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                    THE
                                      A   ■■    '-'■
             AMERICAN

                    OR,
MEDICAL ADMONISHER:
                  CONTAINING
                                     f. :
   <r      SOME  ACCOUNT     \&   >
ANATOMY,
I HE SENSES,
DISEASES,
CASUALTIES; a
DISPENSATORY, and
GLOSSARY.
IN WHICH
The Observations, and Remedies, are adapted to the Diseases, Sfc,
                        OF THE

             UNITED  STATES.
      DESIGNED FOR THE USE OF FAMILIES.
SECOND EDITION, WITH ADDITIONS AND IMPROVEMENTS.
            BY HORATIO GATES JAMESON, M.D.
Honorary Member of the Medical Society of "Maryland, and late a Surgeon in the ■
            General Hospital for the Army at Baltimore.
      BALTIMORE:       O^         ^\
                          '' "ifa^        ''''
PUBLISHED BY THE AUTHOR.     V -^T   y
                              -Vi !{ V    >
     .TOHN D. TOY, PRINTER.             "~—  . * . ' ^
          1818. 
District of Martland, ss.
    BE IT REMEMBERED,  That on this  seventeenth day of February,  in  the
 »****♦*♦* forty-second year of the Independence of the United  States of America,
 |       * Horatio Gates Jameson, of the said District, hath deposited in this office
 2 seal * tne title of a  b00kj the rig^t  whereof he claims as author; in the words
 #«+t*44*K following, to wit:

  "The  American Domestick Medicine; or, Medical Admonisher: containing some
account of Anatomy, The Senses, Diseases, Casualties; a Dispensatory, and Glossary,
in which the Observations, and Remedies, are adapted to the Diseases, &c.  of the
United States.  Designed for the use of families.  Second edition, with additions and
improvements.  By Horatio Gates Jameson, M. D.  Honorary Member of the Medi-
cal Society of Maryland, and late a Surgeon in the General Hospital for the Army at
Baltimore."

  In conformity to the act of the  Congress of the United States, entitled, "An act for
the encouragement of learning, by securing the copies of maps, charts and books, to
the authors and proprietors of such copies during the times therein mentioned."  And
also to the act, entitled,  "An act supplementary to an act,  entitled, 'An act for the
encouragement of learning, by securing the  copies of maps, charts, and books, to the
authors and  proprietors of such copies  during the times therein mentioned,' and ex-
tending the benefits thereof to the arts of designing, engraving, and etching historical
and other prints."
                                                PHILIP MOORE,
                                             Clerk of the District of Maryland.
• 
RECOMMENDATIONS.
IN compliance with custom, the publisher of this work
requested a few of the most eminent professional men
to give  their opinion of it.  The following highly re-
spectable reviews of it have been obtained.

DR. JAMESON,
     Sir—As popular  treatises on diseases will  be al-
ways much  used, and  are often indispensable, it is im-
portant to give to them  the progressive improvements in
medicine.  In this view your book seems to merit, and
no doubt will  acquire, a liberal patronage.  To  the
usual materials of such  productions, you have  added
later facts and observations from the best authorities, in-
cluding your own, and  given to the whole, a method and
style  well adapted  to their purpose.  On the means of
preserving health, you dwell to advantage,  since that,
more than the cure of diseases,  is within the comprehen-
sion and control of your  readers, and since our climate
and mode of living, give to it  particular importance.
  Your sketches of the structure and  laws of the human
body, and application  of them to the use of remedies,
connect science with experience, and indicate the only
safe principles on which  diseases can be treated—thus
combining throughout your work, utility and security,
with commendable success.
ar July 1st, 1817.                      JOHN OWEN.
     Sir,
  I  have examined with as much attention as my time
would admit, your  book, entitled, "The American Do-
mestick Medicine,  or  Medical  Admonisher."   I  am 
iv
much pleased with the design,  and (with few excep-
tions) the ability of the work.   It is executed with a
pious zeal for the benefit of mankind, and is replete
with useful instruction and entertainment to the gentle-
man and scholar.   Your Dispensatory at  the end of the
book will be  highly useful and convenient  in  families,
and  the  Glossary will make  the whole intelligible to
every reader of common understanding.
     I am, respectfully, your  obed't, humble serv't,
                                  JOHN COULTER.
Dr. Horatio Gates Jameson.
    March 15, 1817.
                     Baltimore, March 12th, 1817.
    Dear Sir,
  I have perused your Domestick Medicine with plea-
sure, and have no hesitation in saying, it  is one of the
best productions of the kind which 1 have seen.  You
deserve much credit for your industry and pains in com-
piling a work which is calculated to do much good.  I
hope you will  be  amply remunerated for  your difficult
and arduous undertaking.
    I am, with respect, your obed't, humble serv't,
                               JOHN CROMWELL.
Dr. Horatio G. Jameson.
                         Baltimore, Feb. 16, 1818.
    Dear Sir,
  Having perused the American Domestick  Medici .i
published by you, am of  opinion that  it is a work  of
much merit, and equal, if not superiour, to any  work of a
similar description I have met with, and well  deserving
publick attention and patronage; and will, I think, be
particularly  valuable  to those  gentlemen who reside in
the country, removed  at a distance from a  physician.
The arrangement I  think  judicious, and the prescrip- 
v
tions will be generally found  useful and proper in the
diseases for which they have been recommended.
    I remain, very respectfully, yours, &c.
                                   JAMES SMYTH.
Dr. Horatio Gates Jameson.
                         Baltimore, Feb. 16, 1818.
    Dear Sir,
  We have perused your book, entitled, "The Ameri-
can Domestick Medicine," with much pleasure and sa-
tisfaction.  The  arrangement is  highly judicious, and
we sincerely hope, you will be amply remunerated for
the trouble you have encountered, and for the time you
have expended in the composition of the work.
    We are, dear sir, yours, very respectfully,
                           BROWN &  MACKENZIE.
Dr. Jameson.
          Pastoral-House, East street, June 17, 1817.
    Dear Sir,
  Agreeably to your request signified to  me some time
since, I have perused  your volume recently published,
under the title of "The American Domestick Medicine,
or Medical Admonisher;"  and, although I should deem
it presumption in me to pass any opinion on its merits as
a professional or scientifick work; I  can have no hesita-
tion in acknowledging with pleasure what I may be sup-
posed more competent to discern;  I mean its moral ten-
dencies.   To my best apprehension, your book is auxi-
liary to the soundest principles of religion and virtue.
If the expression of this sentiment shall be of any ser-
vice to you in  the disposal of your publication, it will
impart great pleasure, dear sir, to your friend and ser-
vant,
                                   JAMES  TXGLTS.
Dr. Horatio Gates Jameson. 
 
INTRODUCTION,
THE author, in presenting this volume to the publick,
begs leave to call the attention of its readers, to the cir-
cumstance of the very limited number of Original Works
in the United States.   The subject here  treated of, is
certainly highly important, and strongly claims the at-
tention of every intelligent person.
  The  foregoing highly respectable recommendations
were bestowed  on the first edition; and as the work has
undergone a careful revision, and appears now with some
additions, and improvements,  it is hoped  it will not be
deemed either arrogant or false to say, that this work is
an improvement upon all that have preceded it.
  Among the additions may be mentioned an alphabeti-
cal index, which will greatly assist the reader in finding
what may be wanted suddenly. But, it is confidently be-
lieved, most persons will find some amusement and in-
struction in perusing these sheets, either by finding some-
thing new,  or refreshing the memory in what may be al-
ready known.   To an  enlightened and liberal publick
the author  now appeals, with a  confidence reasonably
arising from ample opportunity  of understanding the
subject. 
      EXPLANATION  OF THE PLATE.


   THE design is from a picture in the possession of my
brother, Dr. Jameson,  of York, Pennsylvania.   It re-
presents the celebrated Galen,  viewing  a human skele-
ton, of whom it is said that,  "Though an Atheist, he was
a strict observer of nature, till by chance finding a skele-
ton, he thought it of too curious a construction to be the
work of chance."  The vast and  sudden expansion of
his views of the Deity, in the following lines, while they
agreeably surprise  us, are a strong confirmation of the
existence of a  "light," in the human capacities, "which
lighteth every  man."
"Forbear, vain man, to launch with reason's eye,
Through the vast depth of dark immensity;
Nor think thy  narrow, but,  presumptuous mind,
The least idea of thy God can  find.
Thought, crowding thought, distracts the laboring brain;
For how can finite infinite explain?
Then God adore, avid conscious rest in this,
None, but Himself, can paint him as He is." 
TABLE  OF  CONTENTS.
                 1st PART—of ANATOMY.

Sept  1. of the Skin      ....
      2. of the Bones or Skeleton    -
      3. of the Cartilage or Gristle
      4. of the Ligaments    -
      5. of the Muscles
      6. of the Muscles within the body
      7. of the Arteries          -
      8. of the Brain  -
      9. of the Circulation       -
    10. of the Blood        ,
    11. of the Glands    -
    12. of the Viscera      -
    13. of the necessary distinction of Parts
              and a Recapitulation of this part

                2d PART—of the SENSES.
S.ect.  1. of the Sense of  Touch
     2. of the Sense of  Taste    ...
     3. of the Sense of  Smelling    -
     4. of the Sense of  Hearing  -       -      -
     5. of the Sense of  Seeing      -      -
     6. of the Senses in general  -
     7. of the Cause of Animal Life
     8. of the Mind     ....
     9. Summary of Physiological Sketches  -

            3d PART—of the NONNATURALS.
Sect. 1. of the Air    -
     2. of Aliment      -
     3. of Sleep     r
     4. of Clothing.....
     5. of Exercise  -
              3 
X
CONTENTS.
Sect. 6. of the Secretions
     7. of the Passions
 Pago.
   82
.   ib.
                4th PART—of the PULSE.               85

                5th PART—of BLEEDING.

Sect. 1. of Bleeding by the Lancet  -      -      -      '    ^j
     2. of Artenotomy   -      -     -      -      ~       •*
     3. of Bleeding by Leeches     -      -      *      "    **•
     4. of Cupping     -----      1°2
     5. of Scarifying.....103

                 6th PART—of DISEASES.

Sect 1. of Nosology    -      -      -      -    .  -      10^
     2. of Diseases of excessive  excitement      -          105
     3. of Diseases of Abstraction     -                    1°°
     4. of Epidemicks      -----   108
     5. of Endemicks   -      -      -      -      r      11*
     6. of Contagious diseases     -      -     -      -to.
     7. of Fortuitous diseases  -      -      -      -      H2
     8. of Habitual diseases       -      -     -      -   113
     9. Summary of general observations      -      -      114

      7th PART—of EPIDEMICKS INDIVIDUALLY.

Sect. 1. of the Yellow Fever       -      -     *      -   118
       Letters from Dr. Drysd ale to Dr. Rush  -      -      120
       Concluding advice on Yellow Fever      -      -   141
     2. of the Bilious Remitting  Fever -                    145
     3. of the Influenza    -      -      -     -      -   147
     4. of Typhus and Typhoid  fevers -                   148
     5. of the Measles     -      -      -     -      -151
     6. of the Hooping-Cough   -      -      -      -      154
     7. of the Scarlatina, or Malignant Sore Throat       -   155
     8. of the Dysentery or Bloody Flux      -      -      157
     9. of the Ague or Intermitting Fever  -     -      -   162

         8th PART—of CONTAGIOUS  DISEASES,

Sect 1. Admonitory Remarks on  Smallpox  -     -      -   164
     2. of the Smallpox   -           -      -      „      165

         9th PART—of FORTUITOUS  DISEASES.
Sect. 1. of Consumption of the Lungs                   .   167
     2. of the Peripneumony    -      -      _      „      179
     3. of the Pleurisy     -      -      -     _      -   181
     4. of the Croup or Hives   -      -      -      .      I83
     5. of a Common Cold         -      -     -      -   185
     6. of Inflammation of the Stomach -     -       -      136 
CONTEtftS.
X*
                                                        Page.
Sect. 7. of Inflammation of the Intestines   -      -       -    187
     8. of Inflammation of the Kidneys  -       -       -       188
     9. of Inflammation of the Bladder     -      -       -    189
    10. of Inflammation of the Diaphram       -       -       190
    11. of Inflammation of the Peritoneum  -      -            ib.
    12. of Inflammation of the Liver    -       -       -       191
    13. of Inflammation of the Brain       -      -       *    193
    14. General observations on Visceral Inflammation  -       195
    15. of Erysipelas      -      -      -      -           198
    16. of the Scarlet Fever                                200
    17. of the Chickenpox  -      -      -      -       -    201
    18. of the Quinsey  -      -      -       -       -        ib.
    19. of the Mumps      -      -      -      -       -    203
    20. of the Miliary Fever    -      -              -        ib.
    21. of Malignant Fever from Local Causes  -       -       204
    22. of Typhus Fever from Local Causes       -       -    207
    23. of a Simple Inflammatory Fever        -       -       209
    24. of the Dropsy      -      -      -      -           210
    25. of the Rheumatism     -      -       -       -       216
    26. of the Apaplexy   -----    217
    27. of the Palsy.....218
    28. of the Locked Jaw, or Tetanus     -      -       -    219
    29. of the St. Vitus's Dance  -      -       -       -       222
    30. of the Hydrophobick Fever -                        223
    31. of the Scurvy   -----       233
    32. of the Jaundice    -----.   234
    33. of a Diabetes   -----       236
    34. of Madness or Insanity    -                        237
    35. of the Cholera Morbus   -      -       -       -       243
    36. of Colick in General      -                        244
        of the Lead Colick                                 245
        of the Flatulent Colick    -       -      -      -   246
        of the Hysterick Colick  -                           247
        of the Iliac Passion -----   248
        of an Epidemick Colick        -                     249
    37. of a Spitting of Blood from the Lungs     -       -   250
        of a Spitting of Blood from the Stomach       -       252
    38. of Bloody Urine                                    ib,
    S9. of Bleeding at the Nose        -      -      -       253
    40. General observations on Hemorrhage      -      -   254
    41. of a Vomiting          -                           257
    42. of a Diarrhsea and Lientery        -                 260
    43. of a Gonorrheea or Clap        _      -      -       262
    44. of Inflammation and Swelling of the Testes -      -   263
    45. of a Gleet.....264
    46. of Onanism, or Self-Pollution             r           ib.
    47. of Phymosis and Paraphymosis -                    265
    48. of Drunkenness or Self-Debasement      -      ■»   266
    49. of Headach.....269
    50. of Toothach,        -      ,-             -      -   271 
xii
CONTENTS.
Sec. 51. of Earach       -      -       -       -
    52. of Inflammation of the Eyes
    53. of Want of Appetite    -
    54. of Heartburn and Waterbrash
    55. of Hickup      -       -       -       -
    56. of Cramp of the Stomach   -
    57. of the Nightmare, or Incubus
    58. of Swoonings, or Faintings  -
    59. of Flatulence, or Windy Bowels
    60. of Chilblains and Kibes
    61. of Herpes, in general
    62. of the Scaldhead   -
    63. of Pimples in the Face  -
    64. of the Itch  -      -      -       -
    65. of Prickliheat   -
    66. of the Yellow Morphew
    67. of the Leprosy  -      -       -       -
    68. of Worms  -
    69. of a Strangury  -      -       -       -
    70. of Ischuria  -      -      -          .
    71. of Eneuresis, or Habit of Wetting the Bed
    72. of Gutta Serena    -
        of Cataract
        of Strabismus, or Squinting -
        of Specks, or Films upon the Eyes
        of the Blood-shot Eye
        of the Watery or Weeping Eye
        of Deafness        -
        of Loss  of the Taste    -
        of the Loss of Smell
        of the Loss of the Sense of Touch
10th PART—of HABITUAL DISEASES.
1. Legitimate Gout -	-	-	304
Vibrating Gout -	*	-	310
9. Irregular Gout -			ib.
of Gout in the Kidneys -	-	-	312
of Gouty Gonorrhoea			ib.
of Gout in the Testes	-	-	318
of Gout in the Hip -			ib.
of the Different Grades of Gout	-	.	314
General observations on Gout	.		316
3. of Chronick Rheumatism	»	-	319
4. of Asthma -			320
5. of Angina Pectoris	.	-	324
6. of the Gravel and Stone			326
7. of Dyspepsia -	-	-	328
8. of Goitre - - - -			■ 330
9. of Scrofula -	-	.	331
  Page.
    273
-   274
    276
-   277
    278
-   279
    280
-   282
    283
-   284
    286
-   287
    288
     ib.
    290
     ib.
    291
-   292
    294
-   295
     ib.
-   296
    297
-   298
     ib.
-   299
     ib.
-   300
    302
     ib.
    303 
CONTENTS.
xiii
		Page.
9. of Rickets -	-	- 332
of Malignant Rickets of Scrofula in the Glands -	-	333
	-	- 334
of Cancer	-	335
10. of Syphilis, or Lues Venerea	-	- 336
11. of the Yaws	-	340
12. of Epilepsy	-	- 341
13. of Hypochondriasis	-	343
14. of Hystericks	-	- 347
15. of the Piles or Hemorrhoids	-	349
16. of the Fistula in Ano	-	- 352
17. of Land Scurvy	-	353
18. of Corns -	-	- 354
                11th PART—of CASUALTIES.

Sect. 1. of Dislocations in general       .  -      -      -   355
       of Dislocation of the Jaw      -                   356
       of Dislocation of the Shoulder     -                357
       of Dislocation of the Wrist     -                   358
       of Dislocation of the Neck        -      -      -    ib.
     2. of Strains      -             -                   359
     3. of Fractures or Broken Bones     -                360
     4. of Wounds which heal by the First Intention   -      363
       of Wounds which should Suppurate       -      -   367
       of Wounds which Bleed       -                   368
       of Bruises   ------   37Q
     5. of Ruptures     -       -      -      -      -      372
     6. of Burns and Scalds       -           -  -      -   374
     7. of Frost Bites  -      -      -      -       -      376
     8. of Disorder from Drinking Cold Water    -      -   378
     9. of Drowning or Submersion     -      -       -      381
    10. of Hanging, &c.   -                              384
       Concluding Advice on Suffocation      -       -      389
    11. of Substances Stopped in the Throat      -      -   391
    12. of Swallowing Cents, &c.      -                   396
    13. of Substances getting into the Windpipe   -      -   397
    14. of Fish-Hooks, &c.     -                          398
    15. of Extraneous Bodies in the Nose and Ears -      -   399

     12th PART—of INFLAMMATION, or PHLOGOSIS.
Sect. 1. of Inflammation in General        -                401
     2. of Mortification        -                          403
       of Mortification in the Mouth -      -          -   405
       of Mortification in the Toes     -                    ib.
     3. of Psoas Abscess   -----   4qq
     4. of Biles, or Phlegmon   -                          407
     5. of Inflammation of the Breasts, or Mammse      -    ib.
     6. of Inflammation of the Nipples  -                   408
     7. of Inflammation of the Fmger, or Felon   -      .   409 
xiv
CONTENTS.
                                                       Pag*:
Sect 8. of Stonebruises and Bloodbiles -      *      -      410
     9. of Inflammation from the Bite of the Viper  -      -   411
        of Inflammation from Bite of Rattlesnake and Copper-
           head        .....tbi
        of the Sting9 ef Insects    -                        413
    10. of Mineral and Vegetable Poisons      -      -      414

           13th PART—of the FEMALE HABIT.

Sect. 1. Introductory Remarks on the Menses      -      -   416
     2. of the Menses  -----      420
     3. of the Appearance and Disappearance of the Menses   423

   14th PART—of a DISEASED STATE of the MENSES.

Sect. 1. of Painful Menstruation       -                     424
        of the Treatment of Painful Menstruation -      -   427
     2. of a too Sparing Condition of the Menses      -      429
     3. of Excessive Menstruation        -                 430
     4. of Retention or Total Absence of the Menses  -      431
     5. of the Final Cessation of the Menses      -      -   432

           15th PART—of PREGNANT WOMEN.

Sect. 1. of Introductory Remarks  -                        433
     2. of the Advantages of Exercise  -                    434
     3. of the Diseases of Gestation and the usual remedies ?  435
              in  the Early Months        -      -       }
        of Sickness and Vomiting     -                    436
        of the Heartburn   ----,.    *&,
        of Irregularity of the Bowels   -                    437
        of Longings        -      -       -      *           ib.
        of Swelling, and Pains in the Breasts   -      -      438
        of Hysterick Fits and Faintings    -                 439
        of Wrong Position of the Womb      -      -      440
     4. of Costiveness, &c. in the Latter Months  -      -   441
        of Piles or Hemorrhoids       -      -      _       fa
        of Swellings of the Belly, Thighs,  &c.     -      -   442
        of Pains in the Back, Belly, &c.       -      -       ib.
        of Cough and Difficulty of Breathing      -      -    ib.
        of Cramps      -----      443
        of Colick Pains     -      -       -      -           ib.
        of Suppression of Urine       -                    444
        of Incontinence of Urine  -       -      -      -   445

          16th PART—of PARTURIENT WOMEN.
Sect. 1. Introductory Remarks     -                        445
     2. of the Diseases of Parturient Women  -       -      449
        of Chills          -      -      -                  ib.
        of Afterpains   -----       fa
        of Puerperal Fever  -                               450 
CONTENTS.
XV
                                                      Page.
Sect. 2. of Vomiting    -----      450
     3. Concluding advice to Parturient Women   -      -    ib.

        17th PART—of DISEASES of the FEMALE.

Sect 1. of Inflammation of the Uterus     -                455
     2. of the Prolapsus Uteri, or Falling Down of the Womb   456
     3, of the Chlorosis, or Green Sickness     -      -      457
     4. of the Fluor Albus.....458

       18th PART—of the DISEASES of CHILDREN.
Sect. 1. Introductory Remarks     -                       459
     2. of Common Gripings   -                          461
     3. of the Yellow Gum -----   462
     4. of the Red Gum       -                          463
     5. of Inflammation of the Eyes       -      -      -    ib.
     6. of Aphthae, or Thrush   -                          464
     7. of Convulsions     -----   465
     8. of Cholera Infantum, or Summer Disease      -      466
     9. of the Cowpox, or Vaccina -      -      -      -   469
    10. of Milk Blotches, or Crusta Lactea     «      -      473
    11. of Teething.....474

   19th PART—DISPENSATORY,  or MATERIA  MEDICA.
Sect. 1. List of Medicines, table of Doses, Weights      -   477
     2. of Purgatives    -----      484
        of Laxatives       -      -     -      -      -   488
     3. of Emeticks     -----      490
     4. of Sudorificks      -      -     -      -      -   491
        of Stimulant Diaphoreticks    -                   493
        of Cooling Diaphoreticks   -      t      -      ,494
     5. of Expectorants -----      495
     6. of Stimulant Diureticks    -                      497
        of Refrigerant Diureticks      -                   498
     7. of Glysters ------    ib.
     8. of Evacuant Alteratives       -      -     -      501
        of Stimulant Alteratives   -     -      -      -   502
     9. of Diffusible Stimulants        »                   506
    10. of Durable Stimulants, or Tonicks  -      -      -   510
    11. of Astringents, or Antihemorrhagicks   -      -      515
        of Restringents    -      -     -      -      -518
        of External Astringents -                          520
    12. of Antispasmodicks       -                      522
    13. of Carminative Stimulants     -                   525
        of Carminative Antacids   -                      526
    14. of Febrifuges    -                                 528
    15. of Emmenagogues   -----   530
    %6. of Lithontripticks      -      -            -      531
        of Antacid Lithontripticks -                      532 
XVI                     CONTENTS.
                                                       Page.
Sec. 16. ef Tonick Lithontripticks  -      -      -      -   533
    17. of Ophthalmicks                                   534
    18. of Anodynes       -      -      -      -      -   536
    19. of Vermifuges   -----       539
    20. of Medicinal Nutrients    -      -      -      -   541
    21. of Diluent Drinks                                  544
        Mild Stimulant Drinks     -      -      -      -   545
        Tonick Drinks   -----       546
        Cordial Drinks      -      -      -      -      -   547
    22. Ointments       -      -             -       -       548
    23. Dentrifice......549
    24. Cephalick Snuff       -                            ib.
    25. Mouth Water, or Gargles  -      -      -      -   550
    26. Poultices       -----        ib.
    27. Gum Plaster       -      -       -       -       -    552 
THE
AMERICAN
OF THE ANATOMY OF THE HUMAN BODY.

                     SECTION I.

THE Anatomy of the human body has been aptly com-
pared, by the illustrious Bell, to a circle; so that, in our
efforts at demonstration, it matters but little from what
point we set out; tracing on the various parts of which
it is composed, all equally dependant on a certain assem-
blage of parts and functions, we  arrive at the point from
which we embarked.
  I have deemed it most natural, and  equally  conve-
nient with any other course, to commence with the skin,
it being that part in which  all the others are enveloped,
and which in some measure characterizes the man.  The
art of modern anatomists has discovered  the skin  to con-
sist of four lamance, or folds; the cuticle, or  scarfskin;
mucous body, or  reticular  tissue; cutis vera,  or true
skin; and from  this last there is separated a vascular
membrane, which is the organized surface of the true
skin.
  The first, or scarfskin, is the outside, and is but a
thin  pellicle, except on particular parts exposed  to fric-
tion.   Persons  who go barefooted, and those who la-
bour much with the hands,  have this  part  of the  skin
of great thickness on the soles of the feet, and palms of
the hands.   Nature has wisely provided, even  for the
infant, a greater body of this substance on those parts:
             3 
18
OF THE ANATOMV
thereby evidently fitting  him for the  various laborious
duties which fall to the lot of the mass of mankind. Oyer
the body, in general, it serves the purpose of defending
the true skin, and is that part which we  remove by the
application of blisters.   However insensible in general,
there is a point at which it will resist injuries; by wear-
ing tight shoes, kc. excrescences, as corns, are formed.
which become exquisitely sensible, and teach us, togeth-
er with  its regular organization, that it is a living part.
and  of  vast  importance  to the human creature.   The
cause of this disease,  appears to me, to be a union of
the scarf with  the  true skin, brought about by a long
continued pressure, by which the mucous body is remo-
ved or destroyed. Affections of the clavus, or corn kind,
occur sometimes along the sides of the finger nails, for
which it is  only necessary carefully to pare  down the
hardened skin, leaving the nails untouched with  the
knife, otherwise, you produce deformity, and increase
the disease.  In youth, the scarfskin is thin and smooth,
in old age it becomes thicker, rough, and  disposed to
furrow.
   The second layer, or mucous body, is  endowed with
organization, being reticular or net-like, and is transpa-
rent, black,  brown, yellow, &c.  and gives  to the body
the colour of the  European,  Negro, Sambo, Mulatto,.
Miistee, &c.   This substance is subject to disease, and
to changes which may comport with the health of the
person affected, but changing very materially the colour^
hence the cause of  white negroes.  It is highly proba-
ble this part of the skin at times acquires considerable
acrimony, which may arise either from disease in itself.
or be the consequence of vicious secretions of the glands,
or vessels of the skin.  This organized membraneous
mucous appears to be much affected in leprosy, plied
polonica, and tinea capitis, or scaldhead.
   Naturalists,  and  others, have  been much  engaged in
dispute about the cause of this interesting colouring mat-
ter.  Many  ascribe it to the effects of climate, and other
causes arising  from filthy habits.  It appears to be an
unnecessary inquiry, as we find many virtues, and bright
intellectual  powers  enclosed  within  the black,  or co* 
OF THE HUMAN  BODY.
19
loured skin: and those who really believe in Revelation
must  admit, that we  are all from one common parent,
and it matters little whether we suppose it the effect of
climate, or whether we attribute it to some special act of
the Deity.
  The third, Cutis Vera, or true skin, has considerable
body  and strength, and is endowed with a  large share
of sensibility, being furnished with a tissue of nerves in-
numerable: we cannot touch it with the finest point of a
needle without causing pain. It in some measure serves
to brace and give strength to the muscles.  The fourth
or inner layer, being a mere tissue of vessels connected
with the more dense part of the skin, is merely mention-
ed as a matter of fact,  without pretending to point out its
particular use, or even its organization.
  The skin then,  taken with all its  component parts,
holds a high place  among the important organs of the hu-
man system. The  healthy skin covering a healthy body,
presents to our view,  in the pretty cheek, shades of red
and white, more beautiful than the rose; the  evanescent
shades of which no pencil can trace—To the lip a ruby
tinct,  more beautiful than the coral—To the plump and
well turned limbs  and heaving  bosom, a  tension and
smoothness, the master-piece of beauty—To the fingers
of both sexes, perceptions and skill which  afford  plea-
sures, exquisite, rational, ornamental, and useful.  Pre-
cious  Robe, what brilliant intellect and virtue has  been
enveloped within thy folds?  What mighty deeds  have
the human muscles performed, assisted by this wonder-
ful covering.  The  skin being carried over every part as
a defence, and being furnished with vessels, glands, &c.
suitable for carrying on the important processes of sen-
sible and insensible perspiration, must be acknowledged
to hold a high place in the living assemblage.  For on
no function of the system  are we more dependant for
health, than that of insensible perspiration,  a constant
discharge through  the skin, consisting of worn out parts
divested  of all living principle,  and therefore highly
noxious.  Sensible  perspiration or sweating, comes  in as
the kind guardian  of the labourer's health, when expo-
sed to the scorching sun: for by its rapid and constant 
go
OF THE ANATOMY
evaporation, the body is cooled several degrees, and i
kept pliant and  healthy.
  Experienced physicians have  long been aware  of i
strong connexion or sympathy, between the skin and the
system generally.  It is the most remarkably associated
with the stomach and lungs; hence the absolute necessity
of cleanliness. It is true many persons of robust consti-
tutions, are raised in dirt, and wallow in it during a long
life of activity.   But this only  argues, that nature can
accommodate herself to powerful evils; to the valetudi-
narian, the idler, and to persons generally, who live  in
an unwholesome atmosphere, nothing can be more hurt-
ful than filthiness, nothing is a more common passport to
disease and to death.

                    SECTION II.
                                           I
  I deem it equally natural and convenient, after having
treated of the general envelope, to enter on the bones,
and  divide the  skeleton into its three prominent parts;
these are the  Head, the Trunk, and the Extremities  or
Limbs.  And first of the head:  This is the Emporium
of the living system; here,  secure  in a strong box  of
bone, lies the brain.
  The bones may be divided into those of the head or
skull-cap, and those of the face.  Those of the skull-cap
are eight in number. 1st. Frontal, forming the forehead.
2nd. Two Parietal bones, or great side walls  of the
head.  8d. The Occijmt, forming all the back part of
the head, and a considerable part of it  attached to the
neck.  4th. Temporal  bones, forming the temple on  ei-
ther  side. 5th. Ethmoidal bone. 6th. Sphenoidal bone:
these two last are difficult to describe.  The Ethmoidal
bone is a  small  square bone, and divides the hollow of
the nose from the cavity of the skull.   It is  perforated
by the Olfactory nerves in so many places as to give it
the appearance of a sieve, and hence its name.
  All these bones are joined together with Sutures,  sC
called from the bones being indented or dove-tailed intf1
each other. The  Coronal Suture extends across the hear
almost from ear  to ear, and joins the Parietal bones tu 
OF THE HUMAN BODY.              21
 the Frontal.  The Lambdoidal Suture runs from behind
 one ear over the head to the other, and in its course some-
 what resembles the letter V. The Sagittal Suture runs
 from the Lambdoidal Suture to the Coronal, joining the
 Parietal bones to each other.   The  Temporal Sutures
join the temporal bones to the Frontal, Parietal, aud
 Occipital bones.
   There are several other sutures which pass through
 the base of the skull  and face, which it is unnecessary
 to describe here.  The bones of the head being thus di-
 vided into several pieces, may probably secure the head
 better from injuries, than one entire or solid box of bone.
 But it is in the birth  of the child  we see the admirable
 wisdom of this  contrivance.  By long continued pressure
 these bones  overlap, and thus lengthen ;md diminish the
 volume  of the  head, so as to suffer it to pass through,
 where otherwise the solid head  must be the destruction
 of both mother and child.  Where the Frontal bone
 meets the Parietal, there is in the infant a considerable
 opening called the Fontanelle, which remains open from
 one to three years.  In rickety or scrofulous children, it
 remains long open, and in those affected with the watery
 head, it sometimes dilates to a considerable extent.
   The  skull-cap is perforated with  a number of holes,
 which serve as outlets to the spinal marrow into the neck,
 and for the nerves, and vessels connecting the head with
the body.
   The  bones of the face are pretty numerous, but being
all united to form the  upper jaw and nose, no benefit can
arise from an enumeration of them.  The  upper jaw is
slightly moveable.
   The under jaw is too familiar as respects its form and
use, to require any particular description. Each jaw has
sixteen  teeth, the four first in each jaw are called incis-
or es; the  two next canine; the rest molar es; the four
last of which are named dentes sapientice, because they
do not arrive till years of discretion.  The first six teeth
in either jaw, have, in general, but one root; the molares
have from two to four roots, and are  most spread in the
upper jaw, which seems necessary to fix them securely
in the spongy  bone, of which the jaw  bone is in good
part composed. 
J),>
OF THE ANATOMY
  The bones of the trunk are those of the Spine, Pehw,
Ribs, and Sternum; the collarbones and shoulder blades
belong to the arm. The spine has generally seven bones
of the neck, twelve of the back, five of the loins;  Sa-
crum and Coxcygis, are a continuation of the spine, but
belong particularly to  the Pelvis.
  The two first bones of the neck are called Atlas  and
Dentata, and are remarkable for giving the principal ro-
tatory motion to the head.  Those of the  back are re-
markable  for  their strength, and connexion  with  the
heads of the ribs.  Those of the loins display the wis-
dom of the contriver, being possessed of a strength  and
facility of motion truly astonishing, in every position of
the body.  The spin?,  throughout its  whole length, with
the exception of the Coxcygis, has a considerable chan-
nel, where the spinal marrow, or  elongation of the  brain,
is securely lodged; between the  vertebrce, or bones of
the back, there is a substance in some  measure of the
nature of both cartilage and ligament.   This substance
is so highly elastick as to yield  to  all the complicated
motions of the spine,  accommodating itself, in a surpri-
sing manner, to the stooping, twisting, and rapid motions
of the body.  It is a well established fact, that it yields
during the day to the pressure  upon it,  and recovers
during the night, so that we are about an inch taller in
the morning than at night.   By  long continued inclina-
tion forwards,  backwards, or  sideways, this substance
accommodates  itself to the bend, yielding on one side.
and enlarging on the other, and  if long continued pro-
duces  deformity.
   Some tolerable idea of the  human spine may be for
inecl by viewing that  of quadruped animals.   The  ribs
are usually twelve on either side; seven are called  true
ribs, because they reach  the Sternum, or breast-bone;
the remaining five are called  false ribs; these are not
connected  with the Sternum, but are below it, and are
fastened together by  cartilages.  The ribs are all, ex-
cept the two or three  lowermost, connected to the bones
of  the spine at two points; and  they afford a pretty se-
cure lodgment to the viscera, and assist largely in the
process of respiration. 
                of the  Human body.             S3

  It has been a prevalent opinion that man has an odd
rib.   This supposition is founded  on the belief of  our
partaking of Adam's altered form, in giving a rib for his
mate: but this case is easily reconciled, by supposing
man was originally formed with an odd one for that very
purpose; we are not  to suppose the work of  creation,
partaking of what we call chance, but that the Creator
in his wisdom had, from all eternity, provided for every
possible thing the suitable means.
  The  Sternum, or breast-bone, completes the bony fa-
brick of the Thorax or chest, and  lies pretty much over
the heart.   In infancy it is composed of eight pieces, in
more advanced life it has but three,  and in old age it
becomes one entire piece; even the cartilage with which
it is connected, becomes bone in many cases;  this carti-
lage, which runs down, shaped somewhat like a sword,
derives its name from that circumstance, and is called
ensiform cartilage.  To the upper end of the Sternum
is"attached the Clavicula, or collar bone.   Having now
spoken of the Vertebrae,  the Ribs, and Sternum, which
form the Chest, Ave are regularly brought to the Sacrum
and Coxcyx, they being the termination of the  Spine,
and forming a considerable part  of the Pelvis.  The
Sacrum forms the back part of the Pelvis, and is a flat
wedge-like bone; to its lower end  is attached the Cox-
eyx, a small bone composed of several pieces, turning in-
wards so as to give some support to the parts within the
Pelvis.  In time of  labour  this  bone  forms  the only
moveable part of the Pelvis,  for by straightening it en-
larges the lower aperture in a small measure.
  In examining the Pelvis, we are first led to contem-
plate it as a great living arch placed between the trunk
and lower extremities; it  being an  irregular circle form-
ed of large solid bones.   It has too deep cavities, one on
either  side,  they are  called Acetabula;  these afford a
deep and firm  socket for the head  of the thigh bone.  In
the child it consists of many pieces; in the adult they are
united.  The entire Pelvis has free motions on the thigh
bones, and also where it is connected to the loins; but its
parts are  firmly bound together.   So strongly  are  the
bones of this living arch bound together, that they can- 
24
OF THE ANATOMY
not yield, even in time of labour, without extreme vio-
lence being done.
  The Ilium, a large flat bone, forming the haunch; the
Ischium, or hip-bone, the lowest part, and that on which
we sit; the Pubis, to which the genitals are attached, all
unite in forming the Acetabulum, on either side and with
the Sacrum and  Coxcygis form the whole Pelvis.  The
last  described bones  being  connected with the thigh
bones, it will be most in order to enter on the bones  of
the lower limbs next.
  The thigh bone called Femur, is strongly bound by a
large round knob or head to the  Pelvis; its body is com-
posed of very solid bone, it has a neck about an inch and
a half long, which connects the body of the bone with its
head, and going off almost at right angles, leaves a  pro-
digious stress on this part, when we carry heavy bodies.
Its lower end is large and spongy, formed of two knobs
or processes, called Condyles; these form the  upper part
of the  knee joint, and by their large size give room for
the insertion of many powerful muscles.
  The leg has two bones called  Tibia and Fibula; one
of which, the Tibia, is connected with the thigh bone in
forming the knee joint;  it also forms the shin.  Immedi-
ately over the knee joint is the  Patella,  or knee-pan, a
small flat bone somewhat triangular, and plays over the
knee joint as a pulley.
  The Fibula ia attached to the  Tibid a little below the
knee joint, and  on the outside.   The Tibia and Fibula
unite in forming the ankle joint, the  former being the
inner, and the latter the outside ankle.
   The foot is formed  of seven bones, two of which it
may be  necessary to  name.  The Astragalus is  con-
nected with the leg bones in forming the ankle joint.
The Os Calcis forms the heel, and gives a firm hold to
the greatest tendon of the body, called Tendino Achillis.
The remaining bones  of the foot, which, with the last
described, composes the Tarsus, and the five metatarsal
bones, with those of the toes, it would be useless to de-
scribe; it may be observed,  that the great  toe has but
two bones, and all the others have three each. 
OF THE HUMAN BODY.
S5
   We are now to return to the upper limbs, and there
 complete our description of the skeleton. The Clavicle,
 on either side, is connected to the Sternum in a manner
 somewhat peculiar; it has no Capsular Ligament, as the
 other joints, and has a small moveable cartilage interpo-
 sed between it and the Sternum, which, like a washer in
 machinery, facilitates  motion, and lessens the friction.
 This bone is solid  and pretty round, moving freely on
 the Sternum, at its inner end; it is  connected with the
 Scapula, or shoulder-blade, by strong ligaments, which
 leave it very little motion.
   The Scapula, or shoulder-blade, is  a very complex
 bone, and divided by the anatomist into many parts: it is
 a thin flat bone of considerable size, attached to the ribs,
 &c. by powerful muscles, which allow  it free motion.
 At its upper edge there is a considerable projection or
 process, called the Acromion, which is highly important,
 as it prevents the head of the Humerus, or shoulder-bone,
 from slipping upwards.  Just below this is the Glenoid
 cavity, a very slight cavity or depression, into which the
 head of the shoulder-bone is received, or perhaps more
 correctly speaking, to  Avhich it is attached;  for there is
 but a very shallow socket, which leaves this joint more
 subject to dislocation than any joint in the body.
   The Humerus, or upper arm-bone, is a pretty round
 smooth bone, with a large round head, where it  is con-
 nected with the shoulder-blade.  At  its lower end it has
 two prominences, called Condyles, which form the upper
 part of the elbow joint; these, or either of them, may be
 fractured and mistaken for dislocation of the joint, and
 therefore, it requires much caution in managing injuries
 of this joint.
  The forearm is composed of two  bones, the Radius
 and Ulna.   The Radius is connected to the outer Con-
 dyle of the Humerus, by a round head, which gives to
 the arm its principal rotatory motion; it forms the prin-
 cipal connexion with the Carpus, or  bones of the wrist.
  The Ulna forms a large share of the elbow joint, being
connected with the inner Condyle of  the Humerus; and
with a hook-like elongation; passes some distance round
             4 
36
OF THE ANATOMY
the arm-bone, forming a hinge-like joint; this process is
called the Olecranon, and is subject to be fractured.
   The wrist is composed of eight bones, called Carpal
1)ones, while the bones of the hand are called Metacapal,
and are five in number.   It is notorious that the fingers
have each three bones, the thumb has but two.
   Having now completed our  description  of  the bones,
so far as it can easily be under stood without plates, or
actual dissection, I shall pass on to the Cartilages and
Ligaments.

                    SECTION III.

                 Of the Cartilages.

   Cartilage, or  gristle, composes the head or knob of
jointed bones, being smooth and in a great degree insen-
sible; it is well suited to the purposes of giving free and
easy  motion  to the joints, without friction or irritation.
The whole  skeleton is Cartilaginous in the  Foetus, or
forming child; and  it is by slow degrees only, that the
Cartilage is  removed by the proper vessels, at the  same
time the bones are forming, by new depositions of bony
matter:  The external ear, and a considerable part of the
nose, remain Cartilaginous during life.   The inner end
of each true jib, is connected to the Sternum by a Car-
tilage of considerable length,  which leaves a portion of
thejbreast without any better defence than this soft Car-
tilaginous substance; it, however, gives great freedom of
motion to the ribs;  the false ribs are connected to each
other by Cartilage at their inner ends; the Sternum is
terminated downwards with Cartilage; the eye lids are
edged with Cartilage.  In short, every union or connex-
ion between bones throughout the body  is formed of Car-
tilage.  It is remarkable of the Cartilage, that while it
lays down the form of the skeleton, in the Foetus, or
forming child, it  has  no  agency in  forming the Callus,
which unites fractured bones.   When the ossifying pro-
cess,  or forming  of bone, is impeded  by accidents,  in
a fractured bone^ instead of a proper bony matter, Car-
tilage is formed, and leaves a kind of artificial joint. 
OF THE HUMAN BODY.
%7
Cartilage, in the finished  skeleton, has  no perceivable
blood vessels.  The Trachea, or windpipe, is formed of
Cartilaginous rings.
  Up to the twentieth year, the Cartilage, forming the
two ends of most of the bones, will separate from the
body of the bone by maceration in  water, and is a cu-
rious coincidence of agreement, between  the  perfection
of the body, and that which, I believe, all nations have
agreed on as the period at  which man becomes indepen-
dent, or in common  language, obtains his age:  this being
the twenty-first year, and the first year of the skeleton's
completion.

                    SECTION IV.

                 Of the Ligaments.

  The whole skeleton is  covered with a membrane,
which is called Periosteum, except on the head where
it has got the name of Pericranium; it is a strong  co-
vering of skin-like  substance, and runs from one bone
to another, throughout the whole body, and by being
attached to  the circumference of the joints, forms  a sack,
called a Capsule which serves  the purpose of strongly
fastening the bones  together,  and of confining the Syno-
via, or liquor of the joints;  here, it takes the name  of
Ligament.   Besides these Capsular Ligaments, formed
so immediately from  the  Periosteum,  there is many
other strong ones running in strap-like pieces, in various
directions, so as to give to the joints great strength; they
are composed of a  matter extremely strong, inelastick,
and possessing little sensibility.

                     SECTION v.

                  Of the Muscles.

  We come now to treat of a very important part of the
animal system, the  Muscles or fleshy part of the body;
in its general appearance it must be familiar to  every per-
son, from its resemblance to that  of our domestick ani- 
38
OF THE ANATOMY
 mals.  Each little bundle or portion of flesh is called a
 muscle, and every muscle has its  origin and  insertion;
 they arise from, and are inserted into the bones through
 the medium of the Periosteum.   Many of the most pow-
 erful  muscles terminate in Tendons, or sinews, which
 like ropes, or cords, increase  the length, and strength of
 the muscle.  It was supposed till very lately, that these
 connecting sinews,  or Tendons,  were mere condensa-
 tions  of the muscular fibres; but it is now well under-
 stood that they are distinct in their nature, and possess-
 ed of no power but what is imposed on them by the mus-
 cles.   Every  muscle is made up of a vast bundle of
 fibres, or thread-like parts;  the distribution  of these
 fibres alters the moving power of  the muscle,  some be-
 ing designed  for strength, while others are particularly
 suited for quickness of motion, and act with a velocity
 altogether inconceivable.  Those having straight long
 fibres, act more slowly, but possess greater strength than
 those which have their fibres running obliquely; the first
 are called rectilineal,  and  the latter penniform muscles.
  Perhaps nothing in creation is more surprising than
 the muscular  power; for a muscle which in the living
 man could  raise an  immense weight, immediately after
 death would be torn by the force of a few pounds.  Au-
 thors still dispute whether there  is any inherent power
 residing absolutely in the muscle, or whether  they de-
 rive all their power from the nerves.   It  is of little con-
 sequence where the power resides; it is equally inscru-
 table as a resident of  the  nerves, as of the muscles; to
 know that  it  exists may exalt our views to Him who
 formed us,  but all disputes referring living principles to
 mechanical agency,  serve but to degrade  the disputants. /
 The red colour of  the muscle in  man, and many other
 animals,  is not a necessary property; we see many ani-
 mals having great activity and strength, whose muscles
 are nearly white.
  The celebrated John Bell, supposes the  muscular
power to be ever the  same, and that fatigue is the con-
sequence of want of the nervous energy, which, rouses
the dormant power of the muscles into  action. Through-
 out the muscular system each one, (or every bundle of 
OF THE HUMAN BODY.
S9
fibres,) has a sheath or covering, which in many places
has great strength: to the great muscles of the thigh, in
particular, it gives much support; this is called the cel-
lular Membrane, but gets the name of Fascia where it
acts as a brace; where it passes over bone, or where Ten-
dons rub together, it becomes thicker, and takes on the
©ffice of lubricating and smoothing those parts.
  But while we admire the wondrous power of the mus-
cles, let us  not forget what a high place they hold, in
giving suitable  form and beauty to  the  human  creature.
Examine the well turned leg  and arm, the lips and face,
or the fingers, with power surpassing wonder; study the
numberless motions of the  body,  the neatness  and the
convenience with which such a variety of muscles act
without hindrance or incommoding each other,  and who
can but  truly and emphatically say,  this is the work of
omniscience.

                     SECTION VI.

           Of the Muscles within the body.

  Tracing  on the muscles, we come to  those situated
within the  body;  here we  discover other wonderful
powers, by which involuntary motions  are effected, de-
signed for the accomplishment of the circulation of the
blood, &c.  Among these, the  Heart holds the first place.
This muscular organ plays incessantly  from the time  of
the formation of the Punctum Saliens,  (the first moving
power in the germ,)  to the cessation of life.   The ge-
neral appearance of the heart must  be well known; it
lies somewhat obliquely in the chest, and is principally
on the left side.
  The Diaphram, or midrif, is  that fleshy  partition
which we see in animals,  dividing  the chest from the
Abdomen, or belly.   It  is the principal  agent in the
business of respiration.   Although the ribs in general
concur by means of the muscles of the  chest in respira-
tion, many cases have been found where the  ribs had
become one  entire frame of bone, without the  power of
motion,  and yet, respiration  went on without  any seri- 
30               OF THE ANATOMY
 ous impediment.  This muscle seems to partake, in  a
 high degree, of the influence which  the  passions  have
 over us^  it has led  a  celebrated naturalist to believe
 this was the centre of the nervous power, but unfortu-
 nately for his notion, he mistook a tendon for  a large
 nerve.  The urinary bladder is a hollow muscle, whose
 oflBce is well known.  The stomach, the intestines, the
 arteries,  and veins are all furnished  with muscular
 coats, or  in other  words,  they are made  principally of
 muscular  matter.

                     SECTION VII.

                   Of the Arteries.

   Having given some account of  the muscles,  I shall
 now endeavour  to  give some idea of the arteries and
 veins; these, with their functions, will be  most easily
 understood, by first giving a description of the heart.
   The heart is  a hollow muscle having four  cavities;
 two of which are somewhat  superficial, called auricles,
 which are sack-like appendages to this organ;  between
 these auricles and the ventricles, there is  a valve or flap
 which admits the  blood to pass into the  heart, but pre-
vents its return.   The ventricles are  two cavities with-
 in the heart.   From the right ventricle arises an artery
tailed the  pulmonary artery, which enters into the lungs,
 and branches out like the limbs of a tree,  and thus sup-
plies every part  of tlie lungs with blood.
  From the left ventricle of the heart, arises the great
artery which sends off the blood to be carried through
the whole body; it is called the aorta; it passes along
up  the spine,  and gives off branches to  be distributed
upon the head and arms; then turning downwards, this
great arterial trunk lies along the left side of the spine,
till it reaches the pelvis; here it gives off many branches
to nourish the fleshy mass about the  pelvis; two main
trunks go  to the  thighs and legs.  Like the branches of
a tree, the arteries divide, and at each division becomes
smaller and smaller, till they are so small, as to be im-
perceptible to the eye.  They pass through every mass 
OF THE HUMAN  BODY.
31
of flesh, through every viscus,  enter every  bone, and
every solid part of the  body.  Having conveyed the
blood, and given life, and warmth, to every  part of the
body, they terminate in the veins.
   The veins, with a reversed course, arise from all the
mouths  or terminations of the arteries, and becoming
larger and larger, like the collecting rivulet, grow into
one immense vein,  called the vena cava, which termi-
nates in the right auricle of the heart.  The veins are
more numerous than the arteries, have less strength, and
are furnished with valves or flaps;  the blood moves up-
wards in most of the veins,  and hence  the necessity of
these valves.   Many of the veins are superficially situ-
ated, but the arteries are more securely and deeply sea-
ted among the  muscles.

                    SECTION  VIII.

                    Of the  Brain.

   In treating of the brain, I shall speak of the whole
brainular system, comprehending the brain, usually so
called, the madulla  spinalis, and the nerves.  If we have
seen wonderful power in the muscles, calculated to exalt
our ideas of the great architect, with how much greater
reverence and admiration shall  we  examine that great
assemblage of  matter, which  gives sensation,  volition,
and motion to  the  whole structure.  To speak of  the
structure of the brain,  with its appendages, according to
its anatomical  divisions, would be useless;  for, such is
the intricacy of this system, that even years of actual dis-
section would be  necessary  for obtaining  a  complete
knowledge of  all its  parts; and  when understood,  no
idea can be formed of its functions from its organization;
all beyond description is mere conjecture.   The brain,
generally so called, is of immense size in the human sub-
ject, being larger than that  of any other animal; it is a
soft pulpy substance, filling the  whole  skull, is closely
enveloped in its circumference, and many of its greater
divisions, by a very strong membrane, called  the dura
mater; and in its smaller divisions, is lapped in a very 
m
OF THE ANATOMY
delicate fine membrane, called the pia mater; this last
is the only partition between some of the greater divi-
sions; these divisions are called ventricles, but there is
no cavities in  a healthy brain: in dropsy of  the head,
these ventricles are filled with water.
  It is remarkable of the internal structure of the head,
that there is a considerable number of large veins, called
sinuses;  these run along  the  dura mater between  the
different lobes of the brain, and contain a great quantity
of blood; and further, that there is no fat within the head,
nor cellular membrane, which is to be found every where
else.   It is supposed that fat is of too unstable a nature
to be  admitted into this grand mansion of life and sensa-
tion.   The  brain has usually been divided into a few
prominent parts; the cerebrum, having two lobes, occu-
pies the fore part of the head; the cerebellum and ma-
dulla  oblongata, the hind part, being the smaller portion.
  Bell considers the madulla spinalis, or spinal marrow,
and even the nerves, as parts of the brain.  In this opi-
nion I concur. The great mass of the brain is  composed
of two parts, called its cortical and madullary substance;
from the madullary part, the nerves go off; they are small
white cords; each one is enveloped like  the brain, in its
membranes, and are accompanied  with blood  vessels in
all their course.
  The nerves originating from the head,  have usually
been reckoned ten pairs, but  one pair of these  arise from
the madulla spinalis, mounts into the head, and  passes
out thence, as though it originated there.  From the mu-
dulla  spinalis go off, generally, thirty pairs, one pair be-
tween each joint of  the spine; these give nerves to  the
arms  and  legs, and  are connected  in many places with
those from the head, and assist in supplying the viscera.
  There is a pretty general connexion among the nerves;
they form nervous centres, which are little knobs called
ganglions, and  also net-like  collections called plexus.
All the nerves of particular  senses, as the olfactory for
smelling  the optick for vision, the auditory for hearing,
the gustatory for tasting, and the cutaneous for the touch,
terminate in a soft pulpy matter.  It is highly probable,
the active matter throughout the whole nervous system, 
OF THE HUMAN BODY.             33
 is similar to that of the brain.   On this foundation, we
 view the brain as ocoupying  not only the head, but as
 being distributed over the whole living system, and giv-
 ing life and activity to all.   When particular nerves are
 destroyed, the parts which they supply lose all power,
 and soon die.  It is a curious fact,  that  the  nerves of
 part of the body, may lose the power of willing, or vo-
 luntary motion, and yet retain the power of carrying on
 the circulation, and maintaining life,  as we see in palsy.


                     SECTION IX.

                  Of the Circulation.

   The  blood from the whole system being collected into
 the great vena cava, enters the right auricle of the heart;
 the peculiar and agreeable stimulus of the  blood, causes
 the auricle,  or sack-like appendage  of the heart, to di-
 late and receive a gush of blood, till being filled, it sud-
 denly resists or contracts, so as to force  the contained
 blood forwards into the  right  ventricle  of the  heart;
 the ventricle in like manner dilates  to receive a charge
 of blood, and then contracts, and  propels the blood
 into  the pulmonary artery,  which  proceeds  from  the
 right ventricle, and enters into the  lungs.  The auri-
 cles and ventricles  are  furnished with valves, or flaps,
 which prevent the blood  from returning.   The  blood
 having passed  through the lungs in the ramifications of
 the pulmonary artery, passes from the numberless arte-
 rial extremities into the pulmonary veins, which collect-
 ing into larger and larger veins, unite in one great vein;
 this vein enters the left auricle of the heart,  and passes
 on the blood  into the left ventricle,  and from  thence it
is thrown into  the great aorta; from thence it is carried
 throughout the whole body.  We may observe here,
 that  there is a double  circulation  of the  blood; first
 through one side of the  heart  and  the lungs, and then
through the other side of the heart, and the general sys-
 tem.  The blood,  in traversing the  lungs, undergoes
some  important change.  It parts with carbon, in a form
unfriendly to health; and receives from the  air taken in-
             5 
34
OF THE ANATOMY
to the lungs a portion of oxygen.   This double process
of rejecting the  parts unfit for the wants of the system,
and receiving oxygen, without which we cannot exist, is
a phenomenon still somewhat clouded with uncertainty,
and of the highest moment to the animal economy. The
blood, by the action of the lungs, becomes of a brighter
red;  and here something is imparted  to the brain and
nerves, without which we cannot exist an instant.  This
appears to  be a modification of oxygen.
  It  has been  supposed  that the reception of oxygen
into the blood, through the lungs, was the cause of ani-
mal heat, but this is at best, a very doubtful matter, if
it be not really refuted.   It  seems more likely that ani-
mal heat is caused by the chymical operations within the
body;  fluids, in  becoming solids,  invariably elicit  heat.
It is probable, that the perpetual renewal of the solids
from  the fluids, set free a portion  of calorick,  or matter
of heat; and thus, instead of a centre of heat in the lungs,
the  very operation by which the solids are every where
formed, gives a  degree or quantity of heat, suited to the
particular well-being of each part.  The blood having
entered into the left ventricle of  the  heart, furnished
with this pabulum or food for the brain, nerves, and  the
whole system of systems, passes  on with an amazing
velocity through the arteries of the whole body.  The
arteries terminate in the veins, and the veins collect the
blood which is no longer fit for the purposes  of life, and
convey it back again to the heart.
  In  its course the blood not only gives nourishment in
the common acceptation of the word, but, with the aid of
the arteries, dissolves down and carries away worn out
parts, and leaves new animalized matter, precisely suit-
ed to the parts over which it passes; with the glands it
leaves juices, some of which are nutricious, someMissol-
vent, some lubricating, and others  excrementitious; and
to the bone it gives bone, to  the flesh it gives flesh, and
so of all the members of the body.  But' highest in  the
scale of  life is  that subtile  something  imparted to  the
brainular system; the brain and nerves, like  all  other
parts, owe their life and power, and perpetual renewal.
to the blood. 
OF THE HUMAN  BODY.
35
  The blood in  its course through  the  body, like the
watch of an army, exchanging sentinel for sentinel, ex-
changes particle for particle; leaving the healthy and vi-
gorous particle or soldier on his  post, while the exhaus-
ted or languishing one is led away for another occasion,
or dismissed the service.
  From about the extremities of the arteries, but not by
anastomosis, or immediate union of mouth to mouth, ari-
ses a set of fine thin vessels, called lymphaticks; these,
like the veins, collect their fluid from small to larger bran-
ches, and terminate in the lacteals, in the large veins,
and thoracick duct, which lies in the chest.
                            i

                     SECTION X.

                    Of the  Blood.

  The blood is composed of three parts, called the cras-
samentum, serum, and red globules.  The serum is that
watery part which geuerally rises to  the top when blood
is suffered to cool in a vessel; the crassamentum is blen-
ded with the red globules; the quantity or proportion of
each of those component parts of the  blood vary consid-
erably: we see it sometimes composed in great part of
serum.   It also  differs  much in  appearance in different
parts of  the healthy body, being florid in the arteries,
purple in the veins, and almost black in the liver,  and
in the great vein connected with the right auricle of the
heart.
  Chymically considered, the blood  is a compound of
many ingredients;  it has a portion of iron; but no ad-
vantage could be expected from  inquiring into its con-
stituent elements in this sketch; it is only by  torturing
it we can separate its parts, and  it is highly probable
that, by our clumsy experiments, we produce new com-
binations.  If the fragrant flower can drink up simple
water, (and this  we know to be a fact,) and give out all
its rich perfume, how little hope is there that we can trace
the elements of even the most simple body in nature! 
m
OF THE ANATOMY
                     SECTION XI.

                   Of the Glands.

  These exist in every part of the body, and are com-
posed of an assemblage of vessels; an artery, a vein, and
lymphatick, with their covering of cellular membrane,
enters  into the formation of every gland.  They differ
much in size, and in their functions; the salivary glands,
situated about the neck and mouth, separate the saliva
or spittle from the blood; the mammae, or breasts of the
female, separate the milk; the kidneys separate the urine,
and so on.  Every joint and every cavity is  constantly
moistened either with a fluid, or thin halitus.   Thus the
glands, constantly washed by the blood, abstract each
one something peculiar from it, or impart to it some new
properties, or lead from the mass excrementitious mat-
ters.   That function by which parts are  elected for  the
use of the system, is called secretion; that by which they
are rejected as useless or unfriendly, is called excretion.
Hence comes secretory, and excretory vessels, which are
probably nothing but  capilliary terminations of the arte-
ries and lymphaticks.

                     SECTION XII.

                   Of the Viscera.

  Having, in the preceding  pages, given some account
of all the parts which are blended more particularly
throughout  the  whole  system,  I come  now to treat of
parts which, although equally necessary for the general
welfare, nevertheless, occupy but a fixed place, and there
seemingly await the agents by which.they are brought
into action.  These are all the organs of the chest  ab-
domen, and pelvis, with their membranes and other ap-
pendages.  In  describing those parts,  I have thought
best to commence with what is usually called the primce
vim, or first passages.
   The masticated food  mixed with a quantity of saliva,
 or spittle, proportioned to the chewing it has  undergone, 
OF THE HUMAN  BODY.
37
passes over the windpipe, enters the throat through the
pharynx into the gullet or oesophagus,  thence  into the
stomach.   Being lodged in the stomach, digestion com-
mences;  such is the organization of the stomach, that its
secretory vessels pour out a juice, called the gastrick li-
quor; this  fluid  has the power of  dissolving down the
food into a thin  or pulpy mass, which  by some incom-
prehensible action in the stomach,  is raised up and pas-
sed out at  the pylorus or entrance into  the gut, for the
orifice is not on  the lower part of the stomach, but situ-
ated near its upper side: the food  now passes down the
intestinal canal, which runs in a tortuous direction through
the belly, and is five or six times the length of the whole
body.
   The intestines are divided by the anatomist into small
and large;  the smaller commence  at the stomach, and
are, first, the duodenum, jejunum,  and ilium; then com-
mences the larger, first, the colon; this  gut is long and
has the second attached to its side, called cozcum, which
is a mere blind  small tube-like appendage; and  lastly,.
the rectum; the termination of the rectum called anus,
is formed of a sphincter muscle, which, by surrounding
the orifice, commands the passage.   Those divisions  of
the intestines are in some measure arbitrary, but are ne-
cessary for the anatomist.  The intestines are provided
with  glands, or absorbent vessels,  which take up the
nutritious thin part of the food, while the grosser parts
are carried through the intestines,  by means of a con-
stant  vermicular motion called the peristaltick motion.
The aliment  having passed  into  the intestines, mixes
with  the bile and pancreatick juice:  the pancreas,  or
sweet bread, is  a large gland under the upper part of the
liver.  From the intestines arise a set of vessels called
the lacteals, whose office it is to take up the nutritious
part of the aliment called chyle; these  vessels, uniting
into larger branches, collect the chyle into one  duct  or
tube,  and convey it up through the chest, and then pass
it into the veins; these lacteal vessels  run on the me-
sentery, or that  strong  skin-like  substance  which ties
down the intestines in all their turnings, as we see  in
quadrupeds. 
38
OF THE ANATOMY
  The chyle being mixed with the blood, is conveyed
through the heart, thence through the lungs;  here, it  is
exposed to the atmospherick air, and becomes somewhat
animalized, passes through the heart again, and thence
into the general circulation. The intestines are also fur-
nished with vessels,  which constantly pour into  their
cavity a mucous substance, for  moistening and sheath-
ing their nervous  coat.  Hence  comes that constant col-
lection of feces, which must be notorious to every one,
for by giving purges daily, as well as in some  wasting
diseases,  we see  copious discharges from the bowels
even where no food is taken.   It is a curious fact  that
where the intestines were wounded  and sewed up with
thread, knotted on the outside, these knots, with the
whole thread, has been carried  into  the intestinal canal,
and carried oft', while at  the same  time the parts were
healed.
  The liver is composed in great measure of a tissue  of
vessels: and through it, there is an extensive circulation
of venous  blood:  it occupies a large  portion of the abdo-
men, filling the right side,  and lapping over the stomach;
its office is to secrete the bile from the blood; the bile is
an indispensable  ingredient in digestion, and is convey-
ed from the liver  into  the duodenum, or first intestine.
As an appendage or reservoir to the  liver we find a gall-
bladder, the duct or passage  from which runs into  that
from the liver, and it is only through this  duct the gall-
bladder is filled,  but for what precise purpose we know
not.
  On the  opposite, or left side of the belly, and in con-
tact with the stomach, lies the spleen; the office of which
is not known, but most probably it  is concerned in the
business of digestion:  this organ suffers particularly  in
long continued agues; and has given rise to the name of
a very unpleasant disease, the spleen, or hypochondria-
sis.  The kidneys lie in the back part of the abdomen,
at the upper part of the  loins, the one in some  mea,
sure under the liver,  and the  other  under the spleen;
they separate the urine from the blood;  from their cavi-
ties, into which the urine is secreted,  arise two tubes
called ureters; they  enter the bladder at its  neck,  in
• 
OF THE HUMAN BODY.
39
such a manner that nothing can pass out at these open-
ings;  from the  bladder  the  urine is occasionally forced
by the abdominal muscles, assisted by its own muscular
fibres.   The passage from the bladder outwards is cal-
led the urethra.
  The whole abdomen is lined with a sensible  mem-
brane called the peritoneum;  and over the fore part is
spread a net-like web, generally loaded with  fat, called
the omentum.   These,  then, complete the parts within
the abdomen and pelvis, excepting the organs of gene-
ration, which will be  spoken of occasionally, or  found
in the glossary at the  end of this book.
  The  chest or thorax, besides  the  heart,  the great
blood vessels, and thoracick duct,  or great chyle vessel,
contains  the pleura,  mediastinum,  pericardium,  and
lungs.   The whole chest is lined with  a  sensible mem-
brane which is called pleura,  the seat  of common pleu-
risy.  The breast in  the human subject, has a double
membranous partition,  which runs lengthwise, and is
called mediastinum; it  divides the two great lobes, or
portions of the lungs.  The heart is inclosed in  a strong
purse-like  sack, called pericardium.
  The lungs are formed of  two great lobes, and these
again are divided into,several smaller lobules; besides
the blood vessels, we find in the lungs a set  of vessels
called  bronchice, these, from  very small beginnings,
unite  into  larger trunks, till they  end upwards in  one
great trunk, called the trachea, or windpipe, which ends
in the back part of the mouth,  in a small  opening called
glottis, and this again is covered by a small lid, or flap,
called the  epiglottis; over this opening all the liquids
and food passes, and yet, such is its  wonderful  struc-
ture and power, that although open at  every  inspiration
and expiration of the breath,  it is but  seldom any acci-
dent occurs.
                   SECTION  XIII.

         Of the necessary distinction of Paris.

  It may not  be amiss  to give  a  short account of   the
names by  which medical writers  designate  particular 
40
OF THE ANATOMY
 parts, by a reference  to certain outward regions.   The
 hollow on the middle  of the breast is called the scrobi-
 culus cordis; the middle of the abdomen, or belly, above
 and  below the navel, about three fingers breadth, is
 called the umbilical region; the middle part of this, epi-
 gastrium; under the cartilages of the  lower ribs, hypo-
 chondrium; and from the  umbilical region, down to the
 pubis, hypogastrium.
   In the mouth the  following parts are  situated; the
 gums are too familiar to require description: Fauces, the
 top of the throat; palat, the roof of the mouth; uvula, a
 small fleshy process hanging from the hind part of the
 mouth, and usually called the palate of the mouth. This
 is subject to inflammation, in which case the muscles of
 the throat,  called pharyngeal, are  excited into action,
 and as it were, suck down this part, as they will all sub-
 stances with which  they come in contact.   This, so far
 as I recollect, is a new idea, and I am well convinced
 it is correct.  And hence it  follows, that to talk of ele-
 vating this part while the swelling continues,  is  ill
 founded; the only means for removing this unpleasant
 involuntary attempt at swallowing the uvula, is frequent
 gargling  with emollient articles, as milk and water,  or
thin  mucilage,  when it is accompanied with inflamma-
tion;  and as soon as the inflammation abates, or if the
 disorder  arises from relaxation, gargle with some spirit,
 or with  a strong decoction  of  oak bark, with a little
 alum.
  A strong faith in  the whimsical remedy of raising th«
palate by taking up forcibly a lock of hair, reminds one
of the ridiculous ideas which have so long maintained
their credit, of bleeding in the hands and feet, in the
head, stomach, and  uterine veins, &c.  when it is as well
known as any other fact upon earth,  that all the veins
communicate immediately with the heart.
  I have more than once seen the busy and woutd-be-
wise women bandying  about the terrible tale, that Miss
----  had been bled, at her own desire, in the uterine
 vein for miscarriage.  Oh! ignorance, where is thy bot-
tom?  Oh! envy, where is thy bounds?   Immeasurable
 as original sin, from which they sprung, naught can mea- 
OF THE HUMAN BODY.
41
sure or restrain these automaton monsters, save religion
and truth; for truth is wisdom in her loveliest garb.
   I have now described all the parts of the body which
I consider most interesting to be known: all those re-
maining, or  anatomical  terms, will be found either in
speaking of the organs of sense, on disease of the vari-
ous parts of the body, or in the glossary which will be
formed at the end of this work.   I  therefore conclude
the subject of anatomy with a short

                  RECAPITULATION.

   It will occur to those possessing a knowledge of ana-
tomy,  that some of the organs have been omitted; among
these is the eye, for instance; but a general outline hav-
ing been given, the reader must in  some measure be pre-
pared  to understand their structure and use,  so far as
may be  necessary for those for whom this work is  de-
signed, when I come to treat of the senses, or of disease.
   1st. I  spoke of the skin as a general envelope or co-
vering for the body, as being furnished with  nerves for
the sense of touch; and further, as sympathizing through
the medium of the nerves and vascular system with the
whole animal economy; and  I may add, that from  the
skin arise the nails and hair.
   2. Of the bones, as giving form and  support to the
body,  and having their blood-vessels and nerves, like
every other part: and I may  add here, that they are in
good measure composed  of lime or earthy matter; and
that the solid bones are hollow and filled with marrow,
having little or no sensation; the use of which we do not
understand.
   3. Of  the cartilage, as giving form, &c. to  the joints,
and connecting some of the  bones, being  what in com-
mon language is called gristle.
   4. Of  the ligaments, being formed out of the perios-
teum, and securing the joints firmly together; and of the
periosteum covering the  whole bony surface.
   5. Of  the muscles, as performing the motion of the
body;  being bundles of fleshy threads;  giving shape to
the body, and possessing  a  wonderful  living;  power.
               6 
42
OF THE ANATOMY
which decreases amazingly after death; for the muscle
which would have raised a heavy load, would not bear
the weight of a few pounds when dead.
   6. Of the tendons or sinews, as connecting the ends
of some of the muscles to the periosteum and bone.
   7. Of muscular organs within the body; and first, the
heart, to circulate the blood, undergoing incessantly, du-
ring life, dilation and contraction of its cavities; and
thereby sending the blood through the  lungs, and then
through the whole body.
   8. Of the  diaphram, being a muscle principally  in-
strumental in respiration, and as being  under the influ-
ence of the passions.
   9. Of the arteries,  as arising from the heart, and car-
rying the blood throughout the  whole  system, and  by
means of the blood constantly renewing every part and
taking away the old.
   10. Of the veins, as collecting the blood from the ex-
tremities of the arteries, and returning  it to the heart;
and of the lymphaticks, as collecting a thin fluid through-
out the body, and conveying it into the  veins.
   11. Of the brain, being the source of sensation, voli-
tion, and motion;  as going in a large column  down  the
spine, and further, as being probably distributed through
the system generally.
   12. Of the circulation, by which the blood is brought
into contact with every particle of living matter, and im-
parting life, even to the  brain and  nerves, and further.
as giving out animal heat.
   13. Of the glands,  as secreting from the blood the va-
rious juices of the body; being associated in the busi-
ness of filling every internal surface with moisture, &c.
   14. Of the  primcz  vice., or first passages,  being  the
stomach and intestines, whose  office it  is  to digest  the
food.
   15. Of the  lacteals, as taking  up the nutritious part
of the food, called chyle, and conveying it into the circu-
lating blood.
   16. Of the liver, secreting  the bile, and pouring it
into  the  intestines below the  stomach; and of the bile
being an  indispensable  ingredient in digestion;  and of 
OF THE HUMAN BODY.
43
a pancveatick juice being also poured into the first in-
testine.
  17. Of the spleen, the offices of which are unknown.
  18. Of the kidneys, secreting the urine and carrying
it into the bladder, through the ureters.
  19. Of the peritoneum, as lining the whole abdomen
and pelvis, and of the omentum covering the bowels.
  20. Of the pleura lining the breast, and being the seat
of pleurisy.
  21. Of the mediastinum, as dividing the chest length-
wise, and also running between the lobes of the lungs.
  22. Of the pericardium, like  a purse enclosing the
heart in a strong sack.
  23. Of the lungs, being composed  of two lobes;  ha-
ving bronchial vessels, which riseup and collect into one
large trunk, called trachea or windpipe, &c.
  Having gone thus far,  it only remains  to  speak of  a
few parts unnoticed, this will be done when treating of
their diseases, or of the organs of sense;  or will be suf-
ficiently  explained in the glossary, at the end of this
book. 
OF THE  SENSES.
                     SECTION I.

               Of the Sense of Touch.

THIS sense exists throughout the whole skin,  but in
greatest perfection in the fingers;  the organs by  which
it operates are pulpy  terminations of nerves, which ri-
sing up in little points, are called papillce.  It may be
remarked  of the  sense  of touch, that while the fingers
possess the  most  exquisite perceptions, they can  still
bear a greater degree  of temperature without pain, than
many other parts, particularly the cheeks.
  The sense of touch seems to  exist in  all parts fur-
nished with  a skin-like surface, and although the exter-
nal skin is more especially endowed with  this property,
we  are well assured that, the tongue, mou^h, throat, sto-
mach, intestines, &c. possess it in a high degree.   Pro-
bably, a large share of the perfect state of this sense in
the skin, is  owing to its being more particularly exerci-
sed in  that way.
  To this sense we may refer the pleasurable sensations
which  arise  from taking food into the stomach; and also
those from taking air  into the lungs.  These, from long
inattention, we are not very sensible of, but who has not
felt pleasurable sensations in the stomach, from  taking
in food after fasting some time? or who has not felt plea-
sure, and a  general invigoration, from inhaling the mild
breezes of salubrious  air into the lungs?
  And may we not carry our views a little further, and
inquire whether the brain too, is not endowed with this
sense,  in its common  acceptation? When we inhale ni-
trous oxyd gas, we apparently operate on the brain, by
the sense of touch, and as it were tickle the mistress of
the sensorium out of  her senses.  Like the tickling on 
OF THE SENSES.
45
 the external surface,  producing a  strange  mixture of
 pleasure,  pain, and violent action, this tickling of the
 brain, by means of this gas, produces violent, irregular,
 and exhausting  operations  of the mind.   If then,  this
 sense is so generally diffused through the system, and so
 intimately connected with the brainular system, with how
 much care ought  we to guard  the  organs by which it
 operates, from filth.   Let every one keep in view,  that
 if he daub his skin  with filth, or fill his  stomach with
 brandy, or inhales noxious air; these all, are in imme-
 diate contact with the brain.
   Hence it is well said, men steep their senses in wine.
 There is,  however, this difference between filth applied
 to the skin and lungs, and that  arising from the potions
 of  Bacchus, that the latter  is the most easily avoided,
 and generally speaking,  begets every kind of filth of
 body and mind, till its  wretched  victims, sometimes
 drag out a  miserable existence,  being a  mere living
 dunghill.   Of such it may be said,
        Poison not only lurks in every vein,
        But filth too, at length, crawls among the brain:
        Teazing, and increasing from ill to bail;
        Until past endurance, the man runs mad:
        Or, if by constitution good and strong,
        He is enabled to pursue the wrong;
        Why not see the fate of those gone before,
        And on the road to ruin find  one more.
        Or, how on such dire warning can he tread,
        While wife, or children, tears in rivers shed.

                      SECTION  II.

                Of the Sense of Taste.

  The organs of  taste are situated  on the tongue,  and
like those belonging to the touch, are little nervous  pa-
pillae, or points; they are only to be  found on the edges
and end of the tongue.  The upper  side, and middle of
the tongue being scabrous, or rough, is only suited for
moving the food through the mouth.   The use, and ap-
pearance of the tongue is so well known, that I have
only  to  observe, that it is  covered with a true  skin,
something like the skin of the body. 
46
OF THE SENSES.
  The taste of man is so much abused and perverted in
his infancy, that we can discover little or no relation be-
tween the aliment  and the  taste.   While the English-
man delights in  his beef and pudding, and the French-
man prefers his  light savoury articles, there  are people
found, who drink down rancid train oil with rapturoug
delight.
  The people of the United States  have no national
taste unless it be for coffee.
  The experience of ages has shown,  that man may
vary his food greatly; but the same experience teaches
us, that to be healthy, we must be temperate; or, in other
words, we must not multiply our  dishes too much, or
disease is the invariable forfeiture.   The taste must be
considered the lowest sense belonging to man; it, how-
ever, is one  which tends to equalise: from the king to
the beggar, disease will follow intemperance in  eating
or drinking.
  We are well  assured, that many great men who had
scarcely exercised this sense at all, lived on the most sim-
ple diet to a good old age.
  To brutes, pretty generally, it is  a tolerable guide for
selecting their food; not so  with man; for whosoever sets
about to whet up this sense for enjoyment in gormandi-
zing, obtains no  more pleasure than  the brute  enjoys dai-
ly, without instruction and  without pains:  and he seldom
fails to pay "dearly, very dearly, for the  whistle."
  It may be said, that while the taste stupidly licks up
the poison, perhaps rolled in  honey, the noble eye points
to danger.  Has your enemy the advantage  of the eye,
in position, the touch, roused by violence offered,  never
deceives in announcing danger; and are you  surrounded
by  darkness, the sense of hearing sounds the alarm; but
the taste, like the insidious serpent, beguiles its votaries.
Then, let me admonish you, beware;  for, like a turuu
lent and unruly  fellow, it must be kept low. It is a kind.
sweet servant, but makes a vicious master. 
OF THE SENSES.
47
                    SECTION  III.

             Of the Sense of Smelling.

  The immediate organ of smell  is a pulpy expansion
©f the olfactory nerves on the fine membrane  covering
the ethmoid bone,  called the sneiderian membrane.
How this nervous expansion takes up sensation Tind car-
ries it to the brain, we can form no conception: but we
know that all bodies which we can smell, emit effluvia, or
very fine particles,  which, by coming in contact with
the pulpy nerves, give impressions according to their
nature.
   The pleasure arising from the smelling of many arti-
cles  is considerable; but much is owing to habit, some
liking best  what others cannot endure:  and further, it
may be said, most perfumery is unwholesome when much
indulged in.
   Through  the organs of smell we can often operate
beneficially on persons affected with hysterick fits, or in
some cases of fainting, by means of pungent articles, as
burnt feathers, volatile spirit of hartshorn, &c,  when all
the other senses are, as it were, locked up.
   By applying suitable articles to the nose, we rouse the
slumbering energies of the system, and often enable the
person to recover recollection and muscular action, with-
out the use of any other means.
   It may be said of  this sense, that we are less depen-
dant on it than  any other, some persons having lost the
power of smelling, without experiencing much inconve-
nience.

                     SECTION IV.

             Of the Sense  of Hearing.

   The appearance of the external ear is well known; we
may however observe, that it owes its form to cartilage;
that it is admirably contrived for the purpose of collec-
ting sounds;  and its  internal parts are defended  from
accidents, in good measure, by a secretion of wax, and 
48                 OF THE  SENSES.
by hair within, which prevent dust or insects from en-
tering.
   From the internal ear there is a passage into the mouth,
called the eustachian tube, which is subservient to com-
plete hearing.
   The auditory nerves are deeply seated, and are acted
on by the vibration, or undulatory motions of the air, for
sound cannot pass through  the exhausted vessel of an
airpump.
   Such is the intricacy, multiplicity of parts, and won-
derful contrivance in the structure of the human ear, that
nothing in the body is less understood; nothing more
beautiful; nothing more strongly manifesting the wisdom
of the omniscient  architect.
   We speak of the  drum of the ear, and  of its hammer,
&c; from which  men were once contented to  believe,
these parts by their mere mechanical contrivance, per-
formed the act of hearing; but these speculations are now
at rest, for instances have been  found, where not only
the drum and  hammer, but several of the bones, have
come away without very much impairing the hearing.
   That all the parts are necessary for the most perfect
enjoyment of  this sense, is certain; but for the common
purposes of life, this sense may be quite good, and  suf-
ficient, after all those parts, which were once supposed
to be the exclusive organs of hearing, have come away,
from suppurations.
   Again, the ear  may be perfect in all its parts, and the
nervous power still wanting, by which  the  impression
could be carried to the sensorium, and this is a hopeless
source of deafness,  unless it be symptomatick of some
other disease.
   None of the senses are more liable to morbid  acute-
ness; so high is the  sensibility at  times in  the nerves,
that common sounds become painful, and false  sounds
arise within  the ear,  resembling the noise of boiling wa-
ter, the tinkling of bells, &c.
   The healthy ear,  perfectly formed, and  suitably ex-
ercised, is a source of the most sublime enjoyment.  All
nations adopt  musick in their forms of worship.  The
dulcet sounds  spread like  seraphick wings, and as  it 
OF THE SENSES.
49
 were, abstract the soul from the body, to soar aloft; and
 tower there!  till the sound dying away, the m nd falls
 again, gently, like the mild  dews of heaven.
   Who  can  enjoy the  rapturous  melody  arising from
 harmonious sounds, without catching a glimpse of hea-
 ven?

                    SECTION  V.

               Of the Sense of Seeing.

   The organs of this sense, are beautifully formed of a
 variety of parts,  many of which it would be useless to
 mention here.  Some of its most conspicuous parts may
 be enumerated with advantage; indeed it is absolutely
 necessary for every person, to have some knowledge of
 this important organ, that they may be enabled to under-
 stand the oculist, when speaking of its diseases.  The
 rational creature  who does not  acquire some knowledge
 of himself, is remiss in duty to his Creator, for it is by
 contemplating the works of nature,  we discover  more
 and more, the wisdom and goodness  of the Supreme.
   The eye, considered as a whole, is a hollow globe,
 filled with fluids. The substance which forms this globe,
 is of a membranous structure, formed  of different layers,
 called coats.   The external coat is a strong whitishsub-
 stance,  and surrounds the whole  eye, (except a small
 part in front;) it is called the sclerotick coat.  It termi-
 nates in a circular opening before,  and into this opening
 there is a circular transparent  coat inserted, called  the
 cornea; this resembles the chrystal set in a watch.  Over
 the sclerotick coat  is spread a thin  coat,  containing a
 great number of  veins,  which  are apt to  become very
 full and  red when the  eye is diseased.   It  may be
 dissected aAvay in part, without injury to the eye, when
 much inflammed.
   From the inner side of the  sclerotick coat,  near the
 termination of the cornea, goes  off a partition, which di-
vides the hollow globe into two chambers, called the an-
terior and posterior chambers.   This partition is called
the iris,  and is that part  which gives colour to the eye;
                          7 
&8
OF THE SENSES.
as the blue, hazle,  &c; it is perforated in the middle
with a round hole, called the pupil.
   Such is the wonderful structure, and power of the iris,
that it opens,  or  dilates the pupil, so  as to regulate the
quantity of light which strikes the  eye;  in a dark place
it opens the pupil to  a great size, in a strong light it
contracts it to a mere point.
   Immediately behind the  iris, lies a small body, some-
what like the glass of a spectacle,  called the chrystaline
lens;  this is the seat of cataract. This chrystaline lens,
theAvaterin  the anteriour  chamber, and the jelly-like
substance,  filling the greater part of the eye,  have got
the very improper names of humours of the eye, and are
knoAvn by the name of aquaous, chrystaline,  and vitri-
ous humours.
   Behind the vitrious  humour, and on the inner side of
the bottom of  the  eye, is a pulpy expansion of the op-
tick nerve, called the  retina.   Hoav  the light operates
on the nerve, and  causes  it to convey sensation to the
sensorium,  is altogether beyond our reach.
   I shall noAV endeavour to  explain how the light ope-
rates  to impress the  image of objects  on the retina.
Light  moves  only  in rays, or thread-like  lines, and
these  lines  or rays, ahvays retain a course  perfectly
straight, from point to point.  When these rays  pass
from a rare, to a denser body, they form an angle strik-
ing inward, toAvards the centre; when they pass from a
dense, to a  rarer body, they diverge,  or  strike outward,
or from the  centre.
   Again, the rays of light  are influenced by the surface
of bodies; opaque substances, reflecting the rays in va-
rious  directions,  while they pass  through transparent
ones, and are altered  in their  course, according to the
shape of the surfaces, at aainch they enter, and pass out.
   If the transparent body be of regular shape, as a spec-
tacle glass for instance, the rays  striking on, and pas-
sing out of a convex surface, the rays are thrown toge-
ther, and form a point called a focus, and this focus will
be nearer the glass in proportion to its  convexity.
   Now when  the rays of light are reflected from an ob-
ject, and strike on the eye, the  cornea being convex, 
OF THE SENSES.                 5i
 the water being denser than the air, and the chrystaline
 lens and vitrious humours  still more dense; the rays of
 light are brought to a focus,  on the nerve at the bottom
 of the eye, and here gives the  image of the object before
 us.
   If the eye be too flat, or  its humours too  thin, the
 rays of light will not be brought to & focus, but strike the
 retina scattered, in a circle, which gives  but a very im-
 perfect knowledge of the object that Ave Avish to see.
   This defect may be remedied by common convex spec-
 tacle glasses, Avhich by bringing the rays  sooner to a fo-
 cus, enables the long sighted  person  to vieAV the object
 nearer  to  the eye; and this  we see daily in  the  aged
 using spectacles.
   There are persons Avhose  eyes  are too convex, and
 therefore, they require concave glasses; these by spread-
 ing the rays of light  before they enter the  eye, extend
 the focus on to the retina,  and gives the image  of ob-
 jects, which with the naked eye, were not discernable.
   The importance of concave  glasses to near sighted
 persons, may be conceived of, Avhen we see the  spy-
 glass bringing objects into  view, which  the naked eye
 could not discern at all.
   The importance of vision  is  such, that every one must
 be conscious Iioav vastly he is indebted to it for the en-
joyments of life.  By this sense, Ave  survey the works
 of nature immediately around us, and  with the aid of op-
 tical instruments, reach in some  measure  the immensity
 of other Avorlds—the twinkling stars, centres  of other
 systems—the exhaustless sun—the mighty globes within
the solar system—the placid  moon, Avithin our orbit—
these lead us to believe, indeed, that, "after millions
of ages  have revolved, the great Father of the universe
Avill become more and  more incomprehensible."  And
well may we say, "the human mind  sinks beneath the
weight of the infinite object  of its future contemplations
and of its oAvn sublime and happy destiny." 
32
OF THE SENSES.
                     SECTION VI.

             Of the  Senses in General.

  Under this head I shall give a short recapitulation,
and  conclude with a few  inferences.   The organs  of
touch are the terminations  of nerves in the skin, and
seem to exist in  all the surfaces of internal parts.
  The  tongue is  furnished with  the  organs of  taste,
which also  are nervous papillae.   The people of the pre-
sent  age abuse this sense in particular.
  The  smelling poAver resides in the  pulpy expansion
of the olfactory nerves, and though subservient to man's
comfort, is  of iess  moment than any other sense.
  The  hearing  is effected  through intricate organs,  is
closely  allied Avith religion; and a source of high enjoy-
ment.
  The sight is, seemingly, of the most indispensable na-
ture  to man, a source of his greatest enjoyments; its or-
gan the eye, better understood than the other organs  of
sense.
  But  after  all the  wonderful powers,  and beautiful
symmetry,  which are found in the living system, Ave are
humbled with the fact, that they are but animal in their
nature; and Ave are met here by a still more humiliating
fact; so totally are the poAvers of body and  mind perver-
ted and abused,  that man, comparatively, is often beloAV
the quadruped of our farms.
  But  revelation  opens to  our vieAv poAvers  imperish-
able; when the nervous power shall die and pass away,
the  immortal mind  shall rise  superiour  to death, and
abide the  decrees of the righteous  Judge.   That the
mind and body are mutually dependant here, is certain;
but I fear Ave too often forget the great distinction.
  Dare I adopt  a neAV word, I  should speak of mind  as
the living innervous principle,  while I  should refer all
animal  actions to  a nervous principle, and according to
common phraseology, an alliance offensive and defen-
sive exists between them. 
OF THE CAUSE OF ANIMAL LIFE.         53
                    SECTION Ml.

            Of the  Cause  of Animal Life.

  i have thought proper to enter next on the cause of
animal life.  Here  1  am conscious of a  knotty subject,
but, however little  we can understand,  or explain  the
living principle, in  the present unsettled and imperfect
state of physiology, we are enabled, by  examining into
some of its laws, to discover useful truths.
  When Ave examine the body soon after death, Ave fre-
quently find every part to appearance  sound,  but  the
spirit of life is fled, and Avith it, sensation and thought.
If our examination  is  made pretty soon  after death, Ave
discover a power of motion  in the muscles, and by means
of galvanism, can throw them into convulsions.
  Hence comes a natural iuference, that life is continued
by the impressions of stimuli on the  living  principle.
Of this principle, we can  form no  distinct conceptions,
but its operations are evident; it is the hinge on which
both health and disease turn;  and it is  by accommoda-
ting stimuli to this  principle,  Ave preserve our health, or
remove disease.  It has been named, most generally,
excitability.
  Health consists in an equal distribution of this excita-.
ble principle throughout the  whole system.    An ani-
mal body Avanting this excitability, has no powers, and
soon undergoes decomposition.
  On this excitability various stimuli act to support life.
Thus light stimulates the eye, sound stimulates the car;
the air stimulates the lungs, and the food stimulates the
stomach; while the  blood stimulates the heart, the brain,
nerves, and in short,  every part having  excitability.   I
have said, health consists in an equal distribution of the
excitability; now, as  this   excitability  is exhausted by
stimuli, it follows, that if we over stimulate any one part,
we produce derangement,  and if long continued, or too
forcible, disease foiloAvs.
  When we operate on the excitability, by stimuli, Ave
produce exHtoment, aii>\ a  due balance betAveen this ex
eitement and the excitability, constitutes  health. 
 54        OF  THE CAUSE OF  ANIMAL LlFE.

   Tf we take a large quantity of any article into the sto-
 mach, it may stimulate by its quantity, although mild in
 its nature;  or  if we take ardent spirit,  or other very
 strong  articles which  stimulate by their quality, Ave  ex-
 haust the excitability; if they are carried too far), indiges-
 tion, or disease follows.   If we exercise moderately,  Ave
 raise the circulation and produce a moderate excitement,
 and thereby expend the excitability, slowly and equally,
 and are benefited by the exercise; for sleep soon  comes
 in to replenish  the store-house.   But if Ave exercise vio-
 lently, or continue it too long, we exhaust the excitabi-
 lity too rapidly, and unequally, and disease or inability
 to proceed,  follows.
   After a certain  expenditure of excitability, the body
 begins to languish; and we feel a propensity to  sleep.
 We place the body at rest and endeavour to  avoid the
 stimulus of light, sounds, and motion  and thought: thus
 situated, sleep kindly accepts the invitation, and spreads
 her  veil of  temporary oblivion over e\7ery sense.  We
pass several hours unconscious of existence, if thus com-
fortably situated; but if loud sounds assail us,  this mild
goddess of the night, retiring in  alarm,  the senses ex-
perience a temporary confusion.
   It has been remarked that old  age resembles  child-
hood; but in respect to sleep, there is  a vast difference.
While the child during sleep seems buried in death,
and may be carried from place to place without Avaking,
the aged generally find their sleep slight  and imperfect.
How the excitability is restored, during sleep, we can-
not even guess; but we know, sound and refreshing sleep
can only be  had by avoiding stimuli, to a  certain extent.
The stimulus of air on the lungs, and that arising from
an  increased circulation during sleep, aae the  only  sti-
muli absolutely necessary; a moderate  stimulus from
food in the stomach, is probably favourable to sleep.   I
shall speak  more particularly Avhen treating on the non-
naturals.
  I have also said, mind is dependant on a suitable con-
iormity of bodily organs.  Let us then extend charity
and forgiveness to those who do wrong, and endeavour,
by example and kind  measures to reclaim them  And 
OF MIND.
55
if we see the mind dormant in the idiot, Jet us not un-
charitably suppose the Almighty has forsaken him. The
capacity of mind is  still there; and unfettered from its
prison,  may rise clothed in glory, even without blemish.
Is thy  brother, then, thus afflicted in  this life? Take
heed, lest your  lustful passions  shall condemn thee,
while he fares well.  From the loAvest grade of idiotism,
let us view man as destined for immortality; nor dare to
despise him.
  By Revelation  Ave are bound to believe, that man is
accountable for the deeds done in the body; and it is ex-
perimentally known that the sum of happiness,  of any
community, is proportioned to the practice of virtue in it.
It is also experimentally known, that drunkenness  not
only impairs the mind and body, but that it completely
destroys the moral faculty in many persons.  Drunken-
ness being generally the source of other vices, is a hei-
nous crime, and ought to be named infidelity.

                    section  vm.

                      Of Mind.

  On a slight vieAV, it may be thought,  medicine has
little  to do with the mind; but on a little reflection we
Avill find,  that in civilized life, at least, the person Avho
has not some knoAvledge of the mutual influence of mind
and body,  is neither acquainted with disease, nor capa-
ble of administering relief.  I shall not pretend to any
nice distinction of the attributes of mind, or attempt any
conjectures of its nature, further than to give a few clear
positions, from  which a few  practical inferences may
be drawn.
  First. Mind, as associated with animal life,  is a ca-
pacity merely, and therefore, it is through the senses only,
we can awaken and exercise it into reasonable maturity.
  Secondly.  Mind active,  or  dormant, resides in every
human  creature;  and being a  created something, must
be subject to change; for nothing but Deity can be im-
mutable. 
56
SUMMARY  ©F
   Thirdly.  Every thing subject to change must be sus-
ceptible of deterioration, as Avell as improvement.   In a
rational creature, there can be no merit, and probably
but imperfect enjoyment, without temptation to do  evil.
   Fourthly. There resides in every human  creature, a
moral  faculty, or power of  distinguishing  right from
wrong; if it sleeps among sound brainular organs, it must
be for  want of incitements to awaken it.
   Fifthly.  Disease may impair every attribute of mind,
the government of the passions, the memory,  will, judg-
ment,  all,  are often  impaired by disease—nor is the
moral  faculty, exempt from the operation of  physical
causes.
   Sixthly. Mind, although connected with sensible or-
gans, is wholly independent of them in one respect; for
when the body shall perish, the mind shall enlarge, and
flourish in renovated  vigour, till a  new  body rising up
at the  smile of our Saviour,  shall unite therewith and
form a  new creature, destined for immortality.   A God!
a Heaven! a creature immortal! all these! in view of man,
oh! favoured mind of man, hoAv art thou exalted;  how
canst thou  then,  refrain from aspiring with constancy
after this, thine destinity.
  I have said  mind is a capacity only, how much then,
does it behoove us to  improve it  with the most sacred
care.   It is a luxuriant soil, and unless instruction, and
example shall awaken the mental  faculties to the  prac-
tice of  virtue,  vice, like  the weeds  of  our gardens, will
grow vigorously; for the seeds are within, and  bad ex-
ample  is never wanting, for corrupting the weak or un-
thinking.  Now, virtue  under every form is temperance,
and therefore, by the constant practice of it, we improve
both mind and body.

                     SECTION IX.

        Summary of Physiological Sketches.

   Having now arrived  at the end of my observations on
the healthy body, I shall conclude with a very short re-
capitulation; and then enter on the nonnaturals, on the 
PHYSIOLOGICAL SKETCHES.           57
 morbid pulse, and give some directions respecting bleed-
 ing, before I treat on the diseases to Avhich we are sub-
ject.  We find the human body a wonderful assemblage
 of parts: moving solids, and moving fluids; with  organs
 of perception, constitute  this complex, yet  beautiful li-
 ving system.  We find it undergoing perpetual renewal;
 for which purpose we must immerse it in air, defend it
 from the cold, and sustain it by food  and  drink; enjoy
its  reasonable animal  pleasures; and  lastly, Ave find a
powerful mind, evolved from the exercise of the various
parts of the body.
   We find the mind capable of directing us, and destin-
 ed  to lead to immortality.   If,  then, Ave find our  bodies
 beautifully formed; let us not forget they are feeble.  If
 Ave find life vigorous;  let us not forget it is short, and
uncertain.  If we find  man destined for immortality; let
us not forget, Ave  may  lose its blessings.  If Ave find a
mutual  connexion betAveen body and mind, let us with
equal care nurture  and  defend them.   Enjoyments!
health!  and future prospects!  are bottomed on  tempe-
 rttncp and activity*.
>; 
           OF THE NONNATURALS.


PHYSICIANS under this name include air, food'waft.
drink, sleep, clothing, exercise, excretions, and the pas-
sions   I shall take them up in the order in Avhich they
have been mentioned, and endeavour to give a few gene-
ral rules, respecting each of them.

                     SECTION I.

                     Of the Air.

  The atmospherick air Avhich we breath, is a compound
of two  ingredients, called oxygen, and azote, diluted
to a  great extent by heat.  Oxygen  is the vital part,
while azote,  is even  deleterious;  they exist in the pro-
portion of about twenty-seven of the former and  seventy-
three parts of the latter.  This  at first vieAV seems a
small proportion of the sustaining principle, but, on ex-
amination Ave find more oxygen would hurry on life too
rapidly, and  would soon exhaust the powers thereof.
  We know, that a variety of salts, &c. can be dissolv-
ed in the same water; in like manner,  a great many ar-
ticles will dissolve in  air.   The dissolving power of the
air, is much greater than is generally imagined;  almost
every substance in  nature  may be dissolved in it; even
the metals  can be volatilized, aid suspended in the air.
  The sense of smell discovers a  great variety of float-
ing bodies, in the air  Ave breathe.
  We are here met by a surprising fact;  so regular is
nature in  many of her most  important laws, that a de-
viation from them can  scarcely be found.   While the air
of the mountain is light, and that of the valley heavy,
and that of the city loaded with millions of effluvia; still
Aye find the proportion of the two great component parts> 
OF THE AIR.
59
to be ever nearly the same.   The most accurate chymi-
cal experiments finds the air of the city, and that of the
country alike.
   We fill the surrounding air  with myriads of arti-
cles,  arising from our ravages on natural and artificial
substances; Ave contaminate vast quantities by our bodies;
yet bounteous nature, from her  immense laboratories,
pours out quantities inexhaustible.
   From pole to pole, from mountain  to mountain, from
sea to sea; or from hillock to hillock, this precious balm
of life sAveeps the surface: true as the sun to his celestial
course, this  second parent of  organization and life, in-
cessantly displays her charms, and without price, gives
to myriads of creatures conscious existence.
   It  is only in obstructing  her course, or Avantonly fil-
ling the space around us Avith filthy effluvia, that in ge-
neral begets the evils arising from the air.
   We are hoAvever,  compelled to  acknowledge, that
here, as in many other  cases,  the  Creator has thought
proper to mix evil  Avith good; and  Avith the good gift,
has made the mild  breeze  to  come  sometimes  loaded
Avith disease and Avith death.
   And at times, the air, as if alarmed at its  own lan-
gour, seems to take au  alarm, and  rising up in terri-
ble majesty, pours out, Avith irresistible force, her pow-
ers; and drives the sea into mountains of Avater, or Avith
a single sweep, prostrates a Avhole  forest.
   It is an unquestionable fact, that Ave are under a great
weight of  air.  If Ave set a tube, a  pump-stock for in-
stance, in water, and exhaust the air by means of a pis-
ton or sucker, the water will rise  about  thirty-two feet
without any force; hence it  follows that Ave move under
a column of air,  which,  is equal  to the Aveight  of a co-
lumn of water thirty-two feet.  This is a great weight;
but when we consider  its  application to the surface  of
our Avhole body, it will  appear an immense load.  From
this,  we may plainly see it is not necessary for us  to
draAV air into the lungs; if  Ave empty the lungs by con-
tracting ov lessening the chest, the heavy air rushes in.
   To be healthy, it is probable nothing is necessary but
a due proportion of oxygen  and azote; a reasonable 
60
OF THE AIR.
temperature, and elasticity, comes as a matter of course.
HoAvever, happily for1 us, many articles floating in the
air do us no material injury; neither is great  precision
necessary, as to temperature: man enjoys health almost
from pole to pole.
  Believing as I do, that no one will doubt the influence
which air must have over us, nor that it  is susceptible
of, and actually does take up a great variety of articles,
many of which are unhealthy,  as the effluvia  arising
from marshy grounds, covered Avith decaying vegetables,
{the source of agues) or the seeds of some diseases, as the
smallpox, I think  it necessary to  give a few general di-
rections.
  Houses ought to be built in open, high situations, so
that nuisances may be washed away, and that we may
have a free circulation of air.
  We should carefully remove all filth from about  our
houses;  and remove  our manure  frequently, and endea-
vour to cover it Avith the earth as soon as possible.
  We should Avhite-wash  our houses  frequently with
lime:  the papering  of common  sitting-rooms, or  bed-
chambers, is certainly improper.
  We shouLd burn all the useless offals of our kitchens,
and of our manufactories, that Ave cannot convert imme-
diately to manure, and have removed.
  We should  not confine ourselves too much at night;
exposure to  the night deAVS is generally unhealthy; but
our bed-rooms  ought to be very spacious,  or well venti-
lated. If you dread leaving open your door, or Avindows,
in summer,  at least, you ought  to  have ventilators in
your doors or  windoAvs.  It  is always best for but feAV
persons to sleep in the same room.
  Endeavour to avoid ponds of stagnated water; and if
you cannot remove them, keep vegetable, or dead  ani-
mal substances, as much from them as possible.
   I'oo  many  trees  near your house  cannot be  whole-
some; they  at times keep up too great  a moisture,  and
at all times they give out unwholesome air at night:  it
is a fact, that the  vegetables which to the light of day,
give out oxygen, to the darkness of night, give nothiug
but foul, carbonated air.  A good garden near the house, 
OF THE AIR.
61
with your trees at a reasonable distance, is both beauti-
ful and healthy.
  Children ought to be freely exposed to the air:  it is
better  to  expose them to severe cold,  or  even wet by
times,  than to keep them too close.
  Cities,  in general, are destructive to  health; but it is,
perhaps, more owing to obstructions given to the current
of air,  and to filthiness, than any other cause; and hence
it is probable, modern cities are much more healthy than
ancient ones;  because, our streets  are  more open, and
our rooms more spacious; we are more cleanly, and Avith-
out Avails or ditches: with due attention to these things,
it is probably the old tales of contagion  will soon be for-
gotten.
  All  large manufactories  ought to be in the country,
and  remote from cities.
  We ought to have as few animals in cities as  pos-
sible;  they contaminate a great deal of air, and leave
much filth.
  We ought to bury our dead reasonably remote  from
cities,  and Avhen convenient, they should be  enclosed in
metal coffins.
  We ought to build our churches  of the most substan-
tial  materials,  as best brick or  stone; they ought to be
spacious, openly situated;  built high, with large doors
and  Avindows;  they should be freely ventilated, by
opening the doors and windows often, or  have large
ventilators; they ought not  to be  kept dark; the sun
should be admitted freely every day.  In damp weather
they should be Avell dried with stoves,  even  in the  sum-
mer.   The floors should be often cleaned,  as well as
the  seats; and the walls should be  frequently  white-
washed.   With these  precautions, the  valetudinary
would have nothing to dread from going to  church.  But
as things now stand, it is a lamentable fact,  that many
delicate persons  are  seriously  injured  by going  to
church, because they are damp, poorly ventilated,  con-
stantly kept dark, too small or too low, or perhaps de-
caying, or in stifled, low situations; or loaded with filth
on the floors, seats and walls. 
6S                  OF ALIMENT.
   If you would approach the Supreme Ruler, let it be
 the first wish of your heart, when you come more particu-
 larly into his presence, to come clean and pure; and into
 a place suitable to the great errand on which you go.
 For even an approving and accept ng Heavenly Father,
 has chosen in general, to bless his people by the opera-
 tion of general laws.   If these are  not attended to,  our
 work is often lost, because He in his providence has or-
 dered  that man shall only reach the throne,  through his
 own efforts, aided by the intercession of the lamb, which
 shed light  over the Avorld! then died to rise in  new
 splendour! not fierce like  death, but lovely  as  love!
 which is the great  "I am that I am."  (See Exodus^
 chap. 3.  ver. 14.  and also the Spectator*

                     SECTION  II.

                    Of Aliment.

   Such is the amazing variety of nature's bountiful pro-
 vision of aliment for man, that I consider it preposterous
 in the  extreme, to  attempt any  thing like a particular
 account of  each article,  for such is the variety of arti-
 cles; such the idiosyncracies in the human stomach, that
 volumes would not suffice to point out the particularities
 of each case.
   In as much as every man  must have a stomach of his
 OAvn, you might as Avell look for a similarity of features
 iu the face,  as  for stomachs precisely alike; and there-
 fore, no very precise rules  can  be  laid down.  Nay,
 more, the very  same stomach is liable to great changes,
 so that articles., that were once the most agreeable/be-
 come unfriendly and even dangerous.
   Let us not then pretend to too nice a distinction,  for
 it is a true saying, that what is one man's meat, is ano-
 ther man's poison.  I shall therefore confine myself to a
 few general  remarks,  for much  must be  done by each
 individual whose  stomach is impaired, to discover what
 articles are  most agreeable.   Fortunately, the generali-
 ty of mankind have little to  dread from all common  ar-
ticles of food, unless they are used in excess. 
OF ALIMENT.
63
     That we,  as creatures of nature, are subject to natu-
   ral laws, must be  clear, but Ave may mistake  our own
   shallow conceits  for her laAvs.  Men have been  found
   advocating the using of our food, as  near a state of na-
   ture as could well be, and hence comes the custom of
   eating raAV beef.   But I think, a little inquiry Avill con-
   vince us, that man Avas not designed, like the lion of the
   forest, to eat his animal food raw; because, the using raw
   animal food  almost invariably begets a ferocious dispo-
   sition.   Did man long after the  bleeding  carcase,—wo
   be to the world,  for it Avould be a scene of horrour, and
   desolation.
     Perhaps the only thing which invariably and abso-
   lutely distinguishes man  from all other animals, is his
   knowledge of the use, and proper management of fire.
     The  daring  ourang outang Avalks the  forest,  and
   mocks  the proud erect walk of man.  Many animals
   ^J«cover a sagacity which may Avell surprise us, but
   man only, under all circumstances, perceives the use of
   fire, and applies it to his  wants.   Although  we must
   acknoAvledge some feAv exceptions, mankind in general,
   apply it to the preparation of their food.
     Now as there  is not such a thing as half truths or half
   laws in nature; it would seem to follow as a fair induc-
   tion, that we must either take a thing wholly from na-
   ture, or trust wholly to her own process.   If you take
   nature for your cook,  be  consistent,  and use your  ani-
   mal food reaking in its blood, and  not carry it to your
   table scorched on the  outside, and bleeding within;  this
   is a mockery of  nature, a slur upon  your  cook, and the
   bane of your health.  It follows, that I am an advocate
   for having animal food Avell done.
     The animal food of the United  States  consists prin-
   cipally of the following familiar articles;  and as stand-
   ing articles, they are used most in  the order in which
   they are mentioned:  beef,  pork, mutton,  veal, poultry,
   and fish.  All of these in common  use, are wholesome
;   agreeable food, when  used  temperately.
     Where circumstances do not forbid, they are best used
[   ffesh, being more Avholesome and giving more nourish' 
64
OF ALIMENT.
ment.  More vegetables ought to be eaten with salt meat
than with fresh.
  Eggs, butter, and cheese, are articles in very, common
use; in moderation they are all sufficiently wholesome,
but I  have  no hesitation in saying too much cheese is
used, and too much rancid butter, in this country,   If
butter  cannot be had nice and fresh, the better way is
to melt it in small parcels at a time,  and  use it in pies,
dumplings, &c.
  Butter should abvays be eaten sparingly, and rather
than eat it rancid, take dry toast.   I also think I may
with propriety say, too much  salted  meat, and fish  are
used,  if not generally,  at least in many families.   It
must be obvious to all, that persons Avho labour hard,
require more solid animal food than  those who lead  se-
dentary lives.
  Too  much animal salted food, is neither nourishing
nor wholesome; persons who use it freely must use  ve-
getables, or scurvy is the consequence.
  The United  States are blessed, in a peculiar manner,
with a variety of the  choicest vegetables suitable  for
bread, and eA^ery other purpose; and also plenty of fruit*
many of them natives, and others  which prosper abun-
dantly with us.
  First in value, as food for man, Ave may place wheat,
rye, speltz, Indian corn, potatoes, barley, rice, and buck-
wheat.   Bread for common use, is probably best made
of a mixture, of wheat or speltz, with corn, or rye, or
even both.
  To  make  good bread it must be  well raised, .but to
talk of fermenting dough, in the common acceptation of
the word, is wrong; but there  is a peculiar fermentation
which  dough undergoes, very properly called the bread,
or panary fermentation.  This species of fermentation is
very rapid, and in  general, the more rapidly dough is
carried through it the  better;  for it  soon changes into
the acetous fermentation, Avhich at once sours and spoils
the bread.   With good sweet yeast, warm flour and wa-
ter, and a warm place to keep your dough; not more than
an hour will be necessary to raise bread.  It is well as-
certained, warm or very fresh bread  is not  wholesome; 
OF ALIMENT.
65
in general, I Avould recommend to families to bake twice
a week.
   Frequent changes of the lighter  kinds  of bread,  is
pleasant and Avholesome; but in general they are eaten
too warm, and with too much butter.   A suitable portion
of molasses, honey, or apple-butter, Avill be more Avhole-
some;  and to those  in  good circumstances,  who prefer
either  of the above mixed with their butter, they will
find it more agreeable to the stomach.
   The poor of the United  States neglect the use  of the
potatoe, shamefully.  It would be better for them to use
potatoes as a standing article, than  either rye  or  buck-
wheat; and it would often  be in their poAver to procure
a nourishing food, for a large family, from a very  small
patch, which would not cost but a few days' labour; for
nothing produces more abundantly; and I have no hesi-
tation  in saying, they are infinitely better than bad-made
bread, even from Avheat.   Many  men of firm stamina,
and lively, vigorous minds, have been raised on this ar-
ticle, with milk.
   The sweet potatoe is also very nourishing,  and a good
substitute for bread;  but is of difficult culture, except in
a very feAV places.  The common potatoe thrives  every
where, with reasonable care;  and easily could a poor
man raise as many with a hoe, as would feed a cow, and
support a smart family Avith a reasonable portion of ani-
mal food.  Such people Avould gain  in health what the
rich lose by living too high.  The poor man will labour
a whole day for a bushel of Avheat, and very  often less;
in one day he could perform labour equivalent to that of
raising twenty bushels of potatoes; from these  he  gives
no miller's toll; but  the tenth of  a good crop will keep
a hog, which yields in time a delicious  feast  of  meat,
sausage, &c.  But, unfortunately, even the  beggar,  in
this country, Avould be ashamed to be caught making a
meal without bread:  such is the prejudice in its favour.
   Before  quitting this  subject, I 'beg leave to say, we
use a great deal too  much  bread  in this country.   The
vast number of mills which every where prosper, plain-
ly show it.  If the rich, with whom the toll is no object,
prefer filling the stomach with light bread at every  meal,
                    9 
66
OF ALIMENT.
let the poor be assured, that by using much of his grain
boiled, he  not  only saves the toll, but, may  also  save
himself from a great  deal of trouble,  loss of time in
borrowing  horses, &c.  for which he often exposes  him-
self to the  frowns of his neighbour.   Nothing is  more
pleasant than well-boiled hominy, or boiled barley, or,
where it is cheap enough, rice,  and  nothing is  more
healthy; and even in the use of his flour, and  of Indian
meal, much fuel will be saved by using tbem in  dum-
plings, &c.  Children are universally fond of dumplings,
puddings,  &c. and I am satisfied  they  Avould  nourish a
king.
  While speaking of the potatoe,  let us not forget that a
great patriot, a Marion, was not ashamed to dine before
the proud Britons, on this root alone.
  No vegetable, perhaps,  in  the  United States,  is so
much neglected as the beet; we seldom see it  unless in
a slice or twro of pickle, and yet nothing is  more palata-
ble, when  well boiled and  eaten as  sauce;  nor  more
wholesome and nutritious; besides, nothing will  yield
such an immense crop  from good ground.
  The poor  also  neglect the onion; eaten  raAV, as they
generally are, they are harsh  and  indigestible; but  when
well boiled, are a mild nourishing article.
  We are  blessed Avith an  astonishing variety of vege-
tables, in the form of leaves,  roots,  or  fruit; those  that
are eatable, are generally known, and require little to
be said respecting them.   Ripe fruits  are  best used as
nature matured them,  but we  preserve such as will not
keep, in sugar; in this form they should be used  more
sparingly.   Unripe fruit can be used in moderation with
safety, cooked  with sugar.
   Vegetables,  if cooked at all, should be well done; for
by merely  parboiling them, you toughen and render them
more difficult of digestion.
   A  reasonable proportion of condiments are at all  times
necessary  with our food, whether animal or  vegetable;
of these, we have quite a sufficiency for the healthy sto-
mach, in our own country: they are principally salt,  mus-
 tard, horseradish, garlick, onions, red pepper, pickles.
 vinegar, &c. 
OF ALIMENT.
67
  It may perhaps not be generally known, that flour mo-
derately sour may be  rendered sweet, pleasant, and
wholesome, by using  a very little pot or  pearl ash with
it; the potash must be dissolved in a good deal of water,
and mixed in making the  dough; if you add too much
potash, your bread will be yellowish, and unpleasant.
This kind of flour is best used in  the form of cakes,
dumplings,  and puddings; all of Avhich it will make
nice, pleasant and wholesome.
  With soups, formed of  our meat and vegetables;  our
milk, with rice, hominy, potatoes, or mush, &c. the Ame-
rican might pass the year, and at its end  return the most
grateful thanks to his  Creator for having  thus bountiful-
ly blessed him; but this is far from being the case, and
we are obliged to speak  of foreign articles before we
conclude.
  And first comes coffee, this although an exotick, has
in a manner become the second  staff of life.  Coffee no
doubt, is a pleasant grateful cordial, when taken in mo-
deration; but did not  our country bless us with a plenty
of substantial articles, we should soon become as lean
as the king-fisher, on  coffee.
  Nearly the same thing may be said of tea, when good,
but much of our tea has lost its aroma before it is used,
and of course, is inferiour as a mild pleasant cordial to
many of the herbs of  our  mountains and  gardens.
  Chocolate Avhen good, contains some nourishment, but
is less cordial than tea, or coffee, &c. too often it is made
of rancid oils, or fat,  and  is then certainly less friendly
than milk, in some form.
  Upon the whole, we  would be infinitely better^ was
eoffee, tea,  and  chocolate, banished  the country; or at
most, they ought to be reserved as in times of old, for a
treat to a friend or for the  sick.   That they should have
become principals in our diet, is a disgrace to our coun-
try, and a high offence against  the bounteous gifts  of
heaven.
  The people of the United  States found a second pa-
radise.   They multiplied  and rose, under a kind provi-
dence, to be a great nation; great in industry; great  in
simplicity;  great in  unanimity; and   great in plenty. 
68
OF ALIMENT.
Their cornucopse, spacious as the heavens which over
spread  them, poured all  the real comforts of life over
their head, most plenteously.   And they were also ena-
bled to spare a little for the luxuries of life; wines, spi-
ceries, and  a few other articles, were obtained in  ex-
change for the products of their soil: This, I fear, Avas
the golden era of America; but would to God, I may be
mistaken, and that my country as it ever has been, shall
continue to be, the  admiration of  nations, and the fa-
vourite of heaven.
  But ah! long since has busy ambition, pride, and ava-
rice, the enemies of freemen, began their  career—-their
daring, but  smiling  witcheries, have caught  the  rising
generation,  and with gigantick  strides, like the bound-
ing lion on the lamb, they are crushing the nation—rise,
then, from your slumbers, ye growing angels,* and ra-
ther lick the dust of your country, than satiate your sto-
machs with the honey of Europe.  There the poison
lurks; then beware, and if you love your  country, love
her productions.   She is the august parent of a Wash-
ington; of millions of freemen, and  of every rational and
reasonable comfort.
  I shall conclude this article with a few general  rules,
which, if attended to, may be useful.
  Vast injury is done by eating too much;  therefore, we
ought in general, instead of oppressing the stomach, to
eat rather less than the appetite calls for.
  A suitable mixture  of animal and vegetable food is
not only to most persons most agreeable, but  absolutely
necessary.
  Our country abounds with milk; and we ought to use
it plentifully.
  It is  safer to exceed in a vegetable diet, than in one
of salted animal food.
  In cold weather we may use oily articles more freely;
thus nuts  seem designed for winter;  while, the greater
number of fruits are  suitable for summer.  More  vege-
tables, therefore, in general, should be used in the sum-
mer, than in the winter months.
*Our youth. 
OF ALIMENT.
69
  It is always unhealthy to fill the stomach with two or
three kinds of meat, fish, and cheese, at one meal, which
is done by  many  persons  every day:  the  more simple
your meal the better.
  No one article of diet ought to be long continued; ex-
perience justifies  the belief, that those Avho use simpli-
city in diet, but vary it almost every day,  are the most
healthy; and it certainly is most  agreeable to most per-
sons.
  The aged ought to eat the most succulent and nourish-^
ing diet; to eat very frequently, but never  oppress the
stomach; long intervals between their meals are extreme-
ly pernicious; and I have no  doubt but many are hur-
ried away by inattention to this particular.
  Those, then, Avhose duty it  may be to cherish the de-
clining parent, should let nothing interfere with the pro-
curing of them a constant store  of savoury, nourishing ar-
ticles; for of all the organs which receive impressions from
suitable stimuli, the  stomach is the  last to yield to age;
and I have said, (see animal life) that life is supported
by  stimuli.   As a general rule, it Avill hold,  that the
aged  need  less salt and less  spiceries, but more  fresh
animal food and cordial drinks;  and never let them re-
tire to bed Avithout a reasonable supper of something so-
lid; nor fast long in the morning.  Their sleep is imper-
fect, and they are distressed  and exposed to danger if
they do not obtain an early breakfast.
  It is improper to take the principal part of our food at
one meal per day: it had better be four, and ought never
to be  less than three meals.   Those who smile at the
clown who takes  his hearty breakfast and supper, and
suppose he only can  be genteel who takes all his food at
dinner, may take care lest the  gout  turn their levity into
sorroAV.  If I mistake not, this custom savours much of
gluttony, and above  all things, is calculated to enervate
the body.  They who practise  it, have generally to force
the stomach with  brandy or wine;  by this means they
may move the load slowly off the stomach; but it is like
whipping a team through the mire, and never fails to ex
haust the powers of the stomach. 
70
OF ALIMENT.
   When habit  does not forbid, supper is probably the
best meal; but Ave are  accustomed, from our infancy, to
light suppers, and  therefore,  in general, although they
ought to be reasonable, they should not be heavy.
   He Avho lives most on the products of our own coun
try, certainly lives most wisely, and will have the best
chance for health.
   All our food,  both animal and vegetable, should be at
least perfectly sound;  inattention to this will often pro-
duce disease.
   To those who cannot do Avithout coffee, I would re
commend the mixing the coffee bean with barley,  or
wheat; and am certain it would be healthy, and  a vast
saving to the country,   Barley, if slowly and thorough-
ly toasted, without burning, or wheat bread sliced thin,
and toasted through, without scorching, Avill make a cof-
fee pleasant and wholesome.
   Our posterity will probably blush, at some future day,
to acknowledge, that for the luxuries  of coffee and tea,
we expended  sums nearly equal to the proceeds of all
our exports of eatables.  The day may come when these
follies shall be considered as extravagant, as the feasts
of peacocks' tongues, of the vain of a former age.
   An observance of the  foregoing  rules, will generally
be sufficient for those in  health.  For the valetudinary,
and the  sick, directions  will  be given in  their proper
place.   It therefore only remains under this head,  to say
something respecting our drink.
   At first vieAV of our  drinks  Ave are struck with  a vast
variety, but by a little  reflection, we are taught that the
base of all  of them is Avater, and, as a diluent, it is per-
haps, all that is necessary.   But custom  has adopted a
great variety  of pleasant  drinks;  some  of which are
slightly nourishing, and others cordial.
   A cordial,  strictly speaking, is that which excites sen-
sation, and involuntary motion, without giving any sub-
stance or actual  nourishment.
   Therefore  solids may be cordial in their nature, as
opium for instance, which in low grades of action  in the
blood vessels, gives  comfort and strength, but certainly
yields no nutriment. 
OF ALIMENT.
71
  The best idea which I can form of the action of a cor
dial is, that it operates  immediately on the  nerves, and
through the sense of touch.   (See the article,  Sense of
Touch.)   If the body is cleansed, and  soft,  pleasant
clothing applied, and Ave enjoy a fine  mild air, we for a
Avhile feel almost a new life.   We feel lively, strong and
good humoured.  Here we receive no actual nutriment,
but are operated on through the medium of  the sense of
touch, by the pleasant stimulus applied  to the surface.
  In like manner, Avhen Ave  take a fluid or solid cordial,
it operates immediately on  the nerves  of touch, Avhich
exist on  every surface,  in or out of the body, and car-
ries a grateful feeling to the brain; and thence,  almost
instantly, throughout the whole body.   So far as my re-
collection serves me, this opinion is my  own; and I hope
it Avill be found sufficiently simple and rational.
  Now,  it must be observed, that cordials being  a mere
stimulus, and imparting to the body no nutriment, it can
no  more  support us than the agreeable stimulus before
mentioned on the skin;  but both act  as a mere spur  on
the living system, Avhile the nutriment  must come from
other sources.  On the other hand,  if we apply some-
thing very rough to the  surface, or if  we tickle a  person
violently, we produce pain, and exhaust  the system, in
proportion to the continuance of the violence;  and through
that very organ (the skin) which received the pleasura-
ble impressions in my first case: we can tickle a person,
perhaps, even to death.
  In like manner, if we take too much ardent spirit, or
opium, without infusing one single particle of substance,
or  nutriment, we stimulate the nerves of touch violently,
and produce a rapid exhaustion of the  principle  of life.
All cordial drinks only give an actual support to the body,
in proportion to the quantity of gelatin, oils,  or sugar, or
water, which they  contain.   Alkohol, the base of spiri-
tuous drink, is wholly different from  any thing existing
in the vegetable, from which it is  produced by fermenta-
tion, and before it  can enter the circulation  must be de-
composed.
   Like the spur which goads on the  horse, with spirits
we drive on the poAvers of life to great exertion, and soon 
7«
OF ALIMENT.
exhaust every energy, without adding one single parti-
cle of support.
   When we consider through how many different mine.
ral articles  water passes, many of  which are unwhole-
some, and that many places have no pure spring water
at all, we are compelled to acknowledge, that man is
sometimes obliged to prepare other  articles for drink.
   When pure water  can be obtained, it is probably the
only beverage necessary; but a little variety is pleasant,
and perfectly Avholesome.   The articles in most general
use in  this country, are malted beer, cider,  cideroyal,
metheglin, mead, molasses-beer;  all of which are plea-
sant and Avholesome.
   Many other  articles  may be used to advantage, such
as molasses and water, milk and water, butter-milk, &c.
Malted beer is the most nourishing; but, for common
use,  contains too much bitter.   The bitter is principally
necessary for preserving the beer, and therefore, if we
were to use  it pretty fresh, less hops would do.
   It is a great misfortune that,  Avhere those  things are
made a business of, men are too often disposed to impose
on the publick  by  adulterations.  The  London breAvers
are known to use vast quantities of aloes.
   Bitters seem  to  operate on the body much like cor-
dials; they stimulate, but give no nutriment.
   It would be best for every family to prepare their own
drinks.
   I  have said the above articles were  in most  general
use; I mean such  as are Avholesome as common drink.
But  it  is a lamentable fact, that grog, and the use of ar-
dent spirits, are the  favourite  drinks.   These  liquors,
as an occasional spur to the languid, or for those expo-
sed to  'much dampness, or those Avho labour in the sun,
may be useful;  but perhaps  habit has  a large share  in
rendering them  necessary; and under all circumstances,
when  used  freely, they are destructive of the  healthy
operations of body and mind.
   Many of our fruits yield Avine, which becomes fine and
wholesome, when  of sufficient  age: Avhat a contemptible
thing, then,  that we must have all our Avines from abroad!
Nature,  although  ever  bountiful, is punctilious: and he 
OF ALIMENT.

who tramples on her favours is sure to be corrected: she
is slow to anger, but sorely avenging Avhen provoked.
   If you would woo her, use the productions  of your
country as standing articles.   Disease, or loss, sAvims in
every glass of foreign liquors.
   We shine in war—Ave spread  a  dazzling  splendour
over the seas*—Ave flourish as statesmen, and are exem-
plary as patriots; but, in our domestick concerns, Ave ex-
hibit a degrading contrast in the eye of Europe.
   In vain we pursue the horrours  of Avar, the terrours of
the sea, or the ennobling paths of science, while  we seek
our nutriment, &c. from other countries.
   It is  a natural operation of the human mind, that
where we seek aid or support, we are considered beloAV
the bestoAver.   Thus  the world  witnesses our search
abroad for a host of articles, which it would  be too te-
dious to mention; they naturally conclude Ave are "poor
and naked," and if they  kneAV all,  might add,  Ave  are
"blind" also.
   True  national greatness consists in independence, not
alone in our thoughts, but in possessing internal re-
sources of every kind.   I am not an advocate for a Chi-
nese policy, but to admit into any country so much fo-
reign articles as to render them principals in our Avants,
or so far as to leave the exchange  against us, is  unwise,
and must entail disgrace and Avant.  Posterity  will weep
over our infatuation, in consuming so  many articles of
foreign groAvth or manufacture; for by it Ave shall load
them Avith debt, and what is worse, Avith gout and myri-
ads of nervous diseases   I shall  conclude this  subject
with a feAV general rules, Avhich ought to be observed.
   Endeavour to use succulent bland food, and you will
seldom  have occasion for much drink.
   If pure Avater can be had, let it  at all times be a con-
siderable part of your drink; water should be colourless
and tasteless, without smell, and ready to mix with soap;
with these properties it is generally good.
   It is  better to suffer  a  little thirst than to  load your
stomach  with fluids; they  impair digestion.
   The aged require cordial drinks, but  the young ought
to use them Avith great caution.
              10 u 
74
OF &LLEi\
   Genuine old wines are the best cordials, and nothing
 stronger ought to be used by young persons; to be use-
 ful, they must be used sparingly.
   Ardent spirits should never be used early in the day;
 the excitability is then active, and too easily excited to
 the stomach; the consequence of this is, that the general
 system is robbed of a large share of its excitability, while
 the stomach suffers equally  from an excess of it.   Une-
 qual  excitement is a strong predisposition to disease,
 and in the case before us, is extremely injurious to every
 constitution.
   It is the duty of all heads of families to prepare  as
 much as possible of their drinks.
   Pleasant  drinks can be  made extemporaneously, by
 mixing a little fruit jelly Avith water; apple-jelly, cur-
 rant,  strawberry,  gooseberry, and many other articles,
 are pleasant  in this Avay; this is perhaps the most allow-
 able way of  using  spirits, mixed  with these vegetable
juices and sugar.
   Domestick spirituous liquors ought to have a  good
 age before they are used; many of them are superiour
to nine tenths  of  the  foreign liquors  consumed in the
United States.
   Let  us not forget, that all cordials are but spurs on
life, and impart no real strength or substance to the hu-
man body.
   These rules will be found sufficient for those in health;
for the sick, directions will  be found in another place.
                     SECTION  III.

                      Of Sleep.

  Those who are temperate,  and use proper exercise,
will in  general enjoy sound sleep.   It is, therefore, a
subject  on which much need not be said; a feAV remarks
may perhaps be useful.
  People should consider it a matter of the utmost im-
portance, to go to bed at a reasonable hour; and always 
OF SLEEP.
75
rise early; this last aa ill  not only promote health, but is
a source of profit.
   Children may be indulged in as  much sleep as they
desire: after about the seventh year they often require
correction in this respect, for they are certainly prone to
sleep too much.  The best rule is to get them early to
bed, and oblige them to rise Avith the family; this Avill
bring them into a good habit.
   People in the vigour of life, had better not accustom
themselves to much covering in bed, many constitutions
are injured in this way.   They ought not, in general, to
sleep more than eight or nine hours in twenty-four; and
in warm Aveather at least, ought to sleep on beds reason
ably hard.
   The  aged should be laid as free from noise as possi
ble, their rooms ought to be warm, but not too close; they
should have plenty of Avoollen covering, and good soft
feather beds, Avhen they can be had;  and in general, they
should take a little solid food before going.to bed.  Their
sleep is imperfect, and therefore they cannot easily sleep
too much;  a little  sle«p  in general will be proper after
dinner for them.
   All beds  ought to be kept clean, often exposed to the
sun, and the clothes, often changed; nicety  in this re-
spect is Aery essential, and the housekeeper Avho  keeps
nice clean beds, free from bugs, Avill always be found a
good housekeeper in other respects.
   Sleep is often interrupted for Avant of a little nourish-
ment in the stomach; to  promote sound sleep, the brain
must be duly stimulated, so that if you go to bed too lan-
guid, or over stimulated, you cannot sleep, for there is a
state of action necessary Avithio, which has properly been
called the sleeping point.
   The eArening ought, if possible, to be ushered in Avith
reasonable  mirth.  The practice  of going to a  neigh-
bour's house, after the business of the day is over, is a
great promoter of sleep.   Nothing is more unfriendly to
sleep than intense thinking, or angry  operations  of th;*
mind; the checkered conversation of an agreeable neigh
hour relieves the mind, and nhv^c. all, concord and plea 
76
OF CLOTHING.
 santness  at  home; leads  to  sound sleep;  or  pleasant
 dreams.
   Never sleep with your clothes on, nor sleep in  the
 daytime,  if it can be avoided;  if circumstances require
 it, undress Avhen you lie down, (see the observations on
 animal life, in a preceding chapter.)

                     SECTION IV.

                    Of Clothing.

   This article is a source of vast expenditures to the
people  of the United  States, and therefore, it must be
evident that unless we make a good part of it ourselves)
or exchange our products  for it, that Ave must  soon  ex-
haust our coffers.  One might believe the present age
supposed, that they too, like  the lilies of the vallies, toil
not, neither do they spin, yet Europe,  clothed in all her
glories, was not like one of them.
   Strange infatuation, that people should think all dis-
tinction consisted of trinkets; and that unless their clo-
thing is fashioned so, or so, they are disgraced.
  The guardian angel of our  liberty, may weep over  the
shining tinsel, for it cometh not of our industry, but often
at the  expense  of our posterity.  Let the statesman
dream of importing our manufactures, or, let the dashing
beau tell  you he gets his  clothes cheapest in London,
still, unless they can show you mountains  of gold or sil-
ver, or find a market for your products, it must be that
they are indirectly enemies to their country.
  After all  our pains to appear fine, it is a lamentable
fact, that  our citizens  generally,  especially the female
part,  dress too thin.   It was the opinion of one of  the
greatest physicians  that ever lived, that more people
died from inattention to, or want of clothing, than from
the sword and pestilence  together.  We  oii"*ht, there-
fore, to use every precaution in suiting our clothes to the
state  of the  weather.   As a general"rule, we ought to
dress rather Avarm, then otherwise.
  We sfcould not change too early in the spring, for the
weather often continues very variable till avc ^re well 
                    OF CLOTHING.                  77

advanced into the  summer; and Avhen we do change, it
ought to be done gradually.
  Aged persons should, if possible, wear Avoollen next
the skin;  the  want of suitable warmth is the greatest
enemy the aged of this country encounter.
  People in vigorous life, who exercise freely, will pro-
bably do as Avell without flannel,  but for the  sedentary,
females generally, and children, they are always  neces-
sary.  Children are certainly often  injured by too much
clothes, both in and out of bed: were it not for the Avetto
which they are  subject,  they  would be  better Avithout
flannel  at all, for it is a fact, that they bear a great deal
of dry cold, not only Avithout complaining, but often to
their advantage.
  It is necessary at all times to avoid tight garters, Avalst-
bands, &c; they are productive of a  great deal of injury.
  The  great desideratum in dress, is to have it  clean,
loose, and sufficiently warm.   Above all things, it is ne-
cessary to have dry warm feet; this is best obtained by
Avearing strong leather shoes  in Avet Aveather; and our
shoes ought to be Avell coated  Avith  oils and Avax.  The
aged should have their shoes lined with soft Avoollens, or
the skin of some animal, Avith the hair on.
  I believe the monstrous tight lacing Avhich the  young
Avomen wear, are not only the source of many diseases,
but are really calculated to belittle the  heart; and have,
by the reflecting generally, been considered an evidence
of a littleness of mind.
  This ungracious squeezing of the abdomen, confines
the viscera of the chest, and makes a woman all sensi-
bility:  thus, Avhile she startles at a feather, the woman
of nature Avill meet death  without much terrour. While
she Aveeps over the tale of fiction, the woman of  nature
has her heart at  home—while she  faints at the sight of
danger, the woman of nature big, yet good of heart, will
defend herself.
  It seems  to be much  lamented  that nature Avas so
awkward  in modelling woman.   In all  countries they
seem dissatisfied with themselves,  and are ever prone
to improve their  shape, &c.   The  Chinese women,  be-
long torturing their children,  have  deformed  their  feel 
7*
01 EXERCISE.
until they are scarcely able to walk, and this they have
done  by confining the feet for successive ages, until it
has become a part of their constitution.   Can we doubt,
then,  that if the feet by pressure can thus be lessened,
that the viscera may not also.  There can be no doubt,
but improper confinement does actually lessen the heart,
and renders the woman feeble and irritable.  I shall say
more  respecting this practice of tight lacing, in my ob-
servations on the diseases of females.
  People who are much exposed to the Aveather, should
wear  oil cloth.  Three or four shirts, or Avaistcoats, will
afford more warmth than a  great coat.

                     SECTION V.

                    Of Exercise.

  This is of  vast importance to man; what a pity then
he is so prone to avoid it.   Exercise is the great physi-
cian of all animated nature, and without it human life is
feeble, painful, and generally short.  While we freely
expend heavy sums for clothing and for food, this great
source of health may be reached not only without price,
but is in general, the source of constant lucre. How Avon-
drous strange then, that man, from the remotest antiquity,
has vieAved exercise as a curse.   It  must be the natural
state  of rational creatures, for without  motion  thought
Avas never elicited from a created being.  Is it not through
the exercise of the organs  of sense that we expand the
mind?
  Without motion, nature  is dead, and void; but a be-
nevolent God has impressed this property upon  atoms
and creatures, and Avorlds, and a universe!
  When Ave ^ast  our eyes around  us,  we behold my-
riads of creatures displaying their joyous gambols, Avhe-
ther in the briny deep, the  silvery rivers; on  the verdant
pastures, the beauteous flowers;  or even the loathsome
mirc,  or corrupting carcase, all, all teems  with life, aud
life Avith motion.
  Or, if Ave raise our eyes  to the celestial bodies, Ave see
all obedient to laAvs of motion: and  shall man alone bp 
OF EXERCISE.
79
exempt from this universal laAv?  HeaAen has forbid it!
Shall the bright  morn be ushered in by the melody of
the plumy songsters—by the  lambs, sporting  over the
green pastures, and by millions of living creatures, Avhile
lazy man slumbers on beds of doAvn? Nature has forbid
it, nor Avill she pardon the transgressor, for it cometh of
perversity!
   The great body of the American people are  in habits
of constant exercise, but in general, they  are unmindful
of its advantages, and many of the athletick agricultur-
ists, blessed with all the real comforts of life, sigh  for
the enervating habits of.the city.
   Our cities have groAvn with a rapidity unparalleled, but
like the hotbed,  they are rearing many  tender plants,
and Avith rapid strides  Ave are endeavouring to raise a
race of people, Avho shall sleep on doAvn, live  on luxu-
ries, and hold Avholesome exercise in contempt.
   Parents Avho have been raised Avith firm stamina, from
exercise, will bear relaxation from labour in the decline
of life; but the  rising generation  despise the habits of
their ancestors, and seem to aspire  after  mind  without
body;  but experience teaches us that healthy, sound or-
gans, are essential to vigorous mind.
   Let me admonish  every member of society that they
owe it to society, to themselves, and  to their Creator, di-
ligently  and  actively to exercise, if not for lucre, for
health.   Surely it must be a vicious crime to shut your
eyes against reason and experience; and does not ex-
perience teach you that  idleness entails disease and vice
on your offspring?
   The guardian angel of your health cannot  smile pro-
pitiously on  the  rebellious sloth; but while  she Aveeps
over your folly, active Pandora shall fill your veins Avith
poison.
   It is one of the great mysteries of this  Avorld, that in
no one thing is there a more universal agreement among
mankind, than as to the salutary nature of exercise; and
yet there is  nothing which they are so prone to avoid;
and this has been the case from the remotest ages.
  Many are seen wallowing in  idleness and  intempe-
rance, and seem to enjoy good health, even to a good old 
80                  OF EXERCISE.
age; but besides the heinous crime of bad example, they
generally entail disease on their posterity.   I here is un-
questionable evidence on record, that temperate ottsprmg
have kept down gout till the second generation; and that
then, without  any change of habits, the lurking gout of
the grandfather has burst out like a ravenous wolf upon
whole families.  Who then can doubt, but idleness and
intemperance may implant disease in the child, while the
father, by superiour force of constitution, shall escape.
  Man can never  be an insulated being; he owes it to
his country to marry; he owes it to his offspring, and to
his Creator, to conduct so far as in him lies, to  avoid en
tailing misery on a living creature;  but that the  father
should, for  the  gratification of appetites, which would
disgrace a brute, run the risk of inflicting incurable mi-
sery on his offspring, is fit work for a demon.
  It remains to offer a few remarks on the regulation of
our exercise.
  By labour, the circulation is augmented, the  lungs di-
late  more freely, and thus enable  the ambient  air to
drive'ihome  the oxygen, and  impart to the blood the re-
quisite of vigorous life: a healthy blood lays down heal-
thy solids, and action propels the blood through every
fibre, and  gives the glowing colour which constitutes
'•beauty without paint."  But, to be useful, it  must not
be excessive;  and he whose employments leads him  to
great exertion, must be cautious; or, by too rapid action,
he exhausts his poAvers and brings  on disease, or pre-
mature old age.   Exercise, then, to  be useful, must be
constant, and regulated according to  the strength.  But
as capital in dealing increases in a certain ratio, so from
exercise, properly regulated, Ave obtain a constant acces-
sion of  strength.
  Those who exercise in carriages, ought to partake of
it freely, otherwise it will be insufficient; and in general,
they should walk a good  deal;  for it surely never was
intended by nature  that man should not walk: she has
given us no carriages, save the graceful carriage  of a well-
bred person, who has strength to walk freely Avithout fa-
tigue.   It is in the employment of walking that man or
woman display their charms: with  what ease and ma- 
OF EXERCISE.                 St
jesty moves the well-bred manor Avomanwith firm mus-
cles!  At such a sight, all nature may smile and  angels
approve.
   Next in  point of natural dignity, appears the  stately
man or woman on the prancing  steed, who, disdaining
inaction, presses on with his precious guide,  and ay hile
he passes on Avith a celerity which is truly astonishing,
at command he stays, and leaves his sprightly rider re-
novated in  every fibre.   People of cities! if  you value
your children put them on horseback:  let them learn to
admire this noble animal, in preference to the glittering
carriage.   If you Avant healthy children, encourage ri-
ding-schools; it is better than  dancing, because it is use-
ful in every period of life.   I consider  this advice of
vast importance.
   The health and constitution of a Cicero  Avas renovated
by riding on horseback.
   I  would  most seriously advise every person,  who is
able to keep a country seat, to keep their horses there,
and use them freely.  When our youth  are  seen daily
on horseback, we shall hear less of consumption.   Phy-
sicians for ages have recommended this  mode of exer-
cise, to the  valetudinary, and  to those in health also.
   It would be a good rule Avith sedentary people, Avho
walk for exercise, to take an  agreeable companion; in-
tense thought on such occasions, will destroy all the be-
nefit of the exercise; the varied discourse of a friend, will
relieve the mind from too close application.
   We ought not to exercise immediately after meals.
   Children seldom require any incitement to exercise;
let them be indulged  freely, and we seldom find  them
inactive.
   Inactivity renders the circulation languid, the  oxyda-
tion of the blood imperfect, loads the body with  fat and
glandular obstructions, impairs the tone of the muscular
fibre; weakens digestion, fills  us with Avind and vapours,
and spleen, and besides a host of evils to the body,  ruins
the spirits and tone of mind.
   I shall have occasion to speak of exercise in treating
of consumption.
              11 
83              OF  THE  SECRETIONS.
SECTION VI.
Of the Secretions.
   The excretions from the body are many, as the alvine,
urinal, sensible, and insensible perspiration, expectora-
tion, and a large discharge from the lungs in the process
of respiration.
   It must however be evident on a slight viewr, that these
are governed, so far as we have  control  over  them, by
the other nonnaturals.  Attention to food and drink, ex-
ercise, apparel, Avholesome air, with  a suitable  control
over the passions, ■will generally secure  healthy excre-
tions; or rather such as are conducive to  health.  It fol-
lows, that I need only refer the reader to the other arti-
cles under the head of nonnaturals; and  to the  sick pro-
mise instructions when I come to treat on diseases.
>   It may not be amiss to observe here, that obstructions
of the  secretions often occur without  producing disease;
but such disorders,  at all  times, predispose  strongly to
disease,  and therefore Ave  should never  neglect to use
some mild suitable means, Avhen we are sensible of a di-
minution of the excretions, as costiveness, small  dis-
charges of urine, and this  of a too acrid  quality;  an un-
pleasant dryness of the skin, attended Avith  languor or
some confinement or stricture about the breast.  We are
also to bear in mind, that we are liable to excessive dis-
charges of all the secretions, Avhich are equally injurious
as defection of them.
                     SECTION VII.

                  Of the  Passions.

  These are, love, grief, fear, hatred, jealousy and anger;
they seem to have appeared in the order in Avhichl have
enumerated them.
  In his primordiate and  perfect state,  man probably
could only be affected with love  and grief; love to the
Supreme,  to his  fellow creatures, and for every created 
OF THE PASSIONS.               83
 being; grief might find place in contemplating the state
 of fallen angels;  this, however, would operate as a zest
 to his enjoyments; not  indeed that he could have felt
 pleasure in their misery, but by comparison, he could
 appreciate his oavii happiness.
   Fear, hatred, jealousy and anger, seem to be a part of
 the mental curse  inflicted upon man, Avhile a general de-
 terioration, impaired in great measure, the state of love
 and grief.   Man seems to have felt the influence of fear
 immediately at his fall, for  we are told, that God de-
 manded of Adam, "Avhere'artthou?" and he said, "I was
 afraid because I  Avas naked;*' and in  the second verse
 preceding, Ave may infer, that Eve felt this passion also.
   Enmity being pronounced betAveen the seed of the wro-
 man and of the serpent, the foundation of  hatred  Avas
 laid in the  human breast.   The other degrading pas-
 sions soon followed; for jealousy, rising up like a con-
 suming fire, in the breast of Cain, ushered in raging an-
 ger, and slaying  a brother, full scope Avas given to all
 the foul passions Avhich defile mankind!  From this early
 period the passions form a part of our constitutions, and
 it becomes our duty to  curb and regulate them by the
 precepts of religion; and avoiding  the physical causes
 which operate upon them.
   Their operations are very different, but like the excess,
 or detraction of stimuli, they all centre in the same point.
 Although  anger generally rouses the poAvers of the body,
 there are  many exceptions,  Avhere anger enfeebles  and
 renders the man pale and trembling; and this sometimes
 terminates in fear.  All the passions, Avhen in force, im-
 pair digestion, debilitate the body, and  corrupt the mind,
 There is  constitutional operations of  the passions, we
 cannot always control, but ninety-nine hundredths of their
 effects are the result of our own conduct.  They are the
 result of bad example,  of intemperance in strong drink,
 or of our neglecting to curb them in lime.
  When Ave see the dreadful effects  of ardent spirits on
the passions, how can we doubt the  effects of ambition,
 avarice, and even intemperate eating.  Idleness and ir-
 regularity of every kind may stir up the passions; cruelty
to brutes is the source of many gusts of passion. 
84
OF THE PASSIONS.
   A few words of advice shall close this article.  Love
is the highest attribute of a created being, but man hav-
ing fallen, this passion suffered Avith him; and hence is
liable to abuse or wrong direction.   Therefore, in the
exercise of this passion, let it be a sacred act of the judg-
ment to determine whether the object is attainable, be-
fore you advance, for it is a slippery path, and many
would turn vhen in it, but fall, and fall victims, very
often, to their indiscretion.
   If you find irritability of mind  arising from long fast-
ing, from Avant of sleep, from spirituous drink, &c. shun
them as you value the Avelfare of your oAvn health, and
the peace, and quietness of your family, or those around
you.
   If fear possess you, call up your faith; a sovereign re-
medy here, is an easy conscience.
   If you  find your  passions  generally unruly,  apply
more closely to business, recreations, or study.  So close-
ly are  the organs of life connected with the passions,
that death lias been the forfeiture  of indulging everyone
of them:  Some  of  them are  sIoav  in their effects, but
every age  of the world,  bears testimony of their fatal
termination.
   There is an affection of the mind somewhat allied to
the passions; but it is often  artificial; and Avhen it does
not arise from diseased organs, (Avhich is.sometimes the
case,) it admits of no excuse:  I mean religious melan-
choly;  it has slain  its thousands.   Of all  the  human
Aveakuesscs this seems the most  strange; that a rational
creature should so far forget his duty to his fellow crea-
tures, and the liveliness  and  loveliness of  natural ob-
jects, and more especially,  that in contemplating a God
who is all perfection and love, he should veil his mind
in gloom.   This affection often arises from habits impo-
sed on themsehes, by which they expect to  become re-
ligious in the eyes of men.   To have a reasonable con-
cern about our future prospects is the duty of all; but let
each one endeavour to do his duty and trust  in God, for
he giveth to whom- he-will.  The bright prospect opened
to our view  by the  christian light will probably, some
day, stamp joy! and loveliness! and continual rejoicing!
 on the face  of every rational creature! 
OF THE PULSE.
I HAVE thought proper, before entering on a descrip-
tion of diseases, and of the usual remedies for them, to
give some account of the pulse, in a state of disease: and
I hope I shall be excused for handling this subject pret-
ty freely,  for it is a subject which has been much neg-
lected, and one which is well worth cultivation.
   I think proper to premise this article with a very short
description of the circulating system.   I have observed,
in my sketch of anatomy, that the heart has four cavities,
that the blood passes through these cavities in succes-
sion, that the aorta,  or great artery,  arises from the left
ventricle of the  heart, and carries the blood from thence
throughout the whole body.   I have also observed, that
the  blood  Avas  carried  through  the   heart, by means
of a  constant dilatation and contraction of  its cavities;
the first act is  called the diastole,  and  the latter  the
systole of the heart.
   It  follows, from the above  facts,  that  at each and
every dilatation of those  cavities,  that there must be  a
suspension of the projectile force, till they contract again,
and thus a kind  of interrupted motion  is given  to  the
blood, Avhich Ave may resemble,  in appearance, to that
of k  common pump, Avhich although it keeps up a con-
stant stream, brings the Avater through the valve, Avhile
the piston descends only;  so Avith the action of the heart,
its diastole and  systole, are performed so rapidly that a
constant stream of blood pours into the great artery,  but
still a jet-like motion is given to the blood;  and this jet-
like motion, arising from ail alternate dilatation and con-
traction, exists  throughout the whole arterial  system,
and constitutes  that beating so easily  discovered in  the
wrist; this is Avhat is technically called the pulse.  It is 
86                 OF THE PULSE.
 to  be felt in the  temples, neck,  fingers,  foot, and  in
 short, exists throughout the Avhole system.
   Having now, as I hope, given  a sufficient account of
 what is meant by the pulse, I have only to remark, that
 the action of the arteries is  in some measure different
 from,  and independent of, the  action of the heart; and
 this position will be clearly  established in detailing the
 variety of action, Avhich occurs in the pulse,  in a state
 of disease.
   To  enter into any intricate disquisition upon  the pulse,
 would be foreign to the intention of this work; therefore
 I shall confine myself to a feAV obvious and  necessary
 distinctions,  and conclude with a feAV observations on
 the information Avhich Ave may derive from  a knowledge
 of the  pulse, and how  far we  may reasonably depend
 upon such information as a guide in cases of disease.
  When a physician speaks of a full pulse,  he means
 that the artery is  fully dilated or expanded, and conse-
 quently, that there  is an increase of the arterial channel,
 and that this expansion is owing to a larger column of
 blood passing through the  arteries.
  When he speaks of a corded or tense pulse,  he means
 that the artery is  more firm, and less yielding to the
 pressure of a finger upon it than usual: this state of the
 pulse may exist in  the full pulse, the small, the feeble,
 and in short, in every other  variety,  except the soft
 pulse,  and seems to be a spasmodick state of  the mus-
 cular coat, or fibres of the arteries.
  When Ave speak  of a  quick pulse, it is meant that the
 artery  contracts in  the shortest possible period of time;
 its dilatation may be as long or longer than usual; so that
the pulse may be quick, and not have more, or it may
 even have less strokes, in a given time,  than the healthy
pulse.
  When we speak  of a frequent pulse, it is meant that
 the artery beats or pulsates rapidly; and this state of ac-
 tion may  exist  in the full, tense,  feeble,  soft, and, in
 short,  in every state of the pulse, except the slow
  An intermitting  pulse is not very common: in this
 state of thejpulse the artery may beat quick, full, feeble,
 &c; but after a certain number of strokes there is a 
OF THE PULSE.                 87
pause for a short period of time, and this pause again is
succeeded by a certain number  of strokes.   This kind
of pulse is mostly unfavourable, and generally accompa-
nies the hour of dissolution.
   A soft pulse is knoAvn by a yielding condition of the
artery; that is, Avhen we apply the fingers Ave can easily
depress the artery, and it is free from any remarkable
jerking of the artery.   It is mostly accompanied with a
moist skin.
   A feeble pulse is Avhere there is but little action in the
artery,  and it may be applied to a state of direct or po-
sitive Aveakness, or it may be applied to a state of indi-
rect weakness, or mere oppression.   Its most correct ap-
plication, hoAvever, is  to  the former state only; for in
cases of indirect debility,  it is more correct to call it the
depressed pulse.
   A weak pulse is synonymous Avith the term feeble
pulse.  But a depressed pulse, is that state of the artery
which arises from oppression, and is a consequence of an
excess of stimulus: it is to be found in malignant fevers,
in  cases  where narcotick poisons  have been taken, as
spirits,  opium, &c, in excess.
   A sIoav pulse is where the pulsations are  repeated at
longer intervals than usual.
   There is also what has been called the shattered pulse,
and also knoAvn by the name of the quill pulse: in  this,
there is a kind of indiscribable sensation imparted to the
fingers, Avhich is a kind of creeping, tingling or thrilling
feeling; this is always an  unfavourable pulse.
   There is also a state of the pulse Avhich has been cal-
led the  locked pulse; and this, I suspect, is  yet but im-
perfectly understood.   I  think 1 have most generally
found this state of the pulse, in common  inflammatory
diseases, of the highest grade, such  as phrenitis and
pneumonia, &c.
   The small pulse is such a state of the  artery  as suf-
fers it to contract  and  lessen its column of  blood; and
this smallness of  the  artery may exist, and its action
partake of the quick, feeble, frequent; but it is seldom
soft.  1 have sometimes found the artery small and soft. 
 88                 of The pulse.

          a  tabular view of  the  pulse.
                   1.  A full Pulse
  Maybe quick, corded, slow, intermitting, or regular,
seldom feeble in its beats.
              2. A tense or corded Pulse
  May be full, quick, slow, feeble, frequent, intermit-
ting, small, depressed, shattered, locked.
                  3. A quick Pulse
  May be full, frequent,  corded, intermitting, feeble,
soft, depressed, small.
                 4. A frequent Pulse
  May be feeble,  depressed, small,  intermitting, soft,
tense, quick, shattered, not often full.
               5.  An  intermitting Pulse
  May partake in its strokes, of the feeble, shattered,
full, small, slow, quick.
                   6. A soft Pulse
  May he full, small, feeble, but seldom if ever partakes
of the other states of the pulse.
                  7. A feeble Pulse
  May be  locked, shattered,  depressed,  tense, small,
quick, frequent, intermitting, slow.
                   8. A sIoav Pulse
   May he full, quick, intermitting,  locked, soft, feeble,
depressed.
                 9. A shattered Pulse
   May he feeble, quick, frequent, intermitting, depres-
 sed. 
OF THE PULSE.                 89
                 10. A locked Pulse
   May be tense, intermitting, quick, small, feeble, slow,
shattered.

                  11.  A small Pulse
   May be quick, frequent, feeble, shattered, locked, in-
termitting, depressed, slow, seldom soft.

   I come iioav to make a feAV  applications of the differ-
ent states of  the pulse, and shall take  them up in the
order of the foregoing table.
   1. The full pulse  is found, principally in persons
of good constitutions, and in the vigour of life, when
labouring  under inflammatory  diseases,  as  pleurisy,
smallpox,  measles,  &c; and where it is simply fullf
quick, tense, and regular, the case is seldom dangerous.
But where the full pulse is intermitting, or slow, it por-
tends rather a more dangerous disease; and this kind of
full pulse is often found in asthma in reduced habits, and
in many diseases arising from mere irritation, or in other
words,  entirely independent of inflammation; nor is there
any possibility of lowering this pulse by the lancet; on
the contrary it seems to increase at  every bleeding, the
coats of the artery yielding more and more; this kind' of
pulse is found  sometimes in hysterical, and what are
called nervous habits; and Avhere we knoAv the habit to
be really such, or where we find the pulse dilate, after
reasonable bleedings have been practised, we may con-
clude that the fulness arises from irritation or weakness,
and can only  be reduced by tonicks, or more especially
by opiates. This state of the pulse, that is, the full in-
termitting one, is  generally attended with a huffy ap-
pearance of the blood, and this seems to arise from the
rapid action,  which operates on  the blood precisely as
high toned action, in cases of inflammation; but the solids
are in  a very different state, and  require  the  use of
opiates  and tonicks, and a suitable  regimen, which, by
giAring tone to the solids, lessens this morbid force of the
circulating system.  The patient at the same  time, is
              it 
90
OF THE PULSE.
carefully to avoid all  irritating things,  in  food, drink,
passions, &c.
  2. A tense, or corded pulse, often attends common m-
flammatory diseases, particularly in those of rather weak-
ly constitutions: in typhus and typhoid fevers, sometimei
in malignant diseases: in a majority of  cases, this kind
of pulse requires the use of the lancet: but great caution
is necessary in distinguishing between this  and the fee-
Me pulse.                                 .
  3. The quick pulse does not particularly indicate the
form or grade, or nature of the disease;  it is to be found
perhaps in every disease, by times, and in general, it is
less dangerous than the very slow, or intermitting. Few
persons pass through a state of convalescence from se-
vere disease,  without this  state of the pulse:  and an in-
creased quickness, if accompanied with a general amend-
ment, may perhaps ahvays be .viewed as  the forerun-
ner of health; this kind of quick pulse,  however, is soft
and tolerably full.
  4. The frequent pulse; it is remarkable of the fre-
quent pulse,  that, although it is to be found at times in
every disease, and perhaps few persons pass through a
severe disease without this state occurring at some time
of it, yet a frequent pulse is by no means a certain sign
of disease: exercise, frights, simple  debility, &c. may
excite the  frequent pulse,  so  that Ave,  perhaps, derive
less distinct information from this state than  any  other.
   5. The intermitting pulse, generally portends danger,
and mostly arises from congestion,  or some visceral ob-
struction;  it is often  found in cases where the viscera
have been injured by  some violence; and in these cases
calls imperiously for the use of  the lancet; it generally
attends the hour of dissolution: but notwithstanding this
unfavourable character of the intermitting pulse, I have
sometimes found it in chronick  rheumatism, and other
disease's not particularly dangerous, so that we are not
to give a rash opinion in cases Avhere Ave find this  pulse.
   6.  The  soft pulse is natural to some persons when in
health, but is particularly to be found about the crisis of
a disease;  and I think is always a favourable occurrence.
In  a pulse really soft, the artery is nearly  natural,  it* 
OF THE PULSE.
01
action, hoAvever, is often frequent,  or quick, the strokes
feeble, and in some few cases the artery is small.   Much
caution is necessary in distinguishing this from the feeble
intermitting, or small tense pulse; such a mistake might
be productive of great danger.
   7.  The feeble pulse, correctly  speaking,  is a weak
pulse;  but in as much as a feeble stroke of the artery is
considered & feeble pulse, and as this feeble action occurs
more frequently in inflammatory  diseases than others,
we are under the necessity of distinguishing the  feeble
pulse by the circumstances of each case.  And although
the feeble pulse occurs in opposite states of the system,
we still may designate this feeble  action by bringing to
 view other  states of the pulse.   Thus,  a pulse simply
feeble,  is an eAridence of direct debility, or exhaustion
of the body; and  sometimes this  kind of pulse may be
small, and  still favourable.   But  a. feeble pulse that  is
locked,  shattered,  tense, intermitting,  or depressed, is
mostly found in inflammatory diseases;  but to this there
 are exceptions; and, therefore, we are  carefully  to ex-
amine  into every  circumstance  of the case, before we
can determine the character of the disease.   I may take
 occasion here to  observe,  that the depressed, feeble,
small and locked  states of the pulse, are not to be dis-
tinguished so much by the action  of the artery as from
the collective circumstances  of the cases; but if Ave bear
in mind that the pulse, really weak, is mostly soft, and
that the feeble stroke of the artery, from excess of stimu-
lus, or  inflammation, is ahvays tense, we may in gene-
ral, judge with tolerable accuracy.
   8.  The slow pulse is apt to partake of the lockedpulse;
and, perhaps, always is accompanied with excessive ex-
citement: it is often found in cases of injury done to the
brain;  it also occurs in the early stage  of many cases of
 malignant fevers.  HoAvever, this condition of the pulse
 may be in some measure natural,  and,  therefore, it re-
 quires  caution in examining it;  but if we bear in mind
the fact, that the dangerous slow pulse is, perhaps, al-
 ways irregular and mostly intermitting, we cannot easi-
 ly err. 
92
OF THE PULSE.
   9.  The shattered pulse is mostly a consequence of an
 aneurism, it is also found in malignant fevers: it is often
 present in the hour of dissolution, particularly  in cases
 of inflammatory violence, Avhich have not been subdued
 by the lancet, or other evacuations.   I have also found
 it present in fatal cases of apoplexy,  especially where
 there was an infarction of the  lungs, Avhich produced
 what is called the  rattles: these cases Avere in the even-
 ing of life.
   10. The locked pulse,, is found to exist, more or less,
 in all cases of very high excitement, such as malignant
 fevers;  inflammatory fevers, of a lower grade;  in affec-
 tions of the brain.  But, I have said, this state of the
 pulse is  not Avell understood;  thus what is often  taken
 for a locked pulse, is  a depressed pulse, which has ad-
 ded to it, or rather is  accompanied with tension, small-
 ness, and feeble action of the arteries: it is true, this is
 but a variety of  the locked pulse; but as the artery is
 ahvays tense, and  acts with such an irregular jerking of
 the  artery, we can seldom mistake this for the iveak
 pulse—more especially if Ave carefully examine into all
 the  circumstances  of  the case.   But  in a pulse  really
 locked, no man could judge with any precision from the
 pulse alone; for there  is almost a total absence of action
 in the artery; yet it is  an unquestionable fact, that in  this
 state of the  pulse  the blood pours through the arteries
 with  great rapidity; this has been so clearly demonstra-
 ted to me in many cases, that I am  quite certain  the
 blood often  circulates rapidly Avithout almost any action
 in the arteries; for in the locked pulse, if you open a vein,
 the blood flows Avith  impetuosity; and yet you can  feel
 no action in the pulse, or  rather there is no pulse.   It
 follows, that in  these  cases Ave  must judge from other
 circumstances; as, the patient's  habits, the prevailing
 diseases,  &c.  I think I have observed,  that in a pulse
full and locked, which does not often occur, Ave can bring
 the arterial system most safely to its regular state by ab-
 stracting  blood  more  slowly, and  frequently repeated;
 for the dilated artery is an evidence of great prostration
 m those cases.  But  in the pulse locked and small, in
 general we may venture to bleed largely, by which ac- 
OF THE PULSE.                  93
tion will soon be restored to the arteries.  I think John
Bell some Avhere hints at this condition of the arteries.*
But I beg leave to assure the reader that I Avas apprised
of  it before I read  Bell's  late works.   It is true, the
locked pulse Avas well known to Hush and others, but I
do  not recollect that any one Avas fully aware of the fact,
that in the locked pulse the blood Avas circulating with
increased impetus.   And it is a matter of importance!
for there still are many practitioners Avho cannot, or will
not, see the propriety of bleeding Avhere the pulse is not
active.   I beg leave  to say to such, that this is a fact of
which they can easily satisfy themselves; for if a patient
of good habit is labouring under  acute  disease, (unless
the prevailing diseases  are well known to be of a  low
grade, and the pulse is found thus  locked up,J by open-
ing a vein they will find that the blood flows with impe-
tuosity;  and this is  proof  positive that we cannot rely
 on the pulse exclusively.
   11.  The small pulse may  be found in  most diseases,
 as  the malignant, typhus, typhoid; it is,  perhaps, most
 common  in  the inflammatory condition;  but is seldom
found in  pleurisy.  In a low state of disease, as typhus,
 &c. it proceeds from Aveakness.   In the  inflammatory,
or  malignant, it proceeds from excess of stimulus or ex-
citement.
   Upon  the whole,  then, Ave discover the pulse veiled
with difficulty, and only to  be tolerably  understood from
considerable application to its study in actual  practice.
 To the  experienced physician it is a  good guide, but
 even the  most experienced  cannot  judge from the pulse
 alone; we must, therefore, in examining cases of disease,
 proceed with extreme caution, and endeavour to investi-
 gate, by  every possible means, the diseases prevailing;
 the habits and usual diseases of the patient, if subject to
 any disease; the eye; the skin; the tongue; pain;  excre-
 tions;  the state of the  mind; the probable remote or

   * The author here named, more than once observes, that, "to stop
 the beating of an artery is one thing, but to check the blood quite
 another."   And he intimates that, surgeons have sometimes been
 disappointed by trusting to pressure on arteries which stopped the
 pulsations, but not the blood. 
94
OF THE PULSE.
 exciting cause, &c.  A discriminating judgment in those
 matters is the highest acquisition of the Medicince Doc-
 tor, and  is only to be obtained by a long application to
 the study of diseases, under the direction of those who
 combine example with their precepts.
   By  a careful examination  of this subject, I think it
 appears that the terms applied to  the pulse have been
 vague, and require correction: thus, for  instance, a
 small  pulse,  a feeble pulse,  a tense pulse, a  locked
pulse, a depressed pulse,  are nearly the same thing as
 respects the action  of the artery; and  this,  strickly
 speaking, is the pulse.   But  there  is a material diffe-
 rence,  at times, between  these different states  of  the
 pulse: a pulse  may be  feeble  and corded; feeble  and
 really weak; feeble  and locked; so  that, in truth,  the
 real or essential difference between the various states of
 the pulse is dependant, more  especially, upon the con-
 dition  of the nervous power, and that of the solids  ge-
 nerally, than that of the arteries in particular; and it is
 a fair induction, from the foregoing account of the pulse>
 that no extent  of experience can  enable us to adjudge
 cases of disease Avithout  the most scrupulous attention to
 every  other circumstance.
   And I  hope  I shall be pardoned.here, for admonish-
 ing young  physicians in  particular,  to ponder Avell,
 vieAv and review every circumstance; never forget  that
 there  are indications and contraindications.  I am led
 to make these  remarks from the fact, that it is  a  trait
 in the character of the times, for physicians to prescribe
 with expedition.   The wig of the Doctor, of the seven-
 teenth century, though it might often cover a weak head,
 and although  I am  by no means disposed to revive it,
 was nevertheless  truly emblematick of the physician's
 character; for it behooves him, with all the penetration,
 and application of an Archimedes, an Euclid, or a New-
 ton, to contemplate as  with  mathematical precision,
 every  iota which may reasonably be called to their aid.
 It is related of the celebrated Cheselden, that he never
 engaged in  a serious surgical operation,  without previ-
 ously offering up a prayer to heaven! and heaven smiled 
OF THE PULSE.
95
on him indeed, for he  was one  of the greatest opera-
tors of his age.
  Let us then ponder well, the silent eye, while it would
reach, as it were, the labouring soul of the suffering pa-
tient, should never lose sight of the important truth, that
the eyes of  heaven,  with beams  of  resplendent light,
beholds the solemn contract; and he who dares to tri-
fle with  disease, may have his name registered in the
eternal records as the murderer of him who committed a
life to his care.
  I have said the arteries have a poAver of contraction,
in some measure independent of the heart. I mean mere-
ly that the contractions  of the arteries are not ahvays si-
multaneous with the contraction of the heart; on the con-
trary, we find in palpitations of the heart, that those of
the arteries do not beat  synchronically with those of the
heart; besides, a simple view of the blood's motion clear-
ly shows, that the arteries possess a  propelling power:
for,  the blood ascends and descends, and therefore, if
the blood owed its  jet-like motion to  the stroke of the
heart, it must vary in its rising and sinking course, but
we find it  the same; and besides we sometimes find the
pulse different in the arms of the  same patient.
  It remains to give a feAV directions for examining the
pulse.
  1.  It is  always necessary to feel the pulse carefully
in both wrists, and in strangers we  must never forget
that the principal artery runs on the back of the wrist of
some persons.  I have known the case of a gentleman
and one of his daughters, having this peculiarity; and
hence the necessity of the utmost caution,  in  one about
to examine the pulse, and also of every man's knowing
the condition of his own pulse Avhenin  health;  it is  obvi-
ous that a mistake of this kind might prove even fatal, as
we might suppose there Avas little or no pulse.
« 2.  Be satisfied that the patient  is not labouring under
any particular alarm or perturbation;  and also that the
arm  has not been under any particular pressure  or con-
finement, (just  then) before you examine the  pulse, for
these circumstances may materially alter the  action  of
fhe artery. 
96
OF THE PULSE.
  3. Never make up"your opinion of the pulse, Avithout
examining it at least twice, at intervals of a few minutes.
  4. Enjoin silence around, and by closing your eyes
endeavour to  exclude  every thought; by practice you
may acquire such a complete power of abstraction, as to
receive as it were the very breathing of the pulse upon
your mind.   What more solemn sight, than that of  the
humane and skilful physician leaning his  very soul, if I
may so express myself, upon the struggling  artery of the
father, mother, &c; and at such a  sight the  host of hea-
ven may pause, till judgment is given,  when recording
angels shall register the solemn act! then beware, for it
may debit or credit you to an immeasurable  amount.
  5. Apply all the 'fingers to the artery at once, and feel
it under several different degrees of pressure, before you
form an opinion.
  6. It would be a good rule to examine the pulse first
by time, as counting the beats for a minute, or less time,
if you have a watch beating seconds, and afterwards close
your eyes, and examine it again.
  I have said, that in general, we cannot form much no-
tion of disease from the frequency of the pulse alone; but
although this is generally true, and although it is true
also, that  the number of strokes in a given time, vary
much in different persons in  health, still  we may set it
down as a fact, that a pulse low as forty beats, or as high
as an hundred  and upwards, always indicates disease;
and when it runs as high as  one hundred and  thirty to
forty, above which we  cannot distinctly count it, it is al-
ways dangerous.   This is not the  only advantage of as-
certaining the state of the pulse by the  watch;  by it Ave
may discover the intermitting pulse, for if we count,  say
fifteen strokes in fifteen seconds, and in the next fifteen
seconds but eight or ten  strokes, avc discover that the
pulse intermits.  If we now lay  aside the watch, and
in the most cautious  manner  proceed  to examine  the
pulse, by the sense of feeling alone, Ave will be enabled,
by withdraAving the mind from every other subject, to
judge of the tension, weakness, quickness, locktdness,
of its fullness, of  its smallness, and also whether it is
shattered.   But as respects  these states of the pulse, we 
OF THE  PULSE.
97
can derive no knoAvledge from the watch, on the contra-
ry, it may withhold the mind in some measure  from a
perfect cognizance of the case under consideration.   In
judging of the frequency of the pulse, we must bear in
mind, that in infancy the pulse is more frequent; seldom
less than a hundred beats, and  in disease considerably
upwards.  I have  sometimes been unable to count its
strokes, for, Avhere it is so extremely frequent, the sen-
sation imparted  to the fingers is rather a tremulous qui-
vering motion, Avhich distracts distinct perceptions.
   In the evening; of life the pulse becomes frequent again,
not, however, to that degree  of frequency which attends
infancy.   At this period of life there is pretty much of a
tendency to what are called ossifications of the arteries,
and should such a thing occur at the  AATist, a fatal mis-
take might be made.  A case of this kind occurred at the
Baltimore Hospital during the late Avar, but the  patient
being lean, the arteries could be  seen pulsating in  places;
for these ossifications were in short pieces.  I have seen
these ossifications existing in various parts of the body;
I have never seen  any resembling bone,  and therefore
am someAvhat surprised, that this incorrect name  should
be continued: they are always cartilaginous, and there-
fore might be called  hyper cartilages.  Since the first
edition of this work, I have met another case of this  af-
fection of the artery, in the right arm of  a male patient,
in the Baltimore Hospital.
13 
6F BLEEDING,  &c.
                      SECTION I.

              Bleeding by the Lancet.

BY  the term bleeding,  blood-letting,  phlebotomy, or
venesection, is mostly  meant the taking of blood from a
vein;  other modes have been sometimes practised, as ar-
tenotomy, or opening an artery; bleeding by leeches; or,
scarifications, sometimes  accompanied by  cupping.  I
shall  take them up in the foregoing order, and give such
directions as are  necessary, for the proper' performance
of those operations: the proper application  of bleeding,
in general, must  be sought for in the body of this Avorfe
   We may remark first, with respect  to common bleed-
ing from a vein, that, the intention in view, in applying
a ligature or string  about the limb, is to stop the blood
from passing in the veins, into the  body, and therefore,
we must always apply a pressure upon the vein, be>
tween the orifice and the body; but if Ave apply this pres-
sure so strongly as to  stop  the blood  in the arteries we
get little or no blood,  for the blood passes outAvardsin
the arteries, butimvards in the veins: in bleeding in the
arm, we  always  tell by feeling the pulse  at the wrist
whether our string is too tight/for if it is, there will be
little or no pulse.
   By far the most usual mode of bleeding is at the bend
of the arm.  In  performing the operation here, we are
to apply  a soft ligature, about an inch and a half above
the place we intend to open the vein,  observing first, to
feel carefully for  the artery  beating, which, we  must al-
ways endeavour  to  avoid, should  we even take a vein
less promising; and there is also a thin tendinous fascia,
which can be felt particularly tight, just under the skin, 
OF BLEEDING.                  99
Avhen the arm is straightened: this should also be avoid-
ed.  This operation is now so generally understood, that
I  think  it unnecessary to say any thing more  than to
state as  my confirmed opinion, that the spring lancet is
the safest and most convenient instrument for  this op-
eration.
   In very fat subjects, and in some feAV persons whose
veins are very deep, Ave cannot bleed in the arm;  in these
cases Ave will generally succeed by immersing the hand
in Avarm water, and opening a vein on the back of it.
   Persons who are liable to faint, from being bled,
should  always lie  doAvn, except the case  requires that
the patient should faint, which is  sometimes necessary,
in cases of dislocations,  strangulated ruptures &c; but
this is an expedient which is only safe in the hands of
competent practitioners.
   It is sometimes advisable to bleed in the  foot,  here Ave
are to apply  the ligature to the ankle, and the foot must
be immersed in Avarm Avater.  Great care must be taken
to avoid cutting immediately over  a sineAV, or a bone. If
Ave Avish to ascertain  correctly the quantity of blood ta-
ken, the foot may  be taken out of the  Avater,  and the
blood caught in a vessel as from the arm.  Where it is
thought material that  we draw blood from the foot, and
find it impracticable, Ave  can often bleed in the ankle to
advantage.
   Opening the jugular veins, situated in the neck, has
also been practised in cases of apoplexy, drowning, and
other sudden comatose cases  of  disease.   This is an
operation that ought not to be undertaken by those una-
quainted with anatomy, unless there is an urgent neces-
sity: the vein will generally rise distinctly  into vieAV, on
a pretty firm  pressure being made  Avith the thumb, about
the middle of the side of the neck.   In performing vene-
section here, we are to apply the thumb on the vein below
the orifice, for the  blood  is passing doAvnwards in the
jugular veins.  As an errour here might prove fatal,  I
think proper to  mention that, a ligature or string tied
round the neck, for the purpose of tilling the vein, might
prove fatal, in a feAV minutes in cases of disease.  But
where  avp, find much difficulty in filling or raising the 
100
OF ARTERIOTOMY,
vein, we may often succeed by applying, to the side of
the neck, a little pad made of a rag folded several times,
and tying this pretty firmly by a string brought up under
the arm of the opposite side, and over the pad.

                      section n.

                   Of Arteriotomy.

  Arteriotomy is only practised on the temporal arteries.
When this operation is thought necessary, by examining
about  the temples, Ave will  discover the  artery by its
beating; if the artery seems deep, it will be advisable to
cut a little opening through the skin, this will bring the
artery  to  vieAV, and enable us  to slit it open; a small
opening will suffice.   When the part has bled sufficient-
ly we  must apply a little lint, and over this a bit of lead
or silver coin, and bind it on: should  there be any diffi-
culty in stopping  the  blood,  the artery may  be cut en-
tirely through, as a  certain  means of stopping the  dis-
charge.  I  have practised this operation frequently on
children who could not be bled in the veins,  and  also
in some cases of adults, Avho  were labouring under phre-
netick affections of the head, accompanied  Avith a fever,
which would not  bear bleeding from  the arm; and beg
leave to  recommend the operation as  not only  safe, but
highly beneficial, Avhen properly applied.

                     SECTION III.

               Of Bleeding  by Leeches.

   Bleeding by means of leeches has been extensively
practised in our  cities, for many years, and with much
advantage,  in cases of local  inflammation, of  the eyes,
and other parts;  and, I  think  I am  correct in saying,
they are much less irritating than the rusty knives usually
fo >nd  in scarificators,  used for cupping, more especially
where cups are applied; but although this is generally
true, there  are exceptions,  where the more  irritating 
OF BLEEDING BY LEECHES.           101
effects of cupping makes the scarificator preferable, as in
rheumatick affections.
  To bleed with leeches, it is necessary to cool the part
by  holding  a cold wet rag  for some time on it,  to rub
the part with a little cream or milk, and to put them into
a vessel Avhich allows them little room to move about. A
common  two ounce vial answers very well if the bottom
is cut off with a  file, and the mouth of it applied to the
part,  or  a common wine glass may be used; the vessel
in  which they are applied  must  be filled Avith  water.
Leeches are a valuable remedy, much neglected in prac-
tice, more especially in the  country.  And as  they are
easily obtained  during the  summer, and may be kept
over  winter,  I  shall give some advice  respecting the
choice of them, the want of which information has, pro-
bably, ofteu prevented persons from using them, as it is
generally understood that some of  them  are poisonous.
   It is best to get leeches from the clearest water, those
that live in dirty stagnated  Avater, produce  more irrita-
tion and inflammation than those found about sandy bot-
toms.   As they are only to  be accurately described by
the use of technical language, I shall merely designate
them by the colours, and, indeed, this is  all that is neces-
sary for  practical persons:  The back is of  a dull green-
ish colour; the belly a blueish ground, spotted Avith yel-
low; on the back and sides are four yellow stripes, run-
ning  leugthwise, and two of these are broken in places
Avith  black.   Those w7hich  have  been  objected to are
nearly all over brown, with some dirty yellow; but even
these have been used with safety, and, 1 think I am cor-
rect in asserting, that, leeches taken from clean Avater
may always  be used,  but for children they should not
be too large.
   To preserve leeches,  put  them  into vessels  half full
of  water, and over the top, tie a piece of thin  muslin
or  old linen.   Examine the vessel once a Aveek, and
change the water; if any die, remove them immediately;
keep several small vessels, so, that, they arc not croAvd-
ed; and when fresh ones are taken, or after using, put
them into a  vessel by themselves.  Be careful to keep
them from freezing, but their water should be kept cool: 
102
OF CUPPING
glass bottles answer well for keeping  leeches m, and it
is  well known that they do not require any iood.  In
general we may leave them on till they fall off, but it we
have any difficulty, by dipping the finger in strong salt
water,  and touching the head  a feAV times, they aa ill let
go. / We  may now  either throw them into a  vessel of
clean water, or we  may lay them on  a smooth  board,
and while we hold down  one end with a finger, we may
strip the blood out at the other end, with a finger of the
other hand.   Should wounds made by leeches, continue
to  bleed longer than we wish, a little dry lint, pressed
upon the  part for some time, will check the  bleeding;
but in  cases where we wish to promote the  discharge,
after they have come away, and which is often necessa-
ry, the part may be well fomented Avith warm water,

                     SECTION IV.

                    Of Cupping.

   Bleeding by the scarificator and cups, usually called
cupping: an instrument may be had for this purpose call-
ed scarificator, in which there is usually about sixteen
short knives, which, by means of a very strong  spring,
cut so quickly as to produce very little pain; and we can,
by moving a slide, set the knives so as to cut deep or
shallow, as we may choose to draw more or less blood,
or as Ave may have  occasion to cut over' fleshy parts, or
the contrary.  Where we wish to draw some blood, in
this way,  the part is to be bathed Avith warm water, and
a bell shaped glass or tin cup is to be applied, as quickly
as possible after burning a little paper or toAV dipped in
a little  spirit of wine' or whiskey, in it.  The cups have
a small hole in the top, stopped with a plug or bit of Avax
which Avill enable us to take off the cup by giving a lit-
tle vent at the opening.  Cupping may  be used to great
advantage in cases  of rheumatism, gout in  the  feet; in
affections of the head, in cases that will not admit of ge-
neral bleeding. 
OF SCARIFYING.—OF DISEASES.        103
                    SECTION V.

                  Of Scarifying.

  Scarifying, by means of a common thumb lancet, is
sometimes practised to great  advantage in severe cases
of hooping cough, and other  affections of the breast of
children.  It is done by making from two to four or six
shallow cuts about an inch long, between the shoulders;
they need not be deeper than just sufficient to cause the
blood to flow a  little.
                 OF DISEASES.


                     SECTION  I.

                    Of Nosology.

IT still remains, for some future genius, to unfold and
explain the laws by which disease, in its varied forms,
can be properly and safely distinguished; and until that
happy epocha, the practice of medicine must be difficult,
and clouded with much uncertainty.
  Whether the human race aa ill ever reach this state of
vast improvement, is more than I shall dare to predict
or deny; but I feel compelled to say, that we never can
be thus blessed, unless moral evil shall be  brought un-
der subjection.
  Many attempts  have been made by men of the most
brilliant talents to class, or arrange diseases, so as to di-
rect us in distinguishing them from each other.   These
systematick arrangements of diseases are  called noso-
logy.
  Other physicians, of equal talent, have called in ques-
tion the usefulness of nosology,  and have been disposed
to simplify; some having  gone  even so far as  to consi- 
104
OF DISEASES.
 der diseased action, in the human body, but an unit, and
 therefore indivisible.
   It is to be lamented that  such is the effect of climate,
 habit, and of vice,  &c.  that diseases are ever varying.
 The  strong, but simple  features,  which  characterized
 the diseases about a century since,  in England, are no
 longer to be found; and, in their stead, a train of ner-
 vous affections have come upon them, which, in systems
 of nosology,  amount to many hundred different diseases,
   It is also  found,  that the same disease is subject to
 perpetual change: a disease, Avhich to-day is highly in-
 flammatory, may to-morrow be low, nervous  or malig.
 nant.  And  further; even  epidemicks,   which  extend
 over large tracts of country,  or over a city, will not yield,
 in different seasons, to the same treatment.
   The yellow  fever of Philadelphia, in 1793, yielded
 most  readily to copious evacuations from the bowels,
 from the use  of calomel and  jalap; and the lancet; while,
 in ninety-eight, and some other seasons, sweating and
 vomits, and, in some  cases, even laudanum was found
 most useful.   Besides, diseases are so much influenced
 and varied in appearance from the use of medicines, or
 even  regimen,  that two cases cannot be found alike,
 Every person has some idiosyncrasy about them, which
 may vary their diseases.   When we review  all those
 things, hoAvvaiu does it appear to expect any thing like
 perfect systems in medicine?
  We must admit, that nosology has done much to adorn
 and  improve the knowledge of disease;  but while  our
 habits, &c. are constantly changing, those systems must
 be constantly varied, and this can only justly be done
 by men possessing talents little short of a Newton; and
after all, before they could  be extensively understood,
they Avould no longer apply.  It follows then, that noso-
logical arrangements are only useful as a dictionary; for,
 as a scholar cannot  Avell be made without a dictionary,
nor yet with it alone, .so, with  nosology, it will neither
make a physician, nor can he do without  it.
  In the following description of disease, I have thought
it best to avail myself of the labours of btfth parties; not
by way of compromise, but because I think a middle 
OF DISEASES.                 105
course will be most proper; at least, for a work of the
nature of this.
  The first distinction which I shall make is, to divide
diseases  into two great classes;  these are distinguished
from the circumstance that one set arises from excessive
excitement; and the other, from abstraction, or exhaus-
tion.
                     SECTION  II.

         Of Diseases of excessive Excitement.

  To give a list of diseases, with  their symptoms, in
each of those classes,  would be to compile a system of
nosology, Avhich I shall not attempt;  because, as I have
said in the preceding article, diseases are never station-
ary.  They change  not only daily,  but, in many cases,
one hour may completely change the character of a dis-
ease.
  Diseases of the most fixed and regular inflammatory
cast, are principally to be found among people who live
regularly,  and in habits of industry, but more especially
those who  are engaged in the pursuits of a new country.
They are not marked with that versatility which accom-
panies the diseases of  more  polished and enervated
people.
  Thus, for instance, a genuine pleurisy, rheumatism, or
inflammatory fever, which are brought on healthy athle-
tick people, by the vicissitudes of the Aveather, or some
oppression, as straining or fatigue, will yield generally
to very simple treatment.   Here the skilful physician
will bleed; and if that will not do, he bleeds again  and
again, until the disease is subdued;  and when nature is
relieved  of her  unwieldy load,  she  rapidly  repairs the
breach, and seldom requires  the aid of stimuli or to-
nicks;  nor, indeed, will she often bear it, and requires
nothing but rest, mild diet, and regular sleep.
  This state of  disease is only to be found among  peo-
ple inhabiting healthy districts of country; for so essen-
tial is a  wholesome  atmosphere, that the best constitu-
tion, and the best habits, cannot secure from  diseases of
a more irregular character,  as agues, bilious remittents*.
              14 
106
OF DISEASES.
and  even typhus fever; all of these may be ushered m
by inflammatory symptoms; and hence comes a dimcul.
ty in their treatment;  for,  if we suffer ourselves to be
led astray by the strong full  pulse, the flushed cheeks,
or the acute pains or stitches, and reduce our patients
suddenly by bleeding, we may produce irreparable mis-
chief.  It is true, these diseases often require the use of
the lancet; but it  can only be used by a skilful physi-
cian.  Some seasons,  they bear pretty free evacuations
by bleeding; in others, we must be contented with such
medicines as operate on the bowels.
  It may be objected that  typhus  can never requirethe
use of the lancet;  but who has not seen a complete ty-
phus transformed into a fever, really inflammatory, and
requiring a corresponding treatment.
                     SECTION  III.

              Of Diseases of Abstraction.

  In taking a view of this grade of disease, we are not
to suppose in all cases, sensible expenditure  has  taken
place; nor that there is not inordinate action somewhere;
but it is generally found in other parts of the system than
those which are the seat of inflammatory ones, manifest-
ing itself, in the nervous or sensorial system.
  This form of disease is occasioned by the gradual loss
of animal powers, from intemperance; and from the va-
rious debilitating habits of the artizan, recluse, or stu-
dious;  and  sometimes suddenly by a pestilential  atmo-
sphere.
  Under this head, we may notice first such diseases as
are the consequence  of  actual abstraction,  as loss of
blood,  want of nourishment, or want of air,  &c.  all of
these may terminate in death; but these causes  produce
the most simple diseases of this class, and seldom re-
quire much from medicine; a wholesome air,  mild nou-
rishment and  rest,  are principally necessary; and it is
truly astonishing how far those things may be borne with-
out disorganization, or congestion.   But where these and
other causes operate very slowly for a length of time, they 
OF DISEASES.                 107
impair, or deprave the fluids, and this leads to conges-
tions and disorganization, the destroyers of animal life.
   Here Ave may next notice, a still more insidious form
of disease, arising from exposure to a  pestilential air.
Such air is often found in crowded camps, jails, &c. and
sometimes diffused through  the atmosphere generally.
These  deleterious gases  act with  such a tremendous
force, as  to hurry the system in a few hours through a
violent  inflammatory stage, and then prostrate the sys-
tem below a healthy action; or  what is more common^
rapid exhaustion, or locking up of the vital  powers,
prostrates the system at once to a most dangerous de-
gree,  and often expends the  living principle so far, or
at least, so completely fixes it on a particular part, as to
leave nothing for medicine to act upon.
   This form of  disease has generally got the  name of
putrid;  but no  such thing as putrifaction can exist in a
living body; this is a property belonging to dead matter
only.  It is true, disease often  approaches to the very
verge of it, but still, any thing like putricency in the fluids,
is wholly incompatible Avith life, and therefore this term
ought t© be exploded.  The term malignant is sufficient-
ly expressiA^e, without comeying false ideas.
   Another form  of  disease exists, the consequence of
idleness and intemperate habits,  such as necessarily, or
viciously  attach to refined  society, as want of exercise,
too cordial and gluttonous diet, sedentary employments,
drunkenness, want of reasonable sleep,  avarice,  intense
study, &c.  This form of  disease, has got the name of
nervous, and the name is sufficiently expressive.
   The  symptoms of this class of  nervous diseases are
numerous beyond calculation; the  various  combinations
of them has given rise to large systems of nosology; and
after all, no two cases can be found precisely alike.
   But amid all this variety and confusion, we have con-
solation  in the  knowledge of their causes, which may
often  be avoided; and in knowing that they are all bot-
tomed on constitutional debility,  and  require  tonicks
adapted to the state of each case.   They may be miti-
gated for a short  time by stimuli, but permanent  relief
can only be expected from the avoidance of their causes, 
108
OF EPIDEMICKS.
the use of tonick, exercise, and a proper regimeu;%nd,
the use of stimuli will lead to greater evils.
   We are naturally  led  to these conclusions,  that al-
though disease is  essentially but twofold, that still Ave
gain but an imperfect knowledge of them without fur-
ther distinctions, for,  so rapidly do these opposite states
succeed each other, and so much is morbid action influ-
enced  by peculiar circumstances, that we can only obtain
a reasonable knowledge of them by seeking their causes,
and classing their characteristick symptoms.
   And, although it be really and undeniably true, that all
our remedies  both medicinal and regimentous, operate
either by reduction and lessening action, or by repletion
and imparting action and tone; yet it requires  an inti-
mate acquaintance with the laAvs of the animal economy,
with the causes of  diseases, and  with the nature, or
respective force or strength of each article of medicine,
&c. to enable us to prescribe with success, or sometimes
even with safety.
   With these general observations, I pass on to what I
consider the next necessary division of our subject, and
shall  divide them into epidemick, endemick, contagious,
fortuitous, and habitual diseases.  It may be necessary
to premise, that these are often blended in such a man-
ner as to render it difficult to class them, or to detect
their symptoms in each  individual case; hut much use-
ful knowledge can be had from proper attention to those
 distinctions.  I am aware, that objections may be made
to this division of diseases by the critick, but after much
reflection, I think it the most proper in a work of the na-
ture of this, it having a tendency to lead the mind to use-
 ful practical distinctions.

                      SECTION IV.

                    Of Epidemicks.

    These are diseases which arise from causes indepen-
 dent of the sensible qualities of the weather;  and per-
 vade whole districts of country, or cities.  Of this class
 no one has been spread  so extensively as the influenza. 
OF EPIDEMICKS.                109
  In the United States, we are subject to yellowr fever,
bilious remitting fever, influenza, typhoid or Ioav fevers,
measles, hooping-cough, scarlatina, or  malignant sore
throat, and perhaps some others.
  Although epidemicks  in general, are under regular
laws which confine them to certain  districts of country,
and seasons of tl^ year, still they are found to be influ-
enced by circumstances, as the habits of the people, the
weather, the climate, and by an influence they have upon
each other.  Of all these particulars we have some know-
ledge, but it is  very imperfect.
  Thus on a delicate people, glandular and nervous af-
fections will be found predominant; while on  a people
of firm stamina, and athletick habits, they seem  to ope-
rate most  conspectably on the muscles and fluids of the
body;  and when left to themselves terminate  n-'jrtally,
more suddenly than the  same  disease on the delicate;
but are much more easily managed in  mild climates by
proper remedies.
  It is manifest that the weather has influence on epide-
micks, for, although sporadick cases of yelloAV fever oc-
cur  during Avinter;  as an  epidemick this disease never
fails to yield to the killing frost of fall.
  Climate is knoAvn to vary the character of epidemicks;
the yelloAV fever is more  rapid in  its progress in Avarm
climates,  and requires  a more prompt treatment, while
large districts of country are found where yellow fever
never existed.
   Epidemicks  have  an influence  upon each other; for
we seldom see  two epidemicks prevailing at the same
time;  two of great force are  never found together; so
much do  the more alarming epidemicks affect all around
them, that chronick and habitual diseases are affected by
them.  Here it may be remarked, that it is a pretty ge-
neral  law in nature, that two diseases shall not exist in
the same subject at the same time; but there are excep-
tions; so are there exceptions to this laAv of epidemicks.
   From the foregoing view of epidemicks we may draw
a few practical remarks.
   Has an epidemick been discovered in  a neighbour-
hood, and distinctly characterized, it behooves every per- 
110
OF EPIDEMICKS.
son to become scrupulously  temperate,  but not too ab.
stemious;  avoiding all excess in eating,  drinking, exer-
cise, exposure to  night dews, curbing closely the pas-
sions, and avoiding every sensual indulgence; for, when
the atmosphere is loaded with the seeds of an epidemick,
any irregularity  may excite the prevailing disease.  But
it must not be forgotten that all extremcPmeet in the same
point; and not to exercise at all,  or,  to live very much
below your healthy  standard,  will be as prejudicial
as an opposite course, and  therefore must be  equally
avoided.
  Should disease  come on, notwithstanding your care,
your  precautions  will not be lost; for, in ninety-nine
cases of an hundred, the  disease will be milder for it;
and if not, it will  be  a precious cordial, when  brought
low, to  believe you have  done your duty, and have not
directly had any agency in bringing on the disease: such
reflections will inspire you with confidence  in Him who
ruleth.
  It is  now  your  duty to call  medical aid; if it is not
obtainable in reasonable time, you aa ill  often be in pos-
session  of knowledge of the suitable  remedies,  from
knowing  what Avas prescribed by medical  men in  your
neighbourhood;  but never let this prevent  your getting
advice.   If you have no such information, you can ne-
ver be wrong in remaining quiet, and opening your boAV-
els freely with injections; but for other remedies, I must
refer to the treatment of each disease.
  By keeping your view  on  the fact that all diseases do
homage to powerful  epidemicks,  you will be  enabled
sometimes to discover at an early stage of an attack that
it is nothing but the prevailing  disease; and if you are
subject to habitual disease, may prevent you from doing
irreparable mischief;  for the  epidemick may be very dif-
ferent, in its nature, from your habitual  disease. These
observations apply principally to yellow fever, remittents,
and typhus fevers: the other diseases, of the class of
epidemicks, are  either more marked in  their character,
or less  dangerous; and therefore I shall  refer my  obser-
vations on them to my catalogue  of diseases. 
OF ENDEMICKS.—OF CONTAGIOUS DISEASES*  111
                     SECTION V.

                   Of Endemicks.

  This class of diseases are so similar to that of epidem-
icks, that I shall have but few remarks to offer concern-
ing them.   They are such as are confined to place, and,
like epidemicks, are occasioned by an unAvholesome air.
  The most prevalent diseases of this class are  agues*,
and remittents: yellow fever, and dysentery, may be pla-
ced in either class; or, perhaps, more correctly speaking,
epidemicks and endemicks  are one and the same thing;
the former, being a more diffused, and the latter a more
local disease.  It follows, that the same precautions and
views apply to both.
  It will not be out of place to observe, that as epidem-
icks are influenced by climate, and occasioned by a con-
taminated air, it  becomes the duty of all, who  conve-
niently can, to remove to some healthy place.  We fly,
at the risk of every thing, from before victorious armies;
and are we not equally bound to flee from disease? Thou-
sands of lives might be saved in  this way.   It is the
duty of the medical  profession to warn the people; not,
however, without good ground; and it becomes the reli-
gious duty of every physician to stand his ground: he who
flees at  such a time,  is unworthy his  profession  and of
the people's confidence.
                    SECTION VI.

              Of Contagious Diseases.

  There is strong grounds for believing that there is but
one contagious disease affecting mankind, and for that we
have been blessed with a certain prophylactick.  I shall
not undertake to say, whether this boon was reserved for
the age that put down the slave trade, and who are car-
rying the light of the gospel to all nations and tongues;
fcut surely it is a pleasing coincidence, and leaves hopes 
112          OF  FORTUITOUS DISEASES.

that similar blessings await our virtuous deeds, should
they continue to wax greater.
   This terrible scourge knoAvs no dictinction; he dwells
in the air, and in the body; from pole to pole, the great
or small, black or Avliite, nor age, nor sex, just or unjust,
are exempt  from its ravages.   The sandy deserts or
flowery valleys, the heathen and  the christian, all, all,
feel this domineering scourge; neither winter nor summer,
nor temperance, can restrain his wrath.
   But a benevolent God, to christian man revealed the
long, long, hidden secret, which on wings of charity,
traversed the world with a speed, Avhich no former  age
could have equalled; and entails on mankind a blessing,
which forms an important era, and probably will go far
to spread Christianity;  for to the heathen was given a
Bible in one hand, and this blessing in the other!
   I believe then, that this is the great seal on contagion,
and that it only remains for man  to live rationally, and
the day will arrive when the word contagion shall cease
to be  known.
   I am not disposed to enter into  any  critical explana-
tions of contagion, but  I am  confident if my opinion is
not correct, it is not mischievous, and that all diseases will
arrange properly under that of fortuitous or epidemich
which have been usually considered contagious.

                    SECTION VII.

               Of Fortuitous Diseases.

   Under this head, I shall take occasion to warn the un-
skilful of the difficulty of acquiring a medical knoAvledge,
and of the danger  of tampering with disease.   Here is
opened  a multiplicity which bewilders  and should con-
vince us, that the Creator has intended man shall not fix
his eyes exclusively on this Avorld.
   Every part of the body, solids  and fluids, and mind,
are all invaded by diseases which Ave can neither trace
to their causes, nor reduce to  system,  because they are
ever varying with  circumstances.   The active and idle,
the strong and  weak,  the male and  female, infancy; 
               OF HABITUAL  DISEASES.            113

youth, and years of maturity, have  all their peculiar
diseases.   And as many of these assail us without any
premonition, how difficult must it be to arrive at a know-
ledge, of them, which  shall  justify  us  in prescribing
where errours may be fatal, and can  never be innocent.
  Many of the diseases which I shall  place in this class,
may be avoided in our present state of knowledge; and
the most of them are the offspring of vice or inattention.
Thus for instance, a venereal gonorrhoea, or lues venerea,
itch, and other diseases, are the offspring of vice, or filth;
and the two former can only be gotten at the  expense of
virtue.
  A rheumatism, pleurisy, or simple imflammatory fever
are most generally OAving to rash exposures to the vicis-
situdes of the Aveather,  or inattention to suitable cloth-
ing, or exposure to the cold dews, after the fatiguing la-
bours of the day.
  Again, the colick and hundreds of nervous diseases,
are occasioned by intemperance or enervating habits.
  Consumption, the greatest  scourge of our country, is
evidently often owing to neglected colds, or other slight
diseases;  or it may be excited by inattention to exercise,
and to the want of suitable care in our apparel.
  An attempt will be made in the proper place, to class
and explain those diseases, and sufficient directions will
be found for their treatment, so far as may be necessary
for  the heads of families.

                  * SECTION  VIII.

                Of Habitual Diseases.

  Many of the habitual diseases arise out of the fortui-
tous, and I have called them  habitual, because by cer-
tain associations, existing in some constitutions, they re-
cur at regular or irregular periods.   As an example, I
will take  asthma; this is often the consequence of some
fortuitous disease; but,  when once  formed, recurs from
various exciting causes, as fatigue, damp weather, &c.
and having spent its force in a term of  days, goes off,
and leaves its victim free from disease, for a  period un- 
114
SUMMARY OF GENERAL
certain in duration.  Gout and piles are strongly marked
diseases in this class.   There are many  others, which
will be noticed in place.  Some of this class ot diseases
merely lurk  in the body, others are always present and
distressing.  It may be remarked here, that this class of
diseases are often hereditary; and Avhen severely and tho-
roughly established, should be considered a bar against
marriage.
   What a miserable prospect  must a  man  or woman
have, who enter into the married state affected with dis-
ease, which may descend to their  posterity, and some of
which may even be communicated to their partner! Such,
we knoAV, is the  case  Avith yaws.   This disease, like
most others, is  original\y fortuitous; but may become so
fixed as to be habitual.
   Should  people  inconsiderately, or unknowingly that
they have a lurking disease, enter into  matrimony, it is
their most sacred  duty to try to lessen the predisposing
causes of disease, to Avhich their children  may be expo
sed; for this purpose a healthy country residence should
be chosen, aud  habits of the strictest temperance formedj
and if they are too feeble to pursue the healthy employ-
ments  of  agriculture, never put them to sedentary em-
ployments, unless absolute necessity compels; for, by
aiding them to  exercise constantly, yet moderately, they
may acquire, eventually, strength to enable them to throw
oh° their disease by good habits aud active industry.

                     SECTION ix.

    Summary of General Observations on Diseases.
or
  I have said, that  however  varied in  grade, form,«
symptoms, the diseases of mankind  may  appear, and
however much disposed to change from  one form to an-
otiier, still there is but a twofold essence in  morbid ac-
tion.
  There is either inordinate action or high  excitement;
or, there is feeble, hurried action, or want of excitement
or exhaustion. 
             OBSERVATIONS ON DISEASES.         115

   I have also said, all extremes meet in the same point:
thus, Avhere stimuli act with great excess  of force on the
body, instead of  rousing up  strong action, they bear
down every energy;  and instead of powerful action, we
have  scarcely any action at all.  But, notwithstanding
this deceptive appearance, such cases belong to diseases
of oppression, and  require the  abstraction of stimuli
from  the body,  by bleeding, purging, emeticks, &c.  to
relieve nature from  a part of the  load, and  reaction
comes on, and nature points out  more clearly  the  real
nature of the case, and enables the physician to judge
Iioav far he must deplete.
   On the other hand, debilitated persons, either consti-
tutionally so, or  from the slow, continued debilitating
effects of umvholesome air, kc. when seized Avith  dis-
ease,  nature, as if suddenly  alarmed, rouses up a  hur-
ried, excessive action; and if Ave  were to judge by the
pulse alone, Ave should, most  certainly, think  such a
case partaking of  high inflammatory action.
   But this  would be an egregious  mistake; for, if Ave
Avere  to deplete in such a case, death or great danger
Avould certainly follow.   This state of the system being
really the opposite of a disease of oppression, is properly
called a disease  of abstraction or exhaustion; and the
sudden sally which nature makes, apparently powerful,
is  slightly bottomed; and to prevent her from expending
the energies of the body in  those transient efforts, Ave
must apply stimuli, and endeavour to accommodate them,
in quality and force, to the state of  the system.
   The first case may be compared to the mighty oak,
borne down by the hurricane;  when the Avind  ceases, it
rises, not only to its proper position, but, by reaction,  is
carried beyond  it.   But, if the wind  cease not, or be-
comes too powerful, with one fatal sweep down goes all
hope.  With hoAV much success may we operate against
such a force, by  strong efforts, in an opposite direction?
A tree secured,  may  be saved from the fatal  storm; so
the skilful physician, by opposing  nature, removes the
disease.
  The opposite  state of the system bears some simili-
tude to a  sickly plant wanting light: it grows  rapidly; 
116            SUMMARY  OF GENERAL
but if the light be not admitted, in makes an unavailing
effort, and then sinks and dies; but if, in due time, light
be admitted, it stimulates,  and raises neAV action, and
health and vigour follows; so  with  the exhausted pa-
tient: infuse suitable stimuli into his  languid system,
and he recovers tone and vigour by degrees.
  Still, such is the variety of the causes of diseases, and
so much are they  governed by present circumstances;
so rapidly do they pass from one form to another, and so
difficult is it to appreciate or apply  remedies, suited in
form to either state of the system, that we are obliged to
class or group our diseases  and  remedies to enable us,
with more success, to trace morbid action, and expel it
from the body.
  When we trace diseases as epidemicks, Ave find them
spreading through a whole country, and producing, not-
withstanding every peculiarity of habit  and circumstan-
ces, in the main,  a train of symptoms and consequences
nearly  alike.   This enables us, when  Ave have disco-
vered a suitable treatment for the present season, to pro-
ceed with much greater ease  and  success, and by know-
ing  our liability should induce us to be more careful
in our habits;  but still there is ahvays such variety as to
call for the  attention of the most  skilful  physicians.
We often have it in our poAver to flee from epidemicks;
it is our duty  to  do  so.  To some of these we are ob-
noxious but once in  life.
  When  we  examine  diseases, as endemicks, we find
them nearly resembling epidemicks;  but  have it still
more in our poAver  to shun  them, because they are lo-
cated, and are often brought on by intemperance, fatigue,
&c;  and because it is often in  our power  to remove
from  them, or  lessen  the remote  causes, which are
effluvia arising  from decaying vegetable  and  animal
matters;  by  draining  ponds and marshes, by cutting
down weeds,  &c. and  removing them  to a dry  place,
or burning them, &c.
  When we view diseases as contagious, we are hum-
bled, indeed, to think that a bounteous Creator has ren-
dered us obnoxious to diseases, against which no effort? 
OBSERVATIONS ON DISEASES.         117
can avail; neither climate, morality or"immorality, Chris-
tianity or paganism, cleanliness or filth, nor naught in
creation can prevent or restrain! Such Avas the smallpox;
but I feel happy in the belief that the vaccina will some
day remove this ungovernable  scourge  from the list of
of our diseases, and that we iioav have it  more com-
pletely under subjection than any other  disease.
  Oh!  man, if  thou canst appreciate the bounteous gifts
of Heaven, rejoice that this fell destroyer is chained from
those who accept the cheap, cheap, proffered favour of a
benevolent God! And have you neglected to secure your
children? Let not the shades of night over-shadoAV  thee
till the good deed is done; for this blessing has gone out,
hand in hand Avith the Bible, to all tongues and nations;
and wilt thou alone  dare thy  God to inflict upon your
children that which he  has ordered to sleep, with the
blindness of the heathen? Can you dare to survey the
pretty  face divine of your child, and  deny it a favour for
which it might  justly despise you?
  When we  turn our attention to fortuitous diseases,
Ave see a necessity for further  distinctions;  they amount
to a very great number;  but it may be said of them that
they are more  the consequence of our  own inattention,
&c. than any other class of diseases; and the causes of
many  of them  being known,  Ave have  it in our power
often to prevent them.
  By suitable inquiry into habitual diseases, we may ac-
quire a knowledge of our own constitution, and often be
enabled to prescribe for ourselves, with that promptitude
which is often necessary, without the advice of a physi-
cian; thus the asthmatick might suffocate before medical
aid could arrive, unless he is able to prescribe for him-
self; and if he do nothing but admit a current of fresh
air, still it is a  remedy,  and implies a belief that the pa-
tient has some  knowledge of his situation.
   It may also  enable him, by extraordinary  care, to '
keep down diseases, which he knows are hereditary,
and were existent in his parents.
   Having now premised with these general observations
of diseases, and of the  general intentions in viewr, in re- 
118
OF THE YELLOW FEVER.
moving or obviating them, so far as I think they will be
found useful, I shall pass on to treat of each individual,
to which we are  most exposed in this country, and ar-
range  them,  so far as  practicable,  on  the plan laid
down.
OF EPIDEMICKS  INDIVIDUALLY,
             SECTION I.--SUBSECTION I.

                Of the Yellow Fever.

THIS has been  knoAvn to  prevail in the cities of the
United States, at considerable intervals, more than a
century.  In Philadelphia it has been publickly acknow-
ledged in the years 1699, 17*1,  1762,  1793, and to a
considerable degree, in several years since.   All of our
cities have  sometimes felt its effects.   It  is a very great
errour  to suppose that it is confined to cities; it has pre-
vailed  in many parts of the country, Avith  a mortality
equalling any thing we have seen in our  cities.
  Sometimes it has appeared as an epidemick; and spo-
radick cases of it  are to be found  in every place where
bilious remittents are rife.
  The most  certain guide for those unacquainted with
its symptoms will be a knoAvledge of  its  prevailing;  for
where  it prevails  as  an  epidemick, or endemick, other
diseases  are  seldom found.  It affects all ages, sexes,
and colours.
  The dreadful  mortality with which it has prevailed
at different times, most  clearly points out, not only the
necessity which there is  for every person to  have some
knowledge of its character, &c. but evidently makes it
the duty of all to acquire a reasonable knowledge of it,
for the following reasons.
  Although the cause of this disease is well known to be
a tainted asmosphere, still, it is equally Avell known that 
OF THE YELLOW FEVER.
Ir9
its exciting causes are various.  Intemperance, fatigue,
exposure to night, and morning and evening air, are some
of its most common exciting causes.  I mean here, that
many persons who breathe the vitiated air, and have the
seeds of yellow fever lurking in the body for weeks, often
escape an attack of fever by avoiding fatigue and irre-
gularities.
  Of Iioav  much importance then must it be to be enabled
to spare physicians from the extraordinary fatigue and
anxiety of mind, exposure to night air, &c? this can on-
ly be done by people possessing a knoAvledge of the dis-
ease; and  Avith  the reasonable aid of the physician,  at
reasonable hours, do  that for themselves  which  may
otherwise be frustrated altogether, by loosing their phy-
sicians.
  Doctor Rush informs us, that from 1793 to 1801 a pe-
riod of eight years, "the  graveyards of Philadelphia
contain the precious  relicks of three and  twenty physi-
cians, Avho have died martyrs to their affectionate  and he-
roick sympathy," for  people • affected Avith  yellow fe-
ver.
  Many of the most observant physicians have noticed,
that yelloAV fever most frequently attacks at night, or very
early in the morning;  and  hence the advantage  of  each
individual  having some knoAvledge of, at least some first
powerful remedy, that the disease  may be taken in its
forming stage.
  Besides, Avhere this  disease domineers terribly, many
or all of the physicians may be unable to attend, and un-
der the greatest  advantages, there may be so many pa-
tients as to render it really impossible, to get even the
advice of a physician in time.
  Impressed Avith the importance  of these remarks, I
think it unnecessary  to offer any apology for giving the
publick au  abstract from a history of the disease,, as h
prevailed in Baltimore in the year 1794.  This excellent
account of  the fever  of '94, is  taken from the Medical
Museum, and was written by Dr. Drysdale.
  It is the best  account of the  disease I have at com
mand, and lays  down  a practice, rational, learned, and
correct; and as I have become a citizen of Baltimore. I 
120        HISTORY OF THE YELLOW FEVER

have chosen to give it the preference.*   I have only to
request my  readers in the most solemn manner not only
to read it, but study it, commit to memory. I have thought
proper to point out all words and sentences, which I deem
particularly important, by  a single comma,  before and
after such words and sentences, and hope thereby to take
the attention of the unskilful, to what is most necesary to
be known.
  This account  is written in the form of letters, to Dr.
Rush; and  Avhile it does credit  to the author's  medical
talents, is strongly marked with the traits of a  benevo-
lent feeling heart.

                    SUBSECTION II.

      Letters from Dr. Drysdale to Dr. Rush.

     "Dear Sir,
  You have requested a history of the yellow remitting
fever, as it prevailed in Baltimore; and I have  perhaps
inconsiderately promised to gratify your  wish.  The dif-
ficulties  which necessarily accompany  such  a task, in-
crease in number, as I travel in imagination through the
region before  me.  "Hills peep o'er hills, and  Alps on
Alps arise," when I contrast  them with the powers of
my youth; I am almost dissuaded from the attempt. But
I now enter on the undertaking with this pleasing  re-
flection,  that you will indulge  the deficiency of execu
tion, where  the critick would condemn, for I am convin-
ced with Dr. Moore,  "that those who have the  greatest
knoAvledge in  their profession, are best  acquainted with
its uncertainty, and most indulgent to the  mistakes and
-errours of others."
  "An account  of the weather which preceded the ap-
pearance, and accompanied  the progress of  this awful
disease to the close of its career, will be  given more pro-
perly in another place.
  *It may be  remarked of the yellow fever of '94, here treated on,
that the disease, and the  treatment found most  useful, corresponds
very precisely with that of the fever of  '93, treated of  by Dr. Rush.
who triumphed that season overall opposition. 
■6F '94, AT BALTIMORE.            181
   "But it may not be unnecessary to  mention here, the
principal diseases Avhich characterized the summer and
autumn.   In the toAvn the cholera made its appearance
among children as early as the months of April and May,
but it is very remarkable, that this disease was unknown
through the summer upon Fell's Point.  On the lower
part of Baltimore,  the month  of  May was  unusually
healthy,  a catarrh only affecting children.  In the begin-
ning of June, intermittents and dysenteries became more
general, and as the season advanced, remittents also made
their appearance.  These three diseases, especially the
first and last, ranged through every part of the country,
and infested even the highest grounds.
   "The  most remarkable disease Avas  the natural small-
pox.  It appeared very early in the  summer,  and soon
became epidemick.   It advanced Avith the  year, and
made such  devastation  among its unfortunate victims,
that Baltimore perhaps never before  experienced so se-
Arere a scourge from this- disease.   Even they who were
innoculated in the  spring, required  peculiar  attention;
for it Avas so unusually insidious, that many unexpect-
edly suffered from its  malignity.
   "The first case ot yellow fever that I saAv, was on the
7th of August.   The patient was in the fourth day of
the disease, and had  been  harassed several hours with
the vomiting of that  dark fluid, so greatly resembling
strong coffee, muddy  Avith its grounds.  His  eyes had
been very red but Avere now,  together  with the skin, yel-
Ioav; the  latter Avas dry and cool; his pulse Avas slow and
full.  He was either oppressed Avith stupor, or deranged
Avith a mild delirium.   In a feAV hours he Avas dead.   I
could not pause a moment in believing his disease to be
the yellow fever.  I mentioned freely Avhat I  had seen,
and expressed my  apprehension that this  case might
prove the prelude of a scene of calamity.   The Point
was now becoming sickly, and many deaths occurred
there suddenly, or after a very short indisposition.
   "The  several  deaths which had  occurred, together
with  the report,  that  the yellow fever had made its ap-
pearance, excited alarming apprehensions in the minds
of the people;  an inquiry  was consequently  made by
               16 
122       HISTORY OF THE YELLOW FEYER

three of the most respectable physicians, into the state of
the health of Baltimore.   On  the fifteenth of August,
they reported, that 'conformably to a request made by
the grand jury,  Ave yesterday proceeded to inquire into
the grounds  of a report, which for some days past had
created very serious alarms among the inhabitants of this
town, viz. that the-West India yelloAV fever did prevail
very generally at Fell's Point, and was accompanied with
its usual mortality; that there are no grounds for believ-
ing that the yellow fever is among us.
  " 'After a careful examination of several persons, con-
fined with fevers, and the most minute inquiry respecting
those cases,  which have lately proved mortal, we  are
unanimous in the  folloAving conclusions:  that the pre-
vailing fever  of that place is the  common epidemick of
the season, which annually visits our southern states, viz.
the bilious remitting fever:  that the late mortality at that
place,  which  had been greatly exaggerated by report,
has not been owing to any one  class of diseases in par-
ticular; that  during the late very hot weather, most of
the sudden deaths arose from accidental causes.  Many
of the labouring class of the people Were  destroyed by
the extreme  heat of the sun, Avhile  employed in their
usual labours.   'Intemperance  Avas  the cause of death
to some, whilst  indiscretions of different  kinds proved
destructive to others.'
  " 'On the whole, Ave are of opinion that the mortality of
this season has not exceeded that of many former ones,
Avhich passed unnoticed, &c. &c.
                Signed by Doctors
                         GEORGE BROWN,
                         JOHN COULTER,
                         LYDE GOODWIN.'

  "Every funeral recalled to the minds of the  Baltimo-
rians, the late calamitous situation of Philadelphia.  With
the  hearse and the  grave  they  invariaby associated  the
idea of yellow fever, which had destroyed so many thou-
sand citizens of a rival city.
  "It is, therefore,  not wonderful that an  alarm should
have been excited disproportionate to the  mortality that 
OF '94,  AT BALTIMORE.           123
had yet occurred.   The agreeable assurances they had
just received, (and I  am confident that the physicians
who gave them had not met in their search a single case
of yelloAV fever,) calmed the apprehensions of their minds.
It is, indeed, to be deeply lamented, that any subsequent
misfortune should have  broken this tranquil situation of
the toAvn.
  "On the fourteenth of August, Master M'C----, (who
lived on BoAvley's  Avharf, in the  store with the  gentle-
man Avho died on the seventh,) became  diseased.  He
recovered from his fever; but on  the nineteenth, a yel-
lowness was very observable over  his body, and soon
became as intense as in jaundice.   On the morning of the
twentieth of August, Mr. M----n called on me  for ad-
vice.   On the first  evening of his disease, I suspected
the real nature of his  fever, and did not hesitate to men-
tion my apprehensions.   I attended  this gentleman in
company with Dr. George BroAvn, my  former preceptor
in medicine; a person  Avho truly comhiues all the merits
of a professional  character, Avith  all  the  endearing and
respected virtues of a gentleman.  Mr. M----e was at-
tacked on the morning of the twenty-second; Mr. A. on
the evening of the same day; and Mr. A----n on the
folloAving morning.  These four gentlemen were engaged
in commercial business  on  the same part of Bowley's
wharf.  Some other persons, living at the  same  place,
Avere also  diseased at this time,  but they  did not fall
under my observation.
  "The peculiar symptoms attending the fever of Mr.
M----n, from its commencement to its fatal close, called
from Dr. BroAvn an unequivocal declaration of its  nature.
His apprehensions were increased by the occurrence of
the  other cases at the  same time,  and at the same place.
The declaration which I had made near three weeks be-
fore, Avas noAV seconded by an authority of the most in-
disputable nature.   A town meeting Avas in consequence
summoned, Avhich terminated in the nomination of a com-
mittee of health.  Their chairman, Gustavus Scott, esq.
was a gentleman of the highest honour and integrity; and
it is, therefore, to be regretted that his  necessary avoca- 
 1S4      HISTORY OF THE YELLOAV FEVER

 tions from town soon took him away from the regulation
 of their conduct through the scenes that folloAved.
   "Fell's Point Avas now becoming very unhealthy, and
 many cases  of disease had terminated there speedily in
 death.  On the thirty-first of August I visited, Avith Dr.
 Allender, Mr. I----r, in the seventh day of his disease.
 He had now a constant hiccup, and copious vomiting of
 the coffee-grounds; his eyes were very yellow; his skin
 cool; his pulse full, but so irregular as to beat sometimes
 three pulsations in one sixth of a minute; sometimes fif-
 teen in the same period of time.   He died the next morn-
 ing.  On the same part of Baltimore I  attended, with
 Dr. Brown, Mr.  Thomas L----, who was  taken ill on
 the twenty-sixth of August; his apprentice  boy on the
 twenty-seventh; and his maid servant on the thirty-first.
 Mr. C----'s son Thomas was attacked on  the twenty-
 eighth; himself and his son Robert on the following day.
 A boy of Captain J----'s Avas attacked on the twenty-
 seventh.  In the town three persons, who had contracted
 their fever on the Point, came under my observation on
 the twenty-ninth and thirtieth of August.  All of these
 cases, except one, terminated favourably.
   "While this scene of distress Avas extending on the
 Point, the town became unusually healthy.  Some took
 advantage of this circumstance to oppose the assertion
 that a yellow fever had appeared among us,  and to ridi-
 cule the authors of such a declaration.  But the disease
 soon extended  itself so Avidely that incredulity ceased,
 and even the tongue of calumny was almost silent.
   "About the sixth of September, the healthy tranquillity
 of the town  of Baltimore was again ruffled by the return
 of remitting  fevers, which, together with the intermittents
 of the season, were almost universally accompanied with
catarrhal symptoms.  The tenth of this month will long
 be remembered by the inhabitants of Baltimore, as the
 day which deprived them of Mr. Stephen Wilson.  He
 died of a bilious colick.   His unshaken patriotism as a
citizen,  the  rectitude of  his conduct as a great commer-
cial character, the liberality of his soul as a humane and
virtuous christian, the dignified  simplicity of  his man-
ners as a man, and the sincerity of his heart as an inesti- 
OF '94,  AT BALTIMORE.            12b
niable  friend, have left on every heart an  impression
Avhich can wear away only with life itself.
  "The yelloAV fever continued to increase on the Point,
in extent and malignity. 'Doctors Allender and Richard
Griffith, and  Degraffenreidt,  were at the same time in
imminent danger of falling victims to it.  Doctor Dorling
had lately died in town, and  Doctor  Griffith, Senr. on
the  Point,  was carried off after thirty hours indisposi-
tion.'   The Reverend Mr. Beeston, of the Roman  Ca-
tholick church, Avho  had been  much engaged  on  the
Point in administering the last offices to the  dying, was
now dangerously ill.   So great Avas the number of  the
sick about the  twenty-fifth, that Doctor Coulter visited
and prescribed for more than a 'hundred and tAventy'
patients daily.
  "Before the  close  of September,  a  panick  spread
through the toAvn, and drove a great number of families
to seek refuge in the country.  As I rode, on the morn-
ing of the'thirtieth, through the Point, I Avas  struck with
the melancholy change induced  by a very few days.
The streets were no longer croAvded and noisy Avith bu-
siness or festivity.  The eye would scarcely meet a do-
zen citizens in its  longest streets.   In the rooms of the
sick, I more particularly observed the stillness of the
streets.
  But  a little time before, even  Avhen  the reduced  vio-
lence  of disease  would have  permitted them to doze,
every slumber  Avas broken or banished  by the noise
without.   The  Avhole day resembled in silence the hours
of night.
  "A  happy change of weather at this time,  checked
the rapid progress of  the fever,  and  rescued the town
from sharing the general misfortunes of  the Point. The
disease declined, and by the middle of October the health
committee closed the aecount of the  dead.  The citizens
returned to their homes and business, and in a very short
time a person passing through the Point itself, Avould be
reminded of its situation only  by observing in some
alleys  the bodies  of a number of dead cats.
  "I have been, sir, as concise as possible in the prece-
ding observations. To have a more  enlarged view of 
1&&       HISTORY OF  THE YELLOAV FEA ER

our situation, while the mind was assailed on the one
part by the actual representation of disease and mortali-
ty,  and supported on the other by the wish and assur-
ance,  that our fears  beheld the occurrence through a
magnifying glass, you must only submit to the  guidance
of memory, while she bids the misfortunes of your own
city to glide  before your imagination.  The retrospect
will remind you of that principle of the  human mind,
which subjects our senses to our Avishes.  The eye is
unwilling to  behold a  scene that gives certainty to our
apprehensions of misfortune;- and Ave prefer lingering in
a state of suspense, (so  tormenting on every other occa-
sion,) to an absolute knowledge of our situation.  Hope
soothes an uncertainty,  but deserts  us when convinced;
We can scarcely believe Avhat we wish to be untrue:  so
powerful is this principle, that as you must have fre-
quently observed a person  while hanging over  the body
of a deceased friend or relation, cannot form an  idea that
it is dead.
  "Hence, sir, it Avas  long before our  citizens could
shake off their fancied  security, by believing the exist-
ence of danger.  But when  the  charm was dissolved,
the panick spread like  electricity, from mind  to mind.
'Now too late, it was  remembered  that  the dictates of
reason had been lulled to rest, and truth had been heard
but opposed, ridiculed,  condemned!'  Adieu."
  Ijetter second.  "We have hitherto, dear sir, travel-
led only round the borders  of our subject.    We  will
now,  if you please, take a nearer view  of the disease,
which,  although neglected and despised for a time, at
length struck the souls  of our citizens with anxiety and
terrour.
  "The yelloAV fever as it appeared here, tended natu-
rally  to death.  A fatal case, therefore, Avill portray more
strikingly its form.   'The  eye of the physician entering
the chamber  of the sick, would be arrested by a counte-
nance of distress;  the countenance of one Aveeping with
the anguish of a hroken heart.  He  would behold a face
suffused with blood; an eye  red, watery, half closed
and sad: the parts  immediately around it swoln: its si-
lent glance spoke sensibly to the soul, and seemed to de-
mand its pity   He Avould find the  tongue  moist, and 
OF '94,  AT BALTIMORE.            187
 white or clean.   His hand Avould feel the skin exces-
 sively dry, and parched Avith heat: a pulse hobbling or
 intermitting, slow or frequent, full or small, but always
 tense.  He Avould behold  the patient  tortured with ex-
 cruciating pains, rendered less  supportable by constant
 exertion to Aromit, till delirium mingled Avith, his groans a
 frantick laugh or song.'
   'At certain periods, the heat of the  skin would abate
 for a short time, but evjry other symptom Avould con-
 tinue with unremitting violence.'
   'But at length the skin would become cool; the pulse
 lose  its tension and frequency, and every pain cease.
 The fiery redness of the eye would disappear, and assume
 the yelloAV livery of bile.  A yellowness Avould appear
 about the neck, and gradually  extend itself over the
 whole body.  A vomiting of  a black fluid would occur,
 resembling the grounds  of coffee.  The  patient would
 be sensible of immense and oppressive weakness.  As
 these symptoms increased, the lips would appear cede-
 matous, and the tongue swoln.   The skin Avould be cold,
 and impart on pressure a sensation like that of a dead
 person.   The pulse would continue preternaturally slow,
 and generally acquire fulness as death approached.  A
 hiccup would at length occur, the pulse rapidly seemed
 to pause after every pulsation, as though it were to beat
 no more.   The blood bursts from different parts of the
 body; the action of the arteries is no longer felt; the
 heart gradually ceases exertions, while delirium and con-
 vulsions announce the victory of death.'
   "The primary  cause of the  preceding catalogue of
 symptoms, will  require  a distinct letter hereafter.   We
 will then  search into the origin of a disease, whose ra-
 vages have not been confined to  one ill  fated portion of
 the globe; and  therefore we  need only remark  in this
 place, that its appearance  in Baltimore  'seems not to
 haAre arisen from importation, but from an internal source.'
 It Avill appear also that the first cases originated from a
 domestick cause,' but that its subsequent extensive range
 depended in part on communication of contagion.*
  * Here that  correct reasoning which is so strongly marked on
every page, seems  for a moment  to have forsaken our amiable 
128        HISTORY OF  THE  YELLOW  FEVER

   "But to rouse the original  seed of disease into actual
fever, generally requires the  co-operation of secondary
causes to which schoolmen have affixed the name of ex-
citing or occasional causes.   Among these Ave may par-
ticularly  enumerate,'

                   1. Intemperance.

   'Almost  all  the  first  victims of  yelloAV  fever, Avere
persons habituated to the immoderate use of ardent spi-
rits:  and it is a melancholy truth, that very few of these
unfortunate creatures could be  rescued from death, by
all the powers of medicine.  So intimately are morals
connected Avith  our physical happiness; that w-e need but
look around us with the eye of reason, always to engage
in our pursuit  of the  one, the company of the other.
All the first occurrences of mortality try the yellow fever,
were generally ascribed to the primary influence of rum.
The mind Avas  unwilling to admit of a more hideou*
cause, while this offered to its  choice.
   'In drinkers of ardent spirits, the fever was excited
not only Avith more facility, but was attended also with
irresistible ATiolence and  malignity.'
   'Even a  moderate, but unusual  indulgence  in  those
liquors, soon roused the disease  into action.  A glass
of wine would  occasion  a headach in those  who were
much  exposed  to the exhalations  of the  sick, or to  the
air of infected  places; and for  a considerable time in

author, in supposing the same cause which originated the disease.
v/as not the most likely to extend it.  The whole tenour of this
history as well as the concurring testimony, of a vast number ot
the most experienced physicians, clearly establish that those per-
sons who breathe  the vitiated air, loaded with that kind of miasma
which produces yellow fever, may and do excite the  disease in va-
rious ways, as by intemperance.
  And nothing is more clearly established than that this miasma is
independent of febrile action.  But when we recollect, that the no-
tions of contagion which had been handed down  by the too credu-
lous writers, pretty generally, up to our  author's time, instead of
wondering at his giving this opinion of contagion, we are compelled
to admire his acute discernment, in  tracing the fever to  its  real
source. 
OF '94, AT  BALTIMORE.           129
September, half the quantity would affect me in a simi-
lar manner.'
   'The intemperate use of food also frequently gave ex-
istence to the latent disease.   A large supper of oysters
excited the fever in one person.   Even indulgence in ac-
customed meals, or in  particular  substances, was  some-
times attended by similar misfortunes.  A dinner of ani-
mal food would often cause an acute pain in the back for
three or four days.  The fever was excited in a gentle-
man before he had completed his supper; and in another,
by using a small quantity of cucumbers at his dinner.'*

                      2. Heat.

   'This was a  very frequent exciting cause, especially
when combined Avith  fatigue, either  of Avalking, riding
on horseback, or labour in the sun.   To the latter cir-
cumstance must, in a great degree, be  attributed the more
general prevalence of the fever among the labouring class
of the citizens.   The heat of  a fire produced, in several
instances, the same effect.   Hence blacksmiths suffered
peculiarly Avith the disease.   Sitting, in  the cool even-
ings or mornings of September, over a  fire, caused an
exacerbation or return of fever in some who were in a
convalescent state.'

                      3.  Cold.

   'Cold,' says  Sydenham,  'has  destroyed abundance
more than the sword, plague and famine, together.'
   'The cold  air and dews of  night excited the fever in
a  great number of those who Avere diseased.  These
powers acted with peculiar force, especially when pre-
ceded by sleep.   A gentleman was attacked with the
disease immediately after falling accidentally into the
river.   The  transition of the atmosphere from heat to
cold, which occurred about the twentieth of September,

  * Some of those trivial exciting causes mentioned, may be acci-
dently simultaneous with the attack: a  lurking disease may break
out from exciting causes, which are  not remembered, and induce us
sometimes to attribute'the attack to that which is present.
             17 
130         HISTORY OF THE YELLOAV FEVER

and continued three or four days, added considerably to
the number of the sick; nor did the cold Aveather, which
occurred after the beginning of October, check the pro-
gress of the disease until aided by heavy frosts.'

                       4.  Sleep.

   "Many persons awoke, in various hours of the night,
with a  chill or fever.   Some Avere not attacked till the
daAvn of day.

                  5. Marsh Miasma.

   "I am disposed to rank this among the exciting causes,
when the body had been  previously exposed to conta-
gion; nor is it one of the most inconsiderable.*  This
acted, when those already enumerated appeared to have
been  insufficient  to  produce  disease; for a  person, in
whom  the seeds of the fever were received, very fre-
quently escaped its  powers  by  exposition  to pure air.
Hence  the disease prevailed  most virulently about  its
primary  source; and seemed more innocuous when car-
ried to  another place  free from  the influence of marsh
miasma.   On Bowleifs wharf, the prevalence of a north-
erly wind during one day,  would be succeeded  by  the
sickness  of several persons.
   'The wind blew the water out of the docks so much,
as to expose the mud to the action of the sun.   The noi-
some exhalations combined their  powers Avith those of
the contagion already acting on the  body, and  excited

   * Here our author is  misled again in his  notions of contagion.
Such is the force of habit, in reasoning, as well as in bodily actions,
that the lessons which he had gotten were so strong as to deceive his
own better judgment.  Nothing can be a stronger argument against
contagion than the variance of the facts here detailed, Avith the ex-
tension  of the fever: it was confined to the lower part of the city!
It is somewhat strange, then, that Dr. Drysdale, whose discernment
enabled  him to discover the existence of yellow fever before conta-
gion could exist, should afterwards place miasma among the exci-
ting causes, when it was  evidently the remote and  predisposing
 cause.  But the mind, when chained down by fashion, is often  con-
 fined to limits, which detract from the judgment. 
OF '94, AT BALTIMORE.
131
fever.   On the Point the gentle shoAvers of rain Avhich
frequently fell, Avere succeeded by an increase  of  pa-
tients; those sources of miasma, Avhich had been dried up
by the sun, being again supplied with sufficient moisture
and heat to generate putrid exhalation.
  "Accidental circumstances sometimes excited the dis-
ease.   A mate of a vessel, having  received a blow on
the head from a cable, Avas immediately attacked with
the fever.
  "Among the exciting causes, some of very discordaut
properties are enumerated.   To account for their effects
in producing the same disease, Ave  must recur to the pe-
culiar nature of the fever itself.
  'The debility attending it, like that of pleurisy, is of
the indirect kind, or produced by excessive action of sti-
muli upon the  body.'  That it was of this nature, may
be inferred from the symptoms of the disease, and from
that mode of treatment Avhich proved most successful in
its cure.  "Causes which produce direct debility,  are not
preceded by a t nse  pulse, nor can their effects be coun-
teracted by debilitating medicines.  It may be  inferred
also from the means which prevent the contagion, when
the body is impregnated Avith it, from arising into actual
fever.  Did it tend to direct debility, would not those
powers which abstracted  stimulus from the  body and
gradually Aveakened all its functions, accelerate the  for-
mation of disease? And would not those persons, already
labouring under direct debility, be most subject to its in-
fluence? But the causes of the yelloAV fever, like that of
the smallpox, and wine, produces debility of the indirect
kind.   In the latter disease,  physicians  endeavour to
counteract this effect by debilitating remedies.
   "A moderate quantity of wine gives increased action
to the heart and arteries;  but when drunken  in  excess,
it is followed by indirect debility.   When the body is
impregnated Avith the contagion^of yellow fever,  disease
must  not necessarily ensue.  Its own stimulus is  not
always sufficient!,  powerful, by itself, to produce  this
effect; but when assisted by ardent spirits, animal food,
heat, or violent exercise, fever is excited.  Is it not suf~ 
 132       HISTORY  OF THE YELLOAV FEVER

 ficiently obvious that, under the influence of these causes,
 excess of arterial action must ensue?
   "Dr. Condiet,  in  his inuagural  thesis  on contagion,
 published  last  spring, has, in my opinion, sir, treated
 this subject so  ingeniously, that it will be unnecessary
 to dwell here any longer on this part of our subject.
   "But among the occasional  causes are cold and  sleep,
 and to these we may add grief and fear, which cannot be
 said to stimulate the body.   I admit this truth under cer-
 tain restrictions.  So far from these powers giving in-
 crease of stimulus to the body, they tend to induce direct
 debility, because they are of a negative nature.  But let
 this principle in philosophy be remembered, that the ab-
 straction  of stimuli  from  the body is  folloAved by in-
 crease of its excitability; this  being necessarily augmen-
 ted when the means  of  exhausting it are  diminished in
 number.*   Evacuations which  have been injudiciously
 immoderate, have occasioned the occurrence of  fever on
 the same principles which explain  its formation after
 cold or sleep.
   "Those who were exposed to the contagion, would be
 affected with headach, a heat and sense  of fulness or
 oppression in the  stomach) want of appetite, a disagree-
 able taste, and costiveness,  a burning of the hands and
feet at  night; restlessness   or droAvsiness; heat of the
 skin, alternately with  profuse sweats, frequently of a
yellow colour.  These symptoms Avere not ahvays suc-
ceeded by disease, yet they  proved the  precursors  of the
fever.
   "Those premonitory symptoms did not  precede  every
 case of fever.   It would often  seize upon its victims
 Avith sudden violence, while occupied in the various em-

  * This was the philosophy of our author's day, and continues, per-
 haps, to prevail very generally; but I am disposed to call its accura-
cy in question.  Excitability, whatever it be, is subject to expendi-
ture, and it is expended  by*exertions, or stimuli  operating on it.
 Now, although i,t seems  to be a law of the animal economy, that
more effect shall arise from  the application of  a stimulant, in a de-
bilitated body, yet that increase of effect is not owing to an augmen-
 tation of excitability,  but to a morbid susceptibility of this principle,
 horn which it is liable to be thrown into inordinate action 
OF '94, AT BALTIMORE.            133
ployments of life, or engaged in the pursuits of business
or pleasure.  A shaking or chill would usher in the dis-
ease in some, and from its degree of intensity we might
suspect the violence of the ensuing case.
  "The influence of the late yellow fever was discover-
ed under the folloAving appearances as it related to the

                      PULSE.

  "The pulse Avas  tense in every form  of the disease,
from its first appearance till its  declension in October.
It bore this peculiar character in the remissions  of the
fever; and even Avhen it commenced its career, under the
insidious coA7er  of an intermittent.   It was also quick;
the mind would be  deceived into a belief, that the pulse
Avas sloAver than it really  Avas, upon account of this pe-
culiarity of its nature, the systole of the heart being per-
formed in an instantaneous period of time.
  "Under the impression of every  temperature of the
air, and under every degree of violence of the disease,
the pulse held forth another emblem of its character, by
hobbling through  its functions.  A full pulsation was
succeeded  by another of less  force, and no tAvo strokes
resembled  each other in frequency.  In one person, 1
counted three pulsations in one sixth  of a  minute; in
another sixth, they amounted to the number  of fifteen.
This irregularity was more or less observable in  every
case, and in every period of the disease.
  'The tension of the pulse is so common an occurrence
that it will be useless to dwell on it for a moment.   When
the fever Avas uncontrolled by medica! aid, or treated im-
properly, the blood vessels were ruptured by the violent
morbid action.   In these cases also,  which were not op-
posed Avith sufficient force, even when the patients were
rescued from the grave, hcemorrhages would occur in a
small degree, before the final crisis of the disease.   The
blood bursted more generally from the nose, but it pour-
ed  also forth from the ears, mouth, bowels, and urinary
bladder.
  "Respiration was much impeded.   It was hurried and
laborious.   As the coldness of the season increased, the 
134       HISTORY OF THE  YELLOW FEVER

determination of the blood to the lungs, became more
obvious.  Pains in the breast became more common, and
a cough, with sometimes expectoration of phlegm, more
frequently accompanied the disease.  The nerves were
not so much diseased, as to occasion  frequently tremours
or twitching? of the tendons.  They in some cases ac-
quired such a morbid degree of sensibility as to render
the whole body  sore to the  touch.  The total destruc-
tion of the appetite for food was very remarkable in the
yellow fever:  nor did it return in the least degree during
its remissions.  It marked so well the violence and dan-
ger of the  fever, that a return of appetite for food pro
ved the most certain  sign of a  favourable  issue; nor
could the patient be ever declared out of danger, while
the total disrelish  for food continued,  notwithstanding
the presence  of other symptoms apparently favourable.
The thirst was excessive in some instances; but in gene-
ral it  was moderate and sometimes absent.  When pre-
sent, Avater Avas  much  desired, and  acid drink,  such as
lemonade  Avere grateful.
   "1  will iioav proceed, sir, to mention that mode of cure
to  Avhich the yellow fever submitted.   I have long ob-
served the superior  efficacy  of mercurial purges over
those  of any other kind, in  bilious diseases.  Blane,
found 'five or ten  grains of calomel succeed in  evacua-
ting bile, Avhen other  purges  had  failed in  this effect.5
Mercury not only cleanses  the bowels,  but acts also
poAverfully over the Avhole glandular system,  and causes
a diaphoresis, when other medicines have proved inef-
fectual in  opening the skin.   It seemed, therefore, ex-
cellently adapted in combatting the yellow fever: 'and a
soreness of the  gums, or a  gentle  salivation, gave  me
pleasure on their appearance, as the first tokens of the
impregnated state  of the body.
   'The good  effects of such  a circumstance have been
noticed by Wade and Chisholm:  the former gentleman
lost no  patient; and the  latter, but one  out of a very
great  number, in whom the mercury  caused a salivation.
You,  also, sir, have added another  testimony to theirs,
by informing us that  you lost but one person, in Avhom
a ptyalism occurred;  and out of many who came under 
OF '94,  AT BALTIMORE.            135
my observation, I know not an exception to their reco-
very from disease.
  'To give small doses of calomel in yelloAV  fever, is to
diminish the probability of a cure by losing time. Their
effects, if they produce any, will be of very little conse-
quence.   If evacuations be too sparingly  made, says
Pringle, a bilious remittent will become continued.
  'As a purge,' says Dr. Greorge Davison, of St. Vin-
cent's, 'calomel  has been used Avith the greatest advan-
tage;  sometimes by itself, but more frequently combined
Avith  some active purgative medicine, such as jalap,
From some peculiarity, an uncommon  quantity of calo-
mel is necessary to affect the boAvels and salivary glands.
As I found small quantities of  it did  not produce  the
effect wished for promptly, I  gradually increased  the
quantity, until  I noAV ventured  to give ten grains of it,
combined with five of jalap,  every two hours,  until stools
are procured.  The calomel is then given by itself.'
   'There are many other testimonies in favour of large
doses of purging medicines,  to  remove childish fears in
their exhibition.   The great Sydenham used to  admi-
nister twenty grains of sweet mercury in a dose, either
alone  or combined  with other  purgatives.   Chisholm
gave an hundred and fifty grains of calomel in one case,
with evident advantage.  You  have adduced irrefragi-
ble proofs of the utility of a similar practice.'
   "At the first appearance of the fever, I combined jalap
with calomel; gave each in  a small dose of eight or ten
grains: they were  repeated every five or six hours, until
the bowels were freely opened.   Frnn four or five such
doses, exhibited during the two or three first  days; I did
not observe an instance of salivation; and although  fre-
quent evacuations from the bowels occurred, yet they
were small, and brought with them but very trifling re-
lief.  The patients were harassed by repeated calls to
the closestool,  and the necessary exertions on these oc-
casions, weakened them more  than the discharges with
which they were attended.   This circumstance, together
with the reflections  that I  always failed in my endea-
vours to excite a salivation after the third day, in violent
cases, by means of the ointment and small quantities <>! 
136        HISTORY OF THE YELLOW  FEVER

mercury, determine! me to increase the quantity of each
dose, from the first  hours of the disease. < Fifteen -rains
of calomel,  still combined with the jalap,  flattered my
hones, by the increased advantages obviously following
their administration.  The evacuations from the bowels
were less frequent and harassing to the sick, than when
smaller doses had been given, but being much more co-
pious, they were  accompanied with speedier and more
sensible relief.   Yet a salivation scarcely ever occurred.
The  jalap  seemed to  carry  the  calomel  too  quickly
through the bowels. I, therefore, omitted it entirely, and
gave the mercury alone, in doses of twenty grains, every
four or six  hours, until two or three copious discharges
were produced   If one dose of this medicine  acted, it
seldom operated more than  twice.   The addition of
twenty more grains scarcely  increased the evacuations
beyond their natural quantity.   In another case, thirty-
six grains of calomel operated but twice; thirty more
grains required the assistance of castor  oil to  produce
another discharge.  In another case, forty grains in two
doses, one taken  at nine o'clock in the morning, and the
other at three in the afternoon, produced but three stools;
another  scruple was hoav given, Avhich operated once or
twrice more.  These uncombined doses of calomel soon
excited a gentle salivation.   As soon  as this occurred,
I had recourse to other purgatives to open the bowels
two or three times daily: castor oil, small doses of salts,
glauber  salts and  cremor  tartar, but more  especially
emollient glisters,  produced the desired  effect.  When
large doses of calomel were given, the evacuations from
the bowels  Avere very copious and few.   The  exertion*
of the patient Avere more than compensated by the dis-
charges which required them; the oppression was remo-
ved,  and he felt revived.   'I never saw a case  in which
fifty or sixty grains of mercury had been given in three
doses, accompanied with one half of that  sense  of im-
mense weakness which attended the exhibition  of fifteen
or twenty grains divided  into three or four parts.  The
weakest constitutions were not injured by large doses of
calomel.  Delicate girls and women derived advantages
from it, equally with robust men.'  The life of an infant, 
OF '94, AT BALTIMORE.            13?
scarcely five months old, was  preserved by taking fre-
quently five or six grains of calomel in a dose.  The
effects of calomel purges were great and obvious.  Their
operation was assisted, and perhaps sometimes varied,
by the bleedings used at the same time.
  1. "In some instances, the mercurial purges in two or
three hours,  produced sensations  of needless dartings
through the Avhole body.  These lasted but a moment,
and Avere succeeded by an universal sAveat.
  2. "The first dose often excited vomiting two or three
times, but being attended Avith very little nausea or retch-
ing, it proved a more safe and less irritating emetick than
the preparations  of antimomy, and vomited only when
there appeared to have been an accumulation of bile.
  3. "The large doses produced  but few discharges from
the boAvels: they were very copious, however, and attend-
ed with great relief to the sick.
  4.  "By removing excess of stimulus and immense op-
pression, they revived  the patient, and gave' him an in-
crease of strength.
  5.  "When the pulse Avas very low, the copious evacu-
ations from the bowels were followed by increased ful-
ness and diminished frequency of the pulse.   And when
it Avas preternaturally slow, they raised it to a more na-
tural degree of frequency.
  6.  "They moderated the violence of the fever, removed
the pains especially from the back, and obviated the re-
turn of severe exacerbations.   Hence they alone Avere
frequently  sufficient to arrest the progress of the disease.
  7-  "They caused the vomiting to cease when it ac-
eompanied the commencement of  the  fever:  and  very
often small doses of calomel, repeated every one or tAvo
hours, prevented the return of the vomiting of coffee
grounds, even after they had made their appearance.
  8.  "By means of  large  doses the whole system Avas
soon impregnated with mercury, and the various glands
resumed their suspended functions.  The general diffu-
sion  of this medicine through  the body, Avas announced
by a tenderness of the gums.  'I saAV no case terminate
fatally after a salivation, however violent  they had pre-
viously been.  The sooner the bowejs were well opeued,
              18 
138       HISTORY OF THE YELLOW FEVER
the greater Avas the prospect of recovery;' and Avhen a
salivation Avas excited, it Avas necessary  to procure at
least three stools daily, by castor oil or glysters.  This
prevention was  very necessary for the lapse of a  few
hours, Avithout an evacuation Avas frequently followed by
increased anxiety, an increase or return of the fever.
   "I  shall uoav consider the effects of blood-letting in
yellow fever.
   1. "When  the pulse was very frequent, venesection
rendered  it  more slow; Avhen very sIoav it gave it  fre-
quency, and  when  depressed and  small, it gave it  ful-
ness.   This latter circumstance is often remarked by sir
John Pringle in remittent fever, and by Donald Monro,
in dysentery.
   2. "Venesection  removed the delirium and the coma-
tose state, with which the sick Avere tortured or oppress-
ed: it likewise removed Avakefulness; and very frequent-
ly acted like  an anodyne, being succeeded  by two or
three  hours' refreshing sleep.
   3. 'It promoted the operation of the calomel in opening
the bowels.'   Hence I have frequently heard the patient
call for the closestool, while the blood Avas floAving from
his arm, although the  boAvels had  previously appeared
obstinately costive.
   4. "It  checked the'violent vomiting in the first stage
of the disease, Avhich had resisted  every other remedy:
and when a hiccup accompanied its  first attack, it yield-
ed to the same remedy.
   5. "It Avas frequently succeeded  by a general perspi
ration, and sometimes by a profuse  sweat.
   6. 'It removed the sense of oppressive weakness,  and
inspired the patient aa ith new strength and vigour.'
   "The pains did not ahvays vanish after bleeding; they
were frequently increased  by one or  two detractions of
blood.  Where pain had only been felt in the head,  one
bleeding has caused it to rage also in the back and limbs.
This occurrence was not new to me: I had formerly bled
an old negro man, Avho complained of some fever,  and
considerable  pain in his  breast: he lost  one pound of
blood, but in the  succeeding hour, the pain had so much
increased, and had become so intolerably acute, that I 
OF '94,  AT BALTIMORE.           139
 was obliged to permit the blood to flow, until it produced
 an abatement of his  state: this was affected by the addi-
 tional loss of twenty ounces, by which  his cure was com-
 pleted.  Whenever this circumstance  may occur in the
 yelloAV fever, the increase of pain ought not to deter us
 from a  repetition of blood-letting:  a second or a third
 bleeding may be necessary to subdue the violent motions
 to Avhich the vessels had been restored by the first.'
   "When the system Avas reduced by purging and bleed-
 ing, so far  as  prudence Avould direct the repetition of
 these remedies, and  Avhen  the action of the vessels was
 still  affected Avith some degree of febrile irregularity,
 blisters were applied Avith advantage to various  parts of
 the  body, particularly the head  and wrists.   In  many
 slight cases they Avere made  use of  in the first  stage of
 the disease.  But I  am inclined to  believe, that the  pa-
 tients would have  recovered sooner without them."
   'When toAvards the  close of  the disease, a  burning
 pain was seated in the stomach, a liniment of laudanum
 and sweet oil sometimes proved serviceable: but when it
 was more obstinate, equal  parts of molasses, milk; and
 castor oil, taken frequently in small doses, effected its
 removal.'  The troublesome vomiting which occurred on
 the third, fourth, or fifth day of the fever, was  freqnMjfly
 appeased by the same remedy.   A large draught of new
 milk,  sometimes equal to a pint,  assisted  very  much
 in checking the black  vomiting in  some instances, in
 which it was tried.  But the  remedy on which  the most
 reliance could be reposed, Avas emollient glysters, occa-
 sionally administered.   'Glysters Avere always  produc-
 tive of good  effects, after the necessary exhibition of mer-
 curial purges.   They prevented the occurrence of vomit-
 ing and checked  it  when existing.  I have  sometimes
 checked the last harassing vomiting, by small  doses of
 calomel, very frequently repeated.   After the reduction
 of the system by the evacuating  plan, an  interval suc-
 ceeded, in which medicine  was no longer required.   To
 use stimulating or tonick medicines Avas dangerous. The
 cure, therefore, Avas submitted to something a little nutri-
 tious, as weak broth, in small quantities; and the symp-
toms soon indicated whether stimulating soups, oysters, 
140     HISTORY OF THE YELLOW  FEVER,  &C.

chocolate, mush and milk, &c. might be  admitted.'  In
this stage the case was almost totally relinquished to such
means, and to the attention of the nurse."
   "Cool air was as necessary to the sick in the disease,
as bleeding."  'I always ordered the room of the patient
to be kept well ventilated, by opening the windows, re-
moving the  bed-curtains, and   placing  the bed  when
practicable, in  the  middle of the room.   The good ef-
fects  of air, were well demonstrated  by the influence a
confined room exerted over the sick.'
   The application of cold water alone,  or  mixed with
vinegar, to the head, on napkins, moderated its burning
heat, and afforded the most grateful relief to the patient.
It greatly mitigated the confusion of the head.  Wash-
ing  the face,  hands and feet Avith cold water, always
proved equally serviceable.   While it refreshed the pa-
tient, it sometimes totally removed the remains of a se-
vere headach.  I experienced this circumstance also in
my OAvn case, Avhen a large dose of calomel had proved
insufficient to remove the pain.   "The drinks also used
by the  sick were either cool or cold.   Mild herb teas,
lemonade  and jelly,  tamarind, apple,  or very  weak
chicken Avater,*  toast or milk and Avater, in every stage
of the disease  Avere used indifferently, according to the
Avishes of the patient.   Water alone was frequently de-
sired, but  could  seldom be granted.  A table spoonful
was sometimes given, but this drink was very apt to ex-
cite  vomiting,  especially in the advanced  state  of the
fever.
   In some cases  drinks acidulated with some of the ve-
getable acids,  proved most  agreeable.  The  elixir vi-
triol was always nauseous, and frequently occasioned
vomiting.  Weak  'coffee and  tea,7 were pleasant, and
used  with  safety in  any stage of the disease.  'Wine'
was universally nauseous, even in the smallest quantities,

  * I am constrained here, to caution the reader against any thing
like a liberal  use of chicken water.  In fevers of Ihigh inflammatory
action, it cannot possibly be a suitable drink: but so soon as there
is good evidence of abatement of the disease, it will be a grateful cor-
dial, and give a little sustenance, at a time when it is first necessa-
ry, or perhaps even  safe. 
      CONCLUDING ADVICE ON YELLOW FEYER.    141

and in every form in which it could be taken, its effects
resembled,  on  a  smaller  scale,  those of  laudanum.
When swalloAved in the fever, if it did not occasion vo-
miting,  it caused a burning heat in the stomach, or de-
lirium.
  'A  vieAV of the yelloAV  fever as the synochus  of Dr.
Cullen led to a pernicious mode of treatment.  The pa-
tient was first bled, then bark, laudanum,  &c. were ad-
ministered, in order to provide against an expected state
of debility.'
  'The  mind was  prepossessed with  a notion  of ap-
proaching putridity, and  the appearance  of inflamma-
tory action in the commencement of the fever, Avas totally
disregarded, or looked upon as a foe in ambush! How
much to be regretted, that the name of a disease  should
ever have more  potent influence over the judgment, than
the symptoms WTtb  which  it is accompanied!'
  "During the  prevalence of the late yellow fever, it is
to be remarked, that the  smallpox did not vanish, but
retained its ground.  But  this is not an objection to the
opinions hitherto advanced.   Is not the yellow fever  a
disease  highly inflammatory? So is the smallpox.   Was
this remitting fever more inflammatory than usual, and
from the particular  constitution of  the  season? So was
the smallpox."
  I here close this abstract, and regret that this account
could not have been presented entire.   Its length, howe-
ver, would not Avell admit insertion in a volume  of this
size.  I shall now close the subject of yellow fever, by
a few practical  remarks.

                   SUBSECTION III.

        Concluding advice  on Yellow Fever.

  Has  the  yellow fever become  prevalent in a neigh-
bourhood, it becomes indispensably necessary  for all
those who cannot leave the place, to become particularly
temperate in every respect.  By due attention to mode-
ration in eating, drinking, exercise, sleep, &c. many
will escape the  disease.  Should an attack come on,  it 
 142   CONCLUDING ADVICE 0"N YELLOAV  FEVER.

 is no longer safe to attempt removal; death is the certain
 consequence of  such  a measure.   It will now be the
 safest course to remain quiet, and attack the disease with
 spirit.  If medical advice, in which you confide, can be
 had,  it is the duty of every citizen to procure advice
 If that cannot be had  speedily, it Avill always be  advi-
 sable to take fifteen or twenty  grains of calomel,  with
 half that quantity of jalap,  every three hours, till your
 bowels  are freely  opened.  If this should  not afford
 manifest relief as soon as it has operated freely; a bleed-
 ing will be necessary, and should be  regulated accord-
 ing to the constitution, and violence  of  the disease.
 From tAvelve to twenty ounces may be taken.
   Should the symptoms even  now  abate,  get advice if
practicable, for  this fever is sometimes extremely insi-
dious; and putting on an appearance of retreat, too often
leads its victims  into  false  security.  If advice is still
not to be had, take calomel in doses of from three  to six
grains, according to age,  &c. every  two or three hours,
until you procure a slight soreness of the gums.  Should
the symptoms run high, the bleeding  must be repeated
till all violent pains or fever are subdued; and, at the
same  time, keep  the boAvels freely  open  by the use of
injections.
   Should the attack be moderate, still it will be impro-
 per to delay:  use the  calomel as above advised; and if
you should, notwithstanding, become Avorse, bleed; and
repeat the calomel  and opening injections.  In violent
attacks Avhich seem to oppress the stomach particularly,
or Avhere it has been preceded by nausea for some  days,
it  will be advisable to combine about twenty grains,
more or less, according to circumstances, of ipecacuanha
with the first dose of calomel.   This will generally ope-
rate freely, Avithout much straining, and instead of Aveak-
ening, will generally impart strength to the patient.
   A free admission of air is as essential  as medicine;
and, therefore, a large, av ell-aired room, with a hard*

  * The patient's habits may, however, be consulted respecting their
bed; for corpulent or very delicate persons, the bed should not be
 too hard. 
      CONCLUDING ADVICE ON  YELLOAV FEVER.    143

bed without curtains, should be preferred.   Animal food
of every kind, even chickeiiAvater, is improper; at least,
in seasons when the symptoms run high;  or, perhaps,
more correctly speaking, in seasons in which a very in-
flammatory constitution  of the air prevails.   It has been
remarked, both in the foregoing account of yelloAV fever,
and also by Dr. Rush, in '93, that tea and coffee were
always  grateful drinks.  They  ought  not  to be taken
too Avarm.  Lemonade, toast and Avater, milk and water,
and very weak pleasant herb teas, as balm, ground ivy,
and hysop, &c. are pleasant and proper drinks.  I have
great partiality for-toast and water as a drink, in all ca-
ses where the stomach is disordered.
   Wine, or ardent spirits, are even poisonous in every
case,  in the early stage; and are seldom admissible till
the convalescence is Avell advanced.   I think it  may
safely be laid doAvn as a general rule, in this disease,
that stimulants ought never to be used  without the  ad-
vice of  a skilful physician.
   Have you  been under the necessity of combating the
disease yourself, and well assured your disease is check-
ed; leave the  rest to nature, remain  quiet; take mild,
nourishing diet, in very small quantities, and if the ap-
petite calls for it, repeat it often;  taking great care to
begin with the milder articles first, as  chocolate,  mush
and  milk, well-boiled rice,  or  barley, reasonably sea-
soned;  then  light broths, &c; and lastly, with the ut-
most  Caution, resume the use of meat.
   Should you have checked, in good measure, the more
severe symptoms, and a lingering feverishness, Avant of
appetite, with occasional nausea and imperfect sleep, &c.
continue, it will  be  advisable  to apply blisters to the
AArrists,  or ankles, or even the stomach, if  that viscus is
affected; but it ought to  be well ascertained that the force
of the fever  is  broken, before they are applied: these,
with  the free  use of glysters,   will generally remove
those lingering symptoms.
   To sum up all in the fewest possible words, those un-
skilled in medicine ought to trust, where adAice is not to
be had, to the liberal use of calomel; the lancet, free ex-
posure  to cool  air, and the  constant use  of injections: 
144    CONCLUDING ADVICE ON YELLOAV FEVER.

with the reasonable use of tea, coffee, toast and water,
&c. as  their common drink.   They are carefully to avoid
spirits, wine, broth, and cold  water:  to  this last there
may be exceptions; but cold Avater, generally, is nause-
ating to the stomach in this disease.
  Should a patient unfortunately be found, who has been
labouring under the disease  to the second or third day,
nothing is  to be expected from stimulants.  The only
hope which remains, is to open the bowels with calomel,
in doses of ten grains, more or less, according to circum-
stances, given at intervals of four or six hours; with this,
the use of injections should be  added, and large blisters
should be  applied to  the stomach and  ankles; a veia
should be opened, and from three to eight ounces of blood
taken,  according  to  circumstances, and repeated every
hour or two, till there.is an abatement of the symptoms. In
such a case, weak chicken water,  or coffee, Avill be the
best drink; wine, and other cordial drinks, must carefully
be avoided.  I would also advise, in  such cases in par-
ticular, and perhaps in all cases where the calomel does
not affect the gums at an early stage, it would be equally
advisable to use mercurial ointment, freely rubbed into
the thighs, feet, &c.
  When the powers of life are prostrated very Ioav, and
we wish for the speedy action of a blister, nothing will
answer the purpose so  quickly and  completely as an
ointment  made  by  rubbing a few grains of corrosive
sublimate of mercury, with a little soft ointment or lard;
it will  often act, Avhere cantharides are ineffectual.
  It would be a good rule in doubtful cases, to abstract
blood in small quantities, and repeat it often, so as to un-
load the system gradually.  Purging at an early stage
of this disease is not easily carried to excess.
  By referring to the section on nosology, it will be found
that, the yellow fever sometimes appears as a disease of
a Ioav  grade,  requiring but  small evacuations  of  any
kind.   In  some few cases laudanum  was found useful,
but I feel satisfied that this grade of yellow fever occurs
but very seldom, so that,  nothing  of the  stimulant kind
can be used without the utmost hazard by those unskil-
led in  medicine. 
          OF THE BILIOUS REMITTING FEVER.      145

  By referring to the section on the pulse, it  will  be
found that, I have stated, that in all cases of depressed
or Aveak pulse, arising  from  an inflammatory  state of
disease,  the pulse is found corded  or tense;  and this
state of the pulse Avas found to prevail throughout the in-
flammatory fever of '94, and continued, says Dr.  Drys-
dale, even during the remissions of the fever.

                     SECTION II.

           Of the Bilious Remitting Fever.

   The bilious remittent of  the United States, is but a
milder grade of the  same disease, seen in the form of
yelloAV  fever.  It has often prevailed as an epidemick,
but it is most generally  in the character of anendemick.
Nothing has given more strong conviction to my mind,
of the impossibility of reducing diseases to system, so as
to prescribe by their names, than the extraordinary  va-
riety which I have seen in various parts of this country,
in remitting  fevers.   Its more common appearance, or
characteristick symptoms and termination, is familiar to
almost every person.  But in the years  1799 and 1800,
a fever of this kind  prevailed, very different from what
I have seen any Avhere  else, on the Ohio, at Wheeling.
It commenced with the usual symptoms of a remittent,
but in spite of any treatment, in many cases,  it termina-
ted in three, four, five or six days, in all the symptoms
of typhus; low muttering, delirium,  or coma, violent sub-
sultus tendinum, Ioav irregular pulse, black tongue and
extreme debility, were its  most  promineut symptoms
The  most healthy robust persons  in the  prime of  life,
Avere its most common victims.
   Every kind of treatment was equally ineffectual, until
I forsook every common path of instruction, and placed
my whole reliance on the free use  of calomel, and mer-
curial ointment.   With these, however, it was always
necessary to use bark, wine, brandy, &c.  Blisters Avere
also found useful.  Such was the success, that the  second
year, out of many patients I lost not a single one.
              19 
146       OF THE BILIOUS REMITTING FEVER.

  I had tAvo patients in particular, who were evidently
rescued from the grave by this treatment.  Each of those
patients, took thirty  grains of calomel every  day, for
twelve or fifteen days,  and yet, but a  soreness of the
gums Avas excited, Avithout a salivation.  They were
both three Aveeks entirely unconscious of things around
them, and Avere sustained by wine  and brandy, which
Avas given to the amount of a pint of each, every twenty-
four  hours.
  Every method had been tried to  prevent the bilious
remittent from terminating in this dangerous typhus; but
ineffectually.  If large evacuations were  made, with a
vieAV of procuring an intermission, which would bear the
bark, the typhus  seemed only  to be  hastened by it.
Neither Avould the bark given early, after cleansing the
stomach and boAvels do better, but,  by augmenting the
disease, lessened in a very high degree the chance of
recovery from the typhus, Avhich was sure to follow.
  The  symptoms of  a common remittent are  generally,
headach, backach, nausea,  slight chills, especially run-
ning along the*back; Avarm skin, which very often to the
patient  feels cold, a sense of oppression  about the sto-
mach.   Sometimes the chills  are scarcely perceptible,
and the patient finds himself at once in a burning fever,
with full  frequent pulse, at other times a strange mix-
ture  of  warm and cold sensations are  felt on the skin.
After several hours are passed in this manner, during
which adults cau  seldom  sleep, the  symptoms  gra-
dually abate, until the situation of the sufferer is tolera-
ble.   After enjoying this respite, without however, get-
ting  wholly free from those symptoms, his distress re-
turns, and very often  with increased violence, at periods
of about a half a day, or sometimes a whole day or more.
  Treatment.—This fever if taken early, will generally
yield to tAvo or three bleedings, and very often one or
two Avill be sufficient, together with opening the bowels
freely, by means of purges, in all  of which calomel should
be freely used.  After those remedies, cooling powders
of nitre and tartar emetick or ipecacuanha, will be useful
taken in snakeroot tea;  cremor tartar may also be used.
But  I have long since remarked that very little depen- 
OF THE  INFLUENZA,
147
dance can be put on any cooling article of medicine, that
does not actually purge.  Glysters are abvays useful.  If
the case is protracted, and sufficient evacuations have
been made, blisters will  haAe a good effect.   We must
touch stimulants or tonicks  Avith great caution,  and in-
deed they are very seldom necessary.
  In seasons Avhen agues prevail most,  and our remit-
tents approach in some measure to their nature, Avhich is
sometimes the case;  the bark Avill certainly shorten re-
mittents, when cautiously administered in the time of the
most complete remission.   But this is a practice extreme-
ly unsafe Avithout the advice of a physician.   Caphora-
ted poAvders are often useful, at the close of remittents,
after sufficient depletion.
  Regimen.—Abstain entirely from meat, or broth, wine,
spirits,  &c.   Drink plentifully of Aveak teas, toast and
water, apple Avater, milk and water, &c.   Nothing solid
should  he eaten till the  disease is Avell subdued, and
even then, it must be resumed with great caution.  Roast-
ed apples, toasted bread soaked in water, or weak mul-
led cider with bread,  will afford a sufficient diet, till the
patient  is coiwalesceut, when broth, chicken, puddings,
&c. may be taken, but great care is necessary to avoid
overloading the stomach.   If the appetite is good the pa-
tient should eat  frequently, but never much at a time.
  Cool  air  and cleanliness is an essentiai part of  the
cure, therefore take a large airy room when practicable:
open your doors and windows freely, and give prefer-
ence to  a hard cool bed.

                     SECTION III.

                  Of the Influenza.

  This disease travels with a speed, and to an extent,
surpassing that of any other  disease in the world.  It is
seldom  mortal;  but on our seabord, and near it, deaths
are sometimes occasioned by it.   Consumpted  persons
are also liable to be  hurried off  Avith it.  Some of its
most troublesome consequences are abscesses up the nose
and in the ears. 
148       TYPHUS AND TYPHOID FEVERS.

   Symptoms.—This  disease is so universally known,
that I shall only give  a few of its most prominent symp-
toms.   They are a  peculiar sensation of  rawness or
soreness low down in the throat or breast; watery eyes;
itching and  heat up the nose; sneezing; considerable de-
bility, with bad taste in the mouth; not apt to be accom-
panied with nausea; more or less fever generally attends
it.  Influenza has the peculiarity of making persons Avho
are subject to habitual disease, to feel  as though  they
were attacked with their old complaint, especially at its
onset.
   Treatment—FeAV  cases of influenza require the use
of medicine, temperate living, but by no  means low, with
proper  attention  to clothing,  will generally  carry tiie
patient safely through the disease.  But, where the fe-
brile symptoms, or affection of the breast, is considera-
ble, bleeding may be  necessary; but it ought never  to be
had recourse to without the advice of a physician; death
has sometimes been the consequence of a rash procedure
of iLis kind.  For the cough and rawness, paregorick,
in very small doses, taken in flaxseed tea, will be useful.
Broths, and  even animal food, may generally be safely
eaten.   Very gentle opening medicines, or rather injec-
tions, ought to be used,  so as to  keep the boAvels laxa-
tive.  Toast and Avater,  or a little wine and water, may
be used for  drink; but, perhaps, nothing is preferable,
in this disease, to milk and  Avater, or weak  flaxseed tea
made savoury with a little hyssop or other pleasant herbs.
   Where the disease is severe, the patient ought by no
means to be  exposed  to the  vicissitudes of the Aveather,
should he even be able to go abroad; but free ventilation
and cleanliness are essential to a speedy recovery.

                     SECTION IV.

             Typhus and Typhoid Fevers.

   Fevers of those grades have prevailed throughout va-
rious parts of the United States for some years past, and,
in most places, with great mortality.  It would require
volumes to lay down  the symptoms, remedies,, and opin- 
TYPHUS AND TYPHOID FEVERS.        149
ions, of the medical men throughout  the country.   It is
a new  disease of insidious character, and, withal, is cer-
tainly a very ungovernable scourge: for few, or perhaps
no physician in this  country, cau console  himself with
having treated it with a success  satisfactory to his OAvn
mind.   It is principally found in the Avinter months.
  I shall first notice a disease of this class, which made
its appearance  in Adams county, Pennsylvania, in the
year 1810  and '11.   It commenced  Avith  sensations of
heat and cold succeeding each other; severe pain in the
head, limbs, and back; mostly a  cough with uneasy res-
piration; pulse nearly natural, but a little tense; blood
generally like pleuritick; symptoms, generally, increased
towards night; boils, or imposthumations, often appeared
at the close  of the disease,  but did not seem to be criti-
cal; delirium was a  very common symptom, and when
considerable, indicated danger.   An affection of the lungs
and chest was so constant,  that  in many cases where it
was absent, at the beginning, by reason of the violence
of fever and pains in different parts  of the body, I was
able to predict,  Avith certainty,  that  a cough, and peri-
pneumonick symptoms would appear, as soon as the ac-
tion of  the blood A7essels was loAvered.  In children,  it
very often  put  on the livery of incipient  dropsy of the
brain.   It could seldom be checked  in less than  fifteen
days, and upwards.   Although  its symptoms were evi-
dently inflammatory at the onset, yet large evacuations
were unsafe.  An unusual torpor of the bowels existed
in some cases.   The best plan of treatment which I
could devise, was to bleed, once or twice, moderately;
open the bowels with calomel and jalap;  and in  many
cases it was necessary to add a feAV grains of gamboge;
and also, to assist those articles with glysters.   Nitre and
camphor, in form of powders,  were useful  as soon as
moderate evacuations had  been  made.  Equal parts  of
laudanum, and sweet spirits of nitre, was serviceable,  at
least, when given at a late hour of the night; at which
time the fever Avas declining, and leaving the patient in
a state of considerable debility.   The use of  calomel, in
such quantities as to effect the  gums, had evidently a 
 150         TYPHUS  AND  TYPHOID  FEVERS.

 very happy effect  in  some cases, and certainly rescued
 the patient from the grave.                    „
   Tonicks, or powerful stimulants, were never necessa-
 ry; mild, nourishing  diet, with a decoction of Iceland
 moss, infusions of valerian or snakeroot, were generally
 the best remedies, during the early stage of convales-
 cence, and very ofteu after a  single hleeding.  As usual
 with  febrile disease, this  too often changed suddenly
 from a low grade  of action to  one  strongly inflamma-
 tory, and required a repetition of bleeding,  &c. to bring
 it doAvn.
   One very remarkable case occurred, where the dis-
 ease was protracted, and  had twice changed its cha-
 racter, completely,  from a very low to  a  high  grade
 of disease.   This patient  certainly  owed his  recovery
 to the modern mode of treating  disease according to
 present symptoms, instead of being  led astray by de-
 ceptive names.  After  a very severe disease of about
 three  weeks duration, this man became convalescent; a
 diarrhseacame on with some pain, and copious discharges
 of blood from  the  bowels.  Tonicks and   astringents
 were given, as opium with white vitriol, sugar of lead,
 &c, but to no purpose; the disease seemed unmoved by
 the use of those articles, and the patient was rapidly de-
 clining.   I had read of Sydenham's fever turned in-
 wards, of Rush's misplaced  fever, and on this great au-
 thority I resolved, in this unpromising case, to bleed; the
 loss of about twelve ounces of blood, taken  from an arm
 apparently all skin and bone, Avith mild laxatives, gave
 an immediate check to the disease, and the patient had
 a most rapid recovery.
  In my observations ou bilious remitting fever, I have
 given some  account of a typhus fever.   Such is the va-
riety of the fevers  under consideration, as influenced by
 different constitutions of the  Aveather; by change of ha-
bits; by  improper  treatment, &c;  that I shall conclude
the subject by admonishing every reader to place his de-
pendance entirely on  the physician; when one is to be
had; Avhen not, a careful perusal of  this article; that on
bilious remittents;  and  especially, by referring  to my
 observations on diseases of  excessive excitement, and 
OF THE MEASLES.               151
defective excitement or exhaustion, a tolerable know-
of the disease can be obtained.
   Of typhus fever as arising from  exposure to the foul
air,  of dirty hospitals,  jails,  or  camps, I shall speak
Avhen  treating  of  fortuitous  diseases; my views being
here confined to epidemicks, it cannot be the proper place
to speak of a disease entirely local.
   It may be observed  that, I have, in various parts of
this work, made use of the terms dirty hospital: lest I
might  possibly be misunderstood, and my words  con-
strued into a disrespectful opinion of hospitals, I think
proper to observe here,  that, I have in all places wished
to convey the idea that, hospitals kept properly clean*
and  suitably arranged in  other respects, are as healthy
as any private  well kept house: and therefore, lest I
might  be understood as mentioning such places as being
unhealthy, I Avish to say once for all, that it is of  hos-
pitals  improperly  kept  I  speak, when I mention the
most usual places of malignant fever, &c.

                     section v.

                   Of  the Measles.

   Here I have thought proper to leave the common tract,
and class measles with  epidemicks.  I am not singular
in the  opinion, that measles are not contagious.   Profes-
sor Potter, of the University of Maryland, is decidedly
of the same opinion.
   Symptoms.—This disease commences with alternate
chills and heat, nausea, a short cough, with slight sore-
ness of the throat; heat, itching, and obstruction of the
nose, with severe sneezing; watery inflamed eyes; con-
siderable lassitude; are its most remarkable, forming
symptoms.  About the fourth  day,  an eruption appears
about the neck, breast  and face,  and spreads gradually
over the whole  body:  they resemble flea-bites, being a
little elevated, but not so much as smallpox.   The ap-
pearance|gf the eruption relieves the stomach and bow-
els in  some  measure; but the cough and difficulty of
breathing,  most commonly increase.   Bleeding at the 
15*2
OF THE MEASLES.
nose  is common in this  disease.  About the sixth  or
seventh day; the eruption begins to turn pale, the whole
skin having taken on a high  colour; by the  ninth  or
tenth, the eruption is gone, having peeled off in branny
scales.
  If the patient has been  properly treated, the disease
now declines pretty rapidly; but if an improper regimen,
or medicines, have been used, the symptoms become now
more particularly dangerous; and those who die, are ge-
nerally carried off about this time.   A violent purging,
petechiae or purple spots, are among the dangerous symp-
toms brought on by improper treatment, and are attend-
ed  with great  danger.  A sudden striking in of the
eruption is likewise a frequent consequence of a too
warm regimen  and stimulants, and portends danger;  it
is generally an evidence of the system having been ex-
hausted by excessive inflammatory  action.   This symp-
tom may generally be prevented, but, Avhen formed, will
most generally yield to mild stimulants; for, in most ca-
ses, it is now too late to  deplete;  but there are cases
where the lancet is absolutely necessary,  after the oc-
currence of this symptom.  This could only be judged
of by an experienced physician.
  There are, however, cases  Avhere this sinking in  of
the eruption is  oAving to want of  energy in the" blood-
vessels, and can  only be  counteracted by mild stimu-
lants.   This generally arises from constitutional debi-
lity of the patient; to his having  just passed  through
some other disease, or to a particular constitution  of
Aveather, which strongly predisposes to low grades  of
fever.   No disease more strongly calls for the skilful
physician; for  it not only is dangerous in its course, but
lays the foundation of many subsequent diseases, as con-
sumption,  and is apt to rouse up lurking scorfula, &c.
   Treatment—There is  almost an universal errour in
keeping patients too warm in  this  disease.  Exposure
to the Aveather, or a current of cool air, would be impro-
per, but they should ahvays, when  able, be dressed and
lay on their bed during the day, and be but reasonably
covered during the night.  Nine tenths, ancL^ perhaps,
a far greater proportion of patients will be injured, nay.. 
OF THE MEASLES.               153
 life endangered,  by using any thing cordial.  Weak
 flaxseed tea, wherein a little hyssop, balm, or other herbs,
 has been  steeped; milk and water, barley water, and
 such  like, are the best drinks; and they should all be
 used cool, but not cold.  For diet, toasted bread soak-
 ed in water, weak chocolate, baked fruit, &c. will be
 sufficiently nutritious in severe cases; in more mild ones,
 a little broth, panada without Avine or spirits, mush and
 milk, &c.  Avill be suitable, and in all cases it will be ne-
 cessary to resume a full diet  sloAvly and cautiously.
 Cordial drinks can scarcely ever be safe; in Ioav cases,
 coffee may be alloAved.  Where there is much affection
 of the stomach, an emetick  wrill be advisable.  This,
 Avith the use of injections, and very mild purgatives, and
 the regimen pointed out, will ansAver every purpose that
 is to be expected from medicine.
   But the principal, and perhaps the only remedy Avhich
 is generally necessary, is bleeding; the patient should
 be bled as soon as practicable, and it must be repeated
 till the fever and cough  abate.  In  all severe cases,
 bleeding Avill be  necessary about  the  time the disease
 has formed a crisis,  and this remedy must be  repeated
 even after the disease is over, Avhile  any  considerable
 affection of the lungs or breast continues.
   In  short, persons unacquainted  Avith diseases,  will
 know the measles best by knowing the disease prevails,
 for it always comes in the character of an  epidemick, or
 endemick.   And  as  no disease is more easily misma-
 naged, they  should get advice Avhen  practicable.  If
 good medical advice is not to be had, bear in mind that
 reasonable bleeding, often repeated in severe cases, and
 a cool low regimen Avill seldom fail to  carry the patient
 safely through the measles.   All rash exposure to cold
 or heat, severe purging, strong diet and cordial drinks
 must be scrupulously avoided.
   But at the  close of the disease, after due depletion.
 great advantages may  sometimes be  had from taking
 small doses of paregorick, or sweet spirits of nitre with
 an  equal  quantity of laudanum, this will mitigate the
"troublesome dry cough, which now harasses the patient. 
154
OF THE HOOPING-COUGH.
It may be remarked, that measles generally prevail in
the  latter winter months, and in the spring.  And that,
it is a disease to Avhich Ave are subject but once.

                    SECTION VI.

               Of the  Hooping-Cough.

  This disease is so well known that any description of
it would be useless.  It may be remarked, hoAvever, that
it prevails as an epidemick, more frequently  than the
measles, and fewer persons escape it in infancy.
  This cough, may often  be  knoAvn by the extraordi-
nary gushing of blood into the face;  even, before any
hooping sound is observable.   Such is the  great length
of continuance of this disease, that it will ahvays be
necessary, to keep an  eye to this circumstance; and, be
cautious "hoAv Ave reduce the patient.  Where the symp-
toms  run  high, bleeding may sometimes be necessary;
but in general the cure may be trusted to laxative mild
medicines, as  rhubarb, or  senna  and manna, gentle
emeticks of ipecacuanha.  Light  but  pretty nourishing
diet; as broth, puddings, milk Avith bread, or mush, light
fresh meats,  oysters,  &c.  For drink; cold water, or
toast Avater, and especially, milk and  Avater are proper
articles.   Removal, so as to get the patient into another
air, where it is convenient, Avill be found useful.  Ad-
vantage is sometimes obtained from the use of tincture
cantharides,  paregorick, and  other articles,  but they
should never he used Avithout the advice of  a physician.
A pitch plaster worn betAveen  the shoulders, will some-
times be useful, and in  severe  cases, I have seen the
most marked advantages from  a large blister, laid be-
tween the  shoulders.  This  disease Avill continue  for
several weeks, in  spite  of all remedies, and I am fully
persuaded much mischief is  done by giving  too much
medicine.
  Thousands of nauseous articles  are crammed down
the throats of the  poor  little sufferers, which often do
them much more mischief than the disease.   Keep your
children from rash exposure to the Aveather, from over 
           OF THE SCARLATINA  ANGINOSA.       155

heating themselves, or eating too much solid harsh diet;
and if in  the winter, keep them in a room at night, of the
same warmth, as  near as possible,  to  that during the
day, and this disease aa ill  seldom  require any other
treatment.
  Like in all other diseases, there Avill be found cases
of hooping-cough, where evacuations cannot be used
Avith safety, but where we must give  a cordial diet, the
bark, as  a tonick, and even Avine whey, aa ill be neces-
sary.   Such cases are Only to be found in children of
very Aveak relaxed habits, or Avhere  they are attacked
at the close of some severe disease.

                    SECTION VII.

Of the  Scarlatina Anginosa, or Malignant Sore Throat.

  This disease partakes of eAery grade of morbid action,
from the typhus to the most inflammatory disease.  No
disease more  imperiously  calls for  the skilful  practi-
tioner  than this.   Its  most usual symptoms are chills
and sickness at stomach; swelling, and inflammation of
the throat, which renders it difficult to speak or swallow,
or even breathe Avith ease.   The tonsils (glandular bo-
dies, situated in the upper part of the throat, just behind
the root of the tongue on either side) are highly inflam-
ed, Avhich terminates in suppuration or mortification; and
sometimes brings  aAvay large sloughs; sometimes swel-
lings behind the ears and blotches in the mouth.  Most
generally there is  an eruption on the skin.  This symp-
tom sometimes precedes the others, and vice versa.  In
seasons  Avhere this sore throat prevails, similar, erup-
tions are found on some persons,  without any other evi-
dence  of the disease, but  generally accompanied Avith
some fever.
   When this disease partakes of the malignant cast,
similar to the malignant typhus, which is most common,
it is very mortal;  and, therefore, requires skilful and
prompt treatment.
   Where advice cannot be had in this disease,  an eme-
tick of ten or fifteen grains of calomel and half a dram 
156        OF  THE  SCARLATINA ANGINOSA.

of ipecacuanha, combined, should be taken, and worked
off Avith chamomile  or  sage tea.  The  calomel should
then be continued in small doses, as three to six grains
tAvice a day;  and if it keeps the boAvels more than rea-
sonably laxative, laudanum should be given to restrain
that  effect.  A gargle of honey and water, with a very
little calomel combined, or an infusion of red pepper in
Avater, or the steam of hot vinegar, should be constantly
used.
   If nausea continue, repeat the emetick; then give rea-
sonable quantities of wine, with ten to twenty  drops of
antimonial Avine, every  three, four, or six hours;  but the
antimonials should never be carried  so far as to keep up
nausea; it will be a safer course to depend  on mild lax-
atives, as  senna and manna, or rochelle salts, or injec-
tions, placing principal reliance on calomel.   The out-
side  of the throat, and behind the ears may be rubbed
with the ointment of corrosive sublimate;  this will soon
excite blisters.
   Cordial  diet, with the  use of  snakeroot, or Iceland
moss, in tea, and the use of light cordial diet, Avill gene-
rally be sufficient in the close of the disease.
   Although I have  said this fever is highly inflamma-
tory, as is evident from its  appearing  so constantly in
Philadelphia since the  year 1783,*  during the most in-
flammatory constitutions of the Aveather; still, such is the
force of the local affection, or inflammation of the throat,
that  the general system is hurried, in a feAV hours, through
an inflammatory stage,  and prostrated  beloAV a  state in
which evacuations, by the  lancet, would be safe;  more
especially as the disease is fixed to an unalterable course
of inflammation, and suppuration  to go  through.
   The use of broths or coffee, or mush and  milk, may
be allowed through the course  of the disease;  but  in all
cases the quantity must be  small; and it is also essential
that  very little  be taken at  once.   Barley water, toast
Avater, or chamomile tea, or porter and Avater sAveetened,
will  be allowable drinks.   The utmost cleanliness  is ne-
cessary, and  free ventilation without rash exposure to

  * See Rush's  Medical Inquiries and Observations. 
          OF DYSENTERY, OR~BLOODY FLUX.       157

cold air.   The  gargles should  be used constantly du-
ring the  night; reasonable allowance  being  made for
sleeping, if the patient can sleep.
  For children, Avho Avill not use gargles, a mixture of
honey and Avater, with a very little calomel, may be fre-
quently put into their mouths, and suffered to pass down;
or the  honey and  water  mixed  with a little  soda, say
half a dram to a gill of the  Avater,  and a tea spoonful
frequently put into the mouth.
  I haA e seen a solitary case of this disease in the Bal-
timore hospital, during the late war, terminate fatally;
yet, by great attention to cleanliness,  no disease was
communicated.  It is true, this patient was removed to
a single Avard, but Avas attended by several persons, and
I frequently inspected his throat, &c.  The disease here
treated  on is so  distinct  in  its  character from common
inflammation of the  throat, or quinsey, that I shall re-
serve the  latter for a section, under  the head of fortui-
tous diseases.

                     SEC10N VIII.

            Of Dysentery, or Bloody Flux.

  The dysentery frequently prevails in the United States
as an endemick, or  epidemick,  and sometimes prevails
over whole  neighbourhoods,  or  large tracts of country,
and is  found in remote places, where no possible com-
munication with infection could  have existed;  so clearly
is this disease dependant on a particular constitution of
the air, that a physician ought to blush when  he pro-
nounces it contagious.  That filthiness will increase the
disposition to this disease, or that unAvholesome diet and
exposure to the hardships of  a dirty camp, may excite a
dysentery, I have no doubt, but this argues nothing for
specifick contagion.  YelloAV fever and bilious remittents,
by this way of reasoning, and even agues are contagious.
But a person labouring  under  a dysentery, if carried
to a  healthy atmosphere, will no more communicate the
disease, than a patient Avould  labouring under yellow
fever. 
 158       OF DYSENTERY, OR UL00DY FLUX.

   I have seen this disease existing as an epidemick se-
 veral times, and ahvays unreservedly examined my pa-
 tients; often administered injections, inspected the stools,
 assisted friends  to the closestool, but never had a symp
 torn of the disease.
   I have strong grounds for believing, I saAV several fa-
 milies affected with dysentery from the imprudence of
 emptying an old  necessary, and carelessly fouling the
 streets Avith its contents in the summer season.  The dis-
 ease Avas not prevalent that year, but tAvo seasons of dy-
 sentery had just  preceded.    We are  seldom  affected
 with dysentery in the middle states, according to my ob-
 servation, except at the close of summer, and the begin-
 ning of the fall  months.
   This disease generally commences like fevers  with
 light chills, loss of strength, and appetite.   Severe gri-
 pings, and bloody, frothy, or slimy stools, without natu-
 ral feces.  Sickness at stomach,  and considerable thirst.
 The stools have soon an appearance of  stringy substan-
 ces in them, and sometimes are almost wholly blood; the
 pain is very acute with bearing  doAvn,  which is apt to
terminate in tenesmus,  or, a  protrusion of the rectum or
 lower gut.  Such is the persecuting nature of this distres-
 sing disease, that  its unfortunate victims, have scarcely
 a moment's respite from the closestools,  Avhilst they are
 borne down with anguish and  debility.
   I am Avell aware of the vast importance of cleanliness
 in this disease, and believe that a Avant of attention to it
 Avill be a powerful predisposing cause to  the disease, and
 often renders all efforts for its  cure  ineffectual.   But to
frighten people constantly Avith the notion of contagion,
 as some authors  do, Avill lead to more mischief than good;
it is the Avorthless part of mankind,  who are  moved to
do  their duty from a sense of fear only; to alarm  such
with false accounts of things is to continue them in igno-
rance; and Avhile ignorance clouds the human mind, man
 does his duty sluggishly, harshly, and is too often guilty
of cruelty to his fellow  creatures, and finds a pretext for
his actions, in the  notions, thoughtlessly, or unwisely in-
 stilled by others 
           OF DYSENTERY, OR BLOODY FLUX.        159

  Let me here admonish every christian, that it is his du-
ty to  approach his afflicted neighbour, and aid him so
far as necessary; and here, as in all other cases he will
find an  agreement behveen his duty and his  oAvn Avel-
fare.  Approach your sick neighbour Avithout dread, pro-
vided due care is observed to cleanliness, and no unne-
cessary crowds of  persons to hinder free ventilation; no-
thing is to be dreaded from the  scarecrow contagion.
These are  sentiments I carried Avith me during a prac-
tice of several years, I have  spent many hours with pa-
tients labouring under every  disease to Avhich this coun-
try is subject, and, thank God, I never had any reason to
repent my conduct in this  respect.
  Has  symptoms  of dysentery come on, attended with
nausea, a dose of ipecacuanha, as tAventy to thirty grains
for an adult, should be taken; and perspiration encoura-
ged by  drinking plentifully of Avarm tea during its ope-
ration.   Should the febrile symptoms, as chills and heat,
Avith full'pulse, run high, it Avill be necessary to bleed,
and even repeat it if those symptoms do not abate.  In-
jections of starch dissolved in warm Avater, or a decoction
of slippery elm bark, three parts milk, and one part lime
water, or mutton broth, should be used three or four times
every tAventy-four  hours, during the violence of the dis-
ease.   As  soon as  the stomach  is well composed after
the emetick, Avhich will generally be in from three to six
hours, or where the patient has strong objections  to an
emetick, ten or fifteen grains of calomel ought  to be giv-
en, and carried through the  boAvels  with rochelle salt,
castor oil, or common glauber salts, or rhubarb.   Should
the stomach reject those purgatives, and no discharge of
natural  feces  follow, it will be necessary to take another
emetick; or to lose blood, but advice should be  had if
possible.   If  the  foregoing treatment should not open
the bowels so as to bring  away .natural stools, the calo-
mel should be repeated and  folloAved up by the other
opening medicines.  So soon as natural stools shall have
been procured, the griping may be obviated by anodynes;
take half a dram of soda, six table  spoonfuls of Avater,
and  two small tea spoonfuls of laudanum; shake the
whole together, and let an adult take v table  spoonful 
160        OF DYSENTERY, OR BLOODY FLUX.
 as occasion may require, not oftener than hvice or thrice
 a day.   Rubbing over the bowels with the  hand, or a
 flesh brush may have a good effect.
  In most cases of dysentery,  the most simple and suc-
 cessful  practice, is to  open  the bowels Avith  injections;
 calomel and other purges, as early as possible in the day,
 and  at night, to take a pretty full anodyne; a pill of opi-
 um and ipecacuanha, from  one  to three grains of opium,
 and  three to five  grains of ipecacuanha, will  be proper
 for an adult.
  The above treatment is  best adapted to the healthy
 jpeople of the country, but like all other diseases, this
 too is found of various  grades, and in very Aveakly ha-
 bits, or malignant constitutions  of the Aveather, it requires
 a course  somewhat different.   Here  calomel and  opi-
 um,  with the constant use of  injections, and a large blis-
 ter applied over the abdomen,  are  our principal depen-
 dance.  The best drinks are  a weak decoction of slippe-
 ry elm, mullein tea, milk and Avater, barley Avater, or lin-
 seed tea.   At the close of the  case, more cordial or as
 tringent  drinks Avillbe proper, chamomile tea, deAvber-
 ry tea, thin broth, and coffee, will  be suitable drinks.
 In cases of a  Ioav grade, Avine Avhey, Avine and Avater,
 or Aveak punch, may be allowed, but not without cau-
 tion, for if avc  over-stimulate;  we will increase the de-
 bility, and  do our patients  much mischief.  For  diet,
 broth may generally be alloAved, and panada, ripe fruits,
 milk Avith Avell mashed  potatoe, bread, or mush,  mild
 soups generally; a soup made  of fresh  cider is a  good
 article.   Raw apples are ahvays unsafe where the sto-
 mach and  bowels are much  debilitated; they  are apt to
 produce  colick.   I have  seen several cases,  some of
 which terminated fatally in a feAV hours.
  Lastly. It is of the highest importance to observe the
 strictest cleanliness, in  removing all filth, and ventilating
the patient's room at all hours, sprinkling the floor (that
is first well cleansed) with vinegar, and washing the pa-
tient's hands and face, and rinsing the mouth frequently
with vinegar and water, will often go far to keep down
 nausea.  And in all cases it  is essential that the patient
put on flannel next the  skin, and wear stockings,  or at
*+ 
       OF  THE DYSENTERY, OR BLOODY FLUX.     161

least socks, Avhen they rise to the  closestool; for want
of attention to this, many persons are lost, by constantly
having the  perspiration turned inwards upon the bowels.
   Great caution is  necessary in returning to a full diet,
and to former habits generally; the bowels are left Aveak,
and Ave are very liable to relapses: due temperance, and
wearing Avarm clothes, are the requisite securities.  Slight
relapses, or a looseness, Avhich sometimes follows,  will
generally yield to mild astringents; as a pretty  strong
decoction of the  dewberry root or leaves, of logAvood,
iceland moss; or the elixir vitriol in water.
   In obstinate cases, white  vitriol, or sugar lead, in the
form of pills, with opium may be necessary;  one grain
of opium, and two or three of either of the other articles,
may be taken once or tAvice a day.
   The tenesmus,  and a falling  doAvn of'the  rectum, is
sometimes  extremely troublesome; and sometimes mor-
tification has been the consequence.   The part ought to
be washed with Avarm milk and water, where this symp-
tom has progressed;  Avhen reduced, or  replaced,  the
parts ought  to be well bathed with cold water, and
often repeated.   When  early attention is given to this
affection, injections of cold Avater and starch will  be
found a good remedy.
   Sometimes the  rectum is found so highly  irritable,
that the smoothest glyster-pipe cannot possibly be intro-
duced, here, setting the patient in a warm bath, which
rises up  OArer the pubis, made  of poppies,  mullein,  or
milk and Avater;  or, when  early attended to, a bath of
bitter herbs  Avill, perhaps, be most  suitable.  For the
tenesmus,  starch glysters  will generally  answer  our
wishes.
   We sometimes meet with  cases where there  is such
a forcing down, that no injection  can be passed.   In
such cases, this troublesome affection  may be  removed,
should the bath fail, by putting a small pill of opium, a
little Avithin  the bowel, and holding it there a few mi-
nutes.
21 
163   OF  THE AGUE, OR  INTERMIT TING FEVER.
                     SECTION  IX.

        Of the Ague, or Intermitting Fever.

  The ague is a disease well knoAvn, and prevails over
a great part of the middle states,  at least.   It is most
common along our waters, or in marshy, low  grounds.
A genuine ague  is seldom attended  with danger;  but
many of our  most malignant fevers are ushered in by
symptoms so strongly resembling ague, that people  are
often led into  fatal mistakes.  And hence the necessity
of carefully reflecting, what diseases are prevalent, and
of getting good advice, or refraining  from the bark, or
other stimulants, till the character of the disease is Avell
ascertained.
  We are  some where told that hvo of England's mo-
narchs died of this disease; it  is, however, highly pro-
bable their deaths were occasioned by other diseases,
wearing the livery of ague.
  It may be  remarked  here, that agues, or intermitting
fevers, are distinguished by the terms of quotidian, ter-
tian, and quartan.   The first, is Avhere there is a parox-
ysm every  day; the second, has a paroxysm every other
day; and the last, every fourth day inclusive.  These
forms are sometimes double or  blended; but in all agues
there  must be a complete interval, from every symptom
of disease, for some time, or the disease is called a re-
mittent.
  When it is  Avell ascertained ague is  formed, take an
emetick of ipecacuanha; or, Avhat is, perhaps, preferable
here, Avhite vitriol, (sulphat.  zink) in doses of from  ten
grains  to  thirty,  dissolved  in  Avater, and  repeated at
short intervals, till it causes free vomiting.   Less atten-
tion is necessary  here, respecting Avarm  drinks; they
may impair the tone of the stomach, and are neA'er ne-
cessary in large quantities; chamomile, carduus, or cen-
taury tea, should be taken in moderate quantities.  The
next day a ^urge may be taken; and I prefer the fol-
loAving pills to any other: take  jalap and rhubarb, each
ten grains; aloes  and calomel, each five grains;  make 
       OF THE AGUE, OR INTERMITTING FEVER.    163

eight pills, for a portion, for  an adult; but the patient's
constitution must be consulted.
  It is not material whether the vomit or purge be given
first;  and in cases  where strong objections exist against
vomiting, one or tAvo  purges, containing some calomel,
will answer every  purpose.
  If it is known that an inflammatory constitution of the
weather prevails,  and the fever, headach, and pains in
the bones, as  it  is called, run high, bleeding once, and
in some  rare  cases, even  several  times will be  neces-
sary, before the  bark  is admissible.   But in general, so
soon as the stomach and boAvels are cleansed, the bark
may be taken, commencing as soon as the paroxysm is
off, and taking it iu such quantities as to take from one to
two ounces before  the next expected chill.  If the bark
Avill not lay on the stomach, it may be combined Avith
about thirty cloves, aud tAvo drams of cremor tartar, to
each ounce of bark.   If this still disagree, and the con-
stitution of the patient is good, take more calomel  and
jalap, or another emetick; or the  bark may be  mixed
with cinnamon Avater, and magnesia, for delicate per-
sons.
  If none of those forms will succeed:  a strong ano-
dyne, as a grain or two of opium, given as soon as the
chill is perceived,  and repeated two or three successive
times, at the near approach  of the  chill, will generally
succeed.   In the intermissions, a decoction of bark, ge-
nerous diet, good wine, or some pleasant  bitter,  will be
useful.
  I have generally succeeded in curing agues with equal
parts of Peruvian  bark, and that of dogwood, or black
oak.  Arsenick and Avhite vitriol, and opium are among
the most valuable articles for the cure of agues, but they
ought never to be touched  Avithout good advice; they
may be the cause of dangerous visceral obstructions.
  Agues should be promptly treated, and relapses will
often be prevented by temperance, and avoiding the night
air, and by generous living.  After recovery, it  will be
advisable to take a little bark occasionally. The bark
in all cases may be taken in  port wine, or snakeroottea,
or even water or  milk, as  is most agreeable.   It ha* 
164          OF CONTAGIOUS DISEASES.

been supposed, wearing a Avaistcoat Avith bark quilted
between its folds, is useful in preventing agues in chil-
dren.
  Where agues are protracted  into  the  cold weather,
and sometimes attended with sAvelled ankles, one or two
bleedings, Avith the application of a couple of blisters to
the ankles will generally remove such remains of the dis-
ease;  these Avith Avarm clothing, generous but temperate
living, and in severe cases the moderate use  of the vit-
riolick, or nitrick acid, Avell diluted with water, will an-
SAver better than the bark, or perhaps any other remedy.
About forty to sixty drops of elixir vitriol,  or the same
quantity of the  nitrick  acid may be taken for a day or
two, and then omitted for the same time, and so continue
alternately for  some time.   Delicate persons, or those
of sedentary habits will be benefitted generally, by the
use of the cold  bath, or  riding on horseback, after the
removal of agues.
OF CONTAGIOUS DISEASES.
                      SECTION I.

I HAVE, in a previous article, given as  my opinion,
that we have but one contagious disease, at  least, in this
country, and for this we have a certain preventive  in
the vaccina, or cowpox.   And it is only to  be lamented
that there is people ignorant or wicked enough to resist
this great gift.
  Some are found who pretend they leave the issue of
events to the Creator, but those people  must either be
extremely  narrow sighted,  or wilfully  criminal.  To
place a dependance on Providence without the suitable
exertions which form  a  part of our duty, and very re-
lation to the various parts of creation, can only be con-
sistent with professions Avhere it is practised as a gene- 
OF THE SMALLPOX.
165
ral rule.   The Turk who is ignorant of the plain fact,
that the Creator  has chosen to govern this Avorld by ge-
neral laAvs,  acts a consistent but  blind part in facing
every danger, because he believes the Great Father will
protect him.
  But how  different  is the case of men, Avho vieAving
things by halves, Avill dare to say that God has sent the
smallpox, and therefore their children  may  take  their
chance, and yet  refuse to  acknowledge  the goodness of
Him, in  sending a preventive  also.  This  is  in  plain
terms, saying the Deity has sent evil, but the good is the
Avork of  man.   I am constrained to obsene here,  I ne-
ver personally knew  a man  neglect his duty in this re-
spect, that was not a niggard at heart.   This scourge is
still found among us almost every year, I shall, therefore,
offer a few remarks on the smallpox.

                     SECTION  II.

                 Of the Smallpox.

  This disease attacks much  in the same manner of other
inflammatory fevers, by chills and heat, headach,  back-
ach, nausea, or vomiting, &c; about the  fourth day after-
wards, an eruption appears, and spreads over every part
of the body; these gradually rise up into pimples, and
they fill first with a limpid fluid, Avhich  turning to pus,
gives the pustles the appearance of little yelloAV bladders:
these appear about the tenth day,  and disappear or dry
up by the fourteenth.  It has of late been distinguished
by the terms confluent and distinct; but even for this there
is very little necessity; the distinct  being  the same dis-
ease, but of less violence  than the confluent.
  Treatment,—The patient must carefully abstain from
all animal food, even broth, butter, cheese, or eggs.  Milk
with  bread, &c. weak tea or coffee, ripe fruit, toasted
bread'soaked in water, boiled rice or barley, &c. will be
suitable diet.  For drink; milk and water, toast water,
apple water, and  milk whey are  proper drinks.   The
bowels ought  to be opened Avith mild cooling  physick:
the patient to be kept quite cool, at all  hours; free veti
lation, and lying on the bed during the day, and but light 
166
of the slallpox.
covering at night are necessary.   There should never be
more than one patient in the same bed.  In  persons of
good constitutions there never can be any necessity for
cordials.  In full habits where the febrile symptoms ruu
high it may be  proper to take a little blood,  and purge
pretty freely.
   There are cases where the patient is too weakly to ena-
ble the blood vessels  to throAV  out the eruption in due
time; even here we must by no means dispense with cool
drinks, cool air, and a cool regimen.  A little cool Avine
whey, chicken broth, chocolate, coffee; with a feAV drops
of laudanum occasionally, will be the safest treatment.
   When the disease is protracted and accompanied with
heavy eruptions, which form crusts or scahs over the
whole body, it will be necessary to use bark freely, with
the reasonable use of opium or laudanum, and elixir vit-
riol.   These can never be necessary till the close of the
usual time for the  scabs drying, and even here, Ave must
stimulate with caution.  In short as we generally meet
with this disease,  almost every thing depends upon cool
air, low diet, reasonable purging, cooling Aveak  drinks,
and in the close of the disease, a little laudanum once
or tAvice a day.
   To  reduce  the  patient in an early stage of this dis-
sease, is dangerous, for it must run its course, and re-
quires a  reasonable energy in the blood vessels.  But
to stimulate or heat in this disease is certain  death, or
maiming, and sometimes an horrible emblem of neglect
or ignorance is the consequence of such  treatment.  This
of all  others, is the most loathsome dreadful disease;
and in every case, where it is practicable,  the best ad-
vice must be had.  Having now according to my plan,
treated of epidemick,  and  of  contagious  diseases,  I
come to speak of fortuitous diseases. 
OF FORTUITOUS DISEASES.
                      SECTION I.

            Of Consumption of the Lungs.

 THE firstdisease which I shall treat of in the class of
fortuitous diseases, is consumption of the lungs.
   While the yelloAV fever levels hundreds  in a season,
 and excites the commisseration of a whole  nation, con-
 sumption destroys thousands,  unpitied, because its vic-
 tims are taken singly.   I am,  however, of  opinion, that
 many cases might be prevented by due care, and a a ast
 many might be removed after they are formed.
   Much errour is practised in this disease by substitu-
 ting medicine for regimen, which alone can  cure the dis-
 ease.  This  applies more particularly to  consumption
 connected with scrofula; Avhere it arises from common
 inflammation  of the lungs, medicine alone can arrest the
 disease, in its forming stage; but Avhen confirmed, leaves
 nothing but chronick debility to be removed by exercise
 and regimen.
   From  a most careful examination of this disease,  I
 have thought proper to view  it first  in two divisions,
 which are in  some measure opposite in their nature, and
 therefore require some  difference in the treatment.
   1. Such as are connected with scrofula,  which, lurk-
 ing in some part of the system, is liable to be roused up
 by inflammatory affections of the lungs.
   2. Such as arise from pneumonick affections, or other
 debilitating causes; and cases  which  have  been impro-
 perly treated, neglected, or from violence done the lungs
 by inflammation, leaves a predisposing debility, which
 is  readily acted on by  cold, intemperance,  &c.  Each
of those kinds of consumption have three distinct stages,
as the inflammatory, hectick, and typhus.   These dif- 
168
OF FORTUITOUS  DISEASES.
ferent stages of this disease are with  difficulty distin-
guished  from each other, and  hence arises one of the
greatest difficulties in the treatment of it.
  I believe with the great Rush, that  scrofula is not a
frequent cause  of consumption  in  the United  States;
but Ave are well assured that the reverse is  true in Eng-
land; and, from the rapid manner in which we are suc-
ceeding that country in a round or succession of diseases,
from more and more debilitating habits, we are warrant-
ed in belieAing, that in our cities in particular, and even
in the country, we are to look for scrofula as a growing
cause of this disease.   I ascribe but little to turbercles,
in my a ieAV of scrofula; these  are, perhaps, ahvays a
consequence, and  not  a cause of a consumptive habit.
They are, probably, the effect of chronick inflammation,
which may  be, and probably often is,  wholly indepen-
dent of scrofula; and simliar to  tumours found on the
omentum from yellow  fever; on the intestines from dy-
sentery;  and, indeed, all inflamed surfaces seem dispo-
sed to take on this appearance, or at least exudation and
much inequality of surface.
  I believe it to  be  an undeniable position,  that both
kinds of consumption are bottomed on general and chro-
nick bebility.  And further, 1 believe  that so far as the
lungs are concerned in this disease, it is  one and the same
thing; and, consequently, that the difference of consump-
tions consists of a difference in the general system.
  Scrofula is  the consequence of morbid debility, inhe-
rited or brought on by weak unwholesome  diet, aa ant of
exercise, &c; and it is highly  probable  the lungs are
less disposed  to take  on scrofulous action, than many
other parts of the body.  I  will go even further, and de-
clare  my unequivocal  opinion, that scrofula  seldom, if
ever,  is principally seated in the lungs, until  invited by
chronick  debility  of this organ, arising from  neglected
colds, measles, intemperance, &c. Hence it follows that
scrofula is no more disposed to induce consumption, than
any other kind of  chronick  debility.   And the only rea-
son why scrofula is so generally a predisposing cause of
consumption in England, is owing to this being the most
common effect of chronick debility in that country. For 
OF CONSUMPTION OF THE LUNGS.       169
a knowledge of scrofula, I must refer my readers to my
observations on that disease.
  I wish to suggest here, that it is of the utmost impor-
tance to distinguish between a scrofulous habit and one
of mere debility.   For  the latter may exist as a  mere
diminution of bodily powers,  while scrofula is ever de-
bility of a morbid cast.   Hence, when a patient is threa-
tened with consumption, it behooAres us to ascertain whe-
ther there is lurking scrofula  in the habit; for if there is,
the use of mercury would prove destructive.   In no stage
or form of scrofula can mercury be given without the ut-
most danger; whereas, hundreds have been speedily re-
lieved from consumptive symptoms; at an early stage of
the disease, Avhere  there Avas no scrofulous taint, from
the use of that medicine.
  Having now endeavoured, to show the necessity of dis-
tinguishing consumption of scrofulous  habits before we
can safely  attempt the cure by mercury, and declared it
as my settled opinion, that consumptions of this country
Avill partake more  and more of that character, 1  shall
make a few observations on the disease arising from ge-
neral debility, independent of scrofula.
  And first.  It is a fact Avell known, that the Indians of
our country are affected with pleurisy and  pneumonick
complaints, but exempt from consumption.
  2. It is  a truth, that  of the many cases of wounds in
the lungs, from bullets  and bayonets in the army, &c.
scarcely any terminate in consumption: all these circum-
stances go to  show that consumption is not a primary
disease of the lungs, but of the general system. And the
circumstance that it affects females, the delicate, and those
debilitated by intemperance, and succeeds large evacua-
tions, as excessive purging, debilitating diseases, as mea-
sles, protracted pneumony, &c. plainly shows the disease
of the lungs is secondary, and is excited and maintained
by general debility.  It is true, this general debility  is
often  induced by pneumony;  but of all the causes from
which consumption may arise, this is one most  easily
reached by proper remedies.   Indeed, no disease will
yield with more certainty to medicine  than an incipient
consumption from pneumony will to the use of mercury,
succeeded by suitable exercise.  It is true, the lungs seem
                 22 
170      OF CONSUMPTION  OF THE LUNGS.

to be a centre on which the principal force of chronick
debility operates after they are brought into sympathy;
but in all dangerous cases this is secondary.
   Hydrophobia, malignant sore throat,  smallpox, and
other violent and dangerous diseases, operate on the ge-
neral system primarily; but still, their essential charac-
ter consists in local  affections.  So with consumption,
an essential characteristick is  an affection of the lungs;
but danger is principally to  be apprehended  from the
prostration of the general system, it being primarily and
more deeply  affected.
  But, lest 1 confuse my readers  Avith  my attempts at
reasoning on this disease, or possibly bewilder myself, I
shall now endeavour to point out the disease in its differ-
ent stages, and conclude with some practical instructions.
  In giving the symptoms of  the first or inflammatory
stage of this disease, I have  copied  them as described
by Dr. Rush.
  "The symptoms which mark its first stage, are seldom
observed; or, if observed, they are too often treated with
neglect by patients and physicians.   I shall briefly enu-
merate these symptoms.   They are a slight fever increa-
sed by the least exercise; a burning and dryness in the
palms of the  hands,  more especially towards evening;
rheumy eyes  upon waking from sleep; an increase of
urine; a dryness of the skin, more especially of the feet
in the morning; an occasional flushing in one and some-
times in both cheeks; a hoarseness; a slight or acute pain
in the breast;  a fixed pain in one side, or shooting pains
in both sides; headach; occasional sick and fainty fits; a
deficiency of  appetite, and a general indisposition to ex-
ercise or motion of every  kind."
  These are,  most generally, the premonitory symptoms
of consumption; and,  if proper attention is paid to them,
before there is a confirmed cough,  they will generally
yield to such remedies as are calculated to restore tone
and vigour to the general system.  These are the  care-
ful avoidance  of all debilitating causes, as intemperance,
exposure  to  the  vicissitudes  of the Aveather;  wet feet;
damp beds; confinement; too thin clothing, &c.
  The use of iron in the form of filings or rust, with
bitters, or the use  of the bark, and  elixir vitriol with 
          OF CONSUMPTION* OF THE LUNGS.        171

attention to the boAvels, and exercise, more especially on
horseback,  Avill  generally  remove  these premonitory
symptoms, and restore good health.   It is in this  stage
of consumption in particular, that voyages to sea, or tra-
velling aa ill generally cure; and so will constant exercise,
gradually increased  according as the system acquires
strength.
  Should the disease, notAvithstanding our efforts to ob-
viate it, advance, and the cough become fixed, Avith  ex-
pectoration of phlegm, blood, or pus, or should occasion-
al hemorrhages occur from the lungs Avith increased in-
flammation of the trachea, as manifested in the increase
of hoarseness,  an increase of debility, some difficulty in
respiration,  Avith a disposition to sAveat at night, and an
increase of lassitude after eating; Ave may noAv view the
disease as arrived at the height of the inflammatory stage.
This vieAV of the case is applicable to both kinds of con-
sumption, or more correctly speaking, applies to the dis-
ease Avhether accompanied Avith scrofula or not.
  I beg leave here, once more, to give a  strong view of
my notion of  the connexion between  consumption and
scrofula.  Consumption is a disease sui  generis, so is
scrofula; they  may  and  sometimes do exist together, but
either may, and does most generally in this country, exist
alone.   Scrofula may be a predisposing  cause,  or may
be roused up from its lurking place by consumption, so
may consumption pass by a scrofulous taint, and  leave
it undisturbed, provided it does not continue too long,
and hence, the advantage in all cases of taking this dis-
ease early.  This also suggests another  cause for cau-
tion in the use  of mercury for this disease, for this medi-
cine aa ill rouse up a lurking scrofula more certainly than
consumption itself.
  I am irresistibly led into a digression  here, and offer
as my opinion  that  the dreadful consequences which
sometimes arise from  the use of mercury, is owing to its
rousing up scrofula, which was dormant, and would pro-
bably have  remained so, with due temperance of habits
generally.
  Let  us not  then, if we meet with those unfortunate
cases  sometimes, attribute the  mischief to the abuse of
mercury, or to the  virulence of the disease, but to  this 
17$        OF CONSUMPTION, OF THE LUNGS.
foe in ambush  Without extraordinary imprudence mer-
cury will never produce any disease, but when it meets
scrofula in its travels through the living system, dreadful
consequences ensue from their meeting, and the preoccu-
pant always comes off victorious, but not Avithout angry
expressions for such intrusion.
   A consumption having arrived at the verge of its first
or inflammatory stage, as  manifested by the symptoms
just mentioned, together with liability to getting repeated
colds:  it will now be necessary to abstain for some time
from every article of diet but milk, in any form in which
it can be taken best.   Where the stomach does not seem
to relish it, we sometimes succeed by trying it in every
way, sweet, sour, neAv, skimmed, with its cream  or skim-
med and diluted with water, or buttermilk, or the milk
of the goat, or ass.  Where none of this will succeed, a
little seasoning of ginger will answer, or boiling the milk
and mixing it with flour, or well boiled rice Avith a little
sugar.   If none of these will succeed, gruel or sweeten-
ed milk whey, or toast and Avater v/ill ansAver.  In short
unless the patient is of a very Aveakly constitution, they
cannot well live too low; regard may/ also be had  here,
to the prevailing constitution of the  Aveather, if. mortal
epidemicks prevail of a Ioav grade, it will be prudent to
use a little broth  or coffee.
   In  all cases, mush of well mashed potatoes, Indian
meal, or rye, or bread, and choice ripe fruits may be used.
The mdrning and evening air, as Avell as night air, is to
be carefully avoided.  Warm clothing, especially warm
dry feet, and one or more  flannel shirts  must be worn.
Nothing but milk and water, or weak cool infusions of
pleasant bitters ought to be drank.  But moderate cover-
ing at  night, and a spacious  or well aired room is abso-
lutely  necessary; a hard bed at least in summer, and
sleeping alone is best.  The bowels  ought to be kept
pretty open with injections, or very mild  purgative arti-
cles, as rhubarb,  or rochelle salts, or sulphur and cremor
tartar.   Bleeding once or twice a week according to cir-
cumstances is indispensable; gentle and constant exercise
is  necessary, as well as going abroad every day during
good weather.  But  in this stage of the complaint,  no-
thing can possibly be more ruinous than fatigue. 
OF CONSUMPTION OF THE LUNGS.       173
   Should the symptoms decline and  evident improve-
ment advance, this course may be continued for a few
Aveeks, but ought, perhaps, never to exceed five or six.  If
the patient seems to fall away, without any great amend-
ment of the cough, hoarseness,  night sAveats, &c. this
course must be  changed, and the patient is now to be
viewed as being in the hectick stage of the  disease.
   The hectick stage as it becomes more confirmed, is a/
tended with chills, and increase of  fever, great dispos -
tion to flashes of heat after eating,  with a more  marked
hectick colour of the cheeks, increased night SAveats,  or
greater discharges of urine, frequent irregularity of the
bowels, increasing expectoration, hoarseness, and cough,
continues with increased difficulty  in respiration.  In
this condition of the system, 1 view the debility as being
more equalized, but of  a more morbid  character, for it is
a fact, that  a diet  tolerably nutritious,  with  constant ex-
ercise, are among the best remedies.
   He who looks for much aid in this stage of consump-
tion from medicine, will generally be disappointed.  So
soon as consumption is confirmed, and due depletion made
by the remedies pointed out above, nothing will avail but
unremitting exercise on horseback, or otherwise.  Should
the patient take cold, and be affected with pleuretick  or
pneumonick symptoms, blood should  be taken in  small
quantities, and repeated as may  be  necessary.  In this
stage a cordial and nutritious diet is indispensable: I am
so fully persuaded that the  excellent and  great Rush
carried his Ioav diet too far, (and I judge from several ca-
ses I have seen of his prescriptions,) that I think proper
most solemnly to caution  every person not  to carry his
low diet too far.
  Dr. Rush, in all his  vieAvs  of  this disease, considers
if  a  disease of debility: he constantly and  strongly re-
commends exercise.  Surely there is an inconsistency  in
expecting a vigour and strength of  constitution  from
bread and milk given to a people raised on animal  food,
&c; and, who are to be  constantly on horseback.  I
would lay it down as a general rule, that so soon as the
patient begins exercise in  good earnest, either at home
or on a journey, that the diet should  comport in  some
measure with the exertion.   Broth,  Avell boiled chicken, 
174       OF CONSUMPTION OF THE LUNGS.

or other light, fresh animal food; eggs, oysters, fresh
fish, and coffee, and now and then a  little very good
wine, will be proper, and, indeed, indispensable.   If
these,  or now and then getting cold, should hurry the
circulation, and augment the cough and pain of the breast,
bleed, and repeat in small quantities, as may be neces-
sary.  If such diet disagree  Avith the stomach or bow-
els, a change of condiment may be useful, as a little nut-
meg, cinnamon, ginger, &c.
  When the stomach becomes much disordered, a gentle
emetick of ipecacuanha may  be useful; but  a  frequent
repetition of this remedy Avill  impair the  stomach, and
increase  the debility of the patient.  I  shall now pass
on to the typhus stage.
  When the disease  arrives at its last stage, there is  an
increase of all the symptoms, particularly of fever, which
confines  the  patient in good measure to bed; the expec-
torated  matter becomes  generally thin  pus; the sweats
increase; there is frequent severe  diarrhoea,  and nausea
or  vomiting;  palpitation  of the heart; faintness;  cold
sAveats; smallness of the fingers, Avith curving in of the
nails; respiration becomes hurried; the  body wastes ra-
pidly: thus the symptoms continue; sometimes one, then
another predominating.   A sudden rupture of an  ab-
scess, or blood vessel, or a sudden suffocated  excitement
about the trachea, leads the sufferer from a scene of dis-
tress.  Death, with a feeble dart, severs the  last strug-
gling efforts, and kindly gives the patient a passport to
another Avorld.
  In this last stage of consumption, a cordial and pretty
full diet;  cordial drinks; as Avine whey, coffee,  chicken,
Avater, punch, porter, or porter and Avater sweetened;
Avith the use of laudanum, tAvo or three times in twenty-
four hours.   A good  drink for such patients,  is a pretty
strong infusion of Iceland moss in milk, or nice chocolate;
a little bark, or pleasant bitters, may be useful; boiled
onions, oysters,  and even beef steak, and the liberal use
of good wine, has been found useful in this low state of
consumption.
  But exercise must never be relinquished; if the patient
cannot Avalk or ride, nor have access to a carriage, move
him on a small carriage made for the purpose; or if no- 
          OF CONSUMPTION OF THE LUNGS.        175

thing better is at command, place his bed on planks, and
carry him on a Avheelbarrow; if he improves, his exercise
may be gradually increased.   It  noAv remains to make a
feAV general conclusions.
   If Ave are fully satisfied that no scrofulous taint exists,
mercury may be  tried at any stage of consumption; but
it ought never to interfere, for any length of time, Avith
exercise.   After  the  inflammatory  stage is pretty Avell
over,  a salivation has often removed  consumption in its
forming stage; but I have never been able to succeed
Avith it after the disease might, decidedly, be said to be
beyond the verge of pneumonia;  although  I have tried
it Avith every precaution, and under circumstances appa-
rently favourable; having gone even  so far as to take
some  patients to my own house.
   Upon the whole, very little is to  be expected from
mercury in this disease, or any other  medicine.   Exer-
cise is the sheet-anchor and  only hope in this terrible
disease; it must be accommodated  to the  strength and
stage of the disease.  It  may begin with riding on  a
smooth road or floor in a carriage, the patient sitting up,
if possible; next increasing the motion by moving faster;
then reasonable riding at a walk  of the horse, then trot-
ting; afterwards, more constant walking, riding, running,
dancing; and lastly, constant labour.
   I agree Avith Rush, that sea voyages have seldom been
useful, unless the patient partakes of the common  labour
of managing the ship.  But I feel compelled to observe,
that I  think the Doctor's views of grading exercise are
erroneous, and likely to lead sometimes to mistakes.   I
will briefly give my OAvn views.
   I consider every kind  of  swinging, sailing, rocking,
or exposure to dangerous precipices, sedative in their
operation, until we  become accustomed to these kinds o!<
motion; and, therefore, they are only useful, or even safe,
where Ave wish to remove an inflammatory diathesis.   It
folloAvs, that where consumpted persons were  benefited
by those modes of exercise, (and this has often occurred,]
that they were labouring  under the disease in its inflam
matory stage.   And this kind of exercise is probablv
one of the most active  and agreeable  means of reducing
inflammatory action of a  chronick nature. 
176        OF CONSUMPTION OF THE LUNGS.

  It may be well to bear  in mind, in the  diseases of
children and others, that these modes of exercise will
reduce  the strength rapidly, before  the body can be ac-
customed to  them;  and, therefore,  where children are
much reduced, they are certainly sometimes injured by
rocking in a  cradle.   The rocking  interrupts  the  func-
tions  of the  lungs,  and thereby increases the debility
present.  The  evident  tendency which rocking has to
lull to rest, is a proof of its sedative nature.
  The  next thing in point of importance, is  attention to
diet; and it is, perhaps, safer to err on the side of a diet
too low, than run the risk of living  too high, especially
the first few weeks.   When the disease is confirmed, the
patient  must, in some measure, consult his OAvn feelings;
but I feel full assurance in observing, I have never seen
any advantage from a very low diet,  after Hie disease was
confirmed, and somewhat advanced.   Blood-letting in
every stage of consumption may be practised; but such
patients never can bear large evacuations, and it ought
to be reserved for the increase of symptoms,  which so
often arise from getting colds.
  Through every stage it will  be advisable to  keep a
small sore over the breast-bone,  by rubbing  noAV and
then with a little ointment of corrosive sublimate.
  In the regulation of our diet, we  must ahvays bear in
mind, that the stomach is weak, and therefore calls for
small, frequent meals,  of  the  lightest kinds  of  food.
Where a cordial diet is  necessary, a little salted meat
Avill be proper, more especially  in the summer; for there
is much disposition to diarrhoea from using fresh meat at
this  season of the year.   Through every stage of this
disease, mush and milk, or  iceland moss boiled in  milk,
will be  allowable.  All conserves, syrups and confections,
tend to impair the appetite; therefore they should  never
be alloAved for any length of time, unless on trial  mani-
fest advantage  is derived from them; a little  fruit jelly
and milk will be a better  desert for a Aveak stomach;
honey,  if it agrees with the bowels, may be used;  but it
generally disagrees; tar-water, resins and  balsams, if
ever they can be  useful, it  must be in a very low state
of the  typhus stage; or, in the early stage, before any
considerable  fever has occurred. 
          OF CONSUMPTION xOF THE LUNGS.        177

  Persons have recovered from consumption from under
every discouraging appearance; and therefore we should
never Avholly despair.   It is our duty, Avhile life lasts, to
persevere in our efforts.
  I have still to observe, that a spitting of blood, or he-
morrhage, from the  lungs, calls  loudly for the lancet;
and we should  never desist till Ave subdue that symptom;
for it is always better to bleed from the  arm than from
the lungs.   But those discharges of blood may generally
be checked by taking freely of common table  salt, from
one or two tea spoonfuls to ten or a dozen of dry salt,
taken gradually, will have a speedy effect in stopping
this discharge.
  As you value your life, never be advised  to tamper
Avith nostrums.  When  you  are  distressed with  urgent
symptoms, losing a little blood, or, in the advanced stage,
a little laudanum Avill mitigate; but no medicine will avail
any thing towards a radical cure, therefore place depen-
dance  wholly on unremitting exercise, and a diet accom-
modated to the stage of the disease.
  However much chronick debility, arising from various
causes, may predispose to consumption, I am inclined to
believe this disease  partakes, in good measure,  of the
character of an epidemick.  That is, I imagine some pe-
culiar state of the air, acting on a debilitated person, will
excite  this disease.   It never is either contagious, or he-
reditary.  Unhealthy parents may leave a weakly con-
stitution, or a peculiar conformation of the breast, &c. in
their offspring; but all this predisposes only, and requires
an unhealthy atmosphere to produce the disease.   This
view of the subject leads us  to the hope, that by great
care as to temperance, warm clothing, and active indus-
try, we may often, perhaps generally, escape.
  Dr.  Rush was strongly predisposed to consumption
during a long life: he had inherited from his parents a
strong tendency to it; but his  extraordinary industry, in
every period of his life, together with  temperance, and
great attention to clothing, &c. carried him to  a good old
age, Avhen he dropped into his grave, amid his undimi-
nished usefulness, from another disease.
                  2% 
 178        OF CONSUMPTION OF THE LUNGS. '

   A nervous consumption is sometimes met with: it i$
 called atrophy, and was described by European authors
 under the name of tabes.  This is  a  Avasting away of
 the body, without any considerable fever or  affection of
 the breast; and is probably a disease originating in the
 stomach, and  pervading gradually all  the assimilating
 poAvers of the body.  I suspect it is generally accompa-
 nied with diabetes.   Indigestion, languor, inward fever-
 ishness, together Avith a rapid wasting of the body, are
 its principal symptoms.
   Treatment. Exercise here is an essential  part of the
 cure; tonicks, and bark, iron, the cold bath, &c. Avith light
 but nourishing diet.
   Some of the chalybeate mineral Avaters of our country
 may  be useful in this disease; but for consumption of the
 lungs, they can seldom, if ever, be  safe.  Where  con-
 sumption proceeds from any known debilitating cause,
 it is obvious our first efforts  must be to avoid such  cau-
 ses; as intemperance, giving suck, &c.  and endeavour to
 restore tone by tonicks, &c; but if these do not succeed
 in reasonable time, Ave may conclude that an inflamma-
 tory diathesis is  established, and will only yield  to ab-
 stemious diet, repeated small bleedings, exercise, &c.
   Nature seems to desert us in this disease, and unkindly
 leaves the patient to struggle with it, while she adds an
 almost irresistible propensity to rest.   But in vigorously
 opposing this fatal tendency to  inaction, we do no more
 than in counteracting her blind, or unfriendly efforts to-
 wards sleep, when pressed severely by cold.  To yield to
 her sluggish  invitation in either case,  is certain ruin.
 She is a kind parent, but a bad physician.   She  would
 carry those  suffering Avith cold to a bed of snow,  and to
 death!  She would  entice the suffering  consumpted to
 beds of down, to scenes of sloth! and to mistaken views
 of his danger! adding to each succeeding assent, another
 down! down! until the yielding patient is no longer able
to oppose the rushing torrent! the harassed soul on sera-
phick wings takes its flight to regions eternal.
  Let me then admonish  every patient in this  disease,
to bear in mind that a disposition to  rest stands in the
same relation to him, that a disposition to sleep does to 
OF THE PERIPNEUMONY.
179
one likely to be frozen. With might and main, then, bear
up against so fatal a propensity! remembering that as too
violent exertion Avould wear down the chilled traveller,
and lead to equal danger with its opposite; so in Con-
sumption, by too violent exertion we frustrate the inten-
tention in view.  Exercise, must be as constant as  the
return of day; but carefully accommodated to  the  cir-
cumstances of each case.
  Let all those affected Avith consumption, or any serious
affection of the breast, bear in mind that Avarm clothing
is of the very greatest importance; flannels should be
worn next the  skin; Avarm stockings and strong shoes,
Avell  greased, in wet weather, are also particularly ne-
cessary.  Such persons are very sensible to changes of
the weather, and are, in  general, disposed to chilliness;
and the only safe remedy against those chills is Avarm clo-
thing; being much about the fire or a  stove room, is gene-
rally injurious to such people, except the Aveather be cold.
  Many patients are injured by exposing themselves too
early to the morning air; no one labouring under any se-
rious  affection of the breast should go abroad before the
sun is about an hour high; and, even prior to going out,
this late in the morning, should breakfast; or if the appe-
tite is too languid, so early in the morning, a little food
of some kind should be taken; something solid will ge-
nerally be  best, as gingerbread, or a mere taste of nice
dried meat, with bread and butter, &c; or, if the patient
is on a low. diet, a little bread Avith preserve, or a little
Avarm milk Avith a small  quantity of  pepper   may be
taken.
                     SECTION  II.

                Of the Peripneumony.

  This disease is  an inflammation of the lungs, very
much resembling a pleurisy, being  attended, however,
with a greater difficulty of breathing, less pain or stich-
es.   It often succeeds obstinate, or  improperly treated
cases of croup.   It generally  commences with  febrile
symptoms, as  chills, and heat,  some cough, and some-
times pretty free expectoration  attends with streaks of 
180
OF THE PERIPNEUMONY.
blood; the urine is  apt to be unusually high coloured.
It is sometimes  complicated with pleurisy.   There is
also a lower grade of peripneumony, which has been
called the bastard, or peripneumonia notha.   All thes.e
diseases, or rather symptoms, are one and the same thing,
differing only in  grade; pleurisy being the highest, and
the bastard peripneumony, the lowest grade of this affec-
tion, of the chest; and they are noAV generally all spoken
of under the term pneumonia.
  In our efforts at curing this disease Ave are to use the
lancet, more  freely,  as  the case  approaches  nearer the
pleurisy, in its appearances, Avhile in the Ioav grade of
the bastard peripneumony, we  must bleed  with great
caution, and  sometimes not at all.
  In an active peripneumony, as manifested by general
fever, chills, difficult respiration, cough, spitting of frothy
matter, streaked Avith blood,  a full or  corded pulse, &c.
we ought to bleed, and according to  the constitution of
an adult person, take from ten to sixteen ounces of blood,
should this not relieve, or should it increase the  symp-
toms, which  is often the case, we must repeat the bleed-
ings frequently, until the symptoms yield.   In this stage
of the case Ave may content  ourselves Avith opening the
bowels with  mild purges, as  senna and manna, salts and
manna, or rochelle salts, or even injections, provided Ave
bleed according to the symptoms.  If this treatment re-
lieves the patient, Avhich is generally the  case, Ave may
leave the case to nature, so soon as free respiration, con-
siderable abatement of  the fever, and the disappearance
of bloody streaks in the spittle, Avith  a more regular and
softer pulse  has  taken place.   Mild warm  drinks, as
milk whey,  Aveak teas, barley Avater, apple Avater, or
milk and Avater, must constitute the only beverage. Wine,
spirituous drink, or animal food, must not be touched till
the convalescence is well advanced.
  If the case becomes protracted, blisters will be neces-
sary, applied over the breast; the spirits hartshorn in
doses of  ten  to twenty drops  in a glass of cool water, or
a decoction of seneka snakeroot, will be necessary, re-
peated every tAvo hours, or tincture cantharides may be
given till it excite slight strangury. 
OF THE PLEURISY.
181
  In low cases, where the pulse is weak, and does not
rise after bleeding moderately, or in very debilitated ha-
bits, without bleeding at all, Ave should give calomel in
doses of five grains twice a day, and restrain its opera-
tion on the boAvels, if necessary, with a few drops of lau-
danum, given Avith an equal quantity of spirits harts-
horn.   A  large  blister should  be  applied over the
breast, and if the case is obstinate, it  must be repeated
as soon as  it dries up.  The tincture of cantharides
should be given till it  excite  strangury, if the symptoms
do not abate sensibly after the blister.
  The decoction of seneka snakeroot may noAv be given
with advantage.  The bowels should be regular, but
purging is perhaps never necessary,  and  often  unsafe.
A little wine Avhey may be allowed in this low grade
of the disease, chicken broth, chocolate, oysters, &c. in
small quantities.
  When convalescent, the patient may use the bark and
elixir vitriol to advantage.  Great care must be taken to
avoid damp Aveather, or damp clothes, or rash meals, for
this  disease is apt to return without much care.
  Peripneumony of a Ioav grade is  a very dangerous
disease, being apt to terminate  in  suffusion of tough
phlegm, into the vessels of  the lungs, which brings on
what Dr. Rush calls suffocated excitement, and destroys
the patient; the free use of blisters is a  principal remedy,
and  in  dangerous cases I would recommend the oint-
ment of corrosive sublimate in preference to the common
blisters which act much more slowly.   In  active cases
of this disease, ipecacuanha and calomel, given so as to
excite slight nausea, will be  advisable.

                     SECTION in.

                   Of the Pleurisy.

  The  reader  before he proceed to prescribe in a pleu-
risy, should turn to the article on peripneumony.  A ge-
nuine pleurisy is not"found in practice,  except among the
athletick people of healthy neighbourhoods.  This dis-
ease is generally brought on by rash exposure, to cold 
182
OF THE PLEURISY.
or night air, fatigue, too thin clothing, and especially
neglecting to put on  clothing, which may have  been
uncomfortably warm during the day.  Nothing can be
more improper  than neglect in this respect; every la-
bourer should put on his hat, coat,  shoes, &c. as soon
as he leaves off work and feels cooler.
   Chills and acute pain or stitches, generally announce
the attack of pleurisy; these stitches  soon  become  into-
lerable, shooting towards the shoulder blades, or among
the ribs, particularly on drawing breath.   The breath-
ing is confined and difficult, the pulse is full, strong and
tense.   A cough, often  slight at the commencement, but
increases  as  the disease advances, with  some spittings
generally streaked with blood.
   Treatment.—We must bleed largely and repeatedly
to subdue a violent pleurisy, and in general, the benefit
from  bleeding  will  be  greatest,  from abstracting the
blood suddenly; we  should make a large  orifice and
draw in the  case of a stout man, from sixteen to tvven-
ty-four  ounces,  or in  other words,  from  one to three
pints of blood  should  be taken  at  the first bleeding,
afterwards they should  be less, but  always  large, and
repeated tAvice a day till the symptoms abate.
  If the case is obstinate, after plentiful  bleeding, we
may apply a large blister over  the breast; give spirits
hartshorn in small doses every two hours, or  the decoc-
tion of  seneka,  with small  doses  of calomel.   Tartar
emetick dissolved in a good deal of water, or ipecacu-
anha in small  doses,  so as to excite a slight  nausea
Avithout vomiting,  may  be given during the inflammato-
ry symptoms: two grains of tartar emetick, in a pint of
Avater, will form a good febrifuge in  this disease.   The
boAvels  should  be kept  open, but purging will not have
much effect.
  The  lowest  possible diet  should be used,  such as
toasted  bread soaked in water; a roasted apple,  or  a
little very weak tea with bread.  For drink, milk and
Avater, thin barley water, apple water, toast and water,
thin flaxseed tea with  a little liquorice, or milk wheyj
or cremor tartar Avater,  may be used freely. 
OF THE CROUP, OR HIVES.          188
   Soon as the cough, fever and stiches abate, leave the
 case to nature, taking great care not to return to cordial
 or heating drinks, or animal food,  but Avith the utmost
 caution.
   Should this disease terminate in an obstinate cough,
 which will seldom be the case if it is properly treated, a
 perpetual blister should be applied to  the breast; and it
 we are well assured no scrofulous taint exists, we should
 have recourse to calomel, so as to bring on a soreness of
 the mouth, and continue it for a period,  of from one to
 two or three weeks, as may be necessary, avoiding a sa-
 livation, by  quitting the calomel  occasionally.  Every
 person rising out of a pleurisy, must dress warmer than
 usual, and Avear flannel next the skin.

                     SECTION IV.

               Of the Croup, or Hives.

   Children,  under seven years, are most subject to croup;
 it sometimes attacks at a  very early period of life, and
 becomes in some  measure habitual; recurring in  some
 children,  at times, in form  of a common  cold; but  more
 frequently very suddenly.   Children who are put to bed
 apparently quite well, or,  perhaps, sometimes  slightly
 indisposed, are liable to be attacked with this disease in
 a violent and dangerous manner; so that  it becomes  the
 absolute  duty of those present, to rise and administer
 some suitable remedy, Avhich should always be at hand;
 for to wait till morning would often be to wait  till  the
 case is beyond all hope.
  It is an unquestionable fact, that no disease is so com-
 pletely under the  control of medicine, if taken in its
 forming stage; nor is there one more mortal, when  ne-
 glected or wrong treated.   This disease may be known
 by a peculiar hoarseness, which, with the  difficulty of
 breathing, plainly shows that there is some obstruction in
 the windpipe.  This peculiar hoarse, suffocating sound,
 attends every spell  of  coughing,  and gives a  curious
 choking-like  sound to the act of hreathing.  So  charac
teristick is this hoarseness, that  a person who has seen 
 184          OF THE CROUP, OR  HIVES.

" croup but once, could scarcely mistake  it  afterwards.
 The face has always an  unpleasant staring appearance:
 the difficulty of getting breath is so great, that such pa-
 tients are extremely restless, and labour with all the ef-
 forts which they can command, over the muscles of the
 belly and* chest.
   When the disease is violent, it is called bold, or boAvel
 hives.   Sometimes it is attended with eruptions or pim-
 ples on  the body; but, these have no essential connexion
 with the disease.  When this disease is  discovered at
 an early stage, a vomit of Avhite vitriol, ipecacuanha, or
 antimonial Avine, provided it operates  freely, is  sure to
 check the disease.   If it does, it  is only necessary to
 guard, a few days, against cold; not, however,  denying
 the privilege of going abroad, if the weather is good.
   A decoction of seneka, given three or four times a day,
 may be  useful in removing the slight remains of the dis-
 ease.  If the case yield  not to a brisk vomit, as above
 mentioned, calomel should be given in large doses: from
 five, to twenty grains, may be given, twice a day.  At
 the same time, if the vomit  has not checked the com-
 plaint, bleeding must be  had recourse to, as an indispen-
 sable remedy; and should be repeated as often as suffo-
 cation seems threatening.
   If the case becomes protracted, the use of  the calomel
 must be continued; blisters may be applied, and a strong
 decoction of seneka given.  But I  have seen more bene-
 fit derived from the application of linseed meal, or bread
 and milk poultice, with  flaxseed boiled in it: this is to
 be applied oyer the Avhole breast, and down to the navel,
 as warm as it can be reasonably borne.
   Weak onion tea, or milk  and Avater, will be proper
 drinks.   No cordials, nor animal,  or even  solid food,
 should be given, till the patient  is quite recovered.  And
 even Avhen well, in children Avho are subject  to this com-
 plaint, full  meals are among the most frequent exciting
 causes of the croup.
   Croup is  sometimes protracted so as to continue for
 several days; it will be necessary in such  cases  to give
 the calomel in  smaller  doses, after the  second day of
 using it.  The warm bath is sometimes  useful in the 
OF A  COMMON OOLD.
185
close of the'disease, or after free evacuations.  In very
Aveakly, delicate children, the treatment of this disease
may be most safely trusted to large doses of calomel.
  I cannot conclude this article Avithout cautioning  the
people of the country, in the most solemn manner, against
the  extremely dangerous practice recommended by Bu-
chan, in his Domestick Medicine. How far this practice
may ansAver in England, I will not undertake to say; but
of all things it would be the most dangerous, in the mid-
dle, or northern states.  I do  not  believe one in  fifty
would escape from a severe spell of croup, under such
treatment.
  It is even questionable whether the practice will apply
to England generally, for the celebrated Darwin calls it
a pleurisy of the windpipe; a name, at  once expressive
of his idea of the disease, and of a depleting plan of treat-
ment.  Many English authors, of the highest respecta-
bility, consider  croup a disease highly  inflammatory.
Cullen, Thomas,  Wilson, &c.  are  quite decided  on
this  subject, against the opinion of Buchan.

                     section v.

                 Of a Common Cold.

  All those affections which go by the name of common
colds, are accompanied with some feverishness, however
slight; and, therefore, when we are conscious of having
caught cold, as  manifested by obstructed watery nose;
inflamed eyes; sneezing; more or less lassitude, or want
of appetite, or  a slight cough:  it will be sufficient in
general, to avoid night, and morning, and evening air; to
dress a little Avarmer, bathe the feet going to bed; and
drinking a little warm tea, and using a reduced diet, re-
gulated according to the violence of the case, will be ad-
visable.
  In  severe colds, a total abstinence for a day or two, is
a sovereign remedy with many persons.  But unless some
disease arises from such colds, the abstinence should never
be continued leng.  If a cough becomes troublesome,
take a little opening medicine, and if that does not afford
                  24 
186     OF  INFLAMMATION OF THE STOMACH.

relief, bleeding  may be necessary.   If much fever or
cough arise, it will be necessary to look at the sections
on peripneumony, and on pleurisy.
  Many people on taking cold have recourse to hot stews;
they ought never to be used until you are well convinced
no fever is lurking in the body, otherwise  death may be
the forfeiture, for many of our most malignant fevers, &c.
commence like a common cold.  A syrup  of lemons, or
of strong pleasant vinegar, will often be useful, and in
old cases, a syrup or other preparations of horehound,
or a conserve of Indian turnip,  with regular exercise,
and avoiding wet beds, Avet feet, or exposure in damp
Aveather,  will restore the health.

                     SECTION VI.
                         /
     Of Inflammation of the Stomach, or  Gastritis.

   One of the most infallible signs of inflammation of the
stomach,  is severe pain on taking food, or drink, toge-
ther Avith some fulness and pain from pressure being
made on  the part: a constant symptom of this disease is,
a small, quick,  and tense pulse; nausea, or vomiting is
common on taking food or drink.   Faintness,  cold ex-
tremities, difficult breathing, &c. are also  generally pre-
sent.  A hiccup is an unpleasant symptom.  In all the
cases of this disease which I have seen, neither food, nor
drink of  any kind could be borne, until the disease Avas
much abated.   Indeed I think it highly probable, diges-
tion is wholly suspended during  active inflammation of
the  stomach, and, therefore, no advantage  can arise from
taking food, or  even drink, except  in very small quan-
tity, for the purpose of lubricating the  surface.
   A spoonful of milk and water, or a  thin decoction of
slippery elm bark, or thin gruel,  taken in  quantities of a
single table spoonful, and repeated frequently, is all that
ought to  be given by the mouth; no  medicines^ food, or
drinks, in any considerable quantity, can be given with-
out the utmost hazard,  and no benefit can  possibly arise
from it.   Injections of  a mild  opening  quality should be
given frequently, and when the bowels are well opened, 
        OF INFLAMMATION OF THE INTESTINES.     187

injections of broth, containing each a feAV grains of calo-
mel, should be given.   But the patient's safety depends
principally on repeated bleedings, till Ave raise the pulse,
and relieve the pain, and the soreness, which arises from
pressure.
  FeAV diseases deceive us more in  the  appearance of
the pulse  than this, and feAV require a more free  use of
the lancet.  In all cases,  a large  blister should  be ap-
plied over the stomach.   After free bleeding, if the pain
and other symptoms have not evidently abated,  the warm
bath should be used, and repeated according to circum-
stances.   When the disease is checked, it requires great
care in returning to the usual diet and drinks.   No sti-
mulants or solid harsh food ought to be ventured on for
several days,  nor  indeed  till the  strength of the general
system is  pretty well restored by means of exercise.

                     SECTION ATI.

   Of Inflammation of the Intestines, or Enteritis.

  This affection is attended with a constant seATere pain
of the boAvels, eructations of Avind, nausea, quick, tense,
small  pulse;  obstructed bowels;  and sometimes Avith a
ATomiting  of the feces; great debility; anxiety.  In  this
disease Ave must bleed freely, and repeat  according to
circumstances.  A large blister should  be  applied; mild
injections must be given frequently, or Avhat is better, a
large quantity of warm water: a gallon or two may be
thrown up  from  a large bladder as rapidly  as  possi-
ble.   Soon as free depletion has been made, calomel in
doses of five  to ten grains, should  be given,  combined
with a little opium, and  repeated every six hours, till
there is an abatement; should none of these  remedies
succeed in the course of the second day, the warm bath
should be had recourse  to.  The diet must  be light,
such as milk, light broth, well boiled meats, oysters,
gruel, rice well boiled, &c. for some  time  after the  dis-
ease is checked.  During the disease the patient should
avoid food and drink, except chicken water,  milk  and
water, slippery elm bark water, or other light  mucilagi-
nous drinks. 
188      OF  INFLAMMATION OF THE KIDNEYS.

  In  distinguishing  this  disease  from  colick, regard
should principally be had to the circumstance of extreme
debility, which always accompanies it; while in colick
the patient is seldom so sensible of weakness; nor is the
pulse so much disturbed in  the colick.  All these in-
flammatory affections of the viscera are highly danger
ous, and, therefore, advice should always be had, where
it is practicable.

                    SECTION VIII.

    Of  Inflammation of the Kidneys, or J\Tephritis.

  An inflammation of the kidneys  may arise from vari-
ous causes; but its most common known causes are calcu-
li, formed within them; the extravagant  use of cantha-
rides, or spirits  turpentine; but most frequently I have
met with this disease, as arising from violence done the
parts, by blows, falls, &c.  There is generally a severe
dull pain in the loins, extending dow7n one or both thighs.
Little urine,  sometimes bloody, but at  other times pale.
It is often attended writh nausea or vomiting, and the
pain, in severe cases, seems to  affect the abdomen with
an inflammatory  diathesis; and general  fever is a fre
quent concomitant.
  In this disease Ave must bleed with freedom, in healthy
habits; give cooling mucilaginous drinks, as slippery elm
bark Avater, an infusion of quince seed, or water melon
seed, or milk and water, taken cool.  The boAvels should
be opened with emollient injections; and these assisted in
their  operation Avith  reasonable doses of calomel: no
drastick, or saline article should be used: nitre, cremor
tartar, &c. must be avoided.  The safest article of this
class of medicine, is phosphorated  soda.   In severe ca-
ses, blisters to the back, produced by the application of
the ointment of corrosive sublimate, will be advisable.
Cantharides must not be applied on any account; it might
be productive of much mischief.  A very Ioav diet is es-
sential.
  Should this treatment not remove the complaint in five
or six days, we must omit bleeding,  and content  our- 
        OF INFLAMMATION OF  THE BLADDER.       189

 selves with keeping the bowels open with injections of
 mild articles; rest, and moderate diet, and await the issue
 of suppuration, which will  probably take place; even
 noAV, mucilaginous drinks are necessary; small quantities
 of laudanum may be given.  Cordial and saline articles,
 must be avoided Avith  care, and the patient  put on the
 use of the uva ursi: from twenty to sixty grains may be
 taken three times a day, in milk, or Avater; and the pa-
 tient should  live on a milk diet.  Exercise in a carriage
 will be most suitable.

                     SECTION IX.

     Of Inflammation of the Bladder, or Cystitis.

   Inflammation of the bladder may be known by more
 or less fever, pain and  sAvelling in the lower part of the
 belly; frequent difficult and painful discharges of water;
 tenesmus or  inclination to go  to stool.  Bleeding will be
 necessary, according to circumstances, and must be re-
 peated  till the severity of the symptoms abate.   The
 bowels  should be freely opened Avith mild injections, as
 linseed  tea, slippery elm bark water, milk and Avater, or
 even Avarm water.   Castor oil, magnesia, or  calomel,
 may be  given to open the boAvels; but no saline, nor diu-
 retick articles, are admissible.  In  obstinate cases the
 Avarm bath may be useful,  after suitable  bleeding.
   Should the case become  protracted, Ave must continue
the mucilaginous drinks,  and  use the uva  ursi; from
twenty to sixty grains, three times a day, may be taken
in milk  or water, as may be most agreeable.  It is essen-
tial in this disease to encourage a perspiration, by suita-
able clothing, and avoiding sudden changes of tempera-
ture; but no  heating sudorificks can be used,  without  t
much  danger. 
190   OF INFLAMMATION OF  THE DIAPHRAM, &C
                     SECTION X.

Of Inflammation of the Diaphram, or Paraphrenias.

  This disease is attended with an acute pain low down
in the breast; particularly severe when we let in or pass
out the breath: this induces the patient to hold in his bel-
ly, and breathe frequent and feebly.  These symptoms
are generally attended Avith, and much aggravated by, a
cough and frequent sneezing.   Every effort of the body
augments the pain; as going to stool, taking food, &c.
An unpleasant grinning of the face is often present; and
in severe cases, delirium.
   Blood-letting is the principal  remedy in this disease;
the bleedings  must be pretty large,  and frequently re-
peated.   This disease will frequently require more fre-
quent bleedings than the pleurisy; but we should never
make them so large.  The free use of purgative injec-
tions is indispensable.  Nausea should be slightly kept
up, after pretty free bleedings,  by the use of very small
doses of  ipecacuanha.
   The diet must be low and thin; and the drinks cool,
and  of the mildest  kinds.   It is particularly necessary,
in -his affection, to  remain as quiet as possible. Purging
medicines may also be used to  advantage; but I must re-
peat, that in  the height of  this complaint  the  patient
should scarcely move, and depend on the lancet.  In ob-
stinate cases, a blister should be applied over the part
affected.

                     SECTION  XI.

  Of Inflammation  of the Peritoneum, or Peritonitis.

   This affection maybe known by an acute pain through
the  abdomen, attended with extreme soreness when pres-
sure is made on the part.   Where this inflammation runs
high, the patient can scarcely bear the bed-clothes; there
is more or less fever, and short hurried breathing. This
 disease most commonly arises from wounds,  or ruptures;
 and is often attended Avith great danger. 
          OF INFLAMMATION OF THE LIVER.       191

  In all wounds of the abdomen, large anodynes of so-
lid opium should be given, which will go far to prevent
this disease.  But, after inflammation has come on, opi-
um would be highly dangerous.  Repeated bleedings, the
free use of mild injections, and copious evacuations from
the bowels; for Avhich purpose, castor oil, calomel, salts,
rochelle salts, or senna aud mauna, may he used. Large
quantities of warm Avater  may be injected into the bow-
els, and fomentations  applied ouhvardly.

                     SECTION XII.

     Of Inflammation of the Liver, or Hepatitis.

  Inflammation of the liver is less distinct in its symp-
toms, at least to an  unskilful person, than that in the
other viscera.   It is commonly attended with dull, severe
paiu, in the right side of the belly; more especially Avhen
the patient moves  suddenly, or when pressure is made
on the part. A fulness is often discovered, particularly
on feeling up under the false ribs. There is some fever,
some difficulty of breathing; and often a short dry cough.
A dull pain extends  up about the shoulder of the  right
side, very often.  Sometimes symptoms of jaundice are
present. When the inflammation is situated on the upper
edge of the liver, a pain and soreness on pressure is felt
over the  stomach, or just beloAV the pit of the breast.
Frequently, however, this disease is only discovered at
an early stage, by pretty firm pressure on the part;  or by
an inability to lie on the opposite or left side of the body.
The pulse is most commonly not very much  affected.
This organ is so essentially different in its organization,
and connexion Avith the circulating system, that Ave have
no cause for Avonder if Ave  find the symptoms less distinct:
and the treatment materially different.
  It may  be remarked of  the liver, that although it bears
some resemblance to the lungs, in having a great many
blood vessels, yet, those  of the lungs, are  composed of
an equal number of arteries and veins, while those of the
liver are  almost wholly veins.  The circulation through
the liver is venous, slow, and I might almost «ray chymi- 
 1J)£        Jf INFLAMMATION OF THE LIVER.

cal, or attractive, for, its arteries are extremely small,
and feAV, barely  sufficient to  give  life  to its substance;
Avhile the great tissue of veins carry through the venous
blood, without any well marked propelling force; and as
it passes along, the bile is secreted from the dark blood,
collected from the other viscera, &c.
  In this disease we must bleed pretty freely at the com-
mencement.  The boAvels should be well opened with
injections.   Then, a large blister may be applied, over
the part affected.   After which, the cure may  be princi-
pally trusted to the use of calomel and opium.  Calomel
may be given in doses of from two to five grains twice
a day, combined with one or two  grains of opium  for
each day.  The abdomen, more especially over the right
side, and stomach, should be rubbed with mercurial oint-
ment.  If  the pulse remains active, with some  pain, or
much cough, we  should repeat the bleedings.  Warm
fomentations which are often useful in other inflammations,
are never  alloAvable in this.   They increase the risk of
suppuration, a frequent consequence of  imflammation of
the liver.
  Should  the case prove obstinate,  Ave  must  persevere
with the mercury until a salivation is produced;  and
keep it up  until the case yields, which will very gene-
rally be the case, in persons of temperate habits, provid-
ed the case has not heen neglected, or improperly treat-
ed, in  the  early  stage  of it.  Should  the disease con-
tinue  after a reasonable  continuance of the salivation,
Ave may view the disease as settled into scirrhus, and no
longer under the  control of medicine.
  I have seen many cases of suppuration  in the liver,
which pointing outwards, were  opened low down near
the back; and one case, where  an  abscess on the upper
edge of the liver pointing outwards, Avas opened  above
the navel:  most of the cases I have seen, were children;
and they all recovered.  If we  are  even certain suppu-
ration has taken place in the liver, we  are by no  means
to apply poultices, or fomentations; their use is extreme-
ly doubtful, if not really dangerous. Fever must be kept
down  by the common remedies for fever:  mercury  can
no longer be useful.  The patient must be kept quiet; 
OF INFLAMMATION OF THE BRAIN.       1Q3
and await the suppuration.  A skilful practitioner must
always be called; or, if it is possible such a thing is not
obtainable, a Aery small poultice of bread and milk may
be applied for a day or t\vo, over the prominent part,
and then a puncture made Avith a common thumb lancet.'
But in all cases, it must be Avell ascertained, by feeling
Avith the finger, that pus is actually formed, and lodged
superficially, before Ave make such puncture; and in all
doubtful cases it is best to Avait till we are certain.
  Through the whole treatment of this disease, the pa-
tient must be kept on a very Ioav bland diet; as Avell boiled
rice, milk,  buttermilk,  with Avheat or rye mush; or Avell
mashed potato, a roasted  apple;  very Aveak tea, with
bread,  &c.  For  drink,  mucilaginous   articles  alone
should be taken, as milk and water, barley water, slip-
pery elm Avater, &c.  No  saline  or drastick articles
should be taken, either in  drink, food, or medicine; all
cordials or animal food would be poison for such patients.
After the disease is removed, in delicate  persons,  or
those of intemperate habits, the nitrick acid should  be
used pretty freely for some time.

                    SECTION XIII.

     Of Inflammation of  the Brain, or  Phrenitis.

  Phrenitis  is  generally  attended with  symptoms  of
violent  inflammatory fever; but as in inflammatory fevers
Ave often  meet Avith a depressed small pulse, so, in vio-
lent cases of inflammation of the brain, Ave often find the
same kind of small tense  pulse.   This is  supposed to
arise from a  more immediate  affection of the substance
of the brain, while the more active pulse, is considered
an evidence of an affection of the membranes.  They are
equally dangerous,  for if  the  inflammation of the sub-
stance of the  brain destroys more suddenly, by an exhaus-
tion or destruction of the brainular energies; inflammation
of the membranes, by pouring out watery congestions, is
sure ultimately to produce the same effect.
   But after all, inflammation can probably never exist to
any considerable amount, Avithout affecting both the mat-
              25 
194
OF INFLAMMATION OF  THE BRAIN.
 ter of the brain and its membranes.   This  disease  is
 most generally  known, in this country, by the name  of
 pleurisy  of  the head:  a name well chosen,  from the
 strong resemblance in the proper  treatment  between it
 and a pleurisy, properly so called; in addition to symp-
 toms of severe fever, there is violent pain in the head;
 intolerance to light, and loud  sounds; tinkling  in the
 ears; delirium,  sometimes low and muttering, at  other
 times outrageous; violent beatings of the temporal arte-
 ries, and those of the neck; flushings of the face; dilated
 pupils, or very much contracted; costiveness;  inability to
 sleep.
   In country practice, I have generally found it  con-
 nected with inflammatory affections of the breast.  This
 disease is sometimes brought on by exposure  to the sun;
 especially when the person has  undergone  fatigue, or
 has been  exposed to the cool night air: this  is called  a
 stroke of  the sun.
   In the treatment of this disease, we must generally
 bleed largely; but regard must always be had to the pa-
 tient's constitution; and to the constitution of the Aveather;
 it often attends the low grade of typhoid fever, or  bas-
 tard peripneumony,  of our country: and large bleedings
 in such cases would  be fatal.   I shall  first point  out a
 suitable treatment for a genuine simple inflammation of
 the  brain.  We must bleed largely   and  frequently;
 give the most active purgatives,  as jalap and  calomel,
 or calomel and aloes—purgative injections. Constant ap-
 plications of cold vinegar and water  to  the head;  strict
 quietness: cooling drinks, of nitre or  cremor tartar, tam-
 arinds, &c.   A  total abstinence from solid, or cordial,
 or animal food: lay  the head high; avoid  strong light,
 or much talking, by  the patient, or others.  Leeches, or
 cupping glasses about the head, on parts first scarified:
 or the  temporal artery should he  cut,  and suffered to
 bleed freely; this is  attended  with no danger, and  will
 pease bleeding on a moderate  pressure being  applied.
   On the  other hand, should delicate weakly  persons be
 affected with this disease; or should it succeed  other
 diseases, Avhich have reduced the patient much; or should
Ave have well grounded fears, that  the patient is also af- 
            GENERAL OBSERVATIONS, &C.          195

fected with an epidemick of a low grade; we must bleed
from the arm with great caution, if at all.  Stimulant
purging injections, as salts, or a decoction of senna, Avith
a very little aloes, may be given; or calomel and aloes,
may be given by the mouth, so  as to purge pretty freely.
Blisters should be applied on the neck; and sinapisms to
the feet.   Cupping and leeches,  should be used freely,
about the head;  and if these rouse up a more inflammato-
ry set of symptoms; Ave must bleed  cautiously  from the
arm, or open the temporal artery.  Should the symp-
toms  not abate  speedily,; the head should be  shaved,
and a blister applied over the scalp; this should never
be delayed beyond the second day; and in severe cases,
it would be best to apply it at first.
  In those low cases, calomel may be given in small do-
ses; a little light vegetable food should be taken  if the
appetite call for  it.   A little coffee, or Aveak chocolate,
given in very small quantities at a time, may be allowed;
but it  would always be best to wait a day or two, be-
fore we venture  on any thing stronger  than toast water,
milk and water, &c.  This is a dangerous disease, and
must be promptly treated, or it will  soon  terminate in
death, or dropsy of the brain;  a disease that is Avholly
beyond our reach, after it is fully formed.

                    SECTION XIV.

   General  Observations on Visceral Inflammation.

  A very generally received opinion of inflammation, is,
that it terminates in three ways.
  1st. By resolution, or scattering.
  2d. By suppuration.
  3d.  Gangrene, or mortification.  As  it respects  in-
flammation in muscular parts, this is nearly correct; and
sufficiently points out  its  consequences.  But in exam-
ining carefully into inflammation of the viscera, or inter-
nal organs, we find great variety, and each organ having
a peculiar termination of its inflammation.  I shall brief
ly enumerate the most remarkable* 
196
GENERAL OBSERVATIONS ON
   Inflammation of the lungs, seldom terminates  in gan-
grene, or  mortification:  but in suppuration, called a vo-
mica; in effusion; in chronick inflammation, as consump-
tion; and sometimes in what Dr. Rush  has called suffo-
cated excitement; in Avhich case, he supposes the excite-
ment of so high a grade, as to destroy life, before the
common appearances of inflammation occurs.   I am dis-
posed to attribute those cases to an affection of the brain-
ular matter itself.  John Bell, has given it as his opin-
ion, and  I  concur in the  opinion, [See  observations
on  the. brain, in  the preceding  part  of this book,]
that a matter resembling  the madullary  part of the
brain,  accompanies the  nerves throughout  the whole
body.   I consider this kind of inflammation or  ex-
citement as  operating on this nervous  matter, and it is
sometimes situated in the brain of the head;  in the sto-
mach; intestines; heart; and, perhaps, sometimes affect-
ing the  Avhole system.   Cases of it are often found  in
the croup: many dissections of patients Avho have died
of cynanche  trachealis, with the most imflammatory ap-
pearances before death, exhibited no marks of inflamma-
tion after death.   This kind of affection seems to differ
from common inflammation attended with error loci,  or
congestions; in this, that Avhile pain, feA7er, and suppura-
tion, attend  the  latter;  the former is occasioned by an
overwhelming stimulus, which destroys the living prin-
ciple at once.
  I am aAvare, however, that Ave might often be mista-
ken, were Ave to judge alone from the circumstance of no
marks of inflammation being found after death; for the
vessels may empty themselves from congestions of blood,
&c. in the very struggles of death.   But the many cases
which put on inflammatory  appearances, and  Avhich ter-
minate before the usual course of inflammation, plainly
shows, that something like  Avhat I have hinted at, often
occurs; and the liver is probably the only organ  exempt
from this kind of brainular inflammation.
  Effusion into the lungs, when the body is very low, is
a most dangerous symptom; and as it is always the con-
sequence  of inflammation,  we  should  endeavour by
prompt treatment, to arrest this fatal tendency. 
VISCERAL INFLAMMATION.
197
  Inflammation of the stomach, is most likely to termi-
nate in mortification; sometimes in scirrhus: that  of  the
bowels, in introsuseption,  or one part of the gut slip-
ping into another, and thus producing strangulation and
mortification; in chronick inflammation, or in little  tu-
mours.
  Inflammation of the uterus, is liable to terminate in
chronick inflammation, mortification, or scirrhus: that of
the liver, in suppuration, torpor, chronick inflammation,
and scirrhus: that of the brain, in congestions of Avater
or blood; producing  dropsy or apoplexy, insanity, con-
A7ulsions, or epilepsy.  Those different consequences of
visceral inflammation are pointed out to show, that not-
Avithstanding all inflammatory affections are, in a gener-
al vieAV, to be treated on the same  principles, or in other
Avords, although evacuations, rest, abstinence, free dilu-
tion, with mild, weak, cool, or tepid drinks, &c. are the
leading articles, there still  is an  absolute necessity for
referring to the treatment laid down for each viscus or
organ.  1 am met here by an opinion which I heard the
illustrious Rush make in  one of his lectures; that in our
efforts for the removal of inflammation of the chest, Ave
could obtain little  aid from  purging;  that the  lancet
alone, Avould arrest such affections Avith that prompti-
tude which is  essential; Avhile, in inflammation of the
head, severe purging seemed more especially suited; and
that, although  the use of the lancet Avas  indispensable,
Avithout purging Ave could seldom succeed to our wishes.
   Having now completed my  observations  on  visceral
inflammation, with all of which the general system sym-
pathizes,  I have  one further remark  to make; and then
shall proceed  to describe a set of diseases, principally
characterized by local inflammation, but of a different
kind, and accompanied also Avith  general febrile symp-
toms.
   In examining  patients labouring under  visceral ob-
structions, Ave  sometimes meet Avith the  humbling fact,
that such is the force of the disease, that the organ prin-
cipally affected is unable to express its suffering; while
a neighbouring one, but slightly affected, shall sympa-
thize, give pain, and  thus lead us from the real seat of 
198
OF THE ERYSIPELAS,
the disease; this is most easily seen in the sympathetic^
affections of the stomach, and where the brain, kidneys,
&c.  are  affected: other sympathies, much less known,
sometimes occur in the bladder, and other organs.  These
should induce us to examine our patients daily; and al-
Avays in visceral affections, feel over the chest and abdo-
men, firmly, so as to be certain our views are just.
  It may not be much out of place here, to remark, that
abscesses on the upper part of the liver, have often found
their way into the lungs, and were thus carried upwards,
and  discharged by  expectoration.   I  have known one
case of long standing, and consumption has not follow-
ed.*
  Lastly. In all suppurations of the  viscera, where the
discharge is great, we must have recourse to tonicks, as
bark, the acids, bitters, light nourishing diet and drinks,
or the patient's strength will fail.

                     SECTION XV.

      Of the Erysipelas, or St. Anthony's Fire.

  This disease is seldom  dangerous, unless symptoma-
tick  of some other disease; but when it has once affect-
ed a person severely,  they are very liable  to neAV at-
tacks on getting slight colds, or using cordial or stimu-
lant  articles.   It most commonly  attacks adults; but
children are also frequently affected with it.   Common
precursors of fever, as  chills, &c.  generally usher in
erysipelas.    Sick  stomach,  or vomiting attends, with
headach, backach, heat of the skin,  restlessness,  quick
tense pulse, and some difficulty  of breathing.  If it is
not preceded, or accompanied Avith  a swelling and red-
ness of the face, by  the second or third  day, the face
sAvells; the eyes are closed; pimples or watery pustules

  * It may not be amiss to  remark that, Larrey,  an  eminent
French army-surgeon, has recorded several cases, where, on dissec-
tion, an opening was found through the diaphragm into the lungs,
of patients who died ofaifections of the liver.
  I mention these cases because the possibility of such an occur-
rence has been denied by some physicians. 
or st. Anthony's fire.
199
appear, which often extend to the breast, and even over
the Avhole body; these are at length filled  with yellow
pus, or matter.
   There is also another kind of erysipelas, which might
properly be called the dry: it comes on suddenly.  The
first notice of it is an itching and heat in the skin, which
rises up all over the body, even among the hair of  the
head, in lumps or welts.  It is often attended with diffi-
cult respiration, which sometimes amounts almost to suf-
focation.  The  itching, and smarting, is  sometimes so
intolerable as to distract the patient, and in a few mi-
nutes continuance, is almost more  than  human  nature
can bear; yet, I have never seen it prove fatal; it gene-
rally goes  off almost as suddenly  as  it came on.   This
has  been called nettle  rash; and, in the country, very
improperly, hives, which is a very different disease.
   The best remedy in this kind of erysipelas, is to rub
over the body smartly with  flour, and rye  flour is reck-
oned the best.   Give an emetick of antimonial wine;  af-
terwards, a little cooling physick may be necessary.
   The  common erysipelas,  has been also called wild
fire, &c.  Small repeated bleedings with cooling purga-
tives, and injections; cooling drinks, containing cremor
tartar, or a little nitre;  or very small doses of salts, as
two drams  tAvice a day, Avith a little ipecacuanha; and
strict abstinence, will generally remove this disease.  If
it has not been opposed in time, gangrene will sometimes
follow; in those cases the bark should be given freely,
and  the  parts  washed  with a mixture of equal parts,
spirits  camphor and  tincture  tolu; or  camphorated
spirits and  sweet oil, shook well together; and if  the
symptoms do not amend in a few hours, a  large blister
must be applied.
  During the early or inflammatory stage of the erup-
tion, Ave should by no means apply any repelling washes,
or ointments; the first, may repel the inflammation to the
brain or lungs, Avhich is a very common occurrence; and
the latter, is apt to leave ulcers; which are sure to mark
the face.  The only thing which should be applied out-
wardly, is dry flour, or finely poAvdered starch, or pre-
pared chalk. 
200
OF THE SCARLET  FEVER.
  There is also another variety of erysipelas,  confined
to the legs, called the rose.   This is apt to become chro-
nick, and therefore ought to be promptly treated.  The
best remedy for this disease, in its forming stage, is blis-
tering over the part; bleeding moderately from  the arm;
cooling purges, and drinks,  and a low diet.  All spices,
spirits,  and animal  food, must be  avoided in an erysi-
pelas.
  Should the rose become established, all the usual re-
medies for strengthening the constitution must be resort-
ed to; the part affected should be frequently bathed with
a strong decoction of oak bark; or cold vinegar and spi-
rits of some kind; and an issue put into the arm. These
remedies, with temperate habits, Avill often remove this
troublesome disease.

                    SECTION xvi.

                 Of the Scarlet Fever.

  This fever comes  on in the usual Avay, with chills and
heat; nausea; headach;  pains in  the  back,  &c.  The
skin is soon covered with a deep red eruption; in blotch-
es sometimes, at other times all  over the body.  These
detach the scarfskin,  and it falls off in thin scales in
three or four days.   A  genuine scarlet fever is a mild
disease, and  requires  nothing but rest; strict Ioav diet;
the mildest tepid drinks; a little cooling physick;  and in
severe cases, abstracting a little blood will be necessary.
  There, however, are Ioav or malignant fevers, accompa-
nied with the appearances of scarlet fever.  These are
generally referrihle to malignant sore throat; or Avhat has
been called spotted fevers.   This grade of fever requires
an opposite treatment, to that above laid down for com-
mon scarlet fever.   And it will be necessary to turn to
the remarks which  are to be found in this work, on ma-
lignant fevers.
  This low grade of scarlet fever,  however,  should be
treated first with an emetick, of ipecacuanha, or antimo-
nial wine; then the bark, conjoined with snakeroot, or
camphor, and  the  mineral  acids  Avell diluted;  coffee, 
OF THE CHICKENPOX.              201
bitter  teas, cool;  and  sometimes  wine  whey should
be given; broth may be allowed, and ripe fruits, &c.  It
is essential in every grade of this disease, to observe
strict cleanliness;  and to have the patient's room well
ventilated; but sudden changes of temperature, are care-
fully to be avoided.   This disease puts on much of the
appearance of an epidemick.

                    SECTION XVII.

                 Of the Chickenpox.

   This disease affects persons but once in life, and it is
mostly in infancy.   It generally comes on with slight fe-
brile symptoms; these are followed the second or third
day, by pimples distinctly defined, and generally  but
few  in number.  In  six or seven days, from  the attack,
the pustules are dried up and fall off, sometimes leaving
pits, Avhich never disappear.  These pustules are always
filled with limpid,  or a whey-coloured fluid,  which dis-
tinguishes them from smallpox, which last  are always
rilled with yellow  pus.
   It was once a matter of the utmost importance to dis-
tinguish between the chicken and the smallpox; but as
we may now ahvays have our children secured by vac-
eination from the smallpox, it cannot be of so much im-
portance, nor can Ave easily err.   I have once seen this
disease accompanied with high fever and delirium.
   The  patient should be kept cool; take a little cooling
physick, and live abstemiously, and by carefully  avoid-
ing heating drinks, or much animal food, the case soon
terminates in health,

                   SECTION XVIII.

   Of the Quinsey,  or Inflammation of the  Throat.

  This like all other local inflammation, is attended with
more or less fever.  But is principally known by pain
in the throat with  swelling.  This swelling and an in-
flammation is evident on looking into the upper part of
                36 
20#             OF 1HE CIUCKENPO.V

the throat; pain and difficulty in sAvalloAving comes on;
and soon renders it impossible to sAvalloAA^ solids.  And
Avhen the disease runs high, breathing is painful, and
difficult; and a total inability to  SAvallow attends, so that
if the patient suffers fluids to pass into his throat, a sense
of suffocation is excited; and the drink is forced, with
impetuosity through the nose.   A constant repetition of
the ac£ of sAvallowing takes place; and troubles the pa-
tion excessively'.
  If the disease is well treated, it is seldom dangerous;
but fatal errours might arise from  mistaking malignant
sore throat for this mild disease.   By attention to the
prevailing diseases,  and often from the patient's being
subject  to quinsey, Ave may distinguish this more simple
disease  from the malignant.  This  disease is generally
excited  by  cold, dampness, &c. succeeding fatigue, or
overheating.  It is, however, often excited by breath-
ing in a room very much crowded.   If it is attacked ear-
ly,  suppuration may mostly be avoided.  We should
bleed once  or twice;  purge freely; enjoin strict absti-
nence;  the  weakest tepid  drinks should be used.  A
piece  of flannel should be applied, and the outside of the
throat frequently rubbed with volatile liniment.  If the
symptoms still advance, we must aAvait suppuration; and,
in general,  it will only be necessary to keep quiet; the
bowels  open; and gargle the throat frequently with milk
and Avater.   If symptoms  of suffocation  threaten, Ave
must bleed  moderately, even during suppuration;  and
gargle frequently with a gargle of  sage  tea, containing
vinegar and honey.  A blister applied round the throat
at an  early stage of this disease, Avill be useful,  by pre-
venting suppuration.   It sometimes  Avill be necessary to
keep up slight nausea, by the use of ipecacuanha, or an
timonial Avine.
  If the suppuration is tardy, a poultice of onions should
be applied.   It Avill ahvays be necessary to guard the
neck well from cold; to avoid crowded rooms,  and pre-
serve the feet warm and dry, after a spell of  quinsey.
For, persons once  severely affected with it, are  liable to
repeated attacks on getting cold, &c. 
OF MUMPS. OR ANGINA PAROTIDE \, &C.    208
                   SECTION XIX,

          Of Mumps, or Angina Parotidcea.

  The mumps is a painful sAvellingof the parotid glands.
It generally comes  on Avith  some fever; stiffness of the
neck; then comes SAvellings behind the angles of the low-
er jaAV, and severe pain on moving the jaAvs; severe sting-
ing sensations through the inflamed glands, especially on
tasting any article not entirely insipid:  the sAvelling be-
comes so considerable as to affect swallowing, in  many
cases.   In three or  four days the swelling, mostly, be-
gins to subside; and sometimes is suddenly translated to
the scrotum in men, or mammae in women.
  This disease is  generally mild, and unattended with
danger; but  sometimes the fever runs very high, and is
attended with delirium, and pain of the testes, or of the
mammce; and requires much care.  This disease  some-
times appears in the character of an epidemick: and at-
tacks but once in life.   In most cases, it aa ill only be ne-
cessary to enjoin rest; and to avoid cold, or wet Aveather;
to wear flannel round  the neck; rub the  swelling with the
marroAV of salted hog's jaws; or a little  Aveak volatile
liniment.  But if the  symptoms run high, we must bleed
according to the urgency of  the case.
  If the disease is  translated  from the neck as above-
mentioned, apply a blister to the throat, of considerable
size: and give a dose or  hvo of cooling physick.   No
local application ought to be alloAved, in any case, to the
testes or mammae.   The diet  must be abstemious; and
the drinks cooling.

                     SECTION xx.

                Of the Miliary  Fever.

   This is seldom a primary disease, but  often a  symp-
tom of other  fevers;  partaking of every grade.  Being
sometimes highly inflammatory, and at others, of a ma-
lignant cast.  All the cases which I have seen, of this 
204
OF MALIGNANT FEVER.
fever, were in childbed women;  and always proceeded
from a too hot regimen, and  close  rooms, &c.  There
Avas an eruption of very small pimples, of a pretty bright
red colour, attended Avith itching of the skin; and smart-
ing of the eyes; high fever, Avith full quick pulse; chills
and heat, blended, or alternating with each other; head-
ach; and sometimes delirium; great thirst, and some diffi.
culty of breathing:  very generally accompanied with a
retention of the usual discharges at  this  time.
  Bleed, according to circumstances; but in healthy wo-
men at an early stage of the  disease, Ave should bleed
once pretty copiously.   Open the boAvels Avith castor oil,
rochelle salts, or senna and manna, Avith a feAV grains of
soda;  enjoin  a cool regimen, Avith the mildest tepid, or
rather cool drinks.   Cremor tartar,  and  small doses of
nitre, A\ill be useful.
  In mild cases we may content ourselves Avith opening
the bowels Avith cooling injections, which are always ne-
cessary for childbed Avomen, and a cool very  low regi-
men, and frequent changes of  linen, and  bed clothes,
together with free ventilation by removing bed curtains,
&c. taking care always to avoid a draught of cold air,
immediately on the patient; as Avell as all heating articles
of food, drink or medicine.  And it will be a good rule
with such patients, if able, to dress  and  lie on the bed
during the day.  This  treatment Avill apply to all per-
sons affected with  a miliary fever of a  common inflam-
matory grade.   For the treatment in  malignant fevers,
taking on this kind of eruption  on the skin, I must re-
fer  the reader  to the various articles on malignant fe-
vers, &c.

                    SECTION XXI.

  Of Malignant Fever, arising from Local Causes.

  This fever has usually been  considered a  putrid fe-
ver, but I have elsewhere said the term putrid should be
banished from our medical nomenclature.  This opinion
is not mine, but was propagated by Dr. Rush, and others.
We find it placed in Rush's theory of fever, at the head 
OF MALIGNANT FEVER.
205
 of his scale.  It is there supposed to transcend the com-
 mon force of inflammatory action.   I  have, in a prece-
 ding article said, [See general observations  on visceral
 inflammation] that the sudden fatal termination of those
 fevers, may be owing to inflammation passing by the ves-
 sels concerned in common  inflammation, aud attacking
 the brainular or sensorial system.
  This, however, does not change the case as respects its
 treatment, it is still neither a putrid  fever,  which is a
 thing impossible; nor a nervous disease, according to the
 commonly received notions of nervous diseases.   But a
 disease of the highest grade, seated in an organ most es-
 sential to life; and it is only by reducing the circulating
 powers that we invite  the disease from the nerves, to the
 blood  vessels,  or by  more  sIoav  remedies, equalise the
 morbid excitement.  This is always a difficult thing, for
 in a few hours, and sometimes even before disease is per-
 cehed, the blood vessels, and whole system  is invaded
 by  this nervous  inflammation, and  prostrated below a
 power of reaction.
  Malignant fever  is generally known by sudden, and
 great prostration of strength; sick stomach, an absence of
chills,  and most generally of pain.  A slow, depressed, or
 intermitting pulse takes place;  and is  soon followed  by
 extreme anxiety and restlessness; disposition to faint, on
 moving.   Sometimes Avith diarrhoea,  but oftener Avith tor-
por of  the bowels, and costiveness, vomiting, dulness and
heaviness of the eyes, attended often Avith inflammation,
soreness about the  stomach, a disposition to sigh, tre-
mours.   The tongue is usually, as Avell as the teeth, co-
vered with a black crust.   To these symptoms, often suc-
ceed eruptions on the skin, or in the mouth.  The skin is
sometimes preternaturally Avarm,  at other times cold.
  This form of fever  is found in jails, dirty hospitals;
in smallpox, hydrophobia,  from taking opium, and in
yelloAV fever, &c.   When it is not occasioned by an epi-
demical atmosphere, Avhich is often the case, it is strictly
a fortuitous disease, having its origin from filthiness, un-
wholesome diet, and exposure to great fatigue, night air,
much wet, &c.  If due regard is  had to cleanliness, and
high, open, dry grounds, chosen for  camps; and healthy 
3Qg             OF MALIGNANT FEVER.
situations, spacious rooms, open yards, free ventilation,
strictest possible cleanliness, frequent Avhite Avashing, &c.
in hospitals or jails, is observed, we should hear but lit-
tie of malignant fever in those places.   This fever may
be excited in camps, &c. from using too much animal
food; and more especially from Avet straw, too long used,
together with neglect respecting privies, slaughtering
places, and the usual offals.   Where those things are not
most rigidly attended to, and  buried or burned, malig-
nant fever or dysentery, Avill thin the ranks.
   In the cure of those fevers,  Ave are to commence with
free  ventilation and attention to cleanliness, gentle eme-
ticks of ipecacuanha ^nd calomel; and, if called early, a
little blood should be taken;  and, if the pulse rise, or
active pains come on, we must repeat the bleeding.  The
bowels  should be  freely opened with  calomel, and this
medicine continued, in small doses, two or three times a
day.  The mildest diaphoreticks should be given, as salt
tartar, or soda, mixed with  lemonade,  or vinegar  sugar
and Avater,  or Aveak punch, cremor tartar water, with a
very little ipecacuanha  in it,  and the most perfect rest
enjoined.
   If the patient seem to sink under this treatment, Ave
should  give ether;  pretty generous punch, made of fruit,
vinegar, or cremor tartar; push the calomel; blister ovef
the stomach; apply sinapisms to the feet.  Give cool cof-
fee,  or  bitter infusions,  for drink,  If  inflammation ap-
pears in the mouth or throat, a mixture of soda,  or salt
tartar Avith honey and Avater, should be very often used
as a gargle.  And in very Ioav cases, an infusion  of red
pepper in water, should be used in the  same Avay.  The
hark, or other  stimulants, can seldom be safe, until the
patient is convalescent, when the bark and acids may be
given, but commenced in small doses,  and gradually in-
creased.  I have generally seen good effects from the use
of the camphor poAvders, which will be found by refer-
ence to the list of medicines in this book. 
OF TYPHUS FEVER.               207
                   SECTION XXII.

    Of Typhus Fever, arising from Local Causes.

  This fever, like the malignant just spoken of, is often
found in camps, jails, dirty hospitals, kc.   It has gene-
uerally got the name of nervous.   As this is but a low
grade, or chronick form of the disease, treated on in the
preceding article, I shall refer the reader to that article,
and proceed to describe the symptoms, and cure, of this
loAvest grade of fever.  In general it arises from the same
causes as the malignant fever, in camps, jails, &c. which
operate less forcibly, and, therefore, more slowly.  This
less concentrated, hut long continued cause,  produces  a
set of symptoms less violent, but chronical; and, unless
skilfully treated, equally mortal.
  The symptoms, commonly, are a weak frequent pulse,
drowsiness, languor, tremours of the hands, a dry tongue.
These symptoms  are soon attended  by low muttering,
coma, delirium, diarrhoea, or torpor  of the bowels, sub-
sultus tendinum,  deafness, black or dark tongue, tum-
blings, picking about with the fingers, and constant efforts
at collecting the irregular ideas which the patient is sen-
sible of, but cannot collect.   These all  give  way, some-
times, to constant,  heavy, uneasy sleep, from which the
patient can only be roused by such violence as always
seems to alarm him.  The mouth is  generally open  du-
ring sleep, which adds to the unpleasant dryness of the
tongue, mouth, and throat; utterance is generally indis-
tinct,  and often lost.   Even where the organs  seem to
possess the poAver, the mind  is unable to  arrange ideas,
so as  to enable the sufferer to complete even  a short sen-
tence.
  The treatment of this disease should be  commenced
Avith a gentle emetick of ipecacuanha or antimonial wine,
if this does not open the howels, injections slightly pur-
gative, should be given.  Calomel, in doses of from three
to five grains, should be given: and,  if  the mouth is not
affected in three or four days, the dose should be increa-
sed rapidly, until thirty grains, or even more, are given 
208              °1 TYPHUS  FEVER.
per day:  taking  care  ahvays  to  provide the  patient
with opium; or laudanum, Avhich must be taken  in such
quantities as will restrain the calomel, from acting on the
bowels.
  If this course does not soon affect the gums, the use of
mercurial ointment should be joined, with that of the ca-
lomel,  and rubbed freely into the thighs, and worn on the
feet in socks or stockings.   During the  use of the calo-
mel, the patient should take Avine in reasonable quantity,
and  snakeroot,  or valerian tea.   This treatment  will
sometimes raise inflammatory symptoms, fever, full pulse,
pains in some part of the body, thirst, &cu  If this should
happen, the patient must  be bled moderately, and even
repeated if the symptoms indicate it.   But even here, Ave
must not cease to press on the calomel, infusions of snake-
root, &c. but Avine and opium  should be Avithheld; al-
ways, hoAvever, recollecting, it  is  better to give opium
than to quit the calomel, or letting  the patient sink under
a purging.  So soon as the disease seems completely set-
tled into a typhus, blisters should be applied freely, and
repeated as fast as they heal.   The bark must be began
Avith, and used along with the calomel, if the case conti-
nues many days.   In short, the principal remedies in this
disease, are wine, tonicks, blisters, and  mild diaphoret-
icks, but, more especially, calomel, to any extent which
may be necessary, to affect the gums.   For the frequent
low spells which such patients  are subject to, called by
country people, the patient of death, pretty large doses
of ether, or spirits hartshorn, will be proper.   In very
low cases, even raw brandy  should be given, in large
quantity.  I have given a pint of Avine, and a pint of raw
strong French brandy, to patients lowr in this  disease,
every twenty-four hours; so soon as the  disease seems to
be subdued, a nourishing, but thin light diet should be
used, Avith bark and Avine.
  I cannot close this  article without a declaration, as im-
portant as it is true.   I have seen many cases of this dis-
ease; I never saw  one recover from the use of stimulants,
without mercury.  I have treated many fh the way above
laid down: I have never lost a  patient.   If I had  seen
but a case or two, I might admit this was accidental; but 
         OF A SIMPLE INFLAMMATORY FEVER.      209

1 have seen and treated more than hventy cases, and I
therefore beg leave to admonish every reader, that there
is no  safety in any course of treatment without mercu-
ry:  but aa hen properly treated, it is seldom mortal, should
it even become protracted.   It may be necessary to cau-
tion the reader, that feAV of our fevers remain stationary,
for  any considerable  time.  They are liable to change
and become blended:  typhus, sometimes, become inflam-
matory, and vice versa, so do fevers often hold a grade,
between those two extremes, called typhoid, &c.

                   SECTION XXIII.

          Of a Simple Inflammatory Fever.

  This is also sometimes called a continual fever.  It
is rarely met with distinct from local  inflammation.  It
generally succeeds wounds, burns, &c. and accompanies
smallpox, quinsey, and many other inflammatory dis-
eases.  It, hoAvever, is sometimes met with as a primary
disease, and  may arise  from exposure  to  changeable
weather;  heating  diet,  or drinks;  or  any other causes
which may excite pleurisy, &c.
  It attacks suddenly with chills, more or less severe, as
the cause has acted with a greater or less force.  There
are pains in the bones,  joints,  head, sides or breast, the
pulse full mostly, always tense and frequent; great heat,
thirst, Avith considerable debility, and dry skin. Where
the disease  is violent, delirium, and difficult respiration
attend.
  In this disease we  must bleed, and repeat according
to circumstances.  Give cooling purges once a day, and
accompany  them  with  small doses of ipecacuanha,  or
antimonial wine, so as to keep up a slight nausea: after
the bowels have  been well  evacuated, the pulse and
pains reduced, we may in  general, trust to small doses
of  nitre and ipecacuanha, with very free dilution, with
the most cooling drinks, as  cremor tartar whey, toast
 and Avater, slippery elm  water,  apple water,  tamarind
water,  &c.   Almost  a  total abstinence is necessary till
the force of  the disease is  checked.  Toasted  bread
              27 
210
OF THE DROPSY.
soaked in Avater,  roasted  apples; bread with very Aveak
tea, or a  feAV spoonfuls of panada, without Avine or spi-
rits, will afford a sufficient diet: and even Avhen the dis-
ease is somewhat arrested, Ave must return to a full diet
cautiously and gradually.
  A fever of this  kind long  continued, is a  frequent
cause of dropsy, and therefore should be promptly treat
ed; nor is it without danger,  without  the  utmost  care;
free  ventilation  and cleanliness  are  essential:  and as
you value life, avoid animal food, even broth,  and also
all  stimulant, or heating articles of  drink,  &c.  Hard
drinkers  have always more or less of this kind  of  fever
about them, which often terminates in dropsy, and very
probably sometimes in the head, Avhen  it is not suspect-
ed; and producing apoplexy,  causes sudden death: or
madness,  or convulsions, which so often destroy drunk
ards.
                    SECTION XXIV.

                   Of the Dropsy.

  This disease  is certainly less common in the United
States than some years back, oAving, I suspect, to a more
prompt and successful treatment of acute, or febrile dis-
eases.  For although a dropsy may arise from intemper-
ance, too  low watery diet, want of exercise, &c. in nine
cases of ten, I believe, it has been occasioned by conges-
tions, which MIoav visceral or other inflammation, impro-
perly treated.
  By a more  free use of  the lancet,  cool regimen, and
the universal custom of free purging in febrile affections,
few chronick diseases follow them; and more especially
dropsy, and hystericks,  seem  to have  lessened.   Con-
sumption, gout,  and scrofula, are now  the most leading
maladies, arising from acute disease.   I feel it  my duty
in making this  declaration,  which I am sure comports
with my observations for many years,  to add, that the
medical faculty share  no part of the blame, in giving
this new direction to our diseases.  The fault lies whol-
ly in the people, who by enervating habits, carry about a
chronick debility, which occasions  those new disorders:
and for which there is no remedy in the Materia Medi- 
OF THE DROPSY.
211
ca.   But industry, temperance, kc. are remedies which
would drive  chronick  diseases in good measure, from
our country.
  Dropsy has  been distinguished by different names,
according to the part affected by  it.   A general dropsy
is called an anasarca; that confined to the belly, ascites;
hydrops pectoris in the breast; and hydrocephalus, when
situated in the  brain: and although  a dropsy generally
speaking, is to  be treated on general principles, it is of-
ten necessary to vary the treatment, according to the part
affected.   I therefore shall first hint.at a few peculiari-
ties; and then speak of dropsy in general.
  An anasarca is very generally an inflammatory dis-
ease: and may be connected  with ascites; or encysted
dropsy of the ovaria, kc.   In this kind of dropsy, after
it  is  fully established, the  patient  should be rubb»d
twice a day briskly, Avith  a  flesh brush, or dry hand:
the legs and abdomen  should be moderately bound up,
by applying rollers suited to the season, but in general
very fine flannel is best; the bandaging must be began at
the toes, and c.dried up over the  abdomen; care must be
taken, however, not to  make  it too tight.   Such rod' rs
are made by tearing the cloth into strips about three or
four fingers width, and seAving them together at the em s,
so as to leave no seams.  The feet and legs may be sca-
rified noAV  and then through the skin, by this much wa-
ter will be  discharged, and Ave are assured by Dr. Rush,
no danger attends this  practice.
  In an ascites the abdomen may be bandaged;  and if
the disease is much advanced, tapping  Avill be neces-
sary.  In the dropsy of the breast tapping may also be
performed, but only by an able practitioner.  Less  be-
nefit can be  obtained  in this  species  of dropsy, than
others, from purging; it is generally inflammatory, and
requires the pretty free use  of the lancet.  If ever digi-
talis is useful in dropsy, it is most allowable in this, af-
ter suitable bleeding, and after depletion, we must rest
the cure on the  use of mercury, not omitting, however, in
all cases, to keep the bowels open.
   In dropsy of the brain 'there is little to hope for, after
it is formed, a  salivation should be tried.   This kind of 
212
OF THE DROPSY.
  dropsy in most cases, proceeds from inflammatory affec-
  tions of the head, which are  either overlooked, or mis-
  treated.   I shall therefore point out, here,  the premoni-
  tory symptoms of this fatal disease.
     Hydrocephalus most commonly  affects children, but
  adults are  also  subject to  it.   Symptoms—Languor,
  drowsiness, peevishness.  The appetite weak, sick sto-
  mach, or vomiting once  or oftener a day; the skin gene-
  rally hot and dry,  especially towards  evening; then
  sharp headach, often in  the fore part, sometimes in one
  side; inclination to liold the head to one side, as though
  the neck was weak; pains in the neck,  shoulders, extre-
  mities, and sometimes in the bowels.  The patient dis-
  likes the light, cries much, sleeps little, which is  disturb-
  ed; grinds his teeth, and starts or screams out frequently
  when  dozing:  boAvels   generally  obstinately  costive,
  sometimes in an opposite state; the  pupils of  the eyes
  become larger, the eyes look dull; A7iolent delirium comes
  on,  accompanied Avith  fever.  After  these  symptoms
- have continued, sometimes for a few days,  in other mil-
  der cases for weeks, or even months, the pupils  become
  more dilated; the patient less sensible of pain; a squint-
  ing; heaAy slumbers, or  perpetual restlessness:  the pa-
  tient lies Avith one or both eyes open,  Avhich are often
  found insensible to light: convulsions often attend every
  stage of this disease.  If food is  presented,  it is swal-
  lowed  Avith voracity: the costiveness is  now generally
  more obstinate.
    If this disease  is discovered at an early  stage, .copi-
  ous and repeated bleedings, and the free use of calomel,
  given until it operates freely on the boAvels, and also af-
  fects the mouth, Avill seldom fail to arrest it.   If the case
  has  progressed some time, a  salivation should  be kept
  up.  It will be obvious that Ioav diet, weak cool  drinks,
  rest and quietness,  must be enjoined; and  laying Avith
  the head high, must not be dispensed with; and if the
  patient is able to  go  about, the hot sun  must be avoided,
  as Avell as much dampness.
    Hydrocele,  or dropsy  of the scrotum, requires also a
  particular treatment,  which can only be safely conduct-
  ed by a skilful practitioner.   Some relief may, however, 
OF THE DROPSY.
213
often be obtained from a bandage in form of a cup, to
contain the part, and tied up with strings to a handker-
chief, or other bandage, about the body; by taking mo-
derate doses of aloes and calomel daily,  for some time,
and by scarifications on the  part: but a radical cure is
only to be expected from an  operation by seton, or in-
jections.
  I come now to speak  of  dropsy  in general.  This,
like all other diseased action, to which the human body
is subject,  is of a twofold nature; being sometimes in-
flammatory; and at other times dependant on general de-
bility: it is, hoAvever, highly  probable, that all dropsies,
or rather the diseases which precede them, are inflamma-
tory.   This inflammatory diathesis may be either gene-
ral or partial.   When a dropsy is really formed, Ave are
still to examine the pulse, the patient's constitution, ha-
bits, the probable cause of the  disease,  &c. before we
can safely attempt a cure.
  If the case is found inflammatory, we must bleed ac-
cording to circumstances; give active purges,  as calo-
mel and aloes,  or jalap, calomel and gamboge, daily;
nitre and cremor tartar should be drank freely, diluted
with a great deal of Avater: of these drinks the  patient
should drink largely; or cider, or tamarind water, Avith
a very little soda, may be used  with freedom.   Should
this course not succeed in two, three, or four Aveeks at
furthest, according to circumstances,  Ave must change the
treatment, and treat it as a dropsy arising from debility.
   Here we find a continuance of a distressing thirst, but
without fever;  the other symptoms  being  nearly alike
in tonick or atonick states of dropsy, I  shall here give
the symptoms  which usually attend.   A  feverishness,
great thirst, little urine, costiveness, the breathing be-
comes difficult, the skin dry,  heaviness or weariness,
and most commonly more or  less cough.  In an anasarca
a swelling of the feet is often the first symptom discover-
ed, which rising upwards gradually, invades the whole
body: even here, in  most cases, those  swellings have
been preceded by some fever:  sAvelling of the abdomen,
added to the above symptoms, characterize the ascites:
it is always necessary to  sound  the belly, lest we mis- 
214
OF THE DROPS V.
 take a tympanites for water: if we  hold one  hand on
 one side  of the belly, or hold  the  ear near to it, and
 strike the other side of  the belly gently,  we  may dis-
 cover a splashing-like motion of fluid  v itliin.  If it be
 wind, as  in a tympanites, no such motion will be heard.
   In hydrops pectoris to  these  general symptoms, there
 is usually added an alarming sense of  suffocation, if at-
 tempts are made to lie down; and when the disease has
 adAranced, this is wholly  impossible: the pulse  is gene-
 rally tense, and hurried; and, even here, a skilful person
 can distinguish a fluctuation of water, on striking the side
 pretty smartly with  one hand, while the other is applied
 to the opposite side.  This affection of the chest may be
 known from an asthma, by its being  constant; while the
 asthma intermits; from vomica,  or suppuration,  by there
 being less pain, cough, and fever generally in the drop-
 sy, Avhile the  difficulty of breathing is  more distressing.
 High fever, hoAvever, often attends dropsy in the onset.
   After an inflammatory case of dropsy has been treated
 as above mentioned;  or in cases accompanied with direct
 debility, which constitutes atonick dropsy, the treatment
 must be varied; and, in most cases, the  following method
 will be proper.
   Let the patient avoid drink as much  as possible; cool-
 ing  fruits, or  acid juice of fruit, taken gradually, must,
 as  much  as  possible, supply the place of drink.  The
 food should be dry, as hard biscuit, a little roasted meat,
 dry bread &c:  animal food  must be used very  sparing-
 ly.  The use of calomel, or the quicksilver pill,  should
 now be advised;  the blue  ointment  rubbed well into the
 part affected in partial dropsy; and in anasarca into the
 thighs, and sides.  The bowels must be evacuated with
jalap and cremor tartar, &c. more or less freely,  as the
 rase partakes of inflammation.   With these remedies tbe
 patient should use  large quantities of  horseradish; and
 take, now and then, a little nitre, soda, or salt tartar, in
 a little vinegar and water, lemon juice, or other mild ve-
 getable acid.
   Should the strength rapidly decline, we must support
 the patient with Avine, biscuit soaked in brandy; whole 
OF THE DROPSY.                215
mustard seed, roasted fresh meat, or a little sound salted
meat, or fish.
  Patients are found who increase in weight, more than
the weight of the body and the food  and drinks added
together; this can only be accounted for on the supposi-
tion that the body absorbs moisture, (amounting to fluids)
from the air through the skin, or through the lungs; and
most probably in both Avays.  So far as the skin is con-
cerned, benefit may probably arise from rubbing the skin
daily with nice oil; sAveet oil, fresh  lard, or Dutter Avell
Avashed, or melted, aa ill answer this purpose.
  Moreover, embrocations of oil have been found highly
beneficial in  fevers; and,  on that  consideration alone,
they should be  used  in  dropsv, if  there is no other.
Though nitre is a  valuable  medicine in dropsies, it must
never be continued long, otherAvise the stomach Avill suf-
fer.   It Avill ahvays be advisable to Avear flannel; and to
leave off every thing like garters, tight Avaistbands, &c.
  In  all dropsies,  exercise is indispensable, and even la-
bour has often effected cures.   When the disease is re-
moved, the bark, acids, cold bath, &c. should be  used
for  some time, till  the constitution is restored;- and, even
now, it Avill be  advisable to take freely  of horseradish,
mustard, garlick, and now and then a little cremor tar-
tar  and nitre.   Should a purging become too alarmingly
great, in a low state of dropsy, a little good  coffee may
be taken; should this not succeed  in checking it, injec-
tions, containing a little laudanum should be given: and
in extreme cases, apply a  large blister over the belly:
but these are things very seldom necessary.   Through-
out  the whole course of both kinds of dropsy, exercise,
frequent, and long continued rubbing, carrying the hand
upwards, and moderate  bandaging Avith flannel  rollei\s
applied, will be advisable; but, unless they are carefully
applied, so as to be smooth, and equally tight in every
part, it Avould be better to omit them altogether. 
216
OF THE RHEUMATISM.
                    SECTION XXAr.

                 Of the Rheumatism.

   The rheumatism commonly comes on like a common
 inflammatory  fever, which is soon attended  with severe
 pains in the limbs, or rather in the joints;  these gener-
 ally seem enlarged.  When  the  symptoms  are in the
 most aggravated form, the joints are permanently distor-
 ted.  I haAe  seen cases where the hip joint was thrown
 out  of place, by  rheumatism.   There is  also  cases,
 where, in young subjects, the first notice of the disease
 is a pain and swelling in one of the joints,  as the knee,
 hip, &c.
   The treatment here,  must be the same as that recom-
 mended for the inflammatory  fever; to which  must be
 added blisters, to the part:  and  of all articles, the best
 is the ointment of corrosive sublimate, reduced by mixing
 it with a little lard, so as to excite a blister, first on one
 side, and next day on the other;  the joint should then be
 lapped in heated cabbage leaves.  If this does not soon
 relieve the  patient;  after the system is reduced by one or
 more bleedings, according to circumstances, with the low
 diet, purging,  &c. recommended in inflammatory fever;
 it will  be  advisable to put  the patient on the following
 course.  For an adult, take  salts one  ounce, calomel ten
 grains, tartar emetick two grains, make twelve powders,
 after grinding the salts fine.  Give one of these morning
 and evening; and let the patient  drink largely of milk
 whey, or elder blossom, or ground ivy tea.
   During all this time, rub the part affected tAvo or three
 times  a day, with equal parts spirits wine saturated with
" camphor, and tincture tolu.   If this cannot be had, very
 strong volatile liniment may be used, or an infusion of
 red pepper, in whiskey.
   If the disease does still not yield completely, give a full
 dose  of Dover's powder; let him go to bed, and refrain
 from drink for about two hours, then begin and  drink
 freely of wine or milk whey; as  the case may be more or
 less inflammatory, we must regulate the quantity of wine. 
OF THE APOPLEXY.
217
This  may be repeated,  if necessary, for two or three
nights.   The patient  is  to remain within doors during
this time, and Avhen  able to go out,  must be carefully
dressed;  never omitting to have flannel next the skin.
  A return to the usual diet must be made Avith great
caution, and always gradually.   So soon as a  convales-
cence is  well established, the cold bath  should be used
and constant exercise enjoined during good weather.  If
the disease does not yield, or if the patient is subject to fre-
quent relapses, especially without a swelling  of the joints
affected,  we may conclude the disease has taken  on the
chronick form, and is now in  some measure  habitual.
For the treatment of  chronick rheumatism I must refer
the reader to the class of habitual diseases.

                   section  xxvi.

                  Of the Apoplexy.

  The immediate cause of an apoplexy is a  rupture of a
blood vessel in the head, or a very sudden accumulation
of a watery fluid, which leaves the brain no time to  ac-
commodate itself to the stimulus,  &c. arising  from the
pressure.   It is  supposed, persons of short necks, and
florid countenance, are most subject to this disease.   Its
most usual remote or predisposing  cause is intemperance
of every kind.
  This disease is often preceded by giddiness, drowsi-
ness, noise in the ears, night mare, &c.  and sometimes
loss of memory,  but in general there is very little notice;
persons sometimes fall down dead, or  at once into dread-
ful stupor; the breathing becomes laborious,  and loud,
like a person snoring, the face sometimes  flushed, at oth-
ers pale.  In short, a person  in an apoplexy, resembles
in appearance one in a very heavy  sleep,  but from which
the apoplectick cannot be awaked; the pulse is various-
ly affected, being sometimes full, at others depressed and
corded.
  In persons of  full habits, Ave must bleed copiously: no
disease, generally speaking, requires such copious bleed-
ings, we must open a  vein, and let it bleed until the pa-
                28 
218
Ox- THE PALSY.
 tient recovers his feeling, in some measure, or as far as
 is consisient with life.  Dr. Rush tells us, that Dr. Phy-
 sick drew ninety  ounces  of blood from Dr. Dewees, at
 one bleeding, in this disease, and thereby, so completely
 relieved him that he Avas enabled to attend to his ordina-
 ry business in three day/s.  It would  also be  proper to
 open the temporal artery  and  let it bleed freely.   Stim-
 ulant common injections should be given, as a handful of
 salt, in the usual quantity of water, or a strong decoction
 of senna,  &c.
   Purges should never be given till the vessels are emp-
 tied by bleeding, for, by exciting vomiting, they may do
 mischief.   The head should be laid high, and free circu-
 lation of  air kept up  about the patient, on a hard bed.
 Cold applications should  be made to the head.
   But the cure is principally to be trusted to copious, re-
 peated  bleedings, and strong  purging glysters.  Many
 persons might be saved in apoplexies, byr a bold and im-
 mediate use  of  the lancet, wrho are lost by Avaiting on a
 physician.  The drink must be cool, and  of the Aveakest
 kinds;  and when food is desired, the lightest articles
 should  be given for a few  days even after recovery.

                   SECTION  XXVII.

                    Of the Palsy.

   A palsy is  so different  from all other diseases that it
 cannot well be mistaken.   It  has been named according
 to the part affected: hemiplegia, when one side of the
 body is affected.  Paraplegia, when affecting the lower
 part of the body.  Like most other  diseases, palsy is
 sometimes accompanied with inflammatory  symptoms,
 and sometimes with direct debility. It seldom affects the
 whole body.  When the  pulse is full and strong, or de-
 pressed, the face flushed, the breathing difficult, we must
 bleed freely, and repeat frequently; apply blisters to the
 head  in hemiplegia, or over the limbs affected in para-
 plegia.  Strong [ urging injections and purgatives should
 be  given,  and repeated often: the affected limb should
be rubbed with flour of mustard.   And as soon  as the 
         of the Tetanus, or  locked  jaw.      219

febrile symptoms abate, or in cases depending on evident
direct debility, we  must pursue an opposite course of
treatment:  a cordial diet,  of light nutritious articles,  as
light well boiled meats; or, a little salted meat, in warm
weather  in particular;  eggs,  coffee, broth, milk, &c.
Cordial drinks,  as  wine and water, bitter  infusions of
pleasant  herbs, chocolate, kc. Avith the free use of mus-
tard, horseradish, ginger, &c.   The most stimulant me-
dicines, as volatile tincture, guaiacum, ether, valerian in
poAvder,  or in tea; whole  mustard seed, electricity, &c.
Nor must constant dry rubbing be omitted, and now and
then accompanied Avith the use of volatile liniments,  or
dry mustard poAvdered.
  Exercise must be enjoined as  soon as it is practicable,
and folloAved up Avith spirit, and constancy.   Cheerful
company is always  useful.   Compound spirit  of laven-
der, is a good medicine: vomits are sometimes useful, but
they must be very gentle,  and  are not often necessary;
but where there is a troublesome nausea, or Avant of ap-
petite  of some standing, they  should be tried.  Benefit
is sometimes derived from cephalick snuff, or sternutato-
ries: forms for these Avill be found in the list  of medi-
cines.

                   SECTION XXVIII.

           Of the  Tetanus, or Locked Jaw.

  The tetanus has" been variously  named according to
each particular set of muscles affected: but these distinc-
tions are useless, for the cure must be conducted on ge-
neral principles. Regard should, however, be had to its
cause  where it  is  evident.  It generally  arises from
wounds,  and most  commonly from very trifling ones: a
stroke with a Avhip, stumping  the  toe,  tramping on a
nail, &c.   But sometimes it is occasioned by other dis-
eases, as yelloAV fever;  from pneumonia, and also from
poisons,  fear, &c.   Where it arises from other diseases,
the cure  must principally consist of such remedies as are
suitable  for the diseases from which it arose: but I  be- 
 220      OF THE TETANUS, OR LOCKED  JAW.,

 lieve the tincture of cantharides should always be given
 freely, Avithout regard to the cause of tetanus.
   Dr. Rush tells us, that " tetanus,  from all its causes,
 has nearly the same premonitory symptoms.  These are
 a stiffness in the neck, a disposition to bend forward, in
 order to relieve a pain in the back,  costiveness,  a pain
 about the external region of the stomach, and a dispo-
 sition to sleep.  In this feeble state of the disease, an
 emetick, a strong dose of laudanum, the warm bath, or
 a few doses of bark, have often prevented its being com-
 pletely  formed.  When it has arisen from a wound,
 dilating it, if small or healed, and aftenvards inflaming
 it, by applying to it turpentine, common salt, corrosive
 sublimate, or Spanish flies, have, in many hundred in-
 stances, been attended with the same salutary effects."
   If the disease advances,  the pain about the stomach
 increases, the patient's head is  violently bent towards
 his breast; or his head and heels are drawn backwards
 till they sometimes meet;  or the  jaws are immovably
 fixed together, so that almost no violence is sufficient to
 force them  open.   These  symptoms  intermit for a few
 minutes, but only to return  with greater  violence, and
 as they  advance, approach the nature of convulsions.
   All the cases  of tetanus Avhich  I  have seen, Avere
 males.  I have seen and checked the premonitory symp-
 toms mentioned by Dr. Rush,  by applying hot turpen-
 tine to sores, as old burns, &c.  I have also seen a case
 of tetanus  succeed an  inflammatory  affection  of  the
 breast, in a patient in the Baltimore hospitalt  This case
 was arrested,  after it was formed in great force, by the
 usual remedies for pneumonia, and the free use of the
tincture cantharides until a strangury Avas excited.
   Should a patient be affected with this disease, and no
physician  at hand,  there should be  a  careful examina-
tion of the body, and if any sores  are  found, or  if it is
known that  within a few  days,  or even several  weeks
before,  the  person tramped on a sharp body, &c.  the
part should be irritated by  applying hot spirits turpen-
tine,  or the strongest hot ley,  or salt and  water hot.
And if the  disease has not advanced far,  or  in  other
words, if it is  but a few  hours since the symptoms  ap- 
OF THE TETANUS, OR LOCKED JAW.      221
 peared, a strong vomit should be given; for this purpose
 thirty grains of white vitriol may be given, and repeat-
 ed every ten minutes till it operates freely;  or a large
 portion of antimonial wine given every fifteen minutes,
 till it operates freely: for children, the doses must be re-
 gulated according to the table for dosing medicine.  In-
 jections containing large,quantities of laudanum, and a
 little spirits of turpentine, as two tea spoonfuls of spirits
 turpentine; or to the laudanum may be added, five or ten
 drops oil of amber: these should be repeated every three
 or four hours, in glysters of the usual quantity of water.
 If the jaws are closed, an attempt must be made to open
 them with a spoon-handle, a smooth stick, or a piece of
 ivory.  Sometimes one  or  more teeth being out,  gives
 us an opportunity, Avithout  airy further trouble, to give
 large quantities of Avine, Avhich  should be commenced
 immediately; and at the same  time opium, in doses  of
 two,  three, or even six grains should be given, and re-
 peated every three or four hours: oil of amber, in  doses
 of from five to ten  drops, should be given every two  or
 three hours  in  wine; and  in  desperate  cases, brandy
 should be given largely.   The  warm  bath should  be
 used, twice or more,  every day, and continued as  long
 as it can be borne at each time.
   If the cold bath is useful  in this disease, it must be at
 an early stage;  I suspect it  is ahvays a dangerous reme-
 dy.   I have seen  almost instant death succeed it in one
 case.   It should never be used without good advice.   I
 should place my principal dependance in all cases of te-
 tanus, on a very constant use of the warm bath, and the
 free use of tincture cantharides, as a tea spoonful every
 few hours; and the free  use of wine,  never forgetting,
 however, to apply  some powerful stimulant to the wound,
 if it should arise from that cause.
   Benefit,is sometimes derived from dilating the wound
 with  a  knife; but, unless the part is very superficially
 situated, it must not be attempted but by the surgeon.
 Where it arises from an amputation, stimulants, the most
 powerful, must be applied to  the stump,  and the case
 treated on general principles.  If it proceeds from low-
 fevers, or if the case becomes protracted, large quantities
of bark should be given. 
222         OF THE ST. VITUS'S DANCE-
                   SECTION XXIX.

               Of the St. Vitus''s Dance.

  This disorder is known by convulsive motions of on«
side:  the leg is generally dragged after the patient, like
that of a palsied leg:  the arm is  full of antick gestures,
and in perpetual motion; so  that  Avhen the  patient at-
tempts to carry any thing to the mouth, it is done with
precipitancy.  It sometimes becomes so violent  as to
convulse the whole body, and bears a strong resemblance
to tetanus.   It possibly may, sometimes, arise from an
affection of the brain; but in a majority of  cases it is
brought on by falls, or  injuries  done some  part of the
body.   It was excited in a brother of mine,  hy a fall on
the ice.
  All the cases which  I  have seen were in patients un-
der fourteen years, as remarked long since hy the great
Sydenham.   I have always  succeeded in curing the dis-
ease in a feAV days; and  although it  has sometimes re-
lapsed,  from fatigue, &c. still the same treatment soon
checked it, and the cure  became permanent.
  Treatment.-—Bleed  moderately once;  then give  a
purge; after this, put the patient  on  the use of valerian,
and in severe cases, combine it with bark.   After using
this a few days, or, what will answer equally well, is a
dram of iron filings, and  a dram of assafcetida, made into
twenty-four pills:  of  these,  four may be used  daily;,
drinking after them a little bitter infusion of  some plea-
sant root or herb.  After using either of the above pre-
scriptions a few days, the cold bath should be used daily,
for some time.  And, after the disease is removed, a lit-
tle bark, or a few of the above  pills, should be  taken
now and then, till the health is well re-established. 
OF THE HYDROPIIOEICK  FEVER.        223
                    SECTION XXX.
                                                    *
             Of the Hydropkobick Fever.

   I purpose under this head, first, to speak of the usual
appearances of mad dogs; secondly,  of  the preventives:
and, lastly, of  the disease,  Avhen it breaks out in the
dreadful form of the disease, usually called hydrophobia,
but which I shall designate by the name of hydrophobick
fever.   It has been supposed that unwholesome food, too
much heat, and excessive thirst, Avas the usual cause  of
this disease in  dogs.  But from the great number of Avild
animals which  go mad, it is probable there is something
in the constitution of the canine race in particular, and
also in some other animals, Avhich predisposes them  to
this disease, from some cause yet unknown; but,  like
causes which produce malignant fever,  sometimes  quite
local, at other times diffused through considerable space.
We have several instances in this  country of Avolves,
foxes, and cats, going mad, and biting persons, some  of
which have went mad.
   In many instances of this fever in dogs, the first notice
Ave have had of their indisposition is from abroad.  So
sudden is the attack, that a dog Avho has discovered no
symptoms of illness  at night, has been found running  at
a distance from home in the morning, Avith all the symp-
toms of  madness.   In  many cases, however, there  i<-
pretty strongly marked premonitory symptoms, Avhich are
these: he refuses food, looks dull, wishes to avoid other
dogs, as  well as the  members of the family; he ceases  to
bark, seems  timid, but  snarlish, hnd rc?n1y  to  bite  at
strangers; his tail, ears, and Avhole appearance is droop-
ed.  His eyes become more watery; his tongue begins  to
hang out, and he froths at the mouth: in this situation,
in general, he takes  to flight, runs apparently needles?-
whither,  and in his travels, goaded on by the most aAvful
horrours, he bites every thing which  he meets.
   There are instances, however, where a set of symp-
toms very different accompany this disease: these are the
same heavy watery eyes, loss of appetite, timidity, droop 
 224         OF THE HYDROPHOBICK FEVER.

 edness, frothing, &c; but instead of ill temper or taking
 to flight, he fondles, and caresses his master, and seems
•to beseech pity, and relief.   In either case, the misera-
 ble animal is worn down by fever, horrours, and fatigue,
 in two, three or four days.
   There can be no doubt, but by far the greater number
 of dogs  destroyed under a belief  of their  being  mad,
 Avere either labouring under some other fever; or by fa-
 tigue, fear and fasting, owing sometimes to  being lost
 they were bewildered:  thus distressed, he is often pur-
 sued  by persons and beat, stoned,  and harassed in all
 quarters.   No Avonder  he should take every one for his
 enemy, and attempt to bite: if he is a dog  of spirit, he
 may now be  said to be mad indeed, but in forty-nine ca-
 ses in fifty, perhaps, he has no hydrophobick fever, which
 certainly is a rare disease.
  Should a  dog show symptoms  of indisposition, he
 should be confined;  and, has he bitten a person, or other
 animals, it becomes doubly necessary to confine him, and
 to spare his life, in order that we may judge Avith some
 precision, whether  he Avas mad.  The  canine race are
 not the only animals liable to spontaneous hydrophobick
 fever: manyr  cases are on record, of human subjects be-
 ing affected with it  from excessive thirst, from yellow fe-
 ver, putrid animal food, Avounds from the bite of enraged
 animals not mad.   It would seem to follow as a fair in-
 duction, that all animals liable to this disease from the
 bite of hydrophobick animals, are also subject to it from
 the usual exciting causes.
  I come now to speak of the preventives.   Such has
 been the confidence reposed in various nostrums for this
 purpose, that I must avoid giving a positive  opinion;  1
 shall  point out some of the most celebrated preventives, !
 and detail some facts within my  own knowledge.       j
  Dr. Richard Mead, whose reputation stood high as a
 physician, says, that the following had been used a thou- '
 sand times, and never failed to prevent the disease.  But J
 subsequent trials have  often disappointed the faculty I
 The prescription is this: "take ash-coloured ground liver- ji
 wort, cleaned, dried,  and  powdered, half an ounce; of
 black pepper powdered, a quarter of an ounce, mix these 
           OF THE HYDROPHOBICK FEVER.        229

together, and divide the powder into four doses; one of
which must be taken every morning fasting, for  four
mornings  successively,  in  half a pint of cows'  milk
warm.   After these four doses are taken, the patient must
go into the cold bath, or a cold spring or river, every
morning fasting for a month; he must be dipped all over,
but not stay in (with his head above water) longer  than
half a minute, if the water be very cold.   After this he
must go  in three times a week for a fortnight longer.
The person must be bled before he begins to use the me-
dicine."
  The following nostrum has been used with good faith:
"take of native and factitiouscinnabar,  of  each twenty-
four grains; take this at one dose, and repeat in thirty
days; and if symptoms of the disease appear, take a dose
immediately," this prescription is  too ridiculous to  re-
quire notice.
  Another, "take purified nitre half an ounce, Virginian
snakeroot in powder two drams, camphor one dram; rub
them together in a mortar, and divide the whole into ten
powders."
  The, following remedy has  been used much, in this
country, and according to the late Rev. Mr. Muhlenberg,
in Germany,  and Switzerland  also, for a considerable
length of time.  Take of red chickAveed,  or (anagal-
lis phoznica,) which has  been gathered when in  full
bloom, or ripe and dried in the shade;  reduce it to pow-
der, and give a small table spoonful, at one dose, to a
grown person in beer or water, in weight one dram and
one scruple; for a child an equal dose, but give it at three
doses, or it may be eaten with bread and butter, or  ho-
ney, or molasses.  For beasts, a large spoonful is a dose.
This remedy, it is said,  has  succeeded several weeks
after the bite of rabid dogs.  The wound is to be wash-
ed with the green juice.
  A majority, perhaps,  of physicians,  have given  opin-
ions in  favour of mercury, as a remedy for this disease.
There has been a remedy celebrated in some parts of this
country, said  to be the prescription of a  Mr. Web; in
this great stress is  laid on nine leaves of sage.   Amulets
              29 
£26          OF THE  HYDROPHOBICK FEVER.

have also had their confidants, and have probably saved,
as many as any of the foregoing remedies.
   I shall now conclude this part of my subject by stating
the  remedies used by myself, and also by my father: he
commenced by having the part bitten well washed with
salt water, then it Avas rubbed daily with mercurial oint-
ment:  at the same time Mead's remedy  was given,  and
this succeeded by a course of mercury;  after continuing
this course a few days, it was omitted a few days,  and
the patient ordered to use the cold  bath, as directed by
Mead.   In  an extensive practice of upwards of forty
years, not a  solitary case of hydrophobia followed.
   When I entered into practice I felt so strongly prepos-
sessed in favour of mercury, in this  disease,  that I ven-
tured  to change the treatment, and used nothing inter-
nally but pills of calomel.  I had the part well bathed
Avith salt and water every day; and afterwards directed
some strong mercurial  ointment to be rubbed into it:  af-
ter leaving a day or two for the mercury to wear off, the
patient was  ordered to use the cold bath for  some days.
I have prescribed for at least ten, or twehe persons, who
were bit by dogs really mad,  they all escaped.
   Dr. Wilkins of Baltimore, reposes great confidence in
the use  of caustick,  to destroy the part.  Dr. Mosely,
well known in the medical wrorld, recommends a similar
practice.  We are told by Dr. Zinke, at Jena, that the
disease has sometimes made its appearance after the use
of the caustick, and even where the part had been imme-
diately cut out.
   A Dr. Stoey, in Pennsylvania, Avas long celebrated
for the cure of the bite of rabid animals;  after his death a
patent was obtained by his family; I was solicited to take
an agency in it: being very anxious to get information on
this dark subject, I took an oath that I would  not divulge
the secret for fourteen years:  I am not yet at liberty* but
I feel it my duty to  observe  that the discovery made to
me, was disgraceful  to  Dr.  Stoey;  nor was there any
thing neAV in it. I therefore never acted, to give it a trial.
   Now  Ave are well assured from  various sources, that
hydrophobia has followed the use of every remedy which
I have mentioned; even mercury  which gained credit in 
OF THE  HYDROPHOBICK FEVER.        227
my own practice, and more especially in that of my fa-
ther; has often failed according to Dr. Rush, and others.
Mead's remedy, which had answered a thousand times,
has, since failed, and I have knowledge of the duckweed
failing also.  In short, every method which ever has been
practised has failed.
  In our present knowledge of this disease, Ave ought cer-
tainly to try preventives, and I think none more  rational
has been offered, than to cut out the part when it can be
safely done, or destroy the neighbouring parts reasona-
bly around,  by means  of caustick: and I should prefer
arsenick for this purpose;  Ave knoAV it may be  applied
ouhvardly  with safety; and the alkaline caustick, as
well as the lunar caustick,  have  both failed to secure the
patient.
  Give the chickweed or Mead's remedy; then touch the
mouth a few days with mercury, let this Avearoff a little,
and then use the cold bath, if it agrees with the patient's
health,  if not, tepid baths with a little salt; let this be
continued for  a feAV weeks.
  But, reader! startle not if I boldly pronounce,  that you
are in no more danger from the bite of a rabid animal
than from the  bite of a healthy  one.   I  do not  wish to
prevent persons from using the usual remedies, but I feel
it  my duty  to state as my confirmed opinion,  that  we
wrong the poor dog; and  what  is worse, torment our-
selves with notions for which there is no foundation.
  I now proceed to give  my reasons for thinking  the
hydrophobick dog has no poison.
  1. Because  the flesh of hogs that were labouring under
this disease, has been eaten with impunity.
  2. The milk of cows affected with this disease has been
used by whole families.
  3. Hydrophobia has been brought  on by many other
causes than bites.
  4. A  number of rabid wild animals have been found
nearly about the same time.
  5. Several dogs are generally found mad in the same
neighbourhood,  hefore the disease could have passed
from one animal to the other.  An intelligent old lady of
Adams county assured me, that a great many dogs,  and 
228        OF THE HYDROPHOBICK FEVER.
 other animals Avent mad prior to a very mortal low fever,
 which prevailed in the winter.   It is also a fact, that
 many mad foxes and dogs were seen about the year 1810,
 just prior to a mortal fever which has prevailed there for
 several years.
   6.  Dr. Rush tells us a case  of hydrophobia followed
 an injury from a mad dog Avhere the skin was not broken.
   7- Because no well marked cases are on record, or at
 least within my reach, of the disease following  the bite
 very speedily; on the contrary, weeks and months; and,
 credulity says, several years have passed between  the
 bite and the hydrophobick fever.
   8. Because, small wounds  and other causes which
 produce tetanus,  produce the same set of symptoms on
 whatever part of the body they were made.
   In short,  I feel the fullest conviction that we have been
 all mistaken in our views of this disease; and as I have
 new ideas on the subject, I beg leave noAV to'state them,
 hoping the reader will carefully attend to all I have said,
 as to its causes, &c.
   I believe, that hydrophobick fever  arises  from some
 unknoAvn cause, but something like those which produce
malignant fever, and that this cause is something like an
 endemick.   I shall explain my views here by a  few ca-
 ses.   I prescribed for Alexander Ogle, esq.  of  Somer-
 set county, Pennsylvania, for a case of dog bite, which
was attended Avith the folloAving circumstances: this dog
had been bitten by another: and a horse in Mr. Ogle's sta-
ble Avas bitten by his own dog, about the same time he bit
his master;  this horse went mad and died, as I  Avas in-
formed, at Shippensburgh.
   Now is it not extremely probable, that this other dog
which was in the habit of playing about the  same yard
 and stable,  as well  as the horse being  subjected to the
same air, that they may all have taken this disease from
the same source: if it  arose spontaneously in one case,
why not in all, the biting having probably nothing to do
with either case.
   Dr. Rush gives the case of Mr. Todd's  son,  of Phi-
ladelphia.   In this case,  the bite Avas on the sixth of Au-
gust^ and the symptoms  made  their appearance on the 
OF THE HYDROPHOBICK FEVER.        229
13th of September,  a period of thirty-eight days; the
same dog bit a cow, a pig, a dog, and a servant.  The
cow and pig went mad and died;  the dog became mad
and was killed by his master.  Now, is it not extremely
probable, that this child, the two dogs, the cow, and the
pig, were all exposed to  the same  cause.  Why are  we
to suppose that it arose  spontaneously in one dog, and
accidentally in all the other cases?   This is certainly de-
serting  the common rules of reasoning, and  appears  to
me to have its .origin in  this.   Of all animals, the dog
Seems most subject to this dreadful fever, his propensi-
ties when enrasred naturallv lead him to  bite.   If it is
ansAvered, that man, too, is prone  to bite Avhen  affected
Avith hydrophobia, I retort, that persons mad  from  other
causes,  as well as hysterical patients, Avill often bite  the
by-standers; and after all, this propensity to bite,  is not
so great as some people imagine.   I shall presently de-
tail a case which I have  seen;  to  this we may add, the
circumstance, that in most cases of this disease, the mind
is prepossessed with a notion of this mark of the disease,
and, I believe, cases are not Avanting, where the imagi-
nation has excited this disease, and led particularly to
this symptom.
   Upon the whole, I take the hydrophobia to be a most
malignant fever, as suggested by Dr.  Rush: and I think
it but a variety of tetanus.  We know that tetanus arises
from the same causes, and that the symptom of dreading
water, is not universal in hydrophobick fever.   This va-
riety of tetanus (if I dare so call it) is principally seated
about the throat, while the common form invades a cer-
tain set of muscles; but both arealike attended with vio-
lent disease of  the whole system.
  I view the hydrophobia as partaking more of  the com-
mon inflammatory diathesis than tetanus.   This is per-
haps not the proper place to discuss this subject, I there-
fore proceed to give what I think the most likely  treat-
ment for the disease when formed.  The patient should
be  bled copiously, and  the tincture  cantharides  given
largely, as in tetanus, and the patient kept in a warm bath
as long as it can be home; mercurial ointment should be
rubbed  into the whole body, and  particularly into the 
230        OF THE HYDROPHOBICK  FEVER.

throat.   This disease is  extremely rapid,  and passes
sometimes through its  inflammatory symptoms in a few-
hours; therefore, we should place our Avhole dependance
in one or hvo bleedings, as large as are consistent with
life; and the constant use of the bath as long as it can be
borne at each time.  We  must now carefully watch our
patient, and as soon as the symptoms yield, tonicks should
be given, particularly the acids, freely; and the most pow-
erful vegetable tonicks, as bark, in large  quantity; or
some bitter sudorificks, as valerian, snakeroot, &c.
  I have not had  an opportunity of trying the above
treatment; but, from the almost universal failure of other
remedies, together with a  full persuasion that it is but a
variety of tetanus, I recommend the above Avith conside-
rable confidence.
  I have still to relate one case of this disease, which I
have seen.   A German, near Chambersburgh, Avas bitten
by a mad dog (and if a dog went mad spontaneously, why
not the man too, Avhen we knoAV to a certainty it has ori-
ginated in that way?)   About five or 'six weeks there-
after,  when going to his sawmill, as usual, he felt a sud-
den horrour in attempting to Across the millrace; several
attempts were made; but he was obliged to return to his
house.  This poor man probably had but little dread on
his mind; for, after being bitten, he had applied to a Ger-
man minister at Chambersburgh, avIio gave him some
kind of an  amulet, and dismissed him with full assu-
rance that it would save him.  [This great doctor is since
dead.]
  He was noAV brought, in a Avagon, to my father's: I
Avas a lad at the time, and therefore cannot give the par-
ticulars of the treatment adopted: nor  have I access, at
this time, to my father's minutes of the case; but the ap-
pearance and actions of the patient made a strong impres-
sion on my mind.  He was perfectly rational the greater
part of the time; all of a sudden he  would  signify that
the paroxysm was coming, and in the same breath he was
raging: he did make some slight efforts to  bite, but the
prevailing symptoms were  a kind of desperate struggling,
partly as though he was trying to  escape, and partly
struggling for breath.  He was held down by four stout 
OF THE HYDROPHOBICK  FEVER.        231
men, always present; after he was completely exhausted,
he  seemed to swoon, and to  lie feeble  and calm; the
breathing became easier, and he gradually recovered his
mind and strength, so as to converse rationally with his
friends for a considerable time.
  He expressed great horrour  at the sight of water, and
also at red and white clothes. He lived three or four days,
the last of which his disease  was completely subdued,
and he was enabled to drink some Avater, through a tube,
from a covered  cup, and also to swallow a good deal of
bread, rolled up in the form of pills:  the first efforts at
swalloAving Avere painful and difficult.  His friends and
his physician had noAV considered him out of danger; all
his friends had  left the room, and were at supper; he Avas
sleeping as sweetly and comfortably as a person in health;
and had  discovered no  derangement of ideas  that day.
Apparently in his sleep, his eyes and eyelids began to
tremble;  a tremour or slight spasm ran over his Avhole
body; he gasped two or three times, and his soul took its
flight.  Before  his  friends  could assemble, he was  no
more;  but it having fallen  to my lot, Avith some  other
young members of the family, to watch during supper,
the circumstances are still  strongly  impressed  on my
mind.
  I have thought this case  Avorth relating for hvo reasons;
the case  Avas checked;  and it is probable, had his  phy-
sician been aware of the great prostration of strength pre-
sent, by a suitable use of tonicks he might possibly have
saved the patient; for he, to all appearance, died from
mere debility: let it not be thought that I throAV a shade
of blame on  the humane  physician who attended him;
he had done much for him; but the case was rare, and no
precedent for his guide.  The other reason is this: Dr.
Physick  has proposed, and Dr. Rush recommends the
measure, to open the windpipe, in order to let the patient
breathe, till suitable remedies could be administered; but
in this case no advantage Avould have been gained; and
I am disposed to think this enlightened  man, for  once,
is mistaken in his views of this disease.
  Should it then turn  out,  after  sufficient observation,
that this is  a malignant state of  fever,  and originating 
 232        OF THE HYDROPHOBICK FEVER.

 from other causes than biting by rabid animals; that this
 cause predisposes no more to it  than any other  small
 wound, allowance being made for the influence of imagi-
 nation; what a mass of anxiety, &c. may be savedl  And
 if then, we  can  place this on  the  footing of other dis-
 eases, as  tetanus, Avhich  arises, generally, from  small
 wounds, humanity may  still weep over the evils arising
 from our mistaken views, while ignorance, in the garb of
 murder, shall tremble at the horrid tales  of persons ha-
 ving been bled, or smothered to death, because they were
 sick!
   I am aware that Dr. Zinke has related a set of ex-
 periments  where he succeeded in producing hydrophobick
fever, by  inoculating animals with the saliva of a dog,
 which had died of this disease.  But how often have we
 been deceived by experiments?  Persons  have in like
 manner  been  engaged  in inoculating  for the measles;
 they could sometimes succeed if the  disease was preva-
 lent in the neighbourhood, but not otherwise;  one  could
 succeed Avith the blood, another by rubbing Avith a piece
 of flannel  which had  been worn;  others  again with the
 tears, Avhile all these have been most generally ineffec-
 tual; and  no doubt was only succeeded by measles  when
 the  patient  was  exposed to  an  atmosphere,  or  other
 causes, Avhich give rise to measles.  So with Dr. Zinke's
 experiments; he  may have been misled  by all  the ani-
 mals having been exposed to the same cause which pro-
 duced this fever in his dog; and if liable to it accidently,
 Avhy not spontaneously?  Or, after all, harsh treatment,
 and taking  animals out of their usual  habits, may pro-
 duce disease, and the  imagination is  ready to take up
 any indisposition for that-winch, we wish to see.*

   * We are told by Cullen, that carditis or  inflammation of the
 heart, has been the cause of hydrophobia. This is respectfully sub-
 mitted to the attention of the Faculty.  Should it turn out,  by dis-
 section, iLc. that hydrophobia always proceeds from inflammation
 ot the heart, which I think highly probable,  some correct or settled
 plan of treatment might be  derived from a knowledge of the real
 seat of the disease.  If  it be an inflammation of  this most  impor-
 tant organ,  we might possibly recommend blistering over the whole
 thorax, and be governed in the use of the lancet, by the same rules
 which govern us in cases of malignant fever,  with local inflamma- 
OF THE SCURVY.
238
  The foregoing observations on hydrophobia have given
rise to some clamour, and also to some very reasonable
criticism;  but, after the most mature reflection,  I  have
thought proper to continue the article Avithout alteration.
  The  opinion maintained  here, respecting  the origin
of this disease is not mine,  it has been held  by others
long ago.  But whatever may be the fate of this opinion, I
have no hesitation in saying many things Avhich Avere as
contrary to settled opinions as this, have sometimes  burst
through the clouds of dogmatism and SAvept pyramids of
errour from their foundation.  To conclude, every liberal
minded reader Avill perceive that I have faithfully given
the usual remedies with all care, and have been so far from
a Avish of  perversion that I have acknowledged some per-
sons Avent mad who Avere  bit by mad foxes,  &c. but
not,  as I suppose, from specifick poison.  Surely,  then,
my expression of doubts, in the almost universally re-
ceived opinions, on this subject,  aa ill not  subject me to
illiberal criticism; for,  he Avho follows my advice Avill
carefully  use means,  Avhile  he cherishes a fond hope that
he is in little danger: Avhere the advantage of torment-
ing his mind even if I am mistaken?   And it will be per-
ceived that I  have written  principally with a vieAV of
exciting inquiry Avhich can  do this -subject no  injury.

                     section xxxi.

                    Of the  Scurvy.

   The scurvy is thus correctly described by Sydenham:
" It is accompanied with spontaneous  lassitude; heavi-
ness; difficulty of  breathing, especially after exercise;
rottenness of the gums; fetid breath; frequent bleedings
at the nose; difficulty of walking; a swelling  sometimes,
and sometimes a wasting of the legs, on Avhich spots al-
Avays appear, that are either lived, or of a lead, yellow,
or purple colour, and a salloAV complexion.*'
tion from other causes.  From the happy effects which the tincture
cantharides has sometimes had upon tetanus, and  from the probable
similarity of tetanus and hydrophobia, with my  present viev.s I
would blister the whole thorax.
                 30 
234
OF THE JAUNDICE,
   I have never  seen a well marked case of scurvy in
 country practice. I have seen Avhat is called land scurvy;
 this is an affection of the mouth and teeth, and is a habi-
 tual disease, and therefore will be found described in
 that class  of diseases.   Symptoms strongly resembling
 scurvy are often seen in chlorosis, which Avill be noticed
 in place.  Scurvy is the sailors' scourge, but happily for
 mankind,  such  people have it in their  power to banish
 this disease from the  ocean,  by taking a sufficiency of
 vegetables,  as sourkrout, and other pickled articles; by
 having a supply of Avholesome water, aud by strict at-
 tention to cleanliness, and exercise.
   In recent scurvy,  provided the patient has access to
 vegetables, plenty of vinegar, or even mineral acids; he
 should  be  hied moderately,  and  take a little  cooling
 physick, after Avhich the cure may be trusted to the free
 use of vegetable food:  all kinds of sallads, as also scur-
 vy grass, horseradish,  and fruits, as lemons, oranges, or
 sour apples, or jellies of sour fruit, and  in Ioav cases the
 free use of  generous punch; and this  may be made in
 case of necessity, from vinegar, cremor tartar, or even
 vitriolick acid,  or the  nitrick, or muriatick acids. In
 cases of long standing we must not bleed, but rest the
 cure principally  on generous  punch, with a little  fresh
 animal food, or good  wine,  in form  of whey.   The
 nitrick acid should ahvays be used  in this disease, for
 it is a  powerful tonick,  as  well as a corrector  of scorbu-
 tick action.

                    section xxxn.

                   Of the  Jaundice.

   A common jaundice  is  discovered, first, by a yellow-
ness of the eyes; the skin becomes yellow, and the pa-
tient often  sees things'with a yellowish shade over them;
it is attended with itching,  heaviness,  lassitude, bitter
taste; whitish excrements, or  thin bilious stools, urine
yellow, and stains linen a saffron colour; hiccup, and a
bilious vomiting  sometimes attend.   If the disease be-
comes  obstinate, the eyes and skin put on a darkish yel- 
OF THE JAUNDICE.
233
 low colour, and the disease is now called the black jaun-
 dice.
   This disease is supposed to be occasioned by obstruc-
 tions  in the gall ducts of the liver; by concretions, or lit-
 tle stone-like bodies,  which are often found in the liver:
 it may, hoAvever, arise from torpor, or slight inflamma-
 tion of the liver, or from a  secretion of unhealthy bile.
 I suspect gall stones are its most infrequent cause, and that
 most  of the cases of jaundice are brought on by surfeits
 in eating or drinking:  an excessive meal of meat  will
 sometimes excite a jaundice.   Where it is not attended
 with  pain, or extreme sickness, or considerable soreness
 from  pressing on the  liver, Avhich are symptoms attend-
 ing inflammation, scirrhus, or large collections  of  gall
 stones; it yields to mild treatment.
   I strongly suspect the notion of gall stones obstructing
 the biliary ducts, and being the cause of jaundice, is not
 often  Avell founded; but that those concretions in the liver
 produce inflammation, Avhich interferes with the  healthy
 secretion of bile.  See inflammation of the  liver and
 scirrhus.
   I iioav proceed to detail the treatment for simple jaun-
 dice:  Give the patient, if  an adult, one scruple of ipeca-
 cuanha  combined with  ten grains of calomel; if it pro-
 duces vomiting, drink weak tea, or warm Avater, as usual.
 Repeat this every other day, till three doses  are given,
 if necessary.   If  the jaundice is  attended with fever, it
 will be advisable to  bleed the patient moderately.   On
 the intermediate days of taking the above medicine, take
 of these pills, rhubarb one dram,  castile soap one dram,
 syrup or molasses enough  to form pills; make twenty-
 four pills; and of these give four  per day.  The patient
 must  live on a light vegetable diet, as Avell-boiled rice, or
 barley, roasted apples, sallads, &c; light broths  may be
 used;  greasy articles are to be avoided; milk may be used;
 and, perhaps, the sour is best.  For drink, toast and wa-
ter, or apple water, or any mild herb tea, cool, or even
water, provided it is not rashly used, or near the time of
taking the  ipecacuanha and calomel.
   Moderate exercise is never to be dispensed with. The
above treatment will be safe in jaundice from any cause. 
236
OF A  DIABETES.
but if it should not relieve, advice must be had.  If there
is  an abatement of  the symptoms, the same treatment
might be continued a while longer, leaving longer inter-
vals between  the  doses of ipecacuanha; and continuing
the pills;  should too severe purging arise from the me-
dicine, a moderate anodyne at night, as half a  grain of
opium Avith two or three grains of ipecacuanha, will be
found useful.

                   SECTION XXXIII.

                    Of a Diabetes.

   The characterizing symptom in this disease  is a too
copious discharge of urine, mostly of  a  sweetish taste,
and which will  yield a species of imperfect sugar; but
sometimes no  particular difference is  discoverable in the
taste of the  urine; it is said ahvays to lose its urinous
smell; this increased discharge is attended with  thirst,
feverishness, lassitude, pain in the back, heat, and unea-
siness in the belly, costiveness mostly, sometimes a swel-
ling of the hips and loins; and, when inveterate, a frothi-
ness about the throat and mouth; to these succeed a rapid
Avasting of the whole body.   It has been supposed that
the seat of this disease is in the stomach; and from opi-
nions respecting  the functions of  the liver, delivered by
Dr. Rush, it has been supposed to be seated in that vis-
cus: both opinions were founded on  a belief,  that the
proximate cause was  an imperfect assimilation of the
food to the necessary animal  properties.   That is, the
stomach or liver, Avas supposed to be impaired in their
functions, so that the food was not duly prepared before
it  entered the circulation, and therefore, the various parts
through Avhich this  imperfect blood  aa as carried, could
not elect particles suitable to their purposes, and that the
kidneys strained or took up this crude matter,  and pas-
sed it out of the body.
   This disease most usually attacks great eaters and
drunkards.  I  think most persons  who feed too much are
more or less affected  by this disease.   It has  generally
been reckoned an incurable disease.   Astringents have 
OF MADNESS, OR INSANITY.           23?
been tried; a diet of animal food has been recommended,
but I believe, these things have seldom succeeded.  Se-
veral cases are on record of cures being effected from the
free use of the  lancet, such as  bleeding  once  a  day till
the symptoms are  abated, or till from fifty to upwards of
a hundred ounces  were  drawn.  This was accompanied
with a diet suited to the case, being light, but partaking
more or less  of animal food, as there Avas  more or less
fever.   Other cases are on record, Avhere the frequent
repetition of  vomits has succeeded.
  Upon the Avhole, this is a dangerous disease,  and re-
quires the best advice.  I  Avould, hoAvever, advise per-
sons deprhed of medical aid, to bleed once or twice pret-
ty largely, then take a  couple of vomits, three  or four
days apart; live  principally  on light  animal  food; and
take before  every meal, tAvo or three tea spoonfuls of
beef's gall, either mixed Avith  a little milk, or the gall
dried in a pan  set in water, Avhich Avill prevent it from
burning; of this a large tea spoonful may be mixed with
a little milk,  and taken as quickly as possible.   If the
bowels  are  costive, glysters should  be  used, and if a
dangerous diarrhoea occurs, give small doses of lauda-
num.

                   SECTION  XXXIV.

               Of Madness,  or Insanity.

  There is much A'ariety found in this deplorable condi-
tion of man,  such indeed is the variety, that 1 shall not
attempt, here,  either a detail  of its  various forms, nor
yet of its cure.  My design is merely to suggest, to per-
sons unacquainted Avith such maladies of the mind, that
many cases arise from diseases of the body,  and are
often removalje by medicine,  or  other  treatment.  Its
causes appear  to  be various, as intemperance,  intense
study, or  violent passions,  and perhaps  sometimes con-
stitutional predisposition, long continued fevers, certain
conditions of the  uterus, affections of the mammae:  it
often  alternates Avith  other  diseases, as  consumption.
Most of the  causes of madness impair digestion; and 
 238         OF MADNESS, OR IN S AN IT V.

 how sensible are Ave all of the influence of the mind over
 the  stomach!   In vain we look  for appetite Avhile the
 mind is agitated with the passions, with intense thought,
 or strong desires.  These considerations lead  me to be-
 lieve, not only that intense study, &c. produces madness,
 by operating primarily on the stomach, but that many ca-
 ses of madness  have their seat in the organs of  diges-
 tion, as the stomach, liver, and spleen, and here, as in
 many other cases, the mind is only sympathetically af-
 fected.
   From the vast number of  diseased brains  found on
 dissection, where no madness existed, I think  it highly
 probable, that organ is not the most common seat of mad-
 ness; and that a destructive, or ineffectual treatment has
 been a frequent consequence of a different opinion: and
 which led to severe treatment about the head, Avhile per-
 haps, this faithful monitor disclosed  the insidious dis-
 ease of the  liver, spleen,  stomach, uterus,  mammae,  or
 perhaps, in some cases, parts of Avhich Ave  have yet no
 suspicion.
   Upon the whole, I suspect, that although insanity, in
 many cases, arises from local affections, yet, the general
 system is  not only diseased,  but  partaking of a pecu-
 liar diathesis, or species  of action * ssentially connected
 with the insanity; and that to  effect* a  cure Ave must ge-
 nerally operate on the whole constitution; and not as soon
 as irregular ideas are discovered, attack the head with
 violence.  What blisters!   What cold clay caps!  What
 cold affusions!   What ice!  What shaving, cupping, &c.
 have  been applied to the human head; sometimes, no
 doubt, much to  the  advantage of the  patient,  but in a
 majority of cases, perhaps, for operations of the mind
 wholly sympathetical; and which can only be reached by
 remedies which  operate on the whole system.
  I think insanity often curable, and mostly a disease of
the whole system, for the  following  reasons.  I have
known a case, where after deplorable madness of seven
years standing,  the mind  spontaneously recovered, and
performed its  functions regularly for  many years; this
Avorthy old man was at length attacked by a bilious re-
 mittent, which again impaired the faculties of his mind, 
              OF MADNESS, OR  INSANITY.         239

but being at a good old age, he soon glided to another
world.   Many have been restored by means, and by time
alone: the great Boerhaave gives a case of a person Avho
by the long use of  Avhey, Avater, and garden fruits, eva-
cuated a great deal  of black matter,  and recovered. Con-
finement  and solitude  has often  restored  a deranged
mind; and the Aveakness of the head, Avhich  often re-
mains for Aveeks after fevers, gradually disappears as the
general  system  gains  strength.   Now, if madness  has
been  cured spontaneously, and by medicine too, even in
one case, why may Ave not hope for it  in  all, and never
cease our efforts Avhile there is life.
   We seem to have been misled in  our vieAvs of madness
from  its  resemblance to delirium, as respects  the mind,
and because  the mind recovers its functions when fever
goes  off, Ave are ready to conclude that madness is essen-
tially different, because no sensible signs of disease at-
tend  confirmed insanity.  But do we not find  in every
'department of nature, things subject to a variety of  mo-
difications Avhich render their sensible signs invisible?
Thus the matter of heat enters  into a variety of combi-
nations,  and  is so completely latent, or hidden, as to have
eluded the observation of mankind, for several thousand
years.   Light enters into myriads of  bodies, and loses
its sensible properties, giving life and colour to all the
vegetable kingdom; but leaving no distinct evidence of
itself as light.  Diseases often invade the body so slowly,
that we have no notice of them till far advanced, as ossi-
fications, and aneurism of the great arteries, yet doubt-
less,  even these are often the consequence of general de-
bility, or of general disease.  A slight Avound Avhich Avas
scarcely  recognized by the general  system, nevertheless,
Avill sometimes invade sIoaa ly and imperceptibly, and no
matter Avhat  part of the body was touched, a certain set
of muscles are violently attacked,  and tetanus  folloAVs;
if a slight Avound in a  remote part of the body ahvays
affects a  certain set of muscles, Avhen tetanus arises, Avhy
should Ave doubt, but, that, causes which  elude  our  ob-
servation may produce this chronical delirium, or  de-
rangement of the mind?   Why  are Ave not, then, in both 
240          OF MADNESS,  OR INSANITY.
cases, to apply remedies which operate, generally, on the
body.
   Again, Ave know that many diseases do lurk  in the
body, and are  only knoAvn by some local affections, as
cancer, asthma, and palsy; the last disease often  leaves
all the natural  and vital functions perfectly sound, so far
as Ave can see,  for many years, yet in all those cases and
many others, disease  lurks  in the av hole  system.  In
short, a great many diseases are sometimes hidden or im-
perfectly expressed;  fevers often  assume this insidious
character.   Persons  have often been seen walking in the
last stage of yellow fever, and sometimes conscious too
of their situation, but free from sensible signs of disease:
a case is on record, of a lady in Baltimore, avIio rose  a
very short time prior to her death, and made prepara-
tions  for her funeral.   Surely all those  things go to esta-
blish  the fact, that there is a lurking disease in mania,
and there is strong grounds  for believing the brain, or
any part of the head, is but secondarily affected:  and if
so, while Ave direct all our efforts  toAvards the head, we
will often be disappointed, in our efforts for relief. There
are many cases on record, where transient lucid inter-
vals followed bodily pain, as whipping, and other severe
treatment.   Such people, too, are less  sensible to cold
and hunger; all which shows the body to be out of its
natural state.
  Upon the Avhole, then, I think there  is strong grounds
for believing, that when the nature of this dreadful ma-
lady is  better understood, or, perhaps, with  prevailing
notions of it, the day may arrive, aa hen  man shall not be
abandoned, because he is unable to  help himself.  Let
us then view every  maniack as labouring under some
disease and never abandon them.   Persons have been cu-
red of all other chronick  diseases; and if madness has
sometimes cured itself, spontaneously, after several years
continuance, why should Ave  ever  relinquish our efforts?
We knoAv that other inveterate diseases, after resisting
every effort for years, have afterwards yielded to the most
trifling  thins*;  and  why may not this be expected in
madness?  If our efforts prove abortive, let us desist for
weeks, months, or even years, as circumstances may seem 
               OF MADNESS, OR  INSANITY.         211

  to direct, and then try again and again.   While there is
  life there is hope, is the language in other diseases; and
  shall the poor  maniack remain Avithout hope, without
  effort?
    It is a truth that, many of the affairs of mankind that
  are suppose! most settled, and thought even self-evident,
  are the greatest errours upon earth; and Avhen found to
  be such, Ave are astonished at our ignorance.  How long
'  Avas the Avhole philosophick Avorld misled by the notion
  of four elements? The mind noAV beholds Avith wonder,
  that  ages of mankind should have  viewed water as an
  element,  when it Avas decomposing every hour in the day,
  as in evaporation, in giving substance to plants, &c.
    Let not envy tax me Avith arrogance or vanity:  if I am
  mistaken, I  err on the safest side, and humanity guides
  my pen—she hangs upon my elboAv, Avhile suffering ma-
  niacks  arrange  themselves around my chair—their ges-
  tures SAvell my bosom with anguish—and I can ease my
  heart but Avith tears Avhich I shed over this  my feeble ef-
  fort, to excite attention to the pitiable maniack.   Who
  can behold the giddy, the wicked sport of boys, pointed at
  the travelling maniack, and Avithhold the tear of pity? If
  angels  Aveep, it must be at such a sight.  And shall cold,
  languid pity, ease thy heart at  his suffering, Avithout an
  effort to relieve him? What, though the mind, clouded
  by a diseased body, cannot repel the offence, the  great
  Giver of mind Avill in due time remove  the cloud,  when
  the  distorted features shall change, and shine brighter
  than the sun, more placid than the moon, and put to
  shame  and derision the silly mocker.  But  ah! again my
  heart doth  swell, and the big tear rolls doAvn my cheek;
  for  with  all its horrours  stands before my imagination
  thousands of human  creatures  immersed in the gloomy
  cells  of  hospitals—unpitied, unnoticed, and untried—
  their bodies chained or confined to a cell—while the soul,
  perhaps unspotted, is tortured by bodily disease, against
  which no efforts are made.
    Let me admonish every keeper of an hospital,  every
  physician, and every relative, that it is a duty  which they
  owe their Maker, a suffering fellow-creature, and  them-
  selves, to leave no means untried: if Ave fail in our efforts,
              31 
 342           OF MADNESS, OR INSANITY.

give the system time to recover, and try again and again:
bear in mind the great precept of our Saviour, that you
are not only to forgive your brother seven times, but sev-
enty times seven.   And  if Ave  find extreme  difficulty,
from  the strange perversity of  such persons, let us not
neglect him on that account; it  would seem  as though
nature  rendered him  thus perverse that we  should be
prompted to relieve him,  and thus get rid of his vexa-
tious conduct to ourselves.
   With justice may the  anxious physician exult, that
heaven has given him  the victory in cases Avhere he has
apparently rescued a felloAV creature from the grave, by
the suitable means; but how doubly thankful,  how ex-
alted, and how blessed will be  the lot of the physician
who shall conquer this  horrible  disease.  Already, me-
thinks, I see  the humane physician bringing from the
long-forgotten cell a trophy of his skill—leading the new-
born fellow-creature to his former connexions with the
world.—Prayers! thanks! and rejoicings! shall ascend
on high; and while I contemplate the scene but in ima-
gination, I seal this humble effort  for the insane with
tears of joy.
   The learned Dr. Mead gives an affecting  account of
the case ot'JSfebuchadnezzar, Avho, losing his reason, rov-
ed about seven years with the beasts of the fields; and
then recovered to acknoAvledge his dependance on a kind
Providence, and also to understand the relation in which
he stood with the world.
  As this book may possibly fall into the hands of phy-
sicians, and especially as this is  a disease much neglect-
ed, because often considered incurable, I shall conclude
this article, by offering a feAV queries.
  What Avould be the effect  of slight,  long continued
nausea, brought on by safe articles,  as ipecacuanha?
  What Avould be the effect of long confinement to one
simple article of diet?
  What would be the effect of long continued, but slight
pain, from setons, blisters,  &c?
  What Avould be the  effect of abstinence bordering on
starvation?  This cruel remedy should not be continued
too long. 
OF THE CHOLERA  MORBUS.
243
  What would be the effect of using vegetable tonicks,
given to a greater extent than has been practised hereto-
fore?
  The following course has often succeeded in the prac-
tice of a brother of mine.   Reduce the patient, according
to circumstances, by bleeding,  purges, and vomits, and
very strict diet; then put the patient into the warm bath
as long as it can be  borne;  take  him out speedily, and
throw a bucketful of cold water over the head; this gives
a terrible shock: it  is, however, not only safe, but has
often  proved effectual.
  What might be the effect of obliging such patients  to
be sickened daily by Avhirling round?
  What the effect of obliging them to Avalk on the highest
possible places, apparently  dangerous, but having them
sufficiently secured from danger?
  What effect from the greatest possible frights, from va-
ried means! Lastly, all severe means should be used but
for  short periods of time, and under the direction of per-
sons  of skill, lest our efforts turn to cruelty  operating
without hope.

                   section xxxv.

              Of the  Cholera Morbus.

  This appears to be a colick  of a  high grade,  so that
the  force of the disease prostrates the stomach and bow-
els  at  once below  that state of sensibility, which gives
pain,  as in common colick.   Cholera is often a symptom
of malignant fever, and therefore requires great caution,
more  especially as it is a disease of great danger, and
speedy of termination.  It is known by a violent purg-
ing, and vomiting, sometimes bilious, at other times acid
vomitings with very  loose stools, accompanied Avith ex-
treme debility, in a  short time after the attack;  it most
frequently, according to my observations, occurs in warm
weather, and at night.
  It is always dangerous for the unskilful to use evacu-
ations in a  cholera,  and  where  it  is the  only  disease
they  are  seldom  if ever  necessary.   Chamomile  tea 
244
OF THE COLICK.
should be drank freely, audit may also be given in glys-
ters;  soon  as there  has been  a reasonable number of
motions, or evacuations  upwards and  downwards, Ave
may suppose the stomach sufficiently cleansed, and com-
mence the following: take a table spoonful every fifteen
or twenty minutes, till the disease is abated, or till the
Avhole quantity is taken. If the third or fourth dose does
not check the vomiting,  ten or twenty drops of lauda-
num must be given with each dose: take  soda tAvo scru-
ples,  rub it fine  and add eight table spoonfuls of cold
mint  water,  or  three or four drops of essence of pep-
permint may be rubbed with the soda before it is mixed
Avith the Avater.   If chamomile is not at hand, centaury,
carduus, or  mint tea Avill often answer.  Soda water
highly charged Avith fixed air may be taken freely.  If
the disease  still progress, apply a blister over the sto-
mach; sinapisms to the feet; and if the physician is not
to be  had,  take a little strong well made coffee, a little
good  wine, or even strong brandy, but be cautious how
you use stimulants, unless you are well satisfied no fe-
ver is lurking in the  body.  If the case is lingering,
but not very violent, small  doses of calomel should be
used.  Toast and water, weak cool bitter teas, or good
porter and water, will make the most  suitable  drinks,
and the  patient must return to his former  diets with
great caution, beginning with light broth, or good coffee
or tea, with  a little relish of nice salted meat or fish,
and water biscuit, or good bread.   Should soda not he
at hand, half a dram of  salt tartar may  be  used in its
stead.
           SECTION XXXAI.--SUBSECTION  I.

                    Of the Colick.

  Colicks, usually so called, are the bilious, lead, fla-
tulent, hysterick, and the iliac passion.   I  shall treat
of them briefly in the  order in which they  have  been
named.  Bilious colick  differs in nothing from a com-
mon colick, but that it occurs in bilious habits.   Its usual
exciting causes are surfeits, from eating or drinking, from
neglected costiveness,  or  from rash exposure to cold 
OF THE LEAD COLICK.
245
 moist air,  and damp or wet feet.  The symptoms  are
 some fever; pain in the bowels, Avhich seem  drawn to-
 gether: if the pain abates, now and then, it returns with
 a sharp pain as though something Avas piercing through
 the parts; severe vomiting of bile, bowels  generally ob-
 stinately costive, sometimes loose bilious stools.
  Bleed once  or twice, according to circumstances, give
 opening injections freely, open the  bowels  Avith rochelle
 salts, salts and manna, and if the case is obstinate, giAre
 calomel in large doses.  If costipation withstand all those
 remedies, throw up large quantities of Avarm  Avater, by
 means of a large bladder, two or more gallons may be
 injected: if this does not succeed, give an injection, con-
 taining a little tobacco juice, got by boiling a little tobac-
 co in Avater.   Or, if possible, by means of  a large blad-
 der, throw up tobacco smoke, till  the  patient becomes
 sickened Avith it.   In obstinate cases, very large doses of
 opium Avill sometimes succeed, as two  or  three  grains,
 repeated at short intervals, till the  pain entirely abates;
 but those violent  articles  ought not to be  used Avithout
 good advice, if it is to be had.
  Where advice cannot be had, provided due caution has
 been observed in not jumbling too many things together,
 and always alloAving a reasonable time for remedies to
 act,  it will be safer to proceed than to wait too long on a
 physician, for skill cannot avail if the disease is too far
 advanced.   Bilious colicks sometimes arise from vitiated
 bile Avhich  excoriates the  rectum, and tinges the skin of
 a yellowish hue:  here we must use gentle vomits, and
 small doses of calomel; and also mucilaginous  liquids
 by way of glysters, and for  drinks.

                   SUBSECTION II.

                 Of the Lead Colick.

  Lead colick, or such as arise from working among lead.
To the usual symptoms of colick, are added here, spasms
of the whole body;  these soon terminate in palsy.  In
this colick it should always be remembered, that lead is
only injurious so far as it is acted  on,  and divided by 
246         01\ THE FLATULENT COLICK.

acids, therefore, every thing acid must be avoided, and
this caution applies not only to such persons as work in
lead,  when diseased, but at all times, they should as
much as may be consistent with circumstances, avoid ve-
getables, more especially acids:  potatoes,  onions, old
Avell-made wheat bread, with rich hroth, in small quan-
tity, and animal food, with oily articles: always remem-
bering,  that much smaller meals of such articles are al-
lowable than of vegetables.  Taking a little good sweet
oil before going into lead works, is ahvays advisable.
  When this colick comes on, large quantities of warm
mucilage should be throAvn up the bowels, and also drank,
for  this  purpose, slippery elm bark, flaxseed,  or water
melon seed may be used; or considerable quantities of
nice oil, or nicest fresh butter melted,  should be taken
and succeeded by large quantities of warm water, by way
of glysters.   The patient  should be put into a warm
bath, and this must be repeated according to circumstan-
ces.  One part balsam copaiba, and three parts castor oil
should be given in doses of a large spoonful; or a spoon-
ful  of castor oil, with thirty drops of balsam peru, every
two hours, till the bowels are open: if the stomach rejects
this medicine, it may be given in glysters.   If  the pain
is violent,  and does not  yield to the  above treatment,
opium may be given in  full doses till the disease abates.
Toast and water, or onion tea Avill be the best drinks; or
a very weak infusion  of peruvian bark.   Where  this
disease  comes on persons not long subject to lead fumes,
and of good habit of body, bleeding may be useful; but
we should not repeat it  often.

                   SUBSECTION III.

               Of the Flatulent Colick.

  This  is a mere collection of sharp air in the bowels,
arising from indigestion, surfeits, too much acid food, or
malt liquors.  It is known by severe pain in the bowels
Avith rumbling of wind,.or discharges of wind upAvards.
If it is taken early, a few drops of essence peppermint, 
OF THE HYSTERICK COLICK.          247
or spearmint, or  a  little strong tea of either of those
herbs; or a little ginger tea, or a little soda or salt  tar-
tar, dissolved in water, and taken  in small doses, with
bathing the feet in warm water, will generally relieve.
   These  things will be found  to  answer the  purpose
much better than spirits of any  kind, which  may do a
great deal of mischief if inflammation or fever exists.
Calamus tea has often been used with advantage.  Or a
few drops of laudanum, Avith an equal quantity of sweet
spirits of  nitre, Avill generally  succeed.  The  patient
should  eat sparingly for  a feAV  days; and take  a little
salts and manna, or rochelle salts:  vegetables should be
used but sparingly:  for drink, toast water, or cold Aveak
infusions  of pleasant bitters.

                   SUBSECTION IV.

               Of the Hysterick Colick.

   This disorder has, added to the symptoms of flatulent
colick, agitations of the mind, and a sense of suffocation,
from a sensation as though a ball was rising up into the
throat, and generally attended with a vomiting of green-
ish matter.   A gentle vomit of aa bite vitriol, or ipecacu-
anha should be given, and as soon as it operates, large
quantities of very weak tea should be drank; and when
the stomach is composed  again,  ten or fifteen drops of
laudanum should be given in weak ginger tea, or  any
other pleasant tea: and repeated frequently till the colick
abates;  the bowels should be opened by  mild glysters.
If attended with fever, it may sometimes  be  necessary
to bleed  moderately.   A  feAV drops of ether, or equal
parts sweet spirits nitre and spirits hartshorn, in doses
of twenty to thirty drops  will  often succeed.   These
palliatives should be followed up with pills of iron filings
and assafcetida:  where assafcetida is particularly offen-
sive, a feAV grains of saffron, or camphor may be added.,
and the bowels in all cases must be kept open, with mild
articles, as magnesia, or rhubarb.  A little decoction of
bark, or infusion of gentian may be  used occasionally:
all spirituous drinks or strong teas are carefully to be 
248             OF THE ILIAC PASSION.
avoided.  The diet should be light but  nourishing, as
good coffee, Avith a little  relisher of salted  dried  beef,
nice ham, venison, or good salted fish; plain  broth with-
out much vegetables, /light meats, poached eggs, a little
nice butter, good wheat bread:  a little garlick, and pota-
toes may be used.  The drink should iu general be wa-
ter, or sometimes a little good wine; weak cold  infusions
Avill be the best drink, where there  is objection to water,
and chamomile, bark, centaury, or carduus, Avill  answer
for this purpose.
  Women disposed to hysterical affections should encou-
rage cheerful company; reasonable amusement with con-
stant but moderate exercise, must not be neglected.  Go-
ing abroad frequently to the house of an agreeable neigh-
bour,  and  encouraging them to exchange  visits, Avill
always be found  useful.

                    SUBSECTION V.

                 Of the Iliac Passion.

  This is a violent disease of the  bowels, wherein the
whole order, or action of  the bowels seem to  be changed,
so that they, instead of carrying the feces doAVUAvards,
turn it upAvards into the stomach; and from  thence it is
vomited with all  the disagreeable  qualities of common
feces.   There is  generally severe pain at first;  and great
prostration of strength, and obstinate costiveness attend.
This  disease mostly arises from ruptures, from wounds
or bruises on the ahdomen, or from  common colick ter-
minating in introsusception, or one gut running into ano-
ther till they become confined, strangulated, and  infla-
med.
  If it arises from  a strangulated rupture, the first thing
must be to reduce,  or return the part which  has escaped
from the abdomen.   In general, if taken early, it will be
proper to bleed pretty freely; then apply gentle pressure
to the tumour; if this will not succeed, inject as  much
Avarm water as possible into the bowels;  apply cold wa-
ter to the ruptured  part for a few minutes, then try to re-
duce again, ahvays guarding against rough  handling of 
              OF AN EFIDEMICK COLICK.          249

 the parts:  if this does not succeed, force tobacco smoke
 up the boAvels; raise the patient's thighs high and dash
 cold water over his  feet, or over the tumour.
1  If this disease proceeds from injuries  of the abdomen,
 we must place much of our  dependance on frequent
 bleedings,  warm mild  injections; and if the case is early
 attended to,  opium  may be used freely  to compose the
 stomach, even while  Ave use the lancet.  No nourish-
 ment should be taken; the patient may  drink freely of
 mucilaginous drinks, as milk and water, slippery elm wa-
 ter, Jbarley Avater: or toast and water will  sometimes  be
 suitable; a single mouthful of bread,  or other solid food
 in such a case, may occasion death.
   If it arise from common colick, bleed moderately, and
 use the treatment recommended for bilious colick.  See
 also the article on enteritis, or inflammation of the in-
 testines.

                   SUBSECTION  VI.

               Of an Epidemick Colick.

   I have seen colick prevail in three successive years,
 as an endemick, during the whole of the winter and spring
months.  This constitution of the Aveather,  had been pre-
ceded Avith unusual prevalence of remitting  and inter-
mitting fevers; these Avere succeeded by two summers of
dysentery,  somewhat  inflammatory.   And the  colicky
constitution Avas succeeded by insidious  typhoid fevers,
accompanied with  catarrhal  affections  of the breast.
This colick was a painful obstinate  disease,  much dis-
posed to return on those Avho had been once affected.  I
had tried various methods of cure, but am inclined to be-
lieve, the following was the most successful:  Frequent-
ly repeated mild injections,  mild purges attended Avith
anodynes; a mixture of castor oil, and Godfrey's cordial,
or rochelle, or epsom salts, generally were the best pur-
gatives: if  the pulse was active bleeding once or twice
was useful.   A thin  light but nourishing diet was best:
drinks were  given of  toast and water,  chicken  Avater,
Aveak teas.   Out of a vast number of patients  thus treat -
              32 
 250  OF  AN H^MOPTOE, OR SPITTING OF BLOOD.

 ed, I never lost a single one.   In one obstinate case,
 benefit was derived from the use of large quantities of
 warm water thrown up the bowels,  by means of  a tube
 connected in the usual way, to a large bladder, but about
 twice the length of the common  tubes.  In one case re-
 lief could only be obtained by  means of the tobacco
 smoke. If no better means are at  hand, for using tobacco,
 it Avill be advisable to cause the patients to breathe air
 containing  tobacco smoke,  till  they become sick  at
 stomach.
   Upon the whole, no disease will bear a more free use
 of opium, than all kinds of colick;  all violent cases are
 attended with spasm, and this is  often increased by pur-
 gatives, if they are not accompanied with opium.   Pur-
 ges are very liable too, to irritate the stomach, and pro-
 duce vomiting.   Stimulant injections, as a handful of
 salt added to the usual quantity of water, or a strong de-
 coction of senna, should be given now and then, and in
 the  intervals very frequent  repetitions of the mildest
 glysters.  If pain does not yield  kindly to opium, bleed;
 and blister over the abdomen.
   I recommend this treatment from extensive experience
 in those affections.   But I must admonish the reader,
 that colick is sometimes but a symptom of violent dis-
 eases, either manifest throughout the whole  body; or
 the disease is  locked  up or misplaced, so as not to be
 discernable,  but from the circumstance of some malig-
 nant  epidemick being prevalent; or by the skill of an
 experienced physician.

                   SECTION  XXXVII.

        Of an Hwmoptoe, or  Spitting of Blood.

                   SUBSECTION  I.

          Spitting of Blood from the Lungs.

  This disease is most commonly a vicarious one, and
arises from obstructed menses, or habitual bleeding piles,
bleeding at the  nose, kc.  It is, however, often a prima- 
      OF AN HiEMOPTOE,  OR SPITTING OF BLOOD.    251

 ry disease, and also sometimes merely symptomatick, as
 in consumption.   It is particularly dangerous in persons
 predisposed to consumption.  It may be excited hy vio-
 lent exertions of the lungs; by obstructed perspiration;
 cough, and  other causes.  It is a thing never to be de-
 sired; inflammation of the lungs, or any other disease
 can be  much  more safely relieved by bleeding at the
 arm, by setons,  and other  evacuations from  the  body.
 Therefore,  as  soon as  this  hemorrhage  occurs,  from
 whateAer  cause, Ave should take common salt in its dry
 state, freely, till it is checked; and if symptoms of fever,
 plethora,  or pain in any part of the hody attends, we
 must bleed in small quantities, and repeat it frequently
 till the bleeding from the lungs ceases.  The.body may
 be reduced a little by mild diet and  gentle  purges; and
 in full habits,  a slight nausea should be kept up  for a
 few days.   Where it is evidently the translation of some
 other disease, we must refer to the respective maladies
 from which it arises, and treat it on general principles.
    It may  be distinguished from a spitting of  blood from
 the stomach, by these  symptoms: some Avarmth, or a
 languid or feeble like sensation is felt in the  breast; the
 heart immediately sensible of the breach, in the lungs,
 palpitates, and if fear attends, this is augmented; a lan-
 guid loose cough comes on, and florid thin blood is spit
 up.   There is generally  considerable tightness felt
 through the breast, and a flash of heat runs over the bo-
 dy: if the  case is severe, chills are also present.   Where
 a simple haemoptoe, occurs in delicate habits, depletion
' or low diet must by no means be continued more  than a
 few  days; and  if it is  even found  necessary to bleed,
 Avhich Ave must  never omit while the  lungs bleed, we
  should at the same  time advise a light but nourishing
 diet in small quantities:  give tonicks as nitrick acid,  or
 elixir vitriol; or decoctions of bark,  or cherry tree bark.
 The patient should use constant,  but gentle  exercise  in
 the open  air when the  Aveather is  good;  dress  warm,
 avoid stooping, laughter,  loud  singing,  or reading;  or
 sudden gusts  of passion,  or sudden motion.   But the
 lungs  should  be reasonably exercised by speaking or
 very gentle swinging. 
252              OF  BLOODY  URINE.
                    SUBSECTION II.

        A Spitting of Blood from the Stomach.

   This is generally owing to a rupture of a vessel in the
 stomach;  and the hemorrhage is known by the blood be-
 ing dark  coloured, and  attended  with heat or^pain in
 the stomach, mostly accompanied, by considerable chills
 and heat: if the discharge is great, it becomes of a bright-
 er  red, but  still there is  no particular affection of the
 breast.  This is almost always but a symptom of some
 other disease, to which we must turn our attention.  Ma-
 lignant fevers often lead  to hemorrhage from the stom-
 ach.  All stimulants must be avoided; mild mucilaginous
 drinks must be given; the patient bled, if there are no
 contraindications;  give small doses of rochelle salts, or
 epsom salts, or cremor tartar with mucilage of gum ara-
 bick; and Avhen the bowels are opened with these, assist-
 ed  by injections, give  a few doses of nitre.  But, in gen-
 eral, we may rest the treatment principally on repeated
 bleedings, cooling mucilaginous drinks, with a little ro-
 chelle salts.  The patient ought to take but little food,
 and this should consist of milk, or mild vegetables, for
 some days  after recovery.  In alarming cases  of this
 kind, I would give common salt, as recommended for
 spitting of blood from the lungs; or three, four, or five
 grains of sugar of  lead.

                  SECTION xxxvm.

                  Of Bloody  Urine.

  This disorder, perhaps, never exists as a primary af-
fection of the whole body, but is accidental, arising from
stones lodged in the kidneys, or bladder, or from  inflam-
mation in the  kidneys,  as in smallpox.   In our efforts
for  its  removal, we must  act on general principles, go-
verned by the disease,  or prominent  symptoms.   But in
general, the very liberal use of mucilage, as that  of gum
arabick, slippery elm, or flaxseed, or even milk and wa- 
OF A  BLEEDING AT THE NOSE.          253
ter, with emollient glysters; and if much pain attends, the
Avarm bath, or opium, or bleeding, according to circum-
stances,  will be proper, provided  no general disease  is
present to contraindicate their use; all stimulants are  to
be  avoided, but  especially, regard must be had to the
disease from which it proceeds.

                   section xxxix.

            Of a Bleeding  at the  Nose.

  A bleeding at  the nose is  often a symptom of other
diseases, as scurvy and other disorders; whatever mate-
rially depraves the fluids, or hurries the circulation, Avill
occasion a bleeding at the nose, in persons predisposed
to this hemorrhage. Where this occurs in healthy habits,
there is no danger to be apprehended; it may sometimes
be useful to suffer it to bleed a little.
  To  check it, the face may be washed in cold%Avater,
and Avater snuffed up the nose.  If this does not succeed,
pour cold water on the neck: and  immerse the genitals
in cold Avater; and if the case has not progressed too far,
bleed from the  arm.   The nostrils may be stopped with
lint soaked in strong vinegar, or a cord passed from the
mouth into each nostril; but this last is seldom necessa-
ry.  Should the  case resist all those remedies,  put lint
up the nose, rolled in  powdered blue-stone, and give a
small dose  of  ipecacuanha,  till nausea is  excited.  If
clots form in the  nose,  they ought  not to be removed for
tAvo or three days.  Frequent small doses  of nitre and
cremor tartar should be given;  cool drinks, Avith vinegar
or fruit jelly; the bowels opened by glysters, if necessary.
If the patient is  diseased, reference must be had  to the
remedies proper for the di-ea^e from Avhich the bleeding
at the nose may arise.
  Bleeding piles Avill be found under the head of habi-
tual diseases; and of bloody flux, I have treated already.
It remains here, to give some general observations on he-
morrhage. 
254    GENERAL OBSERVATIONS ON HEMORRHAGE.
                    SECTION  XL.

       General Observations  on Hemorrhage.

  I beg leave, in the most pointed manner, to differ from
Buchan in his opinions  respecting  hemorrhage being
most generally salutary, and therefore not to be opposed.
This has been a prevalent notion, and is founded on the
belief that, being the Avork of nature, it must  be salutary.
But is not almost all our prescriptions and remedies for
dieases at open war with nature?  In the case before us,
the examination has been but  superficial.  Thus a dis-
ease lurks through the whole system, depraving the flu-
ids, or disease is situated in the uterus, or about the rec-
tum, as in bleeding piles: owing to circumstances of some
kind,  these may be checked; the blood vessels receive a
neAV stimulus; they make an effort to throw  off this of-
fending stimulus, now operating on the Avhole body; but
disease is excited, and the blood, in its rounds through the
body, tries every part till a weak part is discovered, and
there  pours out blood at random.   But does she always,
or even in a majority of cases, choose parts that are safe?
Does she not frequently pour out the blood into the lungs,
stomach, and even the brain?   And is it not safer, then,
to assist  her  irregular efforts, and draw  blood from the
arm or foot?  Do Ave not know that hemorrhage is often
accidental, and having once, by a feAV repetitions, become
habitual, that it is ever liable to be checked, and thrown
on some part immediately essential to life?  Why, then,
suffer so dangerous and fickle a habit to be formed, Avhich
no prudence can confine, Avith any certainty, to any one
part of the system?
   I am well convinced, after this habit is once formed, it
would be dangerous to check  hemorrhages  too sudden-
ly; but in no case can they be critical at their commence-
ment, and therefore they ought to be attacked with spirit.
I feel fully justified in saying, that spontaneous hemor-
rhage is ever an enemy to the human constitution, if let
alone.  Besides, in this  case, we may, without perver-
sion of language, say, we MIoav up the hint given by na- 
       GENERAL OBSERVATIONS ON HEMORRHAGE.   255

ture, when we boldly  attack  hemorrhage.   If nature
shows  you blood  as an  evidence of plethora, or dis-
ease, Avhy leave her to repeat those struggles?  Why not
rather take the hint, and abstract blood, or othenvise re-
duce the system, and thus do more, in half an hour, than
the natural operations in  a month, or perhaps in a life-
time?
  Moreover,  such is often the violence which nature has
to exert in translating  hemorrhage from one part of the
body to another, that fever, pain, and  sickness, are the
consequence;  while one or two bleedings at such a time
gives not only present relief from  pain, but in a few days
infuses new life and vigour into the whole system.  These
observations  apply to  active hemorrhages,  or such  as
arise from a plethora, or  inflammatory diathesis.
  It now remains to say a feAV Avords on passive hemor-
rhages, or such as  arise  from direct debility:  these are
the consequence of depraved fluids, or languid solids, of
the living system.   Here  nature, forsaking every friendly
relation of the various parts of the body, would pour out
the purple fluid of life; not only Avithout reason or appa-
rent design, but really prejudicially throw it away.  True,
it may be urged, she shows the  danger  lurking in the
body, by presenting specimens of the  blood; but,  alas!
where  a tea  spoonful  would answer,  she would waste
quarts, and bring the sufferer speedily to his end.
  Upon the Avhole, I would advise those long subject to
hemorrhages, to go on  in the old way; but those who are
threatened in that way, I would most seriously admonish
them to attack every considerable hemorrhage with spi-
rit, and never let prejudice induce them  to believe, na-
ture ever designed that man should bleed from the anus,
nose, lungs, stomach, &c. This ridiculous notion comes
from the well knoAvn habits of the female, whose constitu-
tion was originally thus formed, but after all the menses
are no hemorrhage, but a  peculiar secretion, as taught by
professor Davidge, and hinted at by others.
  To conclude, although hemorrhages are to be treated
in some  measure  according to the  part affected, they
should nevertheless, be considered and treated on gene-
ral principles 
256   GENERAL OBSERVATIONS ON HEMORRHAGE.

   All hemorrhages are either active or passive; active
Avhen proceeding from plethora, or an inflammatory dia-
thesis; and perhaps all simple cases arise from plethora
or fulness of the vessels, while the more active ones pro-
ceed from some disease.   The  indications in all  those
cases are the same, differing only in force; they are de-
pletion brought about by abstracting blood; by increasing
all the secretions, by means of purges; cooling medicines,
and diluting drinks; and  by lessening  the  force of the
heart and arteries by exciting nausea; and in the inter-
vals, especially, by withholding the stimulus arising from
full diet, which may stimulate either by its  bulk, or too
cordial or stimulating  qualities.   So that Ave must use
mild vegetable or  milk diet; and not stimulate unduly,
even with those articles.
   On the other hand, passive hemorrhage is perhaps al-
ways the consequence of some disease, and few of  these
are to  be removed or relieved by a sudden stimulus given
to the blood or system, by cordials or stimulating articles
of diet.  We must in  general  proceed slowly and cau-
tiously, Avith light nourishing diet; never full nor gross;
Avith mild tonicks, as the  mineral acids; and vegetable
tonicks,  as bark, and ail pleasant bitters.
   After all, there is unquestionable evidence of the mine-
ral tonicks  having arrested hemorrhages, both active and
passive,  until remedies more permanent, because opera-
ting more generally, were  used.  Among these are sugar
lead, in doses of tAvo to five grains, Avith a little opium:
Avhite vitriol and opium.  I beg leave to observe lastly,
that every person subject habitually to hemorrhage, is in
some measure an invalid; and therefore, every one threat-
ened with this crippling of the constitution,  should get
the best  advice; and boldly resist this unfriendly guest.
And where the habit is in good measure formed, by pur-
suing a proper regimen, and wearing a seton, or issue for
a length of time,  this bad  habit may be removed. 
OF VOMITING.                257
                     SECTION XLI.

                    Of Vomiting.

   Vomiting proceeds from  a great variety of causes; it
 is a symptom of most diseases, as fevers, colicks, obstruc-
 ted secretions from sudden debility brought on by bloAv.',
 on the elboAv,* on the head, or from the sudden abstraction
 of blood. It is, however, often brought on by mere surfeits
 in eating, or drink, by sailing, whirling round, and many
 other causes.   In every case of vomiting we must, if pos-
 sible, discover the cause and regulate the  treatment ac-
 cordingly.  There is a vomiting in some measure habi-
 tual to some persons, Avho, notwithstanding,  in  general,
 enjoy good health; but in all cases, if long continued, the
 constitution is much injured by frequent vomiting.  For
 a vomiting brought  on by disease, as --gout,  hystericks,
 colicks, injuries done the brain, inflammation of  the kid-
 neys, intestines, liver; by ruptures; iniiammation of the
 stomach, or of the brain; from malignant fever, or chole-
 ra morbus; or from  hemorrhage,  we  can only prescribe
 with the greatest circumspection, and never till we have
 carefully considered the disease from Avhich it arose; and
 then prescribe  on general  principles,  bearing in mind,
 however, that even where it is but symptomatick, it must
 be appeased  by suitable drinks, glysters,  warm stimu-
 lants  applied  outwardly; by laudanum in  small doses;
 ether, gentle emeticks, wine, brandy,  aromatick  teas;  or
 cold infusions of aromaticks, as  cinnamon,  mint; lime
 water and milk, a little strong coffee, Aveak solutions of
 soda, or  salt tartar, more especially  impregnated with
fixed  air or carbonick  acid.   \t> must be  evident, that
much skill is necessary to apply such a variety of  articles,
 differing so widely in  their qualities,  even with safety.
 But if we bear in mind, that we are always to stimulate,
or lessen the excitement of the stomach, we can proceed
with considerable certainty: thus in gouty habits, in hys-
terical cases;  and in intemperate persons, we must stimu-
late according to circumstances.  In high excitement, or
indirect debility of the stomach, known by the  disease
              33 
258                 OF VOMITING.
present, by the constitution, and habits of the patient; we
must pursue an opposite course, and by bleeding, injec-
tions, cool pleasant saline articles, with mild aromaticks
lessen the force of the general circulation, and more es-
pecially lessen the excitement of the stomach.
   Where the cause of vomiting is unknoAvn, soda water,
prepared chalk, lime water and milk, a few drops of lau-
danum, or ether, with glysters, and outward applications,
will be the safest  articles; toast and water,  carefully
made, is also a valuable article in all cases.  A vomiting
brought on by surfeits in persons not otherwise diseased,
is most speedily removed by gentle emeticks, provided
they are taken early; but if  a cholera has come  on it
would be dangerous.   Vomiting from injuries of the head
generally yields to purging injections:  that from hemor-
rhage to rest, opium and cooling drinks: that from gout
to laudanum, warm wine with aromaticks,  or brandy,
ether, tincture  guaiacum, &c: that from hystericks to a
gentle vomit, followed by small doses of laudanum with
hartshorn, or ether: that from inflammation  in  the kid-
neys, to bleeding and mucilaginous drinks, with  emol-
lient glysters:  that from a rupture,  to its reduction. But
for the treatment in all these cases, I must refer the rea-
der to the respective diseases from Avhich vomiting may
arise.
   Vomiting from sailing, called sea sickness, seems to
proceed from a disturbance excited in  the brain, by the
peculiar motion of the vessel, and the operation on the
stomach is probably, a sudden loss of excitement and of
its excitability, and this most likely extends to the whole
system.   It appears someAvhat strange how a cause appa-
rently so trifling, should so  speedily prostrate the sto-
mach, and Avhole system.  That it proceeds from reduc-
tion of excitement, I  infer from the circumstances that
no pain or inflammation, or local disease of any kind, ever
follows sea sickness, and further, that depletion is neither
useful, nor safe.   It Avould appear as  though the healthy
connexion  or  affinities, between the excitability, and
stimuli, was suddenly disturbed, and probably more par-
ticularly in the article oxygen.  Thus if  Ave turn  round
suddenly, or sAving suddenly through  the atmosphere; or 
OF VOMITING.
259
if we stand on  a dangerous precipice, Ave Avill find, by
attending to the  circumstances, that respiration is espe-
cially interrupted, not by dispncea, but by mere neglect
of exercising the muscles of respirat!  n: the lungs Le in
some measure idle; and the energies of the body languish
for lack of the  usual  stimulus from oxygen.   If these
premises are correct,  the folloAving inferences  may  rea-
sonably be deduced from them:
   1. That free exposure to open air, with so much exer-
ercise as will rouse this torpor of the lungs, without in-
ducing fatigue, is one of the principal remedies for  this
disease.
   2. HoAvever much the stomach suffers, it is the third
point assailed  by  this distressing affection,  first,  the
lungs, secondly the brain, and thirdly the stomach. And
hence probably comes the inefficacy of all remedies  ap-
plied to the  stomach;  to remove all irritating substances
from the stomach, by drinking warm Avater or chamomile
tea, and afterwards taking small doses  of laudanum, or
Aery small  doses,  as  two or three table spoonfuls of
highly charged soda water will  probably give some re-
lief.   But Avhat would be the effect of inhaling vital air?
Or Avho knows but stimulating  the muscles of respiration
might have a good effect? This might be done by means
of electricity, or galvanism, or  rubbing the  spine,  the
sides, and abdomen, with spirits hartshorn,  or washing
those parts with a strong solution of salt amoniacum in
good vinegar.  I have already observed,  in my treatise
on consumption, that sailing was adapted to its inflam-
matory stage:  it would seem to follow,  upon the Avhole,
that turning round, and swinging of every kind, has an
effect opposite to exercise in  general, and therefore much
mischief may arise from swinging  consumpted patients,
or those otherwise debilitated, except the debility be of
the indirect kind, and Ave wish to reduce an inflammato-
ry diathesis.  It is true, in  forcibly sAvinging the oxy
gen is forced powerfully upon  the lungs, but this excesi
of force on lungs debilitated, may be as little suited to a
proper decomposition of the air, as the torpor,  or inacti-
vity of them, occasioned by sailing,  and other causes.
What might be  the effect of  frequent cold bathing  (by 
 260     OF A DIARRHOEA,  AND OF A LIENTERY.

 pouring cold water over the body, or applying cold cloth*
 to the thorax) in sea sickness?

                    SECTION XLII.

          Of a Diarrhoea, and of a Lientery.

   A looseness, or diarrhoea, may arise from a great varie-
 ty of causes, often from diseases, as acrid secretions of
 the liver, from debility in  the stomach and bowels. But
 mostcommonly it is occasioned by catching cold, Avhereby
 the secretions are obstructed;  or from eating or drinking
 articles which disagree with the first passages; and from
 irritation applied to various parts of the body, as teeth-
 ing in children, or worms  irritating the bowels.
   It is Avondrous strange it should ever have entered in-
 to the head of  any man,  that these discharges are sa-
 lutary,  and therefore to he borne, and rather viewed as
 friendly companions.  I admit, that,to a person Avhohas
 no knowledge of a suitable remedy for this complaint, it
 would be best to let nature alone.   But this is no more
 the case in diarrhoea, than any  other disease to which
 we are subject.   The truth is, that in many cases nature
 makes an unavailing effort to carry off  some offending
 matter within the body,  but this is seldom proportioned
 to the case, being sometimes too sparing,  and often too
 gre,at.  How are we to  expect Avonders  from nature in
 curing our diseases, when  we never  pursue her most ob-
 vious tracts,  when in health?  A pretty specimen of fol-
 lowing  nature  indeed,  search  the  globe for luxuries,
 gorge ourselves  with trash, in food, in drink, and pour
 doAvn hot,  and then cold, &c.   &c. and  when  nature
 would endeavour to throw off those dregs of imprudence
 or inattention, we are to call out,  let nature alone and she
 will cure you, all your efforts in bringing on disease, to
the contrary notwithstanding.  And Avhat a pretty com-
panion she gives you,  in  sending you every half hour,
perhaps, to enjoy the  perfumes of your  cloatick vault.
 She acts here as the spoiled child, and the more you
humour her,  the oftener will she send you on this disa-
greeable errand. 
        OF A DIARRHCEA, AND OF A LIENTERY.     261

   Let it not be imagined that I hold nature's efforts in
 contempt;  on the contrary,  I Avould  avoo her ever as my
jjjuide,  but not view her things Avithout a scrutinizing,
 eye,  in order to comprehend her  real designs.   Thus,
 if nature shows you by a diarrhoea, that there is lurking
 disease, Avhy not take the hint she gives you, and carry
 off the offending matter by increasing the secretions from
 the  use of purges,  emeticks, sudorificks,  and tempe-
 rance?  Or, if  nature  is overpoAvered, as is often  the
 case in all diseases,  why not support, and  aid  her, by
 means  of such articles as give tone or strength,  and thus
 arrest wasting disease?  Therefore, never let a diarrhoea
 run on; if you knoAv the cause, remove it, if  in your
 power; this you can ahvays  do in part.  Then, if  no-
 thing forbid, take purgative injections, or emeticks; live
 temperately: when this is done, try mild tonicks, as the
 mineral acids, bitter infusions, a little laudanum, &c.
   A purging is sometimes attended with' pain in  the
 bowels, some  fever, and considerable  thirst: in habits
 not subject to such complaints, or no particular debility
 to forbid,  we should bleed moderately, give castor  oil,
 rochelle salts,  or  other purges,  once  a  day, or every
 other day.   To conclude, mild glysters,  gentle purges,
 temperate  living, and dressing reasonably  warm, will
 generally do more in a feAV days, than the natural efforts
 in a month, or perhaps in a life time.'
   A diarrhoea that is in some measure habitual, Avill re-
 quire very little purging; mild glysters will generally
 remove the foulness of the intestines; then we are to en-
 deavour to give tone, by means of a  suitable diet, and
 mild astringents, as  bark, lime Avater, tar water,  elixir
 vitriol,  or pleasant  bitter  infusions; in  these  cases  a
 reasonable use  of old spirituous liquors,  best Avines,  a
 little salted animal food, reasonable exercise, warm dry
 feet, Avill be found useful;  so may a reasonable use of
 the bath,  either cold, tepid, or Avarm.   Lastly, it Avill
 generally be necessary to avoid a free use of vegetables,
 of malt liquors, large meals, wet or cold  feet, damp
 beds, close rooms, &c.
   A lientery is  a diarrhoea wherein the food passes oft'
 undigested; the  food appearina; Avhole. and in some r.isee 
262         OF  A GONORRHOEA, OR CLAP.

running through  the boAvels in a few minutes.   In these
cases very gentle emeticks, Aveak  solutions of soda, or
tincture of rhubarb, may be given, and  folloAved  by the
use of  elixir vitriol, decoction of bark  with magnesia;
bitter infusions ofcarduus, centaury, or chamomile. The
diet must be thin, light, and  well boiled; an excellent
diet in  those cases is milk boiled with a little crumb of
bread rubbed fine,  and a little horseradish grated into it:
ginger, mustard, and cinnamon, should be  used mode-
rately.
  It must be obvious, that in  all cases of looseness, so-
lid or harsh diet  must be avoided, as well as full  meals,
and also the free  use of spirituous drinks.  I have said,
cordial drinks are sometimes necessary;  but to be useful,
they must be used  sparingly,  or much injury will arise
from them;  they  give a present stimulus, hut debility
will always folloAv if they are  taken in large quantities.

                    SECTION XLIII.

              Of a Gonorrhoea, or Clap.

  The cause of this disease is  well knoAvn, and too of-
ten  encountered.   Its symptoms are smarting in making
water; a discharge of Avhitish,  yellow, or even greenish,
mucous matter, from the urethra.  There is considera-
ble   difficulty in   distinguishing this  disease from its
eldest  brother, the pox, or lues venerea, and therefore
it Avould ahvays  be best to apply  speedily  to an expe-
rienced physician.  If circumstances render that imprac-
ticable, these circumstances may be remembered, that
chancre or ulcer  on the  glans penis,  is a strong  symp-
tom  of lues; so  is any  very considerable inflammation,
swelling,  and pain of the glands of the groins.  A run
ning, swelled testicles,  inflamed  groins, pain  in mak-
ing  water, and fever, all arise, sometimes, from a clap:
these symptoms, however, yield  speedily to bleeding,
oily  purges,  mucilaginous drinks, &c.  Avhile venereal
buboes resist  for  some time every effort.
  Unless a clap is very  mild,  it is ahvays safest to take,
in conjunction  Avith the remedies for  this disease,  a 
OF A HERNIA HUMORALIS, &C.         263
little calomel and opium, for a few days.   The inflam-
mation in the urethra should be treated Avith mild injec-
tions, for a few days, as milk and water,  mucilage  of
best gum arabick, or very  clean mucilage  of  slippery
elm; then take one scruple of calomel, a tea spoonful of
honey, and three  or four ounces  of  water; shake this
Avell together, and inject a syringeful of it three or four
times a day.   If priapisms are distressing, take lauda-
num every  night.   If a gleet remains, take balsam co-
paiba; and  inject a weak solution of lead, as half a dram
of sugar, lead, in half a pint of water.   These things,
particularly,   are to  be attended  to  in clap; use a Ioav
diet, keep  the bowels open with  oil,  or  salts, or  rhu-
barb; take  one full  dose of jalap and calomel, bleed
once; use mucilage  plentifully; avoid venery and heat-
ing drinks.   And if there is any doubt of the nature of
the disease, take  calomel and opium,  and use the calo-
mel injection.

                   SECTION XLIV.

Of a Hernia Humoralis, or Inflammation and Swelling
                   of the Testes.

  This is a painful swelling of the testes, accompanied
generally with considerable fever." It arises from vari-
ous causes, as a translation of inflammation from  clap;
from astringent injections in  such cases;  from mumps;
very hard labour, &c.  Where the symptoms run  high
from whatever cause it may arise,  we must  bleed large-
ly and repeatedly;  give mild  opening  glysters;  cooling
physick and drinks;  enjoin  rest, cold applications  to
the scrotum,  as  a cold poultice  of  bread Avith  lead
water, or slippery ehn bark moistened.
  If the patient is able to go about, the  parts must be
suspended in a bandage in form of a cup,  and tied  Avith
strings to a bandage  round the body.   In  this disease
we must never cease to bleed till the pain is entirely re-
moved, unless constitutional debility,  or constitution  of
weather prevails,  which predisposes strongly to diseases 
264          OF A GLEET.—OF ONANISM.
 of a low  grade; here, after reasonable bleeding, we
 must trust the cure to rest, cold applications, and opium,
 given according to circumstances.

                    SECTION XLV.

                      Of a Gleet.

   A gleet, or thin discharge from  the urethra,  may
 proceed from  general debility, gout, or other diseases,
 but is more frequently the consequence of gonorrhoea or
 onanism.  In our efforts at cure,  the  principal indica-
 tions are the same.   Light but nourishing diet; the cold
 bath; riding on horseback and the use of tonicks; and
 the following will generally answer: take iron filings,'
 assafcetida  and myrrh,  each one dram; make this into
 pills of the usual size, and take three or four daily;
 drinking after each some pleasant bitter infusion. Along
 with these, as  constant  remedies,  the occasional use of
 balsam copaiba,  or small  doses of tincture cantharides,
 will be proper.   A  hard  bed, and moderate  anodynes
 at  night,  will be advisable; and  the boAvels  should al-
 ways be kept reasonably open. Anodynes should, ho\v-
 ever, never be given for any length of time; a little bark,
 or powdered Colombo root,  taken in cool water going to
 bed, would answer to alternate with anodynes.  It must
 be  obvious that where  the  cause is known, it must be
 avoided.   Gleets  are sometimes  accompanied Avith a
 smarting in the  urethral  in those cases  mucilaginous
 drinks should be taken, and very nice oil, or milk and
 water, injected into the urethra.

                   SECTION  XLVI.

                     Of Onanism.

  This  disease has  been knoAvn for many ages, as we
may read in Scripture of the case of  Onan.   Excess of
venery  is a dreadful and  common cause of dangerous
diseases, but self-pollution  is tenfold more destructive.
The excessive irritation which accompanies this act, ex- 
          OF PHYMOSIS, AND PARAPHYMOSIS.      265

 hausts or racks every energy of the brain, Avhich is con-
 cerned in the animal, vital, and  natural functions, and
 the mind itself scarcely escapes.   The first  consequen-
 ces, in  general,  are parapisms,  nocturnal emissions,
 gleet; these are followed by general  debility, indiges-
 tion,  hypocondriasis, and sometimes by paraplegia,  or
 palsy of the lower limbs,  and according to Tissot, and
 others, even instant death.
  No remedies  Avill succeed in removing this disease
 while the cause continues, and the best cure in general,
 if it has not been suffered to progress too far/  is matri-
 mony.   If circumstances  forbid this, by  avoiding the
 practice  Avhich leads to this disease,  and pursuing the
 plan laid down for gleets, Ave will generally succeed in
 making the patient tolerably comfortable. It is  said both
 sexes suffer from this vicious practice.

                    SECTION XLVII.

           Of Phymosis,  and Paraphymosis.

  A phymosis is  a painful contraction of the prepuce, or
 foreskin  of the penis.  Paraphymosis is a  painful stric-
 ture on the glans penis,  occasioned by a contraction,
 swelling and inflammation  of the prepuce, which has
 been drawn back over the head of the penis.   In chil-
 dren, those affections arise from a variety  of causes,  as
 uncleanness of  the parts,  irritation from handling $vith
 dirty fingers, from venereal taints:  and paraphymosis,
 from  imprudence  in draAving back the  prepuce  before
 the  parts  are sufficiently  grown.  But in  the  adulf,  it,
 perhaps, is almost in every  case, the effect of vinereal
 disease.
  The treatment  is pretty generally the  same, as res-
 pects this local affection.  Ii the symptoms run high Ave
 must bleed, apply leeches to the  part, warm  fomenta-
 tions; give cooling purges, low diet, mildest drinks: and
 in phymosis, inject milk and Avater,  frequently, into
 the  space between the glans penis  and prepuce.  If the
disease does not yield to this treatment,  the  stricture
must be cut, by slitting it so  far as  will give freedom  to
             34 
266
OF DRUNKENNESS.
the parts.  Nor must this operation be delayed too long,
or mortification may follow; but this must be left to the
surgeon if one is to be had; if not, it would be the safest
after  a trial of several  hours,  or  a day or two, of the
above remedies, to  venture to  do it  Avith a very sharp
penknife; this  must be entered Avith its back  next tha
glans penis, and the part slit with an outward cut.  The
emollients, &c. must still be continued, till the inflam-
mation is removed.
   In  cases arising from syphilis, it will generally yield
to a free  use of emollients,  and the liberal use of mercu-
rial ointment,  but the ointment used for this  purpose,
ought neither to be old nor contain any stimulant article,
as balsam, honey, turpentine,  &c. which are generally
added to this  ointment.  Quicksilver  and nicest fresh
lard,  should alone compose this ointment.

                   SECTION  XLVIII.

        Of Drunkenness,  or Self-Debasement.

   This is a disease known in  every age, and perhaps,
in every country.  It is one of the evils which mankind
choose to bring upon themselves; and its most usual cau-
ses are supposed to be the love of cheerful company; dis-
tress  of mind; want of sense in children, and idiots; lan-
guor  of spirits, or of the corporeal feelings, and neces-
sityVrom habits  thoughtlessly contracted,  which  ever
after  render this stimulus necessary.   Many circum-
stances may lead to a man's  getting  drunk once in his
life, and for which he may be excused, but drunkenness
as a  habit, is ever bottomed on infidelity.  In common
language we talk of being as drunk as a brute.  This
is a strange abuse of language, and of the  brute  tribe,
who in this particular is always man's superiour. I have
never heard of but  one animal being intoxicated, and
this was a goat who wholly disdained a repetition of it.
   Man alone is capable of transgressing every law, na-
tural  or  divine, by boldly turning himself  upside down
to lick up the dust of every  vice.   He who becomes a
drunkard, erects a temple to vice, and all the horrid sw- 
OF DRUNKENNESS.             267
perstructure rests  on infidelity.  We are commanded to
break no laAv; but he who wallows in the temple of Bac-
chus, built by himself, can keep no law.   Bacchus  ac-
knoAvledges no Avorshippers who do not renounce all other
gods: at least, Avhile in his presence.  Besides, no man
can worship tAvo masters; he Avill love one and hate  the
other; and it is especially true Avith  those avLo love  the
bottle. This is the most unhallowed  ground upon which
man can walk; and  the  deity has  marked every step
through  it Avith vice in all its most heinous forms;  so
that this crime is  seldom found alone:  and  instead of
being a cloak or excuse for other offences, it is the cause
of them;  and, therefore, ahvays  doubles offence,  in-
stead of lessening  it.   But, I forbear: it belongs to  an-
other profession to point out its heinous consequences,
in this Avorld, and more especially in that to come; while
to punish the offender belongs to the civil laAv.  It is  the
business  of the physician, in his usual garb of humanity,
to overlook the fault, and apply a remedy for the relief
of suffering man, under all circtynstances.
  If you find a man who has been  wicked enough,  or
fool enough, to get drunk, or a child umvittingly made
so,  a first consideration in such cases is a free current of
fresh air; if it is discovered at an early stage,  a  gentle
vomit of white vitriol  or ipecacuanha may be given; if it
is far advanced, it will be best to turn the patient on his
side, or on  his  belly, that he may be enabled  to  vomit;
and the stomach may  be left to empty itself; all garters,
handkerchiefs, and tight clothes, must be loosened;  and
if the patient is very far gone, stimulant injections of salt
and water  should  he  given.  We must never bleed till
the  patient has in good measure recovered, when it may
possibly be useful  in preventing congestions, particular-
ly in bad habits. It is never necessary, however, to bleed
largely; on the contrary, such a practice would be dan-
gerous.   But perhaps the only remedy generally neces-
sary, is throwing cold Avater on the patient's head until
he is sobered.  I have used this  in  many cases,  and in
some where the patients Avere entirely senseless,  and it
has always  given speedy relief.   I have  also seen quar-
relsome persons Avhen drunk, and about to fight, to get 
268               OF DRUNKENNESS.
to a pump, and by letting a good deal of cold water pasa
over the head become much sobered.
  I am much at  a loss  to  account for  the  manner in
which cold  Avater acts in these cases.   The following
seems the most satifactory to my  mind: it  operates hy
rousing the lungs from a state of torpor, and thus  infu-
ses neAV vigour into the system by means of oxygen.  I
also  imagine, that the prostration from  drinking ardent
spirits is  always occasioned by its operating primarily
on the lungs, impairing their  functions; and the brain
is thereby suddenly  subjected to a reduction of stimu-
lus, for want of  oxygen.   Hence it  would seem to fol-
low, that  the indication of cure is  to  restore completely
the  process of respiration,  and strength and  regularity
of action returns, liotAvithstanding there may be a con^
siderable  quantity of spirit upon the stomach; and all thi«
corresponds  with the  circumstances and  facts in the
case.
  It  has been a prevalent opinion, that persons once in
this habit cannot leave i4off Avithout danger.   This is an
errour; and let no man, surrounded by weeping, or per-
haps needy friends, weeping 0Arer his baseness, console
himself writh the notion  that however much he  may re:
pent having formed such a habit, that he no longer has
it in his power to retract. He should, he must, and may
safely retract, or else, wo be to the wretch, Avho, in spite
of every endearing entreaty, and every caressing invita-
tion  to the contrary, dabbles along until he becomes the
torment of his  friends, the indignant  scorn of strangers,
the cruoifier of his  own  body;  until his  conscience and
every faculty of the mind is seared as w ith a hot iron;
nor stops  the devouring foe till he has destroyed even a
moral faculty,  and leaves  the  filthy  body goaded Avith
resolve upon resolves; but fortitude has fled, neA7er to re-
turn till tea, coffee,  bitter  infusions,  cordial diet, mild
drinks of small beer, buttermilk,  milk and  water, and
active industry,  shall wholly change  the  constitution;
and  this  is  generally  but the  work  of a feAV weeks or
months.
  Let it not be said I colour the picture too high. If you,
reader, feel in reading as I  do in writing, you would 
OF HEADACH.                  269
agree Avith me, that, were it possible to banish drunken-
ness from the  world, it Avould be worthy martyrdom at
the stake.  If it is  not impious thus to speak,  what
praise, what glory would folloAV the man who Avowld die
at the  stake,  to save such a host of sinners!  But, thou
Mightiest, such  is  not thy  righteous providence: thou
hast infused light into each one, by which he shall  walk
in the light of  day, but stumble in the  s'ooiny strides of
night,  and answer,  at the mi^ty day, each one, for
the dark deeds done in the  derk hours of the conscience.
   Let me admonish every one,   then, to choose the
light, burnish  bright the conscience—like the  L,;ass of
the helmet,  it rusteth, and passeth away—the steady
practice of virtue shall burnish this faculty of the mind,
brighter than brass,  more durable than gold—and when
the bells of  death shall ring in your ears—its knocker
strike at your  bursting heart, this light shall  not be ex-
tinguished; for the science of alchymy applies alone to the
mind of man;  here lies the philosopher's stone, handled
skilfully, the conscience, more base than iron, shall wax
vastly  more precious than gold.

                   SECTION XLIX.

                    Of  Headach.

   Headach  is generally  *but a  symptom  of disease.
Where it is habitual, which is often the case, it mostly
arises from gout, or from  chronick affections of the sto-
mach.   It would be entirely useless  to speak in this
place of headach, as arising from  the various diseases
with which  we are  afflicted;  for in such cases regard
must be had to the primary symptoms.  Headach, how-
ever, sometimes  arises from debauch; from eating too
much;  or from  an article happening to disagree with
the stomach, or from sudden diminution of the secretions.
In all those cases it will be sufficient to take a little phy-
sick, a gentle emetick, or cleanse the stomach by drink-
ing plentifully of chamomile tea; and in healthy, or full
habits, to lose a  little blood.   I have been subject to se-
vere headach; I discovered it arose generally from eat- 
VtfQ                 OF HEADACH.

ing fresh pork, Avith turnips or cabbage;  by avoidii^j
those articles, I have not had it for many months.  The
only  speedy remedy which I found  for this disorder,
was a pretty full  bleeding.  The application  of cold
water or vinegar to the head will sqmetimes be useful,
and also bathing the feet in warm water.
   Upon the whole, headach is generally a consequence of
intemperance, or neglect to observe how each article of
diet agrees Avith us; or costiveness; and all those thingi
may generally be avoided,  and we thereby escape  thii
severe pain of the head.
   In  nervous headach,  Avhich is generally excited  by
something  disagreeing with the stomach, an opening in-
jection, and afterwards taking a few drops of ether, spirit
hartshorn, compound spirit  lavender, or a little elixir vit-
riol, in a small glass of cold Avater, will answer: smelling
at hartshorn, or lavender, will sometimes be useful. But
even here, if the symptoms run high,  a Aery mild emet-
ick, or a small bleeding will answer.  In obstinate cases,
irritation applied to the neck by scratching smartly, or
applying a Mister will be advisable.
   Vertigo or giddiness, and megrim  or a pain over on«
eye, generally accompanied Avith giddiness, are but vari-
eties of this disorder, and are excited by the same causes
as headach, and  require a similar treatment: these  af-
fections are most commonly the consequence of irregular-
ity of the bowels, in the decline of life, and yield best to
Avarm purgathycs, as tincture rhubarb;  heirapicrain spi-
rits; or a little castor oil taken in wine, or a little strong
toddy; if these do not relieve, we should in all cases, take
a little blood, and it is a fact that the aged bear small
bleedings Avell,  and  often derive great benefit from this
remedy in their diseases. In young persons troubled with
giddiness,  purging or bleeding moderately, or a gentle
emetick, will generally relieve them. They  should never
touch spirituous purgatives.  At all periods of life gid-
diness sometimes arises from fasting; for such  cases a
very little food should be taken, and a little interval left
before we make a meal,  for the stomach being generally
debilitated,  may easily be injured by  taking  much food 
OF THE TOOTHAGH.             271
before its action is in some measure restored, by means of
a little mild food; this  is infinitely  better than a dram,
which is too often taken for this purpose.

                     SECTION L.

                  Ofjhe Toothach.

  Toothach is very often connected with  a rheumatick
diathesis, but it also arises from caries or rottenness of
the teeth, and this is probably oftenerthe consequence of
some defect in the constitution, than of sweets or the rash
exposure of the teeth to hot, and cold,  articles of drink
and food.   I am inclined to believe,  that except from ac-
tual violence,  we seldom injure the  enamel of the teeth,
until the constitution is impaired, by  the manifold irregu-
larities which Ave practise.   Or Avhat is noAv, perhaps,
equally common, constitutional debility, which is inher-
ited.
  It is true that toothach in general, although dependant
on general  disorders, is so locally fixed on the teeth, that
it is to them alone Ave can apply a remedy.  I have sel-
dom seen any benefit arise from bleeding, purging, absti-
nence, &c: toothach sometimes is accompanied with fe-
ver, catarrh, headach, &c; in such cases bleeding, absti-
nence, and other remedies, which operate generally on
the system, may be useful.   But where we are not sen-
sible of other  symptoms of disease, Ave should always
confine ourselves  to local remedies.  If the tooth is hol-
low, a pill of camphor and opium, a little lint  moistened
with oil cinnamon, oil cloves, of peppermint, or a strong
tincture of the pricklyash berries, will often succeed.   If
it does not, or if the tooth is not carious, & pretty large
blister applied from behind the ear to a considerable wa\
on the under jaw, will seldom fail to  remove this painful
affection.
  The tooth ought noAV  to be plugged with metal, or for
want of an artist, gum mastick, wbite wax, or gum elas-
tick Avill answer.   Articles applied outwardly as hot as
they can be borne, are often useful, as scorched tow, or
a cotton cloth Tolled up and held to the cheek; but moist 
272             OF  THE TOOTHACH.

warm  applications ought to be avoided; they certainly
predispose much to catching cold;  in very obstinate ca-
ses a poultice of mashed potatoes, or a  poultice of bread
and milk, with a little camphor, aa ill give effectual relief,
if we are careful to avoid -catching cold.
   Should  all those things  fail,  the tooth  should  be
draAvn, for the  constant irritation of an aching tooth on
some constitutions, may be productive of much mischief;
nor is  it apt to leave the temper unruffled.  Aqua fortis,
or oil vitriol, or spirits  sea salt, should never be applied
to the teeth; if a caustick is necessary,  burning the  part
with a hotwire,  through a quill to avoid burning the lips,
will be much safer than'those acids, and equally effectual.
I shall conclude this  article by admonishing the reader
to avoid much scouring of the teeth with tooth powders,
or filing them.   Strict  cleanliness is at all times essen-
tial, and frequent brushing with a  soft brush and  cold
water, may he useful.  But I have no hesitation in  say-
ing, that  attention to such things  as improve the gene-
ral health, as exercise, temperance,  &c.  are more effec-
tual in giving health and soundness to  the teeth, than
all the dentists, and dentrifices in the world.   Let it not
be supposed  that  I  aa ish to throAV the least  shade of
censure or disrespect on the useful  profession here men-
tioned.  I  only mean that  by proper  attention to such
means as promote health, we should have less need of
the dentist.  But with  respect to dentrifices, I am clear-
ly  of  opinion,  that much injury has  been  done by an
abuse  of them, as Avell as by using such as are pernicious
in themselves.  Those who  are prejudiced  in favour of
dentrifices Avill  find a good one in the  list of medicines.
For gum biles,  the best application is a roasted fig kept
on the part, till the  suppuration  is perfected, when  it
must be opened if it  does not burst; frequent  rinsing of
the  mouth with very weak soda  water, or  some Aveak
bitter  infusion  will  be  necessary, and soon restore
soundness of the part.
» 
OF EARACH.                 273
                    SECTION LI.

                     Of Earach.

  Earach often arises from inflammation, from the sud-
den obstruction of some of tie excretions, and sometimes
from insects getting into the ear.  Where there is evi-
dence of inflammation av e  should bleed,  purge,  and en-
join  abstinence, and apply  blisters behind the  ears; if
the symptoms  progress notwithstanding  these remedies,
Ave may expect a suppuration, and should  apply poul-
tices of bread  and milk over the ear,  aud syringe the
part  Avell two or three  times a day, with a little warm
milk and Avater; and Avhen the abscess  breaks,  the  ear
should be tied up Avith a pleget of cotton or tow, and
frequently syringed Avith Avarm soapsuds for a feAV days;
afterwards, Avith chamomile, or sage tea.
  When it arises from taking cold, by which some of
the excretions are obstructed, a  little  cooling physick,
with bathing the feet, and  drinking a little  warm tea
going to bed, aud stopping  the ears with a little wool,
or cotton, Avill generally succeed.   When it arises from
insects, Avhich I have seen, Ave  will generally dislodge
them, if alive, by injecting Avar in oil, or weak campho-
rated spirits,  into the ear.   In all  cases of violent pain
in the ear, Ave ought carefully to examine the ear in a
strong light, and ahvays  pour oil into  the ear.   1 was
once  applied  to for a distracting pain in the ear,  in
which the patient described his distress to be extreme.
On inspecting  the ear,* I  discovered some fine threads
therein, this  induced me to  introduce a probe,  and I
soon entangled a large quantity of spider's web.   I now
threw in an injection,  and  a pretty large spider came
rushing out in full vigour; it had been there upAvards of
twenty hours, and  Avas so far entered  that I could not
see it,  though I examined iu a strong light.
   Another case occurred, iu my  practice, where one of
those  large  black  beetles,  commonly called  clocks,
Avhich  fly about in the evening, darted suddenly into the
ear of a gentleman.  He described his sufferings as be-
              35 
 274       OF INFLAMMATION OF THE EYES.

 ing extreme; the noise he  likened to loud thunder,  and
 an indescribable restlessness and horrotir,  which exist-
 ed, rendered his agony peculiarly great.   I drew  the
 insect from his ear by means of a flat probe bent at the
 end.  Had the accident occurred in  his sleep he would
 not have  had the least idea of the cause of his distress.
 Let this case be remembered; for, even in this case the
 persons in  company could not  believe  him,  until they
 saw the insect actually brought forth.

                     SECTION LII.

             Of Inflammation of the Eyes.

   This inflammation may arise from  a variety of causes,
 as dust, or small particles of stone,  wood, &c. getting
 into one or both of them, from the eye lashes turning in-
 Avards, from the hair pushing their roots too far inwards;
 the down from  the expanding leaf-buds in spring,  and
 riding through  the  woods  where Ave come in  contact
 with spider webs, is a very frequent cause  of inflamma-
 tion of the  eyes.  Acrid fumes  of aqua  fortis, spirits
 hartshorn, &c. will   sometimes  inflame  the eyes.  It is
 sometimes epidemical, and often passes through a whole
 family; most inflammatory  diseases inflame the eyes.
 Lues venerea sometimes brings it on in the most aggrava-
 ted form:  if is also obvious that it may often be the con-
 sequence of accidents, as the sting of insects, a stroke,
 &c;  much straining, or stooping; or improper straining
 of the eyes in viewing the sun, or other luminous bodies,
 or too  close looking at candle  light,  in  fine  sewing,
 reading, &c.
   In all cases of this affection, it is  particularly neces-
 sary to discover its  cause, and if possible avoid it,  and
 then the disease must in common be treated on general
principles.  Low diet, cooling drinks, avoidance of light
 and dust,  or the heat of  a  fire; and using cooling phy-
 sick, and frequently Avashing the parts in cold rose \a ater,
 or a Aveak cold infusion of chamomile,  Avill  generally
succeed.   If the case is violent, and does not seem to
yield speedily  to the above treatment, pieces of bread 
           OF INFLAMMATION  OF THE EYES.       275

soaked in cool weak lead Avater; or the pith of sassafras;
or slippery elm bark, soaked in cool Avater, may be tried
for a few days; and blisters applied to the  neck, and
behind the ears.   Leeches should  ahvays  be applied
freely about the eyes when much inflamed.  Should  all
the above  remedies fail, Ave may now  consider the  in-
flammation of a chronick nature, and a change must be
made in the treatment.
  I have found in all cases of  inflammation of the eyes,
where there seemed to be a vibration between acute and
chronick inflammation,  that washes of every kind are
either useless or hurtful.   The best remedies here, are
the free use of liniment of best oil of almonds and nice
clear fresh  lime water;  or  the same oil Avith a very little
sugar lead in it.   In the more inveterate cases,  warm
poultices of bread and milk; or  a blister applied  imme-
diately  over  the eye lids, in conjunction  Avith the lini-
ment, should be advised.   Blisters should never  be ap-
plied over the eye, in recent  inflammation:  at any rate,
not till we  reduce the patient by bleeding, purging, ab-
stinence, &c.
  I am well conviuced that much mischief is done to  the
eyes, not only by applying eye Avaters too  strong, and
with saline matters in them that chrystalize, or dry into
salts; but also by  continuing  watery  moisture  of any
kind too long.  Thus,  for instance, Ave make a  strong
wash of sugar lead, of Avhite  vitriol, &c.  Ave apply this
freely to the eyes,  the heat dries up or  rather evaporates
the fluids,  and leaves the  saline matter on the eye, and
thereby produces much irritation instead of lessening  in-
flammation.  I am  convinced from experience that whe-
ther the above explanation be correct or not, vast injury
is done by  washes of sugar lead, and white vitriol,  in
active inflammation of the eyes: and  I am certain,  the
practice  Avould  be improved  if Ave  were to reject those
things  altogether,  and substitute in their place, the cold
mucilage of  elm,  and  sassafras pith, cold  milk and
water, rose water, or cold infusions of chamomile flowers.
And in cases somewhat advanced, mild liniments: those
cases still  more chronick, sugar lead, white  vitriol, or
laudanum and water, may be used Avith good effect.  But 
276
OF AVANT OF  APPETITE.
even here, it is highly probable, brandy, or laudanum di-
luted according to circumstances, Avith water,  av ill su-
percede  the necessiiy of all saline articles, and 1 most
seriously recommend to every person, to try those reme-
dies first; and I hope on trial, it aa ill be found a  great
improvement in ophthalmick inflammation.  It remains
to remind the reader, that in all cases of recent inflam-
nation of  the eyes, the  Ioav est possible diet; cooling
drinks, pretty  free bleeding; and cooling purges,  and
careful avoidance  of light, are especially requisite, to se-
cure the  sight.

                     SECTION LIU.

                  Of want of Appetite.

  Want of  appetite  is  occasioned by many causes, as
intemperance in eating and  drinking, want of exercise,
grief, or the pressure of any of the passions on the mind,
too gross  a diet,  the immoderate use of  tea, coffee, to-
bacco, or opium, and from constitutional debility. Want
of appetite attends all febrile diseases, and  most others;
in this condition of the body, appetite is by no means to
be desired, and therefore what I say respecting appetite,
is to be understood as relating to persons avIio are labour-
ing under no particular disease, and able to  attend to
their business.
  In general, the  first and principal means for its remo-
val, are sufficient exercise, and strict temperance in diet,
as well as drink;  then a close examination of the respec-
tive articles of our food,  and  aa e  Avill  often  find it
owing to the use of some article of diet, Avhich disagree!
with  the stomach.  We must, in general,  avoid grea-
sy, or sweet articles, warm bread, or cakes containing
fat, or butter.   A spare diet should be used for a few
days, and if this„  with a little cooling physick, does not
relieve, the  elixir vitriol in water will often succeed.
If the case is obstinate,  a gentle vomit ay ill be necessa-
ry.   In languid constitutions, the tincture of bark,  Avith
a little ether, will succeed admirably.  Pleasant bitter
infusions are mostly useful.  Where  it proceeds  from 
       OF THE HEARTBURN, AND WATERBRASH.     277

 the passions, we must try by all means to avoid their in-
 fluence,  by travelling, keeping company,  or application
 to business.
   Upon the av hole,  they who live temperately, and ex-
 ercise reasonably, Avill seldom suffer from  Avant of appe-
 tite; and if  nature should languish a little in this respect,
 we need not be  over anxious, but leave a little to time
 and abstinence.  But there are cases Avhere the stomach
 becomes Aveak from the use of too poor, or  scanty diet; of
 this, persons of common sense can judge best themselves,
 and they will seldom find any thing necessary but a gra-
 dual improvement in their diet; making it reasonably sti-
 mulant,  by  increasing the quantity of animal food, and
 condiments, as pepper, mustard, &c: and  sometimes by
 taking a little good Avine,  or even brandy.   But those
 stimulant articles can never be useful to young persons,
 except for a few  days, as medicine, on a debilitated sto-
 mach: their constant use will impair  the digestion of
 such people.

                    SECTION LIAT.

         Of the  Heartburn, and Waterbrash.

  The heartburn is a disease of the stomach, notwith-
 standing the absurdity of its name; and it is  generally
 accompanied Avith waterbrash; Avhich last, is a fluid col-
 lection upon the stomach   someAvhat acrid,  generally
 acid,  sometimes mixed with bile.  Heartburn may pro-
 ceed from any thing which  impairs the tone of  the sto-
 mach; it is sometimes attended with nausea, or vomiting,
 or a  considerable Aoav of watery fluids from the mouth.
 It often attends pregnant women; distress of mind, or
 any thing Avhich debilitates  the stomach, or the general
 system, may excite it.  In severe cases it will be ne-
 cessary to open the boAvels with rhubarb and magnesia:
 then the use of a little magnesia, or calcined  magne-
sia, a  little  milk, or milk and lime Avater, cheAving a
feAV kernels of peach stones,  a little sweet spirit nitre
in cool Avater, a few drops of elixir vitriol in  water, or
 t little soda  dissolved in  v.at^r, Avill !re;jerally succeed: 
278
OF THE HICKUP.
 but permanent relief is only to be  expected from exer-
 cise,  and close attention to that kind of food, and drinks,
 which agree best with the patient.
   This disorder is mostly  habitual, and a symptom of
 dyspepsia, or chronick debility of the stomach, to which
 I must refer the reader for further instruction.  I  beg
 leave to admonish every  person who values his health,
 or prospects in life, to ahstain from  spirituous medicines,
 or  drams,  for this affection  of the stomach;  they, in ge-
 neral, will  eventually do more mischief than the dis-
 ease.  It is  true,  a dram of rum or brandy will for a
 time, force  the stomach into  action,  but at each repeti-
 tion,  it loses more and more this effect, till  a man  may
 drown his stomach in spirits,  and obtain no benefit, but
 increasing harm.  To persons in the decline of life, they
 ate often useful, and mostly safe.

                     SECTION LV.

                   Of the Hickup.

  Hickup is mostly a symptom of a disease, and seems
 to be a  spasmodick  affection of the stomach and dia-
phram.  It arises  from various causes, as diseases of
 the stomach, brought on  by malignant, or Ioav fevers;
from  poisons; scirrhus; or injuries  done some of the
viscera; it  also  frequently  arises  from indigestion, or
from swallowing much dry food, as crust of bread.  We
should  always, if possible,  discover  the cause, and
adapt the  treatment  to the  circumstances.  Where it
proceeds from violent disease, in its last stage,  it is al-
ways  a dangerous  symptom; a little  milk and lime Avater;
magnesia rubbed in cold Avater, and a very little cinnamon
Avater or oil anise; or a few grains of soda, Avith a  little
mint,  nutmeg, cinnamon; or a little cardamum seed pow-
dered fine and mixed with cool water.  Brandy, or lau-
danum, should be rubbed over the region of the stomach;
or mint pounded and laid on.  A spoonful of milk will
sometimes succeed, SAveet spirit nitre; or ether, in  small
doses, or a  few drops of laudanum, or sometimes a
glass of very good wine,  or wine  whey, will succeed; 
OF CRAMP OF  THE STOMACH.         279
 we should apply a blister over the stomach in severe ca-
 ses.  Where it arises from overloading the stomach, an
 opening glyster; a few drops of elixir vitriol in water,
 or  drinking a glass of cold Avater, very leisurely, or a
 glass of soda water, Avill generally succeed.   If they do
 not, a gentle vomit,  or cathartick, should be taken.
  Where it arises from poisons, or wounds,  mild muci-
 laginous drinks  should be taken, and  such remedies
 used as are suited to expel, or destroy the poison.   To
 the mucilaginous drinks in cases of wounds, we  should
 add the use  of opium or laudanum,  and keep down in-
 flammatory symptoms,  by bleeding and  cooling injec-
 tii.ns.   For  hickup  arising in a healthy stomach, from
 en ling dry food, or a little too much common food, a sud-
 den call, or drinking a little cool a\ etcr very leisurely,
 will generally be sufficient; if not, a ;;retty full dose of
 magnesia should be taken.  I  conclude by most solemn-
 ly admonishing  every person, to refrain from drams in
 such cases.  Unless  it be in  the decline of  life, it Avill
 invariably lead  to mischief.

                     SECTION LVI.

             Of Cramp of the Stomach.

  This affection is  occasioned by gout, and is  apt to
 come on suddenly, attended with much  danger: and it
 may arise from irregular gout under appearances of hy-
 pochondriasis, or  hystericks; from strong vomits; and a
 slighter kind of it, sometimes attends pregnant women;
 and, it is, also, in some measure habitual in aged per-
 sons, Avho have been long affected Avith dyspepsia, or ir-
 regular gout.  In all seA7ere cases of cramp in the sto-
 mach, we  should give laudanum largely; open the boAV-
 els by mild injections; get the patient, as soon as possi-
 ble, into the warm bath.
  If it be from gout of long standing, and more especial-
 ly, if in the decline of life,  and in persons accustomed to
the use of ardent spirits, brandy must be given with free-
dom; the feet should be bathed in warm  water.   In fe-
males Avho have not been accustomed to  ardent  spirits, 
280       OF THE NIGHTMARE,  OR INCUBUS.

ether in pretty full doses, Avill be a safer remedy.   If it
arise from pregnancy, the bowels should be opened with
injections, and a little blood taken; or if the habit  is re-
duced, a few drops of laudanum may be  taken;  after-
Avards  magnesia,  or rhubarb, must be used to keep the
boAvels open.
  In persons predisposed to this disease, the occasional
use of whole mustard seed, will answer a good purpose,
and if taken going to bed, will lessen the liability  to at-
tacks in the night, its most usual time of attack.  Where
it arises from a strong vomit, at its commencement, it may
generally be removed by drinking plentifully of  warm
Avater,  and applying  hot Avet cloths to  the stomach,
bathing the feet, and giving glysters.   But if it has pro-
gressed till  the patient is  much  prostrated, these  reme-
dies would  be  dangerous;  laudanum alone should be
trusted, and it should be repeated every five or ten min-
uies, till it answers the purpose.   If it is not to be had,
Avin* whey, or toddy, should be given, and efforts made
by  purging glysters, to open the bowels, as soon as
possible; or a few drops of sweet spirit nitre, or com-
pound spirit lavender, may be giA^enfor Avant of laudanum.

                    SECTION LV1I.

           Of tlie JVightmare,  or Incubus.

  This disorder attacks persons in  their sleep, and in
its most  severe form, distresses with ideas of danger,
such as imagining they  are  about to be torn by animals,
or stabbed, or shot at; about to fall from dangerous  preci-
pices; or bestrode by some vicious creature, av hich  keeps
us from  moving; from these Ave  make desperate   efforts
to escape, by getting away,  or by hallowing, or striking,
&c.  The  immediate cause of this affection is probably
some obstruction in the blood, from debility of the  heart,
or other parts concerned in the  circulation.  And its
most usual  cause is debility, arising from great fatigue^
or such as  is constitutional.
  That overloading the stomach at supper, may occasion
this disease, I have no doubt, but I  am well convinced 
OF THE NIGHTMARE, OR INCUBUS.       281
an empty stomach is  more dangerous to  such persons;
they should  by no means  overload the stomach, nor
should they ever retire to bed Avithout some  solid food
upon the stomach.  Its cause in most cases is constitu- *
tional debility; and, anxiety or Avant of exercise, or fa-
tigue, or intense  study, aa ill excite it; so will sleeping
with the clothes on,  especially garters, handkerchiefs,
&c. It may also ar se from indirect debility in full habits.
  Whatever is calculated to invigorate the conslitution,
as temperance, exercise, &c.  is calculated  to remove this
disorder.  All sensualities,  fatigue,  kc. must  be aAoid-
ed.   The cold bath,  and the occasional use of prepara-
tions of iron, bark, and elixir vitriol, Avill sometimes be
highly useful.   Those of full habits must lose blood,
and take a little  cooling physick.   Persons  subject to
this disease  should not sleep alone, or  at least, they
should sleep in a room Avhere there  is some other per-
son; and enjoin upon them, in case of moaning or hollow-
ing, that they shake or call  the sufferer, till he answer;
this may probably sometimes prevent death, in such cases.
  There is a milder  form of this disease, in  which the
patient imagines himself to be flying, or jumping, Avith all
the sang-froid of a merry-andrew, over rh'ers, houses,
trees,  &c. and generally concludes  with  a self-compli-
ment for having performed great feats,  before admiring
multitudes.    Sometimes, hoAvever,  he  soars  too high,
and the jaunt becomes painful, and terminates  in strug-
gles similar to those of common incubus.  Persons long
subject to nightmare,  are generally entirely, conscious of
their situation, and while they endeavour to rouse a bed-
fellow, Avho they desire, most anxiously, to shake them,
they still  are unable  to stir even a finger; but by great
exertion they either moan or breathe aud ably, till they
recover, or rouse up some person  to their relief.
  To conclude, Avhatever  invigorates the  constitution is
the remedy for incubus.  But I cannot dismiss this arti-
cle, without cautioning the reader against  a horrid prac
tice sometimes recommended:  the  taking of  drams  at
night, in order to prevent it; such a practice may possi-
bly sometimes keep off this  disorder, but in most cases,
it will bring the devil in its  stead.   If the stomach re-
              36 
282          OF SAV00NINGS, OR FAINTING.
quires a late stimulus, take a little Avhole mustard seed,
bark, elixir vitriol, or a little well boiled onion, or a pill
or two of assafcetida and iron filings.

                    SECTION LVIII.

             Of Swoonings, or Fainting.

  Fainting appears to be a sudden prostration of the an-
imal functions, while  the  vital, though  impaired, still
perform their office.   Its causes are various, as loss of
Mood, fright, excessive  fatigue, or weakness either di-
rect,  or  indirect, long fasting, violent affections of the
mind, breathing air of crowded places, which has lost a
part of its oxygen.   It also may arise from, sudden ex-
posure to a stove-room, or fire, after having suffered much
cold.  I have seen it brought on, once, from swallowing
a spoonful of hot  soup: the person lay in a deep swoon
for a  few minutes; he then  arose, and made no  further
complaint.  It is often excited from striking the elboWj
so as to injure the ulnar nerve.
  In  all cases of fainting, it  is essential,  in the first
place, to give the  patient free access to  the air; if they
sink in a crowded room,  or a room too warm, they must
be carefully and speedily removed, cold  water,  or vine-
gar and water, may  be sprinkled or thrown in the face;
the body must ahvays be laid  straight,  and with but a
very small elevation of the head.   If the place is warm,
fanning will always  be necessary; hartshorn, spirit lav-
ender, or burnt feathers, may be held to  the nose.
  If fainting is  alarming from its long continuance, we
should give spirits hartshorn, spirits  lavender, or ether;
or,  for want of these, a little Avine, or spirit and water.
And if it occurs in full habits, we should bleed as soon
as the patient is somewhat recovered, for fear of conges-
tion; and it may be well to open the  bowels, and avoid
whatever may have  occasioned  the fit.   Where it pro-
ceeds from exhaustion, as from hemorrhage, flooding in
childbed, kc. the patient's safety often depends on the
strictest quietness: a little exertion, at such a time, may
destroy  life:  we should give a little  Avine,  with a fe\v 
       OF FLATULENCE, OR WINDY BOWELS.      283

drops of laudanum, as soon as possible; and a little salt-
ed meat, or nice fish, or a little panada, Avill be advisa-
ble.   We must always bear in mind, that there is much
danger to be apprehended from stimulating too rapidly;
therefore,  in  all cases, Ave  must give our remedies  in
small quantities.  Where it arises from sudden distress
of mind, it Avill generally  be sufficient to rouse the pa-
tient by volatiles applied to the  nose; and when  some-
what recovered, let the patient drink freely of some mild
drink, to promote perspiration.
  Persons Avho have fainted should never be bled Avith-
out the the advice of a physician.  All such as are lia-
ble to faint easily, should avoid croAvded places, more es-
pecially in the summer.  Let it be remembered, that in
all cases, Ave must  give the  patient free access to fresh
air, lay the body on the back, and not raise the head too
much; throw water in the face: the last remedy must not
be continued long;  if it does not succeed, volatiles must
be used. Many persons have been lost,  for want of those
simple remedies, and more especially, where they have
been suddenly raised  to a sitting posture,  by  Avhich
means, the aa eight of blood is throAvn too much upon the
languid heart, and lungs,  and destroys the patient.
  Persons Avho have fainted, should indulge themselves,
for a day or two, and live on the lighter  kinds of diet; al-
ways  remembering  that, where there is much languor,
from exhaustion, the diet should be cordial, and consist-
ing pretty much of animal  food, if there is no strong con-
traindications, from an inflammatory  diathesis,  Avhich
sometimes attends persons labouring under debility.
  To conclude, frequent fainting is an unpleasant and
dangerous occurrence, and the best advice should be had,
to discover its cause, and  remove that  state of the sys-
tem, which may predispose to  it.

                    SECTION LIX.

          Of Flatulence, or Windy Bowels.

  "This  disorder mostly troubles persons who do not use
sufficient exercise,  those who study intensely, or whate- 
284           Or CHILBLAINS AND KIBES.

ver tends to impair the tone of the stomach, or general
system.   If it arise from costiveness,  a  pretty free use
of magnesia,  or mild glysters, aa ill be  necessary.  We
must endeavour  to use such articles, as agree best with
the stomach,  and in general, it will be found much ve-
getables cannot be used; potatoes  and well boiled on-
ions, are  mostly the best; and the frequent use of dry
water biscuit, and a very little salted meat once a day,
with proper exercise, will be principal remedies towards
per nanent relief.   This affection is mostly accompanied
by acidity, arising from indigestion, which suffers a spe-
cies of fermentation to take place.  As palliatives, the
following articles will generally ansAver: take soda half
a dram, oil anise, or peppermint five  drops,  rub this a
little, and add ten table  spoonfuls of cold Avater; of this
a table spoonful may be taken occasionally.   Or, take
magnesia tAvo drams, and treat it in the same manner;
of this a table spoonful aaUI be a dose, and if too thiok
for some persons to swallow, a little more water may be
added.   A little strong ginger tea, a tea spoonful or
more of ether, or sweet  spirits of nitre, and in some, car
ses laudanum, aa ill give relief. The use of the iron pill,
which Avill  be found in the list of medicines, or the elixir
vitriol in Avater, or tincture of bark,  with ether will be
excellent remedies.
   Lastly, avoid drams; they may spur  up your stomach,
but  soon  lose their effect, and never fail  to impair the
tone of the  stomach of young people.    The  aged will
often find relief in those cases, from taking tincture rhu-
barb, or heira picra, dissolved in good old  whiskey or
spirit.

                     SECTION LX.

               Of Chilblains and Kibes.

   There  appears to be some ambiguity in the applica-
tion of these arbitrary terms. I shall speak first of kibes,
as a disease of the heels; it proceeds, perhaps; in all cases
from exposure to frost, or much wet applied Io the feet;
snow water in particular.  It  is a  paiuful affection of 
            OF CHILBLAINS AND KIBES.          285

the heels, but, something similar occurs about the toes,
in some cases; the symptoms  are  swelling, intolerable
itching, small Avhey  coloured  blisters, crackings of the
skin, like cuts: it occurs in Avinter, and  is most trouble-
some when the patient becomes warm.   Apply equal
parts sweet oil and spirits turpentine, tAvo or three times
a day,  and wear a plaster of some mild ointment, and
in general, such  persous,  even children, ought to Avear
boots in time of snow, or wet Aveather, and these should
be Avell oiled or Avaxed. Roasted turnips are sometimes
applied, they may be u-eful in casts Avhich have been
suffered to  run on till there is high inflammation, but
they should never be applied in recent cases.  Vinegar
containing  a  considerable quantity of sugar lead, is a
good remedy: a  liniment of lime Avater and sweet oil,
will sometimes succeed.
   Chilblains maybe excited in the same Avay askibes,
by dabbling Avith the hands in hot Avater, or too much
handling of saow, or suoav Avater, and also by slight frost
bites.   But I suspect, this is often a humour connected
with some constitutional defection, and is someAvhat sim-
ilar to ringAvorm, and  humours v. ich occur about the
periiueum.  Chilblains is  a violent itching and cracking
of the skin of the  palm of the hands, in particular, or on
the fingers, or other  parts, these dry up noAV and then;
a new  itching comes on after an uncertain interval, and
is soon followed by Avhey coloured blisters, cracks in the
skin, &c.
   The same remedies may be applied here,  as  directed
for kibes, particularly a very strong Avash  of sugar lead
and vinegar, or a weak solution of arsenick may.be used:.
frequent Avashings Avith castile soap and Avater; or lime
Water and sweet oil, may  be applied.  But  persons  af-
fected Avith chilblains  should take a little cooling phy-
sick, particularly cremor tartar Avith a great  deal of mu-
cilage noAV and then, and  perhaps that of the slippery
elm is  best; nice  gum  arabick, or other mucilage, may,
howeve  be used. The diet must be temperate, and the
drinks of the mildest kinds, as milk and  water, butter-
milk,  infusions of burdock, sarsaparilla, or sassafras,
but these should be  very Aveak, and taken Avhen cold. 
286            OF HERPES  IN  GENERAL.
                    SECTION LXI.

               Of Herpes in general.

   There is a great variety of this affection of the skin:
I shall mention a few necessary distinctions.
   1.  Herpes simplex,  a dry mealy eruption, which af-
fects  various  parts of the body, sometimes confined to
the knees, or face, &c.
   2.  Herpes miliaris, or ringworm, mostly on the face.
   3.  Herpes zoster, or shingles, encircling the body.
   All these appear to be but varieties  of the same dis-
ease.   Where they have become  habitual, it is useless
to apply outward remedies; here mild diet consisting of
a good deal oi milk; taking occasionally a little cooling
physick, as cremor tartar, alone, or mixed with sulphur
or magnesia; the use of mucilaginous  drinks, and fre-
quently Avashing the parts affected with mild soap and
water, and after drying the part well, it may be dusted
with  prepared chalk,  starch, flowers of sulphur, or pe-
nt vian bark.
   A course of mucilage of slippery elm  Avater, and small
doses of FoAvler's solution, may he safely tried, but the
arsenick must not be continued long at a time; two or
three  Aveeks, in small doses will be sufficient at one term,
but it will often be necessary to repeat.
   The ringworm  may, however, generally be removed
by outward applications:  a strong  solution of sugar lead
in vinegar; rubbing with green walnuts, or an ointment
of white precipitate.  Sometimes a liniment of sweet oil
and sugar lead will answer, or a very weak ointment of
corrosive sublimate, Or a solution of corrosive sublimate
in lime water, or a blister applied over the part.
  4. Herpes syphiliticus, or venereal eruptions.
  5. Herpes pustulosus, or the milk crusts of infants,
the scaldhead, and other ulcerous  affections of the skin.
  For the treatment of syphilitick herpes, the reader is
referred to the article on syphilis; for that of milk crust,
to the diseases of children; it remains, then, to say some-
thing  respecting scaldhead. 
OF SCALDHEAD, OR TINEA  CAPITIS.      287
                    SECTION LXII.

          Of Scaldhead, or Tinea Capitis.

  This is a  dreadful scabbing and ulceration  of the
head, mostly in children, and is mostly theyconsequence
of filthiness, or gross feeding.  To the unpleasant symp-
toms of violent itching, scabs, and ulcers, is soon added
an abundance of lice; these, Avith the matting of the hair,
render the disease as disgusting to the sight, as  dread-
fully tormenting to the patient.  If this disease is early
attended to, a feAV careful washings with soapsuds, tAvice
a day,  and,  after drying the  part, applying a pretty
strong ointment of red or Avhite precipitate, or of tobac-
co, Avith a feAV purges, and mild  diet will seldom  fail
to arrest it.
  If it has progressed, we must proceed with caution;
the boAvels should be opened, the hair cut away, or care-
fully shaved  off; the  head well Avashed  tAvice a day Avith
soap and Avater, and a poultice of carrots and yeast ap-
plied for a few days; then the head may be dusted with
well powdered fresh charcoal, and this  succeeded  in  a
few days with sprinklings of bark, at first, containing a
little poAvdered savin leaves, never, however, forgetting
to continue the washing, nor to give cremor tartar, or
magnesia, Avith mucilage, so as to  keep the bowels well
open.  In violent, neglected cases, we should commence
the washings Avith milk and Avater, for a day or two, and
must never, if the Aveather is cool, neglect to keep a Avarm
cap  on the  head, after, removing the  carrot poultice.
The lice will cause  much irritation, and must carefully
be sought after and removed.
  Almost instant death has followed the rash application
of tobacco, and other violent things, to the head exten-
sively  ulcerated  and inflamed.  And in other cases, dan-
gerous diseases  of the eyes, ears, and  general disease,
as fever, and even dropsy of the brain.  I have always
found the course above laid  down to be successful  and
perfectly safe.  If there  should be a translation of this
disease, we must give a little brisk physick, as jalap  and 
288    OF PIMPLES IN THE FACE.--OF THE ITCH.

calomel, bleed according to circumstances, as Sever or
pain require, and apply blisters on the neck; and if there
is much  apparent  danger,  Avarm fomentations, and an
onion poultice may be applied, or linseed meal may be
made into a poultice and applied.

                   SECTION LXIII.

              Of Pimples in the Face.

   These need  no  description, but are sometimes very
troublesome. Persons much troubled Avith these pimples
should avoid too much  singing,  stooping,  exposure to
the heat of a fire or stove; all spirituous drinks, as Avell
as fermented liquors,  are to be avoided, and much ani-
mal food.  They should lhre on a diet consisting a good
deal of milk and vegetables, and  drink nothing hut cool
water, milk and water,  buttermilk, or vinegar and  wa-
ter.   A little cremor tartar, and flowers" sulphur, or mag-
nesia, should be taken,  to keep the bowels open,  and a
free use, new and then,  of mucilage of slippery elm will
be found useful; afterwards the pimples may be rubbed
with flower of sulphur in the  evening, and washed  off
in the morning; or rubbing them with sweet cream,  and
Avashing off Avith castile soap and water; or wash the face
with sour buttermilk, or a decoction of  sour dock; but
these must be applied cool.

                   SECTION LXIV.

                     Of the Itch.

   The itch is most generally the companion  of those who
live uncleanly, but by contact Avith  the  matter of it, it
sometimes  invades  the  most cleanly  families, affecting
all its members before  they  are aAvare of  its nature.
This eruption  is found  particularly about the fingers,
elbows, hams, but in tender skius it rapidly  spreads over
the whole body; and  I have even seen it in infants, not
only excessively tormenting, but  really dangerous.  It
may  be known by its regularity of appearance;  while 
OF THE ITCH.
289
 other eruptions change colour frequently, this  goes on
 sloAvly, and regularly to increase, and  it is in the even
 ings when Ave undress, that it is  particularly  trouble
 some.   The little Avatery pimples  which appear about,
 and particularly between the fingers, and which contain
 a thin fluid, may be considered as sufficient evidence of
 itch.
   Philosophers have amused us with their speculations
 about animalculse, resembling ticks, turtle, kc.  I shall
 not stop to acknoAvledge or  deny those notions, for  if it
 be caused by animals of diminutive size, #am sure they
 are vicious little gluttons; and as they prejpon our living
 bodies,  we should destroy them Avherever Ave find them.
 This I  know to be true of itch,  that dirty families  can
 seldom  be free from it,  and I strongly suspect, clean-
 liness alone would eventually hauls h it  from society.
   The  most speedy and effectual  remedy for  itch, is
 flowers  sulphur mixed with lard,  and rubbed on the
 parts affected, every evening.  A strong ointment of Avhite
 precipitate, is a very good application for this affection of
 the skin.   Or an ointment of red precipitate, or  of Avhite
 hellebore, or a Aveak wash of oil vitriol in Avater. Wash-
 ing the parts with soap andAvater, and after drying, rub-
 bing with dry flowrers of sulphur, or starch containing a
 little very fine powdered white hellebore. In inveterate
 cases it  may be necessary to take a little floAver  sulphur
 and cremor tartar, so as to keep the bowels open, and use
 a course of the mucilage of elm.
   Lastly, bed clothes, apparel, and in short, every  arti-
 cle of the household  must be  perfectly cleaned, and kept
 so, or you can never banish  this disease of the  skin for
 any length of time.  In delicate persons it Avill be safest
 not to rub too much of the body at once, but go over it
 gradually with the ointment.   Quicksilver ointment is  a
 dangerous, unnecessary, and very often an ineffectual re-
 medy, and ought never to be used  by persons exposed
 to the weather. Nor should persons exposed to the wea-
 ther use the other ointments  too freely: I have seen a
case of severe salivation, from the use of the red  precipi-
tate ointment, applied on account of itch.
              37 
290 OF  PRICKLIHEAT.—-OF YELLOAV MORPHEW, &C
                   SECTION LXV.

                   Of Prickliheat.

  Pricklibeat bears some  resemblance to itch,  but  is
more fiery coloured when the body is warm, and  almost
disappears Avhen the skin is  cool; not much about the
fingers, and more equally distributed over the body than
itch.  Its usual causes are, uncleanness of the skin, sur-
feits in eating-gtnd drinking, too much acidity on the sto-
mach, and sudden exposure to extremes of temperature.
Use mucilaginous  drinks  Avith cremor tartar and sul-
phur; or magnesia and rhubarb.  A tepid bath, and fre-
quent changes of linen, or flannel next the s\m, and
avoiding all irregularities av ill be necessary.

                   SECTION LXVI.

  Of the Yellow Morphew, or Morphcea Icteroides.

  This disease of the skin principally  affects persons of
delicate constitution. It generally begins about the breast
and neck, and from thence spreading  very slowly over
the whole body, gives the skin the appearance of deep
sun freckles; but wherever it  appears the scarfskin  is
raised, and may be easily rubbed off", leaving a red spot;
upon this the same yellow scarfskin soon appears again.
Sometimes it appears in the face, but this is very rare.
  From its long continuance, it no doubt has some con-
nexion Avith some visceral  disorder, and this I suspect
is always the liver; no discolouration is seen in the eyes,
and so far as my information goes it is  not dangerous.  It
very probably is more owing  to slight debility  in the
functions of the liver,  than  to any real disease in that or-
gan. Sulphur, applied in ointment, will remove it spee-
dily, but it returns, and probably  nothing  but remedies
which operate on the Avhole system, so as to give tone
and vigour, will remove it, such as reasonably good liv-
ing, with constant  exercise, and perhaps,  the occasion-
al use of tonicks, and of mucilaginous drinks.   Cleanlh 
OF THE LEPROSY.
291
ne'ss is essential, but T suspect bathing is generally im-
proper for such persons, for there is an openness of the
skin which causes it to absorb Avater. This I suspect from
the following  circumstance:  I have been affected with
this eruption for  many years, and ever since, if I go in-
to the water but a feAV minutes, my skin  feels tense and
unpleasant, and gives considerable impediment to walk-
ing for some time after it, and if I remain for more than
a few minutes in,  I  become enfeebled, and  sickness at
stomach, and sometimes very severe vominng succeeds.
I have been less sensible of these symptoms from the
cold bath.   Such persons should wear flannel  at all
times, and in the Avinter, two ply of flannel  should be
worn, for they are predisposed from this openness of the
skin, to pulmonary affections, and suffer particularly from
cold moisture, or even duckings from rain.

                   section lxvii.

                   Of the Leprosy.

   This disease  does not often  appear in this country,
but instances do sometimes occur.   It  is a great scourge
to the eastern nations, but I suspect it is mostly the off-
spring of uncleanness.  The diseasejs known by a very
extraordinary thickening of the skin,'cracks,  Avelts, dry
prominences, with a whitish scurf constantly  forming, a
weeping which issues from these cracks. The whole ap-
pearance of the skin at some  distance, is something like
a light mouse or lead colour.   But there is nothing more
characteristick of this disease, than the thickening of the
skin.  I have seen but one case of it, the subject Avas a
Frenchman, a young mechanick who  had just made a
trip to Orleans, from the Ohio, and came by the Avay of
one of our seaports. During this long journey, he was sub-
jected to a great variety of water, and no doubt Avas not
sufficiently cleanly in changing his linen, &c.  Immedi-
ately after his return, he was attacked with a bilious re-
mitting fever, then prevalent, and Avith it came the lepro-
sy.   He was the patient of a physician of great experi-
ence. Avho politely asked me to see the case with kina: 
292
OF AVORMS.
every endeavour Avas made to relieve him, his fever Avas
subdued, but the prostration Avas too great for him  to
contend  with this  horrible leprosy;  and after  suffering
a feAV weeks he died.   ,
  I do not feel competent to lay down the best treatment
for this  disease, at any rate advice should be taken.  I
will, however, state, here, as my opinion, that the utmost
cleanliness and frequent  washing  with mild  soap and
water, Avith the liberal use of mucilaginous drinks, mild
tonicks and diaphoreticks, as sweet spirits of nitre  taken
two or three times a day,  and succeeded with cold infu-
sions of bark, snakeroot, or contrayerva, are among the
principal remedies.

                   SECTION  LXVIII.

                     Of Worms.

  I beg  leave, in the first place, to observe that this is
the hobby of quacks,  old women, and mothers.   What
cramming and  stuffing have I seen practised on  ooor lit-
tle  children,  suffering under  diseases,  sometimes no
doubt, incases in which worms had no concern.  Even
agues, inflammatory fevers, &c. must be treated as though
eATery child Avas likely to be eaten up with  these Avorms.
And it is a fact as strange as it is true, that many, very
many mothers are to be found, who will cram their chil-
dren, and by force too, with-pink root tea, garlick boil-
ed in milk, worm seed and its oil, soot, rue, &c. that will
turn their faces against every thing Avhich they call doc-
tor stuff; should it even be a few grains of ipecacuanha
or prepared chalk, unless you assure them it is for the
worms.   Thus, if a child have a bad breath, it is Avorms:
if it grind  its  teeth in  sleep,  it is worms: if it eat too
much, or if it has little appetite, it is  worms: if its  upper
lip  sAvells,  it is worms: if it start in sleep, has a purging
whether  sick or well, it is worms.   Iu short, such  is the
ridiculous infatuation of people about Avorms,  that few
children  are safe, even under the care of the most skil-
ful  physician, for in almost every family,  they  will give
Avhat they consider  vermifuges, by  which the stomach 
op worms.                 293
and bowels are rendered weak and irritable, or fever, or
inflammatory affections of the viscera, the head, &c.  are
so much aggravated, that no skill can avail.   Reader!
I speak without prejudice, for I have  no favourite  no-
tions to offer, but I have beheld such wicked and prosti-
tuted exercise of parental authority, that my heart bleeds
for the poor little sufferers, Avho smart under the ignorant
regimen, of worm mothers, and worm doctors.   I will
answer for it, if  your child is full of worms, it is your
OAvn fault: give children such diet as they ought to have;
keep them clean, and  let them exercise freely, and you
may spare your trouble, and much risk  to your chil-
dren.
  If a child  is labouring under a pleurisy, or inflamma-
tion of the head, or if inflammation exists about the liver,
bowels, &c. Avhat greater risk could you expose your
child  to,  than  to give  it strong  pink  root tea,  oil
wormseed, aud  such like heating articles;  thousands of
children are thus detsroyed.   I  would admonish every
head of a family, that they  should never give worm
medicine without good advice, Avhen their children are
sick, and most sacredly folloAV directions; Avhen they are
well it is not often needed.
  The only certain sign of worms is their appearing in
the stools, or being vomited up, and it must he admitted
that they sometimes produce  disease, both in children
and adults, particularly the tape  Avorm.  The following
are the most common kinds Avhich are found.
  1. The teres, or common round worm, resembling the
earth worm.
  2. Ascarides,  or small thread like worms, particular-
ly troublesome about the rectum.
  3. Taenia, or tape worm: there are many others found
in the  human intestines, but they are rare, and will yield
to such remedies  as are proper for the  expulsion of the
three kinds  enumerated.  Where advice is not to be had,
the following symptoms may be considered pretty strong
evidence of worms: a sudden swelling of the upper lip,
provided the subject is not scrofulous, frequent pains  and
uneasiness in the bowels without fever, irregular appe-
tite.  If these  or other symptoms leave strong grounds 
294               OF A STRANGURY.
for believing Avorms are present, a purge of jalap and cal-
omel may be given,  provided the patient  is not labour-
ing under a Ioav state of disease ; this Avill generally dis-
lodge more or less of  them, and we may hoav venture,
provided no inflammatory  disease  forbids, to give oil
wormseed, powder of tin, pink root, rue, garlick, or a lit-
tle salt water, always remembering to work those articles
off, with castor oil, or jalap and cremor tartar.   More
than one or two doses of calomel should not be given, in
those cases.
   Those habitually troubled with  worms,  should take
pills composed of equal parts of tin powdered,  and assa-
fcetida, made into pills.  Or any other tonicks, as bark,
bitters,  iron filings,  elixir  vitriol,  &c.   They  should
avoid unripe trash of fruit,  or green herbs:  and  live on
solid wholesome food,  and for a time, delicate children,
or perhaps others, will be benefited from an occasional
glass of good  old wine:  exercise and sound nourishing
food, in small  quantities, are the best preventives.
   The ascarides are sometimes excessively troublesome
on account  of the itching, they produce about  the seat,
and as they are situated so low down, are more difficult
to dislodge by medicines.   Glysters  alone wTill remove
them speedily: glysters containing a good deal  of salt
will  sometimes succeed, or two or three table  spoonfuls
of SAveet oil, and  a  feAV drops of oil Avormseed, in the
usual quantity of water; or a little aloes ground in water,
or lime Avater, or a strong decoction of wormseed.

                    SECTION LX1X.

                  Of  a  Strangury.

   A strangury or difficulty of  passing urine, proceeds
from various causes, as stone or gravel, from injuries
done the abdomen, from diseases, the application of blis-
ters, &c.   In all  cases we should open  the bowels Avith
emollient  glysters, give mucilaginous drinks; and now
and  then, a tea spoonful of sweet spirit  nitre.   If these
do not succeed, Ave must have recourse to the warm bath,
or bleeding; according to  circumstances.   In reduced
patients where much pain accompanies this affection, we 
          OF ISCHURIA.—OF ENEURESIS, &C       295

must give laudanum.   In general, the use of linseed or
parsley tea, with sweet spirit nitre, will relieve.

                    SECTION LXX.

                     Of Ischuria.

  Ischuria is a term which seems to  have a much more
extensive  application than that of strangur.   It is  ap-
plied to obstructions of urine from every cause, as dis-
eases  of the kidneys,  ureters,  bladder or strictures of
the urethra.  In all cases of ischuria, we must  careful-
ly ascertain, whether the disorder be a retention  merely,
as in strangury, or Avhether the  kidneys have ceased to
perform their functions.  By feeling gently on the low-
er part of the belly,  we  may feel the bladder full and
tense, and  the  presure gives the patient pain:  here, it
would be improper to give the patient  diuretick drinks;
we must either bleed, give emollient glysters, apply Avarm'
fomentations, or the  warm  bath, according to circum-
stances; and, if these do not succeed, a catheter  must be
introduced,  and when the  water is  drawn off, gentle
purges, and mucilaginous drinks, and SAveet spirit nitre
may  be given; and in aged persons,  a very free use of
horseradish is necessary.   If there is no Urine found in
the bladder from pressure, we must  give mucilaginous
drinks, mild glysters and purges.   When it proceeds
from diseases, as inflammation of the kidneys, or ureters,
or bladder, or the stone, &c. the reader is referred to the
treatment in such cases.

                   SECTION LXXI.

    Of Eneuresis, or a Habit of wetting the Bed.

  This disagreeable habit is sometimes found in grown
persons, and there is some probability of its arising from
neglecting to correct  children for this practice.   But
while I give it as my  opinion that this habijt is often es-
tablished by neglect,  I have no doubt but it is often a
disorder,  over which the person  affected has no  control, 
 206     OF DISEASES OF THE ORGANS OF SENSE.

 and therefore  measures for correction should never be
 extended to cruelty.  We are  assured by Cullan,  that
 blistering the perincenum has often succeeded in remo-
 ving this disorder.   I would recommend  it to be tried,
 in preference to the many ridiculous articles which have
 been used:  but I think it highly probable  that the tine
 ture cantharides would answer our wishes.

                    SECTION LXXII.

          Of Diseases of the Organs of Sense.

                    SUBSECTION I.

                    Gutta  Serena*

   Is a deprivation of sight, without any very evident
 defect of the eye.   It is a loss of nervous power, and
*most generally an incurable disease.  Sometimes, how-
 ever, it may be removed where it proceeds from inflam-
 mation, or from  congestions, or Avhat is called humours
 about the eye.   It sometimes proceeds from a hardening
 or wasting of the optick nerve: all such cases are hope-
 lc-ss.   But as the most skilful cannot judge of this in the
 living eye, and as this disorder has sometimes been cured,
 we should in all cases indulge hope, and use our best en-
 deavours, particularly at an early stage; and as diseases
 of the eye are  only to be distinguished by skilful occu-
 lists, the earliest opportunity should be taken to consult
 a person who is  competent, otherwise we may easily do
 ourselves irreparable mischief.
   There never can be any necessity for persons prescrib-
 ing for themselves, in cases of gutta serena, but it may
 save  them  from imposing  quacks,  &c. to describe the
 disease, and point out some principal remedies.   There
 is a glassy, dead-like appearance of the eye, the pupils
 mostly considerably enlarged,  but after the  disease is
 confirmed, it is sometimes very small.  If the eye is held
 shut  some time,  and then opened in a strong light, no
 change occurs in the pupil; whereas, in an  eye where
 the nerve is sound,  it dilates while the eye is shut and 
OF A  CATARACT.               297
 dark, and contracts rapidly when the light is admitted
 to the eye again.
   In the early stage of this disease  mercurial  purges;
 blisters to the neck; and, in full habits, bleeding from the
 arm, and leeches applied about the temples.  When it
 is more confirmed, a salivation, a seton  in  the neck, ce-
 phalick snuff, Avith a little calomel added  to it.  Take
 white hellebore in fine  powder half a dram,  sage or
 other green leaves well dried two drams, calomel half a
 dram;  rub  these fine, and  use  frequently as  snuff.  In
 some cases gutta serena is accompanied Avith constitu-
 tional  debility, and Avith scrofula,  Avhich would render
 it unsafe to give strong purges,  or to salivate.  In those
 cases Ave should use the seton, the  cephalick snuff, and
 tonicks, as bark; iron, with the gums; and  if no strong
 symptoms of scrofula are present, calomel in small doses,
 combined Avith  tonicks.  In all cases of gutta  serena,
 we should use electricity, or rather galvanism,  as soon
 as the more inflammatory symptoms are  removed.  And
 in cases accompanied with scrofula, the extract of  hem-
 lock should be given, accompanied with occasional mild
 purges, in full habits; and Avith tonicks, where there is
 much debility.

                    subsectio#n 2.

                   Of  a Cataract.

   In cataract the optick nerve remains healthy, but vision
 is lost  in consequence of the chrystaline  lens  turning
 white, or clouded, so as  to prevent the rays  of light from
 reaching the retina or optick nerve, at the bottom of the
 eye.   When confirmed, it gives something like  the ap-
 pearance of a speck upon the eye to the unskilful.  If the
 eye is held shut, and then opened before a  strong light,
 the pupil contracts rapidly before the  light.  Such peo-
 ple can always distinguish day from night.
   No outward  applications can be of any  use in these
 cases, and they have often done much mischief.   In the
 early stage, we  should  use the same remedies as  for
gutta serena, but when the disease is confirmed, nothing
             38 
298     OF A STRABISMUS—OF SPECKS OR FILMS.

but an operation affords the least hope.   I have known
instances  of severe applications being made, under an
idea of specks on the eye, when it was a cataract, entire-
ly out of the reach of all such remedies.   In all diseases
of the eyes, it is particularly necessary to get good ad-
vice, early.  Diseases of this organ, require prompt and
poAverful treatment, and  a little errour may be destruc-
tive  to vision.

                    subsection  3.

            Of a Strabismus, or Squinting.

   This affection of the eyes is too well known to require
any  description.   It is generally occasioned by expos-
ing  children to the light in such a manner, as  to let it
shine into one eye only; often it proceeds from imitation,
therefore, nurses who squint, may excite this unpleasant
disorder among young children.   When it is early at-
tendedto, Avearing goggles Avhich oblige the child to look
straight forwards, will often remove  squinting:  it must
be obvious, such children should be removed from per-
sons of this habit.

                    SUBJECTION  4.

          Of Specks or Films upon the Eyes.

   These  are generally the consequence of violent inflam-
mations, and often succeed smallpox, the measles, inju-
ries done the eye, &c.   I suspect most of them proceed
from neglect, or improperly treated inflammation.  In
recent  cases, while active inflammation continues, we
should by no means use vitriol, white sugar, alum, and
many other things of this kind,  which are often recom-
mended;  they are ahvays attended with danger, and oc-
casion total blindness in some cases.  Instead of these
violent articles, two or  three brisk  mercurial purges;
blisters to the ears, and neck; and a liniment of best oil
almonds  and fresh  clear lime water, are the best rem-
edies. 
     OF THE BLOOD SHOT EYE--WATERY EYE, &C.  299

   If the case is confirmed, and inflammation removed,
 benefit may sometimes be derived  from using strong vi-
 triol water, made  by dissolving Avhite vitriol in  water;
 or, a little  alum and white sugar, rubbed tiil you  cannot
 feel their particles, may be bloAvn into the eye.   These
 are ahvays very doubtful, and I have never seen any ad-
 vantage from them,  in my own practice.   Nor  have I
 ever failed in cases proceeding from common inflamma-
 tion, in arresting these specks at an  early stage, by purges,
 blisters, free use of warm milk and water, and the lime
 water liniment.  See the article, Inflammation  of the
 Eyes.

                   SUBSECTION 5.

               Of the Blood-Shot Eye.

   This is occasioned by many causes, as strokes upon
 the eye, straining in vomiting, coughing, and often from
 intemperance in drinking.  If pain and inflammation fol-
 Ioav, Ave must have recourse to such remedies'as are re-
 commended  for inflammation of  the eyes, from  otlier
 causes.  Washing the eye Avith cold mucilage of  elm,
 Avill often succeed, if not, Ave should apply leeches:  take
 a little cooling physick, live Ioav, and if these do not suc-
 ceed, Ave should use brandy, beginning with it consider-
 ably reduced, and gradually augmenting  the  strength
 till it answers the  purpose, or till  we use the strongest
 brandy Avithout dilution.

                   SUBSECTION 6.

         Of the Watery, or Weeping Eye..

  This is  generally owing to neglect or badly treated
 inflammation; sometimes it proceeds from, relaxation, and
 debility of the vessels of the eye, and this from scrofula
or other  constitutional debility.  Sometimes it is OAving
to an obstruction of the lachrymal duct,'by which the
tears that are constantly forming to moisten the eye, (and
then pass into the nose,) are thrown out upon the cheek. 
300
OF DEAFNESS.
The use of general strengthening remedies, and temper-
ance, aAToiding much candle  light Re wing, or reading;
with frequently washing the part with brandy, or a very
clean filtered infusion of bark.  When it proceeds ijom
an obstruction of the lachrymal duct, nothing can be of
the least  service, but an operation, by which we restore
the passage for the tears into the nose, this obstruction is
called fistula lachrymalis.

                    subsection 7-

                    Of Deafness:

  The ear is liable to many accidents, which interrupt
its functions, or  impair  or  destroy its structure.   Dis-
eases, catching cold, wounds;  too much or  hardened
wax;  too much moisture; or malconformation of the ear
may occasion deafness.   When it proceeds from disease,
we must in general keep our views upon the disease, and
leave the symptom of  deafness to nature.  But if it re-
mains after the disease is removed, or when it proceeds
from an unknown cause, by examining the ear, we will
often  find  it choaked up Avith Avax; too dry, or weeping
out a thin fluid.  In all those cases the treatment may he
nearly the same, and must be very simple.   Syringe the
ear frequently  with milk and water,  or mild  soapsuds;
stop the ears Avith avooI,  or cotton, and drop a few drops
of oil almonds, or nice SAveet oil into the affected ear, ev-
ery night.   Blisters should be applied, and repeated, but
I most seriously caution  every person not  to tamper with
the inside of the ear; its structure is delicate, and easily
injured, therefore, the best advice should be taken.  We
are told  by the celebrated Cheselden, that a gentleman
in England had four children born deaf, he was advised
to apply blisters to the ears of his future children.  He
did so, and three were born and thus treated, and all had
their hearing.   Does this not leave a hope that congeni-
tal deafness,  if early discovered, might  be removed by
blisters, electricity, or other remedies, under  the direc-
tion of a skilful physician. 
OF DEAFNESS.
301
  What a lamentable fact it is, that we luwe no schools
for the dumb in  this country!   Hoav has it  happened
that no good heart, in devising aud executing plans, for
the comfort of their fellow creatures, or honour of their
country, should not have chosen this humane and neces-
sary measure, for  the  vast  number  of dumb persons,
which are in a good measure useless to themselves and
to society; and indeed, often rendered vicious  from ill
treatment, or  for want of understanding those around
them!  If some humane person, or persons, Avere to set
about this great Avork,  by  raising a small fund,  some
gentleman of talent might  soon be got to teach such a
school, aud scholars no doubt would soon accumulate.
After the success of Mr. Braidwood, and since at Lon-
don, it really is  surprising no such  schools have been
attempted in this country, at least none within my knoAV-
ledge.  I recollect reading somewhere, an interesting
account of a young gentleman who was sent from New-
York, to  Mr. Braidwood's school in Edinburgh, which
I consider one of the  most agreeable narrations upon
earth.
  Let a fond parent imagine their unfortunate child, sul-
len, stupid, vicious, or rash and aAvkward: Avho like the
animals around him has no movements of the sweet little
tattler, to express his Avants, his thankfulness to his  pa-
rents, nor of knowing, and acknowledging the goodness
of Him Avho made us, as sent to a school where he shall
not only learn to read and Avrite, but speak in daylight,
with fluency;  and what greater source of pleasure, praise,
and gratitude could they find.
  Would it not be worth your while to rest upon  a pil-
low  of straAV, and live on  bread and water, to obtain
such a gift for your unfortunate child!   But more espe-
cially, Avould it not be Avorth the attention of every cler-
gyman, and every society, to endeavour to found schools
for such persons, and make' them free to the poor, and
even maintain such as require it?   Surely, if the Lord
repays gifts  given to  the poor,  this must be  one which
will  never reap less than "thirty, sixty, or an hundred
foU." 
302  LOSS OF THE TASTE--OF THE LOSS OF SMELL.

   It is Avith peculiar gratification I mention, that, since
the first  edition of this work, a school  has been  estab-
lished at Hartford, in Connecticut;  ou  a very extensive
plan, by which, it is hoped all the dumb persons  of the
whole nation may be  accommodated, for a considerable
time to come.

                    SUBSECTION 8.

                  Loss of the Taste

   Is generally the consequence of some disease, but no
doubt this sense is often impaired by intemperance,  and
too high  seasoned food.  We must endeavour to find out
the cause, and avoid it if possible.   If this defect exists
in Aveakly habits, or is accompanied \vith palsy, we must
use such remedies as are calculated to invigorate  the
constitution; apply gentle galvanick  shocks; or simply
chewing horseradish and beets, alternately, will probably     }
often  have a good effect, for, galvanick piles, of v  eak
powers may be made of these roots; or you  may gargle     f
the mouth with a  decoction of seneka snakeroot.  In
cases Avhere an inflammatory state of the mouth, or gen-
eral  system exists, Ave must  pursue an  opposite course,
such as sipping frequently mucilaginous drinks; taking
a little cooling  physick, and if much  foulness  of  the
mouth, or nausea  are present, we should  give a gentle
emetick,  and use a mild vegetable diet.  In all cases it
will be essentially necessary, to  keep the mouth perfect-
ly clean, by frequently gargling Avith mild stimulant gar-
gles in cases of Ioav action, and in the inflammatory, with
milk and water.

                   subsection 9.

                Of the Loss of Smell.

   This sense is often  destroyed by the use of tobacco;
or inflammation, suppuration; or by the nervous poAyer
being impaired oi* destroyed, or suspended  by polypus
in the nose.  In general, it will be best to content our- 
           OF LOSS OF THE SENSE OF TOUCH.       303

selves, in this disorder, Avith frequent Avashing, by means
of a syringe, or snuffing up the nose milk and water, or
mild soapsuds; and attending particularly to the general
health.   In polypus, a surgical operation alone, can re-
move either the polypus, or restore  the  smell.  Stimu-
lants, as  different kinds of cephalick snuff, or pungent
articles, may somestimes be useful, but there never need
be any particular hurry in those cases, and therefore ad-
vice  should be had.

                   SUBSECTION 10.

            Of Loss of the Sense of  Touch.

   This perhaps is always a symptom of palsy, and there-
fore, is to be treated on general princir ies, as  laid down
for that disease.  There is, however, a, morbid acuteness
of this sense  dependant on irritath a, applied to some
part  of the body, particularly the  stomach, as in hypo-
chondriacks; this too, must be treated on general princi-
ples, as laid doAvn for hypochondriasis.  The cold bath,
or tepid bath, according to circumstances, will be neces-
sary in most cases. 
OF HABITUAL DISEASES.
I AM now about to enter upon a set of diseases, which
are known to lurk in the body, and are easily excited, by
a variety of causes, into activity for  a  time, till having
expended their force, the patient gradually returns again
to his usual health, and this in many cases, is very per-
fect until some little accident, or irregularity lets it loose
upon the system  again.   Or such as having grown out
of some epidemick, or fortuitous disease, continues with
more or less violence to distress during life, as scirrhous,
cancer, and other diseases.
  I shall  commence  my observations  on  habitual, or
chronick diseases,  wdth gout, and treat of  its varieties,
as legitimate gout, irregular  gout, and chronick Rheu-
matism.

             SECTION L--SUBSECTION  1.

               Of a Legitimate Gout.

  I believe a true or legitimate gout is mostly heredi-
tary, or occasioned  by the intemperate use of ardent spi-
rits, and perhaps,  more frequently by the immoderate
use of wine, and  malt liquors, together  with want of ex-
ercise.  But in those strongly predisposed to gout, the
most trifling causes may excite it.   Such as fatigue, idle-
ness, a full meal, catching a slight cold, or it may be ex-
cited by disease, intense thinking, and many other causes,
so that persons subject to gout, or who have reason to
expect it, from their ancestors having been severely affect-
ed Avith it, must use the utmost circumspection, to guard
against this most  cruel foe.   The attacks of the gout are
supposed to be most usual in the spring, or beginning of
winter. 
OF A LEGITIMATE GOUT.
305
  As there is a great similitude behveen the grade of dis-
eases of the United  States, and those of Sydenham's
time in England, I have copied his description of the
gout.  He says, "this distemper comes towards the lat-
ter end of January, or the beginning of February, and
begins commonly about two in the morning, with a pain
in the great toe, but sometimes in the heel,the ankle, or
the calf of the leg: immediately a chilness, shivering,
and  slight fevers succeed, the pain  increases gradually
every hoar, and chilness and shivering abate in propor-
tion  as the pain becomes more severe, which at length
comes to its height toAvards night, sometimes resembling
a violent tensiou, sometimes the gnawing of a dog, and
sometimes a weight and constriction of the parts affected,
which  becomes so exquisitely painful, that the  patient
cannot bear the weight of  the cloches upon it, nor the
shaking of the room from a  person's walking briskly
therein. The pain does not abate till two or three the next
morning, that is twenty-four hours from the beginning of
the fit, when the patient being in a breathing sweat, falls
asleep, and at waking finds the pain much abated, and
the part affected  neAvly sAvelled.   A slight pain is felt
next day,  and sometimes the two or three folloAving days,
which increases towards night, and remits toAvards break
of day.  In a feAV days it  seizes the other foot in the
same manner, and after attacking both feet, the subse-
quent fits  prove irregular both Avilk respect to the time
of seizure  and their duration; and what Ave term  a fit of
the gout is made up of a number of these small fits, and
goes off sooner or latar, according to the age of the pa-
tient.  Thus, for instance,  in strong constitutions, and
such as seldom have the gout, the fit often goes off in  a
fortnight;  but in the aged, and those who have frequent
returns of the disease, it lasts two months; and in such
as are more debilitated, either with age or the long con-
tinuance of the distemper, the fit dees not go off till the
summer advances, Avhich drives it away.
  "During the first fortnight the urine is high coloured,
and lets fall a red gravelly sediment, and the patient is
usually costive.   A  loss of appetite, and a chilness of
the Avhole  body toAvards  evening,  accompanying the fit
             39 
306
OF A LESrTIMATE G'OUl.
throughout; and Avhen it is going off, a violent itching
seizes the affected foot between the toes, and afterwards
the skin of it peels off by scales.
   "In this state of the distemper the pain ouly affects the
foot; but when the gout is exasperated, either by wrong
management or long continuance, so that the substance
of  the body is in a manner changed into gouty matter,
it then seizes the hands, Avrists, elbows, knees, and other
parts; sometimes rendering one or more fingers crooked,
hy degrees destroying their motion, and forming at length
stony concretions in  the  ligaments of the joints like
chalk, or crab's eyes.  Sometimes it occasions a whitish
swelling upon the  elboAV, almost as large as an egg,
which gradually grows red.  Sometimes  it seizes the
thigh, which seems to sustain a great weight, yet without
much pain, and thence gaining the knee, attacks that
part more violently, and the limbs are noAV so contracted
and disabled that  the patient halts  with  pain.  Th«
urine resembles  that which is voided in a diabetes, and
the back and other parts itch much towards bedtime.
   "After many severe fits, the subsequent fits  are less
painful, nature being parti/ oppressed by the large quan-
tity of peccant matter, and partly by old age; but instead
of the usual outward pain, the patient is seized Avith a
sickness at stomach, pain in the belly, spontaneous las-
situde, and sometimes a tendency towards a looseness.
Upon the return of the pain into the joints the symptoms
go off, and the pain and sickness coming thus by turns,
prolong the fit considerably.   In many persons the gout
breeds the stone in the kidneys.  It seldom attacks wo-
men, and only the aged of this sex, and those of a mas-
culine habit of body.  Children and young persons rare-
ly have it."
   It may be remarked of the above description of gout,
that it does not very generally assume all those terrible
symptoms in the United States.   This is, perhaps, ow-
ing to so few families having, for a succession of several
ages, pursued such habits of high living, and inactivity,
as  in  England.   And also, to  the great improvement
W the treatment  of our acute diseases.  I am decidedly
of  opinion, a true gout is  always an inflammatory dis- 
OF A  LEGITIMATE GOUT.
307
 ease, and as much under the control of the skilful phy-
 sician, as any other, provided the patients will live as be-
 come them  in the intervals.  That it is a curable dis-
 ease, I infer from the circumstance, that many have been
 cured by misfortunes Avhich obliged them to labour for
 a subsistence; and others, almost in the tAvinkling of an
 eye, from fright.
  Unfortunately for mankind, theories or notions of this
 disease gained such firm ground,  during  the mistaken
 ideas of concoction,  an undue reliance on the anima me-
 dica of Stahl, or the vires naturae medicatrices of Cul-
 len, that they still chain down the practice in this dis-
 ease with despotick sAvay.  Thus, Ave are gravely told
 by Buchan, that it Avould be as prudent to stop the small-
 pox from rising, and to drive them into the blood, as to
 attempt to  repel the gouty matter, after  it has been
 thrown upon the extremities.  In the first place I an-
 swer to   this,  that there  is  no  similitude  betAveen
 smallpox and gout.  The first is a violeut acute disease,
 Avherein the system  has  to undergo a thorough change,
 which shall secure it in  future from similar disease du-
 ring life; while the latter is  a mere chronick predisposi-
 tion, capable always of restraint, and sometimes to spee-
 dy removal, eAren in its paroxisms, or fits.
  Again.   What a pretty out AAras made of smallpox be^-
 fore the time of Sydenham, in consequence of these no-
 tions of concoction, and assisting nature to throw off the
 offending matter!  By unduly stimulating the body, the
 whole mass, solids and  fluids, Avere assimilated  to the
 nature of smallpox  matter, so far as a living system
 could sustain it.   And are Ave not to look for a similar
 result from neglected, or improperly treated gout, which
 always has a tendency to assimilate the body to its own
 nature, or more correctly speaking, fills the body with
 congestions, which,  like a stock in trade, or the exer-
 cise of the mind,  accumulates in proportion  to the ca-
pital?
  Moreover, when the discerning genius of the great Sv
 denham discovered the errours in smallpox, and boldly
pronounced, that we  not only must refrain from pushing
on nature's apparent efforts^ in driving out the matter up- 
308           OF A LEGITIMATE GOUT.
on the skin, but that Ave could not trust her Avithout ac-
tual opposition, the Avhole faculty Avas alarmed.   Thus,
nature raised a fever, Sydenham endeavoured to lower
it, the skin was warm, this invited the pustules, K ap-
plied cool air, gave cool drinks,  &c.  to  oppose the ex-
travagant efforts of nature.  And what was s^id? ali.i^st
the Avhole world rose up at this exposed darir-g re.-..iyt-
ance to the anima medica, or he. ling powers of nature.
But happily the improvement in the practice was  s?lf-
evident, and irresistibly gained ground, slowly, spite of
all opposition.   Wre cannot hope for so easy a con qv est
in the treatment of gout; but I feel sanguine in the be-
lief, that mankind will eventually perceive, not only the
folly  of grounding our hopes in the healing power of ma-
ture,  but discover also, that most of the terrible ravages
of gout, are owing to wrong treatment, and more  espe-
cially to viewing it as operating some friend iy change
upon the system.
   It is a furious despotick disease, and  one unAvorthy
the courtship of the meanest reptile.  A man who nur-
ses the gout under an idea-of its improving his system,
and prolonging his life, is like  one Avho having lost all
hope of pardon  from heaven, sells himself to the  devil,
as was the case with Judas Iscariot.   The result aa7ill
ahvays  be similar, and instead of finding  rest,  they
plunge into greater misery.
   And, while the people of Lancastershire,  elejfha7itise
themselves, by wearing monstrous legs made of avooI, to
keep off this disease,* the aborigines of our country walk
the snoAvy  forest with a thin mockasin,  nor dream they
of gout.  Let proper remedies be  used, both in and out
of fits of the gout, and  we need not be afraid to immerse
the tortured foot in cold water.
   I am not singular in the opinion that  gout is curable,
and ought  never to be invited or nursed: the illustrious
Rush, gave rise to the  Ariews I have of this disease, and
I believe Avith him, it is a general  disease, accompanied
with local inflammation, of a high grade; and which may
often be subdued by  the usual remedies, for inflamraato-
*See Buchan on Gout. 
OF A LEGITIMATE GOUT.           309
ry diseases.  It behooves all mankind to live temperate-
ly, and actively, but to those Avho are predisposed to
gout,  from gouty ancestors, it is  absolutely necessary,
otherwise the disease  will come on at some period of
life.  A legitimate gout, generally comes on in the spring
or fall, therefore, it behooves them to be doubly circum-
spect  at those seasons, regulating their affairs according
to circumstances.  Those of w eakly frail habits, are by
no means to live low; they should live reasonably Avell,
and take  as much exercise as possible; and on feeling
any indisposition, in the usual time of the appearance of
gout,  a mild purge of sulphur, or rhubarb and magnesia,
may be taken.   Those of full habits are to live temper-
ately; milk and vegetables ^should compose the principal
part of their diet.
  If  gout comes on with many  or all the  symptoms
laid doAvn by Sydenham,  Ave should  attack  it at  once
with spirit: we are to abstract blood from the arm, ac-
cording to circumstances, give purges  every day in ac-
tive cases of sulphur,  combined with cremor tartar, or
rhubarb; and if nausea, or indigestion are manifested,
by  wind  or  acid eructations, we should  give  gentle
vomits:  after  carrying these  to  a reasonable extent,
we may safely venture to apply cold Avater, or cold mo-
lasses to the part affected, but in general, it will be suffi-
cient to expose the part freely  and uncovered,  to the
cool air.   These remedies in first attacks of gout, ac-
companied Avith rest, low diet, and mild cooling drinks,
and, perhaps, pleasant bitter infusions will be the  best,
will generally completely banish it from the system, till
it is recalled by some  irregularity; and with  this great
advantage over suffering nature,  to work off the disease,
that no congestions are left, which terminate  in chalky
stones in various parts of the body.  These concretions
in the kidneys, liver and joints, from gout, are the con-
sequence of inflammatory action, unwisely left to vitiate
the whole system, and assimilate all  its  parts, to this
morbid condition.   And this is precisely similar, to wa-
tery congestions in the head,  from neglected or Avrong
treated inflammation of this part of the body. 
310   OF VIBRATING GOUT.-—OF IRREGULAR GOUT.
                    SUBSECTION  2.

                 Of Vibrating Gout.

   There is a  vibrating  state of gout, occasioned some?
times by the great force of the disease, which soon pros-
trates the  system; but, perhaps, more frequently, it is
occasioned by suffering the disease to expend  itself se-
veral times unopposed.   This is a critical state of the
system, and calls for the utmost skill to adapt suitable
remedies, but  in general, we must be governed  by symp-
toms.  If there be violent pain in the feet, or joints, we
must bleed and purge moderately; if the disease shifts its
ground, and attacks  the  stomach or liver, we are to ap-
prehend the disease has lost its inflammatory grade, and
we must now  test the system with laudanum: if it allays
the pain, and  no fever, nor other unfavourable symptoms
occur, Ave may proceed to give laudanum in small doses,
with mild tonicks; and .particularly iron filings, and plea-
sant bitters: and it may be well to apply blisters to  the
feet, or at least keep them  warm, not fearing to bathe
them in tepid, or cold water, according to circumstances.
I shall now pass on to give some account of  irregular
gout, and conclude with some general observations.

            SECTION  III.--SUBSECTION  1.

         Of Irregular, or Illegitimate Gout.

  I do not intend, under this head, to speak of that vi-
brating state of gout, which has just been mentioned, nor
of the low  grade of gouty diseases, usually acknowledg-
ed as such, but to speak of such as are either not gener-
ally known, or acknowledged to be of a gouty nature.
This is departing, in some measure, from the usual  ap-
plication of the  names applied to this disease; but on
much reflection, I consider the application of these terms,
Avhich I  have chosen, calculated to lead to important
truths, which are not generally known, or  received.
Among these cases of misplaced gout, Ave may notice the 
©F IRREGULAR GOUT.
311
 cephalalgia spasmodica, or the sick or habitual headach.
 This often exists at an early period of life, and as it pro-
 gresses, is mostly conjoined Avith dyspepsia. It is a state
 of gout of much less force, than  the  arthritis podagra,
 or gout of the feet; and I think the most local, or fixed,
 of any other variety of this disease.   It is known by its
 periodical returns; but these periods are uncertain in du-
 ration, being governed much by the conduct of the sub-
 ject.  Violent passions, want of regular sleep, excess in
 eating, taking cold, and many other causes may excite it
 A violent headach of several hours, or even days contin-
 uance, Ioav spirits, loss  of appetite, nausea,, and in some
 cases, especially after repeated attacks, severe vomiting
 attends, sometimes great intolerance to noise.  In those
 whose constitutions are  not  particularly broken down,
 bleeding is  a safe and certain  remedy, and  it ought in
 general to be checked by a single bleeding; that is, if the
 patient, in the intervals, is in good health, me may draw
 blood till some symptoms of faintness are produced, and
 if the patient is difficultly affected in that Avay, he should
 be desired to stand up while the' blood flows; hut Ave ought
 never to  bleed very largely, we should rather  endeavour
 to bleed  suddenly, by means of a large orifice.  If any
 remains are left of the disease,  a  purge or two of castor
 oil, senna and manna, &c. should be given.
  If the case becomes protracted, or where the disease
 exists in  very weakly habits, or Avhere dyspepsia is  ra-
 ther the most distressing,  we should  give a gentle eme-
 tick of ipecacuanha  or white vitriol, and follow it up
 with purges of rhubarb and magnesia, or sulphur and cre-
 mor tartar.  In cases still more  reduced, Ave should emp-
 ty the stomach by the free use of chamomile, or carduu*
 tea: open the bowels Avith mild glysters, and give lauda-
 num in small doses, frequently repeated. But I have sel-
 dom seen this disease, Avhere it would not only be safe,
 but really necessary, to take a little blood, and if it is
 succeeded by small  doses of laudanum,  it can scarely
 ever be Avrong.   In the intervals, persons liable  to this
 variety of gout must pay a scrupulous regard to regulari-
ty; but it is seldom,  if ever necessary, for them  to live
very Ioav; in general,  a diet somewhat generous is best. 
 312        OF GOUT IN THE KIDNEYS, &C.

 consisting a good deal of the lighter kind of animal food:
 fat meats and windy A'egetables are to be avoided; and if
 spirituous drink  is ever allowable, it must be used very
 sparingly.  Much malt liquors,, or cider, are improper;
 the best porter is, however, often one of the best drinks;
 nor need such persons,  in general,  be afraid of a glass of
 pure old wine; but unless it be really such, it ought never
 to be used.  It is essentially necessary for those subject
 to gout in the head, to avoid intense study, troubles of
 the mind, costiveness, and loss of sleep.  They should
 never encounter fatigue, but reasonable and constant ex-
 ercise must be unceasingly pursued.

                    subsection 2.

               Of Gout in the  Kidneys.

   Nephralgia, or pain in  the kidneys, without fever, is
 also, sometimes,  a misplaced gout; and whether accom-
 panied with calculi or not, in its height, is an inflamma-
 tory state of disease, and requiring the use of the lancet,
 mucilaginous drinks, the free use of magnesia, and mild
 injections; and after the reasonable use of those remedies,
 small repeated doses of laudanum; and a common dia-
 chylon  plaster, worn for some time, will be advisable.
 A milk diet, and the occasional use of lime Avater, will
 be useful in this  affection of the kidneys.

                    SUBSECTION 3.

                 Of Gouty Gonorrhoea.

   Gonorrhoea  spuria,  or  laxorum, a  disease resem-
 bling gonorrhoea from impure coition, is also a gouty af-
 fection, requiring remedies which  operate generally on
 the system.  The same may very often be said of the
fluor  albus of Avomen.   In both these cases mild injec-
 tions, first of milk and Avater, or mild mucilage; and these
 succeeded  by weak solutions of lead, or peruvian bark
 filtered through paper: in some cases of gouty gonor-
 rhoea,  injections of nice sallad oil, Avith a few  drops of
 laudanum, will be found an excellent remedy. 
OF GOUT IN THE TESTES, AND IN THE HIP.   313
                    SUBSCETION 4.

               Of Gout in the Testes.

  A sudden and excruciating pain  of the testes without
 swelling, or any venereal complaint, is  also, sometimes,
 a symptom of gout; it is apt to alternate with slight gou-
 ty affections  of the stomach.  This  pain is so severe
 sometimes, as to prostrate  the patient very rapidly, and
 the part affected continues painful for a day, or more, aud
 then leaves the part  extremely sore.   Large  doses  of
 ether, combined Avith repeated small doses of laudanum,
 will generally answer; and after a feAV doses have been
 given, pouring ether upon  the part affected, and suffer-
 ing it to  evaporate, will be useful: theboAvels should be
 opened Avith mild laxatives, and mild glysters given.

                   SUBSECTION 5.

                Of Gout in the Hip.

  There is a most obstinate and severe  pain in the hip,
 which sometimes lasts several weeks or  months, in spite
 of all remedies: there  is neither swelling, nor does the
 part ever suppurate, although the hip joint is sometimes
 crippled.  This form of gout  is found, according to my
 observations,  mostly in females, and seems to bear a near
 similitude to gout in the feet of men. I  have  never been
 able to arrest this disease until it has  continued several
 weeks, and sometimes several months.   A salivation in
 one instance  had no sensible effect, the pain continued
 during the height of it: this remedy  does, hoAvever, suc-
 ceed sometimes, after the  disease has in some measure
 expended its force.  Perpetual blisters have little effect.
 I am inclined to believe we should bleed largely, at the
 commencement of this affection, and MIoav  it up with
 large doses of ether and laudanum; and now and then
give tincture cantharides, so as  to excite strangury.
  A pain of an obstinate nature, but not very acute, ac-
companied with some fever, nausea or vomiting, and cos-
             40 
314     OF THE  DIFFERENT GRADES OF GOUT.

tiveness, but more especially a discharge of bile,  green
as grass, or rather resembling  the  verdigrise green, is
also  a gouty affection, and most usually found in the fe-
male.  Mercury, and gentle emeticks, are the principal
remedies in these cases; but it is slow to yield to any
treatment.   It will seldom bear stimulants, or even to-
nicks, till the system is reduced by  bleeding and purg-
ing,  which is generally necessary in those cases.
   In short, every part of the body is invaded by this
disease,  and in  all  cases where  sudden  pain occurs,
which does not yield speedily to depletion, or anodynes,
and especially if disposed to recur, now and then, wheth-
er it be in the same part of the hody, or sometimes  in
one part, and then another, or whether accompanied with
fever or not, we are to view it as gout,  and treat it on
general principles.

                    subsection 6.

           Of the different  Grades  of Gout.

   I  shall here endeavour to lay down a scale of gout,
which applies to the  regular as well as the irregular gout,
by which,  I think, we may in general, with  tolerable
certainty, determine the grade or inflammatory condition
present:  they appear to he
   1. Gout of the lower extremities.
   2. Of the head, in form of habitual headach.
   3. Of the hip, resembling rheumatism, and to be met
with, principally in females, or weakly habits.
   4. Diffused throughout the body, in the joints resem-
bling chronick rheumatism.
   5. In the kidneys, liver;  and in the lungs, in form of
asthma.
   6. In the lungs, in the form of angina pectoris.
   7. In the urethra, vagina; in the skin, resembling le-
prosy, and various  eruptions.
   8. In the  stomach, and intestines; this is the lowest
grade, and seldom appears  till the constitution has been
debilitated by gout in  some other part of the body.   If 
         OF THE DIFFERENT GRADES OF GOUT.     315

there  be exceptions to this remark, it is in cases of ob-
stinate dyspepsia.
  What has been termed flying gout, will be found
more or less inflammatory, as it preponderates to either
extreme of this scale.   Each case of misplaced gout calls
for some little variety in the treatment, locally considered,
but gout is ahvays to be treated on general principles,
both as regards medicine and regimen.  And I feel con-
fident that, by bearing in mind  the foregoing scale, we
Avill seldom be wrong.   It  follows that in  gout of the
stomach, or intestines, Ave are to stimulate rapidly, and
largely;  large doses  of ether; laudanum; tincture gua-
iacum; tincture  assafcetida  in  spirit  Avine,  Avith  equal
quantities of ether, are good remedies; the juice of gar-
lick or rue, and especially Avine,  or even brandy, in large
quantities, in some cases, is indispensably necessary.
  There is still one variety of gout to  mention, I  have
seen two cases  of it.  This  form  of the  disease, is  a
strange mixture of angina pectoris, and hysterical symp-
toms; or rather, it resembles the symptoms of both those
diseases at the same time, and as the case is more or less
inflammatory, partakes more  or less of the  one or the
other;  those resembling angina pectoris, being most in-
flammatory.  It is accompanied with a strange condition
of the arterial system, Avhich is a most powerful and con-
vulsive force in the pulse; this extraordinary action of the
arteries extends throughout the system, and  continues in
considerable force during the intermissions, remissions, or
intervals of the other symptoms.  The larger  arteries
cannot be compressed, such is  their tension:  the blood is
sizey, and the abstraction of blood generally gives tem-
porary relief.  But blood-letting in this disease, like in
consumption, is but a palliative, and the cure depends on
the use of the most powerful tonicks, as iron filings with
assafcetida; bark; and the  acetate lead; arsenick, &c.
but those mineral tonicks ought not to be given without
good advice.   In the  paroxysms incredible quantities of
ether, tincture  assafcetida,  garlick,  and rue  juice, are
necessary; a saturated tincture of camphor is also useful.
  Of all the forms of misplaced gout, that of the intes-
tines is most difficultly known.   It occurs mostly in the 
316      GENERAL OBSERVATIONS ON GOUT.

decline of life, and often hurries away its victims, in a
few hours, or a day or two.  Persons Avho are subject to
indigestion, to asthma, to chronick  rheumatism, or gout
in other parts of the body, are admonished to be on their
guard against this insidious disease; and avo be to those,
who in the decline of life, should view this  as a salutary
effort of nature, to throw off disease, and suffer it to run
on.  Persons who have reason to apprehend a looseness
or other  affection of  the bowels, is of a gouty nature,
should take glysters containing full doses of laudanum;
small doses of laudanum and ether, should be taken by
the mouth;  Avarm Avine, toddy, or  brandy, according to
circumstances; an anodyne plaster should be  applied
over the abdomen, and  in  obstinate cases sinapisms to
the feet.   When convalescent, especial care  must be
used to avoid catching cold, by keeping the feet warm,
wearing flannel, and dressing warm.  A mild nutritious
diet should be used, of light  animal  food,  and warm
drinks, slightly cordial, as warm wine whey, snakeroot
tea, warm toddy,  milk toddy, or milk and Avater with a
little ginger.

                   subsection 7-

            General Observations  on Gout.

  I come now to  make  a few general observations.  It
has been  alleged by  the great Cullen,  that wherever
bleeding was proper, opium was inadmissible; this no
doubt is strictly true as respects acute diseases, but I be-
lieve the reverse is nearer the truth in chronick diseases,
and particularly so, in  gout and chronick rheumatism.
We may generally with perfect safety bleed, and purge,
in those diseases, provided Ave  follow it up immediately
with anodynes.   It has  been held as ridiculous, or even
dangerous by some physicians, to  pull  down Avith one
hand, while we build up with the otlier, as they express
it.  This language is somewhat imposing,  but  crouches
before a scrutinizing examination:  and facts  will be al-
ways found  to  support this  contrary position, that where
we deplete,  and succeed it immediately with stimulants, 
general observations on gout.       317
and particularly opium, or mercury, the abstraction of
blood will reduce excitement, and leave the excitability
not accumulated as some Avould have it, but much more
susceptible of being acted upon.   This increased suscep-
tibility, is disposed to take on new impressions, and ac-
tion, or a condition  follows, which is characterized  by
the new stimulus.  Thus if we remove a part of peccant
stimulus, by abstracting blood, and give a dose of laud-
anum, a new and more healthy condition is induced, and
this position is supported by facts; and Ave can bleed
in gout, or  chronick rheumatism, or the diseases  of the
aged generally, with perfect safety, if inflammatory symp-
toms are present, provided Ave foiloAV it with opiates; and
these  should mostly be  conjoined with SAveet spirits of
nitre, which will determine slightly to the  skin, and to
the kidneys.   I  consider this an important fact, not gen-
erally knoAvn;  and applicable to consumption, and most
chronick  diseases.
  It must be acknoAvledged that  gout is often so firmly
seated from constitutional predisposition inherited, or ac-
quired; or the system may be so  completely gouty con-
ditioned,  that  it  is not to  be removed, nor  even  rashly
treated.  But  such  a condition  of the system is, most
generally, the  consequence of wrong management in its
first fits.   To  illustrate and maintain this opinion, let us
examine but a single series of gouty fits.   It commences
with fever, and violent pain in the loAver extremities; and
it has been remarked, that the duration and violence of
the gout, is mostly in proportion to the severity of the
fever.  And are Ave not to infer  from the  periodical in-
crease of  pain, that fever continues; the state of the pulse
generally indicates it.  Now, what are Ave to expect from
this fever; does  it make any particular deposition upon
the feet, and thereby renovate the  system?   It may be
answered without hesitation, that it does not; on the con-
trary, congestions are formed in other joints, in the liver,
in the kidneys; and I have no doubt, in the urinary blad-
der also.   Then why are  we to let this fever expend its
unfriendly force on  the body?   Fever, from whatever
cause, is unfriendly; and if inflammatory, will always
form congestions in some part of  the body, if Ave  do not
remove the fever. 
318      general observations ON GOUT.

  Facts Avarrant the assertion, that in proportion to the
continuance of this fever, so will be the increase of the
gouty diathesis in future, for it will assimilate the system,
more and more, to  the gouty condition.  It is true, na-
ture eventually wears off the fever; this she is enabled
to do, by the patient's lessening the usual stimuli, as that
from exercise of the mind and body; change in diet, and
drinks, &c.  and thus by this weak, but gradual abstrac-
tion, the fever and  pain is carried off.  This  in general
could be more safely and effectually  accomplished, in a
few days by suitable remedies, than  in so many weeks,
or even months, in some cases, by the natural  operations
of the body.
  Let not the intemperate or idle gouty cripple imagine,
nature will  remove the consequences  of his own, or his
ancestors artificial diseases; if we expect nature to cure
our diseases, we must dive agreeably to her dictates, but
so long as we trample on her laws by intemperance, she
will mock us to scorn: and while she  wrings the de-
bauchee by  the great toe, &c.  she would scare him from
his  folly, hut not cure his disease.
  How long are we to talk of nature's  curing our dis-
eases, Avhich are wholly artificial?  Is  it not  one of na-
ture's most invariable laAvs to lead us to death; and there
is no period of life exempt from it, why are we  not rather
to suppose it one of her leading aims, to carry us to the
grave.
  To conclude, disease is  ever a war  upon  animation,
and Ave are to endeavour to remove it under all circum-
stances.   If we are often disappointed, we are  still to
suppose that the physician, who has to trust his patients
to nature, and endeavour to cure them by expectation,
has gained but a slight knowledge of his profession.
  Lastly, in all forms of gout, most reliance is to be placed
on  activity,  and regularity in every thing appertaining
to our condition.  Those of gross full habits,  or subject
to regular gout, must live Ioav, particularly, a milk diet;
those subject  to the vibrating, or misplaced gout, must
be less  abstemious, but strict  temperance is always ne-
cessary, and Avhile ever the gouty subject can walk, he
should walk, and even labour constantly. 
OF CHRONICK  RHEUMATISM,          319
 Chronick rheumatism, asthma, angina pectoris, gravel,
dyspepsia, and  goutier, are satellites revolving around
gout, as their sun or centre; and although some of them
are remote, still their motions are excited and maintained
by this gouty centre.  I shall, therefore, briefly treat of
those diseases, in the order in which they have been enu-
merated.  This brings me, first, according to promise, at
the commencement of gout, to  treat on chronick  rheu-
matism.

                    SECTION III.

             Of Chronick Rheumatism.

  Chronick  rheumatism is  seldom attended with fever,
or SAvelling, or evident inflammation.   Persons in the de-
cline of life are most subject to this kind of rheumatism,
and in general it is fixed to some particular part, as  one
or more of the joints, the back, loins, and shoulder blade,
&c.  It is remarkable of rheumatism, that persons affect-
ed with it, are highly sensible to the changes of Aveather;
and like the  barometer, are sensible of changes, before
they are perceptible by persons  in general.   It is also
notable of rheumatism, that it is most troublesome at
night, and not apt to suppurate.   There is a kind of ve-
nereal  rheumatism, attended Avith painful suppurations.
These  are often taken for mercurial sores; but I suspect
they are always scrofulous.   The disease under consid-
eration, appears to be  continued by a  predisposition to
taking cold, whereby inflammatory action  of a peculiar
kind, is excited;  and therefore, we are to pay especial
regard to our dress.  I think, in general, the diet should
be reasonable and  not too low:  it is  not  reasonable to
suppose that a  disease, Avhich yields  most generally to
stimulants, should require a Ioav diet.   But such person*
must avoid ardent spirits, and gross animal food, or too
much fats.   When the disease is present, the diet must
be low, consisting of milk, and mild vegetables;  and the
drinks should be mild and  cool.   Small bleedings,  and
frequent purging with sulphur, and where this will not
©perate sufficiently, castor eil, or rhubarb, or jalap, should 
320
OF THE ASTHMA.
be given to carry it through the bowels.   A decoction of
seneka  snakeroot, Avill be often found useful, and after
the inflammatory symptoms are  somewhat abated, tinc-
ture guaiacum, or powder of bark, which will be found
in the list of medicines; or poAvders of snakeroot cam-
phor and nitre.  This may be made by mixing one dram
of snakeroot in powder, (no matter which kind) camphor
half a dram, nitre one dram, grind these fine, and make
four or  six powders, according to circumstances, one of
which may be taken morning, and evening, drinking a
cup of Avhey after it.  An infusion of prickley-ash and
pine knot shavings, is a good  remedy; or a table spoon-
ful of whole mustard seed;  if of the dark seed a little
less  will  do.  The limb pained may  be rubbed with
opodeldock, volatile liniment; or a blister laid on till it
merely inflames the skin; or a poultice of mustard, may
be applied, till it becomes painful: but, in general, Ave
should reduce the system a little, before we  stimulate
outwardly: I  have seen rheumatism translated in good
measure to the skin, by such applications, and the skin
became  intolerably painful,  and  sore to the touch.  It
will ahvays require a discriminating judgment, to adopt
suitable remedies to this disease: I shall conclude this
article by observing, that the cold bath, purging Avith
sulphur, and the plentiful use  of whey, are the principal
remedies for rheumatism; and Avarm  clothing, and exer-
cise are indispensable.

                    SECTION IV.

                   Of the Asthma.

  I shall copy this article principally from Buchan:  his
ideas of a spasmodick  asthma,  without any marks by
which it is to  be distinguished,  I shall omit, for, I con-
fess I know of no difference in asthma, except that of its
being of more or less force  or violence.  I shall also
take occasion to suggest a few remedies, which have been
particularly useful in my own practice.  "Asthma is a
disease  of the  lungs, Avhich  seldom admits of  a cure.
Persons in the decline of  life  are most liable to it.  It 
OF THE ASTHMA.               321
is distinguished  into  the  moist and  dry,  or humoral
and nervous.   The former is attended with expectora-
tion or spitting; but in the latter, the patient seldom spits,
unless sometimes a little tough phlegm by the mere force
of coughing.
  uCauses.—The asthma is  sometimes hereditary.   It
may likewise proceed from  bad conformation  of  the
breast; the fumes of  metals or minerals taken into the
lungs; violent exercise, especially running;  the obstruc-
tion of customary evacuations, as the menses, hemorrhoids,
&c. the sudden retrocession of the gout, or striking in of
eruptions, as smallpox, measles, &c. violent passions of
the mind, as  sudden  fear or  surprise.   In  a word,  the
disease may proceed from any cause that either impedes
the circulation of the  blood through the lungs, or pre-
vents their being duly expanded by the air.
  "Symptoms.—An asthma is known  by a quick labori-
ous breathing, which is generally performed with a kind
of wheezing noise.  Sometimes the difficulty  of breath-
ing is so great, that the patient  is obliged to keep in  an
erect posture, otherwise, he is in danger of being suffo-
cated.   A fit or paroxysm  of the asthma, generally hap-
pens after a person has  been exposed to cold easterly
winds, or has been abroad in thick foggy weather, or has
got wet, or continued long in a damp place under ground,
or has taken some food which the stomach could  not di-
gest, as  pastries,  toasted cheese, or the like.
  "The paroxysm is commonly  ushered in Avith listless-
ness,  want of sleep,  hoarseness, a cough, belching of
wind, a sense of heaviness  about the breast, a difficulty
of breathing.  To these succeed heat, fever, pain of the
head, sickness  and nausea,  great  oppression  of the
breast, palpitation of the heart, a weak, and  sometimes
intermitting pulse,  an- involuntary flow of tears,  bilious
vomitings, &c. AU  these symptoms groAV worse towards
night; the patient is easier Avhen up, than in bed, and is
very desirous of  cool air.
  aRegimen.—The food ought to be  light  and  easy of
digestion.  Boiled meats are to  be preferred to roasted,
and the flesh  of young animals to that of old. All windy
food, and whatever is apt  to swell in  the stomach, is to
             41 
322
OF THE ASTHMA-
be avoided. Light puddings, Avhite broth, and ripe fruits,
baked, boiled, or roasted, are proper.  Strong liquors,
of all kinds, especially malt liquors,  are hurtful.  The
patient should eat a very light supper, or rather none at
all,* and should "never suffer himself to be long costive.
His clothing should  be Avarm, especially in the winter
season.  And all disorders of the breast are much reliev-
ed by keeping the'feet warm, and promoting the  perspi-
ration; 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.   Asthmatick people
can seldom either bear the close heavy air of a large town,
or the sharp,  keen atmosphere of a bleak hilly country;
a medium therefore between these, is to be chosen.  The
air near  a large toAvn is often better than at a distance,
provided the patient be removed so far as not to be affect-
ed with  the smoke.   Some asthmatick  patients breath
easier in toAvn than in the country; but this is seldom the
case, especially in  toAvns  Avhere much coal  is burnt.
Asthmatick persons  Avho are obliged  to be in town all
day, ought at least to sleep out of it.  This Avill  often
prove of great service.   Those wlio can afford it, ought
to travel intb  a Avarmer climate.   Many asthmalick per-
sons, who cannot live in Britain, enjoy very good health
in the south of France, Portugal,  Spain, or Italy.
   "'Exercise is of  very great importance in the asthma,
as it promotes the digestion, preparation of the blood,
&c.   The blood of  asthmatick persons, is seldom  duly
prepared,  owing to the proper action of the lungs being
impeded.  For this  reason, such people ought daily, to
take as much exercise, either on foot,  horseback,  or in a
carriage, as they can bear.
   "Medicine.—Almost all that -can  be  done  by medi-
cine, in this disease,  is to relieve the patient when seized

  * 1 would rather advise asthmaticks, at all times, to take  small
meals and repeat them often.  And in a majority of cases, they will
be the better of a light supper.  Persons much reduced will  gene-
rally find benefit from taking a little food, once or oftener, during the
night.  A desideratum here, seems to be, neither to suffer the st(H
mach to be entirely empty, nor overloaded. 
OF THE ASTHMA.               323
   with a violent fit.   This,  indeed, requires the greatest
   expedition,  as  the disease often proves  suddenly fatal.
   In the paroxysm oij fit,  the  body is generally bound; a
   purging glyster, Avith a solution  of assafcetida, ought
   therefore to  be administered, and if there be occasion, it
   may be repeated two or three times.   The patient's fret
   and legs should be immersed in warm Avater, and after-
   wards rubbed with a warm hand or  dry cloth.  Bleed
   ing, unless extreme Aveakness, or old age forbid it, is
   highly proper.*   If there be a violent spasm about  the
   breast or stomach, warm fomentations, or bladders filled
   with warm milk and Avater,  may  be applied to the part
   affected and warm cataplasms to the soles of the feet.
   The patient must drink freely of diluting liquors, and
   may take a  tea  spoonful of  the tincture of castor and of
   saffron mixed together, in  a  cup of valerian tea, twice or
   thrice a day.  Sometimes*a  vomit has a very good effect,
   and  snatches the  patient from the jaws of death.  This,
   however, will be more safe after other evacuations have
   been premised.  A very strong infusion of roasted coffee,
•   is said to give ease in an asthmatick paroxysm.  In  the
   moist asthma, such things  as promote expectoration or
   spitting are to be used; as the  syrup of squills, gum'am-
   motiiack, and such like. A common spoonful of the syrup,
   or oxymel  of squills mixed  with an equal quantity of
   cinnamon water,may betaken three or four times through
   the day, and four or five pills, of equal parts  of assafce-
   tida  and gum ammoniack,  at bed time.   After copious
   evacuations, large doses of  ether have been found a ery

     * Old age can never be an objection to bleeding.  The aged  can-
   not bear large  bleedings, but their diseases, in general, yield to small
   repeated bleedings more readily than at any other period of life.
   Vomits rack them to pieces,  purges sieken.and exhaust them; but
   reasonable bleeding, they not only bear with safety, but in diseases
   of high excitement, it is the only remedy that will either give speedy
   relief, or prevent congestions, so often the consequence of fever left
 1  unsubdued by this  remedy. Further, sweating subjects them to take
   cold, so that bleeding, and diureticks, are remedies especially adap-
   ted to the aged.  Therefore, in asthmatick, as well as in the dis-
   eases, in general, of the aged,  we are not  to ask "how old art
   thou?"  but examine into the force or violence of the symptoms, &<;.
   and prescribe accordingly. 
324             OF ANGINA PECTORIS.
 efficacious in removing a fit of the asthma.   I have like-
 wise known the following mixture produce very happy
 effects: To four or five ounces of the solution of gumam-
 moniack, add two ounces of simple cinnamon-water, the
 same quantity of balsamick syrup, and half an  ounce of
 the paregorick elixir.  Of this, two table spoonfuls may
 be taken every three hours."
   To these remedies, I shall now add, that I have found
 more  benefit in the paroxysms of asthma,  after evacua-
 tions, from the use of sugar of lead and opium, than any
 other  remedy.   In weakly patients, where the blood
 vessels are not much disturbed, this  medicine may safe-
 ly be given immediately:  Take sugar lead twelve grains,
 opium three grains, make six pills:  of these, the patient
 may take one every hour, till the disease abates, or till
 three, four, or the Avhole six  are taken, according to the
 sex or strength of the patient. This Avill generally check
 the fit, and it will now be advisable to follow these pills,
 with some  of  the above remedies.   Much benefit has
 been derived, in some cases,  from smoking the leaves of
 the  Jamestown weed or stramonium in  the fits.  Dr.
 Miller, of this  state, who has been severely affected with
 this disease, speaks of it in high terms.
   Lastly.   Asmaticks must exercise,  dress carefully,
 keep warm dry feet.  And  they will find benefit from
 the occasional u& of the cold bath,  and taking pills of
 assafcetida and  iron filings in the intervals.

                     SECTION V.

                Of Angina  Pectoris.

   This disease is treated of in the appendix to the article
 on medicine, in Dobson's Encyclopaedia. Dr. Heberden
 is said to be the first who has written upon this disease.
 It seizes those who are subject to it when they are walk-
 ing, and particularly when they walk soon after eating,
with a most disagreeable and painful sensasion  in the
breast,  which seems to threaten immediate death;  but
the moment they stand still, all uneasiness vanishes.  In
all other respects, the patients, at the beginning of this 
OF ANGINA PECTORIS.
325
disorder, are well, and have no shortness of breath; from
Avhich, the angina pectoris is wholly different.
  After it has continued some months, the fits will  not
cease instantaneously on standing still; and it will come
on, not only when the patients  are walking, but when
they are lying down, and oblige them to rise up every
night, for many months together.   In one or two very
inveterate cases, it has been  brought on by the motion
of a horse or carriage, and even by swallowing,  cough-
ing, going to stool,  speaking, or by  any disturbance of
mind.   The subjects of it are principally men, but cases
of it have been found in boys and Avomen.  The best
opinion which I can form of this complaint, (which has
been spoken of by many eminent men since Dr. Heber-
den's reports,  as Fothergill, Wall,  Percival, Haygarth;
and by  Smyth of Ireland, who has  probably suggested
the best, or only method of cure,) is, that it is a gouty af-
fection of the heart.   This disease has mostly terminated
in sudden death.  But I entertain strong hopes, that if it
is viewed as a gout of a middle grade,  and reasonable
evacuations  by  blood-letting, &c. advised, in the first
paroxysms, and in the intervals treated according to  the
advice of  Dr.  Fothergill, together  Avith immediate  re-
course to one or more issues, according to circumstan-
ces, this disease may often be cured.
  Such persons are advised by Fothergill, not to eat vo-
raciously; to be particularly  abstemious, in respect to
every thing  heating;  spices, spirits,  wines,  and all fer-
mented liquors; to guard most scrupulously against pas-
sion, or any vehement emotions; and to make use of all
the  usual means of establishing  and preserving general
health; to mitigate  excesses  of  irritability or pains, if
they quicken the circulation, by anodynes; to disperse
flatulencies w hen they distend the stomach, by moderate
doses of carminatives;  among  Avhich, perhaps pepper-
mint Avater may be  reckoned one of the safest.  But since
obesity is justly considered as a predisposing cause,  he
insists on the necessity of preventing an increase of  fat
by a vegetable diet, and using every practicable method
of promoting the thinner secretions. 
 326         OF THE GRAVEL  AND STONE.

   I have twice seen a disease of this kind blended with
 hysterical affections, which I have spoken of under the
 head of gout.   I shall conclude this article by admonish-
 ing the reader, that all the usual means of invigorating
 the general system, with one or more issues open, is his
 principal hope, and in the paroxysms  large doses of
 ether, tincture  of assafcetida, &c. in reduced habits; and
 moderate bleeding, and the use of mineral tonicks after-
 wards,  in first paroxysms, or in strong habits.

                     SECTION  vi.

               Of  the  Gravel and Stone.

   It  is said, the  gravel or  stone is occasioned by un-
 wholesome waters, containing stony or calculous matter;
 unwholesome windy  food; by high living; a sedentary
 life; lying long on the back; an hereditary disposition;
 the use of strong and astringent wines.   People at every
 period of life arc subject to stone, but it is mostly found
 in persons who have been affected Avith  gouty or rheu-
 matic k pains.   In short,  stone and  gravel  is attended
 Avith all the usual symptoms of vibrating or retrocessent
 gout; and often accompanies  regular or inflammatory
 gout, being a congestion commencing in the kidneys, and
 growing out of an infarction  of these organs.
   Gravel in the.  kidneys occasions  pain in the loins;
 sickness; vomiting,  and  sometimes  bloody urine.   A
 stone in the ureters occasions more acute pain reaching
 doAvn toAvards the bladder; the thigh and leg of the side
 affected  are benumbed,  and the testes are sometimes
 draAvn upAvards, and there is more or less obstruction of
 urine.   A stone in the bladder occasions pain in the low-
 er part of the belly, and is particularly  felt at the time of
 making water,  and immediately  afterwards; the urine
 can, often, only be discharged by drops, and is some-
 times bloody,  particularly after riding in a carriage,  or
 more especially on a horse: there is occasional discharges
 of mucous, which  is either white  and thick, or at other
times even fetid, and accompanied Avith small particles
 of gravel.  There is a needless inclination to go to stool, 
OF THE GRAVEL  AND  STONE.         327
arising from irritation communicated to the rectum.  In
the male, there is an unpleasant stinging itchiness about
the end of the urethra; and in the female, a similar irri-
tation about the urethra,  and often a most  tormenting
bearing down of the uterus, accompanied with pain and
much irritation of this organ, which sometimes excites
considerable fever.   These symptoms are generally suf-
ficient to enable us to distinguish cases of stone and gra-
vel, at least, so far as is necessary in directing to a suit-
able .remedy.   It will, however, ahvays be necessary for
tjie surgeon, to determine  by sounding in the bladder,
with a suitable sound, or catheter, whether mere gravel
or a  stone is present, before he could think of an opera-
tion.
   Persons subject  to  this disorder should avoid much
Avindy vegetables, or gross fat diet.   They should live
temperately, but not too low; mild animal food, and even
a little salted meat, occasionally, av ill be proper.   Milk
with ginger,  or horseradish boiled in it, is a good arti-
cle:  well boiled onions, asparagus,  spinage, radishes,
and  Avell boiled turnips,  and cellery, are perhaps the
best  vegetables.  They should drink mild mucilaginous
drinks, as milk and Avater, slippery elm,  gum arabick,
quince seed, or other pure  mucilage may be used;  or in-
fusions of parsley, march mallows, or linseed. In Aveak-
ly habits, a little good gin  is alloAvable, or  other nice old
spirit with a drop or two of oil juniper.
   Much may be  done in the early stage of this disease,
by exercise, and such other remedies as  are calculated
to strengthen the system;  and iron filings  in particular,
will  be useful  as a tonick; but Avhen the disease has pro-
gressed, exercise to any great extent is impossible:  it
ought in every case to be pursued in some form, so long
as it can be borne.  Soap of the mildest  kinds, as cas
tile,  has been  taken in large quantities Avith  good  effect,
and  also lime  water used freely; but Ave should ahvays
commence with small doses, and increase them gradual-
ly.  Half an ounce of soap, and  half a pint  of lime Ava-
ter per  day, are reasonable portions of these  articles:
they may be continued for years, at intervals, but a too
constant use of them will injure the stomach.  A decoo 
328
OF DYSPEPSIA.
tion of raw coffee berries; and of the Avild carrot seeds,
sweetened with honey, has been found useful in some ca-
ses.  From twenty to sixty grains of powdered uva ursi,
taken in milk, has been found useful.
  In inveterate cases, particularly in the decline of life,
the free use of laudanum, and the Avarm bath become in-
dispensably necessary.   I suspect a- gouty fever often
accompanies cases of stone or gravel, and in fits particu-
larly severe, we Avill give much relief by bleeding;  nor
need Ave be afraid to repeat it several times, if the symp-
toms run high.  When the kidneys, uterus, &c. take on
much irritation or inflammation, which is often occasion-
ed by exercise on a rough-gaited horse, we must bleed,
give mucilage, and enjoin abstinence for a few days.  In
the intervals,  I  have  uniformly seen the  most marked
advantages from the use of large  quantities of  magnesia,
and mucilage.  To  most persons,  it is more agreeable
than soap or lime water,  and I believe it better, because
it keeps the boAvels  open.  It will always be a deside-
ratum to get magnesia of a good  quality.

                     SECTION  vn.

                    Of Dyspepsia.

  It has been pretty generally supposed, that dyspepsia,
is seldom a primary, or  a local disease of the stomach.
I suspect, it is most commonly a gouty affection.  It is
knoAvn  to folloAV gouty habits invariably.   No disease
admits of a greater uniformity  of treatment; so that for
dyspeptick symptoms, Ave are to rest our indications of
cure, first on correcting the acidity present, and second-
ly, by means of mild tonicks, give tone to the stomach.
The disease is known by irregular appetite, mostly bad;
occasional nausea; dejection of spirits; flatulency of the
stomach, and boAvels; cardialgia, or pain at the pit of the
stomach;  much belchings of sourish, or  other unpleasant
tasted fluids, Avhich  rise  up, and are sometimes thrown
up in mouthfuls; slight spasms are often felt, headach is
frequently one of the most distressing symptoms; great
oppression about the stomach after eating;  with general 
OF DYSPEPSIA.
329
languor and  giddiness.   These symptoms  sufficiently
characterize dyspepsia, and they are generally more or
less violent, or constant, as the patient conducts respect-
ing his food  and  drink, and  general condition.   It
may be remarked of dyspepsia,  that although acidity is
mostly present, there is nevertheless, exceptions, where
the contents of the stomach offend in form of oxyds, and
in other cases,  these fluids have even been found alka-
line; in these  cases, it must be obvious,  acids,  are the
proper correctors; and in all cases, Avhere sourness is not
plainly perceived, or where magnesia in reasonable quan-
tities does not loosen the boAvels, we  are to suspect this
condition of the gastrick liquor.  The depraved fluids
of the stomach may be corrected by magnesia;  but in
some cases it must be calcined;  soda Avater highly char-
ged with fixed  air;  prepared chalk;  or white oxyd of
bismuth: and also by the elixir vitriol, or nitrick acid;
and in some cases the acid of lemons, or even nice vine-
gar rendered aromatick by a little cayenne or other pep-
per: these acids will often succeed even in cases where
acidity  abounds, for they are as capable  of destroying
the phosphorick,  and other weak acids in the stomach,
as the alkalies are.  These remedies with emptying the
stomach in severe  cases, by a gentle vomit, or by drink-
ing freely of chamomile or carduus tea, and opening the
bowels, will generally remove the symptoms  for a time:
but as debility either partial, or, mostly, general, is the
cause  of dyspepsia, we are only  to expect permanent re-
lief from such remedies as are calculated  to   invigorate
the body.   These have been so fully pointed out in va-
rious parts  of this  work, that I  shall briefly state a few
leading aims.
  Exercise, and particularly on horseback;  or labour-
ing; the occasional use of the bath, cold, warm, or tepid,
according to circumstances; a diet consisting principally
of light animal food; dry plain biscuit, rice, barley, and
potatoes well boiled, in general,  are preferable to fer-
mented bread:  boiled onions; milk with horseradish, or
ginger, boiled in it.  A  glass of choice wine, or a  little
old spirit and water, may be  taken by persons in the de-
cline of life; but the young had  better use a feAV drops »f
              42 
330
OF GOUTIER, OR GOITRE.
elixir vitriol, or increase  the  quantity  of condiments.
Cold water may generally be used, or cold pleasant bit-
ter infusions; sometimes good porter is agreeable.   But
in general, fermented liquors, much butter, cheese, fat, or
much salted meat, is to be avoided.  In general, such
people will be enabled by attend ing-to their diet, to dis-
cover Avhat agrees best with the stomach, for each case
has some peculiarity.
   A little salted meat once a day will impart an agreea-
ble stimulus and tone to the stomach; and in Avarm wea-
ther it is  indispensably necessary.  W ith the above re-
gimen our views will often be promoted, by using occa-
sionally as tonicks, iron filings combined Avith the gums;
bitters as  poAvdered bark, columbo, or gentian; the elixir
vitriol; Avhite oxyd of bismuth.   The bowels must be
kept open;  nor is a looseness, which sometimes occurs,
in dyspepsia to be considered as answering this purpose,
on the  contrary,  it generally indicates  a necessity for
mild laxatives; much purging  is perhaps always injuri-
ous to such patients, and therefore, after  mild laxatives
we ought  to check it by laudanum, if necessary.

                     SECTION  ATII.

                Of Goutier, or Goitre.

   This is an enlargement of the thyroid gland, or an un-
pleasant sAvelling of the neck.   It prevails in  Switzer-
land, some parts of New-England, and in some parts of
the western country, adjacent  to  the Ohio; but cases of
it  are to be met with in every part of this country, in
which I have travelled.  All  the cases of this disease
which I have seen, that were of long continuance, Avere
accompanied  Avith asthmatick symptoms.   There  is ca-
ses, on record, ay here removal  has effected cures, but in
general this affection of the  throat is associated aa ith some
other visceral affection, and  I suspect, it is only  to be
removed by occasional b eedings, and one or more issues
kept open for a long period, or during life.  Exercise,
particularly in the form of travelling, the cold bath, and 
OF SCROFULA.
331
such tonicks  as are  most durable and least stimulant,
should be used.
  In the early  stage of it, I think it highly probable, that
by adding to the  above remedies,  frequent  applications
of the extract of lead to the part affected, the disease may
be arrested.  I think it  particularly  necessary  to keep
the feet dry and warm.  And the issues  Avill probably
answer best in  the calf of the leg.
  Several causes have been assigned as producing this
disorder, such  as  snow Avater, cold climates, and hilly
countries.  There appears to be something of an ende-
mick character  in this disease;  but 1  suspect it  is occa-
sioned most  frequently, by  persons  going barefooted,
who are predisposed to gout.   It folioavs,  that, in places
where goitre prevails, females in particular are to pay
a scrupulous  attention to keeping the feet and legs Avarm.
If they are  more exempt from  regular gout than men,
they are more liable to goitre* and  to misplaced gout;
and, in this country, suffer more from  neglecting to keep
the feet and legs Avarm, than from  any  other  circum-
stance.

            SECTION  IX.--SUBSECTION 1.

                    Of Scrofula.

  In treating on scrofula, I have thought proper to de-
part from the common tract, and suggest some new ideas,
which I think calculated to lead to a rational and  safe
practice.   I shall divide the subject into strumosa rachi-
tialis, or rickets  strumosa glandulosa simplex, or sim-
ple, scrofula of the  glands:  and strumosa maligna,  or
malignant scrofula.  Each of these forms of this disease,
partake of different grades,  and like all  other diseases
affecting different parts of the system, are  often blended,
er transformed from one grade to another. 
332          OF RICKETS, OR  RACHITIS.
                   SUBSECTION 2.

              Of Rickets,  or Rachitis.

  A simple rachitis usually commences with a looseness;
flabbiness of the skin; a SAvelling of the abdomen, while
the muscles in general grow  lean; a flaccid tumour of the
head and face;  the joints appear enlarged; the  patient
becomes weak, and languid; the bones soft and yielding,.
so that if the child has been walking, it becomes  gradu-
ally weak and tottering, till at length it is unable to walk;
and this is often rendered more difficult on account of an
enlargement of the head, which often occurs: the  sutures
of the  head open,  the  breast  becomes distorted, the
ribs knotted or crooked, the abdomen becomes still more
protuberant, the teeth become blackish, and the tongue
generally falters.   And  if these symptoms are not ar-
rested, the Avhole of the  solids become dissolved down,
and the  patient  having lost  all power to support himself,
dies.  In most cases, however, this disease Avould even-
tually Avear off'; but not  without much deformity.  My
principal reason for placing rickets as a variety of scro-
fula, is to caution persons Avho have been  affected with
this disease in infancy, that they are disposed to scrofu-
la,  and  must be circumspect in pursuing the strictest re-
gularity.   This form of scrofula is principally found in
young children.
  In attempting its cure,  Ave are always  to  attend to
keeping the alvine excretions regular; this Avith perse-
verance  in the folloAving tonicks, using them alternately,
Avill mostly answer our purpose:  Iron filings made into
pills, Avith  extract of bark; or the iron combined Avilh
a little gum myrrh, and crumb of bread;  from  five to
twenty  grains of filings per  day, should be  given; phos-
phate of lime,  in doses, of from five to fifteen grains,
twice a  day.   In low  cases muriated tincture of iron,
Avith the alternate use of the above articles; we are also
to use diligent frictions applied to the whole body,  and
there is strong  reason  for  believing  frictions with oil,
would be useful.   The  cold,  or tepid bath, must be 
OF MALIGNANT  RICKETS.           333
constantly used, and such exercise as the patients can
take,  or  sustain, should never be omitted; they should
wear flannel next the skin, and the utmost attention paid
to keeping them dry.   Their diet must be light, but nu-
tritious; milk  boiled with  ginger, or horseradish, or  a
little pepper; and dry Avater biscuit, should constitute a
large portion  of the diet;  light animal food,  and occa-
sionally a little salted meat will be proper; and a glass
of choice wine may be allowed.   A little ripe fruit may
be allowed;  all unripe fruit or vegetable trash, are to be
withheld; nice fresh jelly of calves feet,  &c. are proper.

                   SUBSECTION  3.

                Of Malignant Rickets.

   A more malignant form of this disease,  because more
concentrated on one particular part of tlie body, is seen
in Avhite sAvellings, usually so  called; the hip disease,
and the spina bifida or disease of the spine; these are all
but varieties  of rachitis,  of  a  more malignant  form.
And the same general indications of cure are necessary,
with  some variety  in  the  local or topical applications.
This form of  scrofula is usually ushered  in by violent
inflammatory symptoms, particularly Avhen it attacks the
hip, or knee:  the symptoms generally  run high where
any  of the  larger  joints or bones are attacked; the in-
flammatory symptoms are less marked when the spine is
attacked.  In  these cases, active measures should  be
speedily adopted; bleeding from  the arm; purging; sca-
rifications, on the  part  pained,  with cupping glasses;
leeches; blisters: after these remedies have been, speedi-
ly, carried,  as far as may be  considered safe, we may
apply warm fomentations, and give anodynes combined
Avith ipecacuanha or sweet spirit  of nitre, and await sup-
puration,  which is often tedious,  and  requires  onion
.poultices; but in all cases, it is improper to continue wet
or dampness of any kind, for a length of time:  gum plas-
ters will answer better.
   In the disease of the spine, we are never to apply poul-
tices; a warm  gum plaster may be applied; if the' disease
advances, our  only  hope is issues, on  either side of the 
 334        OF SCROFULA IN THE  GLANDS.

 spine, kept open with savin ointment.   This form of the
 disease usually attacks weakly children; and seldom re-
 quires severe evacuations; the principal indication, here,
 is to strengthen the general system, and keep open the
 issues.
   All machines, tight bandages, &c. are to be carefully
 avoided, they are the offspring of ignorance, or officious-
 ness, and  never  fail to harass the Jittle sufferers with
 more pain  than the disease.  The  cold  bath, frictions,
 and such exercise as can  be borne, are the only things
 which will support an automaton machine.   Let me ad-
 monish every head of a family to bury all these tormen-
 ting machines Avith the "quiescent  momentum" of a late
 machine, said to possess powers of perpetual motion.  I
 am not singular in these opinions; professor Davidge has
 taken much pains to propagate this important  advice,
 against these machines.   A staff  or crutch,  will often
 be useful,  and even  with  these long standing should be
 avoided.
   The machines Avorn for a weak back or  legs,  may be
 called, emphatically, yokes of folly, designed to support
 the back, but break  the heart Avith vexation, and double
 labour, owing to the obstructions put upon the circula-
 tion.

                    SUBSECTION 4.

            Of Scrofula in the Glands.

  I come now to speak of  strumosa gland ulosa simplex,
 or the simple scrofula of the glands.   This form of the
 disease is known by hard indolent swellings under the
chin;  behind the ears, &c; they go on mostly to enlarge
gradually,  then, sometimes, go away in the same gradual
manner;  at other times they go on to increase in size and
number, and become painful, suppurate slowly, and then
discharge a thin watery or brownish liquid. Sometimes
the arm pits, groin, hands, eyes, mammae, &c.  are affec-
ted in a similar manner.   The lungs, liver, spleen, &c.
are also liable to  strumous  affections; but this  form of
scrofula seldom  affects the viscera; a permanent  swell- 
OF MALIGNANT SCROFULA.
335
ing of the  upper lip, is reckoned  a strong mark of a
scrofulous habit.
  In this form of the disease, the free use  of the bark,
iron filings, cold bathing, travelling, with the usual ex-
act attention to diet and regimen generally, which has
been pointed out for rickets, are the principal remedies.
If the case  becomes inveterate,  tending to obstinate sup-
purations, and  ulcerations, advantage may be expected
from  alternating the  use of hemlock,  Avith  the bark.
But I think it clearly established, that the very free use
of the bark, and cold bath, with due attention to keep-
ing the bowels regular, by opening them with phosphate
of soda, when costive, and restraining a looseness Avhen
necessary, Avith small doses of laudanum, are the only
means likely to arrest this disease.   Mercury  is never
useful, and is attended with much danger.

                   subsection 5.

       Of Malignant Scrofula, or Cancer, 8gc.

   Strumosa maligna is found  in the form of scirrhus,
and cancer; I shall speak of them conjointly, and Avish
merely to premise,  that cancerous ulcers sometimes  oc-
cur Avithout  scirrhus  having  preceded; but from  the
frequent termination of scirrhus in cancer, we are war-
ranted in considering  them one and the same disease;
scirrhi being incipient or occult cancers.
   In these diseases, when they are locally situated,  we
are to extirpate the part, and thus remove the centre of
the disease; after which  suitable remedies may subdue
the slighter taint of the general system.  The removal
of these tumours is the business of the most experienced
surgeon, but it  may be proper to point out those cases,
which at an early stage, may generally be removed, these
are scirrhus of the mammae, of the testes, and tumours
generally which are superficially situated.   In that  va-
riety of scrofula, knoAvn  at present by the name offun-
gus hcematodes, amputation is alone to be trusted.
   The liver,  stomach, and uterus, are more especially
liable to scirrhus: these are known by pain and burning 
 336     fo OF SYPHILIS, OR  LUliS VENEREA.

 in the part affected, and a hardn ess is soon perceptible,
 by pressing on the part.  Such  cases require the most
 skilful attention, and therefore, I shall conclude this ar-
 ticle with a few general observations.
   We are never to apply  external  remedies to scrofu-
 lous sores, unless they break:  in common cases, an oint-
 ment Avith a feAV drops of oil of savin in it, or some of
 the  powrdered leaves in common basilicon is the best
 dressing.
   In malignant  cases we may use the carrot poultice,
 sprinkle the part Avith powdered savin leaves, touch it
 with the juice of garlick, or a weak solution of arsenick;
 but where these articles produce irritation and pain, they
 should be omitted, and the carrot poultice, with frequent
 fomentations  of hemlock,  or  JamestoAvn weed  used.
 Exercise, and frictions,  accompanied with mild nutri-
 tious  diet, are proper in all cases  of scrofula, but in the
 malignant we are not to expect any benefit from the cold
 bath, if it be not really dangerous; neither is any benefit
 to be  expected from the bark, in the malignant scrofula:
 the free use of hemlock, and perhaps the occasional use
 of a  solution of arsenick, with avoiding all heating
 drinks, or  harsh articles of  diet, disturbances of the
 mind, and attention to the  bowels, are our  hopes, to-
 gether with occasional anodynes,  to keep doAvn  pain or
 irritation.   An incipient scirrhus of the liver, may pro-
 bably be arrested by mercury, but in all other  cases it is
 useless or hurtful.

                     section  x.

            Of Syphilis, or Lues Venerea.

  In treating on this disease, I consider it a  matter of
 primary importance, to point out the symptoms by which
 it may be known.   Persons are sometimes found willing
 to believe that scrofula and other diseases are venereal;
 but more frequently, persons are found who wish to con-
 ceal this disease, under pretence of having some other.
Moreover,  we are assured by many most reputable au-
thors that this disease may be communicated by simple
i^ 
OF SYPHILIS, OR LUES  VENEREA.       337
contact, as touching the virus with a part from Avhich the
scarf skin is removed, sucking a venereal person, Avith
a sore mouth, &c.  in these cases it may be of great im-
portance to distinguish this  disease from scurvy.   But
although I liaAe no doubt of such communications pro-
ducing this disease, I am confident they are very rare,
and many people conceal their OAvn vices under a cover of
this kind.   I  believe ninety-nine  cases of a hundred,
are the offspring of impure coition, and therefore not only
might be avoided, but cannot be contracted but at the
expense of virtue, of one of the parties, in all cases.
  I shall take  occasion to observe here, that the more
artificial our diseases, the more difficult are they of cure;
and this is  strongly  exemplified in syphilis and  gout.
When the usual local symptoms of a virulent gonorrhoea.
as chancres, buboes, phymosis,  kc. do not yield  to the
usual remedies, or if these heal,  and break out again,
Avithout a reneAved infection, Ave are to suspect the gene-
ral system is affected.  If ulcers break out in the throat,
pains in the shins, Avith nodes or little knots upon the
bone; ulcers in various parts of the body, or ill-looking
blotches, or eruptions, unattended Avith itching. Ave may
generally conclude the case is venereal.  Venereal ulcers
may  be distinguished from scorbutick  ones from these
circumstances:  Venereal ulcers never  affect the gums
first, but generally commence in that part of the mouth
called the fauces, more commonly in the tonsils, or uvula,
of the upper part of the throat; scorbutick ulcers affect
the gums first.  Venereal ulcers  are red around their
edges, scorbutick  ones  are  livid.   Venereal ulcers are
mostly deep and covered at bottom Avith Avhite or yelloAV-
ish  sloughs,  scorbutick  mostly  put out loose fungi.
Venereal ulcers are apt to rot the subjacent bones, scor-
butick almost never.  Venereal ulcers are Avell defined
in their edges and mostly circular, scorbutick are more
extended and  undefined.  Venereal ulcers are callous
in their edges,  scorbutick ones are not so.   Venereal
ulcers are  apt  to  spread from  the mouth  to the  nose.
scorbutick are not.  Lastly: scurvy may be known by
difficult  breathing, remarkable lassitude, rotten  gums,
and SAvelled legs.   But our greatest  danger is that  of 
338        OF SYPHILIS, OR LUES VENEREA.

mistaking scrofula for syphilitick affections; nor in ge-
neral can we determine without much experience in these
diseases, unless it be from the circumstance of knowing
Ave have been infected with syphilitick poison; or Avhere
it is preceded Avith the most usual forerunners, as buboes,
chancres, kc. or from the  circumstance that the patient
is  evidently scrofulous; and even this will sometimes de-
ceive us,  for scrofula  and syphilis are often blended.
And further, a  scrofulous taint ^which lies dormant, is
sometimes roused up by syphilis, but more especially
by mercury used for  its cure.  It follows,  that persons
of scrofulous  habits  run double  risk from contracting
lues venerea, for they cannot be cured of syphilis  with-
out mercury, nor use it in scrofula  without risk: and I
have elsewhere said, that, I believe most  of the dread-
ful consequences which sometimes folloAV the use of mer-
cury, and what is usually  called the mercurial  disease,
is nothing but aggravated scrofula.
   Upon the whole, I consider it one of the most impor-
tant affairs in medicine to  distinguish between  scrofula
and  syphilis, in some cases; and as  much mischief may
arise from mistakes, it behooves every patient to take the
best advice.   I therefore, shall conclude this article Avith
a feAV general observations.   I have cured  lues at every
stage of  the  disease by the  mildest remedies, Avhich
have been proposed  for this disease.  Give from three
to five grains of calomel, according  to circumstances, in
pills; suffer these to purge the patient a few days; and
if the least affection of the  gums occurs, quit the calomel
till this wears off.   After  the patient has been reaso-
nably  purged,  if necessary, combine opium Avith the
calomel.
   If the case is recent, we  should  bleed once or twice,
and  enjoin a low diet with mild  drinks.   But in con-
firmed  cases, we may commence at  once  aa ith pills of
calomel and opium,  observing always to omit the medi-
cine when the gums are affected, till this aa ears oft', and
then begin again; after pursuing this course for a few
weeks,  Ave should quit  the medicine, and put the patient
on the use of nitrick  acid;  with this, should be used de-
coctions of mezereon, sarsaparilla, sassafras, or burdock; 
OF SYPHILIS, OR LUES  VENEREA.       339
 this course is to be continued for a feAV Aveeks, and then
 changed again for the calomel  and opium.
   In all reduced habits,  or in cases accompanied with
 scrofula, Ave are to commence  Avith short courses of the
 mercury,  and longer courses of the acid, &c.   In °*ood
 habits and  recent  cases, we  are to reverse this proce-
 dure.  In all scrofulous  habits, we should constantly
 use the bark, in conjunction aa ith otlier remedies.
   By  this treatment Ave  can  arrest syphilis  in  every
 stage,  (and I speak  from actual experience,)  provided
 due attention is paid  to avoid catching cold, by keeping
 the feet and legs  warm and dry,  and wearing flannel
 next the  skin, dressing warm,  avoiding heating articles
 of diet or drinks,  venery, and fatigue, and  excess of
 every  kind:  but free  exercise  is always  necessary in
 good weather.   The patient is  also to avoid rash ex-
 posure to night air, and also that of cool mornings and
 evenings, and getting Avet,  or  rashly drinking  cold Ava-
 ter when warm.   In  recent  cases,  animal food, and
 spirits, and  spiceries,  must be avoided:  in those more
 confirmed, or in Aveakly habits, a tolerable generous di-
 et,  Avith  a  little gin  and Avater, may  be used,  more
 especially if the patient has been accustomed to ardent
 spirits.
  For local affections, as  buboes, chancres, ulcers of the
 mouth, or sores of other parts.of the body, if ulcerated,
 a Avash of calomel,  honey  and water, together with daily
 Avashing the parts very clean, with mild soapsuds, will
 answer eAery purpose.  This  wash may  be  made by
 rubbing half a dram of calomel Avith two small tea spoon-
 fuls of honey, to which, add two ounces of cold water.
  For venereal inflammation of the eyes, or buboes not
 open, mercurial ointment is the best remedy; but for the
 eyes, the ointment should  be fresh, and contain nothing
 but the quicksilver, and the best fresh lard.  It will be
 advisable, in ulcers of the mouth,  to gargle frequently
 with a weak decoction of bark, containing a little  soda.
  I am satisfied from observation, that the use of  mer-
curial ointment is one of the most  unsafe  forms of this
medicine.  We can make little or no calculation on the
effects  which Avill follow,  and patients are  often saliva 
340
OF THE YAAVS.
 ted in this way before they are aAvare of it: this is never
 necessary,  and to persons who are going about, or to
 scrofulous patients, it is ahvays dangerous.  Besides, it
 is  a  dirty practice, as disgusting as it is unnecessary.
 In cases of fever, where Ave wish to salivate, and where
 of course the patient is confined to the house,  the oint-
 ment should ahvays be preferred; or accompany mercu-
 ry in some other form.
   Much confidence has been placed in the use of the cor-
 rosive sublimate:  it often answers  a good purpose; but
 the calomel is  more mild, and equally effectual: besides,
 serious injury  is often  done the stomach  and appetite,
 by using corrosive sublimate,* which I have never seen
 folloAV the use  of calomel.   Where  there is much pain,
 we should use anodynes freely; but in general we must
 endeavour to avoid the long continued use of opium.
   Let me solemnly admonish every  person, to beware
 of persons who pretend to cure  confirmed lues Avithout
 mercury:  they  will either deceive you in giving it clan-
 destinely, or they will injure your constitution, and pos-
 sibly do away  all chance,  Avhich  you  might have had,
 for its removal, by mercury.  And further, never daub
 your  skin with mercurial  ointment, if you intend to go
 abroad during its use,  or if you have any suspicions of
 scrofula.

                     SECTION XI.

                     Of the Yaws.

  Much confusion or ambiguity exists respecting this
 disease,  but from the best information Avhich I have of
 it, it does not prevail among us, at least, not in the form
 known under the  names of frambozsia guineensis,  or
 americana, the former of Avhich prevails in Guinea, and
 the latter iu St. Domingo,  &c. I suspect, Avhat takes the
 name of yaws in the United  States, is a combination of
a slow or  Ioav  grade  of lues and glandular scrofula.

  Vrhis medicine has acquired a very great reputation in  the pub-
lick institutions in New York, brought about by Dr. Hosack.
• 
OF EPILEPSY.
341
 Such has been the case with all the cases I have seen,
 and when thoroughly  confirmed,  it is  seldom if  ever
 cured.   But  there  is  some consolation in  the belief,
 Avhich I think well founded, that those deplorable cases
 are always the consequence of neglect, or improper treat-
 ment on the part of the physician,  or imprudence,  &c.
 on the part of venereal  patients.  All these declarations
 comport with  my observations on cases called yaws.
   It Avould seem to folloAV, that by avoiding the usual
 causes of lues, and by carefully attending to the speedy
 removal of it  when caught accidentally, or at the ex-
 pense of decency and virtue, Ave may banish this uncouth
 name from the list of our  diseases.   Or, perhaps, no
 better term can be used than that of framboesia for this
 compound disease, formed of scrofula and  lues,  more
 especially as the American people seem to have adapted
 the term yaws, to a low chronick state of syphilis.

                     SECTION  XII.

                     Of Epilepsy.

   This disease is also  knoAvn  by the name of falling
 sickness, from the circumstance of the  patient's being
 generally suddenly seized; and falls down,  and some-
 times receives  great injury from fire, bruises, cuts, &c.
   I have seen one most shocking case of an epileptick
 patient falling with his face against a hot stove.  I  Avas
 present, but the weather being cold, and not recollecting
 immediately that  he was  an  epileptick  patient, at my
 father's, he Avas suffered to remain a few moments before
 the true state of his disease occured,for it was supposed
 he had merely stooped  to  Avarm himself, till the usual
 noise  made by such people, called me to  his  assistance:
 and it appeared as though  he Avould  have been burned
 to death, if I had not been present, for he  made no efforts
 towards relieving himself.  This suggests a strong cau-
 tion, to those who are subject to sudden attacks, to avoid
 dangers of this kind.
  There are many cases where the  fits are preceded by
premonitory symptoms,  Avhich enable the patient to pre- 
342
OF EPILEPSY.
pare in some measure for the attack: these symptoms are
pain and confusion of the head, lassitude, dread, noise in
the ears, palpitation of the heart, uneasiness of the head,
disturbed sleep> &c. these are often  succeeded by cold
tremulous like sensations, ascending upwards to the head.
If the patient be  standing he noAV falls, and generally
utters  a violent  distressful cry, and these are often re-
peated; the thumbs are  draAvn up into the hands, the
eyes are distorted, the breathing is laborious; sensation
is suspended;  so that smelling, seeing, hearing,  and
feeling, are entirely suspended.   Many other unpleasant
symptoms occur, which it is unnecessary to mention, in as
much as the above always sufficiently characterize epilep-
sy.   After these symptoms, if  they occur  in the day,
the patient may be aAvoke, and he feels sore, and stupified
•for some time afterwards.  Often, hoAvever, it attacks in
sleep,  an J  the patient, after  the most violent fits, falls*
asleep again unconscious of what has  happened,  except
from  the soreness which is felt over the whole body.
In inveterate cases,  a pretty constant giddiness and con-
fusion of the head continues.       ;
   All search  after the cause of this unpleasant disease
has  been  fruitless, the dissection  of persons who have
died after  being affected aa ith epilepsy, has sometimes
discovered organical affections of the brain, caries of the
skull,  indurations, collections of  water, matter, &c; but
in many cases no traces  av hate ver Avere to  be discovered.
   Cases of epilepsy are  to be found where strong pres-
sure upon  the region of the  stomach will suspend the
fit, or  check its  violence, so that upon the whole, I
imagine, epilepsy is as often the consequence of diseased
viscera, and particularly of the stomach, as of disorders
of the  head.   And indeed, from the remedies which have
often been  found useful  in this disease,  and sometimes
cured  it, I think it  highly probable the  stomach is the
seat of the disease,  at least in those cases which yield
to powerful tonicks.  It is generally believed, epilepsy
is incurable after puberty, but there are many cases on
record, where they Avere  cured after this  period of life.
   I  have generally been able to suspend the force  of
epilepsy, by the use of sugar lead, but it has always re- 
OF HYPOCHONDRIASIS.            343
turned:  but by a more free and long continued use of
this article, I think it likely it might be cured, where there
is no disorganization of parts, Avhich must preclude all
hopes from medicine.  It behooves persons subject to this
disorder, to live temperately, avoiding all excess in eat-
ing, drinking, exercise, passions, venery, kc.  Of all un-
friendly things venery, and disturbances of the mind, are
most conspicuous.   With the strictest regulnvi'y wiiti re-
spect to exercise,Avhich should be constant, but mode rate,
to diet,  sleep, avoiding spirits, and much  gross animal
food, I should recommend the following course in pre-
ference  to  any other.  Take  the floAvers  of zink for a
feAV Aveeks, in the usual doses; then use iron filings and
assafcetida, for a like period; succeed this with the sugar
lead, in doses of from one  to four or six grains a day;
then stramonium in the usual doses; then the bark in the
largest possible quantities, that the stomach aa ill  bear;
then the cuprum  ammoniacum.  AVith these remedies
Ave should open one or more issues,  in some part  of the
body; and use the cold bath occasionally.   Should a
round of all the above powerful tonicks  prove abortive,
it will be advisable to go over them  again,  changing the
order of them in some measure, so as to produce as much
variety  as possible.

                    SECTION  XIII.

                 Of Hypochondriasis.

  It has  been  supposed  by many  unthinking people,
that  hypochondriasis  is  but an  imaginary  disease; and
it is  often unwittingly called blue devils, and other rude
or trivial names.   For that of spleen, there is some foun-
dation;  as from the days of Hippocrates, it has been
supposed to be an affection of the spleen.   But this dis-
tressing malady, probably is seated in the  three princi-
pal  organs of digestion, the stomach, liver and spleen;
and the  melancholy state of the mind is symptomatick of
a languor, or perhaps OAving  to depraved functions of
the organs enumerated; by Avhich I think it highly pro- 
344
OF HYPOCHONDRIASIS.
bable the blood, and  animal fluids,  are not sufficiently
prepared.
  It is well known that reasonable pleasantry or mirth,
has a beneficial effect upon hypochondriacks, and sub-
jects of other diseases, and hence it comes that well dis-
posed persons, Avho wished to befriend or relieve such
patients, by a prudent use of good  humour,  &c. have
brought the unthinking to suppose hypochondriacks are
fit subjects for  derision,  and rude sport, because their
disease is  imaginary.  But let  me  admonish all  such,
that this  is an egregious errour, and as inhumane as it is
ill founded.  We knoAv  that all diseases are much in-
fluenced  by the mind; and moreover, that the stoutest
heart, or constitution is assailable by, and essentially go-
verned, supported, or depressed and  even destroyed, by
the operations of the mind.
  In hypochondriacks we have unequivocal evidence of
disease preceding,  and giving rise and maintenance, to
the gloom of the mind, this is manifested  by the follow-
ing symptoms: all the usual symptoms of dyspepsia; cos-
tiveness, tormenting pains under the  false ribs, which
sometimes become  lancinating,  burning,  &c.  disturbed
sleep.   Sometimes there is an inflation about the region
of the, stomach, or spleen, flushings of the face, and heat
or prickling through Aarious parts of the body, with slight
twitching or quivering of the flesh, colicky, and cardial-
gick pains; to  these  and many  other symptoms,  which
sometimes occur, succeed  dread, and  a great suscepti-
bility  to frights: then comes  gloomy  forebodings, and
still more  disturbed sleep, insomuch that such patients
are often almost deprived of sleep, under an apprehen-
sion that they Avill die without Avaking.  When the dis-
ease is confirmed, it is particularly characterized by er-
rour of judgment respecting their OAvn case,  while the
judgment, and  other poAvers of  the mind  are correct on
all other subjects;  and also, by a propensity to dwell,
with minuteness, on every trifling symptom which occurs.
If the  case becomes still  more inveterate from neglect,
improper management, &c. this disease  sometimes ter-
minates  in fixed melancholy, or a gloomy Ioav  state of 
OF HYPOCHONDRIASIS.             345
madness, often leading to a desire of death, and Avhich
too often is accomplished, violently by their OAvn hands.
  This  disease is generally curable, or  perhaps more
correctly speaking, may mostly be mitigated by suitable
attention to regimen, exercise, and the occasional use of
medicine.   In all recent cases, and in the  occasional ex-
acerbations, small evacuations are essentially necessary,
as bleeding, aloetick purges, gentle emeticks, and these
are to be repeated till  the symptoms  abate.   In the in-
tervals, I have no  hesitation in pronouncing the use of
iron, the cold bath, and riding on horseback, superiour
to all other remedies, and I speak from Avhat I have seen
in the  extensive  practice of  my father,  Avho has  fre-
quently  had these  kind of patients, coming from a  dis-
tance; and often sent them home perfectly well; some of
which never  relapsed.  It is, however,  probable, that
the  change of scene, &c. Avhich attended going to,  and
residing for  some time Avith  or  near  a physician, in
whom the patient had confidence, had a  large share in
affording that relief, which invariably followed cases
from a distance, in  the practice  of my father.  And, I
feel confidence in  recommending to hypochondriacks, to
seek out some celebrated distant physician,  in  prefer-
ence to taking medicine at home.
  The  following course Avill  generally  succeed:  take
nonfilings, gum myrrh, and assafcetida, each equal quan-
tity: form these into pills  of the usual size,  and take
four to  six  per day,  drinking a small glass of a bitter
infusion, made by steeping a little bark, chamomile, car-
duus, centaury, orange peel, or gentian;  either of these
alone or combined, Avill ansAver;  and a quart of Avater,
and one gill of pleasant old rum, spirits or whiskey, (to
prevent  souring,)  and one dram of salt of tartar.   If the
bowels  are costive, give a little aloes and calomel.  It
Avill always be necessary to observe the state of the feces;
if they are not blackened from the use of the iron, Ave
should omit the salt of tartar, and give fifteen or hventy
drops of elixir vitriol, before  each meal,  about an hour.
If things progress Avell, we should discontinue the  iron
and  bitters, once in every ten or fifteen days,  and give
the  elixir vitriol, as above, Avithout any other medicine.
              44 
346
OF HYPOCHONDRIASIS.
for three or four days.   In all cases Avhere evacuations
are necessary, and in debilitated habits, and  generally,
in cases of long standing, Ave should give mild anodynes
at night; half a grain of opium, with two or three grains
of ipecacuanha, is the best form of the anodyne, as it is
more durable in its effects than laudanum, and the ipeca-
cuanha determines mildly  to the surface.   An anodyne
plaster should be worn over the stomach.   These reme-
dies, with the  occasional use of the cold or tepid bath;
and constant riding on horseback, will render such peo-
ple comfortable, and often  wholly eradicate disease from
the body.
   Much benefit will, however, be derived from proper"
attention to  the mind.   Those  who Avish  such  persons
Avell, are to avoid all rude jokes, and every  thing like
intimation, that cheerfulness is assumed merely to  rouse
them from imaginary evils; such conduct is generally of-
fensive, and often drives such  patients from  society  to
gloomy retirement.  The  better Avay is to listen  with
good nature, to their distressful relations,  by  times, but
on all suitable occasions preserve a cheerful  lively de-
portment; endeavouring to  recall all pleasurable subjects
which may lave preceded, orAvhich may be anticipated,
relating either to the patient, or his companions.  If he
takes offence at a too lively deportment, and seems  to
think it pointed at him, never  argue or contradict him;
yield the point, and  after  a  seeming repentance for
having given offence, go on, but not particularly in his
presence,  to cheer up those around you by lively airs of
musick, or the sprightly gambols of children and young
persons; ahvays guarding' against rude noise.   The fre-
quent company of agreeable neighbours, Or when riding,
endeavouringioconnect it Avith business, Avill be beneficial.
   It will readily occur to the reader that I am address-
ing myself particularly to  the wife; but persons of every
description may  materially promote the welfare of suf-
fering hypochondriacks, by suitable endeavours to amuse
and  call off their attention  from their disease.   It is also
of importance that such persons avoid spirituous drinks,
and gross, or much vegetable trashy food, or pickles, fats,
and  excess  of every  kind.  The diet should consist 
OF HYSTERICKS.
34?
principally of light animal food, Avith esjgs, milk season-
ed with  ginger,. horseradish  or pepper, well boiled
onions, and occasionally a little garlick, as a condiment.
Glood coffee Avith  bread, and a little nice  butter, and a
relisher of a little nice ham,  salted beef, or fish is a good
breakfast; but coffee in general should not be used  more
than once a  day;  water biscuit should  occasionally be
preferred to raised bread,  and also well  boiled rice, po-
tatoes, or barley, &c: animal jellies are proper, and roast-
ted or broiled animal food, is  preferable to boiled; and
broths, unless rich and in  small quantities, are improper.
It is to be  particularly  observed, that  such  persons
neither fast long,  nor  eat full  meals;  they should eat
more  frequently, but upon  the Avhole  they should eat
sparingly; and if any particular article is found to  disa-
gree,  or to agree  Avell, they  must choose accordingly.
For drinks, Avater should constitute their principal drink;
and if it seems to disagree Avith the stomach, a slice of
carefully toasted bread, Avithout burning, Avill often make
it agreeable; or very Aveak bitter cold infusions may be
drank; an occasional glass of good wine after dinner, will
mostly be proper; but such people must be cautious how
they use fermented or spirituous drinks; they are never
allowable in  large quantities.   Persons in the decline of
life, may be the better of a little old spirit,  of some kind,
mixed with a little Avater;  but it must be  used with much
caution, and  can seldom be  used with safety,  as freely,
as by persons of the same  age in health.

                    SECTION  XIV.

                    Of Hystericks.

   This disease nearly resembles hypochondriasis, but
differs in some measure  in its symptoms, and requires
some difference in  the method of cure.   For the treat-
ment of hysterick colick,  the reader is referred to the ar
tide colick.  Hysteria has mostly been supposed  to be
a disease peculiar to females; but I have seen all its most
marked symptoms in males.   It occurs  sometimes  Avith,
and often Avithout,  the most permanent symptoms of by 
348
OF HYSTERICKS.
pochondriasis.  The disturbance of the mind in this
disease is more transient, and violent, than in hypochon-
driasis, consisting mostly of sighing, crying, talkative-
ness, laughter, &c. wonderfully alternating  each  other:
a  choking sensation iu the throat, from  a feeling  as
though  a ball Avas rising up; large quantities of limpid
urine;  sick  stomach,  vomiting,  and colick.  In some
rare cases libidinous desires are excited.  For permanent
relief from hysterical habits, we are to pursue the means
laid down for hypochondriacks; in the fits or exacerba-
tions, we are to pursue  a treatment somewhat  different.
In  full  habits we should bleed, give a gentle emetick,
and then  use diffusible stimuli in  small doses,  as
ether, laudanum,  spirit hartshorn, tincture  assafcetida,
peppermint essence, or mixtures  of these;  the juice  of
garlick, or rue, Avill often have a good effect.
  In reduced habits, we may generally content ourselves
with emptying the stomach by draughts of chamomile or
carduus tea; and  in those still more reduced, this may
even be dispensed with, and the diffusible  stimuli just
mentioned,  given  aa ith considerable  freed cm: an ano-
dyne, plaster may be applied over the stomach.  But in
general a  very weak  dose  of ipecacuanha should  be
given, where there is much nausea or vomiting.   It Avill
always  be  necessary to attend to the boAvels; and mag-
nesia, or a little calomel and aloes, where the bowels are
not easily moved, will answer.  In old age  the tincture
of rhubarb, or tincture  of rhubarb and senna,  will an-
swer, or heira picra.   Such patients should  carefully
pursue the regimen, &c. laid down for hypochondriacks;
and it is especially necessary to guard against passions of
the mind, and to keep the feet  dry and warm; and here,
as  in all  other cases of the valetudinary  condition of
the body, flannel  should be worn next the skin.
  Persons much  subject  to  hysterical  affections, must
carefully avoid indulgence in sensual pleasures; in deli-
cate females it is  often  an exciting cause of the disease,
and the offspring of the cohabitation of healthy vigo-
rous men with Aveakly females, more especially Avhere
the Avoman is barren; but there are cases where bearing
children does not prevent such consequences, and where 
OF THE PILES, OR HEMORRHOIDS.       349
the increased  stimulus  of pregnancy  upon the system
aggravates the case.  I beg that this may be particular-
ly remembered; it is not the transient notion of my own
imagination, but is  founded on a av ell-grounded opinion
of an aged physician, who justly  acquired much cele-
brity for his skill in chronick  diseases.

                    •section xv.

            Of the  Piles, or Hemorrhoids.

   This is  a troublesome  affection about  the muscles,
Avhich form the termination of the rectum.   It has been
called the blind piles, and the bleeding piles; the first is
formed of one  or  more painful tumours, the latter has
added to the tumours occasional, or periodical discharges
of blood. They have also been divided into external and
internal piles;  sometimes this affection is av holly out-
ward about the verge of the anus, at other times they
are entirely Avithin.  But  for these distinctions there is
no good foundation: Avhether  the  disease  be seated an
inch higher, or loAver, can be of no consequence.
  I think it of much more consequence, to do away th>
ridiculous notion of the salutary nature of this discharge
Avhich is held by  Buchan, and others.   I can easily be-
lieve that Avhere the patient has been long under the ha-
bit of bleeding piles, it Avould be  dangerous to check it
suddenly: but no person should dream of inviting such  a
crippling: on  the contrary, it should be attacked Avith
spirit, and ever vieAved as an enemy to  the constitution.
  This affection may arise from a  variety of causes, as
costiveness, or an  opposite state  of the boAvels; from
drastick purges; heavy lifting; a weakly, or gross habit;
but it seems to be more especially excited by irritation
about the  rectum, from the above  enumerated and all
other causes.   Strict temperance in every thing  apper-
taining to our condition, is the most  likely means to avoid,
or remove piles.  When they become painful,  or bleed
much, it Avill ahvays be advisable  to use means as early
as possible, for a little neglect now'may subject you for
life to a loathsome and painful disease. 
 330       OF THE  PILES,  OR HEMORRHOIDS.

   Treatment.—Where it is accompanied Avith costive-
 ness, whether blind, or bleeding, we should open the bow-
 els with mild laxatives, as  sulphur and cremor  tartar,
 or rhubarb and magnesia.   If the bowels  are laxative,
 and in a state of debility,  injections of cool starch and
 Avater should be used; sulphur may be  taken alone as a
 purgative, and at the same time a little laudanum  and
 SAveet spirit  nitre,  now and then*  In full or good ha-
 bits, if piles  are accompanied with very severe pain, and
 some fever, the patient should be bled once, or oftener, if
 the symptoms require it.
   It is obvious, that as piles may arise in opposite states
 of the system, Ave  are  to  suit our general remedies to
 that state which is present.   In full or  athletick habits,
 low  diet Avith occasional laxatives,  &c.  will be necessa-
 ry.  In the weakly, the occasional use of the bark, elixir
 vitriol, reasonable exercise, the cold bath, &c.  As a
 local application, sugar lead Avill generally answer every
 purpose.   Persons subject occasionally to piles, should
 keep a strong liniment of sugar lead and sweet oil; and
 as soon as strong symptoms of piles occur, they should
 lay down on the back, elevate the feet and legs, and em-
 ploy an hour or tAvo in gently rubbing the part with this
 liniment,  noAV and then; and in the intervals,  apply a
 gentle steady pressure upon the  part:  for want  of this
 liniment,  strong  cold  lead  water  will  mostly  answer.
 This Avill seldom fail to arrest outAvard piles, if the pa-
 tient can indulge a little for a day or two; and a relapse
 may often be  prevented  by  applying a pledget of tow,
 and binding  this up pretty firmly with  a strap fastened
 to a bandage around the body;  this should be worn till
the parts recover tone.
   If  the  disease  is internal,  or attended  Avith  much
 bleeding,  cold starch and water may be injected, and if
this does not check the bleeding, or remove the pain, an
injection of weak lead water should be thrown  in,  not
exceeding in quantity a spoonful or  two; and the same
procedure should be pursued by lying doAvn, &c. as di-
rected for the outward affection.   In these internal cases,
Ave should pass a piece  of ivory, or a smooth wax, or
clean tallow candle, of a small size, up the rectum, and 
         OF  THE PILES, OR HEMORRHOIDS.        351

confine it there an hour or tAvo.   If the case has pro-
gressed for some time, and the pain has become extreme,
Avhether the disorder is internal or external, Ave must use
emollients:  in this  condition  of the parts,  it might be
dangerous to  apply cold astringent applications; here Ave
should foment the part Avith a bath  of bitter herbs; and
in more severe cases, a poultice of bread and milk, Avith
a little camphor  in  it, should be applied.   But  these
warm emollients are seldom or never necessary, unless
the case has been neglected.   I have had occasion in ma-
ny cases to apply them, and suppuration has never fol-
lowed; so  that, in all  cases where the cold  astringents,
with bleeding and purging,  in strong  habits, and mild
glysters and  gentle  anodynes in Aveakly habits, do not
succeed in checking the pain, Ave may in all cases where
the pain is extreme, have recourse  to  emollients  with
safety and  advantage.
  But it is a  fact not generally knoAvn, that in most cases
of blind piles, the  pain arises from  the violent contrac-
tion of the  sphincter muscle of the  anus.  Where this
exists, keeping  some  smooth  substance up the rectum
for an hour or tAvo,  now and then, Avill not only remove
the pain, but Avholly  subdue the disease: it is ahvays
advisable at the same time, to use  cooling  Avashes,  or
warm fomentations, as the state of the case may require.
  There is a case on record, which occurred in this  state,
of a man who had suffered the most  extreme torture from
this disease, for several months, in spite  of the usual re-
medies, applied under the direction of several respecta-
ble physicians.  An old lady at length advised hvisting
some toAV pretty firmly into  a long plug, and after greas-
ing it Avell, it Avas passed up the rectum; and to the as-
tonishment of every one, it gave instant relief, and the
patient soon recovered.   In such  cases the sphincter
muscle becomes irritable,  and  contracts, its surface is
sore, this  gives an increased propensity to contract, and
the muscle, by  thus forcing its  tender surface  together,
produces extreme pain, and the passage becomes so clo-
sed,  that even.a small  glysterpipe can scarcely be intro-
duced. 
352            OF A FISTULA IN AXO.

  All  persons subject to piles, should take a  little sul-
phur uoav and then;  should avoid  sitting long at the
cloatick vault; should  occasionally use common  glys-
ters, particularly  if they feel any  itching or soreness
about  the seat, or are affected Avith ejections of a  hard
consistence.   They  should  always, Avhen undergoing
fatigue, or  Avhen  the disease  is  present, wear a firm
smooth bandage, so as to keep up the part: this is easily
done by a  cushion of tow, confined  by a strip of cotton
cloth, made by  doubling the cloth several times, and
fastening this  bandage to a handkerchief,  or other ban-
dage around the body.   Lastly.   A habit of this kind is
always a sign  of debility,  and therefore every  thing
Avhich  may contribute to give tone and vigour, is to be
practised: and this consists, principally,  in temperance
and regularity,  of every kind.

                     SECTION  XVI.

                Of a Fistula in Ano.

  This is  a  disagreeable and painful affection of the
rectum and perinceum,'Ai\d consists of an opening along-
side of the anus.   It, perhaps, most  commonly arises
from neglected piles,  Avhich are suffered to run on till the
part suppurates, and  a cavity, or an  opening is formed:
into this the feces is  forced, and  if there is no opening
through the perinozum, neAv  suppurations occur,  and af-
ter much suffering, an opening is formed,  which mostly
becomes callous in its sides, and will not heal.   This
disease seldom,  perhaps never, heals Avithout a surgical
operation, but  it is one attended Avith little  or no danger,
in the hands of a skilful surgeon.  The best advice is ne-
cessary in these  cases, and the disease is mentioned here
more with a view of admonishing people never  to neglect
piles, and if habitually troubled Avith this  disease,  they
must guard against costiveness, by the frequent use of
glysters.
  But although piles  are probably often the cause of fis-
tulous  sores,  I strongly suspect these fistulous  sinuses
arise from an  affection-which I believe has not been no- 
OF THE LAND SCURVY.
353
ticed  by  any author, except Denman, who treats of it
under the name  of the ball stool; this affection is not in-
frequent in some of our domestick animals.   It proceeds
from hardened feces  happening to lodge firmly in the
rectum, and remaining there, the natural efforts of the
intestines, &c. force  on the feces, a  small opening is
forced, and  through this  the  thiner part of the feces is
strained, while the more solid part continues to accumu-
late till much irritation arises; first from the distention,
and secondly the feces acquire such an increase of acri-
mony,  as to  unduly stimulate the parts.
  When this disease is someAvhat advanced,  it will some-
times require  manual assistance, with a proper instru-
ment; but in  most cases  it may be preArented,  and to
those  disposed to piles, this is a matter  of much impor-
tance.   Therefore,  in all cases Avhere persons haA^e to
sit long at the cloatick vault, where  there is itching,
heat, obstinate costiveness,  although there may be small
loose stools, it behooves all such to use frequent injections.
In every state of the  body, persons of  a costive habit
should use frequent glysters; but in those troubled with
piles, they are especially necessary;  these, with every
other attention to cleanliness, Avill render even those la-
bouring under fistula, tolerably comfortable; but in all
such cases, if a surgeon of judgment can be had, an ope-
ration should be  submitted to; as an early operation aa ill
seldom fail to remove  the  disease, and never is attended
with danger in  the hands of a surgeon of good judg-
ment.

                   SECTION XVII.

                Of the Land Scurvy.

  Scurvy  is sometimes found in garrisons, Avith  all the
horrible train of symptoms which attend this disease at
sea.  This kind of scurvy proceeds from the same cau-
ses, and requires the same treatment as that to which
seamen are liable.   There is another disease often met
with, in children and  others, in country families, princi-
pally in the winter; and seems to arise from  the use of
              45 
354
OF CORNS.
too much salted meat.   But owing to such persons  haA-
ing free access to pure  air, partaking of exercise freely,
and being reasonably clean; and also to  their taking a
good deal of vegetable food,  the disease is  generally
very mild, and seems to be local.  If it extends beyond
the mouth, it probably, under the above circumstances,
never goes  beyond  a  slight affection of the  stomach.
The symptoms are spongy gums, which bleed on being
touched with a finger or any hard body; the breath be-
comes offensive.   It is probable that cold has  a share in
the production of this complaint.
   We should dress the patient warm, but let them  par-
take freely of the fresh air and proper  exercise;  give
more  fresh meat and vegetables, and less salted meat.
Let them use cremor tartar freely, in any  Avay it can bt
most easily  taken; and if the  cure  is obstinate, give a
small dose of ipecacuanha every third evening, till two
or three doses are given.  If these articles should not
purge the patient moderately, give a little senna tea.
   Another disease of the mouth is sometimes met with,
Avhich is supposed be of a scorbutick nature.   Its symp-
toms  are  spongy gums, which are apt to bleed; loose
teeth; a fetid  breath.   It progresses till the teeth some-
times are all removed.  Whether we should class this
as a variety of scurvy or scrofula, I am at a loss to say;
but, it i* known to be attended with caries of tlie spongy
part of the jaAV-bones,  in which the teeth  are  set, called
the alveolar processes.   I know of no remedy for this dis-
ease which can  be applied  without surgical  skill, and
therefore, I only wish to observe that cleanliness and the
frequent use of charcoal, as  a dentrifice, are ail I can re-
commend.

                   SECTION XVIII.

                      Of Corns.

  I have observed in a preceding part of this work, Avhen
speaking  of  the anatomy of the skin, that corns seem
to arise from a union of the scarf with the  true skin; this
seems to be unquestionable, since  cases  are  met  with 
           OF DISLOCATIONS  IN GENERAL.        355

where  nerves  and  blood-vessels are found throughout
their substance.   It follows from this, as well as experi-
ence, that, to avoid, or remove this disease, we must re-
moAre all severe pressure from the part.  There are cases,
hoAvever, where,  after such union of parts, the disease
reaches through  the muscles  to  the periosteum.  The
best remedy is bathing the part in warm water,  and par-
ing down the excrescence so far as it is devoid of feeling.
The part may  then be covered with a gum plaster, on
very soft leather;  or the expressed juice of garlick may
be applied, and a little soft cotton laid over the toe, or
•ther part affected.
               OF  CASUALTIES.

                     SECTION  I.

UNDER this head, I shall treat of accidents of every
description to which we are generally  liable, whether
belonging to cases of surgery or not; a distinction into
cases, such as require the physician, and those Avhich re-
quire the surgeon, can be of no use in a work of the na-
ture of this, I proceed to speak of dislocations.

                    subsection  1.

             Of Dislocations in General.

  When the articulation or connexion  of the bones is
broken up at the joint, it is called a dislocation, or luxa-
tion, and in common language, it is said  to  be out  of
joint.   But, little can be done by persons unacquainted
with the structure of the parts, and in many cases, a cer-
tain practical dexterity,  will alone enable us to reduce
or replace a luxated bone.  Besides, luxations are some-
times  accompanied  with compound  fractures near the
joint, which renders these  cases still more  difficult. 
356         OF DISLOCATION OF THE JAW.

  Luxations are  sometimes incomplete, and at  other
times so sufficient a laceration of the  ligaments has oc-
curred, as to render it an easy matter to reduce, and
therefore, in all cases where the practitioner is not to be
had speedily; it Avould be advisable to endeavour  to re-
lieve the sufferer, as speedily as possible.   The most
usual dislocations are those of the jaw, the shoulder and
Avrist.   Other luxations occur; but I am Avell persuaded,
no benefit will arise from  unskilful attempts to reduce
them, unless they are  evidently incomplete;  and  much
mischief  may  easily  be  done  by  increasing the ir-
ritation and swelling,  which always  follows, and  is ag-
gravated by every unsuccessful effort at reduction:  luxa-
tion of the neck is perhaps an exception and will be des-
cribed.

                   SUBSECTION 2.

              Of Dislocation of the  Jaw.

   Some persons  have the under jaw so loosely connect-
 ed, that it is throAvn out frequently from gaping, &c. this
 accident also occurs from Ariolence, as blows, falls, &c.
 To reduce it, place your thumbs  firmly  against the in-
 side of the  jaw,  and your fingers on the outside; taking
 a firm grasp, you are to pull the under jaAV pretty forci-
 bly directly  outward, it  will generally follow a little
 Avay,  pretty easily; at the precise moment  it seems to
 halt, you are to  press  downward,  applying the force as
 far back upon the jaw as  possible, and  while  pressing
 doAvnward,  you are to force the jaw to that side from
 which it has receded.   These motions are difficult to ex-
 press, but by a few repetitions we  will find that we can
 impress a kind of three-fold motion, outward  from the
 head, downward on the inner end  of the jaw, making a
fulcrum of your thumbs and fingers, and sideways by
 pressure in that direction; and all these  different  direc-
 tions  of force, may be impressed almost simultaneously,
 or in  such quick succession that they seem to operate to-
 gether.  It will always be necessary to secure the thumbs, 
         OF DISLOCATION Of  THE SHOULDER.     357

by lapping  a handkerchief or a piece of sheep skin,
around them.
  A luxation on both sides, is known by the chin being
pushed  forward, and downward, while the mouth is
Avide open.  When but one side is luxated, the jaw is
downward and sideways, in this case, Ave are only to
change the direction  of the force, putting it principally
on the side affected.   The patient must be careful in ga-
ping, or any considerable use  of the jaAv for some days,
as the part is ahvays left much Aveakened and liable to
to be thrown out.

                   SUBSECTION 3.

          Of Dislocation of the Shoulder.

  In luxations of the shoulder,  we are to pull the arm
outward by taking hold of the wrist, Avhile we set the
foot against  the arm pit, or rather below it, always pla-
cing the foot lengthwise upon the body, so as to get into
the hollow,  formed by the muscles before  and behind
when Ave raise the arm; the arm is noAV to be raised to a
right angle with the body, and pulled  with regular force
for some time if necessary.  If this does not succeed,  we
should increase the force, and carry the hand of the pa-
tient in various directions.  If this  does not succeed,  let
one person make these extensions,  and after having ele-
vated the arm, lower it gradually while another person
pretty forcibly presses the arm upAvard, applying his
force near the body, but never pressing on the portions of
flesh  Avhich rise up  on either side of the arm pit.  The
arm should be carried in a sling for a  few days, and the
part  washed frequently  with  good vinegar,  in  which
some sugar of lead is dissolved, and  if much SAvelling
occurs, it may be well to bleed the patient, and he should
be abstemious in his diet. 
 358    OF DISLOCATIONS OF THE WRIST.—&C

                     SUBSECTION 4.

             Of Dislocations of the  Wrist.

   There is somewhat of an exception here to the general
 rule of extending the limbs, when luxations are to be
 reduced; in general,  we will succeed by general exten-
 sion, while our principal  force is applied inwards; the
 palms of the hand are to be applied to both edges of the
 wrist, or the sides to which the thumb  and little finger
 are  attached, we are  then to press powerfully inwards;
 or while  we grasp the wrist  with all  the force of one
 hand, with the other we should carry  the hand upAvards,
 and downwards a few times.
   But in general, most people make poor out at reducing
 dislocations, and if surgeons are to be had in reasonable
 time, any considerable  efforts should  not be made.—
 Some people are  incredibly awkward  in  such matters,
 and others are too timid; and all  this I speak from ex-
 perience; and can with truth add further, I have more
 than once corrected the mistakes of men long in prac-
 tice.
                    subsection  5.

            Of a Dislocation of the  Neck.

   This accident seldom, if ever, proceeds from any other
 cause than falls, such as falling from  an eminence, from
 a running horse, &c.   A complete dislocation of the ver-
 tebrae of the neck, can never occur without producing in-
 stant death, because the spinal marrow, or elongation of
 the brain, is always injured.  But cases  sometimes oc-
 cur where the bones are slightly misplaced, and  the pa-
 tient may easily be relieved by almost any person.
   If a person falls and lies stupified,  his chin  forced to-
 ward the breast, his face bloated and  livid, and with the
 face  turned in some measure toward one  side, together
 Avith the loss of sense and motion, attempts should imme-
 diately be made to relieve him; and for that purpose, the
patient should be turned on his back, the head is to be
 raised and firmly grasped, while the knees of the opera- 
Of strains.
359
tor are to be placed against the shoulders of the patient.
The head is now to be drawn, and the force directed in
such a manner as to straighten the neck, which  will be
done by pulling principally upon the chin, and  turning
the  head to  that side from which it has moved.  The
force should be gradually augmented till it is considera-
ble, if necessary.   If we succeed in time, the patient re-
sumes breathing, a9 soon as the parts are replaced; and
he ought to be bled as soon as the system has recovered
the  shock in some measure;  and take a little  cooling
physick, and  refrain from much exercise  for a day or
tAvo.  In these cases, if Ave were to Avait for a surgeon,
the  patient Avould expire  in a few minutes, and there-
fore, we should promptly give assistance.

                    section  II.

                     Of Strains.

  Considerable strains  about the joints, are sometimes
difficultly distinguished from luxations, or  even fracture
of the condyles, or ends  of some of the  bones, as the
outer ankle hones, the olecranon of the elbow, the con-
dyles of the arm bone, &c.  As these cases often end in
stiff joints; or remain very long Aveak,  and painful, we
should endeavour to get the best advice as  early as pos-
sible.  Where this is either impracticable, or the injury
not  of sufficient importance, the best application is good
vinegar, applied either cold or warm, as the patient may
prefer.  If the inflammation runs very high, apply cold
poultices of slippery elm,  comphrey  root, or milk and
bread, with linseed. The patient should be bled, take  a
purge, drink cooling drinks, with cremor tartar; reduce the
diet, and always rest the injured part, and keep it eleva-
ted, particularly, if in  the  lower extremities or hand.
After the inflammation and pain has began sensibly  to de-
cline, apply equal parts of vinegar and whiskey; if much
discolouration occurs, and the swelling seems obstinate,
add camphor to this mixture;  or use volatile liniment,
camphorated spirits, and such  like.   I have seen well
marked benefit from the application of the  cold slippery
elm poultices: the manner of preparing this will be found 
360       OF FRACTURES, OR BROKEN  BONES.

in the list of preparations, but it is only suited to the in-
flammatory stage of strains.   No advice is of more im-
portance in these cases than  recommending perfect rest
of the injured part, and never  neglect any considerable
strain; a little attention in time would save many persons
from  being crippled.

                     SECTION  III.

          Of Fractures, or  Broken Bones.

   These call for the most skilful surgeon,  and therefore
ought never to be undertaken by others, unless absolute
necessity render it unavoidable.   I shall treat this sub-
ject Avith a few general observations and directions.
   Has a compound fracture occurred, which is, Avhere the
flesh  is Avounded, and the bones either thrusted out, or
liable to be easily forced through, much caution is to be
observed in handling the patient. Many thoughtless peo-
ple, the moment a person falls, no matter Avhat injury
they may have received, lift them hastily and rudely: such
a procedure has often rendered fractures compound, that
were but simple and  oblique;  the ends  of the  broken
bone being very sharp, passes through and cuts, bruises,
or lacerates the flesh and skin, and thereby does exten-
sive mischief.
   Fractures are not the only cases where persons are thus
injured who have fallen; in all such cases Ave should care-
fully  examine the patient, and content ourselves by first
gently turning the patient on his back, carefully observ-
ing, even here, whether all the  limbs follow,  if we have
any suspicions of fracture.  Let the head be gently rais-
ed, and fan the patient with your hat,  if necessary; and
if means are at command, such remedies  as  are recom-
mended for  fainting or sAvooning,  are to be applied.
   When the patient revives, carefully examine his limbs,
Avhether any fracture exists, before you attempt to raise
him.  If there is  a  fracture, the patient should remain
where he is, till the easiest carriage can be obtained to re-
move him; and if cold or wet weather does not forbid, the
surgeon should be taken to the  spot;  and  the  patient
dressed before  he is moved. 
OF FRACTURES,  OR BROKEN BONES.       361
  If no surgeon is to be had, the limb should be secured,
if a leg, by applying a pillow, and outside of this, a
strong splint on either side; this should be tied with wool-
len strings, firmly, but not too tight.   When the patient
has been carried  to a suitable  place, the limb is to be
washed with vinegar; but if there be deep holes, as most-
ly happens in compound  fractures, we should carefully
stop them with lint, and prevent the vinegar from getting
in, otherwise it may  do much mischief.
  We are now to take a pillow, spread on it, first, strips
of strong muslin or fine flannel, about two inches wide,
or rather less, and long enough to go round the limb af-
ter the splints are applied; these strips are to  be spread
so as to lap over each otlier nearly one half, and from
on,e end of the limb to the otlier; that is, in the  leg, we
should  carry them from the foot to the top of the knee
joint; and in the thigh, from the knee to the groin, and if
the fracture be oblique, we should carry the splints, &c.
to the foot.   On these, we are to lay two strong splints
of shingle, or thin board, one for the inner,  and one for
the  outside, and  a flexible one in the middle, made of
green wood,  to lay immediately  under the limb;  these
splints  are to be the length of the limb, or as long as the
layer of strips, and well lapped with soft tow; on these
again we are to spread a clean soft piece of old muslin,
or linen, large enough to lap up  the whole limb.  The
pillow thus furnished is to be laid under by one person,
while a second  gently raises the limb;  the lapping cloth
is now  to be  smoothly applied; on this,  the  splints; all
spaces between the splints and limb, are now to be filled
with tow or cotton, and while they are held in place by
one person, another begins at that end of the limb where
the last strip was laid, and laps them  over one by one,
and when the whole  are evenly applied, a few pins must
be put  in where they overlap, to  prevent their opening.
The whole is now to be wet with vinegar, and kept Avet:
these dressings should be changed once in two,  four, or
six days, accordingly as the weather is warm, or the skin
open.   The patient may lie on the back, or either side,
provided the limb is  carefully adjusted to the position nf
the body.
             46 
363      OF FRACTURES, OR BROKEN BONES.

  In fractures of the arm, we are to proceed nearly in the
same manner; but unless the fracture be very near the
joint, we may put it into a sling, taking care in all frac-
tures of the forearm, or about the elbow joint, to secure
the fingers from all motion,  by carrying the splints and
bandages out over them.
  In severe fractures it Avill always be necessary to bleed
once or tAvice; take a little cooling physick, and live ab-
stemiously, except there be considerable debility of habit,
or in patients accustomed to high living.   But even such
persons will be benefited by  a reduction of their diet,
taking care not to continue it so long as Avould be neces-
sary for those of better constitutions and habits.   In de-
praved habits, as soon as the inflammatory symptoms be-
gin to subside, which will generally be from five to seven
or eight days, the bark and port wine should be given
with some  freedom.  If mortification threatens, which
seldom, if ever, occurs in good  habits, without  misma-
nagement, but is always to be dreaded in depraved habits;
and more especially where there has been considerable
lacerations, we  are to examine the limb every day, par-
ticularly if there be much fever, or pain and heat in the
limb.  If the part Aveeps out thin bloody  matter, feels
flabby about the edges, has much ill, or dark-looking flesh,
and more especially if the limb begins to blister, exhibit-
ing small blisters for some  distance  around, Ave  should
apply a  blistering plaster, reaching all round  the limb,
and a good distance above and below the sore, having a
hole the size of the sore; and over this part Ave are to lay
the carrot  poultice; and  after the blister is removed, Ave
should extend  the poultice  over the  limb, as far as the
blistering plaster has acted, or as far as those of the gan-
grene extend.   At the same time the  bark must be taken,
with elixir vitriol, snakeroot tea, or  vinegar, &c. as the
case may be supposed more or less inflammatory.
  And it may be remembered, that the bark will avail no-
thing in mortification, unless it be taken largely, as two to
four ounces in twenty-four hours.  Let it also be  remem-
bered, that these instructions are given for cases of abso-
lute necessity, and that fractures ahvays call for the utmost
skill and attention, and there are even but few practition- 
OF AVOUNDS.
363
ers, Avho are really competent to manage them: Iioav much
less then are we to trust  these cases to  the  ignorant in
those matters.
  In all places, officious persons are found, avIio are not
only willing, but  anxious  to be employed in such mat-
ters; such conduct is sometimes highly reprehensible, and
never justifiable unless necessity requires it, when it be-
comes a duty,  and is sometimes attended Avith  success,
as I have seen.  But I am compelled to observe, that in
general, I have found those  most  officious in  these mat-
ters, least calculated to manage them, and woful mischief
often folloAVs.   Nay, more, I have seen ignorance itself
endeavouring to direct the skilful  surgeon, who with all
tenderness was applying the proper means,  so that upon
the Avhole, I think the best advice I can  give in cases of
this kind, is, for those who are anxious or willing to act,
simply this:  select the best horse you have,  or  can  get,
and go with all speed for a skilful practitioner, and you
Avill seldom do any mischief, barring accidents which may
befall the inconsiderate rider.

                    SECTION IV.

                    Of  Wounds.  .

                   SUBSECTION 1.

      Of Cases which heal by the first Intention.

  From the earliest ages of mankind, mistaken views
have prevailed, respecting the healing poAvers of many ar-
ticles.  Every nation, surgeon, or old woman, possesses
some wonderful healing nostrum,  and from the variety of
discordant things employed, we have Avell grounded as-
surance, that some of those supposed remedies are inert,
some of them slightly unfriendly, others highly injurious.
It seems as if the human mind was ever more subject to
embrace, and perpetuate errour, than to discover truth, or
correct views of subjects, until corrected by long  suffer-
ing.  I am led to these reflections  from the unaccountable
circumstance, that from time immemorial mankind have
i 
364
OP WOUNDS.
looked up to the natural operations of the body, for the
cure of their internal, or hidden diseases, while in those
obvious to our senses, because  superficially  situated,
they  attribute little or nothing to the  natural healing
powers.
   And yet, the united judgment of many men of experi-
ence and discernment, has long since discovered, that the
reverse is much  nearer the truth; that is, while the natu-
ral powers are seldom to be trusted in internal diseases,
in wounds or superficial diseases, these natural powers
are alone to be depended on.
   It may not be amiss to state a few positions in favour
of the opinion, that Ave are to expect more from the natu-
ral operations in external, than  in the internal diseases,
with  which mankind are afflicted.   In the present state
of society, all our diseases are in great measure artifi-
cial, or perhaps more correctly speaking, they are the off-
spring of vicious, or improper habits, and as they are
brought on us hy warring Avith, or trampling on the natu-
ral healthy operations, we cannot even hope that like the
licking cur, nature will kiss the hand of the assassin, or
unthinking persecutor.   He who is an enemy to himself,
must  be an enemy to the anima medica; and Avhile expe-
rience proves beyond a doubt that nature is punctilious,
yet kind to those who tread with becoming fidelity, and
pleasantry in her sober but delicious paths, the same ex-
perience teaches us, that she will meet her enemy face to
face, or hand to hand, and while she whips the culprit with
his own weapon, Avith her right hand  she points  to the
grave, and with Aveeping eyes, the left quivers on the
beam, unwilling to give the preponderating stroke, till
heart broken with  anguish and despair, with closed eyes
the tremulous stroke is given, and disease or death mounts
the scale.  But she is not inexorable, but often relenting
she lends her aid, in banishing disease from the body; not
often, however, till she has obtained promises of amend-
ment, from the sufferer.
  I have elsewhere endeavoured to prove that nature ei-
ther cannot, or will not cure our diseases, I therefore pro-
ceed to state some opposite positions, why we may rea-
sonably look up to nature for aid in our superficial dis- 
OF WOUNDS.
365
eases or wounds.  In all situations and conditions of life,
mankind are liable to casualties, and therefore, it has been
kindly and wisely provided, that the natural powers shall
restore in a reasonable degree, the various breaches made
on our bodies; and although the surgeon must often aid
by taking up bleeding arteries, removing unsound bone,
or mangled limbs, yet, the healing process is wholly de-
pendant  on nature.  If we  find  these healing powers,
slow at times, at  others Ave are equally astonished at the
vast and important  repairs, which she accomplishes in
a short time; and it will often be  found, that the most
tardy cures are owing to disease, lurking  or manifest
Avithin.
  Upon the whole, I am supported by innumerable facts,
and the concurring experience of many discerning men,
that in disease we are ever to watch nature carefully, and
never trust wholly to her operations; while in wounds or
external  laesions, we can do nothing  more than defend
the parts by suitable warmth or moisture, and by proper
means, guard against irritation, by suitable bandages, or
dressings; but to dream of adding one particle towards
the restoration, by  outward  applications, is truly  pre-.
posterous.
  But  although nature may emphatically be styled the
physician in these cases, avc can promote her intentions by
suitable means, founded on experience, and  on science:
to point out these  indications and means, shall be the se-
quel of this section.
  Nature has two modes of healing wounds, first by an
immediate union of vessel to vessel, fibre to fibre, or  par-
ticle toparticle, this is called healing by the first intention.
The second mode she employs in more  violent injuries,
and here she accomplishes her purpose, by  suppuration
or secreting a healthy matter or pus, designed to defend
and support the arteries, and nerves, in their architectural
functions.  These modes being opposite in their nature,
it follows that we are to vary our applications, or Ave  may
materially thwart her designs.  In judging of the proba-
bility of  a wound's healing by the first intention, Ave are
to bear in mind, that superficial clean cuts, or those which
run lengthwise on the limb,  or those which merely split 
366
©F WOUNDS.
the muscular fibres, those which have  not been exposed
too long to  the air, and accompanied  with  the  circum-
stance of a healthy body, are most likely to heal by the
first intention.  And in all these cases, if we are well sa-
tisfied nothing extraneous lies within, Ave ought not even
to wet the part; all applications of spirits, tinctures, bal-
sams, or washes, are at least unnecessary, and often high-
ly injurious: the best method is simply to bring the part
into contact, first removing clotted blood with a clean fin-
ger, or by means of a  small stick lapped with soft lea-
ther; then with adhesive strips or sticking plaster of suf-
ficient length, secure the edges of the  wound  well toge-
ther, and over this lay a soft compress, and secure this
by  means of a roller  passed several times  round the
limb.
  If things  go on well, in three or four days  the dress-
ings may be removed,   and it will now be  advisable to
Avash  the part clean and apply a little mild ointment, and
renew the roller.   But if the pain  increase to violence,
and particularly if the  wound is considerable, or the ha-
bit  bad, Ave  may expect suppuration, or even mortifica-
tion may occur, and, therefore, the part should be un-
done, and if necessary, treat the case as  detailed in this
section for wounds, which do not heal by  the first in-
tention.
  We are also to remark, that in most cases of incised
wounds or cuts, though across the muscles, much benefit
will arise from a few stitches  in the part to keep them in
contact, and they Avill mostly, at least in good habits, heal
in great part by the first intention; and sometimes entire-
ly.  But we are to  remember that such wounds must
have ceased to bleed furiously, that all extraneous bodies
are to be removed, in the most tender manner, before wre
proceed to sew up; in doing which Ave must have a crook-
ed needle, that we may reach to the bottom of the Avound,
and large enough to carry a strong flaxen thread; the nee-
dle should be entered a considerable  distance from the
edge, otherwise the threads will soon cut  out, and unless
we carry the needle to the bottom there will be a cavity
left, where collections of matter will form, and which,
if considerable, must ever find its way out through the 
OF WOUNDS.
367
^wound, or it may descend among the muscles, and pro-
 duce serious consequences.

                    subsection 2.

           Of Cases which should suppurate.

   In cases where there is considerable lacerations, or loss
 of substance, we must pursue such measures as will pro-
 mote suppuration, or in  other Avords Ave should keep the
 part clean, warm and  moist,  that nature may not be hin-
 dered by the irritation, which Avould arise from unclean-
 ness, extraneous bodies, or the  contact of cool air in ac-
 complishing her secretion of bland  pus,  to cover the
 tender parts, which  are to be formed by the arteries and
 nerves.   To answer these intentions, we should first co-
 ver such wounds with lint, spread with the mildest oint-
 ment, and as soon as  any considerable pain or  soreness
 of the part supervene, Ave should apply warm poultices
 of bread and milk, or common Indian mush; and unless
 there be considerable  cavities, we may apply the poultice
 immediately to the sore; but if there are cavities running
 in various  directions, we are to put in  a little very soft
 clean lint, spread with  mild ointment; and  the poultice
 should be greased Avith a little nice oil, or fresh lard.  At
 every reneAval  of the poultice, Avhich  should be  three
 times in twenty-four hours, the part  should  be well
 washed with milk  and water, Avarmed a little, and  in
 three or four days we are to use mild soapsuds for this
 purpose; remembering ahvays  to remove all old lint  or
 pieces of poultice, Avhich may adhere to the sore, but in
 doing this, we are by  no means to use any  violence.   If
 things progress Avell, Ave should continue this course from
 ten to fifteen days, according to circumstances, and then
 the common basilicon, mixed with a little spirit turpen-
 tine, should be applied twice a  day; never forgetting that
 in all sores it is of the  utmost importance to keep not only
 the sore clean,  but the skin  around, or rather the whole
 limb,  x
   In addition to these external remedies, we are to pay
 the most scrupulous attention to the general system,  \n 
368
OF WOUNDS.
all considerable wounds.  From the commencement, the
patient should be put on a very low diet, refraining, if of
good  habit of body, from spirits,  animal  food, or even
broth, or much fats.   The mildest drinks of  milk and
w ater, slippery elm, toast Avater, apple, or  barley, water,
and such like.  The bowels must be kept open by using
cremor tartar mild glysters, or mild physick, if necessary,
and from the commencement, the use of full anodynes at
night should  be  advised: and  if fever  supervene, Ave
must  bleed, and repeat, according to the violence or ob-
stinacy of the ease.  The above means carefully applied,
will generally answer  our wishes.   But  unpleasant  or
dangerous  consequences sometimes supervene, notwith-
standing all our efforts.   These are, first, mortification;
if the sore does not matter well, but discharges a thin  or
brownish fluid, with considerable heat in the part, looks
foul and ill-coloured, we are to pay close attention, lest
mortification progress before we are  aware of it.  If  to
the above  appearances are  added blisters around the
sore, .with  considerable chills and flashes of heat,  gan-
grene or incipient mortification is at hand, and the treat-
ment must be changed: the part is still to be fomented
well  with  mild soapsuds,  and the carrot  poultice ap-
plied, and renewed  every two  or three hours: for the
treatment in these cases, see the article mortification.
  If  locked jaw or tetanus  arise from wounds, see the
article on tetanus.

                    subsection 3.

Of Wounds which bleed, or are like to  bleed, danger-
                        ously.

  It  ought to be borne in mind, by every man, that, in
many cases of wounds, life may be lost in a few minutes
for Avant of  stopping  bleeding from a  wounded arte-
ry.   By early attention to wounds of the limbs, which
bleed furiously, a companion, or the patient himself, may
often save  life, till  a surgeon  is called to secure the
bleeding vessel.  For this purpose, in all wounds Avhich
bleed dangerously, a ligature or strong string should be 
OF WOUNDS.                 369
passed around the limb, and always between the wound
and the body; this is to be tied so as to leave room for
running a stick into the loop, and then, by turning round
the stick, you are to twist the ligature so tight as to stop
the bleeding.  For want of a stick, a strong man can
sometimes draw the knot sufficiently tight; or after tying
the string tight, it may be rendered still  more tight by
stuffing in a waistcoat, or the like.   A handkerchief will
answer for the ligature, and where this is not at hand,
tear a strong strip  from your shirt.   Many a life has
been lost for want of attention to such means.
   In  deep wounds, as  gunshot,  from  the sAVord, or
other instruments which enter the flesh any considerable
distance, another consequence is to be apprehended still
more alarming than tljose enumerated above:  if the in-
jury has happened near to, or perhaps  slightly injured a
large artery, as those of the arm or leg and  thigh, there
always is  danger of the artery being opened,  by the
slough which has  to  come  aAvay, and  the period at
which  this will happen, is very Uncertain; it may occur
at any time from the  accident, to  the third  week; in
general, the term of two or three Aveeks  is  most dan-
gerous.
  Upon the Avhole,  it plainly appears that  much skill
and prudence is necessary in  all considerable wounds,,
and therefore experienced practitioners ought alone to
be trusted.  It may be remarked here, that mortification,
as well as traumatick tetanus, mostly proceeds from too
high inflammation; and, therefore, in mortification from
Wounds in good habits, we are by no means  to stimulate
by wine,  bark,  or  any other articles; the  indications
here, are to lessen action by a more frequent repetition
of the fomentations  and poultices, and that  of slippery
elm is  particularly  proper; by bleeding  from the arm,
applying leeches, or scarifications  and cups about the
part; and if gangrene occurs, blisters should be applied
entirely around the limb, above and below  the wound,
but leaving the,lacerated parts open for the application
of the  carrot poultice.  But if the habit be bad, or if a
sickly season exists and diseases partake of a low ^rade,
We must be extremely cautious in the use of evacuations,
             47 
370                 OF BRUTSES,

and if kindly suppuration does not occur by the fourth or
fifth day, use  the  carrot poultice;  give  the  bark with
elixir vitriol, or with Avine, snakeroot tea, or milk, ac-
cording to circumstances; and  give the patient for diet,
a little rich panada, broth, or light  animal food, coffee,
and such like: take especial care to give but sparingly
of any kind of food for a few days.   For more particu-
lar instructions^ see mortification.

                    subsection  4.

                     Of Bruises.

  Under this head some very formidable accidents may
be placed, occasioned by falls, bU>ws, or from a person
being run over by  a carriage,  a  horse, &c.  In all con-
siderable bruises we are to expect considerable fever,
and unless it is  subdued, suppuration or mortification may
supervene:  severe  pain,  throbbing  or  beating  in  the
part, Avith general  chills and  heats, are always unfa-
vourable.
  To bruises on the limbs we should apply slippery elm
bark, moistened with good  vinegar, or several  folds of
muslin or linen wet with vinegar, in which a little sal.
ammoniack  or sugar lead is dissolved; these are to be
renewed every two or three hours;  the patient must be
bled, and the operation  repeated  daily till the fever and
chills abate;  cooling purges, as rochelle salts,  senna and
cremor tartar, or a free use of cremor tartar water.   The
lowest possible diet, and mild cooling drinks.  As soon
as the inflammatory symptoms abate  considerably, or in
cases where these do not occur by the fifth, seventh, or
tenth day, according to circumstances, AAe must change
the outward applications: whiskey and vinegar, volatile
liniment, camphorated spirits, or  opodeldock, or some of
the patent articles may be applied, as British oil, Colum-
bian oil,  &c; but it should be  made an invariable rule
to wash  those  articles clean off with  soapsuds, once a
day.  These directions apply to  persons  in good habits
and health.   When these accidents occur in bad habits,
or very delicate habits, or in sickly seasons,  we are to 
OF BRUISES.                 371
deplete with great caution, and often not at all; we are
to apply stimulants outwardly from the  commencement,
as poultices  containing camphor, or with British, sene-
ka,  or  other stimulant  oils,  spread over them: repeat
these twice a day, and Avash  the skin clean once a  day
with soap; the bowels are to  be kept open, but purging
is to be avoided; laudanum should betaken every even-
ing.  The diet must be light, but reasonably nourish-
ing, and  a  little good  wine, or weak punch may be
taken.  Snakeroot tea, a little bark,  or elixir vitriol,
ought to be used.
  In considerable bruises of  the abdomen,  or  chest, we
are generally to bleed Avith great freedom; open the bow-
els with  mild injections, and  if vomiting occurs, give
opiates with freedom: the utmost quietness  and ease is
necessary, and  thin Aveak diet is only to  be  allowed,
with the mildest cooling drinks.
  In good habits, the less nourishment is taken the bet-
ter for the first  five or six days; and, I have often seen
marked advantages from living on a little toasted bread
soaked in water, with cooling drinks.  I know of no
cases which so invariably call for the use of the lancet:
in strong athletick persons, we must bleed largely and
freely, and even in the most delicate, a few small bleed-
ings are indispensable;  but Ave must be cautious in in-
temperate, or depraved  habits, not to continue to bleed
too  long.  Opiates, and  open  bowels  are  never to be
overlooked;  but these cases  often call for the greatest
skill, and therefore competent practitioners are alone  to
be trusted.
  Bruises, or blows  on  the head,  attended with
stupor or violent pain, generally require bleeding, and
also the free use of stimulant, or purging glysters, with
low diet and cooling drinks;  mild purges are sometimes
necessary.
  But if a person be suddenly knocked down, and lies
stunned or  insensible, we are by no means hastily  to
draw blood, a too frequent custom; but we ought, merely,
to turn the patient on his back, and raise the head a lit-
tle;  a free circulation of air is  necessary; a little water, or
wine, or toddy, may be given; and if obtainable, a glyster 
372           OF RUPTURES, OF HERNlJE.
must be administered.   A practitioner should be called
in, but if none is at hand, in a reasonable time, we should
venture to bleed as soon as the pulse is found active:  if
the pulse do not rise, it will ahvays be safest  to omit
bleeding, and give repeated  glysters, and  a little wine
and Avater, or five or ten drops of spirits of hartshorn in
water, may be given.
  Under these  circumstances the skilful  surgeon Avill
often find it expedient to bleed, but I am confident I gh'e
a well grounded and correct opinion, when I say vast
mischief is done in those, and many other  cases, by the
precipitate use of the lancet, by unskilful persons.  Let
no one infer  from these remarks, that I am opposed to
bleeding in these cases, we generally find  it absolutely
necessary,  and without it,  perhaps, few persons would
recover from  very considerable injuries done Avithin the
head.   But it was long ago remarked by Solomon, that
there is  a time for  every thing under  the  sun; and to
bleed  too  soon, before the  system  has recovered the
shock, is generally bleeding out of  time, and Avhatever
is not  well  timed,  is wrongly applied.   Therefore,
never  be too much  in a hurry about bleeding, a few
hours, or even a day or two in some cases, are neces-
sary for the reaction of the system to bring the body to
the bleeding  point.
   Lastly, if no skilful person is to be had, and the pulse
does not rise in a reasonable  time, we must bleed, or
reaction may never occur,  and the patient might be lost
for Avant of unlocking the blood vessels.

                     section v.

              Of Ruptures, or Hernice.

   Ruptures, or a protrusion of the  intestines, omentum,
peritoneum,  &c. occur in various parts of the abdomen,
and pelvis: these ruptures  are called hernice,  and occur
most frequently in the groin, thigh, navel, and some-
times through  the layers of the abdominal muscles, in
various  parts.   They are sometimes congenital; some
occur, without  any known cause, at every period of life: 
OF RUPTURES, OR  HERNIJE.           373
and often they proceed from violence, done by straining,
lifting, &c.   They are known to exist in many persons
for long periods without any particular injury, but  all
such  persons are invalids, and liable to suffer much;
besides running extreme hazard from trifling causes, as
slight injuries  done the part;  from the parts taking  on
inflammation and swelling, by which  the  gut, or other
parts protruded, becomes strangulated, that is, the open-
ing closes, and pinches or confines so as to check the
circulation; and this soon leads to mortification.
   In young  persons, these openings often heal, if the
patient  Avears for a sufficient  length of time a  truss,
Avell adapted to the part; and  in those more advanced
in life, trusses ought always to be worn, for, besides the
greater security obtained by keeping  the  parts within,
there is much less risk of its being violently  thrust out
from lifting, &c.
   These trusses are ahvays to be  had by applying at
the apothecaries,* or by consulting Country physicians.
Persons affected with ruptures should carefully guard
against costiveness, and while they pursue active exer-
cise, in order to maintain a due strength of muscular
fibre, they are most scrupulously to avoid straining, or
heavy lifts.
   If a rupture at the groin, or elsewhere, becomes stran-
gulated, as manifested by extreme  pain, colick, costive-
ness, sickness and vomiting, all possible speed is to be
made in returning the part into the abdomen.  This is
first to be attempted by the person  lying  down and en-
deavouring to push up the part; if he does not succeed
by reasonable efforts, cold water should be poured upon
the part; mild  injections should be used to  empty the
bowels;  the attempts at reduction are now to be reneAV-
ed; if these do not succeed, wre should, in good habits,
bleed till some symptoms of  fainting  occur, when the
attempts are  to  be  repeated: all this failing, injections
of tobacco, or the smoke of it should be thrown  up the
bowels.  These remedies are to be used without loss of
  * A truss has lately been imported from England, of a superiour
construction to any I have seen. They  are knows by the  name
of Wright's patent truss. 
§74           of burns, and scalds.
time, and if ineffectual, a surgeon is to be called in, who,
by a timely operation, can often save life; or who, by
his superiour judgment, may think it safe to continue the
means for reduction sometime longer.
   In attempting reduction in general, if the patient is  at
years of maturity, he should reduce it  himself: most
persons are very heavy fingered, and aAvkward in hand-
ling such things, and may easily do dreadful mischief, by
hastening mortification, which is always to be feared in
these cases, and should induce us to be speedy  in get-
ting the best assistance.
   Large quantities of warm  water throAvn up the intes-
tines, is sometimes useful, and may  always he tried be-
fore using the disagreeable remedy of tobacco smoke.
   After the reduction, it will always be advisable to
take an anodyne or two, to keep the bowels open with
mildglysiers, and avoid all solid food: these precautions,
with reasonable rest, are of vast importance to those Avho
have been severely affected with this dangerous kind of
affliction.

                    SECTION  VI.

                Of Burns, and Scalds.

   For slight burns or scalds, the immediate application of
clean, soft carded cotton is a  good application; or if this
is not at hand, equal parts of turpentine and SAveet oil, or
weak brandy, should be applied, and for want of all these,
slippery elm bark, simply wet with cold water, or scra-
ped potato.  But if the burn is deep, Ave  should apply
warm milk and water, till we can get spirit turpentine
and sweet oil; or lime water and oil; or linseed oil, fresh
and cold drawn, mixed with lime water.  The patient
should take a  full  dose of laudanum, and  this is to be
repeated till chilness abates,  aa hich ahvays attends large
burns.
   If, on examination at a  second or  third dressing, we
discover that the true skin is destroyed, and will of course
slough off, we should apply a mild poultice of bread and
milk, and repeat them every three hours till the parts sup- 
OF burns, and  scalds.           375
purate freely, and pain and fever abate: when these ap-
pearances of suppuration  are well marked, we may re-
move the poultice, and dress the sore with basilicon, con-
taining  some spirit of turpentine; if this should cause
any pain, which is seldom the case, it must be removed,
and Turner's cerate, or other mild ointments applied. In
cases tolerably severe, we Avill in general succeed Ave 11 by
using the sweet oil and  spirit turpentine, three times  a
day, and covering the sore in the intervals Avith soft lint,
or old muslin spread with the basilicon and spirit of tur-
pentine: or by simply applying, very frequently, linseed
oil and lime water; but in all cases it aa ill be Avell to wash
the parts well with milk and water for a few days, and
afterAvards with mild soapsuds once a day.
  In bad habits, or where cases have been  improperly
treated, this kind of inflammation, like all others, is lia-
ble to terminate in mortification:  if the sore continues
painful  and ill looking, and especially if blisters rise af-
ter the second or third day, we  are to be cautious  how
Ave proceed;  and, for instruction in such cases,  see the
article on mortification.   In all  extensive burns Ave are
carefully to watch the health of the patient; they should
live low, drink nothing but mild cooling  drinks; take  a
cooling  purge noAV and then; and if much fever super-
vene, bleeding,  repeated according to the  severity or
continuance of the fever, will be necessary.
   But where there is reason to apprehend mortification
from a bad habit of body, a more generous diet will be
advisable, consisting.in part of broth, light animal food;
and a little good wine or punch may be alloAved; and
the bark and elixir vitriol, &c. must be taken; but for
instructions on this form or grade of inflammation, from
whatever cause, see the article on mortification.
   Since the publication of the first edition of this work,
a very alarming accident occurred in my family. A child
of two years fell backwards into a tub of water and clothes
nearly boiling hot; the clothes prevented him from sink-
ing deep, but the whole of his back, hips, &c. to the ex-
tent of nearly a foot, in  every direction, was severely
scalded, and of  a most fiery red; his pain was extreme.
I had seen many similar accidents, and, had no doubt but 
376
OF FROST BITES.
the whole would blister  and throw off the scarf skin;
but, fortunately I had a bottle of spirits of turpentine in
which some Avhite wax was dissolved, this was applied
freely in less perhaps than one minute: after bathing the
part for some minutes with this, soft cotton  Avas laid on,
and secured Avith a handkerchief.   The child slept in a
few minutes, and enjoyed it for two hours; he then arose
and made no complaint.   The part was opened in a few
hours; and to my great surprize the whole had termina-
ted in a few small blisters. The same dressings Avere con-
tinued till next day, Avhen the whole was thrown off.   I
have no doubt but if this  case had been otherwise treat-
ed, or if there had been  any delay in the application,
the whole would have blistered; and as these  accidents
occur frequently, every family should always keep those
articles  ready.

                    SECTION VII.

                   Of Frost Bites.

   In treating on these accidents, I shall first speak of the
means necessary to secure against their occurrence, and
then conclude with some  instructions for  those thus un-
fortunately situated.
   Persons who are about to travel in severe cold weather,
should never drink any considerable quantity of spirits,
as is generally practised,  for spirituous drink not only is
very transient in its stimulant effects, but always leaves
the system lowered in its excitement, when it has ex-
pended its force,.and this is more particularly the case
in intense cold, which in a peculiar  manner,  seems  to
destroy the stimulant poAvers of ardent spirit.   Neither
should  they eat a full meal just before setting out; per-
sons of observation must  be aware, that chilness almost
invariably succeeds a large meal,  even of animal food.
The first consideration is to provide suitable warm clothes,
and particularly to guard the feet: it may be said every
person is sufficiently aware of this, but I beg leave  to
observe, many persons are found thoughtless  enough to 
OF FROST BITES.
377
despise cold, and sometimes suffer either severe  frost-
bites, or other disorders, and even death.
  In this country, people seldom suffer death from in-
tense cold, unless iutoxication prepares the system for this
cold, but fatal stroke.  It may be remembered, that much
advantage may be gained by those Avho are about to travel
on foot, by  taking care not to encumber themselves with
heavy great coats, or heavy clumsy shoes; mokasins, or
cloth shoes  soaled with a piece of an  old hat, is vastly
warmer than the thickest leather shoes; instead of one or
more heavy long coats, which are often worn, it will al-
ways be better to put on two or three pair of pantaloons,
as many shirts and waistcoats.  Every person, perhaps,
knows the fatal tendency of sleep, which presses on the
benumbed traveller, but  every one may not be aware of
the irresistible power it  has over  the most manly spirit:
instances are on record of persons remarkable for good
sense, and  accustomed to travelling, and cold, being so
overcome that they were anxious to enjoy this fatal sleep,
although well aware of  its nature.
  In addition to the things prescribed above, for dress-
ing, I would  recommend to such travellers  always to
let digestion progress half an hour, or a little more, be-
fore they venture  on their journey, after taking a nou-
rishing meal, and this  is always necessary; some solid
article of food should be taken along, as gingerbread, a
little crust of bread and cold meat, or a little whole mus-
tard seed may be  taken now and then.
  When any part of the body is frostbitten, hold the part
a few minutes in cold water, this, or gently rubbing the
part Avith snow is  the only safe remedy: to go into a warm
room without a careful application of this remedy, would
be certain ruin, the part  will invariably mortify, and if
the frost has penetrated deep, fever and death may fol-
low.   The  patient must keep from the fire until the pain
ceases; if able he shbuld walk about until relieved,  if too
much exhausted,  he ghould be constantly rubbed with a
cold  Avet hand, until the pain ceases.  If the patient is
languid, a  little warm tea, or a little panada, or broth,
should be taken:  should inflammation or ulceration fol-
             48 
378        of DRINKING cold water, &c,

low, the case must be treated as  inflammation or ulcers,
from other causes.
  Should persons be  found apparently dead from cold,
I would advise, in preference to  any other means, to se-
lect a sunshiny situation, as free from cold wind as may
be, and there bury the  body Avith the clothes  on, with
snow, and await the issue, or if  attainable a little warm
tea, or warm wine and water, should be given.   If this
is not attainable, carry the body carefully, that is, gently
and without suffering any of the limbs  to hang  down,
into a cold room, and there rub  them gently Avith snow;
or they may be  dipped once or twice into  cold  spring
water, and then lapped up in cold clothes, first a single
cold sheet, then another, then a  blanket, and thus leave
the body.
  It will  be obvious, that the room must not be as low
as a freezing temperature, but it must be quite cool; and
in the application of  clothes to the body, we are not to
be in too  much hurry; if a blanket is applied  too soon
it may have  a bad effect.  For  the treatment  of slight
frost bites in the hands and feet, see the articles kibes,
and chilblains.

                     SECTION VIII.

Of the Disorder arising from drinking Cold Water, §V.

   It  is to be remembered, that other cold liquids are
equally dangerous, when taken  under the following cir-
cumstances:
   1.  When the body is much heated.
   8.  The liquid very cold, and
   3.  When  taken  in large quantity, and  it has been
correctly observed, by Dr. Rush, that the danger is pro-
portioned to the amount in combination,  of all these cir-
cumstances.
   I shall first give a few cautions for its avoidance, and
then describe the symptoms  of  the disorder, and point
out its cure.  Before proceeding to these details, I think
proper to admonish the reader, that if such dreadful and
immediate consequences follow the rash drinking of cold 
OF DRINKING COLD WATER, &C         379
liquids, we cannot doubt for one moment, but that many
bad consequences do follow such  practices, and which
are less known because less evident, but often more fa-
tal, because more slow and hidden in their operations.
And, therefore, Avhile Ave rejoice with the amiable and
illustrious Rush, that this disease is  nearly banished from
Philadelphia, by the humane and skilful attention of
scientifick men, Ave should carefully remember that,  by
an improper use of cold liquids, too early in the day, or
Avhen too Avarm, from exercise, we  may suffer seriously,
and attribute it to some other cause.  Among  these, we
are to  reckon, cold punch,  cold water, mineral Avater,*
ice creams, &c.  all these, when the  body is too Avarm,
produce extensive mischief: consumptions, cholera mor-
bus, colick,  fevers, palpitations, dyspepsia, gout of the
stomach,  and many other  diseases  proceed  from the
abuse of these articles.
  Preventives: early rising which will enable you to
get through your business, and alloAv a sufficient time to
rest in the heat of the day; using mild bland food, and a
reasonable quantity of good ripe fruit, will, in good mea-
sure, do aAvay any ungovernable desire for these articles;
and to  pour them doAvn  without desire is semle, and
base: if it is  done from artificial taste, or with a view of
amusing the palate, it is brutish; and after all, the brute
in this respect is your  superiour, for while they enjoy
their regular appetites undiminished, the fickle palate of
man, as if on purpose to befriend, soon loses all  keen
zest, and it is a fact, that the epicure enjoys of all other
creatures  upon earth, least pleasure from the taste: it
often becomes a very curse,  and while he racks every
energy to procure new relations between his  taste  and
aliment, each in its turn becomes offensh'e.  A reasona-
ble use of those cold articles is not particularly unfriend-
ly, but we should ever  bear in mind, the three circum-
stances which render them particularly dangerous, and
which  have been mentioned in this section.  These  are

  * Of all these articles, water impregnated with fixed air, (carbon-
Ick acid,) is the safest,  but, it may be misused, either by taking it
too early in the day, too much of it, or too cold when the body i?
much heated. 
380         OF DRINKING COLD WATER, &C.

a heated body, very cold articles, and lastly, taking them
in considerable quantity.
  In drinking cold water Avhen Ave are much heated, we
should  rinse the mouth, or wash the hands or face; or
simply  holding a vessel in the hands, and taking a sip
or two  before we SAvallow much water, will obviate the
danger; and it may be well to consider, that we often
allay thirst better by small repeated drinks, than large
draughts of cold Avater, which are never necessary, and
are only indulged in by the hasty or inconsiderate.
  If a person is found who has injured himself  materi-
ally in this way, the following symptoms are said by Dr.
Rush to follow, "in  a few minutes  after the patient has
SAvallowed the water, he is  affected by a dimness of
si^ht; he  staggers  in attempting  to  Avalk, and  unless
supported falls to the ground; he breathes Avith  difficul-
ty; and  a rattling is heard in his throat; his nostrils and
cheeks  expand, and contract in every act of respiration,
his face appears  suffused Avith blood, and of  a livid
colour;  his extremities  become cold, and his  pulse im-
perceptible; and, unless relief be speedily obtained, the
disease  terminates in death,  in four or five minutes."
  "This description includes  only the common cases of
the effects of drinking a large quantity of cold Avater,
when the body is preternaturally heated. More fre-
quently, patients are seized with acute spasms in the
breast or stomach.   These  spasms are so painful as to
produce syncope, and even asphyxia.   They  are some-
times of the tonick,  but more frequently of the clonick
kind.   In  the intervals of the spasms, the patient ap-
pears to be perfectly well.   The intervals between  each
spasm becomes longer or shorter, according as  the dis-
ease tends to life or death."
  And  the doctor tells  us  he knows of no remedy for
this  disease  but liquid laudanum,  given in doses of
from a  small tea spoonful to a small table spoonful, as
the case maybe more or less violent.   For want of lau-
danum, a little raw whiskey  should be ghTen, and fhe
region  of the stomach bathed with the same, warmed.
If disease follows, we are to treat it according to symp-
toms, but in general I would advise such patients, to live 
OF DROWNING,  OR SUBMERSION.        381
on thin mild nourishing articles for a few days, avoiding
full meals; and if headach, or pain, or a feverishness re-
main, they should be bled, or congestions  of  a danger-
ous nature may be formed.  Or a few mild  injections
may be useful.

                     SECTION  IX.

           Of Drowning, or  Submersion.

  Persons have frequently been recovered after remain-
ing a  considerable time under water, and sometimes not
till after long continued efforts, therefore, in all cases, we
are to act promptly, tenderly, and perseveringly.  I have
chosen to  give the means suggested by the late amiable
and learned Dr. James Cocke,  of Baltimore, for the re-
covery of  droAvned persons.
  "1. Remove the body from the water as  speedily as
possible, to the most convenient place;  let the clothes be
taken off gently, and let the skin be dried by the applica-
tion of soft towels or sponges.  Place the body on a ma-
trass or blanket, and cover it with a blanket.  It is de-
sirable it should be on the back.  Having the  apparatus
prepared.
  "2. Expand the lungs at the earliest practicable mo-
ment; this may be done by  introducing a proper pipe
into the glottis; if one is at hand; otherwise by putting
the nozle  of a  common pair of bellows into the mouth
or nostrils and  working it, the air being prevented from
returning  by closing the mouth and nostrils,  and from
descending into the stomach, by  pressure on the thyroid
cartilage (or Adam's apple.) If neither the pipe and bel-
lows,  nor the bellows alone, can be procured on the in-
stant,  it will be  advisable to have the lungs of the patient
expanded  by the breath of an assistant.  If the inflation
of the lungs cannot be effected by these means, tracheo-
tomy must be resorted to.   In either case, after the air
bas continued about a minute in the lungs, it is  to  be
pressed out again,  and the lungs are  to be re-inflated,
Avhich alternated action is to be supported until signs of
animation  return. 
 382        OF  DROWNING, OR  SUBMERSION.

  "3. The temperature of the place, in Avhich an attempt
is to be made to restore  the apparently dead from sub-
mersion, should never exceed summer heat.  When the
temperature of the air and water is about sixty degrees of
Fahrenheit,no additional warmth need be applied; when
the temperature of the  air is beloAV sixty, a very gradual
augmentation of it may be allowed, until it has attained
that  point, beyond which it should not be increased by
external means.  The air  used in artificial respiration,
will, perhaps, furnish as much additional heat as  ought
to be applied, before there are  obvious symptoms  of re-
turning animation.
  "4. Permit no unnecessary persons  about the body, or
to remain in the apartment, which should be freely and
fully ventilated.
  "5. Let neither blood-letting, emeticks, agitation, nor
the fumes of tobacco be resorted to.
  "6. Electricity, if used at all, should be very cautious-
ly exhibited, and never  until the lungs  have been fre-
quently filled with air and emptied alternately for the
space of three  or four hours, except  in cases in  Avhich
the subjects have been long under water, then electricity
may be used earlier in the process, as a  desperate re-
medy.
  "7-  Stimulant applications to  the  senses  must be in-
effectual,  until  animation is in some  measure restored,
without which  there can be no sensibility.
  "8. The application of cordials to the stomach, and sti-
mulating  injections to  the intestines,  can  only be  useful
after a passage for the blood, through  the lungs, has been
opened; they should not, therefore, be introduced  before
the lungs have been several times completely filled with
air and emptied alternately,  after which they may be
serviceable; but nothing of greater bulk than four  or five
ounces of brandy or wine, or diluted aqua ammonice, or
compound spirit of lavender, diluted, should ever be
thrown into the stomach or intestines.
  "9. Every degree of friction is  to be carefully avoided,
until the  lungs have been several times expanded, and
the heart  has relieved itself of its  distention; after which,
friction should be  unremittingly and sedulously made 
           OF DROWNING, OR SUBMERSION.        383

four or five hours, or until the circulation is re-establish-
ed.  Frictions should only be made with the hand, lubri-
cated by oil,  or with a piece of soft flannel, and always
from the ends of  the extremities towards the body.
   "10.  Persevere."
   It may be remarked of the above instructions that they
differ in some measure from those usually given, or em-
ployed, for the recovery of drowned  persons;  but from
Avhat I have seen practised in those cases without system,
or any well-marked design, often embracing  things  the
most discordant, I am  led to consider the foregoing di-
rections of high importance: they are founded on scien-
tifick views of the subject, and detail the means with a
regularity which  I have no doubt will often ensure sue
cess.   I Avish also to observe that the doctor gives more
full explanations of his views in the Medical Recorder,
from which this article Avas extracted, but which are  too
lengthy for insertion here.  But as the Avhole of this was
intended for the physician, Avho, it is  always presumed,
may make any small variation which may occasionally
be necessary, I shall offer  a feAV remarks.
   1. No caution  is of  more importance  than to be care-
ful in handling the body; in carrying it, a small  incli-
nation of the head, or twist of  the  body, may prove
fatal.
   2. Let no authority, hoAvever respectable, induce you
to use tobacco smoke.
   3. If the patient revives in  some measure, and is kept
long in a languid horrible state of life, in which he seems
to be struggling with death, and apparently can neither
recover nor die, Ave should in some measure transgress
the doctor's rule for rubbing.  I  have seen a  most dis-
tressing case of this kind, where the patient Avas quickly
relieved by brisk rubbing  with a rough towel, till  the
skin was much inflamed: but it is to  be remembered
that this Avould only exhaust the little remaining life  be
fore the circulation is in good measure restored.
   I have some little doubt about the propriety of rub-
bing only from the end  of the extremities toward the  bo-
dy; I suspect the use of friction is  not  quite  so me-
chanical as to merely act by pushing on the blood.  Be-
sides, this view of the subject supposes the heart to be 
384   OF  STRANGULATION  FROM  HANGING, &C.

more capable of action than the veins; the reverse of this
is nearer the truth; so that,  by forcing on the blood  be-
fore the heart is able to act, we may crowd the heart  un-
duly, and thus prevent its action altogether.  I imagine
friction acts by its  stimulus  acting on  the excitability,
and thus renewing excitement,  and therefore it is, per-
haps, not material in what direction, we apply the strokes.
But it must ever be remembered, that a reduced excita-
bility is most easily destroyed by powerful stimuli, and
therefore we are  by no means to rub harshly,  until  the
lungs and heart have in some measure resumed their ac-
tion.  Does this  not explain the  reason Avhy electricity
operated so fatally  on the heart of drowned animals, in
the experiments of Mr. Kite, as related by Dr. Cocke?
And are Ave not warranted on this ground, never to  ap-
ply electricity in force, or any other powerful stimulant,
until the excitability shall have been in  some  measure
restored?
  4. Never let our efforts  cease for many hours: per-
sons have recovered after appearing  lifeless for five or
six hours.
  5. Never over-stimulate  by means of outward  heat,
before there is  considerable  life.   It  is  a pleasing coin-
cidence, that while I offer the best instructions in those
cases, I bestow a small encomium  upon departed worth;
this friend of science and of the afflicted is no more;  but
let  us imitate his good examples, and wrhile we mourn
his early exit from scenes of usefulness, which pointed
to fame, let us christian-like believe  he has secured  the
place of rest! and benignly smiles  on  those Avho walk in
the paths of rectitude and of honour.

              SECTION  X.--SUBSECTION  1.

  Of Strangulation from Hanging, and other  Causes.

  Persons are  sometimes found, Avho in a fit of despair
hang themselves, or this may be wickedly  done  by
others.  We also meet with children who are overlaid
by  their mothers or nurses, which  may arise either
from carelessness or some  disease of  the nurses, such 
       OF STRANGULATION FROM HANGING, &C.      385

as fits.   It  is  obvious no woman avIio is  liable to con-
cisions of any kind, should ever take  an infant into
bed with her.
  Death in all these cases is occasioned by the depriva-
tion of air,  or  its oxygen (unless the  spinal marrow has
been injured by a dislocation of the neck)  and, therefore,
I shall point out the means  suited to such cases, with-
out distinguishing them by the causes from Avhich they
originate.
  A first, aud  principal means, in all these cases,  is the
introduction of air into the lungs, as speedily as  possi-
ble, by means  of an apparatus  for the purpose,  or by
introducing air  by a common belloAvs,  taking care to
press on the prominence  on the throat called Adam's ap-
ple, reasonably, so as to prevent the air  going into the
stomach,  and  also to close  the  mouth,  and  the  otner
nostril; the air should be left, nearly  a minute, and then
pressed out again, and thus alternately inflate and gently
press out the air, so as  in some measure, to imitate the
process of  breathing.  Thevbodyis  to  be briskly but
gently rubbed, Avithout intermission, while we  entertain
any hope.
  If we have a well  grounded belief that the patient has
not been  strangled for a length  of time, the application
of cold water, by throAving it over the naked body, is  a
remedy Avhich I beg leave to recommend, in preference
to heating the body.  I am supported  in my opinion
respecting the  use of cold Avater, by  the fact of its use-
fulness in suspended animation from lightning, and also
in great depression from intoxication, as well as in cases
of dangerous fainting from  too  violent exercise, which
sometimes occurs, in those unaccustomed  to  labour.   I
suppose it operates by rousing the lungs into action, and
therefore in all cases of sudden depression or suspension
of life, I think it one of the principal  remedies, and very
often the only one necessary, where the  excitability or
sensibility is not too much exhausted.
  If we examine into the means by  which animal heat
is produced, we are sensibly met with the fact, that in
What ever way it is  elicited throughout the system, the
process of respiration alone, can maintain  it: and hence,
            49 
386     OF STRANGULATION FROM HANGING, &C.

it follows, tjiat where life is suspended by a sudden de-
privation of air^the  principal indication  is  to  restore
breathing;  that the sudden application of cold water ex-
cites the muscles of respiration into powerful action, is
manifest from the deep inspirations which we are forced
to make, on going  into the cold bath, &c.   If this opi-
nion be correct, it applies extensively to depressed life,
from the use of spirits, opium, narcotick poisons, over-
heating, or violent exercise; and from inhaling  delete-
rious gasses, from lightning, submersion, strangulation,
and, perhaps, all other causes which require a  sudden
restoration of  breathing; and we derive encouragement
from the fact,  that in all cases, Avhere it has been tried,
it has answered our wishes, in a greater degree than any
other means, usually resorted to.
  Mankind seem  universally to  have adopted opinions
in good measure opposite to the foregoing, and seem to
found all their hopes  on infusing heat, and thus restor-
ing life;  and apparently from the simple belief that life
is ever accompanied Avith heat, and  heat being reduced
in those cases, they seem  to think, that  to apply heat,
must necessarily tend to restore animation.  But I hope
to prove by  a few positions,  that this opinion,  or this
practice, on whatever views it may be predicated, is un-
philosophical, unchymical, and ill founded.
  1. Because heat is  not a necessary condition of animal
lifey many cold blooded animals, as fishes, possess great
vigour; if it be objected that this is irrelevant, I answer,
it is no more so than the supposition, that  extraneous
heat shall have a friendly influence on depressed life.
  2. In most  cases of sudden depression, which alone
are under consideration, we have no evidence of  the ex-
penditure of heat; on the contrary, all the blood, nervous
matter, and heat, are within, and the defection  is occa-
sioned by  chymical or other operations,  by which the
heat becomes  latent or bidden, and there is no more af-
finity between latent heat, and that Avhich is sensible and
free, than there is  betAveen any other bodies  in  nature.
The exceptions  to these remarks are cases  Avhere the
body has laid long in cold water, or exposed to a  low
temperature;  here free calorick or heat, in obeying its 
       OF STRANGULATION FROM HANGING, &C.     38?

general  laws, will pass from the warm to the colder
body, and, by congealing the fluids, will add to the danger
of the case.   But we are by no means to infer from this,
that a hasty application  of external heat, which has no
peculiar animal principle combined with it, is likely to
be useful in recoveriug life; for, simply to dissolve those
congelations is one thing, to put them into motion is
another, and one Avhich  can only be affected by the ac-
tion of the lungs, brain, heart,  and blood-vessels; the
main spring by which these are put into, and main-
tained in, action, is oxygen derived from the atmosphere
in breathing.
  3.  If it be  argued that by dissolving or rarefying the
fluids, by external heat, Ave prepare them to be  acted on
by the lungs,  &c; I  answer, that until the lungs  and
brain act, these cannot move: if the principal vital or-
gans act, heat is inhaled and distributed throughout the
system,  and elicited with a force and quantum  Avhich is
especially suited to every part.
  4. And further, I think it obvious beyond denial, that
the heart and brain are oppressed Avith a weight of blood,
and to dissolve and crowd on the  fluids, remaining in
the vessels, before the lungs are  expanded to empty
the heart, and  brain  of their surcharge, is  only to in-
crease the disorder, by croAvding them still more.   Be-
sides, the fluids in a  temperature reasonably low,  Avill
not undergo decomposition so soon as in a higher tem-
perature.
   5. The  circumstances that  a  child  Avill   suffocate
speedily in the warm  bosom of its mother or nurse, and
that a person  hung in  a warm room, or drowned in Avarm
water, has no more chance of recovery than those placed
in a reasonable temperature, must be admitted;  nay
more, I  feel no hesitation in giving  as my opinion, that
those placed in a warm bed, &c.  Avould die sooner than
those in the usual summer temperature of the air, or wa-
ter of rivers.
  Upon the whole, I am persuaded, the sudden application
of a heat, greater  than about sixty or seventy  degrees,
is highly dangerous, and further, I think it probable this
remedy has maintained its reputation principally because 
388     OF STRANGULATION FROM HANGING, &C

it can seldom be obtained, until the patient has in some
measure recovered  from  frictions, from inflating the
lungs, &c.
  Lastly, heat is a considerable stimulant, operating on
the living body, under all circumstances, relatively, that
is, the same degree of heat will produce an effect vastly
different, in different conditions of the body; and when
in any  reasonably degree, will exert  a greater force in
proportion to  the debility, or depression of the body, so
that a degree  of heat which might be friendly or inno-
cent, to a body in health, may unduly stimulate in cases
of suspended animation, and thus destroy the small re-
mains of excitability.  This observation applies to all
stimulants, and, therefore,  Ave are to commence in all
cases Avith the mildest methods and means.
  I shall conclude my reasonings, on this subject, by a
few remarks on the use of cordials, and on blood-letting.
It is universally known that excess in the force of stimu-
lants, applied  to the body, will prostrate the strength,
and may subvert every action.   In what condition of
the body, then, can we apply the greatest force of stimu-
li?   Will  the enfeebled body, Avhether habitually or ac-
cidentally so, bear  the greatest force of stimuli?  I an-
swer it will not, and instead of more powerful  stimuli
being necessary, they will exert a greater influence in
proportion to the reduction of the excitability, and Avhen
excitability is gone, life_ is extinct.  If these ideas are
correct, it follows that we may easily destroy the remain-
ing excitability by throwing stimulants into the stomach,
and therefore, they  should never be given till the circu-
lation is in some measure restored, and then, with a very
sparing hand.  In  all sudden cases that are early dis-
covered, a glass of cold Avater is a more rational and safe
remedy; and where the body has laid a considerable
time, a little warm  tea, or  the wine,  or  brandy, &c.
usually given, should be largely diluted.
   Blood-letting can never be necessary until the lungs
 are restored in some measure, for, it is a fact well known,
 that in all cases under consideration, the left ventricle of
 the heart, the arteries, and the veins of  the extremities,
 empty  themselves and force  the blood on into the great 
   CONCLUDING ADVICE IN CASES OF SUFFOCATION. 389

-internal veins, the  right auricle, and  ventricle of* the
heart.   How then are we to  remove this disorder in the
sanguiferous  system, by abstracting  blood from  the
veins?  There cannot be the remotest hope unless it be
by bleeding in the jugular veins; even this is doubtful,
and may interfere with the more important means of infla-
ting the lungs.   So soon as  the  breathing has  been re-
stored, and of course the circulation in good measure,
we should bleed moderately, aud repeat according to
circumstances, in order  to lessen the quantity of blood,
Avhich must have suffered some deterioration, and thus
enable the vessels, heart, and lungs,  to perform their
functions more easily, and thereby, prevent congestions,
infarctions, or infraction, in some of the  tender parts of
the body.

                    subsection 2.

     Concluding Advice in Cases  of Suffocation-.

   I here seriously beg leave to request the reader to read
the first section of  this article, and also the section, on
submersion; and I go on to state what I consider the
most likely means, for recovering those suddenly ex-
posed to whatever may suspend life, for want of air.
This more obviously includes  submersion,  strangula-
tion, deleterious gasses, as those of  mines, or wells, or
 old cellars, or  chymical operations, and fainting from
 sudden overaction, blows, shocks  from lightning, smo-
 thering, &c.
   1st Indication.  Lay the body carefully on the back,
 with the head slightly raised.  If the air is cold or Avet,
 carry it with the utmost caution to a room well  ventilat-
 ed, forbid  unnecessary persons from coming in, for the
 lungs require the purest air.
   2d Indication. If the body is wet, or dressed, Avipe the
 skin dry, or remove  the  clothes and commence gentle,
 but brisk,  frictions all over the body, having a blanket;
 under, and another thrown loose over the body.
   3d Indication.  Apply a suitable apparatus to one nos-
tril, or mouth, close the other nostril anjd mouth, or both 
390  CONCLUDING ADVICE IN CASES OF SUFFOCATION.

nostrils;  press on the prominent  part of the throat, or
Adam's apple; this Avill prevent the air from returning,
before it has entered the lungs, and also from passing in-
to the stomach; leave the air in some seconds, then press
it out, by applying a hand gently to the  abdomen,  and
in doing this, apply the hand pretty low down, so as to
avoid pressure immediately on  the stomach.  For want
of a proper apparatus, a common bellows may be used,
and  for want  of these, the breath of a  strong person
should be forced into the mouth; this process in immita-
tion  of breathing, must be constantly used while there is
any  hope.  These means  are more especially suited to
submersion, or where the body has laid exposed to bad
Aveather,  orwhere we suspect the patient has been some-
time affected.
  4th Indication. ThroAV cold water over  the naked
body and head; wipe the body dry, and repeat this a few
times; if no benefit follows, resume your  frictions,  and
inflation  of the  lungs; this remedy (the  cold water) is
particularly suited to injuries  arising from narcoticks,
blows, lightning, hanging, or suffocation, and least use-
ful  in cases of drowning;  but even  here, provided the
body was taken  up immediately, it ought to be used; and
I may Observe here, that the chance of success, from this
remedy, will be  in proportion to the earliness of its ap-
plication.
  5th Indication. As soon as there are signs of life, give
a little cool water, provided the accident has momenta-
rily  preceded; if some time has elapsed,  a little warm
tea,  broth,  wine  and water, or brandy and Avater, may
be given; giving preference always to the weaker arti-
cles, unless the patient is known to be of intemperate ha-
bits; here we may venture to give warm wine,  or equal
parts of brandy  and water.   This advice is  applicable
to all cases.
  6th Indication. Open the bowels  with injections con-
taining common  salt.
  7th Indication. If life return imperfectly, and the pa-
tient is harassed with a coming and going of the breath,
and  circulation,  and this continues more than a few mi-
nutes, bleed the patient in the arm, or jugular vein, and 
     OF SUBSTANCES STOPPED IN THE THROAT.    391

increase the force of your frictions: if your patient re-
vive under this treatment, put him to bed, cover mode-
rately, let his room be Avell aired, give him a few draughts
of warm tea, either common tea or chamomile, &c; and
if he now incline to sleep, let him enjoy it.
  There aa ill in general be great susceptibility to chills;
and against these the  patient must guard by dressing
Avarm, taking warm teas, or broth, or panada, avoiding
much liquor, Avhich Avill over stimulate, and dispose  to
disease.  Lastly. It has been proposed, that if the lungs
cannot be inflated, that the windpipe should be opened,
and air forced in and out, as before recommended.  Cases
may occur Avhere a spasm may  close up  the  glottis  or
opening  from the mouth, and render this operation ne-
cessary, but it will very seldom be found necessary, and
can only, Avith propriety, be performed by a person ac-
quainted with the anatomy of the part.

                    SECTION XI.

        Of Substances stopped in the TJiroat.

  I have to acknowledge here,  that I have seen  but feAV
accidents of this  kind, and as I think Avell of  the direc-
tions given by Buchan, I have copied this article from his
Avork.
  "Accidents of  this kind  are  very  common, and ex-
tremely dangerous, yet they are generally the effect of
carelessness.  Children should be taught to chew their
food Avell, and to put nothing into their mouths which it
would be dangerous for them to swallow.  But children
are not the only persons guilty of this imprudence; many
adults put pins, nails, and other sharp pointed substances
into their mouths on every occasion, and sometimes even
sleep Avith the former  there all  night:  a fit of coughing,
or twenty other accidents, may force over the substance
before the person is aware.
   "When any substance is detained in the gullet, there
are two ways of removing it, viz. either by extracting it,
or pushing it down.   The  safest and most certain way
is to extract it; but this is not ahvays the easiest; it may 
 392   OF SUBSTANCES STOPPED IN THE THROAT.

 be more eligible sometimes to thrust it down, especially
 when the obstructing body is of such a nature, that there
 is uo danger from its reception into the stomach.   The
 substances Avhich may be pushed down without danger,
 are all common  nourishing ones, as bread, flesh, fruits,
 and the like.  All indigestible bodies  as cork, wood,
 bones, pieces of metal, and such like, ought, if possible,
 to be extracted,  especially if those bodies be sharp point-
 ed, as pins, needles, fish bones, bits of glass, &c.
   "When such  substances have not passed too deep, we
 should endeavour to extract them with our fingers, which
 method often succeeds.   When they are lower, we must
 make use of nippers, or a small pair of forceps, such as
 surgeons use.   But  this attempt to extract rarely suc-
ceeds, if the substance be of a flexible nature, and has
 descended far into the gullet.
   "If the fingers and nippers fail, or cannot be duly ap-
 plied, crotchets, a kind of hooks, must  be employed;
 These may be made at once, by bending a piece of pret-
 ty strong iron-Avire at one end.   It must  be introduced
 in the flat Avay;  and, for the better conducting it, there
 should likewise  be a curve or bending,  at the end it is
held by, to serve as  a kind of  handle to it;  Avhich has
 this further  use, that it may be secured by a string tied
 to it, a circumstance not to be omitted in any instrument
used on such occasions,  to  avoid  such ill accidents as
 have sometimes  occurred from these instruments slipping
 out of the operator's hands. After the crotchet has pass-
 ed beloAV the substance that obstructs the  passage,  it is
drawn up again, and hooks up the body along with it.
 The crotchet is also  very convenient, when a substance,
 somewhat flexible, as a pin  or  fish Iwne,  sticks across
the gullet, the hook in such  cases, seizing them about
their middle, crooks, and thus disengages them; or, if
they are very brittle  substances, serves to break them.
  "When the  obstructing bodies are small, and only
 stop up a part of the passage, and which may either ea-
 sily elude the hook,  or straighten it by their  resistance,
a kind of rings,  made either of wire, wool, or silk, may
be used.  A piece of fine wire, of a proper length, may
 be bent into a circle  about the middle, of  about an inch 
      OF SUBSTANCES STOPPED IN THE THROAT.   393

diameter, and the long unbent sides brought parallel, and
near each other:   These are to be held in the hand, and
the circular part or ring introduced into the gullet,  in
order to be conducted about the  obstructing body, and
so to extract it.   More flexible rings  may be made  of
wool, thread, silk, or small pack-thread, which may  be
waxed, for the greater  strength and consistence.   One
of these is to be tied fast to a handle of iron wire, whale
bone, or any kind of flexible Avood, and by  this means
introduced, in order to surround  the  obstructing sub-
stance, and to draw it out.  Several  of these rings passed
through one another, may  be used, the more certainly to
lay hold of the obstructing body, which may be involved
by one, if another should miss it. These rings have one
advantage, which is, that Avhen the substance to be ex-
tracted, is once laid hold of, it may then, by turning the
handle, be retained so strongly in the rings thus twisted,
as to be movedjevery wray, which  must, in many cases,
be a considerable advantage.
  "A material employed on these  occasions is the
sponge.   Its  property of  swelling considerably on be-
ing wet, is the principal foundation of its usefulness here.
If any substance is  stopped in the gullet,  but without
filling up the whole  passage, a bit of sponge may be in-
troduced into that part which is unstopt, and beyond the
substance.  The sponge soon dilates,  and grows larger
in this moist situation; and, indeed, the enlargement of
it may be forwarded, by making the patient swallow a
little water.   Afterwards it is to be drawn back, by the
handle to which it is fastened, and as it is now too large
to return through the small cavity by which it was con-
veyed  in, it draws out  the  obstructing  body  along
with it.
  "The compressibility of sponge is another foundation
for its usefulness in such cases.   A pretty large piece of
sponge may be compressed or squeezed into a small size,
by winding a string of tape closely about it, which may
be easily unwound,  and withdraAvn, after the sponge has
been introduced.   A bit of sponge may likewise  be
compressed by a piece of  whale-bone split at one end;
           50 
394    OF SUBSTANCES STOPPED IN THE THROAT.

but this can hardly be  introduced in such a manner a*
not to hurt the patient.
  "I have  often known pins, and other sharp  bodies,
which had stuck in the throat, brought up,  by causing
the patient to swallow a bit of tough meat tied to a thread,
and drawing it quickly  up again.  This is  safer than
swallowing sponge,  and  will often answer the purpose
equally well.
  "When all  these methods prove unsuccessful, there
remains one more, which  is,  to make the patient vomit:
but this can scarcely be  of any service, unless such ob-
structing bodies are simply engaged in, and  not hooked
or stuck into the sides of the  gullet; as in this case, vo-
miting might produce some further mischief.    If the pa-
tient can swallow, vomiting may  be  excited by taking
half a dram, or two scruples, of ipecacuanha in powder,
made into a draught.   If he is not able to swallow, an
attempt may be made to excite vomiting by tickling the
throat with a feather; and if that  should not succeed, a
glyster  of tobacco may  be administered in  a sufficient
quantity of Avater.  It is made by boiling an ounce of to-
bacco in a sufficient  quantity of water:  this  has often
been found to succeed, when otlier attempts  to excite
vomiting have failed.
  "When the obstructing  body is of such a nature that
it may Avith safety be pushed downwards, this may be
attempted by means of a wax-candle oiled, and  a little
heated,  so as to make it flexible;  or a piece  of  whale-
bone, wire,  or flexible wood, with a sponge fastened t«
one end.
  "Should it be impossible to extract even those bodies
which it is dangerous to admit into the stomach, we must
prefer the least of two evils,  and rather run the  hazard
of pushing them doAvn, than  suffer the patient to perish
in a few minutes; and Ave ought to scruple this resolution
the less, as a great  many  instances  have  happened,
where the swallowing of  such  hurtful and indigestible
substances  has been folloAved by no disorder.
  "Whenever it  is manifest, that all endeavours to ex-
tract or push down the substance must prove  ineffectual,
they should be discontinued}  because the inflammation, 
      OF SUBSTANCES STOPPED IN THE THROAT.    395

 occasioned by persisting in them, might be as dangerous
 as the obstruction itself. Some have died in consequence
 of the inflammation, even after  the body which caused
 the obstruction had been entirely removed.
   "While the means recommended above are used, the
 patient should often swalloAV, or, if he cannot, he should
 frequently receive by injection, through a crooked tube
 or pipe that may reach down to the gullet,  some  emol-
 lient liquor, as warm milk and  Avater,  barley Avater,  or
 a decoction of mallows.  Injections of this kind not only
 soften and sooth the irritated parts; but, when thrown in
 Avith force, are often more successful in loosening the ob-
 struction than all attempts with instruments.
   "When, after all our endeavours, Ave are obliged to
 leave the obstructing body in the part,  the patient must
 be treated as if he had an  inflammatory disease.  He
 should be bled, kept upon a low diet, and have his whole
 neck  surrounded  with  emollient  poultices.   The like
 treatment must also be used, if  there be  any reason to
 suspect an inflammation of the passages, though the ob-
 structing body be  removed.
   "A proper degree of agitation has sometimes loosened
 the inhering body more effectually than instruments.
 Thus, a  blow on the back has often forced  up a sub-
 stance which stuck in  the gullet; but  this is still more
 proper and efficacious, when the substance gets into the
' windpipe.  In this case, vomiting and sneezing are like-
 wise to be excited.  Pins,  Avhich stuck  in  the gullet,
 have  been frequently  discharged by  riding on horse-
 back, or  in a carriage.
   "When any indigestible  substance has been  forced
 down into the stomach, the patient should use a very
 mild and smooth diet, consisting chiefly of fruits and fa-
 rinaceous substances,  as pudding,  pottage, and  soup.
 He should avoid  all heating and irritable  things,  as
 wine, punch, pepper, and such like; and his drink should
 be milk and water, barley water, or whey.   When the
 gullet is  so strongly and fully closed,  that the patient
 can receive no food by the mouth, he must be nourished
 by glysters of soup, jelly, and the like. 
396    OF SWALLOWING CENTS, BUTTONS, &C.

   "When the patient is in  danger of being immediately
suffocated, and  all hope of freeing the passage is va-
nished, so that death seems  at hand, if respiration be not
restored,  the  operation of bronchotomy,  or  opening of
the windpipe, must be directly performed.  As the ope-
ration  is neither difficult to an expert surgeon, nor very
painful to the patient, and is  often the only  method
which  can be taken to preserve  life in these emergen-
cies, we mention it, but it should only be attempted by
persons skilled in surgery."
   It may  be remarked of the foregoing instructions, that
they are quite ample; but,  in general, I  would recom-
mend to persons thus unfortunately situated, not to be
too precipitate, lest they do great mischief, by awkward
attempts to extract the offending substance, and unless
there is danger of immediate suffocation, it will  always
be most advisable to call in a practitioner.
  In addition to the usual danger of accidents from pins,
we are sometimes endangered by  an  improper practice
some cooks have of sticking pins  into turkeys, &c. which
they are about to roast, and afterwards forget to remove
them.  I  once dined at a very respectable house; Judge
Hamilton, of Pennsylvania, was a guest,  where as ma-
ny as four or five pins were found in a turkey; and a gen-
tleman of the bar got a pin in his throat before we  were
aware of the danger.   This should be a caution to cooks,
and also to those who dine Avith strangers; for so small
an article  as a pin may easily escape their notice, and
getting into the throat may do serious injury, and  even
materially endanger life.

                    SECTION XII.

          Of Swallowing Cents, Buttons, 8£c.

  Children sometimes incautiously swallow cents, half
cents,  buttons, and other indigestible articles, which
may injure either from their hardness, roughness,  or
sharp points or edges.   I have seen several cases, where
such articles were swallowed without any  dangerous
consequences following; but they are always to be ap- 
    OF SUBSTANCES GETTING INTO THE WINDPIPE. 897

prehended: and cases are on record of deplorable sali-
vations, and other unpleasant effects having followed the
swallowing of copper; and therefore children should be
taught, as early as possible, to  view these practices in
their proper and  dangerous light, and severely correct-
ed, when necessary, to break so dangerous a practice.
  I recollect reading a distressing case of a lad, who died
about his seventeenth  year from having swallowed a
halfpenny when a child; it had  stuck in his  throat, and
remained there until his death,  and  during all this pe-
riod, was a source of great suffering.   Children who have
swallowed such articles, must be kept from all harsh or
heating diet, milk and other bland articles should be gi-
ven;  and the bowels should be frequently opened with
castor oil; or rather a mixture of this and sweet oil; mu-
cilage should be given.   If  fever comes on, it must be
reduced by bleeding, &c.  If there be severe pain, with-
out fever, a few drops of laudanum should be given now
and then.

                   SECTION xm.

     Of Substances getting into the  Windpipe.

  This most  alarming, and  dangerous accident occurs,
pretty often; but perhaps, a more singular and distressing
circumstance can  scarcely be found, than the fact, that a
sister of mine lost two fine boys, in  less than two years,
by each of them  getting into the windpipe  a  bean,  by
which they were suffocated.  Nothing can be attempted
by unskilful persons in those cases, but a skilful surgeon
should not hesitate a moment, to open the windpipe, and
endeavour to  extract the substance.   Perhaps it would
be well in all such cases, to raise the patient for a moment
upon the head, and then lay them down gently with the
head low, and by this means the article may possibly be
thrown into the mouth, or lodged high up in the wind-
pipe, where it will be much less irritating than on the
lungs.   In full habits we should bleed largely, and then
keep down irritation, by the free use of laudanum. 
398            OF FISHING HOOKS, &C
    I haAre seen a case Avhere a delicate child, not more than
  five or six years of age, got a cherry stone into this situa-
  tion; he was affected frequently with violent coughing,
  and symptoms of suffocation from which he narrowly
  escaped; at the end of the third week, in a violent fit of
  coughing, the stone was thrown out, and he soon reco-
  vered.  I am encouraged in recommending turning the
  patient up on his head, from the circumstance that ou
  either side of the windpipe, pretty high up, there is a lit-
  tle cup or shelf-like cavity, where bodies as large as can
  well pass the glottis, may,  and no doubt often do lodge,
  therefore, in turning the patient upon his head, the body
 rshould always incline to  one side; but these attempts
\,nmst not be repeated too often.  I think it would be ad-
Sjvisable always to bleed the patient  pretty largely, and
'  give a dose of laudanum; and obtain the best assistance
  as soon as possible.

                     SECTION XIV.

  Of Fishing Hooks, and other pointed articles, sticking
                     in the Body.

    I have known some  shameful cases, in which persons
  who had got fishing hooks into the cheek, and other parts
  of the body, were considerably cut by  medical men, in
  order to extract.  When I resided on the Ohio, a lad got
  a fish-hook into his cheek, and within  the  mouth, the
  shank of the hook had a considerable flaw, which stood
  as a barb, and  was fast to  the boys round-a-bout; thus
  situated he exhibited  a ludicrous appearance:  but, the
  wonder of the case is this, an old surgeon who had serv-
  ed in the revolution was called, in my absence, Tmt was
  not willing to act; I met him at the door, and was stop-
  ped by him, till he gravely told me to hold the shank firm-
  ly with the left hand, while with the other, with a bistoury
  I should trace out the hook, which would serve  as a di-
  rector!!  Finding the boy in this situation, I cut off the
  end next his jacket with cutting pinchers, and then with
  a plain pair, forced on the point which soon reached the 
            OF EXTRANEOUS BODIES, &C.         399

inside of the cheek, and was thus forced out, without
any cutting of the parts.
  Let this be remembered, in all cases; you have nothing
to do but cut off the line, if the hook is attached to one,
and then force the hook on till the point turns out,  which
must necessarily take place from its curved shape.
  I beg leave to relate a case of ingenuity, related to me
by a person of veracity.   A child had unwittingly swal-
lowed a fish-hook, attached to the line; a  neighbour
finding  the child likely to be  strangled, took a leaden
bullet, put a hole through it, through this hole he slip-
ped the line, aud then  suffering the bullet to fall into the
throat succeeded thus,  in  speedily dislodging  the hook,
and drawing it up with the bullet, which served the dou-
ble purpose, by its weight, of loosening the hook, and
guarding the point while it was drawn upwards.
  Pieces of glass, bone, wood, metal, or old  nails, &c.
sometimes get into  the feet and other parts of the body;
these  ought always to be extracted by means of tweezers,
or nippers;  but  where considerable bodies are tightly
wedged in, or broken off, as  sometimes happen, with
splinters of wood, it is  necessary to cut down or enlarge
the opening, which can only be done with  safety, by
those  acquainted with  anatomy, otherwise injury may be
done by cutting arteries  or nerves.   The pain  which
follows  these accidents should be mitigated, by reason-
able doses of  opium, and the solid  will be preferable.
Emollient poultices should be applied of mush, or bread
and milk, in all considerable injuries of this  kind; but
in slight cases the application of a bacon skin, or bit of
old bacon Avill answer a good purpose.  If fever follows,
we must bleed, give cooling purges, enjoin a low diet,
and mild cooling drink; if symptoms  of tetanus, or lock-
ed jaw occur, see the article on that  disease

                    section xv.

     Of Extraneous Bodies in the Nose and Ears.

  Children are often found, who unwittingly  put be.-ms
Hid such  like, into the nose,  and in their attempts to 
400         OF EXTRANEOUS BODIES, &C.

withdraw them, thrust them so far up, that it becomes a
difficult matter  to extract them.   No article is more
troublesome in these  cases than  beans, which swell so
readily on being subjected to warmth and moisture, and
by becoming thus enlarged,  are very difficult to with-
draw unless they are speedily discovered and extracted.
   I have always succeeded, in daylight, with the utmost
ease,  by simply grasping the nose firmly, high up, while
with the flattened end of a common probe, I have  care-
fully got beyond the substance, and with a hooking-like
motion forced it out:  the  handle of a small silver  tea
spoon, is well suited  for this purpose.
   If a few efforts do not succeed, it will be advisable to
send for medical assistance, otherwise much  injury may
proceed from the irritation,  as  suppuration,  or injuries
to the organs of smell.
   When substances  have entered the ears, as cherry
stones, beans, &c. (which children will sometimes intro-
duce,) or insects, we are to attempt their extraction, and
in this, I have always succeeded best with the flattened
probe, a little bent near the point; the forceps which are
often recommended for this purpose, are  apt to let the
body  slip, and sometimes with a projectile force which
sends it much further in, besides they occupy too much
room, as their ends must always be further asunder, than
the diameter of the body.   Live insects are best remov-
ed by means of injections  of oil, or camphorated spirits;
see the article on earach. 
OF INFLAMMATION, OR PHLOGOSIS
SECTION I.
I HAVE so fully treated on visceral inflammation, and
have had occasion to speak so repeatedly of inflammato-
ry diseases, that I shall confine my remarks in this sec-
tion, to that kind of inflammation only, Avhich is found
in the muscular  or  glandular parts of the body, but
more especially among the muscles of the  limbs.  The
only case of internal inflammation which  properly be-
longs to this article is the psoas abscess.
  This kind of inflammation  follows wounds, bruises,
fevers, &c. and in all cases of considerable severity, i*
accompanied with fever.
  Imposthumations,  healings, biles, stonebruises, &c.
are consequences  of this species of inflammation.  And
in all cases it can terminate but in three Avays:
  1. By resolution or scattering.
  2. By suppuration or beating.
  •3. By mortification.
  In all cases of simple inflammation, provided there is
no contraindications, we should endeavour at its com-
mencement to disperse  the disorder, by means of bleed-
ing from the arm, topical bleeding by leeches, or scari-
fying and cupping;  by cooling embrocations, as sal.
ammoniack in vinegar,  or lead water, &c. with Ioav diet,
cooling drinks, rest, and purging.
  But where  these cases succeed severe  fevers,  or vio-
lence done the part,  and Avhich will not probably yield
to discussive applications, Ave are to encourage suppura-
tion by mild warm fomentations, and emollient poultices,
             51 
40£       OF INFLAMMATION, OR PHLOGOSIS.

frequently reneAved; as every two  or three hours; the
best of these  is, bread  and milk,  or mush  containing
linseed, ground elm bark,  white lily roots, and  such
mild articles;  and  Avhere  the  suppuration is tardy, in
Aveakly or reduced habits, fomentations of bitter herbs,
Avith the addition of onions to the poultices, and in cases
still more tardy, a gum plaster will  answer best, with oc-
casional embrocations, with some stimulating oil.
  In all cases of tardy inflammation of every kind, and
in all kinds of habits, I have remarked that a long con-
tinuance of Avet articles are injurious; and I feel full con-
fidence in observing from considerable experience, that
Ave ought never to continue Avashes, or poultices beyond
the second w eek.
  Suppuration is  knoAvn  to  progress,  by  occasional
chills;  throbbing or beating in the  part;  heat; redness,
Avell defined, or marked in its circumference; and if not
very deeply seated, by a prominence of the part, and a
soft feel,  indicating the existence  of pus or matter:  as
the suppuration advances,  the pain Avhich Avas constant
and severe,  together Avith the throbbing intermits, and
finally,  in good habits when the abscess is completed,
pain almost ceases, for a time.  But the matter  must
now be  discharged by a  sufficient opening Avhich can on-
ly be attempted by a surgeon, and Avhich is ahvays bet-
ter than leaving the part to burst.   After it  is open, a
poultice, in all considerable cases, is to be applied for a
day or two; after which, a  plaster of basilicon may be
applied.
  If an abscess is deep  seated, and Ave neglect to  open
it at the proper time,  the  absorbents gradually recover
strength,  if the habit is good, and taking up the matter
Avill raise a considerable  fever, or other unpleasant
symptoms.
  I once met Avith a case of this kind in a boy, Avho had
a large abscess formed in his arm  pit; finding him la-
bouring under considerable fever,  and the tumour un-
pleasantly hard  about its  circumference, I  bled  him,
and a large quantity  of  distinct pus was floating in the
blood. 
OF MORTIFICATION.               403
   I also met another case of abscess in the thigh, Avhere
 the abscess, for Avant of opening, had nearly destroyed a
 boy of good constitution; but before I saAv him it had
 terminated in  a groAving fleshy tumour,  Avhich was of
 considerable  size.   These cases should be a caution to
 all timid, or careless people, to take good  advice, and
 never object to opening, Avhen thought advisable by men
 of experience, otherAvise  severe, and irremediable con-
 sequences may folloAV.
   With a due  regard to the local applications above re-
 commended,  Ave must  carefully bear in mind that there
 is a certain point, or force in inflammation, necessary for
 suppuration; and excess of force or action,  either local
 or general, will as certainly terminate in gangrene or
 mortification, as Avhere the  force or action is below the
 suppurating point.   Aud hence it folloAvs, that Ave must
 attend to the  general system, and if there be too much
 action, as manifested by fever,  severe chills,  excesshe
 pain, or an absence of it, Avith considerable extension of
 the swelling, Ave should bleed,  purge,  and  use  general
 means for reducing action; and  this course is often abso-
 lutely necessary  after gangrene, or incipient mortifica-
 tion has supeiwened.
  If the  patient  is  of Aveakly habit,  intemperate, con-
 valescent from fever, &c. avc must evacuate with great
 eaution, if at  all; more generally  Ave must support the
 patient Avith light but nourishing food; a little good Avine,
 bark,  elixir vitriol, &c.
  But in both these opposite states of the body, we Avill
 sometimes be disappointed in our Avishes, and gangrene
 occurs, or Ave  may often  meet with cases which have
 been mismanaged, and have, actually, terminated in mor-
 tification.

            SECTION II.--SUBSECTION \ ■
          »•

                  Of Mortificaition.

  In entering on mortification, I  must remind the reader,
that I have elsewhere observed,  that all our diseases are 
404
OF MORTIFICATION.
but twofold, that is, morbid,  or peccant action, is  ac-
companied either with an excess, or defection of excite-
ment, and is to be arrested or removed by infusing an  ad-
ditional impetus into the blood and nerves; or, what is
much more common,  by abstracting stimuli, and thus
lessening the impetuosity of those things.  If inflamma-
tion has resisted the usual remedies  employed for scatter-
ing or repelling it, or those used with a view of effecting
suppuration, or if cases are found thus advanced, to this
fatal and last stage of mortification, we must in some mea-
sure vary the treatment.
  This species of inflammation is  to be known by  the
absence of the usual throbbing,  an increased heat and
burning in the part, by a dirty ill-looking  surface, blis-
ters extending some distance around on the skin, which
was sound before, and  often by livid edges, or  a dark
coloured circumference,  from Avhich the skin peels  off.
When these symptoms occur, we ought to apply blisters
entirely around the limb, but not immediately upon  the
sore, and at the same time, apply the carrot poultice, aud
repeat every two hours,  washing the part clean once or
twice a day Avith mild soapsuds, or milk and Avater, as  the
case is more or less inflammatory, if there is a raw sur-
face: a perseverance in the use of this poultice, and wash-
ing, with a repetition of the blisters if necessary, are  our
only hope, as  external remedies.
  But we are carefully to  attend to the  general system
and if there is well grounded belief,  that the patient is
labouring under inflammatory fever, we should purge
gently, or bleed, give small doses  of ipecacuanha and
camphor, to excite  slight nausea, and a  mild perspira-
tion;  cooling  drinks, Avith cremor tartar, or a little  ni-
tre, may be given,  but all sudden evacuations are to be
avoided; for, by a sudden prostration, we may invite  the
gangrenous action throughout the blood vessels; a low
diet, and rest, and quietness, are by no means to be  ne-
glected.
  In the opposite state of the system, wre are to use  the
same outward applications; or, perhaps, the addition of
washing the sore twice a day, Avith  a strong decoction of
bark, applied in a tepid  state.   But internally we are to 
       OF MORTIFICATION IN THE MOUTH, &C.    405

use bark, snakeroot tea, wine, opium, a light but gene-
rous diet, and elixir vitriol; remembering that the bark
can never be useful in these cases, unless it is used large-
ly, as two or four ounces or more, per day.
  If our remedies succeed, a distinct line of separation
will be discovered about the edges, in part, this gradually
spreads round, and healthy pus is deposited between the
sound and unsound part; or rather, the vessels of the part
are loAvered, or raised in their action, as the case may be,
to the  suppurating point, and  pouring out healthy pus
cast off the dead, or mortified part.
  A part gangrened, or in the first stage of mortification,
may recover, but mortification is always actual death of
the part, and must be throAvn off;  after which we are to
treat the case as a common ulcer, remembering that the
excitability of the part, is mostly of such a nature as to
require pretty stimulant dressings, as the soapsuds; and
basilicon, mixed with some spirit of turpentine.

                   subsection 2.

          Of Mortification  in  the Mouth.

  Here some difficulty occurs from the impracticability
of applying our usual remedies, we should reduce the pa-
tient reasonably, if necessary, and then  give the  bark
largely, the more the better, in general.   The mouth
should be frequently rinsed with water containing a  little
salt of tartar, and gargled constantly with a thin paste of
raw carrots, or the expressed juice, mixed with a portion
of good yeast; and if the disease passes through the
cheek a blister should be applied.

                   SUBSECTION 3.

            Of Mortification in the Toes.

  This occurs in aged persons, or those of very bad ha-
bits, especially in cold weather, and is to  be  treated by
simply giving pretty large, and repeated anodynes every 
406
OF PSOAS  ABSCESS.
 few hours, and washing with tepid soapsuds, and mild
 poultices, applied tepid and repeated every few hours.

                     SECTION III.

                  Of Psoas Abscess.

   This is so called from its being formed in the psoas
 muscle, very large and powerful  muscles which arise
 from the inside of the back, on either side, and passing
 along the loins they go out over the bones of the pelvis,
 and are inserted  into the  thigh  bone.   This disorder is
 probably induced by  a bruise, strain, &c. of the back; or
 it may proceed from other causes, which produce absces-
 ses in other parts of the body.   It commences with ten-
 sion, and pain of the loins, the pain soon extends up
 about the back and doAvn to the thigh, and mostly, there
 is some  difficulty of  standing erect.   These  symptoms
 are often taken for affections of the kidneys, and hence the
 necessity of getting good advice early, in those cases,
 or bleeding, and  reducing  the  body by  all  the usual
 means, particularly purging, and low diet, and rest.  At
 the same time, deep scarifications and cups on the back
 of the  loins, are to be used, provided the patient has not
 access  to  a skilful practitioner.  For, if to the above
 symptoms be added, considerable chills and heats, and a
 dull throbbing pain,  we  are to apprehend suppuration
will take place, and matter forming it will fall down about
the seat, or into the thigh, and must be let out, or serious
consequences will  ensue.  Therefore, wherever any con-
 siderable affection of this  kind occurs, disclose your
situation at once.  Dr. Rush mentions a case of a young
lady of great respectability and  Avorth, who perished in
consequence of concealing this disease, through a sense
of shame, till all hope of recovery was past. 
        OF  COMMON PHLEGMON,  OR BILE, &C.     407


                    SECTION IV.

          Of Common Phlegmon, or Bile.

  These occur sometimes  in habits  apparently good,
but Avhere they  are numerous, or frequently returning,
Ave are always to  suspect  some defection in the habit,
and should recommend the  use of occasional purges, the
use of cremor tartar and  sulphur, Avith mucilaginous
drinks; and  a diet suited to the case; generally a vegeta-
ble diet, but in Aveakly or depraved habits, a nourishing
but light diet:  avoid harsh, fat, or high seasoned food:
mostly a milk diet will be proper, and if the stomach is
Aveak, a little seasoning of  ginger, horseradish, or other
pleasant aromaticks should be mixed with it.   As a lo-
cal application, nothing,  in general, aa ill  ansAver better
than the bread and milk poultice, and when they are tar-
tly, some onion may be added, and if still more tardy,
discontinue the poultice, and use a gum plaster, or honey
and floAver, or  sugar and soap, kc.

                     section v.

Inflammation, and Beating of the Breast, or Mamma.

  By a timely application  of discutients, as  cold lead
water, or sal. ammoniack in vinegar and water, we  will
often succeed in  healthy Avomen,  if early  applied to,  in
repelling inflammation.   But in general, there is such a
dullness attends these cases, that these remedies can nei-
ther  be applied with propriety, or prospect of success,
here, bathing the part with the steam of hot Ainegar; rub-
bing for a length of time with warm oil; or  applying
warm dry salt, together, with bleeding, purging, cooling
diet and drinks,  rest, &c. unless a considerable debility
or depravity of habit forbid these evacuations, in which
case we must use mild  diaphoreticks,  as nitre  and cam
phor, opium  and ipecacuanha, &c.
  If suppuration advances, nothing will ansAver better
than the bread and milk poultice,  and to poor persons 
408      OF inflammation of the nipples.

who cannot well procure this, well mashed potatoes, or
mush with flaxseed, lily roots, or elm bark will answer
equally Avell; and as soon as matter is formed it must be
let out by a puncture, with a lancet; the poultice may be
changed in a day or two  afterwards, for the common
basilicon, taking care, to  keep the breast A\arm by a
covering of tow, or wool, or a few folds of flannel.
   Should ulcers form and  not  heal kindly; take about
four ounces of  water, or near  a gill, and add to it one
tea spoonful of honey, and to this, half a dram of calomel,
shake well every time before using, which is to be done
by injecting into each opening or ulcer, a small syringe-
ful of it once a day.  This I recommend from conside-
rable experience of its universal innocence, and great
success  in my practice.

                    section vi.

           Of Inflammation of the Nipples.

   This  is sometimes a very troublesome and painful af-
fection;  in slight cases, it will often be sufficient to wash
the part clean with milk and  water, before the child
sucks, and afterwards, or when it has  sucked,  with a
weak solution of borax in rose water, or in common
spring water.
   If this does not succeed,  nipple glasses, or medicated
wax caps should be worn; these are made by mixing
some ground armenian bole, with the  melted  Avax, and
pouring  this into a tea  cup  until it  rises  about three
fourths of an inch from the bottom, into this  a  smooth
piece of wood the size of the nipple, is  to be put while
it is  cooling, and forced near to the bottom; when the
wax is taken out, a small hole  may be  made  through,
which will  suffer the milk,  which weeps  out  to pass
away.
   With the use of the nipple glasses,  or caps, the wash
of borax, is to be continued;  if this does not succeed in
a few days, wash with  French brandy, or mix equal
parts of very clear lime water and oil of almonds; apply
this as soon as the child has sucked, or every feAV hours: 
     OF INFLAMMATION OF THE FINGER,  OR FELON.  409

and before it sucks, the nipple should be washed, which
will promote the healing of the parts;  but neither of these
articles, recommended, will injure the child.
  With due cleanliness, and  in gross or full habits, an
occasional dose of physick, and a reasonable diet, avoid-
ing much heating articles of food, or drink, and keeping
the bosom reasonably, but by no means  too warm, will
generally answer every purpose.
  And, I beg leave to admonish patients of this kind,
not to be too ready to  adopt  the advice  of officious, or
anxious persons, who, often Avith much willingness, but
little judgment in inflammation of the breast, undertake
to prescribe.  I have seen many bad consequences from
random applications, either  wrong in their nature, or
too frequently changed.

                    SECTION VII.

Of Deep seated Inflammation of the Finger, or Felon.

  This is a most painful  and tedious kind of disorder;
mostly, it is seated in the periosteum,  or,  perhaps, in the
bone itself: this constitutes the Avorst kind of felon, and
it is especially apt to  attack the joints.   But there are
slighter cases which  are seated in the muscle, or cellular
substance  of the part.  All  these cases are  extremely
painful, OAving, in great part, to the high degree of sen-
sibility which the fingers possess; but, perhaps, it is oft-
en augmented by the thickness and strength of the skin.
When  the pain seems  deep seated,  or about the joint,
we may, in general, prognosticate unfavourably.
  The finger affected should be held in spirit of turpen-
tine, as hot as it can be borne, or spirit of wine, or for
Avant of these, hot water.  In  heating these inflammable
articles, care must be taken not to set them on fire.   If
the spirit of Avine, whiskey, or turpentine, is  put into a
vial, and this stopped, loosely, with a rag, and then put
into cold water; the whole being now put over the fire,
may be heated Avithout danger; Avant of care in this mat-
ter, might, by a sudden flash, materially injure the face
or eyes.  If these articles do not succeed, the best thing
              52 
410     OF ST0NEBRU1SES, AND OF BLOODBILES.

we can do is to cut down, at one stroke, to the bone, with
ft sharp knife; but a surgeon will always do this most
easily.
   If these remedies are ineffectual, or neglected, suppu-
ration will progress,  and will in the main, be more  or
less tedious, as the disease lies deep or shallow.  When
we find suppuration unavoidable, it  must, in all cases, be
promoted by  the  mildest  fomentations and poultices,
and  nothing  will  answer this purpose better than bath-
ing the part, for half an hour, in Avarm milk and water,
at every renewal of the poultice, which ought to be eve-
ry two or three hours.  And the patient may always,
Avith great advantage, take full anodynes, morning and
evening; if they interrupt sleep,  the patient should be
bled, and take a purge.   This mild treatment will an-
swer our wishes more completely than any more heating
articles, which are often applied, and  often to the great
injury of the patient, by increasing the pain, and some-
times occasions the loss of a finger or joint.

                     SECTION VIII.

         Of Stonebruises, and of Bloodbiles.

   Stonebruises  are a little bloody bile  seated  in the
sole of the foot, and ate, perhaps, seldom found, except
in those who go barefooted. It is extremely painful, and
owing to the thickness of the skin, is very tedious. The
best treatment is to soak the foot well in  Avarm  water,
and then pare down as close  as possible, and then a
poultice of bread  and milk  may be applied as usual.
When the  presence of matter  is ascertained,  by some
abatement of the pain and prominence, and softness of
the part, an incision should be  made,  but this need ne-
ver be large;  a poultice should be  continued a day  or
two, and then a plaster of basilicon will answer.   Great
care is necessary to keep the dirt  from getting into the
sore.
  Bloodbiles, as they are called, are,  perhaps,  nothing
but common biles,  Avhich, by corroding some of the small
blood-vessels,  fill  the cavity with  a  mixture of  blood 
BITE OF THE VIPER.
411
and matter, or a stroke which ruptures a small vessel,
may be followed by a bealing, and the quantity of blood
extravasated cannot be changed  into pus,  but acquires
a dark appearance.   These, however, cannot ahvays be
distinguished, nor need the  treatment be different from
that  of common biles.  But in  general, after they are
opened, they require more stimulant dressings, as the
basilicon, containing a little  ground red precipitate, or
a little ground savin leaves.

                    SECTION IX.

  Inflammation from the Bite of Poisonous Animals.

                   SUBSECTION 1.

                 Bite of the Viper.

  I shall, here, first speak of the  bite of our serpents;
and  also, of those insects which  can annoy us by their
stings, particularly  when they unite,  and thus inflict a
considerable injury.
  The viper is found in this country; but they are neither
numerous nor particularly vicious.   I believe it is now
pretty well  ascertained, in England, that oil used with
freedom, is a principal, and often  the only remedy ne-
cessary.  Sucking the part bitten immediately, with the
mouth, is also strongly recommended; and it is  said to
be free from  all  risk to the operator, especially  if he
use the precaution of rinsing  his mouth frequently with
oil.  A mild emetick is also recommended; and washing
the part with alkaline washes, together with the free use
of vinegar.

                    subsection 2.

       Bite of the Rattlesnake and Copperhead.

  Although these are different snakes, they are about
equally poisonous,   making  allowance  for size and
strength  of the rattlesnake:"and the same remedies will 
 412 BITE of the RATTLESNAKE AND COPPERHEAD.

 answer, equally well, in all cases.   But after much re-
 flection, I am much at a loss to lay down the best treat-
 ment.  I have seen several  cases of bites  by the cop-
 perhead, but none by the rattlesnake till sometime after
 the  accident.   At one  time the juice of plaintain and
 horehound  Avas  much  celebrated;  and  was first pre-
 scribed by a negro of Cr rolina.   He gave a spoonful of
 the expressed juice of these herbs, mixed, and repeated
 it a  feAV times; a leaf of tobacco was  applied to the
 wound.  Alkalies outAvardly applied, and  taken  in so-
 lution by the mouth, has  been recommended.   Scarify-
 ing the part has been  practised.   Drawing with small
 cupping glasses is advisable, after having made an inci-
 sion into every mark of the tooth, through the skin, but
 it ought not to  be  made deeper.   If we omit to cut
 through the skin, by its swelling, it may so completely
 close the punctures, made by the teeth, as to prevent the
 suction  from reaching the poison.  If such glasses are
 not to be had, a hen may be set with the naked fundament
upon the part; and, I have been credibly informed, this
 has  succeeded well, and  that  several  hens have been
 thus killed in one case, which  seems to raise the  belief
 that the poison was thus  forcibly extracted.  But from
 what I  have heard from various cases of snake bites, I
 imagine the plentiful  use  of warm oil is the best  reme-
 dy; and perhaps nice fresh butter or lard would ansAver
 equally well.
  I cannot undertake to reconcile the common report of
 the innocence or  harmlessness of the poison of the rat-
tlesnake, with the fact that the late Dr. Barton of Phila-
 delphia, nearly lost  his life by tasting  the poison, very
 largely  diluted Avith Avater.  But I think myself clearly
justifiable in cautioning persons from such a practice; a
wine-glass,  or small  cup or  an  air  pump, when  either
can be  procured, will  ansAver; for any  sore  about the
mouth,  or any accidental biting of the tongue, &c. might
prove fatal.
  The Indians are said to be successful in treating cases
 of this kind.  I can neither  deny, nor support this re-
port.  I have seen one case of a bite, in the hand, which
was  treated by their  mode; the suppuration which fol- 
OF THE STINGS OF INSECTS.          413
lowed was tedious and severe; extending to the perio-
steum, and bone; but the patient stated that the acute
pain, and fever,  had been  less severe than  common.
What they used I know not, but the hand and arm was
made to sweat considerably.
  Warm oil has been recommended for exciting sweat-
ing in cases of fever, and  it  is probable that brisk fric-
tions Avith warm oil, over  the whole limb  on which the
bite was inflicted, would be  a principal remedy.  In all
the cases which  I have seen of persons who had been
bitten by the rattlesnake, severe, tardy, and  painful,
suppurations continued some time,  bearing a strong re-
semblance  to scrofulous  suppurations.  Active stimu-
lants are best suited to these cases, as fomentations of
the stramonium or Jamestown weed, and the basilicon,
rendered more active by adding a little ground red pre-
cipitate, or the savin oil, or savin leaves ground fine.

                   subsection 3.

             Of the  Stings of Insects.

  These are inflicted on us in this  country, by the com-
mon  honey bee, the humblebee, hornet, wasp,  yellow-
jacket,  musketoes, &c.  In general,  violent pain suc-
ceeds the  stings of all these, except the  musketoe, but
danger never succeeds  unless a number unite in this lili-
pution Avarfare, and under these circumstances, even the
musketoes become what the fellow called galley-nippers,
who for a wager, had undertaken to brave these little war-
riours, and who lost his stake by his opponent applying a
bite of fire, Avithout his knowledge, on which he sprung
up and cried out a galley-nipper, by Jehu! If, then, these
insects sometimes become galley-nippers in earnest, from
their number, or  happening to  unsheath their  powerful
swords in a tender part, we are sometimes in  need of re
lief. The application of salt and water, applied cold, Avill
answer a good purpose;  or  strong cold vinegar may be
applied: if these  do not succeed, rub the part Avell with
warm SAveet oil.   And in bad habits, if little ulcers suc-
ceed, wash the part with brandy; with a strong solution 
 414     OF MINERAL AND VEGETABLE POISONS.

 of lead; or apply some stimulant oil, as British, Colum-
 bian, or seneka oil.

                      section x.

          Of Mineral and Vegetable Poisons.

   The success of remedies in cases of poison, will, ge-
 nerally, be in proportion to the earliness of their applica-
 tion, and, therefore, every person ought to know what is
 to be done on these occasions, which often arise acciden-
 tally in children, and others, by  taking arsenick which
 has been set for rats, flies, &c. also from cobalt, which
 is set for fly poison, and contains arsenick, as its active
 part.
   The attention of medical men has been much directed
 towards finding particular specificks for poisons, but, lit-
 tle success has attended their efforts, and all that is known,
 on the subject is  of no value.   It may be  remarked,
 however, that vinegar Avhich has been generally recom-
 mended for vegetable poisons, would  be dangerous in
 the mineral; and I have strong doubts about its  efficacy
 in cases of vegetable poison.  All mineral poisons be-
 come active only so far as they are opeued in their tex-
 ture, or oxydated  by  acids, or oxygen, and, therefore,
 acids are to be carefully avoided.
   In all cases where it is known poison was swallowed,
 we should, if possible, instantly,  give a dose of white vi-
triol, as from ten grains to twenty, every five or ten mi-
nutes;  and to adults from thirty to fifty  grains.  Then,
Avith all possible speed, give large quantities of SAveet
milk and oil, or melted fat, or, for Avant of milk, warm
water;  as soon as possible, let a muscilage of  slippery
elm bark, or linseed be prepared, and given in large
quantities; these, in general, are better  than  oil; but al-
ways  require time for their preparation, which  is well
occupied by the free use of milk,'or warm water with
oils or fat.
  If no vomit is at hand, oil and milk, or warm Avater,
are to be forced  down, largely, and rapidly,  and if the
patient does not vomit immediately, put the finger or a 
       OF  MINERAL AND VEGETABLE POISONS.    415

feather into the throat, and thus provoke vomiting.  The
patient, especially if he has swallowed arsenick, or other
minerals, must continue the mucilaginous drinks till the
stomach has  recovered its healthy state.  The boAvels
ought, in all cases, to be opened Avith mild, or purgative
injections, as the case may require.
  If fainting occurs, of an alarming  appearance, throw
cold water over the patient; and I think this  Avould be
advisable in all severe cases of narcotick poisons, as opi-
um, stramonium  or Jamestown  Aveed,  nightshade, and
ardent spirits.
  Many accidents arise from children's eating the seeds
of the  stramonium;  thousands  of  families suffer their
houses  to be  surrounded Avith  this  dangerous poison,
without ever cautioning their children to avoid it.  Many
others  are found who are  in  the  habit of dosing their
children with laudanum, or Godfrey's cordial, and leav-
ing it in the reach of children, of which they unwarily
take an overdose.  I have  met with cases of this kind,
where the mother, or others, have been disingenious, or
weak, or silly enough, to conceal these things from the
physician, till after a recovery.
  Let it be a matter of importance, with all families, to
keep the  stramonium, the nightshade, opium or  lauda-
num, from the reach of children; or carefully  impress on
their minds, the danger attendingthe swallowing of these
articles.  And let arsenick, and fly poison, be touched
with great caution: I have seen many deplorable cases of
accidents, from mistakes Avith these articles,  which had
been set for the rats.
  In all cases of severe pain of the stomach  of healthy
children, or sudden extreme sickness or  violent delirium,
we are to suspect poison, and if there be any doubt of the
fact, Avith all possible speed get a physician, or on strong-
er conviction, administer the remedies mentioned in this
section. In addition to the danger of fatal mistakes, Avhich
may occur from setting poison  for rats, an awful opportu-
nity is hereby given to evil minded persons, should any
be about you, to  do mischief and cover it under pretence
of mistake. 
OF THE  DISEASES OF  WOMEN.
                     SECTION I.

               Introductory Remarks.

IT is my design here to speak, first, briefly of the prin-
cipal peculiarity of the female constitution; secondly, of
their diseases; thirdly, of pregnancy; fourthly, of partu-
rient women.
  The general delicacy of structure in the female system,
must be familiar to every person;  it may not be  amiss,
however, to point out a few of the most striking.  Their
limbs  are better rounded, their skins are softer  and
smoother, their bodies are smaller, their whole body is
less firm, than that of man; and, while a certain combi-
nation of these forms female bodily perfection, true femi-
nine excellence and beauty exists  in the mind, and the
face divine.
  What charms? what power? arise  from the proper
government of the female face.  Here lies all true beauty
and excellence, not, indeed, in the regularity of features,
but the operations of the soul within. We are certainly,
much inclined to admire the regular well formed features,
which are, usually, denominated pretty or beautiful.  But
let not  vanity attach to these  pretty features; she is  a
proud jade, of  a low character, and would ever humble
the female, by dipping the face in poison, which shall
wholly banish from it that holy and bright mirror, which
shone in the face of Moses after conversing with his Ma-
ker.   Here the mind, in a manner  partaking of its heav-
enly beautitude, wrought up  the features  of a man to
such a state of beauty and perfection, that the vulgar or
wicked eye could not behold it, without pain:  and least
of all  in  the train of observers, of this heavenly face, 
OF THE DISEASES OF AVOMEN.         417
was, probably, what the world terms beauty.   For, this
beauty of face was wholly different from common beauty,
and would  have shone  Avith equal splendour over the
face of age, and was especially calculated to humble the
vanity of common  beauty, because it Avas calculated to
equalise, and to mock  to  scorn  the boastings of the
proudest models of clay, Avhile the homely exterior rose
to its destined elevation.  This narration is so impres-
sive and so strikingly calculated to show the real nature
of beauty, that I shall quote the three last verses of this
chapter of Exodus.
  "And till Moses had done  speaking Avith  them, he
put a veil on his face.
  "But when Moses went in before the  Lord to speak
with him, he took the veil off, until  he came out.  And
he came out and spake unto the children of Israel that
which he was commanded.
  "And the children of Israel saw the  face of Moses,
that the  skin of Moses' face shone: and  Moses put the
veil upon his face again, until he went in to speak Avith
Him."                 *                  *
  Here, then, we have a strong case of divine perfection
and beauty, Avhich may be associated with the organs
of life;  and,  although we are not to expect so high a
display of it in this life, we are justifiable in the belief,
that dignity of soul is ever a  type, or resemblance of this
excellence; and  that genuine  beauty is that  angelick
serenity and steady lustre of face, Avhich flows from in-
ward Avorkings  of  the mind.   And, it may be worthy
remark, here, that common  beauty is characterized by
so much of a sameness, that it loses much of  its appa-
rent value,  from that circumstance; while genuine beau-
ty, flowing  from virtue and other divine perfections, has
a progressive quality of improvement, Avhich renders it
more and  more beautiful; and as it progresses in  the
contemplation  and  discovery of the supreme  fountain,
shall become more and more sensible of  the little com-
parative value of bodily exterior,  and of the unalterable
greatness,  goodness, and mercy, of that  Being from
whom every creature receives being, and whose face
shall ever be veiled, for He has said, "Thou canst not
             53 
418
OF THE DISEASES OF WOMEN.
see my face:  for there shall no man see me  and live."
Thus it would  appear that to see the divine perfection
would produce extinction, and that, as the creature shall
become  more intelligent, the great Supreme will recede
more  and more, by the splendour of his  immeasurable
wisdom, and perfections.
1  I hope I shall be pardoned for carrying my illustration
a little further;  and I wish to call  the  attention of the
reader, again, to the circumstances attending the case of
Moses:  "he put the veil  upon his  face:" here we may
suppose, not only, that such was the vast serenity and
dignity  of his countenance, that it would have humbled
the beholders in so  great  a degree as to have destroyed,
or have materially impaired their faculties of mind, but,
also so  strongly impressed on  his  mind an  increase of
the divine nature, that it Avould have exposed the Aveak-
ness and corruption of his kindred to have seen them
when he was thus  clothed with  this additional mental
poAver, arising from so striking a display of  Deity, and
would probably have  ghen him future pain;  and hence,
he was veiled till his  mind had fallen to its regular hu-
man state or condition.
■  I hope it will be  perceived that these observations on
beauty,  are intended to impress on  the female mind, or
rather the mind which is associated  with the female
economy, that while feminine beauty  consists here, in
good part, in cleanliness, reasonable dress, &c. that per-
manent worldly beauty consists,  principally, in a tem-
per, and actions, corresponding with real  excellence,
which knows no sex.  What value is there  in the but-
terfly's  gaudy dress?  these ephemeral tinsels, like the
flower of the morn, are cut down at eve!  But if  these
are the idols of the female heart,  or if these come at the
expense of virtue!  I shudder at the thought.
   Let  me, then,  admonish the female  to  abhor the
thoughtless, the wicked practice of tight lacing, for the
improvement of the shape; for common  sense, religion,
and your relation to this world, forbid this practice: nei-
ther do you gain one advantage from it; for I do aver,
Avithout fear of contradiction, that many homely women
have reciprocated with their husbands the utmost felicity, 
OF THE DISEASES OF AVOMEN.          419
  compatible with this life, who, in the common accept*
  tion oi  the word, were really  homely; and I can point
  at  once to the family  of our immortal Washington.
  Where, or what, were the charms which captivated the
  hand, the heart, the very soul of this great man?  Was
  it a Avoman squeezed thin as the reed, or was it the wo-
  man all sensibility of sIioav, or of vanity?   No, no; it
  was the eye which  sparkled with virtue, and with  that
  serene and lovely spark of Deity, Avhich, nurtured  and
  cherished aa ithin, displays the index  in the expressive
  eye!  In  this  heavenly organ,  Avhich savs, to every lan-
  guage,  cease to speak of me, for thou art dumb,  Wash-
  ington read the movements of the soul.
    And let it not be forgotten, that this kindred eye Avas
 * suited to the choice Avhich his judgment approved; Avhile
  the  shallow tinsel  covering the empty or vicious mind,
  or even the refiued  mind Avithout energy of body to give
  action to the living  sparkler, will ever be most likely to
  captivate  the empty beau, Avhose discernment is as shal-
  lovy as his flatteries are temporary; for so soon as the ex-
  terior charms are gone, what he took for gold is found
  to be but  tinsel!  And the days of age are days of hea-
(  viness!  while, of all others, the days of age are the most
  happy to  those whose souls, as it were, are fed by the
  same oil—the smooth and silvery flames of life unite,
  while Deity,  smiling propitiously on  the  happy union,
  spreads over  the evening of their days the kindling elec-
  tron, to lengthen  out the flame of life,  and gradually
  leads to that  happy condition where naught is fashioned
  by hands, and where distinction of sex is unknoAvn.
    I have  said, your relation to the  Avorld required your
  avoiding  this unwise custom; if  it be asked, "whose
  concern is it,  if I injure myself; I am the sufferer, and
  if I choose to run the risk Avho has a right  to object?"
  I answer, that this language can only be just, on the sup-
  position that the consequences  are  confined  to yourself;
  but have you  ideas of becoming a mother, and of entail
  ing misery on your offspring? if you view this lightly in
  anticipation, its  realization Avill be doubly sev:ir,  and thr
  idea that you, by the follies of your youth, rendered your
  child miserable, or have brought it into the world to suffer 
420        OF  THE DISEASES OF WOMEN.

and to die, will wring your heart with the most poignant
grief, and shade the hair of your head with the silvery
frost ere therseason come; or may, in the  morn or noon
of your life, lead you to that gulf of poison, where con-
sumption on downy wings wafts her seeds, and finding
the kindred soil in your little, impoverished, confined bo-
som, there she plants the deadly^eed; and while your
soul ardently desires the converse of kindred or friends,
this cruel foe of the female, lops off at every stroke ano-
ther thread! and soon closes your eyes from the vanity of
tinsel, and the cutting and galling machines, which you
have  proudly, vainly Avorn, in  defiance of friendly ad-
monitions.
   Oh! mothers, how long will you tolerate this slow me-
thod of suicide? rise up in your real nature; clothe your
minds Avith the vestments of angels, and as you yield up
the nectar, from y nr warm bosom, instil into your male
child an abhorrence to murder,  in the form of  duelling,
and of intemperance; and into the female,  an abhorrence
to the vicious  practice of tight lacing; then shall ye dis-
charge the most sacred duties of mothers,  and while you
enjoy much felicity here, from the reciprocated affection
of your  daughter, whose heart dilates, unconfined, to a
proper size, and fills the woman, not with undue sensi-
bility and irritability, but with  the big, good,  feminine
heart, which can enjoy itself, and impart to the man of her
choice felicity and happiness, neArer known where a for-
bidding constitutional debility is predominant;  you may
then close your eyes on the world, in the belief that you
have performed one of the  greatest works towards the
maintenance  of  health, to  your posterity; and may be
greeted, at the final call, with the cheering voice of the
host of heaven.

                    SECTION II.

                   Of the  Menses.

   I pass on  to speak of that peculiar habit  which so
strikingly distinguishes the female, and on the regularity
of which their health  in some measure depends, from 
OF THE MENSES.
421
   years of discretion, till  the  evening of life, I mean the
   menses.  As the means which have been pointed out, in
   various parts of this work, for the promotion or mainte-
»   nance of health, is  equally  suited to the female; and as
   temperance, regularity  and activity,  will  alone infuse
   health, I shall proceed to point out, the different periods
   at which this discharge requires particular attention; and
   then Speak of it in the diseased  state.
     In speaking of those interesting periods, I think pro-
   per to premise, that in general a great errour prevails in
   supposing health is maintained, only, by this secretion of
   the menses; and that when it is disordered, we have no-
   thing to do but procure its return, and health MIoavs of
   course.   This is an  errour, for many women who men-
   struate tolerably regular, are unhealthy; and many du-
   ring acute and other diseases menstruate without any ma-
   nifest advantage, or injury from it.
     It must be admitted, that  this disc' Urge is of vast im-
   portance to the female;  and where it  is long absent, or
   irregular, the health is  bad; but the truth  is, that some
   disorder generally precedes  these irregularities; and thus
   the disordered menses is not the cause of the disease, but
   the disease is the cause of this obstruction, or irregularity.
   So that we are to direct our attention to the state of the
   system, and prescribe according to symptoms; and the
   menses return as a matter of course.
     This errour respecting the female habit may be com-
   pared to the notions of the ignorant, about appetite when
   sick; all their lamentations are about eating, and they are
   ever pestering the physician for  something  to restore the
   power  or desire of eating;  not knowing, or stopping to
   reflect, that when the disease is removed, appetite returns
   as a matter of course.   So Avith the females, when their
   menses are disordered, they stop  not to inquire the cause,
   or to reflect that they are diseased, and that when this
   disease is removed, the secretion being a natural condi-
   tion of the healthy Avoman,  comes again when health re-
   turns, with as much certainty, and under precisely simi-
   lar circumstances, as  the appetite of the case above re-
   presented. 
4£2               OF THE  MENSES.

  This vieAv of the rr.se is of vast importance, and should
be a caution to females, not to take the rash advice of old
Avomen, who under the sanctified appearance of age give
advice, often unsafe, because predicated  on false views,
or rather without any view at all,  except it be that of
Avishing success; and  it  is a lamentable  fact, that those
who are the least competent, are the most willing to ad-
vise; and incalculable mischief is done to females, by the
mistaken notion of forcing the menses.
  All the usual remedies are of a heating nature, or Avhat
they call forcing, and it must be evident, that if a woman
is labouring under inflammatory diseases, which are most
common, these  heating articles  must do immense  mis-
chief:  consumptions,  and other'fatal diseases,  are the
consequences.
  Let  me then  admonish the female, that, under all cir-
cumstances, she is to pay especial  regard to her general
healih, and iu ninety-nine cases of an hundred it would
be better if she paid no regard whatever to her menses,
as a part of her disease.
  If you have an inflammatory disease,  it will be  most
speedily and safely  removed  by  the  usual means, as
bleeding, purging, Ioav diet, &c.
  If you are affected Avith chronick debility, or aa ith low
disease, tonicks and stimulants, as bark, iron, exercise,
generous but light diet, &c. will restore the tone of body,
and in either case, as health returns, the menses comes
as a matter of course.
  I have long been so sensible of  this true state of the
case, and also that this trifling secretion once a month,
when fully established, operates principally on the ute-
rine system; and by  giving health, and a proper degree
of excitement there,  contributes, indirectly, to the wel-
fare of the general system, that for several years of an
extensive practice, 1 paid no more attention in acute dis-
eases to the menses, than 1 did  to the appetite for  food,
for I was well convinced from observation, that of what-
ever importance the regular recurrence  of the menses
may be to women, that it is only to be regulated or con-
trolled, by due attention to the usual means for promot-
ing health, when health is present, and  in disease, by 
      OF THE APPEARANCE, &C. OF THE MENSES.   423

examining into the symptoms, and founding our indica-
tions of cure, on them.

                    SECTION III.

Of the Appearance, and Disappearance of the Menses.

  The commencement of the menses, which occurs from
the thirteenth to the seventeenth year usually, and which
ceases from about the fortieth to the fiftieth year, are pe-1
riods which are supposed to be particularly interesting.
That this change operates very powerfully on the system,
at both  these periods, is very certain and well knoAvn;
nor is there any Avonder in this.   The irritability of the
system, which  arises from a  new action, of Avhich the
whole economy partakes, and keeps up a  kind of fever,
is always  a critical time  of life,  and  requires a most
scrupulous  attention; not, hoAvever, to nostrums; but  to
greater regularity in whatever concerns the affairs of life.
All rash exposures to cold, long dabbling in cold water,
indulgence  in  trashy vegetables, violent fatigue, hearty
meals of harsh food, rash drinks of cold water, or the use
of ardent spirits, are to be carefully avoided.  Warm
clothing, regular sleep, reasonable diet and exercise, and
open boAvels are some of the principal means for promot-
ing health;  and it may be added, that at  these periods
women should view themselves, in some measure, as in-
valids entitled to a little indulgence from all the more se-
vere  duties  of life;  remembering always to  avoid too
much indulgence; for to want exercise, &c. in a reasona-
ble degree, is  an  extreme to  be avoided  with  as much
care, as the opposite excess: and if such persons are ta-
ken sick they are to be treated as such, Avithout any parti-
cular regard to their condition, as respects the menses. 
OF A DISEASED STATE OF THE MENSES.
             SECTION I.—SUBSECTION 1.

             Of Painful Menstruation.

THE disorder of this secretion may be treated of,
  1st.  As Painful.
  2d. Reduced in quantity.
  3d. Excessive, and
  4th. Retained.
  I shall speak of them in the order in which they have
been enumerated.
  Painful menstruation, as far  as my observations ena-
ble me to judge, is always accompanied  either with a
deficiency of this secretion, or it is accompanied with the
formation  of a membrane, or skin-like substance, which
is discharged at  the usual periods; in this last case the
menses are sometimes deficient, but at other times it is
copious.   These different conditions do not call for any
particular difference in  the treatment, being but  a dif-
ferent grade of the same disease.
  This disorder of the menses is, perhaps, always an in-
flammatory disease; but as the inflammation is chronick
or habitual, we are not to expect to remove it by any
sudden application of the usual remedies for inflamma-
tion, as bleeding, active purging, &c.  On the contrary,
use gentle evacuations, during the spells of pain, and in
the intervals endeavour to raise the  system above this
low grade of inflammatory action, by means of stimulants
of a particular kind:  these are, principally, such as  are
found most useful in  chronick  rheumatism; and hence,
there is grounds for believing, that this disease partakes
of the rheumatick condition. 
             GF  PAINFUL MENSTRUATION.         425

   I believe, with the  great Denman, that no woman in
 the habit of forming this membrane, will conceive; and
 also, that unmarried women or virgins, are liable to this
 disease;  but it  seems to have escaped the notice of this
 acute observer, that in a great majority of cases of this
 affection, in the unmarried state, that a change of their
 condition is one  of the most effectual  means for  its
 removal.  The formation of  this membrane is  a  dis-
 tressing  malady in all cases, but  is particularly so with
 the unmarried;  because severe uterine pains attend, and,
 frequently, partake so  much of the bearing doAvn pains,
 and other symptoms resembling labour, that unjust sus-
 picions are  often, thereby, excited: indeed, I have  met
 a*ith a few cases  so strongly resembling  abortions,  that
 I was led strongly to suspect young ladies, of  high re-
 spectability, until my doubts were cleared away, by the
 recurrence of these symptoms, at  the usual times or pe-
 riods of menstruation.  And I am led, here,  to mention
 that such has been the violence of the pain, itching and
 distress,  that ill  nature or ignorance might  have sup-
 posed some violence had been committed, with a view
 of procuring abortion:  and further, this membrane being
 detached, but in  part,  may fall down  and close up the
 mouth of the uterus; the menstrual vessels go on to se-
 crete a fluid, which accumulating till the uterus is dis-
 tended, a violent  set of symptoms are thus excited; and
 the abdominal muscles being brought into vigorous ac-
 tion, forces down  the contents of the uterus, Avith a force
 or violence, which  may not  only raise suspicions, but
 may, unquestionably, lacerate the hymen:  and hence we
 may call in  question the opinion of Denman when  he
 says, "the hymen is found generally, if not ahvays, in
 virgins;" and when he says, "the  hymen  is peculiar to
 the human  species, from  which  circumstance  a moral
 writer might draw inferences favourable to the  estima-
 tion of chastity  in women."
  I am not  going to call  in  question, the propriety of
considering this a condition which characterizes the vir-
 gin, in general;  and therefore, is always a strong ground
 of suspicion  when wanting; but to lay this down as an
 infallible criterion, by which we are to consign a woman
             54 
426          OF PAINFUL MENSTRUATION.

to infamy, is unwise, unjust, and ill founded.   Because
nature, in her occasional formation of lusus naturae, adds
supernumerary parts in some cases, but Avithholds them
in others; and in both cases, her sportive, or vicious freaks
invade every part of the body; and if she sometimes forms
the hymen so strong, as not only to be a sufficient and
absolute bar ag.unst unchastity, but so as to prevent the
escape of the menses and thereby excites most distressing
complaints, calculated  to raise suspicions, till the  real
nature of the case is known: is it not a fair inference, that
the opposite, or a very thin hymen, sometimes exists, and
that the merest  trifle  may deprive the virtuous woman of
this  common mark  of  chastity?  But  more  especially
Avhen disease,  such  as that above described, happens to
be  associated  with  a  weak hymen,  who  Avould  risk
their reputation on this  mark of chastity?  Women have
been born,  as I have seen, with one  mamma,  without
arms; human creatures are born with strong characters of
the hermaphrodite condition, and-after all this, is Avoman
to be condemned for Avant of the hymen?   I  have long
thought  it  a good rule in taking evidence,  to appreciate
that which  is related, jmore by the general character of
the testifier, than the consideration of an oath,  Avhere the
character was notoriously  bad: so, in cases of  judging
tbe female,  Ave are ahvays to give great Aveight to the
general deportment and character, nor venture hastily to
condemn, on premises  which av ill sometimes be found
ill grounded.  Upon the Avhole, this mark of chastity is
to be looked for almost universally, and requires all the
Aveight of good character, and of other  circumstances, to
support the character: natural defection may,  generally,
have the testimony  of a mother.   But humanity pleads
here for the orphan!  I shall conclude by making this fur-
ther remark; Ave.are beset by fallibility and defection, of
various kinds;  correct deportment in all the various du-
ties of life,  forms the character;  and let this be  the test:
if Ave have  doubts,  time  Avill remove  them; then let us
beware lest Ave condemn the spotless soul of the virgin
for bodily defection; Avhich she can mostly control,  but
can never form. 
OF THE TREATMENT OF PAINFUL MENSTRUATION. 427
                   SUBSECTION  2.

      Ofthev Treatment of Painful Menstruation.

  In cases of paiuful menstruation, the folloAving course,
persisted in for a sufficient length of  time, has mostly
ansAvered my Avishes.   In the spells of pain, and espe-
cially as soon as it occurs, bleed either in the arm or foot,
and, if the symptoms are severe, we may take a pretty
large quantity, or we may repeat the next day.  Take a
portion of castor oil,  or rhubarb, with a feAV grains of
calomel.   Use emollient glysters twice a day,  and if the
pains of the uterus are severe, but more especially if the
formation of skiny substances, are knoAvn to take place,
milk and water, warmed, are to be thrown very frequent-
ly into the vagina, with a neAv clean apparatus formed of
the  bladder,  &c. in  the usual Avay;  and the pipe  ought
sometimes to be  entered into the mouth of the uterus, and
the  milk and water injected into its cavity.  The mouth
of the uterus will readily be discovered,  by feeling with
the  finger, as it lies loose in the vagina; at its lower roun-
ded smooth end, an opening can easily and distinctly be
felt.   I esteem the free  and constant use of these  glys-
ters, and injections into the uterus, of primary importance.
Sometimes benefit is obtained from sitting over  hot Avater,
or bitter herbs boiled in Avater, &c; but in general, they
should be avoided, as they predispose strongly to taking
cold.  If the pains continue beyond the third or fourth
day, notwithstanding these remedies, together with the
use  of a low diet, mild tepid drinks,  and rest:  anodynes
are now to be used, and carried as far as may be neces-
sary for  subduing the  pain; the opium, or iaudanum,
should be combined with a little ipecacuanha, or a double
quantity  of  SAveet spirit of nitre  given with laudanum,
that is, mix about ten drops of laudanum with tAventy of
spirit of nitre, and take  this every three or four hours as
the case may require.
  In the intervals,  between the times of the menses or
pain, at Avhich time it is no uncommon thing for the pa-
tient to enjoy good health, active measures should be pur- 
  428 OF THE TREATMENT OF PAINFUL MENSTRUATION.

  sued to remove that peculiar condition, or diathesis, which
  keeps  up the disease, and I know of no habit which re-
  quires a greater sameness of treatment.
     The milder cases will yield  to the use of the volatile
  tincture of guaiacum, taken in doses of one or two tea
  spoonfuls, twice a day, in a little sweet  milk. If the case
  yields not  to this remedy, and due attention to the bow-
  els, we must alternate the use  of the tincture,  with the
  use of calomel and opium:  a pill containing two or three
  grains of calomel and half or a whole  grain of opium,
  may be taken at bed time;  and so  soon as the  slightest
  soreness of the  gums is  perceived, we  must desist and
  resume the tincture, allowing a day or  two for  the mer-
  cury to wear off, and thus continue to use these medi-
  cines,  alternately, till we subdue the disease.   In cases
  attended Avith marked constitutional debility, we should
  use the iron pills, in conjunction with  the tincture;  not,
  hoAvever, omitting  the mercury, unless there  be well-
  grounded evidence of scrofula, which should ever be a
  bar to the use of mercury.
     But 1  do not recollect one case of this disease,  which
  required the use of chalybeates.  The tincture  of guai-
  acum is a principal remedy, but in  inveterate cases, and
/  especially in the married state,  I would advise the use of
  mercury, and am well convinced it will sometimes remove
  barrenness, which  may  be owing to this morbid condi-
  tion of the uterus.  I have made  it a rule, for the last
  years of my practice, to recommend matrimony  in obsti-
  nate cases; and  although-the disease returned for a term
  or two, they have generally conceived,  which effectually
  destroyed this habit.
     In all cases of this kind, a diet reasonably good is ne-
  cessary: all vegetable trash should  be  avoided: spirits,
  spices, fatigue, passions of the mind, indolence, are to be
  avoided.   A milk diet, with light animal food in mode-
  ration, the use of boiled  wholesome vegetables,  as pota-
  toes,  onions,  rice,  turnips, and  good fruit,  fresh or
  dried;  horseradish, a little garlick and mustard, a little
  whole mustard seed, iioav and then, will be the most suit-
  able in general.   In full habits, a  diet somewhat more
  absteniinous will be necessary.  Exercise, adapted to the 
    OF A TOO SPARING CONDITION OF THE MENSES.  429

strength, is to be constantly pursued, and the cold bath
may be useful in cases accompanied with direct debility.

                     section n.

      Of a too'Sparing condition of the Menses.

  We meet with two very opposite states of the system,
which must be attended to in prescribing in those cases;
and it has been  remarked, in the  sections treating on
menstruation, that these derangements of the uterine pur-
gations  are the  consequence, mostly,  of some previous
disease.  The two opposite states alluded to above, are,
first, those accompanied with a pale  leucophlegmatick
look,  and an evident  want  of power or energy  of the
whole body, together with  a bloated, or  lax state of the
limbs; and Avith  vapours and indigestion.  The other is
accompanied  with most of the above symptoms, in a less
degree, but attended with a florid complexion, and a fe-
verish disposition, which is readily augmented by fatigue,
full diet, and such like.
  In the first of these conditions, we are  to endeavour to
rouse the languid action, by tonicks, and  particularly by
chalybeates.   The muriated tincture of iron is a valuable
medicine here; but,  I  have seen great benefit from the
use of the  iron  pills, and  common bitters.  Bark and
elixir vitriol are also valuable articles, electrical shocks
may be used occasionally, passed through the region of
the uterus.
  If these remedies prove ineffectual, the use of com-
mon madder may be alternated with them: half a dram,
two or three times a day: or the pills of calomel and opi-
um, may be given for a few days, now and  then, and
these succeeded by the use of good bitters, as gentian,
columbo, or the bark; or iron, elixir vitriol, &c.
  A pretty generous but  light diet is to be used, and
exercise, proportioned to the strength, must be persever-
ed in, avoiding fatigue.  Riding on horseback will gene-
rally be  suitable.   A glass of good wine, will be  pro-
per, now and then, and it is essential that the bowels be 
■130 OF THE STATE OF EXCESSIVE MENSTRUATION.

kept open; aloes  and calomel will answer best for this
purpose, in general.
  It may  also be  remarked, that a gentle  emetick, or
purgative,  previous to entering on the tonicks, and also
once in  tAvo or three weeks, Avill be useful in  freeing
the system from retentions,  which may be present, from
the sluggish state of the vessels and  glands of the body.
  In the second condition, with the florid face and fever-
ish habit, we are to use  a  diet  somewhat reduced, but
not too Ioav;  wine and spirits are to be  avoided; exer-
cise to be recommended;  occasional small bleedings,
and aloetick  purges; cremor tartar and  nitre; small do-
ses of  ipecacuanha and nitre; an emetick, kc. are to be
used till  the  system is  a little reduced, when the use of
bark, and elixir vitriol, bitters, &c.  with the occasional
use of calomel, will  generally  ansAver our wishes, by
due -perseverance; for it must be remembered, that chro-
nick diseases, of Avhich character this partakes, are, in
general, only to be removed by a pursuit of some regu-
lar course.

                     SECTION III.

       Of the State of Excessive Menstruation.

  This disorder may either be excessive in quantity at
the usual periods: or from its too long continuance; and
also from  a  too frequent recurrence of this discharge.
But- a  distinction of more practical  importance, is, that
all these varieties may  proceed from opposite conditions
of the body.  They may arise from  a  laxity, or want of
tone; or they may proceed from fulness of habit, or from
a disordered state of the  uterine Aessels, in particular:
and both these states of the uterus, and its  appendages
may be of  that laxity; or its opposite state of plethora,
or fulness,  or increased action.
  The indications of cure in these cases, are to be found-
ed  on  the  state of the system: if there be debility and
laxity  of the habit, such  means  are to be used, as are
calculated  to give strength  and  tone  to  the system, as
bitters, elixir vitriol; and, in the spells, opiates with a lit- 
         OF RETENTION, &C. OF THE MENSES.      43l

tie white vitriol may be taken, and rest must be enjoined.
The application of cloths wrung out of cold vinegar, ap-
plied once or tAvice a day, will answer a good purpose.
These cases in general, will not bear iron.  But I  think
the  bark,  mixed  with about half its quantity of cremor
tartar, and some  mild aroma tick, as a  little alspice, or
cloves, is one of the best tonicks we can give in the in-
tervals.
  When it arises from plethora or fulness, we must bleed
and  purge moderately, give occasional emeticks; but if
the  health is not much affected in the intervals: Ave may
in general, confine our attention  to the spells of the dis-
charge, and "here, Ave  should bleed, purge, give nauseat-
ing  doses  of ipecacuanha, and if these do  not  succeed,
we may noAV apply cold bathing  to the pubes, and  abdo-
men: give  opium  and nitre.  In the intervals  cremor tar-
tar, taken pretty  freely, will in  general ansAver a good
purpose.   But  in many cases, regular  exercise, sleep,
diet, temperance in drinking, kc. will restore the health;
for in most cases it arises from  irregularity in some of
these things, or  from inattention to dressing  suitably
warm: and to pay more attention aa ill often be sufficient
to banish the disease.

                     SECTION IV.

    Of Retention, or total Absence of the Menses.

  This may be reckoned, in  some measure, as of two
kinds, such as  sometimes  occur  in Avomeu who have
menstruated, but afterwards, from some disease, it has
been  checked; or such females  as go beyond the  usual
term of its appearance.
  In all these cases, Ave are to pay especial regard  to the
general health;  while that is good, Ave should by  no
means interfere; for we may  much  more easily do mis-
chief than  good.   It will be advisable, however, in ge-
neral, for such females to vie/vv themselves as  invalids,
in some degree, and therefore it behooves them to ob-
serve unusual care, and avoid all excess or irregularity.
If disease  come on, they are to  treat it according to the 
432  OF THE FINAL CESSATION OF THE MENSES.

symptoms, which in full habits will consist of moderate
evacuations by  bleeding, purging, &c:  and in the op-
posite or low state of the system, iron, bark, elixir vitri-
ol, and other tonick or strengthening remedies, &c.

                     SECTION v.

        Of the final Cessation  of the Menses.

   Many women are under great apprehensions about the
period of the final cessation of the menses: and I verily
believe they suffer more harm from their groundless ap-
prehensions, than from the disorder.  They seem to for-
get, that, it is as natural an operation of the body, for the
menses to cease at a certain period of life, as it is for them
to exist at another period.
   I have said, in section third of this chapter on the dis-
eases of women, that such women are invalids generally;
but let it be remembered, that  they  are  not to tamper
with medicine without cause, nor are they to view every
disease, with which they are attacked, as proceeding from
this cause, which is  too often the case, and leads  to im-
proper views, and prescriptions; because  they are al-
ways founded on false notions about this  supposed dis-
eased state of the menses.
   And they had better, in general, direct their attention
to the state of the  menses only when it is excessive, or
painful; in these cases, rest, mild glysters,  and a mode-
rate bleeding, in full habits, will answer every purpose;
in weakly persons,  rest, glysters, and a few anodynes,
will answer every reasonable expectation.
   If they are otherwise diseased, medicines, &c. are to
be used  according to the nature and state of the disor-
der; and here, in all severe cases, a physician  of expe-
rience should be called in. 
OF PREGNANT WOMEN.
                     SECTION I.

               Introductory Remarks.

 TO describe all the diseases which may occur in the
 state of pregnancy, in  child-bed, &c. with the various
 means  necessary for their  removal, and convey the ne-
 cessary anatomical knowledge, belongs most properly to
 books on  midwifery, and requires  room which cannot
 be bestowed on  it in this work.  I therefore shall but
 briefly  mention some of the peculiarities of the pregnant
 Avoman, and endeavour to correct a few errours which
 prevail, pretty   generally,  respecting  their  condition.
 There have been warm disputes tending to prove, or dis-
 prove, the idea of pregnancy being  a  state of  disease;
 but here, as in most other things, human actions are car-
 ried to  extremes.
  One  set would have a woman all disease from con-
 ception to the completion of  her parturient term, while
 another would argue that so far from pregnancy being a
 disease, such  women are, in general, more  healthy and
 exempt from disease on this account; and that a woman
 left to herself would seldom, if ever, perish either from
 disease during pregnancy, or  in the parturient state, un-
 less it  be from disease or accidents, which might  arise
 independently of pregnancy.
  I believe the  truth lies between these two extremes.
 Pregnancy is  not a disease, but it is  a predisposition to
 disease, and predisposes  to  a peculiar set of maladies;
 while the  woman at the same time is liable to  diseases
 which  affect  them  in  common with  other  women,  or
mankind in general.  But  this predisposition is  not  a
necessary  condition  of the  pregnant woman,  but ari-
             55 
434 ON THE ADVANTAGES OF EXERCISE TO WOMEN.

ses from her  infirmities, which often spring from refin-
ed life.
  In the first edition of this work, some reflections were
offered on the curse pronounced on the conception, &c.
of woman, at the  fall of our first parents.  But, after
more mature  reflection, I have thought advisable to omit
them in  the  present edition, because  it is a  subject
which, more properly, belongs to books  on  midwifery.

                     SECTION II.

     On the  Advantages of Exercise to Women.

  Independent of  all reasoning on this  subject,  I think
experience plainly teaches us, that pregnancy is not a
disease, and it is probable that with all the strength of
constitution Avhich women do sometimes possess, there
is not  even any particular tendency to disease.   But as
we find women in general, they carry during their preg-
nancy such a tendency,  and are also liable to many inci-
dental  disorders in the  term of parturition; by which I
mean, that period  which begins with labour, and ends
Avhen health has been regained.
  This view of the case is of vast importance, as it leads
to admonish the mother, that as the stamina, or sound-
ness of constitution of her daughter is established by all
the usual means bestowed upon her from infancy, so will
be in the main, the future hopes of her daughter.
  But  it is especially to be recollected, that pregnancy
and parturition is  to the woman entirely animal; and  if
she loses some  of those animal advantages which the
women of the forest possess, she is amply  compensated
for a reasonable weakness of body, by the  manifold en-
dearments  and  blessings  of refined life.   This Aveak-
ness of  constitution  must be reasonable, or  women
loses all  the greater blessings of life;  for which  all the
learning  and embellishments of the mind  cannot com-
pensate, and therefore in rearing these tender plants, let
especial care  be taken to unfold the body  by sufficient
exercise. 
            DISEASES OF GESTATION, &C.         135

  Let them use their own  limbs and  not those of ser-
vants; these form, if duly expanded and strengthened by
use,  a  support for them in  the  hour  of travail.  The
limbs of  the latter, like the shattered reed, may sigh tp
the wind, but sighs avail not in the hour of trouble! nor
are we rashly to call on heaven for aid.  The ways and
means  Avere originally  measured out  to  mankind, and
they  Avho neglect the means, invoke an insulted heaven
in vain!
  If  your situation requires the avoidance of the common
duties,  on the part of your  daughter, let walking, danc-
ing, and riding, be enjoined  as  an indispensable duty.
And  rather forego  some of the softer delicacies, or ex-
treme refinements than risk the health of your posterity.
  And it  Avill be found in general, that the jolly girl who
can  crack the  Avhip, and mount the prancing  but safe
horse; leap the  ditch;  or drive the carriage, &c. will not
only be more acceptable to the man of sense, but  the very
consciousness of her own strength, Avill paint her cheeks
with  the bloom of health; while the woman, all sensibili-
ty or refinement, conscious  of bodily weakness, startles
at her OAvn pale face, aud as she applies paint for weak-
ness, spoils the Avork with her OAvn tears!

                    SECTION III.

  Diseases of  Gestation, and of the usual Remedies.-

                   SUBSECTION  1.

      Of the Diseases of the early Months,  fife.

  It  may with  truth  be  said, that most of the diseases
with  which preguant women are sometimes affected, oc-
cur at all other periods of life: but there are a few disor-
ders  which are evidently the consequence of an increased
irritability of habit, and which  arise from the  stimulus
of the  active uterus.  There is, however, no necessity
for distinguishing these from those which are more inci-
dental; for I have elsewhere endeavoured to maintain 
436         DISEASES OF GESTATION, &C
that they are  all incidental, as respects the woman  of
complete animal powers.
  The most usual  disorders which attend the  early
months, are sickness at  stomach and  vomiting; heart-
burn; irregularity of the bowels; longings; swellings,
and pain in the breasts; hysterick fits; wrong position of
the womb.

                    subsection  2.

    Sickness  and Vomiting of Pregnant Women.

  This arises sometimes in very opposite habits: in those
of  good habit, if there be a feverishness, or flushing of
the face, or bleeding at the nose,  with much straining to
vomit, and general evidence of fulness, we should bleed,
use a light vegetable diet, and the most  cooling drinks,
and keep the bowels open with the mildest purgatives or
injections.  When these symptoms occur in reduced ha-
bits, attended Avith languor, and  a disposition to sweat,
&c. a light nutritious diet, the moderate use of good wine,
pleasant bitters, as bark, columbo, &c. will be advisa-
ble.  If the case is  obstinate, in  both  states of the sys-
tem, unless extreme weakness forbids, a very gentle eme-
tick of ipecacuanha will  be advisable.  Opiates, parti-
cularly in weakly habits, will often be found useful; or an
anodyne plaster may be worn over the stomach.  Exer-
cise, accommodated  to the circumstances of the case, is
never to be neglected.

                    subsection  3.

           Heartburn of Pregnant  Women.

  This disease is common at every period of pregnancy;
but as  it often occurs early, I have placed it  here.   If
attended  with costiveness,  magnesia and  rhubarb will
mostly answer our wishes; a little milk and lime water,
or a few peach  kernels;  a little soda  water;  calcined
magnesia; or a little nice gum arabick dissolved in wa- 
            diseases  of gestation,  &c.         437

ter, and made tart Avith lemon acid and sugar, and taken
in small quantities occasionally, will be found useful.

                   subsection 4.

   Irregularity of the  Bowels of Pregnant  Women.

   The most usual  state of the boAvels,  when disordered
in the early months, is  a looseness.  If it is accompanied
with sick stomach, a gentle emetick of ipecacuanha should
be taken:  and the foulness which accumulates from an
increased  action or excitement of the boAvels, should be
removed by the  use of magnesia  and rhubarb, or best
castor oil, or the epsom salts.
   It these do not succeed, there would still be no safety
in using opiates, or astringents, unless the habit is redu-
ced; and in this case they are  indispensably necessary.
The use of glysters of starch and Avater will ansAver a
good puspose, where there is much heat and pain in the
boAvels; and if the habit is reduced,  laudanum should be
given in the starch glysters; and this  will be the best
mode of administering opiates.

                   subsection  5.

  Unnatural Desires or Longings of Pregnant Women.

   Longings have been a source of  much confusion and
 diversity of opinion; some arguing  that they might even
 influence  the  welfare  of the  child; others denying any
 possibility of such influence, Avhile many have been wa-
 vering between  these opposite opinions, and of course
 have no settled  opinion about it.
   I think it highly probable, as suggested by the cele-
 brated Denman, that the first opinion, or that Avhich holds
 that even the child was liable  to suffer from this longing,
 arose from good nature or humanity, at a time when the
 female was degraded, and held the place of the servant,
 instead of that of the wife of equality.   And Avas kindly
 intended to relieve them of a part of the  toils which
 unpolished or unenlightened man is known to exert over
 the female in every country. 
438         diseases of gestation, &c.
   But these causes have ceased to operate, generally, in
 our country.   It is time to banish such unfounded opin-
 ions from every female mind;  for it is  not only an er-
 rour as commonly viewed, but leads  often  to mischief,
 by impressing the mind with anxieties injurious to health.
 Hence it may be said, longings lead to disease,  because
 they disturb the mind; and a disordered mind will  prey
 upon the health, whether arising from real or imaginary
 evils.
   Experience warrants fully the belief, that longings can
 never injure the mother, or child; on the contrary, an in-
 dulgence or gra'ification  of such desires is highly detri-
 mental, and should be  viewed  as a disease of  the sto-
 mach.
   Tbe woman nearly in a state of nature, probably knoAVs
 nothing about these longings, and when they occur in ci-
 vilized life, they call for the aid of medicine, like every
 other disease.   It may be remembered, however, that in
 some rare cases where the patient is much debilitated,
 appetites seemingly somewhat extravagant, are to be in-
 dulged reasonably, but in no greater degree on  account
 of the pregnant state, than in any other condition of the
 diseased body; and therefore,  the pregnant woman  who
 otherwise enjoys health, should curb every unnatural  or
 unreasonable propensity.
   A gentle emetick, or a few doses of epsom  salts,  or
 rhubarb und  megnesia, will generally, with temperate
 diet, relieve those cravings.   I am clearly of opinion,
that the increased irritability of habit which attends preg-
nancy, calls for, and strongly claims indulgence in every
thing relating to life, but, the  golden rule hert is mode-
ration .

                    SUBSECTION 6.

   Swellings, and Pain in the Breasts  of Pregnant
                      Women.

   A remarkable sympathy or connexion exists between
the breasts and uterus; and, in particular, all the natu-
ral and healthy operations of the impregnated uterus are 
DISEASES  OF GESTATION, &C.         439
felt in the mammae; pain and swelling is generally pre-
sent at an  early state of pregnancy, but seldom require
any thing more than leaving the breasts room  to  dilate
freely; and living a little abstemiously, carefully avoid-
ing stays, &c.  A little warm oil may be rubbed into the
breasts, once or twice a day, if the pain is considerable;
or if still more severe, a bleeding and a cooling purge or
two, may be necessary.

                    SUBSECTION 7«

 Hysterick Fits, and Paintings of Pregnant Women.

  These sometimes occur in the early months in irritable
habits: if they  arise from the irritation of the distending
uterus, they are seldom if  ever attended  Avith any dan-
ger.   They are mostly temporary, but if severe, remedies
must be applied, suited to  that condition of the system,
which happens  to be present,  for these disorders may
arise in opposite conditions of the system.
  If the habit is full, we must advise bleeding, and re
lieve congestions of the boAvels, by cooling physick or
glysters.
   If the habit is weakly and irritable, opiates, with due
attention to  the bowels, Avill  answer; or other antispas-
modicks, as assafcetida, ether, &c. may be used.
   Particular attention is to be paid to the mind, and ev-
ery reasonable allowance made for its increased irritabi-
lity, but let no  weak minded woman claim to herself un-
due alloAvance, in this respect; prudence here, is almost
every thing, and therefore,  every prudent woman, while
she receives indulgence, is to make it her constant study,
to reciprocate the favours of good nature;  and by endea-
A'ouring to please others, she can never fail to please her
self. 
440         DISEASES OF  GESTATION, &C.
                    SUBSECTION 8.

            Wrong Position of the  Womb.

   About the fourth month, the womb begins to rise from
 its situation in the pelvis, and to mount slowly into the
 abdomen.  If it happens  to lose its  proper position, so
 that its longest diameter presses  on the rectum and blad-
 der, unpleasant symptoms are excited, as bearing down
 of the womb, tenesmus, inflammation of the bladder, ob-
 structed urine, and obstructions of the boAvels.
   If  these symptoms  become troublesome during the
 fourth month, or a little sooner or later, the patient can
 in general determine, by feeling with the fingers, whether
 the uterus is wedged or confined in  the pelvis: if it is,
 rest, in time, will often alone remove the complaint; but
 if it has advanced, the case becomes critical, and requires
 advice.
   The womb is to be  replaced, by gentle pressure up-
 ward, and the patient to keep pretty much in a horizon-
 tal position.  But sometimes  the uterus is  not easily rai-
 sed, and the  case becomes urgent from the confinement
 of the uterus, &c. in this case the catheter is to be intro-
 duced, to  draw off the water, and glysters must be given,
to open the boAvels; and if the symptoms  notwithstand-
ing run high, we are by all means to  bleed, enjoin a low
diet, and then give  gentle anodynes: but this case is men-
tioned most,  Avith  a view to put the Avoman  upon her
guard; and when it occurs, the best advice  should be ob-
tained without delay. 
OF THE DISEASES 8F THE LATTER MONTHS, &C.  441
                     SECTION IV.

      Of the Diseases of the Latter Months, $c.

                   SUBSECTION 1.

      Of Costiveness, 8£c.  of Pregnant Women.

   I shall here speak briefly, of some  of the most com-
mon diseases Avhich trouble women, in the latter momhs
of pregnancy.   These are costiveness;  piles;  swellings
of the legs; pains in  the back, &c;  cough, and difficult
breathing; cramps; colick-pains; suppression  of urine,
and incontinence of urine.
  It is probably true, that pregnant women are less in-
jured  by costiveness, than in  any other  condition of the
body, and in general, if no inconvenience is  experienced
from it, they may leave the case to nature, observing ev-
ery necessary regularity.  But if inconvenience seems to
arise  from it, injections,  or  epsom  salt, or castor  oil,
should be taken to remove it
  Reasonable exercise in general, with a vegetable diet,
and the reasonable use of ripe fruit, Avill be found useful,
provided no extreme  debility of the constitution forbids;
if this be the case, a light thin diet, consisting a good
deal of fresh animal food, will answer a good purpose.

                   subsection 2.

               Piles, or Hemorrhoids.

  This is a common complaint in the latter months,  but
no particular difference is necessary betAveen this disease
in the term of pregnancy, than at other times: the reader
is referred to the article on this disease.
56 
442  OF THE DISEASES OF THE LATTER MONTHS, &C.
                    SUBSECTION 3.

  Swellings of Legs, Thighs,  and Belly, of Pregnant
                       Women.

   These swellings are only particularly entitled to no-
 tice, when they become considerable.
   If they occur in delicate habits, rest, frequent gentle
 rubbings with a soft flesh-brush, or smooth flannel, are
 principal remedies, but still exercise is by no means to
 be wholly avoided; the bowels are to be kept open, and
 the diet  suited to the circumstances of the case.
   If there is a fulness, with pain, we should bleed mode-
 rately,  give a gentle purge, and enjoin a low diet; and
 accommodate the exercise  to the strength of the patient,
 not forgetting that moderate exercise is indispensable in
 all cases where it can be borne.

                   subsection 4.

            Pains in the Back, Belly,  8£c.

   These arise from the pressure of the distended and
 heavy uterus,  and will yield to  occasional small bleed-
 ings; suitable diet;  open bowels; and opiates, regulated
 according to the constitution of  the patient.  It is espe-
 cially to be recollected by such patients, that they should
 change  their positions  frequently, as well  during the
 night as  during the day;  and,  in general, they should
 avoid much stooping.

                   subsection 5.

        Of Cough and Difficulty of Breathing.

   These  are complaints Avhich are not often removable
by any means till after delivery, when they will  cease of
course.   They arise from  the confinement of the chest,
and this confinement is occasioned by the uterus, which
now distends the Avhole abdomen, so as to press power- 
   OF THE DISEASES OF THE LATTER MONTHS, &C.  443

fully upwards, and thus confines the diaphram, and the -
viscera of the chest.
  If the difficulty of breathing is great, occasional bleed-
ings, Avith low diet, in full habits, will have  a good ef-
fect, but in reduced habits Ave must bleed with caution;
mild opiates, combined with SAveet spirits of nitre, may
have a good effect in  these  cases.   For  the cough, the
same  remedies as  are  recommended  for the  difficult
breathing, Avill usually answer.  It is especially neces-
sary in these cases, for the patient to breathe a Avholesome
air; their bed-rooms should  be  airy; they should sleep
alone, avoid curtains about the bed, and in the day care-
fully avoid crowded or sultry places.  Reasonable ex-
ercise, with a diet as Ioav as can  reasonably be borne,
may be expected to have a salutary effect.

                   SUBSECTION 6.

           Cramps of Pregnant Women.

  These sometimes occur  in the legs, thighs, &c. in the
latter months; and especially at night.   This  affection
must be  treated on general principles: bleeding; laxa-
tives; low diet, followed by  opiates, may be used in full
or good habits.   In opposite habits, rubbing the parts
with opodeldock, or ether and laudanum; and the use of
opiates, and  a  spoonful of  whole mustard  seed, taken
in molasses at night, together Avith a reasonable diet,
will  seldom fail to remove this severe complaint.  Ex-
ercise and dry rubbings  frequently  repeated, must not
be omitted.

                   subsection 7.

         Colick-Pains of Pregnant Women.

  These sometimes are severe, and resemble, in a good
degree, the pains of labour.  They  may  arise  from the
irritation occasioned by the  uterus confining the viscera,
but are often the  consequence of eating unsuitable diet,
or costiveness may have a  share in its production.  If 
444 OF THE DISEASES OF THE LATTER MONTHS, &C.

costiveness attend, this is carefully to be removed, but if
the symptoms are urgent, opiates are to be administered
freely; if fever occurs oris  present, bleed.  Glysters are
to  be  given  occasionally,  Avhile  any tendency to these
pains continues, and  especial care is to  be paid to the
diet, and drinks, which are to be plain, and taken more
frequently than usual, but upon the whole, the diet should
be  sparing.
   If the colicky pains are obstinate,  and we are not well
satisfied  tbe bowels are completely opened, an examina-
tion must be had of the rectum; this can be done by in-
troducing a finger into the vagina, to ascertain whether
there be not indurated feces confined  in the rectum.  For
Ave are assured by Denman, that a retention of the feces
sometimes occurs even where the boAvels seem to be open,
which may be owing to a narrow passage, which permits
the thin feces to pass without removing the more harden-
ed part  If such balls or feces are found  on feeling, they
must be removed by the finger, passed into the vagina,
or a smooth instrument, in form of a scoop, must be pass-
ed up the rectum to bring down the confined matter, other-
Avise fatal  consequences may occur  from mortification.
Purgatives are by no means to be given if we are aware
of the  existence of this  complaint.   They may in gene-
ral be  removed by taking a tube  about twice the length
of the  usual ivory glyster pipes,  and passing it careful-
ly and gently through the  feces,  Avhich can  be felt, and
as we  pass  among it Avith  the pipe, let  the  usual con-
tents of an injection  be  passed up.  By  repeating this a
few times we will probably generally succeed, but great
caution is necessary not  to excite any pain, or use any
violence.

                   SUBSECTION  8.

              Of Suppression of Urine.

  Little can be done in this  affection till the woman is
delivered, Avhen it will cease, provided it has not been
improperly treated.   All that should be done  in these
cases is to endeavour  carefully to evacuate the urine by 
OF PARTURIENT WOMEN.
415
laying down, and pressing up the Aveight of the belly, as
often as a desire to pass urine occurs.   If this will not
succeed, a catheter should be used as often as necessary,
and in general this instrument may be used  without
hazard by females  of reasonable discernment.   But it
would be best, in all such cases, to get the best advice.

                   subsection 9.

             Of Incontinence  of  Urine.

  This mostly arises from neglecting the case of suppres-
sion, and is to be removed by the same means.   When
this cannot be effected, the patient may be rendered more
comfortable by preserving dryness of her under clothes,
by wearing a large  sponge, or several folds of flannel,
which will require frequent removal.
OF PARTURIENT  WOMEN.
                     SECTION  I.


               Introductory Remarks.

AMPLE instructions for parturient women are only te
be expected in systems of midwifery; I shall, therefore,
but briefly, point  out a few errours which prevail, and
conclude with a few general instructions.
  Incalculable mischief arises from superstition in all the
affairs  of mankind; but when it operates on the mind
of the parturient woman, it is doubly cruel and  destruc-
tive; because, in refined  life, they are always  brought
low, and require all our kindest attentions to support the
trying hour of travaih
k 
446
OF PARTURIENT WOMEN.
  Superstition may be defined thus: a propensity of the
mind to acknowledge things represented by others, with-
out due  caution in requiring the data,  or  grounds, on
which things, or reports, are founded: hence, this lazy,
loAV-bred jade, blind and vicious, is maintained by  two
propensities of the mind; and both of these propensities
are vicious in their nature.  The first of these propensi-
ties is a vain desire to obtain credit for superiour sagacity;
and this begets another propensity in the mind, which is
a desire to  hide our weakness or ignorance; and so pow-
erful  is this propensity,  that  feAV ignorant  persons  can
veil their ignorance in  silence; on the  contrary, in pro-
portion to their ignorance, so  will they be  more loqua-
cious; and  as the most common thinker Avishes to  avoid
detection in his sayings,  they are ever anxious to propa-
gate those  kind  of notions which are difficult to detect;
otherAvise  they have to dread, not  only  a discovery of
their ignorance,  but are brought under the imputation of
falsehood.
  The other propensity is that lazy habit, too common,
of admitting reports or sayings without examining the
grounds  on which they are predicated; and it is vicious,
because as rational creatures Ave OAve it to ourselves, to
society, and to  the Creator,  to exercise our reasoning
powers; and a first or leading aim in ratiocination is to
reject such things as ought to be accompanied with facts,
unless those facts are obvious; and, in the second place,
those things which admit not of demonstration require
all the force of long experience,  or the most careful ex-
amination of their results.
  A destroying monster has gone forth to slay parturient
women, under the name  of leap year.  And, reader,
can  you hesitate to believe, that an impression of this
kind  may  and  has  done vast mischief, although it is
wholly imaginary.  Thus, some would-be-wise person
starts an idea  that leap years are fatal to parturient wo-
men; a pregnant woman anticipates the fatal* blow at
the end of her pregnancy, and the constant impressiou
of fear seriously impairs tlie constitution; and as she Avas
weak enough  to give up her mind to superstition, with-
out due  examination, she often  views things, the most 
              OF PARTURIENT WOMEN.           44?

common, as ominous, till every breath of Avind, or sound
at night, rings the alarm, until she, like the frightened boy
pursued at night by ghosts, at every accession of speed
is pierced with new honours, and feels the grasp of the
pursuer at every spring.  Every energy of the  animal
power  are under heavy contributions  in the case of the
boy, and at length he arrives exhausted at his home, and
congratulates himself on the happy escape from the man
without a head, &c.  But lo! the light of morn  dispels
his  fears, and retracing the road of terrours, he meets
a stump! a bush! a rock! and finds, indeed, it was Avith-
out  a head.   And that  he  has  acted a part Avhich would
have called forth plaudits  for his speed, but which dis-
graced the weak mind.
  Let the pregnant woman  spurn from her  confidence
the  weak, who would thus iguominiously set her mind
to fly from point to point, like, the  frightened boy, but
with less hope of escape.  The boy runs for  home, and
hope supports the trembling  frame;  but  alas!   Avhence
shall Aveeping woman derive her hope?—Like the unan-
chored ship amid the troubled  Avaves, she is loaded with
despair!   This is  a  species of fear Avhich pursues  its
victim by night,  and in  the light of day; but the  light
of reason dispels  the  gloom,  and brings conviction to
the  mind that this report  is founded on ignorance, and
ought to suffuse the face of the busy tattler with  shame,
for  propagating  so cruel,  and so unwise, and impious
a tale.
  I shall advance but two positions to clear aAvay this
demon, of human creation.
  1. Nothing is more invariably true, than that the ways
of providence are inscrutable, and particularly veiled in
that kind of mystery, which prevents mankind from pry-
ing  into futurity, and we  are  even expressly told, we
are  not to look for signs and wonders.  This alone makes
man's abode here tolerable, for, if the Deity had allowed
that we should foresee  events, an entire new order of
things must  arise, or man soon would perish under the
load of anxiety which he might anticipate.
  2. All the  supposed  mystery of a leap-year's influence
falls prostrate before the simple fact, that it is wholly ar- 
448
OF PARTURIENT WOMEN.
tificial, and established by the ingenuity of man.   Time,
as respects created bodies, runs from beginning to its ter-
mination, and as respects this world,  the various parts
of it have days, and seasons, regulated by their situations,
as respects latitude, longitude, &c: and the world exis-
ted for thousands of years,  before mankind discovered
the convenience of dividing time, so as to square their ac-
count of it once in four years.   But people have been
found making these periods of different lengths, thus we
may have two days at  the  end of eight years, or three
days at twelve years, or we may even go on until we add
an additional month; so that there can  be nothing in this
notion of leap years,  for they are arbitrary  divisions  of
time, made by modern astronomers.
   There are  many other things which  are held as  omi-
nous, but which would crouch before the test of reason.
But all of them may exert a baneful influence, by work-
ing on the imagination, for here to imagine, is to  admit,
and to admit, is to bring about the consequences, of such
admission, whether the fancy is founded on false or true
premises.
   Let me remind the pregnant and parturient Avoman,
that Revelation pointedly discloses the protection of the
Supreme over the Avidow, and the orphan; and it is said
"suffer little children to come unto me, for of such is the
kingdom of heaven."  And  shall we believe that, that
merciful  God who  protects the widoAV and the orphan,
and whose kingdom fosters "little children,"  will forsake
the pregnant  or parturient woman.
   At each addition to the flock  of little children a Sa-
viour smiles,  and a virtuous  woman who is the instru-
ment  of  this increasing flock, of  immortals, while she
Avalks in that becoming humility to the divine laws which
is required of all, may derive fortitude from the circum-
stance that she is under double protection, first she may
reasonably look for equal protection herself, and more
especial protection for  the child of her womb.  While
she Avalks then in the narrow path of virtue, let her feel
full confidence that she is especially protected; and if a
neighbour sinks aAvay at such a time, it can have no con-
nexion with her. 
               OF PARTURIENT  WOMEN.           449

  From the commencement of life to old age, we are all
liable to death; when or where it is to happen has been
kindly concealed.  Let us then be prepared, and Avithout
fear, or forebodings, discharge the duties assigned us;
for it  is both unAvise and impious to  apprehend danger
when it is not  actually present.

             SECTION  II--SUBSECTION  1.

        Of the diseases of Parturient Women.

  I come  noAV  to mention a feAV  of the diseases  which
sometimes accompany  parturition, and to  suggest a few
cautions  and  remedies.  A woman may  approach  the
parturient bed without  apprehension, for  it is a natural
process, and the same protecting power which brought
themselves into being, aatII sustain the approaching child
and its mother.  But to lose  confidence,  and  hope, in
the hour of travail, is to incur danger, for fear often be-
gets evils, which it created.

                   SUBSECTION  2.

                      Of Chills.

  Considerable chills often accompany the first symp-
toms of labour, these are best let alone; or if severe, a
little weak Avarm tea may be taken.   But wine, spirits,
&c.  which are often taken at such a time, are extremely
pernicious; they may lead to inflammation of the uterus,
to fevers,  and  many other evils.

                    subsection 3.

                   Of Afterpains.

  Almost every female midwife, and especially the igno-
rant, are provided with remedies  for afterpains; and of-
ten give heating cordials Avhich do much mischief.   No-
thing is necessary but to keep the bowels open, with mild
injections, or  best  castor oil,  or rhubarb  Avith a little
            57 
450
OF PARTURIENT WOMEN.
senna and coriander seeds; and as often as the pains are
severe, take twenty-five to thirty-five drops of equal parts
of sweet spirit of nitre and laudanum.

                   SUBSECTION 4.

                Of Puerperal Fever.

   If fever comes on before the third  day, or after milk
is formed in the breasts; or if it at any time runs higher
than Ave may  reasonably expect from the milk fever, but
more especially, if  it  is  accompanied with soreness, or
constant pain in the lower part  of the belly, the best ad-
Vice should be got.  If advice is not to be had, in reason-
able time, Ave should bleed and repeat according to the
violence and obstinacy  of the  pain  and  fever; cooling
drinks,  mild purges, and cooling powders of nitre and
cremor tartar should be taken.
   The diet must be very low, and free  admission of air
allowed, and strict attention to cleanliness by frequent
changes of clothes, &c.
   For inflammation of the breasts, or sore nipples, see
the article on inflammation.

                   subsection 5,

                   Of Vomiting.

   Vomiting often attends labour:  in general it is not at-
tended  with  danger,  and requires nothing but a little
chamomile, or nice green tea, to empty the stomach.  If
it becomes  severe, a few drops of hartshorn may be ta-
ken, and in weakly habits a few drops of laudanum.

                    section  III.

      Concluding Advice to Parturient Women.

   Let it always be remembered, that prevention is bet-
ter than cure, and therefore, it is  a matter of the utmost
importance to procure the  advice and assistance ©f the 
OF PARTURIENT WOMEN.
451
most skilful.   A good deal  of diversity of opinion pre-
vails respecting our choice of men; or women, midwives,
but this is an  inquiry Avithout reason, for the question is
not of Avhat  sex is the practitioner, but Avhat  are their
qualifications?
  It  is a lamentable fact that Avomen midAvives  in gene-
ral, commence practice Avithout any instruction, and what
is worse, feAV women of intelligence, or standing in soci-
ety, will engage in this practice,  for it is really viewed
as mean and only  Avorthy the attention of the  meanest
and most ignorant.
   Strange infatuation, that  in an enlightened  country,
the life of the mother, and  of the heir, is committed to
the hands of ignorance!   It is no uncommon thing  for
the kind husband to watch the sick bed of his wife, and
while he freely calls in two or more physicians, to  her
assistance, still feels all the tortures of anxiety; yet when
that same lovely Avoman is  about to take the bed of tra-
vail, and has her child's life in some measure hazarded
with her own, that same husband  commits all to the care
of some old woman, who is not only, perhaps, the most
ignorant woman in the neighbourhood, but often nearly
blind, and unhandy from age: and Avhat is worse, most-
ly feels hostile to  practitioners of superiour  judgment,
and will often make the most daring efforts in  order to
expedite, lest they may be  thought  unskilful,  or some
other practitioner called in.
   It seems  strange how  so important an affair  should
have become so degraded in the eyes  of the publick.  A
woman of respectability Avould disdain the name of gran-
ny, for female practitioners are held  in equal  contempt
with the servant.   A  little reflection Avill convince us that
this is all right, and that the ignominy is not  attached to
the profession, but to the professor.   No Avonder a gran-
ny is held as a low member of society, for the term gran-
ny is synonymous with poverty, and with ignorance.
   Reader, from actual experience I can most truly say,
I  have seen  such ignorance, daring  adventure, actual
mischief, &c. that, Avhen I survey  in imagination, over the
face  of this  immense  country, the danger, the  suffering,
and  the actual destruction of our lovely females, and of 
452
OF PARTURIENT  WOMEN.
our infants, my eyes groAV dim, and my heart SAvims in
soitoav, and I  might'truly exclaim, oh! that mine head
was a fountain  of water, and my eyes a flood of tears,
that I might weep day and night, for the slain of the
daughters of my country.
  A detail of what I have seen in country practice, would
sicken the feeling mind; few can imagine the danger and
injury which our women and infants suffer.
  In  the loAver  ranks  of life 1 can readily suppose that
some repugnance is  felt against.male practitioners, but
where the mind has been enlightened, and where  none
but men of good character and  of education, would be
employed, such feelings can have no share in the things
which conspire  to keep up objections to men accoucheurs.
  After much reflection, I am clearly of opinion, it is in
good measure  owing to meanness;  an old crippled wo-
man cau be got for a dollar or two; the doctor will charge
from five  to twenty.   What a saving?  the wife of your
bosom once in a year, or mostly every second year, sub-
jects you to this expense.  And is it so, that for the paltry
consideration of a few dollars, you will subject a wife,
and a mother too, to the care of stupidity, often blended
with the most daring temerity.
  3ut I forbear: each one must know best his reasons
for  countenancing this cruel degrading practice.  I beg
leave, however, to admonish every man who regards the
welfare of his wife  and offspring, to make it a matter of
conscience to admit none to the  parturient chamber but
practitioners of  probity and of experience.
  And it is the height of folly, to suppose  an old woman
is qualified to takecharge of the health and life of your
wife and child,  because she is a mother:  common cases
of midwifery afford  no instruction; and, therefore, a wo-
man might have seen scores  of children born, and be
wholly incompetent  to the management of the  slightest
deviation from the most common  cases.
  Let it not be supposed, from these  remarks, that I
vievv child-bearing as so very dangerous as to call for any
particular skill in general; on  the contrary, assistance is
seldom necessary, and it is by doing too much, that ig-
norant persons do most injury. 
OF PARTURIENT WOMEN.
458
  Accidents  do sometimes occur, and very often  the
merest trifle is turned into a state the most  dangerous,
in the hands of ignorance.   What anxiety! Avhat pain!
what fear might be prevented by employing the most en-
lightened and experienced practitioners in all parturient
cases.   What  hope!  what  fortitude! and Avhat power
consequential of this hope  and fortitude!  may suffering
A^oman derive from the presence  of a  practitioner of rec-
titude, of humanity, and of experience!  The mind sup-
ported by this honourable confidence, carries the tortur-
ed body through the troubled waves, and if ideas of dan-
ger Avould assail her trembling heart, she drops her  an-
chor at every swell.   The means are present, if heaven
bless them, for  Avhat more can she wish?   How different
is the case of her who is committed to the care of igno-
rance!  Here, the heart trembles  at every pause, and the
suffering Avoman, as one Avithout hope, looks out for ap-
proaching danger, and should it be announced, what must
be her suffering!
  Imagine a Avoman tortured, reduced  and feeble, who
has been brought thus low in the hands of ignorance,
abruptly told she must send  for the doctor; and what
may Ave not suppose her anguish, more especially if she
be a mother.   What anxiety, what  danger  might have
been saAed by haA'ing called in  a practitioner of judg-
ment at first!
  Oh! that some meek spirit would hover over the land,
and Avith all  the poAvers of love, invite every man and
woman to unite, whereArer honourable love exists, in re-
vising and  correcting this cruel  custom of our country.
Shall the American boast of the fair women of his coun-
try, while they are thus neglected?   Rise as  sons of li-
berty, and weave the shield!   I  plead for your mothers!
sisters! and daughters! shield them from suffering! guard
them from ignorant midwives!
  It remains to offer a few words of advice  respecting
the necessary preparation, and of the most suitable ma-
nagement, during the child-bed state.
  Great exertions are made by people, in the country,
to procure  cordials; wine, rum, spirits, whiskey, toge-
ther with cheese, cinnamon, nutmeg,  &c. as though they 
454            OF PARTURIENT  WOMEN.
intended to worship at the shrine of Bacchus.   Would
that there was half the anxiety about getting good ad-
vice,  that  there is about procuring these unnecessary
stores.
  Every housekeeper must be  supposed capable of en-
tertaining his acquaintances; but I feel full confidence
in saying, it would be vastly better if spirituous drink
was used Avith a more sparing hand, on these occasions.
To the parturient women they are seldom necessary^ or
even safe.   Such women are always more or less fever-
ish, particularly till after the breasts are filled with milk.
Although the weakness, under which they labour, is of
a direct kind, still, such is the irritability and disposition
to fever,  that cordials can seldom be used.   So soon as
the milk  fever is over, a diet reasonably nutritious will
generally be allowable; but spirits, or cordial drinks, im-
part no sustenance, and will, in all cases, excite more or
less fever.
  Much  errour is practised in keeping  such women too
warm: their apartments should never be warmer than
they are  accustomed to when well, and when  feverish,
their rooms ought to be cooler.  Besides this practice
of heating rooms too much, women  in  the  country ge-
nerally have too much clothing on: it is not uncommon
for  them  to get to bed  Avith as much clothes on as they
usually wear; the injury arising from this source is im-
mense, and therefore every effort  ought to  be  made to
banish it.
  It would be  Avell if  those things were kept more pri-
vate; as things  now stand, every woman of slight ac-
quaintance, expects to be invited  to the feast, and much
fatigue to the patient is often the consequence; besides,
the visiters never come without news, and often of such
a character as to do  serious injury to the  patient.  It
Avould be a good rule  if none but  a particular  friend or
two Avere admitted to the room of the patient,  until she
is able to sit up without fatigue.
  Diseases of parturient women generally proceed from
mismanagement; and as the system is always considera-
bly reduced, it is ahvays necessary to use the utmost ex-
pedition  in getting good advice, as soon as any thing 
         OF INFLAMMATION  OF THE  UTERUS.      455

amiss is  discovered; and as men of medical skill are
noAV to be found in every part of our country, the only
advice absolutely necessary here, is to admonish them to
beware of quacks, whether men or women, and conform
strictly to the advice of those known to be competent.
OF DISEASES OF THE FEMALE.
                     SECTION  I.

           Of Inflammation of the Uterus.

 THE reader, by turning to the observations on inflam-
 mation of the other viscera, and especially to my general
 observations  on  visceral  inflammation, will be prepared
 to prescribe in cases of inflammation of the womb.  This
 disease is sometimes met with in all the different condi-
 tions of Avoman.
   It is known by pain in the loAver part of the belly; ex-
 treme soreness is felt from feeling over the region of the
 uterus; there  are considerable chills and flashes of heat;
 distress of countenance;  a hard Aveak pulse; vomiting;
 frequent  inclination  to go to  stool; obstruction of urine;
 and, in severe cases, delirium; and sometimes a discharge
 of acrid fluids from the uterus.
   This inflammation is to be removed by bleeding, cool-
 ing mild purges, as rochelle salts, or epsom salts, or
 phosphat of soda, or best cold-drawn  castor oil, emol-
 lient glysters; cooling mixtures of nitre, cremor tartar,
 &c: always  remembering, that we must regulate  the
 strength  and  repetition of these remedies according to
 the strength of constitution, &c.  The lowest possible
 diet, and cooling drinks, are indispensably necessary  du-
ring active inflammation of the womb.   And this treat- 
456        OF THE  PROLAPSUS UTERI, &C
ment applies to the parturient woman equally Avell as in
other conditions of life.

                     SECTION  II.

Of the Prolapsus Uteri, or falling down of the Womb.

   This disagreeable complaint is often the consequence
of too seAere labour of females, such as too much stand-
ing, lifting, kc.  It may also arise from Avhatever relaxes
the body.  There is, perhaps, no more common cause
of this disorder than too early exertion after lying-in.   It
is not uncommon, where this disease is suffered  to run
on, for the uterus  to be protruded without the labia.  In
relaxed habits especial care is to be paid to the general
system, and every useful means for invigorating the body
is to  be pursued; much stooping, or  straining, is care-
fully  to be avoided, but reasonable exercise is  never  to
be omitted.   Costiveness is to be carefully avoided; this
indeed, is sometimes the cause of the prolapsus.  The
bowels should be kept regular; the habits in general, must
be temperate; mild  astringent injections should be fre-
quently used, of weak solutions of sugar lead in water,
infusions of bark, or oak bark with a little alum; but if
any considerable inflammation and pain are present, these
articles must not be used; the patient should be bleid, use
emollient glysters,  and foment the prolapsed  part fre-
quently with warm milk and Avater.
  As soon as these symptoms of inflammation and pain
are removed, by  the  above  means, together with rest,
the patient should  resume the astringent Avashes, and
other means for strengthening the parts affected, as well
as the whole system.
  Should all those things prove ineffectual, by applying
to men of judgment, an instrument called a pessary may
be had, which will render the patient more comfortable,
by keeping up the parts. 
       OF  THE  CHLOROSIS, OR GREEN  SICKNESS.    457


                    SECTION III.

        Of the Chlorosis, or Green Sickness.

  This disease affects, principally, young Avomen, and
the unmarried  are most subject  to it.   It is  known by
a bad colour, a dead-like Avhiteness in the face and other
parts; great lassitude  and heaviness;  swelling of the
face  and ankles; tension,  and weariness  of the feet and
legs; difficult respiration, or rather a panting  after  exer-
cise; palpitation of the heart; pain in the head; fever-
ishness; droAA siness; an unusual  appetite for  some kind
of trash, as clay, chalk, coals, salt, sugar, kc. and gene-
rally a suppression of the menses.  When the case  is in-
veterate, yelloAvish or dark greenish splotches, which
have the appearance of bruises, are found on the  legs       *
in particular; and Avith  hemorrhages from   the  nose,
and tender gums, give the disease some  resemblance to
scurvy.
  The following treatment AvilLgenerally  succeed.  Give
a purge, and the following is  probably best—rhubarb
and jalap, each ten grains, calomel  and aloes, each five
grains, make eight pills, give five of these, and if they
do not operate pretty well, give the remainder in four or
six hours.   The next day, give  one scruple of ipecacu-
anha, and whether it operates or not, drink freely of weak
sage or ground ivy tea; ahvays, hoAvever, leaving the me-
dicine about an hour on the stomach if it  does not vomit,
before you begin to drink.  The next day put two grains
of tartar emetick into a pint of  water,  take one or two
spoonfuls of this, as the stomach will bear, in the morn-
ing and evening: this should be used five or six days.
During all  the above time the patient should take a mild
anodyne every night; for  this purpose  take  opium four
grains, ipecacuanha  six grains, make eight  pills, and
take  one of these each night.
  After using the above five or six days, commence with
the following, and continue it until  the strength, &c. is
well restored.  Take  iron filings and assafcetida each
one dram, flour or  crumb of bread enough to make the
             58 
458
OF THE FLUOR  ALBUS.
 mass tough enough for pills; make sixty-four: two to be
 taken morning and  evening, drinking after each half a
 wine glass of bitters of gentian, columbo, orange peel, &c.
 steeped in water and a little spirit of some kind, to pre-
 vent its souring:  about a gill of spirits, or good old whis-
 key to a quart of water, will answer this purpose; about a
 dram of salt tartar  or soda, may be  added to a quart:
 this should always  be strained after standing two  or
 three days.  The patient must carefully avoid all unna-
 tural food, and live on a light nourishing diet.  Cold wa-
 ter will be the best drink:  spirits,  much spices, or grea-
 sy food, must be avoided, as well  as  too much sour arti-
 cles, as pickles, vinegar/&c.   Exercise must never  be
 omitted in this disease.

                     SECTION  IV.

                 Of the Fluor Albus.

   A simple fluor albus unaccompanied with some  seri-
 ous affection of the uterus, is known by these symptoms,
 a discharge from the vagina of a whitish or yellowish
 mucous, sometimes becoming greenish, and having an
 ill smell; this, however, is  often the consequence of ne-
 glect, or want of cleanliness.   These symptoms are  ac-
 companied with paleness of the face, severe pains in the
 back, loss of appetite, swelling of  the legs and eyelids.
 For  this disease, precisely  the same treatment as recom- ■
 mended in the preceding article will answer, but should
 be aided by injections of milk and water,.often repeat-
 ed; and if these do not succeed, a little sugar lead may
 be added to water, and used in the  same way; but these
 injections into the vagina should be  very Aveak, half a
 dram of sugar lead to  a  pint of water will be a proper
 strength, and it should be used tepid.  Where the symp-
toms have  run high from want of  frequent  washing  of
the part affected,  or other causes, bleeding once or more
will  be  necessary, with the constant use of the milk and
water injections into  the vagina, and  at the same  time
glysters, of  the emollient kind, must be used frequently;
sitting over a warm bath will also be adAisable in severe 
           OF THE DISEASES OF CHILDREN.       459

cases.   As soon as  the  symptoms abate, the iron pills,
&c. recommended for chlorosis, should be used with ex-
ercise accommodated to the patient's strength:  the cold
bath may also be used to advantage.  Much stooping,
or Avorking over the fire will not suit such women.
  Gross  or fat women are often troubled with a milder
kind of this disease, which requires nothing  but  exer-
cise, and great attention to cleanliness; for it is  often
in some measure constitutional, and cannot  be removed.
The Avarm balsams, as copaiba, &c. have been  found
useful  in debilitated habits.  Tincture cantharides  is
also a valuable medicine; twenty or thirty drops may
be given twice a day: if strangury come on,  omit the
medicine  till this symptom wears  off, and then  begin
again.
OF THE DISEASES OF  CHILDREN.
                    SECTION I.

              Introductory Remarks.

IT is in works on the diseases of Avomen and children
only, that full directions can be expected for those dis-
eases.  I shall therefore but very briefly, point out a
few cautions, for the management of new born infants,
and beg leave to refer  the reader to works on the com-
plaints of women and children.
  1. The newborn infant should neAer be washed with
spirits, nothing but warm water should be applied, nor
is it material whether all the scurf comes off at the first
washing.  It is  vastly better to leave a considerable
portion of it, than to fret the very tender skin by th?
harsh rubbing, which is often practised.
  2. Mitch injury is done infants by giving them harsh
articles, with a vieAV of carrying off the meconium; things 
460        OF  THE DISEASES OF CHILDREN.

the most discordant are crammed down their throats, aa
soon as they fall into the hands of ignorant midwives.
It is very seldom any thing is necessary for this pur-
pose, the child should be put to its mother's breast as
soon as practicable, and this will generally  answer eAre-
ry purpose.   If tiie meconium is tardy in coming aAvay,
mix equal parts of SAveet milk and boiling water, sweeten
this well Avith  sugar, and give a feAV tea spoonfuls eve-
ry now and  then, and if this does not succeed,  a lit-
tle warm water should be  given as a glyster.  Never
give purgatives or other doubtful articles, without good
adArice.
  3. Much injury is done children by keeping them too
warm, and  also  by exposing them to  too  much  light;
sore eyes, fevers, kc.  are  usual consequences of mis-
management  in those things.
  4. It should be made an invariable rule to wash chil-
dren  once every  day, all  over; the water should be te-
pid at first, but  in a few days it ought to be cold: this
will not only tend to invigorate the body, but is  indis-
pensably necessary for the purpose of keeping the skin
sound;  and it  is also  necessary that their clothes  be
changed every day, at least  their cap  and linen, and
their clean cloths should be frequently changed; this is
not only necessary as  a means for preventing what is
called scalding,  &c. but the practice of  suffering chil-
dren to remain wet disposes them to rickets and other
diseases.
  5. Children  who have the breast of the mother, or of
a healthy nurse whose milk is fresh, that  is, one that
lay-in about the  time of the mother, should not be fed;
the milk of a healthy Avoman is quite sufficient, and the
only article which is really suited to the stomach of ten-
der infancy.
  6. Where the  breast is not to be had from accidental
circumstances,  milk  Avith a little sugar should be their
only diet for the first few  days, or even weeks;  after-
Avards,  a little  flour may be boiled in their  milk.   The
milk ought to be reduced a little, for some time, by mix-
ing it with water; for the human milk, which suits them
best, contains less cheese and butter, but more sugary 
          OF COMMON GRIPING OF CHILDREN. x    46l

matter than cow's milk; so that, by adding water, we
lessen the quantity of cheese and butter, which are too
heavy for the infantile  stomach, and  by adding sugar,
in reasonable quantity, Ave  have a mixture strongly re-
sembling human milk.
  Vast injury is done infants by overfeeding them, and
more  especially by giving articles too gross "for  their di-
gestive powers.

                     section n.

          Of common Griping of Children.

  Children  are much disposed to gripings, but doubt-
less in a majority of cases, this affliction proceeds from
mismanagement,  overfeeding, keeping them too warm,
or suffering them to remain wet,  are the  most usual
causes of gripings;  the first by suffering a kind of fer-
mentation to take place in the stomach, from the ina-
bility of the stomach  to digest, more than a certain quan-
tity of wholesome food, and from an inability to digest
gross articles at all, fills the boAvels and  stomach Avith
sharp Avind.  The two latter, that  is keeping them too
Avarm, or suffering them to remain wet, by relaxing the
general system, destroys the tone of the stomach.
  Where due attention  is  paid to the management of
children, in regimenous  matters, they will seldom re-
quire medicine, for the removal of gripings.
  But no degree of prudence, or skill, can pre/vent this
complaint from troubling some children; even here, we
are not rashly to fly to medicine.   The following will
often  succeed: take pure Avater two ounces, oil  of  mint,
or fennel, or anise one  drop, soda  ten grains;  of this,
one or more tea spoonfuls  may be  given  whenever the
pains are severe.   If this does not succeed,  give a little
rhubarb and magnesia, or an emollien: glyster.
  In  extreme cases, a little Godfrey's  cordial, or a few
drops of equal parts of spirits nitre, and laudanum, may
be given; but opiates are to be given sparingly, and it
Will generally, be better to suffer them to cry reasona-
bly, than to give opium to  lull them to rest; this is too 
462
OF THE YELLOW GUM.
often  done solely with a vieAV of getting  rid of their
noise:  such conduct is highly reprehensible.   To con-
clude,  I have no doubt but a free use of opiates, or cor-
dials,  generally,  not only very materially  impairs  the
strength, and disposes to  scrofula, foulness of the skin,
&c; but, that it really often materially impairs the fa-
culties of  the  mind.  I  think  I have seen one well
marked case of deplorable epilepsy, from the abuse of
opium and cordials.
  Let  it be a matter of conscience, to use the  proper at-
tention to  dress,  exercise, food, &c. of your  child, and
if obslinate griping troubles it, get good advice.

                     SECTION III.

                 Of the Yellow Gum.

  This disorder  is characterized by a yellowness  of
the skin, and of the white of the eyes.  European aur
thors   speak  of it,  as  being  frequently  a  dangerous
disease.
  I am inclined to believe, it is neither common nor dan-
gerous, in  the United States.   But I  have seen many
cases  of it in one  neighbourhood: in Somerset county,
Pennsylvania, this disease is veryr common, but I have
never  seen it attended with danger.   It has  been sup-
posed  that this yellowness of the skin is OAving to me-
chanical  obstruction of the biliary ducts, but these  no-
tions are probably ill founded;  it is much  more likely,
that the liver either  secretes the bile in undue quantity,
or of  a  vitiated   quality; or  Avhat  I  think  still  more
probable, this affection of the skin  is OAving  to inflam-
mation of the skin or liver; for in all the cases of yel-
low gum which I have seen, the discoloration occurred
a few  days after birth,  and ahvays  followed tedious
labours.
  We should never give medicine for this disorder, un-
less the  child  be  really  sick, when it will mostly an-
swer every purpose  to open the boAvels with castor oil,
if it can be had very nice, if not, rhubarb and magnesia
will answer; and a gentle  emetick of ipecacuanha should 
     ©F INFLAMMATION, OR SORENESS OF THE EYES. 463

 be given:  these remedies with  the  daily use of the te-
 pid bath, will generally answer; but if the symptoms of
 fever, pain, or distress  of any  kind continue, the best
 advice should be obtained, for authors of much respec-
 tability tell us this disease is sometimes dangerous.

                    .SECTION IV.

                  Of the Red Gum.

   The red gum is a  disease which affects the skin of
 infants, and resembles measles much in its appearance.
 The eruption appears in little  red  pimples, Avhich rise
 up so as to be  felt, and these  prominences sometimes
 appear yelloAvish;  but,  in some cases the eruption  is
 confined to particular  parts of the body.  It is seldom
 attended with much feArer, or distress, unless augmented
 by mismanagement.
   There is no doubt with me,  but  this affection  is al-
 most  universally the consequence of surfeits from feed-
 ing children too much;  from Avet; or from keeping in-
 fants  too warm, or not  changing  their clothes as often  as
 is necessary.
   A faithful use of the tepid, or cold bath, according to
 the manner iu Avhich the child has been managed, Avill
 seldom fail to remove this disease of the skin;  if fever
 comes on, the bowels ought to be opened with the mild-
 est purgatives, or glysters.   But children  thus affected,
 are liable  to other  diseases, so  that in all cases where
 any considerable indisposition  occurs, get advice,  for
 in all cases, much is  gained by early application to the
 skilful.

                     SECTION V.

      Of Inflammation,  or Soreness of the Eyes.

  This is mostly owing to exposing infants too much  to
 the light; we should carefully shade the eyes of young
infants from the light; but let us not, in doing this, de-
prive them  of free exposure to air, as is often practised. 
 464         OF THE  APHTHA, OR THRUSH.

 Let their rooms be well aired; but never suffer a strong
 light to shine into their eyes, for  the first two  or three
 weeks.
   Never be induced by any authority, however respec-
 table, to apply washes of sugar lead, and such like, to
 the  eyes of infants.  Bathe them very  frequently with
 Warm milk and water; and if the case is obstinate, blind-
 fold the eyes, by applying very clean rags wet with milk
 and water; and applyr  a small blister to  the back of the
 neck;  give a little cooling physick, and let the nurse be
 a little abstemious for  a few days.
   If they do not mend, under this treatment, apply cold
 spring water, or nice rose water.   If this inflammation
 occurs in  children  a little advanced in life, we should
 pay a scrupulous attention to the nonnaturals; for where
 this affection of the eyes arises from a relaxed habit,
 which is  sometimes the case, no local applications can
 avail;  our only hope is  in invigorating the general sys-
 tem, by  all  the usual  means for that purpose, among
 Avhich, exercise in the open  air, holds an  important
 share.

                     SECTION VI.

              Of the Aphthae, or Thrush.

  The thrush is  a common disease in nurseries, Avhere
 children are overfed, but whatever tends  to relax the ge-
 neral system will tend to produce this affection; for it is
 probably always accompanied with, if not actually caus-
 ed by, indigestion.
  It is known by the appearance  of little whitish, or
 whey-coloured blisters, on the lips, in the mouth, throat,
 &c; and it is excessively painful, and will bleed from
 the act of  sucking,  or from  attempts  at washing  the
 mouth.  It is often attended with fever  and  other dis-
tressing symptoms, as nausea,  &c.
  In bad habits, Avhere a too cordial diet,  and a too warm
regimen, has brought on the disease, these blisters some
times terminate in mortification. 
           OF CONVULSIONS  OF CHILDREN.         465

  No rude  attempts  at washing the mouth Avi h rags,
&c. should ever be made; for, by the violence used, you
increase the inflammation, and  thus add  to the foulness
of the mouth, and aggravate the disease.
  It will generally be sufficient, in these  cases, to give
an emetick of ipecacuanha or  white vitriol; then open the
boAvels with rhubarb,  or its syrup.   At the same time,
let the following mixture be  put  frequently  into  the
mouth, in portions of one or more  tea spoonfuls every
now and then.  Take soda one scruple, Avater two ounces,
dissolve the soda in  the Avater, and then add two tea
spoonfuls of honey; mix the whole w ell together.
  These cases are, however, sometimes extremely dan-
gerous, partaking of the character of angina maligna, or
ulcerous sore throat; so that,  iu all  cases  attended with
serious indisposition, the best advice should be obtained.

                      SECTION VII.

            Of  Convulsions of Children.

  From some peculiarity in the constitution of children,
they are subject  to convulsions  from a variety of causes;
among these may be  enumerated irritation of the sto-
mach or boAvels, from  indigestion; injuries of  the head,
or other parts; even cuts, burns, injuries from pins,  &c;
the sudden reyulsion  of eruptive disorders, particularly
where that sinking in of the  eruption is  occasioned by
too warm  a regimen.
  Smallpox, measles, and other fevers, lead to convul-
sions; so does teething, violent frights, &c.   From this
variety of causes of convulsions, it must be evident much
judgment is necessary to enable us  to distinguish or dis-
cover the cause, and  adapt  a  suitable treatment; mor«
especially Avhen  Ave recollect  that convulsions are always
dangerous; death, crippling,  or epilepsy, are often the
CjOnsequences  of convulsions:  with  what  care, then,
should we  endeavour  to avert these dreadful conse-
quences by getting good advice!
  Jn all cases of sudden convulsions, the child should be
stripped  and examined whether no  Avound  exists, for
             59 
466       OP THE  CHOLERA INFANTUM, &C
x even the pricking of a pin may be the cause.  If the ha-
 bit is good, we should  bleed pretty freely, and if the
 cause is unknown, or if there is any suspicions of poison,
 as James Town weed, spirits, &c.  an emetick of white
 vitriol, or ipecacuanha, should be given.
    Should the  convulsions  still continue, or, in  reduced
 habits, at first, give stimulant glysters till the bowels are
 freely opened, then put the patient into the warm bath;
 but while those things are transacting, get  a practitioner
 of judgment, as much skill is often  necessary on these
 occasions.

                    SECTION  VIII.

     Of the Cholera Infantum, or Summer Disease.

   This disease of children is principally found in cities,
 and it is  said,  by Dr.  Rush, to affect infants principally
 from the  first or second week, till the end of the second
 year of their age.  And, according to Rush, it occurs in
 Philadelphia about tlie first of June, but something  ear-
 lier in the Southern states.
   Its  most severe symptoms are violent sickness,  and
 vomiting; purging; high fever.  The discharges by stool
 and vomiting, are mostly, a yellowish green, but liente-
 rick  symptoms often  attend, as  slimy stools, and the
 passing the food undigested, or they are quite watery, &c.
 The patient is extremely restless, tossing and drawing up
 the feet, and throwing back the head; the pulse is gene-
rally soon found very Aveak; and the fever which attends
 is remittent in  its character, and is mostly highest in the
evenings; delirium, and even mania are sometimes pre-
 sent.  The belly is generally swoln, the countenance  lan-
guid, and distressed;  the  eyes are open during sleep.
There is great thirst; considerable emaciation takes place;
the stools are mostly extremely fetid.
   Many  more distressing symptoms sometimes attend
this distressing and mortal complaint.
   A first  consideration, in these cases, is to get the  pa-
tient into  the  country; and if circumstances do not  ad-
mit of their removal, they should be carried out daily du- 
          OF THE CHOLERA INFANTUM, &C.       467

ring good Aveather, once or oftener.  In all cases, as soon
as any serious vomiting occurs during the season of this
disease, a  gentle emetick of ipecacuanha should be  gi-
ven, the bowels should be opened aa ith glysters, contain-
ing a very little rochelle salts; and as soon as the bowels
are opened, or rather as soon as the injection has  come
away, give mild anodynes, and the following formula will
generally ansAver a good  purpose:   Take soda half a
dram, water  two ounces, oil cinnamon,  or mint,* two
drops, dissolve the soda in the Avater, and give from half
a tea spoonful, to three  or four, according to the age of
the patient; and Avith  the  first dose, and every two or
three hours afterAvards if necessary, give a common small
dose of laudanum.
  Soda water highly impregnated with fixed air, should
be given, nice toast and  Avater, or linseed tea, or slippery
elm water, will be suitable drinks, in the early state of
the disease.   When the case is somewhat advanced,
dewberry tea, or chamomile in cold infusion, or best wine
and water, may be given.
  The diet ought in general to be light and nutritious,
as well toasted bread Avith milk, sago, animal jellies, a
little  ripe  fruit, smalt quantities of rich broth, or where
the stomach will not  retain these articles, glysters should
be given, of weak mutton, or other light broth,  three or
four times  every twenty-four hours.
  This disease sometimes terminates in recovery or death
in two or three days, in other cases it continues off and
on, for as many Aveeks and even months.
  I suspect the most usual cause of this disease is over-
eating, and this may be the case where very little is eat-
en, owing  to the relaxed  state of the  stomach, and the
general  system,  from the debilitating tendency of the
warm season.  This debility or languor of the stomach,
and general system,  may often be prevented, by taking
weakly children, frequently into the country; by the mo-
derate use of good old wine, and of a little salt meat,
or salted  fish; by avoiding much trashy vegetables, or
much sweetmeats.  A reasonable  use of ripe fruit is al-
ways necessary, but  is easily carried to excess  with de-
licate children. 
468        OF THE CHOLERA INFANTUM, &C.

  This disease is usually  very mortal in cities; and
calls for much skill when protracted, for a more deplora-
ble case can hardly be met with than the last stage of this
disease, where it has continued  long; the body becomes
so emaciated as to cause the bones to cut the skin, hick-
cup, convulsions, sore mouth, &c. render the case some-
times truly distressing.
  Although the cholera  infantum is most common, and
most dangerous in  our cities, cases of it are  to be met
with every season, in country practice.   It is  known in
many places by the name of "summer purging;" I have
generally succeeded in  these cases by giving a gentle
emetick, opening the bowels with mild  purges, as  senna
and manna Avith  a little  cremor tartar; and after these
evacuations, a mixture of soda and Avater, with some es-
sential oil, and occasional doses  of laudanum and sweet
spirits  of nitre.  But  in  a majority  of cases,.a single
dose of the senna, &c. and afterwards the soda mixture
would check the complaint.  In inveterate cases where
the patient was reduced, a mixture of magnesia, oil anise1,
sugar and water, would generally answer.
  The  same diet and drinks should  be used as  above
mentioned.   Let it be carefully  remembered  in all vio-
lent cases of cholera infantum, that evacuations are never
necessary, except they are used before the debility is con-
siderable; on the contrary, they  Avould be attended with
the utmost hazard, and therefore where there are doubts,
a physician should be consulted.  If none is to be had
in reasonable time, Ave  may give the soda mixture with
laudanum, not only without risk, but with considerable
prospect of success   It has been supposed the teething
of children renders this disease  more severe, but Ave de-
rive little advantage from a knowledge of this fact. I have
given as my opinion, that the health of the teeth depends
especially on the general health, so  that it would seem to
follow, that we can only aid the infant in cutting its teeth
by proper attention to the usual means, for invigorating
the general system.
  It may be remembered, that  by the  careful manage-
ment of those means, Ave not only promote  more easy 
OF THE VACCINA, OR COWPOX.        469
teething, but the same means  are  the most certain pre-
ventives from cholera infantum.
  Children  in general, are  kept too much confined in
Avarm rooms, they are rendered delicate by too much
nursing, by which  they are  kept from  using  their own
limbs; they are indulged in too  much sweetmeats; they
use too little milk, too much coffee, and fresh meat, and
cheese; they should never pass a day in the warm sea-
son without a little salted meat, or fish; but these articles
must be used sparingly, or by exciting thirst they will do
much mischief, for nothing is Avorse than oppressing the
stomach Avith too  much watery  liquids.   Lastly, in all
cases of cholera infantum,' I  would advise the exhibition
of a glyster or tAvo, of tepid or  cool water and starch;
and if this simple  remedy is used as soon as any symp-
toms of this disease appears, it Avill often check it in its
forming state; and this same remedy ought always, to be
used in cases where a child  passes tAventy-four hours
without a stool, in the Avarm Aveather.

                     SECTION IX.

             Of the Vaccina,  or Cowpox.

   A period of nearly twenty years has now elapsed since
the illustrious Jenner, discovered the prophylactick poAv-
ers of this disease.  And like a noble  philosopher and
christian, he made every endeavour to convey this migh-
ty blessing, not only to his  nation, but to a world; the
savage, the  heathen, in short, mankind was the family
to Avhich Jenner ardently Avished to bestow this  heaven-
ly JEgis.
   How wondrous  strange that  parents, guardians, &c.
should still foolishly or wickedly neglect to secure those
under their care, from the dreadful horrours, and suffer-
ings of smallpox.  The countenance of the christian and
of the  savage, through every land, has been  made to
smile and to acknowledge the goodness of the giver, and
still shameless wretches are found, who regardless of eve-
ry obligation which they owe  their children and society;
and regardless of the certainty of the preventive powers 
470         OF THE VACCINA, OR COWPOX.
 of this mild disease, known to be so, by long experience,
 suffer their children to run every hazard, for the paltry
 consideration of saving a few shillings.
   Many people formerly made a pretence of pious sub-
 mission to the will of  heaven, in suffering their children
 to take the smallpox naturally, because some little risk
 attended the inoculation, for that disease, but as there is
 no possible danger attends the vaccina, there is not the
 shadow of an excuse.
   We have a strong manifestation here of the proneness
 or liability of mankind to run  into excess; and a little
 reflection will convince us that this is one  of the princi-
 pal sources of our  troubles  and wrongs to each  other.
 No sooner had the humane discoverer, of this preven-
 tive, and after him, humane physicians in every country,
 used all their eloquence and  persuasion, to procure con-
 viction, and the adoption of this preventive, than they
 were  assailed by opposition  the most intemperate; this
 led to a necessity for making this preventive cheap, and
 easily accessible to the poor, and the consequence of this
 was, that the people soon view this as really worth little
 or nothing.
   Aud many considering even a dollar or two too much,
 undertook to vaccinate their own people: but I beg leave
 to tell all  such that this is extreme meanness.
   What, though I  have several children,  or a  score of
 slaves, who have not  had this  disease, can I Avith any
 kind  of propriety,  go  to  the patient of the physician,
 and actually infringe  on his  rights?  shame could  cloud
 the face of every man who would act thus meanly, where
 a physician is  to  be had.   This preventive  is Avanted
 but once during life, and the expense is a trifle;  besides,
 it  cannot with any  appearance of truth, or probability,
 be maintained that  there is not a considerable degree of
judgment, founded on experience, necessary to enable us
 to decide with any certainty, in doubtful cases, which
 are ever liable to occur from  the  most trifling accidental
 causes.
   Was it not a physician to  whom this blessing was re-
 vealed? was it not  the physicians Avho brought  it here,
 and maintain it among you, by preserving the infection; 
OF THE VACCINA, OR COWPOX.        471
and has  it ever been a source of profit to them.  It is
true, a few practitioners made a little when there Avas a
vast number  of patients, but compared with the benefit
which they distributed, the  amount was nothing.  But,
as things now stand, no physician in the country can pos-
sibly vaccinate for a dollar or hvo, without actual loss of
time; and even in town, the value of the things is so vast-
ly great, and so decidedly belongs to medical men, that   '
the usual fees ought at least to be doubled.
   Notwithstanding I am  so decidedly of opinion, that
this disease  should be left  to  the physician, I  am still
clearly of opinion, that every person should make it their
business to be w7ell acquainted Avith its character, for the
following reasons.
   1. Persons in the country may have to do with stran-
gers; Avho under pretence of being physicians, may  im-
pose on the publick, and deceive the unfortunate patient.
   2. Men of ample experience are sometimes remiss in
their attention, and woful consequences sometimes arise
from their neglect.
   3. This disease can only  be known by its outAvard ap-
pearance; and  if  the pock  is  accidentally injured  by
scratching, &c. the physician of skill, and with every at-
tention may be perplexed and put to much trouble: thus
on the morning of the eighth day, a beautiful pock exists
on the arm, a feAV minutes before the practitioner arrives
it  is torn off, how is he to decide?
   In all these cases, a proper knoAvledge of the appear-
ance of the disease, by  those who nurse,  will enable
themselves and the vaccinator, Avith much greater cer-
tainty to decide,  and if imposition is  attempted  to be
practised by strangers, it may often be detected.
   This pock  has these appearances: on the third day the
part where the  infection was inserted, resembles a flea-
bite; by the sixth, it resembles a pretty little pearl, being
pearl coloured, and perfectly circular in its circumference,
boldly elevated at its edge, and filled with a limpid fluid,
and depressed in the middle, Avhere there is a little dark
spot.  If two punctures were made  by the  lancet, or if
an incision was made, the pock will be oval, but the dint
in  the middle, and prominent edge are  always present. 
472        OF THE VACCINA,  QR COWPOX.

JBy the  eighth day, the peck  is  considerably larger, is
more  elevated, and the part a little swoln, and slightly
red, and there is considerable hardness extending pretty
deep into the arm.   On the tenth, there is a little brown-
ish yellow circle, which  looks speckled, and is called
areola; and from this on the same day, is spread a beau-
tiful red  colour of the skin, for a considerable  distance
around, called the efflorescence.  By the twelfth day this
has nearly disappeared, and the pock being pretty much
dried, looks yelloAvish,  but there never is any yellow
pus through the whole disease.  The scab soon becomes
brown, or  mahogany coloured, and by the eighteenth,
it may7 often be removed.
  About the fourth  day a slight feverishness is felt, and
a more considerable one in  a few cases, particularly in
adults, about the seventh,  eighth, or ninth day; about
this time there is considerable sAvelling and soreness un-
der the arm.
  Persons who will make  it their business to  examine
carefully a few cases of cowpox, cannot easily be  at a
loss to distinguish  it aftenvards; and  it is most clearly
the duty of every  person  to have such knoAvledge.  I
have, more than once, visited children on the eighth day,
and neither father  nor mother could tell even whether
the operation  had succeeded,  and where  the pock  had
been  rubbed; this  was sometimes a source of much
trouble and anxiety\
  No child should be suffered to pass the second or third
month without being vaccinated.
  It may be necessary to observe, that there is consider-
able variety in the progress of  the pock, in a few cases,
some  running their course more sloAvly, and some more
rapidly, than according to the  course above pointed out.
There are also some cases where little or none of the are-
ola or efflorescence is present; and in the coloured  skin
we cannot perceive it.  But the elevated edge, the dint
in the middle, the limpidness of the fluid within, and the
brownness and regularity of the scab, are always present,
and sufficiently distinguish this from every other eruption.
A single pock is sufficient. 
OF MILK BLOTCHES, OR CRUSTA LACTEA.    473
                    SECTION X.

        Of Milk Blotches, or Crusta Lactea.

  Eruptions of this kind  occur  in  gross  children, and
seem to proceed from  some defect in the milk of the
nurse.  I think it is highly probable overfeeding has a
considerable share in its production in many cases.
  This disease is not dangerous nor is it apt to pene-
trate so far as  to occasion  marks,  generally speaking;
but it is sometimes excessively troublesome, and if ne-
glected, or improperly treated, may become dangerous,
and liable to leave unpleasant marks.
  It is known by a whitish or dusky eruption in  large
scabs, affecting the forehead, head  and face, but also
found sometimes over the body.   This affection, like
many others, has been viewed, by some physicians, as
salutary: but this is an unfortunate errour for the poor
little sufferers.
  Like disease in every other form, it is an enemy, and
ought to be removed as far as in our power.  I am con-
strained to observe, that it is probable that these old  no-
tions of the salutary nature of many diseases arose,  in the
first instance, from motives really base.  Thus, in  the
infancy of medical science, Avhen physicians and patients
were ever looking for specificks, the former were likely
to be brought under the imputation  of being ignorant or
unskilful, because many diseases, in spite of all their ef-
forts, continued for weeks, and even months.
  This Avas  vexatious to the patient, and humbling to
the doctor; and as it was much easier to propagate false
notions than to cure their patients,  nothing could so ad-
mirably answer their purpose as to persuade the patient
that his  disease was salutary.  , The  credulous patient
Avould groan,  sweat,  and might die,  hugging up  this
phantom, and the doctor, who Avas, perhaps, more igno-
rant than the patient, got much  credit for his wonderful
knoAvledge in finding diseases he could not cure, were
salutary,  and therefore patiently to be borne. 
474       OF TEETHING, OR CUTTING TEETH.
   The motive aa as, I have no doubt, originally a base
 one; but the publick having no means of refuting it, and
 the majority of the faculty falling in Avith it Avithout re-
 flecting for themselves, the first motive was  soon lost
 sight of, more especially as men were soon found who
 undertook to defend these notions by  reasonings; and
 such were the times, that, however sophistical, any thing
 in the form of reasoning was  held almost  as sacred.  I
 haA7e in my library a book  printed  in  the year 1552,
 called the "Boke of Secretes," which  is marvellously
 marvellous.
   I hope I shall be pardoned for this digression; for I
 think this the most destructive of all errours, in the prac-
 tice of medicine, in the present day:  and this is the last
 opportunity I shall have, in this work, to speak of it.  I
 now return to my subject.
   The cure for crusta  lactea is, in good measure, to be
 looked for  from a change of the nurse, when perfectly
 convenient, Avhen not, the parent or nurse should live, as
 much as  her health will admit of, on a vegetable and
 milk diet.   But the infant, if it has been fed, should be
 stinted in  some measure in its food, or  the food should
 be rendered thinner and lighter; and animal food should
 be wholly withheld for  some time, unless it  be a very
 little salted meat, during the warm season.
   The bowels should  be kept reasonably laxative, by
 the use of cremor tartar and sulphur, or magnesia and
 rhubarb.   The tepid, or cold  bath, should be used dai-
 ly; and occasional Avashing Avith the mildest castile soap
 will be useful; but other washes, or drying applications,
 should never be used Avithout advice.

                     SECTION XI.

           Of Teething, or Cutting Teeth.

   There has been much diversity of  opinion respecting
the process of teething.   Some practitioners and nurses
attributed almost all the diseases of children to the irri-
tation, &c.  arising from  the cutting of the teeth; while
another set argue, because it is a natural process it can- 
         OF TEETHING,  OR CUTTING TEETH.      475

not reasonably be supposed to be attended Avith pain, or
disturbance to the animal economy.  Both these extremes
are probably Avrong; and  the  truth most likely is, that
children, nearly in a state of nature, are not much affect-
ed by  the  coming  of  the teeth; but in civilized life,
where our infants so evidently come into the world with
an infirm constitution, how can we reasonably suppose
they will not  be affected with  pain and  other  conse-
quences from this piercing of the gums by the teeth?
  Children  somewhat advanced  in life, are  subject  to
considerable pain in cutting their teeth.   But after much
reflection and  considerable experience, I am clearly of
opinion the majority of the publick attribute much more
to the teething of their children than is  consistent with
truth.   I believe that most cases  of diseased bowels and
of convulsions, &c. Avhich are attributed to the teeth, are
occasioned by overfeeding, Avhich  produces colicky af-
fections of the stomach and boAvels.
  Upon the Avhole, I think  it is pretty evident the pro-
cess of  cutting teeth depends on the general health, and
therefore it is only by strict attention to the nonnaturals,
&c. that Ave can aid them through this necessary process.
And I would advise parents not to indulge their infants
with hard substances to bite upon; nothing but a crust
of bread ought to be used for this purpose; for even oris
root, wax candles,  elastick gum, &c. will, by constant
use,  harden the gums quite  as much as harder sub-
stances.
  About the fourth month, often later, two teeth  appear
in the lower jaw, in front; and  pretty soon thereafter,
two more appear in the upper jaAv, the others gradually
succeed; so that, by the  end of the second year, chil-
dren have often ten teeth in either jaw.
  In  cutting these, some  children suffer considerably;
but little  can  be done, except endeavouring to  invigo-
rate  the constitution.  Cutting  of the gums is  seldom
necessary; if they are  cut  early, the incision will heal,
and render the gums more callous; if we delay it till the
teeth are nearly through, the worst is mostly over, and
the cutting with an  instrument is unnecessary.  The
gums should never be cut Avithout good advice. 
476      OF  TEETHING,  OR CUTTING TEETH.

  Lastly. If a child  is  sick, we must be governed by
the symptoms present, whether they are cutting teeth or
not.   I am well convinced children are often injured by
inattention to this rule; thus, if a child is supposed to be
affected with worms, or troubled by its teeth, the whole
attention is directed  to  this  supposed cause; and, per-
haps, in a majority of cases, the disease is from a cause
wholly different; so that, in our  prescriptions, we are to
be governed by symptoms, and prescribe  for those pre-
sent, while we, at the same time, carefully endeavour to
find  out the  cause; but alas! how often is this  hidden,
and even mistaken! 
DISPENSATORY, OR MATERIA  MEDICA.
                     SECTION I.

                  List of Medicines.

IN this  list all articles will be found, which are to be
kept as permanent medicines,  and the properties of each
is pointed out.  The reader will also observe, that every
word printed in italicks, either shows that the receipt for
preparing the article, will be  found under  the  word so
marked,  or that  something important will be found un-
der that  head.

Aloes—purgative—laxative—em m ena gogue.
Alum—antihemorrhagick—restringent.
Ammoniacum—stimulant expectorant.
Arsenick—tonick, in form of FoAvler's solution—caustick.
Assafcetida—diffusible stimulant, in form of tincture—
  antispasmodick in form of  tincture, glyster, and in
  substance.
Armenian Bole (or Red Bole)—external astringent, in
  form of ointment.
Balsam  Copaiba—stimulant alterative—stimulant diu-
  retick.
Balsam Peru—antispasmodick—stimulant expectorant.
Balsam  Tolu—stimulant  expectorant—external stimu-
  lant.
Bark Peruvian—tonick—diffusible stimulant, in form of
  tincture, and also the tincture combined with ether.
Benzoin—expectorant—anodyne, inform ofparegorick.
Balm, the herb—cooling  diaphoretick—mild  stimulant
  drink.
Bismuth, white oxyd of—tonick—carminative antacid.
Bitters, pleasant herbs and roots—tonick,  in form of cold
  infusion, tea or poAvder. 
478
LIST OF MEDICINES.
 Borax—external astringent.
 Burdock—stimulant alterative.
 Calomel—purgative—stimulant alterative——emmena-
   gogue.
 Camphor—diffusible stimulant, in  form  of spirit—sti-
   mulant diaphoretick, in form of poAvder.
 Canella Alba—aromatick, but used conjoined Avith aloes
   only.
 Cantharides—diffusible stimulant—blistering, in form of
   ointment.
 Carduus—tonick in form of infusion, cold or warm.
 Chamomile—stimulant diaphoretick—cooling diaphore-
   tick, in form of very Aveak tea acidulated—tonick.
 Cinnamon—aromatick, antemetick,  stimulant.
 Castor Oil—purgative.
 Cherry Bark (wild)—tonick.
 Cephalick Snuff.
 Caustick, Common.
 Caustick, Lunar.
 Centaury-—tonick.
 Corrosive Sublimate—stimulant  alterative—blistering,
   in form of ointment.
 Contrayerva—stimulant diaphoretick—sudorifick.
 Cremor Tartar—laxative—evacuant alterative.
 Cloves—in powder of bark, tonick  and aromatick.
 Cuprum Ammoniacum—tonick.
 Dewberry, root, and leaves—astringent, or restringent.
 Diachylon—used as a strengthening  plaster, spread upon
   leather.
D ogwood—tonick.
Elm, Slippery—alterative—expectorant—nutrient—and
   used in diluent drink—also diuretick—dietetick.
Ether, Vitriolick—diffusible stimulant—antispasmodick.
Extract of Bark—tonick.
Extract of Hemlock—stimulant alterative.
Gamboge—purgative.
Garlick—diffusible stimulant—antispasmodick—vermi-
   fuge.
Ginger—stimulant, aromatick,  dietetick.
Gentian—tonick. 
LIST OF MEDICINES.             479
Ground Ivy—cooling diaphoretick, acidulated—mild sti-
   mulant drink.
Gum Arabick—diuretick—medicinal nutrient—diluent
   in drink.
Guaiacum—stimulant alterative, in substance, and in
   form of tincture—emmenagogue.
Hartshorn, Spirits of—diffusible stimulant—expectorant.
Hellebore—errhine, in form of cephalick snuff-—for itch
   in ointment.
Heira Picra—purgative—laxative.
Horehound—tonick and  pectoral, and,  therefore,  only
   proper in coughs, kc. of some standing.
Iceland Moss—restringent—dietetick, or medicinal nu-
   trient—mild tonick.
Iron Filings—tonick—vermifuge—emmenagogue.
Iron Rust—tonick—vermifuge—emmenagogue—stimu-
   lant alterative, in form of muriated tincture.
Ipecacuanha—emetick—sudoriflck,  in form  of Dover^s
   powder—stimulant diaphoretick, Avith nitre—evacuant
   alterative, Avith sal. nitre—febrifuge.
Hog's Lard—used in most ointments.
Sugar Lead—antihemorrhagick—antispasmodick—ex-
   ternal astringent, in form of lead water—ophthalmick.
White Lead—external astringent, in form of ointment.
Laudanum—diffusible stimulant—antispasmodick—an-
   tihemorrhagick—anodyne—restringent.
Lime water—restringent—external  astringent—antacid
   lithontriptick—antemetick with milk.
Liquorice—expectorant.
Lavender, compound spirit of—diffusible stimulant—an-
   tispasmodick.
Magnesia—laxative—lithontriptick—antacid.
Magnesia Calcined—antacid—laxative.
Madder—emmenagogue.
Manna—laxative—purgative.
Mallows, March—refrigerant diuretick—medicinal nu-
   trient—diluent, in drink.
Mercurial Pills—stimulant alterative.
Mercurial Ointment—stimulant alterative, in acute dis-
   eases;  sometimes highly stimulant—ophthalmick  in
   venereal inflammation. 
480
LIST OF MEDICINES.
Mezereon—stimulant alterative.
Mustard—external stimulant—stimulant alterative—an-
  tispasmodick—-emmenagogue.
Myrrh—stimulant alterative—external stimulant,  and
  astringent, applied to languid sores, or carious bone.
Nitre Sal.—refrigerant diuretick—cooling diaphoretick
  —febrifuge, in form of powder, and mixture—revacn-
  ant alterative with ipecacuanha.
Nitre, Sweet Spirit of—-antispasmodick—stimulant dia-
  phoretick—stimulant  diuretick—febrifuge,  in  small
  doses.
Nitrick Acid—tonick.
Oil Cinnamon—good for toothach, aromatick, antemetick.
Oil Savin—external stimulant, in ointment.
Oil Spearmint—antemetick—carminative stimulant.
Oil Peppermint, mostly mixed with spirits wine, and call-
  ed  essence  of  peppermint—stimulant diaphoretick—
  diffusible stimulant—carminative stimulant.
Oil Pennyroyal—emmenagogue—powerful stimulant di-
  aphoretick, in form of weak tea.
Oil Amber—antispasmodick—diffusible stimulant.
Oil Anise—aromatick—carminative stimulant.
Oil Fennel—aromatick—carminative  stimulant, used iu
  Godfrey's cordial as an anodyne.
Oil Almonds—emollient—ophthalmick.
Oil Linseed, cold-drawn—external astringent with lime
  water, good for burns—supposed to be expectorant.
Oil, SAveet, or Olive—emollient—external astringent, in
  form of liniment with  lead.
Oil, Wormseed—vermifuge—stimulant.
Oak Bark—tonick—restringent—external astringent.
Opium  solid—diffusible stimulant—antispasmodick—
  anodyne antihemorrhagick—restringent.
Orange Peel—tonick—slightly aromatick.
Oris Root—used for children who are teething; perfume
  in dentifrice.
Ointments.
Pennyroyal.   See the Oil of.
Paregorick—expectorant—anodyne.
Precipitate, Red; used in pintment for itch, and languid
  or foul sores. 
LIST OF  MEDICINES.
481
Precipitate, white; used in ointment, for itch and herpe-
  tick eruptions.
Pink, Carolina, or Worm—vermifuge—slightly narco-
  tick.
Pitch, Burgundy—stimulant plaster, on leather, for hoop-
  ing cough, &c.
Poke—stimulant alterative.
Pine Knot Shavings—stimulant alterative.
Prickly Ash Bark—stimulant alterative.
Prickly Ash Berries—powerful  stimulant, used in tinc-
  ture for toothach.
Poppies—emollient, and anodyne, used in form of bath.
Quicksilver.—See mercurial pills, and ointment.
Quasia Wood—tonick.
Rhubarb—purgative—laxative.
Rue Juice—antispasmodick—vermifuge.
Rose Water—ophthalmick—slightly  astringent; leaves
  restringent.
Rosin, White, or common; used in  stimulant or drawing
  ointment.
Sago—medicinal nutrient.
Salts, Glauber---purgative---evacuant  alterative,  in
  Kuhn7s  powders.
Sal. Epsom—purgative; said to allay colicky pains.
Sal. Rochelle—purgative; in general preferable to Glau-
  ber's  salts.
Sal. Tartar—carminative antacid—febrifuge in saline
  mixture—refrigerant diuretick—lithontriptick.
Sal. Soda—the same as sal. tartar, but less offensive to
  the taste.
Saffron, English—stimulant diaphoretick—cordial.
Sassafras Bark—stimulant alterative—aromatick.
Sarsaparilla—stimulant alterative,  properties weak and
  doubtful.
Senna—purgative.
Snakeroot, Virginian—sudoriflck—tonick—stimulant
  diaphoretick, in form of weak tea.
Snakeroot,  Seneka—expectorant—stimulant  diaphore-
  tick.
61 
482
LIST OF MEDICINES.
Squills—expectorant, combined with sal. nitre or calo-
   mel, or both, also in form of syrup—diuretick in vine-
   gar.
Spanish flies—see cantharides.
Sweet spirit of nitre—see nitre, spirit of.
Savin—see oil of.
Sulphur floAvers of—laxative—evacuant alterative—used
   for itch, in form of ointment.
Tartar  Emetick—'emetick—febrifuge—diaphoretick—
   evacuant alterative, in form of Kuhn's poAvders.
Turpentine, spirits—stimulant diuretick—diffusible sti-
   mulant, used as an external stimulant in ointments.
Tartar vitriolated—used in Dover's poAvder.
Uva ursi—restringent—tonick lithontriptick.
Vitriol, blue—astringent in  bleeding from the nose—es-
   charotick.
Vitriol,  white—-emetick—restringent—antihemorrha-
   gick.
Valerian—antispasmodick—slightly tonick.
Vitriolick acid—tonick—restringent—carminative anta-
   cid.
Wax, white and yelloAV—used in ointments.
Wine—cordial—diffusible stimulant—stimulant altera-
   tive.
Wormseed—vermifuge—see oil of.
Zink, flowers of—tonick—cosmetick.
   Let it  be observed, that, in the foregoing treatise on
diseases, and also in this dispensatory, the doses mention-
ed are intended for persons of adult years, unless express
mention is made of children.
   Many attempts have been made at fixing precise doses
for persons according to age, &c; and physicians some-
times obtain credit for a studied measuring of doses, &c.
But nothing can be more preposterous, nothing more un-
wise; and every person of good sense must be  sensible,
that much depends on the constitution, and on  the state
of the body present.   Thus a  dose of opium which
would procure sleep at one  time, would  produce  deli-
rium at another, in the  same person.   One ounce of cas-
tor oil, or one  grain of tartar emetick, will produce more
effect at  one time than three or four times that quantity 
LIST OF MEDICINES.              483
at another, in the same person.  I have been long so sen-
sible of this, that I have considered it a matter of great
importance to divide all active medicines into two or three
portions, aud give them a feAV minutes apart, instead of
giving all at once, as commonly practised.  But, although
I am so Avell convinced of the uncertainty of the effects
of a given quantity of an active medicine, still I beg leave,
in the most solemn manner, to caution every person from
giving medicine, Avithout making it a matter of conscience,
to Aveigh or measure it with  the greatest precision; and
then, by repeating in small doses, every reasonable wish
can be obtained.
  As a general rule, the following table of doses will be
quite sufficient;  but much must always be left to the judg-
ment of the prescriber, who alone can judge of  the con-
stitution,  and state of the case:
  A person from  fourteen to twenty  years  of age, may
    take two-thirds of a dose  intended for an adult.
  From nine to fourteen, one-half.
  From six to nine, one-third.
  From four to  six, one-fourth.
  From two to four, one-sixth.
  From one to two,  one-tenth.
  BeloAv  one year,  a  twelfth.  A  woman, generally,
    should take a little less than a man.
               Apothecaries   Weights.
  A pound contains twelve ounces.
  An ounce—eight drams.
  A dram—three scruples.
  A scruple—twenty grains.
               Measure for Liquids.
  A pint contains sixteen ounces.
  An ounce—eight drams.
  A table spoonful is about half an ounce.
  A tea spoonful is one fourth of a table spoonful.
  Sixty drops make one tea spoonful. 
484
OF PURGATIVES.
             SECTION II.--SUBSECTION 1.

                   Of Purgatives.

   These are a valuable class of medicines, and are found
in abundance in both the mineral  and vegetable king-
doms.  I, however, have chosen to select a few of those
with which  I am best acquainted; and Avhich the present
practice sanctions more particularly: they Avill be found
amply sufficient.
                        Aloes.
   Three kind of aloes  are met with in the shops, dis-
tinguished  by the  names of Socotorine, Hepatick, and
Fetid.  It is only necessary to choose that which is clean
and freest from smell.  The socotorine is generally most
agreeable.   This article  forms  a part of almost every
patent pill.  Aloes  is  seldom given alone; it may be com-
bined with calomel, jalap, rhubarb, and also with canella
alba.   It is principally given as a laxative.  Dose from
from two  to ten grains.  Aloes is  supposed to  operate
principally  on  the  lower intestines, and therefore is  an
improper laxative for persons  subject to piles.
                       Calomel.
   Calomel has long maintained the character of being a
valuable medicine.   The illustrious Sydenham  gave a
scruple at a dose.  In bilious diseases, in dropsy, malig-
nant fevers, malignant sore throat, our summer diseases
generally, in the  croup, &c. calomel is an invaluable me-
dicine.  Ii is seldom  given alone as a purge, but may
be conjoined with  jalap, rhubarb,  aloes, and, in  short,
with almost  every purgative.   This medicine is  a valua-
ble one for children, and  perfectly safe, provided Ave  do
not continue it long.   Dr.  Rush  tells us several de-
plorable accidents followed its use with children at Phi-
ladelphia. Dose from tAvo or three grains to twenty; five
grains, combined with some other purgative, is the most
usual dose.
                       Jalap.
  This is an active  and valuable article.  It is used prin-
cipally in the form of pills or powder, but is apt to nause 
OF PURGATIVES.               485
ate  the stomach when given alone.  It may be taken
with calomel  or  cremor tartar.  Dose from twenty to
thirty grains for healthy persons.  Weakly persons sel-
dom require the use of jalap.
                      Rhubarb.
  The best rhubarb is imported, and is  called Turkey
rhubarb.  It is a mild purge, and may be  combined to
advantage with calomel, magnesia, &c.  Dose from twen-
ty to forty grains, in pills or poAvder.
                     Castor Oil.
  Castor oil is a  valuable purge.  It should  be chosen
clear and light coloured, with but little  smell; the best
has neither much smell or taste.  Dose from one to three
table spoonfuls; and  it may be  made  less offensive to
the  taste, by taking it on some warm liquid, as wine
and  water, weak toddy, coffee, or  a little warm water
sAveetened.
                      Gamboge.
  Gamboge is never  given  alone, but may be combined
with most of  the other purgatives.   Where the boAvels
are  insensible to less  active articles, this is an excellent
auxiliary.   Much, hoAvever,  depends on  the  grinding
of it: if it is ground to a powder completely impalpable,
it Avill seldom nauseate  the stomach, or  gripe, but  is
speedy and safe in its operation.  Dose from one to five
grains.
                   Glauber Salts.
  Glauber  salts is an excellent  purgative.   It operates
mildly and effectually; but its unpleasant taste is a pow-
erful objection against it, with many persons.   It is sup-
posed that it disposes to costiveness.   It may be mixed
with senna, manna,  &c.  Dose from one to three table
spoonfuls.  This medicine  should be strained after it is
dissolved,  and the cleanest should be carefully sought
after when buying it.
                   Rochelle Salts.
  Rochelle salts is so similar to glauber salts, that it may
be used in its stead.  The taste is less offensive than that
of salts.  I think it better than salts in general, if it were
only for its being cleaner; but independent of this, I can, 
486
OF PURGATIVES.
 with confidence, recommend Rochelle salts as a most in-
 valuable purge.   Dose from six to twelve drams.
                    Epsom Salts.
   Epsom salts is  entirely different from glauber  and ro-
 chelle salts in its  constituent parts, but is nearly similar
 in its properties and strength.  It has been supposed that
 this medicine allays the pain of colick, independent of its
 purgative operation.  It has more of the bitter, and less
 saltish taste than Glauber's salts, which is sometimes sold
 for it.  The salts is rendered similar to it in appearance,
 by shaking the vessel Avhile the common salts is chrysta-
 lizing, and thus  making the  chrystals smaller.   Dose
 from six to twelve drams.
                       Senna.
   Much has been said in favour of the Alexandrian sen-
 na;  but  from considerable experience, I feel full  assu-
 rance  in saying,  that there is little or  no difference.
 Choose senna that is clean and free from stalks, and you
 will find it answer your wishes as a mild purgative. . It
 is mostly combined with other articles, as salts, rhubarb,
 manna, &c.  Its  tendency  to  griping  may be obviated
 by a little coriander seeds, or a few grains of soda. Dose
 from one to three  drams in decoction.
                      Manna.
   Two kinds of manna are met with in the shops, called
 flake, and manna in sorts.   This medicine is never given
 alone to adults, but to very young children it is sometimes
 given, dissolved in warm water; for this purpose  a dram
 may be dissolved, and a feAV tea  spoonfuls given every
 hour till it  operates.  Manna is said to be adulterated by
 adding sugar and  a  little of some active  purgative, as
 scammony, &c.  and therefore  Ave should  endeavour to
 procure that which has been tried, before we give it to
 tender infants.
                    Heir a  Pier a.
  Heira picra may  be made by mixing four ounces of
best aloes Avith one  ounce of cannella alba; both these
 articles should be well ground, separately.  This medi-
cine is used principally, dissolved infspirits of some kind,
and is  an useful purgative or laxative, for persons in the
 decline of life, but should not be touched by young per- 
OF PURGATIVES.               487
sons, more espesially when  dissolved in spirits.   Heira
picra may be mixed in  the  proportion of an ounce to a
quart of good rye whiskey or rum.  Dose from a half to
two table spoonfuls, observing to shake the bottle  before
pouring out
           Tincture of Rhubarb and Senna.
  Tincture of rhubarb  and senna may be made thus:
take rhubarb in coarse powder two ounces, senna  a little
bruised one ounce,  ginger two drams, proof spirits one
pint.   Dose from one to three table spoonfuls.   It is a
valuable purgative for the aged, or persons intemperate in
the use of ardent spirits; but should never be given to
people of any other description.  It should be strained,
after infusing eight or ten days.
                   Purging Pills.
  Jalap, twenty-five grains, } Moisten  Avith a  little mo-
  Calomel, five grains.     5 lasses, thin paste, or water,
and make eight pills; take five, and if they do not purge
the patient in tAvo or three hours, take the remainder.
When they operate, drink weak sage, green, or balm
tea, or thin gruel.
             Purging Pills with Aloes.
  Jalap and Rhubarb, each ten grains, ) Grind  the aloes,
  Calomel and aloes, each five grains. 5 an^ mix with the
other ingredients, and make eight pills, as  above  direct-
ed: they are to be taken as the purging pills above.
           Purging Pills  with Gamboge.
   Jalap, twenty  grains,               7 Grind the gam-
   Calomel. Gamboge, each five grains. 3 boge Avith great
care, as fine as possible, and then mix and make eight
pills, which are to be taken  as the above purging pills:
these are  an  active and  useful purgative for persons of
athletick habits.
                 Purging Infusion.
   Senna, Rhubarb root, each one dram, ? Pour a  pint of
   Salts and Manna, each two drams.   5   boiling Avater
on the ingredients, keep it at the fire half an hour; take
from  half to a whole tea cupful, every two  hours, till
it operates freely.   Weak  tea, or thin gruel, may be
drank; or  persons  free from fever may use weak  chick-
en water. 
488                OF LAXATIVES.
                 Infusion of Senna.
   Senna, three drams,         ~) Infuse in a pint of boil-
   Cremor Tartar, one dram,   > ing  water, and take
   Coriander seeds, half a dram. ) from half to  a whole
tea cupful every hour or two till it operates; it may be
sweetened with sugar or manna.

                    subsection 2.

                    Of Laxatives.

   Laxatives are  so  similar to  purgatives, that I have
placed them in the same section; but as  the former  are
used with different intentions from that of purgatives, I
have thought best to place laxatives by themselves. It is
true, many articles may be used with  propriety either as
purgatives or laxatives, but there are many others which
are only suited to one intention; thus, sulphur, cremor
tartar, &c. are laxatives.  Calomel, jalap, senna, &c.  are
purgatives.  A laxative, strictly speaking, is an article
not only mild  in its operation, but ought to be such as
may be used for a length of time with  safety, and I have
had regard to this circumstance in selecting.
                  Cremor Tartar.
   Cremor tartar  is an  excellent laxative.   It may be
taken in closes of from one to three tea spoonfuls, in mo-
lasses, or made into a paste with sugar and water; or two
drams put into  a pint of boiling water, and taken in  do-
ses of a wine glass, and it may be sweetened with brown
sugar.  This article should never be put into any metal -
ick vessel.
                Flowers of Sulphur.
   FloAvers  of sulphur is a useful and safe  article, and
is  particularly proper for the gouty or rheumatick.  It
may be taken in molasses or syrup, in doses of from one
to  four tea spoonfuls.   It may be combined to advantage
with cremor tartar.  This article should  be chosen free
from acid taste.
                     Magnesia.
   Magnesia should be perfectly white, free from gritti-
ness, and lighter  than any other article which it resem- 
OF LAXATIVES.
489
hies.   This, in many cases, is a very valuable laxative.
but is only so where acidity abounds; for it only operates
as a laxative when changed by the acid of the stomach
into a neutral salt.   When it  is  used as  a laxative, it
ought  in  general  to be conjoined with  rhubarb.  Dose
from one to three tea spoonfuls.   It may be made into a
thin paste Avith Avater, and a little sugar added, if desir-
ed: many persons can take it in a dry state, and this  is
probably the best.
                   Rhubarb Root.
  Rhubarb root simply chewed,  or in syrup, is a good
laxative.
                 Syrup of Rhubarb.
  Rhubarb in poAvder one ounce, 7 Pour a pint of boiling
  Race ginger two drams.      5 water on  the  ingre-
dients, and keep it warm half a day, then strain through
a linen rag, and add ten ounces of best brown sugar. This
is a good laxative for children.   Dose from one to five
tea spoonfuls.
            Bitter Tincture of  Rhubarb.
  Rhubarb one ounce and a half, 7 Put the ingredients
  Gentian sliced, three  drams.    5 m^° a Pmf °f good
whiskey or rum, infuse a week, and strain.  This is an
useful  laxative for persons of Aveak stomach, but more
particularly for persons accustomed to the free use of ar-
dent spirits.  Dose from one to four table spoonfuls.
                   Laxative Pills.
  Socotorine aloes,                       ? r ,* a n
  Rhubarb and castile soap, each two drams. 3
aloes, then mix the Avhole with a little syrup, or molasses.
and make seventy-two pills. This is a useful laxative for
persons habitually costive, and will answer as a substi-
tute for Anderson's, Fisher's, and other pills.  Dose
from one to six.
                    Heira Picra.
  Heira picra is a good laxative for the aged, dissolved
in spirits; one ounce may be dissolved in  a quart of
Avhiskey or rum.   It ought by no means to  be given to
children, or young people.  Dose from a half to two ta-
ble spoonfuls.
             62 
490                 OF EMETICKS.
                  Laxative Potion.
   Salts, manna,^ach tAvo drams.   Dissolve in  a little
warm Avater, and take it at one dose.  This is a valua-
ble laxative, after colick, fevers, &c.

                     SECTION  III.

                    Of Emeticks.

   A great variety of  articles may be used for this pur-
pose, but Avith these, as with all other articles possessing
considerable activity, the  safest  method  is  to choose a
few only, Avhich are well knoAvn from long  experience.
The present practice gives preference to the following,
and they are all articles  of which I have had considera-
ble experience; they  are ipecacuanha,  Avhite  vitriol,
(sulphat.  zink,) and antimonials.    Vomits prudently
used, are sometimes  highly beneficial, but a frequent
repetition of them, or strong vomits, may be productive
of very great mischief; and, therefore, I would advise the
unskilful never to tamper with emeticks:  purges, parti-
cularly pills, containing a little calomel, are often better,
and I can confidently assert, there is less risk of taking
cold from using calomel prudently, than there  is from
taking vomits.
                    Ipecacuanha.
   Ipecacuanha is a medicine  of very great value.  It
may be  given with safety in  all cases Avhere a vomit is
necessary; for strong habits, a grain of tartar emetick
may be  added.  Dose from one to two scruples, in two
doses a feAV minutes apart.  It is  only Avhere Ave Avish
to reduce the patient, that large draughts of warm water
are necessary during the operation of vomits; in general,
a little Aveak chamomile, sage, or very weak carduus tea,
is preferable.
                    White Vitriol.
   White vitriol is particularly useful as an  emetick, on
account of its  quick  operation.  Where  poisons have
been swallowed, or in all cases where we merely wish
to empty the stomach speedily, this  is  a valuable medi-
cine.  I have also thought it  most useful,  from many 
SUDORIFICKS.
491
trials, in agues;  but where we wish to open the skin,
ipecacuanha is mostly better.   Dose from one to' two,
or even three scruples dissolved in  a little warm water
                 Antimonial Wine.
  Antimonial wine  is a useful emetick in  cases of sud-
den attacks  of croup, erysipelas, &c. and may be given
in most cases writh safety to children, or adults, of good
constitution, but should never be given to weakly chil-
dren or adults.  This article is made by dissolving two
scruples of tartar emetick, in two ounces of warm water,
and then adding it to a pint of Lisbon wine.   Dose from
half to two table spoonfuls at two or three doses, taken
a few minutes apart.
                   Tartar Emetick
  Is seldom used as an emetick by cautious experienced
physicians; but to labouring people, of gross strong ha-
bits, it may be given sometimes to advantage; but upon
the Avhole I am convinced the practice of .medicine would
lose nothing by laying aside full doses of tartar as a
vomit.  Dose from two to six grains, in three or  four
doses a few minutes apart.  Where this medicine is ne-
cessary or advisable as a vomit, warm water should be
drank freely.
                  Emetick Powder.
   Ipecacuanha,  one dram, 7 Rub these ingredients well
   Calomel, half a dram.  3 together, and  put it  into a
vial.   This will be found a valuable medicine in croup,
malignant sore  throat, &c.  Dose from thirty to forty
grains: for children see table of doses.

             SECTION  IV.--SUBSECTION 1.

                     Sudorificks.

   A great number of articles  have long  since been se-
lected from  the vegetable, animal, and  mineral king-
doms, and used as sudorificks, or as things  having  a
tendency to cause sweating.   But, perhaps, no class of
medicines are more uncertain in their operation, for much
depends on the state of the  system at the time they are
 given.  Still, however, by knoAving the  state suited to 
492                 SUDORIFICKS.
 such medicines, we can administer them with considera-
 ble certainty.  Let it be remembered, that where there
 is much fever, or where an inflammatory diathesis is pre-
 sent, sudorificks should not be given, for in this state of
 the  body, bleeding, purging, cool drinks,  cool air, and
 abstinence,  will open the  skin, and bring  on  a gentle
 perspiration, or even sweating, while common sudorificks
 are  sure  to  increase the fever;  but when the body is
 somewhat reduced, or in diseases of feeble action, as low
 typhus, or typhoid fevers, or in all febrile diseases af-
 ter suitable depletion, or reduction of the patient, sudo-
 rificks or diaphoreticks are useful, and  often indispen-
 sable.  In chronick inflammation, as in chronick rheu-
 matism, vibrating gout, sudorificks may often be used to
 advantage.
                Virginian  Snakeroot.
   This is a useful sudoriflck in all low fevers, or at the
 close of malignant  diseases.  It may be  used in all
 cases where  we wish to soften the skin, while we at the
 same time intend to support the tone of the solids in a
 slight degree.   It  is  often given with advantage  con-
joined with bark, or nitrous, or camphor poAvders.  This
 article is destroyed  by boiling,  or by  long standing;
 therefore but very small quantities of tea should be made
 at once, and  this should be put into boiling water and
closely  covered.  It  may  be ground fine,  and  mixed
 with bark or other bitters; but the powder should not
be kept; it soon loses its properties.
                  Dover's Powder.
  Ipecacuanha, Opium, each one part, ~) The driest  opi-
  Vitriolated Tartar, eight parts.     5 um  should   be
chosen, and the greatest possible  pains taken to grind
the mass to a completely fine powder.   This  is proba-
bly the best sudorifick  known.   Dose from  eight  to
twenty grains, and  the patient should  avoid  drink for
an hour or tAvo after taking it; then large  quantities of
cremor tartar whey, milk whey, wine whey, &c. accord-
ingly as the disease is viewed as being more or less in-
flammatory are to be taken. 
STIMULANT DIAPHORETICKS.
483
                    Contrayerva.
   Contrayerva root may be used as snakeroot, in tea, or
 decoction.  It may also be given to advantage in doses
 of about from twenty to thirty grains, ground fine, and
 mixed with an equal quantity of prepared chalk.  This
 is a useful medicine in low fevers.
                  Seneka Snakeroot.
   Seneka snakeroot is generally given in decoction: two
 drams may be boiled for some time in half a pint of Ava-
 ter.  Dose one or two table spoonfuls.  This is a use-
 ful medicine for  children in the close of  croup.  Chil-
 dren are  to take it in doses of one or two  tea spoonfuls,
 frequently repeated.

                   subsection 2.

              Stimulant  Diaphoreticks.

   Stimulant diaphoreticks are very little  different from
 sudorificks.  Some articles, however, in this class are
 more heating when ghTen with  freedom, some  less so,
 while others  may be used Avith either intention, as Ave
 make the doses stronger or weaker.  Most of the arti-
 cles set  down as stimulants are better suited for exci-
 ting a slight moisture on the skin than for sweating; and
 this is only to be  expected of them after the body is re-
 duced by more active evacuants.
                  Camphor Powder.
   Camphor half a dram, 7 Grind the camphor with a few
   Sal. nitre one dram.  3 ch'°Ps of spirit of  wine,  or
 whiskey;  rub  till nearly dry; then add the nitre; Avhen
 well ground, make six poAvders.   Dose  one powder,
 every two, three, or four hours, in water, or weak snake-
 root tea.
               Diaphoretick Powders.
  Sal. nitre one dram,      ~) Grind fine and make eight
  Ipecacuanha one  scruple. 3 powders.  Dose one pow-
der every three or four hours. 
494
COOLING DIAPHORETICKS.
               Sweet Spirit of Nitre.
  Spirit of nitre is a mild diaphoretick, but is two stimu-
lant during an inflammatory diathesis.  Dose from twen-
ty drops to two tea spoonfuls.   This medicine, combin-
ed with.laudanum-in equal parts, is  a valuable diapho-
retick and anodyne, in low cases  of  fever, and in many
nervous diseases.
Contrayerva, weak,
Snakeroot, Virg.  Aveak,
Chamomile, weak,
Peppermint, Aveak,
Pennyroyal, very weak,
Valerian, weak,
Saffron, very weak,
 These are to be used in the
 form of teas, and we are to
 endeavour to regulate them
>to the disease, as it is more
 or less inflammatory; in ge-
 neral they ought to he very
 weak; for if Ave wish to sti-
 mulate, more  active articles should be chosen.   They
 should be made by pouring on  boiling water, and but
 small quantities at a time.
                 Spirit of Hartshorn.
   Spirit of hartshorn is a warm diaphoretick, and only
 admissible Avhere the disease is  of a Ioav grade, or has
 lost its inflammatory force.   Dose from five  to twenty-
 five drops, in cool water.

                   SUBSECTION  3.

               Cooling Diaphoreticks.

   Cooling or refrigerant diaphoreticks, are articles which
 may ahvays  be given  in diseases of moderate or mid-
 dling grade, and in delicate habits, in most  diseases
 from the  first, even  in inflammatory diseases.   These
 are articles which promote perspiration, by lessening
heat, or morbid action.  And it  may be proper here to
observe, that all evacuants, as bleeding, purging,  &c. as
well as cool air, cool weak drinks, are always followed
by diaphoresis, or a moist skin, provided they are carri-
ed far  enough, and, therefore, in  inflammatory diseases
are the best diaphoreticks. 
EXPECTORANTS.
495
                     Sal. Nitre.
  Sal. nitre, taken in doses of from five to hventy grains,
is cooling and diaphoretick.  It may be given with a dou-
ble portion of cremor  tartar, for the same purpose.
                 Nitrous Mixture.
  Sal. nitre,  two drams,                1 Rub the ni-
  "Vinegar, two table  spoonfuls,           1 tie  and su-
  Sugar, or sugar candy, half an ounce,  fgan in amor-
  Water, fresh and cool, 12 table spoonfuls, j tar, and then
add  the  liquids.   Dose, a table  spoonful every two
hours.
                   Cremor Tartar.
  Cremor tartar, tAvo drams, 7 This is a useful cooling
  Boiling Avater, a  pint.    5 medicine,  very mild, and
Avhen a little sugar  is added, is a pleasant diaphoretick.
Dose, a wine glass frequently.   This  article must  be
kept in an earthen, or glass vessel.
                 Spirit Mindererus.
  Best vinegar three  parts,  ~) Mix in small quantities,
  Spirit hartshorn  one  part. 5 and give from one to three
tea spoonfuls, once in every two or  three hours.   This
is a valuable medicine,  and may be given early, even in
inflammatory diseases; in those  of the typhoid grade, it
is generally highly beneficial.
  Balm tea,  very weak,      "1  These  should be taken
  Ground  ivy tea, very weak, I  largely, but  must  be
  Elder blossom tea, Aveak,   j  made very Aveak,  and
  Chamomile tea, very weak. J  taken  tepid,  or  cool,
and  acidulated with  a little lemon juice, or vinegar, or
they Avill stimulate.

                     section v.

                   Expectorants.

  Expectorants  are medicines supposed to operate on
the viscera of the chest, but their effects depend much
on the state of the system, so that what Avould  be expec-
torant in one case, might prove injurious in another dis-
ease of a different  grade.  But, however much we may
be at a loss  to explain, or understand, the manner of 
496
EXPECTORANTS.
operation, still long experience establishes the fact, that
some articles when properly adapted to the condition of
body present, do promote expectoration or spitting, and
thus relieve  the lungs of a part of effusions into them.
We find articles in this class very different, as to stimu-
lant properties, but, I have thought proper to place them
all under one head.  It may be observed, that the most
stimulant are placed first, and their stimulant properties
diminish downwards.  Where there is  evidence of much
inflammation we are not to use stimulant expectorants; in
this condition of the system, bleeding,  and  other active
evacuants, are the best expectorants.
                      Squills. .
  Squills may be given in powder, ground with  a little
sal. nitre; from half a grain to three grains, repeated eve-
ry few hours; or a grain or two of  calomel may be given
with the squills in obstinate cases of pneumonia.
         Stramonium, or James Town Weed.
  This article smoked in  a pipe, as people use tobacco,
is a powerfnl expectorant, in cases of confirmed asthma.
  Balsam Peru, ~> These  are  warm expectorants,  and
  Balsam Tolu. 3 sometimes useful in  old coughs, or af-
fections of the breast, without active inflammation. Dose
from ten to thirty drops on  a'little sugar.  The tolu is
often dry or in form of a resin; in this state it may be ta-
ken in pills from three to twenty grains the dose.
                    Ammoniacum.
  Ammoniack, a gum-resin, is a good expectorant. Dose
from ten to thirty grains:  or it may be dissolved in vine-
gar, and taken diluted with a little Avater.
                  Spii'it Hartshorn.
  Spirit of hartshorn may be given as a stimulant expec-
torant, in doses of from five to twenty-five drops, in cool
water.
                  Syrup of Squills.
  Steep half an ounce of squills in half a pint of good
vinegar, and two spoonfuls of spirit, or whiskey.   Let it
steep four days, then strain, and add to the strained li-
quor, half a pound of loaf sugar.  This is  a useful ex-.
pectorant, for children.  Dose for adults, from two to five
tea spoonfuls. 
               STIMULANT DIURETICKS.           497

                    Paregorick.
  Paregorick elixir is expectorant, and anodyne, in do-
ses of from one to three tea spoonfuls.
                 Seneka Snakeroot.
  One or two  drams of Seneka root, boiled for a few
minutes iu half a pint of Avater, is an expectorant. Dose
from two to six tea spoonfuls.
                  March Mallows.
  March malloAVs, either in simple tea, or sAveetened Avith
honey, or sugar candy, and taken tepid or warm, is a mild
expectorant.
  Slippery elm bark,     ~) These are all mild expecto-
Flaxseed tea,
rants.   The elm may  be
   Liquorice root tea, with fused by simply  mixing  a
     a little nitre in  it.    J little of  the ground bark
 in water, and it may be rendered pleasant by adding a
 little sugar and vinegar.
   Flaxseed tea should not be too slimy, neither must the
 seed by any means be roasted, as  is practised in  the
 country; this  wholly changes the properties of it; and it
 is  no longer expectorant.   A little hysop, sage, or ground
 ivy,  will render  it more pleasant.   Honey is  supposed
 to  be useful in all expectorant drinks.

             SECTION VI.--SUBSECTION  1.

                Stimulant Diureticks.

   Horseradish  is a  powerful diuretick.  It  should be
 grated, and taken in vinegar; a table spoonful or more
 may  be taken.  It may be taken in its raw state  grated,
 and rolled in  a  little  pap, or thickened milk.
                 Sweet Spirit Nitre,
  In doses of one or two tea  spoonfuls, taken  in cool
water, is a valuable diuretick; and although considera-
bly stimulant, when much  fever is present, is, neverthe-
less, a mild article in cases  of strangury from blisters, &c.
                 Spirit Turpentine.
  Spirit turpentine, in the decline of life, and where the
urinal organs  are  somewhat palsied, is a good stimulant
             63 
498
GLYSTERS,  OR INJECTIONS
diuretick, but  is inadmissible in  any other condition of
the body.  Dose from ten to thirty drops on sugar.
                  Balsam Copaiba.
  This is somewhat similar to the spirit turpentine, but
is less stimulant, and being laxative, renders it a valua-
ble medicine in a languid state of the kidneys, in gleets,
fluor albus, &c.
                 Vinegar of Squills.
  For the preparation of  this article, see expectorants.
The vinegar of  squills  may be given  in doses  of from
half to one table spoonful; but, where we wish to avoid
nausea, we should combine it with  cinnamon.   This
remedy is best suited to cases somewhat chronick, as in
dropsy, &c. it being considerably stimulant.

                    SUBSECTION  2.

         Refrigerant, or  cooling Diureticks.

   These are medicines which promote or increase the
quantity  of urine, without heating the body, or increas-
ing the circulation.
                     Sal. Nitre,
   Given in  doses of from five to twenty grains, dissol-
ved in cool Avater, or a  little vinegar and  sugar may be
added.   It may also be given in parsley or flaxseed tea.
                   Saline Mixture.
   Salt tartar, or soda, one dram, dissolved in half a pint
of Avater; then,  add lemon-juice,  lemon acid, or nice vi-
negar, gradually, till it ceases to effervesce.   Dose two
table spoonfuls, often repeated.
   Parsley root,  in tea,-j Are mild and useful diureticks;
   March malloAvs tea, J- they may be taken cool, or te-
   AU mild  mucilages,! pid, pretty freely.

                     SECTION VII.

                Glysters, or Injections.

   Glysters are of vast importance in the practice of me-
dicine; and  many are lost by the  neglect of this invalua- 
GLYSTERS,  OR INJECTIONS.
499
ble mode of administering remedies.  Were I confined
to one remedy for the cure  of diseases, I should choose
glysters.  They are not only safe, but highly useful in
every disease, in its  forming stage.  In dysentery, and
many other  diseases, no  physician  can  acquit his con-
science for an omission of this  remedy.  Every family
should have an apparatus for this purpose, and view it as
a matter of the highest importance to keep it in clean
complete order.  The best way, in general,  is  to have
a syringe fixed in a stool; this enables the patient to use
it without assistance, and this  kind of syringes  are to
be had  for  a small  sum, at the  apothecaries, made of
pewter,  and  are easily connected to a bench or stool.
But for  children, or  those who are too Aveak  to  sit up,
the common instrument made of a bladder and a small
ivory pipe, should  always be in readiness.   All heads
of families should  make  it  a matter of the greatest im-
portance to save bladders in time of killing.  There is
no doubt,  with me, but a very great number of  persons
are lost  every year, in the country, for want of glysters;
and this Avant arises from several causes, as the want of
instruments, Avant of persons to administer this simple
remedy, aversion to  their use,  and an omission on the
part  of  physicians, arising, often, from the aversion or
incapacity in the attendants, and sometimes from  the
want of knowing the vast  importance of this remedy.
In every family one or more persons should  be compe-
tent to this business.   Where modesty is likely to inter-
fere,  a small leather  tube may be connected to the blad-
der and pipe, and carried under the bed-clothes by the
patient.   We are enabled  by glysters to evacuate the
contents  of  the  bowels,  to sheath  and cool  them, and
thus  allay pain and  fever, to check a purging, &c. and
in cases Avhere the patient is unable to take nourishment
on account  of swelling of the throat, or wounds, and
other causes, Ave may nourish the patient, and thus save
life till  food can be taken in the usual way.   Physi-
cians! Nurses! Parents!  Let me humbly admonish you,
that this is a most important matter; for I have seen ma-
ny cases, in  country practice, where almost  anything
Avould have been given for a bladder which  could not 
500          GLYSTERS, OR  INJECTIONS.
be procured, and Avillingly would a hog, a sheep, or an
ox, have been sacrificed for the bladder; but this, alas!
Avould not  answer, because the  bladder must be dried.
If it, then, really be  a fact, that a  life may be lost for
want of a bladder, Avith how much care should  we pre-
serve them!   And if they are so beneficial, why so child-
ishly neglect their use, because, to those  unaccustomed
to them, they seem indelicate;  but what has delicacy to
do Avith matters Avhich jeopardize human life?
                  Emollient Glyster.
  Milk and Avarm water, of each from a gill to half a pint.
                      Another.
   Slippery elm bark, half an  ounce, in powder; infuse
a feAV minutes in a pint, or a little less, of aa arm water,
and strain.
                      Another.
  Dissolve a table spoonful of starch  in a little Avarm
water; Avhen mixed into a smooth paste, add a pint or a
little less of Avarm water  All these are convenient and
useful glysters, in all cases of pain and  heat in the boAV-
els, in fevers, dysentery, and many  other cases.
                  Cooling Glyster.
  Rub a spoonful of  starch in a little  cool water, then
add about half a pint of cool water.  This is a safe and
valuable remedy in cases of inward piles, in flux, and in
all purgings  attended Avith much heat.  It is  a sove-
reign remedy in all cases of high fever in children:  the
quantity must be  lessened:  from  half  to a whole gill
will  usually answer for children.
                  Purging Glyster.
   Salts one ounce, water, warmed a little, nearly a pint.
              Stimulant Purging Glyster.
  Table salt  from one to three spoonfuls, dissolve in
nearly a pint of water.
                      Another.
   Senna half an ounce, stew it, for some time, in a pint
of water, and strain through a  rag.
                  Laxative Glyster.
  Warm water nearly a pint, sweet oil,  or nice fresh
lard,  or fresh butter, a spoonful, sugar or  molasses, a
spoonful. 
EVACUANT ALTERATIVES.
501
                  Anodyne Glyster.
  Prepare an  emollient glyster, and add from thirty to
sixty drops of laudanum.  This will be found useful in
lingering cases of flux, &c.
                  Stimulant Glyster.
  Prepare a glyster of the usual quantity of water, and
a spoonful or two of oil, or clean lard; to this, add one
or two tea spoonfuls of spirits of turpentine.   This is
sometimes useful in  paralytick affections, and in the co-
matose state of low fevers, and also in gout of the intes-
tines attended Avith great prostration of strength.
                  Nutrient Glysters.
  These are warm milk, broth, barley water, and such
like.   It will  readily be  perceived  by the intelligent
reader,  that  almost every article of medicine may  be
administered by way  of glyster; and all those forms
may be varied to suit  each individual case.   For chil-
dren of from seven to  ten years of age, about half  the
quantities will answer; for those younger or older, we
must increase or  diminish  the  quantity to suit the age,
as near as  may be, but except it be in the use of lauda-
num, turpentine and strong medicines, no great precision
is necessary.

            SECTION VIII.--SUBSECTION 1.

                Evacuant Alteratives.

  These are  medicines which operate some friendly
change on the body, by gradual and mild evacuations, and
ought to be such as may be continued for a considerable
time, with  safety.   In diseases of the skin, or in habits
subject to biles, or piles, and  in cases of chronick dis-
eases, pretty generally, evacuant alteratives are useful.
In most cases, where  we wish to continue  them long,
mild aromaticks,  or  carminatives  should be conjoined.
Some of these  medicines operate on  the bowels, others
on the urinal organs, and others, again on the skin, &c.
  Cremor tartar,     ) These may  be used separately, or
  Flowers sulphur. 3 combined, in doses of  from one to
three tea spoonfuls in syrup or molasses.    These are 
502
STIMULANT ALTERATIVES.
 safe and beneficial in all cases where evacuant alteratives
 are proper; but it is to be remembered, that they are in-
 admissible in all cases of great  debility.   Sulphur alone
 is most useful in rheumatick or gouty habits.
                  Nitrous  Powder's.
   Sal. nitre, one dram,     ? These articles are to be
   Ipecacuanha, one scruple. 3 rubbed  fine, and  divided
 into eight powders.  These poAvders are a useful evacu-
 ant alterative, in lingering fevers, but cannot be continu-
 ed longer than ten or fifteen days, or they may injure the
 stomach; to be taken every three or four hours.
                  Kuhn's Powders.
   Salts, one ounce,         -j Grind  the  salts fine, and
   Calomel, eight grains,    > after  mixing  the whole
   Tartar emetick, one grain. J with  great care,  make
 eight powders.   One or two of these may be taken dai-
 ly in  cool water.  This medicine may safely be taken for
 several weeks, and is of singular efficacy in rheumatick
 cases, in cases of protracted gonorrhoea, &c.
                    Slippery Elm,
   Taken in powder, or in mucilage made by mixing  it
 with water, has been found useful in diseases of the skin.
 It may be taken in quantities of from two to four drams
 per day.
                   SUBSECTION 2.

               Stimulant Alteratives.

   Stimulant alteratives  are articles which operate on the
 body  in a manner someAvhat less evident,  than evacuant
 alteratives; but as they are evidently different from diffu-
 sible stimulants, and also from  common tonicks  and as-
 tringents, Ave must suppose them to have a peculiar ope-
 ration.  They are evidently stimulants, but they  seem to
 operate more especially on the glandular system: whether
 it  be by simply raising the excitement of "those parts, or
 whether they produce some specifick operation, calculat-
 ed to remove disease, I shall not venture positively to de-
termine; but I think  we are Avarranted in saying, some
 of them operate by the second  mode.  Mercury has  a
 specifick operation  on  syphilis, hemlock on glandular 
              STIMULANT ALTERATIVES.           503

scrofula; but upon the whole, it is probable, stimulant al-
teratives effect a change on the body, affected with chro
nick disease, by keeping up a gentle increase of excite-
ment in the glands; and thereby enables them to perform
the important functions of secretion, and excretion: Avhile
evacuant alteratives accomplish the same ends, by lower-
ing undue, or a too high excitement of the glands.
                      Mercury.
   Mercury is a poAverful stimulant  alterative, and may
be given to advantage in both acute  and chronick  disea-
ses; but as I have given directions in  the various cases
to Avhich it  is  applicable Avhen  treating on diseases, I
shall iioav proceed to mention a few  mercurials, Avhich I
consider most useful and safe, as  stimulant alteratives.
                       Calomel.
   Calomel combined with opium, and given in small do-
ses, is a valuable alterative.
                 Corrosive Sublimate.
   Corrosive sublimate of mercury, dissolved in Avhiskey,
or spirit, has been much celebrated as an  alterative, in
venereal  cases.   It is certainly a valuable medicine, but
I suspect calomel and opium will  always answer our
Avishes equally  well.  This medicine  has been gene-
rally given  according  to  the  directions of Van Swie-
ten* corrosive sublimate one grain, French brandy, or
 common spirit,  two ounces.   Dose a small table  spoon-
 ful every morning and evening.   I  have seen this medi-
 cine continued a long time without any benefit.
                   Mercurial Pills.
   Quicksilver,  one dram,                 ? Add a feAV
   Conserve of roses, or manna, three drams. 3  drops  of
 molasses, or Avater, and rub until no particles of the quick-
 silver can be discovered, by rubbing a little of the mass
 on white paper; then add a little powdered starch, and
 make forty-eight pills.  Dose from  two to five.
   The alterative effects of all these mercurials are in
 creased by diet drinks of sassafras, burdock, sarsaparil
 la, and mezereon.
                 Mercurial  Ointment.
   Quicksilver,  half an ounce,         ? Rub the quick-
   The best fresh hogs lard, two ounces. 3 silver with a lit-
 tle of the lard  until no globules can be perceived:  then 
504
STIMULANT ALTERATIVES.
mix the whole.  For inflammation of the eyes, this oint-
ment should be fresh made; but in fevers, &c. that  has
age will be best.   It is a dangerous, slovenly, and  un-
necessary method of using mercury, for  persons going
about; but in fevers or other cases, where the patient is
confined to the house, and we  wish to salivate speedily,
it is a most invaluable stimulant alterative.
                Hemlock, or Cicuta.
  Hemlock is best used in  the form of extract; and it is
particularly to be remembered, that no two parcels of this
article have equal strength; and, therefore, with new par-
cels, the  patient must always begin with  small  doses,
and increase  them gradually.  The most respectable au-
thority advises this  medicine in cases of scrofula.   Dose
from two grains to one dram, usually given twice  a day.
The extract made by boiling the juice of  the plant to a
thick syrup, and then adding of the pow dered leaves till
the mass becomes pretty solid, is the  best.
                     Guaiacum.
  Guaiacum, the gum resin, is a valuable stimulant al-
terative in many chronick  diseases, but particularly in
rheumatick and gouty affections, and also in some uterine
affections.  It may  be given-in substance, in doses  of
from tAventy to forty grains.
               Tincture of Guaiacum.
  Guaiacum, one ounce,   1 Pound  the guaiacum and
  Good Avhiskey, one pint, \ alspice,  then infuse them
  Alspice, two drams.     ) in the whiskey eight days,
and strain.   Dose from one to three tea spoonfuls: it is
most pleasant taken in milk; and where Ave Avish it to act
as a diffusible stimulant, a few drops of spirits of harts-
horn may be  added to each dose: this addition is  some-
times useful in cases of painful menstruation.
             Muriated Tincture of Iron.
  The muriated tincture is certainly eutitled  to the cha-
racter of a stimulant alterative; for the quantity of spi-
rits, or etherial liquor which is formed in preparing it,
being so small in a dose, we  must vieAV it as a  chaly-
beate.  Rust of iron two  ounces,  muriatick acid  six
ounces, spirits of Avine three gills; digest the  rust in  the
acid three days in a glass vessel; pour off the clear liquor. 
STIMULANT  ALTERATIVES.          505
and evaporate nearly one half, ra ncAv earthen vessel Avill
ansAver for this purpose,) then add the spirit. Dose from
ten to tAventy drops, two or three times a day.  It is best
taken in a little mild mucilage.
                      Mustard.
  The whole seeds of mustard, taken in  doses of from
one to six tea spoonfuls, in molasses or jelly, is a useful
stimulant  alterative  in rheumatism, gouty cramps, and
other diseases.
                       Myrrh.
  The character  of myrrh is somewhat  doubtful; but
combined  Avith  assafcetida and iron, it is a mild and use-
ful stimulant alterative.  The  tincture of myrrh has long
been celebrated as an useful remedy in old sores, and par-
ticularly Avhere we Avish to remove caries of the bone. It,
doubtless, is a good application to old languid sores; but
for affections of the bones, the surgeon can remove the
bone better by  means of a cutting instrument.  The dose
of myrrh, as an alterative, is  from ten to thirty or forty
grains.  This medicine is proper in all cases where iron
is indicated.
                  Balsam  Copaiba.
   This balsam is a Avarm but mild  alterative.  It has
been found particularly useful in cases of gleet and fluor
albus; and may be given with good prospect in all cases
of debility of the uterine organs.  Dose from one to two
tea spoonfuls twice a day, taken on sugar.
                  Poke, or Garget.
   Poke berries, fully ripe, infused iu Avhiskey or rum,
and taken in doses of from half to tAvo table spoonfuls,
has been  found useful in cases of  rheumatism; and, ac-
cording to some accounts, in scrofula also.
Mezereon Root,
Sassafras Bark,
Seneka Snakeroot,
These are all stimulant al-
teratives, & are used in de-
coctions, called diet drinks.
Prickly Ash Bark,      ^They may  be used sepa
rately, or conjoined: they
may be considered more or
less  stimulant as they are
  Pine, the chips of knots,
  Sarsaparilla  Root,
  Burdock Root,
placed in this list, the mezereon being most stimulant,
and the burdock least so.  They will all bear boiling to
             64 
506           DIFFUSIBLE STIMULANTS.

advantage, except the sassafras, which should  merely
be scalded.  From  two drams to an ounce, of tAvo or
three of those articles, may be boiled in a quart of water
to a pint, and a wine glassful taken  tAvice  a day, in all
cases where  alteratives are  indicated; but particularly
in venereal cases, foulness of the skin;  and in all habits
much  subject to biles  or ulcers, or  obstinate sores.
They add much to the  efficacy of  mercury in all chro-
nick affections.
                       Wine.
   Good old win© is certainly alterative:  but as it  evi-
dently belongs to the class of stimulants, it Avill be ob-
vious that it can only be salutary for  those wanting a
proper tone of fibre.  And experience warrants the de-
claration, that like all other stimulants it must  be pro-
portioned to the condition or diathesis  present.  Those
unaccustomed to wine will probably derive much benefit
from  the use of it, in most diseases accompanied with
chronick debility; but iu all febrile diseases, and in per-
sons of plethorick habits, it may prove  highly detrimen-
tal.   Upon the whole, this article can only be used Avith
good prospect of success,  byr  a cautious regulation as to
quantity, evenAvhere it is  a proper remedy.  It may not
be amiss to remark, that wine is ahvays more or less nu-
trient, Avhere it is judiciously used.

                     SECTION  IX.

                Diffusible Stimulants.

   Diffusible stimulants  are articles which act suddenly,
and transiently  on the  living body.    Where the sys-
tem is deprived of its proper energies, by reason of lan-
guor or exhaustion,  these are calculated to excite new or
increased action.  But where they are administered in
plethorick or inflammatory states of  the body, or when
given largely, under all circumstances, by raising undue
excitement, they produce  indirect debility, which, if long
continued, terminates in exhaustion, disease,  or death.
So that diffusible stimulants  are only useful in general,
in Avhat  are called nervous diseases; and  even here we 
DIFFUSIBLE STIMULANTS.
507
ought to view them  as palliatives.  It folloAVS, that in
the administration  of diffusible  stimulants,  we are to
place our hopes of permanent relief, on mild nutrients,
tonicks, exercise, cleanliness, and wholesome air.  Dif-
fusible stimulants, though invaluable, and speedy reme-
dies, require much caution in their use;  for if they exceed
the proper dose, instead of imparting agreeable feelings,
and a more healthy excitement; or, instead of rendering
excitement more equal throughout the  system, they will
render it still more unequal; or, by interrupting the func-
tions of the brainular system, they increase the disease,
and tend poAverfully towards death.  And of all reme-
dies, diffusible stimulants  most  speedily, and certainly
create  a habit which calls for  repetition; and a still
greater evil  is  that they  soon cease to  operate, Avith the
same force, without a constant increase of  the quantity.
Upon  the whole, to be useful  or even safe, diffusible
stimulants must be reserved for emergencies, and should
ever be viewed as resembling the sudden and sparkling
sallies of wit; for, like it they amuse us for a time, and
withdrawing as suddenly as they appeared in both cases,
a langour is  left proportionate to the elevation.  While
durable stimulants, or tonicks, and  mild nutrients, &c
like  the slow, solemn, constant operations of the  judg-
ment, carry along the subject with that equinecessity of
force, Avhich is likely to  secure the wonted vigour  of
mind and body.
                        Ether.
   Ether (sulphurick, or vitriolick)  is  a valuable  medi-
cine.   Dose from twenty to sixty  drops, and must always
be taken in cold water.   Much depends on keeping your
ether well stopped; it should be stopped with great care,
and  kept in the coldest place you can  get.
            Compound Spirit of Lavender.
   Oil of lavender, three drams,! Put  the  oils into the
   Oil of rosemary, one dram,    spirit of wine, let it in-
   One nutmeg, grated,          I fuse twenty-four hours,
   Oil cinnamon, thirty drops,   ^observing to shake ilr
   Oil cloves, twenty drops,      now  and then.  After-
   Spirit of wine, four ounces,  j wards fill up a conlmon
black  bottle with proof  spirits, or in  other words, add 
508
DIFFUSIBLE STIMULANTS
three half pints of best whiskey, or rum.   Dose from
twenty drops to tAvo or three tea spoonfuls on sugar.
                Tincture Cantharides.
  Cantharides pounded, one dram, } Digest seven days,
  Good whiskey or rum, one pint.  3 and  then  strain
carefully through paper, (this must never be omitted.)
Dose from ten drops to twenty; but in tetanus, from one
to three tea spoonfuls.
                Spirit of Turpentine.
  Turpentine is seldom used in practice, but in palsy,
or in cases of severe chronick rheumatism, and in gout
of the loAvest grade, in cases of general debility, accom-
panied Avith  gleet, fluor  albus, &c. this article may be
given to advantage; it may also be  used ay ith good effect
in some protracted cases of ague, taken just before the
chill.  But it must ahvays be recollected that turpentine
is a poAverful stimulant, and must  never  be  given until
Ave are Avell satisfied nothing like plethora, or an inflam-
matory  diathesis exists.   Dose  from twenty drops to
sixty, taken on sugar, or beat up with a  little ravv egg.
               Essence of Peppermint.
  Essence of peppermint is  a safe and valuable medi-
cine in cases of flatulence, and pain in the stomach and
bowels, arising from debility or want of tone.  Dose
from five to twenty-five drops on  sugar.
               Tincture of Assafcetida.
  Tincture of assafcetida is a useful medicine in nervous
diseases, but unless the case is attended Avith very con-
siderable  direct debility, we cannot expect  much effect
from it; the usual  doses containing so  little  assafcetida
that the spirits wine becomes the principal.  Dose from
twenty drops to sixty on sugar, or in water.
                    Oil of Amber.
  Oil of amber is a poAverful stimulant, and a valuable
medicine, where Ave wish to stimulate powerfully.  Dose
from three to ten drops, taken on sugar, or administered
in glysters.
                Spirit of Hartshorn.
  Spirit of hartshorn in closes of from five to twenty-five
drops; in cool water, is a safe and  useful diffusible sti-
mulant, but its effects are very transient. 
DIFFUSIBLE STIMULANTS.
509
                       Garlick.
   Garlick is most easily taken cut in small slices, or the
juice may be expressed from the garlick, and  mixed
with a little sweet  milk;  the sooner  it is  taken after
mixing the better.  Dose a clove or tAvo, or about a tea
spoonful of the juice.  But  if Ave express the juice of
garlick, and dry it slowly, it forms an  extract so strong-
ly resembling assafcetida, that it requires some judgment
to distinguish  them; for it  smells like assafcetida, is
whitish Avithin, and when broken open, it soon acquires
a reddish colour.  I am much inclined  to believe, this
inspissated juice would ansAver every purpose that we
obtain from the assafcetida.
             Tincture of Bark and Ether.
   Tincture of bark, one ounce      ~) Mix:  Dose from
   Ether, two or  three tea spoonfuls. 3 one to three tea
spoonfuls.  This is  a valuable palliative in all habitual
cases of debility of the stomach.
                  Tincture of Bark.
   Bark, one ounce,               ? Digest  one  week,
   Good whiskey or rum, one pint. 3 and then   strain.
Dose from two  to six tea spoonfuls.   This medicine is
seldom necessary; where bark is  necessary, it is best
given in any other form.
                     Laudanum.
   Laudanum is a valuable diffusible stimulant  in many
nervous diseases as  hystericks, low fevers,  &c.  Dose
from ten to sixty drops, repeated twice or  oftener per
day.   For the  preparation of this medicine, see antis-
pasmodick s.
         Stramonium, or James Town Weed.
   Stramonium, according to Dr.  Barton, is  a  valuable
medicine  in maniacal cases, and  in  epilepsy.  (The
leaves or seed ground to a fine powder.) Dose, commence
with two  or three grains, and cautiously increase the
quantity to thirty or forty grains.
                     Electricity.
  Electricity has been  used for  a long time, but, if I
mistake not, it was falling into disuse till it Avas revived
by the discovery of Galvani.   Since the experiments of
Volta, and others of France, electricity  has been revived. 
510      DURABLE STIMULANTS, OR TONICK?.

and used much in the form of galvanism, as Avell as in the
common way.   I have tried both forms in many cases of
palsy, rheumatism, &c. and I  can  with truth declare, I
never saw any marked benefit from it.   And, notwith*
standing the general recommendation of this remedy, I
am persuaded  a faithful report Avould convince us, that
little benefit follows the use of it.  I am inclined to be-
lieve that, its efficacy  is principally OAving to our over-
looking the nature of it.  It is a diffusible stimulant, and
like remedies of this class is but a palliative, and always
transient in its effects.   If electricity ever  becomes ex-
tensively useful, it must be accompanied with durable
tonicks, as well  as exercise, and particular  attention to
all the usual means for invigorating the body.  I suspect
chalybeates will mostly be found useful where electricity
is likely to be beneficial.   To conclude, it  is probable
that by using electricity as a diffusible  stimulant  only,
Ave will derive some advantage from it.   An interesting
case of a diseased liver is mentioned, I think, by Darwin,
in Avhich this  remedy Avas of singular  service;  but, al-
though I have used this remedy in  many cases, in which
it is usually thought proper, I  have never seen any well
marked benefit from it.
                Camphorated Spirits.
  Camphor, half an ounce,    } Dissolve the camphor
  Good whiskey or rum, a pint. 5 in the spirit, and keep
it  closely  stopped.   This answers well  as a stimu-
lant, in some  hysterical  cases, and  in very low fevers.
Dose, from one to three tea spoonfuls; but this medicine
is used mostly outwardly in strains, &c.

                     section x.

          Durable Stimulants, or Tonicks.

  Incalculable advantages are derived from the use  of
tonicks; of this important truth, we have the most ample
evidence from the experience of every writer, and  also,
in the practice of every day.  But notwithstanding the
most positive  conviction of their utility, when skilfully
applied, still there is proof, equally strong, of pernicious 
         DURABLE  STIMULANTS, OR TONICKS.      511

consequences following their use, in unsuitable conditions
of the body.   And, although I have to acknowledge my
inability to explain their mode of operation, there is no
doubt on the  mind of those skilled iu medicine, but that
they are only useful, or even safe, in cases of direct de-
bility; that is, Avhere there is langour or weakness, unat-
tended by fever or generaL inflammation.
  This important truth  has  been longer overlooked in
cases of mortification, than in any other case; and even
to the present day, physicians of respectability are found,
who vieAV the bark as a kind of specifick in cases of mor-
tification; Avhereas, in gangrene or insipient mortifica-
tion, nothing could be more injurious than so poAverful a
tonick  and stimulant, where there Avas a great excess of
excitement or action  in  the part inflamed; but after the
inflammation is brought  doAvn, the bark becomes indis-
pensably necessary.
  It is  probable, all tonicks  operate principally on the
stomach, and by  giving tone or vigour to that important
organ, exert  a friendly  influence over the  general sys-
tem; both by an  improvement in the process of diges-
tion, and also by an immediate operation upon the ner-
vous system.
   But to conclude: tonicks  or durable stimulants, to be
useful,  must  only be taken Avhen the body is enfeebled,
Avithout fever, or  Avithout an active state of the blood ves-
sels.   In a great majority of our diseases, we must re-
duce the patient by evacuants of  some kind, before they
Avill bear tonicks.  Persons subject to habitual diseases,
mostly  require mild tonicks, in the intervals of their dis-
ease, but during its paroxysm, they mostly  require mild
evacuants, or diffusible stimulants.
                   Peruvian Bark.
   This  valuable medicine  has  been brought to  us in
great variety, and I really feel some doubts, after much
reflection, in  giving an opinion.  I believe, in general, the
yelloAV  that is well ground will be found to  answer, and
for the  present, that which is  put up by  Dr. Sanford, is
the best.
  Many persons  in the country, entertain strong preju-
dices against the bark, from a belief that it  will  stick in 
512     DURABLE STIMULANTS, OR TONICKS.

the bones; nothing can be more ridiculous, for there is no
likelihood of  its even getting into  the  circulation; the
truth is, that  this medicine is a powerful tonick, and
therefore if given in an inflammatory state of the system,
like all other  stimulants, it will  aggravate the disease,
and by the consequent excessive action,  congestions are
formed, which leave obstinate; or incurable rheumatick
affections; but this is  not the fault of the medicine, but
proceeds from  the abuse of it; and the same  consequences
Avould often follow the use of animal food or any other
stimulant, when the body is labouring under an inflam-
matory diathesis.  Dose, from a tea spoonful to a table
spoonful taken in wine,  snakeroot tea, milk, Avater, &c.
according to circumstances; where  it  is used  in  small
quantities, simply as a tonick, it is conjoined to small do-
ses of the elixir of vitriol, to great advantage.
                  Dogwood Bark.
   This is a Araluable  tonick, and may be substituted in
many cases for the bark.   It is sometimes recommended
in strong decoction, but I have seldom found persons wil-
ling or able to take it in this Avay; it  generally nauseates
the stomach: but if the bark is carefully  dried, and then
pounded and sifted through a very fine piece of gauze, or
apiece of bolting cloth, it answers (particularly when
mixed Avith a little bark)  every purpose which Ave can ex-
pect from the bark alone.  Dose, from one to three or four
tea spoonfuls.
                   Elixir Vitriol.
   Elixir a itriol is a mild and invaluable tonick, and has
been long used for indigestion, debilitating SAveats, &c.—
Dose, from five to thirty drops, diluted Avith two or three
table spoonfuls of cool Avater, or it may be combined Avith
bitter cold infusions, such as chamomile,  bark, centaury,
&c.  It is prepared thus:
   Good Whiskey or  rum,  one pint,             7 y.
   Sulphurick  Acid, or oil. Vitriol, three ounces. 3 A'roP
the acid sloAvly into the spirits, digest in  a glass vessel a
feAV hours, then add of cinnamon and ginger, powdered,
each half an ounce; digest again for a feAV days, and then
suffer the grounds to subside to the bottom, and pour off
the clear liquor. 
DURABLE STIMULANTS, OR TONICKS.     513
                  Black Oak Bark:
   This article was warmly recommended by Dr. Rous-
seau, of Philadelphia, a few years  since.  I have used
it Avith evident advantage in several cases  of intermit-
tents.   Its efficacy depends much on the fineness of the
powder.  Dose from one to four tea spoonfuls, or even
more.
                    Nitrick Acid.
   Nitrick acid is a valuable tonick in scurvy, syphilis,
and in  the  coiwalescence of most fevers; it must be di-
luted in a good deal of Avater.   Dose from  ten  to forty
drops.
                  Extract of Bark.
   Extract of bark is sometimes used instead of poAvder-
ed bark, and has some advantage in the smallness of the
dose; as a mild tonick, it will perhaps answer; but in in-
termittents and mortifications, the bark in substance can
alone be trusted.   Dose from five to thirty grains, in form
of pills.
                  Powder of Bark.
   Bark, two ounces,           1 Grind the cloves well
   Cremor Tartar, half an ounce, \ Avith the cremor tar-
   Thirty Cloves.               ) tar, and mix the whole
well together. This powder will often lay on the sto-
mach where bark alone will not.  Dose from two to six
tea spoonfuls.
                  Wild  Cherry Bark.
   The  bark of the Avild cherry tree dried, and rendered
perfectly  fine, is a pleasant and useful tonick in cases  of
,consumption,  &c; and in all cases where tonicks are ne-
cessary for a length of time, this  will be found a pleasant
 and useful change.
Quassia Wood,
Gentian Root,
Columbo Root,
These are all mild aud va-
luable tonicks; and in cases
of simple debility, they aa ill
  Chamomile Flowers,   ^generally answer our wish
  Carduus, the herb,
  Orange Peel, Centaury.,
but the extract, or Avine bitters made of them, are also va-
luable articles.
              65
es. In general they are best
in the form of cold infusion, 
514      DURABLE STIMULANTS, OR TONICKS.

               Iron Filings and Must.
   These are both valuable tonicks where we  wish to
continue such medicines for a length of time.  They are
more particularly useful in hypochondriacal and hysteri-
cal cases, and in a languid state of the uterine vessel.
Dose from five  to  twenty grains, two or three times a
day.   The following pills will be found a good formula:
Iron filings or rust two drams, myrrh, or assafcetida, one
dram; make sixty-four pills, by adding a  sufficiency of
crumb of bread.
   Physicians are  found avIio still carelessly talk  about
steel, when they mean iron.  This may lead to errour;
for it is well knoAvn the softest iron is the best tonick
this metal affords.
   To have it pure, is a matter of vast importance; and
can only be obtained by filing a soft piece of iron for the
purpose; that from work shops is never to be trusted, as
it  always contains brass, or other metals.
               White  Oxyd of Bismuth.
   White oxyd of bismuth, perfectly white and pure, is
a valuable tonick in cases of dyspepsia.   But for persons
habitually dyspeptick, this article should only be used
as a palliative occasionally; for it soon loses its power.
Dose from tAvo to ten grains, two or three times a day, in
form of pills.
                  Flowers of Zink.
   The flowers of zink have sometimes been found useful
in  epilepsy, and in other spasmodick  diseases.   Dose
from one to seven grains twice a dayr, in form of pills.
               Cuprum Ammoniacum.
   The ammoniated copper  has been recommended by
Cullen  and others, in cases of epilepsy.   Dose from
half a grain to three or four grains.  This article is not
much used in the present practice, but it may, Avith pro-
priety, be alterated Avith otlier tonicks in cases of epilepsy.
                 Fowler's Solution.
   This is a preparation of arsenick, but  may be  used
Avith safety in cases of agues, or in a languid state of the
body, provided we  are certain nothing like plethora or
inflammation is present.  It forms the base of, perhaps,
all ague  drops.  Dose from five to twenty drops, but it 
        ASTRINGENTS, OR  ANTIHEMORRHAGICKS.    515

should never be continued long; and in general, I would
advise people not to use it without advice.

             SECTION XI.--SUBSECTION 1.

         Astringents, or Antihemorrhagicks.

   Some men of eminence doubt Avhether  any articles
operate on  the  living body as astringents, and are for
placing all the articles usually called astringents as com-
mon tonicks.  It is probable  no article, can operate on,
the living fibre so as to produce constriction, or that kind
of solidification Avhich we see in the process of tanning
leather; and further, it must be  admitted that all astrin-
gents, or, in otlier words,  all the articles which have
been considered as astringents, are tonicks.
  But Ave are equally certain  that tonicks differ much in
their operation on  the living  body; aud whatever may
be their mode of operation, some  do certainly restrain
hemorrhage, SAveating, and fluxes, from the bowels,  &c.
while others have  no such effect.   I  have, in  the pre-
ceding article, given  as my opinion, that it is probable
tonicks operate on  the general economy of the stomach,
and thereby improve or perfect the digestion of the food,
and also that they exert an  immediate influence upon
the nerves,  and in either, or both Avays, they give vigour
or strength  to the  system, provided there is a lack of
stimulus.
  If this opinion be correct, Ave may, with tolerable cer-
tainty, conclude that tonicks, which haAe  the property
of restraining the secretions and excretions, operate more
especially upon  the nervous  system.   This conclusion
derives support from the circumstance, that  many of the
astringents belong  to the class of diffusible stimulants,
which have always been  supposed to  operate on  the
nerves;  and further, that they operate  so speedily as to
answer the intention, particularly in hemorrhages, before
any additional strength or  action is imparted  to the  ge-
neral system.   Lastly:  However unable to explain their
mode of operation, the  practice of every  day clearly
shoAvs that Avhat  are considered  astriugents, will check 
516    ASTRINGENTS, OR ANTIHEMORRHAGICKS.

excessive discharges from the body almost  instantly in
some cases, and in others in a gradual manner, but with
equal certainty; and  often too in inflammatory conditions
of the body.
   It is to be  remembered, however, that  astringents,
generally speaking,  are but palliatives  like  diffusible
stimulants, and, further, that in all cases Avhere plethora
or an inflammatory diathesis is present, they must only
be used upon urgent  necessity;, and always accompanied
or succeeded by  evacuations, and particularly  by ab-
stracting blood: this last remark applies to  cases of he-
morrhages, and, indeed, these are the only  cases which
require absolutely, that we continue the term astringent
to some tonicks and  stimulants; or perhaps,  it would be
well to  substitute  the term antihemorrhagicks.    So
speedily will astringents sometimes arrest hemorrhage,
as common salt in bleeding from the lungs; sugar lead
and  opium, uterine  hemorrhage,  &c. that I think  it a
matter of the highest importance that we continue to view
some tonicks, and diffusible stimulants, as having pow-
ers,  in  good measure, specifick  in checking fluxes of
blood; and, whether they operate  on the living, as the
most of them are  known to act upon dead animal matter,
(Avhich is extremely  doubtful,) is a matter of no  conse-
quence, but to  lose  sight  of their effects, Which  are as
evident as the effects of any other remedies, Avould  ma-
terially injure the practice, and lead to danger, for al-
though all  astringents  are either  stimulants or tonicks,
all these are by no means astringents or  antihemorrha-
gicks;  and  hence, to  stickle at viewing some tonicks as
having a peculiar influence, which is more especially cal-
culated to check bleedings for a time, till the  vessels may
be emptied in some degree, because Ave are  able to say,
astringents cannot act on the living as they do on the dead
animal fibre, is certainly to stickle about  trifles, and in
the face of experience. Let us then, on the safe basis
of experience, boldly administer our astringents as anti-
hemorrhagicks  in alarming cases  of hemorrhages, but
never forget they are palliatives, and must be assisted or
followed by remedies suited to the  present  condition of
the body. 
       ASTRINGENTS, OR  ANTIHEMORRHAGICKS.     517

                    Common  Salt.
  The unquestionable efficacy of this remedy, in check-
ing hemorrhage from the lungs, has given rise to the li-
berty I take  in proposing the term  antihemorrhagicks,
for that of astringents, for common salt  cannot, strictly
speaking, be  viewed either as an astringent, or tonick, in
the case before us, according to the common notion of as-^
tringency; but there is  every appearance of  this article,
and several others, as opium and ipecacuanha, having
antihemorrhagick effects,  and therefore, I think it Avould
be an improvement in nomenclature to substitute the term
antihemorrhagicks, in  many cases,  for  that of astrin-
gents; but as I feel much diffidence in suggesting innova-
tion in technical language, I have continued the term as-
tringents, and hope this explanation will excuse me for
including under this head, things which are certainly an-
tihemorrhagick, but are not astringent.
  Common table salt is given to arrest bleeding from the
lungs,  Avith safety  and  good prospect of success in all ca-
ses, but must always be folloAved by suitable remedies
which are more permanent, but sloAver in operation; these,
generally, are bleeding, or nauseating articles, &c; but
in cases of Avell marked, direct debility, durable tonicks,
rest, and mild but nutrient food.   Dose from  two  to ten
or more tea  spoonfuls, taken  in  a  dry  state, nor must
the patient drink  immediately afterAvards, or its effect
will be lost.
             Laudanum, and solid Opium.
  Strong  opiates  are  valuable antihemorihagicks, in
some cases of uterine hemorrhage, and  bleeding from the
bowels; but are only admissible Avhere inflammation has
not come on, which opiates will often prevent, or after in-
flammation has in a good measure subsided.   Where Ave
have doubts about the presence of inflammation, or where
it has not made its appearance, Ave should combine a lit-
tle sal. nitre, or a very little ipecacuanha; the first Avill
have a tendency to cool, and the latter, by exciting nan
sea, will weaken the force of the heart, and thus accom-
plish our purpose.  Dose of laudanum from ten to  six-
teen drops, of opium from one to three grains. 
518       ASTRINGENTS, OR RESTRINGENTS.

                    Sugar Lead.
   Sugar of lead may be given with safety and advantage
in hemorrhages from the uterus,  fi om the intestines, or
from the stomach; but although perfectly safe in the hands
of the physician, I would advise  that it only be used in
cases of emergency Avithout advice.   Dose from  one to
five grains, in form of pills, and I think it should always
be  combined with a fourth, a half, or a  whole grain of
opium, to each dose.  And it must be remembered, that
unless two or three doses answer our wishes, we should
not repeat oftener, on  the same day: three or four pills
containing each two grains of the lead, and repeated eve-
ry quarter, half, Avhole, or two  hours, according to the
urgency of the case, aa ill mostly answer our purpose.
                   White Vitriol.
  White vitriol, in doses of two or three grains, combin-
ed Avith a fourth, or half a grain of  opium, has been found
a useful antihemorrhagick; where fever is present, it
must be given so as to  excite slight nausea.   It is prin-
cipally useful in hemorrhage from  theboAvels unattended
with considerable fever.
                       Alum.
   Alum has  been much used for restraining hemor-
rhages in  general, but, since the introduction of sugar of
lead, it has been less used.  Where other articles are not
at hand, it may be used sometimes with considerable ef-
fect.  Dose from ten to  twenty grains, repeated  every
half hour, or  as the  case may require.   Alum  may be
used Avith good effect in agues, w here the bark cannot be
taken; for this purpose, it must be combined with  some
aromatick, as nutmeg, or cinnamon, &c.

                  SUBSECTION 2.

           Astringents, or Restringents.

  Restringents are, perhaps, all tonicks; but as all ton-
icks have no immediate or speedy restringent effect, there
is an absolute necessity for distinguishing a few of them,
under the head of restringents. 
          ASTRINGENTS, OR RESTRINGENTS.        519

  The articles placed under this  head, are such as are
known to lessen profluvia, or excessive discharges from
the body; but being tonick, are never allowable or safe,
where there  is plethora, or inflammatory action.  Most
of them have little or no antihemorrhagick effect; those
that have, are  either given in smaller quantities, or  at
longer intervals; they are given principally for affections
of the first passages.
             Dewberry Root and Leaves.
  A large handful of deAvberry root fresh, and cut  into
pieces; or the same quantity of leaves, boiled a few mi-
nutes in a neAv earthen  pot, with one quart of water, is a
mild and useful restringent, in cases of diarrhoea, dysen-
tery, &c.  Dose a wine glass every tAvo or three hours.
                    Iceland Moss.
  Iceland moss is a valuable and mild restringent, in ca-
ses of diarrhoea, particularly that attending consumption;
and on account of its nutrient, mild tonick and restrin-
gent properties, is  an invaluable  medicine; and,  in my
opinion, ought to be much more used in all cases of chro-
nick debility.  It may  be boiled in Avater, in the propor-
tion of an ounce to a quart of Avater for cases of diarrhoeas
but where Ave Avish to  obtain  its  nutrient properties, it
should be boiled in milk; in this form, it is essential that
Ave prepare but little  at once.  In both forms, it may be
taken in the quantities of a Avine glass, occasionally.
                     Uva  Ursi.
  Uva Ursi, taken in the form of powder, in doses of from
tAventy to sixty grains, two  or three times a  day, is a
valuable restringent, more particularly, in debilitating
discharges from the urinal organs.   It may also be given,
Avith good effect, in debility of the bowels; and Avhen ta-
ken in milk,  it is  slightly nutrient.
                    Lime Water.
  Lime water is an useful restringent in  cases of protract-
ed  diarrhoea, weakness of the urinal  organs, attended
Avith stone or gravel.    It is  made by moistening a Avell
burnt piece of lime Avith a small quantity of water,  and
as soon as the lime is  slacked, pour on cold water, which
in bulk, Avould  be  about ten times  greater than the lime,
stir this well, then suffer the lime  to subside, and strain 
520           EXTERNAL ASTRINGENTS.
the clear liquor  through common brown paper placed
over a funnel; afterwards it must be carefully stopped in
glass bottles, and this must be done immediately, or the
lime will separate from the water.  Dose from two to four
ounces, frequently repeated, but like the alkalies, it will
injure the stomach if long continued.
                Kino, (a Gum Resin.)
  Kino, in form of pills, or ground in water, with a lit-
tle sugar, and one drop of oil of anise to each ounce of
Avater, is a valuable restringent where Ave Avish a speedy
effect; and even in protracted cases of hemorrhage, it will
be found a valuable astringent.  The dose of kino, ei-
ther in substance or mixture, is from five to hventy grains,
twice a day.   Laudanum in small doses is  a  valuable
restringent.
  Alum.             1 These are all safe restringents,
  White vitriol,         but Avith the  exception of  the
  Sugar lead,          ^oak bark, they must be given in
  Extract of logwood,   very small doses, and may most-
  Elixir vitriol,         ly be combined with small  do-
  All pleasant bitters.J ses of laudanum.   Or require
the co-operation of exercise, strict temperance, bathing,
mild  but  nutritious  diet.  The  sugar  of lead,  though
perfectly safe, in small  doses, as half or a whole grain,
should never be continued more than a feAV days.

                   SUBSECTION  3.

               External Astringents.

  External astringents  are remedies  applied in form of
liniments, ointments, or  embrocations, with the intention
of repelling or drying up sores, of various kinds.   And it
must  be remembered of these, that like internal astrin-
gents, they are only safe, where the body is free from any
considerable fever or plethora.   But in many cases,  ex-
ternal astringents may be used before fever has come on,
and thus arrest local affections before the general system
is brought into sympathy.   And in many slighter cases,
nothing is to be  apprehended from their application to
weeping surfaces. 
               EXTERNAL  ASTRINGENTS.           521

               Decoction of Oak Bark.
  The inner bark of oak is to be chipped, and a large
handful boiled a few minutes in a new earthen pot, with
about half a gallon of water. This may be used for Avash-
ing old sores, ulcers, protracted cases of burns, and scor-
butick or scrofulous ulcers; and where there is considera-
ble debility without fever,  a little  alum may be  added.
This decoction should be used tepid.
                    Lime Water.
  For preparing lime Avater, see subsection second, of the
article on astringents.   This is a valuable external as-
tringent in all cases where Ave Avish to  dry up weeping
or running sores.
               Lime Water Liniment.
  Mix equal quantities of lime Avater, and  SAveet oil or
cold draAvn flaxseed oil.  This is generally viewed ra-
ther as an emollient, but is certainly slightly astringent,
and a valuable application in  cases of burns, and other
painful  sores.
                 Liniment of Lead.'
  Sweet oil one ounce, sHgar lead half a dram, shake this
well together.  This is a valuable astringent in cases of
piles, and for other painful sores, it may sometimes be
applied to inflamed eyes.
                    Lead Water.
  Spring water one  gill,  sugar of lead fifteen grains.
This is a mild and useful external astringent, and may
be made a little stronger or Aveaker, as the case may re-
quire; it will be obvious that the more lead, the more as-
tringent the solution.  It should never be applied to large
raAv surfaces.
                       Borax.
  Borax dissolved in rose water or common water, is a
valuable external astringent for sore nipples, chaps of the
lips, &c.  It is also a valuable  article  in mouth Avater.
Dissolve half a dram in one gill of cold Avater.
              Ointment of White Lead.
  Bees-Avax one ounce, best hogslard three ounces, melt,
and while cooling, stir in six drams of the Avhite lead
ground fine.  This ointment is useful in chaps, excoria-
             66 
52%               ANTISPASMODICS.
tions, &c. and may sometimes be applied to small ulcers
with advantage.
               Ointment of Calamine.
  Yellow Avax  two ounces, best lard six ounces, melt,
afoid while cooling, stir in two ounces of well ground ca-
lamine, (or lapis calaminaris.)  This has long been used,
as a mild  drying, or astringent ointment; and is  similar
to the celebrated Turner's cerate.   It is used by apply-
ing once a day; and, in general, where it is used, mild
astringent  embrocations or washes, are to be used, as
lime Avater, oak bark, &c. but there may be cases where
the cerate, or  ointment, will answer  better, by  simply
washing the sore with castile soapsuds.
            Ointment of Armenian Bole.
  Red, or Armenian bole, ground fine, may be added in
the proportion of  half an ounce, to  three ounces  of lard
and  one  ounce of wax,  melted, observing  to stir  the
Avhole Avell together till the ointment becomes stiff. This
ointment is often useful in  old superficial sores; but in
general, the calamine ointment Avill answer every purpose
to which this is applied.

                    SECTION XII.

                  Antispasmodicks.

  Antispasmodicks, strictly speaking, are remedies which
are only useful, or even safe, in cases of spasm  arising
from debility;  being Avhat  is properly called  atonick
spasms; for, where  spasm arises in an  opposite  or ple-
thorick, or inflammatory state of the system, being Avhat
has been  called tonick spasms, nothing of a stimulant
quality can be admissible; here bleediug  and other evacu-
ants are the proper, and only antispasmodicks. We are,
therefore, carefully to examine the  case before Ave admi-
nister common antispasmodicks, and be satisfied the
spasm present  is  pf the  atonick kind, or dependant on
direct debility.
                      Opium.
  Opium, in the milder spasmodick diseases, as  hyster-
icks, hypochondriasis, &c. is a valuable  antispasmodick, 
ANTISPASMODICKS.              523
given in doses of, from an eighth of a grain, to a whole
grain.   But in cases of violent spasmodick colick, in se-
vere contused wounds, or in tetanus, we  should begin
with doses of, from one to five or six grains.   Its effects
commence generally in a few minutes, and  Avear off in
from two to twenty-four hours.  It is to be remembered,
that although opium, in proper doses, is a poAverful anti-
spasmodick, it nevertheless will produce  spasms, when
given in overdoses.
                     Laudanum.
  Opium, half an  ounce,  good whiskey or rum, half a
pint; cut the opium into small slices, digest about a week,
and then strain.  The same observations apply to lauda-
num as  to the solid opium, with this difference, that the
liquid will operate more speedily, and sooner lose its ef-
fects. Dose in mild diseases from ten to thirty drops; in
violent cases from a tea spoonful to a table spoonful; it is
in cases of disease from drinking cold water, Dr. Rush
mentions so  large a dose as a table spoonful;  it is seldom
safe to give more than two or three tea spoonfuls.
                       Ether.
  Vitriolick ether is a powerful, and  speedy, antispas-
modick, and may be given in doses of, from ten  drops to
hvo or three tea spoonfuls; more  than a tea spoonful is
not often necessary.  It must  always be taken  in cold
water, and may  be combined Avith laudanum to advan-
tage.  Ether must always be well stopped, and it will
generally be best to pour the quantity wanted, as near as
we can guess, at once into a tea spoon, for,  if we suffer
it to drop, it Avill evaporate and lose  its properties.  It
may be Avell to  remember, that if it is dropped near a
candle it may take fire, and this getting into the vial, has,
sometimes produced great alarm, and is not without dan-
ger to the bystanders.
            Compound Spirit of Lavender.
  For the preparation of  compound  spirit of lavender,
see the section on diffusible stimulants.  This is an use-
ful antispasmodick, in low nervous diseases;  but is a
powerful  stimulant.  Dose from twenty drops to one or
two tea spoonfuls. 
524
ANTISPASMODICS
                     Assafcetida.
  Assafcetida, in form of pills, is  a valuable antispas-
modic^ and  has the  advantage of opening the bowels
slightly.   Dose  from five to twenty grains.
              Tincture of Assafcetida.
  Assafcetida six drams, good whiskey or rum, half a
pint, digest about a week, and strain; this is given in do-
ses of, from ten to fifty drops, in cases of hysterical, or
other mild spasmodick diseases.
              Antispasmodick  Glyster.
  Dissolve one or tAvo drams of assafcetida, in the usual
quantity of water, and administer it as a glyster; this will
sometimes be found a valuable article for persons affect-
ed with asthma,  hystericks, &c.  and for those who can-
not take assafcetida in any other form.
                      Garlick.
  A clove or tAvo of  garlick sliced, and taken  raw; or
the expressed juice inspissated, and made into pills, is
a valuable antispasmodick, in cases of hystericks, hypo-
chondriasis and  asthma, more particularly, when these
diseases are of long standing, or in reduced habits.  The
dose of the inspissated juice may be from five to tAventy
grains.
                Whole Mustard Seed.
  Whole mustard taken in doses of, from half to a whole
table spoonful, in molasses or thin jelly, is  a valuable
antispasmodick,  in cases of habitual or  gouty cramps in
the limbs.
                  Rue, the Juice.
  Rue juice, expressed from the fresh  plant, and taken
in doses of, from one to two tea  spoonfuls, in milk, or a
little mucilage, is a good antispasmodick, in hysterical
cases, and in cases of spasmodick affections of the lungs.
                        Wine.
  Good old madeira, sherry, or lisbon  wine, sAveetened
in water,  or made into Avhey Avith milk, is an excellent
antispasmodick, in all  cases  of spasms of the atonick
kind.  But, in general, other articles are to be prefer-
red, lest the Avine lead to a bad practice of taking too
much. 
CARMINATIVE STIMULANTS.
525
                    Oil of Amber.
   Oil of amber is a useful antispasmodick, in cases of
 tetanus, and in the comatose state of low fevers.  Dose
 from three to ten drops on sugar.   This article may also
 be used in injections, from fifteen to twenty-five drops,
 may be added to a common  glyster.
                    Balsam Peru.
   Balsam Peru in doses of from tAventy to thirty drops,
 on sugar, is a useful antispasmodick, in cases of lead co-
 lick.   It may be combined with castor oil.
               Sweet Spirit of Nitre.
   Spirit of nitre, in doses of from one to three tea spoon-
 fuls, is a pleasant and valuable antispasmodick, in al-
 most every variety of spasm.   It must always be taken
 in cold Avater.
            Valerian, (Sylvestris  or  wild.)
   Valerian, in form of powder, or in tea, is a valuable
 and mild antispasmodick, in hystericks, and in low fe-
 vers, St. Vitus' dance, epilepsy, &c.  Dose in poAvder,
 from tAventy to forty grains, in tea; half a pint of boiling
 water may be added to two drams of valerian. The tea
 must not be suffered to boil, it must be  closely covered,
 and never suffered to stand  long.
                    Sugar Lead.
   Sugar of lead combined with opium, in form of pills,
 will be found a   safe  and valuable  antispasmodick, in
 some cases of violent asthma.   Sugar lead, eight grains,
 opium two grains, with a little crumb of bread, make four
 pills; give one every twenty or thirty minutes.

            SECTION XIII.--SUBSECTION 1.

               Carminative Stimulants.

   Carminatives in  general, are both diffusible stimulants,
 and antispasmodicks; but nevertheless differ in this, that
 carminatives are given exclusively with a view of expell-
 ing wind from the stomach.  They seem to operate by
 imparting a due degree of stimulus to the languid sto-
mach, by which this viscus is enabled to throw off sharp
wind, &c.  And it is to be remembered of carminatives, 
526
CARMINATIVE ANTACIDS-
 that they are only admissible Avhere the stomach is in a
 state of atony, for as they are stimulants of speedy ope-
 ration, much mischief may arise from their use in cases
 of inflammation of the stomach and bowels, and also, in
 cases of disordered stomach attended with fever.
              Essence of Peppermint.
   Essence of peppermint is a valuable carminative, ta-
 ken in  doses of  from five to twenty drops on sugar, or
 made into tea.  Or tea may be  made of the dried herb.
                 Oil of Spear Mint.
   The oil  of mint, taken  on sugar, or in the form of
 tea, is an excellent carminative.  Dose from two to six
 drops.
                    Oil of Anise.
   The oil of anise, and of fennel, are good carminatives,
 Dose from  one to four drops, on sugar, or mixed with a
 little magnesia.

   Ginger given in form of strong tea, but, in small doses,
 as two or three table spoonfuls,  is a good carminative.
                  Spirit of Nitre.
  The sweet spirit of nitre is a very valuable carmina-
 tive, in doses of from ten to thirty drops, in cool water.
                      Saffron.
  Tea of English saffron,  made weak, is a good carmi-
 native.  It is to be taken in small doses.
                    Soda  Water.
  Soda water, highly charged with fixed air, is an ex
 cellent carminative.   But this is more properly, a car-
minative antacid.  Mild pleasant aromaticks in general,
 are carminative, as cinnamon, nutmeg, &c.

                   subsection 2.

               Carminative Antacids.

  Carminative antacids are remedies Avhich exert an im-
mediate effect upon the stomach.  But they operate  very
differently from carminative stimulants; for, instead of any
immediate stimulant operation upon the economy of the
stomach, they afford relief by neutralizing acid wind or
Ginger. 
CARMINATIVE  ANTACIDS.
527
fluids, and probably also destroy fluids, &c. in the form
of oxyds, which offend the stomach.  And as the chymi-
cal changes  among those articles, when taken into the
stomach affected Avith acid, have a refrigerant effect, and
often  form mild neutral salts, Avhich  gently move the
bowels, we may often give carminative antacids,  even in
cases  of  high fever, with the most happy effects; and in
those  general diseases of a middle grade, attended with
much sickness at stomach, or pain in the stomach, they
may be combined with small doses of carminative stimu-
lants with great advantage.  But active inflammation of
the general system, should ever be a bar to the use of car-
minative stimulants.
                       Soda.
   Sal. soda, or the mineral alkali, is a most invaluable
antacid.   Half a dram may be dissolved in ten  table
spoonfuls of cold water; of this a spoonful may be taken
occasionally, in violent cases  of cholera morbus, every
few minutes.  This is a useful medicine for the  griping
of children; for this purpose, a very small portion of oil
of anise, or spearmint, may be added.
                     Sal. Tartar.
   Salt of tartar may be used in all cases Avhere antacids
are necessary, but it is much more offensive to the  taste;
and I have long been of opinion that it would sooner in-
jure the stomach, where it is long continued, than  soda.
One scruple will be found about equal to half a dram of
the soda.  Both these articles may be rendered more pa-
latable, and often equally useful, by mixing a little lemon
juice, or pleasant vinegar, to solutions of  them,  and by
way of variety, a little sugar may sometimes be added.
They may also be advantageously combined with essen-
tial oils, as mint,  &c.
                     Magnesia.
   Magnesia is less refrigerant than salt of tartar, or soda;
but as it is calculated to combine with acids in the sto-
mach, and, by such combination, to form a saline  matter,
which opens the bowels, it is admissible in all cases
where antacids are proper; but it is never useful, unless
acid be present, which causes it to pass through the boAV-
els.   Dose from one to three tea spoonfuls, in water, or 
528
FEBRIFUGES.
eaten in the dry state.  Calcined magnesia, is the strong-
est antacid.
                  Prepared Chalk.
   Prepared chalk is a valuable antacid, particularly for
children.   A few grains may be mixed with water, and
the smallest possible quantity of oil of anise added, or
it  may be given alone, in cases of colicky  affections of
children.   If costiveness attend its  use, a  little  lemon
juice or vinegar and sugar may be given; and if this does
not open the bowels, give a purge.
                    Lime  Water.
   Lime water is a valuable carminative antacid in cases
of dyspepsia, and many other windy affections of the sto-
mach and boAvels; but  it seems more particularly suited
to persons advanced in life.  Dose from a spoonful to
half a gill occasionally.  [See restringents for the me-
thod of making it.]
               White  Oxyd of Bismuth.
   The oxyd of bismuth must be chosen perfectly Avhite.
It is  a most excellent antacid  in  cases  of dyspepsia,
Dose from two to ten grains twice a day.
                   Elixir  Vitriol.
   Elixir vitriol is, perhaps, more generally used as an
antacid than any  other medicine.  It is more slow in its
effects than most others, but may be  continued  longer
than any one with Avhich I am acquainted. It is a valua-
ble tonick, Avhile all the articles mentioned  in this sec-
tion are mere palliatives, and ought never to be used for
any great length of time.  Magnesia is someAvhat of an
exception to this remark.

                    SECTION XIV.

                     Febrifuges.

   Febrifuges are medicines which are  supposed to have
some cooling, or rather a specifick effect, in  cases of fe-
ver.  But  it may be remarked in the first place, that
nothing Avill have much effect in cases of ardent fever,
but such  as produce some  considerable  evacuation, as
bleeding, purging, vomiting,  sAveating, &c.  And,  se~ 
FEBRIFUGES.
529
 condly, it may be observed, that all remedies which have
 been considered febrifuge, are laxatives or  diaphoret-
 icks, or diureticks, &c; and as the effects which usually
 folloAV diaphoreticks are only calculated to remove slight
 febrile  diseases, Ave must always view febrifuges as mild
 auxiliaries to more poAverful evacuants.  And from care-
 ful observations for several years, I am well  satisfied
 but little  dependance can be put on any medicine given
 as a febrifuge that does  not actually purge, or produce
 some other considerable evacuation.  But in fevers of a
 Ioav grade, or in other cases, after the body is someAvhat
 reduced,  by more active articles, febrifuges  are  valuable
 medicines.
                      Sal. Nitre.
   Sal.  nitre,  or purified saltpetre, has been long and
 generally used  as  a febrifuge.  It may be  given  in fe-
 vers in general; but if it is given in  large doses, it will
 sicken the stomach, and if long continued, will always
 impair  digestion.  Dose from five to fifteen grains, every
 feAV hours.
                   Tartar Emetick.
  Tartar emetick is a useful febrifuge in cases  of com-
 mon inflammatory fevers, as pleurisy, phrenitis,  &c. pro-
 vided sufficient evacuations are  made by the use of the
 lancet,  purges, &c.  Dissolve  two grains in a pint of
 cool water.   Dose one or two table spoonfuls every few
 hours.
                  Antimonial  Wine.
  For the preparation of antimonial wine, see the article
 on emeticks.  This is a good  febrifuge, but is  not  es-
 sentially different from the mixture  of tartar emetick.
 The dose being smaller, and the  taste less  offensive,
 renders it sometimes preferable to the solution.
                    Ipecacuanha.
  Ipecacuanha is a valuable febrifuge in cases of fevers,
 &c. where we wish to lessen the  action of the pulse.
But it must be given so as to excite  slight nausea.   It
may be combined with small doses  of calomel or of sal.
nitre.   Dose from one to five grains.
67 
530
EMMENAGOGUES.
                   Cremor Tartar.
   Cremor tartar taken in doses of a tea spoonful or two,
 and repeated pretty often, so as to open the bowels, is a
 mild and useful febrifuge.   From half, to an ounce may
 be taken in twenty-four hours, and it may be rendered
 palatable by mixing with sugar.   Or a pint of boiling
 water may be poured  on two drains of cremor tartar, and
 a little sugar added; of this, let the feverish patient drink
 freely.
                   Saline Mixture.
   For the preparation of this saline mixture, see the sub-
 section on refrigerant diureticks.   It is a mild and use-
 ful febrifuge in fevers  generally.  Dose from half to a
 whole table spoonful, repeated every few hours.
                  Nitrous Mixture.
   For the preparation of this article, see the subsection
 on cooling diaphoreticks. It is a very pleasant and use-
 ful febrifuge, and admissible in all cases where we wish
 to lessen  febrile action.  Dose a table  spoonful about
 every two or three hours.

                     section xv.

                   Emmenagogues.

   Emmenagogues are medicines which  are supposed  to
 have some specifick operation over the menstrual dis-
 charges of women.  But while Ave are compelled to ad-
 mit that some articles do exert such influence, we should
 carefully bear in  mind, that all reputed emmenagogues
 are powerful stimulants and therefore can only be given
 with safety where there is strong evidence of langour, or
 debility of the general system, or Avhere periodical dis-
 eases, or chronick inflammation is present,  and being  of
 the rheumatick kind.  In all these cases, emmenagogues,
judiciously given, may have  a ^ood effect upon the fe-
 male constitution, where the menses are absent.
                 Calomel and Aloes.
   Calomel half a dram, aloes one scruple; rub the aloes
fine, and make  sixteen  pills, adding a  little crumb  of
bread.   One of these may be taken every other evening 
LITHONTRIPTICKS.
531
in chlorotick cases, or in cases of obstructed menses ge-
nerally.  If they purge much, an  anodyne may be given
on the evenings no pill is taken.
               Tincture of Guaiacum.
  For the preparation of this tincture, see subsection on
stimulant alteratives.  Dose from one to three tea spoon-
fuls.  This tincture is most beneficial in  cases of pain-
ful menstruation, but may be given with advantage, in all
cases of obstructed menses, attended with langour or de-
bility of habit.
                      Madder.
  Though the efficacy of this article is somewhat doubt-
ful, it is recommended  by the excellent Denman, as an
emmenagogue.   Dose about half  a dram.
                    Pennyroyal.
  Pennyroyal has been used Avith  advantage as an emme-
nagogue, and was lately brought into notice by Dr. Wat-
kins, of Baltimore.  It may be used in tea, or from one
to five drops of the  oil.   It is a powerful stimulant, and
only proper for persons free from fever, and only a few
doses taken at the time the menses are expected.
                     Mustard.
  Whole mustard seed may be taken in doses of from
a half to a Avhole table spoonful every night going to bed,
in molasses; and is often a good emmenagogue.
                        Iron.
  Iron, the rust or filings, is a most valuable  emmena-
gogue in cases of considerable debility of habit, but as it
acts on the general system by its tonick properties, I
must refer the reader to the section on tonicks.

            SECTION  XVI.--SUBSECTION  1.

                   Lithontripticks.

  Lithontripticks  are medicines  which were long used
under a belief that they possessed the power of dissolving
calculi, or stones  in  the human bladder; and perhaps
they are still taken by persons  under similar expecta-
tions.  The most ample experience however, has proved
that no medicine has any such poAver.  But there is strong 
 532          ANTACID LITHRONTIPTICKS.

 grounds for believing that those articles Avhich have
 maintained their credit as lithontripticks, are either  an-
 tacids or mild tonicks.  And it is highly probable, con-
 stitutional  debility is almost universally the cause of cal-
 culi, or stones in the bladder.  I have elsewhere endea-
 voured to argue that gravelly complaints are often the con-
 sequence of a gouty diathesis.  Now although we are not
 able by means of lithontripticks, to  dissolve the stone,
 the above view of such cases, teaches us that, as acidity
 in the stomach, &c. is the cause of such stony collections,
 and that this tendency  to acidity, arises from debility of
 habit, Ave have reason to believe, that by giving antacids,
 we can, not only prevent  their increase, but  further by
 combining tonicks with our antacids,  Ave may wholly re-
 move such tendency from  the  system, and therefore we
 may justly consider several articles as having lithontrip-
 tick properties.  Believing as  I do, that it is a matter of
 consequence to have  a correct notion  of lithontripticks, I
 shall briefly state their nature, as  respects gravelly pa-
 tients.  Chronick debility disposes to acidity, acidity in
 some habits disposes to gravel, therefore, the indications
 are to  obviate such a state of debility, to destroy or re-
 move such acidity as predisposes to  stone  and  gravel,
 and thereby to prevent the future increase of such a com-
 plaint.  But experience amply proves  that some mild
 tonicks have something like a  specifick effect  in calcu-
 lous complaints; not of dissolving concretions, but they
 have a diuretick, or some kind  of  soothing power.  But
 after all, if the above theoretick view be correct, we are
 always to  combine the antacid,  with tonick lithontrip-
 ticks.   All  lithontripticks should be  combined freely
 Avith mucilage.

                   subsection 2.

                     Magnesia.

  Of all antacids magnesia is  the best for gravelly pa-
tients:  I have often  seen  the most marked advantages
from it, and it may be taken, I think, with the same free-
dom, as to time, as was allowed by Sydenham  for the 
TONICK LITHONTRIPTICKS.
533
use of steel, Avhich was to use it thirty years, and then if
necessary, begin again.   If it operates gently upon the
boAvels, it  is  sure to give great relief, in cases of stone
and gravel, that are  not advanced beyond remedy.  The
calcined will  sometimes  be necessary to alternate with
the common magnesia. Dose from two to six tea spoon-
fuls, tAvice a day.
                     Castile Soap.
   Castile soap, if genuine, that is, made of fresh olive oil
and soda, as it ought to be, and not too old, is a most ex-
cellent lithontriptick, and may be continued for any length
of time.  The soda destroys the acid of the habit, while
the oil defends the surface of the stomach, from the acri-
mony of the soda.   Dose from one to four drams, taken
in two or three doses per day.
                    Lime Water.
   Lime water carefully made, and strained, is a valuable
lithontriptick; but if long continued will injure the sto-
mach.  In general, this  article should  be  taken along
with castile soap; or, I think the best Avay is to alternate
the lime water with  the other articles, and never use it
more than a feAV weeks at a time, and then leave a con-
siderable interval before it is used again.  Dose from half
a gill to half a pint per day.  For the preparation  of lime
water, see the second subsection on astringents.
                     Sal. Tartar.
   Sal. tartar has sometimes been used as a lithontriptick,
but this article can never be given for any considerable
length of time, without much risk of impairing the tone
of the stomach.

                    subsection 3.

                      Uva  Ursi.

   Uva ursi is probably, one of the best touick lithontrip-
ticks, and may be given in all cases of gravel or stone
But I think, we should ahvays combine antacids with the
uva ursi, or any other tonick lithontriptick.   Dose from
twenty to sixty grains, of the leaves powdered, tAvire a
day, in a little milk. 
534
OPHTHALMICKS.
                     Raw Coffee.
   Raw coffee has been given with good effect, in cases of
 gravel, &c. and as it has no immediate antacid proper-
 ties, Ave are warranted  in placing it among the  tonick
 lithontripticks.  Take a large spoonful of green  coffee,
 well washed,  and boil it for a few minutes, in a quart of
 water; this may be all drank in two days.
               Wild Carrot, {the seed.) #
   The wild carrot seeds have been used Avith good effect,
 in many cases of gravel, and may always be alternated
 with those above.  Take an ounce of the seed,  and boil
 them in a quart of water, then take the infusion in such
 quantities as to use it all in three days.   But it is more
 economical to powder the seeds fine, and take from a half
 to a whole dram, twice a day.  The coffee beans may
 also be used more economically, in the form of  powder.
                    Iron Filings.
   Although iron cannot be said  to have any immediate
 lithontriptick properties, still as it is one of the best ton-
 icks, and as gravel is mostly found in debilitated habits,
 the iron  is among the best  remedies, in  such habits for
 the gravel or stone.   For this purpose the iron in form of
 filings, or rust, may be combined with antacid, or tonick
 lithontripticks, as the case may require; and from half to
 a dram of the iron per day, may be taken.

                    section XVII.

                    Ophthalmicks.

   Ophthalmicks are  remedies applied to the eyes,  in ca-
 ses of  inflammation,  or what  is commonly called sore
 eyes.   A very great  number of articles have been pro-
 posed for this purpose, and from  the  extreme discor-
 dance of their properties, there is little doubt but more
 mischief has  been done the eyes than benefit.  It was
long ago observed, by the illustrious Cheselden, that no
washes containing powders should be applied to the eyes.
And as far as  my opportunities enable me to judge,  this
opinion is correct, and of vast importance.  I have ob-
served, see inflammation of the eyes, that saline articles 
OPHTHALMICKS.               535
ought not to be used in active inflammation of the eyes.
The following ophthalmicks will generally be found to
answer our wishes.
                  Milk and  Water.
  Take equal parts by measure, of hot water, and milk
Avhich  has stood a few hours and been  once skimmed.
This should  be made in small quantities, and  may  be
applied to the eyes in all severe cases, either warm or
cold: persons Avho  go out should not use it warm, at least
when the weather  is cold.  No person who has not made
sufficient trial, can imagine the benefit Avhich may gene-
rally be derived  from  a  perseverance  in  this article.
But I have seen many persons making a large  mixture
of milk and Avater, and washing the eyes  in the same
vessel  for a day or two, but it should be made every two
hours in warm weather, and twice a day in winter, and
but a little of it should be poured out for use at each time
of using.
                  Saffronized Milk.
  Boil a few grains of English  saffron a few minutes, in
equal  parts of milk and water.  This may by used as
above directed, for milk and water, but it may be observ-
ed, that this is a little stimulant, and will be found most
useful  in cases  somewhat abated of their inflammation.
It should ahvays be carefully strained, and never long
kept.
                    Rose Water.
  Rose water is a  very mild astringent, and Avhen appli-
ed  at  a very early stage of  ophthalmick inflammation,
will often go far to prevent its progress.   This article is
always to be applied cold, and therefore  is not proper in
cases of very high  inflammation.
               Lime Water Liniment.
  Best sweet oil, or oil of almonds, and lime water equal
parts.  This may  be applied  in cases  of inflamed eyes,
with great success, particularly in cases where washes have
been used ineffectually, or where the eye lids incline to
stick together. For want of good lime water, about three
grains  of sugar of  lead may be dissolved in an ounce of
oil of almonds, but this is more stimulant, and not as  ge-
nerally successful. 
536
anodynes.
   Brandy diluted Avith water,
   Rose water with a little laudanum,
   Chamomile boiled in milk, and a little laudanum,
   Lead water,
   Weak solutions  of white vitriol, are all  stimulant
ophthalmicks, and are often used with advantage before
inflammation has run high, but more  particularly after it
has assumed the chronick form.   They are always dan-
gerous where there is much  pain or acute inflammation.
It is  to be observed of diseases of the  eyes, that al-
though the foregoing articles and many others  are often
highly beneficial, we are never to trust them alone in se-
vere cases.
   The most prompt use of the lancet; leeches  about the
eyes;  blistering about the neck; or even on the eye; ac-
tive cooling purges; Ioav diet; and shunning the light, are
often  necessary to prevent the loss of sight.

                   section xviii.

                     Anodynes.

   But few people have any correct notion of anodynes,
for it is almost universally supposed, that opium is the on-
ly medicine which promotes sleep, and this it is  supposed
to do  hy some specifick property, of a soporifick quality.
But the truth is, that opium  in every  form, is a poAverful
diffusible stimulant, and  therefore, unless  the  system is
suitably languid, or reduced, or at least free from inflam-
matory action  or  fever, opium instead of promoting or
producing sleep,  distracts the brain, and often  produces
delirium or total inability to sleep.   So that in all  dis-
eases  where there is considerable fever or fulness of ha-
bit, things quite opposite in their nature from opium, be-
come  anodyne, Avhile opium will raise the fever, &c.  and
have quite an opposite effect. Here a bleeding, a purge,
an emetick, or cooling drinks, accommodated to the case,
will induce sleep, by loAvering febrile action.
   Let it be remembered then, that all remedies which are
reputed anodynes are stimulants, and are only admissible
where there is no acute inflammation.  And further, opium 
ANODYNES.
537
being a stimulant, and as was long since observed by Sy-
denham, a cordial also, we are by no means to view it as
a mere soporifick; on the contrary, in all low fevers, in
many cases of chronick inflammation, in recent Avounds,
in all painful diseases, and even in cases of delirium at-
tending Ioav fevers, opium becomes a most invaluable sti-
mulant or cordial, and can be given Avith great benefit at
all times in the day.
   The common but erroneous practice of giving opium at
bed time only, originated at a time Avhen the properties
of opium Avere not understood; and the physician Avho is
not aAvare of the vast benefit Avhich may be derived from
the cordial, or stimulant properties of it, by a proper
adaption of it to a reduced or irritable state  of the sys-
tem, is deprived of one of the greatest sources of pleasure
and convenience to himself, and of incalculable advan-
tages  to his patients.
                       Opium.
   The dose of pure opium is from one fourth of a grain
to three or more, in very violent cases; but the most usual
is about one grain, as a full anodyne. But I strongly sus-
pect Ave neAer meet Avith pure opium in the shops.
   The Eastern people Avho prepare this article, adulter-
ate it shamefully Avith an extract of the poppy, and in con
sequence of this adulteration the dose ought, in general,
to be larger than  is usually recommended; for it is a fact,
that where opium is given to stimulate the languid sys-
tem to the sleeping point, and it  falls sliort of that stimu-
lus Avhich is necessary, it Avill interrupt sleep, instead of
inducing it.  The best way is to  try small doses first, and
gradually increase them; but I have no hesitation in say-
ing, after careful observation, that in consequence of the
reduced quality of opium, our anodynes are generally too
small.
   He who is able to distinguish the proper state of the
body, and the times for administering opiates, may ob-
tain vast advantages from it, and may use it Avith a free-
dom Avhich is not often practised; but if it is given in a
Avrong state of the body, or at an improper time, as  in the
paroxysm of a remitting or intermitting fever, &c. conse-
quences the most dreadful may follow, and the mischief, 
538
ANODYNES.
in all cases where it is wrongly applied, will be 111 pro-
portion to the quantity giveu.  It will be advisable, in all
cases, when commencing with new parcels of opium or
laudanum, to begin  Avith small doses, lest a material dif-
ference in the quality may do injury.
                     Laudanum.
   For the preparation of laudanum, see the section on
antispasmodicks.  This being a mere solution of opium,
we are to expect the same effects from it  as from solid
opium, and the same  observations, as to its nature and
use, apply.  I may  remark, however, that its effects are
more immediate; and the whole quantity coming into con-
tact with the stomach at once, produce greater, but more
transient effects.  It seems to  folloAV that smaller  do-
ses of laudanum must be given, and more .frequently re-
peated.
   There is no doubt on my mind but Ave use a great deal
too much laudanum; and I am convinced many  persons
lose the chance which they might have of procuring sleep
from anodynes, by taking laudanum instead of solid opi-
um.  To conclude,  opium, as a diffusible stimulant, or
antispasmodick, should ahvays be given in the  form of
liquid laudanum; when it is given as an anodyne, it
should, almost invariably, be given in the solid form; and
in most cases of low fever, or acute disease, it should be
combined with two or three grains of ipecacuanha.  The
universal practice of giving laudanum must certainly have
arose' from a lazy habit, Avhich too many have, of giving
their medicines iu the most convenient form.  The mak-
ing of pills is  some trouble; to buy laudanum of the apo-
thecary, is much easier; but let me admonish every per-
son, that reason supports me, and experience gives full
assurance, that opium given as an anodyne must be gi-
ven in a solid state,  or its effects will wear off long be-
fore morning, and leave the patient in a languid, unplea-
sant, or dangerous state.  If laudanum must be given,
never omit to repeat the dose about three o'clock in the
morning, provided no paroxysm of fever be then present,
which would render  it improper. 
VERMIFUGES.                539
                     Paregorick.
   Paregorick may be  made thus: opium,  flowers  of
 benzoin, each half a dram; camphor one scruple; oil of
 anise  half  a dram; good Avhiskey,  or  rum, one pint;
 digest ten  days, and then strain.   The  elixir of pare-
 gorick is certainly entitled to the name  of an anodyne,
 but  is, perhaps, strictly speaking, more  properly consi-
 dered a stimulant expectorant.  It is a valuable remedy
 in cases of protracted colds, in asthma at the close of its
 paroxysms, in hooping-cough on the decline, &c.  But it
 being a  powerful stimulant, it should by no means be
 trifled with, or given to persons labouring under fever.
 Dose from a tea spoonful to three or four.
                  Godfrey's Cordial.
   Godfrey's cordial, when properly prepared, is a Aveak
 solution of opium, salt of tartar, oil fennel, Avhiskey and
 molasses in water; and  is a useful  medicine  in gripings
 of children unattended Avith fever, and is often useful in
 dysentery, old colds, declining hooping-cough, &c.  But
 nothing can be more prejudicial than the practice, too
 common, of constantly dosing children with stupifying li-
 quids.  It should never be given for habitual griping;
 for, by keeping up a constant overstimulus in  the brainu-
 lar system, the constitution may  be totally ruined.
                  The  Common Hop.
   The hop, which we use in  making beer, is supposed
 to have anodyne properties.  It may be  used by laying
 a small bag, containing good fresh hops, under the head
 of patients; but it is a remedy which I canuot recom-
 mend from actual  experience.

                    SECTION  XTX.

                     Vermifuges.

  Vermifuges are  medicines which are given with a vieAV
of destroying worms, found in the human intestines, and
particularly to children.  But as it is highly probable
that  they are not so often detrimental as has been suppo-
sed,  and  as  all reputed vermifuges  are either poAverful
stimulants or drastick articles, they ought to be given with 
540                  VERMIFUGES.
caution.  And let it ever be remembered, that almost all
the diseases of children are inflammatory; and, therefore,
even where there is strong evidence of Avorms, we should
reduce febrile action by evacuations, before we venture
to give vermifuges, and then most of the vermifuges can
be given, not only with a view of destroying worms, but
as useful stimulants, Avhen the system being reduced re-
quires this new stimulus.
  Where there is good evidence of worms injuring a
child, without the presence of fever, common vermifuges
may be given with safety, but we should never give more
than two or three doses; and then carry it off with some
pretty active purge.
                      Calomel.
   Calomel may be given to children with perfect safety,
provided due caution  is  observed.   From five  to ten
grains, mixed with a little sugar, may be given children
from two to ten years,  proportioning the  dose according
to the constitution of the child, and  to the age, &c.  It
should be given going to bed, and carried off in  the morn-
ing with a brisk purge; remembering, however,  that a lit-
tle jalap, or castor oil, will ansAver our Avishes, as the
calomel has a purgative quality.  I have seen more bene-
fit from this medicine than any other vermifuge.
                   Oil Wormseed.
   The oil wormseed is a valuable stimulant vermifuge.
Its stimulant properties render it inadmissible in cases
attended with fever.  This article is to be had of the apo-
thecaries with suitable directions, for its administration.
                 Spigelia, or Pink.
   The worm  pink  is  principally given  in the form of
decoction, but may be given to advantage in the form of
powder,  in doses of from ten grains to half a dram, ac-
cording to  the age of the child.   It may be used in de-
coction; half an ounce may be boiled for some time in a
pint of water, and the  tea sweetened, given in  the space
of tAvo days; Avhen it  should  be Avorked off with some
purgative.   This  article  being a diffusible stimulant,
and someAvhat narcotick, is always dangerous during the
presence of fever,"but when fever has  abated, is given
with much success both as a vermifuge and stimulant. 
MEDICINAL nutrients.
541
                    Common Salt.
   Table salt is favourably spoken of by Dr. Rush, as a
vermifuge.  It may be given in doses of from one to two
or three scruples, according to the age of the child, in
the morning fasting; it may be dissolved in a little wa-
ter, or given dry.
   Wormseed, } These are all stimulants, and therefore
   Rue,       V not  proper Avhere  there is fever,  they
   Garlick,    ) are  to  be  boiled  in  milk,  and given
fasting.

                     SECTION XX.

                Medicinal  Nutrients.

   These are articles Avhich are calculated to obtund acri-
mony of the body, whether partial  or general, but more
particularly when seated in the stomach  and bowels,
Avhile they at  the same time impart a  slight  portion of
nourishment; and this nutrient effect is to be expected of
them, in all cases Avhere the stomach is in a state to act
upon them; and, it is highly probable, a state of the sto-
mach which Avould not act on those mild nutrients would
speedily prove destructive.
                   Slippery Elm.
   The slippery elm bark powdered fine, and  dissolved
in water, is  a mild and agreeable nutriment, and may be
rendered palatable, if necessary, by seasoning Avith wine,
vinegar and sugar, cinnamon and sugar, or lemon juice,
&c; but Avhere it is given for affections of the skin, it is
best taken in its simple state, and in this form, it affords
a  valuable drink in fevers, &c.  Dissolve one or  two
drams in a pint of cold water; this  is an excellent, and
nourishing drink in dysentery, and  if not unpleasant to
the taste, may be made stronger for  such patients.
                    Gum Arabick.
   Gum arabick Avhich has been carefully selected, so as
to be pure and perfectly clean, is a pleasant and nutrient
article, and beneficial in cases of skin diseases, dysente-
ries, stone or gravel, and when made thin,  is a pleasant
and useful  drink in fevers; it may be rendered savou- 
542            MEDICINAL NUTRIENTS.
ry by adding a little  of some pleasant herb, as balm,
sage, &c.
                   March Mallows.
  Mallows in form of tea is a pleasant and useful nutri-
ent, in intestinal diseases, and in diseases of the skin.
It may be  used either green or dried.  All these nutri-
ents as well as several pure mucilages, Avill be found par-
ticularly useful in consumption, and may be used  in eve-
ry stage  of it; and also in gout, or scrofula affecting the
bladder, the kidneys or the skin.
                    Iceland Moss.
  The iceland moss is a useful nutrient, and being slight-
ly tonick also, renders it particularly beneficial in con-
sumption and other diseases attended with chronick, or
general debility.  For the method of preparing and us-
ing it, see the article astringents, or  restringents.   I am
strongly  inclined to believe this moss would be useful in
old cases of gravel.
                        Sago.
  Though sago has usually been considered simply a
light article of diet, I have thought proper to place it
among the  medicinals.   All light nourishing articles be-
come medicinal in some measure, in all cases of chronick
debility,  as well as during the  convalescence after acute
diseases.   And from the very  general use of this article,
I have thought necessary to say something respecting its
preparation, &c.  Sago is often  mouldy, and is often made
of potatoes, &c.  whereas the pure or genuine sago is the
pith of a  tree.  We should endeavour to select that which
is free from musty taste or smell.  Sago should be wash-
ed first in  hot water, then through several cold waters,
and afterwards boiled till it is a perfect jelly; Avhen re-
moved from the fire, it may be  seasoned with wine, vine-
gar and  sugar, cinnamon, ginger, &c. according  to  the
taste of  the patient.   But persons affected with fever,
should never use it seasoned with wine, and it should be
made an invariable rule never to keep it  long.
                    Toast Water.
  Toast  water is a valuable medicinal nutrient, and ge-
nerally grateful to the  stomach.   In cases  of wounds,
aud in many acute diseases, this is the best, and  should
4 
MEDICINAL NUTRIENTS.
543
often be the only nourishment allowed.  I have general-
ly seen such a great want of care or knoAvledge in pre-
paring this article, that I think it a matter of the highest
importance to admonish the reader, that although this is
certainly one of the best medicinal nutrients in acute dis-
eases, Avhen Avell prepared, it nevertheless,  is sometimes
rendered even prejudicial  by want  of  care.  First, cut
your bread thin,  (which should be one  or tAvo days old)
then toast it sloAvly, and until  it is  toasted  through and
through.  Secondly, make small quantities  and prepare
it often: it will, however, often  be advisable to keep a
slice or two of the bread toasted, but it should never be
put into the Avater till it is Avanted.   Thirdly, it is a mat-
ter of vast importance  to avoid burning  it.   Most people
cut off a piece of crust, and burn it hastily, this renders
it rancid, Tough,  and in great measure destroys its nutri-
ent properties.  I consider this of so much importance,
that I am confident many persons labouring  under disea-
ses  of  the stomach are lost for Avant of preparing this
simple drink, in a proper manner.  Where  Ave give it as
the only nourishment, the patient is to eat the toast, soak-
ed in the Avater, in reasonable quantities.
                    Wine Whey.
   Wine whey is a valuable medicinal nutrient in all ca-
ses  of  direct debility, or Avhere there is no  considerable
fever; see the article on cordial drinks.
          Gruel of Wheat, or Oaten Flour.
   This is a valuable mild nutrient, and may be made by
throwing  one or  more tea spoonfuls of flour into a ves-
sel,  then pour over it without stirring, a pint of boiling
Avater;  when it has stood a feAV minutes, stir aud strain it
through an old piece  of linen.  This  may be seasoned
Avhere it is  used as a  nutrient, Avith sugar  and  vinegar,
Avine, cinnamon,  &c. but let it ever be most  carefully re-
membered, that by adding much seasoning Ave destroy
the mild nutrient properties of these articles, and there-
fore, in general, they are to be used as  plain as  may be.
   All mild  diluent drinks are medicinal  nutrients, and
when made quite weak, so as to obviate any risk of sti-
mulating, are of vast importance in cases of  fever, &c. 
544
DILUENT DRINKS.
            SECTION XXI.—SUBSECTION  1.

                  Diluent Drinks.

  Diluent drinks are such as are proper in all common
fevers, wounds, or in short, all cases attended writh an
inflammatory diathesis.
                  Milk and  Water.
  Mix  one third  sweet  milk,  which has  stood  a few
hours, and which has been skimmed once, Avith two parts
of boiling water.   Let  it be taken cold or tepid, as the
case may require, and never kept more than a few hours.
                   Barley Water.
  Pour boiling water on one spoonful of pearl barley,
stir well, and afterwards wash through several cold wa-
ters; then boil in  clean water till  the barley is entirely
bursted.  Set it in a cool place, and when wanted, stir
a table spoonful of it well into  a pint of water: it must
iioav be  suffered to stand, and then pour  off the thin li-
quor, or it may be strained through an open old piece of
linen. Barley Avater may be used cold or tepid, but must
always be used fresh.
                    Toast Water.
  For the preparation of toast and Avater, see the section
on medicinal nutrients.
                    Milk Whey.
  Place a pint of milk near the fire, till it becomes sour,
and separates into curd and Avater; let it  remain an hour
or tAvo, and then pour it into another pint of sweet skim-
med milk; keep it warm till this second pint is turned;
afterwards, strain it through  a  thin rag.   This may be
taken warm, tepid or cold, as may be thought necessary.
                Slippery Elm  Water.
  Scrape a table spoonful of slippery elm bark,  green
from  the tree, or dissolve two or three tea spoonfuls of
the  dry  bark pounded  fine, in  a  pint of boiling water;
beat it well with a spoon, and then strain.   This may
be taken cold or tepid. 
              MILD STIMULANT DRINKS.          545

                    Apple Water.
  Roast a pleasant sour apple thoroughly, without burn-
ing, and mash it in a pint of  cold water; this is a grate-
ful  drink where no acidity of the stomach is present.
                  Tamarind Water.
  Take a table spoonful of tamarinds, pour over it a pint
of boiling water; stir it well, and after letting it stand half
an hour, strain.  This is generally taken cool, and most-
ly requires a little sweetening with sugar or syrup.
               Cremor Tartar Whey.
  Heat a pint of milk which has been once  skimmed;
and stir into it one or two  tea spoonfuls of cremor tartar.
This may be taken cold or tepid.
                    Thin Gruel.
  Put  one heaped tea spoonful of flour, first tied up in a
rag, into a suitable vessel, and pour over it a pint of boil-
ing water.   A very little salt may be added, where ex-
cessive thirst does not forbid.
                     Lemonade.
  Drinks similar to lemonade, may be made by mixing
a little good vinegar and sugar,  or boiled cider, cremor
tartar,  and sugar, &c. and  the lemonade itself, by  mix-
ing the juice or salt of lemon with sugar, and mixing with
a considerable quantity of  water.  The quantity of these
may be regulated in some measure according to the taste
of the  patient, but let  it be carefully remembered, that
where this drink is used as  a diluent, in cases of fever, &c.
it must always be very weak.
                March Mallows Tea.
  This article  may be made by boiling the  mallows a
few minutes in water.
  Flaxseed tea is made by pouring a pint of boiling wa-
ter on  one or two  tea spoonfuls of Avhole flaxseed, ob-
serving to wash the seed.

                    SUBSECTION 2.

              Mild Stimulant Drinks.

  Drinks slightly stimulant, are seldom necessary till the
force of most of our diseases, is in some measure reduced,
             69 
548
TONICK DRINKS.
But in most inflammatory diseases, as soon as they are
somewhat abated, and in those of a low grade, from the
commencement, they are of vast importance, and often
become principal remedies.  I have seen much mischief
by using these kinds of drinks, either because they were
a  great deal too strong, or given when the patient was
affected with inflammatory disease; therefore let it be re-
membered, that they are never to be given strong; if it
is necessary to stimulate with drinks,  those found under
the head of cordial drinks Avill be found better, provided
due caution is observed in accommodating them  to the
state of debility present.
   Contrayerva,
   Virginian snakeroot,
   Chamomile,
   Valerian,
   Common imported tea,
   Saffron,
   Hysop,
   Sage,
   Balm,
   Ground ivy.   All these in form of very weak tea, are
mild stimulant drinks.

                   SUBSECTION 3.

                   Tonick Drinks.

   Tonick drinks, like tonicks  in  every otlier form, can
only act as such, where there is a debility or languor of
the system, which  renders their use necessary;  when
taken too freely, or in a  too feA'erish habit of body, they
will always depress or weaken the body, by stimulating
unduly.
   Cold infusion of chamomile,
   Carduus tea,
   Centaury tea,
   Bitter teas generally, and cold bitter infusions, of bark.
&c. &c.
  Porter, 
CORDIAL DRINKS.
547
   Strong beer.   These are all tonick drinks, and in ca-
ses ot health or disease, where they are properly propor-
tioned to  the condition of the stomach, the two latter,
that is porter and beer, are also slightly nutrient.

                    SUBSECTION 4,

                   Cordial Drinks,

   Cordial drinks like those of the tonick kind, are inad-
missible unless Ave Avish to stimulate, and then it is to be
remembered, that they are more violent generally, in their
effects, but more transient than tonick drinks.
                     Wine Whey.
  Heat a pint of neAV milk till it nearly boils, then throw in-
to it from half to a Avhole gill of wine, strain.  This article
must not be kept more than twelve or fifteen hours. Wine
Avhey is highly nutritious  in debilitated habits, but in ca-
ses of dyspeptick patients, Ave should give magnesia, or
the Avhey  is very liable  to sour on the stomach.
  Wine,
  Punch,
  Toddy,
  Brandy,
  Coffee.  These are  all cordial drinks, and often of
singular service, in cases of  Ioav fever, and debility of
habit.   Brandy and wine are  always to be largely dilut-
ed when they are used  as drink.  They are sometimes
necessary in their raAv or undiluted state, but here we are
ahvays to view them as medicinal, and relieve the thirst
of the patient, by the use  of drinks more mild; most ge-
nerally they should be of the tonick class.   Let it ever be
scrupulously observed, that cordial drinks are never pro
per for chronick debility, or what may be called habi-
tual debility of constitution; in all such cases, mild to-
nick drinks, alternated Avith diluents, are most proper. In
short, cordial drinks are used too much, and do much
mischief, and it will always be the safest Avay to use the
diluent or Aveak tonick  drinks till advice can be obtain-
ed, and if this is not at hand, we should be Avell satisfied
the debility present, is  of the direct  kind, and clearly 
548                 OINTMENTS.
requiring a  poAverful stimulus.   Where there is any
thing like an inflammatory diathesis, cordial drinks will
do immense mischief, nay, will often destroy life, spite of
all remedies.

                    SECTION  XXII.

                      Ointments.

                      Basilicon.

   Hogslard, eight parts; rosin, five parts; bees wax, two
parts.   Melt and strain while hot, taking care to melt it
over a slow fire.  This ointment mixed with a portion of
spirits of turpentine, is a valuable dressing for burns and
other languid sores.
                   Savin Ointment.
   Basilicon,  one ounce; savin leaves  ground fine, one
dram.   Mix on a marble slab, or smooth board.  For
want of savin leaves, from ten to twenty drops of oil of
savin may be mixed with the basilicon.
           Ointment of White Precipitate.
   White precipitate of mercury, one dram; hogslard, one
ounce; oil lemon, or rosemary, five drops.  Rub the pre-
cipitate fine, and mix.  For the itch, and other eruptions
of a chronick nature.
            Ointment of Red Precipitate.
   Red precipitate of mercury, ground  fine, one dram;
hogslard,  one ounce; oil lemon, or rosemary, five drops:
mix.   For the itch or foul sores, or ulcers, &c.
            Ointment of White Hellebore.
   White hellebore, ground  fine, one dram; hogslard, one
ounce: mix.  For the itch, &c.
                Ointment of Sulphur.
   Flowers sulphur, two drams;  hogslard,  one ounce;
oil lemon, or lavender, a few drops: mix.  This is an in-
fallible cure for the itch.
                Blistering Ointment.
   Wax, mutton suet, rosin, cantharides, equal weights.
Grind the cantharides fine, and stir it into the other arti- 
           DENTIFRICE.—CEPHALICK SNUFF.       549

cles melted, and beginning to groAV cold; stir well till the
mass becomes stiff.
          Ointment of Corrosive Sublimate.
  Grind two scruples of corrosive sublimate  of mercu-
ry, very fine, and mix on a slab of marble, or a smooth
board, with one ounce of lard.   It will often be neces-
sary to increase the quantity of lard for persons of ten-
der skin.
                   Turner's Cerate.
  See the article external astringents.
              Ointment  of  White Lead.
  See the article external astringents.
             Ointment of Armenian Bole.
  See the  subsection on  external astringents.
Simple Ointment,  commonly ca'led Healing Ointment.
  White wax, or best clean beeswax, one  ounce; best
hogslard, three ounces;  melt.  This ointment may be
applied to all fresh cuts, excoriations, &c.

                   SECTION XXIII.

                      Dentrifice.

  Peruvian  bark, in powder, one ounce; common salt,
half a dram;  powdered oris root, a few grains.   Dissolve
the salt in as little water as possible, then pour it over
the bark, and grind it a few minutes in a mortar; add
the oris, and spread the  powder on paper, till it is per
fectly  dry.

                    SECTION XXIV.

                   Cephalick Snuff.

  Grind half an ounce of sage, or other pleasant herb;
and add one dram  of white hellebore, in very fine pow
der. 
550
MOUTH AVATER.--POULTICES.
                    SECTION XXV.

              Mouth Water, or Gargle.

   Dissolve half a dram of borax in a gill of rose water,
or spring water.
                      Another.
   Take one pint of sage tea, not too strong; add one ta-
ble spoonful of good vinegar, and a little honey or  su-
gar.  If we add a little alum, this makes a useful mouth
water, in languid sores of the mouth, or for cleansing  the
mouth at the close of fevers.  Shumack berries boiled
in Avater, and this SAveetened a little, is a valuable mouth
water.

                    SECTION XXVI.

                      Poultices.

   Poultices are principally used as emollients, for ripen-
ing beatings, or for promoting  the  formation of pus in
wounds or sores, Avhich ought to suppurate.   But some-
times they are used Avith a view of rendering cold appli-
cations more permanent; for  stimulating the feet in cases
of fever; and here they are called sinapisms; and they are
also used in cases of gangrene or mortification, for des-
troying  the  gangrenous ferment.  Poultices for  each of
those purposes will be found in this  section.
             Bread and  Milk Poultice.
   Break as much crumb of good wheat bread, one or two
days old, as Avill make the milk yrou use about the con-
sistence of good mush; stir  it constantly Avhile boiling,
and as soon  as the bread is well softened, it may be  re-
moved from  the fire; but before Ave do this, we are to add
a little more milk, or bread,  provided the consistence is
not such as we Avish.  The milk should be nearly  neAV,
and the  poultice should never be kept more than a few
hours.  It is ahvays necessary to renew this poultice eve-
ry tAvo or three hours, where Ave Avish to promote suppu-
ration,  It must ahvays be sufficiently stiff to prevent its 
POULTICES.                 551
running, and so moist as to remain wet upon the sore till
it is removed, and it should be  greased with a little oil,
lard or butter, after it is spread  on a rag.
                Indian Meal Poultice.
  This poultice is made by simply making mush in the
usual wray, and spreading a little grease over its surface
before it is applied.  The same observations apply to this
as Avill be found respecting the  bread and milk poultice.
It is a valuable substitute for the bread and milk, and in
general will answer equally Avell.   I suspect it  is a lit-
tle more stimulant.
                   Onion Poultice.
   Boil an onion very soft, then mash it well in milk or
Avater, and thicken it with Indian meal or crumb of bread.
This poultice is a stimulant, suitable for languid heal-
ings, and will be more stimulant according to the quan-
tity of onions it contains.   It must be applied warm, and
often repeated.
                  Flaxseed Poultice.
   Boil some flaxseed well in Avater, then thicken with
crumb of bread, or Indian meal.   This  is a valuable
emollient poultice.   A poultice of the white lily roots, or
of the slippery elm bark, may be prepared in the same
manner.  And  it will be found that a proper application
of the emollient poultices, which  have  been described,
Avill answer every purpose which we can reasonably ex-
pect from emollients.
                Slippery Elm Poultice.
   Take the green or fresh bark of the slippery elm, and
scrape it fine into cold water till you have it of a proper
consistence. Or, pound of the dried bark and steep it in
cold water or vinegar.  This is a valuable article in ca-
ses of strains, or recent inflammation, where we wish to
prevent  suppuration, and  may be applied to  the  eyes
with much advantage.
                   Bread Poultice.
   Soak crumb of bread in lead water, and after mashing
it well, apply  to strains, or recent inflammation from
bruises, &c.  This may also be prepared with vinegar,
instead of water- 
552
POULTICES.
                   Bran Poultice.
  Mix bran and vinegar in a proportion suited to form
a poultice, and apply it to strains, &c.  All these cold
poultices are discutients, and therefore only to be appli-
ed in recent bruises, strains, or inflammations, which we
may reasonably expect to scatter.
           Stimulant Poultice, or Sinapism.
  Take one or two table spoonfuls of best flour of mus-
tard, or well pounded mustard seed; or the same quan-
tity  of grated horseradish, with crumb of bread, or In-
dian meal moistened with vinegar; make a poultice.  This
is  applied to the feet, in cases  of low fevers, &c. with
great advantage; and also to palsied limbs, or for rheu-
matism in the joints.
                   Carrot Poultice
  Grate fresh carrots, and add to it about an equal weight
of good yeast, mix Avell together.  This is applied cold,
in cases of gangrene or mortification, and also for cancer.
                    Gum Plaster.
  Take of diachylon plaster eight parts; gum ammonia-
cum, galbanum, yellow wax, each one part; melt  toge-
ther over a slow fire.  This plaster  has been recom-
mended in this work for indolent healings, and is often
useful as a defence, from the Aveather, in rheumatisms, &c. 
INDEX.
ABDOMEN,  or  belly—necessary outward distinc-
  tions, 39.
Anatomy of the human body, 17.—Recapitulation of, 41,
Alum—Antihemorrhagick, 518.—Astringent, 520.
Animal Life—Observations on, 53.
Angina Pectoris, 324.
Abscess, Psoas, 406.
Abscess—See Biles.
Accidents from swallowing  cents, buttons,  &c.  396.
  From substances stopped in the windpipe, 397-—From
  fish-hooks, &c. 398.—From extraneous bodies in the
  nose and ears, 399-
Animals—Poisonous bites of, 411.
Air, Atmospherical—Observations on, 58.—Great Aveight
  of, 59.—Remarkable sameness of its chymical proper-
  ties, 59.
Aliment—Observations on, 62.
Animal Food—Not to be eaten raw, 63.
Arteries—Described, 30.
Anterior Chamber—See eye.
Aquaous Humour—See eye.
Arteriotomy—Described, 100.
Assafcetida—Antispasmodick, 524.
Ague, 162.
Apoplexy, 217-
Appetite, want of, 276.
Ascarides—See worms.
Asthma, 320.
Arsenick, Accidents from—See poisons, 414.
Antihemorrhagicks, 515.
Afterpains, 449.
Aphthse or Thrush, 464.
Alterative Stimulants, 502.—Alterative Evacuants, 501
             70 
554
INDEX.
Apple Water—Diluent Drink, 545.
Antispasmodicks, 522.
Astringents, 518.
Aloes—Purgative, 484.
Antimonial Wine—Emetick, 491.—Febrifuge, 529.
Ammoniacum—Expectorant, 496.
Amber, oil of—Diffusible Stimulant, 508.
Anodynes, 536.
Bark, a poAvder of—Tonick, 513.
Balm, the herb—Cooling Diaphoretick, 495.
Bark, extract of—Tonick, 513.
Ball Stool—See fistula in ano, 353.
Barley Water—Diluent  drink, 544.
Balsam  Peru—Expectorant,  496.—Antispasmodick,
  525.—Tolu—Expectorant,   496.—Copaiba—Stimu-
  lant Diuretick, 498.—Stimulant Alterative, 505.
Bark, Peruvian—Tonick, 511.
Beer-T-Sometimes adulterated with Aloes, 72.
Biles, 407-
Bilious Fever, 145.
Bitters, all Astringents, 520.
Bleeding—By means of the lancet, &c. 98.—In the jugu-
  lar vein, 99.—In the temporal artery, 100.—By means
  of Leeches, 100.—Sometimes  necessary to  produce
  fainting thereby, 99-—In the foot, 99.
Bleeding at the Nose, 253.
Blood—Circulation of,  and subject to some change in
  passing through the lungs, 33.—Its component parts,
  35.
Bloody Urine, 252.
Bloodshot Eye—See eyre.
Blood Biles, 410.
Bones—Anatomy of, 20.—Of the head, Avisely contrived
  for the  birth, 21.—Of the elbow, 25.—Fractures of,
  360.
Borax—External Astringent, 521.
Brain—Described, 31.
Bread—Some advice concerning it, 64.
Bronchiae—Described, 39.
Bruises, 370.
Breast—Bealing of, 407-—Swelling and pain of, in preg-
  nant Avomen, 438. 
INDEX.
555
 Burdock—Stimulant Alterative, 505.
 Buttons—Swallowing of, 396.
 Burns and Scalds, 374.
 Butter—Should be eaten sparingly, 64.
 Cancer, 335.
 Carminatives,  525.—Carminative  Antiacids,  526.—
 Cartilage—Described, 26.—Become bones slowly till the
   twenty-first year, 27.
 Calomel—Purgative,  484.—Stimulant Alterative, 503.
   Emmenagogue, 530.—Vermifuge, 540.
 Carduus—Tonick, 513.
 Carrot, Wild—Seed of, Lithontriptick, 534.
 Cataract, 297-
 Castile Soap—Lithontriptick, 533.
 Castor Oil—Purgative, 485.
 Cents—SwalloAviug of, 396.
 Circulation of the Blood, 33.
 Centaury—Tonick, 513.
 Cities—More healthy now than anciently, 61.
 Chilblains and Kibes, 284.
 Chalk, Prepared—Carminative Antacid, 526.
 Children—Introductory remarks on their diseases, 459.
 Cephalick Snuff, 549.
 Child-bed Women—See parturient.
 Chamomile—Stimulant  Diaphoretick,  494.—Cooling
   Diaphoretick, 495.—Tonick, 513.
 Chlorosis or Green Sickness, 457.
 Cholera Infantum, or  summer  disease of children, 466.
 Cholera Morbus, 243.
 Chickenpox, 201.
 Chrystaline Lens—See eye.
 Chrystaline Humour—See eye.
 Churches—Some observations  on, 61.
 Clap, 262.
 Clothing—Remarks on, 76.—Children sometimes injur-
   ed by too much, 77-
 Contrayerva—Stimulant  Diaphoretick,  494.—Sudori-
  flck,  493.
Corrosive Sublimate—Stimulant Alterative, 503.—Blis-
  tering in Ointment, 549.
Coffee, RaAV—Lithontriptick, 534. 
556
INDEX.
Cold Water—Disease from, 378.
Columbo—Tonick, 513.
Convulsions of Children, 465.
Copperhead—Bite of, 411.
Cowpox, or Vaccina, 469-
Corns—Remarks on nature of, 18.—Treatment for, 354.
Colds, or common Catarrh, 185.
Consumption, 167.
Cordial—Remarks on its nature, 71 •
Cornea—See  eye.
Contagious Diseases—Remarks on, 111 & 164.
Colicky common, 244.—Lead, 245.—Flatulent, 246.—
  Hysterick,  247.—Epidemick, 249.
Cremor Tartar—Laxative, 488.—Cooling Diaphoretick,
  495.—Evacuant Alterative, 501.—Febrifuge, 530,
Croup, 183.
Crust a Lactea of Children, 473.
Cramp of the Stomach, 279.
Cupping—Directions for, 102.
Cuprum Ammoniacum—Tonick, 514.
Dance, St. Vitus's, 222.
DeAvberry Root and Leaves—Astringent, 519.
Deafness, 300.
Dentrifice, 549.
Diaphram—Described, 29.
Diabetes, 236.
Diarrhoea, 260.
Diaphoreticks—Stimulant, 493.—Cooling, 494.
Diet—Simplicity of, recommended, 69.
Diffusible Stimulants, 506.
Dinner—Should not be too large, 69.
Diureticks—Stimulant, 497.—Cooling, 498.
Disorder from drinking cold water, 378.
Diseases—Require cautious investigation, 93.—Intro-
  duction to,  under the head of Nosology, 103.—Of ex-
  cessive excitement, 105.—Of Abstraction, 106.—Ha-
  bitual, remarks on, 113.—Summary of, general obser-
  vations on,  114.—Of women, introductory remarks on,
  416.—Of children, introductory remarks on, 459.
Dislocation of the Jaw, 356.—Of the Shoulder, 357—
  Of the Wrist, 358.—Of the Neck, 358. 
INDEX.                   557
Domestick Liquors—Ought to have age, 74.
Dogwood—Tonick, 512.
Doses of Medicine—Table of, 482.
Dover's Powder—Sudoriflck, 492.
Drinks—Observations on, 71 .—Aged persons require
  cordial drinks, 73.—Tonick, 546.—Cordial, 547.—
  Diluent,  544.—Mild Stimulant, 545.
Dropsy, 210.
Drowning,  381.
Drunkenness, 266.
Dyspepsia, 328.
Ears—Stoppage of from insects, &c. 399.
Earach, 273.
Emeticks, 490.—Powder, 491.
Electricity—Diffusible Stimulant, 509.
Elixir Vitriol—Tonick, 512.—Restringent, 520.—Car-
  minative  Antacid, 528.
Elm,  Slippery—Expectorant, 497-—Alterative, 502.—
  Diuretick, 498.—Medicinal Nutrient, 541.—Used in
  drink, 544.
Elder Blossoms—Cooling  Diaphoretick, 495.
Emmenagogues, 530.
Endemick Diseases, 111.
Eneuresis,  or habit of wetting the bed, 295.
Epiglottis—Described, 39.
Epigastrium—Described, 40.
Epidemicks—Introduction to, 108.—Treated individu-
  ally, beginning with yellow fever, 118.  (
Epilepsy, 341.
Erysipelas, 198.
Essence of  Peppermint—Carminative Stimulant, 526.
Ether—Diffusible   Stimulant,  507-—Antispasmodick,
  523.
Eustachian Tube—Described, 48.
Expectorants, 495.
Excitement—Mentioned, 53.
Excitability—Its properties mentioned, 53.
Exercise—Remarks on, 78.—Advantages of, 80.—Dis-
  advantages from neglect of, 81.
Extract of Bark—Tonick, 513.—Of Logwood, Astrin-
  gent, 520. 
558                   INDEX.
Eye—Structure  described,  49.—Inflammation of, 274.
  Specks on, 298.—Bloodshot, 299.—Watery or weep-
  ing, 299.
External Astringents, 520.
Fasting—Injurious to aged  people, 69.
Fainting, 282.
Falling Sickness, 341.
Fauces—Part of the mouth, 40.
Fever, Yellow, introductory remarks on, 118.—History
  of,  120.—Treatment  of commences,  134.—Conclud-
  ing remarks on, 141.
Febrifuges, 528.
Fever, Bilious, Remittent, 145.—Typhus, Epidemical,
  148 & 145.—From local causes, 207.
Fever—Intermittent, 162.—Scarlet, 200.—Miliary, 203.
  Malignant, from  local causes, 204.—Inflammatory,
  209.—Puerperal,  450.
Felon, or deep seated inflammation of the finger, 409.
Fish-Hooks—Accidents from, 398.
Fistula in ano, 352.
Flatulence, or Avindy bowels, 283.
Flux, bloody, 157-
Fluor Albus, 458.
Fly Poison, 414.
Focus—See eye, 49.
Food—Improper to take too much at dinner, 69.
Fortuitous Diseases—Remarks on, 112.
Fowler's Solution—Tonick, 514.
Fractures of the Bones, 360.
Frostbites, 376.
Gamboge—Purgative, 485.
Gargle—Mouth Water, 550.
Garlick---Diffusible  Stimulant,  509.—Antispasmodic^
  524.—Vermifuge, 541.
Gall Bladder—Described, 38.
Ginger—Carminative Stimulant, 526.
Glands—Described, 36.
Gentian Root—Tonick, 513.
Glottis—Described,  39.
Gleet, 264. 
INDEX.
559
Glysters, 498.—Emollient, 500.—Cooling, 500.—Purg-
  ing, 500.—Stimulant Purging, 500.—Laxative, 500.
  —Anodyne, 501.—Stimulant, 501.—Nutrient, 501.—
  Antispasmodick, 524.
Glauber's Salts—Purgative, 4S5.—Alterative in Kuhn's
  poAvders, 502.
Godfrey's Cordial—Anodyne, 539.
Gonorrhoea, 262.
Goitre, 330.
Gout, Legitimate, 304.—Vibrating,  310—Illegitimate,
  310.—In the kidneys, 312.—Gonorrhceal, 312.—In
  the testes, 313.—In the hip, 313.—In the intestines,
  315.—Different grades of, 314.—General observations
  on, 316.
Ground Ivy—Cooling Diaphoretick, 495.—Mild Stimu-
  lant, 546.
Gripings of Children, 461.
Gravel, 326.
Green Sickness—See chlorosis.
Gruel—Diluent drink, 545.—Nutrient, 543.
Gutta Serena,  296.
Gum, red—Disease of children,  463.—Yellow Gum,
  462.
Gum Arabick—Nutrient, 541.
Guaiacum—Stimulant Alterative, 504.—Emmenagogue,
  531.
Habitual Diseases—Remarks on, 113.
Haemoptoe, 250.
Hanging,  384.
Hemorrhoids, 349.
Hcematodes—See malignant scrofula, 335.
Heart—Described, 80.
Hearing—Organs of, described, 47.
Headach, 269.
Heartburn, 277.—Of pregnant Avomen, 436.
Hernia Humoralis, 263.
Hernia-, or Ruptures, 372.
Hemlock, or Cicuta—Stimulant Alterative, 504.
Herpetick Affections, 286.
Hemorrhage, or bleeding  from the nose, 253.—General
  observations on, 254.
Heira Picra—Purgative, 486.—Laxative, 489. 
560
INDEX.
Hives, or Croup, 183.
Hickup, 278.
Hooping-Cough, 154.
Hops, common—Anodyne, 539.
Horseradish—Stimulant Diuretick, 497-
Hypochondrium—Described, 40.
Hypogastrium—Described, 40.
Hydrops Pectoris, or Dropsy of the Breast—See dropsy.
Hydrocephalus, Dropsy of the Head—See dropsy.
Hydrocele, Dropsy of the Scrotum—See dropsy.
Hydrophobia, 223.
Hypochondriasis, 343.
Hystericks,  347-—Hysterick  fits of pregnant women,
  439.
Iliac Passion, 248.
Insanity—Remarks on, 237-
Inflammation—Of the Stomach, 186.—Of the Intestines,
  187— Of the Kidneys, 188.—Of the Bladder, 189.—
  Of the Diaphram, 190.—Of the Peritoneum, 190.—Of
  the Liver, 191.—Of the  Brain, 193.—General obser-
  vations on, 195.—Of the Testes, 263.—Of the Eyes,
  274.—Of the eyes of Infants, 463.—Of the Muscular
  and Glandular parts, 401.—Of the Female Breast, 407.
  Of the Nipples, 408.—Of the finger, called Felon, 409.
  Of the Uterus, 455.
Influenza, 147-
Iceland Moss—Nutrient, 542.—Astringent, 519.
Incubus, 280.
Injections, or Glysters, 498.
Introductory remarks on diseases of women, 416.
Insects—Stings of,  413.
Infusion of Senna—Purgative, 488.
Ipecacuanha—Emetick, 490.--Sudoriflck, 492.—Stimu-
  lant Diaphoretick, 483.—Alterative, 502.—Febrifuge,
  529.
Iron—Emmenagogue,   530.—Filings  of—Lithontrip-
  tick,  534.—Filings—Tonick, 514.
Ischuria, 295.
Itch, 288.
James Toavu Weed, or Stramonium--Accidents from,
  See poisons.—Expectorant, 496.—Diffusible Stimu-
  lants, 509. 
INDEX.
561
Jalap—Purgative, 484.
Joints—Dislocations of—See dislocations.
Jaundice, 234.
Kidneys—Described, 38.
Kibes and Chilblains, 284.
Kino—Astringent, 520.
Lachrymal Duct—See watery eye.
Lacteals—Described, 37.
Lacing—Practised by females, highly pernicious, 77-
Laudanum—Diffusible Stimulant, 509,—Anodyne, 538.
  Antispasmodick, 523.—Antihemorrhagick, 517.
Laxatives, 488.—Pills, 489.
Leeches—Bleeding with,  and  how to preserve them
  alive, 100.
Lemonade—Diluent Drink, 545.
Leprosy, 291.
Lime Water—Carminative Antacid, 528.—Lithontrip-
  tick,  533.—External Astringent, 521.—Astringent,
  519.
Lientery, 260.
Ligaments—Described, 27-
Liquorice Root—Expectorant, 497-
Liniment of Lime Water—Ophthalmick, 535.
List of  Medicines, in which the properties of each arti-
  cle is carefully pointed out; and this  is  information
  highly important, 477.
Liniment of Lead—External Astringent, 521.
Liver—Described, 38.
Lithontripticks, 531.
Locked Jaw, 219.
Logwood, extract of—Astringent, 520.
Longings of Pregnant Women, 437.
Love__Dangerous without a proper direction of it, 84.
Lues Venerea, 336.
Madder—Emmenagogue,  531.
Madness, 237.
Magnesia—Laxative, 488.—Carminative Antacid, 527-
  Lithontriptick, 532.                       .
Mallows, March—Nutrient, 542.—Diluent Drink, 545,
Malignant Sore Throat, 155.
Malignant Fever, 204.
             71 
562
INDEX.
Manna—Purgative, 486.—Laxative, 490.
March Mallows—Expectorant, 497-—Cooling Diapho-
  retick, 498.
Materia Medica—Commences with  a valuable  list  of
  medicines, 477«
Measles, 151.
Medicinal Nutrients, 541.
Mediastinum—Described, 39.
Melancholy, Religious—Observations on, 84.
Menses—Introductory Remarks on, 420.—Appearance
  and Disappearance of, 423.—Painful  State of, 424.
  Treatment for the Painful, 427.—Too Sparing Con-
  dition of, 429.—Excessive State of, 430.—Total Re-
  tention of, 431.—Final Cessation of, 432.
Measures for Liquids, Table of, 483.
Mesentery—Described, 37.
Mercury—Stimulant Alterative, 503.—See list of medi-
  cines for  the properties of Calomel, Mercurial Oint-
  ment, and Mercury, 477«
Mezereon—Stimulant Alterative,  505.
Milk Whey—Diluent Drink, 544.
Miliary Fever, 203.
Milk and Water—Ophthalmick,  535.—Diluent Drink,
  544.
Milk Crusts of Children, 473.
Mind—A sketch of its nature, 55.
Mixture, Nitrous Cooling, 495.—Saline Cooling, 498.
MorpheAV, 290.
Mortification, 403.—In the Mouth, 405.—In  the Toes,
  405.
Mouth—Description of its Parts,  40.
Mouth Waters, 550.
Mumps, 203.
Muscles—Described, 27.—Those within  the Body, 29,
Mustard,  the Seed—Antispasmodick, 524.—Emmena-
  gogue, 531.
Myrrh, 505.—See list of medicines.
Nerves—Described,  32.
Night Air—Should not interfere with ventilation, 60.
Nightshade—Accidents from—See poisons.
Nitrous Mixture—Febrifuge, 530. 
INDEX.
563
Nightmare, 280.,
Nipples—Inflammation of, 408.
Nitrick Acid—Tonick, 513.
Nonnaturals, 58.
Nosology, 103.
Nose—Stopped by Beans, &c. 399.
Oak Black, bark of—Tonick, 513.—External Astrin
  gent, 521.
Old People—Require nourishing food, and should avoid
  fasting, 69.—Require retired or quiet rooms to sleep
  in, 75.
Olfactory Nerve—In the Nose, 47.
Omentum—Described, 39.
Onanism, 264.
Ointment—Mercurial, 503.—Of White Lead—External
  Astringent, 521.—Calamine, 522.—Of Armenian Bole.
  522.
Ointments, 548.
Oil Spearmint—Carminative Stimulant, 526.
Oil Anise—Carminative Stimulant, 526.
Oil Amber—Diffusible  Stimulant, 508.—Antispasmod-
  ick,  525.
Orange Peel—Tonick, 513.
Opium—Anodyne, 537.—Antihemorrhagick, 517.—An-
  tispasmodick, 522.
Oil Wormseed—Vermifuge, 540.
Oxyd Bismuth—Tonick, 514.
Ophthalmicks, 534.
Pancreatick Juice, concerned in digestion,  37-
Palsy, 218.
Passion Iliac, 248.—Observations on the  Human Pas
  sions, 82.—Extremes of, meet in the same point, 83.
Paraphymosis, 265.
Palate—Properly called Uvula, 40.
Paregorick—Expectorant, 497-—Anodyne, 539.
Parturient Women—Introductory Remarks, 415.—Dis-
  eases of, 449.—Chills of, 449.—Afterpains of, 449.—
  Vomiting of, 450.—Puerperal Fever  of, 450.—Con-
  cluding Advice to, 450.
Physiological Sketches—Summary of, 56.
Perspiration—Insensible, 19. 
564
INDEX.
Peripneumony, 170.
Pleura—Described, 39.
Pleurisy, 181.
Pennyroyal—Stimulant Diaphoretick, 494.—Emmena-
   gogue, 531.
Peppermint—Stimulant Diaphoretick, 494.—Essence
   of, 508.
Peripneumonia Notha—A low disease of the Lungs, 180.
Phlegmon—See biles, 407-
Phymosis, 265.
Piles, 349.
Pimples  in the Face, 288.
Pink Worm—Vermifuge, 540.
Pine Chips—Stimulant Alterative, 505.
Pills—Laxative,  489.—Mercurial—Stimulant  Altera-
   tive, 503.
Poisons,  414.
Posterior Chamber—See eye, structure of.
Potato—Recommended, 65.
Pox, or Lues, 336.
Poke—Stimulant Alterative, 505.
Poultices, 550.
Powders of Camphor—Stimulant Diaphoretick, 493.—
   Nitrous Cooling, 502.—Diaphoretick, 493.—Kuhn's
   —Evacuant Alterative, 502.
Pregnancy—Introductory Remarks on, 433.
Pregnant Women—Advantages of exercise to such, 434.
   —Sick Stomach of, 436.—Heartburn of, 436.—Irregu-
   lar Bowels  of, 437.—Longings  of, 437.—Swelling
   and Pains in  the  Breasts of, 438.—Hysterick  Fits
   and Fainting of, 439.—Wrong Position of the Womb,
   440.—Costiveness  of, 441.—Swellings of the  Legs
   and Belly of, 442.—Cough and Difficulty of Breath-
   ing of, 442.—Cramps of Legs,  &c.  443.—Colick
   Pains of, 443.—Suppression of Urine of, 444.—In-
   continence of Urine of, 445.
Prickly Heat, 290.
Prickly Ash—Stimulant Alterative,  505.
Prolapsus Uteri, 456.
Pulse—Observations  on, 85.—Sometimes hidden by the
   hardness of the Artery, 95.—Tabular view of, 68. 
INDEX,
565
Psoas Abscess, 406.
Purging  Pills, 487.—Purgative, 484.—With Aloes,
  487.—With Gamboge, 487.—Infusion, 487.
Pupil—See eye, structure of.
Quassia—Tonick, 513.
Quinsy, 201.
Rattlesnake—Bite of, 411.
Red Gum of  Children, 463.—Yellow, 462.
Retina—See  eye, 50.
Rheumatism—Acute, 216.—Chronick, 319.
Rhubarb—Purgative, 485.—Laxative, 489.—Syrup of,,
  489.—Bitter Tincture of, 489.
Rickets—Simple, 332.—Malignant, 333.
Ringworm—See herpes.
Riding on Horseback—Recommended, 81.
Rochelle Salts—Purgative, 485.
Rose—A species of Erysipelas, 200.
Rose Water—Ophthalmick, 535.
Ruptures, 372.
Rue, the Juice—Vermifuge, 541.—Antispasmodick, 524.
Saffron, English—Stimulant  Diaphoretick, 494.—Car-
  minative Stimulant, 526.—Ophthalmick, 535.
Salts—Glauber—Nitre—Febrifuge, 529.—Epsom—Ro-
  chelle—For their properties see list of medicines, 477.
Sago—Nutrient, 542.
Salt, Common—Vermifuge,  541.—Antihemorrhagick,
  517.
Salt of Tartar—Lithontriptick, 533.—Carminative An-
  tacid, 527.
Saline Mixture—Cooling, 498.—Febrifuge, 530.
Sarsaparilla—Stimulant  Alterative,  505.—See list of
  medicines.
Sassafras—Stimulant Alterative, 505.
Scarfskin—Remarks on, 17-—Skin, true, 17.
Scarlatina  Anginosa, 155.
Scarifying—How performed,  103.
Scaldhead, 287-
Scalds and Burns, 374.
Sclerotick  Coat—See eye.
Scarlet Fever, 200.
Scurvy, common, 233.—Laud Scurvy, 353. 
566
INDEX.
Secretions—Remarks on, 82.
Sense—Of Hearing, 47.—Of  Taste, 45.—Of  Touch,
  4*.—Of  Seeing,  and  the Eye Described, 49.—Of
  Smelling, 47.—Of the  Senses in General, 52.
Senna—Purgative, 486.—See list of medicines.
Scrofula—Introductory Remarks on,  331.—In the
  Glands, 334.—Malignant, 335.
Seneka Snakeroot—Expectorant, 497*—See list of medi-
  cines.
Shingles—See herpes.
Sleep—Observations on, 74.
Short Sighted—Hoav occasioned, and the remedy, 51.
Shoes—Ought to be Avell  oiled  or waxed, 77.
Smallpox, 165.
Smell—Loss  of, 302.
Snakeroot,  Virginian—Sudoriflck, 492.-—See  list  of
  medicines.
Snakeroot,  Seneka—Sudoriflck, 493.—See list of medi-
  cines.
Skin—Anatomy of, 17-—Sympathy between it and the
  Lungs, 20.
Spectacles—Why useful,  51.
Specks—Upon the  Eye, 298.
Spirit Turpentine—Diffusible Stimulant, 508.—See list
  of medicines.
Spirit  of Lavender, Compound—Diffusible Stimulant,
  507.—See list-of medicines.
Spirit of Mindererus—Diaphoretick, 495.
Spirit  of Hartshorn—Stimulant Diaphoretick, 494.—
  See list of medicines.
Spirit  Nitre,  Sweet—Diaphoretick,  494.—See list  of
  medicines.
Spitting of Blood from the Stomach, 252.—From the
  Lungs, 250.
Spirituous Drinks.—Should not be used early in the day,
  74.—Mere  Spur upon Life, 71.
Spirit of Camphor—Diffusible  Stimulant, 510.
Spinal Marrow—Described, 32.
Spleen—Described, 38.
Sore Eyes—Of Children, 463. 
INDEX.
567
Soda—Carminative Antacid, 527.—Soda Water—Car-
  minative Stimulant, 526.
Squills—Expectorant, 496.
Squinting, 298.
Submersion—See DroAvning.
Suffocation—From  Various  Causes, 389.—From Sub-
  stances in the Throat, 391.
Sugar Lead—Antispasmodick, 525.—Antihemorrhagick,
  518.—Astringent, 520.
Suppuration—See Inflammation, 401.
Sudorificks, 491.
Sulphur, Flowers of—Laxative, 488.—See list of medi-
  cines.
Summer Purging of Children, 466.
St. Vitus's Dance, 222,
Stings of Insects, 413.
Stone—See gravel.
Stool Ball—See fistula in ano.
Stonebruises, 410.
Strangulation from Hanging, &c. 384.
Strains, 359.
Strangury, 294.
Sweet Spirit of Nitre—Diuretick, 497.—See list of me-
  dicines.
SAvellings of the Testes, 263.
Swoonings, or Faintings, 282.
Syrup of Squills—Expectorant, 496.—See list of me-
  dicines.
Syrup of Rhubarb, 489.—See list of medicines.
Tamarind Water—Diluent Drink, 545.
Tartar Emetick, 491.—See list of medicines.
Taste, Sense of, 45.—Loss of, 302.
Teeth, Names of, 21.—Teething of Children, 474.
Tetanus, 219.
Thorax or Chest, 39-
Throat—Stopped dangerously, 391.
Thrush of Children, 464.
Tincture of Rhubarb, and Senna—Purgative, 487.
Tincture Iron Muriated—Stimulant Alterative, 504.
Tincture of Cantharides—Diffusible  Stimulant, 508.
Tincture of Assafcetida—Diffusible Stimulant, 508. 
568
INDEX.
Tincture of Bark with Ether—Diffusible Stimulant, 500-
Tincture Guaiacum—Stimulant Alterative, 504.
Tincture of Bark—Diffusible Stimulant, 509.
Tinea Capitis, 287.
Toast Water—Nutrient, 542.—Diluent Drink, 544
Tonicks, 510.
Touch, Sense of, 44.—Loss of, 303.
Toothach, 271.
Trees near a House—Unwholesome at Night, 60.
Typhus Fever—Epidemical, 145 & 148.—From Local
  Causes, 207-
Umbilical Region—Described,  40.
Ureters—The  passage from the Kidneys  to the Blad-
  der, 38.
Urine—Bloody, 252.—Retention of, 295.—Involuntary
  Passing of at Night, 295.
Uterus—Prolapsus of, 456.—Inflammation of, 455.
Uva Ursi—Lithontriptick, 533.—Astringent, 519.
Valerian—Stimulant Diaphoretick, 494.—See list of me-
  dicines.
Venereal Disease, 336.
Veins—Described, 31.
Vermifuges, 539.
Vision—How Effected by the Eye, 50.
Viscera—Of the Abdomen, 36.—Of the Chest or Tho-
  rax, 39.
Viper—Bite of, 411.
Vitriol, White—Emetick, 490.
Vinegar of Squills—Stimulant Diuretick, 498.
Vomits, 490.
Vomiting  from Disease of the Stomach, 257.—Of Par-
  turient Women, 450.
Waterbrash, 277*
Watery Eye, 299.
White Vitriol—Antemorrhagick, 518.—Astringent, 520.
Weights, Apothecary, 483.
White Oxyd of Bismuth—Tonick, 514.—Carminative
  Antacid, 528.
Wines, Domestick—Ought to be more used, 72.
Whey, of Cremor Tartar—Diluent Drink, 545.
Wine--Stimulant Alterative, 506.-Antispasmodick, 524. 
INDEX.
569
Wine Whey—Nutrient, 543.—Cordial Drink, 547.
Windpipe—Sudden Stoppage of, 397-
Worms, 292.
Womb—Wrong Position of, 440.
Worm Seed—Vermifuge, 540.
Wounds—Of those which heal by  the first Intention,
  363.—Which should Suppurate, 367.—Which Bleed
  Dangerously, 368.

Yellow Gum of Children, 462.
Zink, Flowers  of—Tonick, 514.
72 
 
GLOSSARY.
ABSORBENTS—Vessels which take up fluids from
  cavities, &c. in the human body.
Abdomen—Belly.
Alvine—Evacuations by stool.
Anima Medica—The natural healing powers.
Animal Functions—The voluntary functions of an ani-
  mal.
Anus—The fundament.
Alkalies—Potash, soda, hartshorn, lime, magnesia, &c.
Aneurism—A disease of an artery, being a dilatation.
Aqua Ammonia—Spirit of hartshorn.
Asphyxia—A suspension of the heart's motion—faint-
  ing.
Ascites—Dropsy of the belly.
Arthritis Podagra—Gout of the feet.
Atonick—Relaxed, enfeebled.
Atrophy—A nervous consumption.
Auricle—A sack-like  appendage of the heart, through
  which the blood passes from the vein into the heart.
Azote—The base of a deleterious air.
Bistoury—A surgeon's knife.
Bronchotomy—The operation of opening the windpipe.
Buboes—Swellings in the glands of the groin.
Cardialgia—Pain of the stomach seated about its upper
  orifice.
Carbon—The base of foul air, found in wells, cellars, and
  caverns, &c.   It may be discovered by putting down
  a lighted candle, if it burns, no carbonick air is pre- 
572
GLOSSARY.
  sent.   But if the candle goes out, it  would be death
  to go down, till we have destroyed this foul air, which
  may be done by throwing down a quantity of fire; or a
  quantity of unslacked lime, observing to increase the
  quantity till a candle will burn, which is satisfactory
  evidence that there is no longer any danger.
Catarrhal Affections—Colds, as cough,  spitting, &c.
Calculi—Stone-like substances found in the body.
Chancers—Venereal ulcers on the penis.
Cataplasms—Stimulant applications to the feet.
Caries—Rottenness of  the bones.
Catheter—An instrument for drawing off the urine.
Cephalagia Spasmodica—Sick headach.
Chyle—Thin part  of nourishment taken into the circu*
  lation.
Clean Cloths—Clouts of children.
Cloatick Vault—A necessary.
Cellular Membrane-—A net-like membrane which is lap-
  ped about the muscles, and other parts.
Condyle—The knob-like ends of some of the bones.
Contraindications—Something which forbids usual indi-
  cations.
Diathesis—A condition of the body.
Diaphram—Partition between the belly and chest.
Dyspnoea—Difficulty of breathing.
Emporium—A  place   where  important  transactions
  abound.
Error Loci—Fluids wrong placed in the body.
Electron—A figurative expression meaning something
  subtile.
Encysted—Confined as iu a bladder.
Extravasated—Out of  the proper vessels of the circu-
  lation.
Fascia—A thin tendon.
Feces—Excrement—Sediment.
Fungi—Spongy lumps  of flesh, similar to what is called
  proud flesh.
Gastric k Liquor—Natural juice of the stomach.
Galvanism—A  species of electricity, obtained chymi-
  cally.
Glans Penis—Extremity of the Penis, called the head. 
GLOSSARY.
573
Halitus—A vapour  found in the  cavities of the body
  while it is Avarm.
Hydrops Pectoris—Dropsy of the breast.
Hydrocephalus—Dropsy of the head.
Hydrocele—Dropsy of the scrotum.
Incipient—Just forming, or beginning.
Introsusception—One gut slipping into another.
Laesions-^Wounds.
Lusus Naturae—Out of natural order.
Mammae—Female breasts.
Megrim—A painful giddiness.
Meconium—-Feces of unborn infants.
Nocturnal Emissions—Loss of the seed  at night.
Nostrum—A random prescription.
Onanism—Self-pollution.
Oxygen—The base of vital air, of acids, and combined
  with many other substances.
Olecranon—A part of the lower arm bone, and forms the
  hind part of the elbow.
Ossifications—JFlesh or tendons changed into something
  like bone.
CEsophagus—the gullet.
Ovaria—Bodies resembling eggs attached to the outside
  of  the womb.
Polypus—A  disease of the  nose, see index for loss of
  smell.
Parotid Glands—Glands about the back ends of the un-
  der jaw.
Pabulum—Support by way of nourishment.
Papillae—Small points.
Pancreatick Juice—A liquor poured into the gut just be-
  Ioav the stomach,  and  is secreted by the SAveet bread.
Pandora—A heathen goddess supposed to deal out dis-
  eases.
Pelvis—Lower part of the body, formed  by the bones of
  this part.
Periosteum^-The covering of the bones; described with
  the ligaments.
Peritoneum—The lining of the abdomen.
Perineum—Parts between the privates and anus.
Pericardium—Purse-like sack enclosing the heart. 
574                  GLOSSARY.
Phlebotomy—Common bleeding.
Pharynx—Upper orifice of the gullet.
Priapisms—Painful erections of the penis.
Primal Vise—Stomach and bowels.
Pubis—The lower part of the body, covered with hair.
Prepuce—Foreskin of the penis.
Pneumonia—Inflammation of the chest.
Rectum—The lower gut, being a short straight gut.
Sanguiferous System—The blood vessels.
Sphincter—A muscle which surrounds and closes  some
  passage.
Scarificator—An instrument used in cupping.
Scrobiculus Cordis—Pit of the breast.
Sensorium—That function of the  brain which conveys
  sensation to the mind.
Sinapisms—Applications of mustard to the feet.
Scrotum—Sack of the privates.
Subsultus Tendinum—Twitcbings of the tendons.
Sui Generis—Of itself, unlike any thing else.
Thyroid Cartilage—Part of the windpipe.
Toncils—Glandular bodies in the  back and upper part
  of the mouth.
Typhus—-Alow state of fever, formerly called nervous.
Torpor—A sickly state of languor.
Typhoid—A fever a little above a typhus.
Traumatick Tetanus—Locked jaw from Avounds.
Tympanites—Wind pent in the  belly without the intes-
  tines.
Tracheotomy—Operation of opening the windpipe.
Tenesmus—A painful inclination but inability to stool.
Trachea—Windpipe.
Uterus—The womb.
Uvula—A part of the mouth usually called the palate.
Urethra—Water passage from the  bladder outwards.
Venesection—Common bleeding.
Vertigo—A severe giddiness.
Vice Versa—Contrarhvise.
Vires Naturae Medicatrises—The  natural healing powr
  ers.
Vitrious Humour—See eye, structure of. 
0
               ERRATUM.



Page 265, line % for "parapisms" read priapisms. 
              ADVERTISEMENT.


  John D. Toy, Baltimore, has just printed for the au-
thor, the first number of a series of "Lectures on Fevers
in general; in which their causes, symptoms, and sana-
tives are reviewed.  With critical observations on cau-
ses, pathology, animal life, &c. &c.  By Horatio Gates
Jameson, M. D. Honorary Member of the Medical So-
ciety of Maryland, and one of the Surgeons to the Balti-
more Hospital."—This Lecture contains a new and inge-
nious classification of Fevers, and their Causes, in which
the  author evinces considerable reading, and a  sound
judgment.  It is the outline of a system, which may be
made useful to the Medical world; and it is to be hoped,
that the Doctor will meet with sufficient encouragement
from his brethren, to enable him to complete his design—
which is, to publish twenty-four Lectures, of  tAventy-four
pages each, at the price of twenty-five cents, a number,
or four hundred and fifty cents for  the whole; the num-
bers to appear "as circumstances shall justify."
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