*** START OF THE PROJECT GUTENBERG EBOOK 74359 ***





                           Domestic Medicine:
                                 OR, A
                                TREATISE
                                 ON THE
                          PREVENTION AND CURE
                                   OF
                                DISEASES
                                   BY
                     REGIMEN AND SIMPLE MEDICINES.
                                  WITH
     An APPENDIX, containing a DISPENSATORY for the Use of Private
                             Practitioners.


                         BY WILLIAM BUCHAN, M. D.
          Fellow of the Royal College of Physicians, Edinburgh.


                           THE TWELFTH EDITION.


                                 LONDON:

 Printed for A. STRAHAN; T. CADELL in the Strand; and J. BALFOUR, and W.
                          CREECH, at Edinburgh.

                                M DCC XCI.

  Omnes homines artem medicam nôsse oportet.——Sapientiæ cognitionem
    medicinæ sororem ac contubernalem esse puto.

                                                            HIPPOCRATES.

  Primoque medendi scientia, sapientiæ pars habebatur.——Rationalem
    quidem puto medicinam esse debere.

                                                                 CELSUS.

  Quemadmodum sanitas omnium rerum pretium excedit, omnisque felicitas
    fundamentum est, ita scientia vitæ ac sanitatis tuendæ omnium
    nobilissima, omnibusque hominibus commendatissima esse debet.

                                                                HOFFMAN.




                                   TO
                        Sir JOSEPH BANKS, Bart.
                    PRESIDENT OF THE ROYAL SOCIETY.


  SIR,

The DOMESTIC MEDICINE having been honoured, on its first appearance,
with the patronage of your learned and worthy Predecessor, the late Sir
JOHN PRINGLE, I beg leave, in a more improved state, to dedicate it to
you, as a small, but sincere, testimony of that veneration and esteem
with which I have long beheld the Man who, born to ease and affluence,
had resolution to encounter the dangers of unknown seas and distant
climes, in pursuit of useful Science; and whose constant object has been
to render that Science subservient to the happiness and civilization of
Society,

I have the honour to be, with great respect,

                                         SIR,
                                             Your most obedient servant,

      London,
  Nov. 10, 1783.

                                                              W. BUCHAN.




                             ADVERTISEMENT.


Twenty years have now elapsed since the first Edition of this Book made
its appearance. During this period, the Author, having been in constant
practice, has taken occasion to improve several articles, which were
with less accuracy inserted in the more early impressions. For this he
has been censured by some, but the more candid and discerning must
approve his conduct. It would be unpardonable in an Author to suffer an
error in a book, on which health and life may depend, to stand
uncorrected; nor would it be much less so to perceive an omission, and
leave it unsupplied. His improvements, however, are not the result of
mercenary views. The same principle which prompted the Author to write
the Book, will ever induce him to improve it to the utmost of his power.

The Author has indeed to regret, that the limits of one volume preclude
many interesting observations, and likewise deprive him of the pleasure
of inserting a number of very useful remarks made by his learned and
ingenious friend Doctor DUPLANIL, of Paris, who has done him the honour
of publishing an elegant translation of this Work, in five volumes
octavo, accompanied with an excellent commentary.

The improvements of the later editions are chiefly inserted in the form
of notes. These are intended either to illustrate the text, or to put
people on their guard in dangerous situations, and prevent fatal
mistakes in the practice of medicine, which it is to be regretted are
but too common.

Some attention has likewise been paid to the language. Where that was
either inaccurate or obscure, as far as was practicable, it has been
corrected. Indeed, the Author has all along endeavoured to observe such
simplicity and perspicuity in his style as might enable the reader
clearly to understand it: a circumstance of the utmost importance in a
performance of this nature.

Although the DOMESTIC MEDICINE was never intended to supercede the use
of a physician, but to supply his place in situations where medical
assistance could not easily be obtained; yet the Author is sorry to
observe, that the jealousies and fears of the Faculty have prompted many
of them to treat this Work in a manner altogether unbecoming the
professors of a liberal science: notwithstanding their injurious
treatment, he is determined to persist in his plan, being fully
convinced of its utility; nor shall interest or prejudice ever deter him
from exerting his best endeavours _to render the Medical Art more
extensively beneficial to_ MANKIND.

But this illiberal treatment of the Faculty is not the only thing of
which the Author has cause to complain. By some of them his Book has
been served up mangled and mutilated, and its title, type, size, &c. so
closely imitated, that purchasers are misled, and frequently buy these
spurious productions instead of the real one. That a needy Author,
incapable himself of producing an original work, should prey upon
another, and that a mercenary Bookseller should vend such productions,
knowing them to be stolen, are things not at all to be wondered at: but
that all this can be done with impunity, shews that the laws of this
country respecting literary property, are still in a very imperfect
state, and stand much in need of amendment.

      LONDON,
  Dec. 10, 1789.




                                PREFACE.


When I first signified my intention of publishing the following sheets,
I was told by my friends it would draw on me the resentment of the whole
Faculty. As I never could entertain such an unfavourable idea, I was
resolved to make the experiment, which indeed came out pretty much as
might have been expected. Many whose learning and liberality of
sentiments do honour to medicine received the book in a manner which at
once shewed their indulgence, and the falsity of the opinion _that every
physician wishes to conceal his art_; while the more selfish and
narrow-minded, generally the most numerous in every profession, have not
failed to persecute both the book and its author.

The reception, however, which this work has met with from the Public
merits my most grateful acknowledgments. As the best way of expressing
these, I have endeavoured to render it more generally useful, by
enlarging the _prophylaxis_, or that part which treats of preventing
diseases; and by adding many articles which had been entirely omitted in
the former impressions. It is needless to enumerate these additions; I
shall only say, that I hope they will be found real improvements.

The observations relative to Nursing and the Management of Children,
were chiefly suggested by an extensive practice among infants, in a
large branch of the Foundling Hospital, where I had an opportunity not
only of treating the diseases incident to childhood, but likewise of
trying different plans of nursing, and observing their effects. Whenever
I had it in my power to place the children under the care of proper
nurses, to instruct these nurses in their duty, and to be satisfied that
they performed it, very few of them died; but when, from distance of
place, and other unavoidable circumstances, the children were left to
the sole care of mercenary nurses, without any person to instruct or
superintend them, scarce any of them lived.

This was so apparent, as with me to amount to a proof of the following
melancholy fact: _That almost one half of the human species perish in
infancy, by improper management or neglect_. This reflection has made me
often wish to be the happy instrument of alleviating the miseries of
those suffering innocents, or of rescuing them from an untimely grave.
No one, who has not had an opportunity of observing them, can imagine
what absurd and ridiculous practices still prevail in the nursing and
management of infants, and what numbers of lives are by that means lost
to society. As these practices are chiefly owing to ignorance, it is to
be hoped, that when nurses are better informed, their conduct will be
more proper.

The application of medicine to the various occupations of life has been
in general the result of observation. An extensive practice for several
years, in one of the largest manufacturing towns in England, afforded me
sufficient opportunities of observing the injuries which those useful
people sustain from their particular employments, and likewise of trying
various methods of obviating such injuries. The success which attended
these trials was sufficient to encourage this attempt, which I hope will
be of use to those who are under the necessity of earning their bread by
such employments as are unfavourable to health.

I do not mean to intimidate men, far less to insinuate that even those
arts, the practice of which is attended with some degree of danger,
should not be carried on; but to guard the less cautious and unwary
against those dangers which they have it in their power to avoid, and
which they often, through mere ignorance, incur. As every occupation in
life disposes those who follow it to some particular diseases more than
to others, it is certainly of importance to know these, in order that
people may be upon their guard against them. It is always better to be
warned of the approach of an enemy, than to be surprised by him,
especially where there is a possibility of avoiding the danger.

The observations concerning Diet, Air, Exercise, &c. are of a more
general nature, and have not escaped the attention of physicians in any
age. They are subjects of too great importance, however, to be passed
over in an attempt of this kind, and can never be sufficiently
recommended. The man who pays a proper attention to these, will seldom
need the physician; and he who does not, will seldom enjoy health, let
him employ as many physicians as he pleases.

Though we have endeavoured to point out the causes of diseases, and to
put people upon their guard against them, yet it must be acknowledged
that they are often of such a nature as to admit of being removed only
by the diligence and activity of the public magistrate. We are sorry,
indeed, to observe, that the power of the magistrate is seldom exerted
in this country for the preservation of health. The importance of a
proper medical police is either not understood, or little regarded. Many
things highly injurious to the public health are daily practiced with
impunity, while others, absolutely necessary for its preservation, are
entirely neglected.

Some of the public means of preserving health are mentioned in the
general prophylaxis, as the inspection of provisions, widening the
streets of great towns, keeping them clean, supplying the inhabitants
with wholesome water, &c.; but they are passed over in a very cursory
manner. A proper attention to these would have swelled this volume to
too large a size; I have therefore reserved them for the subject of a
future publication.

In the treatment of diseases, I have been peculiarly attentive to
regimen. The generality of people lay too much stress upon Medicine, and
trust too little to their own endeavours. It is always in the power of
the patient, or of those about him, to do as much towards his recovery
as can be effected by the physician. By not attending to this, the
designs of Medicine are often frustrated; and the patient, by pursuing a
wrong plan of regimen, not only defeats the Doctor’s endeavours, but
renders them dangerous. I have often known patients killed by an error
in regimen, when they were using very proper medicines. It will be said,
the physician always orders the regimen when he prescribes a medicine. I
wish it were so, both for the honour of the Faculty and the safety of
their patients: but physicians, as well as other people, are too little
attentive to this matter.

Though many reckon it doubtful whether physic is more beneficial or
hurtful to mankind, yet all allow the necessity and importance of a
proper regimen in diseases. Indeed the very appetites of the sick prove
its propriety. No man in his senses ever imagined that a person in a
fever, for example, could eat, drink, or conduct himself in the same
manner as one in perfect health. This part of medicine, therefore, is
evidently founded in Nature, and is every way consistent with reason and
common sense. Had men been more attentive to it, and less solicitous in
hunting after secret remedies, Medicine had never become an object of
ridicule.

This seems to have been the first idea of Medicine. The ancient
physicians acted chiefly in the capacity of nurses. They went very
little beyond aliment in their prescriptions; and even this they
generally administered themselves, attending the sick for that purpose
through the whole course of the disease; which gave them an opportunity
not only of marking the changes of diseases with great accuracy, but
likewise of observing the effects of their different applications, and
adapting them to the symptoms.

The learned Dr. Arbuthnot asserts, that by a proper attention to those
things which are almost within the reach of every body, more good and
less mischief will be done in acute diseases, than by medicines
improperly and unseasonably administered; and that great cures may be
effected in chronical distempers, by a proper regimen of the diet only.
So entirely do the Doctor’s sentiments and mine agree, that I would
advise every person, ignorant of physic, to confine his practice solely
to diet, and the other parts of regimen; by which means he may often do
much good, and can seldom do any hurt.

This seems also to have been the opinion of the ingenious Dr. Huxham,
who observes, that we often seek from Art what all-bountiful Nature most
readily, and as effectually, offers us, had we diligence and sagacity
enough to observe and make use of them; that the _dietetic_ part of
Medicine is not so much studied as it ought to be; and that, though less
pompous, yet it is the most natural method of curing diseases.

To render the book more generally useful, however, as well as more
acceptable to the intelligent part of mankind, I have in most diseases,
besides regimen, recommended some of the most simple and approved forms
of medicine, and added such cautions and directions as seemed necessary
for their safe administration, it would no doubt have been more
acceptable to many, had it abounded with pompous prescriptions, and
promised great cures in consequence of their use; but this was not my
plan: I think the administration of medicines always doubtful, and often
dangerous, and would much rather teach men how to avoid the necessity of
using them, than how they should be used.

Several medicines, and those of considerable efficacy, may be
administered with great freedom and safety. Physicians generally trifle
a long time with medicines before they learn their proper use. Many
peasants at present know better how to use some of the most important
articles in the _materia medica_, than physicians did a century ago; and
doubtless the same observation will hold with regard to others some time
hence. Wherever I was convinced that medicine might be used with safety,
or where the cure depended chiefly upon it, I have taken care to
recommend it; but where it was either highly dangerous, or not very
necessary, it is omitted.

I have not troubled the reader with an useless parade of quotations from
different authors, but have in general adopted their observations where
my own were either defective, or totally wanting. Those to whom I am
most obliged are, Ramazini, Arbuthnot, and Tissot; the last of which, in
his _Avis au Peuple_, comes the nearest to my views of any author which
I have seen. Had the Doctor’s plan been as complete as the execution is
masterly, we should have had no occasion for any new treatise of this
kind soon; but by confining himself to the acute diseases, he has in my
opinion omitted the most useful part of his subject. People in acute
diseases may sometimes be their own physicians; but in the chronic, the
cure must ever depend chiefly upon the patient’s own endeavours. The
Doctor has also passed over the _Prophylaxis_, or preventive part of
Medicine, very slightly, though it is certainly of the greatest
importance in such a work. He had no doubt his reasons for so doing, and
I am so far from finding fault with him, that I think his performance
does great honour both to his head and to his heart.

Several other foreign physicians of eminence have written on nearly the
same plan with Tissot, as the Baron Van Swieten, physician to their
Imperial Majesties, M. Rosen, first physician of the kingdom of Sweden,
&c.; but these gentlemen’s productions have never come to my hand. I
cannot help wishing, however, that some of our distinguished countrymen
would follow their example. There still remains much to be done on this
subject, and it does not appear to me how any man could better employ
his time or talents, than in eradicating hurtful prejudices, and
diffusing useful knowledge among the people.

I know some of the Faculty disapprove of every attempt of this nature,
imagining that it must totally destroy their influence. But this notion
appears to me to be as absurd as it is illiberal. People in distress
will always apply for relief to men of superior abilities, when they
have it in their power; and they will do this with far greater
confidence and readiness when they believe that Medicine is a rational
science, than when they take it to be only a matter of mere conjecture.

Though I have endeavoured to render this Treatise plain and useful, yet
I found it impossible to avoid some terms of art; but those are in
general either explained, or are such as most people understand. In
short, I have endeavoured to conform my style to the capacities of
mankind in general; and, if my Readers do not flatter either themselves
or me, with some degree of success. On a medical subject, this is not so
easy a matter as some may imagine. To make a shew of learning is easier
than to write plain sense, especially in a science which has been kept
at such a distance from common observation. It would however be no
difficult matter to prove, that every thing valuable in the practical
part of Medicine is within the reach of common abilities.

It would be ungenerous not to express my warmest acknowledgments to
those Gentlemen who have endeavoured to extend the usefulness of this
Performance, by translating it into the language of their respective
countries. Most of them have not only given elegant translations of the
Book, but have also enriched it with many useful observations; by which
it is rendered more complete, and better adapted to the climate and the
constitutions of their countrymen. To the learned Dr. Duplanil of Paris,
physician to the Count d’Artois, I lie under particular obligations; as
this Gentleman has not only considerably enlarged my Treatise, but, by
his very ingenious and useful notes, has rendered it so popular on the
Continent, as to occasion its being translated into all the languages of
modern Europe.

I have only to add, that the book has not more exceeded my expectations
in its success, than in the effects it has produced. Some of the most
pernicious practices, with regard to the treatment of the sick, have
already given place to a more rational conduct; and many of the most
hurtful prejudices, which seemed to be quite insurmountable, have in a
great measure yielded to better information. Of this a stronger instance
cannot be given than the inoculation of the small-pox. Few mothers, some
years ago, would submit to have their children inoculated even by the
hand of a Physician; yet nothing is more certain, than that of late many
of them have performed this operation with their own hands; and as their
success has been equal to that of the most dignified inoculators, there
is little reason to doubt that the practice will become general.
Whenever this shall be the case, more lives will be saved by inoculation
alone, than are at present by all the endeavours of the Faculty.




                             INTRODUCTION.


The improvements in Medicine, since the revival of learning, have by no
means kept pace with those of the other arts. The reason is obvious.
Medicine has been studied by few, except those who intended to live by
it as a trade. Such, either from a mistaken zeal for the honour of
Medicine, or to raise their own importance, have endeavoured to disguise
and conceal the art. Medical authors have generally written in a foreign
language; and those who were unequal to this talk, have even valued
themselves upon couching, at least, their prescriptions, in terms and
characters unintelligible to the rest of mankind.

The contentions of the clergy, which happened soon after the restoration
of learning, engaged the attention of mankind, and paved the way for
that freedom of thought and inquiry, which has since prevailed in most
parts of Europe with regard to religious matters. Every man took a side
in those bloody disputes; and every gentleman, that he might distinguish
himself on one side or other, was instructed in Divinity. This taught
people to think and reason for themselves in matters of religion, and at
last totally destroyed that complete and absolute dominion which the
clergy had obtained over the minds of men.

The study of Law has likewise, in most civilized nations, been justly
deemed a necessary part of the education of a gentleman. Every gentleman
ought certainly to know at least the laws of his own country: and, if he
were also acquainted with those of others, it might be more than barely
an ornament to him.

The different branches of Philosophy have also of late been very
universally studied by all who pretended to a liberal education. The
advantages of this are manifest. It frees the mind from prejudice and
superstition; fits it for the investigation of truth; induces habits of
reasoning and judging properly; opens an inexhaustible source of
entertainment; paves the way to the improvement of arts and agriculture;
and qualifies men for acting with propriety in the most important
stations of life.

Natural History is likewise become an object of general attention; and
it well deserves to be so. It leads to discoveries of the greatest
importance. Indeed agriculture, the most useful of all arts, is only a
branch of Natural History, and can never arrive at a high degree of
improvement where the study of that science is neglected.

Medicine however has not, as far as I know, in any country, been
reckoned a necessary part of the education of a gentleman. But surely no
sufficient reason can be assigned for this omission. No science lays
open a more extensive field of useful knowledge, or affords more ample
entertainment to an inquisitive mind. Anatomy, Botany, Chymistry, and
the _Materia Medica_, are all branches of Natural History, and are
fraught with such amusement and utility, that the man who entirely
neglects them has but a sorry claim either to taste or learning. If a
gentleman has a turn for observation, says an excellent and sensible
writer[1], surely the natural history of his own species is a more
interesting subject, and presents a more ample field for the exertion of
genius, than the natural history of spiders and cockle-shells.

We do not mean that every man should become a physician. This would be
an attempt as ridiculous as it is impossible. All we plead for is, that
men of sense and learning should be so far acquainted with the general
principles of Medicine, as to be in a condition to derive from it some
of those advantages with which it is fraught; and at the same time to
guard themselves against the destructive influences of Ignorance,
Superstition, and Quackery.

As matters stand at present, it is easier to cheat a man out of his life
than of a shilling, and almost impossible either to detect or punish the
offender. Notwithstanding this, people still shut their eyes, and take
every thing upon trust that is administered by any Pretender to
Medicine, without daring to ask him a reason for any part of his
conduct. Implicit faith, every where else the object of ridicule, is
still sacred here. Many of the faculty are no doubt worthy of all the
confidence that can be reposed in them; but as this can never be the
character of every individual in any profession, it would certainly be
for the safety, as well as the honour, of mankind, to have some check
upon the conduct of those to whom they entrust so valuable a treasure as
health.

The veil of mystery, which still hangs over medicine, renders it not
only a conjectural, but even a suspicious art. This has been long ago
removed from the other sciences, which induces many to believe that
Medicine is a mere trick, and that it will not bear a fair and candid
examination. Medicine, however, needs only to be better known, in order
to secure the general esteem of mankind. Its precepts are such as every
wise man would chuse to observe, and it forbids nothing but what is
incompatible with true happiness.

Disguising Medicine not only retards its improvement as a science, but
exposes the profession to ridicule, and is injurious to the true
interests of society. An art founded on observation never can arrive at
any high degree of improvement, while it is confined to a few who make a
trade of it. The united observations of all the ingenious and sensible
part of mankind, would do more in a few years towards the improvement of
Medicine, than those of the Faculty alone in a great many. Any man can
tell when a medicine gives him ease as well as a physician; and if he
only knows the name and dose of the medicine, and the name of the
disease, it is sufficient to perpetuate the fact. Yet the man who adds
one single fact to the stock of medical observations, does more real
service to the art, than he who writes a volume in support of some
favourable hypothesis.

Very few of the valuable discoveries in Medicine have been made by
physicians. They have in general either been the effect of chance or of
necessity, and have been usually opposed by the Faculty, till every one
else was convinced of their importance. An implicit faith in the
opinions of teachers, an attachment to systems and established forms,
and the dread of reflections, will always operate upon those who follow
Medicine as a trade. Few improvements are to be expected from a man who
might ruin his character and family by even the smallest deviation from
an established rule.

If men of letters, says the author of the performance quoted above, were
to claim their right of inquiry into a matter that so nearly concerns
them, the good effects on Medicine would soon appear. Such men would
have no separate interest from that of the art. They would detect and
expose assuming Ignorance under the mask of Gravity and Importance, and
would be the judges and patrons of modest merit. Not having their
understandings perverted in their youth by false theories, unawed by
authority, and unbiassed by interest, they would canvass with freedom
the most universally received principles in Medicine, and expose the
uncertainty of many of those doctrines, of which a physician dares not
so much as seem to doubt.

No argument, continues he, can be brought against laying open Medicine,
which does not apply with equal, if not greater force, to religion; yet
experience has shewn, that since the laity have asserted their right of
inquiry into these subjects, Theology, considered as a science, has been
improved, the interests of real religion have been promoted, and the
clergy have become a more learned, a more useful, and a more respectable
body of men, than they ever were in the days of their greatest power and
splendour.

Had other medical writers been as honest as this gentleman, the art had
been upon a very different footing at this day. Most of them extol the
merit of those men who brought Philosophy out of the schools, and
subjected it to the rules of common sense. But they never consider that
Medicine, at present, is in nearly the same situation as Philosophy was
at that time, and that it might be as much improved by being treated in
the same manner. Indeed, no science can either be rendered rational or
useful, without being submitted to the common sense and reason of
mankind. These alone stamp a value upon science; and what will not bear
the test of these ought to be rejected.

I know it will be said, that diffusing medical knowledge among the
people might induce them to tamper with Medicine, and to trust to their
own skill instead of calling a physician. The reverse of this however is
true. Persons who have most knowledge in these matters, are commonly
most ready both to ask and to follow advice, when it is necessary. The
ignorant are always most apt to tamper with Medicine, and have the least
confidence in physicians. Instances of this are daily to be met with
among the ignorant peasants, who, while they absolutely refuse to take a
medicine which has been prescribed by a physician, will swallow with
greediness any thing that is recommended to them by their credulous
neighbours. Where men will act even without knowledge, it is certainly
more rational to afford them all the light we can, than to leave them
entirely in the dark.

It may also be alleged, that laying Medicine more open to mankind would
lessen their faith in it. This would indeed be the case with regard to
some; but it would have a quite contrary effect upon others. I know many
people who have the utmost dread and horror of every thing prescribed by
a physician, but who will nevertheless very readily take a medicine
which they know, and whose qualities they are in some measure acquainted
with. Hence it is evident, that the dread arises from the doctor, not
from the drug. Nothing ever can or will inspire mankind with an absolute
confidence in physicians, but an open, frank, and undisguised behaviour.
While the least shadow of mystery remains in the conduct of the Faculty,
doubts, jealousies, and suspicions, will arise in the minds of men.

No doubt cases will sometimes occur, where a prudent physician may find
it expedient to disguise a medicine. The whims and humours of men must
be regarded by those who mean to do them service; but this can never
affect the general argument in favour of candour and openness. A man
might as well allege, because there are knaves and fools in the world,
that he ought to take every one he meets for such, and to treat him
accordingly. A sensible physician will always know where disguise is
necessary; but it ought never to appear on the face of his general
conduct.

The appearance of mystery in the conduct of physicians not only renders
their art suspicious, but lays the foundations of Quackery, which is the
disgrace of Medicine. No two characters can be more different than that
of the honest physician and the quack; yet they have generally been very
much confounded. The line between them is not sufficiently apparent; at
least it is too fine for the general eye. Few persons are able to
distinguish sufficiently between the conduct of that man who administers
a secret medicine, and him who writes a prescription in mystical
characters and an unknown tongue. Thus the conduct of the honest
physician, which needs no disguise, gives a sanction to that of the
villain, whose sole consequence depends upon secrecy.

No laws will ever be able to prevent quackery, while people believe that
the quack is as honest a man, and as well qualified, as the physician. A
very small degree of medical knowledge, however, would be sufficient to
break this spell; and nothing else can effectually undeceive them. It is
the ignorance and credulity of the multitude, with regard to medicine,
which renders them such an easy prey to every one who has the hardiness
to attack them on this quarter. Nor can the evil be remedied by any
other means but by making them wiser.

The most effectual way to destroy quackery in any art or science, is to
diffuse the knowledge of it among mankind. Did physicians write their
prescriptions in the common language of the country, and explain their
intentions to the patient, as far as he could understand them, it would
enable him to know when the medicine had the desired effect; would
inspire him with absolute confidence in the physician; and would make
him dread and detest every man who pretended to cram a secret medicine
down his throat.

Men in the different states of society, have very different views of the
same object. Some time ago it was the practice of this country for every
person to say his prayers in Latin, whether he knew any thing of that
language or not. This conduct, though sacred in the eyes of our
ancestors, appears ridiculous enough to us; and doubtless some parts of
ours will seem as strange to posterity. Among these we may reckon the
present mode of medical prescription, which, we venture to affirm, will
sometime hence appear to have been completely ridiculous, and a very
high burlesque upon the common sense of mankind.

But this practice is not only ridiculous, it is likewise dangerous.
However capable physicians may be of writing Latin, I am certain
apothecaries are not always in a condition to read it, and that
dangerous mistakes, in consequence of this, often happen. But suppose
the apothecary ever so able to read the physician’s prescription, he is
generally otherwise employed, and the business of making up
prescriptions is left entirely to the apprentice. By this means the
greatest man in the kingdom, even when he employs a first-rate
physician, in reality trusts his life in the hands of an idle boy, who
has not only the chance of being very ignorant, but likewise giddy and
careless. Mistakes will sometimes happen in spite of the greatest care;
but, where human lives are concerned, all possible methods ought
certainly to be taken to prevent them. For this reason, the
prescriptions of physicians, instead of being couched in mystical
characters and a foreign language, ought, in my humble opinion, to be
conceived in the most plain and obvious terms imaginable.

Diffusing medical knowledge among the people would not only tend to
improve the art, and to banish quackery, but likewise to render Medicine
more universally useful, by extending its benefits to society. However
long Medicine may have been known as a science, we will venture to say,
that many of its most important purposes to society have either been
overlooked, or very little attended to. The cure of diseases is
doubtless a matter of great importance; but the preservation of health
is of still greater. This is the concern of every man, and surely what
relates to it ought to be rendered as plain and obvious to all as
possible. It is not to be supposed, that men can be sufficiently upon
their guard against diseases, who are totally ignorant of their causes.
Neither can the legislature, in whose power it is to do much more for
preserving the public health than can ever be done by the Faculty, exert
that power with propriety, and to the greatest advantage, without some
degree of medical knowledge.

Men of every occupation and condition in life might avail themselves of
a degree of medical knowledge; as it would teach them to avoid the
dangers peculiar to their respective stations; which is always easier
than to remove their effects. Medical knowledge, instead of being a
check upon the enjoyments of life, only teaches men how to make the most
of them. It has indeed been said, _that to live medically is to live
miserably_: but it might with equal propriety be said, that to live
rationally is to live miserably. If physicians obtrude their own
ridiculous whims upon mankind, or lay down rules inconsistent with
reason or common sense, no doubt they will be despised. But this is not
the fault of Medicine. It proposes no rules that I know, but such as are
perfectly consistent with the true enjoyment of life, and every way
conducive to the real happiness of mankind.

We are sorry indeed to observe, that Medicine has hitherto hardly been
considered as a popular science, but as a branch of knowledge solely
confined to a particular set of men, while all the rest have been taught
not only to neglect, but even to dread and despise it. It will however
appear, upon a more strict examination, that no science better deserves
their attention, or is more capable of being rendered generally useful.

People are told, that if they dip the least into medical knowledge, it
will render them fanciful, and make them believe they have every disease
of which they read. This I am satisfied will seldom be the case with
sensible people; and, suppose it were, they must soon be undeceived. A
short time will shew them their error, and a little more reading will
infallibly correct it. A single instance will shew the absurdity of this
notion. A sensible lady, rather than read a medical performance, which
would instruct her in the management of her children, must leave them
entirely to the care and conduct of the most ignorant, credulous, and
superstitious part of the human species.

No part of Medicine is of more general importance than that which
relates to the nursing and management of children. Yet few parents pay a
proper attention to it. They leave the sole care of their tender
offspring, at the very time when care and attention are most necessary,
to hirelings, who are either too careless to do their duty, or too
ignorant to know it. We will venture to affirm, that more human lives
are lost by the carelessness and inattention of parents and nurses, than
are saved by the Faculty; and that the joint and well-conducted
endeavours, both of private persons and the public, for the preservation
of infant lives, would be of more advantage to society, than the whole
art of Medicine, upon its present footing.

The benefits of Medicine, as a trade, will ever be confined to those who
are able to pay for them; and of course, the far greater part of mankind
will be every where deprived of them. Physicians, like other people,
must live by their employment, and the poor must either want advice
altogether, or take up with that which is worse than none. There are not
however any where wanting well-disposed people, of better sense, who are
willing to supply the defect of medical advice to the poor, did not
their fear of doing ill often suppress their inclination to do good.
Such people are often deterred from the most noble and praise-worthy
actions, by the foolish alarms sounded in their ears by a set of men
who, to raise their own importance, magnify the difficulties of doing
good, find fault with what is truly commendable, and fleer at every
attempt to relieve the sick which is not conducted by the precise rules
of Medicine. These gentlemen must however excuse me for saying, that I
have often known such well-disposed persons do much good; and that their
practice, which is generally the result of good sense and observation,
assisted by a little medical reading, is frequently more rational than
that of the ignorant retainer to physic, who despises both reason and
observation, _that he may go wrong by rule_; and who, while he is dosing
his patient with medicines, often neglects other things of far greater
importance.

Many things are necessary for the sick besides medicine. Nor is the
person who takes care to procure those for them, of less importance than
a physician. The poor oftener perish in diseases for want of proper
nursing than of medicine. They are frequently in want of even the
necessaries of life, and still more so of what is proper for a sickbed.
No one can imagine, who has not been a witness of these situations, how
much good a well-disposed person may do, by only taking care to have
such wants supplied. There certainly cannot be a more necessary, a more
noble, or a more godlike action, than to administer to the wants of our
fellow-creatures in distress. While virtue or religion are known among
mankind, this conduct will be approved; and while Heaven is just, it
must be rewarded!

Persons who do not chuse to administer medicine to the sick, may
nevertheless direct their regimen. An eminent medical author has said,
That by diet alone all the intentions of Medicine may be answered[2]. No
doubt a great many of them may; but there are other things beside diet,
which ought by no means to be neglected. Many hurtful and destructive
prejudices, with regard to the treatment of the sick, still prevail
among the people, which persons of better sense and learning alone can
eradicate. To guard the poor against the influence of these prejudices,
and to instil into their minds some just ideas of the importance of
proper food, fresh air, cleanliness, and other pieces of regimen
necessary in diseases, would be a work of great merit, and productive of
many happy consequences. A proper regimen, in most diseases, is at least
equal to medicine, and in many of them it is greatly superior.

To assist the well-meant endeavours of the humane and benevolent in
relieving distress; to eradicate dangerous and hurtful prejudices; to
guard the ignorant and credulous against the frauds and impositions of
quacks and impostors; and to shew men what is in their own power, both
with regard to the prevention and cure of diseases, are certainly
objects worthy of the physician’s attention. These were the leading
views in composing and publishing the following sheets. They were
suggested by an attention to the conduct of mankind, with regard to
Medicine, in the course of a pretty long practice in different parts of
this island, during which the author has often had occasion to wish that
his patients, or those about them, had been possessed of some such plain
directory for regulating their conduct. How far he has succeeded in his
endeavours to supply this deficiency, must be left for others to
determine; but if they be found to contribute in any measure towards
alleviating the calamities of mankind, he will think his labour very
well bestowed.




                               CONTENTS.


                                 PART I.
                   Of the general Causes of Diseases.

                                CHAP. I.
 Of Children                                                      Page 1
 — Diseased Parents                                                    7
 — Clothing of Children                                                9
 — Food of ditto                                                      15
 — Exercise of ditto                                                  21
 — Bad Effects of unwholesome Air upon ditto                          30
 — Nurses                                                             33

                                CHAP. II.
 Of the Laborious, &c.                                                37
 — the Sedentary                                                      47
 — the Studious                                                       54

                               CHAP. III.
 Of Aliment                                                           62

                                CHAP. IV.
 Of Air                                                               75

                                CHAP. V.
 Of Exercise                                                          81

                                CHAP. VI.
 Of Sleep                                                             87
 — Clothing                                                           89

                               CHAP. VII.
 Of Intemperance                                                      94

                               CHAP. VIII.
 Of Cleanliness                                                      100

                                CHAP. IX.
 Of Infection                                                        106

                                CHAP. X.
 Of the Passions                                                     111
 — Anger                                                             112
 — Fear                                                              ib.
 — Grief                                                             116
 — Love                                                              119
 — Religious Melancholy                                              120

                                CHAP. XI.
 Of the Common Evacuations                                           121
 — Stool                                                             ib.
 — Urine                                                             123
 — Perspiration                                                      125
 — being affected by Changes in the Atmosphere                       126
 — Wet Clothes                                                       127
 — Wet Feet                                                          ib.
 — Night Air                                                         128
 — Damp Beds                                                         ib.
 — Damp Houses                                                       130
 — Sudden Transitions from Heat to Cold                              131

                                PART II.
                              Of Diseases.

                               CHAP. XII.
 Of the Knowledge and Cure of Diseases                               135

                               CHAP. XIII.
 Fevers in general                                                   140

                               CHAP. XIV.
 Of intermitting Fevers or Agues                                     147

                                CHAP. XV.
 Of an Acute Continual Fever                                         157

                               CHAP. XVI.
 Of the Pleurisy                                                     163
 —— Bastard ditto                                                    169
 —— Paraphrenitis                                                    170

                               CHAP. XVII.
 Inflammation of the Lungs                                           171

                              CHAP. XVIII.
 Of Consumptions                                                     174

                               CHAP. XIX.
 Of the Slow or Nervous Fever                                        188

                                CHAP. XX.
 Malignant, Putrid, or Spotted Fever                                 195

                               CHAP. XXI.
 Miliary Fever                                                       205

                               CHAP. XXII.
 Remitting Fever                                                     210

                              CHAP. XXIII.
 The Small-pox                                                       214
 Inoculation                                                         227

                               CHAP. XXIV.
 The Measles                                                         240
 — Scarlet Fever                                                     245
 — Bilious Fever                                                     247

                               CHAP. XXV.
 St. Anthony’s Fire                                                  248

                               CHAP. XXVI.
 Inflammation of the Brain                                           254

                              CHAP. XXVII.
 Inflammation of the Eyes                                            258

                              CHAP. XXVIII.
 The Quinsey                                                         264
 — Malignant ditto                                                   271

                               CHAP. XXIX.
 Colds and Coughs                                                    276
 A Common Cough                                                      280
 Hooping-Cough                                                       284

                               CHAP. XXX.
 Inflammation of the Stomach                                         289
 —— of the Intestines                                                291
 Of the Colic                                                        295
 Inflammation of the Kidnies                                         301
 —— of the Bladder                                                   304
 —— of the Liver                                                     305

                               CHAP. XXXI.
 Of the Cholera Morbus, and other excessive Discharges from the
   Stomach and Bowels                                                309
 — a Diarrhœa, or Looseness                                          312
 — Vomiting                                                          315

                              CHAP. XXXII.
 Disorders of the Kidnies and Bladder                                319
 Of the Diabetes, or excessive Discharge of Urine                    ib.
 — Suppression of ditto                                              322
 — the Gravel and Stone                                              324

                              CHAP. XXXIII.
 Involuntary Discharges of Blood                                     328
 Bleeding at the Nose                                                331
 Bleeding and Blind Piles                                            334
 Spitting of Blood                                                   337
 Vomiting of ditto                                                   341
 Bloody Urine                                                        342
 —— Flux                                                             345
 Cœliac Passion                                                      351

                              CHAP. XXXIV.
 Of the Head-ach                                                     352
 —— Tooth-ach                                                        357
 —— Ear-ach                                                          360
 Pain of the Stomach, &c.                                            362

                               CHAP. XXXV.
 Of Worms                                                            365

                              CHAP. XXXVI.
 Of the Jaundice                                                     370

                              CHAP. XXXVII.
 Of the Dropsy                                                       374

                             CHAP. XXXVIII.
 Of the Gout                                                         380
 —— Rheumatism                                                       388

                              CHAP. XXXIX.
 Of the Scurvy                                                       393
 —— Scrophula                                                        398
 —— Itch                                                             403

                                CHAP. XL.
 Of the Asthma                                                       406

                               CHAP. XLI.
 Of the Apoplexy                                                     410

                               CHAP. XLII.
 Of Costiveness                                                      414
 — Want of Appetite                                                  416
 — Heart-burn                                                        418

                              CHAP. XLIII.
 Of Nervous Diseases                                                 420
 — Melancholy                                                        426
 — the Palsy                                                         430
 — the Epilepsy, or Falling Sickness                                 432
 — the Hiccup                                                        436
 — Cramp of the Stomach                                              438
 — the Night-mare                                                    439
 — Swoonings                                                         440
 — Flatulencies, or Wind                                             443
 — Low Spirits                                                       446
 — Hysteric Affections                                               447
 — Hypochondriac Affections                                          451

                               CHAP. XLIV.
 Disorders of the Senses                                             456
 —— of the Eye                                                       ib.
 A Gutta Serena                                                      458
 A Cataract                                                          458
 Short Sightedness                                                   459
 Seeing only at too great a Distance                                 ib.
 Squinting                                                           ib.
 Spots or Specks                                                     ib.
 Bloodshot Eye                                                       ib.
 Watery or Weeping Eye                                               460
 Of the Ear                                                          ib.
 —— Taste and Smell                                                  463
 —— Touch                                                            465

                               CHAP. XLV.
 Of a Scirrhus and Cancer                                            466

                               CHAP. XLVI.
 Of Poisons                                                          472
 — Mineral Poisons                                                   474
 — Vegetable ditto                                                   475
 Bites of poisonous Animals                                          477
 —— of the Mad Dog                                                   ib.
 —— of the Viper                                                     485
 —— of poisonous Infects                                             486
 —— of the Rattle-Snake                                              488

                              CHAP. XLVII.
 Of the Venereal Disease                                             489
 —— Virulent Gonorrhœa                                               490
 — Gleets                                                            500
 — Swelled Testicle                                                  503
 — Buboes                                                            504
 — Chancres                                                          506
 — A Confirmed Lues or Pox                                           510
 General Observations                                                515

                              CHAP. XLVIII.
 Diseases of Women                                                   521
 Of the Menstrual Discharge                                          522
 — Pregnancy                                                         530
 — Childbirth                                                        533
 — Barrenness                                                        542

                               CHAP. XLIX.
 Diseases of Children                                                544
 Of the Meconium                                                     546
 — the Apthæ or Thrush                                               547
 — Acidities                                                         548
 — Galling and Excoriation                                           550
 — Stoppage of the Nose                                              ib.
 — Vomiting                                                          551
 — a Looseness                                                       552
 — Eruptions                                                         554
 — the Croup                                                         557
 — Teething                                                          559
 — the Rickets                                                       562
 — Convulsions                                                       565
 — Water in the Head                                                 567

                                CHAP. L.
 Of Surgery                                                          569
 — Bleeding                                                          570
 — Inflammations and Abscesses                                       573
 — Wounds                                                            575
 — Burns                                                             580
 — Bruises                                                           582
 Ulcers                                                              583

                                CHAP. LI.
 Of Dislocations                                                     586
 Dislocation of the Jaw                                              588
 —— of the Neck                                                      589
 —— of the Ribs                                                      590
 —— of the Shoulder                                                  ib.
 —— of the Elbow                                                     591
 —— of the Wrist and Fingers                                         592
 —— of the Thigh                                                     ib.
 —— of the Knees                                                     ib.
 —— of the Ancles                                                    ib.
 —— of the Toes                                                      ib.

                               CHAP. LII.
 Of broken Bones, &c.                                                593
 — Strains                                                           597
 — Ruptures                                                          598

                               CHAP. LIII.
 Of Casualties                                                       600
 — Substances stopt between the Mouth and Stomach                    602
 — Drowned Persons                                                   608
 — Noxious Vapours                                                   613
 Effects of Extreme Cold                                             616
 —— Heat                                                             618

                               CHAP. LIV.
 Of Fainting Fits, and other Cases which require immediate
   Assistance                                                        618
 — Intoxication                                                      623
 — Suffocation and Strangling                                        626
 — Persons who expire in Convulsion Fits                             629

                                CHAP. LV.
 Cautions concerning Cold Bathing, and drinking the Mineral
   Waters                                                            633


                       CONTENTS of the APPENDIX.

 Introduction                                                   Page 649
 List of Simples                                                     654

                          Medical Preparations.
 Balsams                                                             657
 Boluses                                                             658
 Cataplasms and Sinapisms                                            659
 Clysters                                                            660
 Collyria, or Eye-waters                                             662
 Confections                                                         663
 Conserves and Preserves                                             664
 Decoctions                                                          665
 Draughts                                                            668
 Electuaries                                                         669
 Emulsions                                                           672
 Extracts                                                            673
 Fomentations                                                        ib.
 Gargles                                                             674
 Infusions                                                           676
 Juleps                                                              678
 Mixtures                                                            680
 Ointments, Liniments, and Cerates                                   681
 Pills                                                               684
 Plasters                                                            688
 Powders                                                             690
 Syrups                                                              694
 Tinctures, Elixirs, &c.                                             ib.
 Vinegars                                                            699
 Waters by Infusion, &c.                                             701
 Simple distilled Waters                                             703
 Spirituous distilled Waters                                         704
 Wheys                                                               ib.
 Wines                                                               705

 A GLOSSARY                                                          708
 INDEX                                                               713




                                PART I.
                                 OF THE
                      GENERAL CAUSES OF DISEASES.




                                CHAP. I.
                              OF CHILDREN.


The better to trace diseases from their original causes, we shall take a
view of the common treatment of mankind in the state of infancy. In this
period of our lives, the foundations of a good or bad constitution are
generally laid; it is therefore of importance, that parents be well
acquainted with the various causes which may injure the health of their
offspring.

It appears from the annual registers of the dead, that almost one half
of the children born in Great Britain die under twelve years of age. To
many, indeed, this may appear a natural evil; but, on due examination,
it will be found to be one of our own creating. Were the death of
infants a natural evil, other animals would be as liable to die young as
man; but this we find is by no means the case.

It may seem strange that man, notwithstanding his superior reason,
should fall so far short of other animals in the management of his
young: But our surprise will soon cease, if we consider that brutes,
guided by instinct, never err in this respect; while man, trusting
solely to art, is seldom right. Were a catalogue of those infants who
perish annually by art alone exhibited to public view, it would astonish
most people.

If parents are above taking care of their children, others must be
employed for that purpose: these will always endeavour to recommend
themselves by the appearance of extraordinary skill and address. By this
means such a number of unnecessary and destructive articles have been
introduced into the diet, clothing, &c. of infants, that it is no wonder
so many of them perish.

Nothing can be more preposterous than a mother who thinks it below her
to take care of her own child, or who is so ignorant as not to know what
is proper to be done for it. If we search Nature throughout, we cannot
find a parallel to this. Every other animal is the nurse of its own
offspring, and they thrive accordingly. Were the brutes to bring up
their young by proxy, they would share the same fate with those of the
human species.

We mean not, however, to impose it as a task upon every mother to suckle
her own child. This, whatever speculative writers may allege, is in some
cases impracticable, and would inevitably prove destructive both to the
mother and child. Women of delicate constitutions, subject to hysteric
fits, or other nervous affections, make very bad nurses: and these
complaints are now so common, that it is rare to find a woman of fashion
free from them; such women, therefore, supposing them willing, are often
unable to suckle their own children.

Almost every mother would be in a condition to give suck, did mankind
live agreeably to Nature: but whoever considers how far many mothers
deviate from her dictates, will not be surprised to find some of them
unable to perform that necessary office. Mothers who do not eat a
sufficient quantity of solid food, nor enjoy the benefit of free air and
exercise, can neither have wholesome juices themselves, nor afford
proper nourishment to an infant. Hence children who are suckled by
delicate women, either die young, or continue weak and sickly all their
lives.

When we say that mothers are not always in a condition to suckle their
own children, we would not be understood as discouraging that practice.
Every mother who can, ought certainly to perform so tender and agreeable
an office[3]. But, suppose it to be out of her power, she may,
nevertheless, be of great service to her child. The business of nursing
is by no means confined to giving suck. To a woman who abounds with
milk, this is the easiest part of it. Numberless other offices are
necessary for a child, which the mother ought at least to see done.

A mother who abandons the fruit of her womb, as soon as it is born, to
the sole care of an hireling, hardly deserves that name. A child, by
being brought up under the mother’s eye, not only secures her affection,
but may reap all the advantages of a parent’s care, though it be suckled
by another. How can a mother be better employed than in superintending
the nursery? This is at once the most delightful and important office;
yet the most trivial business or insipid amusements are often preferred
to it! A strong proof both of the bad taste and wrong education of
modern females.

It is indeed to be regretted, that more care is not bestowed in teaching
the proper management of children to those whom Nature has designed for
mothers. This, instead of being made the principal, is seldom considered
as any part of female education. Is it any wonder, when females so
educated come to be mothers, that they should be quite ignorant of the
duties belonging to that character? However strange it may appear, it is
certainly true, that many mothers, and those of fashion too, are as
ignorant, when they have brought a child into the world, of what is to
be done for it, as the infant itself. Indeed, the most ignorant of the
sex are generally reckoned most knowing in the business of nursing.
Hence, sensible people become the dupes of ignorance and superstition;
and the nursing of children, instead of being conducted by reason, is
the result of whim and caprice[4].

Were the time that is generally spent by females in the acquisition of
trifling accomplishments, employed in learning how to bring up their
children; how to dress them so as not to hurt, cramp, or confine their
motions; how to feed them with wholesome and nourishing food; how to
exercise their tender bodies, so as best to promote their growth and
strength: were these made the objects of female instruction, mankind
would derive the greatest advantages from it. But while the education of
females implies little more than what relates to dress and public shew,
we have nothing to expect from them but ignorance even in the most
important concerns.

Did mothers reflect on their own importance, and lay it to heart, they
would embrace every opportunity of informing themselves of the duties
which they owe to their infant offspring. It is their province, not only
to form the body, but also to give the mind its most early bias. They
have it very much in their power to make men healthy or valetudinary,
useful in life, or the pests of society.

But the mother is not the only person concerned in the management of
children. The father has an equal interest in their welfare, and ought
to assist in every thing that respects either the improvement of the
body or mind.

It is pity that the men should be so inattentive to this matter. Their
negligence is one reason why females know so little of it. Women will
ever be desirous to excel in such accomplishments as recommend them to
the other sex. But men generally keep at such a distance from even the
smallest acquaintance with the affairs of the nursery, that many would
reckon it an affront, were they supposed to know any thing of them. Not
so, however, with the kennel or the stables: a gentleman of the first
rank is not ashamed to give directions concerning the management of his
dogs or horses, yet would blush were he surprised in performing the same
office for that being who derived its exigence from himself, who is the
heir of his fortunes, and the future hope of his country.

Nor have physicians themselves been sufficiently attentive to the
management of children: this has been generally considered as the sole
province of old women, while men of the first character in physic have
refused to visit infants even when sick. Such conduct in the faculty has
not only caused this branch of medicine to be neglected, but has also
encouraged the other sex to assume an absolute title to prescribe for
children in the most dangerous diseases. The consequence is, that a
physician is seldom called till the good women have exhausted all their
skill; when his attendance can only serve to divide the blame, and
appease the disconsolate parents.

Nurses should do all in their power to prevent diseases; but when a
child is taken ill, some person of skill ought immediately to be
consulted. The diseases of children are generally acute, and the least
delay is dangerous.

Were physicians more attentive to the diseases of infants, they would
not only be better qualified to treat them properly when sick, but
likewise to give useful directions for their management when well. The
diseases of children are by no means so difficult to be understood as
many imagine. It is true, children cannot tell their complaints; but the
causes of them may be pretty certainly discovered by observing the
symptoms, and putting proper questions to the nurses. Besides, the
diseases of infants being less complicated, are easier cured than those
of adults[5].

It is really astonishing, that so little attention should in general be
paid to the preservation of infants. What labour and expence are daily
bestowed to prop an old tottering carcase for a few years, while
thousands of those who might be useful in life, perish without being
regarded! Mankind are too apt to value things according to their
present, not their future, usefulness. Though this is of all others the
most erroneous method of estimation; yet upon no other principle is it
possible to account for the general indifference with respect to the
death of infants.


                         _Of Diseased Parents._

One great source of the diseases of children is, the UNHEALTHINESS OF
PARENTS. It would be as reasonable to expect a rich crop from a barren
soil, as that strong and healthy children should be born of parents
whose constitutions have been worn out with intemperance or disease.

An ingenious writer[6] observes, that on the constitution of mothers
depends originally that of their offspring. No one who believes this,
will be surprised, on a view of the female world, to find diseases and
death so frequent among children. A delicate female, brought up within
doors, an utter stranger to exercise and open air, who lives on tea and
other slops, may bring a child into the world, but it will hardly be fit
to live. The first blast of disease will nip the tender plant in the
bud: or, should it struggle through a few years existence, its feeble
frame, shaken with convulsions from every trivial cause, will be unable
to perform the common functions of life, and prove a burden to society.

If to the delicacy of mothers, we add the irregular lives of fathers, we
shall see further cause to believe that children are often hurt by the
constitution of their parents. A sickly frame may be originally induced
by hardships or intemperance, but chiefly by the latter. It is
impossible that a course of vice should not spoil the best constitution:
and, did the evil terminate here, it would be a just punishment for the
folly of the sufferer; but when once a disease is contracted and riveted
in the habit, it is entailed on posterity. What a dreadful inheritance
is the gout, the scurvy, or the King’s evil, to transmit to our
offspring! how happy had it been for the heir of many a great estate,
had he been born a beggar, rather than to inherit his father’s fortunes
at the expence of inheriting his diseases!

A person labouring under any incurable malady ought not to marry. He
thereby not only shortens his own life, but transmits misery to others:
but when both parties are deeply tainted with the scrophula, the scurvy,
or the like, the effects must be still worse. If such have any issue,
they must be miserable indeed. Want of attention to these things, in
forming connexions for life, has rooted out more families than plague,
famine, or the sword; and as long as these connexions are formed from
mercenary views, the evil will be continued[7].

In our matrimonial contracts, it is amazing so little regard is had to
the health and form of the object. Our sportsmen know, that the generous
courser cannot be bred out of the foundered jade, nor the sagacious
spaniel out of the snarling cur. This is settled upon immutable laws.
The man who marries a woman of a sickly constitution, and descended of
unhealthy parents, whatever his views may be, cannot be said to act a
prudent part. A diseased woman may prove fertile; should this be the
case, the family must become an infirmary: what prospect of happiness
the father of such a family has, we shall leave any one to judge[8].

Such children as have the misfortune to be born of diseased parents,
will require to be nursed with greater care than others. This is the
only way to make amends for the defects of constitution; and it will
often go a great length. A healthy nurse, wholesome air, and sufficient
exercise, will do wonders. But when these are neglected, little is to be
expected from any other quarter. The defects of constitution cannot be
supplied by medicine.

Those who inherit any family disease ought to be very circumspect in
their manner of living. They should consider well the nature of such
disease, and guard against it by a proper regimen. It is certain, that
family diseases have often, by proper care, been kept off for one
generation; and there is reason to believe, that, by persisting in the
same course, such diseases might at length be wholly eradicated. This is
a subject very little regarded, though of the greatest importance.
Family constitutions are as capable of improvement as family estates;
and the libertine, who impairs the one, does greater injury to his
posterity, than the prodigal who squanders away the other.


                     _Of the Clothing of Children._

The clothing of an infant is so simple a matter, that it is surprising
how any person should err in it; yet many children lose their lives, and
others are deformed, by inattention to this article.

Nature knows no use of clothes to an infant, but to keep it warm. All
that is necessary for this purpose, is to wrap it in a soft loose
covering. Were a mother left to the dictates of Nature alone, she would
certainly pursue this course. But the business of dressing an infant has
long been out of the hands of mothers, and has at last become a secret
which none but adepts pretend to understand.

From the most early ages it has been thought necessary, that a woman in
labour should have some person to attend her. This in time became a
business; and, as in all others, those who were employed in it strove to
outdo one another in the different branches of their profession. The
dressing of a child came of course to be considered as the midwife’s
province, who no doubt imagined, that the more dexterity she could shew
in this article, the more her skill would be admired. Her attempts were
seconded by the vanity of parents, who, too often desirous of making a
shew of the infant as soon as it was born, were ambitious to have as
much finery heaped upon it as possible. Thus it came to be thought as
necessary for a midwife to excel in bracing and dressing an infant, as
for a surgeon to be expert in applying bandages to a broken limb; and
the poor child, as soon as it came into the world, had as many rollers
and wrappers applied to its body, as if every bone had been fractured in
the birth; while these were often so tight, as not only to gall and
wound its tender frame, but even to obstruct the motion of the heart,
lungs, and other organs necessary for life.

In most parts of Britain, the practice of rolling children with so many
bandages is now, in some measure, laid aside; but it would still be a
difficult task to persuade the generality of mankind, that the shape of
an infant does not entirely depend on the care of the midwife. So far,
however, are all her endeavours to mend the shape from being successful,
that they constantly operate the contrary way, and mankind become
deformed in proportion to the means used to prevent it. How little
deformity of body is to be found among uncivilized nations? So little
indeed, that it is vulgarly believed they put all their deformed
children to death. The truth is, they hardly know such a thing as a
deformed child. Neither should we, if we followed their example. Savage
nations never think of manacling their children. They allow them the
full use of every organ, carry them abroad in the open air, wash their
bodies daily in cold water, &c. By this management, their children
become so strong and hardy, that, by the time our puny infants get out
of the nurse’s arms, theirs are able to shift for themselves[9].

Among brute animals, no art is necessary to procure a fine shape. Though
many of them are extremely delicate when they come into the world, yet
we never find them grow crooked for want of swaddling bands. Is nature
less generous to the human kind? No: but we take the business out of
Nature’s hands.

Not only the analogy of other animals, but the very feelings of infants
tell us, they ought to be kept easy and free from all pressure. They
cannot indeed tell their complaints; but they can shew signs of pain;
and this they never fail to do, by crying when hurt by their clothes. No
sooner are they freed from their bracings, than they seem pleased and
happy; yet, strange infatuation! the moment they hold their peace, they
are again committed to their chains.

If we consider the body of an infant as a bundle of soft pipes,
replenished with fluids in continual motion, the danger of pressure will
appear in the strongest light. Nature, in order to make way for the
growth of children, has formed their bodies soft and flexible; and lest
they should receive any injury from pressure in the womb, has surrounded
the _fœtus_ every where with fluids. This shews the care which Nature
takes to prevent all unequal pressure on the bodies of infants, and to
defend them against every thing that might in the least cramp or confine
their motions.

Even the bones of an infant are so soft and cartilaginous, that they
readily yield to the slightest pressure, and easily assume a bad shape,
which can never after be remedied. Hence it is, that so many people
appear with high shoulders, crooked spines, and flat breasts, who were
as well proportioned at their birth as others, but had the misfortune to
be squeezed out of shape by the application of stays and bandages.

Pressure, by obstructing the circulation, likewise prevents the equal
distribution of nourishment to the different parts of the body, by which
means the growth becomes unequal. One part grows too large, while
another remains too small; and thus in time the whole frame becomes
disproportioned and misshapen. To this we must add, that when a child is
cramped in its clothes, it naturally shrinks from the part that is hurt;
and, by putting its body into unnatural postures it becomes deformed by
habit.

Deformity of body may indeed proceed from weakness or disease; but, in
general, it is the effect of improper clothing. Nine-tenths, at least,
of the deformity among mankind, must be imputed to this cause. A
deformed body is not only disagreeable to the eye, but by a bad figure
both the animal and vital functions must be impeded, and of course
health impaired. Hence few people remarkably mishapen are strong or
healthy.

The new motions which commence at the birth, as the circulation of the
whole mass of blood through the lungs, respiration, the peristaltic
motion, &c. afford another strong argument for keeping the body of an
infant free from all pressure. These organs, not having been accustomed
to move, are easily stopped; but when this happens, death must ensue.
Hardly any method could be devised more effectually to stop these
motions, than bracing the body too tight with rollers[10] and bandages.
Were these to be applied in the same manner to the body of an adult for
an equal length of time, they would hardly fail to hurt the digestion
and make him sick. How much more hurtful they must prove to the tender
bodies of infants, we shall leave any one to judge.

Whoever considers these things will not be surprised, that so many
children die of convulsions soon after the birth. These fits are
generally attributed to some inward cause; but in fact, they oftener
proceed from our own imprudent conduct. I have known a child seized with
convulsion-fits soon after the midwife had done swaddling it, who, upon
taking off the rollers and bandages, was immediately relieved, and never
had the disease afterwards. Numerous examples of this might be given,
were they necessary.

It would be safer to fasten the cloths of an infant with strings than
pins, as these often gall and irritate their tender skins, and occasion
disorders. Pins have been found sticking above half an inch into the
body of a child, after it had died of convulsion fits, which, in all
probability, proceeded from that cause.

Children are not only hurt by the tightness of their clothes, but also
by the quantity. Every child has some degree of fever after the birth;
and if it be loaded with too many clothes, the fever must be increased.
But this is not all; the child is generally laid in bed with the mother,
who is often likewise feverish; to which we may add the heat of the
bed-chamber, the wines, and other heating things, too frequently given
to children immediately after the birth. When all these are combined,
which does not seldom happen, they must increase the fever to such a
degree as will endanger the life of the infant.

The danger of keeping infants too hot will further appear, if we
consider that, after they have been for some time in the situation
mentioned above, they are often sent into the country to be nursed in a
cold house. Is it any wonder, if a child, from such a transition,
catches a mortal cold, or contracts some other fatal disease? When an
infant is kept too hot, its lungs, not being sufficiently expanded, are
apt to remain weak and flaccid for life; hence proceed coughs,
consumptions, and other diseases of the breast.

It would answer little purpose to specify the particular species of
dress proper for an infant. These will always vary in different
countries, according to custom and the humour of parents. The great rule
to be observed is, _That a child have no more clothes than are necessary
to keep it warm, and that they be quite easy for its body_.

Stays are the very bane of infants. A volume would not suffice to point
out all the bad effects of this ridiculous piece of dress both on
children and adults. The madness in favour of stays seems, however, to
be somewhat abated; and it is to be hoped the world will, in time,
become wise enough to know, that the human shape does not solely depend
upon whale-bone and bend-leather[11].

I shall only add with respect to the clothes of children, that they
ought to be kept thoroughly clean. Children perspire more than adults;
and if their clothes be not frequently changed, they become very
hurtful. Dirty clothes not only gall and fret the tender skins of
infants, but likewise occasion ill smells; and, what is worse, tend to
produce vermin and cutaneous diseases.

Cleanliness is not only agreeable to the eye, but tends greatly to
preserve the health of children. It promotes the perspiration, and, by
that means, frees the body from superfluous humours, which, if retained,
could not fail to occasion diseases. No mother or nurse can have any
excuse for allowing a child to be dirty. Poverty may oblige her to give
it coarse clothes; but if she does not keep them clean, it must be her
own fault.


                       _Of the Food of Children._

Nature not only points out the food proper for an infant, but actually
prepares it. This, however, is not sufficient to prevent some who think
themselves wiser than Nature, from attempting to bring up their children
without her provision. Nothing can shew the disposition which mankind
have to depart from Nature, more than their endeavouring to bring up
children without the breast. The mother’s milk, or that of a healthy
nurse, is unquestionably the best food for an infant. Neither art nor
nature can afford a proper substitute for it. Children may seem to
thrive for a few months without the breast; but, when teething, the
small-pox, and other diseases incident to childhood, come on, they
generally perish.

A child, soon after the birth, shews an inclination to suck; and there
is no reason why it should not be gratified. It is true, the mother’s
milk does not always come immediately after the birth; but this is the
way to bring it: besides, the first milk that the child can squeeze out
of the breast answers the purpose of cleansing, better than all the
drugs in the apothecary’s shop, and at the same time prevents
inflammations of the breast, fevers, and other diseases incident to
mothers.

It is strange how people came to think that the first thing given to a
child should be drugs. This is beginning with medicine by times, and no
wonder if they generally ended with it. It sometimes happens, indeed,
that a child does not discharge the _meconium_ so soon as could be
wished; this has induced physicians, in such cases, to give something of
an opening nature to cleanse the first passages. Midwives have improved
upon this hint, and never fail to give syrups, oils, &c. whether they be
necessary or not. Cramming an infant with such indigestible stuff as
soon as it is born, can hardly fail to make it sick, and is more likely
to occasion diseases, than to prevent them. Children are seldom long
after the birth without having passage both by stool and urine; though
these evacuations may be wanting for some time without any danger. But
if children must have something before they be allowed the breast, let
it be a little thin water-pap, to which may be added an equal quantity
of new milk; or rather water alone, with the addition of a little raw
sugar. If this be given without any wines or spiceries, it will neither
heat the blood, load the stomach, nor occasion gripes.

Upon the first sight of an infant, almost every person is struck with
the idea of its being weak, feeble, and wanting support. This naturally
suggests the need of cordials. Accordingly wines are universally mixed
with the first food of children. Nothing can be more fallacious than
this way of reasoning, or more hurtful to infants than the conduct
founded upon it. Children require very little food for some time after
the birth; and what they receive should be thin, weak, light, and of a
cooling quality. A very small quantity of wine is sufficient to heat and
inflame the blood of an infant; but every person conversant in these
matters must know, that most of the diseases of infants proceed from the
heat of their humours.

If the mother or nurse has enough of milk, the child will need little or
no other food before the third or four month. It will then be proper to
give it, once or twice a day, a little of some food that is easy of
digestion, as water-pap, milk-pottage, weak broth with bread in it, and
such like. This will ease the mother, will accustom the child by degrees
to take food, and will render the weaning both less difficult and less
dangerous. All great and sudden transitions are to be avoided in
nursing. For this purpose, the food of children ought not only to be
simple, but to resemble, as nearly as possible, the properties of milk.
Indeed milk itself should make a principal part of their food, not only
before they are weaned, but for some time after.

Next to milk, we would recommend good light bread. Bread may be given to
a child as soon as it shews an inclination to chew; and it may at all
times be allowed as much plain bread as it will eat. The very chewing of
bread will promote the cutting of the teeth, and the discharge of
_saliva_, while, by mixing with the nurse’s milk in the stomach, it will
afford an excellent nourishment. Children discover an early inclination
to chew whatever is put into their hands. Parents observe the
inclination, but generally mistake the object. Instead of giving the
child something which may at once exercise its gums and afford it
nourishment, they commonly put into its hands a piece of hard metal, or
impenetrable coral. A crust of bread is the best gum-stick. It not only
answers the purpose better than any thing else, but has the additional
properties of nourishing the child and carrying the saliva down to the
stomach, which is too valuable a liquor to be lost.

Bread, besides being used dry, may be many ways prepared into food for
children. One of the best methods is to boil it in water, afterwards
pouring the water off, and mixing with the bread a proper quantity of
new milk unboiled. Milk is both more wholesome and nourishing this way
than boiled, and is less apt to occasion costiveness. For a child
farther advanced, bread may be mixed in veal or chicken broth, made into
puddings, or the like. Bread is a proper food for children at all times,
provided it be plain, made of wholesome grain, and well fermented; but
when enriched with fruits, sugars, or such things, it becomes very
unwholesome.

It is soon enough to allow children animal food when they have got teeth
to eat it. They should never taste it till after they are weaned, and
even then they ought to use it sparingly. Indeed, when children live
wholly on vegetable food, it is apt to sour on their stomachs; but, on
the other hand, too much flesh heats the body, and occasions fevers and
other inflammatory diseases. This plainly points out a due mixture of
animal and vegetable food as most proper for children.

Few things prove more hurtful to infants, than the common method of
sweetening their food. It entices them to take more than they ought to
do, which makes them grow fat and bloated. It is pretty certain, if the
food of children were quite plain, that they would never take more than
enough. Their excesses are entirely owing to nurses. If a child be
gorged with food at all hours, and enticed to take it, by making it
sweet and agreeable to the palate, is it any wonder that such a child
should in time be induced to crave more food than it ought to have?

Children may be hurt by too little as well as too much food. After a
child is weaned, it ought to be fed four or five times a day; but should
never be accustomed to eat in the night; neither should it have too much
at a time. Children thrive best with small quantities of food frequently
given. This neither overloads the stomach nor hurts the digestion, and
is certainly most agreeable to Nature.

Writers on nursing have inveighed with such vehemence against giving
children too much food, that many parents, by endeavouring to shun that
error, have run into the opposite extreme, and ruined the constitutions
of their children. But the error of pinching children in their food is
more hurtful than the other extreme. Nature has many ways of relieving
herself when overcharged; but a child, who is pinched with hunger, will
never become a strong or healthy man. That errors are frequently
committed on both sides, we are ready to acknowledge; but where one
child is hurt by the quantity of its food, ten suffer from the quality.
This is the principal evil, and claims our strictest attention.

Many people imagine, that the food which they themselves love cannot be
bad for their children: but this notion is very absurd. In the more
advanced periods of life we often acquire an inclination for food, which
when children we could not endure. Besides, there are many things that
by habit may agree very well with the stomach of a grown person, which
would be hurtful to a child; as high-seasoned, salted, and smoke-dried
provisions, &c. It would also be improper to feed children with fat
meat, strong broths, rich soups, or the like.

All strong liquors are hurtful to children. Some parents teach their
children to guzzle ale, and other fermented liquors, at every meal. Such
a practice cannot fail to do mischief. These children seldom escape the
violence of the small-pox, measles, hooping cough, or some inflammatory
disorder. Milk, water, butter-milk, or whey, are the most proper for
children to drink. If they have any thing stronger, it may be fine small
beer, or a little wine mixed with water. The stomachs of children can
digest well enough without the assistance of warm stimulants: besides,
being naturally hot, they are easily hurt by every thing of a heating
quality.

Few things are more hurtful to children than unripe fruits. They weaken
the powers of digestion, and sour and relax the stomach, by which means
it becomes a proper nest for insects. Children indeed shew a great
inclination for fruit, and I am apt to believe, that if good ripe fruit
were allowed them in proper quantity, it would have no bad effects. We
never find a natural inclination wrong, if properly regulated. Fruits
are generally of a cooling nature, and correct the heat and acrimony of
the humours. This is what most children require; only care should be
taken lest they exceed. Indeed the best way to prevent children from
going to excess in the use of fruit, or eating that which is bad, is to
allow them a proper quantity of what is good[12].

Roots which contain a crude viscid juice should be sparingly given to
children. They fill the body with gross humours, and tend to produce
eruptive diseases. This caution is peculiarly necessary for the poor;
glad to obtain at a small price what will fill the bellies of their
children, they stuff them two or three times a day with greasy potatoes,
or other crude vegetables. Children had better eat a smaller quantity of
food which yields a wholesome nourishment, than be crammed with what
their digestive powers are unable properly to assimilate.

Butter ought likewise to be sparingly given to children. It both relaxes
the stomach, and produces gross humours. Indeed, most things that are
fat or oily, have this effect. Butter, when salted, becomes still more
hurtful. Instead of butter, so liberally given to children in most parts
of Britain, we would recommend honey. Honey is not only wholesome, but
cooling, cleansing, and tends to sweeten the humours. Children who eat
honey are seldom troubled with worms: they are also less subject to
cutaneous diseases, as itch, scabbed head, &c.

Many people err in thinking that the diet of children ought to be
altogether moist. When children live entirely upon slops, it relaxes
their solids, renders them weak, and disposes them to the rickets, the
scrophula, and other glandular disorders. Relaxation is one of the most
general causes of the diseases of children. Every thing therefore which
tends to unbrace their solids, ought to be carefully avoided.

We would not be understood by these observations as confining children
to any particular kind of food. Their diet may be frequently varied,
provided always that sufficient regard be had to simplicity.


                     _Of the Exercise of Children._

Of all the causes which conspire to render the life of man short and
miserable, none has greater influence than the want of proper EXERCISE:
healthy parents, wholesome food, and proper clothing, will avail little,
where exercise is neglected. Sufficient exercise will make up for
several defects in nursing; but nothing can supply the want of it. It is
absolutely necessary to the health, the growth, and the strength of
children.

The desire of exercise is coëval with life itself. Were this principle
attended to, many diseases might be prevented. But, while indolence and
sedentary employments prevent two-thirds of mankind from either taking
sufficient exercise themselves, or giving it to their children, what
have we to expect but diseases and deformity among their offspring? The
rickets, so destructive to children, never appeared in Britain till
manufactures began to flourish, and people, attracted by the love of
gain, left the country to follow sedentary employments in great towns.
It is amongst these people that this disease chiefly prevails, and not
only deforms, but kills many of their offspring.

The conduct of other young animals shews the propriety of giving
exercise to children. Every other animal makes use of its organs of
motion as soon as it can, and many of them, even when under no necessity
of moving in quest of food, cannot be restrained without force. This is
evidently the case with the calf, the lamb, and most other young
animals. If these creatures were not permitted to frisk about and take
exercise, they would soon die or become diseased. The same inclination
appears very early in the human species; but as they are not able to
take exercise themselves, it is the business of their parents and nurses
to assist them.

Children may be exercised various ways. The best method, while they are
light, is to carry them about in the nurse’s arms[13]. This gives the
nurse an opportunity of talking to the child, and of pointing out every
thing that may please and delight its fancy. Besides, it is much safer
than swinging an infant in a machine, or leaving it to the care of such
as are not fit to take care of themselves. Nothing can be more absurd
than to set one child to keep another: this conduct has proved fatal to
many infants, and has rendered others miserable for life.

When children begin to walk, the safest and best method of leading them
about, is by the hands. The common way, of swinging them in
leading-strings fixed to their backs, has several bad consequences. It
makes them throw their bodies forward, and press with their whole weight
upon the stomach and breast; by this means the breathing is obstructed,
the breast flattened, and the bowels compressed; which must hurt the
digestion, and occasion consumptions of the lungs, and other diseases.

It is a common notion, that if children are set upon their feet too
soon, their legs will become crooked. There is reason to believe, that
the very reverse of this is true. Every member acquires strength in
proportion as it is exercised. The limbs of children are weak indeed,
but their bodies are proportionally light; and had they skill to direct
themselves, they would soon be able to support their own weight. Who
ever heard of any other animal that became crooked by using its legs too
soon? Indeed, if a child is not permitted to make any use of its legs
till a considerable time after the birth, and be then set upon them with
its whole weight at once, there may be some danger; but this proceeds
entirely from the child’s not having been accustomed to use its legs
from the beginning.

Mothers of the poorer sort think they are great gainers by making their
children lie or sit while they themselves work. In this they are greatly
mistaken. By neglecting to give their children exercise, they are
obliged to keep them a long time before they can do any thing for
themselves, and to spend more on medicine than would have paid for
proper care.

To take care of their children, is the most useful business in which
even the poor can be employed: but, alas! it is not always in their
power. Poverty often obliges them to neglect their offspring, in order
to procure the necessaries of life. When this is the case, it becomes
the interest as well as the duty of the public to assist them. Ten
thousand times more benefit would accrue to the State, by enabling the
poor to bring up their own children, than from all the hospitals[14]
that ever can be erected for that purpose.

Whoever considers the structure of the human body will soon be convinced
of the necessity of exercise for the health of children. The body is
composed of an infinite number of tubes, whose fluids cannot be pushed
on without the action and pressure of the muscles. But, if the fluids
remain inactive, obstructions must happen, and the humours will of
course be vitiated, which cannot fail to occasion diseases. Nature has
furnished both the vessels which carry the blood and lymph with numerous
valves, in order that the action of every muscle might push forward
their contents; but without action, this admirable contrivance can have
no effect. This part of the animal œconomy proves to a demonstration the
necessity of exercise for the preservation of health.

Arguments to shew the importance of exercise might be drawn from every
part of the animal œconomy; without exercise, the circulation of the
blood cannot be properly carried on, nor the different secretions duly
performed; without exercise, the fluids cannot be properly prepared, nor
the solids rendered strong or firm. The action of the heart, the motion
of the lungs, and all the vital functions, are greatly assisted by
exercise. But to point out the manner in which these effects are
produced, would lead us farther into the œconomy of the human body, than
most of those for whom this treatise is intended would be able to
follow. We shall therefore only add, that, where exercise is neglected,
none of the animal functions can be duly performed; and when that is the
case, the whole constitution must go to wreck.

A good constitution ought certainly to be our first object in the
management of children. It lays a foundation for their being useful and
happy in life; and whoever neglects it, not only fails in his duty to
his offspring, but to society.

One very common error of parents, by which they hurt the constitutions
of their children, is the sending them too young to school. This is
often done solely to prevent trouble. When the child is at school, he
needs no keeper. Thus the schoolmaster is made the nurse; and the poor
child is fixed to a seat seven or eight hours a day, which time ought to
be spent in exercise and diversions. Sitting so long cannot fail to
produce the worst effects upon the body; nor is the mind less injured.
Early application weakens the faculties, and often fixes in the mind an
aversion to books, which continues for life[15].

But, suppose this were the way to make children scholars, it certainly
ought not to be done at the expence of their constitutions. Our
ancestors, who seldom went to school very young, were not less learned
than we. But we imagine the boy’s education will be quite marred, unless
he be carried to school in his nurse’s arms. No wonder if such hotbed
plants seldom become either scholars or men!

Not only the confinement of children in public schools, but their
number, often proves hurtful. Children are much injured by being kept in
crowds within doors; their breathing not only renders the place
unwholesome, but if any one of them happens to be diseased, the rest
catch the infection. A single child has been often known to communicate
the bloody flux, the hooping-cough, the itch, or other diseases, to
almost every individual in a numerous school.

But, if fashion must prevail, and infants are to be sent to school, we
would recommend it to teachers, as they value the interests of society,
not to confine them too long at a time, but allow them to run about and
play at such active diversions as may promote their growth, and
strengthen their constitutions. Were boys, instead of being whipped for
stealing an hour to run, ride, swim, or the like, encouraged to employ a
proper part of their time in these manly and useful exercises, it would
have many excellent effects.

It would be of great service to boys, if, at a proper age, they were
taught the military exercise. This would increase their strength,
inspire them with courage, and when their country called for their
assistance, would enable them to act in her defence, without being
obliged to undergo a tedious and troublesome course of instructions, at
a time when they are less fit to learn new motions, gestures, &c.[16]

An effeminate education will infallibly spoil the best natural
constitution; and if boys are brought up in a more delicate manner than
even girls ought to be, they never will be men.

Nor is the common education of girls less hurtful to the constitution
than that of boys. Miss is set down to her frame before she can put on
her clothes; and is taught to believe, that to excel at the needle is
the only thing that can entitle her to general esteem. It is unnecessary
here to insist upon the dangerous consequences of obliging girls to sit
too much. They are pretty well known, and are too often felt at a
certain time of life. But supposing this critical period to be got over,
greater dangers still await them when they come to be mothers. Women who
have been early accustomed to a sedentary life, generally run great
hazard in child-bed; while those who have been used to romp about, and
take sufficient exercise, are seldom in any danger.

One hardly meets with a girl who can at the same time boast of early
performances by the needle, and a good constitution. Close and early
confinement generally occasions indigestions, head-achs, pale
complexions, pain of the stomach, loss of appetite, coughs, consumptions
of the lungs, and deformity of body. The last of these indeed is not to
be wondered at, considering the awkward postures in which girls sit at
many kinds of needle-work, and the delicate flexible state of their
bodies in the early periods of life.

Would mothers, instead of having their daughters instructed in many
trifling accomplishments, employ them in plain work and housewifery, and
allow them sufficient exercise in the open air, they would both make
them more healthy mothers, and more useful members of society. I am no
enemy to genteel accomplishments, but would have them only considered as
secondary, and always disregarded when they impair health.

Many people imagine it a great advantage for children to be early taught
to earn their bread. This opinion is certainly right, provided they were
so employed as not to hurt their health or growth; but, when these
suffer, society, instead of being benefited, is a real loser by their
labour. There are few employments, except sedentary ones, by which
children can earn a livelihood; and if they be set to these too soon, it
ruins their constitutions. Thus, by gaining a few years from childhood,
we generally lose twice as many in the latter period of life, and even
render the person less useful while he does live.

In order to be satisfied of the truth of this observation, we need only
look into the great manufacturing towns, where we shall find a puny
degenerate race of people, weak and sickly all their lives, seldom
exceeding the middle period of life; or if they do, being unfit for
business, they become a burden to society. Thus arts and manufactures,
though they may increase the riches of a country, are by no means
favourable to the health of its inhabitants. Good policy would therefore
require, that such people as labour during life, should not be set too
early to work. Every person conversant in the breed of horses, or other
working animals, knows, that if they be set to hard labour too soon,
they never will turn out to advantage. This is equally true with respect
to the human species.

There are nevertheless various ways of employing young people without
hurting their health. The easier parts of gardening, husbandry, or any
business carried on without doors, are most proper. These are
employments which most young people are fond of, and some parts of them
may always be adapted to their age, taste, and strength[17].

Such parents, however, as are under the necessity of employing their
children within doors, ought to allow them sufficient time for active
diversions without. This would both encourage them to do more work, and
prevent their constitutions from being hurt.

Some imagine, that exercise within doors is sufficient; but they are
greatly mistaken. One hour spent in running, or any other exercise
without doors, is worth ten within. When children cannot go abroad, they
may indeed be exercised at home. The best method of doing this, is to
make them run about in a long room, or dance. This last kind of
exercise, if not carried to excess, is of excellent service to young
people. It cheers the spirits, promotes perspiration, strengthens the
limbs, &c. I know an eminent physician who used to say, that he made his
children dance, instead of giving them physic. It were well if more
people followed his example.

The COLD BATH may be considered as an aid to exercise. By it the body is
braced and strengthened, the circulation and secretions promoted, and,
were it conducted with prudence, many diseases, as the rickets,
scrophula, &c. might thereby be prevented. The ancients, who took every
method to render children hardy and robust, were no strangers to the use
of the cold bath; and, if we may credit report, the practice of
immersing children daily in cold water must have been very common among
our ancestors.

The greatest objection to the use of the cold bath arises from the
superstitious prejudices of nurses. These are often so strong, that it
is impossible to bring them to make a proper use of it. I have known
some of them who would not dry a child’s skin after bathing it, lest it
should destroy the effect of the water. Others will even put cloths dipt
in the water upon the child, and either put it to bed, or suffer it to
go about in that condition. Some believe, that the whole virtue of the
water depends upon its being dedicated to a particular saint: while
others place their confidence in a certain number of dips, as three,
seven, nine, or the like; and the world could not persuade them, if
these do not succeed, to try it a little longer. Thus, by the whims of
nurses, children lose the benefit of the cold bath, and the hopes of the
physician from that medicine are often frustrated.

We ought not, however, entirely to set aside the cold bath, because some
nurses make a wrong use of it. Every child, when in health, should at
least have its extremities daily washed in cold water. This is a partial
use of the cold bath, and is better than none. In winter this may
suffice; but, in the warm season, if a child be relaxed, or seem to have
a tendency to the rickets or scrophula, its whole body ought to be
frequently immersed in cold water. Care however must be taken not to do
this when the body is hot, or the stomach full. The child should be dipt
only once at a time, should be taken out immediately, and have its skin
well rubbed with a dry cloth.


          _The bad Effects of unwholesome Air upon Children._

Few things prove more destructive to children than confined or
unwholesome air. This is one reason why so few of those infants, who are
put into hospitals, or parish workhouses, live. These places are
generally crowded with old, sickly, and infirm people; by which means
the air is rendered so extremely pernicious, that it becomes a poison to
infants.

Want of wholesome air is likewise destructive to many of the children
born in great towns. There the poorer sort of inhabitants live in low,
dirty, confined houses, to which the fresh air has hardly any access.
Though grown people, who are hardy and robust, may live in such
situations, yet they generally prove fatal to their offspring, few of
whom arrive at maturity, and those who do are weak and deformed. As such
people are not in a condition to carry their children abroad into the
open air, we must lay our account with losing the greater part of them.
But the rich have not this excuse. It is their business to see that
their children be daily carried abroad, and that they be kept in the
open air for a sufficient time. This will always succeed better if the
mother goes along with them. Servants are often negligent in these
matters, and allow a child to sit or lie on the damp ground, instead of
leading or carrying it about. The mother surely needs air as well as her
children; and how can she be better employed than in attending them?

A very bad custom prevails, of making children sleep in small
apartments, or crowding two or three beds into one chamber. Instead of
this, the nursery ought always to be the largest and best aired room in
the house. When children are confined in small apartments, the air not
only becomes unwholesome, but the heat relaxes their solids, renders
them delicate, and disposes them to colds and many other disorders. Nor
is the custom of wrapping them up too close in cradles less pernicious.
One would think that nurses were afraid lest children should suffer by
breathing free air, as many of them actually cover the child’s face
while asleep, and others wrap a covering over the whole cradle, by which
means the child is forced to breathe the same air over and over all the
time it sleeps. Cradles indeed are on many accounts hurtful to children,
and it would be better if the use of them were totally laid aside[18].

A child is generally laid to sleep with all its clothes on; and if a
number of others are heaped above them, it must be overheated; by which
means it cannot fail to catch cold on being taken out of the cradle, and
exposed to the open air with only its usual clothing, which is too
frequently the case.

Children who are kept within doors all day, and sleep all night in warm
close apartments, may, with great propriety, be compared to plants,
nursed in a hot-house, instead of the open air. Though such plants may
by this means be kept alive for some time, they will never arrive at
that degree of strength, vigour, and magnitude, which they would have
acquired in the open air, nor would they be able to bear it afterwards,
should they be exposed to it.

Children brought up in the country, who have been accustomed to open
air, should not be too early sent to great towns, where it is confined
and unwholesome. This is frequently done with a view to forward their
education, but proves very hurtful to their health. All schools and
seminaries of learning ought, if possible, to be so situated as to have
fresh, dry, wholesome air, and should never be too much crowded.

Without entering into a detail of the particular advantages of wholesome
air to children, or of the bad consequences which proceed from the want
of it, I shall only observe, that, of several thousands of children
which have been under my care, I do not remember one instance of a
single child who continued healthy in a close confined situation; but
have often known the most obstinate diseases cured by removing them from
such a situation to an open free air.


                              _Of Nurses._

It is not here intended to lay down rules for the choice of nurses. This
would be wasting time. Common sense will direct every one to chuse a
woman who is healthy, and has plenty of milk[19]. If she be at the same
time cleanly, careful, and goodnatured, she can hardly fail to make a
proper nurse. After all, however, the only certain proof of a good
nurse, is a healthy child upon her breast. But, as the misconduct of
nurses often proves fatal to children, it will be of importance to point
out a few of their most baneful errors, in order to rouse the attention
of parents, and to make them look more strictly into the conduct of
those to whom they commit the care of their infant offspring.

Though it admits of some exceptions, yet we may lay it down as a general
rule, _that every woman who nurses for hire should be carefully looked
after, otherwise she will not do her duty_. For this reason parents
ought always to have their children nursed under their own eye, if
possible; and where this cannot be done, they should be extremely
circumspect in the choice of those persons to whom they entrust them. It
is folly to imagine that any woman, who abandons her own child to suckle
another for the sake of gain, should feel all the affections of a parent
towards her nursing; yet so necessary are these affections in a nurse,
that, but for them, the human race would soon be extinct.

One of the most common faults of those who nurse for hire, is to dose
children with stupefactives, or such things as lull them asleep. An
indolent nurse, who does not give a child sufficient exercise in the
open air to make it sleep, and does not chuse to be disturbed by it in
the night, will seldom fail to procure for it a dose of laudanum,
diacodium, saffron, or what answers the same purpose, a dose of spirits,
or other strong liquors. These, though they be certain poison to
infants, are every day administered by many who bear the character of
very good nurses[20].

A nurse who has not milk enough is apt to imagine that this defect may
be supplied by giving the child wines, cordial waters, or other strong
liquors. This is an egregious mistake. The only thing that has any
chance to supply the place of the nurse’s milk, must be somewhat nearly
of the same quality, as cow’s milk, ass’s milk, or beef tea, with good
bread. It never can be done by the help of strong liquors. These,
instead of nourishing an infant, never fail to produce the contrary
effect.

Children are often hurt by nurses suffering them to cry long and
vehemently. This strains their tender bodies, and frequently occasions
ruptures, inflammations of the throat, lungs, &c. A child never
continues to cry long without some cause, which might always be
discovered by proper attention; and the nurse who can hear an infant cry
till it has almost spent itself, without endeavouring to please it, must
be cruel indeed, and is unworthy to be intrusted with the care of an
human creature.

Nurses who deal much in medicine are always to be suspected. They trust
to it, and neglect their duty. I never knew a good nurse who had her
Godfrey’s cordials, Daffy’s elixirs, &c. at hand. Such generally
imagine, that a dose of medicine will make up for all defects in food,
air, exercise, and cleanliness. By errors of this kind, I will venture
to say, that one half the children who die annually in London lose their
lives.

Allowing children to continue long wet, is another very pernicious
custom of indolent nurses. This is not only disagreeable, but it galls
and frets the infant, and by relaxing the solids, occasions scrophulas,
rickets, and other diseases. A dirty nurse is always to be suspected.

Nature often attempts to free the bodies of children from bad humours,
by throwing them upon the skin: by this means fevers and other diseases
are prevented. Nurses are apt to mistake such critical eruptions for an
itch, or some other infectious disorder. Accordingly they take every
method to drive them in. In this way many children lose their lives; and
no wonder, as Nature is opposed in the very method she takes to relieve
them. It ought to be a rule, which every nurse should observe, never to
stop any eruption without proper advice, or being well assured that it
is not of a critical nature. At any rate, it is never to be done without
previous evacuations.

Loose stools is another method by which Nature often prevents or carries
off the diseases of infants. If these proceed too far, no doubt they
ought to be checked; but this is never to be done without the greatest
caution. Nurses, upon the first appearance of loose stools, frequently
fly to the use of astringents, or such things as bind the body. Hence
inflammatory fevers, and other fatal diseases, are occasioned. A dose of
rhubarb, a gentle vomit, or some other evacuation, should always precede
the use of astringent medicines.

One of the greatest faults of nurses is, concealing the diseases of
children from their parents. This they are extremely ready to do,
especially when the disease is the effect of their own negligence. Many
instances might be given of persons who have been rendered lame for life
by a fall from their nurse’s arms, which she, through fear, concealed
till the misfortune was past cure. Every parent who intrusts a nurse
with the care of a child, ought to give her the strictest charge not to
conceal the most trifling disorder or misfortune that may befal it.

We can see no reason why a nurse, who conceals any misfortune which
happens to a child under her care, till it loses its life or limbs,
should not be punished. A few examples of this would save the lives of
many infants; but as there is little reason to expect that it ever will
be the case, we would earnestly recommend it to all parents to look
carefully after their children, and not to trust so valuable a treasure
entirely in the hands of an hireling.

No person ought to imagine these things unworthy of his attention. On
the proper management of children depend not only their health and
usefulness in life, but likewise the safety and prosperity of the state
to which they belong. Effeminacy ever will prove the ruin of any state
where it prevails; and, when its foundations are laid in infancy, it can
never afterwards be wholly eradicated. Parents who love their offspring,
and wish well to their country, ought therefore, in the management of
their children, to avoid every thing that may have a tendency to make
them weak or effeminate, and to take every method in their power to
render their constitutions strong and hardy.

                          ——By arts like these
            Laconia nurs’d of old her hardy sons;
            And Rome’s unconquer’d legions urg’d their way,
            Unhurt, thro’ every toil in every clime[21].




                               CHAP. II.
           OF THE LABORIOUS, THE SEDENTARY, AND THE STUDIOUS.


That men are exposed to particular diseases from the occupations which
they follow, is a fact well known; but to remedy this evil is a matter
of some difficulty. Most people are under the necessity of following
those employments to which they have been bred, whether they be
favourable to health or not. For this reason, instead of inveighing, in
a general way, as some authors have done, against those occupations
which are hurtful to health, we shall endeavour to point out the
circumstances in each of them from which the danger chiefly arises, and
to propose the most rational methods of preventing it.

Chymists, founders, forgers, glass-makers, and several other artists,
are hurt by the unwholesome air which they are obliged to breathe. This
air is not only loaded with the noxious exhalations arising from metals
and minerals, but is so charged with phlogiston as to be rendered unfit
for expanding the lungs sufficiently, and answering the other important
purposes of respiration. Hence proceed asthmas, coughs, and consumptions
of the lungs, so incident to persons who follow these employments.

To prevent such consequences, as far as possible, the places where these
occupations are carried on, ought to be constructed in such a manner as
to discharge the smoke and other exhalations, and admit a free current
of fresh air. Such artists ought never to continue too long at work; and
when they give over, they should suffer themselves to cool gradually,
and put on their clothes before they go into the open air. They ought
never to drink large quantities of cold, weak, or watery liquors, while
their bodies are hot, nor to indulge in raw fruits, sallads, or any
thing that is cold on the stomach[22].

Miners, and all who work under ground, are likewise hurt by unwholesome
air. The air, by its stagnation in deep mines, not only loses its proper
spring and other qualities necessary for respiration, but is often
loaded with such noxious exhalations as to become a most deadly poison.

The two kinds of air which prove most destructive to miners, are what
they call the _fire damp_, and the _choke damp_. In both cases the air
becomes a poison, by its being loaded with phlogiston. The danger from
the former may be obviated by making it explode before it accumulates in
too great quantities; and the latter may be generally carried off by
promoting a free circulation of air in the mine.

Miners are not only hurt by unwholesome air, but likewise by the
particles of metal which adhere to their skin, clothes, &c. These are
absorbed, or taken up into the body, and occasion palsies, vertigoes,
and other nervous affections, which often prove fatal. Fallopius
observes, that those who work in mines of mercury seldom live above
three or four years. Lead, and several other metals, are likewise very
pernicious to the health.

Miners ought never to go to work fasting, nor to continue too long at
work. Their food ought to be nourishing, and their liquor generous:
nothing more certainly hurts them than living too low. They should by
all means avoid costiveness. This may either be done by chewing a little
rhubarb, or taking a sufficient quantity of sallad oil. Oil not only
opens the body, but sheaths and defends the intestines from the ill
effects of the metals. All who work in mines or metals ought to wash
carefully, and to change their clothes as soon as they give over
working. Nothing would tend more to preserve the health of such people
than a strict, and almost religious regard to cleanliness.

Plumbers, painters, gilders, smelters, makers of white lead, and many
others who work in metals, are liable to the same diseases as miners,
and ought to observe the same directions for avoiding them.

Tallow-chandlers, boilers of oil, and all who work in putrid animal
substances, are likewise liable to suffer from the unwholesome smells or
effluvia of these bodies. They ought to pay the same regard to
cleanliness as miners; and when they are affected with nausea, sickness,
or indigestion, we would advise them to take a vomit or a gentle purge.
Such substances ought always to be manufactured as soon as possible.
When long kept, they not only become unwholesome to those who
manufacture them, but likewise to people who live in the neighbourhood.

It would greatly exceed the limits of this part of our subject, to
specify the diseases peculiar to persons of every occupation; we shall
therefore consider mankind under the general classes of _Laborious_,
_Sedentary_, and _Studious_.


                             THE LABORIOUS.

Though those who follow laborious employments are in general the most
healthy of mankind, yet the nature of their occupations, and the places
where they are carried on, expose them more particularly to some
diseases. Husbandmen, for example, are exposed to all the vicissitudes
of the weather, which, in this country, are often very great and sudden,
and occasion colds, coughs, quinsies, rheumatisms, fevers, and other
acute disorders. They are likewise forced to work hard, and often to
carry burdens above their strength, which, by overstraining the vessels,
occasion asthmas, ruptures, pleurisies, &c.

Those who labour without doors are often afflicted with intermitting
fevers or agues, occasioned by the frequent vicissitudes of heat and
cold, poor living, bad water, sitting or lying on the damp ground,
evening dews, night air, &c. to which they are frequently exposed.

Such as bear heavy burdens, as porters, labourers, &c. are obliged to
draw in the air with much greater force, and also to keep their lungs
distended with more violence than is necessary for common respiration:
by this means the tender vessels of the lungs are overstretched, and
often burst, insomuch that a spitting of blood or fever ensues.
Hippocrates mentions an instance to this purpose, of a man, who, upon a
wager, carried an ass; but was soon after seized with a fever, a
vomiting of blood, and a rupture.

Carrying heavy burdens is generally the effect of mere laziness, which
prompts people to do at once what should be done at twice. Sometimes it
proceeds from vanity or emulation. Hence it is, that the strongest men
are most commonly hurt by heavy burdens, hard labour, or feats of
activity. It is rare to find one who boasts of his strength without a
rupture, a spitting of blood, or some other disease, which he reaps as
the fruit of his folly. One would imagine, the daily instances we have,
of the fatal effects of carrying great weights, running, wrestling, and
the like, would be sufficient to prevent such practices.

There are indeed some employments which necessarily require a great
exertion of strength, as porters, blacksmiths, carpenters, &c. None
ought to follow these but men of strong body; and they should never
exert their strength to the utmost, nor work too long. When the muscles
are violently strained, frequent rest is necessary, in order that they
may recover their tone; without this, the strength and constitution will
soon be worn out, and a premature old age be induced.

The erysipelas, or St. Anthony’s fire, is a disease very incident to the
laborious. It is occasioned by whatever gives a sudden check to the
perspiration, as drinking cold water when the body is warm, wet feet,
keeping on wet clothes, sitting or lying on the damp ground, &c. It is
impossible for those who labour without doors always to guard against
these inconveniences; but it is known from experience, that their ill
consequences might often be prevented by proper care.

The iliac passion, the cholic, and other complaints of the bowels, are
often occasioned by the same causes as the erysipelas; but they may
likewise proceed from flatulent and indigestible food. Labourers
generally eat unfermented bread, made of peas, beans, rye, and other
windy ingredients. They also devour great quantities of unripe fruits,
baked, stewed, or raw, with various kinds of roots and herbs, upon which
they often drink sour milk, stale small beer, or the like. Such a
mixture cannot fail to fill the bowels with wind, and occasion diseases
of those parts.

Inflammations, whitloes, and other diseases of the extremities, are
likewise common among those who labour without doors. These diseases are
often attributed to venom, or some kind of poison; but they generally
proceed either from sudden heat after cold, or the contrary. When
labourers, milk-maids, &c. come from the field, cold or wet, they run to
the fire, and often plunge their hands in warm water, by which means the
blood and other humours in those parts are suddenly expanded, and, the
vessels not yielding so quickly, a strangulation happens, and an
inflammation or a mortification ensues.

When such persons come home cold, they ought to keep at a distance from
the fire for some time, to wash their hands in cold water, and to rub
them well with a dry cloth. It sometimes happens, that people are so
benumbed with cold, as to be quite deprived of the use of their limbs.
In this case, the only remedy is to rub the parts affected with snow,
or, where it cannot be had, with cold water. If they be held near the
fire, or plunged into warm water, a mortification will generally ensue.

Labourers in the hot season are apt to lie down, and sleep in the sun.
This practice is so dangerous, that they often wake in a burning fever.
These ardent fevers, which prove so fatal about the end of summer and
beginning of autumn, are frequently occasioned by this means. When
labourers leave off work, which they ought always to do during the heat
of the day, they should go home, or, at least, get under some cover,
where they may repose themselves in safety.

Many people follow their employments in the fields from morning till
night, without eating any thing. This cannot fail to hurt their health.
However homely their fare be, they ought to have it at regular times;
and the harder they work, the more frequently they should eat. If the
humours be not frequently replenished with fresh nourishment, they soon
become putrid, and produce fevers of the very worst kind.

Many peasants are extremely careless with respect to what they eat or
drink, and often, through mere indolence, use unwholesome food, when
they might for the same expence have that which is wholesome. In some
parts of Britain, the peasants are too careless even to take the trouble
of dressing their own victuals. Such people would live upon one meal a
day in indolence, rather than labour, though it were to procure them the
greatest affluence.

Fevers of a very bad kind are often occasioned among labourers by _poor
living_. When the body is not sufficiently nourished, the humours become
vitiated, and the solids weak; from whence the most fatal consequences
ensue. _Poor living_ is likewise productive of many of those cutaneous
diseases so frequent among the lower class of people. It is remarkable
that cattle, when pinched in their food, are generally affected with
diseases of the skin, which seldom fail to disappear, when they are put
upon a good pasture. This shews how much a good state of the humours
depends upon a sufficient quantity of proper nourishment.

Poverty not only occasions, but aggravates, many of the diseases of the
laborious. Few of them have much foresight; and, if they had, it is
seldom in their power to save any thing. They are glad to make a shift
to live from day to day; and, when any disease overtakes them, they are
miserable indeed. Here the godlike virtue of charity ought always to
exert itself. To relieve the industrious poor in distress, is surely the
most exalted act of religion and humanity. They alone, who are witnesses
of those scenes of calamity, can form a notion of what numbers perish in
diseases, for want of proper assistance, and even for want of the
necessaries of life.

Labourers are often hurt by a foolish emulation, which prompts them to
vie with one another, till they overheat themselves to such a degree as
to occasion a fever, or even to drop down dead. Such as wantonly throw
away their lives in this manner, deserve to be looked upon in no better
light than self-murderers.

The office of a _soldier_, in time of war, may be ranked among the
laborious employments. Soldiers suffer many hardships from the
inclemency of seasons, long marches, bad provisions, hunger, watching,
unwholesome climates, bad water, &c. These occasion fevers, fluxes,
rheumatisms, and other fatal diseases, which generally do greater
execution than the sword, especially when campaigns are continued too
late in the season. A few weeks of cold rainy weather will often prove
more fatal than an engagement.

Those who have the command of armies should take care that their
soldiers be well clothed and well fed. They ought also to finish their
campaigns in due season, and to provide their men with dry and
well-aired winter quarters. These rules, taking care, at the same time,
to keep the sick at a proper distance from those in health, would tend
greatly to preserve the lives of the soldiery[23].

Sailors may also be numbered among the laborious. They undergo great
hardships from change of climate, the violence of weather, hard labour,
bad provisions, &c. Sailors are of so great importance both to the trade
and safety of this kingdom, that too much pains can never be bestowed in
pointing out the means of preserving their lives.

One great source of the diseases of sea-faring people is excess. When
they get on shore, after having been long at sea, without regard to the
climate, or their own constitutions, they plunge headlong into all
manner of riot, and often persist till a fever puts an end to their
lives. Thus intemperance, and not the climate, is often the cause why so
many of our brave sailors die on foreign coasts. Such people ought not
to live too low; but they will find moderation the best defence against
fevers, and many other maladies.

Sailors, when on duty, cannot avoid sometimes getting wet. When this
happens, they should change their clothes as soon as they are relieved,
and take every method to restore the perspiration. They should not, in
this case, make too free with spirits or other strong liquors, but
should rather drink them diluted with warm water, and go immediately to
bed, where a sound sleep and a gentle sweat would set all to rights.

But the health of sailors suffers most from unwholesome food. The
constant use of salted provisions vitiates their humours, and occasions
the scurvy, and other obstinate maladies. It is no easy matter to
prevent this disease in long voyages; yet we cannot help thinking, that
much might be done towards effecting so desirable an end, were due pains
bestowed for that purpose. For example, various roots, greens, and
fruits, might be kept a long time at sea, as onions, potatoes, cabbages,
lemons, oranges, tamarinds, apples, &c. When fruits cannot be kept, the
juices of them, either fresh or fermented, may. With these all the
drink, and even the food of the ship’s company, ought to be acidulated
in long voyages.

Stale bread and beer likewise contribute to vitiate the humours. Flour
will keep for a long time on board, of which fresh bread might
frequently be made. Malt too might be kept, and infused with boiling
water at any time. This liquor, when drank even in form of wort, is very
wholesome, and is found to be an antidote against the scurvy. Small
wines and cyder might likewise be plentifully laid in; and should they
turn sour, they would still be useful as vinegar. Vinegar is a great
antidote against diseases, and should be used by all travellers,
especially at sea. It may either be mixed with the water they drink, or
taken in their food.

Such animals as can be kept alive, ought likewise to be carried on
board, as hens, ducks, pigs, &c. Fresh broths made of portable soup, and
puddings made of peas, or other vegetables, ought to be used
plentifully. Many other things will readily occur to people conversant
in these matters, which would tend to preserve the health of that brave
and useful set of men[24].

We have reason to believe, if due attention were paid to the diet, air,
clothing, and above all things to the cleanliness of sea-faring people,
they would be the most healthy set of men in the world; but when these
are neglected, the very reverse will happen.

The best _medical antidote_ that we can recommend to sailors or
soldiers, on foreign coasts, especially where dampness prevails, is the
Peruvian bark. This will often prevent fevers, and other fatal diseases.
About a drachm of it may be chewed every day; or if this should prove
disagreeable, an ounce of bark, with half an ounce of orange peel, and
two drachms of snake-root coarsely powdered, may be infused for two or
three days in an English quart of brandy, and half a wine glass of it
taken twice or thrice a-day, when the stomach is empty. This has been
found to be an excellent antidote against fluxes, putrid, intermitting,
and other fevers, in unhealthy climates. It is not material in what form
this medicine is taken. It may either be infused in water, wine, or
spirits, as recommended above, or made into an electuary with syrup of
lemons, oranges, or the like.


                             THE SEDENTARY.

Though nothing can be more contrary to the nature of man than a
sedentary life, yet this class comprehends by far the greater part of
the species. Almost the whole female world, and in manufacturing
countries, the major part of the males, may be reckoned sedentary[25].

Agriculture, the first and most healthful of all employments, is now
followed by few who are able to carry on any other business. But those
who imagine that the culture of the earth is not sufficient to employ
all its inhabitants are greatly mistaken. An ancient Roman, we are told,
could maintain his family from the produce of one acre of ground. So
might a modern Briton, if he would be contented to live like a Roman.
This shews what an immense increase of inhabitants Britain might admit
of, and all of them live by the culture of the ground.

Agriculture is the great source of domestic riches. Where it is
neglected, whatever wealth may be imported from abroad, poverty and
misery will abound at home. Such is, and ever will be, the fluctuating
state of trade and manufactures, that thousands of people may be in full
employment to-day, and in beggary to-morrow. This can never happen to
those who cultivate the ground. They can eat the fruit of their labour,
and can always by industry obtain, at least, the necessaries of life.

Though sedentary employments are necessary, yet there seems to be no
reason why any person should be confined for life to these alone. Were
such employments intermixed with the more active and laborious, they
would never do hurt. It is constant confinement that ruins the health. A
man may not be hurt by sitting five or six hours a-day; but if he is
obliged to sit ten or twelve, he will soon become diseased.

But it is not want of exercise alone which hurts sedentary people; they
likewise suffer from the confined air which they breathe. It is very
common to see ten or a dozen taylors[26], or staymakers, for example,
crowded into one small apartment, where there is hardly room for one
person to breathe freely. In this situation they generally continue for
many hours at a time, often with the addition of several candles, which
tend likewise to waste the air, and render it less fit for respiration.
Air that is breathed repeatedly becomes unfit for expanding the lungs.
This is one cause of the phthisical coughs, and other complaints of the
breath, so incident to sedentary artificers.

Even the perspiration from a great number of persons pent up together,
renders the air unwholesome. The danger from this quarter will be
greatly increased, if any one of them happens to have bad lungs, or to
be otherwise diseased. Those who sit near him, being forced to breathe
the same air, can hardly fail to be infected. It would be a rare thing,
however, to find a dozen of sedentary people all in good health. The
danger of crowding them together must therefore be evident to every one.

Many of those who follow sedentary employments are constantly in a
bending posture, as shoemakers, taylors, cutlers, &c. Such a situation
is extremely hurtful. A bending posture obstructs all the vital motions,
and of course must destroy the health. Accordingly we find such
artificers generally complaining of indigestions, flatulencies,
head-achs, pains of the breast, &c.

The aliment in sedentary people, instead of being pushed forwards by an
erect posture, and the action of the muscles, is in a manner confined in
the bowels. Hence indigestions, costiveness, wind, and other
hypochondriacal affections, the constant companions of the sedentary.
Indeed none of the excretions can be duly performed where exercise is
wanting; and when the matter which ought to be discharged in this way is
retained too long in the body, it must have bad effects, as it is again
taken up into the mass of humours.

A bending posture is likewise hurtful to the lungs. When this organ is
compressed, the air cannot have free access into all its parts, so as to
expand them properly. Hence tubercles, adhesions, &c. are formed, which
often end in consumptions. Besides, the proper action of the lungs being
absolutely necessary for making good blood, when that organ fails, the
humours soon become universally depraved, and the whole constitution
goes to wreck.

Sedentary artificers are not only hurt by pressure on the bowels, but
also on the inferior extremities, which obstructs the circulation in
these parts, and renders them weak and feeble. Thus taylors, shoemakers,
&c. frequently lose the use of their legs altogether: besides, the blood
and humours are, by stagnation, vitiated, and the perspiration is
obstructed: from whence proceed the scab, ulcerous sores, foul blotches,
and other cutaneous diseases, so common among sedentary artificers.

A bad figure of body is a very common consequence of close application
to sedentary employments. The spine, for example, by being continually
bent, puts on a crooked shape, and generally remains so ever after. But
a bad figure of body has already been observed to be hurtful to health,
as the vital functions are thereby impeded.

A sedentary life seldom fails to occasion an universal relaxation of the
solids. This is the great source from whence most of the diseases of
sedentary people flow. The scrophula, consumption, hysterics, and
nervous diseases, now so common, were very little known in this country
before sedentary artificers became so numerous: and they are very little
known still among such of our people as follow active employments
without doors, though in great towns at least two-thirds of the
inhabitants are afflicted with them.

It is very difficult to remedy those evils, because many who have been
accustomed to a sedentary life, like rickety children, lose all
inclination for exercise; we shall, however, throw out a few hints with
respect to the most likely means for preserving the health of this
useful set of people, which some of them, we hope, will be wise enough
to take.

It has been already observed, that sedentary artificers are often hurt
by their bending posture. They ought therefore to stand or sit as erect
as the nature of their employments will permit. They should likewise
change their posture frequently, and should never sit too long at a
time, but leave off work, and walk, ride, run, or do any thing that will
promote the vital functions.

Sedentary artificers are generally allowed too little time for exercise;
yet, short as it is, they seldom employ it properly. A journeyman taylor
or weaver, for example, instead of walking abroad for exercise and fresh
air, at his hours of leisure, chuses often to spend them in a
public-house, or in playing at some sedentary game, by which he
generally loses both his time and his money.

The awkward postures in which many sedentary artificers work, seem
rather to be the effect of custom than necessity. For example, a table
might surely be contrived for ten or a dozen taylors to sit round, with
liberty for their legs either to hang down, or rest upon a foot-board,
as they should chuse. A place might likewise be cut out for each person,
in such a manner that he might sit as conveniently for working as in the
present mode of sitting cross-legged.

All sedentary artificers ought to pay the most religious regard to
cleanliness. Both their situation and occupations render this highly
necessary. Nothing would contribute more to preserve their health, than
a strict attention to it; and such of them as neglect it, not only run
the hazard of losing health, but of becoming a nuisance to their
neighbours.

Sedentary people ought to avoid food that is windy, or hard of
digestion, and should pay the strictest regard to sobriety. A person who
works hard without doors will soon throw off a debauch; but one who sits
has by no means an equal chance. Hence it often happens, that sedentary
people are seized with fevers after hard drinking. When such persons
feel their spirits low, instead of running to the tavern for relief,
they should ride, or walk in the fields. This would remove the complaint
more effectually than strong liquor, and would never hurt the
constitution.

Instead of multiplying rules for preserving the health of the sedentary,
we shall recommend to them the following general plan, viz. That every
person who follows a sedentary employment should cultivate a piece of
ground with his own hands. This he might dig, plant, sow, and weed at
leisure hours, so as to make it both an exercise and amusement, while it
produced many of the necessaries of life. After working an hour in a
garden, a man will return with more keenness to his employment within
doors, than if he had been all the while idle.

Labouring the ground is every way conducive to health. It not only gives
exercise to every part of the body, but the very smell of the earth and
fresh herbs revives and cheers the spirits, whilst the perpetual
prospect of something coming to maturity, delights and entertains the
mind. We are so formed as to be always pleased with somewhat in
prospect, however distant or however trivial. Hence the happiness that
most men feel in planting, sowing, building, &c. These seem to have been
the chief employments of the more early ages: and, when kings and
conquerors cultivated the ground, there is reason to believe that they
knew as well wherein true happiness consisted as we do.

It may seem romantic to recommend gardening to manufacturers in great
towns; but observation proves that the plan is very practicable. In the
town of Sheffield, in Yorkshire, where the great iron manufacture is
carried on, there is hardly a journeyman cutler who does not possess a
piece of ground, which he cultivates as a garden. This practice has many
salutary effects. It not only induces these people to take exercise
without doors, but also to eat many greens, roots, &c. of their own
growth, which they would never think of purchasing. There can be no
reason why manufacturers in any other town in Great Britain should not
follow the same plan. It is indeed to be regretted, that in such a place
as London a plan of this kind is not practicable; yet even there
sedentary artificers may find opportunities of taking air and exercise,
if they chuse to embrace them.

Mechanics are too much inclined to crowd into great towns. The situation
may have some advantages; but it has likewise many disadvantages. All
mechanics who live in the country have it in their power to cultivate a
piece of ground; which indeed most of them do. This not only gives them
exercise, but enables them to live more comfortably. So far at least as
my observation extends, mechanics who live in the country are far more
happy than those in great towns. They enjoy better health, live in
greater affluence, and seldom fail to rear a healthy and numerous
offspring.

In a word, exercise without doors, in one shape or another, is
absolutely necessary to health. Those who neglect it, though they may
for a while drag out life, can hardly be said to enjoy it. Weak and
effeminate, they languish for a few years, and soon drop into an
untimely grave.


                             THE STUDIOUS.

Intense thinking is so destructive to health, that few instances can be
produced of studious persons who are strong and healthy. Hard study
always implies a sedentary life; and when intense thinking is joined to
the want of exercise, the consequences must be bad. We have frequently
known even a few months of close application to study ruin an excellent
constitution, by inducing a train of nervous complaints which could
never be removed. Man is evidently not formed for continual thought more
than for perpetual action, and would be as soon worn out by the one as
by the other.

So great is the power of the mind over the body, that, by its influence,
the whole vital motions may be accelerated or retarded, to almost any
degree. Thus cheerfulness and mirth quicken the circulation, and promote
all the secretions; whereas sadness and profound thought never fail to
retard them. Hence it would appear, that even a degree of
thoughtlessness is necessary to health. Indeed, the perpetual thinker
seldom enjoys either health or spirits; while the person, who can hardly
be said to think at all, generally enjoys both.

Perpetual thinkers, as they are called, seldom think long. In a few
years they generally become quite stupid, and exhibit a melancholy proof
how readily the greatest blessings may be abused. Thinking, like every
thing else, when carried to extreme, becomes a vice: nor can any thing
afford a greater proof of wisdom, than for a man frequently and
reasonably to unbend his mind. This may generally be done by mixing in
cheerful company, active diversions, or the like.

Instead of attempting to investigate the nature of that connection which
subsists between the mind and body, or to inquire into the manner in
which they mutually affect each other, we shall only mention those
diseases to which the learned are more peculiarly liable, and endeavour
to point out the means of avoiding them.

Studious persons are very subject to the gout. This painful disease in a
great measure proceeds from indigestion, and an obstructed perspiration.
It is impossible that the man who sits from morning till night should
either digest his food, or have any of the secretions in due quantity.
But when that matter, which should be thrown off by the skin, is
retained in the body, and the humours are not duly prepared, diseases
must ensue.

The studious are likewise very liable to the stone and gravel. Exercise
greatly promotes both the secretion and discharge of urine; consequently
a sedentary life must have the contrary effect. Any one may be satisfied
of this by observing, that he passes much more urine by day than in the
night, and also when he walks or rides, than when he sits.

The circulation in the liver being flow, obstructions in that organ can
hardly fail to be the consequence of inactivity. Hence sedentary people
are frequently afflicted with schirrous livers. But the proper secretion
and discharge of the bile is so necessary a part of the animal œconomy,
that where these are not duly performed, the health must soon be
impaired. Jaundice, indigestion, loss of appetite, and a wasting of the
whole body, seldom fail to be the consequences of a vitiated state of
the liver, or obstructions of the bile.

Few diseases prove more fatal to the studious than consumptions of the
lungs. It has already been observed, that this organ cannot be duly
expanded in those who do not take proper exercise; and where that is the
case, obstructions and adhesions will ensue. Not only want of exercise,
but the posture in which studious persons generally sit, is very hurtful
to the lungs. Those who read or write much are ready to contract a habit
of bending forwards, and often press with their breast upon a table or
bench. This posture cannot fail to hurt the lungs.

The functions of the heart may likewise by this means be injured. I
remember to have seen a man opened, whose pericardium adhered to the
breast-bone in such a manner as to obstruct the motion of the heart, and
occasion his death. The only probable cause that could be assigned for
this singular symptom was, that the man, whose business was writing,
used constantly to sit in a bending posture, with his breast pressing
upon the edge of a plain table.

No person can enjoy health who does not properly digest his food. But
intense thinking and inactivity never fail to weaken the powers of
digestion. Hence the humours become crude and vitiated, the solids weak
and relaxed, and the whole constitution goes to ruin.

Long and intense thinking often occasions grievous head-achs, which
bring on vertigoes, apoplexies, palsies, and other fatal disorders. The
best way to prevent these is, never to study too long at one time, and
to keep the body regular, either by proper food, or taking frequently a
little of some opening medicine.

Those who read or write much are often afflicted with sore eyes.
Studying by candle-light is peculiarly hurtful to the sight. This ought
to be practised as seldom as possible. When it is unavoidable, the eyes
should be shaded, and the head should not be held too low. When the eyes
are weak or painful, they should be bathed every night and morning in
cold water, to which a little brandy may be added.

It has already been observed, that the excretions are very defective in
the studious. The dropsy is often occasioned by the retention of those
humours which ought to be carried off in this way. Any person may
observe, that sitting makes his legs swell, and that this goes off by
exercise; which clearly points out the method of prevention.

Fevers, especially of the nervous kind, are often the effect of study.
Nothing affects the nerves so much as intense thought. It in a manner
unhinges the whole human frame, and not only hurts the vital motions,
but disorders the mind itself. Hence a delirium, melancholy, and even
madness, are often the effect of close application to study. In fine,
there is no disease which can proceed either from a bad state of the
humours, a defect of the usual secretions, or a debility of the nervous
system, which may not be induced by intense thinking.

But the most afflicting of all the diseases which attack the studious is
the hypochondriac. This disease seldom fails to be the companion of deep
thought. It may rather be called a complication of maladies than a
single one. To what a wretched condition are the best of men often
reduced by it! Their strength and appetite fail; a perpetual gloom hangs
over their minds; they live in the constant dread of death, and are
continually in search of relief from medicine, where, alas! it is not to
be found. Those who labour under this disorder, though they are often
made the subject of ridicule, justly claim our highest sympathy and
compassion.

Hardly any thing can be more preposterous than for a person to make
study his sole business. A mere student is seldom an useful member of
society. He often neglects the most important duties of life, in order
to pursue studies of a very trifling nature. Indeed it rarely happens,
that any useful invention is the effect of mere study. The farther men
dive into profound researches, they generally deviate the more from
common sense, and too often lose sight of it altogether. Profound
speculations, instead of making men wiser or better, generally render
them absolute sceptics, and overwhelm them with doubt and uncertainty.
All that is necessary for man to know, in order to be happy, is easily
obtained; and the rest, like the forbidden fruit, serves only to
increase his misery.

Studious persons, in order to relieve their minds, must not only
discontinue to read and write, but engage in some employment or
diversion, that will so far occupy the thought as to make them forget
the business of the closet. A solitary ride or walk are so far from
relaxing the mind, that they rather encourage thought. Nothing can
divert the mind, when it gets into a train of serious thinking, but
attention to subjects of a more trivial nature. These prove a kind of
play to the mind, and consequently relieve it.

Learned men often contract a contempt for what they call trifling
company. They are ashamed to be seen with any but philosophers. This
however is no proof of their being philosophers themselves. No man
deserves that name who is ashamed to unbend his mind, by associating
with the cheerful and gay. Even the society of children will relieve the
mind, and expel the gloom which application to study is too apt to
occasion.

As studious people are necessarily much within doors, they should make
choice of a large and well-aired place for study. This would not only
prevent the bad effects which attend confined air, but would cheer the
spirits, and have a most happy influence both on the body and mind. It
is said of Euripides the tragedian, that he used to retire to a dark
cave to compose his tragedies, and of Demosthenes the Grecian orator,
that he chose a place for study where nothing could be either heard or
seen. With all deference to such venerable names, we cannot help
condemning their taste. A man may surely think to as good purpose in an
elegant apartment as in a cave; and may have as happy conceptions where
the all-cheering rays of the sun render the air wholesome, as in places
where they never enter.

Those who read or write much should be very attentive to their posture.
They ought to sit and stand by turns, always keeping as nearly in an
erect posture as possible. Those who dictate, may do it walking. It has
an excellent effect frequently to read or speak aloud. This not only
exercises the lungs, but almost the whole body. Hence studious people
are greatly benefited by delivering discourses in public. Public
speakers, indeed, sometimes hurt themselves by overacting their part;
but this is their own fault. The martyr to mere vociferation merits not
our sympathy.

The morning has, by all medical writers, been reckoned the best time for
study. It is so. But it is also the most proper season for exercise,
while the stomach is empty, and the spirits refreshed with sleep.
Studious people should therefore sometimes spend the morning in walking,
riding, or some manly diversions without doors. This would make them
return to study with greater alacrity, and would be of more service than
twice the time after their spirits are worn out with fatigue. It is not
sufficient to take diversion only when we can think no longer. Every
studious person should make it a part of his business, and should let
nothing interrupt his hours of recreation more than those of study.

Music has a very happy effect in relieving the mind when fatigued with
study. It would be well if every studious person were so far acquainted
with that science as to amuse himself after severe thought, by playing
such airs as have a tendency to raise the spirits, and inspire
cheerfulness and good humour.

It is a reproach to Learning, that any of her votaries, to relieve the
mind after study, should betake themselves to the use of strong liquors.
This indeed is a remedy; but it is a desperate one, and always proves
destructive. Would such persons, when their spirits are low, get on
horseback, and ride ten or a dozen miles, they would find it a more
effectual remedy than any cordial medicine in the apothecary’s shop, or
all the strong liquors in the world.

The following is my plan, and I cannot recommend a better to others.
When my mind is fatigued with study, or other serious business, I mount
my horse, and ride ten or twelve miles into the country, where I spend a
day, and sometimes two, with a cheerful friend; after which I never fail
to return to town with new vigour, and to pursue my studies or business
with fresh alacrity.

It is much to be regretted, that learned men, while in health, pay so
little regard to these things! There is not any thing more common than
to see a miserable object over-run with nervous diseases, bathing,
walking, riding, and, in a word, doing every thing for health after it
is gone; yet, if any one had recommended these things to him by way of
prevention, the advice would, in all probability, have been treated with
contempt, or, at least, with neglect. Such is the weakness and folly of
mankind, and such the want of foresight, even in those who ought to be
wiser than others!

With regard to the diet of the studious, we see no reason why they
should abstain from any kind of food that is wholesome, provided they
use it in moderation. They ought, however, to be sparing in the use of
every thing that is windy, rancid, or hard of digestion. Their suppers
should always be light, or taken soon in the evening. Their drink may be
water, fine malt liquor, not too strong, good cyder, wine and water, or,
if troubled with acidities, water mixed with a little brandy, rum, or
any other genuine spirit.

We shall only observe, with regard to those kinds of exercise which are
most proper for the studious, that they should not be too violent, nor
ever carried to the degree of excessive fatigue. They ought likewise to
be frequently varied so as to give action to all the different parts of
the body; and should, as often as possible, be taken in the open air. In
general, riding on horseback, walking, working in a garden, or playing
at some active diversions, are the best.

We would likewise recommend the use of the cold bath to the studious. It
will, in some measure, supply the place of exercise, and should not be
neglected by persons of a relaxed habit, especially in the warm season.

No person ought either to take violent exercise, or to study immediately
after a full meal.




                               CHAP. III.
                              OF ALIMENT.


Unwholesome food, and irregularities in diet, occasion many diseases.
There is no doubt but the whole constitution of body may be changed by
diet alone. The fluids may be thereby attenuated or condensed, rendered
mild or acrimonious, coagulated or diluted, to almost any degree. Nor
are its effects upon the solids less considerable. They may be braced or
relaxed, have their sensibility, motions, &c. greatly increased or
diminished, by different kinds of aliment. A very small attention to
these things will be sufficient to shew, how much the preservation of
health depends upon a proper regimen of the diet.

Nor is an attention to diet necessary for the preservation of health
only: it is likewise of importance in the cure of diseases. Every
intention in the cure of many diseases, may be answered by diet alone.
Its effects, indeed, are not always so quick as those of medicine, but
they are generally more lasting: besides, it is neither so disagreeable
to the patient, nor so dangerous as medicine, and is always more easily
obtained.

Our intention here is not to inquire minutely into the nature and
properties of the various kinds of aliment in use among mankind; nor to
shew their effects upon the different constitutions of the human body;
but to mark some of the most pernicious errors which people are apt to
fall into, with respect both to the quantity and qualities of their
food, and to point out their influence upon health.

It is not indeed an easy matter to ascertain the exact quantity of food
proper for every age, sex, and constitution: but a scrupulous nicety
here is by no means necessary. The best rule is to avoid all extremes.
Mankind were never intended to weigh and measure their food. Nature
teaches every creature when it has enough; and the calls of thirst and
hunger are sufficient to inform them when more is necessary.

Though _moderation_ is the chief rule with regard to the quantity, yet
the quality of food merits a farther consideration. There are many ways
by which provisions may be rendered unwholesome. Bad seasons may either
prevent the ripening of grain, or damage it afterwards. These, indeed,
are acts of Providence, and we must submit to them; but surely no
punishment can be too severe for those who suffer provisions to spoil by
hoarding them, on purpose to raise the price, or who promote their own
interest by adulterating the necessaries of life[27].

Animal, as well as vegetable food, may be rendered unwholesome, by being
kept too long. All animal substances have a constant tendency to
putrefaction; and, when that has proceeded too far, they not only become
offensive to the senses, but hurtful to health. Diseased animals, and
such as die of themselves, ought never to be eaten. It is a common
practice, however, in some grazing countries, for servants and poor
people to eat such animals as die of any disease, or are killed by
accident. Poverty, indeed, may oblige people to do this; but they had
better eat a smaller quantity of what is sound and wholesome: it would
both afford a better nourishment, and be attended with less danger.

The injunctions given to the Jews, not to eat any creature which died of
itself, seem to have a strict regard to health; and ought to be observed
by Christians as well as Jews. Animals never die themselves without some
previous disease; but how a diseased animal should be wholesome food, is
inconceivable: even those which die by accident must be hurtful, as
their blood is mixed with the flesh, and soon turns putrid.

Animals which feed grossly, as tame ducks, hogs, &c. are neither so
easily digested, nor afford such wholesome nourishment as others. No
animal can be wholesome which does not take sufficient exercise. Most of
our stalled cattle are crammed with gross food, but not allowed exercise
nor free air; by which means they indeed grow fat, but their juices not
being properly prepared or assimilated, remain crude, and occasion
indigestions, gross humours, and oppression of the spirits, in those who
feed upon them.

Animals are often rendered unwholesome by being overheated. Excessive
heat causes a fever, exalts the animal salts, and mixes the blood so
intimately with the flesh, that it cannot be separated. For this reason,
butchers should be severely punished who over-drive their cattle. No
person would chuse to eat the flesh of an animal which had died in a
high fever; yet that is the case with all over-drove cattle; and the
fever is often raised even to the degree of madness.

But this is not the only way by which butchers render meat unwholesome.
The abominable custom of filling the cellular membrane of animals with
air, in order to make them appear fat, is every day practised. This not
only spoils the meat, and renders it unfit for keeping, but is such a
dirty trick, that the very idea of it is sufficient to disgust a person
of any delicacy at every thing which comes from the shambles. Who can
bear the thought of eating meat which has been blown up with air from
the lungs of a dirty fellow, perhaps labouring under the very worst of
diseases?

Butchers have likewise a method of filling the cellular membranes of
animals with blood. This makes the meat seem fatter, and likewise weigh
more, but is notwithstanding a very pernicious custom, as it both
renders the meat unwholesome and unfit for keeping. I seldom see a piece
of meat from the shambles, where the blood is not diffused through the
cellular texture. I shall not say that this is always the effect of
design; but I am certain it is not the case with animals that are killed
for domestic use, and properly blooded. Veal seems to be most frequently
spoilt in this way. Perhaps that may in some measure be owing to the
practice of carrying calves from a great distance to market, by which
means their tender flesh is bruised, and many of their vessels burst.

No people in the world eat such quantities of animal food as the
English, which is one reason why they are so generally tainted with the
scurvy and its numerous train of consequences, indigestion, low spirits,
hypochondriacism, &c. Animal food was surely designed for man, and, with
a proper mixture of vegetables, it will be found the most wholesome; but
to gorge beef, mutton, pork, fish, and fowl, twice or thrice a day, is
certainly too much. All who value health ought to be contented with
making one meal of flesh in the twenty-four hours, and this ought to
consist of one kind only.

The most obstinate scurvy has often been cured by a vegetable diet; nay,
milk alone will frequently do more in that disease than any medicine.
Hence it is evident, that if vegetables and milk were more used in diet,
we should have less scurvy, and likewise fewer putrid and inflammatory
fevers. Fresh vegetables, indeed, come to be daily more used in diet;
this laudable practice we hope will continue to gain ground.

Our aliment ought neither to be too moist nor too dry. Moist aliment
relaxes the solids, and renders the body feeble. Thus we see females,
who live much on tea and other watery diet, generally become weak, and
unable to digest solid food: hence proceed hysterics, and all their
dreadful consequences. On the other hand, food that is too dry, renders
the solids in a manner rigid, and the humours viscid, which disposes the
body to inflammatory fevers, scurvies, and the like.

Much has been said on the ill effects of tea in diet. They are, no
doubt, numerous; but they proceed rather from the imprudent use of it,
than from any bad qualities in the tea itself. Tea is now the universal
breakfast in this part of the world; but the morning is surely the most
improper time of the day for drinking it. Most delicate persons, who, by
the bye, are the greatest tea-drinkers, cannot eat any thing in the
morning. If such persons, after fasting ten or twelve hours, drink four
or five cups of tea without eating almost any bread, it must hurt them.
Good tea, taken in moderate quantity, not too strong, nor too hot, nor
drank upon an empty stomach, will seldom do harm; but if it be bad,
which is often the case, or substituted in the room of solid food, it
must have many ill effects.

The arts of cookery render many things unwholesome, which are not so in
their own nature. By jumbling together a number of different
ingredients, in order to make a poignant sauce or rich soup, the
composition proves almost a poison. All high seasoning, pickles, &c. are
only incentives to luxury, and never fail to hurt the stomach. It were
well for mankind, if cookery, as an art, were entirely prohibited. Plain
roasting or boiling is all that the stomach requires. These alone are
sufficient for people in health, and the sick have still less need of a
cook.

The liquid part of our aliment likewise claims our attention. Water is
not only the basis of most liquors, but also composes a great part of
our solid food. Good water must therefore be of the greatest importance
in diet. The best water is that which is most pure, and free from any
mixture of foreign bodies. Water takes up parts of most bodies with
which it comes into contact; by this means it is often impregnated with
metals or minerals of a hurtful or poisonous nature. Hence the
inhabitants of some hilly countries have peculiar diseases, which in all
probability proceed from the water. Thus the people who live near the
Alps in Switzerland, and the inhabitants of the Peak of Derby in
England, have large tumours or wens on their necks. This disease is
generally imputed to the snow water; but there is more reason to believe
it is owing to the minerals in the mountains through which the waters
pass.

When water is impregnated with foreign bodies, it generally appears by
its weight, colour, taste, smell, heat, or some other sensible quality.
Our business therefore is to chuse such water, for common use, as is
lightest, and without any particular colour, taste, or smell. In most
places of Britain the inhabitants have it in their power to make choice
of their water; and few things would contribute more to health than a
due attention to this article. But mere indolence often induces people
to make use of the water that is nearest to them, without considering
its qualities.

Before water is brought into great towns, the strictest attention ought
to be paid to its qualities, as many diseases may be occasioned or
aggravated by bad water; and when once it has been procured at a great
expence, people are unwilling to give it up.

The common methods of rendering water clear by filtration, or soft, by
exposing it to the sun and air, &c. are so generally known, that it is
unnecessary to spend time in explaining them. We shall only, in general,
advise all to avoid waters which stagnate long in small lakes, ponds, or
the like, as such waters often become putrid, by the corruption of
animal and vegetable bodies with which they abound. Even cattle
frequently suffer by drinking, in dry seasons, water which has stood
long in small reservoirs, without being supplied by springs, or
freshened with showers. All wells ought to be kept clean, and to have a
free communication with the air.

As fermented liquors, notwithstanding they have been exclaimed against
by many writers, still continue to be the common drink of almost every
person who can afford them; we shall rather endeavour to assist people
in the choice of these liquors, than pretend to condemn what custom has
so firmly established. It is not the moderate use of sound fermented
liquors which hurts mankind: it is excess, and using such as are ill
prepared or vitiated.

Fermented liquors, which are too strong, hurt digestion; and the body is
so far from being strengthened by them, that it is weakened and relaxed.
Many imagine that hard labour could not be supported without drinking
strong liquors: this is a very erroneous notion. Men who never taste
strong liquors are not only able to endure more fatigue, but also live
much longer, than those who use them daily. But, suppose strong liquors
did enable a man to do more work, they must nevertheless waste the
powers of life, and occasion premature old age. They keep up a constant
fever, which exhausts the spirits, inflames the blood, and disposes the
body to numberless diseases.

But fermented liquors may be too weak as well as too strong: when that
is the case, they must either be drank new, or they become sour and
dead: when such liquors are drank new, the fermentation not being over,
they generate air in the bowels, and occasion flatulencies; and, when
kept till stale, they turn sour on the stomach, and hurt digestion. For
this reason all malt liquors, cider, &c. ought to be of such strength as
to keep till they be ripe, and then they should be used. When such
liquors are kept too long, though they should not become sour, yet they
generally contract a hardness, which renders them unwholesome.

All families, who can, ought to prepare their own liquors. Since
preparing and vending of liquors became one of the most general branches
of business, every method has been tried to adulterate them. The great
object both to the makers and venders of liquor is, to render it
intoxicating, and give it the appearance of age. But it is well known
that this may be done by other ingredients than those which ought to be
used for making it strong. It would be imprudent even to name those
things which are daily made use of to render liquors heady. Suffice it
to say, that the practice is very common, and that all the ingredients
used for this purpose are of a narcotic or stupefactive quality. But as
all opiates are poisonous, it is easy to see what must be the
consequence of their general use. Though they do not kill suddenly, yet
they hurt the nerves, relax and weaken the stomach, and spoil the
digestion.

Were fermented liquors faithfully prepared, kept to a proper age, and
used in moderation, they would prove real blessings to mankind. But,
while they are ill prepared, various ways adulterated, and taken to
excess, they must have many pernicious effects.

We would recommend it to families, not only to prepare their own
liquors, but likewise their bread. Bread is so necessary a part of diet,
that too much care cannot be bestowed in order to have it sound and
wholesome. For this purpose, it is not only necessary that it be made of
good grain, but likewise properly prepared, and kept free from all
unwholesome ingredients. This, however, we have reason to believe is not
always the case with bread prepared by those who make a trade of vending
it. Their object is rather to please the eye, than to consult the
health. The best bread is that which is neither too coarse nor too fine;
well fermented and made of wheat flour, or rather of wheat and rye mixed
together.

To specify the different kinds of aliment, to explain their nature and
properties, and to point out their effects in different constitutions,
would far exceed the limits of our design. Instead of a detail of this
kind, which would not be generally understood, and of course little
attended to, we shall only mention the following easy rules with respect
to the choice of aliment.

Persons, whose solids are weak and relaxed, ought to avoid all viscid
food, or such things as are hard of digestion. Their diet, however,
ought to be nourishing; and they should take sufficient exercise in the
open air.

Such as abound with blood should be sparing in the use of every thing
that is highly nourishing, as fat meat, rich wines, strong ale, and such
like. Their food should consist chiefly of bread and other vegetable
substances; and their drink ought to be water, whey, or small beer.

Fat people should not eat freely of oily nourishing diet. They ought
frequently to use raddish, garlic, spices, or such things as are heating
and promote perspiration and urine. Their drink should be water, coffee,
tea, or the like; and they ought to take much exercise and little sleep.

Those who are too lean must follow an opposite course.

Such as are troubled with acidities, or whose food is apt to sour on the
stomach, should live much on animal food; and those who are afflicted
with hot alkaline eructations, ought to use a diet consisting chiefly of
acid vegetables.

People who are affected with the gout, low spirits, hypochondriac or
hysteric disorders, ought to avoid all flatulent food, every thing that
is viscid, or hard of digestion, all salted or smoke-dried provisions,
and whatever is austere, acid, or apt to turn sour on the stomach. Their
food should be light, spare, cool, and of an opening nature.

The diet ought not only to be suited to the age and constitution, but
also to the manner of life: a sedentary or studious person should live
more sparingly than one who labours hard without doors. Many kinds of
food will nourish a peasant very well which would be almost indigestible
to a citizen; and the latter will live upon a diet on which the former
would starve.

Diet ought not to be too uniform. The constant use of one kind of food
might have some bad effects. Nature teaches us this, by the great
variety of aliment which she has provided for man, and likewise by
giving him an appetite for different kinds of food.

Those who labour under any particular disease, ought to avoid such
aliments as have a tendency to increase it: for example, a gouty person
should not indulge in rich wines, strong soups, or gravies, and should
avoid all acids. One who is troubled with the gravel ought to shun all
austere and astringent aliments; and those who are scorbutic should be
sparing in the use of salted provisions, &c.

In the first period of life, our food ought to be light, but nourishing,
and frequently taken. Food that is solid, with a sufficient degree of
tenacity, is most proper for the state of manhood. The diet suited to
the last period of life, when nature is upon the decline, approaches
nearly to that of the first. It should be lighter and more succulent
than that of vigorous age, and likewise more frequently taken.

It is not only necessary for health that our diet be wholesome, but also
that it be taken at regular periods. Some imagine long fasting will
atone for excess; but this, instead of mending the matter, generally
makes it worse. When the stomach and intestines are over-distended with
food, they lose their proper tone, and, by long fasting, they become
weak, and inflated with wind. Thus, either gluttony or fasting destroys
the powers of digestion.

The frequent repetition of aliment is not only necessary for repairing
the continual waste of our bodies, but likewise to keep the fluids sound
and sweet. Our humours, even in the most healthy state, have a constant
tendency to putrefaction, which can only be prevented by frequent
supplies of fresh nourishment: when that is wanting too long, the
putrefaction often proceeds so far as to occasion very dangerous fevers.
From hence we may learn the necessity of regular meals. No person can
enjoy a good state of health, whose vessels are either frequently
overcharged, or the humours long deprived of fresh supplies of chyle.

Long fasting is extremely hurtful to young people; it not only vitiates
their humours, but prevents their growth. Nor is it less injurious to
the aged. Most persons, in the decline of life, are afflicted with wind:
this complaint is not only increased, but even rendered dangerous, and
often fatal, by long fasting. Old people, when their stomachs are empty,
are frequently seized with giddiness, head-achs, and faintness. These
complaints may generally be removed by a piece of bread and a glass of
wine, or taking any other solid food; which plainly points out the
method of preventing them.

It is more than probable, that many of the sudden deaths, which happen
in the advanced periods of life, are occasioned by fasting too long, as
it exhausts the spirits, and fills the bowels with wind; we would
therefore advise people, in the decline of life, never to allow their
stomachs to be too long empty. Many people take nothing but a few cups
of tea and a little bread, from nine o’clock at night till two or three
next afternoon. Such may be said to fast almost three-fourths of their
time. This can hardly fail to ruin the appetite, vitiate the humours,
and fill the bowels with wind; all which might be prevented by a solid
breakfast.

It is a very common practice to eat a light breakfast and a heavy
supper. This custom ought to be reversed. When people sup late, their
supper should be very light; but the breakfast ought always to be solid.
If any one eats a light supper, goes soon to bed, and rises betimes in
the morning, he will be sure to find an appetite for his breakfast, and
he may freely indulge it.

The strong and healthy do not indeed suffer so much from fasting as the
weak and delicate; but they run great hazard from its opposite, _viz._
repletion. Many diseases, especially fevers, are the effect of a
plethora, or too great fulness of the vessels. Strong people, in high
health, have generally a great quantity of blood and other humours. When
these are suddenly increased, by an overcharge of rich and nourishing
diet, the vessels become too much distended, and obstructions and
inflammations ensue. Hence so many people are seized with inflammatory
and eruptive fevers after a feast or debauch.

All great and sudden changes in diet are dangerous. What the stomach has
been long accustomed to digest, though less wholesome, will agree better
with it than food of a more salutary nature which it has not been used
to. When therefore a change becomes necessary, it ought always to be
made gradually; a sudden transition from a poor and low, to a rich and
luxurious diet, or the contrary, might so disturb the functions of the
body as to endanger health, or even to occasion death itself.

When we recommend regularity in diet, we would not be understood as
condemning every small deviation from it. It is next to impossible for
people at all times to avoid some degree of excess, and living too much
by rule might make even the smallest deviation dangerous. It may
therefore be prudent to vary a little, sometimes taking more, sometimes
less, than the usual quantity of meat and drink, provided always that a
due regard be had to moderation.




                               CHAP. IV.
                                OF AIR.


Unwholesome air is a very common cause of diseases. Few are aware of the
danger arising from it. People generally pay some attention to what they
eat and drink, but seldom regard what goes into the lungs, though the
latter proves often more suddenly fatal than the former.

Air, as well as water, takes up parts of most bodies with which it comes
in contact, and is often so replenished with those of a noxious quality,
as to occasion immediate death. But such violent effects seldom happen,
as people are generally on their guard against them. The less
perceptible influences of bad air prove more generally hurtful to
mankind; we shall therefore endeavour to point out some of these, and to
shew from whence the danger chiefly arises.

Air may become noxious many ways. Whatever greatly alters its degree of
heat, cold, moisture, &c. renders it unwholesome: for example, that
which is too hot dissipates the watry parts of the blood, exalts the
bile, and renders the whole humour adust and thick. Hence proceed
bilious and inflammatory fevers, cholera morbus, &c. Very cold air
obstructs the perspiration, constringes the solids, and condenses the
fluids. It occasions rheumatisms, coughs, and catarrhs, with other
diseases of the throat and breast. Air that is too moist destroys the
elasticity or spring of the solids, induces phlegmatic or lax
constitutions, and disposes the body to agues, or intermitting fevers,
dropsies, &c.

Wherever great numbers of people are crowded into one place, if the air
has not a free circulation, it soon becomes unwholesome. Hence it is
that delicate persons are so apt to turn sick or faint in crowded
churches, assemblies, or any place where the air is injured by
breathing, fires, candles, or the like.

In great cities so many things tend to contaminate the air, that it is
no wonder it proves so fatal to the inhabitants. The air in cities is
not only breathed repeatedly over, but is likewise loaded with sulphur,
smoke, and other exhalations, besides the vapours continually arising
from innumerable putrid substances, as dunghills, slaughterhouses, &c.
All possible care should be taken to keep the streets of large towns
open and wide, that the air may have a free current through them. They
ought likewise to be kept very clean. Nothing tends more to pollute and
contaminate the air of a city than dirty streets.

It is very common in this country to have church-yards in the middle of
populous cities. Whether this be the effect of ancient superstition, or
owing to the increase of such towns, is a matter of no consequence.
Whatever gave rise to the custom, it is a bad one. It is habit alone
which reconciles us to these things; by means of which the most
ridiculous, nay pernicious customs, often become sacred. Certain it is,
that thousands of putrid carcasses, so near the surface of the earth, in
a place where the air is confined, cannot fail to taint it; and that
such air, when breathed into the lungs, must occasion diseases[28].

Burying within churches is a practice still more detestable. The air in
churches is seldom good, and the effluvia from putrid carcasses must
render it still worse. Churches are commonly old buildings with arched
roofs. They are seldom open above once a week, are never ventilated by
fires nor open windows, and rarely kept clean. This occasions that damp,
musty, unwholesome smell which one feels upon entering a church, and
renders it a very unsafe place for the weak and valetudinary. These
inconveniences might, in a great measure, be obviated, by prohibiting
all persons from burying within churches, by keeping them clean, and
permitting a stream of fresh air to pass frequently through them, by
opening opposite doors and windows[29].

Wherever air stagnates long, it becomes unwholesome. Hence the unhappy
persons confined in jails not only contract malignant fevers themselves,
but often communicate them to others. Nor are many of the holes, for we
cannot call them houses, possessed by the poor in great towns, much
better than jails. These low dirty habitations are the very
lurking-places of bad air and contagious diseases. Such as live in them
seldom enjoy good health; and their children commonly die young. In the
choice of a house, those who have it in their power ought always to pay
the greatest attention to open free air.

The various methods which luxury has invented to make houses close and
warm, contribute not a little to render them unwholesome. No house can
be wholesome unless the air has a free passage through it. For which
reason houses ought daily to be ventilated, by opening opposite windows,
and admitting a current of fresh air into every room. Beds, instead of
being made up as soon as people rise out of them, ought to be turned
down, and exposed to the fresh air from the open windows through the
day. This would expel any noxious vapour, and could not fail to promote
the health of the inhabitants.

In hospitals, jails, ships, &c. where that cannot be conveniently done,
ventilators should be used. The method of expelling foul, and
introducing fresh air, by means of ventilators, is a most salutary
invention, and is indeed the most useful of all our modern medical
improvements. It is capable of universal application, and is fraught
with numerous advantages, both to those in health and sickness. In all
places, where numbers of people are crowded together, ventilation
becomes absolutely necessary.

Air which stagnates in mines, wells, cellars, &c. is extremely noxious.
That kind of air is to be avoided as the most deadly poison. It often
kills almost as quickly as lightning. For this reason, people should be
very cautious in opening cellars that have been long shut, or going down
into deep wells or pits, especially if they have been kept close
covered[30].

Many people who have splendid houses, chuse to sleep in small
apartments. This conduct is very imprudent. A bed-chamber ought always
to be well-aired; as it is generally occupied in the night only, when
all doors and windows are shut. If a fire be kept in it, the danger from
a small room becomes still greater. Numbers have been stifled when
asleep by a fire in a small apartment, which is always hurtful.

Those who are obliged, on account of business, to spend the day in close
towns, ought, if possible, to sleep in the country. Breathing free air
in the night will, in some measure, make up for the want of it through
the day. This practice would have a greater effect in preserving the
health of citizens than is commonly imagined.

Delicate persons ought, as much as possible, to avoid the air of great
towns. It is peculiarly hurtful to the asthmatic and consumptive. Such
persons should avoid cities as they would the plague. The hypochondriac
are likewise much hurt by it. I have often seen persons so much
afflicted with this malady while in town, that it seemed impossible for
them to live, who, upon being removed to the country, were immediately
relieved. The same observation holds with regard to nervous and hysteric
women. Many people, indeed, have it not in their power to change their
situation in quest of better air. All we can say to such persons is,
that they should go as often abroad into the open air as they can, that
they should admit fresh air frequently into their houses, and take care
to keep them very clean.

It was necessary in former times, for safety, to surround cities,
colleges, and even single houses, with high walls. These, by obstructing
the free current of air, never fail to render such places damp and
unwholesome. As such walls are now, in most parts of this country,
become useless, they ought to be pulled down, and every method taken to
admit a free passage to the air. Proper attention to AIR and CLEANLINESS
would tend more to preserve the health of mankind, than all the
endeavours of the faculty.

Surrounding houses too closely with planting, or thick woods, likewise
tends to render the air unwholesome. Wood not only obstructs the free
current of the air, but sends forth great quantities of moist
exhalations, which render it constantly damp. Wood is very agreeable at
a proper distance from a house, but should never be planted too near it,
especially in a flat country. Many of the gentlemen’s seats in England
are rendered very unwholesome from the great quantity of wood which
surrounds them.

Houses situated in low marshy countries, or near large lakes of
stagnating water, are likewise unwholesome. Waters which stagnate not
only render the air damp, but load it with putrid exhalations, which
produce the most dangerous and fatal diseases. Those who are obliged to
inhabit marshy countries, ought to make choice of the dryest situations
they can find, to live generously, and to pay the strictest regard to
cleanliness.

If fresh air be necessary for those in health, it is still more so for
the sick, who often lose their lives for want of it. The notion that
sick people must be kept very hot, is so common, that one can hardly
enter the chamber where a patient lies, without being ready to faint, by
reason of the hot suffocating smell. How this must affect the sick any
one may judge. No medicine is so beneficial to the sick as fresh air. It
is the most reviving of all cordials, if it be administered with
prudence. We are not, however, to throw open doors and windows at random
upon the sick. Fresh air is to be let into the chamber gradually, and,
if possible, by opening the windows of some other apartment.

The air of a sick person’s chamber may be greatly freshened, and the
patient much revived, by sprinkling the floor, bed, &c. frequently with
vinegar, juice of lemon, or any other strong vegetable acid.

In places where numbers of sick are crowded into the same house, or,
which is often the case, into the same apartment, the frequent admission
of fresh air becomes absolutely necessary. Infirmaries, hospitals, &c.
are often rendered so noxious, for want of proper ventilation, that the
sick run more hazard from them than from the disease. This is
particularly the case when putrid fevers, dysenteries, and other
infectious diseases prevail.

Physicians, surgeons, and others who attend hospitals, ought, for their
own safety, to take care that they be properly ventilated. Such persons
as are obliged to spend most of their time amongst the sick, run great
hazard of being themselves infected when the air is bad. All hospitals,
and places of reception for the sick, ought to have an open situation,
at some distance from any great town, and such patients as labour under
any infectious disease ought never to be suffered to come near the
rest[31].




                                CHAP. V.
                              OF EXERCISE.


Many people look upon the necessity man is under of earning his bread by
labour, as a curse. Be this as it may, it is evident from the structure
of the body, that exercise is not less necessary than food for the
preservation of health: those whom poverty obliges to labour for daily
bread, are not only the most healthy, but generally the most happy part
of mankind. Industry seldom fails to place them above want, and activity
serves them instead of physic. This is peculiarly the case with those
who live by the culture of the ground. The great increase of inhabitants
in infant colonies, and the longevity of such as follow agriculture
every where, evidently prove it to be the most healthful as well as the
most useful employment.

The love of activity shews itself very early in man. So strong is this
principle, that a healthy youth cannot be restrained from exercise, even
by the fear of punishment. Our love of motion is surely a strong proof
of its utility. Nature implants no disposition in vain. It seems to be a
catholic law throughout the whole animal creation, that no creature,
without exercise, should enjoy health, or be able to find subsistence.
Every creature, except man, takes as much of it as is necessary. He
alone, and such animals as are under his direction, deviate from this
original law, and they suffer accordingly.

Inactivity never fails to induce an universal relaxation of the solids,
which disposes the body to innumerable diseases. When the solids are
relaxed, neither the digestion, nor any of the secretions, can be duly
performed. In this case, the worst consequences must ensue. How can
persons who loll all day in easy chairs, and sleep all night on beds of
down, fail to be relaxed? Nor do such greatly mend the matter, who never
stir abroad but in a coach, sedan, or such like. These elegant pieces of
luxury are become so common, that the inhabitants of great towns seem to
be in some danger of losing the use of their limbs altogether. It is now
below any one to walk, who can afford to be carried. How ridiculous
would it seem, to a person unacquainted with modern luxury, to behold
the young and healthy swinging along on the shoulders of their
fellow-creatures! or to see a fat carcase, over-run with diseases
occasioned by inactivity, dragged through the streets by half a dozen
horses[32]!

Glandular obstructions, now so common, generally proceed from
inactivity. These are the most obstinate of maladies. So long as the
liver, kidnies, and other glands, duly perform their functions, health
is seldom impaired; but, when they fail, nothing can restore it.
Exercise is almost the only cure we know for glandular obstructions;
indeed, it does not always succeed as a remedy; but there is reason to
believe that it would seldom fail to prevent these complaints, were it
used in due time. One thing is certain, that, amongst those who take
sufficient exercise, glandular diseases are very little known; whereas
the indolent and inactive are seldom free from them.

Weak nerves are the constant companions of inactivity. Nothing but
exercise and open air can brace and strengthen the nerves, or prevent
the endless train of diseases which proceed from a relaxed state of
these organs. We seldom hear the active or laborious complain of nervous
diseases; these are reserved for the sons of ease and affluence. Many
have been completely cured of these disorders by being reduced, from a
stare of opulence, to labour for their daily bread. This plainly points
out the sources from whence nervous diseases flow, and the means by
which they may be prevented.

It is absolutely impossible to enjoy health, where the perspiration is
not duly carried on; but that can never be the case where exercise is
neglected. When the matter which ought to be thrown off by perspiration
is retained in the body, it vitiates the humours, and occasions the
gout, fevers, rheumatism, &c. Exercise alone would prevent many of those
diseases which cannot be cured, and would remove others where medicine
proves ineffectual.

A late author[33], in his excellent treatise on health, says, that the
weak and valetudinary ought to make exercise a part of their religion.
We would recommend this, not only to the weak and valetudinary, but to
all whose business does not oblige them to take sufficient exercise, as
sedentary artificers[34], shop-keepers, studious persons, &c. Such ought
to use exercise as regularly as they take food. This might generally be
done without any interruption to business or real loss of time.

No piece of indolence hurts the health more than the modern custom of
lying a-bed too long in a morning. This is the general practice in great
towns. The inhabitants of cities seldom rise before eight or nine
o’clock; but the morning is undoubtedly the best time for exercise,
while the stomach is empty, and the body refreshed with sleep. Besides,
the morning air braces and strengthens the nerves, and, in some measure,
answers the purpose of a cold bath. Let any one who has been accustomed
to lie a-bed till eight or nine o’clock, rise by six or seven, spend a
couple of hours in walking, riding, or any active diversion without
doors, and he will find his spirits cheerful and serene through the day,
his appetite keen, and his body braced and strengthened. Custom soon
renders early rising agreeable, and nothing contributes more to the
preservation of health.

The inactive are continually complaining of pains of the stomach,
flatulencies, indigestions, &c. These complaints, which pave the way to
many others, are not to be removed by medicines. They can only be cured
by a vigorous course of exercise, to which indeed they seldom fail to
yield.

Exercise, if possible, ought always to be taken in the open air. When
that cannot be done, various methods may be contrived for exercising the
body within doors, as the dumb bell, dancing, fencing, &c. It is not
necessary to adhere strictly to any particular kind of exercise. The
best way is to take them by turns, and to use that longest which is most
suitable to the strength and constitution. Those kinds of exercise which
give action to most of the bodily organs, are always to be preferred, as
walking, running, riding, digging, swimming, and such like.

It is much to be regretted, that active and manly diversions are now so
little practised. Diversions make people take more exercise than they
otherwise would do, and are of the greatest service to such as are not
under the necessity of labouring for their bread. As active diversions
lose ground, those of a sedentary kind seem to prevail. Sedentary
diversions are of no other use but to consume time. Instead of relieving
the mind, they often require more thought than either study or business.
Every thing that induces people to sit still, unless it be some
necessary employment, ought to be avoided.

The diversions which afford the best exercise are, hunting, shooting,
playing at cricket, handball, golf[35], &c. These exercise the limbs,
promote perspiration, and the other secretions. They likewise strengthen
the lungs, and give firmness and agility to the whole body.

Such as can, ought to spend two or three hours a-day on horseback; those
who cannot ride, should employ the same time in walking. Exercise should
never be continued too long. Over-fatigue prevents the benefit of
exercise, and instead of strengthening the body tends to weaken it.

Every man should lay himself under some sort of necessity to take
exercise. Indolence, like other vices when indulged, gains ground, and
at length becomes agreeable. Hence many who were fond of exercise in the
early part of life, become quite averse from it afterwards. This is the
case of most hypochondriac and gouty people, which renders their
diseases in a great measure incurable.

In some countries laws have been made, obliging every man, of whatever
rank, to learn some mechanical employment. Whether such laws were
designed for the preservation of health, or the encouragement of
manufacture, is a question of no importance, Certain it is, that if
gentlemen were frequently to amuse and exercise themselves in this way,
it might have many good effects. They would at least derive as much
honour from a few masterly specimens of their own workmanship, as from
the character of having ruined most of their companions by gaming or
drinking. Besides, men of leisure, by applying themselves to the
mechanical arts, might improve them, to the great benefit of society.

Indolence not only occasions diseases, and renders men useless to
society, but promotes all manner of vice. To say a man is idle, is
little better than to call him vicious. The mind, if not engaged in some
useful pursuit, is constantly in quest of ideal pleasures, or impressed
with the apprehension of some imaginary evil. From these sources proceed
most of the miseries of mankind. Certainly man was never intended to be
idle. Inactivity frustrates the very design of his creation; whereas an
active life is the best guardian of virtue, and the greatest
preservative of health.




                               CHAP. VI.
                         OF SLEEP AND CLOTHING.


Sleep, as well as diet, ought to be duly regulated. Too little sleep
weakens the nerves, exhausts the spirits, and occasions diseases; and
too much renders the mind dull, the body gross, and disposes to
apoplexies, lethargies, and other complaints of a similar nature. A
medium ought therefore to be observed; but this is not easy to fix.
Children require more sleep than grown persons, the laborious than the
idle, and such as eat and drink freely, than those who live
abstemiously. Besides, the real quantity of sleep cannot be measured by
time; as one person will be more refreshed by five or six hours sleep,
than another by eight or ten.

Children may always be allowed to take as much sleep as they please;
but, for adults, six or seven hours is certainly sufficient, and no one
ought to exceed eight. Those who lie a-bed more than eight hours may
slumber, but they can hardly be said to sleep; such generally toss and
dream away the fore-part of the night, sink to rest towards morning, and
dose till noon. The best way to make sleep sound and refreshing is to
rise betimes. The custom of lying a-bed for nine or ten hours, not only
makes the sleep less refreshing, but relaxes the solids, and greatly
weakens the constitution.

Nature points out night as the proper season for sleep. Nothing more
certainly destroys the constitution than night-watching. It is great
pity that a practice so destructive to health should be so much in
fashion. How quickly the want of rest in due season will blast the most
blooming complexion, or ruin the best constitution, is evident from the
ghastly countenances of those who, as the phrase is, turn day into
night, and night into day.

To make sleep refreshing, the following things are requisite: First, to
take sufficient exercise in the open air; to avoid strong tea or coffee;
next, to eat a light supper; and lastly, to lie down with a mind as
cheerful and serene as possible.

It is certain that too much exercise will prevent sleep, as well as too
little. We seldom however hear the active and laborious complain of
restless nights. It is the indolent and slothful who generally have
these complaints. Is it any wonder that a bed of down should not be
refreshing to a person who sits all day in an easy chair? A great part
of the pleasure of life consists in alternate rest and motion; but they
who neglect the latter can never relish the former. The labourer enjoys
more true luxury in plain food and sound sleep, than is to be found in
sumptuous tables and downy pillows, where exercise is wanting.

That light suppers cause sound sleep, is true even to a proverb. Many
persons, if they exceed the least at that meal, are sure to have uneasy
nights; and, if they fall asleep, the load and oppression on their
stomach and spirits occasion frightful dreams, broken and disturbed
repose, the night-mare, &c. Were the same persons to go to bed with a
light supper, or sit up till that meal was pretty well digested, they
would enjoy sound sleep, and rise refreshed and cheerful. There are
indeed some people who cannot sleep unless they have eat some solid food
at night, but this does not imply the necessity of a heavy supper;
besides, these are generally persons who have accustomed themselves to
this method, and who do not take a sufficient quantity of solid food and
exercise.

Nothing more certainly disturbs our repose than anxiety. When the mind
is not at ease, one seldom enjoys sound sleep. The greatest of human
blessings flies the wretched, and visits the happy, the cheerful, and
the gay. This is a sufficient reason why every man should endeavour to
be as easy in his mind as possible when he goes to rest. Many, by
indulging grief and anxious thought, have banished sound sleep so long,
that they could never afterwards enjoy it.

Sleep, when taken in the fore-part of the night, is generally reckoned
most refreshing. Whether this be the effect of habit or not, is hard to
say; but as most people are accustomed to go early to bed when young, it
may be presumed that sleep, at this season, will prove most refreshing
to them ever after. Whether the fore-part of the night be best for sleep
or not, surely the fore-part of the day is fitted both for business and
amusement. I hardly ever knew an early riser who did not enjoy a good
state of health[36].


                             _Of Clothing._

The clothing ought to be suited to the climate. Custom has no doubt a
very great influence in this article; but no custom can ever change the
nature of things so far, as to render the same clothing fit for an
inhabitant of Nova Zembla and the island of Jamaica. It is not indeed
necessary to observe an exact proportion between the quantity of clothes
we wear, and the degree of latitude which we inhabit; but, at the same
time, proper attention ought to be paid to it, as well as to the
openness of the country, the frequency and violence of storms, &c.

In youth, while the blood is hot and the perspiration free, it is less
necessary to cover the body with a great quantity of clothes; but, in
the decline of life, when the skin becomes rigid and the humours more
cool, the clothing should be increased. Many diseases in the latter
period of life proceed from a defect of perspiration: these may, in some
measure, be prevented by a suitable addition to the clothing, or by
wearing such as are better calculated for promoting the discharge from
the skin, as clothes made of cotton, flannel, &c.

The clothing ought likewise to be suited to the season of the year.
Clothing may be warm enough for summer, which is by no means sufficient
for winter. The greatest caution, however, is necessary in making these
changes. We ought neither to put off our winter clothes too soon, nor to
wear our summer ones too long. In this country, the winter often sets in
very early with great rigour, and we have frequently cold weather even
after the commencement of the summer months. It would likewise be
prudent not to make the change all at once, but to do it gradually; and
indeed the changes of apparel in this climate ought to be very
inconsiderable, especially among those who have passed the meridian of
life[37].

Clothes often become hurtful by their being made subservient to the
purposes of pride or vanity. Mankind in all ages seem to have considered
clothes in this view; accordingly their fashion and figure have been
continually varying, with very little regard either to health, the
climate, or conveniency: a farthingale, for example, may be very
necessary in hot southern climates, but surely nothing can be more
ridiculous in the cold regions of the north.

Even the human shape is often attempted to be mended by dress, and those
who know no better believe that mankind would be monsters without its
assistance. All attempts of this nature are highly pernicious. The most
destructive of them in this country is that of squeezing the stomach and
bowels into as narrow a compass as possible, to procure, what is falsely
called, a fine shape[38]. By this practice the action of the stomach and
bowels, the motion of the heart and lungs, and almost all the vital
functions, are obstructed. Hence proceed indigestions, syncopes, or
fainting fits, coughs, consumptions of the lungs, and other complaints
so common among females.

The feet likewise often suffer by pressure. How a small foot came to be
reckoned genteel, I will not pretend to say; but certain it is, that
this notion has made many persons lame. Almost nine-tenths of mankind
are troubled with corns: a disease that is seldom or never occasioned
but by strait shoes. Corns are not only very troublesome, but by
rendering people unable to walk, they may likewise be considered as the
remote cause of other diseases[39].

The size and figure of the shoe ought certainly to be adapted to the
foot. In children the feet are as well shaped as the hands, and the
motion of the toes as free and easy as that of the fingers; yet few
persons in the advanced periods of life are able to make any use of
their toes. They are generally, by narrow shoes, squeezed all of a heap,
and often laid over one another in such a manner as to be rendered
altogether incapable of motion. Nor is the high heel less hurtful than
the narrow toe. A lady may seem taller for walking on her tiptoes, but
she will never walk well in this manner. It strains her joints, distorts
her limbs, makes her stoop, and utterly destroys all her ease and
gracefulness of motion: it is entirely owing to shoes with high heels
and narrow toes, that not one female in ten can be said to walk well.

In fixing on the clothes, due care should be taken to avoid all tight
bandages. Garters, buckles, &c. when drawn too tight, not only prevent
the free motion and use of the parts about which they are bound, but
likewise obstruct the circulation of the blood, which prevents the equal
nourishment and growth of these parts, and occasions various diseases.
Tight bandages about the neck, as stocks, cravats, necklaces, &c. are
extremely dangerous. They obstruct the blood in its course from the
brain, by which means head-achs, vertigoes, apoplexies, and other fatal
diseases are often occasioned.

The perfection of dress is to be easy and clean. Nothing can be more
ridiculous, than for any one to make himself a slave to fine clothes.
Such a one, and many such there are, would rather remain as fixt as a
statue from morning till night, than discompose a single hair or alter
the position of a pin. Were we to recommend any particular pattern for
dress, it would be that which is worn by the people called Quakers. They
are always neat, clean, and often elegant, without any thing
superfluous. What others lay out upon tawdry laces, ruffles, and
ribands, they bestow upon superior cleanliness. Finery is only the
affectation of dress, and very often covers a great deal of dirt.

We shall only add, with regard to clothing, that it ought not only to be
suited to the climate, the season of the year, and the period of life;
but likewise to the temperature and constitution. Robust persons are
able to endure either cold or heat better than the delicate;
consequently may be less attentive to their clothing. But the precise
quantity of clothes necessary for any person cannot be determined by
reasoning. It is entirely a matter of experience, and every man is the
best judge for himself what quantity of clothes is necessary to keep him
warm[40].




                               CHAP. VII.
                            OF INTEMPERANCE.


A modern author[41] observes, that temperance and exercise are the two
best physicians in the world. He might have added, that if these were
duly regarded, there would be little occasion for any other. Temperance
may justly be called the parent of health; yet numbers of mankind act as
if they thought diseases and death too slow in their progress, and by
intemperance and debauch seem as it were to solicit their approach.

The danger of intemperance appears from the very construction of the
human body. Health depends on that state of the solids and fluids which
fits them for the due performance of the vital functions; and, while
these go regularly on, we are sound and well; but whatever disturbs them
necessarily impairs health. Intemperance never fails to disorder the
whole animal œconomy; it hurts the digestion, relaxes the nerves,
renders the different secretions irregular, vitiates the humours, and
occasions numberless diseases.

The analogy between the nourishment of plants and animals affords a
striking proof of the danger of intemperance. Moisture and manure
greatly promote vegetation; yet an over-quantity of either will entirely
destroy it. The best things become hurtful, nay destructive, when
carried to excess. Hence we learn, that the highest degree of human
wisdom consists in regulating our appetites and passions so as to avoid
all extremes. It is that chiefly which entitles us to the character of
rational beings. The slave of appetite will ever be the disgrace of
human nature.

The Author of Nature hath endued us with various passions, for the
propagation of the species, the preservation of the individual, &c.
Intemperance is the abuse of these passions; and moderation consists in
the proper regulation of them. Men, not contented with satisfying the
simple calls of Nature, create artificial wants, and are perpetually in
search of something that may gratify them; but imaginary wants can never
be gratified. Nature is content with little; but luxury knows no bounds.
Hence the epicure, the drunkard, and the debauchee, seldom stop in their
career, till their money or their constitution fails: then indeed they
generally see their error when too late.

It is impossible to lay down fixt rules with regard to diet, on account
of the different constitutions of mankind. The most ignorant person,
however, certainly knows what is meant by excess; and it is in the power
of every man, if he chuses, to avoid it.

The great rule of diet is to study simplicity. Nature delights in the
most plain and simple food, and every animal, except man, follows her
dictates. Man alone riots at large, and ransacks the whole creation in
quest of luxuries, to his own destruction. An elegant writer[42] of the
last age speaks thus of intemperance in diet: “For my part, when I
behold a fashionable table set out in all its magnificence, I fancy that
I see gouts and dropsies, fevers and lethargies, with other innumerable
distempers, lying in ambuscade among the dishes.”

Nor is intemperance in other things less destructive than in diet. How
quickly does the immoderate pursuit of carnal pleasures, or the abuse of
intoxicating liquors, ruin the best constitution! Indeed these vices
generally go hand in hand. Hence it is that we so often behold the
votaries of Bacchus and Venus, even before they have arrived at the
prime of life, worn out with diseases, and hasting with swift pace to an
untimely grave. Did men reflect on the painful diseases, and premature
deaths, which are daily occasioned by intemperance, it would be
sufficient to make them shrink back with horror from the indulgence even
of their darling pleasures.

Intemperance does not hurt its votaries alone; the innocent too often
feel the direful effects of it. How many wretched orphans are to be seen
embracing dunghills, whose parents, regardless of the future, spent in
riot and debauch what might have served to bring up their offspring in a
decent manner? How often do we behold the miserable mother, with her
helpless infants, pining in want, while the cruel father is indulging
his insatiate appetites?

Families are not only reduced to misery, but even extirpated, by
intemperance. Nothing tends so much to prevent propagation, and to
shorten the lives of children, as the intemperance of parents. The poor
man who labours all day, and at night lies down contented with his
humble fare, can boast a numerous offspring, while his pampered lord,
sunk in ease and luxury, often languishes without an heir to his ample
fortunes. Even states and empires feel the influence of intemperance,
and rise or fall as it prevails.

Instead of mentioning the different kinds of intemperance, and pointing
out their influence upon health, we shall only, by way of example, make
a few observations on one particular species of that vice, _viz._ the
abuse of intoxicating liquors.

Every act of intoxication puts Nature to the expence of a fever, in
order to discharge the poisonous draught. When this is repeated almost
every day, it is easy to foresee the consequences. That constitution
must be strong indeed, which is able long to hold out under a daily
fever! but fevers occasioned by drinking do not always go off in a day;
they frequently end in an inflammation of the breast, liver, or brain,
and produce fatal effects.

Though the drunkard should not fall by an acute disease, he seldom
escapes those of a chronic kind. Intoxicating liquors, when used to
excess, weaken the bowels and spoil the digestion; they destroy the
power of the nerves, and occasion paralytic and convulsive disorders;
they likewise heat and inflame the blood, destroy its balsamic quality,
render it unfit for circulation, and the nourishment of the body. Hence
obstructions, atrophies, dropsies, and consumptions of the lungs. These
are the common ways in which drunkards make their exit. Diseases of this
kind, when brought on by hard drinking, seldom admit of a cure.

Many people injure their health by drinking, who seldom get drunk. The
continual habit of soaking, as it is called, though its effects be not
so violent, is not less pernicious. When the vessels are kept constantly
full and upon the stretch, the different digestions can neither be duly
performed, nor the humours properly prepared. Hence most people of this
character are afflicted with the gout, the gravel, ulcerous sores in the
legs, &c. If these disorders do not appear, they are seized with low
spirits, hypochondriacal affections, and other symptoms of indigestion.

Consumptions are now so common, that it is thought one-tenth of the
inhabitants of great towns die of that disease. Hard drinking is no
doubt one of the causes to which we must impute the increase of
consumptions. The great quantities of viscid malt liquor drank by the
common people of England, cannot fail to render the blood sizy and unfit
for circulation; from whence proceed obstructions, and inflammations of
the lungs. There are few great ale-drinkers who are not phthisical: nor
is that to be wondered at, considering the glutinous and almost
indigestible nature of strong ale.

Those who drink ardent spirits or strong wines run still greater hazard;
these liquors heat and inflame the blood, and tear the tender vessels of
the lungs to pieces; yet so great is the consumption of them in this
country, that one would almost be induced to think that the inhabitants
lived upon them[43].

The habit of drinking proceeds frequently from misfortunes in life. The
miserable fly to it for relief. It affords them indeed a temporary ease.
But, alas! this solace is short-lived; and when it is over, the spirits
sink as much below their usual tone as they had before been raised above
it. Hence a repetition of the dose becomes necessary, and every fresh
dose makes way for another, till the unhappy wretch becomes a slave to
the bottle, and at length falls a sacrifice to what at first perhaps was
taken only as a medicine. No man is so dejected as the drunkard when his
debauch is gone off. Hence it is, that those who have the greatest flow
of spirits while the glass circulates freely, are of all others the most
melancholy when sober, and often put an end to their own miserable
existence in a fit of spleen or ill humour.

Drunkenness not only proves destructive to health, but likewise to the
faculties of the mind. It is strange that creatures who value themselves
on account of a superior degree of reason to that of brutes, should take
pleasure in sinking so far below them. Were such as voluntarily deprive
themselves of the use of reason, to continue ever after in that
condition, it would seem but a just punishment. Though this be not the
consequence of one act of intoxication, it seldom fails to succeed a
course of it. By a habit of drinking, the greatest genius is often
reduced to a mere idiot[44].

Intoxication is peculiarly hurtful to young persons. It heats their
blood, impairs their strength, and obstructs their growth; besides, the
frequent use of strong liquors in the early part of life destroys any
benefit that might arise from them afterwards. Those who make a practice
of drinking generous liquors when young, cannot expert to reap any
benefit from them as a cordial in the decline of life.

Drunkenness is not only in itself a most abominable vice, but is an
inducement to many others. There is hardly any crime so horrid that the
drunkard will not perpetrate for the love of liquor. We have known
mothers sell their children’s clothes, the food that they should have
eat, and afterwards even the infants themselves, in order to purchase
the accursed draught.




                              CHAP. VIII.
                            OF CLEANLINESS.


The want of cleanliness is a fault which admits of no excuse. Where
water can be had for nothing, it is surely in the power of every person
to be clean. The continual discharge from our bodies by perspiration,
renders frequent change of apparel necessary. Changing apparel greatly
promotes the secretion from the skin, so necessary for health. When that
matter which ought to be carried off by perspiration, is either retained
in the body, or resorbed from dirty clothes, it must occasion diseases.

Diseases of the skin are chiefly owing to want of cleanliness[45]. They
may indeed be caught by infection, or brought on by poor living,
unwholesome food, &c. but they will seldom continue long where
cleanliness prevails. To the same cause must we impute the various kinds
of vermin which infest the human body, houses, &c. These may always be
banished by cleanliness alone, and wherever they abound, we have reason
to believe it is neglected.

One common cause of putrid and malignant fevers, is the want of
cleanliness. These fevers commonly begin among the inhabitants of close
dirty houses, who breathe unwholesome air, take little exercise, and
wear dirty clothes. There the infection is generally hatched, which
often spreads far and wide, to the destruction of many. Hence
cleanliness may be considered as an object of public attention. It is
not sufficient that I be clean myself, while the want of it in my
neighbour affects my health as well as his own. If dirty people cannot
be removed as a common nuisance, they ought at least to be avoided as
infectious. All who regard their health should keep at a distance even
from their habitations.

In places where great numbers of people are collected, cleanliness
becomes of the utmost importance. It is well known that infectious
diseases are communicated by tainted air. Every thing, therefore, which
tends to pollute the air, or spread the infection, ought with the utmost
care to be guarded against. For this reason, in great towns, no filth,
of any kind, should be permitted to lie upon the streets. Nothing is
more apt to convey infection than the excrements of the diseased.

In many great towns the streets are little better than dunghills, being
frequently covered with ashes, dung, and nastiness of every kind. Even
slaughterhouses, or killing shambles, are often to be seen in the very
centre of great towns. The putrid blood, excrements, &c. with which
these places are generally covered, cannot fail to taint the air, and
render it unwholesome. How easily might this be prevented by active
magistrates, who have it always in their power to make proper laws
relative to things of this nature, and to enforce the observance of
them!

We are sorry to say, that the importance of general cleanliness does not
seem to be sufficiently understood by the magistrates of most great
towns in Britain; though health, pleasure, and delicacy, all conspire to
recommend an attention to it. Nothing can be more agreeable to the
senses, more to the honour of the inhabitants, or more conducive to
their health, than a clean town; nor can any thing impress a stranger
with a more disrespectful idea of any people than its opposite. Whatever
pretensions people may make to learning, politeness, or civilization, we
will venture to affirm, that while they neglect cleanliness, they are in
a state of barbarity[46].

The peasants in most countries seem to hold cleanliness in a sort of
contempt. Were it not for the open situation of their houses, they would
often feel the bad effects of this disposition. One seldom sees a
farm-house without a dunghill before the door, and frequently the cattle
and their masters lodge under the same roof. Peasants are likewise
extremely careless with respect to change of apparel, keeping their
houses, &c. clean. This is merely the effect of indolence and a dirty
disposition. Habit may indeed render it less disagreeable to them, but
no habit can ever make it salutary to wear dirty clothes or breathe
unwholesome air.

As many articles of diet come through the hands of peasants, every
method should be taken to encourage and promote habits of cleanliness
among them. This, for example, might be done by giving a small premium
to the person who brings the cleanest and best article of any kind to
market, as butter, cheese, &c. and by punishing severely those who bring
it dirty. The same method should be taken with butchers, bakers,
brewers, and all who are employed in preparing the necessaries of life.

In camps the strictest regard should be paid to cleanliness. By
negligence in this matter, infectious diseases are often spread amongst
a whole army; and frequently more die of these than by the sword. The
Jews during their encampments in the wilderness, received particular
instructions with respect to cleanliness[47]. The rules enjoined them
ought to be observed by all in the like situation. Indeed the whole
system of laws delivered to that people has a manifest tendency to
promote cleanliness. Whoever considers the nature of their climate, the
diseases to which they were liable, and their dirty disposition, will
see the propriety of such laws.

It is remarkable that, in most eastern countries, cleanliness makes a
great part of their religion. The Mahometan, as well as the Jewish
religion, enjoins various bathings, washings, and purifications. No
doubt these might be designed to represent inward purity; but they were
at the same time calculated for the preservation of health. However
whimsical these washings may appear to some, few things would tend more
to prevent diseases than a proper attention to many of them. Were every
person, for example, after visiting the sick, handling a dead body, or
touching any thing that might convey infection, to wash before he went
into company, or sat down to meat, he would run less hazard either of
catching the infection himself, or of communicating it to others.

Frequent washing not only removes the filth and sordes which adhere to
the skin, but likewise promotes the perspiration, braces the body, and
enlivens the spirits. How refreshed, how cheerful, and agreeable does
one feel on being shaved, washed, and shifted; especially when these
offices have been neglected longer than usual!

The eastern custom of washing the feet, though less necessary in this
country, is nevertheless a very agreeable piece of cleanliness, and
contributes greatly to the preservation of health. The sweat and dirt
with which these parts are frequently covered, cannot fail to obstruct
the perspiration. This piece of cleanliness would often prevent colds
and fevers. Were people careful to bathe their feet and legs in lukewarm
water at night, after being exposed to cold or wet through the day, they
would seldom experience the ill effects which often proceed from these
causes.

A proper attention to cleanliness is no where more necessary than on
shipboard. If epidemical distempers break out there, no one can be safe.
The best way to prevent them, is to take care that the whole company be
cleanly in their clothes, bedding, &c. When infectious diseases do break
out, cleanliness is the most likely means to prevent their spreading; it
is likewise necessary to prevent their returning afterwards, or being
conveyed to other places. For this purpose, the clothes, bedding, &c. of
the sick ought to be carefully washed, and fumigated with brimstone.
Infection will lodge a long time in dirty clothes, and afterwards break
out in the most terrible manner.

In places where great numbers of sick people are collected together,
cleanliness ought to be most religiously observed. The very smell in
such places is often sufficient to make one sick. It is easy to imagine
what effect that is likely to have upon the diseased. In an hospital or
infirmary, where cleanliness is neglected, a person in perfect health
has a greater chance to become sick, than a sick person has to get well.

Few things are more unaccountable than that neglect, or rather dread of
cleanliness, which appears among those who have the care of the sick;
they think it almost criminal to suffer any thing that is clean to come
near a person in a fever, for example, and would rather allow him to
wallow in all manner of filth, than change the least bit of his linen.
If cleanliness be necessary for persons in health, it is certainly more
so for the sick. Many diseases may be cured by cleanliness alone; most
of them might be mitigated by it; and, where it is neglected, the
slightest disorders are often changed into the most malignant. The same
mistaken care which prompted people to prevent the least admission of
fresh air to the sick, seems to have induced them to keep them dirty.
Both these destructive prejudices will, we hope, be soon entirely
eradicated.

Cleanliness is certainly agreeable to our nature. We cannot help
approving it in others, even though we should not practice it ourselves.
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 station, and cannot be dispensed with in either. Few virtues are
of more importance to society than general cleanliness. It ought to be
carefully cultivated every where; but in populous cities it should be
almost revered[48].




                               CHAP. IX.
                             OF INFECTION.


Many diseases are infectious. Every person ought therefore, as far as he
can, to avoid all communication with the diseased. The common practice
of visiting the sick, though often well meant, has many ill
consequences. Far be it from us to discourage any act of charity or
benevolence, especially towards those in distress; but we cannot help
blaming such as endanger their own or their neighbours lives by a
mistaken friendship or an impertinent curiosity.

The houses of the sick, especially in the country, are generally crowded
from morning till night with idle visitors. It is customary, in such
places, for servants and young people to wait upon the sick by turns,
and even to sit up with them all night. It would be a miracle indeed
should such always escape. Experience teaches us the danger of this
conduct. People often catch fevers in this way, and communicate them to
others, till at length they become epidemic.

It would be thought highly improper, for one who had not had the
small-pox, to wait upon a patient in that disease; yet many other fevers
are almost as infectious as the small-pox, and not less fatal. Some
imagine that fevers prove more fatal in villages than in great towns,
for want of proper medical assistance. This may sometimes be the case;
but we are inclined to think it oftener proceeds from the cause above
mentioned.

Were a plan to be laid down for communicating infection, it could not be
done more effectually than by the common method of visiting the sick.
Such visitors not only endanger themselves and their connections, but
likewise hurt the sick. By crowding the house, they render the air
unwholesome, and by their private whispers and dismal countenances
disturb the imagination of the patient, and depress his spirits. Persons
who are ill, especially in fevers, ought to be kept as quiet as
possible. The sight of strange faces, and every thing that disturbs the
mind, hurts them.

The common practice in country-places of inviting great numbers of
people to funerals, and crowding them into the same apartment where the
corpse lies, is another way of spreading infection. The infection does
not always die with the patient. Every thing that comes into contact
with his body while alive, receives the contagion, and some of them, as
clothes, blankets, &c. will retain it for a long time. Persons who die
of infectious disorders ought not to lie long unburied; and people
should keep as much as possible at a distance from them.

It would tend greatly to prevent the spreading of infectious diseases,
if those in health were kept at a proper distance from the sick. The
Jewish Legislator, among many other wise institutions for preserving
health, has been peculiarly attentive to the means of preventing
infection, or _defilement_ as it is called, either from a diseased
person or a dead body. In many cases the diseased were to be separated
from those in health; and it was deemed a crime even to approach their
habitations. If a person only touched a diseased or dead body, he was
appointed to wash himself in water, and to keep for some time at a
distance from society.

Infectious diseases are often communicated by clothes. It is extremely
dangerous to wear apparel which has been worn by the deceased, unless it
has been well washed and fumigated, as infection may lodge a long time
in it, and afterwards produce very tragical effects. This shews the
danger of buying at random the clothes which have been worn by other
people.

Infectious disorders are frequently imported. Commerce, together with
the riches of foreign climes, brings us also their diseases. These do
often more than counterbalance all the advantages of that trade by means
of which they are introduced. It is to be regretted, that so little care
is commonly bestowed, either to prevent the introduction or spreading of
infectious maladies. Some attention indeed is generally paid to the
plague; but other diseases pass unregarded[49].

Infection is often spread through cities, by jails, hospitals, &c. These
are frequently situated in the very middle of populous towns; and when
infectious diseases break out in them, it is impossible for the
inhabitants to escape. Did magistrates pay any regard to the health of
the people, this evil might be easily remedied.

Many are the causes which tend to diffuse infection through populous
cities. The whole atmosphere of a large town is one contaminated mass,
abounding with various kinds of infection, and must be pernicious to
health. The best advice that we can give to such as are obliged to live
in large cities is, to chuse an open situation; to avoid narrow, dirty,
crowded streets; to keep their own house and offices clean; and to be as
much abroad in the open air as their time will permit.

It would tend greatly to prevent the spreading of infectious diseases,
were proper nurses every where employed to take care of the sick. This
might often save a family, or even a whole town, from being infected by
one person. We do not mean that people should abandon their friends or
relations in distress, but only to put them on their guard against being
too much in company with those who are afflicted with diseases of an
infectious nature.

Such as wait upon the sick in infectious diseases run very great hazard.
They should stuff their noses with tobacco, or some other strong
smelling herb, as rue, tansy, or the like. They ought likewise to keep
the patient very clean, to sprinkle the room where he lies with vinegar,
or other strong acids, frequently to admit a stream of fresh air into
it, and to avoid the smell of his breath as much as they can. They ought
never to go into company without having changed their clothes and washed
their hands; otherwise, if the disease be infectious, they will in all
probability carry the contagion along with them[50].

However trifling it may appear to inconsiderate persons, we will venture
to affirm, that a due attention to those things which tend to diffuse
infection would be of great importance in preventing diseases. As most
diseases are in some degree infectious, no one should continue long with
the sick, except the necessary attendants. I mean not, however, by this
caution, to deter those whose duty or office leads them to wait upon the
sick, from such a laudable and necessary employment.

Many things are in the power of the magistrate which would tend to
prevent the spreading of infection; as the promoting of public
cleanliness; removing jails, hospitals, burying grounds, and other
places where infection may be generated, at a proper distance from great
towns[51]; widening the streets; pulling down useless walls, and taking
all methods to promote a free circulation of air through every part of
the town, &c. Public hospitals, or proper places of reception for the
sick, provided they were kept clean, well ventilated, and placed in an
open situation, would likewise tend to prevent the spreading of
infection. Such places of reception would prevent the poor, when sick,
from being visited by their idle or officious neighbours. They would
likewise render it unnecessary for sick servants to be kept in their
master’s houses. Masters had better pay for having their servants taken
care of in an hospital, than run the hazard of having an infectious
disease diffused among a numerous family. Sick servants and poor people,
when placed in hospitals, are not only less apt to diffuse infection
among their neighbours, but have likewise the advantage of being well
attended.

We are not, however, to learn that hospitals, instead of preventing
infection, may become the means of diffusing it. When they are placed in
the middle of great towns; when numbers of patients are crowded together
in small apartments; when there is a constant communication kept up
between the citizens and the patients; and when cleanliness and
ventilation are neglected, they become nests for hatching diseases, and
every one who goes into them not only runs a risk of receiving infection
himself, but likewise of communicating it to others. This however is not
the fault of the hospitals, but of those who have the management of
them. It were to be wished, that they were both more numerous, and upon
a more respectable footing, as that would induce people to go into them
with less reluctance. This is the more to be desired, because most of
the putrid fevers and other infectious disorders break out among the
poor, and are by them communicated to the better sort. Were proper
attention paid to the first appearances of such disorders, and the
patients early conveyed to an hospital, we should seldom see a putrid
fever, which is almost as infectious as the plague, become epidemic.




                                CHAP. X.
                            OF THE PASSIONS.


The passions have great influence both in the cause and cure of
diseases. How the mind affects the body, will in all probability ever
remain a secret. It is sufficient for us to know, that there is
established a reciprocal influence between the mental and corporeal
parts; and that whatever injures the one disorders the other.


                              _Of Anger._

The passion of _anger_ ruffles the mind, distorts the countenance,
hurries on the circulation of the blood, and disorders the whole vital
and animal functions. It often occasions fevers, and other acute
diseases; and sometimes even sudden death. This passion is peculiarly
hurtful to the delicate, and those of weak nerves. I have known such
persons frequently lose their lives by a violent fit of anger, and would
advise them to guard against the excess of this passion with the utmost
care.

It is not indeed always in our power to prevent being angry; but we may
surely avoid harbouring resentment in our breast. Resentment preys upon
the mind, and occasions the most obstinate chronical disorders, which
gradually waste the constitution. Nothing shews true greatness of mind
more than to forgive injuries; it promotes the peace of society, and
greatly conduces to our own ease, health, and felicity.

Such as value health should avoid violent gusts of anger, as they would
the most deadly poison. Neither ought they to indulge resentment, but to
endeavour at all times to keep their minds calm and serene. Nothing
tends so much to the health of the body as a constant tranquillity of
mind.


                               _Of Fear._

The influence of _fear_, both in occasioning and aggravating diseases,
is very great. No man ought to be blamed for a decent concern about
life; but too great a desire to preserve it is often the cause of losing
it. Fear and anxiety, by depressing the spirits, not only dispose us to
diseases, but often render those diseases fatal which an undaunted mind
would overcome.

Sudden fear has generally violent effects. Epileptic fits, and other
convulsive disorders, are often occasioned by it. Hence the danger of
that practice, so common among young people, of frightening one another.
Many have lost their lives, and others have been rendered miserable, by
frolics of this kind. It is dangerous to tamper with the human passions.
The mind may easily be thrown into such disorder as never again to act
with regularity.

But the gradual effects of fear prove most hurtful. The constant dread
of some future evil, by dwelling upon the mind, often occasions the very
evil itself. Hence it comes to pass, that so many die of those very
diseases of which they long had a dread, or which had been impressed on
their minds by some accident, or foolish prediction. This, for example,
is often the case with women in child-bed. Many of those who die in that
situation are impressed with the notion of their death a long time
before it happens; and there is reason to believe that this impression
is often the cause of it.

The methods taken to impress the minds of women with the apprehensions
of the great _pain_ and _peril_ of child-birth, are very hurtful. Few
women die in labour, though many lose their lives after it; which may be
thus accounted for. A woman after delivery, finding herself weak and
exhausted, immediately apprehends she is in danger; but this fear seldom
fails to obstruct the necessary evacuations, upon which her recovery
depends. Thus the sex often fall a sacrifice to their own imaginations,
when there would be no danger, did they apprehend none.

It seldom happens that two or three women in a great town die in
child-bed, but their death is followed by many others. Every woman of
their acquaintance who is with child dreads the same fate, and the
disease becomes epidemical by the mere force of imagination. This should
induce pregnant women to despise fear, and by all means to avoid those
tattling gossips who are continually buzzing in their ears the
misfortunes of others. Every thing that may in the least alarm a
pregnant or child-bed woman, ought with the greatest care to be guarded
against.

Many women have lost their lives in child-bed by the old superstitious
custom, still kept up in most parts of Britain, of tolling the parish
bell for every person who dies. People who think themselves in danger
are very inquisitive; and if they come to know that the bell tolls for
one who died in the same situation with themselves, what must be the
consequence? At any rate they are apt to suppose that this is the case,
and it will often be found a very difficult matter to persuade them of
the contrary.

But this custom is not pernicious to child-bed women only. It is hurtful
in many other cases. When low fevers, in which it is difficult to
support the patient’s spirits, prevail, what must be the effect of a
funeral peal sounding five or six times a day in his ears? No doubt his
imagination will suggest that others died of the same disease under
which he labours. This apprehension will have a greater tendency to
depress his spirits, than all the cordials of which medicine can boast
will have to raise them.

If this useless piece of ceremony cannot be abolished, we ought to keep
the sick as much from hearing it as possible, and from every other thing
that may tend to alarm them. So far however is this from being generally
attended to, that many make it their business to visit the sick, on
purpose to whisper dismal stories in their ears. Such may pass for
sympathizing friends, but they ought rather to be considered as enemies.
All who wish well to the sick ought to keep such persons at the greatest
distance from them.

A custom has long prevailed among physicians, of prognosticating, as
they call it, the patient’s fate, or foretelling the issue of the
disease. Vanity no doubt introduced this practice, and still supports
it, in spite of common sense and the safety of mankind. I have known a
physician barbarous enough to boast, that he pronounced more _sentences_
than all his Majesty’s judges. Would to God that such sentences were not
often equally fatal! It may indeed be alleged, that the doctor does not
declare his opinion before the patient. So much the worse. A sensible
patient had better hear what the doctor says, than learn it from the
disconsolate looks, the watery eyes, and the broken whispers of those
about him. It seldom happens, when the doctor gives an unfavourable
opinion, that it can be concealed from the patient. The very
embarrassment which the friends and attendants shew in disguising what
he has said, is generally sufficient to discover the truth.

Kind Heaven has, for the wisest ends, concealed from mortals their fate;
and we do not see what right any man has to announce the death of
another, especially if such a declaration has a chance to kill him.
Mankind are indeed very fond of prying into future events, and seldom
fail to solicit the physician for his opinion. A doubtful answer,
however, or one that may tend rather to encourage the hopes of the sick,
is surely the most safe. This conduct could neither hurt the patient nor
the physician. Nothing tends more to destroy the credit of physic than
those bold prognosticators, who, by the bye, are generally the most
ignorant of the faculty. The mistakes which daily happen in this way are
so many standing proofs of human vanity, and the weakness of science.

We readily admit, that there are cases where the physician ought to give
intimation of the patient’s danger to some of his near connexions;
though even this ought always to be done with the greatest caution: but
it never can be necessary in any case that the whole town and country
should know, immediately after the doctor has made his first visit,
_that he has no hopes of his patient’s recovery_. Persons whose
impertinent curiosity leads them to question the physician, with regard
to the fate of his patient, certainly deserve no other than an evasive
answer.

The vanity of foretelling the fate of the sick is not peculiar to the
faculty. Others follow their example, and those who think themselves
wiser than their neighbours often do much hurt in this way. Humanity
surely calls upon every one to comfort the sick, and not to add to their
affliction by alarming their fears. A friend, or even a physician, may
often do more good by a mild and sympathizing behaviour than by
medicine, and should never neglect to administer that greatest of all
cordials, HOPE.


                              _Of Grief._

Grief is the most destructive of all the passions. Its effects are
permanent, and when it sinks deep into the mind, it generally proves
fatal. Anger and fear, being of a more violent nature, seldom last long;
but grief often changes into a fixed melancholy, which preys upon the
spirits, and wastes the constitution. This passion ought not to be
indulged. It may generally be conquered at the beginning; but when it
has gained strength, all attempts to remove it are vain.

No person can prevent misfortunes in life; but it shews true greatness
of mind to bear them with serenity. Many persons make a merit of
indulging grief, and when misfortunes happen, they obstinately refuse
all consolation, till the mind, overwhelmed with melancholy, sinks under
the load. Such conduct is not only destructive to health, but
inconsistent with reason, religion, and common sense.

Change of ideas is as necessary for health as change of posture. When
the mind dwells long upon one subject, especially of a disagreeable
nature, it hurts the whole functions of the body. Hence grief indulged
spoils the digestion and destroys the appetite; by which means the
spirits are depressed, the nerves relaxed, the bowels inflated with
wind, and the humours, for want of fresh supplies of chyle, vitiated.
Thus many an excellent constitution has been ruined by a family
misfortune, or any thing that occasions excessive grief.

It is utterly impossible, that any person of a dejected mind should
enjoy health. Life may indeed be dragged out for a few years; but
whoever would live to a good old age, must be good-humoured and
cheerful. This indeed is not altogether in our own power; yet our temper
of mind, as well as our actions, depend greatly upon ourselves. We can
either associate with cheerful or melancholy companions, mingle in the
amusements and offices of life, or sit still and brood over our
calamities as we choose. These, and many such things, are certainly in
our power, and from these the mind generally takes its cast.

The variety of scenes which present themselves to the senses, were
certainly designed to prevent our attention from being too long fixed
upon any one object. Nature abounds with variety, and the mind, unless
fixed down by habit, delights in contemplating new objects. This at once
points out the method of relieving the mind in distress. Turn the
attention frequently to new objects. Examine them for some time. When
the mind begins to recoil, shift the scene. By this means a constant
succession of new ideas may be kept up, till the disagreeable ones
entirely disappear. Thus travelling, the study of any art or science,
reading or writing on such subjects as deeply engage the attention, will
sooner expel grief than the most sprightly amusements.

It has already been observed, that the body cannot be healthy unless it
be exercised; neither can the mind. Indolence nourishes grief. When the
mind has nothing else to think of but calamities, no wonder that it
dwells there. Few people who pursue business with attention are hurt by
grief. Instead therefore of abstracting ourselves from the world or
business, when misfortunes happen, we ought to engage in it with more
than usual attention, to discharge with double diligence the functions
of our station, and to mix with friends of a cheerful and social temper.

Innocent amusements are by no means to be neglected. These, by leading
the mind insensibly to the contemplation of agreeable objects, help to
dispel the gloom which misfortunes cast over it. They make time seem
less tedious, and have many other happy effects.

Some persons, when overwhelmed with grief, betake themselves to
drinking. This is making the cure worse than the disease. It seldom
fails to end in the ruin of fortune, character, and constitution.


                               _Of Love._

Love is perhaps the strongest of all the passions; at least, when it
becomes violent, it is less subject to the control either of the
understanding or will, than any of the rest. Fear, anger, and several
other passions, are necessary for the preservation of the individual,
but love is necessary for the continuation of the species itself; it was
therefore proper that this passion should be deeply rooted in the human
breast.

Though love be a strong passion, it is seldom so rapid in its progress
as several of the others. Few persons fall desperately in love all at
once. We would therefore advise every one, before he tampers with this
passion, to consider well the probability of his being able to obtain
the object of his love. When that is not likely, he should avoid every
occasion of increasing it. He ought immediately to fly the company of
the beloved object; to apply his mind attentively to business or study;
to take every kind of amusement; and above all, to endeavour, if
possible, to find another object which may engage his affections, and
which it may be in his power to obtain.

There is no passion with which people are so ready to tamper as love,
although none is more dangerous. Some men make love for amusement,
others from mere vanity, or on purpose to shew their consequence with
the fair. This is perhaps the greatest piece of cruelty which any one
can be guilty of. What we eagerly wish for we easily credit. Hence the
too credulous fair are often betrayed into a situation which is truly
deplorable, before they are able to discover that the pretended lover
was only in jest. But there is no jesting with this passion. When love
is got to a certain height, it admits of no other cure but the
possession of its object, which in this case ought always if possible to
be obtained[52].


                       _Of Religious Melancholy._

Many persons of a religious turn of mind behave as if they thought it a
crime to be cheerful. They imagine the whole of religion consists in
certain mortifications, or denying themselves the smallest indulgence,
even of the most innocent amusements. A perpetual gloom hangs over their
countenances, while the deepest melancholy preys upon their minds. At
length the fairest prospects vanish, every thing puts on a dismal
appearance, and those very objects which ought to give delight afford
nothing but disgust. Life itself becomes a burden, and the unhappy
wretch, persuaded that no evil can equal what he feels, often puts an
end to his own miserable existence.

It is great pity that ever religion should be so far perverted, as to
become the cause of those very evils which it was designed to cure.
Nothing can be better calculated than _True Religion_, to raise and
support the mind of its votaries under every affliction that can befal
them. It teaches them that even the sufferings of this life are
preparatory to the happiness of the next; and that all who persist in a
course of virtue shall at length arrive at complete felicity.

Persons whose business it is to recommend religion to others, should
beware of dwelling too much on gloomy subjects. That peace and
tranquillity of mind, which true religion is calculated to inspire, is a
more powerful argument in its favour than all the terrors that can be
uttered. Terror may indeed deter men from outward acts of wickedness,
but can never inspire them with that love of God, and real goodness of
heart, in which alone true religion consists.

To conclude; the best way to counteract the violence of any passion, is
to keep the mind closely engaged in some useful pursuit.




                               CHAP. XI.
                       OF THE COMMON EVACUATIONS.


The principal evacuations from the human body are those by _stool_,
_urine_, and _insensible perspiration_. None of these can be long
obstructed without impairing the health. When that which ought to be
thrown out of the body is too long retained, it not only occasions a
_plethora_, or too great fulness of the vessels, but acquires qualities
which are hurtful to the health, as acrimony, putrescence, &c.


                     _Of the Evacuation by Stool._

Few things conduce more to health than keeping the body regular. When
the _fæces_ lie too long in the bowels, they vitiate the humours; and
when they are too soon discharged, the body is not sufficiently
nourished. A medium is therefore to be desired, which can only be
obtained by regularity in diet, sleep, and exercise. Whenever the body
is not regular, there is reason to suspect a fault in one or other of
these.

Persons who eat and drink at irregular hours, and who eat various kinds
of food, and drink of several different liquors at every meal, have no
reason to expect either that their digestion will be good, or their
discharges regular. Irregularity in eating and drinking disturbs every
part of the animal œconomy, and never fails to occasion diseases. Either
too much or too little food will have this effect. The former indeed
generally occasions looseness, and the latter costiveness; but both have
a tendency to hurt the health.

It would be difficult to ascertain the exact number of stools which may
be consistent with health, as these differ in the different periods of
life, in different constitutions, and even in the same constitution
under a different regimen of diet, exercise, &c. It is however generally
allowed, that one stool a-day is sufficient for an adult, and that less
is hurtful. But this, like most general rules, admits of many
exceptions. I have known persons in perfect health who did not go to
stool above once a-week. Such a degree of costiveness however is not
safe; though the person who labours under it may for some time enjoy
tolerable health, yet at length it may occasion diseases.

One method of procuring a stool every day is to rise betimes, and go
abroad in the open air. Not only the posture in bed is unfavourable to
regular stools, but also the warmth. This, by promoting the
perspiration, lessens all the other discharges.

The method recommended for this purpose by Mr. Locke is likewise very
proper, _viz. to solicit nature, by going regularly to stool every
morning whether one has a call or not_. Habits of this kind may be
acquired, which will in time become natural.

Persons who have frequent recourse to medicines for preventing
costiveness seldom fail to ruin their constitution. Purging medicines
frequently repeated weaken the bowels, hurt the digestion, and every
dose makes way for another, till at length they become as necessary as
daily bread. Those who are troubled with costiveness ought rather, if
possible, to remove it by diet than drugs. They should likewise go
thinly clothed, and avoid every thing of an astringent or of an heating
nature. The diet and other regimen necessary in this case will be found
under the article _Costiveness_, where this state of the bowels is
treated as a disease.

Such persons as are troubled with a habitual looseness ought likewise to
suit their diet to the nature of their complaint. They should use food
which braces and strengthens the bowels, and which is rather of an
astringent quality, as wheat-bread made of the finest flour, cheese,
eggs, rice boiled in milk, &c. Their drink should be red port, claret,
brandy and water in which toasted bread has been boiled, and such like.

As a habitual looseness is often owing to an obstructed perspiration,
persons affected with it ought to keep their feet warm, to wear flannel
next their skin, and take every other method to promote the
perspiration. Further directions with regard to the treatment of this
complaint will be found under the article _Looseness_.


                              _Of Urine._

So many things tend to change both the quantity and appearances of the
urine, that it is very difficult to lay down any determined rules for
judging of either[53]. Dr. Cheyne says, the urine ought to be equal to
three-fourths of the liquid part of our aliment. But suppose any one
were to take the trouble of measuring both, he would find that every
thing which altered the degree of perspiration, would alter this
proportion, and likewise that different kinds of aliment would afford
very different quantities of urine. Though for these, and other reasons,
no rule can be given for judging of the precise quantity of urine which
ought to be discharged, yet a person of common sense will seldom be at a
loss to know when it is in either extreme.

As a free discharge of urine not only prevents but actually cures many
diseases, it ought by all means to be promoted; and every thing that may
obstruct it should be carefully avoided. Both the secretion and
discharge of urine are lessened by a sedentary life, sleeping on beds
that are too soft and warm, food of a dry and heating quality, liquors
which are astringent and heating, as red port, claret, and such like.
Those who have reason to suspect that their urine is in too small
quantity, or who have any symptoms of the gravel, ought not only to
avoid these things, but whatever else they find has a tendency to lessen
the quantity of their urine.

When the urine is too long retained, it is not only resorbed, or taken
up again into the mass of fluids, but by stagnating in the bladder it
becomes thicker, the more watery parts flying off first, and the more
gross and earthy remaining behind. By the constant tendency which these
have to concrete, the formation of stones and gravel in the bladder is
promoted. Hence it comes to pass, that indolent and sedentary people are
much more liable to these diseases, than persons of a more active life.

Many persons have lost their lives, and others have brought on very
tedious, and even incurable disorders, by retaining their urine too
long, from a false delicacy. When the bladder has been over-distended,
it often loses its power of action altogether, or becomes paralytic, by
which means it is rendered unable either to retain the urine, or expel
it properly. The calls of Nature ought never to be postponed. Delicacy
is doubtless a virtue, but that can never be reckoned true delicacy,
which induces any one to risk his health or hazard his life.

But the urine may be in too great as well as too small a quantity. This
may be occasioned by drinking large quantities of weak watery liquors,
by the excessive use of alkaline salts, or any thing that stimulates the
kidnies, dilutes the blood, &c. This disorder very soon weakens the
body, and induces a consumption. It is difficult to cure, but may be
mitigated by strengthening diet and astringent medicines, such as are
recommended under the article Diabetes, or excessive discharge of urine.


                         _Of the Perspiration._

Insensible perspiration is generally reckoned the greatest of all the
discharges from the human body. It is of so great importance to health,
that few diseases attack us while it goes properly on; but when it is
obstructed, the whole frame is soon disordered. This discharge however,
being less perceptible than any of the rest, is consequently less
attended to. Hence it is, that acute fevers, rheumatisms, agues, &c.
often proceed from obstructed perspiration before we are aware of its
having taken place.

On examining patients, we find most of them impute their diseases either
to violent colds which they had caught, or to slight ones which had been
neglected. For this reason, instead of a critical inquiry into the
nature of the perspiration, its difference in different seasons,
climates, constitutions, &c. we shall endeavour to point out the causes
which most commonly obstruct it, and to shew how far they may be either
avoided, or have their influence counteracted by timely care. The want
of a due attention to these, costs Britain annually some thousands of
useful lives.


                      _Changes in the Atmosphere._

One of the most common causes of obstructed perspiration, or catching
cold, in this country, is the changeableness of the weather, or state of
the atmosphere. There is no place where such changes happen more
frequently than in Great Britain. With us the degrees of heat and cold
are not only very different in the different seasons of the year, but
often change almost from one extreme to another in a few days, and
sometimes even in the course of one day. That such changes must affect
the state of the perspiration is obvious to every one[54].

The best method of fortifying the body against the changes of the
weather, is to be abroad every day. Those who keep most within doors are
most liable to catch cold. Such persons generally render themselves so
delicate as to feel even the slightest changes in the atmosphere, and by
their pains, coughs, and oppressions of the breast, &c. they become a
kind of living barometers.


                             _Wet Clothes._

Wet clothes not only by their coldness obstruct the perspiration, but
their moisture, by being absorbed, or taken up into the body, greatly
increases the danger. The most robust constitution is not proof against
the danger arising from wet clothes; they daily occasion fevers,
rheumatisms, and other fatal disorders, even in the young and healthy.

It is impossible for people who go frequently abroad to avoid sometimes
being wet. But the danger might generally be lessened, if not wholly
prevented, by changing their clothes soon; when this cannot be done,
they should keep in motion till they be dry. So far are many from taking
this precaution, that they often sit or lie down in the fields with
their clothes wet, and frequently sleep even whole nights in this
condition. The frequent instances which we have of the fatal effects of
this conduct, ought certainly to deter others from being guilty of it.


                              _Wet Feet._

Even wet feet often occasion fatal diseases. The colic, inflammations of
the breast and of the bowels, the iliac passion, _cholera morbus_, &c.
are often occasioned by wet feet. Habit will, no doubt, render this less
dangerous; but it ought, as far as possible, to be avoided. The
delicate, and those who are not accustomed to have their clothes or feet
wet should be peculiarly careful in this respect.


                              _Night Air._

The perspiration is often obstructed by night air; even in summer, this
ought to be avoided. The dews which fall plentifully after the hottest
day, make the night more dangerous than when the weather is cool. Hence,
in warm countries, the evening dews are more hurtful than where the
climate is more temperate.

It is very agreeable after a warm day to be abroad in the cool evening;
but this is a pleasure to be avoided by all who value their health. The
effects of evening dews are gradual indeed, and almost imperceptible;
but they are not the less to be dreaded: we would therefore advise
travellers, labourers, and all who are much heated by day, carefully to
avoid them. When the perspiration has been great, these become dangerous
in proportion. By not attending to this, in flat marshy countries, where
the exhalations and dews are copious, labourers are often seized with
intermitting fevers, quinseys, and other dangerous diseases.


                              _Damp Beds._

Beds become damp, either from their not being used, standing in damp
houses, or in rooms without fire. Nothing is more to be dreaded by
travellers than damp beds, which are very common in all places where
fuel is scarce. When a traveller, cold and wet, arrives at an inn, he
may by means of a good fire, warm diluting liquor, and a dry bed, have
the perspiration restored; but if he be put into a cold room, and laid
on a damp bed, it will be more obstructed, and the worst consequences
will ensue. Travellers should avoid inns which are noted for damp beds,
as they would a house infected with the plague, as no man, however
robust, is proof against the danger arising from them.

But inns are not the only places where damp beds are to be met with.
Beds kept in private families for the reception of strangers are often
equally dangerous. All kinds of linen and bedding, when not frequently
used, become damp. How then is it possible that beds, which are not
slept in above two or three times a year, should be safe? Nothing is
more common than to hear people complain of having caught cold by
changing their bed. The reason is obvious: were they careful never to
sleep in a bed but what was frequently used, they would seldom find any
ill consequences from a change.

Nothing is more to be dreaded by a delicate person when on a visit, than
being laid in a bed which is kept on purpose for strangers. That
ill-judged piece of complaisance becomes a real injury. All the bad
consequences from this quarter might easily be prevented in private
families, by causing their servants to sleep in the spare beds, and
resign them to strangers when they come. In inns where the beds are used
almost every night, nothing else is necessary than to keep the rooms
well seasoned by frequent fires, and the linen dry.

That baneful custom said to be practised in many inns, of damping
sheets, and pressing them in order to save washing, and afterwards
laying them on the beds, ought, when discovered; to be punished with the
utmost severity. It is really a species of murder, and will often prove
as fatal as poison or gunshot. Indeed no linen, especially if it has
been washed in winter, ought to be used till it has been exposed for
some time to the fire; nor is this operation less necessary for linen
washed in summer, provided it has lain by for any length of time. This
caution is the more needful, as gentlemen are often exceedingly
attentive to what they eat or drink at an inn, yet pay no regard to a
circumstance of much more importance[55].


                             _Damp Houses._

Damp houses frequently produce the like ill consequences; for this
reason those who build should be careful to chuse a dry situation. A
house which stands on a damp marshy soil or deep clay, will never be
thoroughly dry. All houses, unless where the ground is exceeding dry,
should have the first door a little raised. Servants and others, who are
obliged to live in cellars and sunk stories, seldom continue long in
health: masters ought surely to pay some regard to the health of their
servants, as well as to their own.

Nothing is more common than for people, merely to avoid some trifling
inconveniency, to hazard their lives, by inhabiting a house almost as
soon as the masons, plasterers, &c. have done with it: such houses are
not only dangerous from their dampness, but likewise from the smell of
lime, paint, &c. The asthmas, consumptions, and other diseases of the
lungs, so incident to people who work in these articles, are sufficient
proofs of their being unwholesome.

Rooms are often rendered damp by an unseasonable piece of cleanliness; I
mean the pernicious custom of washing them immediately before company is
put into them. Most people catch cold, if they sit but a very short time
in a room that has been lately washed; the delicate ought carefully to
avoid such a situation, and even the robust are not always proof against
its influence[56].


                _Sudden Transitions from Heat to Cold._

The perspiration is commonly obstructed by SUDDEN TRANSITIONS from heat
to cold. Colds are seldom caught, unless when people have been too much
heated. Heat rarifies the blood, quickens the circulation, and increases
the perspiration; but when these are suddenly checked, the consequences
must be bad. It is indeed impossible for labourers not to be too hot
upon some occasions; but it is generally in their power to let
themselves cool gradually, to put on their clothes when they leave off
work, to make choice of a dry place to rest themselves in, and to avoid
sleeping in the open fields. These easy rules, if observed, would often
prevent fevers and other fatal disorders.

It is very common for people, when hot, to drink freely of cold water,
or small liquors. This conduct is extremely dangerous. Thirst indeed is
hard to bear, and the inclination to gratify that appetite frequently
gets the better of reason, and makes us do what our judgment
disapproves. Every peasant, however, knows, if his horse be permitted to
drink his bellyful of cold water after violent exercise, and be
immediately put into the stable, or suffered to remain at rest, that it
will kill him. This they take the utmost care to prevent. It were well
if they were equally attentive to their own safety.

Thirst may be quenched many ways without swallowing large quantities of
cold liquor. The fields afford variety of acid fruits and plants, the
very chewing of which would abate thirst. Water kept in the mouth for
some time, and spit out again, if frequently repeated, will have the
same effect. If a bit of bread be eaten along with a few mouthfuls of
water, it will both quench thirst more effectually, and make the danger
less. When a person is extremely hot, a mouthful of brandy, or other
spirits, if it can be obtained, ought to be preferred to any thing else.
But if any one has been so foolish, when hot, as to drink freely of cold
liquor, he ought to continue his exercise at least till what he drank be
thoroughly warmed upon his stomach.

It would be tedious to enumerate all the bad effects which flow from
drinking cold liquors when the body is hot. Sometimes this has
occasioned immediate death. Hoarseness, quinseys, and fevers of various
kinds, are its common consequences. Neither is it safe when warm to eat
freely of raw fruits, sallads, or the like. These indeed have not so
sudden an effect on the body as cold liquors, but they are
notwithstanding dangerous, and ought to be avoided.

Sitting in a warm room, and drinking hot liquors till the pores are
quite open, and immediately going into the cold air, is extremely
dangerous. Colds, coughs, and inflammations of the breast, are the usual
effects of this conduct: yet nothing is more common than for people,
after they have drank warm liquors for several hours, to walk or ride a
number of miles in the coldest night, or to ramble about in the
streets[57].

People are very apt, when a room is hot, to throw open a window, and to
sit near it. This is a most dangerous practice. Any person had better
sit without doors than in such a situation, as the current of air is
directed against one particular part of the body. Inflammatory fevers
and consumptions have often been occasioned by sitting or standing
thinly clothed near an open window. Nor is sleeping with open windows
less to be dreaded. That ought never to be done, even in the hottest
season, unless the window is at a distance. I have known mechanics
frequently contract fatal diseases, by working stript at an open window,
and would advise all of them to beware of such a practice.

Few things expose people more to catch cold than keeping their own
houses too warm; such persons may be said to live in a sort of
hot-houses; they can hardly stir abroad to visit a neighbour, but at the
hazard of their lives. Were there no other reason for keeping houses
moderately cool, that alone is sufficient: but no house that is too hot
can be wholesome; heat destroys the spring and elasticity of the air,
and renders it less fit for expanding the lungs, and the other purposes
of respiration. Hence it is, that consumptions and other diseases of the
lungs prove so fatal to people who work in forges, glasshouses, and the
like.

Some are even so fool-hardy, as to plunge themselves when hot in cold
water. Not only fevers, but madness itself, has frequently been the
effect of this conduct. Indeed it looks too like the action of a madman
to deserve a serious consideration.

The result of all these observations is, that every one ought to avoid,
with the utmost attention, all sudden transitions from heat to cold, and
to keep the body in as uniform a temperature as possible; or, where that
cannot be done, to take care to let it cool gradually.

People may imagine that too strict an attention to these things would
tend to render them delicate. So far however is this from being my
design, that the very first rule proposed for preventing colds, is to
harden the body, by enuring it daily to the open air.

I shall put an end to what relates to this part of my subject, by giving
an abstract of the justly celebrated advice of Celsus, with respect to
the preservation of health. “A man,” says he, “who is blessed with good
health, should confine himself to no particular rules, either with
respect to regimen or medicine. He ought frequently to diversify his
manner of living; to be sometimes in town, sometimes in the country; to
hunt, sail, indulge himself in rest, but more frequently to use
exercise. He ought to refuse no kind of food that is commonly used, but
sometimes to eat more and sometimes less; sometimes to make one at an
entertainment, and sometimes to forbear it; to make rather two meals
a-day than one, and always to eat heartily, provided he can digest it.
He ought neither too eagerly to pursue, nor too scrupulously to avoid,
intercourse with the fair sex: pleasures of this kind, rarely indulged,
render the body alert and active; but, when too frequently repeated,
weak and languid. He should be careful in time of health not to destroy,
by excesses of any kind, that vigour of constitution which should
support him under sickness.”




                                PART II.
                              OF DISEASES.




                               CHAP. XII.
                 OF THE KNOWLEDGE AND CURE OF DISEASES.


The knowledge of diseases does not depend so much upon scientific
principles as many imagine. It is chiefly the result of experience and
observation. By attending the sick, and carefully observing the various
occurrences in diseases, a great degree of accuracy may be acquired,
both in distinguishing their symptoms, and in the application of
medicines. Hence sensible nurses, and other persons who wait upon the
sick, often discover a disease sooner than those who have been bred to
physic. We do not however mean to insinuate that a medical education is
of no use: it is doubtless of the greatest importance; but it never can
supply the place of observation and experience.

Every disease may be considered as an assemblage of symptoms, and must
be distinguished by those which are most obvious and permanent. Instead
therefore of giving a classical arrangement of diseases, according to
the systematic method, it will be more suitable, in a performance of
this nature, to give a full and accurate description of each particular
disease as it occurs; and, where any of the symptoms of one disease have
a near resemblance to those of another, to take notice of that
circumstance, and at the same time to point out the peculiar or
characteristic symptoms by which it may be distinguished. By a due
attention to these, the investigation of diseases will be found to be a
less difficult matter than most people would at first be ready to
imagine.

A proper attention to the patient’s age, sex, temper of mind,
constitution, and manner of life, will likewise greatly assist, both in
the investigation and treatment of diseases.

In childhood the fibres are lax and soft, the nerves extremely
irritable, and the fluids thin; whereas in old age the fibres are rigid,
the nerves become almost insensible, and many of the vessels
imperviable. These and other peculiarities render the diseases of the
young and aged very different, and of course they must require a
different method of treatment.

Females are liable to many diseases which do not afflict the other sex:
besides, the nervous system being more irritable in them than in men,
their diseases require to be treated with greater caution. They are less
able to bear large evacuations; and all stimulating medicines ought to
be administered to them with a sparing hand.

Particular constitutions not only dispose persons to peculiar diseases,
but likewise render it necessary to treat these diseases in a peculiar
manner. A delicate person, for example, with weak nerves, who lives
mostly within doors, must not be treated, under any disease, precisely
in the same manner as one who is hardy and robust, and who is much
exposed to the open air.

The temper of mind ought to be carefully attended to in diseases. Fear,
anxiety, and a fretful temper, both occasion and aggravate diseases. In
vain do we apply medicines to the body to remove maladies which proceed
from the mind. When it is affected, the best medicine is to sooth the
passions, to divert the mind from anxious thought, and to keep the
patient as easy and cheerful as possible.

Attention ought likewise to be paid to the climate, or place where the
patient lives, the air he breathes, his diet, &c. Such as live in low
marshy situations are subject to many diseases which are unknown to the
inhabitants of high countries. Those who breathe the impure air of
cities, have many maladies to which the more happy rustics are entire
strangers. Persons who feed grossly, and indulge in strong liquors, are
liable to diseases which do not affect the temperate and abstemious, &c.

It has already been observed, that the different occupations and
situations in life dispose men to peculiar diseases. It is therefore
necessary to inquire into the patient’s occupation, manner of life, &c.
This will not only assist us in finding out the disease, but will
likewise direct us in the treatment of it. It would be very imprudent to
treat the laborious and the sedentary precisely in the same manner, even
supposing them to labour under the same disease.

It will likewise be proper to inquire, whether the disease be
constitutional or accidental; whether it has been of long or short
duration; whether it proceeds from any great and sudden alteration in
the diet, manner of life, &c. The state of the patient’s body, and of
the other evacuations, ought also to be inquired into; and likewise
whether he can with ease perform all the vital and animal functions, as
breathing, digestion, &c.

Lastly, it will be proper to inquire what diseases the patient has
formerly been liable to, and what medicines were most beneficial to him;
if he has a strong aversion to any particular drug, &c.

As many of the indications of cure may be answered by diet alone, it is
always the first thing to be attended to in the treatment of diseases.
Those who know no better, imagine that every thing which goes by the
name of a medicine possesses some wonderful power or secret charm, and
think, if the patient swallows enough of drugs, that he must do well.
This mistake has many ill consequences; it makes people trust to drugs,
and neglect their own endeavours; besides, it discourages all attempts
to relieve the sick where medicines cannot be obtained.

Medicines are no doubt useful in their place; and, when administered
with prudence, they may do much good; but when they are put in place of
every thing else, or administered at random, which is not seldom the
case, they must do mischief. We would therefore wish to call the
attention of mankind from the pursuit of secret medicines, to such
things as they are acquainted with. The proper regulation of these may
often do much good, and there is little danger of their ever doing hurt.

Every disease weakens the digestive powers. The diet ought therefore, in
all diseases, to be light and of easy digestion. It would be as prudent
for a person with a broken leg to attempt to walk, as for one in a fever
to eat the same kind of food, and in the same quantity, as when he was
in perfect health. Even abstinence alone will often cure a fever,
especially when it has been occasioned by excess in eating or drinking.

In all fevers attended with inflammation, as pleurisies, peripneumonies,
&c. thin gruels, wheys, watery infusions of mucilaginous plants, roots,
&c. are not only proper for the patients food, but they are likewise the
best medicines which can be administered.

In fevers of a slow, nervous, or putrid kind, where there are no
symptoms of inflammation, and where the patient must be supported with
cordials, that intention can always be more effectually answered by
nourishing diet and generous wines, than by any medicines yet known.

Nor is a proper attention to diet of less importance in chronic than in
acute diseases. Persons afflicted with low spirits, wind, weak nerves,
and other hypochondriacal affections, generally find more benefit from
the use of solid food and generous liquors, than from all the cordial
and carminitive medicines which can be administered to them.

The scurvy, that most obstinate malady, will sooner yield to a proper
vegetable diet, than to all the boasted antiscorbutic remedies of the
shops.

In consumptions, when the humours are vitiated, and the stomach so much
weakened as to be unable to digest the solid fibres of animals, or even
to assimilate the juices of vegetables, a diet consisting chiefly of
_milk_ will not only support the patient, but will often cure the
disease after every other medicine has failed.

Nor is an attention to other things of less importance than to diet. The
strange infatuation which has long induced people to shut up the sick
from all communication with the external air, has done great mischief.
Not only in fevers, but in many other diseases, the patient will receive
more benefit from having the fresh air prudently admitted into his
chamber, than from all the medicines which can be given him.

Exercise may likewise in many cases be considered as a medicine.
Sailing, or riding on horseback, for example, will be of more service in
the cure of consumptions, glandular obstructions, &c. than any medicine
yet known. In diseases which proceed from a relaxed state of the solids,
the cold bath, and other parts of the gymnastic regimen, will be found
equally beneficial.

Few things are of greater importance in the cure of diseases than
cleanliness. When a patient is suffered to lie in dirty clothes,
whatever perspires from his body is again resorbed, or taken up into it,
which serves to nourish the disease and increase the danger. Many
diseases may be cured by cleanliness alone; most of them may be
mitigated by it, and in all of them it is highly necessary both for the
patient and those who attend him.

Many other observations, were it necessary, might be adduced to prove
the importance of a proper regimen in diseases. Regimen will often cure
diseases without medicine, but medicine will seldom succeed where a
proper regimen is neglected. For this reason, in the treatment of
diseases, we have always given the first place to regimen. Those who are
ignorant of medicine may confine themselves to it only. For others who
have more knowledge, we have recommended some of the most simple but
approved forms of medicine in every disease. These however are never to
be administered but by people of better understanding; nor even by them
without the greatest precaution.




                              CHAP. XIII.
                         OF FEVERS IN GENERAL.


As more than one half of mankind is said to perish by fevers, it is of
importance to be acquainted with their causes. The most general causes
of fevers are, _infection, errors in diet, unwholesome air, violent
emotions of the mind, excess or suppression of usual evacuations,
external or internal injuries, and extreme degrees of heat or cold_. As
most of these have already been treated of at considerable length, and
their effects shewn, we shall not now resume the consideration of them,
but shall only recommend it to all, as they would wish to avoid fevers
and other fatal diseases, to pay the most punctual attention to these
articles.

Fevers are not only the most frequent of all diseases, but they are
likewise the most complex. In the most simple species of fever there is
always a combination of several different symptoms. The distinguishing
symptoms of fever are, _increased heat_, _frequency of pulse_, _loss of
appetite_, _general debility_, _pain in the head_, and _a difficulty in
performing some of the vital or animal functions_. The other symptoms
usually attendant on fevers are, nausea, thirst, anxiety, delirium,
weariness, wasting of the flesh, want of sleep, or the sleep disturbed
and not refreshing.

When the fever comes on gradually, the patient generally complains first
of languor or listlessness, soreness of the flesh, or the bones, as the
country people express it, heaviness of the head, loss of appetite,
sickness, with clamminess of the mouth; after some time come on
excessive heat, violent thirst, restlessness, &c.

When the fever attacks suddenly, it always begins with an uneasy
sensation of excessive cold, accompanied with debility and loss of
appetite; frequently the cold is attended with shivering, oppression
about the heart, and sickness at stomach, or vomiting.

Fevers are divided into continual, remitting, intermitting, and such as
are attended with cutaneous eruption or topical inflammation, as the
small-pox, erysipelas, &c. By a continual fever is meant that which
never leaves the patient during the whole course of the disease, or
which shews no remarkable increase or abatement in the symptoms. This
kind of fever is likewise divided into acute, slow, and malignant. The
fever is called _acute_ when its progress is quick, and the symptoms
violent; but when these are more gentle, it is generally denominated
_slow_. When livid or petechial spots shew a putrid state of the
humours, the fever is called _malignant_, _putrid_, or _petechial_.

A remitting fever differs from a continual only in a degree. It has
frequent increases and decreases, or exacerbations and remissions, but
never wholly leaves the patient during the course of the disease.
Intermitting fevers or agues are those which, during the time that the
patient may be said to be ill, have evident intervals or remissions of
the symptoms.

As a fever is only an effort of Nature to free herself from an offending
cause, it is the business of those who have the care of the sick to
observe with diligence which way Nature points, and to endeavour to
assist her operations. Our bodies are so framed, as to have a constant
tendency to expel or throw off whatever is injurious to health. This is
generally done by urine, sweat, stool, expectoration, vomit, or some
other evacuation.

There is reason to believe, if the efforts of Nature, at the beginning
of a fever, were duly attended to and promoted, it would seldom continue
long; but when her attempts are either neglected or counteracted, it is
no wonder if the disease proves fatal. There are daily instances of
persons who, after catching cold, have all the symptoms of a beginning
fever; but by keeping warm, drinking diluting liquors, bathing their
feet in warm water, &c. the symptoms in a few hours disappear, and the
danger is prevented.

When fevers of a putrid kind threaten, the best method of obviating
their effects is by repeated vomits.

Our design is not to enter into a critical inquiry into the nature and
immediate causes of fevers, but to mark their most obvious symptoms, and
to point out the proper treatment of the patient with respect to his
diet, drink, air, &c. in the different stages of the disease. In these
articles the inclinations of the patient will in a great measure direct
our conduct.

Almost every person in a fever complains of great thirst, and calls out
for drink, especially of a cooling nature. This at once points out the
use of _water_, and other cooling liquors. What is so likely to abate
the heat, attenuate the humours, remove spasms and obstructions, promote
perspiration, increase the quantity of urine, and in short produce every
salutary effect in an ardent or inflammatory fever, as drinking
plentifully of water, thin gruel, or any other weak liquor, of which
water is the basis? The necessity of diluting liquors is pointed out by
the dry tongue, the parched skin, and the burning heat, as well as by
the unquenchable thirst of the patient.

Many cooling liquors, which are extremely grateful to patients in a
fever, may be prepared from fruits, as decoctions of tamarinds,
apple-tea, orange-whey, and the like. Mucilaginous liquors might also be
prepared from marsh-mallow roots, linseed, lime-tree buds, and other
mild vegetables. These liquors, especially when acidulated, are highly
agreeable to the patient, and should never be denied him.

At the beginning of a fever the patient generally complains of great
lassitude or weariness, and has no inclination to move. This evidently
shews the propriety of keeping him easy, and if possible in bed. Lying
in bed relaxes the spasms, abates the violence of the circulation, and
gives Nature an opportunity of exerting all her force to overcome the
disease. The bed alone would often remove a fever at the beginning; but
when the patient struggles with the disease, instead of driving it off,
he only fixes it the deeper, and renders it more dangerous. This
observation is too often verified in travellers, who happen when on a
journey to be seized with a fever. Their anxiety to get home induces
them to travel with the fever upon them, which conduct seldom fails to
render it fatal.

In fevers the mind as well as the body should be kept easy. Company is
seldom agreeable to the sick. Indeed every thing that disturbs the
imagination increases the disease; for which reason every person in a
fever ought to be kept perfectly quiet, and neither allowed to see nor
hear any thing that may in the least affect or discompose his mind.

Though the patient in a fever has the greatest inclination for drink,
yet he seldom has any appetite for solid food; hence the impropriety of
urging him to take victuals is evident. Much solid food in a fever is
every way hurtful. It oppresses nature, and, instead of nourishing the
patient, serves only to feed the disease. What food the patient takes
should be in small quantity, light, and of easy digestion. It ought to
be chiefly of the vegetable kind, as panada, roasted apples, gruels, and
such like.

Poor people, when any of their family are taken ill, run directly to
their rich neighbours for cordials, and pour wine, spirits, &c. into the
patient, who perhaps never had been accustomed to taste such liquors
when in health. If there be any degree of fever, this conduct must
increase it, and if there be none, this is the ready way to raise one.
Stuffing the patient with sweetmeats and other delicacies is likewise
very pernicious. These are always harder to digest than common food, and
cannot fail to hurt the stomach.

Nothing is more desired by a patient in a fever than fresh air. It not
only removes his anxiety, but cools the blood, revives the spirits, and
proves every way beneficial. Many patients are in a manner stifled to
death in fevers for want of fresh air; yet such is the unaccountable
infatuation of most people, that the moment they think a person in a
fever, they imagine he should be kept in a close chamber, into which not
one particle of fresh air must be admitted. Instead of this, there ought
to be a constant stream of fresh air into a sick person’s chamber, so as
to keep it moderately cool. Indeed its degree of warmth ought never to
be greater than is agreeable to one in perfect health.

Nothing spoils the air of a sick person’s chamber, or hurts the patient
more, than a number of people breathing in it. When the blood is
inflamed, or the humours in a putrid state, air that has been breathed
repeatedly will greatly increase the disease. Such air not only loses
its spring, and becomes unfit for the purpose of respiration, but
acquires a noxious quality, which renders it in a manner poisonous to
the sick.

In fevers, when the patient’s spirits are low and depressed, he is not
only to be supported with cordials, but every method should be taken to
cheer and comfort his mind. Many, from a mistaken zeal, when they think
a person in danger, instead of solacing his mind with the hopes and
consolations of religion, fright him with the views of hell and
damnation. It would be unsuitable here to dwell upon the impropriety and
dangerous consequences of this conduct; it often hurts the body, and
there is reason to believe seldom benefits the soul.

Among common people, the very name of a fever generally suggests the
necessity of bleeding. This notion seems to have taken its rise from
most fevers in this country having been formerly of an inflammatory
nature; but true inflammatory fevers are now seldom to be met with.
Sedentary occupations, and a different manner of living, have so changed
the state of diseases in Britain, that there is now hardly one fever in
ten where the lancet is necessary. In most low, nervous, and putrid
fevers, which are now so common, bleeding is really hurtful, as it
weakens the patient, sinks his spirits, &c. We would recommend this
general rule, never to bleed at the beginning of a fever, unless there
be evident signs of inflammation. Bleeding is an excellent medicine when
necessary, but should never be wantonly performed.

It is likewise a common notion, that sweating is always necessary in the
beginning of a fever. When the fever proceeds from an obstructed
perspiration, this notion is not ill-founded. If the patient only lies
in bed, bathes his feet and legs in warm water, and drinks freely of
water-gruel, or any other weak diluting liquor, he will seldom fail to
perspire freely. The warmth of the bed, and the diluting drink, will
relax the universal spasm, which generally affects the skin at the
beginning of a fever; it will open the pores, and promote the
perspiration, by means of which the fever may often be carried off. But
instead of this, the common practice is to heap clothes upon the
patient, and to give him things of a hot nature, as spirits, spiceries,
&c. which fire his blood, increase the spasms, and render the disease
more dangerous.

In all fevers a proper attention should be paid to the patient’s
longings. These are the calls of Nature, and often point out what may be
of real use. Patients are not indeed to be indulged in every thing that
the sickly appetite may crave; but it is generally right to let them
have a little of what they eagerly desire, though it may not seem
altogether proper. What the patient longs for, his stomach will
generally digest; and such things have sometimes a very happy effect.

When a patient is recovering from a fever, great care is necessary to
prevent a relapse. Many persons, by too soon imagining themselves well,
have lost their lives, or contracted other diseases of an obstinate
nature. As the body after a fever is weak and delicate, it is necessary
to guard against catching cold. Moderate exercise in the open air will
be of use, but great fatigue is by all means to be avoided; agreeable
company will also have a good effect. The diet must be light, but
nourishing. It should be taken frequently, but in small quantities. It
is dangerous at such a time to eat as much as the stomach may crave.




                               CHAP. XIV.
                   OF INTERMITTING FEVERS, OR AGUES.


Intermitting fevers afford the best opportunity both of observing the
nature of a fever, and also the effects of medicine. No person can be at
a loss to distinguish an intermitting fever from any other, and the
proper medicine for it is now almost universally known.

The several kinds of intermitting fevers take their names from the
period in which the fit returns, as quotidian, tertian, quartan, &c.

CAUSES.——Agues are occasioned by effluvia from putrid stagnating water.
This is evident from their abounding in rainy seasons, and being most
frequent in countries where the soil is marshy, as in Holland, the Fens
of Cambridgeshire, the Hundreds of Essex, &c. This disease may also be
occasioned by eating too much stone fruit, by a poor watery diet, damp
houses, evening dews, lying upon the damp ground, watching, fatigue,
depressing passions, and the like. When the inhabitants of a high
country remove to a low one, they are generally seized with intermitting
fevers, and to such the disease is most apt to prove fatal. In a word,
whatever relaxes the solids, diminishes the perspiration, or obstructs
the circulation in the capillary or small vessels, disposes the body to
agues.

SYMPTOMS.——An intermitting fever generally begins with a pain of the
head and loins, weariness of the limbs, coldness of the extremities,
stretching, yawning, with sometimes great sickness and vomiting; to
which succeed shivering and violent shaking. Afterwards the skin becomes
moist, and a profuse sweat breaks out, which generally terminates the
fit or paroxysm. Sometimes indeed the disease comes on suddenly, when
the person thinks himself in perfect health; but it is more commonly
preceded by listlessness, loss of appetite, and the symptoms mentioned
above.

REGIMEN.——While the fit continues, the patient ought to drink freely of
water-gruel, orange-whey, weak camomile-tea; or, if his spirits be low,
small wine-whey, sharpened with the juice of lemon. All his drink should
be warm, as that will assist in bringing on the sweat, and consequently
shorten the paroxysm[58].

Between the paroxysms the patient must be supported with food that is
nourishing, but light and easy of digestion, as veal or chicken-broths,
sago, gruel with a little wine, light puddings, and such like. His drink
may be small negus, acidulated with the juice of lemons or oranges, and
sometimes a little weak punch. He may likewise drink infusions of bitter
herbs, as camomile, wormwood, or water-trefoil, and may now and then
take a glass of small wine, in which gentian root, centaury, or some
other bitter, has been infused.

As the chief intentions of cure in an ague are to brace the solids, and
promote perspiration, the patient ought to take as much exercise between
the fits as he can bear. If he be able to go abroad, riding on
horseback, or in a carriage, will be of great service. But if he cannot
bear that kind of exercise, he ought to take such as his strength will
permit. Nothing tends more to prolong an intermitting fever, than
indulging a lazy indolent disposition.

Intermitting fevers, under a proper regimen, will often go off without
medicine; and when the disease is mild, in an open dry country, there is
seldom any danger from allowing it to take its course; but when the
patient’s strength seems to decline, or the paroxysms are so violent
that his life is in danger, medicine ought immediately to be
administered. This however should never be done till the disease be
properly formed, that is to say, till the patient has had several fits
of shaking and sweating.

MEDICINE.——The first thing to be done in the cure of an intermitting
fever, is to cleanse the stomach and bowels. This not only renders the
application of other medicines more safe, but likewise more efficacious.
In this disease, the stomach is generally loaded with cold viscid
phlegm, and frequently great quantities of bile are discharged by vomit;
which plainly points out the necessity of such evacuations. Vomits are
therefore to be administered before the patient takes any other
medicine. A dose of ipecacuanha will generally answer this purpose very
well. A scruple or half a dram of the powder will be sufficient for an
adult, and for a younger person the dose must be less in proportion.
After the vomit begins to operate, the patient ought to drink
plentifully of weak camomile-tea. The vomit should be taken two or three
hours before the return of the fit, and may be repeated at the distance
of two or three days. Vomits not only cleanse the stomach, but increase
the perspiration, and all the other secretions, which render them of
such importance, that they often cure intermitting fevers without the
assistance of any other medicine.

Purging medicines are likewise useful and often necessary in
intermitting fevers. A smart purge has been known to cure an obstinate
ague, after the Peruvian bark and other medicines had been used in vain.
Vomits however are more suitable in this disease, and render purging
less necessary; but if the patient be afraid to take a vomit, he ought
in this case to cleanse the bowels by a dose or two of Glauber’s salt,
jalap, or rhubarb.

Bleeding may sometimes be proper at the beginning of an intermitting
fever, when excessive heat, a delirium, &c. give reason to suspect an
inflammation; but as the blood is seldom in an inflammatory slate in
intermitting fevers, this operation is rarely necessary. When frequently
repeated, it tends to prolong the disease.

After proper evacuations the patient may safely use the Peruvian bark,
which may be taken in any way that is most agreeable to him. No
preparation of the bark seems to answer better than the most simple form
in which it can be given, viz. in powder.

Two ounces of the best Peruvian bark, finely powdered, may be divided
into twenty-four doses. These may either be made into boluses as they
are used, with a little syrup of lemon, or mixed in a glass of red wine,
a cup of camomile-tea, water-gruel, or any other drink that is more
agreeable to the patient[59].

In an ague which returns every day, one of the above doses may be taken
every two hours during the interval of the fits. By this method the
patient will be able to take five or six doses between each paroxysm. In
a tertian or third-day ague it will be sufficient to take a dose every
third hour during the interval, and in a quartan every fourth. If the
patient cannot take so large a dose of the bark, he may divide each of
the powders into two parts, and take one every hour, &c. For a young
person a smaller quantity of this medicine will be sufficient, and the
dose must be adapted to the age, constitution, and violence of the
symptoms[60].

The above quantity of bark will frequently cure an ague; the patient,
however, ought not to leave off taking the medicine as soon as the
paroxysms are stopped, but should continue to use it till there is
reason to believe the disease is entirely overcome. Most of the failures
in the cure of this disease are owing to patients not continuing to use
the medicine long enough. They are generally directed to take it till
the fits are stopped, then to leave it off, and begin again at some
distance of time; by which means the disease gathers strength, and often
returns with as much violence as before. A relapse may always be
prevented by the patient’s continuing to take small doses of the
medicine for some time after the symptoms disappear. This is both the
most safe and effectual method of cure.

An ounce of gentian root, calamus aromaticus, and orange-peel, of each
half an ounce, with three or four handfuls of camomile-flowers, and an
handful of coriander-seed, all bruised together in a mortar, may be used
in form of infusion or tea. About half an handful of these ingredients
may be put into a tea-pot, and an English pint of boiling water poured
on them. A cup of this infusion drank three or four times a day will
greatly promote the cure. Such patients as cannot drink the watery
infusion, may put two handfuls of the same ingredients into a bottle of
white wine, and take a glass of it twice or thrice a day. If patients
drink freely of the above, or any other proper infusion of bitters, a
smaller quantity of bark than is generally used, will be sufficient to
cure an ague[61].

Those who cannot swallow the bark in substance, may take it in decoction
or infusion. An ounce of bark in powder may be infused in a bottle of
white wine for four or five days, frequently shaking the bottle,
afterwards let the powder subside, and pour off the clear liquor. A wine
glass may be drank three or four times a day, or oftener, as there is
occasion. If a decoction be more agreeable, an ounce of the bark, and
two drams of snake-root bruised, with an equal quantity of salt of
wormwood, may be boiled in a quart of water, into an English pint. To
the strained liquor may be added an equal quantity of red wine, and a
glass of it taken frequently.

In obstinate agues, the bark will be found much more efficacious when
assisted by brandy, or other warm cordials, than taken alone. This I
have had frequently occasion to observe in a country where intermittent
fevers were endemical. The bark seldom succeeded unless assisted by
snake-root, ginger, canella alba, or some other warm aromatic. When the
fits are very frequent and violent, in which case the fever often
approaches towards an inflammatory nature, it will be safer to keep out
the aromatics, and to add salt of tartar in their stead. But in an
obstinate tertian or quartan, in the end of autumn or beginning of
winter, warm and cordial medicines are absolutely necessary[62].

As autumnal and winter agues generally prove much more obstinate than
those which attack the patient in spring or summer, it will be necessary
to continue the use of medicines longer in the former than in the
latter. A person who is seized with an intermitting fever in the
beginning of winter, ought frequently, if the season proves rainy, to
take a little medicine, although the disease may seem to be cured, to
prevent a relapse, till the return of the warm season. He ought likewise
to take care not to be much abroad in wet weather, especially in cold
easterly winds.

When agues are not properly cured, they often degenerate into obstinate
chronical diseases, as the dropsy, jaundice, &c. For this reason all
possible care should be taken to have them radically cured, before the
constitution has been too much weakened.

Though nothing is more rational than the method of treating intermitting
fevers, yet, by some strange infatuation, more charms and whimsical
remedies are daily used for removing this than any other disease. There
is hardly an old woman who is not in possession of a nostrum for
stopping an ague; and it is amazing with what readiness their
pretensions are believed. Those in distress eagerly grasp at any thing
that promises sudden relief; but the shortest way is not always the best
in the treatment of diseases. The only method to obtain a safe and
lasting cure, is gradually to assist Nature in removing the cause of the
disorder.

Some indeed try bold, or rather fool-hardy experiments to cure agues, as
drinking great quantities of strong liquors, jumping into a river, &c.
These may sometimes have the desired effect, but must always be attended
with danger[63]. When there is any degree of inflammation, or the least
tendency to it, such experiments may prove fatal. The only patient whom
I remember to have lost in an intermittent fever, evidently killed
himself by drinking strong liquor, which some person had persuaded him
would prove an infallible remedy.

Many dirty things are extolled for the cure of intermitting fevers, as
spiders, cobwebs, snuffings of candles, &c. Though these may sometimes
succeed, yet their very nastiness is sufficient to set them aside,
especially when cleanly medicines will answer the purpose better. The
only medicine that can be depended upon, for thoroughly curing an
intermittent fever, is the Peruvian bark. It may always be used with
safety: and I can honestly declare, that in all my practice I never knew
it fail, when combined with the medicines mentioned above, and duly
persisted in.

Where agues are endemical, even children are often afflicted with that
disease. Such patients are very difficult to cure, as they can seldom be
prevailed upon to take the bark, or any other disagreeable medicine. One
method of rendering this medicine more palatable, is to make it into a
mixture with distilled waters and syrup, and afterwards to give it an
agreeable sharpness with the elixir or spirit of vitriol. This both
improves the medicine, and takes off the nauseous taste. In cases where
the bark cannot be administered, the _saline mixture_ may be given with
advantage to children[64].

Wine-whey is a very proper drink for a child in an ague; to half an
English pint of which may be put a tea-spoonful of the spirit of
hartshorn. Exercise is likewise of considerable service; and when the
disease proves obstinate, the child ought, if possible, to be removed to
a warm dry air. The food ought to be nourishing, and sometimes a little
generous wine should be allowed.

To children, and such as cannot swallow the bark, or when the stomach
will not bear it, it may be given by clyster. Half an ounce of the
extract of bark, dissolved in four ounces of warm water, with the
addition of half an ounce of sweet oil, and six or eight drops of
laudanum, in the form recommended by Dr. Lind for an adult, and this to
be repeated every fourth hour, or oftener, as the occasion shall
require. For children the quantity of extract and laudanum must be
proportionally lessened. Children have been cured of agues by making
them wear a waistcoat with powdered bark quilted between the folds of
it; by bathing them frequently in a strong decoction of the bark, and by
rubbing the spine with strong spirits, or with a mixture of equal parts
of laudanum and the saponaceous liniment.

We have been the more full upon this disease, because it is very common,
and because few patients in an ague apply to physicians unless in
extremities. There are, however, many cases in which the disease is very
irregular, being complicated with other diseases, or attended with
symptoms which are both very dangerous and very difficult to understand.
All these we have purposely passed over, as they would only bewilder the
generality of readers. When the disease is very irregular, or the
symptoms dangerous, the patient ought immediately to apply to a
physician, and strictly to follow his advice.

To prevent agues, people must endeavour to avoid their causes. These
have been already pointed out in the beginning of this section; we shall
therefore only add one preventive medicine, which may be of use to such
as are obliged to live in low marshy countries, or who are liable to
frequent attacks of this disease.

Take an ounce of the best Peruvian bark; Virginian snake-root, and
orange-peel, of each half an ounce; bruise them all together, and infuse
for five or six days in a bottle of brandy, Holland gin, or any good
spirit; afterwards pour off the clear liquor; and take a wine glass of
it twice or thrice a day. This indeed is recommending a dram; but the
bitter ingredients in a great measure take off the ill effects of the
spirit. Those who do not chuse it in brandy, may infuse it in wine; and
such as can bring themselves to chew the bark, will find that method
succeed very well. Gentian root, or calamus aromaticus, may also be
chewed by turns for the same purpose. All bitters seem to be antidotes
to agues, especially those that are warm and astringent.




                               CHAP. XV.
                      OF AN ACUTE CONTINUAL FEVER.


This fever is denominated acute, ardent, or inflammatory. It most
commonly attacks the young, or persons about the prime or vigour of
life, especially such as live high, abound with blood, and whose fibres
are strong and elastic. It seizes people at all seasons of the year; but
is most frequent in the spring and beginning of summer.

CAUSES.——An ardent fever may be occasioned by any thing that overheats
the body, or produces plethora, as violent exercise, sleeping in the
sun, drinking strong liquors, eating spiceries, a full diet, with little
exercise, &c. It may likewise be occasioned by whatever obstructs the
perspiration, as lying on the damp ground, drinking cold liquor when the
body is hot, night-watching, or the like.

SYMPTOMS.—A rigour or chilliness generally ushers in this fever, which
is soon succeeded by great heat, a frequent and full pulse, pain of the
head, dry skin, redness of the eyes, a florid countenance, pains in the
back, loins, &c. To these succeed difficulty of breathing, sickness,
with an inclination to vomit. The patient complains of great thirst, has
no appetite for solid food, is restless, and his tongue generally
appears black and rough.

A delirium, excessive restlessness, great oppression of the breast, with
laborious respiration, starting of the tendons, hiccup, cold clammy
sweats, and an involuntary discharge of urine, are very dangerous
symptoms.

As this disease is always attended with danger, the best medical
assistance ought to be procured as soon as possible. A physician may be
of use at the beginning, but his skill is often of no avail afterwards.
Nothing can be more unaccountable than the conduct of those who have it
in their power, at the beginning of a fever, to procure the best medical
assistance, yet put it off till things come to an extremity. When the
disease, by delay or wrong treatment, has become incurable, and has
exhausted the strength of the patient, it is in vain to hope for relief
from medicine. Physicians may indeed assist Nature; but their attempts
must ever prove fruitless, when she is no longer able to co-operate with
their endeavours.

REGIMEN.—From the symptoms of this disease, it is evident, that the
blood and other humours require to be diluted; that the perspiration,
urine, saliva, and all the other secretions, are in too small quantity;
that the vessels are rigid, and the heat of the whole body too great:
all these clearly point out the necessity of a regimen calculated to
dilute the blood, correct the acrimony of the humours, allay the
excessive heat, remove the spasmodic stricture of the vessels, and
promote the secretions.

These important purposes may be greatly promoted by drinking plentifully
of diluting liquors; as water-gruel, or oatmeal-tea, clear whey,
barley-water, balm-tea, apple-tea, &c. These may be sharpened with juice
of orange, jelly of currants, raspberries, and such like: orange-whey is
likewise an excellent cooling drink. It is made by boiling among milk
and water a bitter orange sliced, till the curd separates. If no orange
can be had, a lemon, a little cream of tartar, or a few spoonfuls of
vinegar, will have the same effect. Two or three spoonfuls of white wine
may occasionally be added to the liquor when boiling.

If the patient be costive, an ounce of tamarinds, with two ounces of
stoned raisins of the sun, and a couple of figs, may be boiled in three
English pints of water to a quart. This makes a very pleasant drink, and
may be used at discretion. The common pectoral decoction is likewise a
very proper drink in this disease. A tea-cupful of it may be taken every
two hours, or oftener, if the patient’s heat and thirst be very
great[65].

The above liquids must all be drank a little warm. They may be used in
smaller quantities at the beginning of a fever, but more freely
afterwards, in order to assist in carrying off the disease by promoting
the different excretions. We have mentioned a variety of drinks, that
the patient may have it in his power to chuse those which are most
agreeable; and that when tired of one, he may have recourse to another.

The patient’s diet must be very spare and light. All sorts of
flesh-meats, and even chicken-broths, are to be avoided. He may be
allowed groat-gruel, panado, or light bread boiled in water; to which
may be added a few grains of common salt, and a little sugar, which will
render it more palatable. He may eat roasted apples with a little sugar,
toasted bread with jelly of currants, boiled prunes, &c.

It will greatly relieve the patient, especially in an hot season, to
have fresh air frequently let into his chamber. This, however, must
always be done in such a manner as not to endanger his catching cold.

It is too common in fevers to load the patient with bed-clothes, under
the pretence of making him sweat, or defending him from the cold. This
custom has many ill effects. It increases the heat of the body, fatigues
the patient, and retards, instead of promoting, the perspiration.

Sitting upright in bed, if the patient is able to bear it, will often
have a good effect. It relieves the head, by retarding the motion of the
blood to the brain. But this posture ought never to be continued too
long: and if the patient is inclined to sweat, it will be more safe to
let him lie, only raising his head a little with pillows.

Sprinkling the chamber with vinegar, juice of lemon, or vinegar and
rose-water, with a little nitre dissolved in it, will greatly refresh
the patient. This ought to be done frequently, especially if the weather
is hot.

The patient’s mouth should be often washed with a mixture of water and
honey, to which a little vinegar may be added, or with a decoction of
figs in barley-water. His feet and hands ought likewise frequently to be
bathed in lukewarm water; especially if the head is affected.

The patient should be kept as quiet and easy as possible. Company,
noise, and every thing that disturbs the mind, is hurtful. Even too much
light, or any thing that affects the senses, ought to be avoided. His
attendants should be as few as possible, and they ought not to be too
often changed. His inclinations ought rather to be soothed than
contradicted; even the promise of what he craves will often satisfy him
as much as its reality.

MEDICINE.——In this and all other fevers, attended with a hard, full,
quick pulse, bleeding is of the greatest importance. This operation
ought always to be performed as soon as the symptoms of an inflammatory
fever appear. The quantity of blood to be taken away, however, must be
in proportion to the strength of the patient and the violence of the
disease. If after the first bleeding the fever should increase, and the
pulse become more frequent and hard, there will be a necessity for
repeating it a second, and perhaps a third, or even a fourth time, which
may be done at the distance of twelve, eighteen, or twenty-four hours
from each other, as the symptoms require. If the pulse continues soft,
and the patient is tolerably easy after the first bleeding, it ought not
to be repeated.

If the heat and fever be very great, forty or fifty drops of the
dulcified or sweet spirit of nitre may be made into a draught, with an
ounce of rose-water, two ounces of common water, and half an ounce of
simple syrup, or a bit of loaf-sugar. This draught may be given to the
patient every three or four hours while the fever is violent; afterwards
once in five or six hours will be sufficient.

If the patient be afflicted with retching, or an inclination to vomit,
it will be right to assist Nature’s attempts, by giving him weak
camomile-tea, or lukewarm water to drink.

If the body is bound, a clyster of milk and water with a little salt,
and a spoonful of sweet oil or fresh butter in it, ought daily to be
administered. Should this not have the desired effect, a tea-spoonful of
magnesia alba, or cream of tartar, may be frequently put into his drink.
He may likewise eat tamarinds, boiled prunes, roasted apples, and the
like.

If about the tenth, eleventh, or twelfth day, the pulse becomes more
soft, the tongue moister, and the urine begins to let fall a reddish
settlement, there is reason to expect a favourable issue to the disease.
But if, instead of these symptoms, the patient’s spirits grow languid,
his pulse sinks, and his breathing becomes difficult; with a stupor,
trembling of the nerves, starting of the tendons, &c. there is reason to
fear that the consequences will be fatal. In this case blistering
plasters must be applied to the head, ancles, inside of the legs or
thighs, as there may be occasion; poultices of wheat-bread, mustard, and
vinegar, may likewise be applied to the soles of the feet, and the
patient must be supported with cordials, as strong wine-whey, negus,
sago-gruel with wine in it, and such like.

A proper regimen is not only necessary during the fever, but likewise
after the patient begins to recover. By neglecting this, many relapse,
or fall into other diseases, and continue valetudinary for life. Though
the body is weak after a fever, yet the diet for some time ought to be
rather light than of too nourishing a nature. Too much food, drink,
exercise, company, &c. are carefully to be avoided. The mind ought
likewise to be kept easy, and the patient should not attempt to pursue
study, or any business that requires intense thinking.

If the digestion is bad, or the patient is seized at times with feverish
heats, an infusion of Peruvian bark in cold water will be of use. It
will strengthen the stomach, and help to subdue the remains of the
fever.

When the patient’s strength is pretty well recovered, he ought to take
some gentle laxative. An ounce of tamarinds and a dram of sena may be
boiled for a few minutes in an English pint of water, and an ounce of
manna dissolved in the decoction; afterwards it may be strained, and a
tea-cupful drank every hour till it operates. This dose may be repeated
twice or thrice, five or six days intervening between each dose.

Those who follow laborious employments ought not to return too soon to
their labour after a fever, but should keep easy till their strength and
spirits are sufficiently recruited.




                               CHAP. XVI.
                            OF THE PLEURISY.


The true pleurisy is an inflammation of that membrane called the
_pleura_, which lines the inside of the breast. It is distinguished into
the moist and dry. In the former the patient spits freely; in the
latter, little or none at all. There is likewise a species of this
disease, which is called the _spurious_ or _bastard pleurisy_, in which
the pain is more external, and chiefly affects the muscles between the
ribs. The pleurisy prevails among labouring people, especially such as
work without doors, and are of a sanguine constitution. It is most
frequent in the spring season.

CAUSES.——The pleurisy may be occasioned by whatever obstructs the
perspiration; as cold northerly winds; drinking cold liquors when the
body is hot; sleeping without doors on the damp ground; wet clothes;
plunging the body into cold water, or exposing it to the cold air, when
covered with sweat, &c. It may likewise be occasioned by drinking strong
liquors; by the stoppage of usual evacuations; as old ulcers, issues,
sweating of the feet or hands, &c. the sudden striking in of any
eruption, as the itch, the measles, or the small-pox. Those who have
been accustomed to bleed at a certain season of the year are apt, if
they neglect it, to be seized with a pleurisy. Keeping the body too warm
by means of fire, clothes, &c. renders it more liable to this disease. A
pleurisy may likewise be occasioned by violent exercise, as running,
wrestling, leaping, or by supporting great weight, blows on the breast,
&c. A bad conformation of the body renders persons more liable to this
disease, as a narrow chest, a straitness of the arteries of the pleura,
&c.

SYMPTOMS.—This, like most other fevers, generally begins with chillness
and shivering, which are followed by heat, thirst, and restlessness. To
these succeeds a violent pricking pain in one of the sides among the
ribs. Sometimes the pain extends towards the back bone, sometimes
towards the fore-part of the breast, and at other times towards the
shoulder blades. The pain is generally most violent when the patient
draws his breath.

The pulse in this disease is commonly quick and hard, the urine
high-coloured; and if blood be let, it is covered with a tough crust, or
buffy coat. The patient’s spittle is at first thin, but afterwards it
becomes grosser, and is often streaked with blood.

REGIMEN.——Nature generally endeavours to carry off this disease by a
critical discharge of blood from some part of the body, by
expectoration, sweat, loose stools, thick urine, or the like. We ought
therefore to second her intentions by lessening the force of the
circulation, relaxing the vessels, diluting the humours, and promoting
expectoration.

For these purposes the diet, as in the former disease, ought to be cool,
slender, and diluting. The patient must avoid all food that is viscid,
hard of digestion, or that affords much nourishment; as flesh, butter,
cheese, eggs, milk, and also every thing that is of a heating nature.
His drink may be whey, or an infusion of pectoral and balsamic
vegetables[66].

Barley-water, with a little honey or jelly of currants mixed with it, is
likewise a very proper drink in this disease. It is made by boiling an
ounce of pearl-barley in three English pints of water to two, which must
afterwards be strained. The decoction of figs, raisins, barley,
recommended in the preceding disease, is here likewise very proper.
These and other diluting liquors are not to be drank in large quantities
at a time, but the patient ought to keep continually sipping them, so as
to render his mouth and throat always moist. All his food and drink
should be taken a little warm.

The patient should be kept quiet, cool, and every way easy, as directed
under the foregoing disease. His feet and hands ought daily to be bathed
in lukewarm water; and he may sometimes sit up in bed for a short space,
in order to relieve his head.

MEDICINE.——Almost every person knows, when a fever is attended with a
violent pain of the side, and a quick hard pulse, that bleeding is
necessary. When these symptoms come on, the sooner this operation is
performed the better; and the quantity at first must be pretty large,
provided the patient is able to bear it. A large quantity of blood let
at once, in the beginning of a pleurisy, has a much better effect than
repeated small bleedings. A man may lose twelve or fourteen ounces of
blood as soon as it is certainly known that he is seized with a
pleurisy. For a younger person, or one of a delicate constitution, the
quantity must be less.

If, after the first bleeding, the stitch, with the other violent
symptoms, should still continue, it will be necessary, at the distance
of twelve or eighteen hours, to let eight or nine ounces more. If the
symptoms do not then abate, and the blood shews a strong buffy coat, a
third or even a fourth bleeding may be requisite. If the pain of the
side abates, the pulse becomes softer, or the patient begins to spit
freely, bleeding ought not to be repeated. This operation is seldom
necessary after the third or fourth day of the fever, and ought not then
to be performed, unless in the most urgent circumstances.

The blood may be many ways attenuated without bleeding. There are
likewise many things that may be done to ease the pain of the side
without this operation, as fomenting, blistering, &c. Fomentations may
be made by boiling a handful of the flowers of elder, camomile, and
common mallows, or any other soft vegetables, in a proper quantity of
water. The herbs may be either put into a flannel bag, and applied warm
to the side, or flannels may be dipped in the decoction, afterwards
wrung out, and applied to the part affected, with as much warmth as the
patient can easily bear. As the clothes grow cool, they must be changed,
and great care taken that the patient do not catch cold. A bladder may
be filled with warm milk and water, and applied to the side, if the
above method of fomenting be found inconvenient. Fomentations not only
ease the pain, but relax the vessels, and prevent the stagnation of the
blood and other humours. The side may likewise be frequently rubbed with
a little of the volatile liniment[67].

Topical bleeding has often a very good effect in this disease. It may
either be performed by applying a number of leeches to the part
affected, or by cupping, which is both a more certain and expeditious
method than the other.

Leaves of various plants might likewise be applied to the patient’s side
with advantage. I have often seen great benefit from young
cabbage-leaves applied warm to the side in a pleurisy. These not only
relax the parts, but likewise draw off a little moisture, and may
prevent the necessity of blistering-plasters; which however, when other
things fail, must be applied.

If the stitch continues after repeated bleedings, fomentations, &c. a
blistering-plaster must be applied over the part affected, and suffered
to remain for two days. This not only procures a discharge from the
side, but takes off the spasm, and by that means assists in removing the
cause of the disease. To prevent a strangury when the blistering-plaster
is on, the patient may drink freely of the Arabic emulsion[68].

If the patient is costive, a clyster of thin water-gruel, or of
barley-water, in which a handful of mallows, or any other emollient
vegetable has been boiled, may be daily administered. This will not only
empty the bowels, but have the effect of a warm fomentation applied to
the inferior viscera, which will help to make a derivation from the
breast.

The expectoration of spitting may be promoted by sharp, oily, and
mucilaginous medicines. For this purpose an ounce of the oxymel, or the
vinegar of squills, may be added to six ounces of the pectoral
decoction, and two table-spoonfuls of it taken every two hours.

Should the squill disagree with the stomach, the oily emulsion may be
administered[69]; or, in place of it, two ounces of the oil of sweet
almonds, or oil of olives, and two ounces of the syrup of violets, may
be mixed with as much sugar-candy powdered, as will make an electuary of
the consistence of honey. The patient may take a tea-spoonful of this
frequently, when the cough is troublesome. Should oily medicines prove
nauseous, which is sometimes the case, two table-spoonfuls of the
solution of gum ammoniac in barley-water may be given three or four
times a-day[70].

If the patient does not perspire, but has a burning heat upon his skin,
and passes very little water, some small doses of purified nitre and
camphire will be of use. Two drams of the former may be rubbed with five
or six grains of the latter in a mortar, and the whole divided into six
doses, one of which may be taken every five or six hours, in a little of
the patient’s ordinary drink.

We shall only mention one medicine more, which some reckon almost a
specific in the pleurisy, _viz._ the decoction of the seneka
rattle-snake root[71]. After bleeding and other evacuations have been
premised, the patient may take two, three, or four table-spoonfuls of
this decoction, according as his stomach will bear it, three or four
times a-day. If it should occasion vomiting, two or three ounces of
simple cinnamon-water may be mixed with the quantity of decoction here
directed, or it may be taken in smaller doses. As this medicine promotes
perspiration and urine, and likewise keeps the body easy, it may be of
some service in a pleurisy, or any other inflammation of the breast.

No one will imagine that these medicines are all to be used at the same
time. We have mentioned different things, on purpose that people may
have it in their power to chuse; and likewise, that when one cannot be
obtained, they may make use of another. Different medicines are no doubt
necessary in the different periods of a disorder; and where one fails of
success, or disagrees with the patient, it will be proper to try
another.

What is called the crisis, or height of the fever, is sometimes attended
with very alarming symptoms, as difficulty of breathing, an irregular
pulse, convulsive motions, &c. These are apt to frighten the attendants,
and induce them to do improper things, as bleeding the patient, giving
him strong stimulating medicines, or the like. But they are only the
struggles of Nature to overcome the disease, in which she ought to be
assisted by plenty of diluting drink, which is then peculiarly
necessary. If the patient’s strength however be much exhausted by the
disease, it will be necessary at this time to support him with frequent
small draughts of wine-whey, negus, or the like.

When the pain and fever are gone, it will be proper, after the patient
has recovered sufficient strength, to give him some gentle purges, as
those directed towards the end of the acute continual fever. He ought
likewise to use a light diet, of easy digestion, and his drink should be
butter-milk, whey, and other things of a cleansing nature.

Of the BASTARD PLEURISY.

That species of pleurisy which is called the _bastard_ or _spurious_,
generally goes off by keeping warm for a few days, drinking plenty of
diluting liquors, and observing a cooling regimen.

It is known by a dry cough, a quick pulse, and a difficulty of lying on
the affected side, which last does not always happen in the true
pleurisy. Sometimes indeed this disease proves obstinate, and requires
bleeding, with cupping, and scarifications of the part affected. These,
together with the use of nitrous and other cooling medicines, seldom
fail to effect a cure.

Of the PARAPHRENITIS.

The _paraphrenitis_, or inflammation of the diaphragm, is so nearly
connected with the pleurisy, and resembles it so much in the manner of
treatment, that it is scarce necessary to consider it as a separate
disease.

It is attended with a very acute fever, and an extreme pain in the part
affected, which is generally augmented by coughing, sneezing, drawing in
the breath, taking food, going to stool, making water, &c. Hence the
patient breathes quick, and draws in his bowels to prevent the motion of
the diaphragm; is restless, anxious, has a dry cough, a hiccup, and
often a delirium. A convulsive laugh, or rather a kind of involuntary
grin, is no uncommon symptom of this disease.

Every method must be taken to prevent a suppuration, as it is impossible
to save the patient’s life when this happens. The regimen and medicine
are in all respects the same as in the pleurisy. We shall only add, that
in this disease emollient clysters are peculiarly useful, as they relax
the bowels, and by that means make a derivation from the part affected.




                              CHAP. XVII.
            OF A PERIPNEUMONY, OR INFLAMMATION OF THE LUNGS.


As this disease affects an organ which is absolutely necessary to life,
it must always be attended with danger. Persons who abound with thick
blood, whose fibres are tense and rigid, who feed upon gross aliment,
and drink strong viscid liquors, are most liable to a peripneumony. It
is generally fatal to those who have a flat breast, or narrow chest, and
to such as are afflicted with an asthma, especially in the decline of
life. Sometimes the inflammation reaches to one lobe of the lungs only,
at other times the whole of the organ is affected; in which case the
disease can hardly fail to prove fatal.

When the disease proceeds from a viscid pituitous matter obstructing the
vessels of the lungs, it is called a _spurious_ or _bastard
peripneumony_. When it arises from a thin acrid defluxion on the lungs,
it is denominated a _catarrhal peripneumony_, &c.

CAUSES.——An inflammation of the lungs is sometimes a primary disease,
and sometimes it is the consequence of other diseases, as a quinsey, a
pleurisy, &c. It proceeds from the same causes as the pleurisy, _viz._
an obstructed perspiration from cold, wet clothes, &c. or from an
increased circulation of the blood by violent exercise, the use of
spiceries, ardent spirits, and such like. The pleurisy and peripneumony
are often complicated; in which case the disease is called a
_pleuro-peripneumony_.

SYMPTOMS.——Most of the symptoms of a pleurisy likewise attend an
inflammation of the lungs; only in the latter the pulse is more soft,
and the pain less acute; but the difficulty of breathing, and oppression
of the breast, are generally greater.

REGIMEN.——As the regimen and medicine are in all respects the same in
the true peripneumony as in the pleurisy, we shall not here repeat them,
but refer the reader to the treatment of that disease. It may not
however be improper to add, that the aliment ought to be more slender
and thin in this than in any other inflammatory disease. The learned Dr.
Arbuthnot asserts, that even common whey is sufficient to support the
patient, and that decoctions of barley, and infusions of fennel roots in
warm water with milk, are the most proper both for drink and
nourishment. He likewise recommends the steam of warm water taken in by
the breath, which serves as a kind of internal fomentation, and helps to
attenuate the impacted humours. If the patient has loose stools, but is
not weakened by them, they are not to be stopped, but rather promoted by
the use of emollient clysters.

It has already been observed, that the _spurious_ or _bastard_
peripneumony is occasioned by a viscid pituitous matter obstructing the
vessels of the lungs. It commonly attacks the old, infirm, and
phlegmatic, in winter and wet seasons.

The patient at the beginning is cold and hot by turns, has a small quick
pulse, feels sense of weight upon his breast, breathes with difficulty,
and sometimes complains of a pain and giddiness of his head. His urine
is usually pale, and his colour very little changed.

The diet in this, as well as in the true peripneumony, must be very
slender, as weak broths, sharpened with the juice of orange or lemon,
and such like. His drink may be thin water-gruel sweetened with honey,
or a decoction of the roots of fennel, liquorice, and quick grass. An
ounce of each of these may be boiled in three English pints of water to
a quart, and sharpened with a little currant-jelly, or the like.

Bleeding and purging are generally proper at the beginning of this
disease; but if the patient’s spittle is pretty thick, or well
concocted, neither of them are necessary. It will be sufficient to
assist the expectoration by some of the sharp medicines recommended for
that purpose in the pleurisy, as the solution of gum ammoniac with
oxymel of squills, &c. Blistering plasters have generally a good effect,
and ought to be applied pretty early.

If the patient does not spit, he must be bled according as his strength
will permit, and have a gentle purge administered. Afterwards his body
may be kept open by clysters, and the expectoration promoted, by taking
every four hours two table-spoonfuls of the solution mentioned above.

When an inflammation of the breast does not yield to bleeding,
blistering, and other evacuations, it commonly ends in a suppuration,
which is more or less dangerous, according to the part where it is
situated. When this happens in the pleura, it sometimes breaks
outwardly, and the matter is discharged by the wound.

When the suppuration happens within the substance or body of the lungs,
the matter may be discharged by expectoration; but if the matter floats
in the cavity of the breast, between the pleura and the lungs, it can
only be discharged by an incision made betwixt the ribs.

If the patient’s strength does not return after the inflammation is to
all appearance removed; if his pulse continues quick though soft, his
breathing difficult and oppressed; if he has cold shiverings at times,
his cheeks flushed, his lips dry; and if he complains of thirst, and
want of appetite, there is reason to fear a suppuration, and that a
phthisis or consumption of the lungs will ensue. We shall therefore next
proceed to consider the proper treatment of that disease.




                              CHAP. XVIII.
                            OF CONSUMPTIONS.


A consumption is a wasting or decay of the whole body from an ulcer,
tubercles, or concretions of the lungs, an empyema, a nervous atrophy,
or a cachexy.

Dr. Arbuthnot observes, that in his time consumptions made up above
one-tenth part of the bills of mortality in and about London. There is
reason to believe they have rather increased since, and we know from
experience, that they are not less fatal in some other towns of England
than in London.

Young persons, between the age of fifteen and thirty, of a slender make,
long neck, high shoulders, and flat breasts, are most liable to this
disease.

Consumptions prevail more in England than in any other part of the
world, owing perhaps to the great use of animal food and malt liquors,
the general application to sedentary employments, and the great quantity
of pit-coal which is there burnt; to which we may add the perpetual
changes in the atmosphere, or variableness of the weather.

CAUSES.——It has already been observed, that an inflammation of the
breast often ends in an imposthume: consequently whatever disposes
people to this disease, must likewise be considered as a cause of
consumption.

Other diseases, by vitiating the habit, may likewise occasion
consumptions; as the scurvy, the scrophula, or king’s evil, the venereal
disease, the asthma, small-pox, measles, &c.

As this disease is seldom cured, we shall endeavour the more
particularly to point out its causes, in order that people may be
enabled to avoid it. These are:

——Confined or unwholesome air. When this fluid is impregnated with the
fumes of metals or minerals, it proves extremely hurtful to the lungs,
and often corrodes the tender vessels of that necessary organ.

——Violent passions, exertions, or affections of the mind; as grief,
disappointment, anxiety, or close application to the study of abstruse
arts or sciences.

——Great evacuations; as sweating, diarrhœas, diabetes, excessive venery,
the fluor albus, an over-discharge of the menstrual flux, giving suck
too long, &c.

——The sudden stoppage of customary evacuations; as the bleeding piles,
sweating of the feet, bleeding at the nose, the menses, issues, ulcers,
or eruptions of any kind.

——Injuries done to the lungs, calculi, &c. I lately saw the symptoms of
a phthisis occasioned by a small bone sticking in the _bronchæ_. It was
afterwards vomited along with a considerable quantity of purulent
matter, and the patient, by a proper regimen, and the use of the
Peruvian bark, recovered.

——Making a sudden transition from a hot to a very cold climate, change
of apparel, or whatever greatly lessens the perspiration.

——Frequent and excessive debaucheries. Late watching, and drinking
strong liquors, which generally go together, can hardly fail to destroy
the lungs. Hence the _bon companion_ generally falls a sacrifice to this
disease.

——Infection. Consumptions are likewise caught by sleeping with the
diseased; for which reason this should be carefully avoided. It cannot
be of great benefit to the sick, and must hurt those in health.

——Occupations in life. Those artificers who sit much, and are constantly
leaning forward, or pressing upon the stomach and breast, as cutlers,
taylors, shoemakers, seamstresses, &c. often die of consumptions. They
likewise prove fatal to singers, and all who have occasion to make
frequent and violent exertions of the lungs.

——Cold. More consumptive patients date the beginning of their disorders
from wet feet, damp beds, night air, wet clothes, or catching cold after
the body had been heated, than from all other causes.

Sharp, saline, and aromatic aliments, which heat and inflame the blood,
are likewise frequently the cause of consumptions.

We shall only add, that this disease is often owing to an hereditary
taint, or a scrophulous habit; in which case it is generally incurable.

SYMPTOMS.——This disease generally begins with a dry cough, which often
continues for some months. If a disposition to vomit after eating be
excited by it, there is still greater reason to fear an approaching
consumption. The patient complains of a more than usual degree of heat,
a pain and oppression of the breast, especially after motion; his
spittle is of a saltish taste, and sometimes mixed with blood. He is apt
to be sad; his appetite is bad, and his thirst great. There is generally
a quick, soft, small pulse; though sometimes the pulse is pretty full,
and rather hard. These are the common symptoms of a beginning
consumption.

Afterwards the patient begins to spit a greenish, white, or bloody
matter. His body is extenuated by the hectic fever, and colliquative
sweats, which mutually succeed one another, _viz._ the one towards
night, and the other in the morning. A looseness, and an excessive
discharge of urine, are often troublesome symptoms at this time, and
greatly weaken the patient. There is a burning heat in the palms of the
hands, and the face generally flushes after eating; the fingers become
remarkably small, the nails are bent inwards, and the hairs fall off.

At last the swelling of the feet and legs, the total loss of strength,
the sinking of the eyes, the difficulty of swallowing, and the coldness
of the extremities, shew the immediate approach of death, which however
the patient seldom believes to be so near. Such is the usual progress of
this fatal disease, which, if not early checked, commonly sets all
medicine at defiance.

REGIMEN.——On the first appearance of a consumption, if the patient lives
in a large town, or any place where the air is confined, he ought
immediately to quit it, and to make choice of a situation in the
country, where the air is pure and free. Here he must not remain
inactive, but take every day as much exercise as he can bear.

The best method of taking exercise is to ride on horseback, as this
gives the body a great deal of motion without much fatigue. Such as
cannot bear this kind of exercise, must make use of a carriage. A long
journey, as it amuses the mind by a continual change of objects, is
greatly preferable to riding the same ground over and over. Care however
must be taken to avoid catching cold from wet clothes, damp beds, or the
like. The patient ought always to finish his ride in the morning, or at
least before dinner; otherwise it will oftener do harm than good.

It is pity those who attend the sick seldom recommend riding in this
disease, till the patient is either unable to bear it, or the malady has
become incurable. Patients are likewise apt to trifle with everything
that is in their own power. They cannot see how one of the common
actions of life should prove a remedy in an obstinate disease, and
therefore they reject it, while they greedily hunt after relief from
medicine, merely because they do not understand it.

Those who have strength and courage to undertake a pretty long voyage,
may expect great advantage from it. This, to my knowledge, has
frequently cured a consumption after the patient was, to all appearance,
far advanced in that disease, and where medicine had proved ineffectual.
Hence it is reasonable to conclude, that if a voyage were undertaken in
due time, it would seldom fail to perform a cure[72].

Such as try this method of cure ought to carry as much fresh provisions
along with them as will serve for the whole time they are at sea. As
milk is not easily obtained in this situation, they ought to live upon
fruits, and the broth of chickens, or other young animals which can be
kept alive on board. It is scarce necessary to add, that such voyages
should be undertaken, if possible, in the mildest season, and that they
ought to be towards a warmer climate[73].

Those who have not courage for a long voyage may travel into a more
southern climate, as the south of France, Spain, or Portugal; and if
they find the air of these countries agree with them, they should
continue there, at least till their health be confirmed.

Next to proper air and exercise, we would recommend a due attention to
diet. The patient should eat nothing that is either heating or hard of
digestion, and his drink must be of a soft and cooling nature. All the
diet ought to be calculated to lessen the acrimony of the humours, and
to nourish and support the patient. For this purpose he must keep
chiefly to the use of vegetables and milk. Milk alone is of more value
in this disease than the whole _materia medica_.

Asses milk is commonly reckoned preferable to any other; but it cannot
always be obtained; besides, it is generally taken in a very small
quantity; whereas, to produce any effects, it ought to make a
considerable part of the patient’s diet. It is hardly to be expected,
that a gill or two of asses milk, drank in the space of twenty-four
hours, should be able to produce any considerable change in the humours
of an adult; and when people do not perceive its effects soon, they lose
hope, and so leave it off. Hence it happens that this medicine, however
valuable, very seldom performs a cure. The reason is obvious; it is
commonly used too late, is taken in too small quantities, and is not
duly persisted in.

I have known very extraordinary effects from asses milk in obstinate
coughs, which threatened a consumption of the lungs; and do verily
believe, if used at this period, that it would seldom fail; But if it be
delayed till an ulcer is formed, which is generally the case, how can it
be expected to succeed?

Asses milk ought to be drank, if possible, in its natural warmth, and,
by a grown person, in the quantity of half an English pint at a time.
Instead of taking this quantity night and morning only, the patient
ought to take it four times, or at least thrice a-day, and to eat a
little light bread along with it, so as to make it a kind of meal.

If the milk should happen to purge, it may be mixed with old conserve of
roses. When that cannot be obtained, the powder of crabs claws may be
used in its stead. Asses milk is usually ordered to be drank warm in
bed; but as it generally throws the patient in a sweat when taken in
this way, it would perhaps be better to give it after he rises.

Some extraordinary cures in consumptive cases have been performed by
women’s milk. Could this be obtained in sufficient quantity, we would
recommend it in preference to any other. It is better if the patient can
suck it from the breast, than to drink it afterwards. I knew a man who
was reduced to such a degree of weakness in a consumption, as not to be
able to turn himself in bed. His wife was at that time giving suck, and
the child happening to die, he sucked her breasts, not with a view to
reap any advantage from the milk, but to make her easy. Finding himself
however greatly benefited by it, he continued to suck her till he became
perfectly well, and is at present a strong and healthy man.

Some prefer butter-milk to any other, and it is indeed a very valuable
medicine, if the stomach be able to bear it. It does not agree with
every person at first; and is therefore often laid aside without a
sufficient trial. It should at first be taken sparingly, and the
quantity gradually increased, until it comes to be almost the sole food.
I never knew it succeed unless where the patient almost lived upon it.

Cows milk is most readily obtained of any, and though it be not so
easily digested as that of asses or mares, it may be rendered lighter by
adding to it an equal quantity of barley-water, or allowing it to stand
for some hours, and afterwards taking off the cream. If it should
notwithstanding prove heavy on the stomach, a small quantity of brandy
or rum, with a little sugar, may be added, which will render it both
more light and nourishing.

It is not to be wondered, that milk should for some time disagree with a
stomach that has not been accustomed to digest any thing but flesh and
strong liquors, which is the case with many of those who fall into
consumptions. We do not however advise those have been accustomed to
animal food and strong liquors, to leave them off all at once. This
might be dangerous. It will be necessary for such to eat a little once
a-day of the flesh of some young animal, or rather to use the broth made
of chickens, veal, lamb, or such like. They ought likewise to drink a
little wine made into negus, or diluted with twice or thrice its
quantity of water, and to make it gradually weaker till they can leave
it off altogether.

These must be used only as preparatives to a diet consisting chiefly of
milk and vegetables, which the sooner the patient can be brought to
bear, the better. Rice and milk, or barley and milk, boiled with a
little sugar, is very proper food. Ripe fruits roasted, baked, or
boiled, are likewise proper, as goose or currant berry tarts, apples
roasted, or boiled in milk, &c. The jellies, conserves, and preserves,
&c. of ripe subacid fruits, ought to be eaten plentifully, as the jelly
of currants, conserve of roses, preserved plums, cherries, &c.

Wholesome air, proper exercise, and a diet consisting chiefly of these
and other vegetables, with milk, is the only course that can be depended
on in a beginning consumption. If the patient has strength and
sufficient resolution to persist in this course, he will seldom be
disappointed of a cure.

In a populous town in England[74], where consumptions are very common, I
have frequently seen consumptive patients, who had been sent to the
country with orders to ride, and live upon milk and vegetables, return
in a few months quite plump, and free from any complaint. This indeed
was not always the case, especially when the disease was hereditary, or
far advanced; but it was the only method in which success was to be
expected: where it failed, I never knew medicine succeed.

If the patient’s strength and spirits flag, he must be supported by
strong broths, jellies, and such like. Some recommend shell-fish in this
disorder, and with some reason, as they are nourishing and
restorative[75]. All the food and drink ought however to be taken in
small quantities, lest an overcharge of fresh chyle should oppress the
lungs, and too much accelerate the circulation of the blood.

The patient’s mind ought to be kept as easy and cheerful as possible.
Consumptions are often occasioned, and always aggravated, by a
melancholy cast of mind; for which reason music, cheerful company, and
every thing that inspires mirth, are highly beneficial. The patient
ought seldom to be left alone, as brooding over his calamities is sure
to render them worse.

MEDICINE.——Though the cure of this disease depends chiefly upon regimen
and the patient’s own endeavours, yet we shall mention a few things
which may be of service in relieving some of the more violent symptoms.

In the first stage of a consumption, the cough may sometimes be appeased
by bleeding; and the expectoration may be promoted by the following
medicines. Take fresh squills, gum-ammoniac, and powdered cardamum
seeds, of each a quarter of an ounce; beat them together in a mortar,
and if the mass proves too hard for pills, a little of any kind of syrup
may be added to it. This may be formed into pills of a moderate size,
and four or five of them taken twice or thrice a-day, according as the
patient’s stomach will bear them.

The _lac ammoniacum_, or milk of gum-ammoniac, as it is called, is
likewise a proper medicine in this stage of the disease. It may be used
as directed in the pleurisy.

A mixture made of equal parts of lemon-juice, fine honey, and syrup of
poppies, may likewise be used. Four ounces of each of these may be
simmered together in a sauce-pan, over a gentle fire, and a
table-spoonful of it taken at any time when the cough is troublesome.

It is common in this stage of the disease to load the patient’s stomach
with oily and balsamic medicines. These, instead of removing the cause
of the disease, tend rather to increase it, by heating the blood, while
they pall the appetite, relax the solids, and prove every way hurtful to
the patient. Whatever is used for removing the cough, besides riding and
other proper regimen, ought to be medicines of a sharp and cleaning
nature; as oxymel, syrup of lemon, &c.

Acids seem to have peculiarly good effects in this disease; they both
tend to quench the patient’s thirst and to cool the blood. The vegetable
acids, as apples, oranges, lemons, &c. appear to be the most proper. I
have known patients suck the juice of several lemons every day with
manifest advantage, and would for this reason recommend acid vegetables
to be taken in as great quantity as the stomach will bear them.

For the patient’s drink, we would recommend infusions of the bitter
plants, as ground-ivy, the lesser centaury, camomile flowers, or
water-trefoil. These infusions may be drank at pleasure. They strengthen
the stomach, promote digestion, rectify the blood, and at the same time
answer all the purposes of dilution, and quench thirst much better than
things that are luscious or sweet. But if the patient spits blood, he
ought to use, for his ordinary drink, infusions or decoctions of the
vulnerary roots, plants, &c.[76]

There are many other mucilaginous plants and seeds, of a healing and
agglutinating nature, from which decoctions or infusions may be prepared
with the same intention; as the orches, the quince-seed, coltsfoot,
linseed, sasaparilla, &c. It is not necessary to mention the different
ways in which these may be prepared. Simple infusion or boiling is all
that is necessary, and the dose may be at discretion.

The conserve of roses is here peculiarly proper. It may either be put
into the decoction above prescribed, or eaten by itself. No benefit is
to be expected from trifling doses of this medicine. I never knew it of
any service, unless where three or four ounces at least were used daily
for a considerable time. In this way I have seen it produce very happy
effects, and would recommend it wherever there is a discharge of blood
from the lungs.

When the spitting up of gross matter, oppression of the breast, and the
hectic symptoms, shew that an imposthume is formed in the lungs, we
would recommend the Peruvian bark, that being the only drug which has
any chance to counteract the general tendency which the humours then
have to putrefaction.

An ounce of the bark in powder may be divided into eighteen or twenty
doses, of which one may be taken every three hours through the day, in a
little syrup, or a cup of horehound tea.

If the bark should happen to purge, it may be made into an electuary,
with the conserve of roses, thus: Take old conserve of roses a quarter
of a pound, Peruvian bark in powder an ounce, syrup of orange or lemon,
as much as will make it of the consistence of honey. This quantity will
serve the patient four or five days, and may be repeated as there is
occasion.

Such as cannot take the bark in substance, may infuse it in cold water.
This seems to be the best menstruum for extracting the virtues of that
drug. Half an ounce of bark in powder may be infused for twenty-four
hours in half an English pint of water. Afterwards let it be passed
through a fine strainer, and an ordinary tea-cupful of it taken three or
four times a-day.

We would not recommend the bark while there are any symptoms of an
inflammation of the breast; but when it is certainly known that matter
is collected there, it is one of the best medicines which can be used.
Few patients indeed have resolution enough to give the bark a fair trial
at this period of the disease, otherwise we have reason to believe that
some benefit might be reaped from it.

When it is evident that there is an imposthume in the breast, and the
matter can neither be spit up nor carried off by absorption, the patient
must endeavour to make it break inwardly, by drawing in the steams of
warm water or vinegar with his breath, coughing, laughing, or bawling
aloud, &c. When it happens to burst within the lungs, the matter may be
discharged by the mouth. Sometimes indeed the bursting of the vomica
occasions immediate death, by suffocating the patient. When the quantity
of matter is great, and the patient’s strength exhausted, this is
commonly the case. At any rate the patient is ready to fall into a
swoon, and should have volatile salts or spirits held to his nose.

If the matter discharged be thick, and the cough and breathing become
easier, there may be some hopes of a cure. The diet at this time ought
to be light, but restorative, as chicken-broths, sago-gruel, rice-milk,
&c. the drink, butter-milk, or whey, sweetened with honey. This is
likewise a proper time for using the Peruvian bark, which may be taken
as directed above.

If the vomica or imposthume should discharge itself into the cavity of
the breast, betwixt the pleura and the lungs, there is no way of getting
the matter out but by an incision, as has already been observed. As this
operation must always be performed by a surgeon, it is not necessary
here to describe it. We shall only add, that it is not so dreadful as
people are apt to imagine, and that it is the only chance the patient in
this case has for his life.


A nervous consumption is a wasting or decay of the whole body, without
any considerable degree of fever, cough, or difficulty of breathing. It
is attended with indigestion, weakness, and want of appetite, &c.

Those who are of a fretful temper, who indulge in spirituous liquors, or
who breathe an unwholesome air, are most liable to this disease.

We would chiefly recommend, for the cure of a nervous consumption, a
light and nourishing diet, plenty of exercise in a free open air, and
the use of such bitters as brace and strengthen the stomach; as the
Peruvian bark, gentian root, camomile, horehound, &c. These may be
infused in water or wine, and a glass of it drank frequently.

It will greatly assist the digestion, and promote the cure of this
disease, to take twice-a-day twenty or thirty drops of the elixir of
vitriol in a glass of wine or water. The chalybeate wine is likewise an
excellent medicine in this case. It strengthens the solids, and
powerfully assists Nature in the preparation of good blood[77].

Agreeable amusements, cheerful company, and riding about, are however
preferable to all medicines in this disease. For which reason, when the
patient can afford it, we would recommend a long journey of pleasure, as
the most likely means to restore his health.

What is called a _symptomatic consumption_ cannot be cured without first
removing the disease by which it is occasioned. Thus, when a consumption
proceeds from, the scrophula or king’s evil, from the scurvy, the
asthma, the venereal disease, &c. a due attention must be paid to the
malady from whence it arises, and the regimen and medicine directed
accordingly.

When _excessive evacuations_ of any kind occasion a consumption, they
must not only be restrained, but the patient’s strength must be restored
by gentle exercise, nourishing diet, and generous cordials. Young and
delicate mothers often fall into consumptions, by giving suck too long.
As soon as they perceive their strength and appetite begin to fail, they
ought immediately to wean the child, or provide another nurse, otherwise
they cannot expect a cure.

Before we quit this subject, we would earnestly recommend it to all, as
they wish to avoid consumptions, to take as much exercise without doors
as they can, to avoid unwholesome air, and to study sobriety.
Consumptions owe their present increase not a little to the fashion of
sitting up late, eating hot suppers, and spending every evening over a
bowl of hot punch or other strong liquors. These liquors, when too
freely used, not only hurt the digestion, and spoil the appetite, but
heat and inflame the blood, and set the whole constitution on fire.




                               CHAP. XIX.
                     OF THE SLOW OR NERVOUS FEVER.


Nervous fevers have increased greatly of late years in this island,
owing doubtless to our different manner of living, and the increase of
sedentary employments; as they commonly attack persons of a weak relaxed
habit, who neglect exercise, eat little solid food, study hard, or
indulge in spirituous liquors.

CAUSES.——Nervous fevers may be occasioned by whatever depresses the
spirits, or impoverishes the blood; as grief, fear, anxiety, want of
sleep, intense thought, living on poor watery diet, unripe fruits,
cucumbers, melons, mushrooms, &c. They may likewise be occasioned by
damp, confined, or unwholesome air. Hence they are very common in rainy
seasons, and prove most fatal to those who live in dirty low houses,
crowded streets, hospitals, jails, or such-like places.

Persons whose constitutions have been broken by excessive venery,
frequent salivations, too free an use of purgative medicines, or any
other excessive evacuations, are most liable to this disease.

Keeping on wet clothes, lying on the damp ground, excessive fatigue, and
whatever obstructs the perspiration, or causes a spasmodic stricture of
the solids, may likewise occasion nervous fevers. We shall only add,
frequent and great irregularities in diet. Too great abstinence, as well
as excess, is hurtful. Nothing tends so much to preserve the body in a
sound state as a regular diet; nor can any thing contribute more to
occasion fevers of the worst kind than its opposite.

SYMPTOMS.——Low spirits, want of appetite, weakness, weariness after
motion, watchfulness, deep sighing, and dejection of mind, are generally
the forerunners of this disease. These are succeeded by a quick low
pulse, a dry tongue without any considerable thirst, chillness and
flushing in turns, &c.

After some time the patient complains of a giddiness and pain of the
head, has a nausea, with reachings and vomiting; the pulse is quick, and
sometimes intermitting; the urine pale, resembling dead small-beer, and
the breathing is difficult, with oppression of the breast, and slight
alienations of mind.

If towards the ninth, tenth, or twelfth day, the tongue becomes more
moist, with a plentiful spitting, a gentle purging, or a moisture upon
the skin; or if a suppuration happens in one or both ears, or large
pustules break out about the lips and nose, there is reason to hope for
a favourable crisis.

But if there is an excessive looseness, or wasting sweats, with frequent
fainting fits; if the tongue, when put out, trembles excessively, and
the extremities feel cold, with a fluttering or slow creeping pulse; if
there is a starting of the tendons, an almost total loss of sight and
hearing, and an involuntary discharge by stool and urine, there is great
reason to fear that death is approaching.

REGIMEN.——It is very necessary in this disease to keep the patient cool
and quiet. The least motion would fatigue him, and will be apt to
occasion weariness, and even faintings. His mind ought not only to be
kept easy, but soothed and comforted with the hopes of a speedy
recovery. Nothing is more hurtful in low fevers of this kind than
presenting to the patient’s imagination gloomy or frightful ideas. These
of themselves often occasion nervous fevers, and it is not to be doubted
but they will likewise aggravate them.

The patient must not be kept too low. His strength and spirits ought to
be supported by nourishing diet and generous cordials. For this purpose
his gruel, panado, or whatever food he takes, must be mixed with wine
according as the symptoms may require. Pretty strong wine-whey, or small
negus, sharpened with the juice of orange or lemon, will be proper for
his ordinary drink. Mustard-whey is likewise a very proper drink in this
fever, and may be rendered an excellent cordial medicine by the addition
of a proper quantity of white-wine[78].

Wine in this disease, if it could be obtained genuine, is almost the
only medicine that would be necessary. Good wine possesses all the
virtues of the cordial medicines, while it is free from many of their
bad qualities. I say good wine; for however common this article of
luxury is now become, it is rarely to be obtained genuine, especially by
the poor, who are obliged to purchase it in small quantities.

I have often seen patients in low nervous fevers where the pulse could
hardly be felt, with a constant delirium, coldness of the extremities,
and almost every other mortal symptom, recover by using in whey, gruel,
and negus, a bottle or two of strong wine every day. Good old sound
claret is the best, and may be made into negus, or given by itself, as
circumstances require.

In a word, the great aim in this disease is to support the patient’s
strength, by giving him frequently small quantities of the above, or
other drinks of a warm and cordial nature. He is not however to be
overheated either with liquor or clothes; and his food ought to be
light, and given in small quantities.

MEDICINE.——Where a nausea, load, and sickness at stomach, prevail at the
beginning of the fever, it will be necessary to give the patient a
gentle vomit. Fifteen or twenty grains of ipecacuanha in fine powder, or
a few spoonfuls of the vomiting julep[79], will generally answer this
purpose very well. This may be repeated any time before the third or
fourth day, if the above symptoms continue. Vomits not only clean the
stomach, but, by the general shock which they give, promote the
perspiration, and have many other excellent effects in slow fevers,
where there are no signs of inflammation, and nature wants rousing.

Such as dare not venture upon a vomit, may clean the bowels by a small
dose of Turkey rhubarb, or an infusion of senna and manna.

In all fevers, the great point is to regulate the symptoms, so as to
prevent them from going to either extreme. Thus, in fevers of the
inflammatory kind, where the force of the circulation is too great, or
the blood dense, and the fibres too rigid, bleeding and other
evacuations are necessary. But in nervous fevers, where nature flags,
where the blood is vapid and poor, and the solids relaxed, the lancet
must be spared, and wine, with other cordials, plentifully administered.

It is the more necessary to caution people against bleeding in this
disease, as there is generally at the beginning an universal stricture
upon the vessels, and sometimes an oppression and difficulty of
breathing, which suggest the idea of a plethora, or too great a quantity
of blood. I have known even some of the faculty deceived by their own
feelings in this respect, so far as to insist upon being bled, when it
was evident from the consequences that the operation was improper.

Though bleeding is generally improper in this disease, yet blistering is
highly necessary. Blistering-plasters may be applied at all times of the
fever with great advantage. If the patient is delirious, he ought to be
blistered on the neck or head, and it will be the safest course, when
the insensibility continues, as soon as the discharge occasioned by one
blistering-plaster abates, to apply another to some other part of the
body, and by that means keep up a continual succession of them till he
be out of danger.

I have been more sensible of the advantage of blistering in this than in
any other disease. Blistering-plasters not only stimulate the solids to
action, but likewise occasion a continual discharge, which may in some
measure supply the want of critical evacuations, which seldom happen in
this kind of fever. They are most proper, however, either towards the
beginning, or after some degree of stupor has come on, in which last
case it will always be proper to blister the head.

If the patient is costive through the course of the disease, it will be
necessary to procure a stool, by giving him every other day a clyster of
milk and water, with a little sugar, to which may be added a spoonful of
common salt, if the above does not operate.

Should a violent looseness come on, it may be checked by small
quantities of Venice treacle, or giving the patient for his ordinary
drink the white decoction[80].

A miliary eruption sometimes breaks out about the ninth or tenth day. As
eruptions are often critical, great care should be taken not to retard
Nature’s operation in this particular. The eruption ought neither to be
checked by bleeding nor other evacuations, nor pushed out by a hot
regimen; but the patient should be supported by gentle cordials, as
wine-whey, small negus, sago-gruel with a little wine in it, and such
like. He ought not to be kept too warm; yet a kindly breathing sweat
should by no means be checked.

Though blistering and the use of cordial liquors are the chief things to
be depended on in this kind of fever; yet, for those who may chuse to
use them, we shall mention one or two of the forms of medicine which are
commonly prescribed in it[81].

In desperate cases, where the hiccup and starting of the tendons have
already come on, we have sometimes seen extraordinary effects from large
doses of musk frequently repeated. Musk is doubtless an antispasmodic,
and may be given to the quantity of a scruple three or four times a-day,
or oftener if necessary. Sometimes it may be proper to add to the musk a
few grains of camphire, and salt of hartshorn, as these tend to promote
perspiration and the discharge of urine. Thus fifteen grains of musk,
with three grains of camphire, and six grains of salt of hartshorn, may
be made into a bolus with a little syrup, and given as above.

If the fever should happen to intermit, which it frequently does towards
the decline, or if the patient’s strength should be wasted with
colliquative sweats, &c. it will be necessary to give him the Peruvian
bark. Half a drachm, or a whole drachm, if the stomach will bear it, of
the bark in fine powder, may be given four or five times a-day in a
glass of red port or claret. Should the bark in substance not sit easy
on the stomach, an ounce of it in powder may be infused in a bottle of
Lisbon or Rhenish wine for two or three days, afterwards it may be
strained, and a glass of it taken frequently[82].

Some give the bark in this and other fevers, where there are no symptoms
of inflammation, without any regard to the remission or intermission of
the fever. How far future observations may tend to establish this
practice, we will not pretend to say; but we have reason to believe that
the bark is a very universal febrifuge, and that it may be administered
with advantage in most fevers where bleeding is not necessary, or where
there are no symptoms of topical inflammation.




                               CHAP. XX.
              OF THE MALIGNANT, PUTRID, OR SPOTTED FEVER.


This may be called the _pestilential fever_ of Europe, as in many of its
symptoms it bears a great resemblance to that dreadful disease the
plague. Persons of a lax habit, a melancholy disposition, and those
whose vigour has been wasted by long fasting, watching, hard labour,
excessive venery, frequent salivations, &c. are most liable to it.

CAUSES.——This fever is occasioned by foul air, from a number of people
being confined in a narrow place, not properly ventilated; from putrid
animal and vegetable effluvia, &c. Hence it prevails in camps, jails,
hospitals and infirmaries, especially where such places are too much
crowded, and cleanliness is neglected.

A close constitution of the air, with long rainy or foggy weather,
likewise occasions putrid fevers. They often succeed great inundations
in low and marshy countries, especially when these are preceded or
followed by a hot and sultry season.

Living too much upon animal food, without a proper mixture of
vegetables, or eating fish or flesh that has been kept too long, are
likewise apt to occasion this kind of fever. Hence sailors on long
voyages, and the inhabitants of besieged cities, are very often visited
with putrid fevers.

Corn that has been greatly damaged by rainy seasons, or long keeping,
and water which has become putrid by stagnation, &c. may likewise
occasion this fever.

Dead carcases tainting the air, especially in hot seasons, are very apt
to occasion putrid diseases. Hence this kind of fever often prevails in
countries which are the scenes of war and bloodshed. This shews the
propriety of removing burying grounds, slaughterhouses, &c. at a proper
distance from great towns.

Want of cleanliness is a very general cause of putrid fevers. Hence they
prevail amongst the poor inhabitants of large towns, who breathe a
confined unwholesome air, and neglect cleanliness. Such mechanics as
carry on dirty employments, and are constantly confined within doors,
are likewise very liable to this disease.

We shall only add, that putrid, malignant, or spotted fevers, are highly
infectious, and are therefore often communicated by contagion. For which
reason all persons ought to keep at a distance from those affected with
such diseases, unless their attendance is absolutely necessary.

SYMPTOMS.——The malignant fever is generally preceded by a remarkable
weakness or loss of strength, without any apparent cause. This is
sometimes so great, that the patient can scarce walk, or even sit
upright, without being in danger of fainting away. His mind too is
greatly dejected; he sighs, and is full of dreadful apprehensions.

There is a nausea, and sometimes a vomiting of bile; a violent pain of
the head, with a strong pulsation or throbbing of the temporal arteries;
the eyes often appear red and inflamed, with a pain at the bottom of the
orbit; there is a noise in the ears, the breathing is laborious, and
often interrupted with a sigh; the patient complains of a pain about the
region of the stomach, and in his back and loins; his tongue is at first
white, but afterwards it appears black and chaped; and his teeth are
covered with a black crust. He sometimes passes worms both upwards and
downwards, is affected with tremors or shaking, and often becomes
delirious.

If blood is let, it appears dissolved, or with a very small degree of
cohesion, and soon becomes putrid; the stools smell extremely fœtid, and
are sometimes of a greenish, black, or reddish cast. Spots of a pale
purple, dun, or black colour, often appear upon the skin, and sometimes
there are violent hæmorrhages, or discharges of blood from the mouth,
eyes, nose, &c.

Putrid fevers may be distinguished from the inflammatory, by the
smallness of the pulse, the great dejection of mind, the dissolved state
of the blood, the petechiæ, or purple spots, and the putrid smell of the
excrements. They may likewise be distinguished from the low or nervous
fever by the heat and thirst being greater, the urine of a higher
colour, and the loss of strength, dejection of mind, and all the other
symptoms more violent.

It sometimes happens, however, that the inflammatory, nervous, and
putrid symptoms are so blended together, as to render it very difficult
to determine to which class the fever belongs. In this case the greatest
caution and skill are requisite. Attention must be paid to those
symptoms which are most prevalent, and both the regimen and medicines
adapted to them.

Inflammatory and nervous fevers may be converted into malignant and
putrid, by too hot a regimen or improper medicines.

The duration of putrid fevers is extremely uncertain; sometimes they
terminate between the seventh and fourteenth day, and at other times
they are prolonged for five or six weeks. Their duration depends greatly
upon the constitution of the patient, and the manner of treating the
disease.

The most favourable symptoms are, a gentle looseness after the fourth or
fifth day, with a warm mild sweat. These, when continued for a
considerable time, often carry off the fever, and should never be
imprudently stopped. Small miliary pustules appearing between the
petechiæ or purple spots are likewise favourable, as also hot scabby
eruptions about the mouth and nose. It is a good sign when the pulse
rises upon the use of wine, or other cordials, and the nervous symptoms
abate; deafness coming on towards the decline of the fever, is likewise
often a favourable symptom[83], as are abscesses in the groin or parotid
glands.

Among the unfavourable symptoms may be reckoned an excessive looseness,
with a hard swelled belly; large black or livid blotches breaking out
upon the skin; apthæ in the mouth; cold clammy sweats; blindness; change
of the voice; a wild flaring of the eyes; difficulty of swallowing;
inability to put out the tongue; and a constant inclination to uncover
the breast. When the sweat and saliva are tinged with blood, and the
urine is black, or deposits a black sooty sediment, the patient is in
great danger. Starting of the tendons, and fœtid, ichorous, involuntary
stools, attended with coldness of the extremities, are generally the
forerunners of death.

REGIMEN.——In the treatment of this disease we ought to endeavour as far
as possible to counteract the putrid tendency of the humours; to support
the patient’s strength and spirits; and to assist Nature in expelling
the cause of this disease, by gently promoting perspiration and the
other evacuations.

It has been observed, that putrid fevers are often occasioned by
unwholesome air, and of course they must be aggravated by it. Care
should therefore be taken to prevent the air from stagnating in the
patient’s chamber, to keep it cool, and renew it frequently, by opening
the doors or windows of some adjacent apartment. The breath and
perspiration of persons in perfect health soon render the air of a small
apartment noxious; but this will sooner happen from the perspiration and
breath of a person whose whole mass of humours are in a putrid state.

Besides the frequent admission of fresh air, we would recommend the use
of vinegar, verjuice, juice of lemon, Seville orange, or any kind of
vegetable acid that can be most readily obtained. These ought frequently
to be sprinkled upon the floor, the bed, and every part of the room.
They may also be evaporated with a hot iron, or by boiling, &c. The
fresh skins of lemons or oranges ought likewise to be laid in different
parts of the room, and they should be frequently held to the patient’s
nose. The use of acids in this manner would not only prove very
refreshing to the patient, but would likewise tend to prevent the
infection from spreading among those who attend him. Strong scented
herbs, as rue, tansy, rosemary, wormwood, &c. may likewise be laid in
different parts of the house, and smelled to by those who go near the
patient.

The patient must not only be kept cool, but likewise quiet and easy. The
least noise will affect his head, and the smallest fatigue will be apt
to make him faint.

Few things are of greater importance in this disease than acids, which
ought to be mixed with all the patient’s food as well as drink. Orange,
lemon, or vinegar whey, are all very proper, and may be drank by turns,
according to the patient’s inclination. They may be rendered cordial by
the addition of wine in such quantity as the patient’s strength seems to
require. When he is very low, he may drink negus, with only one half
water, and sharpened with the juice of orange or lemon. In some cases a
glass of wine may now and then be allowed. The most proper wine is
Rhenish; but if the body be open, red port or claret is to be preferred.

When the body is bound, a tea-spoonful of the cream of tartar may be put
into a cup of the patient’s drink, as there is occasion; or he may drink
a decoction of tamarinds, which will both quench his thirst, and promote
a discharge by stool.

If camomile-tea will sit upon his stomach, it is a very proper drink in
this disease. It may be sharpened by adding to every cup of the tea ten
or fifteen drops of the elixir of vitriol.

The food must be light, as panado or groat-gruel, to which a little wine
may be added, if the patient be weak and low; and they ought all to be
sharpened with the juice of orange, the jelly of currants, or the like.
The patient ought likewise to eat freely of ripe fruits, as roasted
apples, currant or gooseberry tarts, preserved cherries, or plums, &c.

Taking a little food or drink frequently, not only supports the spirits,
but counteracts the putrid tendency of the humours; for which reason the
patient ought frequently to be sipping small quantities of some of the
acid liquors mentioned above, or any that may be more agreeable to his
palate, or more readily obtained.

If he is delirious, his feet and hands ought to be frequently fomented
with a strong infusion of camomile flowers. This, or an infusion of the
bark, to such as can afford it, cannot fail to have a good effect.
Fomentations of this kind not only relieve the head, by relaxing the
vessels in the extremities, but as their contents are absorbed, and
taken into the system, they may assist in preventing the putrescency of
the humours.

MEDICINE.——If a vomit be given at the beginning of this fever, it will
hardly fail to have a good effect; but if the fever has gone on for some
days, and the symptoms are violent, vomits are not quite so safe. The
body however is always to be kept gently open by clysters, or mild
laxative medicines.

Bleeding is seldom necessary in putrid fevers. If there be signs of an
inflammation, it may sometimes be permitted at the first onset; but the
repetition of it generally proves hurtful.

Blistering plasters are never to be used unless in the greatest
extremities. If the petechiæ or spots should suddenly disappear, the
patient’s pulse sink remarkably, and a delirium, with other bad
symptoms, come on, blistering may be permitted. In this case the
blistering plasters are to be applied to the head, and inside of the
legs or thighs. But as they are sometimes apt to occasion a gangrene, we
would rather recommend warm cataplasms or poultices of mustard and
vinegar to be applied to the feet, having recourse to blisters only in
the utmost extremities.

It is common in the beginning of this fever to give the emetic tartar in
small doses, repeated every second or third hour, till it shall either
vomit, purge, or throw the patient into a sweat. This practice is very
proper, provided it be not pushed so far as to weaken the patient.

A very ridiculous notion has long prevailed, of expelling the poisonous
matter of malignant diseases by trifling doses of cordial or
alexipharmic medicines. In consequence of this notion, the
contrayerva-root, the cordial confection, the mithridate, &c. have been
extolled as infallible remedies. There is reason however to believe,
that these seldom do much good. Where cordials are necessary, we know
none that is superior to good wine; and therefore again recommend it
both as the safest and best. Wine, with acids and antiseptics, are the
only things to be relied on in the cure of malignant fevers.

In the most dangerous species of this disease, when it is attended with
purple, livid, or black spots, the Peruvian bark must be administered. I
have seen it, when joined with acids, prove successful, even in cases
where the petechiæ had the most threatening aspect. But, to answer this
purpose, it must not only be given in large doses, but duly persisted
in.

The best method of administering the bark is certainly in substance. An
ounce of it in powder may be mixed with half an English pint of water,
and the same quantity of red wine, and sharpened with the elixir or the
spirit of vitriol, which will both make it sit easier on the stomach,
and render it more beneficial. Two or three ounces of the syrup of lemon
may be added, and two table-spoonfuls of the mixture taken every two
hours, or oftener, if the stomach is able to bear it.

Those who cannot take the bark in substance may infuse it in wine, as
recommended in the preceding disease.

If there be a violent looseness, the bark must be boiled in red wine
with a little cinnamon, and sharpened with the elixir of vitriol, as
above. Nothing can be more beneficial in this kind of looseness than
plenty of acids, and such things as promote a gentle perspiration.

If the patient be troubled with vomiting, a dram of the salt of
wormwood, dissolved in an ounce and half of fresh lemon-juice, and made
into a draught with an ounce of simple cinnamon water, and a bit of
sugar, may be given and repeated as often as it is necessary.

If swellings of the glands appear, their suppuration is to be promoted
by the application of poultices, ripening cataplasms, &c. And as soon as
there is any appearance of matter in them, they ought to be laid open,
and the poultices continued.

I have known large ulcerous sores break out in various parts of the
body, in the decline of this fever, of a livid gangrenous appearance,
and a most putrid cadaverous smell. These gradually healed, and the
patient recovered, by the plentiful use of Peruvian bark and wine,
sharpened with the spirits of vitriol.

For preventing putrid fevers we would recommend a strict regard to
cleanliness; a dry situation; sufficient exercise in the open air;
wholesome food, and a moderate use of generous liquors. Infection ought
above all things to be avoided. No constitution is proof against it. I
have known persons seized with a putrid fever, by only making a single
visit to a patient in it; others have caught it by lodging for one night
in a town where it prevailed; and some by attending the funerals of such
as died of it[84].

When a putrid fever seizes any person in a family, the greatest
attention is necessary to prevent the disease from spreading. The sick
ought to be placed in a large apartment, as remote from the rest of the
family as possible; he ought likewise to be kept extremely clean, and
should have fresh air frequently let into his chamber; whatever comes
from him should be immediately removed, his linen should be frequently
changed, and those in health ought to avoid all unnecessary
communication with him.

Any one who is apprehensive of having caught the infection, ought
immediately to take a vomit, and to work it off by drinking plentifully
of camomile-tea. This may be repeated in a day or two, if the
apprehensions still continue, or any unfavourable symptoms appear.

The person ought likewise to take an infusion of the bark and camomile
flowers for his ordinary drink; and before he goes to bed, he may drink
an English pint of pretty strong negus, or a few glasses of generous
wine. I have been frequently obliged to follow this course, when
malignant fevers prevailed, and have likewise recommended it to others
with constant success.

People generally fly to bleeding and purging as antidotes against
infection; but these are so far from securing them, that they often, by
debilitating the body, increase the danger.

Those who wait upon the sick in putrid fevers, ought always to have a
piece of spunge or a handkerchief dipt in vinegar, or juice of lemon, to
smell to while near the patient. They ought likewise to wash their
hands, and, if possible, to change their clothes, before they go into
company.




                               CHAP. XXI.
                         OF THE MILIARY FEVER.


This fever takes its name from the small pustules or bladders which
appear on the skin, resembling, in shape and size, the seeds of millet.
The pustules are either red or white, and sometimes both are mixed
together.

The whole body is sometimes covered with pustules; but they are
generally more numerous where the sweat is most abundant, as on the
breast, the back, &c. A gentle sweat, or moisture on the skin, greatly
promotes the eruption; but, when the skin is dry, the eruption is both
more painful and dangerous.

Sometimes this is a primary disease; but it is much oftener only a
symptom of some other malady, as the small-pox, measles, ardent, putrid,
or nervous fever, &c. In all these cases it is generally the effect of
too hot a regimen or medicines.

The miliary fever chiefly attacks the idle and the phlegmatic, or
persons of a relaxed habit. The young and the aged are more liable to it
than those in the vigour and prime of life. It is likewise more incident
to women than men, especially the delicate and the indolent, who,
neglecting exercise, keep continually within doors, and live upon weak
watery diet. Such females are extremely liable to be seized with this
disease in child-bed, and often lose their lives by it.

CAUSES.——The miliary fever is sometimes occasioned by violent passions
or affections of the mind; as excessive grief, anxiety, thoughtfulness,
&c. It may likewise be occasioned by excessive watching, great
evacuations, a weak watery diet, rainy seasons, eating too freely of
cold, crude, unripe fruits, as plums, cherries, cucumbers, melons; &c.
Impure waters, or provisions which have been spoiled by rainy seasons,
long keeping, &c. may likewise cause miliary fevers. They may also be
occasioned by the stoppage of any customary evacuation, as issues,
setons, ulcers, the bleeding piles in men, or the menstrual flux in
women, &c.

This disease in child-bed-women is sometimes the effect of great
costiveness during pregnancy; it may likewise be occasioned by their
excessive use of green trash, and other unwholesome things, in which
pregnant women are too apt to indulge. But its most general cause is
indolence. Such women as lead a sedentary life, especially during
pregnancy, and at the same time live grossly, can hardly escape this
disease in child-bed. Hence it proves extremely fatal to women of
fashion, and likewise to those women in manufacturing towns, who, in
order to assist their husbands, sit close within doors for almost the
whole of their time. But among women who are active and laborious, who
live in the country, and take sufficient exercise without doors, this
disease is very little known.

SYMPTOMS.——When this is a primary disease, it makes its attack, like
most other eruptive fevers, with a slight shivering, which is succeeded
by heat, loss of strength, faintishness, sighing, a low quick pulse,
difficulty of breathing, with great anxiety and oppression of the
breast. The patient is restless, and sometimes delirious; the tongue
appears white, and the hands shake, with often a burning heat in the
palms; and in child-bed-women the milk generally goes away, and the
other discharges stop.

The patient feels an itching or pricking pain under the skin, after
which innumerable small pustules of a red or white colour begin to
appear. Upon this the symptoms generally abate, the pulse becomes more
full and soft, the skin grows moister, and the sweat, as the disease
advances, begins to have a peculiar fœtid smell; the great load on the
breast, and oppression of the spirits, generally go off, and the
customary evacuations gradually return. About the sixth or seventh day
from the eruption, the pustules begin to dry and fall off, which
occasions a very disagreeable itching in the skin.

It is impossible to ascertain the exact time when the pustules will
either appear or go off. They generally come out on the third or fourth
day, when the eruption is critical; but, when symptomatic, they may
appear at any time of the disease.

Sometimes the pustules appear and vanish by turns. When that is the
case, there is always danger; but when they go in all of a sudden, and
do not appear again, the danger is very great.

In child-bed-women the pustules are commonly at first filled with clear
water, afterwards they grow yellowish. Sometimes they are interspersed
with pustules of a red colour. When these only appear the disease goes
by the name of a _rash_.

REGIMEN.——In all eruptive fevers, of whatever kind, the chief point is
to prevent the sudden disappearing of the pustules, and to promote their
maturation. For this purpose the patient must be kept in such a
temperature, as neither to push out the eruption too fast, nor to cause
it to retreat prematurely. The diet and drink ought therefore to be in a
moderate degree nourishing and cordial; but neither strong nor heating.
The patient’s chamber ought neither to be kept too hot nor cold; and he
should not be too much covered with clothes. Above all, the mind is to
be kept easy and cheerful. Nothing so certainly makes an eruption go in
as fear, or the apprehension of danger.

The food must be weak chicken-broth with bread, panado, sago, or groat
gruel, &c. to a gill of which may be added a spoonful or two of wine, as
the patient’s strength requires, with a few grains of salt and a little
sugar. Good apples roasted or boiled, with other ripe fruits of an
opening cooling nature, may be eaten.

The drink may be suited to the state of the patient’s strength and
spirits. If these be pretty high, the drink ought to be weak; as
water-gruel, balm-tea, or the decoction mentioned below[85].

When the patient’s spirits are low, and the eruption does not rise
sufficiently, his drink must be a little more generous; as wine-whey, or
small negus, sharpened with the juice of orange or lemon, and made
stronger or weaker as circumstances may require.

Sometimes the miliary fever approaches towards a putrid nature, in which
case the patient’s strength must be supported with generous cordials,
joined with acids; and, if the degree of putrescence be great, the
Peruvian bark must be administered. If the head be much affected, the
body must be kept open by emollient clysters[86].

MEDICINE.——If the food and drink be properly regulated, there will be
little occasion for medicine in this disease. Should the eruption
however not rise, or the spirits flag, it will not only be necessary to
support the patient with cordials, but likewise to apply blistering
plasters. The most proper cordial, in this case, is good wine, which may
either be taken in the patient’s food or drink; and if there be signs of
putrescence, the bark and acids may be mixed with wine, as directed in
the putrid fever.

Some recommend blistering through the whole course of this disease; and
where Nature flags, and the eruption comes and goes, it may be necessary
to keep up a stimulus, by a continual succession of small blistering
plasters; but we would not recommend above one at a time. If however the
pulse should sink remarkably, the pustules fall in, and the head be
affected, it will be necessary to apply several blistering plasters to
the most sensible parts, as the inside of the legs and thighs, &c.

Bleeding is seldom necessary in this disease, and sometimes it does much
hurt, as it weakens the patient, and depresses his spirits. It is
therefore never to be attempted unless by the advice of a physician. We
mention this, because it has been customary to treat this disease in
child-bed-women by plentiful bleeding, and other evacuations, as if it
were highly inflammatory. But this practice is generally very unsafe.
Patients in this situation bear evacuations very ill. And indeed the
disease seems often to be more of a putrid than of an inflammatory
nature.

Though this fever is often occasioned in child-bed-women by too hot a
regimen, yet it would be dangerous to leave that off all of a sudden,
and have recourse to a very cool regimen, and large evacuations. We have
reason to believe, that supporting the patient’s spirits, and promoting
the natural evacuations, is here much safer than to have recourse to
artificial ones, as these, by sinking the spirits, seldom fail to
increase the danger.

If the disease proves tedious, or the recovery slow, we would recommend
the Peruvian bark, which may either be taken in substance, or infused in
wine or water, as the patient inclines.

The miliary fever, like other eruptive diseases, requires gentle
purging, which should not be neglected, as soon as the fever is gone
off, and the patient’s strength will permit.

To prevent this disease, a pure dry air, sufficient exercise, and
wholesome food, are necessary. Pregnant women should guard against
costiveness, and take daily as much exercise as they can bear, avoiding
all green trashy fruits, and other unwholesome things; and when in
child-bed, they ought strictly to observe a cool regimen.




                              CHAP. XXII.
                        OF THE REMITTING FEVER.


This fever takes its name from a remission of the symptoms, which
happens sometimes sooner, and sometimes later, but generally before the
eighth day. The remission is commonly preceded by a gentle sweat, after
which the patient seems greatly relieved, but in a few hours the fever
returns. These remissions return at very irregular periods, and are
sometimes of longer, sometimes of shorter duration; the nearer however
that the fever approaches to a regular intermittent, the danger is the
less.

CAUSES.——Remitting fevers prevail in low marshy countries abounding with
wood and stagnating water; but they prove most fatal in places where
great heat and moisture are combined, as in some parts of Africa, the
province of Bengal in the East Indies, &c. where remitting fevers are
generally of a putrid kind, and prove very fatal. They are most frequent
in close calm weather, especially after rainy seasons, great
inundations, or the like. No age, sex, or constitution, is exempted from
the attack of this fever; but it chiefly seizes persons of a relaxed
habit, who live in low dirty habitations, breathe an impure stagnating
air, take little exercise, and use unwholesome diet.

SYMPTOMS.——The first symptoms of this fever are generally yawning,
stretching, pain, and giddiness in the head, with alternate fits of heat
and cold. Sometimes the patient is affected with a delirium at the very
first attack. There is a pain, and sometimes a swelling, about the
region of the stomach; the tongue is white, the eyes and skin frequently
appear yellow, and the patient is often afflicted with bilious
vomitings. The pulse is sometimes a little hard, but seldom full, and
the blood, when let, rarely shews any signs of inflammation. Some
patients are exceedingly costive, and others are afflicted with a very
troublesome looseness.

It is impossible to describe all the symptoms of this disease, as they
vary according to the situation, the season of the year, and the
constitution of the patient. They may likewise be greatly changed by the
method of treatment, and by many other circumstances too tedious to
mention. Sometimes the bilious symptoms predominate, sometimes the
nervous, and at other times the putrid. Nor is it at all uncommon to
find a succession of each of these, or even a complication of them at
the same time, in the same person.

REGIMEN.——The regimen must be adapted to the prevailing symptoms. When
there are any signs of inflammation, the diet must be slender, and the
drink weak and diluting. But when nervous or putrid symptoms occur, it
will be necessary to support the patient with food and liquors of a more
generous nature, such as are recommended in the immediately preceding
fevers. We must however be very cautious in the use of things of a
heating quality, as this fever is frequently changed into a _continual_
by an hot regimen, and improper medicines.

Whatever the symptoms are, the patient ought to be kept cool, quiet, and
clean. His apartment, if possible, should be large, and frequently
ventilated by letting in fresh air at the doors or windows. It ought
likewise to be sprinkled with vinegar, juice of lemon, or the like. His
linen, bed-clothes, &c. should be frequently changed, and all his
excrements immediately removed. Though these things have been
recommended before, we think it necessary to repeat them here, as they
are of more importance to the sick than practitioners are apt to
imagine[87].

MEDICINE.——In order to cure this fever, we must endeavour to bring it to
a regular intermission. This intention may be promoted by bleeding, if
there be any signs of inflammation; but when that is not the case,
bleeding ought by no means to be attempted, as it will weaken the
patient and prolong the disease. A vomit however will seldom be
improper, and is generally of great service. Twenty or thirty grains of
ipecacuanha will answer this purpose very well; but, where it can be
obtained, we would rather recommend a grain or two of tartar emetic,
with five or six grains of ipecacuanha, to be made into a draught, and
given for a vomit. This may be repeated once or twice at proper
intervals, if the sickness or nausea continues.

The body ought to be kept open either by clysters or gentle laxatives,
as weak infusions of senna and manna, small doses of the lenitive
electuary, cream of tartar, tamarinds, stewed prunes, or the like; but
all strong or drastic purgatives are to be carefully avoided.

By this course the fever in a few days may generally be brought to a
pretty regular or distinct intermission, in which case the Peruvian bark
may be administered, and it will seldom fail to perfect the cure. It is
needless here to repeat the methods of giving the bark, as we have
already had occasion frequently to mention them.

The most likely way to avoid this fever is to use a wholesome and
nourishing diet, to pay the most scrupulous attention to cleanliness, to
keep the body warm, to take sufficient exercise, and in hot countries to
avoid damp situations, night air, evening dews, and the like. In
countries where it is endemical, the best preventive medicine which we
can recommend, is the Peruvian bark, which may either be chewed, or
infused in brandy or wine, &c. Some recommend smoking tobacco as very
beneficial in marshy countries, both for the prevention of this and
intermitting fevers.




                              CHAP. XXIII.
                           OF THE SMALL-POX.


This disease, which originally came from Arabia, is now become so
general, that very few escape it at one time of life or another. It is a
most contagious malady; and has for many years proved the scourge of
Europe.

The small-pox generally appear towards the spring. They are very
frequent in summer, less so in autumn, and least of all in winter.
Children are most liable to this disease; and those whose food is
unwholesome, who want proper exercise, and abound with gross humours,
run the greatest hazard from it.

The disease is distinguished into the distinct and confluent kind; the
latter of which is always attended with danger. There are likewise other
distinctions of the small-pox; as the crystalline, the bloody, &c.

CAUSES.——The small-pox is commonly caught by infection. Since the
disease was first brought into Europe, the infection has never been
wholly extinguished, nor have any proper methods, as far as I know, been
taken for that purpose; so that now it has become in a manner
constitutional. Children who have overheated themselves by running,
wrestling, &c. or adults after a debauch, are most apt to be seized with
the small-pox.

SYMPTOMS.——This disease is so generally known, that a minute description
of it is unnecessary. Children commonly look a little dull, seem
lifeless and drowsy for a few days before the more violent symptoms of
the small-pox appear. They are likewise more inclined to drink than
usual, have little appetite for solid food, complain of weariness, and,
upon taking exercise, are apt to sweat. These are succeeded by slight
fits of cold and heat in turns, which, as the time of the eruption
approaches, become more violent, and are accompanied with pains of the
head and loins, vomiting, &c. The pulse is quick, with a great heat of
the skin, and restlessness. When the patient drops asleep, he wakes in a
kind of horror, with a sudden start, which is a very common symptom of
the approaching eruption; as are also convulsion-fits in very young
children.

About the third or fourth day from the time of sickening, the small-pox
generally begin to appear; sometimes indeed they appear sooner, but that
is no favourable symptom. At first they very nearly resemble flea-bites,
and are soonest discovered on the face, arms, and breast.

The most favourable symptoms are a slow eruption, and an abatement of
the fever as soon as the pustules appear. In a mild distinct kind of
small-pox the pustules seldom appear before the fourth day from the time
of sickening, and they generally keep coming out gradually for several
days after. Pustules which are distinct, with a florid red basis, and
which fill with thick purulent matter, first of a whitish, and
afterwards of a yellowish colour, are the best.

A livid brown colour of the pustules is an unfavourable symptom; as also
when they are small and flat, with black specks in the middle. Pustules
which contain a thin watery ichor are very bad. A great number of pox on
the face is always attended with danger. It is likewise a very bad sign
when they run into one another.

It is a most unfavourable symptom when petechiæ, or purple, brown, or
black spots are interspersed among the pustules. These are signs of a
putrid dissolution of the blood, and shew the danger to be very great.
Bloody stools or urine, with a swelled belly, are bad symptoms; as is
also a continual strangury. Pale urine and a violent throbbing of the
arteries of the neck are signs of an approaching delirium, or of
convulsion-fits. When the face does not swell, or falls before the pox
come to maturity, it is very unfavourable. If the face begins to fall
about the eleventh or twelfth day, and at the same time the hands and
feet begin to swell, the patient generally does well; but when these do
not succeed to each other, there is reason to apprehend danger. When the
tongue is covered with a brown crust, it is an unfavourable symptom.
Cold shivering fits coming on at the height of the disease are likewise
unfavourable. Grinding of the teeth, when it proceeds from an affection
of the nervous system, is a bad sign; but sometimes it is occasioned by
worms, or a disordered stomach.

REGIMEN.——When the first symptoms of the small-pox appear, people are
ready to be alarmed, and often fly to the use of medicine, to the great
danger of the patient’s life. I have known children, to appease the
anxiety of their parents, bled, blistered, and purged, during the fever
which preceded the eruption of the small-pox, to such a degree, that
Nature was not only disturbed in her operation, but rendered unable to
support the pustules after they were out; so that the patient, exhausted
by mere evacuations, sunk under the disease.

When convulsions appear, they give a dreadful alarm. Immediately some
nostrum is applied, as if this were a primary disease; whereas it is
only a symptom, and far from being an unfavourable one, of the
approaching eruption. As the fits generally go off before the actual
appearance of the small-pox, it is attributed to the medicine, which by
this means acquires a reputation without any merit[88].

All that is, generally speaking, necessary during the eruptive fever, is
to keep the patient cool and easy, allowing him to drink freely of some
weak diluting liquors; as balm-tea, barley-water, clear whey, gruels,
&c. He should not be confined to bed, but should sit up as much as he is
able, and should have his feet and legs frequently bathed in lukewarm
water. His food ought to be very light; and he should be as little
disturbed with company as possible.

Much mischief is done at this period by confining the patient too soon
to his bed, and plying him with warm cordials or sudorific medicines.
Every thing that heats and inflames the blood increases the fever, and
pushes out the pustules prematurely. This has numberless ill effects. It
not only increases the number of pustules, but likewise tends to make
them run into one another; and when they have been pushed out with too
great violence, they generally fall in before they come to maturity.

The good women, as soon as they see the small-pox begin to appear,
commonly ply their tender charge with cordials, saffron, and
marigold-teas, wine, punch, and even brandy itself. All these are given
with a view, as they term it, to throw out the eruption from the heart.
This, like most other popular mistakes, is the abuse of a very just
observation, _that when there is a moisture on the skin, the pox rise
better, and the patient is easier, than when it continues dry and
parched_. But that is no reason for forcing the patient into a sweat.
Sweating never relieves unless where it comes spontaneously, or is the
effect of drinking weak diluting liquors.

Children are often so peevish, that they will not lie a-bed without a
nurse constantly by them. Indulging them in this, we have reason to
believe, has many bad effects both upon the nurse and child. Even the
natural heat of the nurse cannot fail to augment the fever of the child,
but if she too proves feverish, which is often the case, the danger must
be increased[89].

Laying several children who have the small-pox in the same bed has many
ill consequences. They ought if possible never to be in the same
chamber, as the perspiration, the heat, the smell, &c. all tend to
augment the fever, and to heighten the disease. It is common among the
poor to see two or three children lying in the same bed, with such a
load of pustules that even their skins stick together. One can hardly
view a scene of this kind without being sickened by the sight. But how
must the effluvia affect the poor patients, many of whom perish by this
usage[90]!

A very dirty custom prevails among the lower class of people, of
allowing children in the small-pox to keep on the same linen during the
whole period of that loathsome disease. This is done lest they should
catch cold; but it has many ill consequences. The linen becomes hard by
the moisture which it absorbs, and frets the tender skin. It likewise
occasions a bad smell, which is very pernicious both to the patient and
those about him; besides, the filth and sordes which adhere to the linen
being resorbed, or taken up again into the body, greatly augment the
disease.

A patient should not be suffered to be dirty in an internal disease, far
less in the small-pox. Cutaneous disorders are often occasioned by
nastiness alone, and are always increased by it. Were the patient’s
linen to be changed every day, it would greatly refresh him. Care indeed
is to be taken that the linen be thoroughly dry. It ought likewise to be
put on when the patient is most cool.

So strong is the vulgar prejudice in this country, notwithstanding all
that has been said against the hot regimen in the small-pox, that
numbers still fall a sacrifice to that error. I have seen poor women
travelling in the depth of winter, and carrying their children along
with them in the small-pox, and have frequently observed others begging
by the way-side, with infants in their arms covered with the pustules;
yet I could never learn that one of these children died by this sort of
treatment. This is certainly a sufficient proof of the safety at least,
of exposing patients in the small-pox to the open air. There can be no
reason however for exposing them to public view. It is now very common
in the environs of great towns to meet patients in the small-pox on the
public walks. This practice, however well it may suit the purposes of
boasting inoculators, is dangerous to the citizens, and contrary to the
laws of humanity and sound policy.

The food in this disease ought to be very light, and of a cooling
nature, as panado, or bread boiled with equal quantities of milk and
water, good apples roasted or boiled with milk, and sweetened with a
little sugar, or such like.

The drink may be equal parts of milk and water, clear sweet whey,
barley-water, or thin gruel, &c. After the pox are full, butter-milk,
being of an opening and cleansing nature, is a very proper drink.

MEDICINE.——This disease is generally divided into four different
periods, _viz._ the fever which precedes the eruption, the eruption
itself, the suppuration, or maturation of the pustules, and the
secondary fever.

It has already been observed, that little more is necessary during the
primary fever than to keep the patient cool and quiet, allowing him to
drink diluting liquors, and bathing his feet frequently in warm water.
Though this be generally the safest course that can be taken with
infants, yet adults of a strong constitution and plethoric habit
sometimes require bleeding. When a full pulse, a dry skin, and other
symptoms of inflammation render this operation necessary, it ought to be
performed; but, unless these symptoms are urgent, it is safer to let it
alone; if the body is bound, emollient clysters may be thrown in.

If there is a great nausea or inclination to vomit, weak camomile-tea or
lukewarm water may be drank, in order to clean the stomach. At the
beginning of a fever, Nature generally attempts a discharge, either
upwards or downwards, which, if promoted by gentle means, would tend
greatly to abate the violence of the disease.

Though every method is to be taken during the primary fever, by a cool
regimen, &c. to prevent too great an eruption; yet after the pustules
have made their appearance, our business is to promote the suppuration,
by diluting drink, light food, and, if Nature seems to flag, by generous
cordials. When a low, creeping pulse, faintishness, and great loss of
strength, render cordials necessary, we would recommend good wine, which
may be made into negus, with an equal quantity of water, and sharpened
with the juice of orange, the jelly of currants, or the like. Wine-whey,
sharpened as above, is likewise a proper drink in this case; great care
however must be taken not to overheat the patient by any of these
things. This, instead of promoting, would retard the eruption.

The rising of the small-pox is often prevented by the violence of the
fever; in this case the cool regimen is strictly to be observed. The
patient’s chamber must not only be kept cool, but he ought likewise
frequently to be taken out of bed, and to be lightly covered with
clothes while in it.

Excessive restlessness often prevents the rising and filling of the
small-pox. When this happens, gentle opiates are necessary. These
however ought always to be administered with a sparing hand. To an
infant, a tea-spoonful of the syrup of poppies may be given every five
or six hours till it has the desired effect. An adult will require a
table-spoonful in order to answer the same purpose.

If the patient be troubled with a strangury, or suppression of urine,
which often happens in the small-pox, he should be frequently taken out
of bed, and, if he be able, should walk across the room with his feet
bare. When he cannot do this, he may be frequently set on his knees in
bed, and should endeavour to pass his urine as often as he can. When
these do not succeed, a tea-spoonful of the sweet spirits of nitre may
be occasionally mixed with his drink. Nothing more certainly relieves
the patient, or is more beneficial in the small-pox, than a plentiful
discharge of urine.

If the mouth be foul, and the tongue dry and chapped, it ought to be
frequently washed, and the throat gargled with water and honey,
sharpened with a little vinegar or currant jelly.

During the rising of the small-pox, it frequently happens that the
patient is eight or ten days without a stool. This not only tends to
heat and inflame the blood, but the fæces, by lodging so long in the
body, become acrid, and even putrid; from whence bad consequences must
ensue. It will therefore be proper, when the body is bound, to throw in
an emollient clyster every second or third day, through the whole course
of the disease. This will greatly cool and relieve the patient.

When petechiæ, or purple, black, or livid spots appear among the
small-pox, the Peruvian bark must immediately be administered in as
large doses as the patient’s stomach can bear. For a child, two drachms
of the bark in powder may be mixed in three ounces of common water, one
ounce of simple cinnamon-water, and two ounces of the syrup of orange or
lemon. This may be sharpened with the spirits of vitriol, and a
table-spoonful of it given every hour. If it be given to an adult in the
same form, he may take at least three or four spoonfuls every hour. This
medicine ought not to be trifled with, but must be administered as
frequently as the stomach can bear it; in which case it will often
produce very happy effects. I have frequently seen the petechiæ
disappear, and the small-pox, which had a very threatening aspect, rise
and fill with laudable matter, by the use of the bark and acids.

The patient’s drink ought likewise in this case to be generous, as wine
or strong negus acidulated with spirits of vitriol, vinegar, the juice
of lemon, jelly of currants, or such like. His food must consist of
apples roasted or boiled, preserved cherries, plums, and other fruits of
an acid nature.

The bark and acids are not only necessary when the petechiæ or putrid
symptoms appear, but likewise in the lymphatic or crystalline small-pox,
where the matter is thin, and not duly prepared. The Peruvian bark seems
to possess a singular power of assisting Nature in preparing laudable
pus, or what is called good matter; consequently it must be beneficial
both in this and other diseases, where the crisis depends on a
suppuration. I have often observed where the small-pox were flat, and
the matter contained in them quite clear and transparent, and where at
first they had the appearance of running into one another, that the
Peruvian bark, acidulated as above, changed the colour and consistence
of the matter, and produced the most happy effects.

When the eruption subsides suddenly, or, as the good women term it, when
the small-pox _strike in_, before they have arrived at maturity, the
danger is very great. In this case blistering-plasters must be
immediately applied to the wrists and ancles, and the patient’s spirits
supported with cordials.

Sometimes bleeding has a surprising effect in raising the pustules after
they have subsided; but it requires skill to know when this is proper,
or to what length the patient can bear it. Sharp cataplasms however may
be applied to the feet and hands, as they tend to promote the swelling
of these parts, and by that means to draw the humours towards the
extremities.

The most dangerous period of this disease is what we call the secondary
fever. This generally comes on when the small-pox begin to blacken, or
turn on the face; and most of those who die of the small-pox are carried
off by this fever.

Nature generally attempts, at the turn of the small-pox, to relieve the
patient by loose stools. Her endeavours this way are by no means to be
counteracted, but promoted, and the patient at the same time supported
by food and drink of a nourishing and cordial nature.

If, at the approach of the secondary fever, the pulse be very quick,
hard, and strong, the heat intense, and the breathing laborious, with
other symptoms of an inflammation of the breast, the patient must
immediately be bled. The quantity of blood to be let must be regulated
by the patient’s strength, age, and the urgency of the symptoms.

But, in the secondary fever, if the patient be faintish, the pustules
become suddenly pale, and if there be great coldness of the extremities,
blistering plasters must be applied, and the patient must be supported
with generous cordials. Wine and even spirits have sometimes been given
in such cases with amazing success.

As the secondary fever is in great measure, if not wholly, owing to the
absorption of the matter, it would seem highly consonant to reason, that
the pustules, as soon as they come to maturity, should be opened. This
is every day practiced in other phlegmons which tend to suppuration; and
there seems to be no cause why it should be less proper here. On the
contrary, we have reason to believe, that by this means the secondary
fever might always be lessened, and often wholly prevented.

The pustules should be opened when they begin to turn of a yellow
colour. Very little art is necessary for this operation. They may either
be opened with a lancet or a needle, and the matter absorbed by a little
dry lint. As the pustules are generally first ripe on the face, it will
be proper to begin with opening these, and the others in course as they
become ripe. The pustules generally fill again, a second or even a third
time; for which cause the operation must be repeated, or rather
continued as long as there is any considerable appearance of matter in
the pustules.

We have reason to believe that this operation, rational as it is, has
been neglected from a piece of mistaken tenderness in parents. They
believe that it must give great pain to the poor child; and therefore
would rather see it die than have it thus tortured. This notion however
is entirely without foundation. I have frequently opened the pustules
when the patient did not see me, without his being in the least sensible
of it; but suppose it were attended with a little pain, that is nothing
in comparison to the advantages which arise from it.

Opening the pustules not only prevents the resorption of the matter into
the blood, but likewise takes off the tension of the skin, and by that
means greatly relieves the patient. It likewise tends to prevent the
pitting, which is a matter of no small importance. Acrid matter, by
lodging long in the pustules, cannot fail to corrode the tender skin; by
which many a handsome face becomes so deformed as hardly to bear a
resemblance to the human figure[91].

It is generally necessary, after the small-pox are gone off, to purge
the patient. If however the body has been open through the whole course
of the disease, or if butter-milk and other things of an opening nature
have been drank freely after the height of the small-pox, purging
becomes less necessary; but it ought never wholly to be neglected.

For very young children, an infusion of senna and prunes, with a little
rhubarb, may be sweetened with coarse sugar, and given in small
quantities till it operates. Those who are farther advanced must take
medicines of a sharper nature. For example, a child of five or six years
of age may take eight or ten grains of fine rhubarb in powder over
night, and the same quantity of jalap in powder next morning. This may
be wrought off with fresh broth or water-gruel, and may be repeated
three or four times, five or six days intervening between each dose. For
children further advanced, and adults, the dose must be increased in
proportion to the age and constitution[92].

When imposthumes happen after the small-pox, which is not seldom the
case, they must be brought to suppuration as soon as possible, by means
of ripening poultices; and when they have been opened, or have broke of
their own accord, the patient must be purged. The Peruvian bark and a
milk diet will likewise be useful in this case.

When a cough, a difficulty of breathing, or other symptoms of a
consumption, succeed to the small-pox, the patient must be sent to a
place where the air is good, and put upon a course of asses milk, with
such exercise as he can bear. For further directions in this case, see
the article _Consumptions_.


                            OF INOCULATION.

Though no disease, after it is formed, baffles the powers of medicine
more effectually than the small-pox, yet more may be done before-hand to
render this disease favourable than any one we know, as almost all the
danger from it may be prevented by inoculation. This salutary invention
has been known in Europe above half a century; but, like most other
useful discoveries, it has till of late made but slow progress. It must
however be acknowledged, to the honour of this country, that inoculation
has met with a more favourable reception here, than among any of our
neighbours. It is still however far from being general, which we have
reason to fear will be the case, as long as the practice continues in
the hands of the faculty.

No discovery can be of general utility, while the practice of it is kept
in the hands of a few. Had the inoculation of the small-pox been
introduced as a fashion, and not as a medical discovery, or had it been
practiced by the same kind of operators here, as it is in those
countries from whence we learned it, it had long ago been universal. The
fears, the jealousies, the prejudices, and the opposite interests of the
faculty, are, and ever will be, the most effectual obstacles to the
progress of any salutary discovery. Hence it is that the practice of
inoculation never became in any measure general, even in England, till
taken up by men not bred to physic. These have not only rendered the
practice more extensive, but likewise more safe, and by acting under
less restraint than the regular practitioners, have taught them that the
patient’s greatest danger arose, not from the want of care, but from the
excess of it.

They know very little of the matter, who impute the success of modern
inoculators to any superior skill, either in preparing the patient or
communicating the disease. Some of them indeed, from a sordid desire of
engrossing the whole practice to themselves, pretend to have
extraordinary secrets or nostrums for preparing persons for inoculation,
which never fail of success. But this is only a pretence calculated to
blind the ignorant and inattentive. Common sense and prudence alone are
sufficient both in the choice of the subject and management of the
operation. Whoever is possessed of these may perform this office for his
children whenever he finds it convenient, provided they be in a good
state of health.

This sentiment is not the result of theory, but of observation. Though
few physicians have had more opportunities of trying inoculation in all
its different forms, so little appears to me to depend on those,
generally reckoned important circumstances, of preparing the body,
communicating the infection by this or the other method, &c. that for
several years past I have persuaded the parents or nurses to perform the
whole themselves, and have found that method followed with equal
success, while it is free from many inconveniences that attend the
other[93].

The small-pox may be communicated in a great variety of ways with nearly
the same degree of safety and success. In Turkey, from whence we learned
the practice, the women communicate the disease to children, by opening
a bit of the skin with a needle, and putting into the wound a little
matter taken from a ripe pustule. On the coast of Barbary they pass a
thread wet with the matter through the skin between the thumb and
fore-finger; and in some of the states of Barbary, inoculation is
performed by rubbing in the variolous matter between the thumb and
fore-finger, or on other parts of the body. The practice of
communicating the small-pox, by rubbing the variolous matter upon the
skin, has been long known in many parts of Asia and Europe, as well as
in Barbary, and has generally gone by the name of _buying the
small-pox_.

The present method of inoculating in Britain is to make two or three
slanting incisions in the arm, so superficial as not to pierce quite
through the skin, with a lancet wet with fresh matter taken from a ripe
pustule; afterwards the wounds are closed up, and left without any
dressing. Some make use of a lancet covered with the dry matter; but
this is less certain, and ought never to be used unless where fresh
matter cannot be obtained: when this is the case, the matter ought to be
moistened by holding the lancet for some time in the steam of warm
water[94].

Indeed, if fresh matter be applied long enough to the skin, there is no
occasion for any wound at all. Let a bit of thread, about half an inch
long, wet with the matter, be immediately applied to the arm, midway
between the shoulder and the elbow, and covered with a piece of the
common sticking-plaster, and kept on for eight or ten days. This will
seldom fail to communicate the disease. We mention this method, because
many people are afraid of a wound; and doubtless the more easily the
operation can be performed, it has the greater chance to become general.
Some people imagine, that the discharge from a wound lessens the
eruption; but there is no great stress to be laid upon this notion;
besides, deep wounds often ulcerate, and become troublesome.

We do not find that inoculation is at all considered as a medical
operation in those countries from whence we learned it. In Turkey it is
performed by the women, and in the East Indies by the Brachmins or
priests. In this country the custom is still in its infancy; we make no
doubt, however, but it will soon become so familiar, that parents will
think no more of inoculating their children, than at present they do of
giving them a purge.

No set of men have it so much in their power to render the practice of
inoculation general as the clergy, the greatest opposition to it still
arising from some scruples of conscience, which they alone can remove. I
would recommend it to them not only to endeavour to remove the religious
objections which weak minds may have to this salutary practice, but to
enjoin it as a duty, and to point out the danger of neglecting to make
use of a mean which Providence has put in our power for saving the lives
of our offspring. Surely such parents as wilfully neglect the means of
saving their children’s lives, are as guilty as those who put them to
death. I wish this matter were duly weighed. No one is more ready to
make allowance for human weakness and religious prejudices, yet I cannot
help recommending it, in the warmest manner, to parents, to consider how
great an injury they do their children, by neglecting to give them this
disease in the early period of life.

The numerous advantages arising from the inoculation of the small-pox
have been pretty fully pointed out by the learned Dr. M‘Kenzie, in his
History of Health[95]. To those mentioned by the Doctor we shall only
add, that such as have not had the small-pox in the early period of
life, are not only rendered unhappy, but likewise in a great measure
unfit for sustaining many of the most useful and important offices. Few
people would chuse even to hire a servant who had not had the small-pox,
far less to purchase a slave who had the chance of dying of this
disease. How could a physician or a surgeon, who had never had the
small-pox himself, attend others under that malady? How deplorable is
the situation of females, who arrive at mature age without having had
the small-pox! A woman with child seldom survives this disease: and if
an infant happen to be seized with the small-pox upon the mother’s
breast, who has not had the disease herself the scene must be
distressing! If she continue to suckle the child, it is at the peril of
her own life; and if she wean it, in all probability it will perish. How
often is the affectionate mother forced to leave her house, and abandon
her children, at the very time when her care is most necessary? Yet
should parental affection get the better of her fears, the consequences
would often prove fatal. I have known the tender mother and her sucking
infant laid in the same grave, both untimely victims to this dreadful
malady. But these are scenes too shocking even to mention. Let parents
who run away with their children to avoid the small-pox, or who refuse
to inoculate them in infancy, consider to what deplorable situations,
they may be reduced by this mistaken tenderness!

As the small-pox is now become an epidemical disease in most parts of
the known world, no other choice remains but to render the malady as
mild as possible. This is the only manner of extirpation now left in our
power; and though it may seem paradoxical, the artificial method of
communicating the disease, could it be rendered universal, would amount
to nearly the same thing as rooting it out. It is a matter of small
consequence, whether a disease be entirely extirpated, or rendered so
mild as neither to destroy life nor hurt the constitution; but that this
may be done by inoculation, does not now admit of a doubt. The numbers
who die under inoculation hardly deserve to be named. In the natural
way, one in four or five generally dies; but by inoculation not one of a
thousand. Nay, some can boast of having inoculated ten thousand without
the loss of a single patient.

I have often wished to see some plan established for rendering this
salutary practice universal; but am afraid I shall never be so happy.
The difficulties indeed are many; yet the thing is by no means
impracticable. The aim is great; no less than saving the lives of
one-fourth part of mankind. What ought not to be attempted in order to
accomplish so desirable an end?

The first step towards rendering the practice universal, must be to
remove the religious prejudices against it. This, as already observed,
can only be done by the clergy. They must not only recommend it as a
duty to others, but likewise practise it on their own children. Example
will ever have more influence than precept.

The next thing requisite is to put it in the power of all. For this
purpose we would recommend it to the Faculty to inoculate the children
of the poor _gratis_. It is hard that so useful a part of mankind should
by their poverty be excluded from such a benefit.

Should this fail, it is surely in the power of any State to render the
practice general, at least as far as their dominion extends. We do not
mean that it ought to be enforced by a law. The best way to promote it
would be to employ a sufficient number of operators at the public
expence to inoculate the children of the poor. This would only be
necessary till the practice became general; afterwards custom, the
strongest of all laws, would oblige every individual to inoculate his
children to prevent reflections.

It may be objected to this scheme, that the poor would refuse to employ
the inoculators: this difficulty is easily removed. A small premium to
enable mothers to attend their children while under the disease, would
be a sufficient inducement; besides, the success attending the operation
would soon banish all objections to it. Even considerations of profit
would induce the poor to embrace this plan. They often bring up their
children to the age of ten or twelve, and when they come to be useful,
they are snatched away by this malady, to the great loss of their
parents, and detriment of the public.

The British legislature has of late years shewn great attention to the
preservation of infant lives, by supporting the foundling hospital, &c.
But we will venture to say, if one-tenth part of the sums laid out in
supporting that institution, had been bestowed towards promoting the
practice of inoculation of the small-pox among the poor, that not only
more useful lives had been saved, but the practice ere now rendered
quite universal in this island. It is not to be imagined what effect
example and a little money will have upon the poor; yet, if left to
themselves, they would go on for ever in the old way, without thinking
of any improvement. We only mean this as a hint to the humane and
public-spirited. Should such a scheme be approved, a proper plan might
easily be laid down for the execution of it.

But as public plans are very difficult to bring about, and often, by the
selfish views and misconduct of those intrusted with the execution of
them, fail of answering the noble purposes for which they were designed;
we shall therefore point out some other method by which the benefits of
inoculation may be extended to the poor.

There is no doubt but inoculators will daily become more numerous. We
would therefore have every parish in Britain to allow one of them a
small annual salary for inoculating all the children of the parish at a
proper age. This might be done at a very trifling expence, and it would
enable every one to enjoy the benefit of this salutary invention.

Two things chiefly operate to prevent the progress of inoculation. The
one is a wish to put the evil day as far off as possible. This is a
principle in our nature; and as inoculation seems rather to be
anticipating a future evil, it is no wonder mankind are so averse to it.
But this objection is sufficiently answered by the success. Who in his
senses would not prefer a lesser evil to-day to a greater to-morrow,
provided they were equally certain?

The other obstacle is the fear of reflections. This has very great
weight with the bulk of mankind. Should the child die, they think the
world would blame them. This they cannot bear. Here lies the difficulty;
and till that be removed, inoculation will make but small progress.
Nothing however can remove it but custom. Make the practice fashionable,
and all objections will soon vanish. It is fashion alone that has led
the multitude since the beginning of the world, and will lead them to
the end. We must therefore call upon the more enlightened part of
mankind to set a pattern to the rest. Their example, though it may for
some time meet with opposition, will at length prevail.

I am aware of an objection to this practice from the expence with which
it may be attended: this is easily obviated. We do not mean that every
parish ought to employ a Sutton or a Dimsdale as inoculators. These have
by their success already recommended themselves to crowned heads, and
are beyond the vulgar reach; but have not others an equal chance to
succeed? They certainly have. Let them make the same trial, and the
difficulties will soon vanish. There is not a parish, and hardly a
village in Britain, destitute of some person who can bleed. But this is
a far more difficult operation, and requires both more skill and
dexterity than inoculation.

The persons to whom we would chiefly recommend the performance of this
operation are the clergy. Most of them know something of medicine.
Almost all of them bleed, and can order a purge, which are all the
qualifications necessary for the practice of inoculation. The priests
among the less enlightened Indians perform this office, and why should a
Christian teacher think himself above it? Surely the bodies of men, as
well as their souls, merit a part of the pastor’s care; at lead the
greatest Teacher who ever appeared among men seems to have thought so.

Should all other methods fail, we would recommend it to parents to
perform the operation themselves. Let them take any method of
communicating the disease they please; provided the subjects be healthy,
and of a proper age, they will seldom fail to succeed to their wish. I
have known many instances even of mothers performing the operation, and
never so much as heard of one bad consequence. A planter in one of the
West India islands is said to have inoculated, with his own hand, in one
year, three hundred of his slaves, who, notwithstanding the warmth of
the climate, and other unfavourable circumstances, all did well. Common
mechanics have often, to my knowledge, performed the operation with as
good success as physicians. We do not however mean to discourage those
who have it in their power, from employing people of skill to inoculate
their children, and attend them while under the disease, but only to
shew, that where such cannot be had, the operation ought not upon that
account to be neglected.

Instead of multiplying arguments to recommend this practice, I shall
just beg leave to mention the method which I took with my own son, then
an only child. After giving him two gentle purges, I ordered the nurse
to take a bit of thread which had been previously wet with fresh matter
from a pock, and to lay it upon his arm, covering it with a piece of
sticking-plaster. This remained on six or seven days, till it was rubbed
off by accident. At the usual time the small-pox made their appearance,
and were exceedingly favourable. Surely this, which is all that is
generally necessary, may be done without any skill in medicine.

We have been the more full upon this subject because the benefits of
inoculation cannot be extended to society by any other means than making
the practice general. While it is confined to a few, it must prove
hurtful to the whole. By means of it the contagion is spread, and is
communicated to many who might otherwise never have had the disease.
Accordingly it is found that more die of the small-pox now than before
inoculation was introduced; and this important discovery, by which alone
more lives might be saved than by all the endeavours of the Faculty, is
in a great measure lost by its benefits not being extended to the whole
community[96].

The spring and autumn have been usually reckoned the most proper seasons
for inoculation, on account of the weather being then most temperate;
but it ought to be considered that these are generally the most
unhealthy seasons of the whole year. Undoubtedly the best preparation
for the disease is a previous good state of health. I have always
observed that children in particular are more sickly towards the end of
spring and autumn than at any other time of the year. On this account,
as well as for the advantage of cool air, I would propose winter as the
most proper season for inoculation; though, on every other
consideration, the spring would seem to be preferable.

The most proper age for inoculation is between three and five. Many
approve of inoculating on the breast, and where no circumstances forbid
this practice, I have no objection to it. Children, however, are more
liable to convulsions at this time than afterwards; besides, the anxiety
of the mother or nurse, should the child be in danger, would not fail to
heighten it by spoiling the milk.

Children who have constitutional diseases must nevertheless be
inoculated. It will often mend the habit of body; but ought to be
performed at a time when they are most healthy. Accidental diseases
should always be removed before inoculation.

It is generally thought necessary to regulate the diet for some time
before the disease be communicated. In children, however, great
alteration in diet is seldom necessary, their food being commonly of the
most simple and wholesome kind, as milk, water-pap, weak broths, bread,
light pudding, mild roots, and white meats.

But children who have been accustomed to a hotter diet, who are of a
gross habit, or abound with bad humours, ought to be put upon a spare
diet before they are inoculated. Their food should be of a light cooling
nature, and their drink whey, butter-milk, and such like.

We would recommend no other medicinal preparation but two or three mild
purges, which ought to be suited to the age and strength of the patient.
The success of inoculators does not depend on the preparation of their
patients, but on their management of them while under the disease. Their
constant care is to keep them cool, and their bodies gently open, by
which means the fever is kept low, and the eruption greatly lessened.
The danger is seldom great when the pustules are few; and their number
is generally in proportion to the fever which precedes and attends the
eruption. Hence the chief secret of inoculation consists in regulating
the eruptive fever, which generally may be kept sufficiently low by the
methods mentioned above.

The regimen during the disease is in all respects the same as under the
natural small-pox. The patient must be kept cool, his diet should be
light, and his drink weak and diluting, &c. Should any bad symptoms
appear, which is seldom the case, they must be treated in the same way
as directed in the natural small-pox. Purging is not less necessary
after the small-pox by inoculation than in the natural way, and ought by
no means to be neglected.




                              CHAP. XXIV.
                            OF THE MEASLES.


The measles appeared in Europe about the same time with the small-pox,
and have a great affinity to that disease. They both came from the same
quarter of the world, are both infectious, and seldom attack the same
person more than once. The measles are most common in the spring season,
and generally disappear in summer. The disease itself, when properly
managed, seldom proves fatal; but its consequences are often very
troublesome.

CAUSE.——This disease, like the small-pox, proceeds from infection, and
is more or less dangerous according to the constitution of the patient,
the season of the year, the climate, &c.

SYMPTOMS.——The measles, like other fevers, are preceded by alternate
fits of heat and cold, with sickness, and loss of appetite. The tongue
is white, but generally moist. There is a short cough, a heaviness of
the head and eyes, drowsiness, and a running at the nose. Sometimes
indeed the cough does not come before the eruption has appeared. There
is an inflammation and heat in the eyes, accompanied with a defluxion of
sharp rheum, and great acuteness of sensation, so that they cannot bear
the light without pain. The eye-lids frequently swell so as to occasion
blindness. The patient generally complains of his throat; and a vomiting
or looseness often precedes the eruption. The stools in children are
commonly greenish; they complain of an itching of the skin, and are
remarkably peevish. Bleeding at the nose is common, both before and in
the progress of the disease.

About the fourth day, small spots, resembling flea-bites, appear, first
upon the face; then upon the breast, and afterwards on the extremities:
these may be distinguished from the small pox by their scarcely rising
above the skin. The fever, cough, and difficulty of breathing, instead
of being removed by the eruption as in the small pox, are rather
increased; but the vomiting generally ceases.

About the sixth or seventh day from the time of sickening, the measles
begin to turn pale on the face, and afterwards upon the body; so that by
the ninth day they entirely disappear. The fever; however, and
difficulty of breathing, often continue, especially if the patient has
been kept upon too hot a regimen. Petechiæ, or purple spots, may
likewise be occasioned by this error.

A violent looseness sometimes succeeds the measles; in which case the
patient’s life is in imminent danger.

Such as die of the measles generally expire about the ninth day from the
invasion, and are commonly carried off by a peripneumony, or
inflammation of the lungs.

The most favourable symptoms are a moderate looseness, a moist skin, and
a plentiful discharge of urine.

When the eruption suddenly falls in, and the patient is seized with a
delirium, he is in the greatest danger. If the measles turn too soon of
a pale colour, it is an unfavourable symptom, as are also great
weakness, vomiting, restlessness, and difficulty of swallowing. Purple
or black spots appearing among the measles are very unfavourable. When a
continual cough, with hoarseness, succeeds the disease, there is reason
to suspect an approaching consumption of the lungs.

Our business in this disease is to assist Nature, by proper cordials, in
throwing out the eruption, if her efforts be too languid; but when they
are too violent they must be restrained by evacuations, and cool
diluting liquors, &c. We ought likewise to endeavour to appease the most
urgent symptoms, as the cough, restlessness, and difficulty of
breathing.

REGIMEN.——The cool regimen is necessary here as well as in the
small-pox. The food too must be light, and the drink diluting. Acids
however do not answer so well in the measles as in the small-pox, as
they tend to exasperate the cough. Small beer likewise, though a good
drink in the small-pox, is here improper. The most suitable liquors are
decoctions of liquorice with marsh-mallow roots and sarsaparilla,
infusions of linseed, or of the flowers of elder, balm-tea, clarified
whey, barley-water, and such like. These, if the patient be costive, may
be sweetened with honey; or, if that should disagree with the stomach, a
little manna may occasionally be added to them.

MEDICINE.——The measles being an inflammatory disease, without any
critical discharge of matter, as in the small-pox, bleeding is commonly
necessary, especially when the fever runs high, with difficulty of
breathing, and great oppression of the breast. But if the disease be of
a mild kind, bleeding may be omitted[97].

Bathing the feet and legs frequently in lukewarm water both tends to
abate the violence of the fever, and to promote the eruption.

The patient is often greatly relieved by vomiting. When there is a
tendency this way, it ought to be promoted by drinking lukewarm water,
or weak camomile-tea.

When the cough is very troublesome, with dryness of the throat, and
difficulty of breathing, the patient may hold his head over the steam of
warm water, and draw the steam into his lungs.

He may likewise lick a little sperma-ceti and sugar-candy pounded
together; or take now and then a spoonful of the oil of sweet almonds,
with sugar-candy dissolved in it. These will soften the throat, and
relieve the tickling cough.

If at the turn of the disease the fever assumes new vigour, and there
appears great danger of suffocation, the patient must be bled according
to his strength, and blistering-plasters applied, with a view to prevent
the load from being thrown on the lungs, where if an inflammation should
fix itself, the patient’s life will be in imminent danger.

In case the measles should suddenly disappear, it will be necessary to
pursue the same method which we have recommended when the small-pox
recede. The patient must be supported with wine and cordials.
Blistering-plasters must be applied to the legs and arms, and the body
rubbed all over with warm flannels. Warm poultices may likewise be
applied to the feet and palms of the hands.

When purple or black spots appear, the patient’s drink should be
sharpened with spirits of vitriol; and if the putrid symptoms increase,
the Peruvian bark must be administered in the same manner as directed in
the small-pox.

Opiates are sometimes necessary, but should never be given except in
cases of extreme restlessness, a violent looseness, or when the cough is
very troublesome. For children, the syrup of poppies is sufficient. A
tea-spoonful or two may be occasionally given, according to the
patient’s age, or the violence of the symptoms.

After the measles are gone off, the patient ought to be purged. This may
be conducted in the same manner as directed in the small-pox.

If a violent looseness succeeds the measles, it may be checked by taking
for some days a gentle dose of rhubarb in the morning, and an opiate
over night; but if these do not remove it, bleeding will seldom fail to
have that effect.

Patients recovering after the measles should be careful what they eat or
drink. Their food for some time ought to be light, and in small
quantities, and their drink diluting, and rather of an opening nature,
as butter-milk, whey, and such like. They ought also to beware of
exposing themselves too soon to the cold air, lest a suffocating
catarrh, an asthma, or a consumption of the lungs, should ensue.

Should a cough, with difficulty of breathing, and other symptoms of a
consumption, remain after the measles, small quantities of blood may be
frequently let at proper intervals, as the patient’s strength and
constitution will permit. He ought likewise to drink asses milk, to
remove to a free air, if in a large town, and to ride daily on
horseback. He must keep close to a diet consisting of milk and
vegetables; and lastly, if these do not succeed, let him remove to a
warmer climate[98].


                         OF THE SCARLET FEVER.

The scarlet fever is so called from the colour of the patient’s skin,
which appears as if it were tinged with red wine. It happens at any
season of the year, but is most common towards the end of summer; at
which time it often seizes whole families; children and young persons
are most subject to it.

It begins like other fevers, with coldness and shivering, without any
violent sickness. Afterwards the skin is covered with red spots, which
are broader, more florid, and less uniform than the measles. They
continue two or three days, and then disappear; after which the cuticle,
or scarf-skin, falls off.

There is seldom any occasion for medicine in this disease. The patient
ought however to keep within doors, to abstain from flesh, strong
liquors, and cordials, and to drink freely of cool diluting liquors. If
the fever runs high, the body must be kept gently open by emollient
clysters, or small doses of nitre and rhubarb. A scruple of the former,
with five grains of the latter, may be taken thrice a-day, or oftener,
if necessary.

Children and young persons are sometimes seized at the beginning of this
disease with a kind of stupor and epileptic fits. In this case the feet
and legs should be bathed in warm water, a large blistering-plaster
applied to the neck, and a dose of the syrup of poppies given every
night till the patient recovers[99].

The scarlet fever however is not always of so mild a nature. It is
sometimes attended with putrid or malignant symptoms, in which case it
is always dangerous. In the malignant scarlet fever the patient is not
only affected with coldness and shivering, but with languor, sickness,
and great oppression, to these succeed excessive heat, nausea and
vomiting, with a soreness of the throat; the pulse is extremely quick,
but small and depressed; the breathing frequent and laborious; the skin
hot, but not quite dry; the tongue moist, and covered with a whitish
mucus; the tonsils inflamed and ulcerated. When the eruption appears, it
brings no relief: on the contrary, the symptoms generally grow worse,
and fresh ones come on, as purging, delirium, &c.

When this disease is mistaken for a simple inflammation, and treated
with repeated bleedings, purging and cooling medicines, it generally
proves fatal. The only medicines that can be depended on in this case
are cordials and antiseptics, as the Peruvian bark, wine, snake-root,
and the like. The treatment must be in general similar to that of the
putrid fever, or of the malignant ulcerous sore throat[100].


                         OF THE BILIOUS FEVER.

When a continual, remitting, or intermitting fever is accompanied with a
frequent or copious evacuation of bile, either by vomit or stool, the
fever is denominated bilious. In Britain the bilious fever generally
makes its appearance about the end of summer, and ceases towards the
approach of winter. It is most frequent and fatal in warm countries,
especially where the soil is marshy, and when great rains are succeeded
by sultry heats. Persons who work without doors, lie in camps, or who
are exposed to the night air, are most liable to this kind of fever.

If there are symptoms of inflammation at the beginning of this fever, it
will be necessary to bleed, and to put the patient upon the cool
diluting regimen recommended in the inflammatory fever. The saline
draught may likewise be frequently administered, and the patient’s body
kept open by clysters or mild purgatives. But if the fever should remit
or intermit, bleeding will seldom be necessary. In this case a vomit may
be administered, and, if the body be bound, a gentle purge; after which
the Peruvian bark will generally complete the cure.

In case of a violent looseness, the patient must be supported with
chicken broth, jellies of hartshorn, and the like; and he may use the
_white decoction_ for his ordinary drink[101]. If a bloody flux should
accompany this fever, it must be treated in the manner recommended under
the article _Dysentery_.

When there is a burning heat, and the patient does not sweat, that
evacuation may be promoted by giving him, three or four times a day, a
table-spoonful of Mindererus’s spirit[102] mixed in a cup of his
ordinary drink.

If the bilious fever be attended with the nervous, malignant, or putrid
symptoms, which is sometimes the case, the patient must be treated in
the same manner as directed under these diseases.

After this fever, proper care is necessary to prevent a relapse. For
this purpose the patient, especially towards the end of autumn, ought to
continue the use of the Peruvian bark for some time after he is well. He
should likewise abstain from all trashy fruits, new liquors, and every
kind of flatulent aliment.




                               CHAP. XXV.
               OF THE ERYSIPELAS, OR ST. ANTHONY’S FIRE.


This disease, which in some parts of Britain is called _the rose_,
attacks persons at any period of life, but is most common between the
age of thirty and forty. Persons of a sanguine or plethoric habit are
most liable to it. It often attacks young people, and pregnant women;
and such as have once been afflicted with it are very liable to have it
again. Sometimes it is a primary disease, and at other times only a
symptom of some other malady. Every part of the body is liable to be
attacked by an erysipelas, but it most frequently seizes the legs or
face, especially the latter. It is most common in autumn, or when hot
weather is succeeded by cold and wet.

CAUSES.——The erysipelas may be occasioned by violent passions or
affections of the mind; as fear, anger, &c. When the body has been
heated to a great degree, and is immediately exposed to the cold air, so
that the perspiration is suddenly checked, an erysipelas will often
ensue[103]. It may also be occasioned by drinking to excess, by
continuing too long in a warm bath, or by any thing that overheats the
blood. If any of the natural evacuations be obstructed, or in too small
quantity, it may cause an erysipelas. The same effect will follow from
the stoppage of artificial evacuations; as issues, setons, or the like.

SYMPTOMS.——The erysipelas attacks with shivering, thirst, loss of
strength, pain in the head and back, heat, restlessness, and a quick
pulse; to which may be added vomiting, and sometimes a delirium. On the
second, third, or fourth day, the part swells, becomes red, and small
pustules appear at which time the fever generally abates.

When the erysipelas seizes the foot, the parts contiguous swell, the
skin shines; and, if the pain be violent, it will ascend to the leg, and
will not bear to be touched.

When it attacks the face, it swells, appears red, and the skin is
covered with small pustules filled with clear water. One or both eyes
are generally closed with the swelling; and there is a difficulty of
breathing. If the mouth and nostrils be very dry, and the patient
drowsy, there is reason to suspect an inflammation of the brain.

If the erysipelas affects the breast, it swells and becomes exceedingly
hard, with great pain, and is apt to suppurate. There is a violent pain
in the arm-pit on the side affected, where an abscess is often formed.

If in a day or two the swelling subsides, the heat and pain abate, the
colour of the part turns yellow, and the cuticle breaks and falls off in
scales, the danger is over.

When the erysipelas is large, deep, and affects a very sensible part of
the body, the danger is great. If the red colour changes into a livid or
black, it will end in a mortification. Sometimes the inflammation cannot
be discussed, but comes to a suppuration; in which case fistulas, a
gangrene, or mortification, often ensue.

Such as die of this disease are commonly carried off by the fever, which
is attended with difficulty of breathing, and sometimes with a delirium
and great drowsiness. They generally die about the seventh or eighth
day.

REGIMEN.——In the erysipelas the patient must neither be kept too hot nor
too cold, as either of these extremes will tend to make it retreat,
which is always to be guarded against. When the disease is mild, it will
be sufficient to keep the patient within doors, without confining him to
his bed, and to promote the perspiration by diluting liquors, &c.

The diet ought to be slender, and of a moderately cooling and moistening
quality, as groat-gruel, panado, chicken or barley-broth, with cooling
herbs and fruits, &c. avoiding flesh, fish, strong drink, spices,
pickles, and all other things that may heat and inflame the blood; the
drink may be barley-water, an infusion of elder-flowers, common whey,
and such like.

But if the pulse be low, and the spirits sunk, the patient must be
supported with negus, and other things of a cordial nature. His food may
be sago-gruel with a little wine, and nourishing broths taken in small
quantities, and often repeated. Great care however must be taken not to
overheat him.

MEDICINE.——In this disease much mischief is often done by medicine,
especially by external applications. People, when they see an
inflammation, immediately think that something ought to be applied to
it. This indeed is necessary in large phlegmons; but in an erysipelas
the safer course is to apply nothing. Almost all ointments, salves, and
plasters, being of a greasy nature, tend rather to obstruct and repel,
than promote any discharge from the part. At the beginning of this
disease it is neither safe to promote a suppuration, nor to repel the
matter too quickly. The erysipelas in many respects resembles the gout,
and is to be treated with the greatest caution. Fine wool, or very soft
flannel, are the safest applications to the part. These not only defend
it from the external air, but likewise promote the perspiration, which
has a great tendency to carry off the disease. In Scotland the common
people generally apply a mealy cloth to the parts affected, which is far
from being improper.

It is common to bleed in the erysipelas; but this likewise requires
caution. If however the fever be high, the pulse hard and strong, and
the patient vigorous, it will be proper to bleed; but the quantity must
be regulated by these circumstances, and the operation repeated as the
symptoms may require. If the patient has been accustomed to strong
liquors, and the disease attacks his head, bleeding is absolutely
necessary.

Bathing the feet and legs frequently in lukewarm water, when the disease
attacks the face or brain, has an excellent effect. It tends to make a
derivation from the head, and seldom fails to relieve the patient. When
bathing proves ineffectual, poultices, or sharp sinapisms, may be
applied to the soles of the feet, for the same purpose.

In cases where bleeding is requisite, it is likewise necessary to keep
the body open. This may be effected by emollient clysters, or small
doses of nitre and rhubarb. Some indeed recommend very large doses of
nitre in the erysipelas; but nitre seldom sits easy on the stomach when
taken in large doses. It is however one of the best medicines when the
fever and inflammation run high. Half a drachm of it, with four or five
grains of rhubarb, may be taken in the patient’s ordinary drink, four
times a day.

When the erysipelas leaves the extremities, and seizes the head so as to
occasion a delirium or stupor, it is absolutely necessary to open the
body. If clysters and mild purgatives fail to have this effect, stronger
ones must be given. Blistering plasters must likewise be applied to the
neck, or behind the ears, and sharp cataplasms laid to the soles of the
feet.

When the inflammation cannot be discussed, and the part has a tendency
to ulcerate, it will then be proper to promote suppuration, which may be
done by the application of ripening poultices with saffron, warm
fomentations, and such like.

When the black, livid, or blue colour of the part shews a tendency to
mortification, the Peruvian bark must be administered. It may be taken
along with acids, as recommended in the small-pox, or in any other form
more agreeable to the patient. It must not however be trifled with, as
the patient’s life is at stake. A drachm may be given every two hours,
if the symptoms be threatening, and cloths dipped in warm camphorated
spirits of wine, or the tincture of myrrh and aloes, may be applied to
the part, and frequently renewed. It may likewise be proper in this case
to apply poultices of the bark, or to foment the part affected with a
strong decoction of it.

In what is commonly called the _scorbutic erysipelas_, which continues
for a considerable time, it will only be necessary to give gentle
laxatives, and such things as purify the blood and promote the
perspiration. Thus, after the inflammation has been checked by opening
medicines, the decoction of woods[104] may be drank, after which a
course of bitters will be proper.

Such as are liable to frequent attacks of the erysipelas ought carefully
to guard against all violent passions; to abstain from strong liquors,
and all fat, viscid, and highly nourishing food. They should likewise
take sufficient exercise, carefully avoiding the extremes of heat or
cold. Their food should consist chiefly of milk, and such fruits, herbs,
and roots, as are of a cooling quality; and their drink ought to be
small-beer, whey, butter-milk, and such like. They should never suffer
themselves to be long costive. If that cannot be prevented by suitable
diet, it will be proper to take frequently a gentle dose of rhubarb,
cream of tartar, the lenitive electuary, or some other mild purgative.




                              CHAP. XXVI.
            OF THE PHRENITIS, OR INFLAMMATION OF THE BRAIN.


This is sometimes a primary disease, but oftener only a symptom of some
other malady; as the inflammatory, eruptive, or spotted fever, &c. It is
very common however as a primary disease in warm climates, and is most
incident to persons about the prime or vigour of life. The passionate,
the studious, and those whose nervous system is irritable in a high
degree, are most liable to it.

CAUSES.——This disease is often occasioned by night-watching, especially
when joined with hard study: it may likewise proceed from hard drinking,
anger, grief, or anxiety. It is often occasioned by the stoppage of
usual evacuations; as the bleeding piles in men, the customary
discharges of women, &c. Such as imprudently expose themselves to the
heat of the sun, especially by sleeping without doors in a hot season
with their heads uncovered, are often suddenly seized with an
inflammation of the brain, so as to awake quite delirious. When
repellents are imprudently used in an erysipelas, an inflammation of the
brain is sometimes the consequence. It may likewise be occasioned by
external injuries, as blows or bruises upon the head, &c.

SYMPTOMS.——The symptoms which usually precede a true inflammation of the
brain are pain of the head, redness of the eyes, a violent flushing of
the face, disturbed sleep, or a total want of it, great dryness of the
skin, costiveness, a retention of urine, a small dropping of blood from
the nose, singing of the ears, and extreme sensibility of the nervous
system.

When the inflammation is formed, the symptoms in general are similar to
those of the inflammatory fever. The pulse indeed is often weak,
irregular, and trembling; but sometimes it is hard and contracted. When
the brain itself is inflamed, the pulse is always soft and low; but when
the inflammation only affects the integuments of the brain, viz. the
dura and pia mater, it is hard. A remarkable quickness of hearing is a
common symptom of this disease; but that seldom continues long. Another
usual symptom is a great throbbing or pulsation in the arteries of the
neck and temples. Though the tongue is often black and dry, yet the
patient seldom complains of thirst, and even refuses drink. The mind
chiefly runs upon such objects as have before made a deep impression on
it; and sometimes, from a sullen silence, the patient becomes all of a
sudden quite outrageous.

A constant trembling and starting of the tendons is an unfavourable
symptom, as are also a suppression of urine; a total want of sleep; a
constant spitting; a grinding of the teeth, which last may be considered
as a kind of convulsion. When a phrenitis succeeds an inflammation of
the lungs, of the intestines, or of the throat, &c. it is owing to a
translation of the disease from these parts to the brain, and generally
proves fatal. This shews the necessity of proper evacuations, and the
danger of repellents in all inflammatory diseases.

The favourable symptoms are, a free perspiration, a copious discharge of
blood from the nose, the bleeding piles, a plentiful discharge of urine,
which lets fall a copious sediment. Sometimes the disease is carried off
by a looseness, and in women by an excessive flow of the _menses_.

As this disease often proves fatal in a few days, it requires the most
speedy applications. When it is prolonged, or improperly treated, it
sometimes ends in madness, or a kind of stupidity which continues for
life.

In the cure, two things are chiefly to be attended to, _viz._ to lessen
the quantity of blood in the brain, and to retard the circulation
towards the head.

REGIMEN.——The patient ought to be kept very quiet. Company, noise, and
every thing that affects the senses, or disturbs the imagination,
increases the disease. Even too much light is hurtful: for which reason
the patient’s chamber ought to be a little darkened, and he should
neither be kept too hot nor cold. It is not however necessary to exclude
the company of an agreeable friend, as this has a tendency to sooth and
quiet the mind. Neither ought the patient to be kept too much in the
dark, lest it should occasion a gloomy melancholy, which is too often
the consequence of this disease.

The patient must, as far as possible, be soothed and humoured in every
thing. Contradiction will ruffle his mind, and increase his malady. Even
when he calls for things which are not to be obtained, or which might
prove hurtful, he is not to be positively denied them, but rather put
off with the promise of having them as soon as they can be obtained, or
by some other excuse. A little of any thing that the mind is set upon,
though not quite proper, will hurt the patient less than a positive
refusal. In a word, whatever he was fond of, or used to be delighted
with when in health, may here be tried, as pleasing stories, soft music,
or whatever has a tendency to sooth the passions and compose the mind.
Boerhaave proposes several mechanical experiments for this purpose; as
the soft noise of water distilling by drops into a bason, and the
patient trying to reckon them, &c. Any uniform sound, if low and
continued, has a tendency to procure sleep, and consequently may be of
service.

The aliment ought to be light, consisting chiefly of farinaceous
substances; as panado, and water-gruel sharpened with jelly of currants,
or juice of lemons, ripe fruits roasted or boiled, jellies, preserves,
&c. The drink small, diluting, and cooling; as whey, barley-water, or
decoctions of barley and tamarinds, which latter not only render the
liquor more palatable, but likewise more beneficial, as they are of an
opening nature.

MEDICINE.——In an inflammation of the brain, nothing more certainly
relieves the patient than a free discharge of blood from the nose. When
this comes of its own accord, it is by no means to be stopped, but
rather promoted, by applying cloths dipped in warm water to the part.
When bleeding at the nose does not happen spontaneously, it may be
provoked, by putting a straw, or any other sharp body, up the nostril.

Bleeding in the temporal arteries greatly relieves the head: but as this
operation cannot always be performed, we would recommend in its stead
bleeding in the jugular veins. When the patient’s pulse and spirits are
so low, that he cannot bear bleeding with the lancet, leeches may be
applied to the temples. These not only draw off the blood more
gradually, but by being applied nearer to the part affected, generally
give more immediate relief.

A discharge of blood from the hæmorrhoidal veins is likewise of great
service, and ought by all means to be promoted. If the patient has been
subject to the bleeding piles, and that discharge has been stopped,
every method must be tried to restore it; as the application of leeches
to the parts, sitting over the steams of warm water, sharp clysters, or
suppositories made of honey, aloes, and rock-salt.

If the inflammation of the brain be occasioned by the stoppage of
evacuations either natural or artificial, as the menses, issues, setons,
or such like, all means must be used to restore them as soon as
possible, or to substitute others in their stead.

The patient’s body must be kept open by stimulating clysters or smart
purges; and small quantities of nitre ought frequently to be mixed with
his drink. Two or three drachms, or more, if the case be dangerous, may
be used in the space of twenty-four hours.

The head should be shaved and frequently rubbed with vinegar and
rose-water. Cloths dipped in this mixture may likewise be applied to the
temples. The feet ought frequently to be bathed in lukewarm water, and
soft poultices of bread and milk may be kept constantly applied to them.

If the disease proves obstinate, and does not yield to these medicines,
it will be necessary to apply a blistering-plaster to the whole head.




                              CHAP. XXVII.
            OF THE OPHTHALMIA, OR INFLAMMATION OF THE EYES.


This disease may be occasioned by external injuries; as blows, burns,
bruises, and the like. It may likewise proceed from dust, quicklime, or
other substances, getting into the eyes. It is often caused by the
stoppage of customary evacuations; as the healing of old sores, drying
up of issues, the suppressing of gentle morning sweats, or of the
sweating of the feet, &c. Long exposure to the night air, especially in
cold northerly winds, or whatever suddenly checks the perspiration,
especially after the body has been much heated, is very apt to cause an
inflammation of the eyes. Viewing snow or other white bodies for a long
time, or looking stedfastly at the sun, a clear fire, or any bright
object, will likewise occasion this malady. A sudden transition from
darkness to very bright light will often have the same effect.

Nothing more certainly occasions an inflammation of the eyes than
night-watching, especially reading or writing by candle-light. Drinking
spirituous liquors, and excess of venery, are likewise very hurtful to
the eyes. The acrid fumes of metals, and of several kinds of fuel, are
also pernicious. Sometimes an inflammation of the eyes proceeds from a
venereal taint, and often from a scrophulous or gouty habit. It may
likewise be occasioned by hairs in the eye-lids turning inwards, and
hurting the eyes. Sometimes the disease is epidemic, especially after
wet seasons; and I have frequently known it prove infectious,
particularly to those who lived in the same house with the patient. It
may be occasioned by moist air, or living in low damp houses, especially
in persons who are not accustomed to such situations. In children it
often proceeds from imprudently drying up of scabbed heads, a running
behind the ears, or any other discharge of that kind. Inflammations of
the eyes often succeed the small-pox or measles, especially in children
of a scrophulous habit.

SYMPTOMS.——An inflammation of the eyes is attended with acute pain,
heat, redness, and swelling. The patient is not able to bear the light,
and sometimes he feels a pricking pain, as if his eyes were pierced with
a thorn. Sometimes he imagines his eyes are full of motes, or thinks he
sees flies dancing before him. The eyes are filled with a scalding
rheum, which rushes forth in great quantities, whenever the patient
attempts to look up. The pulse is generally quick and hard, with some
degree of fever. When the disease is violent, the neighbouring parts
swell, and there is a throbbing or pulsation in the temporal arteries,
&c.

A slight inflammation of the eyes, especially from an external cause, is
easily cured; but when the disease is violent, and continues long, it
often leaves specks upon the eyes, or dimness of sight, and sometimes
total blindness.

If the patient be seized with a looseness, it has a good effect; and
when the inflammation passes from one eye to another, as it were by
infection, it is no unfavourable symptom. But when the disease is
accompanied with a violent pain of the head, and continues long, the
patient is in danger of losing his sight.

REGIMEN.——The diet, unless in scrophulous cases, can hardly be too
spare, especially at the beginning. The patient must abstain from every
thing of a heating nature. His food should consist chiefly of mild
vegetables, weak broths, and gruels. His drink may be barley-water,
balm-tea, common whey, and such like.

The patient’s chamber must be darkened, or his eyes shaded by a cover,
so as to exclude the light, but not to press upon the eyes. He should
not look at a candle, the fire, or any luminous object, and ought to
avoid all smoke, as the fumes of tobacco, or any thing that may cause
coughing, sneezing, or vomiting. He should be kept quiet, avoiding all
violent efforts, either of body or mind, and encouraging sleep as much
as possible.

MEDICINE.——This is one of those diseases wherein great hurt is often
done by external applications. Almost every person pretends to be
possessed of a remedy for the cure of sore eyes. These remedies
generally consist of eye-waters and ointments, with other external
applications, which do mischief twenty times for once they do good.
People ought therefore to be very cautious how they use such things, as
even the pressure upon the eyes often increases the malady.

Bleeding, in a violent inflammation of the eyes, is always necessary.
This should be performed as near the part affected as possible. An adult
may lose ten or twelve ounces of blood from the jugular vein, and the
operation may be repeated according to the urgency of the symptoms. If
it should not be convenient to bleed in the neck, the same quantity may
be let from the arm, or any other part of the body.

Leeches are often applied to the temples, or under the eyes, with good
effect. The wounds must be suffered to bleed for some hours, and if the
bleeding stop soon, it may be promoted by the application of cloths dipt
in warm water. In obstinate cases, it will be necessary to repeat this
operation several times.

Opening and diluting medicines are by no means to be neglected. The
patient may take a small dose of Glauber’s salts, and cream of tartar,
every second or third day, or a decoction of tamarinds with senna. If
these be not agreeable, gentle doses of rhubarb and nitre, a little of
the lenitive electuary, or any other mild purgative, will answer the
same end. The patient at the same time must drink freely of water-gruel,
tea, whey, or any other weak diluting liquor. He ought likewise to take,
at bed-time, a large draught of very weak wine-whey, in order to promote
perspiration. His feet and legs must frequently be bathed in lukewarm
water, and his head shaved twice or thrice a-week, and afterwards washed
in cold water. This has often a remarkably good effect.

If the inflammation does not yield to these evacuations,
blistering-plasters must be applied to the temples, behind the ears, or
upon the neck, and kept open for some time by the mild blistering
ointment. I have seldom known these, if long enough kept open, fail to
remove the most obstinate inflammation of the eyes; but for this purpose
it is often necessary to continue the discharge for several weeks.

When the disease has been of long standing, I have seen very
extraordinary effects from a seton in the neck, or between the
shoulders, especially the latter. It should be put upwards and
downwards, or in the direction of the spine, and in the middle between
the shoulder-blades. It may be dressed twice a-day with yellow
basilicon. I have known patients, who had been blind for a considerable
time, recover sight by means of a seton placed as above. When the seton
is put across the neck, it soon wears out, and is both more painful and
troublesome than between the shoulders; besides, it leaves a
disagreeable mark, and does not discharge so freely.

When the heat and pain of the eyes are very great, a poultice of bread
and milk, softened with sweet oil or fresh butter, may be applied to
them, at least all night; and they may be bathed with lukewarm milk and
water in the morning.

If the patient cannot sleep, which is sometimes the case, he may take
twenty or thirty drops of laudanum, or two spoonfuls of the syrup of
poppies, over night, more or less according to his age, or the violence
of the symptoms.

After the inflammation is gone off, if the eyes still remain weak and
tender, they may be bathed every night and morning with cold water and a
little brandy, six parts of the former to one of the latter. A method
should be contrived by which the eye can be quite immersed in the brandy
and water, where it should be kept for some time. I have generally found
this, or cold water and vinegar, as good a strengthener of the eyes as
any of the most celebrated collyriums.

When an inflammation of the eyes proceeds from a scrophulous habit, it
generally proves very obstinate. In this case the patient’s diet must
not be too low, and he may be allowed to drink small negus, or now and
then a glass of wine, The most proper medicine is the Peruvian bark,
which may either be given in substance, or prepared in the following
manner:

Take an ounce of the bark in powder, with two drachms of Winter’s bark,
and boil them in an English quart of water to a pint; when it has boiled
nearly long enough, add half an ounce of liquorice-root sliced. Let the
liquor be strained. Two, three, or four table-spoonfuls, according to
the age of the patient, may be taken three or four times a-day, It is
impossible to say how long this medicine should be continued, as the
cure is sooner performed in some than in others; but in general it
requires a considerable time to produce any lasting effects.

Dr. Cheyne says, ‘That Æthiops mineral never fails in obstinate
inflammations of the eyes, even scrophulous ones, if given in a
sufficient dose, and duly persisted in.’ There is no doubt but this and
other preparations of mercury may be of singular service in ophthalmias
of long continuance, but they ought always to be administered with the
greatest caution, or by persons of skill in physic.

It will be proper frequently to look into the eyes, to see if any hairs
be turned inwards, or pressing upon them[105]. These ought to be removed
by plucking them out with a pair of small pincers.

Those who are liable to frequent returns of this disease, ought
constantly to have an issue in one or both arms. Bleeding or purging in
the spring and autumn, will be very beneficial to such persons. They
ought likewise to live with the greatest regularity, avoiding strong
liquor, and every thing of a heating quality. Above all, let them avoid
the night-air and late studies[106].




                             CHAP. XXVIII.
             OF THE QUINSEY, OR INFLAMMATION OF THE THROAT.


This disease is very common in Britain, and is frequently attended with
great danger. It prevails in the winter and spring, and is most fatal to
young people of a sanguine temperament.

CAUSES.——In general it proceeds from the same causes as other
inflammatory disorders, _viz._ an obstructed perspiration, or whatever
heats or inflames the blood. An inflammation of the throat is often
occasioned by omitting some part of the covering usually worn about the
neck, by drinking cold liquor when the body is warm, by riding or
walking against a cold northerly wind, or any thing that greatly cools
the throat, and parts adjacent. It may likewise proceed from the neglect
of bleeding, purging, or any customary evacuation.

Singing, speaking loud and long, or whatever strains the throat, may
likewise cause an inflammation of that organ. I have often known the
quinsey prove fatal to jovial companions, who, after sitting long in a
warm room, drinking hot liquors, and singing with vehemence, were so
imprudent as to go abroad in the cold night-air. Sitting with wet feet,
or keeping on wet clothes, are very apt to occasion, this malady. It is
likewise frequently occasioned by continuing long in a moist place,
sitting near an open window, sleeping in a damp bed, sitting in a room
that has been newly plastered, &c. I know people who never fail to have
a sore throat if they sit even but a short time in a room that has been
lately washed.

Acrid or irritating food may likewise inflame the throat, and occasion a
quinsey. It may also proceed from bones, pins, or other sharp substances
sticking in the throat, or from the caustic fumes of metals or minerals,
as arsenic, antimony, &c. taken in by the breath. This disease is
sometimes epidemic and infectious.

SYMPTOMS.——The inflammation of the throat is evident from inspection,
the parts appearing red and swelled; besides, the patient complains of
pain in swallowing. His pulse is quick and hard, with other symptoms of
a fever. If blood be let, it is generally covered with a tough coat of a
whitish colour, and the patient spits a tough phlegm. As the swelling
and inflammation increase, the breathing and swallowing become more
difficult; the pain affects the ears; the eyes generally appear red; and
the face swells. The patient is often obliged to keep himself in an
erect posture, being in danger of suffocation; there is a constant
nausea, or inclination to vomit, and the drink, instead of passing into
the stomach, is often returned by the nose. The patient is sometimes
starved at last, merely from an inability to swallow any kind of food.

When the breathing is laborious, with straitnesss of the breast, and
anxiety, the danger is great. Though the pain in swallowing be very
great, yet while the patient breathes easy, there is not so much danger·
An external swelling is no unfavourable symptom; but if it suddenly
falls, and the disease affects the breast, the danger is very great.
When a quinsey is the consequence of some other disease, which has
already weakened the patient, his situation is dangerous. A frothing at
the mouth, with a swelled tongue, a pale, ghastly countenance, and
coldness of the extremities, are fatal symptoms.

REGIMEN.——The regimen in this disease is in all respects the same as in
the pleurisy, or peripneumony. The food must be light, and in small
quantity, and the drink plentiful, weak, and diluting, mixed with acids.

It is highly necessary that the patient be kept easy and quiet. Violent
affections of the mind, or great efforts of the body, may prove fatal.
He should not even attempt to speak but in a low voice. Such a degree of
warmth as to promote a constant, gentle sweat, is proper. When the
patient is in bed, his head ought to be raised a little higher than
usual.

It is peculiarly necessary that the neck be kept warm; for which purpose
several folds of soft flannel may be wrapt round it. That alone will
often remove a slight complaint of the throat, especially if applied in
due time. We cannot here omit observing the propriety of a custom which
prevails among the peasants of Scotland. When they feel any uneasiness
of the throat, they wrap a stocking about it all night. So effectual is
this remedy, that in many places it passes for a charm, and the stocking
is applied with particular ceremonies: the custom, however, is
undoubtedly a good one, and should never be neglected. When the throat
has been thus wrapped up all night, it must not be exposed to the cold
air through the day, but a handkerchief or a piece of flannel kept about
it till the inflammation be removed.

The jelly of black currants is a medicine very much in esteem for
complaints of the throat; and indeed it is of some use. It should be
almost constantly kept in the mouth, and swallowed down leisurely. It
may likewise be mixed in the patient’s drink, or taken any other way.
When it cannot be obtained, the jelly of red currants, or of mulberries,
may be used in its stead.

Gargles for the throat are very beneficial, They may be made of
sage-tea, with a little vinegar and honey, or by adding to half an
English pint of the pectoral decoction two or three spoonfuls of honey,
and the same quantity of currant-jelly. This may be used three or four
times a-day; and if the patient be troubled with tough viscid phlegm,
the gargle may be rendered more sharp and cleansing, by adding to it a
tea-spoonful of the spirit of _sal ammoniac_. Some recommend gargles
made of a decoction of the leaves or bark of the black currant-bush; but
where the jelly can be had, these are unnecessary.

There is no disease wherein the benefit of bathing the feet and legs in
lukewarm water is more apparent: that practice ought therefore never to
be neglected. If people were careful to keep warm, to wrap up their
throats with flannel, to bathe their feet and legs in warm water, and to
use a spare diet, with diluting liquors, at the beginning of this
disease, it would seldom proceed to a great height, or be attended with
any danger; but when these precautions are neglected, and the disease
becomes violent, more powerful medicines are necessary.

MEDICINE.——An inflammation of the throat being a most acute and
dangerous distemper, which sometimes takes off the patient very
suddenly, it will be proper, as soon as the symptoms appear, to bleed in
the arm, or rather in the jugular vein, and to repeat the operation if
circumstances require.

The body should likewise be kept gently open. This may either be done by
giving the patient for his ordinary drink a decoction of figs and
tamarinds, or small doses of rhubarb and nitre, as recommended in the
erysipelas. These may be increased according to the age of the patient,
and repeated till they have the desired effect.

I have often known very good effects from a bit of _sal prunel_, or
purified nitre, held in the mouth, and swallowed down as it melted. This
promotes the discharge of _saliva_, by which means it answers the end of
a gargle, while at the same time it abates the fever, by promoting the
discharge of urine, &c.

The throat ought likewise to be rubbed twice or thrice a-day with a
little of the volatile liniment. This seldom fails to produce some good
effects. At the same time the neck ought to be carefully covered with
wool or flannel, to prevent the cold from penetrating the skin, as this
application renders it very tender. Many other external applications are
recommended in this disease, as a swallow’s nest, poultices made of the
fungus called Jew’s ears, album Græcum, &c. But as we do not look upon
any of these to be preferable to a common poultice of bread and milk, we
shall take no farther notice of them.

Some recommend the gum guaiacum as a specific in this disease. Half a
dram of the gum in powder may be made into an electuary with the rob of
elderberries, or the jelly of currants for a dose, and repeated
occasionally[107].

Blistering upon the neck or behind the ears in violent inflammations of
the throat is very beneficial; and in bad cases it will be necessary to
lay a blistering-plaster quite across the throat, so as to reach from
ear to ear. After the plasters are taken off, the parts ought to be kept
running by the application of issue ointment, till the inflammation is
gone; otherwise, upon their drying up, the patient will be in danger of
a relapse.

When the patient has been treated as above, a suppuration seldom
happens. This however is sometimes the case, in spite of all endeavours
to prevent it. When the inflammation and swelling continue, and it is
evident that a suppuration will ensue, it ought to be promoted by
drawing the steam of warm water into the throat through a tunnel, or the
like. Soft poultices ought likewise to be applied outwardly, and the
patient may keep a roasted fig constantly in his mouth.

It sometimes happens, before the tumour breaks, that the swelling is so
great, as entirely to prevent any thing from getting down into the
stomach. In this case the patient must inevitably perish, unless he can
be supported in some other way. This can only be done by nourishing
clysters of broth, or gruel with milk, &c. Patients have often been
supported by these for Several days, till the tumour has broke; and
afterwards they have recovered.

Not only the swallowing, but the breathing, is often prevented by the
tumour. In this case nothing can save the patient’s life, but opening
the _trachea_ or wind-pipe. As that has been often done with success, no
person, in such desperate circumstances, ought to hesitate a moment
about the operation; but as it can only be performed by a surgeon, it is
not necessary here to give any directions about it.

When a difficulty of swallowing is not attended with an acute pain or
inflammation, it is generally owing to an obstruction of the glands
about the throat, and only requires that the part be kept warm, and the
throat frequently gargled with something that may gently stimulate the
glands, as a decoction of figs with vinegar and honey; to which may be
added a little mustard, or a small quantity of spirits. But this gargle
is never to be used where there are signs of an inflammation. This
species of _angina_ has various names among the common people, as _the
pap of the throat_, the falling down of the _almonds of the ears_, &c.
Accordingly, to remove it, they lift the patient up by the hair of the
head, and thrust their fingers under his jaws, &c. all which practices
are at best useless, and often hurtful.

Those who are subject to inflammations of the throat, in order to avoid
that disease, ought to live temperate. Such as do not chuse to observe
this rule, must have frequent recourse to purging and other evacuations,
to discharge the superfluous humours. They ought likewise to beware of
catching cold, and should abstain from aliment and medicines of an
astringent or stimulating nature.

Violent exercise, by increasing the motion and force of the blood, is
apt to occasion an inflammation of the throat, especially if cold liquor
be drank immediately after it, or the body suffered suddenly to cool.
Those who would avoid this disease ought therefore, after speaking
aloud, singing, running, drinking warm liquor, or doing any thing that
may strain the throat, or increase the circulation of the blood towards
it, to take care to cool gradually, and to wrap some additional
coverings about their necks.

I have often known persons who had been subject to sore throats,
entirely freed from that complaint by only wearing a riband, or a bit of
flannel, constantly about their necks, or by wearing thicker shoes, a
flannel waistcoat, or the like. These may seem trifling, but they have
great effect. There is danger indeed in leaving them off after persons
have been accustomed to them; but surely the inconveniency of using such
things for life, is not to be compared with the danger which may attend
the neglect of them.

Sometimes, after an inflammation, the glands of the throat continue
swelled, and become hard and callous. This complaint is not easily
removed, and is often rendered dangerous by the too frequent application
of strong stimulating and styptic medicines. The best method is to keep
it warm, and to gargle it twice a-day with a decoction of figs sharpened
a little with the elixir or spirit of vitriol.

OF THE MALIGNANT QUINSEY, OR PUTRID, ULCEROUS SORE THROAT.

This kind of quinsey is but little known in the northern parts of
Britain, though, for some time past, it has been fatal in the more
southern counties. Children are more liable to it than adults, females
than males, and the delicate than those who are hardy and robust. It
prevails chiefly in autumn, and is most frequent after a long course of
damp or sultry weather.

CAUSES.——This is evidently a contagious distemper, and is generally
communicated by infection. Whole families, and even entire villages,
often receive the infection from one person. This ought to put people
upon their guard against going near such patients as labour under the
disorder; as by that means they endanger not only their own lives, but
likewise those of their friends and connexions. Whatever tends to
produce putrid or malignant fevers, may likewise occasion the putrid
ulcerous sore throat, as unwholesome air, damaged provisions, neglect of
cleanliness, &c.

SYMPTOMS.——It begins with alternate fits of shivering and heat. The
pulse is quick, but low and unequal, and generally continues so through
the whole course of the disease. The patient complains greatly of
weakness and oppression of the breast, his spirits are low, and he is
apt to faint away when set upright; he is troubled with a nausea, and
often with a vomiting or purging. The two latter are most common in
children. The eyes appear red and watery, and the face swells. The urine
is at first pale and crude; but, as the disease advances, it turns more
of a yellowish colour. The tongue is white, and generally moist, which
distinguishes this from an inflammatory disease. Upon looking into the
throat it appears swelled, and of a florid red colour. Pale or
ash-coloured spots, however, are here and there interspersed, and
sometimes one broad patch or spot, of an irregular figure, and pale
white colour, surrounded with florid red, only appears. These whitish
spots or sloughs cover so many ulcers.

An efflorescence, or eruption upon the neck, arms, breast, and fingers,
about the second or third day, is a common symptom of this disease. When
it appears, the purging and vomiting generally cease.

There is often a slight degree of delirium, and the face frequently
appears bloated, and the inside of the nostrils red and inflamed. The
patient complains of a disagreeable putrid smell, and his breath is very
offensive.

The putrid, ulcerous sore throat may be distinguished from the
inflammatory by the vomiting and looseness with which it is generally
ushered in; the foul ulcers in the throat covered with a white or livid
coat; and by the excessive weakness of the patient; with other symptoms
of a putrid fever.

Unfavourable symptoms are, an obstinate purging, extreme weakness,
dimness of the sight, a livid or black colour of the spots, and frequent
shiverings, with a weak, fluttering pulse. If the eruption upon the skin
suddenly disappears, or becomes of a livid colour, with a discharge of
blood from the nose or mouth, the danger is very great.

If a gentle sweat break out about the third or fourth day, and continue
with a slow, firm, and equal pulse; if the sloughs cast off in a kindly
manner, and appear clean and florid at the bottom; and if the breathing
is soft and free, with a lively colour of the eyes, there is reason to
hope for a salutary crisis.

REGIMEN.——The patient must be kept quiet, and for the most part in bed,
as he will be apt to faint when taken out of it. His food must be
nourishing and restorative; as sago-gruel with red wine, jellies, strong
broths, &c. His drink ought to be generous, and of an antiseptic
quality; as red-wine negus, white-wine whey, and such like.

MEDICINE.——The medicine in this kind of quinsey is entirely different
from that which is proper in the inflammatory. All evacuations, as
bleeding, purging, &c. which weaken the patient, must be avoided.
Cooling medicines, as nitre and cream of tartar, are likewise hurtful.
Strengthening cordials alone can be used with safety; and these ought
never to be neglected.

If at the beginning there is a great nausea, or inclination to vomit,
the patient must drink an infusion of green tea, camomile flowers, or
_carduus benedictus_, in order to cleanse the stomach. If these are not
sufficient, he may take a few grains of the powder of ipecacuanha, or
any other gentle vomit.

If the disease is mild, the throat may be gargled with an infusion of
sage and rose leaves, to a gill of which may be added a spoonful or two
of honey, and as much vinegar as will make it agreeably acid; but when
the symptoms are urgent, the sloughs large and thick, and the breath
very offensive, the following gargle may be used:

To six or seven ounces of the pectoral decoction, when boiling, add half
an ounce of contrayerva-root; let it boil for some time, and afterwards
strain the liquor; to which add two ounces of white-wine vinegar, an
ounce of fine honey, and an ounce of the tincture of myrrh. This ought
not only to be used as a gargle, but a little of it should frequently be
injected with a syringe to clean the throat, before the patient takes
any meat or drink. This method is peculiarly necessary for children, who
cannot use a gargle.

It will be of great benefit if the patient frequently receives into his
mouth, through an inverted funnel, the steams of warm vinegar, myrrh,
and honey.

But when the putrid symptoms run high, and the disease is attended with
danger, the only medicine that can be depended upon is the Peruvian
bark. It may be taken in substance, if the patient’s stomach will bear
it. If not, an ounce of bark grossly powdered, with two drachms of
Virginian snake-root, may be boiled in an English pint and a half of
water to half a pint; to which a tea-spoonful of the elixir of vitriol
may be added, and an ordinary tea-cupful of it taken every three or four
hours. Blistering-plasters are very beneficial in this disease,
especially when the patient’s pulse and spirits are low. They may be
applied to the throat, behind the ears, or upon the back part of the
neck.

Should the vomiting prove troublesome, it will be proper to give the
patient two table-spoonfuls of the saline julep every hour. Tea made of
mint and a little cinnamon will be very proper for his ordinary drink,
especially if an equal quantity of red-wine be mixed with it.

In case of a violent looseness, the size of a nutmeg of _diascordium_,
or the japonic confection, may be taken two or three times a-day, or
oftener if necessary.

If a discharge of blood from the nose happens, the steams of warm
vinegar may be received up the nostrils frequently; and the drink must
be sharpened with spirits of vitriol, or tincture of roses.

In case of a strangury, the belly must be fomented with warm water, and
emollient clysters given three or four times a-day.

After the violence of the disease is over, the body should still be kept
open with mild purgatives; as manna, senna, rhubarb, or the like.

If great weakness and dejection of spirits, or night-sweats, with other
symptoms of a consumption, should ensue, we would advise the patient to
continue the use of the Peruvian bark, with the elixir of vitriol, and
to take frequently a glass of generous wine. These, together with a milk
diet, and riding on horseback, are the most likely means for recovering
his strength.




                              CHAP. XXIX.
                          OF COLDS AND COUGHS.


It has already been observed, that colds are the effect of an obstructed
perspiration; the common causes of which we have likewise endeavoured to
point out, and shall not here repeat them. Neither shall we spend time
in enumerating all the various symptoms of colds, as they are pretty
generally known. It may not however be amiss to observe, that almost
every cold is a kind of fever, which only differs in degree from some of
those that have already been treated of.

No age, sex, or constitution, is exempted from this disease; neither is
it in the power of any medicine or regimen to prevent it. The
inhabitants of every climate are liable to catch cold, nor can even the
greatest circumspection defend them at all times from its attacks.
Indeed, if the human body could be kept constantly in an uniform degree
of warmth, such a thing as catching cold would be impossible: but as
that cannot be effected by any means, the perspiration must be liable to
many changes. Such changes, however, when small, do not affect the
health; but, when great, they must prove hurtful.

When oppression of the breast, a stuffing of the nose, unusual
weariness, pain of the head, &c. give ground to believe that the
perspiration is obstructed, or, in other words, that the person has
caught cold, he ought immediately to lessen his diet, at least the usual
quantity of his solid food, and to abstain from all strong liquors.
Instead of flesh, fish, eggs, milk, and other nourishing diet, he may
eat light bread-pudding, veal or chicken broth, panado, gruels, and such
like. His drink may be water-gruel sweetened with a little honey; an
infusion of balm, or linseed sharpened with the juice of orange or
lemon; a decoction of barley and liquorice, with tamarinds, or any other
cool, diluting, acid liquor.

Above all, his supper should be light; as small posset, or water-gruel
sweetened with honey, and a little toasted bread in it. If honey should
disagree with the stomach, the gruel may be sweetened with treacle or
coarse sugar, and sharpened with the jelly of currants. Those who have
been accustomed to generous liquors may take wine-whey instead of gruel,
which may be sweetened as above.

The patient ought to lie longer than usual a-bed, and to encourage a
gentle sweat, which is easily brought on towards morning, by drinking
tea, or any kind of warm diluting liquor. I have often known this
practice carry off a cold in one day, which in all probability, had it
been neglected, would have cost the patient his life, or have confined
him for some months. Would people sacrifice a little time to ease and
warmth, and practice a moderate degree of abstinence when the first
symptoms of a cold appear, we have reason to believe, that most of the
bad effects which flow from an obstructed perspiration might be
prevented. But, after the disease has gathered strength by delay, all
attempts to remove it often prove vain. A pleurisy, a peripneumony, or a
fatal consumption of the lungs, are the common effects of colds which
have either been totally neglected or treated improperly.

Many attempt to cure a cold, by getting drunk. But this, to say no worse
of it, is a very hazardous experiment. No doubt it may sometimes
succeed, by suddenly restoring the perspiration; but when there is any
degree of inflammation, which is frequently the case, strong liquors,
instead of removing the malady, will increase it. By this means a common
cold may be converted into an inflammatory fever.

When those who labour for their daily bread have the misfortune to catch
cold, they cannot afford to lose a day or two, in order to keep
themselves warm, and take a little medicine; by which means the disorder
is often so aggravated as to confine them for a long time, or even to
render them ever after unable to sustain hard labour. But even such of
the labouring poor as can afford to take care of themselves, are often
too hardy to do it; they affect to despise colds, and as long as they
can crawl about, scorn to be confined by what they call a _common cold_.
Hence it is, that colds destroy such numbers of mankind. Like an enemy
despised, they gather strength from delay, till at length they become
invincible. We often see this verified in travellers, who, rather than
lose a day in the prosecution of their business, throw away their lives
by pursuing their journey, even in the severest weather, with this
disease upon them.

It is certain, however, that colds may be too much indulged. When a
person, for every slight cold, shuts himself up in a warm room, and
drinks great quantities of warm liquor, it may occasion such a general
relaxation of the solids as will not be easily removed. It will
therefore be proper, when the disease will permit, and the weather is
mild, to join to the regimen mentioned above gentle exercise; as
walking, riding on horseback, or in a carriage, &c. An obstinate cold,
which no medicine can remove, will yield to gentle exercise and a proper
regimen of the diet.

Bathing the feet and legs in warm water has a great tendency to restore
the perspiration. But care must be taken that the water be not too warm,
otherwise it will do hurt. It should never be much warmer than the
blood, and the patient should go immediately to bed after using it.
Bathing the feet in warm water, lying in bed, and drinking warm
water-gruel, or other weak liquors, will sooner take off a spasm, and
restore the perspiration, than all the hot sudorific medicines in the
world. This is all that is necessary for removing a common cold; and if
this course be taken at the beginning, it will seldom fail.

But when the symptoms do not yield to abstinence, warmth, and diluting
liquors, there is reason to fear the approach of some other disease, as
an inflammation of the breast, an ardent fever, or the like. If the
pulse therefore be hard and frequent, the skin hot and dry, and the
patient complains of his head or breast, it will be necessary to bleed,
and to give the cooling powders recommended in the scarlet fever every
three or four hours, till they give a stool.

It will likewise be proper to put a blistering-plaster on the back, to
give two table-spoonfuls of the saline mixture every two hours, and in
short to treat the patient in all respects as for a slight fever. I have
often seen this course, when observed at the beginning, remove the
complaint in two or three days, when the patient had all the symptoms of
an approaching ardent fever, or an inflammation of the breast.

The chief secret of preventing colds lies in avoiding, as far as
possible, all extremes either of heat or cold, and in taking care, when
the body is heated, to let it cool gradually. These and other
circumstances relating to this important subject, are so fully treated
of under the article _Obstructed Perspiration_, that it is needless here
to resume the consideration of them.


                           OF A COMMON COUGH.

A cough is generally the effect of a cold, which has either been
improperly treated, or entirely neglected. When it proves obstinate,
there is always reason to fear the consequences, as this shews a weak
state of the lungs, and is often the forerunner of a consumption.

If the cough be violent, and the patient young and strong, with a hard
quick pulse, bleeding will be proper; but in weak and relaxed habits,
bleeding rather prolongs the disease. When the patient spits freely,
bleeding is unnecessary, and sometimes hurtful, as it tends to lessen
that discharge.

When the cough is not attended with any degree of fever, and the spittle
is viscid and tough, sharp pectoral medicines are to be administered; as
gum ammoniac, squills, &c. Two table-spoonfuls of the solution of gum
ammoniac may be taken three or four times a-day, more or less, according
to the age and constitution of the patient. Squills may be given various
ways; two ounces of the vinegar, the oxymel, or the syrup, may be mixed
with the same quantity of simple cinnamon water, to which may be added
an ounce of common water and an ounce of balsamic syrup. Two
table-spoonfuls of this mixture may be taken three or four times a-day.

A syrup made of equal parts of lemon-juice, honey, and sugar-candy, is
likewise very proper in this kind of cough. A table-spoonful of it may
be taken at pleasure.

But when the defluxion is sharp and thin, these medicines rather do
hurt. In this case gentle opiates, oils, and mucilages, are more proper.
A cup of an infusion of wild poppy leaves, and marsh-mallow roots, or
the flowers of coltsfoot, may be taken frequently; or a tea-spoonful of
the paregoric elixir may be put into the patient’s drink twice a-day.
Fuller’s Spanish infusion is also a very proper medicine in this case,
and may be taken in the quantity of a tea-cupful three or four times
a-day[108].

When a cough is occasioned by acrid humours tickling the throat and
_fauces_, the patient should keep some soft pectoral lozenges almost
constantly in his mouth; as the Pontefract liquorice cakes,
barley-sugar, the common balsamic lozenges, Spanish juice, &c. These
blunt the acrimony of the humours, and by taking off their stimulating
quality, help to appease the cough[109].

In obstinate coughs, proceeding from a flux of humours upon the lungs,
it will often be necessary, besides expectorating medicines, to have
recourse to issues, setons, or some other drain. In this case I have
often observed the most happy effects from a Burgundy-pitch plaster
applied between the shoulders. I have ordered this simple remedy in the
most obstinate coughs, in a great number of cases, and in many different
constitutions, without ever knowing it fail to give relief, unless where
there were evident signs of an ulcer in the lungs.

About the bulk of a nutmeg of Burgundy-pitch may be spread thin upon a
piece of soft leather, about the size of the hand, and laid between the
shoulder-blades. It may be taken off and wiped every three or four days,
and ought to be renewed once a fortnight or three weeks. This is indeed
a cheap and simple medicine, and consequently apt to be despised; but we
will venture to affirm, that the whole _materia medica_ does not afford
an application more efficacious in almost every kind of cough. It has
not indeed always an immediate effect; but, if kept on for some time, it
will succeed where most other medicines fail.

The only inconveniency attending this plaster is the itching which it
occasions; but surely this may be dispensed with, considering the
advantage which the patient may expect to reap from the application;
besides, when the itching becomes very uneasy, the plaster may be taken
off, and the part rubbed with a dry cloth, or washed with a little warm
milk and water. Some caution indeed is necessary in discontinuing the
use of such a plaster; this however may be safely done by making it
smaller by degrees, and at length quitting it altogether in a warm
season[110].

But coughs proceed from many other causes besides defluxions upon the
lungs. In these cases the cure is not to be attempted by pectoral
medicines. Thus, in a cough proceeding from a foulness and debility of
the stomach, syrups, oils, mucilages, and all kinds of balsamic
medicines do hurt. The _stomach cough_ may be known from one that is
owing to a fault in the lungs by this, that in the latter the patient
coughs whenever he inspires, or draws in his breath fully; but in the
former that does not happen.

The cure of this cough depends chiefly upon cleansing and strengthening
the stomach; for which purpose gentle vomits and bitter purgatives are
most proper. Thus, after a vomit or two, the sacred tincture, as it is
called, may be taken for a considerable time in the dose of one or two
table-spoonfuls twice a-day, or as often as it is found necessary, to
keep the body gently open. People may make this tincture themselves, by
infusing an ounce of _hiera picra_[111] in an English pint of white
wine, letting it stand a few days, and then draining it.

In coughs which proceed from a debility of the stomach, the Peruvian
bark is likewise of considerable service. It may either be chewed, taken
in powder, or made into a tincture along with other stomachic bitters.

_A nervous cough_ can only be removed by change of air and proper
exercise; to which may be added the use of gentle opiates. Instead of
the saponaceous pill, the paregoric elixir, &c. which are only opium
disguised, ten, fifteen, twenty, or twenty-five drops of liquid
laudanum, more or less, as circumstances require, may be taken at
bed-time, or when the cough is most troublesome. Immersing the feet and
hands in warm water will often appease the violence of a nervous cough.

When a cough is only the symptom of some other malady, it is in vain to
attempt to remove it without first curing the disease from which it
proceeds. Thus when a cough is occasioned by _teething_, keeping the
body open, scarifying the gums, or whatever facilitates the cutting of
the teeth, likewise appeases the cough. In like manner, when _worms_
occasion a cough, such medicines as remove these vermin will generally
cure the cough; as bitter purgatives, oily clysters, and such like.

Women, during the last months of pregnancy, are often greatly afflicted
with a cough, which is generally relieved by bleeding, and keeping the
body gently open. They ought to avoid all flatulent food, and to wear a
loose easy dress.

A cough is not only a symptom, but is often likewise the forerunner of
diseases. Thus, the gout is frequently ushered in by a very troublesome
cough, which affects the patient for some days before the coming on of
the fit. This cough is generally removed by a paroxysm of the gout,
which should therefore be promoted, by keeping the extremities warm,
drinking warm liquors, and bathing the feet and legs frequently in
lukewarm water.


                  OF THE HOOPING-COUGH, OR CHIN-COUGH.

This cough seldom affects adults, but proves often fatal to children.
Such children as live upon thin watery diet, who breathe unwholesome
air, and have too little exercise, are most liable to this disease, and
generally suffer most from it.

The chin-cough is so well known, even to nurses, that a description of
it is unnecessary. Whatever hurts the digestion, obstructs the
perspiration, or relaxes the solids, disposes to this disease:
consequently its cure must depend upon cleansing and strengthening the
stomach, bracing the solids, and at the same time promoting perspiration
and the different secretions.

The diet must be light, and of easy digestion; for children, good bread
made into pap or pudding, chicken-broth, with other light spoon meats,
are proper; but those who are farther advanced may be allowed
sago-gruel, and if the fever be not high, a little boiled chicken, or
other white meats. The drink may be hyssop, or penny-royal tea,
sweetened with honey or sugar-candy, small wine-whey; or, if the patient
be weak, he may sometimes be allowed a little negus.

One of the most effectual remedies in the chin-cough is change of air.
This often removes the malady, even when the change seems to be from a
purer to a less wholesome air. This may in some measure depend on the
patient’s being removed from the place where the infection prevails.
Most of the diseases of children are infectious; nor is it at all
uncommon to find the chin-cough prevailing in one town or village, when
another, at a very small distance, is quite free from it. But whatever
be the cause, we are sure of the fact. No time ought therefore to be
lost in removing the patient at some distance from the place where he
caught the disease, and, if possible, into a more pure and warm
air[112].

When the disease proves violent, and the patient is in danger of being
suffocated by the cough, he ought to be bled, especially if there be a
fever with a hard full pulse. But as the chief intention of bleeding is
to prevent an inflammation of the lungs, and to render it more safe to
give vomits, it will seldom be necessary to repeat the operation; yet if
there are symptoms of an inflammation of the lungs, a second or even a
third bleeding may be requisite.

It is generally reckoned a favourable symptom when a fit of coughing
makes the patient vomit. This cleanses the stomach, and greatly relieves
the cough. It will therefore be proper to promote this discharge, either
by small doses of ipecacuanha, or the vomiting julep recommended in the
Appendix[113].

It is very difficult to make children drink after a vomit. I have often
seen them happily deceived, by infusing a scruple or half a drachm of
the powder of ipecacuanha in a tea-pot, with half an English pint of
boiling water. If this be disguised with a few drops of milk and a
little sugar, they will imagine it tea, and drink it very greedily. A
small tea-cupful of this may be given every quarter of an hour, or
rather every ten minutes, till it operates. When the child begins to
puke, there will be no occasion for drinking any more, as the water
already on the stomach will be sufficient.

Vomits not only cleanse the stomach, which in this disease is generally
loaded with viscid phlegm, but they likewise promote the perspiration
and other secretions, and ought therefore to be repeated according to
the obstinacy of the disease. They should not however be strong; gentle
vomits frequently repeated are both less dangerous, and more beneficial
than strong ones.

The body ought to be kept gently open. The best medicines for this
purpose are rhubarb and its preparations, as the syrup, tincture, &c. Of
these a tea-spoonful or two may be given to an infant twice or thrice
a-day, as there is occasion. To such as are farther advanced, the dose
must be proportionally increased, and repeated till it has the desired
effect. Those who cannot be brought to take the bitter tincture, may
have an infusion of senna and prunes, sweetened with manna, coarse
sugar, or honey; or a few grains of rhubarb mixed with a tea-spoonful or
two of syrup, or currant jelly, so as to disguise the taste. Most
children are fond of syrups and jellies, and seldom refuse even a
disagreeable medicine when mixed with them.

Many people believe that oily, pectoral, and balsamic medicines possess
wonderful virtues for the cure of the chin-cough, and accordingly
exhibit them plentifully to patients of every age and constitution,
without considering that every thing of this nature must load the
stomach, hurt the digestion, and of course aggravate the disorder[114].

The _millepedes_, or woodlice, are greatly recommended for the cure of a
chin-cough. Those who chuse to make use of these insects, may infuse two
ounces of them bruised in an English pint of small white-wine for one
night. Afterwards the liquor may be drained through a cloth, and a
table-spoonful of it given to the patient three or four times a-day.

Opiates are sometimes necessary to allay the violence of the cough. For
this purpose a little of the syrup of poppies, or five, six, or seven
drops of laudanum, according to the age of the patient, may be taken in
a cup of hyssop or penny-royal-tea, and repeated occasionally[115].

The garlic ointment is a well-known remedy in North Britain for the
chin-cough. It is made by beating in a mortar garlic with an equal
quantity of hogs lard. With this the soles of the feet may be rubbed
twice or thrice a-day; but the best method is to spread it upon a rag,
and apply it in the form of plaster. It should be renewed every night
and morning at least, as the garlic soon loses its virtue. This is an
exceeding good medicine both in the chin-cough, and in most other coughs
of an obstinate nature. It ought not however to be used when the patient
is very hot or feverish, lest it should increase these symptoms.

The feet should be bathed once every two or three days in lukewarm
water; and a Burgundy-pitch plaster kept constantly between the
shoulders. But when the disease proves very violent, it will be
necessary, instead of it, to apply a blistering-plaster, and to keep the
part open for some time with issue ointment.

When the disease is prolonged, and the patient is free from a fever, the
Peruvian bark, and other bitters, are the most proper medicines. The
bark may either be taken in substance, or in a decoction or infusion, as
is most agreeable. For a child, ten, fifteen, or twenty grains,
according to the age of the patient, may be given three or four times a
day. For an adult, half a drachm or two scruples will be proper. Some
give the extract of the bark with cantharides; but to manage this
requires a considerable attention. It is more safe to give a few grains
of castor along with the bark. A child of six or seven years of age may
take seven or eight grains of castor, with fifteen grains of powdered
bark, for a dose. This may be made into a mixture with two or three
ounces of any simple distilled water, and a little syrup, and taken
three or four times a-day.




                               CHAP. XXX.
            INFLAMMATION OF THE STOMACH, AND OTHER VISCERA.


All inflammations of the bowels are dangerous, and require the most
speedy assistance; as they frequently end in a suppuration, and
sometimes in a mortification, which is certain death.

CAUSES.——An inflammation of the stomach may proceed from any of the
causes which produce an inflammatory fever; as cold liquor drank while
the body is warm, obstructed perspiration, or the sudden striking in of
any eruption. It may likewise proceed from the acrimony of the bile, or
from acrid and stimulating substances taken into the stomach; as strong
vomits or purges, corrosive poisons, and such like. When the gout has
been repelled from the extremities, either by cold or improper
applications, it often occasions an inflammation of the stomach. Hard or
indigestible substances taken into the stomach, as bones, the stones of
fruit, &c. may likewise have that effect.

SYMPTOMS.——It is attended with a fixed pain and burning heat in the
stomach; great restlessness and anxiety; a small, quick, and hard pulse;
vomiting, or, at least, a nausea and sickness; excessive thirst;
coldness of the extremities; difficulty of breathing; cold clammy
sweats; and sometimes convulsions and fainting fits. The stomach is
swelled, and often feels hard to the touch. One of the most certain
signs of this disease is the sense of pain, which the patient feels upon
taking any kind of food or drink, especially if it be either too hot or
too cold.

When the patient vomits every thing he eats or drinks, is extremely
restless, has a hiccup, with an intermitting pulse, and frequent
fainting fits, the danger is very great.

REGIMEN.——All acrimonious, heating, and irritating food and drink are
carefully to be avoided. The weakness of the patient may deceive the
bystanders, and induce them to give him wines, spirits, or other
cordials; but these never fail to increase the disease, and often
occasion sudden death. The inclination to vomit may likewise impose on
the attendants, and make them think a vomit necessary; but that too is
almost certain death.

The food must be light, thin, cool, and easy of digestion. It must be
given in small quantities, and should neither be quite cold nor too hot.
Thin gruel made of barley or oatmeal, light toasted bread dissolved in
boiling water, or very weak chicken broth, are the most proper. The
drink should be clear whey, barley-water, water in which toasted bread
has been boiled, or decoctions of emollient vegetables; as liquorice and
marsh-mallow roots, sarsaparilla, &c.

MEDICINE.——Bleeding in this disease is absolutely necessary, and is
almost the only thing that can be depended on. When the disease proves
obstinate, it will often be proper to repeat this operation several
times, nor must the low state of the pulse deter us from doing so. The
pulse indeed generally rises upon bleeding, and as long as that is the
case, the operation is safe.

Frequent fomentations with lukewarm water, or a decoction of emollient
vegetables, are likewise beneficial. Flannel cloths dipped in these must
be applied to the region of the stomach, and removed as they grow cool.
They must neither be applied too warm, nor be suffered to continue till
they become quite cold, as either of these extremities would aggravate
the disease.

The feet and legs ought likewise to be frequently bathed in lukewarm
water, and warm bricks or poultices may be applied to the soles of the
feet. The warm bath, if it can be conveniently used, will be of great
service.

In this, and all other inflammations of the bowels, an epispastic, or
blistering-plaster, applied over the part affected, is one of the best
remedies I know. I have often used it, and do not recollect one instance
wherein it did not give relief to the patient.

The only internal medicines which we shall venture to recommend in this
disease, are mild clysters. These may be made of warm water, or thin
water-gruel; and if the patient is costive, a little sweet oil, honey,
or manna, may be added. Clysters answer the purpose of an internal
fomentation, while they keep the body open, and at the same time nourish
the patient, who is often in this disease unable to retain any food upon
his stomach. For these reasons they must not be neglected, as the
patient’s life may depend on them.


                    INFLAMMATION OF THE INTESTINES.

This is one of the most painful and dangerous diseases that mankind is
liable to. It generally proceeds from the same _causes_ as the
inflammation of the stomach; to which may be added costiveness, worms,
eating unripe fruits, or great quantities of nuts, drinking hard windy
malt liquors, as stale bottled beer or ale, sour wine, cyder, &c. It may
likewise be occasioned by a rupture, by schirrous tumours of the
intestines, or by their opposite sides growing together.

The inflammation of the intestines is denominated _Iliac passion,
Enteritis, &c._ according to the name of the parts affected. The
treatment however is nearly the same whatever part of the intestinal
canal be the seat of the disease; we shall therefore omit these
distinctions, lest they should perplex the reader.

The _symptoms_ here are nearly the same as in the foregoing disease;
only the pain, if possible, is more acute, and is situated lower. The
vomiting is likewise more violent, and sometimes even the excrements,
together with the clysters, are discharged by the mouth. The patient is
continually belching up wind, and has often an obstruction of his urine.

While the pain shifts, and the vomiting only returns at certain
intervals, and while the clysters pass downwards, there is ground for
hope; but when the clysters and _fæces_ are vomited, and the patient is
exceeding weak, with a low fluttering pulse, a pale countenance, and a
disagreeable or stinking breath, there is great reason to fear that the
consequences will prove fatal. Clammy sweats, black fœtid stools, with a
small intermitting pulse, and a total cessation of pain, are signs of a
mortification already begun, and of approaching death.

REGIMEN.——The regimen in this disease is in general the same as in an
inflammation of the stomach. The patient must be kept quiet, avoiding
cold, and all violent passions of the mind. His food ought to be very
light, and given in small quantities; his drink weak and diluting; as
clear whey, barley-water, and such like.

MEDICINE.——Bleeding in this, as well as in the inflammation of the
stomach, is of the greatest importance. It should be performed as soon
as the symptoms appear, and must be repeated according to the strength
of the patient, and the violence of the disease.

A blistering plaster is here likewise to be applied immediately over the
part where the most violent pain is. This not only relieves the pain of
the bowels, but even clysters and purgative medicines, which before had
no effect, will operate when the blister begins to rise.

Fomentations and laxative clysters are by no means to be omitted. The
patient’s feet and legs should frequently be bathed in warm water; and
cloths dipped in it applied to his belly. Bladders filled with warm
water may likewise be applied to the region of the navel, and warm
bricks, or bottles filled with warm water, to the soles of the feet. The
clysters may be made of barley-water or thin gruel with salt, and
softened with sweet oil or fresh butter. These may be administered every
two or three hours, or oftener, if the patient continues costive.

If the disease does not yield to clysters and fomentations, recourse
must be had to pretty strong purgatives; but as these, by irritating the
bowels, often increase their contraction, and by that means frustrate
their own intention, it will be necessary to join them with opiates,
which, by allaying the pain, and relaxing the spasmodic contractions of
the guts, greatly assist the operation of purgatives in this case.

What answers the purpose of opening the body very well, is a solution of
the bitter purging salts. Two ounces of these may be dissolved in an
English pint of warm water, or thin gruel, and a tea-cupful of it taken
every half hour till it operates. At the same time fifteen, twenty, or
twenty-five drops of laudanum may be given in a glass of peppermint or
simple cinnamon-water, to appease the irritation, and prevent the
vomiting, &c.

Acids have often a very happy effect in staying the vomiting, and
appeasing the other violent symptoms of this disease. It will therefore
be of use to sharpen the patient’s drink with cream of tartar, juice of
lemon; or, when these cannot be obtained, with vinegar.

But it often happens that no liquid whatever will stay on the stomach.
In this case the patient must take purging pills. I have generally found
the following answer very well: Take jalap in powder, and vitriolated
tartar, of each half a drachm, opium one grain, Castile soap as much as
will make the mass fit for pills. These must be taken at one dose, and
if they do not operate in a few hours, the dose may be repeated.

If a stool cannot be procured by any of the above means, it will be
necessary to immerse the patient in warm water up to the breast. I have
often seen this succeed when other means had been tried in vain. The
patient must continue in the water as long as he can easily bear it
without fainting, and if one immersion has not the desired effect, it
may be repeated as soon as the patient’s strength and spirits are
recruited. It is more safe for him to go frequently into the bath, than
to continue too long at a time; and it is often necessary to repeat it
several times before it has the desired effect.

It has sometimes happened, after all other means of procuring a stool
had been tried to no purpose, that this was brought about by immersing
the patient’s lower extremities in cold water, or making him walk upon a
wet pavement, and dashing his legs and thighs with the cold water. This
method, when others fail, at least merits a trial. It is indeed attended
with some danger; but a doubtful remedy is better than none.

In desperate cases it is common to give quicksilver. This may be given
to the quantity of several ounces, or even a pound, but should not
exceed that[116]. When there is reason to suspect a mortification of the
guts, this medicine ought not to be tried. In that case it cannot cure
the patient, and will only hasten his death. But when the obstruction is
occasioned by any cause that can be removed by force, quicksilver is not
only a proper medicine, but the best that can be administered, as it is
the fittest body we know for making its way through the intestinal
canal.

If the disease proceed from a rupture, the patient must be laid with his
head very low, and the intestines returned by gentle pressure with the
hand. If this, with fomentations and clysters, should not succeed,
recourse must be had to a surgical operation, which may give the patient
relief.

Such as would avoid this excruciating and dangerous disease, must take
care never to be too long without a stool. Some who have died of it have
had several pounds of hard dry _fæces_ taken out of their guts. They
should likewise beware of eating too freely of sour or unripe fruits, or
drinking stale windy liquors, &c. I have known it brought on by living
too much on baked fruits, which are seldom good. It likewise proceeds
frequently from cold caught by wet clothes, &c. but especially from wet
feet.


                             OF THE COLIC.

The colic has a great resemblance to the two preceding diseases, both in
its symptoms and method of cure. It is generally attended with
costiveness and acute pain of the bowels; and requires diluting diet,
evacuations, fomentations, &c.

Colics are variously denominated according to their causes, as the
_flatulent_, the _bilious_, the _hysteric_, the _nervous_, &c. As each
of these requires a particular method of treatment, we shall point out
their most general symptoms, and the means to be used for their relief.

The _flatulent_, or wind-colic, is generally occasioned by an indiscreet
use of unripe fruits, meats of hard digestion, windy vegetables,
fermenting liquors, and such like. It may likewise proceed from an
obstructed perspiration, or catching cold. Delicate people, whose
digestive powers are weak, are most liable to this kind of colic.

The flatulent colic may either affect the stomach or intestines. It is
attended with a painful stretching of the affected part. The patient
feels a rumbling in his guts, and is generally relieved by a discharge
of wind, either upwards or downwards. The pain is seldom confined to any
particular part, as the vapour wanders from one division of the bowels
to another till it finds a vent.

When the disease proceeds from windy liquor, green fruit, sour herbs, or
the like, the best medicine on the first appearance of the symptoms is a
dram of brandy, gin, or any good spirits. The patient should likewise
sit with his feet upon a warm hearth-stone, or apply warm bricks to
them; and warm cloths may be applied to his stomach and bowels.

This is the only colic wherein ardent spirits, spiceries, or any thing
of a hot nature, may be ventured upon. Nor indeed are they to be used
here unless at the very beginning, before any symptoms of inflammation
appear. We have reason to believe, that a colic occasioned by wind or
flatulent food might always be cured by spirits and warm liquors, if
they were taken immediately upon perceiving the first uneasiness; but
when the pain has continued for a considerable time, and there is reason
to fear an inflammation of the bowels is already begun, all hot things
are to be avoided as poison, and the patient is to be treated in the
same manner as for the inflammation of the intestines.

Several kinds of food, as honey, eggs, &c. occasion colics in some
particular constitutions. I have generally found the best method of cure
for these was to drink plentifully of small diluting liquors, as
water-gruel, small posset, water with toasted bread soaked in it, &c.

Colics which proceed from excess and indigestion generally cure
themselves by occasioning vomiting or purging. These discharges are by
no means to be stopped, but promoted by drinking plentifully of warm
water, or weak posset. When their violence is over, the patient may take
a dose of rhubarb, or any other gentle purge, to carry off the dregs of
his debauch.

Colics which are occasioned by wet feet, or catching cold, may generally
be removed at the beginning, by bathing the feet and legs in warm water,
and drinking such warm diluting liquors as will promote the
perspiration, as weak wine-whey, or water-gruel, with a small quantity
of spirits in it.

Those flatulent colics, which prevail so much among country people,
might generally be prevented were they careful to change their clothes
when they get wet. They ought likewise to take a dram, or to drink some
warm liquor after eating any kind of green trash. We do not mean to
recommend the practice of dram-drinking, but in this case ardent spirits
prove a real medicine, and indeed the best that can be administered. A
glass of good peppermint water will have nearly the same effect as a
glass of brandy, and in some cases is rather to be preferred.

The _bilious_ colic is attended with very acute pains about the region
of the navel. The patient complains of great thirst, and is generally
costive. He vomits a hot, bitter, yellow-coloured bile, which being
discharged, seems to afford some relief, but is quickly followed by the
same violent pain as before. As the distemper advances, the propensity
to vomit sometimes increases so as to become almost continual, and the
proper motion of the intestines is so far perverted, that there are all
the symptoms of an impending iliac passion.

If the patient be young and strong, and the pulse full and frequent, it
will be proper to bleed, after which clysters may be administered. Clear
whey or gruel, sharpened with the juice of lemon, or cream of tartar,
must be drank freely. Small chicken-broth, with a little manna dissolved
in it, or a slight decoction of tamarinds, are likewise very proper, or
any other thin, acid, opening liquor.

Besides bleeding and plentiful dilution, it will be necessary to foment
the belly with cloths dipped in warm water, and if this should not
succeed, the patient must be immersed up to the breast in warm water.

In the bilious colic the vomiting is often very difficult to restrain.
When this happens, the patient may drink a decoction of toasted bread,
or an infusion of garden-mint in boiling water. Should these not have
the desired effect, the saline draught, with a few drops of laudanum in
it, may be given, and repeated according to the urgency of the symptoms.
A small quantity of Venice treacle may be spread in form of a cataplasm,
and applied to the pit of the stomach. Clysters, with a proper quantity
of Venice treacle or liquid laudanum in them, may likewise be frequently
administered.

Such as are liable to frequent returns of the bilious colic should use
flesh sparingly, and live chiefly upon a light vegetable diet. They
should likewise take frequently a dose of cream of tartar with
tamarinds, or any other cool acid purge.

The _hysteric_ colic bears a great resemblance to the bilious. It is
attended with acute pains about the region of the stomach, vomiting, &c.
But what the patient vomits in this case is commonly of a greenish
colour. There is a great sinking of the spirits, with dejection of mind
and difficulty of breathing, which are the characteristic symptoms of
this disorder. Sometimes it is accompanied with the jaundice, but this
generally goes off of its own accord in a few days.

In this colic all evacuations, as bleeding, purging, vomiting, &c. do
hurt. Every thing that weakens the patient, or sinks the spirits, is to
be avoided. If however the vomiting should prove violent, lukewarm
water, or small posset, may be drank to cleanse the stomach. Afterwards
the patient may take fifteen, twenty, or twenty-five drops of liquid
laudanum in a glass of cinnamon water. This may be repeated every ten or
twelve hours till the symptoms abate.

The patient may likewise take four or five of the fœtid pills every six
hours, and drink a cup of penny-royal tea after them. If asafœtida
should prove disagreeable, which is sometimes the case, a tea-spoonful
of the tincture of castor in a cup of penny-royal tea, or thirty or
forty drops of the balsam of Peru dropped upon a bit of loaf-sugar, may
be taken in its stead. The anti-hysteric plaster may also be used, which
has often a good effect[117].

The _nervous_ colic prevails among miners, smelters of lead, plumbers,
the manufacturers of white lead, &c. It is very common in the cyder
counties of England, and is supposed to be occasioned by the leaden
vessels used in preparing that liquor. It is likewise a frequent disease
in the West Indies, where it is termed the dry belly-ache.

No disease of the bowels is attended with more excruciating pain than
this. Nor is it soon at an end. I have known it continue eight or ten
days with very little intermission, the body all the while continuing
bound in spite of medicine, yet at length yield, and the patient
recover[118]. It generally however leaves the patient weak, and often
ends in a palsy.

The general treatment of this disease is so nearly the same with that of
the iliac passion, or inflammation of the guts, that we shall not insist
upon it. The body is to be opened by mild purgatives given in small
doses, and frequently repeated, and their operation must be assisted by
soft oily clysters, fomentations, &c. The castor oil is reckoned
peculiarly proper in this disease. It may both be mixed with the
clysters and given by the mouth.

The Barbadoes tar is said to be an efficacious medicine in this
complaint. It may be taken to the quantity of two drachms three times a
day, or oftner if the stomach will bear it. This tar, mixed with an
equal quantity of strong rum, is likewise proper for rubbing the spine,
in case any tingling, or other symptoms of a palsy, are felt. When the
tar cannot be obtained, the back may be rubbed with strong spirits, or a
little oil of nutmegs or of rosemary.

If the patient remains weak and languid after this disease, he must take
exercise on horseback, and use an infusion of the Peruvian bark in wine.
When the disease ends in a palsy, the Bath-waters are found to be
extremely proper.

To avoid this kind of colic, people must shun all sour fruits, acids,
and austere liquors, &c. Those who work in lead ought never to go to
their business fasting, and their food should be oily or fat. They may
take a glass of sallad oil, with a little brandy or rum every morning,
but should never take spirits alone. Liquid aliment is best for them; as
fat broths, &c. but low living is bad. They should frequently go a
little out of the tainted air; and should never suffer themselves to be
costive. In the West Indies, and on the coast of Guinea, it has been
found of great use, for preventing this colic, to wear a piece of
flannel round the waist, and to drink an infusion of ginger by way of
tea.

Sundry other kinds of this disease might be mentioned, but too many
distinctions would tend only to perplex the reader. Those already
mentioned are the most material, and should indeed be attended to, as
their treatment is very different. But even persons who are not in a
condition to distinguish very accurately in these matters, may
nevertheless be of great service to patients in colics of every kind, by
only observing the following general rules, _viz._ To bathe the feet and
legs in warm water; to apply bladders filled with warm water, or cloths
dipped in it, to the stomach and bowels; to make the patient drink
freely of diluting mucilaginous liquors; and to give him an emollient
clyster every two or three hours. Should these not succeed, the patient
ought to be immersed in warm water.


                      INFLAMMATION OF THE KIDNEYS.

CAUSES.——This disease may proceed from any of those causes which produce
an inflammatory fever. It may likewise be occasioned by wounds or
bruises of the kidneys; small stones or gravel lodging within them; by
strong diuretic medicines; as spirits of turpentine, tincture of
cantharides, &c. Violent motion, as hard riding or walking, especially
in hot weather, or whatever drives the blood too forcibly into the
kidneys, may occasion this malady. It may likewise proceed from lying
too soft, too much on the back, involuntary contractions, or spasms, in
the urinary vessels, &c.

SYMPTOMS.——There is a sharp pain about the region of the kidneys, with
some degree of fever, and a stupor or dull pain in the thigh of the
affected side. The urine is at first clear, and afterwards of a reddish
colour; but in the worst kind of the disease it generally continues
pale, is passed with difficulty, and commonly in small quantities at a
time. The patient feels great uneasiness when he endeavours to walk or
sit upright. He lies with most ease on the affected side, and has
generally a nausea or vomiting, resembling that which happens in the
colic.

This disease however may be distinguished from the colic by the pain
being seated farther back, and by the difficulty of passing urine with
which it is constantly attended.

REGIMEN.——Every thing of a heating or stimulating nature is to be
avoided. The food must be thin and light; as panado, small broths, with
mild vegetables, and the like. Emollient and thin liquors must be
plentifully drank; as clear whey, or balm-tea sweetened with honey,
decoctions of marsh-mallow roots, with barley and liquorice, &c. The
patient, notwithstanding the vomiting, must constantly keep sipping
small quantities of these or other diluting liquors. Nothing so safely
and certainly abates the inflammation, and expels the obstructing cause,
as copious dilution. The patient must be kept easy, quiet, and free from
cold, as long as any symptoms of inflammation remain.

MEDICINE.——Bleeding is generally necessary, especially at the beginning.
Ten or twelve ounces may be let from the arm or foot with a lancet, and
if the pain and inflammation continue, the operation may be repeated in
twenty-four hours, especially if the patient be of a full habit. Leeches
may likewise be applied to the hæmorrhoidal veins, as a discharge from
these will greatly relieve the patient.

Cloths dipped in warm water, or bladders filled with it, must be applied
as near as possible to the part affected, and renewed as they grow cool.
If the bladders be filled with a decoction of mallows and camomile
flowers, to which a little saffron is added, and mixed with about a
third part of new milk, it will be still more beneficial.

Emollient clysters ought frequently to be administered; and if these do
not open the body, a little salt and honey or manna may be added to
them.

The same course is to be followed where gravel or stone is lodged in the
kidney, but when the gravel or stone is separated from the kidney, and
lodges in the Ureter[119], it will be proper, besides the fomentations,
to rub the small of the back with sweet oil, and to give gentle
diuretics; as juniper-water sweetened with the syrup of marsh-mallows: a
tea-spoonful of the sweet spirits of nitre, with a few drops of
laudanum, may now and then be put in a cup of the patient’s drink. He
ought likewise to take exercise on horseback, or in a carriage, if he be
able to bear it.

When the disease is protracted beyond the seventh or eighth day, and the
patient complains of a stupor and heaviness of the part, has frequent
returns of chillness, shivering, &c. there is reason to suspect that
matter is forming in the kidney, and that an abscess will ensue.

When matter in the urine shews that an ulcer is already formed in the
kidney, the patient must be careful to abstain from all acrid, sour, and
salted provisions; and to live chiefly upon mild mucilaginous herbs and
fruits, together with the broth of young animals, made with barley, and
common pot-herbs, &c. His drink may be whey, and butter-milk that is not
sour. The latter is by some reckoned a specific remedy in ulcers of the
kidneys. To answer this character, however, it must be drank for a
considerable time. Chalybeate waters have likewise been found beneficial
in this disease. This medicine is easily obtained, as it is found in
every part of Great Britain. It must likewise be used for a considerable
time, in order to produce any salutary effects.

Those who are liable to frequent returns of inflammation, or
obstructions of the kidneys, must abstain from wines, especially such as
abound with tartar; and their food ought to be light, and of easy
digestion. They should use moderate exercise, and should not lie too
hot, nor too much on their back.


                      INFLAMMATION OF THE BLADDER.

The inflammation of the bladder proceeds, in a great measure, from the
same causes as that of the kidneys. It is known by an acute pain towards
the bottom of the belly, and difficulty of passing urine, with some
degree of fever, a constant inclination to go to stool, and a perpetual
desire to make water.

This disease must be treated on the same principles as the one
immediately preceding. The diet must be light and thin, and the drink of
a cooling nature. Bleeding is very proper at the beginning, and in
robust constitutions it will often be necessary to repeat it. The lower
part of the belly should be fomented with warm water, or a decoction of
mild vegetables; and emollient clysters ought frequently to be
administered, &c.

The patient should abstain from every thing that is of a hot, acrid, and
stimulating quality, and should live entirely upon small broths, gruels,
or mild vegetables.

A stoppage of urine may proceed from other causes besides an
inflammation of the bladder; as a swelling of the hæmorrhoidal veins,
hard _fæces_ lodged in the _rectum_; a stone in the bladder;
excrescences in the urinary passages, a palsy of the bladder, hysteric
affections, &c. Each of these requires a particular treatment, which
does not fall under our present consideration. We shall only observe,
that in all of them mild and gentle applications are the safest, as
strong diuretic medicines, or things of an irritating nature, generally
increase the danger.

I have known some persons kill themselves by introducing probes into the
urinary passages, to remove, as they thought, somewhat that obstructed
the discharge of urine, and others bring on a violent inflammation of
the bladder, by using strong diuretics, as oil of turpentine, &c. for
that purpose.


                       INFLAMMATION OF THE LIVER.

The liver is less subject to inflammation than most of the other
viscera, as in it the circulation is slower; but when an inflammation
does happen, it is with difficulty removed, and often ends in a
suppuration or scirrhus.

CAUSES.——Besides the common causes of inflammation, we may here reckon
the following, _viz._ excessive fatness, a scirrhus of the liver itself,
violent shocks from strong vomits when the liver was before unsound, an
adust or atrabiliarian state of the blood, any thing that suddenly cools
the liver after it has been greatly heated, stones obstructing the
course of the bile, drinking strong wines and spirituous liquors, using
hot spicy aliment, obstinate hypochondriacal affections, &c.

SYMPTOMS.——This disease is known by a painful tension of the right side
under the false ribs, attended with some degree of fever, a sense of
weight, or fulness of the part, difficulty of breathing, loathing of
food, great thirst, with a pale or yellowish colour of the skin and
eyes.

The _symptoms_ here are various, according to the degree of
inflammation, and likewise according to the particular part of the liver
where the inflammation happens. Sometimes the pain is so inconsiderable,
that an inflammation is not so much as suspected; but when it happens in
the upper or convex part of the liver, the pain is more acute, the pulse
quicker, and the patient is often troubled with a dry cough, a hiccup,
and a pain extending to the shoulder, with difficulty of lying on the
left side, &c.

This disease may be distinguished from the pleurisy by the pain being
less violent, seated under the false ribs, the pulse not so hard, and by
the difficulty of lying on the left side. It may be distinguished from
the hysteric and hypochondriac disorders by the degree of fever with
which it is always attended.

This disease, if properly treated, is seldom mortal. A constant
hiccuping, violent fever, and excessive thirst, are bad symptoms. If it
ends in a suppuration, and the matter cannot be discharged outwardly,
the danger is great. When the scirrhus of the liver ensues, the patient,
if he observes a proper regimen, may nevertheless live a number of years
tolerably easy; but if he indulge in animal food and strong liquors, or
take medicines of an acrid or irritating nature, the scirrhus will be
converted into a cancer, which must infallibly prove fatal.

REGIMEN.——The same regimen is to be observed in this as in other
inflammatory disorders. All hot things are to be carefully avoided, and
cool diluting liquors, as whey, barley-water, &c. drank freely. The food
must be light and thin, and the body, as well as the mind, kept easy and
quiet.

MEDICINE.——Bleeding is proper at the beginning of this disease, and it
will often be necessary, even though the pulse should not feel hard, to
repeat it. All violent purgatives are to be avoided; the body however
must be kept gently open. A decoction of tamarinds, with a little honey
or manna, will answer this purpose very well. The side affected must be
fomented in the manner directed in the foregoing diseases. Mild laxative
clysters should be frequently administered; and, if the pain should
notwithstanding continue violent, a blistering plaster may be applied
over the part affected.

Medicines which promote the secretion of urine have a very good effect
here. For this purpose half a drachm of purified nitre, or a
tea-spoonful of the sweet spirits of nitre, may be taken in a cup of the
patient’s drink three or four times a-day.

When there is an inclination to sweat, it ought to be promoted, but not
by warm sudorifics. The only thing to be used for that purpose is plenty
of diluting liquors drank about the warmth of the human blood. Indeed
the patient in this case, as well as in all other topical inflammations,
ought to drink nothing that is colder than the blood.

If the stools should be loose, and even streaked with blood, no means
must be used to stop them, unless they be so frequent as to weaken the
patient. Loose stools often prove critical, and carry off the disease.

If an abscess or imposthume is formed in the liver, all methods should
be tried to make it break and discharge itself outwardly, as
fomentations, the application of poultices, ripening cataplasms, &c.
Sometimes indeed the matter of an abscess comes away in the urine, and
sometimes it is discharged by stool, but these are efforts of Nature
which no means can promote. When the abscess bursts into the cavity of
the _abdomen_ at large, death must ensue; nor will the event be more
favourable when the abscess is opened by an incision, unless in cases
where the liver adheres to the _peritonæum_, so as to form a bag for the
matter, and prevent it from falling into the cavity of the _abdomen_; in
which case opening the abscess by a sufficiently large incision will
probably save the patient’s life[120].

If the disorder, in spite of all endeavours to the contrary, should end
in a scirrhus, the patient must be careful to regulate his diet, &c. in
such a manner as not to aggravate the disease. He must not indulge in
flesh, fish, strong liquors, or any highly seasoned or salted
provisions; but should, for the most part, live on mild vegetables, as
fruits and roots; taking gentle exercise, and drinking whey,
barley-water, or butter-milk. If he takes any thing stronger, it should
be fine mild ale, which is less heating than wines or spirits.

We shall take no notice of inflammations of the other viscera. They must
in general be treated upon the same principles as those already
mentioned. The chief rule with respect to all of them, is to let blood,
to avoid every thing that is strong, or of a heating nature, to apply
warm fomentations to the part affected, and to cause the patient to
drink a sufficient quantity of warm diluting liquors.




                              CHAP. XXXI.
 OF THE CHOLERA MORBUS, AND OTHER EXCESSIVE DISCHARGES FROM THE STOMACH
                              AND BOWELS.


The _cholera morbus_ is a violent purging and vomiting, attended with
gripes, sickness, and a constant desire to go to stool. It comes on
suddenly, and is most common in autumn. There is hardly any disease that
kills more quickly than this, when proper means are not used in due time
for removing it.

CAUSES.——It is occasioned by a redundancy and putrid acrimony of the
bile; cold; food that easily turns rancid or sour on the stomach; as
butter, bacon, sweetmeats, cucumbers, melons, cherries, and other cold
fruits[121]. It is sometimes the effect of strong acrid purges or
vomits, or of poisonous substances taken into the stomach. It may
likewise proceed from violent passions or affections of the mind; as
fear, anger, &c.

SYMPTOMS.——It is generally preceded by a _cardialgia_, or heart-burn,
sour belchings, and flatulencies, with pain of the stomach and
intestines. To these succeed excessive vomiting, and purging of green,
yellow, or blackish-coloured bile, with a distension of the stomach, and
violent griping pains. There is likewise a great thirst, with a very
quick unequal pulse, and often a fixed acute pain about the region of
the navel. As the disease advances, the pulse often sinks low as to
become quite imperceptible, the extremities grow cold, or cramped, and
are often covered with a clammy sweat, the urine is obstructed, and
there is a palpitation of the heart. Violent hiccuping, fainting, and
convulsions, are the signs of approaching death.

MEDICINE.——At the beginning of this disease the efforts of Nature to
expel the offending cause should be assisted, by promoting the purging
and vomiting. For this purpose the patient must drink freely of diluting
liquors; as whey, butter-milk, warm water, thin water-gruel, small
posset, or, what is perhaps preferable to any of them, very weak chicken
broth. This should not only be drank plentifully to promote the
vomiting, but a clyster of it given every hour in order to promote the
purging.

After these evacuations have been continued for some time, a decoction
of toasted oat-bread may be drank to stop the vomiting. The bread should
be toasted till it is of a brown colour, and afterwards boiled in spring
water. If oat-bread cannot be had, wheat-bread, or oatmeal well toasted,
may be used in its stead. If this does not put a stop to the vomiting,
two table-spoonfuls of the saline julep, with ten drops of laudanum, may
be taken every hour till it ceases.

The vomiting and purging however ought never to be stopped too soon. As
long as these discharges do not weaken the patient, they are salutary,
and may be allowed to go on, or rather ought to be promoted. But when
the patient is weakened by the evacuations, which may be known from the
sinking of his pulse, &c. recourse must immediately be had to opiates,
as recommended above; to which may be added strong wines, with
spirituous cinnamon-waters, and other generous cordials. Warm negus, or
strong wine-whey, will likewise be necessary to support the patient’s
spirits, and promote the perspiration. His legs should be bathed in warm
water, and afterwards rubbed with flannel cloths, or wrapped in warm
blankets, and warm bricks applied to the soles of his feet. Flannels
wrung out of warm spirituous fomentations should likewise be applied to
the region of the stomach.

When the violence of the disease is over, to prevent a relapse, it will
be necessary for some time to continue the use of small doses of
laudanum. Ten or twelve drops may be taken in a glass of wine, at least
twice a day, for eight or ten days. The patient’s food ought to be
nourishing, but taken in small quantities, and he should use moderate
exercise. As the stomach and intestines are generally much weakened, an
infusion of the bark, or other bitters, in small wine, sharpened with
the elixir of vitriol, may be drank for some time.

Though physicians are seldom called in due time in this disease, they
ought not to despair of relieving the patient even in the most desperate
circumstances. Of this I lately saw a very striking proof in an old man
and his son, who had been both seized with it about the middle of the
night.

I did not see them till next morning, when they had much more the
appearance of dead than of living men. No pulse could be felt; the
extremities were cold and rigid; the countenance was ghastly, and the
strength almost quite exhausted. Yet from this deplorable condition they
were both recovered by the use of opiates and cordial medicines.


                      OF A DIARRHŒA, or LOOSENESS.

A looseness, in many cases, is not to be considered as a disease, but
rather as a salutary evacuation. It ought therefore never to be stopped,
unless when it continues too long, or evidently weakens the patient. As
this however sometimes happens, we shall point out the most common
causes of a looseness, with the proper method of treatment.

When a looseness is occasioned by catching cold, or an obstructed
perspiration, the patient ought to keep warm, to drink freely of weak
diluting liquors, to bathe his feet and legs frequently in lukewarm
water, to wear flannel next his skin, and to take every other method to
restore the perspiration.

In a looseness which proceeds from excess or repletion, a vomit is the
proper medicine. Vomits not only cleanse the stomach, but promote all
the secretions, which renders them of great importance in carrying off a
debauch. Half a drachm of ipecacuanha in powder will answer this purpose
very well. A day or two after the vomit, the same quantity of rhubarb
may be taken, and repeated two or three times, if the looseness
continues. The patient ought to live upon light vegetable food of easy
digestion, and to drink whey, thin gruel, or barley-water.

A looseness, occasioned by the obstruction of any customary evacuation,
generally requires bleeding. If that does not succeed, other evacuations
may be substituted in the room of those which are obstructed. At the
same time, every method is to be taken to restore the usual discharges,
as not only the cure of the disease, but the patient’s life, may depend
on this.

A periodical looseness ought never to be stopped. It is always an effort
of Nature to carry off some offending matter, which, if retained in the
body, might have fatal effects. Children are very liable to this kind of
looseness, especially while teething. It is however so far from being
hurtful to them, that such children generally get their teeth with least
trouble. If these loose stools should at any time prove sour or griping,
a tea-spoonful of magnesia alba, with four or five grains of rhubarb,
may be given to the child in a little panado, or any other food. This,
if repeated three or four times, will generally correct the acidity, and
carry off the griping stools.

A diarrhœa, or looseness, which proceeds from violent passions or
affections of the mind, must be treated with the greatest caution.
Vomits in this case are highly improper. Nor are purges safe, unless
they be very mild, and given in small quantities. Opiates, and other
antispasmodic medicines, are most proper. Ten or twelve drops of liquid
laudanum may be taken in a cup of valerian or penny-royal tea every
eight or ten hours, till the symptoms abate. Ease, cheerfulness, and
tranquillity of mind, are here of the greatest importance.

When a looseness proceeds from acrid or poisonous substances taken into
the stomach, the patient must drink large quantities of diluting
liquors, with oil or fat broths, to promote vomiting and purging.
Afterwards, if there be reason to suspect that the bowels are inflamed,
bleeding will be necessary. Small doses of laudanum may likewise be
taken to remove their irritation.

When the gout, repelled from the extremities, occasions a looseness, it
ought to be promoted by gentle doses of rhubarb, or other mild
purgatives. The gouty matter is likewise to be solicited towards the
extremities by warm fomentations, cataplasms, &c. The perspiration ought
at the same time to be promoted by warm diluting liquors; as wine-whey,
with spirits of hartshorn, or a few drops of liquid laudanum, in it.

When a looseness proceeds from worms, which may be known from the
sliminess of the stools, mixed with pieces of decayed worms, &c.
medicines must be given to kill and carry off these vermin, as the
powder of tin with purges of rhubarb and calomel. Afterwards lime-water,
either alone, or with a small quantity of rhubarb infused, will be
proper to strengthen the bowels, and prevent the new generation of
worms.

A looseness is often occasioned by drinking bad water. When this is the
case, the disease generally proves epidemical. When there is reason to
believe that this or any other disease proceeds from the use of
unwholesome water, it ought immediately to be changed, or, if that
cannot be done, it may be corrected by mixing with it quicklime, chalk,
or the like.

In people whose stomachs are weak, violent exercise immediately after
eating will occasion a looseness. Though the cure of this is obvious,
yet it will be proper, besides avoiding violent exercise, to use such
medicines as tend to brace and strengthen the stomach, as infusions of
the bark, with other bitter and astringent ingredients, in white-wine.
Such persons ought likewise to take frequently a glass or two of old red
port, or good claret.

From whatever cause a looseness proceeds, when it is found necessary to
check it, the diet ought to consist of rice boiled with milk, and
flavoured with cinnamon; rice-jelly; sago, with red port; and the
lighter sorts of flesh-meat roasted. The drink may be thin water-gruel,
rice-water, or weak broth made from lean veal, or with a sheep’s head,
as being more gelatinous than mutton, beef, or chicken-broth.

Persons who, from a peculiar weakness, or too great an irritability of
the bowels, are liable to frequent returns of this disease, should live
temperately, avoiding crude summer fruits, all unwholesome food, and
meats of hard digestion. They ought likewise to beware of cold,
moisture, or whatever may obstruct the perspiration, and should wear
flannel next their skin. All violent passions, as fear, anger, &c. are
likewise carefully to be guarded against.


                              OF VOMITING.

Vomiting may proceed from various causes; as excess in eating and
drinking; foulness of the stomach; the acrimony of the aliments; a
translation of the morbific matter of ulcers, of the gout, the
erysipelas, or other diseases, to the stomach. It may likewise proceed
from a looseness having been too suddenly stopped; from the stoppage of
any customary evacuation, as the bleeding piles, the _menses_, &c. from
a weakness of the stomach, the colic, the iliac passion, a rupture, a
fit of the gravel, worms; or from any kind of poison taken into the
stomach. It is an usual symptom of injuries done to the brain; as
contusions, compressions, &c. It is likewise a symptom of wounds or
inflammations of the diaphragm, intestines, spleen, liver, kidneys, &c.

Vomiting may be occasioned by unusual motions; as sailing, being drawn
backwards in a cart or coach, &c. It may likewise be excited by violent
passions, or by the idea of nauseous or disagreeable objects, especially
of such things as have formerly produced vomiting. Sometimes it proceeds
from a regurgitation of the bile into the stomach: in this case, what
the patient vomits is generally of a yellow or greenish colour, and has
a bitter taste. Persons who are subject to nervous affections are often
suddenly seized with violent fits of vomiting. Lastly, vomiting is a
common symptom of pregnancy. In this case it generally comes on about
two weeks after the stoppage of the _menses_, and continues during the
first three or four months.

When vomiting proceeds from a foul stomach or indigestion, it is not to
be considered as a disease, but as the cure of a disease. It ought
therefore to be promoted by drinking lukewarm water, or thin gruel. If
this does not put a stop to the vomiting, a dose of ipecacuanha may be
taken, and worked off with weak camomile-tea.

When the retrocession of the gout, or the obstruction of customary
evacuations, occasion vomiting, all means must be used to restore these
discharges; or, if that cannot be effected, their place must be supplied
by others, as bleeding, purging, bathing the extremities in warm water,
opening issues, setons, perpetual blisters, &c.

When vomiting is the effect of pregnancy, it may generally be mitigated
by bleeding, and keeping the body gently open. The bleeding however
ought to be in small quantities at a time, and the purgatives should be
of the mildest kind, as figs, stewed prunes, manna, or senna. Pregnant
women are most apt to vomit in the morning, immediately after getting
out of bed, which is owing partly to the change of posture, but more to
the emptiness of the stomach. It may generally be prevented by taking a
dish of coffee, tea, or some light breakfast in bed. Pregnant women who
are afflicted with vomiting ought to be kept easy both in body and mind.
They should neither allow their stomachs to be quite empty, nor should
they eat much at once. Cold water is a very proper drink in this case;
if the stomach be weak, a little brandy may be added to it. If the
spirits are low, and the person apt to faint, a spoonful of
cinnamon-water, with a little marmalade of quinces or oranges, may be
taken.

If vomiting proceeds from weakness of the stomach, bitters will be of
service. Peruvian bark infused in wine or brandy, with as much rhubarb
as will keep the body gently open, is an excellent medicine in this
case. The elixir of vitriol is also a good medicine. It may be taken in
the dose of fifteen or twenty drops, twice or thrice a day, in a glass
of wine or water. Habitual vomitings are sometimes alleviated by making
oysters a principal part of diet.

A vomiting, which proceeds from acidities in the stomach, is relieved by
alkaline purges. The best medicine of this kind is the magnesia alba, a
tea-spoonful of which may be taken in a dish of tea or a little milk,
three or four times a day, or oftener if necessary, to keep the body
open.

When vomiting proceeds from violent passions, or affections of the mind,
all evacuants must be carefully avoided, especially vomits. These are
exceedingly dangerous. The patient in this case ought to be kept
perfectly easy and quiet, to have the mind soothed, and to take some
gentle cordial, as negus, or a little brandy and water, to which a few
drops of laudanum may occasionally be added.

When vomiting proceeds from spasmodic affections of the stomach, musk,
castor, and other antispasmodic medicines, are of use. Warm and aromatic
plasters have likewise a good effect. The stomach plaster of the London
or Edinburgh dispensatory may be applied to the pit of the stomach, or a
plaster of _theriaca_, which will answer rather better. Aromatic
medicines may likewise be taken inwardly, as cinnamon or mint-tea, wine
with spiceries boiled in it, &c. The region of the stomach may be rubbed
with æther, or, if that cannot be had, with strong brandy, or other
spirits. The belly should be fomented with warm water, or the patient
immersed up to the breast in a warm bath.

I have always found the saline draughts taken in the act of
effervescence, of singular use in stopping a vomiting, from whatever
cause it proceeded. These may be prepared by dissolving a drachm of the
salt of tartar in an ounce and half of fresh lemon-juice, and adding to
it an ounce of peppermint-water, the same quantity of simple
cinnamon-water, and a little white sugar. This draught must be swallowed
before the effervescence is quite over, and may be repeated every two
hours, or oftner, if the vomiting be violent. A violent vomiting has
sometimes been stopped by cupping on the region of the stomach after all
other means had failed.

As the least motion will often bring on the vomiting again, even after
it has been stopped, the patient must avoid all manner of action. The
diet must be so regulated as to sit easy upon the stomach, and nothing
should be taken that is hard of digestion. We do not however mean that
the patient should live entirely upon slops. Solid food, in this case,
often sits easier on the stomach than liquids.




                              CHAP. XXXII.
    OF THE DIABETES, AND OTHER DISORDERS OF THE KIDNEYS AND BLADDER.


The diabetes is a frequent and excessive discharge of urine. It is
seldom to be met with among young people; but often attacks persons in
the decline of life, especially those who follow the more violent
employments, or have been hard drinkers in their youth.

CAUSES.——A diabetes is often the consequence of acute diseases, as
fevers, fluxes, &c. where the patient has suffered by excessive
evacuations; it may also be occasioned by great fatigue, as riding long
journies upon a hard-trotting horse, carrying heavy burdens, running,
&c. It may be brought on by hard drinking, or the use of strong
stimulating diuretic medicines, as tincture of cantharides, spirits of
turpentine, and such like. It is often the effect of drinking too great
quantities of mineral waters. Many imagine that these will do them no
service unless they be drank in great quantities, by which mistake it
often happens that they occasion worse diseases than those they were
intended to cure. In a word, this disease may either proceed from too
great a laxity of the organs which secrete the urine, from something
that stimulates the kidneys too much, or from a thin dissolved state of
the blood, which makes too great a quantity of it run off by the urinary
passages.

SYMPTOMS.——In a diabetes, the urine generally exceeds in quantity all
the liquid food which the patient takes. It is thin and pale, of a
sweetish taste, and an agreeable smell. The patient has a continual
thirst, with some degree of fever; his mouth is dry, and he spits
frequently a frothy spittle. The strength fails, the appetite decays,
and the flesh wastes away till the patient is reduced to skin and bone.
There is a heat of the bowels; and frequently the loins, testicles, and
feet are swelled.

This disease may generally be cured at the beginning; but after it has
continued long, the cure becomes very difficult. In drunkards, and very
old people, a perfect cure is not to be expected.

REGIMEN.——Every thing that stimulates the urinary passages, or tends to
relax the habit, must be avoided. For this reason the patient should
live chiefly on solid food. His thirst may be quenched with acids; as
sorrel, juice of lemon, or vinegar. The mucilaginous vegetables, as
rice, sago, and salop, with milk, are the most proper food. Of animal
substances, shell-fish are to be preferred; as oysters, crabs, &c.

The drink may be Bristol-water. When that cannot be obtained,
lime-water, in which a due proportion of oak bark has been macerated,
may be used. The white decoction[122], with isinglass dissolved in it,
is likewise a very proper drink.

The patient ought daily to take exercise, but it should be so gentle as
not to fatigue him. He should lie upon a hard bed or matrass. Nothing
hurts the kidneys more than lying too soft. A warm dry air, the use of
the flesh-brush, and every thing that promotes perspiration, is of
service. For this reason the patient ought to wear flannel next his
skin. A large strengthening plaster may be applied to the back; or, what
will answer better, a great part of the body may be wrapt in plaster.

MEDICINE.——Gentle purges, if the patient be not too much weakened by the
disease, have a good effect. They may consist of rhubarb, with cardamum
seeds, or any other spiceries, infused in wine, and may be taken in such
quantities as to keep the body gently open.

The patient must next have recourse to astringents and corroborants.
Half a drachm of powder made of equal parts of allum and the inspissated
juice commonly called _Terra Japonica_, may be taken four times a-day,
or oftner, if the stomach will bear it. The allum must first be melted
in a crucible; afterwards they may both be pounded together. Along with
every dose of this powder the patient may take a tea-cupful of the
tincture of roses[123].

If the patient’s stomach cannot bear the allum in substance, whey may be
made of it, and taken in the dose of a tea-cupful three or four times
a-day. The allum-whey is prepared by boiling two English quarts of milk
over a slow fire, with three drachms of allum, till the curd separates.

Opiates are of service in this disease, even though the patient rests
well. They take off spasm and irritation, and at the same time lessen
the force of the circulation. Ten or twelve drops of liquid laudanum may
be taken in a cup of the patient’s drink three or four times a-day.

The best corroborants which we know, are the Peruvian bark and wine. A
drachm of bark may be taken in a glass of red port or claret three times
a-day. The medicine will be both more efficacious and less disagreeable,
if fifteen or twenty drops of the acid elixir of vitriol be added to
each dose. Such as cannot take the bark in substance may use the
decoction, mixed with an equal quantity of red wine, and sharpened as
above.

There is a disease incident to labouring people in the decline of life,
called _an INCONTINENCY of urine_. But this is very different from a
diabetes, as the water passes off involuntarily by drops, and does not
exceed the usual quantity. This disease is rather troublesome than
dangerous. It is owing to a relaxation of the sphincter of the bladder,
and is often the effect of a palsy. Sometimes it proceeds from hurts, or
injuries occasioned by blows, bruises, preternatural labours, &c.
Sometimes it is the effect of a fever. It may likewise be occasioned by
a long use of strong diuretics, or of stimulating medicines injected
into the bladder.

This disease may be mitigated by the use of astringent and corroborating
medicines, such as have been mentioned above; but we do not remember
ever to have seen it cured.

In an incontinency of urine, from whatever cause, a piece of sponge
ought to be worn, or a bladder applied in such a manner as to prevent
the urine from galling and excoriating the parts.


                       OF A SUPPRESSION OF URINE.

It has already been observed, that a suppression of urine may proceed
from various causes; as an inflammation of the kidneys, or bladder;
small stones or gravel lodging in the urinary passages, hard _fæces_
lying in the _rectum_, pregnancy, a spasm or contraction of the neck of
the bladder, clotted blood in the bladder itself, a swelling of the
hæmorrhoidal veins, &c.

Some of these cases require the catheter, both to remove the obstructing
matter, and to draw off the urine; but as this instrument can only be
managed with safety by persons skilled in surgery, we shall say nothing
further of its use. A bougee may be used by any cautious hand, and will
often succeed better than the catheter.

We would chiefly recommend, in all obstructions of urine, fomentations
and evacuants. Bleeding, as far as the patient’s strength will permit,
is necessary, especially where there are symptoms of topical
inflammation. Bleeding in this case not only abates the fever, by
lessening the force of the circulation, but, by relaxing the solids, it
takes off the spasm or stricture upon the vessels which occasioned the
obstruction.

After bleeding, fomentations must be used. These may either consist of
warm water alone, or of decoctions of mild vegetables; as mallows,
camomile-flowers, &c. Cloths dipped in these may either be applied to
the part affected, or a large bladder filled with the decoction may be
kept continually upon it. Some put the herbs themselves into a flannel
bag, and apply them to the part, which is far from being a bad method.
These continue longer warm than cloths dipped in the decoction, and at
the same time keep the part equally moist.

In all obstructions of urine, the body ought to be kept open. This is
not however to be attempted by strong purgatives, but by emollient
clysters, or gentle infusions of senna and manna. Clysters in this case
not only open the body, but answer the purpose of an internal
fomentation, and greatly assist in removing the spasms of the bladder
and parts adjacent.

The food must be light, and taken in small quantities. The drink may be
weak broth, or decoctions and infusions of mucilaginous vegetables, as
marsh-mallow roots, lime-tree buds, &c. A tea-spoonful of the sweet
spirits of nitre, or a drachm of Castile soap, may be frequently put
into the patient’s drink; and, if there be no inflammation, he may drink
small gin-punch.

Persons subject to a suppression of urine ought to live very temperate.
Their diet should be light, and their liquor diluting. They should avoid
all acids and austere wines, should take sufficient exercise, lie hard,
and avoid study and sedentary occupations.


                        OF THE GRAVEL AND STONE.

When small stones are lodged in the kidneys, or discharged along with
the urine, the patient is said to be afflicted with the gravel. If one
of these stones happens to make a lodgment in the bladder for some time,
it accumulates fresh matter, and at length becomes too large to pass off
with the urine. In this case the patient is said to have the stone.

CAUSES.——The stone and gravel may be occasioned by high living; the use
of strong astringent wines; a sedentary life; lying too hot, soft, or
too much on the back; the constant use of water impregnated with earthy
or stony particles; aliments of an astringent or windy nature, &c. It
may likewise proceed from an hereditary disposition. Persons in the
decline of life, and those who have been much afflicted with the gout or
rheumatism, are most liable to it.

SYMPTOMS.——Small stones or gravel in the kidneys occasion pain in the
loins; sickness; vomiting; and sometimes bloody urine. When the stone
descends into the _ureter_, and is too large to pass along with ease,
all the above symptoms are increased; the pain extends towards the
bladder; the thigh and leg of the affected side are benumbed; the
testicles are drawn upwards, and the urine is obstructed.

A stone in the bladder is known from a pain, at the time, as well as
before and after making water; from the urine coming away by drops, or
stopping suddenly when it was running in a full stream; by a violent
pain in the neck of the bladder upon motion, especially on horseback, or
in a carriage on a rough road; from a white, thick, copious, stinking,
mucous sediment in the urine; from an itching in the top of the _penis_;
from bloody urine; from an inclination to go to stool during the
discharge of urine; from the patient’s passing his urine more easily
when lying than in an erect posture; from a kind of convulsive motion
occasioned by the sharp pain in discharging the last drops of the urine;
and lastly, from sounding or searching with the catheter.

REGIMEN.——Persons afflicted with the gravel or stone should avoid
aliments of a windy or heating nature, as salt meats, sour fruits, &c.
Their diet ought chiefly to consist of such things as tend to promote
the secretion of urine, and to keep the body open. Artichokes,
asparagus, spinnage, lettuce, parsley, succory, purslane, turnips,
potatoes, carrots, and radishes, may be safely eaten. Onions, leeks, and
celery are, in this case, reckoned medicinal. The most proper drinks are
whey, butter-milk, milk and water, barley-water; decoctions or infusions
of the roots of marsh-mallows, parsley, liquorice, or of other mild
mucilaginous vegetables, as linseed, lime-tree buds or leaves, &c. If
the patient has been accustomed to generous liquors, he may drink small
gin-punch.

Gentle exercise is proper; but violent motion is apt to occasion bloody
urine. We would therefore advise that it should be taken in moderation.
Persons afflicted with gravel often pass a great number of stones after
riding on horseback, or in a carriage; but those who have a stone in the
bladder are seldom able to bear these kinds of exercise. Where there is
a hereditary tendency to this disease, a sedentary life ought never to
be indulged. Were people careful, upon the first symptoms of gravel, to
observe a proper regimen of diet, and to take sufficient exercise, it
might often be carried off, or at least prevented from increasing; but
if the same course which occasioned the disease is persisted in, it must
be aggravated.

MEDICINE.——In what is called a fit of the gravel, which is commonly
occasioned by a stone sticking in the _ureter_ or some part of the
urinary passages, the patient must be bled, warm fomentations should
likewise be applied to the part affected, emollient clysters
administered, and diluting mucilaginous liquors drank, &c. The treatment
of this case has been fully pointed out under the articles,
_inflammation of the kidneys and bladder_, to which we refer.

Dr. Whytt advises patients who are subject to frequent fits of gravel in
the kidneys, but have no stone in the bladder, to drink every morning,
two or three hours before breakfast, an English pint of oyster or
cockle-shell lime-water. The Doctor very justly observes, that though
this quantity might be too small to have any sensible effect in
dissolving a stone in the bladder, yet it may very probably prevent its
growth.

When a stone is formed in the bladder, the Doctor recommends Alicant
soap, and oyster or cockle-shell lime-water[124], to be taken in the
following manner: The patient must swallow every day, in any form that
is least disagreeable, an ounce of the internal part of Alicant soap,
and drink three or four English pints of oyster or cockle shell
lime-water. The soap is to be divided into three doses; the largest to
be taken fasting in the morning early; the second at noon; and the third
at seven in the evening; drinking above each dose a large draught of the
lime-water; the remainder of which he may take any time betwixt dinner
and supper, instead of other liquors.

The patient should begin with a smaller quantity of the lime-water and
soap than that mentioned above; at first an English pint of the former,
and three drachms of the latter, may be taken daily. This quantity,
however, he may increase by degrees, and ought to persevere in the use
of these medicines, especially if he finds any abatement of his
complaints, for several months; nay, if the stone be very large, for
years. It may likewise be proper for the patient, if he be severely
pained, not only to begin with the soap and lime-water in small
quantities, but to take the second or third lime-water instead of the
first. However, after he has been for some time accustomed to these
medicines, he may not only take the first water, but, if he finds he can
easily bear it, heighten its dissolving power still more by pouring it a
second time on fresh calcined shells.

The caustic alkali, or soap-lees, is the medicine chiefly in vogue at
present for the stone. It is of a very acrid nature, and ought therefore
to be given in some gelatinous or mucilaginous liquor; as veal-broth,
new milk, linseed-tea, a solution of gum-arabic, or a decoction of
marsh-mallow roots. The patient must begin with small doses of the lees,
as thirty or forty drops, and increase by degrees, as far as the stomach
can bear it[125].

Though the soap-lees and lime-water are the most powerful medicines
which have hitherto been discovered for the stone; yet there are some
things of a more simple nature, which in certain cases are found to be
beneficial, and therefore deserve a trial. An infusion of the seeds of
_daucus sylvestris_, or wild carrot, sweetened with honey, has been
found to give considerable ease in cases where the stomach could not
bear any thing of an acrid nature. A decoction of raw coffee berries
taken morning and evening, to the quantity of eight or ten ounces, with
ten drops of sweet spirit of nitre, has likewise been found very
efficacious in bringing away large quantities of earthy matter in
flakes. Honey is likewise found to be of considerable service, and may
be taken in gruel, or in any other form that is more agreeable.

The only other medicine which we shall mention is the _uva ursi_. It has
been greatly extolled of late both for the gravel and stone. It seems
however to be in all respects inferior to the soap and lime-water; but
it is less disagreeable, and has frequently, to my knowledge, relieved
gravelly complaints. It is generally taken in powder from half a drachm
to a whole drachm, two or three times a day. It may however be taken to
the quantity of seven or eight drachms a day, with great safety and good
effect.




                             CHAP. XXXIII.
                  OF INVOLUNTARY DISCHARGES OF BLOOD.


Spontaneous or involuntary discharges of blood, often happen from
various parts of the body. These however are so far from being always
dangerous, that they often prove salutary. When such discharges are
critical, which is frequently the case in fevers, they ought not to be
stopped. Nor indeed is it proper at any time to stop them, unless they
be so great as to endanger the patient’s life. Most people, afraid of
the smallest discharge of blood from any part of the body, fly
immediately to the use of styptic and astringent medicines, by which
means an inflammation of the brain, or some other fatal disease, is
occasioned, which, had the discharge been allowed to go on, might have
been prevented.

Periodical discharges of blood, from whatever part of the body they
proceed, must not be stopped. They are always the efforts of Nature to
relieve herself; and fatal diseases have often been the consequence of
obstructing them. It may indeed be sometimes necessary to check the
violence of such discharges; but even this requires the greatest
caution. Instances might be given where the stopping of a small
periodical flux of blood, from one of the fingers, has proved fatal.

In the early period of life, bleeding at the nose is very common. Those
who are farther advanced in years are more liable to hæmoptoe, or
discharge of blood from the lungs. After the middle period of life,
hæmorrhoidal fluxes are most common; and in the decline of life,
discharges of blood from the urinary passages.

Involuntary fluxes of blood may proceed from very different, and often
from quite opposite causes. Sometimes they are owing to a particular
construction of the body, as a sanguine temperament, a laxity of the
vessels, a plethoric habit, &c. At other times they proceed from a
determination of the blood towards one particular part, as the head, the
hæmorrhoidal veins, &c. They may likewise proceed from an inflammatory
disposition of the blood, in which case there is generally some degree
of fever: this likewise happens when the flux is occasioned by an
obstructed perspiration, or a stricture upon the skin, the bowels, or
any particular part of the system.

But a dissolved state of the blood will likewise occasion hæmorrhages.
Thus, in putrid fevers, the dysentery, the scurvy, the malignant
small-pox, &c. there are often very great discharges of blood from
different parts of the body. They may likewise be brought on by too
liberal an use of medicines which tend to dissolve the blood, as
cantharides, the volatile alkaline salts, &c. Food of an acrid or
irritating quality may likewise occasion hæmorrhages; as also strong
purges and vomits, or any thing that greatly stimulates the bowels.

Violent passions or agitations of the mind will likewise have this
effect. These often cause bleeding at the nose, and I have known them
sometimes occasion an hæmorrhage in the brain. Violent efforts of the
body, by overstraining or hurting the vessels, may have the same effect,
especially when the body is long kept in an unnatural posture, as
hanging the head very low, &c.

The cure of an hæmorrhage must be adapted to its cause. When it proceeds
from too much blood, or a tendency to inflammation, bleeding, with
gentle purges, and other evacuations, will be necessary. It will
likewise be proper for the patient in this case to live chiefly upon a
vegetable diet, to avoid all strong liquors, and food that is of an
acrid, hot, or stimulating quality. The body should be kept cool, and
the mind easy.

When an hæmorrhage is owing to a putrid or dissolved state of the blood,
the patient ought to live chiefly upon acid fruits with milk, and
vegetables of a nourishing nature, as sago, salop, &c. His drink may be
wine diluted with water, and sharpened with the juice of lemon, vinegar,
or spirits of vitriol. The best medicine in this case is the Peruvian
bark, which may be taken according to the urgency of the symptoms.

When a flux of blood is the effect of acrid food, or of strong
stimulating medicines, the cure is to be effected by soft and
mucilaginous diet. The patient may likewise take frequently about the
bulk of a nutmeg of Locatelli’s balsam, or the same quantity of
sperma-ceti.

When an obstructed perspiration, or a stricture upon any part of the
system, is the cause of an hæmorrhage, it may be removed by drinking
warm diluting liquors, lying a-bed, bathing the extremities in warm
water, &c.


                        OF BLEEDING AT THE NOSE.

Bleeding at the nose is commonly preceded by some degree of quickness of
the pulse, flushing in the face, pulsation of the temporal arteries,
heaviness in the head, dimness of the sight, heat and itching of the
nostrils, &c.

To persons who abound with blood this discharge is very salutary. It
often cures a vertigo, the head-ach, a phrenzy, and even an epilepsy. In
fevers, where there is a great determination of blood towards the head,
it is of the utmost service. It is likewise beneficial in inflammations
of the liver and spleen, and often in the gout and rheumatism. In all
diseases where bleeding is necessary, a spontaneous discharge of blood
from the nose is of much more service than the same quantity let with a
lancet.

In a discharge of blood from the nose, the great point is to determine
whether it ought to be stopped or not. It is a common practice to stop
the bleeding, without considering whether it be a disease, or the cure
of a disease. This conduct proceeds from fear; but it has often bad, and
sometimes fatal consequences.

When a discharge of blood from the nose happens in an inflammatory
disease, there is always reason to believe that it may prove salutary;
and therefore it should be suffered to go on, at least as long as the
patient is not weakened by it.

When it happens to persons in perfect health, who are full of blood, it
ought not to be suddenly stopped, especially if the symptoms of
plethora, mentioned above, have preceded it. In this case it cannot be
stopped without risking the patient’s life.

In fine, whenever bleeding at the nose relieves any bad symptom, and
does not proceed so far as to endanger the patient’s life, it ought not
to be stopped. But when it returns frequently, or continues till the
pulse becomes low, the extremities begin to grow cold, the lips pale, or
the patient complains of being sick or faint, it must immediately be
stopped.

For this purpose the patient should be set nearly upright, with his head
reclining a little, and his legs immersed in water about the warmth of
new milk. His hands ought likewise to be put in lukewarm water, and his
garters may be tied a little tighter than usual. Ligatures may be
applied to the arms, about the place where they are usually made for
bleeding, and with nearly the same degree of tightness. These must be
gradually slackened as the blood begins to stop, and removed entirely as
soon as it gives over.

Sometimes dry lint put up the nostrils will stop the bleeding. When this
does not succeed, dossils of lint dipped in strong spirits of wine, may
be put up the nostrils, or if that cannot be had, they may be dipped in
brandy. Blue vitriol dissolved in water may likewise be used for this
purpose, or a tent dipped in the white of an egg beat up, may be rolled
in a powder made of equal parts of white sugar, burnt allum, and white
vitriol, and put up the nostril from whence the blood issues.

Internal medicines can hardly be of use here, as they have seldom time
to operate. It may not however be amiss to give the patient half an
ounce of Glauber’s salt, and the same quantity of manna, dissolved in
four or five ounces of barley-water. This may be taken at a draught, and
repeated, if it does not operate, in a few hours. Ten or twelve grains
of nitre may be taken in a glass of cold water and vinegar every hour,
or oftner, if the stomach will bear it. If a stronger medicine be
necessary, a tea-cupful of the tincture of roses, with twenty or thirty
drops of the weak spirit of vitriol, may be taken every hour. When these
things cannot be had, the patient may drink water, with a little common
salt in it, or equal parts of water and vinegar.

If the genitals be immersed for some time in cold water, it will
generally stop a bleeding at the nose. I have not known this fail.

Sometimes, when the bleeding is stopped outwardly, it continues
inwardly. This is very troublesome, and requires particular attention,
as the patient is apt to be suffocated with the blood, especially if he
falls asleep, which he is very ready to do after losing a great quantity
of blood.

When the patient is in danger of suffocation from the blood getting into
his throat, the passages may be stopped by drawing threads up the
nostrils, and bringing them out at the mouth, then fastening pieces of
spunge, or small rolls of linen cloth to their extremities; afterwards
drawing them back, and tying them on the outside with a sufficient
degree of tightness.

After the bleeding is stopped, the patient ought to be kept as easy and
quiet as possible. He should not pick his nose, nor take away the tents
or clotted blood, till they fall off of their own accord, and should not
lie with his head low.

Those who are affected with frequent bleeding at the nose ought to bathe
their feet often in warm water, and to keep them warm and dry. They
ought to wear nothing tight about their necks, to keep their body as
much in an erect posture as possible, and never to view any object
obliquely. If they have too much blood, a vegetable diet, with now and
then a cooling purge, is the safest way to lessen it.

But when the disease proceeds from a thin dissolved flare of the blood,
the diet should be rich and nourishing; as strong broths and jellies,
sago-gruel with wine and sugar, &c. Infusions of the Peruvian bark in
wine ought likewise to be taken and persisted in for a considerable
time.


                    OF THE BLEEDING AND BLIND PILES.

A discharge of blood from the hæmorrhoidal vessels is called the
_bleeding piles_. When the vessels only swell, and discharge no blood,
but are exceeding painful, the disease is called the _blind piles_.

Persons of a loose spungy fibre, of a bulky size, who live high, and
lead a sedentary inactive life, are most subject to this disease. It is
often owing to a hereditary disposition. Where this is the case, it
attacks persons more early in life than when it is accidental. Men are
more liable to it than women, especially those of a sanguine, plethoric,
or a scorbutic habit, or of a melancholy disposition.

The piles may be occasioned by an excess of blood, by strong aloetic
purges, high-seasoned food, drinking great quantities of sweet wines,
the neglect of bleeding, or other customary evacuations, much riding,
great costiveness, or any thing that occasions hard or difficult stools.
Anger, grief, or other violent passions, will likewise occasion the
piles. I have often known them brought on by sitting on the damp ground.
A pair of thin breeches will excite the disorder in a person who is
subject to it, and sometimes even in those who never had it before.
Pregnant women are often afflicted with the piles.

A flux of blood from the _anus_ is not always to be treated as a
disease. It is even more salutary than bleeding at the nose, and often
prevents or carries off diseases. It is peculiarly beneficial in the
gout, rheumatism, asthma, and hypochondriacal complaints, and often
proves critical in colics, and inflammatory fevers.

In the management of the patient, regard must be had to his habit of
body, his age, strength, and manner of living. A discharge which might
be excessive and prove hurtful to one, may be very moderate, and even
salutary to another. That only is to be esteemed dangerous which
continues too long, and is in such quantity as to waste the patient’s
strength, hurt the digestion, nutrition, and other functions necessary
to life.

When this is the case, the discharge must be checked by a proper
regimen, and astringent medicines. The DIET must be cool but nourishing,
consisting chiefly of bread, milk, cooling vegetables and broths. The
drink may be chalybeate water, orange-whey, decoctions or infusions of
the astringent and mucilaginous plants, as the tormentil root, bistort,
the marsh-mallow-roots, &c.

Old conserve of red roses is a very good medicine in this case. It may
be mixed with new milk, and taken in the quantity of an ounce three or
four times a-day. This medicine is in no great repute, owing to its
being seldom taken in such quantity as to produce any effects; but when
taken as here directed, and duly persisted in, I have known it perform
very extraordinary cures in violent hæmorrhages, especially when
assisted by the tincture of roses; a tea-cupful of which may be taken
about an hour after every dose of the conserve.

The Peruvian bark is likewise proper in this case, both as a
strengthener and astringent. Half a drachm of it may be taken in a glass
of red-wine, sharpened with a few drops of the elixir of vitriol, three
or four times a-day.

The bleeding piles are sometimes periodical, and return regularly once a
month, or once in three weeks. In this case they are always to be
considered as a salutary discharge, and by no means to be stopped. Some
have entirely ruined their health by stopping a periodical discharge of
blood from the hæmorrhoidal veins.

In the _blind piles_ bleeding is generally of use. The diet must be
light and thin, and the drink cool and diluting. It is likewise
necessary that the body be kept gently open. This may be done by small
doses of the flowers of brimstone and cream of tartar. These may be
mixed in equal quantities, and a tea-spoonful taken two or three times
a-day, or oftner if necessary. Or an ounce of the flowers of brimstone
and half an ounce of purified nitre may be mixed with three or four
ounces of the lenitive electuary, and a tea-spoonful of it taken three
or four times a-day.

Emollient clysters are here likewise beneficial; but there is sometimes
such an astriction of the _anus_, that they cannot be thrown up. In this
case I have known a vomit have a very good effect.

When the piles are exceeding painful and swelled, but discharge nothing,
the patient must sit over the steams of warm water. He may likewise
apply a linen cloth dipped in warm spirits of wine to the part, or
poultices made of bread and milk, or of leeks fried with butter. If
these do not produce a discharge, and the piles appear large, leeches
must be applied as near them as possible, or, if they will fix upon the
piles themselves, so much the better. When leeches will not fix, the
piles may be opened with a lancet. The operation is very easy, and is
attended with no danger.

Various ointments, and other external applications, are recommended in
the piles; but I do not remember to have seen any effects from these
worth mentioning. Their principal use is to keep the part moist, which
may be done as well by a soft poultice, or an emollient cataplasm. When
the pain however is very great, a liniment made of two ounces of
emollient ointment, and half an ounce of liquid laudanum, beat up with
the yolk of an egg, may be applied.


                           SPITTING OF BLOOD.

We mean here to treat of that discharge of blood from the lungs only
which is called an _hæmoptoe_, or _spitting of blood_. Persons of a
slender make, and a lax fibre, who have long necks and strait breasts,
are most liable to this disease. It is most common in the spring, and
generally attacks people before they arrive at the prime or middle
period of life. It is a common observation, that those who have been
subject to bleeding at the nose when young, are afterwards most liable
to an hæmoptoe.

CAUSES.——An hæmoptoe may proceed from excess of blood, from a peculiar
weakness of the lungs, or a bad conformation of the breast. It is often
occasioned by excessive drinking, running, wrestling, singing, or
speaking aloud. Such as have weak lungs ought to avoid all violent
exertions of that organ, as they value life. They should likewise guard
against violent passions, excessive drinking, and every thing that
occasions a rapid circulation of the blood.

This disease may likewise proceed from wounds of the lungs. These may
either be received from without, or they may be occasioned by hard
bodies getting into the wind-pipe, and so falling down upon the lungs,
and hurting that tender organ. The obstruction of any customary
evacuation may occasion a spitting of blood; as neglect of bleeding or
purging at the usual seasons, the stoppage of the bleeding piles in men,
or the menses in women, &c. It may likewise proceed from a polypus,
scirrhous concretions, or any thing that obstructs the circulation of
the blood in the lungs. It is often the effect of a long and violent
cough; in which case it is generally the forerunner of a consumption. A
violent degree of cold suddenly applied to the external parts of the
body will occasion an hæmoptoe. It may likewise be occasioned by
breathing air which is too much rarified to be able properly to expand
the lungs. This is often the case with those who work in hot places, as
furnaces, glasshouses, or the like. It is likewise said to happen to
such as ascend to the top of very high mountains, as the Peak of
Teneriff, &c.

Spitting of blood is not always to be considered as a primary disease.
It is often only a symptom, and in some diseases not an unfavourable
one. This is the case in pleurisies, peripneumonies, and sundry other
fevers. In a dropsy, scurvy, or consumption, it is a bad symptom, and
shews that the lungs are ulcerated.

SYMPTOMS.——Spitting of blood is generally preceded by a sense of weight,
and oppression of the breast, a dry tickling cough, hoarseness, and a
difficulty of breathing. Sometimes it is ushered in with shivering
coldness of the extremities, costiveness, great lassitude, flatulence,
pain of the back and loins, &c. As these shew a general stricture upon
the vessels, and a tendency of the blood to inflammation, they are
commonly the forerunners of a very copious discharge. The above symptoms
do not attend a discharge of blood from the gums or fauces, by which
means these may always be distinguished from an hæmoptoe. Sometimes the
blood that is spit up is thin, and of a florid red colour; and at other
times it is thick, and of a dark or blackish colour; nothing however can
be inferred from this circumstance, but that the blood has lain a longer
or shorter time in the breast before it was discharged.

Spitting of blood, in a strong healthy person, of a sound constitution,
is not very dangerous; but when it attacks the tender and delicate, or
persons of a weak lax fibre, it is with difficulty removed. When it
proceeds from a scirrhus or polypus of the lungs, it is bad. The danger
is greater when the discharge proceeds from the rupture of a large
vessel than of a small one. When the extravasated blood is not spit up,
but lodges in the breast, it corrupts, and greatly increases the danger.
When the blood proceeds from an ulcer in the lungs, it is generally
fatal.

REGIMEN.——The patient ought to be kept cool and easy. Every thing that
heats the body or quickens the circulation, increases the danger. The
mind ought likewise to be soothed, and every occasion of exciting the
passions avoided. The diet should be soft, cooling, and slender; as rice
boiled with milk, small broths, barley-gruels, panado, &c. The diet, in
this case, can scarce be too low. Even water-gruel is sufficient to
support the patient for some days. All strong liquors must be avoided.
The patient may drink milk and water, barley-water, whey, butter-milk,
and such like. Every thing however should be drank cold, and in small
quantities at a time. He should observe the strictest silence, or at
least speak with a very low voice.

MEDICINE.——This, like the other involuntary discharges of blood, ought
not to be suddenly stopped by astringent medicines. More mischief is
often done by these than if it were suffered to go on. It may however
proceed so far as to weaken the patient, and even endanger his life; in
which case proper means must be used for restraining it.

The body should be kept gently open by laxative diet; as roasted apples,
stewed prunes, and such like. If these should not have the desired
effect, a tea-spoonful of the lenitive electuary may be taken twice or
thrice a-day, as is found necessary. If the bleeding proves violent,
ligatures may be applied to the extremities, as directed for a bleeding
at the nose.

If the patient be hot or feverish, bleeding and small doses of nitre
will be of use; a scruple or half a drachm of nitre may be taken in a
cup of his ordinary drink twice or thrice a-day. His drink may likewise
be sharpened with acids, as juice of lemon, or a few drops of the spirit
of vitriol; or he may take frequently a cup of the tincture of roses.

Bathing the feet and legs in lukewarm water has likewise a very good
effect in this disease. Opiates too are sometimes beneficial; but these
must be administered with caution. Ten or twelve drops of laudanum may
be given in a cup of barley-water twice a-day, and continued for some
time, provided they be found beneficial.

The conserve of roses is likewise a very good medicine in this case,
provided it be taken in sufficient quantity, and long enough persisted
in. It may be taken to the quantity of three or four ounces a-day; and,
if the patient be troubled with a cough, it should be made into an
electuary with balsamic syrup, and a little of the syrup of poppies.

If stronger astringents be necessary, fifteen or twenty drops of the
elixir of vitriol may be given in a glass of water three or four times
a-day.

Those who are subject to frequent returns of this disease should avoid
all excess. Their diet should be light and cool, consisting chiefly of
milk and vegetables. Above all, let them beware of vigorous efforts of
the body, and violent agitations of the mind.


                           VOMITING OF BLOOD.

This is not so common as the other discharges of blood which have
already been mentioned; but it is very dangerous, and requires
particular attention.

Vomiting of blood is generally preceded by pain of the stomach,
sickness, and nausea; and is accompanied with great anxiety, and
frequent fainting fits.

This disease is sometimes periodical; in which case it is less
dangerous. It often proceeds from an obstruction of the menses in women;
and sometimes from the stopping of the hæmorrhoidal flux in men. It may
be occasioned by any thing that greatly stimulates or wounds the
stomach, as strong vomits or purges, acrid poisons, sharp or hard
substances taken into the stomach, &c. It is often the effect of
obstructions in the liver, the spleen, or some of the other viscera. It
may likewise proceed from external violence, as blows or bruises, or
from any of the causes which produce inflammation. In hysteric women,
vomiting of blood is a very common, but by no means a dangerous symptom.

A great part of the danger in this disease arises from the extravasated
blood lodging in the bowels, and becoming putrid, by which means a
dysentery or putrid fever may be occasioned. The best way of preventing
this, is to keep the body gently open, by frequently exhibiting
emollient clysters. Purges must not be given till the discharge is
stopt, otherwise they will irritate the stomach, and increase the
disorder. All the food and drink must be of a mild cooling nature, and
taken in small quantities. Even drinking cold water has sometimes proved
a remedy, but it will succeed better when sharpened with the weak
spirits of vitriol. When there are signs of an inflammation, bleeding
may be necessary; but the patient’s weakness will seldom permit it.
Opiates may be of use; but they must be given in very small doses, as
four or five drops of liquid laudanum twice or thrice a-day.

After the discharge is over, as the patient is generally troubled with
gripes, occasioned by the acrimony of the blood lodged in the
intestines, gentle purges will be necessary.


                            OF BLOODY URINE.

This is a discharge of blood from the vessels of the kidneys or bladder,
occasioned by their being either enlarged, broken, or eroded. It is more
or less dangerous according to the different circumstances which attend
it.

When pure blood is voided suddenly without interruption and without
pain, it proceeds from the kidneys; but if the blood be in small
quantity, of a dark colour, and emitted with heat and pain about the
bottom of the belly, it proceeds from the bladder. When bloody urine is
occasioned by a rough stone descending from the kidneys to the bladder,
which wounds the _ureters_, it is attended with a sharp pain in the
back, and difficulty of making water. If the coats of the bladder are
hurt by a stone, and the bloody urine follows, it is attended with the
most acute pain, and a previous stoppage of urine.

Bloody urine may likewise be occasioned by falls, blows, the lifting or
carrying of heavy burdens, hard riding, or any violent motion. It may
also proceed from ulcers of the bladder, from a stone lodged in the
kidneys, or from violent purges, or sharp diuretic medicines, especially
cantharides.

Bloody urine is always attended with some degree of danger: but it is
peculiarly so when mixed with purulent matter, as this shews an ulcer
somewhere in the urinary passages. Sometimes this discharge proceeds
from excess of blood, in which case it is rather to be considered as a
salutary evacuation than a disease. If the discharge however be very
great, it may waste the patient’s strength, and occasion an ill habit of
body, a dropsy, or a consumption.

The treatment of this disorder must be varied according to the different
causes from which it proceeds.

When it is owing to a stone in the bladder, the cure depends upon an
operation; a description of which would be foreign to our purpose.

If it be attended with a plethora, and symptoms of inflammation,
bleeding will be necessary. The body must likewise be kept open by
emollient clysters, or cooling purgative medicines; as cream of tartar,
rhubarb, manna, or small doses of lenitive electuary.

When bloody urine proceeds from a dissolved state of the blood, it is
commonly the symptom of some malignant disease; as the small-pox, a
putrid fever, or the like. In this case the patient’s life depends on
the liberal use of the Peruvian bark and acids, as has already been
shewn.

When there is reason to suspect an ulcer in the kidneys or bladder, the
patient’s diet must be cool, and his drink of a soft, healing, balsamic
quality, as decoctions of marsh-mallow roots with liquorice, solutions
of gum-arabic, &c. Three ounces of marsh-mallow roots, and half an ounce
of liquorice, may be boiled in two English quarts of water to one; two
ounces of gum-arabic, and half an ounce of purified nitre, may be
dissolved in the strained liquor, and a tea-cupful of it taken four or
five times a-day.

The early use of astringents in this disease has often bad consequences.
When the flux is stopped too soon, the grumous blood, by being confined
in the vessels, may produce inflammations, abscess, and ulcers. If
however the case be urgent, or the patient seems to suffer from the loss
of blood, gentle astringents may be necessary. In this case the patient
may take three or four ounces of lime-water, with half an ounce of the
tincture of Peruvian bark, three times a-day.


                   OF THE DYSENTERY, OR BLOODY FLUX.

This disease prevails in the spring and autumn. It is most common in
marshy countries, where, after hot and dry summers, it is apt to become
epidemic. Persons are most liable to it who are much exposed to the
night-air, or who live in places where the air is confined and
unwholesome. Hence it often proves fatal in camps, on shipboard, in
jails, hospitals, and such like places.

CAUSES.——The dysentery may be occasioned by any thing that obstructs the
perforation, or renders the humours putrid; as damp beds, wet clothes,
unwholesome diet, air, &c. But it is most frequently communicated by
infection. This ought to make people extremely cautious in going near
such persons as labour under the disease. Even the smell of the
patient’s excrements has been known to communicate the infection.

SYMPTOMS.——It is known by a flux of the belly, attended with violent
pain of the bowels, a constant inclination to go to stool, and generally
more or less blood in the stools. It begins, like other fevers, with
chillness, loss of strength, a quick pulse, great thirst, and an
inclination to vomit. The stools are at first greasy and frothy,
afterwards they are streaked with blood, and at last have frequently the
appearance of pure blood, mixed with small filaments resembling bits of
skin. Worms are sometimes passed both upwards and downwards through the
whole course of the disease. When the patient goes to stool, he feels a
bearing down, as if the whole bowels were falling out, and sometimes a
part of the intestine is actually protruded, which proves exceeding
troublesome, especially in children. Flatulency is likewise a
troublesome symptom, especially towards the end of the disease.

This disease may be distinguished from a diarrhœa or looseness, by the
acute pain of the bowels, and the blood which generally appears in the
stools. It may be distinguished from the _cholera morbus_ by its not
being attended with such violent and frequent fits of vomiting, &c.

When the dysentery attacks the old, the delicate, or such as have been
wasted by the gout, the scurvy, or other lingering diseases, it
generally proves fatal. Vomiting and hiccuping are bad signs, as they
shew an inflammation of the stomach. When the stools are green, black,
or have an exceeding disagreeable cadaverous smell, the danger is very
great, as it shows the disease to be of the putrid kind. It is an
unfavourable symptom when clysters are immediately returned; but still
more so, when the passage is so obstinately shut, that they cannot be
injected. A feeble pulse, coldness of the extremities, with difficulty
of swallowing, and convulsions, are signs of approaching death.

REGIMEN.——Nothing is of more importance in this disease than
cleanliness. It contributes greatly to the recovery of the patient, and
no less to the safety of such as attend him. In all contagious diseases
the danger is increased, and the infection spread, by the neglect of
cleanliness, but in no one more than this. Every thing about the patient
should be frequently changed. The excrements should never be suffered to
continue in his chamber, but removed immediately, and buried under
ground. A constant stream of fresh air should be admitted into the
chamber; and it ought frequently to be sprinkled with vinegar, juice of
lemon, or some other strong acid.

The patient must not be discouraged, but his spirits kept up in hopes of
a cure. Nothing tends more to render any putrid disease mortal, than the
fears and apprehensions of the sick. All diseases of this nature have a
tendency to sink and depress the spirits, and when that is increased by
fears and alarms from those whom the patient believes to be persons of
skill, it cannot fail to have the worst effects.

A flannel waistcoat worn next the skin has often a very good effect in
the dysentery. This promotes the perspiration without overheating the
body. Great caution however is necessary in leaving it off. I have often
known a dysentery brought on by imprudently throwing off a flannel
waistcoat before the season was sufficiently warm. For whatever purpose
this piece of dress is worn, it should never be left off but in a warm
season.

In this disease the greatest attention must be paid to the patient’s
diet. Flesh, fish, and every thing that has a tendency to turn putrid or
rancid on the stomach, must be abstained from. Apples boiled in milk,
water-pap, and plain light pudding, with broth made of the gelatinous
parts of animals, may constitute the principal part of the patient’s
food. Gelatinous broth not only answers the purpose of food, but
likewise of medicine. I have often known dysenteries, which were not of
a putrid nature, cured by it after pompous medicines had proved
ineffectual[126].

Another kind of food very proper in the dysentery, which may be used by
such as cannot take the broth mentioned above, is made by boiling a few
handfuls of fine flour, tied in a cloth, for six or seven hours, till it
becomes as hard as starch. Two or three table-spoonfuls of this may be
grated down, and boiled in such a quantity of new milk and water as to
be of the thickness of pap. This may be sweetened to the patient’s
taste, and taken for his ordinary food[127].

In a _putrid dysentery_ the patient may be allowed to eat freely of most
kinds of good ripe fruit; as apples, grapes, gooseberries,
currant-berries, strawberries, &c. These may either be eaten raw or
boiled, with or without milk, as the patient chuses. The prejudice
against fruit in this disease is so great, that many believe it to be
the common cause of dysenteries. This however is an egregious mistake.
Both reason and experience shew, that good fruit is one of the best
medicines, both for the prevention and cure of the dysentery. Good fruit
is in every respect calculated to counteract that tendency to
putrefaction, from whence the most dangerous kind of dysentery proceeds.
The patient in such a case ought therefore be allowed to eat as much
fruit as he pleases, provided it be ripe[128].

The most proper drink in this disorder is whey. The dysentery has often
been cured by the use of clear whey alone. It may be taken both for
drink and in form of clyster. When whey cannot be had, barley-water
sharpened with cream of tartar may be drank, or a decoction of barley
and tamarinds; two ounces of the former and one of the latter may be
boiled in two English quarts of water to one. Warm water, water-gruel,
or water wherein hot iron has been frequently quenched, are all very
proper, and may be drank in turns. Camomile-tea, if the stomach will
bear it, is an exceeding proper drink. It both strengthens the stomach,
and by its antiseptic quality tends to prevent a mortification of the
bowels.

MEDICINE.——At the beginning of this disease it is always necessary to
cleanse the first passages. For this purpose a vomit of ipecacuanha must
be given, and wrought off with weak camomile-tea. Strong vomits are
seldom necessary here. A scruple, or at most half a drachm of
ipecacuanha, is generally sufficient for an adult, and sometimes a very
few grains will suffice. The day after the vomit, half a drachm, or two
scruples of rhubarb, must be taken; or, what will answer the purpose
rather better, an ounce or an ounce and a half of Epsom salts. This dose
may be repeated every other day for two or three times. Afterwards small
doles of ipecacuanha may be taken for some time. Two or three grains of
the powder may be mixed in a table-spoonful of the syrup of poppies, and
taken three times a day.

These evacuations, and the regimen prescribed above, will often be
sufficient to effect a cure. Should it however happen otherwise, the
following astringent medicines may be used.

A clyster of starch or fat mutton-broth, with thirty or forty drops of
liquid laudanum in it, may be administered twice a-day. At the same time
an ounce of gum-arabic, and half an ounce of gum-tragacanth, may be
dissolved in an English pint of barley-water, over a slow fire, and a
table-spoonful of it taken every hour.

If these have not the desired effect, the patient may take, four times
a-day, about the bulk of a nutmeg of the _Japonic confection_, drinking
after it a tea-cupful of the decoction of logwood[129].

Persons who have been cured of this disease are very liable to suffer a
relapse; to prevent which, great circumspection with respect to diet is
necessary. The patient must abstain from all fermented liquors, except
now and then a glass of good wine; but he must drink no kind of
malt-liquor. He should likewise abstain from animal food, as fish and
flesh, and live principally on milk and vegetables.

Gentle exercise and wholesome air are likewise of importance. The
patient should go to the country as soon as his strength will permit,
and should take exercise daily on horseback, or in a carriage. He may
likewise use bitters infused in wine or brandy, and may drink twice
a-day a gill of lime-water mixed with an equal quantity of new milk.

When dysenteries prevail, we would recommend a strict attention to
cleanliness, a spare use of animal food, and the free use of sound ripe
fruits, and other vegetables. The night air is to be carefully avoided,
and all communication with the sick. Bad smells are likewise to be
shunned, especially those which arise from putrid animal substances. The
necessaries where the sick go are carefully to be avoided.

When the first symptoms of the dysentery appear, the patient ought
immediately to take a vomit, to go to bed, and drink plentifully of weak
warm liquor, to promote a sweat. This, with a dose or two of rhubarb at
the beginning, would often carry off the disease. In countries where
dysenteries prevail, we would advise such as are liable to them, to take
either a vomit or a purge every spring or autumn, as a preventive.

There are sundry other fluxes of the belly, as the LIENTERY and CŒLIAC
PASSION, which, though less dangerous than the dysentery, yet merit
consideration. These diseases generally proceed from a relaxed state of
the stomach and intestines, which is sometimes so great, that the food
passes through them without almost any sensible alterations; and the
patient dies merely from the want of nourishment.

When the lientery or cœliac passion succeeds to a dysentery, the case is
bad. They are always dangerous in old age, especially when the
constitution has been broken by excess or acute diseases. If the stools
be very frequent, and quite crude, the thirst great, with little urine,
the mouth ulcerated, and the face marked with spots of different
colours, the danger is very great.

The treatment of the patient is in general the same as in the dysentery.
In all obstinate fluxes of the belly, the cure must be attempted, by
first cleansing the stomach and bowels with gentle vomits and purges;
afterwards such a diet as has a tendency to heal and strengthen the
bowels, with opiates and astringent medicines, will generally perfect
the cure.

The same observation holds with respect to a TENESMUS, or frequent
desire of going to stool. This disease resembles the dysentery so much,
both in its symptoms and method of cure, that we think it needless to
insist upon it.




                              CHAP. XXXIV.
                            OF THE HEAD-ACH.


Aches and pains proceed from very different causes, and may affect any
part of the body; but we shall point out those only which occur most
frequently, and are attended with the greatest danger.

When the head-ach is slight, and affects a particular part of the head
only, it is called _cephalalgia_; when the whole head is affected,
_cephalæa_; and when on one side only, _hemicrania_. A fixed pain in the
forehead, which may be covered with the end of the thumb, is called the
_clavis hystericus_.

There are also other distinctions. Sometimes the pain is internal,
sometimes external; sometimes it is an original disease, and at other
times only symptomatic. When the head-ach proceeds from a hot bilious
habit, the pain is very acute and throbbing, with a considerable heat of
the part affected. When from a cold phlegmatic habit, the patient
complains of a dull heavy pain, and has a sense of coldness in the part.
This kind of head-ach is sometimes attended with a degree of stupidity
or folly.

Whatever obstructs the free circulation of the blood through the vessels
of the head, may occasion a head-ach. In persons of a full habit, who
abound with blood, or other humours, the head-ach often proceeds from
the suppression of customary evacuations; as bleeding at the nose,
sweating of the feet, &c. It may likewise proceed from any cause that
determines a great flux of blood towards the head; as coldness of the
extremities, or hanging down the head for a long time. Whatever prevents
the return of the blood from the head will likewise occasion a head-ach;
as looking long obliquely at any object, wearing any thing tight about
the neck, or the like.

When a head-ach proceeds from the stoppage of a running at the nose,
there is a heavy, obtuse, pressing pain in the fore-part of the head, in
which there seems to be such a weight, that the patient can scarce hold
it up. When it is occasioned by the caustic matter of the venereal
disease, it generally affects the skull, and often produces a _caries_
of the bones.

Sometimes the head-ach proceeds from the repulsion or retrocession of
the gout, the erysipelas, the small-pox, measles, itch, or other
eruptive diseases. What is called a _hemicrania_ generally proceeds from
crudities or indigestion. Inanition, or emptiness, will often also
occasion head-achs. I have often seen instances of this in nurses who
gave suck too long, or who did not take a sufficient quantity of solid
food.

There is likewise a most violent, fixed, constant, and almost
intolerable head-ach, which occasions great debility both of body and
mind, prevents sleep, destroys the appetite, causes a _vertigo_, dimness
of sight, a noise in the ears, convulsions, epileptic fits, and
sometimes vomiting, costiveness, coldness of the extremities, &c.

The head-ach is often symptomatic in continual and intermitting fevers,
especially quartans. It is likewise a very common symptom in hysteric
and hypochondriac complaints.

When a head-ach attends an acute fever, with pale urine, it is an
unfavourable symptom. In excessive head-achs, coldness of the
extremities is a bad sign.

When the disease continues long, and is very violent, it often
terminates in blindness, an apoplexy, deafness, a _vertigo_, the palsy,
epilepsy, &c.

In this disease the cool regimen in general is to be observed. The diet
ought to consist of such emollient substances as will correct the
acrimony of the humours, and keep the body open; as apples boiled in
milk, spinage, turnips, and such like. The drink ought to be diluting;
as barley-water, infusions of mild mucilaginous vegetables, decoctions
of the sudorific woods, &c. The feet and legs ought to be kept warm, and
frequently bathed in lukewarm water; the head should be shaved, and
bathed with water and vinegar. The patient ought as much as possible to
keep in an erect posture, and not to lie with his head too low.

When the head-ach is owing to excess of blood, or an hot bilious
constitution, bleeding is necessary. The patient may be bled in the
jugular vein, and the operation repeated if there be occasion. Cupping
also, or the application of leeches to the temples, and behind the ears,
will be of service. Afterwards a blistering-plaster may be applied to
the neck behind the ears, or to any part of the head that is most
affected. In some cases it will be proper to blister the whole head. In
persons of a gross habit, issues or perpetual blisters will be of
service. The body ought likewise to be kept open by gentle laxatives.

But when the head-ach proceeds from a copious vitiated _serum_
stagnating in the membranes, either within or without the skull, with a
dull, heavy, continual pain, which will neither yield to bleeding nor
gentle laxatives, then more powerful purgatives are necessary, as pills
made of aloes, resin of jalap, or the like. It will also be necessary in
this case to blister the whole head, and to keep the back part of the
neck open for a considerable time by a perpetual blister.

When the head-ach is occasioned by the stoppage of a running at the
nose, the patient should frequently smell to a bottle of volatile salts;
he may likewise take snuff, or any thing that will irritate the nose, so
as to promote a discharge from it; as the herb mastich, ground-ivy, &c.

A _hemicrania_, especially a periodical one, is generally owing to a
foulness of the stomach, for which gentle vomits must be administered,
as also purges of rhubarb. After the bowels have been sufficiently
cleared, chalybeate waters, and such bitters as strengthen the stomach,
will be necessary. A periodical head-ach has been cured by wearing a
piece of flannel over the forehead during the night.

When the head-ach arises from a vitiated state of the humours, as in the
scurvy and venereal disease, the patient, after proper evacuations, must
drink freely of the decoction of woods, or the decoction of
sarsaparilla, with raisins and liquorice[130]. These promote
perspiration, sweeten the humours, and, if duly persisted in, will
produce very happy effects. When a collection of matter is felt under
the skin, it must be discharged by an incision, otherwise it will render
the bone carious.

When the head-ach is so intolerable as to endanger the patient’s life,
or is attended with continual watching, delirium, &c. recourse must be
had to opiates. These, after proper evacuations by clysters or mild
purgatives, may be applied both externally and internally. The affected
part may be rubbed with Bate’s anodyne balsam, or a cloth dipped in it
may be applied to the part. The patient may, at the same time, take
twenty drops of laudanum, in a cup of valerian or penny-royal tea, twice
or thrice a day. This is only to be done in case of extreme pain. Proper
evacuations ought always to accompany and follow the use of
opiates[131].

When the patient cannot bear the loss of blood, his feet ought
frequently to be bathed in lukewarm water, and well rubbed with a coarse
cloth. Cataplasms with mustard or horse-radish ought likewise to be
applied to them. This course is peculiarly necessary when the pain
proceeds from a gouty humour affecting the head.

When the head-ach is occasioned by great heat, hard labour, or violent
exercise of any kind, it may be allayed by cooling medicines; as the
saline draughts with nitre, and the like.

A little of Ward’s essence, dropt into the palm of the hand, and applied
to the forehead, will sometimes remove a violent head-ach; and so will
æther, when applied in the same manner.


                           OF THE TOOTH-ACH.

This disease is so well known, that it needs no description. It has
great affinity with the rheumatism, and often succeeds pains of the
shoulders and other parts of the body.

It may proceed from obstructed perspiration, or any of the other causes
of inflammation. I have often known the tooth-ach occasioned by
neglecting some part of the usual coverings of the head, by sitting with
the head bare near an open window, or exposing it any how to a draught
of cold air. Food or drink taken either too hot or too cold is very
hurtful to the teeth. Great quantities of sugar, or other sweetmeats,
are likewise hurtful. Nothing is more destructive to the teeth than
cracking nuts, or chewing any kind of hard substances. Picking the teeth
with pins, needles, or any thing that may hurt the enamel with which
they are covered, does great mischief, as the tooth is sure to be
spoiled whenever the air gets into it. Breeding women are very subject
to the tooth-ach, especially during the first three or four months of
pregnancy. The tooth-ach often proceeds from scorbutic humours affecting
the gums. In this case the teeth are sometimes wasted, and fall out
without any considerable degree of pain. The more immediate cause of the
tooth-ach is a rotten or _carious_ tooth.

In order to relieve the tooth-ach, we must first endeavour to lessen the
flux of humours to the part affected. This may be done by mild
purgatives, scarifying the gums, or applying leeches to them, and
bathing the feet frequently with warm water. The perspiration ought
likewise to be promoted, by drinking freely of weak wine-whey, or other
diluting liquors, with small doses of nitre. Vomits too have often an
exceeding good effect in the tooth-ach. It is seldom safe to administer
opiates, or any kind of heating medicines, or even to draw a tooth, till
proper evacuations have been premised; and these alone will often effect
the cure.

If this fails, and the pain and inflammation still increase, a
suppuration may be expected, to promote which a toasted fig should be
held between the gum and the cheek; bags filled with boiled
camomile-flowers, flowers of elder, or the like, may be applied near the
part affected, with as great a degree of warmth as the patient can bear,
and renewed as they grow cool: the patient may likewise receive the
steams of warm water into his mouth, through an inverted funnel, or by
holding his head over the mouth of a porringer filled with warm water,
&c.

Such things as promote the discharge of saliva, or cause the patient to
spit, are generally of service. For this purpose, bitter, hot, or
pungent vegetables may be chewed; as gentian, calamus aromaticus, or
pellitory of Spain. Allen recommends the root of _yellow water
flower-de-luce_ in this case. This root may either be rubbed upon the
tooth, or a little of it chewed. Brookes says he hardly ever knew it
fail to ease the tooth-ach. It ought however to be used with caution.

Many other herbs, roots, and seeds, are recommended for curing the
tooth-ach; as the leaves of roots of millefoil or yarrow chewed, tobacco
smoked or chewed, staves-acre, or the seeds of mustard chewed, &c. These
bitter, hot, and pungent things, by occasioning a greater flow of
_saliva_, frequently give ease in the tooth-ach.

Opiates often relieve the tooth-ach. For this purpose a little cotton
wet with laudanum may be held between the teeth; or a piece of
sticking-plaster, about the bigness of a shilling, with a bit of opium
in the middle of it, of a size not to prevent the sticking of the other,
may be laid on the temporal artery, where the pulsation is most
sensible. _De la Motte_ affirms, that there are few cases wherein this
will not give relief. If there be a hollow tooth, a small pill made of
equal parts of camphire and opium, put into the hollow, is often
beneficial. When this cannot be had, the hollow tooth may be filled with
gum mastich, wax, lead, or any substance that will stick in it, and keep
out the external air.

Few applications give more relief in the tooth-ach than
blistering-plasters. These may be applied between the shoulders; but
they have the best effect when put behind the ears, and made so large as
to cover a great part of the lower jaw.

After all, when a tooth is carious, it is often impossible to remove the
pain without extracting it; and, as a spoilt tooth never becomes sound
again, it is prudent to draw it soon, lest it should affect the rest.
Tooth-drawing, like bleeding, is very much practiced by mechanics, as
well as persons of the medical profession. The operation however is not
without danger, and ought always to be performed with care. A person
unacquainted with the structure of the parts will be in danger of
hurting the jaw-bone, or of drawing a sound tooth instead of a rotten
one[132].

When the tooth-ach returns periodically, and the pain chiefly affects
the gums, it may be cured by the bark.

Some pretend to have found great benefit in the tooth-ach, from the
application of an artificial magnet to the affected tooth. We shall not
attempt to account for its mode of operation; but, if it be found to
answer, though only in particular cases, it certainly deserves a trial,
as it is attended with no expence, and cannot do any harm. Electricity
has likewise been recommended, and particular instruments have been
invented for sending a shock through the affected tooth.

Persons who have returns of the tooth-ach at certain seasons, as spring
and autumn, might often prevent it by taking a purge at these times.

Keeping the teeth clean has no doubt a tendency to prevent the
tooth-ach. The best method of doing this is to wash them daily with salt
and water, a decoction of the bark, or with cold water alone. All
brushing and scraping of the teeth is dangerous, and, unless it be
performed with great care, does mischief.


                            OF THE EAR-ACH.

This disorder chiefly affects the membrane which lines the inner cavity
of the ear called the _meatus auditorius_. It is often so violent as to
occasion great restlessness, anxiety, and even delirium. Sometimes
epileptic fits, and other convulsive disorders, have been brought on by
extreme pain in the ear.

The ear-ach may proceed from any of the causes which produce
inflammation. It often proceeds from a sudden suppression of
perspiration, or from the head being exposed to cold when covered with
sweat. It may also be occasioned by worms, or other insects getting into
the ear, or being bred there; or from any hard body sticking in the ear.
Sometimes it proceeds from the translation of morbific matter to the
ear. This often happens in the decline of malignant fevers, and
occasions deafness, which is generally reckoned a favourable symptom.

When the ear-ach proceeds from insects, or any hard body sticking in the
ear, every method must be taken to remove them as soon as possible. The
membranes may be relaxed by dropping into the ear oil of sweet almonds,
or olive oil. Afterwards the patient should be made to sneeze, by taking
snuff, or some strong sternutatory. If this should not force out the
body, it must be extracted by art. I have seen insects, which had got
into the ear, come out of their own accord upon pouring in oil, which is
a thing they cannot bear.

When the pain of the ear proceeds from inflammation, it must be treated
like other topical inflammations, by a cooling regimen, and opening
medicines. Bleeding at the beginning, either in the arm or jugular vein,
or cupping in the neck, will be proper. The ear may likewise be fomented
with steams of warm water; or flannel bags filled with boiled mallows
and camomile flowers may be applied to it warm; or bladders filled with
warm milk and water. An exceeding good method of fomenting the ear is to
apply it close to the mouth of a jug filled with warm water, or a strong
decoction of camomile flowers.

The patient’s feet should be frequently bathed in lukewarm water, and he
ought to take small doses of nitre and rhubarb, _viz._ a scruple of the
former, and ten grains of the latter, three times a-day. His drink may
be whey, or decoction of barley and liquorice with figs or raisins. The
parts behind the ear ought frequently to be rubbed with camphorated oil,
or a little of the volatile liniment.

When the inflammation cannot be discussed, a poultice of bread and milk,
or roasted onions, may be applied to the ear, and frequently renewed,
till the abscess breaks, or can be opened. Afterwards the humours may be
diverted from the part by gentle laxatives, blisters, or issues; but the
discharge must not be suddenly dried up by any external application.


                        PAIN OF THE STOMACH, &c.

This may proceed from various causes; as indigestion; wind; the acrimony
of the bile; sharp, acrid, or poisonous substances taken into the
stomach, &c. It may likewise be occasioned by worms; the stoppage of
customary evacuations; a translation of gouty matter to the stomach, the
bowels, &c.

Women in the decline of life are very liable to pains of the stomach and
bowels, especially such as are afflicted with hysteric complaints. It is
likewise very common to hypochondriac men of a sedentary and luxurious
life. In such persons it often proves so extremely obstinate as to
baffle all the powers of medicine.

When the pain of the stomach is most violent after eating, there is
reason to suspect that it proceeds from some fault either in the
digestion or the food. In this case the patient ought to change his
diet, till he finds what kind of food agrees best with his stomach, and
should continue chiefly to use it. If a change of diet does not remove
the complaint, the patient may take a gentle vomit, and afterwards a
dose or two of rhubarb. He ought likewise to take an infusion of
camomile flowers, or some other stomachic bitter, either in wine or
water. I have often known exercise remove this complaint, especially
sailing, or a long journey on horseback, or in a carriage.

When a pain of the stomach proceeds from flatulency, the patient is
constantly belching up wind, and feels an uneasy distention of the
stomach after meals. This is a most deplorable disease, and is seldom
thoroughly cured. In general, the patient ought to avoid all windy diet,
and every thing that sours on the stomach, as greens, roots, &c. This
rule however admits of some exceptions. There are many instances of
persons very much troubled with wind, who have received great benefit
from eating parched pease, though that grain is generally supposed to be
of a windy nature[133].

This complaint may likewise be greatly relieved by labour, especially
digging, reaping, mowing, or any kind of active employment by which the
bowels are alternately compressed and dilated. The most obstinate case
of this kind I ever met with was in a person of a sedentary occupation,
whom I advised, after he had tried every kind of medicine in vain, to
turn gardener; which he did, and has ever since enjoyed good health.

When a pain of the stomach is occasioned by the swallowing of acrid or
poisonous substances, they must be discharged by vomit; this may be
excited by butter, oils, or other soft things, which sheath and defend
the stomach from the acrimony of its contents.

When pain of the stomach proceeds from a translation of gouty matter,
warm cordials are necessary, as generous wines, French brandy, &c. Some
have drank a whole bottle of brandy or rum, in this case, in a few
hours, without being in the least intoxicated, or even feeling the
stomach warmed by it. It is impossible to ascertain the quantities
necessary upon these occasions. This must be left to the feelings and
discretion of the patient. The safer way however is, not to go too far.
When there is an inclination to vomit, it may be promoted by drinking an
infusion of camomile flowers, or _carduus benedictus_.

If a pain of the stomach proceed from the stoppage of customary
evacuations, bleeding will be necessary, especially in sanguine and very
full habits. It will likewise be of use to keep the body gently open by
mild purgatives; as rhubarb or senna, &c. When this disease affects
women, in the decline of life, after the stoppage of the _menses_,
making an issue in the leg or arm will be of peculiar service.

When the disease is occasioned by worms, they must be destroyed, or
expelled by such means as are recommended in the following section.

When the stomach is greatly relaxed and the digestion bad, which often
occasion flatulencies, the elixir of vitriol will be of singular
service. Fifteen or twenty drops of it may be taken in a glass of wine
or water twice or thrice a-day.

Persons afflicted with flatulency are generally unhappy unless they be
taking some purgative medicines; these, though they may give immediate
ease, tend to weaken and relax the stomach and bowels, and consequently
increase the disorder. Their best method is to mix purgatives and
stomachics together. Equal parts of Peruvian bark and rhubarb may be
infused in brandy or wine, and taken in such quantity as to keep the
body gently open.




                              CHAP. XXXV.
                               OF WORMS.


These are chiefly of three kinds, _viz._ the _tænia_, or tape-worm; the
_teres_, or round and long worm; and the _ascarides_, or round and short
worm. There are many other kinds of worms found in the human body; but
as they proceed, in a great measure, from similar causes, have nearly
the same symptoms, and require almost the same method of treatment as
these already mentioned, we shall not spend time in enumerating them.

The tape-worm is white, very long, and full of joints. It is generally
bred either in the stomach or small intestines. The round and long worm
is likewise bred in the small guts, and sometimes in the stomach. The
round and short worms commonly lodge in the _rectum_, or what is called
the end gut, and occasion a disagreeable itching about the seat.

The long round worms occasion squeamishness, vomiting, a disagreeable
breath, gripes, looseness, swelling of the belly, swoonings, loathing of
food, and at other times a voracious appetite, a dry cough, convulsions,
epileptic fits, and sometimes a privation of speech. These worms have
been known to perforate the intestines, and get into the cavity of the
belly. The effects of the tape-worm are nearly the same with those of
the long and round, but rather more violent.

Andry says, the following symptoms particularly attend the _solium_,
which is a species of the tape-worm, _viz._ swoonings, privation of
speech, and a voracious appetite. The round worms called _ascarides_,
besides an itching of the _anus_, cause swoonings, and tenesmus, or an
inclination to go to stool.

CAUSES.——Worms may proceed from various causes; but they are seldom
found except in weak and relaxed stomachs, where the digestion is bad.
Sedentary persons are more liable to them than the active and laborious.
Those who eat great quantities of unripe fruit, or who live much on raw
herbs and roots, are generally subject to worms. There seems to be a
hereditary disposition in some persons to this disease. I have often
seen all the children of a family subject to worms of a particular kind.
They seem likewise frequently to be owing to the nurse. Children of the
same family, nursed by one woman, have often worms, when those nursed by
another have none.

SYMPTOMS.——The common symptoms of worms are, paleness of the
countenance, and at other times, an universal flushing of the face;
itching of the nose; this however is doubtful, as children pick their
noses in all diseases; starting, and grinding of the teeth in sleep;
swelling of the upper lip; the appetite sometimes bad, at other times
quite voracious; looseness; a sour or stinking breath; a hard swelled
belly; great thirst; the urine frothy, and sometimes of a whitish
colour; griping, or colic pains; an involuntary discharge of _saliva_,
especially when asleep; frequent pains of the side, with a dry cough,
and unequal pulse; palpitations of the heart; swoonings; drowsiness;
cold sweats; palsy; epileptic fits, with many other unaccountable
nervous symptoms, which were formerly attributed to witchcraft, or the
influence of evil spirits. Small bodies in the excrements resembling
melon or cucumber seeds are symptoms of the tape-worm.

I lately saw some very surprising effect of worms in a girl about five
years of age, who used to lie for whole hours as if dead. She at last
expired, and, upon opening her body, a number of the _teres_, or long
round worms, were found in her guts, which were considerably inflamed;
and what anatomists call an _intus susceptio_, or involving of one part
of the gut within another, had taken place in no less than four
different parts of the intestinal canal[134].

MEDICINE.——Though numberless medicines are extolled for expelling and
killing worms[135], yet no disease more frequently baffles the
physician’s skill. In general, the most proper medicines for their
expulsion are strong purgatives; and to prevent their breeding,
stomachic bitters, with now and then a glass of good wine.

The best purge for an adult is jalap and calomel. Five and twenty or
thirty grains of the former with six or seven of the latter, mixed in
syrup, may be taken early in the morning, for a dose. It will be proper
that the patient keep the house all day, and drink nothing cold. The
dose may be repeated once or twice a week, for a fortnight or three
weeks. On the intermediate days the patient may take a drachm of the
powder of tin, twice or thrice a-day, mixed with syrup, honey, or
treacle.

Those who do not chuse to take calomel may make use of the bitter
purgatives; as aloes, hiera picra, tincture of senna, and rhubarb, &c.

Oily medicines are sometimes found beneficial for expelling worms. An
ounce of sallad oil and a table-spoonful of common salt may be taken in
a glass of red port wine thrice a-day, or oftner, if the stomach will
bear it. But the more common form of using oil is in clysters. Oily
clysters, sweetened with sugar or honey, are very efficacious in
bringing away the short round worms called _ascarides_, and likewise the
_teres_.

The Harrowgate water is an excellent medicine for expelling worms,
especially the _ascarides_. As this water is impregnated with sulphur,
we may hence infer, that sulphur alone must be a good medicine in this
case; which is found to be a fact. Many practitioners give flour of
sulphur in very large doses, and with great success. It should be made
into an electuary with honey or treacle, and taken in such quantity as
to purge the patient.

Where Harrowgate water cannot be obtained, sea-water may be used, which
is far from being a contemptible medicine in this case. If sea-water
cannot be had, common salt dissolved in water may be drank. I have often
seen this used by country nurses with very good effect. Some flour of
sulphur may be taken over night, and the salt-water in the morning.

But worms, though expelled, will soon breed again, if the stomach
remains weak and relaxed; to prevent which, we would recommend the
Peruvian bark. Half a drachm of bark in powder may be taken in a glass
of red port wine three or four times a-day, after the above medicines
have been used. Lime-water is likewise good for this purpose, or a
table-spoonful of the chalybeate wine taken twice or thrice a-day.
Infusions or decoctions of bitter herbs may likewise be drank; as the
infusion of tansy, water-trefoil, camomile flowers, tops of wormwood,
the lesser centaury, &c.

For a child of four or five years old, six grains of rhubarb, five of
jalap, and two of calomel, may be mixed in a spoonful of syrup or honey,
and given in the morning. The child should keep the house all day, and
take nothing cold. This dose may be repeated twice a-week for three or
four weeks. On the intermediate days the child may take a scruple of
powdered tin and ten grains of æthiops mineral in a spoonful of treacle
twice a-day. This dose must be increased or diminished according to the
age of the patient.

Bisset says, the great bastard black hellebore, or _bear’s foot_, is a
most powerful vermifuge for the long round worms. He orders the
decoction of about a drachm of the green leaves, or about fifteen grains
of the dried leaves in powder for a dose to a child between four and
seven years of age. This dose is to be repeated two or three times. He
adds, that the green leaves made into a syrup with coarse sugar, is
almost the only medicine he has used for round worms for three years
past. Before pressing out the juice, he moistens the bruised leaves with
vinegar, which corrects the medicine. The dose is a tea-spoonful at
bed-time, and one or two next morning.

I have frequently known those big bellies, which in children are
commonly reckoned a sign of worms, quite removed by giving them white
soap in their pottage, or other food. Tansy, garlic, and rue, are all
good against worms, and may be used various ways. We might here mention
many other plants, both for external and internal use, as the
cabbage-bark, &c. but think the powder of tin with æthiops mineral, and
the purges of rhubarb and calomel, are more to be depended on.

Ball’s purging vermifuge powder is a very powerful medicine. It is made
of equal parts of rhubarb, seammony, and calomel, with as much double
refined sugar as is equal to the weight of all the other ingredients.
These must be well mixed together, and reduced to a fine powder. The
dose for a child is from ten grains to twenty, once or twice a-week. An
adult may take a drachm for a dose[136].

Parents who would preserve their children from worms ought to allow them
plenty of exercise in the open air; to take care that their food be
wholesome and sufficiently solid; and, as far as possible, to prevent
their eating raw herbs, roots, or green trashy fruits. It will not be
amiss to allow a child who is subject to worms, a glass of red wine
after meals; as every thing that braces and strengthens the stomach is
good both for preventing and expelling these vermin[137].




                              CHAP. XXXVI.
                            OF THE JAUNDICE.


This disease is first observable in the white of the eye, which appears
yellow. Afterwards the whole skin puts on a yellow appearance. The urine
too is of a saffron hue, and dies a white cloth of the same colour.
There is likewise a species of this disease called the Black Jaundice.

CAUSES.——The immediate cause of the jaundice is an obstruction of the
bile. The remote or occasional causes are, the bites of poisonous
animals, as the viper, mad dog, &c. the bilious or hysteric colic;
violent passions, as grief, anger, &c. Strong purges or vomits will
likewise occasion the jaundice. Sometimes it proceeds from obstinate
agues, or from that disease being prematurely stopped by astringent
medicines. In infants it is often occasioned by the _meconium_ not being
sufficiently purged off. Pregnant women are very subject to it. It is
likewise a symptom in several kinds of fever. Catching cold, or the
stoppage of customary evacuations, as the _menses_, the bleeding piles,
issues, &c. will occasion the jaundice.

SYMPTOMS.——The patient at first complains of excessive weariness, and
has great aversion to every kind of motion. His skin is dry, and he
generally feels a kind of itching or pricking pain over the whole body.
The stools are of a whitish or clay colour, and the urine, as was
observed above, is yellow. The breathing is difficult, and the patient
complains of an unusual load or oppression on his breast. There is a
heat in the nostrils, a bitter taste in the mouth, loathing of food,
sickness at the stomach, vomiting, flatulency, and other symptoms of
indigestion.

If the patient be young, and the disease complicated with no other
malady, it is seldom dangerous; but in old people, where it continues
long, returns frequently, or is complicated with the dropsy or
hypochondriac symptoms, it generally proves fatal. The black jaundice is
more dangerous than the yellow.

REGIMEN.——The diet should be cool, light, and diluting, consisting
chiefly of ripe fruits and mild vegetables; as apples boiled or roasted,
stewed prunes, preserved plums, boiled spinage, &c. Veal or
chicken-broth, with light bread, are likewise very proper. Many have
been cured by living almost wholly for some days on raw eggs. The drink
should be butter-milk, whey sweetened with honey, or decoctions of cool
opening vegetables; or marsh-mallow roots, with liquorice, &c.

The patient should take as much exercise as he can bear, either on
horseback, or in a carriage; walking, running, and even jumping, are
likewise proper, provided he can bear them without pain, and there be no
symptoms of inflammation. Patients have been often cured of this disease
by a long journey, after medicines had proved ineffectual.

Amusements are likewise of great use in the jaundice. The disease is
often occasioned by a sedentary life, joined to a dull melancholy
disposition. Whatever therefore tends to promote the circulation, and to
cheer the spirits, must have a good effect; as dancing, laughing,
singing, &c.

MEDICINE.——If the patient be young, of a full sanguine habit, and
complains of pain in the right side about the region of the liver,
bleeding will be necessary. After this a vomit must be administered, and
if the disease proves obstinate, it may be repeated once or twice. No
medicines are more beneficial in the jaundice than vomits, especially
where it is not attended with inflammation. Half a drachm of ipecacuanha
in powder will be a sufficient dose for an adult. It may be wrought off
with weak camomile-tea, or lukewarm water. The body must likewise be
kept open by taking a sufficient quantity of Castile soap, or the pills
for the jaundice recommended in the Appendix.

Fomenting the parts about the region of the stomach and liver, and
rubbing them with a warm hand or flesh-brush, are likewise beneficial;
but it is still more so for the patient to sit in a bath of warm water
up to the breast. He ought to do this frequently, and should continue in
it as long as his strength will permit.

Many dirty things are recommended for the cure of the jaundice; as lice,
millepedes, &c. But these do more harm than good, as people trust to
them, and neglect more valuable medicines; besides, they are seldom
taken in sufficient quantity to produce any effects. People always
expect that such _things_ should act as charms, and consequently seldom
persist in the use of them. Vomits, purges, fomentations, and exercise,
will seldom fail to cure the jaundice when it is a simple disease; and
when complicated with the dropsy, a scirrhous liver, or other chronic
complaints, it is hardly to be cured by any means.

Numberless British herbs are extolled for the cure of this disease. The
author of the _Medicina Britannica_ mentions near a hundred, all famous
for curing the jaundice. The fact is, the disease often goes off of its
own accord; in which case the last medicine is always said to have
performed the cure. I have sometimes however seen considerable benefit,
in a very obstinate jaundice, from a decoction of hempseed. Four ounces
of the seed may be boiled in two English quarts of ale, and sweetened
with coarse sugar. The dose is half an English pint every morning. It
may be continued for eight or nine days.

I have likewise known Harrowgate sulphur-water cure a jaundice of very
long standing. It should be used for some weeks, and the patient must
both drink and bathe.

The soluble tartar is a very proper medicine in the jaundice. A drachm
of it may be taken every night and morning in a cup of tea or
water-gruel. If it does not open the body, the dose may be increased.

Persons subject to the jaundice ought to take as much exercise as
possible, and to avoid all heating and astringent aliments.




                             CHAP. XXXVII.
                             OF THE DROPSY.


The dropsy is a preternatural swelling of the whole body, or some part
of it, occasioned by a collection of watery humour. It is distinguished
by different names, according to the part affected, as the _anasarca_,
or a collection of water under the skin; the _ascites_, or a collection
of water in the belly; the _hydrops pectoris_, or dropsy of the breast;
the _hydrocephalus_, or dropsy of the brain, &c.

CAUSES.——The dropsy is often owing to an hereditary disposition. It may
likewise proceed from drinking ardent spirits, or other strong liquors.
It is true almost to a proverb, that great drinkers die of a dropsy. The
want of exercise is also a very common cause of the dropsy. Hence it is
justly reckoned among the diseases of the sedentary. It often proceeds
from excessive evacuations, as frequent and copious bleedings, strong
purges often repeated, frequent salivations, &c. The sudden stoppage of
customary or necessary evacuations, as the _menses_, the hæmorrhoids,
fluxes of the belly, &c. may likewise cause a dropsy.

I have known the dropsy occasioned by drinking large quantities of cold,
weak, watery liquor, when the body was heated by violent exercise. A
low, damp, or marshy situation is likewise a frequent cause of it. Hence
it is a common disease in moist, flat, fenny countries. It may also be
brought on by a long use of poor watery diet, or of viscous aliment that
is hard of digestion. It is often the effect of other diseases, as the
jaundice, a scirrhus of the liver, a violent ague of long continuance, a
diarrhœa, a dysentery, an empyema, or a consumption of the lungs. In
short, whatever obstructs the perspiration, or prevents the blood from
being duly prepared, may occasion a dropsy.

SYMPTOMS.——The _anasarca_ generally begins with a swelling of the feet
and ancles towards night, which for some time disappears in the morning.
In the evening the parts, if pressed with the finger, will pit. The
swelling gradually ascends, and occupies the trunk of the body, the
arms, and the head. Afterwards the breathing becomes difficult, the
urine is in small quantity, and the thirst great; the body is bound, and
the perspiration is greatly obstructed. To these succeed torpor,
heaviness, a slow wasting fever, and a troublesome cough. This last is
generally a fatal symptom, as it shews that the lungs are affected.

In an _ascites_, besides the above symptoms, there is a swelling of the
belly, and often a fluctuation, which may be perceived by striking the
belly on one side, and laying the palm of the hand on the opposite. This
may be distinguished from a _tympany_ by the weight of the swelling, as
well as by the fluctuation. When the _anasarca_ and _ascites_ are
combined, the case is very dangerous. Even a simple _ascites_ seldom
admits of a radical cure. Almost all that can be done is, to let off the
water by tapping, which seldom affords more than a temporary relief.

When the disease comes suddenly on, and the patient is young and strong,
there is reason however to hope for a cure, especially if medicine be
given early. But if the patient be old, has led an irregular or a
sedentary life, or if there be reason to suspect that the liver, lungs,
or any of the viscera are unsound, there is great reason to fear that
the consequences will prove fatal.

REGIMEN.——The patient must abstain, as much as possible, from all drink,
especially weak and watery liquors, and must quench his thirst with
mustard-whey, or acids, as juice of lemons, oranges, sorrel, or such
like. His aliment ought to be dry, of a stimulating and diuretic
quality, as toasted bread, the flesh of birds, or other wild animals
roasted; pungent and aromatic vegetables, as garlic, mustard, onions,
cresses, horse-radish, rocambole, shalot, &c. He may also eat
sea-biscuit dipt in wine or a little brandy. This is not only
nourishing, but tends to quench thirst. Some have been actually cured of
a dropsy by a total abstinence from all liquids, and living entirely
upon such things as are mentioned above. If the patient must have drink,
the Spa-water, or Rhenish wine, with diuretic medicines infused in it,
are the best.

Exercise is of the greatest importance in a dropsy. If the patient be
able to walk, dig, or the like, he ought to continue these exercises as
long as he can. If he is not able to walk or labour, he must ride on
horseback, or in a carriage, and the more violent the motion so much the
better, provided he can bear it. His bed ought to be hard, and the air
of his apartments warm and dry. If he lives in a damp country, he ought
to be removed into a dry one, and, if possible, into a warmer climate.
In a word, every method should be taken to promote the perspiration, and
to brace the solids. For this purpose it will likewise be proper to rub
the patient’s body, two or three times a day, with a hard cloth, or the
flesh-brush; and he ought constantly to wear flannel next his skin.

MEDICINE.——If the patient be young, his constitution good, and the
disease has come on suddenly, it may generally be removed by strong
vomits, brisk purges, and such medicines as promote a discharge by sweat
and urine. For an adult, half a drachm of ipecacuanha in powder, and
half an ounce of oxymel of squills, will be a proper vomit. This may be
repeated as often as is found necessary, three or four days intervening
between the doses. The patient must not drink much after taking the
vomit, otherwise he destroys its effect. A cup or two of camomile-tea
will be sufficient to work it off.

Between each vomit, on one of the intermediate days, the patient may
take the following purge: Jalap in powder half a drachm, cream of
tartar, two drachms, calomel six grains. These may be made into a bolus
with a little syrup of pale roses, and taken early in the morning. The
less the patient drinks after it the better. If he be much griped, he
may now and then take a cup of chicken-broth.

The patient may likewise take every night at bed-time the following
bolus: To four or five grains of camphor add one grain of opium, and as
much syrup of orange-peel as is sufficient to make them into a bolus.
This will generally promote a gentle sweat, which should be encouraged
by drinking now and then a small cup of wine-whey, with a tea-spoonful
of the spirits of hartshorn in it. A tea-cupful of the following
diuretic infusion may likewise be taken every four or five hours through
the day:

Take juniper-berries, mustard-seed, and horse-radish, of each half an
ounce, ashes of broom half a pound; infuse them in a quart of Rhenish
wine or strong ale for a few days, and afterwards strain off the liquor.
Such as cannot take this infusion, may use the decoction of seneka-root,
which is both diuretic and sudorific. I have known an obstinate
_anasarca_ cured by an infusion of the ashes of broom in wine.

The above course will often cure an incidental dropsy, if the
constitution be good; but when the disease proceeds from a bad habit, or
an unsound state of the viscera, strong purges and vomits are not to be
ventured upon. In this case, the safer course is to palliate the
symptoms by the use of such medicines as promote the secretions, and to
support the patient’s strength by warm and nourishing cordials.

The secretion of urine may be greatly promoted by nitre. Brookes says,
he knew a young woman who was cured of a dropsy by taking a drachm of
nitre every morning in a draught of ale, after she had been given over
as incurable. The powder of squills is likewise a good diuretic. Six or
eight grains of it, with a scruple of nitre, may be given twice a-day in
a glass of strong cinnamon-water. Ball says, a large spoonful of
unbruised mustard-seed taken every night and morning, and drinking half
an English pint of the decoction of the tops of green broom after it,
has performed a cure after other powerful medicines had proved
ineffectual.

I have sometimes seen good effects from cream of tartar in this disease.
It promotes the discharges by stool and urine, and will at least
palliate, if it does not perform a cure. The patient may begin by taking
an ounce every second or third day, and may increase the quantity to two
or even to three ounces, if the stomach will bear it. This quantity is
not however to be taken at once, but divided into three or four doses.

To promote perspiration, the patient may use the decoction of
seneka-root, as directed above; or he may take two table-spoonfuls of
Mindererus’s spirit in a cup of wine-whey three or four times a-day. To
promote a discharge of urine, the following infusion of the London
hospitals will likewise be beneficial:

Take of zedoary-root two drachms; dried squills, rhubarb, and
juniper-berries bruised, of each a drachm; cinnamon in powder, three
drachms; salt of wormwood, a drachm and a half; infuse in an English
pint and a half of old hock-wine, and when fit for use, filter the
liquor. A wine-glass of it may be taken three or four times a-day.

In the _anasarca_ it is usual to scarify the feet and legs. By this
means the water is often discharged; but the operator must be cautious
not to make the incisions too deep; they ought barely to pierce through
the skin, and especial care must be taken, by spirituous fomentations
and proper digestives, to prevent a gangrene.

In an _ascites_, when the disease does not evidently and speedily give
way to purgative and diuretic medicines, the water ought to be let off
by tapping. This is a very simple and safe operation, and would often
succeed, if it were performed in due time; but if it be delayed till the
humours are vitiated, or the bowels spoiled, by long soaking in water,
it can hardly be expected that any permanent relief will be
procured[138].

After the evacuation of the water, the patient is to be put on a course
of strengthening medicines; as the Peruvian bark; the elixir of vitriol;
warm aromatics, with a due proportion of rhubarb, infused in wine, and
such like. His diet ought to be dry and nourishing, such as is
recommended in the beginning of the Chapter; and he should take as much
exercise as he can bear without fatigue. He should wear flannel next his
skin, and make daily use of the flesh-brush.




                             CHAP. XXXVIII.
                              OF THE GOUT.


There is no disease which shews the imperfection of medicine, or sets
the advantages of temperance and exercise in a stronger light, than the
gout. Excess and idleness are the true sources from whence it originally
sprung, and all who would avoid it must be _active_ and _temperate_.

Though idleness and intemperance are the principal causes of the gout,
yet many other things may contribute to bring on the disorder in those
who are not, and to induce a paroxysm in those who are subject to it; as
intense study; too free an use of acidulated liquors; night-watching;
grief or uneasiness of mind; an obstruction or defect of any of the
customary discharges, as the _menses_, sweating of the feet,
perspiration, &c.

SYMPTOMS.——A fit of the gout is generally preceded by indigestion,
drowsiness, belching of wind, a slight head-ach, sickness, and sometimes
vomiting. The patient complains of weariness and dejection of spirits,
and has often a pain in the limbs, with a sensation as if wind or cold
water were passing down the thigh. The appetite is often remarkably keen
a day or two before the fit, and there is a slight pain in passing
urine, and sometimes an involuntary shedding of tears. Sometimes these
symptoms are much more violent, especially upon the near approach of the
fit; and some observe, that as is the fever which ushers in the gout, so
will the fit be; if the fever be short and sharp, the fit will be so
likewise; if it be feeble, long, and lingering, the fit will be such
also. But this observation can only hold with respect to very regular
fits of the gout.

The regular gout generally makes its attack in the spring, or beginning
of winter, in the following manner: About two or three in the morning,
the patient is seized with a pain in his great toe, sometimes in the
heel, and at other times in the ancle or calf of the leg. This pain is
accompanied with a sensation as if cold water were poured upon the part,
which is succeeded by a shivering, with some degree of fever. Afterwards
the pain increases, and fixing among the small bones of the foot, the
patient feels all the different kinds of torture, as if the part were
stretched, burnt, squeezed, gnawed, or torn in pieces, &c. The part at
length becomes so exquisitely sensible, that the patient cannot bear to
have it touched, or even suffer any person to walk across the room.

The patient is generally in exquisite torture for twenty-four hours,
from the time of the coming on of the fit: he then becomes easier, the
part begins to swell, appears red, and is covered with a little
moisture. Towards morning he drops asleep, and generally falls into a
gentle breathing sweat. This terminates the first paroxysm, a number of
which constitutes a fit of the gout; which is longer or shorter
according to the patient’s age, strength, the season of the year, and
the disposition of the body to this disease.

The patient is always worse towards night, and easier in the morning.
The paroxysms however generally grow milder every day, till at length
the disease is carried off by perspiration, urine, and the other
evacuations. In some patients this happens in a few days; in others, it
requires weeks, and in some, months, to finish the fit. Those whom age
and frequent fits of the gout have greatly debilitated, seldom get free
from it before the approach of summer, and sometimes not till it be
pretty far advanced.

REGIMEN.——As there are no medicines yet known that will cure the gout,
we shall confine our observations chiefly to regimen, both in and out of
the fit.

In the fit, if the patient be young and strong, his diet ought to be
thin and cooling, and his drink of a diluting nature; but where the
constitution is weak, and the patient has been accustomed to live high,
this is not a proper time to retrench. In this case he must keep nearly
to his usual diet, and should take frequently a cup of strong negus, or
a glass of generous wine. Wine-whey is a very proper drink in this case,
as it promotes the perspiration without greatly heating the patient. It
will answer this purpose better if a tea-spoonful of _sal volatile
oleosum_, or spirits of hartshorn, be put into a cup of it twice a-day.
It will likewise be proper to give at bed-time a tea-spoonful of the
volatile tincture of _guaiacum_ in a large draught of warm wine-whey.
This will greatly promote perspiration through the night.

As the most safe and efficacious method of discharging the gouty matter
is by perspiration, this ought to be kept up by all means, especially in
the affected part. For this purpose the leg and foot should be wrapt in
soft flannel, fur, or wool. The last is most readily obtained, and seems
to answer the purpose better than any thing else. The people of
Lancashire look upon wool as a kind of specific in the gout. They wrap a
great quantity of it about the leg and foot affected, and cover it with
a skin of soft dressed leather. This they suffer to continue for eight
or ten days, and sometimes for a fortnight or three weeks, or longer, if
the pain does not cease. I never knew any external application answer so
well in the gout. I have often seen it applied when the swelling and
inflammation were very great, with violent pain, and have found all
these symptoms relieved by it in a few days. The wool which they use is
generally greased, and carded or combed. They chuse the softest which
can be had, and seldom or never remove it till the fit be entirely gone
off.

The patient ought likewise to be kept quiet and easy during the fit.
Every thing that affects the mind disturbs the paroxysm, and tends to
throw the gout upon the nobler parts. All external applications that
repel the matter are to be avoided as death. They do not cure the
disease, but remove it from a safer to a more dangerous part of the
body, where it often proves fatal. A fit of the gout is to be considered
as Nature’s method of removing something that might prove destructive to
the body, and all that we can do, with safety, is to promote her
intentions, and to assist her in expelling the enemy in her own way.
Evacuations by bleeding, stool, &c. are likewise to be used with
caution; they do not remove the cause of the disease, and sometimes by
weakening the patient prolong the fit: but where the constitution is
able to bear it, it will be of use to keep the body gently open by diet,
or very mild laxative medicines.

Many things will indeed shorten a fit of the gout, and some will drive
it off altogether: but nothing has yet been found which will do this
with safety to the patient. In pain we eagerly grasp at any thing that
promises immediate ease, and even hazard life itself for a temporary
relief. This is the true reason why so many infallible remedies have
been proposed for the gout, and why such numbers have lost their lives
by the use of them. It would be as prudent to stop the small-pox from
rising, and to drive them into the blood, as to attempt to repel the
gouty matter after it has been thrown upon the extremities. The latter
is as much an effort of Nature to free herself from an offending cause
as the former, and ought equally to be promoted.

When the pain however is very great, and the patient is restless, thirty
or forty drops of laudanum, more or less, according to the violence of
the symptoms, may be taken at bed-time. This will ease the pain, procure
rest, promote perspiration, and forward the crisis of the disease.

After the fit is over, the patient ought to take a gentle dose or two of
the bitter tincture of rhubarb, or some other warm stomachic purge. He
should also drink a weak infusion of stomachic bitters in small wine or
ale, as the Peruvian bark, with cinnamon, Virginian snake-root, and
orange-peel. The diet at this time should be light, but nourishing, and
gentle exercise ought to be taken on horseback, or in a carriage.

Out of the fit, it is in the patient’s power to do many things towards
preventing a return of the disorder, or rendering the fit, if it should
return, less severe. This however is not to be attempted by medicine. I
have frequently known the gout kept off for several years by the
Peruvian bark and other astringent medicines; but in all the cases where
I had occasion to see this tried, the persons died suddenly, and, to all
appearance, for want of a regular fit of the gout. One would be apt,
from hence, to conclude, that a fit of the gout, to some constitutions,
in the decline of life, is rather salutary than hurtful.

Though it may be dangerous to stop a fit of the gout by medicine, yet if
the constitution can be so changed by diet and exercise, as to lessen or
totally prevent its return, there certainly can be no danger in
following such a course. It is well known that the whole habit may be so
altered by a proper regimen, as quite to eradicate this disease; and
those only who have sufficient resolution to persist in such a course
have reason to expect a cure.

The course which we would recommend for preventing the gout, is as
follows: In the first place, _universal temperance_. In the next place
_sufficient exercise_[139]. By this we do not mean sauntering about in
an indolent manner, but labour, sweat, and toil. These only can render
the humours wholesome, and keep them so. Going early to bed, and rising
betimes, are also of great importance. It is likewise proper to avoid
night studies, and all intense thought. The supper should be light, and
taken early. All strong liquors, especially generous wines and sour
punch, are to be avoided.

We would likewise recommend some doses of _magnesia alba_ and rhubarb to
be taken every spring and autumn; and afterwards a course of stomachic
bitters, as tansey or water-trefoil tea, an infusion of gentian and
camomile flowers, or a decoction of burdock root, &c. Any of these, or
an infusion of any wholesome bitter that is more agreeable to the
patient, may be drank for two or three weeks in March and October twice
a-day. An issue or perpetual blister has a great tendency to prevent the
gout. If these were more generally used in the decline of life, they
would not only often prevent the gout, but also other chronic maladies.
Such as can afford to go to Bath, will find great benefit from bathing
and drinking the water. It both promotes digestion, and invigorates the
habit.

Though there is little room for medicine during a regular fit of the
gout, yet when it leaves the extremities, and falls on some of the
internal parts, proper applications to recal and fix it become
absolutely necessary. When the gout affects the head, the pain of the
joints ceases, and the swelling disappears, while either severe
head-ach, drowsiness, trembling, giddiness, convulsions, or delirium
come on. When it seizes the lungs, great oppression, with cough and
difficulty of breathing, ensue. If it attacks the stomach, extreme
sickness, vomiting, anxiety, pain in the epigastric region, and total
loss of strength, will succeed.

When the gout attacks the head or lungs, every method must be taken to
fix it in the feet. They must be frequently bathed in warm water, and
acrid cataplasms applied to the soles. Blistering-plasters ought
likewise to be applied to the ancles or calves of the legs. Bleeding in
the feet or ancles is also necessary, and warm stomachic purges. The
patient ought to keep in bed for the most part, if there be any signs of
inflammation, and should be very careful not to catch cold.

If it attacks the stomach with a sense of cold, the most warm cordials
are necessary; as strong wine boiled up with cinnamon or other spices;
cinnamon-water; peppermint-water; and even brandy or rum. The patient
should keep his bed, and endeavour to promote a sweat by drinking warm
liquors; and if he should be troubled with a nausea, or inclination to
vomit, he may drink camomile-tea, or any thing that will make him vomit
freely.

When the gout attacks the kidneys, and imitates gravel-pains, the
patient ought to drink freely of a decoction of marsh-mallows, and to
have the parts fomented with warm water. An emollient clyster ought
likewise to be given, and afterwards an opiate. If the pain be very
violent, twenty or thirty drops of laudanum may be taken in a cup of the
decoction.

Persons who have had the gout should be very attentive to any complaints
that may happen to them about the time when they have reason to expect a
return of the fit. The gout imitates many other disorders, and by being
mistaken for them, and treated improperly, is often diverted from its
regular course, to the great danger of the patient’s life.

Those who never had the gout, but who, from their constitution or manner
of living, have reason to expect it, ought likewise to be very
circumspect with regard to its first approach. If the disease, by wrong
conduct or improper medicines, be diverted from its proper course, the
miserable patient has a chance to be ever after tormented with
head-achs, coughs, pains of the stomach and intestines; and to fall at
last a victim to its attack upon some of the more noble parts.


                           OF THE RHEUMATISM.

This disease has often a resemblance to the gout. It generally attacks
the joints with exquisite pain, and is sometimes attended with
inflammation and swelling. It is most common in the spring, and towards
the end of autumn. It is usually distinguished into acute and chronic;
or the rheumatism with and without a fever.

CAUSES.——The causes of a rheumatism are frequently the same as those of
an inflammatory fever, _viz._ an obstructed perspiration, the immoderate
use of strong liquors, and the like. Sudden changes of the weather, and
all quick transitions from heat to cold, are very apt to occasion the
rheumatism. The most extraordinary case of a rheumatism that I ever saw,
where almost every joint of the body was distorted, was a man who used
to work one part of the day by the fire, and the other part of it in the
water. Very obstinate rheumatisms have likewise been brought on by
persons not accustomed to it, allowing their feet to continue long wet.
The same effects are often produced by wet clothes, damp beds, sitting
or lying on the damp ground, travelling in the night, &c.

The rheumatism may likewise be occasioned by excessive evacuations, or
the stoppage of customary discharges. It is often the effect of chronic
diseases, which vitiate the humours; as the scurvy, the _lues venerea_,
obstinate autumnal agues, &c.

The rheumatism prevails in cold, damp, marshy countries. It is most
common among the poorer sort of peasants, who are ill clothed, live in
low damp houses, and eat coarse unwholesome food, which contains but
little nourishment, and is not easily digested.

SYMPTOMS.——The _acute_ rheumatism commonly begins with weariness,
shivering, a quick pulse, restlessness, thirst, and other symptoms of
fever. Afterwards the patient complains of flying pains, which are
increased by the least motion. These at length fix in the joints, which
are often affected with swelling and inflammation. If blood be let in
this disease, it has generally the same appearance as in the pleurisy.

In this kind of rheumatism the treatment of the patient is nearly the
same as in an acute or inflammatory fever. If he be young and strong,
bleeding is necessary, which may be repeated according to the exigencies
of the case. The body ought likewise to be kept open by emollient
clysters, or cool opening liquors; as decoctions of tamarinds, cream of
tartar whey, senna-tea, and the like. The diet should be light, and in
small quantity, consisting chiefly of roasted apples, groat-gruel, or
weak chicken-broth. After the feverish symptoms have abated, if the pain
still continues, the patient must keep his bed, and take such things as
promote perspiration; as wine-whey, with _spiritus Mindereri_, &c. He
may likewise take, for a few nights, at bed-time, in a cup of wine-whey,
a drachm of the cream of tartar, and half a drachm of gum guaiacum in
powder.

Warm bathing, after proper evacuations, has often an exceeding good
effect. The patient may either be put into a bath of warm water, or have
cloths wrung out of it applied to the parts affected. Great care must be
taken that he do not catch cold after bathing.

The _chronic_ rheumatism is seldom attended with any considerable degree
of fever, and is generally confined to some particular part of the body,
as the shoulders, the back, or the loins. There is seldom any
inflammation or swelling in this case. Persons in the decline of life
are most subject to the chronic rheumatism. In such patients it often
proves extremely obstinate, and sometimes incurable.

In this kind of rheumatism the regimen should be nearly the same as in
the acute. Cool and diluting diet, consisting chiefly of vegetable
substances, as stewed prunes, coddled apples, currants or gooseberries
boiled in milk, is most proper. Arbuthnot says, “If there be a specific
in aliment for the rheumatism, it is certainly whey,” and adds, “That he
knew a person subject to this disease, who could never be cured by any
other method but a diet of whey and bread.” He likewise says, “That
cream of tartar in water-gruel, taken for several days, will ease
rheumatic pains considerably.” This I have often experienced, but found
it always more efficacious when joined with gum guaiacum, as already
directed. In this case the patient may take the dose formerly mentioned
twice a-day, and likewise a tea-spoonful of the volatile tincture of gum
guaiacum, at bed-time, in wine-whey.

This course may be continued for a week, or longer, if the case proves
obstinate, and the patient’s strength will permit. It ought then to be
omitted for a few days, and repeated again. At the same time leeches or
a blistering-plaster may be applied to the part affected. What I have
generally found answer better than either of these, in obstinate fixed
rheumatic pains, is the _warm plaster_[140]. I have likewise known a
plaster of Burgundy pitch worn for some time on the part affected give
great relief in rheumatic pains. My ingenious friend, Dr. Alexander of
Edinburgh, says, he has frequently cured very obstinate rheumatic pains
by rubbing the part affected with tincture of cantharides. When the
common tincture did not succeed, he used it of a double or treble
strength. Cupping upon the part affected is likewise often very
beneficial, and is greatly preferable to the application of leeches.

Though this disease may not seem to yield to medicines for some time,
yet they ought still to be persisted in. Persons who are subject to
frequent returns of the rheumatism, will often find their account in
using medicines, whether they be immediately affected with the disease
or not. The chronic rheumatism is similar to the gout in this respect,
that the most proper time for using medicines to extirpate it, is when
the patient is most free from the disorder.

To those who can afford the expence, I would recommend the warm baths of
Buxton or Matlock in Derbyshire. These have often, to my knowledge,
cured very obstinate rheumatisms, and are always safe either in or out
of the fit. When the rheumatism is complicated with scorbutic
complaints, which is not seldom the case, the Harrowgate waters, and
those of Moffat, are proper. They should both be drank and used as a
warm bath.

There are several of our own domestic plants which may be used with
advantage in the rheumatism. One of the best is the white _mustard_. A
table-spoonful of the seed of this plant may be taken twice or thrice
a-day, in a glass of water or small wine. The water-trefoil is likewise
of great use in this complaint. It may be infused in wine or ale, or
drank in form of tea. The ground-ivy, camomile, and several other
bitters, are also beneficial, and may be used in the same manner. No
benefit however is to be expected from these, unless they be taken for a
considerable time. Excellent medicines are often despised in this
disease, because they do not perform an immediate cure; whereas nothing
would be more certain than their effect, were they duly persisted in.
Want of perseverance in the use of medicines is one reason why chronic
diseases are so seldom cured.

Cold bathing, especially in salt-water, often cures the rheumatism. We
would also recommend riding on horseback, and wearing flannel next the
skin. Issues are likewise very proper, especially in chronic cases. If
the pain affects the shoulders, an issue may be made in the arm; but if
it affects the loins, it should be put into the leg or thigh.

Persons afflicted with the scurvy are very subject to rheumatic
complaints. The best medicines in this case are bitters and mild
purgatives. These may either be taken separately or together, as the
patient inclines. An ounce of Peruvian bark, and half an ounce of
rhubarb in powder, may be infused in a bottle of wine; and one, two, or
three wine glasses of it taken daily, as shall be found necessary for
keeping the body gently open. In cases where the bark itself proves
sufficiently purgative, the rhubarb may be omitted.

Such as are subject to frequent attacks of the rheumatism ought to make
choice of a dry, warm situation, to avoid the night-air, wet clothes,
and wet feet, as much as possible. Their clothing should be warm, and
they should wear flannel next their skin, and make frequent use of the
flesh-brush.




                              CHAP. XXXIX.
                             OF THE SCURVY.


This disease prevails chiefly in cold northern countries, especially in
low damp situations, near large marshes, or great quantities of
stagnating water. Sedentary people, of a dull melancholy disposition,
are most subject to it. It proves often fatal to sailors on long
voyages, particularly in ships that are not properly ventilated, have
many people on board, or where cleanliness is neglected.

It is not necessary to mention the different species into which this
disease has been divided, as they differ from one another chiefly in
degree. What is called the _land-scurvy_, however, is seldom attended
with those highly putrid symptoms which appear in patients who have been
long at sea, and which, we presume, are rather owing to confined air,
want of exercise, and the unwholesome food eaten by sailors on long
voyages, than to any specific difference in the disease.

CAUSES.——The scurvy is occasioned by cold moist air; by the long use of
salted or smoke-dried provisions, or any kind of food that is hard of
digestion, and affords little nourishment. It may also proceed from the
suppression of customary evacuations; as the _menses_, the hæmorrhoidal
flux, &c. It is sometimes owing to a hereditary taint, in which case a
very small cause will excite the latent disorder. Grief, fear, and other
depressing passions, have a great tendency both to excite and aggravate
this disease. The same observation holds with regard to neglect of
cleanliness; bad clothing; the want of proper exercise; confined air;
unwholesome food; or any disease which greatly weakens the body, or
vitiates the humours.

SYMPTOMS.——This disease may be known by unusual weariness, heaviness,
and difficulty of breathing, especially after motion; rottenness of the
gums, which are apt to bleed on the slightest touch; a stinking breath;
frequent bleeding at the nose; crackling of the joints; difficulty of
walking; sometimes a swelling and sometimes a falling away of the legs,
on which there are livid, yellow, or violet-coloured spots; the face is
generally of a pale or leaden colour. As the disease advances, other
symptoms come on; as rottenness of the teeth, hæmorrhages, or discharges
of blood from different parts of the body, foul obstinate ulcers, pains
in various parts, especially about the breast, dry scaly eruptions all
over the body, &c. At last a wasting or hectic fever comes on, and the
miserable patient is often carried off by a dysentery, a diarrhœa, a
dropsy, the palsy, fainting fits, or a mortification of some of the
bowels.

CURE.——We know no way of curing this disease but by pursuing a plan
directly opposite to that which brings it on. It proceeds from a
vitiated state of the humours, occasioned by errors in diet, air, or
exercise; and this cannot be removed but by a proper attention to these
important articles.

If the patient has been obliged to breathe a cold, damp, or confined
air, he should be removed, as soon as possible, to a dry, open, and
moderately warm one. If there is reason to believe that the disease
proceeds from a sedentary life, or depressing passions, as grief, fear,
&c. the patient must take daily as much exercise in the open air as he
can bear, and his mind should be diverted by cheerful company and other
amusements. Nothing has a greater tendency either to prevent or remove
this disease, than constant cheerfulness and good humour. But this,
alas! is seldom the lot of persons afflicted with the scurvy; they are
generally surly, peevish, and morose.

When the scurvy has been brought on by a long use of salted provisions,
the proper medicine is a diet consisting chiefly of fresh vegetables; as
oranges, apples, lemons, limes, tamarinds, water-cresses, scurvy-grass,
brook lime, &c. The use of these, with milk, pot-herbs, new bread, and
fresh beer or cyder, will seldom fail to remove a scurvy of this kind,
if taken before it be too far advanced; but to have this effect, they
must be persisted in for a considerable time. When fresh vegetables
cannot be obtained, pickled or preserved ones may be used; and where
these are wanting, recourse must be had to the chymical acids. All the
patient’s food and drink should in this case be sharpened with cream of
tartar, elixir of vitriol, vinegar, or the spirit of sea-salt.

These things however will more certainly prevent than cure the scurvy;
for which reason sea-faring people, especially on long voyages, ought to
lay in plenty of them. Cabbages, onions, gooseberries, and many other
vegetables, may be kept a long time by _pickling_, _preserving_, &c. and
when these fail, the chymical acids, recommended above, which will keep
for any length of time, may be used. We have reason to believe, if ships
were well ventilated, had good store of fruits, greens, cyder, &c. laid
in, and if proper regard were paid to cleanliness and warmth, that
sailors would be the most healthy people in the world, and would seldom
suffer either from the scurvy or putrid fevers, which are so fatal to
that useful set of men; but it is too much the temper of such people to
despise all precaution; they will not think of any calamity till it
overtakes them, when it is too late to ward off the blow.

It must indeed be owned, that many of them have it not in their power to
make the provision we are speaking of; but in this case it is the duty
of their employers to make it for them; and no man ought to engage in a
long voyage without having these articles secured.

I have often seen very extraordinary effects in the land-scurvy from a
milk diet. This preparation of Nature is a mixture of animal and
vegetable properties, which of all others is the most fit for restoring
a decayed constitution, and removing that particular acrimony of the
humours, which seems to constitute the very essence of the scurvy, and
many other diseases. But people despise this wholesome and nourishing
food, because it is cheap, and devour with greediness, flesh, and
fermented liquors, while milk is only deemed fit for their hogs.

The most proper drink in the scurvy is whey or butter-milk. When these
cannot be had, sound cyder, perry, or spruce-beer, may be used. Wort has
likewise been found to be a proper drink in the scurvy, and may be used
at sea, as malt will keep during the longest voyage. A decoction of the
tops of the spruce fir is likewise proper. It may be drank in the
quantity of an English pint twice a-day. Tar-water may be used for the
same purpose, or decoctions of any of the mild mucilaginous vegetables;
as sarsaparilla, marsh-mallow roots, &c. Infusions of the bitter plants,
as ground-ivy, the lesser centaury, marsh-trefoil, &c. are likewise
beneficial. I have seen the peasants in some parts of Britain express
the juice of the last-mentioned plant, and drink it with good effect in
those foul scorbutic eruptions with which they are often troubled in the
spring season.

Harrowgate water is certainly an excellent medicine in the land-scurvy.
I have often seen patients who had been reduced to the most deplorable
condition by this disease, greatly relieved by drinking the
sulphur-water, and bathing in it. The chalybeate water may also be used
with advantage, especially with a view to brace the stomach after
drinking the sulphur-water, which, though it sharpens the appetite,
never fails to weaken the powers of digestion.

A slight degree of scurvy may be carried off by frequently sucking a
little of the juice of a bitter orange, or a lemon. When the disease
affects the gums only, this practice, if continued for some time, will
generally carry it off. We would however recommend the bitter orange as
greatly preferable to lemon; it seems to be as good a medicine, and is
not near so hurtful to the stomach. Perhaps our own sorrel may be little
inferior to either of them.

All kinds of sallad are good in the scurvy, and ought to be eaten very
plentifully, as spinage, lettuce, parsley, celery, endive, radish,
dandelion, &c. It is amazing to see how soon fresh vegetables in the
spring cure the brute animals of any scab or foulness which is upon
their skins. It is reasonable to suppose that their effects would be as
great upon the human species, were they used in proper quantity for a
sufficient length of time.

I have sometimes seen good effects in scorbutic complaints of very long
standing, from the use of a decoction of the roots of water-dock. It is
usually made by boiling a pound of the fresh root in six English pints
of water, till about one-third of it be consumed. The dose is from half
a pint to a whole pint of the decoction every day. But in all the cases
where I have seen it prove beneficial, it was made much stronger, and
drank in larger quantities. The safest way, however, is for the patient
to begin with small doses, and increase them both in strength and
quantity as he finds his stomach will bear it. It must be used for a
considerable time. I have known some take it for many months, and have
been told of others who had used it for several years, before they were
sensible of any benefit, but who nevertheless were cured by it at
length.

The leprosy, which was so common in this country long ago, seems to have
been near-akin to the scurvy. Perhaps its appearing so seldom now, may
be owing to the inhabitants of Britain eating more vegetable food than
formerly, living more upon tea and other diluting diet, using less
salted meat, being more cleanly, better lodged and clothed, &c.—For the
cure of this disease we would recommend the same course of diet and
medicine as in the scurvy.


                   OF THE SCROPHULA, OR KING’S EVIL.

This disease chiefly affects the glands, especially those of the neck.
Children and young persons of a sedentary life are very subject to it.
It is one of those diseases which may be removed by proper regimen, but
seldom yields to medicine. The inhabitants of cold, damp, marshy
countries are most liable to the scrophula.

CAUSES.——This disease may proceed from a hereditary taint, from a
scrophulous nurse, &c. Children who have the misfortune to be born of
sickly parents, whose constitutions have been greatly injured by the
pox, or other chronic diseases, are apt to be affected with the
scrophula. It may likewise proceed from such diseases as weaken the
habit or vitiate the humours, as the small-pox, measles, &c. External
injuries, as blows, bruises, and the like, sometimes produce scrophulous
ulcers; but we have reason to believe, when this happens, that there has
been a predisposition in the habit to this disease. In short, whatever
tends to vitiate the humours or relax the solids, paves the way to the
scrophula; as the want of proper exercise, too much heat or cold,
confined air, unwholesome food, bad water, the long use of poor, weak,
watery aliments, the neglect of cleanliness, &c. Nothing tends more to
induce this disease in children than allowing them to continue long
wet[141].

SYMPTOMS.——At first small knots appear under the chin or behind the
ears, which gradually increase in number and size, till they form one
large hard tumour. This often continues for a long time without
breaking, and when it does break, it only discharges a thin _sanies_, or
watery humour. Other parts of the body are likewise liable to its
attack, as the armpits, groins, feet, hands, eyes, breasts, &c. Nor are
the internal parts exempt from it. It often affects the lungs, liver, or
spleen; and I have frequently seen the glands of the mesentery greatly
enlarged by it.

Those obstinate ulcers which break out upon the feet and hands with
swelling, and little or no redness, are of the scrophulous kind. They
seldom discharge good matter, and are exceedingly difficult to cure. The
_white swellings_ of the joints seem likewise to be of this kind. They
are with difficulty brought to a suppuration, and when opened they only
discharge a thin ichor. There is not a more general symptom of the
scrophula than a swelling of the upper lip and nose.

REGIMEN.——As this disease proceeds, in a great measure, from relaxation,
the diet ought to be generous and nourishing, but at the same time light
and of easy digestion; as well-fermented bread, made of sound grain, the
flesh and broth of young animals, with now and then a glass of generous
wine, or good ale. The air ought to be open, dry, and not too cold, and
the patient should take as much exercise as he can bear. This is of the
utmost importance. Children who have sufficient exercise are seldom
troubled with the scrophula.

MEDICINE.——The vulgar are remarkably credulous with regard to the cure
of the scrophula; many of them believing in the virtue of the royal
touch, that of the seventh son, &c. The truth is, we know but little
either of the nature or cure of this disease, and where reason or
medicines fail, superstition always comes in their place. Hence it is,
that in diseases which are the most difficult to understand, we
generally hear of the greatest number of miraculous cures being
performed. Here, however, the deception is easily accounted for. The
scrophula, at a certain period of life, often cures of itself; and, if
the patient happens to be touched about this time, the cure is imputed
to the touch, and not to Nature, who is really the physician. In the
same way the insignificant nostrums of quacks and old women often gain
applause when they deserve none.

There is nothing more pernicious than the custom of plying children in
the scrophula with strong purgative medicines. People imagine it
proceeds from humours which must be purged off, without considering that
these purgatives increase the debility and aggravate the disease. It has
indeed been found, that keeping the body gently open for some time,
especially with sea-water, has a good effect; but this should only be
given in gross habits, and in such quantity as to procure one, or at
most two stools every day.

Bathing in the salt-water has likewise a very good effect, especially in
the warm season. I have often known a course of bathing in salt-water,
and drinking it in such quantities as to keep the body gently open, cure
a scrophula, after many other medicines had been tried in vain. When
salt-water cannot be obtained, the patient may be bathed in fresh water,
and his body kept open by small quantities of salt and water, or some
other mild purgative.

Next to cold bathing, and drinking the salt-water, we would recommend
the Peruvian bark. The cold bath may be used in summer, and the bark in
winter. To an adult half a drachm of the bark in powder may be given in
a glass of red wine four or five times a-day. Children, and such as
cannot take it in substance, may use the decoction made in the following
manner:

Boil an ounce of Peruvian bark and a drachm of Winter’s bark, both
grossly powdered, in an English quart of water to a pint: towards the
end half an ounce of sliced liquorice-root, and a handful of raisins may
be added, which will both render the decoction less disagreeable, and
make it take up more of the bark. The liquor must be strained, and two,
three, or four table-spoonfuls, according to the age of the patient,
given three times a-day.

The Moffat and Harrowgate waters, especially the latter, are likewise
very proper medicines in the scrophula. They ought not however to be
drank in large quantities, but should be taken so as to keep the body
gently open, and must be used for a considerable time.

The hemlock may sometimes be used with advantage in the scrophula. Some
lay it down as a general rule, that the sea-water is most proper before
there are any suppuration or symptoms of _tabes_; the Peruvian bark,
when there are running sores, and a degree of hectic fever, and the
hemlock in old inveterate cases, approaching to the scirrhous or
cancerous state. Either the extract or the fresh juice of this plant may
be used. The dose must be small at first, and increased gradually as far
as the stomach is able to bear it.

External applications are of little use. Before the tumour breaks,
nothing ought to be applied to it, unless a piece of flannel, or
something to keep it warm. After it breaks, the sore may be dressed with
some digestive ointment. What I have always found to answer best, was
the yellow basilicon mixed with about a sixth or eighth part of its
weight of red precipitate of mercury. The sore may be dressed with this
twice a-day; and if it be very fungous, and does not digest well, a
larger proportion of the precipitate may be added.

Medicines which mitigate this disease, though they do not cure it, are
not to be despised. If the patient can be kept alive by any means till
he arrives at the age of puberty, he has a great chance to get well; but
if he does not recover at this time, in all probability he never will.

There is no malady which parents are so apt to communicate to their
offspring as the scrophula, for which reason people ought to beware of
marrying into families affected with this disease.

For the means of preventing the scrophula, we must refer the reader to
the observations on nursing, at the beginning of the book.


                              OF THE ITCH.

Though this disease is commonly communicated by infection, yet it seldom
prevails where due regard is paid to cleanliness, fresh air, and
wholesome diet. It generally appears in form of small watery pustules,
first about the wrists, or between the fingers; afterwards it affects
the arms, legs, thighs, &c. These pustules are attended with an
intolerable itching, especially when the patient is warm a-bed, or sits
by the fire. Sometimes indeed the skin is covered with large blotches or
scabs, and at other times with a white scurf, or scaly eruption. This
last is called the dry itch, and is the most difficult to cure.

The itch is seldom a dangerous disease, unless when it is rendered so by
neglect, or improper treatment. If it be suffered to continue too long,
it may vitiate the whole mass of humours; and, if it be suddenly drove
in, without proper evacuations, it may occasion fevers, inflammations of
the viscera, or other internal disorders.

The best medicine yet known for the itch is sulphur, which ought to be
used both externally and internally. The parts most affected may be
rubbed with an ointment made of the flower of sulphur, two ounces; crude
sal ammoniac finely powdered two drachms; hog’s lard, or butter, four
ounces. If a scruple or half a drachm of the essence of lemon be added,
it will entirely take away the disagreeable smell. About the bulk of a
nutmeg of this may be rubbed upon the extremities at bed-time twice or
thrice a-week. It is seldom necessary to rub the whole body; but when it
is, it ought not to be done all at once, but by turns, as it is
dangerous to stop too many pores at the same time.

Before the patient begins to use the ointment, he ought, if he be of a
full habit, to bleed or take a purge or two. It will likewise be proper,
during the use of it, to take every night and morning as much of the
flower of brimstone and cream of tartar, in a little treacle or new
milk, as will keep the body gently open. He should beware of catching
cold, should wear more clothes than usual, and take every thing warm.
The same clothes, the linen excepted, ought to be worn all the time of
using the ointment; and such clothes as have been worn while the patient
was under the disease, are not to be used again, unless they have been
fumigated with brimstone, and thoroughly cleaned, otherwise they will
communicate the infection anew[142].

I never knew brimstone, when used as directed above, fail to cure the
itch; and I have reason to believe, that, if duly persisted in, it never
will fail; but if it be only used once or twice, and cleanliness
neglected, it is no wonder if the disorder returns. The quantity of
ointment mentioned above will generally be sufficient for the cure of
one person; but, if any symptoms of the disease should appear again, the
medicine may be repeated. It is both more safe and efficacious when
persisted in for a considerable time, than when a large quantity is
applied at once. As most people dislike the smell of sulphur, they may
use in its place the powder of white hellebore root made up into an
ointment, in the same manner, which will seldom fail to cure the itch.

People ought to be extremely cautious lest they take other eruptions for
the itch; as the stoppage of these may be attended with fatal
consequences. Many of the eruptive disorders to which children are
liable, have a near resemblance to this disease; and I have often known
infants killed by being rubbed with greasy ointments that made these
eruptions strike suddenly in, which Nature had thrown out to preserve
the patient’s life, or prevent some other malady.

Much mischief is likewise done by the use of mercury in this disease.
Some persons are so fool-hardy as to wash the parts affected with a
strong solution of the corrosive sublimate. Others use the mercurial
ointment, without taking the least care either to avoid cold, keep the
body open, or observe a proper regimen. The consequences of such conduct
may be easily guessed. I have known even the mercurial girdles produce
bad effects, and would advise every person, as he values his health, to
beware how he uses them. Mercury ought never to be used as a medicine
without the greatest care. Ignorant people look upon these girdles as a
kind of charm, without considering that the mercury enters the body.

It is not to be told what mischief is done by using mercurial ointment
for curing the itch and killing vermin; yet it is unnecessary for
either: the former may be always more certainly cured by sulphur, and
the latter will never be found where due regard is paid to cleanliness.

Those who would avoid this detestable disease ought to beware of
infected persons, to use wholesome food, and to study universal
cleanliness[143].




                               CHAP. XL.
                             OF THE ASTHMA.


The asthma is a disease of the lungs, which seldom admits of a cure.
Persons in the decline of life are most liable to it. It is
distinguished into the moist and dry, or humoural and nervous. The
former is attended with expectoration or spitting; but in the latter the
patient seldom spits, unless sometimes a little tough phlegm by the mere
force of coughing.

CAUSES.——The asthma is sometimes hereditary. It may likewise proceed
from a bad formation of the breast; the fumes of metals or minerals
taken into the lungs; violent exercise, especially running; the
obstruction of customary evacuations, as the menses, hæmorrhoids, &c.
the sudden retrocession of the gout, or striking in of eruptions, as the
small-pox, measles, &c. violent passions of the mind, as sudden fear or
surprise. In a word, the disease may proceed from any cause that either
impedes the circulation of the blood through the lungs, or prevents
their being duly expanded by the air.

SYMPTOMS.——An asthma is known by a quick laborious breathing, which is
generally performed with a kind of wheezing noise. Sometimes the
difficulty of breathing is so great, that the patient is obliged to keep
in an erect posture, otherwise he is in danger of being suffocated. A
fit or paroxysm of the asthma generally happens after a person has been
exposed to cold easterly winds, or has been abroad in thick foggy
weather, or has got wet, or continued long in a damp place under ground,
or has taken some food which the stomach could not digest, as pastries,
toasted cheese, or the like.

The paroxysm is commonly ushered in with listlessness, want of sleep,
hoarseness, a cough, belching of wind, a sense of heaviness about the
breast, and difficulty of breathing. To these succeed heat, fever, pain
of the head, sickness and nausea, great oppression of the breast,
palpitation of the heart, a weak and sometimes intermitting pulse, an
involuntary flow of tears, bilious vomitings, &c. All the symptoms grow
worse towards night; the patient is easier when up than in bed, and is
very desirous of cool air.

REGIMEN.——The food ought to be light, and of easy digestion. Boiled
meats are to be preferred to roasted, and the flesh of young animals to
that of old. All windy food, and whatever is apt to swell in the
stomach, is to be avoided. Light puddings, white broths, and ripe fruits
baked, boiled, or roasted, are proper. Strong liquors of all kinds,
especially malt-liquor, are hurtful. The patient should eat a very light
supper, or rather none at all, and should never suffer himself to be
long costive. His clothing should be warm, especially in the
winter-season. As all disorders of the breast are much relieved by
keeping the feet warm, and promoting the perspiration, a flannel shirt
or waistcoat, and thick shoes, will be of singular service.

But nothing is of so great importance in the asthma as pure and
moderately warm air. Asthmatic people can seldom bear either the close
heavy air of a large town, or the sharp, keen atmosphere of a bleak
hilly country; a medium therefore between these is to be chosen. The air
near a large town is often better than at a distance, provided the
patient be removed so far as not to be affected by the smoke. Some
asthmatic patients indeed breathe easier in town than in the country;
but this is seldom the case, especially in towns where much coal is
burnt. Asthmatic persons who are obliged to be in town all day, ought at
least to sleep out of it. Even this will often prove of great service.
Those who can afford it ought to travel into a warmer climate. Many
asthmatic persons who cannot live in Britain, enjoy very good health in
the south of France, Portugal, Spain, or Italy.

Exercise is likewise of very great importance in the asthma, as it
promotes the digestion, preparation of the blood, &c. The blood of
asthmatic persons is seldom duly prepared, owing to the proper action of
the lungs being impeded. For this reason such people ought daily to take
as much exercise, either on foot, horseback, or in a carriage, as they
can bear.

MEDICINE.——Almost all that can be done by medicine in this disease, is
to relieve the patient when seized with a violent fit. This indeed
requires the greatest expedition, as the disease often proves suddenly
fatal. In the paroxysm or fit, the body is generally bound; a purging
clyster, with a solution of asafœtida, ought therefore to be
administered, and if there be occasion, it may be repeated two or three
times. The patient’s feet and legs ought to be immersed in warm water,
and afterwards rubbed with a warm hand, or dry cloth. Bleeding, unless
extreme weakness or old age should forbid it, is highly proper. If there
be a violent spasm about the breast or stomach, warm fomentations, or
bladders filled with warm milk and water, may be applied to the part
affected, and warm cataplasms to the soles of the feet. The patient must
drink freely of diluting liquors, and may take a tea-spoonful of the
tincture of castor and of saffron mixed together, in a cup of
valerian-tea, twice or thrice a-day. Sometimes a vomit has a very good
effect, and snatches the patient, as it were, from the jaws of death.
This however will be more safe after other evacuations have been
premised. A very strong infusion of roasted coffee is said to give ease
in an asthmatic paroxysm.

In the moist asthma, such things as promote expectoration or spitting
ought to be used; as the syrup of squills, gum ammoniac, and such like.
A common spoonful of the syrup, or oxymel of squills, mixed with an
equal quantity of cinnamon-water, may be taken three or four times
through the day, and four or five pills made of equal parts of asafœtida
and gum-ammoniac, at bed-time[144].

For the convulsive or nervous asthma, antispasmodics and bracers are the
most proper medicines. The patient may take a tea-spoonful of the
paregoric elixir twice a-day. The Peruvian bark is sometimes found to be
of use in this case. It may be taken in substance, or infused in wine.
In short, every thing that braces the nerves, or takes off spasm, may be
of use in a nervous asthma. It is often relieved by the use of asses
milk; I have likewise known cows milk drank warm in the morning have a
very good effect in this case.

In every species of asthma, setons and issues have a good effect; they
may either be set in the back or side, and should never be allowed to
dry up. We shall here, once for all, observe, that not only in the
asthma, but in most chronic diseases, issues are extremely proper. They
are both a safe and efficacious remedy; and though they do not always
cure the disease, yet they will often prolong the patient’s life.




                               CHAP. XLI.
                            OF THE APOPLEXY.


The apoplexy is a sudden loss of sense and motion, wherein the patient
is to all appearance dead; the heart and lungs however still continue to
move. Though this disease proves often fatal, yet it may sometimes be
removed by proper care. It chiefly attacks sedentary persons of a gross
habit, who use a rich and plentiful diet, and indulge in strong liquors.
People in the decline of life are most subject to the apoplexy. It
prevails most in winter, especially in rainy seasons, and very low
states of the barometer.

CAUSES.——The immediate cause of an apoplexy is a compression of the
brain, occasioned by an excess of blood, or a collection of watery
humours. The former is called a _sanguine_, and the latter a _serous
apoplexy_. It may be occasioned by any thing that increases the
circulation towards the brain, or prevents the return of the blood from
the head; as intense study; violent passions[145]; viewing objects for a
long time obliquely; wearing any thing too tight about the neck; a rich
and luxurious diet; suppression of urine; suffering the body to cool
suddenly after having been greatly heated; continuing long in a warm or
a cold bath; the excessive use of spiceries, or high-seasoned food;
excess of venery; the sudden striking in of any eruption; suffering
issues, setons, &c. suddenly to dry up, or the stoppage of any customary
evacuation; a mercurial salivation pushed too far, or suddenly checked
by cold; wounds or bruises on the head; long exposure to excessive cold;
poisonous exhalations, &c.

SYMPTOMS, and method of cure.——The usual forerunners of an apoplexy are
giddiness, pain and swimming of the head; loss of memory; drowsiness;
noise in the ears; the night-mare; a spontaneous flux of tears, and
laborious respiration. When persons of an apoplectic make observe these
symptoms, they have reason to fear the approach of a fit, and should
endeavour to prevent it by bleeding, a slender diet, and opening
medicines.

In the sanguine apoplexy, if the patient does not die suddenly, the
countenance appears florid, the face is swelled or puffed up, and the
blood-vessels, especially about the neck and temples, are turgid; the
pulse beats strong; the eyes are prominent and fixed, and the breathing
is difficult, and performed with a snorting noise. The excrements and
urine are often voided spontaneously, and the patient is sometimes
seized with vomiting.

In this species of apoplexy every method must be taken to lessen the
force of the circulation towards the head. The patient should be kept
perfectly easy and cool. His head should be raised pretty high, and his
feet suffered to hang down. His clothes ought to be loosened, especially
about the neck, and fresh air admitted into his chamber. His garters
should be tied pretty tight, by which means the motion of the blood from
the lower extremities will be retarded. As soon as the patient is placed
in a proper posture, he should be bled freely in the neck or arm, and,
if there be occasion, the operation may be repeated in two or three
hours. A laxative clyster, with plenty of sweet oil, or fresh butter,
and a spoonful or two of common salt in it, may be administered every
two hours; and blistering-plasters applied between the shoulders, and to
the calves of the legs.

As soon as the symptoms are a little abated, and the patient is able to
swallow, he ought to drink freely of some diluting opening liquor, as a
decoction of tamarinds and liquorice, cream-tartar-whey, or common whey
with cream of tartar dissolved in it. Or he may take any cooling purge,
as Glauber’s salt, manna dissolved in an infusion of senna, or the like.
All spirits and other strong liquors are to be avoided. Even volatile
salts held to the nose do mischief. Vomits, for the same reason, ought
not to be given, nor any thing that may increase the motion of the blood
towards the head.

In the serous apoplexy, the symptoms are nearly the same, only the pulse
is not so strong, the countenance is less florid, and the breathing less
difficult. Bleeding is not so necessary here as in the former case. It
may however generally be performed once with safety and advantage, but
should not be repeated. The patient should be placed in the same posture
as directed above, and should have blistering-plasters applied, and
receive opening clysters in the same manner. Purges here are likewise
necessary, and the patient may drink strong balm-tea. If he be inclined
to sweat, it ought to be promoted by drinking small wine-whey, or an
infusion of carduus benedictus. A plentiful sweat kept up for a
considerable time has often carried off a serous apoplexy.

When apoplectic symptoms proceed from opium, or other narcotic
substances taken into the stomach, vomits are necessary. The patient is
generally relieved as soon as he has discharged the poison in this way.

Persons of an apoplectic make, or those who have been attacked by it,
ought to use a very spare and slender diet, avoiding all strong liquors,
spiceries, and high-seasoned food. They ought likewise to guard against
all violent passions, and to avoid the extremes of heat and cold. The
head should be shaved, and daily washed with cold water. The feet ought
to be kept warm, and never suffered to continue long wet. The body must
be kept open either by food or medicine, and a little blood may be let
every spring and fall. Exercise should by no means be neglected; but it
ought to be taken in moderation. Nothing has a more happy effect in
preventing an apoplexy than perpetual issues or setons; great care
however must be taken not to suffer them to dry up, without opening
others in their stead. Apoplectic persons ought never to go to rest with
a full stomach, or to lie with their heads low, or wear any thing too
tight about their necks.




                              CHAP. XLII.
    OF COSTIVENESS, AND OTHER AFFECTIONS OF THE STOMACH AND BOWELS.


We do not here mean to treat of those astrictions of the bowels which
are the symptoms of diseases, as of the colic, the iliac passion, &c.
but only to take notice of that infrequency of stools which sometimes
happens, and which in some particular constitutions may occasion
diseases.

Costiveness may proceed from drinking rough red wines, or other
astringent liquors; too much exercise, especially on horseback. It may
likewise proceed from a long use of cold insipid food, which does not
sufficiently stimulate the intestines. Sometimes it is owing to the bile
not descending to the intestines, as in the jaundice; and at other times
it proceeds from diseases of the intestines themselves, as a palsy,
spasms, torpor, tumours, a cold dry state of the intestines, &c.

Excessive costiveness is apt to occasion pains of the head, vomiting,
colics, and other complaints of the bowels. It is peculiarly hurtful to
hypochondriac and hysteric persons, as it generates wind and other
grievous symptoms. Some people however can bear costiveness to a great
degree. I know persons who enjoy pretty good health, yet do not go to
stool above once a-week, and others not above once a fortnight. Indeed I
have heard of some who do not go above once a month.

Persons who are generally costive should live upon a moistening and
laxative diet, as roasted or boiled apples, pears, stewed prunes,
raisins, gruels with currants, butter, honey, sugar, and such like.
Broths with spinage, leeks, and other soft pot-herbs, are likewise
proper. Rye-bread, or that which is made of a mixture of wheat and rye
together, ought to be eaten. No person troubled with costiveness should
eat white bread alone, especially that which is made of fine flour. The
best bread for keeping the body soluble is what in some parts of England
they call _meslin_. It is made of a mixture of wheat and rye, and is
very agreeable to those who are accustomed to it.

Costiveness is increased by keeping the body too warm, and by every
thing that promotes the perspiration; as wearing flannel, lying too long
a-bed, &c. Intense thought, and a sedentary life, are likewise hurtful.
All the secretions and excretions are promoted by moderate exercise
without doors, and by a gay, cheerful, sprightly temper of mind.

The drink should be of an opening quality. All ardent spirits, austere
and astringent wines, as port, claret, &c. ought to be avoided.
Malt-liquor that is fine, and of a moderate strength, is very proper.
Butter-milk, whey, and other watery liquors, are likewise proper, and
may be drank in turns, as the patient’s inclination directs.

Those who are troubled with costiveness, ought, if possible, to
remedy it by diet, as the constant use of medicines for that purpose
is attended with many inconveniencies, and often with bad
consequences[146]. I never knew any one get into a habit of taking
medicine for keeping the body open, who could leave it off. In time
the custom becomes necessary, and generally ends in a total
relaxation of the bowels, indigestion, loss of appetite, wasting of
the strength, and death.

When the body cannot be kept open without medicine, we would recommend
gentle doses of rhubarb to be taken twice or thrice a-week. This is not
near so injurious to the stomach as aloes, jalap, or the other drastic
purgatives so much in use. Infusions of senna and manna may likewise be
taken, or half an ounce of soluble tartar dissolved in water-gruel.
About the size of a nutmeg of lenitive electuary taken twice or thrice
a-day generally answers the purpose very well.


                           WANT OF APPETITE.

This may proceed from a foul stomach; indigestion; the want of free air
and exercise; grief; fear; anxiety; or any of the depressing passions;
excessive heat; the use of strong broths, fat meats, or any thing that
palls the appetite, or is hard of digestion, the immoderate use of
strong liquors, tea, tobacco, opium, &c.

The patient ought, if possible, to make choice of an open dry air; to
take exercise daily on horseback or in a carriage; to rise betimes; and
to avoid all intense thought. He should use a diet of easy digestion;
and should avoid excessive heat and great fatigue.

If want of appetite proceeds from errors in diet, or any other part of
the patient’s regimen, it ought to be changed. If nausea and reachings
shew that the stomach is loaded with crudities, a vomit will be of
service. After this a gentle purge or two of rhubarb, or of any of the
bitter purging salts, may be taken. The patient ought next to use some
of the stomachic bitters infused in wine. Though gentle evacuations be
necessary, yet strong purges and vomits are to be avoided, as they
weaken the stomach, and hurt digestion.

Elixir of vitriol is an excellent medicine in most cases of indigestion,
weakness of the stomach, or want of appetite. From twenty to thirty
drops of it may be taken twice or thrice a-day in a glass of wine or
water. It may likewise be mixed with the tincture of the bark, one
drachm of the former to an ounce of the latter, and two tea-spoonfuls of
it taken in wine or water, as above.

The chalybeate waters, if drank in moderation, are generally of
considerable service in this case. The salt-water has likewise good
effects; but it must not be used too freely. The waters of Harrowgate,
Scarborough, Moffat, and most other Spas in Britain, may be used with
advantage. We would advise all who are afflicted with indigestion and
want of appetite, to repair to these places of public rendezvous. The
very change of air, and the cheerful company, will be of service; not to
mention the exercise, dissipation, amusements, &c.


                           OF THE HEART-BURN.

What is commonly called the _heart-burn_, is not a disease of that
organ, but an uneasy sensation of heat or acrimony about the pit of the
stomach, which is sometimes attended with anxiety, nausea, and vomiting.

It may proceed from debility of the stomach, indigestion, bile, the
abounding of an acid in the stomach, &c. Persons who are liable to this
complaint ought to avoid stale liquors, acids, windy or greasy aliments,
and should never use violent exercise soon after a plentiful meal. I
know many persons who never fail to have the heart-burn if they ride
soon after dinner, provided they have drank ale, wine, or any fermented
liquor; but are never troubled with it when they have drank rum or
brandy and water without any sugar or acid.

When the heart-burn proceeds from debility of the stomach, or
indigestion, the patient ought to take a dose or two of rhubarb;
afterwards he may use infusions of the Peruvian bark, or any other of
the stomachic bitters, in wine or brandy. Exercise in the open air will
likewise be of use, and every thing that promotes digestion.

When bilious humours occasion the heart-burn, a tea-spoonful of the
sweet spirit of nitre in a glass of water, or a cup of tea, will
generally give ease. If it proceeds from the use of greasy aliments, a
dram of brandy or rum may be taken.

If acidity or sourness of the stomach occasions the heart-burn,
absorbents are the proper medicines. In this case an ounce of powdered
chalk, half an ounce of fine sugar, and a quarter of an ounce of
gum-arabic, may be mixed in an English quart of water, and a tea-cupful
of it taken as often as is necessary. Such as do not chuse chalk may
take a tea-spoonful of prepared oyster-shells, or of the powder called
crabs eyes, in a glass of cinnamon or peppermint-water. But the safest
and bed absorbent is _magnesia alba_. This not only acts as an
absorbent, but likewise as a purgative; whereas chalk, and other
absorbents of that kind, are apt to lie in the intestines, and occasion
obstructions. This powder is not disagreeable, and may be taken in a cup
of tea, or a glass of mint-water. A large tea-spoonful is the usual
dose; but it may be taken in a much greater quantity when there is
occasion. These things are now generally made up into lozenges for the
conveniency of being carried in the pocket, and taken at pleasure.

If wind be the cause of this complaint, the most proper medicines are
those called carminatives; as anniseeds, juniper-berries, ginger,
canella alba, cardamom seeds, &c. These may either be chewed, or infused
in wine, brandy, or other spirits. One of the safest medicines of this
kind is the tincture made by infusing an ounce of rhubarb, and a quarter
of an ounce of the lesser cardamom seeds, in an English pint of brandy.
After this has digested for two or three days, it ought to be strained,
and four ounces of white sugar-candy added to it. It must stand to
digest a second time till the sugar be dissolved. A table-spoonful of it
may be taken occasionally for a dose.

I have frequently known the heart-burn cured, particularly in pregnant
women, by chewing green tea. Two table-spoonfuls of what is called the
milk of gum-ammoniac, taken once or twice a-day, will sometimes cure the
heart-burn.




                              CHAP. XLIII.
                          OF NERVOUS DISEASES.


Of all diseases incident to mankind, those of the nervous kind are the
most complicated and difficult to cure. A volume would not be sufficient
to point out their various appearances. They imitate almost every
disease; and are seldom alike in two different persons, or even in the
same person at different times. Proteus-like, they are continually
changing shape; and upon every fresh attack, the patient thinks he feels
symptoms which he never experienced before. Nor do they only affect the
body; the mind likewise suffers, and is often thereby rendered extremely
weak and peevish. The low spirits, timorousness, melancholy, and
fickleness of temper, which generally attend nervous disorders, induce
many to believe that they are entirely diseases of the mind; but this
change of temper is rather a consequence, than the cause of nervous
diseases.

CAUSES.——Every thing that tends to relax or weaken the body, disposes it
to nervous diseases, as indolence, excessive venery, drinking too much
tea, or other weak, watery liquors warm, frequent bleeding, purging,
vomiting, &c. Whatever hurts the digestion, or prevents the proper
assimilation of the food, has likewise this effect; as long fasting,
excess in eating or drinking, the use of windy, crude, or unwholesome
aliments, an unfavourable posture of the body, &c.

Nervous disorders often proceed from intense application to study.
Indeed few studious persons are entirely free from them. Nor is this at
all to be wondered at; intense thinking not only preys upon the spirits,
but prevents the person from taking proper exercise, by which means the
digestion is impaired, the nourishment prevented, the solids relaxed,
and the whole mass of humours vitiated. Grief and disappointment
likewise produce the same effects. I have known more nervous patients,
who dated the commencement of their disorders from the loss of a
husband, a favourite child, or from some disappointment in life, than
from any other cause. In a word, whatever weakens the body, or depresses
the spirits, may occasion nervous disorders, as unwholesome air, want of
sleep, great fatigue, disagreeable apprehensions, anxiety, vexation, &c.

SYMPTOMS.——We shall only mention some of the most general symptoms of
these disorders, as it would be both an useless and an endless task to
enumerate the whole. They generally begin with windy inflations or
distentions of the stomach and intestines; the appetite and digestion
are usually bad; yet sometimes there is an uncommon craving for food,
and a quick digestion. The food often turns sour on the stomach; and the
patient is troubled with vomiting of clear water, tough phlegm, or a
blackish-coloured liquor resembling the grounds of coffee. Excruciating
pains are often felt about the navel, attended with a rumbling or
murmuring noise in the bowels. The body is sometimes loose, but more
commonly bound, which occasions a retention of wind and great
uneasiness.

The urine is sometimes in small quantity, at other times very copious
and quite clear. There is a great straitness of the breast, with
difficulty of breathing; violent palpitations of the heart; sudden
flushings of heat in various parts of the body; at other times a sense
of cold, as if water were poured on them; flying pains in the arms and
limbs; pains in the back and belly, resembling those occasioned by
gravel; the pulse very variable, sometimes uncommonly slow, and at other
times very quick; yawning, the hiccup, frequent sighing, and a sense of
suffocation, as if from a ball or lump in the throat; alternate fits of
crying and convulsive laughing; the sleep is unsound and seldom
refreshing; and the patient is often troubled with the night-mare.

As the disease increases, the patient is molested with head-achs,
cramps, and fixed pains in various parts of the body; the eyes are
clouded, and often affected with pain and dryness; there is a noise in
the ears, and often a dulness of hearing; in short, the whole animal
functions are impaired. The mind is disturbed on the most trivial
occasions, and is hurried into the most perverse commotions,
inquietudes, terror, sadness, anger, diffidence, &c. The patient is apt
to entertain wild imaginations and extravagant fancies; the memory
becomes weak, and the judgment fails.

Nothing is more characteristic of this disease than a constant dread of
death. This renders those unhappy persons who labour under it peevish,
fickle, impatient, and apt to run from one physician to another; which
is one reason why they seldom reap any benefit from medicine, as they
have not sufficient resolution to persist in any one course till it has
time to produce its proper effects. They are likewise apt to imagine
that they labour under diseases from which they are quite free; and are
very angry if any one attempts to set them right, or laugh them out of
their ridiculous notions.

REGIMEN.——Persons afflicted with nervous diseases ought never to fast
long. Their food should be solid and nourishing, but of easy digestion.
Fat meats and heavy sauces are hurtful. All excess should be carefully
avoided. They ought never to eat more at a time than they can easily
digest; but if they feel themselves weak and faint between meals, they
ought to eat a bit of bread, and drink a glass of wine. Heavy suppers
are to be avoided. Though wine in excess enfeebles the body, and impairs
the faculties of the mind, yet taken in moderation, it strengthens the
stomach, and promotes digestion. Wine and water is a very proper drink
at meals; but if wine sours on the stomach, or the patient is much
troubled with wind, brandy and water will answer better. Every thing
that is windy or hard of digestion must be avoided. All weak and warm
liquors are hurtful, as tea, coffee, punch, &c. People may find a
temporary relief in the use of these, but they always increase the
malady, as they weaken the stomach and hurt digestion. Above all things,
drams are to be avoided. Whatever immediate ease the patient may feel
from the use of ardent spirits, they are sure to aggravate the malady,
and prove certain poisons at last. These cautions are the more
necessary, as most nervous people are peculiarly fond of tea and ardent
spirits; to the use of which many of them fall victims.

Exercise in nervous disorders is superior to all medicines. Riding on
horseback is generally esteemed the best, as it gives motion to the
whole body, without fatiguing it. I have known some patients, however,
with whom walking agreed better, and others who were most benefited by
riding in a carriage. Every one ought to use that which he finds most
beneficial. Long sea-voyages have an excellent effect; and to those who
have sufficient resolution, we would by all means recommend this course.
Even change of place, and the sight of new objects, by diverting the
mind, have a great tendency to remove these complaints. For this reason
a long journey, or a voyage, is of much more advantage than riding short
journeys near home.

A cool and dry air is proper, as it braces, and invigorates the whole
body. Few things tend more to relax and enervate than hot air,
especially that which is rendered so by great fires, or stoves in small
apartments. But when the stomach or bowels are weak, the body ought to
be well guarded against cold, especially in winter, by wearing a thin
flannel waistcoat next the skin. This will keep up an equal
perspiration, and defend the alimentary canal from many impressions to
which it would otherwise be subject, upon every sudden change from warm
to cold weather. Rubbing the body frequently with a flesh-brush, or a
coarse linen cloth, is likewise beneficial, as it promotes the
circulation, perspiration, &c. Persons who have weak nerves ought to
rise early, and take exercise before breakfast, as lying too long a-bed
cannot fail to relax the solids. They ought likewise to be diverted, and
to be kept as easy and cheerful as possible. There is not any thing
which hurts the nervous system, or weakens the digestive powers, more
than fear, grief, or anxiety.

MEDICINES.——Though nervous diseases are seldom radically cured, yet
their symptoms may sometimes be alleviated, and the patient’s life
rendered at least more comfortable by proper medicines.

When the patient is costive, he ought to take a little rhubarb, or some
other mild purgative, and should never suffer his body to be long bound.
All strong and violent purgatives are however to be avoided, as aloes,
jalap, &c. I have generally seen an infusion of senna and rhubarb in
brandy answer very well. This may be made of any strength, and taken in
such quantity as the patient finds necessary. When digestion is bad, or
the stomach relaxed and weak, the following infusion of Peruvian bark
and other bitters may be used with advantage:

Take of Peruvian bark an ounce, gentian root, orange-peel, and
coriander-seed, of each half an ounce; let these ingredients be all
bruised in a mortar, and infused in a bottle of brandy or whiskey, for
the space of five or six days. A table-spoonful of the strained liquor
may be taken in half a glass of water, an hour before breakfast, dinner,
and supper.

Few things tend more to strengthen the nervous system than cold bathing.
This practice, if duly persisted in, will produce very extraordinary
effects; but when the liver or other _viscera_ are obstructed, or
otherwise unsound, the cold bath is improper. It is therefore to be used
with very great caution. The most proper seasons for it are summer and
autumn. It will be sufficient, especially for persons of a spare habit,
to go into the cold bath three or four times a-week. If the patient be
weakened by it, or feels chilly for a long time after coming out, it is
improper.

In patients afflicted with wind, I have always observed the greatest
benefit from the elixir of vitriol. It may be taken in the quantity of
fifteen, twenty, or thirty drops, twice or thrice a-day in a glass of
water. This both expels wind, strengthens the stomach, and promotes
digestion.

Opiates are generally extolled in these maladies; but as they only
palliate the symptoms, and generally afterwards increase the disease, we
would advise people to be extremely sparing in the use of them, lest
habit render them at last absolutely necessary.

It would be an easy matter to enumerate many medicines which have been
extolled for relieving nervous disorders; but whoever wishes for a
thorough cure must expect it from regimen alone; we shall therefore omit
mentioning more medicines, and again recommend the strictest attention
to DIET, AIR, EXERCISE, and AMUSEMENTS.


                             OF MELANCHOLY.

Melancholy is that state of alienation or weakness of mind which renders
people incapable of enjoying the pleasures, or performing the duties of
life. It is a degree of insanity, and often terminates in absolute
madness.

CAUSES.——It may proceed from an hereditary disposition; intense
thinking, especially where the mind is long occupied about one object;
violent passions or affections of the mind, as love, fear, joy, grief,
over-weening pride, and such like. It may also be occasioned by
excessive venery; narcotic or stupefactive poisons; a sedentary life;
solitude; the suppression of customary evacuations; acute fevers, or
other diseases. Violent anger will change melancholy into madness; and
excessive cold, especially of the lower extremities, will force the
blood into the brain, and produce all the symptoms of madness. It may
likewise proceed from the use of aliment that is hard of digestion, or
which cannot be easily assimilated; from a callous state of the
integuments of the brain, or a dryness of the brain itself. To all which
we may add gloomy or mistaken notions of religion.

SYMPTOMS.——When persons begin to be melancholy, they are timorous;
watchful; fond of solitude; fretful; fickle; captious and inquisitive;
solicitous about trifles; sometimes niggardly, and at other times
prodigal. The body is generally bound; the urine thin, and in small
quantity; the stomach and bowels inflated with wind; the complexion
pale; the pulse slow and weak. The functions of the mind are also
greatly perverted, in so much that the patient often imagines himself
dead, or changed into some other animal. Some have imagined their bodies
were made of glass, or other brittle substances, and were afraid to
move, lest they should be broken to pieces. The unhappy patient, in this
case, unless carefully watched, is apt to put an end to his own
miserable life.

When the disease is owing to an obstruction of customary evacuations, or
any bodily disorder, it is easier cured than when it proceeds from
affections of the mind, or an hereditary taint. A discharge of blood
from the nose, looseness, scabby eruptions, the bleeding piles, or the
_menses_, sometimes carry off this disease.

REGIMEN.——The diet should consist chiefly of vegetables of a cooling and
opening quality. Animal food, especially salted or smoke-dried fish or
flesh, ought to be avoided. All kinds of shell-fish are bad. Aliments
prepared with onions, garlic, or any thing that generates thick blood,
are likewise improper. All kind of fruits that are wholesome may be
eaten with advantage. Boerhaave gives an instance of a patient who, by a
long use of whey, water, and garden-fruit, recovered, after having
evacuated a great quantity of black-coloured matter.

Strong liquors of every kind ought to be avoided as poison. The most
proper drink is water, whey, or very small beer. Tea and coffee are
improper. If honey agrees with the patient, it may be eaten freely, or
his drink may be sweetened with it. Infusions of balm-leaves,
penny-royal, the roots of wild valerian, or the flowers of the
lime-tree, may be drank freely, either by themselves, or sweetened with
honey, as the patient shall chuse.

The patient ought to take as much exercise in the open air as he can
bear. This helps to dissolve the viscid humours, it removes
obstructions, promotes the perspiration, and all the other secretions.
Every kind of madness is attended with a diminished perspiration; all
means ought therefore to be used to promote that necessary and salutary
discharge. Nothing can have a more direct tendency to increase the
disease than confining the patient to a close apartment. Were he forced
to ride or walk a certain number of miles every day, it would tend
greatly to alleviate his disorder; but it would have still a better
effect, if he were obliged to labour a piece of ground. By digging,
hoeing, planting, sowing, &c. both the body and mind would be exercised.
A long journey, or a voyage, especially towards a warmer climate, with
agreeable companions, has often very happy effects. A plan of this kind,
with a strict attention to diet, is a much more rational method of cure,
than confining the patient within doors and plying him with medicines.

MEDICINE.——In the cure of this disease particular attention must be paid
to the mind. When the patient is in a low state, his mind ought to be
soothed and diverted with variety of amusements, as entertaining
stories, pastimes, music, &c. This seems to have been the method of
curing melancholy among the Jews, as we learn from the story of King
Saul; and indeed it is a very rational one. Nothing can remove diseases
of the mind so effectually as applications to the mind itself, the most
efficacious of which is music. The patient’s company ought likewise to
consist of such persons as are agreeable to him. People in this state
are apt to conceive unaccountable aversions against particular persons;
and the very sight of such persons is sufficient to distract their
minds, and throw them into the utmost perturbation.

When the patient is high, evacuations are necessary. In this case he
must be bled, and have his body kept open by purging medicines, as
manna, rhubarb, cream of tartar, or the soluble tartar. I have seen the
last have very happy effects. It may be taken in the dose of half an
ounce, dissolved in water-gruel, every day, for sundry weeks, or even
for months, if necessary. More or less may be given according as it
operates. Vomits have likewise a good effect; but they must be pretty
strong, otherwise they will not operate.

Whatever increases the evacuation of urine or promotes perspiration, has
a tendency to remove this disease. Both these secretions may be promoted
by the use of nitre and vinegar. Half a drachm of purified nitre may be
given three or four times a-day in any manner that is most agreeable to
the patient; and an ounce and a half of distilled vinegar may be daily
mixed with his drink. Dr. Locker seems to think vinegar the best
medicine that can be given in this disease.

Camphire and musk have likewise been used in this case with advantage.
Ten or twelve grains of camphire may be rubbed in a mortar with half a
drachm of nitre, and taken twice a-day, or oftner, if the stomach will
bear it. If it will not sit upon the stomach in this form, it may be
made into pills with gum asafœtida and Russian castor, and taken in the
quantity above directed. If musk is to be administered, a scruple or
twenty-five grains of it may be made into a bolus with a little honey or
common syrup, and taken twice or thrice a-day. We do not mean that all
these medicines should be administered at once; but whichever of them is
given, must be duly persisted in, and where one fails another may be
tried.

As it is very difficult to induce patients in this disease to take
medicines, we shall mention a few outward applications, which sometimes
do good; the principal of these are issues, setons, and warm bathing.
Issues may be made in any part of the body, but they generally have the
best effect near the spine. The discharge from these may be greatly
promoted by dressing them with the mild blistering ointment, and keeping
what are commonly called the orrice pease in them. The most proper place
for a seton is between the shoulder-blades; and it ought to be placed
upwards and downwards, or in the direction of the spine.


                             OF THE PALSY.

The palsy is a loss or diminution of sense or motion, or of both, in one
or more parts of the body. Of all the affections called nervous, this is
the most suddenly fatal. It is more or less dangerous, according to the
importance of the part affected. A palsy of the heart, lungs, or any
part necessary to life, is mortal. When it affects the stomach, the
intestines, or the bladder, it is highly dangerous. If the face be
affected, the case is bad, as it shews that the disease proceeds from
the brain. When the part affected feels cold, is insensible, or wastes
away, or when the judgment and memory begin to fail, there is small hope
of a cure.

CAUSES.——The immediate cause of palsy is any thing that prevents the
regular exertion of the nervous power upon any particular muscle or part
of the body. The occasional and predisposing causes are various, as
drunkenness; wounds of the brain, or spinal marrow; pressure upon the
brain or nerves; very cold or damp air; the suppression of customary
evacuations; sudden fear; want of exercise; or whatever greatly relaxes
the system, as drinking much tea[147], or coffee, &c. The palsy may
likewise proceed from wounds of the nerves themselves, from the
poisonous fumes of metals or minerals, as mercury, lead, arsenic.

In young persons of a full habit, the palsy must be treated in the same
manner as the sanguine apoplexy. The patient must be bled, blistered,
and have his body opened by sharp clysters or purgative medicines. But,
in old age, or when the disease proceeds from relaxation or debility,
which is generally the case, a quite contrary course must be pursued.
The diet must be warm and invigorating, seasoned with spicy and aromatic
vegetables, as mustard, horse-radish, &c. The drink may be generous
wine, mustard-whey, or brandy and water. Friction with the flesh-brush,
or a warm hand, is extremely proper, especially on the parts affected.
Blistering-plasters may likewise be applied to the affected parts with
advantage. When this cannot be done, they may be rubbed with the
volatile liniment, or the nerve ointment of the Edinburgh dispensatory.
One of the best external applications is electricity. The shocks, or
rather vibrations, should be received on the part affected; and they
ought daily to be repeated for several weeks.

Vomits are very beneficial in this kind of palsy, and ought frequently
to be administered. Cephalic snuff, or any thing that makes the patient
sneeze, is likewise of use. Some pretend to have found great benefit
from rubbing the parts affected with nettles; but this does not seem to
be any way preferable to blistering. If the tongue is affected, the
patient may gargle his mouth frequently with brandy and mustard; or he
may hold a bit of sugar in his mouth wet with the palsy-drops or
compound spirits of lavender. The wild valerian-root is a very proper
medicine in this case. It may either be taken in an infusion with
sage-leaves, or half a drachm of it in powder may be given in a glass of
wine three times a-day. If the patient cannot use the valerian, he may
take of _sal volatile oleosum_, compound spirits of lavender, and
tincture of castor, each half an ounce; mix these together, and take
forty or fifty drops in a glass of wine three or four times a-day. A
table-spoonful of mustard-seed taken frequently is a very good medicine.
The patient ought likewise to chew cinnamon bark, ginger, or other warm
spiceries.

Exercise is of the utmost importance in the palsy; but the patient must
beware of cold, damp, and moist air. He ought to wear flannel next his
skin; and, if possible, should remove into a warmer climate.


                 OF THE EPILEPSY, OR FALLING SICKNESS.

The epilepsy is a sudden deprivation of all the senses, wherein the
patient falls suddenly down, and is affected with violent convulsive
motions. Children, especially those who are delicately brought up, are
most subject to it. It more frequently attacks men than women, and is
very difficult to cure. When the epilepsy attacks children, there is
reason to hope it may go off about the time of puberty. When it attacks
any person after twenty years of age, the cure is difficult; but when
after forty, a cure is hardly to be expected. If the fit continues only
for a short space, and returns seldom, there is reason to hope; but if
it continues long, and returns frequently, the prospect is bad. It is a
very unfavourable symptom when the patient is seized with the fits in
his sleep.

CAUSES.——The epilepsy is sometimes hereditary. It may likewise proceed
from blows, bruises, or wounds on the head; a collection of water,
blood, or serous humours in the brain; a polypus; tumours or concretions
within the skull; excessive drinking; intense study; excess of venery;
worms; teething; suppression of customary evacuations; too great
emptiness or repletion; violent passions or affections of the mind, as
fear, joy, &c.; hysteric affections; contagion received into the body,
as the infection of the small-pox, measles, &c.

SYMPTOMS.——An epileptic fit is generally preceded by unusual weariness;
pain of the head; dulness; giddiness; noise in the ears; dimness of
sight; palpitation of the heart; disturbed sleep; difficult breathing;
the bowels are inflated with wind; the urine is in great quantity, but
thin; the complexion is pale; the extremities are cold; and the patient
often feels, as it were, a stream of cold air ascending towards his
head.

In the fit, the patient generally makes an unusual noise; his thumbs are
drawn in towards the palms of the hands; his eyes are distorted; he
starts, and foams at the mouth; his extremities are bent or twitted
various ways; he often discharges his seed, urine, and fæces
involuntarily; and is quite destitute of all sense and reason. After the
fit is over, his senses gradually return, and he complains of a kind of
stupor, weariness, and pain of his head; but has no remembrance of what
happened to him during the fit.

The fits are sometimes excited by violent affections of the mind, a
debauch of liquor, excessive heat, cold, or the like.

This disease, from the difficulty of investigating its causes, and its
strange symptoms, was formerly attributed to the wrath of the gods, or
the agency of evil spirits. In modern times it has often, by the vulgar,
been imputed to witchcraft or fascination. It depends however as much
upon natural causes as any other malady; and its cure may often be
effected by persisting in the use of proper means.

REGIMEN.——Epileptic patients ought, if possible, to breathe a pure and
free air. Their diet should be light but nourishing. They ought to drink
nothing strong, to avoid swine’s flesh, water-fowl, and likewise all
windy and oily vegetables, as cabbage, nuts, &c. They ought to keep
themselves cheerful, carefully guarding against all violent passions, as
anger, fear, excessive joy, and the like.

Exercise is likewise of great use; but the patient must be careful to
avoid all extremes either of heat or cold, all dangerous situations, as
standing upon precipices, riding, deep waters, and such like.

MEDICINE.——The intentions of cure must vary according to the cause of
the disease. If the patient be of a sanguine temperament, and there be
reason to fear an obstruction in the brain, bleeding and other
evacuations will be necessary. When the disease is occasioned by the
stoppage of customary evacuations, these, if possible, must be restored;
if this cannot be done, others may be substituted in their place. Issues
or setons in this case have often a very good effect. When there is
reason to believe that the disease proceeds from worms, proper medicines
must be used to kill, or carry off these vermin. When the disease
proceeds from teething, the body should be kept open by emollient
clysters, the feet frequently bathed in warm water, and, if the fits
prove obstinate, a blistering-plaster may be put betwixt the shoulders.
The same method is to be followed, when epileptic fits precede the
eruption of the small-pox, or measles, &c.

When the disease is hereditary, or proceeds from a wrong formation of
the brain, a cure is not to be expected. When it is owing to a debility,
or too great an irritability of the nervous system, such medicines as
tend to brace and strengthen the nerves may be used, as the Peruvian
bark, and steel; or the _anti-epileptic_ electuaries, recommended by
Fuller and Mead[148].

The flowers of zinc have of late been highly extolled for the cure of
the epilepsy. Though this medicine will not be found to answer the
expectations which have been raised concerning it, yet in obstinate
epileptic cases it deserves a trial. The dose is from one to three or
four grains, which may be taken either in pills or a bolus, as the
patient inclines. The best method is to begin with a single grain four
or five times a day, and gradually to increase the dose as far as the
patient can bear it. I have known this medicine, when duly persisted in,
prove beneficial.

Musk has sometimes been found to succeed in the epilepsy. Ten or twelve
grains of it, with the same quantity of factitious cinnabar, may be made
up into a bolus, and taken every night and morning.

Sometimes the epilepsy has been cured by electricity.

Convulsion-fits proceed from the same causes, and must be treated in the
same manner as the epilepsy.

There is one particular species of convulsion-fits which commonly goes
by the name of St. Vitus’s dance, wherein the patient is agitated with
strange motions and gesticulations, which by the common people are
generally believed to be the effects of witchcraft. This disease may be
cured by repeated bleedings and purges; and afterwards using the
medicines prescribed above for the epilepsy, _viz._ the Peruvian bark
and snake-root, &c. Chalybeate waters are found to be beneficial in this
case. The cold bath is likewise of singular service, and ought never to
be neglected when the patient can bear it.


                             OF THE HICCUP.

The hiccup is a spasmodic or convulsive affection of the stomach and
midriff, arising from any cause that irritates their nervous fibres.

It may proceed from excess in eating or drinking; from a hurt of the
stomach; poisons; inflammations or scirrhous tumours of the stomach,
intestines, bladder, midriff, or the rest of the _viscera_. In
gangrenes, acute and malignant fevers, a hiccup is often the forerunner
of death.

When the hiccup proceeds from the use of aliment that is flatulent, or
hard of digestion, a draught of generous wine, or a dram of any
spirituous liquor, will generally remove it. If poison be the cause,
plenty of milk and oil must be drank, as has been formerly recommended.
When it proceeds from an inflammation of the stomach, &c. it is very
dangerous. In this case the cooling regimen ought to be strictly
observed. The patient must be bled, and take frequently a few drops of
the sweet spirits of nitre in a cup of wine-whey. His stomach should
likewise be fomented with cloths dipped in warm water, or have bladders
filled with warm milk and water applied to it.

When the hiccup proceeds from a gangrene or mortification, the Peruvian
bark, with other antiseptics, are the only medicines which have a chance
to succeed. When it is a primary disease, and proceeds from a foul
stomach, loaded either with a pituitous or a bilious humour, a gentle
vomit and purge, if the patient be able to bear them, will be of
service. If it arises from flatulencies, the carminative medicines
directed for the heart-burn must be used.

When the hiccup proves very obstinate, recourse must be had to the most
powerful aromatic and antispasmodic medicines. The principal of these is
musk; fifteen or twenty grains of which may be made into a bolus, and
repeated occasionally. Opiates are likewise of service; but they must be
used with caution. A bit of sugar dipped in compound spirits of
lavender, or the volatile aromatic tincture, may be taken frequently.
External applications are sometimes also beneficial; as the stomach
plaster, or a cataplasm of the Venice treacle of the Edinburgh or London
dispensatory, applied to the region of the stomach.

I lately attended a patient who had almost a constant hiccup for above
nine weeks. It was frequently stopped by the use of musk, opium, wine,
and other cordial and antispasmodic medicines, but always returned.
Nothing however gave the patient so much ease as brisk small-beer. By
drinking freely of this, the hiccup was often kept off for several days,
which was more than could be done by the most powerful medicines. The
patient was at length seized with a vomiting of blood, which soon put an
end to his life. Upon opening the body, a large scirrhous tumour was
found near the pylorus or right orifice of the stomach.

The hiccup may be removed by taking vinegar, or a few drops of the oil
of vitriol taken in water.


                         CRAMP OF THE STOMACH.

This disease often seizes people suddenly, is very dangerous, and
requires immediate assistance. It is most incident to persons in the
decline of life, especially the nervous, gouty, hysteric, and
hypochondriac.

If the patient has any inclination to vomit, he ought to take some
draughts of warm water, or weak camomile-tea, to cleanse his stomach.
After this, if he has been costive, a laxative clyster may be given. He
ought then to take laudanum. The best way of administering it is in a
clyster. Sixty or seventy drops of liquid laudanum may be given in a
clyster of warm water. This is much more certain than laudanum given by
the mouth, which is often vomited, and in some cases increases the pain
and spasms in the stomach.

If the pain and cramps return with great violence, after the effects of
the anodyne clyster are over, another, with an equal or a larger
quantity of opium, may be given; and every four or five hours a bolus,
with ten or twelve grains of musk, and half a drachm of the Venice
treacle.

In the mean time, the stomach ought to be fomented with cloths dipped in
warm water, or bladders filled with warm milk and water should be
constantly applied to it. I have often seen these produce the most happy
effects. The anodyne balsam may also be rubbed on the part affected; and
an anti-hysteric plaster worn upon it for some time after the cramps are
removed, to prevent their return.

In very violent and lasting pains of the stomach, some blood ought to be
let, unless the weakness of the patient forbids it. When the pain or
cramps proceed from a suppression of the _menses_, bleeding is of use.
If they be owing to the gout, recourse must be had to spirits, or some
of the warm cordial waters. Blistering plasters ought likewise in this
case to be applied to the ancles. I have often seen violent cramps and
pains of the stomach removed by covering it with a large plaster of
Venice treacle.


                           OF THE NIGHT-MARE.

In this disease the patient, in time of sleep, imagines he feels an
uncommon oppression or weight about his breast or stomach, which he can
by no means shake off. He groans, and sometimes cries out, though oftner
he attempts to speak in vain. Sometimes he imagines himself engaged with
an enemy, and in danger of being killed, attempts to run away, but finds
he cannot. Sometimes he fancies himself in a house that is on fire, or
that he is in danger of being drowned in a river. He often thinks he is
falling over a precipice, and the dread of being dashed to pieces
suddenly awakes him.

This disorder has been supposed to proceed from too much blood; from a
stagnation of blood in the brain, lungs, &c. But it is rather a nervous
affection, and arises chiefly from indigestion. Hence we find that
persons of weak nerves, who lead a sedentary life, and live full, are
most commonly afflicted with the night-mare. Nothing tends more to
produce it than heavy suppers, especially when eaten late, or the
patient goes to bed soon after. Wind is likewise a very frequent cause
of this disease; for which reason those who are afflicted with it ought
to avoid all flatulent food. Deep thought, anxiety, or any thing that
oppresses the mind, ought also to be avoided.

As persons afflicted with the night-mare generally moan, or make some
noise in the fit, they should be waked, or spoken to by such as hear
them, as the uneasiness generally goes off as soon as the patient is
awake. Dr. Whytt says, he generally found a dram of brandy, taken at
bed-time, prevent this disease. That however is a bad custom, and in
time loses its effect. We would rather have the patient depend upon the
use of food of easy digestion, cheerfulness, exercise through the day,
and a light supper taken early, than to accustom himself to drams. A
glass of peppermint-water will often promote digestion as much as a
glass of brandy, and is much safer. After a person of weak digestion,
however, has eaten flatulent food, a dram may be necessary; in this case
we would recommend it as the most proper medicine.

Persons who are young, and full of blood, if troubled with the
night-mare, ought to take a purge frequently, and use a spare diet.


                             OF SWOONINGS.

People of weak nerves or delicate constitutions are liable to swoonings
or fainting fits. These indeed are seldom dangerous when duly attended
to; but when wholly neglected, or improperly treated, they often prove
hurtful, and sometimes fatal.

The general causes of swoonings are, sudden transition from cold to
heat; breathing air that is deprived of its proper spring or elasticity;
great fatigue; excessive weakness; loss of blood; long fasting; fear,
grief, and other violent passions or affections of the mind.

It is well known, that persons who have been long exposed to cold, often
faint or fall into a swoon, upon coming into the house, especially if
they drink hot liquor, or sit near a large fire. This might easily be
prevented by people taking care not to go into a warm room immediately
after they have been exposed to the cold air, to approach the fire
gradually, and not to eat or drink any thing hot, till the body has been
gradually brought into a warm temperature.

When any one, in consequence of neglecting these precautions, falls into
a swoon, he ought immediately to be removed to a cooler apartment, to
have ligatures applied above his knees and elbows, and to have his hands
and face sprinkled with vinegar or cold water. He should likewise be
made to smell to vinegar, and should have a spoonful or two of water, if
he can swallow, with about a third part of vinegar mixed with it, poured
into his mouth. If these should not remove the complaint, it will be
necessary to bleed the patient, and afterwards to give him a clyster.

As air that is breathed frequently loses its elasticity or spring, it is
no wonder if persons who respire in it often fall into a swoon or
fainting fit. They are in this case deprived of the very principle of
life. Hence it is that fainting fits are so frequent in all crowded
assemblies, especially in hot seasons. Such fits however must be
considered as a kind of temporary death; and, to the weak and delicate,
they sometimes prove fatal. They ought therefore with the utmost care to
be guarded against. The method of doing this is obvious. Let
assembly-rooms, and all other places of public resort, be large and well
ventilated; and let the weak and delicate avoid such places,
particularly in warm seasons.

A person who faints, in such a situation, ought immediately to be
carried into the open air; his temples should be rubbed with strong
vinegar or brandy, and volatile spirits of salts held to his nose. He
should be laid upon his back with his head low, and have a little wine,
or some other cordial, as soon as he is able to swallow it, poured into
his mouth. If the person has been subject to hysteric fits, castor or
asafœtida should be applied to the nose, or burnt feathers, horn, or
leather, &c.

When fainting fits proceed from mere weakness or exhaustion, which is
often the case after great fatigue, long fasting, loss of blood, or the
like, the patient must be supported with generous cordials, as jellies,
wines, spirituous liquors, &c. These however must be given at first in
very small quantities, and increased gradually as the patient is able to
bear them. He ought to be allowed to lie quite still and easy upon his
back, with his head low, and should have fresh air admitted into his
chamber. His food should consist of nourishing broths, sago-gruel with
wine, new milk, and other things of a light and cordial nature. These
things are to be given out of the fit. All that can be done in the fit
is, to let him smell to a bottle of Hungary-water, _eau de luce_, or
spirits of hartshorn, and to rub his temples with warm brandy, or to lay
a compress dipped in it to the pit of the stomach.

In fainting fits that proceed from fear, grief, or other violent
passions or affections of the mind, the patient must be very cautiously
managed. He should be suffered to remain at rest, and only made to smell
to some vinegar. After he is come to himself he may drink freely of warm
lemonade, or balm-tea, with some orange or lemon-peel in it. It will
likewise be proper, if the fainting fits have been long and severe, to
clean the bowels by throwing in an emollient clyster.

It is common in fainting fits, from whatever cause they proceed, to
bleed the patient. This practice may be very proper in strong persons of
a full habit; but in those who are weak and delicate, or subject to
nervous disorders, it is dangerous. The proper method with such people
is, to expose them to the free air, and to use cordial and stimulating
medicines, as volatile salts, Hungary-water, spirits of lavender,
tincture of castor, and the like.


                       OF FLATULENCIES, OR WIND.

All nervous patients, without exception, are afflicted with wind or
flatulencies in the stomach and bowels, which arise chiefly from the
want of tone or vigour in these organs. Crude flatulent aliment, as
green peas, beans, coleworts, cabbages, and such like, may increase this
complaint; but strong and healthy people are seldom troubled with wind,
unless they either overload their stomachs, or drink liquors that are in
a fermenting state, and consequently full of elastic air. While
therefore the matter of flatulence proceeds from our aliments, the cause
which makes air separate from them in such quantity as to occasion
complaints, is almost always a fault of the bowels themselves, which are
too weak either to prevent the production of elastic air, or to expel it
after it is produced.

To relieve this complaint, such medicines ought to be used as have a
tendency to expel wind, and by strengthening the alimentary canal, to
prevent its being produced there[149].

The list of medicines for expelling wind is very numerous; they often
however disappoint the expectations of both the physician and his
patient. The most celebrated among the class of carminatives are juniper
berries; the roots of ginger and zedoary; the seeds of anise, caraway,
and coriander; gum asafœtida and opium; the warm waters, tinctures, and
spirits, as the aromatic water, the tincture of wood-soot, the volatile
aromatic spirit, æther, &c.

Dr. Whytt says, he found no medicines more efficacious in expelling wind
than æther and laudanum. He generally gave the laudanum in a mixture
with peppermint-water and tincture of castor, or sweet spirits of nitre.
Sometimes, in place of this, he gave opium in pills with asafœtida. He
observes that the good effects of opiates are equally conspicuous,
whether the flatulence be contained in the stomach or intestines;
whereas those warm medicines, commonly called _carminatives_, do not
often give immediate relief, except when the wind is in the stomach.

With regard to æther, the Doctor says, he has often seen very good
effects from it in flatulent complaints, where other medicines failed.
The dose is a tea-spoonful mixed with two table-spoonfuls of water[150].
In gouty cases he observes, that æther, a glass of French brandy, or of
the aromatic water, or ginger, either taken in substance or infused in
boiling water, are among the best medicines for expelling wind.

When the case of flatulent patients is such as makes it improper to give
them warm medicines inwardly, the Doctor recommends external
applications, which are sometimes of advantage. Equal parts of the
anti-hysteric and stomach plaster may be spread upon a piece of soft
leather, of such size as to cover the greater part of the belly. This
should be kept on for a considerable time, provided the patient be able
to bear it; if it should give great uneasiness, it may be taken off, and
the following liniment used in its stead:

Take of Bates’s anodyne balsam an ounce; of the expressed oil of mace
half an ounce; oil of mint two drachms. Let these ingredients be mixed
together, and about a table-spoonful well rubbed on the parts at
bed-time.

For strengthening the stomach and bowels, and consequently for lessening
the production of flatulence, the Doctor recommends the Peruvian bark,
bitters, chalybeates, and exercise. In flatulent cases, he thinks some
nutmeg or ginger should be added to the tincture of the bark and
bitters, and that the aromatic powder should be joined with the filings
of iron.

When windy complaints are attended with costiveness, which is often the
case, few things will be found to answer better than four or five of the
following pills taken every night at bed-time:

Take of asafœtida two drachms; succotorine aloes, salt of iron, and
powdered ginger, of each one drachm; as much of the _elixir
proprietatis_ as will be sufficient to form them into pills.

On the other hand, when the body is too open, twelve or fifteen grains
of rhubarb, with half a drachm or two scruples of the Japonic
confection, given every other evening, will have very good effects.

In those flatulent complaints which come on about the time the _menses_
cease, repeated small bleedings often give more relief than any other
remedy.

With regard to diet, the Doctor observes, that tea, and likewise all
flatulent aliments, are to be avoided; and that for drink, water with a
little brandy or rum is not only preferable to malt liquor, but in most
cases also to wine.

As Dr. Whytt has paid great attention to this subject, and as his
sentiments upon it in a great measure agree with mine, I have taken the
liberty to adopt them; and shall only add to his observations, that
exercise is in my opinion superior to all medicine, both for preventing
the production and likewise for expelling of flatulencies. These
effects, however, are not to be expected from sauntering about, or
lolling in a carriage; but from labour, or such active amusements as
give exercise to every part of the body.


                            OF LOW SPIRITS.

All who have weak nerves are subject to low spirits in a greater or less
degree. Generous diet, the cold bath, exercise, and amusements, are the
most likely means to remove this complaint. It is greatly increased by
solitude and indulging gloomy ideas; but may often be relieved by
cheerful company and sprightly amusements.

When low spirits are owing to a weak relaxed state of the stomach and
bowels, an infusion of the Peruvian bark with cinnamon or nutmeg will be
proper. Steel joined with aromatics may likewise in this case be used
with advantage; but riding, and a proper diet, are most to be depended
on.

When they arise from a foulness of the stomach and intestines, or
obstruction in the hypochondriac viscera, aloetic purges will be proper.
I have sometimes known the Harrowgate sulphur-water of service in this
case.

When low spirits proceed from a suppression of the menstrual or of the
hæmorrhoidal flux, these evacuations may either be restored, or some
others substituted in their place, as issues, setons, or the like. Dr.
Whytt observes, that nothing has such sudden good effects in this case
as bleeding.

When low spirits have been brought on by long-continued grief, anxiety,
or other distress of mind, agreeable company, variety of amusements, and
change of place, especially travelling into foreign countries, will
afford the most certain relief.

Persons afflicted with low spirits should avoid all kinds of excess,
especially of venery and strong liquors. The moderate use of wine and
other strong liquors is by no means hurtful; but when taken to excess
they weaken the stomach, vitiate the humours, and depress the spirits.
This caution is the more necessary, as the unfortunate and melancholy
often fly to strong liquors for relief, by which means they never fail
to precipitate their own destruction.


                        OF HYSTERIC AFFECTIONS.

These likewise belong to the numerous tribe of nervous diseases, which
may be justly reckoned the reproach of medicine. Women of a delicate
habit, whose stomach and intestines are relaxed, and whose nervous
system is extremely sensible, are most subject to hysteric complaints.
In such persons a hysteric fit, as it is called, may be brought on by an
irritation of the nerves of the stomach or intestines, by wind, acrid
humour, or the like. A sudden suppression of the _menses_ often gives
rise to hysteric fits. They may likewise be excited by violent passions
or affections of the mind, as fear, grief, anger, or great
disappointments.

Sometimes the hysteric fit resembles a swoon or fainting fit, during
which the patient lies as in a sleep, only the breathing is so low as
scarce to be perceived. At other times the patient is affected with
catchings and strong convulsions. The symptoms which precede hysteric
fits are likewise various in different persons. Sometimes the fits come
on with coldness of the extremities, yawning and stretching, lowness of
spirits, oppression and anxiety. At other times the approach of the fit
is foretold by a feeling, as if there were a ball at the lower part of
the belly, which gradually rises towards the stomach, where it occasions
inflation, sickness, and sometimes vomiting; afterwards it rises into
the gullet, and occasions a degree of suffocation, to which quick
breathing, palpitation of the heart, giddiness of the head, dimness of
the sight, loss of hearing, with convulsive motions of the extremities
and other parts of the body, succeed. The hysteric paroxysm is often
introduced by an immoderate fit of laughter, and sometimes it goes off
by crying. Indeed there is not much difference between the laughing and
crying of an highly hysteric lady.

Our aim in the treatment of this disease must be to shorten the fit or
paroxysm when present, and to prevent its return. The longer the fits
continue, and the more frequently they return, the disease becomes the
more obstinate. Their strength is increased by habit, and they induce so
great a relaxation of the system, that it is with difficulty removed.

It is customary, during the hysteric fit or paroxysm, to bleed the
patient. In strong persons of a plethoric habit, and where the pulse is
full, this may be proper; but in weak and delicate constitutions, or
where the disease has been of long standing, or arises from inanition,
it is not safe. The best course in such cases is to rouse the patient by
strong smells, as burnt feathers, asafœtida, or spirits of hartshorn,
held to the nose. Hot bricks may also be applied to the soles of the
feet, and the legs, arms, and belly may be strongly rubbed with a warm
cloth. But the best application is to put the feet and legs into warm
water. This is peculiarly proper when the fits precede the flow of the
menses. In case of costiveness, a laxative clyster with asafœtida will
be proper; and as soon as the patient can swallow, two table-spoonfuls
of a solution of asafœtida, or of some cordial julep, may be given[151].

The radical cure of this disorder will be best attempted at a time when
the patient is most free from the fits. It will be greatly promoted by a
proper attention to diet. A milk and vegetable diet, when duly persisted
in, will often perform a cure. If however the patient has been
accustomed to a more generous diet, it will not be safe to leave it off
all at once, but by degrees. The most proper drink is water with a small
quantity of spirits. A cool dry air is the best. Cold bathing and every
thing that braces the nerves, and invigorates the system, is beneficial;
but lying too long in bed, or whatever relaxes the body, is hurtful. It
is of the greatest importance to have the mind kept constantly easy and
cheerful, and, if possible, to have it always engaged in some agreeable
and interesting pursuit.

The proper medicines are those which strengthen the alimentary canal and
the whole nervous system, as the preparations of iron, the Peruvian
bark, and other bitters. Twenty drops of the elixir of vitriol, in a cup
of the infusion of the bark, may be taken twice or thrice a day. The
bark and iron may likewise be taken in substance, provided the stomach
can bear them; but they are generally given in too small doses to have
any effect. The chalybeate waters generally prove beneficial in this
disorder.

If the stomach is loaded with phlegm, vomits will be of use; but they
should not be too strong, nor frequently repeated, as they tend to relax
and weaken the stomach. If there be a tendency to costiveness, it must
be removed either by diet, or by taking an opening pill as often as it
shall be found necessary.

To lessen the irritability of the system, antispasmodic medicines will
be of use. The best antispasmodic medicines are musk, opium, and castor.
When opium disagrees with the stomach, it may either be applied
externally, or given in clysters. It is often successful in removing
those periodical head-achs to which hysteric and hypochondriac patients
are subject. Castor has in some cases been found to procure sleep where
opium failed; for which reason Dr. Whytt advises, that they should be
joined together. He likewise recommends the anti-hysteric plaster to be
applied to the _abdomen_[152].

Hysteric women are often afflicted with cramps in various parts of the
body, which are most apt to seize them in bed, or when asleep. The most
efficacious medicines in this case are opium, blistering-plasters, and
warm bathing or fomentations. When the cramp or spasm is very violent,
opium is the remedy most to be depended on. In milder cases, immersing
the feet and legs in warm water, or applying a blistering-plaster to the
part affected, will often be sufficient to remove the complaint. In
patients whose nerves are uncommonly delicate and sensible, it will be
better to omit the blistering-plaster, and to attempt the cure by
opiates, musk, camphire, and the warm bath.

Cramps are often prevented or cured by compression. Thus cramps in the
legs are prevented, and sometimes removed, by tight bandages; and when
convulsions arise from a flatulent distention of the intestines, or from
spasms beginning in them, they may be often lessened or cured by making
a pretty strong compression upon the _abdomen_ by means of a broad belt.
A roll of brimstone held in the hand is frequently used as a remedy for
cramps. Though this seems to owe its effect chiefly to imagination; yet,
as it sometimes succeeds, it merits a trial[153]. When spasms or
convulsive motions arise from sharp humours in the stomach and
intestines, no lasting relief can be procured till these are either
corrected or expelled. The Peruvian bark has sometimes cured periodic
convulsions after other medicines had failed.


                      OF HYPOCHONDRIAC AFFECTIONS.

This disease generally attacks the indolent, the luxurious, the
unfortunate, and the studious. It becomes daily more common in this
country, owing, no doubt, to the increase of luxury and sedentary
employments. It has so near a resemblance to the immediately preceding,
that many authors consider them as the same disease, and treat them
accordingly. They require however a very different regimen; and the
symptoms of the latter, though less violent, are more permanent than
those of the former.

Men of a melancholy temperament, whose minds are capable of great
attention, and whose passions are not easily moved, are, in the advanced
periods of life, most liable to this disease. It is usually brought on
by long and serious attention to abstruse subjects, grief, the
suppression of customary evacuations, excess of venery, the repulsion of
cutaneous eruptions, long-continued evacuations, obstructions in some of
the viscera, as the liver, spleen, &c.

Hypochondriac persons ought never to fast long, and their food should be
solid and nourishing. All acescent and windy vegetables are to be
avoided. Flesh-meats agree best with them, and their drink should be old
claret, or good madeira. Should these disagree with the stomach, water
with a little brandy or rum in it may be drank.

Cheerfulness and serenity of mind are by all means to be cultivated.
Exercise of every kind is useful. The cold bath is likewise beneficial;
and, where it does not agree with the patient, frictions with the
flesh-brush or a coarse cloth may be tried. If the patient has it in his
power, he ought to travel either by sea or land. A voyage or a long
journey, especially towards a warmer climate, will be of more service
than any medicine.

The general intentions of cure, in this disease, are to strengthen the
alimentary canal, and to promote the secretions. These intentions will
be best answered by the different preparations of iron and the Peruvian
bark, which, after proper evacuations, may be taken in the same manner
as directed in the preceding disease.

If the patient be costive, it will be necessary to make use of some
gentle opening medicine, as pills composed of equal parts of aloes,
rhubarb, and asafœtida, with as much of the elixir proprietatis as is
necessary to form the ingredients into pills. Two, three, or four of
these may be taken as often as it shall be found needful, to keep the
body gently open. Such as cannot bear the asafœtida may substitute
Spanish soap in its place.

Though a cheerful glass may have good effects in this disease, yet all
manner of excess is hurtful. Intense study, and every thing that
depresses the spirits, are likewise pernicious.

Though the general symptoms and treatment of nervous disorders were
pointed out in the beginning of this chapter; yet, for the benefit of
the unhappy persons afflicted with those obstinate and complicated
maladies, I have treated several of their capital symptoms under
distinct or separate heads. These however are not to be considered as
different diseases, but as various modifications of the same disease.
They all arise from the same general causes, and require nearly the same
method of treatment. There are many other symptoms that merit particular
attention, which the nature of my plan will not permit me to treat of at
full length. I shall therefore omit them altogether, and conclude this
chapter with a few general remarks on the most obvious means of
preventing or avoiding nervous disorders.

In all persons afflicted with nervous disorders, there is a great
delicacy and sensibility of the whole nervous system, and an uncommon
degree of weakness of the organs of digestion. These may be either
natural or acquired. When owing to a defect in the constitution, they
are hardly to be removed; but may be mitigated by proper care. When
induced by diseases, as long or repeated fevers, profuse hæmorrhages, or
the like, they prove also very obstinate, and will yield only to a
course of regimen calculated to restore and invigorate the habit.

But nervous affections arise more frequently from causes, which it is in
a great measure in our own power to avoid, than from diseases, or an
original fault in the constitution, &c. Excessive grief, intense study,
improper diet, and neglect of exercise, are the great sources of this
extensive class of diseases.

It has been already observed, that grief indulged destroys the appetite
and digestion, depresses the spirits, and induces an universal
relaxation and debility of the whole system. Instances of this are daily
to be seen. The loss of a near relation, or any other misfortune in
life, is often sufficient to occasion the most complicated series of
nervous symptoms. Such misfortunes indeed are not to be avoided, but
surely their effects, by a vigorous and proper exertion of the mind,
might be rendered less hurtful. For directions in this matter we must
refer the reader to the article GRIEF, in the chapter on the passions.

The effects of intense study are pretty similar to those occasioned by
grief. It preys upon the animal spirits, and destroys the appetite and
digestion. To prevent these effects, studious persons ought, according
to the Poet, _to toy with their books_[154]. They should never study too
long at a time; nor attend long to one particular subject, especially if
it be of a serious nature. They ought likewise to be attentive to their
posture, and should take care frequently to unbend their minds by music,
diversions, or going into agreeable company.

With regard to diet, I shall only observe, that nervous diseases may be
induced either by excess or inanition. Both of these extremes hurt
indigestion, and vitiate the humours. When Nature is oppressed with
fresh loads of food, before she has had time to digest and assimilate
the former meal, her powers are weakened, and the vessels are filled
with crude humours. On the other hand, when the food is not sufficiently
nourishing, or is taken too seldom, the bowels are inflated with wind,
and the humours, for want of regular fresh supplies of wholesome chyle,
are vitiated. These extremes are therefore with equal care to be
avoided. They both tend to induce a relaxation, and debility of the
nervous system, with all its dreadful train of consequences.

But the most general cause of nervous disorders is _indolence_. The
active and laborious are seldom troubled with them. They are reserved
for the children of ease and affluence, who generally feel their keenest
force. All we shall say to such persons is, that the means of prevention
and cure are both in their own power. If the constitution of human
nature be such, that man must either labour or suffer diseases, surely
no individual has any right to expect an exemption from the general
rule.

Those however who are willing to take exercise, but whose occupations
confine them to the house, and perhaps to an unfavourable posture,
really deserve our pity. We have in a former part of the book
endeavoured to lay down rules for their conduct; and shall only add,
that where these cannot be complied with, their place may, in some
measure, be supplied by the use of bracing and strengthening medicines,
as the Peruvian bark, with other bitters; the preparations of steel; the
elixir of vitriol, &c.




                              CHAP. XLIV.
                        DISORDERS OF THE SENSES.


We do not mean to treat of the nature of our sensations, or to give a
minute description of the various organs by which they are performed;
but to point out some of the diseases to which these organs are most
liable, and to shew how they may be prevented or remedied.


                              OF THE EYE.

No organ of the body is subject to more diseases than the eye; nor is
there any one of which the diseases are more difficult to cure. Though
more ignorant persons pretend to cure these than any other class of
diseases; yet a very superficial acquaintance with the structure of the
eye, and the nature of vision, will be sufficient to convince any one of
the danger of trusting to them. These diseases often exceed the skill of
the most learned physician; hence we may easily infer the danger of
trusting them to ignorant quacks, who, without all peradventure, put out
more eyes than they cure. But, though the diseases of the eye can seldom
be cured, they might often, by due care, be prevented; and, even where
the sight is totally lost, many things might be done, which are
generally neglected, to render the unhappy person both more useful to
himself and to society[155].

The eyes are hurt by viewing bright or luminous objects; keeping the
head too long in a hanging posture; violent head-achs; excessive venery;
the long use of bitters; the effluvia from acrid or volatile substances;
various diseases; as the small-pox, measles, &c. but, above all, from
night-watching, and candle-light studies. Long fasting is likewise
hurtful to the eyes, and frequent heats and colds are no less
pernicious. The eyes are often hurt by the stoppage of customary
evacuations; as morning sweats; sweating of the feet; the menses in
women; and the bleeding piles in men. All kinds of excess are likewise
hurtful to the sight, particularly the immoderate use of ardent spirits
and other strong liquors.

In all diseases of the eyes, especially those attended with
inflammation, the cool regimen ought to be observed. The patient must
abstain from all spirituous liquors. The smoke of tobacco, smoky rooms,
the vapours of onions and garlic, and all vivid lights and glaring
colours, are carefully to be avoided. The drink may be water, whey, or
small beer; and the aliment must be light and of easy digestion.

For preventing disorders of the eyes, issues and setons are of prime
use. Every person, whose eyes are tender, ought to have one or more of
these in some part of the body. It will likewise be of use to keep the
body gently open, and either to bleed or purge every spring and fall.
All excess and night studies are to be avoided. Such as do not chuse a
seton or an issue, will find benefit from wearing a small Burgundy-pitch
plaster between their shoulders.

A _gutta serena_, or _amaurosis_, is an abolition of the sight without
any apparent cause or fault in the eyes. When it is owing to a decay or
wasting of the optic nerve, it does not admit of a cure; but when it
proceeds from a compression of the nerves by redundant humours, these
may in some measure be drained off, and the patient relieved. For this
purpose, the body must be kept open with the laxative mercurial pills.
If the patient be young and of a sanguine habit, he may be bled.
Cupping, with scarifications on the back part of the head, will likewise
be of use. A running at the nose may be promoted by volatile salts,
stimulating powders, &c. But the most likely means for relieving the
patient are issues or blisters kept open for a long time on the back
part of the head, behind the ears, or on the neck. I have known these
restore sight, even after it had been for a considerable time lost.

Should these fail, recourse must be had to a mercurial salivation; or
what will perhaps answer the purpose better, twelve grains of the
corrosive sublimate of mercury may be dissolved in an English pint and a
half of brandy, and a table-spoonful of it taken twice a-day, drinking
half a pint of the decoction of sarsaparilla after it.

A _cataract_ is an obstruction of the pupil, by the interposition of
some opaque substance which either diminishes or totally extinguishes
the sight. It is generally an opacity of the crystalline humour. In a
recent or beginning cataract, the same medicines are to be used as in
the gutta serena; and they will sometimes succeed. But when this does
not happen, and the cataract becomes firm, it must be couched, or rather
extracted. I have resolved a recent cataract by giving the patient
frequent purges with calomel, keeping a poultice of fresh hemlock
constantly upon the eye, and a perpetual blister on the neck.

The _myopia_, or _short sightedness_, and the _presbyopia_, or _seeing
only at too great a distance_, are disorders which depend on the
original structure or figure of the eye, therefore admit of no cure. The
inconveniencies arising from them may however be, in some measure,
remedied by the help of proper glasses. The former requires the aid of a
concave, and the latter of a convex glass.

A _strabismus_, or _squinting_, depends upon an irregular contraction of
the muscles of the eye from a spasm, palsy, epilepsy, or an ill habit.
Children often contract this disorder by having their eyes unequally
exposed to the light. They may likewise acquire it by imitation from a
squinting nurse or play-fellow, &c. As this disorder can hardly be
cured, parents ought to be careful to prevent it. Almost the only thing
which can be done for it is, to contrive a mask for the child to wear,
which will only permit him to see in a straight direction.

_Spots_ or _specks_ on the eyes are generally the effect of
inflammation, and often appear after the small-pox, the measles, or
violent ophthalmias. They are very difficult to cure, and often occasion
total blindness. If the specks are soft and thin, they may sometimes be
taken off by gentle caustics and discutients; as vitriol, the juice of
celandine, &c. When these do not succeed, a surgical operation may be
tried: the success of this however is always very doubtful.

The _blood-shot_ eye may be occasioned by a stroke, a fall, retching,
vomiting, violent coughing, &c. I have frequently known it happen to
children in the hooping-cough. It appears at first like a bit of
scarlet, and is afterwards of a livid or blackish colour. This disorder
generally goes off without medicine. Should it prove obstinate, the
patient may be bled, and have his eyes fomented with a decoction of
comphrey roots and elder flowers. A soft poultice may be applied to the
eyes; and the body should be kept open by gentle purgatives.

The _watery_, or _weeping eye_, is generally occasioned by a relaxation
or weakness of the glandular parts of that organ. These may be braced
and strengthened by bathing the eye with brandy and water,
Hungary-water, rose-water with white vitriol dissolved in it, &c.
Medicines which make a revulsion are likewise proper; as mild
purgatives, perpetual blisters on the neck, bathing the feet frequently
in lukewarm water, &c.

When this disease proceeds from an obstruction of the lachrymal duct, or
natural passage of the tears, it is called a _fistula lachrymalis_, and
can only be cured by a surgical operation.


                              OF THE EAR.

The functions of the ear may be injured by wounds, ulcers, or any thing
that hurts its fabric. The hearing may likewise be hurt by excessive
noise; violent colds in the head; fevers; hard wax, or other substances
sticking in the cavity of the ear; too great a degree of moisture or
dryness of the ear. Deafness is very often the effect of old age, and is
incident to most people in the decline of life. Sometimes it is owing to
an original fault in the structure or formation of the ear itself. When
this is the case, it admits of no cure; and the unhappy person not only
continues deaf, but generally likewise dumb, for life[156].

When deafness is the effect of wounds or ulcers of the ears, or of old
age, it is not easily removed. When it proceeds from cold of the head,
the patient must be careful to keep his head warm, especially in the
night; he should likewise take some gentle purges, and keep his feet
warm, and bathe them frequently in lukewarm water at bed-time. When
deafness is the effect of a fever, it generally goes off after the
patient recovers. If it proceeds from dry wax sticking in the ears, it
may be softened by dropping oil into them; afterwards they must be
syringed with warm milk and water.

If deafness proceeds from dryness of the ears, which may be known by
looking into them, half an ounce of the oil of sweet almonds, and the
same quantity of liquid apodeldoch, or tincture of asafœtida, may be
mixed together, and a few drops of it put into the ear every night at
bed-time, stopping them afterwards with a little wool or cotton. Some,
instead of oil, put a small slice of the fat of bacon into each ear,
which is said to answer the purpose very well. When the ears abound with
moisture, it may be drained off by an issue or seton, which should be
made as near the affected parts as possible.

Some, for the cure of deafness, recommend the gall of an eel mixed with
spirit of wine, to be dropped into the ear; others, equal parts of
Hungary-water and spirit of lavender. Etmuller extols amber and musk;
and Brookes says, he has often known hardness of hearing cured by
putting a grain or two of musk into the ear with cottonwool. But these
and other applications must be varied according to the cause of the
disorder[157].

Though such applications may sometimes be of service, yet they much
oftner fail, and frequently they do hurt. Neither the eyes nor ears
ought to be tampered with; they are tender organs, and require a very
delicate touch. For this reason, what we would chiefly recommend in
deafness, is, to keep the head warm. From whatever cause the disorder
proceeds, this is always proper; and I have known more benefit from it
alone, in the most obstinate cases of deafness, than from all the
medicines I ever used.


                        OF THE TASTE AND SMELL.

Though these senses are not of so great importance to man in a state of
society, as the sight and hearing; yet, as the loss of them is attended
with some inconveniency, they deserve our notice. They are seldom to be
restored when lost; which ought to make us very attentive to their
preservation, by carefully avoiding whatever may in the least prove
injurious to them. As there is a very great affinity between the organs
of tasting and smelling, whatever hurts the one generally affects the
other.

Luxury is highly injurious to these organs. When the nose and palate are
frequently stimulated by fragrant and poignant dishes, they soon lose
the power of distinguishing tastes and odours with any degree of nicety.
Man, in a state of nature, may perhaps have these faculties as acute as
any other animal.

The sense of smelling may be diminished or destroyed by diseases; as,
the moisture, dryness, inflammation or suppuration of that membrane
which lines the inside of the nose, commonly called the olfactory
membrane; the compression of the nerves which supply this membrane, or
some fault in the brain itself at their origin. A defect, or too great a
degree of solidity, of the small spungy bones of the upper jaw, the
caverns of the forehead, &c. may likewise impair the sense of smelling.
It may also be injured by a collection of fœtid matter in those caverns,
which keeps constantly exhaling from them. Few things are more hurtful
to the sense of smelling than taking great quantities of snuff.

When the nose abounds with moisture, after gentle evacuations, such
things as tend to take off irritation, and coagulate the thin sharp
serum, may be applied; as the oil of anise mixed with fine flour;
camphire dissolved in oil of almonds, &c. The vapours of amber,
frankincense, gum-mastic, and benjamin, may likewise be received into
the nose and mouth.

For moistening the mucus when it is too dry, some recommend snuff made
of the leaves of marjoram, mixed with the oil of amber, marjoram and
aniseed; or a sternutatory of calcined white vitriol; twelve grains of
which may be mixed with two ounces of marjoram-water, and filtrated. The
steam or vapour of vinegar upon hot iron received up the nostrils is
likewise of use for softening the mucus, opening obstructions, &c.

If there is an ulcer in the nose, it ought to be dressed with some
emollient ointment, to which, if the pain be very great, a little
laudanum may be added. If it be a venereal ulcer, it is not to be cured
without mercury. In that case, the solution of the corrosive sublimate
in brandy may be taken, as directed in the gutta serena. The ulcer ought
likewise to be washed with it; and the fumes of cinnabar may be received
up the nostrils.

If there be reason to suspect that the nerves which supply the organs of
smelling are inert, or want stimulating, volatile salts, strong snuffs,
and other things which occasion sneezing, may be applied to the nose.
The forehead may likewise be anointed with balsam of Peru, to which may
be added a little of the oil of amber.

The _taste_ may be diminished by crusts, filth, mucus, aphthæ,
pellicles, warts, &c. covering the tongue: it may be depraved by a fault
of the saliva, which, being discharged into the mouth, gives the same
sensation as if the food which the person takes had really a bad taste;
or it may be entirely destroyed by injuries done to the nerves of the
tongue and palate. Few things prove more hurtful either to the sense of
tasting or smelling than obstinate colds, especially those which affect
the head.

When the taste is diminished by filth, mucus, &c. the tongue ought to be
scraped and frequently washed with a mixture of water, vinegar, and
honey, or some other detergent. When the saliva is vitiated, which
seldom happens unless in fevers or other diseases, the curing of the
disorder is the cure of this symptom. To relieve it however in the mean
time, the following things may be of use; if there be a bitter taste, it
may be taken away by vomits, purges, and other things which evacuate
bile. What is called a nidorous taste, arising from putrid humours, is
corrected by the juice of citrons, oranges, and other acids. A salt
taste is cured by plentiful dilution with watery liquors. An acid taste
is destroyed by absorbents, and alkaline salts, as powder of
oyster-shells, salt of wormwood, &c.

When the sensibility of the nerves which supply the organs of taste is
diminished, the chewing of horse-radish, or other stimulating
substances, will help to recover it.


                             OF THE TOUCH.

The sense of touching may be hurt by any thing that obstructs the
nervous influence, or prevents its being regularly conveyed to the
organs of touching; as pressure, extreme cold, &c. It may likewise be
hurt by too great a degree of sensibility, when the nerve is not
sufficiently covered by the cuticle or scarf-skin, or where there is too
great a tension of it, or it is too delicate. Whatever disorders the
functions of the brain and nerves, hurts the sense of touching. Hence it
appears to proceed from the same general causes as palsy and apoplexy,
and requires nearly the same method of treatment.

In a _stupor_, or defect of touching, which arises from an obstruction
of the cutaneous nerves, the patient must first be purged; afterwards
such medicines as excite the action of the nerves, or stimulate the
system, may be used. For this purpose, the spirit of hartshorn, _sal
volatile oleosum_, horse-radish, &c. may be taken inwardly; the
disordered parts, at the same time, may be frequently rubbed with fresh
nettles or spirit of _sal ammoniac_. Blistering-plasters and sinapisms
applied to the parts will likewise be of use, as also warm bathing,
especially in the natural hot baths.




                               CHAP. XLV.
                       OF A SCIRRHUS AND CANCER.


A scirrhus is a hard indolent tumour seated in some of the glands; as
the breasts, the armpits, &c. If the tumour becomes large, unequal, of a
livid, blackish, or leaden colour, and is attended with violent pain, it
gets the name of an _occult cancer_. When the skin is broken, and a
_sanies_ or ichorous matter of an abominably fœtid smell is discharged
from the sore, it is called an open or ulcerated cancer. Persons after
the age of forty-five, particularly women, and those who lead an
indolent sedentary life, are most subject to this disease.

CAUSES.——This disease is often owing to suppressed evacuations; hence it
proves so frequently fatal to women of a gross habit, particularly old
maids and widows, about the time when the menstrual flux ceases. It may
likewise be occasioned by excessive fear, grief, anger, religious
melancholy, or any of the depressing passions. Hence the unfortunate,
the choleric, and those persons who devote themselves to a religious
life in convents or monasteries, are often afflicted with it. It may
also be occasioned by the long-continued use of food that is too hard of
digestion, or of an acrid nature; by barrenness; celibacy; indolence;
cold; blows; friction; pressure; or the like. Women often suffer from
the last of these by means of their stays, which squeeze and compress
their breast so as to occasion great mischief. Sometimes the disease is
owing to an hereditary disposition.

SYMPTOMS.——This disorder seems often very trifling at the beginning. A
hard tumour about the size of a hazle-nut, or perhaps smaller, is
generally the first symptom. This will often continue for a long time
without seeming to increase, or giving the patient great uneasiness; but
if the constitution be hurt, or the tumour irritated by pressure, or
improper treatment of any kind, it begins to extend itself towards the
neighbouring parts by pushing out a kind of roots or limbs. It then gets
the name of _cancer_, from a fancied resemblance between these limbs and
the claws of a crab. The colour of the skin begins to change, which is
first red, afterwards purple, then bluish, livid, and at last black. The
patient complains of heat, with a burning, gnawing, shooting pain. The
tumour is very hard, rough, and unequal, with a protuberance, or rising,
in the middle; its size increases daily, and the neighbouring veins
become thick, knotty, and of a blackish colour.

The skin at length gives way, and a thin sharp ichor begins to flow,
which corrodes the neighbouring parts till it forms a large unsightly
ulcer. More occult cancers arise, and communicate with the neighbouring
glands. The pain and stench become intolerable; the appetite fails; the
strength is exhausted by a continual hectic fever; at last, a violent
hæmorrhage, or discharge of blood, from some part of the body, with
faintings, or convulsion fits, generally put an end to the miserable
patient’s life.

REGIMEN.——The diet ought to be light, but nourishing. All strong
liquors, and high-seasoned or salted provisions, are to be avoided. The
patient may take as much exercise as he can easily bear; and should use
every method to divert thought, and amuse his fancy. All kinds of
external injury are carefully to be guarded against, particularly of the
affected part, which ought to be defended from all pressure, and even
from the external air, by covering it with fur or soft flannel.

MEDICINE.——This is one of those diseases for which no certain remedy is
yet known. Its progress however may sometimes be retarded, and some of
its most disagreeable symptoms mitigated, by proper applications. One
misfortune attending the disease is, that the unhappy patient often
conceals it too long. Were proper means used in due time, a cancer might
often be cured; but after the disorder has arrived at a certain height,
it generally sets all medicine at defiance.

When a scirrhous tumour is first discovered, the patient ought to
observe a proper regimen, and to take twice or thrice a-week a dose of
the common purging mercurial pill. Some blood may also be let, and the
part affected may be gently rubbed twice a-day with a little of the
mercurial ointment, and kept warm with fur or flannel. The food must be
light, and an English pint of the decoction of woods or sarsaparilla may
be drank daily. I have sometimes discussed hard tumours, which had the
appearance of beginning cancers, by a course of this kind.

Should the tumour however not yield to this treatment, but, on the
contrary, become larger and harder, it will be proper to extirpate it,
either by the knife or caustic. Indeed, whenever this can be done with
safety, the sooner it is done the better. It can answer no purpose to
extirpate a cancer after the constitution is ruined, or the whole mass
of humours corrupted by it. This however is the common way, which makes
the operation so seldom succeed. Few people will submit to the
extirpation till death stares them in the face; whereas, if it were done
early, the patient’s life would not be endangered by the operation, and
it would generally prove a radical cure.

When the cancer is so situated that it cannot be cut off, or if the
patient will not submit to the operation, such medicines as will
mitigate or relieve the most urgent symptoms may be used. Dr. Home says,
that half a grain of the corrosive sublimate of mercury, dissolved in a
proper quantity of brandy, and taken night and morning, will often be of
service in cancers of the face and nose. He likewise recommends an
infusion of the _solanum_, or night-shade, in cancers of the breasts.

But the medicine most in repute at present for this disease is hemlock.
Dr. Stork, physician at Vienna, has of late recommended the extract of
this plant as very efficacious in cancers of every kind. The Doctor
says, he has given some hundred weights of it without ever hurting any
body, and often with manifest advantage. He advises the patient however
to begin with very small doses, as two or three grains, and to increase
the dose gradually till some good effect be perceived, and there to rest
without further increase. From two or three grains at first, the Doctor
says he has increased the dose to two, three, or four drachms a-day, and
finds that such doses may be continued for several weeks without any bad
consequences.

The regimen which the Doctor recommends during the use of the medicine,
is to avoid farinaceous substances not fermented, and too acrid
aromatics. He says, good wine will not be hurtful to those who are
accustomed to it, nor a moderate use of acids; and adds, that the
patient should live in a pure free air, and keep his mind as quiet and
cheerful as possible.

The Doctor does not pretend to fix the time in which a cancer may be
resolved by the use of hemlock, but says he has given it for above two
years in large doses without any apparent benefit; nevertheless the
patient has been cured by persisting in the use of it for half a year
longer. This is at least encouragement to give it a fair trial. Though
we are far from thinking the hemlock merits those extravagant encomiums
which the Doctor has bestowed upon it, yet, in a disease which has so
long baffled the boasted powers of medicine, we think it ought always to
be tried.

The powder of hemlock is by some preferred to the extract. They are both
made of the fresh leaves, and may be used nearly in the same manner. Dr.
Nicholson of Berwick says, he gradually increased the dose of the powder
from a few grains to half a drachm, and gave near four drachms of it in
the day with remarkably good effects. The hemlock may also be used
externally either as a poultice or fomentation. The sore may likewise be
kept clean by injecting daily a strong decoction of the tops and leaves
into it.

Few things contribute more to the healing of foul sordid ulcers of any
kind than keeping them thoroughly clean. This ought never to be
neglected. The best application for this purpose seems to be the carrot
poultice. The root of the common carrot may be grated, and moistened
with as much water as will bring it to the consistence of a poultice or
cataplasm. This must be applied to the sore, and renewed twice a-day. It
generally cleans the sore, eases the pain, and takes away the
disagreeable smell, which are objects of no small importance in such a
dreadful disorder[158].

Wort, or an infusion of malt, has been recommended not only as a proper
drink, but as a powerful medicine in this disease, It must be frequently
made fresh, and the patient may take it at pleasure. Two, three, or even
four English pints of it may be drank every day for a considerable time.
No benefit can be expected from any medicine in this disease, unless it
be persisted in for a long time. It is of too obstinate a nature to be
soon removed; and, when it admits of a cure at all, it must be brought
about by inducing an almost total change of the habit, which must always
be a work of time. Setons or issues in the neighbourhood of the cancer
have sometimes good effects[159].

When all other medicines fail, recourse must be had to opium, as a kind
of solace. This will not indeed cure the disease, but it will ease the
patient’s agony, and render life more tolerable while it continues.

To avoid this dreadful disorder, people ought to use wholesome food; to
take sufficient exercise in the open air; to be as easy and cheerful as
possible; and carefully to guard against all blows, bruises, and every
kind of pressure upon the breasts or other glandular parts[160].




                              CHAP. XLVI.
                              OF POISONS.


Every person ought, in some measure, to be acquainted with the nature
and cure of poisons. They are generally taken unawares, and their
effects are often so sudden and violent, as not to admit of delay, or
allow time to procure the assistance of physicians. Happily indeed no
great degree of medical knowledge is here necessary; the remedies for
most poisons being generally at hand, or easily obtained, and nothing
but common prudence needful in the application of them.

The vulgar notion, that every poison is cured by some counter-poison, as
a specific, has done much hurt. People believe they can do nothing for
the patient, unless they know the particular antidote to that kind of
poison which he has taken. Whereas the cure of all poisons taken into
the stomach, without exception, depends chiefly on discharging them as
soon as possible.

There is no case wherein the indications of cure are more obvious.
Poison is seldom long in the stomach before it occasions sickness, with
an inclination to vomit. This shews plainly what ought to be done.
Indeed common sense dictates to every one, that, if any thing has been
taken into the stomach which endangers life, it ought immediately to be
discharged. Were this duly regarded, the danger arising from poisons
might generally be avoided. The method of prevention is obvious, and the
means are in the hands of every one.

We shall not take up the reader’s time with a detail of the ridiculous
notions which have prevailed among ignorant people in different ages
with regard to poisons; neither shall we mention the boasted antidotes,
which have been recommended either for preventing or obviating their
effects; but shall content ourselves with pointing out the poisons most
common in this country, and the means of avoiding their dangerous
consequences.

Poisons either belong to the mineral, the vegetable, or the animal
kingdom.

Mineral poisons are commonly of an acrid or corrosive quality; as
arsenic, cobalt, the corrosive sublimate of mercury, &c.

Those of the vegetable kind are generally of a narcotic or stupefactive
quality; as poppy, hemlock, henbane, berries of the deadly night-shade,
&c.

Poisonous animals communicate their infection either by the bite or
sting. This poison is very different from the former, and only produces
its effects when received into the body by a wound.

MINERAL POISONS.——Arsenic is the most common of this class; and, as the
whole of them are pretty similar both in their effects and method of
cure, what is said with respect to it will be applicable to every other
species of corrosive poison.

When a person has taken arsenic, he soon perceives a burning heat, and a
violent pricking pain in his stomach and bowels, with an intolerable
thirst, and an inclination to vomit. The tongue and throat feel rough
and dry; and, if proper means be not soon administered, the patient is
seized with great anxiety, hiccuping, faintings, and coldness of the
extremities. To these succeed black vomits, fœtid stools, with a
mortification of the stomach and intestines, which are the immediate
forerunners of death.

On the first appearance of these symptoms the patient should drink large
quantities of new milk and sallad oil till he vomits; or he may drink
warm water mixed with oil. Fat broths are likewise proper, provided they
can be got ready in time. Where no oil is to be had, fresh butter may be
melted and mixed with the milk or water. These things are to be drank as
long as the inclination to vomit continues. Some have drank eight or ten
English quarts before the vomiting ceased; and it is never safe to leave
off drinking while one particle of the poison remains in the stomach.

These oily or fat substances not only provoke vomiting, but likewise
blunt the acrimony of the poison, and prevent its wounding the bowels;
but if they should not make the person vomit, half a drachm or two
scruples of the powder of ipecacuanha must be given, or a few spoonfuls
of the oxymel or vinegar of squills may be mixed with the water which he
drinks. Vomiting may likewise be excited by tickling the inside of the
throat with a feather. Should these methods however fail, half a drachm
of white vitriol, or five or six grains of emetic tartar, must be
administered.

If tormenting pains are felt in the lower belly, and there is reason to
fear that the poison has got down to the intestines, clysters of milk
and oil must be very frequently thrown up; and the patient must drink
emollient decoctions of barley, oatmeal, marsh-mallows, and such like.
He must likewise take an infusion of senna and manna, a solution of
Glauber’s salts, or some other purgative.

After the poison has been evacuated, the patient ought, for some time,
to live upon such things as are of a healing and cooling quality; to
abstain from flesh and all strong liquors, and to live upon milk, broth,
gruel, light puddings, and other spoon meats of easy digestion. His
drink should be barley-water, linseed-tea, or infusions of any of the
mild mucilaginous vegetables.

VEGETABLE POISONS, besides heat and pain of the stomach, commonly
occasion some degree of giddiness, and often a kind of stupidity or
folly. Persons who have taken these poisons must be treated in the same
manner as for the mineral or corrosive.

Though the vegetable poisons, when allowed to remain in the stomach,
often prove fatal; yet the danger is generally over as soon as they are
discharged. Not being of such a caustic or corrosive nature, they are
less apt to wound or inflame the bowels than mineral substances: no
time, however, ought to be lost in having them discharged.

Opium, being frequently taken by mistake, merits particular attention.
It is used as a medicine both in a solid and liquid form, which latter
commonly goes by the name of laudanum. It is indeed a valuable medicine
when taken in proper quantity; but as an over-dose proves a strong
poison, we shall point out its common effects, together with the method
of cure.

An over-dose of opium generally occasions great drowsiness, with stupor
and other apoplectic symptoms. Sometimes the person has so great an
inclination to sleep, that it is almost impossible to keep him awake.
Every method must however be tried for this purpose. He should be
tossed, shaked, and moved about. Sharp blistering-plasters should be
applied to his legs or arms, and stimulating medicines, as salts of
hartshorn, &c. held under his nose. It will also be proper to let blood.
At the same time every method must be taken to make him discharge the
poison. This may be done in the manner directed above, _viz._ by the use
of strong vomits, drinking plenty of warm water with oil, &c.

Mead, besides vomits, in this case, recommends acid medicines with
lixivial salts. He says, that he has often given salt of wormwood mixed
with juice of lemon in repeated doses with great success.

If the body should remain weak and languid after the poison has been
discharged, nourishing diet and cordials will be proper; but when there
is reason to fear that the stomach or bowels are inflamed, the greatest
circumspection is necessary both with regard to food and medicine.


                   OF THE BITES OF POISONOUS ANIMALS.

We shall begin with the bite of a mad dog, as it is both the most common
and dangerous animal-poison in this country.

The creatures naturally liable to contract this disease are, as far as
we yet know, all of the dog kind, _viz._ foxes, dogs, and wolves. Hence
it is called the _rabies canina_, or dog madness. Of the last we have
none in this island; and it so seldom happens that any person is bit by
the first, that they scarce deserve to be taken notice of. If such a
thing should happen, the method of treatment is precisely the same as
for the bite of a mad dog.

The symptoms of madness in a dog are as follow: At first he looks dull,
shews an aversion to food and company: he does not bark as usual, but
seems to murmur, is peevish, and apt to bite strangers: his ears and
tail droop more than usual, and he appears drowsy: afterwards he begins
to loll out his tongue, and froth at the mouth, his eyes seeming heavy
and watery: he now, if not confined, takes off, runs panting along with
a kind of dejected air, and endeavours to bite every one he meets. Other
dogs are said to fly from him. Some think this a certain sign of
madness, supposing that they know him by the smell; but it is not to be
depended on. If he escapes being killed, he seldom runs above two or
three days, till he dies exhausted with heat, hunger, and fatigue.

This disease is most frequent after long, dry, hot seasons; and such
dogs as live upon putrid stinking carrion, without having enough of
fresh water, are most liable to it.

When any person has been bit by a dog, the strictest inquiry ought to be
made whether the animal was really mad. Many disagreeable consequences
arise from neglecting to ascertain this point. Some people have lived in
continual anxiety for many years, because they had been bit by a dog
which they believed to be mad; but, as he had been killed on the spot,
it was impossible to ascertain the fact. This should induce us, instead
of killing a dog the moment he has bit any person, to do all in our
power to keep him alive, at least till we can be certain whether he be
mad or not.

Many circumstances may contribute to make people imagine a dog mad. He
loses his master, runs about in quest of him, is set upon by other dogs,
and perhaps by men. The creature, thus frightened, beat, and abused,
looks wild, and lolls out his tongue as he runs along. Immediately a
crowd is after him; while he, finding himself closely pursued, and
taking every one he meets for an enemy, naturally attempts to bite him
in self-defence. He soon gets knocked on the head, and it passes
currently that he was mad, as it is then impossible to prove the
contrary.

This being the true history of, by far, the greater part of those dogs
which pass for mad, is it any wonder that numberless whimsical medicines
have been extolled for preventing the effects of their bite? This
readily accounts for the great variety of infallible remedies for the
bite of a mad dog, which are to be met with in almost every family.
Though not one in a thousand has any claim to merit, yet they are all
supported by numberless vouchers. No wonder that imaginary diseases
should be cured by imaginary remedies. In this way, credulous people
first impose upon themselves, and then deceive others. The same medicine
which was supposed to prevent the effects of the bite, when the dog was
not mad, is recommended to a person who has had the misfortune to be bit
by a dog that was really mad. He takes it, trusts to it, and is undone.

To these mistakes we must impute the frequent ill success of the
medicines used for preventing the effects of the bite of a mad dog. It
is not owing so much to a defect in medicine, as to wrong applications.
I am persuaded, if proper medicines were administered immediately after
the bite is received, and continued for a sufficient length of time, we
should not lose one in a thousand of those who have the misfortune to be
bit by a mad dog.

This poison is generally communicated by a wound, which nevertheless
heals as soon as a common wound: but afterwards it begins to feel
painful, and as the pain spreads towards the neighbouring parts, the
person becomes heavy and listless. His sleep is unquiet with frightful
dreams; he sighs, looks dull, and loves solitude. These are the
forerunners, or rather the first symptoms of that dreadful disease
occasioned by the bite of a mad dog. But as we do not propose to treat
fully of the disease itself, but to point out the method of preventing
it, we shall not take up time in shewing its progress from the first
invasion to its commonly fatal end.

The common notion, that this poison may lie in the body for many years,
and afterwards prove fatal, is both hurtful and ridiculous. It must
render such persons as have had the misfortune to be bit very unhappy,
and can have no good effects. If the person takes proper medicines for
forty days after the time of his being bit, and feels no symptoms of the
disease, there is reason to believe him out of danger.

The medicines recommended for preventing the effects of the bite of a
mad dog, are chiefly such as promote the different secretions, and
antispasmodics.

Dr. Mead recommends a preventive medicine, which he says he never knew
fail, though in the space of thirty years he had used it a thousand
times.

The Doctor’s prescription is as follows:

“Take ash-coloured ground liver-wort, cleaned, dried, and powdered, half
an ounce; of black pepper powdered, a quarter of an ounce. Mix these
well together, and divide the powder into four doses; one of which must
be taken every morning fasting, for four mornings successively, in half
an English pint of cows milk warm.

“After these four doses are taken, the patient must go into the cold
bath, or a cold spring or river, every morning fasting, for a month; he
must be dipped all over, but not stay in (with his head above water)
longer than half a minute, if the water be very cold. After this he must
go in three times a-week for a fortnight longer.

“The person must be bled before he begins to use the medicine[161].”

We shall next mention the famous East India specific, as it is called.
This medicine is composed of cinnabar and musk. It is esteemed a great
antispasmodic; and, by many, extolled as an infallible remedy for
preventing the effects of the bite of a mad dog.

“Take native and factitious cinnabar, of each twenty-four grains, musk
sixteen grains. Let these be made into a fine powder, and taken in a
glass of arrack or brandy.”

This single dose is said to secure the person for thirty days, at the
end of which it must be repeated; but if he has any symptoms of the
disease, it must be repeated in three hours.

The following is likewise reckoned a good antispasmodic medicine:

“Take of Virginian snake-root in powder, half a drachm, gum asafœtida
twelve grains, gum camphire seven grains; make these into a bolus with a
little syrup of saffron.”

Camphire may also be given in the following manner:

“Take purified nitre half an ounce, Virginian snake-root in powder two
drachms, camphire one drachm; rub them together in a mortar, and divide
the whole into ten doses.”

Mercury is likewise recommended as of great efficacy, both in the
prevention and cure of this kind of madness. When used as a preventive,
it will be sufficient to rub daily a drachm of the ointment into the
parts about the wound.

Vinegar is likewise of considerable service, and should be taken freely,
either in the patient’s food or drink.

These are the principal medicines recommended for preventing the effects
of the bite of a mad dog. We would not however advise people to trust to
any one of them; but from a proper combination of their different
powers, there is the greatest reason to hope for success.

The great error in the use of these medicines lies in not taking them
for a sufficient length of time. They are used more like charms, than
medicines intended to produce any change in the body. To this, and not
to the insufficiency of the medicines, we must impute their frequent
want of success.

Dr. Mead says, that the virtue of his medicine consists in promoting
urine. But how a poison should be expelled by urine, with only three or
four doses of any medicine, however powerful, it is not easy to
conceive. More time is certainly necessary, even though the medicine
were more powerful than that which the Doctor prescribes.

The East India specific is still more exceptionable on this account.

As these and most other medicines, taken singly, have frequently been
found to fail, we shall recommend the following course:

If a person be bit in a fleshy part, where there is no hazard of hurting
any large blood-vessel, the parts adjacent to the wound may be cut away.
But if this be not done soon after the bite has been received, it will
be better to omit it.

The wound may be dressed with salt and water, or a pickle made of
vinegar and salt, and afterwards dressed twice a-day with yellow
basilicon mixed with red precipitate of mercury.

The patient should begin to use either Dr. Mead’s medicine, or some of
the others mentioned above. If he takes Mead’s medicine, he may use it
as the Doctor directs for four days successively. Let him then omit it
for two or three days, and again repeat the same number of doses as
before.

During this course, he must rub into the parts about the wound, daily,
one drachm of the mercurial ointment. This may be done for ten or twelve
days at least.

When this course is over, he may take a purge or two, and wait a few
days till the effect of the mercury be gone off. He must then begin to
use the cold bath, into which he may go every morning for five or six
weeks. If he should feel cold and chilly for a long time after coming
out of the cold bath, it will be better to use a tepid one, or to have
the water a little warmed.

In the mean time, we would advise him not to leave off all internal
medicines, but to take either one of the boluses of snake-root,
asafœtida, and camphire; or one of the powders of nitre, camphire, and
snake-root, twice a-day. These may be used during the whole time he is
bathing.

During the use of the mercurial ointment, the patient must keep within
doors, and take nothing cold.

A proper regimen must be observed throughout the whole course. The
patient should abstain from flesh, and all salted and high-seasoned
provisions. He must avoid strong liquors, and live mostly upon a light
and rather spare diet. His mind should be kept as easy and cheerful as
possible, and all excessive heat and violent passions avoided with the
utmost care.

I have never seen this course of medicine, with proper regimen, fail to
prevent the hydrophobia, and cannot help again observing, that the want
of success must generally be owing either to the application of improper
medicines, or not using proper ones for a sufficient length of time.

Mankind are extremely fond of every thing that promises a sudden or
miraculous cure. By trusting to these they often lose their lives, when
a regular course of medicine would have rendered them absolutely safe.
This holds remarkably in the present case. Numbers of people, for
example, believe if they or their cattle were once dipped in the sea, it
is sufficient; as if the salt-water were a charm against the effects of
the bite. This, and such like whims, have proved fatal to many.

It is a common notion, if a person be bit by a dog which is not mad,
that, if he should go mad afterwards, the person would be affected with
the disorder at the same time; but this notion is too ridiculous to
deserve a serious consideration. It is a good rule, however, to avoid
dogs as much as possible, as the disease is often upon them for some
time before its violent symptoms appear. The hydrophobia has been
occasioned by the bite of a dog which shewed no other symptoms of the
disease but listlessness and a sullen disposition.

Though we do not mean to treat fully of the cure of the hydrophobia, yet
we are far from reckoning it incurable. The notion that this disease
could not be cured, has been productive of the most horrid consequences.
It was usual either to abandon the unhappy persons, as soon as they were
seized with the disease, to their fate, to bleed them to death, or to
suffocate them between matrasses or feather-beds, &c. This conduct
certainly deserved the severest punishment! We hope, for the honour of
human nature, it will never again be heard of.

I have never had an opportunity of treating this disease, and therefore
can say nothing of it from my own experience; but the learned Dr. Tissot
says, it may be cured in the following manner:

1. The patient must be bled to a considerable quantity; and this may be
repeated twice, or thrice, or even a fourth time, if circumstances
require it.

2. The patient should be put, if possible, into a warm bath; and this
should be used twice a-day.

3. He should every day receive two, or even three emollient clysters.

4. The wound, and the parts adjoining to it, should be rubbed with the
mercurial ointment twice a-day.

5. The whole limb which contains the wound should be rubbed with oil,
and be wrapped up in an oily flannel.

6. Every three hours a dose of Cob’s powder should be taken in a cup of
the infusion of lime-tree and elder-flowers. This powder is made, by
rubbing together in a mortar, to a very fine powder, of native and
factitious cinnabar, each twenty-four grains; of musk, sixteen
grains[162].

7. The following bolus is to be given every night, and to be repeated in
the morning, if the patient is not easy, washing it down with the
infusion mentioned above: Take one drachm of Virginian snake-root in
powder; of camphire and asafœtida, ten grains each; of opium, one grain;
and, with a sufficient quantity of conserve, or rob of elder, make a
bolus.

8. If there be a great nausea at the stomach, with a bitterness in the
mouth, thirty-five or forty grains of ipecacuanha, in powder, may be
taken for a vomit.

9. The patient’s food, if he takes any, must be light; as panado, soups
made of farinaceous or mealy vegetables, &c.

10. If the patient should long continue weak, and subject to terrors, he
may take half a drachm of the Peruvian bark thrice a-day.


The next poisonous animal which we shall mention is the VIPER. The
grease of this animal rubbed into the wound is said to cure the bite.
Though that is all the viper-catchers generally do when bit, we should
not think it sufficient for the bite of an enraged viper. It would
surely be more safe to have the wound well sucked[163], and afterwards
rubbed with warm salad-oil. A poultice of bread and milk, softened with
salad-oil, should likewise be applied to the wound; and the patient
ought to drink freely of vinegar whey, or water-gruel with vinegar in
it, to make him sweat. Vinegar is one of the best medicines which can be
used in any kind of poison, and ought to be taken very liberally. If the
patient be sick, he may take a vomit. This course will be sufficient to
cure the bite of any of the poisonous animals of this country.

With regard to poisonous insects, as the bee, the wasp, the hornet, &c.
their stings are seldom attended with danger, unless when a person
happens to be stung by a great number of them at the same time; in which
case something should be done to abate the inflammation and swelling.
Some, for this purpose, apply honey, others lay pounded parsley to the
part. A mixture of vinegar and Venice treacle is likewise recommended;
but I have always found rubbing the part with warm salad-oil succeed
very well. Indeed, when the stings are so numerous as to endanger the
patient’s life, which is sometimes the case, he must not only have oily
poultices applied to the part, but should likewise be bled, and take
some cooling medicines, as nitre, or cream of tartar, and should drink
plentifully of diluting liquors.

It is the happiness of this island to have very few poisonous animals,
and those which we have are by no means of the most virulent kind.
Nine-tenths of the effects attributed to poison or venom in this
country, are really other diseases, and proceed from quite different
causes.

We cannot however make the same observation with regard to poisonous
vegetables. These abound every where, and prove often fatal to the
ignorant and unwary. This indeed is chiefly owing to carelessness.
Children ought early to be cautioned against eating any kind of fruit,
roots, or berries, which they do not know, and all poisonous plants to
which they can have access, ought, as far as possible, to be destroyed.
This would not be so difficult a task as some people imagine.

Poisonous plants have no doubt their use, and they ought to be
propagated in proper places; but, as they prove often destructive to
cattle, they should be rooted out of all pasture-grounds. They ought
likewise, for the safety of the human species, to be destroyed in the
neighbourhood of all towns and villages; which, by the bye, are the
places where they most commonly abound. I have seen the poisonous
hemlock, henbane, wolfsbane, and deadly night-shade, all growing within
the _environs_ of a small town, where, though several persons, within
the memory of those living in it, had lost their lives by one or other
of these plants; yet no method, that I could hear of, had ever been
taken to root them out; though this might be done at a very trifling
expence.

Seldom a year passes but we have accounts of several persons poisoned by
eating hemlock-roots instead of parsnips, or some kinds of fungus which
they had gathered for mushrooms. These examples ought to put people upon
their guard with respect to the former, and to put the latter entirely
out of use. Mushrooms may be a delicate dish, but they are a dangerous
one, as they are generally gathered by persons who do not know one kind
of fungus from another, and take every thing for a mushroom which has
that appearance.

We might here mention many other plants and animals of a poisonous
nature which are found in foreign countries; but, as our observations
are chiefly intended for this island, we shall pass these over. It may
not however be amiss to observe, for the benefit of such of our
countrymen as go to America, that an effectual remedy is now said to be
found for the bite of the rattle-snake.—The prescription is as follows:
Take of the roots of plantain and horehound, in summer, roots and
branches together, a sufficient quantity; bruise them in a mortar, and
squeeze out the juice, of which give, as soon as possible, one large
spoonful; if the patient be swelled, you must force it down his throat.
This generally will cure; but, if he finds no relief in an hour after,
you may give another spoonful, which never fails.—If the roots are
dried, they must be moistened with a little water. To the wound may be
applied a leaf of good tobacco moistened with rum.

We give this upon the faith of Dr. Brookes, who says it was the
invention of a negro; for the discovery of which he had his freedom
purchased, and a hundred pounds _per annum_ settled upon him during
life, by the General Assembly of Carolina.

It is possible there may be in nature specific remedies for every kind
of poison; but as we have very little faith in any of those which have
yet been pretended to be discovered, we shall beg leave again to
recommend the most strict attention to the following rules, _viz._ That
when any poisonous substance has been taken into the stomach, it ought,
as soon as possible, to be discharged by vomits, clysters, and purges;
and, when poison has been received into the body by a wound, that it be
expelled by medicines which promote the different secretions, especially
those of sweat, urine, and insensible perspiration; to which may be
joined antispasmodics, or such medicines as take off tension and
irritation; the chief of which are opium, musk, camphire, and asafœtida.




                              CHAP. XLVII.
                        OF THE VENEREAL DISEASE.


In the first edition of this book the venereal disease was omitted. The
reasons however which at that time induced me to leave it out, have upon
more mature consideration vanished. Bad consequences, no doubt, may
arise from ignorant persons tampering with medicine in this disorder;
but the danger from that quarter seems to be more than balanced by the
great and solid advantages, which must arise to the patient from an
early knowledge of his case, and an attention to a plan of regimen,
which, if it does not cure the disease, will be sure to render it more
mild, and less hurtful to the constitution.

It is peculiarly unfortunate for the unhappy persons who contract this
disease, that it lies under a sort of disgrace. This renders disguise
necessary, and makes the patient either conceal his disorder altogether,
or apply to those who promise a sudden and secret cure; but who in fact
only remove the symptoms for a time, while they fix the disease deeper
in the habit. By this means a slight infection, which might have been
easily removed, is often converted into an obstinate, and sometimes
incurable malady.

Another unfavourable circumstance attending this disease is, that it
assumes a variety of different shapes, and may with more propriety be
called an assemblage of diseases, than a single one. No two diseases can
require a more different method of treatment than this does in its
different stages. Hence the folly and danger of trusting to any
particular nostrum for the cure of it. Such nostrums are however
generally administered in the same manner to all who apply for them,
without the least regard to the state of the disease, the constitution
of the patient, the degree of infection, and a thousand other
circumstances of the utmost importance.

Though the venereal disease is generally the fruit of unlawful embraces,
yet it may be communicated to the innocent as well as the guilty.
Infants, nurses, midwives, and married women whose husbands lead
dissolute lives, are often affected with it, and frequently lose their
lives by not being aware of their danger in due time. The unhappy
condition of such persons will certainly plead our excuse, if any excuse
be necessary, for endeavouring to point out the symptoms and cure of
this too common disease.

To enumerate all its different symptoms, however, and to trace the
disease minutely through its various stages, would require a much larger
space than falls to this part of my subject; I shall therefore confine
my observations chiefly to circumstances of importance, omitting such as
are either trifling, or which occur but seldom. I shall likewise pass
over the history of the disease, with the different methods of treatment
which it has undergone since it was first introduced into Europe, and
many other circumstances of a similar nature; all of which, though they
might tend to amuse the reader, yet could afford him little or no useful
knowledge.


                       OF THE VIRULENT GONORRHŒA.

The virulent gonorrhœa is an involuntary discharge of infectious matter
from the parts of generation in either sex. It generally makes its
appearance within eight or ten days after the infection has been
received: sometimes indeed it appears in two or three days, and at other
times not before the end of four or five weeks. Previous to the
discharge, the patient feels an itching with a small degree of pain in
the genitals. Afterwards a thin glary matter begins to distil from the
urinary passage, which stains the linen, and occasions a small degree of
titillation, particularly in the time of making water; this gradually
increasing, arises at length to a degree of heat and pain, which are
chiefly perceived about the extremity of the urinary passage, where a
slight degree of redness and inflammation likewise begin to appear.

As the disorder advances, the pain, heat of urine, and running,
increase, while fresh symptoms daily ensue. In men the erections become
painful and involuntary, and are more frequent and lasting than when
natural. This symptom is most troublesome when the patient is warm in
bed. The pain which was at first only perceived towards the extremity,
now begins to reach all up the urinary passage, and is most intense just
after the patient has done making water. The running gradually recedes
from the colour of seed, grows yellow, and at length puts on the
appearance of matter.

When the disorder has arrived at its height, all the symptoms are more
intense; the heat of urine is so great, that the patient dreads the
making water; and though he feels a constant inclination this way, yet
it is rendered with the greatest difficulty, and often only by drops:
the involuntary erections now become extremely painful and frequent;
there is also a pain, heat, and sense of fulness about the seat, and the
running is plentiful and sharp, of a brown, greenish, and sometimes of a
bloody colour.

By a proper treatment the violence of the symptoms gradually abates; the
heat of urine goes off; the involuntary and painful erections, and the
heat and pain about the seat, become easier; the running also gradually
decreases, grows whiter and thicker, till at last it entirely
disappears.

By attending to these symptoms, the gonorrhœa may be generally
distinguished from any other disease. There are however some few
disorders for which it may be mistaken, as an ulcer in the kidnies or
bladder, the _fluor albus_ or whites in women, &c. But in the former of
these, the matter comes away only with the urine, or when the sphincter
of the bladder is open; whereas in a gonorrhœa, the discharge is
constant. The latter is more difficult to distinguish, and must be known
chiefly from its effects, as pain, communicating the infection, &c.

REGIMEN.——When a person has reason to suspect that he has caught the
venereal infection, he ought most strictly to observe a cooling regimen,
to avoid every thing of a heating nature, as wines, spirituous liquors,
rich sauces, spiced, salted, high-seasoned and smoke-dried provisions,
&c. as also all aromatic and stimulating vegetables, as onions, garlic,
shallot, nutmeg, mustard, cinnamon, mace, ginger, and such like. His
food ought chiefly to consist of mild vegetables, milk, broths, light
puddings, panado, gruels, &c. His drink may be barley-water, milk and
water, decoctions of marsh-mallows and liquorice, linseed-tea, or clear
whey. Of these he ought to drink plentifully. Violent exercise of all
kinds, especially riding on horseback, and venereal pleasures, are to be
avoided. The patient must beware of cold, and when the inflammation is
violent, he ought to keep his bed.

MEDICINE.——A virulent gonorrhœa cannot always be cured speedily and
effectually at the same time. The patient ought therefore not to expect,
nor the physician to promise it. It will often continue for two or three
weeks, and sometimes for five or six, even where the treatment has been
very proper.

Sometimes indeed a slight infection may be carried off in a few days, by
bathing the parts in warm milk and water, and injecting frequently up
the urethra a little sweet oil or linseed-tea about the warmth of new
milk. Should these not succeed in carrying off the infection, they will
at least have a tendency to lessen its virulence.

To effect a cure, however, astringent injections will generally be found
necessary. These may be various ways prepared, but I think those made
with the white vitriol are both most safe and efficacious. They can be
made stronger or weaker as circumstances may require; but it is best to
begin with the more gentle, and increase their power if necessary. I
generally order a drachm of white vitriol to be dissolved in eight or
nine ounces of common or rose-water, and an ordinary syringe full of it
to be thrown up three or four times a-day. If this quantity does not
perform a cure, it may be repeated, and the dose increased[164].

Whether injections be used or not, cooling purges are always proper in
the gonorrhœa. They ought not however to be of the strong or drastic
kind. Whatever raises a violent commotion in the body increases the
danger, and tends to drive the disease deeper into the habit. Procuring
two or three stools every second or third day for the first fortnight,
and the same number every fourth or fifth day for the second, will
generally be sufficient to remove the inflammatory symptoms, to diminish
the running, and to change its colour and consistence. It gradually
becomes more white and ropy as the virulence abates[165].

When the inflammatory symptoms run high, bleeding is always necessary at
the beginning. This operation, as in other topical inflammations, must
be repeated according to the strength and constitution of the patient,
and the vehemence and urgency of the symptoms.

Medicines which promote the secretion of urine, are likewise proper in
this stage of the disorder. For this purpose, an ounce of nitre and two
ounces of gum-arabic, pounded together, may be divided into twenty-four
doses, one of which may be taken frequently in a cup of the patient’s
drink. If these should make him pass his urine so often as to become
troublesome to him, he may either take them less frequently, or leave
out the nitre altogether, and take equal parts of gum-arabic and cream
of tartar. These may be pounded together, and a tea-spoonful taken in a
cup of the patient’s drink four or five times a-day. I have generally
found this answer extremely well both as a diuretic, and for keeping the
body gently open.

When the pain and inflammation are seated high towards the neck of the
bladder, it will be proper frequently to throw up an emollient clyster,
which, besides the benefit of procuring stools, will serve as a
fomentation to the inflamed parts.

Soft poultices, when they can conveniently be applied to the parts, are
of great service. They may be made of the flour of linseed, or of
wheat-bread and milk, softened with fresh butter or sweet oil. When
poultices cannot be conveniently used, cloths wrung out of warm water,
or bladders filled with warm milk and water, may be applied. I have
often known the most excruciating pains, during the inflammatory state
of the gonorrhœa, relieved by one or other of these applications.

Few things tend more to keep off inflammation in the spermatic vessels,
than a proper truss for the scrotum. It ought to be so contrived as to
support the testicles, and should be worn from the first appearance of
the disease till it has ceased some weeks.

The above treatment will sometimes remove the gonorrhœa so quickly, that
the person will be in doubt whether he really laboured under that
disease. This, however, is too favourable a turn to be often expected.
It more frequently happens, that we are able only to procure an
abatement or remission of the inflammatory symptoms, so far as to make
it safe to have recourse to the great antidote _mercury_.

Many people, on the first appearance of a gonorrhœa, fly to the use of
mercury. This is a bad plan. Mercury is often not at all necessary in a
gonorrhœa; and when taken too early, it does mischief. It may be
necessary to complete the cure, but can never be proper at the
commencement of it.

When bleeding, purging, fomentations, and the other things recommended
above, have eased the pain, softened the pulse, relieved the heat of
urine, and rendered the involuntary erections less frequent, the patient
may begin to use mercury in any form that is least disagreeable to him.

If he takes the common mercurial pill, two at night and one in the
morning will be a sufficient dose at first. Should they affect the mouth
too much, the dose must be lessened; if not at all, it may be gradually
increased to five or six pills in the day. If calomel be thought
preferable, two or three grains of it, formed into a bolus with a little
of the conserve of hips, may be taken at bed-time, and the dose
gradually increased to eight or ten grains. One of the most common
preparations of mercury now in use is the corrosive sublimate. This may
be taken in the manner afterwards recommended under the confirmed lues
or pox. I have always found it one of the most safe and efficacious
medicines when properly used.

The above medicines may either be taken every day or every other day, as
the patient is able to bear them. They ought never to be taken in such
quantity as to raise a salivation, unless in a very slight degree. The
disease may be more safely, and as certainly, cured without a salivation
as with it. When the mercury runs off by the mouth, it is not so
successful in carrying off the disease, as when it continues longer in
the body, and is discharged gradually.

Should the patient be purged or griped in the night by the mercury, he
must take an infusion of senna, or some other purgative, and drink
freely of water-gruel to prevent bloody stools, which are very apt to
happen should the patient catch cold, or if the mercury has not been
duly prepared. When the bowels are weak and the mercury is apt to gripe
or purge, these disagreeable consequences may be prevented by taking,
with the above pills or bolus, half a drachm or two scruples of
diascordium, or of the Japonic confection.

To prevent the disagreeable circumstance of the mercury’s affecting the
mouth too much, or bringing on a salivation, it may be combined with
purgatives. With this view the laxative mercurial pill has been
contrived, the usual dose of which is half a drachm, or three pills,
night and morning, to be repeated every other day; but the safer way is
for the patient to begin with two, or even with one pill, gradually
increasing the dose.

To such persons as can neither swallow a bolus nor a pill, mercury may
be given in a liquid form, as it can be suspended even in a watery
vehicle, by means of gum-arabic; which not only serves this purpose, but
likewise prevents the mercury from affecting the mouth, and renders it
in many respects a better medicine[166].

It happens very fortunately for those who cannot be brought to take
mercury inwardly, and likewise for persons whose bowels are too tender
to bear it, that an external application of it will answer equally well,
and in some respects better. It must be acknowledged, that mercury,
taken inwardly for any length of time, greatly weakens and disorders the
bowels; for which reason, when a plentiful use of it becomes necessary,
we would prefer rubbing to the mercurial pills. The common mercurial or
blue ointment will answer very well. Of that which is made by rubbing
together equal quantities of hog’s lard and quicksilver, about a drachm
may be used at a time. The best time for rubbing it on is at night, and
the most proper place the inner side of the thighs. The patient should
stand before the fire when he rubs, and should wear flannel drawers next
his skin at the time he is using the ointment. If ointment of a weaker
or stronger kind be used, the quantity must be increased or diminished
in proportion.

If, during the use of the ointment, the inflammation of the genital
parts, together with the heat and feverishness, should return, or if the
mouth should grow sore, the gums tender, and the breath become
offensive, a dose or two of Glauber’s salts, or some other cooling
purge, may be taken, and the rubbing intermitted for a few days. As
soon, however, as the signs of spitting are gone off, if the virulency
be not quite corrected, the ointment must be repeated, but in smaller
quantities, and at longer intervals than before. Whatever way mercury is
administered, its use must be persisted in as long as any virulency is
suspected to remain.

During this, which may be called the second stage of the disorder,
though so strict a regimen is not necessary as in the first or
inflammatory state, yet intemperance of every kind must be avoided. The
food must be light, plain, and of easy digestion; and the greatest
indulgence that may be allowed with respect to drink is, a little wine
diluted with a sufficient quantity of water. Spirituous liquors are to
be avoided in every shape. I have often known the inflammatory symptoms
renewed and heightened, the running increased, and the cure rendered
extremely difficult and tedious, by one fit of excessive drinking.

When the above treatment has removed the heat of urine, and soreness of
the genital parts; when the quantity of running is considerably
lessened, without any pain or swelling in the groin or testicle
supervening; when the patient is free from involuntary erections; and
lastly, when the running becomes pale, whitish, thick, void of ill
smell, and tenacious or ropy; when all or most of these symptoms appear,
the gonorrhœa is arrived at its last stage, and we may gradually proceed
to treat it as a gleet with astringent and agglutinating medicines.


                               OF GLEETS.

A gonorrhœa frequently repeated, or improperly treated, often ends in a
gleet, which may either proceed from relaxation, or from some remains of
the disease. It is however of the greatest importance in the cure of the
gleet, to know from which of these causes it proceeds. When the
discharge proves very obstinate, and receives little or no check from
astringent remedies, there is ground to suspect that it is owing to the
latter; but if the drain is inconstant, and is chiefly observable when
the patient is stimulated by lascivious ideas, or upon straining to go
to stool, we may reasonably conclude that it is chiefly owing to the
former.

In the cure of a gleet proceeding from relaxation, the principal design
is to brace, and restore a proper degree of tension to the debilitated
and relaxed vessels. For this purpose, besides the medicines recommended
in the gonorrhœa, the patient may have recourse to stronger and more
powerful astringents, as the Peruvian bark[167], alum, vitriol, galls,
tormentil, bistort, baldustines, tincture of gum kino, &c. The
injections may be rendered more astringent by the addition of a few
grains of alum, or increasing the quantity of vitriol as far as the
parts are able to bear it.

The last remedy which we shall mention in this case is the cold bath,
than which there is not perhaps a more powerful bracer in the whole
compass of medicine. It ought never to be omitted in this species of
gleet, unless there be something in the constitution of the patient
which renders the use of it unsafe. The chief objections to the use of
the cold bath are, a full habit, and an unsound state of the viscera.
The danger from the former may always be lessened, if not removed, by
purging and bleeding; but the latter is an insurmountable obstacle, as
the pressure of the water, and the sudden contraction of the external
vessels, by throwing the blood with too much force upon the internal
parts, are apt to occasion ruptures of the vessels, or a flux of humours
upon the diseased organs. But where no objection of this kind prevails,
the patient ought to plunge over head in water every morning fasting,
for three or four weeks together. He should not however stay long in the
water, and should take care to have his skin dried as soon as he comes
out.

The regimen proper in this case is the same as was mentioned in the last
stage of the gonorrhœa: the diet must be drying and astringent, and the
drink Spa, Pyrmont, or Bristol waters, with which a little claret or red
wine may sometimes be mixed. Any person may now afford to drink these
waters, as they can be every where prepared at almost no expence, by a
mixture of common chalk and oil of vitriol.

When the gleet does not in the smallest degree yield to these medicines,
there is reason to suspect that it proceeds from ulcers. In this case
recourse must be had to mercury, and such medicines as tend to correct
any predominant acrimony with which the juices may be affected, as the
decoction of China, sarsaparilla, sassafras, or the like.

Mr. Fordyce says, he has seen many obstinate gleets of two, three, or
four years standing, effectually cured by a mercurial inunction, when
almost every other medicine has been tried in vain. Dr. Chapman seems to
be of the same opinion; but says, he has always found the mercury
succeed best in this case when joined with terebinthinate and other
agglutinating medicines. For which reason the Doctor recommends pills
made of calomel and Venice turpentine[168]; and desires that their use
may be accompanied with a decoction of guaiacum or sarsaparilla.

The last kind of remedy which we shall mention for the cure of ulcers in
the urinary passage, are the suppurating candles or bougies: as these
are prepared various ways, and are generally to be bought ready made, it
is needless to spend time in enumerating the different ingredients of
which they are composed, or teaching the manner of preparing them.
Before a bougie be introduced into the urethra, however, it should be
smeared all over with sweet oil, to prevent it from stimulating too
suddenly; it may be suffered to continue in from one to seven or eight
hours, according as the patient can bear it. Obstinate ulcers are not
only often healed, but tumours and excrescences in the urinary passages
taken away, and an obstruction of urine removed by means of bougies.
Obstinate gleets may be removed by the use of bougies.


                        OF THE SWELLED TESTICLE.

The swelled testicle may either proceed from infection lately
contracted, or from the venereal poison lurking in the blood: the latter
indeed is not very common, but the former frequently happens both in the
first and second stages of a gonorrhœa; particularly when the running is
unseasonably checked, by cold, hard drinking, strong drastic purges,
violent exercise, the too early use of astringent medicines, or the
like.

In the inflammatory stage bleeding is necessary, which must be repeated
according to the urgency of the symptoms[169]. The food must be light,
and the drink diluting. High-seasoned food, flesh, wines, and every
thing of a heating nature, are to be avoided. Fomentations are of
singular service. Poultices of bread and milk, softened with fresh
butter or oil, are likewise very proper, and ought constantly to be
applied when the patient is in bed: when he is up, the testicles should
be kept warm, and supported by a bag or truss, which may easily be
contrived in such a manner as to prevent the weight of the testicle from
having any effect.

If it should be found impracticable to clear the testicle by the cooling
regimen now pointed out, and extended according to circumstances, it
will be necessary to lead the patient through such a complete
antivenereal course as shall ensure him against any future uneasiness.
For this purpose, besides rubbing the mercurial ointment on the part, if
free from pain, or on the thighs, as directed in the gonorrhœa, the
patient must be confined to bed, if necessary, for five or six weeks,
suspending the testicle all the while with a bag or truss, and plying
him inwardly with strong decoctions of sarsaparilla.

When these means do not succeed, and there is reason to suspect a
scrophulous or cancerous habit, either of which may support a scirrhous
induration, after the venereal poison is corrected, the parts should be
fomented daily with a decoction of hemlock, the bruised leaves of which
may likewise be added to the poultice, and the extract at the same time
taken inwardly[170]. This practice is strongly recommended by Dr. Stork
in scirrhous and cancerous cases; and Mr. Fordyce assures us, that by
this method he has cured diseased testicles of two or three years
standing, even when ulcerated, and when the scirrhus had begun to be
affected with pricking and lancing pains.


                               OF BUBOES.

Venereal buboes are hard tumours seated in the groin, occasioned by the
venereal poison lodged in this part. They are of two kinds; _viz._ such
as proceed from a recent infection, and such as accompany a confirmed
lues.

The cure of recent buboes, that is, such as appear soon after impure
coition, may be first attempted by _dispersion_, and, if that should not
succeed, by _suppuration_. To promote the dispersion of a bubo, the same
regimen must be observed as was directed in the first stage of a
gonorrhœa. The patient must likewise be bled, and take some cooling
purges, as the decoction of tamarinds and senna, Glauber’s salts, and
the like. If, by this course, the swelling and other inflammatory
symptoms abate, we may safely proceed to the use of mercury, which must
be continued till the venereal virus is quite subdued[171].

But if the bubo should, from the beginning, be attended with great heat,
pain, and pulsation, it will be proper to promote its suppuration. For
this purpose the patient may be allowed to use his ordinary diet, and to
take now and then a glass of wine. Emollient cataplasms, consisting of
bread and milk softened with oil or fresh butter, may be applied to the
part; and, in cold constitutions, where the tumour advances slowly,
white lily-roots boiled, or sliced onions raw, and a sufficient quantity
of yellow basilicon, may be added to the poultice.

When the tumour is ripe, which may be known by its conical figure, the
softness of the skin, and a fluctuation of matter plainly to be felt
under the finger, it may be opened either by a caustic or a lancet, and
afterwards dressed with digestive ointment.

It sometimes however happens, that buboes can neither be dispersed nor
brought to a suppuration, but remain hard, indolent tumours. In this
case the indurated glands must be consumed by caustic; if they should
become scirrhous, they must be dissolved by the application of hemlock,
both externally and internally, as directed in the scirrhous testicle.


                              OF CHANCRES.

Chancres are superficial, callous, eating ulcers; which may happen
either with or without a gonorrhœa. They are commonly seated about the
glans, and make their appearance in the following manner: First a little
red pimple arises, which soon becomes pointed at top, and is filled with
a whitish matter inclining to yellow. This pimple is hot, and itches
generally before it breaks: afterwards it degenerates into an obstinate
ulcer, the bottom of which is usually covered with a viscid mucus, and
whose edges gradually become hard and callous. Sometimes the first
appearance resembles a simple excoriation of the cuticle; which however,
if the cause be venereal, soon becomes a true chancre.

A chancre is sometimes a primary affection, but it is much oftner
symptomatic, and is the mark of a confirmed lues. Primary chancres
discover themselves soon after impure coition, and are generally seated
in parts covered with a thin cuticle, as the lips, the nipples of women,
the _glans penis_ of men, &c.[172].

When a chancre appears soon after impure coition, its treatment is
nearly similar to that of the virulent gonorrhœa. The patient must
observe the cooling regimen, lose a little blood, and take some gentle
doses of salts and manna. The parts affected ought frequently to be
bathed, or rather soaked, in warm milk and water, and, if the
inflammation be great, an emollient poultice or cataplasm may be applied
to them. This course will, in most cases, be sufficient to abate the
inflammation, and prepare the patient for the use of mercury.

Symptomatic chancres are commonly accompanied with ulcers in the throat,
nocturnal pains, scurfy eruptions about the roots of the hair, and other
symptoms of a confirmed lues. Though they may be seated in any of the
parts mentioned above, they commonly appear upon the private parts, or
the inside of the thigh. They are also less painful, but frequently much
larger and harder than primary chancres. As their cure must depend upon
that of the pox, of which they are only a symptom, we shall take no
further notice of them, till we come to treat of a confirmed lues[173].

Thus we have related most of the symptoms which accompany or succeed a
violent gonorrhœa, and have also given a short view of their proper
treatment; there are, however, several others which sometimes attend
this disease, as a _strangury_ or obstruction of urine, _phymosis_,
_paraphymosis_, &c.

A strangury may be occasioned either by a spasmodic constriction, or an
inflammation of the urethra and parts about the neck of the bladder. In
the former case, the patient begins to void his urine with tolerable
ease; but, as soon as it touches the galled or inflamed urethra, a
sudden constriction takes place, and the urine is voided by spurts, and
sometimes by drops only. When the strangury is owing to an inflammation
about the neck of the bladder, there is a constant heat and uneasiness
of the part, a perpetual desire to make water, while the patient can
only render a few drops, and a troublesome _tenesmus_, or constant
inclination to go to stool.

When the strangury is owing to spasm, such medicines as tend to dilute
and blunt the salts of the urine will be proper. For this purpose,
besides the common diluting liquors, soft and cooling emulsions,
sweetened with the syrup of poppies, may be used. Should these not have
the desired effect, bleeding, and emollient fomentations, will be
necessary.

When the complaint is evidently owing to an inflammation about the neck
of the bladder, bleeding must be more liberally performed, and repeated
according to the urgency of the symptoms. After bleeding, if the
strangury still continues, soft clysters, with a proper quantity of
laudanum in them, may be administered, and emollient fomentations
applied to the region of the bladder. At the same time, the patient may
take every four hours a tea-cupful of barley-water, to an English pint
of which six ounces of the syrup of marsh-mallows, four ounces of the
oil of sweet almonds, and half an ounce of nitre, may be added. If these
remedies should not relieve the complaint, and a total suppression of
urine should come on, bleeding must be repeated, and the patient set in
a warm bath up to the middle. It will be proper in this case to
discontinue the diuretics, and to draw off the water with a catheter;
but as the patient is seldom able to bear its being introduced, we would
rather recommend the use of mild bougies. These often lubricate the
passage, and greatly facilitate the discharge of urine. Whenever they
begin to stimulate or give any uneasiness, they may be withdrawn.

The _phymosis_ is such a constriction of the prepuce over the glans, as
hinders it from being drawn backwards; the _paraphymosis_, on the
contrary, is such a constriction of the prepuce behind the glans, as
hinders it from being brought forward.

The treatment of these symptoms is so nearly the same with that of the
virulent gonorrhœa, that we have no occasion to enlarge upon it. In
general, bleeding, purging, poultices, and emollient fomentations are
sufficient. Should these, however, fail of removing the stricture, and
the parts be threatened with a mortification, twenty or thirty grains of
ipecacuanha, and one grain of emetic tartar, may be given for a vomit,
and may be worked off with warm water or thin gruel.

It sometimes happens, that, in spite of all endeavours to the contrary,
the inflammation goes on, and symptoms of a beginning mortification
appear. When this is the case, the prepuce must be scarified with a
lancet, and, if necessary, divided, in order to prevent a strangulation,
and set the imprisoned glans at liberty. We shall not describe the
manner of performing this operation, as it ought always to be done by a
surgeon. When a mortification has actually taken place, it will be
necessary, besides performing the above operations, to foment the parts
frequently with cloths wrung out of a strong decoction of
camomile-flowers and bark, and to give the patient a drachm of the bark
in powder every two or three hours.

With regard to the _priapism_, _chordee_, and other distortions of the
_penis_, their treatment is no way different from that of the gonorrhœa.
When they prove very troublesome, the patient may take a few drops of
laudanum at night, especially after the operation of a purgative through
the day.


                          OF A CONFIRMED LUES.

We have hitherto treated of those affections in which the venereal
poison is supposed to be confined chiefly to the particular part by
which it was received, and shall next take a view of the lues in its
confirmed state; that is, when the poison is actually received into the
blood, and, circulating with it through every part of the body, mixes
with the several secretions, and renders the whole habit tainted.

The symptoms of a confirmed lues are, buboes in the groin, pains of the
head and joints, which are peculiarly troublesome in the night, or when
the patient is warm in bed; scabs and scurfs in various parts of the
body, especially on the head, of a yellowish colour, resembling a
honey-comb; corroding ulcers in various parts of the body, which
generally begin about the throat, from whence they creep gradually, by
the palate, towards the cartilage of the nose, which they destroy;
excrescences or exostoses arise in the middle of the bones, and their
spongy ends become brittle, and break upon the least accident; at other
times they are soft, and bend like wax; the conglobate glands become
hard and callous, and form, in the neck, armpits, groin, and mesentery,
hard moveable tumours, like the king’s evil; tumours of different kinds
are likewise formed in the lymphatic vessels, tendons, ligaments, and
nerves, as the _gummata_, _ganglia_, _nodes_, _tophs_, &c.; the eyes are
affected with itching, pain, redness, and sometimes with total
blindness, and the ears with a singing noise, pain, and deafness, whilst
their internal substance is exulcerated and rendered carious; at length
all the animal, vital, and natural functions are depraved; the face
becomes pale and livid; the body emaciated and unfit for motion, and the
miserable patient falls into an atrophy or wasting consumption.

Women have symptoms peculiar to the sex; as cancers of the breast; a
suppression or overflowing of the menses; the whites; hysteric
affections; an inflammation, abscess, scirrhus, gangrene, cancer, or
ulcer of the womb; they are generally either barren or subject to
abortion; or, if they bring children into the world, they have an
universal erysipelas, are half rotten, and covered with ulcers.

Such is the catalogue of symptoms attending this dreadful disease in its
confirmed state. Indeed they are seldom all to be met with in the same
person, or at the same time; so many of them, however, are generally
present as are sufficient to alarm the patient; and if he has reason to
suspect the infection is lurking in his body, he ought immediately to
set about the expulsion of it, otherwise the most tragical consequences
will ensue.

The only certain remedy hitherto known in Europe, for the cure of this
disease, is mercury, which may be used in a great variety of forms, with
nearly the same success. Some time ago it was reckoned impossible to
cure a confirmed lues without a salivation. This method is now however
pretty generally laid aside, and mercury is found to be as efficacious,
or rather more so, in expelling the venereal poison, when administered
in such a manner as not to run off by the salivary glands.

Though many are of opinion, that the mercurial ointment is as
efficacious as any other preparation of that mineral; yet experience has
taught me to think otherwise. I have often seen the most obstinate
venereal cases, where great quantities of mercurial ointment had been
used in vain, yield to the saline preparations of mercury. Nor am I
singular in this opinion. My ingenious friend, Mr. Clare, an eminent
surgeon of this city, assures me, that for some time past he has
employed, in venereal cases, a saline preparation of mercury with most
happy success. This preparation, rubbed with a sufficient quantity of
any mild powder, he applies, in small portions, to the tongue, where,
with a gentle degree of friction, it is immediately absorbed, and
produces its full effect; upon the system, without doing the least
injury to the stomach or bowels; a matter of the greatest importance in
the application of this most active and powerful remedy.

It is impossible to ascertain either the exact quantity of medicines
that must be taken, or the time they ought to be continued, in order to
perform a cure. These will ever vary according to the constitution of
the patient, the season of the year, the degree of infection, the time
it has lodged in the body, &c. But though it is difficult, as Astruc
observes, to determine _à priori_, what quantity of mercury will, in the
whole, be necessary to cure this distemper completely; yet it may be
judged of _à posteriori_, from the abatement and ceasing of the
symptoms. The same author adds, that commonly not less than two ounces
of the strong mercurial ointment is sufficient, and not more than three
or four ounces necessary.

The only chemical preparation of mercury which we shall take notice of,
is the corrosive sublimate. This was some time ago brought into use for
the venereal disease, in Germany, by the illustrious Baron Van Swieten;
and was soon after introduced into Britain by the learned Sir John
Pringle, at that time physician to the army. The method of giving it is
as follows: One grain of corrosive sublimate is dissolved in two ounces
of French brandy or malt spirits; and of this solution, an ordinary
table-spoonful, or the quantity of half an ounce, is to be taken twice
a-day, and to be continued as long as any symptoms of the disorder
remain. To those whose stomach cannot bear the solution, the sublimate
may be given in form of pill[174].

Several roots, woods, and barks, have been recommended for curing the
venereal disease; but none of them have been found, upon experience, to
answer the high encomiums which had been bestowed upon them. Though no
one of these is to be depended upon alone, yet, when joined with
mercury, some of them are found to be very beneficial in promoting a
cure. One of the best we know yet is sarsaparilla, which may be prepared
and taken according to the directions in the Appendix[175].

The mezereon root is likewise found to be a powerful assistant to the
sublimate, or any other mercurial. It may either be used along with the
sarsaparilla, as directed in the Appendix, or by itself. Those who chuse
to use the mezereon by itself, may boil an ounce of the fresh bark,
taken from the root, in twelve English pints of water to eight, adding
towards the end an ounce of liquorice. The dose of this is the same as
of the decoction of sarsaparilla.

We have been told that the natives of America cure the venereal disease,
in every stage, by a decoction of the root of a plant called the
Lobelia. It is used either fresh or dried; but we have no certain
accounts with regard to the proportion. Sometimes they mix other roots
with it, as those of the ranunculus, the ceanothus, &c.; but whether
these are designed to disguise or assist it, is doubtful. The patient
takes a large draught of the decoction early in the morning, and
continues to use it for his ordinary drink through the day[176].

Many other roots and woods might be mentioned which have been extolled
for curing the venereal disease, as the china-root, the roots of
soap-wort, burdock, &c. as also the wood of guaiacum and sassafras; but
as none of these have been found to possess virtues superior to those
already mentioned, we shall, for the sake of brevity, pass them over,
and shall conclude our observations on this disease with a few general
remarks concerning the proper management of the patient, and the nature
of the infection.


                         GENERAL OBSERVATIONS.

The condition of the patient ought always to be considered previous to
his entering upon a course of mercury in any form. It would be equally
rash and dangerous to administer mercury to a person labouring under any
violent acute disease, as a putrid fever, pleurisy, peripneumony, or the
like. It would likewise be dangerous in some chronic cases; as a slow
hectic fever, or the last stage of a consumption. Sometimes, however,
these diseases proceed from a confirmed lues; in which case it will be
necessary to give mercury. In chronic diseases of a less dangerous
nature, as the asthma, the gravel, and such like, mercury, if necessary,
may be safely administered. If the patient’s strength has been greatly
exhausted by sickness, labour, abstinence, or any other cause, the use
of mercury must be postponed, till by time, rest, and a nourishing diet,
it can be sufficiently restored.

Mercury ought not to be administered to women during the menstrual flux,
or when the period is near at hand. Neither should it be given in the
last stage of pregnancy. If, however, the woman be not near the time of
her delivery, and circumstances render it necessary, mercury may be
given, but in smaller doses, and at greater intervals than usual: with
these precautions, both the mother and child may be cured at the same
time; if not, the disorder will at least be kept from growing worse,
till the woman be brought to bed, and sufficiently recovered, when a
more effectual method may be pursued, which, if she suckles her child,
will in all probability be sufficient for the cure of both.

Mercury ought always to be administered to infants with the greatest
caution. Their tender condition unfits them for supporting a salivation,
and makes it necessary to administer even the mildest preparations of
mercury to them with a sparing hand. A similar conduct is recommended in
the treatment of old persons, who have the misfortune to labour under a
confirmed lues. No doubt the infirmities of age must render people less
able to undergo the fatigues of a salivation; but this, as was formerly
observed, is never necessary; besides, we have generally found, that
mercury had much less effect upon very old persons than on those who
were younger.

Hysteric and hypochondriac persons, and such as are subject to an
habitual diarrhœa or dysentery, or to frequent and violent attacks of
the epilepsy, or who are afflicted with the scrophula, or the scurvy,
ought to be cautious in the use of mercury. Where any one of these
disorders prevails, it ought either, if possible, to be cured, or at
least palliated, before the patient enters upon a course of mercury.
When this cannot be done, the mercury must be administered in smaller
doses, and at longer intervals than usual.

The most proper seasons for entering upon a course of mercury, are the
spring and autumn, when the air is of a moderate warmth. If the
circumstances of the case, however, will not admit of delay, we must not
defer the cure on account of the season, but must administer the
mercury; taking care at the same time to keep the patient’s chamber
warmer or cooler, according as the season of the year requires.

The next thing to be considered is the preparation necessary to be
observed before we proceed to administer a course of mercury. Some lay
great stress upon this circumstance, observing, that by previously
relaxing the vessels, and correcting any disorder which may happen to
prevail in the blood, not only the mercury will be disposed to act more
kindly, but many other inconveniencies will be prevented.

We have already recommended bleeding and gentle purges, previous to the
administration of mercury, and shall only now add, that these are always
to be repeated according to the age, strength, constitution, and other
circumstances of the patient. Afterwards, if it can be conveniently
done, the patient ought to bathe once or twice a-day, for a few days, in
lukewarm water. His diet in the mean time must be light, moist, and
cooling. Wine, and all heating liquors, also violent bodily exercise,
and all great exertions of the mind, are carefully to be avoided.

A proper regimen is likewise to be observed by such as are under a
course of mercury. Inattention to this not only endangers the patient’s
life but often also disappoints him of a cure. A much smaller quantity
of mercury will be sufficient for the cure of a person who lives low,
keeps warm, and avoids all manner of excess, than of one who cannot
endure to put the smallest restraint upon his appetites: indeed it but
rarely happens that such are thoroughly cured.

There is hardly any thing of more importance, either for preventing or
removing venereal infection than cleanliness. By an early attention to
this, the infection might often be prevented from entering the body;
and, where it has already taken place, its effects may be greatly
mitigated. The moment any person has reason to suspect that he has
received the infection, he ought to wash the parts with water and
spirits, sweet oil, or milk and water; a small quantity of the last may
likewise be injected up the urethra, if it can be conveniently done.
Whether this disease at first took its rise from dirtiness is hard to
say; but wherever that prevails, the infection is found in its greatest
degree of virulence, which gives ground to believe that a strict
attention to cleanliness would go far towards extirpating it
altogether[177].

When the venereal disease has been neglected, or improperly treated, it
often becomes a disorder of the habit. In this case the cure must be
attempted by restoratives, as a milk diet, the decoction of
sarsaparilla, and such like, to which mercury may be occasionally added.
It is a common practice in North Britain to send such patients to drink
goat-whey. This is a very proper plan, provided the infection has been
totally eradicated before-hand; but when that is not the case, and the
patient trusts to the whey for finishing his cure, he will often be
disappointed. I have frequently known the disease return with all its
virulence after a course of goat-whey, even when that course had been
thought quite sufficient for completing the cure.

One of the most unfortunate circumstances attending patients in this
disease, is the necessity they are often laid under of being soon well.
This induces them to take medicine too fast, and to leave it off too
soon. A few grains more of medicine, or a few days longer confinement,
would often be sufficient to perfect the cure; whereas, by neglect of
these, a small degree of virulence is still left in the humours, which
gradually vitiates, and at length contaminates the whole mass. To avoid
this, we would advise, that the patient should never leave off taking
medicine immediately upon the disappearing of the symptoms, but continue
it for some time after, gradually lessening the quantity, till there is
sufficient ground to believe that the disease is entirely eradicated.

It is not only difficult, but absolutely impossible, to ascertain the
exact degree of virulence that may attend the disease; for which reason
it will always be a much safer rule to continue the use of medicine too
long, than to leave it off too soon. This seems to be the leading maxim
of a modern practitioner of some note for the venereal disease, who
always orders his patient to perform a quarantine of at least forty
days, during which time he takes forty bottles of, I suppose, a strong
decoction of sarsaparilla, or some other antivenereal simple. Whoever
takes this method, and adds a sufficient quantity of corrosive
sublimate, or some other active preparation of mercury to the decoction,
will seldom fail to cure a confirmed lues.

It is peculiarly unfortunate for the cure of this disease, that not one
in ten of those who contract it, are either able or willing to submit to
a proper plan of regimen. The patient is willing to take medicine; but
he must follow his business, and, to prevent suspicions, must eat and
drink like the rest of the family. This is the true source of
nine-tenths of all the mischief arising from the venereal disease. I
never knew the cure attended with any great difficulty or danger where
the patient strictly followed the physician’s advice: but a volume would
not be sufficient to point out the dreadful consequences which proceed
from an opposite conduct. Scirrhous testicles, ulcerous sore throats,
madness, consumptions, carious bones, and a rotten progeny, are a few of
the blessings derived from this source.

There is a species of false reasoning, with regard to this disease,
which proves fatal to many. A person of a sound constitution contracts a
slight degree of the disorder. He gets well without taking any great
care, or using much medicine, and hence concludes that this will always
be the case. The next time the disease occurs, though, ten times more
virulent, he pursues the same course, and his constitution is ruined.
Indeed, the different degrees of virulence in the small-pox are not
greater than in this disease, though, as the learned Sydenham observes,
in some cases the most skilful physicians cannot cure, and in others the
most ignorant old woman cannot kill the patient in that disorder. Though
a good constitution is always in favour of the patient, yet too great
stress may be laid upon it. It does not appear from observation, that
the most robust constitution is able to overcome the virulence of the
venereal contagion, after it has got into the habit. In this case a
proper course of medicine is always indispensably necessary.

Although it is impossible, on account of the different degrees of
virulence, &c. to lay down fixed and certain rules for the cure of this
disease, yet the following general plan will always be found safe, and
often successful, _viz._ to bleed and administer gentle purges with
diuretics during the inflammatory state, and as soon as the symptoms of
inflammation are abated, to administer mercury, in any form that may be
most agreeable to the patient. The same medicine, assisted by the
decoction of sarsaparilla, and a proper regimen, will not only secure
the constitution against the further progress of a confirmed pox, but
will generally perform a complete cure.




                             CHAP. XLVIII.
                           DISEASES OF WOMEN.


Women, in all civilized nations, have the management of domestic
affairs, and it is very proper they should, as Nature has made them less
fit for the more active and laborious employments. This indulgence,
however, is generally carried too far; and females, instead of being
benefited by it, are greatly injured, from the want of exercise and free
air. To be satisfied of this, one need only compare the fresh and ruddy
looks of a milk-maid, with the pale complexion of those females whose
whole time is spent within doors. Though Nature has made an evident
distinction between the male and female with regard to bodily strength
and vigour, yet she certainly never meant, either that the one should be
always without, or the other always within doors.

The confinement of females, besides hurting their figure and complexion,
relaxes their solids, weakens their minds, and disorders all the
functions of the body. Hence proceed obstructions, indigestion,
flatulence, abortions, and the whole train of nervous disorders. These
not only unfit women for being mothers and nurses, but often render them
whimsical and ridiculous. A sound mind depends so much upon a healthy
body, that where the latter is wanting the former is rarely to be found.

I have always observed, that women who were chiefly employed without
doors, in the different branches of husbandry, gardening, and the like,
were almost as hardy as their husbands, and that their children were
likewise strong and healthy. But as the bad effects of confinement and
inactivity upon both sexes have been already shewn, we shall proceed to
point out those circumstances in the structure and design of females,
which subject them to peculiar diseases; the chief of which are, their
_monthly evacuations_, _pregnancy_, and _child-bearing_. These indeed
cannot properly be called diseases, but from the delicacy of the sex,
and their being often improperly managed in such situations, they become
the source of numerous calamities.


                      OF THE MENSTRUAL DISCHARGE.

Females generally begin to menstruate about the age of fifteen, and
leave it off about fifty, which renders these two periods the most
critical of their lives. About the first appearance of this discharge,
the constitution undergoes a very considerable change, generally indeed
for the better, though sometimes for the worse. The greatest care is now
necessary, as the future health and happiness of the female depends in a
great measure upon her conduct at this period[178].

If a girl about this time of life be confined to the house, kept
constantly sitting, and neither allowed to romp about, nor employed in
any active business, which gives exercise to the whole body, she becomes
weak, relaxed, and puny; her blood not being duly prepared, she looks
pale and wan; her health, spirits, and vigour decline, and she sinks
into a valetudinarian for life. Such is the fate of numbers of those
unhappy females, who, either from too much indulgence, or their own
narrow circumstances, are, at this critical period, denied the benefit
of exercise and free air.

A lazy indolent disposition proves likewise very hurtful to girls at
this period. One seldom meets with complaints from obstructions amongst
the more active and industrious part of the sex; whereas the indolent
and lazy are seldom free from them. These are in a manner eaten up by
the _chlorosis_, or green-sickness, and other diseases of this nature.
We would therefore recommend it to all who wish to escape these
calamities, to avoid indolence and inactivity, as their greatest
enemies, and to be as much abroad in the open air as possible.

Another thing which proves very hurtful to girls about this period of
life, is unwholesome food. Fond of all manner of trash, they often
indulge in it, till their whole humours are quite vitiated. Hence ensue
indigestions, want of appetite, and a numerous train of evils. If the
fluids be not duly prepared, it is utterly impossible that the
secretions should go properly on. Accordingly we find, that such girls
as lead an indolent life, and eat great quantities of trash, are not
only subject to obstructions of the _menses_, but likewise to glandular
obstructions; as the scrophula, or king’s evil, &c.

A dull disposition is also very hurtful to girls at this period. It is a
rare thing to see a sprightly girl who does not enjoy good health, while
the grave, moping, melancholy creature, proves the very prey of vapours
and hysterics. Youth is the season for mirth and cheerfulness. Let it
therefore be indulged. It is an absolute duty. To lay in a stock of
health in time of youth, is as necessary a piece of prudence, as to make
provision against the decays of old age. While, therefore, wise Nature
prompts the happy youth to join in sprightly amusements, let not the
severe dictates of hoary age forbid the useful impulse, nor damp, with
serious gloom, the season destined to mirth and innocent festivity.

Another thing very hurtful to females about this period of life is
strait clothes. They are fond of a fine shape, and foolishly imagine
that this can be acquired by lacing themselves tight. Hence, by
squeezing the stomach and bowels, they hurt the digestion, and occasion
many incurable maladies. This error is not indeed so common as it has
been; but, as fashions change, it may come about again: we therefore
think it not improper to mention it. I know many females who, to this
day, feel the direful effects of that wretched custom which prevailed
some years ago, of squeezing every girl into as small a size in the
middle as possible. Human invention could not possibly have devised a
practice more destructive to health.

After a female has arrived at that period of life when the _menses_
usually begin to flow, and they do not appear, but, on the contrary, her
health and spirits begin to decline, we would advise, instead of
shutting the poor girl up in the house, and dosing her with steel,
asafœtida, and other nauseous drugs, to place her in a situation where
she can enjoy the benefit of free air and agreeable company. There let
her eat wholesome food, take sufficient exercise, and amuse herself in
the most agreeable manner; and we have little reason to fear, but
Nature, thus assisted, will do her proper work. Indeed she seldom fails,
unless where the fault is on our side.

This discharge in the beginning is seldom so instantaneous as to
surprise females unawares. It is generally preceded by symptoms which
foretel its approach; as a sense of heat, weight, and dull pain in the
loins; distension and hardness of the breasts; head-ach; loss of
appetite; lassitude; paleness of the countenance; and sometimes a slight
degree of fever. When these symptoms appear about the age at which the
menstrual flux usually begins, every thing should be carefully avoided
which may obstruct that necessary and salutary evacuation; and all means
used to promote it; as sitting frequently over the steams of warm water,
drinking warm diluting liquors, &c.

After the _menses_ have once begun to flow, the greatest care should be
taken to avoid every thing that may tend to obstruct them. Females ought
to be exceeding cautious of what they eat or drink at the time they are
out of order. Every thing that is cold, or apt to sour on the stomach,
ought to be avoided; as fruit, butter-milk, and such like. Fish, and all
kinds of food that are hard of digestion, are also to be avoided. As it
is impossible to mention every thing that may disagree with individuals
at this time, we would recommend it to every female to be very attentive
to what disagrees with herself, and carefully to avoid it.

Cold is extremely hurtful at this particular period. More of the sex
date their disorders from colds, caught while they are out of order,
than from all other causes. This ought surely to put them upon their
guard, and to make them very circumspect in their conduct at such times.
A degree of cold that will not at the least hurt them at another time,
will at this period be sufficient entirely to ruin their health and
constitution.

The greatest attention ought likewise to be paid to the mind, which
should be kept as easy and cheerful as possible. Every part of the
animal economy is influenced by the passions, but none more so than
this. Anger, fear, grief, and other affections of the mind, often
occasion obstructions of the menstrual flux, which prove absolutely
incurable.

From whatever cause this flux is obstructed, except in the state of
pregnancy, proper means should be used to restore it. For this purpose
we would recommend sufficient exercise, in a dry, open, and rather cool
air; wholesome diet, and, if the body be weak and languid, generous
liquors; also cheerful company and all manner of amusements. If these
fail, recourse must be had to medicine.

When obstructions proceed from a weak relaxed state of the solids, such
medicines as tend to promote digestion, to brace the solids, and assist
the body in preparing good blood, ought to be used. The principal of
these are iron and the Peruvian bark, with other bitter and astringent
medicines. Filings of iron may be infused in wine or ale, two or three
ounces to an English quart, and after it has stood for two or three
weeks it may be filtered, and about half a wine-glass of it taken twice
a-day: or prepared steel may be taken in the dose of half a drachm,
mixed with a little honey or treacle, three or four times a-day. The
bark and other bitters may either be taken in substance or infusion, as
is most agreeable to the patient.

When obstructions proceed from a viscid state of the blood; or for women
of a gross or full habit, evacuations, and such medicines as attenuate
the humours, are necessary. The patient in this case ought to be bled,
to bathe her feet frequently in warm water, to take now and then a
cooling purge, and to live upon a spare thin diet. Her drink should be
whey, water, or small beer, and she ought to take sufficient exercise. A
tea-spoonful of the tincture of black hellebore may also be taken twice
a-day in a cup of warm water.

When obstructions proceed from affections of the mind, as grief, fear,
anger, &c. every method should be taken to amuse and divert the patient.
And that she may the more readily forget the cause of her affliction,
she ought, if possible, to be removed from the place where it happened.
A change of place, by presenting the mind with a variety of new objects,
has often a very happy influence in relieving it from the deepest
distress. A soothing, kind, and affable behaviour to females in this
situation is also of the last importance.

An obstruction of the _menses_ is often the effect of other maladies.
When this is the case, instead of giving medicines to force that
discharge, which might be dangerous, we ought by all means to endeavour
to restore the patient’s health and strength. When that is effected, the
other will return of course.

But the menstrual flux may be too great as well as too small. When this
happens, the patient becomes weak, the colour pale, the appetite and
digestion are bad, and œdematous swellings of the feet, dropsies, and
consumptions often ensue. This frequently happens to women about the age
of forty-five or fifty, and is very difficult to cure. It may proceed
from a sedentary life; a full diet, consisting chiefly of salted,
high-seasoned, or acrid food; the use of spirituous liquors; excessive
fatigue; relaxation; a dissolved state of the blood; violent passions of
the mind, &c.

The treatment of this disease must be varied according to its cause.
When it is occasioned by any error in the patient’s regimen, an opposite
course to that which induced the disorder must be pursued, and such
medicines taken as have a tendency to restrain the flux, and counteract
the morbid affections of the system from whence it proceeds.

To restrain the flux, the patient should be kept quiet and easy both in
body and mind. If it be very violent, she ought to lie in bed with her
head low; to live upon a cool and slender diet, as veal or chicken
broths with bread; and to drink decoctions of nettle-roots, or the
greater comfrey. If these be not sufficient to stop the flux, stronger
astringents may be used, as Japan earth, allum, elixir of vitriol, the
Peruvian bark, &c.[179]

The _uterine flux_ may offend in quality as well as in quantity. What is
usually called the _fluor albus_, or whites, is a very common disease,
and proves extremely hurtful to delicate women. This discharge, however,
is not always white, but sometimes pale, yellow, green, or of a blackish
colour; sometimes it is sharp and corrosive, sometimes foul and fœtid,
&c. It is attended with a pale complexion, pain in the back, loss of
appetite, swelling of the feet, and other signs of debility. It
generally proceeds from a relaxed state of the body, arising from
indolence, the excessive use of tea, coffee, or other weak and watery
diet.

To remove this disease, the patient must take as much exercise as she
can bear without fatigue. Her food should be solid and nourishing, but
of easy digestion; and her drink rather generous, as red port or claret,
mixed with Pyrmont, Bristol, or lime-water. Tea and coffee are to be
avoided. I have often known strong broths have an exceeding good effect,
and sometimes a milk diet alone will perform a cure. The patient ought
not to lie too long a-bed. When medicine is necessary, we know none
preferable to the Peruvian bark, which in this case ought always to be
taken in substance. In warm weather, the cold bath will be of
considerable service.

That period of life at which the _menses_ cease to flow, is likewise
very critical to the sex. The stoppage of any customary evacuation,
however small, is sufficient to disorder the whole frame, and often to
destroy life itself. Hence it comes to pass, that so many women either
fall into chronic disorders, or die about this time. Such of them,
however, as survive it, without contracting any chronic disease, often
become more healthy and hardy than they were before, and enjoy strength
and vigour to a very great age.

If the _menses_ cease all of a sudden, in women of a full habit, they
ought to abate somewhat of their usual quantity of food, especially of
the more nourishing kind, as flesh, eggs, &c. They ought likewise to
take sufficient exercise, and to keep the body open. This may be done by
taking, once or twice a-week, a little rhubarb, or an infusion of hiera
picra in wine or brandy.

It often happens that women of a gross habit, at this period of life,
have ulcerous sores break out about their ancles, or in other parts of
the body. Such ulcers ought to be considered as critical, and should
either be suffered to continue open, or have artificial drains
substituted in their stead. Women who will have such sores dried up, are
often soon after carried off by acute diseases, or fall into those of a
chronic nature.


                             OF PREGNANCY.

Though pregnancy is not a disease, yet that state is often attended with
a variety of complaints which merit attention, and which sometimes
require the assistance of medicine. Some women indeed are more healthy
during their pregnancy than at any other time; but this is by no means
the general case: most of them _breed in sorrow_, and are frequently
indisposed during the whole time of pregnancy. Few fatal diseases,
however, happen during that period; and hardly any, except abortion,
that can be called dangerous. We shall therefore pay particular
attention to it, as it proves generally fatal to the child, and
sometimes so to the mother.

Pregnant women are often afflicted with the heart-burn. The method of
treating this complaint has been already pointed out. They are likewise,
in the more early periods of pregnancy, often harassed with sickness and
vomiting, especially in the morning. The method of relieving these
complaints has also been shewn. Both the head-ach and tooth-ach are very
troublesome symptoms of pregnancy. The former may generally be removed
by keeping the body gently open, by the use of prunes, figs, roasted
apples, and such like. When the pain is very violent, bleeding may be
necessary. For the treatment of the latter, we must refer to that
article. Several other complaints incident to pregnant women might be
mentioned, as a cough and difficulty of breathing, suppression and
incontinency of urine, &c.; but as all of these have been taken notice
of before, it is needless to repeat them.

Every pregnant woman is more or less in danger of abortion. This should
be guarded against with the greatest care, as it not only weakens the
constitution, but renders the woman liable to the same misfortune
afterwards[180]. Abortion may happen at any period of pregnancy, but it
is most common in the second or third month. Sometimes, however, it
happens in the fourth or fifth. If it happens within the first month, it
is usually called a false conception; if after the seventh month, the
child may often be kept alive by proper care.

The common causes of abortion are, the death of the child; weakness or
relaxation of the mother; great evacuations; violent exercise; raising
great weights; reaching too high; jumping, or stepping from an eminence;
vomiting; coughing; convulsion fits; blows on the belly; falls; fevers;
disagreeable smells; excess of blood; indolence; high living; or the
contrary; violent passions or affections of the mind, as fear, grief,
&c.

The signs of approaching abortion are, pain in the loins, or about the
bottom of the belly; a dull heavy pain in the inside of the thighs; a
slight degree of coldness, or shivering; sickness, palpitation of the
heart; the breasts become flat and soft; the belly falls; and there is a
discharge of blood or watery humours from the womb.

To prevent abortion, we would advise women of a weak or relaxed habit to
use solid food, avoiding great quantities of tea, and other weak and
watery liquors; to rise early and go soon to bed; to shun damp houses;
to take frequent exercise in the open air, but to avoid fatigue; and
never to go abroad in damp foggy weather, if they can shun it.

Women of a full habit ought to use a spare diet, avoiding strong
liquors, and every thing that may tend to heat the body, or increase the
quantity of blood. Their diet should be of an opening nature, consisting
principally of vegetable substances. Every woman with child ought to be
kept cheerful and easy in her mind. Her appetites, even though depraved,
ought to be indulged as far as prudence will permit.

When any signs of abortion appear, the woman ought to be laid in bed on
a mattrass, with her head low. She should be kept quiet, and her mind
soothed and comforted. She ought not to be kept too hot, nor to take any
thing of a heating nature. Her food should consist of broths, rice and
milk, jellies, gruels made of oatmeal, and the like, all of which ought
to be taken cold.

If she be able to bear it, she should lose at least half a pound of
blood from the arm. Her drink ought to be barley-water sharpened with
juice of lemon; or she may take half a drachm of powdered nitre, in a
cup of water-gruel, every five or six hours. If the woman be seized with
a violent looseness, she ought to drink the decoction of calcined
hartshorn prepared. If she be affected with vomiting, let her take
frequently two table-spoonfuls of the saline mixture. In general,
opiates are of service; but they should always be given with caution.

Sanguine robust women, who are liable to miscarry at a certain time of
pregnancy, ought always to be bled a few days before that period
arrives. By this means, and observing the regimen above prescribed, they
might often escape that misfortune.

Though we recommend due care for preventing abortion, we would not be
understood as restraining pregnant women from their usual exercises.
This would generally operate the quite contrary way. Want of exercise
not only relaxes the body, but induces a plethora, or too great a
fulness of the vessels, which are the two principal causes of abortion.
There are, however, some women of so delicate a texture, that it is
necessary for them to avoid almost every kind of exercise during the
whole period of pregnancy.


                            OF CHILD-BIRTH.

Many diseases proceed from the want of due care in child-bed; and the
more hardy part of the sex are most apt to despise the necessary
precautions in this state. This is peculiarly the case with young wives.
They think, when the labour-pains are ended, the danger is over; but in
truth it may only then be said to be begun. Nature, if left to herself,
will seldom fail to expel the _fœtus_; but proper care and management
are certainly necessary for the recovery of the mother. No doubt
mischief may be done by too much as well as by too little care. Hence
females who have the greatest number of attendants in child-bed
generally recover worst. But this is not peculiar to the state of
child-bed. Excessive care always defeats its own intention, and is
generally more dangerous than none at all[181].

During actual labour, nothing of a heating nature ought to be given. The
woman may now and then take a little panado, and her drink ought to be
toast and water, or thin groat-gruel. Spirits, wines, cordial waters,
and other things which are given with a view to strengthen the mother,
and promote the birth, for the most part tend only to increase the
fever, inflame the womb, and retard the labour. Besides, they endanger
the woman afterwards, as they often occasion violent and mortal
hæmorrhages, or dispose her to eruptive and other fevers.

When the labour proves tedious and difficult, to prevent inflammations,
it will be proper to bleed. An emollient clyster ought likewise
frequently to be administered; and the patient should sit over the
steams of warm water. The passage ought to be gently rubbed with a
little soft _pomatum_ or fresh butter, and cloths wrung out of warm
water applied over the belly. If nature seems to sink, and the woman is
greatly exhausted with fatigue, a draught of generous wine, or some
other cordial, may be given, but not otherwise. These directions are
sufficient in natural labours; and in all preternatural cases, a skilful
surgeon, or man-midwife, ought to be called as soon as possible.

After delivery, the woman ought to be kept as quiet and easy as
possible[182]. Her food should be light and thin, as gruel, panado, &c.
and her drink weak and diluting. To this rule, however, there are many
exceptions. I have known several women, whose spirits could not be
supported in child-bed without solid food and generous liquors; to such,
a glass of wine and a bit of chicken must be allowed.

Sometimes an excessive hæmorrhage or flooding happens after delivery. In
this case the patient should be laid with her head low, kept cool, and
be in all respects treated as for an excessive flux of the _menses_. If
the flooding proves violent, linen cloths, which have been wrung out of
a mixture of equal parts of vinegar and water, or red wine, should be
applied to the belly, the loins, and the thighs: these must be changed
as they grow dry; and may be discontinued as soon as the flooding
abates[183].

If there be violent pains after delivery, the patient ought to drink
plentifully of warm diluting liquors, as groat-gruel, or tea with a
little saffron in it; and to take small broths, with carrawayseeds, or a
bit of orange-peel in them; an ounce of the oil of sweet almonds may
likewise be frequently taken in a cup of any of the above liquors; and
if the patient be restless, a spoonful of the syrup of poppies may now
and then be mixed with a cup of her drink. If she be hot or feverish,
one of the following powders may be taken in a cup of her usual drink
every five or six hours[184].

An inflammation of the womb is a dangerous and not unfrequent disease
after delivery. It is known by pains in the lower part of the belly,
which are greatly increased upon touching; by the tension or tightness
of the parts; great weakness; change of countenance; a constant fever,
with a weak and hard pulse; a slight _delirium_ or raving; sometimes
incessant vomiting; a hiccup; a discharge of reddish, stinking, sharp
water from the womb; an inclination to go frequently to stool; a heat,
and sometimes total suppression of urine.

This must be treated like other inflammatory disorders, by bleeding and
plentiful dilution. The drink may be thin gruel or barley-water; in a
cup of which half a drachm of nitre may be dissolved, and taken three or
four times a-day. Clysters of warm milk and water must be frequently
administered; and the belly should be fomented by cloths wrung out of
warm water, or by applying bladders filled with warm milk and water to
it.

A suppression of the _lochia_, or usual discharges after delivery, and
the milk-fever, must be treated nearly in the same manner as an
inflammation of the womb. In all these cases, the safest course is
plentiful dilution, gentle evacuations, and fomentations of the parts
affected. In the milk-fever, the breads may be embrocated with a little
warm linseed oil, or the leaves of red cabbage may be applied to them.
The child should be often put to the breast, or it should be drawn by
some other person.

Nothing would tend more to prevent the milk-fever than putting the child
early to the breast. The custom of not allowing children to suck for the
first two or three days, is contrary to Nature and common sense, and is
very hurtful both to the mother and child.

Every mother who has milk in her breasts, ought either to suckle her own
child, or to have her breasts frequently drawn, at least for the first
month. This would prevent many of the diseases which prove fatal to
women in child-bed.

When an inflammation happens in the breast, attended with redness,
hardness, and other symptoms of suppuration, the safest application is a
poultice of bread and milk, softened with oil or fresh butter. This may
be renewed twice a-day, till the tumour be either discussed or brought
to suppuration. The use of repellents, in this case, is very dangerous;
they often occasion fevers, and sometimes cancers; whereas a suppuration
is seldom attended with any danger, and has often the most salutary
effects.

When the nipples are fretted or chapt, they may be anointed with a
mixture of oil and beeswax, or a little powdered gum-arabic may be
sprinkled on them. I have seen Hungary water applied to the nipples have
a very good effect. Should the complaint prove obstinate, a cooling
purge may be given, which generally removes it.

The miliary fever is a disease incident to women in child-bed; but as it
has been treated of already, we shall take no further notice of it. The
celebrated Hoffman observes, That this fever of child-bed women might
generally be prevented, if they, during their pregnancy, were regular in
their diet, used moderate exercise, took now and then a gentle laxative
of manna, rhubarb, or cream of tartar; not forgetting to bleed in the
first months, and avoid all sharp air. When the labour is coming on, it
is not to be hastened with forcing medicines, which inflame the blood
and humours, or put them into unnatural commotions. Care should be
taken, after the birth, that the natural excretions proceed regularly;
and if the pulse be quick, a little nitrous powder, or some other
cooling medicines, should be administered.

The most fatal disorder consequent upon delivery is the _puerperal_, or
child-bed fever. It generally makes its attack upon the second or third
day after delivery. Sometimes indeed it comes on sooner, and at other
times, though rarely, it does not appear before the fifth or sixth day.

It begins, like most other fevers, with a cold or shivering fit, which
is succeeded by restlessness, pain of the head, great sickness at
stomach, and bilious vomiting. The pulse is generally quick, the tongue
dry, and there is a remarkable depression of spirits and loss of
strength. A great pain is usually felt in the back, hips, and region of
the womb; a sudden change in the quantity or quality of the _lochia_
also takes place; and the patient is frequently troubled with a
_tenesmus_, or constant inclination to go to stool. The urine, which is
very high-coloured, is discharged in small quantity, and generally with
pain. The belly sometimes swells to a considerable bulk, and becomes
susceptible of pain from the slightest touch. When the fever has
continued for a few days, the symptoms of inflammation usually subside,
and the disease acquires a more putrid form. At this period, if not
sooner, a bilious or putrid looseness, of an obstinate and dangerous
nature, comes on, and accompanies the disease through all its future
progress.

There is not any disease that requires to be treated with more skill and
attention than this; consequently the best assistance ought always to be
obtained as soon as possible. In women of plethoric constitutions,
bleeding will generally be proper at the beginning; it ought however to
be used with caution, and not to be repeated unless where the signs of
inflammation rise high; in which case it will also be necessary to apply
a blistering-plaster to the region of the womb.

During the rigour, or cold fit, proper means should be used to abate its
violence, and shorten its duration. For this purpose the patient may
drink freely of warm diluting liquors, and, if low, may take now and
then a cup of whine-whey; warm applications to the extremities, as
heated bricks, bottles or bladders filled with warm water, and such
like, may also be used with advantage.

Emollient clysters of milk and water, or of chicken water, ought to be
frequently administered through the course of the disease. These prove
beneficial by promoting a discharge from the intestines, and also by
acting as a kindly fomentation to the womb and parts adjacent. Great
care however is requisite in giving them, on account of the tenderness
of the parts in the _pelvis_ at this time.

To evacuate the offending bile from the stomach, a vomit is generally
given. But as this is apt to increase the irritability of the stomach,
already too great, it will be safer to omit it, and to give in its stead
a gentle laxative, which will both tend to cool the body, and to procure
a free discharge of the bile[185].

The medicine which I have always found to succeed best in this disease
is the saline draught. This, if frequently repeated, will often put a
stop to the vomiting, and at the same time lessen the violence of the
fever. If it runs off by stool, or if the patient be restless, a few
drops of laudanum, or some syrup of poppies, may occasionally be added.

If the stools should prove so frequent as to weaken and exhaust the
patient, a starch clyster, with thirty or forty drops of laudanum in it,
may be administered as occasion shall require; and the drink may be
rice-water, in every English pint of which half an ounce of gum-arabic
has been dissolved. Should these fail, recourse must be had to
Columbo-root, or some other strong astringent.

Though in general the food ought to be light, and the drink diluting,
yet when the disease has been long protracted, and the patient is
greatly spent by evacuations, it will be necessary to support her with
nourishing diet and generous cordials.

It was observed that this fever, after continuing for some time, often
acquires a putrid form. In this case the Peruvian bark must be given,
either by itself, or joined with cordials, as circumstances may require.
As the bark in substance will be apt to purge, it may be given in
decoction or infusion mixed with the tincture of roses, or other gentle
astringents; or, a scruple of the extract of bark with half an ounce of
spirituous cinnamon-water, two ounces of common water, and ten drops of
laudanum, may be made into a draught, and given every second, third, or
fourth hour, as shall be found necessary.

When the stomach will not bear any kind of nourishment, the patient may
be supported for some time by clysters of beef tea, or chicken water.

To avoid this fever, every woman in child-bed ought to be kept perfectly
easy; her food should be light and simple, and her bed-chamber cool, and
properly ventilated. There is not any thing more hurtful to a woman in
this situation than being kept too warm. She ought not to have her body
bound too tight, nor to rise too soon from bed, after delivery; catching
cold is also to be avoided; and a proper attention should be paid to
cleanliness.

To prevent the milk-fever, the breast ought to be frequently drawn; and
if they are filled previous to the onset of a fever, they should, upon
its first appearance, be drawn, to prevent the milk from becoming acrid,
and its being absorbed in this state. Costiveness is likewise to be
avoided. This will be best effected by the use of mild clysters and a
laxative diet.

We shall conclude our observations on child-bed women by recommending it
to them, above all things, to beware of cold. Poor women, whose
circumstances oblige them to quit their bed too soon, often contract
diseases from cold, of which they never recover. It is pity the poor are
not better taken care of in this situation.

But the better sort of women run the greatest hazard from too much heat.
They are generally kept in a sort of bagnio for the first eight or ten
days, and then dressed out to see company. The danger of this conduct
must be obvious to every one.

The superstitious custom of obliging women to keep the house till they
go to church, is likewise a very common cause of catching cold. All
churches are damp, and most of them cold; consequently they are the very
word places to which a woman can go to make her first visit, after
having been confined in a warm room for a month.


                             OF BARRENNESS.

Barrenness may be very properly reckoned among the diseases of females,
as few married women who have not children enjoy a good state of health.
It may proceed from various causes, as high living, grief, relaxation,
&c. but it is chiefly owing to an obstruction or irregularity of the
menstrual flux.

It is very certain that high living vitiates the humours, and prevents
fecundity. We seldom find a barren woman among the labouring poor, while
nothing is more common among the rich and affluent. The inhabitants of
every country are prolific in proportion to their poverty; and it would
be an easy matter to adduce many instances of women, who, by being
reduced to live entirely upon a milk and vegetable diet, have conceived
and brought forth children, though they never had any before. Would the
rich use the same sort of food and exercise as the better sort of
peasants, they would seldom have cause to envy their poor vassals and
dependants the blessing of a numerous and healthy offspring, while they
pine in sorrow for the want of even a single heir to their extensive
domains.

Affluence begets indolence, which not only vitiates the humours, but
induces a general relaxation of the solids; a state, highly unfavourable
to procreation. To remove this, we would recommend the following course:
First, sufficient exercise in the open air; secondly, a diet consisting
chiefly of milk and vegetables[186]; thirdly, the use of astringent
medicines, as steel, allum, dragon’s blood, elixir of vitriol, the Spaw
or Tunbridge waters, Peruvian bark, &c.; and lastly, above all, the cold
bath.

Barrenness is often the consequence of grief, sudden fear, anxiety, or
any of the passions which tend to obstruct the menstrual flux. When
barrenness is suspected to proceed from affections of the mind, the
person ought to be kept as easy and cheerful as possible; all
disagreeable objects are to be avoided, and every method taken to amuse
and entertain the fancy.




                              CHAP. XLIX.
                         DISEASES OF CHILDREN.


Miserable indeed is the lot of man in the state of infancy! He comes
into the world more helpless than any other animal, and stands much
longer in need of the protection and care of his parents; but, alas!
this care is not always bestowed upon him; and when it is, he often
suffers as much from improper management as he would have done from
neglect. Hence the officious care of parents, nurses, and midwives,
becomes one of the most fruitful sources of the disorders of
infants[187].

It must be obvious to every attentive person, that the first diseases of
infants arise chiefly from their bowels. Nor is this in the least to be
wondered at, as they are in a manner poisoned with indigestible drugs
and improper diet as soon as they come into the world. Every thing that
the stomach cannot digest may be Considered as a poison; and unless it
can be thrown up, or voided by stool, it must occasion sickness, gripes,
spasmodic affections of the bowels, or what the good women call inward
fits, and at last convulsions and death.

As these symptoms evidently arise from somewhat that irritates the
intestines, doubtless the proper method of cure must be to expel it as
soon as possible. The most safe and effectual method of doing this is by
gentle vomits. Five or six grains of the powder of ipecacuanha may be
mixed in two table-spoonfuls of water, and sweetened with a little
sugar. A tea-spoonful of this may be given to the infant every quarter
of an hour till it operates; or, what will more certainly answer the
purpose, a grain of emetic tartar may be dissolved in three ounces of
water, sweetened with a little syrup, and given as above. Those who are
unwilling to use the emetic tartar, may give six or seven drops of the
antimonial wine, in a tea-spoonful of water or thin gruel. Small doses
of the ipecacuanha wine will be found more gentle than any of the above,
and ought to be preferred.

These medicines will not only cleanse the stomach, but will generally
likewise open the body. Should this however not happen, and if the child
be costive, some gentle purge will be necessary: for this purpose, some
manna and pulp of cassia may be dissolved in boiling water, and given in
small quantities till it operates; or, what will answer rather better, a
few grains of _magnesia alba_ may be mixed in any kind of food that is
given to the child, and continued till it has the desired effect. If
these medicines be properly administered, and the child’s belly and
limbs frequently rubbed with a warm hand before the fire, they will
seldom fail to relieve those affections of the stomach and bowels from
which infants suffer so much.

These general directions include most of what can be done for relieving
the internal disorders of infants. They will likewise go a considerable
way in alleviating those which appear externally, as the rash, _gum_, or
_fellon_, &c. These, as was formerly observed, are principally owing to
too hot a regimen, and consequently will be most effectually relieved by
gentle evacuations. Indeed, evacuations of one kind or other constitute
a principal part of the medicine of infants, and will seldom, if
administered with prudence, in any of their diseases, fail to give
relief.


                            OF THE MECONIUM.

The stomach and bowels of a new-born infant are filled with a
blackish-coloured matter of the consistence of syrup, commonly called
the _meconium_. This is generally passed soon after the birth, by the
mere effort of Nature; in which case it is not necessary to give the
infant any kind of medicine. But if it should be retained, or not
sufficiently carried off, a little manna or _magnesia alba_ may be
given, as mentioned above; or, if these should not be at hand, a common
spoonful of whey, sweetened with a little honey, or raw sugar, will
answer the purpose.

The most proper medicine for expelling the _meconium_ is the mother’s
milk, which is always at first of a purgative quality. Were children
allowed to suck as soon as they shew an inclination for the breast, they
would seldom have occasion for medicines to discharge the _meconium_;
but even where this is not allowed, they ought never to have daubs of
syrup, oils, and other indigestible stuff, crammed down their throats.


                         THE APHTHÆ OR THRUSH.

The aphthæ are little whitish ulcers affecting the whole inside of the
mouth, tongue, throat, and stomach of infants. Sometimes they reach
through the whole intestinal canal; in which case they are very
dangerous, and often put an end to the infant’s life.

If the aphthæ are of a pale colour, pellucid, few in number, soft,
superficial, and fall easily off, they are not dangerous; but if opake,
yellow, brown, black, thick, or running together, they ought to be
dreaded.

It is generally thought that the aphthæ owe their origin to acid
humours; we have reason however to believe, they are more frequently
owing to too hot a regimen both of the mother and child. It is a rare
thing to find a child who is not dosed with wine, punch,
cinnamon-waters, or some other hot and inflaming liquors, almost as soon
as it is born. It is well known that these will occasion inflammatory
disorders even in adults; is it any wonder then that they should heat
and inflame the tender bodies of infants, and set as it were the whole
constitution on a blaze?

The most proper medicines for the aphthæ are vomits, such as have been
already recommended, and gentle laxatives. Five grains of rhubarb and
half a drachm of _magnesia alba_ may be rubbed together, and divided
into six doses, one of which may be given to the infant every four or
five hours till they operate. These powders may either be given in the
child’s food, or a little of the syrup of pale roses, and may be
repeated as often as is found necessary to keep the body open. It is
common in this case to administer calomel; but as that medicine
sometimes occasions gripes, it ought always to be given to infants with
caution.

Many things have been recommended for gargling the mouth and throat in
this disease; but it is not easy to apply these in very young infants;
we would therefore recommend it to the nurse to rub the child’s mouth
frequently with a little borax and honey; or with the following mixture:
Take fine honey an ounce, borax a drachm, burnt alum half a drachm,
rose-water two drachms; mix them together. A very proper application in
this case, is a solution of ten or twelve grains of white vitriol in
eight ounces of barley-water. These may be applied with the finger, or
by means of a bit of soft rag tied to the end of a probe.


                             OF ACIDITIES.

The food of children being for the most part of an acescent nature, it
readily turns sour upon the stomach, especially if the body be any way
disordered. Hence most diseases of children are accompanied with evident
signs of acidity, as green stools, gripes, &c. These appearances have
induced many to believe, that all the diseases of children were owing to
an acid abounding in the stomach and bowels; but whoever considers the
matter attentively, will find that these symptoms of acidity are oftner
the effect than the cause of their diseases.

Nature evidently intended, that the food of children should be acescent;
and unless the body be disordered, or the digestion hurt, from some
other cause, we will venture to say, that the acescent quality of their
food is seldom injurious to them. Acidity, however, is often a symptom
of disorders in children, and, as it is sometimes a troublesome one, we
shall point out the method of relieving it.

When green stools, gripes, purgings, sour smells, &c. shew that the
bowels abound with an acid, the child should have a little small broth,
with light white bread in it; and should have sufficient exercise in
order to promote the digestion. It has been customary in this case to
give the pearl-julep, chalk, crabs eyes, and other testaceous powders.
These, indeed, by their absorbent quality, may correct the acidity; but
they are attended with this inconvenience, that they are apt to lodge in
the bowels, and occasion costiveness, which may prove very hurtful to
the infant. For this reason they should never be given unless mixed with
purgative medicines; as rhubarb, manna, or such like.

The best medicine which we know, in all cases of acidity, is that fine
insipid powder called _magnesia alba_. It purges, and at the same time
corrects the acidity: by which means it not only removes the disease,
but carries off its cause. It may be given in any kind of food, or in a
mixture, as recommended in the Appendix[188].

When an infant is troubled with gripes, it ought not at first to be
dosed with brandy, spiceries, and other hot things, but should have its
body opened with an emollient clyster, or the medicine mentioned above;
and at the same time a little brandy may be rubbed on its belly with a
warm hand before the fire. I have seldom seen this fail to ease the
gripes of infants. If it should happen, however, not to succeed, a
little brandy or other spirits may be mixed with thrice the quantity of
warm water, and a tea-spoonful of it given frequently till the infant be
easier. Sometimes a little peppermint-water will answer this purpose
very well.


                        GALLING AND EXCORIATION.

These are very troublesome to children. They happen chiefly about the
groin and wrinkles of the neck, under the arms, behind the ears, and in
other parts that are moistened by the sweat or urine.

As these complaints are, in a great measure, owing to want of
cleanliness, the most effectual means of preventing them are, to wash
the parts frequently with cold water, to change the linen often, and, in
a word, to keep the child in all respects thoroughly clean. When this is
not sufficient, the excoriated parts may be sprinkled with absorbent or
drying powders; as burnt hartshorn, tutty, chalk, crabs claws prepared,
and the like. When the parts affected are very sore, and tend to a real
ulceration, it will be proper to add a little sugar of lead to the
powders; or to anoint the place with the camphorated ointment. If the
parts be washed with spring water, in which a little white vitriol has
been dissolved, it will dry and heal them very powerfully. One of the
best applications for this purpose, is to dissolve some fuller’s earth
in a sufficient quantity of hot water; and after it has stood till it is
cold, to rub it gently upon the galled parts once or twice a-day.


                         STOPPAGE OF THE NOSE.

The nostrils of infants are often plugged up with a gross _mucus_, which
prevents their breathing freely, and likewise renders it difficult for
them to suck or swallow.

Some in this case order, after a suitable purge, two or three grains of
white vitriol dissolved in half an ounce of marjoram-water, and
filtered, to be applied now and then to the nostrils with a linen rag.
Wedelius says, If two grains of white vitriol, and the same quantity of
_elaterium_, be dissolved in half an ounce of marjoram-water, and
applied to the nose, as above directed, that it brings away the _mucus_
without sneezing.

In obstinate cases these medicines may be tried; but I have never found
any thing necessary, besides rubbing the nose at bed-time with a little
sweet oil, or fresh butter. This resolves the filth, and renders the
breathing more free[189].


                              OF VOMITING.

From the delicate state of children, and the great sensibility of their
organs, a vomiting or looseness may be induced by any thing that
irritates the nerves of the stomach or intestines. Hence these disorders
are much more common in childhood than in the more advanced periods of
life. They are seldom however dangerous, and ought never to be
considered as diseases, unless when they are violent, or continue so
long as to exhaust the strength of the patient.

Vomiting may be excited by an over-quantity of food; by food that is of
such a nature as to irritate the nerves of the stomach too much; or by
the sensibility of the nerves being so much increased as to render them
unable to bear the stimulus of even the mildest element.

When vomiting is occasioned by too much food, it ought to be promoted,
as the cure will depend upon cleansing the stomach. This may be done
either by a few grains of ipecacuanha, or a weak solution of emetic
tartar, as mentioned before. When it is owing to food of an acrid or
irritating quality, the diet ought to be changed, and aliment of a
milder nature substituted in its stead.

When vomiting proceeds from an increased degree of sensibility, or too
great an irritability of the nerves of the stomach, such medicines as
have a tendency to brace and strengthen that organ, and to abate its
sensibility, must be used. The first of these intentions may be answered
by a slight infusion of the Peruvian bark, with the addition of a little
rhubarb and orange-peel; and the second by the saline draughts, to which
a few drops of liquid laudanum may be occasionally added.

In obstinate vomitings the operation of internal medicines may be
assisted by aromatic fomentations made with wine, applied warm to the
pit of the stomach; or the use of the stomach plaster, with the addition
of a little _Theriaca_.


                            OF A LOOSENESS.

A looseness may generally be reckoned salutary when the stools are sour,
slimy, green, or curdled. It is not the discharge, but the production of
such stools, which ought to be remedied. Even where the purging is thin
and watery, it ought not to be checked too suddenly, as it often proves
critical, especially when the child has caught cold, or an eruption on
the skin has disappeared. Sometimes an evacuation of this kind succeeds
a humid state of the atmosphere, in which case it may also prove of
advantage, by carrying off a quantity of watery humours, which would
otherwise tend to relax the habit.

As the principal intention of the cure of a looseness is to evacuate the
offending matter, it is customary to give the patient a gentle vomit of
ipecacuanha, and afterwards to exhibit small and frequent doses of
rhubarb; interposing absorbent medicines, to mitigate the acrimony of
the humours. The best purge, however, in this case, is _magnesia alba_.
It is at the same time absorbent and laxative, and operates without
exciting gripes.

The antimonial wine, which acts both as an emetic and purge, is also an
excellent medicine in this case. By being diluted with water, it may be
proportioned to the weakest constitution; and, not being disagreeable to
the palate, it may be repeated as often as occasion requires. Even one
dose will frequently mitigate the disease, and pave the way for the use
of absorbents. If, however, the patient’s strength will permit, the
medicine ought to be repeated every six or eight hours, till the stools
begin to assume a more natural appearance; afterwards a longer space may
be allowed to intervene between the doses. When it is necessary to
repeat the medicine frequently, the dose ought always to be a little
increased, as its efficacy is generally diminished by use.

Some, upon the first appearance of a looseness, fly immediately to the
use of absorbent medicines and astringents. If these be administered
before the offending humours are discharged, though the disease may
appear to be mitigated for a little time, it soon afterwards breaks
forth with greater violence, and often proves fatal. After proper
evacuations, however, these medicines may be administered with
considerable advantage.

Should any gripings or restlessness remain after the stomach and bowels
have been cleansed, a tea-spoonful of the syrup of poppies may be given
in a little simple cinnamon-water, three or four times a-day till these
symptoms have ceased.


                             OF ERUPTIONS.

Children, while on the breast, are seldom free from eruptions of one
kind or other. These, however, are not often dangerous, and ought never
to be dried up but with the greatest caution. They tend to free the
bodies of infants from hurtful humours, which, if retained, might
produce fatal disorders.

The eruptions of children are chiefly owing to improper food and neglect
of cleanliness. If a child be stuffed at all hours with food that its
stomach is not able to digest, such food, not being properly
assimilated, instead of nourishing the body, fills it with gross
humours. These must either break out in form of eruptions upon the skin,
or remain in the body, and occasion fevers and other internal disorders.
That neglect of cleanliness is a very general cause of eruptive
disorders, must be obvious to every one. The children of the poor, and
of all who despise cleanliness, are almost constantly found to swarm
with vermin, and are generally covered with the scab, itch, and other
eruptions.

When eruptions are the effect of improper food, or want of cleanliness,
a proper attention to these alone will generally be sufficient to remove
them. If this should not be the case, some drying medicines will be
necessary. When they are applied, the body ought at the same time to be
kept open, and cold is carefully to be avoided. We know no medicine that
is more safe for drying up cutaneous eruptions than sulphur, provided it
be prudently used. A little of the flour of sulphur may be mixed with
fresh butter, oil, or hog’s lard, and the parts affected frequently
touched with it.

The most obstinate of all the eruptions incident to children are, the
_tinea capitis_, or scabbed head, and chilblains. The scabbed head is
often exceeding difficult to cure, and sometimes indeed the cure proves
worse than the disease. I have frequently known children seized with
internal disorders, of which they died soon after their scabbed heads
had been healed by the application of drying medicines[190]. The cure
ought always first to be attempted by keeping the head very clean,
cutting off the hair, combing and brushing away the scabs, &c. If this
is not sufficient, let the head be shaved once a-week, washed daily with
soap suds, and gently anointed with a liniment made of train oil eight
ounces, red precipitate, in fine powder, one drachm. And if there be
proud flesh, it should be touched with a bit of blue vitriol, sprinkled
with a little burnt allum. While these things are doing, the patient
must be confined to a regular light diet, the body should be kept gently
open; and cold, as far as possible, ought to be avoided. To prevent any
bad consequences from stopping this discharge, it will be proper,
especially in children of a gross habit, to make an issue in the neck or
arm, which may be kept open till the patient becomes more strong, and
the constitution be somewhat mended.

Chilblains commonly attack children in cold weather. They are generally
occasioned by the feet or hands being kept long wet or cold, and
afterwards suddenly heated. When children are cold, instead of taking
exercise to warm themselves gradually, they run to the fire. This
occasions a sudden rarefaction of the humours, and an infarction of the
vessels; which being often repeated, the vessels are at last
over-distended, and forced to give way.

To prevent it, violent cold and sudden heat must be equally avoided.
When the parts begin to look red and swell, the patient ought to be
purged, and to have the affected parts frequently rubbed with mustard
and brandy, or something of a warming nature. They ought likewise to be
covered with flannel, and kept warm and dry. Some apply warm ashes
between cloths to the swelled parts, which frequently help to reduce
them. When there is a sore, it must be dressed with Turner’s cerate, the
ointment of tutty, the plaster of cerus, or some other drying ointment.
These sores are indeed troublesome, but seldom dangerous. They generally
heal as soon as the warm weather sets in.


                             OF THE CROUP.

Children are often seized very suddenly with this disease, which, if not
quickly relieved, proves mortal. It is known by various names in
different parts of Britain. On the east coast of Scotland it is called
the _croup_. On the west they call it the _chock_ or _stuffing_. In some
parts of England, where I have observed it, the good women call it _the
rising of the lights_. It seems to be a species of _asthma_, attended
with very acute and violent catarrhal symptoms.

This disease generally prevails in cold and wet seasons. It is most
common upon the sea-coast, and in low marshy countries. Children of a
gross and lax habit are most liable to it. I have sometimes known it
hereditary. It generally attacks children in the night, after having
been much exposed to damp cold easterly winds through the day. Damp
houses, wet feet, thin shoes, wet clothes, or any thing that obstructs
the perspiration, may occasion the croup.

It is attended with a frequent pulse, quick and laborious breathing,
which is performed with a peculiar kind of croaking noise, that may be
heard at a considerable distance. The voice is sharp and shrill, and the
face is generally much flushed, though sometimes it is of a livid
colour.

When a child is seized with the above symptoms, his feet should
immediately be put into warm water. He ought likewise to be bled[191],
and to have a laxative clyster administered as soon as possible. He
should be made to breathe over the steams of warm water and vinegar; or
an emollient decoction, and emollient cataplasms or fomentations may be
applied round his neck. If the symptoms do not abate, a blistering
plaster must be applied round the neck, or between the shoulders, and
the child may take frequently a table-spoonful of the following julep:
Take penny-royal water three ounces, syrup of althea and balsamic syrup,
each one ounce, mix them together.

Asafœtida is found to have a good effect in this case. It may be both
given in form of clyster, and taken by the mouth. Two drachms of
asafœtida may be dissolved in one ounce of Mindererus’s spirit, and
three ounces of penny-royal water. A table-spoonful of this mixture may
be given every hour, or oftner, if the patient’s stomach be able to bear
it. If the child cannot be brought to take this medicine, two drachms of
the asafœtida may be dissolved in a common clyster, and administered
every six or eight hours, till the violence of the disease abates[192].

To prevent a return of the disorder, all those things which occasion it
must be carefully avoided; as wet feet, cold, damp, easterly winds, &c.
Children who have had frequent returns of this disease, or whose
constitutions seem to dispose them to it, ought to have their diet
properly regulated; all food that is viscid or hard of digestion, and
all crude, raw, trashy fruits, are to be avoided. They ought likewise to
have a drain constantly kept open in some part of their body, by means
of a seton or issue. I have sometimes known a Burgundy-pitch plaster,
worn continually between the shoulders for several years, have a very
happy effect in preventing the return of this dreadful disorder.


                              OF TEETHING.

Dr. Arbuthnot observes, that above a tenth part of infants die in
teething, by symptoms proceeding from the irritation of the tender
nervous parts of the jaws, occasioning inflammations, fevers,
convulsions, gangrenes, &c. These symptoms are in a great measure owing
to the great delicacy and exquisite sensibility of the nervous system at
this time of life, which is too often increased by an effeminate
education. Hence it comes to pass, that children who are delicately
brought up, always suffer most in teething, and often fall by convulsive
disorders.

About the sixth or seventh month the teeth generally begin to make their
appearance; first, the _incisores_, or fore-teeth; next, the _canini_,
or dogteeth; and, lastly, the _molares_, or grinders. About the seventh
year, there comes a new set; and about the twentieth, the two inner
grinders, called _dentes sapientiæ_, the teeth of wisdom.

Children, about the time of cutting their teeth, slaver much, and have
generally a looseness. When the teething is difficult, especially when
the dogteeth begin to make their way through the gums, the child has
startings in his sleep, tumours of the gums, watchings, gripes, green
stools, the thrush, fever, difficult breathing, and convulsions.

Difficult teething requires nearly the same treatment as an inflammatory
disease. If the body be bound, it must be opened either by emollient
clysters or gentle purgatives; as manna, _magnesia alba_, rhubarb,
senna, or the like. The food should be light, and in small quantity; the
drink plentiful, but weak and diluting, as infusions of balm, or of the
lime-tree flowers; to which about a third or fourth part of milk may be
added.

If the fever be high, bleeding will be necessary; but this in very young
children ought always to be sparingly performed. It is an evacuation
which they bear the worst of any. Purging, vomiting, or sweating, agree
much better with them, and are generally more beneficial. Harris,
however, observes, that, when an inflammation appears, the physician
will labour in vain, if the _cure_ be not begun with applying a leech
under each ear. If the child be seized with convulsion-fits, a
blistering-plaster may be applied between the shoulders, or one behind
each ear.

Sydenham says, that in fevers occasioned by teething, he never found any
remedy so effectual as two, three, or four drops of spirits of hartshorn
in a spoonful of simple water, or other convenient vehicle, given every
four hours. The number of doses may be four, five, or six. I have often
prescribed this medicine with success, but always found a larger dose
necessary. It may be given from five drops to fifteen or twenty,
according to the age of the child, and, when costiveness does not forbid
it, three or four drops of laudanum may be added to each dose.

In Scotland, it is very common, when children are cutting their teeth,
to put a small Burgundy-pitch plaster between their shoulders. This
generally eases the tickling cough which attends teething, and is by no
means an useless application. When the teeth are cut with difficulty, it
ought to be kept on during the whole time of teething. It may be
enlarged as occasion requires, and ought to be renewed at least once a
fortnight.

Several things have been recommended for rubbing the gums, as oils,
mucilages, &c.; but from these much is not to be expected. If any thing
of this kind is to be used, we would recommend a little fine honey,
which may be rubbed on with the finger three or four times a-day.
Children are generally at this time disposed to chew whatever they get
into their hands. For this reason they ought never to be without
somewhat that will yield a little to the pressure of their gums, as a
crust of bread, a wax-candle, a bit of liquorice-root, or such like.

With regard to cutting the gums, we have seldom known it of any great
benefit. In obstinate cases, however, it ought to be tried. It may be
performed by the finger-nail, the edge of a six-penny piece that is worn
thin, or any sharp body which can be with safety introduced into the
mouth; but the lancet, in a skilful hand, is certainly the most proper.

In order to render the teething less difficult, parents ought to take
care that their children’s food be light and wholesome, and that their
nerves be braced by sufficient exercise without doors, the use of the
cold bath, &c. Were these things duly regarded, they would have a much
better effect than _teething necklaces_, or other nonsensical amulets
worn for that purpose.


                            OF THE RICKETS.

This disease generally attacks children between the age of nine months
and two years. It appeared first in England about the time when
manufactures began to flourish, and still prevails most in towns where
the inhabitants follow sedentary employments, by which means they
neglect either to take proper exercise themselves, or to give it to
their children.

CAUSES.——One cause of the rickets is diseased parents. Mothers of a weak
relaxed habit, who neglect exercise, and live upon weak watery diet, can
neither be expected to bring forth strong and healthy children, or to be
able to nurse them, after they are brought forth. Accordingly we find,
that the children of such women generally die of the rickets, the
scrophula, consumptions, or such like diseases. Children begotten by men
in the decline of life, who are subject to the gout, the gravel, or
other chronic diseases, or who have been often affected with the
venereal disease in their youth, are likewise very liable to the
rickets.

Any disorder that weakens the constitution, or relaxes the habit of
children, as the small-pox, measles, teething, the hooping-cough, &c.
disposes them to this disease. It may likewise be occasioned by improper
diet, as food that is either too weak and watery, or so viscid that the
stomach cannot digest it.

Bad nursing is the chief cause of this disease. When the nurse is either
diseased, or has not enough of milk to nourish the child, it cannot
thrive. But children suffer oftner by want of care in nurses than want
of food. Allowing an infant to lie or sit too much, or not keeping it
thoroughly clean in its clothes, has the most pernicious effects.

The want of free air is likewise very hurtful to children in this
respect. When a nurse lives in a close small house, where the air is
damp and confined, and is too indolent to carry her child abroad into
the open air, it will hardly escape this disease. A healthy child should
always be in motion, unless when asleep; if it be suffered to lie, or
sit, instead of being tossed and dandled about, it will not thrive.

SYMPTOMS.——At the beginning of this disease the child’s flesh grows soft
and flabby; its strength is diminished; it loses its wonted
cheerfulness, looks more grave and composed than is natural for its age,
and does not chuse to be moved. The head and belly become too large in
proportion to the other parts; the face appears full, and the complexion
florid. Afterwards the bones begin to be affected, especially in the
more soft and spungy parts. Hence the wrists and ancles become thicker
than usual; the spine or backbone puts on an unnatural shape; the breast
is likewise often deformed; and the bones of the arms and legs grow
crooked. All these symptoms vary according to the violence of the
disease. The pulse is generally quick, but feeble; the appetite and
digestion for the most part bad; the teeth come slowly and with
difficulty, and they often rot and fall out afterwards. Ricketty
children generally have great acuteness of mind, and an understanding
above their years. Whether this is owing to their being more in the
company of adults than other children, or to the preternatural
enlargement of the brain, is not material.

REGIMEN.——As this disease is always attended with evident signs of
weakness and relaxation, our chief aim in the cure must be to brace and
strengthen the solids, and to promote digestion and the due preparation
of the fluids. These important ends will be best answered by wholesome
nourishing diet, suited to the age and strength of the patient, open dry
air, and sufficient exercise. If the child has a bad nurse, who either
neglects her duty, or does not understand it, she should be changed. If
the season be cold, the child ought to be kept warm; and when the
weather is hot, it ought to be kept cool; as sweating is apt to weaken
it, and too great a degree of cold has the same effect. The limbs should
be rubbed frequently with a warm hand, and the child kept as cheerful as
possible.

The diet ought to be dry and nourishing, as good bread, roasted flesh,
&c. Biscuit is generally reckoned the best bread; and pigeons, pullets,
veal, rabbits, or mutton roasted or minced, are the most proper flesh.
If the child be too young for flesh-meats, he may have rice, millet, or
pearl-barley boiled with raisins, to which may be added a little wine
and spice. His drink may be good claret, mixed with an equal quantity of
water. Those who cannot afford claret, may give the child now and then a
wine-glass of mild ale, or good porter.

MEDICINE.——Medicines are here of little avail. The disease may often be
cured by the nurse, but seldom by the physician. In children of a gross
habit, gentle vomits and repeated purges of rhubarb may sometimes be of
use, but they will seldom carry off the disease; that must depend
chiefly upon such things as brace and strengthen the system: for which
purpose, besides the regimen mentioned above, we would recommend the
cold bath, especially in the warm season. It must however be used with
prudence, as some ricketty children cannot bear it. The best time for
using the cold bath is in the morning, and the child should be well
rubbed with a dry cloth immediately after he comes out of it. If the
child should be weakened by the cold bath, it must be discontinued.

Sometimes issues have been found beneficial in this disease. They are
peculiarly necessary for children who abound with gross humours. An
infusion of the Peruvian bark in wine or ale would be of service, were
it possible to bring children to take it. We might here mention many
other medicines which have been recommended for the rickets; but as
there is far more danger in trusting to these than in neglecting them
altogether, we chuse rather to pass them over, and to recommend a proper
regimen as the thing chiefly to be depended on.


                            OF CONVULSIONS.

Though more children are said to die of convulsions than of any other
disease, yet they are for the most part only a symptom of some other
malady. Whatever greatly irritates or stimulates the nerves, may
occasion convulsions. Hence infants whose nerves are easily affected,
are often thrown into convulsions by any thing that irritates the
alimentary canal; likewise by teething; strait clothes; the approach of
the small-pox, measles, or other eruptive diseases.

When convulsions proceed from an irritation of the stomach or bowels,
whatever clears them of their acrid contents, or renders these mild and
inoffensive, will generally perform a cure: wherefore, if the child be
costive, the best way will be to begin with a clyster, and afterwards to
give a gentle vomit, which may be repeated occasionally, and the body in
the mean time kept open by gentle doses of _magnesia alba_, or small
quantities of rhubarb mixed with the powder of crabs claws.

Convulsions which precede the eruption of the small-pox or measles
generally go off upon these making their appearance. The principal
danger in this case arises from the fears and apprehensions of those who
have the care of the patient. Convulsions are very alarming, and
something must be done to appease the affrighted parents, nurses, &c.
Hence the unhappy infant often undergoes bleeding, blistering, and
several other operations, to the great danger of its life, when a little
time, bathing the feet in warm water, and throwing in a mild clyster,
would have set all to rights.

When convulsion fits arise from the cutting of teeth, besides gentle
evacuations, we would recommend blistering, and the use of antispasmodic
medicines, as the tincture of soot, asafœtida, or castor. A few drops of
any of these may be mixed in a cup of white-wine whey, and given
occasionally.

When convulsions proceed from any external cause, as the pressure
occasioned by strait clothes or bandages, &c. these ought immediately to
be removed; though in this case taking away the cause will not always
remove the effect, yet it ought to be done. It is not likely that the
patient will recover, as long as the cause which first gave rise to the
disorder continues to act.

When a child is seized with convulsions without having any complaint in
the bowels, or symptoms of teething; or any rash or other discharge
which has been suddenly dried up; we have reason to conclude that it is
a primary disease, and proceeds immediately from the brain. Cases of
this kind, however, happen but seldom, which is very fortunate, as
little can be done to relieve the unhappy patient. When a disease
proceeds from an origial fault in the formation or structure of the
brain itself, we cannot expect that it should yield to medicine. But as
this is not always the cause, even of convulsions which proceed
immediately from the brain, some attempts should be made to remove them.
The chief intention to be pursued for this purpose, is to make some
derivation from the head, by blistering, purging, and the like. Should
these fail, issues or setons may be put in the neck, or between the
shoulders.


                         OF WATER IN THE HEAD.

Though water in the head, or a dropsy of the brain, may affect adults as
well as children, yet, as the latter are more peculiarly liable to it,
we thought it would be most proper to place it among the diseases of
infants.

CAUSES.——A dropsy of the brain may proceed from injuries done to the
brain itself by falls, blows, or the like; it may likewise proceed from
an original laxity or weakness of the brain; from scirrhous tumours or
excrescences within the skull; a thin watery state of the blood; a
diminished secretion of urine; and, lastly, from tedious and lingering
diseases, which waste and consume the patient.

SYMPTOMS.——This disease has at first the appearance of a slow fever; the
patient complains of a pain in the crown of his head, or over his eyes;
he shuns the light; is sick, and sometimes vomits; his pulse is
irregular and generally low: though he seems heavy and dull, yet he does
not sleep: he is sometimes delirious, and frequently sees objects
double; towards the end of this commonly fatal disease, the pulse
becomes more frequent, the pupils are generally dilated, the cheeks
flushed, the patient becomes comatose, and convulsions ensue.

MEDICINE.——No medicine has hitherto been found sufficient to carry off a
dropsy of the brain. It is laudable, however, to make some attempts, as
time or chance may bring many things to light, of which at present we
have no idea. The medicines generally used are, purges of rhubarb or
jalap with calomel, and blistering-plasters applied to the neck or back
part of the head. To which we would beg leave to add diuretics, or
medicines which promote the secretion of urine, such as are recommended
in the common dropsy. A discharge from the nose ought likewise to be
promoted by causing the patient to snuff the powder of asarum, white
hellebore, or the like.

Some practitioners have of late pretended to cure this disease by the
use of mercury. I have not been so happy as to see any instances of a
cure being performed in a confirmed dropsy of the brain; but in so
desperate a malady every thing deserves a trial[193].




                                CHAP. L.
                              OF SURGERY.


To describe all the operations of surgery, and to point out the
different diseases in which these operations are necessary, would extend
this article far beyond the limits allotted to it: we must therefore
confine our observations to such cases as most generally occur, and in
which proper assistance is either not asked, or not always to be
obtained.

Though an acquaintance with the structure of the human body is
indispensably necessary to qualify a man for being an expert surgeon;
yet many things may be done to save the lives of their fellow-men in
emergencies by those who are no adepts in anatomy. It is amazing with
what facility the peasants daily perform operations upon brute animals,
which are not of a less difficult nature than many of those performed on
the human species; yet they seldom fail of success.

Indeed every man is in some measure a surgeon whether he will or not. He
feels an inclination to assist his fellow-men in distress, and accidents
happen every hour which give occasion to exercise this feeling. The
feelings of the heart, however, when not directed by the judgment, are
apt to mislead. Thus one, by a rash attempt to save his friend, may
sometimes destroy him; while another, for fear of doing amiss, stands
still and sees his bosom-friend expire without so much as attempting to
relieve him, even when the means are in his power. As every good man
would wish to steer a course different from either of these, it will no
doubt be agreeable to him to know what ought to be done upon such
emergencies.


                              OF BLEEDING.

No operation of surgery is so frequently necessary as bleeding; it ought
therefore to be very generally understood. But though practised by
midwives, gardeners, blacksmiths, we have reason to believe that very
few know when it is proper. Even physicians themselves have been so much
the dupes of theory in this article, as to render it the subject of
ridicule. It is however an operation of great importance, and must, when
seasonably and properly performed, be of singular service to those in
distress.

Bleeding is proper at the beginning of all inflammatory fevers, as
pleurisies, peripneumonies, &c. It is likewise proper in all topical
inflammations, as those of the intestines, womb, bladder, stomach,
kidnies, throat, eyes, &c. as also in the asthma, sciatic pains, coughs,
head-achs, rheumatisms, the apoplexy, epilepsy, and bloody flux. After
falls, blows, bruises, or any violent hurt received either externally or
internally, bleeding is necessary. It is likewise necessary for persons
who have had the misfortune to be strangled, drowned, suffocated with
foul air, the fumes of metal, or the like. In a word, whenever the vital
motions have been suddenly stopt from any cause whatever, except in
swoonings occasioned by mere weakness or hysteric affections, it is
proper to open a vein. But in all disorders proceeding from a relaxation
of the solids, and an impoverished state of the blood, as dropsies,
cacochymies, &c. bleeding is improper.

Bleeding for topical inflammations ought always to be performed as near
the part affected as possible. When this can be done with a lancet, it
is to be preferred to any other method; but where a vein cannot be
found, recourse must be had to leeches or cupping.

The quantity of blood to be let must always be regulated by the
strength, age, constitution, manner of life, and other circumstances
relating to the patient. It would be ridiculous to suppose that a child
could bear to lose as much blood as a grown person, or that a delicate
lady should be bled to the same extent as a robust man.

From whatever part of the body blood is to be let, a bandage must be
applied between that part and the heart. As it is often necessary, in
order to raise the vein, to make the bandage pretty tight, it will be
proper in such cases, as soon as the blood begins to flow, to slacken it
a little. The bandage ought to be applied at least an inch, or an inch
and half from the place where the wound is intended to be made.

Persons not skilled in anatomy ought never to bleed in a vein that lies
over an artery or a tendon, if they can avoid it. The former may easily
be known from its pulsation or beating, and the latter from its feeling
hard or tight like a whipcord under the finger.

It was formerly a rule, even among those who had the character of being
regular practitioners, to bleed their patients in certain diseases till
they fainted. Surely a more ridiculous rule could not be proposed. One
person will faint at the very sight of a lancet, while another will lose
almost the whole blood of his body before he faints. Swooning depends
more upon the state of the mind than of the body; besides, it may often
be occasioned or prevented by the manner in which the operation is
performed.

Children are generally bled with leeches. This, though sometimes
necessary, is a very troublesome and uncertain practice. It is
impossible to know what quantity of blood is taken away by leeches;
besides, the bleeding is often very difficult to stop, and the wounds
are not easily healed. Would those who practice bleeding take a little
more pains, and accustom themselves to bleed children, they would not
find it such a difficult operation as they imagine.

Certain hurtful prejudices with regard to bleeding still prevail among
the country people. They talk, for instance, of head-veins, heart-veins,
breast-veins, &c. and believe that bleeding in these will certainly cure
all diseases of the parts from whence they are supposed to come, without
considering that all the blood-vessels arise from the heart, and return
to it again; for which reason, unless in topical inflammations, it
signifies very little from what part of the body blood is taken. But
this, though a foolish prejudice, is not near so hurtful as the vulgar
notion that the first bleeding will perform wonders. This belief makes
them often postpone the operation when necessary, in order to reserve it
for some more important occasion, and, when they think themselves in
extreme danger, they fly to it for relief, whether it be proper or not.
Bleeding at certain dated periods or seasons has likewise bad effects.

It is a common notion that bleeding in the feet draws the humours
downwards, and consequently cures diseases of the head and other
superior parts: but we have already observed that, in all topical
affections, the blood ought to be drawn as near the part as possible.
When it is necessary, however, to bleed in the foot or hand, as the
veins are small, and the bleeding is apt to stop too soon, the part
ought to be immersed in warm water, and kept there till a sufficient
quantity of blood be let.

We shall not spend time in describing the manner of performing this
operation: that will be better learned by example than precept. Twenty
pages of description would not convey so just an idea of the operation
as seeing it once performed by an expert hand. Neither is it necessary
to point out the different parts of the body from whence blood may be
taken, as the arm, foot, forehead, temples, neck, &c. These will readily
occur to every intelligent person, and the foregoing observations will
be sufficient for determining which of them is most proper upon any
particular occasion. In all cases where the intention is merely to
lessen the general mass of blood, the arm is the most commodious part of
the body in which the operation can be performed.


                    OF INFLAMMATIONS AND ABSCESSES.

From whatever cause an inflammation proceeds, it must terminate either
by dispersion, suppuration, or gangrene. Though it is impossible to
foretel with certainty in which of these ways any particular
inflammation will terminate, yet a probable conjecture may be formed
with regard to the event, from a knowledge of the patient’s age and
constitution. Inflammations happening in a slight degree upon colds, and
without any previous indisposition, will most probably be dispersed;
those which follow close upon a fever, or happen to persons of a gross
habit of body, will generally suppurate; and those which attack very old
people, or persons of a dropsical habit, will have a strong tendency to
gangrene.

If the inflammation be slight, and the constitution sound, the
dispersion ought always to be attempted. This will be best promoted by a
slender diluting diet, plentiful bleeding, and repeated purges. The part
itself must be fomented, and, if the skin be very tense, it may be
embrocated with a mixture of three-fourths of sweet oil, and one-fourth
of vinegar, and afterwards covered with a piece of wax plaster.

If, notwithstanding these applications, the symptomatic fever increases,
and the tumour becomes larger, with violent pain and pulsation, it will
be proper to promote the suppuration. The best application for this
purpose is a soft poultice, which may be renewed twice a day. If the
suppuration proceeds but slowly, a raw onion cut small or bruised may be
spread upon the poultice. When the abscess is ripe or fit for opening,
which may easily be known from the thinness of the skin in the most
prominent part of it, a fluctuation of matter which may be felt under
the finger, and, generally speaking, an abatement of the pain, it may be
opened either with a lancet or by means of caustic.

The last way in which an inflammation terminates, is in a gangrene or
mortification, the approach of which may be known by the following
symptoms: the inflammation loses its redness, and becomes duskish or
livid; the tension of the skin goes off, and it feels flabby; little
bladders filled with ichor of different colours spread all over it; the
tumour subsides, and from a duskish complexion becomes black; a quick
low pulse, with cold clammy sweats, are the immediate forerunners of
death.

When these symptoms first appear, the part ought to be dressed with
London treacle, or a cataplasm made of lixivium and bran. Should the
symptoms become worse, the part must be scarified, and afterwards
dressed with basilicum softened with oil of turpentine. All the
dressings must be applied warm. With regard to internal medicines, the
patient must be supported with generous cordials, and the Peruvian bark
exhibited in as large doses as the stomach will bear it. If the
mortified parts should separate, the wound will become a common ulcer,
and must be treated accordingly.

This article includes the treatment of all those diseases, which, in
different parts of the country, go by the names of _biles_,
_imposthumes_, _whitloes_, &c. They are all abscesses in consequence of
a previous inflammation, which, if possible, ought to be discussed; but
when this cannot be done, the suppuration should be promoted, and the
matter discharged by an incision, if necessary; afterwards the sore may
be dressed with yellow basilicum, or some other digestive ointment.


                               OF WOUNDS.

No part of medicine has been more mistaken than the treatment or cure of
wounds. Mankind in general believe that certain herbs, ointments, and
plasters are possessed of wonderful healing powers, and imagine that no
wound can be cured without the application of them. It is however a
fact, that no external application whatever contributes towards the cure
of a wound, any other way than by keeping the parts soft, clean, and
defending them from the external air, which may be as effectually done
by dry lint, as by the most pompous applications, while it is exempt
from many of the bad consequences attending them.

The same observation holds with respect to internal applications. These
only promote the cure of wounds as far as they tend to prevent a fever,
or to remove any cause that might obstruct or impede the operations of
Nature. It is Nature alone that cures wounds. All that Art can do is to
remove obstacles, and to put the parts in such a condition as is the
most favourable to Nature’s efforts.

With this simple view we shall consider the treatment of wounds, and
endeavour to point out such steps as ought to be taken to facilitate
their cure.

The first thing to be done when a person has received a wound, is to
examine whether any foreign body be lodged in it, as wood, stone, iron,
lead, glass, dirt, bits of cloth, or the like. These, if possible, ought
to be extracted, and the wound cleaned, before any dressings be applied.
When that cannot be effected with safety, on account of the patient’s
weakness, or loss of blood, they must be suffered to remain in the
wound, and afterwards extracted when he is more able to bear it.

When a wound penetrates into any of the cavities of the body, as the
breast, the bowels, &c. or where any considerable blood-vessel is cut, a
skilful surgeon ought immediately to be called, otherwise the patient
may lose his life. But sometimes the discharge of blood is so great,
that if it be not stopt, the patient may die even before a surgeon,
though at no great distance, can arrive. In this case, something must be
done by those who are present. If the wound be in any of the limbs, the
bleeding may generally be stopt by applying a tight ligature or bandage
round the member a little above the wound. The best method of doing this
is to put a strong broad garter round the part, but so slack as easily
to admit a small piece of stick to be put under it, which must be
twisted, in the same manner as a countryman does a cart-rope to secure
his loading, till the bleeding stops. Whenever this is the case, he must
take care to twist it no longer, as straining it too much might occasion
an inflammation of the parts, and endanger a gangrene.

In parts where this bandage cannot be applied, various other methods may
be tried to stop the bleeding, as the application of styptics,
astringents, &c. Cloths dipped in a solution of blue vitriol in water,
or the _styptic water_ of the Dispensatories, may be applied to the
wound. When these cannot be obtained, strong spirits of wine may be
used. Some recommend the _agaric_[194] of the oak as preferable to any
of the other styptics; and indeed it deserves considerable encomiums. It
is easily obtained, and ought to be kept in every family, in case of
accidents. A piece of it must be laid upon the wound, and covered with a
good deal of lint, above which a bandage may be applied so tight as to
keep it firmly on.

Though spirits, tinctures, and hot balsams may be used, in order to stop
the bleeding when it is excessive, they are improper at other times.
They do not promote but retard the cure, and often change a simple wound
into an ulcer. People imagine, because hot balsams congeal the blood,
and seem, as it were, to solder up the wound, that they therefore heal
it; but this is only a deception. They may indeed stop the flowing
blood, by searing the mouths of the vessels; but, by rendering the parts
callous, they obstruct the cure.

In slight wounds, which do not penetrate much deeper than the skin, the
best application is a bit of the common black sticking-plaster. This
keeps the sides of the wound together, and prevents the air from hurting
it, which is all that is necessary. When a wound penetrates deep, it is
not safe to keep its lips quite close: this keeps in the matter, and is
apt to make the wound fester. In this case the best way is to fill the
wound with soft lint, commonly called _caddis_. It however must not be
stuffed in too hard, otherwise it will do hurt. The lint may be covered
with a cloth dipped in oil, or spread with the common wax plaster[195];
and the whole must be kept on by a proper bandage.

We shall not spend time in describing the different bandages that may be
proper for wounds in different parts of the body; common sense will
generally suggest the most commodious method of applying a bandage;
besides, descriptions of this kind are not easily understood or
remembered.

The first dressing ought to continue on for at least two days; after
which it may be removed, and fresh lint applied as before. If any part
of the first dressing sticks so close as not to be removed with ease or
safety to the patient, it may be allowed to continue, and fresh lint
dipped in sweet oil laid over it. This will soften it, so as to make it
come off easily at next dressing. Afterwards the wound may be dressed
twice a-day in the same manner till it be quite healed. Those who are
fond of salves or ointments, may, after the wound is become very
superficial, dress it with the yellow _basilicum_[196]; and if fungous,
or what is called _proud flesh_, should rise in the wound, it may be
checked, by mixing with the ointment a little burnt alum or red
precipitate of mercury.

When a wound is greatly inflamed, the most proper application is a
poultice of bread and milk, softened with a little sweet oil or fresh
butter. This must be applied instead of a plaster, and should be changed
twice a-day.

If the wound be large, and there is reason to fear an inflammation, the
patient should be kept on a very low diet. He must abstain from flesh,
strong liquors, and every thing that is of a heating nature. If he be of
a full habit, and has lost but little blood from the wound, he must be
bled; and, if the symptoms be urgent, the operation may be repeated. But
when the patient has been greatly weakened by loss of blood from the
wound, it will be dangerous to bleed him, even though a fever should
ensue. Nature should never be too far exhausted. It is always more safe
to allow her to struggle with the disease in her own way, than to sink
the patient’s strength by excessive evacuations.

Wounded persons ought to be kept perfectly quiet and easy. Every thing
that ruffles the mind or moves the passions, as love, anger, fear,
excessive joy, &c. are very hurtful. They ought above all things to
abstain from venery. The body should be kept gently open, either by
laxative clysters, or by a cool vegetable diet, as roasted apples,
stewed prunes, boiled spinage, and such like.


                               OF BURNS.

In slight burns which do not break the skin, it is customary to hold the
part near the fire for a competent time, to rub it with salt, or to lay
a compress upon it dipped in spirits of wine or brandy. But when the
burn has penetrated so deep as to blister or break the skin, it must be
dressed with some of the liniment for burns mentioned in the Appendix,
or with the emollient and gently drying ointment, commonly called
_Turner’s cerate_[197]. This may be mixed with an equal quantity of
fresh olive oil, and spread upon a soft rag, and applied to the part
affected. When this ointment cannot be had, an egg may be beat up with
about an equal quantity of the sweetest salad-oil. This will serve very
well till a proper ointment can be prepared. When the burning is very
deep, after the first two or three days, it should be dressed with equal
parts of yellow _basilicum_ and _Turner’s cerate_ mixed together.

When the burn is violent, or has occasioned a high degree of
inflammation, and there is reason to fear a gangrene or mortification,
the same means must be used to prevent it as are recommended in other
violent inflammations. The patient, in this case, must live low, and
drink freely of weak diluting liquors. He must likewise be bled, and
have his body kept open. But if the burnt parts should become livid or
black, with other symptoms of mortification, it will be necessary to
bathe them frequently with warm camphorated spirits of wine, tincture of
myrrh, or other antiseptics, mixed with a decoction of the bark. In this
case the bark must likewise be taken internally, and the patient’s diet
must be more generous.

As example teaches better than precept, I shall relate the treatment of
the most dreadful case of this kind that has occurred in my practice. A
middle-aged man, of a good constitution, fell into a large vessel full
of boiling water, and miserably scalded about one half of his body. As
his clothes were on, the burning in some parts was very deep before they
could be got off. For the first two days the scalded parts had been
frequently anointed with a mixture of lime-water and oil, which is a
very proper application for recent burnings. On the third day, when I
first saw him, his fever was high, and his body costive, for which he
was bled, and had an emollient clyster administered. Poultices of bread
and milk, softened with fresh butter, were likewise applied to the
affected parts, to abate the heat and inflammation. His fever still
continuing high, he was bled a second time, was kept strictly on the
cooling regimen, took the saline mixture with small doses of nitre, and
had an emollient clyster administered once a-day. When the inflammation
began to abate, the parts were dressed with a digestive composed of
brown cerate and yellow basilicum. Where any black spots appeared, they
were slightly scarified, and touched with the tincture of myrrh; and, to
prevent their spreading, the Peruvian bark was administered. By this
course, the man was so well in three weeks as to be able to attend his
business.


                              OF BRUISES.

Bruises are generally productive of worse consequences than wounds. The
danger from them does not appear immediately, by which means it often
happens that they are neglected. It is needless to give any definition
of a disease so universally known; we shall therefore proceed to point
out the method of treating it.

In slight bruises it will be sufficient to bathe the part with warm
vinegar, to which a little brandy or rum may occasionally be added, and
to keep cloths wet with this mixture constantly applied to it. This is
more proper than rubbing it with brandy, spirits of wine, or other
ardent spirits, which are commonly used in such cases.

In some parts of the country the peasants apply to a recent bruise a
cataplasm of fresh cow-dung. I have often seen this cataplasm applied to
violent contusions occasioned by blows, falls, bruises, and such like,
and never knew it fail to have a good effect.

When a bruise is very violent, the patient ought immediately to be bled,
and put upon a proper regimen. His food should be light and cool, and
his drink weak, and of an opening nature; as whey sweetened with honey,
decoctions of tamarinds, barley, cream-tartar-whey, and such like. The
bruised part must be bathed with vinegar and water, as directed above;
and a poultice made by boiling crumb of bread, elder-flowers, and
camomile-flowers, in equal quantities of vinegar and water, applied to
it. This poultice is peculiarly proper when a wound is joined to the
bruise. It may be renewed two or three times a-day.

As the structure of the vessels is totally destroyed by a violent
bruise, there often ensues a great loss of substance, which produces an
ulcerous sore very difficult to cure. If the bone be affected, the sore
will not heal before an exfoliation takes place; that is, before the
diseased part of the bone separates, and comes out through the wound.
This is often a very slow operation, and may even require several years
to be completed. Hence it happens, that these sores are frequently
mistaken for the king’s evil, and treated as such, though in fact they
proceed solely from the injury which the solid parts received from the
blow.

Patients in this situation are pestered with different advices. Every
one who sees them proposes a new remedy, till the sore is so much
irritated with various and opposite applications, that it is often at
length rendered absolutely incurable. The best method of managing such
sores is, to take care that the patient’s constitution does not suffer
by confinement, or improper medicine, and to apply nothing to them
besides simple ointment spread upon soft lint, over which a poultice of
bread and milk, with boiled camomile-flowers, or the like, may be put,
to nourish the part, and keep it soft and warm. Nature, thus assisted,
will generally in time operate a cure, by throwing off the diseased
parts of the bone, after which the sore soon heals.


                               OF ULCERS.

Ulcers may be the consequence of wounds, bruises, or imposthumes
improperly treated; they may likewise proceed from an ill state of the
humours, or what may be called a bad habit of body.

In the latter case, they ought not to be hastily dried up, otherwise it
may prove fatal to the patient. Ulcers happen most commonly in the
decline of life; and persons who neglect exercise, and live grossly, are
most liable to them. They might often be prevented by retrenching some
part of the solid food, or by opening artificial drains, as issues,
setons, or the like.

An ulcer may be distinguished from a wound by its discharging a thin
watery humour, which is often so acrid as to inflame and corrode the
skin; by the hardness and perpendicular situation of its sides or edges,
by the time of its duration, &c.

It requires considerable skill to be able to judge whether or not an
ulcer ought to be dried up. In general, all ulcers which proceed from a
bad habit of body, should be suffered to continue open, at least till
the constitution has been so far changed by proper regimen, or the use
of medicine, that they seem disposed to heal of their own accord. Ulcers
which are the effect of malignant fevers, or other acute diseases, may
generally be healed with safety after the health has been restored for
some time. The cure ought not however to be attempted too soon, nor at
any time without the use of purging medicines and a proper regimen. When
wounds or bruises have, by wrong treatment, degenerated into ulcers, if
the constitution be good, they may generally be healed with safety. When
ulcers either accompany chronical diseases, or come in their stead, they
must be cautiously healed. If an ulcer conduces to the patient’s health,
from whatever cause it proceeds, it ought not to be healed; but if, on
the contrary, it wastes the strength, and consumes the patient by a slow
fever, it should be healed as soon as possible.

We would earnestly recommend a strict attention to these particulars, to
all who have the misfortune to labour under this disorder, particularly
persons in the decline of life; as we have frequently known people throw
away their lives by the want of it, while they were extolling and
generously rewarding those whom they ought to have looked upon as their
executioners.

The most proper regimen for promoting the cure of ulcers, is to avoid
all spices, salted and high-seasoned food, all strong liquors, and to
lessen the usual quantity of flesh meat. The body ought to be kept
gently open by a diet consisting chiefly of cooling laxative vegetables,
and by drinking butter-milk, whey sweetened with honey, or the like. The
patient ought to be kept cheerful, and should take as much exercise as
he can easily bear.

When the bottom and sides of an ulcer seem hard and callous, they may be
sprinkled twice a-day with a little red precipitate of mercury, and
afterwards dressed with the yellow _basilicum_ ointment. Sometimes it
will be necessary to have the edges of the ulcer scarified with the
lancet.

Lime-water has frequently been known to have very happy effects in the
cure of obstinate ulcers. It may be used in the same manner as directed
for the stone and gravel.

My late learned and ingenious friend, Dr. Whytt, strongly recommends the
use of the solution of corrosive sublimate of mercury in brandy, for the
cure of obstinate ill conditioned ulcers. I have frequently found this
medicine, when given according to the Doctor’s directions, prove very
successful. The dose is a table-spoonful night and morning; at the same
time washing the sore twice or thrice a-day with it. In a letter which I
had from the Doctor a little before his death, he informed me, “That he
observed washing the sore thrice a-day with the solution of a triple
strength was very beneficial[198].”

A fistulous ulcer can seldom be cured without an operation. It must
either be laid open so as to have its callous parts destroyed by some
corrosive application, or they must be entirely cut away by the knife:
but as this operation requires the hand of an expert surgeon, there is
no occasion to describe it. Ulcers about the _anus_ are most apt to
become fistulous, and are very difficult to cure. Some indeed pretend to
have found Ward’s Fistula paste very successful in this complaint. It is
not a dangerous medicine, and being easily procured, it may deserve a
trial; but as these ulcers generally proceed from an ill habit of body,
they will seldom yield to any thing except a long course of regimen,
assisted by medicines, which are calculated to correct that particular
habit, and to induce an almost total change in the constitution.




                               CHAP. LI.
                            OF DISLOCATIONS.


When a bone is moved out of its place or articulation, so as to impede
its proper functions, it is said to be _luxated_ or _dislocated_. As
this often happens to persons in situations where no medical assistance
can be obtained, by which means limbs, and even lives, are frequently
lost, we shall endeavour to point out the method of reducing the most
common luxations, and those which require immediate assistance. Any
person of common sense and resolution, who is present when a dislocation
happens, may often be of more service to the patient, than the most
expert surgeon can after the swelling and inflammation have come on.
When these are present, it is difficult to know the state of the joint,
and dangerous to attempt a reduction; and by waiting till they are gone
off, the muscles become so relaxed, and the cavity filled up, that the
bone can never afterwards be retained in its place.

A recent dislocation may generally be reduced by extension alone, which
must always be greater or less according to the strength of the muscles
which move the joint, the age, robustness, and other circumstances of
the patient. When the bone has been out of its place for any
considerable time, and a swelling or inflammation has come on, it will
be necessary to bleed the patient, and, after fomenting the part, to
apply soft poultices with vinegar to it for some time before the
reduction is attempted.

All that is necessary after the reduction, is to apply cloths dipt in
vinegar or camphorated spirits of wine to the part, and to keep it
perfectly easy. Many bad consequences proceed from the neglect of this
rule. A dislocation seldom happens without the tendons and ligaments of
the joint being stretched and sometimes torn. When these are kept easy
till they recover their strength and tone, all goes on very well; but is
the injury be increased by too frequent an exertion of the parts, no
wonder if they be found weak and diseased ever after.


                        DISLOCATION OF THE JAW.

The lower jaw may be luxated by yawning, blows, falls, chewing hard
substances, or the like. It is easily known from the patient’s being
unable to shut his mouth, or to eat any thing, as the teeth of the under
jaw do not correspond with those of the upper; besides, the chin either
hangs down, or is thrown toward one side, and the patient is neither
able to speak distinctly, nor to swallow without considerable
difficulty.

The usual method of reducing a dislocated jaw, is to set the patient
upon a low stool, so as an assistant may hold the head firm by pressing
it against his breast. The operator is then to thrust his two thumbs,
being first wrapped up with linen cloths that they may not slip, as far
back into the patient’s mouth as he can, while his fingers are applied
to the jaw externally. After he has got firm hold of the jaw, he is to
press it strongly downwards and backwards, by which means the elapsed
heads of the jaw may be easily pushed into their former cavities.

The peasants in some parts of the country have a peculiar way of
performing this operation. One of them puts a handkerchief under the
patient’s chin, then turning his back to that of the patient, pulls him
up by the chin so as to suspend him from the ground. This method often
succeeds, but we think it a dangerous one, and therefore recommend the
former.


                        DISLOCATION OF THE NECK.

The neck may be dislocated by falls, violent blows, or the like. In this
case, if the patient receives no assistance, he soon dies, which makes
people imagine the neck was broken; it is, however, for the most part
only partially dislocated, and may be reduced by almost any person who
has resolution enough to attempt it. A complete dislocation of the neck
is instantaneous death.

When the neck is dislocated, the patient is immediately deprived of all
sense and motion; his neck swells, his countenance appears bloated; his
chin lies upon his breast, and his face is generally turned towards one
side.

To reduce this dislocation, the unhappy person should immediately be
laid upon his back on the ground, and the operator must place himself
behind him so as to be able to lay hold of his head with both hands,
while he makes a resistance by placing his knees against the patient’s
shoulders. In this posture he must pull the head with considerable
force, gently twisting it at the same time, if the face be turned to one
side, till he perceives that the joint is replaced, which may be known
from the noise which the bones generally make when going in, the
patient’s beginning to breathe, and the head continuing in its natural
posture.

This is one of those operations which it is more easy to perform than
describe. I have known instances of its being happily performed even by
women, and often by men of no medical education. After the neck is
reduced, the patient ought to be bled, and should be suffered to rest
for some days, till the parts recover their proper tone.


                        DISLOCATION OF THE RIBS.

As the articulation of the ribs with the backbone is very strong, they
are not often dislocated. It does however sometimes happen, which is a
sufficient reason for our taking notice of it. When a rib is dislocated
either upwards or downwards, in order to replace it, the patient should
be laid upon his belly on a table, and the operator must endeavour to
push the head of the bone into its proper place. Should this method not
succeed, the arm of the disordered side may be suspended over a gate or
ladder, and, while the ribs are thus stretched asunder, the heads of
such as are out of place may be thrust into their former situation.

Those dislocations wherein the heads of the ribs are forced inwards, are
both more dangerous and the most difficult to reduce, as neither the
hand nor any instrument can be applied internally to direct the luxated
heads of the ribs. Almost the only thing that can be done is, to lay the
patient his belly over a cask, or some gibbous body, and to move the
fore-part of the rib inward towards the back, sometimes shaking it; by
this means the heads of the luxated ribs may slip into their former
place.


                      DISLOCATION OF THE SHOULDER.

The humerus or upper bone of the arm may be dislocated in various
directions: it happens however most frequently downwards, but very
seldom directly upwards. From the nature of its articulation, as well as
from its exposure to external injuries, this bone is the most subject to
dislocation of any in the body. A dislocation of the humerus may be
known by a depression or cavity on the top of the shoulder, and an
inability to move the arm. When the dislocation is downward or forward,
the arm is elongated, and a ball or lump is perceived under the arm-pit;
but when it is backward, there appears a protuberance behind the
shoulder, and the arm is thrown forwards toward the breast.

The usual method of reducing dislocations of the shoulder is to seat the
patient upon a low stool, and to cause an assistant to hold his body so
that it may not give way to the extension, while another lays hold of
the arm a little above the elbow, and gradually extends it. The operator
then puts a napkin under the patient’s arm, and causes it to be tied
behind his own neck: by this, while a sufficient extension is made, he
lifts up the head of the bone, and with his hands directs it into its
proper place. There are various machines invented for facilitating this
operation, but the hand of an expert surgeon is always more safe. In
young and delicate patients, I have generally found it a very easy
matter to reduce the shoulder, by extending the arm with one hand, and
thrusting in the head of the bone with the other. In making the
extension, the arm ought always to be a little bent.


                       DISLOCATION OF THE ELBOW.

The bones of the fore-arm may be dislocated in any direction. When this
is the case, a protuberance may be observed on that side of the arm
towards which the bone is pushed, from which, and the patient’s
inability to bend his arm, a dislocation of this joint may easily be
known.

Two assistants are generally necessary for reducing a dislocation of the
elbow; one of them must lay hold of the arm above, and the other below
the joint, and make a pretty strong extension, while the operator
returns the bones into their proper place. Afterwards the arm must be
bent, and suspended for some time with a sling about the neck.

Luxations of the wrist and fingers are to be reduced in the same manner
as those of the elbow, _viz._ by making an extension in different
directions, and thrusting the head of the bone into its place.


                       DISLOCATION OF THE THIGH.

When the thigh-bone is dislocated forward and downward, the knee and
foot are turned out, and the leg is longer than the other; but when it
is displaced backward, it is usually pushed upward at the same time, by
which means the limb is shortened, and the foot is turned inwards.

When the thigh-bone is displaced forward and downward, the patient, in
order to have it reduced, must be laid upon his back, and made fast by
bandages, or held by assistants, while by others an extension is made by
means of slings fixed about the bottom of the thigh a little above the
knee. While the extension is made, the operator must push the head of
the bone outward, till it gets into the socket. If the dislocation be
outward, the patient must be laid upon his face, and, during the
extension, the head of the bone must be pushed inward.

Dislocations of the _knees_, _ancles_, and _toes_, are reduced much in
the same manner as those of the upper extremities, _viz._ by making an
extension in opposite directions, while the operator replaces the bones.
In many cases, however, the extension alone is sufficient, and the bone
will slip into its place merely by pulling the limb with sufficient
force. It is not hereby meant, that force alone is sufficient for the
reduction of dislocations. Skill and address will often succeed better
than force. I have known a dislocation of the thigh reduced by one man,
after all the force that could be used by six had proved ineffectual.




                               CHAP. LII.
                          OF BROKEN BONES, &c.


There is, in most country villages, some person who pretends to the art
of reducing fractures. Though in general such persons are very ignorant,
yet some of them are very successful; which evidently proves, that a
small degree of learning, with a sufficient share of common sense and a
mechanical head, will enable a man to be useful in this way. We would,
however, advise people never to employ such operators, when an expert
and skilful surgeon can be had; but when that is impracticable, they
must be employed: we shall therefore recommend the following hints to
their consideration:

When a large bone is broken, the patient’s diet ought in all respects to
be the same as in an inflammatory fever. He should likewise be kept
quiet and cool, and his body open by emollient clysters; or, if these
cannot be conveniently administered, by food that is. of an opening
quality; as stewed prunes, apples boiled in milk, boiled spinage, and
the like. It ought however to be here remarked, that persons who have
been accustomed to live high, are not all of a sudden to be reduced to a
very low diet. This might have fatal effects. There is often a necessity
for indulging even bad habits, in some measure, where the nature of the
disease might require a different treatment.

It will generally be necessary to bleed the patient immediately after a
fracture, especially if he be young, of a full habit, or has at the same
time received any bruise or contusion. This operation should not only be
performed soon after the accident happens, but if the patient be very
feverish, it may be repeated next day. When several of the ribs are
broken, bleeding is peculiarly necessary.

If any of the large bones which support the body are broken, the patient
must keep his bed for several weeks. It is by no means necessary,
however, that he should lie all that time, as is customary, upon his
back. This situation sinks the spirits, galls and frets the patient’s
skin, and renders him very uneasy. After the second week he may be
gently raised up, and may sit several hours, supported by a bed-chair,
or the like, which will greatly relieve him. Great care, however, must
be taken in raising him up, and laying him down, that he make no
exertions himself, otherwise the action of the muscles may pull the bone
out of its place[199].

It is of great importance to keep the patient dry and clean while in
this situation. By neglecting this, he is often so galled and
excoriated, that he is forced to keep shifting places for ease. I have
known a fractured thigh-bone, after it had been kept straight for above
a fortnight, displaced by this means, and continue bent for life, in
spite of all that could be done.

It has been customary when a bone was broken, to keep the limb for five
or six weeks continually upon the stretch. But this is a bad posture. It
is both uneasy to the patient, and unfavourable to the cure. The best
situation is to keep the limb a little bent. This is the posture into
which every animal puts its limbs when it goes to rest, and in which
fewest muscles are upon the stretch. It is easily effected, by either
laying the patient upon his side, or making the bed so as to favour this
position of the limb.

Bone-setters ought carefully to examine whether the bone be not
shattered or broken into several pieces. In this case it will sometimes
be necessary to have the limb immediately taken off, otherwise a
gangrene or mortification may ensue. The horror which attends the very
idea of an amputation often occasions its being delayed in such cases
till too late. I have known this principle operate so strongly, that a
limb, where the bones were shattered into more than twenty pieces, was
not amputated before the third day after the accident, when the gangrene
had proceeded so far as to render the operation useless.

When a fracture is accompanied with a wound, it must be dressed in all
respects as a common wound.

All that art can do towards the cure of a broken bone, is to lay it
perfectly straight, and to keep it quite easy. All tight bandages do
hurt. They had much better be wanting altogether. A great many of the
bad consequences which succeed to fractured bones are owing to tight
bandages. This is one of the ways in which the excess of art, or rather
the abuse of it, does more mischief than would be occasioned by the want
of it. Some of the most sudden cures of broken bones which were ever
known, happened where no bandages were applied at all. Some method
however must be taken to keep the member steady; but this may be done
many ways without bracing it with a tight bandage.

The best method of retention is by two or more splints made of leather
or pasteboard. These, if moistened before they be applied, soon assume
the shape of the included member, and are sufficient, by the assistance
of a very slight bandage, for all the purposes of retention. The bandage
which we would recommend is that made with twelve or eighteen tails. It
is much easier applied and taken off than rollers, and answers all the
purposes of retention equally well. The splints should always be as long
as the limb, with holes cut for the ancles when the fracture is in the
leg.

In fractures of the ribs, where a bandage cannot be properly used, an
adhesive plaster may be applied over the part. The patient in this case
ought to keep himself quite easy, avoiding every thing that may occasion
sneezing, laughing, coughing, or the like. He ought to keep his body in
a straight posture, and should take care that his stomach be constantly
distended, by taking frequently some light food, and drinking freely of
weak watery liquors.

The most proper external application for a fracture is _oxycrate_, or a
mixture of vinegar and water. The bandages should be wet with this at
every dressing.


                              OF STRAINS.

Strains are often attended with worse consequences than broken bones.
The reason is obvious; they are generally neglected. When a bone is
broken, the patient is obliged to keep the member easy, because he
cannot make use of it; but when a joint is only strained, the person,
finding he can still make a shift to move it, is sorry to lose his time
for so trifling an ailment. In this way he deceives himself, and
converts into an incurable malady what might have been removed by only
keeping the part easy for a few days.

Country people generally immerse a strained limb in cold water. This is
very proper, provided it be done immediately, and not kept in too long.
But the custom of keeping the part immersed in cold water for a long
time is certainly dangerous. It relaxes instead of bracing the part, and
is more likely to produce a disease than remove one.

Wrapping a garter, or some other bandage, pretty tight about the
strained part, is likewise of use. It helps to restore the proper tone
of the vessels, and prevents the action of the parts from increasing the
disease. It should not however be applied too tight. I have frequently
known bleeding near the affected part have a very good effect: but what
we would recommend above all is _ease_. It is more to be depended on
than any medicine, and seldom fails to remove the complaint[200].


                              OF RUPTURES.

Children and old people are most liable to this disease. In the former
it is generally occasioned by excessive crying, coughing, vomiting, or
the like. In the latter, it is commonly the effect of blows or violent
exertions of the strength, as leaping, carrying great weights, &c. In
both, a relaxed habit, indolence, and an oily or very moist diet,
dispose the body to this disease.

A rupture sometimes proves fatal before it is discovered. Whenever
sickness, vomiting, and obstinate costiveness give reason to suspect an
obstruction of the bowels, all those places where ruptures usually
happen ought carefully to be examined. The protrusion of a very small
part of the gut will occasion all these symptoms; and, if not returned
in due time, will prove mortal.

On the first appearance of a rupture in an infant, it ought to be laid
upon its back, with its head very low. While in this posture, if the gut
does not return of itself, it may easily be put up by gentle pressure.
After it is returned, a piece of sticking-plaster may be applied over
the part, and a proper truss or bandage must be constantly worn for a
considerable time. The method of making and applying these
rupture-bandages for children is pretty well known. The child must, as
far as possible, be kept from crying, and from all violent exertions,
till the rupture is quite healed.

In adults, when the gut has been forced down with great violence, or
happens from any cause to be inflamed, there is often great difficulty
in returning it, and sometimes the thing is quite impracticable without
an operation; a description of which is foreign to our purpose. As I
have been fortunate enough, however, always to succeed in my attempts to
return the gut, without having recourse to any other means than what are
in the power of every man, I shall briefly mention the method which I
generally pursue.

After the patient has been bled, he must be laid upon his back, with his
head very low, and his breech raised high with pillows. In this
situation flannel cloths wrung out of a decoction of mallows and
camomile-flowers, or, if these are not at hand, of warm water, must be
applied for a considerable time. A clyster made of this decoction, with
a large spoonful of butter and an ounce or two of salt, may be
afterwards thrown up. If these should not prove successful, recourse
must be had to pressure. If the tumour be very hard, considerable force
will be necessary; but it is not force alone which succeeds here. The
operator, at the same time that he makes a pressure with the palms of
his hand, must with his fingers artfully conduct the gut in by the same
aperture through which it came out. The manner of doing this can be much
easier conceived than described. Should these endeavours prove
ineffectual, clysters of the smoke of tobacco may be tried. These have
been often known to succeed where every other method failed.

There is reason to believe that, by persisting in the use of these, and
such other means as the circumstances of the case may suggest, most
_hernias_ might be reduced without an operation. Cutting for the
_hernia_ is a nice and difficult matter. I would therefore advise
surgeons to try every method of returning the gut before they have
recourse to the knife. I have once and again succeeded by persevering in
my endeavours, after eminent surgeons had declared the reduction of the
gut impracticable without an operation[201].

An adult, after the gut has been returned, must wear a steel bandage. It
is needless to describe this, as it may always be had ready made from
the artists. Such bandages are generally uneasy to the wearer for some
time, but by custom they become quite easy. No person who has had a
rupture after he arrived at man’s estate should ever be without one of
these bandages.

Persons who have a rupture ought carefully to avoid all violent
exercise, carrying great weights, leaping, running, and the like. They
should likewise avoid windy aliment and strong liquors; and should
carefully guard against catching cold.




                              CHAP. LIII.
                             OF CASUALTIES.


It is certain that life, when to all appearance lost, may often, by due
care, be restored. Accidents frequently prove fatal, merely because
proper means are not used to counteract their effects, No person ought
to be looked upon as killed by any accident, unless where the structure
of the heart, brain, or some organ necessary to life, is evidently
destroyed. The action of these organs may be so far impaired as even to
be for some time imperceptible, when life is by no means gone. In this
case, however, if the fluids be suffered to grow cold, it will be
impossible to put them again in motion, even though the solids should
recover their power of acting. Thus, when the motion of the lungs has
been stopt by unwholesome vapour, the action of the heart by a stroke on
the breast, or the functions of the brain by a blow on the head, if the
person be suffered to grow cold, he will in all probability continue so;
but, if the body be kept warm, as soon as the injured part has recovered
its power of acting, the fluids will again begin to move, and all the
vital functions will be restored.

It is a horrid custom immediately to consign over to death every person
who has the misfortune, by a fall, a blow, or the like, to be deprived
of the appearance of life. The unhappy person, instead of being carried
into a warm house, and laid by the fire, or put to a warm bed, is
generally hurried away to church, or a barn, or some other cold damp
house, where, after a fruitless attempt has been made to bleed him,
perhaps by one who knew nothing of the matter, he is given over for
dead, and no further notice taken of him. This conduct seems to be the
result of ignorance, supported by an ancient superstitious notion, which
forbids the body of any person killed by accident to be laid in an house
that is inhabited. What the ground of this superstition may be, we shall
not pretend to inquire; but surely the conduct founded upon it is
contrary to all the principles of reason, humanity, and common sense.

When a person seems to be suddenly deprived of life, our first business
is to inquire into the cause. We ought carefully to observe whether any
substance be lodged in the wind-pipe or gullet; and, if that is the
case, attempts must be made to remove it. When unwholesome air is the
cause, the patient ought immediately to be removed out of it. If the
circulation be suddenly stopped, from any cause whatever, except mere
weakness, the patient should be bled. If the blood does not flow, he may
be immersed in warm water, or rubbed with warm cloths, &c. to promote
the circulation. When the cause cannot be suddenly removed, our great
aim must be to keep up the vital warmth, by rubbing the patient with hot
cloths, or salt, and covering his body with warm sand, ashes, or the
like.

I should now proceed to treat more fully of those accidents, which,
without immediate assistance, would often prove fatal, and to point out
the most likely means for relieving the unhappy sufferers; but as I have
been happily anticipated in this part of my subject by the learned and
humane Dr. Tissot, I shall content myself with selecting such of his
observations as seem to be the most important, and adding such of my own
as have occurred in the course of practice.


           OF SUBSTANCES STOPT BETWEEN THE MOUTH AND STOMACH.

Though accidents of this kind are very common, and extremely dangerous,
yet they are generally the effect of carelessness. Children should be
taught to chew their food well, and to put nothing into their mouths
which it would be dangerous for them to swallow. But children are not
the only persons guilty of this piece of imprudence. I know many adults
who put pins, nails, and other sharp-pointed substances in their mouths
upon every occasion, and some who even sleep with the former there all
night. This conduct is exceedingly injudicious, as a fit of coughing, or
twenty other accidents, may force over the substance before the person
is aware[202].

When any substance is detained in the gullet, there are two ways of
removing it, _viz._ either by extracting it, or pushing it down. The
safest and most certain way is to extract it; but this is pot always the
easiest; it may therefore be more eligible sometimes to thrust it down,
especially when the obstructing body is of such a nature, that there is
no danger from its reception into the stomach. The substances which may
be pushed down without danger are, all common nourishing ones, as bread,
flesh, fruits, and the like. All indigestible bodies, as cork, wood,
bones, pieces of metal, and such like, ought if possible to be
extracted, especially if these bodies be sharp pointed, as pins,
needles, fish-bones, bits of glass, &c.

When such substances have not passed in too deep, we should endeavour to
extract them with our fingers, which method often succeeds. When they
are lower, we must make use of nippers, or a small pair of forceps, such
as surgeons use. But this attempt to extract rarely succeeds, if the
substance be of a flexible nature, and has descended far into the
gullet.

If the fingers and nippers fail, or cannot be duly applied, crotchets, a
kind of hooks, must be employed. These may be made at once, by bending a
piece of pretty strong iron wire at one end. It must be introduced in
the flat way; and for the better conducing it, there should likewise be
a curve or bending at the end it is held by, to serve as a kind of
handle to it; which has this further use, that it may be secured by a
string tied to it, a circumstance not to be omitted in any instrument
employed on such occasions, to avoid such ill accidents as have
sometimes ensued from these instruments slipping out of the operator’s
hand. After the crotchet has passed below the substance that obstructs
the passage, it is drawn up again, and hooks up the body along with it.
The crotchet is also very convenient, when a substance somewhat
flexible, as a pin or fish-bone, sticks across the gullet, the hook, in
such cases, seizing them about their middle part, crooks and thus
disengages them; or, if they are very brittle substances, serves to
break them.

When the obstructing bodies are small, and only stop up a part of the
passage, and which may either easily elude the hook, or straiten it by
their resistance, a kind of rings, made either of wire, wool, or silk,
may be used. A piece of fine wire of a proper length may be bent into a
circle, about the middle, of about an inch diameter, and the long unbent
sides brought parallel, and near each other: these are to be held in the
hand, and the circular part or ring introduced into the gullet, in order
to be conduced about the obstructing body, and so to extract it. More
flexible rings may be made of wool, thread, silk, or small pack-thread,
which may be waxed for their greater strength and consistence. One of
these is to be tied fast to a handle of iron wire, whale-bone, or any
kind of flexible wood, and by this means introduced, in order to
surround the obstructing substance, and to draw it out. Several of these
rings passed through one another may be used, the more certainly to lay
hold of the obstructing body, which may be involved by one, if another
should miss it. These rings have one advantage, which is, that when the
substance to be extracted is once laid hold of, it may then, by turning
the handle, be retained so strongly in the ring thus twitted, as to be
moved every way, which must in many cases be a considerable advantage.

Another material employed on these unhappy occassions is the sponge. Its
property of swelling considerably on being wet is the principal
foundation of its usefulness here. If any substance is stopt in the
gullet, but without filling up the whole passage, a bit of sponge may be
introduced into that part which is unstopt, and beyond the substance.
The sponge soon dilates, and grows larger in this moist situation; and
indeed the enlargement of it may be forwarded by making the patient
swallow a few drops of water. Afterwards it is to be drawn back by the
handle to which it is fastened; and as it is now too large to return
through the small cavity by which it was conveyed in, it draws out the
obstructing body along with it.

The compressibility of sponge is another foundation of its usefulness in
such cases. A pretty large piece of sponge may be compressed or squeezed
into a small size, by winding a string of tape closely about it, which
may be easily unwound, and withdrawn, after the sponge has been
introduced. A bit of sponge may likewise be, compressed by a piece of
whale-bone split at one end; but this can hardly be introduced in such a
manner as not to hurt the patient.

I have often known pins and other sharp bodies, which had stuck in the
throat, brought up by causing the person to swallow a bit of tough meat
tied to a thread, and drawing it quickly up again. This is safer than
swallowing sponge, and will often answer the purpose equally well.

When all these methods prove unsuccessful, there remains one more, which
is, to make the patient vomit: but this can scarcely be of any service,
unless when such obstructing bodies are simply engaged in, and not
hooked or stuck into the sides of the gullet, as in this case vomiting
might sometimes occasion further mischief. If the patient can swallow,
vomiting may be excited by taking half a drachm or two scruples of
ipecacuanha in powder made into a draught. If he is not able to swallow,
an attempt may be made to excite vomiting, by tickling his throat with a
feather; and, if that should not succeed, a clyster of tobacco may be
administered. It is made by boiling an ounce of tobacco in a sufficient
quantity of water: this has often been found to succeed, when other
attempts to excite vomiting had failed.

When the obstructing body is of such a nature that it may with safety be
pushed downwards, this may be attempted by means of a wax-candle oiled,
and a little heated, so as to make it flexible; or a piece of
whale-bone, wire, or flexible wood, with a sponge fastened to one end.

Should it be impossible to extract even those bodies which it is
dangerous to admit into the stomach, we must then prefer the least of
two evils, and rather run the hazard of pushing them down than suffer
the patient to perish in a few minutes; and we ought to scruple this
resolution the less, as a great many instances have happened, where the
swallowing of such hurtful and indigestible substances has been followed
by no disorder.

Whenever it is manifest that all endeavours either to extract or push
down the substance must prove ineffectual, they should be discontinued;
because the inflammation occasioned by persisting in them might be as
dangerous as the obstruction itself. Some have died in consequence of
the inflammation, even after the body which caused the obstruction had
been entirely removed.

While the means recommended above are making use of, the patient should
often swallow, or, if he cannot, he should frequently receive by
injection through a crooked tube or pipe that may reach down to the
gullet, some emollient liquor, as warm milk and water, barley-water, or
a decoction of mallows. Injections of this kind not only soften and
sooth the irritated parts, but, when thrown in with force, are often
more successful in loosening the obstruction than all attempts with
instruments.

When, after all our endeavours, we are obliged to leave the obstructing
body in the part, the patient must be treated as if he had an
inflammatory disease. He should be bled, kept upon a low diet, and have
his whole neck surrounded with emollient poultices. The like treatment
must also be used, if there be any reason to suspect an inflammation of
the passages, though the obstructing body be removed.

A proper degree of agitation has sometimes loosened the inhering body
more effectually than instruments. Thus, a blow on the back has often
forced up a substance which stuck in the gullet; but this is still more
proper and efficacious when the substance gets into the wind-pipe. In
this case, vomiting and sneezing are likewise to be excited. Pins, which
stuck in the gullet, have been frequently discharged by riding on
horseback, or in a carriage.

When any indigestible substance has been forced down into the stomach,
the patient should use a very mild and smooth diet, consisting chiefly
of fruits and farinaceous substances, as puddings, pottage, and soups.
He should avoid all heating and irritating things, as wine, punch,
pepper, and such like; and his drink should be milk and water,
barley-water, or whey.

When the gullet is so strongly and fully closed, that the patient can
receive no food by the mouth, he must be nourished by clysters of soup,
jelly, and the like.

When the patient is in danger of being immediately suffocated, and all
hope of freeing the passage is vanished, so that death seems at hand, if
respiration be not restored; the operation of _bronchotomy_, or opening
of the wind-pipe, must be directly performed. As this operation is
neither difficult to an expert surgeon, nor very painful to the patient,
and is often the only method which can be taken to preserve life in
these emergencies, we thought proper to mention it, though it should
only be attempted by persons skilled in surgery.


                          OF DROWNED PERSONS.

When a person has remained above a quarter of an hour under water, there
can be no considerable hopes of his recovery. But as several
circumstances, may happen to have continued life, in such an unfortunate
situation, beyond the ordinary term, we should never too soon resign the
unhappy object to his fate, but try every method for his relief, as
there are many well attested proofs of the recovery of persons to life
and health who had been taken out of the water apparently dead, and who
remained a considerable time without exhibiting any signs of life.

The first thing to be done, after the body is taken out of the water, is
to convey it as soon as possible to some convenient place where the
necessary operations for its recovery may be performed. In doing this,
care must be taken not to bruise or injure the body by carrying it in
any unnatural posture with the head downwards, or the like. If an adult
body, it ought to be laid on a bed, or on straw, with the head a little
raised, and carried on a cart or on men’s shoulders, and kept in as
natural and easy a position as possible. A small body may be carried in
the arms.

In attempting to recover persons apparently drowned, the principal
intention to be pursued is, _to restore the natural warmth_, upon which
all the vital functions depend; and to excite these functions by the
application of stimulants, not only to the skin, but likewise to the
lungs, intestines, &c.

Though cold was by no means the cause of the person’s death, yet it will
prove an effectual obstacle to his recovery. For this reason, after
stripping him of his wet clothes, his body must be strongly rubbed for a
considerable time with coarse linen cloths, as warm as they can be made;
and, as soon as a well-heated bed can be got ready, he may be laid in
it, and the rubbing should be continued. Warm cloths ought likewise to
be frequently applied to the stomach and bowels, and hot bricks, or
bottles of warm water, to the soles of his feet, and to the palms of his
hands.

Strong volatile spirits should be frequently applied to the nose; and
the spine of the back and pit of the stomach may be rubbed with warm
brandy or spirit of wine. The temples ought always to be chafed with
volatile spirits; and stimulating powders, as that of tobacco or
marjoram, may be blown up the nostrils.

To renew the breathing, a strong person may blow his own breath into the
patient’s mouth with all the force he can, holding his nostrils at the
same time. When it can be perceived by the rising of the chest or belly
that the lungs are filled with air, the person ought to desist from
blowing, and should press the breast and belly so as to expel the air
again; and this operation may be repeated for some time, alternately
inflating and depressing the lungs so as to imitate natural respiration.

If the lungs cannot be inflated in this manner, it may be attempted by
blowing through one of the nostrils, and at the same time keeping the
other close. Dr. Monro for this purpose recommends a wooden pipe fitted
at one end for filling the nostril, and at the other for being blown
into by a person’s mouth, or for receiving the pipe of a pair of
bellows, to be employed for the same purpose, if necessary.

When air cannot be forced into the chest by the mouth or nose, it may be
necessary to make an opening into the wind-pipe for this purpose. It is
needless, however, to spend time in describing this operation, as it
should not be attempted unless by persons skilled in surgery.

To stimulate the intestines, the fume of tobacco may be thrown up in
form of clyster. There are various pieces of apparatus contrived for
this purpose, which may be used when at hand; but where these cannot be
obtained, the business may be done by a common tobacco-pipe. The bowl of
the pipe must be filled with tobacco well kindled, and, after the small
tube has been introduced into the fundament, the smoke may be forced up
by blowing through a piece of paper full of holes wrapped round the
mouth of the pipe, or by blowing through an empty pipe, the mouth of
which is applied close to that of the other. This may also be done in
the following manner: A common clyster-pipe with a bag mounted upon it
may be introduced into the fundament, and the mouth of the bag may be
applied round the small end of a tobacco-pipe, in the bowl of which
tobacco is to be kindled, and the smoke blown up as directed above.
Should it be found impracticable to throw up the smoke of tobacco,
clysters of warm water, with the addition of a little salt and some wine
or spirits, may be frequently administered. This may be done by a common
clyster-bag and pipe; but, as it ought to be thrown well up, a pretty
large syringe will answer the purpose better.

While these things are doing, some of the attendants ought to be
preparing a warm bath, into which the person should be put, if the above
endeavours prove ineffectual. Where there are no conveniencies for using
the warm bath, the body may be covered with warm salt, sand, ashes,
grains, or such like. Tissot mentions an instance of a girl who was
restored to life, after she had been taken out of the water, swelled,
bloated, and to all appearance dead, by laying her naked body upon hot
ashes, covering her with others equally hot, putting a bonnet round her
head, and a stocking round her neck stuffed with the same, and heaping
coverings over all. After she had remained half an hour in this
situation, her pulse returned, she recovered speech, and cried out, _I
freeze, I freeze_; a little cherry-brandy was given her, and she
remained buried as it were under the ashes for eight hours; afterwards
she was taken out, without any other complaint except that of lassitude
or weariness, which went off in a few days. The Doctor mentions likewise
an instance of a man who was restored to life, after he had remained six
hours under water, by the heat of a dunghill.

Till the patient shews some signs of life, and is able to swallow, it
would be useless and even dangerous to pour liquors into his mouth. His
lips, however, and tongue, may be frequently wet with a feather dipt in
warm brandy or other strong spirits; and, as soon as he has recovered
the power of swallowing, a little warm wine, or some other cordial,
ought every now and then to be administered.

Some recommend a vomit after the patient is a little re-animated; but if
he can be made to puke without the sickening draught, it will be more
safe: this may generally be done by tickling the throat and fauces with
an oiled feather, or some other soft substance, which will not injure
the parts. Tissot in this case recommends the oxymel of squills, a
table-spoonful of which, diluted with water, may be given every quarter
of an hour, till the patient has taken five or six doses. Where that
medicine is not at hand, a strong infusion of sage, camomile-flowers, or
_carduus benedictus_, sweetened with honey, or some warm water, with the
addition of a little salt, may, he says, supply its place. The Doctor
does not intend that any of these things should be given in such
quantity as to occasion vomiting. He thinks emetics in this situation
are not expedient.

We are by no means to discontinue our assistance as soon as the patients
discover some tokens of life, since they sometimes expire after these
first appearances of recovering. The warm and stimulating applications
are still to be continued, and small quantities of some cordial liquor
ought frequently to be administered. Lastly, though the person should be
manifestly re-animated, there sometimes remain an oppression, a cough,
and feverishness, which effectually constitute a disease. In this case
it will be necessary to bleed the patient in the arm, and to cause him
to drink plentifully of barley-water, elder-flower-tea, or any other
soft pectoral infusions.

Such persons as have the misfortune to be deprived of the appearances of
life, by a fall, a blow, suffocation, or the like, must be treated
nearly in the same manner as those who have been for some time under
water. I once attended a patient who was so stunned by a fall from a
horse, that for above six hours he scarcely exhibited any signs of life;
yet this man, by being bled, and proper methods taken to keep up the
vital warmth, recovered, and in a few days was perfectly well. Dr.
Alexander gives an instance to the same purpose, in the Edinburgh
Physical and Literary Essays, of a man who was to all appearance killed
by a blow on the breast, but recovered upon being immersed for some time
in warm water. These, and other instances of a similar nature, which
might be adduced, amount to a full proof of this fact, that many of
those unhappy persons who lose their lives by falls, blows, and other
accidents, might be saved _by the use of proper means duly persisted
in_.


                          OF NOXIOUS VAPOURS.

Air may be many ways rendered noxious, or even destructive to animals.
This may either happen from its vivifying principle being destroyed, or
from subtle exhalations with which it is impregnated. Thus air that has
passed through burning fuel is neither capable of supporting fire nor
the life of animals. Hence the danger of sleeping in close chambers with
charcoal fires. Some indeed suppose the danger here proceeds from the
sulphureous oil contained in the charcoal, which is set at liberty and
diffused all over the chamber; while others imagine it is owing to the
air of the room being charged with phlogiston. Be this as it may, it is
a situation carefully to be avoided. Indeed, it is dangerous to sleep in
a small apartment with a fire of any kind. I lately saw four persons who
had been suffocated by sleeping in an apartment where a small fire of
coal had been left burning.

The vapour which exhales from wine, cyder, beer, or other liquors, in
the state of fermentation, contains something poisonous, which kills in
the same manner as the vapour of coal. Hence there is always danger in
going into cellars where a large quantity of these liquors is in a state
of fermentation, especially if they have been close shut up for some
time. There have been many instances of persons struck dead on entering
such places, and of others who have with difficulty escaped.

When subterraneous caves, that have been very long shut, are opened, or
when deep wells are cleaned, which have not been emptied for several
years, the vapours arising from them produce the same effects as those
mentioned above. For this reason, no person ought to venture into a
well, pit, cellar, or any place that is damp, and has been long shut up,
till the air has been sufficiently purified, by burning gunpowder in it.
It is easy to know, as has been observed in a former part of this work,
when the air of such places is unwholesome, by letting down a lighted
candle, throwing in burning fuel, or the like. If these continue to
burn, people may safely venture in; but where they are suddenly
extinguished, no one ought to enter till the air has been first purified
by fire.

The offensive smell of lamps and of candles, especially when their
flames are extinguished, operate like other vapours, though with less
violence, and less suddenly. There have however been instances of people
killed by the fumes of lamps which had been extinguished in a close
chamber, and persons of weak delicate breasts generally find themselves
quickly oppressed in apartments illuminated with many candles.

Such as are sensible of their danger in these situations, and retreat
seasonably from it, are generally relieved as soon as they get into the
open air, or, if they have any remaining uneasiness, a little water and
vinegar, or lemonade, drank hot, affords them relief. But when they are
so far poisoned, as to have lost their feeling and understanding, the
following means must be used for their recovery:

The patient should be exposed to a very pure, fresh, and open air; and
volatile salts, or other stimulating substances, held to his nose. He
should next be bled in the arm, or if that does not succeed, in the
neck. His legs ought to be put into warm water, and well rubbed. As soon
as he can swallow, some lemonade, or water and vinegar, with the
addition of a little nitre, may be given him.

Nor are sharp clysters by any means to be neglected; these may be made,
by adding to the common clyster, syrup of buckthorn and tincture of
senna, of each two ounces; or, in their stead, half an ounce of Venice
turpentine dissolved in the yolk of an egg. Should these things not be
at hand, two or three large spoonfuls of common salt may be put into the
clyster. The same means, if necessary, which were recommended in the
former part of this chapter, may be used to restore the circulation,
warmth, &c.

Mr. Tossach, surgeon at Alloa, relates the case of a man suffocated by
the steam of burning coal, whom he recovered by blowing his breath into
the patient’s mouth, bleeding him in the arm, and causing him to be well
rubbed and tossed about. And Dr. Frewen, of Sussex, mentions the case of
a young man who was stupified by the smoke of sea-coal, but was
recovered by being plunged into cold water, and afterwards laid in a
warm bed.

The practice of plunging persons suffocated by noxious vapours in cold
water, would seem to be supported by the common experiment of
suffocating dogs in the _grotto del cani_, and afterwards recovering
them, by throwing them into the neighbouring lake.


                        EFFECTS OF EXTREME COLD.

When cold is extremely severe, and a person is exposed to it for a long
time, it proves mortal, in consequence of its stopping the circulation
in the extremities, and forcing too great a proportion of blood towards
the brain; so that the patient dies of a kind of apoplexy, preceded by
great sleepiness. The traveller, in this situation, who finds himself
begin to grow drowsy, should redouble his efforts to extricate himself
from the imminent danger he is exposed to. This sleep, which he might
consider as some alleviation of his sufferings, would, if indulged,
prove his last.

Such violent effects of cold are happily not very common in this
country; it frequently happens, however, that the hands or feet of
travellers are so benumbed or frozen, as to be in danger of a
mortification, if proper means are not used to prevent it. The chief
danger in this situation arises from the sudden application of heat. It
is very common, when the hands or feet are pinched with cold, to hold
them to the fire; yet reason and observation shew that this is a most
dangerous and imprudent practice.

Every peasant knows, if frozen meat, fruits, or roots of any kind, be
brought near the fire, or put into warm water, they will be destroyed,
by rottenness, or a kind of mortification; and that the only way to
recover them, is to immerse them for some time in very cold water. The
same observation holds with regard to animals in this condition.

When the hands or feet are greatly benumbed with cold, they ought either
to be immersed in cold water, or rubbed with snow, till they recover
their natural warmth and sensibility: after which the person may be
removed into an apartment a little warmer, and may drink some cups of
tea, or an infusion of elder flowers sweetened with honey. Every person
must have observed, when his hands were even but slightly affected with
cold, that the best way to warm them was by washing them in cold water,
and continuing to rub them well for some time.

When a person has been so long exposed to the cold, that all appearances
of life are gone, it will be necessary to rub him all over with snow or
cold water; or, what will answer better, if it can be obtained, to
immerse him in a bath of the very coldest water. There is the greatest
encouragement to persist in the use of these means, as we are assured
that persons who had remained in the snow, or had been exposed to the
freezing air during five or six successive days, and who had discovered
no marks of life for several hours, have nevertheless been revived.

I have always thought, that the whitloes, kibes, chilblains, and other
inflammations of the extremities, which are so common among the peasants
in the cold season, were chiefly occasioned by their sudden transitions
from cold to heat. After they have been exposed to an extreme degree of
cold, they immediately apply their hands and feet to the fire, or, if
they have occasion, plunge them into warm water, by which means, if a
mortification does not happen, an inflammation seldom fails to ensue.
Most of the ill consequences from this quarter might be easily avoided,
by only observing the precautions mentioned above.


                        EFFECTS OF EXTREME HEAT.

The effects of extreme heat, though not so common in this country, are
no less fatal, and much more sudden than those of cold. In hot countries
people frequently drop down dead in the streets, exhausted with heat and
fatigue. In this case, if any warm cordial can be poured into the mouth
it ought to be done. If this cannot be effected, they may be thrown up
in form of a clyster. Volatile spirits, and other things of a
stimulating nature, may be applied to the skin, which should be well
rubbed with coarse-cloths, whipped with nettles, or other stimulating
things. Some of the ancient physicians are said to have restored to life
persons apparently dead, by beating them with rods.




                               CHAP. LIV.
 OF FAINTING FITS, AND OTHER CASES WHICH REQUIRE IMMEDIATE ASSISTANCE.


Strong and healthy persons, who abound with blood, are often seized with
sudden fainting fits, after violent exercise, drinking freely of warm or
strong liquors, exposure to great heat, intense application to study, or
the like.

In such cases the patient should be made to smell to some vinegar. His
temples, forehead, and wrists ought at the same time to be bathed with
vinegar mixed with an equal quantity of warm water; and two or three
spoonfuls of vinegar, with four or five times as much water, may, if he
can swallow, be poured into his mouth.

If the fainting proves obstinate, or degenerates into a _syncope_, that
is, an abolition of feeling and understanding, the patient must be bled.
After the bleeding, a clyster will be proper, and then he should be kept
easy and quiet, only giving him every half hour a cup or two of an
infusion of any mild vegetable, with the addition of a little sugar and
vinegar.

When swoonings, which arise from this cause, occur frequently in the
same person, he should, in order to escape them, confine himself to a
light diet, confiding chiefly of bread, fruits, and other vegetables.
His drink ought to be water or small beer, and he should deep but
moderately, and take much exercise.

But fainting fits proceed much oftner from a defect than an excess of
blood. Hence they are very ready to happen after great evacuations of
any kind, obstinate watching, want of appetite, or such like. In these
an almost directly opposite course to that mentioned above must be
pursued.

The patient should be laid in bed, with his head low, and being covered,
should have his legs, thighs, arms, and his whole body rubbed strongly
with hot flannels. Hungary water, volatile salts, or strong smelling
herbs, as rue, mint, or rosemary, may be held to his nose. His mouth may
be wet with a little rum or brandy; and, if he can swallow, some hot
wine, mixed with sugar and cinnamon, which is an excellent cordial, may
be poured into his mouth. A compress of flannel dipt in hot wine or
brandy must be applied to the pit of his stomach, and warm bricks, or
bottles filled with hot water, laid to the feet.

As soon as the patient is recovered a little, he should take some strong
soup or broth, or a little bread or biscuit soaked in hot-spiced wine.
To prevent the return of the fits, he ought to take often, but in small
quantities, some light yet strengthening nourishment, as panado made
with soup instead of water, new laid eggs lightly poached, chocolate,
light roast meats, jellies, and such like.

Those fainting fits, which are the effect of bleeding, or of the violent
operation of purges, belong to this class. Such as happen after
artificial bleeding are seldom dangerous, generally terminating as soon
as the patient is laid upon the bed; indeed persons subject to this kind
should always be bled lying, in order to prevent it. Should the fainting
however continue longer than usual, volatile spirits may be held to the
nose, and rubbed on the temples, &c.

When fainting is the effect of too strong or acrid purges or vomits, the
patient must be treated in all respects as if he had taken poison. He
should be made to drink plentifully of milk, warm water, and oil,
barley-water, or suck like; emollient clysters will likewise be proper,
and the patient’s strength should afterwards be recruited, by giving him
generous cordials, and anodyne medicines.

Faintings are often occasioned by indigestion. This may either proceed
from the quantity or quality of the food. When the former of these is
the cause, the cure will be best performed by vomiting, which may be
promoted by causing the patient to drink a weak infusion of
camomile-flowers, _carduus benedictus_ or the like. When the disorder
proceeds from the nature of the food, the patient, as in the case of
weakness, must be revived by strong smells, &c. after which he should be
made to swallow a large quantity of light warm fluid, which may serve to
drown, as it were, the offending matter, to soften its acrimony, and
either to effect a discharge of it by vomiting, or force it down into
the intestines.

Even disagreeable smells will sometimes occasion swoonings, especially
in people of weak nerves. When this happens, the patient should be
carried into the open air, have stimulating things held to his nose, and
those substances which are disagreeable to him ought immediately to be
removed. But we have already taken notice of swoonings which arise from
nervous disorders, and shall therefore say no more upon that head.

Fainting fits often happen in the progress of diseases. In the beginning
of putrid diseases they generally denote an oppression at stomach, or a
mass of corrupted humours, and they cease after evacuations either by
vomit or stool. When they occur at the beginning of malignant fevers,
they indicate great danger. In each of these cases, vinegar used both
externally and internally is the best remedy during the paroxysm, and
plenty of lemon-juice and water after it. Swoonings which happen in
diseases accompanied with great evacuations, must be treated like those
which are owing to weakness, and the evacuations ought to be restrained.
When they happen towards the end of a violent fit of an intermitting
fever, or at that of each exacerbation of a continual fever, the patient
must be supported by small draughts of wine and water.

Delicate and hysteric women are very liable to swooning or fainting fits
after delivery. These might be often prevented by generous cordials, and
the admission of fresh air. When they are occasioned by excessive
flooding, it ought by all means to be restrained. They are generally the
effect of mere weakness or exhaustion. Dr. Engleman relates the case of
a woman “in child-bed, who, after being happily delivered, suddenly
fainted, and lay upwards of a quarter of an hour apparently dead. A
physician was sent for; her own maid, in the mean while, being out of
patience at his delay, attempted to assist her herself, and extending
herself upon her mistress, applied her mouth to her’s, blew in as much
breath as she possibly could, and in a very short time the exhausted
woman awaked as out of a profound sleep; when proper things being given
her, she soon recovered.

“The maid being asked how she came to think of this expedient, said she
had seen it practised at Altenburgh, by midwives, upon children with the
happiest effect.”

We mention this case chiefly that other midwives may be induced to
follow so laudable an example. Many children are born without any signs
of life, and others expire soon after the birth, who might, without all
doubt, by proper care, be restored to life.

From whatever cause fainting fits proceed, fresh air is always of the
greatest importance to the patient. By not attending to this
circumstance, people often kill their friends while they are
endeavouring to save them. Alarmed at the patient’s situation, they call
in a crowd of people to his assistance, or perhaps to witness his exit,
whose breathing exhausts the air, and increases the danger. There is not
the least doubt but this practice, which is very common among the lower
sort of people, often proves fatal, especially to the delicate, and such
persons as fall into fainting fits from mere exhaustion, or the violence
of some disease. No more persons ought ever to be admitted into the room
where a patient lies in a swoon than are absolutely necessary for his
assistance, and the windows of the apartment should always be opened, at
least as far as to admit a stream of fresh air.

Persons subject to frequent swoonings, or fainting fits, should neglect
no means to remove the cause of them, as their consequences are always
injurious to the constitution. Every fainting fit leaves the person in
dejection and weakness; the secretions are thereby suspended, the
humours disposed to stagnation, coagulations and obstructions are
formed, and, if the motion of the blood be totally intercepted, or very
considerably checked, _polypuses_ are sometimes formed in the heart or
larger vessels. The only kind of swoonings not to be dreaded are those
which sometimes mark the _crisis_ in fevers; yet even these ought, as
soon as possible, to be removed.


                            OF INTOXICATION.

The effects of intoxication are often fatal. No kind of poison kills
more certainly than an over-dose of ardent spirits. Sometimes, by
destroying the nervous energy, they put an end to life at once; but in
general their effects are more slow, and in many respects similar to
those of opium. Other kinds of intoxicating liquors may prove fatal when
taken to excess, as well as ardent spirits; but they may generally be
discharged by vomiting, which ought always to be excited when the
stomach is overcharged with liquor.

More of those unhappy persons, who die intoxicated, lose their lives
from an inability to conduct themselves than from the destructive
quality of the liquor. Unable to walk, they tumble down, and lie in some
awkward posture, which obstructs the circulation or breathing, and often
continue in this situation till they die. No drunken person should be
left by himself, till his clothes have been loosened, and his body laid
in such a posture as is most favourable for continuing the vital
motions, discharging the contents of the stomach, &c. The best posture
for discharging the contents of the stomach is to lay the person upon
his belly; when asleep he may be laid on his side, with his head a
little raised, and particular care must be taken that his neck be no way
bent, twisted, or have any thing too tight about it.

The excessive degree of thirst occasioned by drinking strong liquors,
often induces people to quench it by taking what is hurtful. I have
known fatal consequences even from drinking freely of milk after a
debauch of wine or sour punch; these acid liquors, together with the
heat of the stomach, having coagulated the milk in such a manner that it
could never be digested. The safest drink after a debauch is water with
a toast, tea, infusions of balm, sage, barley-water, and such like. If
the person wants to vomit, he may drink a weak infusion of
camomile-flowers, or lukewarm water and oil; but in this condition
vomiting may generally be excited by only tickling the throat with the
finger or a feather.

Instead of giving a detail of all the different symptoms of intoxication
which indicate danger, and proposing a general plan of treatment for
persons in this situation, I shall briefly relate the history of a case
which lately fell under my own observation, wherein most of those
symptoms usually reckoned dangerous concurred, and where the treatment
was successful.

A young man, about fifteen years of age, had, for a hire, drank ten
glasses of strong brandy. He soon after fell fast asleep, and continued
in that situation for near twelve hours, till at length his uneasy
manner of breathing, the coldness of the extremities, and other
threatening symptoms, alarmed his friends, and made them send for me. I
found him still sleeping, his countenance ghastly, and his skin covered
with a cold clammy sweat. Almost the only signs of life remaining were,
a deep laborious breathing, and a convulsive motion or agitation of his
bowels.

I tried to rouse him, but in vain, by pinching, shaking, applying
volatile spirits, and other stimulating things to his nose, &c. A few
ounces of blood were likewise taken from his arm, and a mixture of
vinegar and water was poured into his mouth; but, as he could not
swallow, very little of this got into the stomach. None of these things
having the least effect, and the danger seeming to increase, I ordered
his legs to be put into warm water, and a sharp clyster to be
immediately administered. This gave him a stool, and was the first thing
that relieved him. It was afterwards repeated with the same happy
effect, and seemed to be the chief cause of his recovery. He then began
to shew some signs of life, took drink when it was offered him, and came
gradually to his senses. He continued, however, for several days weak
and feverish, and complained much of a soreness in his bowels, which
gradually went off, by means of a slender diet, and cool mucilaginous
liquors.

This young man would probably have been suffered to die, without any
assistance being called, had not a neighbour, a few days before, who had
been advised to drink a bottle of spirits to cure him of an ague,
expired under very similar circumstances.


                     OF SUFFOCATION AND STRANGLING·

These may sometimes proceed from an infarction of the lungs, produced by
viscid clammy humours, or a spasmodic affection of the nerves of that
organ. Persons who feed grossly, and abound in rich blood, are very
liable to suffocating fits from the former of these causes. Such ought,
as soon as they are attacked, to be bled, to receive an emollient
clyster, and to take frequently a cup of diluting liquor with a little
nitre in it. They should likewise receive the steams of hot vinegar into
their lungs by breathing.

Nervous and asthmatic persons are most subject to spasmodic affections
of the lungs. In this case the patient’s legs should be immersed in warm
water, and the steams of vinegar applied as above. Warm diluting liquors
should likewise be drank; to a cup of which a tea-spoonful of the
parygoric elixir may occasionally be added. Burnt paper, feathers, or
leather, may be held to the patient’s nose, and fresh air should be
freely admitted to him.

Infants are often suffocated by the carelessness or inattention of their
nurses[203]. An infant when in bed should always be laid so, that it
cannot tumble down with its head under the bed-clothes; and when in a
cradle, its face ought never to be covered. A small degree of attention
to these two simple rules would save the lives of many infants, and
prevent others from being rendered weak and sickly all their days by the
injuries done to their lungs.

Instead of laying down a plan for the recovery of infants who are
suffocated, or overlaid, as it is termed by their nurses, I shall give
the history of a case related by Monsieur _Janin_, of the Royal College
of Surgery at Paris, as it was attended with success, and contains
almost every thing that can be done on such occasions.

A nurse having had the misfortune to over-lay a child, he was called in,
and found the infant without any signs of life; no pulsation in the
arteries, no respiration, the face livid, the eyes open, dull, and
tarnished, the nose full of snivel, the mouth gaping, in short it was
almost cold. Whilst some linen clothes and a parcel of ashes were
warming, he had the boy unswathed, and laid him in a warm bed, and on
the right side. He then was rubbed all over with fine linen, for fear of
fretting his tender and delicate skin. As soon as the ashes had received
their due degree of heat, Mr. _Janin_ buried him in them, except the
face, placed him on the side opposite to that on which he had been at
first laid, and covered him with a blanket. He had a bottle of _eau de
luce_ in his pocket, which he presented to his nose from time to time;
and between whiles some puffs of tobacco were blown up his nostrils: to
these succeeded the blowing into his mouth, and squeezing tight his
nose. Animal heat began thus to be excited gradually; the pulsations of
the temporal artery were soon felt, the breathing became more frequent
and free, and the eyes closed and opened alternately. At length the
child fetched some cries expressive of his want of the breast, which
being applied to his mouth, he catched at it with avidity, and sucked as
if nothing had happened to him. Though the pulsations of the arteries
were by this time very well re-established, and it was hot weather, yet
Mr. _Janin_ thought it advisable to leave his little patient three
quarters of an hour longer under the ashes. He was afterwards taken out,
cleaned and dressed as usual; to which a gentle sleep succeeded, and he
continued perfectly well.

Mr. Janin mentions likewise an example of a young man who had hanged
himself through despair, to whom he administered help as effectually as
in the preceding case.

Mr. Glover, surgeon in Doctors Commons, London, relates the case of a
person who was restored to life after twenty-nine minutes hanging, and
continued in good health for many years after.

The principal means used to restore this man to life were, opening the
temporal artery and the external jugular; rubbing the back, mouth, and
neck, with a quantity of volatile spirits and oil; administering the
tobacco clyster by means of lighted pipes, and strong frictions of the
legs and arms. This course had been continued for about four hours, when
an incision was made into the wind-pipe, and air blown strongly through
a canula into the lungs. About twenty minutes after this, the blood at
the artery began to run down the face, and a slow pulse was just
perceptible at the wrist. The frictions were continued for some time
longer; his pulse became more frequent, and his mouth and nose being
irritated with spirit of sal ammoniac, he opened his eyes. Warm cordials
were then administered to him, and in two days he was so well as to be
able to walk eight miles.

These cases are sufficient to shew what may be done for the recovery of
those unhappy persons who strangle themselves in a fit of despair.


               OF PERSONS WHO EXPIRE IN CONVULSION FITS.

Convulsion fits often constitute the last scene of acute or chronic
disorders. When this is the case, there can remain but small hopes of
the patient’s recovery after expiring in a fit. But when a person, who
appears to be in perfect health, is suddenly seized with a convulsion
fit, and seems to expire, some attempts ought always to be made to
restore him to life. Infants are most liable to convulsions, and are
often carried off very suddenly by one or more fits about the time of
teething. There are many well-authenticated accounts of infants having
been restored to life, after they had to all appearance expired in
convulsions; but we shall only relate the following instance mentioned
by Dr. Johnson in his pamphlet _on the practicability of recovering
persons visibly dead_.

In the parish of St. _Clemens_ in _Colchester_, a child of six months
old, lying upon its mother’s lap, having had the breast, was seized with
a strong convulsion fit, which lasted so long, and ended with so total a
privation of motion in the body, lungs, and pulse, that it was deemed
absolutely dead. It was accordingly stripped, laid out, the passing-bell
ordered to be tolled, and a coffin to be made; but a neighbouring
gentlewoman who used to admire the child, hearing of its sudden death,
hastened to the house, and upon examining the child found it not cold,
its joints limber, and fancied that a glass she held to its mouth and
nose was a little damped with the breath; upon which she took the child
in her lap, sat down before the fire, rubbed it, and kept it in gentle
agitation. In a quarter of an hour she felt the heart begin to beat
faintly; she then put a little of the mother’s milk into its mouth,
continued to rub its palms and soles, found the child begin to move, and
the milk was swallowed; and in another quarter of an hour she had the
satisfaction of restoring to its disconsolate mother the babe quite
recovered, eager to lay hold of the breast, and able to suck again. The
child throve, had no more fits, is grown up, and at present alive.

These means, which are certainly in the power of every person, were
sufficient to restore to life an infant to all appearance dead, and who,
in all probability, but for the use of these simple endeavours, would
have remained so. There are however many other things which might be
done in case the above should not succeed; as rubbing the body with
strong spirits, covering it with warm ashes or salt, blowing air into
the lungs, throwing up warm stimulating clysters, or the smoke of
tobacco, into the intestines, and such like.

When children are dead born, or expire soon after the birth, the same
means ought to be used for their recovery, as if they had expired in
circumstances similar to those mentioned above.

These directions may likewise be extended to adults, attention being
always paid to the age and other circumstances of the patient.

The foregoing cases and observations afford sufficient proof of the
success which may attend the endeavours of persons totally ignorant of
medicine, in assisting those who are suddenly deprived of life by any
accident or disease. Many facts of a similar nature might be adduced,
were it necessary; but these, it is hoped, will be sufficient to call up
the attention of the public, and to excite the humane and benevolent to
exert their utmost endeavours for the preservation of their fellow-men.

_The society for the recovery of drowned persons_, instituted at
Amsterdam in the year 1767, had the satisfaction to find that not fewer
than 150 persons in the space of four years had been saved by the means
pointed out by them, many of whom owed their preservation to peasants
and people of no medical knowledge. But the means used with so much
efficacy in recovering drowned persons are, with equal success,
applicable to a number of cases where the powers of life seem in reality
to be only suspended, and to remain capable of renewing all their
functions, on being put into motion again. It is shocking to reflect,
that for want of this consideration many persons have been committed to
the grave, in whom the principles of life might have been revived.

The cases wherein such endeavours are most likely to be attended with
success, are all those called sudden deaths from an invisible cause, as
apoplexies, hysterics, faintings, and many other disorders wherein
persons in a moment sink down and expire. The various casualties in
which they may be tried are, suffocations, from the sulphureous damps of
mines, coal-pits, &c.; the unwholesome air of long unopened wells or
caverns; the noxious vapours arising from fermenting liquors; the steams
of burning charcoal; sulphureous mineral acids; arsenical effluvia, &c.

The various accidents of drowning, strangling, and apparent deaths, by
blows, falls, hunger, cold, &c. likewise furnish opportunities of trying
such endeavours. Those perhaps who to appearance are killed by
lightning, or by any violent agitation of the passions, as fear, joy,
surprise, and such like, might also be frequently recovered by the use
of proper means, as blowing strongly into their lungs, &c.

The means to be used for the recovery of persons suddenly deprived of
life are nearly the same in all cases; they are practicable by every one
who happens to be present at the accident, and require no great expence,
and less skill. The great aim is to restore the warmth and vital
motions. This may in general be attempted by means of heat, frictions,
bleeding, blowing air into the lungs, administering clysters and
generous cordials. These must be varied according to circumstances.
Common sense, and the situation of the patient, will suggest the proper
manner of conducting them. Above all we would recommend _perseverance_.
People ought never to despair on account of discouraging circumstances,
or to leave off their endeavours as long as there is the least hope of
success. Where much good and no hurt can be done, no one ought to grudge
his labour.

It were greatly to be wished, that an institution, similar to that of
Amsterdam, was established, upon a more extensive plan, in Great
Britain; and that a reward was allowed to every one who should be
instrumental in restoring to life a person seemingly dead[204]. Men will
do much for fame, but still more for money. Should no profit, however,
be annexed to those benevolent offices, the heartfelt pleasure which a
good man must enjoy, on reflecting that he has been the happy instrument
of saving one of his fellow-creatures from an untimely grave, is itself
a sufficient reward.




                               CHAP. LV.
   CAUTIONS CONCERNING COLD BATHING, AND DRINKING THE MINERAL WATERS.


As it is now fashionable for persons of all ranks to plunge into the
sea, and drink the mineral waters, I was desirous of rendering this work
still more extensively useful, by the addition of some practical remarks
on these active and useful medicines. Finding it impossible to bring
these observations within so narrow a compass as not to swell the book,
already too large, into an enormous size, I resolved to confine myself
to a few hints or cautions; which may be of service to persons who
bathe, or drink the mineral waters, without being able to put themselves
under the care of a physician.

No part of the practice of medicine is of greater importance, or merits
more the attention of the physician, as many lives are lost, and numbers
ruin their health, by cold bathing, and an imprudent use of the mineral
waters. On some future occasion I may probably resume this subject, as I
know not any work that contains a sufficient number of practical
observations to regulate the patient’s conduct in the use of these
active and important medicines.

We have indeed many books on the mineral waters, and some of them are
written with much ingenuity; but they are chiefly employed in
ascertaining the contents of the waters by chymical analysis. This no
doubt has its use, but it is by no means of such importance as some may
imagine. A man may know the chymical analysis of all the articles in the
_materia medica_, without being able properly to apply any one of them
in the cure of diseases. One page of practical observations is worth a
whole volume of chymical analysis. But where are such observations to be
met with? Few physicians are in a situation to make them, and fewer
still are qualified for such a task. It can only be accomplished by
practitioners who reside at the fountains, and who possessing minds
superior to local prejudices, are capable of distinguishing diseases
with accuracy, and of forming a sound judgment respecting the genuine
effects of medicines.

Without a proper discrimination with regard to the disease and the
constitution of the patient, the most powerful medicine is more likely
to do harm than good. Every one knows that the same physician who, by
cold bathing, cured Augustus, by an imprudent use of the same medicine
killed his heir. This induced the Roman senate to make laws for
regulating the baths, and preventing the numerous evils which arose from
an imprudent and promiscuous use of those elegant and fashionable pieces
of luxury. But as no such laws exist in this country, _every one does
that which is right in his own eyes_, and of course many must do wrong.

People are apt to imagine that the simple element of water can do no
hurt, and that they may plunge into it at any time with impunity. In
this, however, they are much mistaken. I have known apoplexies
occasioned by going into the cold bath, fevers excited by staying too
long in it, and other maladies so much aggravated by its continued use,
that they could never be wholly eradicated. Nor are examples wanting,
either in ancient or modern times, of the baneful consequences which
have arisen also from an injudicious application of the _warm_ bath; but
as warm baths are not so common in this country, and are seldom used but
under the direction of a physician, I shall not enlarge on that part of
the subject.

Immersion in cold water is a custom which lays claim to the most remote
antiquity: indeed it must have been coëval with man himself. The
necessity of water for the purpose of cleanliness, and the pleasure
arising from its application to the body in hot countries, must very
early have recommended it to the human species. Even the example of
other animals was sufficient to give the hint to man. By instinct many
of them are led to apply cold water in this manner; and some, when
deprived of its use, have been known to languish, and even to die. But
whether the practice of cold bathing arose from necessity, reasoning, or
imitation, is an inquiry of no importance; our business is to point out
the advantages which may be derived from it, and to guard people against
an improper use of it.

The cold bath recommends itself in a variety of cases, and is peculiarly
beneficial to the inhabitants of populous cities, who indulge in
idleness, and lead sedentary lives. In persons of this description the
action of the solids is always too weak, which induces a languid
circulation, a crude indigested mass of humours, and obstructions in the
capillary vessels and glandular system. Cold water, from its gravity as
well as its tonic power, is well calculated either to obviate or remove
these symptoms. It accelerates the motion of the blood, promotes the
different secretions, and gives permanent vigour to the solids. But all
these important purposes will be more essentially answered by the
application of _salt-water_. This ought not only to be preferred on
account of its superior gravity, but likewise for its greater power of
stimulating the skin, which promotes the perspiration, and prevents the
patient from catching cold.

It is necessary, however, to observe, that cold bathing is more likely
to prevent, than to remove obstructions of the glandular or lymphatic
system. Indeed, when these have arrived at a certain pitch, they are not
to be removed by any means. In this case the cold bath will only
aggravate the symptoms, and hurry the unhappy patient into an untimely
grave. It is therefore of the utmost importance, previous to the
patient’s entering upon the use of the cold bath, to determine whether
or not he labours under any obstinate obstructions of the lungs or other
_viscera_; and where this is the case, cold bathing ought strictly to be
prohibited[205].

In what is called a plethoric state, or too great a fulness of the body,
it is likewise dangerous to use the cold bath, without due preparation.
In this case there is great danger of bursting a blood-vessel, or
occasioning an inflammation of the brain, or some of the _viscera_. This
precaution is the more necessary to citizens, as most of them live full,
and are of a gross habit. Yet, what is very remarkable, these people
resort in crowds every season to the sea-side, and plunge in the water
without the least consideration. No doubt they often escape with
impunity, but does this give a sanction to the practice? Persons of this
description ought by no means to bathe, unless the body has been
previously prepared by suitable evacuations.

Another class of patients, who stand peculiarly in need of the bracing
qualities of cold water, is the nervous. This includes a great number of
the male, and almost all the female inhabitants of great cities. Yet
even those persons ought to be cautious in using the cold bath. Nervous
people have often weak bowels, and may, as well as others, be subject to
congestions and obstructions of the _viscera_; and in this case they
will not be able to bear the effects of the cold water. For them,
therefore, and indeed for all delicate people, the best plan would be to
accustom themselves to it by the most pleasing and gentle degrees. They
ought to begin with the temperate bath, and gradually use it cooler,
till at length the coldest proves quite agreeable. Nature revolts
against all great transitions; and those who do violence to her
dictates, have often cause to repent of their temerity.

Wherever cold bathing is practised, there ought likewise to be tepid
baths for the purpose mentioned above. Indeed it is the practice of some
countries to throw cold water over the patient as soon as he comes out
of the warm bath; but though this may not injure a Russian peasant, we
dare not recommend it to the inhabitants of this country. The ancient
Greeks and Romans, we are told, when covered with sweat and dust, used
to plunge into rivers, without receiving the smallest injury. Though
they might often escape danger from this imprudent conduct, yet it was
certainly contrary to sound reason. I have known many robust men throw
away their lives by such an attempt. We would not however advise
patients to go into the cold water when the body is chilly; as much
exercise, at least, ought to be taken, as may excite a gentle glow all
over the body, but by no means so as to overheat it.

To young people, and particularly to children, cold bathing is of the
last importance. Their lax fibres render its tonic powers peculiarly
proper. It promotes their growth, increases their strength[206], and
prevents a variety of diseases incident to childhood. Were infants early
accustomed to the cold bath, it would seldom disagree with them; and we
should see fewer instances of the scrofula, rickets, and other diseases,
which prove fatal to many, and make others miserable for life.
Sometimes, indeed, these disorders render infants incapable of bearing
the shock of cold water; but this is owing to their not having been
early and regularly accustomed to it. It is however necessary here to
caution young men against too frequent bathing; as I have known many
fatal consequences result from the daily practice of plunging into
rivers, and continuing there too long.

The most proper time of the day for using the cold bath is no doubt the
morning, or at least before dinner; and the best mode, that of quick
immersion. As cold bathing has a constant tendency to propel the blood
and other humours towards the head, it ought to be a rule always to wet
that part as soon as possible. By due attention to this circumstance,
there is reason to believe, that violent head-achs, and other
complaints, which frequently proceed from cold bathing, might be often
prevented.

The cold bath, when too long-continued in, not only occasions an
excessive flux of humours towards the head, but chills the blood, cramps
the muscles, relaxes the nerves, and wholly defeats the intention of
bathing. Hence, by not adverting to this circumstance, expert swimmers
are often injured, and sometimes even lose their lives. All the
beneficial purposes of cold bathing are answered by one immersion at a
time; and the patient ought to be rubbed dry the moment he comes out of
the water, and should continue to take exercise for some time after.

When cold bathing occasions chillness, loss of appetite, listlessness,
pain of the breast or bowels, a prostration of strength, or violent
head-achs, it ought to be discontinued.

Though these hints are by no means intended to point out all the cases
where cold bathing may be hurtful, nor to illustrate its extensive
utility as a medicine; yet it is hoped they may serve to guard people
against some of those errors into which, from mere inattention, they are
apt to fall, and thereby not only endanger their own lives, but bring an
excellent medicine into disrepute.


                   _Of drinking the Mineral Waters._

The internal use of water, as a medicine, is no less an object of the
physician’s attention than the external. Pure elementary water is indeed
the most inoffensive of all liquors, and constitutes a principal part of
the food of every animal. But this element is often impregnated with
substances of a very active and penetrating nature; and of such an
insidious quality, that, while they promote certain secretions, and even
alleviate some disagreeable symptoms, they weaken the powers of life,
undermine the constitution, and lay the foundation of worse diseases
than those which they were employed to remove. Of this every
practitioner must have seen instances; and physicians of eminence have
more than once declared that they have known more diseases occasioned
than removed by the use of mineral waters. This doubtless has proceeded
from the abuse of these powerful medicines, which evinces the necessity
of using them with caution.

By examining the contents of the mineral waters which are most used in
this country, we shall be enabled to form an idea of the danger which
may arise from an improper application of them either externally or
internally, though it is to the latter of these that the present
observations are chiefly confined.

The waters most in use for medical purposes in Britain, are those
impregnated with salts, sulphur, iron, and mephitic air, either
separately, or variously combined. Of these the most powerful is the
saline sulphureous water of Harrowgate, of which I have had more
occasion to observe the pernicious consequences, when improperly used,
than of any other. To this, therefore, the following remarks will more
immediately relate, though they will be found applicable to all the
purging waters in the kingdom which are strong enough to merit
attention[207].

The errors which so often defeat the intention of drinking the purgative
mineral waters, and which so frequently prove injurious to the patient,
proceed from the manner of using them, the quantity taken, the regimen
pursued, or using them in cases where they are not proper.

A very hurtful prejudice still prevails in this country, that all
diseases must be cured by medicines taken into the stomach, and that the
more violently these medicines operate, they are the more likely to have
the desired effect. This opinion has proved fatal to thousands, and
will, in all probability, destroy many more before it can be wholly
eradicated. Purging is often useful in acute diseases, and in chronical
cases may pave the way for the operation of other medicines; but it will
seldom perform a cure; and by exhausting the strength of the patient,
will often leave him in a worse condition than it found him. That this
is frequently the case with regard to the more active mineral waters,
every person conversant in these matters will readily allow.

Strong stimulants applied to the stomach and bowels for a length of
time, must tend to weaken and destroy their energy; and what stimulants
are more active than salt and sulphur, especially when these substances
are intimately combined, and carried through the system by the
penetrating medium of water? Those bowels must be strong indeed, which
can withstand the daily operation of such active principles for months
together, and not be injured. This however is the plan pursued by most
of those who drink the purging mineral waters, and whose circumstances
will permit them to continue long enough at those fashionable places of
resort.

Many people imagine that every thing depends on the quantity of water
taken, and that the more they drink they will the sooner get well. This
is an egregious error; for, while the unhappy patient thinks he is by
this means eradicating his disorder, he is often in fact undermining the
powers of life, and ruining his constitution. Indeed nothing can do this
so effectually as weakening the powers of digestion by the improper
application of strong stimulants. The very essence of health depends on
the digestive organs performing their due functions, and the most
tedious maladies are all connected with indigestion.

Drinking the water in too great quantity, not only injures the bowels
and occasions indigestion, but generally defeats the intention for which
it is taken. The diseases for the cure of which mineral waters are
chiefly celebrated, are mostly of the chronic kind; and it is well known
that such diseases can only be cured by the slow operation of
alteratives, or such medicines as act by inducing a gradual change in
the habit. This requires length of time, and never can be effected by
medicines which run off by stool, and operate chiefly on the first
passages.

Those who wish for the cure of any obstinate malady from the mineral
waters, ought to take them in such a manner as hardly to produce any
effect whatever on the bowels. With this view a half-pint glass may be
drank at bed-time[208], and the same quantity an hour before breakfast,
dinner, and supper. The dose, however, must vary according to
circumstances. Even the quantity mentioned above will purge some
persons, while others will drink twice as much without being in the
least moved by it. Its operation on the bowels is the only standard for
using the water as an alterative. No more ought to be taken than barely
to move the body; nor is it always necessary to carry it this length,
provided the water goes off by the other emunctories, and does not
occasion a chillness, or flatulency in the stomach or bowels. When the
water is intended to purge, the quantity mentioned above may be all
taken before breakfast.

I would not only caution patients who drink the purging mineral waters
over night to avoid heavy suppers, but also from eating heavy meals at
any time. The stimulus of water, impregnated with salts, seems to create
a false appetite. I have seen a delicate person, after drinking the
Harrowgate waters of a morning, eat a breakfast sufficient to have
served two ploughmen, devour a plentiful dinner of flesh and fish, and,
to crown all, eat such a supper as might have satisfied a hungry porter.
All this, indeed, the stomach seemed to crave; but this craving had
better remain not quite satisfied, than that the stomach should be
loaded with what exceeds its powers. To starve patients was never my
plans; but I am clearly of opinion, that, in the use of all the purging
mineral waters, a light and rather diluting diet is the most proper; and
that no person, during such a course, ought to eat to the full extent to
what his appetite craves.

To promote the operation of mineral waters, and to carry them through
the system, exercise is indispensably necessary. This may be taken in
any manner that is most agreeable to the patient; but he ought never to
carry it to excess. The best kinds of exercise are those connected with
amusement. Every thing that tends to exhilarate the spirits, not only
promotes the operation of the waters, but acts as a medicine. All who
resort to the mineral waters ought therefore to leave every care behind,
to mix with the company, and to make themselves as cheerful and happy as
possible. From this conduct, assisted by the free and wholesome air of
those fashionable places of resort, and also the regular and early hours
which are usually kept, the patient often receives more benefit than
from using the waters.

But the greatest errors in drinking the purging mineral waters arise
from their being used in cases where they are absolutely improper, and
adverse to the nature of the disease. When people hear of a wonderful
cure having been performed by some mineral water, they immediately
conclude that it will cure every thing, and accordingly swallow it down,
when they might as well take poison. Patients ought to be well informed,
before they begin to drink the more active kinds of mineral waters, of
the propriety of the course, and should never persist in using them when
they are found to aggravate the disorder.

In all cases where purging is indicated, the saline mineral waters will
be found to fulfil this intention better than any other medicine. Their
operation, if taken in proper quantity, is generally mild; and they are
neither found to irritate the nerves, nor debilitate the patient so much
as the other purgatives.

As a purgative, these waters are chiefly recommended in diseases of the
first passages, accompanied with, or proceeding from, inactivity of the
stomach and bowels, acidity, indigestion, vitiated bile, worms, putrid
sordes, the piles, and jaundice. In most cases of this kind they are the
best medicines that can be administered. But when used with this view,
it is sufficient to take them twice, or at most three times a-week, so
as to move the body three or four times; and it will be proper to
continue this course for some weeks.

But the operation of the more active mineral waters is not confined to
the bowels. They often promote the discharge of urine, and not
unfrequently increase the perspiration. This shews that they are capable
of penetrating into every part of the body, and of stimulating the whole
system. Hence arises their efficacy in removing the most obstinate of
all disorders, _obstructions of the glandular and lymphatic system_.
Under this class is comprehended the scrofula or _King’s evil_, indolent
tumours, obstructions of the liver, spleen, kidnies, and mesenteric
glands. When these great purposes are to be effected, the waters must be
used in the gradual manner mentioned above, and persisted in for a
length of time. It will be proper however now and then to discontinue
their use for a few days.

The next great class of diseases where mineral waters are found to be
beneficial, are those of the skin, as the itch, scab, tetters,
ringworms, scaly eruptions, leprosies, blotches, foul ulcers, &c. Though
these may seem superficial, yet they are often the most obstinate which
the physician has to encounter, and not unfrequently set his skill at
defiance: but they will sometimes yield to the application of mineral
waters for a sufficient length of time, and in most cases of this kind
these waters deserve a trial. The saline sulphureous waters, such as
those of Moffat in Scotland, and Harrowgate in England, are the most
likely to succeed in diseases of the skin; but for this purpose it will
be necessary not only to drink the waters, but likewise to use them
externally.

To enumerate more particularly the qualities of the different mineral
waters, to specify those diseases in which they are respectively
indicated, and to point out their proper modes of application, would be
an useful, and by no means a disagreeable employment; but as the limits
prescribed to these remarks will not allow me to treat the subject at
more length, I shall conclude by observing, that whenever the mineral
waters are found to exhaust the strength, depress the spirits, take away
the appetite, excite fevers, distend the bowels, or occasion a cough,
they ought to be discontinued.


  ⁂ These _Cautions_ having been printed and sold separately for the
  accommodation of those who had purchased the former editions of this
  book, has induced some persons to consider them as a Treatise on
  sea-bathing and drinking the mineral waters; whereas the author’s sole
  intention was to furnish a few general hints to persons who frequent
  those fashionable places of resort, without putting themselves under
  the care of a physician. As he looks upon this subject however to be
  of the greatest importance to the sick, he pledges himself to treat it
  at more length on a future occasion.




                               APPENDIX:


                               CONTAINING

  A List of Simples and of such Medicinal Preparations as ought to be
    kept in Readiness for private Practice:

  The Method of preparing and compounding such Medicines as are
    recommended in the former Part of the Book, with the Addition of
    several others of a similar Nature:

      Remarks on the Doses, Uses, and Manner of applying the different
                               Preparations.

      _Medicamentorum varietas ignorantiæ filia est._      BACON.




                             INTRODUCTION.


Ignorance and superstition have attributed extraordinary medical virtues
to almost every production of nature. That such virtues were often
imaginary, time and experience have sufficiently shewn. Physicians,
however, from a veneration for antiquity, still retain in their lists of
medicine many things which owe their reputation entirely to the
superstition and credulity of our ancestors.

The instruments of medicine will always be multiplied, in proportion to
men’s ignorance of the nature and cause of diseases: when these are
sufficiently understood, the method of cure will be simple and obvious.

Ignorance of the real nature and permanent properties of those
substances employed in the cure of diseases, is another reason why they
have been so greatly multiplied. Physicians thought they could effect by
a number of ingredients, what could not be done by any one of them.
Hence arose those amazing farragos which have so long disgraced the
medical art, and which were esteemed powerful in proportion to the
number of simples that entered their composition.

The great variety of forms into which almost every article of medicine
has been manufactured, affords another proof of the imperfection of the
medical art. A drug which is perhaps most efficacious in the simplest
form in which it can be administered, has been nevertheless served up in
so many different shapes, that one would be induced to think the whole
art of physic lay in exhibiting medicine under as many different modes
as possible.

Different forms of medicine, no doubt, have their use; but they ought
never to be wantonly increased. They are by no means so necessary as is
generally imagined. A few grains of powdered rhubarb, jalap, or
ipecacuanha, will actually perform all that can be done by the different
preparations of these roots, and may also be exhibited in as safe and
agreeable a manner. The same observation holds with regard to the
Peruvian bark, and many other simples of which the preparations are very
numerous.

Multiplying the ingredients of a medicine, not only renders it more
expensive, but also less certain, both in its dose and operation. Nor is
this all. The compound, when kept, is apt to spoil, or acquire qualities
of a different nature. When a medicine is rendered more safe,
efficacious, or agreeable, by the addition of another, they ought, no
doubt, to be joined; in all other cases, they are better kept asunder.
The combination of medicines embarrasses the physician, and retards the
progress of medical knowledge. It is impossible to ascertain the precise
effect of any one medicine, as long as it is combined with others,
either of a similar or dissimilar nature.

In the exhibition of medicine, regard should not only be had to
simplicity, but likewise to elegance. Patients seldom reap much benefit
from things that are highly disagreeable to their senses. To taste or
smell like a drug, is become a proverb; and to say truth, there is too
much ground for it. Indeed no art can take away the disagreeable taste
and flavour of some drugs, without entirely destroying their efficacy:
it is possible, however, to render many medicines less disgustful, and
others even agreeable; an object highly deserving the attention of all
who administer medicine.

The design of the following pages is, to exhibit such a list of drugs
and medicines as may be necessary for private practice. They are
considerably more numerous indeed than those recommended in the former
part of the Book, but are still greatly within the number contained in
the most reformed dispensatories. The same medicine is seldom exhibited
under different forms; and where different medicines answer nearly the
same intention, there is commonly no more than one of them retained.
Multiplying forms of medicine for the same intention tends rather to
bewilder than assist the young practitioner, and the experienced
physician can never be at a loss to vary his prescriptions as occasion
requires.

The chemical and other difficult preparations are for the most part
omitted. All of them that are used by any private practitioner are not
worth preparing. He will buy them much cheaper than he can make them.
Great care however is necessary to obtain them genuine. They are often
adulterated, and ought never to be purchased unless from persons of
known veracity. Such of them as are in common use are inserted in the
list of drugs and medicines. Their proper doses and manner of
application, are mentioned in the practical part of the Book, wherever
they are prescribed.

Such articles of medicine as are to be found in the house or garden of
almost every peasant, as barley, eggs, onions, &c. are likewise, for the
most part, omitted. It is needless to swell a list of medicines with
such things as can be obtained whenever they are wanted, and which spoil
by being kept.

The preparations made and sold by distillers and confectioners are also
generally left out. These people, by operating upon a larger plan,
generally make things better, while it is in their power to afford them
much cheaper, than they can be prepared by any private hand.

The quantity ordered of every medicine is as small as could well be
prepared, both to prevent unnecessary expence, and that the medicine
might not spoil by keeping. Almost every medicine suffers by being kept,
and should be used as soon after it has been prepared as possible. Even
simple drugs are apt to spoil, and should therefore be laid in in small
quantities; they either rot, are consumed by insects, or evaporate so as
to lose their peculiar taste or flavour, and often become quite
insignificant.

In the preparation of medicines, I have generally followed the most
improved dispensatories; but have taken the liberty to differ from them
wherever my own observations, or those of other practical writers, on
whose judgment I could depend, suggested an improvement.

In several compositions, the ingredient on which the efficacy of the
medicine principally depends is increased, while the auxiliaries, which
are generally ordered in such trifling quantities as to be of no
importance, are left out, or only such of them retained as are necessary
to give the medicine a proper consistence, or the like.

The colouring ingredients are likewise for the most part omitted. They
increase the bulk and price of the medicine; without adding any thing to
its value. It would be well if they were never used at all. Medicines
are often adulterated for the sake of a colour. Acrid and even poisonous
substances are, for this purpose, sometimes introduced into those
medicines which ought to be most bland and emollient. Ointment of elder,
for example, is often mixed with verdegrise to give it a fine green
colour, which entirely frustrates the intention of that mild ointment.
Those who wish to obtain genuine medicines should pay no regard to their
colour.

Some regard is likewise paid to expence. Such ingredients as greatly
increase the price of any composition, without adding considerably to
its virtue, are generally either omitted, or somewhat less expensive
substituted in their place. Medicines are by no means powerful in
proportion to their price. The cheapest are often the best; besides,
they are the least apt to be adulterated, and are always most readily
obtained.

With regard to the method of compounding medicines, I have generally
followed that which seemed to be the most simple and natural, mentioning
the different steps of the process in the same order in which they ought
to be taken, without paying an implicit regard to the method of other
dispensatories.

For many of the remarks concerning the preparation, &c. of medicines, I
have been obliged to the author of the New Dispensatory. The other
observations are either such as have occurred to myself in practice, or
have been suggested in the course of reading, by authors whose names I
am not able distinctly to recollect.

I have followed the alphabetical order, both with regard to the simples
and preparations. A more scientific method would have been agreeable to
some persons, but less useful to the generality of readers. The
different classes of medicine have no great dependance upon one another;
and, where they have, it is hard to say which should stand first or
last; no doubt the simple preparations ought to precede the more
compound. But all the advantages arising from this method of arrangement
do not appear equal to that single one, of being able, on the first
opening of the book, to find out any article, which, by the alphabetical
order, is rendered quite easy.

The dose of every medicine is mentioned whenever it appeared necessary.
When this is omitted it is to be understood that the medicine may be
used at discretion. The dose mentioned is always for an adult, unless
when the contrary is expressed. It is not an easy matter to proportion
the doses of medicine exactly to the different ages, constitutions, &c.
of patients; but, happily for mankind, mathematical exactness here is by
no means necessary.

Several attempts have been made to ascertain the proportional doses for
the different ages and constitutions of patients; but, after all that
can be said upon this subject, a great deal must be left to the judgment
and skill of the person who administers the medicine. The following
general proportions may be observed; but they are by no means intended
for exact rules. A patient between twenty and fourteen may take two
thirds of the dose ordered for an adult; from fourteen to nine, one
half; from nine to six, one-third; from six to four, one-fourth; from
four to two, one-sixth; from two to one, a tenth; and below one, a
twelfth.

Dispensatories are usually written in the Latin language. Even authors
who write in English, generally give their prescriptions in Latin; and
some of them shew so great an attachment to that language, as first to
write their _recipes_ in it, and afterwards translate them; while
others, to compromise the matter, write the one half in Latin and the
other in English. What peculiar charm a medical prescription, when
written in Latin, may have, I shall not pretend to say; but have
ventured to make use of the plainest English I could, and hope my
prescriptions will succeed no worse for it.

_N. B._ The Apothecary’s weights, and the English wine measures, are
used throughout the whole book, the different denominations of which
will appear from the following Table:

                   A pound   contains twelve ounces.
                   An ounce    −  −   eight drachms.
                   A drachm    −  −   three scruples.
                   A scruple   −  −   twenty grains.

                   A gallon  contains eight pints.
                   A pint      −  −   sixteen ounces.
                   An ounce    −  −   eight drachms.

                   A spoonful is the measure of half
                               an ounce.




 A LIST of SIMPLES, and of such MEDICINAL PREPARATIONS, as ought to be
                kept in readiness for private Practice.


  Agaric
  Alum
  Antimony, crude
  —— cinnabar of
  —— sulphur of
  Balsam of Capivi
  —— of Peru
  —— of Tolu
  Bark, cascarilla
  —— cinnamon
  —— mezereon
  —— Peruvian
  —— Winter’s, or canella alba
  Borax
  Calamine stone, levigated
  Castor, Russian
  Caustic, common
  —— lunar
  Earth, Fuller’s
  —— Japan
  —— Armenian bole
  —— French ditto
  Extracts of gentian
  —— of guaiacum
  —— of hellebore, black
  —— of hemlock
  —— of jalap
  —— of liquorice
  —— of Peruvian bark
  —— of poppies
  —— of wormwood
  Flowers of camomile
  —— colt’s foot
  —— elder
  —— rosemary
  —— damask roses
  —— red ditto
  Fruits, almonds
  —— bitter apple
  —— cassia fistularis
  —— Curassao oranges
  —— figs, dried
  —— French prunes
  —— Jamaica pepper
  —— juniper berries
  —— nutmegs
  —— tamarinds
  Gums, aloes
  —— ammoniac, in tears
  —— arabic
  —— asafœtida
  —— camphor
  —— galbanum
  —— gamboge
  —— guaiacum
  —— kino
  —— myrrh
  —— opium
  Hartshorn, calcined
  —— shavings of
  Herbs, lesser centaury
  —— peppermint
  —— spearmint
  —— penny-royal
  —— savin
  —— trefoil
  —— uva ursi
  —— wormwood
  Lead, Litharge
  —— white
  —— sugar of
  Lemon-peel
  Mace
  Magnesia alba
  Manna
  Mercury, crude
  —— calcinated
  —— Æthiop’s mineral
  —— calomel
  —— corrosive sublimate
  —— red precipitate
  —— white ditto
  Musk
  Oil, essential, of amber
  —— —— of annise
  —— —— of cinnamon
  —— —— of juniper
  —— —— of lemon-peel
  —— —— of peppermint
  —— expressed, of almonds
  —— —— of linseed
  Oil of olives, or Florence oil
  —— of palms
  —— of turpentine
  Orange-peel
  Oyster-shells prepared
  Poppy-heads
  Resins, benzoin
  —— —— flowers of
  —— Burgundy pitch
  —— dragon’s blood
  —— frankincense
  —— liquid storax
  —— white, or rosin
  —— scammony
  Roots, birthwort
  —— calamus aromaticus
  —— contrayerva
  —— garlic
  —— gentian
  —— ginger
  —— hellebore, black, white
  —— jalap
  —— ipecacuanha
  —— lily, white
  —— liquorice
  —— marsh-mallow
  —— mezerion
  —— rhubarb
  —— sarsaparilla
  —— seneka
  —— squills
  —— tormentil
  —— turmeric
  —— Virginian snake
  —— wild valerian
  —— zedoary
  Saffron
  Sal ammoniac, crude
  —— volatile
  Salt, Epsom
  —— of Glauber
  —— of hartshorn
  —— nitre, purified, or prunel
  —— Polychrest
  —— Rochel
  —— of tartar
  Seeds, anise
  —— carraway
  —— cardamom
  —— coriander
  —— cummin
  —— mustard
  —— sweet fennel
  —— wild carrot
  Senna
  Spanish flies
  Sperma ceti
  Spirits, æthereal, or æther
  —— of hartshorn
  —— of lavender, compound
  —— of nitre
  —— ditto dulcified
  —— of sal ammoniac
  —— of sea salt
  —— of vinegar
  —— of vitriol
  —— of wine rectified
  —— volatile aromatic
  Steel, filings of
  —— rust of, prepared
  —— soluble salt of
  Sulphur vivum
  —— balsam of
  Sulphur, flowers of
  Tar
  —— Barbadoes
  Tartar, cream of
  —— emetic
  —— soluble
  —— vitriolated
  Tin prepared
  Tutty, levigated
  Turpentine, Venice
  Verdegrise
  Vitriol, green
  —— blue
  —— white
  Wax, white
  —— yellow
  Woods, guaiacum
  —— logwood
  —— sassafras
  —— saunders, red
  Zinc, flowers of




                        MEDICINAL PREPARATIONS.


                                BALSAMS.

The subject of this section is not the natural balsams, but certain
compositions, which, from their being supposed to possess balsamic
qualities, generally go by that name.

This class of medicines was formerly very numerous, and held in great
esteem: modern practice, however, has justly reduced it to a very narrow
compass.


                           _Anodyne Balsam._

Take of white Spanish soap, one ounce; opium, unprepared, two drachms;
rectified spirit of wine, nine ounces. Digest them together in a gentle
heat for three days; then strain off the liquor, and add to it three
drachms of camphor.

This balsam, as its title expresses, is intended to ease pain. It is of
service in violent strains and rheumatic complaints, when not attended
with inflammation. It must be rubbed with a warm hand on the part
affected; or a linen rag moistened with it may be applied to the part,
and renewed every third or fourth hour, till the pain abates. If the
opium is left out, this will be the _saponacious balsam_.


                         _Locatelli’s Balsam._

Take of olive oil, one pint; Strasburg turpentine and yellow wax, of
each half a pound; red saunders, six drachms. Melt the wax with some
part of the oil over a gentle fire; then adding the remaining part of
the oil and the turpentine; afterwards mix in the saunders, previously
reduced to a powder, and keep them stirring together till the balsam is
cold.

This balsam is recommended in erosions of the intestines, the dysentery,
hæmorrhages, internal bruises, and in some complaints of the breast.
Outwardly it is used for healing and cleansing wounds and ulcers. The
dose, when taken internally, is from two scruples to two drachms.


                        _The vulnerary Balsam._

Take of benzoin, powdered, three ounces; balsam of Peru, two ounces;
hepatic aloes, in powder, half an ounce; rectified spirit of wine, two
pints. Digest them in a gentle heat for three days, and then strain the
balsam.

This balsam, or rather tincture, is applied externally to heal recent
wounds and bruises. It is likewise employed internally to remove coughs,
asthmas, and other complaints of the breast. It is said to ease the
colic, cleanse the kidnies, and to heal internal ulcers, &c.

The dose is from twenty to sixty drops.

This, though a medicine of some value, does not deserve the extravagant
encomiums which have been bestowed on it. It has been celebrated under
the different names of _The Commander’s Balsam_, _Persian Balsam_,
_Balsam of Berne_, _Wade’s Balsam_, _Friar’s Balsam_, _Jesuit’s Drops_,
_Turlington’s Drops_, &c.


                                BOLUSES.

As boluses are intended for immediate use, volatile salts and other
ingredients improper for being kept, are admitted into their
composition. They are generally composed of powders, with a proper
quantity of syrup, conserve, or mucilage. The lighter powders are
commonly made up with syrup, and the more ponderous, as mercury, &c.
with conserve; but those of the lighter kind would be more conveniently
made up with mucilage, as it increases their bulk less than the other
additions, and likewise occasions the medicine to pass down more easily.


                          _Astringent Bolus._

Take of alum, in powder, fifteen grains; gum kino, five grains; syrup, a
sufficient quantity to make a bolus.

In an excessive flow of the _menses_, and other violent discharges of
blood, proceeding from relaxation, this bolus may be given every four or
five hours, till the discharge abates.


                          _Diaphoretic Bolus._

Take of gum guaiacum, in powder, ten grains; flowers of sulphur and
cream of tartar, of each one scruple; simple syrup, a sufficient
quantity.

In rheumatic complaints, and disorders of the skin, this bolus may be
taken twice a day. It will also be of service in the inflammatory
quinsey.


                           _Mercurial Bolus._

Take of calomel, six grains; conserve of roses, half a drachm. Make a
bolus.

Where mercury is necessary, this bolus may be taken twice or thrice a
week. It may be taken over night; and if it does not operate, a few
grains of jalap will be proper next day to carry it off.


                    _Bolus of Rhubarb and Mercury._

Take of the best rhubarb, in powder, from a scruple to half a drachm; of
calomel, from four to six grains; simple syrup, a sufficient quantity to
make a bolus.

This is a proper purge in hypochondriac constitutions; but its principal
intention is to expel worms. Where a stronger purge is necessary, jalap
may be used instead of the rhubarb.


                           _Pectoral Bolus._

Take of sperma-ceti, a scruple; gum ammoniac, ten grains; salt of
hartshorn, six grains; simple syrup, as much as will make them into a
bolus.

This bolus is given in colds and coughs of long standing, asthmas, and
beginning consumptions of the lungs. It is generally proper to bleed the
patient before he begins to use it.


                            _Purging Bolus._

Take of jalap, in powder, a scruple; cream of tartar, two scruples. Let
them be rubbed together, and formed into a bolus, with simple syrup.

Where a mild purge is wanted, this will answer the purpose very well. If
a stronger dose is necessary, the jalap may be increased to half a
drachm or upwards.


                       CATAPLASMS AND SINAPISMS.

Cataplasms possess few or no virtues superior to a poultice, which may
be so made, as, in most cases, to supply their place. They are chiefly
intended either to act as discutients, or to promote suppuration; and as
they may be of service in some cases, we shall give a specimen of each
kind.


                        _Discutient Cataplasm._

Take of barley-meal, six ounces; fresh hemlock leaves, bruised; two
ounces; vinegar, a sufficient quantity. Boil the meal and hemlock in the
vinegar for a little, and then add two drachms of the sugar of lead.


                         _Ripening Cataplasm._

Take of white lily root, four ounces; fat figs and raw onions, bruised,
of each one ounce; yellow basilicum ointment, two ounces; gum galbanum,
half an ounce; linseed meal, as much as necessary. Boil the roots along
with the figs in a sufficient quantity of water; then bruise and add to
them the other ingredients, so as to form the whole into a soft
cataplasm. The galbanum must be previously dissolved with the yolk of an
egg.

Where it is necessary to promote suppuration, this cataplasm may be used
by those who chuse to be at the trouble and expence of making it. For my
part, I have never found any application more proper for this purpose
than a poultice of bread and milk, with a sufficient quantity of either
boiled or raw onion in it, and softened with oil or fresh butter.


                              _Sinapisms._

Sinapisms are employed to recal the blood and spirits to a weak part, as
in the palsy and atrophy. They are also of service in deep-seated pains,
as the sciatica, &c. When the gout seizes the head or the stomach, they
are applied to the feet to bring the disorder to these parts. They are
likewise applied to the patient’s soles in the low state of fevers. They
should not be suffered to lie on, however, till they have raised
blisters, but till the parts become red, and will continue so when
pressed with the finger.

The sinapism is only a poultice made with vinegar instead of milk, and
rendered warm and stimulating by the addition of mustard, horse-radish,
or garlic.

The common sinapism is made by taking crumb of bread and mustard-seed in
powder, of each equal quantities; strong vinegar, as much as is
sufficient, and mixing them so as to make a poultice.

When sinapisms of a more stimulating nature are wanted, a little bruised
garlic may be added to the above.


                               CLYSTERS.

This class of medicines is of more importance than is generally
imagined. clysters serve, not only to evacuate the contents of the
belly, but also to convey very active medicines into the system. Opium,
for example, may be administered in this way when it will not sit upon
the stomach, and also in larger doses than at any time it can be taken
by the mouth. The Peruvian bark may likewise be, with good effect,
administered in form of clyster to persons who cannot take it by the
mouth.

A simple clyster can seldom do hurt, and there are many cases where it
may do much good. A clyster even of warm water, by serving as a
fomentation to the parts, may be of considerable service in
inflammations of the bladder, and the lower intestines, &c.

Some substances, as the smoke of tobacco, may be thrown into the bowels
in this way, which cannot by any other means whatever. This may be
easily effected by means of a pair of hand-bellows, with an apparatus
fitted to them for that purpose.

Nor is the use of clysters confined to medicines. Aliment may also be
conveyed in this way. Persons unable to swallow, have been, for a
considerable time, supported by clysters.


                          _Emollient Clyster._

Take of linseed-tea and new milk, each six ounces. Mix them.

If fifty or sixty drops of laudanum be added to this, it will supply the
place of the _Anodyne Clyster_.


                          _Laxative Clyster._

Take of milk and water, each six ounces; sweet oil or fresh butter, and
brown sugar, of each two ounces. Mix them.

If an ounce of Glauber’s salt, or two table-spoonfuls of common salt, be
added to this, it will be the _Purging Clyster_.


                         _Carminative Clyster._

Take of camomile flowers, an ounce; anise-seeds, half an ounce. Boil in
a pint and a half of water to one pint.

In hysteric and hypochondriac complaints this may be administered
instead of the _Fœtid Clyster_, the smell of which is so disagreeable to
most patients.


                            _Oily Clyster._

To four ounces of the infusion of camomile flowers, add an equal
quantity of Florence oil.

This clyster is beneficial in bringing off the small worms lodged in the
lower parts of the alimentary canal. When given to children the quantity
must be proportionably lessened.


                           _Starch Clyster._

Take jelly of starch, four ounces; linseed oil, half an ounce. Liquify
the jelly over a gentle fire, and then mix in the oil.

In the dysentery or bloody flux, this clyster may be administered after
every loose stool, to heal the ulcerated intestines and blunt the
sharpness of corroding humours. Forty or fifty drops of laudanum may be
occasionally added; in which case, it will generally supply the place of
the _Astringent Clyster_.


                         _Turpentine Clyster._

Take of common decoction, ten ounces; Venice turpentine, dissolved with
the yolk of an egg, half an ounce; Florence oil, one ounce. Mix them.

This diuretic clyster is proper in obstructions of the urinary passages,
and in colicky complaints, proceeding from gravel.


                           _Vinegar Clyster._

This clyster is made by mixing three ounces of vinegar with five of
water-gruel.

It answers all the purposes of a common clyster, with the peculiar
advantage of being proper either in inflammatory or putrid disorders,
especially in the latter.

☞ We think it unnecessary to give more examples of this class of
medicines, as ingredients adapted to any particular intention may be
occasionally added to one or other of the above forms.


                        COLLYRIA, or EYE-WATERS.

Eye-waters have been multiplied without number, almost every person
pretending to be possessed of some secret preparation for the cure of
sore eyes. I have examined many of them, and find that they are pretty
much alike, the basis of most of them being either alum, vitriol, or
lead. Their effects evidently are, to brace and restore the tone of the
parts; hence they are principally of service in slight inflammations;
and in that relaxed state of the parts which is induced by obstinate
ones.

Camphor is commonly added to these compositions; but as it seldom
incorporates properly with the water, it can be of little use. Boles and
other earthy substances, as they do not dissolve in water, are likewise
unfit for this purpose.


                          _Collyrium of Alum._

Take of alum, half a drachm; agitate it well together with the white of
one egg.

This is the Collyrium of Riverius. It is used in inflammation of the
eyes, to allay heat, and restrain the flux of humours. It must be spread
upon linen, and applied to the eyes; but should not be kept on above
three or four hours at a time.


                         _Vitriolic Collyrium._

Take of white vitriol, half a drachm; rose-water, six ounces. Dissolve
the vitriol in the water, and filter the liquor.

This, though simple, is perhaps equal in virtue to most of the
celebrated collyria. It is an useful application in weak, watery, and
inflamed eyes. Though the slighter inflammations will generally yield to
it, yet in those of a more obstinate nature the assistance of bleeding
and blistering will often be necessary.

When a strong astringent is judged proper, a double or triple quantity
of the vitriol may be used. I have seen a solution of four times the
strength of the above used with manifest advantage.


                          _Collyrium of Lead._

Take sugar of lead, and crude sal ammoniac, of each four grains.
Dissolve them in eight ounces of common water.

Forty or fifty drops of laudanum may be occasionally added to this
collyrium.

Those who chuse may substitute instead of this the collyrium of lead
recommended by Goulard; which is made by putting twenty-five drops of
his _Extract of Lead_ to eight ounces of water, and adding a
tea-spoonful of brandy.

Indeed, common water and brandy, without any other addition, will in
many cases answer very well as a collyrium. An ounce of the latter may
be added to five or six ounces of the former; and the eyes, if weak,
bathed with it night and morning.


                              CONFECTIONS.

Confections containing above sixty ingredients are still to be found in
some of the most reformed dispensatories. As most of their intentions,
however, may be more certainly, and as effectually answered by a few
glasses of wine or grains of opium, we shall pass over this class of
medicines very slightly.


                         _Japonic Confection._

Take of Japan earth, three ounces; tormentil root, nutmeg, olibanum, of
each two ounces; opium dissolved in a sufficient quantity of Lisbon
wine, a drachm and a half; simple syrup and conserve of roles, of each
fourteen ounces. Mix and make them into an electuary.

This supplies the place of the Diascordium.

The dose of this electuary is from a scruple to a drachm.


                        CONSERVES AND PRESERVES.

Every Apothecary’s shop was formerly so full of these preparations, that
it might have passed for a confectioner’s warehouse. They possess very
few medicinal properties, and may rather be classed among sweetmeats
than medicines. They are sometimes, however, of use, for reducing into
boluses or pills some of the more ponderous powders, as the preparations
of iron, mercury, and tin.

Conserves are compositions of fresh vegetables and sugar, beaten
together into an uniform mass. In making these preparations, the leaves
of vegetables must be freed from their stalks, the flowers from their
cups, and the yellow part of orange-peel taken off with a rasp. They are
then to be pounded in a marble mortar, with a wooden pestle, into a
smooth mass; after which, thrice their weight of fine sugar is commonly
added by degrees, and the beating continued till they are uniformly
mixed; but the conserve will be better if only twice its weight of sugar
be added.

Those who prepare large quantities of conserve generally reduce the
vegetables to a pulp by the means of a mill, and afterwards beat them up
with the sugar.


                        _Conserve of Red Roses._

Take a pound of red rose buds, cleared of their heels; beat them well in
a mortar, and, adding by degrees two pounds of double-refined sugar, in
powder, make a conserve.

After the same manner are prepared the conserves of orange-peel,
rosemary flowers, sea-wormwood, of the leaves of wood-sorrel, &c.

The conserve of roses is one of the most agreeable and useful
preparations belonging to this class. A drachm or two of it, dissolved
in warm milk, is ordered to be given as a gentle restringent in weakness
of the stomach, and likewise in phthisical coughs, and spitting of
blood. To have any considerable effects, however, it must be taken in
larger quantities.


                          _Conserve of Sloes._

This may be made by boiling the sloes gently in water, being careful to
take them out before they burst; afterwards expressing the juice, and
beating it up with three times its weight of fine sugar.

In relaxations of the _uvula_ and glands of the throat, this makes an
excellent gargle, and may be used at discretion.

_Preserves_ are made by steeping or boiling fresh vegetables first in
water, and afterwards in syrup, or a solution of sugar. The subject is
either preserved moist in the syrup, or taken out and dried, that the
sugar may candy upon it. The last is the most useful method.


                         _Candied Orange Peel._

Soak Seville orange-peel in several waters, till it loses its
bitterness; then boil it in a solution of double-refined sugar in water,
till it becomes tender and transparent.

Candied lemon-peel is prepared in the same manner.

It is needless to add more of these preparations, as they belong rather
to the art of the confectioner than that of the apothecary.


                              DECOCTIONS.

Water readily extracts the gummy and saline parts of vegetables; and
though its action is chiefly confined to these, yet the resinous and
oily being intimately blended with the gummy and saline, are in great
part taken up along with them. Hence watery decoctions and infusions of
vegetables, constitute a large, and not unuseful, class of medicines.
Although most vegetables yield their virtues to water, as well by
infusion as decoction, yet the latter is often necessary, as it saves
time, and does in a few minutes what the other would require hours, and
sometimes days, to effect.

The medicines of this class are all intended for immediate use.


                         _Decoction of Althæa._

Take of the roots of marsh-mallows, moderately dried, three ounces;
raisins of the sun, one ounce; water, three pints.

Boil the ingredients in the water till one-third of it is consumed;
afterwards strain the decoction and let it stand for some time to
settle. If the roots be thoroughly dried, they must be boiled till one
half the water be consumed.

In coughs, and sharp defluctions upon the lungs, this decoction may be
used for ordinary drink.


                        _The Common Decoction._

Take of camomile flowers, one ounce; elder flowers, and sweet fennel
seeds, of each half an ounce; water, two quarts. Boil them for a little,
and then strain the decoction.

A medicine equally good may be prepared by infusing the ingredients for
some hours in boiling water.

This decoction is chiefly intended as the basis of clysters, to which
other ingredients may be occasionally added. It will likewise serve as a
common fomentation, spirit of wine or other things being added in such
quantity as the case may require.


                        _Decoction of Logwood._

Boil three ounces of the shavings, or chips, of logwood, in four pints
of water, till one half the liquor is wasted. Two or three ounces of
simple cinnamon-water may be added to this decoction.

In fluxes of the belly, where the stronger astringents are improper, a
tea-cupful of this decoction may be taken with advantage three or four
times a-day.


                        _Decoction of the Bark._

Boil an ounce of the Peruvian bark, grossly powdered, in a pint and a
half of water to one pint; then strain the decoction. If a tea-spoonful
of the weak spirit of vitriol be added to this medicine, it will render
it both more agreeable and efficacious.


                   _Compound Decoction of the Bark._

Take of Peruvian bark and Virginian snake-root, grossly powdered, each
three drachms. Boil them in a pint of water to one half. To the strained
liquor add an ounce and a half of aromatic water.

Sir John Pringle recommends this as a proper medicine towards the
decline of malignant fevers, when the pulse is low, the voice weak, and
the head affected with a stupor but with little delirium.

The dose is four spoonfuls every fourth or sixth hour.


                      _Decoction of Sarsaparilla._

Take of fresh sarsaparilla root, sliced and bruised, two ounces;
shavings of guaiacum wood, one ounce. Boil over a slow fire, in three
quarts of water, to one; adding towards the end, half an ounce of
sassafras wood, and three drachms of liquorice. Strain the decoction.

This may either be employed as an assistant to a course of mercurial
alteratives, or taken after the mercury has been used for some time. It
strengthens the stomach, and restores flesh and vigour to habits
emaciated by the venereal disease. It may also be taken in the
rheumatism, and cutaneous disorders proceeding from foulness of the
blood and juices. For all these intentions it is greatly preferable to
the _Decoction of Woods_.

This decoction may be taken, from a pint and a half to two quarts in the
day.

The following decoction is said to be similar to that used by _Kennedy_,
in the cure of the venereal disease, and may supply the place of Lisbon
diet drink:

Take of sarsaparilla, three ounces; liquorice and mezereon root, of each
half an ounce; shavings of guaiacum and sassafras wood, of each one
ounce; crude antimony, powdered, an ounce and a half. Infuse these
ingredients in eight pints of boiling water for twenty-four hours, then
boil them till one half of the water is consumed; afterwards strain the
decoction.

This decoction may be used in the same manner as the preceding.


                         _Decoction of Seneka._

Take of seneka rattle-snake root, one ounce; water, a pint and a half.
Boil to one pint, and strain.

This decoction is recommended in the pleurisy, dropsy, rheumatism, and
some obstinate disorders of the skin. The dose is two ounces, three or
four times a-day, or oftner, if the stomach will bear it.


                           _White Decoction._

Take of the purest chalk, in powder, two ounces; gum arabic, half an
ounce; water, three pints. Boil to one quart, and strain the decoction.

This is a proper drink in acute diseases, attended with, or inclining
to, a looseness, and where acidities abound in the stomach or bowels. It
is peculiarly proper for children when afflicted with sourness of the
stomach, and for persons who are subject to the heart-burn. It may be
sweetened with sugar, as it is used, and two or three ounces of simple
cinnamon-water added to it.

An ounce of powdered chalk, mixed with two pints of water, will
occasionally supply the place of this decoction, and also of the chalk
julep.


                               DRAUGHTS.

This is a proper form for exhibiting such medicines as are intended to
operate immediately, and which do not need to be frequently repeated; as
purges, vomits, and a few others, which are to be taken at one dose.
Where a medicine requires to be used for any length of time, it is
better to make up a larger quantity of it at once, which saves both
trouble and expence.


                           _Anodyne Draught._

Take of liquid laudanum, twenty-five drops; simple cinnamon water, an
ounce; common syrup, two drachms. Mix them.

In excessive pain, where bleeding is not necessary, and in great
restlessness, this composing draught may be taken and repeated
occasionally.


                          _Diuretic Draught._

Take of the diuretic salt, two scruples; syrup of poppies, two drachms;
simple cinnamon-water and common water, of each an ounce.

This draught is of service in an obstruction or deficiency of urine.


                          _Purging Draughts._

Take of manna, an ounce; soluble tartar, or Rochel salt, from three to
four drachms. Dissolve in three ounces of boiling water; to which add
Jamaica pepper water, half an ounce.

As manna sometimes will not sit upon the stomach, an ounce or ten
drachms of the bitter purging salts, dissolved in four ounces of water,
may be taken instead of the above.

Those who cannot take salts may use the following draught:

Take of jalap in powder, a scruple; common water, an ounce; aromatic
tincture, six drachms. Rub the jalap with twice its weight of sugar, and
add to it the other ingredients.


                          _Sweating Draught._

Take spirit of Mindererus, two ounces; salt of hartshorn, five grains;
simple cinnamon-water, and syrup of poppies, of each half an ounce. Make
them into a draught.

In recent colds and rheumatic complaints, this draught is of service. To
promote its effects, however, the patient ought to drink freely of warm
water-gruel, or of some other weak diluting liquor.


                          _Vomiting Draughts._

Take of ipecacuanha, in powder, a scruple; water, an ounce; simple
syrup, a drachm. Mix them.

Persons who require a stronger vomit may add to the above half a grain,
or a grain, of emetic tartar.

Those who do not chuse the powder, may take ten drachms of the
ipecacuanha wine; or half an ounce of the wine, and an equal quantity of
the syrup of squills.


                              ELECTUARIES.

Electuaries are generally composed of the lighter powders, mixed with
syrup, honey, conserve, or mucilage, into such a consistence, that the
powders may neither separate by keeping, nor the mass prove too stiff
for swallowing. They receive chiefly the milder alterative medicines,
and such as are not ungrateful to the palate.

Astringent electuaries, and such as have pulps of fruit in them, should
be prepared only in small quantities; as astringent medicines lose their
virtues by being kept in this form, and the pulps of fruits are apt to
ferment.

For the extraction of pulps it will be necessary to boil unripe fruits,
and ripe ones if they are dried, in a small quantity of water till they
become soft. The pulp is then to be pressed out through a strong hair
sieve, or thin cloth, and afterwards boiled to a due consistence, in an
earthen vessel, over a gentle fire, taking care to prevent the matter
from burning by continually stirring it. The pulps of fruit that are
both ripe and fresh may be pressed out without any previous boiling.


                         _Lenitive Electuary._

Take of senna, in fine powder, eight ounces; coriander seed, also in
powder, four ounces; pulp of tamarinds and of French prunes, each a
pound. Mix the pulps and powders together, and with a sufficient
quantity of simple syrup, reduce the whole into an electuary.

A tea-spoonful of this electuary, taken two or three times a day,
generally proves an agreeable laxative. It likewise serves as a
convenient vehicle for exhibiting more active medicines, as jalaps,
scammony, and such like.

This may supply the place of the electuary of _Cassia_.


                     _Electuary for the Dysentery._

Take of the Japonic confection, two ounces; Locatelli’s balsam, one
ounce; rhubarb in powder, half an ounce; syrup of marsh-mallows, enough
to make an electuary.

It is often dangerous in dysenteries to give opiates and astringents,
without interposing purgatives. The purgative is here joined with these
ingredients, which renders this a very safe and useful medicine for the
purposes expressed in the title.

About the bulk of a nutmeg should be taken twice or thrice a-day, as the
symptoms and constitution may require.


                     _Electuary for the Epilepsy._

Take of Peruvian bark, in powder, an ounce; of powdered tin, and wild
valerian-root, each half an ounce; simple syrup, enough to make an
electuary.

Dr. Mead directs a drachm of an electuary similar to this to be taken
evening and morning, in the epilepsy, for the space of three months. It
will be proper, however, to discontinue the use of it for a few days
every now and then. I have added the powdered tin, because the epilepsy
often proceeds from worms.


                     _Electuary for the Gonorrhœa._

Take of lenitive electuary, three ounces; jalap and rhubarb, in powder,
of each two drachms; nitre, half an ounce; simple syrup, enough to make
an electuary.

During the inflammation and tension of the urinary passages, which
accompany a virulent gonorrhœa, this cooling laxative may be used with
advantage.

The dose is a drachm, or about the bulk of a nutmeg, two or three times
a-day; more or less, as may be necessary to keep the body gently open.

An electuary made of cream of tartar and simple syrup will occasionally
supply the place of this.

After the inflammation is gone off, the following electuary may be used:

Take of lenitive electuary, two ounces; balsam of capivi, one ounce; gum
guaiacum and rhubarb, in powder, of each two drachms; simple syrup,
enough to make an electuary. The dose is the same as of the preceding.


                        _Electuary of the Bark._

Take of Peruvian bark, in powder, three ounces; cascarilla, half an
ounce; syrup of ginger, enough to make an electuary.

In the cure of obstinate intermitting fevers, the bark is assisted by
the cascarilla. In hectic habits, however, it will be better to leave
out the cascarilla, and put three drachms of crude sal ammoniac in its
stead.


                       _Electuary for the Piles._

Take flowers of sulphur, one ounce; cream of tartar, half an ounce;
treacle, a sufficient quantity to form an electuary.

A tea-spoonful of this may be taken three or four times a-day.


                       _Electuary for the Palsy._

Take of powdered mustard-seed, and conserve of roses, each an ounce;
syrup of ginger, enough to make an electuary.

A tea-spoonful of this may be taken three or four times a-day.


                    _Electuary for the Rheumatism._

Take of conserve of roses, two ounces; cinnabar of antimony, levigated,
an ounce and a half; gum guaiacum, in powder, an ounce; syrup of ginger,
a sufficient quantity to make an electuary.

In obstinate rheumatisms, which are not accompanied with a fever, a
tea-spoonful of this electuary may be taken twice a-day with
considerable advantage.


                               EMULSIONS.

Emulsions, beside their use as medicines, are also proper vehicles for
certain substances, which could not otherwise be conveniently taken in a
liquid form. Thus camphor, triturated with almonds, readily unites with
water into an emulsion. Pure oils, balsams, resins, and other similar
substances, are likewise rendered miscible with water by the
intervention of mucilages.


                           _Common Emulsion._

Take of sweet almonds, an ounce; bitter almonds, a drachm; water, two
pints.

Let the almonds be blanched, and beat up in a marble mortar; adding the
water by little and little, so as to make an emulsion; afterwards let it
be strained.


                           _Arabic Emulsion._

This is made in the same manner as the above, adding to the almonds
while beating, two ounces and a half of the mucilage of gum arabic.

Where soft cooling liquors are necessary, these emulsions may be used as
ordinary drink.


                        _Camphorated Emulsion._

Take of camphor, half a drachm; sweet almonds, half a dozen; white
sugar, half an ounce; mint-water, eight ounces. Grind the camphor and
almonds well together in a stone mortar, and add by degrees the mint
water; then strain the liquor, and dissolve in it the sugar.

In fevers, and other disorders which require the use of camphor, a
table-spoonful of this emulsion may be taken every two or three hours.


                      _Emulsion of Gum Ammoniac._

Take of gum ammoniac, two drachms; water, eight ounces. Grind the gum
with the water poured upon it by little and little, till it is
dissolved.

This emulsion is used for attenuating tough, viscid phlegm, and
promoting expectoration. In obstinate coughs, two ounces of the syrup of
poppies may be added to it. The dose is two table-spoonfuls three or
four times a-day.


                            _Oily Emulsion._

Take of soft water, six ounces; volatile aromatic spirit, two drachms;
Florence oil, an ounce; shake them well together, and add, of simple
syrup, half an ounce.

In recent colds and coughs, this emulsion is generally of service; but
if the cough proves obstinate, it will succeed better when made with the
paregoric elixir of the Edinburgh Dispensatory, instead of the volatile
aromatic spirit. A table-spoonful of it may be taken every two or three
hours.


                               EXTRACTS.

Extracts are prepared by boiling the subject in water, and evaporating
the strained decoction to a due consistence. By this process some of the
more active parts of plants are freed from the useless, indissoluble
earthy matter, which makes the larger share of their bulk. Water,
however, is not the only menstruum used in the preparation of extracts;
sometimes it is joined with spirits, and at other times rectified spirit
alone is employed for that purpose.

Extracts are prepared from a variety of different drugs, as the bark,
gentian, jalap, &c.; but as they require a troublesome and tedious
operation, it will be more convenient for a private practitioner to
purchase what he needs of them from a professed druggist, than to
prepare them himself. Such of them as are generally used are inserted in
our list of such drugs and medicines as are to be kept for private
practice.


                             FOMENTATIONS.

Fomentations are generally intended either to ease pain, by taking off
tension and spasm; or to brace and restore the tone and vigour of those
parts to which they are applied. The first of these intentions may
generally be answered by warm water, and the second by cold. Certain
substances, however, are usually added to water, with a view to heighten
its effects, as anodynes, aromatics, astringents, &c. We shall therefore
subjoin a few of the most useful medicated fomentations, that people may
have it in their power to make use of them if they chuse.


                         _Anodyne Fomentation._

Take of white poppy-heads, two ounces; elder flowers, half an ounce;
water, three pints. Boil till one pint is evaporated, and strain out the
liquor.

This fomentation, as its title expresses, is used for relieving acute
pain.


                        _Aromatic Fomentation._

Take of Jamaica pepper, half an ounce; red wine, a pint. Boil them for a
little, and then strain the liquor.

This is intended, not only as a topical application for external
complaints, but also for relieving the internal parts. Pains of the
bowels, which accompany dysenteries and diarrhœas, flatulent colics,
uneasiness of the stomach, and reachings to vomit, are frequently abated
by fomenting the abdomen and region of the stomach with the warm liquor.


                         _Common Fomentation._

Take tops of wormwood and camomile flowers, dried, of each two ounces;
water, two quarts. After a slight boiling, pour off the liquor.

Brandy or spirit of wine may be added to this fomentation, in such
quantity as the particular circumstances of the case shall require; but
these are not always necessary.


                        _Emollient Fomentation._

This is the same as the common decoction.


                      _Strengthening Fomentation._

Take of oak bark, one ounce; granate peel, half an ounce; alum, two
drachms; smith’s forge water, three pints. Boil the water with the bark
and peel to the consumption of one-third; then strain the remaining
decoction, and dissolve it in alum.

This astringent liquor is employed as an external fomentation to weak
parts; it may also be used internally.


                                GARGLES.

However trifling this class of medicines may appear, they are by no
means without their use. They seldom indeed cure diseases, but they
often alleviate very disagreeable symptoms; as parchedness of the mouth,
foulness of the tongue and fauces, &c. they are peculiarly useful in
fevers and sore throats. In the latter, a gargle will sometimes remove
the disorder; and in the former, few things are more refreshing or
agreeable to the patient, than to have his mouth frequently washed with
some soft detergent gargle.

One advantage of these medicines is, that they are easily prepared. A
little barley-water and honey may be had any where; and if to these be
added as much vinegar as will give them an agreeable sharpness, they
will make a very useful gargle for softening and cleansing the mouth.

Gargles have the best effect when injected with a syringe.


                         _Attenuating Gargle._

Take of water, six ounces; honey, one ounce; nitre, a drachm and a half.
Mix them.

This cooling gargle may be used either in the inflammatory quinsey, or
in fevers, for cleaning the tongue and fauces.


                            _Common Gargle._

Take of rose-water, six ounces; syrup of clove July-flowers, half an
ounce; spirit of vitriol, a sufficient quantity to give it an agreeable
sharpness. Mix them.

This gargle, besides cleansing the tongue and fauces, acts as a gentle
repellent, and will sometimes remove a slight quinsey.


                          _Detergent Gargle._

Take of the emollient gargle, a pint; tincture of myrrh, an ounce;
honey, two ounces. Mix them.

When exulcerations require to be cleansed, or the excretion of tough
viscid saliva promoted, this gargle will be of service.


                          _Emollient Gargle._

Take an ounce of marsh-mallow roots, and two or three figs; boil them in
a quart of water till near one half of it be consumed; then strain out
the liquor.

If an ounce of honey, and half an ounce of spirit of sal ammoniac, be
added to the above, it will then be an exceeding good _attenuating
gargle_.

This gargle is beneficial in fevers, where the tongue and fauces are
rough and parched, to soften these parts, and promote the discharge of
saliva.

The learned and accurate Sir John Pringle observes, that in the
inflammatory quinsey, or strangulation of the fauces, little benefit
arises from the common gargles; that such as are of an acid nature do
more harm than good, by contracting the emunctories of the saliva and
mucus, and thickening those humours; that a decoction of figs in milk
and water has a contrary effect, especially if some sal ammoniac be
added; by which the saliva is made thinner, and the glands brought to
secrete more freely; a circumstance always conducive to the cure.


                               INFUSIONS.

Vegetables yield nearly the same properties to water by infusion as by
decoction; and though they may require a longer time to give out their
virtues in this way, yet it has several advantages over the other; since
boiling is found to dissipate the finer parts of many bitter and
aromatic substances, without more fully extracting their medicinal
principles.

The author of the New Dispensatory observes, that even from those
vegetables which are weak in virtue, rich infusions may be obtained, by
returning the liquor upon fresh quantities of the subject, the water
loading itself more and more with the active parts; and that these
loaded infusions are applicable to valuable purposes in medicine, as
they contain in a small compass the finer, more subtile, and active
principles of vegetables, in a form readily miscible with the fluids of
the human body.


                           _Bitter Infusion._

Take tops of the lesser centaury and camomile flowers, of each half an
ounce; yellow rind of lemon and orange peel, carefully freed from the
inner white part, of each two drachms. Cut them in small pieces, and
infuse them in a quart of boiling water.

For indigestion, weakness of the stomach, or want of appetite, a
tea-cupful of this infusion may be taken twice or thrice a day.


                        _Infusion of the Bark._

To an ounce of the bark, in powder, add four or five table-spoonfuls of
brandy, and a pint of boiling water. Let them infuse for two or three
days.

This is one of the best preparations of the bark for weak stomachs. In
disorders where the corroborating virtues of that medicine are required,
a tea-cupful of it may be taken two or three times a-day.


                         _Infusion of Carduus._

Infuse an ounce of the dried leaves of carduus benedictus, or blessed
thistle, in a pint of common water, for six hours, without heat; then
filter the liquor through paper.

This light infusion may be given, with great benefit, in weakness of the
stomach, where the common bitters do not agree. It may be flavoured at
pleasure with cinnamon, or other aromatic materials.


                         _Infusion of Linseed._

Take of linseed, two spoonfuls; liquorice root, sliced, half an ounce;
boiling water, three pints. Let them stand to infuse by the fire for
some hours, and then strain off the liquor.

If an ounce of the leaves of colt’s foot be added to these ingredients,
it will then be the _pectoral infusion_. Both these are emollient
mucilaginous liquors, and may be taken with advantage as ordinary drink
in difficulty of making water; and in coughs and other complaints of the
breast.


                          _Infusion of Roses._

Take of red roses, dried, half an ounce; boiling water, a quart;
vitriolic acid, commonly called oil of vitriol, half a drachm; loaf
sugar, an ounce.

Infuse the roses in the water for four hours, in an unglazed earthen
vessel; afterwards pour in the acid, and having strained the liquor, add
to it the sugar.

In an excessive flow of the _menses_, vomiting of blood, and other
hæmorrhages, a tea-cupful of this gently astringent infusion may be
taken every three or four hours. It likewise makes an exceeding good
gargle.

As the quantity of roses used here can have little or no effect, an
equally valuable medicine may be prepared by mixing the acid and water
without infusion.


                   _Infusion of Tamarinds and Senna._

Take of tamarinds, one ounce; senna, and crystals of tartar, each two
drachms. Let these ingredients be infused four or five hours in a pint
of boiling water; afterwards let the liquor be strained, and an ounce or
two of the aromatic tincture added to it. Persons who are easily purged
may leave out either the tamarinds or the crystals of tartar.

This is an agreeable cooling purge. A tea-cupful may be given every half
hour till it operates.

This supplies the place of the _decoction of tamarinds and senna_.


                          _Spanish Infusion._

Take of Spanish juice, cut into small pieces, an ounce; salt of tartar,
three drachms. Infuse in a quart of boiling water for a night. To the
drained liquor add an ounce and a half of the syrup of poppies.

In recent colds, coughs, and obstructions of the breast, a tea-cupful of
this infusion may be taken with advantage three or four times a-day.


                       _Infusion for the Palsy._

Take of horse-radish root shaved, mustard-seed bruised, each four
ounces; outer rind of orange-peel, one ounce. Infuse them in two quarts
of boiling water, in a close vessel, for twenty-four hours.

In paralytic complaints, a tea-cupful of this warm stimulating medicine
may be taken three or four times a-day. It excites the action of the
solids, proves diuretic, and, if the patient be kept warm, promotes
perspiration.

If two or three ounces of the dried leaves of marsh-trefoil be used
instead of the mustard, it will make the _antiscorbutic infusion_.


                                JULEPS.

The basis of juleps is generally common water, or some simple distilled
water, with one-third or one-fourth its quantity of distilled spirituous
water, and as much sugar or syrup as is sufficient to render the mixture
agreeable. This is sharpened with vegetable or mineral acids, or
impregnated with other medicines suitable to the intention.


                          _Camphorated Julep._

Take of camphor, one drachm; rectified spirit of wine, ten drops; double
refined sugar, half an ounce; boiling distilled water, one pint. Rub the
camphor first with the spirit of wine, then with the sugar; lastly, add
the water by degrees, and strain the liquor.

In hysterical and other complaints where camphor is proper, this julep
may be taken in the dose of a spoonful or two as often as the stomach
will bear it.


                            _Cordial Julep._

Take of simple cinnamon-water, four ounces; Jamaica pepper water, two
ounces; volatile aromatic spirit, and compound spirit of lavender, of
each two drachms; syrup of orange-peel, an ounce. Mix them.

This is given in the dose of two spoonfuls three or four times a day, in
disorders accompanied with great weakness and depression of spirits.


                         _Expectorating Julep._

Take of the emulsion of gum ammoniac, six ounces; syrup of squills, two
ounces. Mix them.

In coughs, asthmas, and obstructions of the breast, two table-spoonfuls
of this julep may be taken every three or four hours.


                             _Musk Julep._

Rub half a drachm of musk well together with half an ounce of sugar, and
add to it, gradually, of simple cinnamon and peppermint water, each two
ounces; of the volatile aromatic spirit, two drachms.

In the low state of nervous fevers, hiccuping, convulsions, and other
spasmodic affections, two table-spoonfuls of this julep may be taken
every two or three hours.


                            _Saline Julep._

Dissolve two drachms of salt of tartar in three ounces of fresh
lemon-juice, strained; when the effervescence is over, add, of
mint-water, and common water, each two ounces; of simple syrup, one
ounce.

This removes sickness at the stomach, relieves vomiting, promotes
perspiration, and may be of some service in fevers, especially of the
inflammatory kind.


                           _Vomiting Julep._

Dissolve four grains of emetic tartar in eight ounces of water; and add
to it half an ounce of the syrup of clove July flowers.

In the beginning of fevers, where there is no topical inflammation, this
julep may be given in the dose of one table-spoonful every quarter of an
hour till it operates. Antimonial vomits serve not only to evacuate the
contents of the stomach, but likewise to promote the different
excretions. Hence they are found in fevers to have nearly the same
effects as Dr. _James’s Powder_.


                               MIXTURES.

A mixture differs from a julep in this respect, that it receives into
its composition not only salts, extracts, and other substances
dissoluble in water, but also earths, powders, and such substances as
cannot be dissolved. A mixture is seldom either an elegant or agreeable
medicine. It is nevertheless necessary. Many persons can take a mixture,
who are not able to swallow a bolus or an electuary: besides, there are
medicines which act better in this than in any other form.


                         _Astringent Mixture._

Take simple cinnamon-water and common water, of each three ounces;
spirituous cinnamon-water, an ounce and a half; Japonic confection, half
an ounce. Mix them.

In dysenteries which are not of long standing, after the necessary
evacuations, a spoonful or two of this mixture may be taken every four
hours, interposing every second or third day a dose of rhubarb.


                          _Diuretic Mixture._

Take of mint-water, five ounces; vinegar of squills, six drachms; sweet
spirit of nitre, half an ounce; syrup of ginger, an ounce and a half.
Mix them.

In obstructions of the urinary passages, two spoonfuls of this mixture
may be taken twice or thrice a-day.


                     _Laxative Absorbent Mixture._

Rub one drachm of magnesia alba in a mortar with ten or twelve grains of
the best Turkey rhubarb, and add to them three ounces of common water;
simple cinnamon-water, and syrup of sugar, of each one ounce.

As most diseases of infants are accompanied with acidities, this mixture
may either be given with a view to correct these, or to open the body. A
table-spoonful may be taken for a dose, and repeated three times a-day.
To a very young child half a spoonful will be sufficient.

When the mixture is intended to purge, the dose may either be increased,
or the quantity of rhubarb doubled.

This is one of the most generally useful medicines for children with
which I am acquainted.


                           _Saline Mixture._

Dissolve a drachm of the salt of tartar in four ounces of boiling water;
and, when cold, drop into it spirit of vitriol till the effervescence
ceases; then add, of peppermint-water, two ounces, simple syrup, one
ounce.

Where fresh lemons cannot be had, this mixture may occasionally supply
the place of the saline julep.


                           _Squill Mixture._

Take of simple cinnamon-water, five ounces; vinegar of squills, one
ounce; syrup of marsh-mallows, an ounce and a half. Mix them.

This mixture, by promoting expectoration, and the secretion of urine,
proves serviceable in asthmatic and dropsical habits. A table-spoonful
of it may be taken frequently.


                   OINTMENTS, LINIMENTS, and CERATES.

Notwithstanding the extravagant encomiums which have been bestowed on
different preparations of this kind, with regard to their efficacy in
the cure of wounds, sores, &c. it is beyond a doubt, that the most
proper application to a green wound is dry lint. But though ointments do
not heal wounds and sores, yet they serve to defend them from the
external air, and to retain such substances as may be necessary for
drying, deterging, destroying proud flesh, and such like. For these
purposes, however, it will be sufficient to insert only a few of the
most simple forms, as ingredients of a more active nature can
occasionally be added to them.


                      _Yellow Basilicum Ointment._

Take of yellow wax, white resin, and frankincense, each a quarter of a
pound; melt them together over a gentle fire; then add, of hogs’ lard
prepared, one pound. Strain the ointment while warm.

This ointment is employed for cleansing and healing wounds and ulcers.


                        _Ointment of Calamine._

Take of olive oil, a pint and a half; white wax, and calamine stone
levigated, of each half a pound. Let the calamine stone, reduced into a
fine powder, be rubbed with some part of the oil, and afterwards added
to the rest of the oil and wax, previously melted together, continually
stirring them till quite cold.

This ointment, which is commonly known by the name of _Turner’s Cerate_,
is an exceeding good application in burns and excoriations, from
whatever cause.


                         _Emollient Ointment._

Take of palm oil, two pounds; olive oil, a pint and a half; yellow wax,
half a pound; Venice turpentine, a quarter of a pound. Melt the wax in
the oils over a gentle fire; then mix in the turpentine, and strain the
ointment.

This supplies the place of _Althæ Ointment_. It may be used for
anointing inflamed parts, &c.


                            _Eye Ointment._

Take of hogs’ lard prepared, four ounces; white wax, two drachms; tutty
prepared, one ounce; melt the wax with the lard over a gentle fire, and
then sprinkle in the tutty, continually stirring them till the ointment
is cold.

This ointment will be more efficacious, and of a better confidence, if
two or three drachms of camphor be rubbed up with a little oil, and
intimately mixed with it.


                               _Another._

Take of camphor, and calamine stone levigated, each six drachms;
verdegrise well prepared, two drachms; hogs’ lard, and mutton suet
prepared, of each two ounces. Rub the camphor well with the powder;
afterwards mix in the lard and suet, continuing the triture till they be
perfectly united.

This ointment has been long in esteem for diseases of the eyes. It
ought, however, to be used with caution, when the eyes are much inflamed
or very tender.


                           _Issue Ointment._

Mix half an ounce of Spanish flies, finely powdered, in six ounces of
yellow basilicum ointment.

This ointment is chiefly intended for dressing blisters, in order to
keep them open during pleasure.


                          _Ointment of Lead._

Take of olive oil, half a pint; white wax, two ounces; sugar of lead,
three drachms. Let the sugar of lead, reduced into a fine powder, be
rubbed up with some part of the oil, and afterwards added to the other
ingredients, previously melted together, continually stirring them till
quite cold.

This cooling and gently astringent ointment may be used in all cases
where the intention is to dry and skin over the part, as in scalding,
&c.


                         _Mercurial Ointment._

Take of quicksilver, two ounces; hogs’ lard, three ounces; mutton suet,
one ounce. Rub the quicksilver with an ounce of the hogs’ lard in a warm
mortar, till the globules be perfectly extinguished; then rub it up with
the rest of the lard and suet, previously melted together.

The principal intention of this ointment is to convey mercury into the
body by being rubbed upon the skin.


                         _Ointment of Sulphur._

Take of hogs’ lard prepared, four ounces; flowers of sulphur, an ounce
and a half; crude sal ammoniac, two drachms; essence of lemon, ten or
twelve drops. Make them into an ointment.

This ointment, rubbed upon the parts affected, will generally cure the
itch. It is both the safest and best application for that purpose, and,
when made in this way, has no disagreeable smell.


                           _White Ointment._

Take of olive oil, one pint; white wax and sperma-ceti, of each three
ounces. Melt them with a gentle heat, and keep them constantly and
briskly stirring together, till quite cold.

If two drachms of camphor, previously rubbed with a small quantity of
oil, be added to the above, it will make the _White camphorated
Ointment_.


                         _Liniment for Burns._

Take equal parts of Florence oil, or of fresh drawn linseed oil, and
lime-water; shake them well together in a wide mouthed bottle, so as to
form a liniment.

This is found to be an exceeding proper application for recent scalds or
burns. It may either be spread upon a cloth, or the parts affected may
be anointed with it twice or thrice a-day.


                           _White Liniment._

This is made in the same manner as the white ointment, two-thirds of the
wax being left out.

This liniment may be applied in cases of excoriation, where, on account
of the largeness of the surface, the ointments with lead or calamine
might be improper.


                       _Liniment for the Piles._

Take of emollient ointment, two ounces; liquid laudanum, half an ounce.
Mix these ingredients with the yolk of an egg, and work them well
together.


                          _Volatile Liniment._

Take of Florence oil, an ounce; spirit of hartshorn, half an ounce.
Shake them together.

This liniment, made with equal parts of the spirit and oil, will be more
efficacious, where the patient’s skin is able to bear it.

Sir John Pringle observes, that in the inflammatory quinsey, a piece of
flannel, moistened with this liniment, and applied to the throat, to be
renewed every four or five hours, is one of the most efficacious
remedies; and that it seldom fails, after bleeding, either to lessen or
carry off the complaint. The truth of this observation I have often
experienced.


                           _Camphorated Oil._

Rub an ounce of camphor, with two ounces of Florence oil, in a mortar,
till the camphor be entirely dissolved.

This antispasmodic liniment may be used in obstinate rheumatisms, and in
some other cases accompanied with extreme pain and tension of the parts.


                                 PILLS.

Medicines which operate in a small dose, and whose disagreeable taste,
or smell, makes it necessary that they should be concealed from the
palate, are most commodiously exhibited in this form. No medicine,
however, that is intended to operate quickly, ought to be made into
pills, as they often lie for a considerable time on the stomach before
they are dissolved, so as to produce any effect.

As the ingredients which enter the composition of pills are generally so
contrived, that one pill of an ordinary size may contain about five
grains of the compound, in mentioning the dose we shall only specify the
number of pills to be taken; as one, two, three, &c.


                           _Composing Pill._

Take of purified opium, ten grains; Castile soap, half a drachm. Beat
them together, and form the whole into twenty pills.

When a quieting draught will not sit upon the stomach, one, two, or
three of these pills may be taken, as occasion requires.


                             _Fœtid Pill._

Take of asafœtida, half an ounce; simple syrup, as much as is necessary
to form it into pills.

In hysteric complaints, four or five pills, of an ordinary size, may be
taken twice or thrice a-day. They may likewise be of service to persons
afflicted with the asthma.

When it is necessary to keep the body open, a proper quantity of
rhubarb, aloes, or jalap, may occasionally be added to the above mass.


                            _Hemlock Pill._

Take any quantity of the extract of hemlock, and adding to it about a
fifth part its weight of the powder of the dried leaves, form it into
pills of the ordinary size.

The extract of hemlock may be taken from one grain to several drachms in
the day. The best method, however, of using these pills, is to begin
with one or two, and to increase the dose gradually, as far as the
patient can bear them, without any remarkable degree of stupor or
giddiness.


                           _Mercurial Pill._

Take of purified quicksilver and honey, each half an ounce. Rub them
together in a mortar, till the globules of mercury are perfectly
extinguished; then add, of Castile soap, two drachms, powdered
liquorice, or crumb of bread, a sufficient quantity to give the mass a
proper consistence for pills.

When stronger mercurial pills are wanted, the quantity of quicksilver
may be doubled.

The dose of these pills is different, according to the intention with
which they are given. As an alterant, two or three maybe taken daily. To
raise a salivation, four or five will be necessary.

Equal parts of the above pill and powdered rhubarb made into a mass,
with a sufficient quantity of simple syrup, will make a _Mercurial
purging Pill_.


                      _Mercurial sublimate Pill._

Dissolve fifteen grains of the corrosive sublimate of mercury in two
drachms of the saturated solution of crude sal ammoniac, and make it
into a paste, in a glass mortar, with a sufficient quantity of the crumb
of bread. This mass must be formed into one hundred and twenty pills.

This pill, which is the most agreeable form of exhibiting the sublimate,
has been found efficacious, not only in curing the venereal disease, but
also in killing and expelling _worms_, after other powerful medicines
had failed[209].

For the venereal disease, four of these pills may be taken twice a-day,
as an alterant three, and for worms two.


                           _Plummer’s Pill._

Take of calomel, or sweet mercury, and precipitated sulphur of antimony,
each three drachms; extract of liquorice, two drachms. Rub the sulphur
and mercury well together; afterwards add the extract, and, with a
sufficient quantity of the mucilage of gum arabic, make them into pills.

This pill has been found a powerful, yet safe, alterative in obstinate
cutaneous disorders; and has completed a cure after salivation had
failed. In venereal cases it has likewise produced excellent effects.
Two or three pills of an ordinary size may be taken night and morning,
the patient keeping moderately warm, and drinking after each dose a
draught of decoction of the woods, or of sarsaparilla.


                            _Purging Pills._

Take of succotorine aloes, and Castile soap, each two drachms; of simple
syrup, a sufficient quantity to make them into pills.

Four or five of these pills will generally prove a sufficient purge. For
keeping the body gently open, one may be taken night and morning. They
are reckoned both deobstruent and stomachic, and will be found to answer
all the purposes of Dr. Anderson’s pills, the principal ingredient of
which is aloes.

Where aloetic purges are improper, the following pills may be used:

Take extract of jalap, and vitriolated tartar, of each two drachms;
syrup of ginger, as much as will make them of a proper consistence for
pills.

These pills may be taken in the same quantity as the above.


                        _Pill for the Jaundice._

Take of Castile soap, succotorine aloes, and rhubarb, of each one
drachm. Make them into pills with a sufficient quantity of syrup or
mucilage.

These pills, as their title expresses, are chiefly intended for the
jaundice, which, with the assistance of proper diet, they will often
cure. Five or six of them may be taken twice a-day, more or less, as is
necessary to keep the body open. It will be proper, however, during
their use, to interpose now and then a vomit of ipecacuanha or tartar
emetic.


                           _Stomachic Pill._

Take extract of gentian, two drachms; powdered rhubarb and vitriolated
tartar, of each one drachm; oil of mint, thirty drops; simple syrup, a
sufficient quantity.

Three or four of these pills may be taken twice a-day, for invigorating
the stomach, and keeping the body gently open.


                            _Squill Pills._

Take powder of dried squills, a drachm and a half; gum ammoniac, and
cardamom seeds, in powder, of each three drachms; simple syrup, a
sufficient quantity.

In dropsical and asthmatic complaints, two or three of these pills may
be taken twice a-day, or oftner, if the stomach will bear them.


                         _Strengthening Pill._

Take soft extract of the bark, and salt of steel, each a drachm. Make
into pills.

In disorders arising from excessive debility, or relaxation of the
solids, as the _chlorosis_, or green-sickness, two of these pills may be
taken three times a-day.


                               PLASTERS.

Plasters ought to be of a different consistence, according to the
purposes for which they are intended. Such as are to be applied to the
breasts or stomach ought to be soft and yielding; while those designed
for the limbs should be firm and adhesive.

It has been supposed, that plasters might be impregnated with the
virtues of different vegetables, by boiling the recent vegetable with
the oil employed for the composition of the plaster; but this treatment
does not communicate to the oils any valuable qualities.

The _calces_ of lead boiled with oils unite with them into a plaster of
a proper consistence, which make the basis of several other plasters. In
boiling these compositions, a quantity of hot water must be added from
time to time to prevent the plaster from burning or growing black. This,
however, should be done with care, lest it cause the matter to explode.


                           _Common Plaster._

Take of common olive oil, six pints; litharge reduced to a fine powder,
two pounds and a half. Boil the litharge and oil together over a gentle
fire, continually stirring them, and keeping always about half a gallon
of water in the vessel: after they have boiled about three hours, a
little of the plaster may be taken out and put into cold water, to try
if it be of a proper consistence: when that is the case, the whole may
be suffered to cool, and the water well pressed out of it with the
hands.

This plaster is generally applied in slight wounds and excoriations of
the skin. It keeps the part soft and warm, and defends it from the air,
which is all that is necessary in such cases. Its principal use,
however, is to serve as a basis for other plasters.


                          _Adhesive Plaster._

Take of common plaster, half a pound; of Burgundy pitch, a quarter of a
pound. Melt them together.

This plaster is principally used for keeping on other dressings.


                           _Anodyne Plaster._

Melt an ounce of adhesive plaster, and, when it is cooling, mix with it
a drachm of powdered opium, and the same quantity of camphor, previously
rubbed up with a little oil.

This plaster generally gives ease in acute pains, especially of the
nervous kind.


                         _Blistering Plaster._

Take of Venice turpentine, six ounces; yellow wax, two ounces; Spanish
flies in fine powder, three ounces; powdered mustard, one ounce. Melt
the wax, and while it is warm, add to it the turpentine, taking care not
to evaporate it by too much heat. After the turpentine and wax are
sufficiently incorporated, sprinkle in the powders, continually stirring
the mass till it be cold.

Though this plaster is made in a variety of ways, one seldom meets with
it of a proper consistence. When compounded with oils and other greasy
substances, its effects are blunted, and it is apt to run; while pitch
and resin render it too hard and very inconvenient.

When the blistering plaster is not at hand, its place may be supplied by
mixing with any soft ointment a sufficient quantity of powdered flies;
or by forming them into a paste with flour and vinegar.


                             _Gum Plaster._

Take of the common plaster, four pounds; gum ammoniac and galbanum,
strained, of each half a pound. Melt them together, and add, of Venice
turpentine, six ounces.

This plaster is used as a digestive, and likewise for discussing
indolent tumours.


                          _Mercurial Plaster._

Take of common plaster, one pound; of gum ammoniac, strained, half a
pound. Melt them together, and, when cooling, add eight ounces of
quicksilver, previously extinguished by triture, with three ounces of
hog’s lard.

This plaster is recommended in pains of the limbs arising from a
venereal cause. Indurations of the glands, and other violent tumours,
are likewise found sometimes to yield to it.


                           _Stomach Plaster._

Take of gum plaster, half a pound; camphorated oil, an ounce and a half;
black pepper, or capsicum, where it can be had, one ounce. Melt the
plaster, and mix with it the oil; then sprinkle in the pepper,
previously reduced to a fine powder.

An ounce or two of this plaster, spread upon soft leather, and applied
to the region of the stomach, will be of service in flatulencies arising
from hysteric and hypochondriac affections. A little of the expressed
oil of mace, or a few drops of the essential oil of mint, may be rubbed
upon it before it is applied.

This may supply the place of the _Anti-hysteric Plaster_.


                            _Warm Plaster._

Take of gum plaster, one ounce; blistering plaster, two drachms. Melt
them together over a gentle fire.

This plaster is useful in the sciatica and other fixed pains of the
rheumatic kind: it ought, however, to be worn for some time, and to be
renewed, at least, once a-week. If this is found to blister the part,
which is sometimes the case, it must be made with a smaller proportion
of the blistering plaster.


                             _Wax Plaster._

Take of yellow wax, one pound; white resin, half a pound; mutton suet,
three quarters of a pound. Melt them together.

This is generally used instead of the _Melilot Plaster_. It is a proper
application after blisters, and in other cases where a gentle digestive
is necessary.


                                POWDERS.

This is one of the most simple forms in which medicine can be
administered. Many medicinal substances, however, cannot be reduced into
powder, and others are too disagreeable to be taken in this form.

The lighter powders may be mixed in any agreeable thin liquor, as tea or
water-gruel. The more ponderous will require a more consistent vehicle,
as syrup, conserve, jelly, or honey.

Gums, and other substances which are difficult to powder, should be
pounded along with the drier ones; but those which are too dry,
especially aromatics, ought to be sprinkled during their pulverization
with a few drops of any proper water.

Aromatic powders are to be prepared only in small quantities at a time,
and kept in glass vessels closely stopped. Indeed, no powders ought to
be exposed to the air or kept too long, otherwise their virtues will be
in great measure destroyed.


                          _Astringent Powder._

Take of alum and Japan earth, each two drachms. Pound them together, and
divide the whole into ten or twelve doses.

In an immoderate flow of the _menses_, and other hæmorrhages, one of
these powders may be taken every hour, or every half hour, if the
discharge be violent.


                           _Powder of Bole._

Take of bole armenic, or French bole, two ounces; cinnamon, one ounce;
tormentil root and gum arabic, of each six drachms; long pepper, one
drachm. Let all these ingredients be reduced into a powder.

This warm, glutinous astringent powder, is given in fluxes, and other
disorders where medicines of that class are necessary, in the dose of a
scruple, or half a drachm.

If a drachm of opium be added, it will make the _Powder of Bole with
Opium_, which is a medicine of considerable efficacy. It may be taken in
the same quantity as the former, but not above twice or thrice a day.


                         _Carminative Powder._

Take of coriander-seed, half an ounce; ginger, one drachm; nutmegs, half
a drachm; fine sugar, a drachm and a half. Reduce them into powder for
twelve doses.

This powder is employed for expelling flatulencies arising from
indigestion, particularly those to which hysteric and hypochondriac
persons are so liable. It may likewise be given in small quantities to
children in their food, when troubled with gripes.


                           _Diuretic Powder._

Take of gum arabic, four ounces; purified nitre, one ounce. Pound them
together, and divide the whole into twenty-four doses.

During the first stage of the venereal disease, one of these cooling
powders may be taken three times a-day, with considerable advantage.


                       _Aromatic Opening Powder._

Take of the best Turkey rhubarb, cinnamon, and fine sugar, each two
drachms. Let the ingredients be pounded, and afterwards mixed well
together.

Where flatulency is accompanied with costiveness, a tea-spoonful of this
powder may be taken once or twice a-day, according to circumstances.


                       _Saline Laxative Powder._

Take of soluble tartar, and cream of tartar, each one drachm; purified
nitre, half a drachm. Make them into a powder.

In fevers, and other inflammatory disorders, where it is necessary to
keep the body gently open, one of these cooling laxative powders may be
taken in a little gruel, and repeated occasionally.


                            _Steel Powder._

Take filings of steel, and loaf-sugar, of each two ounces; ginger, two
drachms. Pound them together.

In obstructions of the _menses_, and other cases where steel is proper,
a tea-spoonful of this powder may be taken twice a-day, and washed down
with a little wine or water.


                          _Sudorific Powder._

Take purified nitre and vitriolated tartar of each half an ounce; opium
and ipecacuanha, of each one drachm. Mix the ingredients, and reduce
them to a fine powder.

This is generally known by the name of _Dover’s Powder_. It is a
powerful sudorific. In obstinate rheumatisms, and other cases where it
is necessary to excite a copious sweat, this powder may be administered
in the dose of a scruple or half a drachm. Some patients will require
two scruples. It ought to be accompanied with the plentiful use of some
warm diluting liquor.


                            _Worm-powders._

Take of tin reduced into a fine powder, an ounce; Æthiop’s mineral, two
drachms. Mix them well together, and divide the whole into six doses.

One of these powders may be taken in a little syrup, honey, or treacle,
twice a-day. After they have been all used, the following anthelmintic
purge may be proper.


                         _Purging Worm-powder._

Take of powdered rhubarb, a scruple; scammony and calomel, of each five
grains. Rub them together in a mortar for one dose.

For children the above doses must be lessened according to their age.

If the powder of tin be given alone, its dose may be considerably
increased. The late Dr. Alston gave it to the amount of two ounces in
three days, and says, when thus administered, that it proved an
egregious anthelmintic. He purged his patients both before they took the
powder and afterwards.


                      _Powder for the Tape-worm._

Early in the morning the patient is to take in any liquid, two or three
drachms, according to his age and constitution, of the root of the male
fern reduced into a fine powder. About two hours afterwards, he is to
take of calomel and resin of scammony, each ten grains; gum gamboge, six
grains. These ingredients must be finely powdered and given in a little
syrup, honey, treacle, or any thing that is most agreeable to the
patient. He is then to walk gently about, now and then drinking a dish
of weak green tea, till the worm is passed. If the powder of the fern
produces nausea, or sickness, it may be removed by sucking the juice of
an orange or lemon.

This medicine, which had been long kept a secret abroad for the cure of
the tape-worm, was some time ago purchased by the French King, and made
public for the benefit of mankind. Not having had an opportunity of
trying it, I can say nothing from experience concerning its efficacy. It
seems, however, from its ingredients, to be an active medicine, and
ought to be taken with care. The dose here prescribed is sufficient for
the strongest patient; it must, therefore, be reduced according to the
age and constitution.


                                SYRUPS.

Syrups were some time ago looked upon as medicines of considerable
value. They are at present, however, regarded chiefly as vehicles for
medicines of greater efficacy, and are used for sweetening draughts,
juleps, or mixtures; and for reducing the lighter powders into boluses,
pills, and electuaries. As all these purposes may be answered by the
simple syrup alone, there is little occasion for any other; especially
as they are seldom found but in a state of fermentation; and as the dose
of any medicine given in this form is very uncertain. Persons who serve
the public must keep whatever their customers call for; but to the
private practitioner nine-tenths of the syrups usually kept in the shops
are unnecessary.


                             _Simple Syrup_

Is made by dissolving in water, either with or without heat, about
double its weight of fine sugar.

If twenty-five drops of laudanum be added to an ounce of the simple
syrup, it will supply the place of diacodium, or the syrup of poppies,
and will be found a more safe and certain medicine.

The lubricating virtues of the syrup of marsh-mallows may likewise be
supplied, by adding to the common syrup a sufficient quantity of
mucilage of gum arabic.

Those who chuse to preserve the juice of lemons in form of syrup, may
dissolve in it, by the heat of a warm bath, nearly double its weight of
fine sugar. The juice ought to be previously strained, and suffered to
stand till it settles.

The syrup of ginger is sometimes of use as a warm vehicle for giving
medicines to persons afflicted with flatulency. It may be made by
infusing two ounces of bruised ginger in two pints of boiling water for
twenty-four hours. After the liquor has been strained, and has stood to
settle for some time, it may be poured off, and a little more than
double its weight of fine powdered sugar dissolved in it.


                        TINCTURES, ELIXIRS, &c.

Rectified spirit is the direct menstruum of the resins and essential
oils of vegetables, and totally extracts these active principles from
sundry substances, which yield them to water, either not at all, or only
in part.

It dissolves likewise those parts of animal substances in which their
peculiar smells and tastes reside. Hence the tinctures prepared with
rectified spirits form an useful and elegant class of medicines,
possessing many of the most essential virtues of simples, without being
clogged with their inert or useless parts.

Water, however, being the proper menstruum of the gummy, saline, and
saccharine parts of medicinal substances, it will be necessary, in the
preparation of several tinctures, to make use of a weak spirit, or a
composition of rectified spirit and water.


                          _Aromatic Tincture._

Infuse two ounces of Jamaica pepper in two pints of brandy, without
heat, for a few days; then strain off the tincture.

This simple tincture will sufficiently answer all the intentions of the
more costly preparations of this kind. It is rather too hot to be taken
by itself; but is very proper for mixing with such medicines as might
otherwise prove too cold for the stomach.


                    _Compound Tincture of the Bark._

Take of Peruvian bark, two ounces; Seville orange-peel and cinnamon, of
each half an ounce. Let the bark be powdered, and the other ingredients
bruised; then infuse the whole in a pint and a half of brandy, for five
or six days, in a close vessel; afterwards strain off the tincture.

This tincture is not only beneficial in intermitting fevers, but also in
the slow, nervous, and putrid kinds, especially towards their decline.

The dose is from one drachm to three or four, every fifth or sixth hour.
It may be given in any suitable liquor, and occasionally sharpened with
a few drops of the spirit of vitriol.


                       _Volatile Fœtid Tincture._

Infuse two ounces of asafœtida in one pint of volatile aromatic spirit,
for eight days, in a close bottle, frequently shaking it; then strain
the tincture.

This medicine is beneficial in hysteric disorders, especially when
attended with lowness of spirits, and faintings. A tea-spoonful of it
may be taken in a glass of wine, or a cup of penny-royal tea.


                  _Volatile Tincture of Gum Guaiacum._

Take of gum guaiacum, four ounces; volatile aromatic spirit, a pint.
Infuse without heat, in a vessel well stopped, for a few days; then
strain off the tincture[210].

In rheumatic complaints, a tea-spoonful of this tincture may be taken in
a cup of the infusion of water-trefoil, twice or thrice a-day.


                     _Tincture of Black Hellebore._

Infuse two ounces of the roots of black hellebore, bruised, in a pint of
proof spirit, for seven or eight days; then filter the tincture through
paper. A scruple of cochineal may be infused along with the roots, to
give the tincture a colour.

In obstructions of the _menses_, a tea-spoonful of this tincture may be
taken in a cup of camomile or penny-royal tea twice a-day.


                         _Astringent Tincture._

Digest two ounces of gum kino, in a pint and a half of brandy, for eight
days; afterwards strain it for use.

This tincture, though not generally known, is a good astringent
medicine. With this view, an ounce, or more, of it may be taken three or
four times a-day.


                     _Tincture of Myrrh and Aloes._

Take of gum myrrh, an ounce and a half; hepatic aloes, one ounce. Let
them be reduced to a powder, and infused in two pints of rectified
spirits, for six days, in a gentle heat; then strain the tincture.

This is principally used by surgeons for cleansing foul ulcers, and
restraining the progress of gangrenes. It is also, by some, recommended
as a proper application to green wounds.


                _Tincture of Opium, or Liquid Laudanum._

Take of crude opium, two ounces; spirituous aromatic water, and mountain
wine, of each ten ounces. Dissolve the opium, sliced, in the wine, with
a gentle heat, frequently stirring it; afterwards add the spirit, and
strain off the tincture.

As twenty-five drops of this tincture contain about a grain of opium,
the common dose may be from twenty to thirty drops.


             _Sacred Tincture, or Tincture of Hiera Picra._

Take of succotorine aloes in powder, one ounce; Virginian snake-root and
ginger, of each two drachms. Infuse in a pint of mountain wine, and half
a pint of brandy, for a week, frequently shaking the bottle, then strain
off the tincture.

This is a safe and useful purge for persons of a languid and phlegmatic
habit; but is thought to have better effects, taken in small doses as a
laxative.

The dose, as a purge, is from one to two ounces.


                     _Compound Tincture of Senna._

Take of senna, one ounce; jalap, coriander seeds, and cream of tartar,
of each half an ounce. Infuse them in a pint and a half of French brandy
for a week; then strain the tincture, and add to it four ounces of fine
sugar.

This is an agreeable purge, and answers all the purposes of the _Elixir
salutis_, and of _Daffy’s Elixir_.

The dose is from one to two or three ounces.


                      _Tincture of Spanish Flies._

Take of Spanish flies, reduced to a fine powder, two ounces; spirit of
wine, one pint. Infuse for two or three days; then strain off the
tincture.

This is intended as an acrid stimulant for external use. Parts affected
with the palsy or chronic rheumatism may be frequently rubbed with it.


                   _Tincture of the Balsam of Tolu._

Take of the balsam of Tolu, an ounce and a half; rectified spirit of
wine, a pint. Infuse in a gentle heat until the balsam is dissolved;
then strain the tincture.

This tincture possesses all the virtues of the balsam. In coughs, and
other complaints of the breast, a tea-spoonful or two of it may be taken
in a bit of loaf-sugar. But the best way of using it is in syrup. An
ounce of the tincture, properly mixed with two pounds of simple syrup,
will make what is commonly called the _Balsamic Syrup_.


                         _Tincture of Rhubarb._

Take of rhubarb, two ounces and a half; lesser cardamom seeds, half an
ounce; brandy, two pints. Digest for a week, and strain the tincture.

Those who chuse to have a vinous tincture of rhubarb may infuse the
above ingredients in a bottle of Lisbon wine, adding to it about two
ounces of proof spirits.

If half an ounce of gentian root, and a drachm of Virginian snake-root
be added to the above ingredients, it will make the bitter tincture of
rhubarb.

All these tinctures are designed as stomachics and corroborants as well
as purgatives. In weakness of the stomach, indigestion, laxity of the
intestines, fluxes, colicky and such like complaints, they are
frequently of great service. The dose is from half a spoonful to three
or four spoonfuls or more, according to the circumstances of the
patient, and the purposes it is intended to answer.


                          _Paregoric Elixir._

Take of flowers of benzoin, half an ounce; opium, two drachms. Infuse in
one pound of the volatile aromatic spirit, for four or five days,
frequently shaking the bottle; afterwards strain the elixir.

This is an agreeable and safe way of administering opium. It eases pain,
allays tickling coughs, relieves difficult breathing, and is useful in
many disorders of children, particularly the hooping cough.

The dose to an adult is from fifty to a hundred drops.


                            _Sacred Elixir._

Take of rhubarb cut small, ten drachms; succotorine aloes, in powder,
six drachms; lesser cardamom seeds, half an ounce; French brandy, two
pints. Infuse for two or three days, and then strain the elixir.

This useful stomachic purge may be taken from one ounce to an ounce and
a half.


                          _Stomachic Elixir._

Take of gentian root, two ounces; Curassao oranges, one ounce; Virginian
snake-root, half an ounce. Let the ingredients be bruised, and infused
for three or four days in two pints of French brandy; afterwards, strain
out the elixir.

This is an elegant stomachic bitter. In flatulencies, indigestion, want
of appetite, and such like complaints, a small glass of it may be taken
twice a-day. It likewise relieves the gout in the stomach, when taken in
a large dose.


                       _Acid Elixir of Vitriol._

Take of the aromatic tincture, one pint; oil of vitriol, three ounces.
Mix them gradually, and after the fæces have subsided, filter the elixir
through paper, in a glass funnel.

This is one of the best medicines which I know for hysteric and
hypochondriac patients, afflicted with flatulencies arising from
relaxation or debility of the stomach and intestines. It will succeed
where the most celebrated stomachic bitters have no effect. The dose is
from ten to forty drops, in a glass of wine or water, or a cup of any
bitter infusion, twice or thrice a-day. It should be taken when the
stomach is most empty.


                     _Camphorated Spirit of Wine._

Dissolve an ounce of camphor in a pint of rectified spirits.

This solution is chiefly employed as an embrocation in bruises, palsies,
the chronic rheumatism, and for preventing gangrenes.

The above quantity of camphor, dissolved in half a pound of the volatile
aromatic spirit, makes _Ward’s Essence_.


                        _Spirit of Mindererus._

Take of volatile sal ammoniac, any quantity. Pour on it gradually
distilled vinegar, till the effervescence ceases.

This medicine is useful in promoting a discharge both by the skin and
urinary passages. It is also a good external application in strains and
bruises.

When intended to raise a sweat, half an ounce of it in a cup of warm
gruel may be given to the patient in bed every hour till it has the
desired effect.


                               VINEGARS.

Vinegar is an acid produced from vinous liquors by a second
fermentation. It is an useful medicine both in inflammatory and putrid
disorders. Its effects are, to cool the blood, quench thirst, counteract
a tendency to putrefaction, and allay inordinate motions of the system.
It likewise promotes the natural secretions, and in some cases excites a
copious sweat, where the warm medicines, called alexipharmic, tend
rather to prevent that salutary evacuation.

Weakness, faintings, vomitings, and other hysteric affections, are often
relieved by vinegar applied to the mouth and nose, or received into the
stomach. It is of excellent use also in correcting many poisonous
substances, when taken into the stomach; and in promoting their
expulsion, by the different emunctories, when received into the blood.

Vinegar is not only an useful medicine, but serves likewise to extract,
in tolerable perfection, the virtues of several other medicinal
substances. Most of the odoriferous flowers impart to it their
fragrance, together with a beautiful purplish or red colour. It also
assists or coincides with the intention of squills, garlic, gum
ammoniac, and several other valuable medicines.

These effects, however, are not to be expected from every thing that is
sold under the name of vinegar, but from such as is sound and well
prepared.

The best vinegars are those prepared from French wines.

It is necessary for some purposes that the vinegar be distilled; but as
this operation requires a particular chemical apparatus, we shall not
insert it.


                         _Vinegar of Litharge._

Take of litharge, half a pound; strong vinegar, two pints. Infuse them
together in a moderate heat for three days, frequently shaking the
vessel; then filter the liquor for use.

This medicine is little used, from a general notion of its being
dangerous. There is reason, however, to believe, that the preparations
of lead with vinegar are possessed of some valuable properties, and that
they may be used in many cases with safety and success.

A preparation of a similar nature with the above has of late been
extolled by Goulard, a French surgeon, as a safe and extensively useful
medicine, which he calls the _Extract of Saturn_, and orders to be made
in the following manner:

Take of litharge, one pound; vinegar made of French wine, two pints. Put
them together into a glazed earthen pipkin, and let them boil, or rather
simmer, for an hour, or an hour and a quarter, taking care to stir them
all the while with a wooden spatula. After the whole has stood to
settle, pour off the liquor which is upon the top into bottles for use.

With this extract Goulard makes his _vegeto-mineral water_[211], which
he recommends in a great variety of external disorders, as
inflammations, burns, bruises, sprains, ulcers, &c.

He likewise prepares with it a number of other forms of medicine, as
poultices, plasters, ointments, powders, &c.


                          _Vinegar of Roses._

Take of red roses, half a pound; strong vinegar, half a gallon. Infuse
in a close vessel for several weeks, in a gentle heat; and then strain
off the liquor.

This is principally used as an embrocation for head-achs, &c.


                         _Vinegar of Squills._

Take of dried squills, two ounces; distilled vinegar, two pints. Infuse
for ten days or a fortnight in a gentle degree of heat, afterwards
strain off the liquor, and add to it about a twelfth part its quantity
of proof spirits.

This medicine has good effects in disorders of the breast, occasioned by
a load of viscid phlegm. It is also of use in hydropic cases for
promoting a discharge of urine.

The dose is from two drachms to two ounces, according to the intention
for which it is given. When intended to act as a vomit, the dose ought
to be large. In other cases, it must not only be exhibited in small
doses, but also mixed with cinnamon water, or some other agreeable
aromatic liquor, to prevent the nausea it might otherwise occasion.


                        WATERS BY INFUSION, &c.


                             _Lime-Water._

Pour two gallons of water gradually upon a pound of fresh burnt
quicklime; and when the ebullition ceases, stir them well together; then
suffer the whole to stand at rest, that the lime may settle, and
afterwards filter the liquor through paper, which is to be kept in
vessels closely stopt.

The lime-water from calcined oyster-shells, is prepared in the same
manner.

Lime-water is principally used for the gravel; in which case, from a
pint to two or more of it may be drunk daily. Externally it is used for
washing foul ulcers, and removing the itch, and other diseases of the
skin.


                         _Compound Lime-Water._

Take shavings of guaiacum wood, half a pound; liquorice root, one ounce;
sassafras bark, half an ounce; coriander seeds, three drachms; simple
lime-water, six pints.

Infuse without heat for two days, and then strain off the liquor.

In the same manner may lime-water be impregnated with the virtues of
other vegetable substances. Such impregnation not only renders the water
more agreeable to the palate, but also a more efficacious medicine,
especially in cutaneous disorders, and foulness of the blood and juices.

It may be taken in the same quantity as the simple water.


                           _Sublimate Water._

Dissolve eight grains of the corrosive sublimate in a pint of cinnamon
water.

If a stronger solution is wanted, a double or triple quantity of
sublimate may be used.

The principal intention of this is to cleanse foul ulcers, and consume
proud flesh.


                            _Styptic Water._

Take of blue vitriol and alum, each an ounce and a half; water, one
pint. Boil them until the salts are dissolved, then filter the liquor,
and add to it a drachm of the oil of vitriol.

This water is used for stopping a bleeding at the nose, and other
hæmorrhages; for which purpose cloths or dossils dipt in it must be
applied to the part.


                              _Tar Water._

Pour a gallon of water on two pounds of Norway tar, and stir them
strongly together with a wooden rod: after they have stood to settle for
two days, pour off the water for use.

Though tar-water falls greatly short of the character which has been
given of it, yet it possesses some medicinal virtues. It sensibly raises
the pulse, increases the secretions, and sometimes opens the body, or
occasions vomiting.

A pint of it may be drank daily, or more, if the stomach can bear it. It
is generally ordered to be taken on an empty stomach, viz. four ounces
morning and evening, and the same quantity about two hours after
breakfast and dinner.


                        SIMPLE DISTILLED WATERS.

A great number of distilled waters were formerly kept in the shops, and
are still retained in some Dispensatories. But we consider them chiefly
in the light of grateful diluents, suitable vehicles for medicines of
greater efficacy, or for rendering disgustful ones more agreeable to the
palate and stomach. We shall therefore insert only a few of those which
are best adapted to these intentions.

The management of a still being now generally understood, it is needless
to spend time in giving directions for that purpose.


                           _Cinnamon Water._

Steep one pound of cinnamon bark, bruised, in a gallon and a half of
water, and one pint of brandy, for two days; and then distil off one
gallon.

This is an agreeable aromatic water, possessing in a high degree the
fragrance and cordial virtues of the spice.


                          _Pennyroyal Water._

Take of penny-royal leaves, dried, a pound and a half; water, from a
gallon and a half to two gallons. Draw off by distillation one gallon.

This water possesses, in a considerable degree, the smell, taste, and
virtues of the plant. It is given in mixtures and juleps to hysteric
patients.

An infusion of the herb, in boiling water answers nearly the same
purposes.


                          _Peppermint Water._

This is made in the same manner as the preceding.


                           _Spearmint Water._

This may also be prepared in the same way as the penny-royal water.

Both these are useful stomachic waters, and will sometimes relieve
vomiting, especially when it proceeds from indigestion, or cold viscid
phlegm. They are likewise useful in some colicky complaints, the gout in
the stomach, &c. particularly the peppermint water.

An infusion of the fresh plant is frequently found to have the same
effects as the distilled water.


                             _Rose Water._

Take of roses fresh gathered, six pounds; water, two gallons. Distil off
one gallon.

This water is principally valued on account of its fine flavour.


                        _Jamaica Pepper Water._

Take of Jamaica pepper, half a pound; water, a gallon and a half. Distil
off one gallon.

This is a very elegant distilled water, and may in most cases supply the
place of the more costly spice waters.


                      SPIRITUOUS DISTILLED WATERS.


                      _Spirituous Cinnamon Water._

Take of cinnamon bark, one pound; proof spirit, and common water, of
each one gallon. Steep the cinnamon in the liquor for two days; then
distil off one gallon.


                   _Spirituous Jamaica Pepper Water._

Take of Jamaica pepper, half a pound; proof spirit, three gallons;
water, two gallons. Distil off three gallons.

This is a sufficiently agreeable cordial, and may supply the place of
the _Aromatic Water_.


                                 WHEYS.


                              _Alum Whey._

Boil two drachms of powdered alum in a pint of milk till it is curdled;
then strain out the whey.

This whey is beneficial in an immoderate flow of the _menses_, and in a
_diabetes_, or excessive discharge of urine.

The dose is two, three, or four ounces, according as the stomach will
bear it, three times a-day. If it should occasion vomiting, it may be
diluted.


                            _Mustard-Whey._

Take milk and water, of each a pint; bruised mustard-seed, an ounce and
a half. Boil them together till the curd is perfectly separated;
afterwards strain the whey through a cloth.

This is the most elegant, and by no means the least efficacious method
of exhibiting mustard. It warms and invigorates the habit, and promotes
the different secretions. Hence, in the low state of nervous fevers, it
will often supply the place of wine. It is also of use in the chronic
rheumatism, palsy, dropsy, &c. The addition of a little sugar will
render it more agreeable.

The dose is an ordinary tea-cupful four or five times a-day.


                           _Scorbutic Whey._

This whey is made by boiling half a pint of the scorbutic juices in a
quart of cow’s milk. More benefit, however, is to be expected from
eating the plants, than from their expressed juices.

The scorbutic plants are, bitter oranges, brooklime, garden
scurvy-grass, and water-cresses.

A number of other wheys may be prepared nearly in the same manner, as
orange whey, cream of tartar whey, &c. These are cooling pleasant drinks
in fevers, and may be rendered cordial, when necessary, by the addition
of wine.


                                 WINES.

The effects of wine are, to raise the pulse, promote perspiration, warm
the habit, and exhilarate the spirits. The red wines, besides these
effects, have an astringent quality, by which they strengthen the tone
of the stomach and intestines, and by this means prove serviceable in
restraining immoderate secretions.

The thin sharp wines have a different tendency. They pass off freely by
the different emunctories, and gently open the body. The effects of the
full bodied wines are, however, much more durable than those of the
thinner.

All sweet wines contain a glutinous substance, and do not pass off
freely. Hence they will heat the body more than an equal quantity of any
other wine, though it should contain fully as much spirit.

From the obvious qualities of wine, it must appear to be an excellent
cordial medicine. Indeed, to say the truth, it is worth all the rest put
together.

But to answer this character, it must be sound and good. No benefit is
to be expected from the common trash that is often sold by the name of
wine, without possessing one drop of the juice of the grape. Perhaps no
medicine is more rarely obtained genuine than wine.

Wine is not only used as a medicine, but is also employed as a
_menstruum_ for extracting the virtues of other medicinal substances;
for which it is not ill adapted, being a compound of water, inflammable
spirit, and acid; by which means it is enabled to act upon vegetable and
animal substances, and also to dissolve some bodies of the metallic
kind, so as to impregnate itself with their virtues, as steel, antimony,
&c.


                          _Anthelmintic Wine._

Take of rhubarb, half an ounce; worm-seed, an ounce. Bruise them, and
infuse without heat in two pints of red port wine for a few days, then
strain off the wine.

As the stomachs of persons afflicted with worms are always debilitated,
red wine alone will often prove serviceable: it must, however, have
still better effects when joined with bitter and purgative ingredients,
as in the above form.

A glass of this wine may be taken twice or thrice a-day.


                           _Antimonial Wine._

Take glass of antimony, reduced to a fine powder, half an ounce; Lisbon
wine, eight ounces. Digest, without heat, for three or four days, now
and then shaking the bottle; afterwards filter the wine through paper.

The dose of this wine varies according to the intention. As an
alterative and diaphoretic, it may be taken from ten to fifty or sixty
drops. In a larger dose it generally proves cathartic, or excites
vomiting.


                             _Bitter Wine._

Take of gentian root, yellow rind of lemon-peel, fresh, each one ounce;
long pepper, two drachms; mountain wine, two pints. Infuse without heat
for a week, and strain out the wine for use.

In complaints arising from weakness of the stomach, or indigestion, a
glass of this wine may be taken an hour before dinner and supper.


                          _Ipecacuanha Wine._

Take of ipecacuanha, in powder, one ounce; mountain wine, a pint. Infuse
for three or four days; then filter the tincture.

This is a safe vomit, and answers extremely well for such persons as
cannot swallow the powder, or whose stomachs are too irritable to bear
it.

The dose is from one ounce to an ounce and a half.


                      _Chalybeate or Steel Wine._

Take filings of iron, two ounces; cinnamon and mace, of each two
drachms; Rhenish wine, two pints. Infuse for three or four weeks,
frequently shaking the bottle; then pass the wine through a filter.

In obstructions of the _menses_, this preparation of iron may be taken,
in the dose of half a wine-glass twice or thrice a-day.

The medicine would probably be as good if made with Lisbon wine,
sharpened with half an ounce of the cream of tartar, or a small quantity
of the vitriolic acid.


                            _Stomach Wine._

Take of Peruvian bark, grossly powdered, an ounce; cardamom seeds, and
orange peel, bruised, of each two drachms. Infuse in a bottle of white
port or Lisbon wine for five or six days; then drain off the wine.

This wine is not only of service in debility of the stomach and
intestines, but may also be taken as a preventive, by persons liable to
the intermittent fever, or who reside in places where this disease
prevails. It will be of use likewise to those who recover slowly after
fevers of any kind, as it assists digestion, and helps to restore the
tone and vigour of the system.

A glass of it may be taken two or three times a-day.




                                   A
                               GLOSSARY.


Although terms of art have been sedulously avoided in the composition of
this treatise, it is impossible entirely to banish technical phrases
when writing on medicine, a science that has been less generally
attended to by mankind, and continues therefore to be more infected with
the jargon of the schools, than perhaps any other. Several persons
having expressed their opinion that a Glossary would make this work more
generally intelligible, the following concise explanation of the few
terms of art that occur, has been added in compliance with their
sentiments, and to fulfil the original intention of this treatise, by
rendering it intelligible and useful to all ranks and classes of
mankind.


                                      A.

  _Abdomen._ The belly.

  _Absorbents._ Vessels that convey the nourishment from the intestines,
      and the secreted fluids from the various cavities into the mass of
      blood.

  _Acrimony._ Corrosive sharpness.

  _Acute._ A disease, the symptoms of which are violent, and tend to a
      speedy termination, is called acute.

  _Adult._ Of mature age.

  _Adust._ Dry, warm.

  _Antispasmodic._ Whatever tends to prevent or remove spasm.

  _Aphthæ._ Small whitish ulcers appearing in the mouth.

  _Astriction._ A tightening or lessening.

  _Atrabilarian._ An epithet commonly applied to people of a certain
      temperament, marked by a dark complexion, black hair, spare habit,
      &c. which the ancients supposed to arise from the _atra bilis_, or
      the black bile.


                                      B.

  _Bile, or Gall._ A fluid which is secreted by the liver into the
      gall-bladder, and from thence passes into the intestines, in order
      to promote digestion.


                                      C.

  _Cacochymie._ An unhealthy state of the body.

  _Caries._ A rottenness of a bone.

  _Chyle._ A milky fluid separated from the aliment in the intestines,
      and conveyed by the absorbents into the blood to supply the waste
      of the animal body.

  _Chronic._ A disease whose progress is slow, in opposition to acute.

  _Circulation._ The motion of the blood, which is driven by the heart
      through the arteries, and returns by the veins.

  _Comatose._ Sleepy.

  _Conglobate Gland._ A simple gland.

  _Conglomerate._ A compound gland.

  _Contagion._ Infectious matter.

  _Cutis._ The skin.

  _Cutaneous._ Of or belonging to the skin.

  _Crisis._ A certain period in the progress of a disease, from whence a
      decided alteration either for the better or the worse takes place.

  _Critical._ Decisive or important.

  _Critical Days._ The fourth, fifth, seventh, ninth, eleventh,
      thirteenth, fourteenth, seventeenth, and twenty-first, are by some
      authors denominated critical days, because febrile complaints have
      been observed to take a decisive change at these periods.


                                      D.

  _Debility._ Weakness.

  _Delirium._ A temporary disorder of the mental faculties.

  _Diaphragm._ A membrane separating the cavity of the chest from that
      of the belly.

  _Diuretic._ A medicine that promotes the secretion of urine.

  _Drastic._ Is applied to such purgative medicines as are violent or
      harsh in their operation.


                                      E.

  _Empyema._ A collection of purulent matter in the cavity of the
      breast.

  _Endemic._ A disease peculiar to a certain district of country.

  _Epidemic._ A disease generally infectious.

  _Exacerbation._ The increase of any disease.


                                      F.

  _Fœces._ Excrements.

  _Fœtid._ Emitting an offensive smell.

  _Fœtus._ The child before birth, or when born before the proper
      period, is thus termed.

  _Flatulent._ Producing wind.

  _Fungus._ Proud flesh.


                                      G.

  _Gangrene._ Mortification.

                   _Gummata._│Venereal excrescences.
                   _Ganglia._│          „

  _Gymnastic._ Exercise taken with a view to preserve or restore
      health.—The ancient physicians reckoned this an important branch
      of medicine.


                                      H.

  _Hectic fever._ A slow consuming fever, generally attending a bad
      habit of body, or some incurable and deep rooted disease.

  _Hæmorrhoids._ The piles.

  _Hæmorrhage._ Discharge of blood.

  _Hypochondriacism._ Low spirits.

  _Hypochondriac viscera._ The liver, spleen, &c. so termed from their
      situation in the hypochondriac or upper and lateral parts of the
      belly.


                                      I.

  _Ichor._ Thin bad matter.

  _Imposthume._ A collection of purulent matter.

  _Inflammation._ A surcharge of blood, and an increased action of the
      vessels, in any particular part of the body.


                                      L.

  _Ligature._ Bandage.

  _Lixivium._ Ley.


                                      M.

  _Miliary Eruption._ Eruption of small pustules resembling the seeds of
      millet.

  _Morbific._ Causing disease, or diseased.

  _Mucus._ The matter discharged from the nose, lungs, &c.

  _Mysentery._ A double membrane which connects the intestines to the
      back bone.


                                      N.

  _Nervous._ Irritable.

  _Nausea._ An inclination to vomit.

  _Nodes._ Enlargements of the bones produced by the venereal disease.


                                      P.

  _Pectoral._ Medicines adapted to cure diseases of the breast.

  _Pelvis._ The bones situated at the lower part of the trunk; thus
      named from their resembling in some measure a bason.

  _Peritonæum._ A membrane lining the cavity of the belly and covering
      the intestines.

  _Pericardium._ Membrane containing the heart.

  _Perspiration._ The matter discharged from the pores of the skin in
      form of vapour or sweat.

  _Phlogiston._ Is here used to signify somewhat rendering the air unfit
      for the purposes of respiration.

  _Phlegmatic._ Watery, relaxed.

  _Plethoric._ Replete with blood.

  _Polypus._ A diseased excrescence, or a substance formed of coagulable
      lymph, frequently found in the large blood vessels.

  _Pus._ Matter contained in a boil.


                                      R.

  _Regimen._ Regulation of diet.

  _Rectum._ The straight gut, in which the fœces are contained.

  _Respiration._ The act of breathing.


                                      S.

  _Saliva._ The fluid secreted by the glands of the mouth.

  _Sanies._ A thin bad matter, discharged from an ill conditioned sore.

  _Scirrhous._ A state of diseased hardness.

  _Slough._ A part separated and thrown off by suppuration.

  _Spasm._ A diseased contraction.

  _Spine._ The back bone.

  _Styptic._ A medicine for stopping the discharge of blood.

  _Syncope._ A fainting fit attended with a complete abolition of
      sensation and thought.


                                      T.

  _Tabes._ A species of consumption.

  _Temperament._ A peculiar habit of body, of which there are generally
      reckoned four, viz. the sanguine, the bilious, the melancholic,
      and the phlegmatic.


                                      U.

  _Vertigo._ Giddiness.

  _Ulcer._ An ill conditioned sore.

  _Ureters._ Two long and small canals which convey the urine from the
      kidneys to the bladder.

  _Urethra._ The canal which conveys the urine from the bladder.




                                 INDEX.


                                   A.

 _Ablutions_, Jewish and Mahometan, well calculated for the preservation
    of health, 103.

 _Abortion_, causes and symptoms of, 531.
   Means of prevention, 532.
   Proper treatment in the case of, _ibid._

 _Abscesses_, how to be treated, 308. 573.

 _Accidents._ See _Casualties_.

 _Acids_, of peculiar service in consumptions, 183.
   In putrid fevers, 199.
   Not suitable to the measles, 242.

 _Acidities_ in the bowels of infants, the origin of, 548.
   Method of cure, 549.

 _Ackworth_, foundling hospital at, cause of the children there being
    afflicted with scabbed heads, and fatal consequences of their ill
    treatment, 555, _note_.

 _Addison_, his remark on the luxury of the table, 95.

 _Æther_, very serviceable in removing fits of the asthma, 409.
   Is excellent for flatulencies, 444.

 _Æthiops_ mineral, strongly recommended by Dr. Cheyne in inflammations
    of the eyes, 263.

 _Africans_, their treatment of children, 11, _note_.

 _Agaric_ of the oak, its merit as a styptic, 577.
   Method of gathering, preparing, and applying it, _ibid._ _note_.

 _Agriculture_, a healthful, constant, and profitable employment, 48.
   Is too much neglected in favour of manufactures, _ibid._
   Gardening the most wholesome amusement for sedentary persons, 53.

 _Ague_, a species of fever no person can mistake, and the proper
    medicine for, generally known, 147.
   Causes of, 148.
   Symptoms, _ibid._
   Regimen for, _ibid._
   Under a proper regimen will often go off, without medicine, 150.
   Medical treatment of, 151.
   Often degenerates into obstinate chronical diseases, if not radically
      cured, 154.
   Peruvian bark the only medicine to be relied on in, 155.
   Children how to be treated in, _ibid._
   Preventive medicine for those who live in marshy countries, 156.

 _Air_, confined, poisonous to children, 30.
   A free open air will sometimes cure the most obstinate disorders in
      children, 33.
   Occupations which injure the health by unwholesome air, 37. 49.
   The qualities of, act more sensibly on the body, than is generally
      imagined, 75.
   The several noxious qualities of, specified, _ibid._
   In large cities, polluted by various circumstances, 76.
   The air in churches, how rendered unwholesome, _ibid._
   Houses ought to be ventilated daily, 78.
   The danger attending small apartments, _ibid._
   Persons whose business confines them to town ought to sleep in the
      country, _ibid._
   High walls obstruct the free current of air, 79.
   Trees should not be planted too near to houses, _ibid._
   Fresh air peculiarly necessary for the sick, 80.
   The sick in hospitals in more danger from the want of fresh air, than
      from their disorders, _ibid._
   Wholesomeness of the morning air, 84.
   The changeableness of, one great cause of catching cold, 126.
   Those who keep most within doors, the most sensible of these changes,
      127.
   Of the night, to be carefully guarded against, 128.
   Fresh air often of more efficacy in diseases than medicine, 139.
   Its importance in fevers, 145. 160.
   States of, liable to produce putrid fevers, 195.
   Must be kept cool and fresh in sick chambers under this disorder,
      199.
   Change of, one of the most effectual remedies for the hooping-cough,
      285.
   The qualities of, a material consideration for asthmatic patients,
      408.
   The various ways by which it may be rendered noxious, 614.
   Confined, how to try, and purify, _ibid._
   Method of recovering persons poisoned by foul air, 615.
   Fresh, of the greatest importance in fainting fits, 622.

 _Aitken_, Mr. his treatise on the nature and cure of fractures,
    recommended, 594, _note_.

 _Alcali_, caustic, recommended in the stone, 327.
   How to prepare it, _ibid._ _note_.

 _Aliment_ is capable of changing the whole constitution of the body,
    62.
   Will in many cases answer every intention in the cure of diseases,
      _ibid._
   The calls of hunger and thirst, sufficient for regulating the due
      quantity of, 63.
   The quality of, how injured, _ibid._
   A due mixture of vegetables necessary with our animal food, 65.
   To what the bad effects of tea are principally owing, 65.
   Water, good and bad, distinguished, 66.
   Inquiry into the qualities of fermented liquors, with instructions
      for the due making of them, 69.
   The qualities of good bread, and why adulterated by bakers, 70.
   General rules for the choice of food, _ibid._
   Ought not to be too uniform, 71.
   Meals ought to be taken at regular times, 72.
   Long fasting injurious both to old and young, 73.
   Breakfasts and suppers, _ibid._
   Changes of diet ought to be gradually made, 74.

 _Amaurosis._ See _Gutta serena_.

 _American_ Indians, their method of curing the venereal disease, 513.

 _Amusements_, sedentary, improper for sedentary persons, 51.
   Ought always to be of an active kind, 85.

 _Anasarca._ See _Dropsy_.

 _Anger_, violent fits of, injurious to the constitution, 112.
   Tranquillity of mind essential to health, _ibid._

 _Animal_ food, cautions in giving it to children, 18.
   Animals that die of themselves, unfit for food, 63.
   Overdriven cattle rendered unwholesome, 64.
   The artifices of butchers exposed, 65.
   Too great a quantity of, generates the scurvy, _ibid._

 _Animals_ and plants, the analogy in the nourishment of, stated, 94.

 _Anthony’s_ Fire, St. See _Erysipelas_.

 _Aphthæ._ See _Thrush_.

 _Apoplexy_, who most liable to this disorder, 410.
   Causes, _ibid._
   Symptoms and method of cure, 411.
   Cautions to persons of an apoplectic make, 413.

 _Apothecaries_ weights, a table of, 653.

 _Apparel_, See _Clothing_.

 _Appetite_, want of, causes and remedies for, 417.

 _Arbuthnot_, Dr. his advice in the inflammation of the lungs, 172.
   His advice for persons troubled with costiveness, 415, _note_.

 _Arsenic_, the effects of, on the stomach, 474.
   Medical treatment when the symptoms appear, _ibid._

 _Arts._ See _Manufactures_.

 _Ascites._ See _Dropsy_.

 _Asses_ milk, why it seldom does any good, 179.
   Instructions for taking it, _ibid._

 _Asthma_, the different kinds of this disorder distinguished, with its
    causes, 406.
   Symptoms, 407.
   Regimen, _ibid._
   Medical treatment, 408.
   Remedies proper in the moist asthma, 409.

 _Atmosphere._ See _Air_.


                                   B.

 _Ball’s_ purging vermifuge powder, preparation of, 369.

 _Balsams_, how to prepare.
   Anodyne balsam, 657.
   Locatelli’s balsam, _ibid._
   Vulnerary balsam, _ibid._

 _Bandages_, tight, produce most of the bad consequences attending
    fractured bones, 595.

 _Bark_, Peruvian, the best antidote for sailors against disorders on a
    foreign coast, 47.
   How to be administered in the ague, 151.
   Distinction between the red bark and quill bark, _ibid._ _note_.
   A decoction or infusion of, may be taken by those who cannot swallow
      it in substance, 153.
   Is often adulterated, _ibid._ _note_.
   Is the only medicine to be depended on in agues, 155.
   How it may be rendered more palatable, _ibid._
   May be administered by clyster, 156.
   Cold water the best menstruum for extracting the virtues of this
      drug, 185.
   How to be administered in the putrid fever, 202; and in the
      erysipelas, 252.
   In an inflammation of the eyes, 263.
   Its efficacy in a malignant quinsey, 274.
   In the hooping-cough, 288.
   A good medicine in vomiting, when it proceeds from weakness of the
      stomach, 317.
   Its efficacy in a diabetes, and how to take it, 321.
   Is good against the piles, 336; and worms, 368.
   Its use dangerous for preventing a fit of the gout, 385.
   A good remedy in the King’s evil, 401;
     and in the _fluor albus_, 529.

 _Barley_ water, how made, 165.

 _Barrenness_ in women, the general causes of, 542.
   Course of relief, 543.
   Dr. Cheyne’s observations on, _ibid. note_.

 _Bath_ waters, good in the gout, 386.

 _Bath_, cold, the good effects of, on children, 29.
   Recommended to the studious, 62.
   Is peculiarly excellent for strengthening the nervous system, 425.
   Therefore should never be omitted in gleets, 501.
   Is good for rickety children, 564.
   Cautions concerning the improper use of, in adults, 633–639.

 _Bath_, warm, of great service in an inflammation of the stomach, 291.

 _Bathing_, a religious duty under the Judaic and Mahometan laws, 103.
   Is conducive to health, 104.

 _Bears_ foot, recommended as a powerful remedy against worms, 369.

 _Beds_, instead of being made up again as soon as persons rise from
    them, ought to be turned down and exposed to the air, 77.
   Bad effects of too great indulgence in bed, 84.
   Damp, the danger of, 128.
   Soft, are injurious to the kidneys, 320. 324.

 _Beer_, the ill consequences of making it too weak, 69.
   Pernicious artifices of the dealers in, _ibid._

 _Bells_, parish, the tolling them for the dead, a dangerous custom,
    114.

 _Biles_, 575.

 _Bilious_ colic, symptoms and treatment of, 298.

 _Bilious_ fever. See _Fever_.

 _Bite_ of a mad dog. See _Dog_.

 _Bitters_, warm and astringent, antidotes to agues, 151.
   Are serviceable in vomiting when it proceeds from weakness in the
      stomach, 317.

 _Bladder_, inflammation of, its general causes, 305.
   Medical treatment of, _ibid._

 _Bladder_, stone in. See _Stone_.

 _Blast._ See _Erysipelas_.

 _Bleeding_, cautions for the operation of, in fevers, 146.
   In the ague, 150.
   Its importance in the acute continual fever, 161.
   In the pleurisy, 166.
   When necessary in an inflammation of the lungs, 173.
   Caution against, in a nervous fever, 192.
   In the putrid fever, 201.
   In the miliary fever, 209.
   When necessary in the small-pox, 221.
   When useful in the measles, 243.
   When necessary in the bilious fever, 247.
   Under what circumstances proper in the erysipelas, 251.
   Mode of, proper in an inflammation of the brain, 257.
   Is always necessary in an inflammation of the eyes, 261.
   When proper, and improper, in a cough, 280.
   When proper in the hooping-cough, 285.
   Is almost the only thing to be depended on in an inflammation of the
      stomach, 290.
   And in an inflammation of the intestines, 292.
   Is necessary in an inflammation of the kidneys, 303.
   Its use in a suppression of urine, 323.
   Is proper in an asthma, 409.
   Is dangerous in fainting fits, without due caution, 442.
   Cautions proper in the puerperal fever, 539.
   Is an operation generally performed by persons who do not understand
      when it is proper, 570.
   In what case it ought to be had recourse to, _ibid._
   The quantity taken away, how to be regulated, 571.
   General rules for the operation, _ibid._
   Objections to bleeding by leeches, 572.
   Prevailing prejudices relating to bleeding, _ibid._
   The arm the most commodious part to take blood from, 573.

 _Bleeding_ at the nose, spontaneous, is of more service, where bleeding
    is necessary, than the operation with the lancet, 321.
   Ought not to be stopped without due consideration, _ibid._
   How to stop it when necessary, 332.
   Cautions to prevent frequent returns of, 334.

 _Blind_ persons, when born so, might be educated to employments suited
    to their capacity, 456, _note_.

 _Blisters_, peculiarly advantageous in the nervous fever, 192.
   When only to be applied in the putrid fever, 201.
   When proper in the miliary fever, 209.
   Seldom fail to remove the most obstinate inflammation of the eyes,
      262.
   A good remedy in the quinsey, 269.
   Proper for a violent hooping-cough, 288.
   Is one of the best remedies for an inflammation of the stomach, 291.
   Are efficacious in the tooth-ach, 359.

 _Blood_, involuntary discharges of, often salutary, and ought not to be
    rashly stopped, 329.
   The several kinds of these discharges, with their usual causes,
      _ibid._
   Methods of cure, 330.

 _Blood_, spitting of, who most subject to, and at what seasons, 337.
   Its causes, _ibid._
   Symptoms, 339.
   Proper regimen in, _ibid._
   Medical treatment, 340.
   Cautions for persons subject to it, 341.

 _Blood_, vomiting of, its causes and symptoms, 341.
   Medical treatment, 342.

 _Blood_-shot eye, how to cure, 450.

 _Bloody_-flux. See _Dysentery_.

 _Boerhaave_, his observation on dress, 93, _note_.
   His mechanical expedients to relieve an inflammation of the brain,
      256.

 _Boluses_, general rules for the preparing of, 658.
   The astringent bolus, _ibid._
   Diaphoretic bolus, _ibid._
   Mercurial bolus, _ibid._
   Bolus of rhubarb and mercury, 659.
   Pectoral bolus, _ibid._
   Purging bolus, _ibid._

 _Bones_, the exfoliation of, a very slow operation, 583.
   Bones, broken, often successfully undertaken by ignorant operators,
      593.
   Regimen to be adopted after the accident, 594.
   Hints of conduct if the patient is confined to his bed, _ibid._
   Cleanliness to be regarded during this confinement, 595.
   The limb not to be kept continually on the stretch, _ibid._
   Cautions to be observed in setting a bone, _ibid._
   Tight bandages condemned, 596.
   How to keep the limb steady by an easy method, _ibid._
   Fractures of the ribs, _ibid._

 _Bowels_, inflammation of. See _Stomach_.

 _Boys_, the military exercise proper for them, 26.

 _Braidwood_, Mr. his skill in teaching the dumb to speak, 461, _note_.

 _Brain_, inflammation of, who most liable to it, with its causes and
    symptoms, 254.
   Regimen, 256.
   Medical treatment, 257.

 _Bread_, proper food for children, as soon as they can chew it, 17.
   A crust of, the best gum-stick, _ibid._
   The best modes of preparing it in food for children, 18.
   Good, the qualities of, and for what purpose adulterated by the
      bakers, 70.
   Toasted, a decoction of, good to check the vomiting in a _cholera
      morbus_, 310.

 _Brimstone._ See _Sulphur_.

 _Broth_, gelatinous, recommended in the dysentery, how to make, 347.

 _Bruises_, why of worse consequence than wounds, 582.
   Proper treatment of, _ibid._
   The exfoliation of injured bones a very slow operation, 583.
   How to cure sores occasioned by, _ibid._

 _Buboes_, two kinds of, distinguished, with their proper treatment,
    504.

 _Burdens_, heavy, injurious to the lungs, 40.

 _Burgundy_ pitch, a plaster of, between the shoulders, an excellent
    remedy in a cough, 281.
   In a hooping-cough, 288.
   And for children in teething, 560.

 _Burials_, the dangers attending their being allowed in the midst of
    populous towns, 76.

 _Burns_, slight, how to cure, 580.
   Treatment of, when violent, _ibid._
   Extraordinary case of, 581.
   Liniment for, 680.

 _Butchers_, their professional artifices explained, and condemned, 65.

 _Butter_ ought to be very sparingly given to children, 21.


                                   C.

 _Cabbage_ leaves, topical application of, in a pleurisy, 167.

 _Camphor_, why of little use in eye-waters, 662.

 _Camphorated_ oil, preparation of, 684.

 _Camphorated_ spirit of wine, 699.

 _Camps_, the greatest necessity of consulting cleanliness in, 103.

 _Cancer_, its different stages described, with the producing causes,
    460.
   Symptoms, 467.
   Regimen, and medical treatment, 468.
   Dr. Stork’s method of treating this disorder, 469.
   Cautions for avoiding it, 472.

 _Cancer scroti_, a disorder peculiar to chimney-sweepers, owing to want
    of cleanliness, 100, _note_.

 _Carriages_, the indulgence of, a sacrifice of health to vanity, 82.

 _Carrot_, wild, recommended in the stone, 328.

 _Carrot_ poultice for cancers, how to prepare, 471.

 _Casualties_, which apparently put an end to life, necessary cautions
    respecting, 600. 608. 613. 631.

 —— substances stopped in the gullet, 602.

 —— drowning, 609.

 —— noxious vapours, 613.

 —— extremity of cold, 616.

 —— extreme heat, 618.

 _Cataplasms_, their general intention, 659.
   Preparation of the discutient cataplasm, _ibid._
   Ripening cataplasm, _ibid._

 _Cataract_, the disorder and its proper treatment described, 458.

 _Cattle_, stall fed, are unwholesome food, 64.
   Overdriven, are killed in a high fever, _ibid._
   The artifices of butchers exposed, 65.

 _Cellars_, long shut, ought to be cautiously opened, 78.
   And sunk stories of houses, unhealthy to live in, 130.
   Of liquors in a state of fermentation, dangerous to enter, 614.
   How to purify the air in, _ibid._

 _Celsus_, his rules for the preservation of health, 134.

 _Chancres_, described, 506.
   Primary, how to treat, _ibid._
   Symptomatic, 507.

 _Charcoal_ fire, the danger of sleeping in the fume of, 613.

 _Charity_, the proper exercise of, 43.

 _Cheyne_, Dr. his persuasive to the use of exercise, 83.
   His judgment of the due quantity of urine, not to be relied on, 124.
   Strongly recommends Æthiops mineral in inflammations of the eyes,
      263.
   His observations on barrenness, 543, _note_.

 _Chilblains_, cause of, 556.
   How to cure, _ibid._

 _Child-bed_ women, how to be treated under a miliary fever, 210.

 _Child-bed_ fever. See _Fever_.

 _Child-birth_, the season of, requires due care after the labour pains
    are over, 533.
   Medical advice to women in labour, 534.
   Ill effects of collecting a number of women on such occasions, 535,
      _note_.
   How to guard against the miliary fever, 538.
   Symptoms of the puerperal fever, _ibid._
     Proper treatment of this fever, 539.
   General cautions for women at this season, 541, 542.

 _Children_, their diseases generally acute, and delay dangerous, 6.
   Their disorders less complicated, and easier cured, than those of
      adults, _ibid._
   Are often the heirs of the diseases of their parents, 7.
   Those born of diseased parents, require peculiar care in the nursing,
      8.
   Are often killed or deformed by injudicious clothing, _ibid._
   How treated in Africa, 11, _note_.
   The usual causes of deformity in, explained, _ibid._
   Their clothes ought to be fastened on with strings, 13.
   General rule for clothing them, 14.
   Cleanliness an important article in their dress, _ibid._
   The milk of the mother the most natural food for, 15.
   Absurdity of giving them drugs as their first food, 16.
   The best method of expelling the _meconium_, _ibid._
   How they ought to be weaned from the breast, 17.
   A crust of bread the best gum-stick for them, _ibid._
   How to prepare bread in their food, 18.
   Cautions as to giving them animal food, _ibid._
   Cautions as to the quantity of their food, _ibid._
   Errors in the quality of their food more frequent than in the
      quantity, 19.
   The food of adults improper for children, _ibid._
   Strong liquors expose them to inflammatory disorders, _ibid._
   Ill effects of unripe fruit, 20.
   Butter, 21.
   Honey, a wholesome article of food for them, _ibid._
   The importance of exercise to promote their growth and strength,
      _ibid._
   Rules for their exercise, 22.
   Poverty of parents occasions their neglect of children, 23.
   The utility of exercise demonstrated from the organical structure of
      children, 24.
   Philosophical arguments shewing the necessity of exercise, _ibid._
   Ought not to be sent to school too soon, 25.
   Nor be put too soon to labour, 28.
   Dancing an excellent exercise for them, 29.
   The cold bath, _ibid._
   Want of wholesome air destructive to children, 30.
   To wrap them up close in cradles, pernicious, 32.
   Are treated like plants in a hot-house, _ibid._
   The usual faulty conduct of nurses pointed out, 34.
   Are crammed with cordials by indolent nurses, 35.
   Eruptions ignorantly treated by nurses, _ibid._
   Loose stools, the proper treatment of, _ibid._
   Every method ought to be taken to make them strong and hardy, 37.
   Indications of the small-pox in, 214.

 _Chincough._ See _Cough_.

 _Cholera morbus_, the disorder defined, with its causes and symptoms,
    309.
   Medical treatment, 310.

 _Churches_, the several circumstances that render the air in,
    unwholesome, 76.

 _Churching of women_ after lying in, a dangerous custom, 542.

 _Church-yards_, the bad consequences of having them in large towns, 76.

 _Cities_, large, the air in, contaminated by various means, 76.
   The bad effects of burying the dead in, _ibid._
   Houses ought to be ventilated daily, 77.
   The danger attending small apartments, 78.
   All who can ought to sleep in the country, _ibid._
   Disorders that large towns are peculiarly hurtful to, 79.
   Cleanliness not sufficiently attended to in, 101.
   Should be supplied with plenty of water, 105, _note_.
   The best means to guard against infection in, 109.

 _Clare_, Mr. his method of applying saline preparations of mercury in
    venereal cases, 512.

 _Cleanliness_, an important article of attention in the dress of
    children, 14;
     and to sedentary artists, 52.
   Finery in dress often covers dirt, 93.
   Is necessary to health, 100.
   Disorders originating from the want of, _ibid._
   Is not sufficiently attended to in large towns, 101.
   Nor by country peasants, 102.
   Great attention paid to, by the ancient Romans, _ibid._ _note_.
   Necessity of consulting cleanliness in camps, 103.
   Was the principal object of the whole system of the Jewish laws,
      _ibid._
   Is a great part of the religion of the Eastern countries, _ibid._
   Bathing and washing greatly conducive to health, 104.
   Cleanliness peculiarly necessary on board of ships, _ibid._
     and to the sick, _ibid._
   General remarks on, 105.
   Many disorders may be cured by cleanliness alone, 140.
   The want of, a very general cause of putrid fevers, 196.
   Is a great preservative against venereal infection, 517;
     and against galling in infants, 550.

 _Clergy_, exhorted to remove popular prejudices against inoculation,
    231.
   Might do great good by undertaking the practice of it themselves,
      236.

 _Clothing_, the only natural use of, 9.
   That of children, has become a secret art, 10.
   Ought to be fastened on infants with strings instead of pins, 13.
   Pernicious consequences of stays, 14.
   Importance of cleanliness to children, _ibid._
   The due quantity of, dictated by the climate, 94.
   Should be increased in the decline of life, _ibid._ and adapted to
      the seasons, _ibid._
   Is often hurtful by being made subservient to the purposes of vanity,
      91.
   Pernicious consequences of attempting to mend the shape by dress,
      _ibid._
   Stays, _ibid._
   Shoes, _ibid._
   Garters, buckles, and other bandages, 92.
   The perfection of, to be easy and clean, 93.
   General remarks on, _ibid._
   Wet, the danger of, and how to guard against it, 127.

 _Clysters_, a proper form of, for an inflammation of the stomach, 291.
   And for an inflammation of the intestines, 293.
   Of tobacco smoke, its efficacy in procuring a stool, 300, _note_.
   Of chicken broth salutary in the _cholera morbus_, 310.
   Their use in a suppression of urine, 323.
   Ought to be frequently administered in the puerperal fever, 539.
   Of tobacco, to excite a vomit, 606.
   Of tobacco fumes, to stimulate the intestines, 610.
   The general intention of, 660.
   Preparation of the emollient clyster, 661.
     Laxative clyster, _ibid._
     Carminative clyster, _ibid._
     Oily clyster, _ibid._
     Starch clyster, 662.
     Turpentine clyster, _ibid._
     Vinegar clyster, _ibid._

 _Cœliac passion_, proper treatment for, 351.

 _Coffee berries_ recommended in the stone, 328.

 _Cold_, extreme, its effects on the human frame, 616.
   The sudden application of heat dangerous in such cases, _ibid._
   How to recover frozen or benumbed limbs, 617.

 _Cold Bath._ See _Bath_.

 _Colds_, frequently occasioned by imprudent changes of clothes at the
    first approaches of summer, 90, _note_.
   Various causes of, specified, 126.
   Their general causes, 276.
   Proper regimen on the symptoms of, appearing, _ibid._
   Danger of neglecting the disorder, 278.
   The chief secret for avoiding, 280.

 Colic, different species of, 296.
   Medical treatment of, according to their species and causes, 297.
   Bilious colic, 298.
   Hysteric colic, 299.
   Nervous colic, _ibid._
   Cautions necessary to guard against the nervous colic, 300.
   General advice in colics, 301.

 _Collyria_. See _Eye-waters_.

 _Commerce_ often imports infectious disorders, 107.
   Means suggested to guard against this danger, 108, _note_.

 _Confections_ often very needlessly compounded, 663.
   Preparation of the Japonic confection, 664.

 _Conserves_ and _preserves_, general remarks on, and their composition,
    664.
   Of red roses, _ibid._
   Of sloes, 665.
   Candied orange-peel, _ibid._

 _Constitution_, good or bad, the foundation of, generally laid during
    infancy, 1.

 _Consumptions_, the increase of this disorder may be attributed to hard
    drinking, 97.
   Who most liable to, and its causes, 174.
   Symptoms, 176.
   Regimen, 177.
   Riding, _ibid._
   Much benefit to be expected from going a long voyage, 178.
   Travelling, _ibid._
   Diet, 179.
   Great efficacy of milk in, _ibid._
   Medical treatment, 182.

 —— Nervous, defined, and the persons most liable to, 186.
   Proper treatment of, _ibid._

 —— Symptomatic, the treatment of, must be directed to the producing
    cause, 187.

 _Convulsions_, why new-born infants are so liable to, 12.
   Those preceding the eruption in the small-pox favourable symptoms,
      217.
   The general causes of, 565.
   Proper treatment of, 566.
   Extraordinary recovery of an infant seemingly killed by, 629.
   Farther instructions in like cases, 630.

 _Cook_, Captain, the circumnavigator, his means of preserving the
    health of his men, 46, _note_.

 _Cookery_, the arts of, render many things unwholesome, that are not
    naturally so, 67.

 _Cordials_, ought not to be given to infants, 16.
   Are the common refuge of nurses who neglect their duty to children,
      35.
   Are often fatal in an inflammation of the stomach, 290.
   When good in the colic, 297.
   Ought not to be given to a pregnant woman during labour, 534.

 _Corn_, damaged, will produce the putrid fever, 195.

 _Corns_ in the feet are occasioned by wearing tight shoes, 91.

 _Cortex._ See _Bark_.

 _Costiveness_, a frequent recourse to medicines for the prevention of,
    injurious to the constitution, 122.
   Is rather to be removed by diet than by drugs, 123.
   Its general causes, and ill effects, 414.
   Regimen, _ibid._
   Remedies for, 416.

 _Cough_, the proper remedies for, 280.
   A plaster of Burgundy pitch laid between the shoulders an excellent
      remedy for, 281.
   The stomach cough, and cough of the lungs, distinguished, 282.
   Treatment for the nervous cough, 283.

 _Cough_, hooping, who most liable to, with its disposing causes, 284.
   Remedies, 285.
   Is infectious, _ibid._
   Vomits, their use, and how to administer them to children, 286.
   Garlic ointment a good remedy for, 287.

 _Cough_, phthisical, incident to sedentary artificers, from their
    breathing confined air, 49.

 _Cradles_, on many accounts hurtful to children, 32.

 _Cramp_, proper remedies for, 451.

 _Cramp of the stomach_, who most subject to, 438.
   Medical treatment of, _ibid._

 _Crotchets_, how to use for extracting substances detained in the
    gullet, 603.

 _Croup in children_, described, 557.
   Its symptoms and proper treatment, _ibid._

 _Cyder_, the ill consequences of making it too weak, 69.


                                   D.

 _Dancing_, an excellent kind of exercise for young persons, 29.

 _Daucus sylvestris._ See _Carrot_.

 _Deafness_, when a favourable symptom in the putrid fever, 198, _note_.
   Methods of cure, according to its causes, 461.

 _Death_, the evidences of, sometimes fallacious, and ought not to be
    too soon credited, 601. 608. 612. 631.
   The means to be used for the recovery of persons from, nearly the
      same in all cases, 632.

 _Decoctions_, general remarks on, 665.
   Preparation of the decoction of althæa, _ibid._
   Common decoction, 666.
   Of logwood, _ibid._
   Of bark, _ibid._
   Compound decoction of bark, _ibid._
   Of sarsaparilla, 667.
   Of seneka, _ibid._
   White decoction, _ibid._

 _Deformity_, often occasioned by the injudicious manner of dressing
    children, 9.
   Is seldom found among savage nations, 10.
   The usual causes of, explained, _ibid._

 _Dews_, night, dangerous to health, 128.

 _Diabetes_, who most liable to this disorder, 319.
   Its causes and symptoms, _ibid._
   Regimen, and medical treatment, 320.
   Distinguished from incontinency of urine, 322.

 _Diarrhœa._ See _Looseness_.

 _Diet_, will often answer all the indications of cure in diseases, 138.
   Illustrations, 139.
   See _Aliment_.

 _Digestion_, the powers of, equally impaired by repletion or inanition,
    72.

 _Diseases_, hereditary, cautions to persons afflicted with, 8.
   Peculiar disorders attending particular occupations, 38.
   Many of them infectious, 106.
   The knowledge of, depends more upon experience and observation than
      upon scientifical principles, 135.
   Are to be distinguished by the most obvious and permanent symptoms,
      _ibid._
   The differences of sex, age, and constitution, to be considered, 136.
   Of the mind, to be distinguished from those of the body, _ibid._
   Climate, situation, and occupation, to be attended to, 137.
   Other collateral circumstances, _ibid._
   Many indications of cure, to be answered by diet alone, 138.
   Cures often effected by fresh air, by exercise, or by cleanliness,
      139.
   Nervous diseases, of a complicated nature, and difficult to cure,
      420.

 _Dislocations_, should be reduced before the swelling and inflammation
    come on, and how, 587.
   Of the jaw, 588.
   Of the neck, 589.
   Of the ribs, 590.
   Of the shoulder, _ibid._
   Of the elbow, 591.
   Of the thigh, 592.
   Of the knees, ancles, and toes, _ibid._

 _Diuretic infusion for the Dropsy_, how to prepare, 377, 378.

 _Dog_, symptoms of madness in, 477.
   Ought to be carefully preserved after biting any person, to ascertain
      whether he is mad or not, 478.
   Is often reputed mad when he is not so, _ibid._
   Symptoms of the bite of a mad dog, 479.
   The poison cannot lie many years dormant in the body, as is supposed,
      _ibid._
   Dr. Mead’s receipt for the bite, 480.
   The famous East Indian specific for, _ibid._
   Other recipes, 481.
   Vinegar of considerable service in this disorder, _ibid._
   Medical course of treatment recommended, _ibid._
   Regimen, 481.
   Dipping in the sea not to be relied on, 483.
   Dr. Tissot’s medical course for the cure of the hydrophobia, 484.
   Remarks on the Ormskirk medicine, 485, _note_.

 _Doses_ of medicines, the relative proportions of, for different ages,
    653.

 _Drams_ ought to be avoided by persons afflicted with nervous
    disorders, 423.

 _Draught_, is the proper form for such medicines as are intended for
    immediate operation, 668.
   How to prepare the anodyne draught, _ibid._
   Diuretic draught, _ibid._
   Purging draught, _ibid._
   Sweating draught, 669.
   Vomiting draught, _ibid._

 _Dress._ See _Clothing_.

 _Drinking_, persons who are seldom intoxicated may nevertheless injure
    their constitutions by, 97.
   The habit of drinking frequently originates from misfortunes, 98.
   Frequently destroys the powers of the mind, 99.
   Persons often forced to it by mistaken hospitality, _ibid._ _note_.
   Leads to other vices, _ibid._

 _Dropsy_, the several distinctions of, with its causes, 374.
   Symptoms, 375.
   Regimen, 376.
   Medical treatment, 377.
   Tapping, a safe and simple operation, 379.

 _Dropsy of the brain._ See _Water in the head_.

 _Drowned persons_, ought not to be rashly given up for dead, 608.
   Proper trials for the recovery of, _ibid._
   Endeavours ought not to be suspended upon the first returns of life,
      612.
   Success of the Amsterdam society for the recovery of, 631.

 _Drunkenness._ See _Intoxication_.

 _Dumb persons_ may be taught to read, write, and discourse, 461,
    _note_.

 _Dysentery_, where and when most prevalent, 345.
   Its causes and symptoms, _ibid._
   Regimen, 346.
   Fruit, one of the best remedies for, 348.
   Proper drink for, 349.
   Medical treatment, _ibid._
   Cautions to prevent a relapse, 350.


                                   E.

 _Ear_, the several injuries it is liable to, 460.
   Deafness, medical treatment of, according to its causes, 461.
   Ought not to be tampered with, 462.

 _Ear-ach_, its causes, and proper treatment for, 360.
   How to drive insects out of, _ibid._

 _Education of children_, should be begun at home by the parents, 25,
    _note_.
   That of girls hurtful to their constitution, 27.

 _Effluvia_, putrid, will occasion the spotted fever, 195.

 _Electricity_ beneficial in the palsy, 431.

 _Electuaries_, general rules for making, 669.
   Preparation of lenitive electuary, 670.
   Electuary for the dysentery, _ibid._
   For the epilepsy, _ibid._
   For the gonorrhœa, _ibid._
   Of the bark, 671.
   For the piles, _ibid._
   For the palsy, _ibid._
   For the rheumatism, _ibid._

 _Elixir_, paregoric, how to prepare, 698.
   Sacred elixir, _ibid._
   Stomachic elixir, _ibid._
   Acid elixir of vitriol, 699.

 _Emulsions_, their uses, 672.
   Preparation of the common emulsion, _ibid._
   Arabic emulsion, _ibid._
   Camphorated emulsion, _ibid._
   Emulsion of gum ammoniac, _ibid._
   Oily emulsion, 673.

 _Engleman_, Dr. his account of the German method of recovering persons
    from fainting fits, 622.

 _Entrails._ See _Intestines_.

 _Epilepsy_, the disorder defined, 432.
   Its causes and symptoms, 433.
   Due regimen, 434.
   Medical treatment, _ibid._

 _Eruption_ in children often free them from bad humours, but are
    mistaken and ill-treated by nurses, 35.
   Ought never to be stopped without proper advice, 36.
   In fevers, how to be treated, 193. 201. 207. 209.
   In the small-pox, 217. 221.
   In children, the causes of, 551.
   How to cure, 554.

 _Erysipelas_, a disorder incident to the laborious, 41.
   Its causes explained, and who most subject to it, 249.
   Its symptoms, _ibid._
   Regimen, 250.
   Medical treatment, 253.
   The scorbutic erysipelas, 253.
   Instructions for those who are subject to this disorder, _ibid._

 _Evacuations_ of the human body, the principal, specified, 121.
   By stool, _ibid._
   Urine, 123.
   Perspiration, 125.

 _Exercise_, the importance of, to promote the growth and strength of
    children, 21.
   All young animals exert their organs of motion as soon as they are
      able, 22.
   The utility of, proved from anatomical considerations, 24.
   And from philosophical deductions, _ibid._
   Military exercise recommended for boys, 26.
   Benefits of dancing, 29.
   Is better for sedentary persons under lowness of spirits than the
      tavern, 52.
   Gardening the best exercise for the sedentary, 53.
   Violent, ought not to be taken immediately after a full meal, 61.
   Is as necessary as food for the preservation of health, 81.
   Our love of activity, an evidence of its utility, 82.
   Indolence relaxes the solids, _ibid._
   The indulgence of carriages as absurd as pernicious, _ibid._
   Is almost the only cure for glandular obstructions, 83.
   Will prevent and remove those disorders that medicine can not cure,
      _ibid._
   Is the best cure for complaints in the stomach, 84.
   How to be taken within doors, when not to be done in the open air,
      85.
   Active sports better than sedentary amusements, _ibid._
   The golf, a better exercise than cricket, _ibid._ _note_.
   Exercise should not be extended to fatigue, 86.
   Is as necessary for the mind as for the body, 118.
   Is often of more efficacy than any medicine whatever, 139.
   The best mode of taking it in a consumption, 177.
   Is of the greatest importance in a dropsy, 376.
   Muscular, for the gout, 385.
   Is necessary for the asthmatic, 408.
   Is superior to all medicine in nervous disorders, 423.
   And in the palsy, 432.
   Is proper for pregnant women, unless they are of a very delicate
      texture, 533.
   Want of, the occasion of rickets in children, 563.

 _Extracts_, general rules for making; but are more conveniently
    purchased ready made, 673.

 _Eyes_, inflammation of, its general causes, 258.
   Symptoms, 259.
   Medical treatment, 260.
   How to be treated when it proceeds from a scrophulous habit, 263.
   Advice to those who are subject to this complaint, 264.
   Are subject to many diseases which are difficult to cure, 456.
   The means by which they are frequently injured, 457.
   General means of prevention, _ibid._
   The several disorders of, with their medical treatment, 458.

 _Eye-waters_, general remarks on, and their principal intentions, 662.
   Collyrium of alum, 663.
   Vitriolic collyrium, _ibid._
   Collyrium of lead, _ibid._


                                   F.

 _Fainting fits_, how to cure, 441. 618.
   Cautions to persons subject to them, 623.

 _Falling sickness._ See _Epilepsy_.

 _Fasting_, long, injurious to those who labour hard, 43.
   Is hurtful both to old and young, 73.

 _Fathers_, culpably inattentive to the management of their children, 5.
   Their irregular lives often injure the constitution of their
      children, 7.

 _Fear_, the influence of, very great, in occasioning and aggravating
    diseases, 112.
   Its various operations, 113.

 _Feet_, injured by wearing tight shoes, 91.
   The washing of, an agreeable article of cleanliness, 104.
   Wet, the danger of, 127.
   Bathing them in warm water, a good remedy in a cold, 279.
   And in the hooping-cough, 288.

 _Fermentation_, the vapour of liquors in a state of, noxious, 614.

 _Fevers_, of a bad kind, often occasioned among labourers by poor
    living, 43.
   Frequently attack sedentary persons after hard drinking, 52.
   Nervous, often the consequence of intense study, 57.
   Putrid and malignant, often occasioned by want of cleanliness, 100.
   The most general causes of, enumerated, 140.
   The distinguishing symptoms of, 141.
   The several species of, _ibid._
   Is an effort of nature, which ought to be assisted, 142.
   How this is to be done, 143.
   Cordials and sweetmeats improper in, 144.
   Fresh air of great importance in, 145.
   The mind of the patient ought not to be alarmed with religious
      terrors, _ibid._
   Cautions as to bleeding and sweating in, 146.
   Longings, the calls of nature, and deserve attention, _ibid._
   Cautions to prevent a relapse, 147.

 _Fever_, acute continual, who most liable to, 157.
   Causes, _ibid._
   Symptoms, 158.
   Regimen, _ibid._
   Medical treatment, 161.
   Symptoms favourable and unfavourable, _ibid._
   Regimen to be observed during recovery, 162.

 _Fever_, bilious, general time of its appearance, 247.
   Proper treatment of, according to its symptoms, 248.

 _Fever_, intermitting. See _Ague_.

 _Fever_, miliary, from what the name derived, and its general
    appearances, 205.
   Who most liable to it, _ibid._
   Causes, _ibid._
   Symptoms, 206.
   Regimen, 207.
   Account of a miliary fever at Strasburg, 208, _note_.
   Proper medical treatment, 209.
   Cautions for avoiding this disorder, 210.
   How to prevent, in child-bed-women, 538.

 _Fever_, milk, how occasioned, 537.
   How to prevent, 541.

 _Fever_, nervous, why more common now than formerly, and who most
    liable to it, 188.
   Its causes, _ibid._
   Symptoms and proper regimen, 189.
   Medical treatment, 191.

 _Fever_, puerperal, or child-bed, the time of its attack, and symptoms,
    538.
   Medical treatment of, 539.
   Cautions for the prevention of this fever, 541.

 _Fever_, putrid, is of a pestilential nature, and who most liable to
    it, 195.
   Its general causes, _ibid._
   Symptoms of, 196.
   Other fevers may be converted to this, by improper treatment, 197.
   Favourable and unfavourable symptoms of, _ibid._
   Regimen, 198.
   Medical treatment, 201.
   Cautions for the prevention of this disorder, 203.

 _Fever_, remitting, derivation of its name, 210.
   Its causes and symptoms, 211.
   Proper regimen, 212.
   Medical treatment, 213.
   Cautions for avoiding this fever, _ibid._

 _Fever_, scarlet, why so named, and its usual season of attack, 245.
   Proper treatment of, 246.
   Is sometimes attended with putrid and malignant symptoms, _ibid._
   Medicines adapted to this stage of the malady, _ibid._
   History of a fever of this kind at Edinburgh, 247, _note_.

 _Fever_, secondary, in the small-pox, proper treatment of, 224.

 _Flatulencies_ in the stomach, remedies against, 363.
   The several causes of, 443.
   Medical treatment of, 444.

 _Flatulent colic_, its causes, and seat of the disorder, 296.
   Remedies for, _ibid._

 _Flower-de-luce_, the yellow water, the root of, recommended for the
    tooth-ach, 358.

 _Fluor albus_ described, with its proper treatment, 529.

 _Fomentations_, how to make and apply, 673.
   General intentions of, _ibid._
   Anodyne fomentation, 674.
   Aromatic fomentation, _ibid._
   Common fomentation, _ibid._
   Emollient fomentation, _ibid._
   Strengthening fomentation, 675.

 _Food._ See _Aliment_.

 _Forgiveness of injuries_, ought to be practised from a regard to our
    own health, 112.

 _Fractures._ See _Bones_, broken.

 _Frozen limbs_, how to recover, 617.

 _Fruit_, unripe, very hurtful to children, 20.
   One of the best medicines, both for the prevention and cure of a
      dysentery, 348.

 _Funerals_, the great number of visitors attending them, dangerous to
    their health, 107.


                                   G.

 _Galling_, in infants, the cause and cure of, 550.

 _Gangrene_, proper treatment of, 574.

 _Gardening_, a wholesome amusement for sedentary persons, 52.

 _Gargles for the throat_, how to make, 267. 270. 274.
   General intentions of, 675.
   Method of making the attenuating gargle, _ibid._
   Common gargle, _ibid._
   Detergent gargle, _ibid._
   Emollient gargle, _ibid._
   For the mouth of infants in the thrush, 548.

 _Garlic ointment_, a North British remedy for the hooping-cough, how to
    apply it, 287.

 _Generals of armies_, how they ought to consult the health of the men
    they command, 44.

 _Gilders._ See _Miners_.

 _Ginger_, syrup of, how to prepare, 694.

 _Girls_, the common mode of education prejudicial to their
    constitution, 27.
   Means of rectifying it recommended, _ibid._

 _Gleet_, how occasioned, and its symptoms, 500.
   Method of cure, _ibid._
   Regimen, 501.
   Obstinate gleets cured by mercurial inunctions, 502.
   How to apply bougies, _ibid._

 _Glover_, Mr. his course of treatment for the recovery of a hanged man,
    628.

 _Gonorrhœa_, virulent, the nature of, and its symptoms, 491.
   Regimen, 492.
   Medical treatment, 493.
   Is often cured by astringent injections, _ibid._
   Cooling purges always proper in, 494.
   Mercury seldom necessary in a gonorrhœa, 496.
     How to administer it when needful, 497.

 _Goulard_, M. preparation of his celebrated extract of Saturn, 700.
   His various applications of it, _ibid._

 _Gout_, the general causes of, 55.
   How to treat a looseness occasioned by repelling it from the
      extremities, 313.
   The sources of this disorder, and its symptoms, 380, 381.
   Regimen for, 382.
   Wool the best external application in, 383.
   Why there are so many nostrums for, 384.
   Proper medicines after the fit, _ibid._
   Proper regimen in the intervals between fits to keep off their
      return, 385.
   How to remove it from the nobler parts to the extremities, 386.
   General cautions to prevent danger by mistaking it for other
      disorders, 387.

 _Gravel_, how formed in the bladder, 125.
   How distinguished from the stone, 324.
   Causes and symptoms, _ibid._
   Regimen, 325.
   Medical treatment, 326.

 _Green-sickness_ originates in indolence, 523.

 _Grief_, its effects permanent, and often fatal, 116.
   Danger of the mind dwelling long upon one subject, especially if of a
      disagreeable nature, 117.
   The mind requires exercise as well as the body, 118.
   Innocent amusements not to be neglected, _ibid._
   Is productive of nervous diseases, 421.

 _Gripes in infants_, proper treatment of, 549.

 _Guaiacum_, gum, a good remedy for the quinsey, 268;
   and rheumatism, 390.

 _Gullet_, how to remove substances detained in, 603.
   Cautions for the use of crotchets with this intention, _ibid._
   Other mechanical expedients, 604.
   Treatment if the obstruction cannot be removed, 607.

 _Gums of children_, applications to, during teething, and how to cut
    them, 561.

 _Gutta serena_, proper treatment of, 458.


                                   H.

 _Hæmoptoe_, spitting of blood. See _Blood_.

 _Hæmorrhages._ See _Blood_.

 _Harrowgate water_, an excellent medicine for expelling worms, 368.
   And for the jaundice, 373.
   In the scurvy, 391.

 _Head-ach_, the species of, distinguished, 352.
   Causes of, 353.
   Regimen, 354.
   Medical treatment, 355.

 _Health of the people in general_, a proper object of attention for the
    magistrates, xi.
   Ought to be attended to in matrimonial contracts, 8.
   Is often laboured for after it is destroyed, 61.
   Rules given by Celsus for the preservation of, 134.

 _Heart-burn_, the nature of this disorder, with its causes, and
    remedies for, 418.

 _Heat_, extreme, how to recover persons overcome by, 618.

 _Hemlock_, a good remedy in the King’s evil, 402.
   Is recommended by Dr. Stork for the cure of cancers, 469.

 _Hemp-seed_, a decoction of, good in the jaundice, and how to prepare
    it, 373.

 _Hiccup_, its causes, and method of treatment, 436.

 _Hoffman_, his rules for guarding child-bed women against the miliary
    fever, 538.

 _Honey_, a wholesome article of food for children, 21.
   Is recommended in the stone, 328.

 _Hooping-cough._ See _Cough_.

 _Hospitals_, the want of fresh air in, more dangerous to the patients
    than their disorders, 81.
   Cleanliness peculiarly necessary in, 105.
   Often spread infection by being situated in the middle of populous
      towns, 108.
   How they might be rendered proper receptacles for the sick, 110.
   Particularly in infectious disorders, 111.
   The sick in, ought not to be crowded together, 219, _note_.

 _Horse-radish_, the chewing of, will restore sensibility to the organs
    of taste when injured, 465.

 _Houses_, instead of contrivances to make them close and warm, ought to
    be regularly ventilated, 78.
   In marshy situations unwholesome, 80.
   Ought to be built in a dry situation, 130.
   Danger of inhabiting new-built houses before thoroughly dry, _ibid._
   Are often rendered damp by unseasonable cleanliness, _ibid._
   Are dangerous when kept too close and hot, 133.

 _Husbandmen_, the peculiar disorders they are exposed to, from the
    vicissitudes of the weather, 40.

 _Huxham_, Dr. recommends the study of the dietetic part of medicine,
    xiii.

 _Hydrocephalus._ See _Dropsy_.

 _Hydrophobia_, Dr. Tissot’s method of curing, 484.

 _Hydrops pectoris._ See _Dropsy_.

 _Hypochondriac affections_, frequently produced by intense study, 58.
   Their causes, and who most subject to them, 452.
   The general intentions of cure, _ibid._
   Regimen, 454.

 _Hysterics_, a disorder produced by the habitual use of tea, 66.
   General causes of, 447.
   Symptoms, 448.
   Proper treatment of, _ibid._
   Regimen, 449.
   Medicines adapted to, 450.

 _Hysteric colic_, symptoms and treatment of, 299.


                                   J.

 _Jails_, why malignant fevers are often generated in them, 77.
   Often spread infection by being situated in the middle of populous
      towns, 108.
   Ought to be removed, 110.

 _Janin_, M. his relation of the recovery of an overlaid infant, 627.
   And of a man who had hanged himself, 628.

 _Jaundice_, the different stages of its appearance, with the causes of
    this disorder, 370, 371.
   Symptoms and regimen, 371.
   Medical treatment, 372.

 _Jesuits Bark._ See _Bark_.

 _Jews_, the whole system of their laws tending to promote cleanliness,
    103. 107.

 _Iliac passion_, a particular kind of inflammation of the intestines,
    292.

 _Imposthume in the breast_, in consumptions, how to make it break
    inwardly, when not to be discharged by other means, 185.
   Imposthumes after the small-pox, proper treatment of, 227.

 _Incontinency of urine_, distinguished from a diabetes, 322.
   Expedient for relief, _ibid._

 _Indigestion_, is one consequence of intense study, 56.
   General causes, and remedies for, 416.

 _Indolence_, its bad effects on the constitution, 82.
   Occasions glandular obstructions, 83.
   Ill consequences of too much indulgence in bed, 84.
   Is the parent of vice, 86.
   Is the general cause of most nervous disorders, 455.

 _Infancy_, the foundation of a good or bad constitution, generally laid
    in this season of life, 1.

 _Infants_, nearly one half of those born in Great Britain die under
    twelve years of age, 1.
   Perish mostly by art, 2.
   Ought not
   to be suckled by delicate women, 3.
   Importance of their being nursed by their mothers, 4.
   Often lose their lives, or become deformed, by errors in clothing
      them, 9.
   How the art of bandaging them became the province of the midwife, 10.
   How treated in Africa, 11, _note_.
   Philosophical observations on their organical structure, and on the
      causes of deformity, _ibid._
   Why they so frequently die of convulsions, 12.
   Why exposed to fevers, 13.
   And colds, 14.
   Rules for their dress, _ibid._
   Their food, 15.
   Reflections on the many evils they are exposed to, 544.
   Why their first disorders are in their bowels, _ibid._
   How to cleanse their bowels, 545.
   The meconium, 546.
   Thrush, 547.
   Acidities, 548.
   Gripes, 549.
   Galling and excoriations, 550.
   Stoppage of the nose, _ibid._
   Vomiting, 551.
   Looseness, 552.
   Eruptions, 553.
   Scabbed heads, 555.
   Chilblains, 556.
   The croup, 557.
   Teething, 559.
   Rickets, 562.
   Convulsions, 565.
   Water in the head, 567.
   How to recover infants seemingly dead, 622.
   Ought never to sleep in the same bed with their mothers or nurses,
      626, _note_.
   Case of the recovery of an overlaid infant, 627.
   Case of an infant seemingly killed by a strong convulsion fit, and
      recovered, 629.
   See _Children_.

 _Infection_, the danger of, incurred by injudicious or unnecessary
    attendance on the sick, 106.
   And on funerals, 107.
   Is often communicated by clothes, _ibid._
   Is frequently imported, 108.
   Is spread by hospitals and jails being situated in the middle of
      populous towns, _ibid._
   How to prevent infection in sick chambers, 109.
   Physicians liable to spread infection, _ibid._ _note_.
   In what respects the spreading of infection might be checked by the
      magistrate, 110.
   Bleeding and purging increase the danger of, by debilitating the
      body, 204.
   Small-pox, 214.
   Of the small-pox may be received again, 218, _note_.

 _Inflammations_, how the laborious part of mankind expose themselves
    to, 42.
   Proper treatment of, 574.

 _Inflammation_ of the bladder. See _Bladder_.

 —— of the brain. See _Brain_.

 —— of the eyes. See _Eyes_.

 —— of the intestines. See _Intestines_.

 —— of the kidneys. See _Kidneys_.

 —— of the liver. See _Liver_.

 —— of the lungs. See _Peripneumony_.

 —— of the stomach. See _Stomach_.

 —— of the throat. See _Quinsey_.

 —— of the womb. See _Womb_.

 _Infusions_, advantages of, over decoctions, 676.
   How to obtain rich infusions from weak vegetables, _ibid._
   Preparation of the bitter infusion, _ibid._
   Infusion of the bark, _ibid._
   Infusion of carduus, 677.
   Of linseed, _ibid._
   Of roses, _ibid._
   Of tamarinds, and senna, _ibid._
   Spanish infusion, 678.
   For the palsy, _ibid._

 _Inns_, the great danger of meeting with damp beds in them, 128.
   The sheets in, how treated to save washing, 129.

 _Inoculation_ of the small-pox, more favourably received here than in
    neighbouring countries, 227.
   Cannot prove of general utility while kept in the hands of a few,
      228.
   No mystery in the process, _ibid._
   May safely be performed by parents or nurses, 229.
   Various methods of doing it, _ibid._
   The clergy exhorted to remove the prejudices against the operation,
      231.
   Arguments cited from Dr. Mackenzie in favour of inoculation, _ibid._
      _note_.
   Ought to be rendered universal, 233.
   Means of extending the practice of, 234.
   Two obstacles to the progress of, stated, 235.
   Might be performed by clergymen, or by parents themselves, 236.
   The proper seasons and age for performing it, 239.
   Will often mend the habit of body, _ibid._
   Necessary preparation and regimen for, _ibid._

 _Insects_, when they creep into the ear, how to force them out, 361.
   Poisonous, the bites of, how to be treated, 486.

 _Intemperance_, one great cause of the diseases of seamen, 45.
   The danger of, argued from the constructions of the human body, 94.
   The analogy in the nourishment of plants and animals, _ibid._
   Is the abuse of natural passions, _ibid._
   In diet, 95.
   In liquor and carnal pleasures, _ibid._
   The bad consequences of, involve whole families, 96.
   Effects of drunkenness on the constitution, _ibid._
   Persons who seldom get drunk, may nevertheless injure their
      constitutions by drink, 97.
   The habit of drinking frequently acquired under misfortunes, 98.
   Is peculiarly hurtful to young persons, 99.
   Leads to all other vices, _ibid._

 _Intermitting fever._ See _Ague_.

 _Intestines_, inflammation of, general causes from whence it proceeds,
    291.
   The symptoms, regimen, and medical treatment, 292.
   Cautions to guard against it, 295.

 _Intoxication_ produces a fever, 96.
   Fatal consequences of a daily repetition of this vice, _ibid._
   Persons who seldom get drunk, may nevertheless injure their
      constitution by drinking, _ibid._
   Getting drunk, a hazardous remedy for a cold, 277.
   Often produces fatal effects, 623.
   Proper cautions for treating persons in liquor, 624.
   The safest drink after a debauch, _ibid._
   Remarkable case, 625.

 _Johnson_, Dr. extraordinary recovery of an infant seemingly killed by
    a strong convulsion fit, related by, 629.

 _Issues_, how to make them take the best effect, 430.

 _Itch_, the nature and symptoms of this disease described, 403.
   Sulphur, the best remedy against, _ibid._
   Great danger of the injudicious use of mercurial preparations for,
      405.
   Cleanliness the best preservative against, 406, _note_.

 _Juleps_, the form of, explained, 678.
   Preparation of the camphorated julep, _ibid._
   Cordial julep, 679.
   Expectorating julep, _ibid._
   Musk julep, _ibid._
   Saline julep, _ibid._
   Vomiting julep, _ibid._


                                   K.

 _Kermes mineral_, recommended by Dr. Duplanil for the hooping cough,
    287, _note_.

 _Kidneys_, inflammation of, its general causes, 301.
   Its symptoms and proper regimen, 302.
   Medical treatment, 305.
   Where it proceeds from the stone and gravel, _ibid._
   Cautions for those subject to this disorder, _ibid._ See _Gravel_.

 _King’s evil._ See _Scrophula_.


                                   L.

 _Laborious employments_, the peculiar disorders incident to, 40.
   The folly of men emulating each other in trials of strength, 41.
   Disadvantages attending their diet, _ibid._
   How they expose themselves to inflammations, 42.
   Danger of sleeping in the sun, _ibid._
   Long fasting hurtful to them, _ibid._
   Injuries arising from poor living, 43.
   Many of the diseases of labourers, not only occasioned, but
      aggravated, by poverty, _ibid._

 _Labour_ should not be imposed too early on children, 28.

 _Labour_ in child-bed, medical advice for, 534.
   Inconveniencies of collecting a number of women at, 535, _note_.

 _Laudanum_, its efficacy in fits of an ague, 149, _note_.
   How to be administered in a cholera morbus, 311.
   In a looseness, 313.
   In a diabetes, 321.
   When proper for the head-ach, 356.
   How to apply, for the tooth-ach, 358.
   Will ease pain in the gout, 384.
   How to administer for the cramp in the stomach, 438.
   Is good for flatulences, 444.
   Effects of an over-dose of, 470.
   Medical treatment in this case, 476.

 _Leading-strings_, injurious to young children, 23.

 _Leeches_, may be successfully applied to inflamed testicles, 503,
    _note_.
   And to disperse buboes, 505, _note_.
   Are proper to apply to children where inflammations appear in
      teething, 560.
   Objections to bleeding with them, 572.

 _Lemons._ See _Oranges_.

 _Leprosy_, why less frequent in this country now than formerly, 398.
   Requires the same treatment as the scurvy, _ibid._

 _Lientery_, proper treatment for, 351.

 _Life_ may frequently be restored, when the appearances of it are
    suspended by sudden casualties, 601. 608. 613. 631.

 _Lightning_, persons apparently killed by, might possibly be recovered
    by the use of proper means, 631.

 _Lime-water_ recommended to prevent gravel in the kidneys from
    degenerating to the stone in the bladder, 326.
   Is a good remedy for worms, 368.
   Happy effects of, in the cure of obstinate ulcers, 585.

 _Lind_, Dr. his prescription to abate fits of an ague, 149, _note_.
   His directions for the treatment of patients under putrid remitting
      fevers, 212, _note_.

 _Liniment_ for burns, preparation of, 683.
   White liniment, 684.
   For the piles, _ibid._
   Volatile liniment, _ibid._

 _Liquors_, strong, expose children to inflammatory disorders, 19.
   Fermented, the qualities of, examined, 68.
   The bad consequences of making them too weak, 69.
   Why all families ought to prepare their own liquors, _ibid._
   Cold, the danger of drinking, when a person is hot, 131.

 _Liver_, schirrous, produced by sedentary employments, 56.

 _Liver_, inflammation of, its causes and symptoms, 306.
   Regimen and medical treatment, 307.
   Abscess in, how to be treated, 308.
   Cautions in the event of a schirrous being formed, _ibid._

 _Lobelia_, an American plant used by the natives in the venereal
    disease, 514.

 _Lochia_, a suppression of, how to be treated, 537.

 _Longings_, in diseases, are the calls of nature, and often point out
    what may be of real use, 146.

 _Looseness_, habitual, general directions for persons subject to, 122.
   Its general causes, 312.
   A periodical looseness ought never to be stopped, 313.
   Medical treatment of, according to its various causes, _ibid._
   Means of checking it when necessary, 314.
   In children, proper treatment of, 552.

 _Love_, why perhaps the strongest of all the passions, 119.
   Is not rapid in its progress, and may therefore be guarded against at
      its commencement, _ibid._
   To pretend to it for amusement, cruelty to the object, _ibid._
   Children often real martyrs between inclination and duty, 120,
      _note_.

 _Lues_, confirmed, symptoms of, 510.
   Mercury the only certain remedy known in Europe for this disease,
      511.
   Saline preparations of mercury more efficacious than the ointment,
      512.
   How to administer corrosive sublimate, _ibid._
   American method of curing this disease, 513.

 _Lungs_, injured by artists working in bending postures, 50.
   Studious persons liable to consumptions of, 56.

 _Luxury_, highly injurious to the organs of taste and smell, 463.


                                   M.

 _Mackenzie_, Dr. his arguments in favour of inoculating in the
    small-pox, 231, _note_.

 _Mad dog._ See _Dog_.

 _Magnesia alba_, a remedy for the heart-burn, 419.
   Is the best medicine in all cases of acidity, 549.

 _Magnets_, artificial, their reputed virtue in the tooth-ach, 359.

 _Malt_ liquors, hurtful in the asthma, 407.
   See _Beer_.

 _Man_, why inferior to brutes in the management of his young, 1.
   Was never intended to be idle, 87.

 _Manufactures_, the growth of, produced the rickets in children, 21.
   More favourable to riches than to health, 28.
   Some, injurious to health by confining artists in unwholesome air,
      37.
   Cautions to the workmen, 38.
   Compared with agriculture, 48.
   Are injurious to health from artists being crowded together, 49.
   And from their working in confined postures, _ibid._
   Cautions offered to sedentary artists, 50.
   Sedentary arts better suited to women than to men, 83, _note_.

 _Matrimony_ ought not to be contracted without a due attention to
    health and form, 8.

 _Mead_, Dr. his famous recipe for the bite of a mad dog, 480.
   His character as a physician, _ibid._ _note_.

 _Meals_ ought to be taken at regular times, 72.
   Reasons for this uniformity, _ibid._

 _Measles_, have great affinity with the small-pox, 240.
   Cause and symptoms, _ibid._
   Proper regimen and medicine, 242, 243.
   Inoculation of, might prove very salutary, 245, _note_.

 _Mechanics_ ought to employ their leisure hours in gardening, 54.

 _Meconium_, the best mode of expelling it, 16. 546.

 _Medicine_, the origin of the art of, xii.
   The operation of, doubtful at best, xiv.
   Is made a mystery of, by its professors, xxi.
   The study of, neglected by gentlemen, xxii.
   This ignorance lays men open to pretenders, xxiii.
   Ought to be generally understood, xxiv.
   A diffusion of the knowledge of, would destroy quackery, xxvii.
   Objections to the cultivation of medical knowledge answered, xxviii.
   The theory of, can never supply the want of experience and
      observation, 135.

 _Medicines_ have more virtue attributed to them than they deserve, 138.
   Ought not to be administered by the ignorant, nor without caution,
      140.
   Want of perseverance in the use of, one reason why chronic diseases
      are so seldom cured, 392.
   Many retained, which owe their reputation to credulity, 649.
   Are multiplied and compounded in proportion to ignorance of the
      causes and nature of diseases, _ibid._
   Disadvantages of compounded medicines, _ibid._
   Are often adulterated for the sake of colour, _ibid._
   The relative proportions of doses of, for different ages, 652.
   A list of such medical preparations as ought to be kept for private
      practice, 654.

 _Melancholy_, religious, its effects, 120.
   Leads to suicide, _ibid._
   Defined, with its causes, 426.
   Symptoms and regimen, 426, 427.
   Medicinal treatment, 428.

 _Menstrual_ discharge in women, the commencement and decline of, the
    most critical periods of their lives, 522.
   Confinement injurious to growing young women, 523;
     and tight lacing for a fine shape, 524.
   Symptoms of the first appearance of this discharge, 525.
   Objects of attention in regimen at this time, _ibid._
   Ought to be restored whenever unnaturally obstructed, and how, 526.
   When an obstruction proceeds from another malady, the first cause is
      to be removed, 527.
   Treatment under a redundancy of the discharge, 528.
   Regimen and medicine proper at the final decline of the menses, 529.

 _Mercury_, may be given in desperate cases of an inflammation of the
    intestines, 294.
   Cautions for administering it, _ibid._ _note_.
   Great caution necessary in using mercurial preparations for the itch,
      405.
   Is seldom necessary in a gonorrhœa, 496.
   How to administer it when needful in that disorder, 497.
   Solution of mercury, how to make, 498, _note_.
   Is the only certain remedy known in Europe for the cure of a
      confirmed lues, 511.
   Saline preparations of, more efficacious than the mercurial ointment,
      _ibid._
   How to administer corrosive sublimate in venereal cases, 512.
   Necessary cautions in the use of mercury, 515.
   Proper seasons for entering on a course of, 516.
   Preparations for, _ibid._
   Regimen under a course of, 517.

 _Mezereon_ root, a powerful assistant in venereal cases, 513.

 _Midwifery_, ought not to be allowed to be practiced by any woman not
    properly qualified, 534, _note_.

 _Midwives_, historical view of the profession, 9.
   How they became intrusted with the care of bandaging infants, with
      the ill effects of their attempts at dexterity in this office, 10.
   Instances of their rashness and officious ignorance, 540, _note_,
      544, _note_.

 _Miliary_ fever. See _Fever_.

 _Military_ exercise recommended for boys to practise, 26.

 _Milk_, that of the mother, the most natural food for an infant, 15.
   Cows milk, better unboiled than boiled, 18.
   Is a good antidote against the scurvy, 66.
   Of more value in consumptions than the whole _Materia Medica_, 179.
   Its great efficacy in the scurvy, 396.
   A milk diet proper both for men and women, in cases of barrenness,
      543.

 _Milk_ fever. See _Fever_.

 _Millipedes_, how to administer for the hooping-cough, 287.

 _Mind_, diseases of, to be distinguished from those of the body, 136.
   See _Passions_.

 _Miners_, exposed to injuries from unwholesome air, and mineral
    particles, 38.
   Cautions to, 39.

 _Mineral_ waters, the danger of drinking them in too large quantities,
    319.
   Are of considerable service in weaknesses of the stomach, 417.
   Cautions concerning the drinking of, 639–646.

 _Mixtures_, general remarks on this form of medicines, 680.
   Composition of the astringent mixture, _ibid._
   Diuretic mixture, _ibid._
   Laxative absorbent mixture, _ibid._
   Saline mixture, 681.
   Squill mixture, _ibid._

 _Molasses_, an intoxicating spirit much used by the common people at
    Edinburgh, 91.

 _Mothers_, preposterous, when they think it below them to nurse their
    own children, 2.
   Under what circumstances they may be really unfit to perform this
      task, _ibid._
   Importance of their suckling their own children, 3, _note_.
   Delicate mothers produce unhealthy short-lived children, 7.
   Their milk, the best food for children, 15.
   Ought to give their children proper exercise, 23;
     and air, 31.

 _Mouth_, cautions against putting pins or other dangerous articles
    into, 603.

 _Muscular_ exercise a cure for the gout, 385.

 _Mushrooms_, a dangerous article of food, as other funguses are often
    gathered instead of them, 488.

 _Music_, the performance of, recommended as a proper amusement for
    studious persons, 60.

 _Musk_, extraordinary effects produced by, under particular
    circumstances, in the nervous fever, 193.
   Is a good remedy in the epilepsy, 435.
     And for the hiccup, 437.
   Deafness cured by, 462.

 _Mustard_, white, a good remedy in the rheumatism, 391.


                                   N.

 _Natural_ history, the study of, necessary to the improvement of
    agriculture, xx.

 _Nervous_ diseases, the most complicated and difficult to cure of all
    others, 420.
   General causes of, _ibid._
   Symptoms of, 421.
   Regimen, 422.
   Medical treatment, 424.
   A cure only to be expected from regimen, 426.
   The several symptoms of, though differently named, all modifications
      of the same disease, 453.

 _Nervous_ colic, its causes and symptoms, 299.
   Medical treatment of, 300.

 _Nervous_ fever. See _Fever_.

 _Night-mare_, its causes and symptoms described, 439.
   Proper treatment of, 440.

 _Nightshade_, an infusion of, recommended in a cancer, 469.

 _Nitre_, purified, its good effects in a quinsey, 268.
   Is an efficacious remedy for the dropsy, 378.
   Promotes urine and perspiration, 429.

 _Nose_, ulcer in, how to cure, 464.
   Stoppage of, in children, how to cure, 551.
   See _Bleeding at_.

 _Nurses_, their superstitious prejudices in bathing of children, 30.
   The only certain evidence of a good one, 33.
   Their usual faults pointed out, 34.
   Administer cordials to remedy their neglect of duty toward children,
      35.
   Their mistaken treatment of eruptions, _ibid._
   And loose stools, _ibid._
   Are apt to conceal the disorders of children that arise from their
      own negligence, 36.
   Ought to be punished for the misfortunes they thus occasion, _ibid._
   Sensible, often able to discover diseases sooner than persons bred to
      physic, 135.
   Are liable to catch the small-pox again from those they nurse in that
      disorder, 218, _note_.

 _Nursery_ ought to be the largest and best aired room in a house, 31.


                                   O.

 _Oil_, an antidote to the injuries arising from working in mines or
    metals, 39.
   Sallad oil, the best application to the bite of a wasp or bee, 486.
   Camphorated, how to prepare, 684.

 _Oils_, essential, of vegetables, the proper menstruum for, 694.

 _Ointment_ for the itch, 403.
   Use of ointments when applied to wounds and sores, 681.
   Preparation of yellow basilicum, _ibid._
   Emollient ointment, 682.
   Eye ointments, _ibid._
   Issue ointment, _ibid._
   Ointment of lead, 683.
   Mercurial ointment, _ibid._
   Ointment of sulphur, _ibid._
   White ointment, _ibid._
   See _Liniment_.

 _Ophthalmia._ See _Eye_.

 _Opiates_, efficacious in a _cholera morbus_, 311.
   In a diabetes, 320.
   When proper for the head-ach, 356.
   Recommended for the tooth-ach, _ibid._
   Are delusive remedies in nervous diseases, 425.
   See _Laudanum_.

 _Orange_ and lemon-peel, how to candy, 665.
   How to preserve orange and lemon-juice in the form of syrup, 694.

 _Ormskirk_ medicine for the bite of a mad dog, remarks on, 485, _note_.

 _Oxycrate_, the most proper external application in a fracture, 596.

 _Oysters_ of great service in consumptions, 182, _note_.


                                   P.

 _Painters._ See _Miners_.

 _Palsy_, the nature of this disorder explained, with its causes, 430.
   Medical treatment, 431.

 _Paraphrenitis_, its symptoms and treatment, 170.

 _Parents_, their interested views in the disposal of their children in
    marriage, often a source of bitter repentance, 120, _note_. See
    _Fathers_, and _Mothers_.

 _Passions_, intemperance the abuse of, 94.
   Have great influence both in the cause and cure of diseases, 111.
   Anger, 112.
   Fear, _ibid._
   Grief, 116.
   Love, 119.
   Religious melancholy, 120.
   The best method of counteracting the violence of any of the passions,
      _ibid._

 _Peas_, parched, good in cases of flatulency, 363.

 _Peruvian_ bark. See _Bark_.

 _Penis_, ulcerated, cured, and partly regenerated, by a careful
    attention to cleanliness, 518, _note_.

 _Peripneumony_, who most subject to, 171.
   Its causes, symptoms, and proper regimen, _ibid._ 172.

 _Perspiration_, insensible, the obstruction of, disorders the whole
    frame, 126.
   The various causes of its being checked, _ibid._
   Changes in the atmosphere, _ibid._
   Wet clothes, 127.
   Wet feet, _ibid._
   Night air, 128.
   Damp beds, _ibid._
   Damp houses, 130.
   Sudden transitions from heat to cold, 131.

 _Philosophy_, advantages resulting from the study of, xxiii.

 _Phrenitis._ See _Brain_.

 _Phymosis_ described, and how to treat, 509.

 _Physicians_, ill consequences of their inattention to the management
    of children, 5.
   Are liable to spread infection, 109, _note_.
   Their custom of prognosticating the fate of their patients, a bad
      practice, 115.
   Are seldom called in, until medicine can give no relief, 158.
   The faculty oppose every salutary discovery, 328.

 _Pickles_, provocatives injurious to the stomach, 67.

 _Piles_, bleeding and blind, the distinction between, 334.
   Who most subject to the disorder, _ibid._
   General causes, _ibid._
   Medical treatment of, 335.
   Periodical discharges of, ought not to be stopped, 336.
   Proper treatment of the blind piles, _ibid._
   External ointments of little use, 337.

 _Pills_, purging, proper form of, for an inflammation of the
    intestines, 294.
   The general intention of this class of medicines, 684.
   Preparation of the composing pill, 685.
   Fœtid pill, _ibid._
   Hemlock pill, _ibid._
   Mercurial pill, _ibid._
   Mercurial sublimate pills, 686.
   Plummer’s pill, _ibid._
   Purging pill, 687.
   Pill for the jaundice, _ibid._
   Squill pills, _ibid._
   Strengthening pills, 688.

 _Pins_ ought never to be used in the dressing of children, 13.
   Swallowed, discharged from an ulcer in the side, 603, _note_.

 _Plasters_, the general intentions of, and their usual basis, 688.
   Preparation of the common plaster, _ibid._
   Adhesive plaster, 689.
   Anodyne plaster, _ibid._
   Blistering plaster, _ibid._
   Gum plaster, _ibid._
   Mercurial plaster, _ibid._
   Stomach plaster, 690.
   Warm plaster, _ibid._
   Wax plaster, _ibid._

 _Pleurisy_, the nature of the disorder explained, with its causes, 163.
   Symptoms, 164.
   Regimen, _ibid._
   Medical treatment, 165.
   A decoction of seneka reckoned a specific in, 168.
   Bastard pleurisy, 169.

 _Plumbers._ See _Miners_.

 _Poisons_, the nature and cure of, a general concern, and easily
    acquired, 472.
   Mineral poisons, 473.
   Vegetable poisons, 475.
   Bites of poisonous animals, 477.
   Bite of a mad dog, 479.
   Bite of a viper, 485.
   The practice of sucking the poison out of wounds recommended, 486,
      _note_.
   Poisonous plants ought to be destroyed in the neighbourhood of towns,
      487.
   Negro remedy to cure the bite of a rattle-snake, 488.
   General rules for security against poisons, 489.

 _Poor_ living, the dangers of, 43.

 _Porters_ subject to disorders of the lungs, 40.

 _Postures_, confined, injurious to the health of sedentary artists, 50.

 _Poverty_, occasions parents to neglect giving their children proper
    exercise, 23.
   Destroys parental affection, 24, _note_.
   Not only occasions, but aggravates, many of the diseases of
      labourers, 43.
   The poor great sufferers by the sale of bad provisions, 63.
   And by bad air in large cities, 77.

 _Poultices_ proper for inflamed wounds, 579.

 _Powders_, general instructions for making and administering, 691.
   Astringent powder, preparation and doses of, 692.
   Powder of bole, _ibid._
   Carminative powder, _ibid._
   Diuretic powder, 693.
   Aromatic purging powder, _ibid._
   Saline laxative powder, _ibid._
   Steel powder, _ibid._
   Sudorific powder, _ibid._
   Worm powder, 694.
   Purging worm powder, _ibid._
   Powder for the tape-worm, _ibid._

 _Pox_, small, who most liable to, and at what seasons, 214.
   Its causes and symptoms, _ibid._ 215.
   Favourable and unfavourable symptoms in, 215, 216.
   Regimen, 216.
   How the patient ought to be treated during the eruptive fever, 217.
   Children in this disorder ought not to lie together in the same bed,
      219.
   Should be allowed clean linen, _ibid._
   Patients under this disorder ought not to appear in public view, 220.
   Medical treatment, _ibid._
   The secondary fever, 224.
   When and how to open the pustules, 225.
   Of inoculation, 227.

 _Pregnancy_, how to treat vomiting when the effect of, 316.
   Rules of conduct for women under the disorders incident to, 530.
   Causes and symptoms of abortion, 532.
   How to guard against abortion, _ibid._
   Treatment in cases of abortion, _ibid._
   Childbirth, 533.

 _Prescriptions_, medical, patients exposed to danger by their being
    written in Latin, xxvi.

 _Provisions_, unsound, the sale of, a public injury, 63.

 _Puerperal_ fever. See _Fever_.

 _Purges_, the frequent taking of them renders the habitual use of them
    necessary, 123.
   Their efficacy in agues, 150.
   Proper form of, for an inflammation of the intestines, 293.
   Cooling purges always proper in a gonorrhœa, 494.
   Midwives too rash in the giving of purges, 540, _note_.
   Form of a gentle purge for infants disordered in the bowels, 545.
   For the thrush, 547.

 _Pustules_ in the small-pox, favourable and unfavourable appearances
    of, 215, 216.
   The suppuration of, to be promoted, 221.
   When and how to open, 225.

 _Putrid_ fever. See _Fever_.


                                   Q.

 _Quacks_ put out more eyes than they cure, 456.

 _Quackery_, how to destroy, xxv.

 _Quakers_, their mode of dressing recommended, 93.

 _Quinsey_, a common and dangerous disorder, and to whom most fatal,
    264.
   Its causes, _ibid._
   Symptoms, 265.
   Regimen, 266.
   Medical applications, 268.
   How to promote suppuration, 269.
   How to nourish the patient when he cannot swallow, 270.
   Advice to persons subject to this disorder, _ibid._

 ——, malignant, who most subject to, and its causes, 271.
   Its symptoms, 272.
   Regimen and medical treatment, 273.


                                   R.

 _Rattlesnake_, Negro remedy for the cure of its bite, 488.

 _Regimen_ ought to co-operate with medicine to accomplish the cure of
    diseases, xiii.
   Will often cure diseases without medicine, 140.
   See _Aliment_.

 _Religion_, true, calculated to support the mind under every
    affliction, 120.
   The instructions in, ought not to dwell too much on gloomy subjects,
      121.

 _Remitting_ fever. See _Fever_.

 _Repletion_, impairs the digestive power, 72.
   Diseases occasioned by, 74.
   How to treat a looseness produced by, 312.

 _Resentment_, the indulgence of, injurious to the constitution, 112.

 _Resins_, and essential oils, the proper menstruum for, 695.

 _Respiration_, how to restore in a drowned person, 609.

 _Rheumatism_ acute and chronic, distinguished, 388.
   Causes, _ibid._
   Symptoms, 389.
   Medical treatment, _ibid._
   Cautions to persons subject to this disorder, 390.

 _Rickets_, the appearance of, in Britain, dated from the growth of
    manufactures and sedentary employments, 23.
   The causes of, 562.
   Symptoms, 563.
   Regimen, and medical treatment, _ibid._

 _Rollers_, pernicious tendency of applying them round the bodies of
    infants, 12.

 _Romans_, ancient, their great attention to the cleanliness of their
    towns, 102, _note_.

 _Roses_, conserve of, its great virtue against hæmorrhages, 336, 341.

 _Rosemary_, the external application of, a popular remedy for the
    cramp, 451, _note_.

 _Ruptures_, are chiefly incident to children and very old persons, 598.
   The causes respectively, _ibid._
   Method of treatment, _ibid._
   Cutting should be avoided if possible, 599.
   Cautions for persons afflicted with a rupture, 600.
   Often prove fatal before discovered, _ibid._ _note_.

 _Rutherford_, Dr. his preparation for the cure of a dysentery, 347,
    _note_.


                                   S.

 _Sailors_, their health injured by change of climate, hard weather, and
    bad provisions, 45.
   Many of their diseases spring from intemperance, _ibid._
   Ought to guard against wet clothes, _ibid._
   How the ill effects of salt provisions might be corrected, _ibid._
   Peruvian bark the best antidote to sailors on a foreign coast, 47.
   Cleanliness greatly conducive to their health, 103.

 _Sal prunellæ_, its good effects in a quinsey, 268.

 _Saline_ draughts, of good use for stopping a vomiting, 318.
   Preparation of, for this purpose, _ibid._
   Peculiarly good in the puerperal fever, 540.

 _Salivation_ not necessary in the cure of the venereal disease, 511.

 _Sarsaparilla_, a powerful assistant in venereal cases, 513.

 _Scabbed_ head in children, difficult to cure, 555.
   Medical treatment, _ibid._

 _Scarlet_ fever. See _Fever_.

 _School_, sending children there too young, its bad consequences, 25.
   Ought to be seated in a dry air, and not to be too much crowded, 33.

 _Scirrhus_ in the liver, proper regimen in the case of, 308.
   See _Cancer_.

 _Scrophula_, nature of this disease, and its causes, 398.
   Symptoms, and regimen, 399.
   Medical treatment, 400.

 _Scurvy_, why prevalent among the English, 65.
   Where most prevalent, and the two distinctions of, 393.
   Causes of, _ibid._
   Symptoms and cure, 394.
   Instructions to sea-faring men, 395.
   Extraordinary effects of milk, 396.
   Proper liquors, _ibid._

 _Sedentary_ life, includes the greater part of the human species, 47.
   Few persons follow agriculture who are capable of other business, 48.
   Sedentary and active employments ought to be intermixed, for the sake
      of health, _ibid._
   Artists suffer from unwholesome air, by being crowded together,
      _ibid._
   The postures artists are confined to, injurious to health, 49.
   Disorders produced by, _ibid._
   Cautions offered to the sedentary, 50.
   Sedentary amusements improper for sedentary persons, 51.
   Hints relating to improper food, 52.
   Exercise a surer relief for low spirits than drinking, _ibid._
   Gardening a wholesome amusement for the sedentary, _ibid._
   Disorders occasioned by intense study, 55.
   Dietetical advice to the sedentary, 71.
   Sedentary occupations better adapted to women than men, 83, _note_.

 _Sea_ water, a good remedy in the King’s evil, 400.

 _Senses_, disorders of, 456.

 _Seton_, sometimes has extraordinary effects in an inflammation of the
    eyes, 262.
   Is of service for preventing apoplexies, 413.
   The best method of making it, 430.

 _Shoes_, tight, the bad consequences resulting from, 91.
   The high heels of women’s shoes, 92.

 _Sibbins_, a venereal disorder so termed in the west of Scotland, how
    to cure, 518, _note_.

 _Sick_, the mutual danger incurred by unnecessary visitors to, 106.
   Persons in health to be kept at a distance from the sick, 107.
   Proper nurses ought to be employed about them, 109.
   Instructions for avoiding infection, _ibid._
   Physicians too unguarded in their visits to them, _ibid._ _note_.
   Tolling of bells for the dead very dangerous to, 114.
   Their fears ought not to be alarmed, 116.

 _Sight_ injured by studying by candle-light, 57.

 _Simples_, a list of those proper to be kept for private practice, 654.

 _Sinapisms_, the general intentions of, 660.
   Directions for making of, _ibid._

 _Sleep_, the due proportion of, not easy to fix, 87.
   How to make it refreshing, 88.
   Complaints of the want of, chiefly made by the indolent, _ibid._
   Heavy suppers cause uneasy nights, _ibid._
   Anxiety destructive of sleep, 89.
   That in the fore-part of the night most refreshing, _ibid._
   Early risers the longest livers, 90, _note_.

 _Sleeping_ in the sun, the danger of, 42.

 _Small pox._ See _Pox_.

 _Smell_, injuries to which the sense of, is liable, with the remedies
    applicable to, 463.

 _Soap_, Alicant, recommended in the stone, 327.
   Soap-lees, how to take, _ibid._

 _Solanum._ See _Nightshade_.

 _Soldiers_, exposed to many disorders from the hardships they undergo,
    44.
   Ought to be employed in moderate labour in times of peace, 44,
      _note_.

 _Spine_, often bent by artists working in unfavourable postures, 50.

 _Spirit_, rectified, the direct menstruum for resins and essential oils
    of vegetables, 695.
   Of wine, camphorated, how to prepare, 699.
   Spirit of Mindererus, _ibid._

 _Spirits_, lowness of, the general forerunner of a nervous fever, 189.
   The proper remedies for, 446.
   Cautions to persons under this complaint, 447.

 _Spirituous liquors_, when good in the colic, 296.
   And for gouty complaints in the stomach, 363.
   Should be avoided by all persons afflicted with nervous disorders,
      423.
   The use of, often fatal, 623.

 _Spitting of blood._ See _Blood_.

 _Spunge_, may be used to supply the want of agaric as a styptic, 577,
    _note_.
   Its use in extracting substances stopped in the gullet, 605.

 _Sports_, active, far more wholesome than sedentary amusements, 85.
   Golf, a better exercise than cricket, _ibid._ _note_.

 _Spots_ in the eye, how to treat, 459.

 _Squinting_, how to correct the habit of, 459.

 _Stays_, a ridiculous and pernicious article of female dress, 14, 91.
   The wearing of, tends to produce cancers in the breasts, 467.

 _Sternutatories_, preparations of, recommended for restoring lost
    smell, 464.

 _Sticking-plaster_ is the best application for slight wounds, 578.

 _Stomach_, exercise the best cure for disorders of, 84.
   Inflammation of, a disorder that calls for speedy assistance, 289.
   Its causes, _ibid._
   Symptoms, _ibid._
   Regimen, 290.
   Medical treatment, _ibid._
   Pain in, its causes, 362.
   Remedies for, 363.
   Instructions for persons subject to, 364.

 _Stone_, the formation of, in the bladder, explained, 124.
   This disorder how distinguished from the gravel, 324.
   Causes and symptoms, _ibid._
   Regimen, 325.
   Medical treatment, 326.
   Alicant soap and lime-water, how to take for this disorder, 327.
   The uva ursi, a remedy in present request for, 328.

 _Stool_, loose, the benefit of, to children, 35.
   Proper treatment of, when excessive, 36.
   The discharge by, cannot be regular, if the mode of living be
      irregular, 121.
   One in a day generally sufficient for an adult, 122.
   How to produce a regularity of, _ibid._
   Frequent recourse to medicines for costiveness, injurious to the
      constitution, 123.

 _Stork_, Dr. his method of treating cancers, 469.

 _Strabismus._ See _Squinting_.

 _Strains_, proper method of treating, 597.
   The safest external applications, _ibid._ _note_.

 _Strangury_, from a blistering plaster, how to guard against, 167.
   In the small-pox, how to relieve, 222.
   From a venereal cause, described, with its proper treatment, 507.

 _Strangulation_, course of treatment for the recovery of persons from,
    628.

 _Strasburgh_, successful treatment of a miliary fever there, 208,
    _note_.

 _Strength_, the folly of trials of, from emulation, 40. 44.

 _Study_, intense, injurious to health, 54.
   The disorders occasioned by, 55.
   Character of a mere student, 58.
   Hints of advice to studious persons, 59.
   Danger of their having recourse to cordials, 60.
   Health often neglected while in possession, and laboured for after it
      is destroyed, 61.
   No person ought to study immediately after a full meal, 62.
   Diatetical advice to the studious, 71.
   The general effects of, on the constitution, 420.

 _Sublimate_, corrosive, how to administer in venereal cases, 512.

 _Suffocation_, by the fumes of charcoal, liable to happen in close
    chambers, 613.
   General causes of suffocation, 626.
   Overlaying of infants, 627.

 _Sugar_, an improper article in the food of children, 18.

 _Sulphur_, a good remedy for expelling worms, 368.
   And for the itch, 403.

 _Suppers_, ought not to destroy the appetite for breakfast, 73.
   Heavy suppers sure to occasion uneasy nights, 88.

 _Surgery_, many of the operations of, successfully performed by persons
    unskilled in anatomy, 569.
   Humanity induces every one more or less to be a surgeon, _ibid._

 _Sweating_, generally excited in an improper manner, in fevers, 146.
    160.

 _Swoonings_, the several causes of, described, 424.
   Proper treatment of this disorder, 425. 618.
   Cautions to persons subject to them, 622.

 _Sydenham_, Dr. his method of treating fevers in children from
    teething, 560.

 _Symptoms_, diseases better distinguished by, than by the systematical
    arrangement of, 135.
   The differences of sex, age, and constitution, to be considered, 136.
   Diseases of the mind to be distinguished from those of the body, 137.

 _Syncope_, proper treatment in, 619.

 _Syrups_, the general intention of, 695.
   How to make simple syrup, and to modify it for particular purposes,
      _ibid._


                                   T.

 _Tacitus_, his remark on the degeneracy of the Roman ladies, 4, _note_.

 _Tallow-chandlers_, and others working on putrid animal substances,
    cautions to, 39.

 _Tapping_ for the dropsy, a safe and simple operation, 379.

 _Tar_, Barbadoes, its efficacy in the nervous colic, 300.

 _Tartar_, soluble, a good remedy for the jaundice, 373.
   Cream of, a good remedy in a dropsy, 378.
     And rheumatism, 390.

 _Taste_, how to restore the sense of, when injured, 465.

 _Taylors_, are exposed to injuries from breathing confined air, 49.
   Are subject to consumptions, _ibid._ _note_.
   Often lose the use of their legs, 50.
   Hints of instruction offered to them in regard to their health, 51.

 _Tea_, the customary use of, injurious to female constitutions, 7.
   Destroys their digestive powers, and produces hysterics, 66.
   The bad qualities of, principally owing to imprudence in the use of
      it, _ibid._
   Green, chewing of, a remedy for the heart-burn, 419.
   Has a powerful effect upon the nerves, 431, _note_.
   Is bad for persons troubled with flatulences, 445.

 _Teething_, the disorders attending, 559.
   Regimen, and medical treatment in, 560.
   Applications to the gums, and how to cut them, 561.

 _Temperance_, the parent of health, 94.

 _Testicles_, swelled, the cause of, 503.
   Regimen and medicine in, _ibid._
   Treatment under a cancerous or scrophulous habit, 504.

 _Thirst_, how it may be quenched when a person is hot, without danger,
    132.

 _Thought_, intense, destructive of health, 54.

 _Thrush_ in infants, the disorder and its causes described, 547.
   Medical treatment of, _ibid._

 _Tinctures and elixirs_, the proper medicines to exhibit in the form
    of, 696.
   Preparations of the aromatic tincture, _ibid._
   Compound tincture of the bark, _ibid._
   Volatile fœtid tincture, _ibid._
   Volatile tincture of gum guaiacum, 697.
   Tincture of black hellebore, _ibid._
   Astringent tincture, _ibid._
   Tincture of myrrh and aloes, _ibid._
   Tincture of opium, or liquid laudanum, _ibid._
   Tincture of hiera picra, 698.
   Compound tincture of senna, _ibid._
   Tincture of Spanish flies, _ibid._
   Tincture of the balsam of Tolu, _ibid._
   Tincture of rhubarb, 699.

 _Tissot_, Dr. character of his _Avis au Peuple_, xiv.
   His medical course for the cure of the hydrophobia, 484.
   His directions for gathering, preparing, and applying agaric of the
      oak as a styptic, 577, _note_.
   Instances from, of the recovery of drowned persons, 611.

 _Tobacco_, a clyster of a decoction of, useful to excite a vomit, 606.
   A clyster of the fumes of, will stimulate the intestines, and produce
      a stool, 300. 610.

 _Toes_, the free motion of, destroyed by wearing tight shoes, 92.

 _Tooth ach_, the general causes of, 357.
   Medical treatment of, _ibid._
   When recourse must be had to extraction, 359.
   Directions for cleaning the teeth, 360.

 _Touch_, injuries to which the sense of, is liable, with the remedies
    applicable to, 465.

 _Towns_, great, the air of, destructive to the children of the poor,
    30.
   Children bred in the country ought not to be sent too early into
      towns, 32.
   Cleanliness not sufficiently attended to in, 101.
   Ought to be supplied with plenty of water for washing the streets,
      105, _note_.
   The best means to guard against infection in, 109.

 _Trades_, some injurious to health by making artists breathe
    unwholesome air, 37. 49.

 _Transitions_, sudden, from heat to cold, the ill effects of, to the
    constitution, 131.

 _Travellers_, the use of vinegar recommended to, 46.
   Ought to be very careful not to sleep in damp beds, 128.
   Fevers why often fatal to, 144.

 _Trees_ should not be planted too near to houses, 79.

 _Trefoil_ water, a good remedy in the rheumatism, 391,

 _Tumours_, proper treatment of, 574.

 _Turnbull_, Dr. his method of treating the croup in children, 558,
    _note_.

 _Turner’s cerate_, preparation of, 682.


                                   V.

 _Vapour_ of fermenting liquors, noxious nature of, 613.

 _Vegetables_, wholesome corrections of the bad qualities of animal
    food, 65.
   Their extraordinary effects in the scurvy, 397.

 _Venereal disease_, why omitted in the first edition of this work, 489.
   Unfavourable circumstances attending this disorder, 490.
   The virulent gonorrhœa, 491.
   Gleets, 500.
   Swelled testicles, 503.
   Buboes, 504.
   Chancres, 509.
   Strangury, 507.
   Phymosis, 509.
   A confirmed lues, 510.
   American method of curing this disease, 513.
   General observations, 515.
   Cleanliness a great preservative against, 517.
   The use of medicines ought not to be hastily dropped, 519.
   Is often too much disregarded, 520.

 _Ventilators_, the most useful of all modern medical improvements, 78.

 _Vertigo_ often produced by intense study, 57.

 _Vinegar_, a great antidote against diseases, and ought to be used by
    all travellers, 56.
   Should be sprinkled in sick chambers, 109. 160. 199.
   Is of considerable service in the bite of a mad dog, 481;
     and in any kind of poison, 486.
   Its medical properties, 700.
   Is of use to extract the virtues of several medicinal substances,
      _ibid._
   How to prepare vinegar of litharge, _ibid._
   Vinegar of roses, 701.
   Vinegar of squills, _ibid._

 _Viper_, the bite of, the sufficiency of the grease for the cure of,
    doubted, 486.
   Method of treatment recommended, _ibid._

 _Vitriol_, elixir of, an excellent medicine in weaknesses of the
    stomach, 417.
   And for windy complaints, 425.

 _Vitus_, St. his dance, method of cure of, 436.

 _Ulcers_, proper treatment of, according to their different natures,
    583.
   Lime-water a good remedy, 585.
   Dr. Whytt’s method of treating them, _ibid._
   Fistulous ulcers, 586.

 _Vomits_, their use in agues, 150;
     and in the nervous fever, 191.
   Caution for administering in the putrid fever, 201.
   Ought by no means to be administered in an inflammation of the
      stomach, 290.
   Are useful in cases of repletion, 312.
   Are powerful remedies in the jaundice, 372.
   Are the first object to be pursued when poison has been received into
      the stomach, 473.
   Their use in the hooping cough, and how to administer them to
      children, 286.
   Midwives too rash in the use of, 540, _note_.
   Form of a gentle one for infants disordered in the bowels, 545.

 _Vomiting_, the several causes of, 315.
   Medical treatment of, 316.
   Saline draught for stopping of, 317.
   Causes of, in children, 551.
   How to be treated, 552.
   Of blood: See _Blood_.

 _Voyage_, a long one frequently cures a consumption, 178.
   Voyages have an excellent effect on persons afflicted with nervous
      disorders, 423.

 _Ureters_, and their use, described, 303, _note_.

 _Urine_, the appearances and quantity of, too uncertain to form any
    determined judgment from, 123.
   Dr. Cheyne’s judgment as to the due quantity of, not to be relied on,
      124.
   The secretion and discharge of, how obstructed, _ibid._
   Bad consequences of retaining it too long, 125.
   Too great a quantity of, tends to a consumption, _ibid._
   Stoppage of, its general causes, 305.
   Caution as to the treatment of, _ibid._
   Diabetes, 319.
   Incontinency of, 322.
   Suppression of, medical treatment in, _ibid._
   Cautions to persons subject to this disorder, 324.
   Bloody, causes of, _ibid._
   Medical treatment of, 344.
   An obstinate deafness cured by warm urine, 462, _note_.

 _Urine_ doctors, their impudence, and great success from the credulity
    of the populace, 124, _note_.

 _Uva ursi_, a remedy in present request for the stone, 328.


                                   W.

 _Walls_, high, unwholesome, by obstructing the free current of air, 79.

 _Ward_’s essence, preparation of, 699.
   His fistula paste, a popular remedy that may deserve trial, 586.

 _Wars_ occasion putrid fevers, by tainting the air with the effluvia of
    dead carcases, 196.

 _Wasps_, hornets, or bees, how the bite of, ought to be treated, 486.

 _Water_, frequently unwholesome by mineral impregnations, 67.
   Cautions for the choice of, 68.
   Cold, the danger of drinking when a person is hot, 131.

 _Water_ in the head, is a disorder chiefly incident to children, 567.
   Its causes, symptoms, and proper treatment, _ibid._
   The nature of the disorder seldom discovered in due time for cure,
      568, _note_.

 _Waters_ by infusion, how to prepare: Lime-water, 701.
   Compound lime-water, 702.
   Sublimate water, _ibid._
   Styptic water, _ibid._
   Tar water, _ibid._

 _Waters_, simple distilled, their medical uses, 703.
   Preparation of cinnamon water, _ibid._
   Pennyroyal water, _ibid._
   Peppermint water, _ibid._
   Spearmint water, _ibid._
   Rose-water, 704.
   Jamaica pepper water, _ibid._

 _Waters_, spirituous distilled, how to prepare: Spirituous cinnamon
    water, 704.
   Spirituous Jamaica pepper water, _ibid._

 _Watery_ eye, how to cure, 460.

 _Weaning_ of children from the breast, the proper mode of, 17, 18.

 _Weather_, states of, which produce the putrid fever, 195.

 _Wells_, caution to persons going down into them, 77, _note_.
   Deep, ought not to be entered until the air in, is purified, 614.

 _Whey_, an excellent drink in a dysentery, 349;
     and in the rheumatism, 390.
   Orange-whey, how to make, 159.
   Alum whey, 321. 704.
   Mustard-whey, 705.
   Scorbutic whey, _ibid._

 _Whitlow_, 575.

 _Whytt_, Dr. his remedies for flatulences, 444.

 _Wind._ See _Flatulences_.

 _Windows_, the danger of throwing them open on account of heat, and
    sitting near them, 133.

 _Wine_, good, almost the only medicine necessary in a nervous fever,
    190.

 _Wines_, the medical properties of, 705.
   Their use in extracting the virtues of medicinal substances, 706.
   Preparation of anthelminthic wine, _ibid._
   Antimonial wine, _ibid._
   Bitter wine, _ibid._
   Ipecacuanha wine, 707.
   Chalybeate or steel wine, _ibid._
   Stomachic wine, _ibid._

 _Womb_, inflammation of, its symptoms, 536.
   Medical treatment of, 537.

 _Women_, errors in their education pointed out, 4.
   Why subject to hysterics, 66.
   Are better adapted to follow sedentary occupations than men, 83,
      _note_.
   In child-bed, often die from their apprehensions of death, 113.
   Their disorders rendered epidemical by the force of imagination, 114.
   Every thing that can alarm them to be carefully guarded against,
      _ibid._
   Evil tendency of tolling bells for the dead, _ibid._
   How exposed to a miliary fever during pregnancy, 205.
   Their constitutions injured by living too much within doors, 521.
   Those who work in the open air almost as hardy as men, 522.
   Advice to, with reference to the menstrual discharge, _ibid._
   At the commencement, 523.
   _Fluor albus_, with its proper treatment, described, 529.
   Advice to, at the ceasing of the menses, 530.
   Rules of conduct during pregnancy, _ibid._
   Causes and symptoms of abortion, 531.
   How to guard against abortion, 532.
   Treatment in cases of abortion, _ibid._
   Instructions at the time of child-birth, 533.
   Cause of the milk-fever, 537.
   How to guard against the miliary fever, 538.
   The puerperal fever, _ibid._
   General cautions for women in child-bed, 542.
   Causes of barrenness, _ibid._

 _Wool_, the best external application in the gout, 383.

 _Workhouses_ poisonous to infants, 30.

 _Worms_, how to treat a looseness produced by, 314.
   Three principal kinds of, distinguished, 365.
   Symptoms of, _ibid._
   Causes, 366.
   Medical treatment for, 367.
   Remedy for children, 368.
   General cautions for preserving children from them, 370.
   Danger of taking quack medicines for them, _ibid._ _note_.

 _Wort_, recommended for the scurvy, and proper to drink at sea, 396.
   Is a powerful remedy in cancerous cases, 471.

 _Wounds_, are not cured by external applications, 575.
   Are cured by nature, 576.
   Proper course of treatment, _ibid._
   How to stop the bleeding, _ibid._
   Caution against improper styptics, 577.
   Method of dressing them, 578.
   Poultices for inflamed wounds, 579.
   Regimen in, _ibid._

 _Writing_, hints of advice to those who are much employed in, 56. 59.


                                   Y.

 _Yaws_, general hint for the cure of, 518, _note_.

 _Young_ animals, all exert their organs of motion as soon as they are
    able, 22.


                                   Z.

 _Zinc_, the flowers of, a popular remedy for the epilepsy, 435.


                                THE END.

-----

Footnote 1:

  Observations on the Duties and Offices of a Physician.

Footnote 2:

  Arbuthnot.

Footnote 3:

  Many advantages would arise to society, as well as to individuals,
  from mothers suckling their own children. It would prevent the
  temptation which poor women are laid under of abandoning their
  children to suckle those of the rich for the sake of gain: by which
  means society loses many of its most useful members, and mothers
  become in some sense the murderers of their own offspring. I am sure I
  speak within the truth when I say, that not one in twenty of those
  children live, who are thus abandoned by their mothers. For this
  reason no mother should be allowed to suckle another’s child, till her
  own is either dead, or fit to be weaned. A regulation of this kind
  would save many lives among the poorer sort, and could do no hurt to
  the rich, as most women who make good nurses are able to suckle two
  children in succession upon the same milk.

Footnote 4:

  Tacitus, the celebrated Roman historian, complains greatly of the
  degeneracy of the Roman ladies in his time, with regard to the care of
  their offspring. He says that, in former times, the greatest women in
  Rome used to account it their chief glory to keep the house and attend
  their children; but that now the young infant was committed to the
  sole care of some poor Grecian wench, or other menial servant.—We are
  afraid, wherever luxury and effeminacy prevail, there will be too much
  ground for this complaint.

Footnote 5:

  The common opinion, that the diseases of infants are hard to discover
  and difficult to cure, has deterred many physicians from paying that
  attention to them which they deserve. I can, however, from experience
  declare, that this opinion is without foundation; and that the
  diseases of infants are neither so difficult to discover, nor so ill
  to cure, as those of adults.

Footnote 6:

  Rousseau.

Footnote 7:

  The Lacedemonians condemned their king Archidamus for having married a
  weak, puny woman; because, said they, instead of propagating a race of
  heroes, you will fill the throne with a progeny of changelings.

Footnote 8:

  The Jews, by their laws, were, in certain cases, forbid to have any
  manner of commerce with the diseased; and indeed to this all wise
  legislators ought to have a special regard. In some countries,
  diseased persons have actually been forbid to marry. This is an evil
  of a complicated kind, a natural deformity, and political mischief;
  and therefore requires a public consideration.

Footnote 9:

  A friend of mine, who was several years on the coast of Africa, tells
  me, that the natives neither put any clothes upon their children, nor
  apply to their bodies bandages of any kind, but lay them on a pallet,
  and suffer them to tumble about at pleasure; yet they are all strait,
  and seldom have any disease.

Footnote 10:

  This is by no means inveighing against a thing that does not happen.
  In many parts of Britain at this day, a roller, eight or ten feet in
  length, is applied tightly round the child’s body as soon as it is
  born.

Footnote 11:

  Stays made of bend-leather are worn by all the women of lower station
  in many parts of England.

  I am sorry to understand, that there are still mothers mad enough to
  lace their daughters very tight in order to improve their shape. As
  reasoning would be totally lost upon such people, I shall beg leave
  just to ask them, Why there are ten deformed women for one man? and
  likewise to recommend to their perusal a short moral precept, which
  forbids us to _deform the human body_.

Footnote 12:

  Children are always sickly in the fruit season, which may be thus
  accounted for: Two-thirds of the fruit which comes to market in this
  country is really unripe; and children not being in a condition to
  judge for themselves, eat whatever they can lay their hands upon,
  which often proves little better than a poison to their tender bowels.
  Servants, and others who have the care of children, should be strictly
  forbid to give them any fruit without the knowledge of their parents.

Footnote 13:

  The nurse ought to be careful to keep the child in a proper position;
  as deformity is often the consequence of inattention to this
  circumstance. Its situation ought also to be frequently changed. I
  have known a child’s legs bent all on one side, by the nurse carrying
  it constantly on one arm.

Footnote 14:

  If it were made the interest of the poor to keep their children alive,
  we should lose very few of them. A small premium given annually to
  each poor family, for every child they have alive at the year’s end,
  would save more infant lives than if the whole revenue of the crown
  were expended on hospitals for this purpose. This would make the poor
  esteem fertility a blessing; whereas many of them think it the
  greatest curse that can befal them; and in place of wishing their
  children to live, so far does poverty get the better of natural
  affection, that they are often very happy when they die.

Footnote 15:

  It is undoubtedly the duty of parents to instruct their children, at
  least till they are of an age proper to take some care of themselves.
  This would tend much to confirm the ties of parental tenderness and
  filial affection, of the want of which there are at present so many
  deplorable instances. Though few fathers have time to instruct their
  children, yet most mothers have; and surely they cannot be better
  employed.

Footnote 16:

  I am happy to find that the masters of academies now begin to put in
  practice this advice. Each of them ought to keep a drill serjeant for
  teaching the boys the military exercise. This, besides contributing to
  their health and vigour of body, would have many other happy effects.

Footnote 17:

  I have been told that in China, where the police is the best in the
  world, all the children are employed in the easier part of gardening
  and husbandry; as weeding, gathering stones off the land, and such
  like.

Footnote 18:

  It is amazing how children escape suffocation, considering the manner
  in which they are often rolled up in flannels, &c. I lately attended
  an infant, whom I found muffled up over head and ears in many folds of
  flannel, though it was in the middle of June. I begged for a little
  free air to the poor babe; but though this indulgence was granted
  during my stay, I found it always on my return in the same situation.
  Death, as might be expected, soon freed the infant from all its
  miseries; but it was not in my power to free the minds of its parents
  from those prejudices which proved fatal to their child.

  I was very lately called to see an infant which was said to be
  expiring in convulsion fits. I desired the mother to strip the child,
  and wrap it in a loose covering. It had no more convulsion fits.

Footnote 19:

  I have often known people so imposed upon, as to give an infant to a
  nurse to be suckled who had not one drop of milk in her breast.

Footnote 20:

  If a mother on visiting her child at nurse find it always asleep, I
  would advise her to remove it immediately; otherwise it will soon
  sleep its last.

Footnote 21:

  Armstrong.

Footnote 22:

  When persons heated with labour have drank cold liquor, they ought to
  continue at work for some time after.

Footnote 23:

  It is indeed to be regretted, that soldiers suffer not less from
  indolence and intemperance in time of peace, than from hardships in
  time of war. If men are idle they will be vicious. It would therefore
  be of great importance, could a scheme be formed for rendering the
  military, in times of peace, both more healthy and more useful. These
  desirable objects might, in our opinion, be obtained, by employing
  them for some hours every day, and advancing their pay accordingly. By
  this means, idleness, the mother of vice, might be prevented, the
  price of labour lowered, public works, as harbours, canals, turnpike
  roads, &c. might be made without hurting manufactures; and soldiers
  might be enabled to marry, and bring up children. A scheme of this
  kind might easily be conducted, so as not to depress the martial
  spirit, provided the men were only to work four or five hours every
  day, and always to work without doors: no soldier should be suffered
  to work too long, or to follow any sedentary employment. Sedentary
  employments render men weak and effeminate, quite unfit for the
  hardships of war: whereas working for a few hours every day without
  doors would inure them to the weather, brace their nerves, and
  increase their strength and courage.

Footnote 24:

  Our countryman, the celebrated Captain COOK, has shewn how far, by
  proper care and attention, the diseases formerly so fatal to seamen
  may be prevented. In a voyage of three years and eighteen days, during
  which he was exposed to every climate, from the 52° north to the 71°
  of south latitude, of one hundred and eighteen men composing the
  ship’s company, he lost only one, who died of a _phthisis pulmonalis_.
  The principal means he used were, to preserve a strict attention to
  cleanliness, to procure abundance of vegetables and fresh provisions,
  especially good water, and to allow his people sufficient time for
  rest.

Footnote 25:

  The appellation of sedentary has generally been given only to the
  studious; we can see no reason, however, for restricting it to them
  alone. Many artificers may, with as much propriety, be denominated
  sedentary as the studious, with this particular disadvantage, that
  they are often obliged to sit in very awkward postures, which the
  studious need not do, unless they please.

Footnote 26:

  A person of observation in that line of life told me, that most
  taylors die of consumptions; which he attributed chiefly to the
  unfavourable postures in which they sit, and the unwholesomeness of
  those places where their business is carried on. If more attention was
  not paid to profit than to the preservation of human lives, this evil
  might be easily remedied; but while masters only mind their own
  interest, nothing will be done for the safety of their servants.

Footnote 27:

  The poor, indeed, are generally the first who suffer by unsound
  provisions; but the lives of the labouring poor are of great
  importance to the state: besides, diseases occasioned by unwholesome
  food often prove infectious, by which means they reach people in every
  station. It is therefore the interest of all to take care that no
  spoilt provisions of any kind be exposed to sale.

Footnote 28:

  In most eastern countries it was customary to bury the dead at some
  distance from any town. As this practice obtained among the Jews, the
  Greeks, and also the Romans, it is strange that the western parts of
  Europe should not have followed their example in a custom so truly
  laudable.

Footnote 29:

  One cannot pass through a large church or cathedral, even in summer,
  without feeling quite chilly.

Footnote 30:

  We have daily accounts of persons who lose their lives by going down
  into deep wells and other places where the air stagnates; all these
  accidents might be prevented by only letting down a lighted candle
  before them, and stopping when they perceive it go out; yet this
  precaution, simple as it is, is seldom used.

Footnote 31:

  A year seldom passes that we do not hear of some hospital physician or
  surgeon having lost his life by an hospital fever caught from his
  patients. For this they have themselves alone to blame. Their patients
  are either in an improper situation, or they are too careless with
  regard to their own conduct.

Footnote 32:

  It is not necessity, but fashion, which makes the use of carriages so
  common. There are many people who have not exercise enough to keep
  their humours wholesome, who yet dare not venture to make a visit to
  their next neighbours, but in a coach or sedan, lest they should be
  looked down upon. Strange, that men should be such fools as to be
  laughed out of the use of their limbs, or to throw away their health,
  in order to gratify a piece of vanity, or to comply with a ridiculous
  fashion!

Footnote 33:

  Cheyne.

Footnote 34:

  Sedentary occupations ought chiefly to be followed by women. They bear
  confinement much better than men, and are fitter for every kind of
  business which does not require much strength. It is ridiculous enough
  to see a lusty fellow making pins, needles, or watch-wheels, while
  many of the laborious parts of husbandry are carried on by the other
  sex. The fact is, we want men for laborious employments, while one
  half of the other sex are rendered useless for want of occupations
  suited to their strength, &c. Were girls bred to mechanical
  employments, we should not see such numbers of them prostitute
  themselves for bread, nor find such a want of men for the important
  purposes of navigation, agriculture, &c. An eminent silk manufacturer
  told me, that he found women answer better for that business, than
  men; and that he had lately taken a great many girls apprentices as
  silk-weavers. I hope his example will be followed by many others.

Footnote 35:

  Golff is a diversion very common in North Britain. It is well
  calculated for exercising the body, and may always be taken in such
  moderation, as neither to overheat nor fatigue. It has greatly the
  preference over cricket, tennis, or any of those games which cannot be
  played without violence.

Footnote 36:

  Men of every occupation, and in every situation of life, have lived to
  a good old age; nay some have enjoyed this blessing whose plan of
  living was by no means regular: but it consists with observation, that
  all very old men have been early risers. This is the only circumstance
  attending longevity, to which I never knew an exception.

Footnote 37:

  _That colds kill more than plagues_, is an old observation; and, with
  regard to this country, it holds strictly true. Every person of
  discernment, however, will perceive, that most of the colds which
  prove so destructive to the inhabitants of Britain are owing to their
  imprudence in changing clothes. A few warm days in March or April
  induce them to throw off their winter garments, without considering
  that our most penetrating colds generally happen in the spring.

Footnote 38:

  This madness seems to have pervaded the minds of mothers in every age
  and country. Terence, in his Comedy of the Eunuch, ridicules the Roman
  matrons for attempting to mend the shape of their daughters.

Footnote 39:

  We often see persons, who are rendered quite lame by the nails of
  their toes having grown into the flesh, and frequently hear of
  mortifications proceeding from this cause. All these, and many other
  inconveniences attending the feet, must be imputed solely to the use
  of short and strait shoes.

Footnote 40:

  The celebrated Boerhaave used to say, that no body suffered by cold
  save fools and beggars; the latter not being able to procure clothes,
  and the former not having sense to wear them. Be this as it may, I can
  with the strictest truth declare, that in many cases where the powers
  of medicine had been tried in vain, I have cured the patient by
  recommending thick shoes, a flannel waistcoat and drawers, a pair of
  under stockings, or a flannel petticoat, to be worn during the cold
  season at least.

Footnote 41:

  Rousseau.

Footnote 42:

  Addison.

Footnote 43:

  We may form some notion of the immense quantity of ardent spirits
  consumed in Great Britain from this circumstance, that in the city of
  Edinburgh and its environs, besides the great quantity of foreign
  spirits duly entered, and the still greater quantity which is supposed
  to be smuggled, it is computed that above two thousand private stills
  are constantly employed in preparing a poisonous liquor called
  _Molasses_. The common people have got so universally into the habit
  of drinking this base spirit, that when a porter or labourer is seen
  reeling along the streets, they say, _he has got molassed_.

Footnote 44:

  It is amazing that our improvements in arts, learning, and politeness,
  have not put the barbarous custom of drinking to excess out of
  fashion. It is indeed less common in South Britain than it was
  formerly; but it still prevails very much in the North, where this
  relic of barbarity is mistaken for hospitality. There no man is
  supposed to entertain his guests well, who does not make them drunk.
  Forcing people to drink, is certainly the greatest piece of rudeness
  that any man can be guilty of. Manliness, complaisance, or mere
  good-nature, may induce a man to take his glass, if urged to it, at a
  time when he might as well take poison. The custom of drinking to
  excess has long been out of fashion in France; and, as it begins to
  lose ground among the politer part of the English, we hope it will
  soon be banished from every part of this island.

Footnote 45:

  Mr. Pot, in his surgical observations, mentions a disease which he
  calls the chimney-sweeper’s cancer, as it is almost peculiar to that
  unhappy set of people. This he attributes to neglect of cleanliness,
  and with great justice. I am convinced, that if that part of the body
  which is the seat of this cruel disease was kept clean by frequent
  walking, it would never happen. The climbing boys, as they are called,
  are certainly the most miserable wretches on the face of the earth;
  yet, for cleaning chimnies, no such persons are necessary.

Footnote 46:

  In ancient Rome the greatest men did not think cleanliness an object
  unworthy of their attention. Pliny says, the _Cloacæ_, or common
  sewers for the conveyance of filth and nastiness from the city, were
  the greatest of all the public works; and bestows higher encomiums
  upon Tarquinius, Agrippa, and others who made and improved them, than
  on those who achieved the greatest conquests.

  How truly great does the emperor Trajan appear, when giving directions
  to Pliny his proconsul, concerning the making of a common sewer for
  the health and convenience of a conquered city?

Footnote 47:

  Thou shalt have a place also without the camp, whither thou shalt go
  forth abroad; and thou shalt have a paddle upon thy weapon: and it
  shall be when thou shalt ease thyself abroad, thou shalt dig
  therewith, and shalt turn back, and cover that which cometh from thee,
  &c.

                                        Deuter, chap. xxii. ver. 12, 13.

Footnote 48:

  As it is impossible to be thoroughly clean without a sufficient
  quantity of water, we would earnestly recommend it to the magistrates
  of great towns to be particularly attentive to this article. Most
  great towns in Britain are so situated as to be easily supplied with
  water; and those persons who will not make a proper use of it, after
  it is brought to their hand, certainly deserve to be severely
  punished. The streets of great towns, where water can be had, ought to
  be washed every day. This is the only effectual method for keeping
  them thoroughly clean; and, upon trial, we are persuaded it will be
  found the cheapest.

  Some of the most dreadful diseases incident to human nature might, in
  my opinion, be entirely eradicated by cleanliness.

Footnote 49:

  Were the tenth part of the care taken to prevent the importation of
  diseases, that there is to prevent smuggling, it would be attended
  with many happy consequences. This might easily be done by appointing
  a physician at every considerable sea-port, to inspect the ship’s
  company, passengers, &c. before they came ashore, and, if any fever or
  other infectious disorder prevailed, to order the ship to perform a
  short quarantine, and to send the sick to some hospital or proper
  place to be cured. He might likewise order all the clothes, bedding,
  &c. which had been used by the sick during the voyage, to be either
  destroyed, or thoroughly cleansed by fumigation, &c. before any of it
  were sent ashore. A scheme of this kind, if properly conducted, would
  prevent many fevers, and other infectious diseases, from being brought
  by sailors into sea-port towns, and by this means diffused all over
  the country.

Footnote 50:

  There is reason to believe that infection is often conveyed from one
  place to another by the carelessness of the faculty themselves. Many
  physicians affect a familiar way of sitting upon the patient’s
  bedside, and holding his arm for a considerable time. If the patient
  has the small-pox, or any other infectious disease, there is no doubt
  but the doctor’s hands, clothes, &c. will carry away some of the
  infection; and, if he goes directly to visit another patient without
  washing his hands, changing his clothes, or being exposed to the open
  air, which is not seldom the case, is it any wonder that he should
  carry the disease along with him? Physicians not only endanger others,
  but also themselves, by this practice. And indeed they sometimes
  suffer for their want of care.

Footnote 51:

  The ancients would not suffer even the temples of their gods, where
  the sick resorted, to be built within the walls of a city.

Footnote 52:

  The conduct of parents with regard to the disposal of their children
  in marriage is often very blamable. An advantageous match is the
  constant aim of parents; while their children often suffer a real
  martyrdom betwixt their inclinations and duty. The first thing which
  parents ought to consult in disposing their children in marriage, is
  certainly their inclinations. Were due regard always paid to these,
  there would be fewer unhappy couples, and parents would not have so
  often cause to repent the severity of their conduct, after a ruined
  constitution, a lost character, or a distracted mind, has shewn them
  their mistake.

Footnote 53:

  It has long been an observation among physicians, that the appearances
  of the urine are very uncertain, and very little to be depended on. No
  one will be surprised at this who considers how many ways it may be
  affected, and consequently have its appearance altered. The passions,
  the state of the atmosphere, the quantity and quality of the food, the
  exercise, the clothing, the state of the other evacuations, and
  numberless other causes, are sufficient to induce a change either in
  the quantity or appearance of the urine. Any one who attends to this,
  will be astonished at the impudence of those daring quacks, who
  pretend to find out diseases, and prescribe to patients from the bare
  inspection of their urine. These impostors, however, are very common
  all over Britain, and by the amazing credulity of the populace, many
  of them amass considerable fortunes. Of all the medical prejudices
  which prevail in this country, that in favour of _urine doctors_ is
  the strongest. The common people have still an unlimited faith in
  their skill, although it has been demonstrated that no one of them is
  able to distinguish the urine of a horse, or any other animal, from
  that of a man.

Footnote 54:

  I never knew a more remarkable instance of the uncertainty of the
  weather in this country, than happened while I was writing these
  notes. This morning, August 14, 1783, the thermometer in the shade was
  down at fifty-three degrees, and a very few days ago it stood above
  eighty. No one who reflects on such great and sudden changes in the
  atmosphere, will be surprised to find colds, coughs, rheums, with
  other affections of the breast and bowels, so common in this country.

Footnote 55:

  If a person suspects that his bed is damp, the simple precaution of
  taking off the sheets and lying in the blankets, with all, or most of
  his clothes on, will prevent all the danger. I have practised this for
  many years, and never have been hurt by damp beds, though no
  constitution, without care, is proof against their baneful influence.

Footnote 56:

  People imagine if a good fire is made in a room after it has been
  washed, that there is no danger from sitting in it; but they must give
  me leave to say that this increases the danger. The evaporation
  excited by the fire generates cold, and renders the damp more active.

Footnote 57:

  The tap-rooms in London and other great towns, where such numbers of
  people spend their evenings, are highly pernicious. The breath of a
  number of people crowded into a low apartment, with the addition of
  fires, candles, the smoke of tobacco, and the fumes of hot liquor, &c.
  must not only render it hurtful to continue in such places, but
  dangerous to go out of them into a cold and chilly atmosphere.

Footnote 58:

  Dr. Lind says, that twenty or twenty-five drops of laudanum put into a
  cup of the patient’s drink, and given about half an hour after the
  commencement of the hot fit, promotes the sweat, shortens the fit,
  relieves the head, and tends greatly to remove the disease.

Footnote 59:

  It has lately been observed, that the red bark is more powerful than
  that which has for some time been in common use. Its superior efficacy
  seems to arise from its being of a more perfect growth than the quill
  bark, and consequently more fully impregnated with the medical
  properties of the plant.

Footnote 60:

  In intermitting fevers of an obstinate nature, I have found it
  necessary to throw in the bark much faster. Indeed the benefits
  arising from this medicine depend chiefly upon a large quantity of it
  being administered in a short time. Several ounces of bark given in a
  few days will do more than as many pounds taken in the course of some
  weeks. When this medicine is intended either to stop a mortification,
  or cure an obstinate ague, it ought to be thrown in as fast as the
  stomach can possibly bear it. Inattention to this circumstance has
  hurt the reputation of one of the best medicines of which we are in
  possession.

Footnote 61:

  There is reason to believe, that sundry of our own plants or barks,
  which are very bitter and astringent, would succeed in the cure of
  intermittent fevers, especially when assisted by aromatics. But as the
  Peruvian bark has been long approved in the cure of this disease, and
  is now to be obtained at a very reasonable rate, it is of less
  importance to search after new medicines. We cannot however omit
  taking notice, that the Peruvian bark is very often adulterated, and
  that it requires considerable skill to distinguish between the genuine
  and the false. This ought to make people very cautious of whom they
  purchase it.

Footnote 62:

  In obstinate agues, when the patient is old, the habit phlegmatic, the
  season rainy, the situation damp, or the like, it will be necessary to
  mix with two ounces of the bark, half an ounce of Virginian
  snake-root, and a quarter of an ounce of ginger, or some other warm
  aromatic; but when the symptoms are of an inflammatory nature, half an
  ounce of salt of wormwood or salt of tartar may be added to the above
  quantity of bark.

Footnote 63:

  Arsenic has of late been recommended as an infallible remedy in the
  ague; but I would advise that it should be used only under the eye of
  a physician.

Footnote 64:

  See Appendix, _Saline mixture_.

Footnote 65:

  See Appendix, _Pectoral decoction_.

Footnote 66:

  See Appendix, _Pectoral infusion_.

Footnote 67:

  See Appendix, _Volatile liniment_.

Footnote 68:

  See Appendix, _Arabic emulsion_.

Footnote 69:

  See Appendix, _Oily emulsion_.

Footnote 70:

  See Appendix, _Solution of gum ammoniac_.

Footnote 71:

  See Appendix, _Decoction of seneka-root_.

Footnote 72:

  Two things chiefly operate to prevent the benefits which would arise
  from sailing. The one is, that physicians seldom order it till the
  disease is too far advanced; and the other is, that they seldom order
  a voyage of a sufficient length. A patient may receive no benefit by
  crossing the channel, who, should he cross the Atlantic, might be
  completely cured. Indeed we have reason to believe, that a voyage of
  this kind, if taken in due time, would seldom fail to cure a
  consumption.

Footnote 73:

  Though I do not remember to have seen one instance of a genuine
  consumption of the lungs cured by medicine, yet I have known a West
  India voyage work wonders in that dreadful disorder.

Footnote 74:

  Sheffield.

Footnote 75:

  I have often known persons of a consumptive habit, where the symptoms
  were not violent, reap great benefit from the use of oysters. They
  generally ate them raw, and drank the juice along with them.

Footnote 76:

  See Appendix, _Vulnerary decoction_.

Footnote 77:

  See Appendix, _Chalybeate wine_.

Footnote 78:

  See Appendix, _Mustard-whey_.

Footnote 79:

  See Appendix, _Vomiting Julep_.

Footnote 80:

  See Appendix, _White Decoction_.

Footnote 81:

  When the patient is low, ten grains of Virginian snake-root, and the
  same quantity of contrayerva-root, with five grains of Russian castor,
  all in fine powder, may be made into a bolus with a little of the
  cordial confection or syrup of saffron. One of these may be taken
  every four or five hours.

  The following powder may be used with the same intention: Take wild
  Valerian-root in powder one scruple, saffron and castor each four
  grains. Mix these by rubbing them together in a mortar, and give one
  in a cup of wine-whey, three or four times a-day.

Footnote 82:

  The bark may likewise be very properly administered, along with other
  cordials, in the following manner: Take an ounce of Peruvian bark,
  orange-peel half an ounce, Virginian snake-root two drachms, saffron
  one drachm. Let all of them be powdered, and infused in an English
  pint of the best brandy for three or four days. Afterwards the liquor
  may be strained, and two tea-spoonfuls of it given three or four times
  a-day in a glass of small wine or negus.

Footnote 83:

  Deafness is not always a favourable symptom in this disease. Perhaps
  it is only so when occasioned by abscesses formed within the ears.

Footnote 84:

  The late Sir John Pringle expressed a concern lest these cautions
  should prevent people from attending their friends or relations when
  afflicted with putrid fevers. I told him I meant only to discourage
  unnecessary attendance, and mentioned a number of instances where
  putrid fevers had proved fatal to persons, who were rather hurtful
  than beneficial to the sick. This sagacious physician agreed with me,
  in thinking that a good doctor and a careful nurse were the only
  necessary attendants; and that all others not only endangered
  themselves, but generally, by their solicitude and ill-directed care,
  hurt the sick.

Footnote 85:

  Take two ounces of the shavings of hartshorn, and the same quantity of
  sarsaparilla, boil them in two English quarts of water. To the
  strained decoction add a little white sugar, and let the patient take
  it for his ordinary drink.

Footnote 86:

  In the _commercium literarium_ for the year 1735, we have the history
  of an epidemical miliary fever, which raged at Strasburgh in the
  months of November, December, and January; from which we learn the
  necessity of a temperate regimen in this malady, and likewise that
  physicians are not always the first who discover the proper treatment
  of diseases. “This fever made terrible havock even among men of robust
  constitutions, and all medicine proved in vain. They were seized in an
  instant with shivering, yawning, stretching, and pains in the back,
  succeeded by a most intense heat; at the same time there was a great
  loss of strength and appetite. On the seventh or ninth day the miliary
  eruptions appeared, or spots like flea-bites, with great anxiety, a
  delirium, restlessness, and tossing in bed. Bleeding was fatal. While
  matters were in this unhappy situation, a midwife, of her own accord,
  gave to a patient, in the height of the disease, a clyster of
  rain-water and butter without salt, and for his ordinary drink a quart
  of spring water, half a pint of generous wine, the juice of a lemon,
  and six ounces of the whitest sugar, gently boiled till a scum arose,
  and this with great success; for the belly was soon loosened, the
  grievous symptoms vanished, and the patient was restored to his
  senses, and snatched from the jaws of death.” This practice was
  imitated by others with the like happy effects.

Footnote 87:

  The ingenious Dr. Lind, of Edinburgh, in his inaugural dissertation
  concerning the putrid remitting fever of Bengal, has the following
  observation: “Indusia, lodices, ac stragula, sæpius sunt mutanda, ac
  aëri exponenda; fœces sordesque quam primum removendæ; oportet etiam
  ut loca quibus ægri decumbunt sint salubria, et aceto conspersa;
  denique ut ægris cura quanta maxima prospiciatur. Compertum ego habeo,
  medicum hæc fedulo observantem, quique ea exequi potest, multo magis
  ægris profuturum, quam medicum peritiorem hisce commodis destitutum.”

  “The patient’s shirt, bed-clothes, and bedding, ought frequently to be
  changed, and exposed to the air, and all his excrements immediately
  removed; the bed-chamber should be well ventilated, and frequently
  sprinkled with vinegar; in short, every attention should be paid to
  the patient. I can affirm, that a physician who puts these in practice
  will much oftener succeed than one who is even more skilful, but has
  not opportunity of using these means.”

Footnote 88:

  Convulsion-fits are no doubt very alarming, but their effects are
  often salutary. They seem to be one of the means made use of by Nature
  for breaking the force of a fever. I have always observed the fever
  abated, and sometimes quite removed, after one or more
  convulsion-fits. This readily accounts for convulsions being a
  favourable symptom in the fever which precedes the eruption of the
  small-pox, as every thing that mitigates this fever lessens the
  eruption.

Footnote 89:

  I have known a nurse, who had the small-pox before, so infected by
  lying constantly a-bed with a child in a bad kind of small-pox, that
  she had not only a great number of pustules which broke out all over
  her body, but afterwards a malignant fever, which terminated in a
  number of imposthumes or boils, and from which she narrowly escaped
  with her life. We mention this to put others upon their guard against
  the danger of this virulent infection.

Footnote 90:

  This observation is likewise applicable to hospitals, workhouses, &c.
  where numbers of children happen to have the small-pox at the same
  time. I have seen above forty children cooped up in one apartment all
  the while they had this disease, without any of them being admitted to
  breathe the fresh air. No one can be at a loss to see the impropriety
  of such conduct. It ought to be a rule, not only in hospitals for the
  small-pox, but likewise for other diseases, that no patient should be
  within sight or hearing of another. This is a matter to which too
  little regard is paid. In most hospitals and infirmaries, the sick,
  the dying, and the dead, are often to be seen in the same apartment.

Footnote 91:

  Though this operation can never do harm, yet it is only necessary when
  the patient has a great load of small-pox, or when the matter which
  they contain is of so thin and acrid a nature, that there is reason to
  apprehend bad consequences from its being too quickly resorbed, or
  taken up again into the mass of circulating humours.

Footnote 92:

  I have of late been accustomed, after the small-pox, to give one, two,
  three, four, or five grains of calomel, according to the age of the
  patient, over night, and to work it off next morning with a suitable
  dose of jalap.

Footnote 93:

  A critical situation, too often to be met with, first put me upon
  trying this method. A gentleman who had lost all his children except
  one son by the natural small-pox, was determined to have him
  inoculated. He told me his intention, and desired I would persuade the
  mother and grandmother, &c. of its propriety. But that was impossible.
  They were not to be persuaded, and either could not get the better of
  their fears, or were determined against conviction. It was always a
  point with me not to perform the operation without the consent of the
  parties concerned. I therefore advised the father, after giving his
  son a dose or two of rhubarb, to go to a patient who had the small-pox
  of a good kind, to open two or three of the pustules, taking up the
  matter with a little cotton, and as soon as he came home to take his
  son apart, and give his arm a slight scratch with a pin, afterwards to
  rub the place well with the cotton, and take no farther notice of it.
  All this he punctually performed; and at the usual period the
  small-pox made their appearance, which were of an exceeding good kind,
  and so mild as not to confine the boy an hour to his bed. None of the
  other relations knew but the disease had come in the natural way, till
  the boy was well.

Footnote 94:

  Mr. TRONCHIN communicates this disease by a little bit of thread dipt
  in the matter, which he covers with a small blistering-plaster. This
  method may no doubt be used with advantage in those cases where the
  patient is very much alarmed at the sight of any cutting instrument.

Footnote 95:

  “Many and great,” says this humane author, “are the dangers attending
  the natural infection, from all which the inoculation is quite secure.
  The natural infection may invade weaker distempered bodies, by no
  means disposed for its kindly reception. It may attack them at a
  season of the year either violently hot or intensely cold. It may be
  communicated from a sort of small-pox impregnated with the utmost
  virulence. It may lay hold upon people unexpectedly, when a dangerous
  sort is imprudently imported into a maritime place. It may surprise us
  soon after excesses committed in luxury, intemperance, or lewdness. It
  may likewise seize on the innocent after indispensably watchings, hard
  labour, or necessary journies. And is it a trivial advantage, that all
  these unhappy circumstances can be prevented by inoculation? By
  inoculation numbers are saved from deformity as well as from death. In
  the natural small-pox, how often are the finest features, and the most
  beautiful complexions, miserably disfigured? Whereas inoculation
  rarely leaves any ugly marks of scars, even where the number of
  pustules on the face has been very considerable, and the symptoms by
  no means favourable. And many other grievous complaints, that are
  frequently subsequent to the natural sort, seldom follow the
  artificial. Does not inoculation also prevent those inexpressible
  terrors that perpetually harass persons who never had this disease,
  insomuch that when the small-pox is epidemical, entire villages are
  depopulated, markets ruined, and the face of distress spread over the
  whole country? From this terror it arises, that justice is frequently
  postponed, or discouraged, at sessions or assizes where the small-pox
  rages. Witnesses and juries dare not appear; and by reason of the
  necessary absence of some gentlemen, our honourable and useful judges
  are not attended with that reverence and splendour due to their office
  and merit. Does not inoculation, in like manner, prevent our brave
  sailors from being seized with this distemper on shipboard, where they
  must quickly spread the infection among such of the crew who never had
  it before, and where they have scarce any chance to escape, being half
  stifled with the closeness of their cabins, and but very indifferently
  nursed? Lastly, with regard to the soldiery, the miseries attending
  these poor creatures, when attacked by the small-pox on a march, are
  inconceivable, without attendance, without lodgings, without any
  accommodation; so that one of three commonly perishes.”

Footnote 96:

  By a well-laid plan for extending inoculation, more lives might be
  saved at a small expence, than are at present preserved by all the
  hospitals in England, which cost the public such an amazing sum.

Footnote 97:

  I do not know any disease wherein bleeding is more necessary than in
  the measles, especially when the fever runs high: in this case I have
  always found it relieve the patient.

Footnote 98:

  Attempts have been made to communicate the measles, as well as the
  small-pox, by inoculation, and we make no doubt but in time the
  practice may succeed. Dr. Home of Edinburgh says, he communicated the
  disease by the blood. Others have tried this method, and have not
  found it succeed. Some think the disease would be more certainly
  communicated by rubbing the skin of a patient who has the measles with
  cotton, and afterwards applying the cotton to a wound, as in the
  small-pox; while others recommend a bit of flannel which had been
  applied to the patient’s skin, all the time of the disease, to be
  afterwards laid upon the arm or leg of the person to whom the
  infection is to be communicated. There is no doubt but this disease,
  as well as the small-pox, may be communicated various ways; the most
  probable, however, is either from cotton rubbed upon the skin, as
  mentioned above, or by introducing a little of the sharp humour which
  distils from the eyes of the patient into the blood. It is agreed on
  all hands, that such patients as have been inoculated had the disease
  very mildly; we therefore wish the practice were more general, as the
  measles have of late become very fatal.

Footnote 99:

  Sydenham.

Footnote 100:

  In the year 1774, during winter, a very bad species of this fever
  prevailed in Edinburgh. It raged chiefly among young people. The
  eruption was generally accompanied with a quinsey, and the
  inflammatory symptoms were so blended with others of a putrid nature,
  as to render the treatment of the disease very difficult. Many of the
  patients, towards the decline of the fever, were afflicted with large
  swellings of the submaxillary glands, and not a few had a suppuration
  in one or both ears.

Footnote 101:

  See Appendix, _White Decoction_.

Footnote 102:

  See Appendix, _Spirit of Mindererus_.

Footnote 103:

  The country people in many parts of Britain call this disease a
  _blast_, and imagine it proceeds from foul air, or ill wind, as they
  term it. The truth is, they often lie down to rest them, when warm and
  fatigued, upon the damp ground, where they fall asleep, and lie so
  long as to catch cold, which occasions the erysipelas. This disease
  may indeed proceed from other causes, but we may venture to say, that
  nine times out of ten it is occasioned by cold caught after the body
  has been greatly heated or fatigued.

Footnote 104:

  See Appendix, _Decoction of Woods_.

Footnote 105:

  Any foreign body lodged in the eye may be expeditiously removed by
  passing a small hair pencil between the eye-lid and the ball of the
  eye. In some places, the peasants do this very effectually, by using
  their tongue in the same manner.

Footnote 106:

  As most people are fond of using eye-waters and ointments in this and
  other diseases of the eyes, we have inserted some of the most approved
  forms of these medicines in the Appendix. See Appendix, _Eye-water_
  and _Eye-salve_.

Footnote 107:

  Dr. Home.

Footnote 108:

  See Appendix, _Spanish Infusion_.

Footnote 109:

  In a former edition of this book I recommended, for an obstinate
  tickling cough, an oily emulsion, made with the paregoric elixir of
  the Edinburgh Dispensatory, instead of the common alkaline spirit. I
  have since been told by several practitioners, that they found it to
  be an excellent medicine in this disorder, and every way deserving of
  the character which I had given it. Where this elixir is not kept, its
  place may be supplied by adding to the common oily emulsion, an
  adequate proportion of the _Thebaic tincture_, or liquid laudanum.

Footnote 110:

  Some complain that the pitch plaster adheres too fast, while others
  find difficulty in keeping it on. This proceeds from the different
  kinds of pitch made use of, and likewise from the manner of making it.
  I generally find it answer best when mixed with a little beeswax, and
  spread as cool as possible. The clear, hard, transparent pitch answers
  the purpose best.

Footnote 111:

  See Appendix, _Hiera Picra_.

Footnote 112:

  Some think the air ought not to be changed till the disease is on the
  decline; but there seems to be no sufficient reason for this opinion,
  as patients have been known to reap benefit from a change of air at
  all periods of the disease. It is not sufficient to take the patient
  out daily in a carriage. This seldom answers any good purpose; but
  often does hurt, by giving him cold.

Footnote 113:

  See Appendix, _Vomiting Julep_.

Footnote 114:

  Dr. DUPLANIL says, he has seen many good effects from the kermes
  mineral in this complaint, the cough being frequently alleviated even
  by the first dose. The dose for a child of one year old, is a quarter
  of a grain dissolved in a cup of any liquid, repeated two or three
  times a-day. For a child of two years the dose is half a grain; and
  the quantity must be thus increased in proportion to the age of the
  patient.

Footnote 115:

  Some recommend the extract of hemlock as an extraordinary remedy in
  the hooping-cough; but so far as I have been able to observe, it is no
  way superior to opium, which, when properly administered, will often
  relieve some of the most troublesome symptoms of this disorder.

Footnote 116:

  When quicksilver is given in too large quantities, it defeats its own
  intention, as it drags down the bottom of the stomach, which prevents
  it getting over the Pylorus. In this case the patient should be hung
  up by the heels, in order that the quicksilver may be discharged by
  his mouth.

Footnote 117:

  See Appendix, _Anti-hysteric Plaster_.

Footnote 118:

  As the smoke of tobacco thrown into the bowels will often procure a
  stool when all other means have failed, an apparatus for this purpose
  ought to be kept by every surgeon. It may be purchased at a small
  expence, and will be of service in several other cases, the recovery
  of drowned persons, &c.

Footnote 119:

  The Ureters are two long and small canals, one on each side, which
  carry the urine from the bason of the kidneys to the bladder. They are
  sometimes obstructed by small stones of gravel falling down from the
  kidneys, and lodging in them.

Footnote 120:

  I knew a gentleman who has had several abscesses of the liver opened,
  and is now a strong and healthy man, though above eighty years of age.

Footnote 121:

  I have been twice brought to the gates of death by this disease, and
  both times it was occasioned by eating rancid bacon.

Footnote 122:

  See Appendix, _White Decoction_.

Footnote 123:

  See Appendix, _Tincture of Roses_.

Footnote 124:

  See Appendix, _Lime-water_.

Footnote 125:

  The caustic alkali may be prepared by mixing two parts of quicklime
  with one of pot-ashes, and suffering them to stand till the lixivium
  be formed, which must be carefully filtrated before it be used. If the
  solution does not happen readily, a small quantity of water may be
  added to the mixture.

Footnote 126:

  The manner of making this broth is, to take a sheep’s head and feet
  with the skin upon them, and to burn the wool off with a hot iron;
  afterwards to boil them till the broth is quite a jelly. A little
  cinnamon or mace may be added, to give the broth an agreeable flavour,
  and the patient may take a little of it warm with toasted bread three
  or four times a-day. A clyster of it may likewise be given twice
  a-day. Such as cannot use the broth made in this way, may have the
  head and feet skinned; but we have reason to believe that this hurts
  the medicine. It is not our business here to reason upon the nature
  and qualities of medicine, otherwise this might be shewn to possess
  virtues every way suited to the cure of a dysentery which does not
  proceed from a putrid state of the humours. One thing we know, which
  is preferable to all reasoning, that whole families have often been
  cured by it, after they had used many other medicines in vain. It
  will, however, be proper that the patient take a vomit, and a dose or
  two of rhubarb, before he begins to use the broth. It will likewise be
  necessary to continue the use of it for a considerable time, and to
  make it the principal food.

Footnote 127:

  The learned and humane Dr. Rutherford, late professor of medicine in
  the university of Edinburgh, used to mention this food in his public
  lectures with great encomiums. He directed it to be made by tying a
  pound or two of the finest flour, as tight as possible, in a linen
  rag, afterwards to dip it frequently in water, and to dredge the
  outside with flour, till a cake or crust was formed around it, which
  prevents the water from soaking into it while boiling. It is then to
  be boiled till it becomes a hard dry mass, as directed above. This,
  when mixed with milk and water, will not only answer the purpose of
  food, but may likewise be given in clysters.

Footnote 128:

  I lately saw a young man who had been seized with a dysentery in North
  America. Many things had been tried there for his relief, but to no
  purpose. At length, tired out with disappointments from medicine, and
  reduced to skin and bone, he came over to Britain, rather with a view
  to die among his relations, than with any hopes of a cure. After
  taking sundry medicines here with no better success than abroad, I
  advised him to leave off the use of drugs, and to trust entirely to a
  diet of milk and fruits, with gentle exercise. Strawberries was the
  only fruit he could procure at that season. These he ate with milk
  twice, and sometimes thrice a-day. The consequence was, that in a
  short time his stools were reduced from upwards of twenty in a-day, to
  three or four, and sometimes not so many. He used the other fruits as
  they came in, and was in a few weeks so well as to leave that part of
  the country where I was, with a view to return to America.

Footnote 129:

  See Appendix, _Decoction of Logwood_.

Footnote 130:

  See Appendix, _Decoction of Sarsaparilla_.

Footnote 131:

  When the pain is very violent, and does not yield to small doses of
  laudanum, the quantity may be increased. I have known a patient in
  extreme pain take three hundred drops in twenty-four hours; but such
  doses ought only to be administered by a person of skill.

Footnote 132:

  This may always be prevented by the operator striking upon the teeth
  with any piece of metal, as this never fails to excite the pain in the
  carious tooth.

Footnote 133:

  These are prepared by steeping or soaking pease in water, and
  afterwards drying them in a pot or kiln till they be quite hard. They
  may be used at pleasure.

Footnote 134:

  That worms exist in the human body there can be no doubt; and that
  they must sometimes be considered as a disease, is equally certain:
  but this is not the case so often as people imagine. The idea that
  worms occasion many diseases, gives an opportunity to the professed
  worm-doctors of imposing on the credulity of mankind, and doing much
  mischief. They find worms in every case, and liberally throw in their
  antidotes, which generally consist of strong, drastic purges. I have
  known these given in delicate constitutions to the destruction of the
  patient, where there was not the least symptom of worms.

Footnote 135:

  A medical writer of the present age has enumerated upwards of fifty
  British plants, all celebrated for killing and expelling worms.

Footnote 136:

  A powder for the tape-worm resembling this, was long kept a secret on
  the Continent; it was lately purchased by the French king, and will be
  found under the article _Powder_, in the Appendix.

Footnote 137:

  We think it necessary here to warn people of their danger who buy
  cakes, powders, and other worm medicines, at random from quacks, and
  give them to their children without proper care. The principal
  ingredients in most of these medicines is mercury, which is never to
  be trifled with. I lately saw a shocking instance of the danger of
  this conduct. A girl who had taken a dose of worm powder, bought of a
  travelling quack, went out, and perhaps was so imprudent as to drink
  cold water during its operation. She immediately swelled, and died on
  the following day, with all the symptoms of having been poisoned.

Footnote 138:

  The very name of an operation is dreadful to most people, and they
  wish to try every thing before they have recourse to it. This is the
  reason why tapping so seldom succeeds to our wish. I have had a
  patient who was regularly tapped once a month for several years, and
  who used to eat her dinner as well after the operation as if nothing
  had happened. She died at last rather worn out by age than by the
  disease.

Footnote 139:

  Some make a secret of curing the gout by _muscular exercise_. This
  secret, however, is as old as Celsus, who strongly recommends that
  mode of cure; and whoever will submit to it, in the fullest extent,
  may expect to reap solid and permanent advantages.

Footnote 140:

  See Appendix, _Warm Plaster_.

Footnote 141:

  The scrophula, as well as the rickets, is found to prevail in large
  manufacturing towns, where people live gross, and lead sedentary
  lives.

Footnote 142:

  Sir John Pringle observes, that though this disease may seem trifling,
  there is no one in the army that is more troublesome to cure, as the
  infection often lurks in clothes, &c. and breaks out a second, or even
  a third time. The same inconveniency occurs in private families,
  unless particular regard is paid to the changing or cleaning of their
  clothes, which last is by no means an easy operation.

Footnote 143:

  The itch is now by cleanliness banished from every genteel family in
  Britain. It still however prevails among the poorer sort of peasants
  in Scotland, and among the manufacturers in England. These are not
  only sufficient to keep the seeds of the disease alive, but to spread
  the infection among others. It were to be wished that some effectual
  method could be devised for extirpating it altogether. Several country
  clergymen have told me, that by getting such as were infected cured,
  and strongly recommending an attention to cleanliness, they have
  banished the itch entirely out of their parishes. Why might not others
  do the same?

Footnote 144:

  After copious evacuations, large doses of æther have been found very
  efficacious in removing a fit of the asthma. I have likewise known the
  following mixture produce very happy effects: To four or five ounces
  of the solution of gum-ammoniac add two ounces of simple
  cinnamon-water, the same quantity of balsamic syrup, and half an ounce
  of paregoric elixir. Of this two table-spoonfuls may be taken every
  three hours.

Footnote 145:

  I knew a woman who in a violent fit of anger was seized with a
  sanguine apoplexy. She at first complained of extreme pain, _as if
  daggers had been thrust through her head_, as she expressed it.
  Afterwards she became comatose, her pulse sunk very low, and was
  exceeding slow. By bleeding, blistering, and other evacuations, she
  was kept alive for about a fortnight. When her head was opened, a
  large quantity of extravasated blood was found in the left ventricle
  of the brain.

Footnote 146:

  The learned Dr. Arbuthnot advises those who are troubled with
  costiveness to use animal oils, as fresh butter, cream, marrow, fat
  broths, especially those made of the internal parts of animals, as the
  liver, heart, midriff, &c. He likewise recommends the expressed oils
  of mild vegetables, as olives, almonds, pastaches, and the fruits
  themselves; all oily and mild fruits, as figs; decoctions of mealy
  vegetables; these lubricate the intestines; some saponaceous
  substances which stimulate gently, as honey, hydromel, or boiled honey
  and water, unrefined sugar, &c.

  The Doctor observes, that such lenitive substances are proper for
  persons of dry atrabilarian constitutions, who are subject to
  astriction of the belly, and the piles, and will operate when stronger
  medicinal substances are sometimes ineffectual; but that such lenitive
  diet hurts those whose bowels are weak and lax. He likewise observes,
  that all watery substances are lenitive, and that even common water,
  whey, sour milk, and butter-milk, have that effect;—That new milk,
  especially asses milk, stimulates still more when it sours on the
  stomach; and that whey turned sour will purge strongly;—That most
  garden fruits are likewise laxative; and that some of them, as grapes,
  will throw such as take them immoderately into a cholera morbus, or
  incurable diarrhœa.

Footnote 147:

  Many people imagine, that tea has no tendency to hurt the nerves, and
  that drinking the same quantity of warm water would be equally
  pernicious. This however seems to be a mistake. Many persons drink
  three or four cups of warm milk and water daily, without feeling any
  bad consequences; yet the same quantity of tea will make their hands
  shake for twenty-four hours. That tea affects the nerves, is likewise
  evident from its preventing sleep, occasioning giddiness, dimness of
  the sight, sickness, &c.

Footnote 148:

  See Appendix, _Electuary for the Epilepsy_.

Footnote 149:

  Many nervous people find great benefit from eating a dry biscuit,
  especially when the stomach is empty. I look upon this as one of the
  best carminative medicines; and would recommend it in all complaints
  of the stomach, arising from flatulence, indigestion, &c.

Footnote 150:

  Though the patient may begin with this quantity, it will be necessary
  to increase the dose gradually as the stomach can bear it. Æther is
  now given in considerably greater doses than it was in Dr. Whytt’s
  time.

Footnote 151:

  When hysteric fits are occasioned by sympathy, they may be cured by
  exciting an opposite passion. This is said to have been the case of a
  whole school of young ladies in Holland, who were all cured by being
  told, that the first who was seized should be burnt to death. But this
  method of cure, to my knowledge, will not always succeed. I would
  therefore advise, that young ladies who are subject to hysteric fits
  should not be sent to boarding schools, as the disease may be caught
  by imitation. I have known madness itself brought on by sympathy.

Footnote 152:

  Though antispasmodics and anodynes are universally recommended in this
  disease, yet all the extraordinary cures that I ever knew in hysteric
  cases, were performed by means of tonic and corroborating medicines.

Footnote 153:

  Some persons afflicted with cramps pretend to reap great benefit from
  small bundles of rosemary tied all night about their feet, ancles, and
  knees.

Footnote 154:

  Armstrong on Health.

Footnote 155:

  It is a pity those who have the misfortune to be born blind, or who
  lose their sight when young, should be suffered to remain in
  ignorance, or to beg. This is both cruelty and want of economy. There
  are many employments of which blind persons are very capable, as
  knitting, carding, turning a wheel, teaching languages, &c. Nor are
  instances wanting of persons who have arrived at the highest pitch of
  learning, without having the least idea of light. Witness the late
  famous Nicholas Sanderson of Cambridge, and my worthy friend Dr.
  Thomas Blacklock of Edinburgh. The former was one of the first
  mathematicians of his age, and the latter, besides being a good poet
  and philosopher, is master of all the learned languages, and a very
  considerable adept in the liberal arts.

Footnote 156:

  Though those who have the misfortune to be born deaf are generally
  suffered to continue dumb, and consequently are in a great measure
  lost to society, yet nothing is more certain than that such persons
  may be taught not only to read and write, but also to speak, and to
  understand what others say to them. Teaching the dumb to speak will
  appear paradoxical to those who do not consider that the formation of
  sounds is merely mechanical, and may be taught without the assistance
  of the ear. This is not only capable of demonstration, but is actually
  reduced to practice by the ingenious Mr. Thomas Braidwood of
  Edinburgh. This gentleman has, by the mere force of genius and
  application, brought the teaching of dumb persons to such a degree of
  perfection, that his scholars are generally more forward in their
  education than those of the same age who enjoy all their faculties.
  They not only read and write with the utmost readiness, but likewise
  _speak_, and are capable of holding conversation with any person in
  the light. What a pity any of the human species should remain in a
  state of idiotism, who are capable of being rendered as useful and
  intelligent as others! We mention this not only from humanity to those
  who have the misfortune to be born deaf, but also in justice to Mr.
  Braidwood, whose success has far exceeded all former attempts this
  way; and indeed it exceeds imagination itself so far, that no person
  who has not seen and examined his pupils, can believe what they are
  capable of.—As this gentleman, however willing, is only able to teach
  a few, and as the far greater part of those who are born deaf cannot
  afford to attend him, it would be an act of great humanity, as well as
  of public utility, to erect an academy for their benefit.

Footnote 157:

  A gentleman, on whose veracity I can depend, told me, that after using
  many things to no purpose for an obstinate deafness, he was at last
  advised to put a few drops of his own urine warm into his ears every
  night and morning, from which he received great benefit. It is
  probable that a solution of _sal ammoniac_, in water, would produce
  the same effect.

Footnote 158:

  London Medical Essays.

Footnote 159:

  In a cancer which had set all medicines, and even surgery, at
  defiance, I lately saw remarkable effects from an obstinate
  perseverance in a course of antiseptics. I ordered the deep ulcers to
  be washed to the bottom by means of a syringe, twice or thrice a-day,
  either with an infusion of the bark, or a decoction of carrot, and
  that the patient should take four or five times a-day, a glass of good
  wine, with half a drachm of the best powdered bark in it. The sores,
  after being washed, were likewise sprinkled with the same powder. When
  the patient began this course, her death was daily expected. She
  continued it for above two years, with manifest advantage; but being
  told by an eminent surgeon, that the bark would not cure a cancer, and
  that the sores ought not to be washed, she discontinued the practice,
  and died in a few weeks. This course was not expected to cure the
  cancer, but to prolong the patient’s life, which it evidently did
  almost to a miracle.

Footnote 160:

  As hemlock is the principal medicine recommended in this disease, we
  would have given some directions for the gathering and preparing of
  that plant; but as its different preparations are now kept in the
  shops, we think it much safer for people to get them there, with
  proper directions for using them.

Footnote 161:

  Though we give this prescription on the credit of Dr. Mead, yet we
  would not advise any person, who has reason to believe that he has
  been bit by a dog which was really mad, to trust to it alone. Mead was
  an able physician, but he seems to have been no great philosopher, and
  was some times the dupe of his own credulity.

Footnote 162:

  The Ormskirk medicine, as it is called, seems to me to consist chiefly
  of cinnabar. Though it is said to be infallible, as a preventive; yet
  I would not advise any one to trust to it alone. Indeed it is ordered
  to be taken in a manner which gives it more the appearance of a charm
  than of a medicine. Surely if a medicine is to produce any change in
  the body, it must be taken for some considerable time, and in
  sufficient quantity.

Footnote 163:

  The practice of sucking out poisons is very ancient; and indeed
  nothing can be more rational. Where the bite cannot be cut out, this
  is the most likely way for extracting the poison. There can be no
  danger in performing this office, as the poison does no harm unless it
  be taken into the body by a wound. The person who sucks the wound
  ought however to wash his mouth frequently with salad-oil, which will
  secure him from even the least inconveniency. The _Psylli_ in Africa,
  and the _Marsi_ in Italy, were famed for curing the bites of poisonous
  animals by sucking the wound; and we are told, that the Indians in
  North America practise the same at this day.

Footnote 164:

  Although it is now very common to cure the gonorrhœa by astringent
  injections, there are still many practitioners who do not approve this
  mode of practice. I can, however, from much experience, assert, that
  it is both the most easy, elegant, and efficacious method of cure; and
  that any bad consequences arising from it must be owing to the
  ignorance or misconduct of the practitioner himself, and not to the
  remedy. Many, for example, use strong preparations of lead, all of
  which are dangerous when applied to the internal surfaces of the body;
  others use escharotics, which inflame and injure the parts. I have
  known a gonorrhœa actually cured by an injection made of green tea,
  and would always recommend gentle methods where they will succeed.

Footnote 165:

  If the patient can swallow a solution of salts and manna, he may take
  six drachms, or, if his constitution requires it, an ounce of the
  former, with half an ounce of the latter. These may be dissolved in an
  English pint of boiling water, whey, or thin water-gruel, and taken
  early in the morning.

  If an infusion of senna and tamarinds be more agreeable, two drachms
  of the former, and an ounce of the latter, may be infused all night in
  an English pint of boiling water. The infusion may be strained next
  morning, and half an ounce of Glauber’s salts dissolved in it. A
  tea-cupful of this infusion may be taken every half hour till it
  operates.

  Should the patient prefer an electuary, the following will be found to
  answer very well. Take of the lenitive electuary four ounces, cream of
  tartar two ounces, jalap in powder two drachms, rhubarb one drachm,
  and as much of the syrup of pale roses as will serve to make up the
  whole into a soft electuary. Two or three tea-spoonfuls of this may be
  taken over-night, and about the same quantity next morning, every day
  that the patient chuses to take a purge.

  The doses of the above medicines may be increased or diminished
  according as the patient finds it necessary. We have ordered the salts
  to be dissolved in a large quantity of water, because it renders their
  operation more mild.

Footnote 166:

  Take quicksilver one drachm, gum-arabic reduced to a mucilage two
  drachms; let the quicksilver be rubbed with the mucilage, in a marble
  mortar, until the globules of mercury entirely disappear; afterwards
  add gradually, still continuing the trituration, half an ounce of
  balsamic syrup, and eight ounces of simple cinnamon-water. Two
  table-spoonfuls of this solution may be taken night and morning. Some
  reckon this the best form in which quicksilver can be exhibited for
  the cure of a gonorrhœa.

Footnote 167:

  The Peruvian bark may be combined with other astringents, and prepared
  in the following manner:

  Take of Peruvian bark bruised six drachms, of fresh galls bruised two
  drachms; boil them in a pound and a half of water to a pound; to the
  strained liquor add three ounces of the simple tincture of the bark. A
  small tea-cupful of this may be taken three times a-day, adding to
  each cup fifteen or twenty drops of the acid elixir of vitriol.

Footnote 168:

  Take Venice turpentine, boiled to a sufficient degree of hardness,
  half an ounce, calomel half a drachm. Let these be mixed and formed
  into sixty pills, of which five or six may be taken night and morning.
  If, during the use of these pills, the mouth should grow sore, or the
  breath become offensive, they must be discontinued till these symptoms
  disappear.

Footnote 169:

  I have been accustomed for some time past to apply leeches to inflamed
  testicles, which practice has always been followed with the most happy
  effects.

Footnote 170:

  The extract of hemlock may be made into pills, and taken in the manner
  directed under the article Cancer.

Footnote 171:

  For the dispersion of a bubo, a number of leeches applied to the part
  affected will be found equally efficacious as in the inflamed
  testicle.

Footnote 172:

  When venereal ulcers are seated in the lips, the infection may be
  communicated by kissing. I have seen very obstinate venereal ulcers in
  the lips, which I had all the reason in the world to believe were
  communicated in this manner.

  Nurses ought to beware of suckling infected children, or having their
  breasts drawn by persons tainted with the venereal disease. This
  caution is peculiarly necessary for nurses who reside in the
  neighbourhood of great towns.

Footnote 173:

  I have found it answer extremely well to sprinkle chancres twice a-day
  with calomel. This will often perform a cure without any other
  application whatever. If the chancres are upon the _glans_, they may
  be washed with milk and water, a little warm, and afterwards the
  calomel may be applied as above.

Footnote 174:

  The sublimate may be given in distilled water, or any other liquor
  that the patient chuses. I commonly order ten grains to be dissolved
  in an ounce of the spirit of wine, for the conveniency of carriage,
  and let the patient take twenty or thirty drops of it night and
  morning in half a glass of brandy or other spirits. Mr. Debraw, an
  ingenious chymist of this place, informs me, that he prepares a salt
  of mercury much more mild and gentle in its operation than the
  sublimate, though equally efficacious.

Footnote 175:

  See Appendix, _Decoct. of Sarsaparilla_.

Footnote 176:

  Though we are still very much in the dark with regard to the method of
  curing this disease among the natives of America, yet it is generally
  affirmed, that they do cure it with speed, safety, and success, and
  that without the least knowledge of mercury. Hence it becomes an
  object of considerable importance to discover their method of cure.
  This might surely be done by making trials of the various plants which
  are found in those parts, and particularly of such as the natives are
  known to make use of. All people in a rude state take their medicines
  chiefly from the vegetable kingdom, and are often possessed of
  valuable secrets with regard to the virtues of plants, of which more
  enlightened nations are ignorant. Indeed we make no doubt but some
  plants of our own growth, were proper pains taken to discover them,
  would be found as efficacious in curing the venereal disease as those
  of America. It must however be remembered, that what will cure the
  venereal disease in one country, will not always be found to have
  equal success in another.

Footnote 177:

  I have not only often seen a recent infection carried off in a few
  days by means of cleanliness, viz. bathing, fomentations, injections,
  &c. but have likewise found it of the greatest advantage in the more
  advanced stages of the disease. Of this I had lately a very remarkable
  instance, in a man whose penis was almost wholly consumed by venereal
  ulcers; the matter had been allowed to continue on the sores, without
  any care having been taken to clean them, till, notwithstanding the
  use of mercury and other medicines, it had produced the effects above
  mentioned. I ordered warm milk and water to be injected three or four
  times a-day into all the sinuous ulcers, in order to wash out the
  matter; after which they were stuffed with dry lint to absorb the
  fresh matter as it was generated. The patient at the same time took
  every day half a grain of the corrective sublimate of mercury,
  dissolved in an ounce of brandy, and drank an English quart of the
  decoction of sarsaparilla. By this treatment, in about six weeks, he
  was perfectly cured; and, what was very remarkable, a part of the
  penis was actually regenerated.

  Doctor Gilchrist has given an account of a species of the _lues
  venerea_ which prevails in the west of Scotland, to which the natives
  give the name of _Sibbins_ or _Sivvins_. The Doctor observes, that the
  spreading of this disease is chiefly owing to a neglect of
  cleanliness, and seems to think, that by due attention to that
  _virtue_, it might be extirpated. The treatment of this disease is
  similar to that of a confirmed lues or pox. The _yaws_, a disease
  which is now very common both in America and the West India islands,
  may also be cured in the same manner.

Footnote 178:

  It is the duty of mothers, and those who are intrusted with the
  education of girls, to instruct them early in the conduct and
  management of themselves at this critical period of their lives. False
  modesty, inattention, and ignorance of what is beneficial or hurtful
  at this time, are the sources of many diseases and misfortunes in
  life, which a few sensible lessons from an experienced matron might
  have prevented. Nor is care less necessary in the subsequent returns
  of this discharge. Taking improper food, violent affections of the
  mind, or catching cold at this period, is often sufficient to ruin the
  health, or to render the female ever after incapable of procreation.

Footnote 179:

  Two drachms of allum and one of Japan earth may be pounded together,
  and divided into eight or nine doses, one of which may be taken three
  times a day.

  Persons whose stomachs cannot bear the allum, may take two
  table-spoonfuls of the tincture of roses three or four times a-day, to
  each dose of which ten drops of laudanum may be added.

  If these should fail, half a drachm of the Peruvian bark, in powder,
  with ten drops of the elixir of vitriol, may be taken, in a glass of
  red wine, four times a-day.

Footnote 180:

  Every mother who procures an abortion does it at the hazard of her
  life; yet there are not a few who run this risk merely to prevent the
  trouble of bearing and bringing up children. It is surely a most
  unnatural crime, and cannot, even in the most abandoned, be viewed
  without horror; but in the decent matron, it is still more
  unpardonable.—Those wretches who daily advertise their assistance to
  women in this business, deserve, in my opinion, the most severe of all
  human punishments.

Footnote 181:

  Though the management of women in child-bed has been practised as an
  employment since the earliest accounts of time; yet it is still in
  most countries on a very bad footing. Few women think of following
  this employment till they are reduced to the necessity of doing it for
  bread. Hence not one in a hundred of them have any education, or
  proper knowledge of their business. It is true, that Nature, if left
  to herself, will generally expel the _fœtus_; but it is equally true,
  that most women in child-bed require to be managed with skill and
  attention, and that they are often hurt by the superstitious
  prejudices of ignorant and officious midwives. The mischief done in
  this way is much greater than is generally imagined; most of which
  might be prevented by allowing no women to practise midwifery but such
  as are properly qualified. Were due attention paid to this, it would
  not only be the means of saving many lives, but would prevent the
  necessity of employing men in this indelicate and disagreeable branch
  of medicine, which is, on many accounts, more proper for the other
  sex.

Footnote 182:

  We cannot help taking notice of that ridiculous custom which still
  prevails in some parts of the country, of collecting a number of women
  together upon such occasions. These, instead of being useful, serve
  only to crowd the house, and obstruct the necessary attendants.
  Besides, they hurt the patient with their noise; and often, by their
  untimely and impertinent advice, do much mischief.

Footnote 183:

  In a violent flooding after delivery, I have seen very good effects
  from the following mixture: Take of penny-royal water, simple
  cinnamon-water, and syrup of poppies, each two ounces, elixir of
  vitriol a drachm. Mix, and take two table-spoonfuls every two hours,
  or oftner, if necessary.

Footnote 184:

  Take of crabs claws prepared half an ounce, purified nitre two
  drachms, saffron powdered half a drachm; rub them together in a
  mortar, and divide the whole into eight or nine doses.

  When the patient is low-spirited, or troubled with hysterical
  complaints, she ought to take frequently twelve or fifteen drops of
  the tincture of asafœtida in a cup of penny-royal tea.

Footnote 185:

  Midwives ought to be very cautious in administering vomits or purges
  to women in child-bed. I have known a woman, who was recovering
  extremely well, thrown into the most imminent danger, by a strong
  purge which was given her by an officious midwife.

Footnote 186:

  Dr. Cheyne avers, that want of children is oftner the fault of the
  male than of the female, and strongly recommends a milk and vegetable
  diet to the former as well as the latter; adding, that his friend Dr.
  Taylor, whom he calls the Milk-doctor of Croydon, had brought sundry
  opulent families in his neighbourhood, who had continued some years
  after marriage without progeny, to have several fine children, by
  keeping both parents, for a considerable time, to a milk and vegetable
  diet.

Footnote 187:

  Of the officious and ill-judged care of midwives, we shall adduce only
  one instance, viz. the common practice of torturing infants by
  squeezing their breasts, to draw off the milk, as they call it. Though
  a small quantity of moisture is generally found in the breasts of
  infants, yet, as they are certainly not intended to give suck, this
  ought never to be drawn off. I have seen this cruel operation bring on
  hardness, inflammation, and suppuration of the breasts; but never knew
  any ill consequences from its being omitted. When the breasts are
  hard, the only application that we would recommend is a soft poultice,
  or a little of the diachylon plaster, spread thin upon a bit of soft
  leather, about the size of half a crown, and applied over each nipple.
  These may be suffered to continue till the hardness disappears.

Footnote 188:

  See Appendix, _Laxative absorbent Mixture_.

Footnote 189:

  Some nurses remove this complaint by sucking the child’s nose. This is
  by no means a cleanly operation; but when nurses have the resolution
  to do it, I am far from discouraging the practice.

Footnote 190:

  I some time ago saw a very striking instance of the danger of
  substituting drying medicines in the place of cleanliness and
  wholesome food, in the Foundling Hospital at Ackworth, where the
  children were grievously afflicted with scabbed heads and other
  cutaneous disorders. Upon inquiry it was found, that very little
  attention was paid either to the propriety or soundness of their
  provisions, and that cleanliness was totally neglected; accordingly it
  was advised that they should have more wholesome food, and be kept
  thoroughly clean. This advice, however, was not followed. It was too
  troublesome to the servants, superintendants, &c. The business was to
  be done by medicine; which was accordingly attempted, but had nearly
  proved fatal to the whole house. Fevers and other internal disorders
  immediately appeared, and at length a putrid dysentery, which proved
  so infectious, that it carried off a great many of the children, and
  spread over a considerable part of the neighbouring country.

Footnote 191:

  In this disease bleeding is not always proper; but in very full habits
  it must certainly be of use.

Footnote 192:

  I was lately favoured with a letter from Dr. William Turnbull in
  London, a physician of great experience, and who, from his former
  situation on the north-east coast of England, had many opportunities
  of observing the symptoms and progress of this dangerous disease. I am
  sorry the letter came too late to be inserted at length; but as the
  Doctor’s sentiments differ very little from my own, this misfortune is
  the less to be regretted. The Doctor indeed observes, that he never
  found blistering of any service; but recommends cataplasms of garlic,
  camphor, and Venice treacle, to be applied both to the throat and
  soles of the feet. He likewise recommends boluses of camphor, castor,
  valerian root, salt of hartshorn, and musk, adapted to the age,
  strength, &c. of the patient; after which he advises two spoonfuls of
  the following decoction:—Take of garlic and distilled vinegar each an
  ounce, hysop-water eight ounces; beat up the ingredients together,
  gradually mixing the water, and adding three ounces of honey. Let the
  whole be simmered over a gentle fire, and afterwards drained for use.

Footnote 193:

  One reason why this disease is seldom or never cured, may be, that it
  is seldom known till too far advanced to admit of remedy. Did parents
  watch the first symptoms, and call a physician in due time, I am
  inclined to think that something might be done. But these symptoms are
  not yet sufficiently known, and are often mistaken even by physicians
  themselves. Of this I lately saw a striking instance in a patient
  attended by an eminent practitioner of this city, who had all along
  mistaken the disease for teething.

Footnote 194:

  Dr. Tissot, in his _Advice to the People_, gives the following
  directions for gathering, preparing, and applying the agaric.—“Gather
  in autumn,” says he, “while the fine weather lasts, the agaric of the
  oak, which is a kind of fungus or excrescence issuing from the wood of
  that tree. It consists at first of four parts, which present
  themselves successively: 1. The outward rind or skin, which may be
  thrown away. 2. The part immediately under this rind, which is the
  best of all. This is to be beat well with a hammer, till it becomes
  soft and very pliable. This is the only preparation it requires, and a
  slice of it of a proper size is to be applied directly over the
  bursting open blood vessels. It constringes and brings them close
  together, stops the bleeding, and generally falls off at the end of
  two days. 3. The third part adhering to the second may serve to stop
  the bleeding from the smaller vessels; and the fourth and last part
  may be reduced to powder as conducing to the same purpose.”—Where the
  agaric cannot be had, sponge may be used in its stead. It must be
  applied in the same manner, and has nearly the same effects.

Footnote 195:

  See Appendix, _Wax plaster_.

Footnote 196:

  See Appendix, _Yellow basilicum_.

Footnote 197:

  See Appendix, _Turner’s cerate_.

Footnote 198:

  In ulcers of the lower limbs great benefit is often received from
  tight rollers, or wearing a laced stocking, as this prevents the flux
  of humours to the sores, and disposes them to heal.

Footnote 199:

  Various pieces of machinery have been contrived for counteracting the
  force of the muscles, and retaining the fragments of broken bones; but
  as descriptions of these without drawings would be of little use, I
  shall refer the reader to a cheap and useful performance _on the
  nature and cure of fractures_, lately published by my ingenious friend
  Mr. Aitken, surgeon in Edinburgh; wherein that gentleman has not only
  given an account of the machines recommended in fractures by former
  authors, but has likewise added several improvements of his own, which
  are peculiarly useful in compound fractures, and in cases where
  patients with broken bones are obliged to be transported from one
  place to another.

Footnote 200:

  A great many external applications are recommended for strains, some
  of which do good, and others hurt. The following are such as may be
  used with the greatest safety, viz. poultices made of stale beer or
  vinegar and oatmeal, camphorated spirits of wine, Mindererus’s spirit,
  volatile liniment, volatile aromatic spirit diluted with a double
  quantity of water, and the common fomentation, with the addition of
  brandy or spirit of wine.

Footnote 201:

  I would here beg leave to recommend it to every practitioner, when his
  patient complains of pain in the belly with obstinate costiveness, to
  examine the groins and every place where a rupture may happen, in
  order that it may be immediately reduced. By neglecting this, many
  perish who were not suspected to have had ruptures till after they
  were dead. I have known this happen where half a dozen of the faculty
  were in attendance.

Footnote 202:

  A woman in one of the hospitals of this city lately discharged a great
  number of pins, which she had swallowed in the course of her business,
  through an ulcer in her side.

Footnote 203:

  These accidents are not always the effects of carelessness. I have
  known an infant overlaid by its mother being seized in the night with
  an hysteric fit. This ought to serve as a caution against employing
  hysteric women as nurses; and should likewise teach such women never
  to lay an infant in the same bed with themselves, but in a small
  adjacent one.

Footnote 204:

  The Author is happy to observe, that, since the first publication of
  this work, several societies have been instituted in Britain with the
  same benevolent intention as that of Amsterdam, and that their
  endeavours have proved no less successful. He is likewise happy to
  observe, that premiums have been awarded to those who have been active
  in their endeavours to restore to life persons who had been drowned,
  or suddenly deprived of life by any accident. How much is this
  superior to the superstitious institution, which allows any man a
  premium who brings a dead person out of the water, so that he may
  receive Christian burial; but allows nothing to the person who brings
  him out alive, or who recovers him after he has been to all appearance
  dead.

Footnote 205:

  The late celebrated Dr. Smollet has indeed said, that if he were
  persuaded he had an ulcer in the lungs, he would jump into the cold
  bath: but here the Doctor evidently shews more courage than
  discretion; and that he was more a man of wit than a physician, every
  one will allow. A nervous asthma, or an atrophy, may be mistaken for a
  pulmonary consumption; yet, in the two former, the cold bath proves
  often beneficial, though I never knew it to in the latter. Indeed, all
  the phthisical patients I ever saw, who had tried the cold bath, were
  evidently hurt by it.

Footnote 206:

  The celebrated Galen says, that immersion in cold water is fit only
  for the young of lions and bears; and recommends warm bathing, as
  conducive to the growth and strength of infants. How egregiously do
  the greatest men err whenever they lose sight of facts, and substitute
  reasoning in physic in place of observation and experience!

Footnote 207:

  The greatest class of mineral waters in this country is the
  chalybeate. In many parts of Britain these are to be found in almost
  every field; but those chiefly in use, for medical purposes, are the
  purging chalybeates, as the waters of Scarborough, Cheltenham, Thorp
  Arch, Nevil Holt, &c. Of those which do not purge, the waters of
  Tunbridge stand in the highest repute. The saline purging waters, as
  those of Acton, Epsom, Kilburn, &c. are also in very general esteem;
  but the fountains most frequented by the sick in this country, are
  those to which the minerals impart a certain degree of heat, as Bath,
  Bristol, Buxton, &c.

Footnote 208:

  When I speak of drinking a glass of the water over-night, I must beg
  leave to caution those who follow this plan against eating heavy
  suppers. The late Dr. Daultry of York, who was the first that brought
  the Harrowgate waters into repute, used to advise his patients to
  drink a glass before they went to bed; the consequence of which was,
  that having eat a flesh supper, and the water operating in the night,
  they were often tormented with gripes, and obliged to call for medical
  assistance.

Footnote 209:

  See a paper on this subject in the Edinburgh Physical and Literary
  Essays, by the ingenious Dr. John Gardener.

Footnote 210:

  A very good tincture of guaiacum, for domestic use, may be made by
  infusing two or three ounces of the gum in a bottle of rum or brandy.

Footnote 211:

  See _Collyrium of Lead_.

------------------------------------------------------------------------




                          TRANSCRIBER’S NOTES


 Page Changed from                     Changed to

  161 If the patient be afflicted with If the patient be afflicted with
      reaching, or an inclination      retching, or an inclination

  357 sitting with the head bear near  sitting with the head bare near
      an open window, or               an open window, or

  415 as wearing flannel, lying to     as wearing flannel, lying too
      long a-bed                       long a-bed

  533 but induces a plethora, or two   but induces a plethora, or too
      great a fulness of               great a fulness of

 ● Typos fixed; non-standard spelling and dialect retained.
 ● Used numbers for footnotes, placing them all at the end of the last
     chapter.
 ● Enclosed italics font in _underscores_.



*** END OF THE PROJECT GUTENBERG EBOOK 74359 ***