THE CURE OF THE MILIARY FEVER. THE CURE OF THE MILIARY FEVER. To which is Annex’d, Advice to the Apothecaries. By CHARLES HALES, Surgeon. ‘You, whosoever you are, insigniz’d or not insigniz’d ‘with the Degree of Doctor, Master, or Batchelor, ‘whether skilful in Art, or by some other Privilege ‘promoted, pause a while, and hear what I have ‘here to say. I will shew you the Truth, without ‘any Mixture of Falsity. I will make you under- ‘stand who proceeds rightly, and who unadvisedly. ‘You Apothecaries; you, I say, who hitherto have ‘been blind, suffer a Collyrium to be poured into your ‘Eyes, and permit them to be anointed with Balsam, ‘that the most thick Skin of Blindness may fall from ‘your Sight, and you behold the Truth as in a most ‘clear Glass.’ BASIL VALENTINE. The Second Edition. LONDON: Printed for C. SAY, in Newgate-Street, MDCCLIV. THE PREFACE. THE miliary Fever, either in its simple or compound State, is the most frequent Disease that happens to Men, Wo- men, and Children, of all Degrees, and almost all Ages, throughout all Seasons of the Year; in Child- bed Women ’tis rare to meet with any other Fever of Consequence: Notwithstanding hitherto it has been less taken Notice of by Authors in general, is less known by the Phy- sicians and Apothecaries, and its B2 right (iv) right Method of Cure less under- stood, than any other acute Distem- per that afflicts Mankind. How to account for this general, but unpardonable Ignorance, I am much at a Loss, except the pre- vailing Opinion of some Physicians, That this Fever is a Creature of our own making, and that the Eruption is brought forth by the Use of too hot Medicines; I say, except that pre- vailing Opinion has run through the whole College, and from thence the dangerous Infection been conveyed to the Apothecaries; of whom the greatest Part are indeed so very in- considerate and negligent, and so little inquisitive into the Nature of Distempers, that they must of Con- Sequence be great Strangers to Ob- servation (v) servation and Experience, the most faithful Guides to a right Practice of Physic. I would not romance, or speak with Malice, but can assert with great Confidence, that I have had an Opportunity of discoursing with some Physicians, and many Apothecaries, concerning the Na- ture and Treatment of this Distem- per; but, good God, how great their Ignorance, how unaccountable their Stupidity and Obstinacy! I can hardly forbear blushing when I think of it, and yet all the Assu- rance I could give them of my Suc- cess, by Word of Mouth, had no Effect, they still resolutely persist- ing in their destructive Treatment, tho’ half of their Patients fell under their Hands; till I had an Oppor- tunity of convincing them by ocu- lar (vi) lar Demonstration, with how much Safety, Ease, and Expedition, I cur’d those who were under my own Care; and almost with as much Certainty as Intermittents by the Bark; not more than one in twenty dying, except I have been called in at the last Stage of the Distemper, when I found their Mittimus al- ready signed. During several of my younger Years, I had an Opportu- nity of attending one of these Gen- tlemen, very eminent in his Profes- sion, and in great Practice; but, all the Time I was with him, I only once heard mention’d the Words miliary Fever, and those in so slight a Manner, as not sufficiently to at- tract my Attention; but knew no- thing of the Nature of the Distem- per, or the miliary Eruption, hav- ing (vii) ing not seen one Patient, who, it was said, had them, altho’ this Gen- tleman had been in the Profession Twenty Years; Monstrum horrendum, informe, in- gens, cui Lumen ademptum. Virg. And that it is a Fever sui generis, and altogether as different from o- ther Fevers, as the Measles from the Small-Pox, is with me out of Dis- pute; and that it existed, long be- fore my Time, is sufficiently re- corded by the Testimonies of Sir Richard Blackmore and Sir David Hamilton; the last of whom Dr. Cheyne mentions with great Reve- rence and Respect (a). That (a) And here I am obliged, by many Ties, to do Justice to that very worthy and skilful Gentleman, Sir (viii) That the Eruption is caus’d by the Use of too hot Medicines and Regimen, I absolutely deny, altho’ such Method, I know, will prolong the Cure, if it does not soon kill the Patient; for I have often attended poor Men, Women, and Children, who have scarcely had Cloaths to cover them, and have taken no Me- dicines, but drank cold Water, or Small- Sir David Hamilton, Physician, lately deceased, who in our conjunct Attendance on a Person of Quality in this last Distemper (the miliary Fever) did, to my great Satisfaction, so readily foretel every succeeding Change, and so aptly furnish out a Remedy for every Accident, as did abundantly shew it familiar to him, and justify the History and Method of Cure published by him, of this tedious and dangerous Disease, the miliary Fever. A Disease, tho’ less common,(b) yet as various and as nice, and much more tedious than the Small-Pox itself. Cheyne. (b) This is a Mistake of the Doctor's, through Want of Observation. (ix) Small-Beer, four or five Days or lon- ger, before I have been call’d to them, and yet this Fever, according to the best Account I could collect, has gone thro’ its various Symp- toms, but in a terrible Manner, even to a very plentiful Eruption of the crystalline Pustles; but, by the Use of too cold a Regimen, then almost ready to expire for Want of other Assistance, such as cordial and diaphoretic Medicines, to con- duct them safely thro’ the last Stage of the Disease, which was by such Means very soon and surprisingly effected. In the Year 1741, this Fever in its worst Degree was more epidemi- cal than ever I have found it with- in my Time, and swept away great G Num- (x) Numbers of People of all Degrees and Ages under Fifty, (for few a- bove that Age were then seiz’d with it,) infomuch that the Bills of Mor- tality amounted weekly to twelve or fifteen Hundred, for a consider- able Time: In the Beginning; of this Constitution, Patients were treated, by other Practisers as well as myself, with Bleeding and Vo- miting indiscriminately, Blistering early and without Mercy, Sal Nitri, or Saline Draughts, with or with- out Sal. Vol. C. C. which were con- tinu’d four or five Days without real Advantage, and were then changed for Conf. Raleigh, which, doing no more Service than the for- mer, was again chang’d in three or four Days more for Sal, C. C, Pulv. Serp. &c. which then brought on Deli- (xi) Delirium and Subsultus Tendinum, Symptoms which introduc’d a Suc- cession of Blistering Plaisters from Head to Foot, which were not like- ly to relieve the Patient in any De- gree, so long as the Causes of all this Mischief, too hot Medicines, were daily repeated, till the Scene clos’d in Death; but which did not frequently happen till the 15th, 20th, or sometimes the 25th Day; with this Satisfaction only to their surviving Relations and Friends, that they had, as they thought, done all that could be done for the Deceas'd; altho’, to speak the Truth, they could not take a more effectual Me- thod to remove them out of the World. This shocking Success, which made me almost weary of my Profession, as I could not avoid C2 think (xii) thinking, that we all treated this Fever after a wrong Manner, obli- ged me often to think seriously up- on the Matter, and examine many of the best Authors, who had wrote of Fevers; I could find nothing in them that suited my Purpose, and but very few that even mention’d such a Fever; till, dipping into Allen's Synopsis, I found that Sir David Hamilton's Treatise upon that Subject was my chief Depen- dance (c). This I procur’d, and, after reading it over and over again with great Attention, determin’d to follow the same Method in that Case, with all the Patients who should happen (c) I did not know that Sir Richard Blackmore had wrote upon that Subject, till very lately I accidentally read his Discourse of the Plague, wherein I found a previous Account of the miliary Fever. (xiii) happen afterwards to fall under my sole Management; as I religiously observ’d the speculative, as well as the practical Part, so did I ever af- ter as happily conduct my Patients thro' every Stage of the Disease; for, as before, not more than five out of ten liv’d, so now not one in ten died, and those only who had some other Disease in Conjunction with this Fever; with this Inconvenience only, that the Cure, tho’ almost certain, was very tedious, even 20, 25, or 30 Days. But happy was I, that I had met with even a tedious Cure; nothing now remain’d for me to do, but farther to consider if it was not practicable to contract the Cure within a shorter Compass, by more powerful Medicines, and yet such as would by no Means ag- gravate (xiv) gravate the Symptoms. Whilst I was thus pondering, I recollected that my Author observ’d, as a favourable Prognostic, that the drowsier Pati- ents are, the happier they recover(d). Reasoning with myself upon this Principle, I luckily hit upon a speedier Method, which from Time to Time, with the greatest Care and Attention, I alter’d, till I had re- duc'd the Cure of this devouring Fever to as great Certainty, as al- most any we can boast of in the Pradice of Physic : Thus I fix’d the Rule of my Practice for the fu- ture, and which I have continu’d from that Time to this, with so much (d) A Physician may as certainly take the cura- tive Indications from the smallest Circumstances of the Disease, as he does the Diagnostic from them. SYDENHAM (xv) much Success, that, for seven Years past, I confidently affirm, I have not lost above four Patients out of a Hundred, of that Fever in its simple State; nay furthermore, for one Patient that I have had under my Care fifteen Days, ten have per- fectly recover’d in two Thirds of the Time, and, even in many, all dangerous Symptoms have been ab- solutely remov’d before the Erup- tion appear’d; which, altho’ it may seem strange to most of our Pro- fession, is nevertheless no more strange than true, as they them- selves may prove, if they diligently observe the Nature of the Disease, and exactly follow the Method of Cure, as I have done before them. For (xvi) For the present Purpose, I have abstracted from Sir David Hamilton, and Sir Richard Blackmore, all that I judge necessary in Relation to the Description and Nature of this Fe- ver; to which I have added occa- sional Remarks, and my own Me- thod of Cure, which by repeated Trials, and diligent Observation, I have prov’d to be more easy, speedy, and safe, than even theirs, or any other, that I know of; if any Body shall hereafter publish a better, I shall receive the same with as much Satisfaction as I communicate mine, having nothing more at Heart than the Service of my Profession, and the Use of all possible Means for the public Welfare. I have taken the Liberty to give Advice to the Apo- thecaries (xvii) thecaries in general, which (how much soever I may be censur’d for it) I am sure they stand much in Need of at this Time of Day, as their own Consciences must un- doubtedly tell them; for it is not the Physician’s Attendance and Pre- scriptions, on which they so much rely, that will alone cure Diseases; there are many other Requisites ab- solutely necessary, which of Conse- quence fall to the Medicaster's Share. D OF OF THE MILIARY FEVER. By the late Learned Sir DAVID HAMILTON, Fellow of the Royal College of Physicians, and of the Royal Society; as likewise Phy- sician in Ordinary to her late excellent Ma- jesty Queen Anne. THE PREFACE. I Have chosen to describe, before all other Diseases, the Nature and Method of curing a Miliary Fever; because I know of none who have hitherto treated of this Fever, as of a different Sort, at least, in any satisfactory Way; when, notwithstanding, I have known it, in several, to turn either into a chronical Distemper, or in a short Time to prove fatal. For this sometimes comes to pass, in a mild Beginning of this Distemper, from a Neglect of themselves, or thro' an Impatience of the Sick at its long Continuance; and sometimes also (xxii) also from the Ignorance of the Physi- cians, being deluded with its fallaci- ous Symptoms; or, lastly, thro’ an un- reasonable Fear(e) of being thought greedy of Gain, they omit conti- nuing their necessary Visits. Where- fore, I have thought it a Work wor- thy of my Time, if by these my Observations, being diligently col- lected from the daily Inspection, or Attendance upon sick Persons, I might afford some Light to young Practitioners; and by these Means stir up the more skilful to pub- lish their own; and the Reader may assuredly believe, that I have acted With great Veracity. OF (e) The Patient will be in no Danger, on that Account, now; for that Sort of Fear has been long since banished. OF THE MILIARY FEVER. Of the Name, Kind, and Sorts of this Distemper. A Miliary Fever take its Name from the Pustules, or Vesicles, in some Sort resembling the Form of Gromwel Seeds, appearing chiefly about the upper Parts; yet I think it ought ra- ther to be called a vesicular Fever, because the Pustules are Vesicles, or little Blisters, filled at first with a limpid Serum, and afterwards with a whitish, not unlike to the Colour of Pearls. There [24] There are some who think, that only the pestilential and spotted Fevers ought to be reckoned amongst the malign Kind; but I am of Opinion, that there are like- wise others of a different Species, which may very well be referred to the malign Class. 1. What Kind of Fevers soever, which are acquired by Contact, or Breathing (Vapour) or any other Manner of In- fection. 2. Also those Sorts of Fevers, which, immediately from the Beginning, are ac- companied with a violent Pain, and fix’d to some Part; as to the Head, or Region of the Guts, or Kidneys, or even to the Limbs: Like as if the Patient should be affected with a Pain of the Head, or a Cholic, or a nephritic, or a gouty, or a rheu- matic Pain; or even with the Pains (like those) of Child-birth, as if the same was an original Distemper; when, notwith- standing [25] standing, such Sort are the Symptoms of a miliary Fever; they will not give Way to Remedies which are wont to be of Service, when the Diseases so nam’d are primary. 3. Also in whom the animal Spirits are suddenly oppress’d and eclips’d; and where the aforesaid Symptoms seem to depend on no evident Cause, but on a certain la- tent Poison, call’d, by the Antients, an oc- cult Quality, and by the Moderns, Va- pours. Or, Lastly, where sudden Death arises from a Cause which seems to be void of Danger; all which, as they denote a Ma- lignity, so also have I observed the same to happen in a miliary Fever. And it is worthy of Remark, that this Fever rages with the same Malignity, as the petechial or spotted Fever in the In- dies. E This [26] This Kind of Fever is two-fold, simple and compound. I call it simple, as often as no Pustles besides the miliary appear, whereof I am going to discourse; but com- pound, when red, papillary Pustules are interspers’d with the miliary, and which, when they are solitary, are commonly cal- led a Rash. And it is farther to be observ’d that miliary Pustules are sometimes in- termix’d with the Small-Pox, and, while the Small-Pox rises up, those gradually wither away; but remain standing, after the papillary are dried up. A Description of the Miliary Fever. That I may the better describe the Hi- story of a miliary Fever, I shall reckon up the Antecedents, Concomitants, and Con- sequences. The Antecedents are, a weak Consti- tution of Body, whether the same be na- tural [27] tural or adventitious, caus’d by immode- rate Evacuations, or too spare Diet; a se- rous or wat’ry Blood; a weak and timo- rous Mind, and easily annoy’d by external Accidents, as in Women and effeminate Men; much and deep Study (or Thought- fulness) or Sorrow; an Obstruction, or Ulcer in any Part, attended with Pain; Whence those Persons who have been long afflicted with a Cholic Pain, Gout, or Stone, or an Ulcer of the Kidneys, are more ob- noxious to this Fever. Also an inward Heat in Women, with or without Thirst, and especially about the Time of their Deli- very, whereby also the Pains of Child-bear- ing are less severe than usual, and the Spirits, without any evident Cause, are very much depress’d, with an Oppression of the Breast, causing Sighs; wherein, as in all other Fe- vers, here also generally happens an exter- nal Coldness. The Concomitants, or Symptoms ac- companying this Fever, are oftentimes a Pain resembling that of the Cholic, Stone E2 of [28] of the Kidneys, Pleurisy, Rheumatism, or that of Child-birth; likewise an Oppression of the Breast, with a Sinking of the Spirits: And, two or three Days after the said Pain is gone off, there comes on a Shivering of the whole Body, and then a Coldness and an Heat alternately arise. Yet this Heat is milder than in a common continual Fever, and comes nearer to that of natural; the Palms of the Hands are affected with a more intense Heat, while the Back-part is much cooler; the Pulse also is frequent, but weak; the Spirits often flag very much; and the Breast, being oppressed as it were with a great Weight, causeth Sighings; the Sleep stealing on is suddenly interrup- ted, tne most inseparable Token of all the Symptoms; for the Patients are often with- out Sleep for many Days and Nights to- gether(f) without a Delirium, or a Pain of the Head, and generally much longer than in other Fevers, I met with a very singu- (f) This Symptom will scarcely, or ever, be met with, if the Fever be treated in the Manner, as here- after directed. [29] singular Example of this Case, in a certain Lady who was under the Care of the learned Dr. Bernard. She was a whole Month in this Fever, without Sleep; yet free of a Delirium, or any Pain in the Head. The Tongue is sometimes cover’d over with white Aphthœ, or a Thrush, and some- times like that of Persons in Health; the Urine is one while as pale as common Wa- ter, at others, of a natural Colour: Which Symptoms, deceiving young Physicians, make them frequently attribute this Effect to the Vapours, as they term it. They who are seized with this Fever, are some times afflicted with a Sickness at Stomach, especially after Sleep; and sometimes with a Soreness, either by their own Negligence, or a bad Practice; to wit, while heating Medicines, usual in hysteric Paroxysms, are prescrib'd, without Diaphoretics; whence in Lieu of a mild Procedure of Nature, ex- pelling the morbific Matter by a gentle Sweating, a rapid Fermentation throws down the same into the Guts. The Belly is [30] is sometimes bound, and sometimes loose, with a Sickness at the Stomach, and Pains of the Bowels; one while they are thirsty, at others, very little; sometimes the Hands and Tongue, being stretched out to the Physician, tremble, and the Patient speaks in a trembling Manner; they are also often molested with convulsive Motions, a Deli- rium, and a difficult Respiration; the Exa- cerbations of which Symptoms return like the Paroxysms of an intermitting Fever. An Oppression of the Breast with Sighing, or a greater Sinking of the Spirits, without manifest Cause; Watchings, and a Com- motion of the Spirits, commonly called a Hurry in the Head, as often as the Sick compose themselves to Sleep; as likewise a frequent and weak Pulse, being conjoin’d with certain other Symptoms, are always the Fore-runners of the miliary Pustles at Hand: And they are all wont to continue till the miliary Pustles break out, and then the Patients are freed from most of them. These [31] These Pustles generally appear in the Breast, Neck, and Interstices of the Fin- gers, sometimes also in the whole Body; and, after a daily and gradual Increase, they at last vanish away, leaving the Skin rough in the Seats of the Pustles. They some- times itch, especially in a complex miliary Fever; that is, where red papillary Pustles are mix’d with the miliary. And it is to be observ’d, that, by how much Ampler this Fever is, by fo much slighter are the Symptoms, and which for this very Rea- son frequently creates a Neglect, both in the unwary Physicians, and in the Patients; whereby this Fever either becomes more perilous, or another Disease often arises; for, by taking less Care at first than ought to have been used, it sometimes begins with more grievous Symptoms; as, with a Sickness of the Stomach, Loss of Appetite, an inward Heat, an Oppression of the Breast, Sinking of the Spirits, Sighing and irregu- lar Returns of Heat and Cold, Watchings, and the like. In the Declination of this Fever [32] Fever, the upper Part of the Hands are often moisten’d with a cold Sweat. It is very difficult to observe, whether the miliary Pustles are wont to appear on a certain Day; seeing the first Appearance of this Distemper, and the Patient’s Ac- count of the same, are so uncertain. But, as far as I can learn, I take them mostly to appear about the Tenth or Eleventh Day from the Beginning, if so be the Fever have a regular Progress, and are dried up about the Eighteenth; or, where there is Plenty of morbific Matter, about the Twen- ty-first or Twenty-second Day. I have chiefly endeavour’d to observe the Time of the Eruption in those Women, to whom I have been call’d, on the Third Day after their Delivery; and have heard them complaining of a Shivering or Cold- ness, follow’d with an Heat: For when I found, in looking upon their Breast: and Neck, the miliary Pustles there, I conclud- ed, that they had been seiz’d many Days before [33] before with a miliary Fever; and, upon a strict Scrutiny made even from the Begin- ning of the Distemper, I understood that they had perceiv’d either a preternatural Heat, or a Pain of some Part, with or with- out Thirst, and a vehement Oppression of the Breast, with Sighings, and a Sinking of the Spirits before they were brought to-bed; which Symptoms being suppos’d to depend on the approaching Birth, they hop’d all wou’d be well, when it was over. More- over, altho' they have the Pains of Child- birth milder than usual, yet the great Op- pression of the Breast in such, with the Sighing and Deficiency of Spirits (called by the Midwives Fear and Vapours) and the quick and weak Pulse are sure Prog- nostics of the approaching miliary Pustles; to whose Eruption in Child-bed Women, a Way is made by their composing in Bed to sweat; Therefore I commonly reckon ele- ven Days from the first inward Heat, or Pain before the Birth, to the Eruption after the Birth. But the Ignorance, and pre- posterous Relation the Patients give of their F own [34] own State, do, for the most Part, so con- found the Physician’s Prognostic, that even the most curious can’t find out the very Pay. The Consequences of a miliary Fever, as far as my Observation reacheth, are a Swel- ling of the Thighs, Legs, and Feet, not al- ways free from Pain; a Swelling and Ab- scess of the Breasts; an immoderate Flux of the Lochia, and of Urine; Hypocon- driac or Hysteric-like Affects; an inward Heat join’d with a Weakness, Faintness, and Loss of Appetite: One or other of these, I say, are generally the Consequen- ces, as often as this Fever, either by Rea- son of its own ill-nature, or bad treatment of the Physician, makes an unhappy End- ing(g). (g) The Symptoms of the miliary Fever, in the Year 1741, were these; Shivering or Coldness, and Heat alternately; a Pain of the Head, Limbs; Back, like the Stone in the Kidneys; Belly, like the Cholic; Sickness, bilious Vomiting, Looseness; Sinking of the Spirits, Oppression at the Breast; a moist Tongue, little. [35] Of the Prognostic Signs in this Fever. A Prognostic is thus to be made in this Fever; if the Sick hath not observ’d a due Regimen in the Beginning, or the Phy- sician prescrib’d heating Medicines, not rai- sing a Sweat; altho’ the Symptoms were milder from the Beginning, yet the Di~ stemper often turns to the worse, and threatens either Death or a lingering illness. F2 If little Thirst; the Urine of an Amber Colour, like that of a Person in Health; a strong, full, quick Pulse at the Beginning, but three or four Days after- wards, weak, low, and swift; Delirium, Subsultus Tendinum, difficult Respiration; the Heat milder than in other continual Fevers. The Appearance of the Eruption, which was chief- ly of the crystalline Kind, did not happen till the 14th, 15th, or 16th Days; which, I have now Rea- son to believe, would have appear’d sooner, if it had not been retarded, by the bad Conduct of the Patient or Nurse, or imprudent Treatment of the Physician. [36] If some Part should be pain'd from the Beginning; or the Patient grow hot with- out Pain; or be sick at the Stomach; and afterwards should have irregular Returns of hot and cold Fits, and a Sinking of the Spirits, and an Oppression of the Breast, with Sighings, attended with a free Breath- ing, and the Pustles come out at last with a gentle and continu'd Sweating; the Case is generally hopeful. If a Delirium, con- vulsive Motions, a Convulsion, or an Apo- plexy, should accompany the Pathogno- monic Signs of the Fever, that is, a great Oppression of the Breast, with Sighing, and Sinking of the Spirits, and they should hap- pen in the Beginning, they yield more easily to a regular and diligent Practice: But in a more advanced State of the Di- stemper, and in the Declination, where the Sick is weaker, and the miliary Pustles, either by catching Cold, or perhaps by an irregular Management, do not appear, a deadly Translation is made upon the Brain and [37] and Nerves, and Death the speedy Conse- quence of it. A yellow Colour of the Urine, which suddenly turns pale, warns the Physician, that a Translation is to be feared. A Looseness in Child-bed Women, seiz’d with this Fever, is a dangerous Symptom; for it not only hinders the Eruption of the Pustules, but also the Flowing of the Lochia. A difficult Breathing, an intercepted Speech, and a Trembling of the Tongue, are to be rank’d amongst the perilous Symptoms, especially a nervous Dyspnœa, or Difficulty of Breathing. The drowsier the Patients are, the hap- pier they recover. Those who are of a milder Nature, es- cape more easily, than the furious and wrathful Tempers do. If [38] If Nature and the Physician concur to- gether, the Sick immediately recovers Strength, after the drying up of the Pustles; unless, by Reason of the Abundance of morbific Matter, the Relicks be thrown upon some certain Part. If in a Scarlet Fever miliary Pustles should arise, dying away with a red Co- lour, they promise Safety. OF OF THE MILIARY FEVER. BY Sir Richard Blackmore, M. D. OF THE MILIARY FEVER. THE miliary Fever, so called from the small red Eruptions that re- semble Millet-seed, is the most frequent in this Country of all the malignant Kind. The Patient often seems to himself at first only somewhat faint and indispos’d, his Strength and Appetite diminished, and his Sleep interrupted, and his Dreams disorderly and tumultuous, while he goes abroad and applies to his usual Business, and hopes his Indisposition will soon wear off, not suspecting that he nourishes a malignant Fever in his Bosom. At length after about seven or eight Days, when he G has [42] has taken to his Bed, by Means of copious and profuse Sweats, the miliary Eruptions before mention’d appear in the Temples, the Neck and Breast, and sometimes spread over the whole Body. If the Quantity be not great, as in the distinct Kind of the Small-Pox, they generally presage a happy Event; but if they are very numerous, and cover the whole Surface of the Skin, then, like the Small-Pox of the confluent Kind, they are often fatal, and always dangerous; and they are in this too like that Sort of Small-Pox, that, as I have seen, in their Ripening, they sometimes flow or run in- to each other(h). These little red Eruptions grow by De- grees to Maturity, acquire white Heads full of Matter, and then grow dry, and die away; which Course, in the more kindly Sort, is generally accomplish’d in seven Days (h) There are, notwithstanding, Physicians, who, to this day, ignorantly presage the happiest Event, from the greatest Quantity of Pustles; of which I have often been an Ear-witness. [43] Days; but, in the worst Sort, the Time is much farther protracted, and this happens also in the worst Sort of Small-Pox; and it is very remarkable, that it sometimes falls out, that in this Sort of Fevers, after one Eruption of a more malignant Kind has compleated its Course, and the Skin is clear’d of its putrid Crop, yet a swift, trou- bled Pulse, great Drought and Want of Spi- rits, shall continue, and the Physician may be assur’d, that either Death, or another Erup- tion(i) like the first is at Hand, to carry off the Matter of the Fever, which the first was unable wholly to perform: And this I have seen repeated the third Time, and even after that the Patient has recover’d, which but rarely happens. The great and profuse Sweats, that pre- cede the miliary Eruption, are by no Means G2 such (i) A second fever and Eruption, I likewise know, often succeed the first, but that is only when the Pa- tient has been ill-treated, or when the Continuance of proper Medicines, for a sufficient Time, has been obstinately refus’d. [44] such as critically discharge the Putrefaction that causes the Disease; but they arise from the violent Conflict and Agitation of the Blood, while the found and active Parts exert their Force, to digest and expel the Matter of the Disease; and therefore they do not re- lieve oppress’d Nature, but sink and weaken the Spirits by an excessive Evacuation (k); which however is necessary, that the putrid Parts may be excluded from the Blood by the miliary Eruptions that follow, in which consists the critical Separation by which Nature is deliver’d, and the Blood recovers its healthful State; as it does by casting out the Matter of the Small-Pox, at first complicated and entangled with the Mass of Blood. Some (k) This brings to my Mind the Case of a Female Patient, who, at my first Visit, I found drowning, if I may so say, in those Sweats; with an interrupted pulse, and the Feet and Hands growing cold; at which, I presag’d Death in a short Time. The Apo- thecary, being told, upon Enquiry, my Opinion, said. He cou’d not see any Thing which had that Appear- ance, for that she was in a fine breathing Sweat, and a most sweet Sleep; but, fine and sweet as they were, she died in twenty-four Hours afterwards. [45] Some Physicians, too fond of the cool Method in the Management of Fevers, from their Observation of the Usefulness of that Conduct in inflammatory Distempers, such as the Small-Pox, Rheumatisms, Pleuri- sies, Quinsies, and St. Anthony's Fire; have injudiciously extended it to the Cure of malignant Cases, in which a considerable Quantity of the Blood is putrefied or pe- rish’d by the Dissolution or Separation of the Parts, as before describ’d; but they seem not to act under the Guidance of Reason, but, in a mechanical Way of Practice, ap- ply the same Method of Cure to all Sorts of Fevers, tho’ their Nature be ever so much distinguish’d. And hence it is, that these Gentlemen will not allow, that the miliary Eruptions are a regular Discharge of the Feverish Matter from the Blood; but, say they, they are the Effect of an unskilful Conduct, in using Remedies of too hot a Nature, by which the Blood is put into too great a Hurry and Agitation: But this Assertion affronts all Reason and Observation. They [46] They may as well affirm, that the Small- Pox, Measles, and Scarlet Suffusions, Boils, and Blanes, wou’d never appear on the Skin, were they not produc’d and exclud- ed by the Administration of too warm and active Remedies. I have often seen those Eruptions break out in great Abundance, where the cool Method has been exactly observ’d; and of this every Practiser may be soon convinc’d, if he carefully attends to the Growth and Progress of this Distem- per. In this, as in the Diseases above- nam’d, the hurtful Matter, admitted into the Blood, is by Nature’s Determination to be first concocted, and then separated by the Strainers of the Skin, where, being en- tangled, and not suffered to perspire, it produces a miliary Harvest; and a Phy- sician, being but a Servant of Nature, ought to follow her Steps, promote her Inten- tions, and not to turn her from her Path, and oppose her Operations(l). When (l) When the opposite Practice is made use of, by Mistake, it is manifestly preductive of great Evils; as when, for Example, the miliary Fever is taken for an [47] When a Patient has long struggled with a Fever accompanied with Putrefaction, and, after twelve Days, no miliary Break- ings an Intermittent; saline Draughts, succeeded by the Bark, are then not only confidently prescrib'd, but the Practiser without Hesitation declares the Danger entirely over, not knowing that he is at once giving a fatal Stab to his own Reputation, and his Patient's Life; for Death most assuredly, and to the Surprize of the Doctor, as well as all about the poor Sufferer, must soon close the Tragedy. As when, likewise, that Fever is taken for a Cho- lic, the Stone in the Kidneys, or the Rheumatism, the same fatal Issue must be the Consequence; with this Difference only, that, in these latter Cases Death makes his Approach, more flow, but more terrible; for it is then not uncommon for an Abscess to be form'd in the Breast or Belly, or other lingering Disorders to follow, which, together with an hectic Fever, at length, finish Life. Some eminent and worthy Physicians, of my Ac- quaintance, know what I say to be true, because they must be sensible how much they have suffer'd in their Reputations, by these fatal Mistakes; particularly, by the Mal-administration of their ador'd Cortex. I cou'd [48] ings out are observ’d, it is usual that small wat’ry Bladders, from their Transparency, call’d crystalline, appear in the Temples, Neck, and Breast, which often gradually ripen, and become such of Matter; these perform the Office of the former Erup- tions, by freeing the Blood of the noxious Ferment that disturbs it, but not so safe- ly and effectually(m). It is to be observ’d, that there is a Fe- ver, which I call hypochondriacal or hys- teric, tho’ it be not rang’d in the Classes of I could relate many Histories of these tragical Events, but I think these Hints are alone sufficient to mark out the dangerous Rocks, which lie in the Way to a safe Harbour. (m) I must confess, that it is a Matter of Doubt with me, whether these Bladders do not rather only portend the gangrenous State of some Part of the Fluids, than that they are a critical Discharge of the noxious Matter; any more than the Vesications, which are usual in Gangrenes of the Solids, free the diseas’d Subject from the impending Danger, which, of Consequence, threatens the Loss of the Limb, Life, or both. [49] of that Disease by any Authors, as far as I know, that, by its Similitude to the ma- lignant Kind, often imposes on Physicians, and induces them to believe that it is of that Sort. And this is the only true Fe- ver of the Spirits, and which I have often seen. It imitates closely the malignant Sort in the greatest Parts of its Symptoms, but it differs in this, that the Exercise of their Reason is not interrupted, or suspend- ed, during its whole Course, which runs out sometimes to more than twenty Days; whereas most commonly the Head is much, if not chiefly affected, and the Faculties of Reason and Memory are greatly dis- turb’d and broken, in malignant Fevers, Another Distinction is, that in the first Sort the Patient is not troubled with Looseness, or Thrush; nor do there ever appear in the Skin any miliary Eruptions, or Spots, of any Sort whatsoever. But on the contrary, in the last Kind, some putrefied Matter is always excluded from the Blood, and determin’d to the Skin, or ought to be so, if sufficient Force remains in the Blood to H effect [50] effect it (n). It is true, that in simple Fevers, where no Parts of the Blood are corrupted, there needs no critical Separa- tion, but by Sweats and Transpiration, which cool the feverish Flame, carry off the offensive Matter from the Blood, and restore Nature to its regular Constitution; but, when many Parts of the Blood are ac- tually mortified, how can Nature ordina- rily be restor'd to a healthful State, with- out expelling them to the Skin? Can a Gangrene in the solid Parts be heal’d till the found Flesh be freed from the mortified Fibres? No more can the Mass of Blood be cur'd, till it is clear’d and purg'd from its putrid and perish’d Portions; which usually must be done by excluding them from its Bosom by friend- ly Sweats, or lodging them in the Surface of the Body; I said usually, because some- times this putrid Matter may be discharg’d by the Glands or Strainers of the Guts, tho' that does not often happen; for frequent- ly (n) Or If the Intention of Nature be not revers’d by Mal-practice. [51] ly the Looseness, that at the latter End at- tends malignant Fevers, if the Patient re- covers, is taken up by a Thrush or sore Mouth; and hence it appears, that the hypochondriacal Fever, mentioned before, has not the essential Properties of the ma- lignant, and therefore does not arise from Putrefaction; tho’ it is certain, that the malignant Kind have, at their Beginning, such a Conformity of Symptoms and Ap- pearances to hypochondriacal Passions, that it is difficult to discern, whether the Pa- tient be attack’d by a putrid Fever, or an hysteric Disorder, or Perturbation of the Spirits: For Instance, Chilness, Shiver- ings, and rigorous great Inquietude, Vo- mitings, Dejection of Appetite, Anxiety, Sickness, and immoderate Sweats, Wake- fulness, a low weak Pulse, Faintness, and great Diminution of Strength, are Symptoms common to both; and therefore for several Days a malignant Fever has so near a Resemblance to one, that is only hysteric, that many Physicians and Stan- H2 ders [52] ders-by, I am apt to believe, mistake the first for the last, and look upon a great and dangerous Disease to be only the Spleen, or a Fit of the Vapours, to the great Ha- zard of the Patient. OF OF THE CURE OF THE MILIARY FEVER. By CHARLES HALES, Surgeon. OF THE CURE Of the SIMPLE MILIARY FEVER WHEN I am sent for to a Patient in a Fever, I attentively listen to the Account he gives of himself, without In- terruption, and then carefully examine into the Progress of every Symptom (o) from the first Seizure; I mean, from the first Hour that he found himself in the least dis- order'd (o) For by what more compendious, or other Way, can the curative Indications, or the morbific Causes we are to oppose, be searched for, than by a certain and distinct Perception of peculiar Symptoms? SYDENHAM [56] order'd; in order to find out, with as much Certainty as possible, the Nature of the Fever; for on that depend the Hopes of an expeditious Cure; altho’, for the most Part, I can certainly foretell, whether, or not, it will prove of the miliary Kind, from the Pulse alone, the Moment I touch it, which, in this Case, discovers itself to me, in a more extraordinary and distinguish- ing Manner, than in any other I have ever met with; for altho’ in the Beginning of the Fever, in a robust Constitution, it is sometimes frequent, full and vigorous, yet it seldoms fails, in three or four Days, to become remarkably swift, weak, and de- press’d; which also happens in most People at the Beginning: But these nice Distinc- tions are not to be acquir’d, without long Observation and Experience, arising from constant and unwearied Attendance, in a Multiplicity of Practice; so that the young Practitioner must not only content himself with forming a Judgment from the gene- ral Indications, but be particularly careful not to hazard his Patient’s his Life, or his own Repu- [57] Reputation, by mistaking the Case for an inflammatory, nervous, or intermit- tent Fever, which may easily happen to the unexperienc’d and unwary(p); nay, to my certain Knowledge, hath often so hap- pen’d, even to many old, but very emi- nent in the Profession, Physicians as well as Apothecaries, to the Destruction of Num- bers; who might otherwise have been now living Monuments of their Know- ledge and Success. I wou’d therefore by all Means advise the young Practitioners to stand upon their Guard; to study Nature (q), and pursue her to her most intricate I Recesses (p) For there are found Diseases, which are re- duc’d under the same Genus and Name, and, as to Symptoms, are like one another, yet they are diffe- rent in their Natures, and require a different Way of Cure.—The Cure whereof had not been now to seek, if Writers, in communicating their Experiments and Observations, had not took one Disease for another. SYDENHAM. (q) For the sagacious Man (Hippocrates) perceived, that Nature cures Diseases, and does all, being help’d by a few simple Forms of Remedies, and sometimes without any. SYDENHAM [58] Recesses; to search out diligently the Na- ture and Properties of Medicines, and to attend indefatigably the Poor as well as the Rich; which will not only teach them to ward off the furious Attacks of a most potent Enemy, but may, one Time or other, prevent themselves and Families, from falling Victims to their own Igno- rance. From what I have said, if any Body ex- pects to see a copious and pompous Form of Remedies, he will be much disappoint- ed; for I delight in Simplicity of Medi- cine, for the Cure of acute Diseases, as much as in simple Diet, for the Preserva- tion of Health and long Life. In my Preface, I have objected to the Method of Practice in 1741, for that the Sal Nitri and Saline Draughts are too cold, and Sal. Vol. C.C. Conf. Raleigh, &c. are of too hot a Nature, and quite inconsistent with that moderately cordial and diapho- retic Quality, necessary in this Case; there- fore [59] fore cannot by any Means be admitted in- to the Rank of Remedies for a miliary Fe- ver, without manifest Hazard of prolonging the Distemper with dire Symptoms(r), or Death itself: What a preposterous Fashion have some of our modern Physicians crept into? A sudden Transition from cold to hot, or hot to cold; either of which not having sufficient Efficacy to produce the desir’d End, they agree in Consultation, the dernier Resort, to sign a Neutrality(s), their extreme Unction(t): Would they not account it Madness in a Man, who not being able to endure the extreme Cold I2 of (r) It often happens that the Face of the Disease varies according to the various Processes of Healing; and some Symptoms rather proceed from the Physi- cian than the Disease. SYDENHAM. (s) Sal. Vol. C. C. with Sal. Nitri, or Saline Draughts. (t) Tho’ many Patients fall under the wisest Ap- plication of Remedies, and the Physician is not to be condemn’d for killing all that he cannot cure; it must, however, be acknowledg’d, that some unable Physi- cians of little Sagacity and Judgment, of a cloudy Imagi- [60] of Greenland, would from thence, if possible, instantly fly to the extreme Heat of the Indies? Therefore, O Medici, Medici! Quœ vos dementia cepit? If I am call’d within the first three Days to a Man of a robust Constitution, with a vigorous Pulse, I immediately order eight Ounces of Blood to be taken from the Arm, and then as follows: ꝶ. Croc. Castor opt. pulv. ana gr. x Syr. Croc. q. s. ut f. Bol. h. s. sumend. et mane repetend. cum Haust. seq. ꝶ. Vin. Imagination, and whose weak Reason is continually puzzled, as well as other bold and rash Practisers, do often increase the Distemper, and make it more dangerous, by an injudicious Method, and improper Remedies; and if the Patient recovers, and Nature prevails against the Doctor, he is greatly satisfied in himself, and confirm’d in the Opinion of his Medi- cines, believing he has cur’d the Patient, who had on- ly the good Fortune to escape. BLACKMORE. [61] ꝶ Vin. Coccinel. (u) 3j Aq. Alexet. Simp. ʒj. ß. ejusd. Spirituos. ℥ij. Syr. Albi ʒj. M. F. Haust. The next Day, if Nauseousness and In- clination to vomit indicate the Necessity of an Emetic, the following may be given: ꝶ. Rad. Ipecac. pulv. gr. x. vel xv. Aq. Alexet. Simp. M. F. Haust. pomerid. sumend. superbib. infus. Flor. Chamcœm thj. vel ij. pro Ratione Operationis. Afterwards, ꝶ. Conf. Damocrat. ʒ. ß. Croc. gr. v. Syr. Alb. q. s. f.Bol. H. S. post Emetic, sumend. & singula nocte repetend. ꝶ. Pulv. Contrayerv. comp. ʒj. Croc, gr. v. Vin. Coccinel. gut. 30. Aq. Alexet. Simp. ℥j. ß. ejusd. Spirituos. ʒij. Syr. Alb. ʒj. f. Haust. sextâ. qq. Horâ sumend. incipiend. Hor. sex. post Bolum. But (u) Vinum Coccinellœ. Rx Coccinellœ pulv. ℥j. Vin. Canarin. tbj. Macera sine Calore & Cola. [62] But if there should be no Occasion for Bleeding or Vomiting, I begin with the Draughts and Bolus last prescrib’d, the first Time I see the Patient, and continue them till about the sixth Day, I mean, from the first Complaint; but, after that Time, pre- scribe thus; Rx. Conf. Damocrat. ʒf. Croc. Castor. and gr. v. Syr. Alb. q. s. ut f. Bolus sexta qq. Hor. sumend. superbib. Coch. iv. Julep seq. Rx. Aq. Alexet. Simp. ℥vj. ejusd. Spiri- tuos. ℥ij. Syr. Alb. ℥ ß. Vin. Coccinel. ʒij. M. F. Julep. These are to be continu’d to the Ap- pearance of the miliary or crystalline Erup- tion, separately or together, which if all Things have been well conducted, will generally happen, in small Quantity, about the Eighth or Tenth Day; about that Time also, the dangerous Symptoms will abate, and the Fever soon after vanish, without Danger of Relapse or more to do, than keeping out of the cold Air, observ- ing [63] ing a proper Diet, and taking a Bolus, with some of the Julep, Night and Morning, for a Week longer. I have often found but three or four crystalline Pustles, which, however, prove the Nature and Degree of the Disease: But if any considerable Er- rors have been committed by the Sick, or those about him, then will no Eruption appear, till about the sixteenth Day, and that generally of the crystalline Kind alone, often in great Quantity, and very large; I have seen Thousands as big as the largest Pin’s Head(x), crouding all over the Body, the Extremities not excepted, like the con- fluent Small-Pox, portending Death. Here is an evident Mark of great Putrefaction; greatly, if I may be allow’d the Simile, tending to a Gangrene of the whole Mass of Blood; therefore here is the Touch- stone of Skill; here the Field, wherein to try the Power and Efficacy of Medicine! If (x) I have lately seen a Child, two Years of Age, afflicted with that Fever, and Breeding the Teeth, with Bladders of clear Water upon the Wrists, whose Circumferences were larger than that of a Shilling, besides many others of prodigious Size all over the Body. The Child died. [64] If by the tenth Day no Eruption ap- pears, and the Symptoms run high, De- lirium and Subsultus Tendinum beginning, a Blistering Plaister must be apply’d im- mediately between the Shoulders, and, the Morning after that, the whole Feet wrapt up in cephalic Plaister two Thirds, Blister- ing Plaister one Third, spread moderately thick; the following Prescription must also take Place: Rx. Conf. Damocrat, ʒ ß. Croc. Castor. a gr. x. Syr. Croc. q. s. ut f. Bol. sexta qq. Hor. sumend. superbib. Coch. iv. Julep prœser. Rx. Vin. Coccinel. Vin. Croc. a ʒ ß. M. cap. Gut. 40. sœpe in Ser. Lact. Vin. Alte- rat. vel Apozem seq. Rx. Aq. Hord, thij ß Gum. Arabic. ℥j. f. M. bibat. Haustul. sœpè tepidè. If the Delirium continues very long, I have sometimes added five Grains of Cam- phire to every Bolus, with good EfFect. This [65] This Method, without Alteration, must be continu’d till Death, or a Recovery, turns the Scale; if Death shou’d take Place, I know of no better Method whereby to prevent it; but a Recovery will most com- monly ensue, if all Things, in this Stage of the Disease also, are faithfully and right- ly manag’d; and then Security from a Relapse depends, as I said before, in keeping the Room, proper Diet, and a Continuance of the Boluses and Julep, Night and Morning, for a Week longer, when the Fever is gone off. If, in any Stage of the Disease, a Pain of the Head becomes very troublesome, the Application of six or eight Leeches to the Temples will be not only absolutely neces- sary, but greatly advantageous; and so it will also be of Consequence, at any Time of the Delirium. If Costiveness intervenes, a Clyster may be injected every third or fourth Day: K Rx. De- [66] Rx. Decoct. Malv. ℥8. Ol. Olivar. ℥ij, Mel. Solutif. ℥j ß. M. f. Enema. I allow for Drink, always to be made warm, Mint, Baum, or Sage Teas, Barley-water, Water-gruel, White-wine Whey, Panada, Chicken-broth, Sago boil’d thin; and some- times, if the Sick is earnestly desirous of it, half a Pint of good Small-beer, with a Toast and grated Nutmeg in it; but no Juice of Orange or Lemon in any Drink. If profuse Sweats render the Linnen dis- agreeable, I allow a clean Cap, Shirt, and Sheets, well dried and warm’d; but then for this Purpose, the Sick must be wrapt up in a warm Blanket, and carefully laid on ano- ther Bed in the same Room; for I am well assur’d, that less Mischief will accrue from this Change, than from the cold Air rushing into the Bed, when all is wet, and while they tumble to and fro’ with great Restlessness; these Sweats being only symp- tomatical. The [67] The Plaisters upon the Feet, which I de- sign for continuing Blisters, to avoid the Cruelty of fleaing alive from Head to Foot, the present Vogue, but not half so easy or effectual as mine, may be taken off in three or four Days, if there is great Com- plaint of Soreness, snipping the Bladders, without tearing off the Skin; the Sores may be dress’d every Day with a Cerate of Wax and Oil, and a little yellow Basilicum: I us’d to order equal Parts of the Plaisters, but since the College have increas’d the Quantity of Flies in the Emp. Vesicat. I have been oblig’d to diminish the Quantity of that Plaister; for my Intention is there- by to raise Blisters very gradually, so that sometimes the Plaisters may lie on a Week, with proper Effect, and without great Un- easiness. Women and Children, in general, may be treated, in the same Manner I have di- rected for Men, with this Difference only, that as they are the weaker Vessels, and of K2 a more [68] a more delicate Texture, less Doses of Medi- cine, with little or no Loss of Blood, ex- cept by Leeches, will best answer the Pur- pose; which any Practiser, who has but a Grain of Sense, may, I think, judge of, and proportionate according to the various Symptoms and Degrees of the Disease, and Circumstances of the Patient, without my Directions; which for every Individual wou’d render this Account too prolix and tedious, and serve only to puzzle and con- found the Reader. And so much for the Cure of the simple miliary Fever; I will now proceed to that call’d compound. Of the Cure of the compound miliary Fever, I call this Fever compound, when it at- tacks Women with Child or in Child-bed; when it is consequent to Children breeding their Teeth, or having a convulsive Cough; when join’d with the confluent Small-Pox, Measles, Scarlet Fever, an Asthma, acute Rheumatism or the Gout; Or when it is render'd [69] render’d so, by a wrong Method of Cure, or imprudent Management on one Side or the other. When it attacks a Woman with Child, Bleeding, according to the Time of her Pregnancy, is absolutely necessary in the Beginning; then the Method I have pre- scrib’d in general, with the Omission only of the Emetic and Castor. Women in Child-bed may omit Bleed- ing, and begin with the following at any Stage of the Disease: Rx. Conf. Damocrat. ℈j. Crot. Castor. ana gr. v. Syr. Alb. q. s. ut f. Bol. fextâ qq. Horâ sumend. cum Coch. iv. Julep. seq. Rx. Aq. Puleg. ʒvj. Alex. Spirituos. ℥ij. Syr. Alb. ℥ ß. Vin. Coccinel. ʒij. M. F. Julep. If Costiveness ensue, a Clyster may be injected once in four Days. There [70] There is seldom. Occasion for more than I have here laid down, having recover’d Scores in this Manner, without the Loss of one Patient, since I have been in Practice; but, if the Symptoms shou’d perchance be- come more violent, Blisters and increas’d Doses of Medicine may take Place: Some Practitioners think, that Opiates suppress or retard the Lochia, but I have always found it otherwise. Children, breeding their Teeth, must have their Gums cut, if necessary, and take the following Mixture : Rx. Pulv. e C. C. C. ℈j. Croc. subtiliss, pulv. gr. iv. Conf. Damocrat. gr. x. vel xv. Aq. Alexet Simp. ℥j ß. Syr. Croc. Zʒi. f. Mist. cujus cap. Coch. parvum sextâ qq. Horâ. Applicentur etiam Emp. Vesicat. nuchœ Et Emplastra pedibus totis, pro re nata. Children [71] Children, having a convulsive Cough, may be bled in the Arm, or with Leeches, in the Neck, at the Beginning of the Fever; may have a Blister, and take the same Mix- ture as above, augmenting or diminishing the Dose, according to Age, till the Fever is gone off; and then nothing will avail, but Change of Air, Asses Milk, and Manna, to keep the Body laxative; which last is generally necessary in both recited Cases, or a Clyster in its Stead, if they have not a Stool once in a Day, When join’d with the confluent Small- Pox, in adult Age, Sydenham's Method may be follow’d, till within forty-eight Hours, that the Turn of the Pustles is expected; then; Rx. Syr. de Mecon. ℥ ß. Aq. Alexet. Simp. ℥j ß. ejusd. spirituos. ℥ij. M. f. Haust. Horâ sextâ matutinâ & vespertinâ sumend. quo- tidie. Rx. Conf. [72] Rx. Conf. Damocrat, ℈j. Croc. gr. x. Sulph. Aurat. Antimon. gr. iij. Syr. Alb. q. s. ut f. Bol. hor. duodecimâ. Meridie & mediâ nocte sumend. superbib. Coch. iv. Mist. seq. Rx. Sperm. Ceti ℥iij. Vitel. ovi q. s. Aq. Alexet. simp. ℥vj. ejusd. spirituos. ℥ij. Syr. Alb. ℥ ß. f. Mist. cujus etiam cap. Coch. iv. sœpe. The Sulphur Auratum promotes Expec- toration better than any Thing, I know of, and the other Medicines cause a Diaphore- sis; Evacuations absolutely necessary in this Case, to remove impending Danger; I have met with great Success by this Treatment, therefore I think it my Duty to recommend it to others. With the Measles or Scarlet Fever, my general Method of Cure for the simple miliary Fever will likewise avail here, with- out Alteration, as no Symptoms in these two eruptive Fevers in the least; contra-in- dicate. With [73] With an Asthma; Bleeding in the Begin- ning, and Blistering about the eighth Day, are without doubt necessary; but Opiates of every Kind must be utterly rejected; therefore. Rx. Croc. Castor. Pulv. Contrayerv. comp- ana gr. x. Syr. Alb. q. s. ut f. Bol. s. xtâ qq. Horâ sumend. superbib. Coch. iv. Mist. seq. Rx. Sperm. Ceti ℥iij. Vitel. Ovi q. s. Aq. Alexet. simp. ℥vj. ejusd. spirituos. ℥ij. Syr. Alb. ℥ ß. Mist. Rx. Spt. Volat. Aromat. Vin. Coccinel. ana ℥ ß. f. Mist. cujus cap. Gutt. 40. bis terve die in Aq. Hord. cum Gum. Arabic. The Cure, in this Case, will be general- ly more tedious and difficult, than in the others; but, for the most Part, with Care, may be safely conducted, L With [74] With an acute Rheumatism; Bleeding in the Beginning ought not to be here ne- glected; and the following may be pre- scrib’d through the whole Course of the Diseases, augmenting or diminishing the Doses, according to the Urgency of the Symptoms: Rx. Conf. Damocrat. ℈j. Pulv. Rad. Poly- gal. Virgin. (Senekka Rattle-Snake Root) Cin. Antimon. Croc. Castor. ana gr. v. Syr. Croc. q. s. ut f. Bol. sextâ qq. Horâ sumend. superbib. Coch. iv. Julep, prœser. cum Vin. Coccinellœ. A Blistering-Plaister to the Back, and Leeches to the Temples, may be applied, if great Pain of the Head requires them. Bleeding often, giving Sal. Nitri, or Gum Guajac, as usually practis’d in this Case, will generally prove fatal. With [75] With the Gout; this Fever rarely in- vades People afflicted with that Oppro- brium Medicorum in a regular Manner, except external Applications, imprudently apply’d, disturb the gouty Matter in the Extremities, its usual Residence, and force it to mingle again with the whole Mass of Blood; when this is the Case, it generally fixeth upon the Brain, Lungs, Stomach, or Intestines, or produceth a Fever of the miliary Kind; if the last happens alone, or is complicated with a small Degree of Pain, in any of the Parts before-nam’d; the same Method may be us’d, as directed before for this Fever, with the Rheuma- tism, with the Alteration only of the Doses, and Times of Administration: Rx. Conf. Damocrat. Pulv. Rad. Polygal. Virgin. Cin. Antimon. Croc. Castor. ana gr. x. Syr. Alb. q. s. ut. f. Bol. quartâ qq. Horâ sumend. superbib. Coch. iv. Julep, seq. L2 Rx. Tinct. Rx. Tinct. Aromat. ʒvj. Vin. Coccinel. ʒij. Aq. Alexet. simp. ℥vj. ejusd. spirituos. ℥ij. Syr. Alb. ℥ ß. M. f. Julep. The Tinct. Aromatic. may be omitted, if the Stomach and Intestines are free from Pain. It must be remark’d, that, as I have en- deavour’d to be as concise as possible, in Relation to these compound Diseases, I have only directed what is necessary to be done, in the Presence of the Fever; when that is gone off, leaving the rest to be manag’d by the skilful Practitioner, as he shall think fit. And here, as an Apology for myself I can’t help quoting a Passage from the ju- dicious Sydenham, one of the worthiest and, best Men that ever liv’d: “If any one shou’d here object, that “others that are as much conversant in “Practice as I, are not of my Mind; it “does not concern me to enquire what “others [77] “others think, but to propose faithfully “my own Observations, in doing which, “I beg the Reader’s Patience, not his Fa- “vour; for the Thing itself will shortly “shew whether I have acted sincerely, or “whether I have been a Man-slayer.” Only I beg Pardon, for that I have not regarded a pure Diction, or an elegant Style, being not at all heedful of nice Matters, if I only write so as to be clearly under- stood. ADVICE ADVICE TO THE APOTHECARIES. I do not take upon me here to give Advice to all, for I know there are many of you undoubtedly honest, generous, and judicious, who scorn to be guilty of a mean or base Action, either in public or private; but a much greater Number in City and Country, of the opposite Charac- ter, are vilely industrious, ignorant, and penurious to a Sin; who set no Value up- on Lives, and study nothing so much as amassing Money at any Rate; there is ano- ther Species of you Gentlemen, who are Men of good natural Parts and genteel Educa- [80] Education, have been brought up regular- ly in Pharmacy, and by your easy Address, and engaging Behaviour, attract Esteem, and command Employment in a great Number of Families; but are, on the other Hand, so strangely attach’d to Taverns and public Diversions, that you have neither Time or Inclination to make a right Pro- gress into the Knowledge of Diseases or their Remedies: It is to you, of these two left opposite Characters, that I present my Address: Therefore, first of all, let me in- treat you to be particularly careful in the Choice of the best Drugs, and exact in the Composition of your Galenicals and Chy- micals; otherwise you hazard your Re- putation, deceive the Physician, and ei- ther kill your Patients, or prolong the Disease, till Nature at length forcibly gets the better. How many People suffer from bad Bark, Rhubarb, Ipeca- coanha, Jalap, Castor, Saffron, &c.? The Dead are past telling the Tale, but you yourselves must be conscious of it, or else confess your great Ignorance of Medicine; many [81] many of you, as I said before, are too ge- nerous to act so base a Part; but a great Number are penurious to such an excessive Degree, that, altho’ your exorbitant Profits exceed those of any other Trade or Em- ployment in the whole World, you wou’d not privately advance a Shilling extraordi- nary, to save the Life of the most valuable Man in the Kingdom. How many perio- dical Cases bring on chronic Diseases, and enslave poor Mortals to a miserable Life, by the Use of bad Bark? How do the vital Liquids run off, in Diarhœa’s and Dysenteries, from the Use of the worst Rhu- barb, Ipecacoanha, Diascordium, &c.? How much deceiv’d is the Physician, when the Apothecary substitutes a cheaper Medicine for a dearer, altho’ the Price of the dearest wou’d not amount to Six-pence a Dose? Lastly, How many perish in Fevers, and linger on with other Diseases, only for Want of good Drugs, Galenicals and Chy- micals? For God’s Sake, Gentlemen, ye Surveyors-general, I speak to now, who by Authority search the Apothecaries Shops, M Search [82] Search them narrowly from Stem to Stern, and where you see Cause, give a severe Reprimand; tho’ you shou’d forfeit the Six Shillings, which are usually given you, like Bolusses, to ease the Pain of your Sto- machs. The wholesale Apothecaries and Chy- mists are often the Sources of these ter- rible Disasters, who basely sophisticate, for the Sake of a little Profit, Medicines which circulate not only through this Kingdom, but many foreign Countries, and destroy five Times more People, than wou’d die of Distempers in a natural Way; and the Druggists, whose Principles are little bet- ter, for vending bad Drugs, excuse them- selves, by saying, If they buy the Devil, they must sell the Devil; but, if the Apotheca- ries did not purchase him from Time to Time, they wou’d soon be tir’d with ex- posing him to Sale. When you have got good Medicines, I must then beseech you to learn the Use of them; [83] them; but hold! you must first learn the Nature of Diseases, and know well how to distinguish one from another; I speak chiefly to you young Ones, tho’ the old Ones, many of them, wou’d not do amiss to take my Advice: For this Purpose, search out the best Authors, which will enrich your Senses; read them over and over again, till their most remarkable Pre- cepts are strongly impress’d on your Minds; but, in the mean time, abstain from Wine, and other strong Liquors, left they drown all your reasonable Reflections, and hurt your Memory. Attend diligently the sick Poor, as well as the Rich; for, tho’ the lat- ter may best suit your Pockets, the former will serve you for experimental Knowledge, which in the End, if you have natural good Principles, will bring you more Sa- tisfaction, than the Mines of Mexico; but be especially careful in your Experiments, that you do no Harm, for that shou’d al- ways be your first Principle in Practice. Whenever you venture out of the beaten Track, or even follow the old one, go on M2 with [84] with Caution in giving small Doses of a doubtful Remedy, and be frequent in your Visits to see the Effect of it; then proceed gradually Step by Step, and never quit the Disease, or the Remedy, till you are Ma- ster of both. When a Physician attends your Patients, which you too often recom- mend, from, I am afraid, a just Sense of your own Inabilities, or to swell your Bill to a greater Bulk, don’t think that your Business is then done, for it more nearly concerns you now to attend with Di- ligence, as you have a greater Work set before you; now your timorous Mind is set at Liberty, to inspect narrowly into the Nature of the Disease, the Remedies pre- scrib’d by the Physician, and to compare the Effects of them with your own Practice in the like Cases. The exorbitant Fees of the Doctor will seldom admit of more than one Visit a Day, and that at a Time when, in acute Distempers, the frightful but informing Symptoms of the Night are ei- ther going, or chiefly gone off; therefore it is your Duty, if you have any Fellow- feel [85] feeling for your Patient, or Regard for yourself, to be constant in your Evening- Attendance, that thereby you may be ready the next Day to give a just Account of the Patient’s Welfare or Sufferings, from the Disease and the Remedy, as well as to establish yourself firm in that Opinion of the Sick, by your Diligence, which cou’d not be brought about by your Judgment alone; this will never fail from Time to Time to advance your Reputation, till your Age and Success fix you on a more solid Foundation. But now presents the dismal Scene: To do all this, you must leave your darling Pleasures, Taverns, and Bottle Companions, Play-houses, Gaming-houses, and other public Diversions; to advance happily and successfully in your Profession, and to arrive at the Pinacle of universal good Character and Esteem, you must forego all jovial Appointments, for the Sake, sometimes, of one Patient only, and even that a poor one, to whom you must perhaps give your Advice and Medicines gratis; who, notwithstanding that, has a Life [86] Life at Stake, as valuable in his Station as that of an Emperor; for his Family are his loving Subjects, and his Cottage is his Kingdom, which must all droop and fall to Decay, after the Demise of their only King; therefore you must absolutely at- tend him as diligently as the Rich, left, by a Surmise of Neglect, you lose more Re- putation in one Day, than you will be able to recover by the greatest Diligence in many Months; especially too, if you are but just enter’d into Life: Do but succeed, tho’ Nature does all, you will have all the Glory; but, if you miscarry. Shame and Confusion will be your Attendants, till, by Time and constant Rubbing, you are suffi- ciently burnish’d, to stand the Fire of a censorious Age: This is a long Lesson, a hard Task; but be assur’d from me, that you will not have it in your Power to make any considerable Figure in your Profession, accor- ding to the old Phrase, till you have no Teeth to eat your Bread, without you pursue the Course I have laid down; except indeed, as sometimes happens, you have the Luck to [87] to have the Bread put into your Mouths, by some well establish’d Practitioners, who take you into Partnership in an early Age: This is the good Fortune of some remark- able Boobies, who, from not being able to get Shoes and Stockings, if they were set on their own Legs barefoot, begin soon to get an Estate; while others of Merit? Knowledge, and Success, are oblig’d to trudge early and late, only for the Sake of a genteel Support. Now I have explain’d the Duty which more immediately concerns the Apothecary, I will give you farther Instructions for the Benefit of your Patients, which will not altogether be useless to yourselves. Be sure to keep a watchful Eye over the sleepy senseless Nurses, suffer no Error or Neglect in their Conduct to pass unregarded, as many of you do, to gain their Esteem, and thence their Commendation, or other- wise to avoid their weak and low Asper- sions [88] sions, and ungrounded Prejudices: Pay the same Deference also to the mighty knowing Midwives, who are only a better Sort of Locusts, that will take the Bread out of your Mouths, if you do not smother their Errors, and proclaim their Qualifications; but mind this, you must be thorough-pac’d in your Profession, and have given repeat- ed Proofs of your Judgment, before you make this hazardous Attempt, Nothing less than a forlorn Hope; for Women are, by a Sort of Infatuation, so excessive fond of this Sort of Creatures, who from thence take such Liberties, that sometimes even in de- sperate Cases, they will, with an uncommon Stock of Impudence, tell you to your Face, in their Language, that sure they have not been so many Years Nurses or Midwives, but that they know what belongs to the Cure of such and such an Ailment, better than a young Apothecary, This you must irresistibly oppose, and never leave them, till you have fairly prov’d that they are Fools and Lyars; otherwise, in Return, they will, much to your [89] your Disadvantage, prove you to be a very ignorant Fellow, which will soon spread a- mongst the neighbouring Women, your Body Guards; but then, I say, you must be conscious that you certainly know how to vanquish the Disorder, which has set you at Variance, or must come to a Parley up- on worse Terms. But, leaving this Di- gression, condescend to examine the several liquid Foods you have order’d for your Patients Subsistence; be not content with one or two Sorts only, but have Plenty where it can be admitted, that the constant Supply which is necessary not only for the Disease, but from the Quality of the Me- dicines, may not nauseate the Stomach, and rob you of Part of your Dependance in the Cure of the Patient; and indeed nothing contributes more to the Ease and Satisfaction of the Sick, than Choice of Liquors properly made; for weak Sto- machs are soon disgusted. As the Physician is often discharg’d, so soon as the Danger is over, the future Con- N duct [90] duct of the Patient lies wholly upon your Care; therefore now is the Time to bestir yourself, to procure a perfect Recovery, by continuing the Medicines order’d by the Physician; for at your Peril do not alter them, left by any Accident the Patient shou’d grow worse, and you incur the Blame; I say, continue the Medicines, as long they are absolutely necessary, but no longer, and take upon you, with becoming Authority, to order the necessary Diet from Time to Time, and strictly scrutinize into the Execution of your Orders; which will not only always gain the Attention and Esteem of the whole Family, but convince them of your upright Intention to prevent a Relapse. One Thing more I must add, and that is this, Revere the Profession to which you belong, and treat every Member of it, who shall deserve it, with the utmost Marks of Sincerity and Respect; be not reserv’d, but with an engaging Air and Freedom, in your mutual [91] mutual Correspondence, communicate eve- ry Thing you know for the public Wel- fare; let no good Thing be buried in the Grave, the Seat of Oblivion; be courteous and affable to all Mankind, especially the sick Poor, who, in their great Distress have little else to alleviate their Sorrows, than your sympathizing Nature, mild Deport- ment, and benevolent Hand; in short, al- ways endeavour to act the Part of the real Gentleman, which, if you do not gain Riches, will generally procure you a con- tented Mind, the next Step to a happy Life. These are the Requisites, which, I have told you in my Preface, must be join’d with the Physician and his Prescriptions, in order to a happy and successful Prac- tice: But what with the Pride, Inability, and Self-conceit of many Physicians, the Negligence, Ignorance, and Penury of many Apothecaries, Sophistication and Villainy of many Chymists and Druggists, I must, upon the [92] the Whole, conclude, that we are, in ge- neraly in no proper Condition to make many great Advances or Improvements in Physick. FINIS. ERRATA. PREFACE pag. vi, last Line, read Eruptions, p. 23. l. 1. read takes, p. 61. l. 9. after Simp. read Z3j. omitted. p. 64. l. 14. read ana Z3 f. l. 17. read Aq. Hard. tbij. p. 66. l. 2. read Solutiv. p. 69. l. 16. read Z3vj. p. 73. l. 7. read sextâ. If I have overlook’d any Errors of the Press, I hope the reader will be careful to rectify them.