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THE MANAGEMENT AND DISEASES OF WOMEN AND CHILDREN. A DISPENSATORY, FOR PREPARING FAMILY MEDICINES, AND A GLOSSARY EXPLAINING TECHNICAL TERMS. TO WHICH ARE ADDED, A BRIEF ANATOMY AND PHYSIOLOGY OF THE HUMAN BODY, SHOWING, ON RATIONAL PRINCIPLES, THE CAUSE AND CURE OF DISEASES: AN ESSAY ON HYGIEINE, OR THE ART OF PRESERVING HEALTH, WITHOUT THE AID OF MEDICINE : AN AMERICAN MATERIA MEDICA, $4 LZsi POINTING OUT THE VIRTUES AND DOSES OF OUR MEDICINAL ALSO, THE NURSE'S GUIDE. BY JAMES JEWELL, ^j^^ PHYSICIAN IN WASHINGTON, FORMERLY OF SAVANNAH. I have always thought it a greater happiness to discover a certain method of curing, even the slightest disease, than to accumulate the largest fortune ; and whosoever compasses the former I esteem not only happier, but wiser and better too.—Sydenham: -------J.___ THE NINTH EDITION, REVISED, ENLARGED, AND VERY CONSIDERABLY IMPROVED. EMBRACING A TREATISE ON EPIDEMIC OR MALIGNANT CHOLERA. PHILADELPHIA: CAREY, LEA AND BLANCHARD. 1836. Entered according to the Act of Congress, in the year 1822, By Cordelia B. Ewell, and Olivia F. Ewell, in the Clerk's Office, of the District Court of Columbia. cJu-o -%-*>- "a-a JO E. & L. Merriam, Printers, Brookfield, Mass. RECOMMENDATIONS. In testimony of the merits of this work, the following commendations, by some of the most dis- tinguished medical characters of the United States, are inserted; together with the letters of their excellencies, Thomas Jefferson, and G. Hyde de Neuville— also, a review by Professor Mitchell, of New-York. Baltimore, Nov. 18, 1822. DEAR SIR, I have been truly gratified in the perusal of the Sixth Edition of your "Medical Companion, or Family Physician" The improvements made in this new impression of your work, compared with the former editions, are, indeed, extensive and im- portant. Independent of your having enlarged considerably on diseases generally, you have introduced additional matter, which greatly enhances its value. The introduction of the Nurse's Guide, as also the treatise you have given on the management of female complaints, will have the most happy effects, in correcting the gross errors daily committed by ignorant persons, and thereby save many valuable lives. I do not hesitate to say, that this new edition of your Medical Companion, is decidedly the best popular treatise on medicine, that has ever been published ; and considering it, as I verily do, a safe and useful guide for heads of families, as well as for young practi- tioners of medicine, I take much pleasure in recommending it to the attention of our fellow citizens, both in town and country. I will only add, if your book meets with that encouragement, to which it is justly entitled, you will very soon be called upon, by the public, for another edition. I am, dear sir, with much respect, Your friend and servant, COLIN MACKENZIE, M. D. Dr. James Ewell. * * Baltimore, Nov. 18th, 1822. DEAR SIR, When the Medical Companion was first published, I considered it <*reatly superior to every work of that character I had read. I have now read the Sixth Edition, and am much gratified in having it in my power to say, that in this Edition you have so enhanced the value of the work, as to claim my unqualified approbation. IV RECOMMENDATIONS. Doctor Rush, during my residence in his house, often spoke of his intention to publish a medical work for the use of families, adapted to the climate of the United States. As he reserved it for the last act of his labors, for the benefit of mankind, unhappily he did not live to accomplish his design. In the work now presented to the public, you have fulfilled the patri- otic intentions of the great and good Rush, to the utmost extent, and I sincerely hope your reward may be, as it deserves, ample. I am, dear sir, very truly, yours, ASHTON ALEXANDER, M. D. Dr. James Ewell. Philadelphia, August 13, 1816. DEAR SIR, I have looked over, with some care, the copy of the Third Edi- tion of the " Medical Companion," which you did me the favor to present to me. By the additions and revisions given to this new impression of the work, it is not only enlarged, but exceedingly improved. After stating so much, I need hardly repeat an opinion, which I publicly expressed on a former occasion, that I consider it, as in- disputably, the most useful popular treatise on medicine with which I am acquainted. Compared with the European Books of the same nature, it has, especially in relation to the treatment of the diseases -of our own country, a very decided superiority. I trust that the success of this literary enterprise may be equal to your very generous and benevolent disposition. With great respect, I am, dear sir, yours, &c. N. CHAPMAN, M. D. Professor of the Institutes and Practice of Medicine, and Clinical Practice, in the University of Pennsylvania. Philadelphia, Aug. 13th, 1816. DEAR SIR, I have derived much satisfaction from a perusal of a third edition of your " Medical Companion." The additions and improvements which it contains, as compared with the first two editions of the work, are extensive and important. To families in the country, remote, not only from medical aid, but from places where common medicinal articles are to be procured, your Materia Medica alone, disclosing to them the healing resources of their own farms and forests, will be of high value. Nor, provided they be true to their best interests, and avail themselves of the advan- tages placed at their disposal, will your rules and directions for the preservation of health, be less useful to them. RECOMMENDATIONS. V In addition to these two important branches, now introduced into the Medical Companion for the first time, it contains a large amount of new miscellaneous matter, which cannot fail to be interesting to the reader. On the whole, if I be not greatly mistaken in my estimation of the character of your work, it is well calculated to prove extensively use- ful, and to place you in the midst of the permanent benefactors of your country. That you may receive, in reputation and wealth, your full reward, is the sincere wish of, Dear sir, your very humble And obedient servant, CH. CALDWELL, M. D. Now Professor of Materia Medica and Physiology in the Transylvania University. Dr. James Ewell. Philadelphia, December 31, 1807. DEAR SIR, I have read your book entitled " The Medical Companion," with pleasure, and think it worthy the attention of the citizens of the United States. W. SHIPPEN, M. D. » Professor of Anatomy. Dr. James Ewell. Philadelphia, December 31, 1807. DEAR SIR, I have carefully perused your work," The Medical Companion" and take much pleasure in expressing my entire approbation of the plan, and of the utility with which you have conducted your inqui- ries. Your book cannot fail to be a very acceptable present to the public in general, and especially to our own countrymen. I really am of opinion, that you are entitled to much praise for the pains which you have taken in furnishing us with a work, the want of which has long been experienced among us. Your friend, &c. B. S. BARTON, M. D. Dr. James Ewell. Professor of Materia Medica, Natural History, and Botany. VI RECOMMENDATIONS. December 28, 1807. I have read " The Medical Companion," by Dr. James Ewell, with satisfaction. It is a book containing a variety of matter in a small compass. The practice which he recommends in diseases, is modern and judicious, and the work cannot fail of being useful in all families in the United States. JAMES WOODHOUSE, M. D. Professor of Chemistry in the University of Pennsylvania. Dr. James Ewell. DEAR SIR, I have looked over your " Medical Companion," with pleasure. The arrangement of the various parts is judicious, the language plain and perspicuous, and the sentiments happily condensed ; the modes of treatment grow out of the most improved state of our science, and may serve as a safe and useful guide to every family cut off from the services of able physicians. Accept the homage of my regard. JOHN B. DAVIDGE, M. D. Professor of Anatomy, Surgery, &c, in the College of Medicine of Maryland. Baltimore, Feb. 19, 1808. Dr. James Ewell. DEAR SIR, We have perused your "Medical Companion" with much satisfac- tion, and strongly recommend it to the attention of those families who cannot with convenience procure medical aid. We think it the best publication we have ever read on the domestic treatment of diseases, more especially as it regards those of our climate. We are, very respectfully, sir, Your most obedient servants, BROWN & MACKENZIE. Baltimore, March 4, 1808. Dr. James Eivell. SIR, I have read your book on Domestic Medicine with pleasure. The practice recommended in it is judicious, and, being from the pen of a native physician, has great advantage over the publica- tions of European authors. JOHN SHAW, M. D. Professor of Chemistry in the College n T n of Medicine of Maryland. Dr. James Ewell. RECOMMENDATIONS. vii Charleston, May 7,1808. DEAR SIR, Your "Medical Companion" contains much useful knowledge in a small compass, and is particularly adapted to these states. Fami- lies remote from medical aid, will find their account in possessing a book which describes diseases so plainly, and prescribes for them so judiciously, as bid fair to save valuable lives, which otherwise might be lost. Your most obedient servant, DAVID RAMSAY, M. D. Dr. James Ewell. Charleston, S. C. May 12, 1808. DEAR SIR, The perusal of your "Medical Companion" has given me the greatest satisfaction. Such a publication has been much wanted, and I think the plan and execution of your work must answer the most valuable purposes. Yours, very truly, ALEX. BARRON. M. D. Dr. James Ewell. Charleston, May 14, 1808. DEAR SIR, I have, with great pleasure, perused your "Family Physician." I find it to be a well digested compend of the most modern and approved modes or treating diseases, especially those to which our country is most exposed.—You have subjoined a dispensatory, ju- diciously calculated to obviate those errors which too frequently en- sue from the exhibition of medicine, where the aid of the practi- tioner cannot be obtained. Yours, &c, PHILIP G. PRIOLEAU. Dr. James Ewell. Washington, March 1, 1808. SIR, I return you my thanks for the copy of "The Medical Compan- ion" you have been so kind as to send me, and must particularly express my sense of the favorable sentiments expressed towards me in the beginning of the work ; especially, too, where it recalls to my recollection the memory of your respectable father, who was the viii RECOMMENDATIONS. friend and companion of my youth, and for whom I retained through life an affectionate attachment. The plan of your work is certainly excellent, and its execution, as far as I am a judge, worthy of the plan. It brings within a moderate compass whatever is useful, levels it to ordinary comprehension, and, as a manuel, will be a valuable possession to every family. I pray you accept my salutations and assurances of esteem and rGSpeCt' TH. JEFFERSON. Dr. Ewell. Washington, July 3, 1808. SIR, I had the honor to thank you viva voce, after my having receiv- ed your book: I owe you new thanks after perusing it. Such a work would be useful, very useful, in every country, but it may be said it is necessary in the United States, and you have acquired true titles to the gratitude of your fellow-citizens, and specially that of the families who happen to be distant from medi- cal aid, by pointing out to them the surest and, at the same time, the simplest rules to be followed in case of sickness. I, above all, offer up my prayers, that your wise hints to ladies may not be laid aside, and that mothers of families may impress them into their minds. Consumption, that inexorable enemy of youth and beauty, is, indeed, in most instances, but the mournful result of an imprudent fashion, and it cannot be too often repeated to young ladies who do not fear to show themselves at assemblies in winter, in light dresses, that which a great physician answered to one of his friends who told him, I am well, I have only got a cold: " Colds," said he, " take away more people than the plague." Agree, sir, with my sincere acknowledgments, the assurance of my truly distinguished consideration. G. HYDE DE NEUVILLE. Dr. James Ewell. The following Review is from that celebrated Work, the New York Medical Repository. Manuals of health, or popular publications on medicine, have become so frequent as to have excited the censure of some giave and oracular members of the profession. They consider their pub- lishing brethren as unnecessarily divulging the arcana of the art, as depreciating its credit and estimation, and as teaching the common RECOMMENDATIONS. IX mass of readers to know as much as themselves. This communi- cative disposition they conceive to be carried to a very faulty ex- treme. Fpr when the secrets of the healing faculty are promulgat- ed by its members with such consumate knowledge and success, what is left for distinguishing the regularly initiated from those who are without the pale ? The propagation of the Esculapian mysteries is viewed to be faulty on another account; in as much as in dimi- nishing the importance, it lessens the profits of the practisers, and thus, for the gratification and emolument of one tell-tale author, the whole fraternity is disparaged. Let us, however, do justice to those sons of physic who are thus accused of faithlessness, in uttering abroad those matters which ought to be viewed as under fhe restriction of closed doors. Con- trast their conduct with that of another class of medical person- ages, who forever deal in nostrums, and are incessantly boasting of their wonder-working powers ; who assure the credulous world they can cure every possible disease of mind and body ; but with a cunning equal to their effrontery, permit no mortal to become ac- quainted with their remedies. Compare the conduct of him who withholds nothing from his fellow citizens, with that of him who keeps every thing to himself. There can scarcely be a stronger exhibition of generous'communication on the one part, and of sel- fish concealment on the other. Whatever may be pleaded in be- half of the persons who refuse to make a magnanimous publication for the good of mankind, of such valuable means of cure as they may possess, or who secure the profits of them under the statute of patents, there certainly is a character of greater disinterestedness and philanthropy, and a temper of a brighter mould and finish in him, who, without fee or price, offers to his fellow creatures all he knows that will be beneficial to them. We know it has been said, that a smattering in the knowledge of the animal economy, and of diseases, multiplies the number of patients, and encourages the practice of physic. Books on such subjects, addressed to the people at large, are peculiarly calculated to alarm their fears whenever they are unwell, and, therefore, im- pel them to seek assistance from those on whose skill they rely. It has been surmised too, that the disciples of Buchan, Willich, and their coadjutors, have often been led, from superficial and con- ceited knowledge, to become prescribers to others, and have, by their blunders, rendered the attendance of the regular physician more needful than ever. Hence it has been argued, that publica- tions of this kind fail to promote the plausible object of their com- position, and, in reality, produce a mischievous, and not a benefi- cial effect. It has even been urged against them, that they are of no service to any person but the writer, who may diffuse his fame and increase his wealth in proportion to the circulation of his book and the consequent disturbance it works in society. Whatever may be the merits of this controversy among those who are toiling night and day in the service of the infirm and disabled, B x RECOMMENDATIONS. or in the compilation of volumes, for our own parts, as reviewers, we feel favorable to the general distribution of knowledge. We are not attached to monopolies of any kind, and less than any, to that which confines to a particular order, the information which will teach man how to prevent sickness and pain, and to remove these ills when they invade. He who publishes wholesome pre- cepfs and directions, cannot be denied the merit of good intention ; and it would be hard to refuse him the additional credit of having done substantial good to those who have followed his advice. Hav- ing indulged these prefatory reflections, we advance to the consi- deration of the work before us. > The author has prefixed to it a dedication to the President of the United States, a preface explanatory of his design, and a num- ber of recommendatory epistles from his friends. Then follows a chapter of preliminary observations, of which we were inclined to- offer an extract for the gratification of our readers ; but our limits forbade. The body of the work is devoted to the consideration of the principal diseases which assail the human frame at different times of life. They begin with fevers, and end with rickets; without, however, observing any strict method or nosological arrangement. Each section stands by itself, and has little or no connection with the preceding or subsequent matter.—But a table of contents and index are two good keys to the subjects discussed. The diseases are severally considered in short and generally ap- propriate terms. After a definition, the observations are mostly comprised under the head of symptoms, causes, treatment, and regimen; to which, in some instances, are added paragraphs on prevention. And it is but justice to observe, that jhe author has manifested a careful and discriminating mind in condensing so much valuable instruction into such a moderate compass. The sen- tentious and, at the same time, intelligible manner of convey- ing his directions, is at once, calculated to give the reader a clear idea of his meaning, and favorable opinion of his understanding. Besides the observations that are strictly medical, the work con- tains a variety of directions upon surgical subjects. To render his compilation more generally useful and acceptable, the author has annexed to it a dispensatory. This consists of two parts: the first comprehends a table of medicines for family use, with their doses and qualities annexed ; and the second contains a collection of recipes for the principal part of the compound medi- cines recommended in the course of the work. And this part of the publication is executed in a manner that justifies the opinion we hinted before, of Dr. Ewell's sagacity and skill. TO HIS EXCELLENCY THOMAS JEFFERSON, PRESIDENT OF THE UNITED STATES. I beg leave to present this Book to Mr. Jefferson, not because he is President of 1807, but because he was the patriot of 1776; and still more, because, through the whole of a long and glorious life, he has been the philosopher and friend of his country : with all the ingenuity of the former, exposing the misrepresentations of illiberal foreigners ; and, with all the ardor of the latter, fanning the fire of Ameri- can science, and watering the roots of that sacred olive which sheds her peaceful blessings over our land. To whom, then, with equal propriety, could I dedicate a book, designed, at least, to promote health and longevity ? And to whom am I so bound by the tenderest ties of affec- tion and gratitude, as to Mr. Jefferson ? The early class- mate and constant friend of my deceased father, and instru- mentaliy the author of my acquaintance with the first cha- racters in the state of Georgia ; among whom, with pecu- liar pleasure, I would mention the honorable names of Mil- ledge, Troup, Bullock, and Flournoy. XU DEDICATION. That you may long direct the councils of a united and wise people, steadily pursuing health, peace, and compe- tence, the main pillars of individual and national happiness, is the fervent prayer of your Excellency's Much obliged, and Very grateful servant, JAMES EWELL. PREFACE. On the important subject of domestic medicine, many books have been written, which, though excellent in other respects, have greatly failed of usefulness to Americans ; because they treat of diseases which, existing in very for- eign climates and constitutions, must widely differ from ours. The book now offered to the public, has, therefore, the great advantage of having been written by a native Ame- rican, of long and successful practice in the Southern states, and who, for years past, has turned much of his attention to the composition of it. The professed object of this book is to treat in the most clear and concise manner, almost every disease to which the human body is subject, to give their common names and surest symptoms, to point out the causes whence they originate, and the most approved method of treatment— and, lastly, to prescribe the suitable regimen and means of prevention. A publication like this cannot but be exceedingly useful to all, but especially to those who live in the country, or who go to sea, where regular and timely assistance cannot always be obtained. Among the many and great services, to be rendered by such a book, we may fairly state its tendency to prevent that dangerous ofiiciousness of ignorant persons, and, that equally pernicious neglect of the patient, at the onset of the diseases, whereby so many lives are lost. These, with many other evils resulting from the want of such a work, constituted the motives which first led the author to offer this publication to his countrymen. It is not for him to de- termine whether it be happily executed or not; but, what- ever may be the general opinion as to its merit, he has the high satisfaction to know, that it not only flows from the purest motives, but also contains a faithful relation of facts, collected principally from his own experience, and, in part, selected from authors of the greatest celebrity. XIV PREFACE. He has not hesitated, occasionally, to use the language of his favorite authors, where he found it sufficiently clear and familiar for his purpose ; and he hopes this acknow- ledgment will be received in place of frequent reference and quotation. The reader will find, in the latter part of the work, a „ table of such medicines most commonly called for in fami- lies, with an adaption of the doses to the age of the patient, together with directions to prepare and administer them. And, as it is impossible entirely to banish technical phrases when writing on medicine, the reader is presented with a Glossary, explaining the medical and scientific terms un- avoidably employed in this work. The author, animated by the extraordinary success of the "Medical Companion," has greatly improved and enlarg- ed it, by a synopsis of the anatomy and physiology of the human body; essays on air, food, exercise, sleep, evacua- tions, and passions ; and a Materia Medica. Thus improved, the Medical Companion not only treats of the art of preserving health, and curing disease, but also inculcates a familiar knowledge of the human sys- tem, in all its parts, and the laws that govern its economy. It is obvious, that by due attention to the non-naturals, by which is to be understood the means of preserving health, we may go far to protect this fabric from injury or disease. To inculcate this truth more universally and successfully, the disquisitions contained in this work, are enlivened with appropriate illustrations, calculated to make impression on the mind of the reader, as lasting as they are important. Not the least valuable portion of this work is the Ma- teria Medica, pointing out those precious simples where- with God has graciously stored our meadows, fields, and woods, for the healing of our disease, and rendering us happily "independent of foreign medicines, which, while they are sometimes hard to be obtained, are frequently adulte- rated, and always costly. To conclude—the author having added much new and important matter to this ninth edition, it will, unquestion- ably, be found much more valuable than any of the former; because he has labored to correct in this, all the errors and imperfections that have hitherto appeared, has enlarged upon the treatment of most diseases, and has introduced preface. XV several others, particularly that scourge of the South and West, the malignant fever, sometimes denominated the Cold Plague, which were not previously noticed, though highly important to be well known and understood. In the present state of the science of medicine, daily im- proving by experience, and adding rapidly to the number of valuable remedies, he felt it incumbent upon him to en- large considerably on the treatment of the diseases gene- rally, as well as to make other additions, which a work of this nature required, in order to its increased usefulness. In a familiar style he has pointed out the modus operandi of the different remedies ; has given the prognostics of dis- eases ; has noticed more particularly the circumstance whence the disorders originate, for the purpose of guarding against occurrences ; has distinguished those cases which yield readily to the employment of simple means, form those which require the regular attendance of a medical practi- tioner ; and has detailed the means for checking or retard- ing the progress of such cases. On the management and diseases of women, he has en- deavored, with the aid of the most distinguished authors on this subject, to give such a description of the complaints to which they are liable, with instructions for their treat- ment, plain enough, to be understood by the attendants or the patients themselves; and which he sincerely hopes will in a measure have the tendency to correct the errors and misconduct of unskilful midwives, and to prevent unneces- sary interference in young practitioners. To all of which has been added a general sketch of the diseases of infancy and childhood. With a view of correcting the gross errors of nurses, whereby .so many valuable lives have been lost, there is in- troduced the "Nurse's Guide," describing the preparations of such aliments as are most proper for the sick; which, as a family assistant, will, unquestionably, be a valuable acquisition. Desirous that nothing "should be omitted, which would in the least add to the value of the work, he has greatly im- proved the Dispensatory ; which is now arranged in a man- ner that will not in the least perplex the reader; having endeavored to render each formula or prescription, as con- cise and clear as possible, both as to the mode of preparing XV'i PREFACE. and the intention of employing it by short practical remarks under each class or head. He has likewise given a detailed Index, so that in all cases of disease, the reader may be directed without trou- ble or embarrassment to the appropriate remedies. And, that the bulk of the volume might not be too large, he has expunged many of the illustrations under the head of Hy- gieine, being of little importance compared with the matter now introduced. The author cannot but think a work of this nature will be exceedingly useful to the student, whose theoretical knowledge has only prepared him to commence the ar- duous duties of his profession; for, it will not be denied, that the most experienced practitioner occasionally feels the want of a guide in his practice. It is worthy to be noticed, when the first edition of the Medical Companion was presented to the public, Professor Barton, with his usual liberality and philanthropy, enjoined upon his pu- pils to procure a copy of the work before they entered upon the duties of their profession, observing, at the same time, that he himself had profited by it in practice, by re- freshing his memory of what he had read in more volumi- nous works. To every family, more especially those in remote situa- tions, the possession, of this book must, unquestionably, be of incalculable value ; for, conducted by such a guide, it will not be presumptuous to say that any person of tolerable ca- pacity, and reasonable attention, may be enabled to prac- tice with safety and advantage, in those cases of simple diseases most incident to our climate. How far the author has accomplished his wishes in these important respects, the reader is left to judge from the high testimonials prefixed to the work, from some of the most distinguished physicians in our country. He will only add, from the time and attention he has devoted, in making the improvements now introduced, he cannot but flatter himself, the " Medical Companion" will not fail to be acceptable to his fellow-citizens; and, under this pleasing impression, he submits it to their generous patronage. PRELIMINARY OBSERVATIONS. Contemplating the numberless diseases to which man is liable, and which may cause him to drag out a protracted life of distress, or suddenly cut >him off in the bloom of his existence, and amidst his usefulness, we must adore the Divine excellence which has given us in medicine the means of counteracting their dreadful effects. As might have been expected, the attention to an art, rising in importance over all others, has ever kept pace with the general pro- gress of intellectual improvement, commanding for it the respect and encouragement of every enlightened people. With the Greeks, especially, the wisest and most polished of all the ancient nations, medicine was held in the highest estimation. Its votaries were cherished and revered by them while living, and in some instances, carrying their enthusiasm so far as to deify them af- ter death. It is not, indeed, easy to conceive a more noble character, than a great and amiable practitioner of medicine, who has expanded his mind to the utmost extent by the brilliant attainments of science, and mellowed the dispositions of his heart by the habitual exercise of benevolence towards the afflicted objects of his care. How ex- emplary are physicians of this description! Such was Hippocrates, the father of medicine. Such was the pious, the enlightened Syden- ham. Such was the benevolent Jones, of Savannah. Such was the enlightened Rush: and such are many others who have emulated their virtues and rivalled their fame ; among whom, I have the high satisfaction to enumerate of my particular friends, the late Drs. Craik, of Alexandria, Weems, of Georgetown, Stevenson, of Baltimore, and Dr. Chapman, of Philadelphia. But unhappily, all those who profess our art do not resemble those bright examples. Medicine, more than any other good thing, is sub- ject to abuse and debasement, by the sordid and mischievous " tricks and devises " of empiricism. Like noxious weeds impostors rise up at first, from the rank soil of their own effrontery ; but they owe much of their subsequent growth to the protection which they derive from the want of that information widely diffused, which would at once detect, and " laugh into scorn " their idle claims, and arraign to con- viction their dangerous tendencies. They live but by tolerance. The slightest examination of their pretensions would drive the herd into their holes and hiding places, and consign their widely spread fame to utter oblivion. 26 PRELIMINARY OBSERVATIONS. It is strange, that so little popular curiosity prevails with regard to medicine, particularly when the public mind is so actively alive to subjects certainly of less moment. Talk to the generality of mankind about property, and you would suppose they were all lawyers, they reason so sensibly on the various points of meum et tuum: but touch them about that which is of more worth than all property, I mean health, and they are silent as mutes. Did not ex- perience evince the fact, we should think it impossible that in things of such high concern, men could be so preposterously deceived ! so careful of the dross, and yet so negligent of the gold. What can be more deeply interesting than the investigation of that beautiful organization which has, emphatically, been pronounced " God's master work ?" What more important than acquiring the knowledge of preserving this admirable mechanism ? And what more pleasant and useful than to investigate the medical plants of our extensive country, whereby we may remedy those painful ma- ladies which assail the human frame ? Half the attention and the time devoted to the minor politics arising out of our party dissensions, assisted by very little of that overboiling zeal given to the acquisition of property, would, if ap- propriated to medical studies, enable any person of tolerable capacity to practise with safety and advantage in those cases of simple disease which are most common to our climate, and to determine between the "arrant quack" and the modest, well-educated, and judicious physician. Assuredly, some care might be profitably directed to medicine. Why will not the intelligent citizens who are scattered throughout the country, dedicate a part of their " liberal leisure" to it ? Of all the sciences, it is the most inviting, and that which opens the largest treasures to its cultivators. No one can lend his mind to it without receiving " usurious interest." Medicine is the digest of human knowledge. It is the great reservoir into which every stream of science pours its tribute, which in return spreads its fertilizing water over every field that brings forth its " ripe and abundant harvest." The want of a popular medical education, we have remarked, pro- motes the success of empirics. To what else can the amazing increase of .these creatures be ascribed ? Would they dare to quit the shades of their native insignificance, if they thought they were to encounter the blaze of criticism, or to be inspected and scrutinized by the torch of truth ? No: the terrors of such a process, were it practised, would exterminate the race, or leave to them only a " beggarly account of empty boxes." We repeat, that empirics are nurtured and sustained exclusively by the prejudices of mankind in their favor, arising from their inabi- lity to judge rightly of their merits. For, can it be presumed that any one acquainted with the subject, would repose the slightest con- fidence in the nostrums of the most stupid, illiterate, dishonest, and 07 PRELIMINARY OBSERVATIONS. ~' vagrant of society, who are confessedly destitute of even the ele- ments, the mere alphabet of medicine. Who can believe, that these nostrums, as generally asserted by their proprietors, are applicable equally to a variety of diseases, op- posite to each other as the poles, and that too, under every differ- ence of a^e, constitution, temperament, habit, season, and climate ? Is it to be credited, that skill can be possessed in a profession the most, complex, without any preparatory devotion to it ? Reason and experience combine, to assert the impossibility. The powers of eloquence or poetry may be an inheritance; but medicine is not intuitive. Whoever acquires it, that is, that thorough knowledge of it, which confers " surpassing skill, must undergo a slow, toilsome, and arduous probation. Its temple is raised on the summit of the loftiest eminence, and the path which leads to it winds in tedious tortuosity, narrow, in- tricate, and perplexed ; but strewed at its different stages, with flowers to tempt, and hung at its termination with fruits to reward. Few,. very few, have ever reached it. The majority of those who set out on the enterprise become soon discouraged, and either linger by the way, or are lost in its mazes. The energies of genius, assisted by unwearied diligence, can only hope to surmount the difficulties and to gain the prize. But candor must still allow that the empiric strengthens, in some degree, his credit with the public, by sometimes performing great and imposing cures. Such instances, however, of occasional success, bring with them no solid claims to confidence. They are, indeed, calculated to excite distrust when properly viewed. TKeir cures, which are admitted to be few, are alone registered and promul- gated. Nothing is ever said of the failures or the deaths produced. No regular and impartial account is kept, nor any striking adjustment of balances : but what must be the fatality of a practice conducted in a way so rash and indiscriminate, without the guide of either principle or experience ? The nostrums employed are uniformly composed of ingredients of the greatest activity, principally of the mineral poisons, as arsenic, corrosive sublimate, calomel, &c, and which can never be neutral in their operations. Whenever administered, they assume a side in the pending contest, and exert all their might either for the patient or the disease, till one or the other yields. The preceding is a faithful picture of empiricism—of its swagger- ing pretensions, of its danger, and its uncertainties ; a plain and un- varnished tale, in which naught is extenuate or set down in malice. But with the too prevalent inclination for nostrums, we regret the strange aversion that exists, and which proceeds from the same neglect of medicine, to some of the most efficacious remedies. Tartar is de- nounced as a certain destroyer of the stomach; mercury, because it lodges in the bones; arsenic, as rancorously poisonous, &c. &c Thtis are those powerful and salutary agents, when in the hands ot a judicious physician, stigmatized by the false views of vulgar pre.- £H PRELIMINARY OBSERVATIONS. judice. It has been wisely and truly declared by *fr™to^% " that all medicines in large doses are poisons, and that poisons in small doses are the best medicines." This w.°° PaJ^^d^ efficacv of a remedy must be proportioned to its force, provided it beadmini tered with discretion fand its operation properly restrained. On the contrary, the weakest medicine becomes poisonous when huffier ofmedTctfwe should be careful to adapt them to the nature of the disease, and the condition of the patient s system at the time ; for the salutary properties of a remedy are not positive, but entirely relative to the peculiar circumstances of the case. A remedy, therefore, may do harm, or prove beneficial, according to the degree of judgment exercised in its employment. - lhis po- sition might easily be illustrated and enforced by a variety of exam- ples. W% shall mention, however, only a few most pertinent. What then is more sanative in its effects than the Peruvian bark in the treatment of intermittent fever, or gangrene ; or more delete- rious if given in an excited system ? Where is there a readier cleanser of a foul stomach than emetics ? yet in inflammations of that organ, nothing would prove so pernicious. The same remark apphes to cathartics, " nature's scavengers of a gorged alimentary canal." With regard to our lancet: what could we do without it ? How quell those dreadful insurrections of acute disease which every where ravage our country ? But indispensable as it is in such cases, yet there is, perhaps, no remedy, which is more mischievous when wrongly applied. . Who has not experienced the soothing restorative operation of opi- um, that divine medicine, which has not with too much force been call- ed, " magnum Dei donum," the great gift of God; and who has not known its demoniacal influence when imprudently employed ? In this way we might proceed through every class of the Materia Medica, deriving proofs to fortify our statement, and to warn us of the danger of abusing remedies. Enough, however, has been said. We trust the admonition will not be neglected. To apply, as we have indicated, the various medicines of which we are possessed, is the secret of successful practice, and constitutes the wide difference between the discriminating physician and em- piric. The practice of the one is governed by principles slowly and cau- tiously deduced from the contributions of long experience and di- versified observations ; that of the other is the result of daring experi- ment, sanctioned only by the chances and calculations of the lottery. In the revolutions of the wheel, and amidst a thousand blanks, a prize may come out! Thus, an important cure by an empiric, like an enormous prize, seizes public attention, and is sounded abroad by the " clarion of fame," while the evidence of the murderous prac- tice, like the blanks of the lottery, is hushed in silence or buried in forgetfulness. PRELIMINARY OBSKRY ATI0NS. 29 it may be proper to observe here, that, in using all active medicines, we should begin with the smallest doses, increasing them gradually, until the quantity suited to the strength of the constitution be dis- covered. For there are instances ol constitutions on which one- fourth, and even one-tenth, of what would not affect others, will act powerfully. As the system speedily accommodates itself to the action of medi- cines, we should never continue one medicine too long at a time. When we find it is losing its efficacy, it should be changed for some other of the same class, and after a short interval the patient may, if he choose, return to his first medicine. By thus varying the re- medies, as the system becomes accustomed to their action, we shall be enabled to cure diseases which, otherwise, would not have yielded; as obstinate intermittents, wherein I have frequently employed the bark without effect: but on changing it for either the solution of arsenic, or vitriolic pills,* a cure has generally taken place, and when it did not, by exciting a slight mercurial action in the system and immediately following it with one or the other of the above medicines, I have pretty constantly succeeded. On this account medicines should never be made too free with, as preventives of disease, unless there be evidently a morbid predisposition lurking in the system : for, by thus wantonly familiarizing ourselves to medicine when there exists no necessity for it, we shall stand a very good chance to be disappointed of its proper effects, in the season of our need. Bitters, those especially made with spirits, like other cordials, have, no doubt their use at times, as in damp weather, which hangs so heavily on the springs of life : but to use them, or mint slings, or drams, as some do every morning, even the brightest, when dumb nature herself is smiling, and every bird and beast are uttering their artless joy, is a species of suicide. It is a most wicked attempt to substitute artificial joys in place of those most pure and natural. Such an impious fighting against God and Nature, generally ends as might be expected. The wretched self destroyers seldom live out half their days. For the same delightful exhilaration, produced by one antifogmatic last year, requires two this year, and in that in- crease, till the habit of intemperate drinking is confirmed. How me- lancholy is it that rational beings should act so madly, and that the all bountiful Creator cannot intrust us with his good things, without our shameful abuse of them ! Thus it is, that men turn into poisons those pleasant beverages given for cordials, to raise their depressed spirits, to invigorate their flaccid nerves, and to enable nature to re- pel the various attacks of a humid or infected atmosphere. Among the many remedies of disease, none, perhaps, holds a high- er place than the bath, in its different forms. The cold bath, by its sudden shock, is peculiarly fitted to invigorate the system, and to re- animate its circulations and secretions. Hence its acknowledged re- * Vid. dispensatory. $Q PRELIMINARY OBSERVATIONS. putation in all cases of weak and relaxed habits, particularly those of the studious and sedentary. It ought, however, to be remembered, that, like every other re- medy, it belongs but to one set of diseases. In affections of the vis- cera, obstructions and inflammations, it is hurtful. If after leaving the bath, the patient do not feel a kindly glow on the surface, he: has good cause to fear that the angel of health was not there before him " to move the waters." On going into the plunging bath, as it is called, it were better to dash in at once head foremost. The shock in this way is more instantaneous, and the distributions of the blood more salutary than when it is driven, as by wetting the feet first,. from the extremities to the head. It is on this principle that the shower bath possesses advantages superior to the plunging. Imme- diately on coming out of the bath, the body should be rubbed dry with flannel or coarse cloths, and moderate exercise taken. Besides the advantages of frequent cold bathing, its partial use is no less salutary in all cases of local action. In periodical headach, and, indeed, in most complaints of the head, the affusion of cold wa- ter, though a simple, is a very effectual remedy. If persons subject to the quinsy and sore throat, instead of muf- fling their necks, would bathe them two or three times a day in cold water, they would find their account in it. When the healthy resort to the cold bath, on account of its purifying and pleasant ef- fects, they may continue in it for some time : but to strengthen and give elasticity to the solids, every thing depends upon the sudden shock.—The time of day for bathing is a matter of indifference, provided it be not immediately after a full meal, or when the body is warm and in a state of free perspiration. The warm bath, about the temperature of the blood, has nearly all the advantages of the cold bath, without being liable to so many objections. Some, indeed, tell us, that it weakens the body ; but so far from doing so, it may justly be considered as one of the most powerful and universal restoratives with which we are acquainted. Instead of heating, it cools the body, diminishes the pulse, and takes off its unnatural quickness, according to the length of time the bath is continued. Hence tepid baths are of great service, when the body has been over-heated, from whatever cause, whether by severe bodily or mental exercise. In all these cases, its happily composing and recuperative virtues seem to be owing to its tenden- cy to promote perspiration, and to relax spasm. Warm bathing can hardly be sufficiently commended, for its so- vereign effects in promoting cleanliness, and, consequently, for curing all diseases of obstructed perspiration from foul skin. It is much to be lamented that so many poor children should be- come the victims of their parents' laziness, and neglect of the most sweet and healthful virtue, cleanliness. For, would they devote a little of their mis-spent time and money to the more decent clothing and frequent washing of their children, there could be no doubt that. PRELIMINARY OBSERVATIONS. 31 the little innocents would enjoy ten thousand times more comfort ■than they can possibly have while covered with filth, and tortured with scald heads, blotches, itch, and vermin. In fine, having seen the fatal termination of so many diseases, in my opinion, easily cura- ble by the bath, I cannot dismiss this important subject without ear- nestly recommending it to every gentleman to provide for his family the convenience of bathing, as not only one of the greatest luxuries, but the best preservative of health in these warm climates. It is essential to health, luxuriously to refresh the person by bathing and washing off the impurities of the skin : and equal care should be taken to remove all filth out of the chambers of the sick ; and frequently to change their linen and bed-clothes, which, when saturated with fetid and perspirable matter, must prove extremely unpleasant and hurtful to the patient. And here I cannot but breathe the most fervent wish that the agriculturists of the south and west, would be persuaded to insist more rigorously on cleanliness in the persons of their slaves. That the constitution of the African is more firm than ours, and better fitted to sustain the toils of warm climates, is very certain ; but it is equally true that his daily labors with the sudden changes of weather, often put his constitution, good as it may be, to trials which loudly call for every aid that humanity can possibly afford him. Of these aids, next to plenty of wholesome food, cleanliness is one of the greatest. It is, indeed, a medicine both of body and mind. The poorest slave, however degraded his condition may be, has still left a portion of mind, which can never be totally insensible to his outward appearance. Cover him with rags and filth, and you not only injure his body by obstructing perspiration and corrupting the fluids, but you attack him in his mind. . Knowing that he appears vile and loathsome to others, he becomes much more so to himself; and this idea imbitters reflection, depresses his spirits, and, in conjunction with other causes, often brings on diseases which press him to an untimely grave. Whereas, by ordering him frequently to bathe, and by affording him three changes of apparel, of which one might always be clean, he would be greatly refreshed and comforted, both in mind and body. Thinking his appearance decent in the eyes of others, he becomes well pleased with himself, and looking on his new habit, however cheap and simple, as an evidence of his master's affection and value for him, he feels at once the touch of an honest pride in himself, and of friendship for his master, which lightens his task and sweet- ens all his toils. But, if cleanliness be of such importance to the healthful, how much more so to the sick slave. When sinking under the heat and burden of his labors, can it be good policy to suffer him to be put, like a mere animal, into a narrow dirty cabin; there left, with scarcely a child to hand him " a cup of cold water" with no food but dry bread, and breathing the fetid atmosphere of a sultry, filthy, 32 PRELIMINARY OBSERVATIONS. habitation! In such circumstances, what, but a miracle, can save him from destruction ? Having been frequently an eye witness of such scenes, of which the owner himself was, perhaps, ignorant, I felt it my duty to advise him, not only for humanity, but interest sake, to erect for his slaves, especially if he have many, a cheap, coarse kind of building as an hospital. This building should be fixed on some spot, enjoying, in the highest degree, the double advantage of good water and air. It ought to consist of but one large room, quite open to the top, well aired by doors, and windows, and with a plank floor, that it may be frequently washed and kept perfectly clean. Some good-tempered, notable old woman of the family, should be appointed to attend the sick, and supply the proper nourishment. In this cheap and simple way, many a valuable slave might, we are certain, be saved to his owner, which, alone, were an ample reward, without counting the present comfort of such humanity, or the future blessings of Him, who has promised that every act of love, even to the poorest slave, shall be remembered as if done to himself. To the truly wonderful effects , of this regimen, embracing cleanliness, fresh air, good nursing and'y diet, I, myself, can bear the most public and unequivocal testimony. ^ In the year 1805, when the summer and autumnal fever raged with uncommon violence and mortality in Savannah, having conside- rable practice among the shipping, I was induced, chiefly, from mo- tives of humanity, to open a private hospital for seamen. And though I had usually from twenty to thirty patients during the sickly season, I lost but one of all who had been taken into the hospital at an early stage of the disease. This extraordinary success, I ascribed, in a great measure, to the virtues of the regimen above recommended. And, in support of the plan recommended, I will venture to assert, that hardly an instance can be quoted of the recovery of seamen, when left neglected, or badly attended, in the confined boarding- rooms, or steerages of the ships, where they were attacked. The very happy result of the little hospital sysfem above stated, cannot but excite the most earnest wish for a similar establishment, in Savannah, on a much larger scale. Such an institution could not fail to prove a great blessing to the state, but more so to the town, where numbers of useful citizens, especially seamen, are annually ■swept off. It affords me pleasure to state, that since the appearance of this friendly hint, in the first edition of this work, the humane citizens of Savannah, have actually established a public hospital, and have found it abundantly productive of the good effects predicted. For- tunate would it be, if similar institutions were erected in all our sea- ports. In addition to the softer whispers of humanity, gratitude now lifts her louder voice ; for surely our gallant sailors, principally the objects of such hospitals, have given glorious proofs in the late awful contest, that they deserve every mark of attention that a great na- tion in the plenitude of munificence can bestow. OF THE STRUCTURE OF THE HUMAN MACHINE. How poor, how rich, how abject, how august; How complicate, how wonderful is man ! How passing wonder He who made him such ! Who centred in our make such strange extremes ! From different natures, marvellously mixed ! An heir of glory! a frail child of, dust! Helpless immortal! insect infinite ! 1 A worm! a God!—I tremble at myself, And in myself am lost. Young. " I am fearfully and wonderfully made, O Lord," exclaimed David, on surveying the admirable mechanism of his own frame. Indeed, so complicated and curious is the structure of the human frame, that no person, who contemplates it, can possibly avoid join- ing with the pious Psalmist. That illustrious physician of antiquity, Galen, is reported in his youth to have been a sceptic, but on witnessing a dissection, and ex- amining the mechanism of the human body, the divine wisdom and design running through all its parts, he was struck with such a sense of the great Architect, that he immediately became a convert, and during his life devoted himself to the worship of the Deity with all the fervor becoming an enlightened and grateful mind. Having himself happily caught the first spark of Divine light from a survey of this wonderful machine, he earnestly recommends to others the study of it as the noblest employment of the faculties, and one of the surest guides to rational devotion. His thoughts on this subject, though emanating from a heathen, are well worth the attention of all Christians.—" Those treatises," says he," which display the excel- lencies of the great Creator, compose one of the noblest and most acceptable hymns. To acquaint ourselves with his sublime perfec- tions, and point out to others his infinite power, his unerring wisdom, and his boundless benignity—this is a more substantial act of devo- tion, than to slay hecatombs of victims at his altar, or kindle moun- tains of spices into incense." Now, as one object of the " Medical Companion " is to treat of the art of preserving this divine piece of workmanship in a healthy state, nothing can impress us more forcibly than the absolute ne- cessity of being made acquainted with its parts, and the laws that 5 34 or the structurevor govern them : without some knowledge thereof, it appears no more possible to take the right care of it, or to keep it in good order, than to perpetuate the regular motion of a clock, or time-piece, without a familiar acquaintance with its mechanism. The study of Anatomy, as it leads to the knowledge of nature, needs not, says the illustrious Cheselden, many tedious descriptions, nor minute dissections, what is most worth knowing being soonest learned, and least subject to difficulty ; while dividing and describ- ing the parts more than the knowledge of their uses requires, per- plex the learners, and make the science tedious, dry, and difficult. Upon this principle, the following anatomical description of the human body is conducted ; and to render it perfectly intelligible to the uninformed readers, technical terms have, as much as possible, been avoided. " When a master builder," says the celebrated Hervey, whose sublime sentiments on this theme are at once so elegant and appro- priate that I have taken the liberty frequently to use them, " un- dertakes to erect a magnificent edifice, he begins with the less deco- rated, but more solid parts, those which are to support, or to con- tain the rest." This order we will follow in considering the struc- ture of the human frame. The Bones are the hardest and most solid parts of the human machine, cast into a variety of moulds, enlarged or contracted into a variety of sizes, and calculated from their strength, to support the whole body. The manner of their articulation is truly admirable, and remarkably various; yet never varied without demonstrating some wise design and answering some valuable end. They con- tain marrow, which makes them less brittle, and are covered with a membrane, or thin substance like a bladder, called periosteum, ex- cept on the skull, where it is called pericranium, which is exquisite- ly sensible in an inflamed state, being plentifully supplied with nerves and blood vessels. Its use is to sustain the vessels which enter the substance of the bones with their nourishment. The Head, designed for the residence of the brain, is framed in exact conform- ity to this important purpose, ample to receive it; strong to uphold it; and firm to defend it. The Ribs, turned into a regular arch, are gently moveable for the act of respiration. They form a secure lodgment for the lungs and the heart. The Back-bone is intended not only to strengthen the body, and sustain its most capacious store-rooms ; but also to bring down that appendage of the brain, which is usually termed spinal marrow. The Arms, pendent on either side, are so exactly proportioned to each other, that the equilibrium of the structure may not be discon- certed. These being the guards which defend, and the ministers which serve the whole body, are fitted for the most diversified and extensive operations; firm with bone, yet not weighty with flesh; and capable of performing, with singular expedition and ease, all THE HUMAN MACHINE. 35 manner of useful morions. To these are annexed the hands, and all terminated by the fingers; which are not, like the arms, of the same length, and of equal bigness, but consisting of various little bones and a multitude of muscles, what shape can they not assume ? what service can they not perform ? The Thighs and Legs are alike substantial and stately columns; articulated in such a manner, that they administer most commodi- ously to the act of walking, yet obstruct not the easy posture of sitting. The legs swell out, towards the top, with a gentle projec- tion ; and are wrought off, towards the bottom, with neat diminu- tions. Which variation lessens their bulk, and at the same time increases their beauty. The Feet compose the firmest and neatest pedestal; infinitely beyond all that statuary or architecture can accomplish ; capable of altering their form, and extending their size, as different circum- stances require. Besides performing the office of a pedestal, they contain a set of the neatest springs, which help to place the body in a variety of graceful attitudes, and qualify it for a multiplicity of advantageous motions. The undermost part of the heel, and the extremity of the sole, are shod with a tough, insensible, sinewy substance. This we may call a natural sandal. It never wears out, never wants repair, and always prevents that undue compres- sion of the vessels, which the weight of the body, in walking or standing, might otherwise occasion. While many animals creep on the ground, while all of them are prone in their posture or their aspect, the attitude of man is erect, by far the most graceful, with an air of dignity, and bespeaking superiority; and by far the most commodious, fitting us for the prosecution of every grand scheme, and facilitating the success of all our extensive designs. It is likewise attended with the greatest safety; being, if not less than any other position exposed to dangers, more happily contrived to repel or avoid them. The Cartilages approach much to the nature of bones, being smooth and elastic. In them there is no sensible cavity to contain marrow, nor are they covered with any membrane to render them sensible as the bones are. They serve to make the bones, whose extremities they cover, move freely in their joints. They also con- tribute, in a great measure, to the formation of several parts, as the wind-pipe, nose, ears, and breast. The Ligaments are tough, compact substances, more flexible than cartilages. They have no conspicuous cavities, neither have they any sensibility, lest they should suffer upon the motion of the joint. They serve to unite the several limbs, and prevent their parting from each other, as happen in dislocations. The Muscles are distinct portions of soft, red flesh, with strong tendinous heads and tails designed for insertion. They are composed of the slenderest fibres, yet endued with incredible strength; fashion- ed after a variety of patterns, but all in the highest taste for ele- 36 OF THE STRUCTURE OF gance, conveniency and usefulness. These, with their tendons annex- ed, constitute the instruments of motion. The former, contracting their substance, operate somewhat like the pulley in mechanics. 1 he latter, resembling the cord, are fastened to a bone or some portion of flesh ; and following the muscular contraction, actuate the part into which they are inserted. This, and all their functions, they exercise, not like a sluggish beast of burden, but quick as lightning. A nerve or more in each muscle sets them at work, diffusing the power of sensation through the body, or, returning upon an impres- sion from without, giving all needful intelligence to the soul; so that flesh and nerves are the principal constituents of a muscle. Inward- ly they supply the several movements of the active machine : out- wardly they render its appearance plump, well proportioned, and graceful. The strength of the muscles is astonishing in all persons, but especially in cases of frenzy, and in certain extraordinary charac- ters, who, by the use of a few muscles only, will easily raise a weight much greater than that of their own bodies. The Tendons, although much smaller than the body of the muscle, are composed of the same number of fibres. They are not capa- ble of contraction, but serve like ropes to pull when the fleshy fibres act, for the commodiousness and firmness of insertion, and the direction of motion. The use of the tendons is to avoid a large quantity of flesh near the joint, to prevent clumsiness in particular places, and for the better admitting of that friction, which, in less compact parts, would have been injurious. The Nerves are surprisingly minute, white cords, derived from the brain, running to every part of the body. They perform two distinct offices ; conveying sensation from all parts of the body to the brain, and carrying the commands of the will from that seat to all the different parts of the body. Most of the muscles of the body producing riiotion are in the guidance of our will; some of them, however, entirely independent of it, as those of the heart and ves- sels which carry on the circulation of the blood • and some are partly under the direction of our will, and partly independent of it, as in respiration. But all the muscles, the involuntary, as well as the voluntary, are enabled to act only by their communication with the brain; for when that is cut off by the destruction of the connecting nerve, whatever impression is made on the part can no longer be felt; the orders of the will to that part can no longer be obeyed, and the part itself can no longer move. The Arteries are strong elastic tubes, which arise from the heart; and thence, striking out, as they go into numberless smaller canals or branches, distribute the blood to every part of the body. These being wide at their origin, lessening as they branch themselves, check the rapid motion of the blood. To sustain this shock, they * THE HUMAN MACHINE. 37 are indued with uncommon strength ; by performing this service they oblige the crimson current to pass into the narrowest defiles, and distribute itself into all quarters. The blood thrown from the heart dilates the arteries, and their own elastic force contracts them; by which means they vibrate, in proper places, very perceivably against the finger; bring advices of the utmost importance to the physician ; and very much assist him both in discovering the nature of diseases, and prescribing for their ^ures. The larger arteries, wherever the body is formed for bending, are situated on the bend- ing side; lest, being stretched to an improper length by the inflec- tion, their dimensions should be lessened, and the circulating fluid retarded. They are not, like several of the considerable veins, laid so near the surface as to be protrusive of the skin ; but are deposit- ed at a proper depth in the flesh. This situation renders them more secure from external injuries. The Veins are tubes or vessels accompanying the arteries, and are appointed to receive the blood from their extremities, and re- convey it to the heart. Small at their rise, and enlarging as they advance, they are void of any pulsation. In these, the pressure of the circulating fluid is not near so forcible as in the arteries; for which reason their texture is considerably slighter. In many places they have valves, because the slow motion of the blood in the veins, and their weaker contractile power, unassisted by a force adequate to that of the heart, have great need of such an invention to ensure its return to the heart. The Secretory vessels are minute tubes in the different organs serving to separate and strain off the different fluids from the general jnass of blood. The Excretory vessels, tubes also belonging to the different or- gans, carry off the humors that are separated. The Glands, commonly called Kernels, are small bodies of finely interwoven vessels, whose office it is to secrete or separate fluids from the blood for particular uses, as spittle in the mouth, bile in the liver, milk in the breast,' &c. Glands, when obstructed, .become large and indurated, from which scirrhus and cancers are produced. The Membranes are thin tunicles or fine webs like a bladder,'ap- pointed to enwrap the fleshy parts ; to form a connexion between some ; to line the cavities, and make a separation between others. The Fibres are simple thread-like bodies, serving to form other parts; hence some are very hard, as the bony ones ; and others soft, as the fleshy parts. The Skin, like a curious surtout, exactly fitted, envelops the whole, formed of the most delicate net-work ; whose meshes are minute, and whose threads are multiplied even to prodigy.—The meshes are so minute that nothing discernible to the eye passes them ; though they discharge every moment myriads of superfluous incum- brances from the body. The steam arising from the warm busi- ness transacted within, is carried off by these real, though impercepti- 38 OF THE STRUCTURE OF ble, funnels; which constitutes what we usually call insensible per- spiration. A single grain of sand, according to M. Lewenhouk, will cover no less than one hundred and twenty-five thousand of these funnels, or what has been prettily styled "cutaneous chimneys." The threads are so multiplied, that the point of the smallest needle cannot pierce any single part without causing an uneasy sensation, and an effusion of blood ; consequently without wounding, even by so small a puncture, both a nerve and a blood-vessel. The outermost covering of the body is that soft whitish tegument which rises in the pustule of a blister, and is called scarf skin. The next, or true skin, is that reddish and exquisitely tender part which appears when the blister is broken, and the dead skin taken off. The first is void of sense, and intended to screen the second, not only from the stroke of injuries, but even from the impressions of the air, which, mild as it may feel to the1sheathed, would be too rough and sharp for the naked nerves. The natural color of the cuticle is white. The apparent, black or brown color in the African or Indian, is entirely owing to the mu- cous substance under it. The skin unites in itself two very essential functions. It is the organ of the sense of the touch, and the channel of perspiration. For this purpose innumerable nerves and vessels are dispersed throughout the skin, which are in the continual act of feeling, and at the same time, of secreting and volatilizing noxious particles. It has been proved by accurate experiments, that the healthy individual daily and insensibly perspires upwards of three pounds' weight of superfluous and impure humors. It may therefore be confidently asserted, that no part of the body is provided with so many importaM organs, by which it is connected with almost every operation pew formed in animal life, as the skin. By this organization, we are placed in immediate connexion with the surrounding atmosphere, which particularly affects us through the skin, and exerts its influence on our health. We farther feel, directly through that medium, the qualities of the air, heat, cold, pressure, and rarefaction. Important as the skin is to external life, it is no less so to the in- ternal economy of the body, where it appears to be peculiarly de- signed to preserve the grand equilibrium of the different systems, by which the human frame is supported in its vital, animal, and sexual functions. If any stagnation, accumulation,"or irregularity arise in the fluids, the skin is the great and ever ready conductor, through which the superfluous particles are separated, the noxious volatilized, and the fluids, stagnating in their course, effectually at- tenuated ; a canal being at the same time opened for the removal of those humors, which, if they could get access to the vital parts, such as the heart and brain, would cause inevitable destruction. By the proper exercise of this organ, many deseases may be suppressed in their early stages ; and those which have already taken place, may be most effectually removed. No disease whatever can be healed THE HUMAN MACHINE. 39 without the co-operation of the skin. The nature and constitution of this organ most certainly determine either our hope or apprehen- sion for the safety of the patient. In the most dangerous inflam- matory diseases, when the prospect of recovery is gloomy, a beneficial change of the skin is the only effort by which nature, almost over- come, relieves herself, and ejects the poison in a surprising manner, frequently in the course of one night. The greatest art of a physician, indeed, consists in the proper management of this extensive organ, and in regulating its activity, where occasion requires. To mention only one circumstance ; it is well known to those who have expe- rienced the beneficial effects of a simple blister, that its stimulus, like a charm, has frequently relieved the most excruciating pains and spasms in the internal parts. When the sensibility 01 the surface is impaired ; when the myriads of orifices designed for the continual purification of our fluids, are obstructed, if not closed; when the subtile nervous texture is nearly deprived of its energy, so that it becomes an impenetrable coat of mail, is there any reason to wonder that we are so often harassed by a sense of constraint and anxiety, and that the uneasiness, in many cases, terminates in gloom and melancholy ? Ask the hypochondriac, whether a certain degree of the cold, paleness, and spasmodic sen- sation in the skin, does not always precede his most violent fits of imbecility; and whether his feelings be not most comfortable when the surface of his body is vigorous, warm, and perspires freely ? In short, the degrees of insensible perspiration are to him the surest barometer of his state of mind. If our skin be disorganized, the free inlets or outlets of the electric, magnetic, and other matters, which affect us at the change of the weather, are inactive.—Thus me origin of extreme sensibility, towards the various atmospheric re- volutions, is no longer a mystery; for, in a healthy surface of the body, no inconvenience will follow from such changes. If we fdrther ad- vert to those acrimonious fluids, which, in consequence of an imper- fect state of perspiration, are retained in the body, and which affect the most sensible nerves and membranes, we shall the better com- prehend how cramps and spasms, the torturing pains of the gout and rheumatism, and the great variety of cutaneous diseases, have of late become so obstinate and general. The just proportion of the fluids, and the circulation of the blood, are also determined, in no small degree, by the skin; so that, if these fluids become languid, the whole momentum of the blood is repelled towards the interior parts. Thus a continual plethora, or fulness of the blood, is occa- sioned ; the head and breast are generally oppressed ; and the exter- nal parts, especially the lower extremities, feel chilly and lanquid. May we not infer, from what has been advanced, that the use of baths is too much neglected, and ought to be universally introduc- ed? Bathing is considered an excellent remedy for alleviating both mental and bodily affections. It is not merely a cleanser of the skin, 40 OF THE STRUCTURE OF enlivening and rendering it more fit for performing its offices; it also refreshes the mind, and spreads over the whole system a sensation of ease, activity, and pleasantness. It likewise removes stagnation in the larger, as well as in the smaller vessels, gives a uniform, free circulation to the blood, and preserves that wonderful harmony in our inferior organs, on the disposition of which our health and com- fort so much depend. A person fatigued or distressed in body and mind, will derive more refreshment from the luxury of a tepid bath, and may drown his disquietude in it more effectually, than by in- dulging in copious libations to Bacchus. There subsists so intimate a relation between our interior and exterior vessels, that almost every error or irregularity in the organs within, shows itself first on the surface of the body, particularly on the face. How often are we struck wfth the countenance of a person who thinks himself in perfect health, but whose illness, the result of some morbid cause, concealed in the body, justifies, in a few days, the serious apprehensions we entertained at our last in- terview ? Nature has wisely ordained, that the first appearance of internal irregularities should be indicated by the countenance, but to what do we generally apply this index ? We refuse to avail ourselves of her beneficent intimation ; and the continual use of pernicious substances, instead of promoting the object we have in view, ultimately tarnishes and impairs that beauty which we meant to adorn and preserve. The secret venom circling in her veins, Works through her skin, and bursts in bloating stains ; Her cheeks their freshness lose, and wonted grace, And an unusual paleness spreads her face. Granville, We imagine it in our power to improve the skin, without attend- ing to the purity of the fluids, though it is indebted to them for its very existence; and yet we should smile at a person who should at- tempt to cleanse an impure tongue by constantly scraping it, when a disordered stomach was the real cause of that impurity. The Cellular Membrane, so called from its numerous cells, adheres very closely to the skin, running between the muscles in general, and between their several fibres in particular ; and communicating with the membrane which lines the inside of the breast and belly. AH its cells communicate with each other throughout the whole body, so that from any one part the whole may be filled with air, as is evident in beasts, from the butchers blowing up their lean meat with air when newly killed, and in emphysema, where the air from a broken rib, getting into one of the cells, forces its way into all the rest, distending the body to a frightful size; as also, in general dropsy, wherein all the cells, filled with water, may, by puncture, be emptied in the course of a night. In health this membrane is filled with an oily substance, giving an agreeable rotundity to the limbs. It is also the seat of biles, and contributes to keep the inner f THE HUMAN MACHINE. 41 parts warm and pliant; and, by filling the interstices of the mus- cles, renders the surface of the body smooth and plump. The Head, that majestic dome, being the seat of the brain, in which the soul is supposed to reside, resembles the GeneraVs tent in an army, or the Monarch's in a city. It has a communication esta- blished with all, even the most remote parts of the system; having outlets and avenues, for the ready despatch of couriers to all quar- ters, and for the reception of speedy intelligence on every interest- ing occasion. It is furnished with lodgments wherein to post sentinels of various chaiacters, and appoint to various offices, to expedite their operations, whether employed in reconnoitring what passes without, or examining what claims admittance within. The whole turns upon a curious pivot, most nicely contrived to afford the largest and freest circumvolutions. This stately capitol is screened from heat, defended from cold, and at the same time, beautified by a copious growth of hair. The Great Creator, profusely gracious to mankind, has made us an inestimable present of the senses to be the inlets of innu- merable pleasures, and the means of administering the most valua- ble comforts. High in the head, bright and conspicuous as a star in the brow of evening, is placed the eye. In this elevated situa- tion, like a sentinel posted in his watch tower, it commands the most enlarged prospect. Consisting only of simple fluids, enclos- ed in thin tunicles, it conveys to our apprehension all the graces of blooming nature, and all the glories of the visible heavens. How prodigiously wonderful that an image of the highest mountains, and a transcript of the most diversified landscapes, shall enter the small circlet of the pupil! How surprisingly artful, that the rays of light, like an inimitable pencil, should paint on the optic nerves, paint in an instant of time, paint in the truest colors, and exactest lineaments, every species of external objects. The Eye is so tender, that a slight accident, scarce perceivable by some other parts of the body, proves very injurious to its delicate frame. It is guarded, therefore, with the most solicitous care ; with a care evidently proportioned to its nice texture, and extensive use- fulness. It is entrenched deep in the head, and barricaded on every side with a strong fortification of bones. The wisdom and goodness of the Creator appear in the astonishing apparatus of muscles with which the eye is furnished to produce all the necessary and conveni- ent motions in the situation where it is placed. The eyebrows serve to defend this delicate organ from too strong a light; and as the incur- sion of the smallest fly would incommode the polished surface, it is farther defended by two substantial curtains (eyelids) hung on a most slender cartilaginous rod, which secure it from floating dust and from every troublesome annoyance. In sleep, when there is no occasion to exercise the sense, but an absolute necessity to protect the organ, these curtains spontaneously close, and bever fail to lie shut. On the inside of these curtains or eyelids, lie glands, which secrete a limpid 6 42 OF THE STRUCTURE OF fluid, that lubricates the eyeball, as often as we wink, or, as it were. oils its wheels, and fits it for a course of unwearied activity. The Ear consists of an outward porch and inner chambers, with tools of the most admirable contrivance, and finished workmanship. The porch is that cartilaginous substance standing somewhat pro- minent from the head, covered with a tight expansion of the skin, and wrought into irregular bends and hollows; which, like circling hills, or surrounding rocky shores, collect the wandering undulations of the air, and transmit them with vigorous impulse to the finely stretched membrane of the tympanum, or drum of the ear. The avenue, or narrow entry, is secured from the insinuating attempts of little insects, by a morass of bitter and viscous matter, disgust- ful to their taste and embarrassing to their feet. The hammer and the anvil, the stirrup and the drum; the winding labyrinths, and the winding galleries; these and other pieces of mechanism, instru- mental to the power of hearing, are, beyond description, curious. Amazingly nice must be the formation, and inconceivably exact the tension of the auditory nerves, since they correspond with the smallest tremors of the atmosphere, and easily distinguish their most subtile variations. With the gentle gales that fan us, or even with ruder blasts that assault us, these delicate strings are but little af- fected. Whereas, they are perfect unisons with those fine, those significant agitations of the air, which the acutest is unable to dis- cern. These living chords, tuned by the touch of an Almighty hand, and diffused through the echoing aisles and sonorous cells, receive the impressions of sound and propagate them to the brain. These give existence to the charms of music, and reciprocate the rational entertainments of discourse. The eye perceives only the objects before it; whereas the ear warns us of transactions above us, behind us, all around us. The eye is useless amidst the gloom of night, and cannot carry its observation through the bolted door or the closed window shutter; but the ear admits intelligence through the darkest medium and the minutest cranny. Hence, when we cannot see a friend, because of an interposing partition, yet, by the friendly aid of this organ, we can learn that he is in the adjoining room by his voice, or that he is near by his steps. The eye is up- on duty only in our waking hours ; but the ear is always expanded, and always accessible ; a courier which never tires, a sentry ever in his box. To secure a resource, in case any misfortune should disa- ble one of the hearing or seeing organs, our all gracious Maker, has given us duplicates of each. As there are tremulous concussions impressed upon the air, discer- nible only by the instruments of hearing ; there are also odoriferous particles wafted by the same aerial vehicle^ which are perceivable only by the smell. The Nostrils are wide at the bottom, that a large quantity of ef- fluvia may enter; narrow at the top, that when entered, they may close their ranks, and act with great vigor. Fine, beyond all imag- THE HUMAN MACHINE. 43 ination, are the streams exhaled from fetid or fragrant bodies. The very best microscopes, which discover thousands and tens of thou- sands of animalcules in a drop of putrified water, cannot bring one individual among all these evanescent legions to our sight. They sail in numberless squadrons close to our eyes, close by our ears ; yet are so amazingly attenuated, that they elude the search of both. Nevertheless, so judiciously are the olfactory nets laid, and so art- fully their meshes seized, that they catch these vanishing fugitives. They catch the roaming perfumes, which fly off from the opening honey-suckle, and take the stationed sweets which hover round the expanded rose. They imbibe all the balmy fragrance of spring, all the aromatic exhalations of autumn, and enable us to banquet even on the invisible dainties of nature. Furnished with these several organs, ***** not a breeze Flies o'er the meadows, not a cloud imbibes The setting sun's effulgence, not a strain From all the tenants of the warbling shade Ascends, but whence our senses can partake Fresh pleasure. Akenside. Another capacity for frequent pleasure, our bountiful Creator has bestowed in the power of taste; by means of which the food, that supports our body, feasts our palate; first treats us with a pleasing regale, then distributes its benefical recruits. The razor, whetted with oil, becomes more exquisitely keen; so the saliva, flowing upon the tongue, and moistening its nerves, quickens them into the liveliest acts of sensation. This sense is circumstanced in a manner peculiarly benign and wise ; so as to be a standing, though silent plea for temperance. The sight, smell, and taste, are not only so many separate sources of delight, but a joint security to our health. They are the vigi- lant and accurate inspectors which examine our food, and inquire into its properties, pleasant or disagreeable, wholesome or noxious. For the discharge of their offices, they are excellently qualified, and most commodiously situated; so that nothing can get admission through the mouth, till it has undergone the scrutiny and obtained the passport of each. To all these, as a most necessary and advantageous supplement, is added the sense of feeling; which renders the assemblage com- plete. While other senses have a particular place of residence, this is diffused throughout the whole body. In the palms of the hands, on the tips of the fingers, and, indeed, through all the extreme parts of the flesh, it is most quick and lively.—The whole army of Xerxes drawn out in battle array, with his millions of supernumerary attendants, was but as a few gleaners straggUng in the field, if compared either in number or order, with those nervous detach- 44 OF THE STRUCTURE OS ments, which pervade the texture of the skin and minister to the act of feeling. . . The crowning gift, improving the satisfaction, and augmenting the beneficial effects of all the senses, is speech. Speech makes me a gainer from the eyes and ears of other people; from the ideas they conceive, and the observations they make. And what an ad- mirable instrument for articulating the voice, and modifying it into speech is the tongue! The tongue has neither bone nor joint; yet fashions itself, with the utmost volubility, into every shape and every posture, to express sentiment, or constitute harmony. This little collection of muscular fibres, under the conducting skill of the Creator, is the artificer of our words. By this we communi- cate the secrets of the breast, and make our very thoughts audible. By this we instruct the ignorant, and comfort the distressed ; we glo- rify God, and edify each other. Who would not bless for this the gift of speech, And in the tongue's beneficence be rich ? But still, what is the mansion of flesh though so exquisitely wrought, compared with the noble and immortal inhabitants, which reside within ? ******* That intellectual being, Those thoughts, which wander through eternity." The mind, or soul, of much higher character than that of the pe- rishable frame with which it is connected, has neither nerves, nor nervous fluids. These are only its agents, in this its imprisoned state. When the " silver cord," is broken, which connects mind and matter together, vitality ceases. The body then, with all its artful and nu- merous vessels, fibres, and nerves, and other exquisite machinery, undergoes decomposition, and is turned into its original elements; but the immortal soul, having shaken off this coil, is destined for a new residence ; to flourish in eternal youth ; to outlive the wreck of elements and the crush of worlds. It is embodied even innts resi- dence in another world. " Thou fool," says the philosopher and apos- tle, " that seed which thou sowest is not quickened except it die.— And that which thou sowest is not that body which shall be, but God giveth it a body as it hath pleased him, and to every seed its own body. So, ako, is the resurrection of the dead. The body is sown in the earth in dishonor, it is raised in glory ; it is sown in weak- ness, it is raised in power ; it is sown a natural body, it is.raised a spiritual.—Behold, I show you a mystery. We shall not all sleep, but we shall all be changed. In a moment, in the twinkling of an eye, at the last trump ; for the trumpet shall sound, and the dead shall be raised incorruptible, and we shall be changed. For this corruptible must put on incorruption, and this mortal must put on immortality." Man, therefore, is not what he will hereafter be. THE HUMAN MACHINE. 45 What we discover of him here below, is only the gross foldage, in which he crawls upon the earth, and which he must shortly cast off. The animal body has no other relation than to this earth. The spiritual body will have enjoyments which " ear hath not heard, nor hath it entered into the heart of man to conceive" New senses will be disclosed, multiplying perfections in an almost infi- nite degree. Man's sphere will be aggrandized, and he will become equal to superior intelligences. Revelation informs us it will be so ; and the parable of the seed is the most expressive and philosophical emblem of this wonderful preordination. The senses, as they are brought into subjection to the soul, will no longer rule over her. Separated from flesh and blood, there will remain in her none of those earthly affections resulting from them. Transported into the regions of light, the human understanding will present no ideas to the will, but those of the highest good. It will then have no other than lawful desires, and God will be their constant and ultimate end. It will love him from gratitude ; fear him from a principle of love; and adore him as the supremely amiable being, the eternal source of life, perfection, and happiness. The Thorax, or breast, is situated between the belly and neck. The front part is commonly called the breast; the posterior part the back ; and the lateral parts the right and left sides. Before we take notice of the internal parts, it may be proper to speak of the mammae or breasts. These are two glandular bodies, of a round oval figure, most re- markable in women. The period of their growing full in the fe- male, is about the age of fourteen or fifteen, and that of their de- creasing, fifty. The breasts are composed of a vast multitude of minute vessels to secrete the milk from the blood. These vessels, as they approach the nipple, fall into, and form eight or ten large pipes, connected together with admirable skill, that, in case of any obstruction or accident in any one or more of them, the milk might not be obstructed. The swelling of the breasts, during the time of gestation, is owing to the consent between them and the womb. The cavity of the breast is lined by a fine smooth membrane, named pleura, and contains those two grand organs, the heart and lungs. The Lungs are divided into two larger portions, called lobes ; the one on the right, and the other on the left side. The vessels which enter the lungs, are the trachea, or wind-pipe, by which we draw in the air; the pulmonary artery, which comes from the right ventricle of the heart; and the pulmonary vein, whose trunk opens into the left ventricle of the heart:—Each of these divides into two branches. The lungs differ from every other part of the body in this re- spect : the wind-pipe, in its minutest ramifications, passes through all parts of its substance, terminating every where in air vesicles, 46 OF THE STRUCTURE OF for the grand purpose of respiration, which keeps it in a continued state of action and reaction. Hence, when the lungs are diseased, their motion is not only increased by the respiration being quick- ened, but they suffer violent concussion by means of coughing. This circumstance renders disorders of the lungs more peculiarly- difficult to cure. The Heart is a strong, active, indefatigable, muscular body, of a conical figure, included in an exceedingly strong membranous bag, called the pericardium, or heart purse, and situated in the cavity of the chest. It has two separate cavities, called ventricles, out of which issue the two large arteries of the human body, one called pulmonary, or artery of the lungs, the other aorta, or large artery of the body, from which all the other arteries go off, as branches of a tree from its trunk, dividing themselves into minute ramifica- tions in their progress. Near the mouths of these two ventricles are two other hollows, which, from their similitude to dog's ears, are called auricles, into which the veins, returning from all parts of the body with the blood, through two large trunks or channels. It has two motions, called systole and diastole; the former is when it con- tracts itself, and thereby forces the blood into the arteries.—The diastole is when it relaxes itself, and receives the blood from the veins. The ventricles of the heart are each capable of receiving an ounce of blood or more, and, therefore, being full in their diastole, we may suppose that they throw out, at least, one ounce of blood each systole. The heart contracts about four thousand times in an hour, more or less, according to the different temperaments, sexes, and ages ; and, therefore, there, pass through the heart, every hour, four thousand ounces, or two hundred and fifty pounds' weight of blood. Now, the common opinion is, that the whole mass of blood does not exceed twenty-five pounds, and, therefore, according to this allowance, a quantity of blood equal to the whole mass, passes through the heart ten times in an hour; that is, about an ounce ev- ery second. If the heart contracts eighty times in a minute, then twenty-five pounds' weight of blood pass through its ventricles once in five minutes, or twelve times in an hour. The farther the blood moves from the heart, its velocity decreases as the artery divides linto more branches, so much so, that the blood moves 5233 times slower in some capillary arteries than it does in the aorta or great artery. The blood is received from the arteries into the veins, where it still moves more slowly as "it returns to the heart again. The arteries are to the veins as 324 to 441, and, consequently, the blood moves in the veins above 7116 times slower than it does in the aorta. The heart is the grand organ of the circulation of the blood, and, consequently, of life. Impelled by this beating engine, part of the blood shoots upwards; and sweeps, with a bounding impetus, into the head. There it impregnates the prolific fields of the brain; and forms those subtik spiritous dews, which impart sense to every THE HUMAN MACHINE. 47 nerve, and communicate motion to every limb.—Part flows down- ward ; rolls the recking current through all the lower quarters ; and dispenses the nutrimental stores, even to the meanest member, and the minutest vessel. Observe, how the stately Thames, and the lordly Potomac re- fresh the forest and groves; water the towns which crowd their banks; and make the meadows they intersect, laugh and sing.—So, only with an incomparably richer fluid, and with infinitely more nu- merous streams, this human river laves the several regions of the body, transfusing vigor, and propagating health through the whole. The living flood never discontinues its interchangeable tide; but night and day, whether we sleep or wake, still perseveres to sally briskly through the arteries, and return softly through the veins. Such astonishing expedients are used to elaborate the chyle, to blend it with the blood, and to distribute both through the body, that the animal constitution is perfectly maintained. In youth," its bulk is increased; in age, its decays are repaired ; and it is kept in tenantable condition for the soul during the space of seventy or eighty years. The doctrine taught by the immortal Harvey, the discoverer of the circulation of the blood, is, that all the veins of the body fall- ing into two trunks, viz. the ascending and descending cava, empty themselves into the right auricle of the heart. The right auricle unloads into the right ventricle of the heart, which throws the blood through the pulmonary artery, into the lungs, by its two branches, which go to the right and left lobes. From the lungs the blood is brought back by the pulmonary veins, into the left auricle, and thence it passes into the left ven- tricle, from which it is distributed through the body by the aorta, or large artery and its branches. These terminate in the veins of the body, which collect the blood and bring it back to the heart, by the two cava, or large veins. In other words, the blood is conveyed from the left ventricle of the heart, by the aorta and its branches, to the minutest and most remote parts of the body, and then, passing from the extremities of the smallest arteries into the incipient veins, circulates through them into their larger branches, and so on into the right auricle of the heart, thence into the right ventricle, whence it is forced, with the fresh supplies that it receives from the chyle in passing through the subclavian vein, into the pulmonary artery, and, after circulating through, and being acted upon by the lungs, in its passage through them, is returned by the pulmonary vein into the left auricle, and thence into the left ventricle, and so on, the same round, until death concludes the progress. There is in the consideration of the organs performing the circula- tion of the blood, an air of grandeur that seizes forcibly on the mind, and penetrates it with the highest admiration. We perceive that the blood, every time it is returned to the right 48 OF THE STRUCTURE OF ventricle of the heart, is directly dispersed through the lungs, and immediately reconveyed to the heart, before it is permitted to begin a new circulation. In the study of nature throughout all her work, however complex the machine, the utility of each part ever claims the admiration of the speculative mind. The observation is beautifully illustrated on the present occasion, and " I believe it will be admitted by every one," says the ingenions author of the Medical Extracts, " that the blood, after having per- formed one round, throughout the animal economy, undergoes some new and important change in its transit through the lungs, especially requisite to support a second circulation. This change is certainly the oxygenation of the blood, and we should expect, if oxygen be the natural stimulus to the heart and arteries, that their pulsation would be in proportion as the blood had access to this principle." That animal heat depends upon the action of the arteries, and the circulation of the blood in general, is very natural to imagine; because whatever increases the velocity of the circulation, whether exercise, friction, or disease, also increases the internal heat; where- as, fainting, hemorrhage, and whatever produces a weak and lan- guid circulation, also diminishes the heat of the body. When a ligature is put round an artery, so as to prevent the blood from being carried to any particular limb, that limb becomes colder than it was, and does not recover its natural heat, until, by removal of the ligature, or the expansion of the branches, which go off from above the ligature, the usual quantity of blood is circulated through the limb. With a new-born infant, the first thing is to infuse into its nos- trils " the breath of life ;" for until the lungs be expanded, and the venal or purple blood changed into arterial or crimson in that organ, the heart does not contract, nor the arteries vibrate ; like a clock not wound up, though sound in all its parts, remaining entirely at rest. In the clock, if we wind it up, the main-spring applying its powers, all the wheels are immediately put into motion, and it marks its hours and minutes; so, likewise, in the animal machine, the blood in the lungs having imbibed the vital principle from the air, the heart acquires its actions, the brain its energy, the nerves their sensibility, and the other subordinate springs of life presently resume their respective functions. No organ can be severely affected without affecting the heart, and disturbing its functions ; nor can the heart be in the smallest degree affected, without disturbing every function of the animal economy. But the heart is not only affected by what injures the body, but also by what ruffles the mind. Rage occasions frequent and forci- ble contractions; sorrow, slow and lanquid ones; and there are in- stances of violent passions suspending the contractions of the heart altogether, and occasioning death. The heart is not only affected by whatever hurts the body or mind of the person, to whom it be- THE HUMAN MACHINE. 49 longs, but also by what hurts the bodies or minds of others. But the extent of this kind of sympathy differs greatly in different per- sons. In some it embraces children, friends, relations, countrymen, and in a certain degree, the whole human race ; in others, it seems to be entirely confined within the limits of their own bodies, or at most, reaches with a blunted sensibility no farther than to those whom they conceive to be their own offspring. While the blood is in circulation, various liquors are separated from it by a process called secretion, all these secretions being necessary for the health and preservation of animal life. When it is taken from the vein by the usual mode of bleeding, and left to itself, it soon congeals, and appears to be composed of two distinct parts, called crassamen- tum, or solid, and serum, or liquid. In a mass of healthy human blood, about one-half is crassamentum, which hath the red color to itself. The serum in a healthy state is almost colorless ; at other times it is'yellowish, or of a greenish hue, while the top of the cras- samentum has different degrees of firmness, and puts on different appearances, with respect to color, according to the constitution and health of the subject, from which it is taken. A due proportion of the respective parts of the blood is necessary to perfect health. The Diaphragm, or, Midriff, is a large thin broad muscle, that divides the breast from the belly. The uses of the midriff are, first to assist in respiration ; for, in taking in the breath, it is pressed downwards, and in expiration, it rises upwards into the cavity of the breast; secondly, to assist the necessary motions of the stomach, intestines, liver, and spleen ; and for assisting the expulsion of the fasces, the urine, the foetus, in parturition, of the secundines or after birth.—It marks our pas- sions by its irregular actions, as sighing, yawning, coughing, laugh- ing. It is affected by spasms, as in hiccough. The Abdomen, or Belly, lies between the breast and pelvis which is formed by the juncture of the haunch bones. The belly contains many of the principal parts of the human bo- dy, as the stomach, the intestines, liver, spleen, pancreas, kidneys, bladder, &c. On its inside, it is lined with a membrane called pe- ritoneum, which is capable of a very great extension ; and after- wards can contract itself to its ordinary size, as we see in pregnan- cy, dropsy, corpulency, and repletion. The Stomach may be considered a dilatation of the oesophagus or gullet, as it is a continuation of the same tube. Its figure near- ly resembles the pouch of a bag-pipe, and has two orifices, the one above from the gullet, through which it receives the crude aliment, the other below, whereby it conveys the partially digested food or chyle into the duodenum. Before the food enters the gullet, it must of necessity pass over the orifice of the wind-pipe; consequently, must be in very imminent danger of falling upon the lungs, which would, if not entirely obstruct the breath, yet occasion violent coughing, and great inconveniencies.. 7 50 OF THE STRUCTURE OF To obviate this evil, the all-foreseeing Contriver has placed a move- able lid, or hung a cartilaginous' draw-bridge; which, when any of the smallest particle of food advances to enter the stomach, is pulled down, and shut close; but the very moment the morsel is swal- lowed, it is set loose and stands open. By this two-fold artifice, the important passage is always barred and made sure against'any nox- ious approaches; yet is always left free for the necessary accession of air, and commodious for the purpose of respiration. When themalster prepares his grain for the transmutation of the brew-house, he suffers it to lie several hours steeping in the cistern, before it is fit to be spread upon the floor, or dried on the kiln. The meat and drink likewise must remain a considerable time in the sto- mach before they are of a proper consistence and temperature, either for the tender coats, or the delicate operation of the bowels. For which purpose that great receiver is made strong to bear, capacious to hold, and so curiously contrived, as to lay a temporary embargo upon its contents. Here they are lodged in the very centre of warmth, and concocted by the most kindly combination of heat and humidity. Here they are saturated with other fermenting or dilut- ing juices ; and are kneaded, as it were by the motion of the sto- mach, and compression of the neighboring parts.. So that every the minutest fragment is separated ; the whole is reduced to a tenuity abundantly finer than the exactest grinding could effect; and all is worked up into the smoothest, most nicely mixed pulp imaginable. From hence it is dislodged by a gentle acting force, and passes by a gradual transition, into the cavity of the intestines. The Intestines form one continued canal from the stomach to the anus, which is usually five or six times the length of the individual. It is curiously convoluted in the abdomen, and is extremely irritable. Although one entire tube, anatomists have divided it into the small and great intestines. The small intestines are called duodenum, jejunum, and ilium ; the larger are the caecum, colon, and rectum. The Duodenum, so called because it is generally twelve inches long in adults, is the widest and shortest of the small intestines. At a short distance from where it joins the stomach, it receives two ducts, the one from the liver bringing the bile, and the other from the pancreas, or sweet bread, bringing its liquor to complete the di- gestion of the food. The second gut is the jejunum, so called. from its being usually found empty, its numerous lacteal vessels having absorbed the chyle. The Ilium is the third and last of the small intestines. The great length of the small guts is evidently for the convenience of a great number of lacteals, that the chyle which misses their orifices in one place may not escape them in another. The Ccecum, or blind gut, is a pouch, as it were of the Colon, about three inches long, and called blind, from its being out of the direction of the passage of the food. The Colon is the greatest and widest of all the intestines, about THE HUMAN MACHINE. 51 eight or nine hands' breadth long, and by lying so contiguous to all the bowels, it communicates all the benefits of the injections thrown into it. When the colon is affected, there is a sense of weight, though the pain is not very acute; whereas in the small guts there is not any sense of weight, but an acute pain. Sometimes a pain in the colon, attended with fever, the pain extending to the ribs, gives a suspicion of pleurisy, though the colon only is affected. The co- lon is narrower on the right side than elsewhere, whence colic pains arise more frequently, and are more severe in this part.—The ex- crements are long retained here, and often are much indurated before they pass farther on. The Rectum, or straight gut, is about a hand's breadth and a half long. It begins where the last curvature of the colon ends, and is terminated at the fundament. At its termination it is sur- rounded by circular muscular fibres, called the sphincter ani, to re- tain the faeces. The intestines are not left to move at random in the cavity of the abdomen, but are artfully tied down by a membranous web, which prevents their circumvolutions from being entangled in each other, at the same time allowing a gentle, but animated motion. That part of it connected with the small intestines is called mesentery, the other part fastened to the colon, mesocolon. All the intestines have in their inner membrane an almost infinite number of very small glands, whose office it is to discharge into the intestines a liquor for the attenuation of the chyle, for lubricating the intestines, and in the large guts to soften the faeces, that they may be evacuated without pain. The intestinal canal serves to complete the first di- gestion, strain off the chyle, and carry off the fosces. Had the intestines been straight and short, the food might have gone through them, without resigning a sufficient quantity of its nourishing particles. Therefore, this grandest of all the vital ducts is artfully convolved, and greatly extended, to afford an opportuni- ty of sifting more thoroughly whatever passes, and of detaining whatever may serve its purposes. Though the alimentary sub- stance can never mistake its way, yet it may, through some acciden- tal impediment, attempt to return backward. In this case a valve intervenes, and renders what would be extremely pernicious almost impracticable. Upon a survey of the use of the stomach and intestines, we can- not avoid being struck with wonder at its apparent simplicity an- swering so many salutary purposes. As soon as we take our food, it is received into a place in all points calculated to render it fit for yielding its nutritious contents. At first, the food taken into the stomach, retaining its peculiar properties, irritates the coat of that organ and occasions a contraction of its two orifices. The food, thus confined, then undergoes a constant agitation by means of the abdominal muscles, and of the diaphragm, and by the motion of the 5Q OF THE STRICTURE OF fibres of the stomach, itself, By these movements, every part of the food is exposed to the action of a fluid secreted in the stomach, called the gastric1 juice, which gradually dissolves and attenuates the food, and prepares it for its passage into and farther change in the intestines. The painful sensation of hunger, which is the irritation of the gas- tric juice on the coat of the stomach, or a sensation of a defective supply of chyle in the arterial system, being removed by the food, we soon feel a mild and undescribable delight, first, from the sti- mulus of the aliment; and secondly, from the distention of this, and theancreased action of other parts. The aliment having remained during two or more hours in the stomach, is converted first into a grayish pulp, which is called chyle. This fluid passes out of the right orifice, the fibres of which relax to allow it to escape ; while the grosser and less altered particles remain in the stomach till they acquire a sufficient fluidity to pass into the intestinal canal. As the digested food enters the duode- num, it stimulates the common duct of the gall-bladder, from which it receives a full supply of bile and of saliva, secreted from the pancreas. The Chyle, drawn off by all the secretory orifices, is carried along millions of the finest ducts, and lodged in several commodious cells. As a traveller, by taking proper refreshments on the road, is better qualified to pursue his journey ; so the chyle, diverted to those lit- tle inns, is mixed with a thin, diluting watery substance, which ren- ders it more apt to flow, and more fit for use. Hence it is con- veyed to one common receptacle, and mounts through a perpendi- cular tube. When provision or ammunition is transmitted to an army, it generally passes under an escort of able troops. As this is the immediate support and principal nourishment of the whole system, its conveyance is guarded with peculiar caution. The perpendicular vessel that conveys it, not having sufficient, force of its own, is laid contiguous to the great artery, whose strong pulsa- tion drives on the creeping fluid, enables it to overcome the steep ascent, and unload its precious treasure at the very door of the heart. Here it enters the trunk of a large vein, secured by a valve, admi- rably constructed to prevent the refluent blood, in case it should offer to return, and opening a free, safe, and easy avenue to intro- duce this milk, this manna of nature. The Blood, through every stage of its simple circuit, having sus- tained great expenses ; being laid under contribution by every gland in the whole system ; and having supplied myriads of the capillary vessels with matter for insensible perspiration, must be very much impoverished; but is most opportunely recruited by this accession of chyle. Besides the uses above specified, appropriated to the stomach and intestines, there is another very considerable bestowed, particularly on the former, by which impressions are diffused to almost every THE HUMAN MACHINE. 53 part of the machine, and from which all the sensible parts receive very peculiar and extraordinary advantages ; namely, conveying ac- tion to different parts, and feeling the effect from these sympathe- tically and instantaneously. For instance, a glass of wine or bran- dy, received into the stomach of a person exhausted with fatigue and ready to faint, gives instantaneous spirits and fresh vigor. This must proceed from the affection of the nerves of the stomach, and their sympathy with the rest of the body, as there is not time for the liquor to be conveyed into the blood in the usual manner. The Stomach universally sympathizes with other parts of the body. A blow on the head occasions vomiting. A disordered stomach often excites a headach. The headach, which is apt to come after drinking too much wine, or other strong liquors, cer- tainly proceeds from the stomach, and sometimes is diminished or entirely removed by a dram. A stomach disordered by indigestion is often accompanied with flushings in the face, palpitations at the heart, difficult breathings, dejection of spirits, uncommon sensibili- ty, and with giddiness. The Omentum, or Caul, is a fine membrane like net-work, lard- ed with fat. It is situated under the peritoneum, and immediately above the intestines, on the surface, resembling an apron tucked up. It serves to lubricate the intestines, that they may the easier per- form their peristaltic motion, to cherish and defend then from cold, and to assist in the formation of the bile. It servos also to temper the acrimony of the humors, and probably, to give nourishment to the body, as all the other fat is supposed to do, when it is incapable of being nourished any other way. • The Liver, situated immediately below the diaphragm or mid- riff, on the right side, reaches as far back almost as the spine, or back-bone, and rests upon the right kidney. It is the largest gland in the body, and is divided into two unequal parts, called lobes. Except for the vessels, which are very numerous, the liver would be very soft, and like a piece of congealed blood. The great use of the liver is to secrete the bile. It is the seat of various disorders, inflammation, abscess, scirrhus, &c, and in most of them, the continuance hath a pale color, or a yellowish one with a green cast. There is one circumstance not much attended to with respect to the situation of the liver; its large or right lobe occupies the whole half of the belly, where it lies from the spine to the in- side of the ribs, laying over the upper part of the kidneys. Now this position of the liver is not often considered, for, when one has a pain in the small of the back, it is said to be in the kidneys; but if it be a little higher up in the back, it is seldom, if ever, thought to be in the liver, though it most undoubtedly may, as its posterior edge lays on that part, on the right side. The Gall-Bladder, or receptacle of bile, is fixed to the under side of the liver. Punctual as a porter in his lodge, it waits, ready to pour its acrimonious, but salutary juices on the aliment, as it ad- 54 OF THE STRUCTURE OF vances from the stomach; which dissolve its remaining viscidities, support the peristaltic motion of the intestines, and greatly assist in completing the digestion. Such is the importance of the bile in our constitution, and the ill consequence of an error in it, that every aid is desirable, by which our knowledge of its nature can be promoted. When there is a de- fect of bile, it disposes the body to various diseases ; as melancholy, indigestion, and obstruction of the viscera, &c. When there is a redundancy of bile, or it offends the stomach by its acrimony, it causes chilliness, shivering, and great anxiety.—It is certain, that in fevers the bile is not ■ nly plentifully generated, but peccant in its quality; and if not duly evacuated must be productive of many disagreeable symptoms ; hence the importance of a soluble belly in febrile disorders. The Pancreas, or Sweet Bread, a large gland, situated near the stomach, serves to secrete a liquor like the saliva, which is dis- charged, by a short duct into the duodenum. . The Spleen is situated under the cartilages of the left short ribs. In its natural and sound state, it is about six or seven inches long, about three in breadth, and one in thickness. It often becomes scirrhous and considerably enlarged in persons who have been fre- quently attacked with intermittent. Its ujse is not precisely known. The Kidneys are two oval bodies, situated in the loins, contigu- ous to the two last short ribs ; the right under the liver, and the left under the spleen. They separate the urine from the blood. The Ureters are tubes about the size of goose quills, and about a foot long; rising from the kidneys, and entering the bladder near its neck. They form to themselves, as it were, valves, so that, upon the contraction of the bladder, the urine is ejected through the urethra, its proper passage. ■ The Bladder is a membranous and fleshy sack or bag, capable of contraction and dilatation, situated in the lower part of the belly. Around its neck, which is longer in men than in women, there goes a small sphincter muscle to contract the orifice, that the urine may not be involuntarily discharged. The use of the bladder is to re- ceive the urine, perpetually secreted into it from the kidneys. The Uterus, or Womb, between the urinary bladder and the rectum, or straight gut, is placed, by Divine Wisdom, in a situation of great security, called the pelvis or basin, being guarded on all sides by the strong bones that form the basis of the trunk. In figure, it very much resembles a pear, its broadest extremity, which is called its bottom, is uppermost, and its small part, the neck, is downwards. The womb, when impregnated, hath a very small cavity, but becomes larger as pregnancy advances, and, in the time of delivery, has its mouth wonderfully dilated, so as to give passage to the child. About the age of puberty, the blood vessels of the uterus become THE HUMAN MACHINE. 55 distended, and secrete monthly a fluid called menses, catamenia, and vulgarly, flowers, courses. The Vagina, or Neck of the Womb, extends from the mouth of the uterus to the pudendum or external parts. In.women it en- larges, and, like the uterus, in the time of birth, dilates very much. Just within the vagina is the orifice of the urethra, which is shorter, wider, and straighter than in men. Beside the womb and vagina, there are two other contrivances supposed to perform particular functions, in the propagation and formation of our species, the one called ovaria, from their retaining small round substances of the nature of eggs, the other Fallopian tubes, from their discoverer, Fallopius. The Fallopian Tubes are situated on the right and left sides of the womb. They rise from its bottom by a narrow beginning, and dilate in the form of a trumpet to their extremities at the ovaria. Their cavity, where they open into the womb, will scarcely admit of a hog's bristle ; but at its widest part, it will take in the end of one's little finger. The tubes are about four or five fingers' breadth long. They serve to convey from the ovaries the rudiments of the foetus to the womb, where they are farther developed and perfected. The Ovaria, or Ovaries, are two small bodies, situated on each side of the fundus uteri, or bottom of the womb behind the Fallo- pian tubes. At the age of puberty they are full and plump, and continue so until the menses are about to depart. They contain from ten to twenty or more pellucid eggs, supposed to contain the primordia of the foetus. The Testes, or Testicles, are two oval glandular bodies, seated in the scrotum, which serve to secrete the semen from the blood. The scrotum, or external covering, is made up of the scarf skinr true skin, and immediately under the latter, is a thick cellular tex- ture closely adhering to it. It is likewise composed of many fleshy, or muscular fibres, by means of which the scrotum is contracted, and is reckoned a sign of health. The Prostate Gland is situated at the neck of the bladder ; and is about the bigness of a walnut. By some it is supposed to se- crete a fluid merely to lubricate the urethra, and by others it is deemed subservient to the process of generation. The Urethra is a canal or pipe of the thickness of a goose quill, and about twelve or thirteen inches long, which begins at the neck of the bladder, and terminates at the end of the penis. Its inner membrane furnishes a mucilaginous liquor; serving to defend it against the acrimony of the urine. The Penis is composed of two spongious bodies, part of the urethra, the glands or nut at its extremity, and its integuments.— The spongious bodies take their name from being porous like sponge, and capable of being distended and enlarged by the blood pene- trating their substance, as in case of erection. The integuments of the penis make a hood to the glands or nut of the yard, called 56 OF THE STRUCTURE OF prepuce or foreskin. The small ligament, by which it is tied to the; under side of the nut, is called fraenum. The use of the prepuce or foreskin, is to keep the nut soft and moist, and to preserve its sensibility. The amputation of it constitutes circumcision, a prac- tice recommended by Moses to the Jews. We shall now conclude the anatomical part of the human body, and trust enough has been said, concise as it is, to give to the unin- formed readers just conceptions of the most important parts of the human machine, and its natural action. We see the greatest multiplicity of parts, yet the most perfect harmony subsists between them all. No one hinders, but each as- sists the operation of another, and all conspire to the benefit and preservation of the whole. Most judiciously has the great apostle touched this subject; and most happily applied it to illustrate the reasonableness, and enforce the practice, both of personal and so- cial duties, of private content, and public concord. The body, he observes, is not one member, but many, to each of which some peculiar and needful office is assigned ; so that the foot, though placed in the lowest order, and destined to serve on the ve- ry ground, has no reason to reckon itself a worthless outcast; or to say, Because I am not the head, I am not of the body. Neither has the head, in its exalted station, and amidst its honorable func- tions, any cause to despise the inferior limbs ; or to say with contempt and self-sufficiency, I have no need of you.—If there were no feet, what would become of the locomotive faculty ? or how could the body convey itself from one place to another ? If there were no hands, what should we do for the instrument of action ? or how could the animal frame be defended and accommodated ? Nay, the parts which seem to be less honorable, are necessary. Even those which form the sediments, or throw off the dregs, are of im- portance to life and its comforts. Should those be obstructed in their action, the most raging torment ensues ; and should the ob- struction continue, death is the inevitable consequence.—By this wise adjustment, there is no schism in the body, no separate or in- terfering ends pursued by the members, but the safety and support of each are the one undivided care of all. Wise, wonderfully wise and eminently gracious, is the regulation both of spontaneous and involuntary motion. Were this regula- tion reversed, what deplorable inconveniences would take place;; nay, what unavoidable ruin must ensue ! Deplorable inconvenien- cies; if the discharge of the bowels, or evacuations of the bladder, were quite independent of our leave. Unavoidable ruin; if the action of the heart required the co-operation of our thoughts, or the business of respiration waited for the concurrence of our will. The will, in some cases, has not so much as a single vote. In others, she determines and commands like an absolute sovereign ;■ nor is there a monarch upon earth so punctually obeyed, as this queen of the human system. If she but intimate her pleasure, the spirit? THE HUMAN MACHINE. 57 run, they fly to execute her orders ; to stretch the arm, or close the hand ; to furrow the brow with frowns, or dimple the cheek with smiles. How easily, as well as punctually, are these orders carried into execution! To turn the screw, or work the lever, is laborious and wearisome; but we move the vertebrae, with all their apparent chambers ; we advance the leg, with the whole incumbent body ; we rise from our seat; we spring from the ground; and, though much force is exerted, though a very considerable weight is raised, we meet with no difficulty, we complain of no fatigue. That all this should be effected without any toil, and by a bare act of the will, is very surprising: but that these motions should be made, renewed, continued, even while we remain entirely ignorant of the manner in which they are performed, is beyond measure as- tonishing. Who can play even a single tune upon the piano, with- out learning the difference of the keys, or studying the rudiments of music ? -Impossible ! Yet the mind of man touches every string of the human machine with the most masterly skill, though she knows nothing at all concerning the nature of her implements, or the process of her operations. We walk, we run, we leap, we throw ourselves into a variety of postures, and perform a multitude of motions, yet are utterly unable to say which nerve should be ac- tive ; what muscles should swell, or what tendons approximate. Put a German flute into the hand even of a sensible person ; with- out a master to instruct him, he is at a loss to make the instrument speak ; much less is he able to sink and soften the sound, to exalt and extend it just as he pleases. Yet we are self-taught in the method of forming, regulating, and varying the voice. Naturally, and with unpremeditated fluency, we give it the languishing cadence of sorrow, or the sprightly airs of joy; the low faltering accents of fear, or the elated tone, and rapid sallies of anger. We can never sufficiently admire this multiplicity of animated organs ; their fin- ished form, and their faultless order.—Yet I must confess myself struck with greater admiration at the power, the truly mysterious power and sway which the soul exercises over them. Ten thou- sand reins are put into her hand; she is not acquainted with their office, their use or their name : she has not learned so much as to distinguish one from another, nevertheless she manages all, con- ducts all without the least perplexity, or the least irregularity ; ra- ther with a promptitude, a consistency, and a speed, which nothing else can equal! Since health depends upon such a numerous as- semblage of moving organs ; since a single secretion stopped, may destroy the salutary state of the fluids, or a single wheel clogged, may put an end to the vital motion of the solids ; with what holy fear should we pass the time of our sojourning here below! trust- ing for continual preservation, not merely to our own care, but to that omnipotent hand which formed the admirable machine : that the same hand which formed it, may superintend its agency and support its being. 8 58 OF THE STRUCTURE OF When we consider the extensive contrivance and delicate me- chanism—what plans of geometry have been laid ; what operations of chemistry are performed ; in a word, what miracles of art and elegance are executed, in order to furnish us with the necessary re- cruits and the several delights of life—is there not abundant reason to cry out with the inspired writer, " How dear are thy counsels unto me, O God!" thy counsels of creating wisdom ! Thou hast not been sparing, but even lavish of thy indulgent designs 1 Thou hast omitted no expedient which might establish my ease, enlarge my comforts, and promote, yea complete, my bodily happiness ! and is not this a most endearing obligation to glorify the blessed God with our bodies, as well as with our spirits ? The mechanism of our body; the connection and subserviency of all its parts to a common purpose ; the exquisite contrivance of its organs, consisting of such various minute vessels, interwoven with wonderful art, have led anatomists of all ages, to acknowledge an infinite, wise and powerful Maker. Among the most precious re- mains of antiquity, are those commentaries of Galen, written on the uses of the several parts of the human body, as hymns and offer- ings of praise to the great Creator. Is it, indeed, otherwise conceivable how such consistency and harmony could have taken place in the different parts of our won- derful frame ? How they could have been so exactly fitted to each other, and to the exterior objects which have an evident relation to them, and the system they compose ? Could the bones, which in all amount to four hundred, and the muscles, still more numer- ous, and each so well disposed for motion, be adjusted without a superior knowledge in mechanics ? The eye, so admirably adapt- ed to light, and appropriated to vision, was it formed without a knowledge of optics ? Or the ear, without the science of sounds ? Even our inclinations and passions, those sources of so much ap- parent ill, are by the Deity providentially rendered the means of our preservation, both as individuals and a race ; and the selfish and social affections, like centripetal and centrifugal forces, conduct us with proper force, to the end intended by our Maker to be pro- duced by them. Yet the love of life and all its enjoyments, the fear of death and all its dreadful harbingers, and the social affec- tions and all their endearments, would not have been sufficient se- curity for our carrying on the vital motions with that constancy and uniformity necessary to the preservation of life, if thus engag- ed these motions had depended upon our will and choice. Reason would have deliberated concerning them with too much slowness, and volition would have executed often with a dangerous and fatal caprice. For, if the heart had been subject to the soul's authority, as nrach as the voluntary muscles are ; if its motions could have been suspended or stopped with the same facility, death would then have cost us no painful pang; and whenever the body was tortured with disease, and the mind in anguish from grief or disappointment, a THE HUMAN MACHINE. 59 remedy so easily applied might have been too frequently resorted to, and yet more unfortunate beings might have rushed uncalled into the presence of Him who stationed us for the wisest reasons here on earth.—The preservation of life, therefore, greatly depends on our vital motions being entirely subject to the wise government of the Author of our lives, who charges Himself with the immediate care of them and of us. All this, when attentively considered, must affect us with a sense of God's goodness ; who, respecting the imbecility of man's nature, hath been pleased, by appetites and passions, to excite him to acts of self-preservation ; where the violence of these might have been hurtful, no less than the slowness and instability of reason, hath taken our safety under his more immediate direc- tion. To attribute contrivances like these, and even understanding itself, to unintelligent causes, rather than to the all wise Parent of Nature, seems an incomprehensible perversion of reason and phi- losophy. That mind must be strongly prepossessed and bewilder- ed with false science, which rather seeks for the cause of these in- voluntary motions in dead matter, organization, chance, necessity, something that, without knowledge or power, acts wisely and pow- erfully, than in the great Fountain of power, wisdom, and anima- tion. If chance could be supposed to produce a regular determinate action, yet it is beyond the highest degree of credulity, to suppose. it could continue this regularity for any time. But we find it re- mains through life, independent of our will; and the same inces- sant vital actions have been carried on from the commencement of the world. It is thus that the sun's influence upon the earth has ever been regular. The production of trees, plants, and herbs ever uniform. Every seed produces now the same fruit it ever did. Every species of animal life is still the same. Could chance con- tinue this regular arrangement ? Could any thing continue it, but the hand of an Omnipotent Creator ? The human body is exalted to a most intimate and personal un- ion with the eternal Son of God. He who decorated the heaven with stars, and crowned the stars with lustre; He vouchsafed to be made flesh, and was found in fashion as a man. Nay, this is even now the apparel of that divine and adorable person. He is clothed with our nature ; he wears our very limbs; and appears in the dress of humanity, even at the right hand of God, and at the head of all the heavenly hosts. W hat think you of another privilege mentioned by the Apostle ? " Your bodies are the temple of the Holy Ghost." Not your souls only, but your very bodies are the shrine in which the high and holy one, that inhabiteth eternity, condescends to dwell. He, who sitteth between the cherubim and walketh in the circuit of the skies, is pleased to sanctify these earthly tenements for his own habitation. And is not this a much grander embellishment, than all their matchless contrivance and masterly workmanship ? 60 OF THE (STRUCTURE, &C. Nor must I omit the dignity—the transcendent dignity, which is reserved for these systems of flesh at the resurrection of the just. They will then be refined and improved into the most perfect state, and the most beauteous form; surpassing whatever is resplendent and amiable in the most ornamental appearances of material nature. They will be purer than the unspotted firmament; brighter than the lustre of the stars ; and, which exceeds all parallel, which com- prehends all perfection, they will be made like unto Christ's glo- rious body; like that incomparably glorious body which the bless- ed Jesus wears in his celestial kingdom, and on his triumphant throne. When we add all these magnificent prerogatives which are re- vealed in Scripture, to all those inimitable niceties which are dis- played by anatomists, what thankfulness, what admiration can equal such a profusion of favors ? Say, why was man so eminently rais'd Amid the vast creation, why ordain'd Through life and death to dart his piercing eye, With thoughts beyond the limit of his frame ? But that the Omnipotent might send him forth, In sight of mortal and immortal powers, . As on a boundless theatre, to run The great career of justice ; to exalt His generous aim to all diviner deeds ; To chase each partial purpose from his breast, And through the tossing tide of chance and pain, To hold his course unfaltering, while the voice Of Truth and Virtue up the steep ascent Of nature, call him to his high reward, The applauding smile of Heaven.—Akenside. ON HYGIEINE; OR, THE ART OF PRESERVING HEALTH. Reason's whole pleasure, all the joys of sense, Lie in three words—Health, Peace, and Competence. But health consists of temperance alone, And Peace, O Virtue, Peace is all thy own.—Pope. In the preceding chapter* I have treated of the structure of the Human Body. I shall now show, that by due attention to the " Non-naturals," air, food, exercise, sleep, evacuations, and pas- sions, we may go far to preserve this fabric in good health from the cradle to the grave. Nay, so wonderful is the body in its resources, its powers of renovation; and so sovereign are the virtues of the Non-naturals, that thousands are the instances of persons who, after having their health apparently ruined by an abuse of them, have, on returning to a wise and temperate use, entirely recovered their health, and attained to a most active and happy old age. Hence, the reason mankind are so often sick, is because they so often err in the use of these, the appointed preservatives of life and health. To inculcate this truth more universally, I have introduced these disquisitions on the art of preserving health, and, to render them more acceptable to my readers, have enlivened them with appro- priate illustrations, hoping thereby to make impressions as lasting as they are important. OF AIR. Thou cheerful guardian of the ruling year, Whether thou wanton'st on the Western gale, Or shak'st the rigid pinions of the North, Diffuses life and vigor through the tracts Of air, through earth and ocean's deep domain. Without thy cheerful active energy No rapture swells the breast; no poet sings : No more the Maids of Helicon delight; G2 ON HYGIEINE, OR THE ART Come then with me, O ! goddess heavenly gay! Beain the song; and let it sweetly flow, And let it sweetly teach thy wholesome laws ; " How best the fickle fabric to support Of mortal man : in healthy body how A healthful mind the longest to maintain.—Armstrong. As soon as an infant enters the world, the air rushes into its lungs, the circulation of the blood through that organ commences, and its life from that moment depends " on the breath that is in its nos- trils," which is incessantly taken in and thrown out of the lungs. While the child remained in the womb, it required no external air, because it existed in the blood which was received from its mother through the umbilical cord, or navel string. But as soon as the in- fant is born, the air is inhaled, and the circulation is determined through the lungs, which ever after continues in that way; and hence the necessity of breathing, which can never cease but with life. Since, then, air is the main instrument of vitality, both to man and all creatures, it certainly must be a most pleasing and profitable study to acquire correct ideas of this great element. By the unlettered part of mankind, the vast atmosphere which surrounds our globe, to the depth of two and thirty miles, is sup- posed to be one simple, colorless, invisible mass, without any es- sential difference of qualities, and without weight. But it is a gross mistake ; for instead of being a simple uniform element, it is com- posed of several parts, some of which are widely different from each other. We have, too, numberless proofs of its weight; like other bodies falling to the earth, and becoming more dense as it approaches its centre. Every one knows that air on the tops of high mountains is much thinner than it is below in the vallies ; but the weight of air is susceptible of demonstration by positive experiment. Having exhausted a thin glass flask, and suspended it at one end of a balance, which being nicely counterpoised by weights in the other scale ; this done, admit the air into the flask ; into which it will rush with a noise, and though the flask was balanced before, it will now, upon admission of the air, preponderate. If the flask hold a quart, it will be found that the weight of the air it now con- tains is about 17 grains, so that a quart of air weighs about 17 grains. We will mention another experiment, easily put into practice. Some water being poured into a saucer, burn a bit of paper in a tea- cup, which by rarifying, will exhaust and make a vacuum in the oup. Then, while the paper is yet burning,-turn it hastily down, paper and all, into the saucer, and the air without will press the wa- ter up1 from the saucer into the cup. The water will stand within the cup in a column ; and if the cup were thirty-two feet high, and the air within it perfectly exhausted, the water would rise to that height in it, as we have said before. This satisfactorily accounts for the rising of water in pumps, or the standing of the quicksilver in the barometer. OF PRESERVING HEALTH. 63 If farther proof be necessary to show the weight of that great ocean of air, which constantly' surrounds us, let a man take a thick glass tube, such as is put over lamps, and place it upright on a table having a small hole in it for an air pump. Then let him place his hand closely over the top of the tube, while a friend with the pump extracts the air, and he will find that as the air on the inside is removed, the air on the outside wall press his hand down with much violence. Nor will he be surprised at this pressure of the air, when he comes .to learn that a column or pillar of air, of only one inch diameter, and thirty-two miles high, which is the depth of the atmosphere from its top above the clouds to the ground, weighs about fourteen pounds. If the hand of the person which covers the top of the tube measure ten inches square,, the pressure on it will be about one hundred and forty pounds—sufficient in all con- science to crush every bone in his hand. By the same token, a square foot of such a column of air would weigh near two thousand pounds, and as a common-sized man measures about fourteen square feet, it is a fact, as curious as it is awful, that every such person bears constantly on his body a weight of fourteen tons, or twenty- eight thousand pounds of a*ir. Some persons may doubt this from the conclusion that such a weight would crush every man to pieces. So it would, if it were to press solely on any particular part. But this conclusion instantly falls to the ground, when it is re- collected, that this pressure of the air is uniform and equal all round him, the air pressing as strongly from below as from above; from one side as from another; thus causing the various pressures most exactly and admirably to counterpoise each other; of this we see a wonderful instance in the case of fishes in the ocean. One of these animals, at a great depth under water, would be crushed to atoms, if all that heavy element pressed only on his back. But the God who made him has so kindly attended to his safety, as to cause the water that surrounds him from below to press upwards as strong- ly as that from above to press downwards. There is another rea- son why our bodies are not so sensible of the tremendous weight of air, which thirty-two miles deep, presses on us ; it is simply this, all bodies are full of air ; and the air within pressing against that without, preserves even the most delicate bodies uninjured. A bladder, or even a bag of oiled paper, if filled with water, remains perfectly unhurt, though a hundred fathoms below the surface of the sea; because the water within furnishes a full resistance to the water without. But take away this resistance from within, and you will find that the slightest pressure will bring the two sides to- gether. According to the late discoveries in chemistry, the atmosphere^ consists of three different species of air—namely, pure, respirable,. or dephlogisticated air ; azotic, or phlogisticated air; and fixed} or carbonic acid air. The proportion of the first, namely, pure or vital air, consists, 64 ON HYGIEINE, OR THE ART according to the French chemists, who have given it the name of Oxygen, of 27 or 28 in the hundred parts; the second, the Azote of the French, of 72 or 73 in the hundred ; and the third, namely, the Carbonic acid air, of about one part only in the hundred. Oxygen is much better adapted to the respiration of animals than common atmospheric air. If two animals be enclosed in vessels, one of which contains pure Oxygen and the other common atmos- pheric air, in proportiops equal to the size of the animals, the for- mer in the Oxygen will be found to live six or seven times as long as the latter in common air. It is properly this Oxygen which we inspire, and which is the grand support of animal life. Persons apparently dead, or in a state of suffocation, have been instantly re- stored to life, by its influence ; and from the corresponding testi- mony of several respectable physicians, it appears to have been em- * ployed with advantage in many obstinate diseases. The celebrat- ed Ingenhouz, therefore, gave it the name of vital air. It pro- motes combustion in a very high degree. A candle will burn in it from six to seven times longer than in common air, with a much grea- ter degree of heat, and a more brilliant flame. Bodies in a glowing state are immediately inflamed; when' put into Oxygen gas; and even metals, which are not very fusible, are melted in it with the greatest facility. Azote, by others called phlogisticated, mephitic, corrupted, or suffocative air, is absolutely unrespirable, and not miscible with wa- ter. It arises from the change which atmospheric air undergoes in every process of combustion, putrefaction, and respiration, whether produced by nature or art. Azote enters into no combination with water, but may be ren- dered less hurtful by shaking it with that fluid. This accounts, in some measure, for the salubrity of the sea-air. It greatly promotes the growth of plants, and readily accumulates in apartments filled with people, or containing articles fresh-painted with oil colors, or in which strongly fragrant flowers are kept without having any ac- cession of fresh air. We should be extremely cautious in entering such places, as diseases of the breast and lungs are too frequently r the consequence of neglect or ignorance. The Carbonic acid air, or fixed air, is miscible with water, but in its pure state is equally unrespirable as the azote. It derives its origin,, partly from the vinous fermentation of vegetables and some animal substances, and partly from the mild alkaline salts and earths combined with acid. Much of this air abounds in mines, where it frequently distresses the workmen by its suffocating effect. It is also observed in most mineral waters, where a stratum of it some- times floats upon the surface of the well.—These waters, as well as fermented liquors, which contain a considerable portion of fixed air, revive from it that well known pungency so agreeable to the pa- late. Hence, flat and spoiled beer or wine, may be corrected and restored to its former briskness, by the addition of fixed air evolved] OF PRESERVING HEALTH. 65 from chalk and vitriolic acid ; or by mixing it with new beer, or wine in a state of fermentation. As this species of air quickly extinguishes fire, animals cannot live in it. These three aerial bodies, though blended together, arrange them- selves, in some degree, according to their specific gravities ; that is, the proportion of azotic air, which is the lighter body of the three, will be found most in the upper part, the oxygen air in the middle, and the fixed air will be found most in the lower part of the apart- ment. This occasions a circulation in the air, the rarified air will ascend, the fixed air sink, and the colder and purer air rush into the apartment through every crevice. To render the circulation of the air plain to sense, if the air of a room be heated by a fire, whilst the air in the next room is cold, and the door between opened, the hot air of one room being rarified, will pass through the upper part of the opening of the door into the cold room ; and on the contrary, the cold air of the other room being heavier, will pass into the former through the lower part of the opening. This may be proved by ap- plying a candle at the upper and lower openings between the two rooms. The direction of the flame of the candle will point out the contrary currents of air. It is for this reason, that when a fire is lighted in a chimney, a strong current of air enters the room, which may be felt by applying the hand near the key-hole, or other small openings, if the door and windows be shut. A fire is said to pu- rify a room : but this it does partly by drying the dampness of the room, and chiefly by promoting the circulation of the air. The fire does not perform such service by purifying the bad air, but by removing it, and substituting that which is fresh and wholesome. Hence it appears that those persons are mistaken, who are over anxious to keep air from the apartments of convalescent persons, studiously stopping, by list, linings, and sand bags, all the smal- lest openings that admit fresh air. Unless the air were constantly renewed, persons would be expos- ed to the most fatal accidents in large assemblies or crowded rooms. A rout was lately given at a celebrated bathing place, or spring. The room was small and the company very numerous. They had not been long seated at the card-tables, before a young gentleman and lady, both in delicate health, fell into a swoon. The doors and windows were immediately thrown open, to afford fresh air, which quickly dissipated the alarm, by reviving the young invalids. A physician present telling one of his medical companions how severe- ly he himself had suffered from the air of that vile oven, and that he had made up his mind to write a bitter phillipic against routs, Was archly answered by his friend :—" Let them alone, doctor, how otherwise should twenty-six physicians subsist in this place ?" A farther illustration :—Take a room thirty feet by twenty-five, and thirty feet high, capable of containing one hundred persons. 9 66 ON HYGIEINE, OR THE ART Now, since each person consumes about five cubic feet of air in an hour, that is, deprives such a quantity of air of its oxygen, or vital principle, it would follow, that, as such a room could contain only twenty-two thousand five hundred cubic feet of air, unless the air was constantly renewed, it would be rendered completely mephitic or noxious in about four hours and a half and it is probable that the greater part of the company would be seriously incommoded, or even perish long before that time. The following affecting narrative is a melancholy confirmation of this fact. In the summer of 1756, the British settlement of Calcutta, in India, was attacked by the natives under the viceroy Rajah Doulah, a young man of the most violent passions, and without the least sense of honor or humanity. After a most obstinate resist- ance, the little garrison surrendered themselves prisoners of war, on a solemn promise from the Rajah of the most honorable treatment. But. no sooner had the monster got them in his power, than, utterly regardless of that due to honor, humanity, and a brave enemy, he barbarously drove them all into a dark shallow vault under ground, called the black hole, only eighteen feet square. The num- ber of the unfortunate men, thus cruelly immured, was one hundred and forty-six, with their gallant commander, Colonel Holwell, the historian of the following tragedy. The humane reader may form some idea of one hundred and forty-six poor fellows, many of them badly wounded and bleeding, and all worn out with the fatigue, and covered with the dust and sweat of a hard day's fighting, cram- med together, on a hot sultry evening, into a small dirty hole, eigh- teen feet square, with only two little windows, and those obstruct- ed by strong iron bars. A profuse sweat quickly broke out on every individual, attended with an insatiable thirst, which became the more intolerable as the body was drained of its moisture. It was in vain they stripped off their clothes, or fanned themselves with their hats. A difficulty in breathing was next observed, and every one pant- ed for breath. Colonel Holwell, who was placed at one of the windows, called to the sergeant of the guard, and after striving to excite his compassion by drawing a pathetic picture of their suffer- ings, promised him a thousand rupees in the morning, provided he could find means to remove some of his people into another place of confinement. The sergeant, allured by the promise of so migh- ty a reward, assured him that he would use his utmost endeavors, and retired for that purpose. What must have been the impatience, at this time, of these un- fortunate objects ? In a few moments the sergeant returned with the woful tidings, that the viceroy was asleep, and no man durst disturb his repose! The despair of the prisoners now became outrageous. They en- deavored to force open the door, that they might rush on the swords OF PRESERVING HEALTH. 67 of the monsters, by whom they were surrounded, and who derided their sufferings ; but all their efforts proved ineffectual. They then used execrations and abuse to provoke the guard to fire upon them. The captain of the guard was at length moved to compassion. He ordered his soldiers to bring some skins containing water, which by enraging the appetite, only served to increase the general agita- tion. There was no other way of conveying it through the win- dows, but by hats; and this mode proved ineffectual, from the ea- gerness of the wretched prisoners who struggled for it in the fits of delirium. The cry of water! water! issued from every mouth. The consequence of this eagerness was, that very little fell to the lot even of those who stood nearest the window ; and the most for- tunate, instead of finding their thirst assuaged, grew more impa- tient. The confusion soon became general and horrid : all was clamor and contest; those who were at a distance, endeavored to force their passage to the window, and the weak were pressed down to the ground, never to rise again. Colonel Holwell, observing now his dearest friends in the agonies of death, or dead, and inhumanly trampled on by the living, finding himself wedged up so closely as to be deprived of all motion/ beg- ged, as the last mark of their regard, that they would for one mo- ment remove the pressure; and allow him to retire from the win- dow, and die in quiet. Even in such dreadful circumstances, which might be supposed to have levelled all distinction, the poor delirious wretches, mani- festing a respect to his rank and character, immediately gave way, and he forced his passage into the centre of the place, which was less crowded, because, by this time, about one-third of the num- ber had perished, while the rest still pressed to both windows. He retired to a platform at the farther end of the room, and lying down upon some of his dead friends, recommended his soul to the mercy of its Creator. Here his thirst grew insupportable ; his difficulty in breathing in- creased and he was seized with a strong palpitation at the heart. These violent symptoms, which he could not bear, urged him to make another effort. He forced his way back to the window, and cried aloud, " Water! for God's sake, a little water!" He had been supposed already dead by his wretched companions, but finding him still alive, they exhibited another extraordinary proof of regard to his person. " Give him water," they cried; nor would one of them attempt to touch it, until he had drank. He now breathed more freely, and the palpitation ceased; but finding himself still more thirsty after drinking, he abstained from water, and moistened his mouth, from time to time, by sucking the perspiration from his shirt sleeves, which tasted soft, pleasant, and refreshing. The miserable prisoners now began to perceive that it was air, » 68 ON HYGIEINE, OR THE ART and not water that they wanted. They dropt fast on all sides, and a strong steam arose from the bodies of the living and the dead, as pungent and volatile as hartshorn. Colonel Holwell, being weary of life, retired once more to the platform, and stretched himself by the Rev. Mr. Bellamy, who to- gether with his son, a young lieutenant, lay dead, locked in each other's arms. , In this situation he was soon deprived of sense, and seemed to all appearance dead, when he was removed by his surviving friends to one of the windows, where the fresh air brought him back to life. The Rajah being at last informed that the greater part of the prisoners were suffocated, inquired if the chief were alive, and be- ing answered in the affirmative, sent an order for their release, when no more than twenty-three survived, of one hundred and forty-six, who entered into this prison. How many melancholy instances of a similar kind have occurred on board vessels engaged in that most abominable and diabolical traffic, the slave trade ! My soul is sick with every day's report Of wrong and outrage with which earth is filled: There is no yielding flesh in man's hard heart, It does not feel for man. The nat'ral bond Of brotherhood is sever'd, as the flax That falleth asunder at the touch of fire. He finds his fellow guilty of a skin Not colored like his own ; and having power To enforce the wrong, for such a worthy cause, Dooms and devotes him as a lawful prey. Thus man devotes his brother ; And, worse than all, and most to be deplored, As human nature's broadest, foulest blot, Chains him, and tasks him, and exacts his sweat With stripes, that mercy with a bleeding heart Weeps when she sees inflicted on a beast. Then what is man ? and what man seeing this, And having human feelings, does not blush And hang his head, to think himself a man ? I would not have a slave to till my ground, To carry me,.to fan me while I sleep, And tremble when I wake, for all the wealth That sinews bought and sold have ever earned.—Cowper. To mention no other fact, a strong proof of the necessity of the frequent renewal of air may be found in the records of the Dublin lying-in hospital. In this hospital two thousand nine hundred and forty-four infants out of seven thousand six hundred and fifty, died in the year 1782, within the first fortnight after their birth, which is nearly every third child! They almost all died in convulsions, or what the nurses call ninth day fits, because they came on nine days after their birth. Many of these children foamed at their mouths, their thumbs drawn OF PRESERVING HEALTH. 69 into the palms of their hands, jaws locked ; and faces swelled and blue, as though they were choked. The last circumstance led Dr. Clark to conclude that the rooms were too close and crowded. That benevolent physician contrived, therefore, air-pipes, by which the rooms were completely ventilated. The consequence was, a pro- digious decrease in the mortality. It is almost unnecessary to men- tion the frequent and sudden deaths that have taken place from en- tering deep wells, cellars, and other confined places. Three poor men at Denton, Maryland, having nearly completed a deep well, quitted their work to go home to keep the holy-days. However, before they left the well, they covered the mouth of it closely. Carbonic acid gas settled at the bottom of it. After some time the unlucky well-diggers returned, and, opening the well, very unsuspiciously let themselves down to their work. Two out of the three perished at the bottom ; the other, not going down, escaped. Lime-kilns, throwing off large quantities of fixed air, are ex- tremely dangerous. Two disorderly young women, after rambling a greater part of the night, crept, early in the morning, into a little hovel contiguous to a lime-kiln, and fell asleep. The kiln being in high blast, dif- fused a portion of vapor through the crevices into the hovel; but the poor wretches were too sound asleep to be awakened. After some hours, the man, who had the care of the kiln, coming to look after his work, finding these women asleep, endeavored to awake them, but in vain! They were taken immediately to the hospital. The one first conveyed recovered, but the other perished. There is another species of mephitic air, which burns with a bright flame, and, if mixed with common air, instantly catches fire and explodes ; hence it has received the name of " inflammable air." Mines and coal-pits are frequently infected with this gas, which, being ten times lighter than common air, ascends to the upper re- gion of the mine, and is called fire-damp. To discharge this, the miners are in the habit of crawling on their hands and feet, and, with a taper affixed to a long stick, set fire to it, which is succeed- ed by a terrible, and sometimes fatal explosion. This air is often generated in the stomach and bowels of animals both living and dead. A lighted candle held near, has often caused it to take fire. The inflammable woman of Coventry, as described by Mr. Wilmer, appears to have reduced herself by dram drinking, to such a state, as to be capable of being set on fire, and burning away like a match : so eager, says the learned Dr. Beddoes, were the principles of which she was composed to combine with Oxygen. The Russians and Germans are frequently exposed to fainting during their cold season, from the noxious air of their stoves, and want of due ventilation. As soon as a person is discovered in this state without sense and motion, he is instantly carried into the open air; and being stript, is rubbed very briskly with snow, or cold water, which generally recovers him, if breathing have not been 70 ON HYGIEINE, OR THE ART suspended above an hour. Faintings, or suffocations from the fumes of charcoal, are commonly cured by cold water thrown on the patient. As the mass of atmospheric air is incessantly corrupted by the respiration of men and animals, by the burning of so many natural and artificial fires, by the dissolution and putrefaction of innu- merable substances, and by various other phlogistic or disoxygenat- ing processes, it would at length become altogether incompetent for its original designation, if the all benevolent Creator had not pro- vided effectual means for its improvement and renovation. Amongst the most powerful of these is the vegetation of plants. For this very important discovery, we are indebted to Dr. Priestley, who was so fortunate as to make it after he had long employed many fruit- less attempts to correct impure air by artificial means. He found that air rendered deleterious by the breathing of animals, which had died in it, was again so completely restored by the vegetation of plants, that after the lapse of some days, an animal could live in it with equal ease, and for the same length of time, as before. The ingenious philosopher, Dr. Ingenhouz, remarked, first, that most plants have the property of correcting bad air within a few hours, when exposed to the light of the sun; but that, on the con- trary, during the night, or in the shade, they corrupt the air: sec- ondly, that plants from their own substance afford a very pure air, or oxygen, when exposed to the rays of the sun ; but a very impure air, or azote, at night, or in the shade: thirdly, that not all parts of plants, but only the green stalks of leaves, produce this benefi- cial effect: fourthly, that the disengagement of pure or vital air does not commence until the sun has been some time above the ho- rizon, that it ceases altogether with the termination of daylight; and that the disadvantage arising from the impure exhalations of plants, during the night, is far exceeded by the great advantage they afford during the day ; insomuch, that the impure air genera- ted by a plant during the whole night, scarcely amounts to a hun- dredth part of the pure vital air, or oxygen, exhaled from the same plant in two hours of a serene day. Thus, the atmosphere is con- stantly preserved in that state of purity, which is the most salutary both to animals and vegetables. As the vegetable kingdom is renewed in spring, and as vegetation in general is most lively in that season, there can be little doubt, that the pure vital air is then most copiously evolved by means of the light and heat of the sun. Hence it follows that the air of spring is more wholesome than that of autumn, which is saturated with impure particles. The cold, however, and the frequent winds which prevail at a more advanced period, prove extremely effica- cious in counteracting the baneful effects of corruption and putre- faction. All strongly scented bodies are more or less pernicious, not only those of a fetid, but even those of a fragrant smell. The latter, if too strong, are particularly dangerous, as a sense of disgust does OF PRESERVING HEALTH. 71 not naturally incline us to avoid them. Hence people who carry large nosegays in the hot days of summer, or sleep in rooms deco- rated with flowers, are apt to feel themselves affected with head- achs: vertigoes, fainting fits, and even apoplexies, have been pro- duced in persons of a plethoric habit. The smell of roses, how pleasing soever to most persons, is not only odious, but almost deadly to others. Warm Air relaxes the body, and occasions a quicker circulation of the fluids: hence the tender and infirm suffer severely in hot weather; hence arise hysteric and hypocondriac complaints, con- vulsions, and diarrhoeas. Cold renders bodies more compact, the appetite stronger, and digestion easier and quicker. On the contrary, the resistance of the fluid parts become so great, that even the increased powers of the solids cannot overcome it, if the cold be too violent. In winter the blood is much disposed to inflammation ; hence stitches in the side, inflammatory sore throats, rheumatism, &c. In persons who take little exercise, the fluids are apt to stagnate, and the solids to chill during the winter. Upon the whole, however, the effects of cold weather may be rendered less hurtful, and even salutary to the body, if proper exercise be not neglected. Damp or Moist Air suddenly relaxes and debilitates, retarding the circulation, checking the perspiration, and depressing the spi- rits. If damp air be accompanied with cold, it tends, by obstruct- ing the perspiration, to throw the retained humors on the breast, throat, stomach, bowels, &c, occasioning sore throats, pleurisies, sick stomach, diarrhoeas, &c. If damp air be accompanied with heat, it is still worse, by opening the pores, through which the mois- ture penetrates in the body, and predisposes every part of it to pu- trefaction and dissolution. This accounts for the great mortality prevalent during the hot season at Batavia, and some of the West India Islands. Dry and Cool Air, from its elasticity, promotes, in an extraordi- nary manner, the serenity and alertness of mind and body; and is, therefore, most agreeable and salubrious, both to the healthy and infirm. Too sudden a transition from warm to cold air, or the reverse, is pernicious. But none have ever complained on leaving, however suddenly, the sickly air of the town, for the dry, pure, temperate air of the country. After all, the surest "sign of good air in any place, is the longevity of its inhabitants. The most certain marks, by which to distinguish whether the air in rooms be damp or not,.are the following. The walls or tapestry change their color ; bread acquires a mouldy surface; sponges in the rooms retain their moisture ; loaf-sugar turns soft; iron rusts ; brass and copper acquire a green color, and wooden furniture moul- ders and crumbles to pieces. In cities the sitting rooms ought, if possible, to be above the 72 ON HYGIEINE, OR THE ART ground floor, or on the second story, well ventilated by convenient doors and windows. And as to the bed-rooms, they ought assured- ly to be in the most elevated stories of the house, that they may be as far removed as possible from that mass of azote, or deadly air which is so copiously generated in large towns, and which naturally settle* near the ground. Dr. Caldwell, lecturing on this subject, states that it was on this principle he was induced, contrary to the remonstrances of his fam- ily and friends, to keep his son in the third story of his house, dur- ing a very sickly season in Philadelphia, and adds, that he could not avoid being sensibly struck with its happy effects in preserving his; health. And I am convinced the excellent health my family en- joyed, during eight or nine years' residence in Savannah, was great- ly owing to sleeping in large well aired chambers, three stories from the ground. The airing of apartments should not be neglected, even in win- ter, as fires alone are not sufficient to carry off the corrupted air. If possible, we should not sit through the day in a room in which we have slept; as the bed clothes, and particularly feather beds, very slowly part with the exhalations they have imbibed during the night. It farther deserves to be remarked, that all damp va- pors are prejudicial ; hence, keeping wet clothes in dwelling rooms; should by all means be carefully avoided. OF FOOD. For this the watchful appetite was given, Daily with fresh materials to repair This unavoidable expense of life, This necessary waste of flesh and blood. Hence the concoctive powers, with various art, Subdued the cruder aliments to chyle ; The chyle to blood : the foamy purple tide To liquors, which through finer arteries To different parts their winding course pursue ; To try new changes, and new forms put on, Or for the public, or some private use.—Armstrong. Nature not only points out the food fit for infancy, but kind- ly prepares it. When the babe, just born into this cold world, is applied to its mother's bosom, it is first agreeably affected by warmth ; next it is delighted with the odor of the milk; then grat- ified by the flavor of it; afterwards the appetites of hunger and of thirst afford pleasure by the possession of their objects, and by the subsequent digestion of the aliment; and lastly, the sense of touch is delighted by the softness and smoothness of the milky fountain, which the innocent embraces with its hands, presses with its lips, and watches with its eyes. Satisfied, it smiles at the enjoyment of such a variety of pleasures. It feels an animal attraction, which is love ; a gratification when the object is present, a desire when it is OF PRESERVING HEALTH. 73 absent, which constitutes the purest source of human felicity, the cordial drop in the otherwise vapid cup of life, overpaying the fond mother for all her solicitudes and cares. Lo ! at the couch where infarit beauty sleeps. Her silent watch the mournful mother keeps ; She, while the lovely babe unconscious lies, Smiles on her sluinb'ring child with pensive eyes, And weaves a song of melancholy joy.—Campbell. A mother who abandons the fruit of her womb, as soon as it is born, to the sole care of a hireling, hardly deserves that tender ap- pellation. Nothing can be so preposterous and unnatural, as a mo- ther abandoning the care of her child. If we search Nature throughout, we cannot find a parallel. Every other animal is the nurse of its own^^fspring, which thrives accordingly. Connubial fair ! whom no fond transport warms, To lull your infant in maternal arms; Who, Mest in vain with tumid bosom, hear His tender wailing with unfeeling ear ; The soothing kiss, and milky rill deny To the sweet pouting lip, and glist'ning eye! Ah! what avails the cradle's damask roof, The eider bolstervand embroider'd woof! Oft hears the gilded coach, unpity'd plains ; And many a tear the tassell'd cushion stains! No voice so sweet attunes his cares to rest, So soft no pillow, as his mother's breast!—Darwin. It is in infancy and early age, that the foundation is laid for the many diseases arising from indigestion, found in almost every fami- ly. If children be fed immoderately, the first passages become too much distended, and the stomach, by degrees, acquires an unnatur- al craving for food, which must be satisfied, whatever be the con- sequence. These excessive supplies are not only unnecessary, but produce the most serious and fatal disorders.—There is a certain relation subsisting between what is taken in, and what is lost by the body. If we eat and drink much, we likewise lose much, without gaining any more by it than we might do by moderate meals. Eat- ing too much retards the growth, and eventually diminishes the di- gestive power of the stomach. Nature is easily satisfied, and, is always best provided if we do not obtrude upon her more than she is accustomed to. If we have, for some time, taken little nourish- ment, nature becomes so habituated to it, that we feel indisposed as soon as the usual measure is transgressed ; and both the stomach and its digestive powers are thereby impaired. It would be impossible to lay down fixed rules, whereby to deter- mine the salubrity or insalubrity of aliments; with respect to the in- dividual. Experience is, indeed, our chief guide upon this subject; for, such is the peculiarity of constitutions, that the same article which 10 I 74 ON HYG1EINE, OR THE ART will nourish and perfectly agree with one person, would prove, high- ly pernicious to another. Let us,itherefore, in the selection of our food, adopt that which long and careful observation has confirmed to be salutary, and avoid those things, however tempting to the pa- late, which we know to be injurious. There are, however, articles of diet obviously improper to every one; which, though they may not manifest their ill effects imme- diately, yet, nevertheless, undermine and break down by gradual operation, the vigor of our systems, and entail upon us, with cer- tainty, a train of chronic disorders, of all others the most trouble- some and difficult to cure. The articles of this description are all high-seasoned dishes, and those which are composed of a great va- riety of ingredients. People in health require no excitement to the relish of good and whole some meat; and to those in the opposite state, the luxuries of the table are poison. '• The sad effects of luxury are these : We drink our poison, and we eat disease. Not so, O Temperance bland; when ruled by thee, The brute's obedient, and the man is free: Soft are his slumbers, balmy is his rest, His veins not boiling from the midnight feast, 'Tis to thy rules, bright Temperance ! we owe All pleasures which from strength and health can flow ; Vigor of body, purity of mind, Unclouded reason, sentiments refined ; Unmix'd, untainted joys, without remorse, The intemperate sensualist's never-failing curse.—Dodd. There are three kinds of appetite: first, the natural appetite— which is equally stimulated and satisfied with the most simple dish, as with the most palatable ; secondly, the artificial appetite, or that excited by bitters, spirits, pickles, and other condiments, which re- main only as long as the operation of these stimulants continues; thirdly, the habitual appetite, or that by which we accustom our- selves to take victuals at certain hours, and frequently without any appetite. Longing for a particular food is likewise a kind of false appetite. By the true and healthy appetite, alone, can we ascertain the quantity of aliment proper for the individual. If, in that state, we no longer relish a common dish, it is a certain evidence of its disa- greeing with our digestive organs. If, after dinner, we feel our- selves as cheerful as before it, we may be assured that we have tak- en a proper meal; for, if the proper measure be exceeded, torpor will ensue, with indigestion, and a variety of unpleasant complaints. When the tired glutton labors through a treat, ■ He finds no relish in the sweetest meat. The,n hear what blessings Temperance can bring, Those blessings, only, form my cause to sing : OF PRESERVING HEALTH. 75 First Health—the stomach cramm'd from every dish, A tomb of roast and boil'd, of flesh and fish, Where bile and wind, and phlegm and acid jar. And all the man is one intestine war, Remembers well the school-boy's simple fare, The temperate sleeps, and spirits light as air.—Pope. A decent well-furnished and hospitable table, is very commenda- ble in those who can afford it. It speaks the greatness of their minds, the goodness of their natures, and gains the blessings of the poor and needy, where they are charitably allowed to come in for a share ; but, when feasting runs into excessive luxury and vain ex- pense, it reproaches the author of it with prodigality and folly ; for no money can be so truly said to be thrown away, as that which is superfluously spent upon the belly. It was a maxim of Socrates, " that we ought to eat and drink to live, and not to live in order to eat and drink." Temperance is the preservation of the dominion of soul over sense, of reason over passion. The want of it destroys health, fortune, and conscience. Chremes, of Greece, though a young man, was very infirm and sickly, through a course of luxury and intemperance ; and subject to those strange sorts of fits which are called trances. In one of these, he thought that a philosopher came to sup with him ; who out of all the dishes served up at the table, would only eat of one, and that the most simple; yet his conversation was sprightly, his knowledge great, his countenance cheerful, and his constitution strong. When the philosopher took his leave, he invited Chremes to sup with him at a house in the neighborhood ; which also took place in his ima- gination ; and he thought he was received with the most polite and affectionate tokens of friendship; but was greatly surprised, when supper came up, to find nothing but milk and honey, and a few roots dressed up in the plainest manner, to which cheerfulness and good sense were the only sauces. As Chremes was unused to this kind of diet, and could not eat, the philosopher ordered another table to be spread more to his taste ; and immediately there succeed- ed a banquet composed of the most artificial dishes that luxury could invent, with great plenty and variety of the richest and most intox- icating wines.—These, too, were accompanied by damsels of the most bewitching beauty. And now Chremes gave a loose to all his ap- petites ; and every thing he tasted raised ecstacies beyond what he had ever known. Their charms enchanted the enraptured guest, already heated with what he had drunk. His senses were lost in ecstatic confusion. Every thing around him seemed Elysium, and he was upon the point of indulging the most boundless freedom ; when lo ! on a sudden, their beauty, which was but a visor, fell off, and discovered to his view forms the most hideous and forbidding imaginable. Lust, revenge, folly, murder, meagre poverty, and frantic despair, now appeared in the most odious shapes, and the place instantly became the direct scene of misery and desolation. 76 ON HYGIEINE, OR THE ART How often did Chremes wish himself far distant from such diaboli- cal company ! and,how dread the fatal consequences which threat- ened him on every side ! His blood ran chill to his heart; his knees smote against each other with fear; and joy and rapture were turned into astonishment and horror.—When the philosopher perceived that this scene had made a sufficient impression on his guest, he thus addressed him : " Know, Chremes, it is I, Esculapi- us, who has thus entertained you ; and what you have here beheld, is the true image of the deceitfulness and misery inseparable from luxury and intemperance.—Would you be happy, be temperate. Temperance is the parent of health, virtue, wisdom, plenty, and of every thing that can render you happy in this world, or the world to come. It is, indeed, the true luxury of life; for without it life cannot be enjoyed." This said, he disappeared ; and Chremes awaking, and instructed by the vision, altered his course of life, became frugal, temperate, industrious; and by that means so mend- ed his health and estate, that he lived without pain to a very old age ; and was esteemed one of the richest, best, and wisest men in Greece. Such is the beautiful moral drawn by the pen of elegant and in- structive fiction ; with which, if there be any mind so insensible as not to be properly affected, let us only turn to that striking reality presented to us in the case of Lewis Cornaro. This gentleman was a Venetian of noble extraction, and memorable for having lived to an extreme old age; for he was above a hundred years old at the time of his death, which happened at Padua, in the year 1565. Amongst other little performances, he left behind him a piece enti- tled, " Of the advantages of a temperate life," of which we will here give our readers some account; not only because it will very well illustrate the life and character of the author, but may possibly be of use to those who take the summum bonum, or chief good of life, to consist in good eating. He was moved, it seems, to com- pose this little piece at the request, and for the benefit of some in- genuous young men, for whom he had a regard ; and who, having long since lost their parents, and seeing him, then eighty-one years old, in a fine florid state of health, were desirous to know of him, what had enabled him to preserve, as he did, a sound mind, in a sound body, to so extreme an age. He describes to them, therefore, his whole manner of living, and the regimen he had always pursued, and was then pursuing. He tells them that, when he was young, he was very intemperate; that his intemperance had brought upon him many and grievous disorders; that from the thirty-fifth to the fortieth year of his age, he spent his nights and days in the utmost anxiety and pain; and that, in short, his life was grown a burden to him. The physicians, however, as he relates, notwithstanding all the vain and/ fruitless efforts which they had made to restore his health, told him that there was one method still remaining which had never been tried, but which, if they could but prevail with him OF PRESERVING HEALTH. i i to use with perseverance, might free him, in time, from all his com- plaints ; and that was a temperate and regular way of living. They added, moreover, that unless he resolved to apply instantly to it, his case would soon become desperate, and there would be no hopes at all of his recovery. Upon this, he immediately prepared him- self for his new regimen ; and now began to eat and drink nothing but what was proper for one in his weak habit of body : but this was, at first, very disagreeable to him. He often wanted to live again in his old manner; and did, indeed, indulge himself in a freedom of diet sometimes, without the* knowledge of his physi- cian ; but, as he informs us, much to his own detriment and uneasi- ness. Driven, in the mean time, by the necessity of the thing, and resolutely exerting all the powers of his understanding, he at last grew confirmed in a settled and uninterrupted course of tem- perance ; by virtue of which, as he assures us, all his disorders had left him in less than a year: and he had been a firm and healthy man, from thenceforward, till the time in which he wrote his trea- tise. Some sensualists, as it appears, had objected to his abstemious manner of living; and in order to evince the reasonableness of their own, had urged that it was not worth while to mortify one's appe- tites at such a rate for the sake of being old, since all that was life, after the age of sixty-five, could not properly be called a living life, but a dead life. " Now," says he, " to show these gentlemen how much they are mistaken, I will briefly run over the satisfactions and pleasures which I myself enjoy in this eighty-third year of my age. In the first place, I am always well, and so active, withal, that I can, with ease, mount a horse upon a flat, or walk upon the tops of very high mountains. In the next place, I am always cheerful, pleasant, perfectly contented, and free from all perturbation, and ev- ery uneasy thought. I have none of that fastidium vitce, that satiety of life, so often to be met with in persons of my age. I take a view of palaces, gardens, antiquities, public buildings, temples, fortifica- tions, and endeavor to let nothing escape me which may afford the least amusement to a rational mind. Nor are these pleasures at all blunted by the usual imperfections of great age ; for I enjoy all my senses in perfect vigor ; my taste especially, in so high a degree, that I have a better relish for the plainest food now, than I had for the choicest delicacies formerly, when immersed in a life of luxury." As a principal rule of diet, we ought to take food with an easy and serene mind, and to eat slowly. The stomach suffering in this case a very gradual distention, as the food has sufficient time to be duly prepared by mastication. To eat of one dish only seems most conformable to nature, and is doubtless, the means of procuring the most healthy fluids. The diet ought not only to be such as is best adapted to the con- stitution, but likewise to be taken at regular periods; for long fast- ing is hurtful at any stage of life. All great and sudden changes. 7.9 ON HYGIEINE, OR THE ART of diet are universally dangerous, particularly from a rich and full diet to a low and sparing one. When, therefore, a change becomes necessary, it ought always to be made by degrees. When a person has suffered so much frorn extreme hunger, much food must not be given at once. By full feeding, thousands long starved at sea have been destroyed at once. Such persons should be supplied with liquid food, and that sparingly. As soon as the food has entered the stomach, the important of- fice of digestion begins. The vigor of the organs exerted on this occasion, ought certainly not to be abridged by violent exercise; but muscular and robust people feel no inconvenience from gentle motion about one hour after the heaviest meal. But as the whole process of digestion is of much longer duration than is generally imagined, the afternoon hours cannot be employed so advantageous- ly to health in any labor requiring strong exertions. In violent exercise, or an increased state of perspiration, the flu- ids are propelled to the external parts, and withdrawn from the sto- mach, where they are indispensable to assist the proper concoction. Exclusive of the quantity and quality of food, great attention is due to the kind of it in particular constitutions. Animal food in general is more nourishing than vegetable, and, when fresh, is like- wise more easy of digestion. On this account, it generally agrees best with delicate and weak constitutions. But the flesh of young animals, with a proportionate quantity of well boiled and wholesome vegetables, is the best diet adapted to our system. In summer it is advisable to increase the proportion of vegetable food, and to make use of ripe fruit. With regard to our food, however, in quantity and quality, it should be proportion- ed to our exercise. The laborer, who is perpetually toiling from morning to night, could not subsist on food appropriated to those who pursue not the severer exercises of the body. His diet must be of the coarser kind ; such as salted meats or fish, cheese, corn bread, potatoes, onions and peas, and these in pretty large quanti- ties. On the whole, it will be found to be the safest, both in health and sickness, to regulate our diet with simplicity ; ever bearing in mind that a preference is to be given to such articles as our personal knowledge has demonstrated to be the most congenial to our con- stitutions and habits. In our aliment, an essential part is drink, the use of which is in- dispensable to the digestion of food. Water, the basis of our drinks, should be carefully obtained in its highest purity. The best water is that which is pure, light, and without any particular color, taste, or smell. Where water cannot be obtained pure from springs, wells, rivers, or lakes, care should be taken to deprive it of its pernicious qualities, by boiling and fil- tering, but most effectually by distillation. Any putrid substan- ces in the water may be corrected by the addition of an acid. OF PRESERVING HEALTH. 79, Thus half an ounce of alum, in powder, will make twelve gallons of corrupted water pure and transparent in two hours, without im- parting a sensible degree of astringency. Charcoal powder has also been found of great efficacy in checking the putrid tendency of water. To the same purpose, vinegar and other strong acids, are well adapted. Whatever kind of drink is used, it ought to be taken always in a moderate quantity. Too much drink, even of water, innocent as it is, tends to oppress and weaken the stomach, of course to ge- nerate acidities and flatulence. Some advise us never to drink without eating something, but he who drinks only when nature requires it, has no occasion to eat eve- ry time he drinks. Persons, on the contrary, once accustomed to drink more than is necessary, or to make use of hot, stimulating, and intoxicating liquors, would do well always to eat some bread, or other solid food, along with them. An undue proportion of drink renders the mass of blood too thin and watery, and occasions a general debility of the body. On the other hand, too little drink renders the blood thick and viscid, and weakens the digestive powers. Light and well fermented beer, is a wholesome, and, at the same time, diluent species of nourishment. Cider, when properly fermented and pure, is also a pleasant and wholesome liquor. On the contrary, when it is new or tart, we cannot recommend it as a salubrious beverage. Wine, when pure, and used in moderation, certainly conduces to health, especially in weak and languid habits. See Vine, Mat. Med. Ardent spirits, when properly diluted, are likewise an excellent beverage and antiseptic. These liquors are of considerable service in preventing the bad effects of a moist and cold atmosphere, pes- tilential vapors, damp military camps, unclean occupations, and, occasionally too, of a temporary abstinence from food. But as the infusion of too great a quantity of oil immediately ex- tinguishes the lamp, the light of reason, and the lamp of life itself, are frequently suffocated, and put out for ever, by an imprudent use of either wine or spirits. Tea is considered by some as being highly injurious, while oth- ers have either asserted its innocence, or even ascribed to it extra- ordinary virtues. When taken in a large quantity, or very strong, and at a late hour, it often produces watchfulness; but if used in moderation, it greatly relieves an oppressed stomach, and pains of the head. It ought, however, to be made of a moderate strength, otherwise, it certainly affects the nerves. Hypochondriac and hys- teric people are much deceived in their opinions of the efficacy of tea; for all the evils arising from weak stomachs and flatulency, of which they complain, are certainly increased by tea, especially if taken in large and strong quantities. The cold stomach which they propose to warm by it, is a mere phantom of the brain; for the 80 ON HYGIEINE, OR THE ART sensation of cold, is nothing but relaxation, which, instead of be- ing removed by hot liquors, is assuredly increased by them. Coffee promotes digestion, and exhilarates the animal spirits ; but an excessive use of it like tea, affects the nerves, occasions watch- fulness, and trembling of the hands. As possessing excellent anti- spasmodic virtues, it is a favorite beverage with the hypochondriac and hysteric. Chocolate is nutritious and wholesome, if taken in small quanti- ty ; but to the corpulent and weak, particularly those with whom a vegetable diet disagrees, it is generally hurtful. OF EXERCISE. ****** j»v health the peasant's toil Is well repaid, if exercisP'were pain Indeed, and temperance pain. By arts like these Laconia nursed of old her hardy sons: And Rome's nnconquercd legions urged their way Unhurt, through eveiy toil and every clime. Toil and be strong. By toil the flaccid nerves Grow firm, and gain a more compacted tone ; The greener juices are by toil subdu'd, Mellowed, and subtiliz'd ; the vapid old Expell'dand all the rancor of the blood. Begin with gentle toils, and, as your nerves Grow firm, to hardier by just steps aspire. The prudent, even in every moderate walk, At first but saunter, and by slow degrees, Increase their pace. This doctrine of the wise, Well knows the masterof the flying steed.—Armstrong. It was a common saying among the ancients, that acute diseases are from heaven, and chronic from ourselves. To die, says Dr. Johnson, is the fate of man ; but to die with lingering anguish, is generally his own folly. Inactivity never fails to induce a universal relaxation of the contractile fibres. When these fibres are relaxed, neither the digestion, the circulation, nor the peristaltic motion can be duly performed. It is absolutely impossible to enjoy health where the perspiration also is not duly carried on ; and that can never be the case, where exercise is neglected. Indolence often originates from a mistaken education, in which pleasure or flattery is made the immediate motive of action, and not future advantage, or what is termed duty. This observation is of great value to those who attend to the education of their own children. I have seen, says Dr. Darwin, one or two young married ladies of fortune, who perpetually became uneasy, and believed themselves ill, a week after their arrival in the country, and contin- ued so uniformly during their stay; yet, on their return to London or Bath, immediately lost all their complaints. I was led to ascribe this to their being surrounded in infancy with menial attendants, OF PRESERVING HEALTH. 81 who had flattered them into the exertions they then used; and that, in riper years, they became torpid for want of this stimulus, and could not amuse themselves by any voluntary employment; requiring, ever after, either to be amused by other people, or to be flattered into activity. Dr. Johnson says, " Whenever chance brings within my obser- vation a knot of young ladies, busy at their needles, I consider my- self as in the school of virtue ; and though I have no extraordina- ry skill in plain work or embroidery, I look upon their operations with as much satisfaction as the governess, because I regard them as providing a security against the most dangerous ensnarers of the soul, by enabling themselves to exclude idleness from their solitary moments, and with idleness, its attendant train of passions, fancies, chimeras, fears, sorrows, and desires." If sedentary employments be intermixed with a due quantity of exercise, they will never injure health. Weak fibres are the constant companions of inactivity. No- thing but daily exercise in the open air can brace and strengthen the powers of the stomach, and prevent an endless train of diseases, which proceed from a relaxed state of that organ. We seldom hear the active and laborious complain of nervous diseases; which are reserved for the sons of idleness. ****** How happy he whose toil Has o'er his languid powerless limbs diffused A pleasing lassitude. He not in vain Invokes the gentle deity of dreams. By toil subdued, the warrior and the hind Sleep fast and deep.—Their active functions soon With generous streams their subtile tubes supply Ere morn, the tonic irritable nerves Feel the fresh impulse and awake the soul.—Armstrong. Idleness is a servile, weak and degenerate habit; that of the mind being worse than that of the body. A gentleman states, that, as he was sitting with some friends be- fore the door of the Capitol, a beggar presented himself, who with sighs, tears, and lamentable gestures, expressed his miserable pov- erty, saying withal, that he " had about him a private disorder, which shame prevented him from discovering to the eyes of men. They, pitying the case of the poor man, gave each of them some- thing, and he departed. One amongst them sent his servant after him, to inquire what his private infirmity might be, which he was , loth to discover ? The servant overtook him ; and desired the sat- isfaction ; and having diligently viewed his face, breast, arms, &c. \ and finding all his limbs in good plight, " I see nothing," said he, ] " whereof you have any such reason to complain." " Alas!" said , the beggar, " the disease that afflicts me is far different from what ij you conceive of, and is such as you cannot see. It is an evil that has crept over my whole body; passing through the very veins and 11 82 ON HYGIEINE, OR THE ART marrow of me, in such a manner, that no one member of my body is able to take proper exercise, or do any work. This disease by some is called idleness." The servant having left him, returned with this account; which not a little amused his master and friends. As idleness is the rust and bane of all human virtues, so, on the contrary, industry and diligence in business are conquerors of all difficulties ; sweetening labor and pains, and giving satisfaction as well as profit, in the accomplishment of what is undertaken. When men work at their play, and play with their work, they invert the order of nature, as well as the Divine command, and must expect in the sequel to come home by Weeping Cross, because they have labored in vain, and played the fool with themselves in neg- lecting to secure to themselves a comfortable subsistence. Among the Athenians and ancient Romans, there was a law exacting an ac- count from every man how he maintained himself and family; and if unable to give a satisfactory answer, he was immediately ba- nished with reproach, as a vermin that devoured what he had no right to, in being an unprofitable excrescence, contributing nothing towards the tranquillity of the public. A gentleman possessed of an estate of about two hundred pounds per annum, in land, kept the whole a great while in his own hands; but finding, notwithstanding all his care and industry, that he still run behind hand, and at length obliged to sell half his estate to pay his debts, let the rest to a farmer by lease for twenty-one years, at an annual rent. His tenant thriving, and coming before the ex- piration of the lease, to pay his rent, he asked his landlord, " if he would sell the land he rented of him r" " Why," said he, " wouldst thou buy it ?" " Yes," said the farmer, " if you will part with it." " That is very strange," said the landlord. " Prithee tell me how it is, that I could not live upon twice so much being my own, and you upon half of it, though you pay rent for it, are able in less than twenty years to buy it ?" " O sir," said the far- mer, " a few words make the difference. When any thing was to be done, you said, ' Go and do it,' and lay in bed or took your plea- sure ; but I always said, ' Come, let us go and do it,' and both as- sisted and saw my business done myself." To show the absolute necessity of exercise in cold climates, we cannot omit relating the botanical excursion of Sir Joseph Banks, Dr. Solander, and others, on the heights of Terra-del-Fuego. Dr. Solander, who had more than once crossed the mountains dividing Sweden from Norway, well knowing that extreme cold produced a torpor and sleepiness almost irresistible, conjured the company to keep always in motion, whatever pain it might cost them, and what- ever relief they might be promised by rest.' " Whoever sits down," said he, " will sleep, and whoever sleeps will wake no more." Thus at once admonished and alarmed, they set forward, but while they were still upon the naked rock, and before they got among the bushes, the cold was so intense, as to produce the effects that had OF PRESERVING HEALTH. 83 been most dreaded. Dr. Solander, himself, was the first who found the inclination, against which he had warned others, irresistible ; and insisted upon being suffered to lie down. Sir Joseph Banks en- treated and remonstrated with him in vain ; down he lay upon the ground, though it was covered with snow; and it was with great difficulty that his friends kept him from sleeping. One of his black servants also began to linger. Partly by persuasion, and part- ly by force, the company made them go forward. Soon, however, \ they both declared, " they would go no farther." Sir Joseph Banks had recourse again to expostulation, but this produced no effect. When the black was told that if he did not go on, he would in a short time be frozen to death, he answered that he desired nothing so much as to lie down and die. The Doctor did not so explicitly renounce his life ; saying, he could go on, but that he must first take " some sleep," though he had before told the company, that "to sleep was to perish." Both in a few minutes fell into a pro- found sleep. After considerable exertions they happily succeeded in waking the Doctor, who had almost lost the use of his limbs, and the muscles were so shrunk, that his shoes fell from his feet; but every attempt to relieve the unfortunate black proved unsuccessful. Since we have touched upon the subject of cold, we cannot for- bear inserting the observations of the immortal Darwin. Animal bodies resist the power of cold probably by their exer- tions : but if these increased exertions be too violent, so as to ex- haust the power of the brain, the animal will probably sooner perish. Thus the moderate quantity of wine or spirit, repeated at proper intervals of time, might be of service to those who are long expos- ed to excessive cold, both by increasing the action of the capillary vessels, and thus producing heat, and, perhaps, by increasing in some degree the secretion of sensorial power in the brain. But the contrary must happen when taken immoderately, and not at due intervals. A well attested story was once related to me of two men, who set out on foot to travel in the snow, one of whom drank two or three glasses of brandy before they began their journey, the oth- er contented himself with his usual diet and potation : the one pe- rished, in spite of every assistance his companion could afford him, and the other performed his journey with safety. In this case the power of the brain was exhausted by the unnecessary motions of incipient intoxication by the stimulus of the brandy, as well as by the exertions of walking, which so weakened the dram-drinker, that the cold sooner destroyed him ; not having power to produce suffi- cient muscular, or arterial action, and in consequence sufficient heat to supply the great expenditure of it. Hence the capilla- ries or smaller vessels of the skin, first ceased to act, and became pale and empty; next those which are immediately associated with them ; as the extremities of the pulmonary artery, as happens on going into the cold bath. By the continued inaction of these parts of the vascular system, the blood becomes accumulated in the in- 84 ON HYGIEINE, OR THE ART ternal arteries, and the brain is supposed to be affected by its com- pression; because these patients are said to sleep, or to become apo- plectic, before they die. Travellers, benighted in deep snow, might frequently save them- selves by laying down on the dry ground, and suffering themselves to be entirely covered with the snow, except a small hole for air. The ground being usually at the 40th degree of cold, that is, eight degrees above freezing, and the snow in contact with their clothes, thawing and contracting into the snow next to it, would form above them a close, dry coverlet, that would perfectly exclude the external cold, and place them in a situation almost as warm as a bed ! My reverend and worthy friend, Dr. Andrew Hunter, of Wash- ington, overcome with the fatigues of a long day's march, during the revolutionary war, threw himself down with the rest of the army, on the cold frozen ground. His only cover was a blanket, and a saddle his pillow. Instantly his wearied senses were locked up in sleep so sound, that he never felt the cold snow, which presently began to fall in heavy flakes upon him. Next morning when he awoke, he was astonished at his situation—a heavy fall of snow a foot deep had completely covered him, through which the heat of his breath, melting the snow as it fell, had formed a nice opening. Having raised his head, and seeing his comrades still asleep, he laid himself down to enjoy a little longer his singular bed, which he de- clared was very pleasant. If these facts were more generally known, they might save the lives of many valuable citizens. !. OF SLEEP. The shades descend, and midnight o'er the world Expands her sable wings. Great Nature droops Through all her works. Now happy he whose toil Has o'er his languid powerless limbs diffused A pleasing lassitude : He not. in vain Invokes the gentle Deity of dreams His powers the most voluptuously dissolve In soft repose: on him the balmy dews Of sleep with double nutriment descend.—Armsth ong. " Tired Nature's sweet restorer, balmy sleep," cannot be dispens- ed with. It introduces a most welcome vacation, both for the soul and the body. The exercises of the brain and the labors of the hands, are at once discontinued ; so that the weary limbs repair their exhausted vigor, while the pensive thoughts drop their load of sorrows, and the busy ones rest from the fatigue of application. Most reviving cordial! equally beneficial to our animal and intellec- tual powers. Since sleep is so absolutely necessary, so inestimably valuable, observe what a fine apparatus Almighty Goodness has made to ac- OF PRESERVING HEALTH. 85 «ompiodate us With the balmy blessing. With how kind a pre- caution he removes whatever might obstruct its access, or impede its influence! He draws around us the curtain of darkness, which inclines to drowsiness, and conceals every object that might too strongly agitate the senses. He conveys peace into our apartments, and imposes silence on the whoie creation. May we not discern in this gracious disposition of things, the tender cares of an affec- tionate Mother, who hushes every noise and excludes every dis- turbance, where she has laid the child of her love to rest ? So, by such soothing circumstances, and gentle working opiates, He giv- eth to his beloved, sleep. No sooner does the morning dawn, and day-light enter the room, than this strange enchantment vanishes. The man awakes, and finds himself possessed of all the valuable endowments which for several hours were suspended or lost. His sinews are braced, and fit for action. His senses are alert and keen. The romantic vi- sionary heightens into the master of reason, and the frozen or be- numbed affections melt into tenderness, and glow with benevolence. *******Q sacre£| rest1 Sweet pleasing sleep ! of all the powers the best; O peace of mind ! repairer of decay ! Whose balms renew the limbs to labors of the day, Care shuns thy soft approach, and sullen flies away.—Dhydew. If sleep do not pay the accustomed visit, the whofe frame of man will in a short time be thrown into disorder; his appetite cease, his spirits dejected, and his mind, abridged of its. slumbering vi- sions, begin to adopt waking dreams. It is in vain that all light is excluded, all sound removed, and books of entertEunment read, the restless and busy mind still retains its former activity, and reason, that wishes to lay down the reins, in spite of herself, is obliged to. maintain them. This is strongly instanced by Shakspeare, in the soliloquy of King Henry. How many thousands of my poorest subjects Are at this hour asleep ! Oh ! gentle sleep, Nature's soft nurse, how have I frighted thee, That thou no more wilt weigh my eye-lids down, And steep my senses in forgetfulness ? Why, rather, sleep, ly'st thou on smoky cribs, Upon uneasy pallets stretching thee, And hush'd with buzzing night-flies to thy slumbers ;, Than in the perfum'd chambers of the great, And lull'd with sounds of sweetest melody 1 O thou dull god, why ly'st thovi with the vile In loathsome beds, and leav'st the kingly couch, A watch-case or a common larum bell? Wilt thou upon the high and giddy mast Seal up the ship-boy's eyes, and rock his brains In cradle of the wild imperious surge ; And in the visitation of the winds, 86 ON HYGIEINE, OR THE ART Who take the ruffian billows by the top, • Curling their monstrous heads, and hanging them, With deaf'ning clamors in the slippery shrouds, That, with the hurley, death itself awakes ? Canst thou, O partial sleep ! give thy repose To the wet sea-boy in an hour so rude ; And in the calmest, and most stillest night, With all the appliances and means to boot, Deny it to a King ? Then, happy low, lie down! Uneasy lies the head that wears a crown. Excess of sleep is not less prejudicial to health than the want of "it. The whole body sinking gradually into a complete state of in- activity, the solid parts become relaxed, the blood circulates slowly, and remains particularly long in the head; perspiration is disorder- ed, the body increases in fat, and rendered incapable of being the medium of mental exertion, the memory is enfeebled, and the un- happy sleeper falls into a lethargic state, by which his sensibility is, in a great measure, destroyed. Sleep, immediately after supper, is apt to occasion the nightmare, or a stagnation of the blood, which, by its pressure, produces the sensation or idea of this troublesome bed-fellow. It is principally the nervous, the debilitated, and those of an impaired digestion, who are visited by such terrific dreams. The proper duration of sleep, in youth and adults, is usually set- tled at six or seven hours; in children and the aged, from eight to nine hours. The more bodily weakness we feel, the more we may indulge in sleep ; provided it be refreshing. If people in a state of health be perfectly cheerful in mind and body, when they awake, this is the most certain criterion that they have slept sufficiently. Though weakly persons may have a disposition to sleep during the day, they ought not to sleep long, since it tends to increase their languor and relaxation. Whether to sleep after dinner be advisable, must be decided by a variety of concurrent circumstances; age, •climate, and the like. However, a sleep after dinner ought never to exceed a half, or one hour at most; and it is also much better sitting, than lying horizontally ; for, in the latter case, we are sub- ject to determinations of the blood towards the head, and conse- quently to headach, and risk apoplexy. In the evening we should eat light food, and not retire to rest till .two or three hours after supper. The mind ought to be serene and cheerful previously to going to rest, and we should then avoid gloomy thoughts ; so that we may as much as possible guard against dreams, which always interfere with the refreshing influences of sleep. Sleep, accompanied either with talking or walking, called som- niloquism and somnambulism, is a transient paroxysm and delirium. When they are induced by an increase of stimuli, whether corporeal or mental, blood-letting, gentle cathartics, vegetable diet, with mo- derate exercise, are the best remedies ; but when they arise from a diminution of customary stimuli, a glass or two of wine, a draught 01' PRESERVING HEALTH. 87 of porter, or a dose of laudanum at bed-time, and a change of air, will generally succeed. The Feather-beds, in which we usually sleep, are certainly not as healthy as mattresses in summer. But, as many individuals have not sufficient resolution to use these, they ought to be particular in having their feather-beds fre- quently shaken and aired. Farther, it is highly improper to sleep in beds overloaded with clothes; they heat the blood more than is consistent with health, and produce an immoderate and enervating perspiration, which still more weakens the organs already relaxed by sleep. The custom of sleeping with the curtains drawn close, is pernicious to health, because the copious exhalations, which then take place, cannot be properly dissipated, and are consequently re- absorbed. It is also very imprudent to cover the head with the bed-clothes. The old and abominable custom of warming the bed, likewise deserves to be condemned ; as it has a direct tendency to produce debility. A spacious and lofty room should always be chosen, if practica- ble, for a bed-chamber, and attention paid to the admission of fresh air, even during the night, in warm weather. Lastly, no candle or fire should be kept burning during the night in a bed-room. ON EVACUATIONS. By subtle fluids pour'd through subtle tubes The natural, vital, functions are performed; By these the stubborn aliments are tamed, The toiling heart distributes life and strength, These the still crumbling frame rebuild.—Armstrong. The evacuations of the body, from its superfluous, impure, and noxious particles, are no less necessary than its nourishment. The same power which changes and assimilates our food and drink, likewise affects the due and timely evacuation of the secretions. It is an object of the first consequence, that nothing remain in the body which ought to be evacuated ; and that nothing be ejected,. which may be of use to its preservation. How many persons do we find who complain of bad health, notwithstanding every atten- tion they pay to air, aliment, exercise, and sleep ; while others en- joy a good state of health, though totally careless with regard to these particulars, and all owing to a difference in the state of evac- uations. If these be disordered, the most rigorous observance of dietetic rules is insufficient to ensure our health ; while, on the con- trary, most of those rules may be neglected, for some time, without any injurious consequences, if the evacuations be regular. Nature removes not only noxious matter, or such as is in a state of corrup- tion, but likewise the useful fluids, if they become superabundant; for instance, the milk, semen, and blood. In such cases, therefore, 88 ON HYGIEINE, OR THE ART these must be considered as objects of evacuation, equally natural and salutary. Nature expels all crude and acrid substances by those three grand emunctories, the kidneys, bowels, and skin ; and accordingly as they are disordered, diseases of different degrees of malignity and duration will necessarily ensue. Nature also frequently relieves herself by more unusual channels; such are the bleeding of the the nose, in plethoric young men ; the hemorrhoids, with which persons of a middle age are sometimes troubled ; the various ulcers common to those whose fluids are in an impure state ; the excre- tions of saliva, and the expectoration of others, &c. By a prema- ture suppression of the troublesome, but salutary efforts of nature, great mischief may be produced to the individual. Many persons perspire much under the arm-pits; others in the hands or feet; others again are subject to eruptions in the face, or different parts of the body : such canals, however, if nature be once accustomed to eject by them certain ill-humors, cannot be sud- \ denly stopped without considerable danger—cleanliness, in the i strictest sense of the word, is almost the only safe remedy to conn- 1 teract their fatal effects. OF THE PASSIONS. Passions, like aliments, though born to fight, Yet mix'd and soften'd, in his work unite, Love, Hope, and Joy, fair Pleasure's smiling train ; Hate, Fear, and Grief, the family of Pain; These mix'd with art, and in due bounds confin'd, Make and maintain the balance of the mind, The lights and shades, whose well accorded strife, Gives all the strength and color to our life.—Pope. Passions are the active forces of the soul: They are its high- est powers, brought into movement and exertion. Like wind and fire, which are instrumental in carrying on many of the beneficent operations of nature, where they rise to undue violence, or deviate from their proper course, their path is marked with ruin: so are the passions either useful or destructive, according to their direction and degree. Yes, yes, dear stoic! hid© it as you can The sphere of pleasure is the sphere of man: This warms our wishes, animates our toil, And forms alike a Newton, or a Hoyle ; Gives all the soul to all the soul regards, Whether she deals in planets, or in cards.—Cawthorm. OF PRESERVING HEALTH. W OF LOVE. Love is a passion by no rule confin'd, The great first mover of the human mind, Spring of our fate ! it lifts the climbing will, Or sinks the soften'd soul in seas of ill; Science, truth, virtue, sweetness, glory, grace, All are love's influence, and adorn his race, Love, too, gives fear, despair, grief, anger, strife, And all the unnumber'd woes which tempest life.—Hill. Love, the most universal and grateful passion of the heart, is not only conducive to health, but contributes greatly to the happiness of every society in which it is introduced. A warm and recipro- cal affection, between two virtuous lovers, may be considered the sweetest charm of life. Where friendship full exerts her softest power, Perfect esteem enlivened by desire, Ineffable, and sympathy of soul; Thought meeting thought, and will preventing will, With boundless confidence: for naught but love Can answer love, and render bliss secure. * * * * What is the world to them, Its pbmp, its pleasure, and its nonsense all! Something than beauty dearer, should.they look Or on the mind, or mind-illumin'd face ; Truth, goodness, honor, harmony, and love, The richest bounty of indulgent Heaven, Mean time a smiling offspring rises round, And mingles both their graces. By degrees, The human blossom blows; and every day, Soft as it rolls along, shows some new charm, The father's lustre, and the mother's bloom.—Thompson. Love arises from a desire of what is beautiful and fair, and is de- fined to be an action of the mind, desiring that which is good. No one loves before he is delighted with the object, let it be what it will, by which means it becomes pleasing in our eyes, and begets a value and esteem in our affections. This amiable passion in ma- ny respects is very wonderful and unaccountable; it is of such power in its operation that it has often taken the diadem from kings and queens, and made them stoop to those of obscure birth and mean fortune. It wrests the sword out of the conqueror's hand, and makes him a captive to liis slave. It has such a variety of snares to entangle the most wary, that few have at one time or oth- er escaped them. Eginardus was secretary of state to Charlemagne, and having placed his affections much higher than his condition admitted, made love to one of fhs daughters, who seeing this man of a brave spirit, and a suitable grace, thought him not too.' low for her, seeing merit had so eminently raised him above his birth. She loved him, and 12 90 ON HYGIEINE, OR THE ART gave him free access, so far as to suffer him to laugh and sport in her chamber on evenings, which ought to have been kept as a sanc- tuary where relics are preserved. It happened in a winter's night, Eginardus, ever hasty in his approaches, but negligent about return- ing, had somewhat too long continued his visit; and in the mean time a snow had fallen, which troubled them both. He feared to be betrayed by his feet, and the lady was unwilling that such prints should be found at her door. Being much perplexed, she did an act for her lover, very unusual for the daughter of one of the greatest men upon earth. She took the gentleman upon her shoulders, and carried him all the length of the court to his chamber, he never setting a foot to the ground, so that the next day no impression might be seen of his footing. It happened that Charlemagne watch- ed at his study this night, and hearing a noise, opened the window -t and perceived this pretty prank, at which he could not tell whether it were best to be angry or to laugh. The next day in a great as- , sembly of lords, and in the presence of his daughter and Eginardus, he asked what punishment that servant was worthy of, who made j use of a king's daughter as a mule, and caused himself to be carried 1 on her shoulders in the midst of winter, through night, snow, and all ^ the sharpness of the season. Every one gave his opinion, and not one but condemned that insolent man to death. The princess and secretary changed color, thinking nothing remained for them but to be flayed alive. But the Emperor, looking on his secretary with a smooth brow, said, " Eginardus, hadst thou loved the princess my daughter, thou oughtest to have come to her father, the dis- poser of her liberty ; thou art worthy of death, but I give thee two lives at present; take thy fair portress in marriage, fear God, and love one another." Though the female be the weaker sex, yet some have so repaid the weakness of their nature by an incredible strength of affection, that they have often times performed as great things as we could expect from the courage and constancy of the most generous amongst men. They have despised death, in whatever shape, and made all sorts of difficulties give way before its invincible force, which seemed proud to show itself most strong, in the greatest ex- tremity of their husbands. Arria, the wife of Cecinna Psetus, understanding that her husband was condemned to die, and that he was permitted to choose the manner of his death, went to him, and having exhorted him to de- part this life courageously, and bidding him farewell, gave herself a stab into the breast with the knife she had hid for that purpose un- der her clothes; then drawing the knife out of the wound, and reaching it to Psetus, she said, " Vulnus, quod feci, Psete, non dolet, sed quod tu facies :" The wound I have made, Pcetus, smarts not; but that only which thou art about to give thyself." Where- upon Martial wrote the following epigram :— OF PRESERVING HEALTH. 91 When Arria to her husband gave the knife, Which made the wound whereby she lost her life, " This wound, dear Partus, grieves me not," quoth she, " But that which thou must give thyself grieves mc." Happy they! the happiest of their kind, Whom gentler stars unite, and in one fate Their hearts, their fortunes, and their beings blend. 'Tis not the coarser tie of human laws Unnat'ral oft, and foreign to the mind, That binds their peace, but harmony itself Attuning all their passions into Love.—Thompson. " It is this," says Lavater, " which has sweetened every bitter of my life; this has alone supported me, when the sorrows of a wound- ed heart wanted vent. When my best endeavors were rejected, ; when the sacred impulse of conscious truth was ridiculed, hissed at and despised, the tear of sorrow was ever wiped away by the gentle, tender, and affectionate address of a female mind, who has an aspect like that of unpractised virginity, which felt, and was en- gf abled to efface each emotion, each passion in the most concealed |r feature of her husband's countenance, and by endearing means, t without what the world would call beauty, always shone forth in $* countenance heavenly as an angel." Serene in virgin modesty she shines, And unobserv'd the glorious orb declines. Oh, blest with temper, whose unclouded ray Can make to-morrow cheerful as to day : She who ne'er answers till a husband cools, Or, if she rules him, never shows she rules; Charms by accepting, by submitting sv/ays, Yet has her humor most when she obeys.—Pope. How delightful that sentiment, which, even in advanced life, in- spires a passion, perhaps, more profound than it excites even in youth; a passion which collects into the soul all that time has rob- bed from the senses, and stripping life, in its last stages, of all gloom, unsociability and indifference, secures us the happiness of meeting death in those arms which sustained our youth, and entwin- ed us in the ardent embraces of love. O the sweet powerful influences of love! It is this that unites the interests as well as the hearts of lovers, and gives to each the joys and felicities of the other. And it is this iwhich induces the deli- cate lady to forget better days, and to smile in poverty, and toil with the husband whom she loves. What charm then under Hea- ven can excel this noble passion ? No pleasures are comparable to those that affect the heart, and there are none that affect it with such exquisite delight, as loving and being beloved by a worthy ob- ject. Ask the husband who is blest with an amiable wife, and he will tell you that the most delicious feelings his heart ever experien- ced were those of virtuous love. 9:> ON HYGIEINE, OR THE ART Go, gentle gales, and bear my sighs along! The birds shall cease to tune their evening song; The winds to breathe, the waving woods to move, And streams to murmur, ere I cease to love.—Pope. Some angry poets spit all their venom against loving husbands; but it in no way depreciates virtue. Virtue, the strength and beauty of the soul, ft pleases and it lasts; a happiness That even above the smiles and frowns of fate Exalts great nature's favorite ;—a wealth That ne'er encumbers, nor to baser hands Can be transferred; it is the only good Man justly boasts of, or can call his own.—Armstrong. A Neapolitan, being at work in a field bordering upon the sea- side, his wife being some distance from him, was seized by some corsairs of Tunis, and carried on board their vessel. Missing his wife, and seeing a ship at anchor, he soon conjectured what the mat- ter was, and throwing himself into the sea, swam to the ship, tell- ing the captain, " He was come to take the same fate with his wife ; for though he understood the hardship and misery he must under- go in slavery, his love had conquered all difficulties, he neither could nor would live but with her." The Turks, admiring the man's unaccountable affection, at their return told it to the King of Tunis, who pleasing himself with so singular an example of love and constancy, gave them both their liberty. Ble'ss'd is the maid, and worthy to be blessed, Whose soul, entire by him she loves possess'd, Feels every vanity in fondness lost; And'asks no power but that of pleasing most: Her's is tie bliss, in just return, to prove The honctt warmth of undissembled love; For her iaconstant man might cease to range, And eratUude forbid desire to change. Love is a vice only in vicious hearts. Fire, though the purest of all substances, will yet emit unwholesome and noxious vapors when it is fed by tainted matter; so love, if it grow in a vicious mind, produces nothing but shameful desires and criminal designs, and is followed with pain, vexation, and misery. But let it rise in an up- right heart, and be kindled by an object adorned with virtue; it is safe from censure. Love, studious how to please, improves our parts With polished manners, and adorned with arts. It kindles all the soul with honor's fire; Curbs and restrains extravagant desire, And to be chaste and kind does still conspire, A just heroic passion, that can find No room in any base degenerate mind.—Drvdf.n. 0E PRESERVING HEALTH. 93 In propitious love the heart beats with joy ; vivacity cheers the countenance, the eye is brilliant, society is courted, and all the be- nevolent affections are indulged. But disappointed love, on the other hand, is extremely detrimental. It depresses the spirits, en- feebles digestion, takes away the appetite, banishes sleep, and not unfrequently produces insanity. History affords many instances of mental derangement from disappointed love.—The following af- fecting cases deserve to be mentioned. A German lady, of great beauty and accomplishments, having married a Hessian officer ordered to America, and not being able to acquire any tidings of him in her own country, came over to England. Here, she could only learn the destiny of her husband from those ships which had either transported troops to the conti- nent or were bringing back the wounded. Day after day she wan- dered on the beach at Portsmouth, and hour after hour she wearied her eyes, bedewed with tears, in the vain expectation of seeing him. She was observed at the same spot, ere it was light, and watched each motion of the waves until the Setting sun. Then her haunted imagination presented him mangled with wounds, and the smallest gust of wind seemed to threaten her with an eternal separation. After eight months spent in this anxious manner, she learned that a ves- sel bringing some wounded Hessian officers had arrived: she kept at some distance, for fear of giving too great a shock to her hus- band's feelings, should he be among them. He was landed with others: she followed to the tavern. When she entered the room, he burst into a flood of tears. A lady was supporting him in her arms. What words or painter could represent the tra- gedy that followed ! He had married in America, and this person was also his wife. He entreated for "pardon," was past reproach, for in a few minutes after he sunk into the arms of death. The lady, whose melancholy history we are recording, rushed from the room, and leaving her clothes and money at her lodging, wandered, she knew not whither, vowing that she would " never enter house more, or trust man." She stopped at last near Bristol, and begged the refreshment of a little milk. There was something so attrac- tive in her whole appearance, as soon produced her whatever she requested. She was young, and extremely beautiful; her man- ners graceful and elegant, and her countenance interesting to the last degree. She was alone, a stranger, and in extreme distress ; she asked only for a little milk, but uttered no complaint, and used no art to excite compassion. Her dress and accent bore visible marks that she was a foreigner of superior birth. All the day she was seen wandering in search i)f a place to lay her wretched head; she scooped towards night a lodging for herself in an old hay-stack. Multitudes soon flocked around her, in this new habitation, attract- ed by the novelty of the circumstance, her singular beauty, but, above all, the suddenness of her arrival. French and Italian- were spoken to her, but she appeared not to understand these languages ; 94 ON HYGIEINE, OR THE ART however, when she was accosted in German, she evidently appear- ed confused, the emotion was too great to be suppressed, she ut- tered some faint exclamations in that tongue, and then, as if she had been hurried into an imprudence, attempted to appear ignorant of this language also. Various conjectures were instantly formed, but what seemed passing strange, was, her acceptance of no food, except bread or milk, and that only from the bands of females. On the men she looked with anger and disdain, but sweetly smiled, as she accepted any present from the other sex. The neighboring ladies remonstrated with her on the danger of so exposed a situa- tion, but in vain; for neither prayers nor menaces could induce her to sleep in a house. Beneath the stack Louisa's dwelling rose, Here the fair maniac bore four winter's snows, Here long she shiver'd, stiff'ning in the blast, And lightnings round her head their horrors cast, Dishevell'd, lo! her beauteous tresses fly, And the wild glance now fills the staring eye, The balls fierce glaring in their orbits move, Bright spheres, where beam'd the sparkling fires of love. It may gratify the reader to learn, that it has been ascertained :since her death, that this fair sufferer was the natural daughter of the Emperor Francis of Germany. In W----, a small village in Saxony, there lived a poor, but ho- nest and upright curate, who for many years had enjoyed without alloy, the tranquil pleasure of domestic happiness. He had a wife, and an only child, a daughter. Content in the sphere wherein they were placed, and unacquainted with the turbulent passions of the fashionable world, their days flowed quietly on in a uniform course of undisturbed felicity. The mother and daughter took a joint care of all the domestic concerns, and strove by every act of atten- tion and love, to diminish the burden which the duties of the good old man imposed on him. Harriet, this was the name of his daugh- ter, was in the strict sense of the word, the child after his own heart. He was unhappy if she were absent even for a few hours; she was, therefore, his constant attendant.—She was about eighteen years old, but had not yet experienced the inquietudes of that passion, which often exhibits itself in very early life in the great world ; and her prin- ciples and mode of thinking were too noble and good to inspire her parents with even the slightest apprehensions as to the wanderings of her heart. But hear her history. Far different from the condi- tion of the Americans, the Saxons are obliged in time of peace, to receive the king's cavalry, which"are quartered in different villa- ges, where it is maintained at the expense of the poor peasantry. Most of the soldiers are riotous young men, who, by virtue of their profession and uniform, obtain entrance into the houses of all the peasantry, and even to the curates, to the great corruption of the innocent and virtuous manners of the country people. One of OF PRESERVING HEALTH. 95 them, a handsome, but giddy young man, was quartered at W----, where he soon made the acquaintance of the good old parson. The young soldier had more culture of mind than is usually met with in such a class of men. He pleased the curate, who often in- vited him to the parsonage, and listened with pleasure to the histo- ries of his battles and warlike achievements. The tender-hearted Harriet found great entertainment in the company of the young warrior, and, like Othello's mistress, the story of his life, the battles, sieges, fortunes that he had passed, the hair-breadth 'scapes, the moving accidents by flood and field, won her heart.—Love had taken possession of her bosom, before she was aware of its approach. She blushed when he took her by the hand, and was unhappy when he left her. The soldier could not resist the beautiful girl, for his heart was formed for love. They, therefore, soon came to an explanation of their mutual passion, which, for the present, they agreed to conceal from their parents, for fear that prudential motives would cause them to oppose it. They bound themselves to each other, however, by an oath, which, at the same time that it showed the strength of their affection, ex- hibited the most romantic turn of mind. They promised to marry, as soon as he could attain the rank of sergeant-major, and agreed that the one should destroy the other, who first failed in the en- gagement. Thus matters stood, when, contrary to the wishes of the lovers, a lawyer from a neighboring town applied to the father of Harriet for the hand of his daughter. He was well received, and his views promoted by the old people ; but when his intention was declared to the unfortunate girl, she fell into the arms of her father, as if struck with lightning, and, on her recovery, wept bit- terly, entreating them not to encourage the addresses of this new lover. Her parents, being ignorant of the true cause of her aver- sion, thought that time would soon overcome it, and, therefore, gave their solemn promise to the lawyer to second his wishes. Harriet, however, resisted every argument, and remained true to her pro- mise ; but her parents, at length growing tired of her opposition, determined to employ their authority, which at last prevailed. The young soldier soon received the intelligence, and instantly formed his desperate resolution, for without his lovely Harriet he could not live. A short time before the marriage day, a dance was given in W----, in honor of the pair. To this he resorted, unable any longer to resist the desire of seeing once more his beloved. He concealed himself among the spectators until he saw her dance ; which roused him to a state of fury. He ran home, took a pair of loaded pistols, and waited until the party broke up. It was a dark night, but he discerned the unhappy bride intended, and her bride- groom, walking hand in hand. He stepped up to her, and in a low voice, requested that she would indulge him with a moment's conversation. She disengaged her arm from that of the lawyer, entreated him to walk on, assuring him she would immediately re- 96 ON HYGIEINE, OR THE ART turn: but, alas ! she was to return no more ! A pistol was heard, ' and when her trembling friends reached the place, they found her weltering in blood at the feet of her murderer. " Now art thou mine," cried the soldier, in tones of horrid joy, and fled, but not to escape. He delivered himself to the officers of justice, and beg- ged to be instantly executed, which event, indeed, soon followed. = Learn parents, from this story, the danger of interfering with your children's affections in so serious an affair as marriage : for as Shakspeare observes: Marriage is sure a matter of more worth Than to be subject for attorneyship : For what is wedlock, forced, but a hell, An age of discord and continual strife ?. Whereas the contrary bringeth forth bliss, And is a pattern of celestial peace. The most dangerous effect of love is jealousy. It is the most vain, idle, foolish, and turbulent disease that ever assaulted and op- pressed the mind of mankind. Of all the diseases of the mind, it is that which most things serve for aliment and fewest for remedy. Bonaventur, sitting at a table, and looking earnestly upon a beau- tiful woman present, was asked by her husband, why he so gazed ? He answered : " That he admired the excellency of the Creator by contemplating the beauty of the creature ; and that if mortals were so amiable, how lovely should we be at the resurrection." This was an example, saith Boschier, that was rather to be admired than imitated; suitable to the golden age, and not this present iron age of the world, wherein jealousy may be compared to the Indian ar- rows, so envenomed, that if they prick the skin it is very danger- ous ; but if they draw blood, it is irrecoverably death: the first mo- tions that rise from this root of bitterness have their evil effects; but where the disease is improved, it impoisons all our comforts, and throws us headlong into the most tragical resolution^. The Marquis of Astorgas, of the family of Osorio, indulged him- self in an illicit intercourse with a most beautiful young woman. His wife on being informed of his intrigue, went immediately to the house where her husband's mistress lived, and murdered her in the most cruel manner. She tore her heart from her bosom, and took it home, ordering it to be hashed and served up to her hus- band for dinner. After he had eaten it, she asked him if it were good ? and, on his answering yes, she said, she was not in the least surprised, for it was the heart of his mistress, whom he so dearly loved. At the same time, she drew from a cupboard the bleeding head of his mur- dered favorite, and rolled it on the table at which this unhappy lov- er was sitting with his friends. His wife immediately departed, and took refuge in a convent, where she soon afterwards went mad with rage and jealousy. OF PRESERVING HEALTH. 97 Earth has no rage like love to hatred turn'd', Nor hell a fury like a woman scorn'd.—Dryden. The power of beauty is universally acknowledged, having been the object of love and admiration in all times and among all nations. But, alas ! what is beauty without the graces of virtue! In Italy there grows an herb called the Basilisco ; it is sweet-scent- ed enough, but, withal, has this strange property, that being laid under a stone in a moist place, in a few days it produces a scorpion. Thus, though the woman, in her first creation, was intended as a help for man, the partner of his joys and cares, the sweet perfume and relish of his days throughout his whole pilgrimage: yet there are some so far degenerated from their primitive institution, though otherwise of exterior beauty and perfection enough, that they have proved more intolerable than scorpions, not only tormenting the fife, but hastening the death of their too indulgent husbands. Not that my verse would blemish all the fair, Bui yet if some be bad, 'tis wisdom to beware ; And better shun the bait, than struggle in the snare.—Dryden. ' Joan, grand-child to Robert, king of Naples, succeeded her grandfather in the kingdom of Naples, and Sicily ; a woman of beautiful person and rare endowments of nature. She was first married to her cousin Andrew, a prince of royal extraction and of sweet disposition ; but being lasciviously disposed, she grew weary of him, and caused him to be strangled in the night, and then threw out his corpse into the garden, where it lay some days unburied. It is said her husband, on seeing her twisting a thick string of silk and silver, asked for what purpose she made it; she answered, " to hang you in!" which he then little believed ; the rather, because those who intend such mischief use not to speak of it before-hand; but it seems she was as good as her word. O fairest of creation! last and best Of all God's works ! creature in whom excelled Whatever can to sight or thought be formed. Holy, divine, good,.amiable, or sweet! How art thou lost!—Milton. Love is never more abused than by those men who do not design to marry. It will generally be found, that libertines will single out from among the herd of females, a raw, innocent, young creature, who thinks all the world as sincere as herself, to whom they design to make their addresses. They take every opportunity to be in their company, and pretend to zeal in love, when it is nothing but lust that fires them. When men's desires and lusts once sated are, For oaths and promises they little care. 13 96 ON HYGIEINE, OR THE ART The female, who yields her virtue to the brutal desires of a false lover degrades herself in his estimation by the infidelity she com- mits/and the surrender of so precious a jewel inspires a remorse and shame, when she ceases to be beloved, that constitutes the bit- terest wo of life. . It is surely matter of wonder, that these destroyers of innocence, though dead to all the higher sentiments of virtue and honor, are not restrained by compassion and humanity. To bring sorrow, con- fusion, and infamy into a family ; to wound the heart of a tender parent, and stain the life of a poor deluded young woman, with a dishonor which never can be wiped off, are circumstances, one would think, sufficient to check the most violent passion, in a heart the least susceptible of feeling. OF HOPE. " Hope springs immortal in the human breast, Man never is, but always to be blest. O Happiness, our being's end and aim, Good, Pleasure, Ease, Content, whate'er thy name : That something still, which prompts the eternal sigh, For which we bear to live, or dare to die."—Pope. Hope is the anticipation of joy, or the presentiment of an ex- pected good. It is attended with all the favorable effects of a for- tunate event, without possessing any of its physical advantages; because the expectation of happiness does not affect us so exces- sively as its enjoyment. Besides, it is not liable to those interrup- tions, from which no human pleasure is exempt; it is employed prin- cipally with ideal or imaginary objects, and generally keeps within the bounds of moderation ; lastly, the sense of happiness contained in hope, far exceeds the satisfaction received from immediate enjoy- ment ; consequently, it has a more beneficial influence on health, than good fortune realized. Although hope is in itself only ideal, and presents its flattering images to the fancy in a borrowed light, yet it is, nevertheless, the only genuine source of human happiness. With thee, sweet Hope! resides the heavenly light, That pours remotest rapture on the sight: Thine is the charm of life's bewilder'd way, That calls each slumb'ring passion into play. Wak'd by thy touch, I see the sister band, On tiptoe watching, start at thy command, And fly where'er thy mandate bids them steer, To Pleasure's path, or Glory's bright career.—Campbell. The poet Hesiod tells us, that the miseries and calamities of man- kind were included in a great tun ; that Pandora took off the lid of it; sent them abroad, and they spread themselves in great quan- tities over all lands and seas ; but at this time. OF PRESERVING HEALTH. 99 Hope only did remain behind, and flew not all abroad, But underneath the utmos|brim and ledge it still abode. And this is that which is our principal antidote, which keeps our hearts from bursting under the pressure of evils; and that flatter- ing mirror that gives us a prospect of greater good. Hence some call it the manna from Heaven, that comforts us in all extremities; others the pleasant and honest flatterer, that caresses the unhappy with expectation of happiness in the bosom of futurity. A very notable case of the influence of hope on the human bo- dy, and its maladies, is recorded in the history of the long siege of Breda, in 1625, by a physician, eye-witness of the fact. That city, from a long siege, suffered all the miseries that fatigue, bad provisions, and distress of mind could bring on its inhabitants. Among other misfortunes the scurvy made its appearance, and car- ried off great numbers. This, added to other calamities, induced the garrison to incline towards a surrender of the place ; when the Prince of Orange, anxious to prevent its loss, and unable to relieve the garrison, contrived to introduce letters addressed to the men, promising them the most speedy assistance. These were accompa- nied with newly discovered medicines against the scurvy, of a most extraordinary price, but still more extraordinary efficacy. To each physician were given three small vials, filled with drops of such so- vereign power, that four drops were sufficient to impart a healing virtue to a gallon of liquor. We now, says the physician, who was one of the eye-witnesses of this curious fact, began to display our wonder-working balsams. Nor were even the commanders let into the secret of the cheat upon the soldiers. All who had the scurvy crowded around us to take their doses. Cheerfulness again appears in every countenance, and the universal faith prevails in the sovereign virtues of the remedy. The effect of this delusion was truly astonishing. Many who had not moved their limbs for a month before, were seen walking the streets erect and perfectly cured. Many who declared they had been rendered worse by all former remedies, recovered in a few days, to their inexpressible joy, and the no less general surprise, by their taking, what we affirm to be, their gracious Prince's cure. " This curious relation," adds Dr. Lind, " would hardly perhaps gain credit, were it not, in every respect, consonant to the most ac- curate observations, and best attested description of that disease. It is given us by an eye-witness, an author of great candor and vera- city, who, as he informs us, wrote down every day the state of his patients, and seems more to be surprised with their unexpected re- covery, than he probably would have been, had he been acquainted with the nature of this surprising malady. An important lesson in physic," adds this excellent writer, " is hence to be learned ; the wonderful influence of the passions of the mind on the state and disorders of the body. This is too often overlooked in the cure ]00 ON HYGIE1NE, OR THE ART of disorders, many of which are sometimes attempted by the sole mechanical operation of drugs, without calling in to our assistance the strong powers of the imagination, or the concurring influences of the soul. Hence it is, that the same remedy will not always pro- duce the same effect, even in the same person; and that common remedies often prove wonderfully successful in the hands of men not 01 the faculty, which do not answer the purpose in a timorous and distrustful patient." Primeval Hope, the Aonian muses say, When Man and Nature mourned their first decay, When every form of death, and every wo, Shot from malignant stars to earth below ; When Murder bared her arm, and rampant War Yok'd the red dragons of her iron car; When Peace and Mercy banish'd from the plain, Sprung on the viewless winds to Heav'n again ; All, all forsook the friendless guilty mind, But hope, the charmer, linger'd still behind.—Campbell. A certain Rhodian, for his over freedom in speech, was cast, by a tyrant, into a cage, and there kept as a wild beast, to his great pain and shame : for his hands were cut off", his nostrils slit, and his face deformed by several wounds upon it. In this extremity, he was advised, by some of his friends, to shorten his life by a volun- tary abstinence from all food. But he rejected their counsel with great indignation ; and told them, " While a man is alive, all things are to be hoped for him." Cease, everyjoy, to glimmer on my mind, But leave—oh ! leave the light of Hope behind ! What though my winged hours of bliss have been, Like angel-visits, few and far between ! Her musing mood shall every pang appease, , And charm when pleasures lose their power to please !—Campbell. But Hope ill-grounded does often trick and bubble the owner, as it did the Spanish woman that, coming with three of her sons a begging to a French shoemaker that lived in Spain, hesaid to her one day, " Good woman, I will ease thee of some part of thy charge; for if thou leave one of thy sons with me I will breed him up in my trade, and make him capable of living like a man, and to be helpful to his parents also." " God forbid," said the woman, " that I should cast away my child to a stranger, and bring him up to so pitiful a mechanic trade as a shoemaker, since I live in hopes that the eldest will be Viceroy of Naples, the second of Mexico, and the youngest of Sardinia." Hope, Fortune's cheating lottery! Where, for one prize, a hundred blanks there be. Fond archer, Hope ! who tak'st thy aim so far, That still, or short or wide, thy arrows are. OF PRESERVING HEALTH. Thin Gmpty cloud! which th' eye deceives With shapes that our own fancy gives : A cloud, which gilt and painted now appears, But must drop presently in tears. Brother of fear! more gaily clad ! The merrier fool o' the two, but quite as mad.—Dryden. OF JOY. Pleasures are ever in our hands or eyes; And when, in act, they ease, in prospect, rise ; Present to grasp, and future still to find, The whole employ of body and of mind. All spread their charms, but charms not all alike ; On difr'rent senses, difF'rent objects strike; Hence dirf'rent passions, more or less inflame, As strong or weak, the organs of the frame ; And hence one master passion in the breast, Like Aaron's serpent, swallows up the rest.—Pope. The consideration of some present good, and which particularly belongs to us, begets in the soul that delight which we call joy ; for as soon as our understanding observes that we are possessed of the good we desired, the imagination presently makes some impression in the brain, from whence proceeds a motion of the sensitive soul, and of the spirits, that excites the passion of joy. By it, the activ- ity of the whole machine is enlivened ; the action of the heart and arteries is increased; the circulation of all the fluids is more vigor- ous and uniform, preventing the formation of disease, and facilitat- ing the cure of such as are formed. There are several degrees of joy, as various circumstances may intervene; and so may we distinguish various differences of the passion itself; for there is no pleasure or good that may not be mix- ed with some ill or inconvenience. Our extremest pleasure has still some air of groaning and complaining in it, unless it be dis- creetly moderated it proves fatal to us when it grows into excess. i Ptolemeus Philadelphus had received the sacred volumes of the law of God, newly brought out of Judea; and while he held them with great reverence in his hands, praising God upon that account, all that were present made a joyful exclamation ; and the king him- self was so overjoyed, that he broke out into tears. Nature having so ordered it, that the expression of sorrow should also be the follower of extraordinary joys. ! Askew,,a wealthy and facetious farmer of Cornwall, was afflicted , with a most alarming imposthumation, of which he appeared to be on the very point of suffocation. Concluding, from his agonies, that he had but a few moments to live, his servants, an ungrateful crew to such a generous master, began to plunder. One seized his gold watch, another laid violent hands on his plate, and the third, more daring still, broke his bureau, and began to finger his gold. 102 ON HYGIEINE-, OR THE ART A monkey, who was present, seeing what they were about, and thinking he might as well take a hand in the game, laid hold of his master's wig, and with his gold-headed cane, made him a low bow, and began to walk about the room as a man of great consequence. The stately steppings and self-assumed dignity of Jacko, so tickled the fancy of Mr. Askew, as to excite a most immoderate fit of laughter. The imposthumation burst, the purulent matter was thrown up—and, to the eternal confusion of his servants, Mr. As- kew perfectly recovered his health. Philemon, a comic poet, beholding an ass eating some figs that a boy had laid down ; when the boy returned, " Go now," said he, " and fetch the ass some drink ;" the old man was so tickled with the fancy of his own jest, that he died laughing. In the same man- ner, and much upon the same occasion, died Crysippus. Diagoras, the Rhodian, when he saw his three sons all victorious in the Olympic games, and crowned the same day, was extremely pleased ; but when his sons came and embraced their aged father, and each put their triumphal wreath upon his head, he was so over- come with joy and delight, that he fell into their arms, and died. If we have anticipated any joyful event, the body is gradually prepared to undergo the emotions connected with it. " For this rea- son we ought to fortify ourselves with the necessary share of firm- ness, to meet joyful as well as disastrous tidings. OF GRIEF. It is the great art of life to manage well The restless mind. For ever on pursuit Of knowledge bent, it starves the grosser powers Quite unemployed,-, against its own repose It turns its fatal edge, and sharper pangs Than what the body knows, imbitter life. Chiefly were solitude, the nurse of care, To sickly musing gives the pensive mind, There madness enters ; and the dim-eyed fiendr Sour melancholy, night and day provokes Her own eternal wound. ***** Armstrong. Grief, like a poison, corrodes the powers of the miml and body; it enfeebles the whole nervous system; the heart beats slower ; the circulation of the blood, and other fluids, become more inert; the appetite and digestion become vitiated, and thus arise obstructions and other distressing complaints. Tears are the anodynes of grief, and ought, therefore, not to be restrained. They have a tendency to prevent the danger to be apprehended from grief, by diminishing the spasmodic motions in the breast and head ; and by restoring re- gularity in respiration, as well as in the circulation of the blood. A widow lady was left in narrow circumstances with a boy and girl, two beautiful and lovely children, the one six, and the other seven years of age. As her circumstances allowed her to keep but OF PRESERVING HEALTH. IDS' one maid servant, these two children were the sole attention, em- ployment, and consolation of her life. She fed them, dressed them, slept with them, and taught them herself. They were both snatch- ed from her by the gangrenous sore throat, in one week; so that she lost at once all that employed her, as well as all that was dear to her. For the first three or four days after their death, when any friend visited her, she sat upright with her eyes wide open, without shedding tears, and affected to speak of indifferent things. After- wards she began to weep much, and for some weeks talked to her friends of nothing else but her dear children ;. but did not for mar ny years, even to her dying hour, get quite over a gloom which was left upon her countenance. When any cause of deep grief is presented to the mind, it fre- quently gains such a force as almost totally to exclude all thoughts, except those that are connected with it. Hence the whole imagi- nation is, by degrees, obscured, and the most usual consequences ofT it are the deepest melancholy, succeeded by insanity—and some- times, that speedier dissolution, " a broken heart." When the Turks came to raise the siege of Buda, there was amongst the of "*F™ causes and accidents, m which they see no light or comfort. Thank OF PRESERVING HEALTH. 105 the Father of Mercies, that into all the evil he sends, he infuses joyful hope, that the sufferings of the present time are not wor- thy to be compared with the glory that shall be revealed in the end to the virtuous and good.. Have we sustained the greatest of all losses ? It is his gain that he yet liveth, that this life is but the threshold, the portal, the entrance to a better place, and that his happiness is as complete as our misery is great. Let us turn our eyes from earth to heaven, from the perishable body to that which endureth forever; and even whilst we are heavy with afflic- tion, let us smile with our eyes turned upwards, and say, " It is thy will: I submit. He is happy. I would not wish him back to a troublesome world. I soon shall follow after him. The mortal hath put on immortality—We shall then meet, never to be separat- ed more." Think, then, ye mourning parents, nor complain For breathless children, as ye weep in vain. Why should you be in lamentations drown'd, While your young babes with victory are crown'd, Before the sword was drawn, or cruel strife Had shed its venom on the ills of life ? Perhaps, Almighty God foresaw some wile, Some tempting evil that should them beguile ; Of sore adversity, a dreadful storm, Or of dire wickedness, a monstrous form. How then in words which nothing can avail, Against that kind precaution dare you rail? Remember that of them you're not bereav'd, • But from " the coming evil they are sav'd."—Anketell. OF FEAR. Tim'rous self-love, with sick'ning fancy's aid, Presents the danger that you dread the most, And ever galls you in your tender part. Hence, some for love, and some for jealousy, Have lost their reason: some for fear of want, Want all their lives ; and others every day, For fear of dying suffer worse than death. Is there an evil worse than fear itself? And what avails it that indulgent Heaven From mortal eyes has wrapt the woes to come, If we, ingenious to torment ourselves, Grow pale at hideous fictions of our own?—Armstrong. Fear has its origin in the apprehension of danger, and is kindly placed in man as a sentinel for self-preservation. But, like every other passion, the excess of it is pernicious. 0 Fear ! I know thee by my throbbing heart; Thy withering power inspir'd each mournful line : Though gentle Pity claim her mingled part, Yet all the thunders of the scene are thine.—Collins. 14 106 ON HYGIEINE, OR THE ART Don Diego Osorius, a Spaniard of noble family, being in love with a young lady of the court, had prevailed with her for a private conference under the shady boughs of a tree, that grew within the gardens of the King of Spain : but, by the unfortunate barking of a little dog, their privacy was betrayed, and the young gentleman seized by some of the king's guard, was imprisoned. It was a capi- tal crime to be found in that place, and, therefore, he was condemn- ed to die. He was so terrified at the hearing of his sentence, that one and the same night saw the same person young, and all turned gray as in age. The jailer, moved at the sight, related the accident to King Ferdinand, as a prodigy ; who, thereupon, pardoned him; saying, " He had been sufficiently punished for his fault, seeing he had exchanged the flower of his youth into the hoary hairs of age." " I knew a surgeon," says Dr. Darwin, " who was always rather of a parsimonious disposition, had a large house, with a fortune of forty thousand pounds left him ; and in a few weeks became insane from the fear of poverty; lamenting that he would die in a jail or a work-house. He had left off a laborious country practice and the daily perception of profit in his books: he also now saw greater expenses going on in his new house than he had been accustomed to observe, and did not so distinctly see the source of supply; which seems to have occasioned the maniacal hallucination. The fear of hell," continues he, " has also, in some instances, been at- tended with fatal effects. In this kind of madness, the poor pa- tients frequently commit suicide ; although they believe they run headlong into the very hell which they dread !" It is said of Epicurus, a profane teacher, that never was a school boy more afraid of a rod, than he was of the thoughts of God and death. No man more feared the things which he taught should be despised, than himself. For whatever there is in the air, there is certainly an elastical power in the conscience, that will bear itself up, notwithstanding all the weight that is laid upon it. Conscience, the torturer of the soul, unseen, Does fiercely brandish a sharp scourge within. Severe decrees may keep our tongues in awe, But to our thoughts what edict can give law ? Even you, yourself, to your own breast shall tell Your crimes, and your own conscience be your hell.—Drydei*. The wretched state of Richard the Third, after he had murdered his nephew, is thus described by Sir Thomas More: " I have heard," saith he, " by credible reports, that after this abominable ? ™.eveT quiet in his mind' and never thought himself safe. When he went abroad his eyes whirled about, his body was privily fenced, his hand ever on his dagger, his countenance and manner like one who was ever ready to strike; he took no rest in the night, lay long waking and musing, sore wearied with care and watching, and rather slumbered than slept, troubled with fearful OF, PRESERVING HEALTH. 107 dreams: he sometimes started suddenly up, leaped out of his bed, and ran about his chamber: his restless heart was continually tos- sed and tumbled with the tedious impression and stormy remem- brance of his horrid and abominable deeds." Conscience, what art thou ? thou mysterious pow'r, That dost inhabit us without our leave. And art within ourselves another self, A master self, that loves to domineer, And treat the monarch frankly as the slave ; How dost thou light a torch to distant deeds. Make the past, present, and the future frown ; How, ever and anon, wake the soul, As with a peal of thunder, to strange horrors!—Shakspeare. The rich Cardinal of Winchester, Henry Beaufort, who procured the death of the good Duke of Gloucester, was soon after struck with an incurable disease ; and, understanding by his physicians, that he could not live, he expressed himself thus : " Fie, will not death be hired ? Will money do nothing ? Must I die who have so great riches ? If the whole realm of England would save my life, I am able, either by policy to get it, or by riches to buy it." But the king of terrors is not to be bribed by gold. It is a pleas- ure to him to mix the brains of princes and politicians with com- mon dust; and how loth soever he was to depart, yet grim death would seize upon him. How shocking must thy summons be, O death! To him that is at ease in his possession ; Who, counting on long years of pleasure here, Is quite unfurnish'd for the world to come ? In that dread moment, how the frantic soul Raves round the walls of her clay tenement Rushes to each avenue, and'hrieks for help, But shrieks in vain. ****** *********** The foe, Like a stanch murderer, steady to his purpose, Pursues him close through every lane of life, Nor misses once the track, but presses on, Till forc'd at last to the tremendous verge, At once he sinks to everlasting ruin.—Blair. The best remedy against this torturing state of the mind is a good conscience, which is to the soul, what health is to the body. It pre- serves a constant ease and serenity within us, and more than coun- tervails all the calamities and afflictions that can befall us. When the mind has been under the influence of sudden surprise, or vehement attention to some interesting object, it has frequently suspended, and even entirely cured, ague and fever, asthma, and other chronic diseases. An officer, of great courage, who had contracted the asthma by Ions service in India, declares, that during a most severe attack of i os ON HYGIE1NE, OR THE ART that complaint, when he could scarcely breathe in an erect posture, and without power to move, as he thought six yards to save his life the alarm guns were fired for the whole line to turn out, be- cause the Mahrattas broke into the camp. Knowing that certain death would be his portion if he remained in his tent, he sprung out with an alacrity that- amazed his attendants, instantly mounted his horse, and with great ease drew his sword, which the day before he could not move from its scabbard, though he had used his whole strength in the attempt. From the instant of the alarm, the debility left him, together with the asthma, nor did the disorder return for some time after. " I have frequently observed," says the ingenious author of the Medical Extracts, "delicate hysterical women, who, for many months, had seldom enjoyed one day's health, suddenly relieved from every complaint, when a favorite child was attacked with a disease, in which danger was apprehended : and they continued in appearance, to be in perfect health during the whole course of the illness, and exhibited an unusual alertness in discharging their duty as nurses and parents. But when they understood that the danger was over, their former complaint gradually returned, to their great surprise ; for, from the health they had lately enjoyed, and for so considerable a time, they believed themselves perfectly cured." A very remarkable instance of the influence the mind has upon disorders of the body, occurred to the celebrated Boerhaave. A person fell down in an epileptic fit in the sight of other patients. The effect of this operated so strongly that great numbers of them became immediately affected in the same manner. The opinion of the great physician above mentioned was requested on this occa- sion. He judiciously reflected, that, as these fits were originally produced by an impression on the mind, that the most proper means of cure would be to eradicate these impressions by others still more powerful. He therefore, directed actual cauteries to be prepared, and kept hot, in readiness to be applied to the person who should next be affected. The consequence was, not one person was seized. i Through a most criminal inattention to children in the nursery, a foundation is sometimes laid in their tender minds for those su- perstitious terrors, from which not all their efforts in subsequent life can entirely relieve them. I allude to those dismal stories about witches, spirits, hobgoblins, raw-head and bloody-bones, where- with silly nurses, especially poor blacks, are so fond of frightening infants. Considering |he importance of deep impressions made during those tender years, parents cannot too strictly forbid every thing of this sort; neither can they ever exceed in their generous labors to illuminate the minds of their children with lofty ideas of their Creator, and that mighty power which he will never fail to exert in their favor, if they will but be good. Timorous persons are more readily infected by contagious disor- OF PRESERVING HEALTH. 109 ders, than those possessed of fortitude. Hence it is we find nurses most frequently escape contagion, while persons of a fearful dispo- sition contract the disease on entering the chamber of the sick only once or twice. Persons under a violent fit of fear should be treated like those who suffer from any other spasmodic contraction. Tea, a little wine, or spirits and water may be given to them; vinegar, laven- der-drops, or spirits of hartshorn may be held to the nostrils ; warm bathing of the feet, and emollient injections may be of advantage; but above all, the mind ought to be duly composed.—Excessive bashfulness borders on fear ; it may be corrected by social inter- course with persons of a cheerful disposition. OF ANGER. When reason, like a skilful charioteer, Can break the fiery passions to the bit, And, spite of their licentious sallies, keep The radiant track of glory; passions, then, Are aids and ornaments. * * * Youno. Resentment of wrong is a useful principle in human nature; and for the wisest purposes was implanted in our frame. It is the necessary guard of private rights, and the great restraint on the in- solence of the violent; who, if no resistance were made, would trample on the gentle and peaceable. But, in the fulness of self- estimation, we are too apt to forget what we are. We are rigorous to offences, as if we did not daily entreat Heaven for mercy. It is a vice that few persons are able to conceal; for, if it do not betray itself by external signs, such as sudden paleness of the counte- nance, and trembling of the joints, it is more impetuous within. Pale and trembling Anger rushes in, With falt'ring speech, and eyes that wildly stare ; Fierce as the tiger, madder than the seas, , Desperate, and arm'd with more than human strength, He whom Anger stings, drops, if he dies, At once, and rushes apoplectic down; Or a fierce fever hurries him to hell.—Armstrong. Those who feel the approach of anger in the mind, should, as much as possible, divert their attention from the object of provoca- tion, and remain silent. They should never use loud oaths, violent upbraidings, or strong expressions of countenance, or gesticulations of the arms, or clenched fists ; as these, by their former associa- tions with anger, will contribute to increase it. " I have been told," says Dr. Darwin, "of a sergeant or corporal, who began mo- derately to cane his soldiers, when they were awkward in their ex- ercise ; but, being addicted to swearing and coarse language, he $10 ON HYCIEINE, OR THE ART used soon to enrage himself by his own expressions of anger, till, towards the end, he was liable to beat the delinquents unmercifully." Is this not applicable to some of us, in the treatment of our slaves? A gentleman in New-Castle county, Delaware, was so enraged with a neighboring slave, for persevering, contrary to his orders, to visit a female servant in his family, that he bought him of his master, at a high price, for the express purpose of getting satis- faction ; that is, to give him a severe flogging; and then to sell him to a negro-buyer. What with the bitter curses and blows he in- flicted upon the poor fellow tied hands and feet, his anger rose at length to a flame he could not control, and, by the time the master had lost the power to inflict, the poor slave had lost the power to suffer—having literally expired under his cruel hands. A sea captain, in Charleston, South Carolina, navigated his vessel with the help of three slaves. On some provocation from one of them, he lara hold of the offender, who was so alarmed at his mas- ter's look, that he jerked away from him. Roused to fury by such an act of treason, as this appeared to him, the master caught up a broad axe, and with the looks and voice of a demon, ordered his other slaves " to seize the d-----d villain." Frightened opt of their wits, they seized their fellow-servant, and the master, black with rage, and regardless of his prayers and supplications, had him drag- ged to a block, and in a most barbarous manner struck off his head. Although the laws of the land did not sentence these inhuman masters to death, yet neither of them long survived their infernal acts. The gnawings of a blood-stained conscience soon brought them down to the grave. Cruelty is the extreme of all vices, an offence to God, abhorrence to nature, the grief of good men, and a pleasure only to devils and monsters divested of humanity. Justice may take away a man's life, to punish his offences, and to deter others by his example, from the commission of the same crimes ; but to do it by racks and other torments, savors little of humanity, less of Christianity. How many millions of men have the Spaniards butchered in South America. Bartholomew Casa affirms, that in forty-five years they destroyed about ten millions of human souls ; an unaccount- able way of converting these poor savages to Christianity. These millions were butchered outright, and if we add those who died la- boring in the mines, doing the drudgery of asses, oxen, and mules, to what a vast number would they amount ? Some of them carry burdens upon their backs of a hundred and sixty pounds' weight, above three hundred miles/ How many of these poor wretches • have perished by water as well as by land, by diving fathoms deep,"' fishing for pearl, who stay there sometimes half an hour under wa- ter, panting and drawing the same breath all the while, and are fed on purpose with coarse biscuit and dry things, to make them long winded. And if what is reported be true, they hunt the poor In- dians with dogs# to make themselves sport. There is a story of OF PRESERVING HEALTH. Ill Hathir Cacica, a stout Indian, who, being to die, was persuaded by a. Franciscan friar to turn Christian, and then he should go to hea- ven ; Cacica asked him whether there were " any Spaniards in hea- ven ?" " Yes," says the friar, «it is full of them." " Stay, then," said the Indian, " I had rather go to hell than have any more of their company." A young gentleman in Augusta, Georgia, going to a party in the neighborhood, in a gig, had not got out of the street, before his horse balked. The youth, leaping from his gig, and angrily catch- ing his horse by the bridle, led him off. Having mounted his gig, he cracked his whip for a second start; but his horse had not gone many steps, before he unfortunately fell back again.—Leaping from the gig in a violent rage, he struck his horse over the head with a loaded whip, and then attempted to lead him off once more. Fright- ed by such violence, the animal, in place of moving forward, drew back. Enraged by such obstinacy, the young man repeated his blows,with the whip until it broke, which rather increased the per- turbation of his mind. By this time, finding himself surrounded by unwelcome spectators of his brutal conduct, he became more furious; and snatching a large club, continued his unmerciful blows, until he brought the horse to the ground ; when, after a, few struggles, his blood and brains flowing copiously, the poor animal expired. As anger is a short madness, so patience is a recollection of all requisite virtues, that enables us to withstand the assaults of the for- mer, and to behave ourselves like sober and prudent men. When Xenocrates came one time to the house of Plato to visit him, he prayed him, " that he would beat his servant for him, in regard he himself was not at present fit to do it, because he was in a passion." Another time he said to one of his servants, " that he would beat him sufficiently, but that he was angry." Forgiveness of injuries, and a merciful disposition towards those who have offended us, are not only infallible marks of a great and noble mind, but are our indispensable duties as reasonable crea- tures, and peculiarly so as Christians. Sir Walter Raleigh, a man of known courage and honor, being very injuriously treated by a hot-headed, rash youth, who next pro- ceeded to challenge*him, and, on his refusal to accept, spit upon him, and that too in public, the knight, taking out his handkerchief, with great calmness, made him only this reply: " Young man, if I could as easily wipe away your blood from my conscience, as I can this injury from my face, I would this moment take away your life." The consequence was, that the youth, struck with a sudden and strong sense of his misbehavior, fell upon his knees, and begged forgiveness. Clinias, the Pythagorean, was a person very different both in his life and manners from other men. If it chanced at any time that he was influenced with anger, he would take his harp, play upon and 112 ON HYGIEINE, OR THE ART sing to it; saying as oft as he was asked the cause of his so doing, " that by this means he found himself reduced to the temper of his former mildness." There is a charm, a power that sways the breast, Bids every passion revel or be still; Inspires with rage, or all your cares dissolves; Can sooth distraction and almost despair. That power is Music. * * * Armstrong. So great is the empire of music over all the faculties of human nature" and so loud have been the ingenious in celebrating its pow- er and praises, that they have left nothing scarcely in heaven, not at all in the air, sea, or on the earth, but what, in excess of fancy or merit, they have subjected to its dominion for the better. Music exalts each joy, allays each grief, Expels diseases, softens every pain, * Subdues the rage of poison, and the plague; And hence the wise of ancient days ador'd One power of Physic—Melody and Song.—Armstrong. \ While the physician prescribes draughts for curing bodily dis- eases, an able musician might prescribe an air for rooting out a vi- cious passion. When the tyrant Eugenius raised that perilous war in the East, and money grew short with the Emperor Theodosius, he determin- ed to raise subsidies, and to gather from all parts more than before he had ever done. The citizens of Antioch bore this exaction with so ill a will, that, after they had uttered many outrageous words against the emperor, they pulled down his statues and those also of the empress his wife. Awhile afterwards, when the heat of their fury was past, they began to repent themselves of their folly, and considered into what danger they had cast themselves and their city. Then did they curse their rashness, confess their fault, implore the goodness of God, and with tears, " That it would please him to calm the emperor's heart." Their supplications and prayers were so- lemnly sung, with sorrowful tunes and lamenting voices. Their bi- shop, Flavianus, employed himself valiantly, in this needful time, in behalf of the city ; made a journey to Theodosius, and did his utmost to appease him : but finding himself rejected, and knowing that the emperor was devising some grievous punishment; and on the other side, not having the boldness to speak again, and yet much troubled in his thoughts because of his people, then came this device into his head; At such time as the emperor sat at meat, 1 certain young boys were wont to sing musically unto him. Flavianus wrought so, that he obtained of those who had charge of the boys, that they would suffer them to sing the supplications and prayer of the city of Antioch. Theodosius, listening to that grave music. was so moved with it, and so touched with compassion, that having OF PRESERVING HEALTH. 113 then the cup in his hand, he with his warm tears watered the wine that was in it, and forgetting all his conceived displeasure against the Antiochans, freely pardoned them and their city. '• Man may most justly tuneful strains admire, His soul is music, and his breast a lyre; A lyre which, while its various notes agree, Enjoys the sweet of its own harmony. * What ravishes the soul? what charms the ear? 'Tis music, though a various dress it wear. Beauty is music too, though in disguise, Too fine to touch the ear, it strikes the eyes, And thro' 'em to the soul-, the silent stroke conveys." OF HATRED. Infernal Malice, only pining Hate, And envy grieving at Another's state; When these are in the human bosom nurst, Can peace reside in dwellings so accurst ?—Hamilton. Hatred is a Fury that never sleeps; ulcerates the soul; and tortures it throughout. Hence it never fails to injure the body. As admiration, tHe first of the passions, rises in the soul before she has considered whether the thing represented to her be good, or convenient to her, or not; so, after she has judged it to be good, there is raised in her the most agreeable and complacent of all pas- sions, love ; and when she hath conceived the same to be evil, she is quickly moved to Hatred, which is nothing but the soul's aversion to that which threatens pain or grief, and may be defined to be " a commotion produced by the spirits, that incite the soul to be will- ing to be separated from objects represented to her as ungrateful and hurtful;" which definition only respects purenature; but through the corruption of men and manners, it may be said to arise from an imbibed prejudice, or envy aggravated by continuance, and height- ened by a malicious intention of malignancy, and injuring the person to whom we have a disaffection, and that too without any reason but what proceeds from a self-contracted wickedness. Anger is sometimes allowable, and, when excessive, is still called but the vice of men ; but hatred is said to be the sin of devils, being not confin- ed at home, but roves abroad, seeking whom it may devour. " Cruel revenge, which still we find, The weakest frailty of a feeble mind: Degenerous passion, and for man too base, It seats its empire in the savage race." A certain Italian, having his enemy in his power, told him there was no possible way for him to save his life, unless he would imme- 15 114 ON HYG1E1NE, OR THE ART diately deny and renounce his Savior. The timorous wretch, in hope of mercy, did it; when the other, forthwith, stabbed him to the heart, saying, that now he had a full revenge, for he had killed at once both his body and soul. In the reign of Edward VI., upon the alteration of religion, there was an insurrection in Cornwall and divers other counties, wherein many were taken and executed by martial law. The chief leaders were sent to London, and there executed. The sedition being thus suppressed, it is memorable what cruel revenge or sport Sir William Kingston, provost-martial, made by virtue of his office, upon men in misery. One Boyer, mayor of Bodmin in Cornwall, had been amongst the rebels, not willingly, but enforced. To him the pro- vost sent word that he would come and dine with him, for whom the mayor made great provision. A little before dinner, the pro- vost took the mayor aside, and whispered him in the ear, " That an execution must that day be done in the town, and therefore requir- ed that a gallows should be set up, against dinner should be over." The mayor failed not of his charge. Presently after dinner, the provost taking the mayor by the hand, desired him to lead him to the place where the gallows was ; which, when he beheld, he asked the mayor " If he thought it to be strong enough?" " Yes," said the mayor," doubtless it is." " Well, then," said the provost, " get you up, speedily, for it is provided for you." " I hope," answered the mayor, " you mean not as you speak ?" "In faith," said the provost, " there is no remedy, for you have been a busy rebel:" and so, without respite or defence, he was hanged. Near the said place, dwelt a miller who had been a busy actor in that rebellion, who', fearing the approach of the marshal, told a sturdy fellow, his ser- vant, that he had ocgasion to go from home, and, therefore, if any came to inquire for the miller, he should not speak of him, but say he was the miller, and had been so for three years before. So, the provost came, and called for the miller, when out comes the servant, and said, " I am the man." The provost demanded, how long he had kept the mill ? " These three years," answered the sepant. Then the provost commanded his men to lay hold of him, and hang him on the next tree. At this the fellow cried out, "I am not the miller, but the miller's man." " Nay, sir," said the provost, " I will take you at your word. If thou beest the miller, thou art a busy knave, if thou art not, thou art a false lying knave; and, howsoever, thou canst never do thy master better service than to hang for him;" and so, without more ado, he was dis- patched. Revenge is but a frailty, incident To craz'd and sickly minds ; the poor content Of little souls, unable to surmount An injury, too weak to bear affront.—Dryden. Revenge is a great sign of cowardice, when an enemy is at one> OF PRESERVING HEALTH. 115 mercy. There is more bravery and disdain in slighting a private enemy, and despising revenge, than in cutting his throat: not that a man should be insensible of an injury or affront, but. that he should not carry his resentments too far, where a gentle revenge is suffi- cient. Excellent was the advice that was given to the Romans by the ambassadors of some cities in Etruria:—That since they were men, they should not rCsent any thing beyond human nature; and that in mortal bodies they should not carry immortal feuds. Light injuries are made none by disregarding them ; which, if we reveng- ed, grow grievous and burdensome, and live to hurt us, when they might die to secure us. It is princely to disdain a wrong ; and they say, princes, when ambassadors have offered indecencies, used not to chide, but deny them audience ; as if silence were the royal way to revenge a wrong. When the Duke of Alva was in Brussels, about the beginning of the tumults in the Netherlands, he had sat down before Hulst, in Flanders ; and there was a provost-marshal in the army who was a favorite of his, and this provost had put some to death by secret commission from the duke. There was one Captain Bolea in the army, who was an intimate friend of the provost's; and one even- ing late he went to the captain's tent, and brought with him a con- fessor and an executioner, as it was his custom. He told the cap- tain he was come to execute his excellency's commission and mar- shal law upon him. The captain started up suddenly, his hair stand- ing upright, and being struck with amazement, asked him, " Where- in have I offended the duke." The provost answered, " Sir, I am not to expostulate the business with you, but to execute my commis- sion ; therefore, I pray prepare yourself, for there is your ghostly fa- ther and executioner." So he fell on his knees before the priest, and having done, and the hangman going (to put the halter about his neck, the provost threw it away, and breaking into a laughter, told him, " there was no such thing, and that he had done this to try his courage, how he would bear the terror of death." The cap- tain, looking ghastly at him, said, " Then, sir, get you out of my tent, for you have done me a very ill office." The next morning, the said Captain Bolea, though a young man of about thirty, had his hair all turned gray, to the admiration of all the world, and the Duke of Alva himself, who questioned him about it; but he would confess nothing. The next year the duke was recalled, and in his journey to the Court of Spain, he was to pass by Saragossa, and this Captain Bolea and the provost went along with him as his domestics. The duke being to repose some days in Saragossa, the young old Captain Bolea told him, " that there was a thing in that town wor- thy to be seen by his excellency, which was a casa de loco, a bed- lam house, such a one as there was not the like in Christendom." " Well," said the duke, " go and tell the warden, I will be there to- morrow in the afternoon." The captain having obtained this, went to the warden, and told him the duke's intention; and that the- 116 ON HYGIEINE, OR THE ART chief occasion that moved him to it was, that he had an unruly pro- vost about him, who was often times subject to fits of frenzy ; and, because he wished him well, he had tried divers means to cure him, but all would not do ; therefore, he would try whether keeping him close in bedlam for some days would do him any good. The next day the duke came with a great train of captains after him, amongst whom was the said provost, very shining and fine. Being entered into the house about the duke's person, Captain Bolea told the war- den, pointing at the provost, "that's the man :" the warden took him aside into a dark lobby, where he had placed some of his men, who muffled him in his cloak, seized upon his sword, and hurried him into a dungeon. The provost had lain there two nights and a day ; and afterwards it happened that a gentleman, coming out of curiosity to see the house, peeped into a small grate where the pro- vost was. The provost conjured him, as he was a Christian, to go and tell the Duke of Alva his provost was there confined, nor could he imagine why. The gentleman did his errand; and the duke, being astonished, sent for the warden with his prisoner. The war- den brought the provost in cuerpo, full of straws and feathers, mad- man-like, before the duke ; who, at the sight of him, burst into laughter, asking the warden why he had made him prisoner? " Sir," said the warden, " it was by virtue of your excellency's com- mission, brought me by Captain Bolea." Bolea stepped forth, and told the duke, " Sir, you have asked me oft how these hairs of mine grew so suddenly gray ; I have not revealed it to any soul breath- ing : but now I will tell your excellency;" and so related the pas- sage in Flanders; and added—" I have been ever since beating my brains to know how to get an equal revenge of him, for making me old before my time." The duke was so well pleased with the story, and the wittiness of the revenge, that he made them both friends. OF ENVY. ******* Malicious Envy rode Upon a ravenous wolf, and still did chew Between his canker'd teeth, a ven'mous toad, That all the poison ran about his jaw: But, inwardly, he chewed his own maw At neighbors' wealth, that made him ever sad: For death it was when any good he saw, And wept, that cause of weeping none he had, But when he heard of harm, he wax'd wondrous glad. He hated all good works, and virtuous deeds, And him no less than any like did use; And who with gracious bread the hungry feeds, His alms for want of faith, he doth accuse, To every good to bad he doth abuse ; And eke the verse of famous poet's wit, He does backbite, and spiteful poison spews From leprous mouth on all that ever writ: Such one, vile Envy was.—Spencer. OF PRESERVING HEALTH. 117 To repine at the superior happiness of others, is the nature of Envy. It arises from self-love or self-interest, particularly in such individuals whom nature has denied certain qualifications of body or mind, which they cannot avoid seeing in others. It is almost the only vice which is practicable at all times, and in every place; the only passion which can never lie quiet for want of irritation ; its effects are, therefore, every way discoverable, and its attempts always to be dreaded. Envy commands a secret band, With sword and poison in her hand, Around her haggard eye-»balls roll, ,, A thousand fiends possess her soul. The artful, unsuspected sprite, With fatal aim, attacks by night. Her troops advance with silent tread, And stab the hero in his bed; Or shoot the wing'd malignant lie, And female honors pine or die.—Cotton. Solomon emphatically styles " Envy a rottenness of the bones," and we too often witness its baneful effects on those who cherish the fatal poison. It shows itself in horrors even on the face of young females, who, it might be supposed, could not possess so odious a passion. Observe an envious girl, while pleased with her- self, appears quite beautiful and pleasing in her manners; but on the appearance of one of her sex, a school-mate, of superior beauty and endowments, her countenance becomes strangely altered. In like manner the spirits become depressed ; and, as the body cannot remain undisturbed, when the mind, to which it is so nearly at- tached, is in such misery, the person who is tormented with it can- not enjoy good health. For it is the passion of the damned ; and, as it richly deserves punishment, it never escapes it. A French lady of quality that was well married, and lived in plenty, hearing her husband's brother had married a very handsome lady with a great fortune, was mightily out of humor, insomuch that she perfectly hated all that spoke in commendation of her new sister-in-law, and hearing her husband also commend her as a very beautiful woman, she bribed a servant in that lady's family to poi- son her; but he, discovering the design, and the lady, being re- proached for it by the husband, poisoned herself and died. Envy's the worst of fiends, procurer of sad events, And only good when she herself torments.—Cowley. Plutarch compares envious persons to cupping-glasses, which ev- er draw the worst humors of the body to them. Like flies they resort only to the raw and corrupt parts of the body; or, if they light on a sound part, never leave blowing upon it till they have disposed it to putrefaction. When Momus could find no fait with 118 ON HYGIEINE, OR THE ART the face in the picture of Venus, he picked a quarrel with her slip- pers ; and so malevolent persons, when thy cannot blame the sub- stance, will yet represent the circumstance of men's best actions with prejudice. The black shadow is still observed to wait upon those that have been the most illustrious for virtue, or remarkable for some kind of perfection: and to excel in either has been an unpardonable crime. " The man who envies, must behold with pain Another's joys, and sicken at his gain." When Aristides, so remarkable for his inviolable attachment to justice, was tried by the people at Athens, and condemned to ban- ishment, a peasant unacquainted with the person of Aristides, ap- plied to him to vote against Aristides. " Has he done you any wrong," said Aristides, " that you are for punishing him in this man- ner?" " No," replied the countryman, " I don't even know him; but I am tired and angry with hearing every one call him the just." Mutius, a citizen of Rome, was noted to be of such an envious and malevolent disposition, that Publius, one day observing him to be very sad, said, " Either some great evil has happened to Mu- tius, or some great good to another." Medicines cannot cure a disease so odious. Education and im- provement of morals are its only antidotes. Envious persons com- monly give too much importance to trifles ; hence they ought to be instructed to employ themselves in more useful pursuits ; to judge of things according to their true value, and to accustom themselves to a philosophic calmness, learn how to overcome or at least to mo- derate their selfishness; to counter balance their expectations with their deserts; and to equal or surpass others in their merits, rather than in their pretensions. OF AVARICE. And, oh ! what man's condition can be worse Than his, whom plenty starves and blessings curse? The beggars but a common fate deplore, The rich poor man's emphatically poor. / If cares and troubles, envy, grief, and fear, The bitter fruits be what fair riches bear, If anew poverty grows out of store, The old plain way, ye gods! let me be poor.—Cowley. This vile passion, which frowns at the approach of the stranger, clinches the hand against the poor, denies all encouragement of public good, and can pinch and starve wife and children, is hardly more detestable in a moral point of view, than it is pernicious in a physical. It is true, that by his unwillingness to part with his mon ey, the miser is generally a temperate, and even an abstemious*eha- OF PRESERVING HEALTH. 119 racter, and so far his vice is beneficial to his health ; but, in many other respects, this detestable vice operates very hurtfully to the health of him who is cursed with it. By the extreme eagerness to make money, by the distressing fears about keeping it, by the in- consolable grief for losing it; besides the heart-achs, the envies and jealousies, the sleepless nights, wearisome days, and numberless other ills which it inflicts on its slaves, it often ruins their health, and brings them down to the grave by some lingering disease, or more horrible suicide. History tells us of illustrious villains ; but there never was an illustrious miser in nature. Can wealth give happiness ? Look round, and see What gay distress ! what splendid misery ! Whatever Fortune lavishly can pour, The mind annihilates, and calls for more.—Young. To declaim against riches, is like a hungry man inveighing against wholesome food, and a naked man railing at warm clothing ; it is spending breath to no purpose, and one would sooner be stigmatis- ed with the character of a fool or madman, than gain belief that the harangue is more than a copy of one's countenance, or like the fox cursing the grapes that were out of his reach ; for there are so many good uses to which riches may be employed, that to. inveigh against them is to satirize upon acts of piety, beneficence, and cha- rity. But to be poor in the midst of riches is the most insupport- able kind of poverty. In vain our fields and flocks increase our store, If our abundance makes us wish for more.—Rose. A rich cotton planter in Georgia, in consequence of losing two cents in the pound on a crop of cotton, was seized with such a sad- ness of heart, that he took to his bed, and refusing to be shaved, shirted, or to take suitable nourishment, died miserably. He was a bachelor, and his estate, on appraisement, amounted to nearly one hundred thousand dollars! In York County, Pennsylvania, a farmer so wealthy as to raise one hundred bushels of clover seed on his own lands, in consequence of losing five dollars per bushel on his clover seed, that is, only get- ting seven dollars in Baltimore, after he had been offered twelve for it at home, was struck with such a deadly heart anguish, that he went into a fit of despondence, and hung himself. After his death, silver to the amount of two hundred thousand dollars, was found barrelled up in his cellar. Vain man! 'tis Heaven's prerogative To take, what it first deigned to give, Thy tributary breath: In awful expectation plac'd, Await thy doom, nor impious haste To pluck from God's right hand his instruments of death.—Wartoic. 120 ON HYGIEINE, OR THE ART Hippocrates, in his epistle to Crateva, the herbalist, gives him this advice for the cure of some rich patients, that if it were possi- ble he should cut up that weed of Covetousness by the roots, that there might be no remainder left, then he might be certain, that, together with their bodies, he might cure all the diseases of their minds. The same great and learned philosopher wished a consultation of all the physicians in the world, that they might advise together up- on the means how to cure covetousness. It is now above two thousand years ago since he had his desire ; and after him a thous- and and a thousand philosophers have employed their endeavors to cure this insatiable dropsy. All of them have lost their labors. The evil rather increases than declines under the multitude of re- medies. There have been a number, in former ages, sick of it; and this wide hospital of the world is as full of patients as ever it was. OF INTEMPERANCE. We curse not vnne—the vile excess we blame ; More fruitful than the accumulated board, Of pain and misery. For the subtle draught Faster and surer swells the vital tide ; And with more active poison than the floods Of grosser crudity convey, pervades The far remote meanders of our frame. ******* For know whate'er Beyond its natural fervor hurries on The sanguine tide; whether the frequent bowl, High-seasoned fare, exercise to toil Protracted, spurs to its last stage tir'd life, And sows the temples with untimely snow.—Armstrong. Temperance, by fortifying the mind and body, leads to happi- ness. Intemperance, by enervating them, ends in misery.—And those who destroy a healthy constitution of body by intemperance, do as manifestly kill themselves, as those who hang, poison, or drown themselves. Virtue is no enemy to pleasure; but, on the contrary, is its most certain friend. Her office is to regulate our desires, that we may enjoy every pleasure with moderation; and then our relish for them will continue. Pleasure, my friend, on this side folly lies ; It may be vig'rous, but it must be wise: And when our organs once that end attain, Each slep beyond it is a step to pain.—Cawthorn. Anacharsis, the Scythian, in order to deter young men from that voluptuousness ever attended with ill effects, applied his discourse to them in a parable, telling them that the vine of youthful gratifi- cation had three branches, producing three clusters. "On the OF PRESERVING HEALTH. I'21 first," says he, "grows pleasure; on the second, so ttishness; on the third, sadness." Struck by the powerful charm the gloom dissolve: In empty air : Elysium opens round A pleasing frenzy buoys the lightened soul, And sanguine hopes dispel your fleeting cares; And what are difficult, and what was dire, Yield to your prowess and superior stars; The happiest you of all that e'er were mad, Or are, or shall be, could this folly last. But soon your heaven is gone; a heavier gloom Shuts o'er your head: and, as the thund'ring stream Swoln o'er its banks with sudden mountain rain. Sinks from its tumult to a silent brook; So, when the frantic raptures in your breast Subside, you languish into mortal man: You sleep,—and waking, find yourself undone, For, prodigal of life,'in one rash night You lavished more than might support three days. A heavy morning comes ; your cares return With tenfold rage.—Armstrong. Drinking is undoubtedly the most miserable refuge from misfor- tune. It is the most broken of all reeds. This solace is truly short-lived ; when over, the spirits commonly sinking as much be- low their usual tone, as they had been before raised above it.— Hence, a repetition of the dose becomes necessary, and every fresh dose makes way for another, till the miserable man is rendered a slave to the bottle ; and at length falls a sacrifice to what at first, perhaps^ was taken only as a medicine. Unhappy man, whom sorrow thus and ragei Two different ills, alternately engage. Whom drinks, alas! but to forget; nor sees That melancholy, sloth, severe disease, Mem'ry confused, and interrupted thought, Death's harbingers, lie latent in the draught, And in the flowers that wreath the sparkling bowl, Fell adders hiss, and poisonous serpents roll.—Prior. « Were the pleasure of the palate lasting," says Cornaro, " there would be some excuse for inebriety; but it is so transitory, that there is scarce any distinguishing between the beginning and the ending ; whereas, the diseases it produces are very durable." O'er the dread feast malignant Chemia scowls, And mingles poison in the nectar'd bowls; Fell gout peeps grinning through the flimsy scene, And bloated dropsy pants behind unseen : Wrapp'd in his robe, white Lepra hides his stains, And silent Frenzy, writhing, bites his chains.—Darwin. The story of Prometheus seems to have been invented by physi- 16 122 ON HYGIKINE, OR THE ART cians in those ancient times when all things were clothed in hiere* glyphic, or in fable. Prometheus was painted stealing fire^from heaven, which might well represent the inflammable spirit produced by fermentation, that may be said to animate and enliven the man of clay • whence the conquest of Bacchus, and the heedless mirth and noise of his devotees. But the after punishment of those who steal his accursed fire, is a vulture gnawing the liver; which well allegorizes the poor inebriate, laboring under painful hepatic diseases. It is thus beautifully described by Darwin :— So when Prometheus braved the Thunderer's ire, Stole from his blazing throne ethereal fire, And lantern'd in his breast, from realms of day, Bore the bright treasure to his man of clay :— High on cold Caucasus, by Vulcan bound, The lean, impatient vulture flutt'ring round ; His writhing limbs in vainlie twists and strains. To break or loose the adamantine chains: The glutt'nous bird, exulting in his pangs, Tears his swoln liver with remorseless fangs. Let those who have been enticed frequently to taste spirituous li- quors, till at length they begin to have a fondness for them, reflect a moment on the danger of their situation, and resolve to make a speedy and honorable retreat. Remember that custom soon change es into habit; that habit is a second nature, more stubborn than the first; and, of all things, most difficult to be subdued. Remem- ber, that it is by little unsuspecting beginnings, that the unfortunate vice is generally contracted ; and, when once confirmed ; scarcely terminates but with life ! Learn, then, in time, to resist this be- witching spirit, whenever it tempts you. Then will you find yourself so perfectly easy without it, as at length never to regret its absence ; nay, peculiarly happy, in hav- ing escaped the allurements of such a dangerous and insidious en- emy, i Those who pride themselves on living fast, and are bent upon " a short and merry life," though, in truth, it is a short and misera- ble one, will, doubtless, spurn at these admonitions, and run head- long to their own destruction. Strange infatuation ! Can you sub- mit to such despicable bondage, and tamely give up your freedom without one generous struggle ? The present conflict, remember, is not for the fading laurel, or tinselled wreath, for which others so earnestly contend, but for those more blooming, more substantial honors, which Health, the daughter of Temperance, only can be- stow. For it is thine, O Health! and thine alone, to diffuse through the human breast that genial warmth, that serene sunshine, which glow on the cheek, shine in the eye, and animate the whole frame! But, if still you have no regard for this blessing, let me remind you of an hereafter! OF PRESERVING HEALTH. 3.23 » wTo die—to sleep—to sleep! perchance to'dream— Ay, there's the rub .'" If death were nothing, and naught after death ; If, when men died, at once, they ceas'd to be. Returning to the barren womb of Nothing, WhoVOe they sprang—then might-the wretch That's weary of the world, and tired of-life, At once give each inquietude the slip, By stealing out of being when he pleased, And by that way, whether by hemp or steel, Death's thousand doors are open. Who Could force The ill-pleased guest to sit out his full tirce. Or blame him if he goes ? Sure, he does well That helps himself as timely as he can, When able. But if there's an hereafter, And that there is, Conscience, uninfluenced, And sufFer'd to speak out, tells every man; Then must it be an awful thing to die : More horrid yet to die by one's own hand. Self-murder I dreadful deed! our island's shame, That makes her the reproach of neighb'ring state* Shall Nature, swerving from her earliest dictates Self-preservation, fall by her own act 1 Forbid it Heaven! Let not, upon disgust, The shameless hand be foully crimson'd o'er With blood of its own lord. Dreadful attempt S Just reeking from self-slaughter, in a rage, To rush into the presence of our Judge; As if we challenged him to do his worst, And heeded not his wrath.—Blair. It is an invariable law of our present condition, that every plea- sure, which is pursued to excess, converts itself into a poison. Could we expose to view the monuments of death, they would read a lecture on moderation much more powerful than any that the most eloquent writers can give. You would behold the graves, peopled with the victims of intemperance. You would behold those chambers of darkness, hung round, on every side, with the trophies of luxury, drunkenness, and sensuality. So numerous would you find those victims to iniquity, that it may be safely as- serted, where war or pestilence have slain their thousands, intempe- rate pleasure has slain its ten thousands. By unhappy excesses, how many amiable dispositions have been corrupted or destroyed! how many rising capacities and powers have been suppressed ! how many flattering hopes of parents and friends have been totally extinguished! Who, but must drop a tear over human nature, when he beholds that morning, which arose so bright, overcast with such untimely darkness ; that good humor, which once captivated all hearts; that vivacity, which sparkled in every company ; those abilities which were fitted for adorning the highest station, all sacrificed at the shrine of low sensuality; and one who was formed foi running the fair career of life in the midst 124 ON HYGIE1NE, OR THE ART of public esteem, cut off by his vices at the beginning of his course; or sunk, for the whole of it, into insignificancy and contempt. Would you extend your narrow span, And make the most of life you can; Would you, when med'cines cannot save, Descend with ease into the grave; Calmly retire like evening light, And cheerful bid the world good night ? Let temperance constantly preside Our best physician, friend, and guide! One of the Fathers justly describes the nature of this beastly vice, when he saith of it, that " It is a flattering devil; a sweet poi- son ; a delightful sin; which he thaj; hath, possesseth not himself; and he that acts it, doth not only commit a sin, but is wholly con- verted into sin; being deserted of his reason, which is at once his counsellor and guardian." A young gentleman of the most respectable parentage, being ra- ther intemperate, was urged by his parents to marry, thinking that might produce a change of his habits. He paid his addresses to a most amiable young lady, of a fair estate, to whom he was soon united in wedlock.—It was not many months after marriage, before he resumed his former habits, and what with drinking and gambling he Very soon exhausted the whole of her fortune. Execution be- ing out against him, he was compelled to keep at home, where he did nothing but get drunk and abuse his amiable wife. One night, filled with rage, he resolved to destroy her, and going at a late hour into the kitchen, where, she had been constrained to retire from his abuse, he continued his opprobrious language to her, and, notwith- standing she gave him only loving and kind words, yet he struck her over the head with a large stick, which she bore patiently, al- though it much injured her face. He still continuing to rage at her, wearied, and in great fear, she rose up and went to the door. Here he followed her with a chopping-knife in his hand, with which'he struck at her wrist, and cut her very much ; no help being near but an old woman, who durst not interpose, fearing for her own life, who prayed her mistress to stay and be quiet, hoping all would be well, and so getting a napkin, bound up her hand with it. After this, still railing and raging at his wife, he struck her on the fore- head with an iron cleaver, whereupon she fell down bleeding; but recovering herself, upon her knees she prayed unto God for the pardon of her own and her husband's sins, praying God to forgive him, as she did. But as she was thus praying, the infernal demon, her husband, split her skull open with a cleaver, so that she died immediately: for which he was apprehended, condemned, and hanged. But so callous was the wretch, that even under the gal- lows he did not exhibit any marks of repentance. It is a lamentable fact, so great is the infatuation of this vice, that few, once deluded, have ever recovered their freedom. Some gk> OF PRESERVING HEALTH. 125 rious instances, however, have occurred, which are surely fine en- couragement to others. We also have the pleasure to find none are greater enemies to vice, than those who formerly were the slaves of it, and have been so fortunate as to break their chain and recover their liberty. A medical gentleman in Virginia, who was married to a.most amiable lady, by associating with dissipated characters,.became, at length, intemperate himself. As soon as he acquired habits of in- temperance, his disposition was altered, and from an affectionate husband he proved very turbulent, and treated his wife so ill that she was constrained to separate from him. After Jiving a disorder- ly life for some time, he was brought to a sense of reflection, and with an entire change of mind and manners, [he renounced all vicious habits, pleaded guilty before his amiable wife, who was rea- dy to forgive, and they have since lived in the utmost harmony. So sensible is he of the danger of using spirituous and vinous li- quors to excess, that he will not taste them, lest he should be entic- ed to exceed the bounds of moderation ; and whenever he sees a person so inclined, never fails to caution him against so insidious an enemy. A gentleman of Maryland, addicted to drunkenness, hearing a considerable uproar in his kitchen one night, felt the curiosity to step without noise to the door, to know what was the matter; when, behold, they were all indulging in the most unbounded roars of laughter, at a couple of his negro boys, who were mimicing himself in his drunken fits !—^as, how he reeled and staggered ! how he looked and nodded, hickuped and tumbled! The pictures which these children of nature drew of him, and which had filled the rest with such inexhaustible merriment, struck him with so sal- utary a disgust, that from that night he became a perfectly sober man, to the inexpressible joy of his wife and children. A very respectable gentleman in Philadelphia had a wife, who, by her fondness for strong drink, had almost broken his heart. At length he was advised, "as a desperate remedy in a desperate dis- ease," to place a barrel of spirits in her closet, and let her kill her- self as soon as possible, since every persuasive means had been used in vain to break her of this beastly vice. At the sight of so extraordinary a visitant in her closet, she was struck with such hor- ror at the idea of the dreadful design on which it was placed there, that she was immediately reclaimed, and recovered all the purity and lustre of her former character, to the infinite joy of her hus- band, children, and numerous friends. O Temperance! support and attendant of other virtues ! Pre- server and restorer of health ! Maintainer of the dignity and lib- erty of rational beings, from the wretched, inhuman slavery of Sen- suality, Taste, Custom, and Example! Brightener of the under- standing and memory! Sweetener of life and all its comforts! Companion of reason, and guardian of the passions ! Bountiful re- \ 26 ON HVGIEINE. OR THE ART warder of thy admirers and followers! how do thine excellencies extort the unwilling commendation of thine ™me^J"d™^ what rapturous delight can thy friends raise up a panegyric m thy praise OF GAMING. The love of gaming is the worst of ills! With ceaseless storms the blacken'd soul it fills ; Inveighs at Heaven, neglects the ties of blood Destroys the power and will of doing good ; Kills health, pawns honor, plunges in disgrace, And, what is still more dreadful—spoils her face.—Young. While gaming keeps within the bounds of innocent diversion, to recreate the body, or compose the mind, and is not tainted with covetousness or passion, the most straight-laced casuist will not censure or Condemn it as a crime ; but, when it breaks the limits of moderation, and transports men into heats, swearing, cursing, re- proaching, and lying; or is taken up as a trade to live by, and pushed on by a covetous desire to enrich ourselves by the loss and ruin of one's neighbor, it is absolutely unlawful, carefully to be avoided, and utterly abominated, as the certain procurer of repen- tance, sorrow, grief, disease, derision, beggary, and contempt. To play sometimes to entertain company, says the Marquis of Halifax, or to divert yourself, is not to be disallowed; but, to do it so often as to be called a gamester, is to be avoided, next to the things that are most criminal. It has consequences of several kinds not to be endured; it will engage you into a habit of idleness and ill hours, draw you into bad company, make you neglect your business, bring you to poverty and disgrace, and cause sleepless nights, and destroy health. What fool would trouble fortune more, When she has been too kind before ; Or tempt her to take back again What she had thrown away in vain, _ By idly venturing her good graces To be disposed of by umes-aces; Or settling it in trust, to uses Out of his power, on trays and deuces; To put it to the chance, and try, F th' ballot of a box and die, Whether his money be his own, And lose it, if he be o'erthrown; As if he were betray'd, and set By his own stars to every cheat, Or wretchedly condemned by Fate To throw dice for his own estate.—Buti.ER. It is true, as it is lamentable in the age in which we live, there OF PRESERVING HEALTH. 127 are too many of all qualities and conditions excessively addicted to this abominable vice ; by which many respectable families have been reduced from affluence to extreme poverty. But the evil does not stop here: it must be fresh in every memory, of the most dia- bolical acts having been perpetrated by persons who enlisted under the banners of a gambler, and squandered away their estate. Let the follow melancholy catastrophe, which I have from the best au- thority not long since took place, prove a warning to others. Mr. A. S——, who had a very comfortable support, was enticed to associate himself with gamblers, and in a short time lost all that he possessed, at cards and dice, which ought to have been treasur- ed up for the subsistence of his family. Reflecting on the foolish manner in which he had thrown away his money, and beholding his children cry about him for victuals, so diseased his mind, that taking advantage of his wife's absence, he cut the throats of his three children, and then hung himself. His wife, on returning: home being so much affrighted at the sight of so barbarous a tra- gedy, fell dead upon the spot. An old ruined gamester, in hopes to make a bubble or prey of a young gentleman that came to town with his pockets full of mo- ney, took him to a gaming-house, and there, to encourage him to play, showed him several topping sparks that were born to no for- tune, who by play had purchased great estates, and lived in pomp and splendor, by success in shaking their elbows—" You show me '* says the young gentleman, " the winners, but I pray what has be- come of the losers ?" To which the old prig making no reply a third person, overhearing their conversation, told the young gentle- man, that since the other was silent and confounded with shame at the question, he would oblige him with an answer—" Many of the losers, saith he, "taking the highway to repair their losses, have been hanged ; others have gone to sea to earn their bread - some have taken up the trade of being bullies to bawdy-houses • others that have not hid themselves as servants under a livery' are begging or mumping about the streets, or starving in jails for debt, where you will be ere long, if you follow that rascal's counsel. " The punishment," says the young gentleman, is fit for the sin, when men, possessed with great sums of their own money, will play the fool to make it another man's; and, if this be the humor of the town, I will return again to the country, and spend my estate among my neighbors and tenants, where you sir " speaking to the gentleman that dealt so plainly with him « shall be very welcome." ' 128 ON HYGIEINE, OR THE ART OF VANITY. So weak are human kind by Nature made Or to such weakness by their vice betray'd ; Almighty Vanity ! to thee they owe Their zest of pleasure, and their balm of wo.—Young. Vanitv consists of an agreeable reverie; and is well ridiculed in the story of Narcissus, who so long contemplated his own beautiful image in the water, that he died from neglect of taking sustenance. « On the green margin sits the youth, and laves His floating train of tresses in the waves ; Sees his fair features paint the streams that pass, And bends for ever o'er the watery glass.—Darwin. As the vain found their claims on qualities which they do not possess, they frequently meet with mortifications ; while their ex- treme solicitude for distinctions they are not entitled to, can never allow them any repose ; hence, vanity is an enemy to health. Observe a lady at a ball, anxious to be thought the finest woman in the assembly, and doubtful of success. The pleasure, which it is the purpose of the assembly to enjoy, is lost to her. She does not for a moment experience such a sensation ; for it is totally ab- sorbed by the prevailing sentiment, and the ^>ains she takes to con- ceal it. She watches the looks, the most trivial marks of the opi- nion of the company, with the attention of a moralist, and the anx- iety of a politician ; and wishing to conceal from every eye the tor- ment she feels, her affectation of gaiety at the triumph of a rival; the turbulence of her conversation when that rival is applauded; the over-acted regard which she expresses for her ; and the unne- cessary efforts which she makes, betray her sufferings and constraint. Grace, that supreme charm of beauty, never displays itself but when the mind is perfectly at ease, and when confidence prevails. If we take the whole sex together, we shall find those who have the strongest possession of men's hearts, are not always eminent for their beauty. As pride destroys all symmetry and grace, so affec- tation is a more terrible enemy to fine faces than the small-pox. And it will always be found, that the lady who has an humble opi- nion of herself, will have every body's applause, because she does not expect it; while the vain creature loses approbation through too great a sense of deserving it, by her own affectation. If a beautiful, proud, and gay woman, would but seriously reflect what a loathsome carcass she must ere long become in the grave, amidst worms and corruption, it would tend to mortify her pride, lessen her vanity, and teach her to be humble. Te proud, ambitious, wealthy, young, and gay, Who drink the spirit of the golden day, And triumph in existence, come with me, OF PRESERVING HEALTH! 129 And in the mould'ring corpse your picture see, What you, and all, must soon or later be.—Solitary Walks. " Pride, well placed and rightly defined, is of ambiguous signi- fication," says the late incomparable Marquis of Halifax : " one kind being as much a virtue as the other a vice." But we are na- turally so apt to choose the worst, that it has become dangerous to commend the best side of it. Pride is a sly, insidious enemy, that wounds the soul unseert, and many, who have resisted other formidable vices, have been ruined by this subtle invader; for, though we smile to ourselveSj at least ironically, when flatterers be- daub us with false encomiums; though we seem many times angry, and blush at our praises -% yet our souls inwardly rejoice ; we are pleased with it, and forget ourselves. Some are proud of their qua- lity, and despise all below it; first, set it up for the idol of a vain imagination, and then their reason must fall down and worship it. They would have the world think, that no amends can be made for the want of a great title. They imagine; that with this advantage, they stand upon the higher ground, which makes them look down upon merit and virtue as things inferior to them. Some, and most commonly women, are proud of their fine clothes; and when they have less wit and sense than the rest of their neighbors, comfort themselves with the reflection that they have more lace. Some la- dies put so much weight upon ornaments, that, if one could see into their hearts, it would be found that even the thought of death was made less heavy to them,, by the contemplation of their being laid out in state, and honorably attended to the grave. The man Of letters is proud of the esteem the world gives him for his know- ledge ; but he might easily cure himself of that disease, by consid- ering how much learning he wants. The military man is proud of some great action performed by him, when possibly it was more owing to fortune than his own valor or conduct: and some are proud of their ignorance, and have as much reason to be so as any of the rest; for they being also compared with others in the same character and condition, will find their defects exceed their acqui- sitions. O, sons of earth ! attempt ye still to rise, By mountains piled on mountains to the skies? Heaven still with laughter the vain toil surveys, And buries madmen in the heaps they raise.—Pope. A person of infinite wit, speaking of what might precisely be call- ed a proud and vain man, once said, " When 1 see him, I feel something like the pleasure of seeing a happy couple; his self- love and he live so happily together." " Pride was not made for men : a conscious sense Of guilt, and folly, and their consequence, Destroy the claim, and to beholders tell, Here nothing but the shape of manhood dwells." 17 130 ON HYGIEINE, OR THE ART " I once saw," says Dr. Darwin, " a handsome young man, who had been so much flattered by his .parents, that his vanity rose so near to insanity, that one might discern, by his perpetual attention to himself, and the difficulty with which he arranged his conversa- tion, that the idea of himself intruded itself at every comma, or pause of his discourse." I dreampt that, buried with myJellow clay, Close by a common beggar's side I lay; And as so mean an object shock'd my pride, Thus, like a corpse of consequence, I cried: " Scoundrel, begone! and henceforth touch me not, More manners learn, and at a distance rot." " Scoundrel, thou," with haughtier tone, cried he, " Proud lump of earth, I scorn thy words and thee ; Here all are equal, now thy case is mine, This is my rotting place, and that is thine."—Dodd. The cure of vanity may be attempted by excess of flattery, which will at length appear ridiculous, or, by its familiarity, will cease to be desired. " I remember," says Dr. Darwin, " to have heard a story of a nobleman, in the court of France, who was so disagree- ably vain in conversation, that the King was pleased to direct his cure, which was thus performed. Two gentlemen were directed always to attend him ; one was to stand behind his chair, and the other at a respectful distance before him : whenever his lordship be- gan to speak, one of them always pronounced, " Lord Galhmaufre is going to say the best thing in the world." And, as soon as his lordship had done speaking, the other attendant pronounced,': Lord Gallimaufre has spoken the best thing in the world." Till, in a few weeks, this noble lord was so disgusted with praise, that he ceased io be vain, and his majesty dismissed his keepers. OF MODESTY. Hail, Modesty! fair female honor hails! Beauty's chief ornament, without whose charms, Beauty disgusts, or gives but vulgar joys. Thou giv'st the smile its grace; the heightened kiss Its balmy essence sweet!—Armstrong. Modesty is to virtue, what a fine veil is to beauty. It is one of the most distinguishing and attractive characteristics of the female sex. It comprises the beauties of the mind, as well as those of the body ; and it not only heightens the desire of the male, but deters him from rudeness and improper behavior. It is, therefore, the in- terest of the men to cherish, and not to injure, by indelicacy, aqua- Jity from which they derive so much pleasure and advantage. OF PRESERVING HEALTH. 131 Naked in nothing should a woman be, But veil her very wit with modesty; • Let man discover, let not her display, But yield her charms of ,mind without delay.—Young. " I remember," says a female author of great distinction, " the Count M-----, one of the most accomplished young men in Vien- na, when I was there; he was passionately in love with a girl of peerless beauty. She was *the daughter of a man of great rank and influence at court; and, on these considerations, as well as in regard to her charms, she was followed by a multitude of suitors. She was lively and amiable, and treated them all with an affability which still kept them in her train, although it was generally known that she had avowed a predilection for the count, and that prepara- tions were making for their nuptials. The count was of a refined mind and delicate sensibility ; and loved her for herself alone ; for the virtues which he believed dwelt in her beautiful form ; and, like a lover of such perfections, he never approached her without timidity; and when he touched her, a fire shot through his veins that warned him not to invade the vermilion sanctuary of her lips Such were his feelings, when, one night, at his intended father-in law's, a party of young people were met to cerebrate a certain fes- tival ; several of the young lady's rejected suitors being present. Forfeits were one of the pastimes, and all went on with a grateful merriment, till the count was commanded, by some witty mademoi- selle, to redeem his glove by saluting the cheek of his intended bride. The count blushed, trembled, advanced to his mistress, re- treated, advanced again—and at last, with a tremor that shook ev- ery fibre in his frame, with a modest grace, he put the soft ringlets, which played upon her cheek, to his lips, and retired to demand his redeemed pledge, in evident confusion. His mistress gaily smil- ed, and the game went on. One of her rejected suitors, but who was of a merry, unthinking disposition, was adjudged by the same indis- creet crier of the forfeits, to snatch a kiss from the lips of the ob- ject of his recent vows. A lively contest between the lady and gentleman lasted for a minute ! but the lady yielded, though in the midst of a convulsive laugh ; and the count had the mortification, the agony to see the lips, which his passionate and delicate love would not allow him to touch, kissed with roughness by another man, and one whom he despised. Without a word, he rose from his chair, and left the room, and the house—and never saw her more! Thus, by that good-natured kiss, the fair boast of Vienna lost a husband and her lover." Although I consider this act of the count as ridiculously fastidi- ous, yet I cannot but think it may prove a good hint to my fair readers. Certainly the sensitive plant cannot shrink more coyly, than should the lovely virgin from the slightest touch of the im- modest. 13* OM HYGIE1NE, OR THE ART "Learn, then,ye fair, to keep the person gacred : * * # * * * like the pure mind, Be that array'd in modest dignity: Nor e'en its beauties flauntingly expose— Thus may ye keep the heart your charms have won." The attractive grace and powerful charm of Modesty cannot be better illustrated, than by relating the following interesting narra- tive :— Charlotte Corday was tall and well-shaped, of the most grace- ful manners and modest demeanor. There was in her counte- nance, which was beautiful and engaging, and in all her movements a mixture of softness and dignity, which were evident indications of a heavenly mind. She came to Paris, and, under a feigned pre- text, gained admission to that republican tyrant, Marat, in whose breast she plunged a dagger, acknowledged the deed, and justified it by asserting that it was a duty she owed her country and man- kind, to rid the world of such a monster. Her deportment during her trial was modest and dignified.—There was a softness so en- gaging in her countenance, that it was difficult to conceive how she could have armed herself with sufficient intrepidity to execute the deed. Her answers to the questions of the tribunal, were full of point and energy. She sometimes surprised the audience by her wit, and excited their admiration by her eloquence. Her face sometimes beamed with sublimity and was sometimes covered with smiles,. She retired while the jury deliberated on their verdict; and when she again entered the tribunal, there was a majestic so- lemnity in her demeanor, which perfectly became her situation. She heard her sentence with attention and composure, and left the court with serenity, her mind being long before prepared even for the last scene. It is difficult to conceive the heroism which she displayed in the way to execution. There was such an atr of chas- tened exultation thrown over her countenance, that she inspired sentiments of love, rather than pity. The spectators, as she pass* ed, uncovered their heads before her, and others gave loud tokens of applause. She ascended the scaffold with undaunted firmness. When the executioner informed her that her feet must be tied to the fatal plank, she submitted with a smile. When he took off her handkerchief, the moment before she bent under the fatal stroke, she blushed deeply; and her head, which was held up to the mul- titude the moment after, exhibited the last impression of offended modesty. Such an instance of a young female, given up to destruction, and yet so tremblingly alive to modesty, that even in her last moments she resents the slightest insult to that, more than she dreads the ex- ecutioner's axe, is a display of the charm, as well as the force of virtue triumphant over death, that deserves to be preserved in ev- erlasting remembrance. Its effects on the crowd beggared all de- scription,. Admiration held the gazing thousands mute. And OF PRESERVING HEALTH. 13S though, while gazing on her cheeks yet divinely enriched with the blush of deathless modesty, they shed their tears over her untimely fate, still their joy-glistening eyes seemed to thank her for such a proof of the divinity of virtue, and the birth-right to heaven. One of the spectators, a young man, by the name of Lux, had his feel- ings wrought to such an adoration of her virtues, that he proposed, in a pamphlet published the day after, to erect a monument to her honor, and to inscribe it with these words :—GREATER THAN BRUTUS. He was instantly sentenced to the guillotine. He re- ceived the news with joy, and died exulting that he had the honor of being offered up at the same altar with Jhe immaculate Charlotte Corday. As lamps burn silent, with unconscious light, So modest ease, in beauty, shines most bright: Unaiming charms with edge resistless fall, And she who means no mischief, does it all.—Hill. Plutarch observes, that as thistles, though noxious things in them- selves, are usually signs of an excellent ground wherein they grow, so bashfulness, though many times a weakness and betrayer of the mind, is yet generally an argument of a soul ingenuously and virtu- ously inclined. We read of many, who, through modesty and fear, when they were to speak publicly, have been so disappointed, that they were forced to hold their tongue. Thus, Cicero writes of Cario, that be- ing to plead in a cause before the senate, he was not able to speak what he had premeditated. Also, Theophrastus being to speak be- fore the people of Athens, was on a sudden so deprived of memory,^ that he remained silent. The same happened to the famous De- mosthenes in the presence of King Philip. Nor are we ignorant that the like misfortunes have befallen many excellent persons in our times. Get that great gift and talent, Impudence, Accomplish'd mankind's highest excellence; 'Tis that alone prefers, alone makes great, Confers alone, wealth, titles, and estate ; Gains place at court, can make a fool a peer, An ass a bishop, can vil'st blockhead rear To wear red hats, and sit in porph'ry chair.—Oldham. When once men have bid adieu to modesty, there is nothing so unmanly, indecent, or reprehensible ; but the brazen brow will ven- ture upon ; and nothing so high or great that his impudence does not pretend a title to. . . A gentleman being asked how it came to pass, that he, being a man of extraordinary natural parts, and those improved by a uni- versity education, foreign travel, diligent study, and the knowledge of most European languages ; besides being well born, and having 134 ON HYGIEINE, OR THE ART many friends to recommend him, missed a considerable employment in the government, at a time when there were so many vacancies? the gentleman answered, " The reason is plain ; I have too much modesty, and too little impudence, to be preferred, where a higher value is put upon the latter than the former." For he that has but impudence, To all things has a fair pretence ; And put among his wants bat shame, To all the world may lay his claim.—Hudibras. •» An Athenian, of decrepit age, came into the theatre at Athens, on a public night, when it was very much crowded. He went to that part of the house where his young countrymen were sitting; but, instead of making room for him, they closed their ranks. By chance he came to a place where sat some young Lacedemonians of the first distinction, who, moved with the age of the man, in rev- erence to his years and hoary hairs, rose up, and placed him in an honorable seat amongst them ; which, when the people beheld, with a loud applause, they approved the modesty of another city. At which one of the Lacedemonians said, " It appears that the Athe- nians do understand what ought to be done, but they neglect the practice of it." These young Lacedemonians were heathens. How devoutly were it to be wished, that all young Christians would copy so fair an example, and learn to treat seniority with a respect equally ami- able and endearing. OF DRESS. If the rude verse that now detains your ear, Should to one female heart conviction bear; Recall one gentler mind from Fashion's crew, To give to Nature what is Nature's due; Whilst others mount the arduous heights of fame, To wake your feelings be my nobler aim: Nor you unblest, if, whilst I fail to move, The fond attempt my kind intention prove.—Roscoe. Pliny, one of the most celebrated naturalists of antiquity, pa- thetically laments, that, " whilst Nature has given various clothing to the brute creation, and even fenced plants and trees with bark against the injuries of the cold and heat, she should have cast man into this world naked, unprovided against the inclemency of differ- ent climates and seasons." But, instead of agreeing with that phi- losopher, that Nature has, in this particular, acted more like a cru- el step-mother, than a kind and indulgent parent to man, we can- not sufficiently extol her providence and wisdom. It was no more than consistent with equity to provide the irrational part of her works with clothing suitable to their circumstances; but man, whom OF PRESERVING HEALTH. 135 she endued with the transcendent faculty of reason, she hath very wisely left to accommodate himself to the difference of season and climate, and to clothe himself, accordingly, with the fleeces and skins of animals, and the products of various plants and trees. Nature knows no other use of clothes but to keep the body warm. The shape God has given, is too often attempted to be mended by dress; and those who know no better, believe that mankind would be frights without its assistance. The bones of growing persons are so cartilaginous, that they readily yield to the slightest pressure, and easily assume the mould in which they are confined. Hence it is that so many girls, in proportion to boys, are misshapen. A lady, whose girls were all misshapen, though her family was numerous, consulted the celebrated anatomist, Mr. Cline, on the prevention. " To have no stays—and to let the next girl run about like the boys," was the excellent advice of this gentleman \ which being complied with, none of the future children were after- wards marred by the ill-placed attention of the ignorant mother. " It has been said," observes a celebrated female author, " that the love of dress is natural to the sex;" and we see no reason why any female should be offended with the assertion. Dress, however, to be consistent with the graces and with nature, must be subject to certain rules. By attending to these particulars, is produced that agreeable exterior which pleases we know not why; which charms, even without that first and powerful attraction, beauty. " A beauty, carelessly array'd, Enamors more, than if display'd. All woman's charms were given, And o'er the bosom's vestal white, • The gauze appears a robe of light, That veils, yet opens heaven." Fashion, in her various flights, frequently soars beyond the reach of propriety. Good sense, taste, and delicacy, then make their appeal in vain. Her despotic and arbitrary sway levels and con- founds. Where is delicacy ? where is policy ? we mentally ex- claim, when we see the fair inconsiderate votary of fashion expos- ing, unseemly, that bosom which good men delight to imagine the abode of innocence and truth. Can the gaze of the voluptuous, the unlicensed admiration of the profligate, compensate the woman of sentiment and purity, for what she loses in the estimation of the moral and just ? But, delicacy apart, what shall we say to the blind conceit of the robust, the coarse, the wanton fair one, who thus 1 obtrudes the ravages of time upon the public eye ? Nature having maintained a harmony between the figure of a ; woman and her years, it is decorous that the consistency should ex- • tend to the materials and fashion of her apparel. For youth to : dress like age, is an instance of bad taste seldom seen. But age affecting the airy garment of youth, the transparent drapery of Cos, 136 ON HYGIEINE, OR THE ART and the sportiveness of a girl, is an anachronism, as frequent as it is ridiculous herself with taste obeya Vir5mf^fcreation that of increasing her charms in the eyes a? 6 virtuousloverVor the husband of her bosom. She is ap- p oved But whenThe wrinkled fair, the hoary-headed mat™ Ltemnts to equip herself for conquest, to awaken sentiments which, t^oomoTher cheek gone, her rouge cari never arouse; then tcannoTbutderide her folly. There is a mediocrity which bounds rrthnigs and even fixes the standard which divides virtue from bombast * ***** * "Loveliness Needs not the foreign aid of ornament; But is, when unadorn'd, adorn'd the most.' It is worthy of remark, an unaffected beauty carries with it a re- spect and superiority that proceeds from the impulse of nature, and not from the artifice of those that have it. "Taste " says Dr. Knox, " requires a congruity between the in- ternal character, and the external appearance."—Another author, the discriminating Chesterfield, observed that «.A prepossessing exterior is a perpetual letter of recommendation. Hence we see that the desire of exhibiting an amiable extenor is essentially requisite in women. It is to be received as an une- quivocal symbol of those qualities/which we seek in a wife ; it indi- cates cleanliness, sweetness, a love of order, and universal proprie- ty What then, is there to censure in a moderate consideration ot dress? Nothing. We may blame, when we find extravagance, profusion, misappropriation) the tyranny of fashion; slavery to va- nity ; in short, bad taste 1 Fashions, like manners, still from courts descend, And what the great begin, the vulgar end. Honor's a mistress all mankind pursue ; Yet most mistake the false one for the true : Lur'd by the trappings, dazzled by the paint, We worship oft the idol for the saint. Courted by all, by few the fair is won; Those lose who seek her, and those gain who shun. Naked she flies to merit in distress, And leaves to courts the garnish of her dress. Although we cannot suppose prodigality in dress would re- tommend the wearers to persons of sense ; yet we consider that a decent habit, proportioned to one's quality and business, is essen- tially necessary. Philopaemon, commonly called the Great, was a person of very mean aspect, and one, that took no care to set himself off with decent apparel, by which means he was often affronted by such people as could not distinguish the man from his clothes. He OF PRESERVING HEALTH. 137 sent notice to one of his friends in Megara that he would take a supper with him ; who went immediately to market to provide an entertainment, and requested his wife, in the mean time, to right up the house, that it might be fit to entertain so noble a guest.— Philopasmon, it seems, made greater haste than his attendants; and the wife of the house, by the meanness of his dress, taking him to be a servant, employed him in cleaving wood for the fire, which he was busy at when his friend returned from the market; who, being astonished at the sight, said, " Why does my great friend Philo- paemon dishonor himself and me, by stooping to so mean an office ?" The great man, with a cheerful and smiling countenance, answer- ed, " I am taking penance for my homely face and bad apparel." Though we cannot hope entirely to escape the unpleasant sensa- tions, or altogether to ward off the fatal effects, occasioned by the sudden changes of our climate ; yet, considering properly the na- ture of clothing, we may avoid much of the danger. If ladies be more subject to catch cold frequently than men, it is not alone their delicacy of constitution, or their being more confined within doors; but the frequent changes they make in the quality and quantity of their garments, and sometimes, however fearful of a partial current of air, because they expose those parts of the body that a little be- fore had been warmly clad. " If," says Dr. Beddoes, " a greater proportion of females fall victims to consumption, is it not because, losing sight more than men of its primary purpose, they regulate their dress solely by fantastic ideas of elegance ?" After the high encomiums bestowed upon flannel by so many re- spectable authors, both ancient^and modern, and by persons who, from long experience, have ascertained its beneficial effects, it is surprising that any individual should be whimsical or hardy enough to dispute its general salubrity, merely with a view to establish his favorite hypothesis. It has been objected, that flannel worn next the skin is debilitat- ing, because it too much increases perspiration ; but this is not founded on truth, since perspiration, as long as the skin remains dry, never can be hurtful. In answer to another objection against the wearing of flannel, it is certain that a flannel shirt may preserve the body as clean, and much cleaner, than linen, if as frequently changed. To cold, phlegmatic temperaments ; to all who lead a sedentary life ; to individuals subject to catarrhs, or frequent colds, gout, diarrhoea, and partial congestions of the blood; to all nefvous pa- tients and convalescents from severe chronic disorders; to persons who are too susceptible of the impressions of the atmosphere; and, lastly, in such climates and pursuits of life, as are exposed to fre- quent and sudden changes of air, the wearing of flannel next to the skin is certainly a salutary dress. It will also be found a better pre- ventive of contagion than any other; because while it encourages per- spiration, it at the same time removes the inhaled poisonous parti- 18 138 ON HYGIEINE, OR THE ART cles. It is a mistaken notion that flannel is too warm a clothing for summer. I have never found the least inconvenience from wearing it during the hottest weather; but, on the contrary, have experienc- ed the greatest advantage. A celebrated author's favorite recipe for health was, " to leave off flannel on mid-summer day, to resume it the day following." To keep an animal in health, beside the retaining of a due de- gree of animal heat, there must be a continual generation of new juices, and a perpetual discharge of the old. Without the due quantity of perspiration, which, with us, depends very rnuch on our clothing, neither the vegetable nor animal can continue in health. A plant, whose perspiration is stopped, becomes sickly and dies. Even an egg, whose shell has been covered with a var- nish, and the perspiration stopped, will-produce no animal. Whilst treating on clothing, I would recommend it to every per- son to be careful in observing that the linen which they put on, and the sheets in which they sleep be properly dried. Due care should also be taken to change the stockings, and other clothmg, as speed- ily as possible, after their becoming wet from exposure to rain or snow. Those who neglect these cautions will expose themselves either to rheumatism, fever, pleurisy, cough, consumption, or some other disease of a dangerous or even fatal nature. OF CLEANLINESS. The grand discharge, of the effusion of the skin, Slowly impair'd, the languid maladies Creep on, and through the sick'ning functions steal; As, when the chilling east invades the spring, , The delicate Narcissus pines away In hectic languor; and a slow disease Taints all the family of flowers, condemned To cruel heav'ns. But why already prone To fade should beauty cherish its own bane! O shame I O pity ! nipt with pale quadrille, And midnight cares, the bloom of Albion dies.—Armstrong. Cleanliness may be considered the grand secret of preserving beauty as well as promoting health ; and, therefore, is applicable to all ages and sexes. It maintains the limbs in their pliancy; the skin in its softness ; the complexion in its lustre; the eyes in their brightness; the teeth in their purity; and the constitution in its fairest vigor. The frequent use of tepid baths is not more grateful to the sense, than it is salutary to health, and to beauty. By such ablutions all - impurities are thrown off: cutaneous obstructions removed; and, while the surface of the body is preserved in its original brightness, many threatening disorders are put to the rout. Indeed, so impor- tant is this regimen, that every family should make a bathing vessel as indispensable an article in the house as a table. OF PRESERVING HEALTH. 139 Against the rigors of a damp, cold heaven, To fortify their bodies, some frequent The gelid cistern, and, where naught forbids, I praise the dauntless heart. ***** With us, the man of no complaint demands The warm ablution, just enough to clear The sluices of the skin ; enough to keep The body sacred from indecent soil. Still to be pure, ev'n did it not conduce, As much it does, to health, were greatly worth Your daily pains. 'Tis this adorns the rich; The want of this is poverty's worst wo— With this external virtue, age maintains A decent grace; without it, youth and charms Are loathsome. This the venal graces know ; So, doubtless, do your wives ; for married sires As well as lovers, still pre,tendto taste ; Nor is it less, all prudent wives can tell, To lose a husband's thaiNa lover's heart.—Armstrono. Cleanliness is certainly agreeable to our nature. It sooner attracts our regard than even finery itself, and often gains esteem where that fails. It is an ornament to the highest, as well as the lowest situation, and cannot be dispensed with in either. " I had occasion," says the author of the Spectator, " to go a few miles out of town, some days since, in a stage-coach, where I had, for my fellow-travellers, a dirty beau, and a pretty young quaker woman. Having no inclination to talk much, I placed myself back- ward, with a design to survey them, and to pick a speculation out of my two companions. Their different figures were sufficient to draw my attention. The gentleman was dressed in a suit, the ground whereof had been black, as I perceived from some few spaces that had escaped the powder which was incorporated with the greatest part of his coat; his periwig, which cost no small sum, was after so slovenly a manner cast over his shoulders, that it seem- ed not to have been combed since the year 1682; his linen, which was not much concealed, was daubed with plain Spanish, from the chin to the lowest button, and the diamond upon his fin- ger, which naturally dreaded the water, put me in mind how it sparkled amidst the rubbish of the mine where it was first disco- vered. " On the other hand, the pretty quaker appeared in all the ele- gance of cleanliness. Not a speck was to be found upon her. A clean, oval face, just edged about with little thin plaits of the purest cambric, received great advantage from the shade of her black hood; as did the whiteness of her arms from that sober-colored stuff in which she had clothed herself. The plainness of her dress was very well suited to the simplicity of her phrases ; all which, put together, gave me an exalted sense of both her good taste and her pure innocence. * 140 ON HYGIF.INE, OR THE ART " This adventure occasioned my throwing together a few hints upon cleanliness, which f shall consider as one of the half virtues, as Aristotle calls them, and shall recommend, under it, the three following heads:—As it is a mark of politeness ; as it produces re- gard ; and as it bears analogy to purity of mind. " First, it is a mark of politeness. It is universally agreed upon, that no one unadorned with this virtue, can go into company with- out giving a manifest offence. The easier or higher any one's for- tune is, this duty rises proportionally. The different nations of the world are as much distinguished by their cleanliness, as by their arts and sciences. The more any country is civilized, the more they consult this part of politeness. We need but compare our ideas of a female Hottentot and an English beauty, to be satisfied of what has been advanced. " In the next place, cleanliness may be said to be the foster-mo- ther of love. Beauty, indeed, most commonly produces that pas- sion in the mind, but cleanliness preserves it. An indifferent face and person, kept in perpetual neatness, has won many a heart from a pretty slattern. Age itself is not unamiable, while it is preserved clean and unsullied ; like a piece of marble constantly kept clean and bright, we look on it with more pleasure than a new vessel that is cankered with rust. " We might observe farther, that as cleanliness renders us agree- able to others, so it makes us easy to ourselves; that it is an excel- lent preservative of health, and that several vices, destructive both to mind and body, are inconsistent with the habit of it.—We find, from experience, that through the prevalence of custom, the most vicious actions lose their horror by being made familiar to us. On the contrary j those who live in the neighborhood of good exam- ple, fly from the first appearance of what is shocking. It fares with us much after the same manner as to our ideas. Our senses, which are the inlets of all the images conveyed to the mind, can only trans- mit the impressions of such things as usually surround them. So that pure and unsullied thoughts are naturally suggested to the mind by those objects that perpetually encompass us, when they aie beautiful and elegant ii* their kind." OF PATRIOTISM. Man, through all ages of revolving time, Unchanging man, in every varying clime, Deems his own land, of every land the pride, Belov'd by Heaven o'er all tin world beside, His home a spot of earth supremely blest, A dearer, sw#eter spot than all the rest.—Montg'omerv. Patriotism, properly defined, is the love of the laws and of the OF PRESERVING HEALTH. • 141 commonwealth. It is a sentiment which makes us prefer the inte- rest of the public to our own. At the very name of country, the wise and brave feel an enthusiasm which renders them invincible. Patriotism also contributes greatly to the promotion of good mo- rals ; and, hence, to health and every other blessing, both private and public. Rome, Athens, and Lacedaemon, owed all their glory to patriotism ; and their nothingness to their forgetfulness of their country, their laws, and morals. Happy if these awful lessons, read to us in the examples of the great republic of antiquity, could but avail to kindle among ourselves that divine patriotism which once exalted them to such glory among the nations. Among innumerable other blessings, health would then be promoted. For the noble virtues of the soul, constitut- ing patriotism, as magnanimity, disinterestedness, valor, and con- sciousness of doing our duty, would diffuse through the heart that habitual complacency and joy most friendly to health; which would be still farther promoted by that simplicity of manners, and activity of life, which belong to republicans. Whereas, on the contrary, in proportion as national patriotism decays, health becomes enervated by luxury and other vices, which are sure to overspread a nation that has lost the animating fire of patriotism. John II., king of Portugal, who, for the nobleness of his mind, was worthy of a greater kingdom, when he heard there was a bird called the pelican, that tears and wounds her breast with her bill, that with her own blood she may restore her young ones to life, when left as dead by the bitings of serpents, this excellent prince took care that the figure of this bird, engaged in this action, should be added to his other royal devices; that he might hereby show, that he was ready, upon occasion, to part with his own blood for the welfare and preservation of his people and country. Pity it is to conceal their names, whose minds have been, in this respect,- as pious and princely as his, not fearing to redeem the lives of their fellow-citizens at the price of their own. Themistocles, the Athenian general, after his many famous ex- ploits, was banished the country, and sought after to be slain. He chose, therefore, to put himself into the power of the Persian king, his enemy, rather than to expose himself to the malice of his fel- low-citizens. He was by him received with great joy ; insomuch that the king, in the midst of his sleep, was heard to cry out thrice aloud, " I have with me Themistocles, the Athenian." He, also did him great honor, for he allotted him three cities fcr his table provisions, and two others for the furniture of his wardrobe and bed. While he remained in that court with such splendor and dignity the Egyptians rebelled, encouraged, and also assisted by the Athe- nians. The Grecian navy had come as far as Cyprus and Cilicia • and Cimoh, the Athenian admiral, rode master at sea. This caused the Persian king to levy soldiers, and appoint commanders to re- press them. He also sent letters to Themistocles, then at Ma°ne- 142 ON HYGIEINE, OR THE ART sia, importing that he had given him the supreme command in that affair, and that he should now be mindful of his promise to him, and undertake this war against Greece. But Themistocles was no way moved with anger against his ungrateful countrymen, nor incited to wage war with them by the gift of all his honor and power ; for, after having sacrificed, he called about him his friends, and, having embraced them, he drank a strong poison, and chose rather to close his own life, than to be an instrument of evil to his natiye country, which yet had deserved so ill at his hands. Thus died Themisto- cles, in the sixty-fifth year of his age, most of which time he had spent in the management of the republic at home, or as the chief commander abroad. At the siege of Turin by the French army, in 1640, a sergeant of the Piedmontese guards signalized himself by a singular example of patriotism : this sergeant guarded, with some soldiers, the subterra- neous parts of a work of the citadel. The mine was charged, and nothing was wanting but what is called a sausage or pudding, to blow up several companies of grenadiers who served in the work and posted themselves in it. The loss of the work would have ac- celerated the surrender of the place.—The sergeant, with great re- solution, ordered the soldiers he commanded to retire, begging them to desire the king his master to protect his wife and children. He then set fire to the powder, and perished for his country. On the surrender of Lord Cornwallis, in the American war, the Loyalist, of 22 guns, then in the Chesapeake, became a party in that disastrous event; her crew were convoyed to the Count de Grasse's fleet—of that fleet the Ardent, captured off Plymouth, made one, but was then in a very leaky condition. The Count be- ing informed that the carpenter of the Loyalist was a man of ta- lents, and perfectly acquainted with the nature of the chain pump, of which the French were ignorant, ordered him on board the Ville de Paris, and addressed him thus : " Sir, you are to go on board the Ardent directly ; use your utmost skill, and save her from sinking, for which service you shall have a premium, and the encouragement due to the carpenter of an equal rate in the British navy; to this I pledge my honor; on refusal, you will, during your captivity, be fed on bread and water only."—The tar, surprised at being thus addressed in his own language, boldly answered : " Noble Count, I am your prisoner. It is in your power to confine me ; but never let it be said that a British sailor forgot his duty to his king and country, and entered, voluntarily, into the service of the enemy; your promises are no inducement to me, and your threats shall not force me to injure my country." There is a land, of every land the pride, Belov'd by heaven o'er all the world beside; Where brighter suns dispense serener light, And milder moons emparadise the night, OF PRESERVING HEALTH. 143 A land of beauty, virtue, valor, truth, Time-tutor'd. age, and love-exalted youth. li Where shall that land, that spot of earth be found!" Art thou a man ? a patriot ? look round; O thou shalt find, howe'er thy footsteps roam, That land thy country, and that spot thy home !—Montgomery. As Americans, we feel the love of country, not merely because it is the land where we were born, but the land where we enjoy freedom, equal rights, and every blessing that can sweeten life, and gild it over with glory. Hence we need not have gone back to ancient times to show what men have dared from patriotism. No, thank God ! we have, in our own country, and in our own days, names as bright as ever adorned the annals of time. The memory of my exulting reader is already flying before-me to a host of he- roes, who even courted wounds and death for their country; to Lawrence, whose last words were " Don't give up the ship !"—to Burrows, who, when desperately wounded on the deck, said, " jf won't be carried below ; prop me "up, that I may see my brave men at their guns!"—to Lowry Donaldson, who cried, "My gal- lant countrymen, 1 die, but don't let the cause of freedom die with me!"—to Davies, who, on the field of Tippecanoe, smiling in the arms of fate, exclaimed," Thank God, I die in the best of causes!" —to a common sailor, who, while below, dressing for a mortal wound, and hearing his companions on deck shouting for victory, snatched away the shattered stump of his arm, saying, Let me go, doctor: I know 1 am dying, but I must give one huzza more for my country /"—to Pike, Covington, Gibson, Wood, Holmes, Stod- dard, Beasley, Mead, Spencer, Wattles, Hoppuck, Jack, Bradford, Armistead, Vanhorn, Olmstead, Middleton, Woolfolk, Smith, M'- Donough, Blaney, Legate, Yates, Jackson, O'Fling, of the army— to Allen, Ludlow, Wilmer, Funk, Babbit, Hamilton, Howell, Stans- bury, Gamble, Cowell, Williams, Brookes, Bush, Broome, of the navy—to Davis, Alle,n, Lauderdale, Henderson, Graves, Hickman, Hart, M'Cracken, Hooper, Pace, Buel, Hamilton, Evans, Quarles, Brown, Belknap, Blakesley, Clagget, Clemm, Jtosevelt, Poe, of the. militia,—and a thousand other Martyrs of Liberty, who all rush- ed into the battle as if animated by the immortal Washington's in- junction,—" Remember, that you are going to fight for Liberty !,r and who all died rejoicing that they had shed their blood to cement her Holy Fabric " To live with fame the gods allow to many; but to die with equal lustre, is a gift which Heaven selects from all the choicest boons of fate, and with a sparing hand on few bestows." 144 ON hygieine, or the art OF RELIGION. Yet, though kind Heav'n points out th' unerring road, That leads through nature up to blisl and God; Spite of that God, and all his voice divine, Speaks to the heart, or teaches from the shrine, Man, feebly vain, and impotently wise, Disdains the manna sent him from the skies ; Tasteless of all that virtue gives to please, For thought too active, and too mad for ease, From wish to wish in life's mad vortex tost, For ever struggling, and for ever lost; He scorns Religion, though her seraphs call, And lives in rapture, or not lives at all.—Cawthors. Some of my readers may'perhaps be surprised, that in a book which professes to treat of Health, I should so far forget the text as to introduce the subject of Religion.—But I trust they will cease to wonder when they consider that health is the physical re- sult of nicely balanced appetites and passions, and that there exists no power on earth, that can so attune these into harmony, as Reli- gion. Cast your eye around you, and say whence have sprung most of the diseases, both mental and corporal, but from lack of this divine guardian of man, Religion. By this great name, I do not mean that hypocrisy which consists in gloomy faces, nor that narrow bigotry which rests on particular forms ; the one only shows that religion is very galling to their feelings ; the other is but too of- ten false and treacherous, deluding those who behold them, into the opinion of their superior sanctity and virtue. Nor can I entertain a more favorable opinion of those who make a profession of reli- gion, and exhibit too much levity. It is a maxim among politicians, " that those who know not how to dissemble, know not how to rule." But this will not hold in religion, where virtue is at all times to be the guide of our actions. There are some sectarians who are so illiberal as to express a be- lief, that those only of their persuasion are in the right road to hea- ven ! Strange infatuation ! Can this be consistent with the Scrip- tures or reason ? The pure spirit of the gospel of Christ breathes forth a holy religion, founded on meekness, charity, kindness, and brotherly love. Could "we forbear dispute, and practice love, We should agree as angels do above ; Where love presides, not vice alone does find No entrance there, but virtue stays behind: Both faith and hope, and all the the meaner train, Of mortal virtues, at the door remain. Love only enters as a native there, For, born in heaven, it does but sojourn here.—Waller. It is of the utmost importance to guard against extremes of ev- ery kind in religion, lest by seeking to avoid one rock we split upon QF PRESERVING HEALTH. 145 another. It has been long the subject of remark, that Supersti- tion and Enthusiasm are two* capital sources of delusion. Su- perstition, on the one hand, attaching men with immoderate zeal to the ritual and external points of religion, and enthusiasm, on the other, directing their whole attention to internal emotions and mys- tical communications with the spiritual world; while neither the one nor the other has paid sufficient regard to, the great moral du- ties of the Christian life. Blest is the man, as far as earth can bless, Whose measur'd passions reach no wild excess ; Who, urg'd by Nature's voice, her gifts enjoys, Nor other means than Nature's force employs.—Zimmerman. In mental illusion, Imagination, when she first begins to exercise her powers, seizes on some fact, of the real nature of which, the mind has but an obscure idea, and for want of tracing it through all its connexions and dependencies, misleads reason into the dark- est paths of error. The wild conjectures, and extravagant opinions which have issued from this source, are innumerable.—The voice of the calm inquirer, Reason, is incapable of being heard amidst the tumult, and the favorite image is animated and enlarged by the glowing fire of the Passions. No power remains to control or regulate, much less to subdue, this mental ray, which inflames the whole soul, and exalts it into the fervor of Enthusiasm, hurries it into the extravagance of Superstition, or precipitates it into the fu- rious frenzies of Fanaticism. The fire of fanaticism is so subtilely powerful, that it is capable of inflaming the coldest minds. The rapidity of its progress cer- tainly depends, in a great degree, on the nature of the materials on which it acts; but, like every dangerous conflagration, its first appearances should be watched, and every means taken to extin- guish its flame. " In the course of my practice as a physician," says Dr. Zim- merman, " I was called upon to attend a young lady, whose natur- al disposition had been extremely cheerful, until a severe fit of sick- ness damped her spirits, and rendered her averse to all those lively pleasures which fascinate the youthful mind. The debility of her frame, and the change of her temper, were not sufficiently at- tended to in the early stages of her convalescence. The anxiety of her mind was visible in the altered features of her face ; and she was frequently heard to express a melancholy regret, that she had consumed so many hours in the frivolous, though innocent, amuse- ments of her age. Time increased, by almost imperceptible de- grees, these symptoms of approaching melancholy; and at length exhibited themselves by penitential lamentations of the sin she had committed with respect to the most trifling actions of her life, and in which no shadow of offence could possibly be found. At the time I was called in, this superstitious melancholy was attended 146 on hygieine, or the art with certain indications of mental derangement. The distemper clearly originated in the indisposition of the body, and the gloomy apprehensions which disease and pain had introduced into the mind during a period of many months. This once lively, handsome, but now almost insane female, was daily attacked with such violent par- oxysms of her complaint, that she lost all consciousness of her sit- uation, and exclaimed, in horrid distraction and deep despair, that her perdition was already accomplished, and that the fiends were waiting to receive her soul, anil plunge it into the bitterest tor- ments of hell. Her constitution, however, still fortunately retained sufficient strength to enable me, by the power of medicine, gradu- ally to change its temperament, and to reduce the violence of the fever which had been long preying on her life. Her mind became more calm in proportion as her nerves recovered their former tone; and when her intellectual powers were in a condition to be acted on with effect, 1 successfully counteracted the baleful effects of Superstition by the wholesome infusion of real Religion, and re- stored, by degrees, a lovely, young, and virtuous woman to her fa- mily and herself." Oh! would mankind but make fair Truth their guide, And force the helm from Prejudice and Pride, Were once these maxims fix'd that God's our friend, Virtue our good, and Happiness our end, How soon must reason o'er the world prevail. And Error, Fraud, and Superstition fail, None would hereafter, then, with groundless fear, Describe the Almighty cruel and severe, Predestinating some, without pretence, To heaven ; and some to hell for no offence ; Inflicting endless pains for transient crimes, And favoring sects or nations, men or times.—Zimmermait. It is that fervent love of God and man, constituting the heart- gladdening religion of Christ, which I mean. This teaches us to deny ourselves, and follow in the exercise of all virtues, wherein consists the life of religion, laying aside all idle quarrels, self-inter- est, and needless debates about circumstantials; for this religion is not in words, but in works ; not in opinions, but in assurances; not in speculation, but in practice. It is this religion all men ought to love for their own sakes, because a holy life, which it teaches, gives (a comfortable death and a happy eternity. He that alone would wise and mighty be, Commands that others love as well as he. Love as he loved—How can wc soar«o high ? He can add wings when he commands to fly. Nor should we be with this command dismay'd ; He that example-gives will give his aid. For he took flesh, that when his precepts fail, His practice, as a pattern, may prevail.—Walle* OF PRESERVING HEALTH. 147 The man who loves God, enjoys that first of felicities, the con- sciousness of having placed his affections on the only object that truly deserves thefn. O! how amiable is gratitude; especially when directed to the Supreme Benefactor. It is the most exalted principle that can actuate the heart of man. When a good man looks round him on this vast world, where beauty and goodness are reflected from every object, and where he beholds millions of creatures in their different ranks, enjoying the blessings of existence, he looks up to the Universal Father, and his heart glows within him. And in every comfort which sweet- ens his own lifethe discerns the same indulgent hand. Thus it is that gratitude prepares a good man for the enjoyment of prosperity ; for not only has he as full a relish as others of the innocent plea- sures of life, but, moreover, in these he holds communion with God. In all that is good or fair he traces his hand. From the beauties of nature, from the improvements of art, from the blessings of pub- lic or private life, he raises his affections to the great Fountain of all happiness which surrounds him, and this widens the sphere of his enjoyments, by adding to the pleasures of sense, the far more exquisite joys of the heart. If this goodness of God be so admirably seen in the works of Nature, and the favors of Providence, with what a noble superiori- ty does it even triumph in the mystery of redemption. Redemp- tion is the brightest mirror in which to contemplate the most lovely attributes of the Deity. Redemption! oh, thou beauteous mystic plan, Thou salutary source of life to man! What tongue can speak thy comprehensive grace ? What thought thy depths unfathomable trace ? O! blest Redeemer, from thy sacred throne, . Where saints and angels sing thy triumphs won ! From that exalted height of bliss supreme, 4 Look down on those who bear thy sacred name ; Restore their ways, inspire them by thy grace, Thy laws to follow, and thy steps to trace; Thy bright example to thy doctrine join, And by their morals prove their faith divine !—Boyse. Religion is so far from debarring us of any innocent pleasure or comfort of human life, that it purifies our enjoyments, and renders them more grateful and generous ; and thus makes us habitually cheerful. , Thou, Cheorfulness, by Heav'n design'd To sway the movements of the mind; Whatever fretful passion springs, Whatever wayward fortune brings To disarrange the power within, And strain the musical machine ; Thou, goddess,thy attempering hand 148 ON HYCIEINE, OR THE ART Doth each discordant string command ; Refines the soft and swells the strong, And, joining' Nature's general song, Through many a varying tone unfolds Thp harmony of human souls.—Akenside. Cheerfulness is consistent with every species of virtue and prac- tice of religion. It bears the same friendly regard to the mind as to the body; it banishes all anxious care and discontent, sooths and composes the passions, and keeps the soul in a perpetual calm. Providence did not design this world should be filled with mur- murs and repinings, and that the heart of man should be involved in perpetual gloom and melancholy. What blessings Thy free bounty gives Let me not cast away; For God is paid when man receives ; T' enjoy is to obey.—P6pe. As I was between sleeping and waking, says a sublime author, I perceived one of the most shocking figures imagination can frame, advancing towards me. She was dressed in black, her eyes deep sunk in her head, and her complexion pale and livid as the counte- nance of death. Her looks were filled with terror and unrelenting severity, and her hands armed with whips and scorpions. As soon as she came near, with a horrid frown, and a voice that chilled my very blood, she bade me follow her. I obeyed, and she led me through rugged paths, beset with briers and thorns, and a deep so- itary valley.—Wherever she passed, the fading verdure withered beneath her steps ; her pestilential breath infected the air with ma- lignant vapors, obscured the lustre of the sun, and involved the fair face of heaven in universal gloom. Dismal howlings resound- ed through the forests, from every baleful tree the night raven croaked his dreadful note ; and the prospect was filled with deso- lation and horror. In the midst of this tremendous scene, she ad- dressed me in the following manner : " Retire with me, O rash, unthinking mortal, from the vain al- lurements of a deceitful world, and learn that pleasure was not de- signed the portion of human life. Man was born to mourn, and to be wretched; this is the condition of all below the stars, and who- ever endeavors to oppose it, acts in contradiction to the will of Heaven. Fly then from the fatal enchantments of youth and so- cial delight, and here consecrate the solitary hours to lamentation and wo. Misery is the duty of all sublunary beings, and every en- joyment is an offence to the Deity, who is to be worshipped only by the mortification of every sense of pleasure, and the everlasting exercise of sighs and tears." This melancholy .picture of life quite sunk my spirits, and seem- ed to annihilate every principle of happiness within me. I threw myself beneath a blasted yew, where the winds blew cold and dis- OF PRESERVING HEALTH. 149 mal round my head, dreadful apprehensions chilled my heart. Here I resolved to lie till the hand of death, which I impatiently invoked, should put an^end to the miseries of a life so deplorably wretched. In this sad situation I espied on one hand of me a deep muddy river, whose heavy waves rolled on in slow and sullen mur- murs, when I found myself suddenly surprised by the sight of the loveliest object I ever beheld. The most engaging charms of youth and beauty appeared in all her form; effulgent glories sparkled in her eyes, and their awful splendors were softened by the gentlest fooks of complacency and peace. At her approach, the frightful spectre, who had before tormented me, vanished away, and with her all the horrors she had caused. The gloomy clouds brightened in cheerful sunshine; the groves recovered their verdure; and the whole region looked gay and blooming as the garden of Eden. I was quite transported at the unexpected change, and reviving hope began to glad my thoughts, when, with a look of inexpressible sweetness, my beauteous deliverer thus uttered her divine instruc- ^ tions : " My name is Religion. I am the offspring of Truth and Love and the parent of Benevolence, Hope, and Joy. That monster from whose power I have freed you, is called Superstition: she is the child of Discontent, and her followers are Fear and Sorrow. Thus, different as we are, she has often the insolence to assume my name and character, and seduces unhappy mortals to think us the same, till she at length drives them to the borders of despair ; that dreadful abyss, into which you were just going to sink. " Look around, and survey the various beauties of the globe which Heaven has destined for the seat of the human race, and consider whether a world thus exquisitely framed, could be meant for the abode of misery and pain. For what end has the lavish hand of Providence diffused such innumerable objects of delight, but that all might rejoice in the privilege of existence, and be filled with gratitude for the blessings he has sent, is virtue and obedi- ence ; and to reject them merely as means of pleasure is pitiable ignorance, or absurd perverseness. Infinite goodness is the source of created existence; the proper tendency of every rational being, from the highest order of raptured seraphs, to the meanest rank of men, is to rise incessantly from lower degrees of happiness to higher. They have, each, faculties assigned, them for various orders of de- light." " What!" cried I, " is this the language of Religion ? Does she lead her votaries through flowery paths, and bid them pass an unlabonous life ?" " The true enjoyments of a reasonable being " answered she, mildly, « do not consist in unbounded indulgence, or luxurious ease, the tumult of passions, the languor of indul- gence, or the flutter of light amusements. Those are often rais- ed into the greatest transports of joy, who are subject to the great- est depressions of melancholy: on the contrary, Cheerfulness* 150 ON HYGIEINE, OR THE ART though it does not give the mind such an exquisite gladness, pre- vents us from falling into depths of sorrow. Mirth is like a flash of lightning, that breaks through a gloom of clouds, and glitters for a moment." Cheerfulness keeps up a kind of day light in the mind, and fills it with a steady and perpetual serenity." Repinings and secret murmurs of heart give imperceptible strokes to those delicate fibres of which we are composed, and wear out the machine insensibly ; not to mention the injury they do the blood, and those irregular disturbed motions which they raise in the vital functions. Whereas Cheerfulness bears the spe friendly re- gard to the mind as to the body; it banishes all anxious care and discontent, sooths and composes the passions, and keeps the soul in a perpetual calm. To aim at a constant succession of high and vivid sensations of pleasure, is an idea of happiness altogether chimerical. Calm and temperate enjoyment is the utmost that is allotted to man. Beyond this, we struggle in vain to raise our state; and, in fact, depress our joys, by endeavoring to heighten them. Look around you on the world ; reflect on the different societies which have fallen under your observation ; and think who among them enjoys life to most advantage ; whether they who, encircled by gay companions, are constantly fatiguing themselves in quest of pleasure; or them to whom pleasure comes unsought, in the course of active, virtuous, and manly life. Religion or philosophy call you not to renounce pleasure, but teaches you how to enjoy it. Instead of abridging it, we exhort you to pursue it with safety. We propose measures for securing its possession, and for prolonging its duration. Though she may appear to contract the bounds of enjoyment, you will, upon reflec- tion, find, that in truth she enlarges them : what is delightful in hu- man enjoyment she readily allows, and not only allows, but height- ens, by that grateful relish which a good conscience gives to every pleasure ; and not only heightens, but adds, when correcting the excess of some passions, she gives room for the growth of others. Amid the turbulence of riot and the fumes of intoxication, unknown are the pleasures of generous friendship, heart-felt love, and do- mestic society ; unknown the conscious satisfaction which accom- pany honorable pursuits, and the justly acquired esteem of those who surround us. It was the daily practice of that eminent physician, Dr. Boer- haave, throughout his whole life, as soon as he arose in the morn- ing, which was generally very early, to retire for an hour to private prayer and meditation on some part of the Scriptures. He often told his friends, when they asked him how it was possible for him to go through so much fatigue, that it was this which gave him spi- rit and vigor in the business of the day. This, therefore, he re- commended, as the best rule he cbuld give : for nothing, he said, could tend more to the health of the body, than the tranquillity of OF PRESERVING HEALTH. 13 f the mind ; and that he knew nothing which could support himself or his fellow-creatures, amidst the various distresses of life, but a well grounded confidence in the Supreme Being, upon the princi- ples of Christianity. We have all of us experienced the effects which any indisposition of the body, even though slight, produces on external prosperity. Visit the gayest and most fortunate man on earth, only with sleep- less nights, disorder any single organ of the senses, corrode but-one of his smallest nerves, and you shall presently see all his gaiety vanish; and you shall hear him complain that he is a miserable creature, and express his envy* of the peasant and the cottager. And can you believe that a disease in the soul is less fatal to enjoy- ment than a disease in the animal frame ; or that a sound mind is not as essential as a sound body to the happiness of man ? Let us rate sensual gratifications as high as we please, we shall be made to feel that the seat of enjoyment is in the soul. Ah ! what is life ? with ills encompass'd round Amidst our hopes, fate strikes the sudden wound: ' To-day the statesman of new honor dreams, To-morrow deajji destroys his airy schemes;' Is mouldy treasure in thy chest confin'd? Think all that treasure thou must leave behind! Thy heir with smiles shall view the blazon'd hearse. And all thy hoards with lavish hand disperse. Should certain fate th' impending blow delay, Thy mirth will sicken, and thy bloom decay; Then feeble age will all thy nerves disarm, No more thy blood its narrow channels warm.—Gat. Let the affections of a man be once softened and dulcified with Divine love, and he is ever secure from the sudden apoplexies of the passionate, the poisonous cups of the drunkard—the murdering pistol of the duellist—the assassinating dagger of the jealous—the loathsome diseases of the harlot—and the wasting hectics of the gambler. Though it is an ill man's interest there should be no God, because then there should be no punishment for sin, and though this inter- est passes into argument, yet it is never so conclusive as to pass in- to an entire satisfaction ; for we cannot believe any person that has the use of his rational faculties, and gives himself the liberty of thinking, can deny the existence of a Deity, both as to creation and providence. Then, if every man believe there is a God, not to live in obedience to his precepts is to enhance one's guilt, and bring conscience as a witness to convict the offender of wilful transgres- sions. As for professed atheists, or such as have pretended to be so, and durst presume to affront their deities, let others read the black- ness of their sin in the exemplary punishment that attended it. A young gentleman of the city of Florence, in Italy, being ac- ' counted brave and dexterous at single sword, was to duel another 152 ON HYGIEINE, OR THE ART young man called Forchebene. They were accompanied into the field by several of their acquaintance, where a friend saluted the former with his good, wishes, saying, « I pray God give you victory over your antagonist." The insolent spark answered How can he fail to do otherwise ?" Forchebene, overhearing them, replied, " These blasphemous words will render me the executioner of Di- vine vengeance." To it they went with equal fury, when the com- bat for some time, was very doubtful; but at length Forchebene made such a home-thrust into his adversary's mouth, that he fixed his tongue to his neck, the sword appearing above six inches on the other side; of which wound he died immediately, and had his death in the part that offended. Oh man! degenerate man! offend no more; Go, learn of brutes thy maker to adore! Shall these through every tribe his bounty own, Of all his works ungrateful thou alone! Mark how the wretch his awful name blasphemes, His pity spares—his clemency reclaims! Observe his patience with the guilty strive, And bid the criminal repent and live; Recall the fugitive with gentle eye, Beseech the obstinate he would not die ! Amazing tenderness—amazing most The soul on whom such mercy should be lost!—Boyle. There are many wicked men who will speak unbecoming things of God, in a humor of bravado amidst company, but will tremble before him in solitude, and shudder at the approach of».death. Man makes a death which nature never made, Then on the point of his own fancy falls, And feels a thousand deaths in fearing one.—Young. Voltaire, a man who, after having long and too justly been con- sidered the patron of infidelity, and after having shown himself equally the enemy to every religious establishment, at length, to the astonishment of all serious minds, and at the close of a long life of nearly eighty years, embraced the Christian religion. If a veteran in the cause of infidelity thus close his life and his works, does it not greatly behoove those who have been deluded and misled by his writings, seriously to look to themselves, and bring home this striking example to their hearts. O then, while penitence can fate disarm, While ling'ring justice yet withholds its arm ; While heavenly patience grants the precious time, Let the lost sinner think him of his crime; Immediate, to the seat of mercy fly, Nor wait to-morrow—lest to-night he die.—Boyle. If men so prodigal in scattering imprecations and curses upon all OF PRESERVING HEALTH. 153 they are displeased at, would take time to consider what they are about before they disgorge them, they would certainly be ashamed of the folly of such a practice, because nobody is hurt by it but themselves ; for curses, like arrows shot against' heaven, fall upon the heads of those that throw them out, but pan never injure the persons or things levelled at. Again, what can be more foolish than for men, in common discourse, to make imprecations upon themselves, to confirm the truth of their assertions, which does not more than give a handle to their auditor's suspicion ? for good men will be believed without them, and scorn to use them ; and bad men can never gain credit, but disparage themselves, by so frequently venting them ; because, by such bitter asseverations, they seem to suspect their own reputation. It is also for want of consideration, and too easy a compliance with a scandalous and vicious custom, that men of sense, in other matters, upon very slight, and some- times no occasion whatever, expose themselves to the wrath of Heaven, by calling upon God to damn them, if what they say be false ; when, at the same time, they know there is no truth in it, and wish they may perish eternally, if they don't do what they ne- ver intend when they speak it. What use of oaths, of promise, or of test, Where men regard no God but interest ? What endless war would jealous nations tear $ If none above did witness what they swear? Sad fate of unbelievers, and yet just, Among themselves to find so little trust! Were Scripture silent, Nature would proclaim. Without a God, our falsehood and our shame.;—Boyle. Among all the nations, there are none so barbarous and cruel, none so utterly lost to all the sentiments of humanity and civility,, but have embraced and continued amongst them the notion of a Deity, or some being entitled to their adoration. This is a princi- ple so deeply engraven in the very nature of man, that no time, nor change, nor chance, hath ever been able to obliterate it; so that, rather than have nothing to worship, men have often been contented to adore as gods, even the works of their own hands. And, indeed, herein their ignorance and folly is chiefly to be lament- ed, that they have still made choice of any thing, rather than the true God, to pay their homage and veneration. In the mean time, they shame some of us, in having been more zealous in their super- stition, than we are in the true religion. The Athenians consulted the oracle of Apollo, demanding what rites they should make use of in matters pf their religion. The answer was, "The rites of their ancestors." Returning thither again, they said, " The manner of their forefathers had been often changed;" they, therefore, inquired, " What custom they should make choice of in so great a variety ?" Apollo replied, " The best." 20 154 ON HYGIEINE, OR THE ART, &C. First to the gods thy humble homage pay ; The greatest this, and first of laws obey : Perform thy vows, observe thy plighted troth, And let religion bind thee to thy oath. The heroes next demand thy just regard, Renown'd on earth, and to the stars preferr'd, To light, and endless life, their virtue's sure reward. Due rites perform, and honors to the deadj To every wise, to every pious shade. With lowly duty to thy parents bow, And grace and favor to thy kindred show : For what concerns the rest of human kind, Choose out the man to virtue best inclin'd ; Him to thy arms receive ; him to thy bosom bind.—Pythagohas. The great Lord Burleigh used to say, " I will never trust any man not of sound religion : for he that is false to God can never be true to man." From the very respectful mention which I have so frequently made of religion, some of my readers may be charitable enough to conclude that I am religious in a high degree. Would to God I were. From my soul I wish that my devotedness to religion had all my life been equal to the exalted opinion which I entertained of it. But, though like most of the human race, I have 1oo often ne- glected my duty in this respect, yet can I say, before my God, that I look upon religion as the only true glory and happiness of man; and though worlds were thrown into the opposite scale, yet would I not relinquish the joys, imperfect as they are, which I derive from it. And from this circumstance I have often been led to think, that if I derive so much comfort from the little religion which I pos- sess, how truly enviable, how superlatively happy must they be, whose whole lives are devoted to her service, and whose hearts are perpetually enjoying those sublime pleasures which her unclouded smile can impart. Arise, my soul, on wings seraphic rise, And praise th' Almighty Sov'reign of the skies ; In him alone essential glory shines, Which not the heaven of heav'ns, nor boundless space confines. While this immortal spark of heavenly flame Distends my breast, and animates my frame; To thee my ardent praises shall be borne . On the first breeze that wakes the blushing morn: The latest star shall hear the pleasing sound, And nature in full choir shall join around, When full of thee my soul excursive flies Through air, earth, ocean, or thy regal skies ; From world to world new wonders still I find, And all the Godhead flashes on my mind. When wing'd with whirlwinds, vice shall take its flight To the deep bosom of eternal night, To thee my soul shall endless praises pay ; Join, men and angels ; join th' exalted lay!—Blac.klock. OF FEVERS IN GENERAL. Under, this head are comprehended all fevers whatever, by which the human frame is affected; but as they arise from a great va- riety of causes, and affect persons of very dissimilar constitutions, they must, of course, differ in their nature, and require a very dis- tinct treatment. Two very opposite states of the human body are supposed to give rise to fevers, and to form their great and fundamental distinctions. The one is called the phlogistic diathesis, or inflammatory disposi- tion ; wherein the heart is excited to rapid and strenuous exertions,. manifested by great strength in the action of the vessels, while the blood itself exhibits a more florid hue and denser texture than usual. In the other, the brain and the nervous system are more directly affected, their energy seems impaired, the force of the heart and vessels is diminished, the blood is of a looser texture, and the fluids tend to dissolution. In the first state, when the inflammation originates from external causes, as wounds, contusions, or burns, the fever follows the local affection, and is in proportion to the degree of inflammation in the part affected. Such fevers are called symptomatic. This is also the case in certain disorders of the lungs, and other viscera, which arise, not from external injuries, but from some vice in the part, which gradually brings on inflammation and fever. If the local inflammation be removed, the fever is removed also; if it cannot be subdued, but increase gradually, destroying the organi- zation of the part, the patient dies sometimes by the violence of the fever, and sometimes merely because an organ essential to life is destroyed. Cold is found, by universal experience, to give a disposition to inflammatory disorders, and heat to those called putrid.* During the winter, and early in the spring, pleurisies, peripneumonies, quin- sies, rheumatisms, and inflammatory fevers prevail. Towards the * We continue this term in obedience to custom only. For it conveys a false view of what really happens in those fevers. Recent experiment and more accurate obseitvation, have de- monstrated, that putrefaction never takes place in a living body. The process which sometimes goes on in these malignant fevers, has some of the appearances. of putrefaction; but it is, in fact, totally distinct. 156 OF FEVERS IN GENERAL. end of summer, and particularly in autumn, fevers of a different na- ture, with dysenteries, and putrid ulcerous sore throats, make their appearance. Although it is true, in general, that cold occasions a disposition to disease of an inflammatory nature, and heat to those supposed putrescent, yet, persons who take violent exercise in sultry weather, or who accidentally fall asleep on the ground, exposed to the beams of the mid-day sun, are sometimes seized with fevers of a highly inflammatory and dangerous quality ; the inflammation directly af- fecting the brain itself, or its membranes. The time, in which intermittents and remittents are most pre- valent, is the end of summer and beginning of autumn, when heat and moisture combine to hasten the corruption of animal and veg- etable substances, and fill the atmosphere with miasmata. These considerations reduce it next to a certainty, that something essen- tially connected with a marshy soil produces fever, and we can sup- pose nothing with so much probability, as the effluvia of stagnant water and corrupting animal and vegetable substances. And if a certain stoppage of perspiration, from the cold of au- tumn, after the body is relaxed by the heat of summer, be sufficient of itself to produce fever in dry and well ventillated countries, where there is no reason to think that marsh miasmata prevail, we cannot be surprised to find them far more universal and more ob- stinate in low and marshy soils, where the first cause concurs with the second. A still more active source of fevers is the effluvia from the living human body, which, when long confined, becomes in the highest degree acrimonious, and gives rise to diseases the most dangerous and malignant. Whenever numbers of people are crowded toge- ther, the air must soon be deprived of its vital ingredient, by re- peated respiration ; hence, this infectious matter will be formed, but with most rapidity in -jails, in hospitals, in the holds of ships, and in dirty dwellings, where its virulent tendency is hastened by nastiness, by unwholesome food, by desponding thoughts, or by the effluvia coming from bodies in a diseased state. It communicates its infection not only to those who approach the places in which it is generated, and the human body from which it flows, but also will remain long entangled in beds, blankets, and other articles, having been in contact with the patient's body, retaining its activity, and capable of infecting others at a considerable distance of time and place, if, unhappily, those contaminated materials be carried abroad. In this manner, one person who is not himself infected, may infect another: the first person, in such cases, being less predisposed to the disease than the second. Although the infection arising from the living human body, is not perceived to act at a great distance from its direct source; yet it seems most probable that it does not immediately lose its virulency ;i but after it is diffused in the atmosphere, continues in some degree INTERMITTENT, OR AGIF. AND FEVER. 157 to act in conjunction with the miasmata of marshes, with heat, ob- structed perspiration, and the other causes of fever, and, according to the various proportions of those causes, combined with the cir- cumstances of season, climate, and the constitution of the patient, the nature of the fever is determined. INTERMITTENT, OR AGUE AND FEVER. Symptoms.—This is that fever which has, periodically, a clear in- termission alternating with a return of its paroxysms. From the length of time between the fits, the species of the fever are distin- guished and named. Thus, if the fit return every day, it is term- ed a quotidian; if -every third, a tertian; if every fourth, a quar- tan. The ague commences with weakness, frequent stretching, and yawnings, succeeded by sensations of cold in the back and ex- tremities, which increase, until the limbs as well as the body be- come agitated with frequent and violent shivering. This continues for some time, during which a violent pain of the head and back, and a sensation resembling a stricture across the stomach, frequent- iy distress the patient; and the sense of coldness is so great, that no endeavors to obtain warmth are of the least avail. These symp- toms, subsiding by degrees, give way finally to warm flushings, which increase, until redness and heat, much greater than natural, are extended over the whole body; the patient at length burning with such extreme heat, as to be now as solicitous for the refresh- ing sensation of cold, as he was before anxious to mitigate its vio- lence. After these symptoms have existed for some time, they gra- dually decline; the thirst goes off, the skin is relaxed, and a mois- ture breaks out on the head, which soon becomes general and pro- fuse ; then it slowly abates, till it entirely ceases. This is the general progress of a regular paroxysm of a well formed intermittent; the patient is often left apparently free of dis- ease, until the next attack. Causes.—The remote causes of ague or autumnal fever are, first the effluvia which arises from marshes or moist grounds acted on by heat. Secondly, cold, especially when accompanied by moisture which will necessarily act with more certainty, if a predisposition to the disease exist. This predisposition may be induced by living too sparingly, or on trashy food, excessive fatigue, impeded perspi- ration, preceding disease, indulgence in spirituous liquors, and, in fine, by whatever tends to weaken the system and impoverish the blood. Hence the poor are more subject to this disease than the rich. 15^ intermittent, or For health consists of spirits and of blood. And these proceed from generous wine and food.—Pope. Treatment.—In the cure of an ague, whether quotidian, tertian, or quartan, much the same plan may be followed ; which is, as far as possible, to prevent the disease from being habitual; for the lon- ger it continues, the more it weakens the constitution, and dispo- ses the glandular viscera, as the liver, spleen, &c, to obstructions, and often prepares the habit of dropsies and other chronic diseas- es. So that although this disease be not very alarming in its ap- pearance, yet, if injudiciously treated, or neglected, it often draws after it the most serious consequences ; and hence merits particu- lar attention. The cure of the disease, therefore, calls for an emetic, or a dose of calomel and jalap, or salts, senna and manna, to free the bowels of their offending contents; and if the patient be of a full habit,. with headache, and flushed countenance, the pulse hard and quick,. showing an inflammatory disposition, blood-letting will be highly necessary. Having by these means prepared the system, strengthening re- medies should next be employed. Of these, the Peruvian bark* is the most celebrated, and may be used with safety in the time of intermission, provided there exist no swelling or hardness of the viscera. In that event the bark must be withheld, until these symp- toms are rendered milder by the administration of gentle laxatives, blisters, and diaphoretic medicines, as the cathartic and saline mix- tures, {see Dispensatory,) whose good effects will be greatly aided by diluent drinks and abstinence from solid food. As soon as the system is properly prepared for the use of the bark, it may then be given in such doses as the stomach will bear, and at such intervals, that six or eight doses may be taken during the intermission. Should it disagree with the patient in substance, give it in some other form, as the cold infusion, decoction or tinc- ture. (See Dispensatory.) * Since the publication of the former editions of this work, the bark has, gradually, gone out of use, as an internal remedy, not only in the treatment of this disease, but of every other in which it was formerly used. Its place is now occupied by the sulphate of quinine, which is a powerful tonic, more certain, in its effects than the Peruvian bark, from which it is obtained, as, unlike that article, it never disagrees with the stomach when that organ is in a proper state to receive any tonic, and from this circumstance, as well as its diminutive dose, may be given to children at the earliest age. The mode of administering the quinine, in the treatment of this disease is as follows:— After cleansing the stomach and bowels, as directed above,, give one grain of the powder, in syrup, or one of the pills, or a tea-spoonful of the solution of quinine, [see Dispensatory,) every hour for the five or- six hours next preceding the expected fit. If by these means a return of the attack be prevented, the patient is well, but it will be advisable to continue the quinine, at the rate of four or five doses d lily, for two or three days, to prevent a relapse. If, on the contrary, the means fail and the fit comes on, it would be most prudent to repeat the cathartic, and after its operation, recommence the use of the quinine. In the treatment of the tertian and quartan forms of this fever, it is not necessarv, during the days of internussion, or what are called the well days, to give the quinine oftener than once in three or four hours. It should be borne in mind, that, neither the quinine nor any other tonic should be given until the patient is entirely free from fever, as such a practice may change the intermittents into the remittent or continued form of fever, or do serious mischief to some of the important, internal organs. AGUE AND FEVER. 159 In the mean time, strict attention must be paid to the habit of body : for in vain shall we expect to cure intermittents, if the bow- els be not kept open and the skin moist. When, therefore, the Peruvian bark produces costiveness, five or six grains of rhubarb, or some mild purgative, should be added to each dose; and in case of cold phlegmatic habits, with a dry skin, the addition of ten or fifteen grains of Virginia snake-root is pecu- liarly proper. In some constitutions the bark produces severe and copious purging. This debilitating effect may be prevented by adding five or six drops of laudanum to each dose. And when the patient is troubled with sourness on the stomach, flatulence, and pain, take the bark in lime-water, or conjoin with each dose, eight or ten grains of salt of tartar, or magnesia. Notwithstanding every precaution, the bark will not sometimes remain on the stomach, and with children it is often difficult for them to swallow this medicine. With such patients it should be employed externally, as directed below.* Some patients are subject to profuse sweats, from debility. In such cases the bark should be united with a few grains of the rust of steel, or ten or fifteen drops of elixir vitriol, and taken in wine. But when these evacuations proceed, as they often do, from an im- perfect cure, accompanied with great and intense heat, during their prevalence, we must immediately resort to the preparatory remedies, as blood-letting, cathartic and diaphoretic. Sometimes the fever will not yield to the bark, even when all the usual preparatory medicines have been employed. In such cases we may justly sus- pect the liver to be diseased, particularly if the countenance be either livid, or pale, or of a yellowish cast; and in that event, the use of the bark should be suspended until those obstructions be removed. For this purpose one of the mercurial pills, {see Dispensatory,) should be given night and morning, until ptyalism, that is, a soreness of the mouth with increased spitting is produced, which will gene- rally succeed ; and when it fails, the nitric acid diluted, and given in its usual doses, (see Dispensatory,) may be depended on. After a ptyalism is effected, recourse must be had to one or other of the strengthening remedies, to, give tone to the system. From the tenor of these observations it follows, that the Peruvian bark is not a remedy to be employed in every case of intermittent fevers, but that much caution is necessary in the use of it, lest it be turned into abuse. For unless the system be properly prepared by suitable remedies, the administration of bark, or any other tonic, is an error fraught with the most serious mischief. * Take a piece of Holland, cut in form of a waistcoat, and for the lining, get humhums of an open texture. Between these cloths, from three to six ounces of bark must be closely quilted, and then the waistcoat applied on the naked skin. Every two or three days, it will be neces- sary to rub the jacket between the hands. It is sometimes proper to unite snake-root with the bark, in the proportion of one ounce of the former to four of the latter. 160 INTERMITTENT, OR The Peruvian bark being so costly, and not always to be had pure, it must afford much pleasure to the benevolent to learn, that the black oak bark of America possesses the same virtues as the Peruvian, as has been verified by repeated experiments, not only in the cure of intermittents, but other diseases hitherto treated with the Peruvian bark alone. It may be taken in the same manner, only in rather larger doses. In substance it is most efficacious, and if well pulverised it will be found more palatable than the Peruvian bark, and not so apt to excite vomiting. Another mode in which this remedy may be employed to great advantage, from its abundance in our country, is by bathing twice or thrice a day in a strong decoction of it; which to children, and patients whose stomachs will not retain medicine, will prove ex- ceedingly beneficial. When the black oak bark is not convenient, the red oak bark, though less efficacious, should be substituted, as I have often witnessed the happiest effects accruing to debilitated persons bathing in a strong decoction of it, about luke-warm, par- ticularly in the last stage of fevers. Hence this remedy well de- serves the attention of the planter. Professor Barton assures us that he has employed the bark of the Spanish oak in gangrene, with the happiest effect, and that he con- sidered it, in powder, equal to the best Peruvian bark. (See Oak. Materia Medica.) The common dog-wood bark, of our country, is also an excellent substitute for Peruvian, particularly in the cure of intermittents; so is the bark of the wild cherry-tree, and of the lyriadendron tulipi- fera, or American poplar, all of which may de given in the same forms and doses, as the Peruvian bark. (See Materia Medica.) The Columbo root, an admirable corrector of bile, is a most useful medicine in this complaint, and will often be retained by the sto- mach, when the bark in every form has been rejected. It is, like- wise, an excellent remedy, joined with steel, as in the form of the tonic powders or pills, (see Dispensatory,) for patients disposed to be dropsical, or who have a swelling and hardness of the spleen, called ague cake; especially if a purge or two have been previously employed, and some mercurial action excited in the system, by one or two grains of calomel, taken every night and morning for a few weeks. Another valuable medicine in the cure of agues, and which has frequently succeeded when the bark failed, is white vitriol. But, like other tonic medicines, it requires that the stomach and bowels should be freed of their morbid contents, before any good effects can result from its use. Therefore, some evacuating medicine is always necessary ; after which, one of the vitriolic pills (see Dis- pensatory,) may be given every three or" four hours during the in- termission of fever, gradually repeating the dose, or increasing it, as the system becomes habituated to its action. AfcllE AND FEVER. 161 Charcoal powder, in doses from a tea to a table spoonful given three or four times during the intermission, has often interrupted the expected paroxysm, and cut short the disease. A scruple of the spider's web, it has been said, in many instan- ces hath proved successful, given an hour before the fit of an ague and an hour after it. But among the remedies of intermittents none is more infallible than the solution of arsenic, which may be given with perfect safe- ty to persons of every age, beginning with the smaller doses, and proportioning them- to the age of the patient. Stimulants administered before the fit, by inducing a salutary change in the system, have frequently overcome the disease. It' is in this way that emetics are considered useful in the coming on of the fit; so is active exercise, and other stimulants. Cataplasms of mustard seed and garlic, or horse radish, applied to the wrists and ankles an hour or two previously to the expected fit, will excite a degree of inflammation so^great as to increase the heat as well as the circulation, and have often succeeded. I have frequently, in obstinate intermittents, prevented the recur- rence of the fit, by giving a large dose of laudanum or ether about an hour before the expected paroxysm. But when an inflammato- ry disposition prevails in the system, this remedy should not be re- sorted to, as it may convert the intermittent into a continued fever. An emetic given previously to the return, while the perspiration is supported by the volatile alkali or Dover's powder, (see Dispen- satory,) in its usual doses, with warm drinks, has also succeeded in obstinate cases. It should be observed, however, that when we attempt to prevent the paroxysm of an intermittent by sweating, this mode of relief must be continued till the period of the parox- ysm is at ah end ; or at least till the time when the sweating stage would have otherwise commenced. Those means which excite terror, surprise, and horror, by produc- ing a train of new emotions will prevent the return of paroxysms. A man has been pushed into the water ; fire has been cried ; the most distressing tidings invented and communicated. All these re- medies fill the mind with such dread as to counteract the impres- sion of the cause ; but in general they are dangerous, and when we wish to prevent the fit, we depend rather on tonics, the stimulants, and the sudorifics. Dr. Kellie, an ingenious surgeon of the British navy, states, that many instances have occurred of the good effects of compression by tourniquets or bandages applied so as to obstruct the circulation in two of the extremities. The plan pursued by him was to apply the instrument on one thigh, and on one arm, of opposite sides, at the same time. In two minutes after the application of the tourni- quets the shaking and other symptoms of the cold stage entirely cease, amild hot stage was immediately induced, and the patient found himself quite relieved. After suffering the instruments to remain 21 168 REMITTENT, OR on for about fifteen minutes, they were removed, and the cold symptoms did not return. He farther states, that, if the tourni- quets be applied previously to the accession of the paroxysm, the cold stage will be entirely prevented ; and that, where the cold stage of°an ague is either thus shortened, or altogether prevented, the following hot stage will be rendered both milder and of shorter duration. As agues are liable to recur, one excellent means of prevention, as well as cure, is to wear flannel next to the skin, and to exchange the situation where the disease was contracted, for another, even though not of a healthier air. This alone has often effected a cure. In like manner, a change of medicines is as necessary as a change of air, that the 4)ody may not become habituated to any one mode of treatment. Therefore it ought to be remembered, that neither bark nor any other tonic medicine, should be continued longer than a fortnight at a time ; but should be changed for another article whose virtues are nearly the same. After.a week or two, the for- mer may be resumed, in case the disease'should prove obstinate; and, to bring about the necessary changes in the constitution, larger doses should be given. Regimen.—As to regimen in the cold fit, very little more is ne- cessary than warm camomile tea. In the hot fit, the drink may be barley water, mint or balm tea, lemonade, toast and water, or cold spring water, taken often, but in small quantities at a time. When the sweating begins, the drinks just enumerated may be enlivened with wine, and if the patient be able to take it, he may be allowed a little nourishment. During the intermission, the diet should be as nutritious as the patient's appetite and digestion will allow. Ev- ery thing that tends to keep up a gentle perspiration, and to give tone to the vessels is useful; hence moderate exercise is singular- ly proper, since nothing is more conducive to these beneficial effects. The exercise should be of that kind to which the patient has been most accustomed ; and taken in the open air, unless wet weather, or a damp situation forbid. But the utmost care should be taken, that exercise be not pushed to fatigue, which, by induc- ing debility, carries thousands, particularly foreigners, to untimely graves. REMITTENT, OR BILIOUS FEVER. Symptoms.—In this fever there is a remission or abatement of its violence, but not a total cessation. Like other fevers, it com- mences with a sense of coldness and shivering, accompanied by violent pains in the head and back, great dejection of spirits, sick- ness at the stomach, giddiness, loss of strength, and difficulty of breathing. The cold stage is succeeded by a considerable degree cC BILIOUS FEVER. 163 heat, the pulse, which in the cold fit was small and quick, becomes full, but abates not of its quickness. The pain of the head and back increases, and the nausea is augmented, frequently terminat- ing in copious vomitings of bile. These symptoms continuing, the skin, which had hitherto been hot and dry, becomes moist. Soon after this, the symptoms abate, and sometimes cease entirely. The patient flatters himself with the hopes of health speedily returning; but, alas ! these pleasing illusions, are soon dissipated by another at- tack, which comes on with increased violence. And if the fever be not opposed by means early employed and sufficiently powerful, a constant delirium and restlessness take place ; the discharges be- come very offensive, succeeded by twitchings of the tendons, pro- fuse clammy sweats, and convulsions which soon terminate in death. , Causes.—Remittents are produced from the same causes which induce intermittents, but acting here in a more powerful manner. Like these, they are most prevalent in the months of August, Sep- tember, and October, when heat and moisture combine to hasten the corruption of animal and vegetable substances, by impregnating the air with noxious exhalations. Treatment.—In the cure of this fever, all our efforts should be made to bring the remission to a complete intermission: and this is to be effected by bleeding, cathartics, emetics, and diluents, with such medicines as have a tendency to solicit the circulation of the fluids to the surface. At the commencement of the disease, where there exists much pain in the head, with a hard and quick pulse, bleeding will be necessary, and may be repeated if the symptoms do not yield to- the first operation. But to evacuate the first passa- ges of their impure contents is always necessary; and this is best done with calomel and jalep, or salts, senna and manna, and when circumstances do not prohibit the use of emetics, they, also, may be employed. The extent to which these means are to be carried, can only be indicated by the symptoms present, the habit of body, and other considerations. It will, in many cases, be proper to ex- hibit an emetic at the first attack, but this may sometimes be for- bidden, by great irritability of the stomach, or the appearance of inflammation. For frequently in diseases of the same origin, and in persons very nearly similar, with respect to age, sex, and temperament, one will frequently be accompanied with an inflam- matory diathesis, whilst another will be more of the low, irritable species ; and, consequently, the treatment must be varied, in propor- tion to the nature and violence of the disease. For among fevers,. we see all the intermediate degrees and varieties, from common agues to those of the most violent and infectious kinds. If the patient be of a strong plethoric constitution, with a hard and quick pulse, a deep-seated pain in the eyes, a burning heat at the stomach, and flushed countenance, indicative of strong inflam- matory disposition, bleeding is absolutely necessary, and should b© 164 P.E*«1.'TTENT, OR repeated every ten or twelve hours, or oftener, until the inflamma. tory symptoms subside. The necessity of diligently evacuating the intestinal canal, must be obvious to every person. And it is not always by one or two brisk cathartics that this complaint is to be cured ; but the opera- tion must be continued until the whole of the bilious matter is eva- cuated, which may be known by the faeces changing their color and putting on a natural appearance. When the irritating matter is thoroughly evacuated, mild*laxatives, as the cathartic mixture, {see Dispensatory,) Seidlitz powders, or castor oil, answer very well in the course of the disease to keep the body gently open; but in desperate cases calomel is most to be depended on. And if a pty- alism, or a slight salivation be excited by the calomel, the patient has no cause of alarm, but rather of joy, as this is a certain indica- tion of recovery. How desirable, then, must it be in high stages of bilious fever, to have this effect produced as early as possible, by giving calomel, and rubbing in mercurial ointment, and dressing the blisters with the same. Besides the aforesaid evacuants, clysters of warm soap-suds, or molasses and water, to which may be added a little vinegar, should be employed; as they are not only useful in removing from the lar- ger intestines any oftendini matter present, but also in producing the good effects of fomentations. Attention having been paid to the state of the bowels, which is always necessary because of the constant disposition to accumulate bile, such medicines as tend to determine the fluids to the surface, are next to be regarded. Of this class are the diaphoretic drops, saline mixture, Mindereru's spirit, febrifuge and Dover's powder. {See Dispensatory.) Either of these may be exhibited in their usual doses, every two or three hours ; but in desperate cases the antimonial powders with calomel, or calomel alone, in small doses, are most to be relied on. The warm bath admirably promotes insensible perspiration, by relaxing the skin, and taking off the stricture of the vessels ; it, con- sequently, should always, when practicable, be used, and if a bath- ing vessel cannot be procured, the extremities should be immersed in warm water at least once a day. The temperature of the batb, should be regulated by the feelings of the patient, and that which affects these most agreeably, should be preferred. The cold affusion by throwing cold water over the patient or sponging the body with vinegar and water, has been attended with the best effects in warm climates, particularly if the application be made during the height of the paroxysm, when the head is generally affected. After the inflammatory disposition has ceased, tonics will conside- rably hasten the cure ; but, if incautiously used during the fever, as unfortunately is too often the case, they will render every symptom more violent, and will almost inevitably prolong the disease. BILIOUS FEVER. 165 However, if the patient suddenly becomes giddy, feeble and lan- guid, quinine, or bark and wine, must be had recourse to, and giv- en freely on the remission ; otherwise it will degenerate into a true nervous fever. But we must not mistake the debility which arises from oppression, requiring evacuants, for an exhausted state of the system ; as, in that case, the use of tonics would be but little better than butchery. Another medicine of great importance in this disease is the Co- lumbo root, which readily checks the vomiting, so frequently an at- tendant, and supports the patient's strength during the use of such medicines as are requisite to abate the febrile heat, and to carry off the bile. After unloading the stomach and intestines, by two or three brisk purges, and diminishing the arterial action by bleeding, if requisite, a wine glass full of the infusion of Columbo, or ten or fifteen grains of the powder may be given in a cup of mint tea, every two or three hours, either conjointly or alternately, with some gentle open- ing medicine, as rhubarb, magnesia, cream of tartar, or salts, tore- move the redundant bile by keeping the bowels open. Salts, though a nauseous medicine, may be rendered much less so by adding a little sugar, acidulated with lemon juice or sharp vinegar, as in the form of the cathartic mixture; and this is an ex- cellent aperient, to be exhibited in small doses after the vitiated bile has been removed by calomel. A solution of salts in Seltzer wa- ter, is a form still more agreeable. During this general treatment, particular symptoms will require attention. The headache, for example, which so frequently accom- panies this fever, is to be treated by applying to the head, cloths wrung out of cold water, or vinegar and water often repeated, un- til the malady is removed ; besides which, a blister should be applied between the shoulders. As to the vomiting, that depending on the peculiarities of habit, is to be variously treated. In some I have found the saline mixture, soda powders, or infusion of Columbo, answer very well; in others) a spoonful or two of new milk, or equal parts of milk and lime-wa- ter, given every hour, have had the happiest effects. A spoonful of sweet oil and molasses has proved beneficial, when vomiting is accompanied with a burning sensation at the pit of the stomach. To others, porter has afforded immediate relief. Never was there a more welcome or wonderful illustration of this, than in the case of Mrs. Carroll, consort of Daniel Carroll, Esq., of Dudington. It was my good fortune to attend this very amiable lady under a most violent attack of the bilious fever, with incessant vomiting. All the usual remedies were employed, without any good effect, which excited considerable alarm. She being in a state of preg- nancy, and recollecting that nature sometimes furnished a cure be- yond the rules of our art, I asked her if there were any article of 166 remittent, or drink to which her appetite particularly led her. " Yes, sir," re- plied she; " I have been craving to drink some good London por- ter for two days past, but I would not mention it, being under the impression you would forbid my taking it." Learning that Dr. Thornton had some of that description, I immediately obtained a few bottles, and giving her a glass of it, diluted with a little water, it act- ed like a charm, and, in a few weeks, I had the very great satisfac- tion of seeing my fair patient perfectly restored to health. The warm bath, or local applications, such as flannels wrung out of a warm decoction of camomile flowers, or mint leaves stewed in spirits, or equal parts of sweet oil and laudanum rubbed on the stomach, have done much good ; and when these fail, a large blis- ter, or a cataplasm of mustard seed, ought instantly to be applied over the region of this organ. When the stomach is in a very irri- table state, the patient may frequently moisten his mouth and throat with cold water, but should drink as little as possible of any liquid. Wakefulness, or inability to sleep, will often yield to the warm bath and blisters ; and when they fail, a glass or two of porter^ or the camphorated julep may be given ; which also failing, a dose of laudanum is proper at bed-time, provided there exist no considera- ble inflammatory diathesis. The pain in the bowels is mostly relieved by the warm bath, or a moderate bleeding and emollient injections ; to which, occasion- ally, may be added twenty or thirty drops of laudanum. If these pro- duce not the desired effect, and the fundament be scalled from the evacuations, give clysters of milk and lime-water, composed of half a pint of each. These failing, inject every hour with cold water, and apply cloths wrung out of it, to the belly. If delirium come on in the first stage of the disease, it is to be treated by bleeding, purging, and the means prescribed above for violent headache; but, should it occur at a later period, the pulse weak and irregular, with a great propensity to sleep, besides making cold applications to the head, the body should be frequently sponged with cold vinegar and water, or equal parts of vinegar and spirits. And, should not the recollection in a few hours become more improved, and the pulse fuller and more uniform from this mode of treatment, it will be proper to apply a blister to the head, and sinapisms or blisters to the extremities ; besides which, wine or some cordial must be allowed ; and if there be a cold sweat, or coldness of. the extremities, flannels wrung out of hot spirits, or spirits of cam- phor, ought to be applied often around the arms, legs, and thighs. On the decline of this fever, patients are sometimes troubled with night sweats, to relieve which, gentle exercise in fresh air, and the tonic powder or pills, (see tfispensatory,) or bark and elixir vitriol will be proper. The unusual fatality of this fever in Washington, as well as in many sections of our country, during the last summer and fall, was bilious fever. 16? sufficient to create alarm, and to induce the benevolent to solicit, through the medium of public prints, imformation, relative to the most successful mode of treatment. Although the practice I pursued last autumn, did not materially differ from that above recommended, yet I am persuaded a brief sketch of the improvement, accompanied with a few remarks, will be gratifying to most of my readers, particularly as I can state, an in- controvertible fact, not a patient who was governed by my prescrip- tions died during the sickly season ; nor was there a case of the dis- ease degenerating into the nervous, when early application was made. This extraordinary success was the more remarkable, as the number of my patients was very considerable; in so much, that it was impracticable to visit all of them daily, and many were attend- ed principally by my students. Some of the indigent sick would doubtless have followed the fate of many of the paupers who died, had I not been sensible that exhibiting medicines, without paying due attention to regimen would not have the desired effect; and knowing this fact, I felt it my duty to those for whom I prescribed, to have them supplied with nourishment suitable to the case. In most instances, the lancet was resorted to ; and with some pa- tients of robust constitutions, and inflammatory dispositions, it was used freely in the early stage of the disease. Aperient medicines being of the greatest importance, were fre- quently administered, and I found their salutary effects evidently in- creased by conjoining such as determined to the surface. Twenty grains of calomel, united with a grain of tartar emetic, or six or eight grains of ipecacuanha, were administered to an adult in the morning, and followed in a few hours by an ounce of Epsom salts, or an infu- sion of salts, senna and manna, in broken doses. When a preference was given to medicine in the form of pills, I directed two of the ape- rient and diaphoretic pills (see Dispensatory,) to be given every two hours, or two of them to be taken at bed time, and the dose repeat- ed every hour in the morning, until several copious evacuations were produced. With infants, calomel and ipecacuanha in large doses repeated occasionally, were often found sufficient. It should be observed, with respect to aperient medicines, that though active in their operation, they do not weaken the patient, as generally supposed ; for they take away the cause of .at least appa- rent weakness ; and we have often found patients in fevers taking bark and stimulants to support them under this apparent debility, who, after the operation of some laxative medicine, required neither. In the employment of this remedy, however, it is necessary to attend to the discharges. The nurses will often report frequent evacua- tions, and if examined, these may be found mucous and insufficient, or a watery fluid scarcely colored. It is necessary that the stools should be truly feculent, and be continued while the discharges are dark and offensive. We ought, therefore, not to be governed by the number of evacuations; but by the effects and the patient's feel- 168 remittent, or ings. If he be relieved after each stool, and the pulse become softer, the hand more moist, and the head less loaded, he need not be ap- prehensive, however violent the discharge. On the contrary, if the pulse become smaller and more frequent, the face sink, and faint- ness come on, however little the discharge, it has been too much. In some cases, emetics were employed with very good effects. They greatly contributed to relieve congestion in the liver, and were also useful in determining to the skin as well as carrying off the bile. When purgatives were not requisite, the febrifuge mixture, dia- phoretic drops, or antimonial powders were administered in their usual doses, every two hours, with the view of promoting a gentle diaphoresis, and to assist their effects, the patient being directed to take frequent small drinks of some tepid diluting liquor. Medicines of this class, by exciting perspiration, will be found to produce most beneficial effects, in those cases where the vital energy is not dimi- nished ; but when considerable debility is present, they frequently fail of having the desired effect, and act on the bowels, producing a dangerous diarrhoea. When the fever manifested a disposition to yield, the infusion of Columbo or camomile was given, particularly after the immediate operation of laxatives ; which had the effect of correcting the bile, restoring the to'ne of the stomach, and support- ing the patient's strength. And so soon as there was an intermis- sion of fever, or symptoms of the disease assuming the typhod state, the bark,* conjoined with Virginia snake-root, was given in such doses as the stomach would retain, which, together with the liberal use of porter and wine, and nourishing diet, speedily arrested the disease. In some instances the nitric acid, diluted, (see Dispensatory,) was employed as a. tonic with considerable advantage, particularly in delicate habits ; or when there were symptoms indicating the liver to be diseased. With others, again, the solution of arsenic in the usual doses was administered with the most happy effects. The warm bath, in every instance in which it was employed, pro- duced beneficial effects; and when this luxury could not be pro- cured, sponging the body and extremities with vinegar and water, or equal parts of vinegar and spirits, afforded great relief. A few cases occurred of patients of robust constitutions, who not only neglected the proper remedies at the commencement, but aggra- vated the disease by taking stimulating drinks or active exercise, were at length attacked with great prostration of strength, accom- panied with cold clammy sweats, coldness of the extremities and impeded pulse. These symptoms indicated that considerable con- gestion had taken place, which would admit of no delay. I directr ed the warm bath, and when this could not be immediately obtain- ed, friction and flannels wrung out of hot spirits, into which red " The sulphate of quinine had not at that time acquired its present celebrity. BILIOUS FEVER. 169 pepper and mustard seed had been infused, were applied to the ex- tremities, and renewed as often as they became the least cold. As soon as the natural warmth was restored, blood-letting with calo- mel and aperient medicines was resorted to ; and also blisters over the region of the liver and extremities.—It will frequently occur, in such cases, that the action of the heart is so overpowered in the first instance, that the blood merely trickles, or rather oozes, from the punctured vessel for a considerable time, being much darker and thicker than natural. Yet, when a few ounces have been drawn, it usually flows with freedom, and becomes, finally, of a brighter color. The deficiency or irregularity of heat on the surface is among the first symptoms that indicate congestive disease ; and if the skin can be restored every where to its natural warmth, a cure may be expected. It is evident the warm bath, frictions of the skin, blood- letting, calomel with purgatives, and blisters are the chief expedi- ents to diminish congestion ; but unless these be very early resort- ed to, they will not succeed, so rapidly does the stage of collapse supervene. Recovery very generally succeeds, if natural warmth be speedily restored, and a universal perspiration excited. Upon this principle is to be explained the repeated success of the prac- tice pursued by some practitioners in the plague; for immediately after persons were perceived * to be affected, and, consequently, while there was yet no arterial excitement, they were subjected to frictions by warm oil, in a close room, and over a brazier of hot coals, until a free perspiration took place. ' Some patients, in the course of the disease, were afflicted with acid eructations and heart-burn, but were relieved by magnesia, the absorbent mixture, or mucilage of gum Arabic. These medicines were also useful in giving check to watery evacuations, which some- times occurred on the exhibition of diaphoretic medicines ; others, again, on the decline of fever, were troubled with pain, arising from flatulency, which required occasionally a little mint water, ginger tea, tincture of asafcetida, or spirits of lavender. This symptom, however, seldom came on when proper attention was paid to the discharge of the bowels. In a few cases, the hiccough became exceedingly troublesome, but was relieved by taking in turns the syrup of damsons, a lump of loaf sugar moistened with brandy, tincture of asafcetida, or the camphorated mixture. When these failed, a cataplasm of mustard seed and vinegar applied over the region of the stomach generally succeeded. Strangury was another spasmodic affection that required partic- ular attention. Although the occurrence of this symptom was fre- quently the effect of blisters, (see Suppression of Urine,) yet, in some cases, it evidently was produced from a spasmodic irritation of the neck of the bladder. And when arising from this cause, the camphorated powders, the warm bath, or injections of warm ca- 2-2 170 REMITTENT, OR momile tea or infusion of hops, with laudanum, proved to be the best remedies. Hemorrhages sometimes occurred, and w»hen preceded by head- ache, the pulse full and hard, indicating an inflammatory disposi- tion recourse was immediately had to blood-letting, followed by aperient and diaphoretic medicines ; but when the discharge was attended with faintness, or happened at the conclusion of fever, the bark, elixir vitriol, or nitric acid, with cold drinks, were prescrib- ed. Nitre, in doses of ten grains every hour or two, in a glass of cold water, as well as cold applications near the parts affected, were employed, in both cases, with evident advantage. Longings for improper food and drink, with some patients, were exceedingly troublesome. On the decline of fever, when this symp- tom did not arise from the caprice of the moment, and the patient anxiously craved any particular food or drink, it was allowed not only with impunity, but considerable advantage. Those cases in which I was consulted after the typhoid state of fever had come on, as manifested by a disturbed state of the brain and nervous system ; showing itself in frequent sighings, wandering delirium, watchfulness or irregular and interrupted sleep ; character- ized, also, in the more advanced stage of fever, by a deranged > state of the secretions and excretions, attended with a brown or black state of the tongue, and a cadaverous and offensive smell of the whole body, my attention was drawn to support the patient's strength by supplying him with nourishing diet, and giving stim- ulants, both diffusable and permanent, as recommended under the head of Nervous Fever. Attention was also paid to the state of the bowels, and their of- fensive contents were evacuated daily, not by active purges, which in this exhausted state of the system, would destroy the patient, but by injections, and the occasional use of small doses of calcined magnesia alone, or conjoined with a few grains of rhubarb. I was no less attentive in having the offensive materials which were constantly excreted by the skin, removed by wiping the body and extremities twice a day with a cloth wetted with equal parts of vinegar and spirits. Care was also taken to have the sheets and linen of the patient frequently changed. By perseverence in the means above stated, several persons, whom I was called to visit at the latter stage of the disease, recovered un- der the most unpromising circumstances. One case particularly de- serves to be noticed, in order to show the impropriety of giving up a patient while there is life. Mrs. Lund Washington lingered under this disease, upwards of six weeks, before application was made to me, and learning she had been given up by her physicians as a hopeless case, I was un- willing to attend ; but from the earnest solicitude of her son, Mr. Peter Washington, I consented, provided the medical gentlemen who attended her would meet me. From some cause or other, nei- BILIOUS FEVER. 171 ther of the physicians appeared at the hour appointed, and as there was no time to be lost, I took the liberty of prescribing in thefr ab- sence. I found her in a state of excessive debility, and on examin- ing her mouth, the tongue was covered with small white blisters, and gums with a foul sordes, accompanied with a cadaverous breath. Her bowels were in a very irritable state, and from theacuteness of pain she occasionally felt in them, caused her to scream out in a most lamentable manner. The state of her mouth readily induced me to ascribe the affection of her bowels to the swallowing of some putrid matter, and notwithstanding her extremely debilitated state, I deemed it necessary to direct a table spoonful of castor oil to be given, and its operation encouraged by injections of soap-suds. At the same time, her strength was supported by arrow-root, made palatable by a plentiful addition of wine and nutmeg. I directed, also, fresh charcoal powder to be given in doses of a spoonful ev- ery two or three hours, which produced most beneficial effects, as the distressing symptoms soon yielded. On farther examination, I found one side of the hip and lower part of the back in a gangre- nous state. To arrest^ this, poultices of charcoal and bark wers frequently applied, and as soon as a bathing vessel could be procur- ed, and a strong decoction of red oak bark prepared, she was taken up in the sheet and bathed daily, from thirty to sixty minutes at a time. The number of blisters which had been applied, together with the large ulcers in her back, occasioned great pain in bathing, as well as in moving her from one sheet to another: but, notwith- standing this, as her stomach would not retain a sufficient quantity of either bark or nitric acid, I had the bath continued about three weeks, which, together with the most nutritious diet and a plentiful use of wine, porter, and other stimulants, her general health was so far improved as to require little or no attention except to the ul- cers. These, after the mortified parts had sloughed off, were very deep and extensive, exposing the bone, and requiring more atten- tion than I was able to give. I therefore requested the surgical aid of Dr. Bailey Washington, and by the skill and attention of this gentleman, those ill-conditioned ulcers were healed in a few weeks. And I am happy to add, this most amiable lady is now restored to- perfect health, to the exceedingly great joy of her affectionate fami- ly and numerous friends. Regimen.—With respect to regimen, the food and drink should be varied, and adapted to the taste of the patient. Nature, per~ haps, generally takes care that no error shall be committed in that way, during the continuance of this disease. The patient is seldom persuaded to swallow any thing but liquids, during the prevalence of the fever; and if by accident he should have an inclination for something more solid, arrow-root, sago, corn, or rice, gruel, mush, panado, custards, roasted apples, oranges, grapes, or other mild ripe fruits are all that should be allowed. To allay the thirst, barley or rice-water, apple-water, tamarind-water, molasses and water, toast I 172 REMITTENT, OR and water, or cold spring water, lemonade, raspberry or currant jelly, .dissolved in w-ater, mint or balm tea, acidulated with lemon juice, or other pleasant acids, may be given with great benefit, in frequent, but small quantities. These cooling drinks not only quench thirst, but also tend to excite perspiration. Washing the face and hands of the patient, from time to time, with vinegar and water, is always refreshing. The room should be somewhat darkened, and kept moderately cool, by a constant suc- cession of fresh air; taking care, however, that the current of the wind be not immediately directed on the patient. The covering of the bed ought to be such as is found most comfortable, and the bo- dy kept, as nearly as possible, at rest. When the fever subsides, and the patient regains a desire for food, it will be best, in addition to the mild articles of diet already mentioned, to begin with puddings of various kinds, newly laid eggs, boiled soft, soups with vegetables, raw oysters, &c, resuming his diet gradually, as he finds his health return. To keep up the tone of the system, a moderate use of genuine wine, or porter diluted, or brandy, or rum and water made weak, will be proper; at the same time paying due attention to air, clean- liness, and exercise. Thus have I detailed, in the clearest manner, according to my experience, the best curative means of this, the most prevalent and dangerous of all our southern maladies. It is, however, much ea- sier to prevent than cure diseases; and, in order to the first, I will point out the general means which have been found conducive to this great end, and which constant experience has sanctioned. Prevention.—To obviate, the attack of summer and autumnal fevers, we should intercept their causes, or guard the habit as much as possible against their influence. Therefore, on visiting a warm climate where any epidemic pre- vails, the first step is to prepare the system, as much as possible, for the unavoidable change it. is about to undergo ; and this prepara- tion consists in living temperately, and taking every other night, or qftener, one or two grains of calomel, or chewing rhubarb, or drink- ing molasses and water, or using sulphur in such doses as to increase the discharge by the bowels, w ithout debilitating the system. If there prevail a fulness of habit, the loss of ten or twelve ounces of blood will also be a useful precaution. In the mean time, an im- prudent exposure to the heat of the sun,' or night air, should be strictly avoided. Hard drinking is another cause of disease, which should be care- fully guarded against in warm climates, particularly by seamen, who of all others are, perhaps, the most inattentive to health. The same admonition applies to their sleeping on deck during the night, and cold bathing when over-heated, or in a state of intoxication, which, by suddenly checking the copious perspiration, seldom fails to bring on disease. BILIOUS FEVER. 173 Cold, moist air is a frequent cause of disease in warni climates; hence, too much attention cannot be paid to comfortable fires, and suiting the dress to the changes of the weather. Flannel worn next to the skin is one of the chief,preservatives of health. Many people, indeed, clamor against it as tending to de- bilitate, because it creates perspiration. But this is altogether a silly prejudice ; as mild perspiration, or a soft skin, so far from be- ing hurtful, is the very habit of health. It preserves a proper me- dium of temperature, by absorbing the excessive moisture from the body during the day, and by preventing the effects of the cold damp air at night. Cleanliness, both in our persons and apartments, is so essential to health, as to form a leading consideration in all our views to that first of blessings. The neglect of this not only renders a man loath- some and offensive to himself, but gives rise to many of our most inveterate and fatal diseases. Among the various means used for the prevention of diseases, and for the preservation of health in general, none, perhaps, is more beneficial in warm climates, than good wine, prudently used. It increases the circulation of the fluids, promotes both the secre- tions and excretions, and invigorates all the functions of the body. How much is it then to be lamented, that so valuable a cordial can- not always be got pure; from the avarice of selfish men, who vend, at a low price, tart or half-spoiled wines ; and, tcr render them sale- able, adulterate them with the most poisonous ingredients, so that they become the most insidious foes to health. The common red wines are most generally adulterated, and arti- ficially colored, as manifested by a red sediment in the glass, as well as in the bottle. But the most pernicious of all adulterations of wine, is that of sugar of lead, or lead itself, which gives it a sweet taste: and, therefore, it ought to be remembered, that every wine of a sweetish taste, accompanied with astringent qualities, may justly be suspected to be adulterated with that noxious mineral. (*S*ee Poison.) When genuine wine cannot be procured, good old spirits are of considerable service, especially when taken in small quantities, and much diluted. These pleasant preventives, whether under the name of grog or toddy, must, in consequence of their gentle stimu- lating qualities, be particularly beneficial to persons whose lot is cast in low situations and moist' air. But they should never forget, that no where is the great virtue of self-government more necessary than in their use. For, if indulged to excess, they seldom fail, whenever a predisposition to any particular disease lurks in the sys- tem, to rouse it to action. In like manner, we must have regard to a proper regulation of diet, which consists in preserving the happy medium between long fasting on the one hand, and immoderate eating on the other. Vet getables are peculiarly adapted to warm climates, and, consequent- 174 NERVOUS FEVER. ly, should constitute the chief part of our diet. Sweet oil, when pure, is perfectly wholesome ; but rancid oil, butter, fat, or meat the least tainted, must be wholly rejected. To those of weak habit and bad digestion, much benefit will re* suit from a glass of the infusion of Columbo, or camomile, or cold water, every morning, on an empty stomach. Such are the general means of preserving health, and preventing diseases in a southern climate. The chief point is to avoid the ex- citing causes, and keep the bowels always moderately lax. NERVOUS FEVER. The fevers already described, and, indeed, all diseases attended with a considerable degree of morbid heat, affect in some measure the nervous system ; but in this particular species, the nervous sys- tem is more immediately and more violently affected, than in any other. When a fever is once produced, from whatever cause, it sel- dom fails, by long continuance, to occasion all the symptoms which appear in the nervous or malignant fever. This fever has been described by different authors under various names ; the typhus or nervous fever, the slow fever, the jail fever, the hospital fevef, the ship fever, the petechial fever, the putrid fever, and the malignant fever. The first appellation it receives from its attacking the brain, and from the effects it produces on the nervous system. The second, from the slow and gradual manner in which it sometimes comes on. The third, fourth, and fifth, from their being apt to arise in jails, hospitals, and ships, when numbers of men are crowded together, and when sufficient care is not taken to have such places well ven- tilated and cleansed. The sixth, from certain spots which some- times appear on the skin of the patients laboring under this dis- ease. The seventh, from the putrid state, or tendency supposed to take place in the fluids; and the last, from the dangerous na- ture and malignity of the fever : but they are all one and the same disease, variously modified, according to the violence of the symp- toms, and the different constitutions of the patients. Symptoms.—The symptoms are commonly more various in this, than in any other fever. It sometimes creeps on in such a slow, insidious manner, that the patient will have suffered the disease to make considerable progress, before he thinks it necessary to use any remedies. On other occasions it comes on with a great degree of rapidity, and with many of the symptoms common to all fevers. Thus, it commences with alternate sensations of heat and cold, a want of appetite, a nausea, and occasional vomiting. These are fol- lowed by some confusion of the head, a sense of weakness, dejection NERVOUS FEVER. 175 of spirits, tremor of the hands, and frequent sighing, without know- ing the cause. At this stage the pulse is irregular, sometimes a lit- tle quicker ; at other times, about the natural standard. In some, a dull and heavy pain, with a sense of coldness, possesses the back part of the head; in others, a pain in the orbit of one eye. These symptoms gradually increasing, the pulse becomes smaller, and at the same time quicker, while the arteries of the temples and neck beat with additional force. The patient is generally more restless towards night, the breathing is somewhat difficult, and very little refreshment is obtained, from his short and disturbed slumbers. This gradual increase of symptoms, with the peculiar, pale, sunk countenance attending fever, will give the alarm, even when other nervous diseases with which the earlier symptoms have been con- founded are present. In the progress of the disease, the system is unequally affected; for sometimes headache, restlessness, and uneasiness, prevail in a high degree, while at the same time the tongue is clean and moist; and at other times, while there is no headache, or restlessness, the tongue will be dry and foul, and profuse sweats will break out. This fever, moreover, is not only thus irregular, in affecting various parts of the body differently, but it is also irregular in its exacerbations ; and these, instead of taking place in the evening, will arise often in the morning. Again, sometimes the fever is very violent for the first three or four days ; it then diminishes for a time, and then per- haps increases again. After, or about the tenth day, the weakness increases considerably; the whole nervous system becomes affected with tremors and twitchings ; the urine is commonly pale ; the fin- gers are in constant motion ; the tongue becomes dry, of a dark co- lor, and trembles when attempted to be put out; and sometimes the gums and lips are covered with a dark viscid substance. To these succeed stupor, cold clammy sweats, with a fetid smell, hic- cough, and twitching of the tendons, together with an involuntary discharge of the excrements. In every malignant case, this fever tends fatally on or before the seventh day : but more frequently those who die, are carried off about the middle or towards the end of the second week. When the patient survives the twentieth day he usually recovers. When the fever terminates favorably before, or at the end of the second week, the crisis is generally obvious ; but when that happens at a later period, particularly ikafter the third week, the favorable turn is less evident; and somerones several days pass, during which the disease goes off so gradually, that the most experienced are in doubts whether it abates or not. At length, however, it becomes evident by a warm moisture on the skin, by the dark-colored gluey sub- stance which adheres to the gums and lips, growing less tenacious, and being more easily removed; by the stools regaining a natural color; by the urine being made in greater quantity, and depositing a sediment; by a return of appetite, and by the pulse becoming 176 NLRVOUS FEVER. slower than it was at the commencement of the disease. Deafness ensuing, tumors appearing behind the ears, a red rash, and an in- flamed scab below the nose, or about the lips, are also considered favorable. The symptoms which point out the near approach of death, are a change of voice, a wild stare, a constant inclination to uncover the breast, purple or livid spots on the skin, laborious respiration, profuse evacuations by sweating or purging, much Watchfulness, sinking of the pulse, great incoherency of ideas, mut- tering, picking at the bed-clothes, considerable dilatation of the pu- pil of the eyes, involuntary discharges by urine and stool, start- ing of the tendons, hiccoughs, and convulsions.. If many of these symptoms occur, little expectation of recovery can be entertained. Causes.—This fever is occasioned by impure air, putrid animal and vegetable effluvia, innutritious diet, and by living on damaged provisions. We are, therefore, not surprised to find it often origi- nate in jails, ships, and dirty dwellings, where numbers are crowd- ed together, and where it is not possible to have sufficient venti- lation. m Though human contagion, and the effluvia arising from putrid animal and vegetable substances, are the most frequent and active causes of this disease, yet they cannot be considered as the only ones ; for we sometimes meet with instances in a country neigh- borhood, of persons being seized with the disease in all its malig- nity, where it is not epidemic ; nor can, it be traced to any place where the human effluvia could be supposed to be confined in any uncommon degree. Hence nastiness, a moist atmosphere, much fatigue, cold, de- pressing passions, scanty diet, excessive study, too free use of mercury, immoderate venery, profuse hemorrhage, or whatever wea- kens the nervous system, may be enumerated among the causes. Treatment.—With regard to the cure, when the inflammatory symptoms appear to run very high, the early use of the lancet will be required. It should be observed, however, if blood-letting be employed in all the various forms of typhus, without due regard to the period of the disease, the quantity of the blood drawn, the age, habit, and constitution of the patient, it will often be followed by fatal consequences. On the contrary, if it be cautiously used in the beginning of the inflammatory typhus, it will be of the great- est utility, as it will render the other means more prompt and effec- tual, and thereby facilitate the cure. M When the lancet is resorted to, the brood should be taken away in&mall quantity, and from a small orifice. And as the rising of the pulse, under bleeding, is a certain indication of its propriety, so its sinking is as certain an indication of its impropriety ; hence we have a criterion to guide us in the operation. Towards the close of most acute fevers of severity, there is some tendency to a change in the constitution of the fluids; and this may occur as soon as the second or third day, in the most malignant cases of typhus. The nervous fever. 171 blood, when drawn in this state, loses its florid color, and as it flows from the arm, exhibits a dirty, dark appearance, sometimes of a muddy blue, and sometimes of a deep black. It does not coagu- late, but continues in a dissolved state in the vessel, which induced the ancients to call it putrid. It is unquestionably very unfavora- ble, and indicates that depletion is improper. In general it will be the safest to resort to the evacuation of the alimentary canal; therefore, on the first appearance of the symp- toms, twenty or thirty grains of ipecacuanha, or four or five grains of tartar emetic, may be dissolved in a pint or more of weak ca- momile tea ; of which the patient may drink a gill every fifteen or twenty minutes, until it excites vomiting, which ought to be assist- ed by drinking freely of warm water: or should any costiveness prevail, give a dose of calomel alone, or conjoined with ipecacuan- ha, and in a few hours afterwards, some rhubarb, Epsom salts, or infusion of salts, senna and manna, in broken doses, to evacuate the bowels of their morbid contents. Through the whole course of the disease, the bowels must be kept in a soluble state, either by some of the above medicines or acid laxatives, as cream tartar and tamarinds, by fruits, or by clysters. Two or three stools daily may be safely borne, though if so great an evacuation should appear to debilitate, even this number should be curtailed. However, the patient should, in no case, be more than two days without a stool, for a great deal of feculent matter is produced in fever, although little food is taken, and costiveness is apt to induce an increase of heat and affection of the head, as delirium, &c. In administering purgatives, care must be taken not to employ them in such doses as would operate very copiously, as great debility might thereby be produced. So long as the alvine evacuations continue of a dark color or unnatural appearance, calomel should be given not only as an aperient, but also with a view of producing ptyalism. The alte- rative operation of this medicine, in the early stage of the disease, is a circumstance highly to be desired, as it equalizes the circula- tion, and diminishes visceral congestions. In typhus proceeding from contagion and of a malignant nature, very few hours should be lost in these preparatory steps; for the disease often hastens with rapidity, and the worst symptoms sometimes occur, as early as the fifth day. In the early period of the simple typhus giving an emetic, fol- lowed the next day by some active purgative medicine, have fre- quently cut short the fever at once ; and when this desirable effect has been produced, they have hardly ever failed fo shorten its du- ration, and to lessen its danger. Although medicines, which might excite profuse sweating, would be highly improper in this fever, yet those possessed of a mild, di- aphoretic power, as Dover's powders, the camphorated powders or mixture, (see Dispensatory,) the spirits of nitre, or infusion of Vir- ginia snake-root, may be occasionally employed with advantage. 23 178 NERVOUS FEVER. The saline mixture given in a state of effervescence, every two hours, readily abates thirst, and removes the increased irritability of the system. In like manner, a table-spoonful of yeast, given every three or four hours, affords much relief, and has, alone, often prov- ed an effectual remedy. The Rev. Edward Cartwright, having read of the power of fix- ed air in preserving meat from putrefying, was induced to make tri- al of yeast on a boy of fourteen years of age, who had been ill se- veral days of a putrid fever, for which bark and wine had been ex- hibited without any apparent advantage, and where there was but little hope of recovery. He directed two table-spoonfuls of yeast to be taken every three hours, which having been complied with, the boy found almost immediate relief, and recovered very quickly. Mr. Cartwright reports, that he gave the same remedy to abov6 fif- ty patients in this fever, without losing one. Whatever may be the mode of action of yeast in typhus, the fact appears to be indisputable, that fixed air takes, off that extreme debility of the stomach so conspicuously marked in disorders of this nature; and in proportion as that subsides, the pulse rises, be- comes slower and fuller, the burning heat on the skin disappears, and a truce is gained for the reception of nourishing supplies. The most agreeable mode of administering yeast, is to add two table- spoonfuls of it to a quart of beer or mild porter, of which a wine glassful may be taken every hour or two. According to the practice of Drs. Thomas, Currie, and Jackson, as well as other eminent practitioners, the affusion of cold water is one of the most powerful and efficacious means which we can make use of in typhus fever. Its effects will be more salutary, in pro- portion as it is early adopted ; that is, during the first stage of the disease. Such being an indisputable fact, established upon the firmest basis, we ought always to employ it, very soon after we have evacuated the contents of the alimentary canal. In the early stage of the disease, cold water may be poured in considerable quantity from a height, or dashed forcibly from a pail on the patient. But aspersion or ablution of the body, by means of a sponge, will be more eligible and safe in the advanced periods. The effects pro- duced by both modes are grateful and refreshing to the patient, and they usually bring about an abatement of fever, followed by more or less of a diaphoresis, and this again by a refreshing sleep. Dr. Currie states, that the cold affusion may be used at any time of the day when there is no sense of chilliness present; when the heat is steadily above what is natural; and when there is no gener- al or profuse perspiration. During the cold stage of the paroxysm of fever, while there is any considerable sense of dullness present, or where the body is under profuse sensible perspiration, this re- medy ought never to be employed, as by so doing we might ex- tinguish life. In the advanced stage of fever, when the heat is reduced, and the debility great, some cordial, such as wine warm- NERVOUS FEVER. 179 ed, with an addition of spice, or even brandy, should be given im- mediately after it. When recourse is had to this remedy, every arrangement should be made for the affusion before the patient is moved at all, and fa- tigue as well as disgust should be avoided as much as possible. In those cases where the delicacy of the system, or the apprehensions of the patient or of the by-standers, may prevent cold affusion from being employed, we may substitute tepid affusion for the more powerful remedy, or we may recommend either ablution or asper- sion. The tepid affusion, the water being luke warm, or from 87 to 97 degrees of Fahrenheit, produces a cooling effect equal to that of cold affusion; partly in consequence of a more speedy evapora- tion, and partly because so great a glow or reaction does not suc- ceed. The important object of diminishing heat, therefore, may be obtained with £reat certainty by the repeated employment of the tepid affusion, suffering the surface of the body to be exposed in the interval to the external air. A diminished frequency of the pulse, and respiration, and a tendency to repose and sleep immediately en- sue, though its effects are not so permanent as those of the cold af- fusion. Dr. Currie reports, that a putrid fever having made its appear- ance in a regiment quartered in Liverpool, he had the men drawn up and examined, seventeen of whom were found with symptoms of it upon them—these he subjected to the cold affusion once, and sometimes twice a day. In fifteen of this number, the conta- gion was extinguished,^ and in the remaining two the fever went through its course. The healthy part of the regiment bathed in the sea, daily, and by these means, he effectually destroyed the contagion. He farther relates, that of thirty-two who went through the disease, by its being too confirmed to be removed at the time of his first seeing them, only two died ; and with these, recourse was not had to the cold affusion. The same remedy has likewise been successfully employed by Dr. Currie, and many others in the more advanced stage of the fe- ver, so as seldom to fail of procuring a safe termination. He re- lates the case of a soldier who was in the ninth day of the disease when he first saw him, his pulse was 100, and feeble, his heat was 104, his thirst very great, his tongue foul and black, his mind much confused, and at times he was delirious, and petechiae were dispersed over his whole body. The mode of treatment was as follows : his strength was directed to be supported by administering a bottle of wine a day, with an equal quantity of gruel; every night he took an opiate draught, and his body was kept open by laxative clysters, and when these failed, by a few grains of calomel. A bucket-full of salt water was directed to be thrown over him immediately, which was to be repeated according to circumstances. The effect was, that in a few minutes after the affusion, the heat lessened to 98, the pulse moderated to 96, and his mind became 180 NERVOUS FEVER. more calm and collected. Two hours afterwards he had relapsed nearly into his former state, but the night was passed with greater tranquillity. The whole of this practice was continued with nearly the same result, until the twelfth day of the disease, the affusion having been performed in the evening, and occasionally at noon. The fever continued its usual period ; but on the twelfth day, the heat having sunk to its natural standard, the cold affusion was thenceforth omitted, and instead of it the body was sponged all over once or twice a day with vinegar. A memorable instance of the good effects of cold affusion carrie under my immediate knowledge some years ago, says Dr. Thomas, whilst I practised in the West Indies. A professional gentleman of my acquaintance, residing in the Island of Nevis, was attacked with this fever; and it proceeded with such violence, that in a few days petechia? appeared on different parts of his body, and a he- morrhage of blood issued from his nostrils, mouth, and other places. Under these unfavorable circumstances, he was freely ex- posed to the open air, and one or two buckets of cold water were thrown over him ; he was then wiped perfectly dry, and replaced in his bed ; which plan of proceeding was repeated twice and some^ times thrice a day. By means of this application, the administra- tion of an opiate at night, and a liberal allowance of wine, his life was preserved to the great, but pleasing astonishment of all his friends. The affusion of cold water on the surface of the body, is consid- ered, by Dr. Jackson, as a power which makes a strong and gene- ral impression on the system, and which arrests the disease, or chan- ges its condition in virtue of that impression ; but not by subtract- ing increased heat, as supposed by Dr. Currie. Indeed, the good effects of the remedy in question, cannot, we think, be wholly ow- ing to the mere subtraction of heat; for it has been used with great advantage in many cases of fever, where there has been no per- ceptible increase of temperature, and where, by affusion, ablution, or aspersion with cold water, the disease has been cut short abrupt- ly, as well as in those where it had risen to a high point. There- fore, we may safely infer, that cold affusion, or the suddenly pour- ing cold water over the whole surface of the body, operates as a powerful stimulant, although its effects probably are of short dura- tion, unless frequently repeated ; they are produced by the sudden- ness of the application affecting the nervous energy, and by the shock rousing the dormant susceptibility, so as to induce a new ac- tion, as it were, of the nervous system, removing spasmodic con- traction of the extreme vessels on the surface, carrying off a large portion of morbid heat by general evaporation, and the remainder by insensible perspiration ; thence restoring the healthy action of the exhalents and capillaries. As the danger of this fever is in proportion to the debility, the great point is to support the patient's strength and spirits by a li- NERVOUS FEVER. 131 beral use of tonics and cordials, which should be early employed. At the same time, a nourishing diet should be used, suited to the taste of the patient, and the most rigid attention paid to clean- liness and to a free circulation of pure air. In having recourse to these means, with a view of supporting the vital energy, we must take care to prevent the feculent matter from being confined, by occasionally administering laxatives or clysters. The sulphate of quinine excels all other tonics in this variety of fever. It should be given in the usual doses, either in pills or solu- tion, (see Dispensatory,) and repeated as often as the urgency of the case requires. Should the quinine not be at hand, the Peruvi- an bark may be given as freely as the stomach will bear, either in substance, decoction, or infusion. The beneficial effects of the bark, may be increased by conjoining it with the snake-root, in pro- portion of one ounce of the former to two drachms of the latter, or by adding to each ounce of the bark, a scruple of camphor. Where the quinine is used the snake-root may be given in infusion. (See Dispensatory, under the head of Diaphoretics.) When the bark is rejected in its various forms, as it frequently is, we should not despair of finding a succedanium as long as our country abounds with the red and black oak. From my own observations in prac- tice, frequent, bathing in a strong decoction of the bark of either will produce,the same salutary effects, as could possibly be expect- ed from a free exhibition of the Peruvian bark internally. (See Materia Medica,—and also Bilious Fever.) The other tonics of most efficacy in typhus are the mineral acids. I have myself employed the nitric acid diluted, (see Dispensatory,) in doses of a wine glassful every two or three hours, with very be- neficial effects. Dr. Thomas speaks highly of the muriatic acid in all febrile diseases of malignant nature. In all such cases, he says, it will be found a powerful and efficacious medicine. His usual plan of administering it is nearly as follows:—Having relieved the stomach by a gentle emetic, where nausea prevails, cleared the bow- els of their feculent contents by a moderate dose of calomel and jalap or rhubarb, and subjected the patient to cold affusion when the circumstances already noticed have admitted of it, he gave to adults ten or twelve drops of the muriatic acid, guarded with five drops of laudanum, in an infusion of Columbo, Virginia snake-root, or bark, and repeated the dose every four hours, gradually increas- ing the quantity to eighteen or twenty drops, or more. He says, from using it in this manner, his practice has been attended with the most decided success. Dr. Thatcher, also, bears testimony in favor of this remedy. He states a case of putrid fever, attended with extreme danger, in which he administered the muriatic acid in a strong decoction of thoroughwort, with a few drops of laudanum. When it had been taken freely for about twelve hours, a profuse sweat ensued, of a yellowish color, and nauseous smell; a favora-. ble change immediately appeared, and the recovery was rapid. 182 NERVOUS FEVER. Dr. Armstrong states, that he has employed the muriatic acid in typhus, with beneficial effects, when it did not excite griping pains or diarrhoea. He has prescribed as much as two drachms of it, largely diluted with water, in twenty-four hours, so as to make it a sort of common drink. Another tonic of considerable efficacy in fevers of a malignant nature, is the solution of arsenic. Dr. Ferrier found, in the last stage of typhus, when neither bark, wine, or brandy, cold bathing, or even occasional doses of Cayenne pepper, had the effect of rousing the powers of life, or lessening the thick crust which cover- ed the tongue, that most singular advantages were obtained by giv- ing the arsenical solutions. As soon as the febrile paroxysms are stopped, he considers it best to suspend the use of the arsenical so- lutions, and to support the patient with bark and different cordials. Dr. Thomas corroborates the efficacy of this medicine, in stating a severe case of typhus which fell under his care; the patient having suffered two relapses of the fever, and her life despaired of, when he was induced to make use of this mineral solution. Its effects exceeded his expectations, for the woman's life was apparently pre- served by it. The solution of arsenic may be given in its usual doses every three or four hours. Of every other medicine, cordials only would supersede the bark; and with these putrid fever is sometimes successfully conducted, when the bark is disagreeable or rejected. The chief is wine, which it is often necessary to give in large quantities. It must be recol- lected, however, that wine is an indirect stimulant, followed by a nar- cotic effect; so that when we begin, we must continue its use until nature can exert herself. In this case, and in all instances of pu- trefaction, whether general or local, our remedies are intended to supply the powers of nature. When these are roused, our exertions may be safely remitted ; and we find that this effect is produced in general fever, when the pulse becomes fuller and softer, the eye more quick, the skin more clear, and the tongue more clean and moist; in partial gangrenes by a beginning suppuration of the mor- tified part. It is impossible to fix the precise quantity of wine that ought to be given, as it must be varied according to the nature of the exist- ing symptoms, the age, constitution, and previous habits of the pa- tient. Madeira is unquestionably preferable to every other wine, but, unfortunately, it is seldom to be procured genuine from the re- tail stores ; consequently, it is better to obtain the Sicily, dry Sherry, Lisbon, or Teneriffe wine. These should not only be given at first diluted, but in small portions at a time. A mixture of wine and milk, in proportion of one part of the former to three or four of the latter, constitutes an excellent drink, as well as diet, in the advanced stage of typhus. When the stronger wines excite too much, the weaker, such as claret, may be tried ; and if these should not an- swer, small repeated draughts of brisk ale or porter, may be given, NERVOUS FEVER. 183 and in many cases with more salutary effects than wine ; either be- ing calculated, in the last stage of typhus, to give that degree of vi- gor to the system, requisite to remove those partial congestions which often exist at the period in combination with general debility. Good cider is another substitute for wine ; and brandy, rum, or whiskey, may, though with less decided success, supply the place of either. Although stimulants are indispensably necessary, where there is a loss of tone in the vascular system, and real debility existing, yet to employ them inconsiderately, will often be attended with bad consequences. Dr. Armstrong observes, that it would be quite as rational to give a half intoxicated man a tolerably free allowance of ardent spirits, with a view to make him sober again, as to attempt to re- store, while the stage of excitement continues, a typhus patient, by the administration of wine; for he may be said to be, in some de- gree, intoxicated by the stimulous of the fever, and he will, therefore, be more affected by every glass of cordial that is administered. Dr. Potter, also, judiciously remarks, that the prescribing of diffusa- ble stimuli in every fever that has the name of typhus attached to it, is one of the greatest absurdities and strongest infatuations that infest the practice of physic. There is no fever that will bear, much less require, such agents to remove it in its first stage. It should be remembered, that when strong stimulants are incau- tiously administered, they have a powerful tendency to produce in- flammation or congestion in the visceral organs, and thus to render the chance of recovery, at the best, very doubtful. Therefore, it is important in administering wine, or any other stimulant, to give it at first sparingly, and notice its effects carefully. If on trial the patient sleep well, breath easily, and feel a universal glow, we may safely go on with it; but if, on the contrary, it produce restlessness, difficulty of breathing, the tongue becoming drier, and the pulse more tense and rapid, its farther use should be omitted until the inflam- matory diathesis be removed. In habitual drunkards, the stage of collapse sometimes rapidly supervenes, and they should always have an earlier and more liberal allowance of stimulous, than those who have lived in an abstemious manner, otherwise they will sink under the evacuations which may be indispensably necessary to remove the disordered condition of certain organs. By this general plan, a cure will, for the most part, be effected ; but in the progress of the disease, particular morbid symptoms will require especial treatment. Thus, affections of the head, with stu- por and delirium, will sometimes be relieved by frequently washing the temples with cold vinegar and water ; and occasionally bathing the feet in warm water. But if these affections, notwithstanding, should continue, it will be necessary to shave the whole of the head, and apply cloths wrung out of cold vinegar and water, which should 184 NERVOUS FEVER. be frequently renewed ; and if the delirium be accompanied with wildness of the eyes, a blister must be applied to the head. Where there prevails any unusual coldness in the lower extremi- ties, recourse must immediately be had to the warm bath, or to some warm stimulating applications externally, as well as the exhibition of stimulants internally, in order to restore the circulation to the surface. The efficacy of the bath will be greatly increased, in such cases, by having it strongly impregnated with salt, and the patient should remain in it, till his skin become warm; and on being re- moved to his bed, he should be well rubbed all over with hot flan- nels, and bottles of hot water, or heated bricks with vinegar poured upon them and enveloped in flannel applied to his feet, legs, and under the armpits. When a bathing vessel cannot be procured, use, as an embrocation, a strong solution of table salt, in heated spi- rits, which admirably recalls the languishing circulation to the sur- face. A depression of the animal heat will sometimes come on in the collapse of typhus without any apparent cause. The pulse be- comes very smallj and the extremities very ccdd ; and if some warm cordial, as mulled wine, hot toddy, or ginger tea, sweetened, with the addition of a little spirits, be not immediately administered internally, and warm stimulating applications applied externally, death will soon follow. Blisters, as well as sinapisms in such cases, have fre- quently been employed, and are serviceable by their stimulating ef- fects ; but they should not be continued on long at a time; and when a blister is raised in this disease, the sore should be frequently washed with an infusion of red oak bark ; and nothing ought to be applied to the part which may tend to increase the discharge ; for that, by debilitating the system, would prove injurious. If nausea or vomiting continue, apply flannels, wrung out of hot spirits, in which red pepper or mustard seed has been steeped, to the stomach and lower extremities. These failing, give the saline or camphorated mixture, and apply a poultice of mint leaves or cloths moistened with laudanum and camphorated spirits, to the sto- mach, and cataplasms of mustard seed and vinegar to the feet. A slight purging, attended with a gentle moisture of the skin, not unfrequently arises towards the close of this fever, and now and then assists in carrying it off: but where it does not seem to produce a criticaleffect, it ought to be stopped as speedily as possible by giv- ing charcoal or the absorbent mixture, with a few drops of laudanum, or by clysters of starch, or the decoction of red oak bark, contain- ing in each a tea-spoonful of laudanum. When the purging is not considerable, wine or brandy mulled up with spice, or a free use of arrow root, with plenty of nutmeg, or rice milk with cinnamon boiled in it, is often sufficient. If purging be produced from swallowing putrid matter, give a .small dose of castor oil or rhubarb and, magnesia, and afterwards • NERVOUS FEVER. 185 (charcoal. (See Bilious Fever.) In the stage of excitement, a di- arrhoea accompanied with bloody stools sometimes occurs, indicative of either a preternatural fulness of the liver, or inflammation of the mucous membrane of the bowels. In this case we must resort to the warm bath, mucilaginous drinks, and evacuants, as calomel, and castor oil. It not unfrequently occurs, that patients, kept in very close apart- ments, have, on the approach of the last stage, black, bloody stools, Without any offensive odor. About the same time petechial or pur- ple spots begin to show themselves upon the extremities, which at first are only few in number, and appear as if drops of black ink had been allowed to dry here and there upon the skin : but becom- ing numerous, they soon spread over different parts of the body, and are generally accompanied by discharges of blood from the nostrils, mouth, bladder, or bowels. When these symptoms are ac- companied with a weak, quick, thready pulse, we may be sure the stage of collapse is at hand. In such cases, recourse must be had to the most powerful antiseptics, such as vegetable and mineral acids, yeast, liquors in a state of fermentation, quinine, wine and bark, and aromatics with very small doses of laudanum. At this momentous crisis, bathing the patient frequently in spirits, or in a bath composed of equal parts of whiskey and decoction of red oak bark, with a free admission of air, will not fail to produce good ef- fects. In addition to this mode of treatment, when the hemorrhage proceeds from the nose, mouth, or ears, it is advisable to make use of local applications, as lints dipped in a solution of alum, or blue Vitriol, or some powerful styptic. Miliary eruptions sometimes appear as the crisis to this fever, and ought, therefore, on no account to be checked by any kind of evacuations ; nor should the patient, oh the contrary, be kept too warm with a view of forcing them out. Profuse sweats are to be obviated by sponging the body and ex- tremities daily with equal parts of vinegar and spirits; by being lightly covered with bed clothes; by admitting fresh air freely into the chamber, and by giving whatever he drinks, cool, and agreea- bly acidulated with lemon juice or elixir vitriol. If hiccoughs or starting of the tendons supervene, it will be ne- cessary to give camphor and volatile sal-ammoniac in large dosesij with the warmest cordials. In cases of retention of urine, the treatment must be varied ac- cording to circumstances. In some instances the kidneys become inflamed, and in this state very little urine is secreted, until the healthy action of the vessels be restored by administering calomel and mild purgatives, swallowing freely of demulcent drinks, andj occasionally, using the warm bath. In the low typhus, the kidneys are rendered incapable of performing their functions from a loss of tone, and in such cases stimulants and tonics, with cold applica- tions over the region of the bladder, as cloths wrung out of spi- •24 • J86 NERVOUS FEVER. rits, or equal parts of vinegar and spirits, are the best remedies. When the bladder is over distended, or inflamed, indicated by acute pain and some tumor, the catheter is indispensably necessa- ry to draw off the water. In febrile complaints, it will be found that, where a small quantity of urine is secreted, the sediment is proportionably copious ; and, on the contrary, where a large quan- tity is secreted, the sediment is proportionably scanty. If attention be' paid to keeping the bowels open from the commencement of fe- ver, a suppression of urine will hardly ever take place. In an advanced stage of the disease, it sometimes happens, that in addition to a profuse secretion of viscid saliva, little white ulcers, or apthse, appear in the mouth. In such cases the detergent gar- gle, (see Dispensatory,) should be frequently employed, and the mouth occasionally washed with a solution of alum in water, an ounce of the former to a pint of the latter, and this will quickly take away the stench that arises from them. The viscid phlegm, which collects about the tongue and teeth, may be wiped away with flannel, dipped in vinegar, or salt and water, or after washing the mouth with sharp vinegar or some austere acid, it may be scraped off with a knife, or a piece of bent whalebone. From want of sleep, much rambling and low delirium sometimes occur, which will require an opiate at early bed-time. The most advisable way of giving it, to prevent any deleterious effects, is to conjoin laudanum, with the camphorated mixture, or the opium with a few grains of camphor, volatile sal-ammoniac, or some mild diaphoretic, as Dover's powder. Opiates are more admissible in this fever than in any other, and, as it is of the utmost consequence to procure rest, they should, with this view, be employed every evening, where there is no great delirium. In all fevers where we wish to procure sleep, and cannot have recourse to opium, on ac- count of delirium being present, a pillow of hops laid under the pa- tient's head, has been used with singular advantage. In case of watchfulness, the camphorated julep, or porter and water will generally succeed. When, however, these means fail, and there is great prostration of strength, followed by stupor, and a train of the most distressing symptoms, wine should be exhibited in large quantities, and it will be found that the patient will show a relish for this valuable cordial, after refusing medicines and every kind of nourishment in a solid form. At first it is better relished mulled; but afterwards the patient will take it freely in its pure state, and in the quantity of one or two quarts a day, without in- toxication. The quantity of wine should be regulated by the de- gree of debility present, the age of the patient, and the effects pro- duced by it. The proper rule to be observed in the use of wine, is to give it until the pulse fills, the delirium abates, and a greater degree of warmth returns to the extremities. And upon the smallest appear- ance of the stupor returning, the pulse quickening, and sinking, for they usually go together, the wine must be resumed and con-- NERVOUS FEVER. is: tinued in that quantity which is found sufficient to keep up the pulse, and ward off the other bad symptoms. When wine cannot be had, rum or brandy diluted with milk or water sweetened, will answer; and with some patients is better re- lished. The friends of the sick should never be disheartened too soon, for here, if any where, we may say, " while there is life, there is hope." And I can truly aver, that I have often seen the patient raised, as it were, from the dead, by the determined use of gener- ous wine alone, especially old Madeira. As soon as the patient is able to take nourishment, such as pa- nado, arrow-root, &c., the quantity of wine must be gradually di- minished. For although it be absolutely necessary to take it so liberally, during the continuance of this fever, yet, as soon as that shall have left the patient, much caution becomes necessary in the use of it; since the third part of what formerly had proved a salu- tary cordial and restorative, would in this state of convalescence, occasion a dangerous intoxication. It sometimes happens, at the close of typhus, that the patient is affected with a slight degree of mania or temporary alienation of the mind. In such a case it will be necessary to support the pa- tient with a generous, nutritive diet; to keep him as quiet as possi- ble ; and to give him tonic medicines, as bark and elixir vitriol, ni- tric acid or tincture, or rust of steel, carefully avoiding evacuations. If the appetite does not readily return on the cessation of the fever, the mineral acids, or stomachic bitters, will be proper. Bath- ing daily in a strong decoction of red or black oak bark, will be found an excellent remedy in removing the irritability and weak- ness which are left behind ; and when there is no visceral obstruc- tion, the shower bath will be attended with beneficial effect. We repeat, it. is of the utmost importance throughout the whole course of the disease, that the most rigid attention be paid to clean- liness, and the communication with the external air kept up in dif- ferent degrees day and night, according to the state of the atmos- phere. None but those whose business it is to attend the sick, ought to be allowed to go near the patient, except when there is little or no affection of the head. In such cases the presence of a friend may sooth the mind and help to dispel gloomy ideas; by comfort- ing the patient with the hope of a speedy recovery, and diverting his thoughts from that anxiety and dread of danger which invaria- bly attends his complaint. Regimen.—In addition to the mild articles of diet enumerated in the bilious fever, bread and milk, with a little water, sugar, and the pulp of a roasted apple, form a most grateful and nutritious food ; and, for the sake of variety, cider, porter, or any other drink which the patient covets, should always be allowed. It has been observed, that this fever often originates from cor- rupted air, and, of course, must be aggravated by it; great care should therefore be taken to prevent the air from stagnating in the 188 NERVOUS FEVER. patient's chamber. When that is small, and cannot be well venti- lated, the patient should be carried into the open air, and allowed to sit there two or three hours every day in mild weather. When this cannot be conveniently done, every means in our power to ventilate the room should be employed. Strong-scented herbs ought every day to be strewed about the room, and vinegar fre- quently sprinkled about the bed-clothes, and some evaporated, by pouring it on hot iron. The bed-clothes ought to be in no greater quantity than is agreeable to his feelings, and when he can sit up, with his clothes loosely put on, it is often a refreshing change of posture and situation. The patient should have his linen and bed- ding changed often, and the stools removed as early as possible; for nothing refreshes the sick more than cool air and cleanliness. In the early stage of this disease, when there is much preterna- tural heat, washing the face and hands often in cold vinegar and water, and wiping the body with wet cloths, will be highly refresh- ing ; and in the more advanced stage of the disease, when there is less febrile heat, the vinegar should be united with an equal quanti- ty of spirit. In all cases where the fever is unusually protracted, and leaves the patient in excessive weakness, the recovery is slow and precarious, and the greatest care is required to prevent any er- ror in diet, during the convalescence, as a very small degree of ex- cess at this time, will produce very troublesome consequences, Food of easy digestion, taken in small quantities, and often repeat- ed ; gentle exercise, when the weather is favorable ; attention to prevent costiveness, by some mild laxative ; and the use of bit- ters to assist digestion, or the rust of steel, when there is any pre- vailing acid on the stomach, are the most certain means of reinstat- ing health. Contagion.—Having in the preceding chapter enumerated the different means for the prevention of diseases, I shall now point out such as are most suitable to arrest the progress of contagion when commenced. When a contagious fever makes its appearance, the first precau- tion is to separate the sick from the healthy, and thus to cut off, as much as possible, the intercourse between them. The next step should be, to purify both beds and clothes from every particle of filth. The chambers must be often fumigated, by burning good sharp vinegar or tar, and the floor washed daily with lie, or the so- lution of potashes, or strong soap-suds. A cloth wetted in lime- water and hung up in the room, and replaced as often as it becomes dry, is also a great mean of purifying infected air. When a contagious disease originates on ship-board, quick-lime should always be added to the water which is used for common drink, in the proportion of one pound of quick-lime to a hogshead of water ; but if the water be impure, a larger quantity of lime will be necessary; and some of it should be put also into the ship's well, to prevent the putrid arid foul air arising thence. NERVOUS FEVER. 1S9 When these means are ineffectual to stop the progress of any contagious disorder, fumigation with the nitrous vapor, will un- doubtedly succeed; and the method of preparing it, is to put half an ounce of vitriolic acid into a cup, warm it over a shovel of coals, adding to it, by little and little, about the same quantity of powder- ed saltpetre, and stirring it occasionally with a slip of glass, as long as the vapor arises. The vessel is then to be carried about the room, the doors and windows being close shut, and put in every corner and place where it can be suspected there is any foul air ; the fumigation to be continued for one or two hours every day, or oftener, until the contagion shall be destroyed. If the vapor should irritate the lungs, so as to excite much cough- ing, fresh air should be admitted, by opening the door or windows of the room. However, after a little familiarity with it, this vapor will not offend the lungs, but on the contrary will prove highly * grateful and refreshing. The vapor of muriatic acid has also been successfully employed in purifying infected air, and destroying contagion. It is made use of in the following manner. Put one pound of common salt into* an earthen vessel, and pour over it, from time to time, a small quan- tity of sulphuric acid, till the whole salt is moistened. If the air be foul and peculiarly offensive, apply a gentle heat under the ves- sel to extricate a larger quantity of vapor ; but in general, the sim- ple addition of the acid to the salt will be found sufficient, unless the apartment be very large. As a purifier, the chloride of lime stands pre-eminent. A table- spoonful or so, may be put in a saucer, and moved from place to place in the room, or it may be mixed with a little water, and sprinkled over the floor and walls. Care should be taken, that the atmosphere of the room be not too highly impregnated with the fumes from this, or either of the articles above mentioned, other- wise, a troublesome cough, with soreness of the throat and breast, will be experienced by the patient and attendants. On the first appearance of typhus, or any infectious disorder, in a jail, hospital, boarding-school, or any other place where many persons are crowded together, one of these gaseous fumigations should be employed in every room, in addition to a free ventilation and the greatest cleanliness. An eminent physician of the marine barracks of Brest, states, that previously to visiting the hospital, he was in the habit of intro- ducing into his nostrils sponge cut into proper size and shape, and moistened with some essential oil. He also kept in his mouth a piece of orange-peel; and in this simple method he escaped seve- ral putrid and pestilential diseases, which in one year killed eleven physicians and one hundred and thirteen students. Where any one is apprehensive of having caught infection, which may be suspected by a bad taste of the mouth, and want of appe- tite, an emetic should be given towards the evening, and on the pa- 190 INFLAMMATORY FEVER. tient going to bed he may be allowed a little mulled cider, or wine whey, with a small dose of the anodyne sudorific drops. (See Dis- pensatory.) , The warm bath, if such a luxury can be commanded, would here be found exceedingly refreshing and beneficial* INFLAMMATORY FEVER. When fever is attended with an inflammatory diathesis, or when actual inflammation affects any part during the existence of fever, the patient is said to labor under one of an inflammatory kind; but according to the different parts in which the inflammation is seated, different denominations are given to the disorder. This dis- ease, however, exists when there is no topical inflammation, and is distinguished by more considerable heat than usual, indicating ,.an increased action of the arterial system. The fever continues for several days with nearly the same violence, the morning remis- sions being scarcely ever observable. Symptoms.—A sense of lassitude and inactivity, succeeded by ver- tigo, chilliness, and pains over the whole body, but more particular- ly in the head and back ; which symptoms are shortly followed by redness of the face, throbbing of the temples, great restlessness, in- tense heat, unquenchable thirst, oppression of breathing and nau- sea. The skin is dry and parched, the eyes inflamed, and incapa- ble of bearing the light, the pulse hard and quick, beating from nine- ty to one hundred and thirty in a minute. The disease usually goes through its course in about fourteen days and terminates critically, either by a diaphoresis, diarrhoea, hemor- rhage from the nose, or a copious deposite of sediment in the urine —otherwise it changes to a typhus. Causes.—Sudden transitions from heat to cold, the application of cold to the body when warm, swallowing cold liquors when much heated by exercise ; too free a use of spirituous liquors; violent pas- sions of the mind ; exposure to the rays of the sun ; topical inflam- mation ; the suppression of habitual evacuations, and the sudden repulsion of eruptions. Treatment.—The symptoms which attend this fever indicate most strongly the necessity of having an early recourse to the lan- cet, which should be freely used. In repeating the operation, we must, however, be governed by the effect it produces on the pulse,. * To this disease the philanthropic Dr. Benjamin Rush, of Philadelphia, fell a victim in the year 1813 •, a man distinguished throughout a long and brilliant life, by his private and social vir- tues. He was efficiently engaged in promoting the independence of the United States in the war of the revolution ; and contributed chiefly to the establishment of the Medical University of Pennsylvania, in which he filled successively the most important chairs. His memory is che- rished with the greatest respect, not only by the members of the profession of which he w»s the ornament, but also by the people of the. United States. INFLAMMATORY FEVER. 191 ^and by the appearance the blood puts on after standing some time. If the former continue full, strong, and tense, and the latter exhi- bit a buffy, sizy coat on its surface, the bleeding should be repeated by all means. The pulse in this fever is apt to become fuller and stronger after bleeding, which may easily be explained ; for the ple- thora may be so great as to distend the vessels beyond their proper tone. In such cases, the vessels cannot act fully, and the pulse is contracted : but when the plethora is taken off by copious bleed- ing, and the vessels are allowed to contract properly, the pulse be- comes fuller, which shows that the remedy is proper. When the fever has been of several days' standing, and the head is much affected, either with severe pain or delirium, topical bleed- ing, by the application of three or four leeches to each temple is advisable, should the pulse not justify the use of the lancet. Applying linen cloths, wetted in cold vinegar and water, to the forehead and temples, will often afford considerable relief. If nausea or sickness prevail at the commencement of the disease, it should be relieved by a gentle emetic. But when the determina- tion to the head is violent, and the vessels have not been sufficiently depleted by blood-letting, the aperient and diaphoretic pills, or a dose of calomel, or infusion of salts, senna and manna, will be most proper. Cathartic medicine will not only relieve the head; but pre- vent determinations to the lungs and liver ; and medicines of this class should be repeated every day or two during the continuance of much febrile action. Diaphoretics are remedies also of great utility in continued fever. Therefore, with a view to determine the circulation to the surface of the body, give the febrifuge powders or mixture, the saline mix- ture, spirit of Mindererus, diaphoretic drops, Dover's, or antimoni- al powders in their usual doses. (See Dispensatory.) The warm bath will be found of considerable efficacy in encouraging the dia- phoretic powers of these medicines. In many cases it will be suffi- cient to induce perspiration for the patient to bathe his feet in warm water, to lie in bed and drink plentifully of diluent liquors, as balm, ground ivy, or flax-seed tea, with the addition of a little nitre; but should these simple means not prove efficacious, it will then be ne- cessary to resort to more powerful agents. It ought to be remembered, in the whole of the inflammatory cases, we should never have recourse to diaphoretics, till arterial action and general excitement are considerably reduced by blood- letting, and aperient medicines. And, it should also be laid down as a general rule, in every species of inflammatory fever, to solicit perspiration rather by simple means, than to force it by any violent measures. When the means employed have a tendency to allay heat, soften the skin, relieve delirium, and induce sleep, we may be assured of their propriety. But sweating, when excited in fe- vers by stimulant, heating and inflammatory medicines, is almost sure to prove hurtful. It likewise proves injurious when excited 192 INFLAMMATORY FEVER. by much external heat, or a load of bed-clothes : as also where, in- stead of relieving, it rather increases the frequency and hardness of the pulse, the anxiety and difficulty of breathing, the headache and delirium.' When sweating is partial, and confined to the superior parts of the body, it will be more likely to prove hurtful than salu- tary. The torpid state of the vessels of the surface, renders it, some- times necessary to have recourse to artificial heat, in order to equal- ize'the circulation and produce perspiration. Therefore, when nei- ther the warm or vapor bath can be procured, hot bricks, after be- ing dipped in water, or vinegar poured upon them, and surrounded with flannels, should be applied to the feet, between the thighs, the sides, or armpits, while the patient is moderately covered, so as to confine the steam or vapors. These means will very generally and speedily cause a relaxation of the surface, and produce an abundant perspiration. In having recourse to the warm bath, it is worthy of remark, that the natural temperature of the human species is about ninety- eight degrees, but owing to the cooling process constantly taking place on the surface, it is here considerably lower, and hence we feel the sensation of warmth, at several points below animal heat. It is this circumstance which renders it difficult to adjust a precise standard, though, perhaps, we may not err by fixing it from ninety to ninety-six degrees. However, it will be proper, from the dif- ferent susceptibilities of persons, always to consult the feelings of the individual, and so to regulate the bath that it may impart a slight, but an agreeable sensation of warmth. But, though the ap- plication of heat to the surface, in the mode which we have de- scribed, will very generally excite sweating, it does not do so uni- formly. There are cases attended by great heat of the surface, particularly in the early stage of the nervous and scarlet fever,'which is aggravated by all the means we have enumerated, as designed to ■create perspiration. And in diseases of this nature, the effusion of cold water will be found more effectual in removing the constitution of the cutaneous vessels, than warm applications. In the progress of this fever, it sometimes happens that particular parts of the body are much affected, and that there prevails either great oppression of breathing, or that violent pains in the head, stu- por or delirium ensue. In all such cases, the application of a blister near the part affected, will be proper, and relief will often be quickly procured by it. Where there is an unusual coldness of the extre- mities, with a sinking pulse, blisters to the inside of the legs will, likewise, prove highly serviceable. Their efficacy, in such cases, may be increased by the application of stimulating cataplasms, to the soles of the feet and palms of the hands. Blisters very power- fully restore the balance of the circulation, and diminish morbid congestions. In all cases of fever there is a fulness of the vessels; and we find the vessels* of the eyes red, the face flushed, and the INFLAMMATORY FEVER. 193 eye-ball itself apparently enlarged ; but congestion produces, also, irritation, and often a less degree of phrensy. The usual wander- ings of the mind are more rapid, the voice quick, the temper irrita- ble, unreasonable, and occasionally violent. In each state, blisters are indicated, and often produce the happiest effects ; sleep frequent- ly coming on as soon as the plaster begins to stimulate. The milder symptoms of congestion yield frequently to purgatives ; and when these have been freely used, blisters are not often necessary. In this fe/ver, as in most others, sleep is much interrupted ; and from a want of this, delirium often arises. Opium, here, would be an uncertain medicine ; for should it fail to procure rest, the deliri- um would be greatly increased by it. In such cases, a pillow of hops laid under the patient's head, or a strong tea of this herb, will generally have the desired effect of procuring refreshing sleep. The camphorated powders or julep, are of considerable utility in fe- vers, and, in many instances, have procured sleep. The calmness which camphor often seems to inspire ; the serenity, and even the temporary ease, which are among its first effects, render it peculiar- ly valuable. Hemorrhages sometimes occur in this fever, and at times are dif- ficult to be restrained. If the pulse be full and hard ; if much head- ache have preceded, the bleeding must be continued. But if it hap- pen at the conclusion of fever, or be attended with faintness, anti- septics constitute the proper remedies. (See Bilious and Nervous Fevers.) ' Palpitation of the heart, is frequently a troublesome symptom in fevers. It is often produced by redundancy of blood, as indicated by a florid countenance, in which case the lancet must be resorted to. It sometimes proceeds from the state of the stomach and bow- els, and may then be relieved by evacuants; but it arises also, in many cases, from a diminution, or an irregular distribution of the nervous power ; and shows that the degree of debility is consider- able when stimulants will be required. In some instances, the fever is continued and kept up solely by debility. In such cases, the bark may be employed, provided on using this medicine, the patient sleep well, breathe easily, and do not find any increased heat; but if, on the contrary, it produce dif- ficulty of breathing, and restlessness, its use should be omitted. If by a prudent and judicious use of the remedies pointed out, we can lessen the congestion in the head, preserve the strength by the due regulation of temperature, and support it after the first days by more nourishing diet, we shall find little occasion for administering bark or other tonics. Cordials are, however, often necessary ; and of these, wine is the most efficacious. In this fever, partial evacuations, such as purging and sweating, which have no tendency to prove critical, often arise. When these happen, we must put a stop to them by resorting to the means re- commended in such cases, under the head of Bilious and Nervous 25 194 INFLAMMATORY FEVER. Fever. Critical evacuations may be distinguished from those which are not so, by attending to the appearances which take place in other parts of the system. For instance, if a purging should arise, and the tongue continue foul, and the skin dry, without any abate- ment of heat and thirst, then we may regard it as by no means cri- tical ; but if, on its taking place, the tongue become clean and moist, the pulse moderate, the febrile symptoms abate, and a gen- tle sweat be universally diffused over the skin, then a crisis may be expected. When this fever does not yield to the remedies pointed out, but assumes the symptoms of typhus, it is then to be treated as advised under the head of Nervous Fever. Among the sequels of fever are cough, night sweats, an irritable and irregular state of mind, a capricious, and often an inordinate appetite. These are, in general, marks of debility only, and disap- pear with returning strength. Tonics are usually employed for a time with little effect. The constitutional powers are at last exert- ed, and the patient gains in hours the strength which, with most powerful tonics, he did not attain in days. The powers of digest tion, however, do not return in the same proportion as the appetite, and relapses are not uncommon from unlimited indulgence. Regimen.—Throughout the whole course of the disease the pa- tient is to abstain from solid food and animal broths. The diet should be chiefly gruel, barley, or rice—water, arrow-root, sub-acid fruits, water acidulated with lemon, the jelly of currants, or simi- lar sharp fruits. It may be drunk warm or cold, as is most agree- able to the patient. His chamber is by no means to be kept warm, either by fires or by being closely shut up, as is too generally the case: on the contrary, it should be of a proper temperature, by al- lowing the admission of cool ^ir into it from time to time. His bed ought to be lightly covered with clothes. The patient may sit up a little each day, according to his strength, for this will lessen the fever, headache, and delirium ; but when a salutary perspiration comes on, he should be indulged in bed. On his recovery, a strict attention should be paid to diet, scru- pulously avoiding to over-load the stomach, and partaking of such things as are light, nutritive, and easy of digestion : all other causes likely to induce a relapse, are also to be carefully shunned. Fresh air, gentle exercise on horseback or in a carriage, agreea- ble company, and a moderate use of wine, will greatly contribute to the recovery of convalescents. Should the appetite not readify return, or the digestion prove weak, the tincture of bark, stomach- ic bitters, or nitric acid will be proper. Having pointed out, in an intelligible manner, the most approv- ed method of treating the intermittent, remittent, and continued fever, as well as the means of prevention, it seems advisable to give some useful hints with regard to the prognosis, by which the at- INFLAMMATORY fever. 195 tei.uve reader may be instructed in the art of foretelling what may happen to the patient, with respect to the termination or change of a disease either by death or recovery. Prognosis of Fevers.—In treating the prognostics of fevers ge- nerally, we shall first present some useful admonitions which are given in the symptoms of impending disease. The prognostic of an impending disease may be drawn from the aspect of the countenance, the mode of living, the changes in ha- bits or situations, and the critical period of life. If a person from a healthy state, become sallow, weak, with loss of appetite and spi- rits, or with disturbed sleep, we may reasonably suppose that some disease threatens. Should these indexes be gradually disclosed, with a countenance tinged lightly with yellow, obstructions in the liver have probably taken place ; if more rapidly, with slight shiverings occasionally, a fever impends. A regular evening exacerbation, with cough, portends a hectic ; a more violent shiver, with consid- erable heat, a continued fever, a deep redness in the face, with in- flammation in the eyes, plainly point out accumulations in the head, and chiefly venous ones; but as these often arise from diseases im- peding a free circulation through the lungs ; so that the state of these organs must be considered in forming the prognosis. They often exist together, and aggravate each other. Violent, fixed pains in the head, recurring at irregular intervals, and usually excited by every cause of increased circulation, generally show that some fix- ed obstruction prevents the free course of the blood through the organ ; and this is followed by convulsions, sometimes by insanity, and frequently a sudden termination of life. A fulness in the sto- mach and abdomen are certain signs of accumulation, and it de- pends on the comparison of the other symptoms, whether it be ob- structions of the viscera, accumulated contents, or merely flatulen- cy : the prognostic must be regulated by comparing the symptoms of each disease. The mode of life will often lead us to form some prognostic of an impending disorder. Late hours cannot be borne with impuni- ty, except by very few ; and their principal effect is to induce ob- structions in the abdominal viscera. If connected with drinking spirituous liquors, the effect is usually felt in the liver. The seden- tary student has reason to apprehend biliary accumulations, with costiveness, and a train of hypochondriac symptoms. Excess in eating or drinking will equally lead us to foretell diseases of the sto- mach, often of the head, connected with the stomach ; but retributive justice is frequently seen to punish the former error with the great- est severity, in the feelings of the patient, by loss of appetite. Al- most every situation is apparently consistent with health, if free air be admitted ; but its deficiency leads to a variety of diseases from debility, which may be easily foreseen, and can only be avoided by a change. Changes of habits and situations are frequently the source of dif- 196 INFLAMMATORY FEVER. ferent diseases, which we can often prognosticate, and sometimei guard against. Abstemiousness, suddenly adopted after free living, and the con- trary, are sources of disease, the former chiefly of complaints aris« ing from insufficient stimulus, the latter from too great excitement. A sedentary, after an active life, is often attended with languor, low spirits, and visceral accumulations ; the contrary, at first with languor and fatigue, soon followed by increased tone and vigor. The critical periods of life merit attention also in our prognostics of various diseases. If scrofulous affections do not yield in the early period of life, there is little prospect of cure. The same may be said of epileptic fits and of Saint Vitus's dance, though to the latter there are many exceptions. The critical period of the fe- male life is that of the cessation rather than appearance of the ca- tamenia; for unless hectic symptoms come on, the discharge, though at a much later period* than usual, becomes regular. The period of cessation, if not preceded by free, often copious dischar- ges of the menses, prognosticates a less healthy old age. Prognostics in diseases are usually drawn from the vital, animal, or natural actions. The vital actions, which give the best infor- mation, are the states of the circulation and the respiration. The first is chiefly known by the pulse. But before we proceed farther on this subject, it may be proper to describe its action. The pulse consists in the reciprocal contraction and dilatation of the heart and arteries, by the former of which the blood is propelled through every part of the body. Much attention is required in feeling the pulse, since it often misleads, unless the practitioner be accus- tomed to its examination. In estimating its strength or weakness, it is necessary to consider the sex, temperature, and age of the pa- tient. The pulse in women is quicker than in men ; in the san- guine than in the melancholic temperament; in youth than in age. During the first year of an infant, its pulse is from one hundred and eight to one hundred and twenty; during the second, from ninety to one hundred and eight; the third, from ninety to one hundred. It varies little till the seventh year, when it is about se- venty-five ; and in the following year scarcely exceeds seventy. These numbers are subject to great variety. The pulse is quicken- ed after a full meal, or taking any stimulus ; after exercise or any agitation ; it is also quicker when standing than sitting, and in the latter posture than when lying down. In hysterical patients it is excited to an inconceivable rapidity by the slightest circumstances without portending danger. A fat 'person has naturally a weak pulse ; but it beats, also, to a disadvantage beneath a layer of fat. This circumstance should also be attended to in our estimate. The size of the artery we can often estimate, for we can feel in thin per- sons, two-thirds of its circumference, and errors can scarcely arise from this source. A natural pulse is from sixty to eighty, more strictly from sixty-five to seventy-five. On feeling the pulse, the ar- INFLAMMATORY FEVER. 197 tery should be first felt gently, and if any doubt arise whether the pulse is weak, it should be compressed strongly by three fingers, and the two uppermost slowly raised. If the pulse be strong, and seemingly weak only from compression, the blood, rapidly return- ing, will strike fully the finger below. If really weak, it gradually recovers its former force. A strong, firm pulse is consistent with high health ; but if it strike the finger like a tense cord, it shows a tendency to disease, and if with this hardness, it be increased in frequency, inflammatory fever is present. A throbbing pulse, which strikes the finger with apparent but not real firmness, will sometimes be mistaken for what is styled the hard pulse. But this has not the same firm resistance which we have described. It strikes sharply, but not strongly, and the relax- ation is as rapid as the pulse is transitory. When there is internal irritation, the throbbing pulse will continue often to the last, show- ing, in every succeeding moment, its peculiar character more strong- ly ; but in the commencement of fevers it often so nearly resembles the strong pulse as to deceive. A small pulse will also be mista- ken for a weak one, unless by a practitioner of experience ; but the lightness of its strokes depends on the small size, sometimes the depth of the artery. If a pulse be at fifty-five or fifty, there is reason to ap- prehend some compression on the brain. A constant pulse of nine- ty in a minute, rising occasionally to one hundred and eight, shows a considerable irritation in the system, and is not. without danger. If, in the early stages of fever, it rise to one hundred and twenty in a. female, not peculiarly irritable, it portends considerable danger, ■either from debility or irritation. If at any stage it exeeed one hun- dred and twenty or considerably exceed it, except for a short time, we have the greatest foundation for apprehension. An intermitting pulse is a mark of considerable debility, and prog- nosticates a dangerous disease. It is also a symptom of organic af- fections. This alarming view of the subject requires, however, some alleviation. An intermitting pulse is frequently owing to ful- ness of the stomach and bowels, and often arises from agitation of mind. It is also habitual; a circumstance not uncommon. In such constitutions, the usual intermission, on the access of fe- ver, often disappears, and the first symptom of amendment is the return of the intermission, which, at the end of the long fever, may appear alarming, if not connected with other favorable symptoms. In general, the favorable signs are, pulses more soft, somewhat fuller,' and in a slight degree more slow. The unfavorable signs are, more thready pulses, as if the artery were smaller, pulsations quick, weak, and irregular. The state of the circulation is also known by the complexion. A sallowness, and a want of transparency show that the blood is not carried to the extreme vessels ; and even when the cheeks are flushed, if the skin round the lips and nose be of an obaque, sallow white- ness, the conclusion will be the same, and the strength of the con- 198 INFLAMMATORY FEVER. stitution is considerably impaired. The appearance of the eyes is equally indicative of strength and weakness, and the character of the features is preserved in proportion to the remaining strength. Each appearance depends on the state of the circulation. Respiration is a vital action connected with the state of the cir- culation, and of the greatest importance as a prognostic. Respira- tion slow, full, and deep, shows the strength and all the vital or- gans to be unimpaired, and in every situation is highly favorable. The weak, slight and insufficient respirations, is, in general, a mark of weakness ; the suffocating of obstruction, the quick of consider- able irritation, exciting rapid expiration. The stertorous shows in- sensibility, from compression on the brain ; the stridulous, inflam- mation of the trachea; the rattling, accumulations of phlegm often unconquerable ; and the intermittent, attends the last efforts of ex- piring life. The animal actions, from which we may draw prognostics, are, ?the senses, muscular action, and sleep. Violent delirium is a symptom of active inflammation in the brain, and is dangerous on- ly so far as it shows a violent acute disorder. The wandering de- lirium, in fevers of a low kind, is a symptom of no great danger, unless it come on early, and in a degree disproportioned to the state of the fever. In other complaints it will excite serious apprehen- sions, and shows that the inequality of excitement depends on de- bility. If it persist after the cessation of the fever, unless evident- ly in consequence of debility, there is reason to suspect an organic injury in the brain, and more so, if violent delirium have occurred in the early part of the complaint. Delirium, arising from want of sleep, is said not to be dangerous ; but the want of sleep itself is generally owing to a languid inflammation of the brain. General restlessness is a symptom of the same kind. Of the external senses, and their organs, the eye affords the most particular symptoms by which the event may be foretold. The sensation of black spots, which induces the patient to pick the clothes, as if he could remove them, is a symptom of debility, and is attributed to a partial palsy in the retina. It is certainly a high- ly dangerous symptom, though by no means a desperate one, as it has been represented. A more dangerous symptom is double vi- sion. It is, in general, an early symptom of hydrocephalus. When the eyelids fall, and can scarcely be elevated by the exertion of the will, it shows considerable weakness, and when the patient sleeps without closing them, great insensibility. The latter symptom is, however, often owing to an irregular contraction of the muscles of the eyes; for in such cases the pupil is drawn up under the lid. The symptom is not, however, on this account, the less alarming. The clear natural appearance of the eye is a favorable symptom; but too great brilliancy, or too quick motions of this organ, show ap- proaching delirium. A severe fixed look, without an object, is a similar symptom. The appearance of the eyelids sometimes points INFLAMMATORY FEVER. 199 out a weak state of the system, particularly when there is a black- ness in the lower lid, towards the inner corner of the eye. A noise in the ears, in fevers, is said to be a sign of approaching delirium, though frequently a symptom of weakness only, and of- ten occurs, from this cause, in weak and old people. If this noise occur in the beginning of fevers, it is said to foretell a violent and a tedious disease. Hearing particularly acute is often a precurser of delirium ; and without fever, it is the effect of strong excitement in the brain. Deafness in fevers is said to be a favorable symptom : we can, at least, observe that we have not found it unfavorable. Vitiated taste is very common, and offers no particular prognostic. Lassitude on the attack of fevers, in so great a degree as to pro- duce fainting, is always a very dangerous occurrence. If attend- ed with a considerable wandering, the danger is greater. It is a favorable sign if, in the beginning of a fever, the patient can sit erect with his head elevated. And, if the patient can sup- port himself in bed, and occasionally turn on his side, about the tenth or twelfth day, the circumstances are favorable. Sleep, if calm and refreshing, is always a favorable symptom ; but if interrupted, broken by terror, excited by dreadful images in dreams; if, instead of tranquil rest, the patient starts, catches, talks in a hurried manner, though not conscious of terror, it is unfavor- able. Deep sleep is itself a disease, and shows a considerable oppression on the brain ; yet, at the period of a crisis, if attended with a soft pulse, moderately slow, and a soft, moist skin, it is salu- tary. After a crisis, the deepest long continued sleep is not dan- gerous, if not attended with stertor, (a sound like snoring,) or with a pulse preternaturally slow. The natural actions which furnish prognostics, are, digestion and its consequences, and the various excretions. In fever the ap- petite is at once destroyed ; nor is it a favorable sign, in an acute disease, that it should remain or return too soon. The appearance of the tongue is of considerable importance as a prognostic. Whiteness of its surface is a sign of fever ; and if white and dry, it shows the fever to be more considerable. In the progress of a fever it becomes brown, a darker brown, and even black ; and these colors are usually seen when the tongue is dry and hard. While the edges continue clean, and of their natural,, speckled appearance, there is little danger; and, indeed, fevers have terminated favorably, though the tongue has been for many days, dark, dry, and even black. The tongue, sometimes, in the course of fever, becomes suddedly clean, and of a shining red. This, in general, shows that the fever will be of long continuance. The tongue sometimes cleans slowly in elderly and debilitated constitu- tions. And, independently of fever, in such habits, the tongue is often black at the back part. A heavy load on the stomach is an unfavorable symptom, unless it arise from indigestible food; since it shows either an accumulation 200 INFLAMMATORY FEVER. of viscid mucus, or a want of energy in the organ. When the ir- ritability of the stomach is exhausted by excessive stimuli, the effect is a heavy load. . Vomiting is the connecting symptom between the affections of the digestive organs, and those of the secretory ones. When vio- lent and incessant, without previous accumulation of bile, it is an unfavorable symptom, as it generally arises from irritation of the brain : even when, from bile, it is distressing, for the act of vomit- ing emulges the biliary duct, and the inverted motion of the duo- denum carries the bilious fluid back into the stomach, thus furnish- ing new fuel for the flame. A frequent diarrhoea, independently of mucous inflammation, is dangerous, as it shows considerable debility, and a difficulty of re- taining the food long as is necessary for its assimilation. The other excretions, which have attracted attention as prognos- tics, are the perspiration; the urinary and alvine evacuations. It is generally acknowledged, that the salutary perspiration is not attended with heat, is not clammy to the touch, is generally diffus- ed without any load, uneasiness, or anxiety. The sweat of an op- posite kind does not relieve, but debilitate. Cold clammy sweats arise from a total relaxation of the exhalents, and are, in general, the preludes of death. The state of the urine has also afforded numerous prognostics, and the discrimination of its clouds, its sediment, &c, has been ' peculiarly minute. The greater number of these appearances may be disregarded. Urine must be examined only after it has been made for some time. It should be poured into a glass while yet warm, and kept in air moderately cold. With such precaution, some useful lessons may, perhaps, be drawn from its appearance. The quantity of urine varies in different persons, and, in the same, at different periods. Hence, from this no conclusion can be drawn. In general, where it is remarkably deficient, it is at other times equally redundant; and this chiefly occurs in hysterical constitu- tions. The excess is also at no time dangerous, unless the quality of the urine is changed, since it only depends on irregular action of the renal vessels. When the urine is in small quantity, its color is necessarily high ; and at the conclusion of a gouty paroxysm, as well as of a paroxysm of an intermittent, it throws down a brick- colored sediment. When highly red, without depositing any sedi- ment, it shows a violent, and probably a long fever. In general, a scum on the top, in the early period of fevers, seems to show con- siderable debility ; and we have usually found such fevers slow and tedious. A cloud suspended at first near the top, and afterwards falling lower till in succession it reaches the bottom of the glass, are favorable signs ; and a suspended cloud, previously to the four- teenth day, shows that the disease will terminate at that period. If it appear after the fourteenth day, the disease terminates at the twen- ty first, gradually lessening on the intervening dstva. INFLAMMATORY FEVER. 201 The progress of the cloud in the urine, in case of fever, is regu- lar. It is, at first, suspended at the top, gradually falls, though for a day or two, often stationary near the middle of the glass, and at last reaches the bottom. It falls to the bottom often some days be- fore it is accompanied by any sediment; but when a white or red- dish sediment also falls down, the crisis is nearly complete. The urine is sometimes turbid, if not at the moment of discharging it, very soon afterwards ; and this, according to the authors of prog- nostics, is said to show an insidious disease. Frothy urine, or which long retains the air bubbles, is said to show a tedious disease, or a slow consuming fever. In bilious fevers, the urine is sometimes of a green or black color, which shows a highly putrid state. The black is more dangerous, but unless highly fetid, we have frequent- ly seen it without its being followed by a fatal event. In chronic diseases, red urine, depositing a copious, red, scaly, or branny sedi- ment, is a mark of considerable debility. A mucous and viscid sediment is usually alarming from the apprehensions which it excites of abscess in the bladder. Mucus is, however, light and equable, wholly free from fcetor, and arises from an inflammation of the mu- cous membrane. It arises also from any irritation of the neck of the bladder ; and is a frequent symptom of gravel and calculus. The nature of the alvine discharge is of considerable impor- tance, and these should be frequently examined with attention. In acute diseases the discharge is often estimated by the number of motions rather than their appearance, and we have been told there has been a free discharge from the bowels, when the stools had not the slightest feculence. Liquid, frothy, watery motions, with little color or smell, denote, in general, a tedious fever, for in every fever there seems to be an obstinate retention of the fasces, and motions of this kind show that the spasm is peculiarly violent. When the stools, in the beginning, are highly fetid and bilious, it has been accounted a dangerous symptom ; but if the discharge be free and copious, they are rather favorable. Calomel will, through the whole course of a fever, often bring off such motions by its superi- or power on the biliary secretion. Small, black, pitch-like motions, are always dangerous, and show equal weakness in the alimentary canal and the biliary system. On the contrary, hardened excre- ment, brought off with little straining or colic, is favorable. From the remarks which have been offered, it will appear that our prognostics of fever must be taken generally from the signs and degree of debility. This is obvious often to the sight. Every cir- cumstance which regards a patient, in a fever, will, by attentive ob- servation at the bed-side, throw some light on this subject. The situation of the patient is dangerous, if the character of the countenance is soon lost; if the eyes apparently glare on vacancy; if the answers are rambling and incoherent; if slight, partial in voluntary contractions occur in the features; if the tongue trem- bles, or is soon dry and dark ; if he soon declines turning on hii 26 2G2 COLD. sides, lies on his back, and sinks down on his bed; if the extremi- ties are cold and benumbed ; if the tendons are particularly tense, and occasionally start; and if he appears to pick off or remove any dark spots on the bed clothes, or wishes some supposed dark object to be removed : each of these symptoms is a mark of debility ; and the earlier they occur in fever, the greater is the danger. If, however, in a fever, the expression of the countenance is un- changed,; if the mind is steady and unruffled; the sleep, though short and interrupted, refreshing, and the patient is sensible of having slept; if the tongue is clean at the edges ; the abdomen nei- ther tense nor painful; if the patient lies on either side, and awakes without hurry or confusion, we may prognosticate a safe termina- tion. In the more usual cases of fevers, if the disease has been pro- perly managed in its earlier period, and the circumstances are on the whole favorable, there are few instances in which a salutary change does not take place on the tenth or fourteenth day. Where this is not observable, a gradual amendment takes place, which is clearly conspicuous on the seventeenth, and the fever has disappeared be- fore the twentieth. COLD, Or, in the language of the nosologists, Catarrh, is a disease of the inflammatory kind, which occurs more frequently on sudden changes of the weather, and attacks persons of all constitutions, but especially those of consumptive habits. It is ^Iso at times epidemic, when it is known by the name of influenza!; and has been erroneously considered as depending upon a specific contagion for its cause. The influenza generally pays us a visit every six or seven years. The season of i'Js visitation is the middle or latter end of autumn, after a long spell of dry weather. It would appear to be no re- specter of persons, knocking equally at the door of the rich and the poor, and attacking the young no less than the aged. Symptoms.—Its first symptoms are a stoppage of the nose, dull pain, with a sense of weight in the forehead ; stiffness in the motion of the eyes, and soon a/ter cough, hoarseness, an increased secre- tion of mucus from the nose, and tears from the eyes, attended with more or less fever, and sometimes sore throat. 'Cause.—This disease is generally the effect of cold, which, by obstructing the perspiration, throws the redundant humors upon the nose, fauces, and lungs ; or to those great physical changes whieh give rise to epidemics. Treatment.—The treatment of this disease, as of all others of an inflammatory nature, consists of the antiphlogistic, or cooling COLD. 203 remedies. Where it is slight, little else will be necessary than to pay attention to the state of the bowels; live abstemiously, avoid cold, and whatever may increase the feverish habit. Bathing the feet in lukewarm water, or bran and water, a little hotter than milk just taken from the cow, at the same time that I something warm, as a glass of hot toddy, punch, or mulled wine, is taken internally, forms a remedy upon which many people place their sole reliance for the removal of their colds. But this, unques- tionably, is a hazardous practice ; for it may be regarded as a gen- eral rule, in inflammatory diseases of whatever description, that all attempts to excite perspiration, by stimulating and heating drinks, will be uniformly injurious. Foot-bathing is certainly a simple, and often found to be a pow- erful assistant of the operation of other remedies, by equalizing the circulation and promoting perspiration. In this practice, however, much caution is necessary not to get fresh cold ; the feet should be carefully and speedily wiped dry, and afterwards wrapped up in a warm dry flannel, or the patient should immediately go into a warm bed. When there exists any febrile action, the free use of cold water, in the early stage of the disease, forms a safer and a much more efficacious remedy than the administration of warm or stimulating liquids. A glass or two of cold water, taken upon going to bed, is a very common, and sometimes a successful remedy for cold. The impression of cold drink upon the stomach, independently of its general refrigerant operation, seems to have the effect of promoting the action of all the secretory and excretory vessels. Taking a draught of cold water every hour or two, with ten or fif- teen grains of nitre dissolved in it, will be found a remedy as effec- tual as it is simple in almost every case of inflammatory catarrh. Should it be observed that the nitre has a tendency to increase the cough, nauseating doses of tartar emetic should be added to each draught of cold water; which promote expectoration as well as diaphoresis, without, at the same time, increasing arterial action. When recourse is had to this medicine, dissolve three grains of tar- tar emetic in a quart of pure cold water, of which solution a gill to a half pint may be given to an adult every three or four hours, or at such intervals as will produce a very gentle nausea, without cre- ating any considerable degree of uncomfortable sensation. The consent of the stomach with every part of the animal system is so generally acknowledged, that this organ is now admitted to be the medium through which almost all medicines, taken internally, pro- duce their effects upon every part of the frame. Hence, cold ap- plied to this viscus must be attended with more speedy and certain effects than to any other part whatever. Its operation in this case is simple: it produces its effects merely by the abstraction of the stimulus of heat. Although it will be admitted these two plans of cure, however 904 COLD. contradictory, have both occasionally succeeded ; yet the cool modo of treatment, when employed with a due degree of circumspection, is unquestionably the most advisable, for the successful removal of the disease in its incipient state. Of all the improvements which have been made for many years, in the practice of medicine, the introduction of the use of external cold, in the treatment of acute disease may be regarded as one of the greatest importance. The theory upon which it is founded is rational, and the practice to which it has led, has been attended with the most happy effects. In fevers, inflammations, and eruptive disorders, it has restored thousands who would otherwise have perished ; but its free and ex- tensive use in catarrh, is inadmissible, as, by exposing the body afresh to a low temperature, the original mischief would be often spread wider, or the foundation would be laid for other diseases more formidable. However, upon the accession of the symptoms indicating the commencement of the disease, the air which imme- diately surrounds the body, and which is inhaled in respiration, should be as cold as is consistent with comfortable feeling. Per- haps a temperature from forty to fifty degrees, will be most saluta- ry. An approximation to this may always be effected by the pa- tient remaining, in cold weather, in a room warmed only by a small fire ; and, in the milder months, by a free exposure to the open air; in all cases carefully avoid ing the causes which operate in rendering the cold air injurious. The covering of the body, both day and night, should be as light as the external temperature will allow, and every thing taken in the stomach should be perfectly cold. By pursuing the refrigerating plan, the activity of the whole arterial system is diminished, the inflamed vessels are relieved from that re- dundancy of blood, and increased action, in which the disease con- sists, and finally recover their wonted healthy tone without any morbid relaxation of their extremities. Whereas, the mode of treatment which admits of warm drinks, warm rooms, and warm air, when it operates in a manner the least dangerous, produces, by excessive excitement, such a relaxation of the exhalents of the bron- chiae, as to admit of a secretion of mucus, or pus, which, though it relieve the topical inflammation, by what is called expectoration, either lays the foundation for chronic catarrh, or terminates in con- sumption. Full vomiting, at the commencement of the complaint, will sel- dom fail to prevent its farther progress. The operation of an eme- tic, besides its more immediate effect in evacuating the contents of the stomach, produces such a universal commotion in the system, as to excite every minute fibre into action ; and in this way it is that emetics prove salutary in the majority of complaints in which they are administered. They excite a new and powerful action, which expels or overbalances the pre-existing weaker one. Thus they arrest the progress of fever, and thus, if administered at the Receision of catarrh, they will prevent the occurrence of the symp- coi.n. 205 toms which would otherwise infallibly ensue. In three cases out of four, perhaps, if upon feeling a stuffing of the nose, dull pain in the head, sneezing, and other symptoms which mark the commence- ment of the complaint, a person has resolution to try the experi- ment, he will find a brisk emetic have the effect of completely re- storing him to his natural feeling. Emetics will also prove benefi- cial, not only at the commencement, but at other periods of the dis- ease, particularly when the lungs are oppressed with phlegm. In the treatment of this complaint, the indications which arise to be fulfilled, may be reduced to the following heads :—To reduce inflammatory action in the early stage—to palliate urgent symp- toms—and to diminish irritation in the protracted stage. When the disease is violent, aperient medicines, in conjunction with bloodletting in a larger or smaller quantity, should be resort- ed to, and repeated as the symptoms may require. Although,the occasional use of aperients is indispensable, and should be had recourse to early in the complaint, yet very active purging is often found more prejudicial than serviceable, by dimi- nishing expectoration. The saline aperients, as Epsom or Glauber salts, in the form of the cathartic mixture, (see Dispensatory,) have the advantage over others in febrile diseases, being sedative and cooling. Those, however, who have an aversion to salts, may substitute any other opening medicine, as castor oil, rhubarb, sul- phur, and cream of tartar, or senna and manna. But the purgative which of all others' is most powerfully febrifuge, is calomel, which may always be administered with perfect safety, provided the pa- tient guard properly against imprudent exposures to wet and cold at the time he is under its operation, and there is no peculiar- ity of temperament that militates against its use. When recourse is had to calomel, give it in the form of the aperient and diaphore- tic pills, (see Dispensatory,) or conjoin therewith a few grains of ipecacuanha, or a small portion of tartar emetic ; and in a few hours after swallowing the medicine, or, if it be taken at bed-time, on the next morning, give a small dose of Epsom salts or castor oil. In catarrh, the means which nature occasionally takes for its re- moval, or, in other words, the symptoms which mark its critical or spontaneous termination, are, principally, a copious and equable flow of sweat, an increased secretion of mucus from the membrane of the trachea and bronchia, the production of a diarrhoea ; and hence, an indication for the use of diaphoretics, expectorants, and laxatives. Therefore, with the view of regulating and promoting the salutary efforts of nature, it is advisable, during the interval of purging, if the skin remain obstinately dry, and there exist a gene- ral feverish disposition, to give the saline mixture in the state of ef- fervescence, spirit of Mindererus, the febrifuge mixture or drops, Dover's, antimonial, or febrifuge powders, (see Dispensatory,) or infusion of seneca root, in their usual doses, with diluting liquors; 206 COLD. as flax-seed, balm or ground ivy teas, weak wine whey, barley wa- ter, &c, in order to produce a determination to the surface. When the cold chiefly occupies the head, it has been advised, to suffer the whole head to remain, for a considerable time, in contact with the steam of water, as hot as the patient can bear. And this is to be done in the following manner:—While the patient sits up in bed, a vessel containing two or three quarts of water, may be placed immediately under and before his face, letting it rest on his lap, and a piece of flannel or thin blanket being put over the head, and extending under and around the pan; this will keep the steam in contact with the face, neck, and head, and, at the same time, will admit sufficient air for respiration. In cases of great stuffing up of the nose, and difficulty of breathing through the nostrils, this prac- tice, has frequently had the effect of removing these symptoms in the course of a few hours ; but it is seldom successful, where there are considerable pain and oppression at the fore-part of the head, in consequence of some inflammation occupying the cavities commu- nicating with the nostrils. In such cases, a pinch of snuff, united with Cayenne pepper, has afforded some relief. But where the pain is extremely severe, the patient will experience most relief from a blister applied to the back of the neck, or to one or both temples. When the mucous membrane of the nose is much affected, it should be washed frequently with a thick mucilage of gum Arabic, or pith of sassafras, (see Materia Medica,) or smeared, from time to time, with a little tallow, thorn-apple, or simple ointment. (See Dispensatory.) An inflammation of the throat, producing soreness and difficulty of swallowing, is an occasional symptom of this complaint; and where it is slight, it will readily be removed by taking the nitre lo- zenges, (see Dispensatory,) or small portions of nitre in the mouth, and swallowing them as they slowly dissolve. Where it is of a more severe nature, the application of onions to the feet, (see Ma- teria Medica,) or the remedies advised under the head of sore throat must be resorted to. In case of pain or oppression at the breast, after the inflammatory action of the system is pretty well subdued, the application of a blister as near as possible to the affected part should not be omitted. The most prominent symptom of cold is cough, which, being uni- formly present, and often very distressing, is usually that to which the patient directs the chief part of his attention.—The medicines to be resorted to for the purpose of alleviating cough, and producing expectoration, are.mucilaginous and sheathing cjrinks, as flax-seed tea, barley-water, &c, or taking now and then, a table-spoonful of the flax-seed sirup, or a tea-spoonful of equal parts of sweet oil and honey, or a mixture composed of one part oil, ahd two of honey and sirup, or some of the more simple pectoral mixtures. (See Dispen- satory.) After the inflammatory symptoms have abated, the pec- COLD. 207 toral mixtures combined with laudanum or "paregoric, (see Dispen- satory,) will afford the greatest relief; and where the patient's rest is particularly disturbed in the night, an opiate at bed-time will be highly necessary, but it should be combined with some diaphoretic, as in the form of the anodyne sudorific bolus or draught, (see Dis- pensatory,) or by giving two parts of paregoric with one of antimo- nial wine in some warm tea. Barley, hoarhound, and sugar candies, liquorice, and various si- rups, of indigenous simples, are universally employed for the purpose of allaying the tickling which produces cough. The effect of all remedies of this kind, is to smear over the glottis or fauces, and, by thus sheathing them, rendering them less susceptible to the irrita- tion. As they have the advantage of being innocent, and are usu- ally found to afford a temporary relief, they may, in every case, be resorted to with advantage, as palliatives. Whenever a cold, either in consequence of its severity, or from its having been neglected in the first instance, runs out to a consi- derable length, it is usually kept up by a state of simple irritation of the part, which supervenes upon the disappearance of the inflam- mation, and becomes as it were habitual, exciting the vessels to an increased secretion of mucus, and producing cough by sympathy with the larynx. In this protracted stage of the complaint, when the cough and spitting alone remain, it is absolutely necessary that the patient should carefully guard against all unnecessary/exposure to cold, and to defend particularly the breast and feet; and when obliged to go into an air of low temperature, to increase his cloth- ing, and hold a thin pocket handkerchief before his mouth and nose. The vessels are in a state of relaxation or debility, when the cough is long protracted, and the consequence of any unusual application of cold is very generally a suppression of their exertions, and a subsequent renewal of the inflammatory affection. And it is in this way that colds are often kept up for months, until they degenerate into a permanently morbid state of the lungs. In such cases, the nitric lac ammoniac, (see Dispensatory,) in doses of a table-spoonful in a cup of flax-seed tea, or sweetened water, every four hours, to adults, will be found a most valuable remedy. Be- nefit will also be derived from wearing a Burgundy pitch, or some warm adhesive plaster, upon the breast, or between the shoulders. Should these means prove ineffectual, one or two grains of calo- mel, with a double quantity of powdered squills, taken by an adult at bed-time, and continued until a ptyalism be produced ; and af- terwards the nitric lac ammoniac, administered as above directed, may be depended upon. Another remedy which has succeeded in this state of the disease, is the tincture of digitalis, in doses of ten drops, three times a day, to adults, and its efficacy will be increased, by using the vapor bath. Inhaling the vapor of hot water is a remedy which has long 203 COLD. been in use, in all inflammatory complaints of the chest. How- ever, upon the first commencement of catarrh, it has the effect of rendering the subsequent symptoms more severe ; but at a more ad- vanced period of the complaint, it tends powerfully to arrest its pro- gress, by increasing the secretion from the glands and vessels of the part, and thereby diminishing their inflammatory action. The va- por has been found most efficacious when impregnated with vine- gar or camphor, or infusions from emollient herbs. The inhaler, invented by Dr. Mudge, of England, is well adapted to render the process perfectly convenient for children. But a common funnel will form a very good succedaneum for the inhaler, when this can- not be conveniently procured, the broad part being inverted over a vessel containing the water, and the steam being received by the mouth applied to the small end. Should a funnel not be at hand, a tea or coffee-pot, may be substituted, and the operation continued from a quarter to a half hour. In this manner, the vapor bath may be received twice or thrice a day, carefully avoiding sudden expo- sure to the external cold air. According to Dr. Mudge, a tea-spoon- ful of paregoric, taken at bed-time, in some warm liquid, and the use of the warm vapor arising from simple water, through this machine, will be sufficient to cure a catarrhous cough in a night's time. An unpleasant and not unfrequent sequel of this complaint, is a hoarseness, or diminution of voice, depending upon a state of the muscles, subservient to speech, approaching to palsy. This is gene- rally of a temporary nature, though it has been known to continue for several months. In such cases the infusion of seneca-root, with one fourth of honey, has been employed in doses of a table-spoonful every two or three hours, and, at the same time, some of it used as a gargle, with the most happy effects. It has also been readily cured by taking a tea-spoonful of the sirup of horse-radish every hour or two ; or by retaining in the mouth a piece of this root, or by gargling the throat frequently with an infusion of red pepper, mus- tard-seed, or horse-radish. This symptom has been known to be instantly removed by means of electricity, and also by inspiring oxygen, or pure air. It is of importance, if the patient be in a de- bilitated state, to invigorate his constitution by nutritious diet, re- gular exercise, and removing to a more salubrious air. A popular writer of considerable celebrity, Dr. White, states a case in which not only a loss of voice, but a partial palsy of the muscles of deglu- tition, producing an imperfect, and, at times, a total incapacity of swallowing, ensued upon the disappearance of a severe catarrh, at- tended with sore throat; and which did not go off for the space of a month. In this case, the patient was in the habit, previously to an attempt^of deglutition, to suffer a tea-spoonful of brandy to pass over the affected parts ; after which, she immediately became capable of swallowing with ease, but again lost the power-of doing so, after the effect of the stimulus had worn off. COLD. 209 Should hoarseness occur in the, inflammatory or early stage of the disease inhaling watery vapors, bleeding, cold water, and demul- cents constitute the proper retnedies. Although the attendant symptoms of cold, in its incipient stage, seldom amount to such a degree of urgency as to demand the an- tiphlogistic mode of treatment in its more active forms ; yet if it be aggravated or rendered frequent in its return, by neglect or im- prudence, it becomes a malady which not only combats, but often defeats the skill of the most experienced physician. And it should be remembered whenever the cough is frequent, the fever conside- rable, and the breathing intercepted by transient pain, or tightness of the chest; unless the most powerful means, as bleeding, purg- ing and blistering, with diluting drinks, be early employed, inflam- mation of the lungs will succeed, which, if not speedily removed, will inevitably terminate in consumption. I have now presented to my readers, in a manner familiar to ev- ery capacity, the most approved plan of cure of this destructive complaint. Should it be adopted in the domestic management of colds, I shall not have wholly failed in my earnest endeavors to les- sen some of the dreadful ills ; for, of all the diseases incident to the human species, there is none so frequent in its occurrence—none which excites so little attention—and none, perhaps, when neglect- ed, is so often followed by fatal consequences, as that under the name of cold ox cough. It is the rock upon which the health and lives of thousands have been wrecked. The frequency of this disease, from the sudden changes of wea- ther to which our climate is subject, and the slight degree of alarm generally excited by what is called " only catching a cold," too of- ten occasions that neglect, which gives rise to the most distressing maladies, such as quinsy, pleurisy, inflammation of the lungs, rheu- matism, &c. Fully satisfied that numbers fall victims to the supposed insigni- ficance of this insidious enemy, I have thought it my duty thus to warn the inattentive. Regimen.—A rigid attention to diet, is not to be looked for at the occurrence of every slight attack of cold; but when the dis- ease rises to such a degree as to produce a state of general febrile indisposition, it will be absolutely necessary for the patient to ab- stain from every thing of a stimulating nature. He should confine his didt to light things, of easy digestion, as arrow-root, sago, tapi- oca, rice-milk, custards, jellies, fruits, &c, &c. Where the symp- toms are so trifling as not to render an abstinence, from animal food requisite, those means of a more digestible nature should be cho- sen ; and if the patient have been accustomed to the use of spirit- uous liquors, he should substitute for them, porter, cider, or wine, diluted with water. Every thing which either stimulates the glottis and fauces in deglutition, or proves indigestible after being received 210 COLD. into the stomach, invariably increases the cough, and consequently is injurious. Prevention.—To guard against this disease, the utmost attention should be paid to a due regulation of the clothing, which ought to be neither too thin, nor so irregularly disposed, as to leave one part of the body naked, whilst the rest is burdened, and too warmly clad ; an error frequently committed among children and young persons. Warm rooms and impure air may weaken the body, but warm clothing can never be injurious in cold weather. The use of flannel cannot be too highly recommended as a preventive of this disease; arid if an objection should be made to wearing it next to the skin, on account of the irritation it occasions, it may be worn over the linen. But, while thus careful to guard against the morbid influence of cold, by accommodating our dress to the weather, we should be equally cautious not to run into the opposite extreme. Too much clothing produces a delicacy of frame that disposes no less to dis- ease than an imprudent disregard of necessary cowering. There are two parts of the body more especially liable to receive the ill impressions of cold, and communicate them to the rest—the feet and the chest, and, with the delicate and susceptible, if fashion govern in all other respects, these, at least, should be defended with the utmost care. Whenever the whole or a part of the body has been exposed to the long-continued action, or otherwise to the sedative influence of cold, it is said to be chilled, or, in pther words, it falls into a state of atony, in consequence of the reduction *)f its nervous energy, and is thereby deprived of the faculty of duly supporting its nat- ural heat. This state occurring universally, and to a great extent, usually proves destructive to life. When local or general in a less degree, it proves the exciting cause to various diseases of the active kind, determined in their seat by the particular predisposition of the per- son ; the weakest part of the body invariably receiving the noxious impression, however generally applied. Thus, those whose pulmo- nary system is weak and irritable, will have catarrh, or inflamma- tion of the lungs; others, whose muscular fibres are most suscep- tible, will be attacked with rheumatism ; and those addicted to drunkenness, will, perhaps, be afflicted with an inflammation of the liver; and so of various other inflammatory affections. Colds, however, are by far the most frequent; which, perhaps, may be ac- counted for, in a great measure, from the lungs being so particular- ly exposed to all the varieties of atmospherical temperature. A person not particularly liable to catarrh, would probably sel- dom feel ill effects from being chilled by an exposure to the cold air, if he were careful to restore the natural warmth of the body by degrees ; but if, during the presence of that uncomfortable state of COLD. 211 feeling, produced by the diminished temperature, he either sudden- ly come into a warm room, or drink of warm stimulating liquids, he will seldom escape with impunity. It should be remembered that when any part of the body has been exposed to cold, it is liable to be much more affected by heat, than before the exposure. Of this, the method of treating frozen limbs in cold countries, affords a beautiful and decisive proof. Were a frozen limb to be brought before the fire, or immersed in warm water, a violent inflammation would come on, and speedily terminate in mortification. They, therefore, rub the parts benumb- ed with snow, and then very gradually expose them to a warm tem- perament. Hence, it will evidently appear, that strong drinks, both before and after exposure to severe cold, must be highly dangerous ; and it should always be remembered, that when the body has been chil- led or much heated, it must be brought back to its natural state by degrees., The common prudence of shunning, when heated, a torrent of cold air from the crevice of a door or window, or throwing off the clothing immediately after taking exercise, is so obvious, as not to be required to be enlarged upon. Putting on wet clothes, or lying in damp sheets, or sitting in wetted rooms, is also so well known to be injurious, that it is hardly necessary to admonish people against such obvious improprieties. The operation of moisture in producing catarrh, appears to act in the same way as cold, by proving a sedative. The feet being most liable to receive the impressions of damp, as they are of cold, one of the most frequent causes of catarrh is getting them wet; to guard against which, is of importance to those liable to the com- plaint ; and when a person has been exposed to the wet weather, the clothes should be changed as soon as possible, after wiping the body and extremities with a cloth wetted in spirits, to which a little table salt has been added. The predisposing causes of catarrh are, 1st. Original peculiarity of constitution; secondly, an acquired morbid irritability of the pulmonary system ; thirdly, a morbid delicacy of frame, induced by enervating indulgences, or weakening occupations, or occasional and accidental debility. The exciting causes are those, which, when applied to the body, under a state of predisposition, excite disease into action. It is worthy of remark, that however predisposed to disease the constitution may be, by"carefully guarding against the causes which more immediately produce it, its dreaded incursions may usually be prevented, and health may often be preserved to old age. The importance, therefore, of avoiding the exciting causes,,of a disease, so insidious in its nature, cannot be too strongly insisted upon, more particularly in the early periods of life, and in constitutions pecu- liarly obnoxious to its attacks. 212 COUGH. Some persons are so susceptible of cold, as to be unable to en- dure the least change of temperature, without having a violent fit of sneezing, coughing, and other symptoms of incipient catarrh. And these will recur so frequently, and are of so temporary a na- ture, as to justify the expression, that they are seldom free from cold'. The means of obviating this susceptibility is, by gradually and cautiously inuring the habit to the impressions of cold, by ac- commodating dress to season and personal feeling; and, when changes from cold to heat, or the contrary, are unavoidable, in guarding against the transition being sudden and1 immediate. Nothing so much contributes to enervate the powers of the hu- man frame, as an excess of artificial heat. The ruinous effect of this indulgence is, that our health and comfort are destroyed by the frequent recurrence of some one or other of those disorders which have their origin in cold. Debilitated by the perpetual stimulus of heat, we become sensible \o every, even the slightest, variation of atmospherical temperature. Few, indeed, of the refinements of modern luxury are more prejudicial to health, by rendering the bo- dy susceptible of cold, than the living in rooms heated by stoves or enormous fires. Let those who have at heart the preservation of their health, and the vigor of whose frames is as yet entire, carefully avoid making this effeminate indulgence necessary to their comfort. Let them, by gradually training themselves to bear the impressions of cold, endeavor to induce that enviable state of hardiness, that will enable them to brave, with impunity, the vicissitudes of the at- mosphere of our climate. It is in the power of every one, to ren- der the apartments they occupy,, cool and airy ; and there are none, perhaps, who have it not in their power, more or less, frequently, during the day, to breathe the open air without doors. In endea- voring, however, to habituate the system to two degrees of tempera- ture, one caution is of the most essential importance to be at- tended to; namely: never to remain inactive, either in the open air or in cool apartments, long enough to induce a continued and unpleasant sensation of actual cold. This, in all cases, would ef- fectually counteract the design proposed ; and by frequent repeti- tion, would, in all probability, ultimately be sufficient to injure the strongest constitution. By attention to these precautions, those inflammatory diseases, for which cold only prepares the system, may be easily avoided. COUGH Is produced by the violent, and, for the most part, involuntary motion of the muscles of respiration. It proceeds from various causes, and is, therefore, as variously to be treated. The seat of every cough is generally in the breast, and the prin- COUGH. 213 cipal parts diseased, are the wind-pipe, and the ramifications, which are irritated by inflammation, obstruetion, or when foreign bodies have been introduced ; but the morbid irritation may be in the ad- jacent part, as the diaphragm, the stomach, the pleura, the oesopha- gus, the liver, &c. Thus, coughs attend pleurisies, wounds about the neck, inflammation of the liver, acrid matter in the stomach, or in the duodenum. Spasmodic disorders are often attended with a cough, the lungs suffering, either by consent from the source of the spasm, or becoming, in their turn, the seat of that which produced the spasm in some distant part. The most frequent cause, howev- er, is suppressed perspiration. Coughs are generally, at first, dry ; but at last, expectoration comes on, and a hectic fever is the consequence. It sometimes happens, however, that a cough continues during a long life, with- out inconvenience; and though it does not lead to consumption, induces at last, asthma, or dropsy of the breast. So far as coughs are connected with the state of the lungs, they have already been considered under the head of cold, and will be farther noticed in treating of consumption, so that we shall here chiefly notice the symptomatic coughs. The cure of the symptomatic coughs depends upon the removal of the original disease ; hence, the absolute necessity, in all chronic coughs, of investigating the cause before we can expect to find the appropriate remedy. Sometimes, coughs have their origin in the stomach, affecting the lungs by sympathy, in which case, recourse must be had to emetics, aperients, stimulants, and tonics, with the view of cleansing and strengthening the organ primarily affected. Should the liver be the seat of the disease, calomel in small doses, together with the nitric lac ammoniac, (see Dispensatory,) constitute the best remedies. It is very evident that coughs more frequently arise from hepatic affections than is generally suspected. The coughs of those who have long resided in warm climates, very generally proceed from a diseased liver. And we are fully persuaded those cases of hectics which have been cured by salivation, originated from scirrhus of that viscus. Women, in the last months of pregnancy, are sometimes afflicted with a troublesome cough, but which will readily yield to small bleedings, at the same time keeping the bowels in a soluble state, and avoiding food indigestible and of a flatulent nature. With children, a cough is occasionally produced by teething, as well as by worms ; in both of which cases, it is to be cured by such medicines as are adapted to those complaints. Coughs which attend the dyspeptic, chlorotic, and hysteric habits, are styled nervous. In this, as in other convulsions, increased irrita- bility, with a less evident stimulus, or sometimes with a stimulus which escapes observation, induces a violent degree of the complaint- 214 COUGH. It is supposed, cough of this kind proceeds from repelled eruption, gout, or the translation of some disease to the lungs. In such cases much benefit will be derived from the warm and vapor bath, and when the secretion of the chest is greatly lessened, and debility alone remains, we must endeavor to give tone to the system, by substituting the cold for the warm bath ; by administering the cold infusion or decoction of bark ; by tranquillity of mind ; by moderate exercise, together with a nourishing and generous diet. It is neces- sary, however, to observe, in having recourse to the cold bath, should the patient feel chilly and uncomfortable, instead of feeling a uni- versal glow over the system and being invigorated, it must not be repeated until the visceral obstructions are removed. Neither will it be proper to continue the use of the bark or any other tonic, if it be found to check expectoration, or produce a difficulty of breath- ing. In several instances of unconquerable coughs of this kind, which have come under my notice, calomel, united with squills, or given alone in small doses to produce ptyalism, has effected a cure. The operation of calomel in the cure of obstinate coughs is, by pro- ducing a determination to the liver, and thus, by an increased secre- tion from that organ, securing more the vital parts and relieving those affected, and by exciting a new and general action in the ar- terial system, which shall transcend or supersede the existing mor- bid action. When the cough is kept up entirely by irritation, arising from an increased secretion of mucus, under a weakened state of the lungs, a dose of paregoric at bed-time, will prove exceedingly beneficial; so the occasional use of some of the pectoral mixture. (*See Dis- pensatory.) In this state, where inflammatory action has totally ceased, some of the balsamic medicines may also be employed with safety and advantage, and of these the tolu is the most valuable. It is a very grateful medicine, in consequence of its fragrant smell, and having a warm, sweetish taste. The dose of the tincture, or sirup, to adults, is a tea-spoonful, in some mucilage or sirup, three or four times a-day. Dr. Hill's balsam of honey is nothing more than the tincture of tolu sweetened with honey. Tar united with bark, and formed in pills, have been administered in doses of six or eight three times a-day, with very good effects. In like manner, tar-water, taken, to the quantity of a quart daily, has been found useful in coughs of long continuance. In coughs of aged people, or in all cases where the lungs are heavily oppressed, and expectorations difficult, gum ammoniac in doses of ten or fifteen grains dissolved in mint water or ginger tea, or administered in the shape of pills, or, which is preferable, given in the form of the nitric, lac ammoniac, (see Dispensatory,) will not fail to produce expectoration and abate the distressing fatigue of cough. From the variety of causes which produce coughs, it must be evi- dent the mode of treatment should vary ; and here we would ear- EPIDEMIC. 215 nestly entreat every one who values the preservation of health ne- ver to trust for the cure of any complaint, more especially affec- tions of this kind, to patent medicines. Let it be impressed upon their minds, that most of those advertised, as infallible remedies for the cure of colds and coughs, are either perfectly inert or really hurtful. And, even supposing the medicine employed to possess the virtue ascribed to it by the proprietor, can it be applicable to all the various forms and stages of the complaint for which it is recommended ? If in one stage of a disease, judiciously adminis- tered, it prove a successful remedy, in another it must of conse- quence be in the highest degree injurious. (*See Preliminary Ob- servations.) By resorting to medicines of this description, they frequently let slip the favorable opportunity, when, by more rational means, their health might have been easily restored ; and their complaint thus gaining ground, under the use of an ineffectual nostrum, will often become inveterate in its nature, and set all human skill at defiance. How lamentable it is that so many valuable lives are yearly sacri- ficed by persisting in the use of quack medicines. It is to the credulity of the lower class of society, that they are most liable to be taken in by the infamous venders of poison, since they very generally prefer the use of a patent medicine to the advice of a practitioner. • But how astonishing it is to find this fatal pre- possession extend farther ! for we have frequently observed persons? of higher order, and who it was expected would have had better understanding, persist in their use, and become a sacrifice to the de- lusion. EPIDEMIC. The attention of the medical gentlemen of our country, was drawn to a disease, which, during the last three winters, pervaded every state in the Union; and in most of them, according to the statements of the physicians, assumed every variety of shape, and required no little diversity of treatment. In some places, the lancet was used freely ; and in others, remedies highly stimulant were administered. In spite, however, of the very different practice pursued, the disease continued its ravages, which, in many places, resembled those of the plague, sweeping whole families into the grave. Extreme debility appears to have been the characterestic feature of the disease ; for all accounts agree, that in whatever form it com- menced, there ensued a great, and sometimes, a very sudden pros- tration of strength. This alarming pestilence did not appear in the city of Washington, until the winter of the year 1815; and even then, not so destructively as in many other places. Most of the cases which I saw, resembled 216 EPIDEMIC very much the bilious pleurisy of our country. They commenced with chill and fever, accompanied with pain in the side and chest, with a dry skin and rather laborious respiration. But the cough was by no means so frequent and distressing as in pleurisy or peripneu- mony. The eyes were wild and red, the countenance uniformly in- dicated great anxiety and distress. In some instances the throat and head were very much affected. The pulse was full, though soft, and readily compressible ; indeed it sometimes indicated so much action that a practitioner not conversant with its peculiarity of type, would be very apt to treat the complaint as an inflamma- tory affection. This counterfeit character, however, did not conti- nue long, for in a very short period it assumed the typhoid form. Of the causes of the disease little has been ascertained. In com- mon with other epidemics, its origin is involved in obscurity. As yet, we know only that it commences in cold weather, and is gen- erally dissipated by the warmth of spring. In the treatment of those cases which came under my care, I generally commenced with an emetic ; and if this had no effect on the bowels, it was followed by a dose of salts, or an infusion of salts, senna and manna. During the operation of the cathartic, I sometimes found it necessary to support the patient, by having wine added to the gruel with which the medicine was to be worked off. As the cure of this formidable disease depended principally on exciting perspiration, I lost no time, after the operation of the me- dicine, in having sudorifics administered ; and of this class, I found nothing superior to the seneca and Virginia snake-root. (See Ma- teria Medica.) In the incipient stage of this disease, I directed a strong decoction of the former to be taken in doses of a tea cup full every hour or two, and as the disease advanced, or the pulse began to sink, the latter Was administered in the same manner. In addition to this, mulled wine or cider highly spiced, or hot tod- dy, was given very freely, in those cases which indicated great pros- tration of power. It was also my uniform practice, to have a blis- ter applied as speedily as possible on the breast or side, over the pained part. If the head were most affected, the blister was put between the shoulders : and when the throat was complained of, a cataplasm of mustard or garlic, (see Materia Medica,) was applied around the neck. Flannels, wrung out of hot spirits, in which mus- tard-seed or red pepper had been steeped, were constantly applied to the extremities, and assisted greatly in producing the desired ef- fect. As the disease advanced, bark, conjoined with Virginia snake- root, proved a useful auxiliary in facilitating the cure. • Dr. Cutbush pursued a very similar plan, in the treatment of his patients, with the same fortunate result. Many other practitioners bear testimony in favor of this mode of practice. The ingenious and learned Professor Chapman, in his very interesting lecture on this epidemic, which I had the pleasure PHRENSY. 217 of hearing, stated, that, in no instance, did any patient die under his care, after perspiration was induced. It was his practice, also, to combine with the diaphoretics, the most cordial stimulants ; and of this class of remedies, he spoke highly of volatile alkali, in fre- quent and large doses. As malignant as this disease was, it appeared to pay some re- spect to persons. For the rich, or rather those who lived gener- ously, were seldom attacked with it; while the poor, and the in- temperate, in those places where its ravages were most destructive, hardly ever escaped. PHRENSY, OR INFLAMMATION OF THE BRAIN. Symptoms.—A deep-seated headach, redness of the eyes and face, violent throbbing or pulsation in the arteries of the neck and temples, incapability of bearing light or noise, a constant watching or delirium, with picking of the bed-clothes. The pulse, although sometimes languid, is generally hard, tense, and strong. The mind chiefly runs upon such subjects as have before made a deep impression upon it; and sometines, from a sudden silence, the patient suddenly be- comes delirious and quite outrageous. An approaching phrensy is announced by intense continual watch- ings ; or, if the patient sleeps, his sleep is interrupted and trou- bled : he starts, and is affected with terrible dreams, soon forgetting what is said. If, at any time, he returns an answer to a question, his fierceness and anger seem to be increased ; a pain is constantly felt in the back part of the head, and, as the disorder increases, the eyes become more fixed and red, tears at the same time flowing from them. The tongue is dry, rough, and of a yellow or black color, the face of a deep red, and the pulse small, quick, and hard. Phrensy is distinguished from mania, by the sudden attack, the violent fever, pain in the head, and an evident exciting cause; and from that species of delirium which occurs in low fevers, unaccom- panied with inflammation, by the appearance of the countenance and ejes ; for, in true phrensy, the features are rather enlarged than shrunk, and the eyes are protuberant and sparkle ; whereas, in the delirium supervening to low fever, the face is pallid, the features are shrunk, and the eyes pearly. Causes.—Exposure of the head to the scorching rays of the sun ; to deep and long continued thinking; excessive drinking; suppres- sion of usual evacuations ; concussion of the brain, and whatever may increase the afflux of blood to the head. Treatment.—Blood-letting is the " anchor of hope," in this disease, which should be employed copiously on its first attack, and 28 218 PHRENSY. repeated as the symptoms and strength of the patient will permit. Immediately after bleeding, a dose of calomel, followed by a large dose of salts, or some cooling purge must be given. Ice pounded and put into a bladder, or folds of cloth wet with vinegar or cold water, should constantly be applied to the head and temples; and if the symptoms prove obstinate, the head ought instantly to be shaved, and the whole of the scalp covered with a blister. When the pulse has been reduced by blood-letting from the arm, if the pain in the head continues severe, let cups or leeches be forthwith applied to the temples, forehead, and back of the head. Bathing the feet and legs in warm water, or wrapping them up in flannel wrung out of hot water, is also of great service, by pro- ducing a revulsion of blood from the head. With the same view, sinapisms and blisters should be employed. One of the antimonial or camphorated powders, (see Dispensa- tory,) given every two hours, or large portions of nitre dissolved into the patient's drink, will be useful. If the disease be occasioned by a sudden stoppage of evacua- tions, every means to restore them must be tried. In all inflamma- tory affections of the head, a copious discharge from the intestines will be found highly beneficial, by diverting the humors from the head; and when we cannot employ purgatives, laxative clysters should be used. To assist also in diminishing the determination of the blood to the head, the patient should be kept as near the erect posture as can easily be borne. In symptomatic phrensy, particular attention should be paid to the primary disease which has given rise to it, and the treat- ment ought to be varied according to the nature and progress of the disorder which has occasioned it. In its early or inflammatory stage, copious bleeding will be necessary; but if it has been of some continuance, drawing blood from the temples, by means of leeches, or cupping with scarifications will be preferable. The ap- plication of a blister to the neck or between the shoulders is not to be omitted, as it is well adapted, by keeping up a steady dis- charge, to lessen the accumulation. When the accumulation is re- moved, its effect, unsteadiness of mind, often continues. This is sometimes supposed to be owing to remaining inflammation, and the violent evacuations are with little discrimination employed; a plan which increases instead of mitigating the disease ; for it depends on the too great previous excitement. We have found no mode of conduct particularly serviceable, except absolute rest of mind, with moderate exercise of body. The camphor, bark with valerian, and some other medicines of this tribe, with cold bathing, and gentle alvine evacuations, seem occasionally to have contributed to the re- lief; but from time alone a cure may be expected. Regimen.—The diet should be of the lightest kind, as ripe fruits, with diluent drinks, such as cold water, tamarinds and water, &c. Q.CTNSY, OR INFLAMMATORY SORE THROAT. 819 freely used. The patient to be kept in a dark room, as cold and quiet as possible, avoiding all irritating causes, and breathing a cur- rent of fresh air.* * It was of this disease, generally termed a stroke of the sun, that the brave General Greene, an officer second only to Washington, died at Mulberry Grove, his country seat near Savan- nah. A true republican, he delighted in exercise, particularly that of gardening, of which ha was so fond as sometimes to continue it under the meridian blaze. It was in this garden that the last summons found him. His honorable friend, E. Telfair, Esq., had often cautioned him against imprudent exposure to the Georgia sun: but believing that he possessed the same nerves that sustained him on the hot field of Monmouth, he still pursued his favorite exercise: but while busily adorning the soil which his own valor had so gloriously defended, a sunbeam pierced his brain, and in a short time translated to heaven as noble a spirit as ever fought un- der the Standard of Liberty. In 1818, the medical community lost, by this inexorable disease, John Syng Dorsey, M. D., who, by his acquirements and performances, had attained to very great distinction, as a physi- cian and teacher. Having been adjunct professor of surgery, with his venerable uncle, Dr. Physick, in the medical school of Philadelphia, and filled with brilliancy the chair of materia medica, he was unanimously elected to the chair of anatomy, as successor of Professor Wistar; and, but a few days before his lamented death, had delivered, with great eclat, his introductory lecture to his intended course. The chair, to which he had been promoted, was long filled by Dr. Shippen and Dr. Wistar; with what success and popularity, need not here be particulariz- ed. The generous and benevolent Shippen has always been accounted one of the fathers, and Wistar not the least magnificent pillar of the scientific edifice, which has contributed a full ■hare of glory to our nation.—The immediate predecessor of Dr. Dorsey was admired, not only for his professional qualities, but for his charming social virtues, and uniformly dignified, and po- lished hospitality. His house was wide open as the benevolence of his heart; and his daily companies comprised the learned of our country, and the enlightened visitors from Europe. On his death, he left vacant the chair of anatomy in the University of Pennsylvania, and tha presidency of the American Philosophical Society. To the former, Dr. Dorsey, one of his fa- vorite pupils and hourly companions, was unanimously elected, and carried with him the confi- dent expectation of every one, that it would not only be reputably sustained, but adorned by hii various genious, attainments, and popular eloquence. To say nothing of the great disappoint- ment which his very sudden, death created in the University, extending alike to the trustees, fac- ulty, and students, we should have left more than enough to fill up this passing tribute of a friend, in the recollections of the infinitely varied attractions of his private character. He was manly and generous ; kind and benevolent; honorable and faithful; gay and good-natured; instructive and entertaining, and died, as all like him, deeply and universally regretted. QUINSY, OR INFLAMMATORY SORE THROAT. Symptoms.—Is distinguished by a sense of heat, pain, and tight- ness in the fauces and throat, accompanied by a difficulty of swal- lowing, particularly fluids. In general, the inflammation begins in one tonsil, a gland on each side of the palate, then spreads across the palate, and then seizes the other tonsil. When the inflamma- tion possesses both sides, the pain becomes very severe, and swal- lowing is performed with extreme difficulty ; but if it attack the upper part of the windpipe, it creates great danger of suffocation. Causes.—Cold, wet feet, throwing off the neck-cloth, or drink- ing cold water when over-heated. Treatment.—The same rules are to be observed, in this as in all cases of disease highly inflammatory, such as bleeding, purging, and other cooling means. The extent to which these are to be used, can only be ascertained by the violence of the disease and the constitu- '2:10 quinsy, or inflammatory sorb Throat. tion of the patient; but, from the danger of this complaint, they should be early and freely employed, particularly if there exist any fever. Local applications have also their good effects, and in slight ca- ses, are often sufficient to remove the inflammation. Receiving the steams of warm water, or vinegar and water, through a funnel, or spout of a tea-pot, will give great relief. Much benefit may be derived from the use of gargles, commencing with the common, and, after the inflammation is considerably abated using the astrin- gent gargles. (See Dispensatory.) At this stage of the disease gargles of port wine, or brandy and water, answer every purpose, to restore the tone of the fibres, relaxed from over distension. External applications are, likewise, of great use. In slight cases it will be sufficient to have the neck rubbed twice or thrice a day with the volatile or camphorated liniment, (see Dispensatory,) and a piece of flannel applied. The embrocation will be rendered still more stimulating by adding a small portion of the tincture of can- tharides. But in those cases where the inflammation is considera- ble, the early application of leeches, or a blister or cataplasm of mustard around the neck, is most to be relied on; which, by excit- ing external inflammation, will lessen the internal. Onions, (see Materia Medica,) are also excellent when applied externally in this disease. In addition to these remedies, the antimonial mixture, or decoc- tion of rattle-snake-root, (see Materia Medica,) given in such do- ses as will excite perspiration, is much to be depended on, when the inflammatory symptoms run high, and before the febrile symp- toms are at all violent, the timely exhibition of an emetic often proves extremely useful, sometimes checking its complete forma- tion. Should these means prove ineffectual, and there appear a tenden- cy to suppuration, it ought to be promoted by frequently taking into the fauces the steam of warm water, or applying warm poul- tices to the neck. As soon as a whitish tumor with fluctuation of matter is discovered, it should be opened by the lancet, and then the detergent gargles, (see Dispensatory,) should be used. If in consequence of the largeness of the tumor the patient cannot swal- low, he must be supported by nourishing clysters of broth, gruel, or milk. If persons, as soon as they discover any uneasiness in the throat, were to use the nitrous lozenges, (see Dispensatory,) or small por- tions of nitre, as recommended under the head of cold ; bathe their feet in warm water ; apply flannels moistened with one of the above liniments ; and keep comfortably warm, this disease would seldom proceed to a great height. Regimen.—With respect to the regimen, it must be of the cool- ing kind, except the application of cold. Barley or rice-water, flax- seed tea, and such like, rendered agreeable to the palate by the ad- PUTRID SORE THROAT. 221 dition of jelly or honey, should be often taken, although difficult to swallow: for the pain consequent on swallowing is more owing to the action of the inflamed parts, by which deglutition is performed, than by the passage of the liquid which is swallowed. Prevention.—For the prevention of this disease, the directions should be adverted to, which have been given under the head of cold. Where it becomes habitual, an issue behind the neck will often succeed in preventing its recurrence.* * Well knowing how deep an interest the world always takes in great men, I trust it will not prove unacceptible to my countrymen, to learn that the above malady, the Quinsy, was the messenger whereby God was pleased to introduce into his own presence, the soul of that purest of human beings, George Washington. On the afternoon of the 13th December, 1799, riding out to one of his farms, he was caught in a driving rain, which soon turning into a snow storm, deposited a considerable quantity of snow betwixt his cravat and neck. Long accustomed to brave the inclemencies of weather, he paid no regard to this circumstance ; but having brushed off the snow on his return, he sup- ped and went to bed, as usual. Some time before day, he was awakened with the sore throat, and difficult breathing, which constitute quinsy. A faithful domestic, who always carried a lan- cet, was called up and bled him, but without affording any relief. About day break, my near relative and honored preceptor Doctor James Craik, of Alexandria, the inseparable friend and physician of Washington, was sent for, who reached Mount Vernon about ten o'clock. Alarmed at the General's symptoms, he communicated his fears to Mrs. Washington, who im- mediately despatched servants for Doctors Dick and Brown. Nothing was omitted that human ingenuity and skill could do for a life so dear, but all in vain. It appeared, in the result, as the illustrious sufferer previously declared, that fits hour was come. To oblige Mrs. Washington, he continued to take medicines offered him, till the inflam- mation and swelling obstructed the power of swa'lowing; when he undressed himself and went to bed, as he said, " to die." About half an hour before he died, he desired his friends to leave him, that he might spend his last moments with God. Thus, after filling Jup life with glorious toils, he went to rest, " in a good old age, ladened with riches and honor." " Levfhe poor witling argue all he can, " It is religion still that makes the man." PUTRID SORE THROAT. This is a contagious disease, and appears more generally in au- tumn, after a hot summer. It oftener attacks children, and persons of relaxed habits, than those of vigorous health. Symptoms.—It generally comes on with a sense of giddiness, such as precedes fainting, and a chilliness or shivering like that of an ague fit, soon followed by a great heat, interchangeably succeed- ing each other during some hours, till, at length, the heat becomes constant and intense. The patient then complains of an acute pain in the head, of heat and soreness in the throat, stiffness of the neck, anxiety and nausea, with vomiting and delirium. On exam- ing the mouth and throat, the uvula and tonsils appear swelled, and are of a deep red, or shining crimson color; soon after covered with white or ash-colored spots, which, in a short time, become ul- cerated. The pain in swallowing is slight, in proportion to the de- gree of inflammation. The patient often complains of an offensive putrid smell, affecting the throat and nostrils, sometimes occasion- ing nausea, before any ulcerations appear. On the third day, or thereabouts, a scarlet eruption is generally thrown out on the akin ; 222 PUTRID sore throat. first, on the face and neck, and then, over the whole body and extremities. From the first attack of the complaint, there is considerable fe- ver, with a small, frequent, and irregular pulse ; and every even- ing, there appears a manifest exacerbation, and in the morning some slight remission, together with a debility and general loss of strength. In slighter kinds, the course is not very different from that of the inflammatory species, though seemingly slight, with alternate chills and heats, pain in the head, &c, till the debility appears, when ev- ery other bad symptom immediately follows. Every sore throat should, therefore, be carefully examined. The putrid sore throat sometimes attends on measles which are of a malignant nature. In a disease which runs its course generally in less than five, al- ways in seven days, no prognostic is to be depended on ; but a more florid appearance in the throat, and a more healthy aspect of the edges of the sores. Causes.—The same which give rise to the nervous or putrid fe- ver, as bad air, damaged provisions, &c. &c. Treatment.—The indications of cure are similar to those of the nervous or malignant fever, as it is analogous in some essential cir- cumstances to that disease : to which we must add the healing of the ulcers. Therefore, on the first attack of the putrid sore throat, an emetic may be given, which may be repeated on the next day, and followed by a mild carthartic. Afterwards it will be necessary to recruit the patient with bark and wine, or milk toddy. The ulcers in the throat demand early and constant attention, as a loss of substance here cannot but threaten much danger to life, or injury to the parts, if the patient should survive : hence, the use of gargles must be obvious to every one. When the disease is of a mild aspect, the common and astringent gargles, (see Dispensato- ry,) frequently used, are often sufficient : but when the symptoms are urgent, the tendency to putrefaction great, the sloughs large, and the breath offensive, the detergent gargle must immediately be resort- ed to. Independently of gargling the throat, it is essential that some of the same liquid be injected in the fauces, with a small syringe. In young subjects, this method is the more necessary, as they do not know how to manage a gargle to any purpose, did the soreness of the parts permit them to do it. When the throat is painful, the application of a piece of flannel moistened with the volatile liniment, spirits of camphor, or tincture of red pepper, to excite a slight degree of inflamation externally, will be attended with good effect. But blisters, from the prevail- ifig disposition to putrefaction, must be carefully avoided. According to Dr. Currie, the affusion of cold water is also bene- ficial in this disease. It was his practice, after a copious affusion, to PUTRID SORE THROAT. 223 have his patient wiped dry and put into bed, and given about eight ounces of wine, if an adult, and so in proportion to children ; which plan, it appears, was very successful; for in fifty out of sixty-two cases, where he had adopted it at the commencement of the disease, he succeeded. Dr. Thomas states, that, when he was in the island of St. Christo- pher's, in the year 1787, this disease prevailed a universal epidemic among children, and a vast number of them fell martyrs to it, in spite of the utmost endeavors of the profession to save them ; when at last the most happy effects were derived from the use of a remedy, the basis of which was Cayenne pepper. The medicine was prepared by infusing two table-spoonsful of this pepper and a tea-spoonful of salt in half a pint of boiling water, adding thereto the same quantity of warm vinegar. After standing for about an hour, the liquor was strained through a fine cloth, and two table-spoonsful were given every half hour. The speedy and good effects produced by the of use this ni<"-•■■!;- cine, in every case in which it was tried, evidently point out the utility of giving warm aromatics, which will bring on a timely sup- puration of the sloughs, as well as other antiseptics, to correct the ten- dency in the parts to gangrene. Since the period above mentioned, many practitioners bear testimony in favor of Cayenne or red pepper, (see Materia Medica,) in the putrid sore throat. Pepper-corns con- stantly bitten, and the saliva swallowed, have been highly useful. The grand objects to be kept in view, in this malignant disease, should be, to check or counteract the septical tendency which pre- vails, to wash off, from time to time, the acrid matter from the fau- ces, and to obviate debility. With this view, give quinine or bark, in large doses every two hours in ginger tea, or a strong infusion of Virginia snake-root. These may be washed down with punch, milk toddy, porter, or cider. It will be necessary, also, to make a libe- ral use of wine, which may be given to persons unaccustomed to it from one to three quarts within twenty-four hours. Even sleep is less necessary than wine and bark, and should it continue above three hours, the patient must be awakened, for the loss of time can- not be regained. The quantity of the wine and bark must be reg- ulated by the effect. If we gain nothing in the first thirty-six hours, we may depend on a fatal event; if we lose ground in twenty-four hours, our hopes will be inconsiderable. In addition to these reme dies, we would earnestly recommend bathing the patient frequently in a strong decoction of oak bark, with one-fourth whiskey. This va- uable remedy should always be resorted to with children, as it is of- ten impractible to prevail on them to take medicine of any kind. It is also advisable with such patients to administer this decoction in a clyster ; or use as an injection two drachms of Peruvian bark with a giil of thin gruel or barley-water, which should be given every three or four hours to young children; and about half an ounce in a proportionate quantity of the liquid to those of eight or ten years of 224 PUTRID SORE THROAT. age. Should the first clyster come away too soon, from five to twenty drops of laudnum may be added to the subsequent ones. Should any particular symptoms arise during its progress which may tend to aggravate it, such as vomiting, diarrhoea, hemorrhage, or suppression of urin, the same remedies must be resorted to as advised under the head of Nervous Fever. Regimen.—Medicine will prove of little efficacy, if the animal powers be not supported by proper nourshment: the attendants must, therefore, constantly supply the patient with arrow-root, sago, panado, gruel, &c, to which may be added, such wine as is most agreeable to the palate. Ripe frutes are peculiarly proper, and fermented liquors, as cider, perry, &c, should constitute the chief part of the patient's drink. But previously to taking any nourishment, gargles and injections should be very carefully employed ; for cleansing away the sharp, acrid humor from the mouth and throat, to prevent, as much as possible, its being swallowed. The patient should be so placed in his bed, that the discharge may freely run out at the corners of the mouth, and great attention should also be paid to cleanliness. The feelings of a tender parent, who views the progress of the disease on a beloved child, cannot but excite our tenderest sympa- thy. Too often, from an ill-judged tenderness to the child, the parent will not suffer this dreadful disease to be checked by medi- cines. But it should be remembered, that although the pain is for a moment increased by these harsh, but necessary means, yet the quantity of pain must, on the whole, be much lessened, and besides, which is the sweetest consideration of all, a precious life thereby saved. Prevention.—The same means as recommended in the nervous fever, to correct infectious air, must strictly be attended to here, and especially with a view to prevent the progress of this disease. FALLING OF THE PALATE. The falling down, or elongation of the palate, is attended with a sense of tickling in the fauces, and soreness at the roots of the tongue. Treatment.—Avoid speaking, and gargle the throat with the astringent gargle, (see Recipe 41,) or, when there is little or no in- flammation, apply salt and pepper by means of the handle of a spoon. If fever accompany this affection, bleed and give cooling purga- tives, using nothing but a vegetable diet. It is sometimes necessary to cut off a portion of the palate, to re- lieve the distressing cough which is produced by a long continuance of the disease. MUMPS.--SORE EYES. 225 MUMPS. A contagious disease, affecting the glands and muscles of the neck externally. Symptoms.—Slight fever, which subsides upon the appearance of a tumor under the jaw, near its extremities : sometimes only on one side, but more frequently on both. It increases till the fourth day, and then declines gradually. Treatment.—This disorder is often so slight as to require very little more than to use a spare diet, and keep a laxative state of the bowels. If, however, there be much fever and pain in the head, it will be necessary, in addition to the above, to bleed, blister behind the neck, and take freely of diluting drinks, as flax-seed4ea, barley or rice-water. . j It has been usual to keep the neck warm, but this is improper. It will be found, generally, that those who have been most neglect- ed, have been soonest restored to health. There is a singular peculiarity now and then attending this com- plaint ; for sometimes the swelling of the neck subsides, the testi- cles of the male, and breasts of the female, are affected with hard and painful tumors, and frequently when one or other of these tu- mors has suddenly been repressed/a delirium of the milder sort oc- curs. In this event, bleed moderately, apply a blister between the shoulders, give a dose of calomel, and endeavor to reproduce the swelling by warm fomentations and stimulating liniments. When these tumors are painful, every precaution should be used to prevent suppuration frorn ensuing, by bleeding, cathartics, anti- monial powders, or mixture, diluent drinks, and by cooling and discutient applications, as cloths wetted with lead-water, (.See Dis- pensatory,) and cold vinegar and water. It is necessary, also, that the swelled testicle should be supported by a suspensory bag. SORE EYES. A disease so well known as to render all description of it unne- cessary. Causes.—External violence done to the eyelids, or to the eye it- self ; extraneous bodies under the eyelids, as particles of dust and sand—acrid fluids or vapors—exposure of the ©yes to a strong light, and night watching, especially sewing, reading or writing by candle light. Inflammation of the eyes may also be the consequence of bad humors in the system, or may accompany other diseases of the eyes, and of the neighboring parts, such as the turning inward of the. eye-lids, or styes growing on them. 29 226 SORE EYES. Treatment.__When the disease is moderate, and the exciting cause no longer exists, the cure is perfectly easy, requiring little more than external application, such as washing the eyes frequent- ly with warm milk and water, mixed with a little brandy, or using for a lotion, mucilage of sassafras, (see Materia Medica,) simple rose-water, or about eight grains of white vitriol dissolved in a gill of spring water. But in more severe affections, bleeding, blistering behind the ears, on the temples, or nape of the neck, with gentle purgatives and the cooling regimen, will be found eminently useful. The greatest benefit will also result from soft linen bandages wet with cold wa- ter, applied to the eyes, and frequently renewed until the heat and inflammation have subsided. Soon as this is effected, use the ano- dyne eye-water, (see Dispensatory,) or two or three drops of lau- danum dropped into the eye, or bathe the eyes in cold water, or brandy and water to restore the tone of the parts. In all inflammations of the eyes from common causes, the reme- dies above specified will generally succeed ; only we should be care- ful not to use any of the more stimulant applications, till the in- flammation begins to abate of its, violence, otherwise they will ra- ther increase, than subdue the malady. In obstinate cases, there is no remedy so effectual as a blister plaster immediately over the eye. For this very important disco- very, I am indebted to the adjunct professor of surgery, Dr. Dor- sey, whom, on his own polite invitation, I accompanied to the hos- pital, where he showed me a case in point. A man, whose invete- rate ophthalmia, after obstinately resisting all the usual applications, was completely cured by a single blister, about an inch and a half in circumference, employed in this novel way. When the pimples on the eye attend an inflammation and sup- purate, they should be opened with the point of a lancet, and wash- ed with the solution of white vitriol. If the eye remains very weak after the inflammation abates, the best applications are the alum curd, (see Dispensatory,) which may be spread thinly on a rag, and applied over the eyes every night; and a solution of alum in the proportion of a drachm to half pint of water ; to which may be added the white of an egg. Bathing the face and eyes every morning in the coldest water, will also be found exceedingly useful. Sometimes the edges of the eyelids become swelled and ulcerat- ed, and from the discharge puts on the appearance of fistula la- chrymalis. When the disease is violent, an adhesion of the eye to the upper lid sometimes takes place, which should be carefully se- ' parated by raising the lid, and dissecting cautiously with a round- edged scalpel. In chronic affections of this kind, the application of an ointment prepared by mixing a scruple or half a drachm of White vitriol with half an ounce of fresh hog's lard to the eye lids, is sometimes alone successful; biit when the disease is violent, the PLEURISY. 227 mercurial ointment is required to give a more active stimulus. If the ulcers are not cicatrized by these means, the solution of blue vitriol, in the proportion of fifteen grains to an ounce of water, will be useful. Each application must be made by means of a camel- hair pencil, and the ointment softened by a gentle heat. When the ointments are used, they must be applied in the evening, and continue on the part all night; the solution must be used two or three times a-day, and the redundant fluid washed away with a sy- ringe and a little cold water. Laudanum may occasionally be em- ployed. In the general conduct of all these remedies, they should excite, on their application, a slight irritation, by which the puriform secretion is at first increased ; but by degrees the edges of the eye- lids become soft, the glands lessen, the internal surface of the pal- pebral become smooth, and of its usual paleness. Inflammations are sometimes followed by specks on the eye, which if not early attended to, will obstruct the sight. They may be removed by daily blowing into the eye, through a quill, a little of the best loaf sugar, finely powdered. When this does not suc- ceed, unite to the sugar an equal quantity of white vitriol or tutty, finely levigated, or blow calomel into the eye. When this disease is occasioned by morbid humors in the habit, as the scrofulous or venereal, we must use the remedies pointed out in the treatment of those complaints. If dirt or foreign mat- ter be lodged in the eye, it may soon be removed by passing a small hair pencil between the eyelids and the ball of the eye. The defending of the eyes from the light by confinement in a dark room, or wearing a piece of green silk over them, is a caution which, though too obvious to be pointed out, is too important to be omitted. Prevention.—To persons liable to this complaint the following instructions may be useful. When the eyes are weak, all painful and fatiguing exertion of them should be carefully avoided, such as looking at the sun, sewing or reading by candle light, or sitting in a smoky room. If there be well grounded suspicion that the inflammation of the eyes originates from the suppression of any of the customary eva- cuations, these evacuations should, as soon as possible, be restored ; and until then, an issue or blister on the neck should be kept run- ning, as a necessary substitute. PLEURISY. Symptoms.—An acute pain of the side, which reaches to the throat, in some to the back, and others to the shoulders, but, in ge- neral, is seated near the fleshy part of the breast, with a high fever, hard and quick pulse, difficulty of breathing, and a teasing cough* 828 PLEURISY. sometimes moist, but most frequently dry. The seat of the in- flammation, and, consequently, of the pain, may vary in different cases, but this is not of much importance, as the same mode of treatment is required in inflammation of the viscera contained in the cavity of the chest, as the membrane which invests them. Causes.—The pleurisy, like other inflammatory diseases, pro- ceeds from whatever obstructs the perspiration, as exposing the bo- dy to the cold air when over-heated. It may likewise be occasion- ed by whatever increases the circulation of the blood, as violent exercise, or an imprudent use of ardent spirits. Treatment.—In the cure of pleurisy or inflammation of the vis- cera, our success depends on subduing the violent action of the ves- sels, by bleeding, blistering, and employing such remedies as are calculated to keep the bowels open, and to determine the fluids to the surface. Hence, at the onset of this disease, a large bleeding is always necessary, succeeded by a dose of salts, senna and manna, castor oil, or some cooling purge, and as long as the blood exhibits a sizy crust on its surface, when cool, and the violence of the symptoms continues, the lancet should be used once or twice a-day, with this exception, that, after a free expectoration has commenced, it will be less necessary. A blister over the pained part, after the pulse has been reduced by bleeding, is by no means to be omitted ; and if the pain be ob- stinate, when the blister on one side ceases to discharge freely, ap- ply another on the other side. When blisters cannot be obtained, some substitute must be resorted to, as a cataplasm of mustard and vinegar. Warm cabbage leaves, or a bladder nearly filled with warm water, applied to the affected side, and repeated as often as it becomes cold, will sometimes afford a little relief. During this treatment, the patient should take freely of warm diluent drinks, as flax-seed, balm, or ground ivy teas, barley or rice- water, to which may be added a little of the juice of lemons. The decoction of pleurisy, or seneca, or rattle-snake-root, (see Materia Medica,) exhibited in doses of one or two table-spoons full every two or three hours, abates the febrile heat, and produces expectoration. The antimonial powders or mixture, or camphorat- ed powders, (see Dispensatory,) also produce these beneficial ef- fects. When these medicines are not at hand, portions of nitre dissolved in the patient's common drink, and ipecacuanha in such doses as will keep up a nausea at the stomach, without vomiting, will answer every purpose. Inhaling the steam of hot water from the spout of a tea-pot, or applying a large sponge dipped in warm vinegar, to the mouth and nostrils, will be beneficial. Flax-seed sirup (see Materia Medica,) is a valuable medicine in this complaint, in allaying the cough, a symptom exceedingly distressing. When this is not convenient, make use of some of the pectoral mixtures, as advised under the PLEURISY. 229 head of cold. In the advanced stage of the disease, when the in- flammatory symptoms are almost wholly abated, and the cough proves the chief cause of pain and loss of sleep, then opiates may be given with the greatest advantage. It should be observed in the exhibition of opiates, that if they be administered in the commencement of inflammatory disease, be- fore the necessary evacuations are made, they increase the inflam- mation, and, consequently, injure the patient; but, if given near the close of such maladies, they are of the greatest service, and complete the cure. When perspiration is obstructed, they should be coupled with some emetic drug, as in the form of the anodyne sudo- rific draught or bolus, (see Dispensatory;) but when this is not the case, opium or laudanum alone should be administered, and that in small doses, when the patient is much debilitated from previous evacuations. A half grain of opium,. or fifteen drops of laud- num, or thirty drops of paregoric, given about an hour before the evening exacerbation, alleviates the symptoms, and if repeated for a few evenings, gradually increasing the dose, ensures the cure. If the pulse sink and become languid, blister the extremities, and give six or eight grains of volatile salts every three hours with mulled wine. The bowels, in the course of the disease, must be kept mo- derately open, by emollient injections or mild laxatives, as castor oil, or the cathartic mixture. The bastard pleurisy is often confounded with true pleurisy. It consists of a rheumatic inflammation of the intercostal muscles, often of the other muscles, of the breast or abdomen. The dis- ease is distinguished by externa^ soreness, and is relieved by bleed- ing, blistering, and exhibiting the seneca-root in decoction. Regimen.—In no disease is a strict abstinence more necessary than in this, since, in proportion to the nourishment taken, will be the increase of the blood, and consequently of fever. Nothing but diluent drinks, as toast and water, barley-water, bran, or flax-seed tea, ought to be allowed, until the violence of the disease is subdu- ed ; and these liquids should be taken often, but in small quantities at a time, and never cold. When nourishment is required, the lighter kinds only should be used, as arrow-root, sago, panago, &c. After recovery, great care must be taken to prevent a relapse ; the sparest diefshould therefore be used ; the inclemencies of the wea- ther carefully guarded against; moderate exercise employed, and the chest protected from the action of cold, by wearing flannel next to the skin. In this state of convalescence, a prudent use of wine with bark or Colombo, will assist digestion, and give tone to the system generally. 230 inflammation of the liver. PERIPNEUMONY, OR INFLAMMATION OF THE LUNGS.' Symptoms.—Febrile affections, succeeded by difficulty of breath- ing, cough, and obtuse pain under the breast bone, or betwixt the :shoulders, increased on inspiration. A sense of fulness and tight- ness across the chest; great anxiety about the heart, restlessness, loss of appetite and sleep ; the pulse quickj sometimes hard, and seldom strong, or regularly full; the breath hot, the tongue covered with ai yellowish mucus, and the urine turbid. From the obstruction to the free passage of blood through the lungs, the veins of the neck are distended, the face swollen, with dark red color about the eyes and cheeks. The pain in the chest is generally aggravated by the patient lying on the side most affected, and very often he can lie only, on his back. Causes.—Cold, obstructing perspiration, and thus producing a morbid determination to the lungs, or violent efforts, by over-dis- tension. Treatment.—Such is the delicate structure of the lungs, that they will not sustain inflammatory attacks many hours before their important functions are destroyed, or so much mischief produced as to lay the foundation of consumption. The antiphlogistic plan, therefore, as advised in the pleurisy, for the resolution of the disease, should be put into immediate opera- tion, and not by degrees, as is often the case, by which many lives are lost, but should be carried to the utmost extent, particularly the taking away of blood in considerable quantities from the arm. We would remark, however, although the evacuating plan is in- dispensably necessary in the early stage of the disease,'yet it should not be continued too long ; for the truly salutary discharge is by ex- pectoration ; and if the strength be too far reduced, this will be pre- vented. \ INFLAMMATION OF THE LIVER, Is of two kinds, the acute and chronic ; and, consequently, re- quires variation in the mode of treatment. Symptoms.—The acute is marked by a pungent pain of the right side, rising to the top of the shoulder, something like that of the pleurisy, attended with considerable fever, difficulty of breathing, dry cough, and often bilious vomiting. The chronic inflammation of the liver, is usually accompanied with INFLAMMATION of the liver. 231 a morbid complexion. The symptoms are sometimes very obscurer and confined rather to the common marks of stomach complaints, as flatulence and frequent eructations. The appetite, in consequence, fails, and occasional uneasiness or pain is felt in the region of the li- ver extending to the right shoulder, the characteristic of the disease. An obscure fever prevails, which is generally worse at night, induc- ing languor, want of sleep, and much oppression. The patient has generally clay-colored stools, and high-colored urine, depositing a red sediment, and ropy mucus. In the progress of the malady, the countenance seems livid and sunk, and the eyes of a dull white or yellowish hue. Under these symptoms, the body becomes gra- dually emaciated, while in the region of the liver, is felt a sense of fulness, with a slight swelling and difficult breathing, attended with a hoarse, dry cough, particularly aggravated when the patient lies on the left side. As the disease advances, dropsical symptoms, accompanied with jaundice, supervene ; and under these complicated maladies, the suf- ferer sinks. Sometimes an abscess opens externally, which, if it do not effect a cure, at least prolongs the life of the patient. Causes.— Violent and repeated shocks from vomits ; sudden changes in "the weather, but especially cold nights after very hot days ; sitting in a stream of air when over-heated; drinking strong spirituous liquors, and using hot spicy aliment. Treatment.—In this, as in all other cases of visceral inflamma- tion, the same means to take off inflammation, as advised in the pleurisy, should be carefully observed. And, as it is an object of the first importance to prevent the formation of matter, we should adopt these means as early as possible, to produce resolution, the only salutary termination.—Scarcely any complaint requires such prompt and copious blood-letting, as acute inflammation of the liv- er. After the acute stage is over, we may consider the affection of a chronic nature, and the mode of treatment must be regulated ac- cordingly. In the chronic species of this disease, the cure depends princi- pally upon mercury, which may be employed in the early stages of the complaint. The mercury may be introduced in the system, ei- ther by taking one or two of the mercurial pills, night and morning, or by rubbing as frequently on the part affected, the ointment about the size of a nutmeg, continuing the one or the other, until a ptya- lism is produced or the disease is subdued. During this course, the use of the tonic powders, or pills, (see Dispensatory,) or bark and snake-root, when febrile symptoms have abated, will greatly hasten the cure. The nitric acid, with patients who are scorbutic, or much debili- tated, is far preferable to the calomel, on account of its antiscorbu- tic and tonic powers. It should be given to the extent of one or two drachms daily, diluted with water, in the proportion of one drachm of the acid to a quart of water. At first, it ought to be given S33 INFLAMMATION OF THE STOMACH. in small doses, and frequently repeated, and the dose, gradually in- creased, as circumstances require. This medicine, like calomel, must be continued until the mouth becomes affected, the salivary glands enlarged, and their secretion increased ; and when this takes place, the disagreeable symptoms will be removed, and the patient, from being debilitated, becomes healthy, vigorous, and cheerful. My own experience of the efficacy of the nitric acid in chronic affections of the liver induces me to speak well of it; and I am hap- py to add it was a favorite remedy of that celebrated anatomist, and distinguished physician, Professor Wistar, in this distressing disease, particularly when there was-an enlargement of the liver. Obstructions and indurations of the spleen, bear some resemblance to a diseased liver, and are very prevalent in low, marshy and aguish situations. Their treatment consists in the use of the same means recommended for the cure of this disease. Regimen.—The food should be easy of digestion, such as veal, Iamb, fowls, or fresh beef. Water-cresses, garlic and other pungent vegetables are useful. A change of climate, and moderate exercise in the open air of the country, is both agreeable to the patient and very salutary.* * Of this formidable disease, died, on the 29th October, 1823, Charles Carroll, of Belle- vue, Maryland. * This inestimable friend was extensively known, and wherever known, was justly esteemed for his intelligence and moral excellence. Whatever of man'y grace and vir- tue belongs to the human character, shone conspicuously in him. An affectionate husband and a kind parent, a generous friend and a polished gentleman ; he stood among his fellows, a bright example of what a man should be. His philanthropy prompted him to devote a considerable portion of his fortune, which was at one time ample, to the alleviation of the distresses of his fellow men. In more than one instance, as the author is able to testify, individuals owed much of their'prosperity and happiness in life to his unso.: When there is a discharge from the mouth, of blood of a florid \ i color, brought up with more or less coughing, preceded by a sense of tightness, weight, and anxiety in the chest, and attended with a saltish taste of the spittle, it is in consequence of a ruptured vessel I of the lungs. Causes.—Plethora; violent exercise of the lungs ; and, frequent- ly, mal-conformation of the chest. Treatment.—The most important remedy in this alarming com- plaint, is blood-letting, which should be actively employed, paying, at the same time, attention to the state of the bowels. Spitting of blood, however, is somestimes owing to the contraction of the chest n with debility ; and in this case, the lancet must not be so freely o used. v Sedatives, particularly those which repress the activity of the o circulation, are highly useful. Of these, the chief are nitre and ti foxgloye. Nitre, in doses of ten grains, given every hour, in the jj coldest water, and swallowed while dissolving, is much to be de- « pended on in the early stage of this disorder.—The tincture of fox- < glove exhibited in small doses every hour or two, by retarding the consumption. 253 action of the pulse, will also prove a most useful auxiliary in sup- pressing pulmonic hemorrhages, particularly in those cases where an inflammatory diathesis prevails. Whenever there is fixed pain in the chest, a blister applied to the breast or back will do much ser- vice. According to Dr. Rush, two tea-spoons full of common salt, dis- solved in a small quantity of water, and exhibited every two hours, or oftener, will check this disease, as well as hemorrhages from the stomach and uterus. Astringents are frequently resorted to, as alum, kino, and sugar of lead ; but they are of little utility, except in the passive haemop- tyses, and even in these, nitre is often found preferable. If the cough be troublesome, it will be necessary to have recourse to demulcents and pectorals, as advised under the head of cold. Sometimes a spitting of blood is produced in consequence of sup- pressed evacuation ; in this case, it is not dangerous, and only re- quires remedies to restore the customary discharge. A spitting of blood may readily be distinguished from a discharge of it from the stomach, as, in the latter, the quantity is usually more considerable, of a darker color, and is generally unattended by coughing. Regimen.—A low diet should be strictly observed, and the body kept as quiet as possible. Nothing should be taken warm; flax- seed tea, barley or rice-water, acidulated with the juice of lemons or elixir vitriol, ought to be used as common drinks, and taken as cold as possible. Prevention.—Carefully avoid all exertions which either detain or hurry the blood in its passage through the lungs, as singing, loud speaking, running, or lifting great weights. Obviate costiveness, by the occasional use of mild aperients, and use a spare diet. On ex- periencing any pain in the chest, blister, bleed, and constantly wear flannel next to the skin. Swinging, sailing, travelling in an easy carriage, and riding on horseback, will be the most appropriate exercise. CONSUMPTION. Symptoms.—Those which mark its first stage, are a slight fever, increased by the least exercise ; a burning and dryness in the palms of the hands, more especially towards evening ; rheumy eyes, upon waking from sleep ; increase of urine ; dryness of the skin, as also of the feet in the morning; occasional flushing in one and some- times both cheeks ; hoarseness ; slight or acute pain in the breast; fixed pain in one side, or shooting pains in both sides ; headache; occasional sick and fainty fits ; a deficiency of appetite; and a gen- eral indisposition to exercise, or motion of every kind. The first appearance of this disease will vary in different cases ; 254 CONSUMPTION. but the most constant symptoms which characterize it, are a cough and phlegm resembling matter, of which, at length, it becomes en- tirely composed. This disease often attacks insidiously, and is chiefly confined to the young, the fair, with light skin and blue eyes, florid complex- ions, contracted chest, and high shoulders. Irr constitutions dis- posed to hectic, the fingers are often long, and the nails bent; they grow rapidly, but seldom expand in breadth and bulk. From the age of twelve or fourteen, to that of about thirty-five, is the hectic period ; more generally from sixteen to twenty-four; and the tenden- cy seems to return about forty-five or fifty, especially in women at the period of the cessation of the catamenia. At the age of fourteen or sixteen in each sex, while the genital organs are evolving, there is often a considerable debility and irritability. The debility in fe- males is often formidable, and a slight cough is no uncommon at- tendant. The cough is either quite dry, or accompanied with an expectoration of a small quantity of a thin frothy matter, which dif- fers from that of true catarrh, in being easily diffusible in other flu- ids. Sooner or later, the general health becomes impaired, and at length, the fatal hectic makes its* appearance with little suspicion; all the symptoms being referred to the great change that then takes A place. No diagnosis can arise from the existence of fever, since in the chlorolic state coldness, with occasional flushing, are not un- frequent. In general, however, the fever of phthisis attacks more pointedly in the evening ; that of chlorosis in the morning. The appetite of hectic patients is best in the forenoon ; of chlorotic at night; and the latter can eat meat suppers frequently with impu- nity. It sometimes occurs that persons who have been improperly treated in the venereal disease, have symptoms which assume the form of consumption ; but, in general, the chest is free, while pains are more violent at night, and more frequently in the middle of the bones of either extremity, or deep-seated in the head, than in the trunk. It has also seldom proceeded so far as to mislead, without showing its nature by eruptions, or by an affection of the throat. From the state of mind, we may draw some distinction ; for cheer- ful hope illumines every hour of the hectic ; despair darkens each moment of the syphilitic patient. Strange as it may appear, amidst all the horrors of this disease, the patient's hopes are seldom abandoned, and even increase, as the fatal termination advances. Causes.—Obstructions and inflammation of the lungs, depending most frequently on the existence of small tubercles in the substance, which, coming to suppuration, burst and discharge a purulent mat- ter. Sometimes, it is induced by a general affection of the system, and sometimes it is a consequence of other diseases, as cold, mea- sles, small-pox, pleurisy, &c. &c. Treatment.—This must be varied and adapted to each stage and case of the disease. In the first or inflammatory stage, moder- CONSUMPTION. 255 ate bleedings, twice or thrice a-week, according to the force of the pulse and habit of the patient, are essential, aided by blisters to the breast and back, and employing, at the same time, a cooling re- gimen. In almost every species of the disease, blisters or issues are often a means of relieving the cough ; for even when they have no ten- dency to remove the stimulating cause producing cough, as when it arises from a tubercle, yet they diminish the effect of the stimulus. They are particularly useful in that period of the disease, when a catarrhal has a disposition to degenerate into a phthisical affec- tion ; for in that modification of the disease, derivation from the lungs is of the utmost consequence. By this means, a change may often be effected in that state of suppuration which takes place from the internal membranes of the lungs, and the purulent discharge may thus be converted into the natural mucus. Among other remedies in consumption, the use of emetics is strongly recommended. By the action of vomiting, the blood is propelled to the extreme vessels in every part of the body, particu- larly to the extreme vessels of the surface. Thus, there is produc- ed a derivation from the lungs, and a consequent change in the state of suppuration at that part of the system ; but they are chief- ly useful in consumption, as obviating symptoms, particularly cough and difficulty of breathing, and by promoting expectoration. A considerable variety of medicines of the refrigerating kinds have been strongly recommended for combating consumption in its incipient state. They tend to diminish the impetus of circulation, and although they do not immediately remove a plethoric state, yet they, perhaps, tend to diminish the inflammatory diathesis even more effectually than the repeated blood-lettings. The cooling neutrals, through the whole course of the disease, are useful; particularly nitre, which may be advantageously taken in any period of the com- plaint. Demulcents are always indicated, and usually employed in the manner we have recommended under the head of cold, to sheath the fauces, and lessen the violence of cough. Gum Arabic held con- stantly in the mouth, will also be found extremely useful in reliev- ing this distressing symptom. Of all the remedies which have of late been fashionable in con- sumption is the foxglove, (see Materia Medica,) but it does not seem to merit all the praises which have been given it. Under proper management, the foxglove produces a slowness of the pulse, not per- haps to be obtained from any other medicine yet discovered. And it has been the opinion of some, that, by reducing it to the natural standard, from the employment of digitalis, consumption may be overcome. But it should be observed, that the quickness of pulse in this disease is merely symptomatic, and that the reduction of it, even below the natural standard, can have no effect either in removing a tubercle, or in healing an ulcer in the lungs. Hence, on this ground, it is in vain to expect a radical cure from its use. However, as a diminution of the celerity of the pulse will somewhat alleviate the 256 CONSUMPTION. hectic fever, it may, in certain cases, be employed with advantage. The most eligible mode of using the foxglove is in a tincture, be- ginning with the dose of ten drops, and gradually increasing it to six- ty to an adult, morning, noon, and night. In exhibiting this medi- cine, it should not, however, be given in such doses as to induce much sickness. Among other active medicines, recourse is frequently had to mer- cury, but unless consumption was excited by a venereal taint, we have never witnessed benefit from this medicine. On the contrary, when mercurial salivation is produced in the genuine consumption, it has uniformly hastened the death of the patient. The Iceland moss, or liverwort, has been, of late, highly extolled as a remedy in this complaint that readily allays cough, facilitates expectoration, abates hectic fever, and quiets the system without constipating the bowels. It is likewise said to strengthen the or- gans of digestion, without increasing the action of the heart and ar- teries. Indeed, the physjcians of Europe have spoken so loudly in its praise, that every patient ought certainly to give it a trial. The most approved method of using it, is in the form of decoction ; an ounce of the herb to a quart of water, boiled for fifteen minutes over a slow fire, to which two drachms of sliced liquorice-root may be added about five minutes before it is taken off. A tea-cup full of this decoction should be taken four times a-day. Another form is by boiling two drachms of the herb in a pint of milk for ten minutes, and taking it for breakfast and supper. If chocolate be preferred, it may be blended with it, by making the chocolate with a decoction of the moss, without the liquorice, as above direct- , ed. Of all our indigenous plants, the Indian turnip, (see Materia Me- dica,) has the highest reputation as a remedy in consumption. It is evidently an active expectorant, and may be useful in the latter stage of the disease. In the treatment of this disease, balsamic medicines are frequently resorted to. They are totally unsuited to the inflammatory state of any one of the complaints of the lungs, whether acute or chronic. Action having been sufficiently subdued by depletory measures, they may be safely and advantageously administered in catarrhal con- sumptions and protracted coughs ; and will be found particularly useful when expectoration is checked from debility, and a want of irritability of the glands. So opposite are the states of the lungs in catarrhal affections, that it requires essentially different substances to produce expectoration. It may be depressed or imperfectly per- j formed, by a constriction of the lungs ; by the removal of which, an infinite degree of relief is often afforded. It is also apparent that " the lungs, occasionaally, from extreme debility, pour out an exces- sive discharge ; and that by direct stimulation of the exhalents, the effusion is abated and oppression removed. The advantages of the vegetable balsams, as they have been called, were supposed to consist in their power of promoting the consumption. 257 heahng of wounds and ulcers. At one time, many of them were highly extolled in pulmonary consumptions ; but each have had their day of fashion, and have each fallen into deserved neglect. Ac- cording to the testimony of Drs. Duncan, Simmons, and other emi- nent physicians, gum-myrrh, exhibited in doses of twenty or thirty grains thrice a-day, united with an equal quantity of nitre, has, in many instances, been employed with the best effects in this intracta- ble disease. While, for resolving tubercles or healing ulcerations in the lungs, many medicines have been taken internally, some modes of cure have been recommended with the view of acting topically on the diseased parts. In this way, different articles have been directed to be inhaled into the lungs, under the form of vapor. In an inflam- matory state of the bronchial glands, warm water vapor may be useful, and vinegar has occasionally been added ; but it seems often to irritate the cough, and the more stimulant vapors are evidently injurious, except where expectoration is difficult and deficient. In cases where the accumulations of the chest are owing to debility of the lungs, or are retained by the viscidity and tenacity of the mat- ter, sulphuric ether is strongly recommended ; and, we are told, up- on the high authority of Doctor Pearson, that its powers are improv- ed by several substances which are soluble in it. Hemlock is parti- cularly praised, half a drachm of which is to be digested in an ounce of ether, for several days, so as to form a saturated tincture of this, two or three tea-spoons full are to be put into a wine glass, to be held up to the mouth, and inspired till the whole is evaporat- ed and repeated reveral times in the day. Similar in its effect to these inhalations, is the practice of smoking tobacco, the stramonium, and other substances. With the same views, tar fumigations, according to a distinguish- ed Russian physician, Dr. Crichton, of St. Petersburg, have been employed, and, it is said, with triumphant success. The mode he recommends for doing this, is, to put the tar in an earthen vessel over a lamp, or heated iron, so as to cause a volatilization, till the air of the room is sufficiently impregnated, and this process is to be re- peated three or four times a-day. Having stated the remedies which have been most highly recom- mended in consumption, and from which, when prqperly adapted to the circumstances of the case, there is the best chance of recovery, we will conclude with a few remarks on the means of obviating Urgent symptoms. It is a fortunate circumstance, that even in those diseases where the prospect of recovery is the most faint, and where there is next to certainty of an approaching dissolution in no long time, we still have it in our power to protract the period of life, and to alleviate the distress of the patient. In many cases of this terrible disease, it is all that we can reasonably expect to accomplish. Although colloquative sweats are not productive of pain, yet they tend very much to debilitate the patient, and by the loss of strength, 258 CONSUMPTION. the chance of recovery is very much diminished. Hence the ne- cessity, in such cases, of giving some tonic, as the elixir vitriol or infusion of bark. In every instance of consumption, it is of importance to prevent costivness, and it is always a desirable circumstance to keep the bowels in a soluble state, which should be obtained rather by diet than medicines. But when diarrhoea occurs spontaneously, this should in like manner be restrained by shunning the use of those articles which are observed to increase it, and by employing what are found to moderate it. Of all the symptoms which require to be mitigated, there is none which more frequently demands attention, than the cough. For this purpose an almost infinite variety of articles, either of the demul- cent or sedative kind, (see Cold,) may be employed with advantage. But of these substances, after the inflammatory symptoms have been subdued, none is so useful or so powerful as opium. This article, however, valuable as it is, cannot be considered free from inconve- nience. There are some individuals with whom, from peculiarity of constitution, it always disagrees, producing confusion in the head, vertigo, sickness at the stomach, and various other distressing symp- toms. In these cases the solution of sulphate or acetate of mor- phine might be given with advantage, as it is free from most of the objections just mentioned. (See Dispensatory.) Recourse has, however, been had to a variety of other sedatives, both with the view of allaying inordinate action, and of procuring sleep. Of all the substitutes for opium, none, according to the testimony of one of the most celebrated and distinguished physicians in England, Dr. Duncan, equals the preparations formed from the common garden lettuce. (See Materia Medica.) It has been supposed, that by the continued use of opiates, we might allay irritation, and contribute to the great object, the healing of the ulcer. They have, however, failed in this view, though we cannot refuse their employment to lessen pain, and keep up the calm serenity, the pleasing delirium, in the midst of distress, and a state of hopeless relief. From what has been said of the principal remedies recommended in consumption, the reader will find but little encouragement to in- dulge a hope of relief. He will probably exclaim, Is consumption then, never cured ? Whence can arise the confident promise, which every newspaper offers, and which the most respectable au- thorities confirm ? The deception arises from two sources. Ca- tarrhal complaints are, in many instances, confounded with consump- tive, and the most experienced eye is occasionally deceived. In some cases, also, vomica; are completely evacuated by expectoration, and the wound heals. So insidious is the attack of consumption, that it has often been taken for catarrh ; and, on the contrary, so violent is often a catarrh, that it has been pronounced to be truly phthisical, by practitioners of judgment and experience ; nor has the delusion been destroyed but by expectoration.—From such errors it is not to CONSUMPTION. 259 be wondered that so many medicines should have gained credit in the cure of consumption. To say, however, that this disease is never cured, would certainly appear rash ; for instances have occur- red in which a recovery has been perfected by nature; but they are so few that they can scarcely inspire hope. Regimen.—Perhaps a greater number of cures in consumption have been effected by regimen than by medicine, especially if under this head be included, not merely diet, but air, exercise, and similar circumstances. It has been but too common to prescribe the same diet in every stage of the disease, which has been attended with the most perni- cious effects, and has often hastened the death of the patient. While the Brunonian fed his patients to avoid debility, the other prac- titioners carried apparently their antiphlogistic system too far. In judging of that diet which is best suited to phthisical patients, due attention must always be paid to its effects upon the system. While a considerable discharge by blood-letting is requisite, it is certainly proper to avoid those articles which can furnish a large supply of rich chyle, even, although they should be, like milk, of the very mildest nature. But after the suppuration takes place, and there is a free discharge of purulent matter, the antiphlogistic plan should be pursued no farther; on the contrary, a more nutritious diet is essen- tially necessary. The healing of tuberculous ulcers in the lungs, as well as of scrofulous sores at other parts, is only to be expected from recruiting and giving vigor to the system. In this state of the dis- ease, therefore, a nutritious diet is naturally indicated; and, indeed, the evident marks of exhaustion point out the propriety of a due sup- ply. Besides these particulars, a liberal and nutritious diet is often manifested in this stage of the disease by the feelings of the patient; for it is by no means uncommon to observe even a craving for animal food ; and it may be remarked, that in very rare instances only are such calls of nature entirely to be neglected. The diet in the inflammatory stage of consumption should be light, and composed of articles that tend to correct acrimony, and diminish inflammation, as milk, butter-milk, rice-milk, arrow-root;. sago, fruits of every kind, and vegetables. In the advanced stage of the disease, and when the pulse is weak, a more cordial and stimulating diet, and strengthening remedies are necessary. To prevent weakness, and other ill effects of an empty stomach, pa- tients should partake frequently of meat, with wine, porter, or tod- dy : raw oysters are thought to be peculiarly proper. With this cordial diet, tar pills, bark, and elixir vitriol, or an infusion of the inner bark of the wild cherry tree, or hoarhound, and bitters of all kinds, have been exceedingly useful in this state of consumption. Air and situation are apparently objects of considerable impor- tance, in a disease where medicine must confess the utility of her resources. Change of air is among the remedies constantly recom- mended ; and to change is often professedly the only object. Exercise, when not carried to fatigue, in a dry country air, often 260 DIFFICULTY OF URINE. does more good than medicine ; and, consequently, should always be taken. Long journeys on horseback are the most effectual modes of ex- ercise, carefully avoiding night air, and the extreme heat of the day in summer. That this exercise may not be carried to fatigue, pa- tients should, at first, travel only a few miles a-day, and gradually increase the distance as they increase their strength. When exer- cise on horseback cannot be supported, sailing and swinging should be substituted, and no efforts to cheer the spirits, or innocently to amuse the mind, should be neglected. Geat care should be taken to regulate the dress according to the changes of the weather. The chest, in particular, should be defend- ed from the cold, and the feet from the damp. In the various stages of this disorder, the bowels ought to be kept moderately open by emollient clysters, or the mildest laxatives, if the diet should not have the desired effects. INCONTINENCE OF URINE. Symptoms.—An involuntary evacuation of urine. Causes.—A relaxation of the sphincter of the bladder ; injuries received about the neck of the bladder ; pressure of the womb in a state of pregnancy, &c. Treatment.—When the disease proceeds from a relaxation of the sphincter of the bladder, a large blister to the os sacrum, or lower most part of the back-bone, will be found highly beneficial, and often effects a cure in one or two days. The cold bath, or dashing cold water upon the genitals, and tonic medicines, as the nitric acid, lime-water, bark, steel, and Columbo, are peculiarly proper in obstinate cases of this kind. The tincture of cantharides, in doses of ten or twelve drops, every three or four hours, is said, by Dr. Morton, to be a specific in this complaint. Others recommend alum whey, made as strong as the stomach will bear it, and direct half a pint to be taken night and morning. With others, the blue vitriol, in doses of half a grain, given twice a-day in any agreeable liquor, is most to be depended on. The occasional use of rhubarb, in small doses, to keep the bowels easy, tends great- ly to alleviate the affection. When it is produced by an impreg- nated womb, little more can be done than observing a horizontal position as much as possible. , DIFFICULTY OF URINE. When there are frequent uneasy urgings to void urine, and it is discharged with difficulty and pain, the disease is called a strangu- DIFFICULTY OF URINE. 261 ry; and when it is totally retained, is called a suppression of urine. Causes.—It arises from a variety of causes, as calculous concre- tions ; obstructions in the urethra ; blisters ; or the tincture of can- tharides, taken internally too freely; wounds, bruises, &c. Treatment.—The cure must greatly depend on the cause. If" the pulse be full and feverish, bleed and procure stools by emollient clysters and cooling laxatives, such as castor oil, or the cathartic mixture. (See Dispensatory.) Much dependence is to be placed in the free use of demulcent drinks, as barley-water, flax-seed tea, mucilage of gum Arabic, decoction of marsh-mallows, of parsley roots, or of watermellon seeds, especially if the affection be owing to the cantharides, or any injury of the bladder. One of the camphor- ated powders, (see Dispensatory,) given every three or four hours, in the patient's common drink, often effects a cure.—Great relief will be obtained from the warm bath, used oftener or seldomer as the case may require, or sitting in a tub of warm water, or from the frequent applications to the belly, of cloths wrung out of hot water, or bladders half filled with it. Opiates are very serviceable, but should never be used in the height of fever. » A starch clyster, with^laudanum, has very frequently given imme- diate relief. Cooling laxatives and diuretics, which operate without any stimulus, particularly the Epsom or Glauber salts, as in the form of the cathartic mixture, often relieve. As a diuretic, the fol- lowing mixture is considered most salutary. Take, of sweet spirits of nitre, one ounce, laudanum and antimonial wine, each, two drachms, a table-spoonful of which may be given in some diluent drink, and half this quantity repeated every hour, if necessary. In the chronic strangury, after other means have failed, the use of calomel in small doses, or mercurial ointment rubbed into the thighs every night till a slight ptyalism ensues, has frequently effected a permanent cure. In such eases an affection of the prostrate gland may be suspected to have been the cause. Walking on a cold wet floor, perhaps dashing water against'the legs and thighs, would, in obstinate cases, succeed in procuring a discharge of urine, as it has done the faeces. When a suppression of urine arises [from partial palsy, as frequently occurs in the old and debilitated constitutions, our best chance of success, in giving temporary relief, is to give the spirits of turpentine in pretty large doses, make use of general sti- mulants, and apply a large blister to the loins. When this complaint is in consequence of calculous concretions or gravel obstructing the urinary passages, which may be known by pain in the loins, sickness at the stomach, and sometimes a dis- charge of bloody urine, an infusion of wild carrot-seed, sweetened with honey, as also the infusion of peach leaves, (see Materia Me- dica,) have been found exceedingly beneficial. The infusion of hops, which is considered a solvent of the stone, administered in doses of a wine-glass full, and taken to the quantity of a pint daily, is said to be an excellent remedy in calculous affections. The uva ursi is likewise celebrated as a remedy in cases of gravel, in doses 262 HEMORRHOIDS, OR PILES. of five grains with half a grain of opium, thrice a-day. A more powerful medicine, however, for gravel complaints, is the caustic alkali, or soaplees, (see Dispensatory,) but, being of an acrid na- ture it ouon, freed of all his complaints. And by strengthening food, generous wine, cheerful company, and m^erate exercise, was soon restored to perfect health. i iTfti » r n _„;ffl;=e" To demonstrate, farther, the happy effects 8f nossessmg quick wft, «ft2bhoot folly as it flies, will cite another case of hypochondriasm, which came under the care ofthat philanthropic an* 35 274 HYPOCHONDRIAC DISEASE. never be attempted. From this supposed bodily affection, the| mind should be diverted by employments suitable to the circumstances and situation in life, and unattended with much emotion anxiety, and fatigue. Company which engages attention, and is at the same time of a cheerful kind, will always be found of great service. 1 he occasional reading of entertaining books, or playing at any game, in which some skill is required, and where the stake is not an object of much anxiety, if not too long protracted, will farther assist in di- verting the mind from itself. The symptoms of indigestion, and hysteric complaints, that so frequently attend this state of mind, although the effect, rather than the cause, are objects of practice ; inasmuch as they tend to aggra- vate and realize the false apprehensions of the patient. The secon- dary affections require the same mode of treatment recommended for indigestion and hysteric disease. The warm bath is peculiarly beneficial in this complaint, and when the system becomes some- what invigorated, the cold bath may be employed with advantage, provided there exist no obstructions in the bowels. From an acid acrimony generally prevailing in the stomach, the rust of steel, or filings of iron, in doses of ten grains thrice a-day, is the most salu- tary medicine of all the tonics. Magnesia and lime-water are use- ful on the same account. Regimen.—A proper diet costitutes an essential part in the treatment of this malady. In general, light animal food is what alone agrees with such patients ; for there are few, if any, vegetables which do not prove flatulent in their bowels.—Acids are particularly injurious. All malt liquors, except porter, are apt to excite too high a fermentation in the stomach ; and wines, for the most part, are liable to the same objection. If an exception can be made in fa- vor of any, it is good old Madeira, when it can be obtained, which not only promotes digestion, and invigorates the concoctive powers, but acts, immediately, as a generous and wholesome cordial. The use of spirituous liquors is not to be recommended as an habitual re- source, though they may be taken occasionally, in a moderate quan tity, diluted with water. Tea and coffee, though hurtful to people learned physician, the late Doctor Crawford, of Baltimore, who, in every tiring amiable and good, was not unlike his intimate friend, Dr. Stevenson. A certain hypochondriac, who, for a long time, fancied himself dying of a liver complaint, was advised by Dr. Crawford, to make a journey to the state of Ohio. After an excursion of three months, he returned home apparently in good health: but upon receiving information of the death of a twin brother, who had actually died of a scirrhous liver, he immediately took the staggers, and falling down, roared out that he was dead, and had, as he always expected, died of a liver complaint. Dr. Crawford-being sent for, immediately attended, and asked the hypochondriac how he could be dead, seeing he could talk. But still he would have it that he was actually dead. Whereupon, the sagacious Doctor exclaimed, " O yes, the gentleman is certainly dead, and it is more than probable, his liver was the death of him. Howef er, to ascertain the fact, I will hasten to cut him open before putrefaction takes place." And (*|ereupon, getting a carving knife, and whetting it as a butcher would to open a dead calf, he stepped up to him and began to open h« waistcoat, when the hypochondriac, horribly frightened, leaped up with the agility of a rabbit, and crying out, " Murder! murder ! murder !" ran off wuli a speed that would have defied a score ot doctors to catch him. After running a considerable mstance, until he was halmost exhausted, he halted ; and not finding the, Doctor at. hii heels-sajDn became composed. From that period,this gentleman wag nevef known to complain of hJpFvcr;. nor had he, for more than twenty yr ftrrwards, any symjitoni rfffhis disc ace. CRAMP.--TETANY, OR LOCK JAW. 275 with bad digestion, are often useful, however, to the hypochondriac. Moderate exercise, we have already observed, is indispensable in the cure of this camplaint; and it cannot be taken any way with so much advantage as in long journeys, when convenient, accompa- nied with such circumstances, as may convert them into an agree- ble amusement. CRAMP A painful spasm of the calf of the leg or muscles of the toes, and sometimes of the stomach. Causes.—Sudden stretching of the limbs ; advanced pregnancy ; acidity; indigestion, irritation, and debility. * Treatment.—A cramp of the calf of the leg is best relieved by standing up, which simple act, by throwing the weight of the body on the toes, forcibly extends the muscles, and thus takes off the spasm. If the cramp arise from acidity or indigestion, give every night a pill composed of half a grain of opium, with six grains each, of rhubarb and prepared chalk, and administer ten grains of the rust of steel, morning and noon. A cramp of the stomach is best treated by an infusion of red pep- per, (see Materia Medica,) or a large dose of ether or laudanum, accompanied with friction on the part, either by a flesh brush or flannel. When these fail, a very copious bleeding will sometimes remove the spasm, after which the patient must be purged. The chief remedies of spasm are those which remove the irri- tating cause. If this cannot be ascertained, we must endeavor to lessen irritability by anodynes. A sudden terror, the apprehension of a severe operation, on the return of the fit, and unexpected sur- prise, have succeeded. Dashing water in the face, touching a per- son with something cold, or throwing up a cold clyster, have, from the same principles, been effectual. Persons subject to the cramp in the leg may prevent it by wearing stockings in bed, and occasionally rubbing the part with camphor- ated oil. According to vulgar authority, sulphur grasped in the hand, is good to cure, and carried in the pocket, to prevent cramp. TETANY, OR LOCK JAW. Symptoms.—A rigid and painful contraction of all or several of the muscles. Its first symptoms are a stiffness in the back of the neck, increasing to pain, extending next to the root of the tongue, then shooting into the breast, and, lastly, seizing the back. Causes.—Wounds of the head or extremities, and punctures of I ■216 tetany, or lock jaw. the slightest kind, as running a splinter under the nail, or into the toe or finger. . It is equally induced from cold or moisture, particularly when sudden vicissitudes prevail, or sleeping on damp ground. Treatment.—On the first appearance of this disease, give one or two table-spoons full of laudanum, or six or eight grains of opi- um every two hours until the symptoms abate, and then the dose should be gradually lessened. Between the doses, wine or spirits should be given very freely. The use of the warm bath will also assist the efficacy of the opium. These remedies should be in- creased, and carried to the utmost extent, as the symptoms may indicate. If the opium cannot be swallowed, six times the quan- tity may be injected in clysters until the patient can swallow. This disease has oftentimes yielded to a salivation. And when there is»time for the operation of mercury, it should be used both internally and externally. At the same time it is advisable to give opium, in more moderate doses. Dr. Brown, who is now one of the principal professors in the Transylvania university, communicated some time since, through the medium of the New York Medical Repository, his success in the cure of tetanus with the tincture of cantharides. When re- course is had to this remedy, give from twenty to thirty drops of the tincture every hour, until it produces strangury or a difficulty of urine. As soon as this occurs, it must be discontinued, and flax- seed or marshmallow tea or barley-water, or some mucilaginous li- quid drunk freely, and some of it injected by way of clysters; to which may be occasionally added two tea-spoons full of laudanum. According to Dr. Nathaniel Miller, the solution of arsenic in doses of ten drops, with an equal quantity of laudanum, and a large spoonful of spirits every half hour, has, in several cases of tetanus, succeeded admirably in performing a cure.—When the symptoms abate, the dose must be diminished and the medicine gradually dis- continued. Among the various remedies which have been recommended for the cure of tetanus, none has been employed with greater success than the cold bath. This is to be done by plunging the patient in the coldest water, or by pouring suddenly over his head and shoul- ders several tubs of cold water. The cold bath must be repeated every three or four hours, until a perfect cure be effected. On the decline of the spasm, bark with wine and opiates at bed- time should be given, until the patient's health be reinstated. Spirits of turpentine and infusion of tobacco (see Materia Medi- ca,) have each been administered, by way of injection, with very happy effects in this alarming disease. In every stage of the disease, it is of importance to keep the bowels open, by the usual stimulating purgatives or clysters. When local injuries have been the cause of this disease, the wound should be dilated and filled with common salt, Spanish flies, or turpentine, and afterwards dressed with warm poultices until the PALPITATION of the HEART.--HICKUP. 277 wound be brought to a state of good digestion. If a wounded fin- ger or toe be the cause of this horrible malady, it ought instantly to be cut off. PALPITATION OF THE HEART. Symptoms.—In this disease, the motion of the heart is perform- ed with more rapidity, and generally with greater force than usual, which may not only be felt by the hand, but often perceived by the eye, and even heard : there is frequently a difficulty of breathing, a purplish hue of the cheeks and lips, and a variety of anxious and painful sensations. It sometimes terminates in sudden death. Causes.—A morbid enlargement of the heart itself, and of the large vessels; organic affections; an hereditary disposition; ple- thora ; debility, or a morbid condition of the system ; mal-confor- mation of the chest, and many of the causes inducing fainting. Treatment.—This complaint is best relieved by keeping the mind and body at rest, avoiding every cause of irritation, and keep- ing up a proper equilibrium of the circulation. When the disease arises from plethora, and the action of the heart is violent, bleeding is indispensable, which should be followed by a cooling cathartic, and afterwards the exhibition of nitre every two or three hours, or the tincture of digitalis, in doses from ten to twenty drops thrice a-day, by lessening the action of the arterial system, will effect a cure. When there is reason to believe this affection is in consequence of debility, the solution of arsenic, in its usual doses, taken for some time, is a certain remedy. When the nervous system is affected,, small doses of ether, laudanum, or some cordial will be found very serviceable. • The feet should be kept dry and warm, frequently rubbed, and, if not otherwise warm, with powdered mustard seed, or tincture of Cayenne pepper. Those who are subject to a palpitation of the heart should care- fully avoid violent exercise, irregular passions, costiveness, and all circumstances that may tend to increase the action of the sanguife- rous system. HICKUP. A spasmodic affection of the diaphragm, and sometimes of the stomach, is a troublesome, but not often a dangerous complaint. Causes.—Debility, acidity, flatulence, cold drinks when the per- son is warm, repletion, worms, repelled gout, &c. Treatment.—When it arises, as is most frequently the case, 273 NIGHTMARE.--ASTHMA. from spasm induced by debilitating causes, the warm antispasmod- ics as ether, laudanum, the camphorated mixture, hartshorn, tinc- ture of asafcetida, or some of the essential oils, will be useful. A tea-spoonful of vinegar, slowly swallowed, has frequently afforded relief. Preserved damsons have likewise been found of excellent use in this complaint. When acidity is discovered to be the cause, give the absorbent mixture, or twenty drops of hartshorn, with a tea-spoonful of mag- nesia in a cup of mint tea, or a spoonful or two of milk and lime- water ; and, to prevent its recurrence, take ten grains of the rust of steel thrice a-day. When occasioned by poisons or improper food, an emetic will be proper. In weak stomachs, oppressed with indigestible food, a glass of good wine or spirits and water often relieves. Ether applied ex- ternally to the stomach on a soft linen rag with a warm hand to confine it, is a good remedy ; so is the application of an acrid cata- plasm or blister in obstinate cases. Like other spasms, it is often stopped by strongly arresting the at- tention, whether by hope, fear, or terror. A sudden alarm has of- ten succeeded in curing this affection after every other means had failed. On the same principle, a deep, continued inspiration will often remove slighter degrees of this troublesome complaint. NIGHTMARE. Symptoms.—An alarming oppression of weight about the breast, with dread of suffocation. Causes.—Late and excessive suppers ; great fatigue ; drunken- ness, or sleeping on the back. Treatment.—If the patient be of a plethoric habit, bleed, purge, and use a spare diet. And when the disease is the consequence of debility and weak nerves, the tonic medicines, as steel, bark, or Co- lumbo in their usual doses, are proper. A glass of brandy, at bed-time will generally prevent the attack. Prevention.—The patient should sleep on a hard bed, which in- vites to frequent changes of sides, eat light suppers, which, with due exercise, and cheerfulness during the day, form the best pre- ventive remedies. ASTHMA Is often hereditary. When attended with an expectoration of phlegm, it is termed moist or humeral; and when with little or none, dry or nervous asthma. Symptoms.—It generally attacks at night with a sense of tight- ASTHMA. 279 ness across the breast, and impeded respiration. The person thus taken, if in a horizontal situation, is obliged immediately to get in- to an erect posture, and solicits a free and cold air. In violent paroxysms, speaking is difficult and uneasy. Treatment.—On the first attack of asthma, bleeding is ser- viceable, if the pain in the chest and difficulty of breathing be con- siderable ; but less so afterwards, since the disease has a natural ten- dency to take off the plethoric state of the system. Emetics frequently repeated have been found of considerable uti- lity in this disease. When there is reason to apprehend a paroxysm in the course of the night, an emetic exhibited in the evening will generally prevent it; and when the fit comes on in consequence of a loaded stomach, it will often afford immediate relief. As in other spasmodic affections, the most powerful antispasmod- ics, as laudanum, and ether, should be resorted to. These may be given conjointly or separately, but in large doses, to allay the violence of the fit, or to prevent its accession. Thus, half a tea-spoonful of laudanum, or one of ether, to be repeated in an hour, if necessary,. in a glass of cold water, has frequently relieved the symptoms, or, when taken at the approach of the fit, have suppressed it altogether. A cup of strong coffee has sometimes afforded great relief; and when the disease proceeds from the irritation of mucus, a table- spoonful or two of vinegar in a glass of cold water is a good remedy. The skunk cabbage and stramonium, or thorn apple, are consi- dered most valuable antispasmodics, and exceedingly beneficial in. this complaint. According to Dr. Cutler, the emetic weed or In- dian tobacco, (see Materia Medica?) is a certain remedy. And Dr. Thomas speaks highly of the efficacy of the tincture of foxglove, in doses of fifteen drops twice a-day, conjoined with a few drops of laudanum. In every stage of this disease, the bowels must be attended to. The connexion of asthmatic paroxysm, with flatulence and costive- ness, plainly points out the importance of aperient medicines and those of the warm class, as aloes and rhubarb. Expectorants are frequently required in this disease. The pow- der, or sirup of squills, or gum-ammoniac exhibited in rather larger doses than usual, will often bring on expectoration, in cases appa- rently desperate. Blisters near the back are singularly useful, and should be often repeated. Cataplasms of garlic or onions to the feet are also valua- ble assistants. Regimen.—A light diet, easily digestible, and not flatulent, is al- ways proper for asthmatic persons, and during the fit, cool drinks and fresh air are proper. It will always be found serviceable to wear a flannel shirt and to keep the feet warm. Prevention.—During the absence of the paroxysm, tonic medi- cines and the cold bath, together with moderate exercise, will be most efficacious in obviating its recurrence. 280 HEART-BURN.--D1SPEPSTA, or indigestion. HEART-BURN. Symptoms.—A burning sensation about t&e pit of the stomach, with acid eructations, flatulence, and sometimes retching to vomit. Causes.—A relaxed state of the stomach, generating acidities and acrimonies from food too long detained. As it is often a symptom of indigestion, the cause may be found under the head of the following chapter. Treatment.—The first indication is to remove the unpleasant sensations existing, which may be done by taking either a small tea, spoonful of salt of tartar, or a table-spoonful of magnesia in a glass of mint-water or tea ; or a tumbler of mucilage of gum Arabic or flax-seed tea taken cold, with a small piece of liquorice ball dis- solved in it. But, to cure the disease effectually, after an emetic, give the lime-water, or ten grains of the rust of steel, thrice a-day for some time, and keep the bowels moderately open with magne- sia or the root of rhubarb chewed occasionally, or the tincture of it, taken in small doses; or the aloetic pill. If it should arise from bile, lemonade, or some of the vegetable acids, or a tea-spoonful of the spirits of nitre in a glass of the in- fusion of Columbo, will often afford immediate relief. When not arising from the contents of the stomach, general warmth, particularly of the feet, is essentially useful; and even rubbing them with flour of mustard, or tincture of Cayenne pepper, has produced good effects. Great benefit has also been experienc- ed, and sometimes a complete cure effected, by the application of a blister to the pit of the stomach. To render it the more efficacious, the blister should be kept running for at least a week. Regimen.—The diet of those who are subject to this complaint, should consist chiefly of animal food ; and all fermented or acid li- quors and greasy aliment must be strictly avoided. A glass of bran- dy, or gin and water after dinner, is the best beverage. Moderate exercise is particularly beneficial. DISPEPSIA, OR INDIGESTION. Symptoms.—Want of appetite ; nausea ; sometimes vomiting;; heart-burn; costiveness ; distentions of the stomach, particularly upon taking a small quantity of food ; frequent risings into the throat of a sharp acid liquor, and eructations of imperfectly digested mat- ter. Causes.—Errors and irregularities in the mode of living ; cold and moisture; intense study ; depressing passions; and abuse of tobacco, opium, or spirits. » Treatment.—To succeed in the cure of this disease, we must avoid the occasional causes, remove such symptoms as tend to ag- DISPEPSIA, OR INDIGESTION. 281 gravate or continue the disease, and invigorate the tone of the sto- mach. Crudities, acidity and costiveness, must be obviated, at least in their excess, as they tend both to aggravate and continue indigestion. The management of diet is also of considerable im- portance. The stomach should never be suffered to remain any time empty in dispepsia, as all the symptoms are aggravated by it. Persons afflicted with this complaint, should frequently eat a crack- er or a piece of ship biscuit, as bread not subject to fermentation is one of the best substances to be frequently taken. In some weak stomachs, a singular aggravation of the symptoms comes on in about an hour or two after a full meal, attended with a sense of sinking or weakness. This seems to be owing to a digestion unu- sually rapid, and consequently imperfect. In such cases, aliment of more difficult digestion, as eggs boiled hard, or the addition of con diments which retard digestion may be allowed ; but, in general, a bit of biscuit and a glass of wine will remove the sense of weak- ness, which is owing to the sudden emptying of the stomach be- fore too much distended. In order to the cure, recourse must be had to emetics, whenever the stomach is offended with mucus, bilious, or other humors. It is not unusual for a large quantity of very viscid mucus to be thrown up on the exhibition of an emetic. And this must occasionally be discharged, and its accumulation prevented by aromaticsand tonics. The Columbo-root is a medicine of great utility, when the sto- mach is languid, and the appetite defective. It may be given thrice a-day, in substance or infusion, with mint-water, or ginger tea, or infused in Madeira wine, or French brandy, now and then interpos- ing small doses of the tincture of rhubarb. Taking a tea-spoonful of mustard seed with half the quantity of Columbo thrice a-day, will be found particularly useful, where acidity and flatulence pre- vail. A great variety of stomachics and tonics of the vegetable class, as camomile, gentian, quassia, Peruvian, and black oak bark, have been employed in the cure of this disease; but scarcely any merits a preference to the Columbo, unless the Samson snake-root. (See Materia Medica.) However, it is not proper to continue the use of any tonic longer than two weeks at a time. When acidity predominates, a wine-glass of lime-water, with an equal quantity of new milk, or ten grains of rust of steel, or filings of iron, will be found exceedingly beneficial. In some cases the digestion is injured by putrid matter, from de- cayed teeth, constantly mixed with the saliva, affecting the organs of taste, and destroying the appetite. In such cases, the charcoal tooth powder, (see Dispensatory,) or washing the mouth night and morning with the solution of alum, will correct this tendency. Even when the teeth could not be the cause of indigestion, I have seen the most happy effects result from the exhibition of charcoal powder, in doses of a table-spoonful, twice or thrice a-day, parti- cularly when conjoined with a few grains of rhubarb, and double the quantity of powdered ginger, or by taking, after dinner, as 282 DISPEPSIA, OR INDIGESTION. much of the tincture of rhubarb as would keep the bowels in a re- gular state. Another medicine, apparently simple, though of con- siderable efficacy in this complaint, is the cob-web of the black spi- der, which generally inhabits the cellars, barns, and stables. Of this' from five to ten grains is to be given morning, noon, and night, in the form of pills. If the disease, as is too often the case, have been brought on by hard drinking, its only radical cure is to be found in temperance, cordial nourishment, exercise, and the use of elixir vitriol with bark, the nitric acid or the tonic powders or pills, (see Dispensatory.) When the patient complains of a pain in the stomach, resort to the remedies for heart-burn, and use friction with a flesh brush or flannel over the part. Should this fail, give a dose of ether or lau- danum ; and, in case of costiveness, administer an injection. This treatment will generally palliate the pain ; after which, endeavor to restore the tone of the stomach by tonic medicines, as the nitric acid, bark, Columbo, steel, &c. The costiveness peculiar to persons in this complaint, must be re- moved by medicines which gently solicit the intestines to a more re- gular discharge of their contents; and this effect is best obtained by flour of sulphur, magnesia, or rhubarb chewed every day, and only the saliva swallowed. Strong purgatives are unfit to correct habits of costiveness, as they weaken the action of the intestines, and thereby increase the complaint when the evacuation is over. But nothing can so effectually obviate this affection, as the con- stant custom, most invariably observed, of going every morning to the privy, although you have not a natural inclination. Regimen.—The diet should consist chiefly of animal food well chewed, and taken in small quantities, followed with a glass of brandy and water, or good wine. Frequent friction with a flesh brush or flannel over the region of the stomach and belly will be found exceedingly beneficial. After taking an emetic, we have known a milk diet, persevered in for several weeks, effectually cure indigestion. This article, al- most always offends the stomach at first; but by continuance, be- comes agreeable to it, and effects a cure. The milk should be new, and free from acidity. Early rising, and moderate exercise in the morning air, can hard- ly be enough recommended, inasmuch as they contribute so happi- ly to restore the tone of the stomach, as also the whole system. It is impossible to furnish a plan of regimen adapted to every constitution and habit; but if the patient will but pay due atten- tion to what benefits, and what injures him, wisely regulating his mode of living by the information thus obtained, his present mala- dies will soon disappear, and their future recurrence for ever inhi- bited. colic 2S3 COLIC. Symptoms.—A violent pain in the bowels originating from con- striction, attended with costiveness, and sometimes vomiting. The pain is commonly seated about the navel, and resembles various sensations, as of burning, twisting, boring, or a ligature drawn very tight across the intestines. It comes on without fever, which soon follows, especially if in- flammation take place in the intestine affected, and then all the symptoms become greatly aggravated. Causes.—Flatulency; indigestible aliment taken into the sto- mach ; acrid bile ; hardened faeces ; costiveness ; worms; drinking too freely of acids ; intermittents improperly cured ; sudden check of perspiration ; and the application of poisons, such as lead, &c. &c. Treatment.—When the disease evidently arises from wind, which may be known by a rumbling in the bowels, by pressure on the belly, or by the ease experienced from a discharge of it, or by the patient's lying on the belly, a glass of brandy, gin, strong mint- water, or tea made of ginger or calamus, will generally give relief : but it is only in colic from wind that these hot, spirituous and carmi- native substances are to be used; for in all other cases they do great harm, and often destroy life. The flatulent colic is frequent- ly caused by wetting the feet, or otherwise checking the perspira- tion.—When this is the case, rubbing the legs and arms with warm cloths, and afterwards keeping the feet for some time in warm water, will be the most effectual remedy. As a spasm is the immediate cause, its resolution is the chief in- dication of cure; for this purpose relaxing and antispasmodic me- dicines with purges, which, while they solicit the internal discharge, will not greatly increase the morbid irritation, are the most proper means. Where the pain is fixed and acute, bleeding is advisable, partic- ularly in full habits, to prevent inflammation. Next, the action of the intestines must be excited by brisk purgatives, such as castor oil, calomel and jalap, or salts, senna and manna, aided by stimulat- ing clysters. The castor oil is often an invaluable medicine in this disease. From one to two or three drops, will often succeed in purging the bowels, where all other remedies have failed. (See Dispensatory.) If these means prove inefficacious, immediate re- course must be had to the warm bath, in which the patient should remain as long as he can bear it. Where a bathing vessel cannot be procured, flannels wrung out of hot water, should be frequent- ly applied over the belly as warm as can be endured. Besides which, tobacco clysters, (see Materia Medica,) ought to be admin- istered ; and when the pain continues obstinate, apply a large blis- ter over the belly. If the above remedies prove ineffectual, opium and calomel, in large doses, should be employed. To their exceeding utility in obsti- '284 COLIC. nate colic, I can subscribe from numberless successful experiments made by myself.* Eminent modern physicians advise, that when all other means are despaired of, the patient should be placed erect on the floor, and a pail of cold water thrown on his feet and legs; this, though apparently a droll remedy, yet certainly deserves to be tried in des- perate cases, especially as we are assured, from the best authority, that it has often succeeded : it acts, as it is said, by occasioning an immediate evacuation of the bowels. For the vomiting which often occurs in this disease, common garden mint, peppermint, (see Materia Medica,) or any other spi- ces boiled in spirits, and flannels wrung out of it, and laid hot on the pit of the stomach, are excellent, especially if a little laudanum be added. If acrid bile be thrown up, the saline mixture, or infu- sion of Columbo should be given ; and when vomiting is attended with cold extremities, warm applications to the feet, and a blister to the back, often relieve this symptom. It is also frequently re- moved by a blister on the pit of the stomach. In violent colics, attended with vomiting, it is always advisable to administer an anodyne injection, and if it be speedily discharg- ed, the clyster should be repeated till the vomiting ceases. A dose of calomel and jalap, castor oil, or infusion of salts, senna and manna, is then to be administered every two or three hours, until evacuations are procured. Regimen.—Evacuations being once procured, mucilaginous drinks and light diet should be strictly adhered to, and the bowels kept moderately open by mild purgatives, giving opiates at bed-time, if necessary, until the soreness and distention of the belly go off, and no hardened fasces appear in the stool. Prevention.—Those who are at times afflicted with pains in the belly should keep the feet dry and warm ; abstain from flatulent food, and attend carefully to the bowels, to prevent constipation. Those whose occupation subjects them to the fumes of lead, should breakfast on fat broth before they begin their work, and frequently interpose oily purgatives. * How I came in possession of this admirable secret, both justice and gratitude require that I should explain. ' In the year 1801,1 spent several weeks in Georgetown, Columbia District. While there,I was requested to visit a Mr. James Turner, who had long been indisposed with the ague and fever ; but then suffering under a severe attack of the colic, accompanied with most obstinate costiveness. For two or three days the best aperients, as calomel, castor oil, salts, senna and manna, and injections, with the warm bath, and blisters, were used but without effect. Being (much alarmed about his situation, I stated the case to my very excellent friend, the ingenious and learned Doctor John Weems, who advised the immediate use of six grains of opium, with twenty of calomel, in a bolus, and one-third of that dose every two hours afterwards, if the first faded to operate. I expressed my fears that so large a'dose of opium might do harm. "No, sir," replied he, "'tis small doses that do harm ; give large doses, large enough to take off the spasms, and you save the patient." I still retained my repugnance ; however, recollecting his great medical attainments, and the desperate case of my patient, I acceded to his advice, and scarcely was the second dose swal- lowed, before it began to operate like a charm. The spasm was taken «ff the intestine? ; copi- ous fetid evacuations succeeded, and our patient was presently restored. This is but one of many extraordinary cures performed by Doctor John Weems. The c'ti- zens of Georgetown and Washington, will long lament the early fate of this gentleman, of whom for ardent friendship, and medical sagacity, I can truly say—his equal I have seldom sew, Jus superior never. cholera morbus. 285 CHOLERA MORBUS, OR VOIVIITING AND PURGING. Causes.—It is generally occasioned by a redundancy and acri- mony of the bile ; indigestible food, or such as becomes rancid or acid on the stomach ; poisons; strong acrid purges or vomits ; passions of the mind, or a sudden check of perspiration. Treatment.—Endeavor, as early as possible, to expel the acri- monious matter which affects the alimentary canal, by large and repeated draughts of chicken-water, beef tea, barley or rice-water, or thin gruel, &c, which should also be given freely in clysters. It is said, upon high authority, that frequent small doses of cold water, not exceeding a gill at a time, will check the purging, cool the ardent heat of the stomach, and abate the thirst. Cold water is the more efficacious as the climate, season, and constitution of the patient are warm; for it cools, blunts acrimony, and restores the tone of the parts. It should be repeated as often as the patient throws up what he drinks ; and if fainting, with other symptoms of weakness come on, a little wine should be added to each draught of water. After having cleansed the stomach and intestines, give a tea-spoonful of ether, or thirty or forty, drops of laudanum, in mint-water or tea, and repeat the dose every hour, or oftener, as the frequency of the evacuations or the urgency of the pain may require. If the laudanum be rejected from the stomach, give a tea-spoon- ful of paregoric, or opium in pills of half a grain, repeated every half hour at the farthest, until the disease be checked ; and at the same time, apply mint leaves stewed in spirits to the pit of the sto- mach. In general, this mode of treatment is sufficient; but if the patient be of a plethoric habit, he ought to lose blood immediately ; and, in case the pain continue violent, be placed in the warm bath. Should the bathing vessel not be at hand, peppermint stewed in spirits, or cloths wrung out of hot spirits or decoction of camomile, hops or la- vender, ought to be applied to the stomach and belly, and often renewed. If acrid bile be the cause of this complaint, the Columbo must be given every hour, or oftener, in large doses ; and, in case of great heat, a small quantity of nitre in the patient's drink, will be proper. In warm climates this remedy is considered almost a specific ; it soon abates the violent evacuations, and, by continuing it a few days, a cure is effected. A tea-spoonful of the Columbo, finely powdered in a glass of mint-water or a gill of the infusion may be repeated every hour or two, according to the urgency of the symptoms. In preparing the infusion, it is better to add one fourth ginger, or some grateful aromatic, in cases unattended with fever. When the disease originates from food, either very acid or putrid, 2S6 EPIDEMIC, OR besides plentiful dilution with the above drinks, give castor oil, salts, or rhubarb • and if from poisons swallowed, the patient should drink largely of pure sweet oil, melted butter, or mucilaginous drinks, with small portions of salt of tartar. Regimen-__As no disease more suddenly weakens the patient, he should take freely of a light but cordial and nourishing diet, occa- sionally assisting his appetite, if deficient, with elixir vitriol, tincture of bark, or infusion of Columbo. If he cannot sleep well, an opiate atb ed-time may be taken until his strength and spirits return. EPIDEMIC, OR MALIGNANT CHOLERA. Causes.—The general or remote causes of this, as of all other epidemics, is some atmospheric influence, the nature of which is veiled in darkness. The exciting causes are imprudence in diet, as eating unripe fruit, imperfectly cooked vegetables, tainted provisions, of any kind, gross animal food, shell-fish, or immoderate quantities of even the most innocent food. Intemperance in drink is a frequent cause, and one which materially lessens the chance of recovery. Exposure to the night air, unusual fatigue of body or mind, the de- pressing influence of fear, any material deviation from accustomed modes of living, in fact, every thing that tends to depress the powers of life below the standard of health will, during the prevalence of the disease, act as an exciting cause. Tampering with medicines, par- ticularly emetics and cathartics, to ward off the disease, has, in num- berless cases, been the cause of an attack. Contagion has been alleged as a cause, but without the shadow of a solid foundation ; on the contrary, the strongest reasons can be given to prove, that the disease is not, under any circumstances, taken, by one person, from another. The attempt, therefore, to keep off the disease, by cutting off communication with an infected district, or by refusing aid to the unfortunate sufferers, is not only a shocking breach of moral law, but of common sense. No—the cause of the disease is in the air we breathe, and every act of inspi- ration, and every act of swallowing increases the quantity of the poi- son in our system. Our safety, therefore, depends on prudence, a- lone, which requires strict attention to the means of prevention and avoidance of the exciting causes. These views I conscientiously ad- vance, with a firm conviction of their truth : and with feelings alive to the responsibility. The Symptoms vary very much in different cases, the variation be- ing occasioned by the exciting causes and by the peculiar condition of the patient's system at the time of attack. In a vast majority of cases, however, the disease presents a uniformity of symptoms rarely to be met with in an epidemic. This disease is evidently a modified form of the common cholera morbus, of our country, being highly aggravated and rendered far more malignant by the malignant cholera. 237 atmospheric influence mentioned above, which is the cause of its becoming epidemic. In this, cholera agrees with dysentery, scarlet fever, and every other disease, that ever becomes epidemic ; for it is a fact well known, that, those diseases are far more malignant when they prevail epidemically than when occasional cases only occur. In a majority of cases the individual is warned of approaching danger, by what are called the " premonitory symptoms." These are furred tongue, frequent pains in the stomach and head, and watery discharges from the bowels. During the prevalence of the epidemic, few persons in the infected district escape without ex- periencing some of these symptoms, particularly the pains in the stomach, which appear to be excited by food which had never, be- fore, disagreed with the individual. The duration of this stage of the disease is uncertain ; in many instances it will continue for days, and if the patient be prudent, it will in some cases go off even with- out medicine, the system, probably, gradually becoming accus- tomed to the atmospheric poison which is the cause of the disease. In other cases the disease advances, the discharges from the bowels become increased in frequency and in quantity, and the disease hur- ries with greater or less rapidity into the second stage, or what may be termed confirmed cholera, when some additional symptoms present themselves. In addition to the copious and frequent discharges of a fluid resembling rice-water, in which are floating numerous white flakes, the patient now complains of oppression and sickness at the stomach, with heart-burn ; vomiting now takes place, at first of the common contents of the stomach, which are soon followed by the same kind of fluid which passes from the bowels ; cramps now come on, affecting at first the feet and hands, but rapidly extending, they, by turns, affect all the muscles of the body, and in some cases every joint, at the same instant, is rendered immoveable. The stomach, in some cases, is also violently cramped. The muscles of the face are sometimes affected, producing great distortion of the countenance,. which contributes not a little, to heighten a scene of horror, which it is as impossible to describe as to forget. The skin is now bathed in a cold sweat, which produces a wrinkled appearance of the fingers resembling those of a person whose hands have been long immersed in water; it is also, as cold or more so, than that of a corpse, par- ticularly over the limbs. Respiration is laborious, and the air ex- pired is cold or nearly so. The tongue is cold and moist; notwith- standing which, the patient complains of an unquenchable thirst,. and excessive burning in the stomach, which neither water nor ice can relieve. The countenance is indicative of the greatest distress and anxiety;—the mind is unimpaired;—the blood, if now examin- ed, is thick and black, and resembles tar more than any thing else to which it could be compared ;—the pulse, which at first was slow, contracted and somewhat tense, now becomes more hurried, small- er and weaker. If the disease be not now arrested, the patient soon sinks into the third stage, called " collapse." In this stage the disease continues 288 epidemic, Or to advance with the same train of symptoms, each moment mak- ing it more evident that the work of death is fast drawing to a close. The blood continues to recede from the surface, the eyes sink in their sockets and are surrounded by a blue or leaden hue— the skin over other parts of the body assumes the same color, par- ticularly about the hands and feet—the lips lose their color, even the inner surface of the lips and cheeks and also the tongue are forsaken by the blood, and become pale and cold. The pulse con- tinues to sink until it is no longer perceptible; even the heart it- self can scarcely make us sensible of its motion. The patient now appears indifferent about his situation—he seems to think or care, neither for himself nor for others, though his mind may retain its faculties to the last. The skin is now universally cold, and still bathed in perspiration, yet even under these circumstances its sen- sibility is sometimes so great, that the patient cannot bear the warm applications made use of to support him, nor can he even bear, patiently, the warmth of a single blanket. In other cases, the skin appears devoid of sensibility, the most stimulating articles produc- ing no effect. In some cases, the vomiting and purging continue to the last, and the cramps have been known to continue for many minutes, and even hours, after every other appearance of life had ceased. In other cases, the primary and most important symptoms, as, vomiting, purging, and the cramps, now take their leave after having forced their victim beyond the reach of nature and of art. If the disease be not arrested, the patient either sinks quietly into the arms of death without a struggle or a pang; or, as is often the case, he leaves the world in a paroxysm of agony, his limbs being distorted into every possible shape by the violence of the cramps. If, however, nature and art should triumph over this terrible minister of death, the first change we should look for, is the appear- ance of bile in the passages from the bowels. When we see this sign we may safely pronounce the patient out of danger ; for I ne- ver saw or heard of a death from this disease after the return of the secretion of bile. I hail the appearance of bile as a harbinger of returning health ; for, as if by magic, the symptoms of the disease disappear; urine, the secretion of which, like that of the bile, had been entirely suppressed, now begins to flow ; the discharge from the skin ceases, the blood returns to the lately deserted surface, and with it, vital heat, and the patient, after copious discharges of bile for two or three days, rapidly returns to health. These are symp- toms of a healthful reaction. There are some cases of reaction which would deceive the inex- perienced, and excite hopes of recovery which would never be re- alized. In these cases, the patient, after remaining from a few hours to two or three days, will exhibit signs of amendment; he maybe free from cramps, from vomiting, and from purging; his pulse may rise, his skin become dry and warm, yet the secretions are not restored. These cases terminate fatally in a few hours af- ter the apparent improvement,^nature, in her last effort, produc- malignant cholera. 289 ing an excitement which may well be compared to the glare of an expiring taper. No reaction can be depended on which is not bas- ed on a restoration of the secretions. The above are the symptoms of cholera as it generally appears. The varieties I will cursorily notice. In some cases the patient has no premonitory symptoms, but is taken suddenly, after eating some improper food, with a sense of weight and sickness at the stomach. Vomiting speedily supervenes, and is succeeded at first by discharges of the ordinary contents of the bowels, which are soon followed by the peculiar discharge ; the other symptoms ra- pidly chime in, and the disease proceeds as above described. Some cases are not attended with cramps, the vomiting and purging be- ing the principal symptoms. Other cases, again, are not attended with vomiting and purging, the cramps being the most striking symptoms. The cramps in these cases are more violent than in the cases which are attended with copious vomiting and purging. Treatment.—The first stage, commonly called " The premoni- tory symptoms," is, in a vast majority of cases, easily managed, and often goes off without any treatment. No one should, however, presume on this, for a slight cause may hurry on the disease, and before the remedies could produce their effects, he may be in eter- nity. Prudence, therefore, dictates that, immediately upon the ap- pearance of the diarrhoea, something should be done to remove it. To effect this, a variety of articles are extolled as specifics ; such as the spirits of camphor, essence or oil of peppermint, laudanum, and other articles possessing similar properties. That these articles sometimes succeed we have no doubt; that they often fail, almost every case of cholera proves; for it is rarely we meet with a con- firmed case of this disease, in which they had not previously re- ceived a fair trial. We should bear in mind that the discharge from the bowels is not the disease itself, but an effect of the disease, which is some considerable disturbance of the system. If, there- fore, we should check the effect without removing the disease, we should, in many cases, act as unwisely as the man who would lock up a thief in his house and leave him to do what mischief he pleas- ed. We should attack the disease itself, with our most powerful means.—Of these, we will always find calomel to be the most cer- tain ; and should, therefore, give it immediately, either in a full dose of twenty grains at once, or in Ave grain doses every hour, until twenty grains have been taken; and, in either case, follow it up with a full dose of rhubarb, or castor oil, to either of which three or four drops of the oil of cinnamon may be added. These medicines must be repeated until the discharges become natural. In some cases where there is much uneasiness in the stomach and head, and the pulse is slow and full, blood-letting is advisable, and may be necessary. These means will almost invariably remove the premonitory symptoms, or what we will call the first or forming stage of chol- era, and the patient returns to health. 37 290 EPIDEMIC, OR In the second stage, or confirmed cholera, we have many indica- tions to fulfil, the leading one of which is to restore the secretions, and particularly that of the bile. This, possibly, we could not ac- complish without fulfilling another important indication, which, is to relieve the congestion of the internal organs, by bringing the blood to the surface. While directing all our energies to the ac- complishment of these objects, we should not neglect two other important indications, which are, to check the discharges and re- lieve the spasms or cramps. The first step in the treatment of this stage is to relieve the sto- mach of any indigestible food, which it may contain. For this pur- pose various emetics have been extolled as possessing superior claims to confidence ; as the white vitriol, ipecacuanha, tartar eme- tic, an infusion of mustard and salt in water. Of these, ipecacu- anha is to be preferred, and should be given in a dose of twenty-five or thirty grains. If this cannot be obtained, the white vitriol may be taken to the same extent. The mustard or tartar emetic I could not recommend. If the stomach have been evacuated by sponta- neous vomiting, an emetic should not be given, for, to say the least, ' it would be a waste of time. The stomach being prepared, from twenty to thirty grains of calomel, to which may be added one or two drops of the oil of cinnamon, must be immediately given, and repeated every hour or oftener, if the symptoms be urgent, until bile appear in the discharges. The calomel had better be taken in sirup, that it may act without delay. ' As a means for relieving congestion and overcoming the cramps, j blood-letting stands pre-eminent. It should be had recourse to, I without delay, notwithstanding, the great apparent debility. The blood is now black, and in some instances so thick that it will not flow unless forced from the orifice by rubbing the vein : if, howev- er, this be persevered in for a few minutes, it becomes thin, and soon runs in a free stream. The quantity of blood to be taken de- pends on the constitution, &c, of the patient. From a robust man from one to two pints may be taken with advantage. In more delicate patients the quantity must be less. The local detraction of blood, by cupping or leeching, has been recommended, but as it is less efficacious than general bleeding, it need not be resorted to, when the latter is practicable;—besides, the unavoidable delay is an insuperable objection, for in this disease, the loss of a few mo- ments may be the loss of the patient. I cannot leave the conside- ration of this remedy, blood-letting, without insisting on its employ- ment, and repeating that it is one of the most powerful means we possess, for overcoming the spasms, removing congestion, and thereby contributing to arrest the morbid discharges and to pro- mote the healthy secretions—thus powerfully aiding in the ful- * filment of the four important indications mentioned above. In ad- dition to the powerful remedies just recommended, there are many others which we may have recourse to, not only with the view of • aiding the former, but also to fulfil some other indication. Thus, to aid in bringing back the blood to the surface and to relieve the malignant cholera. 291 cramps, we must make use of external stimulants, of these dry, heat is the first that suggests itself. This may be applied, by means of jugs or bottles of hot water, to the extremities, and par- ticularly to the muscles affected with cramps.—Frictions, either with a stiff brush or with a warm coarse cloth, are valuable. They should be perseveringly used, and directed principally along the course of the contracted muscles. To increase the efficacy of the frictions, the brush or cloth may be dipped in some stimulating sub- stance, such as spirits of turpentine, infusion of red pepper in whis- key, a strong ointment made of hog's lard and red pepper,' or the powder of red pepper may be used in its dry state, and an oint- ment made of hog's lard and powdered camphor ; but, what is pro- bably better than all, is a strong mercurial ointment, made irritating by the addition of powder of red pepper or camphor. The excessive thirst and burning at the stomach render some kind of drink absolutely necessary. The best drink is water, as cold as it can be obtained. It should, however, be taken in mode- ration. One or two table-spoons full every five or ten minutes will be sufficient, or a small piece of ice may be allowed to dissolve in the mouth. I have now, in as concise a manner as possible, given the prac- tice, which I have found successful in a large majority of cases, and which will suit the various forms of the disease in this stage. There is, however, one form of the disease in which a modification of the treatment may be necessary. This is the form, noticed un- der the head of symptoms, in which there is little or no discharge from the bowels or stomach, but universal spasms of the whole muscular system, affecting also the stomach, and in some cases even the muscles of the tongue. In this form of the disease, if we suspect the stomach contains any kind of food, we should immedi- ately exhibit twenty-five or thirty grains of ipecacuanha, in a tea- cup full of warm water ; and, without waiting for its effects, tie up the arm and bleed until a decided effect is produced on the pulse. At the same time, frictions over the seat of the cramps, with some of the irritating articles, advised above, should be diligently em- ployed. Should these means fail to arrest the cramps, we should, after the operation of the emetic, give laudanum in a dose of from one to two or three tea-spoons full, according to the urgency of the spasms; and if necessary, give a tea-spoonful every half hour, con- tinuing the frictions, until relief is obtained. If nothing occur to prevent it, the patient may be suffered to rest for some hours, after which he should take from twenty to forty grains of calomel, which should be followed by the same quantity of rhubarb, or by two or three drops of Croton oil. Before leaving the consideration of this, the second stage of cho- lera, it will be proper to notice some of the articles which have been extolled in the treatment of the disease. Opium either in substance, or in the form of laudanum, has been extensively em- ployed, and in every variety of dose, from the smallest to the most 202 EPIDEMIC, OR enormous. My opinion of this article is, that it is inadmissible in every form of this disease, with the exception of that variety of it, which has just been treated of. If taken in sufficient quantity to produce any effect, it retards the operation of the calomel, and there- by lessens the chance of the patient's recovery, for on the speedy operation of the calomel his safety depends. Another article, which has been highly spoken of, is the mustard emetic. Against this ar- ticle,^ an internal remedy, I protest: it has, however, been as ex- tensively used as the opium, and I will say, with as little regard to consistency, for many physicians, who condemn the internal use of stimulants in this stage, make it a general rule to administer this ar- ticle in every case, knowing at the same time that it is so highly ir- ritating, that it cannot be endured more than a few minutes on the most insensible parts of the skin. The indiscriminate use of emet- ics, of any kind, is improper. Where vomiting has not taken place, it will generally be advisable to give an emetic of the mildest kind, as ipecacuanha; but where spontaneous vomiting has come on, an emetic will be of no use, but will cause the loss of precious time. Camphor is another article, which attracted much of the public at- tention. As it is a stimulant, its use cannot be justified in this stage. The limits and object of this work will not admit of a detail of rea- sons for the support of opinions : I shall therefore pass on to the treatment of the third or collapsed state of cholera. If the disease be not arrested by the means which have been detailed, it gradually passes into the collapse, and we have a different state of symptoms, which have been described under the proper head. We must still continue the calomel, and aid it in its alterative effects by the steady use of the irritating mercurial ointment formerly advised. If nothing has been done for the patient until now, blood should be drawn, if possible, either in the common way or by cupping. Blood-letting, in this disease, is not employed to reduce the system, but to relieve congestion, and thereby prove an indirect stimulant. We are now obliged to make use of direct stimulants. The external stimu- lants, as heat, frictions, and irritating applications, must be continued. Large mustard plasters should be applied, and moved from place to place as the patient complains of their producing pain. Plasters of blistering ointment should be applied, and if they draw, the sore, should be dressed with mercurial ointment. Internal stimulants must now be given. As spirituous liquors could not be borne, we must have recourse to the vegetable spices, as cloves, ginger, Cay- enne pepper, or oil of cinnamon. A table-spoonful of a strong in- fusion of cloves or ginger, or two or three drops of the oil of cin- namon, may be given every half hour. The following preparation is highly recommended : Take of Cayenne pepper three table spoons full, of fine salt two tea-spoons full, beat them well together, and then pour, on the mixture, half a pint of boiling water ; when cold, strain off the infusion and add an equal quantity of strong vinegar. The dose is a table-spoonful every half hour. Having by these means succeeded in arresting the disease, which MALIGNANT CHOLERA. 293 we are assured of by the reappearance of the secretions, and other changes mentioned under the head of symptoms, we must take care that the reaction does not exceed the bounds of health. In most cases nothing is necessary but a light and nourishing diet, warm clothing, an occasional use of small doses of rhubarb, either alone, or combined with magnesia, and mild tonics, as infusions of Columbo or camomile. In some cases, however, reaction may be followed by fever. In this case, if the pulse be full or strong, we must bleed and resort again to cathartics. If, on the contrary, the pulse be small and weak, and the symptoms resemble those of typhus fever, the remedies directed for that fever must be used. In some cases reaction is followed by determination of blood to the brain, or some other important organ. These cases must be treat- ed by local bleeding, by cups or leeches, over the affected organ, by the use of calomel, unless the system be already affected by it, and other cathartics; and by frictions, with irritating applications to the extremities. If it be the brain that is affected, cold applied to the head will be serviceable. The diet should be light. Prevention.—An old adage says, " An ounce of prevention is worth a pound of cure." In this disease it is worth tons. On the appearance of the epidemic in a neighborhood, the strictest atten- tion should be paid to cleanliness, not only of person, but of houses and lots. Every source of noxious exhalations should be cleansed and sprinkled with lime. The cabins of negroes, partcularly, should be examined frequently, and cleansed and whitewashed. The negroes should be examined daily, and should any of them be affected with the premonitory symptoms, they should be prompt- ly treated. They should be cautioned against the indulgence of their appetites, and informed of the articles they should avoid. The diet should be light and nourishing. Garden vegetables (Irish potatoes excepted,) should be avoided or sparingly used, and, if used, should be well seasoned. Rice is one of the safest arti- cles of diet. Old habits should not now be altered. A man accustomed to strong drink should continue its use ; but the sooner he leaves it off, after the epidemic disappears, the better will it be for his health both of body and mind. The clothing should be warm ; the feet, especially, should be warmly clad. Heavy suppers should be par- ticularly avoided, as the disease generally makes its attack about midnight, or early in the morning. By attending to these direc- tions, and avoiding the causes, the disease will certainly be pre- vented. The following articles should be kept in readiness ; namely: A lancet, calomel, mercurial ointment, rhubarb, castor oil, Croton oil, magnesia, ipecacuanha, laudanum, oil of cinnamon, cloves, cam- phor, mustard, and Cayenne pepper. 294 DIARRHffiA, OR LOOSENESS. DIARRH(EA, OR LOOSENESS. Symptoms.—A purging without sickness or pain, succeeded by loss of appetite. Causes.—Acid or putrid aliments; obstructed perspiration ; acrid bile ; drinking bad water; worms ; violent passions ; or a translation of morbid matter of other diseases to the bowels. Treatment.—If offending matter be lodged in the stomach, give an emetic, and an opiate at bed-time ; and on the succeeding day, if the disease be not removed, a dose of rhubarb or castor oil, follow- ed by forty or fifty drops of laudanum at night. In every case where the diarrhoea continues obstinate, an emetic should be premised. It relieves the stomach from acrimony, checks the increased peristaltic motion downward, and determines to the skin. After the emetic, it is necessary to procure some respite, and with this view opiates may be employed with perfect safety. By lessening or stopping the peristaltic motion, we relax any spasmodic stricture which may prevent the discharge of offending matter, and the gentle laxatives afterwards required, will have a more salutary effect. By thus alternating the opiates and laxatives, we at last succeed in relieving the bowels from the irritation of offending mat- ter, and moderately warm astringents will complete the cure. Opi- ates may sometimes be given in clysters, and in this way they affect the head in a less degree than when swallowed. If the disease be in consequence of cold, or the skin be dry, the antimonial mixture, or Dover's powder, exhibited in small doses during the day, and the anodine sud6rific bolus or draught, (see Dispensatory,) repeated at bed-time, with a flannel shirt, will gene- rally effect a cure. When bile is indicated to be the cause, the Columbo in'decoction or powder, will be found admirable ; and if accompanied with sour and debilitated stomach, the tonic powders or pills, (see Dispensa- tory,) with exercise, are the best remedies. Where bad water is in fault, it should instantly be changed or corrected by wine, brandy, or porter; remembering, that in all cases of continued evacuation, laudanum may be given at night after the stomach and bowels have been cleared. When worms induce this disease, which may be known from the sliminess of the stools, and bad breath, such medicines as are calcu- lated to destroy them must be employed, afterwards a wine-glass full of lime-water with an equal quantity of new milk, will be proper three times a-day. In obstinate cases no medicine is superior to the continued use of the vitriolic solution, (see Dispensatory,) with an opiate at bed- time. The nausea which this medicine produces is very disgust- ing; but from this circumstance much of its efficacy is derived. DIARRHffiA, OR LOOSENESS. 295 Should a common dose fail to nauseate, it should be increased un- til that symptom is effected. The jelly of slippery elm, and the blackberry, (see Materia Me- dica,) conjoined with a small portion of cinnamon, ginger, cala- mus, or some aromatic, are also valuable remedies. According to domestic practice, the efficacy of burnt cork is highly extolled in this troublesome complaint. A friend of mine, of Baltimore, informed me that he administered this medicine to three gentlemen who had their bowels very much disordered by a change of water, and that it afforded them immediate relief. He also stated of having given it to a child afflicted with the dysente- ry, in its chronic form, with the most happy effects. He directs a bottle cork to be burnt to a coal; and after reducing it to a fine powder, it is to be moistened with spirits, and then mixed with a little milk and a lump of sugar. Half of this mixture is to be giv- en to an adult, and about one-third to a child of two or three years of age, repeating the dose, if necessary, in an hour. From the astringent properties of this medicine it is proper to remark, it should never be employed in affections of the bowels, attended with fever. Regimen.—The diet should consist of arrow-root, sago, rice, milk, and the white meats. The drinks may be of the diluting kind, as already enumerated : genuine wine may also be allowed, if it do not turn sour on the stomach. Moderate exercise is peculiarly useful, and nothing facilitates the cure more than flannel next to the skin.* * This was the " Angel in disguise." That opened the prison doors of this uneasy life, and gave happy freedom to my ever-revered father, Colonel Jesse Ewell, of Virginia. My sister Charlotte celebrated his virtues in an Elegy, the following extracts from which I beg permission of the reader to insert, as a small tribute of gratitude to the best of#parents, and but a faint por- traiture of his worth. " Early he woo'd fair virtue for his guide, And rarely wandered from her guardian side ; By him the needy never were denied, He sooth'd their sorrows, and their wants supplied. He mourn'd the contests of the neighboring poor, And opened wide his peace-restoring door; Where soon his wisdom taught their strifes to cease, Revived their loves, and sent them home in peace, The slaves whom Heaven to his care consigned, Ne'er felt the terrors of a slavish mind; Well fed, warm-clad, to moderate labors prest, They loved their fetters, and their bondage blest. As friend—as father—who his praise can tell 7 Where first begin, or with due raptures swell ? To check our wrong, his frowns were ever light, And sweet his smiles whene'er we chose the right, And when at length the awful hour drew nigh, To waft his spirit to its native sky, Such in that moment, as in all the past, " O bless my children, Heaven !" was still his last. Now 'scaped from earth, with God he dwells above, And shares with angels in their feasts of love. DROPST. Then come, blest rAiTH,come hasten to my aid, Lest grief profane disturb his happy shade j Teach me to bow submissive—and adore The unerring counsels of eternal power. Which gives in love or still in love denies, And makes e'en " crosses blessings in disguise." And thou, fond memokv, still my sire recall, Record his virtues, imitate them all— That joys like his my mortal life may prove, And peace eternal crown my state above." DROPSY, A collection of water in some part of the body. Symptoms.—In common dropsies the legs usually swell, and a pit remains for some time after pressing the flesh; the appetite ' abates; the face is bloated ; urine little; thirst great, with slow fe- ver, shortness of breath, and lassitude. Causes.—Excessive drinking; poor diet; protracted intermit- tents ; scirrhous tumors of the abdominal viscera, but particularly ') ] of the liver, and in fine, whatever may occasion too free a secretion of the serous fluids in the cellular membrane, or any cavity of the body, and at the same time diminish the action of the absorbent \ vessels. Treatment.—Like other diseases, the treatment must vary ac- cording to circumstances. In every form of dropsy, if there be a hard, full, and quick pulse, blood-letting constitutes one of the prin- ' cipal remedies, and must be repeated once or twice a-week, until j the action of the arterial system is considerably diminished. . / Brisk purges, as calomel and jalap, cream of tartar and jalap, or / the Croton oil, (see Dispensatory,) in full doses, are indispensable, V and ought always to succeed bleeding, and be given as often as the \ patient's strength will admit, followed by Dover's powder, or the ano- } dyne sudorific bolus or draught, at bed-time. (See Dispensatory.) j The discharge from the intestines is unquestionably of the great- est importance in dropsy ; and when obstructed perspiration is the cause, sudorifics are much to be depended upon. However, this distinction must be made: If purgatives be accompanied by violent colics, and weakness be the consequence, Without producing a con- siderable discharge, the remedy must be discontinued ; but if they operate without pain and inconvenience, the stools watery, and weakness do not follow, whatever the number of evacuations may be, the remedy is good. And if, on the employment of sudorifics, they tend to weaken the system, in general, too much, they should not be persisted in. Another remark to be attended to is, that in every species of dropsy attempted to be cured by internal means, however they may be relieved by different evacuations, unless the urinary organs continue their evacuating power, the cure will ne ver be lasting. DROPSY. 297 While feverish symptoms continue, nitre is extremely useful in this disease, in doses of ten grains four or five times a-day, or in such quantities as the stomach may bear; but should not be con- tinued longer than two weeks, if no good effects result from its use. Another valuable medicine for lessening the action of the pulse, and thereby increasing absorption, is the foxglove, (see Materia Medica,) which may be given in powder, decoction, or tincture. The latter is the most convenient form, and in doses of twenty or thirty drops in a wine glass of mint-water, may be taken twice or thrice a-day, until the water be removed, or the inflammatory dis- position taken off. If this quantity do not induce sickness, or pro- duce, any evidently good effect, the dose must be gradually increas- ed to forty or sixty drops, or more. Cream of tartar, from half an ounce to an ounce, dissolved in a pint or more of water, is a pleasant and useful drink ; and this ta- ken early in the morning has frequently succeeded in evacuating the water. As soon as the action of the pulse becomes lessened, it is neces- sary to strengthen the system and increase the digestive powers, by the nitric acid or the exhibition of steel alone, or the tonic pow- , ders, pills, or drops, (see Dispensatory,) thrice a-day during the intervals of purging. One of the most frequent causes of dropsy is obstructed liver; and when this is suspected, mercurial friction must be resorted to, or a grain or two of calomel, conjoined with a few grains of pow- dered squills, given night and morning, until ptyalism be produced, and afterwards the nitric acid, and other tonics, constitute the pro- per remedy. The squill in every form, is a valuable medicine, and succeeds in the greater number of dropsical cases. United with cream of tartar and a small portion of jalap, it is highly useful as combining a diuretic and purgative effect; and with the resin of jalap and gamboge, in pills, its utility is almost unrivalled. The effi- cacy of this medicine is also highly extolled in dropsies, in doses from five to ten grains, with double the quantity of nitre. It should be observed, however, the squill seldom increases the discharge of urine to any degree, till raised to a nauseating dose. 4 The juice of leeks, in doses of a table-spoonful twice a-day, is said to have performed surprising cures ; at any rate, in this state of the disease the patient can hardly make too free a use of the acrid stimulating vegetables, as garlic, onions, horse-radish, &c. Tight bandages applied in the morning round the belly and limbs, have their good effects in preventing the increase or return of drop- sical swelling. Friction, with a flesh brush or flannel, every morn- ing, from the extremities upwards, is of the greatest service, parti- cularly if the skin be previously moistened with a liniment, com- posed of equal parts of soap, spirit, and vinegar; or with the vola- tile or camphorated liniment. Persons recovering from lingering diseases are very subject to 38 298 DROPSY. anasarcous swellings, particularly if they replenish their weak ves- sels too fast by full diet. Scarifications with a knife are much commended when the legs and thighs are turbid with extravasated serum ; and, indeed, the water is speedily discharged this way ; but the lips of the wound will close in two days, so as to admit of no discharge ; and from a defect of heat in the constitution, the part is apt to mortify. Dr. Fothergill, to obviate these difficulties, advises this operation to be performed with the common scarificator used in cupping, and the instrument to be placed so as to make the wounds transversely. If the skin be thick, the lancet may be so set as to make deeper, and, consequently, wider incisions ; thus, a large quantity of water will often drain from the legs or thighs, without risk of inflamma- tion, or deterring the patient from a repetition, if necessary. The punctures must be made in the most depending part of the leg; and their number and repetition depend on the circumstances of each individual case. The application of glasses, either before or after scarifying, is unnecessary; but the instrument must be gently pressed upon the skin, until a surface is formed sufficiently flat to admit the lancets in the scarificator to act equally. In all ca- ses where the skin is so stretched as to threaten inflammation, rup- ture, or a gangrene, and when the breath is greatly impeded, these openings should be made without delay. Blisters are often em- ployed in the same circumstances instead of scarifications, and are equally useful. An oblong blister may be applied just above the inner ankle, and continued until a thick, white, or purulent dis- charge is produced. After this period but little water appears, and the sore should be healed. If necessary to be longer continued, blisters may be employed on the outside ; and when these have acted sufficiently, we may return to the former surface, which will be now healed. Should a dark or black spot appear, bathe the leg in a strong decoction of oak, and sprinkle the spot with some of the bark, or myrrh powdered, or apply poultices of charcoal and bark, which will soon separate it, and arrest the mortification. When the difficulty of breathing is considerable, relief will very generally be obtained by expectoration ; and for this purpose, pret- ty large doses of gum ammoniac with the squill, or seneca infusion may be repeated as the occasion requires. The infusion of garlic is often useful, and asafcetida, in the form of pills or tincture, re- lieves the difficulty of breathing when it is connected, as is often the case, with wind in the stomach occasioning hysteric affections. Spasms often arise in particular parts, especially about the chest, frequently awaking the patient out of a sound refreshing sleep. In such cases, a grain of opium, with five of camphor, is the most ef- fectual remedy. When the duplication of the peritoneum is the seat of dropsy, tapping is alone the remedy. Regimen.—During the inflammatory disposition, or when there GOUT. 299 is a preternatural heat on the skin, or much action in the pulse, the diet should be light, and easy of digestion. In the other state, when the patient is weak and feeble, it should be of the most nour- ishing kind, with a liberal use of wine. The patient may, in general, drink in proportion to his inclination. Acid liquors, as lemonade, cider, the imperial drink, or wine, or gin and water may be allowed; and thirst is often prevented by holding nitre in the mouth. Exercise is of the greatest importance when not carried to fa- tigue. In the lowest stage of the disease, swinging or riding in a carriage are most proper; but as soon as the patient's strength will admit of it, riding on horseback will be found most beneficial. GOUT Is often hereditary, but, generally, indolence and luxury, the hat- ed parents of this disease, which righteous Heaven has marked with such severity, that, like the leprosy of Naaman, it is hardly ever curable.* But though art has not often succeeded to cure the gout, yet it has discovered a variety of means to shorten the fits, and to render them much more tolerable. Symptoms.—The gout mostly affects the joints, but the viscera are not exempt from its ravages. It sometimes comes on sudden- ly, passing from one part of the body to the other, in the twinkling of an eye; but generally is preceded by indigestion, flatulency, loss of appetite, unusual coldness of the feet and legs, with fre- quent numbness, sense of pricking, and cramp. These symptoms take place several days before the paroxysm comes on, but com- monly the day preceding it, the appetite becomes greater than us- ual. The next morning, the patient is roused from his sleep, by an excruciating pain in the great toe, or ball of the foot, resembling the gnawing of a little dog. Treatment.—No matter what part of the body this disease first seizes, the lancet will be required in every case where there is an increased action of the pulse, to take off the inflammatory disposi- tion. The extent to which the blood-letting must be carried, can only be ascertained by the violence of the disease, and the sex and constitution of the patient. In this, as in all inflammatory fevers, * An English nobleman, after twenty years'riotous living, awoke one morning in the tor- ments of the gout. As he lay writhing with pain, his servant ran up stairs to him with great joy in his countenance:" O ! sir, good news ! good news! there is a famous gout doctor below, who says he wHl venture his ears, he can cure your honor in less than a week." " Ah, that is good news indeed, Tom. Well, run, my good boy, and put up his carriage and horses, and treat the doctor like a prince." " O sir, the gentleman has no carriage and hor*es; I believe he walked a foot!" " Walk a foot! what! cure the gout and walk a foot! go down,, Tom, go down, and instantly drive the rascal out of the house ; set the dogs upon him, do you hear'? the lying varlet! why, if he could cure the gout, he might ride in a richer carriage than his majesty." 300 GOUT. the bowels ought to be kept open freely by laxative medicines, as castor oil, sulphur, cream of tartar, rhubarb, senna, jalap, or calo- mel. Indeed, a fit of the gout may be oftentimes entirely, and is almost instantaneously, removed by active purging. Even drastic purges need not be dreaded in this disease. Nitre, with diluting liquors given in such quantities as to excite a gentle perspiration, are of great utility in the inflammatory stage of the disease. After the action of the pulse is somewhat reduced- by evacuations, blisters over the pained parts are greatly to be re- lied on. As soon as the inflammatory state of the gout has subsided, sti- mulants and tonic medicines, as bark and steel, are the best reme- dies, Laudanum, ether, good French brandy, and aromatics, as ca- lamus, ginger, Virginia snake-root, and red pepper, (see Materia Medica,) in the form of teas, are all exceedingly useful in this feeble state of the disease, especially when it affects the stomach or bow- els. Besides these internal remedies, friction on the stomach and bowels, or the application of cloths wrung out of hot spirits or wa- ter, over the pained parts, and sinapisms to the feet, should be em- ployed whenever the gout attacks the head, lungs, bowels, or sto- mach. Gentlemen long in the habits of intimacy with this disease, should remember that it is of immense rudeness, and ready on the slight- est provocation to quit the toes and knuckles, and seize on the very stomach and bowels of its best friends. They should, therefore, be constantly on their guard, and keep always by them a vial of eth- er or laudanum, or a case of good old French brandy ;* the latter of which is admirable for chasing the gout from the stomach. The white hellebore (see Materia Medica,) is highly extolled as a remedy in this distressing disease. Regimen.—The diet should be regulated according to the state of the patient. If feverish, and of a plethoric habit, the lightest diet ought to be used. If debilitated and of a relaxed habit, gen- erous diet should be allowed. Exercise, although painful at first, must be freely taken. Prevention.—If the person be plethoric, and has been accustom- ed to drink freely of wine, and eat heartily, he should gradually diminish the quantity of the aliment; particularly every spring and fall, as the disease is more liable to recur at those seasons than at any other time. But in debilitating habits predisposed to the gout, a stimulating diet is most proper assisted with the use of the * For lack of this ammunition, the gallant Wavne was cut off long before " his eye was dim, or his natural force abated." Late in December, 1796, he embarked at Detroit for Presque Isle, but not without his usual supply of brandv, which, however, was all lost, through his servant's carelessness in upsetting his case. On th'c passage he caught cold, which brought on a violent attack of the gout in the stomach ; and, for want of his usual remedy, he suffered the most ex- cruciating torture until he reached Presque Isle, where he died early in January, 1797. His bo- dy was deposited in the centre of the fort, to show the children of future days the grave of him who so bravely defended their liberties. Filial piety has since removed it to his nativo state, where it now sleeps with the dust of his fathers. I am happy to acknowledge, that for this anecdote, I am indebted to the politeness of my wor- thy friend, Captain Hugh M'Call, of Savannah. venereal disease. 301 rust of steel, bitters, or bark in every case, costiveness should be avoid- ed ; and flannel worn next to the skin is peculiarly proper. Nothing', however, prevents this disease, more than temperance and exercise. * The story of the wealthy Mr. Palmer, in the reign of George I., though well known to ma- ny, is yet so apropos to our subject, that I cannot deny myself a wish to relate it. Youne Mr. Palmer received from hisfather, what the London merchants call a plum (that is a round 100,- 0O0Z.) of which he contrived to make such "good use," that by the time he was forty years of age, he was torn to pieces by the gout. His physicians advised him to try the virtues of a sea voy- age with the soft, balmy air of Montpelier. He set out, but on his passage up the Mediterranean, was captured by an Algedne corsair, who took him to Morocco, and sold him for a slave. Ho was bought bv a farmer, who carried him into-the country, and set him to hard labor, allowing him nothing belter than brown bread and dates, and even of that hardly enough to support him. His only drink was water, and his only bed a plank. In a few weeks every gouty symptom dis- appeared, and he recovered his health, with an uncommon portion of activity. These first of blessings continued with him all the time he was in captivity, (two years ;) at the expiration of which he was ransomed by his friends. On his return to England, he was hardly k.iown by his acquaintances, so great was the change which temperance and exercise had VENEREAL DISEASE. The venereal disease is of two species ; the one a local affection of the genital organs, termed Gonorrhoea, or Clap ; and the other a general or constitutional complaint, termed Syphilis, or Pox. THE GONORRHOEA, Of which we shall first treat, is an inflammation of the mucous membrane, lining the urethra in men, and the vagina in women ; seated in the male about the fraenum of the penis, and in the female a small distance up the vagina ; but in its progress communicating to all the surrounding parts, and producing a variety of painful sensa- tions. » , Symptoms.—A discharge of mucus, at first white, but soon turn- ing of a yellow or greenish appearance, an acute or scalding pain in making water, with most indecent erections of the penis, term- ed, chordee, very painful, and sometimes followed by a discharge of'blood. At times the inflammation spreads to the contiguous parts, occasioning strangury, swelled testicles, swelling in the groin similar to buboes, or a contraction and thickening of the fore-skin, which, when drawn over the head or nut of the yard, is termed phy- mosis, and paraphymosis when retracted behind it. When these symptoms dance their attendance to the catastrophe, the clap may be said to flourish in its full bloom, and the patient finds himself fairly seated on the stool of repentance. The appearance of clap in the female is pretty much the same as in the male, allowing for the difference of the parts. The dis- ease in them, is always milder; insomuch, that at times, there is no other symptom but the discharge, which is often mistaken for the 302 VENEREAL DISEASE. fluor albus. They are, however, more subject to excoriations of the parts than the men, and, indeed, when the inflammation is con- siderable, it often extends to the urethra, and occasions great pain. Treatment.—In the general treatment of gonorrhoea, rest, to- gether with abstinence from strong food, and every thing of a heat- ing nature, is of the greatest consequence; and this alone, with little assistance from medicine, will complete the cure in a short period. As the disease is local, topical applications in the form of injec- tions become necessary. The patient should, therefore, without de- lay, employ one of the injections, (see Dispensatory,) which, in irritable habits, must be a little weakened, and the strength gradu- ally increased as the inflammation abates. Indeed, when the inflam- mation is very considerable, it is better, at first, to inject with sweet oil or mucilage of sassafras, (see Materia Medica,) and in such cases the testicles ought to be suspended by a bandage, and the anti- phlogistic regimen strictly adhered to, particularly in taking freely of mucilaginous drinks, as flax-seed tea, barley-water, or the muci- lage of gum Arabic, and obviating costiveness, by small and repeat- ed doses of cream of tartar. Whichever of the injections is used, it must be thrown up the urethra six or eight times a-day, immediate- ly after making water, and with a syringe that works easily, that it may not hurt or inflame the parts. It should be observed, if astrin- gent injections of full strength be used in the early period, they often prolong the disease, and occasion swelled testicles, strictures, and enlargement of the prostrate gland; but after the inflammatory state is removed, they may be employed with safety, and will be found to facilitate the cure. Frequently bathing the part, and the great- est cleanliness, are too important to be neglected ; particularly wash- ing under the glands, to prevent the accumulation of the fluids from the odoriferous glands, which produces irritation, inflammation, and often ulcers. For the chordee, which is more severe during the continuance of the inflammation, and occurs mostly in the night, while the patient is warm in bed ; take, on going to rest, a dose of laudanum, or souse the guilty member frequently in a vessel of cold water. Should a hemorrhage supervene, it may be removed by rest, and immersing the part often with cold vinegar and water, or lead-water, of the or- dinary strength, of which the patient may throw a little up. According to Professor Chapman, no remedy succeeds better in the cure of gonorrhoea than balsam capaivi. He commences with this medicine on the very accession of the disease, regardless of all the appearances of inflammation, such as scalding, chordee, &c. The proper dose is about forty drops, more or less according to cir- cumstances, to be repeated morning, noon, and night. He directs it to be taken in a little wine, or milk, or if it should act on the bowels, or be offensive to the stomach in this way, he advises it to be exhibited, agreeably to the following prescription : Take of bal- sam capaivi and sweet spirits of nitre, of each half an ounce, the white of an egg, or powdered gum Arabic and white sugar, each VENEREAL DISEASE. 303 two drachms, mix, and then add laudanum, one drachm, and water three ounces : of this mixture, the dose is a table-spoonful three times a-day. One caution, he suggests, should always be enjoined on patients who are desirous of a speedy cure : An entire abstinence from every heating article of food or drink, and a state of complete repose. He says, contrasted with the ordinary mode of treating it by in- jections, his plan has several advantages. It is more convenient to the patient; it produces no swelled testicles ; it occasions no stric- tures ; it leaves no gleet; it is more prompt and certain in the cure. Of the efficacy of this remedy, coming from such unquestionable authority, there can be no doubt; but candor compels me to ac- knowledge I have never resorted to it, having uniformly succeeded in the cure of gonorrhoea by injections, as above advised. When the inflammatory symptoms of gonorrhoea increase to a violent degree, a swelling or inflammation of one or both testicles sometimes supervenes. The same consequence is often produced by astringent injections imprudently exhibited. In such cases, the general remedies for allaying inflammation, as blood-letting, cooling cathartics, diluent drinks with small portions of nitre dissolved in them, become necessary. Besides which, the testicles must be suspended by a bandage, and kept constantly moistened with cloths wrung out of lead-water, or cold vinegar and water, often renewed. The swelling of the glands in the groin, and of the spermatic chord itself, require a similar treatment. In these affections, a horizontal posture, and spare diet, are particularly enjoined. In case of much pain, with little or no fever, an opiate may be given at bed-time. And if hardness remain after the pain, the patient should have mer- curial ointment rubbed on the part, night and morning, and take freely of a strong decoction of sarsaparilla. But if the swelling with- out hardness follow, one or two vomits, succeeded by tonic medi- cines, with the use of the cold bath, will generally effect a cure. In case of phymosis, cold applications to the penis, as lead-water or cold vinegar and water, and topical bleeding with leeches, con- stitute the proper remedies. Besides which, soap-suds should be often injected with a siringe between the skin and the glands, to prevent the stagnation of matter, the extreme acrimony of which might otherwise produce a mortification of the parts. When these means, assisted by opiates, fail, an operation becomes necessary; it is simple, and by no means dangerous. A sharp-pointed knife, con- cealed, and defended by a grooved directory, which must be pre- viously introduced between the prepuce and glands, are the only in- struments required. The point of the knife should pass through the prepuce at the bottom, and the section be made by drawing it towards the operator. Common dressings are sufficient; but linen or lint should be interposed between the glands and the prepuce, to prevent adhesions. Paraphymosis is the opposite disease, where the prepuce cannot be drawn over the head of the penis; and in this case, bathing the 304 VENEREAL DISEASE. part frequently in milk and water or soap-suds, and taking some cooling laxative medicine, will generally effect a cure. When the inflammation is considerable and long continued, a mixture of syphi- litic infection may be suspected, requiring a mercurial course. In- deed, these affections frequently originate from chancres. Such are the principal symptoms which attend gonorrhoea. Its consequences, which induce a new state of disease, after the origin- al affection is removed, are no less important. GLEET. This is known by a constant discharge of mucous matter, after the inflammatory symptoms have subsided, occasioned by a relaxa- tion of the mucous glands, or stricture in the urethra. A discharge of this kind may also be occasioned by hard drinking, violent exer- cise, or straining. A discharge of mucus, if not connected with venereal taint, even when accompanied with inflammation, which have been excited by high living, or violent exercise, is not infectious. Treatment.—Although this disease often yields with great faci- lity to the common remedies, yet it is sometimes peculiarly distress- ing and obstinate. The remedies generally employed are astringent injections ; the use of balsam capaivi, in doses of thirty or forty drops thrice a-day, and tonics of every kind, particularly cold bathing, both partial and general. In obstinate cases, the uva ursi, (see Materia Medica,) as well as the tincture of cantharides, have often succeeded. None of the remedies should be continued longer than eight or ten days, if they produce no salutary effects. They often in this time remove the complaint which recurs on their being discontinued, so that they should be employed long after the discharge has ceased. The tinc- ture of cantharides may be given conjointly with balsam capaivi, or alone in common drink. This remedy must be cautiously employed, beginning with very small doses, about fifteen drops of the tincture, which may be gradually increased daily, as in the irritable state of these organs even a common dose may excite dangerous inflamma- tion. The application of a blister to the sacrum, or blistering the urethra, in its course, has sometimes succeeded. Upon high autho- rity an obstinate gleet was cured by the injection of punch, a reme- dy suggested in a convivial moment; at another time by green tea; and again by a decoction of red oak bark. An astringent injec- tion of considerable efficacy in obstinate gleets, is prepared by dis- solving twenty or thirty grains of alum in a half pint of water, which should be injected up the urethra, twice or thrice a-day. When an ulcer in the urethra is the cause, which may be sus- pected, if on pressing the penis slightly erected, between the finger and thumb, one part be found more sensible to the touch than ano- ther, the best remedy which has come under my notice in practice, is an injection composed of one or two grains of corrosive subli- venereal disease. 305 hiate in a half pint of water, or made of sufficient strength to ex- cite some degree of inflammation in the part affected. If a stric- ture be the cause, the introduction of a bougie is the only remedy. While the use of a bougie is continued, the discharge usually pro- ceeds, but after three weeks or a month, it should be omitted. If the running stops, the cure is usually effectual; if it continues, the remedy should not be repeated. In women, gleets are equally obstinate, but they generally pass under the appellation of fluor albus, or whites. SEMINAL WEAKNESS Is another consequence of clap, when there has been frequent returns of it, and is known by an involuntary discharge of the se- men. At the beginning of the disease there is a great inclination to erections, and the emission of the semen is attended with plea- sure ; but gradually the penis becomes lame, the testicles hang low- er than usual, and unless they are otherwise suspended, become al- most a burden to the possessor. Although veterans in the wars of Venus, are most liable to be complimented with this kind of gleet, yet it may originate from other causes, as self-pollution, a sudden lift or strain, hot clysters, straining to stool, or the imprudent use of strong diuretics. Let the cause, however, be what it will, there is no drain which steals away the quintessence of life and strength more rapidly. Treatment.—If the emission take place on the slightest irrita- tion, as heat, wine, &c, and be attended with some degree of spasm, it is a sign the patient is in a very rampant state, and can hardly get him a wife too soon. But if he ooze away insensibly, cold bathing and tonic medicines, as bark;, steel, or balsam capaivi in the usual doses, with a generous diet, are the best remedies. Costive^ ness should be carefully avoided. OBSTRUCTION OF URINE Is another formidable symptom, which sometimes succeeds go- norrhoea. It is produced by certain changes of the passage, from tumors seated high up in the urethra, or the contraction of the uri- nary canal. Treatment.—When this affection arises from tumors, a cure may be attempted by the use of the mercurial pills, (see Dispensa- tory,) night and morning, and a decoction of sarsaparilla, or meze- reon ; but it is often incurable. When spasmodic constriction of the passage is the cause, it will be removed by the warm bath or fomentations. The penis may also be rubbed with camphorated oil, (see Dispensatory,) or equal parts of ether and laudanum. If this fail to take off the spasm j bleed, and give laudanum in large doses. 39 306 pox. POX Is trie venereal disease in its confirmed state, manifested by chan- cres, buboes, or warts about the genitals. To these succeed ulcer in the throat, nose, and tongue, blotches on various parts of the body, with nocturnal pains, especially in the shin bones and shoul- ders. The system is now filled with the horrid poison, which, unless mercifully arrested, will soon ulcerate the eyes, consume the nose, contract the body, and convert the loveliest form into such a mass of corruption, such a dunghill of stench, such a picture of ghastli- ness, as is sufficient to strike the guilty person with terror. A pallid youth, beneath a shade, A melancholy scene displayed; His mangled face, and loathsome stains, Proclaimed the poison in his veins ; He raised his eyes, he smote his breast, He wept aloud, and thus addressed: \ " Forbear the harlot's false embrace, Though lewdness wear an angel's face ; Be wise, by my experience taught; I die, alas! for want of thought." Cottof. ELEGY. " Weep o'er the sorrows of a wretched maid, Who sacrificed to man her health and fame : Whoso love, and truth, and trust, were all repaid, By want and wo, disease and endless shame. "Curse not the poor lost wretch, who ev'ry ill That proud unfeeling man can heap, sustains ; Sure she enough is cursed, o'er whom his will, Inflam'd by brutal passion,boundless reigns. " Spurn not my fainting body from your door, Here let me rest my weary, weeping head ; No greater mercy would my wants implore ; My sorrows soon shall lay me with the dead. "Who now beholds, but loathes my faded face, So wan and sallow, cljang'd with sin and care ? Or Who can any former beauty trace, , In eyes so sunk with famine and despair V " That I was virtuous once, and beauteous, too, And free from envious tongues my spotless fame, These but torment, these but my tears renew, These aggravate my present guilt and shama. " Where are my virgin honors, virgin charms ? Oh! whither fled the pride I once maintained 7 POX. 307 Or where the youths that woo'd me to their arms ? Or where the triumphs, which my beauty gain'd? " Ah ! say, insidious demon! monster ! where ? What glory hast thou gain'd by my defeat ? Behold the miseries I am doom'd to bear, Such as have brought me to my winding-sheet." Treatment.—Happily for mankind, the Governor of the world, is " a Father who pitieth his children," and afflicts not to kill, but to cure. In mercy he has appointed a medicine for this dreadful malady. A medicine, which, when taken in sufficient quantity, quickly flies to all parts of the system, attacks the disease at every post, drives it from gland to gland, and with a fidelity and courage truly admirable, never gives it rest until it has completely expelled it from the body, and restored the patient to former health and vi- gor. This wonderful medicine is mercury, which requires only to be so managed as to obtain full possession of the system; not ex- ceeding it by salivation, nor falling short of it by untimely purging. To hit this desirable point, let a table-spoonful of mercurial solu- tion or one of the mercurial pills, (see Dispensatory,) be given night and morning, until the system is fully charged with the me- dicine, which may be known by a slight soreness of the mouth and gums, and fetid breath. This fortunate state of things, carefully supported a few weeks, will remove the disease. ' If the mercury affect the bowels, lessen the dose, or give it at longer intervals, or use the mercurial ointment; and if there be an increased secretion of the salivary glands, we should omit the mer- cury for a few days, and take a tea-spoonful of flour of sulphur, in a glass of milk or flax-seed tea, night and morning. In this way the disease may generally be cured in a short time. It will always be prudent to continue the mercury in small doses for ten or twelve days after the total disappearance of all the symp- toms. There are cases, however, where mercury will not answer, as in those of scrofulous habits, and when the blood is vitiated. In these, the nitric acid should be preferred, and from one to two drachms of it, diluted, (see Dispensatory,) may be taken in the day. This medicine seems especially adapted to cases where the habit of body is much debilitated, from the long continuance of the disease, or where it has acquired great irritabiKty from an incautious use of mercury. It is also a sovereign cure of spungy gums, eruptions, ul- cers, nocturnal pains, and all the train of consequences, usually at- tendant on this disease, when of long standing and imperfectly cured. In the treatment, therefore, of venereal patients, too much at- tention cannot be paid to mark the peculiarities of habit; and we should always remember, that, when unfavorable appearances su- pervene from the use of mercury, other medicine, as the nitric acid, or tar water, (see Dispensatory?) or decoctions of prickly ash, rae- zereon, lobelia, sarsaparilla, sumach, or poke bounce. (See Ma- teria Medica.) 308 pox. In this disease, there are certain symptoms which require local treatment. Thus,, a chancre, which is a small red pimple, termi- nating in ulcer, with hard edges, and generally situated on some part of the prepuce, or the fore-skin of the penis, is best removed by the application of caustic ; or, if recent, washing with spirits or brandy, a solution of alkali, (see Dispensatory,) and applying dry lint to the sore, with cleanliness, will generally prove sufficient. When a bubo supervenes, which is known by pain and swelling in the groin, every attempt should be made to disperse it by rubbing in mercurial ointment on the inside of the thigh or calf of the leg; and the application of cloths, wrung out of lead-water, or ice, if it can be procured, to the swelling, renewed as often as they become warm. Besides which, the patient should be kept still, the bowels open, and the pain alleviated by the use of opiates at bed-time. When a tendency to suppuration is discovered, instead of the former plan, warm poultices of flax-seed, milk and bread, or mush, and fat, must be applied and renewed three or four times a-day, until the tumor break. After which, one or two poultices may be. continued, to accelerate the discharge of matter, for a day or two; when the sore must be kept clean with soap-suds, and dressed night and morning with basilicon, spread on lint, until the matter be mostly discharged. The sore should then be dressed with lint, dip- >' » ped in a solution of alkali, (see Dispensatory,) once or twice in twen- .' ty-four hours, as may be indicated by the discharge of matter; and, ' lastly, when there is no appearance of proud flesh, it may be heal- ed with Turner's cerate, or any healing ointment. Warts are a frequent affection of the penis, and sometimes re- , main after the venereal virus is expelled. In which case they may' be removed by ligatures, or the application of caustic. Regimen.—There is hardly any thing of more importance in the cure of this disease, than a proper regimen. Inattention to this, not only procrastinates the cure, but often endangers the patient's life. In full habits, the diet should always be light and cooling. Exercise should never be carried to excess, and the patient should ^ wear flannel oil using any preparation of mercury. Cleanliness is of too, much importance ever to be neglected. As soon as the dis- ease makes its appearance, the infected part should be frequently washed in milk and water, or soap-suds ; and if, from a neglect of cleanliness, venereal ulcers appear, the sores must .be well cleans- ed, and dressed with dry lint night and morning. In obstinate cases the lint should be dipped in the solution of alkali. When the patient is in delicate health, or much reduced, a nour- ishing diet, with wine, bark, and other tonic medicines, are proper, with pure country air. Prevention.—After a suspicious connexion, it becomes a pru- dent man to discharge his urine ap soon as possible, and wash well his polluted member, by drawing forward the fore-skin, and closing the end with his finger, that i\ may be distended, and retain for a SCURVY. 309 few seconds the urine. The glands and penis should then be well washed with strong soap-suds or grog. In^vomen, besides cleansing the external parts, some portion of the wash should be injected up the vagina, by means of a female syringe. SCURVY. Symptoms.—An unusually weakened state of the body ; pale and bloated countenance ; the breathing affected on the slightest exe^ tion ; the gums soft, swollen, and inclined to bleed on being rubbecr, and sometimes putrid ulcers are formed ; the teeth become loose ; the breath fetid ; and the urine high-colored. The heart is subject to palpitation; the lower extremities to dropsical swellings; the body to pains of a pleuritic or rheumatic kind ; besides which, blotch- es and ulcers break out in different parts of the skin, and often ter- minate in mortification. Causes.—Cold moist air; vitiated or scanty diet; and indolent life, with luxurious indigencies; corrupted water or provisions; and whatever may weaken the body, or vitiate the humors. ( Treatment.—Raw and fresh vegetables of every description, particularly those of an acid kind; and fruits, such as lemons, limes, oranges, sorrel, &c, (see Materia Medica,) furnish the most effec- tual remedies. But as these are not at all times to be obtained, com- mon vinegar, or nitrous vinegar, used freely, will completely answer the end. The nitrous vinegar is prepared by dissolving three or ■ four ounces of nitre or saltpetre, in one quart of good vinegar; and of this solution, from one to two spoons full may be taken three or four times a-day, according to the advanced stage of the disease ; and as frequently, some of it may be used in bathing the limbs, where they are either stiffened, swelled, blotched, or ulcerated. Soda-water or nitric acid, (see Dispensatory,) will be found a use- ful auxiliary, when the disease is inveterate. The belly will most frequently be kept open by this medicine; and when it is not, the exhibition of cream of tartar, or tamarinds, will be highly beneficial. When the gums are enlarged, ulcerated, and fetid, the mouth should be frequently washed with a decoction of red oak bark, in which a little alum is dissolved, and the gums rubbed with a powder composed of equal parts of finely pulverised charcoal and bark, with which the scorbutic ulcers may be dressed morning and night. These ulcers may be known by their soft and spongy edges. Regimen.—So uncommonly salutary are vegetables in this disease, that whenever they can be had fresh, they should, with ripe fruits and milk, constitute the chief part of diet for scorbutic patients. When these articles cannot be procured, a mild nourishing diet, with wine, cider, and porter, is most proper. As nothing is of more 310 eruptions of the skin. importance to the scorbutic, than breathing pure fresh air, it should at all times be well supplied. Seamen, therefore, affected with it, ought constantly to keep on deck in fair weather. ERUPTIONS OF THE SKIN. There subsists so intimate a relation between the internal and external parts of our body, that no disorder scarcely takes place within, that does not show itself ultimately on the surface. Diseases of the skin are therefore very numerous, and, as they most commonly arise from ajConstitutional cause, should be treated by general remedies. Local applications, particularly quack remedies, which are com- posed of mineral poisons, by repelling the vitiated humors to the brain, lungs, or bowels, have often produced fatal consequences. Persons of relaxed habits, especially females, are subject to an eruption, attended with redness and soreness of the skin, forming large spots on the face and neck. This is certainly the mark of a constitutional debility, and can only be removed by tonics ; as the bark, bitters, solution of arsenic, nitric acid, &c, and exercise. Attention should also be paid to a frequent change of linen, and the skin occasionally dusted with starch. Cutaneous eruptions oftentimes arise from a foulness of the sto- mach, in which case, occasional vomiting and purging are found to be highly useful. There are eruptions in the face of persons of apparent health, . called grog blossoms, which are the consequence of an inflamed liver, from a too frequent use of wine and spirits, and high living. An attempt to remove these pimples by external means, would not only be fruitless, but highly dangerous. Their cure can only be effected by gradually correcting the habits of intemperance, both in eating and drinking. The primary affection must be first relieved. This is to be done by taking,- every night, from half a grain to one grain of opium, combined with two grains of calomel. After using this medicine for some time, or until the mouth is affected by salivation, the nitric acid diluted, (see Dispensatory,) in its usual doses, will complete the cure. Scaly affections of the skin, or clusters of small pimples over the body, usually occur, in some habits, in the spring and fall, which will generally yield to sassafras tea, or cream of tartar and sulphur, in doses of a tea-spoonful, night and morning. Should this fail, the decoction of sarsaparilla, and one of the mercurial pills, night and morning, for a week or two, and afterwards, the solution of arsenic will always succeed. The prickly heat, is an eruption which is sometimes very trouble- some, but commonly disappears on keeping moderately cool, and ITCH. 311 avoiding warm drinks. When this is not sufficient, and the itching is severe, the cathartic mixture taken two or three times a-week, and the external applications of elixir vitriol diluted in water, or the itch lotion, (see Dispensatory,) with the addition of a little more water, will prove a good remedy. The nettle rash, so called from its resemblance to eruptions, made by the stinging of nettles, is sometimes attended with intolera- ble itching. When many of the eruptions run together, the part seems swelled, forming tumors, such as appear after being struck with the lash of a whip, and betwixt them, the skin is inflamed and very red. The elevations appear suddenly, but seldom continue long, and are apt to disappear from one part of the body, and ap- pear again in an6ther. The itching is the greatest inconvenience, as it sometimes prevents the patient from sleeping, but the disease is not dangerous. With respect to the cure, observing a cooling regimen and a laxative state of the bowels, is generally sufficient; but if fever supervene, it will be proper to bleed and give the antimonial solu- tion in small doses, to determine the fluids to the surface. When the disease is of a chronic nature, and often returns, twenty drops of elixir vitriol, taken thrice a-day, in a cup of camomile or centaury tea, or the infusion of Columbo, should be directed. To allay the itching, a solution of borax, in vinegar, an ounce of the former, to half a pint of the latter, affords a good wash. ITCH. The itch consists of small watery pimples of a contagious nature, which first appear between the fingers, and on the wrists, but in process of time, spread over the whole body, except the face, at- tended with a great degree of itchiness, especially after being heat- ed by exercise, or when warm in bed. In the cure of this disease, sulphur, used internally and external- ly, is considered as a certain specific. A tea-spoonful of the flour of sulphur, taken in milk, or spirits and water, thrice a-day, and* some of it rubbed on the inside of the arms and legs at bed-time,, either dry, or in the form of unction, will soon effect a cure* Where the sulphur is disliked, the mercurial ointment may be rub- bed in every night about the size of a nutmeg, until the eruption en- tirely disappears. The itch lotion, (see Dispensatory,) will also be found an effectual remedy in this complaint, by washing the parts affected with it two or three times a-day. The internal exhi- bition of sulphur alone, or combined with cream of tartar, should always precede or accompany the external applications. Dock- root, tobacco, and Virginia snake-root, (see Materia Medica,). have sometimes cured when the above remedies failed. 312 tetter, or ring-worm.—tinea, or scalo head. TETTER, OR RING-WORM Is an eruption that attacks various parts of the skin, in a circle, with an inflamed basis, which gradually spreads, forming an ex- tensive excoriation, sometimes moist, at other times dry, and is attended with smarting and itching, succeeded by scurfy scales. Treatment.—If the habit of body be not faulty, external ap- plications alone, are often sufficient to remove this affection. The saturated solution of borax, with vinegar or lemOn juice, one drachm to an ounce of the acid, is an excellent remedy, without producing the least pain on its application. The itch lotion, when prepared with double its strength, is also equally good. Covering' the eruption daily with ink, or the juice of black walnut, (see Ma- teria Medica,) has often effected a cure. Where the disease is inveterate, internal medicines must be exhi- bited and continued for some time, such as lime-water, flour of sul- phur, the mercurial pills, or, which is preferable to all of them in obstinate cases, the solution of arsenic. (See Dispensatory.) TINEA, OR SCALD HEAD. Symptoms.—This disease consists of little ulcers at the roots of the hair, which discharge a humor that dries into a white scab, or thick scales, and has an offensive smell. It is not only a very troublesome complaint, but contagious, and, when united with a scrofulous constitution, is found extremely difficult to be cured. Treatment.—When ft is merely a complaint of the skin, it may be successfully treated with topical applications. In the beginning of the affection, washing the sores well, night and morning, with strong soap-suds, or a decoction of tobacco, or by applying anoint- ment, made of jimson-weed, or pride of China, (see Materia Medi- ca,) will frequently effect a cure. But if the disorder prove obsti- nate, the head ought to be shaved ; and after being well washed with soap-suds, covered with tar and suet, spread on a bladder. My very ingenious friend, Dr. Chapman^ has assured me, when ev- ery other application failed in removing this disease, he always suc- ceeded, by having the affected parts washed with the following lo- tion, twice a-day:—Take liver of sulphur, three drachms ; Span- ish soap, one drachm; lime-water, eight Ounces; rectified spirits of wine, two drachms : mix. But, in cases where topical applications are resisted, medicine , should be given internally, as lime-water; flour of sulphur, or calo- mel, according to circumstances; and, to hasten the cure, the course of the fluids may, in the mean time, be in part diverted from the head, by blisters or sinapisms. scrofula, or king's evil.—jaundice. 313 SCROFULA, OR KING'S EVIL. This disease is most frequent among the children of the poor, and negroes, who are ill-fed, ill-lodged and ill-clothed ; it is also hereditary, but never contagious. It most commonly occurs in children from the third to the seventh year; frequently, however, it discovers itself at a later period in habits peculiarly disposed to it. v Symptoms.—It is known by indolent hard tumors of the lympha- tic gland, particularly those of the neck, behind the ears, or under the chin. The upper lip, and division of the nostrils are swelled, with a smooth skin, and hard belly. In the progress of the disease, these tumors degenerate into ulcers of bad digestion ; the discharge of which consists of a white curdled matter, resembling somewhat the coagulum of milk ; and, previously to their breaking, they ac- quire a sort of purple redness, and a softness to the touch. Treatment.—As soon as the tumors are first discovered, endea- vor to disperse them by sea bathing, or bathing in salt and wa- ter, one pound to three gallons of water, or cold water alone, or by the frequent application of lead-water. Warm fomentations and poultices of every kind do harm, as they seem only to hurry on a suppuration, which, if possible, should be prevented. A draught of sea water every morning is a useful drink. Peruvian bark and steel, used alternately every two weeks, or the nitric acid, will be of infinite service by giving tone to the system. The remedy, however, most to be depended upon in this disease, is the muriate of lime, given in doses of ten to eighty drops, gradually increased, three or four times a-day, diluted with water or tea. When a sup- puration takes place, the solution of arsenic should be given twice or thrice a-day. The best application to scrofulous ulcers, is a pow- der composed of one pound of finely powdered bark, and one ounce of white lead in fine powder, mixed well together, or a fine powder of calamine stone alone, and the ulcers covered with it dai- ly, keeping it on by- brown paper and a bandage. Where these are not to be obtained, the constant application of linen rags, moisten- ed with a solution of one ounce of sugar of lead, in a pint of wa- ter, may answer every purpose. With respect to the diet, it should be nourishing and easily di- gestible, avoiding all viscid food. Moderate exercise, in a dry warm air, is exceedingly beneficial. JAUNDICE. Symptoms.—Yellowness of the skin, but chiefly of the eyes, tfcte urine is also yellow ; inactivity; anxiety and uneasiness at the pit of the stomach; itchiness of the skin. 40 314 WHITE SWELLING. Causes.—Whatever obstructs the passage of the bile, through its natural channel. Treatment.—The indications of cure are, to remove the ob- structions, which, as it- originates from different causes, will require different modes of treatment. As viscid bile is the most common cause of this complaint, in full habits, and where there are any feverish symptoms, begin the cure with bleeding, afterwards give an emetic, and then a day after, a dose of calomel and jalap, which, if necessary, should be often re- peated. Common soap, in large quantities, has been exhibited with much success in this case; but, as this is disagreeable to take, the salt of tartar, which has the same advantage, or soda, may be tak- en in doses of twenty or thirty grains, three or four times a-day, dis- solved in the infusion of Columbo. If there be any acute pain in the region of the liver, with a quickness of the pulse, bleed more freely, give one of the mercuri- al pills, (see Dispensatory,) night and morning, until a ptyalism be produced, use the warm bath, and apply a blister over the pained part. In cases of much pain, three or four table-spoons full of olive oil should be swallowed; and, if it do not succeed in quieting the pain, one or two tea-spoons full of ether, or thirty drops of lau- danum must be given. The warm bath, or bags of hot salt applied to the right side, are likewise beneficial. After the obstruction is removed, the Columbo. or nitric acid, tonic powders or pills, or dog- wood, or cherry-tree bark, (see Materia Medica,) with porter and wine, are necessary to restore the tone of the system. Regimen.—The diet ought to be regulated according to the con- stitution of the patient. In plethoric or feverish habits, the diet should be low ; and in cases of excessive debility it should be of the most nourishing kind. Vegetables, by creating flatulency and acidity, are to be avoided. Mucilaginous drinks are peculiarly proper; and, in many instances, sucking a new-laid egg every morning, on an empty stomach, has succeeded in curing this dis- ease, when all other means failed. WHITE SWELLING Is distinguished by an acute pain, without any external inflamma- tion, of a joint, attended with a gradual increase of its size. Though all the joints are occasionally subject to it, yet its most usual seat is the knee. White swellings are generally of a scrofulous nature, but some- times they are produced by rheumatic affections, and sometimes follow strains that have been neglected, or badly treated. Treatment.—As soon as an af!ect;on of this kind is discovered, the patient should remain in bed. and the limb kept perfectly at rest, without which, remedies cannot produce any good effect. SEA SICKNESS.--INTOXICATION. 315 The great object is to prevent the formation of matter, by the immediate application of leeches, or scarifications to the part affect- ed, and by which, eight or ten ounces of blood may be taken away, every other day, or oftener, according to circumstances. The whole joint should then be kept continually wet and cold with the solution of crude sal-ammoniac, (see Dispensatory,) by means of four or five folds of linen. After the local affection is somewhat abated, frictions with the volatile liniment, or a mixture of soft soap and spirits of camphor, to which may be added some tincture of cantharides, will have a good effect. With one or other of these liniments, the joint is to be rubbed well twice a-day, and afterwards covered with a piece of flannel that has been soaked in the same. If this should not produce good effects, the part must be rubbed night and morning with mercurial ointment, in the quantity of two drachms at a time, and continued until the mouth be gently affect- ed. The cure may then be completed by small blisters on each side of the joint, which should be kept running for a length of time. If the disease in spite of these remedies continue to advance, emollient poultices must be applied often, until various abscesses appear, and these should be opened as soon as they seem to point, afterwards to be treated as ulcers. In cases where the white swelling is evidently scrofulous, tonic medicines, as bark, steel, &c, and a nourishing diet, to correct the constitutional affection, with stimulating applications to the joint, form the best remedies. SEA SICKNESS. Symptoms.—A most unpleasant giddiness, with great nausea and vomiting, occasioned by the motion of the vessel. The duration of this complaint is very uncertain. Generally, it lasts but a day or two, but in some cases it will continue a whole voyage. Treatment.—Though time, perhaps, be the only cure, yet it will be greatly alleviated by keeping the bowels open. A tea- spoonful of ether, in a glass of water, relieves the convulsive affec- tion of the stomach. High-seasoned food, and acidulated drinks, are peculiarly proper. But nothing will be found more serviceable, than exercise, cheerfulness, and fresh air. Persons should, therefore never go below, but romp on the decks, cut capers in the shrouds, and divert their minds and move their bodies as much as possible. INTOXICATION. Symptoms.—Like every other kind of frenzy, it comes on with a 316 INTOXICATION. burning redness of the cheeks ; a swelling of the jugular veins, and fiery wildness of the eyes. The tongue is considerably affected, but very differently in different stages of the disease. At first, on- ly glib and voluble—then loud and louder still—at length noisy and excessively disagreeable. The patient is now quite on his top-. ropes, and nothing goes down with him, but the most ranting songs, roaring laughs, ripping oaths, and the bluntest contradictions, ac- companied with loud thumping of the fist on the table, especially if politics be the topic of conversation. There i$ no complaint that affects patients so differently: some it makes s*o ridiculously loving, as to hug and kiss one another; others it kindles into such rage and fury, that they will frequently throw the bottles and glas- ses at the heads of their best friends. And, indeed, so wonderful is its influence, that it is no uncommon thing with it to inspire cow- ards with courage ; to teach truth to liars, and to make persons na- turally reserved, loquacious, and even boisterous. The memory now partakes of the general infirmity, being hardly able to connect the parts of a story begun. The tongue, at length, as if about to lose its powers, begins to trip ; then to stammer; and, at last, the utterance dies away, generally, in some idle half finished threat or oath. Hickups now ensue, with a silly grin of the mouth, which continues half open, from the falling of the low- er jaw. The face puts on an air of great stupidity—the eyes turn heavy and sleepy, and the patient begins to nod, with his head bending forward, until, becoming too heavy, he sinks under the ta- ble, and not unfrequently, after a filthy vomiting, falls asleep among '< the dogs and cats. Treatment.—In a fit of drunkenness, the patient should instant- ly be placed in an airy situation, the head and shoulders kept erect, and the neck cloth and collar of the shirt unbound, and copiously bled, if his situation seem alarming. The next step is to provoke vomiting, by the most expeditious means, such as tickling the throat with a feather or the finger. Cold applications to the head, as cloths wrung out of cold water, or vinegar and water, often renew- ed, will have the happiest effect; so will plunging the body in cold water; for many instances have occurred of persons having fallen overboard in a drunken fit, who have been picked up sober. Therefore, it will be found an admirable mode of sobering those vagabonds, who, as a nuisance, infest the streets of every city, to take them to the nearest pump, and there deluge them with cold water. This will not only bring them to their senses, but send them off, under that sense of shame, which ever follows the com- mission of a crime so truly ignominious. TO recover persons apparently dead. 317 ' TO RECOVER PERSONS APPARENTLY DROWNED. As soon as the body is taken out of the water, 4t should instantly be rubbed dry, and wrapt in warm blankets, unless thecooling pro- cess should be first necessary, in consequence of the patient being in a half frozen state. For, in that case, the body ought to be rub- bed with snow., or flannels wrung out of cold water or vinegar, before any degree of artificial warmth be applied. After which, the pa- tient is to be placed on a bed or mattress, with the head elevated, and air is then instantly to be blown into the lungs, by inserting the pipe of a pair of bellows into one nostril; or, for want of that article, a tobacco pipe, a quill, or even a card folded in the form of a tube, while the mouth and opposite nostril are closed by an assistant, or covered with some wet paper. By thus forcing air into the lungs, and alternately expelling it by pressing the chest, respiration may happily be restored. Volatile salts, or vinegar, should also frequent- ly be applied to the nostrils. Next the intestines are to be stimulated by injections of warm spirits and water, or mulled wine. It will be more effectual still, if sonie warm spirits and water be introduced immediately into the stomach, by means of-a^ringe and a long flexible tube. While using the internal stimulants, a bladder of warm water should be ap- plied to the region of the stomach, and the le^gs and arms briskly rubbed with a warm hand, or with flannel, extending the friction gradually to the thighs, belly, and chest. At that critical period, when sneezing, slight twitchings, or gaspT ing, mark the first dawn of returning life, it will be prudent to mo- derate the stimulating powers. When respiration and the power of swallowing are restored, the patient should be kept moderately warm, and gentle perspiration encouraged by warm drinks. Should feverish symptoms ensue, moderate bleeding, together with mild laxatives and cooling regimen, will complete the cure. TO Rft>COVER PERSONS \ Apparently killed by Lightning, or noxious Vapors. Treatment.—Instantly throw cold water, with some force, in large quantities, on the face and head, which should be often repeat- ed for some time ; and, if convenient, the whole body may be plung- ed into cold water, and afterwards wiped dry, and warmth gradually applied. If the body and the extremities feel cold, instead of the application of cold water, the warm bath, about the temperature of the blood, should be prepared as soon as possible, and the patient 318 POISON. immersed in it for twenty or thirty minutes, using frictions at the same time with the hand. As soon as the patient is taken out of the bath, his skin must be wiped dry, and wrapped up in warm flan- nel, and gentle stimulants employed to produce a reaction. The vital principle is not unfrequently suspended by the deleteri- ous fumes arising fr©m fermenting liquors, from charcoal, coke, &c.; from combustion, from metals in a state of fusion, particularly arsen- ic and mercury; as, also, very often, from respiring the foul air of wells, privies, caverns, and mines. In such cases, the person should be freely exposed to pure and cool air, and supported, at the same time, in a leaning posture. Volatile salts, or other stimulating sub- stances, are then to be apphed to the nose, and cold water made use of, as above directed. When by these means the circulation of the blood is increased, and the extremities become warm, bleeding will be proper, and must.be often repeated, if the patient have fever, or complain of pain. Besides which, evacuations must be procured by purgative medicines and clysters; and the antiphlogistic plan in every respect strictly pursued, until the febrile symptoms abate. After which, tonic medicines, with wine, in case of debility, are of infinite service. In places where a lighted candle will not burn, animal life cannot be supported ; and, therefore, in all cases, where wells, cist-pools,or deep vaults, are to be opened, a large candle, lighted, ought to- be Jet down very slowly to the bottom, before any person attempt to descend. If the candle be estinguished, means must be adopted to remove the noxious air, before any one descend. To effect this, the follow- ing modes will answer : 1st. Let the leather pipe of an engine be introduced to the bottom of the well, if empty, or the surface of the water, and affix a blacksmith's bellows to the other end, when, by well working this, the foul air may be expelled. 2dly. Carbonic acid gas may be bailed out with a bucket made of coarse cloth like a bag, with a round piece of board, nearly the diameter of the well at the bottom ; let the bucket, thus made, down upon the water, so that the bottom may rest upon it, and let the bag fall upon the bottom; then draw it up, when it will be filled with foul air, which may be brought up to the surface, and emptied by turning out and shaking the bag. 3dly. Let down about a bushel of quick-lime, dipping it into the water occasionally, to slack it; or, if there be no water in the well, throw down some for the purpose. 4thly. Pour down a large quantity of boiling water repeatedly into the well. POISON. Treatment.—The cure of poisons swallowed, whether vegetable or mineral, requires an immediate evacuation, or a counteraction of BITES OF MOSCHETOES, AND OF VENOMOUS ANIMALS. 319 their effects. Therefore, as soon as possible, throw in an emetic, quick in its operation, as blue or white vitriol, in a dose, from five to twenty grains, repeated in fifteen minutes, if necessary, and as- sisted by copious draughts of warm water. To remove the stupefaction which generally ensues after an im- prudent dose of opium, acids of the vegetable class, as lime juice, or vinegar diluted with water, ought to be exhibited freely. But if the patient lay in a deadly stupor, with cold extremities, the warm stimulating plan must be first adopted. Sinapisms or blisters ought instantly to be applied to the extremities ; or, as a more effectual re- medy to produce reaction in the system, the legs and arms should be whipped well with rods, and the soles of the feet seared with a red hot iron. It appears, from incontestable experiments, that the white of an egg beaten up with cold water is the best antidote against corrosive sublimate and the other mercurial preparations. The whites "of twelve or fifteen eggs, are directed to be beaten up and mixed with two pints of cold water, and a glass full taken every two or three minutes, so as to favor vomiting. In defect of eggs, milk and mu- cilaginous drinks may be used with great success. The same me- thod may be pursued, in case arsenic or any other metallic salt has been taken. A drink, composed of equal parts of lime-water and sugar and water, should also be given when arsenic has been swallowed. Unless these, remedies be quickly resorted to, death will inevitably take place. Should fever supervene, the antiphlo- gistic treatment must be pursued. The application of tobacco will assist the operation of an emetic. (See Materia Medica.) For the poisonous effects of lead, see Vine. BITES OF MOSCHETOES. Moscheto bites often degenerate into painful acrid ulcers, parti- cularly on the legs, in consequence of scratching them. It is, there- fore, proper, where these insects are troublesome, to wear loose li- nen buskins to guard the legs in the evening; and when this has been neglected, apply oil, vinegar, lime juice, or camphorated spi- rits, to the part, to allay the itching and tingling occasioned by their bites. BITES OF VENOMOUS ANIMALS. Treatment.—The bites of venomous animals are cured by the same means, which are very simple, if the remedies were always at hand. The caustic volatile alkali, or eau de luce, is a certain an- tidote against the bites or stings of the most venomous serpents or * 320 hydrophobia. spiders. Lint wetted with either of these should instantly be ap- plied to the injured part, and renewed as it becomes dry. A tea- spoonful of the same medicine must also be given to the patient in a little water, every hour, or oftener, as may be indicated by the symptoms. Lunar caustic possesses the same admirable virtue, and should al- ways be employed, when the other medicines are not at hand. The best mode of using it, is to dissolve five or six grains of the caustic in two or three ounces of water, and keep the affected parts moist- ened with it, as above directed. Some of the same ought also to be given internally, only in a more diluted state. When these reme- dies cannot be procured, a cataplasm, made of quick-lime and soap, should be applied to the bitten part, and as much Cayenne, or red pepper, mixed in spirits, swallowed every hour or two, as the sto- mach can possibly bear. The juice of plantain and hoar-hound, in doses of a table-spoonful every hour or two, is considered a good remedy against the bites of venomous serpents, as is also squirrel ear. (*See Materia Medica.) As soon as the person is bitten by a poisonous animal, a tight liga- ture should be made above the injured part, until suitable remedies can be employed. When the toe or finger is bitten, cutting it off immediately will prevent mischief from the poison. It is also a fact that sucking the wound, immediately after being bitten, will arrest the progress of the poison. This was lately ver- ified in the neighborhood of Augusta, in the case of a youth who was bitten by a rattle-snake, and the wound being instantly sucked by a man present, prevented its mischievous effects ; nor did any injury result to the operator. When this remedy is resorted to, it may be prudent for the ope- rator to guard his mouth with sweet oil or milk, and not swallow the saliva. It should never be attempted by a person with a sore mouth or very bad teeth. HYDROPHOBIA, OR THE BITE OF A MAD DOG. This disease is so dreadfully alarming at all times, that we ought, as the best means of security, to endeavor to prevent it. Therefore, as the infection of a rabid animal is conveyed by his teeth into the wound, the sooner it be removed, the less chance is there for absorption. Consequently, the bitten part should imme- diately be washed ; and, where it can be cut out, this should be done deeper and more extensively than the wound itself. Then apply a cupping-glass, with previous scarification, and cauterize the wound with lunar caustic. If the wounded part cannot be excised from its situation, it must be well washed, and then scarified, and GUINEA WORM. 321 a free discharge of blood promoted by a cupping-glass. This be- ing done, the bitten part is to be well cauterized with caustic, and a proper discharge kept up for a considerable time. In addition to this treatment, we should diligently employ mer- cury, both internally and externally, to excite a salivation. Opium, in such doses as are given in tetany, has been said to produce be- neficial effects. A strong solution of arsenic, in water, has been recommended as an excellent wash for wounds inflicted by rabid animals ; this having been found to possess the power of destroying the poison, and thereby preventing hydrophobia from taking place. It is probable, the caustic volatile alkali, might prove an antidote against either the poison of a rabid animal, or that of the most ve- nomous serpents. The scull-cap, chick-weed, and emetic weed, (see Materia Me~ . it firmly, until the warmth of the part secures it; but if the wound ; be deep, this contact of the sides must be made by sutures. In forming sutures, it should be observed, that one stitch, or su- ture, is sufficient for every inch of wound, and that the ligature j or stitch should always be carried near the bottom of the wound, ;; and the threads passed from within, outwards. Thus, a needle be- 5 ing put upon each end of the same thread, well waxed, and each j of the needles inserted at the bottom of the sore, when pushed out- ./ wardly, about half an inch to an inch from the edge of the wound, ; according to its depth, will form one stitch, and the needle being { withdrawn, the same thing must be repeated, according to the ex- >. tent of the wound. When all the stitches are completed, the lips L of the wound are to be pressed together, and supported in that po- I, sition, until the ligatures are tied in the manner as already directed J for making a surgeon's knot. ! It is of consequence to observe, that where the sutures or adhe- r sive plasters have been neglected at first, they may be employed with p advantage during any stage of the sore, as the parts will unite at P; any time very readily ; and it will expedite the cure very much, to k bring the edges of the ulcer into contact, whenever it can be done. ^ wounds. 333 When the parts are brought together, in the manner directed, in order to prevent the access of air, it will be proper to cover them with lint, spread either with a thick mucilage of some mild gum, or some bland ointment; as the simple saturine, or thorn apple oint- merit. In debilitated or relaxed habits, apply Turlington's balsam. (See Dispensatory.) The first dressing of wounds should never be removed, until the cure be completed, or until they appear covered with matter, unless the pain in the wound become severe, and be productive of much inflammation; and then the dressings should immediately be re- moved, and the parts gently rubbed with some olive oil, and a plas- ter of saturine cerate, spread on soft lint, applied. If this prove insufficient, and the inflammation be observed to rise still higher, a separation of the lips, the stitches tense, and the points where stitches pass, particularly inflamed, cut the ligatures, and take away every thing that is like stricture upon the wound. All hopes of procuring adhesion must now be abandoned, and the wound should be brought to a speedy and plentiful suppuration, by flax-seed, or milk and bread poultices, often renewed ; and as soon as there is a full appearance of pus with relief of the more violent symptoms of inflammation, the poultices should be laid aside, and the sore ; then treated as a simple ulcer. ;: When the sutures or plasters have been applied, and the symp- toms of pain and inflammation continue moderate, they may gene- rally be removed about the fifth or sixth day, as a union will by that time be produced. L. Gun-shot;# or lacerated and contused wounds, as marked by their ragged and unequal edges, are the most dangerous of all oth- «: ers, from their disposition to gangrene. Hence, it is obvious, that ■■;. in these wounds, the means to guard against mortification should be early employed. In the treatment of wounds of this descrip- , tion, three stages are to be observed in its progress, which may be i; termed the inflammatory, suppurant, and the incarnating. In the management of the first or inflammatory stage, especially if the pa- r tient complain of much pain, blood-letting should be had recourse to, • and repeated according to the violence of inflammation and strength . of the patient; and, if possible to procure leeches, these should be t applied near the edges of the sore. Emollients are then to be us- ed, as pledgets of mild ointments on the wound, with poultices of lif bread and milk, or flax-seed laid above, and renewed every three j, or four hours, in order to promote a speedy suppuration, which are ^ the best means of preventing gangrene. When the pus is freely * Speaking of gun-shot wounds reminds me of a most awful and melancholy event, which not long since took place in Charleston, S. C.—I mean the death of the great physician and fll historian, Dr. David Ramsay. i J This gentleman, whose urbanity of manners, and extraordinary literary acquisitions, had ren- W* dered him the brightest ornament of science and society, was suddenly cut off amidst his use- illjlt fulness to his family and country, by the pistol of a lunatic. The untimely fate of so truly ami- 11 able a man, and so distinguished a physician and patriot, as Dr. Ramsay, will long be remem- Iw'bered with the deepest regret. 334 WOUNDS. formed, a separation of the most injured parts takes place, and as soon as they have come away, the edges of the wound may be brought together by plasters or bandages, but no kind of suture should be employed ; and the sore will then come to be treated as a simple ulcer. In the second or suppurant stage, the chief point is to check the excess of suppuration, and dispose the wound to heal. This de- pends on a light nourishing diet, with wine, and the plentiful exhi- bition of bark and elixir vitriol. The third or incarnating stage is promoted, by placing the mem- ber in a proper position, to give a free discharge of matter, assist- ed by pressure at the same time, and by opening every collection which appears, by removing splinters, bones, or whatever causes ir- ritation ; and by healing with astringent dressing of lint, dipped in the solution of alkali, lime-water, or any of the astringent washes, (see Dispensatory,) when the discharge is excessive. In the progress of wounds, certain constitutional symptoms arise, that demand particular attention : these are pain, inflammation, and convulsive affections. The first of these usually goes off in a short time, by attending to the posture and ease of the wounded part, and moving any extraneous irritation ; but when it continues very violent, and for a longer time than usual, it will be necessary, in the first place, to try the effects of laudanum, in doses of eight or ten drops every two or four hours; and when the inflammation is violent, to unload the vessels by topical bleedings ; which may be farther aided by fomentations and emollient poultices. If these be insufficient, and the pain still continue acute, it probably depends on a partial separation of nerves; to relieve which, a complete di- vision of them should be made. The latter complaints are spas- modic, which vary in degree from the slightest convulsive twitching, to the highest state of the spasm in the attack of the lock jaw. They are frequently the effects of trifling injuries : a small scratch, for instance, which does not penetrate to a greater depth than the skin, will sometimes induce them ; and, when they happen as the conse- quence of large wounds, they do not make their appearance until the sore seems nearly healed. Upon the first symptoms of these affections, the patient should be immersed in a bath of warm water, soap-suds, or a lie made with wood ashes, as long as he can bear it, and opium should be exhibited in pretty large doses, every two or three hours, as the symptoms may indicate. When this fails, the malady is to be treat- ed by remedies prescribed for tetany. The constitutional treatment of wounds requires, during the in- flammatory stage, the strictest attention to the cooling regimen, a ; low spare diet, the occasional use of laxatives, and the wounded j part kept in such a situation as affords most relief. When suppu- ration is formed, a fuller diet will then be necessary ; and if the $ discharge of matter be excessive, bark and elixir vitriol must be \ employed. r, MORTIFICATION. 335 MORTIFICATION. The word mortification, in its present acceptation or meaning, is generally supposed to have place where the circulation is no longer performed through the diseased part, which generally turns black, and becomes putrid, producing a separation of the diseased surface from the sound flesh, like an eschar, in consequence of a caustic having been applied. In the incipient stage of this disease, which is termed gangrene, there is generally a very high degree of inflam- mation, and a swelling of the parts affected, with some vesications, like those from scalds, but of different colors, according to the ex- travasated fluid, with which they are replete ; sometimes pellucid or yellow, at other times black or brownish. While things are in this state, attempts should be made^to prevent a sudden change to a mortification : but, in order to effect this, it must be observed, that a tendency to mortify may be owing to very opposite causes. It must, therefore, be extremely obvious to every man of consideration, that there cannot be any thing properly a spe- cific for a disease, where a plethora or fulness is the cause in one subject, and inattention in another. We know very well that all inflammations may terminate in mor- tifications. It is also of importance to know, that where there is a languid circulation, as in old age, or in cases of excessive debility, ' from protracted fevers, the extremities not only threaten soon to be- come gangrenous, but the progress to mortification is often very rapid under such circumstances; for not only the vital heat is t deficient, but the vessels themselves are frequently diseased ; and, though duly distended with blood, are incapable of reacting on the : contained fluid, which, consequently, in time, must stagnate in the small vessels. Hence, it is obvious, that a mortification may proceed from a cir- culation that is too rapid, or too languid ; and, consequently, the i treatment must vary according to circumstances, and the cause of , . disease. In the first case, general blood-letting, diluent drinks, with nitre i dissolved in them, and the cooling regimen in every respect, are uC: indispensable for its cure. And in the second, a liberal use of cor- ,,; dials and invigorating medicines, as wine and bark, to raise and main- rs i tain the vital heat, and to check the progress of putrefaction, can jdef- alone be depended upon. When the mortification proceeds from too languid a circulation, j.r or when there is much pain, opium or laudanum is one of the great- .;|fS. est cordials, and should be taken freely every three or four hours, ',,,',- but not in such doses as to produce a narcotic effect. s The best external application to arrest the course of gangrene or '^mortification, is to apply a blister over the gangrenous part, suffi- 11 gentry large to cover one or two inches of the sound flesh, and after- Wards to dress the part with cataplasms, made of bark, charcoal 336 SPRAINS AND BRUISES.--DISLOCATIONS. powder, and yeast, to be renewed every three or four hours, or as Often as they acquire a putrid smell. When the mortified parts begin to separate, remove no more at each dressing than comes away without pain or loss of blood; and as soon as the gangrene stops, and granulations of good flesh ap- pear, it is to be treated as a simple ulcer. SPRAINS AND BRUISES. In the treatment of sprains and bruises, the chief point is to give an instantaneous vigor to the solids, so as to prevent the increase of effusion. Hence, the part should be instantly plunged into cold wa- ter. After this, cloths wetted with vinegar or lead-water, to which, laudanum may be added, should be applied, and renewed as fast as they grow warm, until the pain and inflammation have somewhat subsided. The sprained part may then be dressed two or three times a-day, with a bandage of brown paper, dipped in warm vinegar and spirits, or embrocated with opodeldoc or volatile liniment, (see Dis- pensatory,) always observing to preserve the part in the easiest and most relaxed posture. In addition to this local treatment, if the patient be of a plethoric habit, or the injury very severe, blood-letting, cooling carthartics, and a light diet, are particularly enjoined. When bruises have been neglected at the onset, or become painful, warm fomentations of bitter nerbs are extremely useful; and their good effects will be considerably aided by applying the ingredients themselves as a poul- tice to the part, as warm as can be borne, and sprinkled with a little finely powdered camphor. After serious sprains, the patient often complains of weakness and uneasiness in the injured parts. In such cases, a stream of cold water poured on the part at a considerable height, from the spout of a tea-kettle or pitcher, two or three times a-day, completes the cure, especially if a flesh brush or flannel be vigorously used immediately before and after the application. - Some assistance will likewise be obtained by the use of a bandage or roller, to con- fine the swelling when that symptom occurs. DISLOCATIONS. Dislocation is the removal, by force, of an articulated bone from its natural situation, which is easily known by a degree of protube- rance on one side, equalled by a corresponding hollow on the oth- er; by comparing the joint of one member injured with its fellow;. by an inability to move the injured limb; and by pain and tension in the part affected. In whatever part adisjocation happens, it is Dislocations. 337 of great importance to have it reduced as soon as possible, because, by delay, the operation becomes extremely difficult, and is very fre- quently rendered impracticable, after the inflammation and swell- ing have come on. Therefore, whenever this accident happens in the country, if me- dical assistance cannot immediately be obtained, the most intelli- gent person present should reduce the bone. In the replacing of dislocated limbs, the principal object to be attended to, is the mode in which the extension is made; for the success of the operation depends more on this, than the force with which it may be applied. Therefore, gradually extending from one side to the other, and gently moving it upwards and downwards, is more likely to succeed, than strong extension in a right line: the force should be begun very gradually, and increase slowly at each trial, in case it resists the first. In case of a luxation being obsti- nate to reduce, bleeding, so as to cause faintness, may often be us- ed advantageously, and whilst the patient is in a weak state, there is a greater probability of success, from extension well directed; the operator, at the same time, endeavoring, with his hands, to re- place the dislocated end of the bone. After the bone is replaced, compresses made by two or three folds of old linen, wetted with vinegar or lead-water, should be con- stantly applied to the part, in order to obviate inflammation ; and the limb should be retained in its natural situation, by bandages, which should neither be applied over-tight, nor over-loose ; as in one case, they would compress too much, and in the other, they would be of no use to the parts. Where inflammation has taken place before the reduction is ac- complished, it cannot be performed until that be overcome. For this purpose, we must adopt the antiphlogistic plan, such as bleed- ing, keeping the bowels in a laxative state, by the occasional use of the cathartic mixture, and using warm drinks, together with the camphorated powders, and the antimonial solution, (see Dispensa- tory,) in their usual doses, in order to promote perspiration. DISLOCATION OF THE JAW, The lower jaw may be luxated by yawning, blows, falls, chew- ing hard substances, or the like. This accident may be known to have taken place from the patient's being unable to shut his mouth, or eat any thing. The chin, likewise, either hangs down, or is wrested to one side ; and the patient is neither able to speak dis- tinctly, nor to swallow without considerable difficulty. The common method of reducing a dislocated jaw is to place the patient upon a low stool, in such a manner, that an assistant may hold the head firmly, by pressing it against his breast. The operator is then to push his two thumbs, (protected with linen cloths, that they may not be bitten when the jaw slips into its place,) as far back into the patient's mouth as he can, and then, with his fin- 43 338 DISLOCATIONS. gers applied to the outside of the angle of the jaw, endeavor to bring it forward, till it move a little from its situation. He should then press it forcibly downwards, and backwards ; by which means the elapsed heads of the jaw will immediately slip into their place. DISLOCATION OF THE SHOULDER. The humerus or upper bone of the arm is the most subject to dislocation of any in the body, and may be luxated in various di- rections. The accident, however, happens most frequently down- wards, and very seldom directly upwards. This dislocation may be discovered by the patient's inability to raise his arm, as well as by violent pain in attempting it, and by a depression of cavity on the top of the shoulder. When the dislocation is downward or forward, the arm is lengthened, and a ball or lump is perceived un- der the arm-pit; but when it is backward, there appears a protube- rance behind the shoulder, and the arm is thrown forward towards the breast. The usual mode of reducing a dislocation of shoulder is to set the patient upon a low stool, and to cause an assistant to hold his j body firmly, while another lays hold of his arm a little above the 1 elbow, and gradually extends it. The operator then puts a nap- kin under the patient's arm, and causes it to be tied behind his I own neck. By this, while a sufficient extension is made, he lifts up the head of the bone, and with his hands directs it into its pro- per place. In young and delicate persons, an operator may gene- rally reduce this dislocation by extending the arm with one hand and thrusting in the head of the bone with the other. In making j the extension, the elbow ought always to be a little bent. If much difficulty occur in the operation, blood-letting, sometimes so far as to produce fainting, becomes necessary. This remedy seldom fails to facilitate the reduction. DISLOCATION OF THE ELBOW. The bones of the fore-arm may be dislocated in any direction, but most commonly upwards and backwards. In this luxation, a protuberance may be observed on that side of the arm towards :j« which the bone is pushed ; from which circumstance, joined to the patient's inability to bend his arm, a luxation at the elbow may be known. u For reducing a dislocation at the elbow, two assistants are, for the e most part, necessary: one of them must lay hold of the arm above, i and the other below the joint, and make a pretty strong extension, >.( while the operator returns the bones into their proper place. The ■■; arm must afterwards be bent, and suspended for some time with a ^ sling about the neck. "t Dislocations of the wrist and fingers are to be reduced in the it same manner as those of the elbow ; namely, by making an extension \ INJURIES OF THE HEAD. 339 in different directions and thrusting the head of the bone into its place. DISLOCATION OF THE THIGH. When the thigh-bone is dislocated forward and downward, the knee and foot are turned out, and the limb is longer than the other; but when it is displaced backward, it is usually pushed upward at the same time, by which means the limb is shortened, and the foot is turned inward. When the thigh-bone is displaced forward and downward, the patient, in order to its reduction, must be laid upon his back, and made fast by bandages, or held by assistants, wbile by others an ex- tension is made by means of slings, fixed about the bottom of the thigh, a little above the knee while the extension is made, the ope- rator must push the head of the bone outward until it gets into the socket. If the dislocation be outward, the patient must be laid on his face, and during the extension the head of the bone must be pushed inward. Dislocations of the knees, ankles, and toes, are reduced much in the same manner as those of the upper extremities; namely, by making an extension in opposite directions, while the operator re- : places the bones. In many cases, however, the extension alone is sufficient, and the bone will slip into its place merely by pulling the r limb with sufficient force. It is not hereby meant that force alone 2 is sufficient for the reduction of dislocations. Skill and dexterity r; will often succeed better than force; and one man who possesses s; them has been able to perform what the united force of many was found inadequate to accomplish. INJURIES OF THE HEAD, AND FRACTURES OF THE LIMBS. If, in consequence of a bad fall, or blow, a considerable injury appear to have been received, the sufferer being unable, in con- sequence of the loss of his senses, to point out the injured part, 1 some consideration is necessary, before any attempts are made even to raise him from the ground. Because, should a fracture of one of the bones have happened, and not suspected by his assistants, &\ their exertions to raise him, and to place him on his feet, might "J force the ends of the fractured bone through the soft part, and con- • vert a simple fracture into a very dangerous compound one. The ace limbs, therefore, should be carefully examined; but even if they 1,116 seem to have sustained no material injury, yet should the pa- tient not be precipitately raised, until something be provided, on ^ which he may be placed ; as, thereby, unnecessary and perhaps in- jurious exertions are avoided. 340 FRACTURES OF THE LIMBS. As it will be fair to conclude, from the deprivation of the senses, that the brain may have sustained some injury, great care should be taken to convey the patient to his apartment, with as little in- jury as possible; and, whilst lying in bed, the head should be some- what raised. If the patient be of a plethoric habit, a moderate bleeding will be required as soon as possible after the accident; af- ter which, the bowels should be evacuated either by purgative me- dicines or clysters. One or two stools being procured, and if pos- sible the warm bath used, the anodyne sudorific drops, (see Dis- pensatory,) should next be exhibited to produce perspiration, and to excite absorption of the extravasated blood ; and this mixture should be continued, in doses of ten or twelve drops, every four or six hours, until the patient is out of danger, observing to keep the bowels open. Emring convalescence, the bark, Columbo, or steel, with wine may be employed. If there be a laceration of the scalp, every at- tempt should be made to induce suppuration of the part, by the application of warm fomentations or poultices, and this taking place, a relief of all the symptoms will occur, when it is to be treated as a simple wound. But should it be discovered, that a leg or thigh is broken, the patient is not to be stirred until a proper vehicle, as a door, or two or three boards well secured together, is procured, on which he can be placed. To place him on this, two persons may raise him by means of a sheet slid under his hips, whilst one raises him by the shoulders, one person raising the sound leg, and; one carefully con- ducting the fractured limb, which should be placed on a pillow, with the knee a little bent. The best mode of conv«yance is undoubt- edly by two or four men, and a carriage should never be employed,. when this mode can be adopted. As the patient will be under the necessity of lying some time without getting up,, much subsequent pain and exertion will be prevented by preparing the bed in the following manner:— In place of the laced canvas, bottom boards aie to be laid across the bed frame, which makes the bed hard, and keeps it perfectly level and smooth during the cure. In place of a feather bed, a mattress only is to be laid above those boards ; over this another, cut intov four parts, with a piece of a sheet sewed round each por- tion, is to be placed, that they may be shifted under the patient from time to time. On the bed, thus prepared, a pillow, like a mat- tress, flat and firm, is to be laid for receiving the limb. In setting a broken bone, very little extension is required, nor should tight and firm bandages be used, which give considerable pain to the patient without the least benefit. In a simple fracture of the thigh or leg, with patients not unruly, very little more is ne- cessary than to restore the foot to a right direction with regard to the leg, and then stretch out the limb on a well made pillow, ob- serving to extend, straighten, and lay it anew, when it is disorder- ed or shortened, without fear of hurting the callus. And when you have placed the limb between two splints, or tjoughs, made of FRACTURES OF THE LIMBS. 341 untanned leather or pasteboard, which have been previously soaked and softened, the whole braced down with ribands or tapes, to pre- serve it steady, you have done every thing. Having prepared two long troughs, or pieces of untanned leather or pasteboard bent in a hollow form, lined, or rather cushioned with two or three folds of flannel, with tapes or ribands, four or five in number, attached to the outside of one of the splints, by which both splints may, after all is over, be gently tied together with bow knots, to be slackened or tightened, according to the swelling of the limb; you are then to place these by the side of the fractured leg, and direct one of the assistants to apply his hands broad around the upper part of the limb, and grasp it gently and steadily ; take the foot and ankle in the same manner in your own hand • slip your left hand under the broken part of the limb, slide it gent- ly along, and then lay it upon the splints, to which the ribands are attached. If the bone cannot be reduced by this extension, endeavor to force it in with your thumbs. Begin then to lay the limb smooth ; let your assistant again grasp it, by spreading his hands upon the thigh, or below the knee, with the design of extending, along with you, not by lifting the leg from the pillow, but rather by keeping it down, and steadying it by pressure, while you, with both hands, lift the foot and ankle, grasp them gently, but firmly; raise them a little from the pillow, and draw gently, steadily, and smoothly. When you have thus extended and smoothed the broken leg, in a manner which you almost suppose agreeable, rather than painful, to the patient, press it down gently, and steadily upon the lower splint; the upper is then to be laid above it; and by grasping the soft and moistened splints, you must model them a little to the shape of the limbs. When the whole has taken a form, tie several tapes, one after another; and after having tied them in a general way, go over them again, one by one, and tie them a little closer, so as to ' keep the limb agreeably firm. The process is either slower or more imperfect in children and old people: their bones, therefore, are more apt to be broken again ; hence, with them, the splints should be kept longer applied. On particular occasions, also, particular precautions must be taken. Thus, with delirious patients, and those who are liable to sudden motion, as when at sea, the limb, after being set, must be laid be- tween two pillows, and the pillow's fastened to the bed. It is also sometimes necessary to make the splints more secure, and this may be done by soaking a roller or bandage in whites of eggs mixed with a little flour; or by strewing a little powdered rosin on the bandage, and afterwards soaking it with spirits of wine ; or, finally by soaking the bandage with fine glue, which makes a firm Case^ and is far from being offensive. Lastly, though splints and bandages, in general, are unnecessary during the cure; yet, when a patient rises from bed, rests the weight of his body on a fractured bone, and begins to be exposed 342 FRACTURES OF THE LIMBS. to accidents, the splints laid along the limb should be made firm by a bandage or roller as above described, to prevent those accidents which may be incurred by precipitation and rashness. In fractures of the arm, the parts hang naturally in the best posture, and require but two splints of thin pasteboard, rolled gently with a linen roller : and, in fractures of the forearm, the limb pre- serves its natural length or form ; it requires merely to be laid up- on a long splint of pasteboard, with a small splint laid above, the two splints being secured with light ribands or tapes, and the arm, from the elbow to the fingers' ends, supported by a sling or hand- kerchief round the neck, raising the palm of the hand to the breast, with the fingers moderately bent. When the arm is fractured between the elbow and shoulder, the forearm may be placed in the same position, as already described; but the sling, instead of supporting the whole length of the arm, should only support the hand, which should be raised higher than in the former case, the elbow being allowed to sink; its motion, however, being prevented, by a handkerchief passed moderately tight round the trunk, including the fractured arm. When the small bones happen to be fractured, they must be re- placed and retained in their situation, by splints and bandages fit- ted to the part. In using splints of pasteboard or untanned lea- ther, it is always necessary they should be applied, in the first in- stance, wet, so as to assume the form of the fractured part. After the first fortnight, the dressings should be occasionally removed, to allow some motion of the joints; and then replaced, and daily re- moved for the same purpose. When there is an external wound, communicating with the ca- vity of the fracture, it is termed a compound fracture. This some- times occurs by the protrusion of the bone ; at other times by the same force which caused the fracture. In such cases, the bone is to be reduced by carefully attending to the posture of the limb, and by dilating the wound, when the bone becomes girded in it. The wound is then to be dressed with dry lint, in order to allow the blood to coagulate, which will form a kind of scab, and every effort should be made to unite the wound by the first intention, thereby converting the accident to the state of a simple fracture. Almost all fractures are attended with contusion, and, conse- quently, swelling; the abating of which is the first step that should be taken towards the cure, and is to be effected by bleeding, if the patient be of a plethoric habit, by mild purges, a cooling regi- men, and by the exhibition of the anodyne sudorific drops, as al- ready described ; the application ta the parts affected should be vinegar or lead-water, with crumbs of bread, or poultices made of stale beer, or vinegar and oatmeal, with a little oil to prevent their growing dry or stiff. The swelling of the limb being subsided, and the callus formed',. cold water may be poured through the spout of a tea-kettle over the fractured limb, every morning, to restore the tone of the injur- ed parts. FRACTURES OF THE RIBS.--BLOOD-LETTING. 343 ' FRACTURES OF THE RIBS. The ribs are broken for the most part, near the middle. The accident usually proceeds from blows or falls, and is known by an acute pain m breathing, and a crepitus or grating being per- ceived, on pressing the rib in different places. By carefully passing the hand over the rib, the inequality produced by the fracture may be sometimes distinctly felt. Coughing produces a crepitation, which is frequently perceptible to the patient himself as well as to the bystanders. The only treatment necessary, in simple fractures of the ribs, whether one or several be broken, is to keep the part, during the re- union, as much as possible in a state of rest. This is done by coun- teracting, to a considerable extent, their motion in respiration. To effect this, a bandage, six inches wide, is to be passed repeatedly round the chest, as tightly as the patient can suffer it to be drawn. Its slipping down may be prevented by means of a shoulder strap. Or, instead of a roller, a jacket, of strong linen, capable of being drawn very tight, by means of tapes, may be used. Until the re- union be completed, the patient should be kept as quiet as possible. If the lungs be wounded by a splinter of the rib, blood will be spit up, and high fever and inflammation will be likely to ensue. In this case, blood must be drawn copiously from the arm ; and the patient should be treated, in all respects, as if he were laborino- un- der pleurisy. BLOOD-LETTING. The art of opening a Vein, and the necessary cautions respecting the operation, should be learned by every one ; since cases of emer- gency may happen, when the necessity of its being performed is evident, and where life may be lost before medical assistance can be obtained. Another qualification necessary to be possessed, is that of being able to stop the flow of blood from a Vein thus opened. To bleed, you are to apply a riband or ligature with a degree of tightness, an inch or two above the elbow joint; and as soon as a vein is conspicuous, place the thumb of your left hand about an inch below the place of your puncture, and then with your right hand, holding the lancet firmly betwixt your thumb and fore finger, make' an incision obliquely into the vein, without changing its direction or raising the handle, lest the point, being lowered in proportion, should cut the under part of the vein, ot perhaps even wound an artery.* * To discriminate between an artery and vein, is a matter of the utmost importance. This is readily done if proper attention be paid. The chief mark of distinction is, that the artery has a pulsation which the vein has not. But frequently it happens, that an artery lies so immediately under a vein, that its pulsation 344 BLOOD-LETTING. When the quantity of blood you wish is drawn, untie the ligature, and close the orifice. To accomplish this, let the thumb be placed on the orifice, so as to bring its sides together, and to press it with a moderate force. The flow of blood will now be stopped, and the operator, with the hand, must apply a compress, made by twice doubling a piece of linen, about two inches square, between the ori- fice and his thumb ; over this, place another compress, three or four inches square, of a thickness sufficient to fill up the hollow of the bend of the arm, confining the whole with a riband or tape, passing over the compress, and above and below the elbow, in the form of a figure eight, finishing with a knot over the compress. If the bleeding continue obstinate, the sleeve of the gown or coat above the orifice, ought to be ripped or loosened ; and if this do not succeed, the lips of the incision should be brought nicely together, and while they are compressed firmly by the thumb of the operator, the coldest water should be poured on the arm, or orifice washed with sharp vinegar. The placing of a piece of adhesive plaster over the orifice in the vein generally succeeds in checking the flow of blood. To bleed in the foot, a ligature must be applied above the ankle joint, and after opening the most conspicuous vein, if the flow of blood be not copious, it may be increased by immersion of the part in warm water. On removing the ligature, the blood will readily cease to discharge, and a piece of court-plaster is the best bandage. Topical blood-letting is executed by the application of leeches, as near as possible to the part affected, or by a scarificator, or an in- strument with a number of lancets acted upon by a spring. When leeches are employed they must be previously prepared by drying them, or allowing them to creep over a dry cloth; and the part to attract them should be moistened with cream, sugar, or blood, and they confined on it by applying a wine glass over them. When the scarificator is used, as soon as a wound is made, a cup » exhausted of its atmospheric air, by burning over it, for a few se- conds, a bit of soft paper dipped in the spirit of wine, and on the flame of which, being nearly exhausted, must instantly be applied over the scarified part; when full, it is easily removed by raising one side of it to admit the air. When you have taken away, in this manner, a sufficient quantity of blood, the wounds are to be covered with some cream or mild ointment. In the operation of blood-letting, certain morbid consequences at times arise, which demand a special treatment. The most common of these, is a swelling of the part, termed ec- chymosis; and when it occurs, shifting the position of the arm, so as to induce a free discharge, will lessen the tumor, if not entirely remove it. Should this fail, compresses, dipped in the solution of sal ammoniac or brandy, are to be applied. These also failing, and may be felt through the vein. In such cases, it will be prudent not to open the vein, unless the operator is skilful; for it must be attended with danger. ISSUES. 345 the swelling still continuing, without any diminution, the tumor must be opened, and after removing the coagulated blood, the sore should be treated as a common wound. This result, however, very rarely occurs. Another consequence, which sometimes follows blood-letting, is an acute pain immediately felt on the introduction of the lancet, and communicated from the part to the extremity of the member. The treatment of this complaint consists in the early use of cloths, wrung out of lead-water, applied to the part, and adopting, in ev- ery respect, the antiphlogistic plan, as blood-letting, cooling cathar- tics, and a low diet, to obviate inflammation. This treatment, not succeeding, laudanum must be given in large doses, which, also failing, a free division of the nerve or tendon, which was pricked with the lancet, is the only remedy left. The last accident required to be noticed, is the wounding of an artery, which is known immediately after the operation, by strong compression of the vein, above and below the orifice, by the trem- ulous motion in which the blood flows, and by not being able to stop the discharge as usual. The cure of this affection may be at- tempted in the early stage by compressing, and observing the anti- phlogistic regimen. On their failing, the tumor must be extirpated, and then the ends of the vessel secured by means of a ligature, until a reunion of the parts be effected, when the circulation is made to pursue a different channel. ISSUES. These are a kind of artificial ulcers, formed in different parts of the body, for the purpose of procuring a discharge of purulent matter, which is frequently of advantage in various disorders. Practitioners were formerly of opinion that issues served as drains to carry off noxious humors from the blood ; and, therefore, they placed them as near the affected part as possible. But as it is known that they prove useful, partly by the quantity of matter which they produce, and partly by sympathy, they are generally placed where they will occasion the least inconvenience. The most proper parts for them are, the nape of the neck ; the middle, outer, and fore-parts of the shoulder ; the hollow above the inner side of the knee ; or either side of the back-bone : or between two of the ribs ; or wherever there is a sufficiency of cellular substance for the protection of the parts beneath. The ought never to be plac- ed over the belly of a muscle ; nor over a tendon or thinly covered bone ; nor near any large blood-vessel. The issues commonly used, are the blister-issue, the pea-issue, arid the seton or cord. When a blister-issue is to be used, after the blister is removed, a discharge of matter may be kept up by dressing the part daily with an ointment mixed with a little of the powder of cantharides, or 44 346 MALIGNANT FEVER. Spanish flies. ' If the discharge be too little, more of the powder may be used ; if too great, or if the part be much inflamed, the is- sue-ointment may be laid aside, and the part dressed with basilicon, or with common cerate, till the discharge be diminished, and the inflammation abated. It is sometimes most proper to use the issue-ointment, and a mild one alternately. A pea-issue is formed either by making an incision with a lancet, or by caustic, large enough to admit one or more peas; though, sometimes, instead of peas, kidney-beans, a gentian root, or orange- peel, are used. When the opening is made by an incision, the skin should be pinched up and cut through, of a size sufficient to receive the substance to be put into it. But when it is to be done by caustic, (the common caustic,) or lapis infernalis of the shops an- swers best. It ought to be reduced to a paste with a little water or soft soap, to prevent it from spreading; and an adhesive plaster, with a small hole cut in the centre of it,' should be previously plac- ed, and the caustic paste spread upon the hole. Over the hole, an adhesive plaster should be placed to prevent any caustic from escaping. In ten or twelve hours the whole may be removed, and in three or four days the eschar will separate, when the opening may be filled with peas, or any of the other substances above men- tioned. The seton is used when a large quantity of matter is wanted, and especially from deep-seated parts. It is frequently used in the back of the neck, for diseases of the head or eyes, or between two of the ribs, in affections of the breast. When the cord, which ought to be made of threads of cotton or silk, is to be introduced, the parts at which it is to enter and pass out, should be previously marked with ink, and a small part of the cord being besmeared with some mild ointment, and passed through the eye of the seton needle, the part is to be supported by an as- sistent, and the needle passed fairly through, leaving a few inches of the cord hanging out. The needle is then to be removed, and the part dressed. By this method, matter is produced in quantity proportioned to the degree of irritation applied ; and this can be increased or diminished, by covering the cord daily before it is drawn, with an irritating or mild ointment. MALIGNANT FEVER.* In the year 1823, while the Epidemic Malignant Fever, some- times denominated the Cold Plague was raging in the western *This article, the author wished to place under the head of fevers : but as it could not be , conveniently prepared till the former portion of the volume was in typo, and as the author has not aimed at a strict nosological arrangement, he thought it as well to introduce it at the end of diseases generally. MALIGNANT FEVER. 347 and southern country, and when physicians were unsuccessful in its treatment, and divided about its nature and origin, the author received the following letter* from sundry respectable gentlemen, citizens of Louisiana, asking information from him, as to the man- agement of a disease, which had proved so fatal in their neighbor- hood. The author, having no personal knowledge of the disorder, being far removed from the scene of its devastation, and having no sources for information, on which he could rely, was constrained to decline giving the advice requested. He has since met with the elaborate and satisfactory essays on the subject, written by Samuel A. Cartwright, M. D. of Natchez, Mississippi, and published in the Medical Recorder, Vol. IX., year 1826. From these essays he has made copious extracts, which he presents to his very polite correspondents of Feliciana, and to the public, in general, as the best treatise on the cause, symptoms, and cure of malignant fevers, that has ever been published, and indeed the best which could be gathered from the whole stock of information on the subject, now Feliciana Parish, Louisiana,. September 24th, 1823., * Dr. James Ewell, Dear Sir:—We have perused your Medical Companion, with pleasurable and profitable at- tention, and though professedly ignorant of the science of medicine, we deem that work a valu- able addition to the libraries, and eminently deserving the grateful acknowledgments of yourfel- low citizens, in consequence of its peculiar excellence and utility. That portion, of it dedicated to Materia Medica, the Dispensatory, and a table of Medicine, entitles the author to the grati- tude and respect of many families. From observation, we have found that those physicians are the most successful in their practice who have followed the directions which you nave offered to the public. Entertaining an exalted opinion of your professional talents, we have concurred in address- in" this epistle to you, in the confident expectation, that your popular benevolence will prompt you to favor us with your valued advice on a disease, generally acknowledged mortiferous in this section of the union, which of all others has most severely suffered from annual epidemic distem- pers, mostly of a febrile description. . The Cold Plague is the ordinary denomination of the formidable malady to which we allude, and for which no adequate remedy has, as yet, been discovered. To afford you some idea of its prevalence and malignity, we state the fact, that, in the space of ten days, our neighbor, Mr. Waddle, lost six of his household who were attacked by this dis- ease; that he himself is now its victim, and is hurrying to the threshold of eternity ; while his sister is, at the same time, confined to her bed, with all the symptoms of the same complaint ; and this, sir, is but one instance of many thousands of the fatality of that disease, which annu- ally desolates Louisiana and the bordering state of Mississippi. That distance precludes you from personal contemplation of the symptoms of the cold plague, is seriously lamented by us, as it subjects you to disadvantage in prescribing, and us to less cer- tain benefit from your medical knowledge. We will, however, attempt to describe it. One of the undersigned was seized with the cold plague, about the conclusion of August, 1821. Symptoms.—Pain in the stomach extremely violent; a vibrating coldness ; a fever, during which a profuse perspiration took place, of twenty-four hours' continuance. Will it be credited^ that while it was obvious to the physicians, that the patient was in a high fever, the latter felt a death-like coldness, in all parts of his body, except the region of the heart! He was continually thirsty ; and, for three days and nights, complained of extreme pain in the stomach. We earnestly request you, sir, to give your opinion relative to the best method of treating this enemy of Louisiana. Address to Mr. William George Dixon, St. Francisville, Feliciana Parish, Louisiana. (Signed,) Angus Umphraville, T A. W. Dratjghan, "| Benj. O. Williams, ! Es(.->rs Francis Bryan, Robert Dyer, f i Eli Rentz, David Pipes, Sen. J Joseph Drawdy, Jesse Ksighten, JMerchant. H. R. Harrell, N. M. K. Reid, U. S. Surveyor. Joseph Vick, '| g. Wm. G. Dixon, ") Micaiaii Courtney, J * Wm. Campbell, j Robt. Neyland, John Rowley, ? Planters. M. Dickson, I Stephen Suelton, | B. Cha.mx. J 348 MALIGNANT FEVER. possessed by the profession. The thanks of the medical profes- sion, and of the public, are due to Dr. Cartwright for his zeal and industry in investigating this subject, and for the ability with which he has communicated the results of his labors. Symptoms.—The disease was marked by three distinct stages, each of which had its peculiar symptoms. As it might, in its first » and second stages, have been mistaken for some other malady, I will only describe the last stage, which presented features altoge- ther peculiar, and could be confounded with no other disease what- ever. In the last stage there was apparently no fever, and little or no pain. The patient often regained his strength so far as to be able, in the most of cases, to walk about his room. His eyes were of a yellowish red, sparkling appearance, and lent to a countenance, otherwise of apathy, a strange expression of wildness and horror. Black dissolved blood oozed from the mouth, the gums, and the nose ; coffee ground vomit, or a dark brown flaky matter, with but little effort, was thrown from the stomach; anxiety, restlessness, and great flatulency of the stomach, portended- and accompanied its discharge, spasms seized the muscles ; the breathing became heavy, slow, and irregular, attended often by a hoarse, deep, sullen sound. The speech became incoherent; yet, when the patient,. was spoken to, he appeared to be able to collect himself so far as to answer questions rationally, and although sensible of his situation, seemed resigned to his fate. These were the symptoms that cha- racterized the third or last stage of the disease. Although all of them did not invariably occur in every patient, yet a sufficient num- ber were generally present to point out the character of the disease to the medical attendant the moment he entered the sick room. The first stage consisted in a broken or irregular reaction; and the second, or milder stage, in a general excitement diffused throughout the system. The duration of the first stage was ge- nerally from one to twenty-four hours ; and that of the second stage, from one to forty-eight hours. The first stage could readily be distinguished from the second period, by the partial evolution of heat in the one, and the uniformly hot surface of the other. The patient was found covered up with bed-clothes in the first stage, but in the second and third, he greatly preferred lying entirely na- ked. In a great many cases, the worst cases too, the state of the sys- tem which constitutes the second stage, never occurred; but the disease passed immediately from the first to the last stage, without going through the second stage of reaction.—These were called the cold cases of yellow fever, or yellow fever without reaction. The approach of the first stage of the disease was announced by an intoxicated appearance, and a remarkable exhiliration or depres- sion of spirits, and was soon ushered in by a cotemporaneous sen- sation of heat and cold. The patient, although complaining of great internal heat, was often found under one or more blankets, which he would not permit to be removed. His skin, which to him MALIGNANT FEVER. 349 felt excessively hot, was actually cold to the touch. Yawning, stretching, soreness of the flesh, achings of the bones, and, at length, flatulency of the stomach, with great weight and oppression about the praecordia, took place, followed by pain in the head, stomach, and back. The pain, in this stage, was never so severe as in that of general reaction. Indeed, it was sometimes entirely absent. It was re- marked by a very intelligent and accurate observer of the disease, Dr. Gustine, that the most fatal cases were those which were at- tended with the least pain. A want of thirst also attended the disease in its first stage. The tongue was then seldom much furred ; its edges were often red; sometimes, it presented no unusual appearance in the most malig- nant cases. The patient, in this and the second stage, was as anx- ious about 1 iving, as he was indifferent and careless of life in the last stage. Treatment.—Experience has long since proved that the same remedies produce very different effects in different diseases, and in different stages of the same disease. Stimulants, emetics, cathartics, &c, are the only relative terms ; for, in many conditions of the system stimulants impart no strength, tartar emetic will not puke, nor will calomel purge orsalivate. I shall first point out the state of the system in which they were used, the effect they produced, and the manner in which they influenced the disease. In all important cases, J was in the habit of noting the state of the system when a remedy was given, and on my next visit, noting also the changes produced in the disease. When a remedy, in any particular state of the system, was found to be pernicious or useless, it was not concluded to be pernicious or useless in all states of the system, but only under those particular circumstan- ces in which it had been proved to be so. When the disease ter- minated fatally, I looked back on the situation of the patient when the remedies had been used, their effects on the disease, and imme- diately proceeded to make post mortem examinations, and to note down every morbid appearance. Having the charge of Natchez hospi- tal, from the 6th of September, until the epidemic terminated in No- vember, I had an excellent field for observation. Patients of every de- scription were admitted, and in every stage of the disease,—some who had been under the treatment of other physicians, and others who had taken no medicine. This hospital, with my private prac- tice in the city, in which I resided during the epidemic, and the ex- perience of the disease in my own person, in the present, and also in a former epidemic, are the sources from which the following ob- servations have been drawn. I have seen patients recover from yellow fever under very different, and apparently, opposite modes of treatment. The narrow views which are too often formed of the action of medicines, and of the laws which regulate the system, aid- ed by the dogmas of the schools, have, until within a few years past, shackled the science of medicine, and hindered its progress. Facts 350 malignant fever. are yet too often overlooked or disregarded, when they do net sup- port some slender-built theory, or favorite hypothesis. In the first stage of yellow fever, or that in which consists of an ataxic or crippled reaction, when the blood is unequally determined, the heat unequally diffused, sensation impaired, and secretion sus- pended, I found no other remedy, or combination of remedies, which produced such decided effects, as tartar emetic, in full doses. It, however, seemed sometimes inadequate to make a sufficient impres- sion on the torpid system. When given in this stage of the disease, its effects were not so soon apparent, as in the healthy state of the system, or in less violent diseases. Very often, it would be an hour or more, after a full dose had been taken, before the system appeared to feel it. At length, that peculiar sensation of heat and cold, at the same time, would somewhat yield to a sensation of heat only; the temperature of the skin would become more uniform, and as the ex- citement was brought out, great distress would ensue, and the system appeared to arouse from its torpor, and to regain, in some measure, its organic sensibility. Some one or more of the great organs of se- cretion now took on a secretory action. The nausea, the retching and anxiety, soon gave way to full vomiting, first of phlegm, and then of bile. This, to a spectator, was an alarming period in the disease, and most distressing to the patient. The powers of life would some- times appear as if they were about to give way under it, but happily it was only in appearance. The vomiting at length subsided, and the patient enjoyed a little respite from his sufferings, and, bathed in a perspiration, he would fall into a slumber of short duration, for these were only the first effects which tartar emetic produced on the system. Soon reaction took place, and the disease passed into the second stage ; but the reaction was general, and lost its ataxic or broken character ; it was accompanied with a hot skin, violent pain, and a full, strong, tense pulse. The patient would now com- plain of excessive misery. I delighted to see the disease come out thus openly, and show itself by fever and pain ; for, although the patient might fancy himself worse, yet he was far removed from the danger which attended on the ataxic fever from which his sys- tem had just emerged, and only required a bold use of the lancet, and other remedies hereafter to be mentioned, to restore him to health. But it was not always the tartar emetic, when given in the first stage, would produce vomiting. In those cases in the first stage, in which the skin was cold, and even when the reaction was ataxic and scarcely perceptible, the organs as if palsied, secretion entirely suspended or strangely vitiated, the stomach irritable, and little or no pain complained of, tartar emetic, in full doses, might be given without producing vomiting. Strange as it may appear, tar- tar emetic, in such cases, was a most powerful stimulus; it brought out the excitement, heated the skin, raised the pulse, allayed the ir- ritability of the stomach, restored sensibility to the organs, and finally awakened one or more of them, the kidneys, skin, &c, to ac- tive secretion. To have this effect, it should be given in doses of MALIGNANT fever. 351 from three to ten grains every one, two, or three hours, dissolved in a small quantity of water, or what is better, as I have since learned, in similar states of the system, in pills. When secretion has been brought about by the remedy used in this way, and the excitement developed, it should not, at once, but gradually, be discontinued, by giving smaller portions at longer intervals. Should a vomiting ensue before the skin has its heat and sensibility some- what restored, bile will rarely be evacuated: in this event, another dose of the medicine should be immediately given, and repeated whenever great nausea ensues. I have rarely seen this practice fail, in such states of the system, to check the vomiting and heat the skin, when mustard and blisters had failed. It will be remem- bered, that those which are denominated cold cases, are the most hopeless. I have used the hot bath, frictions, sinapisms, blisters, besides various internal stimulants to bring on reaction ; but the combined influence of all these remedies has never had the same beneficial effect as tartar emetic alone. But in some cases of this kind, particularly in hard drinkers, it fails to produce secretion, and to develop excitement. It may be imagined by men in their closets, that these are cases of congestion only, which1 congestion could rea- dily be removed by small and repeated bleedings combined with in- ternal and external stimulants. If the malignant nature of these cases depend entirely on congestion, it is a very different congestion from that which takes place in many other diseases. It the lat- ter, I have often succeeded in removing the congestion, by blood- letting, combined with internal and external stimulants ; but in the cold cases of yellow fever, never. In such cases, if blood be taken away, even should the patient not immediately sink under it, so far from reaction being produced, the blood vessels lose more and more of their contractile power ; stimulants impart no strength ; the warm bath and rubefacients produce no more effect on the skin than if ap- plied to so much leather * the organs become more paralyzed ; the sympathies more deranged ; and the whole system soon appears as if it were divided into different parts, one not depending on another, and each having the principal of life diminished in it. In- stead, then, of using blood-letting in such cases, to remove conges- tion, I used tartar emetic to produce secretion, and to develop the excitement. Although tartar emetic was sometimes inadequate to produce these desirable effects in the cold cases, it scarcly ever failed to be eminently serviceable in the first stage of cases of a less malignant nature. The earlier it was given in the first stage of the disease, the better. When given freely, so as to produce secre- tion in the liver, kidneys, and skin, a general and equable reaction soon succeeded. It shortened the duration of the first stage, or that of ataxic reaction, and thereby converted a highly malignant into a mild case of yellow fever. For, in the mild cases, when left to nature, the first stage continues but a short time, and the disease soon passes into the second, or that of general reaction. These are the cases which bear bleeding and purging so well, and 352 MALIGNANT FEVER. in which emetics are of no service, (unless given before the gene- ral reaction has taken place. The good effects of emetics appear to depend on their ultimately producing a general and equable'ex- citement throughout the system. In the more malignant forms of yellow fever, the stage of ataxic reaction, when left to nature, con- tinues a longer time ; and should the second stage, or stage of ge- neraPexcitement ever occur, its duration is so limited, that a suffi- cient time is not given to subdue the disease, before it passes into the third and last stage. Tartar emetic, then, given in the first stage, shortens its duration, and places the system in a similar state to what we find it in the milder forms of the disease. And, in proportion as the ataxic stage is shortened, so is the stage of gene- ral excitement prolonged, and the chances of the patient's recovery greatly increased. On looking over my notes, I perceived, that when it had been given in the first stage, such patients not only bore bleeding better, and could be purged more easily, than those to whom it had not been given ; but whether they lived or died, the symptoms of the second stage, or that of reaction, continued longer than when tar- tar emetic had been omitted.—For in those cases in which it had not been given, should the stage of reaction ever occur, it continu- ed but a short time, frequently not more than an hour; then exter- nal reaction, like the blaze of recently ignited coals, would subside, not from the fire having been extinguished, but from the heat which supported it having become greater. My notes, likewise, showed me that tartar emetic, however well adapted to some states of the system, was not so to every one in yellow fever. For when it had been given in the stage of general reaction, its effects were ex- tremely equivocal, and, in some cases, injurious; and in the third stage, it appeared to accelerate the fatal black vomiting. I thus found that I had pushed a favorite remedy too far, by using it im- properly ; and, at the same time, learned the particular states of the system to which it was peculiarly adapted ; namely, during the first stage of the disease, antecedently to the development of a general reaction. Tartar emetic used in this stage, restored sensibility to the torpid organs, produced secretion, and 'destroyed the ataxic charac- ter of the disease, by establishing a general and equable excitement; or, in other words, converted an irregular and intractable condition of the system, into an open, plain, and manageable case of fever. When I first treated yellow fever, in its first stage, by tartar eme- tic, and witnessed the violent reaction that shortly succeeded its use, and heard the agonizing shrieks of my patients, from the pain that attended the increased sensibility and universal excitement that succeeded it, for a moment I thought I had done wrong, and would have ceased to use it, had I not found that this was the only state J of the system in which the lancet could fearlessly and successfully be used. Even when the lancet was not used, the general reaction induced by tartar emetic, was nothing like so fatal, as when an ataxic state cloaked the violence of the disease. To illustrate this MALIGNANT FEVER. 353 remark, Dr. McPheeters, lately from Missouri, was taken ill at the most perilous and alarming period of the epidemic. He found him- self alone, and rendered helpless, by a violent disease that killed generally in three days. Being a man of great strength and energy of mind, he resolved to make use of efficient measures, and, accord- , ingly, mixed up sixty grains of tartar emetic, and took a sixth part of it at once. It produced copious secretion, and was soon follow- ed by a vehement excitement of the whole system. Having no means to subdue the reaction thus brought about, it ran its course. But every part being excited, the system was enabled to bear up against a power that otherwise would have caused it to succumb. Nine or ten days afterwards, I visited him. Reaction had nearly run itself down. He looked more like a patient in the advanced stage of a common synocha, than one in the yellow fever. Had not the ataxic reaction, with which the disease commenced, been re- moved, he would not, most probably, have survived. Blood-letting.—If blood-letting were resorted to before the development of general reaction, the reaction, which had yet only partially developed itself, abated ; the heat which had begun to spread itself over the surface, disappeared ; and the pain would sub- side ; and this, too, before the quantity of blood taken away was, in any degree, considerable. Medicines did not operate, and the dis- ease at once passed into the last stage. During the ataxic reaction, in vain we may be told to bleed to the relief of the symptoms; for they grow worse while the blood is flowing, and continue to become more alarming, and that in proportion to the quantity of blood taken away. When a feeble and broken reaction has taken place, to attack it by the lancet, is like attacking the first phalanx of an enemy, when he attempts to come out of his intrenchments, instead of waiting until the main body has appeared in the open field. But in the second stage, in which the heat of the whole surface is excessively increased, the pulse full and strong, the patient lying naked, and calling on the attendants to fan him, and to give him cold water, we may bleed fearlessly and successfully. The effects produced on the system by blood-letting in the reacting, so far from hastening the disease into the last stage, and bringing on fatal symptoms, pre- vented it from passing into that state, and robbed it of all its vio- lence and danger. I will now give a case in which blood-letting was followed by alarming consequences, from its being used a little too soon in the disease ; that is, before the second or reacting stage had fully developed itself, yet so near the stage of general reaction, as to prevent blood-letting from proving fatal. Mr. McCauley, a printer, was attacked with yellow fever, on the 20th of August. The disease appeared at once to overpower the system. It seemed as if the viscera had absorbed nearly the whole of the circulating- fluids, as the skin was cold and almost insensible; the pulse small, slow, and weak, and no secretion appeared to be taking place from any organ whatever. He complained of no pain, yet was restless • 354 MALIGNANT FEVER. and uneasy, and seemed to be oppressed in his breathing, as if a heavy body were lying across him. In this situation, early in the morning of the 21st, about twelve hours after his attack, a full dose of tarter emetic was given him. In two hours afterwards, he began to complain of pain in his head and back; his skin became some- what warm, particularly about the head and breast; frequent efforts were now made to vomit, but nothing except the drinks was evacu- ated: a clammy sweat bedewed his forehead and breast, which soon dried up, and again appeared. He continued in this state until noon, when full vomiting took place. At 2 o'clock, the vomiting ceased, and the irritability of the stomach was so much allayed, that it re- tained several doses of calomel and castor oil, senna, tea, &c, which were given at regular intervals, until seven o'clock ; and, although assisted by injections, had not operated. He now complained of excruciating pain. His skin, except his extremities, was hot to the touch ; his pulse at the wrist tense, but not full and strong. The ataxic reaction was verging on to general reaction ; but the latter had not, as yet, fully developed itself. Hoping that it would be the means of making the medicine operate, I opened a vein in the arm; as I never feared blood-letting in such states of the system, as, alone, it would either produce secretion, or cause medicines to do it. Being determined to bleed him until some sensible effect was produced, I took away upwards of sixty ounces of black dissolved blood, before the system seemed to feel its l6ss. The blood was stopped, in consequence of a slight sickness at the stomach. The patient answered several questions after I had tied up his arm. I went into an adjoining room, and, in about five minutes, was told the patient was dying. I took hold of his arm, but found no pulse. His face was sprinkled with water, washed with vinegar, and con- stant frictions applied to the skin during fifteen minutes, yet with- out effect.—Some laudanum was now produced, and one hundred and twenty drops poured down his throat. After waiting fifteen minutes longer, for a boy to return from the apothecaries, half an ounce of spirit of hartshorn was given, which he seemed' not to feel. A stimulating injection was administered; his face was washed with the aqua ammonia, and the frictions were kept up. All of his attendants, excepting one, left him, and reported him dead. I thought, myself, that animation- had been suspended too long, in his present condition, to be restored. After remaining in this situation for nearly an hour, signs of life again appeared. After several sighs, respiration took place, and a tremulous pulse was felt. But from the slightest exertion on the part of the patient, syncope would again ensue, and continue for several minutes. I ordered the spirits of turpentine to be freely given, stimulating in- jections to be used, and sinapisms to be applied to the extremities. On the morning of the 22d, I found that no perceptible secretion had taken place : he had neither sweated, urinated, or had an evac- uation from his bowels. Suspecting there might be a want of power in the bladder to evacuate the urine, I examined, but found • MALIGNANT FEVER. 355 no urine in the bladder. I continued to give, the turpentine, in drachm doses, every hour through the day. His bowels, on the evening of the 22d, acted ; and, shortly afterwards, he discharged a httle very turbid urine. On the morning of the 23d, the great or- gans of secretion were all awakened and the patient, though much exhausted, was, in a few days, restored to perfect health. Had the reaction in this case been general, and not of the ataxic kind, I judge from what I have seeri in other cases, that no alarming effects would have followed the use of the lancet; but had not the ataxic approached so nearly to general reaction, I am fully persuaded that the patient would not have borne half the quantity of blood to have been taken away, without producing death. I have dwelt the longer on this case, as the length of time which elapsed before the emetic operated, the changes that took place in the system in consequence of it, the great quantity of blood that was taken away before the system felt its loss, the alarming effects that followed it, and the length of lime before the torpid organs assumed a secretory action, are well calculated to show the character of the most malignant form of yellow fever, and the manner in which they are influenced by remedial agents. I will now give one case, out of many, to show the effects of blood-letting after the excitement is fully evolved. Mr. Welch, a baker, was attacked with yellow fever on the 15th of September. On my visiting him, on the morning of the 16th, I found him wrapped in several blankets, and complaining both of heat and cold. I ordered five grains of tartar emetic every hour, till he vomited copiously. In the evening, I found him lying naked on the floor, as the bed was too warm ; he was raving like a mad- man from the excruciating pain in his head and back ; he begged the attendants to kill him at once, and , put him out of his misery. His pulse was full and strong, and the whole surface of the body re- markably hot.—I took away, at one bleeding, six pints of blood, be- fore the symptoms were relieved. He continued very sick at his stomach only for half an hour, but did nor faint. Calomel and cas- tor oil, then giving, operated freely on his bowels in six hours after- wards, and he speedily recovered. In my own case, I lost four pounds of blood at one time. It was taken away before general reaction had as fully developed itself as I could have wished. A most distressing feeling of exhaustion en- sued, and continued for an hour or two. No healthy secretion took place for twenty-four hours afterwards ; at the end of which time, by a judicious course of treatment pursued by my physician, and friend, Dr. Denny, the skin, the liver, the ^kidneys, and salivary glands, all took on a secretory action ; and in less than a week from my attack, I was able to leave my room; and in two or three days more, I resumed my practice. It was not until I had seen some of the most injurious effects from the loss of the smallest quantity of blood in the ataxic stage of the yellow fever, that I could be con- vinced of the propriety of waiting until the excitement had fully developed itself, before recourse should be had to the lancet. 356 MALIGNANT FEVER. Purgatives.__If purgatives were given immediately on the acces- sion of the first stage, they sometimes produced secretion, which was followed by a reaction more or less general. But it was only in the milder forms of the disease, in which the organic sensibility was not greatly impaired by the first shock of the disease, that pur- gatives produced secretion. Drastic purgatives, in almost any state of the system, would, after so long a time, force away watery stools, which, like similar secretions in cholera morbus, soon exhausted the system, without producing any beneficial effects whatever, either immediately or remotely. When the system was placed in a proper*state for the exhibition ! of purgatives, those of the milder class would be followed by bi- lious discharges, which were beneficial; but when it was not in this state, drastic purgatives would produce serous mucus, or sanguineo- serous discharges, which were extremely injurious. As the milder cathartics were found to have all the good of the drastic, and none of their evil effects, I preferred mild to drastic purgatives. Late in the epidemic, I obtained some of the Croton oil. From the tri- | als I gave it, I am induced to believe that it will be found to be a valuable remedy in many cases of yellow fever. Every time it was j used, copious bilious dejections ensued. It was, however, only re- j sorted to in those states of the system in which I would have used other purgatives. As this medicine is so pleasant to take, and can be retained on the stomach in cases in which almost any other pur- 1 gative would be rejected, it promises to be of great utility in many j; forms of disease. '■ Mercury.—Given in the first stage of the disease, mercurial pre- parations in, by far, the majority of cases, produced no evident ef- I: feet on the system, and, consequently, none on the disease. Some- times, however, even in this stage, they produced ptyalism, yet such ptyalism had little or no effect in arresting its progress. There is a state of the system which, however, occurs more often in bilious than in yellow fever, in which I have found the specific effects of mercury to be particularly serviceable. After reaction has subsided, and the skin, kidneys, and liver have been excited into a secretory action—owing to some organ having, from some cause or other, sustained .a great shock, a torpor will again take > place in one or more of these organs, that produces great irritation in the system, preventing sleep, destroying the appetite, producing I fever, and thereby exhausting, more and, more, the already too much j exhausted patient. If the torpid organ be excited into action by ? any other remedy than mercury, as soon as it ceases to feel the im- pression of the remedy, it ceases to secrete: here, mercury, by keeping up an impression not transient, as the most of other me- dicines, but permanent, will, by enabling the diseased organ to re- gain its powers, restore the patient to health. In the above state of the system, and in many others in which the specific effects of mer- cury are indicated, I had been taught to use calomel in small and frequently repeated doses ; bat experience has convinced me, that MALIGNANT FEVER. 357 there is scarcely any state of the system, requiring the specific ac- tion of mercury, in which calomel, in large doses, is not the best 'means to effect it. Scruple doses of this medicine will not only in- duce the specific effects of mercury sooner, but will be followed by fewer disappointments, and less inconvenience and danger, than when smaller doses of that medicine, or any other form of mercury, have been resorted to. Diuretics.—As a copious secretion of urine was a favorable symptom, and a suppression of it alarming, and often fatal, diuretics were remedies, in many cases, of great importance. When purga- tives would not produce a secretion of bile, instead of trying by re- iterated doses of these medicines, more especially of a drastic na- ture, to force away alvine discharges, which, in such circumstances, would generally be of a serous kind, that tended only to weaken the patient, I endeavored to excite the kidneys to secretion by diuretics. I have often had'the pleasure to find that the urinary secretion produced by them, was of equal advantage in arresting the progress of the disease, as the biliary, by purgatives. Soon after the secre- tion of urine was established, the skin and liver would both gene- rally begin to yield their peculiar secretions, and the disease would no longer be able to re'sist the efforts of these allied organs. Diaphoretics.—When neither the liver nor kidneys could be ex- cited into action, diaphoretics were sometimes serviceable. But the great irritability of the stomach, the distaste to all medicines, the want of nurses, and the rapid march of most cases, prevented me from encumbering my practice by such feeble medicines, in the treatment of a disease, which seemed to require only a few simple, efficient, and well timed medicines. Epispastics.—In every stage of the disease, I have used blisters, applied to the head, over the stomach and bowels, to the extremities and down the spine. The benefit, however, which I had reason to expect from my experience with them in bilious fevers and other diseases never followed their use. Sinapisms to the extremities, to assist tartar emetic, and the hot bath to produce reaction in the cold cases ; or after reaction had been reduced, to stimulate the pros- trated patient, were far more serviceable than blisters. The for- mer acted much more quietly, and produced greater pain than the latter. Stimulants.—How the bark and wine in large doses would have answered in the first stage of this disease, to change the ataxic reac- tion of lhat stage into a general reaction, I cannot from experience determine. The Spanish practice in the Andalusian fever, consisted in large and repeated doses of bark, given immediately when the patient be- gan to complain. This practice, we are told by Dr. Johnson, was attended with extraordinary success. I very much suspect that the good effects of bark, in that fever, principally depended on its trans- forming the broken excitement, with which the disease commenced, 358 MALIGNANT FEVER. to a general reaction, or open case of fever. I lost one patient who drank a large draught of ardent spirits, with pepper in it, immedi- ately after the attack. The fever became developed, but great gastric distress attended throughout its course. Autopsic appearances proved the existence of unusually high inflammation in the stomach. Of the Bath.—The cold batfr, if used in that state of the system which I have called ataxic reaction, was evidently injurious. I can- not better describe its effects, than by the following case:—Mrs. Rice, in the first stage, used ablutions of cold water and vinegar. The ef- forts made by the system, towards general reaction, became imme- diately subdued; and, to use her own language, "the cold water drove the fever in upon her heart and stomach." Great coldness and shi- vering, with internal heat and oppression, succeeded its use. Reac- tion never took place, and the disease passed, at once, into the last stage ; and when I was called to see her, fatal symptoms had ap- peared. Had an emetic, instead of the cold ablutions, been tried, it is probable that reaction would have been general; would have borne blood-letting, and have been attended with a different re- sult. The only condition of the system, in which cold ablutions or affusions were advantageous, was when the surface was uni- formly and preternaturally hot. In this epidemic, I never found any difficulty in reducing the reaction by the lancet and other rem- edies, consequently, I seldom found it necessary to call in the aid of cold affusions. In the yellow fever under review, when reaction was reduced, or on the wane, if secretion did not take place, the tepid bath, appa- rently by removing the remains of morbid heat, and by restoring the natural sensibility of the skin, enabled that important organ to take on a proper secretory action. But cold water, by carrying off too much heat, reduced the temperature of the skin below that degree which is compatible with natural sensibility ; and, conse- quently, with healthy secretions. Pleased with the effect of the tepid bath, after the use of the lancet in the reacting stage of the disease, I resorted to the same remedy in the ataxic stage. The temperature of the bath was 96 degrees. The patient, as "soon as immersed, complained of being disagreeably cold ; he was taken out in a shivering fit, and was shortly afterwards immersed in a bath so hot, as to be extremely painful to my own hands, yet he did not in the least complain of it. His skin soon became gener- ally warm, and an emetic, which he had previously taken, began now to operate. He was removed from the bath, and in a few hours a fever so violent ensued, that copious blood-letting was employed to subdue it. The hot bath, whenever it could be procured, was employed in conjunction with emetics, in the cold cases of yellow fever, in order to bring about a general reaction. If emetics were not used in conjunction with the bath, the skin, it is true, would be heated : but its heat, like that of any inanimate substance would soon subside on being removed into a colder medium. MALIGNANT FEVER. 359 Dr. Cartwright farther states, that he personally witnessed the yellow fever of 1825 in Natchez, " Under the Hill;" in Washing- ton, a village six. miles from the river Mississippi; at Haughton's, a tavern in the country ; and, lastly, in Natchez, " On the Hill;" and he proceeds to give the following additional facts relative to the causes, nature, and treatment, of the disease, which its occurrence and prevalence in the above mentioned places afforded him an op- portunity of observing. Natchez Landing, (or Under the Hill, as it is called,) consists of a few rows of buildings, situated immediately on the brink of the Mis- sissippi river, at the foot of a bluff about two hundred feet high, which forms the site of the principal part of the city, called Natchez " On the Hill." Although during high water, the buildings under the hill are immediately on the brink of the river, yet when the river falls, as it always does in summer, a surface of ground several rods in width, becomes uncovered between the buildings and the river. The surface thus exposed by the falling of the river, consists of mud recently deposited, and of the debris of various vegetable and animal substances, which, during the season of trade, had been thrown out by the flat boats that landed at this place. On the margin of this uncovered surface, there is a warehouse, which, in the months of July and August, 1825, contained a large quantity of spoiled porter and sour pork. The owner of the warehouse was constantly engaged in repacking the pork; the brine from which, was permitted to run through the floor, into a kind of cellar, which had no outlet to it. Some of the porter barrels burst, and the spoiled porter, also, ran through the floor into the cellar, with the * brine from the sour pork. Some few hundred yards above the warehouse, there was a boat containing a quantity of rotten corn, which had been sunk in the water, but became exposed in the sum- mer by the falling of the river; and below the warehouse, but not so far from it, there were two or three houses that contained stag- nant water, others, putrid sour krout, fish, oysters, &c, in their cellars. Leaving Natchez for the present, I proceed to Washington, to give a brief sketch of its topography, and an account of the epi- demic yellow fever, which prevailed there in the autumn of 1825. Washington, a small village, containing about four hundred in- habitants, is situated six miles east of Natchez, and not less than the same distance from the nearest point of the Mississippi river. The town occupies a high and healthy situation, remote from any swampy ground, or from any water-course whatever, except a small stream of running water, a branch of the St. Catherine's, about a quarter of a mile north-east of it. „ The citizens of Natchez, prior to 1825, always found Washington to be a place to which they could retreat with safety, from the ravages of the malignant fever. The inhabitants of that town had hitherto opened their doors to the sick and the dying, and received no harm, as not a case of yel- 360 MALIGNANT FEVER. low fever ever occurred among those who had not breathed the Natchez atmosphere. A grocer, who had been living " Under the Hill," removed his grocery store to Washington in the latter part of the summer. He rented an old wooden house ,x>n the north side of the main street, which, with the lot attached to it, is situated in the hollow space of o-round described above. The earth had been thrown up around the palings of the lot, except at one place, to serve as a drain in rainy weather. This drain was choked up with weeds and trash when I examined it, during the progress of the epidemic about to be de- scribed, and served but imperfectly the purpose for which it was in- tended. The grocer who removed his store to the house on this lot, removed also a quantity of bacon and mackerel, a great part of which had begun to putrify at the time of its removal, or putrified soon afterwards. These provisions the grocer was in the habit of selling to negroes. Mr. Alfred Radcliff informed me, that a few days before the yellow fever originated in Washington, he called on the grocer, in order to purchase some bacon for a friend in the coun- try ; but on examining it carefully, the whole quantity, which the grocer had on hand, was found to be in a putrescent state, and none of it fit to purchase. About two thousand pounds of bacon, he stat- ed, was filled with large worms, and was in a putrid condition. The Rev. Mr. Burress informed me, that in addition to the putrid- ity within the house, the grocer was in the habit of receiving from the fishermen on the Mississippi river, supplies of fresh cat-fish, (a fish in this river weighing from ten to one hundred pounds,) the heads and entrails of which, besides what rotted on his hands, were thrown into the back yard of the lot above described. All I per-« sonally know with respect to the real situation of the grocery, is what every person knows, who either lived near, or came in its vi- cinity, that the stench from it was extremely disagreeable. The principal stores and boarding-houses in town, were situated a short distance from the grocery, both above and below it. Both of the town markets were within twenty-five steps of it. Should it then be a matter of wonder, if a few persons living in the suburbs of Washington, in the most healthy situations, should have been at- tacked with yellow fever, a little time after, the time it broke out around the grocery, when it is recollected that those who visited the stores, the taverns, and the markets, were exposed to the same atmosphere with those residing in the vicinity of the grocery ? The yellow fever of Washington, like that of Natchez, in 1823, had three stages. The first stage was generally preceded by, and attended with, catarrhal symptoms. It was known by the patient's sensations being no true evidence of the actual coldness or heat of his surface; by the heat of the surface being unequally diffused, the head and breast hot, the extremities often cold ; by the patient preferring to be wrapped up in blankets, although, at the time, his skin may have been pungently hot to the touch, by the chilly feeling being greatly increased, if the patient merely reached out his arm MALIGNANT FEVER. 361 to have his pulse felt, or if any of the bed-clothes were removed, although he might have complained of these making him disagree- ably hot, by a copious perspiration occasionally taking place, and drying up without relieving the disagreeable chilly feeling, abating the pungent heat of the skin, equalizing its evolution, or establish- ing the lost relation between the patient's feeling of heat, and the real heat of his body. So different were the sensibilities, both or- ganic and animal, in this fever, from a healthy condition of the sys- tem, that I have known patients to complain of their extremities being cold as ice, when they were actually burning hot. I was for- cibly impressed with this fact, on seeing patients bear to their ex- tremities, particularly their feet, applications sufficiently hot to cor- rode or blister the skin, and produce great pain, were not the orga- nic and animal sensibility of the part very different from health. I recollect having affronted one person, from having him put in a tub of water, disagreeably hot to my hands, not because he found it too hot, but too cold. The second stage was known by the pa- tient losing all his chilly feelings ; by his throwing off the bed- clothes, calling for cold drinks, being tortured with the severest pain in his head and back, tossing himself from side to side in his bed, or going from one bed to another, by his uniformly hot sur- face, by a diminution in the secretory process, to wit: a paucity of bile and urine, great dryness and heat of the skin, and mucous membranes, and, lastly, by an increased energy of the whole arte- rial system. The third stage was pointed out, by the heat of the surface having diminished, but not the patient's sensation of heat having proportionally diminished, by a slow irregular respiration, or even when the number of the respirations differed but little from the healthy state ; by the yellow skin, accession of strength, the black vomit, and hemorrhages from the mouth and nose. The first stage, in some cases, quickly passed into the second; in others, it continued twenty-four, or even forty-eight hours, be- fore the reacting stage ensued. This stage, in some, never occur- red, the disease passing at once from the first to the last stage, while in others badly managed, it lost many of its characteristic features; namely : there would be great heat, thirst, and pain, yet a quick irritable pulse, which would not bear the lancet; a coma- tose state of the brain, similar to typhus fever, accompanied with extreme irritability of the stomach, and a strong disposition in the bowels to take on a watery purging. Such cases were very fatal. The disease, not only in Washington, but in Natchez, the present season, differed from that of the latter place in 1823, in its very great liability, in many cases, to be attended with copious and vi- tiated secretions, not only in its first, but in all its stages. Treatment.—As in 1823, during the first stage, or that of ataxie reaction, tartar emetic was found to be the most useful remedy. I generally gave from six to ten grains at a dose, and repeated it in smaller doses, until it either produced bilious emesis, removed the chilly feeling, developed an excitement throughout the system, pro- 46 362 MALIGNANT FEVER. duced secretion in the skin or kidneys, subdued the ataxic fever, or palsied the deranged organic actions. Vitiated secretions seem- ed to depend on the latter, as, in many cases, the first doses of tar- tar emetic put a stop to the vomiting of a vitiated fluid, which had taken place before its exhibition. Tartar emetic, however, used in small and repeated doses, often rendered the stomach more irrita- ble, and even when used in effectual doses, it often did harm, un- less properly managed. When the chilly sensation was very great, the warm or hot bath, if used a little before, or at the time, the emetic was given, enabled it to produce bilious secretion, much more readily, and with much less distress to the patient, than when the emetic had been trusted to alone. Case.—Mr. K., of Natchez, was violently attacked. He told me to give him any thing but tartar emetic; for it always cramped him, produced great coldness, and he had, every time he had taken it, come near losing his life.1 His life appeared to me to depend on a bold use of the remedy he so much dreaded, as I had no hope of subduing so violent an attack, unless some great change could be produced in his system by the remedy in question. As his kid- neys were torpid, I gave him freely of gin sling, had him put into a hot bath, to remove the chilly sensation he complained of, and gave him, while in the bath, ten grains of tartar emetic in half a pint of strong seneca tea. He vomited bile copiously and easily; and so far from requiring hartshorn, laudanum, &.c, to remove the coldness and cramp, as formerly, he soon lost near two pounds of blood, to subdue the consequent arterial reaction. He soon reco- vered. From Dr. McPheeters, I learned the efficacy of black mus- tard in vinegar, both as an emetic itself, and as a powerful coadju- tor of tartar emetic, in cases wherein the latter alone, from torpor of the stomach or some other cause, failed to awaken the energies of the system. Warm brandy-toddy, in some cases, prevented the fartar emetic from producing vitiated secretions, and at the same time, enabled it to produce those of a proper kind, or at least en- ^ able it to prepare the system for their production. As cold feet and hands had a great effect in opposing the beneficial action of tartar emetic, warm pediluvia, sinapisms, frictions, &c, were found to be necessary to place the system in a proper condition for its re- ception. It was always necessary to subdue by the lancet, general , arterial reaction or fever, w henever it came on, as it sometimes did, before bilious vomiting had been produced. If it were a broken reaction of fever, however, tartar emetic was its best febrifuge. Great determination of, blood to the head, in the ataxic stage, with a pulse at the wrist, which will not indicate blood-letting, while at the same time there is a very strong pulsation of the carotid arte- ries, so far from being a state of the system that contra-indicates tar- tar emetic, is the very state of the system in which I have witnessed more beneficial effects from the remedy in question, than any other whatever. 1 am not the only one who can bear testimony of the beneficial effects of tartar emetic in such states of the system. Dr. MALIGNANT FEVER. 363 McPheeters has kept a record of a great number of cases of this kind, wherein emetics were found to be no less useful than the bark in intermittent fevers. If the pulse, at the wrist, and other cir- cumstances, do not forbid blood-letting, this, of course, should be premised, previously to the exhibition of the emetic; but when this is not the case, the blood-letting should be deferred until after the remedy has produced a change on the deranged organic sensi- bility of the system, broke up the irregular determinations of blood, and brought out a general reaction of the arterial system. The worst consequences sometimes occur from a timid use of tartar emetic, from giving it in too small doses, repeated at too long intervals, or from discontinuing its use on the first appearance of any unpleasant symptom, at a time when it may be most needed. Case.—Col. Marschalk, a very large, corpulent man, was attack- ed with the yellow fever of Washington : I gave him an emetic in the ataxic stage of his fever. In a few hours afterwards, I was cal- led in great haste to see him. He was panting for breath, as if in a fit of asthma. No bilious vomiting had yet been produced. Great heat, pain, and inward distress, were complained of. I bled him about a pint, as his pulse would bear no more, and gave him three grains of tartar emetic every half hdur in spirits aeth. nitr. The second or third dose brought on effectual vomiting, attended with no distress : the skin became moist; the difficulty of breath- ing, internal heat, pain, and distress, were removed, and the patient recovered without farther difficulty. But it behooves me to state, that the worst effects are sometimes produced by tartar emetic rashly persisted in, without regard to the condition of the patient, in order to bring about some particular effect on the system ; as, for instance, bilious vomiting. But who has not witnessed the worst effects from cathartics, or from mercu- ry, rashly persisted in, without regard to the condition of the pa- tient, in order to bring about some particular effect on the system ; as, for instance, dark bilious stools, or a discharge of saliva? By an emetic properly managed, if given early in the disease, not only the fever of Washington, but that of Natchez, was often cut short at once, and the patient recovered without farther trou- ble : while the mildest attacks, if left to nature, ultimately, seldom failed to prove fatal. If the disease did not yield at once to eme- tics, general arterial reaction ensued in the most of cases, requiring the lancet for its reduction, together with purgative medicines, which brought on bilious evacuations, that soon relieved the patient. Sometimes, however, when emetics had not been used at a period of the disease sufficiently early, or, if used, had not been properly managed; or, if properly managed, owing to some pecuharity of the case had not produced their general beneficial effects on the system ; but, most generally, when emetics had been entirely omit- ted, it was difficult to produce, by purgatives, the proper kind of evacuations from the bowels—I mean evacuations of a dark bi- lious matter of tolerable consistency. In such cases, it was very 364 MALIGNANT FEVER. difficult to retain purgative medicines on the stomach, owing to its irritability; and, if retained, even calomel would often produce watery evacuations. In such cases, to continue the use of this or any other purgative remedy, without first altering that condition of the system on which the watery evacuations depended, was to continue to use them to the destruction of the patient. In as much as he became speedily exhausted under such evacuations, I made it a rule to check them by an enema, of a tea-spoonful of laudanum in a little starch gruel, or by giving opium or its tinc- ture. The next object was to alter that morbid condition of the system on which the watery or vitiated secretions depended,. Tar- tar emetic, either with or without the addition of a little opium, in two or three grain doses, every one, two, or three hours, ca- lomel with two or three grains of opium, or with ten or twenty grains of camphor, repeated according to circumstances, and as- sisted by the warm bath, blistering, &c, were often found useful in preparing the system to be properly acted on by purgatives. A remedy, however, which appeared to suit some cases the best, was the sulphate of quinine, or, whera the stomach would bear it, the Peruvian bark with cream of tartar and cloves; either of which was given without regard to fever, if such fever would not admit of blood-letting. Even when the fever (I mean heat of skin, &c.) was increased under this practice, the various organs of the system became more disposed to take on a proper secretory ac- tion, than before such fever had been excited. I am confident that I used the sulphate of quinine in too small doses in our late epi- demic. Dr. Perrine assured me, that in the bilious fever in the country, ten or fifteen miles from Natchez—to prevent a watery purging, which so often Wok place in that disease, he resorted, af- ter having premised sufficient blood-letting, to the use of the sul- phate of quinine in eight grain doses, every two hours through the day, notwithstanding the presence of fever, and at night gave aloes, scammony, and calomel in pills, swll continuing the sulphate. He assured me that under this free use of the sulphate, the fever would abate, and the cathartic would produce thick, copious eva- cuations of a dark color, which would soon relieve the patient; whereas, to use the purgatives without the sulphate of quinine, if they operated at all* they only produced watery stools, which soon robbed the patient of his strength, and aggravated his disease. Dr. McPheeters and myself have both used, with a similar inten- tion, the sulphate of quinine, after the plan of that excellent phy- sician, Dr. Perrine, and we have found it even to surpass our ex- pectations. The purgatives which could be most relied on, in the epidemic of 1825, to produce bilious secretions, were calomel, aloes, and scammony combined, the purified spirits of turpentine, and the Croton oil. When there was much pain in the bowels, accompanied with tenesmus, the charcoal was of great service. The best plan of giving medicine in cases of great irritability of the stomach, which neither sulphuric ether, opium, effervescing MALIGNANT FEVER. 365 mixtures, &c, will allay, has heretofore been with me a desidera- tum in practice. The fate of a patient frequently depends on mi- nutiae, too often unattended to in practice. It is an easy matter to prescribe aloes, scammony, jalap, &c, in order to purge a pa- tient, who is constantly sick at his stomach. But the object of the prescription is often entirely defeated, in consequence of the pa- tient refusing to take these remedies ; or, if he takes them, by the impossibility of his being able to retain them pn his stomach. The best plan I ever tried, of giving these, and similar nauseous medi- cines, so as to obviate the inconvenience of their disagreeable taste, and to prevent them from being vomited, is to have the various purgative articles made into a soft mass with sirup. Any given quantity of this mass, is to be enclosed in a very thin wafer, made of flour, and softened by being soaked a few minutes in water or milk. The enclosed mass is then put into a spoon with a little water in it, out of which the patient is to swallow it. After this manner, a patient can take, at one dose, a mass sufficient to make a dozen pills, and he cannot, without the strongest efforts, throw it from his stomach ; he tastes nothing but the flour wafer, and the nausea of his stomach is not increased, as it would be from his swallowing a quantity of bitter pills. In this way, a large quantity of Peruvian bark may be given at a dose, without the patient's tasting it. One table-spoonful of flour, made into a batter with water, is sufficient to make sixty wafers. The plan of making them is, to have two smoothing irons heated, one of which is to be placed with its face upwards, on which a few drops of the batter is to be poured, and the other iron is then to be pressed upon it. The little cake or wafer, thus made, is, as I before observed, to be soaked in water, before using it, in order to make it sufficiently pliant to enclose the medicine. I venture to assert, that whoever tries this plan of giving nauseous drugs, as aloes, &c, in cases of great irritability of the stomach, will seldom prescribe them in pills, sirup, or solution: calomel, however, can be very conve- niently given, floating on a table-spoonful of common cold water. A table-spoonful of water will float two scruples, if the calomel be not in lumps, and if it be sifted down lightly on the water. Spirits of turpentine should be purified by mixing it with alcohol, as directed by Dr. Nemmo. With these remarks on the manner of administering remedies in cases of great irritability of the sto- mach, remarks, though seemingly of little importance every where else, may not be entirely so at the bed-side of the sick, I close what I have to say on the Washington yellow fever, the history of which disease, if it does nothing else, will show that an epidemic jellow fever is not necessarily confined to water-courses. I how proceed to give an acount of some cases of malignant fe- ver which originated at Haughton's tavern, in the country, about a mile from Natchez. Nine or ten persons died in and about this place with yellow fever. The disease commenced at Haughton's in September, a little prior to its appearance in Natchez, " On the 366 MALIGNANT FEVER. Hill." If medical topography throw light on the origin of yellow fever in other places, it does not withhold its light in the present instance. Haughton's tavern, and Shear's, (the two houses where all the cases referred to originated,) are situated without the char- tered limits of the city, on a small peninsula formed by a junction of two very long, deep, and winding bayous. One of the ba- yous commences on the eastern, the other on the western, side of Natchez ; and, with the exception of two or three'squares, the whole of Natchez is drained by them. The western bayou, after drain- ing the western part of Natchez, passes by the butcheries, receives their offal, and pursues a surpentine course, to meet its fellow, the eastern bayou, at Haughton's. Between the eastern bayou and the foot of the little hill, on which the houses alluded to stand, there is a flat surface of about an acre, surrounded on all sides by hills. A gully, leading through the isthmus formed by the two bayous, conducts the water of an adja- cent field on this flat surface, 6ver which it spreads, before it falls into the bayou. Haughton's tavern is within ten steps of this flat ground, which, besides what the gully brings on it, and besides its own vegetable productions, is the receptacle of the kitchen offal, and of a privy which has no well. When the eastern and western ba- yous meet, a distance from the tavern of about thirty rods, there is also a flat surface surrounded by hills. The eastern and western bayous, in their whole course from Natchez, are seldom less than ten feet wide, and ten feet deep. In many places they are more than fifty yards wide, and as many feet deep. Their banks, which are steep and abrupt, are almost constantly falling in, which ob- structs the current of water from alight rain, but affords no obstruc- tions to the torrents which roll down them during heavy rains. In 1822, the yellow fever prevailed at this place. I then supposed that the polluted atmosphere of the city had extended thus far. I was inclined to this opinion, as several persons, whom I attended, assur- ed me that they had not been in town. I did not, at that time, sus- pect the bayous of having any agency in the production of yellow fever ; but I have, since that time, in my practice through various parts of the adjacent country, which abounds with these bayous, found the remark verified, of an old practitioner of this place, the late Dr. Seip, that a " bayou was more sickly than a marsh." I again return to Natchez. The yellow fever '" On the Hill," in 1825, differed but little from that o| Washington. But "Under the Hill," it resembled more closely, in its symptoms and progress, that of 1823. Nearly all the physicians who got much practice, adopted the emetic plan of treating the disease of the present year, and these seldom lost more than one in ten of their patients; while, under the old plan of trusting to a few grains of calomel, frequently repeated, with inunction of mercurial ointment in order to bring on salivation, the disease was about as fatal as formerly. Dr. Hunt, who came to Natchez very much prejudiced, by education, against emetics in yellow fever, but who is too liberal to advocate the errors of theory MALIGNANT FEVER. d&l unsupported by facts, throw aside his pejudices, and not only pre scribed emetics with great success to his patients, but when attack- ed with yellow fever himself, commenced the cure by an active emetic : so did Dr. Walker. Neither of these gentlemen ever had cause to repent of this first, yet all-important, step in the treatment of their disease. Prevention.—As respects the best method of preventing the dis- ease, while usual health exists; and the best method of preventing the disease, when those who are exposed to its cause tfecome indis- posed, Dr. Cartwright makes the following observations: Those per- sons in health, who, in order to avoid an attack of this epidemic, had recourse to medicines and ardent spirits to which they were unac- customed, were among the first to be attacked. Fumigations and the smelling of volatile substances, were also found to be of no ser- vice. Those persons who escaped, regulated their diet and drinks, not by any fixed rule or standard, but by their former habits; and if they deviated from those habits, they approximated to simplicity and abstemiousness, not carried to the extent of debility; for if the stomach were not sufficiently excited by food and drinks, the same effect was produced as if it had been too highly stimulated ; name- ly, a derangement of action between it and the organs with which it is associated. Those who had been temperate and abstemious, continued to be so. < Two persons who had, for several years, kept up a strong excitement by ardent spirits, continued it during the prevalence of the epidemic, and entirely escaped. But all who had not previously been habitual drunkards that imitated their example, became sick and died. Ardent spirits kept up the equilibrium of action in the systems of the former, but destroyed the equilibrium in the latter. Finally, those who escaped were such as preserved this equilibrium, by accommodating their diet, drinks, sleep, and ' exercise, to the existing state of the system, and to their former ha- bits, avoiding all exciting causes, as heat, cold, fatigue, &c. As to those who are indisposed, it was found that the best means of warding off the attack, or rendering if milder, was to ascertain in what way the threat is made, and to apply the remedies accordingly. Persons of plethoric habit, whenever they felt a fulness and uneasi- ness about the head, or a disposition to fever, were relieved by bleed- ing, and escaped. Others, whose indisposition proceeded from a torpid state of the bowels to which they were subject, escaped by the occasional use of aperients. To those who complained of a bit- ter or mawkish taste of the mouth, sickness at the stomach, achings in the bones, soreness of the flesh, and sleeplessness, emetics were prescribed with success. A gentleman who complained of pain in his back, with restlessness and anxiety, and whose urine had, for several days, been small in quantity, was enabled, by a free use of diluent drinks and diuretics, entirely to avoid the attack of the epi- demic. From these facts it is plain, that though the poisonous atmosphere of yellow fever may long be breathed with impunity, while a due 368 MALIGNANT FEVER. balance of action among the various organs is preserved, yet not so when it is broken; that living in such an atmosphere tends to break this balance; the smallest disturbance of which is announced by symptoms that often point directly to the organ in which the distur- bance has commenced, and which, in many cases, may, by timely and appropriate measures, be restored to its healthy functions. ADMONITORY HINTS TO LADIES. Light were my task, if every gentle breast Owned the just laws of native truth imprest; For not by hopes of vain applause misled, In reason's injured cause alone I plead. 'Tis you to judge; nor I that judgment fear If truth be sacred, and if virtue dear. Roscoe. If we consider but for a moment the wonderful power which su- perior beauty in women exerts over the human breast; how in- stantly, on the approach of its possessor, the hearts of the young are thrown into the most delightful palpitations, and the looks of the aged brightened with admiration and pleasure; we can no lon- ger wonder that it should be so highly prized by the sex. But it is to be lamented, that the most preposterous means should be em- ployed to gain a property so desirable, and that real beauty should be so often abused. Thus, some girls fancy that beauty can only exist in forms slep- der and delicate. At the very thought of being corpulent, they are alarmed, and to obviate grossness, as they call it, they drink such quantities of vinegar, that it not only destroys the tone of the stomach, but introduces a withered ghastly paleness. For the same purpose they continue the absurd practice of wearing jackets, or corsets, so oppressive, as, by compressing the ribs, to prevent the expansion of the lungs. Another imprudence, and still more detrimental, is that of ap- pearing at assemblies, in winter, in light dresses, exposed to the baneful effects of cold, with the aggravating addition of extraordi- nary warmth, by the fatigue of^dancing ; hence, consumptions, and a train of maladies, too long to be here particularly described, are produced. Motives of delicacy, as well as regard for health, have been re- peatedly urged in vain to enforce the necessity of relinquishing these destructive habits; the arguments of the moralist and of the physician, having alike failed to convey conviction ; and hundreds, who would now have been shining forth among the loveliest of their sex, are dressed in shrouds, because, " in an evil hour," they laid 47 370 ADMONITORY HINTS TO LADIES. aside those articles of their apparel which health, as well as decen- cy, forbade them to relinquish. M There are others, who, reading of the fair-skinned belles of Eu- rope, foolishly conclude that the rose and the lily are the only co- lors of beauty. Catching at this female passion for fair and unfreckled faces, the quacks have prepared a number of nostrums, called cosmetics, or beautifiers, which, they vauntingly profess, are to heal the chaps on the lips ; to remove pimples and freckles ; and to give the counte- nance such a fair, smooth and charming appearance, as to render it impossible for any one to contemplate it without being enamor- ed. But, unfortunately, these boasted cosmetics, instead of height- ening the polish and charm of beauty, too often contribute to tar- nish ana destroy them.* The truth is, beauty is not the creature of a quack, but the gift of nature ; and to bring it to perfection, nothing more is necessary than exercise, cleanliness, temperance, and cheerfulness. These are the handmaids of health ; and health, to persons of certain symmetry and expression, is beauty. ------------The rural wilds Invite ; the mountains call you, and the vales, The woods, the streams, and each ambrosial breeze That fans the ever undulating sky; A kindly sky ! whose fostering power regales Man, beast, and all the vegetable reign.—Armstrong. How much, then, is it to be deplored, that so many of our young females should think so meanly of exercise, which, alone, brings the female frame to perfection, paints it in the liveliest colors, and, by giving richness to the blood, and vigor to the nerves, disposes to habitual cheerfulness, and alike qualifies the mind for thought, and the heart for love. v On the contrary, how different is the female who leads an inac- tive and sedentary life, too generally looked on as proofs of a fine modern lady, which seldom fails to relax the system, retards the circulation, vitiate the blood, and obstruct the secretions. Hence that chalky, paleness of the face—that faintness of the eyes, indiges- tion, flatulence, weak nerves, low spirits, irregularities of nature, and constant complainings. The grand discharge, th' effusion of the skin Slowly impaired, the languid maladies Creep on, and through the sinking functions steal.—Ahmstrono. I Yes, many a girl, by constant muffling and housing herself; by dreading that the sun should ever kiss her cheeks, or the wind . * ToBUch of my readers as are partial to the use of cosmetics, an infusion of horse-radish in milk is recommended as one of the best and safest. Another innocent preparation for clear- ing the skin of pimples, and recent eruptions, is the expressed juice of house-leek, mixed with -at -iota yiaut),)- of sweet milk or cream When these fail, blistering the face all over the •"'"'I...... '■ >lt l.ft.'K urrcr,) in .,,.,,.r.)ri„ f);; i?. pages 371-374 missing pages 371-374 missing FEMALE COMPLAINTS. 375 before the final cessation of the discharge, is frequently accompa- nied with sickness and swelling of the belly, from the wind in the bowels. These circumstances, sometimes incline married women, for some weeks, to consider themselves with child. Others again, averse to be thought old, flatter themselves that the magulanty is occasioned by cold, or some accidental circum- stances, and therefore very improperly employ their utmost endea- vors to recall it. The complaints which, in many women, occur at this period of life, are to be ascribed rather to a general change in the habit, than merely to the absence or total cessation of the sexual evacua- tion. Women who have never had children, or good regular health, or those who have been weakened by frequent miscarriage, are most apt to suffer at the decline of life. It frequently happens, that women who were formerly much pained when out of order, or who were troubled with nervous and hysteric complaints, begin at the cessation of the periodical discharge to enjoy a good state of health, to which they had for- merly been strangers. When no particular complaint occurs in consequence of the de- cline of life, it would be exceedingly absurd to reduce the strength by an abstemious diet and low living. If, on the contrary, ■ head ache, flushings of the face, or an in- creased, degree of heat, restlessness in the night, and violent pains in the belly and loins, swellings of the feet, or eruptions on differ- ent parts of the body, take place at this period, there is reason to believe that a general fulness exists, in consequence of the stop- page of the accustomed discharge. Under such circumstances, spare living with increased exercise, occasional blood-letting, and frequent gentle purgatives are enjoined. If ulcers break out in the legs, or in any other part of the body, on a total cessation of the menses, they ought to be regarded as critical discharges, and should by no means be healed up without substituting some other drains by an issue. PAINFUL^ MENSTRUATION. In some instances menstruation is attended with great pain in the back, thighs, and lower part of the belly. This state is sometimes accompanied with suppression of urine, or violent colic pain and spasms of the stomach. The discharge generally takes place slow- ly, and is deficient in quantity, and not unfrequently attended with the expulsion of a skinny looking substance. Causes.—The disease is supposed to be owing to a weak action of the vessels of the uterus, or spasm of the extreme vessels. Pain sometimes attends copious menstruation; but whenever it does, ■* 376 MANAGEMENT OF there is much reason to apprehend some local disorder of the womb. Treatment.—As soon as the symptoms that denote its approach are apparent, recourse should be had to the warm bath ; when this is not convenient, the patient should sit fifteen or twenty minutes in a tub of warm water, or cloths wrung out of warm water or a bladder two-thirds filled with it, should be applied to the lower part of the belly. After this the back and abdomen should be well rubbed with the camphorated, or volatile anodyne liniment, and if the pain continue, the anodyne clysters should be administered. If, not- withstanding these means, the pain become violent, it will be pro- per to give a tea-spoonful of the diaphoretic drops, or four or five grains of Dover's powders, or one of the camphorated powders, (see Dispensatory,) every hour or two until a gentle, but general per- spiration be induced. This is also to be encouraged by drinking warm penny-royal or ginger tea. When this complaint arises from general fulness and irritation, it may require repeated bleeding and purging. If there be pain in the stomach without fever, give a tea- spoonful of laudanum, with twenty drops of essence of peppermint; or should costiveness prevail, give a dose of castor oil in conjunction with the anodyne. For the cure of this distressing complaint, Dr. Fothergill recom- mends a pill of opium, of one grain, to be taken the moment the pain comes on, and to be repeated every hour until it be suppressed; to keep the patient in bed ; and to let her dilute freely with herb teas, until the discharge be fully established, after which the pain seldom returns ; and when the period has passed, chalybeate bitters until within a few days of the next period. Dr. Denrnan proposed small doses of calomel every night at bed-time, for several weeks together, and twice in the course of the day, a dose of the volatile tincture of the Peruvian bark. Dr. Dewrees, of Philadelphia, re- commends the volatile tincture of gum gUaiacum, to be continued for a considerable length of time, and says it acts almost as a specific. And Dr. Robertson, of Edinburgh, is as sanguine in praise of the tincture of cantharides given in pretty large doses, thrice a-day, until it excites some degree of pain in voiding the urine. Prevention.—In order to prevent this painful state, in those who are subject to it, the warm bath should be used, three or four nights preceding the menstrual period, and on going to- bed, two tea-spoons full of the diaphoretic drops, or ten grains of Dover's / powder should be given in some warm tea. The bowels are to be ' kept uniformly regular ; and exposure to cold, especially near the j time of the appearance of the discharge, is to be carefully avoided. \ The constitution is to be improved, and strengthened by such means, as its particular condition requires ; and in general, by the j use of tonic medicines, and the shower bath, provided these do not disagree with the patient. FEMALE COMPLAINTS. 377 OBSTRUCTED MENSES. Many women have the menstrual evacuation postponed for a week or two, beyond the usual time, or miss one or two periods without any very evident cause, and without inconvenience. But when it is suddenly suppressed very troublesome symptoms occur; and when it is retained for any considerable length of time, it is gene- rally accompanied by bad health. Symptoms.—When suddenly checked, it is usually attended with considerable pain in the back, bowels, or stomach, and sometimes in the chest. In persons of a full habit the face is generally flushed, the pulse hard and frequent, flying pains in the chest, perhaps, spit- ting of blood, cough, palpitation, difficulty of breathing, and a com- plication of nervous affection. Persons of a delicate frame and a melancholic temperament, and especially those who have suffered from some debilitating cause, have different symptoms, constituting what has been called chlorosis, or green sickness, a disease always connected with, and depending on, some derangement of the sexual organs. In chlorosis, every symptom of feebleness prevails, a pale skin, and even a greenish complexion, succeeds to the rosy hue of health; the skin under the eyes puffy and of a leaden color; the whole body lax, cedematous and doughy; the judgment, memory, and natural cheerfulness impaired ; the pulse is generally slow and fee- ble, but easily excited ; and it is then accompanied with shortness of breath, a palpitation of the heart, and an almost unconquerable dis- inclination to motion ; the appetite is destroyed, and the stomach so deranged, that the food, instead of being digested, undergoes the fomentation peculiar to its nature. Hence, the patient finds grati- fication in chalk, lime, pieces of old wall, and other improper sub- stances ; and the bowels are commonly costive. It not unfrequently happens that the blood which should have pas- sed off by the uterus, being determined more copiously and forci- bly to other parts, gives rise to hemorrhages ; hence, it is frequently poured from the nose, stomach, lungs, and other parts, in such cases. Causes.—A constriction of the extremities of the vessels of the womb, arising from accidental circumstances, such as exposure to cold, anxiety of the mind, fear, excessive evacuations, inactivity of the body, poor blood, the frequent use of acids, and other sedatives, &c. In some constitutions, particularly in those where pain attends the discharge, very slight occurrences suddenly interrupt the flow, and prevent its usual return, such as passions of the mind, fright, fatigue, irregularities of diet, putting on damp clothes, &c. This fact shows the necessity for certain cautions and attention during the discharge. Obstructions, too, are sometimes the effect of disease of the general habit. Treatment.—When the evacuation has been suddenly checked, it is proper to have immediate recourse to the warm bath, or sitting 48 378 MANAGEMENT OF up to the hips in warm water, or fomentations to the lower part of the abdomen, and bathing the feet in warm water. It is also ad- visable to put the patient to bed and give a tea-spoonful of the di- aphoretic drops, or five or six grains of Dover's powders, in a cup of warm herb tea, such as sage, hyssop, penny-royal, every two hours until a gentle perspiration is produced. Should there be fever, or pain in the head, or discharge of blood from other organs, bleed, give the cathartic mixture, or an infusion of salts, senna and manna, and afterwards endeavor to determine to the surface by the exhibition of diaphoretic medicines. In every case where there are febrile symptoms, an amendment cannot take place until the antiphlogistic plan, such as bleeding, nitrous medicines, cooling cathartics, and a low diet, with rest, are adopted. After the fe- brile symptoms are removed, strengthening medicines, if necessary, may be employed, and in no instance suffer the bowels to remain in a constipated state. It is necessary to observe, in endeavoring to restore the monthly evacuation, we shall more likely succeed, if the usual remedies for removing the constriction which affects the extremities of the ves- sels in the womb are directed at the time of its expected return, or when some natural efforts for that purpose are observable; which may be known by a sense of fulness in the organs of generation, a weight in the back and loins, and slight spasmodic pains in the uterus. At this period, bladders two-thirds filled with warm water, applied to the lower part of the abdomen, or sitting over a vessel filled with hot water, will have a most happy effect. And, to in- crease the relaxing powers of these topical applications, we may, at the same time, give an opiate, particularly in the form of clys- ter, when there is pain. Sometimes an emetic administered about the time when the eva- cuation should appear, and the patient during the operation to sit in 'a warm bath, has been of infinite service. In some instances an obstruction may continue in a young and healthy woman, for many months, without any inconvenience. This is chiefly the case in those who are very corpulent, or who have been in the pernicious practice of employing vinegar and strong purges to reduce their size. By the regular use of exercise, rising early in the morning, avoiding supper, keeping the bowels correct, and living, upon the whole, rather abstemiously, the health will be preserved, and, in course of time, the desired alteration will take place. Obstruction of the menses may also occur in young women with florid complexions, but, at the same time, of very delicate constitu- tions, and subject to a slight cough, with pain in the breast, and a predisposition to consumption. Such cases require the utmost caution ; and in them, small bleedings, an antiphlogistic diet, mild laxatives, a temperate climate, warm dress, and moderate exercise, are essential: and when it can be procured, a sea-voyage, or change of air, will probably prove the most useful remedy. In the chlorotic species of obstruction, the treatment is much the FEMALE COMPLAINTS. 379 same, as advised under the head of menstruation, for the manage- ment of those who are long having this evacuation. It will be found, almost in every instance, the complaint is occasioned by general de- bility, consequently, the cure must be regulated on the plan of in- creasing the tone of the system, and exciting the action of the ute- rine vessels in particular. This is to be effected by a nourishing diet, moderate use of wine, change of air, gentle exercise, particu- larly riding on horseback, with strengthening medicines, as bark and elixir vitriol, the rust or tincture of steel, or the tonic powders or pills in their usual doses, together with the occasional use of ca- lomel or the stimulating purgative pills, (see Dispensatory,) to keep the bowels in a regular state. The nitric acid, diluted in doses of a wine glassful three or four times a-day, will be found a valuable medicine to improve the habit of body. And if the obstruction be attended with cough, it should be given in the form of the nitric lac-ammoniac. (See Dispensatory.) Previously to the use of tonic medicines, it is advisable to give an emetic, and afterwards a dose of calomel and rhubarb, or the aperient and diaphoretic pills, for the purpose of cleansing the sto- mach and freeing it from acidities and inactive fluids. Costiveness being a constant attendant on this disease, it is of the greatest im- portance, that purgatiyes be repeated, until all the sordes which have been collecting, most probably, for a considerable length of time, shall be removed. After this, and not before, the happiest effects may be expected from the use of tonic medicines. Besides the above remedies, many others may be employed with the same view, as an infusion of camomile, wild cherry, or dog- wood bark, tansy, penny-royal, hyssop, rue, &c. A fable-spoon- ful of mustard seed, morning and evening, or a tea cup full of a weak infusion of horse-radish, on some occasions have produced very good effects. Two ounces of the rust of steel, or filings of iron, steeped in a bottle of wine or cider for a week, and given in doses of a small wine-glassful, morning, noon, and night, has also been found bene- ficial. With the view of exciting into action the uterine vessels, the surface of the body should be kept warm by means of a flannel shift and drawers, by frequent friction of the lower part of the ab- domen and limbs with a flesh brush or flannel, and by the exercise of walking, dancing, and jumping. By marriage, or a change in the mode of life, the disorder has frequently been removed, after hav- ing resisted all the ordinary remedies. In those instances where the evacuation has become suppressed in consequence of previous bad health, it is evident that no attempt to restore it can either be effectual or useful till the cause be re- moved. Some have obstruction caused by very slight weakness, or very early in chronic diseases, others continue regular, till even the last stage of consumption. From the great variety of causes of sexual obstruction, it is certain that many medicines, which possess 380 MANAGEMENT OF very opposite powers, may, in different cases, produce the same ef- fects. For the same reason, a remedy which, in one case, may prove mild, inoffensive, and successful, will, in another apparently similar, occasion a most violent disorder. No remedy applicable to every case can possibly be discovered, therefore, medicines, with a view to restore the periodical evacuation, ought to be employed with the greatest caution. IMMODERATE FLOW OF THE MENSES. This alarming complaint may occur under two different states of the constitution. In the one, the Woman is of a full habit, and of- ten of a ruddy countenance. In the other, she is pale, delicate, and easily fatigued. Symptoms.—In plethoric habits it is often preceded by head ache, giddiness, or difficult breathing, and is afterwards attended with pain in the back and loins, universal heat, and a frequent, strong, and hard pulse. But, when it arises from general debility, or in consequence of a laxity of the organ, paleness of the face, chilliness, lassitude of the whole body, oppressed breathing on the slightest effort, pains in the back on remaining any length of time in an erect posture, and coldness of the extremities, together with a long train of nervous complaints. Causes.—A variety of causes may produce this troublesome dis- ease. Some of these are general, such as a state of great weakness, or of too much blood ; others are local, such as debility of the ute- rus, occasioned by tedious labor or frequent miscarriages. It may also be produced by accidental circumstances determining the blood more copiously and forcibly into the uterine vessels, as vio- lent exercise in dancing, much straining at stool from great cos- tiveness, contusion on the belly, excess in venery, or strong pas- sions of the mind, particularly at the menstrual period. Treatment.—In the management of this disease we have two objects : first, to moderate the discharge and procure present secu- rity ; and, secondly, to prevent a return. The first thing to be done when the hemorrhage is sudden or profuse, is instantly to remove the clothing which may occasion the least interruption to the free circulation of the blood, and to put the patient to bed, lightly covered with clothes. So long as the dis- charge continues, it is of importance to keep her in a recumbent posture, as cool as possible, and perfectly at rest, both in body and mind. Cloths, dipped in cold vinegar and water, and renewed as often as they become warm. These cold applications have a pow- erful effect in restraining uterine hemorrhage, and ought never to be omitted where the discharge of blood is profuse. If the patient be of a full habit, attended with severe pain in the head or back, and febrile symptoms, it will be proper to bleed, and FEMALE COMPLAINTS. 391 to give the antimonial, or febrifuge powders or mixture. (See Dis- pensatory.) The state of the belly must also be attended to. It can be kept gently open by the cathartic mixture, sulphur, or any mild laxative medicine. Stimulating purgatives, or clysters, under such circum- stances, are improper, from their tendency to increase the dis- charge. When no symptoms indicating an increased action in the vessels of the womb are present, astringent medicines should be employ- ed. And, in cases where the discharges have not continued long, and the strength not much impaired, it is often sufficient to arrest the disease by giving fifteen or twenty drops of elixir vitriol, or six or eight grains of alum dissolved in a glass of cold water every hour; or, what is preferable, alum whey, sweetened to the taste, in doses of a small cup full, as often as the stomach will receive it. But, if the discharge be obstinate, we should have recourse to pills of sugar of lead and opium. (See Dispensatory.) In no instance which has come under my knowledge, where the hemorrhage was in consequence of a laxity of the uterine vessels, have these pills failed in producing the desired effect. In those cases where the hemorrhage is profuse, or of long con- tinuance, and resists the means already pointed out, it will be pro- per to inject into the uterus from a gill to half a pint of a strong decoction of oak bark, in which one or two drachms of alum have been dissolved, or as much of the saturated solution of alum in wa- ter, in order to constringe and strengthen the vessels of the womb. This may be repeated twice or thrice a-day, according to circum- stances. When symptoms of an increased action in the vessels of the womb are observable, the tincture of foxglove, in doses of twenty drops every four hours, constitutes the best remedy. When there is reason to suppose the hemorrhage proceeds from a scirrhous or ulcerated state of the womb, all that can be done, is to afford temporary relief by giving opium in large doses. Indeed, opiates may be given with advantage in every case where there is considerable pain or anxiety, and the patient much exhausted. Un- der these circumstances, from one to two tea-spoons full of lauda- num, or from two to four grains of opium, according to the urgen- cy of the case, will be useful not only in giving a check to the dis- charge, but also in preserving the strength, and abating nervous ir- ritation. In most cases it is preferable to give opium in the form of injections to allay the spasmodic pains of the womb ; and, when administered in this way, clysters of thin starch or gruel, in each of which two tea-spoons full of laudanum are added, should be given every two hours until relief be obtained. (See Abortion and Flooding.) Regimen.—The diet, at the time of excessive discharge, must be light and cool. The drink must always be cold, as ice-water, lemonade, or tamarind beverage. Port wine, in such cases, is too 382 MANAGEMENT OF frequently reserted to, which uniformly does harm by increasing the circulation. Prevention.—To prevent a recurrence of the attack in those who are subject to it, the patient must necessarily avoid the causes by which it has been produced. When it is evident that the discharge is in consequence of a full habit, it will be proper to reduce the system by living sparingly, by keeping the bowels rather in a laxative state, and by rising early, and taking through the day regular but frequent exercise; and, af- ter the plethora is removed, by strengthening the vessels, which have been over-distended, by the use of the cold bath. In a greater number of cases, however, we meet with a delicate constitution and spare habit, with pale countenance : this state re- quires the use of sea bathing or the shower bath, and the vessels of the womb are particularly strengthened by pouring cold water daU ly on the back and loins. It will be advisable to use a generous nutritive diet, with wine, and to have recourse to some of the tonic medicines, as advised under the head of obstructed menses, to strengthen the system ge- nerally. At the same time the bowels must be attended to, and invigorating exercise taken daily ; whilst, on the other hand, fatigue, and especially exposure to relaxing heat, must be carefully avoided. SEXUAL WEAKNESS. This complaint, commonly called fluor albus, or whites, to which women are peculiarly subject, must form an important object of at- tention, since it is always attended with disagreeable symptoms; and, when aggravated, soon spoils the beauty of a fine face, weakens the digestive powers, produces a general bad habit, and occasions sterility. Symptoms.—An irregular discharge from the passage leading to the womb, of a fluid, which, in different women, varies much in co- lor, being of a white, green, yellow, or brown hue. In the begin- ning it is, however, most usually white and pellucid, and, in pro- gress of the complaint, acquires the various discolorations and dif- ferent degress of acrimony, whence proceed a slight smarting in making water." Besides the discharge, the patient is frequently af- flicted with severe and constant pains in the back and loins, indi- gestion, paleness of the face, chilliness, and languor. In process of time, every symptom becomes highly aggravated, the feet and an- kles swell, palpitations, and a difficulty of respiration are experi- enced, the menstrual discharge is rendered irregular, the urine is turbid, the mind is dejected, and either consumption or dropsy su- pervenes and terminates a miserable existence. In some languid habits, the fluor albus returns periodically, in- stead of the proper menstrual evacuation, until the patient's con- stitution is duly invigorated. female complaints. 383 Causes.—It may be produced by any cause which either weak- ens or irritates the womb and its appendages. It may arise from general debility of the constitution, but it is especially caused by circumstances impairing the power of the womb itself, as, for in- stance, a severe labor, a miscarriage, or profuse menstruation. In some instances it appears to depend on a full and irritable habit of body, and, in other cases, of local irritation, subh as disorders of the womb, or of the urinary organs, or a collection in the gut, of the small thready worms called ascarides. Upon the high authority of Dr. Hamilton, this disease is most fre- quently first brought on by some imprudence in respect to diet and clothing, or exposure to cold or fatigue, or neglect of the bowels about the time when menstruation begins. Treatment.—In the treatment of this complaint regard must be had to the apparent cause, and to the state of the patient. The dis- charge is too often considered by the sex as the effects of general weakness in their habit, and, therefore, are lead to the indiscriminate use of heating medicines, as port wine, balsam capaivi, &c, without paying attention to the habit of the body, or cause of the disease. A milk diet, change of air, and the partial cold bath, as sponging the loins and thighs with cold water every morning, with attention to cleanliness and proper exercise, are often sufficient to arrest the disease, if early adopted. In addition to this plan of treatment, if the patient be of a full habit, a disposition to fever from slight causes, attended with a sense of heat about the passage to the womb, it will be necessary to have recourse to the lancet, cooling cathartics, and febrifuge medicines, and to inject, several times a-day, flax-seed tea or milk and water, into the passage of the womb. In the great majority of cases, the complaint arises from general debility or laxity of the vessels of the parts, and in such cases the indications of cure are to increase the vital heat, promote the digestion, and restrain the preternatural dis- charge. In order to which, recourse must be had to such of the to- nic medicines as will be found to agree best with the patient. Of these, the bark and elixir vitriol, the tonic powders or pills, the rust or tincture of steel, and lime-water have usually been employed, and often with good effects. In some instances, however, I have known these medicines to fail, when the nitric acid, diluted, (see Dispensatory,) in doses of a wine-glassful, three or four times a- day, wonderfully succeeded. Previously to the exhibition of tonic medicines, it is advisable to give a dose of ipecacuanha or antimonial wine. Gentle emetics are supposed to be of singular utility in this complaint, not only by clean- ing the stomach and bowels, and making a revulsion of the humors from the inferior part of the body, but likewise by their exciting all the powers of the constitution to a more vigorous action. » The bowels must be kept in a regular state by conjoining a few grains of rhubarb with some of the tonic medicines, or by taking oc- casionally, at bed-time, one of the aloetic, or aperient or diaphoretic 394 MANAGEMENT OF pills ; or, in the morning, a tea-spoonful of Epsom salts dissolved in a tumbler of water. If there be a fulness of the stomach after eating, the tincture of rhubarb in small doses will excite digestion. In obstinate cases, it is often expedient to produce a change in the system, by giving a grain or two of calomel, or one of the mercurial pills at bed-time, until the gums become slightly affected, and then the cure may be completed by strengthening medicines, together with the shower bath. Besides tonics, stimulating medicines, such as commonly de- termine to the urinary passages, have very frequently been employed with great benefit. Of these, rosin in doses of ten grains in the yolk of an egg, or a spoonful of molasses, or balsam capaiva in doses of a tea-spoonful, or tincture of cantharides in doses of twenty or thirty drops in some mucilaginous drink, and taken three or four times a- "* day, will be found most salutary. These means strike at the cause of the complaint; but if it do not remove the effect very soon, we are not to trust to them alone. For once a morbid secretion being excited, it is very apt to continue, al- though the exciting cause cease to operate. On this accountj we ought, without delay, to have recourse to astringent injections, such as a strong decoction of red oak bark, with the addition of a little alum or a solution of alum in water. Half an ounce of the former to be dissolved in a bottle of water; which should be thrown into the vagina by means of a female sy- ringe, two or three times a-day. The celebrated Dr. Burns, says, after many trials, he satisfied himself, that although assistance may be derived from internal medicines and the cold bath, yet the chief dependence is to be placed on astringent applications to the seat of the discharge ; and these, where there is no fulness of the general system, nor any affection of the womb itself, are perfectly safe, and seldom fail in producing a cure. It will be prudent, when this disease occurs as an early symptom of pregnancy, not to check the discharge suddenly, lest miscarriage be the consequence ; but it may be moderated by injections of wa- ter, with the addition of a little vinegar, or an infusion of green tea. Neither should the discharge be suddenly suppressed when it has been of long standing, and acquired a considerable degree of acri- mony, with an offensive smell. For if it be unseasonably checked, the belly swells, and a train of the most disagreeable symptoms oc- curs. In such cases, soap-suds, or an infusion of camomile flowers or hops, should be frequently thrown up the vagina ; and as soon as the blood is freed of its impurities, by suitable medicines, and has recovered, in some measure, its soft and balmy quality of which it has been deprived, the astringent injections may be employed with perfect safety. The application of a blister to the sacrum, has, in some obstinate cases, been attended with advantage. When the fluor albus proceeds from worms, purgatives and bit- ter clysters are the proper remedies. FEMALE COMPLAINTS. 385 Pain in tne back and loins is often mitigated, by the application of a large adhesive or strengthening plaster, and by avoiding a standing posture of long continuance, much walking, dancing, or any other violent exertion. Women should carefully avoid all the remote causes of the dis- ease: they should pay diligent attention to cleanliness, by washing the parts frequently with cold water; and when there are excoria- tions, milk and water, or lead-water, may be employed as a wash. Regimen.—The diet should be light, cordial, and nourishing, consisting of isinglass dissolved in milk by boiling it, jellies, cus- tards, rice, milk, soft-boiled eggs, gelatinous broths, and light meats, together with a prudent use of genuine wine, particularly claret, or port. Women, affected with this disease, should by no means indulge in the use of tea and other warm slops of a relaxing nature; but should lie on a mattress in preference to a feather bed ; and they should rise early, and take such daily exercise as their strength will admit, particularly on horseback. When there is much lan- guor, with chilliness, friction with the flesh brust, and wearing flan- nel next the skin must not be omitted. PREGNANCY. The great varieties of the female constitution occasion pregnan- cy to be, to some of the sex, of no trouble or distress, through the whole period of child-bearing ; but it is to others often a continual disease, being, perhaps, from the very first week to the last of their pregnancy, more or less disturbed in their frame from the pe- culiar irritability of their habits. Some feel, very soon after conception, such an alteration in the state of the stomach, or in their sensations in general, as apprizes them of