it should affect the rest. Tooth-drawing, like bleeding, is very much prac- tised by mechanics, as well as persons of the medical profession. The operation, however, is not without danger, and ought always to be performed with care. A person unacquainted with the structure of the parts, will be in danger of hurting the jaw-bone, or of drawing a sound tooth instead of a rotten one. This, how- ever, may always be prevented by the operator striking upon the teeth with any piece of metal, as this never fails to excite the pain in the carious tooth. When the tooth-ach returns periodically, and the pain chiefly affects the gums, it may be cured by the bark. Some pretend to have found great benefit in the tooth-ach, from the application of an artificial magnet to the affected tooth. We shall not attempt to account for its mode of operation, but if it be found to answer, though only in particular cases, it certainly de- serves a trial, as it is attended with no expense, and cannot do any harm. Electricity has likewise been recommended, and particu- lar instruments have been invented for sending a shock through the affected tooth. Persons who have returns of the tooth-ach at certain seasons, as spring and autumn, might often prevent it by taking a purge at these times. Keeping the teeth clean has no doubt a tendency to prevent the tooth-ach. The best method of doing this is to wash them daily with salt and water, a decoction of the bark, or with cold water alone. All brushing and scraping of the teeth is dangerous, and, unless it be performed with great care, does mischief. Ear-ach. (Otalgia.) This disorder chiefly affects the membrane which lines the in- ner cavity of the ear, called the meatus auditorius. It is often so violent as to occasion great restlessness, anxiety, and even deliri- um. Sometimes epileptic fits, and other convulsive disorders, have been brought on by extreme pain in the ear. The ear-ach may proceed from any of the causes which pro- duce inflammation. It often proceeds from a sudden suppression of the perspiration, or from the head being exposed to cold when covered with sweat. It may also be occasioned by worms or other insects getting into the ear, or being bred there ; or from any hard body sticking in the ear. Sometimes it proceeds from the trans- lation of morbific matter to the ear. This often happens in the decline of malignant fevers, and occasions deafness, which is gen- erally reckoned a favourable symptom. PAIN OF THE STOMACH, Sec. 259 When the ear-ach proceeds from insects, or any hard body sticking in the ear, every method must be taken to remove them as soon as possible. The membranes may be relaxed by dropping into the ear oil of sweet almonds, or olive oil. Afterwards the pa- tient should be made to sneeze, by taking snuff, or some strong sternutatory. If this should not force out the body, it must be ex- tracted by art. I have seen insects, which had got into the ear, come out of their own accord upon pouring in oil. When the pain of the ear proceeds from inflammation, it must be treated like other topical inflammations, by a cooling regimen, and opening medicines. Bleeding at the beginning, either in the arm or jugular vein, or cupping in the neck, will be proper. The ear may likewise be fomented with steams of warm water ; or flannel bags filled with boiled mallows and camomile-flowers may be applied to it warm ; or bladders filled with warm milk and wa- ter. An exceedingly good method of fomenting the ear is to ap- ply it close to the mouth of z. jug filled with warm water, or a strong decoction of camomile-flowers. The patient's feet should be frequently bathed in lukewarm wa- ter, and he ought to take small doses of nitre and rhubarb, viz. a scruple of the former, and ten grains of the latter three times a- day. His drink may he whey, or decoction of barley and liquor- ice, with figs or raisins. The parts behind the ear ought frequent- ly to be rubbed with camphorated oil, or a little of the volatile lin- iment, and a few drops of the camphorated spirit of wine may be put into the ear with wool or cotton. A blister behind the ear, if applied early, will sometimes remove this complaint. When the inflammation cannot be discussed, a poultice of bread and milk, or roasted onions may be applied to the ear, and fre- quently renewed, till the abscess breaks, or can be opened. Af- terwards the humours may be diverted from the part by gentle laxatives, blisters, or issues ; but the discharge must not be sud- denly dried up by any external application. Ear-ach sometimes continues for some time without any appar- ent inflammation, and is then frequently removed by filling the ear with cotton or wool, moistened with tincture of opium or ether, or even with warm oil or water. Pain in the ear is also sometimes the consequence of a diseased tooth, in which case the ether should be applied to the cheek over the suspected tooth, or a grain of opium with a little camphor, or half a grain of the ex- tract of belladonna may be applied to the tooth itself. Pain op the Stomach, &c. (Gastrodynia.) This may proceed from various causes, as indigestion, wind, the acrimony of the bile ; sharp, acrid, or poisonous substances taken into the stomach, &c. It may likewise be occasioned by worms ; the stoppage of customary evacuations ; or from a trans- lation of gouty matter to the stomach, the bowels, Sec heart-burn, flatulency, and qther dyspeptic symptoms. Women in the decline of life are very liable to pains of the stom- ach and bowels, especially such as are afflicted with hysteric com- plaints. It is likewise very common to hypochondriac men of a 260 PAIN OF THE STOMACH, Sec. sedentary and luxurious life. In such persons it often proves so extremely obstinate as to baffle all the powers of medicine. When the pain of the stomach is most violent after eating, there is reason to suspect that it proceeds from some fault either in the digestion or the food. In this case the patient ought to change hia diet, till he finds what kind of food agrees best with his stomach, and should continue chiefly to use it. If a change of diet does not remove the complaint, the patient may take a gentle vomit, and afterwards a dose or two of rhubarb. He ought likewise to take an infusion of camomile-flowers, or some other stomachic bitter, either in wine or water. I have often known exercise remove this complaint, especially sailing, or a long journey on horseback, or in a carriage. When a pain of the stomach proceeds from flatulency, the pa- tient is constantly belching up wind, and feels an uneasy disten- tion of the stomach after meals. Tfiis is a most deplorable dis- ease, and is seldom thoroughly cured. In general, the patient ought to avoid all windy diet, and every thing that sours on the stomach, as greens, roots, Sec. This rule, however, admits of gome exceptions. There are many instances of persons very much troubled with wind, who have received great benefit from eating parched peas, though that grain is generally supposed to be of a windy nature.* This complaint may likewise be greatly relieved by labour, espe- cially digging, reaping, mowing, or any kind of active employment by which the bowels are alternately compressed and dilated. The most obstinate case of this kind I ever met with, was in a person of a sedentary occupation, whom I advised, after he had tried every kind of medicine in vain, to turn gardener ; which he did, and has ever since enjoyed good health. When a pain of the stomach is occasioned by the swallowing of acrid or poisonous substances, they must be discharged by vomit: this may be excited by butter, oils, or other soft things, which sheath and defend the stomach from the acrimony of its contents. When a pain of the stomach proceeds from a translation of gouty matter, warm cordials are necessary, as generous wines, French brandy, &c. Some have drank a whole bottle of brandy or rum in this case in a few hours, without being in the least in- toxicated, or even feeling the stomach warmed by it. It is impos- sible to ascertain the quantity necessary upon these occasions. This must be left to the feelings and discretion of the patient. The safer way however is, not to go too far. When there is an inclin- ation to vomit, it may be promoted by drinking an infusion of cam- omile-flowers, or carduus benedictus. If a pain of the stomach proceed from the stoppage of custom- ary evacuations, bleeding will be necessary, especially in sanguine and very full habits. It will likewise be of use to keep the body gently open by mild purgatives ; as rhubarb or senna. When this disease affects women in the decline of life, after the stoppage of the menses, making an issue in the leg or arm will be of peculiar service. * These are prepared by steeping or soaking peas in water, and afterwards drying them in a pot or kiln till thev burst. They may be used at pleasure. WORMS. 261 When the disease is occasioned by worms, they must be destroy- ed, or expelled, by such means as are recommended in the follow- ing section. When the stomach is greatly relaxed, and the digestion bad, which often occasion flatulencies, the elixir of vitriol will be of singular service. Fifteen or twenty drops of it may be taken in a glass of wine or water twice or thrice a-day. Persons afflicted with flatulency are generally unhappy unless they be taking some purgative medicines ; these, though they may give immediate ease, tend to weaken and relax the stomach and bowels, and consequently increase the disorder. The best method is to mix purgatives and stomachics together. Equal parts of Peruvian bark and rhubarb may be infused in brandy or wine, and taken in such quantity as to keep the body gently open. In heartburn, water-brash, &c. the oxide of bismuth is a remedy which has been employed in a variety of cases with considerable advantage. The proper dose is from three to ten gtains, with about twenty-five grains of gum-tragacanth, repeated three times a-day. It will be safer, however, to commence with only about three grains, and increase it gradually. Pain of the stomach proceeds from such a variety of causes, that it is difficult to prescribe a medicine for it. The treatment must of course be suited to the nature of the complaint. But I have for some years very generally recommended a plaster, which seldom fails to give relief. Its basis may be any kind of adhesive plaster spread upon leather, to which, while warm, a drachm and a half, or two drachms, of powdered opium may be added. It should be large enough to cover nearly the whole region of the stomach, and should be suffered to remain on as long as it will stick.* CHAP. XXVII. WORMS. (Vermes.) These are chiefly of three kinds, viz. the tenia, or tape-Worm; the teres, or round and long worm; and the ascarides, or round and short worm. There are many other kinds of worms found in the human body; but as they proceed, in a great measure, from simi- lar causes, have nearly the same symptoms, and require almost the same method of treatment as these already mentioned, we Bhall not spend time in enumerating them. The tape-worm is white, very long, and full of joints. It is gen- erally bred either in the stomach or small intestines. The round and long worm is likewise bred in the small guts, and sometimes in the stomach. The round and short worms commonly lodge in the rectum, or what is called the end gut, and occasion a disagree- able itching about the seat. The long round worms occasion squeamisbness, vomiting, a dis- • Pain of the stomach is frequently relieved by drinking a cup or two of water as hot as it can be swallowed. This remedy is always safe, and will frequently be found effectual. Ed. i»G2 WORMS. apreeable breath, gripes, looseness, .swelling of the belly, swoonings, loathing of food, and at other times a voracious appetite, a dry cough, convulsions, epileptic fits, and sometimes a privation of speech. These worms have been known to perforate the intes- tines, and get into the cavity of the belly. The effects of the tape- worm are nearly the same with those of the long and round, but rather more violent. Andry says, the following symptoms particularly attend the soli- um, which is a species of the tape-worm, viz. swoonings, privation of speech, and a voracious appetite. The round worms called ascarides, besides an itching of the anus, cause swoonings, and tenesmus, or an inclination to go to stool. Causes.—Worms may proceed from various causes; but they are seldom found except in weak and relaxed stomachs, where the digestion is bad. Sedentary persons are more liable to them than the active" and laborious. Those who eat great quantities of unripe fruit, or who live much on raw herbs and roots, are generally-sub- ject to worms. There seems to be an hereditary disposition in some persons to this disease. 1 have often seen all the children of a family subject to worms of a particular kind. They seem like- wise frequently to be owing to the nurse. Children of the same family nursed by one woman have often worms, when those nursed by another have none. Symptoms.—The common symptoms of worms are, paleness of the countenance, and, at other times, an universal flushing of the face; itching of the nose (this, however, is doubtful, as children pick their noses in all diseases;) starting, and grinding of the tectli in sleep; swelling of the upper lip; the appetite sometimes bad, at other times quite voracious ; looseness; a sour or stinking breath ; a hard swelled belly; great thirst; the urine frothy, and sometimea of a whitish colour; griping, or colic pains; an involuntary dis- charge of saliva, especially when asleep; frequent pains of the side, with a dry cough, and unequal pulse; palpitations of the heart; swoonings, drowsiness, cold sweats, palsy, epileptic fits, with many other unaccountable nervous symptoms, which were formerly attributed to witchcraft, or the influence of evil spirits. Small bodies in the excrements resembling melon or cucumber- seeds are symptoms of the tape-worm. There is no certain symp- tom of worms but passing them. I lately saw some very surprising effects of worms in a girl about five years of age, who used to lie for whole hours as if dead. She at last expired, and upon opening her body, a number of the teres, or long round worms, were found in her intestines, which were considerably inflamed; and what anatomists call an intus-sus- ceptio, or the involving of one part of the gut within another, had taken place- in no less than four different parts of the intestinal canal.* * That worms exist in the human body there can be no doubt, and that they nrust sometimes be considered as a disease, is equally certain; but this is not the case so often as people imagine. The idea that worms occasion many diseases, gives an op- portunity to the professed worm-doctors of imposing on the credulity of mankind, and WORMS. 26,3 Medicine.—Though numherless medicines are extolled for ex- pelling and killing worms,* yet no disease more frequently baffles the physician's skill. In general, the most proper medicines for their expulsion are strong purgatives, and*, to prevent their breed- ing, stomachic bitters, and now and then a glass of good wine. The best purge for an adult is jalap and calomel. Five-and- twenty or thirty grains of the former, with six or seven of the lat- ter, mixed in syrup, may be taken early in the morning for a dose. It will be proper that the patient keep the house all day, and drink nothing cold. The dose may be repeated once or twice a-week, for a fortnight or three weeks. On the intermediate days the patient may take a drachm of the filings of tin, twice or thrice a-day, mixed with syrup, honey, or treacle. Those who do not choose to take calomel, may make use of the bitter purgatives ; as aloes,t tincture of senna and rhubarb, &c. Oily medicines are sometimes found beneficial for expelling worms. An ounce of salad oil and a table-spoonful of common salt may be taken in a glass of red port wine thrice a day, or oftener if the stomach will bear it; but the more common form of using oil is in clysters. Oily clysters, sweetened with sugar or honey, are very efficacious in bringing away the short round worms called ascarides,^ and likewise the teres. The Harrowgate water is an excellent medicine for expelling worms, especially the ascarides. As this water is impregnated with sulphur, we may hence infer, that sulphur alone must be a good medicine in this case, which is found to be a fact. Many practi- tioners give flour of sulphur in very large doses, and with great success. It should be made into an electuary with honey or trea- cle, and taken in such quantity as to purge the patient. Where Harrowgate water cannot be obtained, sea-water may be used, which is far from being a contemptible medicine in this case. If sea-water cannot be had, common salt dissolved in water may be drank. I have often seen this used by country-nurses with very good effect. Some flour of sulphur may be taken over-night, and the salt-water in the morning. But worms, though expelled, will soon breed again, if the stom- ach remain weak and relaxed; to prevent which, we would recom- mend the Peruvian bark. Half a drachm of bark in powder may be taken in a glass of red port wine, three or four times a-day, after the above medicines have been used.. Lime-water is likewise good for this purpose, or a table-spoonful of the chalybeate wine taken twice or thrice a-day. Infusions or decoctions of bitter herbs may likewise be drank; as the infusion of tansy, water tre- foil, camomile flowers, tops of wormwood, the lesser centaury, «fcc. doing much mischief. They find worms in everycase. and liberally throw in their an- tidotes, which generally consist of strong drastic purges. I have known these given in delicate constitutions, to the destruction of the patient, where there was not ths least symptom of worms. * A medical writer of the present age has enumerated upwards of fifty British plants, all celebrated for killing and expelling worms. fTake Powder of Common Aloes, 1 drm. X Take Mixture of AsafoHida, 3 oz. Water Gruel, thin, 10 oz. Milk. 5 o». Make a clyster—to be given occasionally. Make a clyster. 264 WORMS. The above directions are intended for adults ; but for children the medicines must be more agreeable, and in smaller doses. For a child of four or five years old, six grains of rhubarb, five of jalap, and two of calomel, may be mixed in a spoonful of syrup or hon- ey, and given in the morning. The child should keep the house all day, and take nothing cold. This dose may be repeated twice a-week for three or four weeks. On the intermediate days, the child may take a scruple of powdered tin, and ten grains of sethi- ops mineral, in a spoonful of treacle, twice a-day. This dose must be increased or diminished, according to the age of the patient, or the form annexed below.* Bisset says, the great bastard black hellebore, or bear's foot, is a most powerful vermifuge for the long round worms. He orders the decoction of about a drachm of the green leaves, or about fif- teen grains of the dried leaves in powder, for a dose to a child be- tween four and seven years of age. This dose is to be repeated two or three times. He adds, that the green leaves made into a syrup with coarse sugar is almost the only medicine he has used for round worms for three years past. Before pressing out the juice, he moistens the bruised leaves with vinegar, which cor- rects the medicine. The dose is a tea-spoonful at bed-time, and one or two next morning. I have frequently known those big bellies, which in children are commonly reckoned a sign of worms, quite removed by giving them white soap in their pottage, or other food. Tansy, garlic, and rue, are all good against worms, and may be used various ways. We might here mention many other plants, both for exter- nal and internal use, as the cabbage-bark, Sec, but think the fil- ings of tin with aethiops mineral, and the purges of rhubarb ami calomel, are more to be depended on. Ball's purging vermifuge powder is a very powerful medicine. It is made of equal parts of rhubarb, scammony, and calomel, with as much double-refined sugar as is equal to the weight of all the other ingredients. These must be well mixed together, and reduc- ed to a fine powder. The dose for a child is from ten grains to twenty, once or twice a-week. An adult may take a drachm for a dose. A powder for the tape-worm, resembling this, called Madame Nouffer's powder (the name of the proprietor,)! was long kept a secret on the Continent: it was lately purchased by the French king. Parents who would preserve their children from worms ought to allow them plenty of exercise in the open air ; to take care that their food be wholesome and sufficiently solid ; and, as far as pos- . sible, to prevent their eating raw herbs, roots, or green trashy fruits. It will not be amiss to allow a child who is subject to • Tak,e Powdered Tin, 3 ounces. Confection of Hips, 3 drachms. Simple Syrup, enough to make an electu- ary dose of the size of a nutmeg, in the morning. t Take Male Fern Root, in Powder. 2 to 3 drms. Mint Water, 4 ounces. To be taken fasting in the morning, and two hours after, the following bolus : Take Submuriate of Mercury, 6 or 6 grs. Camboge, in Powder, 6 to 10 grs. Drinking often a cupful of the infusion of green tea. JAUNDICE. 265 worms a glass of red wine after meals ; as every thing that braces and strengthens the stomach is good both for preventing and ex- pelling these vermin.* In order to prevent any mistake of what I have here said in fa- vour of solid food, it may be proper to observe, that I only made use of that word in opposition to slops of every kind ; not to ad- vise parents to cram their children with meat, two or three times a-day. This should only be allowed at dinner, and in moderate quantities, or it would create, instead of preventing worms ; for there is no substance in nature which generates so many worms as the flesh of animals, when in a state of putrefaction. Meat, there- fore, at the principal meal, should always be accompanied with plenty of good bread, and young, tender, and well-boiled vegeta- bles, especially in the spring, when these are poured forth from the bosom of the earth in such profusion. They promote the end in view, by keeping the body moderately open, without the aid of artificial physic. The ripe fruits of autumn produce the same ef- fect; and, from their cooling, antiputrescent qualities, are as wholesome as the unripe are pernicious. I also very earnestly conjure parents not to take the alarm at every imaginary symptom of worms, and directly run for drugs to the quack; or apothecary. They should first try the good effects of proper diet and regimen, and never have recourse to medicines till after unequivocal proofs of the nature of the complaint. Ihe danger of advertised nostrums is sufficiently pointed out and exem- plified in the preceding note. CHAP. XXVIII. JAUNDICE. (Icterus.) This disease is first observable in the white of the eye, which aonears yellow. Afterwards the whole skin puts on a yellow^ap- nearance^ The urine too is of a saffron hue, and dyes a wonte cloth! if put into it, of the same colour. There is likewise a spe- cies of this disease called the Black Jaundice. Causes —The immediate cause of the jaundice is an obsttuOwn of the bfle from biliary calculi in the gall-bladder and its duct* ; rnspi sated bile; spasmodic constriction of the ducts them^ nressins from adjacent tumours ; scirrhosity of the liver, *C Afte remo e o occasional causes are, the bites of poisonous animals as griper, mad dog, &c.; the bilious or hysteric colic ; violent passions?as grief, anger, Sec Strong purges or vomits wilUn- wiseoccasion thejaundice. Sometimes it proceeds from obsti*- . We think U necessary here »™V^*£^^i& fee- ders and other worm medicines, at random from .quacKs, ana gi mcdicrne* is Sren without proper care. The pnnc.pa\'a^^ ^^^^^ of ** the symptoms of having been poisoned. 266 JAUNDICE. ate agues, or from that disease being prematurely stopped by as- tringent medicines. In infants it is often occasioned by the meco- nium not being sufficiently purged oft". Pregnant women are very subject to it. It is likewise a symptom in several kinds of fever. Catching cold, or the stopping of customary evacuations, as the menses, the bleeding piles, issues, &c. will occasion the jaun- dice. Symptoms.—the patient at first complains of excessive weari- ness, languor, and inactivity, and lias great aversion to every kind of motion. His skin is dry, and he generally feels a kind of itch- ing or pricking pain over the whole body. The stools arc of a whitish or clay colour, and the urine, as was observed above, is yellow. The breathing is difficult, and the patient complains of an unusual load t>r oppression of the breast. There is a heat in the nostrils, a bitter taste in the mouth, loathing of food, sickness of the stomach, vomiting, flatulency, and other symptoms of indi- gestion. If the patient be young, and the disease complicated with no other malady, it is seldom dangerous ; but in old people, where it continues long, returns frequently, or is complicated with the drop- sy or hypochondriac symptoms, it generally proves fatal. The black jaundice is more dangerous than the yellow. Regimen.—The diet should be cool, light, and diluting, consist- ing chiefly of ripe fruits and mild vegetables ; as apples boiled or roasted, stewed prunes, preserved plums, boiled spinnage, &c. Veal or chicken-broth, with light bread, are likewise very proper. Many have been cured by living almost wholly for some days on raw eggs. The drink should be buttermilk, whey sweetened with honey, or decoctions of cool opening vegetables ; as marsh-mallow roots, with liquorice, &c. The patient should take as much exercise as he can bear, either on horseback or in a carriage ; walking, running, and even jump- ing, are likewise proper, provided he can bear them without pain, and there be no symptoms of inflammation. Patients have been often cured of this disease by a long journey, after medicines have proved ineffectual. Amusements are likewise of great use in the jaundice. The disease is often occasioned by a sedentary life, joined to a dull mel- ancholy disposition. Whatever therefore tends to promote the circulation, and to cheer the spirits, must have good effect, as dancing, laughing, singing, &c. Medicine.—The cure of jaundice, unpromising as at times it ■say appear, is nevertheless to be attempted, first, by restoring the interrupted passage of the bile through the duct ; secondly by carrying it off by the intestines; and, thirdly, by relieving the particular symptoms. Whether the passage of the bile be ob- structed by biliary concretions, or by spasmodic constriction of the ductus communis choledochus, the same plan nearly must be adopt- If the patient be young, of a full sanguine habit, and complain* ot pain in the right side, about the region of the liver, bleeding will JAUNDICE. 267 be necessary. After this an emetic must be administered; and, if the disease proves obstinate, it may be repeated once or twice. No medicines are more beneficial in the jaundice than emetics, especially where it is not attended with inflammation. Half a drachm of ipecacuanha in powder will be a sufficient dose for an adult. It may be wrought off with weak camomile-tea, or luke- warm water. The body must likewise be kept open by taking a sufficient quantity of Castile soap, or the annexed pills.* Fomenting the parts about the region of the stomach and liver, and rubbing them with a warm hand or flesh-brush, are likewise beneficial; but it is still more so for the patient to sit in a bath of warm water up to the breast. He ought to do this frequently, and should continue in it as long as his strength will permit. Emetics, purges, fomentations, and exercise, will seldom fail to cure the jaundice when it is a simple disease ; and when complica- ted with the dropsy, a scirrhous liver, or other chronic complaints, it is hardly to be cured by any means. Should jaundice have arisen as a consequence of an inflamma- tory affection of the liver, the usual means adopted in such cases of bringing it to a resolution must be early put in practice, viz. venesection, topical bleedings, cooling saline purgatives, and the application of a blister over the part, which ought to be renewed in succession if the disease does not abate : but where these have either failed or been neglected, and it has proceeded on to a chron- ic state of enlargement, or schirrosity, thereby pressing on the biliary ducts, mercury, from time to time, must be used both in- ternally and externally, as advised in chronic inflammation of the liver. . . In cases of this, nature, and in those of jaundice arising from biliary concretions, neutral saltst have been much employed, to- gether with alkalis and other deobstruents. In jaundice, soap has indeed been looked upon as a kind of specific, and is therefore much employed, and in considerable quantities. Hemlock has of- ten been used, and, in combination with mercury and cinchona, it might be rendered more efficacious.} Costiveness is to be removed by means of some gentle laxative, as here advised.§ ,. I have likewise known Harrowgate sulphur-water cure jaundice of very long standing. It should be used for some weeks, and the patient must both drink and bathe. • Take Powdered Rhubarb, 1 scruple. Hard Soap, £ drachm. Submuriate of Mercury, 12 grains. Syrup, a sufficient quantity.—Divide the mass into 24 pills; two or three of which are to be taken at bed time. t Take Compound Infusion of Gentian, 1£ ounce. Tincture of Bark, 2 drachms. Tartrate of Potash, 15 grains. Powder of Rhubarb, 6 grains. Make a draught to be taken morning, noon, and evening. t Take Extract of Bark, ----- of Hemlock, of each, 2 drachms. Simple Syrup, enough to form the mass, to be divided in 60 pills, of which three to twelve are to be taken daily, or Take Mercurial Pill, A drachm. Extract of Hemlock, 2 drachms. Make 50 pills, of which take three morn- ing and night. & Take Socotrine Aloes, »4 drachm. Hard Soap, 1 drachm. Subcarbonate of PotaBh, 4 drachm. Syrup of Buckthorn, enough to make the mass into 36 pills, of which three ar« to be taken at bed time. 268 DROPSY. Persons subject to the jaundice ought to take as much exercise as possible, and to avoid all heating and astringent aliments. The-two last directions are of far greater importance than some people may imagine. In fact, taking exercise, and keeping the body open, are the only assured and rational means of removing a complaint which generally arises from an obstruction of the bilia- ry ducts. I knew a celebrated physician who was subject to this disease, and who, whenever it attacked him, mounted his horse, set out on a journey, and never returned till he was well. For my own part, I should place more reliance on the efficacy of such method, than on the whole catalogue of near a hundred specifics mentioned by the late Doctor Short of Sheffield, though I have known instances where one of them, the decoction of hemp-seed, as already intimated, was found very beneficial. CHAP. XXIX. DROPSY. (Hydrops.) The dropsy is a preternatural swelling of the whole body, or some part of it, occasioned by a collection of watery humour. It is distinguished by different names, according to the part affected, as anasarca, or a collection of water under the cellular membrane; ascites, or a collection of water in the belly ; hydrops pectoris, or dropsy of the breast; hydrocephalus, or dropsy of the brain, &c. Causes.—The dropsy is often owing to an hereditary disposi- tion. It may likewise proceed from drinking ardent spirits, or other strong liquors. It is true almost to a proverb, that great drinkers die of a dropsy. The want of exercise is also a very com- mon cause of the dropsy. Hence it is justly reckoned among the diseases of the sedentary. It often proceeds from excessive evac- uations, as frequent and copious bleedings, strong purges often re- peated, frequent salivations, &c. The sudden stoppage of cus- tomary of necessary evacuations, as the menses, the haemorrhoids, alvine fluxes, &c. may likewise cause a dropsy. I have known the dropsy occasioned by drinking large quanti- ties of cold, weak watery liquor, when the body was heated by vi- olent exercise. A low, damp, or marshy situation is likewise a frequent cause of it. Hence it is a common disease in moist, flat, fenny countries. It may also be brought on by a long use of poor watery diet, or of viscous aliment that is hard of digestion. It is often the effect of other diseases, as the jaundice, a scirrhus of the liver, a violent ague of long continuance, scarlet fever, diar- ihcea, dysentery, empyema, or a consumption of the lungs. In short, whatever obstructs the perspiration, or prevents the blood from being duly prepared, may occasion a dropsy. Symptoms.—Anasarca generally begins with, a swelling of tha feet and ancles towards night, which for some time disappears in the morning. In the evening the parts, if pressed with the finger, DROPSY. 269 will pit. The swelling gradually ascends, and occupies the trunk of the body, the arms, and the head. Afterwards the breathing becomes difficult, the urine is in small quantity, and the thirst great; the body is bound, and perspiration is greatly obstructed. To these succeed torpor, heaviness, a slow wasting fever, and a troublesome cough. This last is generally a fatal symptom, as it Bhows that the lungs are affected. In the ascites, besides the above symptoms, there is a swelling of the belly, and often a fluctuation, which may be perceived by striking the belly on one side, and laying the palm of the hand on the opposite. This may be distinguished from a tympany by the weight of the swelling, as well as by the fluctuation. When the anasarca and ascites are combined, the case is very dangerous. Even a simple ascites seldom admits of a radical cure. Almost all that can be done is, to let off the water by tapping, which seldom affords more than a temporary relief. When the disease comes suddenly on, and the patient is young and strong, there is reason to hope for a cure, especially if me.li- cine be given early. But if the patient be old, has led an irregu- lar or a sedentary life, or if there be reason to suspect that the liv- er, lungs, or any of the viscera are unsound, there is great reason to fear that the consequences will prove fatal. Regimen.—The patient must abstain, as much as possible, from all drink, especially weak and watery liquors,* and must quench his thirst with mustard whey, or acids, as juice of lemons, oranges, sorrel, or such like. His aliment ought to be dry, of a stimulating and diuretic quality, as toasted bread, the flesh of birds, or Other wild animals, roasted ; pungent and aromatic vegetables, as garlic, mustard, onions, cresses, horse-radish, rocambole, shalot, Sec He may also eat sea-biscuit dipped in wine or a little brandy ; this is not only nourishing, but tends to quench thirst. Some have been actually cured of a dropsy by a total abstinence from all liquids, and living entirely upon such things as are mentioned above. If the patient must have drink, the Spa-water, or Rhenish wine, with diuretic medicines infused in it, are the best. Beer boiled with juniper-berries is much used as a diuretic drink, by the German physicians. Exercise is of the greatest importance in a dropsy. If the pa- tient be able to walk, dig, or the like, he ought to continue these exercises as long as he can. If he be not able to walk or la- bour, he must ride on horseback, or in -a carriage, and the more violent the motion so much the better, provided he can bear it. His bed ought to be hard, and the air of bis apartments warm and dry. If he live in a damp country, he ought to be removed into a ► A total abstinence from drink has long been considered as highly necessary in all dropsical cases; but in several cases this practice has been carried too far without any benefit whatever. It seems, however, to have fallen considerably into disrepute, as lar<»e quantities of watery liquors, are now allowed, where diuretics, but more particu- larly the supertartrate of potash, are given. Indeed, this mode of ^aUng dropsy ,s far more rational than the former, as these med.cmes can hardly be earned to theikid- neys without being accompanied with a large portion of water. When, upon a fair trial, the quantity of urine is not found to be increased by dnnking water or other aque- ous fluids, their use may in that case be discontinued. 270 DROPSY. dry one, and, if possible, into a warm climate. In a word, every method should be taken to promote the perspiration, and to brace the solids. For this purpose it will likewise be proper to rub the patient's body two or three times a-day with a hard cloth, or a flesh-brush ; and he ought constantly to wear flannel next his skin. In the treatment of dropsy, the attention should be primarily di- rected to ascertain whether the disease be idiopathic or symptom- atic ; that is, whether it be an original one, or whether it prevail as a symptom of some other ; as by removing the cause we shall often be enabled to remove the effect also, and thus perform a cure. For example, should dropsy have arisen as a consequence of in- temperance, a free use of spirituous liquors, exposure to a moist atmosphere, or having had recourse to large evacuations, particu- larly bleeding; or if it have proceeded from long continued inter- mittent fevers, obstructions in the abdominal or thoracic viscera, &c.; the removal of these will be the first indications of cure. The next will be to evacuate the serous fluid already collected ; and to i ?store the tone of the system, and strengthen the constitution generally. Medical Treatment.—If the patient be young, his constitution good, and the disease has come on suddenly, it may generally be removed by strong emetics, brisk purges, and such medicines as promote a discharge by perspiration and urine. For an adult, half a drachm of ipecacuanha in powder, and half an ounce of oxymel of squills, will be a proper vomit. This may be repeated as often as is found necessary, three or four days intervening between the doses; or of the sulphate of copper as here advised, as having less tendency to exhaust than any other commonly used. The patient must not drink much after taking the vomit, otherwise he destroys its effects. A cup or two of camomile-tea will be suffi- cient to work it off. Between each vomit, on one of the intermediate days, the patient may take the following purge: Jalap in powder half a drachm, cream of tartar, two drachms, calomel, six grains. These may be made into a bolus with a little syrup of pale roses, and taken early in the morning. The less the patient drinks after it the better. If he be much griped, he may now and then take a cup of chicken- broth. , The patient may likewise take every night at bed-time the fol- lowing bolus:—To four or five grains of camphor add one grain of opium, and as much syrup of orange-peel as is sufficient to make them into a bolus. This will generally promote a gentle sweat, which should be encouraged by drinking now and then a small cup Of wine-whey, with a tea-spoonful of the spirits of hartshorn in it. A tea-cupful of the following diuretic infusion may likewise be taken every four or five hours through the day:—Take juniper- berries, mustard-seed, and horse-radish, of each half an ounce, ashes of broom, half a pound; infuse them in a quart of Rhenish wine or strong ale for a few days, and afterwards strain off the liquor. Such as cannot take this infusion, may use the decoction of seneka-root, which is both diuretic and sudorific. I have known an obstinate anasarca cured by an infusion of the ashes of broom »n wine. DROPSY. 271 The above course will often cure an incidental dropsy, if the constitution be good ; but when the disease proceeds from a bad habit, or an unsound state of the viscera, strong purges and vomits are not to be ventured upon. In this case the safer course is to palliate the symptoms by the use of such medicines as promote the secretions, and to support the patient's strength by warm and nour- ishing cordials. The secretion of urine may be greatly promoted by nitre. Brookes says, he knew a young woman who was cured of a dropsy by taking a drachm of nitre every morning in a draught of ale, after she had been given over as incurable. The powder of squills is likewise a good diuretic. Six or eight grains of it, with a scru- ple of nitre, may be given twice a-day in a glass of strong cinna- mon-water. Ball says, a large spoonful of unbruised mustard-seed taken every night and morning, and drinking half an English pint of the decoction of the tops of green broom after it, has performed a cure after other powerful medicines had proved ineffectual. I have sometimes seen good effects from cream of tartar in this disease.* It promotes the discharges by stool and urine, and will at least palliate, if it does not perforin a cure. The patient may begin by taking an ounce every second or third day, and may increase the quantity to two or even three ounces, if the stomach will bear it. This quantity is not, however, to be taken at once, but divided into three or four doses. To promote perspiration, the patient may use the decoction ot seneka-root, as directed above; or he may take two table-spoons- ful of the solution of acetated ammonia (Mindererus s* spirit) in a cup of wine-whey three or four times a-day. To promote a dis- charge of urine, the following infusion of the London hospitals will likewise be beneficial:— Take of zedoary-root two drachms; dried squills, rhubarb, and juniper-berries bruised, of each a drachm ; cinnamon in Pow a constant sore by stimulating the part with savine or other ointments; and produce a greater effect upon the disease. Though this disease may not seem to yield to medicines tor some time, yet they ought still to be persisted in. Persons,who are sub- ject to frequent returns of the rheumatism will often find their ac- count in using medicines, whether they be immediately affected with the disease or not. The chronic rheumatism is similar to the gout in this respect, that the most proper time for using medi- cines to extirpate it is when the patient is most free from the dis- order.______________________________________. . nr Oil 2 ounces. Tincture of Cantharides, 1 drachm. •Take unve \> , 2 drachms. Solution of Ammonia, k ounce. Dissolve^add, Make a liniment. 2-<0 RIIEUMATISM. To those who can afford the expense, I would recommend the warm baths of Buxton or Matlock in Derbyshire. These have often, to my knowledge, cured very obstinate rheumatisms, and are always safe, either in or out of the fit. When the rheu- matism is complicated with scorbutic complaints, which is not sel- dom the case, the Harrowgate waters, and those of Moft'at, are proper. They should both be drank and used as a warm bath. There are several of our own domestic plants which may be used with advantage in the rheumatism. One of the best is the white mustard. A table-spoonful of the seed of this plant may be taken twice or thrice a-day, in a glass of water or small wine. The water trefoil is likewise of great use in this complaint. It may be infused in wine or ale, or drank in form of tea. The ground-ivy, camomile, and several other bitters, are also benefi- cial, and may be used in the same manner. No benefit, however, is to be expected from these, unless they be taken for a considera- ble time. Excellent medicines are often despised in this disease, because they do not perform an immediate cure: whereas nothing would be more certain than their effect, were they duly persist- ed in. Want of perseverance in the use of medicines is one rea- son why chronic diseases are so seldom cured. The internal remedies most generally recommended in chronic rheumatism are sudorifics, and medicines of a stimulating nature, which abound in essential oils and resins ; and therefore volatile alkaline salts, guaiacum, turpentine combined with Cinchona bark, and the like, may be given in any of the undermentioned forms.* Cold bathing, especially in salt water, often cures the rheuma- tism. We would also recommend exercise, and wearing flannel next the skin. Issues are likewise very proper, especially in chronic cases. If the pain affects the shoulders, an issue may be made in the arm ; but if it affects the loins, it should be put into the leg or thigh. Persons afflicted with the scurvy are very subject to rheumatic complaints. The best medicines in this case are bitters and mild purgatives. These may either be taken separately or together, as the patient inclines. An ounce of Peruvian bark, and half an ounce of rhubarb, in powder, may be infused in a bottle of wine, and one, two, or three wine glasses of it taken daily, as shall be found necessary for keeping the body gently open. In cases where the bark itself proves sufficiently purgative^the rhubarb may be omit- ted. • Take Oil of Turpentine, 1A drachm. or Yolk of an egg, enough to mix Take Guaiacum, in Powder, f> grams. them, Antimonial Powder 3 grains Then add, Syrup of Ginger, enough to form a bolat Compound Spirit of Juniper, 1 oz. to be taken three times a day Decoction of Bark, fi ounces. or Make a mixture, of which take two table- Take Ammoniated Tincture of spoonsful every four hours. Guaiacum, 2 drachms. or Spirit of Cinnamon, A ounce. Take Rectified Oil of Turpentine, Decoction of Bark, t ounce. Spirit of Nitric Ether, Solution of Tartarized Antimony, of each equal parts, 1 ounce. 24 drops. K tea-spoonful to be taken three times Make a draught, to be taken two or thr«« a-day in some appropriate vehicle. times a-day. SCURVY. 281 Such as are subject to frequent attacks of the rheumatism ought to make choice of a dry, warm situation, to avoid the night-air, wet clothes, and wet feet, as much as possible. Their clothing should be warm, and they should wear flannel next their skin, and make frequent use of the flesh-brush. One of the best articles of dress, not only for the prevention of the rheumatism, but for powerful co-operation in its cure, is flee- cy hosiery. A medical friend of mine, of long experience and much practice in the isle of Ely, assured me, that the introduction of that manufacture had prevented more rheumatisms, colds, and agues, than all the medicines which had ever been used there. Such of the inhabitants of marshy countries as are in easy circum- stances could not, perhaps, direct their charity and humanity to a better object than to the supplying of their poor neighbours with so cheap and simple a preservative. I have even myself ex- perienced the good effects of such warm covering in the rheuma- tism, to which I was very subject about thirty years ago; but have never experienced any attack of it since I took to warm clothing. When there are any suspicions of the disease being connected with a syphilitic taint, a long continued course of mercurial altera- tives (see Syphilis) must be entered upon. Chronic rheumatism sometimes affects the lumbar region, with an acute pain shooting down into the os sacrum, so that the patient cannot stand upright without suffering considerable pain and in- convenience ; nor does he feel any ease when in bed. This affec- tion is known by the name of lumbago, and, as it frequently does, when it fixes itself in the hip-joint, it is called sciatica. Both of these affections are to be treated in the same manner as chronic rheumatism. In sciatica and local pains of the hip and loins, tur- pentine is often given with relief, as is also guaiacum combined with the essential oil of sassafras ; and the external application of the Bath waters have been recommended by Dr. W. Falconer, as affording considerable benefit. CHAP. XXXI. SCURVY. (Scorbutus.) This disease prevails chiefly in cold northern countries, espe- cially in low damp situations, near large marshes, or great quanti- ties of stagnating water. Sedentary people, of a dull melancholy disposition, are most subject to it. It proves often fatal to sailors on long voyages, particularly in ships that are not properly ventil- ated, have many people on board, or where cleanliness is neglect- It is not necessary to mention the different species into which this disease has been divided, as they differ from one another chief- , in degree. What is called the land scurvy, however, is seldom attended with those highly putrid symptoms which appear in pa- dents who have been long at sea, and which, we presume, are rather owing to confined air, want of exercise, and the unwhole- some food eaten by sailors on long voyages, than to any specific difference in the disease. 2S2 SCURVY. Causes.—The scurvy is occasioned by cold moist air ; by the long use of salted or smoke-dried provisions, or any kind of food, that is hard of digestion, and affords little nourishment. It may also proceed from the suppression of customary evacuations, as the menses, the hemorrhoidal flux, &c. It is sometimes owing to an hereditary taint, in which case a very small cause will excite the latent disorder. Grief, fear, and other depressing passions, have a great tendency both to excite and aggravate this disease. The same observation holds with regard to neglect of cleanliness, bad clothing, the want of proper exercise, confined air, unwhole- some food, or any disease which greatly weakens the body, or vitiates the humours. Symptoms.—This disease may be known by unusual weariness, heaviness, and difficulty of breathing, especially after motion ; rot- tenness of the gums, which are apt to bleed on the slightest touch ; a stinking breath ; frequent bleeding at the nose ; crackling of the joints ; difiiculty of walking ; sometimes a swelling, and sometimes a falling away of the legs, on which there are livid, yellow, or vio- let-coloured spots ; the face is generally of a pale or leaden colour. As the disease advances, other symptoms come on ; as rottenness of the teeth, haemorrhages, or discharges of blood from different parts of the body, foul obstinate ulcers, pains in various parts, es- pecially about the breast, dry scaly eruptions all over the body, &c. At last a wasting or hectic fever comes on, and the miserable patient is often carried off by a dysentery, a diarrhoaa, a dropsy, the palsy, fainting fits, or a mortification of some of the bowels. Cure.—We know no way of curing this disease but by pursuing a"plan directly opposite to that which brings it on. It proceeds from a vitiated state of the humours, occasioned by errors in diet, air, or exercise ; and this cannot be removed but by a proper at- tention to these important articles. If the patient has been obliged to breathe a cold, damp, or con- fined air, he should be removed, as soon as possible, to a dry, open, and moderately warm one. If there is reason to believe that the disease proceeds from a sedentary life, or depressing passions, as grief, fear, &c, the patient must take daily as much exercise in the open air as he can bear, and his mind should be diverted by cheerful company and other amusements. Nothing has a greater tendency either to prevent or remove this disease than constant cheerfulness and good humour. But this, alas ! is seldom the lot of persons afflicted with the scurvy ; they are generally surly, peevish, and morose. When the scurvy has been brought on by a long use of salted provisions, the proper medicine is a diet consisting chiefly of fresh vegetables; as oranges, apples, lemons, limes, tamarinds, water- cresses, scurvy-grass, brook-lime, Sec The use of these, with milk, pot-herbs, new bread, and fresh beer or cider, will seldom fail to remove the scurvy of this kind, if taken before it is too far advanced ; but to have this effect, they must be persisted in for a considerable time. When fresh vegetables cannot be obtained, SCURVY. 283 pickled or preserved ones may be used ; and where these are want- ing, recourse must be had to the chymical acid.-=. All the patient's food and drink should, in this case, be sharpened with cream of tartar, elixir of vitriol, vinegar, or the muriatic acid. These things, however, will more certainly prevent than cure the scurvy, for which reason sea-faring people, especially in long voyages, ought to lay in plenty of them. Cabbages, onions, goose- berries, and many other vegetables, may be kept a long time by pickling, preserving, Sec, and when these fail, the chymical acids recommended above, wbich will keep for any length of time, may be used. We have reason to believe, if ships were well ventilated, had got store of fruits, greens, cider, &c. laid in, and if proper regard were paid to cleanliness and warmth, that.sailors would be the most healthy people in the world, and would seldom suffer either from the scurvy or putrid fevers, which are so fatal to that useful clasps of men : but it is too much the temper of such people to despise all precaution; they will not think of any calamity till it overtakes them, when it is too late to ward off the blow. In the course of the disease particular symptoms may arise re- quiring a separate consideration. Pains of the belly are to be re- lieved by emollients and opiates ; oppression at the chest and im- peded respiration by blisters ; for bleeding is never to be used in this disease ; contractions of the hams and calves of the legs, by fomenting the part with warm vinegar and water, and by the ap- plication of emollient poultices and frictions ; sponginess of the gums, and looseness of the teeth, by washing the mouth frequent- ly with antiseptic and astringent gargles ;* and foul ulcers are to be cleansed and healed by washing them with lemon-juice, or a tincture consisting of equal parts of the tincture of myrrh, and then dressing them with some kind of ointment, or a sorrel poultice. In bad cases of ulceration the charcoal or effervescent poultice may probably be serviceable. It must indeed be owned, that many of them have it not in their power to make the provision we are speaking of; but in this case it is the duty of their employers to make it for them ; and no man ought to engage in a long voyage without having these articles se- cured.! ■ Take Infusion of Roses, 4 ounces, Take Decoction of Bark, 6 ounces. Alum, in Powder, 1£ ounce. Tincture of Myrrh, I & ounce. Honey, 1 drachm. Muriatic Acid," 12 to 20 drops. Mix them for a gargle. Make a gargle. or f Every body knows how much easier it is to prevent than to cure any disease; but this is particularly true with respect to the scurvy. I have therefore recommended the most assured means of preserving our seamen from its formidable attacks. Vege- table and mineral acids are certainly the best correctives of the acrimony occasioned by the long use of salted provisions. These are one of the chief causes of the scurvy not only at sea, but on land also, where salted and smoke dried meats are a favourite and very customary article of food. It appears from the reports of modern travellers, that the scurvy is almost unknown to the natives of Canada, though they live entirely on animal food, but not salted ; while the use of the latter never fails to produce the scurvy. Would it not then be worth while to make various experiments for preserv- ing meat at sea without salt 1 Surely the resources of human invention are not exhausted. The absorbent and antiputrescent properties of sugar are well known; but it might be deemed too expensive a seasoning. I must leave trials of this sort to per sons of more leisure. It is enough for me to suggest the hint. I wish it may lead to a discovery of so much importance. 284 SCURVY. 1 have often seen very extraordinary effects in the land-scurvy from a milk diet. This preparation of Nature is a mixture of an- imal and vegetable properties, which of all others is the most fit for restoring a decayed constitution, and removing that particular acrimony of the humours, which seems to constitute the very essence of the scurvy, and many other diseases. But people despise this wholesome and nourishing food, because it is cheap, and devour with greediness flesh and fermented liquors, while milk is only deemed fit for their hogs. The most proper drink in the scurvy is whey or buttermilk. When these cannot be had, sound cider, perry, or spruce-beer, may be used. Wort has likewise been found to be a proper drink in the scurvy, a^id may be used at sea, as malt will keep during the longest voyage. A decoction of the tops of the spruce-fir is likewise proper. It may be drank in the quantity of an English pint twice a-day. Tar-water may be used for the saraj purpose, or decoctions of any of the mild mucilaginous vegetables; as sarsa- parilla, marsh-mallow roots, &c. Infusions of the bitter plants, as ground ivy, the lesser centaury, marsh-trefoil, &c. are likewise beneficial. I have seen the peasants in some parts of Britain express the juice of the last-mentioned plant, and drink it with good effect in those foul scorbutic eruptions with which they are often troubled in the spring season. Harrowgate-water is certainly an excellent medicine in the land-scurvy. I have often seen patients who had been reduced to the most deplorable condition by this disease, greatly relieved by drinking the sulphur-water, and bathing in it. ' The chalybeate- water may also be used with advantage, especially with a view to brace the stomach after drinking the sulphur-water, which, though it sharpens the appetite, never fails to weaken the powers of diges- tion. A slight degree of scurvy may be carried off by frequently suck- ing a little of the juice of a bitter orange or a lemon. When the disease affects the gums only, this practice, if continued for some time, will generally carry it off. We would, however, recommend the bitter orange as greatly preferable to lemon; it seems to be as good a medicine, and is not near so hurtful to the stomach.. Per- haps our own sorrel may be little inferior to either of them. All kinds of salad are good in the scurvy, and ought to be eaten very plentifully, as spinage, lettuce, parsley, celery, endive, radish, dandelion, &c. It is amazing to see how soon fresh vegetables in the spring cure the brute animals of any scab or foulness which is upon their skins. It is reasonable to suppose that their effects would be as great upon the human species, were they used in proper quantity for a sufficient length of time. I have sometimes seen good effects in scorbutic complaints of very long standing, from the use of a decoction of the roots of water-dock. It is usually made by boiling a pound of the fresh root in six English pints of water, till about one-third of it be con- sumed. The dose is from half a pint to a whole pint of the decoc- tion every day. But in all the cases where I have seen it prove beneficial, it was made much stronger, and drank in larger quan- tities. The safest way, however, is for the patient to begin with SCROFULA, OR KING'S EVIL. 285 small doses, and increase them both in strength and quantity, as he finds his stomach will bear it. It must be used for a conside- rable time. I have known some take it for many months, and have been told of others who had used it for several years, before they were sensible of any benefit, but who nevertheless were cured by it at length. The leprosy, which was so common in this country long ago, seems to have been near a-kin to the scurvy. Perhaps its appear- ing so seldom now, may be owing to the inhabitants of Britain eating more vegetable food than formerly, living more upon tea and other diluting diet, using less salted meat, being more cleanly, better lodged and clothed, &c.—For the cure of this disease, we would recommend the same course of diet and medicine as in the scurvy. I have met with very few cases of real leprosy in the course of my practice. The dry, scaly eruptions all over the body, which are often the effects of the scurvy, are very liable to be considered as leprous symptoms, and certainly resemble them very much. But no evil can arise even from mistake in this particular, as the same alterative plan, which is advisable in the scurvy, will be- gen- erally found efficacious in the leprosy. Perhaps in the latter com- plaint, we ought to lay a greater stress, if possible, on the benefit of good air, and of frequent changes of the linen worn next the skin. What has been peculiarly called the disease of uncleanness, can only be remedied by the practice of the opposite virtue. I have also found, that, after proper means for correcting internal impu- rities had been used for some time, the complete disappearance of the leper's sores was often safely and effectually promoted by the ointment for diseases of the skin mentioned in the Appendix.* The medicinal virtues of the Bath waters, as well as those of Harrowgate, in the cure of the leprosy, are very highly, and I believe very justly esteemed. Scrofula, or King's Evil. This disease chiefly affects the glands, especially those of the neck. Children and young persons of a sedentary life, are very subject to it. It is one of those diseases which may be removed by proper regimen, but seldom yields to medicine. The inhabitants of cold, damp, marshy countries are most liable to the scrofula. Causes.—This disease may proceed from an hereditary taint, infection, a scrofulous nurse, Sec Children who have the misfor- tune to be born of sickly parents, whose constitutions have been greatly injured by the pox, or other chronic diseases, are apt to be affected by the scrofula. It may likewise proceed from such dis- eases as weaken the habit or vitiate the humours, as the small-pox, measles, Sec. External injuries, as blows, bruises, and the like, " I have lately seen soma instances of inveterate eruptions oa the face, commonly termed scorbutic, removed by the use of the dulcamara. Take of the stalks of that plant, half an ounce, liquorice root, two drachms; macerate in two quarts of warm water for two hours, and then boil for ten minutes. Of the strained decoction a tea- oupful with a little milk, may be taken three times a-day. It must be persisted in foi some time. A. P. B, 2c6 SCROFULA, OR KING'S EVIL. sometimes produce scrofulous ulcers; but we have reason to be- lieve, when this happens, that there has been a predisposition in the habit to this disease. In short, whatever tends to vitiate the humours or relax the solids, paves the way to the scrofula ; as the want of proper exercise, too much heat or cold, confined air, un- wholesome food, bad water, the long use of poor, weak, watery aliments, the neglect of cleanliness, Sec Nothing tends more to induce this disease in children than allowing them to continue long wet.* Symptoms.—At first, small knots appear under the chin, or be- hind the ears, which gradually increase in number and size, till they form one large hard tumour. This often continues for along time without breaking, and when it does break, it only discharges a thin sanies, or watery humour. Other parts of the body are likewise liable to its attack, as the arm-pits, groins, feet, hands, eyes, breast, &c. Nor are the internal parts exempt from it. It often affects the lungs, liver, or spleen; and I have frequently seen the glands of the mysentery greatly enlarged by it. Those obstinate ulcers which break out upon the feet and hands with swelling, and little or no redness, are of the scrofulous kind. They seldom discharge good matter, and are exceedingly difficult to cure. The white swellings of the joints seem likewise to be of .is kind. They are with difficulty brought to a suppuration, and •'hen opened they only discharge a thin ichor. There is not a nore general symptom of the scrofula than a swelling of the up- per lip and nose. It sometimes begins in a toe or finger, which con- .inues long swelled, with no great degree of pain, till the bone be- comes carious. Regimen.—As this disease proceeds, in a great measure, from relaxation, the diet ought to be generous and nourishing, but at the same time light and of easy digestion ; as well-fermented bread made of sound grain, the flesh and broth of young animals, with now and then a glass of generous wine, or good ale. The air ought to be open, dry, and not too cold, and the patient should take as much exercise as he can bear. This is of the utmost im- portance. Children who have sufficient exercise are seldom troubled with the scrofula. Medical treatment.—The vulgar are remarkably credulous with regard to the cure of the scrofula ; many of them believing in the virtue of the royal touch, that of the seventh son, &c. The truth is, we know but little either of the nature or cure of this dis- ease, and where reason or medicines fail, superstition always comes in their place. The submuriate of mercury, however, is by far the most celebrated of all the purgative medicines which have been employed in the treatment of scrofula; and it is undoubtedly a serviceable remedy in many stages of the disease. In prescribing it we must be careful not to give it in such a quantity as to pro- " The scrofula, as well as the rickets, is found to prevail in large manufacturing towns, where people live grossly, and lead sedentary lives. SCROFULA, OR KING'S EVIL. 287 duce the- specific effects of mercury to any extent. When given cautiously and in moderate doses, so as to act merely as an'aitera- tive* or gentle purgative, it agrees well in scrofulous complaints, and greatly contributes to discuss tumours and resolve indurations of this nature; or combined with antimony, or opium, where there is much irritation, or where there are deep-seated affections of the joints, &c. The scrofula, at a certain period of life, often cures of itself; and, if the patient happens to be touched about this time, the cure is imputed to the touch, and not to Nature, who is reallv the physician. In the same way the insignificant nostrums of quacks and old women often gain applause when they deserve none. There is nothing more pernicious than the custom of plying children in the scrofula with strong purgative medicines. People imagine it proceeds from humours which must be purged off, with- out considering that these purgatives increase the debility and ag- gravate the disease. It has indeed been found, that keeping the body gently open for some time, especially with sea-water, has a good effect; but this should only be given in gross habits, and in such quantity as to procure one, or at most two stools every day. Bathing in the salt-water has likewise a very good effect, espe- cially in the warm season. I have often known a course of bath- ing in salt-water,*and drinking it in such quantities as to keep the body gently open, cure a scrofula, after many other medicines had been tried in vain. When salt-water cannot be obtained, the pa- tient may be bathed in fresh water, and his body kept open by small quantities of salt and water, or some other mild purgative. Next to cold bathing and drinking the salt-water, we would rec- ommend the Peruvian bark.t Burnt sponge is another remedy which has been irtuch administered in this disease, and frequently with advantage. It may be given either in the form of bolus or draught.^ A more active medicine, however, is the carbonate of soda in doses "from ten to twenty grains to a drachm, twice or thrice a-day.§ The cold bath may be used in summer, and the bark in winter. To an adult half a drachm of the bark in powder may be given .in a glass of red wine four or five times a-day. Children, and such as cannot take it in substance, may use the decoction made in the following manner :— Boil an ounce of Peruvian bark and a drachm of winter's bark, both grossly powdered, in an English quart of water to a pint : " Take Prepared Chalk, 1 drachm. y Take Carbonate of Soda, 2 drachms. Submuriate of Mercury, ^ Infusion of Bark, 6 ounces. 2 to 4*grs.. Compound Tincture of Tartarized Antimony, 2 grains. Cinnamon, A ounce. Mix, and divide in 12 powders, of which ' Syrup of Orange Peel, 2 drachms. let one be taken twice a-day. Make- a Mixture, two table-spoonsful of which arc to be taken three or four tTake Extract of Peruvian Bark, 2 drms. times a-day. ------of Hemlock, 1 drachm. or Make 40 pills; and take two or three Take of Decoctioi of Bark, 10 drachms. three times a-day. C. Tincture of Cardamoms, 1£ drachm. 1 Take Burnt Sponge, 20 to 30 grains. Carbonate of Soda, 15 grains. Rhubarb, 3 grains. Make a draught, to be taken two or three Honey, enough to make a bolus, to be times a-day. taken twice a-day. 288 SCROFULA, OR KING'S EVIL. towards the end, half an ounce of sliced liquorice-root and a hand- ful of raisins may be added, which will both render the decoction less disagreeable, and make it take up more of the bark. The liquor must be strained, and two, three, or four table-spoonsful, according to the age of the patient, given three times a-day; but, in place of this, I now use the compound tincture of bark. The Moffat and Harrowgate waters, especially the latter, are likewise very proper medicines in the scrofula. They ought not, however, to be drank in large quantities, but should be taken so as to keep the body gently open, and must be used for a considerable time. » Hemlock may sometimes be used with advantage in the scrofu- la. Some lay it down as a general rule, that the sea-water is most proper before there are any suppuration or symptoms of tabes; the Peruvian bark, when there are running sores, and a degree of hectic fever ; and the hemlock in old inveterate eases, approach- ing to the scirrhous or cancerous state. Either the extract or the fresh juice of this plant may be used. The dose may be small at first, and increased gradually as far as the stomach is able to bear it. External applications are of little use. Before the tumour breaks, nothing ought to be applied to it, unless a piece of flannel, or something to keep it warm. After it breaks, the sore may be dress- ed with some digestive ointment. What I have always found to an- swer best, was the yellow basilicon mixed with about a sixth or eighth part of its weight of red precipitate of mercury. The sore may be dressed with this twice a-day ; and if it be very fungous, and does not digest well, a larger proportion of the precipitate may be added.* Scrofulous ulcers which had resisted many other remedies hi.vo healed under a weak solution of nitric acid in water (thirty drops or less of the former to a pint of the latter.) In spreading and irritable sores, the application of an aqueous solution of opium, or of hemlock, and afterwards a solution of zinc, may be beneficial. Where the granulations rise above the surface, and are broad and flabby, and where pressure cannot be applied, the sorrel poulticet has proved useful. The topical application of bruised sorrel leaves has been recommended in very flattering terms as contributing essentially to the cicatrization of indolent scrofulous ulcers. In scrofulous sores of an ugly, gleeting, and ill-conditioned ap- . ITCH. 291 The best medicine yet known for the itch is sulphur, which ought to be used both externally and internally. The parts most affect- ed may be rubbed with an ointment made of the flour of sulphur, two ounces ; crude sal ammoniac finely powdered, two drachms : hog's lard, or butter, four ounces. If a scruple or half a drachm of the essence of lemon be added, it will entirely take away the disagreeable smell. About the bulk of a nutmeg of this may be rubbed upon the extremities at bed time, twice or thrice a-week. It is seldom necessary to rub the whole body; but when it is, it ought not to be done all at once, but by turns, as it is dangerous to stop too many pores at the same time. Before the patient begins to use the ointment, he ought, if he be of a full habit, to bleed or take a purge or two. It will likewise be proper, during the use of it, to take every night and morning as much of the flour of brimstone and cream of tartar, in a little treacle or new milk, as will keep the body gently open. He should beware of catching cold, should wear more clothes than usual, and take every thing warm. The same clothes, the linen excepted, ought to be worn all the time of using the ointment; and such clothes as have been worn while the patient was under the disease, are not to be used again, unless they have been fumigated with brimstone, and thoroughly cleansed, otherwise they will communi- cate the infection anew.* I never knew brimstone, when used as directed above, fail to cure the itch; and I have reason to believe, that, if duly persisted in, it never will fail; but if it be only used once or twice, and clean- liness neglected, it is no wonder if the disorder returns. The quantity of ointment mentioned above will generally be sufficient for the cure of one person; but, if any symptoms of the disease should appear again, the medicine must be repeated. It is both more safe and efficacious when persisted in for a considerable time. than when a large quantity is applied at once. As most people dislike the smell of sulphur, they may use in its place the powder of white hellebore root made up into an ointment, in the same manner, which will seldom fail to cure the itch. People ought to be extremely cautious lest they take other eruptions for the itch; as the stoppage of these may be attended with fatal consequences. Many of the eruptive disorders to which children are liable, have a near resemblance; and I have often known infants killed by being rubbed with greasy ointments that make these eruptions strike suddenly in, which nature hod thrown out to preserve the patient's life, or prevent some other malady. As the external use, however, of sulphur is frequently attended with much inconvenience from the dirtiness of the application, as well as its disagreeable smell; other remedies are frequently sub- stituted. The most efficacious of these are a solution of arsenic or oxymuriate of mercury,t different combinations of sulphuric • Sir John Pringle observes, that though this disease may seem trifling, there is no one in the army that is more troublesome to cure, as the infection oftea lurks in clothes, &c. and breaks out a second, or even a third time. The same incon>eniency occurs in private families, unless particular regard be paid to the changing or cleaning of their clothes, which last is by no means an easy operation. ♦ Take Oxymuriate of Mercury, 6 grains. Distilled Water, t2 oancei Muriate of Ammonia. 10 grains. Make a lotion. 292 ASTHMA. acid** white hellebore, and a strong decoction of digitalis. In some' cases, an infusion of tobacco leaves, used as a lotion, has cur- ed the itch. Much mischief is likewise done by the use of mercury in this disease. Some persons are so fool-hardy as to wash the parts af- fected with a strong solution of the corrosive sublimate. Others use the mercurial ointment, without taking the least care" either to avoid cold, keep the body open, or observe a proper regimen. The consequences of such conduct may be easily guessed. I have known even the mercurial girdles produce bad eft'ects, and would advise every person, as he values his health, to beware how he uses them. Mercury ought never to be used as a medicine Avithout the greatest care. Ignorant people look upon these girdles as a kind of charm, without considering that the mercury enters the body. Those who would avoid this detestable disease, ought to beware of infected persons, to use wholesome food, and to study univemil cleanliness.t Asthma. The asthma is a spasmodic! disease of the lungs, coining on by paroxysms, which seldom admits of a cure. Persons in the de- cline of life are most liable to it. It is distinguished into the moist and dry, or humoral and nervous. The former is attended with expectoration or spitting; but in the latter the patient seldom spits, or or Take Oxymuriate of Mercury, 12 grains. Take White Precipitate of Mercury, Muriate of Ammonia, 1 drachm. 2 drachms. Decoction of White Hellebore, Superacetate of Lead, 12 ounces. Subcarbonate of Potash, Make a lotion. of each, 10 grains. Prepared Lard, 2 ounces. •Take Sulphuric Acid, A drachm. Essential Oil of Bergamot, 25 drops. Prepared Lard, r ounce. Make an ointment, to be rubbed in every Make an ointment. night at bed-time. t The itch is now by cleanliness banished from every genteel family in Britain. It still, however, prevails among the .poorer sorts of peasantry, and among the manufac- turers in England. These are not only sufficient to keep the seeds of the disease alive, but to spread the infection among others. It were to be wished that some effectual method could be devised/or extirpating it altogether. Several country clergymen have told me, that by getting such as were infected cured, and strongly recommending an attention to cleanliness, 't'ney have banished the itch entirely out of their parishes. Why might not others do the same ? X Dr. Cullen, and most other writers, refer the proximate or immediate cause of asthma to a preternatural or spasmodic construction of the muscular fibres of the air- cells of the lungs, which not only prevents their being so diluted as to admit of a fren and full inspiration, but also gives them a rigidity which interferes with a free and full expiration. This-doctrine, however, has been disputed by Dr. Bree, who, in a very ingenious treatise on this disease, gives it as his opinion that irritation situated within the bronchia or air-cavities, and arising either from an effusion of serum, or from aerial acrimony, is the true proximate cause of convulsive asthma. The mucus, which is excreted in the course of the disease, and which has been looked upon by Dr. Cullen and others as only an effect, Dr. B. views as a prominent cause of the paroxysm ; or when it is absent, only yielding to a different cause equally irritating to the organ, and exciting spasmodic contractions of the respiratory muscles. Dr. Darwin says, that whatever may be the remote causes of paroxysms of asthma, the immediate canse of the convulsive respiration, whether in the common asthma, or in what is termed the convulsive, which are perhaps only different degrees of the same disease, must be owing to violent voluntary exertions to relieve pain, as in other convulsions; and the increase of irritability to external utimuli, or of sensibility during sleep, must occa- sion them to commence at this time. Ei>. ASTHMA. 293 unless sometimes a little tough phlegm, by the mere force of coughing. It rarely appears before the age of puberty, and seems to attaek men more frequently than women; particularly those of a full habit, in whom it seldom fails, by frequent repetition, to occasion some degree of emaciation. When the disease is attended with an accumulation and discharge of humours from the lungs, it is call- ed the humid asthma; but when it is unaccompanied by any ex- pectoration, it is known by the name of the dry or spasmodic asth- ma. Causes.—The asthma is sometimes hereditary. It may like- wise proceed from a bad formation of the breast; the fumes of metals or minerals taken into the lungs ; violent exercise, especial- ly running; the obstructions of customary evacuations, as the menses, haemorrhoids, &c, sudden retrocession of the gout, or striking-in of eruptions, as the small-pox, measles, Se.c, violent passions of the mind, as sudden fear or surprise. In a word, the disease may proceed from any cause that either impedes the cir- culation of the blood through the lungs, or prevents their being du- ly expanded by the air. Symptoms.—An asthma is known by a quick laborious breath- ing, which is generally performed with a kind of wheezing noise. Sometimes the difficulty of breathing is so great, that the patient is obliged to keep in an erect posture, otherwise he is in danger p of being suffocated. A fit or paroxysm of the asthma generally happens after a person has been exposed to cold easterly winds, or has been abroad in thick foggy weather, or has got wet,. ox con- tinued long in a damp place under ground, or has taken some, food which the stomach could not digest, as pastries, toasted cheese, or the like. The paroxysm is commonly ushered-in with listlessness, want of sleep, hoarseness, a cough, belching of wind, a sense of heavi- ness about the breast, and difiiculty of breathing. To these suc- ceed heat, fever, pain of the head, sickness and nausea, great op- pression of the breast, palpitation of the heart, a weak and some- times intermitting pulse, an involuntary flow of tears, bilious vom- itings, Sec. All these symptoms grow worse towards night; the patient is easier when up than in bed, and is very desirous of cool air. After some nights passed away in this manner, the fits at length moderate, and suffer more considerable remissions, particularly when they are attended by a copious expectoration in the morn- ings, and when this continues from time to time, throughout the day; and, the disease going off at last, the patient enjoys his usu- al rest by night without further disturbance. The pulse, during the fit, is usually not much affected, but in a few cases there is a frequency of it, with some degree of thirst and other febrile symp- toms. Regimen.—The food ought to be light and of easy digestion. Boiled meats are to be preferred to roasted, and the flesh of young 294 ASTHMA. animals to that of old. All windy food, and whatever is apt to swell in the stomach, is to be avoided. Light puddings, white broths, and ripe fruits baked, boiled or roasted, are proper. Strong liquors of all kinds, especially malt liquor, are hurtful. The pa- tient should eat a very light supper, or rather none at all, and should never suffer himself to be long costive. His clothing should be warm, especially in the winter season. As all disorders of the breast are much relieved by keeping the feet warm, and promoting the perspiration, a flannel shirt or waistcoat, and thick shoes, will be of singular service. But nothing is of so great importance in the asthma as pure and moderately warm air. Asthmatic people can seldom bear either the close heavy air of a large town, or the sharp keen at- mosphere of a bleak hilly country : a medium, therefore, between these is to be chosen. The air near a large town is often better than at a distance, provided the patient be removed so far as not to be affected by the smoke. Some asthmatic patients indeed breathe easier in town than in the country ; but this is seldom the case, especially in towns where much coal is burnt. Asthmatic persons who are obliged to be in town all day, ought at least to sleep out of it. Even this will often prove of great service. Those who can afford it ought to travel into a warmer climate. Many asthmatic persons who cannot live in Britain, enjoy very good health in the south of France, Portugal, Spain, or Italy. Exercise is likewise of very great importance in the asthma, as it promotes the digestion, and greatly assists in the perspiration of the blood. The blood of asthmatic persons is seldom duly pre- pared, owing to the proper action of the lungs being impeded. For this reason such people ought daily to take as much exercise, either on foot, horseback, or in a carriage, as they can bear. Medicine.—Almost all that can be done by medicine in this dis- ease, is to relieve the patient when seized with a violent fit. This indeed requires the greatest expedition, as the disease often proves suddenly fatal. During the paroxysm the body is generally bound, a purging clyster, with a solution of assafoetida, ought therefore to be administered, and if there be occasion, it may be repeated two or three times.* The patient's feet and legs ought to be immersed in warm water, and afterwards rubbed with a warm hand, or dry cloth. Bleeding, unless extreme weakness or old age should for- bid it, is highly proper. If there be a violent spasm about the breast or stomach, warm fomentations or bladders filled with warm milk and water, may be applied to the part affected, and warm cata- plasms to the soles of the feet. The patient must drink freely of diluting liquors, and may take a tea-spoonful of the tincture of castor and saffron mixed together in a cup of valerian-tea, twice or thrice a day. Sometimes a vomit has a very good effect, and snatches the patient, as it were, from the jaws of death. This, however, will be more safe after other evacuations have been pre- mised. A very strong infusion of roasted coffee is said to give ease in an asthmatic paroxysm. •Take Compound Decoction of Marsh- of each, 5 ounces. mallow. Castor Oil, £ ounce. Mixture of Assafoetida. Mix for a clyster. ASTHMA. 295 In the moist asthma, such things as promote expectoration or Fpitting, ought to be used ; as the syrup of squills,* gum-ammoni- uc, and such like. A common spoonful of the syrup or oxymel of squills, mixed with an equal quantity of cinnamon-water, may be taken three or four times through the day, and four or five pills made of equal parts of assafoetida and gum-ammoniac at bed time.t A combination of foxglove and opium has proved highly advan- tageous in spasmodic asthma, when given in the dose of half a grain of each eve*y four or five hours. In the petuitous asthma, squill and foxglove might be more advisable.^ On the authority of a modern writer, galvanism was found most efficacious in reliev- ing habitual aslhma.§ For the convulsive or nervous asthma, antispasmodics and ton ics are the most proper medicines. The patient may take a tea- spoonful of the paregoric elixir twice a-day. The Peruvian bark is sometimes found to be of use in this case ; it may be taken in substance or infused in wine. Bitter infusions, chalybeate waters, and preparations of iron, particularly the subcarbonate and sul- phate, in- short, every thing that braces the nerves or takes off spasm, may be of use in a nervous asthma. It is often relieved by the use of asses' milk: I have likewise known cows' milk drank warm in the morning have a very good effect in this case. In addition to other tonics, exercise either in swinging, s filing, riding ia a carriage, or on horseback, but particularly the latter, together with a change of air, will be beneficial to asthmatics: they should try different situations to live in, where the disease is rendered less distressing, or is entirely removed. Their clothing should be warm. In the arthritic asthma, arising from the retrocession of gout, there are usually intermissions and other irregularities of the pulse, £vent anxiety of countenance, with a bluish tinge thereon. Large doses of opium, ether, camphor, and ammonia rse the medicines most likely to afford relief. Sometimes it is necessary to bleed the patient, and often to apply a blister to the chest, assisted with placing the feet in warm water, &c. In every species of asthma setons and issues have a good effect; they mav either be set in the back or side, and should never be al- " Take Mixture of Ammoniacum, 4 oz. or Oxymel of Squills, 3 drs. Take Mixture of Ammoniacum, 1 oa. Solution of Antimony Wine, 40 drps. Solution of Acetated Ammonia, 2 dra. Distilled Vinegar, J oz. ------ Tartarized Antimony, Make a mixture ; of which two table- 15 drops. spoonsful are to be taken often, or when Syrup of Tolu, 1 d.achm. either the cough or shortness of breath Make a draught, to be taken every six is troublesome. hours. t After copious evacuations, large doses of ether have been found very efficacious in removing a fit of the asthma. I have likewise known the following mixture produce very happy effects : To four or five ounces of the solution or milk of gum ammomae add two ounces of simple cinnamon water, the same quantity of balsamic syrup, and half an ounce of paregoric elixir. Of this two table-spoonsful may be taken every three hours. tTake Foxglove in Powder, 6 grains. Syrup of Tolu, enough to make the mass Compound Squill Pill, 2 scruples. into 12 pills, one to be taken three or four times a-day. & See Experimental Inquiry into the Laws of the Vital Functions, &c. by A. P. Wii- son Philip, M. D. o. 329. 296 ASTHMA. lowed to dry up. We shall here, once for all, observe, that not only in the asthma, but in most chronic diseases, issues are ex- tremely proper. They are both a safe and efficacious remedy; and though they do not always cure the disease, yet they will often prolong the patient's life. This disease, though so common with us, is little known in mild climates; and, on that account, it is always advisable to try the effect of a change of climate, which has generally been attended with great benefit. I have already intimated what little confidence I had in the power of any medicine to perform a radi- cal cure of the asthma; but there are many things that will give the patient ease, and, of course, tend to prolong his life. Much, also, may be done by regimen, when drugs are of little service; and I would therefore advise asthmatic patients to procure and keep by them rules for their management both in and out of the fit, adapted to their particular cases. By a proper attention to such rules a man may live many years, and enjoy tolerably good health. I had a patient some time ago, who was often carried, home to his wife in an apparently dying state. She felt little alarm, well knowing what was necessary to be done ; and she always brought him about. This good woman did no more than may be done by any woman of common sense, if the doctor will deign to instruct m her. General rules will not do ; they must, as before observed, be suited to the patient's case and constitution. For want of some such instructions, which a physician should take the earliest op- portunity to give, a patient may lose his life before the doctor can be sent for, or any other medical advice or assistance procured.* Apoplexy. (Apolexia.) ' Apoplexy is a sudden loss of sense and motion, during which the patient is to all appearance dead ; the heart and lungs, how- ever, still continue to move. Though this disease proves often fatal, yet it may sometimes be removed by proper care. It chiefly attacks sedentary persons of a gross habit, who use a rich and plentiful diet, and indulge in strong liquors. People in the decline of life are most subject to the apoplexy. It prevails most in win- ter, especially in rainy seasons,, and very low states of the barome- ter. Causes.—The immediate cause of an apoplexy is a compres- * Asthma is a disease more immediately alarming in appearance, than dangerous in reality. It is well to be aware that there is hardly an instance known of a person dying during the asthmatic paroxysm. The duration of life seems even rarely to be short- ened by this complaint. The celebrated Dr. Floyer, who wrote on asthma, although he' laboured under that disease during his whole life, died upwards of eighty years of age. He was of opinion that he shortened and lightened his fits by drinking some cups of very strong coffee without milk or sugar. I have known more than one asth- matic, who never lay down in bed for a long series of years, and notwithstanding, during the intervals of the fits, enjoyed tolerable health. Much depends on adhering to a dry diet, taking regular exercise, and on abstaining from those things which are known, by individual experience, to disorder the stomach. Considerable benefit is derived, in the nervous asthma, from occasionally taking as much genuine assafoetida, made into pills, as is sufficient to keep the body regular. Smoking the herb Stramo- nium, shortens the duration of a fit, but does not permanently cure the disease, nor even diminish the number of paroxysms. See " New Domestic Medical Manual." by J. S. Forsyth. ' ' APOPLEXY. 297 sion of the brain, occasioned by an excess of blood, or a collec- tion of watery humours. The former is called a sanguine, and the latter a serous apoplexy. It may be occasioned by any thing that increases the circulation towards the brain, or prevents the return of the blood from the head : as intense study ; violent passions ;* viewing objects for a long time obliquely ; wearing any thing too tight about the neck ; a rich and luxurious diet; suppression of urine ; suffering the body to cool suddenly after having been great- ly heated ; continuing long in a warm or cold bath ; the excessive use of spiceries, or high-seasoned food ; excess of venery ; the sudden striking in of any eruption ; suffering issues, setons, &c. sud- denly to dry up, or the stoppage of any customary evacuation ; a mercurial salivation pushed too far, or suddenly checked by cold ; wounds or bruises on the head ; long exposure to excessive cold : poisonous exhalations, &c. Symptoms, and method of cure.—The usual forerunners of an apoplexy are giddiness, pain and Bwimming of the head; loss of memory; drowsiness; noise in the ears ; the nightmare ; a spon- taneous flux of tears, and laborious respiration. When persons of an apoplectic make observe these symptoms, they have reason to fear the approach of a fit, and should endeavour to prevent it by bleeding, a slender diet, and opening medicines. In the sanguine apoplexy, if the patient does not die suddenly, the countenance appears florid, the face is swelled or puffed up, and the blood vessels, especially about the neck and temples, are turgid; the pulse beats strong; the eyes are prominent and fixed, and the breathing is difficult, and performed with a snorting noise. The excrements and urine are often voided spontaneously, and the patient is sometimes seized with vomiting. In this species of apoplexy every method must be taken to les- sen the force of the circulation towards the head. The patient should be kept perfectly easy and cool. His head should be rais- ed pretty high, and his feet suffered to hang down. His clothes ought to be loosened, especially about the neck, and fresh air ad-. mitted into his chamber. His garters should be tied pretty tight, by which means the motion of the blood from the lower extremi- ties will be retarded. As soon as the patient is placed in a proper posture, he should be bled freely in the neck or arm, and, if there be occasion, the operation may be repeated in two or three hours. A laxative clyster,t with plenty of sweet oil or fresh butter, and a spoonful or two of common salt in it, may be administered every two hours ; and blistering plasters applied between the shoulders, and to the calves of the legs. As soon as the symptoms are a little abated, and the patient is •I knew a woman who, in a violent fit of anger, was seized with a sanguine apoplexy. She at first complained of extreme pain, as if daggers had been thrust through her head. as she expressed it. Afterwards she became comatose, her pulse sunk very low, ana was exceeding slow. By bleeding, blistering, and other evacuations, she was kept alive for about a fortnight. When her head was opened, a "large quantity of extrava- sated blood was found in the left ventricle of the brain. ♦ Take Compound Extract of Colocynth, Castor Oil, 1 ounce. £ to 1 drachm. Mix for a clyster, to be injected immeui- Infusion of Senna 11 ounces. ately. N2 298 APOPLEXY. able to swallow, he ought to drink freely of some diluting opening liquor; as a decoction of tamarinds and liquorice, cream-tartar whey, or common whey with cream of tartar dissolved in it. Or he may take any cooling purge, as Glauber's salts, manna dissolv- ed in an infusion of senna, tincture of rhubarb, or the like. AH spirits and other strong liquors are to be avoided. Even volatile salts held to the nose do mischief. Vomits for the same reason, ought not to be given, or any thing that may increase the motion of the blood towards the head. In the serous apoplexy the symptoms are nearly the same, only the pulse is not so strong, the countenance is less florid, and the breathing less difficult. Bleeding is not so necessary here as in the former case. It may, however, generally be performed once with safety and advantage, but should not be repeated. The pa- tient should be placed in the same posture as directed above, and should have blistering plasters applied, and receive opening clys- ters in the same manner. Purges are here likewise necessary, and the patient may drink strong balm tea. If he be inclined to Sweat, it ought to be promoted by drinking small wine whey, or an infu- sion of carduus benedictus. A plentiful perspiration kept up for a considerable time has often carried oft a serous apoplexy. Out of a fit of serous apoplexy the cephalic and nervous medicines recommended in palsy will be proper, taking occasionally some stomachic purgative. If the disease arise in consequence of a sup- pression of piles, leeches should be applied to the hemorrhoidal veins, fomentations must be employed, and the intestines stimulat- ed by means of aloetic purges. When apoplectic symptoms proceed from opium, or other nar- cotic substances taken into the stomach, vomits are necessary. The patient is generally relieved as soon as he has discharged the poison in this way. Persons of plethoric or apoplectic make, or those who have been attacked by it, ought to use a very spare and slender diet, avoiding all strong liquors, spiceries, and high-seasoned food. They ought likewise to guard against all violent passions, and to avoid the ex- tremes of heat and cold. The head should be shaved, and daily washed with cold water. The feet ought to be kept warm, and never suffered to continue long wet. The body must be kept open either by food or medicine, and a little blood may be let every spring and fall. Exercise should by no means be neglected ; but it ought to be taken in moderation. Nothing has a more happy effect in preventing an apoplexy than perpetual issues or setons; great care, however, must be taken not to suffer them to dry up, without opening others in their stead. Apoplectic persons ought never to go to rest with a full stomach, or to lie with their heads low, or to wear any thing too tight about their necks. When an attack of apoplexy is immediately threatened, blood-letting is the remedy most to be relied on, and the blood should be drawn either from the jugular vein or temporal artery, determining the extent of blood to be taken away by the circumstances of the case, Sec When a lethargic disposition prevails, bleeding should also be adopted, particularly topical, from the temples, by means of leech- es, or from the nape of the neck by the scarificator and cupping; COSTIVENESS, Sec 293 the frequent use of cathartics,* and a blister applied to the head or its immediate vicinity. The preceding cautions are of far greater importance than such persons may be aware of. The circulation, which is slower dur- ing sleep than when awake, is farther clogged by a fulness of the stomach. The low posture of the head not only favours, but seems to invite stagnation ; and tight ligatures round the neck, impede the return of the blood from the vessels of the brain, so that an apoplexy, not only very naturally, but almost inevitably follows. Instead of being astonished at the number of those who go to bed in apparent health, and are found dead in the morning, we should consider it as a matter of much more surprise for a per- son of a plethoric habit, after unchecked indulgence in the pleas- ures of the table, to go to rest without any regard to the inclina- tion of his head or the tightness of his collar, and ever to rise again.t Costiveness, and other Affections of the Stomach and Bowels. We do not here mean to treat of those astrictions of the bowels which are the symptoms of diseases, as of the cholic, the iliac pas- sion, were famed for curing the bites of poisonous animals, by sucking the wound; and we are told, that tho Indians in North America practice the same at this dny. BITE OF THE RATTLESNAKE, &c. 351 lent kind. Nine-tenths of the effects attributed to poison or ven- om in this country, are really other diseases, and proceed from quite different causes. We cannot, however, make the same observation with regard to poisonous vegetables. These abound everywhere, and prove often fatal to the ignorant and unwary. This indeed is chiefly owing to carelessness. Children ought early to be cautioned against eating any kind of fruit, roots, or berries, which they do not know ; and all poisonous plants to which they can have access, ought, as far as possible, to be destroyed. This would not be so difficult a task as some people imagine. Poisonous plants have no doubt their use, and they ought to be propagated in proper places ; but, as they often prove destructive to cattle, they should be rooted out of all pasture grounds. They ought likewise, for the safety of the human species, to be destroy- ed in the neighbourhood of all towns and villages; which, by the bye, are the places where they most commonly abound. I have seen the poisonous hemlock, henbane, wolfsbane, and deadly-night- shade, all growing within the' environs of a small town, where, though several persons, within the memory of those living in it, had lost their lives by one or other of these plants, yet no method, that I could hear of, had ever been taken to root them out; though this might be done at a very trifling expence. Seldom a year passes, but we have accounts of several persons poisoned by eating hemlock-roots instead of parsnips, or some kinds of fungus which they had gathered for mushrooms. These examples ought to put people upon their guard with respect to the former, and to put the latter out of use. Mushrooms may be a delicate dish; but they are a dangerous one, as they are generally gathered by persons who do not know one kind of fungus from another, and take every thing for a mushroom which has that ap- pearance. We might here mention many other plants and animals of a poisonous nature, which are found in foreign countries; but, as our observations are chiefly intended for this island, we shall pass them over. It may not, however, be amiss to observe, for the benefit of such of our countrymen as go to America, that an effec- tual remedy is now said to be found for the bite of the rattlesnake. The prescription is as follows:—Take of the herbs plantain and horehound, in summer, roots and branches together, a sufficient quantity : bruise them in a mortar, and squeeze out the juice ; of which give, as soon as possible, one large spoonful: if the patient be swelled, you must force it down his throat. This generally will cure; but, if he finds no relief in an hour after, you may give another spoonful, which never fails.—If the roots are dried, they must be moistened with a little water. To the wound may be ap- plied a leaf of good tobacco moistened with ruin. We give this upon the faith of Dr. Brookes, who says it was the invention of a negro; for the discovery of which he had his free- dom purchased, and a hundred pounds per annum settled upon him during life, by the General Assembly of Carolina. It is possible there may be in nature specific remedies for every kind of poison; but as we have very little faith in any of those 352 BLEEDING. which have yet been pretended to be discovered, we shall beg leave again to recommend the most strict attention to the following rules, viz. That when any poisonous substance has been taken into the 6tomach, it ought, as soon as possible, to be discharged by vomits, clysters, and purges; and, when poison has been received into the body by a wound, that it be expelled by medicines which promote the different secretions, especially those of perspiration and urine ; to which may be added antispasmodics, or such medicines as take off tension anu irritation; the chief of-which are opium, musk, camphor, and asafcetida. PART III. CHAP. I. OF SURGERY. To describe all the operations of surgery, and to point out the different diseases in which these operations are necessary, would extend this article far beyond the limits allotted to it; we must therefore confine our observations to such cases as most generally occur, and in which proper assistance is either not asked, or not always to be obtained. Though an acquaintance with the structure of the human body is indispensably necessary to qualify a man for being an expert sur- geon ; yet many things may be done to save the lives of their fel- low-men in emergencies by those who are not adepts in anatomy. It is amazing with what facility the peasants daily perform opera- tions upon brute animals, which are not of a less difficult nature than those .performed on the human species ; yet they seldom fail of success. Indeed every man is in some measure a surgeon, whether he will or not. He feels an inclination to assist his fellow-men in dis- tress, accidents happen every hour, which give occasion to exer- cise this feeling. The feelings of the heart, however, when not di- rected by the judgment, are apt to mislead. Thus one, by a rash attempt to save his friend, may sometimes destroy him ; while an- other, for fear of doing amiss, stands still and sees his bosom- friend expire, without so much as attempting to relieve him, even when the means are in his power. As every good man would wish to steer a course different from either of these, it will no doubt be agreeable to him to know what ought to be done upon such emer- gencies. Bleeding. No operation of surgery is so frequently necessary as bleeding; it ought therefore to be very generally understood. But though practised by midwives, gardeners, blacksmiths, barbers, and tooth- drawers, we have reason to believe that very few know when it is proper. Even physicians themselves have been so much the dupes of theory in this article, as to render it the subject of ridicule. It is, however, an operation of great importance, and must, when BLEEDING. 353 seasonably and properly performed, be of singular service to those in distress. Bleeding is proper at the beginning of all inflammatory fevers, as pleurisies, peripneumonies, &c. It is likewise proper in all topical inflammations, as those of the intestines, womb, bladder, stomach, kidneys, throat, eyes, &c. as also in the asthma in cer- tain cases, head-achs, acute rheumatism, apoplexy, epilepsy, and bloody flux under certain states. After falls, blows, bruises, or any violent hurt received either externally, or internally, bleeding is necessary. It is likewise necessary for persons who have had the misfortune to be strangled, drowned, suffocated with foul s»ir, the fumes of metal, or the like. . In a word, whenever the vital motions have been suddenly stopped from any cause whatever, ex- cept in swoonings occasioned by mere weakness or hysteric affec- tions, it is proper to open a vein. But in all disorders proceeding from relaxation of the solids, and an impoverished state of the blood, as dropsies, cacochymies, &c. bleeding is improper. Bleeding for topical inflammations ought always to be perform- ed as near the part affected as possible. When this can be done with a lancet, it is to be preferred to any other method ; but where a vein cannot be found, recourse must be had to leeches or cup- ping. The quantity of blood to be taken away must always be regula- ted by the strength, age, constitution, manner of life, and other circumstances relating to the patient. It would be ridiculous to suppose that a child could bear to lose as much blood as a grown person, or that a delicate lady should be bled to the same extent as s robust m nn. The mode of bleeding most frequently practised, is that of open- ing a vein ; and it may be done in the arm, ancle, jugular vein, frontal vein, veins under the tongue, and on the back of the hand, &c. In whatever part, however, venesection is performed, a bandage must be applied between that part and the heart. As it is often necessary, in order to raise the vein, to make the bandage pretty tight, it will be proper in such cases, as soon as the blood begins to flow, to slacken it a little. The bandage ought to be ap- plied at least an inch, or an inch and a half from the place where the puncture is intended to be made. Thus, the return of the blood through the vein is stopped, the vein swells, becomes con- spicuous, and when opened, bleeds much more freely than would otherwise happen. Persons not skilled in anatomy ought never to bleed with the lancet in a vein that lies over an artery or a tendon, if they can avoid it.* The former may easily be known from its pulsation or beating, and the latter from its feeling hard or tight like a whip- cord under the finger. It was formerly a rule, even among those who had the charac- ter of being regular practitioners, to bleed their patients in certain diseases till they fainted. Surely a more ridiculous rule could not be proposed. One person will faint at the very sight of a lancet, « Persons not skilled in anatomy ought never to bleed at all. The risk is greater than the bene6t"; as the advantage to be derived from such a step must depend on practise knowledge. Ed, 354 BLEEDING. while another will lose almost the whole blood of his body before he faints. Swooning depends more upon the state of the mind than of the body : besides it may often be occasioned or prevented by the manner in which the operation is performed. Children are generally bled with leeches. This, though some- times necessary, is a very troublesome and uncertain practice. It is impossible to know what quantity of blood is taken away by leeches ; besides, the bleeding is often very difficult to stop, and the wounds are not easily healed. Would those who practise bleeding take a little more pains, and accustom themselves to bleed children, they would not find it such a difficult operation as they imagine. Certain vulgar prejudices with regard to bleeding still prevail among the country people. They talk, for instance, of head-veins heart-veins, breast-veins, &c. and believe that bleeding in these will certainly cure all diseases of the parts whence they are sup- posed to come, without considering that all the blood-vessels arise from the heart, and return to it again; for which reaso 1, unless in topical inflammations, it signifies very little from what part of the body blood is taken. But this, though a foolish prejudice, is not near so hurtful as the vulgar notion that the first bleeding will per- form wonders. This belief makes them often postpone the oper- ation when necessary, in order to reserve it for some more impor- tant occasion, and, when they think themselves in extreme danger, they fly to it for relief, whether it be proper or not. Bleeding at certain stated periods or seasons has likewise bad effects. It is a common notion that bleeding in the feet draws the hu- mours downwards, and consequently cures diseases of the head and other superior parts ; but we have already observed that, in all topical affections, the blood ought to be drawn as near the part as possible. When it is necessary, however, to bleed in the foot or hand, as the veins are small, and the bleeding is apt to stop too soon, the part ought to be immersed in warm water, and kept there till a sufficient quantity of blood be let. All the apparatus essential for blood-letting, on the part of the patient, is a bandage or fillet, two or more small pieces of folded linen for compresses, a bason to receive the blood, and a little clean water and a towel. The bandage ought to be about a yard in length, and near two inches broad, a common riband or garter being frequently employed. The compresses are made by doub- ling a bit of linen rag about two inches square. On the part of the surgeon, it is necessary for him to have a good lancet, of prop- er shape ; for if the shoulders of the lancet be too broad, it will not readily enter the vein, and when it does enter, it invariably makes a large opening, which is not always desirable. If the lan- cet be too spear-pointed, an incautious operator would often run a risk of transfixing the vein, and wounding the artery beneath it. More, however, depends on the mode of introducing the lancet than on its shape. During the operation of bleeding, the patient may lie down, sit down, or stand up, each of which positions may be chosen, as cir- cumstances may require. If the patient be apt to faint from the less of a small quantity of blood, and such fainting can answer no INFLAMMATION AND ABSCESSES, &c. 355 surgical purpose, it is best to bleed him in a recumbent posture. But when the person is strong and vigorous, there is little occasion for this precaution, and a sitting posture is to be preferred, as the most convenient, both for the surgeon and patient. At the bend of the arm, there are several veins in which a punc- ture may be made, viz. the basilic, cephalic, median basilic, and median cephalic. The median basilic vein being usually the larg- est and most conspicuous, is that in which the operation is mostly performed ; but it should never be forgotten, that it is under this vessel that the brachial artery runs, with the mere intervention of the thin aponeurotic sheath, sent off by the biceps muscle. In ve- ry thin persons, indeed, the medial basilic vein lies almost close to the artery, and nothing is then more easy than to transfix the first of these vessels and wound the last. In fat subjects, the large veins at the bend of the arm are some- times totally imperceptible, notwithstanding the fillet is tightly ap- plied, the limb is put in warm water, and every thing done to make those vessels as turgid as possible. Under these circumstances, if the surgeon has not had much experience in the practice of vene- section, he will do well to be content with opening one of the veins of the back of the hand, after putting the member for some time in warm water, and applying a ligature round the wrist. In chUdren, a sufficient quantity of blood cannot always be ob- tained by venesection, and, in this event, the free application of leeches, and, occasionally, the puncture of the temporal artery, are the only effectual methods. One of the most common ill consequences of bleeding in the arm is a thrombus, or ecchymosis, that is, a small tumour around the orifice, and occasioned by the blood insinuating itself into the ad- joining cellular substance, at the time this fluid is escaping from the vein. Changing the posture of the arm will frequently hinder the thrombus from increasing in size, so as to obstruct the evacua- tion of blood. The best.applications for promoting the absorption of these tumours, are those containing spirit, vinegar, or i (uriate of ammonia. Compresses wetted with any lotion of this sort, u.ay be advantageously put on the swelling, and confined there with a slack bandage. The integuments and subjacent cellular substance, the absorb- ents, the vein, &c. are all liable to inflammation, in consequence of bleeding, a nerve also may be wounded, all requiring proper surgical treatment. Topical Blood-letting. This is performed either by means of a scarificator and cupping- glass, or leeches, or by dividing the visibly distended vessels with a lancet, as is frequently done in cases of inflammation of the eye. Inflammations and Abscesses. From whatever cause inflammation proceeds, it must terminate either by dispersion, suppuration, or gangrene. Though it is im- possible to foretel with certainty in which of these ways any par- ticular inflammation will terminate, yet a probable conjecture may 856 INFLAMMATION AND ABSCESSES. be formed with regard to the event, from a knowledge of the pa- tient's age and constitution. Inflammations happening in a slight degree upon colds, and without any previous indisposition, will most probably be dispersed ; those which follow close upon a fever, or happen to persons of a gross habit of body, will generally sup- purate ; and those which attack very old people, or persons of a dropsical habit, will have a strong tendency to gangrene. If the inflammation be slight, and the constitution sound, the dispersion ought always to be attempted. This will be best pro- moted by a slender diluting diet, plentiful bleeding, and repeated purges. The part itself must be fomented, and, if the skin be very tense, it may be embrocated with a mixture of three-fourths of sweet oil, and one-fourth of vinegar, and afterwards covered with a piece of wax-plaster. If, notwithstanding these applications, the symptomatic fever in- creases, and the tumour becomes larger, with violent pain and pul- sation, it will be proper to promote the suppuration. The best application for this purpose is a soft poultice, which may be renew- ed twice a-day. If the suppuration proceeds but slowly, a raw onion cut small or bruised may be spread upon the poultice. When the abscess is ripe or fit for opening, which may easily be known from the thinness of the skin in the most prominent part of it, fluctuation of matter, which may be felt under the finger, and, gen- erally speaking, an abatement of the pain, it may be opened either with a lancet, or by means of caustic. The last way in which an inflammation terminates, is in a gan- grene or mortification, the approach of which may be knOwn by the following symptoms :—The inflammation loses its redness, and becomes duskish or livid; the tension of the skin goes off, and it feels flabby; little bladders filled with ichor of different colours spread all over it; the tumour subsides, and from a duskish com- plexion becomes black; a quick low pulse, with cold clamm sweats, are the immediate forerunners of death. When these symptoms first appear, the part ought to be dressed with London treacle, or a cataplasm made of lixivium and bran, Should the symptoms become worse, the part must be'scarified, and afterwards dressed with basilicum softened with oil of turpen- tine. All the dressings must be applied warm. With regard to internal medicines, the patient must be supported with 'generous cbrdials, and the Peruvian bark exhibited in as large doses as the stomach will bear it. If the mortified parts should separate, the wound.will become a common ulcer ; and must be treated accord- ingly. This article includes the treatment of all those diseases, which, in different parts of the country, go by the names of biles, impost- hnmes, whitloes,* Sec They are all abscesses in consequence of a * A whitloe is a very painful complaint. It is generally caused by a small quantity of purulent matter lodged very deep, and compressed by the hard unyielding skin cov- ering the finger. The pain may be instantly relieved by making a pretty deep incision with a lancet. The skin should also be rather freely divided, which will prevent the compression of the fungous flesh that is frequently thrown out from a whitloe,and which, when girt by the skin, occasions great pain. The wound may be dressed with a little Peruvian balsam spread on lint. An incipient whitloe may occasionally m dispersed by immersing the part in water as hot as it can be borne. A. P. B. WOUNDS. 367 previous inflammation, which, if possible, ought to be discussed; but, when this cannot be done, the suppuration should be promot- ed, and the matter discharged by an incision, if necessary; after- wards, the sore may be dressed with yellow basilicum, or some other digestive ointment. Wounds. No part of medicine has been more mistaken than the treatment or cure of wounds. Mankind in general believe that certain herbs, ointments, and plasters, are possessed of wonderful healing pow- ers, and imagine that no one can be cured without the application of them. It is, however, a fact, that no external application what- ever contributes towards the cure of a wound, any other way than by keeping the parts soft, clean, and defending them from the ex- ternal air, which may be as effectually done by dry lint, as by the most pompous applications, while it is exempt from many of the bad consequences attending them. ' The same observation holds with respect to internal applications. These only promote the cure of wounds as far as they tend to pre- vent a fever, or to remove any cause that might obstruct or impede the operations of Nature. It is Nature alone that cures wounds. All that art can do is to remove obstacles, and to put the parts in such a condition as is the most favourable to Nature's efforts. With this simple view we shall consider the treatment of wounds, and endeavour to point out such steps as ought to be taken to fa- cilitate their cure. The first thing to be done when a person has received a wound, is to examine whether any foreign body be lodged in it, as wood, 6tone, iron, lead, glass, dirt, bits of cloth, or the like. These, if possible, if it can be conveniently done, ought to be extracted, and the wound cleaned before any dressings be applied. When that cannot be effected with safety, on account of the patient's weak- ness or loss of blood, they must be suffered to remain in the wound, and afterwards extracted when he is more able to bear it. When a wound penetrates into any of the cavities of the body, as the breast, the bowels, &c, or where any considerable blood- vessel is cut, a skilful surgeon ought immediately to be called, otherwise the patient may lose his life. But sometimes the dis- charge of blood is so great, that if it be not stopped, the patient may die, even before a surgeon, though at no great distance, can arrive. In this case, something must be done by those who are present. If the wound be in any of the limbs, the bleeding may generally be stopped by applying a tight ligature or bandage round the member, a little above the wound. The best method of doing this is to put a strong broad garter round the part, but so slack as easily to admit a small piece of stick to be put under it, which must be twisted, in the same manner as a countryman does a cart- rope to secure his loading, till the bleeding stops. Whenever this is the case, he must take care to twist it no longer, as straining it too much might occasion an inflammation of the parts, and endan- ger a gangrene. In parts where this bandage cannot be applied, various other methods may be tried to stop the bleeding, as the application of 358 WOUNDS. styptics, astringents, Sec Cloths dipped in a solution of blue vit- riol in wate1*, or the styptic water of the dispensatories, may be ap- plied to the wound. When these cannot be obtained, strong spir- its of wine may be used. Some recommend the agaric* of the oak as preferable to any of the other styptics ; and indeed it de serves considerable encomiums. It is easily obtained, and ought to be kept in every family, in case of accidents. A piece of it must be laid upon the wound, and covered with a good deal of lint, above which a bandage may be applied so tight as to keep it firm- ly on. Though spirits, tinctures, and hot balsams, may be used, in or- der to stop the bleeding from small vessels when it is excessive, they are improper at other times. They do not promote, but re- tard the cure, and often change a simple wound into an ulcer. People imagine, because hot balsams congeal the blood, and seem, as it were, to solder up the wound, that they therefore heal it; but this is only a deception. They may indeed stop the flowing blood, by searing the mouth of the vessels ; but, by rendering the parts callous, they obstruct the cure. In slight wounds, which do not penetrate much deeper than the skin, the best application is a bit of the common black sticking- plaster. This keeps the sides of the wound together, and prevents the air from hurting it, which is all that is necessary. When a wound penetrates deep, the edges of it, if a clean incised wound, ought to be brought in contact, and retained in that position by means of slips of adhesive plaster, when, in all probability, it will become glued together by what surgeons term the adhesive inflammation. If a deep irregular wound, from blunted instru- ments, it is not safe to keep the lips quite close ; this keeps in the matter, and is apt to make the wound fester. In this case the best way is to fill the wound with soft lint, commonly called caddis. It, however, must not be stuffed in too hard, otherwise it will do hurt. The lint may be covered with a cloth dipped in oil, or spread with the common wax-plaster or poultice; and the whole must be kept on by a proper bandage, as circumstances may point out. The first dressing ought to continue on for at least two days; after which it may be removed, and fresh lint applied as before. If any part of the first dressing sticks so close as not to be remov- ed with ease or safety to the patient, it may be allowed to contin- ue, and fresh lint dipped in sweet oil laid over it. This will soften it so as to make it come off easily at next dressing. Afterwards, the wound may be dressed twice a-day in the same manner till it *Dr. Tissot, in his Advice to the People, gives the following directions for gathering, preparing, and applying the agaric:—"Gather in autumn," says he, "while the fine weather lasts, the agaric of the oak, which is a kind of fungus or excrescence issuing from the wood of that tree. It consists at first of four parts, which present themselves successively: 1. The outward rind or skin, which may be thrown away. 2. The part immediately under this rind, which is the best of all. This is to be beat well with a hammer, till it becomes soft and very pliable. This is the only preparation it requires, and a slice of it of a proper size is to be applied directly over the bursting open blood- vessels. It constringes and brings them close together, stops the bleeding, and gene- rally falls off at the end of two days. 3. The third part adhering to the second, may serve to stop the bleeding from the smaller vessels ; and the fourth and last part may be redueed to powder, as conducing to the same purpose.'—Where the agaric cannot be had, sponge may be used in its stead. It must be applied in the same manner, and bas nearly the same effects. BURNS. 359 be quite healed. Those who are fond of salves or ointments may, after the wound is become very superficial, dress it withthe yellow basilicum ; and if fungous, or what is called proud flesh, should rise in the wound, it may be checked, by mixing with the ointment a little burnt alum, or red precipitate of mercury ; or it may be kept down by a compress. When a wound is greatly inflamed, the most proper application is a poultice of bread and milk, softened with a little sweet oil or fresh butter. This must be applied instead of a plaster, and should be changed twice a-day. If the wound be large, and there is reason to fear an inflamma- tion, the patient should be kept on a very low diet. He must ab- stain from animal food, strong liquors, and every thing that is of a heating nature. If he be of a full habit, and has lost but little blood from the wound, he must be bled ; and, if the symptoms he urgent, the operation may be repeated. But when the patient has been greatly weakened by loss of blood from the wound, it will be dangerous to bleed him, even though a fever should ensue. Nature should never be too far exhausted. It is always more safe to allow her to struggle with the disease in her own way, than to sink the patient's strength by excessive evacuations. Wounded persons ought to be kept perfectly quiet and easy. Every thing that ruffles the mind, or moves the passions, as love, anger, fear, excessive joy, &c. are very hurtful. They ought, above all things, to abstain from venery. The body should be kept gently open, either by laxative clysters, or by a cool vegeta- ble diet, as roasted apples, stewed prunes, boiled spinage, and such like. Burns. In slight burns, which do not break the skin, it is customary t;> hold the part near the fire for a competent time, to rub it with salt, or to lay a compress upon it, dipped in spirits of wine or brandy. It is, however, a preferable practice to plunge immediately the burnt or scalded part into cold water, and keeping it for some time im- mersed. Strong brandy or alcohol is particularly praised. At first the pain is increased by this remedy, but an agreeable sooth- ing sensation soon follows. The parts should be immersed in the spirit, and, when this cannot be done, soft old linen, soaked in the application, should be constantly kept on the part. A strong solution of alum and water is also useful. These applications are fre- quently made to prevent small blisters from arising, and should be continued as long as the pain remains; and in extensive burns, creating great irritation, opium should be prescribed, as the stu- por with which patients so circumstanced are attacked, receives more relief from opium than any thing else. But when the burn has penetrated so deep as to blister or break the skin, it must be dressed with some of the liniments for burns mentioned in the Appendix, or with the emollient and gently-drying ointment, com- monly called Turner's cerate.* This may be mixed with an equal quantity of fresh olive-oil, and spread upon a soft rag, and applied » See Appendix, Turner's Cerate. 360 BURNS. to the part affected. When this ointment cannot be had, an egg may be beat up with an equal quantity of the sweetest salad-oil. This will serve very well, till a proper ointment can be prepared. When the burning is very deep, after the first two or three days, it should be dressed with equal parts of yellow basilicum and Tur- ner's cerate, mixed together. When the burn is violent, or has occasioned a high degree of inflammation, and there is reason to fear a gangrene or mortifica- tion, the same means must be used to prevent, as are recommend- ed in other violent inflammations. The patient, in this case, must live low, and drink freely of weak diluting liquors. He must like- wise be bled and have his body kept open. But if the burnt parts should become livid or black, with other symptoms of mortification, it will be necessary to bathe them frequently with warm campho- rated spirits of wine, tincture of myrrh, or other antiseptics, mix- ed with a decoction of the bark. In this case the bark.must like- wise be taken internally, and the patient's diet must be more gen- erous, with wine, Sec As example teaches better than precept, I shall relate the treat- ment of the most dreadful case of this kind that has occurred in my practice. A middle-aged man, of a good constitution, fell into a large vessel full of boiling water, and miserably scalded about one half of his body. As his clothes were on, the burning in some parts was very deep before they could be got off. For the firsf two days the scalded parts had been frequently anointed with a mixture of lime-water and oil, which is a very proper application for recent burnings. On the third day when I first saw him, his fever was high, and his body costive, for which he was bled, and had an emollient clyster administered. Poultices of bread and milk, softened with fresh butter, were likewise applied to the af- fected parts, to abate the heat and inflammation. His fever still continuing high, he was bled a second time, was kept strictly on the cooling regimen, took the saline mixture with small doses of nitre, and had an emollient clyster administered once a-day. When the inflammation began to abate, the parts were dressed with a digestive composed of brown cerate and yellow basilicum. Where any black spots appeared, they were slightly scarified, and touched with the tincture of myrrh ; and to prevent their spread- ing, the Peruvian bark was administered. By this course, the man was so well in three weeks as to be able to attend his business.* Equal parts of linseed-oil and lime-water form an excellent cooling emollient application to burns produced by gunpowder, or those that are less destroyed. In some cases Goulard's cerate, and a weak solution of the superacetate of lead, more quickly pro- cure ease. * This practice answers very well in scalds; but in severe burns, such as are occa- sioned by the explosion of gunpowder, or of inflammable air in coal mines, the method recommended by Mr. Kentish, of applying to the burned part spirit of turpentine, by means of a feather, till the suppuration is fairly established, and afterwards covering the surface with pure chalk, finely powdered, is preferable practice. The patient's strength must be supported by cordial medicines, and a generous diet. In slight burns and scalds, immersing the part in iced water, or wrapping it in cloths kept con. ■tantly moist with spirit of wine or aether, which by its evaporation occasions cfcld, relieves pain, and prevents vesication. A. P. B. BURNS. 361 Mr. Cleghorn's Plan of treating Burns and Scalds. Mr. Cleghorn, a brewer in Edinburgh, was inclined to pay great attention to the effects of various modes of treating burns, on ac- count of the frequency of these .accidents among his own work- men. His observations led him to prefer the immediate applica- tion of vinegar, which was to be continued for some hours, by any of the most convenient means, until the pain abated, and when this returned the vinegar was renewed. If the burn had been so se- vere as to have produced a destruction of parts, these, as soon as the pain had ceased, were covered with a poultice, the application of which was continued about six, or, at most, eight hours, and af-- ter its removal the parts were entirely covered with finely powder- ed chalk, sc as to take away every appearance of moisture on the surface of the sore. This being done, the whole burnt surface was again covered with poultice. The same mode was pursued every night and morning until the cure was complete. If the use of poultices relaxed the ulcers too much, a plaster or ointment, con- taining subcarbonate of lead, was applied ; but the chalk was still sprinkled on the sore. Diluted sulphuric acid was found to answer as well as vinegar. In cold weather Mr. Cleghorn sometimes warmed the vinegar a little, placed the patients near the fire, gave them something warm internally, and kept them in every respect in a comfortable situa- tion. His object in so doing was to prevent the occurrence of tremblings and chillness, which, in two instances, after the em- ployment of cold vinegar, took place in an alarming degree. Sir James EarWs Plan. This gentleman was an advocate for the use of cold water, or rather ice ; and published several cases of extensive burns, in which this method was employed with the best success. The burnt parts may either be plunged in cold water, or they may be covered with linen dipped in the same, and renewed as often as it acquires warmth from the part. The application should be con- tinued as long as the heat and pain remain, which they will often do for a great many hours. Some caution, however, becomes necessary, in the application of cold, when the scald is of very large size, or situated upon the trunk of the body. In extensive burns, superficial as they may be, the patient is liable to be affected with cold shiverings; and these Bhiverings may be greatly aggravated by exposure, and by the ap- plication of cold. Perhaps, therefore, in these examples warm applications ought to be preferred. The sores resulting from burns are perhaps more disposed than any other ulcer, to form large granulations, which rise considera- bly above the level of the surrounding skin. At this stage no poul- tices should be used. The sores should be dressed with Turner's cerate, or basilicum mixed with a little red precipitate, and if the part will allow of the application of a roller, the pressure will be of great service in keeping down the granulations, (commonly called proud flesh,) and rendering them more healthy. ?&> BRUISES.—ULCERS. Bruises. Bruises are generally productive of worse consequences than wounds. The danger from them does not appear immediately, by which means it often happens that they are neglected. It is need- less to give any definition of a disease so universally known; we shall therefore proceed to point out the method of treating it. In slight bruises it will be sufficient to bathe the part with warm vinegar, to which a little brandy or rum may occasionally be added, and to keep cloths wet with this mixture constantly applied to it. This is more proper than rubbing it with brandy, spirits of wine, or other ardent spirits, which are commonly used in such cases. In some parts of the country the peasants apply to a recent bruise a cataplasm of fresh cow-dung. I have often seen this cata- plasm applied to violent contusions, occasioned by blows, falls, bruises, and such like, and never knew it fail to have a good effect. When a bruise is very violent, the patient ought immediately to be bled, and put upon a proper regimen; a sufficient number of leeches ought likewise to be applied to the part. His food should be light and cool, and his drink weak, and of an opening nature; as whey sweetened with honey, decoctions of tamarinds, barley, cream-tartar-whey, and such like. The bruised part must be bath- ed with vinegar and water, as directed above ; and a poultice made by boiling crumb of bread, elder-flowers, and camomile-flowers, in equal quantities of vinegar and water, applied to it. This poul- tice is peculiarly proper when a wound is joined to the bruise. It may be renewed two or three times a-day. As the structure of the vessels is totally destroyed by a violent bruise, there often ensues a great loss of substance, which produ- ces an ulcerous sore very difficult to cure. If the bone be affected, the sore will not heal before an exfoliation takes place; that is, before the diseased part of the bone separates, and comes out through the wound. This is often a very slow operation, and may even require several years to be completed. Hence it happens, that these sores are frequently mistaken for the king's evil, and treated as such, though in fact they proceed solely from the injury which the solid parts received from the blow. Patients in this situation are pestered with different advices. Every one who sees them proposes a new remedy, till the sore is so much irritated with various and opposite applications, that it is often at length rendered absolutely incurable. The best method of managing such sores is, to take care that the patient's constitu- tion does not suffer by confinement or improper medicine, and to apply nothing to them besides simple ointment spread upon soft lint, over which a poultice of bread and milk, with boiled camomile flowers, or the like, may be put, to nourish the part, and keep it soft and warm. Nature, thus assisted, will generally in time oper- ate a cure, by throwing off the diseased parts of the bone, after which the sore soon heals. Ulcers. Ulcers are divided into local or constitutional; it is only, how- ever, within certain limits that this distinction is well founded ; for ULCERS. 363 an ulcer which is at first completely local, may in time affect the system so as to become constitutional; and ulcers which derive their origin from some general affection of the system, may remain after the removal of the constitutional disorder, by which they were originally produced. Ulcers may be the consequence of wounds, bruises, or impost- humes properly treated ; they may likewise proceed from an ill state of the humours, or what may be called a bad habit of body. In the latter case they ought not to be hastily dried up, other wise it may prove fatal to the patient. Ulcers happen most com- monly in the decline of life; and persons who neglect exercise, and live grossly, are most liable to them. They might often be preventer! by retrenching some part of the solid food, or by open- ing artificial drains, as issues, setons, or the like. An ulcer may be distinguished from a wound' by its discharging a thin watery humour, which is often so acrid as to inflame and corrode the skin; by the hardness and perpendicular situation of its sides or edges; by the time of its duration, &c. It requires considerable skill to be able to judge whether or not an ulcer ought to be dried up. In general, all ulcers which proceed from a bad habit of body, should be suffered to continue open, at least till the constitution has been so far changed by prop- er regimen, or the use of medicine, that they seem disposed to heal of their own accord. Ulcers which are the effect of malig- nant fevers or other acute diseases, may generally be healed with safety after the health has been restored for some time. The cure <. aght not, however, to be attempted too soon, nor at any time without the use of purging medicines and a proper regimen. When wounds or bruises have, by wrong treatment, degenerated into ulcers, if the constitution be good, they may generally be used with safety. When ulcers either accompany chronical diseases, or come in their stead, they must be cautiously healed. If an ul- cer conduces to the patient's health, from whatever cause it pro- ceeds, it ought not to be healed ; but if, on the contrary, it wastes the strength, and consumes the patient by a slow fever, it should be healed as soon as possible. We would earnestly recommend a strict attention to these par- ticulars to all who have the misfortune to labour under this disor- der, particularly persons in the decline of life; as we have fre- quently known people throw away their lives by the want of it, while they were extolling and generously rewarding those whom they ought to have looked upon as their executioners. Cure of Ulcers by Roller and Compresses, &/c. on Mr. Whately\ Plan. Bandages are of the most essential service in healing many kinds of ulcers ; but their efficacy is so great in curing numerous indolent sores, that they are sometimes considered the principal means of cure. Mr. Whately, who is one of the most zealous modern advocates for this mode of treating ulcers, offers the fol- lowing remarks for the application of the roller and compresses. " The best width for a flannel roller, designed for those who 364 LLC ERS. have slender legs, is three inches ; but for those whose legs are of :i larger size, they should always be three inches and a half in width. They must therefore, at first, be torn a little wider, that they may be of their proper width when repeatedly washed. It will likewise be found, that rollers made of fine, soft, and open flannel will answer much better than those made of coarse or hard flannel. The rollers should be often washed, as they become much softer, and of course sit easier when quite clean than when soiled. " In applying a roller (says this gentleman) the first circle should be made round the lowest part of the ancle, as near as possi- ble to the heel; the second should be formed from thence round the foot; the third, to be passed again round the foot quite to the toes. The roller should then be passed from the foot round the ancle and instep a second time, to make the fourth circle. In do- ing this it should be brought nearer (but not over) the point of the heel than it was at the first time of going round the part. The fifth circle should pass over the ancle again, and not more than half an inch higher up the leg than the fourth circle. The sixth, seventh, eighth, and ninth circles should ascend spirally along the small of the leg, at the exact distance of three-fourths of an inch from each other. Having proceeded thus far up the leg, we may begin to increase the distance of the circles from each other, which may now succeed each other upward to the knee, at the dis- tance of from one to two inches, according to the size and shape of the leg. At that part where the calf of the leg commences it is generally necessary to let the upper edge of the roller be once, twice, or thrice turned downwards, for about half the circumfer- ence of the leg, in order to make the roller lay smooth between the middle of the calf and the small of the leg. When the roller has been thus applied as far as the knee there will be a portion of it to spare, of perhaps a yard in length ; this remainder should be brought down by spiral windings, at greater distances from each other than those which were made in the ascent of the roller. The windings should in general be completed in the small of the leg, where the roller should be pinned. " In applying the compresses, it is necessary in every instance, to put them on one by one, and not all in a mass, though they be of a proper size and number. They should be crossed in differ- ent directions; the largest of them should in no case be longer than just to meet on the opposite side of the leg to which they are applied. If the same compresses in any case be applied two days together, they should always be turned on the contrary side at each -re-application, in order to prevent wrinkles on the skin." As Mr. Whately objects to pressure being made with adhesive plaster, the following is the calamine cerate he has usually employed. Take Prepared Hog's Lard, 3 lb. Lead Plaster, 1£ lb. Prepared Calamine, 1 lb. To this formula Mr. Whately adds another for making a cerate, which nearly resembles the unguentum tripharmicum of the old dispensatory ; but being less oily, it makes a much more adhesive' ULCERS. 365 plaster. It should be spread on rag or silk, as an external cover- ing to the dressing on lint, where a tow-plaster cannot be conve- niently used ; as in wounds of the face or hands, a bubo, or any other sore, where an external plaster cannot readily be retained in its situation by a bandage. This plaster is likewise so mild that it never irritates the skin. It has also been found very useful in frac- tures. The following is the formula : Take Lead Plaster, 1 lb. Hog's Lard, Prepared, 6 ounces. Vinegar, 4 ounces. Mix. Mr. Baynton1 s Plan of curing old Ulcers of the Leg by Means of Adhesive Plaster, without Rest. Mr. Baynton says that the means proposed by him will be found, in most instances, sufficient to accomplish cures in the worst cases, without pain or confinement. After having been repeatedly dis- appointed in the cure of old ulcers, Mr. Baynton determined on bringing their edges nearer together by means of slips of adhesive plaster. To this he was chiefly led, from having frequently observ- ed, that the probability of an ulcer continuing sound depended much on the size of the cicatrix which remained after the cure ap- peared to be accomplished; and from knowing well, that the true skin was a much more substantial support and defence, as well as a better covering, than the frail one, which is obtained by the as- sistance of art. But, when he had recourse to the adhesive plaster with a view to lessen the probability of those ulcers breaking out again, he little expected, that an application so simple would prove the easiest, most efficacious, and most agreeable means of treating ulcers. His method is as follows : " The parts should be first cleared of the hair, sometimes found in considerable quantities on the legs, by means of a razor, that none of the discharges, by being retained, may become acrid and inflame the skin, and that the dressings may be removed with ease at each time of their renewal, which, in some cases, where the discharges are profuse, and the ulcers very irritable, may, perhaps, be necessary twice in the twenty-four hours, but which I have in every instance been only under the necessity of performing once in that space of time. " The plaster should be prepared by slowly melting, in an iron ladle, a sufficient quantity of litharge plaster, or diacylon, which, if too brittle when cold to adhere, may be rendered adhesive by melting half a drachm of resin with every ounce of the plaster : when melted it should be stirred till it begins to cool, and then spread thinly upon slips of smooth porous calico, of a convenient length and breadth, by sweeping it quickly from the end held by the left hand of the person who spreads it, to the other, held firmly by another person, with the common elastic spatula used by apoth- ecaries : the uneven edges must be taken off, the pieces cut into slips, about two inches in breadth, and of a length that will, after being passed round the limb, leave an end of about four or five inches. The middle of the piece so prepared is to be applied to the sound part of the limb, opposite to the inferior part of the ulcer, 366 ULCERS. bo that the lower edge of the plaster may be placed about an inch below the the lower edge of the sore, and the ends drawn over the ulcer with as much gradual extension as the patient can well bear; other slips are to be secured in the same way, each above and in contact with the other, until the whole surface of the sore and the limb are completely covered, at least one inch below, and two or three above the diseased part. The whole of the leg should then be equally defended with pieces of soft calico, three or four times doubled, and a bandage of the same, about three inches in breadth, and four or five yards in length, or rather as much as will be suffi- cient to support the limb from the toes to the knee, should be ap- plied as smoothly as can possibly be performed, and with as much firmness as can be borne by the patient, being first passed round the leg at the ancle-joint, then as many times round the foot as will cover and support every part of it, except the toes, and after- wards up the limb till it reaches the knee, observing that each turn of the bandage should have its lower edge so placed as to be about an inch above the lower edge of the fold next below. If the parts be much inflamed, or the discharge very profuse, they should be well moistened, and kept cool with cold spring water, poured upon them as often as the heat may indicate to be necessary, or, perhaps, at least, every hour. The patient may take what exer- cise he pleases, and it will always be found, that an alleviation of his pain and the promotion of his cure will follow as its conse- quence, though, under other modes of treating the disease, it ag- gravates the pain, and prevents the cure. " These means, when circumstances render it convenient, should be applied soon after rising in the morning, as the legs of persons affected with this disease are then found most free from tumefac- tion, and the advantages will be greater than when they are appli- ed to limbs in a swollen state. The first applications will some- times occasion pain, which, however, subsides in a short time, and is less sensibly felt at each succeeding dressing. The force with which the ends are drawn over the limb must then be gradually increased, and when the parts are restored to their natural state of ease and sensibility, which will soon happen, as much may be applied as the calico will bear, or the surgeon can exert; especially if the limb be in that enlarged and compressible state, which has been denominated the scorbutic, or if the edges of the wound be widely separated from each other." " Cures," adds Mr. B., " will be generally obtained without difiiculty by the mere application of the slips and bandage; but, when the parts are much inflamed, and the secretions great, or the season hot, the frequent application of cold water will be found a valuable auxiliary, and may be always safely had recourse to, where the heat of the part is greater than is natural, and the body free from perspiration. The most proper regimen for promoting the cure of ulcers is to avoid all spices, salted and high-seasoned food, all strong liquors, and to lessen the usual quantity of flesh meat. The body ought to be kept gently open by a diet consisting chiefly of cooling laxa- tive vegetables, and by drinking butter-milk, whey sweetened with honey, or the like. The patient ought to be kept cheerful, and should take as much exercise as he can easily bear FISTULA IN ANO. 367 When the bottom and sides of an ulcer seem hard and callous, they may be sprinkled twice a-day with a little red precipitate of mercury, and afterwards dressed with the ointment of yellow 6a- silicon, or cerate of resin. Sometimes it will be necessary to have the edges of the ulcer scarified with the lancet. Limewater has frequently been known to have very happy effects in the cure of obstinate ulcers. It may be ilsed in the same man- ner as directed for the stone and gravel. For indolent ulcers, Sir Everard Home recommends the application of diluted nitrous acid, in the proportion of a scruple to eight ounces of water. It pro- motes, in an uncommon manner, the progress of the cur,e; and, jalthough painful at first, this sensation soon ceases, and produces the best effects. My late learned and ingenious friend Dr. White strongly recom- mends the use of the solution of corrosive sublimate of mercury in brandy, for the cure of obstinate ill-conditioned ulcers. I have frequently found this medicine, when given according to the Doctor's directions, prove very successful. The dose is a table-spoonful night and morning; at the same time washing the sore twice or thrice a-day with it. In a letter which I had from the Doctor a lit- tle before his death, he informed me, " that he observed washing the sore thrice a-day with the solution of a triple strength was very beneficial."* The carrot poultice is found to agree with a great many irrita- ble sores; and the decoction of poppy-heads is also found to be a good liquor for making poultices. The great objection to poulti- ces in these cases being their weight, the limb should always, if possible, rest upon the poultice, and not the poultice, upon the limb. When the weight cannot be avoided and is hurtful, a lighter application should be chosen. When poultices are employed, their use should be continued as long as the granulations are small, and the ulcer rapidly diminishing in size ; and this, even until the cica- trization be complete. When the granulations become large and loose in their texture, poultices should be left off, when a slight or necessary degree of pressure may be adopted. Of the Fistula in Ano. Ulcers in the neighbourhood of the anus are peculiarly liable to become fistulous, and when in that state are very difficult to cure. A fistula, is frequently the consequence of neglected or ill-treated piles. The presence of this complaint is discovered by the sensa- tion of a pricking pain on going to stool, which is also perceived during the exertion of coughing or sneezing. On examination, a stain of a pale colour, occasionally accompanied with a little blood, will be found upon the linen ; the fieces are also slightly streaked with matter. This matter issues from a small ulcer with one or more orifices, in the neighbourhood of the anus, the other extremity of which generally communicates with the internal cav- ity of the rectum. • In ulcers of the lower limbs great benefit is often received from wearing a laced stocking, as this prevents the flux of humours to the sores, and disposes them to heal. 368 FISTULA IN ANO. When this disease is ascertained to be present, costiveness should be guarded against chiefly by means of diet, which ought to be cooling, and consist of ripe figs, roasted apples, and articles of a similar nature. Oatmeal porridge eaten with milk or beer, for breakfast or supper, rarely fails to keep the body regular. The radical cure of this complaint must depend on the proper applica- tion of topical remedies. Much may be done by strict attention to personal cleanliness. The parts should be carefully washed with a sponge and water several times a-day, and regularly after going to stool. Stimulant injections, as for example a solution of corrosive sublimate, or of common culinary salt, tincture of can- tharides", or port wine thrown into the fistula by means of a small syringe, or elastic gum-bottle, furnished with a conical point, have, when duly persisted in, effected a cure. Or, the orifice of the fis- tula may be kept open, and a free passage given to the contained matter, by means of a tent or bougie shaped like a cone, and the ulcer be thus disposed to heal. This disease has also been at- tempted to be cured by introducing a bougie, or flexible leaden probe into the fistula, passing it through the orifice that communi- cates with the rectum, and bringing it out at the anus, then twist- ing the two opposite extremities together, and occasionally tight- ening them, till they destroy the interposed substance, when the fistula, being reduced to the state of a simple ulcer, heals. Drinking any sulphureous mineral water, such as that of Har- rowgate, improves the constitution in general, and by that means tends to promote the healing of the ulcer. In cold, languid, and what are termed phlegmatic habits, tar-water may be taken with considerable advantage. I knew an instance of a fistulous sore, seated near the rectum, being almost healed up by taking regularly half a pint of sea-water morning and evening for six weeks togeth- er, and belieye it might have been completely cured, had the per- son persisted in this course for a sufficient length of time. It is certainly worth while to give any of these remedies a fair trial previous to having recourse to the operation, as even that does not always succeed. Ulcerations about the rectum are frequently symptomatic of af- fections of the liver. When that is known to be the case, or when they occur about the decline of life, or in persons who have resided long in warm climates, we should not be too busy with our efforts to heal them up. In such persons they seem frequently to operate as salutary drains to the constitution, and to prevent the access of other diseases. Many examples have occurred of persons some- what advanced in life being attacked by asthma, spitting of blood, paralysis, and even insanity, within a short period of time after undergoing the operation for the radical cure of a fistula; while others, of apparently similar constitutions, who have submit- ted to the inconveniency of a discharge, and been attentive to keep the parts clean and warm, have lived to an advanced period of life. Individuals past the meridian of life, who determine to un- dergo the operation for fistula, should never omit to have an issue opened in some other part of the body, which may serve as a suc- cedaneum for the natural drain they are about to obliterate. A. P. B. DISLOCATIONS. 369 %* The medical treatment of fistulae in ano will depend on their eause. If they arise from costiveness, the remedies are obvious ; if from disease of the liver, calomel and saline purges ; if from disease of the chest, as dropsy, it is difficult to say what medicine ought to be recommended. It is of great importance, however, to give such medicines as will bring the fistula into a healthy state. With this view the balsam of copaiba may ^be given with advan- tage. If there be much irritation, give soda, which has great effi- cacy in diminishing the irritability of the rectum. Aromatic medi- cines should be given, especially that which used to go by the name of Wards's Paste, having been found by experience to produce ex- cellent effects in this disease: Take of Pepper 2 drachms, Ellecampane and Fennel seeds, of each half an ounce. These are to be mixed up with honey, in the form of an electuary ; of which a tea-spoonful is to be taken two or three times a-day. This soon brings the fistula into a healing state ; healthy granula- tions shoot up from the surface, and the discharge instead of being serous or bloody, consists of good pus. Calomel and saline pur- ges should be occasionally given during the use of these aromatic medicines, with a view of promoting the secretions of the liver and intestines. Ed. CHAP. XI. OF DISLOCATIONS. When a bone is moved out of its place or articulation, so as to impede its proper functions, it is said to be luxated or dislocated. As this often happens to persons in situations where no medical assistance can be obtained, by which means limbs, and even lives are frequently lost, we shall endeavour to point out the method of reducing the most common taxations, and those which require im- mediate assistance. Any person of common sense and resolution, who is present when a dislocation happens, may often be of more Bervice to the patient than the most expert surgeon can after the swelling and inflammation have come on. When these are pre- sent, it is difficult to know the state of the joint, and dangerous to attempt a reduction ; and by waiting till they are gone off, the muscles become so relaxed, and the cavity filled up, that the bone can never afterwards be retained in its place. A recent dislocation may generally be reduced by extension alone, which must always be greater or less according to the strength of the muscles which move the joint, the age, robustness, and other circumstances of the patient. When the bone has been out of its place for any considerable time, and a swelling or in- flammation has come on, it will be necessary to bleed the patient, and, after fomenting the part, to apply soft poultices with vinegar to it"for some time before the reduction is attempted. Q1 370 DISLOCATION OF THE JAW, &c. -t All that is necessary after the reduction, is to apply cloths dipt in vinegar or camphorated spirits of wine to the part, and to keep it perfectly easy. Many bad consequences proceed from the neg- lect of this rule. A dislocation seldom happens without the ten- dons and ligaments of the joint being stretched, and sometimes torn. When these are kept easy till they recover their strength and tone, all goes on very well; but if the injury be increased by too fre- quent an exertion of the parts, no wonder if they be found weak and diseased ever after. Dislocation of the Jaw. The lower jaw may be luxated by yawning, blows, falls, chew- ing hard substances, or the like. It is easily known from the pa- tient's being unable to shut his mouth or to eat any thing, as the teeth of the under jaw do not correspond with those of the upper; besides, the chin either hangs down or is thrown towards one side, and the patient is neither able to speak distinctly, nor to swallow without considerable difficulty. The usual method of reducing a dislocated jaw, is to set the patient upon a low stool, so as an assistant may hold the head firm by pressing it against his breast. The operator is then to thrust his two thumbs, being first wrapt up with linen cloths that they may not slip, as far back into the patient's mouth as he can, while his fingers are applied to the jaw externally. After he has got firm hold of the jaw, he is to press it strongly downwards and backwards, by which means the elapsed heads of the jaw may be easily pushed into their former cavities. The peasants in some parts of the country have a peculiar way of performing this operation. One of them puts a handkerchief under the patient's chin, then turning his back to that of the patient, pulls him up by the chin, so as to suspend him from the ground. This method often succeeds, but we think it a dangerous one, therefore recommend the former. Dislocation of the Neck. The neck may be dislocated by falls, violent blows, or the like.* In this case, if the patient receives no assistance, he soon dies, which makes people imagine the neck was broken; it is, however, for the most part, only partially dislocated, and may be reduced by almost any person who has resolution enough to attempt it. A complete dislocation of the neck is instantaneous death. When the neck is dislocated, the patient is immediately deprived of all sense and motion ; his neck swells, his countenance appears * The os occipitis, and first cervical vertebra, are so firmly connected by ligaments, that there is no instance of their being luxated from an external cause, and were the accident to happen, it would immediately prove fatal by the unavoidable compression and injury of the spinal marrow ; and in dislocations of the first cervical vertebra from the second, patients can hardly be expected to survive a mischief of this kind in so high a situation; when the transverse ligament is broken, and the dentated process is thrown directly backward against the medulla oblongata, the effect must be instant death, as happened in a case lately related by Mr. C. Bell. AH dislocations of the neck in which the processus dentatus is displaced are immediately fatal, although lux ations of the oblique cervical processes lower down may be reduced. Ed. DISLOCATION OF THE RIBS, &c. 371 bloated, his chin lies upon his breast, and his face is generally turned towards one side. To reduce this dislocation, the unhappy person should immedi- ately be laid upon his back on the ground, and the operator must place himself behind him, so as to be able to lay hold of his head with both hands, while he makes a resistance by placing his knees against the patient's shoulder. In this posture he must pull the head with considerable force, gently twisting it at the same time, if the face be turned to one side, till he perceives that the joint is replaced, which may be known from the noise which the bones generally make when going in, the patient's beginning to breathe. and the head continuing in its natural posture. This is one of those operations which it is more easy to perform than describe. I have known instances of its being happily per- formed even by women, and often by men of no medical education. After the neck is reduced, the patient ought to be bled, and should be suffered to rest for some days, till the parts recover their proper tone. Dislocation of the Ribs. i As the articulation of the ribs with the back-bone is very strong, they are not often dislocated. It does, however, sometimes hap- pen, which is a sufficient reason for our taking notice of it. When a rib is dislocated, either upwards or downwards, in order to replace it, the patient should be laid upon his belly on a table, aud the operator must endeavour to push the head of the bone into its proper place. Should this method not succeed, the arm of the disordered side may be suspended over a gate or ladder, and while the ribs are thus stretched asunder, the heads of such as are out of place may be thrust into their former situation. Those dislocations wherein the heads of the ribs are forced inwards, are both more dangerous and the most difficult to reduce, as neither the hand nor any instrument can be applied internally to direct the luxated heads of the ribs. Almost the only thing that can be done is, to lay the patient upon his belly over a cask, or some gibbous body, and to move the fore-part of the rib inward towards the back, sometimes shaking it; by this means the heads of the luxated ribs may slip into their former place. In a modern work* may be read the particulars of a case, where all the ribs are said to have been dislocated from the cartilages. The accident arose from the chest being violently compressed be- tween the beam of a mill and the wall. In such a case, there is no means of reduction, except the effect produced by forcible in- spiration ; nor are there any modes of relief but bleeding, and the application of a roller round the chest. Dislocation of the Shoulder.. The humerus or upper-bone of the arm may be dislocated in various directions : it happens, however, most frequently down- wards, but very seldom directly upwards. From the nature of its • C. Bell's Surg. Observations, p. 171. 372 DISLOCATION OF THE ELBOW, Sec. articulation, R3 well as from its exposure to external injuries, this bone is the most subject to dislocation of any in the body. A dis- location of the humerus may be known by a depression or cavity on the top of the shoulder, and an inability to move the arm. When the dislocation is downward or forward, the arm is elongat- ed, and a ball or lump is perceived under the arm-pit; but when it is backward, there appears a protuberance behind the shoulder, and the arm is thrown forwards towards the breast. The usual method of reducing dislocations of the shoulder is to seat the patient upon a low stool, and to cause an assistant to hold his body so that it may not give way to the extension, while an- other lays hold of the arm a little above the elbow, and gradually >Sf extends it. The operator then puts a napkin under the patient's arm, and causes it to be tied behind his own neck : by this, while a sufficient extension is made, he lifts up the head of the bone, and and with his hands directs it into its proper place. There are various machines invented for facilitating this operation, but the hand of an expert surgeon is always more safe. In young and delicate patients, I have generally found it a very easy matter to reduce the shoulder, by extending the arm with one hand, and thrusting in the head of the bone with the other. In making the extension, the arm ought always to be a little bent. Dislocation of the Elbow. The bones of the fore-artn may be dislocated in any direction. When this is the case, a protuberance may be observed on that side of the arm towards which the bone is pushed, from which, and the patient's inability to bend his arm, a dislocation of this joint may easily be known. Two assistants are generally necessary for reducing a dislocation of the elbow ; one of them must lay hold of the arm above, and the other below the joint, and make a pretty strong extension. while the operator returns the bones into their proper place. Af- terwards the arm must be bent, and suspended for some time with a sling about the neck. Luxations of the wrist and fingers are to be reduced in the same manner as those of the elbow, viz. by making an extension in different directions, and thrusting the head of the bone into its place. Dislocation of the Clavicle or Collar-bone. 4 The clavicle may be luxated at its sternal extremity,* forwards, backwards, arra upwards, but never downwards, on account of the situation of the cartilage of the first rib. The luxation forward is most frequent, and almost the only one ever met with. In reducing these dislocations of the sternal end of the clavicle, a lever is to be made of the arm, by means of which the shoulder is to be brought outwards ; and when thus brought outwards, it is to be pushed forwards, if the dislocation be in that direction; backward, if the dislocation be behind; and upward, if it be above. * The end nearest the breast-bone. DISLOCATION OF THE PATELLA, &c. 373 It is as difficult to keep the bone reduced, as it is easy to reduce it, so smooth and oblique are the articular surfaces. Dislocations of the capsular end of the clavicle, or that nearest the shoulder- joint, are much less common. The luxation upwards is the only one that ever occurs ; and this is reduced by carrying the shoulder outwards, putting a cushion in the axilla, and applying a proper bandage, as in fractures of this bone, making the turns ascend from the elbow to the shoulder, so as to press the luxated end of the bone downward, and keep it in its due situation, at the same time that the elbow is confined close to the side, and supported in ,a sling, by which means the shoulder will be kept raised and in- clined outwards. Dislocation of the Patella or Knee-pan. This bone may be luxated outwards, or even inwards, when vio- lently pushed in this direction. The dislocation outwards is the most frequent. The generality of cases of this description are easily reduced by pressure, when the extensor muscles of the leg have been completely relaxed ; but owing to a lax state of the ligament of the patella, or other predisposing causes, the bone is sometimes with difficulty retained in its proper position, unless a roller be ap- plied. The inflammatory affection of the joint is to be opposed, by top- ical bleeding, purging, and the use of evaporating lotions. The joint must be kept quiet a few days, and then gently moved, to prevent stiffness. Dislocation of the thigh. The head of the thigh-bone may be dislocated upwards (on the dorsum of the ilium,) upwards and forwards (on the body of the os pubis,) downwards and forwards (on the foramen ovale,) and backwards (on the ischiatio notch). The dislocation upward and backward, and that downward and forward, are the most frequent. When the thigh-bone is dislocated forward and downward, the knee and foot are turned out, and the leg is longer than the other ; but when it is displaced backward, it is usually pushed upwards at the same time, by which means the limb is shortened, and the foot is turned inwards. When the thigh-bone is displaced forward and downward, the patient, in order to have it reduced, must be laid upon his back, and made fast by bandages, or held by assistants, while by others a gradual and unremitting extension is made by means of slings, or a pulley fixed about the bottom of the thigh a little above the knee ; a sheet, folded longitudinally, being first placed under the perinaeum or fork, and one end carried behind the patient, the oth- er before him: they are to be fastened to one of the legs or posts of the bed, or other more secure part. While the extension is making, the operator must push the head of the bone outward, or as the circumstances of the case may require, till it gets into the socket. If the dislocation be outward, the patient must be laid 374 BROKEN BONES. upon his face, and during the extension the head of the bone must be pushed inward. Dislocations of the knees, ancles, and toes, are reduced much in the same manner as those of the upper extremities, viz. by making an extension in opposite directions, while the operator replaces the bones. In many cases, however, the extension alone is sufficient, fc and the bone will slip into its place merely by pulling the limb with sufficient force. It is not hereby meant, that force alone is sufficient for the reduction of dislocation. Skill and address will often succeed better than force. I have known a dislocation of the thigh reduced by one man, after all the force that could be used by six had proved ineffectual. . When the force of the muscles in very robust persons resists every effort to reduce a dislocated limb, a grain or two of emetic tartar dissolved in water may be administered, and taking advan- tage of the general languor and debility that precedes the act of vomiting, the limb may be reduced with facility. I have known this plan successfully practised ; to which may be added bleeding and the warm bath. CHAP. III. OF BROKEN BONES, &c. There is, in most country-villages, some person who pretends to the art of reducing fractures. Though in general such persons are very ignorant, yet some of them are very successful; which evidently proves, that a small degree of learning, with a sufficient share of common sense and a mechanical head, will enable a man to be useful in this way. We would, however, advise people never to employ such operators, when an expert and skilful surgeon can be had ; but when that is impracticable, they must be employed : we shall therefore recommend the following hints to their consid- eration :— When a large bone is broken, the patient's diet ought in all re- spects to be the same as in an inflammatory fever. He should likewise be kept quiet and cool, and his body open by emollient clysters; or, if these cannot be conveniently administered, by food that is of an opening quality ; as stewed prunes, apples boiled in milk, boiled spinage, and the like. It ought, however, to be here remarked, that persons who have been accustomed to live high are not all of a sudden to be reduced to a very low diet. This might have fatal effects. There is often a necessity for indulging even bad habits in some measure, where the nature of the disease might require a different treatment. It will generally be necessary to bleed the patient immediately after a fracture, especially if he be young, of a full habit, or haa at the same time received any bruise or contusion. This opera- tion should not only be performed soon after the accident happens, but, if the patient be very feverish, it may be repeated next day. When several of the ribs are broken, bleeding is peculiarly neces- sary. BROKEN BONES. 375 "The most unequivocal symptoms of fractures are, the crepitus or grating noise distinguished on moving the limb, occasioned by the fractured ends; the separation and inequalities of the ends of the fracture, when the bone is superficial; the change in the form of the limb, and the shortening of it. The treatment of fractures in general embraces three principal indications. 1. To reduce the pieces of the bones into their natu- ral situation. 2. To secure and keep them in their place by proper bandages and splints. 3. To prevent unpleasant symptoms, and to relieve them, when, in spite of every effort to the contrary, they do arise." If any of the large bones which support the body are broken, the patient must keep his bed for several weeks. It is by no means necessary, however, that he should lie all that time, as is customa- ry, upon his back. This situation sinks the spirits, galls and frets the patient's skin, and renders him very uneasy. After the second week, he may be gently raised up, and may sit several hours, sup- ported by a bed-chair, or the like, which will greatly relieve him. Great care, however, must be taken in raising him up and laying him down, that he make no exertions himself, otherwise the ac- tion of the muscles may pull the bone out of its place.* It is of great importance to keep the patient dry and clean while in this situation. By neglecting this, he is often so galled and excoriated, that he is forced to keep shifting places for ease. I have known a fractured thigh-bone, after it had been kept straight for above a fortnight, displaced by this means, and continue bent for life, in spite of all that could be done. It has been customary when a bone was broken, to keep the limb for five or six weeks continually upon the stretch. But this is a bad posture. It is both uneasy to the patient, and unfavoura- ble to the cure. The best situation is to keep the joint a little bent. This is the posture into which every animal puts its limbs when it goes to rest, and in which fewest muscles are upon the stretch. It is easily effected, by either laying the patient upon his side, or making the bed so as to favour this position of the limb. Bone-setters ought carefully to examine whether the bone be not shattered or broken into several pieces. In this case it will some- times be necessary to have the limb immediately taken off, other- wise a gangrene or mortification may ensue. The horror which attends the very idea of an amputation often occasions its being de- layed in such cases till too late. I have known this principle ope- rate so strongly, that a limb, where the bones were shattered into more than twenty pieces, was not amputated before the third day after the accident, when the gangrene had proceeded so far as to render the operation useless. * Various pieces of machinery have been contrived for counteracting the force of the muscles, and retaining the fragments of broken bones; but as descriptions of these without drawings would be of little use, I shall refer the reader to a cheap and useful oerformance, On the Nature and Cure of Fractures, lately published by my ingenious friend Mr Vitkin, surgeon, in Edinburgh ; wherein that gentleman has not only given an account of the machines recommended in fractnres by former authors, but has like- wise added several improvements of his own, which are peculiarly useful in compound fractures, and in cases where patienta with broken bones arc obliged to be transported from one place to another. 376 STRAINS. When a fracture is accompanied with a wound, it must be dress- ed in all respects as a wound. All that art can do towards the cure of a broken bone is to lay it perfectly straight, and to keep it quite easy. All tight bandages do hurt. They had much better be omitted altogether. A great many of the bad consequences which succeed to fractured bones are owing to tight bandages. This is one of the ways in which the excess of art, or rather the abuse of it, does more mischief than would be occasioned by the want of it. Some of the most sudden cures of broken bones which were ever known happened where no bandages were applied at all. Some method, however, must be taken to keep the member steady ; but this may be done many ways, without bracing it with a tight bandage. The best method of retention is by two or more splints made of leather or pasteboard. These, if moistened before they are ap- plied, soon assume the shape of the included member, and are suf- ficient, by the assistance of a very slight bandage, for all the pur- poses of retention. The bandage which we would recommend is that made with twelve or eighteen tails. It is much easier applied and taken off than rollers, and answers all the purposes of reten- tion equally well. The splints should always be as long as the limb, with holes cut for the ancles when the fracture is in the leg. In fractures of the ribs, where a bandage cannot be properly used, an adhesive plaster may be applied over the part. The pa- tient in this case ought to be bled, to keep himself quite easy, avoid- ing every thing that may occasion sneezing, laughing, coughing, or the like. He ought to keep his body in a straight posture, and should take care that his stomach be constantly distended, by tak- ing frequently some light food, and drinking freely of weak watery liquors. When the ribs are fractured on both sides bandages are not admissible, as the patient would be in extreme danger of being suffocated, from impeded action of the chest. The most proper external application for a fracture is oxycrate, or a mixture of vinegar and water, to which some spirits of wine may be added. The bandages should be wet with this at every dressing, if the inflammation runs high. CHAP. IV. OF STRAINS. Strains are often attended with worse consequences than brok- en bones. The reason is obvious : they are generally neglected. When a bone is broken, the patient is obliged to keep the member easy, because he cannot make use of it; but when a joint is only strained, the person finding he can still make a shift to move it, is sorry to lose his time for so trifling an ailment. In this way he deceives himself, and converts into an incurable malady what might have been removed by only keeping the part easy for a few days. Country-people generally immerse a strained limb in cold water. RUPTURES. 377 This is very proper, provided it be done immediately, and not kept in too long. But the custom of keeping the part immersed in cold water for a long time is certainly dangerous. It relaxes instead of bracing the part, and is more likely to produce a disease than remove one. Wrapping a garter, or some other bandage, pretty tight about the strained part, is likewise of use. It helps to restore the proper tone of the vessels, and prevents the action of the parts from in- creasing the disease. It should not, however, be applied too tight. I have frequently known bleeding near the affected part have a very good effect; but what we would recommend above all, is ease. It is more to be depended on than any medicine, and sel- dom fails to remove the complaint.* Rupturbs. Children and old people are most liable to this disease. In the former it is generally occasioned by excessive crying, coughing, vomiting, or the like. In the latter, it is commonly the effect of blows or violent exertions of the strength, as leaping, carrying great weights, Sec In both, a relaxed habit, indolence, and an oily or very moist diet, dispose the body to this disease. A rupture sometimes proves fatal before it is discovered. When- ever sickness, vomiting, and obstinate costiveness give reason to suspect an obstruction of the bowels, all those places where rup- tures usually happen ought carefully to be examined. The protru- sion of a very small part of the gut will occasion all these symp- toms ; and, if not returned in due time, will prove fatal. On the first appearance of a rupture in an infant, it ought to be laid upon its back with its head very low. While in this posture, if the gut does not return of itself it may easily be put up by gentle pres- sure. After it is returned, a piece of sticking-plaster may be appli- ed over the part, and a proper truss or bandage must be constantly worn for a considerable time. The method of making and apply- ing rupture-bandages for children is pretty well known. The child must, as far as possible, be kept from crying, and from all violent exertions, till the rupture is quite cured. In adults, when the gut has been forced down with great vio- lence, or happens from any cause to be inflamed, there is often great difficulty in returning it, and sometimes the thing is quite im- practicable without an operation; a description of which is for- eign to our purpose. As I have been fortunate enough, however, always to succeed in my attempts to return the gut, without hav- ing recourse to any other means than what are in the power of every man, I shall briefly mention the method which I generally pursue. . After the patient has been bled, he must be laid upon his back, with his head very low, and his breech nused high with pillows. • A v great sleepiness. The traveller, in this situation, who finds himself begin to grow drowsy, should redouble his efforts to extricate himself from the imminent danger he is exposed to. This sleep, which he might consider as some allevia- tion of his sufferings, would, if indulged, prove his last. Such violent effects of cold are happily not very common in this country : it frequently happens, however, that the hands or feet of travellers are so benumbed or frozen, as to be in danger of a mor- tification, if proper means are not used to prevent it. The chief danger in this situation arises from the "sudden application of heat. It is very common, when the hands or feet are pinched with cold, to hold them to the fire; yet reason and observation show, that this is a most dangerous and imprudent practice. Every peasant knows, if frozen meat, fruits, or roots of any kind, be brought near the fire, or put into warm water, they wiil be destroyed by rottenness, or a kind of mortification ; and that the only way to recover them, is to immerse them for some time in very cold water. The same observation holds with regard to ani- mals in this condition. When the hands or feet are greatly benumbed with cold, they ought either to be immersed in cold water, or rubbed with snow, till they recover their natural warmth and sensibility: after which, the person may be removed into an apartment a little warmer, and may drink some cups of tea, or an infusion of elder-flowers sweet- wncii with honey. Every person must have observed, when his hands were even but slightly affected with cold, that the best way 388 EFFECTS OF EXTREME HEAT. to warm them was by washing them in cold water, and continuing to rub them well for some time. When, therefore, the hands, feet, or nose, or any other part of the body have been exposed to violent cold, so as to be frost-bitten, they ought at first either to be well rubbed with snow, or be put into cold water, and afterwards be subjected to warmth in the most gentle and gradual manner. When a person has been so long exposed to the cold, that nil appearances of life are gone, it will be necessary to rub him all over with snow or cold water; or, what will answer better, if it can be obtained, to immerse him in a bath of the very coldest wa- ter. There is the greatest encouragement to persist in the use of these means, as we are assured that persons who had remained in the snow, or had been exposed to the freezing air during five or six successive days, and who had discovered no marks of life for sev- eral hours, have nevertheless been revived. If the power of swallowing be restored, some warm and gently stimulating drink should be given, such as thin broth, with a little brandy in it, or water with some wine, administered by a spoonful at a time. While the body is cold, and the circulation and respi- ration are languid, blood-letting might be improper. If, however, after these functions, and the natural temperature are restored, the patient should remain any time in a comatose state, with a strong full pulse, the propriety and necessity of venesection can hardly be doubted. I have always thought, that the whitloes, kibes, chilblains, and other inflammations of the extremities, which are so common among the peasants in the cold season, were chiefly occasioned by their sudden transitions from cold to heat. After they have been expos- ed to an extreme degree of cold, they immediately apply their hands and feet to the fire, or, if they have occasion, plunge them into warm water, by which means, if a mortification does not happen, an inflammation seldom fails to ensue. Most of the ill consequences from this quarter might be easily avoided, by only observing the precautions mentioned above. Effects of extreme Heat. The effects of extreme heat, though not so common in this coun- try, are no less fatal, and much more sudden than those of cold. In hot countries people frequently drop down dead in the streets, exhausted with heat and fatigue. In this case, if any warm cor- dial can be poured into the mouth, it ought to be done. If this cannot be effected, they may be thrown up in form of a clyster. Volatile spirits, and other things of a stimulating natnre, may be applied to the skin, which should be well rubbed with coarse cloths, whipped with nettles, or other stimulating things. Some of the ancient physicians are said to have restored to life persons appar- ently dead, by beating them with rods. Head-aches are often occasioned by exposure to intense heat; and in warm climates, where people are very liable to what they call coups de soldi, or strokes of the sun, it is a common custom to lay linen cloths, several times doubled, on the head, and to keep FAINTING FITS. 380 tliem moistened with very cold water for half an hour, or till the stupor is diminished. This they term drawing the fire out of tht head. Of Fainting Fits. (Syncope.) Strong and healthy persons, who abound with blood, are often seized with sudden fainting fits, after violent exercise, drinking freely of warm or strong liquors, exposure to great heat, intense application to study, or the like. In such cases the patient ought to be made to smell to some vinegar. Jrlis temples, forehead, and wrists, ought at the same time to be bathed with vinegar mixed with an equal quantity of warm water ; and two or three spoonsful of vinegar, with four or five times as much water, may, if he can swallow, be poured into his mouth. «, If the fainting proves obstinate, or degenerates into a syncope, that is, an abolition of feeling and understanding, the patient must be bled. After the bleeding, a clyster will be proper, and then he should be kept easy and quiet, only giving him every half-hour a cup or two of an infusion of any mild vegetable, with the addition of a little sugar and vinegar. When swoonings, which arise from this cause, occur frequently in the same person, he should, in order to escape them, confine himself to a light diet, consisting chiefly of bread, fruits, and other vegetables. His drink ought to be water or small beer, and he should sleep but. moderately, and take much exercise. But fainting fits proceed much oftener from a defect than an excess of blood. Hence they are very ready to happen after great evacuations of any kind, obstinate watching, want of appetite, or such like. In these, an almost directly opposite course to that mentioned above must be pursued. The patient should be laid in bed, with his head low, and being covered, should have his legs, thighs, arms, and his whole body rubbed strongly with hot flannels. Hungary-water, volatile salts, or strong smelling herbs, as rue, mint, or rosemary, may be held to his nose. His mouth may be wet with a little rum or brandy ; and, if he can swallow, some hot wine mixed with sugar and cin- namon, which is an excellent cordial, may be poured into his mouth. A compress of flannel dipt in hot wine or brandy must be applied to the pit of his stomach, and warm bricks, or bottles filled with hot water, laid to his feet. As soon as the patient is recovered a little, he should take some strong soup or broth, or a little bread or biscuit soaked in hot- spiced wine. To prevent the return of the fits, he ought to take often, but in small quantities, some light yet strengthening nour- ishment, as panada made with soup instead of water, newlaid eggs lightly poached, chocolate, light roast meats, jellies, and such like. Those fainting fits, which are the effect of bleeding, or of the violent operation of purges, belong to this class. Such as happen after artificial bleeding are seldom dangerous, generally terminat- ing as soon as the patient is laid upon the bed; indeed, persons Bubject to this kind should always be bled lying, in order to prevent it. Should the fainting, however» continue longer than usual, vol- 390 FAINTING FITS. atile spirits may be held to the nose, and rubbed on the temples, &c. When fainting is the effect of too strong or acrid purges or vom- its, the patient must be treated in all respects as if he had taken poison. He should be made to drink plentifully of milk, warm water, and oil, barley-water, or such like ; emollient clysters will likewise be proper, and the patient's strength should afterwards he recruited, by giving him generous cordials, and anodyne medicine. Faintings are often occasioned by indigestion. This may either proceed from the quantity or quality of the food. When the former of these is the cause, the cure will be best performed by vomiting, which may be promoted by causing the patient to drink a weak infusion of camomile flowers, carduus bcneclictus, or the like. When the disorder proceeds from the nature of the food, the patient, as in the case of weakness, must be revived by strong smells, Sec. ; after which he should be made to swallow a large quantity of light warm fluid, which may serve to drown, as it were, the offending matter, to soften its acrimony, and either to effect a discharge of it by vomiting, or force it down into the intestines. Even disagreeable smells will sometimes occasion swoonings, especially in people of weak nerves. When this happens, the patient should be carried into the open air, have stimulating things held to his nose, and those substances which are disagreeable to him ought immediately to be removed. But we have already ta- ken notice of swoonings which arise from nervous disorders, and shall therefore say no more upon that head. Fainting fits often happen in the progress of diseases. In the beginning of putrid diseases, they generally denote an oppression at the stomach, or a mass of corrupted humours, and they cease after evacuations either by vomit or stool. When they occur at the beginning of malignant fevers, they indicate great danger. In each of these cases, vinegar used both externally and internally is the best remedy during the paroxysm, and plenty of lemon-juice and water after it. Swoonings which happen in diseases accom- panied with great evacuations must be treated like those which are owing to weakness, and the evacuations ought to be restrained. When they happen towards the end of a violent fit of an intermit- ting fever, or at that of each exacerbation of a continual fever, the patient must be supported by small draughts of wine and water. Delicate and hysteric women are very liable to swooning or fainting fits after delivery. These might be often prevented by generous cordials, and the admission of fresh air. When they are occasioned by excessive flooding, it ought by all means to be restrained. They are generally the effect of mere weakness or exhaustion. Dr. Engleman relates the case of a woman " in " childbed, who, after being happily delivered, suddenly fainted, " and ray upwards of a quarter of an hour apparently dead. A "physician was sent for; her own maid, in the meanwhile, being "out of patience at his delay, attempted to assist her herself, " and extending herself upon her mistress, applied her mouth to " hers, blew in as much breath as she possibly could, and in a very ••* short time the exhausted woman awaked as out of a profound INTOXICATION. 391 "sleep; when, proper things being given her, she soon recovered. " The maid being asked how she came to think of this expedi- ent, said, she had seen it practised at Altenburgh, by midwives, "upon children, with the happiest effect." We mention this case chiefly that other midwives may be induc- ed to follow so laudable an example. Many children are born without any signs of life, and others expire soon after the birth, who might, beyond all doubt, by proper care, have been restored to life. Fron*. f. natever cause fainting fits proceed, fresh air is always of the greatest importance to the patient. By not attending to this circumstance, people often kill their friends while they are endeav- ouring to save them. Alarmed at the patient's situation, they call in a crowd of people to his assistance, or perhaps to witness his exit, whose breathing exhausts the air, and increases the danger. There is not the least doubt but this practice, which is very com- mon among the lower sort of people, often proves fatal, especially to the delicate, and such persons as fall into fainting fits from mere exhaustion, or the violence of some disease. No more persons ought ever to be admitted into the room where a patient lies in a swoon than are absolutely necessary for his assistance, and the windows of the apartment should always be opened, at least as far as to admit a stream of fresh air. Persons subject to frequent swoonings, or fainting fits, should neglect no means to remove the cause of them, as their consequen- ces are always injurious to the constitution. Every fainting fit leaves the person in dejection and weakness; the secretions are thereby suspended, the humours disposed to stagnation, coagula- tions and obstructions are formed, and, if the motion of the blood be totally intercepted, or very considerably checked, polypuses are sometimes formed in the heart or larger vessels. The only kind of swoonings not to be dreaded are those which sometimes mark the crisis in fevers ;,yet even these ought, as soon as possible, to be removed. I have before remarked, but I deem it of importance to repeat the observation, that it is only when the fainting fit evidently arises from a fulness of the habit, and is accompauied with a total aboli- tion of feeling and understanding, that bleeding is advisable. The use of the lancet might otherwise have the most deadly effect. Many persons, even of robust constitutions, are very apt to faint upon having a vein opened and losing a little blood. How danger- ous,' then, must the operation be, when a patient has already faint- ed, and most probably from extreme weakness and a defect of blood ! I have no doubt but many a murder has been rashly com- mitted in such cases. Of Intoxication. The effects of intoxication are often fatal. No kind of poison kills, more certainly than an overdose of ardent spirits. Sometimes, by destroying the nervous energy, they put an end to life at once; but in general their effects are more slow, and in many respects similar to those of opium. Other kinds of intoxicating liquors 392 INTOXICATION. may prove fatal when taken to excess, as well as ardent spirits; but they may generally Le discharged by vomiting, which ought always to be excited when the stomach is overcharged with liquor. More of those unhappy persons who die intoxicated, lose their lives from an inability to conduct themselves, tlran from the de- structive quality of the liquor. Unable to walk, they tumble down, and lie in some awkward posture, which obstructs the circulation or breathing, and often continue in this situation till they die. No person, when drunk, should be left by himself, till his clothes have been loosened, and his body laid in such a posture as is most fa- vourable for continuing the vital motions and discharging the con- tents of the stomach. The best posture for discharging the con- tents of the stomach is to lay the person upon his belly; when asleep, he may be laid on his side, with his head a little raised, and particular care must be taken that his neck be no way bent, twist- ed, or have any thing too tight about it. The excessive degree of thirst occasioned by drinking strong li- quors often induces people to quench it by taking what is hurtful. I have known fatal consequences even from drinking freely of milk after a debauch of wine or sour punch; these acid liquors, togeth- er with the heat of the stomach, having coagulated the milk in such a manner that it could never be digested. The safest drink after a debauch is water with a toast, tea, infusions of balm, sage, barley-water and such like. If the person wants to vomit, he may drink a weak infusion of camomile flowers or luke-warm water and oil; but in this condition, vomiting may generally be excited by only tickling the throat with the finger or a feather. Instead of giving a detail of all the different symptoms of intoxi- cation which indicate danger, and proposing a general plan of treat- ment for persons in this situation, I shall briefly relate the history of a case which lately fell under my own observation, wherein most of those symptoms usually reckoned dangerous concurred, and where the treatment was successful. A young man, about fifteen years of age, had, for a hire, drank ten glasses of strong brandy. He soon after fell fast asleep, and continued in that situation for several hours, till at length his unea- sy manner of breathing, the coldness of the extremities, and other threatening symptoms, alarmed his friends, and made them send forme. I found him still sleeping, his countenance ghastly, and his skin covered with a cold clammy sweat. Almost the only signs of life remaining were, a deep laborious breathing, and a convulsive motion or agitation of his bowels. I tried to rouse him, but in vain, by pinching, shaking, applying volatile spirits, and other stimulating things to his nose, &c. A few ounces of blood were likewise taken from his arm, and a mix- ture of vinegar and water was poured into his mouth ; but as he could not swallow, very little of this got into the stomach. None of these things having the least effect, and the danger seeming to increase, I ordered his legs to be put into warm water, and a sharp clyster to be immediately administered. This gave him a stool, and was the first thing that relieved him. It was afterwards re- peated with the same happy effect, and seemed to be the chief eause of his recovery. He then began to show some signs of life, SLFFOCATION AND STRANGLING. 393 took drink when it was offered him, and came gradually to his senses. He continued, however, for several days weak and fever- ish, and complained much of a soreness in his bowels, which grad- ually went off, by means of a slender diet, and cool mucilaginou* liquors. This young man would probably have been suffered to die, with- out any assistance being called, had not a neighbour, a few days before, who had been advised to drink a bottle of spirits to cure him of an ague, expired under very similar circumstances.* Of Suffocation and Strangling, from Hanging, Drowning. and other Causes. In cases where life is suspended from hanging, the same means as recommended for drowned people are to be adopted, with the addition of opening the jugular veins, or applying cupping-glasses to the neck, which will tend considerably to facilitate the restora- tion of life, by lessening the quantity of blood contained in the ves- sels of the head, and thereby taking off the pressure from the brain. Except in persons of a full plethoric habit, the quantity drawn off need seldom exceed an ordinary tea-cupful, which in general will be sufficient to unload the vessels of the head, without weakening the powers of life. Suffocation may sometimes proceed from an infarction of the lungs, produced by viscid clammy humours, or a spasmodic affec- tion of the nejves of that organ. Persons who feed grossly, and abound in rich blood, are very liable to suffocating fits from the former of these causes. Such ought, as soon as they are attacked, to be bled, to receive an emollient clyster, and to take frequently a cup of diluting liquor with a little nitre in it. They should like- wise receive the steams of hot vinegar into their lungs by breath- ing. Nervous and asthmatic persons are most subject to spasmodic affection of the lungs. In this case the patient's legs should be immersed in warm water, and the steams of vinegar applied as ahove. Warm diluting liquors should likewise be drunk ; to a cup of which a tea-spoonful of the paregoric elixir may occasionally be added. Burnt paper, feathers, or leather, may be held to the pa- tient's nose, and fresh air should be freely admitted to him. Infants are often suffocated by the carelessness or inattention of their nurses.t An infant when in bed should always be laid so, that it cannot tumble down with its head under the bed clothes ; and when in a cradle, its face ought never to be covered. A small deoree of attention to these two simple rules would save the lives * I have seen repeated instances of persons being restored to perfect sobriety, and the complete use of their senses, from a state of most alarming intoxication, by taking away eight or ten ounces of blood from the nape of the neck, as near the head as pos- sible, by means of cupping-glasses. The same effect is produced by taking blood from the arm, but the practice is not perhaps quite so safe ; cupping certainly deserves the preference. "■• "■ "• tThese accidents arc not always the effects of carelessness. I have known an infant overlaid by its mother bein? seized in the night with a hysteric fit. This ought to serve as a caution against employing hysteric women as nurses; and should likewise teach such women ncer to lay an infant in the same bed with themselves, but in a small adjacent one. 394 SUFFOCATION AND STRANGLING. of many infants, and prevent others from being rendered weak and sickly all their days by the injuries done to their lungs. Instead of laying down a plan for the recovery of infants who are suffocated, or overlaid, as it is termed by their nurses, I shall give the history of a case related by Monsieur Janin, of the Royal College of Surgery at Paris, as it was attended with success, and contains almost every thing that can be done on such occasions. A nurse having had the misfortune to overlay a child, he was called in, and found the infant without any signs of life ; no puls- ation in the arteries, no respiration, the face livid, the eyes open, dull, and tarnished, the nose full of snivel, the mouth gaping, in short it was almost cold. Whilst some linen clothes and a parcel of ashes were warming, he had the boy unswathed, and laid him in a warm bed, and on the right side. He then was rubbed all over with fine linen, for fear of fretting his tender and delicate skin. As soon as the ashes had received their due degree of heat, Mr. Janin buried him in them, except the face, placed him on the side opposite to that on which he had been at first laid, and covered him with a blanket. He lia* * bottle of eau de luce in his pocket, which he presented to his nose from time to time ; and between whiles some puffs of tobacco were blown up his nostrils ; to these succeeded the blowing into his mouth, and squeezing tight his nose. Animal heat began thus to be excited gradually: the pulsations of the temporal artery were soon felt, the breathing be- came more frequent and free, and the eyes closed and opened alternately. At length the child fetched some cries expressive of his want of the breast, which being applied to his mouth, he catch- ed it with avidity, and sucked as if nothing had happened to him. Though the pulsations of the arteries were by this time very well re-established, and it was hot weather, yet Mr. Janin thought it advisable to leave his little patient three quarters of an hour longer under the ashes. He was afterwards taken out, cleaned and dressed as usual; to which a gentle sleep succeeded, and he continued perfectly well. Mr. Janin mentions likewise an example of a young man, who had hanged himself through despair, to whom he administered help as effectually as in the preceding case. Mr. Glover, surgeon in Doctors' Commons, London, relates the case of a person who was restored to life after twenty-nine min- utes hanging, and continued in good health for many years after. The principal means used to restore this man to life were. opening the temporal artery and the external jugular ; rubbing the back, mouth, and neck, with a quantity of volatile spirits and oil; administering the tobacco-clyster by means of lighted pipes, am. strong frictions of the legs and arms. This course had been con tinned for about four hours, when an incision was made into tlu windpipe, and air blown strongly through a canula into the lunge About twenty minutes after this, the blood at the artery began t< run down the face, and a slow pulse was just perceptible at the wrist. The frictions were continued for sometime longer ; his pulse became more frequent, and his mouth aud nose being irritat- ed with spirit of sal ammoniac, he opened his eyes. Warm cor dials were then administered to him, and in two days he was «o well as to be able to walk eight miles. CONVULSION-FITS. 39fi These cases are sufficient to show what may be done for the re- covery of those unhappy persons who strangle themselves in a fit of despair. Of Persons who expire in Convulsion-Fits. Convulsion-fits often constitute the last scene of acute or chronie disorders. When this is the case, there can remain but small hopes of the patient's recovery after expiring in a fit. But when a person who appears to be in perfect health is suddenly seized with a convulsion-fit, and seems to expire, some attempts ought always to be made to restore him to life. Infants are most liable to convulsions, and are often carried off very suddenly by one or more fits about the time of teething. There are many well-au- thenticated accounts of infants having-been restored to life, after they had to all appearance expired in convulsions; but we shall only relate the following instance mentioned by Dr. Johnson, in his pamphlet On the Practicability of recovering Persons visibly dead. In the parish of St. Clements in Colchester, a child of six months old, lying upon its mother's lap, having had the breast, was seized with a strong convulsion-fit, which lasted so long, and ended with bo total a privation of motion in the body, lungs, and pulse, that it was deemed absolutely dead. It was accordingly stripped, laid out, the passing bell ordered to be tolled, and a coffin to be made; but a neighbouring gentlewoman, who used to admire the child, hearing of its sudden death, hastened to the house, and upon ex- amining the child, found it not cold, its joints limber, and fancied that a glass she held to its mouth and nose was a little damped with the breath; upon which she took the child in her lap, sat down before the fire, rubbed it, and kept it in gentle agitation. In a quarter of an hour she felt the heart begin to beat faintly ; she then put a little of the mother's milk into its mouth, continued to rub its palms and soles, found the child begin to move, and the milk was swallowed; and in another quarter of an hour she had the satisfaction of restoring to its disconsolate mother the babe quite recovered, eager to lay hold of the breast, and able to suck again. The child throve, had no more fits, is grown up, and at present alive. These means, which are certainly in the power of every person, were sufficient to restore to life an infant to all appearance dead, and who, in all probability, but for the use of these simple endeav- ours, would have remained so. There are, however, many other things which might be done in case the above should not succeed ; as rubbing the body with strong spirits, covering it with warm ashes or salt, blowing air into the lungs, throwing up warm stimu- lating clysters or the smoke of tobacco into the intestines, and such like. When children are dead-born, or expire soon after the birth, the same means ought to be used for their recovery, as if they had expired in circuinstances similar to those mentioned above. These directions may likewise be extended to adults, attention being always paid to the age and other circumstances of the pa- tient. The foregoing cases and observations afford sufficient proof ©X 496 CASES OF SUDDEN DEATH. the success which may attend the endeavours of persons totally ignorant of medicine, in assisting those who are suddenly deprived of life by an accident or disease. Many facts of a similar nature might be adduced, were it necessary: but these, it is hoped, will be sufficient to call up the attention of the public, and to excite the humane and benevolent to exert their utmost endeavours for the preservation of their fellow-men. The Society for the Recovery of drowned Persons, instituted at Amsterdam in the year 1767, had the satisfaction to find that no fewer than 150 persons, in the space of four years, had been saved by the means pointed out by them, many of whom owed their pre- servation to peasants and people of no medical knowledge. But the means used with so much efficacy in recovering drowned per- sons are, with equal success, applicable to a number of cases where the powers of life seem in reality to be only suspended, and to remain capable of renewing all their functions, on being put into motion again. It is shocking to reflect, that for want of this con- sideration, many persons have been committed to the grave in whom the principles of life might have been revived.* The cases wherein such endeavours are most likely to be attend- ed with success are all those called sudden deaths from an invisible cause, as apoplexies, hysterics, faintings, and many other disorders wherein persons in a moment sink down and expire. The various casualties in which they may be tried are, suffocations from the sulphureous damps of mines, coal-pits, &c.; the unwholesome air of long-unopened wells or caverns; the noxious vapours arising from fermenting liquors; the steams of burning charcoal; sulphu- reous mineral acids ; arsenical effluvia, &c. The various accidents of drowning, strangling, and apparent deaths, by blows, falls, hunger, cold, &c. likewise furnish oppor- tunities of trying such endeavours. Those, perhaps, who, to ap- pearance, are killed by lightning, or by any violent agitation of the passions, as fear, joy, surprise, and such like, might also be frequently recovered by the use of proper means, as blowing strongly into the lungs, &c. The means to be used for the recovery of persons suddenly de- prived of life are nearly the same in all cases ; they are practicable by every one who happens to be present at the accident, and re- quire no great expence, and less skill. The great aim is to restore the warmth and vital motions. This may in general be attempted by means of heat, frictions, bleeding, blowing air into the lungs, administering clysters, and generous cordials. These must be varied according to circumstances. Common sense, and the situa- tion of the patient, will suggest the proper manner of conducting them. Above all, we would recommend perseverance. People ought never to despair on account of discouraging circumstances, or to leave off their endeavours as long as there is the least hope of success. Where much good and no hurt can, be done, no one ought to grudge his labour. * The Royal Humane Society for the recovery of drowned persons, in London, i« aow equal, if not superior to any similar institution in Europe; and the laudable en- deavours, persevering efforts, and encouragement given by its members to promote its utility, are at least upon the same scale, as far as the means are adajjtod?^ the ends. £». DISEASES OF WOMEN. 397 CHAP. VI. DISEASES OF WOMEN. Women, in all civilized nations, have the management of domes- tic affairs, and it is very proper they should, as nature has made them less fit for the more active and laborious employments. This indulgence, however, is generally carried too far ; and fe- males, instead of being benefitted by it, are greatly injured, from the want of exercise and free air. To be satisfied of this, one need only compare the fresh and ruddy looks of a milk-maid, with the pale complexion of those females whose whole time is spent within doors. Though nature has made an evident distinction between the male and the female with regard to bodily strength and vigour, yet she certainly never meant, either that the one should be al- ways without, or the other always within doors. The confinement of females, besides hurting their figure and complexion, relaxes their solids, weakens their minds, and disor- ders all the functions of the body. Hence proceed obstructions, indigestion, flatulence, abortions, and the whole train of nervous disorders. These not only unfit women for being mothers and nurses, but often render them whimsical and ridiculous. A sound mind depends so much upon a. healthy body, that where the latter is wanting, the former is rarely fo be found. I have always observed, that women who were chiefly employed without doors, in the different branches of husbandry, garden- ing, and the like, were almost as hardy as their husbands, and that their children were likewise strong and healthy. But as the bad effects of confinement and inactivity upon both sexes have been already shown, we shall proceed to point out those circum- stances in the structure and design of females, which subject them to peculiar diseases, the chief of which are, their monthly evacua- tions, pi-cgnancy, and child-bearing. These, indeed, cannot prop- er)/ he called diseases ; but, from the delicacy of the sex, and their being often improperly managed in such situations, they become the source of numerous calamities. The Menstrual Discharge. (Catamenia.) Females generally begin to menstruate about the age of fifteen, and leave it off about fifty, which renders these two periods the most critical of their lives. About the first appearance of this dis- charge, the constitution undergoes a very considerable change, generally indeed for the better, though sometimes for the worse. The greatest care is now necessary, as the future health and hap- piness of the female depend in a great measure upon her conduct at this period.* * It is the duty of mothers, and those who are intrusted with the education of girfr, to instruct them early in the conduct and management of themselves at this critical period of their lives. False modesty, inattention, and ignorance of what is beneficial or hurtful at this time, are the sources of many diseases and misfortunes in life, which t few sensible lessons from an experienced matron might have prevented. Nor is car« less necessary in the subsequent return of this discharge. Taking improper food, vio- lent affections of the mind, or catching cold at this period, is often sufficient to rata the health, or to render the female ever after incapable of procreation. 398 THE MENSTRUAL DISCHARGE. If a girl about this time of life be confined to the house, kept constantly sitting, and neither allowed to romp about, nor employ- ed in any active business, which gives exercise to the whole body, she becomes weak, relaxed* and puny; her blood not being duly prepared, she looks pale and wan ; her health, spirits, and vigour decline, and she sinks into a valetudinarian for life. Such is the state of numbers of those unhappy females, who, either from too much indulgence, or their own narrow circumstances, are at this critical period, denied the benefit of exercise and free air. A lazy, indolent disposition proves likewise very hurtful to girls at this period. One seldom meets with complaints from obstruc- tions amongst the more active and industrious part of the sex; whereas the indolent and lazy are seldom free from them. These are in a manner eaten up by the chlorosis, or green-sickness, and other diseases of this nature. We would, therefore, recom- mend it to all who wish to escape these calamities, to avoid indo- lence and inactivity as their greatest enemies, and to be as much abroad in the open air as possible. Another thing which proves very hurtful to girls about this peri- od of life, is unwholesome food. Fond of all manner of trash, they often indulge in it, till their whole humours are quite vitiated. Hence ensue indigestions, want of appetite, and a numerous train of evils. If the fluids be not duly prepared, it is utterly impossible that the secretions should go properly on. Accordingly we find that such girls as lead an indolent life, and eat great quantities of trash, are not only subject to obstructions of the menses, but like- wise to glandular obstructions ; as the scrofula, or king's evil, &c. A dull disposition is also very hurtful to girls at this period. It is a rare thing to see a sprightly girl who does not enjoy good health, while the grave, moping, melancholy creature proves the very prey of vapours and hysterics. Youth is the season for mirth and cheerfulness; let it therefore be indulged; it is an absolute duty. To lay in a stock of health in time of youth, is as necessary a piece of prudence, as to make provision against the decays of old age. While, therefore, wise nature prompts the happy youth to join in sprightly amusements, let not the severe dictates of hoary age forbid the useful impulse, nor damp with serious gloom the season destined to mirth and innocent festivity. Another thing very hurtful to females about this period of life, is strait clothes. They are fond of a fine shape, and foolishly imagine that this can be acquired by lacing themselves tight. Hence, by squeezing the stomach and bowels, they hurt the diges- tion, and occasion many incurable maladies. This error is not indeed so common as it has been, but, as fashions change, it may come about again; we therefore think it not improper to mention it. I know many females who, to this day, feel the dreadful effects of that wretched custom which prevailed some years ago, of squeezing every girl into as small a size in the middle as possible. Human invention could not possibly have devised a practice more destructive to health. After a female has arrived at that period of life when the menses usually begin to flow, and they do not appear, but, on the contrary, her health and spirits begin to decline, we would advise, instead of THE MENSTRUAL DISCHARGE. 399 shutting the poor girl up in the house, and dosing her with steel, asafcetida, and other nauseous drugs, to place her in a situation where she can enjoy the benefit of free air and agreeable company. There let her eat wholesome food, take sufficient exercise, and amuse herself in the most agreeable manner; and we have little reason to fear, but nature, thus assisted, will do her proper work. Indeed she seldom fails, unless where the fault is on our side. This discharge in the beginning is seldom so instantaneous as to surprise females unawares. It is generally preceded by symptoms which foretell its approach; as a sense of heat, weight, and dull pain in the loins; distention and hardness of the breasts; head- ache, loss of appetite, lassitude, paleness of the countenance, and sometimes a slight degree of fever. When these symptoms appear about the age at which the menstrual flux usually begins, every thing should be carefully avoided which may obstruct that necessary and salutary evacuation, and all means used to promote it; as sitting frequently over the steams of warm water, drinking warm diluting liquors, &c. After the menses have once begun to flow, the greatest care should be taken to avoid every thing" that may tend to obstruct them. Females ought to be exceedingly cautious of what they eat or drink at the time they are out of order. Every thing that is cold, or apt to sour on the stomach, ought to be avoided ; as fruit, butter- milk, and such like. Fish, and all kinds of food that are hard of digestion, are also to be avoided. As it is impossible to mention every thing that may disagree with individuals at this time, we would recommend it to every female to be very attentive to what disagrees with herself, and carefully to avoid it. Cold is extremely hurtful at this particular period. More of the sex date their diseases from colds caught while they are out of order, than from all other causes. This ought surely to put them upon their guard, and to make them very circumspect in their conduct at such times. A degree of cold that will not in the least hurt them at another time, will at this period be sufficient entirely to ruin their health and constitution. The greatest attention ought likewise to be paid to the mind, which should be kept as easy and cheerful as possible. Every part of the animal economy is influenced by the passions, but none more so than this. Anger, fear, grief, and other affections of the mind, often occasion obstructions of the menstrual flux, whicb prove absolutely incurable. As far as my observation goes, there are no women in the world Bo inattentive to this discharge as the English; and they suffer accordingly, as a very great number of them are obstructed, and many prove barren in consequence. From whatever cause this flux is obstructed, except in the state of pregnancy, proper means should be used to restore it. For this nurnose we would recommend sufficient exercise in a dry, open, and rather cool air ; wholesome diet, and, if the body be weak and lanimid, generous liquors ; also cheerful company and all manner nf amusements. If these fail, recourse must be had to medicine. WhenObstructions proceed from a weak relaxed state of the solids, such medicines as tend to promote digestion, to brace the 400 THE MENSTRUAL DISCHARGE. solids, and assist the body in preparing good blood, ought to ba used. For this purpose, I have of late made use of pills compos- ed of prepared steel, powdered myrrh,* and the best aloes, equal parts. These must be formed into pills of the common size, and two or three of them given every night at bed-time. The principal medicines, however, are iron, and the Peruvian hark, with other bitters and astringents. Filings of iron may be infused in wine or ale, two or three ounces to an English quart, and after it has stood for two or three weeks, it may be filtered, and about half a wine- glass of it taken twice a-day ; or prepared steel may be taken in the dose of half a drachm, mixed with a little honey or treacle, three or four times a-day. The bark and other bitters may either be taken in substance or infusion, as is most agreeable to the pa- tient. Previous, however, to the use of these medicines, it may be advisable to give a gentle emetic, for the purpose of cleansing the stomach, and freeing it from acidities and inactive fluids. When obstructions proceed from a viscid state of the blood, or for women of a gross or full habit, evacuations, and such medicines as attenuate the humours, are necessary. The patient in this case ought to be bled, to bathe her feet frequently in warm water, to take now and then a cooling purge, and to live upon a spare thin diet. Her drink should be whey, water, or small beer, and she ought to take sufficient exercise.. A teaspoonful of the tincture of black hellebore may also be taken twice a-day in a cup of warm water. When obstructions proceed from affections of the mind, as grief. fear, anger, &c. every method should be taken to amuse and divert the patient. And that she may the more readily forget the cause of her affliction, she ought, if possible, to be removed from the place where it happened. A change of place, by presenting the mind with a variety of new objects, has often a very happy influ- ence in relieving it from the deepest distress. A soothing, kind, and affable behaviour to females in this situation is also of the last importance. An obstruction of the menses is often the effect of other maladies. When this is the case, instead of giving medicines to force that discharge, which might be dangerous, we ought by all means to endeavour to restore the patient's health and strength. When that is effected, the other will return of course. Immoderate Flow op the Menses. The flow of the menses is to be considered as immoderate, when it either returns more frequently than what is natural, continues longer than ordinary, or is more abundant than is usual with the * Take Myrrh, £ drachm. " two table-spoonsful of the following Subcarbonate of Soda, 15 grains. mixture: Sulphate of Iron, 1 scruple. Take Compound Infusion of Gentian, Extract of Bark, 1 scruple. 6 ounces. Syrup of Ginger, enough to form the Tincture of Bark, mass; to be divided in 24 pills, two of-------of Cardamoms, of each, which are to be taken twice or three £ ounce. times a-day; washing them down with Make a mixture. THE MENSTRUAL DISCHARGE. 401 same person than at other times; usually accompanied with pains in the back and belly, somewhat like those of childoirth. But the menstrual discharge may be too great as well as too ■mall. When this happens, the patient becomes weak, the colour pale, the appetite and digestion are bad, to which oedematous swel- lings of the feet, dropsies, and consumptions often ensue. This frequently happens to women about the age of forty-five or fifty, and is very difficult to cure. It may proceed from a sedentary life ; a full diet, consisting chiefly of salted, high seasoned, or acrid food; the use of spirituous liquors; excessive fatigue; relaxation; a dissolved state of the blood; violent passions of the mind, &c. The treatment of this disease must be varied according to its cause. When it is occasioned by any error in the patient's regi- men, an opposite course to that which induced the disorder must be pursued, and such medicines taken as have a tendency to restrain the Row, and counteract the morbid affections of the sys- tem whence it proceeds. To restrain the flux, the patient should be kept quiet and easy both in body and mind. If it be very violent, she ought to lie in bed with her head low; to live upon a cool and slender diet, as veal or chicken broths with bread; and to drink decoctions of net- tle-roots, or the greater comfrey, cooling aperients,* and refrige- rants, as small and frequent doses of nitre ;f cool acidulated liquors, as lemonade ; light covering, and lying on a mattress instead of a bed. If these be not sufficient to stop the flux, stronger astrin gents! may be used, as Japan earth, alum, elixir of vitriol, the Peruvian bark, Sec.: e. g. two drachms of alum and one of Japar earth may be pounded together, and divided into eight or nine doses, one of which may be taken three times a-day. Persons whose stomachs cannot bear the alum, may take two table-spoonsful of the tincture of roses three or four times a-day, to each dose of which ten drops of laudanum may be added. If these should fail, half a drachm of the Peruvian bark, in powder, with ten drops of the elixir of vitriol, may be taken, in a glass of red wine, four times a-day, or any of the forms prescribed below. Fluor Albus. The uterine discharge may offend in quality as well as in quan- tity. What is usually called the fluor albus, or whites, is a very common disease, and proves extremely hurtful to delicate women. This discharge, however, is not always white, but sometimes pale yellow, green, or of a blackish colour: sometimes it is sharp and * Take Epsom Salts, 2 ounces. Warm Water, 6 ounces. Compound Tincture of Senna, A ounce. Syrup of Roses, 2 drachms. Mix; and take two table-spoonsful for a dose. ♦ Take Infusion of Roses, 1 i ounce. Nitre, 10 grains. Occasionally adding, if necessary. Tincture of Opium, 15 drops. Make a draught, to be repeated every third hour. } Take Gum Kino, 8 grains Alum, in Powder, 12 grains. Confection of Roses, enough. Make a bolus, to be taken every third or fourth hour. or Take Purified Alum, 10 grains. Extract of Bark, 12 grains. Confection of Roses, enough. Make a bolus to be taken as above. 402 THE MENSTRUAL DISCHARGE. eorrosive, sometimes foul and fcetid, Sec. It is attended with a pale complexion, pain in the back, loss of appetite, swelling of the feet, and other signs of debility. It generally proceeds from a relaxed state of the body, arising from indolence, the excessive use of tea, coffee, or other weak and watery diet, frequent childbear- ing, Sec To remove this disease, the patient must take as much exercise as she can bear without fatigue. Her food should be solid and nourishing, but of easy digestion ; and her drink rather generous, as red port or claret, mixed with Pyrmont, Bristol, or lime-water. Tea and coffee are to be avoided. I have often known strong broths have an exceeding good effect, and sometimes a milk diet alone will perform a cure. The patient ought not to lie too long in bed. Independent of this regimen, the proper indications of cure to be observed appear to be, to increase the action of the absorbents of the uterus and vagina, by restoring the tone of the system ; to correct the acrimony of the discharge; diminish its quantity; to alleviate other urgent and distressing symptoms; and to strengthen the system, when the disease is complicated with general debility and relaxation. With this view, the first of these intentions is to be effected by astringents, administered by the mouth; and like- wise thrown up into the vagina and uterus in the form of injec- tions.* Alum, sulphate of zinc (white vitriol,) gum kino, and cat- echu, are the astringents most employed as internal remedies; and these may be given either separately or combined with some tonic, as the bark, bitters, chalybeates, and the sulphuric acid as advised below,t with partial cold bathing, or spunging the loins and thighs with cold water. In addition to astringents, it has been usual to employ in fluor albus such stimulating medicines as most commonly determine to the urinary passages, which, from their vicinity to the uterus, have often been found to afford considerable relief. On this occasion, turpentine and other balsams have been used.J Gentle emetics are also supposed to be of singular benefit in this complaint. When there are excoriations externally or internally, the solution of the acetate of lead, sufficiently diluted with water, may be em- ployed as a wash. - Take Decoction of Oak Bark, 1 pint. t Take Powdered Alum, 2 drachms or ----—— Peruvian Bark, A oz. Take Sulnhat* nf 7in„ i j u Syr,up of Ginger> a sufficiency to form an Suier AcetaS nr'l »aA in dr•Chm- electuary, of which the bulk of a small ffilled Water, ' 11 f£T "^ ™y be taken three timeB *■«*'■ Make an injection. { Take Balsam of Copaiba> of ^^ or Turpentine, 2 drachms. TakC H^at^ Gdl' | rr LCt ^^telf ^x'eftogether in a Make an injection. * ^ ""^S^"' a"d gradua11" a7ddounce8 Take Strong Infasio" of Green Tea, tSu^c "finish Fly, (°}P" Make an injection. Mix, and take two dessert-spoonsful thrice a-day. DISEASES OF PREGNANCY. 408 Difficult Menstruation. (Dymenorrhaia.) Besides the other deviations from the usual course of nature, al- luded to under this head, a third sometimes occurs, wherein men- struation, although not entirely suppressed, is nevertheless some- what difficult, and accompanied with severe pains in the back, loins, and bottom of the belly. This disease is supposed to be ow- ing to a weak action of the vessels of the uterus, or spasm of its extreme vessels ; and is to be removed by chalybeates, warm bath- ing, both topical and general, with the use of opiates, which should be employed as soon as the symptoms that denote its approach are apparent. The extract of stramonium, in half grain doses, will often prove serviceable when other anodynes fail. Cessation of the Menses. (Commonly called the " Turn of Life.") That period of life at which the menses cease to flow is likewise very critical to the sex. The stoppage of any customary evacua- tion, however small, is sufficient to disorder the whole frame, and often to destroy life itself. Hence it comes to pass, that so many women either fall into chronic disorders, or die about this time. Such of them, however, as survive it, without contracting any chronic disease, often become more healthy and hardy than they were before, and enjoy strength and vigour to a very great age. If the menses cease all of a sudden, which is seldom the case, in women of a full habit, they ought to abate somewhat of their usu- al quantity of food, especially of the more nourishing kind, as flesh, eggs, &c. They ought likewise to take sufficient exercise, and to keep the body open. This may be done by taking, once or twice a week, a little rhubarb, or an infusion of hiera picra in wine or brandy. Should any scirrhous or cancerous affection of the uterus take place on a stoppage of the menstrual flux, as sometimes happens, all that can be done in such cases is to have recourse to pallia- tives, such as opium, henbane, and hemlock, in the manner point- ed out in the diseases wherein these medicines are indicated. It often happens that women of a gross habit, at this period of life, have ulcerous sores break out about their ankles, or in other parts of the body. Such ulcers ought to be considered as critical, and should either be suffered to continue open or have artificial drains substituted in their stead. Women who will have such sores dried up are often soon after carried off by acute diseases, or fall into those of a chronic nature. CHAP. VII. DISEASES OF PREGNANCY. Though pregnancy is not a disease, yet it is a state often at- tended with a variety of complaints which merit attention, and which sometimes require the assistance of medicine. Some wo- men, indeetl, are more healthy during their pregnancy than at any 404 DISEASES OF PREGNANCY. other time ; but this is by no means generally the case; most of them being frequently indisposed during the whole or greater part of the time of their gestation. Few fatal diseases, however, hap- pen, during this period ; and hardly any except abortion tha^ can be called dangerous. During a state of pregnancy, three different stages evidently ex- ist, each of which has a distinct set of symptoms ; nor need we be surprised, when we come to consider the alteration the constitu- tion suffers as a consequence of impregnation, at the many com- plaints and irregularities which then arise. The first state of pregnancy is usually attended with a suppression of the menses, accompanied with frequent nausea and vomiting, particularly in the morning, heartburn, indigestion, peculiar longing, head-ache, gid- diness, tooth-ache, and sometimes a slight cough: the breasts be- come enlarged, shooting pains extend through them, and the cir- cle round the nipple alters to a dark brown colour. A feverish tendency, with debility, emaciation, irritability, and peevishness-of temper, and a total alteration of the countenance, every feature of which becomes much sharpened, also frequently occur. During the whole or greater part of the second stage of gestation, as well as the first, the vomiting will continue with some women; this, however, does not usually happen. Partial suppressions of urine, with a frequent inclination to void it; itching about the external parts of generation, costiveness, inclination without ability to go to stool, and the piles, are what pregnant women are chiefly incommoded by during the second stage. Quickening.-—Most women quicken about the sixteenth week after conception, at which time the mother becomes sensible of the slightest efforts of the child; and besides the complaints just enumerated, she will then be liable to sudden faintings, and slight hysteric affections.* During the last three months, or third stage of pregnancy, general uneasiness, restlessness (particularly by night,) costiveness, puffy swellings of the feet, ancles, and private parts, cramps in the legs and thighs, difficulty of retaining the urine for any length of time, varicose swellings of the veins of tho belly and lower extremities, and the piles, are the affections which usually prove most troublesome. In delicate and weak women, of an irritable habit, convulsive fits sometimes arise, which are ever to be regarded in a dangerous point of view. Nausea and Vomiting.—-These symptoms most frequently arise immediately on first getting out of bed in the morning; under such circumstances, therefore, it is advisable for the patient never to rise until she has.taken a dish of tea or coffee, or whatever else she may have been accustomed to substitute for her breakfast. * According to the opinion most commonly received, quickening, thus termed, has been generally understood to commence at the time when particular sensations aro perceived by the mother, supposed to be occasioned by the first motion of the child. The most usual time of feeling any such symptoms is abou| the latter end of the fourth or beginning of the fifth month of pregnancy: at this period the uterus filling up the pelvis slips out and rises above the rim; and from that sudden transition, women of a delicate constitution and irritable fibre are apt to faiut, more particularly so if in an erect position. En. DISEASES OF PREGNANCY. 408 Should the vomiting at any time become so severe as to threaten abortion from the violence of the straining, it may then be advisa- ble to direct two or three table-spoonsful of the saline medicine to be taken every now and then in such a manner as the effervescence shall ensue after it is swallowed. The patient also should keep the body open with some gentle laxative. Should these means not succeed, about six ounces of blood may be drawn from the arm, and, if necessary, repeated in a week's time. The sickness in such cases depends on irritation, and is only to be removed with cer- tainty by bleeding. To abate excessive vomiting local applications have been recom- mended. For example, a piece of folded linen cloth, moistened with the tincture of opium, may be kept constantly applied to the stomach; to which, probably, the addition of a small portion of other might increase its effect. It sometimes happens that vomit- ing continues incessantly for many days, accompanied with great prostration of strength, and constant thirst, with, at the same time, an utter impossibility of retaining any thing on the stomach. Under these circuinstances the application of leeches to the pit of the stomach, and a constant attention to swallow nothing that can irri- tate, allowing the patient asses' milk, and that by a single spoonful at a time, have afforded relief. If much nausea should prevail without the possibility of throwing up, fourteen or fifteen grains of the powder of ipecacuanha may then be given, experience hav- ing proved that gentle emetics may be safely administered to preg- nant women. Heartburn.—When a pregnant woman is incommoded by heartburn, (which commonly arises from acidity in the stomach,) half a drachm of magnesia may be taken morning and evening; and, if this fail to obviate it, the absorbent mixture advised below* may be used, which Dr. Sims says he has found the most effica- cious of all remedies for the removal of this distressing complaint. Hkad-ache with Plethora.—When either drowsiness, a sense of fulness of the vessels of the head, or head-ache, prove trouble- some to pregnant women, taking away a few ounces of blood from the arm in robust women will most likely prove serviceable, in women of a weak irritable habit the application of a leech or two to each temple will be more advisable than bleeding from the arm, where the head-ache proves obstinate, and resists the other means employed. Costiveness, Piles, &c.—Costiveness, partial suppressions of urine, and the piles, which attend on the second stage of preg- nancy, are occasioned by the great pressure of the uterus on the rectum and bladder. The first and last of these symptoms are to be obviated by a daily use of some gentle laxative ; such as a solution of manna, or the subjoined electuary.t Pills eom- * Take Magnesia, 1 drachm. Pure Water, 5 ounces. Spirit of Cinnamon, 3 drachms. Solution of Ammonia, I drachm. Make a mixture, of which two or three table-spoonsful may be taken occasion- ally. t Take Confection of Senna, IA ounce. Cream of Tartar, \ ounce. The size of a nutmeg to be taken occa- sionally. 406 DISEASES OF PREGNANCY. poeed of aloes are highly improper, as being of a nature too stim ulating, and very apt to occasion hemorrhages, ahd bring on th« piles. When the piles are troublesonie, the best applications, when they can be applied, are leeches and cold saturnine lotions, as a solution of the superacetate of lead. To allay the irritation, ten grains of the superacetate of lead, dissolved in four ounces of rose-water, to which, if necessary, a little of the vinous tincture of opium may be added, form a good lotion. Tooth-ache.—To relieve the tooth-ache a few t*rops of the oil of cloves, cajeput, juniper, or any other essential oil, applied to the affected tooth, will often remove it for the time. Longings.—It is always desirable to gratify the peculiar longings of pregnant women, otherwise they are apt to miscarry from the anxiety these occasion, when not indulged in them. But that the child in the womb can be marked by any depraved appetite of the mother, or be mutilated by any disagreeable sight that may be presented to her, cannot readily be admitted. Hysterics.—Should sudden fainting, or any other hysterical affection, arise, little more will be necessary than to expose the pa- tient to a free open air, to place her in a horizontal position, and to give her a glass of cold water, with a few drops of hartshorn, or a little wine sufficiently diluted. Diarrhoza.—Diarrhoea during pregnancy should be treated just as at any other time; and after the stomach and intestines are cleared astringents may be used, if there be no great degree of fever present; but should there be fever, that must be attended to and first removed. Suppression of Urine.—To relieve the suppression of urine that frequently takes place in the advanced state of pregnancy, be- sides making use of emollient fomentations, clysters, and gentle purgatives, such as castor-oil, &c, the patient, at the same time, drinking plentifully of diluent liquors, surgical aid will be necessa- ry to draw it off morning and evening by means of a catheter. Troublesome Itchings.—When these sensations arise about the parts of generation during the pregnant state, it will be proper to keep the body perfectly free with some cooling laxative, and to wash the parts three or four times a day with a solution of lead, or the diluted solution of the acetate of lead. If much irritation ac- company this itching, leeches may be applied to the place. Puffy Swellings of the feet, ankles, and private parts, which are apt to arise towards the end of pregnancy, are occasioned by the pressure of the womb on the returning vessels, which prevents the blood being carried back to the heart. Gravid women are usu- ally free from these complaints in the morning, but towards night they frequently suffer much from them. Slight scarifications from the edge of a lancet, to discharge the stagnated fluid, with the af- DISEASES OF PREGNANCY. 407 ter-application of flannels wrung out in a warm effusion of emolli- ent herbs, have been employed in cases of great distention. In general, however, it will only be necessary that the patient does not keep her feet in a pendent position for any length of time. Cramps of the Legs and Thighs are to be relieved by rubbing the parts with cold vinegar; camphor dissolved in oil, or other liniments, the person wearing stockings in bed. At an advanced period of pregnancy they are only to be relieved by labour remov- ing the cause. Proper doses of ether and tincture of opium, with the means advised in hysterical affections, will afford the greatest benefit where the stomach is affected with spasms. In such cases the patient will do well to avoid all kinds of food that are apt to prove flatulent and hard of digestion, and keep the body perfectly open. Restlessness and Want of Sleep prove troublesome complaints towards the latter end of pregnancy, obliging the patient to rise frequently throughout the course of the night, in order to expose herself to the influence of cool air. In cases of this nature noth- ing affords relief so effectually as small bleedings, with the occa- sional use of some cooling laxative medicine. Opiates, in such conditions, are never attended with any advantage. Varicose Veins.—Considerable enlargement and distention of the veins of the legs, thighs, and abdomen often take place to an alarming extent in the last state of pregnancy. But, as no bad consequences have been observed to attend this state, the only thing necessary to be done is to empty the vascular system by moderate bleeding, gentle purging, and a spare diet. Should, how- ever, the vein of any particular part become so distended as to prove troublesome, it may be advisable to apply a bandage of a moderate tightness, so as to give the necessary support to it. Jaundice.—Pregnant women, in some instances, are afflicted with a pain in the side, excessive sh kness at the stomach, and retchings, the skin assuming a deep yellow tint; under which cir- cumstances alone the complaint proves distressing; and it is usual- ly occasioned by the formation of one or more gall-stones, and the obstructions they oppose to the usual and regular passage of the bile. The most efficient means to relieve the patient from this de- gree of the complaint are, bleeding, fomentations of the painful part, and large doses of opium, with such laxatives as shall coun- teract the constipating effects of the latter. When jaundice or any other bilious effects prevail during pregnancy, in consequence of the pressure kept up by the womb on the gall-bladder or ducts, it is to be obviated by keeping the body open with some gentle lax- atives, as pills composed of jalap and rhubarb. Incontinency of Urine is to be removed only by delivery, but may admit of being partially relieved by the horizontal posture. The bad effects of this very disagreeable complaint, may be pre- vented by a scrupulous attention to cleanliness, and the use of a 408 CONVULSIONS. thick compress of linen, or a sponge of considerable size, prop- erly fastened. Over-distention of the Skin.—The skin of the abdomen, in the latter months of pregnancy, will sometimes become cracked and sore. In this case nothing is more effectual than the frequent use of warm oil by friction ; to which a little camphor may be ad- ded to give it somewhat of a medicated appearance. False Pains, resembling those attendant on actual labour, are apt to come on at a late period of pregnancy, often occasioning un- necessary alarm. Confinement in a horizontal position ; bleeding, if of a full habit; laxative medicines if costive, and giving small and frequent doses of some opiate until the patient finds ease, will, in such cases, be necessary. CHAP. VIII. CONVULSIONS. Convulsions may take place either during pregnancy or labour. These are of different kinds, requiring opposite treatment. One species is a consequence of great exhaustion from a tedious labour, excessive fatigue, and profuse hemorrhage; which makes its at- tack without much previous warning, and generally alternates with faintings, or great depression of strength, and debility : the muscles about the face and chest are chiefly affected, and the pulse is small, frequent, and compressible, the face pale, the eyes sunk, the extremities cold. The fits succeed each other rapidly, and ve- ry soon terminate in a fatal syncope.* In all cases of this nature, the first object should be directed towards restraining the hemor- rhage if present, or preventing any kind of exertion, thus husband- ing the remaining strength, or recruiting it by cordials. In con- junction with ether and camphor, opiates will be of considerable service. Delivery is usually necessary. The other species of convulsions, which are those of an hysteri- cal nature, are more common during gestation than during partu- rition. In this case it may only be necessary to add to what has been already said relative to hysterics (p. 390.), that if they do not speedily yield to antispasmodics, bleeding had better be resorted to : should this fail, the woman, if possible, should be delivered. Puerperal convulsions seldom happen before the sixth month, but may occur at any time between this period and the completion of labour. They may arise as the first symptom of labour, or after delivery. This species of convulsion depends on the state of the uterus, and has been remarked to occur more frequently during the first pregnancy than in any subsequent one, particularly where the woman is unmarried. To prevent the occurrence of puerperal convulsions, as they are " It was this species of convulsion, apparently, that destroyed Her Royal Hiirhnsn tie Princess Charlotte of Wales. ABORTION. 409 in every instance to be considered highly dangerous, particularly at an advanced period of pregnancy, it is advisable in women of robust and plethoric habits to bleed frequently during the progress of pregnancy, by abstracting a sufficient quantity of blood at dif- ferent periods ; taking care, at the same time, and particularly near the termination of pregnancy, to keep the body open by cool- ing purgatives. In women of an unstable constitution, all exciting causes should be carefully avoided, and the habit be strengthened as much as possible, and by that means rendered less susceptible of disagreeable impressions. CHAP. IX. ABORTION, &c.. Every pregnant woman is more or less in danger of abortion. This should be guarded against with the greatest care, as it not only weakens the constitution but renders the woman liable to the same misfortune afterwards.* Abortion may happen at any peri- od of pregnancy, but it is most common in the second or third month. Sometimes, however, it happens in the fourth or fifth. If it happens within the tirst month, it is usually called a false con- ception ; if after the seventh month, the child may often be kept alive by proper care. The common causes of abortion are, the death of the child; weakness or relaxation of the mother ; great evacuations; violent exercise ; raising great weights ; reaching too high; jumping, or stepping from an eminence; vomiting; coughing; convulsion- fits ; blows on the belly ; falls ; fevers; disagreeable smells ; ex- cess of blood ; indolence; high living, or the contrary; violent passions or affections of the mind, as fear, grief, &c. The signs of approaching abortion are, pain in the loins, or about the bottom of the belly ; a dull heavy pain in the inside of the thighs; a slight degree of coldness, or shivering; sickness ; palpitation of the heart; the breasts become flat and soft; the beB» ly falls ; and there is a discharge of blood or watery humours from the womb. To prevent abortion, we would advise women of a weak or re- laxed habit to use solid food, avoiding great quantities of tea, and other weak and watery liquors ; to rise early and go soon to bed; to shun damp houses ; to take frequent exercise in the open air, but to avoid fatigue ; and never to go abroad in damp foggy weather, if they can help it. Women of a full habit ought to use a spare diet, avoiding strong liquors, and every thing that may tend to heat the body, or increase the quantity of blood. Their diet should be of an opening nature, consisting principally of vegetable sub- stances. Every woman with child ought to be kept cheerful and » Every mother who procures an abortion does it at the hazard of her life ; yet there are not a few who run this risk merely to prevent the trouble of bearing and bnngi.ig children It is surely a most unnatural crime, and cannot, even in the most aban- doned, be viewed without horror ; but in the decent matron, it is still more unpardon- able. c 410 ABORTION. easy in her mind. Her appetites, even though depraved, ought to he indulged as far as prudence will permit. When any signs of abortion appear, the woman ought to be laid in bed on a mattress, with her head low. She should be kept quiet, and her mind soothed and comforted. She ought not to be kept too hot, nor to take arty thing of a heating nature. Her food should consist of broths, rice and milk, jellies, gruels made of oat- meal, and the like, all of which ought to be taken cold. If she be able to bear it, she should lose at least half a pound of blood from the arm. Her drink ought to be barley-water sharp- ened with the juice of lemon ; or, she may take half a drachm of powdered nitre, in a cup of water-gruel, every five or six hours. If the woman be seized with a violent looseness, she ought to drink the decoction of calcined hartshorn prepared. If she be affected with vomiting, let her take frequently two table-spoonsful of the saline mixture. In general, opiates are of service ; but they should always be given with caution. Sanguine robust women, who are liable to miscarry at a certain time of pregnancy, ought always to be bled a few days before that period arrives. By this means, and observing the regimen above prescribed, they might often escape that misfortune. Though we recommend due care for preventing abortion, we would not be understood as restraining pregnant women from their i:sual exercise. This would generally operate the quite contrary way. Want of exercise not only relaxes the body, but induces a plethora, or too great a fulness of the vessels, which are the two principal causes of abortion. There are, however, some women of so delicate a texture, that.it is necessary for them to avoid al- most every kind of exercise during the whole period cf pregnancy. Where abortion cannot be prevented, the next indication is to conduct the patient safely through the process, by directing our immediate attention to the hemorrhage ; to check which, bleeding is resorted to by some practitioners ; but, unless the vessels be above their natural force and strength of action, it is not likely to be of any service. Astringent injections, composed of alum, oak bark, or sulphate of zinc, and cold applications to the loins, Sec, are often employed in floodings ; and where the hemorrhage is slight, these immediately will prove beneficial; but in floodings without any remission, they do not appear calculated to afford much relief. In such cases it will be best to trust to the formation of a coagulum : enjoining rest, giving an anodyne at bed-time, and Keeping the bowels open by some gentle aperient. But, where these means have been pursued without effect, and the woman be- comes exposed to imminent danger from great loss of strength, the most powerful astringents must be employed ; such as the sul- phate of zinc* and superacetate of leadt; of the last, one, two, or three grains may be given, repeating the dose every three or four lours according to the urgency of the case. As soon, however, • Take Sulphate of Zinc, 2 to 5 grains, t Take Superacetate of Lead, 2 grains. Confect. of Roses, A scruple. Opium, £ grain. Opium, i grain. Make a pill, to be given every hour, Make a bolus, to be taken every fourth should it be required, until sis pills are hour. giyen. MANAGEMENT OF CHILD-BED WOMEN. 411 as the hemorrhage has stopped, give a dose of castor-oil in order to prevent any bad effects from the action of these remedies on the coats of the stomach and intestines. The application of cloths dipped in cold water to the back and external parts will have a much better effect than internal astringents, consequently ought never to be neglected. The introduction of a piece of smooth ice into the vagina has often a very speedy effect in arresting the he- morrhage. A snow-ball wrapt in a bit of soft linen will have the same effect; but neither of these should be continued so long as to cause pain. The most effectual means, then, to be resorted to for relieving the hemorrhage attendant on abortions are: if the pulse be full, hard, and frequent, bleeding is to be resorted to; if not, the fox- glove is to be trusted to, either in the form of pill, tincture, or infusion: the application of cold to the thighs and pubes; admit- ting a free circulation of cool air in the patient's bed-chamber ; keeping the heat of the body at a low temperature; absolute rest in a horizontal position, and which must be continued during the whole process, however long it may be; cold acidulated liquors for ordinary drink ; light food taken in small quantities at a time ; carefully abstaining from every thing stimulant, and plugging up the vagina, Sec. Sec. Sometimes the hemorrhage is kept up by some portion of the ovum remaining partly within and partly without the uterus; wl.en, should circumstances demand it, this should be removed by c.-'.reful manual interference with a pair of armed forceps. For some days after abortion the patient should be confined to bed, as getting up too soon is apt to produce a debilitating dis- charge. Women disposed to abort should the more sedulously avoid the exciting causes of abortion at those dates of utero-gesta- tion when it is most apt to take place. CHAP. X. MANAGEMENT OF CHILDBED-WOMEN. Many diseases proceed from the want of due care in child-bed ; and the more hardy part of the sex are most apt to despise the necessary precautions in this state. This is peculiarly the case tvith young wives. They think, when the labour-pains are ended, the danger is over; but in truth it may only then be said to be begun. Nature, if left to herself, will seldom fail to expel the fatus,- but proper care and management are certainly necessary for the recovery of the mother. No doubt, mischief may be done by too much as well as by too little care. Hence females who have the o-rcatest number of attendants in child-bed generally recover worst. But this is not peculiar to the state ot child-bed. Exces- sive care always defeats its own intention, and is generally more dangerous than none at all.* • Though the management of women in child-bed has been practised as an employ- ment since the earliest accounts of time, yet it is still in most countries on a very bad 412 MANAGEMENT OF CHILD-BED WOMEN. During actual labour, nothing of a heating nature ought to bs i-en. The woman may now and then take a little panado, and •riven fe.,~... -----••-----......._, ----- ™.« -..w.. .^..v, i» .....ty ^uwituvs, u»iu her drink ought to be toast and water, or thin groat-gruel. Spirits, wines, cordial-waters, and other things which are given with a view to strengthen the mother, and promote the birth, for the mo.-t part tend only to increase the fever, inflame the womb, and retard the labour. Besides, they endanger the woman afterwards, as they occasion violent and mortal hemorrhages, or dispose her to erup- tive and other fevers. Parturition. Is that natural process which, at the expiration of forty weeks from conception, is matured, and by which the womb detaches and expels its contents, and returns nearly to the same condition in which it was previous to its impregnation. Classification of Labours, &c. The division of labours, originally made by Hippocrates into natural and preternatural, is sufficiently comprehensive, whilst it forcibly recommends itself by its simplicity and perspicuity. Natural labour, of which we shall only treat here, supposes four things : 1. That the vertex presents. 2. That there be sufficient room in the pelvis to admit of the ready descent of the child in that direction which permits the occiput or back part of the head to emerge under the arch of the pubis. 3. That there be parturi- ent energy adequate to the expulsion of the contents of the uterus, without manual interference; and without danger, either to the mother or child : and, 4. That the process of parturition be com- pleted within a moderate time. Stages of Labour. Certain occurrences take place during the progress of parturi- tion which may be managed under three divisions or stages; the first comprehends all that may occur before the complete dilatation of the os uteri; the second includes all that takes place between the developement of the os uteri and the expulsion of the child; the third embraces every thing connected with the detachment and extension of the placenta and its adherent membranes. Symptoms preceding Labour. For several days before the actual existence of labour arrives, S^EL S * womenfthl"k of following this employment till they are reduced to the necessity of doing it for bread Hence not one in a hundred of them have any edu- cation or proper "knowledge of their business. It is true, that nature, if left to her- self, will generally expel the fatus; but it is equally true/that most women, in child- bed, require to be managed with skill and attention, and that they are often hurt by the superstitious prejud.ces of ignorant and officious niidwive*. The mischief done in this way is much greater than is generally imagined; most of which might be prevent- ed by allowing no women to practise midwifery but such as are properly qualified Were due attention paid to this, it would not only be the means of .caving many lives r,,,M ? Pr<\vent the necessity of employing men in this indelicate and disagreeable urancta of medicine, which is, on many accounts, more proper for the other rex MANAGEMENT OF CinLD-BED WOMEN. 41J there are often certain premonitory symptoms, which, by women who haye borne children, are viewed as precursors of that eventful hour which many of them so much dread. Among these are: 1. Restlessness, particularly at night, very frequently precedes parturition for days and weeks, and is rarely to be considered as bearing unfavourably in labour. 2. Subsidence of the womb and abdomen is not an unusual monitor of the approach of suffering. It may be viewed in a favourable light, inasmuch as it indicates room in the pelvis. 3. Glairy mucuous secretion from the os uteri and vagina, popu- larly termed shew, sometimes occurs for days before the more active symptoms of labour. It is often streaked with blood, and tends to lubricate the parts concerned in parturition. 4. Irritability of the bladder and rectum, demanding their frequent relief, is another occasional precursor of labour. Symptoms accompanying Labour. Owing to the resistance which the womb encounters during its contractile efforts, pain follows every such contraction; but the pain attendant on parturition differs very materially in its nature, and in its influence in the uterus. These paroxysms of pain arc either intestinal or uterine. Paroxysms of intestinal pain, or such as are termed false or spu- rious, may be distinguished from genuine labour-pains by beir»£ unconnected with uterine contraction ; by attacking different parts of the abdomen; and by recurring irregularly. These pains usually originate in some source of intestinal irritation, and may almost always be removed by emptying the bowels, and subsequently exhibiting an opiate. By the observant practitioner, should one be present, they cannot be confounded with pain in the bowels. The true or uterine pains are either dilating or expulsive. Dilating Pains, or, as they are popularly termed, grinding pains, result from contraction of the womb. They are principally con- fined to the back, and occur in the earliest stage of labour, and are often peculiarly distressing to the patient, who expresses her- self by restlessness, despondency, and moaning. They often con- tinue a long time without the intermissions being free from uneasi- ness, and appear almost exclusively to dilate the mouth of the womb, having little influence over the fundus of the uterus. It is during the existence of these dilating pains that cold shiverings most com- monly come on, and may be relieved by avoiding spiced or fer- mented fluid, and by administering any simple warm diluents. When the mouth of the womb is considerably dilated, expulsive pains, sometimes termed forcing or bearing down pains, commence in the loins, and gradually proceed round the abdomen, till they meet at the region of the pubes, and dart down the labia pudendi and thighs. If the accoucheur's hand be placed on the flaccid sides of the abdomen, previous to*the accession of a paroxysm of expulsive pain, before the woman is aware of it, the womb may be felt contracting to a hard, tense, incompressible tumour. These pains observe regular intervals of ease, which become shorter, whilst the pains, in an inverse ratio, increase in their duration and ^14 MANAGEMENT OF CHILD-BED WOMEN. severity; and now it is that the abdominal muscles and diaphragm afford their assistance. During each propulsive effort a larger portion of the membranes, distended with the liquor of the amnion, is forced through the mouth of the womb, performing to it, and all the parts through which the child is to pass, the office of an easy but powerful wedge. With these pains there is often a frequent deposition to empty the rectum ; and sometimes this inclination is so harassing as to justi- fy the administration of a small clyster, with half a drachm of the tincture of opium. Vomiting is a common attendant on uterine pain, and is benefi- cial by rejecting food, which, from its quality or quantity, may be a source of irritation to the stomach. It principally occurs during the dilating pains, and unquestionably assists in the relaxation and dilatation of the mouth of the womb. In a protracted labour, when vomiting continues or returns, after the mouth of the womb is fully dilated, with abdominal tension and pain, without uterine contractions, and with ejection from the stomach of fluid like dark coffee-grounds, with foul tongue, and rapid and hard pulse, it generally must be taken as indicative of inflammatory action, and as requiring immediate and most efficient interference. Besides these attendants on parturition, the pulse usually becomes quickened and full; the countenance florid ; the whole surface of the body covered with profuse perspiration; and the lower extremities cramped. The Process of Natural Labour. r The process of natural labour, to use the words of a modern writer, is at once so simple and beautiful, that it cannot fail to ex- cite the admiration of those who look beneath the surface of the operations of nature. Without repeating what has already been advanced respecting the precursory and accompanying symptoms of delivery, we shall merely recall to the mind those statements, as constituting a part of the history of this process. The symp- toms which announce the commencement of natural labour have continued for an indefinite time; pains in the loins, darting through the pelvis, with an appearance of shew, indicate the ap- proach of unequivocal evidences of this stage of parturition. From time to time these pains are of the dilating kind and on an examination per vaginam, will be found to be diminishing the thickness of the cervix uteri more than to be opening the mouth of the womb. When the neck of the womb becomes reduced to the thickness of the other parts of that organ, it begins to open, and as soon as it can admit the extention of any part of the membranes distended with the liquor of the amnion, the pains rather assume the expulsive character, and there will be a sensible bearing down ,of the whole uterine tumour. Successive p-n-oxysms of pain dilate the mouth of the womb more an'd more, whilst the protruded mem- branes, distended like a tense bladder, fill up the opening, and perform the office of an inimitable wedge, till the womb and the entrance to it form one continuous passage. Soon after this the membranes generally burst during a strong pain, having previously MANAGEMENT OF CHILD-BED WOMEN. 415 contributed to the dilatation of the vagina; and with the escape of the waters, or liquor of the amnion, there is sometimes a tem- porary suspension of pain, and the head of the child falls into the superior aperture or brim of the pelvis, or descends into the cavi- ty ; but more frequently this advance is not made until several pains have followed this occurrence. The contractions of the womb recurring with augmented fre- quency and force, gradually propel the fcetus along the passages, until the head presses on the perinseum or fork, which is put on the full stretch; and also against the soft parts which it protrudes. These by degrees dilate, and permit the back part of the head to emerge under the arch of the pubes, and with the complete extru- sion of the head, the other parts of the body are expelled, some- times by the same pain, but more frequently by one which speedily follows. The same paroxysm of pain that expels the child now and then detaches and expels the placenta, or after-burden, commonly so called; but more frequently the womb remains at rest for about a quarter of an hour, when it resumes its contractions, and throws it off with the adherent membranes. This constitutes the interest- ing process of natural labour, in which the uterus requires no offi- cious interference, but which, when forced to submit to any, she often resents, by harassing the busy meddler with some untoward occurrence. All that it becomes necessary for the accoucheur to do during this interesting process of natural labour, is to support the peri- naeum by his hand, covered smoothly with a soft napkin, and so applied as to give equable support, without in the slightest degree resisting the exit of the head. No other interference, in natural labour, is justifiable, and too strong terms cannot be employed to reprobate the practice of hastening the birth of the body, dragging it forcibly by the head into the world. It should be left to be ex- pelled by the unaided contraction of the uterus. As soon as the child is thus brought into the world, and manifests unequivocal signs of life, the funis or navel-string must be tied, by passing a ligature, consisting of a few threads, or a thin piece of tape, round it, at about the distance of two inches from the navel, and a second at the distance of three inches from the first. The funis may then be divided by a round-pointed pair of scissors, at a point equidistant from each ligature, taking care to cut nothing but the funis. All this should be done in the most delicate manner under the bed-clothes, without exposing either the mother or child. The navel-string being thus secured, and the child separated from the mother, it is to be transferred to the nurse, whilst the bandage, previously passed round the body of the mother, should be moderately tightened, or the womb supported by gentle pressure made by an assistant, which will be found very materially to aid its efforts to detach and expel the placenta. Management of the After-burden. The management of the placenta constitutes a very important part of natural labour ; and if the womb be not permitted to .; ;j MANAGEMENT OF CHILD-BED WOMEN. empty itself gradually, some untoward and alarming circumstance may occur in this stage of parturition. Generally from twenty to thirty minutes elapse between the birth and the expulsion of the placenta. The woman then complains of a slight pain in her back or abdomen, and this secondary contraction of the uterus de- taches the placenta, although it but rarely expels it from the pass- ages"; whence, however, it may usually be easily removed by coil- ing the funis round two of the fingers of the right hand, whilst guided by the cord, the thumb and index finger of the left hand should be passed up to its insertion into the placenta, which, if it can be felt, is a pretty certain indication of the detachment of the whole mass from the sides of the womb. By this means, also, the navel-string is prevented from breaking off, and a firmer hold of the placenta is obtained. To prevent the possibility of inverting the womb, or from its oc- currence without knowing it, the placenta should be permitted to slip by the fingers of the left hand into the vagina ; and the with- drawing of the placental mass should always be in the axis of the brim, cavity, and outlet of the pelvis, as it passes those parts. The hand of the accoucheur should afterwards be laid on the abdomen, to ascertain that the uterus is well contracted : and the pulse should be felt, lest internal hemorrhage redistending the uterus may be going on to the endangering of the patient's life. It is of great importance that a bandage be passed over the re- gion of the womb : this being done, and a well-aired napkin ap- plied to the labia pudendi, or external parts, some mild and ceol nourishment may be given to the woman, who, after having been suffered to remain quiet for about half an hour, should have her soiled linen withdrawn, and, without being raised from her hori- zontal posture on any pretence, may be drawn up to the head of the bed ; whilst she herself remains perfectly passive, without tak- ing any part in this operation, lest hemorrhage or prolapsus of the womb should follow. Tedious Labours.—When the labour proves tedious and diffi- cult, to prevent inflammations, it will be proper to bleed. An emollient clyster ought likewise frequently to be administered, and the patient should sit over the steams of warm water. The pas- sage ought to be gently rubbed with a little soft pomatum, or fresh butter, and cloths wrung out of warm water applied over the belly. If nature seems to sink, and the woman is greatly exhausted with fatigue, a draught of generous wine, or some other cordial, may be given, but not otherwise. These directions are sufficient in natural labours ; and in all preternatural cases, a skilful surgeon, or man-midwife, ought to be called as soon as possible. Treatment after Delivery.—After delivery, the woman ought to be kept as quiet and easy as possible.* Her food should be • We cannot help taking notice of that ridiculous custom which still prevails in some parts of the country, of collecting a number of women together upon such occa- sions. These, instead of being useful, serve only to crowd the house, and obstruct the necessary attendants. Besides, they hurt the patient with their noise ; and often, by their untimely and impertinent advice, do much mischief. MANAGEMENT OF CHILD-BED WOMEN. 417 light and thin, as gruel, panado, Sec. and her drink weak and di- luting. To this rule, however, there are many exceptions. I have known several women, whose spirits could not be supported in child-bed without solid food and generous liquors ; to such, a glass of wine and a bit of chicken must be allowed. Sometimes an excessive hemorrhage or flooding happens after delivery. In this case the patient should be laid with her head low, kept cool, and be in all respects treated as for an excessive flow of the menses. If the flooding prove violent, linen cloths, which have been wrung out of a mixture of equal parts of vinegar and water, or red wine, should be applied to the belly, the loins, and the thigh : these must be changed as they grow dry, and may he discontinued as soon as the flooding abates. In a violent Hooding after delivery, I have seen very good effects from the following mixture :—Take of penny-royal water, simple cinnamon-water, and syrup of poppies, each two ounces, elixir of vitriol, a drachm. Mix, and take two table-spoonsful every two hours, or oftener if necessary. After-Pains.—If there be violent pains after delivery, the pa- tient ought to drink plentifully of warm diluting liquors, as groat- gruel, or tea with a little saffron in it; and to take small broths, with caraway-seeds, or a bit of orange-peel in them ; an ounce of lhe oil of sweet almonds may likewise be frequently taken in a cup of any of the above liquors; and if the patient be restless, a spoonful of the syrup of poppies may now and then be mixed with a cup of her drink.* If she be hot or feverish, one of the follow- ing powders may be taken in a cup of her usual drink every five or six hours. Take of crabs' claws prepared, half an ounce, purified nitre two drachms, saffron powdered, half a drachm ; rub them together in a mortar, and divide the whole into eight or nine doses. And if she be low-spirited, or troubled with hysterical complaints, she ought to take frequently twelve or fifteen drops of the tincture of asafcetida in a cup of penny-royal tea. Costiveness.—Costiveness is apt to prevail after delivery, and should always be removed by a laxative clyster, or some gentle purgative, such as neutral salt and manna, or about an ounce of castor oil. Inflammation of the Womb.—An inflammation of the womb is a dangerous and not unfrequent disease after delivery. It is known by pains in the lower part of the belly, which are greatly increas- ed upon touching; by the tension or tightness of the parts; great weakness; change of countenance, a constant fever, with a weak find hard pulse ; a slight delirium, or raving; sometimes incessant vomiting; a hiccup ; a discharge of reddish, stinking, sharp water from the wound ; an inclination to go frequently to stool ; a heat, and sometimes total suppression of urine. • Take Cinnamon Water, 1 ounce. Tincture of Castor, A drachm. Tincture of Opium, Syrup of Violets, 2 drachms. 30 to 40 drops. Mike a draught, to be taken at bed-tinv S3 418 MANAGEMENT OF CHILD-BED WOMEN. This must be treated like other inflammatory disorders, by bleed- ing and plentiful dilution. The drink may be thin gruel or bar- ley-water ; in a cup of which half a drachm of nitre may be dis- solved and taken three or four times a-day. Clysters of warm milk and water must be frequently administered: and the belly should be fomented by cloths wrung out of warm water, or by ap- plying bladders filled with warm milk and water to it. Suppression of the Lochia.—A suppression of the lochia or usual discharges after delivery, and the milk-fever, must be treated nearly in the same manner as an inflammation of the womb. In all these cases, the safest course is plentiful dilution, gentle evacu- ations, and fomentations of the parts affected. In the milk-fever, the breasts may be embrocated with a little warm linseed-oil, or the leaves of red cabbage may be applied to them. The child should be often put to the breast, or it should be drawn by some other person. Nothing would tend more to prevent the milk-fever than putting the child early to the breast. The custom of not allowing children to suck for the first two or three days, is contrary to Nature and common sense, and is very hurtful both to the mother and child. Every mother who has milk in her breasts ought either to suckle her own child or to have her breasts frequently drawn, at least for the first month. This would prevent many of the diseases which prove fatal to women in child-bed. Inflammation of the Breast.—When an inflammation happens in the breast, attended with redness, hardness, and other symp- toms of suppuration, the safest application is a poultice of brea I and milk, softened with oil or fresh butter. This may be renewed twice a-day, till the tumour be either discussed or brought to sup- puration. The use of repellents, in this case, is very dangerous; they often occasion fevers, and sometimes cancers; whereas a suppuration is seldom attended with any danger, and has often the most salutary effects. Fretted or Chapped Nipples.—When the nipples are fretted or chapped, they may be anointed with a mixture of oil and bees' wax, or a little powdered gum-arabic may be sprinkled on them. I have seen Hungary-water applied to the nipples have a very good effect. Should the complaint prove obstinate, a cooling purge may be given, which generally removes it. Miliary Fever.—The miliary fever is a disease incident to wo- men in child-bed; but as it has been treated of already, we shall take no farther notice of it. The celebrated Hoffman observes, that this fever of child-bed women might generally be prevented, if they, during their pregnancy, were regular in their diet, used moderate exercise, took now and then a gentle laxative of manna, rhubarb, or cream of tartar ; not forgetting to bleed in the first months, and to avoid all sharp air. When the labour is coming on it is not to be hastened with forcing medicines, which inflame the blood and humours, or put them into unnatural commotions. Care should be taken, after the birth, that the natural excretions pro- MANAGEMENT OF CHILDBED WOMEN. 419 ceed regularly ; and if the pulse be quick, a little nitrous powder, or some other cooling medicines, should be administered. Puerperal Fever.—The most fatal disorder consequent upon delivery is the puerperal, or- child-bed fever. It generally makes its attack upon the second or third day after delivery. Some- times, indeed, it comes on sooner, and at other times, though rare- ly, it does not appear before the fifth or sixth day. It begins, like most other fevers, with a cold or shivering fit, which is succeeded by restlessness, pain of the head, great sickness at the stomach, and bilious vomiting. The pulse is generally quick, the tongue dry, and there is a remarkable depression of spirits and loss of strength. A great pain is usually felt in the back, hips, and region of the womb ; a sudden change in the quan- tity or quality of the lochia also takes place ; and the patient is fre- quently troubled with a tenesmus, or constant inclination to go to stool. The urine, which is very high coloured, is discharged in small quantity, and generally with pain. The belly sometimes swells to a considerable bulk, and becomes susceptible of pain from the slightest touch. When the fever has continued for a few days, the symptoms of inflammation usually subside, and the disease ac- quires a more putrid form. At this period, if not sooner, a bilious or putrid looseness, of an obstinate and dangerous nature, comes on, and accompanies the disease through all its future progress. There is not any disease that requires to be treated with more skill and attention than this; consequently the best assistance ought always to be obtained as soon as possible. In women of plethoric constitutions, bleeding will generally be proper at the beginning; it ought, however, to be used with caution, and not to"be repeated, unless where the signs of inflammation rise high; in which case it will also be necessary to apply a blistering-plaster to the region of the womb. During the rigour, or cold fit, proper means should be used to abate its violence and shorten its duration. For this purpose, the patient may drink freely of warm diluting liquors, and, if low, may take now and theu a cup of wine-whey; warm applications to the extremities, as* heated bricks, bottles or bladders filled with warm water, and such like, may also be used with advantage. Emollient clysters of milk and water, or of chicken water, ought to be frequently administered through the course of the disease. These prove beneficial, by promoting a discharge from the intes- tines, and also by acting as a kindly fomentation to the womb and parts adjacent. Great care, however, is requisite in giving them, on account of the tenderness of the parts in the pelvis at this time. To evacuate the offending bile from the stomach, a vomit is gen- erally given. But as this is apt to increase the irritability of the stomach, already too great, it will be safer to omit it, and to give in its stead a gentle laxative, which will both tend to cool the body, unci to procure a free discharge of the bile.* * Midwives ou"ht to be very cautious in administering vomits, or purges to women ,n child bed I have known a woman who was recovering extremely well, thrown in- to the most imminent danger by a strong purge which was given her by an officious midwife. 420 MANAGEMENT OF CHILD-BED WOMEN. The medicine which I have always found to succeed best in this disease, is the saline draught. This, if frequently repeated, will often put a stop to the vomiting, and at the same time lessen the violence of the fever. If it runs off by stool, or if the patient be restless, a few drops of laudanum, or some syrup of poppies, may occasionally be added. If the stools should prove so frequent as to weaken and exhaust the patient, a starch clyster, with thirty or forty drops of laudanum in it, may be administered as occasion shall require ; and the drink may be rice-water, in every English pint of which half an ounce of gum-arabic has been dissolved. Should these fail, recourse must be had to Coluinbo-root, or the powder of bole combined with opium. Though in general the food ought to be light, and the drink diluting, yet, when the disease has been long protracted, and the patient is greatly spent by evacuations, it will be necessary to sup- port her with nourishing diet, and generous cordials. It was observed, that this fever, after continuing for some time, often acquires a putrid form. In this case the Peruvian bark must be given, either by itself, or joined with cordials, as circumstances may require. As the bark in substance will be apt to purge, it may be given in decoction or infusion mixed with the tincture of roses, or other gentle astringents; or a scruple of the extract of bark with half an ounce of spirituous cinnamon-water, two ounces of common water, and ten drops of laudanum, may be made into a draught, and given every second, third, or fourth hour, as shall be found necessary. When the stomach will not bear any kind of nourishment, the patient may be supported for some time by clysters of beef-tea or chicken-broth. To avoid this fever, every woman in child-bed ought to be kept perfectly easy; her food should be light and simple, and her bed- chamber cool and properly ventilated. There is not any thing more hurtful to a woman in this situation than being kept too warm. She ought not to have her body bound too tight, nor to rise too soon from bed after delivery; catching cold is also to be avoided; and a proper attention should be paid to cleanliness. Milk Fever.—To prevent the milk fever, the breasts ought to be frequently drawn; and if they are filled previous to the onset of a fever, they should, upon its first appearance, be drawn, to pre- vent the milk from becoming acrid, and its being absorbed in thia state. Costiveness is likewise to be avoided. This will be best effected by the use of mild clysters and a laxative diet. We shall conclude our observations on child-bed women, by recommending it to them, above all things, to beware of cold. Poor women, whose circumstances oblige them to quit their bed too soon, often contract diseases from cold of which they never recover. It is a pity the poor are not better taken care of in this situation. But the better sort of women run the greatest hazard from too much heat. They are generally kept in a sort of bagnio for the first eight or ten days, and then dressed out to see company. The danger of this conduct must be obvious to every one. The BARRENNESS. 421 Buperstitious custom of obliging women to keep the house till they go to church is likewise a very common cause of catching cold. All churches are damp, and most of them cold; consequently they are the very worst places to which a woman can go to make her first visit, after having been confined in a warm room for a month. CHAP. XI. OF BARRENNESS. Barrenness may be very properly reckoned among the diseases of females, as few married women, who have not children, enjoy a ffood state of health. It may proceed from various causes, as high living, grief, relaxation, &c. ; but it is chiefly owing to an obstruction or irregularity of the menstrual flux. It is very certain that high living vitiates the humours, and pre- vents fecundity. We seldom find a barren woman among the la- bouring poor, while nothing is more common among the rich and affluent. The inhabitants of every country are prolific in propor- tion to their poverty ; and it would be an easy matter to adduce many instances of women, who, by being reduced to live entirely upon milk and vegetable diet, have conceived and brought forth children, though they never had any before. Would the rich use the same sort of food and exercise as the better sort of peasants, they would seldom have cause to envy their poor vassals and de- pendants the blessing of a numerous and healthy offspring, while they pine in sorrow for the want of even a single heir to their ex- tensive domains. Affluence begets indolence, which not only vitiates the humours, but induces a general relaxation of the solids ; a state highly un- favourable to procreation. To remove this, we would recommend the following course :—First, sufficient exercise in the open air ; secondly, a diet consisting chiefly of milk and vegetables*; ?thirdly, the use of astringent medicines, as steel, alum, dragon s blood, elixir of vitriol, the Spa or Tunbridge waters, Peruvian bark, &c; and, lastly, above all, the cold bath. Barrenness is often the consequence of grief, sudden fear, anxi- ety, or any of the passions which tend to obstruct the menstrual flux. When barrenness is suspected to proceed from affections of the mind, the person ought to be kept as easy and cheerful as pos- sible ; all disagreeable objects are to be avoided, and every meth- od taken to amuse and entertain the fancy. I believe I have never written, and I hope I never shall write, any thing offensive to real modesty. Yet I have not suppressed, from motives of false delicacy, what I thought might be of import- * Dr Cheyne avers, that want of children is oftener the fault of the male than of the female'; in this the Doctor and I do not agree ; and strongly recommends a milk^and veeetable diet to the former as well as the latter; adding, that his friend Dr. Taylor, whom he called the Milk-doctor of Croyden, had brought sundry opulent families in his neighbourhood, who had continued some years after marriage without progeny,.to have several fine children, by keeping both parents, for a considerable time, to a milk and vegetable diet. 422 DISEASES OF INFANTS. ance on a subject so closely connected with conjugal happiness. The remarks here made, though few and apparently simple, con- tain all that is really known, in medical practice, of the causes and remedies of barrenness. I therefore wish to put married ladies on their guard against the fallacy of private suggestions, and of public advertisements on this head. The things commonly advis- ed by silly nurses, as well as the grand restoratives of quack im- postors, are all of them dangerous stimulants, that provoke desire, but enfeeble, instead of strengthening, the powers of nature, and render a weakness, which proper treatment might have removed, absolutely incurable. CHAP. XII. DISEASES OF INFANTS. Miserable indeed is the lot of man in the state of infancy! He comes into the world more helpless than any other animal, and stands much longer in need of the protection and care of his pa- rents : but, alas! this care is not always bestowed upon him ; and when it is, he often suffers as much from improper management as he would have done from neglect. Hence the officious care of parents, nurses, and midwives, becomes one of the most fruitful sources of the disorders of infants.* It must be obvious to every attentive person, that the first dis- eases of infants arise chiefly from their bowels. Nor is this in the least to be wondered at, as they are in a manner poisoned with in- digestible drugs and improper diet as soon as they come into the world. Every thing that the stomach cannot digest may be con- sidered as a poison; and unless it can be thrown up, or voided by stool, it must occasion sickness, gripes, spasmodic affections of the bowels, or what the good women call inward fits, and at last convulsions and death. As these symptoms evidently arise from somewhat that irritates the intestines, doubtless the proper method of cure must be to re- move it as soon as possible. The most safe and effectual method of doing this is by gentle vomits. Five or six grains of the powder of ipecacuanha may be mixed in two table-spoonsful of water, and sweetened with a little sugar. A tea-spoonful of this may be given to the infant every quarter of an hour till it operates ; or, what will more certainly answer the purpose, a grain of emetic tar- tar, may be dissolved in three ounces of water, sweetened with a little syrup, and given as above. Those who are unwilling to use * Of the officious and ill-judged care of midwives, we shall adduce only one instance, viz. the common practice of torturing infants, by squeezing their breasts, to draw oft" the milk, as they call it. Though a small quantity of moisture is generally found in the breasts of infants, yet, as they are certainly not intended to give suck, this ought never to be drawn off. I have seen this cruel operation bring on hardness, inflamma- tion, and suppuration of the breasts; but never knew any ill consequences from its being omitted. When the breasts are hard, the only application that we would re- commend is a soft poultice, or a little of the diachylon plaster, spread thin upon a bit of soft leather, about the size of half a crown, and applied over each nipple. These may be suffered to continue till the hardness disappears. DISEASES OF INFANTS. 423 the emetic tartar, may give six or seven drops of the antimonial wine, in a tea-spoonful of water or thin gruel. Small doses of the ipecacuanha wine will be found more gentle than any of the above, and ought to be preferred. These medicines will not only cleanse the stomach, but will gen- erally likewise open the body. Should this, however, not happen, and if the child be costive, some gentle purge will be necessary: for this purpose, some manna and pulp of cassia may be dissolved in boiling water, and given in small quantities till it operates ; or, what will answer rather better, a few grains of magnesia alba may be mixed in any kind of food that is given to the child, and con- tinued till it has the desired effect. If these medicines be properly administered, and the child's, belly and limbs frequently rubbed with a warm hand before the fire, they will seldom fail to relieve those affections of the stomach and bowels from which infants suf- fer so much. These general directions include most of what can be done for relieving the internal disorders of infants. They will likewise go a considerable way in alleviating those which appear externally, U3 the rash, gum, or fellon, Sec These, as was formerly observed, are principally owing to too hot a regimen, and consequently will lie most effectually relieved by gentle evacuations. Indeed, evac- uations of one kind or other constitute a principal part of the med- icine of infants, and will seldom, if administered with prudence, in any of their diseases, fail to give relief. Of the Meconium. The stomach and bowels of a new-born infant are filled with a blackish-coloured mutter of the consistence of syrup, commonly called the meconium. This is generally passed soon after the birth, by the mere effort of nature ; in which case it is not necessary to give the infant any kind of medicine. But if it should be retained, or not sufficiently carried off, a little manna, or magnesia alba, may he given, as mentioned above ; or, if these should not be at hand, a common spoonful of whey, sweetened with a little honey, or moist sugar, will answer the purpose. The most proper medicine for expelling the meconium is the mother's milk, which is always at first of a purgative quality. Were children allowed to suck as soon as they show an inclination for the breast, they would seldom have occasion for medicines to discharge the meconium; but even where this is not allowed, they ought never to have daubs of syrup, oils, and other indigestible stuff, crammed down their throats. The A futile, or Thrush. The aphtha? are little whitish ulcers affecting the whole inside of the mouth, tongue, throat, and stomach of infants. Sometimes they reach through the whole intestinal canal; in which case they are very dangerous, and often put an end to the infant's life. If the,aphtha- are of a pale colour, pellucid, few in number, soft, superficial, and fall easily off, they are not dangerous; but if npake, yellow, brown, black, thick, or running together, they ought to be dreaded. 424 DISEASES OF INFANTS. It is generally thought that the aphthic owe their origin to acrid humours ; we have reason, however, to believe, they are more fre- quently owing to too hot a regimen both of the mother and child. It is a rare thing to find a child who is not dosed with wine, punch, cinnamon-waters, or some other hot and inflaming liquors, almost as soon as it is born. It is well known that these will occasion in- flammatory disorders, even in adults; is it any wonder then that they should heat and inflame the tender bodies of infants, and set, as it were, the whole constitution on a blaze 1 The most proper medicines for the aphtlue are vomits, such as have been already recommended, and gentle laxatives. Five grains of rhubarb, and half a drachm of magnesia alba, may be rubbed together, and divided into six doses, one of which may be given to the infant every four or five hours till they operate. These powders may either be given in the child's food, or a little of the syrup of pale roses, and may be repeated as often as is found ne- cessary to keep the body open. It is common in this case to ad- minister calomel; but as that medicine sometimes occasions gripes, it ought always to be given to infants with caution. Many things have been recommended for gargling the mouth and throat in this disease ; but it is not easy to apply these in very young children; we would therefore recommeud it to the nurse to rub the child's mouth frequently with a little borax and honey; 01 with the following mixture :—Take fine honey an ounce, borax a drachm, burnt alum half a drachm, rose-water two drachms ; mix them together. A very proper application in this case is a solution of ten or twelve grains of white vitriol in eight ounces of barley- water. These may be applied with the finger, or by means of a bit of soft rag tied to the end of a probe. Hiccups. Some infants are much incommoded by hiccups, arising proba- bly, either from acidity in the stomach, or from some nervous irri- tation. In the former case, a powder composed of a little prepar- ed chalk and rhubarb (about eight grains of the former with two or three of the latter) may prove beneficial. In the latter, it may be proper to give a few drops of the aromatic spirit of ammonia, or the compound tincture of camphor (paregoric.) In some cases, a little plain vinegar has proved an effectual remedy. Where the complaint is severe, or returns frequently,""it may be advisable to rub the stomach with soap liniment, to which a little tincture of opium has been added. Or Acidities. The food of children being for the most part of an acescent na- ture, it readily turns sour upon the stomach, especially if the body be any way disordered. Hence most diseases of children are ac- companied with evident signs of acidity, as green stools, gripes, &c. These appearances have induced many to believe, that all the diseases of children were owing to an acid abounding in the stomach and bowels; but whoever considers the matter attentive- ly, will find that these symptoms of acidity are oftener the effect than the cause of their diseases. DISEASES OF INFANTS. 425 Nature evidently intended that the food of children should be acescent; and unless the body be disordered, or the digestion hurt, from some other cause, we will venture to say, that the acescent quality of their food is seldom injurious to them. Acidity, how- ever, is often a symptom of disorders in children ; and, as it is sometimes a troublesome one, we shall point out the method of re- lieving it. When green stools, gripes, purgings, sour smells, &c, show that the bowels abound with an acid, the child should have a little small broth, with light white bread in it; and should have sufficient exer- cise, in order to promote the digestion. It has been customary in this case to give the pearl-julep, chalk, crabs' eyes, and other tes- taceous powders. These, indeed, by their absorbent quality, may correct the acidity; but they are attended with this inconvenience, that they are apt to lodge in the bowels, and occasion costiveness, which may prove very hurtful to the infant. For this reason they should never be given unless mixed with purgative medicines ; as rhubarb, manna, or such like. The best medicine which we know, in all cases of acidity, is that fine insipid powder, called magnesia alba. It purges, and at the same time corrects the acidity: by which means it not only removes the disease, but carries off its cause. It may be given in any kind of food, or in a mixture, as recommended in the Ap- pendix.* When an infant is troubled with gripes, it ought not at first to be dosed with brandy, spiceries, and other hot things ; but should have its body opened with an emollient clyster, or the medicine mentioned above ; and, at the same time, a [little brandy may be rubbed on its belly with a warm hand before the fire. I have sel- dom seen this fail to ease the gripes of infants. If it should hap- pen, however, not to succeed, a little brandy or other spirits may be mixed with thrice the quantity of warm water, and a tea-spoon- ful of it given frequently, till the infant be easier. Sometimes a little peppermint-water will answer this purpose as well.t Galling and Excoriation. These are very troublesome to children. They happen chiefly about the groin and wrinkles of the neck, under the arms, behind the ears, and in other parts that are moistened by the sweat or urine. As these complaints are, in a great measure, owing to want of cleanliness, the most effectual means of preventing them are, to wash the parts frequently with cold water, to change the linen of- ten, and, in a word, to keep the child in all respects thoroughly clean. When this is not sufficient, the excoriated parts may be sprinkled with absorbent or drying powders ; as burnt hartshorn, tutty, chalk, crabs' claws prepared, and the like. When the parts " See Appendix, Laxative absorbent Mixture. t Twenty drops of the spirits of hartshorn given in a little linseed-tea immediately relieves children affected by that acidity of the bowels which frequently attends teeth- ing. Much of the acidity of the stomachs of children arises from the too free use of fermented bread. 426 DISEASES OF INFANTS. affected are very sore, and tend to a real ulceration, it will be proper to add a little sugar of lead to the powders ; or to anoint the place with the camphorated ointment. If the parts be washed with spring-water, in which a little white vitriol has been dissolved, it will dry and heal them very powerfully. One of the best appli- cations for this purpose is to dissolve some fuller's earth in a suffi- cient quantity of hot water ; and after it has stood till it is cold, to rub it gently upon the galled parts once or twice a-day. Or to wash them gently now and then with a mixture of equal parts of rose-water and spirits of wine. Stoppage of the Nose. The nostrils of infants are often plugged up with a gross mucus, which prevents their breathing freely, and likewise renders it diffi- cult for them to suck or swallow. Some in this case order, after a suitable purge, two or three grains of white vitriol, dissolved in half an ounce of marjoram wa- ter, and filtered, to be applied now and then to the nostrils with a linen-rag. Wedellus says, if two grains of white vitriol, and the same quantity of elaterium, be dissolved in half an ounce of marjo- ram-water, and applied to the nose, as above directed, that it brings away the mucus without sneezing. In obstinate cases these medicines may be tried ; but I have nev- er found any thing necessary, besides rubbing the nose at bed-time with a little sweet oil, or fresh butter. This resolves the filth, and renders the breathing more free.* Op Vomiting. From the delicate state of children, and the great sensibility of their organs, a vomiting or looseness may be induced by any thing that irritates the nerves of the stomach or intestines. Hence these disorders are much more common in childhood than in the more advanced periods of life. They are seldom, however, dangerous, and ought never to be considered as diseases, unless when they are violent, or continue so long as to exhaust the strength of the patient. Vomiting may be excited by an over-quantity of food ; by food that is of such a nature as to irritate the nerves of the stomach too much; or by the sensibility of the nerves being so much increased as to render them unable to bear the stimulus of even the mildest aliment. When vomiting is occasioned by too much food, it ought to be promoted, as the cure will depend upon cleansing the stomach. This may be done either by a few grains of ipecacuanha, or a weak solution of emetic tartar, as mentioned before. When it is owing to food of an acrid or irritating quality, the diet ought to be chang- ed, and aliment of a milder nature substituted in its stead. When vomiting proceeds from an increased degree of sensibility, * Some nurses remove this complaint by sucking the child's nose. This is by no means a cleanly operation ; but when nurses have the resolution to do it, I am far from discouraging the practice. DISEASES OF INFANTS. 427 or too great an irritability of the nerves of the stomach, such med- icines as have a tendency to brace and strengthen that organ, and to abate its sensibility, must be used. The first of these intentions may be answered by a slight infusion of the Peruvian bark, with the addition of a little rhubarb and orange-peel; and the second by the saline draughts, to which a few drops of liquid laudanum may occasionally be added. In obstinate vomitings the operation of internal medicines may be assisted by aromatic fomentations made with wine, applied warm to the pit of the stomach ; or the use of the stomach-plaster, with the addition of a little t'teriaca. Looseness. (Diarrhoea.) A looseness may generally be reckoned salutary, when the stools are sour, slimy, green, or curdled. It is not the discharge, but the production of such stools, which ought to be remedied. Even where the purging is thin and watery, it ought not to be checked too suddenly, as it often proves critical, especially when the child has caught cold, or an eruption on the skin has disappear- ed. Sometimes an evacuation of this kind succeeds a humid state of the atmosphere, in which case it may also prove of advantage, by carrying off a quantity of watery humours which would otherwise tend to relax the habit. Diarrhoea may be injurious in different ways. The increased peristaltic motion of so great a tract of sensible muscular substance as the intestinal canal must, like other muscular exertion, weaken the bowels ; and thus the whole body sympathises with it. Great debility is often rapidly excited by affections of the intestinal fibres, though there have been few evacuations. Diarrhoea likewise in- jures the system by the irritation and great secretion which often accompanies it, whether in children or adults; add to this the di- minution of the powers of digestion, and the obstacle afforded to the absorption of the due quantity of chyle, together with the de- rangement which other parts of the system may suffer, and the dis- eases thus excited, such as convulsions, anasarca, &c. As the principal intention in the cure of a looseness is to evacu- ate the offending matter, it is customary to give the patient a gen- tle vomit of ipecacuanha, and afterwards to exhibit small and fre- quent doses of rhubarb ; interposing absorbent medicines to miti- gate the acrimony of the humours. The best purge, however, in this case, is magnesia alba. It is at the same time absorbent and laxative, and operates without exciting gripes. The antimonial wine, which acts both as an emetic and purge, is also an excellent medicine in this case. By being diluted with water, it may be proportioned to the weakest constitution ; and, not being disagreeable to the palate, it may be repeated as often as occasion requires. Even one dose will frequently mitigate the dis- ease, and pave the way for the use of absorbents. If, however, the patient's strength will permit, the medicine ought to be repeat- ed every six or eight hours, till the stools begin to assume a more natural appearance ; afterwards a longer space may be allowed to intervene between the doses. When it is necessary to repeat the 4>8 DISEASES OF INFANTS. medicine frequently, the dose ought always to be a little increased, as its efficacy is generally diminished by use. Some, upon the first appearance of a looseness, fly immediately to the use of absorbent medicines and astringents. If these be ad- ministered before the offending humours arc discharged, though the disease may appear to be mitigated for a little time, it soon af- terwards breaks forth with greater violence, and often proves fatal. After proper evacuations, however, these medicines may be admin- istered with considerable advantage. Should any gripings or restlessness remain after the stomach and bowels have been cleansed, a tea-spoonful of the syrup of pop- pies may be given in a little simple cinnamon-water three or four times a-day, till these symptoms have ceased. Cutaneous Eruptions. Children, while on the breast, are seldom free from eruptions of one kind or other. These, however, are not often dangerous, and ought never to be dried up but with the greatest caution. They tend to free the bodies of infants from hurtful humours, which, if retained, might produce fatal disorders. The eruptions of children are chiefly owing to improper food and neglect of cleanliness. If a child be stuffed at all hours with food that its stomach is not able to digest, such food, not being properly assimilated, instead of nourishing the body, fills it with gross humours. These must either break out in form of eruptions upon the skin, or remain in the body, and occasion fevers and other internal disorders. That neglect of cleanliness is a very general cause of eruptive disorders, must be obvious to every one. The children of the poor, and of all who despise cleanliness, are almost constantly found to swarm with vermin, and are generally covered with the scab, itch, and other eruptions. When eruptions are the effect of improper food, or want of cleanliness, a proper attention to these alone will generally be suf- ficient to remove them. If this should not be the case, some dry- ing medicines will be necessary. When they are applied, the body ought at the same time to be kept open, and cold is carefully to be avoided. We know no medicine that is more safe for drying up cutaneous eruptions than sulphur, provided it be prudently used. A little of the flowers of sulphur may be mixed with fresh butter, oil, or hog's lard, and the parts affected frequently touched with it. The most obstinate of all the eruptions incident to children are, the tinea capitis, or scabbed head, and chilblains. The scabbed head is often exceedingly difficult to cure, and sometimes, indeed, the cure proves worse than the disease. I have frequently known children seized with internal disorders, of which they died soon af- ter their scabbed heads had been healed by the application of dry- ing medicines.* The cure ought always first to be attempted by * I some time ago saw a very striking instance of the danger of substituting drying medicines in the place of cleanliness and wholesome food, in the Foundling Hospital at Ackworth, where the children were grievously afflicted with scabbed heads, and other cutaneous disorders. Upon inquiry it was found, that very little attention was paid either to the propriety or soundness of their provisions, and that cleanliness was totally neglected j accordingly it was advised that they should have more wholesome DISEASES OF INFANTS. 429 keeping the head very clean, cutting off the hair, combing and brushing away the scabs, Sec If this is not sufficient, let the head he shaved once a-week, washed daily with yellow soap, and gently anointed with a liniment made of train-oil eight ounces, red precip- itate, in fine powder, one drachm. And if there be proud flesh, it should be touched with a bit of blue vitriol, or sprinkled with a lit- tle burnt alum. While these things are doing, the patient must be confined to a regular light diet, the body should be kept gently open ; and cold, as far as possible, ought to be avoided. To pre- vent any bad consequences from stopping this discharge, it will be proper, especially in children of a gross habit, to make an issue in the neck or arm, which may be kept open till the patient become* more strong, and the constitution be somewhat mended. Chilblains commonly attack children in cold weather. They are generally occasioned by the feet or hands being kept long wet or cold, and afterwards suddenly heated. When children are cold, instead of taking exercise to warm themselves gradually, they run to the fire. This occasions a sudden rarefaction of the humours, and an infarction of the vessels ; which being often repeated, the vessels are at last over-distended, and forced to give way. To prevent it, violent cold and sudden heat must be equally avoided. When the parts begin to look red and swell, the patient ought to be purged, and to have the affected parts frequently rub- bed with mustard and brandy, or something of a warming nature. They ought likewise to be covered with flannel, and kept warm and dry. Some apply warm ashes between cloths to the swelled parts, which frequently help to reduce them. When there is a sore, it must be dressed with Turner's cerate, the ointment of tutty, the plaster of cerus, or some other drying ointment. These sores are, indeed, troublesome, but seldom dangerous. They generally heal as soon as the warm weather sets in. Of the Croup. Children are often seized very suddenly with this disease, which, if not quickly relieved, proves mortal. It is known by various names in different parts of Britain. On the east "coast of Scotland, it is called the croup. On the west they call it the chock or stuff- ing. In some parts of England, where I have observed it, the good women call it the rising of the lights. It seems to be a spe- cies of asthma, attended with very acute and violent catarrhal symptoms. This disease generally prevails in cold and wet seasons. It is most common upon the sea-coast, and in low marshy countries. Children of a gross and lax habit are most liable to it. I have sometimes known it hereditary. It generally attacks children in the night, after having been much exposed to damp cold easterly winds through the day. Damp houses, wet feet, thin shoes, wet food, and be kept thoroughly clean. This advice, however, was not followed. It was too troublesome to the servants and superintendents. The business was to be done by medicine ; which was accordingly attempted, but had nearly proved fatal to the whol* house. Fevers and other internal disorders, immediately appeared, and at length a putrid dysentery, which proved so infectious, that it carried off a great many of lh« children and spread over a considerable part of the neighbouring country. 430 DISEASES OF INFANTS. clothes, or any thing that obstructs the perspiration, may occasion the croup. It is attended with a frequent pulse, quick and laborious breath- ing, which is performed with a peculiar kind of croaking noise, that may be heard at a considerable distance. The voice is sharp and shrill, and the face is generally much flushed, though some- times it is of a livid colour. When a child is seized with the above symptoms, his feet should immediately be put into warm water. He ought likewise to be bled,* and to have a laxative clyster administered as soon as pos- sible. He should be made to breathe over the steams of warm water and vinegar ; or an emollient decoction, and emollient cata- plasms or fomentations may be applied round his neck. If the symptoms do not abate, a blistering plaster must be applied round the neck, or between the shoulders, and the child may take fre- quently a table-spoonful of the following julep :—Take penny-royal water, three ounces, syrup of althea and of poppies, each one ounce ; mix them together. Assafcetidat is found to have a good effect in this case. It may be both given in form of clyster, and taken by the mouth. Two drachms of assafoetida may be dissolved in one ounce of Minderer- us's spirit, and three ounces of penny-royal water. A table-spoonful of this mixture may be given every hour, or oftener, if the patient'9 stomach be able to bear it.J If the child cannot be brought to take this medicine, two drachms of the assafoetida may be dissolved in a common clyster, and administered every six or eight hours, till the violence of the disease abates.^ Emetics|| have been strongly recommended in croup, whilst oth- ers have little faith in their utility. Much benefit may be derived, nevertheless, from their early use. Even in the advanced stage of the disease, emetics do much service, appearing mechanically to remove the lymphatic membrane. Decoctions of senega and pre- parations of squills have been used to assist the expectoration of the membrane ; but, for this purpose, they do not equal emetics. Calomel would appear to be a powerful remedy in croup, and, * In this disease bleeding is not always proper; but in very full habits it must cer- tainly be of use. t Antispasmodics have been trusted to almost exclusively by many; but their exhibition, it would appear, ought to be confined to a different disease, namely, den- tition. X We find this formula copied into other works, under the name of Dr. Miller's for- mula, though we verily believe it to belong originally to this work! Ed. § I was lately favoured with a letter from Dr. William Turnbull, in London, a phy- sician of great Experience, and who, from his former situation on the north-east coast of England, had many opportunities of observing the symptoms and progress of this dangerous disease. The Doctor's sentiments differ very little from my own : he ob- serves, that he never found blistering of any service ; and recommends cataplasms of garlic, camphor, and Venice treacle to be applied both to the throat and soles of the feet. He likewise recommends boluses of camphor, castor, valerian-root, salt of hartshorn, and musk, adapted to the age, strength, &c. of the patient; after which he advises two spoonsful of the following decoction :—Take of garlic and distilled vinegar each an ounce, hyssop-water eight ounces; beat up the ingredients together, gradually mixing the water, and adding three ounces of honey. Let the whole be sim- mered over a gentle fire, and afterwards strained for use. | Take Tartarizeil^Antimo.'iy, 2 grains, Mix thein together, and give two tea- Pure Water, 2 ounces. spoonsful from time to time until vom- Oxymel of Squill, £ ounce. iting is promoted. DISEASES OF INFANTS. 431 if given early, it will frequently save the child. The early detrac- tion of blood, followed by an emetic, and the subsequent use of calomel,* will afford the greatest hope of removing the disease. To an infant of six months, a grain and a half of calomel may be giv- en every hour, until it purge freely; to a child a year old two grains; and to one of two years old, sometimes even four grains are given every hour, until the bowels are acted on, and the child purges freely, or vomits repeatedly. The stools are generally green in colour, and their discharge is usually accompanied with an alleviation of the symptoms. When this is observed, the dose must be repeated less frequently, perhaps only once in two hours for some time, then still seldomer, and finally abandoned. Should the child be greatly weakened, either by the disease or the medi- cine, the strength must be afterwards carefully supported by nour- ishment and cordials. Notwithstanding the great quantity of cal- omel given in this way, salivation is not produced in children. Dr. James Hamilton, junior, to whom we are chiefly indebted for the introduction of the use of calomel in croup in this country, from the practice of Dr. Rush, is extremely unwilling to bleed children freely in this disease, from its subsequent debilitating ef- fects ; and in croup, begins at once with the calomel, after having used the warm bath. Some children are subject to slight wheezing, continuing for a day or two, with intermissions, and accompanied with a hoarse- ness, but without fever. Emetics, laxatives, and a large Burgun- dy-pitch plaster applied to the back, remove the disease. To prevent a return of the disorder, all those things which occa- sion it must be carefully avoided ; as wet feet, cold, damp, easterly winds, Sec Children who have had frequent returns of this dis- ease, or whose constitutions seem to dispose them to it, ought to have their diet properly regulated; all food that is viscid or hard of di- gestion, and all crude, raw, trashy fruits are to be avoided. They ought likewise to have a drain constantly kept open in some part of their body, by means of a seton or issue. I have sometimes known a Burgundy-pitch plaster, worn continually between the shoulders for several years, have a very happy effect in preventing the return of this dreadful disorder. Of Teethjing. Dr. Arbuthnot observes, that above a tenth part of infants die in teething, by symptoms proceeding from the irritation of the ten- der nervous parts of the jaws, occasioning inflammations, fevers, convulsions, gangrenes, &c. These symptoms are in a great measure owing to the great delicacy and exquisite sensibility of the nervous system at this time of life, which is too often increased by an effeminate education. Hence it comes to pass, that children who are delicately brought up always suffer most in teething, and often fall by convulsive disorders. About the sixth or seventh month the teeth generally begin to make their appearance; first, the incisores, or fore-teeth; next, the canini, or dog-teeth; and, lastly, the molares, or grinders. -About "Take PJiubarb in Powder, 6 grains, Calomel, 2 grains. Make a powder. ■l;j:0 DISEASES OF INFANTS the r-eventh year there conies a new set; and about the twentieth, the two inner grinders, called dentes sapicntia, the teeth of wis- dom. Children about the time of cutting their teeth, slaver much, and have generally a looseness. When the teething is difficult, espe- cially when the dog-teeth begin to make their way through the gums, the child has startings in his sleep, tumours of the gums; watchings, gripes, green stools, the thrush, fever, difficult breathing, and convulsions. Difficult teething requires nearly the same treatment as an in- flammatory disease. If the body be bound, it must be opened either by emollient clysters or gentle purgatives ; as manna, magnesia alba, rhubarb, senna, or the like. The food should be light, and in small quantity; the drink plentiful, but weak and diluting, as infusions of balm, or of the lime-tree flowers; to which about a third or fourth part of milk may be added. If the fever be high, bleeding will be necessary; but this in very young children ought always to be sparingly performed. It is an evacuation which they bear the worst of any. Purging, vomiting, or sweating, agree much better with them, and are generally more beneficial. Harris, however, observes, that when an inflammation appears, the physician will labour in vain, if the cure be not begun with applying a leech under each ear. If the child be seized with convulsion-fits, a blistering plaster may be applied between the shoulders, or one behind each ear. Sydenham says, that in fevers occasioned by teething he never found any remedy so effectual as two, three, or four drops of spir- its of hartshorn in a spoonful of simple water, or other convenient vehicle, given every four hours. The number of doses may be four, five, or six. I have often prescribed this medicine with suc- cess, but always found a larger dose necessary. It may be given from five drops to fifteen or twenty, according to the age of the child, and when costiveness does not forbid it, three or four drops of laudanum may be added to each dose. In Scotland, it is very common, when children are cutting their teeth, to put a small Burgundy-pitch plaster between their shoul- ders. This generally eases the tickling cough which attends teeth- ing, and is by no means a useless application. When the teeth are cut with difficulty, it ought to be kept on during the whole time of teething. It may be enlarged as occasion requires, and ought to be renewed at least once a fortnight. Several things have been recommended for rubbing the gums, as oils, mucilages, Sec ; but from these much is not to be expected. If any thing of this kind is to be used, we would recommend a little fine honey, which may be rubbed on with the finger three or four times a-day. Children are generally at this time disposed to chew whatever they get into their hands. For this reason they ought never to be without somewhat that will yield a little to the pressure of their gums, as a crust of bread, a wax-candle, a bit of liquorice-root, or such like. With regard to cutting the gums, we have seldom known it of any great benefit. In obstinate cases, however, it ought to bo tried. It may be performed by the finger-nail, the edge of a six- DISEASES OF INFANTS. 433 penny piece* that is worn thin, or any sharp body which canbe with safety introduced into the mouth ; but the lancet, in a skilful hand, is certainly the most proper. i;i order to render the teething less difficult, parents ought to lake care that their children's food be light and wholesome, and that their nerves be braced by sufficient exercise without doors, the use of the cold bath, Sec Were these things duly regarded, they would have a much better effect than teething (anodyne) neck- laces, or other nonsensical relics of superstition, worn for that purpose. Infants, during dentition, are subject to sudden attacks of spasm about the wind-pipe, producing a temporary feeling of suffocation, with a crowing sound ; but there is no hoarse cough. It is apt to take place suddenly at night, or when crying. It is cured by giv- ing a combination of tincture of assafoetida and of hyoscyamus (henbane,) and using laxatives. The tepid bath is also useful. The gum should be cut; and if there be any tendency to a return, particularly if the child be hot, and the pulse quick, the eye heavy, and the face unusually pale, or flushed, leeches should be applied, and then a blister to the back of the head. Of the Rickets. This disease generally attacks children between the age of nine months and two years. It appeared first in England about the time when manufactures began to flourish, and still prevails most in towns where the inhabitants follow sedentary employments, by which means they neglect either to take proper exercise themselves, or to give it to their children. Causes.—One cause of the rickets is diseased parents. Mothers of a weak relaxed habit, who neglect exercise, and live upon weak watery diet, can neither be expected to bring forth strong and healthy children, or to be able to nurse them after they are brought forth. Accordingly we find that the children of such women gen- erally die of the rickets, the scrofula, consumptions, or such like diseases. Children begotten by men in the decline of life, who are subject to the gout, the gravel, or other chronic diseases or who have been often afflicted with the venereal disease 1.1 their youth, are likewise very liable to the rickets. Anv disorder that weakens the constitution or relaxes the habit of children, as the small-pox, measles, teething, the hooping-cough &c. disposes them to this disease. It may likewise be occasioned by improper diet, as food that is either too weak and watery, or so viscid that the stomach cannot digest it. But nursing is the chief cause of this disease. When the nurse is either diseased, or has not enough milk to nourish the child, it ^\'^i"^^nJ^Am^^lnll one of the old thin sixpences, or attended be^,tter tf' A lancetcer a nTy/would accomplish the object better could it be ^ttW^rfS^«-> th\howevcr,i9notthecase. El> .<;Vl DISEASES OF INFANTS. cannot thrive. But children suffer oftener by want of care in nur-cs than want of food. Allowing an infant to lie or sit too much, or not keeping it thoroughly clean in its clothes, has the mo>t pernicious effects. The want of free air is likewise very hurtful to children in this respect. When a nurse lives in a close small house, where the air is damp and confined, and is too indolent to carry her child abroad into the open air, it will hardly escape this disease. A healthy child should always be in motion, unless when asleep ; if it be suf- fered to lie or sit, instead of being tossed and dandled about, it will not thrive. Symptoms.—At the beginning of this disease the child's flesh grows soft and flabby ; its strength is diminished ; it loses its wont- ed cheerfulness, looks more grave and composed than is natural for its age, and does not choose to be moved. The head and belly become too large in proportion to the other parts; the face ap- pears full, and the complexion florid. Afterwards the bones begin to be affected, especially in the more soft and spungy parts. Hence :lie wrists and ankles become thicker than usual; the spine or back- bone puts on an unnatural shape; the breast is likewise often de- formed, and the bones of the arms and legs grow crooked. . All these symptoms vary according to the violence of the disease. The pulse is generally quick, but feeble.; the appetite and diges- tion for the most part bad ; the teeth come slowly and with diffi- rulty, and they often rot and fall out afterwards. Ricketty chil- iJivn generally have great acuteness of mind, and an understand- ing above their years. Whether this is owing to their being more in the company of adults than other children, or to the preternatu- ral enlargement of the brain, is not material. Regimen.—As this disease is always attended with evident signs of weakness and relaxation, our chief aim in the cure must be to brace and strengthen the solids, and to promote digestion and the due preparation of the fluids. These important ends will be best answered by wholesome nourishing diet, suited to the age and strength of the patient, open dry air, and sufficient exercise. If the child has a bad nurse, who either neglects her duty, or does not understand it, she should be changed. If the season be cold, the child ought to be kept warm ; and when the weather is hot, it ought to be kept cool; as sweating is apt to weaken it, and too great a degree of cold has the same effect. The limbs should be i ubbed frequently with a warm hand, and the child kept as cheer- ful as possible. The diet ought to be dry and nourishing, as good bread, roast- ed flesh, &c. Biscuit is generally reckoned the best bread ; and pigeons, pullets, veal, rabbits, or mutton roasted or minced, are the most proper meat. If the child be too young for animal food, he may have rice, millet, or pearl-barley, boiled with raisins, to which may be added a little wine or spice. His drink may be good claret mixed with an equal quantity of water. Those who cannot af- ford claret, may give the child now and then a wine-glass of mild ale, or good porter. DISEASES OF INFANTS. 435 Medicine.—Medicines are here of little avail. The disease may often be cured by the nurse, but seldom by the physician. In children of a gross habit, gentle vomits and repeated purges of rhubarb may sometimes be of use, but they will seldom carry off the disease ; that must depend chiefly upon such things as brace and strengthen the system ; for which purpose, besides the regimen mentioned above, we would recommend the cold bath, especially in the warm season. It must, however, be used with prudence, as some ricketty children cannot bear it. The best time for using the cold bath is in the morning, and the child should be well rub- bed with a dry cloth immediately after he comes out of it. If the child should be weakened by the cold bath it must be discon- tinued. Sometimes issues have been found beneficial in this disease. They are peculiarly necessary for children who abound with gross humours. An infusion of the Peruvian bark in wine or ale would be of service, were it possible to bring children to take it. We might here mention many other medicines which have been recom- mended for the rickets ; but as there is far more danger in trusting to these than in neglecting them altogether, we choose rather to pass them over, and to recommend a proper regimen as the thing chiefly to be depended on. Of Convulsions. Though more children are said to die of convulsions than of any other disease, yet they are for the most part only a symptom of some other malady. Whatever greatly irritates or stimulates the nerves may occasion convulsions. Hence infants, whose nerves are easily affected, are often thrown into convulsions by any thing that irritates the alimentary canal; likewise by teething, strait clothes, the approach of the small-pox, measles, or other eruptive diseases. When convulsions proceed from an irritation of the stomach or bowels, whatever clears them of their acrid Contents, or renders these mild and inoffensive, will generally perform a cure; where- fore, if the child be costive, the best way will be to begin with a clyster, and afterwards to give a gentle vomit, which may be re- peated occasionally, and the body in the mean time kept open by gentle doses of magnesia alba, or small quantities of rhubarb mixed. with the powder of crabs' claws. Convulsions which precede the eruption of the small-pox or measles generally go off upon these making their appearance. The principal danger in this case arises from the fear and apprehension of those who have the care of the patient. ConvulsioiiS are very alarming, and something must be done to appease the affrighted parents, nurses, &c. Hence the unhappy infant often undergoes bleeding, blistering, and several other operations, to the great dan- ger of its life, when a little time, bathing the feet in warm water, and throwing in a mild clyster, would have set all to rights. When convulsion-fits arise from the cutting of teeth, besides gen- tle evacuations we would recommend blistering, and the use of an- tispasmodic medicines, as the tincture of soot, assafoetida, or cas- 4:)6 DISEASES OF INFANTS. tor. A few drops of any of these may be mixed in a cup of white- wine whey, and given occasionally. When convulsions proceed from any external cause, as the pres- sure occasioned by strait clothes or bandages, &c. these ought im- mediately to be removed; though iu this case taking away the cause will not always remove the effect, yet it ought to be done. It is not likely that the patient will recover as long as the cause which first gave rise to the disorder continues to act. When a child is seized with convulsions without having any com- plaint in the bowels, or symptoms of teething, or any rash or other discharge which has been suddenly dried up, we have reason to conclude that it is a primary disease, and proceeds immediately from the brain. Cases of this kind, however, happen but seldom, which is very fortunate, as little can be done to relieve the unhap- py patient. When a disease proceeds from an original fault in the formation or structure of the brain itself we cannot expect that it should yield to medicine. But as this is not always the cause even of convulsions which proceed immediately from the brain, some at- tempts should be made to remove them. The chief intention to be pursued for this purpose is to make some derivation from the head, by blistering, purging, and the like. Should these fail, issues or setons may be put in the neck, or between the shoulders. Of Water in the Head. Though water in the head, or a dropsy of the brain, may affect adults as well as children, yet, as the latter are more peculiarly lia- ble to it, we thought it would be most proper to place it among the diseases of infants. Causes.—A dropsy of the brain may proceed from injuries done to the braiu itself by falls, blows, or the like; it may likewise pro- ceed from an original laxity or weakness of the brain; from scir- rhous tumours or excrescences within the skull; a thin watery state of the blood; a diminished secretion of urine ; a sudden check of the perspiration ; and, lastly, from tedious and lingering diseases, which waste and consume the patient. Symptoms.—This disease has at first the appearance of a slow fever ; the patient complains of a pain in the crown of his head, or over his eyes ; he shuns the light, is sick, and sometimes vomits ; his pulse is irregular and generally low ; though he seems heavy and dull, yet he does not sleep; he is sometimes delirious, and fre- quently sees objects double ; towards the end of this commonly fa- tal disease the pulse becomes more frequent, the pupils are gener- ally dilated, the cheeks flushed, the patient becomes comatose, and convulsions ensue.* Medicine.—No medicine has hitherto been found sufficient to larry offa dropsy of the brain. It is laudable, however, to make I have lately lost a patient in this disease where a curious, metastasis seemed to WKe Place The water at first appeared to be in the abdomen, afterwards in the oreast, aiid last of all it mounted up to the brain, where it soon proved fatal. DISEASES OF INFANTS. 437 some attempts, as time or chance may bring many things to light of which at present we have no idea. The medicines generally us- ed are, purges of rhubarb or jalap, with calomel, and blistering- plasters applied to the neck or back part of the head. To which we would beg leave to add diuretics, or medicines which promote the secretion of urine, such as are recommended in the common dropsy. A discharge from the nose ought likewise to be promoted by causing the patient to snuff the powder of asarum, white helle- bore, or the like.* Some practitioners have of late pretended to cure this disease by the use of mercury. I have not been so happy as to see any in- stance of a cure being performed in a confirmed dropsy of the brain ; but in so desperate a malady every thing deserves a trial.t To look over the long catalogue of infantile diseases in some medical books, one would be inclined to think that the real design of the authors, though concealed under the show of precision, was to spread alarm through, every family. I have had a very dif- ferent object in view, to quiet the fears of parents, to direct then- attention to the proper treatment of their children, and thus to ren- der the use of any medicines almost unnecessary. I have shows the folly of having recourse to physic to bring away the black, vis- cid, syrup-like substance contained in the intestines of a new-born infant, when the purgative quality of its mother's milk is so admi- rably* suited to that very purpose. The new milk is thin and wa- terish, but acquires every day greater consistencj, and thus affords a more solid aliment to the child, as he become j more capable of digesting it. If the mother does not vitiate by her own improper diet the pure fountains of nourishment and health which nature has kindly given her, the child will neither be troubled with- «es- tiveness nor gripes. He will escape those complaints of the sto- mach which are occasioned by swallowing crude, inflammatory trash, or still more pernicious drugs. The daily use of the cold bath and frequent exercise in the open air will not only preserve him from colds and defluxions, but from all the disorders which are the consequences of relaxation and of nervous irritability. A child brought up in the manner I have recommended will have lit- tle to fear even from external contagion. The firm texture of his skin, like a shield, will almost resist its approach, and the purity of his habit will correct its malignity. The small-pox is the only infectious disease for which I would have him prepare by any particular process, because that process * When the presence of this disease can be ascertained at a sufficiently early peri- od I believe much benefit may be derived by taking away blood pretty freely by mean- of'leeches applied near the temples. I lately saw an instance where a child was at- tacked with every symptom of this disease, by which its parents had previously lost children Leeches were applied. The puncture made by one of them continuedUo discharge blood during the whole night; on discovering this accident next morning the parentsgwere much alarmed for the'consequences. From that period, however, the child began to recover, and is at present in good health. A. r. ». KP\Aom t One reason why this disease is seldom or never cured may be, that * '■ ""«« known till too far advanced to admit of remedy. Did parents watch the first symptoms, «X rail a ohvsician in due time, I am inclined to think that something might be for teething. 438 PHYSICAL MANAGEMENT is so easy and certain, besides affording a perfect command both of time and circumstances. (Hooping Cough.* See p. 207.) CHAP. XI. OBSERVATIONS ON THE MORAL AND PHYSICAL MANAGEMENT OF CHILDREN, DISEASES, Sec. It is during infancy that the foundation of a good or bad constitu- tion is generally laid; it is therefore of importance that parents should be well acquainted with the various causes which may in- jure the health of their offspring. It appears from the annual'registers of the dead, that almost 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 cre- ating. 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 case. It may seem strange that man, notwithstanding his superior reason, should fall so far short of other animals in the manage- ment of his young; but our surprise will soon sease, if we consid- er that brutes, guided by instinct, never err in this respect; while man, trusting solely to art, is seldom right. Were a catalogue of those infants who perish annually by art alone exhibited to public view, it would astonish most people. If psrer.ts are above taking care of their children, others must be employed for that purpose; these will always endeavour to re- commend themselves by the appearance of extraordinary skill and address. By this means such a number of unnecessary and de- structive articles have been introduced into the diet, clothing, &c. of infants, that it is no wonder so many of them perish. Nothing can be more preposterous than a mother who thinks it below her to take care of her own child, or who is so ignorant as not to know what is proper to be done for it. If we search nature throughout, we cannot find a parallel to this. Every other animal is the nurse of its own offspring, and they thrive accor- dingly. Were the brutes to bring up their young by proxy they would share the same fate with those of the human species. We mean not, however, to impose it as a task upon every moth- er to suckle her own child. This, whatever speculative writers may allege, is in some cases impracticable, and would inevitably prove destructive both to the mother and child. Women of deli- cate constitutions, subject to hysteric fits, or other nervous affec- tions, make very bad nurses ;t and these complaints are now so common, that it is rare to find a woman of fashion free from them ; such women, therefore, supposing them willing, are often unable to suckle their own children. • Small-pox, Measles, Worms, &c. in the body of the work. *iVtnaVC known an hysteric wum;ii> kill her child by being seized with a fit in the OF CHILDREN. 439 Almost every mother would be in a condition to give suck, did mankind live agreeably to nature ; but whoever considers how far many mothers deviate from her dictates, will not be surprised to find some of them unable to perform that necessary office. Moth- ers who do not eat a sufficient quantity of solid food, nor enjoy the benefit of free air and exercise, can neither have wholesome juices themselves, nor afford proper nourishment to an infant. Hence children who are suckled by delicate women either die young, or continue weak and sickly all their lives. When we say that mothers are not always in a condition to suckle their own children, we would not be understood as discour- aging that practice. Every mother who can, ought certainly to perform so tender and agreeable an office.* But suppose it to be out of her power, she may, nevertheless, be of great service to her child. The business of nursing is by no means confined to giving suck. To a woman who abounds with milk, this !S the easiest part of it. Numberless other offices are necessary for a child, which the mother ought at least to see done. A mother who abandons the fruit of her womb as soon as it is born to the sole care of an hireling hardly deserves that name. A child, by being brought up under the mother's eye, not only secures her affection, but may reap all the ad? intages of a parent s care though it be suckled by another. How can a mother be better em- ployed than in superii leading the nursery 1 This is at once the most delightful and important office ; yet the most trivial business or insipid amusements are often preferred to it! A strong proof both of the bad taste and wrong education of modern females. It is indeed to be regretted that more care is not bestowed in teaching the proper management of children to those whom nature has designed for mothers. This, instead of being made the princi- pal, is seldom considered as any part of female education. Is it any wonder, when females so educated come to be mothers, that they should be quite ignorant of the duties belonging to that char- acter ? However strange it may appear, it is certainly true, that many mothers, and those of fashion too, are as ignorant when they have brought a child into the world, of what is to be done for it, as the infant itself. Indeed the most ignorant of the sex are generally reckoned most knowing in the business of nursing. Hence sensible people become the dupes of ignorance and super- JttTon'; 3 tie "nursing of children, instead of being conducted by reason, is the result of whim and capnce.t J some sense the murderers of their own JnK|.l'»v,,JSi abandon- el's child till her own is cither dead or fit to be ™aned. A regui i^:Zer:Lv^rszi *^&Ms?i£3&~ ta —.n the Roman ladies in his time with regard to the care °l tne^r . ^ g chief g,^ 440 PHYSICAL MANAGEMENT Were the time that is generally spent by females in the acquisi- tion of trifling accomplishments employed in learning how to bring up their children ; how to dress them so as not to hurt, cramp, or confine their motions ; how to feed them with wholesome and nourishing food; how to exercise their tender bodies, so as best to promote their growth and strength : were these made the objects of female instruction, mankind would derive the greatest advan- tages from it. But while the education of females implies little more than what relates to dress and public show, we have nothing to expect from them but ignorance even in the most important concerns. Did mothers reflect on their own importance and lay it to heart, they would embrace every opportunity of informing themselves of the duties which they owe to their infant offspring. It is their province, not only to form the body, but also to give the mind its most early bias. They have it very much in their power to make men healthy or valetudinary, useful in life or the pests of society. But the mother is not the only person concerned in the manage- ment of children. The father has an equal interest in their wel- fare, and ought to assist in every thing that respects either the improvement of the body or mind. It. is a pity that the men should be so inattentive to this matter. Their negligence is one reason why females know so little of it. Women will ever be desirous to excel in such accomplishments aa recommend them to the other sex. But men generally keep at such a distance from even the smallest acquaintance with the af- fairs of the nursery, that many would reckon it an affront were they supposed to know any thing of them. Not so, however, with the kennel or the stables ! A gentleman of the first rank is not ashamed to give directions concerning the management of his dogs or horses, yet would blush were he surprised in performing the same office for that being who derived its existence from himself, who is the heir of his fortunes, and the future hope of his country ! Nor have physicians themselves been sufficiently attentive to the management of children. This has been generally considered as the sole province of old women, while men of the first character in physic have refused to visit infants even when sick. Such con- duct in the faculty has not only caused this branch of medicine to be neglected, but has also encouraged the other sex to assume an absolute title to prescribe for children in the most dangerous dis- eases. The consequence is, that a physician is seldom called till the good women have exhausted all their skill ; when his attend- ance can only serve to divide the blame, and appease the discon- solate parents. Nurses should do all in their power to prevent diseases; but when a child is taken ill, some person of skill ought immediately to be consulted. The diseases of children are generally acute, and the least delay is dangerous. Were physicians more attentive to the diseases of infants, they S^^hSvwfux^rv^S ft" GreCian w«ncVf other menial servant.-W. tins complaint ' y d effem,nacy P™vaii, there will be too much ground for OF CHILDREN. 441 would not only be better qualified to treat them properly when sick, but likewise to give useful directions for their management when well. The diseases of children are by no means so difficult to be understood as many imagine. It is true, children cannot tell their complaints ;-but the causes of them may be pretty certainly discovered by observing the symptoms, and putting proper ques- tions to the nurses. Besides, the diseases of infants, being less complicated, are easier cured than those of adults.* It is really astonishing that so little attention should in general be paid to the preservation of infants. What labour and expense are daily bestowed to prop an old tottering carcase for a few years, while thousands of those who might be useful in life perish without being regarded ! Mankind are too apt to value things according to their present, not their future usefulness. Though this is of all others the most erroneous method of estimation, yet upon no other principle is it possible to account for the general indifference with respect to the death of infants. Of Diseased Parents. One great source of the diseases of children is the unhealthi- ness of parents. It would be as reasonable to expect a rich crop from a barren soil, as that strong and healthy children should be born of parents whose constitutions have been worn out with in- tern perauce or disease. An ingenious writert observes, that on the constitution of moth- ers depends originally that of their offspring. No one who be- lieves this will be surprised, on a view of the female world, to find diseases and death so frequent among children. A delicate female, brought up within doors, an utter stranger to exercise and open air, who lives on tea and other slops, may bring a child into the world, but it will hardly be fit to live. The first blast of disease will nip the tender plant in the bud ; or should it struggle through a few years' existence, its feeble frame, shaken with convulsions from every trivial cause, will be unable to perform the common functions of life, and prove a burden to society. If to the delicacy of mothers we add the irregular lives of fathers, we shall see farther cause to believe that children are often hurt by the constitution of their parents. A sickly frame may be origin- ally induced by hardships or intemperance, but chiefly by the lat- ter. It is impossible that a course of vice shall not spoil the best constitution ; and, did the evil terminate here, it would be a just punishment for the folly of the sufferer : but when once a disease is contracted and riveted in the habit, it is entailed on posterity. What a dreadful inheritance is the gout, the scurvy, or the king's evil, to transmit to our offspring ! How happy had it been for the heir of many a great estate had he been born a beggar, rather than * The common opinion, that the diseases qf infants are hard to discover and diffi. cult to cure, has deterred many physicians, from paying that attention to them which Aev deserve I can, however.' from experience declare, that this .opinion is without foundation ; and that the diseases of infants are neither so difficult to discover nor so ill to cure as those of adults. ♦ Rousseau. T2 442 PHYSICAL MANAGEMENT to inherit his father's fortunes at the expense of inheriting his dis- eases ! A person labouring under any incurable malady ought not to marry. He thereby not only shortens his own life but transmits misery to others; but when both parties are deeply tainted with the scrofula, the scurvy, or the like, the effects must be still worse. If such have any issue they must be miserable indeed. Want of attention to these things in forming connections for life has root- ed out more families than plague, famine, or the sword ; and as long as these connections are formed from mercenary views the evil will be continued.* In our matrimonial contracts, it is amazing so little regard is had to the health and form of the object. Our sportsmen know that the generous courser cannot be bred out of the foundered jade, nor the sagacious spaniel out of the snarling cur. This is settled upon immutable laws. The man who marries a woman of a sickly con- stitution, and descended of unhealthy parents, whatever his views may be, cannot be said to act a prudent part. A diseased woman may prove fertile; should this be the case, the family must become an infirmary : what prospect of happiness the father of such a fam- ily has, we shall leave any <5ne to judge.t Such children as have the misfortune to be born of diseased pa- rents will require to be nursed with greater care than others. This is the only way to make amends for the defects of constitution; and it will often go a great length. A healthy nurse, wholesome air, and sufficient exercise, will do wonders. But when these are neglected, little is to be expected from any other quarter. The defects of constitution cannot be supplied by medicine. Those who inherit any family-disease ought to be very circum- spect in their manner of living. They should consider well the nature of such disease, and guard against it by a proper regimen. It is certain, that family diseases have often, by proper care, been kept off for one generation ; and there is reason to believe, that, by persisting in the same course, such diseases might at length be wholly eradicated. This is a subject very little regarded, though of the greatest importance. Family-constitutions are as capable of improvement as family-estates; and the libertine who impairs the one does greater injury to his posterity than the prodigal who squanders the other. 8 Clothing of Children. The clothing of an infant is so simple a matter, that it is sur- prising how any person should err in it; yet many children lose their lives, and others are deformed by inattention to this article. Mature knows of no use of clothes to an infant, but to keep it warm. AH that is necessary for this purpose is to wrap Til a will fill the throne with a progeny- o? c^'an"Ks Pr0Pa«atl"S * race of heroes, you K e ft oTTcScS^rrd ^^"^^^&^"^mtS: OF CHILDREN. 443 Boft loose covering. Were a mother left to the dictates of nature alone, she would certainly pursue this course. But the business of dressing an infant has long been out of the hands of mothers, and has at last become a secret which none but adepts pretend to un- derstand. , iU , From the most early ages it has been thought necessary, that a woman in labour should have some person to attend her. lhis in time became a business; and, as in all others, those who were em- ployed in it strove to outdo one another in the different branches of their profession. The dressing of a child came of course to be considered as the midwife's province ; who, no doubt, imagined, that the more dexterity she could show in this article the more her skill should be admired. Her attempts were seconded by the van- ity of parents, who, too often desirous of making a show of the in- fant as soon as it was born, were ambitious to have as much hnery heaped upon it as possible. Thus it came to be thought as neces- sary for a midwife to excel in bracing and dressing an infant as for a surgeon to be expert in applying bandages to a broken limb ; and the poor child, as soon as it came into the world, had as many rol- lers and wrappers applied to its body as if every bone had been fractured in the birth ; while these were often so tight, as not only to gall and wound its tender frame, but even to obstruct the motion of the heart, lungs, and other organs necessary to life. In most parts of Britain, the practice of rolling children with so many bandages is now, in some measure, laid aside ; but it wouk still be a difficult task to persuade the generality of mankind that the shape of an infant does not entirely depend on the care of the midwife So far, however, are all her endeavours to mend the shape from being successful, that they constantly opera e the con- trary way, and mankind become deformed in proportion to the meansTuYed to prevent it. How little deformity of body.is toi be found among uncivilized nations! /o little indeed, that it is vul- garly believed they put all their deformed children to death. The truth is, they hardly know such a thing as a deformed child. Nei- ther should we, if we followed their example. Savage nations nev- er think of managing their children. They allow them the full use of every organ, carry them abroad in the open air, wash their] bod- ies daily gcod water, &c. By this management their children become so strong and hardy, that by the time our = ^-ts get out of the nurse's arms, theirs are able to shift for themselves. Among brute animals, no art is necessary to procure a fine shapT Though many of them are extremely delicate when they come into the world, yet we never find them grow crooked for wan? of swaddling-bands. Is nature less generous to the human kind ' No : but we take the business out of nature s hands. Not only the analogy of other animals, but the very feelings of infants teU u , thev ought to be kept easy and free from pressure. They cannot, ndeed, tell their con.pk.ints, but they can show signs oVpain; and this they never fail tcwJoJby^ crying when hurt^by oaftrkuM yet they are all strafghl, and seldom have any d.sease. 444 PHYSICAL MANAGEMENT their clothes. No sooner are they froed from their bracings than they seem pleased and happy; yet, strange infatuation ! the moment they hold their peace they are again committed to their chains. If we consider the body of an infant as a bundle of soft pipes, replenished with fluids in continual motion, the danger of pressure will appear in the strongest light. Nature, in order to make way for the growth of the children, has formed their bodies soft and flexible ; and lest they should receive any injury from pressure in the womb, has surrounded the foetus everywhere with fluids. This snows the care which nature takes to prevent all unequal pressure on the bodies of infants, and to defend them against every thing that might in the least cramp or confine their motions. Even the bones of an infant are so soft and cartilaginous that they readily yield to the slightest pressure, and easily assume a bad shape, which can never after be remedied. Hence it is that so many people appear with high shoulders, crooked spines, and flat breasts, who were as well-proportioned at their births as others, but who had the misfortune to be squeezed out of shape by the ap- plication of stays and bandages. Pressure, by obstructing the circulation, likewise prevents the equal distribution of nourishment to the different parts of the body, by which means the growth becomes unequal. One part grows too large, while another remains too small; and thus in time the whole frame becomes disproportioned and misshapen. To this we must add, that when a child is cramped in its clothes it naturally shrinks from the part that is hurt; and by putting its body into unnatural postures, it becomes deformed by habit. Deformity of body may, indeed, proceed from weakness or dis- ease; but, in general, it is the effect of improper clothing. Nine- tenths, at least, of the deformity among mankind must be imputed to this cause. A deformed body is not only disagreeable to the eye, but by a bad figure both the animal and vital functions must be impeded, and of course health impaired. Hence few people re- markably misshapen are strong or healthy. The new motions which commence at the birth, as the circula- tion of the whole mass of blood through the lungs', Aspiration the peristaltic motion, &c. afford another strong argument for keeping he body of an infant free from all pressure. These organs, not having been accustomed to move, are easily stopped ; but when this happens, death must ensue. Hardly any method could be de- vised more effectually to stop these motions than bracifto- the body oo tight with rollers* and bandages. Were these to be appLdS the same manner to the body of an adult for an equal length of time, they would hardly fail to hurt the digestion am 2 him sick. How much more hurtful they must prove to the tender hod les of infants, we shall leave any one to judge Whoever considers these things will not be surnri^ ti,o* many children die of convulsions"soon after the b^rTh Thet fits are generally attributed to some inwardjsausejbut in fact they the child's body as soon as it is born! m length, is applied tightly round OF CHILDREN. 445 oftener proceed from our own imprudent conduct. I have kn°wn a child seized with convulsion-fits soon after the midwife had done swaddling it, who, upon taking off the rollers and bandages, was immediately relieved, and never had the disease afterwards. Nu- merous examples of this might be given were they necessary. . It would be safer to fasten the clothes of an infant with strings than pins, as they often gall and irritate their tender skms, and occasion disorders. Pins have been found sticking above half an inch into the body of a child after it had died of convulsion-fits, which in all probability proceeded from that cause. Children are not only hurt by the tightness of their clothes, but also by the quantity. Every child has some degree of fever after the birth ; and if it be loaded with too many clothes the fever must be increased. But this is not all ; the child is generally laid in bed with the mother, who is often likewise feverish ; to which we may add the heat of the bed-chamber, the wines and other heating things too frequently given to children immediately after birth. When all these are combined, which does not seldom happen, they must increase the fever to such a degree as will endanger the lite of the infant. „ , , -r The danger of keeping infants too hot will further appear, it we consider that, after they have been for some time in the situation mentioned above, tl.ey are often sent into the country to be nursed in a cold house. Is it any wonder if a child, from such a transi- tion, catches a mortal cold, or contracts some other fatal disease . When an infant, is kept too hot, its lungs, not being sufficiently expanded, are apt to remain weak and flaccid for life; hence pro- ceed coughs, consumptions, and other diseases of the breast. It would answer little purpose to specify the particular species of dress proper for an infant. These will always vary in different countries, according to custom and the humour of parents. The great rule to be observed is, That a child have no more clothes than are necessary to keep it warm, and that they be quite easy for its body. Stays are the very bane of infants. A volume would not suffice to point out all the bad effects of this ridiculous piece of dress, both on children and adults. The madness in favour of stays seems however, to be somewhat abated ; and it is to be hoped the world will, in time, become wise enough to know that the human shape does not solely depend upon whalebone and bend leather.* I shall only add with respect to the clothes of children, that they ou-ht to be kept thoroughly clean. Children perspire more than adults, and if their clothes be not frequently changed, they become very hurtful. Dirty clothes not only gaH and fret the tender skins of infants, but likewise occasion ill smells, and, what is worse, tend to produce vermin and cutaneous diseases. . Cleanliness is not only agreeable to the eye, but tends greatly to "• Stays, made of bend leather, are worn by all the women of lower station in many Tam strfl^'understand, that there are still mothers mad enough to lace their j, £.I^7rvtia1it in order to improve their shape. As reasoning would be totally ?"? ^n In! oeoole I ■hall beg leave just to ask them, Why there are ten deformed women for one ffit .Id lik.w5e to recommend to their perusal a short moral pre- «pT, which forbids us to deform the human body. 446 PHYSICAL MANAGEMENT preserve the health of children. It promotes the perspiration, and, by that means, frees the body from superfluous humours, which, if retained, could not fail to occasion diseases. No mother or nurse can have any excuse for allowing a child to be dirty. Poverty may oblige her to give it coarse clothes; but if she does not keep them clean, it must be her own fault. Of the Food of Children. Nature not only points out the food proper for an infant, but ac- tually prepares it. This, however, is not sufficient to prevent some who think themselves wiser than nature from attempting to bring up their children without her provision. Nothing can show the disposition which mankind have to depart from nature more than their endeavouring to bring up children without the breast. The mother's milk, or that of a healthy nurse, is unquestionably the best food for an infant. Neither art nor nature can afford a proper substitute for it. Children may seem to thrive for a few months without the breast; but when teething, the small-pox, and other diseases incident to childhood come on, they generally perish. A child, soon after the birth, shows an inclination to suck; and there is no reason why it should 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; besides, the first milk that the child can squeeze out of the breast answers the purpose of cleansing bet- ter than all the drugs in the apothecary's shop, and at the same time prevents inflammations of the breast, fevers, and other dis- eases incident to mothers. It is strange how people came to think that the first thing given to a child should be drugs. This is beginning with medicine be- times, and no wonder if they generally end with it. It sometimes happens, indeed, that a child does not discharge the meconium so soon as could be wished; this has induced physicians, in such cases, to give something of an opening nature to cleanse the first passages. Midwives have improved upon this hint, and never fail to give syrups, oils, &c. whether they be necessary or not. Cram- ming an infant with such indigestible stuff as soon as it is born can hardly fail to make it sick, and is more likely to occasion dis- eases than to prevent them. Children are seldom long after the birth without having passage both by stool and urine ; though these evacuations may be wanting for some time without any danger. But if children must have something before they be allowed the breast, let it be a little thin water pap, to which may be added an equal quantity of new milk, or rather water alone, with the addi- tion of a little moist sugar. If this be given without any wine or spiceries it will neither heat the blood, load the stomach, nor occa- sion gripes. Upon the first sight of an infant, almost every person is struck with the idea of its being weak, feeble, and wanting support. This naturally suggests the need of cordials. Accordingly wines are universally mixed with the first food of children. Nothing can be more fallacious than this way of reasoning, or more hurtful to in- fants than the conduct founded upon it. Children require very lit- OF CHILDREN. 447 tie food for some time after the birth, and what they receive should be thin, weak, light, and of a cooling quality. A very small quan- tity of wine is sufficient to heat and inflame the blood of an infant; but every person conversant in these matters must know, that most of the diseases of infants proceed from the heat of their hu- mours. If the mother or nurse has enough of milk, the child will need little or no other food for the third or fourth month. It will then be proper to give it, once or twice a-day, a little of some food that is easy of digestion, as water-pap, milk-pottage, weak brtjth with bread in it, and such like. This will ease the mother, will accus- tom the child by degrees to take food, and will render the weaning both less difficult and less dangerous. All great and sudden tran- sitions are to be avoided in nursing. For this purpose the food of children ought not only to be simple, but to resemble, as nearly as possible, the properties of milk. Indeed, milk itself should make a principal part of their food, not only before they are weaned but for some time after. Next to milk, we would recommend good light bread. Bread may be given to a child as soon as it shows 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 discharge of saliva, while, by mixing with the nurse's milk in the stomach, it will afford an excellent nourishment. Chil- dren discover an early inclination to chew whatever is put into their hands. Parents observe the inclination, but generally mis- take the object. Instead of giving the child something which may at once exercise its gums and afford it nourishment, they common- ly put into its hands a piece of hard metal, or impenetrable coral. A crust of bread is the best gum-stick. It not only answers the purpose better than any thing else, but has the additional proper- ties of nourishing the child, and carrying the saliva down into the stomach, which is too valuable a liquor to be lost. Bread, besides being used dry, may be many ways prepared in- to food for children. One of the best 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 whole- some and nourishing this way than boiled, and is less apt to occa- sion costiveness. For a child farther advanced, bread may be mix- ed 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 wholesome grain, and well fermented ; but when enriched with fruits, sugars, or such things, it becomes very un- wholesome. It is soon enough to allow children animal food when they have got teeth to eat it. They should never taste it till after they are weaned, and even then they ought to use it sparingly. Indeed, when children live wholly on vegetable food, it is apt to sour on their stomachs ; but, on the other hand, too much flesh heats the body, and occasions fevers and other inflammatory diseases. This plainly points out a due mixture of animal and vegetable food us most proper for children. Few things prove more hurtful to infants than the common 448 PHYSICAL MANAGEMENT method of sweetening 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 excesses are entirely owing to nurses. If a child be gorged with food at all hours, and enticed to take it, by making- it sweet and agreeable to the palate, is it any wonder that such a child should in time be in- duced to crave more food than it ought to have 1 Children may be hurt by too little as well as by too much food. After a child is weaned it ought to be fed four or five times a-day; but should never be accustomed to eat in the night; neither should it have too much at a time. Children thrive best with small quan- tities of food frequently given. This neither overloads the stomach nor hurts the digestion, and is certainly most agreeable to nature. Writers on nursing have inveighed with such vehemence against giving children too much food, that many parents, by endeavour- ing to shun that error, have run into the opposite extreme, and ru- ined the constitutions of their children. But the error of pinching children in their food is more hurtful than the other extreme. Na- ture has many ways of relieving herself when overcharged ; but a child who is pinched with hunger will never become a strong or a healthy man. That errors are frequently committed on both sides we are ready to acknowledge; but where one child is hurt by the quantity of its food, ten suffer from the quality. This is the prin- cipal evil, and claims our strictest attention. Many people imagine, that the food which they themselves love cannot be bad for their children ; but this notion is very absurd. In the more advanced periods of life we often acquire an inclina- tion for food which when children we could not endure. Besides, there are many things that by habit may agree very well with the stomach of a grown person, which would be hurtful to a child; as high-seasoned, salted, and smoke-dried provisions, &c. It would also be improper to feed children with fat meat, strong broths, rich soups, or the like. All strong liquors are hurtful to children. Some parents teach their children to guzzle ale, and other fermented liquors, at every meal. Such a practice cannot fail to do mischief. These children seldom escape the violence of the small-pox, measles, hooping- cough, or some inflammatory disorder. Milk, water, butter-milk, or whey, are the most proper for children to drink. If they have any thing stronger, it may be fine small beer, or a little wine mix- ed with water. The stomachs of children can digest well enough without the assistance of warm stimulants ; besides, being natu- rally hot, they are easily hurt by every thing of a heating quality. Few things are more hurtful to children than unripe fruits. They weaken the powers of digestion, and sour and relax the stomach, by which means it becomes a proper nest for insects. Children, indeed, show 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 hu- mours. This is what most children require ; only care should be OF CHILDREN. 449 taken lest they exceed. Indeed the best way to prevent children from going to excess in the use of fruit, or eating that which is bad, is to allow them a proper quantity of what is good.* Roots which contain a crude viscid juice should be sparingly given to children. They fill the body with gross humours, and tend to produce eruptive diseases ; this caution is peculiarly neces- sary for the poor. Glad to obtain, at a small price, what will fill the bellies of their children, they stuff them too or three times a day with crude vegetables. Children had better eat a smaller quantity of food which yields a wholesome nourishment, than be crammed with what their digestive powers are unable properly to assimilate. Butter ought likewise to be sparingly given to children. It both relaxes the stomach, and produces gross humours. Indeed, most things that are fat or oily have this effect. Butter when salted be- comes still more hurtful. Instead of butter, so liberally given to children in most parts of Britain, we would recommend honey. Children who eat honey are seldom troubled with worms ; they are also less subject to cutaneous diseases, as itch, scabbed head, &c. Many people err in thinking that the diet of children ought to be altogether moist. • When children live entirely upon slops, it relaxes their solids, renders them weak, and disposes them to the rickets, the scrofula, and other glandular disorders. Relaxation is one of the most general causes of the diseases of children. Ev- ery thing, therefore, which tends to unbrace their solids ought to be carefully avoided. We would not be understood by these observations as confining children to any particular kind of food. Their diet may be fre- quently varied, provided always that sufficient regard be had to simplicity. Exercise of Children. Of all the causes which conspire to render the life of man short and miserable, none has greater influence than the want of proper Exercise : healthy parents, wholesome food, and proper clothing, will avail little, where exercise is neglected. Sufficient exercise will make up for several defects in nursing: but nothing can sup- ply the want of it. It is absolutely necessary to the health, the growth, and the strength of children. The desire of exercise is coeval with life itself. Were this princi- ple attended to, many diseases might be prevented. But, while-in- dolence and sedentary employments prevent two-thirds of mankind from either taking sufficient exercise themselves, or giving it to their children, what have we to expect but diseases and deformity among their offspring? The rickets, so destructive to children, * Children are always sickly in the fruit season, whioh may be thus accounted for :— 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 themselves, eat whatever they can lay their hands upon, which often proves little better than a poison to their tender bowels. Servants, and others who have the care of children, should be strictly forbidden to give them any fruit without the knowledge of their parents. 450 PHYSICAL MANAGEMENT never appeared in Britain till manufactures began to flourish, and people, attracted by the love of gain, left the country to follow sedentary employments in great towns. It is amongst these peo- ple that this disease chiefly prevails, and not only deforms but kills many of their offspring. The conduct of other young animals shows the propriety of giv- ing exercise to children. Every other animal makes use of its or- gans of motion as soon as it can ; and many of them, even when under no necessity of moving in quest of food, cannot be restrain- ed without force. This is evidently the case with the calf, the lamb, and most other young animals. If these creatures were not permitted to frisk about and take exercise, they would soon die or become diseased. The same inclination appears very early in the human species ; but as they are not able to take exercise them- selves, it is the business of their parents and nurses to assist them. Children may be exercised various ways. The best method, while they are light, is to carry them about in the nurse's arms.* This gives the nurse an opportunity of talking to the child, and of pointing out every thing that may please and delight its fancy. Besides, it is much safer than swinging an infant in a machine, or leaving it to the care of such as are not fit to take care of them- selves. Nothing can be more absurd than to set one child to keep another; this conduct has proved fatal to many infants, and has rendered others miserable for life. When children begin to walk, the safest and best method of leading them about is by the hands. The common way, of swing- ing them in leading-strings fixed to their backs, has several bad consequences. It makes them throw their bodies forward,, and press with their whole weight upon.their stomach and breast; by this means the breathing is obstructed, the breast flattened, and the bowels compressed ; which must hurt the digestion, and occasion consumptions of the lungs, and other diseases. It is a common notion, that if children are set upon their feet too soon, their legs will become crooked. There is reason to believe that the very reverse of this is true. Every member acquires strength in proportion as it is exercised. The limbs of children are w-eak indeed, but their bodies are proportionably light; and had they skill to direct themselves, they would soon be able to support their own weight. Who ever heard of any other animal that bc- can.e crooked by using its legs too soon ? Indeed, if a child be not permitted to make any use of its legs till a considerable time after its birth, and be tbe.i set upon them with its whole weight at once, there may be some danger ; but this proceeds entirely trom the child s not having been accustomed to use its legs from the beginning. ° M°tl?er8u?If1the Poorer sort think they are great gainers by mak- ing their children lie or sit while they themselves work. In this they are greatly mistaken. By neglecting to give their children exercise, they are obliged to keep them a long time before they is ofWW6 °Ughtt0 bG ?arefU110 keeP the chiId in a Proper position; as defor^i7v o b^freSLntlvTrCe/f Tn.attenV°n t0 this circumstanceH fts situation ought™ 2 nuSe SyTng^t ctS.y on" one arT" * ^ **» ^ *" °° ^ ^ * *• OF CHILDREN. 451 «^ can do any thing for themselves, and to spend more on medicine than would have paid for proper care. To take care of their children is the most useful business in which even the poor can be employed: but, alas! it is not always in their power. Poverty often obliges them to neglect their off- spring in order to procure the necessaries of life. When this is the case, it becomes the interest as well as the duty of the public to assist them. Ten thousand times more benefit would accrue to the state by enabling the poor to bring up their own children, than from all the hospitals* that ever can be erected for that purpose. Whoever considers the structure of the human body will soon be convinced of the necessity of exercise for the health of children. The body is composed of an infinite number of tubes, whose fluids cannot be pushed on without the action and pressure of the mus- cles. But, if the fluids remain inactive, obstructions must happen, and the humours will of course be vitiated, which cannot fail to occasion diseases. Nature has furnished both the vessels which carry the blood and lymph with numerous valves, in order that the action of every muscle might push forward their contents ; but without action, this admirable contrivance can have no effect. This part of the animal economy proves to a demonstration the neces- sity of exercise for the preservation of health. Arguments to show the importance of exercise might be drawn from every part of the animal economy; without exercise the cir- culation of the blood cannot be properly carried on, nor the differ- ent secretions duly performed; without exercise, the fluids cannot be properly prepared, nor the solids rendered strong or firm. The action of the heart, the motion of the lungs, and all the vital func- tions, are greatly assisted by exercise. But to point out the man- ner in which these effects are produced would lead us farther into the economy of the human body than most of those for whom this treatise is intended would be able to follow. We shall therefore only add, that when exercise is neglected, none of the animal func- tions can be duly performed; and when this is the case, the whole constitution must go to wreck. A good constitution ought certainly to be our first object in the management of children. It lays a foundation for their being use- ful and happy in life ; and whoever neglects it, not only fails in his duty to his offspring, but to society. One very common error of parents, by which they hurt the con- stitutions of their children, is the sending them too young to school. This is often done solely to prevent trouble. When the child is at school, he needs no keeper. Thus the school-master is made the nurse ; and the poor child is fixed to a seat seven or eight hours a-day, which time ought to be spent in exercise and diver- sions. Sitting so long cannot fail to produce the worst effects up- * If it were made the interest of the poor to keep their children alive, we should lose very few of them. A small premium given annually to each poor family, for eve- ry child they have alive at the year's end, would save more infant lives than if the whole revenue of the crown were expended on hospitals for this purpose. This would make the poor esteem fertility a blessing; whereas many of them think it the great- est curse that can befall them; and in place of wishing their children to live, so far does poverty get the better of natural affection, that they are often very happy when they die. 452 PHYSICAL MANAGEMENT on the body ; nor is the mind less injured. Early application weakens the faculties, and often fixes in the mind an aversion to books which continues for life.* But suppose this were the way to make children scholars, it cer- tainly ought not to be done at the expense of their constitutions. Our ancestors, who seldom went to school very young, were not less learned than we. But we imagine the boy's education will be quite marred, unless he be carried to school in his nurse's arms. No wonder that such hot-bed plants seldom become either scholars or men ! Not only the confinement of children in public schools, but their number often proves hurtful. Children are much injured by being kept in crowds within doors; their breathing not only renders the place unwholesome, but if any one of them happen to be diseased, the rest catch the infection. A single child has been often known to communicate the bloody flux, the hooping-cough, the itch, or other diseases, to almost every individual in a numerous school. But, if fashion must prevail, and infants are to be sent to school, we would recommend it to teachers, as they value the interests of society, not to confine them too long at a time, but allow them to run about and play at such active diversions as may promote their growth, and strengthen their constitutions. Were boys, instead of being whipped for stealing an hour to run, ride, swim, or the like, encouraged to employ a proper part of their time in these manly and useful exercises, it would have many excellent effects. It would be of great service to boys, if, at a proper age, they were taught the military exercise. This would increase their Strength; inspire them with courage, and when their country called for their assistance, would enable them to act in her defence, with- out being obliged to undergo a tedious and troublesome course of instructions, at a time when they are less fit to learn new motions, gestures, Secf An effeminate education will infallibly spoil the best natural con- stitution ; and if boys are brought up in a more delicate manner than even girls ought to be, they will never be men. Nor is the common education of girls less hurtful to the constitu- tion than that of boys. Miss is set down to her frame before she can put on her own clothes ; and is taught to believe, that to excel at the needle is the only thing that can entitle her to general es- teem. It is unnecessary here to insist upon the dangerous conse- quences of obliging girls to sit too much. They are pretty well known, and are too often felt at a certain time of life. But suppos- ing this critical period to be got over, greater dangers still wait * It is undoubtedly the duty of parents to instruct their children, at least till they are of an age proper to take some care of themselves. This would tend much to con- firm the ties of paternal tenderness and filial affection, of the want of which there are at present so many deplorable instances. Though few fathers have time to instruct their children, yet most mothers have; and surely they cannot be better employed. 11 am happy to find that the masters of academies now begin to put in practice this advice. Each of them ought to keep a drill-serjeant for teaching the boys the milita- ry exercise. This, besides contributing to their health and vigour of body, would have many other happy effects. wJ-Hi^n^0 exe*ci*es a,re becoming justly popular, and their superiority over the warlike needs not to be told to Americans, Am. Ed.j OF CHILDREN. 453 them when they come to be mothers. Women who have been ear- ly accustomed to a sedentary life, generally run great hazard in child-bed ; while those who have been used to romp about, and take sufficient exercise, are seldom in any danger. One hardly meets with a girl who can at the same time boast of early performances by the needle, and a good constitution. Close and early confinement generally occasions indigestions, head- aches, pale complexions, pain of the stomach, loss of appetite, coughs, consumptions of the lungs, and deformity of body. The last of these, indeed, is not to be wondered at, considering the awk- ward postures in which girls sit at many kinds of needlework, and the delicate flexible state of their bodies in the early periods of life. Would mothers, instead of having their daughters instructed in many trifling accomplishments, employ them in plain work and housewifery, and allow them sufficient exercise in the open air, they would both make them more healthy mothers, and more use- ful members of society. I am no enemy to genteel accomplish- ments, but would have them only considered as secondary, and al- ways disregarded 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 so employed as not to hurt their health or growth; but, when these suffer, society, instead of being benefited, is a real loser by their labour. There are few employments, ex- cept sedentary ones, by which children can earn a livelihood ; and if they be set to these too soon, it ruins their constitutions. Thus, by gaining a few years from childhood, we generally lose twice as many in the latter period of life, and even render the person less useful while he does live. In order to be satisfied of the truth of this observation, we need only look into the great manufacturing towns, where we shall find a puny degenerate race of people, weak and sickly all their lives, seldom exceeding the middle period of life; or if they do, being- unfit for business, they become a burden to society. Thus arts and manufactures, though they may increase the riches of a coun- try, are by no means favourable to the health of its inhabitants. Good policy would therefore require, that such people as labour during life should not be set too early to work. Every person conversant in the breed of horses, or other working animals, knows, that if they be set to hard labour too soon, they will never turn out to advantage. This is equally true with respect to the human species. There are, nevertheless, various ways of employing young peo- ple, without hurting their health. The easier parts of gardening, husbandry, or any business carried on without doors, are most proper. These are employments which most young people are fond of, and some parts of them may be always adapted to their a.re, taste, and strength.* Such parents, however, as are under the necessity of employing their children within doors, ought to allow them sufficient time for • I have been told that in China, where the police is the best in the world, all the children are employed in the easier part of gardening and husbandry; as weeding, gathering stones off the land, and such like. 454 PHYSICAL MANAGEMENT active diversions without. This would both encourage them to do more work, and prevent their constitutions from being hurt. Some imagine that exercise within doors is sufficient; but they are generally mistaken. One hour spent in running, or any other exercise without doors, is worth ten within. When children can- not go abroad, they may indeed be exercised at home. The best method of doing this, is to make them run about in a large room, or dance. This last kind of exercise, if not carried to excess, is of excellent service to young people. It cheers the spirits, pro- motes perspiration, strengthens the limbs, &.c. I knew an eminent physician who used to say, that he made his children dance, instead of giving them physic. It were well if more people followed his example. The cold bath may be considered as an aid to exercise. By it the body is braced and strengthened, the circulation and secretions promoted, and,, were it conducted with prudence, many diseases, as rickets, scrofula, &c. might thereby be prevented. The ancients, who took every method to render children hardy and robust, were no strangers to the use of the cold bath ; and, if we may credit re- port, the practice of immersing children daily in cold water must have been very common among our ancestors. The greatest objection to the use of the cold bath arises from the superstitious prejudices of nurses. These are often so strong, that it is impossible to bring them to make a proper use of it. I have known some of them who would not dry a child's skin after bath- ing it, lest it should destroy the effect of the water. Others will even put cloths dipt in the water upon the child, and either put it to bed, or suffer it to go about in that condition. Some believe, that the whole virtue of the water depends upon its being dedicated to a particular saint; while others place their confidence in a certain number of dips, as three, seven, nine, or the like; and the world could not persuade them, if these do not succeed, to try it a little longer. Thus by the whims of nurses, children lose the benefit of the «old bath, and the hopes of the physician from that remedy are often frustrated. We ought not, however, entirely to set aside the cold bath, be- cause some nurses make a wrong use of it. Every child, when in health, should at least have its extremities daily washed in cold water. This is a partial use of the cold bath, and is better than none. In winter this may suffice; but in the warm season, if a child be relaxed, or seem to have a tendency to the rickets or scro- fula, its whole body ought to be frequently immersed in cold water. Care, however, must be taken not to do this when the body is hot! or the stomach full. The child should be dipped only once at a time, should be taken out immediately, and have its skin well rub- bed with a dry cloth. The bad Effects of unwholesome Air upon Children. Few things prove more destructive to children than confined or unwholesome air. This is one reason why so few of those infants who are put into hospitals, or parish-workhouses, live. Theso places are generally crowded with old, sickly, and infirm people • OF CHILDREN. 455 by which means the air is rendered so extremely pernicious, that it becomes a poison to infants. Want of wholesome air is likewise destructive to many of the children born in great towns. There the poorer sort of inhabit- ants live iu low, dirty, confined houses, to which the fresh air has scarcely any access. Though grown people, who are hardy and robust, may live in such situations, yet they generally prove fatal to their offspring, few of whom arrive at maturity, and those who do are weak and deformed. As such people are not in a condition to carry their children abroad into the open air, we must lay our account with losing the greater part of them. But the rich have not this excuse. It is their business to see that their children be daily carried abroad, and that they be kept in the open air for a sufficient time. This will always succeed better if the mother goes along with them. Servants are often negligent in these matters, and allow a child to sit or lie on the damp ground, instead of leading or carrying it about. The mother surely needs air as well as her children ; and how can she be better employed than in at- tending them 1 A very bad custom prevails, of making children sleep in small apartments, or crowding two or three beds into one chamber. In- stead of this, the nursery ought always to be the largest and best aired room in the house. When children are confined in small apartments, the air not only becomes unwholesome, but the heat relaxes their solids, renders them delicate, and disposes them to colds and many other disorders. Nor is the custom of wrapping them too close in cradles less pernicious. One would think that nurses were afraid lest children should suffer by breathing free air, as many of them actually cover the child's face while asleep, and others wrap a covering over the whole cradle, by which means the child is forced to breathe the same air over and over all the time it sleeps. Cradles, indeed, are on many accounts hurtful to children, and it would be better if the use of them were totally laid aside.* . A child is generally laid to sleep with all its clothes on ; and it a number of others are heaped above them it must be overheated: by which means it cannot fail to catch cold on being taken out of the cradle, and exposed to the open air with only its usual cloth- ing, which is too frequently the case. Children who are kept within doors all day, and sleep all night in warm close apartments, may, with great propriety, be compar- ed to plants nursed in a hot-house, instead of the open air. Though such plants may by this means be kept alive for some time, they will never arrive at that degree of strength, vigour, and magnitude, • It is amazing how children escape suffocation, considering the manner in which thev are often rolled up in flannels, &c. 1 lately attended an infant, whom! do OF CHILDREN. 457 they be certain poison to infants, are every day administered by many who bear the character of very good nurses.* A nurse who has not milk enough is apt to imagine that this de- fect may be supplied by giving the child wines, cordial waters, or other strong liquors. This is an egregious mistake. The only thing that has any chance to supply the place of the nurse's milk, must be somewhat nearly of the same quality, as cow's milk, ass's milk, or beef tea, with a little bread. It never can be done by the use of strong liquors. These, instead of nourishing an infant, nev- er fail to produce the contrary effect. Children.are often hurt by nurses suffering them to cry long and vehemently. This strains their tender bodies, and frequently oc- casions ruptures, inflammations of the throat, lungs, &c. A child never continues to cry long without some cause, which might al- ways be discovered by proper attention ; and the nurse ' who can hear an infant cry till it has almost spent itself, without endeav- ouring to please it, must be cruel indeed, and is unworthy to be in- trusted with the care of a human creature. Nurses who deal much in medicine are always to be suspected. They trust to it and neglect their duty. I never knew a good nurse who had her Godfrey's Cordial, Daffey's Elixir, Dalby's Carminative, &c. at hand.t Such nurses generally imagine that a dose of medicine will make up for all defects in food, air, exer- cise and cleanliness. By errors of this kind, I will venture to say, that one half the children who die annually in London lose their lives. Allowing children to continue long wet, is another very perni- cious custom of indolent nurses. This is not only disagreeable, but it galls and frets the infant, and, by relaxing the solids, occa- sions scrophula, rickets, and other diseases. A dirty nurse is al- ways to be suspected. Nature often attempts to free the bodies of children from bad humours, by throwing them upon the skin; by this means fevers and other diseases are prevented. Nurses are apt to mistake such critical eruptions for an itch, or some other infectious disorder. Accordingly they take every method to drive them in. In this way many children lose their lives ; and no wonder, as Nature is op- posed in the very method she takes to relieve them. It ought to be a rule, which every nurse should observe, never to stop any eruption without proper advice, or being well assured that it is not of a critical nature. At any rate, it is never to be done without previous evacuations. Loose stools is another method by which Nature often prevents or carries off the diseases of infants If these proceed too far, no doubt they ought to be checked ; but this is never to be done with- out the greatest caution. Nurses, upon the first appearance, of loose stools, frequently fly to the use of astringents, or such things as bind the body. Hence inflammatory fevers, and other fatal dis- eases, are occasioned. A dose of rhubarb, a gentle vomit, or some * If a mother on visiting her child at nurse finds it always asleep, I would advise hei to remove it immediately; otherwise it will soon sleep its last. t See Mother's Medical Pocket, p. 70, 71 If .. * . ! .3 PHYSICAL MANAGEMENT, &c. ither evacuation, should always precede the use of astringent med- icines. One of the greatest faults of nurses is, concealing the diseases ..f children from their parents. This they are extremely ready to do, especially when the disease is the effect of their own negli- gence. Many instances might be given of persons who have been rendered lame for life by a fall from their nurse's arms, which she, through fear, concealed till the misfortune was past cure. Every parent who intrusts a nurse with the care of a child, ought to give her the strictest charge not to conceal the most trifling dis- order or misfortune that may befall it. We can see no reason, why a nurse who conceals any misfor- tune which happens to a child under her care, till it loses its life or limb, should not be punished. A few examples of this would save the lives of many infants ; but as there is little reason to ex- pect that it ever will be the case, we would earnestly recommend it to all parents to look carefully after their children, and not to trust so valuable a treasure entirely in the hands of a hireling. No person ought to imagine these things unworthy of his atten- tion. On the proper management of children depend not only their health and usefulness in life, but likewise the safety and pros- perity of the state to which they belong. Effeminacy ever will prove the ruin of any state where it prevails ; and, when its found- ations are laid in infancy, it can never afterwards be wholly erad- icated. Parents who love their offspring, and wish well to their country, ought, therefore, in the management of their children, 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 constitutions strong and hardy— -By arts like these Laconia nurs'd of old her hardy sons; And Rome's unconquer'd legions urg'd their way, Unhurt, thro' every toil in every clime. [Armstrong. Few things tend more to the destruction of children than drenching them with drugs. That medicine may be sometimes necessary for children, I do not deny; but that it hurts them ten times for once it does them good, I will venture to assert. A Lon- don mother, the moment her child seems to ail any thing, runs im- mediately to the apothecary, who throws in his powders, pills, and potions, till the porr infant is poisoned; when the child miffht have been restored to perfect health by a change of diet, air exer- cise, clothing, or some very easy and simple regulation But misguided fondness is not satisfied with drugging children from the apothecary's shop, many of them are fed from the same quarter. A starch from the West Indies, called Flour of Arrow- root, is the food of those infants whose parents can afford to pav for it. I lately offended a mother very much by sayinff, it was not half so good as oatmeal, though more than ten times the price Of this, however, she had sufficient proof by a child in her arms, who had been fed on.that root, and, though a year and a half old, could scarcely put a foot to the ground while her neighbour's child, only ^nine months old, but nursed mi the north country manner, could COLD-BATHING. 459 by a hold of the finger, run all over the house. I have taken no- tice of this powder, to show the influence of fashion even in the feeding of an infant. I wish it were the only instance I could give of the fatal effects of the same cause. Ten thousand infants in this island, before they are out of the nurse's arms, sip tea twice a- day, which to be sure is the true way to propagate heroes. CHAP. XXX. OF COLD-BATHING, IN FRESH AND SALT WATER, WITH REMARKS ON THE CASES IN WHICH THE WARM BATH IS MORE ADVISABLE. The cold bath, at the temperature of sixty-five degrees, is that, which, in this country, is most generally employed. Immersion in cold water is a custom which lays claim to the most remote antiquity. Indeed, it must have been coeval with man himself. The necessity of water for the purpose of cleanli- ness, and the pleasure arising from its application of the body in hot countries, must very early have recommended it to the human species. Even the example of other animals was sufficient to give the hint to man. By instinct, many of them are led to apply cold water in this manner; and some, when deprived of its use, have been known to languish, and even to die. But whether the prac- tice of cold-bathing arose from necessity, reasoning, or imitation, is an enquiry of little consequence : our business is to point out the advantages which may be derived from it, when judiciously resort- ed to, and the danger attending its improper use. People are apt to imagine that the simple element of water can do no hurt, and that they may plunge into it at any time with im- punity. In this, however, they are much mistaken. I have known apoplexies occasioned by going into the cold bath,—fevers excited by staying too long in it,—and other maladies so much aggravated by its continued use as to become absolutely incurable. Without a proper discrimination with regard to the disease and the constitu- tion of the patient, the most powerful medicine is more likely to do harm than good. The physician, who cured Augustus by cold- bathing, killed his heir by the very same prescription. This induc- ed the Roman senate to make laws for regulating t' e baths, and preventing the numerous evils which arose from an imprudent and promiscuous use of those elegant and fashionable pieces of luxury. But as no such laws exist in this country, every one does that which is right in his own eyes, and of course many must do wrong. I hope, however, that when better informed, they will learn to correct er- rors of so fatal a tendency. Absurd prejudices against cold-bathing are not less blameable on the other hand. Though it should never be prescribed for the cure of diseases, without well considering the nature of each case, it can- not be tot earnestly or too generally recommended as a preserva- tive of halth. 1 am, therefore, sorry to see some modern writers attemptir.g to revive the whimsical and long exploded doctrine of Gai en, who said, that immersion in cold water was fit only for the 4(°>ii COLD-BATHING. vounir of lions and bears ; and that warm-bathing was conducive :•- the growth and strength of infants. How egregiously do th* :.:catest men err, whenever they lose sight of facts, and substitute - .Hies of wit or specious arguments in physic for observations and experience.! By these superior excellence of the cold-bath is placed beyond the possibility of a doubt. Its tonic powers are found to be peculiarly proper for the lax fibres of young people, rendering them firm and elastic, and enabling the vital organs to perform their respective functions with ease and regularity. In other parts of this work I had occasion to describe, with greater minuteness than is now necessary, the many good effect^. ■ i' washing children; and I gave a few directions as to the mnn- nei of employing this very salutary operation, from the.moment of their birth. I showed how the use of the cold bath might be grad- ually brought about with the utmost safety ; and I am persuaded that those who give it a fair trial will readily comply with my far- ther advice to continue it ever after, except in such cases of indis- position or infirmity as I shall presently notice. Nothing contrib- utes more to the growth, vigour, and firmness of youth, or to the activity and permanent health of manhood, than daily immersion in cold water. It steels the frame against changes of weather, against the impressions of cold or moisture, and many other exter- nal injuries. It is of course the best preventive of all those diseas- es which arise from a relaxed skin, obstructed or profuse perspira- tion, and nervous weakness. When the cold bath is used merely as a means of preserving health, in which point of view I am now considering it, a single plunge or dip of the whole body will be sufficient, though active swimmers may continue their favourite amusement for five or six minutes without, injury. Any longer stay might prove dangerous, [>y not only occasioning a strong determination of blood to the head, but chilling the vital fluid, cramping the muscles, relaxing the nerves, and wholly defeating the intention of bathing. For want of a due regard to these circumstances, young men have of- ten endangered, and sometimes lost their lives. In all cases, it is highly necessary to be rubbed dry at the instant of coming out of he water, and to take exercise for at least half an hour after. A little| exercise is also advisable before bathing, so as to excite a gentle glow or temperate degree of warmth, and thus guard against 1 u.f,onsecluences of a too sudden shock, when the body is either chilly or overheated. J The like caution should be given against plunging into cold water after dinner, or after much fatigue. Fo!r thfs^and many I ilTJm the ™rninSis very properly recommended to per- sons in health as the best time for bathing. It is the least likelv to interfere with their other pursuits or concerns: itwashes away flch i the skin, before they can be re-absorbed; it afford* fresh supplies of vigour and alacrity, to enter upon the dutieTof the day ; and, as I have already hinted, it fortifVes the bod,"amine. In a state of perfect health, it may be further observed, that peo- . COLD-BATHING. 4oi pie need not give themselves much trouble to enjoy the advantage? of sea-bathing in preference to river-water, as the grand effect ol both is nearly the same, though some considerations of less mo- ment may concur to render the former more inviting. Among these we must reckon the usual resort of gay company to different parts of the coast in summer, the refreshing coolness of the sea-air in that season, and the agreeable stimulus which many persons expe- rience from the action of saline particles, not only in the water, but when they are floating in the atmosphere. It should also be considered, that the temperature ef the sea is more uniform than that of rivers, never rising so high, or sinking so low, in any change of weather. But such points of difference are chiefly interesting to valetudinarians. What I have said of the cold-bath, when used as the means ot preventing disease, will throw some light on the propriety of occa- sionally resorting to it as an important remedy. In cases of pe- culiar delicacy and danger, it is an instrument which can only be entrusted to the most skilful hands; but in many other less critical situations, a few plain rules may be of considerable service. The first object to be attended to in the use of -the cold-bath, rs a remedy, is, whether the patient is not too much enfeebled to bear the shock. This cannot always be determined by appearances ; but a single experiment will remove all doubt. If the immersion be followed by a pleasant glow, and a sense of increasing alacntv. it is the best proof of its agreeing with the constitution, and of its being likely to have a happy influence on the whole frame. Hence the cold-bath is found to be an excellent bracer and restorative in cases of languor, of habitual lassitude, and of muscular or nervous weakness, when arising from much confinement, a sedentary lite, intense study, or any of the usual causes of relaxation. But it is always understood, that, in every instance of this sort, a sufficient strength of original stamina still remains to produce a proper re- action of the heart and arteries, upon which all the salutary effects of bathing depend. . The great efficacy of the cold bath, and particularly ot sea- bathing, has often been experienced in scrofulous complaints, which are always attended with a relaxation of the fibres, and a strong disposition to languor and indolence. In such cases, sea-bathing is not only recommended as a tonic, or bracer, but as a powerful detergent and purifier also, especially if the sea-water be used inter- nally at the same time. No difference of opinion prevails on this head, as far as it relates to the scrofula, but it has been alleged, that sea-bathing, though a good preventive of the scrofula, could not remove the local effects of the disease when once formed. My own practice in the treatment of scrofulous affections has not been extensive enough to enable me to speak to this point with a tone of confidence ; but the contrary doctrine appears to me supported bv the fairest reasoning, and, what is more, by indisputable facts. In the first place, a weak flaccid habit, and a thin skin, very sus- ceptible of impressions from cold moist air, are the principal, if not the only prediPsposing causes of the scrofula. Now the cold-bath is the bes\ remedy for both, as it renders the texture of me skin firm. and invigorates the system. By being therefore so well adapted 462 COLD-BATHING. to obviate causes, it must, according to one of the surest maxim* of medical practice, be very fit to remove effects. The justness of such an inference has been placed beyond a doubt, by the reports of men of professional eminence and veracity, under whose direction, and immediate inspection also, sea-bathing has been known to resolve swellings of the glands, as well as to correct the discharge of scrofulous ulcers, and to dispose them to heal. I am therefore very willing to believe, that a regular course of sea-bathing, and the internal use of sea-water, with the aid of good air, proper exercise, and a light, yet nourishing diet, are the best means hitherto discovered for checking the progress of the evil, or counteracting its morbid effects. But, in order to prevent any possible misconception of my mean- ing, it may be necessary to add, that my opinion of the efficacy of sea-water in scrofulous complaints, is confined to its probable removal of the outward symptoms of the malady, before these have arrived at a certain pitch, or have reduced the patient to a state of extreme debility; in which case, as well as in all internal affections of the scrofula, when it has once fastened upon the lungs, or any other vital part, bathing in the sea, or drinking its waters, would be not only useless, but extremely injurious. It would also imply too great a confidence in the salutary virtues of sea-bathing, to prescribe it as a remedy for cutaneous disorders in general. To many of them the warm-bath is much better adapted; and the proper choice of the one or the other can only be determined by a skilful physician, after a due consideration of the patient's ease. Some eruptions, if imprudently repelled by the action of cold on the skin, may carry back into the habit the seeds of disease, to be deposited, perhaps, on some vital part, in spite of Nature's kind efforts to throw them off. But a medical man will not prescribe sea-bathing in any case where pimples or blotches appear on the surface, without recommending the internal use of the sea-water at the same time, to determine regularly and mode- rately to the bowels, so as to carry off all impurities, without the least injury to the general health, spirits, or appetite. I shall have occasion to repeat this caution, when I come to speak of some mineral waters, which are frequently resorted to for the cure of similar complaints. Though, as before observed, there may be very little difference between the effects of sea-water and of river-water of the same temperature, when applied to a sound skin and healthy body, yet the gently stimulant, detergent, and healing properties of the saline impregnation of the former must give it a decisive superiority in many diseases of the surface and habit. It cleanses sores, and for- wards the progress of granulation. It often disperses tumours that have resisted the most powerful discutient medicines. Even deeply-seated ulcers, though beyond the reach of other appli- cations, sometimes yield to the penetrating action of sea-water. We must not forget, however, that its internal use is a necessary auxiliary in all these cases, and others of a similar nature. About half a pint of it, which contains somewhat more than a quarter of an ounce of salts, taken in the morning, immediately on coming out of the sea, and the like dose fn half an hour after, will com- COLD-BATHING. 463 monly answer the purpose of a mild purgative. The quantity may be augmented, or the dose repeated, if requisite, with perfect safe- ty, and little inconvenience. It excites thirst, but seldom nausea, unless the stomach is very irritable, or the patient very squeamish. In chronic diseases, where a cure cannot be expected but from the long-continued use of any remedy, it is a great recommenda- tion of the sea-water, that it may be persevered in for a considera- ble time, without weakening the stomach, the intestines, or the con- stitution in general. Instances frequently occur of persons who keep the body moderately open by its daily use for months together, and yet enjoy during the whole time a good appetite, and excellent powers of digestion, with increased vigour both of body and mind. It is always most advisable to make use of the sea-water externally and internally, in the manner here directed, only twice or three times a-week, till the patient is encouraged by degrees to employ the salutary process every day. It should also be gradually discon- tinued in the same manner, after the desired end is obtained. There are several disorders, besides those already mentioned, particularly ardent fevers, and various cases of local inflammation and muscular rigidity, in which the external application of cold water may produce good effects. But many of them require great accuracy of distinction, as well as the utmost judgment and caution in the use of a remedy, which a small mistake, or a small change of circumstances, may render hazardous. In a work like this, de- signed for popular instruction, it would be improper to encourage rash experiments, by pointing out such niceties in medical practice as are safe only when under the guidance of medical skill. I do not know any thing in its own nature so salutary, and yet so liable to be abused, as the cold-bath. I shall therefore proceed to touch upon the cases, where the inconsiderate or improper application of such a remedy may prove injurious, and sometimes fatal. It is not merely in the critical cases just alluded to, but in many slighter indispositions, that injudicious immersion in cold water may be attended with very serious consequences. Fevers are much oftener produced than cured by cold-bathing, if rashly re- sorted to. Disorders of the intellectual functions, palsies, apoplex- ies, and death, may be, and are frequently occasioned by a single dip, in cases either of extreme nervous debility or of extreme fulness. When 1 reflect on the frantic precipitancy with which I have seen many persons of very weak, and others of very plethoric habit, after a rapid journey from London to some watering-place, plunge instantly into the sea, without the least preparation, so far from being surprised at the numbers who suffer, I am rather astonished that any should escape. In order to prevent the ignorant and the thoughtless from falling victims to their indiscretion, and to guard persons afflicted with particular complaints against the use of an improper medicine, I shall point out the principal indisposi- tions, in which the cold-bath would be likely to aggravate the symp- toms, and even to endanger the life of the patient. Effects of Cold-Bathing, $?c. When a person in the ordinary state of health is immersed in a 464 COLD-BATHING. cold-bath, he first experiences a general sensation of cold, which is almost immediately succeeded by a general sensation of warmth, the latter rapidly increasing, so as to cause the surrounding water to feel of an' agreeable temperature. If the immersion has been sudden and momentary, and the body be immediately dried and covered from the air, the agreeable sensation of warmth continues, the whole body feels refreshed and invigorated, and, under favour- able circumstances, the natural perspiration is increased. If, how- ever, the immersion be continued for a considerable time, and the water be not at the highest range of the temperature assigned to the cold-bath, the sensation of warmth goes off, and is followed by numbness and shivering, the skin becomes pale and contracted, the vessels near the surface of the body are evidently diminished in diameter, and the blood which flows through them is drawn to- wards the internal parts ; the person feels drowsy and inactive, his joints become rigid and inflexible, his limbs are affected with pain and cramps, his respiration becomes quick and irregular, his pulse low and small, and his perspiration suppressed. If the im- mersion be still continued, or if the water be very cold, the pulse gradually ceases, the action of the heart becomes weak and lan- guid, a sensation of faintness and coldness of the stomach is expe- rienced, followed by a rapid diminution of the whole animal heat; the vital energy at length becomes exhausted, and death ultimately ensues. In the preceding description, it is supposed that the body has been suddenly plunged into the water; if, as it often happens with weak or timid people, the bather enters the bath slowly, or if the water is much below sixty degrees, the sensation of cold is more striking, a shivering is produced, and as the person advances so as to make the water rise towards the belly and chest, a shuddering and convulsive sobbing takes place, sometimes attended with sick- nes's and head-ache. Cautions to be Observed, fyc. When, therefore, cold-bathing occasions chillness, loss of appe- tite, listlessness, pain of the breast or bowels, a prostration of strength, or violent head-achs, it ought to be discontinued. These unpleasant sensations are the surest proofs, that the actual state of the patient's habit is unfit to bear the shock; and that either the re-action of the heart and arteries is too weak to overcome the cold pressure on the surface, or that the determination to the head, or to some other vital part, is too rapidly increased. Every body's feelings, after immersion in cold water, are the best crite- rion by which we can decide on the probability of its good or its bad effects. We might otherwise be deceived by appearances, and be induced to recommend the cold-bath in all cases that might seem to require a tonic and stimulant plan of cure. But it may sometimes be dangerous, or at least very detriment- al, to make even a single experiment. In particular affections of the stomach and bowels, as well as in diseases of the lungs or of Uie brain, and all obstinate obstructions, the effect may be fatal. J-be late Dr. Smollet, indeed, said, that if he were persuaded he COLD-BATHING. 465 had an ulcer in the lungs, he would jump into the cold bath. In doing so, however, the Doctor would certainly show more courage than discretion ; and that he was more a man of wit than a physi- cian, every one »vill allow. A nervous asthma, or an atrophy, may be mistaken for a pulmonary consumption: yet, in the two for- mer, the cold bath proves often beneficial, though I never knew it so in the latter. Indeed, all the phthisical patients I ever saw. who had tried the cold bath, were evidently hurt by it. Persons of very full habits, as I have already hinted, run a great risk of bursting a blood vessel, or of causing an inflammation of some important organ, by rushing into the cold bath, without due preparation. People of this description ought by no means to bathe, unless the body has been previously prepared by suitable evacuations. They will then derive the utmost benefit from what might be otherwise attended with irreparable injury to many of them. Though I recommend the cold-bath in cases of nervous weak- ness, yet the degree of that weakness should be considered, lest the shock might prove too powerful for extreme debility. Not only women of very weakly and delicate habits, but men also in the same predicament, as well as puny children, should begin with the warm-bath, at the same degree nearly as that of animal heat, about 96° of Fahrenheit's thermometer ; and reduce it gradually in pro- portion to the increase of the patient's strength and internal pow- ers of re-action. The cold-bath is often very necessary to com- plete a cure, though not always advisable to begin with. This re- quires particular illustration. In hysteric and hypochondriac cases, cold-bathing at first has done the greatest mischief, though it may be finally resorted to with good effect, after a preparatory and long continued use of the tepid or lukewarm bath. Its warmth must be diminished very slowly, and almost imperceptibly. Nature revolts against all great transitions ; and those who do violence to her dictates, have often cause to repent of their temerity. The like gradual diminution of the temperature of the water is no less proper in rheumatic complaints, and in those muscular con- tractions and convulsive motions which are called St. Vitus's Dance. Indeed, it may be laid down as a pretty general rule in that branch of nervous disorders which includes spasms, convulsions, epilepsies, and similar consequences of the debility or irritability of the system, that we should always begin with the warm-bath, and proceed to the cold by the most pleasing and gentle grada- tions. The chief exceptions to this rule occur in the treatment of spas- modic affections of the intestines, hooping coughs, and convulsive asthmas, in which, though classed under the general head of spasms, the cold-bath would at any time be extremely improper. But this prohibition is also implied in my remark on complaints of the bowels and chest in general, the latter including coughs of ev- ery description. When these are the mere consequences of slight irritation, or cold, bathing the lower extremities in warm water af- fords great relief; but immersing the whole body in either the 466 COLD-BATHING. warm or the cold bath, would only aggravate the symptoms, when the breathing is difficult. As palsies are often occasioned by the inconsiderate use of the cold-bath, it cannot be too strictly prohibited, where any paralytic symptoms are discoverable. There is no complaint that bears and requires a greater degree of external heat than the palsy, and there is none in which the shock of cold water is more directly opposite to every curative indication. The hot-baths, therefore, whether natural or artificial, and particularly if impregnated with salt, which increases their stimulus, are employed as a sovereign reme- dy for paralytic affections. Friction, which should never be neg- lected after bathing, is in these cases of eminent service. In affections of the nervous coat of the stomach, and in cases of indigestion, especially when occasioned by intemperance, cold- bathing is as improper as in complaints of the bowels, before taken notice of. But it is the excess of folly, after immoderate drinking, to use the cold-bath with a view of alleviating its painful effects next day. It must increase the disorder of the stomach, the vio- lence of the head-ach, and the derangement of the circulation. It may be productive of still worse consequences. The cooling op- eration may prove far more powerful and more lasting than was expected, and may extinguish forever the remains of animal heat; or, should nature, by extraordinary efforts, be able to resist the shock, it would probably be attended with symptoms of fever, or with very troublesome eruptions. Many painful affections of the head, as well as those which arise from intoxication, are, indeed, often relieved by what is called the shower-bath, or by the affusion of cold water on the part affected, but never by the rash experi- ment of swimming, or of total immersion. I must take this opportunity to add, that the shower-bath is in many other respects a valuable contrivance. It may be easily pro- cured : its actions can be regulated at pleasure; and as the water descends like rain, it gently impels the blood towards the lower extremities, and prevents the danger which would arise from its sudden or too rapid determination to the lungs and head in some of the cases already mentioned. In uterine haemorrhages, and other fluxes of blood, when so con- siderable as to endanger the patient's life or constitution, cold wa- ter may be applied with good effect. It also forms a part of the tonic plan to be pursued in an immoderate flow of the menses; nor is any thing more likely to prevent the return of this complaint than cold-bathing or drinking chalybeate waters in the intervals of men- struation. But when the discharge of blood is critical, as in some affections of the brain, lungs, &c. or is become habitual, as in the piles, to check so salutary an evacuation by the use of the cold- bath would be the height of madness. This is no less true of ma- ny critical inflammations, those of the gout for instance, in which cold water or any other repellent would evidently counteract the purposes of nature, and very probably throw the disorder upon some vital part. What is called the retrocedent gout frequently arises from some mismanagement of this sort, as well as from some partic- ular weakness or atony of the system. Cold-bathing is a very haz- ardous experiment to be made by persons subject to the gout, except COLD-BATHING. 467 in the absence of the symptoms, when no indisposition is felt in either the head or stomach, when the extremities are not threat- ened with pain ; and then only in concurrence with the best medi- cal advice. Bathing the lower extremities in warm water is generally and very properly recommended both in the retention and suppression of the menses, to excite the action of the uterine vessels, and, in the latter case, to remove any stricture of those vessels which may be induced by cold or fear. A skilful physician, however, will some- times meet with cases of a retention of the menses after the usual age, in which the cold-bath, if seasonably used at the beginning of the disease, may contribute to restore the tone of the system. The delicacy and general irritability of the habit in a state of pregnancy, as well as the danger of too great a determination of the blood to the womb, clearly forbid the use of the cold-bath, un- less it should be rendered advisable by some circumstances of a pe- culiar nature, of which a medical man of skill and experience is the only proper judge. It is a great and often a fatal mistake to rely on the tonic pow- ers of the cold-bath as the best means of repairing the injury done to the constitution by the relaxing influence of hot climates. Peo- ple, on their return to England, after having resided in the East or West Indies, would find the warm-bath not only safer, but far more conducive to the recovery of their former strength. I would not have them venture into a bath of a temperature under 90° for a considerable time, after which they may gradually diminish its warmth, as before recommended in cases of extreme debility. I might here go into farther details, and show how much more salutary the warm-bath is than the cold in diseases of the liver and kidneys, and in numerous other cases of internal derangement; but the principles, which I have laid down, may be easily extended to them all; and I hope that the cautions I have given will operate as some check on the abuse of the most powerful means of preserving and restoring health, with which we are acquainted. Some years ago a foreign quack made a great deal of noise in this country with his medicated baths, but, like other follies of the day, they are now almost sunk into oblivion. A few writers have also been very lavish of their panegyrics on the wonderful effects of vapour-baths as used in Russia: but I do not think that the in- habitants of these milder regions will ever have occasion to envy the rigid fibres of the north the enjoyment of such fanciful luxuries. The strength of steam is, perhaps, better known and more usefully employed =in England than in any quarter of the globe; but we meet with very few cases, where its intense action on the surface of the human body can be deemed essentially necessary either for the prevention or the cure of diseases. Surely the skin of an Eng- lishman may be rendered perspirable by a much gentler stimulus, and without the aid of so troublesome and suffocating a process. 468 MINERAL WATERS CHAP. XZXI. OF MINERAL WATERS. Waters holding minerals in solution are called mineral waters. But as all water, in a mineral state, is, either more or less impreg- nated with some mineral substances, the name mineral waters should be confined to those that are sufficiently impregnated with mineral matter to produce some sensible effects on the animal econ- omy, and either to cure or prevent some of the diseases to which the human body is liable. On which account, these waters with much more propriety might be called medicinal waters, were not the name by which they are commonly known too firmly establish- ed by long use! The mineral waters most esteemed, consequently those most fre- quently resorted to for the cure of diseases, are those of Aix, in Provence, Harrowgate, Spa, Barege, Hartfell, Sedlitz, Bath, Holywell, Sea-water, Bristol, Leamington, Seltzer, Buxton, Malvern, Tunbridge, Borset, Matlock, Vechy, and others Cheltenham, Moffat, of less note. Carlsbad, Pyrmont, Epsom, Scarborough, It is scarcely possible to read without a smile the numberless books, essays, and pamphlets, which* have been written on this subject. It seems to be the favourite region for the exercise of fic- tion and fancy. The traditionary tales of ancient miracles, said to be wrought by holy wells and consecrated springs, do not much surpass in extravagance the modern cures ascribed to those favour- ite haunts of valetudinarians by fraud, ignorance, and credulity. In printed Guides, as they are called, or Pocket Companions, to any of those fountains of health, it may be excusable to amuse us with a little romance ; but we are sorry to find the same spirit per- vading many medical treatises which should be distinguished by the most sacred regard for truth, and a just contempt of puerile embellishments. Some allowance indeed should be made for the influence of local prejudices, and for the strong bias of interest and ambition on the mind of a professional man, who, residing near one of those springs, has, perhaps, no other means of acquiring popularity and reputa- tion, but by an encomium on its virtues, and a description, quite in the poetical style, of the beauties of the surrounding scenery. The latter is, indeed, a harmless puff; it seldom deceives anybody; but is viewed in the same light as an auctioneer's advertisement of an estate, where frightful chasms are often described as curious grottos, a few furze-bushes as a shrubbery laid out by the finger of Nature, and a gallows as a hanging-wood. There is another particular, in which those highly-coloured landscapes that form the MINERAL WATERS. 469 introductory part of almost every treatise on a medicinal spring, may defeat the proposed end, and that is, by exciting a reasonable sus- picion that those waters are chiefly indebted for the high reputation of their efficacy to local circumstances, to the pleasant walks and rides, or the delightful prospects round them. A display of all the attractions of the favourite spot is commonly followed by very minute details of chemical analysis, which are just of as little use to the generality of readers as the description of the scenery. A knowledge of the contents of any mineral water by no means implies a knowledge of its medical properties. These are to be learned by repeated experiments. Were it not for the evidence of facts, the late discoveries in chemistry, as far as they respect the analysis of mineral waters, would only tend to lessen their credit, by showing the little difference between them and any common water of the same purity and temperature. For instance, if we confined ourselves to mere speculation on the subject, how could we suppose that a quarter of a grain of the oxyd of iron sus- pended by a little fixed air in a whole quart of Tunbridge water, the largest quantity usually taken in the course of a day, could produce any remarkable or peculiar effects'? The same thing might be said of the most celebrated springs in the kingdom ; and many physicians of great professional eminence, arguing from this principle, have not hesitated to assert, that the cures performed by those springs were not owing to the ingredients with which they were impregnated, but to the simple elementary part, or what may be called pure water. It would not be easy therefore to determine, whether chemical analysis has furnished more arguments in favour of, or against, the boasted superiority of mineral waters. Dr. Falconer, the author of one of the very few books relative to this subject, that contain something more than the gratification of idle curiosity, candidly confesses, that " chemical analysis, as far as it has been hitherto prosecuted, seems to give us a very imper- fect view of the methods by which these effects (t. e. the medicinal effects of the Bath-waters) have been produced ; and this circum- stance has induced several persons to deny the truth of the facts altogether, or to represent them as highly exaggerated, and that such advantages (if any) as might be in truth received, were owiug to collateral circumstances of uncertain and indeterminate efficacy, as change of air, diet, manner of life, and the like." It is not therefore to the landscape-painter, or to the chemist, that we must look for any useful information on those points, but to the modest and judicious practitioner, who, like the author now quoted, watches with care, and reports with fidelity, the bad as well as the good effects of the waters he describes, the instances of their failure, as well as of their success, in various disorders. I am sorry to add, that the fund of such truly valuable materials is as yet very scanty, and that I must confine myself to general re- marks on the most frequented of our medical springs, so as to di- rect invalids to the fountain, from the use of which they may form some reasonable hopes of relief. As more particular instructions will often be necessary When they get to the spot, I feel it my duty to caution them against choosing for their medical guide any man, however high his reputation may be, who has distinguished himself 470 MINERAL WATERS. as the loudest or most eloquent trumpeter in the indiscriminate praise of the waters near which he resides. The like cautiou may prove still more serviceable to such of our countrymen as resort to foreign springs for medicinal purposes. A popular advocate for the use of any remedy is seldom to be relied on as a good physician ; and we haye always strong reason to sus- pect the skill or the integrity of a'man, who speaks in a tone of confidence of the infallible efficacy of the waters which he pre- scribes. Some of those foreign waters being also frequently im- ported into this kingdom, and used here medicinally, I shall give a short account of a few of them, which are found to possess virtues superior to any of our own in the cure of certain disorders. Classification of Mineral Waters. Mineral waters are usually classed according to their sensible qualities, as perceived by the touch, sight, taste and smell, or ac- cording to some well-known ingredient, which may predominate in this or that particular spring. The most obvious division is into cold and hot fountains ; but both these, being too comprehensive, are again subdivided into chalybeate, saline, sulphureous, and calca- reous, from their being impregnated with iron, salts, sulphur, or lime. There are many still minuter distinctions, where two or more of those ingredients may be found united in the same spring, or combined with different sorts of air, which must have a very powerful effect in the internal use of the waters. The first class of mineral waters, which I shall notice, are those called chalybeates, from a Greek word that signifies iron, the taste of which is very perceptible in them when fresh from the spring, though they lose it on being exposed for some time to the atmos- phere. The reason is, that the small quantity of iron which they contain, being kept in solution by fixed air, when this evaporates, the iron sinks to the bottom, forming the fine ochre that lines the channel or water-course. As iron abounds in almost every part of the earth, it is no wonder that so many springs should be im- pregnated with it, in a greater or less degree, according to the quantity of fixed air they contain, by which the iron is held in a state of solution. Some of those waters have, in conjunction with the iron and fixed air, a pretty strong mixture of purgative salt, and are very different from the others in their effects as well as their taste. In order to distinguish each by a specific name, the former may be called simple chalybeates, and the latter saline or purging chalybeates. Tunbridge-Wells standing in point of repu- tation, or of fashionable resort, at the head of the one, and Chel- tenham at the head of the other; they may be very properly chosen as examples or illustrations of the various medicinal effects of this numerous class of waters. i Tunbridge-Wells. Medicinal Properties, &c. It has been already intimated, that the water of Tunbridge- Wells is found, upon being analyzed, to differ from that of com- mon springs only by containing in every gallon a grain of iron sus- MINERAL WATERS. 471 pended by about three table-spoonsful in bulk of fixed air.* Yet its medicinal effects are very considerable. It gives a gentle stim- ulus to the relaxed nerves, and contributes to restore their proper tone. It affords great relief in many complaints of the stomach, in flatulencies, bilious vomitings, irregular or imperfect digestion, and other consequences of either debility or intemperance. It pro- motes the circulation of the blood, and the various secretions; but more particularly that of urine : and this latter circumstance is one of the best proofs of its agreeing with the habit of the patient. In short, its natural tendency in the cases to which its stimulant and tonic powers are adapted, is to raise the spirits, and increase the general vigour of all the functions. The Tunbridge-waters are eminently serviceable in what may be called the sexual disorders of females, arising from a great weak- ness or derangement of the uterine system; such as an immode- rate How of the menses, green sickness, fluor albus, and other simi- lar indispositions, which are not only relaxing and painful in them- selves, but are often the cause of abortion, or of sterility. If the profuse flow of the menses should be accompanied, as it often is, by feverish symptoms, by pain in the back, and local irritation, the stimulus of the waters might then prove injurious. Indeed, they are improper in all inflammatory cases, except the feverish irrita- tion which attends the green sickness, and which is more frequently abated than increased by the use of chalybeates. In all obstructions of the urinary passages, and other complaints of that region, those waters are found of singular efficacy; for though, as before observed, they in some degree promote every se- cretion, yet their chief and most regular determination is to the kidneys ; and experience has fully proved the good effects of their gently stimulant and diuretic properties. We may proceed still farther in our recommendation of the Tun- bridge-waters, and prescribe them with great probability of success in such chronic disorders as arise from slow beginnings, and are attended with great laxity and weakness of the solids, but without much organic disease. It is necessary to attend to this material exception ; because a general weakness may be often brought on by morbid affections of the mesentery, of the lungs, or of some other important organ, to the cure or relief of which they would be very inadequate. Even in complaints where they have commonly proved efficacious, cases must often occur that require the exercise of the nicest judgment and discrimination. » A recent analysis of the Tunbridge-Wells says: " A single dose of half a pint will contain, according to the analysis which has been given, and the statement made aereeable to Dr. Murray's views, of solid ingredients, about 14-100ths of a grain ot ox- ide of iron : 9-100ths of muriate of lime ; 8-100ths of a grain of muriate of magnesia ; 9-100ths of a grain of the sulphate of soda: 2-100ths of a grain of carbonate of lime, and a minute portion of manganese ; and of gaseous ingredients, half a cubic inch (or a i oz. in bulk) of carbonic acid ; ll-100ths of a cubic inch of azote, and about the same quantity of atmospherical air." These minutiae, be they ever so comet, an ot no use in practice; and we merely give this as a specimen of that ■»/*»» ^J"**1 ear-wiping which the author of the " Domestic Medicine" so justly and so humour- ously disclaims, while he goes at once into the more solid utility to be derived from frequent'n- mineral springs for the cure of disease and the improvement of the general health Dr ScudamoW. book has neither index nor table of content!,, consequently it was never intended to be referred to. (For a general survey, analysis, Properties, Iclf the mineral waters, see •' Natural and Medical Dieteticon, &c") Ed. , 472 MLM.UAL WATERS. But it is not enough to consider well the propriety of having re- course to those waters in nnv particular instance; some caution is also necessary in using them'. Persons of a full habit should not begin to drink them, without losing a little blood, or without some other evacuation. When the stomach is foul, a purgative is com- monly preferable to emetics. What the immediate effect ot the waters may be, can only be known by trial. They often purge very briskly at first, but this effect soon ceases ; and as their con- tinued use has some tendency to occasion costiveness, gently-open- ing medicines from time to time are necessary. The water itself may be easily converted into a purging chalybeate, by the addition of a little magnesia or Glauber's salts, when necessary. In the removal of other obstructions, those more especially to which fe- males are subject, the occasional use of the warm-bath will be found an excellent auxiliary. Directions and Cautions to be observed in the Use of these Waters. In entering upon a course of the Tunbridge-waters, it is always best to begin with a small dose, not exceeding a quarter of a pint, about half an hour before breakfast, to be repeated, at regular in- tervals, once or twice in the forenoon, according to the pleasant- ness of the sensations it excites. The quantity may be soon aug- mented to half a pint or even more at each dose, if agreeable, or necessary, as the waters lose much of their medicinal effect by continued use, the stimulus wearing off in about six or eight weeks, and making no peculiar impression on the stomach or habit. The usual hours for the three doses are eight o'clock, ten o'clock, and twelve. A light breakfast at nine will not impede the proper ac- tion of the waters; and as one of their effects is to improve the appetite, its indulgence should be under the control of moderation. But I have elsewhere enlarged so fully on the advantages of tem- perance, as well as of early hours and exercise, that I need not stop here to point out their importance in promoting the salutary ope- ration of any course of medicines either natural or artificial. As some persons may be too soon prejudiced against the use of chalybeates by any unpleasant or unexpected sensations at first, it is proper to inform them, that giddiness and sometimes a heavi- ness of the head, nausea, vomiting, a slight pain about the heart, and a sense of fulness over the whole body, though by no means uncommon symptoms on beginning a course of these waters, will disappear after a little use. It is only when they stubbornly con- tinue, that they should be regarded as a proof that the waters are not suited to the nature of the complaint or to the patient's consti- tution. The nausea or sickness being often occasioned by the coldness of the fresh-drawn water, acting on an empty or a very weak and irritable stomach, it is advisable, in the first instance, not to drink the waters fasting, till the stomach becomes gradually reconciled to them ; and, in case of extreme irritability, it is a common and judicious practice at Tunbridge to immerse in hot water a bottle filled with the chalybeate, and well corked, that the dullness may be diminished, with as little evaporation of the fixed air as possible. Where this abounds, as in the waters of the Ger- MINERAL WATERS. 473 man Spa, or still more in those of Pyrmont, it need not be preser- ved with so much caution ; but a sufficient quantity of boiling water may be added to that which is taken from the spring, to bring the whole to a moderate temperature. Remarks.—There are many springs of simple chalybeate water in different parts of Great Britain, and even in the neighbourhood of London, which probably are little inferior in medicinal virtue or intrinsic strength to Tunbridge-Wells, though these have acquired a higher reputation. Pure air, temperate living, regular and early hours, active diversions, agreeable company, and a total exemption from all concern, except a rational desire to promote health, are the only circumstances that cause any real difference in the use of waters so similar in quality. This difference, however, is consid- erable ; and the want of some of those co-operating circumstance* will always prevent the springs of Islington or Hampstead from being set in competition with those of Tunbridge, for the certaintv of their effects. The remarks, which I have made on the proper method of drinking the latter, as well as on the disorders and par- ticular habits of body to which they are adapted, are equally appli- cable to all waters of the same description in our island. But there are a few chalybeates on the continent, particularly those of the German Spa and of Pyrmont, which, being more active and pow- erful" in their operation, require to be used with greater caution and delicacy. Pyrmont and German Spa, &c, compared with the Tunbridge Wafers, Sfc. On drinking a glass of the Spa water, the taste immediately perceives a strong infusion of iron blended with an agreeable acid- ity. The latter is owing to the abundance of fixed air, which amounts to near half the bulk of the water, and holds in solution more than four times as much iron as we find in the like quantity of Tunbridge water. The effects are not less perceptible than the taste. A full draught of the Spa water, especially in hot weather, or upon an empty stomach, will produce a swimming in the head, and a sort of intoxication, which sometimes continues for half an hour, and is very like that which arises from spirituous liquors, though it does not leave the same debility after going off. A patient, therefore, should not drink more than a gill at first about an hour after breakfast, and another gill after an interval of two hours more. In three or four days the quantity may be in- creased, and the dose more frequently repeated ; but in these par- ticulars every body's experience will be the best guide. I before suggested the propriety of mixing as much boiling water with the chalybeate as will bring it to a degree of tepid warmth, and there- by prevent any unpleasant sensations, which its natural coldness might excite in a very weak or a very irritable stomach. If some evacuation was recommended to persons of a plethoric habit, before drinking the Tunbridge water, how much more neces- sary must it be to prepare in the same manner for the use of a far strongerstimulaht ? This very active property of the Spa waters must also render them still more improper than those of Tunbridge in inflammatory complaints, attended with determination to the 474 MINERAL WATERS. head, flushing of the face, or any other strong indications of feverish heat. But if the febrile symptoms are very slight, the Spa waters, used cautiously and moderately, may prove beneficial. They quench thirst more than common water ; and they have been frequently known to afford relief in ulcerated sore throats. What has been said of the efficacy of our own simple chaly- beates in cases of nervous relaxation, or of general weakness, ma- ny affections of the stomach and bowels, in disorders of the kid- neys and bladder, or obstructions in the urinary passages, and iz. various complaints peculiarly incident to females, may be asserted with still greater confidence of the waters of the German Spa, be- cause of their superior strength. Yet they do not equal the activ- ity of the Pyrmont waters, which contain as much iron and twice as much fixed air as those of the Spa, besides a larger proportion of earthy salts. The directions already given, will apply to them both, under similar circumstances. Where the stimulus is evidently stronger, more caution is at first necessary ; but every patient must learn from experience what quantity of either of those chaly- beates the stomach or general habit will conveniently bear ; and this quantity, when ascertained, whatever it may be, whether one, two, or. three pints in the course of a day, must be continued with- out farther increase. It may be thought worthy of remark, that the waters of Pyr- mont and Spa, though in their own nature somewhat intoxicating, afford the most refreshing and wholesome draught, to relieve in the morning a weakness of the stomach occasioned by the too free use of the bowl or the bottle the night before. The only peculiarity in the virtues or medicinal effects of the Pyrmont waters is, that, when diluted with new milk, they are found very serviceable in gouty cases, and may therefore be safely prescribed in this form, during the intervals of the fits and the ab- sence of inflammatory symptoms. It is fortunate for a patient who cannot go to drink either of those waters at the fountain head, that they may be conveyed to any distance, and will retain their medicinal properties, with little or no diminution, for two years, if they are inclosed in bottles well corked and covered with cement. They contain so much fixed air that it is usual, after filling the bottles, to leave them uncorked for a while, in order to let the excess of the fixed air escape, as its expansion might- burst the bottles, if they were to be instantly corked and removed to a warm place. The other species of this class of waters, which come next to be noticed, are the saline or purging chalybeates, so called partly from their contents, and partly from their mode of operation. Besides iron and fixed air, which they have in common with the simple cha- lybeates, they hold in solution such a quantity of purgative salt as gives them a regular and strongly marked determination to the bowels. Any chalybeate, whether of the milder sort, as the Tun- bridge-water, or of the rougher, as those of the German Spa and of Pyrmont, will often purge briskly at first; but this is not their certain or constant effect. It seems to depend on the previous habit, or the actual state of the patient's stomach and bowels. It also goes off very soon, and is followed by a tendency to costive- MINERAL WATERS. 475 ness. But the purging chalybeates commonly operate in the same regular, constant, and uniform manner, as long as they are con- tinued. . The chief springs of this description in England are those of Cheltenham and Scarborough, upon the medical properties of which I shall now make a few remarks. Cheltenham Waters. The Cheltenham-waters require no preparation ; but the quan- tity sufficient to produce the desired effect on the bowels, can only be known by experience. Half a pint is as much as any patient can well drink at a time, and this may be repeated three or four times, at proper intervals, in the course of the day, according to its operation, or to the intention with which it is taken. Four doses of half a pint each contain about a quarter of an ounce of purging salts, with somewhat more than a grain of iron held in so- lution by four ounces in bulk of fixed air. As purgatives act very differently in different habits, the quantity here mentioned will op- erate briskly upon some patients, but so weakly upon others, as to render the occasional addition to the crystallized salts necessary, when a powerful and speedy effect is desired. On the other hand, the quantity of the water, or the number of doses, may be lessened, when it is used merely as an alterative. But even persons of very delicate habits may divest themselves of their usual prejudices against cathartics, as those saline chalybeates do not occasion griping or languor. The only unpleasant sensation, which they sometimes excite on first drinking them, is a sort of giddiness, or slight head-ach, which soon goes off; but their agreeable and salu- tary effects are not so transient. They improve the appetite, strengthen the stomach, and promote general alertness, while they correct and carry off the impurities of the whole system. Hence it is that they may be persevered in for a considerable length of time, and the body kept moderately open by their uninterrupted use, without the least debility or inconvenience. These remarks, however, admit of some exceptions, particularly when the consti- tution is either naturally very weak, or much enfeebled by disease, without any marks of obstruction, or of acrimony in the fluids. A constant operation on the bowels would in such cases prove very injurious. Cheltenham-water has often been found of the greatest service in glandular and visceral obstructions, in a variety of bilious and scrofulous complaints, in the first symptoms of a dropsical disposi- tion, and in many of the most distressing scorbutic eruptions and ulcerations on the skin. But the obstinacy of some of these can only be overcome by perseverance. In our endeavours to obtain a cure of any disease of the chronic kind, we should not forget that complaints, slow in their progress, go off also very slowly; and that, according to the judicious remark of Celsus, time is necessa- ry to remove the deep-rooted evils which time has occasioned. The proper season for drinking the waters of Cheltenham is the summer; and as the warm-bath may also be advisable in some of the cases to which the waters are suited, the town is well sup- plied with accommodations for that purpose. 476 MINERAL WATERS. Scarborough Waters. The saline chalybeate at Scarborough does not contain above a third part of the purging salts which are found in a like quantity of the Cheltenham-water. Of course, it cannot be supposed to operate with the same force and activity, unless larger doses are taken than most stomachs will bear, or unless the po-wers of the water are increased by the addition of some opening salts of the like kind as those which it already holds in solution. In its natural state, it is chiefly employed as an alterative, but may, by the arti- ficial means just mentioned, be adapted to all the complaints in which the Cheltenham-water is found efficacious. Neither of them will keep well even in close bottles, or bear to be carried to any great distance, as the iron is deposited in a few days, though the saline impregnation continues. By evaporating the water the purgative salts are procured, for the purpose of being again dis- solved in some more water from the same spring, to increase its operation on the bowels. The inferiority, in point of strength, of the Scarborough-water, is more than counterbalanced by other advantages which Chelten- ham does not possess. In the first place, near the saline chalybeate spring there is another spring of simple chalybeate water, like that of Tunbridge-Wells, which is very convenient for patients in ca- ses where a determination to the kidneys may be desirable. But the situation of Scarborough on the coast is an object of still great- er importance, as it affords an opportunity of bathing in the sea, so conducive to the cure of many of the disorders for which those springs are resorted to. The elevation of the ground, and the un- common purity of the air, deserve also peculiar notice in a medi- cal survey of the local advantages of Scarborough. It is remarkable, that all the saline chalybeates in our island are cold, while many of those on the continent are hot, and are used as baths, as well as internally, in a number of diseases very difficult of cure. I shall therefore reserve my account of one or two of the most celebrated of them, till I come to describe our own hot baths, though the foreign ones, on account of their principal ingredients, may be said more strictly to belong to the class of waters which I have just been considering. The details before entered into respecting the external and inter- nal use of the sea-water, and its admirable effects not only as a grand preservative of health, but as an efficacious restorative of that blessing in various complaints, preclude the necessity of say- ing much of the second class of mineral waters, denominated the simply saline, and differing from common water only in being im- pregnated with some purging salts. We have several of these springs near the metropolis; but they are little used, as it is so easy to procure the sea-water, which is much superior to all others of this description, in the strength of its saline ingredients, and the certainty of its effects. Epsom-water, though one of the first of the salt springs that was brought into use, is now seldom or never prescribed. Bagnigge-Wells, those at the Dog and Duck in St. George's Fields,* as well as at Kilburn and Acton, have also had * The waters of the " Dog and Duck" have long ago been disturbed by the less MINERAL WATERS. 477 their day of medicinal reputation ; but even recommendatory es- says and pamphlets can no longer prop up their fame. The por- tion of salts which they contain is not sufficient to act with certain- ty on the bowels, unless they are taken in such large quantities as delicate stomachs cannot bear, and as very few people can swallow without difficulty and disgust. Two or three pints must be taken one after the other, in a short space of time, to ensure the full pur- gative effect. On this account, when they were in vogue, it was a common practice to administer more convenient doses, smaller in quantity, but strengthened by an additional solution of some of the same salt as that which they already contained. But this differs so little from an artificial dose of physic, as almost to destroy the idea of a remedy prepared by nature. Besides, the facility which our insular situation affords, of procuring salt-water of the greatest efficacy from its grand reservoir, must lessen the value of those substitutes. Local convenience has certainly contributed its share to the high repute of a spring of the like kind at Sedlitz, a village in Bohemia, which, being much more strongly impregnated with fatter purging salt than the Epsom-water, can be more relied upon for its medicinal effects, and is therefore very justly esteemed in a part of the continent far removed from the sea. Seltzer Water. But there is another saline spring in Germany, a more particu- lar account of which must be interesting to the English reader, not only from the peculiarity of its nature and virtues, but because large quantities of it are imported into this country for medicinal purposes. Few mineral waters have acquired a greater degree of celebrity than those which are brought from Seltzer, and which may be said to form a peculiar species, being saline and slightly alkaline, with a strong impregnation of fixed air. This quickly evaporates on being exposed to the atmosphere, so that the water designed for exportation must be instantly bottled, and kept close- ly corked, with the mouths of the bottles well covered with cement, or it will soon become not only vapid but putrescent. If well pre- served, when poured into a glass, it is perfectly clear and spark- ling, and has a gentle saline, and somewhat pungent or acidulous taste: but if the fixed air be suffered to escape, through the least neglect, the water appears turbid, is offensive to the smell, and en- tirely loses its pungency. The stone-bottles, in which it is brought to England, contain about three pints each, a sufficient quantitj for a day, to be taken in half-pint glasses at convenient intervals. Its natural flavour is rather agreeable, and its effects on the spirits are in general exhilarating.. Persons of very irritable stomachs may dilute ft with milk; in which mixed state it is particularly re- commended in cases of hectic fever with expectoration. It corrects and diminishes the discbarge from the lungs, checks the violence of the sweats, and contributes very much to the patient's repose. The Seltzer-water is also used with considerable benefit in ner- vous affections of the stomach and bowels, in cases of indigestion, medicinal but more inebriating and destructive substitution of those of Hodges; and Barclay, Perkins, &c.j a public-house having been erected on the spot. Ed. 478 MINERAL WATERS. foulness, bilious vomiting, acidity, heart-burn, spasmodic pains in the alimentary canal, and various diseases of the urinary organs. Its rapid determination to the kidneys, the action of its stimulus, and perhaps some considerable power as a solvent, may concur to produce the very agreeable effects that are experienced from it, in the latter complaints especially. In any of the former, it is advis- able to take some gently-opening medicine every two or three days ; and the easiest method of doing this is to add to the dose of Seltzer- water such a quantity of vitriolated magnesia as will keep the bowels in a regular state. Though this water cannot be prescribed with so much confi- dence, it may be very safely tried in miliary pustules, and the like sudden eruptions on the skin, attended with general irritation. I consider it merely as a good diet-drink in these disorders ; for the relief of which, greater reliance is justly placed on regimen than on medicine. Harrowgate Waters. In a feW of the waters already described, we. can discover a slight impregnation of sulphur ; but where this principle abounds or predominates, the waters are distinguished by the name of sul- phureous, from their chief ingredient. • The springs of Harrowgate take the lead in this class, and are certainly deserving of the repu- tation they have acquired, though they are also very frequently used with great indiscretion : and as the same error is very com- mon in drinking the other strong purgative mineral waters, I shall take this opportunity of enlarging upon it. A very hurtful prejudice prevails in this country, that all diseases must be cured by medicines taken into the stomach, and that the more violently these medicines operate, they are the more likely to have the desired effect. This opinion has proved fatal to thou- sands, and will, in all probability, destroy many more, before it can be wholly eradicated. Purging is often useful in acute diseas- es, and in chronical cases may pave the way for the operation of other medicines : but it will seldom perform "a cure; and, by ex- hausting the strength of the patient, will often leave him in a worse condition than it found him. That this is frequently the case with regard to the more active mineral" waters, every person conversant in these matters will readily allow. Strong stimulants applied to the stomach and bowels for a length of time must tend to weaken and destroy their energy ; and what stimulants are more active than salt and sulphur, especially when these substances are intimately combined, and carried through the system by the penetrating medium of water 1 Those bowels must be strong indeed which can withstand the daily operation of such active principles for months together, and not be injured. This, however, is the plan too generally pursued by those who drink the purging mineral waters, and whose circumstances permit them to continue long enough at Harrowgate, and the like places of fash- ionable resort. Many people imagine that every thing depends on the quantity of water taken, and that the more they drink, they will the sooner MINERAL WATERS. 479 get well. This is an egregious error ; for, while the unhappy pa- tient thinks he is by this means eradicating his disorder, he is of- ten, in fact, undermining the powers of life, and ruining his consti- tution. Indeed, nothing can do this so effectually as weakening the powers of digestion by the improper application of strong stim- ulants. The very essence of health depends on the digestive organs performing their due functions, and the most tedious maladies are all connected with indigestion. Drinking the water in too great quantity not only" injures the bowels, and occasions indigestion, but generally defeats the inten- tion for which it is taken. The diseases, for the cure of which mineral waters are chiefly celebrated, are mostly of the chronic kind ; and it is well known that such diseases can only be cured by the slow operation of alteratives, or such medicines as act by inducing a gradual change in the habit. This requires length of time, and can never be effected by medicines which run off by stool, and operate chiefly on the first passages. Those who wish for the cure of any obstinate malady from the Harrowgate-waters, or others of the sulphureous or saline class, ought to take them in such a manner as hardly to produce any effect whatever on the bowels. With this view, a half-pint glass may be drank at bed-time,* and the same quantity an hour before breakfast, dinner, and supper. The dose, however, must vary ac- cording to circumstances. Even the quantity mentioned above will purge some persons while others will drink twice as much without being in the least moved by it. Its operation on the bow- els is the only standard for using the water as an alterative. No more ought to be taken than barely to move the body ; nor is it always necessary to carry it even this length, provided the water goes off by the other emunctories, and does not occasion a chilness or flatulency in the stomach or bowels. When the water is intend- ed to purge, in cases where the nature of the patient's complaint requires a strong determination to the bowels, it may be necessary to drink a pint or two before breakfast. I would not only caution patients who drink those waters over- night, to avoid hearty suppers, but also against eating heavy meals at any time. The stimulus of water, impregnated with sulphur and salts, seems to create a false appetite. I have seen a delicate per- son, after drinking the Harrowgate-waters of a morning, eat a breakfast sufficient to have served two ploughmen, devour a plen- tiful dinner of flesh and fish, and, to crown all, eat such a supper as might have satisfied a hungry porter. All this, indeed, the stomach seemed to crave ; but this craving had better remain not quite satisfied, than that the stomach should be loaded with what exceeds its powers. To starve patients was never my plan ; but I am clearly of opinion, that, in the use of all the strongly purging mineral waters, alight and rather diluting diet is the most proper; * When I speak of drinking a glass of the water over-night, I must beg leave to cau- tion those who follow this plan against eatinghearty supperB. The late Dr. Daultry of York, who was the first that brought the Harrowgate-waters into repute, used to ad- vise his patients to drink a glass before they went to bed; the consequence of which was, that having eat a meat-sunper, and the water operating in the night, they were of- ten tormented with gripes, and obliged to call'for medical assistance. 4^0 MINERAL WATERS. and that no person, during such a course, ought to eat to the full extent of what his appetite craves. Exercise is not less conducive to the salutary end in view than temperance. It promotes the operation of the waters, and carries them through the system. It may be taken in any manner that is most agreeable to the patient; but he ought never to carry it to excess. I scarcely need repeat a remark often made in other parts of this work, that the best kinds of exercise are those connected with amusement. Every thing that tends to exhilarate the spirits, not only increases the efficacy of the waters, but acts as a medi- cine. All those who repair to the fountains of health ought there- fore to leave every care behind, to mix with the company, and to make themselves as cheerful and happy as possible. From this conduct, assisted by the free and wholesome air of those fashion- able places of resort, and also the regular and early hours which are usually kept, the patient often receives more benefit than from using the waters. During my residence at Harrowgate, 1 met with many instances of the most mischievous effects produced by drinking the waters in cases where they were absolutely improper, and adverse to the nature of the disease. When people hear of a wonderful cure having been performed by some mineral water, they immediately conclude that it will cure every thing, and accordingly swallow it down, when thej might as well take poison. Before patients be- gin to drink the more active kinds of mineral waters, they ought to be well informed of the propriety of the course, and should never persist in using them, when they are found to aggravate the disorder. On the other hand, I often witnessed the happy issue of experi- ment made with judgment and caution at Harrowgate, when the greatest benefit was derived from the proper use of the waters in various eruptions on the skin, of the most distressing nature; in rheumatism complicated with scorbutic complaints ; in obstructions of the glandular and lymphatic system; and in diseases of the first passages, accompanied with, or proceeding from, inactivity of the stomach and bowels, acidity, indigestion, vitiated bile, worms, pu- trid sores, the piles, and jaundice. They answer two very impor- " tant purposes ; first, when taken in small quantities, acting as an alterative, and inducing, by their mild operation, a gradual change in the habit; and, secondly, when employed in larger doses where purging is indicated, fulfilling that intention in the most desirable manner, without irritating the nerves, or weakening the patient so much as other purgatives. After a little use, almost every body can drink them without any great disgust, though they are at first no less nauseous to the taste, than offensive to the smell. I shall only add, that the external use of the Harrowgate-waters heing justly deemed a very powerful auxiliary in many of the dis- orders for which they are resorted to, particularly those of the cu- taneous class, there are proper baths for this purpose, to the supply of which three springs out of four are devoted, that which is re- served for drinking being more strongly impregnated with salt and sulphur than the rest. MINERAL WATERS. 481 Moffat Waters. The sulphureous and saline waters of Moffat in North Britain are almost as much resorted to as those of Harrowgate. The im- pregnation of the former, indeed, is not so strong as that of the latter, and their effects are of course somewhat different. Two or three quarts of the Moffat water may be drank in a morning, with- out any sensible effect but that of increasing the flow of urine* It now and then purges ; but this is so far from being its constant or regular mode of operation, that opening medicines are almost al- ways necessary during a course of it. Its evident determination to the kidneys renders it of essential service to persons afflicted with the stone and gravel, particularly the latter. It has likewise afforded great relief in many bilious complaints, and in the early symptoms of a scrofulous habit. But its chief point of celebrity, and that in which it may be said to rival the springs of Harrow- gate, is the cure of cutaneous eruptions of every kind. In these cases, the external application of the water, warmed to a consider- able temperature, is very judiciously made a material part of the plan of treatment. One disadvantage, however, attends this pro- cess both at Moffat and Harrowgate. The waters, while heating, unavoidably lose in vapour some of their sulphureous impregna- tion, on which part of their efficacy, even when externally applied, must depend. So far, therefore, a preference is justly due to the natural hot sulphureous springs of Aix-la-Chapelle and Bareges, of which I shall take some farther notice, after I describe the thermal springs in our own island, which constitute the next and last class in my arrangement of mineral waters. In the introductory part of this section, the waters which now remain to be considered are specifically distinguished by the title of calcareous, because they contain more lime or calcareous salts than they do of any other solid substance. I adopted this title, however, in compliance with custom, and merely as a nominal dis- tinction, rather than from considering it as an important charac- teristic, or by any means expressive of the grand cause of the effi- cacy of such waters. It is not to chemical analysis, but to expe- rience that we are indebted for a knowledge of their virtues ; and, instead of giving them a name taken from a part of their contents which conveys no useful information, we had belter s.mpl}'call them hot springs, as every body will then have a clear idea of the most perceptible difference between them and all the other mineral waters in our island. Bath Hot Springs. In this part of our description, the hot springs of Bath have the most indisputable claims to precedency. The fame of their medi- Sd virtues is more widely diffused and more firmly established than that of any other springs in the known world. It is no wonder, herefore, that the pen of industry, of genius, or of ambition, should have been often exercised upon so popular a topic Amidst such kmulfrtude of books, Dr. Falconer's "Practical Dissertation on ?heMea"cinal Effects of the Bath Waters," is acknowledged to be W 482 MINERAL WATERS the best account which has yet appeared of what he justly calls a « powerful, but (in many instances) nice remedy. His situation as physician to the Bath Hospital must have afforded him the best opportunities of observing the effects of those waters ; and he has given the most satisfactory proofs of his being well qualified to profit by those opportunities. One of his remarks is really of more consequence than a whole volume of chymical investigations, which have thrown just as little light upon the efficacy of the wa- ters as the fables concerning Bladud, or the frequently-discovered fragments of Roman antiquities. Chemistry, indeed, makes us ac- quainted with the component parts of those waters, and tells us they contain a good deal of calcareous salts, but little, if any, neu- tral alkaline salts; and that they are impregnated with about a six- tieth part in bulk of fixed air, which holds in solution so very small a quantity of iron as to be scarcely appreciable, though it gives u slight chalybeate taste to the water when hot from the spring. But what inference could we deduce from these and the like amusing details, in the treatment of any particular disease ? It is, then, to the enlightened practitioner, as I said before, that we must look for useful information ; and, in this view of the subject, we cannot wish for more respectable authority than that of Dr. Falconer. According to this writer, the Bath-water, when drank fresh from the spring, has in most persons the effect of raising and rather ac- celerating the pulse, increasing the heat, and exciting the secre- tions. The action on the nervous system is felt at the same time, so that the stimulating properties of the water must be very diffu- sive ; and, what is farther remarkable, though these symptoms come on suddenly, yet they often continue much longer than we can sup- pose them to be excited by the actual presence of the water in the body. Medicinal Properties.—The Bath-waters not only promote urine and perspiration, but also increase the salivary discharge; and quench thirst better than other fluid, in cases where there is no tendency to fever. If any disposition of this kind should appear, a hot stimulant would be evidently improper. It has been generally imagined, that those waters were some- what astringent, on account of the costiveness which frequently accompanies the use of them. But this effect is more reasonably ascribed to their lieating qualities, and to their power of exciting the other secretions. As a proof of this, when perspiration is checked in cold weather, they sometimes prove slightly purgative. The relief which the Bath-waters afford in the colic, in convul- sive retchings which often attend the gout in the stomach, and in many other similar affections, is a sufficient evidence of their anti- spasmodic powers. This account of the primary and immediate effects of the water used internally will enable'any patient to judge, from his own feel- ings, whether it agrees with his constitution or not. If it excites, on being first taken, a pleasing glow in the stomach, followed by an increase of sp:rits, and of appetite, particularly for breakfast, and, above all, a rapid determination to the kidneys, there is the greatest probability of its proving serviceable. But if it occasions head-ach, thirst, and dryness of the tongue ;—if it sits heavy on the MINERAL WATERS. 483 stomach, or produces sickness, and does not pass off by urine or perspiration;—it may be fairly concluded, that its continuance would do injury, unless these symptoms can be removed. If we come next to consider the external application of those waters, we shall find, in the first place, that they unite all the me- dicinal advantages of warm-baths, from about a hundred and six degrees of heat to any inferior degree that may be desired. The extent also of the baths, which affords room to move about in them freely, and the permanence and uniformity of their warmth, are not unimportant recommendations. But Dr. Falconer is of opinion, that the Bath-waters possess some farther powers or specific qual- ities superior to those of common water of the same temperature. He thinks that their action on the nervous system is more stimu- lating than a common warm-Bath;—that they raise the pulse and heat of the body to a higher degree, yet are much less apt to pro- . ducea violent perspiration ;—that they remarkably increase the urinary discharge ;-and that, so far from causing any relaxation or weakness, the bathers are observed to be in general more alert and vigorous, and to have a better appetite on the days of bathing than in the interval. As far as my own opportunities of observa- tion extended during a few short visits at Bath, they are in per- fect concurrence with the Doctor's opinion. The diseases, in which this eminent practitioner very accurately describes the good effects of the Bath-waters, are the green sick- ness, particularly before any considerable affection of the stomach takes place, or any feverish symptoms appear; visceral obstruc- tions, when the consequences of intermittent fever, or of long iev- idence in hot climates, if the disorder in these cases has not .ad- vanced too far; the palsy, from a great variety of causes ; the gout, in that stage of the complaint, when the inflammatory symp- toms, if any have preceded, have in a good measure abated and a degree of weakness and want of tone in the system begins to take place ; the chronic rheumatism, and the acute also, provided the feverish disposition be previously allayed by proper evaluations ; white swellings on the knee ; hip cases ; weakness of the organs of digestion; the colic, accompanied with hysteric symptoms, or produced by he poison of lead; the jaundice when arising from Knplobstruction of the biliary ducts; hypochondriac and hyster- ical complaints ; St. Vitus's Dance; spasmodic affections of the womb and painful menstruation; and, lastly, in many cutaneous, hu* more especially leprous eruptions. I have confined myself here to a bare outline, which may be suf- ficient for the general direction of valetudinarians, who must aval fhemse ves of more particular advice at the fountain-head. Almost eve^y case will require a peculiar mode of treatment; and grea. cautfon will be found necessary to prevent fatal ""takes- can- not too often repeat, that the more powerful any remedy is, the more bableit is to abuse ; and though the efficacy of the Bath, waters ha been fully established in a variety of the most stubborn rnd afflicting disorder., yet their misapplication has also been e.__atit,„iIpH with very serious consequences. E„" when TheVse of the Ba to b<> taken immedi- t Poisonous mushrooms may be distinguished from <=i,«.)i <.<, »»« „ . u, ,. f<- i ney nave eolt Dulbous stalks, grow rapidly, and very soon corrupt Ed. VACCINATION. 493 Land Crab, Conger Eel, Muscle, Rock Fish, Sec. In an hour or two after eating stale fish, or often in much less time, a sense of weight at the stomach comes on, with slight vertigo and head- ach, heat about the head and eyes, and considerable thirst; often an eruption of the skin similar to what is called the nettle rash; and, in some instances, death has been the consequence. Treatment.—An emetic should be taken as soon as any of the preceding symptoms, after eating any of the above fish, begin to manifest themselves; and where it cannot readily be procured, vomiting may be excited by tickling the throat with the finger, and taking large draughts of warm water. After full vomiting an ac- tive purgative should be given to remove any of the noxious mat- ter that may have found its way into the intestines. Vinegar and water may be drank after the operation of these remedies, with which also the body may be sponged. Water made very sweet with sugar, to which some ether may be added, may be drank freely as a corrective ; and a very weak solution of alkali may be given to obviate the effects produced by the poison. If spasms come on after the evacuations, large doses of the tincture of opium are necessary. If inflammation arise, the usual means of remov- ing it must be employed.—See Animal Poison, p. 112, &c* CHAP. XVI. VACCINATION. As a preventive of the small-pox, the vaccine inoculation is now universally practised. This generally produces a very mild and safe disease, consisting of a single vesicle forming on the place where the inoculation was performed. On the third day, the scratch where the vaccine matter was introduced is slightly red, and, if pressed with the finger, feels hard. Next day, the red point is a little increased, and somewhat radiated. On the fifth day, a small vesicle appears, but it is more easily seen on the sixth. This gradually increases, until it acquires the size of a split pea. The colour of the vesicle is dull white, like a pearl. Its shape is circular, or slightly oval when the inoculation has been made with a lengthened scratch, acquiring about the tenth day a diameter equal to about the third or fourth part of an inch. Till the end of the eighth day, the surface is uneven, being depressed in the cen- tre, but on the ninth day it becomes flat, or sometimes higher at the middle than at the edges. The margins are tinged and round- ed, projecting a little over the base of the vesicle. The vesicle is not simple, but cellular, and contains a clear limpid fluid, like the purest water. . . On the eighth or ninth day, the vesicle is surrounded with an areola or circle of intense red colour, which is hard and tumid. About this time an erythematic efflorescence sometimes takes • See New London Medical Po krt Book, P. 23*, to p. 249, for an excellent his- tory of mineral, vegetable, animal, i ".-rial poisons, &c. 494 SEA-SICKNESS. place near the areola, and spreads gradually to a considerable part of the body. It consists of patches, slightly elevated, and is at- tended with symptoms of fever. On the eleventh or twelfth day, as the areola decreases, the surface of the vesicle becomes brown at the centre, and is not so clean at the margin ; the cuticle gives way, and there is found a glassy hard scab, of a reddish brown colour, which is not detached, in general, till the twentieth day. When it falls off, a scar about half an inch in diameter is seen, and having as many pits as there were cells in the vesicles. During the progress of the vesicle, there is often some disorder of the constitution ; and occasionally a papulous eruption, like scrophulus, appears next the vesicle. As security against the small- pox is not secured by spurious vaccine vesicles, it becomes necessa- ry to study carefully the character of the genuine disease, which is here briefly described. CHAP. XVII. SEA-SICKNESS. The cause of this distressing affection is the well-known motion of a vessel on the surface of the water. Some thousands are an- nually, nay daily, prevented from going to sea, either upon busi- ness, health or pleasure, in consequence of the terror of the waves. The most alarming, nay even fatal, consequences have been known to result from the violent retching and vomiting produced by the motion of the vessel, without it being in the power of any one to stop it; for, if it be true that sea-sickness is only to be cur- ed by habit,* what hope can be held out to the afflicted that they will acquire this habit, without inconvenience, and without risk; such as the bursting of a blood vessel, apoplexy, idiotcy, blindness, abortion, Sec, which have been known to result from excessive straining and vomiting ? People of delicate constitutions are known to derive considera- ble benefit from sailing on the sea; though frequently the good they have received has been more than counterbalanced by the in- * With the exception of Dr. Stevenson's Imperial Marine Tincture, which, for the last ten or twelve years, has been privately made and sold, we never before heard of any preparation having a decided efTect on this peculiar malady. It is, however, but common justice to confess, that this tincture has, in conjunction with its other virtues, every claim to the appellation of a specific for this affection, as was witnessed by ua in no less than twelve passengers, male and female, from London to Leith; and on nearly an equal number, with the same effect, from Leith to London, in the year 1817, and frequently since. It possesses also the no less singular quality of completely ar- resting the distressing vomiting to which ladies at various stages of pregnancy are lia- ble. In general debilities and relaxation from long residence in hot climates, the abuse of mercury, excessive drinking, and other species of intemperance ; excessive and debilitating evacuations in women, and the concomitant nervous affections, indiges- tion, &c. the Imperial Marine Tincture is one of the most valuable remedies that ever the ingenuity or talent of man could possibly devise for the relief of Buffeting hu- manity. It is an elegant preparation, purely vegetable ; its properties are those of an agreeable tonic, requiring no increase of dose to reproduce or keep up its effects; it promotes the general circulation, and communicates a congenial warmth ove> tho whole system, which its use invigorates and enlivens, &c. Its analysis baa frequently been attempted, but without success. SEA-SICKNESS. 495 jurious effects that have been caused by the violent sickness there- by occasioned. Those who intend to travel by sea, and are apprehensive of sick- ness, should previously use gentle aperients; and afterwards, to alleviate the nausea and vomiting, drink soda-water in a state of effervescence ; live sparingly; take up their station as near the mid- dle of the ship as possible ; sleep in a hammock or cot, in prefer- ence to a cabin, with their head towards the stern of the vessel; and while they are upon deck to look always in the direction the ship is sailing. Persons of a plethoric constitution should purge, and lose a little blood from the arm. The Imperial Marine Tincture, in doses of one, two, or three tea-spoonsful every quarter of an hour, has the remarkable effect, in the course of a few doses, of completely removing all the symp- toms ; indeed, this is so valuable a medicine, of the nostrum-kind, for this and other affections, that whether by land or sea, in hot, or cold, or temperate climates, it must always prove a safe and most useful medicine to resort to on emergencies. Many persons, on the least motion of a vessel, are instantly ta- ken with nausea and vomiting. Whenever the latter occurs, it should be encouraged, until the contents of the stomach are eject- ed, by copious drafts of tepid water ; after which, a tea-spoonful or two of the Imperial Marine Tincture effectually prevents any recurrence of these unpleasant symptoms. The many flattering encomia that have been lavished upon this valuable preparation in sea-sickness and nervous affections in gen- eral, render it, from the smallness of the dose, and the safety with which it may be taken, an object of some consideration, where such a medicine of the kind may be required. APPENDIX: containing I A List of Simples and of such Medicinil Preparations as are commonly used in Practice, with their proper Doses. 2. The Method of preparing and compounding such Medicines as are recommended in the formal Part of the Book, with the Addition of several others of a similar Nature. 3. Remarks on the Doses, Uses, and Manner of applying the different Preparations. The design of the following pages is, to exhibit such a list of drugs and medicines as may be necessary for private practice. They are considerably more numerous indeed than those recommended in the former part of the book, but are still greatly within the number contained in the most reformed dispensatories. The same medicine is seldom exhibited under different forms; and where different medicines answer nearly the same intention, there is commonly no more than one of them retained. Multiplying forms of medicine for the same intention tends rather to bewilder than assist the young practitioner, and the experienced physician can never be at a loss to vary his prescrip- tions as occasion requires. The chemical and other difficult preparations are for the most part omitted. All of them that are used by any private practitioner are not worth preparing. He will buy them much cheaper than he can make them. Great care, however, is necessary to obtain them genuine. They are often adulterated, and ought never to be purchased unless from persons of known veracity. Such of them as are in common use are inserted in the lists of drugs and medicines. Their proper doses and manner of application are mentioned in the practical part of the book, wherever they arSuchSarticles of medicines as are to be found in the house or garden of almost every peasant as barley, eggs, onions, &c. are likewise for the most part omitted. It is needless to swell a list of medicines with such things as can be obtained whenever they are wanted, and which spoil by being kept. The preparations made and sold by distillers and confectioners are also generally left out These people, by operating upon a larger plan, generally make things bet- ter while it is in their power to afford tbem much cheaper than they can be pre- pared bv any private hand—The quantity ordered of every medicine is as small as could well be prepared, both to prevent unnecessary expense, and that the medicine might not spoil by keeping. Almost every medicine suffers by being kept, and shou d be used as soon after it has been prepared as possible. Even simple drugs are apt to spoil, and should therefore be laid in in small quantities; they either rot, are consumed by insects, or evaporate so as to lose their peculiar taste or flavour, and often become q^n\enve?anificCoampositions, the ingredient on which the efficacy of the medicine prin- cipally depends is increased, while the auxiliaries, which are generally ordered in such trS quantities as to be of no importance, are left out, or only such of them retained as are necessary to give the medicine a proper consistence, or the like. The colourmg ingredients are likewise for the m^et part omitted. They increase the bulk andprice oDf the medicine ; without adding any thing to its value. It would ho well if they were never used at all. Medicines are often adulterated for the sake of a colour A/rid and even poisonous substances are, for this purpose, sornefmesm. troducedinto those medicines which ought to be most bland and emollient Oint- ^nt of elder for example, is often mixed with verdegnse to give it a fine green col- ourwhich^rntirelj frusPtra'tes the intention of that mild ointment. Those who wish to obtain genuine medicines should pay no regard to their colour. increase the Some regard is likewise paid to expense, Such ingredients as greatly menwutne price of any composition" without adding considerably to ,ts virtue, are general y llthtr omitted or somewhat less expensive substituted in their place. Medicines are Cv no m™ans powerful in proportion to their price. The cheapest are often the bes^j blades tliev are the least apt to be adulterated, and are always most readily obtained ^h'reB^otheniethoSofooinpounding medicines, I have e°™fj™}0™dm thaTwSeeieSV!e the most simple and natural, mentioning the different step. 11 . APPENDIX. of the process in the samp order in which they ought to be taken, without paying an implicit regard to the method of other dispensatories. 1 have followed the alphabetical order, both with regard to the simples and prepara- tions. A more scientific method would have been agreeable to some persons, bat less useful to the generality of readers. The different classes of* medicine have no great dependence upon one another, and,- where they have, it is hard to say which should stand first or last; no doubt the simple preparations ought to precede the more com- pound. But all the advantages arising from this method of arrangement do not ap- pear equal to that single one, of being able, on the first opening of the book, to find out any article, which, by the alphabetical order, is rendered quite easy. The dose of every medicine is mentioned, whenever it appeared necessary. When this is omitted, it is to be understood that the medicine may be used at discretion. The dose mentioned is always for an adult, unless when the contrary is expressed. It is not an easy matter to proportion the doses of medicine exactly to the different ages, constitutions, &c. of patients; but, happily for mankind, mathematical exactness here is by no means necessary. Several attempts have been made to ascertain the proportional doses for the differ- ent ages and constitutions of patients ; but, after all that can be said upon this subject, a great deal must be left to the judgment and skill of the person whq administers the medicine. The following general proportions may be observed ; but they are by no means intended for exact rules. A patient between twenty and fourteen may take two-thirds of the dose ordered for an adult; from fourteen tonine, one-half; from nine to six, one-third ; from six to four, onp-fourth ; from four to two, one-sixth ; from two to one, a tenth ; and below one, a twelfth. ^ To prevent mistakes, the English name of every medicine is not only used, but the different articles are arranged according to the order of the English alphabet, and the smallest and largest dose placed opposite to the operation of each article. The doses indeed refer to adults, but may be adapted to different ages by attending to the rules laid down in the opposite page. Short cautions are occasionally inserted under such articles as require to be used with care. Though a greater variety of medicines is contained in this than in any former edition of the Domestic medicine, yet the Author would advise those who peruse it as far as possible, to adhere to simplicity in practice. Diseases are not cured by multiplicity of medicines, but by their proper application. A few simples, judi- ciously administered, and accompanied with a proper regimen, will do moro good than a farrago of medicines employed at random. [ iii 1 A LIST OF THE MEDICINES COMMONLY USED IN PRACTICE, WITH THEIR PARTICULAR VIRTUES AND PROPER DOSES. »,* Explanation of the Abbreviations used in the following Doses: scr. scruple, scrs. scrapie*, dr. drachm, drs. drachms, oz. ounce, drps. drops, gr. grain, grs. grains, grad. gradually. Names. ACACIA, the expressed juice, from Acid, the acetous —, muriatic - —, nitrous, diluted ----, vitriolic, diluted ./Ether, vitriolic iEthiop's mineral Agaric, used externally as a styptic, to staunch blood. Properties. Demulcent. Refrigerant, &c. Antiseptic, &c. Tonic, Febrifuge, &c. Tonic, Antiseptic. Anodyne. Alterative. Aloes Alum .... ., burned - Amber, prepared Ammoniac, gum ■ ■ milk of Angelica, tne root powdered Anise, the seeds Antimony, crude ---------, calcined ■' ----, cinnabar of - , glass of ---------, tartarized Asafcetida, -, milk of - Asarum, Balsam of capivi —— Canadian ------of Peru of Tolu Emenagogue, &c. Astringent. Escharotic, &c. Antispasmodic. Expectorant. Expectorant. Stimulant, &o. Carminative. Febrifuge, &c. Febrifuge. Diaphoretic. Emetic, never used. Emetic. C Emenagogue, Expecto-' < rant, and Antispas-1 C modic. Antispasmodic, &c. Emetic and Errhine. Diuretic, &c. Diuretic, &c. Expectorant, Stimulant. Stimulant, Expectorant. Tonic, &c. Tonic. Doses. 1 scr. to 1 dr. 1 dr. 40 drps. 40 drps. 40 drps. 2 drs. 30 grs. 30 grs. 20 grs. 'fr 30 grs. 1 oz . H dr. lSdr. 1 dr. 1 dr. 1 scr. 2 grs. 4 grs. grs. 20 drps. J scr. Bark, cascarilla ____, Peruvian, powder of Bear's foot, powder of the leaves Narcotic. ~ B.~ — D:— Benzoin resin of, not employed internally, and principally for obtaining Benzoic acid Id grs. 10 grs. 1 scr. 10 grs. & dr. 1 oz. 5 grs. 60 drps. £.dr. 2 scrs. 1 dr. 2 drs. " grs. Bistort, powder of the root Blessed Thistle Astringent. Tonic, Emetic. The same. Astringent. The same. Detergent. , Diuretic. Sudorific, &o. juice of Bole, Armenian ----, French - - - Borax, rarely used internally Broom, ashes of the tops - Burdock, powder of the root Calamine stone, levigated, used externally in Turner's cerate. (Alterative. 1 gr- - 3 g™- Calomel - } Purgative. 3 grs. - 12 grs. 1 scr. 10 grs. 2 drs. ID grs. 10 grs. 1 scr. 10 grs. 1 dr. 1 dr. 2 drs. 40 grs. 1 dr. MEDICINES USED IN PRACTICE, Names. Camphor - Canella alba, powder of Cantharides Cardamoms Caraway seeds Carrot, seed of the wild Cascarilla bark Cassia, the pulp Castor ... Caustic, lunar; used externally as to grs. ij. in epilepsy. Catechu..... Camomile, in powder Centaury, the lesser Chalk..... Cinnamon .... Colocynth .... Columbo ..... Confection, aromatic ----------, opiate Crab's claws, prepared Conserve of roses ... Contrayerva .... Coriander seed ... Cowhage, .... Cummin seed Dandelion, expressed juice of - Decoction of hartshorn - Properties. Narcotic, Diaphoretic. Tonic, Carminative. Stimulant, Diuretic. Carminative. Carminative. Carminative. Tonic. Laxative. Antispasmodic. Doses. 2 grs. to £. 1 scr. 1 scr. to 2 drs. 4gr- 5 grs. 10 grs. 1 scr. 10 grs. S drs. 8 grs. 4 grs. 20 grs. 40 grs. 1 dr. 40 grs. 1 oz. 1 dr. an escnarotic; internally, gr. |, cautiously increased of broom tops •of Peruvian bark of the inner bark of the elm of sarsaparilla Decoction of sarsaparilla, compound - -J ————— of guaiacum Deadly night shade - Dragon's blood Earth, fuller's, use external ) in excoriations $ Electuary of cassia • ---------of scammony -—-----lenitive, or of senna - Elixir of vitriol Elecampane, powder of the root Extract of broom-tops -------Peruvian bark -------cascarilla ————- camomile -------colocynth comp. - Extract of gentian ———-- hemlock ... ------liquorice ... ------logwood ... ———- black hellebore -------guaiacum ———- white poppies -------rue .... ------- savin .... -------senna - ——— wormwood - Fern, powder of the root Astringent. Tonic. Tonic. Absorbent. Carminative. Violently Cathartic. Tonic. Cordial. Anodyne. Absorbent. Astringent. Febrifuge. Carminative. Vermifuge. Stimulant. Diuretic. Demulcent. Diuretic. Tonic. Diuretic. Alterative & diaphoretic. Alterative & diaphoretic. Diaphoretic. 15 grs. 20 grs. 1 scr. 20 grs. 5 grs. 2 grs. 10 grs. 10 grs. 10 grs. 10 grs. 1 dr. 10 grs. 30 grs. 1 Sr. 1 dr. 2 scrs. 1 dr. 10 grs. 1 dr. 2 scrs. 2 scrs. I dr. 1 oz. 2 scrs. 1 dr. 15 grs. - i dr. CThe spiculae of one pod < mixed with honey or C molasses. 1 scr. • I dr. 1 oz. 3 oz. 5 Half a pint, repeated as I often as necessary. C 1 oz. to a pint of water; < to be taken by teacups- C ful. 1 oz. - 4 oz. 4 oz. - 10 oz. daily. 4 oz. - 16 oz. daily. 4 oz. • 16 oz. daily. ( 3 drachms to a pint of ( water. A pint daily. Narcotic, gr. A, to grs. ij. of the powdered leaves Astringent. 10 grs. - 2 scrs. Astringent. Aperient. Purgative. Purgative. Tonic. Stimulant. Diuretic. Tonic. Tonic. Tonic. Cathartic. Stomachic. Alterative. Demulcent. Astringent. Emenagogue. Purgative. Diaphoretic. Anodyne. Emenagogue. The same. Aperient. Tonic. Vermifuge. 1 dr. 20 grs. 30 grs. 15 drps. 20 grs. h dr. 10 grs. 10 grs. 10 grs. 5 grs. 10 grs. ?r 10 grs. 3 grs. 5 grs. 10 grs. 1 gr- 10 grs. 10 grs. 10 grs. 10 grs. J dr. £ ox. MEDICINES USED IN PRACTICE, Namesr- Fennel seed - - -. - Foxglove, powder of the leaves Frankincense .... Flowers of camomile, powder of ------elder .... Cathartic, &c. ------rosemary - Emenagogue. ------damask roses, rarely ~) employed unless to make > Laxative. rose-water. } ------red ditto, in infusion - Astringent. Fruits. Almonds ... Demulcent. ------ Figs, dried ... Aperient. ■ French prunes - - Aperient. ------ Tamarinds Aperient. Galbanum .... Deobstruent. Galls.....Astringent. Garlic, cloves of Expectorant. Gentian.....Tonic. Germander .... Tonic. Ginger.....Carminative. Ginseng - Guaiacum, wood of - - - Diaphoretic. --------, gum-resin - - The same. Gum-arabic .... Demulcent. ----gamboge ... - Hydragogue. Hartshorn, prepared - • Emollient. --------, spirits of - - Hellebore, black - - - Emenagogue. --------white ... Emetic, &c. Hemlock.....Narcotic. Properties. Dosts. Aromatic. 20 grs. to 1 dr. Diuretic. 4 gr. - 3 grs. or a drachm infused in a ) pint of boiling water, £ 1 oz. of which a dose is ) (Administered voith caution.) .....10 grs. - 30 grs. Tonic. 10 grs. - I dr. > Ad libitum. Hiera picra ... Honey of squills ------of roses Hoffman's anodyne liquor Infusion of gentian, compound ------ roses -------senna - Ipecacuanha - Iris, florentine - - - Iron, rust oP ----, ammoniated ----, tartarized Jalap, powder of Juniper, powder of the berries Kino, gum Lead, white ----, sugar of - - Lichen, ash-coloured, ground _______Icelandic, a strong de- coction of Lime-water Lixivium of tartar 10 grs. 10 grs. No. 1. 10 grs. 15 grs. 5 grs. 20 grs. 10 grs. 15 grs. 2 grs. " k dr- - 20 grs. - No. 6. - 40 grs. - 1 dr. - 20 grs. - 30 grs. - 30 grs. - 1 d?. • 12 grs. Linseed Liquorice, root of Purgative. Diuretic. Astringent. Anodyne, &c. • Tonic. • Astringent. Aperient. J Emetic, and expecto- ) I rant, gr. i. to iij. ) Tonic. • Tonic. The same. Tonic. ■ Purgative. • Diuretic. Astringent. J Astringent. Demulcent. I The same. ■ Refrigerant. - Lethontriptic. - Demulcent. - Demulcent. 20 grs. - 1 dr. 10 drps. - 40 drps. 5 grs. - ID grs, 1 gr. - 5 grs. [ Should always be begun with very small doses, as one grain or less, and gradually increased as the constitution will ^ bear. See extract of. 10 grs. 10 grs. 1 dr. 20 drps. - 20 grs. 40 grs. 2 drs. 60 drps. 1 oz. 2 oz. 4 oz. - 3 oz. 8 oz. 2 oz. 10 grs. - 30 grs. 1 scr. 5 grs. 2 grs. 2 grs. - 1 dr. 20 grs. 10 grs. 10 grs. 10 grs. 20 grs. ■ 40 grs. 1 dr. 10 grs. - 30 grs. igr. - 2 grs. 10 grs. - 40 grs. 1 oz. - 4 oz. 4 oz. 15 drps. An infusi a quart used at 8 oz. - 40 drps. on of 1 ounce to of water, may be pleasure. - 1 dr VI Names. Madder powder Mace - - Magnesia - --------, calcined - Manna - Marsh-mallows, root and leaves of .... Mastich, gum - Mercury, crude --------, calcined ,--------, with chalk ———, corrpsive sublimate - --------, cinnabar of -, red precipitate of } MEDICINES USED IN PRACTICE, —, white ditto -, yellow emetic Mezereon Millipedes Musk ... Mustard seed Myrrh, gum Nitre, purified - Nutmeg Oil of Almonds ----amber, rectified ----anniseed - ---- castor ----cinnamon ----juniper ----lemon peel ----linseed ----olive ----palm ----peppermint ----turpenne Onion, expressed juice of Opium ... Opoponax Oyster-shells, prepared Oxymel of colcbicum ------of squills Pennyroyal Peppermint Petroleum Pills, aloetic ----, of the gums ----, mercurial Pitch, Burgundy Pomegranate, powder of Poppy heads Powder, antimonial Properties. Stomachic. Antacid. The same. Aperient. Demulcent. Carminative. Doses. Alterative. Alterative, Antisyphilitic The same. Alterative, &.c. Use chiefly external. Sternutatory. Sialogogue in Decoct Expectorant. Antispasmodic. Stimulant. Emetic. Expectorant. Diuretic. 10 grs. Stomachic. 6 grs. Demulcent. A oz. Antispasmodic 10 drps. Carminative. 1 drp. 2 drs. Stimulant. 1 drp. Diuretic. 2 drps. 2 drps. Demulcent. A oz. Demulcent, Laxative. | oz. Use external. Stimulant, &c. 1 drp. i Diuretic. Externally, ) .g j | stimulant. > " A powerful diuretic. A oz. Narcotic. J gr. Emenagogue. 10 grs. Absorbent. A dr. Expectorant. A dr. Diuretic. | dr. Emenagogue. Stimulant. Antispasmodic. 10 drps. Purgative. 10 grs. Diuretic. 10 grs. Antisyphilitic. 10 grs. A dr 10 grs. A. dr. A, oz. A. dr. 10 grs. &&■ . 10 grs. 4-gr- 10 grs. 1 gr. To a pint of water, 2 drs 20 grs. - 2 drs. 5 grs. - 40 grs. I dr. - 1 oz. 10 grs. 1 dr. I dr 20 grs. 2 drs. 2 oz. 1 dr. 30 grs. 2 grs. 30 grs. 30 grs. 3 grs. 30 grs. A. dr. 1 oz, 30 drps. 5 drps. 1 oz. 3 drps. 10 drps. 5 drps. 1 oz. 1 oz. 3 drps. 30 drps. 2 oz. 2 grs. 30 grs. 2 drs. 1 dr. 1 dr. 30 drps. 30 grs. 30 grs. 20 grs. I dr. 20 grs. Anodyne. Febrifuge. 3 grs. May be taken according to the directions for James's powder, with which, in"effects it nearly coincides. ------of contrayerva, compound The same. ------of chalk, compound - Absorbent. --------------, with opium - Absorbent and anodyne. Powder of ipecacuanha, com- j Diaphoretic. pound, or Dover's-powder. Quassia .... Quince seeds, mucilage of, Rhubarb, powder of Resin, yellow ... Rue powder - Sassafras 15 grs. 20 grs. 10 grs. 10 grs. 6 grs. 30 grs. 40 grs. 40 grs. 30 grs. Tonic. 5 grs. - 30 grs. (One drachm to a pint of water for an infusion.) Demulcent. At pleasure, to obtund acrimony. Purgative. Diuretic. Emenagogue. Diaphoretic, Altera- tive, &c. 10 grs. - 40 grs. 3 grs. - 20 grs. 20 grs. - 40 grs. 1 scr. 1 dr. WITH THEIR PROPER DOSES. Names. Properties. Savin.....Emenagogue. St. John's wort ... Diaphoretic. Saffron ..... Cordial, &c. Sagapenum .... Sal ammoniac .... Stimulant. Salt, Epsom .... Aperient. - , Glauber .... Aperient. ---- of hartshorn - - - Cordial. ---- Polychrest - - - Aperient. ---- Rochel .... Aperient. ---- of tartar .... Aperient. Saunders, red .... Astringent. Sarsaparilla, powder of - - Alterative. Scammony .... Cathartic. Seneka ..... Diaphoretic. Senna ..... Aperient. Soap ..... Lithontriptic. ----lees.....The same. Spearmint .... Stimulant. Cordial. Senna.....Aperient. Scurvy-grass, expressed juice - Antiscorbutic. Snake-root .... Diaphoretic. Sorrel, juice of, depurated - Antiscorbutic. Spirit of lavender - - - Cordial, Stimulant. -----ofmindererus - - Diaphoretic. -----sweet, of vitriol - - Tonic. -------------of nitre - - Diuretic. -----of sal ammoniac - - Diaphoretic, &c. ------------compound ----------'.— foetid - - Antispasmodic, &c. Steel, filings of - - - Tonic, Emenagogue. Spermaceti .... Demulcent. Sponge, burned - - - Deobstruent. Storax ..... Astringent, &c. Sulphur.....Cathartic and diaphoretic. ------, precipitated, of antimony Alterative. Squill, dried powder - - Diuretic. -----, fresh - - - - The same. Syrup of poppies ... Anodyne. -----of buckthorn - - Cathartic. -----of ginger - - - Carminative. -----of meadow saffron - - Diuretic, &c. -----of violets - - - Gently laxative. -----of poppies - - - Anodyne. To children, —■---'s in general Tar ------ Pulmonary. —, water of-......" Tartar, cream of Refrigerant and aperient. -----1 emetic - - - Alterative. ____________. - . - An Emetic. Terra japonica - - - Astringent. Tobacco, an infusion of, 1 drachm to a pint of water; should spoonsful ; powerfully diuretic; or in form of clyster. Tin, powder of - - - Anthelmintic. Turmeric - Turpentine, spirit of - - Diuretic. Venice - - The same. Tincture of aloes - - - Purgative. ___________-, compound - The same. _______. 0f asafcetida - - Antispasmodic. _____,_ of Benzoin, compound Vulnerary. ________of cantharides - - Diuretic. _______of cardamoms - - Carminative. ._______of castor _______of catechu - - - Astringent. _______of Peruvian bark - Tonic. _______of iron, muriated - Tonic. _______ofCalumbo - - Tonic. _______of gentian, compound - Tonic. _______of guiacUm volatile - Diaphoretic. _______of bb.ck hellebore - Emenagogue. 10 grs 20 grs. 5 grs. 10 grs. 10 grs. 2 drs. 4 drs. 10 grs. 20 grs. 2 scrs. 10 grs. h dr. 20 grs. 5 grs. 20 grs. 20 grs. 20 grs. 10 drps. 10 grs. 1 scr. 1 oz. 20 grs. 2 oz. 1 dr. 1 dr. 15 drps. 15 drps. 15. drps. Doses. - 30 grs. - 1 dr. - 20 grs. . 30 grs. - 30 grs. 1 oz. 2 oz. - 20 grs. A. oz. I oz. - 30 grs. - 1 dr. - 40 grs. - 20 grs. - 40 grs. - 40 grs. - A oz. - 30 drps. 2 scrs. - 1 dr. 4 oz. - 40 grs. 4 oz. - 2 drs. 1 oz. - 40 drps. - 40 drps. - 40 drps. 5 grs. - 1 scr. 20 grs. - * 1 dr. 20 grs. - 1 dr. 10 grs. - h dr- 20 grs. - 1 dr. 1 gr. - 4 grs. 1 gr. - 3 grs. 5 grs. - 15 grs. J dr. - £ oz. 1 dr. - 2 drs. 1 dr. A. oz. 1 dr. grad. to 1 oz. 1 dr. - 2 drs. 1 dr. - 2 oz. I dr. - 2 drs. 5 grs. - 1 scr. A pint daily. 2 drs. - 1 oz. J gr- - h gr- I gr. - 3 grs. 20 grs. - 40 grs. be administered by table- MEDICINES USED IN PRACTICE, &-C. Names. Tinct«e> of jalap -----— -of myrrh --------of opium camphor- ated, or paregoric elixir ------of rhubarb - ------of senna ------of snake-root ------of valerian - volatile Tormentil, powder of Tumeric - Turpentine, Venice • Tutty, levigated Properties. Purgative. Emenagogue. Narcotic. Anodyne and antispas- ) modic 5 Purgative, Stomachic. Cathartic, Stomachic. Diaphoretic, &c. Antispasmodic. The same and stimulant Astringent. Diuretic and cathartic. 1 dr. 1 scr. 10 drps, 1 dr. A oz. 2 drs. 1 dr. 1 dr. dr. grs. 1 scr. 1 scr. A Doses. to A oz. - I dr. - 40 drps 3 drs. 2 oz. 1 oz. • 2 drs. - 3 drs. - 2 drs. - 1 dr. - 1 dr. 1 dr. Used externally in ointments and cerates. Uva ursi, in powder • Valerian, wild, powder of Vinegar, distilled -------of squills Verdigris - Vitriol, white Lithontriptic. 20 grs. 1 dr. —, blue Stimulant, Antispasmodic. 20 grs Refrigerant, Antiseptic. Diuretic. As an emetic. Violently emetic. As a Tonic. < As a quickjy operating ) \ emetic, \ Emetic. Watercress, expressed juice of - Antiscorbutic. ------trefoil .... Waters, any of the simple distilled Used as vehicles. Wax, white ----, yellow Wormwood, expressed juice White lead - - - i Demulcent and emollient Wild cucumber Wine, aloetic - -----, antimonial -----, ipecacuanha -----, rhubarb - Zedoary Zinc, flowers of Vermifuge, Tonic. Astringent. Cathartic, Hydragogue. Purgative. Emetic. Emetic. Purgative. Stomachic. Tonic. Antispasmodic. 10 grs. . 40 grs. 3 grs. - 10 grs. [i*l DOMESTIC PHARMACOPCEIA. MEDICINAL PREPARATIONS. Balsams. The subject of this section is not the natural balsams, but certain compositions, which, from their being supposed to possess the balsamic qualities, generally go by that name. This class of medicines was formerly very numerous, and held in great esteem. Modern practice, however, has justly reduced it to a very narrow compass. Anodyne Balsam.—Take of white Spanish soap, one ounce ; opium, unprepared, two drachms ; rectified spirit of wine, nine ounces. Digest them together in a gen- tle heat for three days; then strain off the liquor, and add to it three drachms of cam- phor. This balsam is intended to ease pain. It is of service in violent strains and rheu- matic complaints, when not attended with inflammation. It must be rubbed with a warm hand on the part affected ; or a linen rag moistened with it may be applied to the part, and renewed every third or fourth hour, till the pain abates. If the opium is left out, this will be the Saponaceous Balsam. Locatelli's Balsam.—Take of olive oil, one pint; Strasburg turpentine and yellow wax, of each half a pound; red saunders, six drachms. Melt the wax with some part of the oil, over a gentle fire ; then adding the remaining part of the oil and the turpen- tine ; afterwards mix in the saunders, previously reduced to a powder, and keep them stirring together till the balsam is cold. This balsam is recommended in erosions of the intestines, the dysentery, haemorrha- ges, internal bruises, and in some complaints of the breast. Outwardly it is used for healing and cleansing wounds and ulcers. The dose when taken internally, is from two scruples to"two drachms. The vulnerary Balsam. (Tincture of Benjamin.)—Take of benzoin, powdered, three ounces ; balsam of Peru, two ounces ; hepatic aloes, in powder, half an ounce j rectified spirits of wine, two pints. Digest them in a gentle heat for three days, and then strain the balsam. This balsam, or rather tincture, is applied externally to heal recent wounds and bruises. It is likewise employed internally to remove coughs-, asthmas, and other com- plaints of the breast. It is said to ease the colic, cleanse the kidneys, and to heal in- ternal ulcers, &c. The dose is from twenty to sixty drops. This, though a medicine of some value, does not deserve the extravagant encomi- ums which have been bestowed on it. It has been celebrated under the different names of The Commander's Balsam, Persian Balsam, Balsam of Berne, Wade's Bal- sam, Friar's Balsam, Jesuit's Drops, Turlington's Drops, &c. Boluses. As boluses are intended for immediate use, volatile salts, and other ingredients im- proper for being kept, are admitted into their composition. They are generally com- posed of powdersj with a proper quantity of syrup, conserve, or mucilage. The light- er powders are commonly made up with syrup, and the more ponderous, as mercury, &c. with conserve ; but those of the lighter kind would be more conveniently made up with mucilage, as it increases their bulk less than the other additions, and likewise occasions the medicine to pass down more easily. Astringent Bolus.—Take of alum, in powder, fifteen grains; gum kino, five grains ; syrup, a sufficient quantity to make a bolus. .... In an excessive flow of the menses, and other violent discharges of bloorJ, proceeding fiim relaxation, this bolus may be given every four or five hours, till the discharge abates. Diaphoretic Bolus.—Take of gum guaiacum, in powder, ten grains ; flowers of sul Dhur and cream of tartar, of each one scruple ; simple syrup, a sufficient quantity. In rheumatic complaints, and disorders of the skin, this bolus may be taken twice »-day It will also be of service in the inflammatory quinsey. X CATAPLASMS AM» SINAPISMS. CLYSTERS. Mercurial Bolus-Take of calomel, six grains ; conserve of roses, half a drachm. ^^Vhe^mcrcury is necessary, this bolus may be taken twice or thrice a-week J' .Jbe tak™n over-night; and if it does not operate, a few grams of jalap, or half an ounce of Epsom salts, will be proper next day to carry it off. Bolus of Rhubarb and Mercury.-Tike of the best rhubarb, in powder, from a scru- pie to half a drachm ; of calomel, from four to six grains ; simple syrup, a sufficient quantity to make a bolus. , . ... •••-..■ This is a proper purge in hypochondriac constitutions ; but its principal intention is to expel worms. Where a stronger purge is necessary, jalap may be used instead ot the rhubarb. Pectoral Bolus.—Take of spermaceti, a scruple ; gum ammoniac, ten grains ; salt of hartshorn, six grains; simple syrup, as much as will make them into a bolus. This bolus is given in colds and coughs of long standing, asthmas, and beginning -• Misumptions of the lungs. It is generally proper to bleed the patient before he begins to use it. Purging Bolus.—Take of jalap, in powder, a scruple 5 cream of tartar, two scruples Let them be rubbed together, and formed into a bolus, with simple syrup. Where a mild purge is wanted, this will answer the purpose very well. If a stronger dose is necessary, the jalap may be increased to half a drachm or upwards. Cataplasms and Sinapisms. Cataplasms possess few or no virtues superior to a poultice, which may be so made, as, in most cases, to supply their place. They are chiefly intended either to act as discutients, or to promote suppuration; and as they may be of service in some cases, we shall give a specimen of each kind. Discutient Cataplasm.—Take of barleymeal, six ounces; fresh hemlock leaves, ■ bruised, two ounces ; vinegar, a sufficient quantity. Boil the meal and hemlock in tho vinegar for a little time, and then add two drachms of the sugar of lead. Ripening Cataplasm.—Take of white lily-root, four ounces; fat figs and raw onions bruised, of each one ounce ; yellow basilicum ointment, two ounces ; gum galbantfm, half an ounce; linseed-meal, as much as necessary. Boil the roots along with the rigs in a sufficient quantity of water; then bruise and add to them the other ingredi- ents, so as to form the whole into a soft cataplasm. The galbanum must be previous- ly dissolved with the yolk of an egg. Where it is necessary to promote suppuration, this cataplasm may be used by those who choose to be at the trouble and expense of making it. For my part, I have never found any application more proper for this purpose than a poultice of bread and milk, with a sufficient quantity of either boiled or raw onion in it, and softened with oil or fresh butter. Sinapisms.—Sinapisms are employed to recal the blood and spirits to a part, as in the palsy and atrophy. They are also of service in deep-seated pains, as the sciatica, &c. When the gout seizes the head or the stomach, they are applied to the feet to bring the disorder to those parts. They are likewise applied to the patient's soles in the low state of fevers. They should not be suffered to lie on, however, till they have raised blisters, but till the parts become red, and will continue so when pressed with the finger. The sinapism is only a poultice made with vinegar instead of milk, and rendered warm and stimulating by the addition of mustard, horse-radish, or garlic. The com- mon sinapism is made by taking crumb of bread and mustard-seed in powder, of each equal quantities; strong vinegar, as much as is sufficient, and mixing them so as to make a poultice. When sinapisms of a more stimulating nature are wanted, a little bruised garlic maybe added to the above. Clysters. This class of medicines is of more importance than is generally imagined. Clys- ters serve not only to evacuate the contents of the belly, but also to convey very ac- tive medicines into the system. Opium, for example, may be administered in this way when it will not sit upon the stomach, and also in larger doses than at any time it can be taken by the mouth. The Peruvian bark may likewise be, with good effect administered in form of clyster to persons who cannot take it by the mouth. A sim- ple clyster can seldom do hurt, and there are many cases where it may . . mllc:iase 0f gum arable. dissolved. . .♦♦-nnat.n.r tough viscid phlegm, and promoting expecto- ThU 9tS^^^^S^t^f^ syrup'of poppies may be aided to it. ^Ise^oTableTpIonsful three or four times a-day. "^'recfnt°cUoTdesand coughs, thU. emulsioii is S^fhe^eg^elix* oTtne roay be taken every two or three hours. Extracts. Extracts are prepared by boiling tbe subject in water, and evaporating the strained FOMENTATIONS. GARGLES. decoction to a due consistence. By this process some of the more active parts of ofanU a^ freed from the useless, indissoluble earthy matter, which make, the larger K^« oftheir bulk. Water, however, is not the only menstruum used in the prepara- tion of extracts ; sometimes it is joined with spirits, and at other times rectified spirit alone is employed for that purpose. Extracts are prepared from a variety of different drugs, as the bark, gentian, jalap, &c • but, as they require a troublesome and tedious operation, it will be more conven- ient'for a private practitioner to purchase what he needs of them from a professed druggist, than to prepare them himself. Such of them as are generally used are in- serted in our list of such drugs and medicines as are to be kept for private practice. Fomentations. Fomentations are generally intended either to ease pain, by taking off tension and spasm : or to brace and restore the tone and vigour of those parts to which they are applied. The first of these intentions may generally be answered bv warm water, and the second by cold. Certain substances, however, are usually added to water with a view to heighten its effects, as anodynes, aromatics, astringents, &c. We shall there- fore subjoin a few of the most useful medicated fomentations, that people may have it in their power to make use of them as they choose. Anodyne Fomentation.—Take of white poppy-lieads, two ounces; elder flowers, half an ounce ; water, three pints. Boil till one pint is evapprated, and strain out the liquor. This fomentation is used for relieving acute pain. Aromatic Fomentation.—Take of Jamaica pepper, half an ounce ; red wine, a pint. Boil them a little, and then strain the liquor. This is intended, not only as a topical application for external complaints, but also for relieving the internal parts. Pains of tne bowels, which accompany dysenteries and diarrhoeas, flatulent colics, uneasiness of the stomach, and retchings to vomit, are frequently abated by fomenting the abdomen and region of the stomach with the warm liquor. Common Fomentation.—Take tops of wormwood and camomile flowers dried, of each two 2Ur.Cee; watei, twp quarts. After a slight boiling, pour off the liquor. Brandy or spirit of wine may he added, in such quantity as the particular circum- stances of the case shall require ; but these are not always necessary. Emollient Fomentation.—The same as the common decoction. Strengthening Fomentation.—Take of. oak bark, one ounce; granate peel, half an ounce; alum, two drachms ; smith's forge-water, three pints. Boil the water with the bark and peel to the consumption of one-third; then stiiin the remaining decoc- tion, and dissolve in it the alum. This astringent liquor is employed as an external fomentation to weak parts; it may also be used internally. Gargles. ^ However trifling this class of medicines may appear, they are by no means without their use. They seldom, indeed, cure diseases, but they often alleviate very disagree- able symptoms; as parchedness of the mouth, foulness of the tongue and fauces, &c.; they are peculiarly useful in fevers and sore throats. In the latter, a gargle will some- times remove the disorder : and in the former, few things are more refreshing or agree-' able to the patient, than to nave his mouth frequently washed with some soft detergent ale. One advantage of these medicines is, that they are easily prepared. A little sy-water and honey may be had any where; and if to these be added as much vin- egar as will give them an agreeable sharpness, they will make a very useful gargle for softening and cleansing the mouth. Attenuating Gargle.—Take of water, six ounces; honey, one ounce; nitre, a drachm and a half. Mix them. This cooling gargle may be used either in the inflammatory quinsey, or in fevers, for cleaning the tongue and fauces. Common Gargle.—Take of rose-water, six ounces; syrup of clove July-flowers, half an ounce; spirit of vitriol, a sufficient quantity to give it an agreeable sharpness. Mix them. This gargle, besides cleansing the tongue and fauces, acts as a gentle repellent, and will sometimes remove a slight quinsey. ; tincture of myrrh, an Detergent Gargle.—Take of the emollient gargle, a pint unce : noney, two ounces. Mix them. INFUSIONS. XV11 When exulcerations require to be cleansed, or the excretion of tough viscid saliva promoted, this gargle will be of service. Emollient Gargle.—Take an ounce of marshmallow roots, and two or three figs; boil them in a quart of water till near one-half of it be consumed; then strain out th« If an ounce of honey, and half an ounce of spirit of sal ammoniac, be added to the above, it will then be an exceedingly good attenuating gargle. This gargle is beneficial in fevers, where the tongue and fauces are rough and parch- ed to soften these parts, and promote the discharge of saliva. The learned and accurate Sic John Pringle observes, that in the inflammatory quin- sey or strangulation of the fauces, little benefit arises from the common gargles; that such as are of an acid nature do more harm than good, by contracting the emunctories of the saliva and mucus, and thickening those humours; that a decoction of figs in mil*. and water has a contrary effect, especially if some sal ammoniac be added; by whicn the saliva is made thinner, and the glands are brought to secrete more freely ; a cir- cumstance always conducive to the cure. Infusions. Vegetables yield nearly the same properties to water by infusion as by decoction; nnd though they may require a longer time to give out their virtues in this way, yet_it has severil advantages over the otlfer; since boiling is found to dissipate the finer parts o^many bitter and aromatic substances, without more fully extracting their medicinal nrin^fnles Even from those vegetables which are weak in virtue, rich infusions may Kobtatae'd,^ wturaing the liquor upon fresh quantities of the subject Uje: water loading Use if more and more with the active parts ; and these loaded infusions are ap uhcable to valuable purposes in medicine, as they contain in a small compass the finer £re sub^ of vegetables, in a form readily miscble with the fluids of the human body. R.-rror Infusion - Take tops of the lesser centaury and camomile flowers, of each h Jan ouncT vellow rind if lemon and orange-peel, carefully freed from the inner whulpart oef'eyach tw" drachms. Cut them fn small pieces, and .nfuse them ,n a qXfnoigeXrweakness of the stomach, or want of appetite, a tea-cupful of this infusion may be taken twice or thrice a-day. taken two or three times a-day. mon, or other aromatic materials. hours, and «Jf» ■gJ^^Sfoot be added to these ingredients, it will then be 11 an ounce °f ™« l**™* °i*£" " are emollient mucilaginous liquors, and may be Sk^wradv^rgenas ortnary^dtink ^difficulty of mJing water; and in coughs and other complaints of the breast. r e -o- nf Roses —Take of red roses, dried, half an ounce ; boiling water, a quart; acid and water without infusion. Infusion of Tamarinds ^^^^^^^ fouTor five £2S5. f^^^T^^^ »S« »- strained, and an ounee or xviii JULEPS. MIXTURES. two of the aromatic t'ncture added to it. Persons who are easily purged may leave out either the tamarinds or the crystals of tartar. This is an agreeable cooling purge, and supplies the place of the Ifecoctton Of Tamarinds and Senna. A tea-cupful may be given every half hour till it operates. Spanish Infusion.—Take of Spanish juice, cut into small pieces, an ounce ; salt of tartar, three drachms. Infuse in a quart of boiling water for a night. To the strained liquor add an ounce and a half of the syrup of poppies. In recent colds, coughs, and obstructions of the breast, a tea-cupful of this infusion may be taken with advantage three or four times a-day. Infusion for the Palsy.—Take of horse-radish root shaved, mustard-seed bruised, each four ounces ; outer rind of orange-peel, one ounce. Infuse them in two quarta of boiling water, in a close vessel, for twenty-four hours. In paralytic complaints, a tea-cupful of this warm stimulating medicine maybe taken three or four times a-day. It excites the action of the solids, proves diuretic, and, if the patient be kept warm, promotes perspiration. If two or three ounces of the dried leaves of marsh-trefoil be used instead of the mustard, it will make the Antiscorbutic Infusion. Juleps. The basis of juleps or draughts is generally common water, or some simple distilled water, with one-third or one-fourth its quantity of distilled spirituous water, and aa much sugar or syrup as is sufficient to render the mixture agreeable. This is sharp- ened with vegetable or mineral acids, or impregnated with other medicines suitable to the intention Camphorated Julep.—Take of camphor, one drachm; rectified spirit of wine, ten drops ; double-refined sugar, half an ounce; boiling distilled water, one pint. Rub the camphor first with the spirit of wine, then with the sugar; lastly, ado the water by degrees, and strain the liquor. In hysterical and other complaints where camphor is proper, this julep may be taken in the dose of a spoonful or two as often as the stomach will bear it. Cordial Julep.—Take of simple cinnamon-water, four ounces ; Jamaica pepper-wa- ter, two ounces -, volatile aromatic spirit, and compound spirit of lavender, of each two drachms ; syrup of orange-peel, an ounce. Mix them. Dose, two spoonsful three or four times a-day, in disorders accompanied with great weakness and depression of spirits. Expectorating Julep.—Take of the emulsion of gum ammoniac, six ounces ; syrup of squills, two ounces. Mix them. In coughs, asthmas, and obstructions of the breast, two table-spoonsful of this julep may be taken every three or four hours. Musk Julep.—Rub half a drachm of musk well together with half an ounce of sugar, and add to it, gradually, of simple cinnamon and peppermint-water, each two ounces; of the volatile aromatic spirit, two drachms. In the low state of nervous fevers, hiccuping, convulsions, and other spasmodic af- fections, two table-spoonsful of this julep may be taken every two or three hours. Saline Julep.—Dissolve two drachms of salt of tartar rn three ounces of fresh lemon juice, strained ; when the effervescence is over, add of mint-water, and common wa- ter, each two ounces; of simple syrup, one ounce. This removes sickness at the stomach, relieves vomiting, promotes perspiration, and may be of some service in fevers, especially of the inflammatory kind. Vomiting Julep.—Dissolve four grains of emetic tartar in eight ounces of water, and add to it half an ounce of the syrup of clove July-flowers. In the beginning of fevers, where there is no topical inflammation, this julep may be given in the dose of one table-spoonful every quarter of an hour till it operates. Antimonial vomits serve not only to evacuate the contents of the stomach, but like- wise to promote the different excretions. Hence they are found in fevers to have nearly the same effects as Dr. James's Powder. Mixtures. A mixture differs from a julep in this respect, that it receives into its composition not only salts, extracts, and other substances dissoluble in water, but also earths, pow- ders, and such substances as cannot be dissolved. A mixture is seldom either an ele- gant or agreeable medicine. It is nevertheless necessary. Many persons can take a mixture, who are not able to swallow abolus or an electuary : besides, there are medi cincs which act better in this than in any other form. OINTMENTS--LINIMENTES--CERATES. XIX Astringent Mixture.—Take simple cinnamon-water, and common water, of each three ounces; spirituous cinnamon-water, an ounce and a half; Japonic confection, half an ounce. Mix them. In dysenteries which are not of long standing, after the necessary evacuations, a spoonful or two of this mixture may be taken every four hours, interposing every second or third day a dose of rhubarb. The Astringent Mixture, which I have lately made use of with great success, is pre- pared thus : Take powder of bole with opium, two drachms ; cinnamon-water and penny-royal water, of each three ounces ; spirituous cinnamon-water, six drachms : simple syrup, one ounce. Mix them, and take a table-spoonful four or five times a-day. Diuretic Mixture.—Take of mint-water, five ounces; vinegar of squills, six drachms ; •weet spirit of nitre, half an ounce ; syrup of ginger, an ounce and a half. Mix them. In obstructions of the urinary passages, two spoonsful of this mixture may be taken twice or thrice a-day. Laxative Absorbent Mixture.—Rub one drachm of magnesia alba in a mortar with ten or twelve grains of the best Turkey rhubarb, and add to them three ounces of com- mon water; simple cinnamon-water, and syrup of sugar, of each one ounce. As most diseases of infants are accompanied with acidities, this mixture may either be given with a view to correct these, or to open the body. A table-spoonful may be taken for a dose, and repeated three times a-day. To a very young child half a spoon- ful will be sufficient. When the mixture is intended to purge, the dose may either be increased, or the quantity of rhubarb doubled. This is one of the most generally useful medicines for children with which I am acquainted. Saline Mixture.—Dissolve a drachm of the salt of tartar in four ounces of boiling water ; and when cold, drop into it spirit of vitriol till the effervescence ceases ; then add, of peppermint-water, two ounces ; simple syrup, one ounce. Where fresh lemons cannot be had, this mixture may occasionally supply the place of the saline julep. Squill Mixture.—-Take of simple cinnamon-water, five ounces; vinegar of squills, one ounce ; syrup of marshmallows, an ounce and a half. Mix them. This mixture, by promoting expectoration, and the secretion of urine, proves ser- viceable in asthmatic and dropsical habits. A table-spoonful of it may be taken fre- quently. Ointments, Liniments, and Cerates. Notwithstanding the extravagant encomiums which have been best bestowed on different preparations of this kind, with regard to their efficacy in the cure of wounds, sores, &c. it is beyond a doubt, that the most proper application to a green wound is dry lint. But though ointments do not heal wounds and sores, yet they serve to de- fend them from the external air, and to retain such substances as may be necessary for drying, deterging, destroying proud flesh, and such like. For these purposes however, it will be sufficient to insert only a few of the most simple forms, as ingredients of a more active nature can occasionally be added to them. Yellow Basilicum Ointment.-Take of yellow wax, white resin, and frankincense. each a quarter of a pound; melt them together over a gentle fire ; then add of bog's lard prepared, one pound. Strain the ointment while warm. Employed for cleansing and healing wounds and ulcers. Ointment of Calamine. ( 7Wr>s C^O-Take °f olive oil, a pint and a stone, added thAn* exceedingly good application in burns, and excoriations from whatever cause. parts, &c. Eve Ointment.-Take of hog's lard prepared, four ounces ; white wax, two drachms ; tuuTpreparcd one ounce ; melt the"wax with the lard over a gentle fire, and then Jr nkPle fn the tuuv, continually stirring them t.U the ointment .scold. XX OINTMENTS, &.C. TKi. nrAoaration will be more efficacious, and of a better consistence, if two or three drichms of camphor be rubbed up with a little oil, and intimately mixed with it. Another.—Take of camphor, and calamine stone levigated, each six drachms ; ver degrise well prepared, two drachms; hog's lard, and mutton-suet, prepared, of each two ounces. Rub the camphor well with the powder : afterwards mix in the lard and suet, continuing the triture till they be perfectly united. This ointment has been long in esteem for diseases of the eyes. It ought, howev- er, to be used with caution, when the eyes are much inflamed, or very tender. Issue Ointment.—Mix half an ounce of Spanish flies, finely powdered, in six ounces of yellow basilicum ointment. This ointment is chiefly intended for dressing blisters; in order to keep them open during pleasure. Ointment of. Lead.—Take of olive oil, half a pint; white wax, two ounces ; sugar of lead, three drachms. Let the sugar of lead, reduced into a fine powder, be rubbed up with some part of the oil, and afterwards added to the other ingredients, previously melted together, continually stirring them till quite cold. This cooling and gently astringent ointment may be used in all cases where the in- tention is to dry and skin over the part, as in scalding, &c. Mercurial Ointment.—Take of quicksilver, two ounces ; hog's lard, three ounces ; mutton suet, one ounce. Rub the quicksilver with an ounce of the hog's lard in a warm mortar, till the globules be perfectly extinguished; then rub it up with the rest of the lard and suet, previously melted together. The principal intention of this ointment is to convey mercury into the body by being rubbed upon the skin. Ointment of Sulphur.- -Take of hog's lard prepared, four ounces; flowers of sul- phur, an ounce and a half; crude salammoniac, two drachms; essence of lemon, ten or twelve drops. Make them into an ointment. This ointment, rubbed upon the parts affected, will generally cure the itch. It is both the safest and best application for that purpose, and, when made in this way, has no disagreeable smell. Ointment for Diseases of the Skin.—Take of the ointment, commonly called unguen- turn citrinum, a drachm and a half; flour of brimstone and powder of hellebore, of each an ounce ; hog's lard, three ounces; essence of lemon, or oil of thyme, from twenty to thirty drops, to correct the offensiveness of the smell. Make them into an ointment. I have not only known many ordinary affections of the skin cured by this ointment, but even some of a very malignant nature, and approaching to leprosy. White Ointment.—Take of olive-oil, one pint; white wax and spermaceti, of each three ounces. Melt them with a gentle heat, and keep them constantly and briskly stirring together, till quite cold. If two drachms of camphor, previously rubbed with a small quantity of oil, be ad- ded to the above, it will make the White camphorated Ointment. Liniment for Burns.—Take equal parts of Florence oil, or of fresh drawn linseed oil, and lime-water, shake them well together in a wide-mouthed bottle, so as to form a liniment. This is found to be an exceedingly proper application for recent scalds or burns. It may either be spread upon a cloth, or the parts affected may be anointed with it twice or thrice a-day. White Liniment.—This is made in the same manner as the white ointment, two- thirds of the wax being left out. This liniment roiy be applied in cases of excoriation, where, on account of the largeness of the surface, the ointments with lead or calamine might be improper. Liniment for the Piles.—Take of emollient ointment, two ounces; liquid laudanum, half an ounce. Mix these ingredients with the yolk of an egg, and work them well together. Volatile Liniment.—Take of Florence oil, an ounce ; spirit of hartshorn, half an ounce. Shake them together. This liniment, made with equal, parts of the spirit and oil, will be more efficacious, where the patient's skin is able to bear it. Sir John Pringle observes, that in the inflammatory quinsey, a piece of flannel moist- ened with this liniment, and applied to the throat, to be renewed every four or five hours, is one of the most t'ficacious remedies ; and that it seldom fails, after bleed- PILLs. XXI hours, is one of the most efficacious remedies; and that it seldom fails, aftej' bleed- ing, either to lessen or carry off the complaint. The truth of this observation I have often experienced. Camphorated Oil.—Rub an ounce of camphor, with two ounces of Florence oil, in a mortar, till the camphor be entirely dissolved. This antispasmodic liniment may be used in obstinate rheumatism, and in some Other cases accompanied with extreme pain and tension of the parts. Pills. Medicines which operate in a small dose, and whose disagreeable taste or smell makes it necessary that they should be concealed from the palate, are more commodi- ously exhibited in this form. No medicine, however, that-is intended to operate quick- ly, ought to be made into pills, as they often lie for a considerable time on the stom- ach before they are dissolved, so as to produce any effect. As the ingredients which enter the composition of pills are generally so contrived, that one pill of an ordinary size may contain about five grains of the compound, in mentioning the dose we snail only specify the number of pills to be taken : as one, two, three, &c. Composing Pill.—Take of purified opium, ten grains ; Castile soap, half a drachm. Beat them together, and form the whole into twenty pills. When a quieting draught will not sit upon the stomach, one, two, or three of these pills may be taken, as occasion requires. Deobstruent Pill.—Take salt of steel; succotrine aloes ; myrrh in powder; of each a drachm. Make into forty pills, of which two are to be taken evening and morn- * 1 have found these pills of excellent service in obstructions of the menses. The late Dr. Watkinson made it his dying request, that I would insert this prescription in the ".Domestic Medicine," which he said would be immortal, and that " his soul pant- ed for immortality." Fotid Pill.—Take of asafcetida, half an ounce ; simple syrup, as much as is neces- sary to form it into pills. . In hysteric complaints, four or five pills, of an ordinary size, may be taken twice or thrice a-day They may likewise be of service to persons afflicted with the asthma. When it is necessary to keep the body open, a proper quantity of rhubarb, aloes, or jalap, may occasionally be added to the above mass. Hemlock Pill.—Take any quantity of the extract of hemlock, and adding to it about a fifth part its weight of the powder of the dried leaves, form it into pills of the ordi- '^The extract of hemlock may b* taken from one grain to several drachms in the day. The best method, however, of using these pills, is to begin with one or two, and to in- crease the dose gradually, as far as the patient can bear them/without any remarkable degree of stupor or giddiness. Mercurial Pill.-Take of purified quicksilver and honey, each half an ounce. Rub them to-rether in a mortar, till the globules of mercury are perfectly extinguished; then Sd?of £aatUe soap, two drachms f powdered liquorice, or crumb of bread, a sufficient qUWhen s^rteS ^S^^^^A of quicksilver may be doubled. SicXe TlhZe pills is'different, according to the intention with which they are given As an alterant, two or three may be taken daily. To raise a salivation, four or BVFnWual pa'rUorEbove pill and powdered rhubarb, made into a mass, with a suffi- cient quantity of simple syrup, will make a Mercurial Purging Pill. Mercurial SublimaU ™^^ rnto^7,stncl in a'Mass'mo" a" a sufficient quantity of the crumb of bread. This ra^,e°v^ *, »*» twic a-day,as an alterant "^T^r^TTiuTsubjoctintho Edinburgh P^cal and Literary Essay,, by the h^niou. Dr. John Gardener. XX11 PLASTERS. antimony each three drachms; extract of liquorice, two drachms. Rub the sulphur and merciiry well together : afterwards add the extract, and with a sufficient quantity of the mucilage of gumarabic, make them into pills. This pill has been found a powerful, yet safe alterative in obstinate cutaneous disor- ders ; and has completed a cure after salivation had failed. In venereal cases it haa likewise produced excellent effects. Two or three pills of an ordinary size may be taken night and morning, the patient keeping moderately warm, and drinking after each dose a draught of decoction of the woods, or of sarsaparilla. Purging Pill.—Take of succotrine aloes, and Castile soap, each two drachms; of simple syrup, a sufficient quantity to make them into pills. Four or five of these pills will generally prove a sufficient purge. For keeping the body gently open, one may be taken night and morning. They are reckoned both deobstruent and stomachic, and will be found to answer all the purposes of Dr. Ander- son's pills, the principal ingredient of which is aloes. Where aloetic purges are improper, the following pills may be used:— Take extract of jalap, and vitriolated tartar, of each two drachms ; syrup of ginger, as much as will make them of a proper consistence for pills. To be taken in the same quantity as the above. Purgative Pill.—Take powder or succotrine aloes, one drachm ; of gum sagapene in powder, half a drachm; of gamboge, and gum arabic in powder, each, one scruple ; essential oil of camomile, ten drops ; syrup of buckthorn, a sufficient quantity ; beat the whole into a mass, and divide into thirty-two pills. This pill was contrived by that eminent physician, the late Dr. George Fordyce. It is an excellent purgative, where the bowels are torpid, as in paralytic affections One or two may be taken at bed-time. A. P. B. Pill for the Bile.—Take gum pill and colocynth pill, each a drachm. Beat them together, and make the mass into thirty pills. In bilious and nervous patients, where it was necessary to keep the body gently open, I have found these pills answer the purpose extremely well. I generally give one over-night, and another next morning, once or twice a-week. But the dose must be regulated by the effect. Pill for the Jaundice.—Take of Castile soap, succotrine aloes, and rhubarb, of each one drachm. Make them into pills, with a sufficient quantity of syrup or mucilage. These pills, as their title expresses, are chiefly intended for the jaundice, which, with the assistance of proper diet, they will often cure. Five or six of them may be taken twice a-day, more or less, as is necessary to keep the body open. It will be proper, however, during their use, to interpose now ana then a vomit of ipecacuanha or tartar emetic. Stomachic Pill.—Take extract of gentian, two drachms; powdered rhubarb, and vitriolated tartar, of each one drachm; oil of mint, thirty drops; simple syrup, a suffi- cient quantity. Three or four of these pills may be taken twice a-day, for invigorating the stomach, and keeping the body gently open. Squill Pills.—Take powder of dried squills, a drachm and a half; gum ammoniac, and cardamom seeds, in powder, of each three drachms; simple syrup, a sufficient quantity. In dropsical and asthmatic complaints, two or three of these pills may be taken twice a-day, or oftener, if the stomach will bear them. Strengthening Pills.—Take soft extract of the bark, and salt of steel, each a drachm. Make into pills. In disorders arising from excessive debility, or relaxation of the solids, as the chlo- rosis, or green sickness, two of these pills may be taken three times a-day. Plasters. Plasters ought to be of a different consistence, according to the purposes for which they are intended. Such as are to be applied to the breasts or stomach, ought to be soft and yielding; while those designed for the limbs should be firm and adhe- sive.—It has been supposed, that plasters might be impregnated with the virtues of different vegetables, by boiling the recent vegetable with the oil employed for the composition of the plaster; but this treatment does not communicate to the oils any valuable qualities.—The calces of lead boiled with oils unite with them into a plaster of a proper consistence, which makes the basis of several other plasters. In boiling these compositions, a quantity of hot water must be added from time to time to pre- vent the plaster from burniog or growing black. This, however, should be done with .arc, lest it cause the matter to explode. PLASTERS. XX11I Common Plaster.—-Take of common olive oil, six pints', litharge, reduced to a fine powder, two pounds and a half. Boil the litharge and oil together over a gentle fire, continually stirring them, and keeping always about a half a gallon of water in tho vessel; after they have boiled about three hours, a little of the plaster may be taken out and put into cold water, to try if it be of a proper consistence : when that io the case, the whole may be suffered to cool, and the water well pressed out of it with the hands. This plaster is generally applied in slight wounds and excoriations of the skin. It keeps the part soft and warm, and defends it from the air, which is all that is necessary in such cases. Its principal use, however, is to serve as a basis for other plasters. Adhesive Plaster.—-Take of common plaster, half a pound; of Burgundy pitch, a quarter of a pound. Melt them together. This plaster is principally used for keeping on other dressings. Anodyne Plaster.—Melt an ounce of adhesive plaster, and when it is cooling, mix with it a drachm of powdered opium, and the same quantity of camphor, previously rubbed up with a little oil. This plaster generally gives ease in acute pains, especially of the nervous kind. Blistering Plaster—Take of Venice turpentine, six ounces; yellow wax, two oun- ces : Spanish flies in fine powder, three ounces ; powdered mustard, one ounce. Melt the wax and while it is warm, add to it the turpentine, taking care not to evaporate it by too much heat. After the turpentine and wax are sufficiently incorporated, sprinkle in the powder, continually stirring the mass till it be cold. Though this plaster is made in a variety of ways, one seldom meets with it ot a proper consistence. When compounded with oils and other greasy substances, its ef- fects are blunted, and it is apt to run; while pitch and resin render it too hard and very '" Whenthe blistering-plaster is not at hand, its place may be supplied by mixing with any soft ointment a sufficient quantity of powdered flies ; or by forming them into a ^risTerm^pTas^ers'Jrov^'nighly disagreeable to manypeopl* by occasioning. stran- guarv I have, therefore, of late used a plaster, in which a small quantity of blistering- Mlve has been mixed with the Burgundy pitch-plaster. I lay it oyer the part .affected and suffer it to remain as long as it will stick. The blistering-plaster loses its effect ma few hours, whereas this will act for many days, or even weeks, and seldom fails to remove pain, or slight obstructions. Gum Ploster.-Take of the common plaster, four pounds ; gum ammoniac and gal- banum! strained, of each half a pound. Melt them together, and add, of Venice tur- PeThiseplaster isCused as a digestive, and likewise for discussing indolent tumours. Mercurial Plaster.—Take of common plaster, one pound; of gum ammoniac strain- ed/hX pounr Melt them together, and, when cooling, add eight ounces of quick- silver Dreviouslv extinguished by triture, with three ounces of hog's lard. TWePriSrfc mmended in pains of the limbs arising from a venerea cause. InduratiC of Ae^glands,and otherPindolenttumours,are likewise found sometimes to yield to it. Stomach Plaster-Take of S^^^-^,^ fi SS^l^ST^'SSi^"' MeftThe a^.S^^W,A^af rf S^pre-rf.oil of mace,gor a few drops of the essential oil of mint, may be rubbed upon it before it is applied. This may supply the place of the Anti-hysterxc Plaster. Warm Ploster.-Take of gum plaster, one ounce ; blistering-plaster, two drachms. ?f°& ^Z'^tZ^e W5SK'«Sl£i: the case, it must be made with a smaller proportion of the blistering-plaster. Wax Plaster -Take of yellow wax, one pound; white resin, half a pound; mut- ton-suet, three quarters of a poundL Mett them ggeger. application XXIV POULTICES. POWDERS. Powltices. Through some oversight, this article was omitted in the earlier editions, though it relates to a class of medicines by no means unimportant. Poultices are often bene- ficial, even in the most simple form ; but more so, when employed to retain more ac- tive medicines,—to keep them in contact with the skin,—and to fit it for their absorp- tion. Every nurse knows how to make a poultice. A poor woman who had received a very dangerous wound in the tendons of her thumb from a rusty nail, called upon me some little time since. As her case properly belonged to the department of surgery, I advised her to apply to the hospital; but the official hirelings there refused to take her in, though I always understood that they were obliged to take in accidents. It seems, however, that some very confined meaning was annexed to this word by the surgeon on duty, and that he did not think the danger of a locked jaw to be an accident as deserving of his pity and immediate assistance, as a broken arm, or dislocated ancle. The poor woman came back to me j and, as her situation became every moment more and more alarming, the pain and in- flammation having reached as high as the arm-pit, I advised her to apply to the whole hand and arm a large poultice, with an ounce of laudanum sprinkled over it, and to renew the poultice twice a-day. This she did with so much success, that the thumb is cow quite well, though the accident did not happen above three weeks ago. Alarming as the case was, I had some reason to rely on the efficacy of the poultice, from a former trial somewhat similar. One of those girls, who are employed by book- binders in stilching-the sheets, having wounded her finger with the three-edged needle used on such occasions, soon felt the pain shoot upwards with deadly tendency. I ordered her to apply the same sort of poultice with laudanum, which had the same happy effect. Both these patients made use of the Common Poultice ; but I prefer one made of linseed flour, which is more easily prepared, and keeps moist longer than any other. Powders. This is one of the most simple forms in which medicine can be administered. Many medicinal substances, however, cannot be reduced into powder, and others are too disagreeable to be taken in this form. The lighter powders may be mixed in any agreeable thin liquor, as tea or water-gruel. The more ponderous will require a more consistent vehicle, as syrup, conserve, jelly, or honey. Gums, and other substances, which are difficult to powder, should be pounded along with the drier ones ; but those which are too dry, especially aromatics, ought to be sprinkled during their pulveriza- tion with a few drops of any proper water. Aromatic powders are to be prepared only in small quantities at a time, and kept in glass vessels closely stopped. Indeed, no Sowders ought to be exposed to the air, or kept too long, otherwise their virtues will e in great measure destroyed. Astringent Powder,—Take of alum and Japan earth, each two drachms. Pound them together, and divide the whole into ten or twelve doses. In an immoderate flow of the menses, and other haemorrhages, one of these pow- ders may be taken every hour, or every half-hour, if the discharge be violent. Powder of Bole.—Take of Bole armenic, or French Bole, two ounces ; cinnamon, one ounce ; tormentil root and gum arabic of each six drachms ; long pepper, one drachm. Let all these ingredients be reduced into a powder. This warm, glutinous, astringent powder is given in fluxes, and other disorders where medicines of that class are necessary, in the dose of a scruple, or half a drachm. If a drachm of opium be added, it will make the Powder of Bole with Opium, which is a medicine of considerable efficacy. It may be taken in the same quantity as the former, but not above twice or thrice a-day. Carminative Powder.—Take of coriander-seed, half an ounce ; ginger, one drachm ; nutmegs, half a drachm ; fine sugar, a drachm and a half. Reduce them into powaer for twelve doses. This powder is employed for expelling flatulencies arising from indigestion, particu- larly those to which hysteric and hypochondriac persons are so liable. It may like- wise be given in small quantities to children in their food, when troubled with gripes. Diuretic Powder.—Take of gum arabic four ounces ; purified nitre, one ounce. Pound them together, and divide the whole into twenty-four doses. During the first stage of the venereal disease, one of these cooling powders may be taken three times a-day, with considerable advantage. Aromatic Opening Powder.—Take the best Turkey rhubarb, cinnamon, and fine su- gar, each two drachms Let the ingredients be pounded, and afterwards mixed well together. SYRUPS. XX* When flatulency is accompanied with costiveness, a tea-spoonful of this powder nay be taken once or twice a-day, according to circumstances. Saline Laxative Powder.—Take of soluble tartar, and cream of tartar, each on* drachm ; purified nitre, half a drachm. Make them into a powder. In fevers and other inflammatory disorders, where it is necessary to keep the boor gently open, one of these cooling laxative powders may be taken in a little gruel, and repeated occasionally. Steel Powder.—Take filings of steel, and loaf sugar, of each two ounces; ginger, two drachms. Pound them together. In obstructions of the menses, and other cases where steel is proper, a tea-spoonful of this powder may be taken twice a-day, and washed down with a little wine and water. Sudorific Powder.—Take purified nitre and vitriolated tartar, of each half an ounce ; opium and ipecacuanha, of each one drachm. Mix the ingredients, and reduce them This^gene'rally known by the name of Dover's Powder. It is a powerful sudorific. In obstinate rheumatisms, and other cases where it is necessary to excite a copious sweat, this powder maybe administered in the dose of a scruple or half a drachm. Some patients will require two scruples. It ought to be accompanied with the plen- tiful use of some warm diluting liquor. Worm Powder.—Take of tin reduced into a fine powder, an ounce ; ^Ethiops min- eral, two drachms. Mix them well together, and divide the whole into i|« *"«■■. One of these powders may be taken in a little syrup, honey, or treacle, twice n-day. After they have been all used, the following anthelmintic purge may be proper. Pureine Worm Powder.-Take the powdered rhubarb, a scruple; scammony and calomel of each five grains. Rub them together in a mortar for one dose. For chil- dren however, these doses must be lessened according to their age. If the Powder of tin be given alone, its dose may be considerably increased. The late Dr Ilston%ave it to tEe amount of two ounces in three days, and says, when time admi^teredrth^Tt proves an egregious anthelmintic. He purged his patients both before they took the powder and afterwards. Powder for the Tope WW-Early in the morning the patient is.to.take in any efit of^ mankind. Not having had an llV^^^^i^SsX, toV an experience concerning its efficacy. *« ■ee'n"'•"° ^he dose here prescribed is suffi- active medicine, and ought to be taEen with care ^he ^osenerep cient for the strongest patient; it must, therefore, De reaucea B -e and constitution. Syrups. SvP„rs were some time age.looked upon as ^^^^S^^SS. are at present, however, .^M"™*Kr»n for reducing the light- ,nd are uaed for sweetening draught juleps^ or >^g«" » »°u may8be aMWCr. 6r powders into boluses pills and J^g"™;J*Xany other ; especially as the, edby the simple syrup alone, there is »"le?ccas ion i J >f £ medicine giv. are seldom found out in a state of ^^^^^TpS musfkeep whatever SiS^WLTS'S; thrpr^practitionerrnine-tenths of the syrup. tuually kept in the shops are unnecessary. Simple Syrup-U made by dissolving in water, either with or without heat, about double its weight of fine sugar. of the 8imple syrup, it will 4£8K£. iX&S;rSeV^f pVppies, and will be found a more saf. and certain medicine roarshmallows may likewise be suppled, by ^Krs^-2"^of mucUage of gum XXVi TINCTURES, ELIXIRS, SeC. " Those who choose to preserve the juice of lemons in form of syrup, may disaolye in it by the heat of a warm bath, nearly double its weight of fine sugar. The juice ought to be previously strained, and suffered to stand till it settles. .... The syrup of ginger is sometimes of use as a warm vehicle for giving medicine to persons afflicted with flatulency. It may be made by infusing two ounces of bruised [ringer in two pints of boiling water for twenty-four hours. After the liquor baa been atruned, and has stood to settle for some time, it may be poured off, and a little more than double its weight of fine powdered sugar dissolved in it. Tinctures, Elixirs, &c. Rectified spirit is the direct menstruum of the resins and essential oils of vegeta- bles, and totally extracts these active principles from sundry substances, which yield them to water, either not at all, or only in part. It dissolves likewise those parts of animal substances in which their peculiar smells and tastes reside. Hence, the tinctures prepared with rectified spirits form an useful and elegant class of medicines, possessing many of the most essential virtues of sim- ples, without being clogged with their inert or useless parts. Water, however, being the proper menstruum of the gummy, saline, and saccharine parts of medicinal substances, it will be necessary, in the preparation of several tinctures, to make use of a weak spirit, or a composition of rectified spirit and water, Aromatic Tincture.—Infuse two ounces of Jamaica peppor in two pints of brandy, without heat, for a few days : then strain off the tincture. This simple tincture will sufficiently answer all the intentions of the more costly preparations of this kind. It is rather too hot to be taken by itself; but is very proper for mixing with such medicines as might otherwise prove too cold for the stomach. Compound Tincture of the Bark.—Take of Peruvian bark, two ounces; Seville orange-peel and cinnamon, of each half an ounce. Let the bark be powdered and the other ingredients bruised: then infuse the whole in a pint and a half of brandy, for five or aix days, in a close vessel; afterwards strain off the tincture. The dose is from one drachm to three or four, every fifth or sixth hour. It may be given in any suitable liquor, and occasionally sharpened with a few drops of the spirits of vitriol. Tbis tincture- is not only beneficial in intermitting fevers, but also in the alow, nervous, and putrid kinds, especially towards their decline. Volatile Foetid Tincture.—Infuse two ounces of asafcetida in one pint of volatile aromatic spirit, for eight days, in a close bottle, frequently shaking it; then strain the tincture. This medicine is beneficial in hysteric disorders, especially when, attended with lowness of spirits, and faintings. A tea-spoonful of it may be taken in a glaja of wine, or a cup of penny-royal tea. Volatile Tincture of Gum Guaiacum.—Take of gum guaiacum, four ounces j vola- tile aromatic spirit, a pint. Infuse without heat, in a vessel well stopped, for a few days; then strain off the tincture.* In rheumatic complaints, a tea-spoonful of this tincture may be taken in a cup of the infusion of water trefoil, twice or thrice a-day. Tincture of Black Hellebore.—Infuse two ounces of the roots of black hellebore, bruised, in a pint of proof spirit, for seven or eight days ; then filter the tincture throngb paper. A scruple of cochineal may be infused along with the roots, to give the tinc- ture a colour. In obstructions of the menses, a tea-spoonful of this tincture may be taken in a cup of camomile or penny-royal tea twice a-day. Astringent Tincture.—Digest two ounces of gum kino, in a pint and a half of bran- dy, for eight days ; afterwards strain it for use. This tincture, though not generally known, is a good astringent medicine. With this view, an ounce, or more, of it may be taken three or four times a-day. Tincture of Myrrh and Aloes.—Take of gum myrrh, an ounce and a half; hepatic aloes, one ounce. Let them be reduced to a powder, and infused in two pints of rec- tified spirits, for six days, in a gentle heat; then strain the tincture. This is principally used by surgeons for cleansing foul ulcers, and restraining the progress of gangrenes. It is also, by some, recommended as a proper application to green wounds. r rr 1«nt,A*e^ugoodti"ctUu0f,su?iacum'ror U0|ne«tic use, may be made by infusing two or three ouncesof the gum in a bottle of rumor brandy. ' TINCTURES, See xxvu Tincture of Opium (Liquid Laudanum.)—Take of crude opium, two ounces; enir- ituous aromatic water, and mountain wine, of each ten ounces. Dissolve the opium, sliced, in the wine, with a gentle heat, frequently stirring it; afterwards add the spirit, and* strain off the tincture. As twenty-five drops of this tincture contain about a grain of opium, the common dose may be from twenty to thirty drops. Sacred Tincture, or Tincture of Hiera Picra.—Take of succotrine aloes in pow- der, one ounce ; Virginian snake-root and ginger, of each two drachms. Infuse in a pint of mountain wine, and half a pint of brandy, for a week, frequently shaking the bottle; then strain off the tincture. This is a safe and useful purge for persons of a languid and phlegmatic habit: but t is thought to have better effects, taken in small doses as a laxative. The dose, as a purge, is from one to two ounces. Compound Tincture of Senna.—Take of senna, one ounce ; jalap, coriander-seeds, and cream of tartar, of each half an ounce. Infuse them in a pint and a half of French brandy for a week; then strain the tincture, and add to it four ounces of fine sugar. This is an agreeable purge, and answers all the purposes of the Elixir Salutis, and of Daffy's Elixir. The dose is from one to two or three ounces. Tincture of Spanish Flies.—Take of Spanish flies, reduced to a fine powder, two ounces ; spirit of wine, one pint. Infuse for two or three days ; then strain off the tincture. , -.,••_•_. This is intended as an acrid stimulant for external use. Parts affected with the pal- sy, or chronic rheumatism, may be frequently rubbed with it. Tincture of the Balsam of Tolu.—Take of the balsam of Tolu, an ounce and a half; rectified spirit of wine, a pint. Infuse in a gentle heat until the balsam is dissolved; then strain the tincture. This tincture possesses all the virtues of the balsam. In coughs, and other com- plaints of the breast, a tea-spoonful or two of it may be taken on a bit of loaf-sugar. But the best way of using it is in syrup. An ounce of the tincture properly mixed with two pounds of simple syrup, will make what is commonly called the Balsamic Syrup. Tincture of Rhubarb.—Take of rhubarb, two ounces and a half; lesser cardamom- seeds half an ounce ; brandy, two pints. Digest for a week, and strain the tincture. Those who choose to have a vinous tincture of rhubarb may infuse the above in- gredients in a bottle of Lisbon wine, adding to it about two ounces of proof spirits. If half an ounce of gentian root, and a drachm of Virginian snake-root, be added to the above ingredients, it will make the bitter tincture of rhubarb. All these tinctures are designed as stomachics and corroborants as well as purga- tives. In weakness of the stomach, indigestion, laxity of the intestines, fluxes, col- icky and such like complaints, they are frequently of great service. The dose is from half a spoonful to three or four spoonsful or more, according to the circumstances or the patient, and the purposes it is intended to answer. The Tonic Tincture.—Mix two ounces of the compound tincture of Peruvian bark with the like quantity of the volatile tincture of Valerian ; and of this mixture a tea- spoonful in a glass of wine or water is to be taken three or four times a-day. ™ong^ medicine that will! but where a complete cure cannot be rationally expected, relief is certainly a very desirable object. Paregoric Elixir.—Take of flowers of benzoin, half an ounce; opium, two drachms. InSm one po^nd of the volatile aromatic spirit, for four or five days, frequently shaking the bottle ; afterwards strain the elixir. Sacred Elixir.-Take of rhubarb, cut small, ten *^i™%^£^$£. der, six drachms ; lesser cardamom-seeds, half an ounce ; French oranay, f Virginian snake-root, half an ounce. ^e.1 ^V"^ ds strain out the elixir. ^nis' iS exc^^^ WaDt °f ""*»> xxviii VINEGARS. aid such like complainta, a small glass of it may be taken twice a-day. It likewise re lieves the gout in the stomach, when taken in a large dose. Acid Elixir of Vitriol.—Take of the aromatic tincture, one pint; oil of vitriol, three ounces. Mix them gradually, and after the faeces have subsided, filter the olixir through paper, in a glass funnel. . This is one of the best medicines which I know for hysteric and hypochondriac pa- tients, afflicted with flatulencies arising from relaxation or debility of the stomach and intestines. It will succeed where the most celebrated stomachic bitters have no ef- fect. The dose is from ten to forty drops, in a glass of wine or water, or a cup of any bitter infusion, twice or thrice a-day. It should be taken when the stomach is moet empty. Camphorated Spirit of wine.—Dissolve an ounce of camphor in a pint of rectified spirits. This solution is chiefly employed as an embrocation in bruises, palsies, the chronic rheumatism, and for preventing gangrenes. The above quantity of camphor, dissolved in half a pound of the volatile aromatic spirit, makes Ward's Essence. Spirit of Mindererus. (Solution of acetated Ammonia.) Take of volatile sal ammoniac, any quantity. Pour on it gradually distilled vinegar, till the effervescence ceases. This medicine is useful in promoting a discharge both by the skin and urinary pas- sage. It is also a good external application in strains and bruises. When intended to raise a sweat, half an ounce of it in a cup of warm gruel may be given to the patient in bed every hour till it has the desired effect. Vinegars. Vinegar is an acid produced from vinous liquors by a second fermentation. It is an useful medicine both in inflammatory and putrid disorders. Its effects are, to cool the blood, quench thirst, counteract a tendency to putrefaction, and allay inordinate motions of the system. It likewise promotes the natural secretions, and in some ca- aes excites a copious sweat, where the warm medicines, called alexipharmic, tend rather to prevent that salutary evacuation. Vinegar is also advantageously employed in burns and scalds; by keeping the parts constantly wet with it, by means of linen rags. " In severe burns and scalds,'' observes Mr. Cleghorn, "which have recently happened, and which are attended with large blisters, excoriations or loss of substance, the vinegar must be constantly applied till the heat and pain nearly cease, which will happen in from two to eight hours, accord- ing as the injury is more or less severe. The sores must be covered with rags or clothe well wetted, which, as often as they dry, or any sensation of pain or heat returns, must b* wetted afresh with the vinegar, for two, three, or four hour3." Weakness, faintings, vomitings, and other hysteric affections, are often relieved by vinegar applied to the mouth and nose, or received into the stomach. It is of excel- lent use also in correcting many poisonous substances, when taken into the stomach; and in promoting their expulsion, by the different emunctories, when received into the Mood. Vinegar is not only an useful medicine, but serves likewise to extract, in tolerable Serfection, the virtues of several other medicinal substances. Most of the odoriferous owers impart to it their fragrance, together with a beautiful purplish or red colour. It also assists or coincides with the intention of squills, garlic, gum ammoniac and eeveral other valuable medicines. ' These effects, however, are not to be expected from every thing that is sold under the name of vinegar, but from such as is sound and well prepared. The best vinegars are those prepared from French wines. It is necessary for some purposes that the vinegar be distilled; but as this operation requires a particular chemical apparatus, we shall not insert it. Vinegar of Litharge.—Take of litharge, half a pound; strong vinegar, two pints Infuse them together in a moderate heat for three days, frequently shaking the vessel; tnen filter the liquor for use. This medicine is little used, from a general notion of its being dangerous There is reason, however, to believe, that the preparations of lead with vinegar are possessed of some valuable properties, and that they may be used in many cases with safety and success. * A preparation of a similar nature with the above has of late been extolled bv Gou- £^a Fr*nS .SUrge0j' "V 8afe Land "taMively-uaefuI medicine, which he calls the tonract of Saturn, and orders to be made in the following manner :— Take oflitharge, one pound; vinegar made of French wine, two pints. Put them together into a glazed earthen pipkin, and let them boil, or rather simmer, for an nour, or an hour and a quarter, taking care to stir them all the while with a wooden WATERS BY INFUSION. SIMrLE DISTILLED WATERS. XXIX »m.tula. After the whole has stood to settle, pour off the liquor which .6 upon the top m.o bottles for use. With this extract Goulard makes his vegeto mineral water,* which he recommends in a great variety of external disorders, as inflammations, burns, bruises, sprains. ulcers, &c. He likewise prepares with it a number of other forms of medicine, as poultices, plas- ters, ointments, powders, &c. Vinegar of Roses.—Take of red roses, half a pound ; strong vinegar, half a gallon. Infuse in a close vessel for several weeks, in a gentle heat; and then strain off the liquor. This is principally, used as an embrocation for headachs, &c. Vinegar of Squills.—Take of dried squills, two ounces; distilled vinegar, two pints. Infuse for ten days or a fortnight in a gentle degree of heat, afterwards strain off the liquor, and add to it about a twelfth part of its quantity of proof spirits. This medicine* has good effects in disorders of the breast, occasioned by a.load ot viscid phlegm. It is also of use in hydropic cases for promoting a discharge of «r"ie- The dose is from two drachms to two ounces, according to the intention for which it is given. When intended to act as a vomit, the dose ought to be large. In other ca- ses it must not only be exhibited in small doses, but also mixed with cinnamon:water. or some other agreeable aromatic liquor, to prevent the nausea it might otherwise oc- casion. Waters by Infusion, &c. Lime Water—Pour two gallons of water gradually upon a pound of fresh burnt ouicklime andI when the ebullition ceases, stir them well together; ften suffer the wliole to stand at res? that the lime may settle, and afterwards fflter the liquor through paper/which is to be kept in vessels closely stopped. The lime-water from calcined ^^ 5 in which case, from a pint or two mZrl^£fto&4Mj. Externally it is used for washing foul ulcers, and removing the itcn, and other diseases of the skin. Omr^dLim. H-nter.-Take sha.ing.of 8»»»™™ Xd,,h.*'tEee dreS^ »e%rr.i^^^^ to the palate, but also a more efficacious medicine, especially in cutaneous aisoroer and foulness of the blood and juices. . It may be taken in the same quantity as the simple water. na^tlTf^^^^^^ "'tfprineipj intention of this is to cleanse fonl nleere, and consume pto.d de.h. pour off the water for use. -h-rapter which has been given of it, yet tions'nnometimes W^W.^^™™^ bear it. It is generally 0rdVe£ote\T^ SS^ qiSi^AS. "wo hoJrs after breakfast and dinner. Simfle Distilled Waters. * „..« nn-b.r of distilled '^^Z^T&XX^A^ -----■----------' . * See Collyrium of bead- XXX SPIRITUOUS DISTILLED WATERS. WHEYS. diluents, suitable vehicles for medicines of greater efficacy or for rendering disgustful ones more agreeable to the palate and stomach. We shall therefore insert only a few of those which are best adapted to these intentions. The management of a still being now generally understood, it is needless to spend time-in giving directions for that purpose. Cinnamon Water.—Steep one pound of cinnamon bark, bruised, in a gallon and a half of water, and one pint of brandy, for two days ; and then distil off one gallon. This is an agreeable aromatic water, possessing in a high degree the fragrance and cordial virtues of the spice. Pennyroyal Water.—Take of penny-royal leaves, dried, a pound and a half; water, from a gallon and a half to two gallons. Draw off by distillation one gallon. This water possesses, in a considerable degree, the smell, taste, and virtues of the plant. It is given in mixtures and juleps to hysteric patients. An infusion of the herb in boiling water_answers nearly the same purposes. ; Peppermint Water.—This is made in the same manner as the preceding. Spearmint Water.—This may also be prepared in the same way as the penny-royal water. This and the preceding are useful stomachic waters, and will sometimes relieve vomiting, especially when it proceeds from indigestion, or cold viscid phlegm. They are likewise useful in some colicky complaints, the gout in the stomach, &c, particu- larly the peppermint-water.—An infusion of the fresh plant is frequently found to bave the same effects as the distilled water. Rose Water.—Take of roses, fresh gathered, six pounds ; water, two gallons. Dis- til off one gallon. This water is principally valued on account of its fine flavour. Jamaica-pepper Water.—Take of Jamaica pepper, half a pound; water, a gallon and a half. Distil off one gallon. This is a very elegant distilled water, and may in most cases supply the place of the more costly spice waters. Spirituous Distilled Waters. Spirituous Cinnamon Water.—Take of cinnamon bark, one pound; proof spirit,, and common water, of each one gallon. Steep the cinnamon in the liquor for two days ; then distil off one gallon.. Spirituous Jamaica-pepper Water.—Take of Jamaica pepper, half a pound; proof Bpirit, three gallons; water, two gallons. Distil off three gallons. This is a sufficiently agreeable cordial, and may supply the place of the Aromatic Water. Wheys. Alum Whey.—Boil two drachms of powdered alum in a pint of milk, till it is curdled; then strain out the whey. This whey is beneficial in an immoderate flow of the menses, and in a diabetes, or excessive discharge of urine. The dose is two, three, or four ounces, according as the stomach will bear it, three times a-day. If it should occasion vomiting, it may be diluted. Mustard Whey.—Take milk and water, of each a pint; bruised mustard-seed, an ounce and a half. Boil them together till the curd is perfectly separated; afterwards strain the whey through a cloth. This is the most elegant, and by no means the least efficacious method of exhibiting mustard. It warms and invigorates the habit, and promotes the different secretions. Hence, in the low state of nervous fevers, it will often supply the place of wine. It is also of use in the chronic rheumatism, palsy, dropsy, &c. The addition of a little sugar will render it more agreeable. The dose is an ordinary tea-cupful four or five times a-day. Scorbutic Whey.—TYi\s whey is made by boiling half a pint of the scorbutic juices in a quart of cow's milk. More benefit, however, is to be expected from eating the plants, than from their expressed juices. The scorbutic plants are, bitter oranges, brooklime, garden scurvy-grass, and water- cresses. A number of other wheys may be prepared nearly in the same manner as orange-whey, cream-of-tartar-whey, &c. These are cooling pleasant drinks in fevers and^iay be rendered cordial, when necessary, by the addition of wine. WINES. LICHEN ISLANDICUS. XXXJ Wines. The effects of wine are, to raise the pulse, promote perspiration, warm the habit, and IV 1.1 u .u 8p'!',tS- Jhe red wine3> besides these effects, have an astringent quality, by which they strengthen the tone of the stomach and intestines, and by this means prove serviceable in restraining immoderate secretions. The thin sharp wines have a different tendency They pass off freely by the different emunctories, and gently open the body. 1 he effects of the full-bodied wines are, however, much more durable than those ot the thinner. All sweet wines contain a glutinous substance, and do not pass olt treely. Hence they will heat the body more than an equal quantity of any other wine, though it should contain fully as much spirit. From the obvious qualities of wine, it must appear to be an excellent cordial medicine. Indeed, to say the truth, it is worth all the rest put together. But to answer this character, it must be sound and good. No benefit is to be expected from the common trash that is often sold by the name of wine, without possessing one drop of the juice of the grape. Perhaps no medicine is more rarely obtained genuine than wine. Wine is not only used as a med- icine, but is also employed as a menstruum for extracting the virtues of other medi- cinal substances; for which it is not ill adapted, being a compound of water, inflamma- ble spirit and acid; by which means it is enabled to act upon vegetable and animal sub- Btances, and also to dissolve some bodies of the metallic kind, so as to impregnate itself with their virtue, as steel, antimony, &c. Anthelmintic Wine.—Take of rhubarb, half an ounce; worm-seed, an ounce. Bruise them, and infuse without heat in two pints of red Port wine for a few days, then strain off the'wine. As the stomachs of persons afflicted with worms are always debilitated, red wine alone will often prove serviceable. It must, however, have still better effects when joined with bitter and purgative ingredients, as in the above form.—A glass of this wine may be taken twice or thrice a-day. Antimonial Wine.—Take glass of antimony, reduced to a fine powder, half an ounce; Lisbon wine, eight ounces. Digest, without heat, for three or four days, now and then shaking the bottle ; afterwards filter the wine through paper. The dose of this wine varies according to the intention. As an alterative and dia- phoretic, it may be taken from ten to fifty or sixty drops. In a large dose it generally proves cathartic, or excites vomiting. Bitter Wine.—Take of gentian-root, yellow rind of lemon-peel, fresh, each one ounce ; long pepper, two drachms ; mountain wine, two pints. Infuse without heat for a week, and strain out the wine for use. In complaints arising from weakness of the stomach, or indigestion, a glass of this wine may be taken anbour before dinner and supper. Ipecacuanha Wine.—Take of ipecacuanha, in powder, one ounce, mountain wine. a pint. Infuse for three or four days; then filter the tincture. This is a safe vomit, and answers extremely well for such persons as cannot swallow the powder, or whose stomachs are too irritable to bear it. The dose is from one ounce to an ounce and a half. Chalybeate, or Steel Wine.—Take filings of iron, two ounces ; cinnamon and mace, of each two drachms; Rhenish wine, two pints. Infuse for three or four weeks, fre- quently shaking the bottle; then pass the wine through a filter. In obstructions of the menses, this preparation of iron may be taken, in the dose of half a wine-glass twice or thrice a-day. The medicine would probably be as good if made with Lisbon wine, sharpened with half an ounce of the cream of tartar, or a small quantity of the vitriolic acid. Stomach Wine.— Take of Peruvian bark, grossly powdered, an ounce; cardamom- seeds, and orange-peel, bruised, of each two drachms. Infuse in a bottle of white Port or Lisbon wine for five or six days; then strain off the wine. This wine is not only of service in debility of the stomach and intestines, but may also be taken as a preventive, by persons liable to the intermittent fever, or who re- side in places where this disease prevails. It will be of use likewise to those who re- cover slowly after fevers of any kind, as it assists digestion, and helps to restore the I .ne and vigour of the system. A glass of it may be taken two or three times a-day. Preparation of the Lichen Islandicus. T-i. l.chen i-landicus has of late been much extolled as a remedy in pulmonary con- ,.n!i.ion. Not that it U supposed to possess any peculiar virtues as a pectoral medi XXX11 LICHEN LSLANDICUS. cine, but is rather to be considered as a nutritious' vegetable jelly, which promotes di • gestion by its slight bitterness, and at the same time sufficiently supports the-strength without stimulating the system; thus affording the powers of the constitution an oppor .unity of subduing the diseased action of the lungs. Many animals become very fat while living solely on the lichen islandicus, a proof that it affords abundant nutriment. To derive any essential benefit from the use of this article, it must constitute the sole subsistence. Persons who possess sufficient resolution to persist in such a regimen will find the lichen, prepared according to the following directions, an agreeable article of food:— Four ounces of the lichen, cut in small pieces, are to be boiled in three pints of water, till the quantity be reduced to two. To this add a tea-spoonful of fine wheaten flour, and four ounces of refined sugar; take sixty sweet almonds, and twenty-four bit- ter ones, blanched; beat them into a paste, with a small quantity of water, mingle this with the decoction, and then strain through a linen cloth, previously moistened with warm water. By this process, a nutritious vegetable jelly is formed, which may be poured into moulds, or glasses, and eaten alone, or with milk. The aromatic flavour of the almonds blends itself with, and completely conceals the peculiar bitter of the lichen, and forms a very palatable, easily-digested, and nutritive aliment. A. P. B. [ xxxiii ] CONTENTS. CHAP. I. Observations on Diet, particu- larly that of the common people - - Page 19 General Observations on Ali- ment 20 Of Bread 21 Boiled Grain - - 24 Butter - - 27 Fruits and Roots - 29 Broths and Soups - 34 Remarks on Food - 37 Food considered in a medical point of view 39 Differences between Vegetable and Animal Food - id. CHAP. n. On Sedentary, Studious, and Laborious Occupations, &c 40 On various Employments 42 Soldiers and Sailors, the con- sequences of their Employ- ment 44 The Sedentary - - 46 Injurious Effect of long In- clined Posture, &c - 47 Advice to the Sedentary, &c. 49 The Sedentary Studious 50 Diseases to which Studious People are more peculiarly liable - - - id. Advice to Studious and Intense Thinkers - - 52 Desk Occupations, Sec. 53 Morning best adapted for Study and Exercise, &.c - id. Effects of Music on the Mind id. Dr. Buchan's Plan of invigor- ating the Spirits - 51 i Diet of the Studious - id. | Y The Kind of Exercise recom- mended to Studious Habits 54 CHAP. III. Non-Naturals - 55 Observations on Diet - id. Vegetable Diet - - 57 Plain Rules in the Selection of Diet, &c. 59 General Observations on Diet, long Fasting, its consequen- ces, Regularities, &c. 60 Suppers and Breakfasts con- trasted, &c. - - 61 CHAP. IV. Air .... 62 Burying witnin Churches, a reprehensible Practice 63 Stagnated Air - - 64 Air of great Towns - 65 CHAP. V. Exercise 66 Inactivity, its consequences 67 Exercise in the open Air 68 Indolence, its consequences 69 Sleep, its benefits, &c. - 69 To procure refreshing Sleep, , the danger of ------------, a striking proof of afforded, by what -, families affect- ed by it Intestines, inflammation of the Intoxication, of consequences persons hurtful to young effects of, often fatal Itch Itchings, troublesome, pregnant women J. of 76 211 76 78 391 290 406 Jaundice --------of pregnant wo- men Juleps - Julep, camphorated ----, cordial ----, expectorating ----, musk ----, saline ----, vomiting - id. K. Kidneys, inflammation of 2171 265 407 xviii id. id. id. id. id. 285 Laborious occupations, &c. remarks on - - 40 Labours, classification of 412 Labour, stages of - id. ------, symptoms preceding id. ------, symptoms accompa- 413 414 416 id. 317 nying ----, process of, natural ----, tedious ----, treatment after Laugh, sardonic Lead and its preparations. See Mineral Poisons- Leeks - Lichen, islandicus, prepara- tions of - Lime. See Alkaline Earths Liniment for burns -------, volatile —, white -, for piles Liquors, fermented ------, observations on hot, in warm rooms, 34 xxxi xx id. id. id. 58 59 the danger of drinking Liver, inflammation of Lochia, suppression of Longings of pregnant wo- men . . _ Looseness of infants Love, perhaps the strongest of all passions Low spirits Lungs, inflammation of M. 98 220 418 406 427 90 321 150 Malvern water - - 488 Marine tincture, imperial, for sea-sickness and ner- vous disorders - 495 Matlock waters - - 485 Measles - - - 176 Mechanics, advice to - 49 Meconium ... 423 Medicines used in private practice - . ui-viii --------, names of - id. --------, properties - id. INDEX. xlv Medicines, doses - iii—viii Melancholy - - 306 ---------, religious - 90 Menses, immoderate flow of 401 ------, cessation of - 403 Menstruation, difficult id. Mercury and its prepara- tions. See Mineral Poi- sons. Midwives, their ill-judged care of infants Mind, the temper of in dis- eases, how to be attended to ----, affections of Mindererus's spirit Mineral waters 422 101 85 xxviii 468 classifica- tion of Mixtures - Mixture, astringent ------■, diuretic -------, laxative, absorbent —, saline -, squill 470 xviii xix id. id. id. id. 481 379 201 492 53 331 404 Oil, camphorated Ointments Ointment, yellow basilicum -------, of calamine - --------, emollient --------, eye -----—■, issue --------, lead --------, mercurial --------, sulphur , for diseases of the skin -, white Moftat waters Mouth and nose, substances stopped between Mumps - Mushrooms, poisonous Music, its effects on the mind - Myopia - N. Nausea and vomiting of pregnant woman Nerves, weak, the compan- ion of inactivity - j>7 Nervous diseases - o\)a Night-air - - - 95 Night-mare - - **■< Nipples, fretted or chapped 418 Nitre - - - - 348 Non-naturals - - 55 Nose, bleeding at - 239 ----.stoppage of, in chil- dren • ; " HI Nurses, the duty of - 45b O. Oatmeal frequently made into bread - Opium. See Poisons, Nar- cotic. Onions how dressed P. Pain after - - - Pains false Palsy Paraphrenias Parents, diseased, the effect upon children - Parturition Peas and beans considered as food - Perspiration. See Evacua- tions. causes of, ob- structed Pills - Pill, composing - ---, deobstruent - ---, foetid - ---, hemlock ---, mercurial —r, mercurial sublimate ---, plummer's ---, purging ---, purgative ---, for the bile - jaundice xxi xix id. id. id. id. xx id. id. id. id. id. 34 417 408 309 149 441 412 25 94 xxi id. id. id. id. id. id. id. xxii id. id. id. id. id. id. 241 ---, stomachic ---, squill - ---, strengthening Piles, blind and bleeding Placenta. See After Burden. Plants, poisonous - 351 Plasters - xx|| Plaster, common - xxiii ------, adhesive - id. ------, blistering - id. xlvi Plaster, gum ------•, mercurial ------, stomach .-----, warm INDEX. —, wax Pleurisy bastard - 342, Poisons, mineral ------, vegetable ------, animal - ------; aerial. See Noxious Vapours. narcotic id. id. id. id. id. 144 149 342 490 342 491 Poor living after the course of fever among labourers 44 Posture, injurious effect of, long inclined - 47 ---■—, figure of body, how hurt by id. Potatoes considered as a substitute for bread 30 Potash. See Alkalies. Poultices - xxiv Powders - id. Powder, astringent - id. ------, of bole - - id. ------, carminative - id. ------, diuretic - id. ------■, aromatic opening, id. ------, saline laxative xxv ------, steel - - id. ------, sudorific - id. - -, worm - - id. ------, purging - - id. ————, for tape-worm id. Pregnancy, diseasos of 403 ---------, during, three 1' stages exist - - 404 Preserves. See Conserves. Prognosis, what - - 100 Q. Quickenings - - 404 ----------, opinion rela- tive to id. Quinsey. See Sore Throat, inflammatory. -------, malignant - 197 R. Rattlesnake, bite of - 351 Resurrection. See Animation suspended. Rheumatism Rickets - Rising, early, a consequence of what - Ruptures - S. Sailors and soldiers, conse- quences of their calling Saint Anthony's fire, a dis- ease incident to labouring people - -, iliac pas- 277 433 71 377 44 43 sion, colic, and other com- plaints of the bowels often occasioned by the same cause as - Saint Vitus's dance Salsafy, skirrets, and sever- al kinds of beets, observa- tions on - - - Sanctorius, an Italian phy- sician quoted on pulmona- ry and cutaneous transpi- ration - Scarborough waters Scald head - - - Scenes, the variety of, why designed - Scirrhus - - - Scrofula. See King's Evil. Scurvy ... Sea-sickness ----------, imperial ma- rine tincture for Sedentary, studious, and la- borious occupations, re- marks on --------, sedentary studi- ous -, advice to -,rdiseases of - Seltzer water Senses, disorders of Shortsightedness. See My- opia. Silver, nitrate of, See Min- eral Poisons. Simples, a list of. See Ap- pendix. Simplicity, the great rule of diet - Sinapisms. See Cataplasms. id. 313 33 94 476 428 89 336 281 494 495 40 50 id. id. 477 329 75 INDEX. xlvii Skin, over distention of, in pregnant women - 408 Smell and taste - - 333 Shoe, the size and figure how regulated - 73—74 Sleep, want of, and restless- ness of pregnant women 407 ----, its benefits - - 69 ----, like diet ought to be duly regulated ---, to procure refreshing ---, light suppers procure refreshing, when id. 70 id. 71 168 Small-pox Soda. See Alkalies. Soldiers and sailors, the con- sequences of their employ- ment - Sore throat, inflammatory Spirit of wine, camphorat- ed - - - - xxviii Spring-chalybeate in the Isle of Wight - Squinting. See Strabismus. Stale bread, its effects upon the humours Stone and gravel - Stomach, cramp of -------, pain of -------, inflammation of -------, and bowels, affec- tions of. See Costiveness. Studious and intense think- 44 193 489 45 234 316 259 210 ers, advice to - -------, diet of - Studious occupations, re- marks on - - Strabismus - Strains - Strangling. See Suffocation. Study and exercise, the best time for ... Subjects, gloomy ones, not to be inculcated Suffocation from various causes ... ---------of infants Suppers and breakfasts con- trasted - Surgery Swellings, puffy, of the feet, of pregnant women - Swooning - - - 52 54 40 331 377 53 91 393 id. 61 352 406 318 Syncope. See Fits, Fainting. See Swooning. Syrups ... Tap-rooms, highly pernicious 98 Taste and smell - - 333 Tea, the mischief of, when substituted for solid food Teething - Tests. See Poisons. Thrush. See Aphthae. Tinea, capitis. See Scald Head. Tinctures ... xxvi Tincture, imperial marine, against sea-sickness, &c. 495 —-----, how taken in nerv- ous and other disorders. id. -------, aromatic - xxvi 24 431 -----, compound, of the bark ... id. -----, volatile, foetid id. ------------, of guiacum id. -----, of black hellebore, id. -----, astringent - id. -----, of myrrh and aloes id. -----, of opium - xxvii -----, sacred, or hiera id. compound of senna id. picra balsam of tolu -------, Spanish flies - -------,rhubarb -------, tonic Tooth-ach - —'------, of pregnant wo- men ... Touch, disorders of Transitions, sudden, &c. Tunbridge-wells - -----------—, medicinal properties -------------, Pyrmont, and German spa, compar- ed with - Turner's cerate. See Oint- ment of Oalamine. Turnips, how considered as food. ... id. id. id. id. 256 406 335 97 470 id. 473 33 U. Ulcers 362 xlviii INDEX. in in 367 id. 233 248 406 407 Ulcers, cure of by roller and compresses, &c. on Mr. Whately's plan - 363 ----.-, Baynton, his plan of curing old - - 365 -----, Home, Sir Everard, on -----, Dr. White, on - Urinary organs, diseases of. See Diabetes. Urine, suppression of - -----, bloody -----, suppression of, pregnant women -----, incontinency of. pregnant women V. Vaccination - - 493 Vapours, noxious - - 385 Vegetable and animal food, difference between - 39 --------, observations on 56 Vinegars - - - xxviii Vinegar of litharge - id. --------., roses - xxix --------, squills - id. Vomiting of infants - 228 -------, when from other affections - 229—230 W. Waters by infusion - xxix Water, lime - _ - id. ------, compound - id. — —, sublimate - id. ------, styptic - - id. Water, tar - id- ------, simple distilled id. ------, cinnamon - xxx ------, peppermint - id. ------, spearmint - id. ------, rose - - id. ------, spirituous distilled id. ------, Jamaica pepper id. ------, spirituous cinnamon id. ------, necessary to clean- liness ... 81 Wet clothes - - 95 ----feet - id. Wheys ... xxx Whey, alum - - id. -----, mustard - - id. ——., fspnrbutio - - id. Whites. See Fluor Albus. Wind. See Flatulencies. Wines, ... Wine, anthelmintic -----, bitter ----, ipecacuanha ----, chalybeate or steel stomach See ■ "•■ --, summon Womb, inflammation of Women, diseases of Woody nightshade. Poisons, Narcotic. Worms - Wounds - Z. Zinc, sulphate of, &c. ----, oxyd of. See Mineral Poisons. xxxi id. id. id. id. id. 417 397 261 357 NLM045868736