j Surgeon General's Office a; ^ ■vo^J^v-yft ■•/-^y V -^ * '• .^ v > * V W» DOMESTIC MEDICINE, OR, A TREATISE ON THE PREVENTION AND CURE OF DISEASES BY REGIMEN AND SIMPLE MEDICINES. CONTAINING & Wupznuatovn for the Otoe ot $rtfcate $ractCttowettt, BY WILLIAM BUCHAN, M. D. EELLOW OE THE ROYAL COLLEGE OF PHYSICIANS, EDINBURGH. WITH CONSIDERABLE ADDITIONS, AND VARIOUS NOTES, BY A. P. BUCHAN, M. D. OF THE ROYAL COLLEGE OF PHYSICIANS, 'LONDON, AND PHYSICIAN TO THE WESTMINSTER HOSPITAL. TO WHICH IS ADDED, A FAMILY HERBAL. A NEW EDITION, REVISED AND AMENDED, BY JOHN G. COFFIN, M. D. FELLOW OF THE MASSACHUSETTS MEDICAL SOCIETY. Boston: *\(cU- PITBLISHED BY PHELPS AND FARNHAM, NO. 5, COURT STREET, AND NATHANIEL S. SIMPKINS, CORNER OF COURT AND BRATTLE STREETS. 1825. v\ z 2-dC 39 IS IS25 DISTRICT OF MASSACHUSETTS, TO WIT: District Clerk's Office. Be it remembered, that on the twenty ninth day of October, A.D. 1825, in the fiftieth year of the Independence of the United States of America, Phelps and Farnham and Nathaniel S. Simpkins, of the said District, have de- posited in this office the title of a book, the right whereof they claim as pro- prietors, in the words following, to wit: " Domestic Medicine, or, a Tn.utiie on the Prevention and cure of Diseases by Regimen and Simple Meclicim.'.:. Containing a Dispensatory for the Use of Private Practitioners. By William Buchan, I\l. D. Fellow of the Royal College of Physicians, Edinburgh. With considerable Additions and various Notes, by A. P. Buolian, M. D. Fellow of the Royal College of Physicians, London, and Physician to the Westminster Hospital. A new edition, Revised and Amended, by John G. Coffin, M. D. Fellow of the Massachusetts Medical Society." In conformity to the act of the Congress of the United States, entitled " An act for the encouragement of learning, by securing the copies of maps, charts and books, to the authors and proprietors of such copies, during the times therein mentioned :" and also to an act entitled v* An act supplementary to an act, entitled, An act for the encouragement of learning, by securing the copies of maps, charts and books to the authors and proprietors of such copies during the times therein mentioned ; and extending the benefits thereof to the arts of designing, engraviug and etching historical aud other prints." JNO. W. DAVIS, Cltrk of the District of Massachusetts. ADVERTISEMENT OF THE AMERICAN EDITOR, THE present edition of the Domestic Medicine is printed from the Twentyfirst London Edition, published by the author's son. In this edition, some articles of local and minor impor- tance have been omitted, and others of more value and interest have been inserted in their place. Dr. Buchan's language was uncommonly pure and unexceptionable for the period in which he wrote. A few words, however, then in reputable use, have since become obsolete, and somewhat offensive; these, w7ith the spelling of some others, have been so changed as to keep pace with the present improved state of our lan- guage. For the general character and success of this work, the reader is referred to the author's Advertisement and Preface. The author's instructions for the management of infants and children, are particularly valuable. Prevention is always better than cure ; for the latter involves pain, suffering and loss, even when practicable,—besides its being frequently un- attainable by the best means in our power. A knowledge of the most frequent causes of disease, and of the means of counteracting these causes, should everywhere constitute a part of education. This information, which is indispensable to the wellbeing of the individual, might be attained for much less expense of time and money, than the cost of many superficial and temporary acquirements, which are worth little or nothing to the possessor. iv THE A. E. ADVERTISEMENT. To the present edition is added an Herbal, a Glossary of medical terms, and some other articles, which the reader will readily perceive. The great object of the A. E. has been to render the work of Dr. Buchan, more useful. How far he has succeeded, he must leave others to judge. Some of the additions made by the A. E. are marked C. CONTENTS. To the Public, Page 1 Advertisement to the Eight- eenth Edition, 5 Preface, 8 Introduction, 13 PART I. Of the general Causes of Dis- eases. CHAP. I. Of Children, 21 — Diseased Parents, 25 — Clothing of Children, — Food of ditto, 27 31 — Exercise of ditto, 35 — Bad Effects of unwhole- some Air upon ditto, 42 — Nurses, 44 — On the Management of In fants, 47 CHAP. II. Of Physical Education, &c. 52 CHAP. III. Of the Laborious, &c. 63 — the Sedentary, — the Studious, 70 75 CHAP. IV. Of Aliment, 81 CHAP. v. Of Air, 90 CHAP. VI. Of Exercise, 95 CHAP. VII. Of Sleep, — Clothing, 100 102 CHAP. VIII.. Of Intemperance, 106 CHAP. IX. Of Cleanliness, 111 chap. x. I*age Of Infection, 115 CHAP. XT. Of the Passions, 120 — Anger, ib. — Fear, 121 — Grief, 123 — Love, 125 — Religious Melancholy, 126 CHAP. XII. Of the Common Evacuations, 127 — Stool, ib. — Urine, 129 — Perspiration, 130 — Changes in the Atmosphere.ib. — Wet Clothes, 131 — Wet Feet, ib. — Night Air, 132 —- Damp Houses, 133 — Sudden Transitions from Heat to Cold, 134 PART II. Of Diseases. CHAP. XIII. Of the Knowledge and Cure of Diseases, 137 CHAP. XIV. Fevers in general, 142 CHAP. XV. Of Intermitting Fevers or Agues, 147 CHAP. XVI. Of an Acute Continual Fever, 155 CHAP. XVII. Of the Pleurisy, 160 — the Bastard ditto, 164 CHAP. XVIII. Inflammation of the Lungs, 16il VI CONTENTS. CHAP. XIX. Of Consumptions, 167 CHAP. xx. Of the Slow or Nervous Fever, 1 88 CHAP. xx. Malignant, Putrid, or Spotted Fever, 194 CHAP. XXII. Miliary Fever, 202 CHAP. XXIII. Remitting Fever, 206 CHAP. XXIV. Of the Vaccine Disease, or Cowpock, 209 CHAP. XXV. The Measles, 217 ----Scarlet Fever, 220 ----Bilious Fever, 221 CHAP. XXVI. St. Anthony's Fire, 223 CHAP. XXVII. Inflammation of" the Brain, 227 CHAP. XXVIII. Inflammation of the Eyes, 231 CHAP. XXIX. The Quinsy, 236 ----Malignant ditto, 240 Of the Mumps, 244 CHAP. XXX. Colds and Coughs, 245 A Common Cough, 250 Chincough, 2.33 CHAP. XXXI. Inflammation of the Stomach, 256 -----------of the Intestines,258 Of the Colic, 260 Inflammation of the Kidnevs, 264 -----------of the Bladder, 266 -----------of the Liver, 2G7 CHAP. XXXII. Of the Cholera Morbus, and other excessive Discharges from the Stomach and Bow- els, 270 — a Diarrhoea, or Looseness, 272 — Vomiting, 275 CHAP, xxxiv. Of the Diabetes, and other Dis- • orders of the Kidneys and Bladder, . 277 .— Suppression of Urine, 280 Of the Gravel and Stone, 281 CHAP. XXXIV. Involuntary Discharges of Blood, 285 Bleeding at the Nose, 286 and Blind Piles, 289 Spitting of Blood, 292 Vomiting of ditto, 295 Bloody Urine, 296 Dysentery, or Bloody Flux , 297 CHAP. XXXV. Of the Headache, 302 — the Toothache, 305 — the Earache, 308 Pain of the Stomach, &c. 309 CHAP. XXXVI. Of Worms, 311 CHAP. XXXVII. Of the Jaundice, 316 CHAP. XXXVIII. Of the Dropsy, 318 CHAP. XXXIX. Of the Gout, 323 — the Rheumatism, 329 CHAP. XX. Of the Ssurvy, 332 — the Scrofula, 337 — the Itch, 34'2 CHAP. XLI. Of the Asthma, 344 CHAP. XLII. Of the Apoplexy, 348 CHAP. XLII I. Of Costiveness, 351 — Want of Appetite, ° ^ ■* — Heartburn, 354 CHAP. XLIV. Of Nervous Diseases, 355 — Melancholy, 360 — the Palsy, 363 — the Epilepsy, or Fall >ng Sickness, 364 — St. Vitus's Dance, 367 — the Hickup, 369 — Cramp of the Stomach, — the Night Mare, 370 S71 — Swoonings, 372 — Flatulencies, or Wind, 374 — Low Spirits, 376 — Hysteric Affections, 377 — Hypochondriac Aftections^SSO CONTENTS. vn CHAP. XLV. Disorders of the Senses, 385 --------of the Eye, ib. A Gutta Serena, 386 A Cataract, 387 Shortsightedness, ib. Seeing only at too great a Dis- tance, ib. Squinting, ib. Spots or Specks, ib. Bloodshot Eye, ib. Watery or Weeping Eye, 388 Of the Ear, ib. — the Taste and Smell, 390 — the Touch, 392 .CHAP. XLVI. Of Scirrhus and Cancer, 393 CHAP. XLVII. Of Poisons, 398 — Mineral Poisons, 400 , — Vegetable ditto, 401 Bites of Poisonous Animals, 402 ----of the Mad Dog, ib. ----of the Viper, 408 ----of Poisonous Insects, ib. ----of the Rattlesnake, 409 CHAP. XLVIII. Diseases of Women, 410 Of the Menstrual Discharge, 411 — Pregnancy, 416 — Childbirth, 419 — Barrenness, - 425 CHAP. XLIX. Diseases of Children, 426 Of the Meconium, 427 — the Apthse, or Thrush, 428 — Acidities, 429 — Galling and Excoriation, 430 — Stoppage of the Nose, 431 — Vomiting, ib. — a Looseness, 432 — Eruptions, 433 — the Croup, 435 — Teething, 436 — the Rickets, 438 — Convulsions, 440 — Water in the Head, 441 CHAP. L. Of Surgery, 443 — Bleeding, 444 Of Inflammations and Ab- scesses, 446 —. Wounds, 448 —- Burns, 451 — Bruises, 452 — Ulcers, 453 —• the Fistula in Ano, 454 CHAP. LI. Of Dislocations, 456 Dislocation of the Jaw, 457 ---------of the Neck, ib. ---------of the Ribs, 458 ---------of the Shoulder, 459 ---------of the Elbow, ib. of the Wrist and Fingers, 460 ---------of the Thigh, ib. ---------of the Knees, ib. ---------of the Ankles, ib. ---------of the Toes, ib. CHAP. LII. Of Broken Bones, &c. 461 — Strains, 463 — Ruptures, 464 CHAP. LIII. Of Casualties, 466 — Substances stopped be- tween the Mouth and Stomach, 467 — Drowned Persons, 471 — Noxious Vapors, 474 Effects of extreme Cold, 476 ---------------. Heat, 478 CHAP.'LTV. 1 Of Fainting Fits, and other Cases which require imme- diate Assistance, 478 — Intoxication, 482 — Suffocation and Strajigling,483 — Persons who expire in Con- vulsion Fits, 486 CHAP. LV. Of Cold Bathing, and drinking the Mineral Waters, 488 — Cold Bathing, with Re- marks on the Cases in which the Warm Bath is more adviseable, 489 — Mineral Waters, 499 > * vm CONTENTS. CHAP. LVI. Observations concerning the Diet of the Common People,508 General Observations on Ali- ment, 510 Of Bread, 512 CONTENTS OF THE APPENDIX. Introduction, 535 Ointments, Liniments, and Ce List of Simples, 539 rates, 564 Pills, 567 Medical Preparations. Plasters, 570 Balsams, 546 Poultices, 572 Boluses, 347 Powders, 573 Cataplasms and Sinapisms, 548 Syrups, 575 Clysters, 549 Tinctures, Elixirs, &c. ib. Colly rip, or Eyewaters, Confections, 550 Vinegars, 579 551 Waters by Infusion, &c. 581 Conserves and Preserves, 552 Simple Distilled Waters, 582 Decoctions, 553 Spirituous Distilled Waters, 583 Draughts, 554 Wheys, ib. Electuaries, 555 Wines, ib. Emulsions, 557 Medical Electricity, 586 Extracts, 558 Collection and Preservation Fomentations, ib. of Simples, 589 Gargles, 559 Family Herbal, 592 Infusions, 560 Glossary, 621 Juleps, 562 Index, 627 Mixtures, 563 Of Boiled Grain, 516 — Butter, 519 — Fruits and Roots, 521 — Broths and Soups, 528 — Conclusion, 582 TO THE PUBLIC. A.N instance of a work on the science of Medicine having attained the twenty-first edition of a series of large impressions, is, I believe, without a parallel in the annals of literature. This fact furrtishes a decisive proof, that the DOMESTIC MEDICINE, not- withstanding the many attempts to supplant it by medical publica- tions on a popular plan, still continues to be deemed by the public a valuable and useful book. Public opinion is, perhaps, the best criterion of general utility. Under the sanction of this opinion, I consider it as my peculiar duty to endeavor, by every means in my power, to maintain the claim of this work to a continuance of that general approbation, with which it has, for a period of more than forty years, been eminently distinguish- ed.—I, therefore, willingly embrace the opportunity now presented to me, of making such additions as may, in some measure, tend to keep the general spirit of this work on a level with the improve- ments, which are daily taking place in the science of medicine. Of some complaints hitherto omitted, I know it was my father's intention to have inserted an account in a future edition. From notes found among his papers, combined with the result of my own observations, I have drawn up a history of the symptoms and most approved treatment of Chorea or St/Vitus's Dance, Fistula in Ano, and a peculiar kind of epidemic sore throat, named the Mumps, which occasionally makes its appearance in this country, at distant intervals of time and place. Additions to other articles, of inferior importance, will also be found under their respective heads. Various affections of the lungs, comprized under the general de- nomination of consumption, too frequently prove fatal to the youth of this country at an age when life is, for many reasons, peculiarly valuable. The remarks which I have ventured to introduce on the means of detecting;, and counteracting, the early tendencies to this complaint, originated in some apprehensions entertained concerning my own health at a former period of life, and they have since been matured by more extensive experience. They will not, therefore, I trust, be considered as misplaced in a work, which is not less imme- diately directed to the prevention, than to the cure, of disease. To distinguish the new matter from the original work, I have thought it 1 2 TO THE PUBLIC. right to mark these additions, whether occurring in the text, or in form of notes, with the initials of my name. It is not unreasonable to suppose^that the extensive circulation of so popular a work, must have had some influence on the state of public opinion. This influence may, I think, be distinctly traced in the generally improved treatment of children, respecting their clothing and diet, and the consequent melioration of their health. Nor let it be forgotten, that the utility of those noble and now flourishing chari- ties, the Humane Society, for the recovery of persons apparently drowned; an Institution for teaching the Deaf and Dumb to read and speak ; and a School for the Indigent Blind, was pointed out, and their establishment strongly recommended on the *tore of humanity, more than forty years ago, in the early editions of the Domestic Medicine. That his writings should have contributed in the most remote manner to the formation of establishments emanating from that spirit of charity for which England is renowned among the nations of the earth, must afford the sweetest consolation to 'he mind of the bene- volent author; should he now,indeed, retain any consciousness of, or take any interest in the affairs of this world : and his surviving off- spring may be allowed to derive their sole comfort for the loss of an affectionate and beloved parent, from indulging a hope, that " his works may have followed him." ALEXANDER P. BUCHAN. Percy Street, London, June, 1813. Omnes homines artem medicam nosse oportct.----Sapientice cognitionem medicines sororem ac contubemakm esse puto. Hippocrates. Primoque medendi sciontia, sapientiae pars habebatur.----Rationalem quidcm puto juedicinara esse debere. Celsus. Quemadmodum sanitas omnium rerum pretium excedit, omnisque felicitatis fundamentum est, ita scientia vitae ac sanitatis tuendae omnium no- bilissiraa, omnibusque hominibus commendatissima esse debet. Hoffman. TO SIR JOSEPH BANKS, Bart president op the royal society. SIR, JL HE Domestic Medicine having been honored, on its first appearance, with the patronage of your learned and worthy prede- cessor, the late Sir John Pringle, 1 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 climates, in pursuit of useful science; and whose constant object has been to render that science subser- vient to the happiness and civilization of society. I have the honor to be, with great respect, Sir, Your most obedient servant, W, BUCHAN. London, Nov, 10, 1783. . ADVERTISEMENT TO THE EIGHTEENTH EDITION. THE learned and elegant Arbuthnot seems to have thought it a matter of* no small complaint, that an author, after having written a book, should'be obliged to write another to explain it. Yet, in the discussion of subjects which immediately concern the health and hap- piness of the human species, it is of importance to leave nothing obscure or doubtful, but to place every truth in so strong and clear a light, as to prevent the possibility of the least misconception or mistake. Besides, with whatever industry and exactness a medical writer may prepare his first essays for the public eye, he will find in the course of further practice, many things to correct, others to illustrate, and, perhaps, some valuable discoveries to introduce. The art or science, of which he treats, is in a perpetual progress to perfection. If his writings do not breathe the same spirit, it is plain that he is either too proud to retract former errors, or too indolent to avail himself of new observations and experiments. As gratitude also is supposed to be a greater spur to exertion than even reason itself, I have a still more powerful motive than any of the preceding, for using my best endeavors to make every new edi- tion of this work more worthy of the public favor. It has met with the most flattering reception in every part of the British empire; and some writers of the first medical eminence in Europe have enlarged the sphere of its popularity, by translating it into the languages of their respective countries. I feel the full force of so strong an incite- ment to redouble my efforts, and, as far as I am able, to make improvement keep pace with the rapid extension of such liberal patronage. But while my warmest acknowledgments are due to my generous friends, I must not omit taking notice of some obligations I am under to my adversaries also. On my first attempt to give a familiar form to medical advice, and to explain what every body ought to know, in language which every body could understand, envy, selfishness, and arrogance took the alarm. All the stores of malignant invention were exhausted, to blacken the character of the author, to lower the public opinion of his integrity, as well as of his talents, and totally to de- stroy his pretensions to honest fame. I thank those gentlemen for having taken so much pains to excite attention to my book j and hope 6 ADVERTISEMENT. they will not think this expression of my gratitude ironical, when I assure them, that the sale of above a hundred thousand copies of this work has not been less promoted by their illiberal abuse, than by the kindest testimonies of applause. There is another description of persons, whom I cannot treat with so much pleasantry, as they have left no means untried to make the credit of my book subservient to their private interest, at the ex- pense of both my fame and fortune—I mean the invaders of lite- rary property, who first endeavored to mutilate, mangle, and disfigure the work, in hopes of being able to conceal their fraud, and give the pirated jumble some appearance of originality by a little alteration of the title-page, and a string of prefatory falsehoods.* Having com- pletely failed in a great number of these attempts, they now have recourse to a still more shameless mode of proceeding, and pretend to publish the " Domestic Medicine" itself, with bold claims to considerable improvements! A single glance, however, is sufficient to detect the flimsy artifice. In order to evade the law, by acting under the sanction of an old statute for limiting the period of copyright, they have reprinted the party copies of" my book, published between thirty and forty years ago, which, to say nothing of inaccuracies, did not contain above half the matter inserted in the later editions. Thus they have in reality suppressed what I had been constantly endeavoring to correct, im- prove, and enlarge. Foreseeing, however, that, in consequence of all these omissions, the size of the book, when compared with mine, would expose the deception even to persons incapable of examining the con- v tent9, they increased the bulk of the volume by additions, which be- tray an ignorance, not only of medicine, but of language. It is not likely that any great impression can be made on such characters by the force of ridicule, else I should compliment.them on their extreme modesty in taking out of the hands of an author, whom they professed to admire, the right of improving his own work-. They wished, no doubt, to relieve him from the trouble. Their generosity went still further, and made them affix his name to their curious re- searches, and to the novel beauties of their style, which adorn and il- lustrate every page. He may, indeed, think them too civil by half, in placing their mistakes to the same account, and inducing the public to rely on every thing supposed to come from him, though pregnant with the greatest danger. I should also pay due praise to the legal shrewdness of these gentle- men, in laying hold of the most imperfect editions of my book, and leaving out all the subsequent remarks, rather than violate the laws of their country. As to the infringement of property, or the injury which the reputation of the author might sustain from his being made responsible for their blunders, the old statute they consulted, beiii"- silent on these points, led them to conceive that they had a ri«»ht to * " Like Gipsies, lest the stolen brat be known, *' Defacing first, then claiming for their own." ADVERTISEMENT. publish, under the sanction of his name, the injudicious compilations of any unfortunate hireling. It is not very easy to put me out of humor. I am much more inclined to amuse myself and the reader with laughable strictures on, such frauds and follies. It would be no difficult matter, however, were the subject to be seriously treated, to show how inconsistent it is with common sense and common justice, that property acquired by the labor of the hand should be more permanent or better protected, than that which is derivedMrom the labor of the head. Yet the one is perpetual and well secured, while the other is confined to a very short period, and left almost defenceless. In vain does the man of genius endeavor to impress on his works the stamp of immortality: if he lives but a few years, he may see them cut to pieces, without any means of redress, and his very name made use of to give currency to the most contemptible forgeries. The affection of a parent for a darling child has often been used to illustrate an author's fond attachment to his writings. What then must be the emotions of the latter, when he finds a changeling sub- stituted for the genuine offspring of his brain, or sees, as it were, his mental progeny stripped of their rights and honors by the spurious issue of a pretender! When we consider this matter in another light, and make a fair estimate of the time and money expended in the cultivation of such talents as may qualify a man to write for the instruction, or the rational entertainment of society, we shall be struck with the injustice of robbing him of the fair fruits of his labor. Small as his emoluments may be, they are not sufficiently guarded by law. The acts relative^ to this subject were made when literary property was not deemed of much value, and consequently little care taken to secure it. I hey should therefore be revised ; tor while the exact letter of the law pro- tects the propertv of authors only for a short term of years, it is not in the power of a judge, however upright, to give ample redress ol any wrong done them afterwards. Every author ought to retain an exclusive right in his own compositions during his natural lite at least; and, perhaps, were the question to be brought before the tri- bunal of reason, no satisfactory cause could be assigned, why the advantages which we derive from the gifts of heaven, ought not to descend to our posterity, as well as revenues arising from gifts of the CTcnannot conclude, without informing the public, that, besides the corrections and improvements, I have enlarged the present edition by the introduction of above a hundred pages fTnewfrnJtte^.lnclQU1dl"|aa complete chapter on Sea Bathing, and the Use of the Minera[Wa- ters, which will enable every purchaser of this work easily to distin- guish the genuine from spurious and imperfect copies, and probably lave the health and lives of numberless individuals from being made the sport of unprincipled impostors. BUCHAN. 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 unfavor- able idea, 1 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 honor to medicine, received the book in a manner, which at once showed their indulgence, and the falsity of the opinion, that every Physician Irishes 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, 1 have endeavored to render it more generally useful, by enlarging the prophylaxis, or that part, which treats of pre- venting 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 im- provements. 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 dutv, 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, scarcely any of them lived. This was so apparent, as with me to amount to a proof of the fol- lowing melancholy fact: That almost one half of the human species perish in infancy, by improper management or neglect. This re- flection has made me often wish to be the happy instrument of allevi- ating the miseries of these 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 PREFACE. 9 numbers of lives are, by these means, lost to society. As these prac- tices 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 these 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 ne- cessity of earning their bread by such employments as are unfavorable 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 dis- eases»more than to others, it is certainly of importance to know these, in order that people may be on their guard against them. It is always better to be warned of the approach of an enemy, than to be surprized 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 endeavored to point out the causes of diseases, and to put people on their guard against them, yet it must be acknow- ledged, that they are often of such a nature as to admit of being re- moved 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 practised with impunity, while others, absolutely necessary for its preservation, are entirely neglected. Some of the public means of preserving health are mentioned in the general prophylaxis, as the inspection of provisions, widening the streets of great towns, keeping them clean, supplying the inhabitants with wholesome water, burying the dead out of town, &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, 1 have been peculiarly attentive to regimen. The generality of people lay too much stress on medi- / 10 PREFACE. cine, and trust too little to their own endeavors. It is always id the power of a 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 endeavors, but renders them dangerous. 1 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. Twish it were so, both for the honor 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 per- son in a fever, for example, could eat, drink, or conduct himself in the same manner as one in perfect health. This part of medicine, there- fore, 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 tneir prescriptions; and even this they gene- rally administered themselves, attending the sick for this purpose through the whole course of the disease; which gave them an oppor- tunity, not only of marking the changes of diseases with great accu- racy, but likewise of observing the effects of their different applica- tions, 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 medi- cines 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 1 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. Hux- ham, who observes, that we often seek from Art, what all-bountiful Na- ture most readily, and as effectually,offers us, had we diligence and sa- gacity enough to observe anil 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 this book more generally useful, however, as well as more acceptable to the intelligent part of mankind, I have, in most diseases, besides regimen, recommended some of the most simple and approved forms of medicine, and added such cautions and directions as seemeil necessary for their safe administration. It would, no doubt have been more acceptable to many, had the book abounded with PREFACE. 11 pompous prescriptions, and promised great cures in consequence of their use; but this was not my plan: I think the administration ot medicines always doubtful, and often dangerous, and wou d 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 ad- ministered 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 ot the most impor- tant articles in the Materia Medica, than physicians did a century ago; and doubtless the same observation will hold with regain to others for some time hence. Wherever I was convinced tnat a mem- cine might be used with safety, or where the cure depended chiefly upon it, I have taken care to recommend it; but where it was eitnei highly dangerous, or not very necessary, it is omitted. 1 have not troubled the reader with a useless parade of quotations from different authors, but have in general adopted their observations where my own were either defective or totally wanting. !"«* to whom I am most obliged are, Ramazini, Arbuthuot, and lissot, the last of which, in his Avis au Peuple, comes the nearest to mv tilws of any author whom 1 have seen. Had the doctor s plan been as complete as the execution is masterly, we should have had «« «*»J"» for any new treatise of this kind soon; but by confining him.e It to the acute diseases, he has,in my opinion, omitted the most useful part of the subject. People in acule diseases may sometime* be their own physicians; but in chronic cases, the cure must eyei depn.1 chiefly on the patient's own endeavors. The dorter nas also ££ ed over the prophylaxis, or preventive part o« medicine very shghtly though it is certainly of the greatest impo.^ce in such a wo,k He had/no doubt, his reasons for so do.n5. a.M am m, fa. from fining fault with him, that I think his performance doe* great honoi both to his head and to his heart. Several other foreign physicians of eminence have written on neai- ly the Jame plan with Tissot, as the Baron Van Swieteo, physician Sttil^S Majesties; M. Rosen, first physician of the; kingdom of Sweden, &c.; but these gentlemen's proiluctioiw ha^e nc'" ^£ to my hand. I cannot help wish ng, however, that some of our d^ tinguished countrymen would follow their example. * ^re stJ» « mains much to be done on this subject, and it does not appeal tome how any man could better employ his time or talen «• ^an in eradr eating hurtful prejudices, and diffusing useful knowledge among the P7know some of the faculty disapprove of every'attempt of this nature, imagining that it must totally destroy ^ral Toole in sdence than when they take it to be only a matter of mere con- jecture. 12 PREFACE. Though I have endeavored to render this treatise plain and use- ful, yet I found it impossible to avoid some terms of art; but these are in general either explained, or are such as most people under- stand. In short, I have endeavored to conform my style to the capacities of mankind in general; and, if my readers do not ^ter 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 show of learning is easier than to write plain sense, especially in a science which has been kept at such a distance from common observa- tion. 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 acknowledg- ments to those gentlemen, who have endeavored to extend the use- fulness 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 manv 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 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, ^oaie 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 insurmount- able, have, in a great measure, yielded to better information. Of this a stronger instance cafinot be given than in the inoculation of the small- pox. Few mothers, some years ago, would submit to have their chil- dren 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 firactice will become general. Whenever this shall be the case, more ives will be saved by inoculation alone, than are at present by all the endeavors of the faculty. INTRODUCTION. 1 HE improvements in medicine, since the revival of learning, have by no means kept pace with those of the other arts. The reason is obvious. Medicine has been studied by few, except those who in- tended to live by it as a business. Such, either from a mistaken zeal for the honor of medicine, or to raise their own importance, have endeavored to disguise and conceal the art. Medical authors have generally written in a foreign language; and those who are unequal to this task, have even valued themselves on 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 these bloody disputes; and every gentle- man/that he might distinguish himself on one side or the 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 agri- culture ; and qualifies men for acting with propriety in the most im- portant stations of life. Natural history has likewise become an object of general atten- tion ; and it well deserves to be so. It leads to discoveries of the greatest importance. Indeed agriculture, the most useful of all arts, is only a branch of natural history, and can never arrive at a high degree of improvement where the study of that science is neglected. 14 INTRODUCTION. Medicine, however, has not, as far as I know, in any country, been reckoned a necessary part of the education of a gentleman, dux surely no sufficient reason can be assigned for this omission, rso science lays open a more extensive field of useful knowledge, or affords more ample entertainment to an inquisitive mind. Anatomy, botany, chemistry, and the Materia Medica, are all branches 01 natural history, and are fraught with such amusement and utility, that the man who entirely neglects them has but a sorry claim either to taste or learning. If a gentleman has a turn for observation, says an excellent and sensible writer/ surely the natural history ot 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 cockleshells. . . We do not mean that every man should become a physician. I his 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 sime time to guard themselves against the destructive influ- ence of Ignorance, Superstition, and Quackery. As matters stand at present, it is easier io 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 e\es, 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 honor, of mankind, to have some check on 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 flo-o removed from the* other sciences, which induces many to believe that medicine is a mere trick, and that it will not bear a fair and candid examination. Medicine, however, needs only to be better known, in order to secure the general esteem of mankind. Its precepts are such as every wise man would choose to observe, and it forbids nothing but what is incompatible with true happiness. Disguising medicine not only retards its improvement as a science, but exposes the profession to ridicule, and i? injurious to the true in- terests of society. An art, founded on observation, can never arrive at any high degree of improvement, while it is confined to a few who make a trade of it. The united observations of all the ingenious and sensible part of mankind would do more, in a few year-, 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 * Observations on the Duties and Offices of a Physician. INTRODUCTION. 15 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 obser- vations, does more real service to the art than he who writes a volume in support of some favorite 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 fol- low 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 con- cerns them, the good effects in 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 in- terest, 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 shown, that, since the laity have assert- ed their right of inquiry into these subjects, theology, considered as a science, has been improved, the interests of real religion have been promoted, and the clergy have become a more learned, a more useful, and a more respectable body of men, than they ever were in the days of their greatest power and splendor. 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 neatly the same situa- tion that philosophy was at that time, and that it might be as much improved by being treated in the same manner. Indeed, no science can either be rendered rational or useful, without being submitted to the common sense and reason of mankind. These alone stamp a value upon science; and what will not bear the test of these ought to be rejected. I know it will be said, that diffusing medical knowledge among the people might induce them to tamper with medicine, and to trust to their 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 follow advice, when it is necessary. The ignorant are always most apt to tamper with 16 INTRODUCTION. 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 recom- mended 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 man- kind, 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 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 hu- mors of men must be regarded by those who mean to do them ser- vice ; but this can never effect the general argument in favor of can- dor 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 the) have generally been very much confounded. The line between them is not sufficiently apparent; at least 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 upoh 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 physi- cian. 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, INTRODUCTION. 17 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 de- sired effect; would inspire him with absolute confidence in the phy- sician; 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 some time hence appear to have been com- pletely 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 dan- gerous 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 pre- scriptions is left entirely to the apprentice. By this means the greatest man in the kingdom, even when he employs a firstrate 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 ouo-ht certainly to be taken to prevent them. For this reason, the prescriptions of physicians, instead of being couched in mystical cha- racters and a dead language, ought, in my humble opinion, to be conceived in the most plain and obvious terms imaginable. Diffusing medical knowledge among the people would not only tend to improve the art, and to banish quackery, but likewise to render medicine more universally useful, by extending its benefit 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 igno- rant 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 o-reatest advantage, without some degree of medical knowledge. B Men of every occupation and condition in life might avail them- selves of a degree of medical knowledge; as it would teach them to 3 18 INTRODUCTION. avoid the dangers peculiar to their respective stations; which is al- ways 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, rje said, that to live rationally is to live miserably. If physicians obtrude their own ridiculous whims upon mankind, or lay down rules incon- sistent with reason or common sense, no doubt they will be despised. But this is not the fault of medicine. It proposes no rules, that 1 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 show them their error, and a little more reading will infallibly correct it. A single instance will show the absurdity of this notion. A sensible lady, rather than read a medical performance, which would instruct her in the management of her children, generally leaves them entirely to the care and conduct of the most ignorant, credulous, and superstitious part of the human species. No part of medicine is of more general importance than that which relates to the nursing and management of children. Yet few parents pay a proper attention 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 negligent to do their duty, or too ignorant to know it. We will venture to affirm, that more human lives are lost by the carelessness and inattention of parents and nurses, than are saved by the faculty ; and that the joint and well conducted endeavors, 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 tra?le, 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 medi- cal advice to the poor, did not their tear of doing ill often suppress their inclination to do good. Such people are often deterred from the most noble and praiseworthy actions, by the foolish alarms INTRODUCTION. 19 sounded in their ears by a set of men, who, to raise their own im- portance, 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 fentlemen must, however, excuse me for saying, that I have often nown 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 these for them, of less import- ance 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 sick bed. 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 can- not 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 choose 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.* No doubt a great many of them may; but there are other things besides diet, which ought by no means to be neglected. Many hurtful and destructive prejudices, with regard to the treat- ment 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 conse- quences. A proper regimen, in most diseases, is at least equal to medicine, and in many of them it is greatly superior. To assist the wellmeant endeavors of the humane and benevolent in relieving distress; to eradicate dangerous and hurtful prejudices; to guard the ignorant and credulous against the frauds and imposi- tions of quacks and impostors; and to show men what is in their own power, both with regard to the prevention and cure of diseases, are certainly objects worthy of the physician's attention. These were the leading views in composing and publishing the following sheets. They were suggested by an attention to the conduct of man- kind with regard to medicine, in the course of a pretty long practice in different parts of this island, during which the author has often * Arbuthnot, 20 INTRODUCTION. had occasion to wish that his patients, or those about them, had been possessed of some such plain directory for regulating their conauci. How far he has succeeded in his endeavors to supply this dehciency, must be left to others to determine; but if they be found to contri- bute in any measure towards alleviating the calamities ot manKina, he will think his labor very well bestowed. PART I. OF THE GENERAL CAUSES OF DISEASES. CHAP. X. 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 ani- mals would be as liable to die young as man ; but this we find is by no means the case. It may seem strange that man, notwithstanding his superior reason, should fall so far short of other animals in the manage- ment of his young; but our surprize will soon cease if we consid- er that brutes, guided by instinct, never err in this respect; while man, trusting solely to art, is seldom right. Were a catalogue of those infants who perish annually by art alone exhibited to public view, it would astonish most people. If parents are above taking care of their children, others must be employed for this purpose: these will always endea- vor to recommend themselves by the appearance of extraor- dinary 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. 22 OF CHILDREN. Nothing can be more preposterous than a mother, who thinks it below her to take care of her own child, or who is so igno- rant 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 sur- prized to find some of them unable to perform this 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 nourish- ment 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 dis- couraging this practice. Every mother, who can, ought cer- tainly to perform so tender and agreeable an office.t But suppose it to be out of her power, she may, nevertheless. * I have known an hysteric woman kill her child, by being seized with a fit in the night. t 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 lose many •f their most useful members, and mothers become, in some sense the murderers of their own offspring. I am sure I speak within the truth, when 1 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^ 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 on the same milk. OF CHILDREN. 23 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 this 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 nurse- ry ? 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 edu- cation. Is it any wonder, when females so educated come to be mothers, that they should be quite ignorant of the duties belonging to this 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 chil- dren, instead of being conducted by reason, is the result of whim and caprice.* Were the time, that is generally spent by females in the ac- quisition 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 whole- some 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 show, * Tacitus, the celebrated Roman historian, complains greatly of the de- generacy 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. U OF CHILDREN. 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 off- spring. 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 accomplishments4 as recommend them to the other sex. But men gpnerally 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, how- ever, with the kennel or the stables. A gentleman of the first .rank is not ashamed to give directions concerning the manage- ment of his dogs or horses, yet would blush were he surprized in performing the same office for that being, who derived its existence from himself, who is the heir of his fortunes, and the future hope of his country. Nor have physicians themselves been sufficiently attentive to the management of children: this has been generally con- sidered 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 chil- dren in the most dangerous diseases. The consequence is, that a physician is seldom called till the good women have exhaust- ed 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 ma- nagement when well. The diseases of children are by no means so difficult to be understood as many imagine. It is true, chif- OF CHILDREN. 25 dren 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.* It is really astonishing, that so little attention should, in general, be paid to the preservation of infants. What labor and expense are daily bestowed to prop an old, tottering car- case 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 unhealth- iness 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 writert observes, that on the constitution of mothers depends originally that of their offspring. No one, who believes this, will be surprized, on a view of the female world, to find diseases and death so frequent among children. A de- licate 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 sicklyjrame may be originally induced by hardships or intemperance, but chiefly by the latter. It is impossible that a course of vice * 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 to cure, as those of adults. t Rousseaw. 4 26 OF CHILDREN. shall not spoil the best constitution: and did the evil terminate here, it would be a just punishment for the folly of the sufferer; but when once a disease is contracted and rivetted 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 expense of inheriting his diseases! A person laboring under any incurable malady ought not to marry. He thereby not only shortens his own life, but trans- mits misery to others; but when both parties are deeply taint- ed with the scrofula, the scurvy, or the like, the effects must be still worse. If such have any issue, they must be miserable indeed. Want of attention to these things, in forming con- nexions 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.* In our matrimonial contracts, it is amazing that 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 on 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; but 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.t 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 consti- tution; 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 cir- * The Lacedemonians condemned their king Archidamus for having mar- ried a weak, puny women ; because, said they, instead of propagating a race of heroes, jou will fill the throne with a progeny of changelings. t The Jews, by their laws, were, in certain cases, forbidden to have any manner of commerce with the diseased ; and, indeed, to this all wise legis- lators ought to have a special regard. In some countries, diseased persons have actually been forbidden to marry. This is an evil of a complicated kind natural deformity, and a political mischief; and therefore requires a public consideration. OF CHILDREN. 27 cumspect 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 pro- per care, been kept off for one generation; and there is reason to believe, that, by persisting in the same course, such diseases might at length be wholly eradicated. This is a subject very little regarded, though of the greatest importance. Family constitutions are as capable of improvement as family estates; and the libertine, who impairs the one, does greater injury to his posterity than the prodigal, who squanders the other. OF THE CLOTHING OF CHILDREN. The clothing of an infant is so simple a matter, that it is surprizing how any person should err in it; yet many children lose their lives, and others are deformed, by inattention to this article. . Nature knows of no use of clothes for 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 taken 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 labor 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 show in this article, the more her skill would be admired. Her at- tempts were seconded by the vanity of parents, who, too often desirous of making a show of the infant as soon as it was born, were ambitious to have as much finery heaped on it as pos- sible. Thus it came to be thought as necessary for a midwiie 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 ob- struct the motion of the heart, lungs, and other organs neces- sarv to life. . .., . , In most parts of Britain, the practice of rolling children with 28 OF CHILDREN. so many bandages is now, in some measure, laid aside; but it would still be a difficult task to persuade the generality of man- kind, that the shape of an infant does not entirely depend on the care of the midwife. So far, however, are all her en- deavors to mend the shape from being successful, that they constantly operate the contrary way, and mankind become de- formed in proportion to the means used to prevent it. How little deformity of body is to be found among uncivilized na- tions! 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.* 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 crook- ed 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 pressure. They cannot, indeed, tell their complaints, but they can show signs of pain; and this they never fail to do, by cry- ing when hurt by their clothes. No sooner are thry 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 press- ure will appear in the strongest light. Nature, in order to make way for the growth of the children, has formed their bodies soft and flexible; and,lest they should receive any injury from pressure in the womb, has surrounded the fetus everywhere with fluids. This shows the care which nature takes to prevent all unequal pressure on the bodies of infants, and to defend them * A friend os mine, who was several years on the coast of Africa tells me that the natives neither put any clothes on their children, nor apply to their bodies bandages of any kind, but lay them on a pallet, and suffer them te tumble about at pleasure ; yet they are all straight, and seldom have anv 'liser.se. J OF CHILDREN. 29 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 propor- tioned at their birth as others, but had the misfortune to be squeezed out of shape by the application of stays and band- ages. 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 loo 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 cramp- ed in its clothes, it naturally shrinks from the part that is hurt; and, by putting its body into unnatural postures, it becomes de- formed 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 disagree- able to the eye, but, by a bad figure, both the animal and vital functions must be impeded, and of course health impair- ed. Hence few people remarkably misshapen are strong or healthy. The new motions which commence at the birth, as the circulation of the w*hole 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 press- ure. 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* 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 surprized that * 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 a-s it is horn. so OF CHILDREN. 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, on 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 clothes of an infant with strings than pins, as they 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 this 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 ifbe 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 spe- cies, of dress proper for an infant. These will always vary in different countries, according to custom and the humor of pa- rents. The great rule to be observed is, That a child have no more clothes than are necessary to keep it rearm, and that they be quite easy for its body; and in winter the clothes should be made of non-combustible materials. 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 favor of stays seems, however, to be somewhat abated; and it is to be hoped the world will, in time, become wise enough to know. OF CHILDREN. 31 that the liuman shape does not solely depend on whalebone and bend leather.* 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 chang- ed, 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 perspira- tion, and, by this means, frees the body from superfluous humors, 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. OP 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 show the disposition, which mankind have to depart from na- ture, more than their endeavoring 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 child- hood, come on, they generally perish. A child, soon after the birth, shows an inclination to suck; and there is no reason why it should not be gratified. It is true, the mother's milk does not always come immediately af- ter 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 apothc- * 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, 1 shall beg leave just to ask them, Why there are ten deformed women for one man ? and likewise to recom- mend to their perusal, a short moral precept, which forbids ns to deform fh>. hmgan body. 32 OF CHILDREN. cary'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 things given to a child should be drugs. This is beginning with medicine by times, and no wonder if they generally end with it. It sometimes happens, indeed, that a child does not dis- charge 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 on 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 with- out 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 moist sugar. If this be given with- out any wine or spiceries, it will neither heat the blood, load the stomach, nor occasion gripes. On 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 on it. Chil- dren 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 humors. If the mother or nurse has enough of milk, the child will need little or no other food for the third or fourth month. It will then be proper to give it, once or twice a day, a little of some food that is easy of digestion, as water pap, milk pottage, weak 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. Fortius 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 thev arr* weaned, but for some time aftrr. OF CHILDREN. 33 Next to milk, we would recommend good, light bread. Bread may be given to a child as soon as it shows an inclination to chew ; and it may, at all times, be allowed as much plain bread as it will eat. The very chewing of bread will promote the cutting of the teeth, and the discharge of saliva, while, by mixing with the nurse's milk in the stomach, it will afford an excellent nourishment. 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 gumstick. 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 into 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 further advanced, bread may be mixed in veal or chicken broth, made into pud- dings, 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 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 inflamma- tory 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 thoy ought to do, which makes them grow fat and bloat- ed. 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. 5 34 OF CHILDREN. After a child is weaned, it ought to be fed four or five limes a dav; 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. I his 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 endeavoring to shun this error, have run into the opposite ex- treme, 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 a healthy man. That errors are frequently committed on both sides, we are ready to acknow- ledge; 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 whieh 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 en- dure. 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 smokedried 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, buttermilk, 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 show a great inclination for fruit, and I am apt to believe, that if good ripe fruit were allowed them in proper quantity, it would have no bad effects. We never find a natural inclination wrong, if properly regulated. Fruits are generally of a cooling nature, and correct the heat and acri- OF CHILDREN. 35 Hiony of the humors. 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.* Roots which contain a crude viscid juice should be sparingly given to children. They fill the body with gross humors, and tend to produce eruptive diseases. This caution is pecu- liarly 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 <*rude vegetables. Children had better eat a smaller quantity of food, which yields a wholesome nourishment, than be crammed with what their digestive pow- ers are unable properly to assimilate. Butter ought likewise to be sparingly given to children. It both relaxes the stomach, and produces gross humors. 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 recom- mend honey. Children who eat honey are seldom troubled with worms; they are also less subject to cutaneous diseases, as itch, scabbed head, &c. Many people err in thinking that the diet of children ought to be altogether moist. When children live entirely on slops, it relaxes their solids, renders them weak, and disposes them to the rickets, the scrofula, and other glandular disorders. Relaxation is one of the most general causes of the diseases of children. Every thing, therefore, which tends to unbrace their solids, ought to be carefully avoided. We would not be understood by these observations as con- fining 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 * Children are always sickly in the fruit season, which may be thus ac- counted 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 on, which often proves little better than a poison to their tender bowels. Servants and others, who have the care of children, should be strictly forbidden to give them any fruit without the knowledge of their parents. 3ti OF CHILDREN. 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 coeval 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 dis- eases and deformity among their offspring? The rickets, so destructive to children, never appeared in Britain till manu- factures 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 chief- ly prevails, and not only deforms but kills many of their off- spring. The conduct of other young animals shows 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, can- not 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.* 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, anu 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 seve- ral bad consequences. It makes them throw their bodies for- * The nurse ought to be careful to keep the child in a proper posi- tion ; us deformity is often the consequence of inattention to this circum- stance. 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 ?rm. OF CHILDREN. 37 ward, and press with their whole weight on their stomach and breast; by this means the breathing is obstructed, the breast flattened, and the bowels compressed ; which must hurt the digestion, and occasion consumptions of the lungs, and other diseases. It is a common notion, that if children are set on 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 proportion- ably light; and had they skill to direct themselves, they would soon be able to support their own weight. Whoever 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 its birth, and be then set on 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 lime 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 al- ways 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* 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 chil- dren. The body is composed of an infinite number of tubes, whose fluids cannot be pushed on without the action and press- ure of the muscles. But, if the fluids remain inactive, obstruc- * 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 expend- ed on hospitals for this purpose. This would make the poor esteem fertility a blessine • whereas many of them think it the greatest curse that can befall them • and in place of wishing their children to live, so far does poverty get the better of natural affection, that they are often very happy when they die. 38 OF CHILDREN. lions must happen, and the humors will of course be vitiated, which cannot fail to occasion diseases. Nature has furnished both the vessels which carry the blood and lymph with nume- rous valves, in order that the action of every muscle might push forward their contents; but without action this admirable con- trivance can have no effect. This part of the animal economy proves to a demonstration the necessity of exercise for the preservation of health. Arguments to show the importance of exercise might be drawn from every part of the animal economy. Without exer- cise, the circulation of the blood cannot be properly carried on, nor the different secretions duly performed ; without exer- cise, 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 further into the economy of the human body, than most of those for whom this treatise is in- tended would be able to follow. We shall therefore only add, that when exercise is neglected, none of the animal functions can be duly performed; and when this is the case, the whole constitution must go to wreck. A good constitution ought certainly to be our first object in the management of children. It lays a foundation for their being 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 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 on the body; nor is the mind less injured. Early application weakens the faculties, and often fixes in the mind an aversion to books, which continues for life.* But suppose this were the way to make children scholars, it certainly ought not to be done at the expense of their con- stitutions. Our ancestors, who seldom went to school very * 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. OF CHILDREN. 39 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 in- jured by being kept in crowds within doors ; their breathing not only renders the place unwholesome, but, if any one of them happen to be diseased, the rest catch the infection. A single child has been often known to communicate the bloody flux, the hooping cough, the itch, or other diseases, to almost every individual in a numerous school. But, if fashion must prevail, and infants are to be sent to school, we would recommend it to teachers, as they value the interests of society, not to confine them too long at a time, but allow them to run about and play at such active diversions as may promote their growth, and strengthen their constitutions. Were boys, instead of being whipped for stealing an hour, to run, ride, swim, or the like, encouraged to employ a proper part of their time in these manly and useful exercises, it would have many excellent effects. It would be of great service to boys, if, at a proper age, they were taught the military exercise. This would increase their strength, inspire them with courage, and, when their country called for their assistance, would enable them to act in her defence, 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* 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 will never 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 own clothes; and is taught to be- lieve, that to excel at the needle is the only thing that can en- title her to general esteem. It is unnecessary here to insist on the dangerous consequences of obliging girls to sit too much. They are pretty well known, and are too often felt at a cer- tain time of life. But supposing this critical period to be got over, greater dangers still wait them when they come to be mothers. Women, who have been early accustomed to a * 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 vigor of body, would have many other happy effects. 4(j OF CHILDREN. sedentary life, generally run great hazard in childbed ; 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 con- stitution. Close and early confinement generally occasions indigestions, headaches, pale complexions, pain of the stomach, loss of appetite, coughs, consumptions of the lungs, and defor- mity 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 labor. 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 child- hood, 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 bu^in^ss, they become a burden to society. Thus arts and manufactures, though they may increase the riches of a country, are by no means favora- ble to the health of its inhabitants. Good policy would there- fore require, that such people as labor 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 labor too soon, they will never turn out to ad- vantage. 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 OF CHILDREN. 41 gardening, husbandry, or any business carried on without doors, are most proper. These are employments, which most young people are fond of, and some parts of them may be al- ways adapted to their age, taste, and strength.* Such parents, however, as are under the necessity of em- ploying their children within doors*, ought to allow them suffi- cient time for active diversions without. This would both encourage them to do more work, and prevent their constitu- tions from being hurt. Some imagine, that exercise within doors is sufficient; but they are generally mistaken. One hour spent in running, or any other exercise without doors, is worth ten within. When children cannot go abroad, they may indeed be exercised at home. The best method of doing this, is to make them run about in a large room, or dance. This last kind of exercise, if not carried to excess, is of excellent service to young people. It cheers the spirits, promotes perspiration, strengthens the limbs, &c. I knew an eminent physician, who used to say, that he made his children dance, instead of giving them physic. It were well if more people followed his example. The Cold Bath may be considered as an aid to exercise. By it the body is braced and strengthened, the circulation and secretions promoted, and, were it conducted with prudence, many diseases, as rickets, scrofula, &c. might thereby be prevented. The ancients, who took every method to render children hardy and robust, were no strangers to the use of the cold bath ; and, if we may credit report, the practice of immers- ing 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 dipped in the water on the child, and either put it to bed, or suffer it to <*o about, in this condition. Some believe, that the whole virtue of the water depends on its being dedicated to a particu- lar saint; while others place their confidence in a certain num- ber 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 this remedy are often frustrated. * 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. 42 OF CHILDREN. 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 scrofula, its whole body ought to be frequently immersed in cold water. Care, however, must be taken not to do this when the body is hot, or the stomach full. The child should be dipped only once at a time, should be taken out immediately, and have its skin well rubbed with a dry cloth. the bad effects of unwholesome air on 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 bouses, to which the fresh air has scarcely any access. Though grown people, who are hardy and robust, may live in such situations, yet they generally prove fatal to their offspring, few of whom arrive at maturity, and those who do are weak and deformed. As such people are not in a condition to carry their children abroad into the open air, we must lay our account with losing the greater part of them. But the rich have not this excuse. It is their business to see that their children be daily carried abroad, and that they be kept in the open air for a sufficient time. This will always succeed better if the mother goes along with them. Servants are often negligent in these mat- ters, 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 un- wholesome, but the heat relaxes their solids, renders them deli- OF CHILDREN. 43 cate, and disposes them to colds, and many other disorders. Nor is the custom of wrapping them too close in cradles, less pernicious. One would think, that nurses were afraid lest children should suffer by breathing free air, as many of them actually cover the child's face while asleep, and others wrap a covering over the whole cradle, by which means the child is forced to breathe the same air over and over, all the time it sleeps. Cradles, indeed, are, on many accounts, hurtful to children, and it would be better if the use of them were totally laid aside.* A child is generally laid to sleep with all its clothes on; and 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 hothouse, instead of the open air. Though such plants may, by this means, be kept alive for some lime, they will never arrive at that degree of strength, vigor 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 accus- tomed 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 * It is amazing how children escape suffocation, considering the manner in which they are often rolled up in flannels, &c. 1 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 loos-; covering. It had no more convulsion fits, 44 OF CHILDREN. 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 choose a woman who is healthy, and has plenty of milk.* 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 chil- dren 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 intrust 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 nursling : 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 dosing 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 choose to be disturbed by it in the night, will seldom fail to procure for it a dose of laudanum, paregoric, 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.f * I have often known people so imposed on, as to give an infant to a nurse to be suckled, who had not one drop of milk in her breast. t If a mother, on visiting her child at nurse, finds it always asleep, I would advise her to remove it immediately; otherwise it will soon sleep its last. OF CHILDREN. 4.5 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 a little bread. It never can be done by the help of strong liquors. These, instead of nourish- ing 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 fre- quently 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 endeavoring to please it, must be cruel indeed, and is unworthy to be intrusted with the care of a human creature. Nurses who deal much in medicine are always to be suspect- ed. They trust to it, and neglect their duty. I never knew a good nurse who had her Godfrey's Cordial, Daffy's Elixir, Dalby's Carminative, &c. at hand. Such nurses 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 per- nicious custom of indolent nurses. This is not only disagree- able, but it galls and frets the infant, and, by relaxing the solids, occasions scrofula, rickets, and other diseases. A dirty nurse is always to be suspected. Nature often attempts to free the bodies of children from bad humors, 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 infec- tious 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 pre- vents 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 astrin- 46 OF CHILDREN. gents, 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 al- ways 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 befall it. We can see no reason why a nurse, who conceals any mis- fortune which happens to a child under her care, till it loses its life or limb, should not be punished. A few examples of this would save the lives of many infants; but as there is little rea- son to expect that it ever will be the case, we would earnestly recommend it to all parents to look carefully after their chil- dren, 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, thro1 every toil, in every clime.* Few things tend more to the destruction of children than drenching them with drugs. That medicine may be sometimes necessary for children, I do not deny; but that it hurts them ten times for once it does them good, I will venture to assert. A London mother, the moment her child seems to ail any thing, runs immediately to the apothecary, who throws in his powders, * Armstrong. OF CHILDREN. 47 pills, and potions, till the poor infant is poisoned; when the child might have been restored to perfect health by a change of diet, air, exercise, clothing, or some very easy and simple regulation. But misguided fondness is not satisfied with drugging chil- dren from the apothecary's shop : many of them are fed from the same quarter. A starch from the West Indies, called Flour of Arrowroot, is the food of those infants whose parents can afford to pay for it. I lately offended a mother very much by saying, it was not half so good as oatmeal, though more than ten times the price. Of this, however, she had sufficient proof by a child in her arms, who had been fed on that root, and, though a year and a half old, could scarcely put a foot to the ground, while her neighbour's child, only nine months old, but nursed in the north country manner, could, by a hold of the finger, run all over the house. I have taken notice of this powder, to show the influence of fashion, even in the feeding of an infant. I wish it were the only instance I could give of the fatal effects of the same cause. Ten thousand infants in this island, before they are out of the nurse's arms, sip tea twice a day ; which, to be sure, is the true way to propagate heroes! 'on the management of infants. The object of these remarks is to discountenance the appli- cation of cold water to newborn infants. If the children, who are born in cold climates, could be so reared as to rise above the influence of severe and variable wreather, they would ac- quire the highest attainable security for health and longevity. This is the great purpose of physical education. But how is this desirable object to be accomplished ? Not, on the one hand, by an attempt to withdraw ourselves from those atmospheric changes, which, in this country, we are destined to encounter; nor, on the other, by disregarding the effect of habit, to rush unprepared from one extreme of tem- perature to the other. We can triumph only by such frequent, gradual, and habitual contests with our enemy, as shall enable us either to evade or surmount his assaults. But, that I may assign a reason for rejecting the practice op- posed, permit me, in a few words, to consider the nature and effects of cold water. Setting aside an examination of this agent, as a remedy in diseases, I know but two ways in which 48 OF CHILDREN. it can improve health or prevent sickness,—that is, in which it can be beneficially used by the well. The first mode is, where cold is applied to counteract a de- gree of heat, which is injurious from its excess; the second is, when it is so used as to give strength,—to invigorate the feeble operations of a sound body. Presuming this view of the sub- ject to be just, let me inquire, what effect the application of cold water to the bodies of newborn infants is likely to produce. It cannot act beneficially by diminishing excessive heat; for this does not exist. The question then occurs, can it be useful in the other mode of its operation ? Immersion in cold water, or its affusion over the body, is attended with three distinct effects,—an instantaneous and powerful shock, a sudden abstraction of heat from the surface of the body, and that exertion of vital energy to counteract the shock, and to restore the lost heat, which is termed reaction. The practice, therefore, is never safe, pleasant, or salutary, un- less it so affects the system as to be followed by this return of blood and warmth to the skin, with grateful sensations and sensible refreshment. That these good effects may be secured, the water should be sufficiently cold, and extensively and expeditiously applied. If these circumstances are disregarded, the effects, on the contrary, will be irksome and hazardous. Now the washing of infants with cold water is conducted in this manner: The nurse, as if apprehensive of doing mischief, though wedded to her error, applies the water partially and sparingly, here a lit- tle and there a little, but nowhere in sufficient quantity for the purposes of cleanliness or health, provided the fluid were of the proper temperature. This scanty application of the water, has, I know, been called prudence, and distorted into an argu- ment in favor of the practice ; but it ought to be called, what it is, an absurdity, because the water, if suitably attempered, ought to be used more freely, and if not of the right tempera- ture, it ought not to be used at all. Important and desirable as it is, that children, in northern climates, should be rendered hardy and familiar with cold air and cold water, it should never be forgotten, that this firmness and security can only be obtained by slow and cautious ad- vances. The washing and dressing of infants, with their necessary exposure to the air, constitute a sufficient commencement of the seasoning regimen for the first three months, during which the water should not be suffered to communicate any sensation of cold. The only exception to this rule is, where the child is OF CHILDREN. 49 oppressed with atmospheric heat, in which case the water should be pleasantly cool only. From this period, if the infant be well, and the weather not cold, the temperature of the water may be gradually lowered, so that, at the end of six months, if this be in summer, cold wa- ter may be used ; that is to say, water not artificially heated. Shall the mother impose on her tender infant a severity, which she herself would shudder to encounter when in health ? What would the never-doubting nurse think, if the harsh ex- pedient were prescribed for herself, which, with equal want of judgment and feeling, she practices on her helpless charge ? There is no period of life, nor any condition of health, in which this use of cold water is so unseasonable, so dangerous, and, I may truly say, so cruel. That so abrupt a change as this is un- seasonable or unnatural, will appear from a consideration of the operations and provisions of nature. The freezing blasts of winter do not at once succeed the fer- vid heat of summer: the cooling breezes of autumn are inter- posed, to admonish the vegetable world of the decline of the year, and the progress of the seasons. Among the lower animals, also, the same precautions are ob- served. Birds protect and defend their tender young by their nests, the warmth of their bodies, and shelter of their wings. Other animals act on the same plan, in conformity to their dif- ferent habits and varying resources. It is for man only to disregard a principle, which we should think reason would easily recognize and promptly obey. That this practice is full of danger to the wellbeing of the in- fant, will not so readily be admitted, because it will be said, that many children have done well under it. In reply, I con- tend, that its tendency is always unfavorable. It is true, that many infants have indeed survived very im- proper and unkind treatment; but this, surely, is no defence or recommendation of such treatment, any more than the advanc- ed age of certain intemperate and irregular individuals can recommend or justify their mode of life. The infliction of useless pain is tyranny, and this practice wants nothing but a malignant intention to be such ; while the injury is not the less severe on the innocent sufferer. But so far as this custom arises from a degree of ignorance or prejudice, which might be removed by a disposition and ef- forts to obtain just views of the subject, it is blameable and cruel. On the last day of January, 1816, I found a little patient, three days old, under the cold ablution. She had been pre- viously well and quiet. Her loud and piercing shrieks now drew 5% OF CHILDREN. me to her apartment. On ascertaining the cause of her out- cries, 1 desired the nurse to make the water at least lukewarm for the future. Her self-complacency was evidently much dis- turbed, and her assumed prerogative almost unpardonably infringed. She complied with the worst grace possible, declaring, that this was the second request only of the kind, that had ever been made to her during a long period of many years' employ- ment. This assumption of nurses is not exclusively their own fault. Too many mothers consult them as oracles, and obey them with an entire surrender of their own judgment. This led me to inquire, how prevalent a custom might be, which 1 had rarely witnessed in twenty years' business, and which I had never approved. Of seven accoucheurs, whom I consulted in this town, 1 was indecisive; 1 left the matter to the mother and nurse; 2 used cold water soon after birth; 2 disnpproved of it; and 1 said, that infants generally lived, whether washed in warm or cold water, and seemed quite indifferent, which was pre- ferred ; 4, of an equal number of nurses, always used warm water, unless desired to do otherwise; 3, when left to themselves, used cold water, after the first washing, without any regard to the season of the year. From this it appears, that physicians do not always do their duty, and that mothers and nurses are not to be trusted in this mat- ter, without watching. I do not find any writer on the diseases or management of infants, who recommends this practice. Buchan and Underwood, two of the best authors on this subject, speak of the practice in question in terms of just repre- hension. I shall close these few remarks, which might be easily ex- tended, by advising mothers to read Dr. William Buchan's u Advice to Mothers." This will, in some good measure, en- able them to prevent the mischief, which is daily arising from the negligence of physicians, ignorance of parents, and the rashness of nurses. Here my remarks ended, and I sent them to a medical friend to read. He has expressed a wish, that 1 had spared the cen- sure on the nurses, observing, that they derive the practice in question from medical authority, and for himself, that he had not suspected any injury from it. No one is more inclined than I am fully to estimate the value of good nurses, and to re- OF CHILDREN. spect them, or more ready to believe that many such exist. Within the week past, I have detected enough of hypocrisy in a worthless one, long to induce me to appreciate highly those, who labor to understand and perform their duty. 1 would blame and repress only that arrogance and selfish- ness, which prompt some much sooner to invade the province of the physician, than to be useful in their own, rather to im- pose on the mother, and neglect the infant, than to serve the one, or take proper care of the other. I would persuade mo- thers, that, if they will exercise their own understanding, they will be quite as likely to comprehend a matter of common senre, as the despotic loaders of the nursery, who, in their turn, are too often guided by nothing better than the blind maxims of unthinking tradition. However this chilling practice may have arisen, its effects, if injurious, as I apprehend them to be, are not the less to be regretted on that account. If, in truth, it has originated from a medical source, it would seem to be peculiarly proper, that those guardians of the public health, who think unfavorably of it, should expose and renounce it, that the improvements of each succeeding generation of physicians may repair, as far as possible, the defects of their predecessors. With regard to those subjects, which divide the profession. the individual cannot do better than to study them with an open mind, till he can discover the side of preference; to take his sentiments from the dictates of reason, observation, and experience, and to pursue that practice, which directs him with the greatest certainty to the comfort and security of the well, and the restoration of the sick. It has been said, or I have imagined, that on some topics we do not rest on the line of truth till we have digressed from it in various directions, have perceived our distance from it, and have felt our need of its support. If this be true, it only shows the advantage of entering early on the route of discovery, lhat we may arrive at certainty in good time to make our knowledge useful. The determination not to change, is becoming only to infallible minds. No opi- nion should be held too dear to be relinquished for a nearer approximation to truth than the ground we may occupy. In the mean time, the highest authority which any man can ac- knowledge as qualified to govern his conduct, must be those convictions of his own mind, which he knows to be honestly, and which he believes to be correctly formed.' J. G. C. 52 OF PHYSICAL EDUCATION. CHAP. II- 'OF PHYSICAL EDUCATION IN CONNEXION WITH INTELLECTUAL AND MORAL CULTURE. This chapter consists of an extract from a discourse on this subject, read by the American editor. IF any thing is important, within the scope of human ability and obligation, it is the business of education ; but as education creates nothing, its proper efforts are necessarily limited to the work of unfolding, exercising and improving the material organs, and the intellectual and moral capacities which nature produces. This primary and obvious truth is worth remembering, be- cause some of the friends of human improvement have failed in their benevolent purposes, in consequence of having attempted what is -impossible ; while the more common cause of failure is the opposite fault, of attempting too little. The compound human being is made up of an animal, a moral, and an intellectual constitution,—all equally and essentially important in themselves considered, and in their mutual rela- tions and reciprocal influence on each other. Hence, no man^ is well educated, whose corporeal system, whose head, or whose heart is neglected. The head, indeed, may be furnished, and the heart well dis- posed, but we still want a hand to execute ; and so of the rest. One great defect in our schools is, that the body is disregarded, no provision is made for securing any of those privileges, ad- vantages, or enjoyments, which originate from a hardy, well disciplined body; and we have to regret, that so long as this is the case, moral and intellectual culture can never be perfect,— never so good as each would be rendered in connexion with physical education. It is by the influence of the living power inherent in every part of the body, that all the animal and vital functions of the system are performed, that all voluntary motion takes place, and that every faculty of the mind is exerted. The two principal means, by which the living power is con- stantly expended, are sensation and motion, the former being the property of the nervous, and the latter of the muscular sys- tem. In man, also, the faculties of the mind depend on the same principle for their exertion; and, in health, the supply is OF PHYSICAL EDUCATION. 53 adequate to the performance of all the requisite functions, both corporeal and mental. What then, let me ask, do we need from education ? We want bodies temperate, powerful, adroit,—patient and enduring in privation and suffering,—irresistible in action; minds stored with useful and practical knowledge, and in their place and proportion, with the ornamental attainments ; hearts inclined to estimate and prefer pursuits and possessions according to their respective and intrinsic value. But these happy results are not to be had without being sought, and sought too in the right direction. What would be the character and condition of a people, whose individuals were all thus educated ? How far our present modes of instruction are suited to form such a people, and how much better they might be made, every one is at liberty to consider and decide for himself. In the mean time it cannot be doubted, that happiness is the great and ultimate design of human existence, and, consequently, that that education is the best, which gives us, at once, the highest capacities for enjoyment, and the most effectually quali- fies and disposes us to contribute to the happiness of others. Men do not execute, except by accident, any better than they think, but they do ordinarily execute well, in a proportion, more or less direct, to the justness of their conceptions, or to the perfection of any given model for imitation. Hence the advantage of possessing clear and accurate notions of any sys- tem of operations, which we are concerned to perform in the best manner. So long as our theory of education remains defective, we need not be surprized at imperfect results, and disappointed hopes. If these views of human nature and human \\ants are well founded, our plans of education should embrace corporeal, as well as mental and moral improvement. These inseparable parts w should form a whole, each division of which should go on with the other two, day by day, and year by year, in exact harmony and proportion. When the objects and means of education shall be accurately and generally understood, many intelligent and faithful parents will be enabled and encouraged to do much for their children, before they leave home ; and what is once well done need not be undone at any subsequent period, but will serve as the basis of future eminence and success. We must look to the gymnasium as the only means capable of supplying the great chasm in our seminaries of instruction. This includes a building, with the instruments and surrounding 54 OF PHYSICAL EDUCATION. space, sufficient for the performance of all the palestne exer- cises. The gymnastic art embraces all the rules required to unfold the various organs and structures of the animal mechanism; to improve and perfect their agility, suppleness and stability; to preserve or restore health, and at the same time to develop the physical and mental faculties. If these be the well known effects of the ancient gymnasiums, it is not a little remarkable that, for centuries after the intellec- tual and heroic ages of Greece and Rome, during which the gymnastic discipline formed so essential a part of education, the systematic training of the body should have been entirely lost in modern Europe, if we except only the last twenty or thirty years. And even since the revival of athletic sports on the continent, England has almost confined her taste to the elegant and noble game of cricket, and to the brave but brutal practice of boxing. One or two years ago the system of Capt. Clias, principal of the Gymnastic Academy in Berne, was, indeed, patronized by the commander in chief of the British army, and by his order introduced at the Royal Military Asylum at Chelsea ; where, under the superintendence of a Capt. C, the nu- merous boys of this excellent institution have been practising all these exercises with the best effect, according to the report of the medical officers of the establishment. Children hate to be idle. All the care then is, says Mr. Locke, that their busy humor should be constantly employed in something safe, and likely to be of use to them. Those who have had the educating of children have generally confined their attention to the moral and intellectual parts of it. In England, children rush out of school and play with pegtop or marbles, or hopscotch, which can be of no use to them in after life; for these amusements teach nothing, and lead to nothing. It is no better with us. Swimming, running, skating, jumping, climbing, wrestling and many other sports, promote immediate gratification, invigorate the muscles of the body, and are likely to be called into action for the purposes of personal safety in future life. Mere relaxa- tion of the mind, desirable and necessary as it is, is not alone sufficient; and when boys are left entirely to the invention of their own recreations, nothing else is considered but this mere relaxation; while the promotion of health, vigor, courage, elas- ticity, and graceful action, are accidental circumstances, which may, or may not be, connected with their sports. Much, therefore, is to be taught in these, as in other matters. For ourselves, we have not yet recognized the gymnasium its OF PHYSICAL EDUCATION. oo worthy of any attention; still less have we imagined it capable of elevating the national character. And yet no one, who is qualified to form a just estimate of its influence, will hesitate to believe, that, added to our existing institutions, it would give us, what we can derive from no other source, Roman bodies, Athenian minds, and American hearts. Could the natural effects of these graduated and well adapted exercises be fully and generally secured, with the other branches of general education, they would give us, in the .short space of thirty years, such a race of men and women as have not yet appeared on this earth. And where can the experiment be better made than here ? Our rulers are a part of ourselves; whatever with us consti- tutes the security, the regulated freedom, the wants and well- being of the subject, is no less a part of the individual wants and wishes of our magistrates. No institution of nature is more evident than the necessity of the actual exercise of the animal, as well as of the rational, existence, for the improvement of both, and for maintaining them in a healthy state. A due degree of labor strengthens, and even multiplies, mus- cular fibres ; and the want of it produces various chronic dis- eases, not only of the muscles themselves, but of every organ and function of the animal frame. The healthy and vigorous action of the muscular fibres of one organ, communicates firmness and strength to another. The action of the stomach, for instance, required to subdue hard articles of nourishment, imparts firmness and energy to the voluntary muscles, which the same alimentary matter, in a soft or fluid form, does not give.* The first gymnastic school, which appeared in Europe, since the decline of the Roman empire, was that of Mr. Saltz- mann, in Saxony, in the year 1786. Since this period, gym- nasiums have been established in Sweden, Denmark, Prussia, Germany, Switzerland, Spain and France. It was in Denmark that gymnastic exercises were first considered in a national point of view; and in 1803 the number of these establishments in that country had already amounted to fourteen, to which three thousand young men resorted. Since this time the government have issued an order for allotting a space of two hundred square yards to every public school, for the purpose of gymnastic ex- ercises. In 1810, the gymnastic institution of Berlin was place. under the direction of Jahn; through whose zeal and perse- * Blaoe's Medical Logic, p. 132. 56 OF PHYSICAL EDUCATION. verance a taste for manly sports has been widely diffused over Germany. % Capt. Clias is professor of gymnastics in Berne ; and he says, that he has superintended the physical education of two thousand pupils, not one of whom ever experienced the slightest accident. Very recently, the Prussian government have directed gym- nastic exercises to be introduced into every school in the king- dom, as forming an essential part of education. The teachers of this system, in various parts of Europe, have at length re- duced to practice, and confirmed by the most perfect success, the beautiful theories long since conceived by the most enlight- ened and benevolent individuals. The gymnastic domain is unlimited ; it takes charge of the individual from infancy, and, like a vigilant mother, conducts him through all the stages and aspects of life; and, even when near its close, does not forsake him ; but, with a generous hand, holds out to him the treasures of hope, and opens to his view the prospect of protracted years without infirmity. The production of sound, well formed, and vigorous bodies is not the only good fruit of the gymnastic dis- cipline ; it is also a powerful means of promoting health, of pre- venting, and of curing diseases. At this epoch, when the vaccine preventive is increasing the probability of life, gymnastics, when better known and skilfully applied, will add efficiency to the means of prevention, and new resources and new success to the methods of cure. A student of medicine, seized with a nervous affection which de- prived him of sleep, was completely cured by motions of the superior extremities, repeated twice a day, and carried to fa- tigue. A man, fifty years of age, tormented with a painful sciatic complaint of the hip and loins, and who obtained no relief from four blisters, and other appropriate remedies,—by a series of motions of the affected limb, acquired such a degree of supple- ness and strength, as to walk about and attend to his business. Another case is reported by Mr. Clias : An infant, three years old, could hardly stand alone ; at five years he walked imperfectly, even with the help of leading strings. It was not till the seventh year, that he began to walk without assistance, and even then he fell often, and could not raise hin^elf from the ground. Abandoned by the physicians, he thus passed along to the seventeenth year of his age. Even then his loins and lower extremities could scarcely bear the weight of his body. His arms were extremely weak, and tinned forward toward the chest, n a fermented preparation of mart?1 milk, termed koumiss, they vxry generally recover even lrom the last stages of this disease. A. P. B. t Shetlield. OF CONSUMPTIONS. 173 ing and restorative.* All the food and drink ought, however, to be taken in small quantities, lest an overcharge of fresh chyle should oppress the lungs, and too much accelerate the circula- tion of the blood. The patient's mind ought to be kept as easy and cheerful as possible. Consumptions are often occasioned, and always ag- gravated, by a melancholy cast of mind ; for which reason mu- sic, cheerful company, and everything that inspires mirth, are highly beneficial. The patient ought seldom to be left alone, as brooding over his calamities is sure to render him worse. Medicine.—Though the cure of this disease depends chiefly upon regimen and the patient's own endeavors, 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 pro- moted by the following medicines : Take fresh squills, gum ammoniac, and powdered cardamom seeds, of each a quarter of an ounce ; beat them together in a mortar, and if the mass prove too hard for pills, a little of any kind of syrup may be added to it. This may be formed into pills of a moderate size, and four or five of them taken twice or thrice a day, according as the patient's stomach will bear them. The 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 saucepan, over a gentle fire, and a tablespoonful 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 regi- men, ought to be medicines of a sharp and cleansing nature ; as oxymel, syrup of lemon, he. Acids seem to have peculiarly good effects in this disease ; * 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. They are often more easily digested after being heated, or cooked. 174 OF CONSUMPTIONS. they both tend to quench the patient's thirst, and to cool the blood. The vegetable acids, as apples, oranges, lemons, &x. 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, chamomile flowers, or water trefoil.* These infusions may be drank at pleasure. They strengthen the stomach, promote digestion, and, at the same time, answer all the purposes of dilution, and quench thirst much better than things that are luscious or sweet. But if the patient spit blood, he ought to use, for his ordinary drink, infusions or decoctions of the vulnerary roots, plants, &c.f There are many other mucilaginous plants and seeds, of a healing and agglutinating nature, from which decoctions or in- fusions may be prepared with the same intention; as the orches, the quince seed, coltsfoot, linseed, sarsaparilla, &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 when three or four ounces, at lea*t, 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 symptom^, show 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 humors then have to putrefac- tion. An ounce of the bark in powder may be divided into eigh- teen or twenty doses, of which one may be taken every three hours through the day, in a little syrup, or a cup of horchound tea. If the bark should happen to purge, it may be made into an * The decoction of the lichen Islandicus may be used with great advan- tage as a drink. Its bitterness strengthens the stomach, while the mucilage it contains renders it highly nutritious. A. P. B, t See Appendix, Vulnerary Decoction. OF CONSUMPTIONS. 173 electuary, with the conserve of roses, thus:—Take old con- serve of roses, a quarter of a pound ; Peruvian bark, a quarter of 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 occa- sion. Such as cannot take the bark in substance, may infuse it in cold water. This seems to be the best solvent for extracting the virtues of this drug. Half an ounce of bark in powder may be infused for twentyfour hours in half & English pint of wa- ter. Afterwards, let it be passed through a fine strainer, and an ordinary teacupful 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 cer- tainly known that matter is collecting 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 absorp- tion, the patient must endeavor 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 discharg- ed 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, buttermilk 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, between the pleura and the lungs, there is no way of getting the matter out, but by an incision, as has already been observed. As this operation must always be per- formed 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. 176 OF CONSUMPTIONS. 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 indiges- tion, weakness, want of appetite, &c. Those who are of a fretful temper, who indulge in spirituous liquors, or who breathe an unwholesome air, are most liable to this disease. We would chiefly recommend, for the cure of a nervous con- sumption, a light and nourishing diet, plenty of exercise in a free, open air, and thefcuse.ofsucb bitters as brace and strength- en the stomach ; as the Peruvian bark, gentian root, chamo- mile, 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 likew ise an excellent medicine in this case.* It strength- ens the solids, and powerfully assists nature in the preparation of good blood. Agreeable amusements, cheerful company, and riding about, are however preferable to all medicines in this disease. For which reason, when the patient can afford it, we would recom- mend a long journey of pleasure, as the most likely means to 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 scrofula, 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 consump- tion, they must not only he restrained, but the patient's strength must be restored by gentle exercise, nourishing diet, and gene- rous cordials. Young and delicate mothers often fall into con- sumptions, by giving suck too long. As soon as they perceive their strength and appetite begin to fail, they ought immedi- ately 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 in- crease not a little to the fashion of sitting up late, eating hot suppers, and spending every evening over a bowl of punch, or other strong liquors. These liquors, when too freely used, not * See Appendix, Chalybeate Wi,ne. OF CONSUMPTIONS. 177 only hurt the digestion, and spoil the appetite, but heat and in- flame the blood, and set the whole constitution on fire. At the beginning of this chapter I inserted an observation of Dr. Arbuthnot, that, in his time, consumptions made up above one tenth part of the bills of mortality in and about London. I also expressed my fear, that the proportion was now greater, though 1 had not made the calculation. My reason for think- ing so is, that the education of young people becomes every day more effeminate, and that an effeminate education produces a delicacy of habit, which paves the way to consumption. As all the other causes of a decline operated with as much force about fifty years ago as they do now, the increase in the number of victims can only be ascribed to the enervating change which has taken place in the physical treatment of children. The seeds of disease are sown, as it were, in the cradle, and the fountain of life is poisoned at its source. In tracing the various causes of consumption, I entered into minute details, to put people more upon their guard, as the dis- ease, when deeply seated, seldom admits of a cure. Not but that there are plenty of persons in London, who confidently under- take to perform cures in the most hopeless stages of the com- plaint, though physicians have not been so happy as to find out the art. Perhaps the only art which the others have disco- vered, or which they have ever studied, is the art of impudence and deception. An ignorant man advertises a syrup for the cure of con- ' sumptions. The people swallow it; and the man gets a for- tune, though he never cured a consumption in his life. Indeed, there is no occasion for the quack to cure any disease. The patient imagines he feels relief, and that answers the quack's purpose as much as if he really did. Even if he feels no re- lief, he will say that he does. No man will suffer his under- standing to be impeached for having applied to a quack, when he can so easily get rid of the laugh by pretending to have ex- perienced great benefit from the medicine. But to return to my former argument. As consumptions sel- dom admit of a cure, the utmost care should be exerted to avoid them. The best general caution I can give, is to guard against catching cold, the fruitful mother of consumptions, and of many other disorders. How this is to be done, will be more fully explained when I come to treat of colds and coughs, the bane of this island, and the source of numberless diseases, es- pecially among the young, gay, and thoughtless part of the community, who have no fear of any ill till it overtakes them, when it is generally too late to prevent the fatal consequences. 53 178 OF CONSUMPTIONS. ON THE MEANS OF PREVENTING PULMONARY CONSUMPTION. ' Human beings are so constituted, that they can exist but for a very short space of time without inhaling a fresh portion of atmospheric air. The uninterrupted repetition of this pro- cess, which is absolutely requisite for the support of life, im- plies a perpetual state of activity in the organs by means of which it is carried on. This alternate state of dilatation and contraction of the lungs necessarily forms a great impedi- ment to the cure of any wound or ulceration taking place in their substance, by the same process employed by nciture to heal injuries in other parts of the living body, which admit of a temporary state of quietude and repose. The slightest degree Of diseased action, occurring in an organ so essentially important to the maintenance of existence, is sufficient tocreate alarm, which our melancholy experience of the inefficacy of the art of medi- cine to remove chronic affections of the organs of respiration has no tendency to diminish. A single opportunity of inspect- ing the state of the lungs of a person dead of pulmonary con- sumption, might, I have frequently thought, suffice to correct the pretensions of those who propose to cure the disease, after it is confirmed, by the administration of medicine. But the im- practicability of a cure ought to render us proportionably more attentive to the means of prevention, from which much may be expected, provided they are employed at a sufficiently early period. Pulmonary consumption may be divided into two kinds, which it is of importance, even in a prophylactic point of view, to discriminate from each other.—The lungs may be injured by a blow, or pierced by a wound. Inflammation may take place in them from overexertion, in consequence of the stop- page of some customary evacuation, or from exposure to cold, giving rise to pleurisy or peripneumony; and these diseases may terminate in consumption in persons who have no natural predisposition to that complaint. This species of the disease may be termed symptomatic, and occasionally admits of being cured, by removing the cause whence it originated. Some- times, when an abscess is formed in the lungs, which is termed a vomica, and produces all the symptoms of phthisis, it will at length break either internally, when the matter is coughed up, or point externally, and admit of being opened ; after its con- tents are evacuated, it will heal up, and the patient completely recover. The other species of consumption may be denominated he- reditary, as being derived either from a parent, or occasionally from some more distant relative. As we perceive children to OF CONSUMPTIONS. 179 resemble their parents in the features of their faces, and in the disposition of their minds, so there can be no doubt but they also resemble them in the internal organization of the body, on the peculiar structure of which a predisposition to future dis- ease must necessarily depend. And that children are in fact liable to the diseases of their parents, we have manifold and decisive proofs. How frequently do we see a person at a cer- tain time of life so much resemble what a father was at the same period, that he seems to fill the identical place in society that the former occupied ! In like manner, at certain periods of life, do children become liable to the diseases of their parents, and consumption, gout, or dropsy, makes its appear- ance, the germs of which must have lain in the system from the earliest period of existence, although they did not disclose themselves till their due season. Not only do wre see that chil- dren are peculiarly prone to the diseases of that parent to whom they bear the greatest personal similarity, but as we oc- casionally perceive the resemblance of some more remote an- cestor break forth, as it were, in a family, so we shall find the constitution and diseases of that child differ from those of its immediate parents, and partake rather of the nature of the pro- genitor whom it most resembles. These circumstances are thus particularly noted, because it is only in cases where the predisposition to this disease is sus- pected at a very early period of life, that the means of preven- tion can be employed with any reasonable prospect of success. For the same reason, also, I am desirous of attracting the atten- tion to a point of similarity between parents and children, which has not hitherto been sufficiently attended to. The form and structure of the nails of both extremities afford an excellent criterion to enable us to judge which of the parents the offspring most resembles in constitution. I have known the peculiar structure of a toe nail designate certain individuals of a family for several successive generations. Although these parts of the human body do not make their appearance earlier than about the sixth month of the fetal age, they indicate very decidedly the predominant influence of the parent whom the child most resembles in constitution. It is also a curious fact, that the horns of animals, which often do not appear till several months after birth, afford the best criterion for distinguishing the peculiar breed or race, to those who are conversant with such subjects. But certain peculiarities-in the structure of the nails afford also a strong indication of the propensity to phthisis. In forming an opinion concerning the probable future occurrence of this disease, the nails ought always to be carefully examin- 180 OF CONSUMPTIONS. ed and compared with those of the parents. If these parts of the body are large, of an oblong shape, of a smooth texture, and a pink color, curling over the tips of the fingers, the last joint of which is commonly somewhat enlarged, there is much reason to suspect a phthisical tendency. If, moreover, we find a slender conformation of the body, fine skin and hair, a shrill voice, easily rendered hoarse, hollowness of the temples, sound teeth, and an expanded pupil of the eye, there is little doubt but a person so constituted will, at some future period of life, be- come the victim of pulmonary consumption. The aggregate of these appearances constitute what is term- ed delicacy of constitution. This habit of body is frequently accompanied by superior powers of mind. Individuals, indeed, who seem almost to approach the perfection of our species are peculiarly marked as the victims of pulmonary consumption. This fact not only furnishes a strong motive for endeavoring to prevent the first attack of affections of the lungs, but affords al- so some grounds to encourage the expectation of success. Soundness of teeth, a marked concomitant of the phthisical habit, is commonly considered as one of the surest signs of a sound constitution. A variety of examples might also be ad- duced of persons, who, after having subdued, by regimen and medicine, phthisical symptoms, with which they were threaten- ed in their youth, have protracted existence to a very advanc- ed period of life." As the propensity to this disease must necessarily be the result of a certain combination of habits con- tinued perhaps from one generation to another, combined with the peculiar circumstances in which the individual is placed ; it is reasonable to suppose, that, by altering the former, and counteracting the latter, the general constitution might be changed. Pulmonary consumption is a disease almost peculiar to a cer- tain zone of northern latitude, in which the British Isles are included. A little further to the north, or to the south, the ravages of these complaints are comparatively trifling. The only natural cause to which this can with propriety be attribut- ed, is the fluctuation of our atmospheric temperature between the confines of heat and cold. The increased frequency of pulmonic complaints, which has accompanied the more general diffusion of wealth, and consequent habits of luxurious living in this country, affords, 1 think, sufficient proof, that tender and indulgent treatment are not the best means of obviating them. W hat are the classes of mankind most susceptible of, and most injured by, the impressions of heat and cold ? Pre- cisely those who are least exposed to their influence. Seden- tary artificers, who necessarily pass their days in close and OF CONSUMPTIONS. 181 heated chambers, are swept off in uncountable numbers by pulmonary consumption ; while sailors, ploughmen, butchers, and all persons whose occupations lead them to be much in the open air, enjoy a comparative immunity from the attack of this disease. Among the native inhabitants of America, Dr. Rush informs us, that pulmonary consumption is unknown; but in proportion as they adopt the arts and manners of civiliz- ed life, do they become liable to the fatal influence of this complaint. When a wealthy parent sees a delicate child shiver at the freshness of the breeze, a natural tenderness leads him to avert this unpleasant feeling by the means he can most readily com- mand,—close apartments and warm clothing. But he thus aug- ments that very delicacy of constitution he should endeavor to counteract. The variations of atmospheric temperature are most sensibly felt by those who are cased in the thickest cloth- ing ; as plants reared in the hothouse are least able to bear the blasts of winter. Contrast the leadencolored visage, and the chilblained toes and fingers of the puny schoolboy, shiver- ing and crawling along the street in a winter's day, with the appearance of the country lad, of equal years, employed all day in following the plough ; the surface of his body, in place of being chilled by the cold, is roused to a state of increased vascular action, his countenance glows with the genuine hue of health, and his whole frame bespeaks elasticity and vigor. Surely, from this example we might be taught the most effec- tual method of averting delicacy of constitution, being careful to modify the means according to the object we have to ope- rate upon. Let the child whose wealth can command, and whose future existence is of sufficient importance to justify, such attention, reside in a part of the country where the soil is chalk or limestone, and the air pure. Let him be abroad all day, and during every kind of weather, provided he is employ- ed in active exercise; let him be guarded against suddenly approaching, or sitting much over the fire, even in winter. Let the habit of retiring early to bed, and leaving it early in the morning, be strictly enforced. Let him wear no more clothes than are requisite to guard against cold; and plunge into the sea, or a river, for a moment, daily, during the three warmest months of summer. The phthisical habit is in general attend- ed by a precocity of intellect, which it is of more importance to check than to encourage. In such instances the improve- ment of the mind should be considered as a secondary object, and may well be postponed till a certain share of robustness of constitution has been ensured. This kind of corporeal educa- tion is obviously incompatible with the usual discipline of 182 OF CONSUMPTIONS. schools, whether private or public, and can only be adviseable where the importance of the object justifies the various sacri- fices that must be made in order to attain it. I very recently had occasion to see the success of this plan completely exemplified. Every possible attention was paid to the health of a delicate child by its anxious parents. He lived in spacious apartments, in an open and airy part of London; was carried abroad several times every day, when it did not rain; and the diet was regulated with every attention to pro- priety. Notwithstanding all this care, the flesh of this child was flabby, he was averse to exercise, the belly became promi- nent, and the glands on each side of the neck were very con- siderably enlarged. In this'state the child was removed, the beginning of last summer, to a dry and healthy situation in the neighborhood of the sea. There it ran about and bathed along with other children of a similar age. No particular attention was paid to dress or diet. In the course of a few months the • tumid abdomen subsided, the swellings of the neck disappeared, the flesh became firm, and this child, whose life had been de- spaired of, and was sent from home as on a forlorn hope, re- turned vigorous, active, and healthy. But precautions against this insidious disease are rarely had recourse to at so early a period of life. The buoyant spirits and active propensities of its destined victims rarely excite sus- picion, either in themselves or their friends, of the approaching mischief. As the age of puberty approaches, other indications of the propensity to phthisis are developed. The narrow and elongated form of the chest becomes more apparent, and is chiefly indicated by the prominence of the shoulders, which stand out from it on each side, somewhat like wings. A broad, deep chest, the transverse section of which approaches the cir- cle, affords the best criterion of a healthy and vigorous confor- mation of the body, not only in man, but in all the kinds of quadrupeds, which are subservient to his wants. For the sup- port of life it is necessary that nearly one half of the blood should circulate through the lungs in the same time that the remainder passes through the rest of the body. But if the lungs are prevented from expanding to their proper magnitude in consequence of being confined within the limits of a narrow thorax, their proper blood vessels must be-proportionally di- minished in number as well as in dimensions, and, on any sud- den push of blood, their coats, already overdistended, must be prone to rupture. At this period of life, too, there is evidently an effort of the constitution endeavoring to expand every part to a state of full perfection. This is evinced by frequent dis- charges of blood from the nose. The vessels of this part rea^ OF CONSUMPTIONS. 185 dily heal, but an accident of the same kind, taking place in the lungs, not unfrequently lays the foundation of consumption. This temporary fulness of blood should be counteracted, by strictly adhering to a diet of the farinacea and ripe fruits. Ani- mal food and fermented liquors ought to be rigidly prohibited. Even milk often proves too nutritious. Exercise should be regular, but gentle. Sudden and violent exertions are ex- tremely hazardous. Riding on horseback is preferable to any other kind of exercise. Such efforts of the voice as are re- quired in singing or playing on any wind instrument of music, frequently produce discharges of blood from the lungs; but the practice of reading or reciting, for some time together, in a moderate tone of voice, tends to strengthen these organs, and to diminish the danger of pulmonary hemorrhage from any sudden exertion. During the circulation of the blood through the lungs, a prin- ciple necessary to the support of life is absorbed from the air; and various matters, the longer continuance of which in the body would be noxious, are also discharged in the form of va- por or gas. That there is, besides, no inconsiderable quantity of aqueous fluid secreted and discharged from the lungs, every person must be convinced, who has attended to the deposition of watery particles that takes place from the breath in a frosty day. Of the whole quantity of perspirable matter discharged from the surface of the body in any given portion of time, that exhaled from the surface of the lungs may be estimated as amounting to one third. The skin and the lungs, being both secreting surfaces, must also be considered as organs mutually compensating or balancing each other. If the skin be sudden- ly chilled, a larger share of perspirable matter will endeavor to escape by the lungs, as being an internal, and therefore a warmer surface. It is not surprizing, that this effort should, in a delicate organ, be productive of derangement and disease, and accordingly we daily hear people dating their first attack of pulmonary complaints from sitting in a cold place, after hav- ing been overheated, from being thoroughly soaked with rain, or from cold bathing in an improper state of the system. 'i he purpose of these observations is to enforce the proprie- ty of maintaining cutaneous perspiration, and endeavoring to render the surface of the body less susceptible of atmospheric variations. In persons of a phthisical habit, the skin is in general either dry and scabrous, or clammy, both of which conditions betoken deficient perspiration. The most effectual means of reui'»ving this morbid state of the surface of the body is the sedulous use of cutaneous friction. Why a practice, on which the ancient physicians placed so much dependence, not 184 OF CONSUMPTIONS. only for the cure of many diseases, but, in a preeminent man- ner, for the preservation of health, should have in modern times fallen so completely into neglect, it is not perhaps easy to account; though at present nothing seems to be considered as medicine except what is taken into the stomach ; as if the due regulation of air and exercise did not furnish means of recovery at least as efficacious as drugs. Cutaneous friction is most advantageously performed by means of a flesh brush. To be of any essential use, this in- strument ought to be of a much harder texture than those com- monly offered for sale. The most favorable season for this practice is not immediately on getting out of bed. There ex- ists a sensibility of the skin at this time, which renders the ap- plication of the brush painful and unpleasant. After the cus- tomary diurnal evacuation of the bowels has taken place, the person should strip, and, applying this instrument to various parts of the body in succession, commencing with the chest, continue the friction till a universal redness and glow take place over the whole surface of the body. The temporary exposure of the naked body to the air of the chamber during this operation, accustoms the skin to a certain variety of tem- perature, while any danger of taking cold is completely obvi- ated by the exercise, as a person ought always, if his strength permit, to rub himself. Though somewhat painful and irksome at first, this operation, like all the rest of our active habits, gradually becomes pleasant, and at length necessary, so that a person accustomed to it, feels himself uncomfortable if he has omitted for a day his usual exercise. From regularly persevering, for some length of time, in this practice, I have observed a very obvious alteration produced in the texture of the skin. It appears to acquire thickness, and to become mellow and pliable, a condition very different from that of persons disposed to phthisis, whose skin is commonly thin and harsh. The muscles also seem to derive firmness from this practice. The brush will also be found daily to remove no small quantity of furfuraceous matter, which, wheth- er it be inspissated perspiration adhering to the surface, or particles of decaying cuticle, is certainly better away. This practice also removes every kind of roughness and asperity from the surface of the skin, which becomes beautifully smooth and polished, so that, even as a cosmetic, having no tendency to impair health, cutaneous friction may be advantageously employed. After exposure to wet, to strip and rub the surface of the body till it glows, is unquestionably the best means to prevent taking cold. I do not presume so strenuously to recommend friction of OF CONSUMPTIONS. 185 the skin as a means of supporting the healthy action of the external surface of the body, and of promoting cutaneous per- spiration, without having witnessed remarkable changes for the better produced in the constitution by adopting and persever- ing in this practice. Indeed, I am disposed to attribute much of the benefit derived from exercise on horseback, as well as the good effects of a sea voyage towards a mild climate, to the increase of perspiration produced by these modes of gestation. Every person suspicious of predisposition to pulmonary con- sumption ought at all times, but especially in cold weather, to wear a quantity of woollen clothing, sufficient to obviate any ap- proach to the perception of chilliness. Independently, however, of the actual presence of obstinate hoarseness or cough, I am disposed to think, that the requisite quantity of flannel is more advantageously worn over the usual shirt, than in immediate contact with the skin. The possibility of communicating this disease by contagion is a point that has been much agitated. As a measure of pre- caution, the delicate ought to decide this question for them- selves in the affirmative. Exhalation from the lungs is the mode by which infectious diseases are most generally propa- gated; and from analogy we might infer, that air, impreg- nated with the effluvia of these organs in a state of ulceration, would have a tendency to excite diseased action of a similar kind, if received into the lungs of a person previously disposed to this complaint. I have seen more than one instance of a husband, who appeared to have no previous disposition to con- sumption, being affected with a distressing cough, which con- tinued to harrass him for months, while his wife was lingering under this disease. On one melancholy occasion, I witnessed the successive deaths of three young ladies, two of whom, in my opinion, decidedly caught the disease in consequence of their sedulous attention, during the progress of the indisposi- tion, to her who was first affected, who evidently was of a phthisical habit, which was not apparent in either of the others. If the presence of the symptoms, which have been already described as characterizing this disease, renders its existence no longer equivocal, the person so affected ought without delay to migrate towards a warmer climate. Should circumstances render this expedient impracticable, the next best plan a phthi- sical person can adopt is to remove into a low and rather damp situation. The fatal event of pulmonary consumption is uni- formly accelerated by residing in an elevated region. There are even instances on record of phthisis making its appearance in families, previously unaflfected by it, on changing their place of 24 186 OF CONSUMPTIONS. residence from a level to a hilly country. While, on the con- trary, the inhabitants of extensive districts in Lincolnshire and in Essex enjoy a complete immunity from this disease. In Holland, pulmonary consumption is a disease of comparatively rare occurrence. The same situations that predispose to ague are unfavorable to the attack of phthisis, as if these two states of the constitution were incompatible with each other. The physicians of ancient Rome were accustomed to setid their consumptive patients to the low and marshy land of Egypt. Cicero, the celebrated orator, who, in his youth, was threaten- ed with consumption, as the hollow temples and sharp features of his remaining busts abundantly testify, travelled into Egypt for the recovery of his health. In this country the choice of situation is not sufficiently attended to ; although every practi- tioner of medicine must have retmrked, that even the soft breezes of Brompton and Chelsea hue benefited invalids, who were injured by the keener air of Highgate and H impstead.* In the incipient stages of phthisis pulmonalis, the dry vomit, taken in a morning, fasting, I have known occasionally to be of use. Keeping up a copious discharge from the surface of the chest by the savin ointment, subsequent to the application of a blister, sometimes appears to arrest the progress of the disease. When symptoms of incipient phthisis have been accompani- ed by tumors, commencing at the clavicle, and extending up- wards towards the ear, I have seen much benefit from the administration of calomel combined with steel. When recovery is despaired of, a diet, consisting of butter- milk and the lighter farinacea, prolongs existence, and mitigates the distress of the cough more effectually than the use of opium. From a medicine which of late years has been much extolled as diminishing frequency of the pulse, (digitalis,) I am sorry to say, I have seen no permanent benefit produced in this disease ; and, notwithstanding the boasts of empiricism, a remedv that will resolve tubercles, or heal ulceration of the lungs, I believe ) et remains to be discovered.' A. P. B. The following remarks on the use of flannel, taken from Dr. John Armstrong's Treatise on Pulmonary Consumption, are too valuable to be omitted in this place : " When flannel is worn next the skin, Dr. Barlow remarks, it is almost invariably the practice to keep it on by night as well * In the islands of Guernsey and Jersey, where the climate is so loaded with moisture, that common salt deliquesces if expo-e t to the air, I am in- formed that coughs are very rare, and pulmonary consumptions almost un- known. Of course these islands must be an excellent situation for persons of a phthisical temperament. OF CONSUMPTIONS. 187 as by day. This is not only unnecessary, but injurious. The chief advantage of using a flannel dress next the skin results, not from the actual warmth imparted or retained, an effect which might be obtained to an equal extent by an increase of outward clothing ; but from the uniformity of temperature thus ensured to so large a portion of the surface of the body, and the tendency which this has to keep the highly important, but too much neglected functions of the skin, in an active and healthy condition. During the day the frequent, and oftentimes sudden vicissitudes of our climate are such as to render the effects of flannel in preserving an equality of temperature most valuable. But at night, and during sleep, we are subject to no such vicissitudes ; consequently the same necessity for the use of flannel does not then exist. But while the use of flannel at night thus appears to be unnecessary, there are several con- siderations which show it to be injurious. These considerations regard both the condition of the body and of the flannel itself. Whatever the wants of the body for warmth, during the night, may be, they are in general fully supplied by the bed clothes in ordinary use. The body requires no extraordinary warmth during sleep ; on the contrary, there is at such times even a tendency to an increase of the natural warmth. When to this natural tendency the heat caused by flannel worn next the skin is superadded, the effect is to keep the skin in a state of con- siderable excitement, and to induce perspiration more or less profuse. These effects are not calculated to prepare the body for enduring the vicissitudes of the ensuing day, but rather to render" it more susceptible of injury. Again, continues Dr. Barlow, the property which renders woollen cloth so eminently suited to the purposes in view, is that of its being a slow con- ductor of heat. This property is directly proportionate to its dryness ; and is greatly impaired by its imbibing humidity of any kind. A flannel dress, however, that is worn next the skin throughout the night, becomes so charged with perspiration, that its power of conducting heat is thereby greatly increased, and its preservative effects proportionably diminished. Here, then, is a twofold injury resulting from the prevailing practice of con- tinuing the flannel dress during sleep ; namely, a diminution of the preservative powers of the flannel, and an increased suscep- tibility of the skin. By laying aside die flannel dress on going to bed, and substituting one of coarse calico, the body is kept in that temperature during the night, which fits it for encounter- ing the vicissitudes of the following day, while the flannel is preserved from the deteriorating effects of the nightly perspira- 188 OF THE NERVOUS FEVER. tion, and is resumed in the morning in a state which contributes. both to comfort and protection. A difficulty, Dr. Barlow sub- joins, is experienced with most people, who have accustomed themselves to the nightly use of flannel, in inducing them to alter the habit. Fear of taking cold creates one great obstacle ; and disinclination to the feeling of cold experienced in the mo- ment of changing the flannel for the calico nightdress, especially in winter seasons, is another. Confidence in the medical ad- viser, however, is sufficient to overcome the first, and a very little experience to remove the latter ; for, after a very few trials, the proposed change is found to prove a decided gain, even on the score of sensation, and the gratification derived from resum- ing dry and comfortable flannel in the morning, together with the sensible increase of its utility during the day, are found to compensate amply the slight unpieasantness attending the mo- mentary exposure of the preceding night.* "Dr. Barlow justly observes, that, in many instances, the best interests of mankind, whether we consider their physical or moral welfare, are influenced by circumstances which the world are pleased to deem trivial; but the above suggestions on cloth- ing will not be regarded as such by those who can appreciate the importance of the subject to which they relate, or the talents of the individual from whom they proceeded. These sugges- tions, indeed, of Dr. Barlow relate to the prevention of disease in general, but to that of phthisis in particular, the pathology of which I have proved to be closely connected with the skin ; and to show how the state of this organ may influence the cure of this disease, it is worth mentioning, that I recently received, from a respectable correspondent, an account of two cases re- sembling phthisis, which were arrested, the one by an attack of pemphigus, and the other by that of smallpox." CHAP. XX. OF THE SLOW OR NERVOUS FEVER. IN ERV017S 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 at- tack persons of a weak, relaxed habit, who neglect exercise, cat little solid food, study hard, or indulge in spirituous liquors. * This I have experienced to be exactly true. C. OF THE NERVOUS FEVER. 189 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, as unripe fruits, cucumbers, melons, mushrooms, he. 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 a use of purgative medi- cines," 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. W7e 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 occa- sion fevers of the worst kind, than its opposite. Symptoms.—Low spirits, want of appetite, weakness, weari- ness 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 con- siderable thirst, chilness and flushing in turns, he. After some time the patient complains of giddiness and pain of the head, has a nausea, with retchings and vomiting ; the pulse is quick, and sometimes intermitting ; the urine pale, resembling dead small beer, and the breathing is difficult, with oppression of the breast, and slight alienation of the mind. If, towards the ninth, tenth, or twelfth day, the tongue be- comes more moist, with a plentiful spitting, a gentle purging, or a moisture upon the skin ; or if a suppuration happen in one or both ears, or large pustules break out about the lips and nose, there is reason to hope for a favorable crisis. But if there be an excessive looseness, or wasting sweats, with frequent fainting fits ; if the tongue when put out trembles ex- cessively, and the extremities feel cold, with a fluttering or slow creeping pulse ; if there be a starting of the tendons, and almost total loss of sight and hearing, and an involuntary dis- charge of 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, 190 OF THE NERVOUS FEVER. 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 im- agination gloomy or frightful ideas. These of themselves but too 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, panada, or whatever food he takes, must be mixed with wine according as the symptoms may require. Pretty strong wine whey, or negus, sharpened with the juice of orange or lemon, will be proper for his ordi- nary 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.* Wine, in this disease, if it could be obtained genuine, is al- most the only medicine that would be necessary. Good wine possesses all the virtues of the cordial medicines, while it is free from any of their bad qualities. I say good wine ; for however common this article of luxury is now become, it is rarely to be obtained genuine, especially by the poor, who are obliged to purchase it in small quantities. I have often seen patients in low nervous fevers, where the pulse could hardly be felt, with a constant delirium, coldness of the extremities, and almost every other mortal symptom, re- cover 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 circum- stances require.f 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 in 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 the stomach, * See Appendix, Mustard Whey. t Where wine cannot be procured, I have witnessed equally beneficial effects produced by drinking sound porter or ale with a lemon or orange sliced into it, and rendered agreeabje to the palate of the patient by the addi- tion of sugar. This beverage may be drunk at pleasure, will be found to support strength as effectually as wine, and is in general much relished by the sick ; with the addition of one drachm of muriatic acid to each quart of the liquor, it forms a remedy to which tlie cure of most of the low fevers of this country may with safety be confided. A. P. B. OF THE NERVOUS FEVER. 191 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,* 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 cir- culation 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 a 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 conse- quences, that the operation was improper. Though bleeding is generally improper in this disease, yet blistering is highly necessary. Blistering plasters may be ap- plied 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 this means to 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 stimuhte the solids to action, but likewise occasion a continual discharge, which may in some measure supply the want of criti- * See Appendix, Vomiting Julep. 192 OF THE NERVOUS FEVER. eal 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 be costive through the course of the disease, it will be necessary to procure a stool, by giving him every other day a clyster of milk and water, with a little sugar, to which may be added a spoonful of common salt, if the above does not 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.* 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 choose to use them, we shall mention one or two of die forms of medicine which are commonly prescribed in it.f In desperate cases, where the hickup and starting of the ten- dons have already come on, we have sometimes seen extraor- dinary 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 camphor, and salt of hartshorn, as these tend to promote perspiration and the discharge of urine. Thus, fifteen grains of musk, with three grains of camphor, and six grains of salt of hartshorn, may be made into a bolus with a little syrup, and given as above. * See Appendix, lVhite Decoction. t When the patient is low, ten grains of Virginian snakeroot, and the same quantity of contrayerva root, with live grains of Russian castor, all in fine powder, may be made into a bolus with a little of the cordial confection or vyrup 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. OF THE NERVOUS FEVER. 19$ 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, he. 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 strain- ed, and a glass of it taken frequently.* Some give the bark in this and other fevers, where there are no symptoms of inflammation, without any regard to the remis- sion 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. There is no fever that requires to be watched with more care and attention than this. If the actions of the system are not kept up by stimulating applications, and the patient's strength supported by cordial medicines and nourishing diet, he will sink under the disease ; and it frequently happens, that, when the attendants think him better, he is actually dying. I wish to inspire not only patients in this fever, but their phy- sicians also, with unceasing, unabated hope till the very last extremity. The changes for the better are often as sudden, and unforeseen, as those for the worse. The last gasp alone should induce us to give over the patient. I have left a patient twenty times and more, little expecting to see him alive next day. Yet I did not lose courage, but ordered a bottle, or per- haps two, of generous wine to be given in the course of twenty- four hours; and this patient, to my great satisfaction, recover- ed, and enjoyed health for many years after. * The bark may likewise be very properly administered, with other cor- dials, in the following manner:—Take an ounce of Peruvian bark, orange peel half an ounce, Virginian snakeroot 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 negu9. I now generally administer Huxham's Tincture. 25 194 PUTRID OR SPOTTED FEVER. CHAP. XX. OF THE MALIGNANT, PUTRID, OR SPOTTED FEVER. .1 HIS 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 melan- choly disposition, and those whose vigor has been wasted by long fasting, watching, hard labor, excessive venery, frequent salivations, he. are most liable to it. Causes.—This fever is occasioned by foul air, from a num- ber 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, es- pecially where such places are too much crowded, and cleanli- ness 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, he. may likewise occasion this fever. Dead carcasses 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 shows the propriety of removing burying grounds, slaughter houses, Sec. to 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 cleanli- ness. 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, PUTRID OR SPOTTED FEVER. 195 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 at- tendance 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- ly 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 vio- lent 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 chapped; and his teeth are covered with a black crust. He sometimes passes worms both upwards and dowmwaids, is affected with tremors or shaking, and often becomes delirious. If blood be let, it appears dissolved, or with a very small de- gree of cohesion, and soon becomes putrid ; the stools smell extremely fetid, and are sometimes of a greenish, black or red- dish cast. Spots of a pale, purple, dun, or black color, often appear upon the skin, and sometimes there are violent hemorr- hages or discharges of blood from the mouth, eyes, nose, he. 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 petechiae 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 color, and the loss of strength, dejection of mind, and all the other symptoms more violent. It sometimes happens, however, that the inflammatory, ner- vous, 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. Atten- tion 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 ma- lignant and putrid, by too hot a regimen, or improper medicines. The duration of putrid fevers is extremely uncertain ; some- 196 PUTRID OR SPOTTED FEVER. times 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 favorable 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 petechiae or purple spots, are likewise favorable, 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; deaf- ness coming on towards the decline of the fever is likewise often a favorable symptom,* as are abscesses in the groin, or parotid glands. Among the unfavorable symptoms may be reckoned an ex- cessive looseness, with a hard swelled belly; large black or livid blotches breaking out upon the skin ; apthac in the mouth j cold, clammy sweats ; blindness ; change of the voice ; a wild star- ing 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 fetid, ichorous, in- voluntary stools, attended with coldness of the extremities, are generally the forerunners of death. Regimen.—In the treatment of this disease, we ought to en- deavor, as far as possible, to counteract the putrid tendency of the humors; 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 adja- cent 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 humors are in a putrid state. Besides the frequent admission of fresh air, we would recom- mend the use of vinegar, verjuice, juice of lemon, Seville * Deafness is not always a favorable symptom in this disease. Perhaps it is only so, when occasioned by abscesses formed within the ears. PUTRID OR SPOTTED FEVER. 197 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, he. 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 wTould not only prove very refreshing to the patient, but would likewise tend to pre- vent the infection from spreading among those who attend him, Strongscented herbs, as rue, tansy, rosemary, wormwood, he. 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 drunk 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 bitter 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 teaspoonful of the cream of tartar may be put into a cup of the patient's drink, as there is occa- sion ; or he may drink a decoction of tamarinds, which will both quench his thirst, and promote a discharge by stool. If chamomile 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 tea ten or fifteen drops of the elixir of vitriol. The food must be light, as panada, 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, he. Taking a little food or drink frequently not only supports the spirits, but counteracts the putrid tendency of the humors; 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 ob- tained. 198 PUTRID OR SPOTTED FEVER. If he bo delirious, his feet and hands ought to be frequently fomented with a strong infusion of chamomile 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 re- lieve the head, by relaxing the vessels in the extremities, but as their contents are absorbed, and taken into the system, they must assist in preventing the putrescency of the humors. 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 is never to be used unless in the greatest extremi- ties. If the petechias 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 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, hav- ing 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 cor- dial or alexipharmic medicines. In consequence of this notion, the contrayerva root, the cordial confection, the mithridate, he. 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 tlie only things to be relied on in the cure of malignant fevers. In the most dangerous species of this disease, when it is at- tended with purple, livid, or black spots, the Peruvian bark must be administered. I have seen it, when joined with acids, prove very successful, even in cases where the petechias had PUTRID OR SPOTTED FEVER. 199 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 tablespoonfuls 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 drachm of the salt of wormwood, dissolved in an ounce and a half of fresh lemon juice, and made into a draught, with an ounce of simple cinna- mon 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 dtut in various parts of the body, in the decline of this fever, of a livid, gangrenous appearance, and a most putrid, cadaverous smell. These gradu- ally healed, and the patient recovered, by a plentiful use of Peruvian bark and wine, sharpened with the vitriolic acid. 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.* * 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. 1 told him 1 meant only to discourage unnecessary attendance, and mentioned a number of instances where putrid fevers had proved fatal to 200 PUTRID OR SPOTTED FEVER. When a putrid fever seizes any person in a family, the great- est 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 imme- diately 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 drink- ing plentifully of chamomile tea. This may be repeated in a day or two, if the apprehensions still continue, or any unfavora- ble symptoms appear. The person ought likewise to take an infusion of the bark and chamomile 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 fre- quently 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.* I wished strongly to characterize this disease by calling it the pestilential fever of Europe. It is certain that in our island nothing approaches so near the plague as the putrid or spotted 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 nursf 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. * The above description and mode of treatment of the putrid fever are per- feetly applicable to what is termed the Yellow Fever, &c. of the havoc made by which in our West India possessions during late years we have heard so much. The yellowness of the skin, although generally considered as a fatal symptom, is an adventitious circumstance, resultiug from warmth of climate. In early stages of the yellow fever, smart purges of jalap and calomel, auJ cooling the surface of the body by ablution with sea water, or common water mixed with vinegar, is the most efficacious mode of treatment. Keep- ing the body open and general temperance, are the best preventives. A. P. R. PUTRID OR SPOTTED FEVER. 201 fever. I have often marked its ravages in the narrow lanes of London, but still more frequently in some of the unclean and shamefully neglected seats of putrefaction in the environs. I have seen it in its most horrid form in St. George's Fields, par- ticularly in the King's Bench Prison ; and am afraid the day will come, when the real pestilence will be generated in that quarter. Four hundred thousand people living in a marsh, where there is not the least fall or descent to carry off the perpetually ac- cumulating filth, must in time produce some dreadful putrid disorder. How justly may one apply to the atmosphere of such a place the words of the medical poet, and say, that it is not air the inhabitants breathe, but volatile corruption ! Yet this marsh, by means of sluices or proper drains, might be rendered as healthy a place of residence as any in London, which is, per- haps, the most wholesome city of its size in the world. I shud- der at the idea, that the stagnant mass of so much contagion should be viewed with indifference, and that no steps are likely to be taken to avert the danger, till a terrible sweep of mortality shall spread alarm through the whole kingdom. To show how nearly our putrid fevers resemble the plague, I shall give a short sketch of one that I attended some years ago at Kentish Town. A young lady, about eighteen years of age, who had come from the West Indies for her education, was seized with the common symptoms of a nervous fever ; but this continuing a very unusual length of time, putrefaction began to show itself, and biles and imposthnmes burst forth, and pene- trated so deeply as to lay the bones bare, to an amazing extent, on the back, hips, and various parts of the body; nor were these healed without much time and trouble. curred rare instances, either from unskilful management, or owing to an uncommon peculiarity of the habit and constitution, of its not having prevented smallpox, or rendered the person for ever unsusceptible of variolous contagion ? Attestations of its complete success have been published by a great number of the faculty at Edinburgh, Liverpool, and Dublin. Our readers will find able and satisfactory answers to all the objections that have been urged against the Jennerun practice in the following REPORT. " The Medical Council of the Royal Jennerian Society, hav- ing been informed that various cases had occurred, which ex- cited prejudices against vaccine inoculation, and tended to check the progress of this important discovery in this kingdom, appointed a Committee of twentyfive of their members to in- quire, not only into the nature and truth of such cases, but also into the evidence respecting instances of smallpox alleged to have occurred twice in the same person. " In consequence of this reference, the Committee made dili- gent inquiry into the history of a number of cases, in which it 212 OF THE COWPOCK. was supposed that vaccination had failed to prevent the small- pox, and also of such cases of smallpox as were stated to have happened subsequently to the natural or inoculated small- pox. " In the course of their examination the Committee learned, that opinions and assertions had been advanced and circulated, which charged the cowpock with rendering patients liable to particular diseases, frightful in their appearance, and hitherto unknown ; and judging such opinions to be connected with the question as to the efficacy of the practice, they thought it in- cumbent on them to examine also into the validity of these injurious statements respecting vaccination. "After a very minute investigation of these subjects, the re- sult of their inquiries has been submitted to the Medical Council; and from the report of the Committee it appears, " I. That most of the cases which have been brought for- ward as instances of the failure of vaccination to prevent the smallpox, and which have been the subjects of public attention and conversation, are either wholly unfounded or grossly mis- represented. " II. That some of the cases are now allowed, by the very persons who first related them, to have been erroneously stated, " III. That the statements of such of those cases as are pub- lished have, for the most part, been carefully investigated, ably discussed, and fully refuted, by different writers on the subject. " IV. That, notwithstanding the most incontestable proofs of such misrepresentations, a few medical men have persisted in repeatedly bringing the same unfounded and refuted reports and misrepresentations before the public, thus perversely and disingenuously laboring to excite prejudices against vaccination. " V. That in some printed accounts adverse to vaccination, in which the writers had no authenticated facts to support the opinions they advanced, nor any reasonable arguments to main- tain them, the subject has been treated with indecent and dis- gusting levity ; as if the good or evil of society were fit objects for sarcasm and ridicule. " VI. That, when the practice of vaccination was first intro- duced and recommended by Dr. Jenneh, many persons, who had never seen the effects of the vaccine fluid on the human system, who were almost wholly unacquainted with the history of vaccination, the characteristic marks of the genuine vesicle, and the cautions necessary to be observed in the management of it, and were therefore incompetent to decide whether patients were properly vaccinated or not, nevertheless ventured to inocu- late for the cowpock, OF THE COWPOCK. 213 41 VII. That many persons have been declared duly vac- cinated, when the operation was performed in a very negligent and unskilful manner, and when the inoculator did not after- wards see the patients, and therefore could not ascertain wheth- er infection had taken place or not; and that to this cause are certainly to be attributed many of the cases adduced in proof of the inefficacy of the cowpock. " VIII. That some cases have been brought before the Committee, on wmich they could form no decisive opinion, from the want of necessary information as to the regularity of the preceding vaccination, or the reality of the subsequent appear- ance of the smallpox. " IX. That it is admitted by the Committee, that a few cases have been brought before them of persons having the smallpox, who had apparently passed through the cowpock in a regular way. " X. That cases, supported by evidence equally strong, have been also brought before them of persons who, after having once regularly passed through the smallpox, either by inocu- lation or natural infection, have had the disease a second time. " XI. That, in many cases in which the smallpox has oc- curred a second time, after inoculation or the natural disease, such recurrences have been particularly severe, and often fatal; whereas, when it has appeared to occur after vaccination, the disease has generally been so mild, as to lose some of its characteristic marks, and even sometimes to render its exist- ence doubtful. " XII. That it is a fact well ascertained, that, in some par- ticular states of certain constitutions, whether vaccine or vario- lous matter be employed, a local disease will only be excited by inoculation, the constitution remaining unaffected ; yet that matter taken from such local vaccine or variolous pustule is capable of producing a general and perfect disease. " XIII. That if a person, bearing the strongest and most in- dubitable marks of having had the smallpox, be repeatedly in- oculated for this disease, a pustule may be produced, the mat- ter of which will communicate the disease to those who have not been previously infected. " XIV. That, though it is difficult to determine precisely the number of exceptions to the practice, the Medical Council are fully convinced, that the failure of vaccination, as a pre- ventive of the smallpox, is a very rare occurrence. " XV. That, of the immense number who have been vac- cinated in the army and navy, in different parts of the United 214 OF THE COWPOCK. Kingdom, and in every quarter of the globe, scarcely any in- stances of such failure have been reported to the Committee, but those which are said to have occurred in the metropolis or its vicinity. " XVI. That the Medical Council are fully assured, that in very many places, in which the smallpox raged with great violence, the disease has been speedily and effectually arrested in its progress, and in some populous cities wholly exterminated, by the practice of vaccination. " XVTI. That the practice of inoculation for.the smallpox, on its first introduction into this country, was opposed and very much retarded, in consequence of misrepresentations and arguments drawn from assumed facts, and of miscarriages arising from the want of correct information, similar to those now brought for- ward against vaccination, so that nearly fifty years elapsed be- fore smallpox inoculation was fully established. " XVIII. That, by reference to the bills of mortality, it will appear, that to the unfortunate neglect of vaccination, and to the prejudices raised against it, we may, in a great measure, attribute the loss of nearly two thousand lives by the smallpox, in this metropolis alone, within the present year. " XIX. That the few instances of failure, either in the in- oculation of the cowpock or of the smallpox, ought not to be considered as objections to either practice, but merely as de- viations from the ordinary course of nature. " XX. That, if a comparison be made between the pre- servative effects of vaccination and those of inoculation for the smallpox, it would be necessary to take into account the greater number of persons who have been vaccinated within a given time : as it is probable that, within the last seven years, nearly as many persons have been inoculated for the cowpock, as were ever inoculated for the smallpox, since the practice was intro<- duced into the kingdom. "XXI. That, from all the facts which they have been able to collect, it appears to the Medical Council, that the cowpock is generally mild and harmless in its effects ; and that the few cases which have been alleged against this opinion, may be fairly attributed to peculiarities of constitution. "XXII. That many well known cutaneous diseases, and some scrofulous complaints, have been represented as the effects of vaccine inoculation, when in fact they originated from other causes, and in many instances occurred long after vaccination, and that such diseases are infinitely less frequent after vaccina-- {ion than after either the natural or inoculated smallpox. OF THE COWPOCK. 215 " Having stated these facts, and made these observations, the Medical Council cannot conclude the Report upon a subject so highly important and interesting to all classes of the community, without making this solemn Declaration : " That, in their opinion, founded on their own individual ex- perience, and the information which they have been able to collect from that of others, mankind have already derived great and incalculable benefit from the discovery of vaccination ; and that it is their full belief, that the sanguine expectations of ad- vantage and security, which have been formed from the inocu- lation of the cowpock, will be ultimately and completely ful- filled." This Report and Declaration was signed at the Society's House, Salisbury Square, Fleet Street, January 2, 180G, by fifty physicians and surgeons, who, we may safely presume to say, are not exceeded in medical skill, or intellectual worth, by any other fifty gentlemen of the profession in this great me- tropolis. Medical Treatment.—In general no medicine is required in this mild affection : but if the symptoms happen to run a little more high than usual, the same remedies are to be applied as if they proceeded from any other cause. No preparation is necessary; and no cathartics need be given either before or after vaccination. Should inflammation of the arm exceed the usual bounds, which rarely happens but from tight sleeves, pressure, or fric- tion, it may soon be checked by the very frequent application of compresses of linen dipped in weak lead water. If the scab be rubbed off prematurely, and ulceration take place, cooling and astringent applications may be used, such as a drop of aqua lythargyri acetati, which should be allowed to dry on the part, and then be covered with compresses dipped in water, or any of the saturnine applications above mentioned, and frequently renewed. When the ulceration is deep or extensive, a poultice, either of bread and milk, or of bread with any of the saturnine pre- parations, may be applied, as the case seems to require. They must never be applied till they are nearly or quite cold. In such foul and obstinate sores as resist the foregoing appli- cations, the ointment of nitrated quicksilver, the nitrated quick- silver or lunar caustic, or other similar applications, are some- times resorted to with advantage. A single dressing with these substances is usually sufficient, after which the sore heals under the mildest applications. 216 OF THE COWPOCK. Spurious pustules are frequently followed by ulceration at an early period. This ulceration is to be treated in the same man- ner as if it proceeded from the genuine species. An assurance of perfect security from vaccine inoculation can only be obtained by carefully observing the whole progress of the disease. If any doubt remain, the operation ought to be repeated. WThen the patient has been previously exposed to the infec- tion of the smallpox, that disease will be superseded more or less, according to the time which is suffered to elapse before the inoculation of the cowpock. The advantages of vaccine inoculation being now fully ascer- tained, it is the duty of every member of society, and particu- larly of every member of the medical profession, to discourage the inoculation of the smallpox.* THE FAMILY RECORD. ' In a little book, appropriated for the purpose, should be re- corded the birth of each infant, with his weight, and any pe- culiarity of structure or condition. Once a year, on a fixed day, the height and weight of each child should be noted, with the annual changes in his progress, relating to his acquirements, general state, and character, physi- cal and moral, and whatever else may be worth knowing in future life. In this history should be recorded the time and manner in which each individual may have passed through any of those diseases, which we have once only, as chincough, measles, cow- pock, he.; so that, whenever one of the family is to leave home, he may not be in doubt in regard to any of these com- plaints. This information would prevent any painful apprehension where there is no danger, and any unconsciousness of danger where it really existed. This record, which is very easily kept, if continued to manhood, would furnish a complete natural his- tory of each member of the domestic community, and might be of great value to the parent, the physician, or guardian, in the management of individuals under their care. I have for a number of years kept such a record, and already find it more and more curious and interesting, and it certainly may prove to be something more than this.' C. * It seemed adviseable to insert this chapter on con-pock in place of one on smallpox, though the source whence it originated is at present unknown. C. OF THE MEASLES. 217 CHAP. XXV. OF THE MEASLES. THE measles appeared in Europe about the same time with the smallpox, and have a great affinity to that disease. They both came from the same quarter of the world, are both conta- gious, 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. Causes.—This disease, like the smallpox, proceeds from con- tagion, and is more or less dangerous, according to the consti- tution and state of the patient, the season of the year, the cli- mate, &c. Symptoms.—The measles, like other fevers, are preceded by alternate fits of heat and cold, with sickness and loss of appe- tite. 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 inflam- mation and heat in the eyes, accompanied with a defluction of sharp rheum, and great acuteness of sensation, so that they cannot bear the light without pain. The eyelids frequently swell so as to occasion blindness. The patient generally com- plains of his throat; and a vomiting or looseness often pre- cedes 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, ap- pear, 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 smallpox, 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 up- on the body; so that by the ninth day they entirely disap- pear. The fever, however, and difficulty of breathing, often continue, especially if the patient has been kept upon too hot a regimen. Petechias, or purple spots, may likewise be occa- sioned by this error. 23 218 OF THE MEASLES. 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 pe- ripneumony, or inflammation of the lungs. The most favorable symptoms are a moderate looseness, a moist skin, and a plentiful discharge of urine. When the eruption suddenly falls in, and the patient is seiz- ed with a delirium, he is in the greatest danger. If the measles turn too soon of a pale color, it is an unfavorable symptom, as are also great weakness, vomiting, restlessness, and difficulty of swallowing. Purple or black spots, appearing among the mea- sles, are very unfavorable. 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 lan- guid ; but when they are too violent, they must be restrained by evacuations, and cool, diluting liquors, &c. We ought like- wise to endeavor to appease the most urgent symptoms, as the cough, restlessness, and difficulty of breathing. Regimen.—The cool regimen is necessary in this disease. The food must be light, and the drink diluting. Acids, how- ever, as they tend to exasperate the cough, should not be employed. The most suitable liquors are decoctions of li- quorice, with marshmallow 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 this 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, 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.* 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 chamomile tea. When the cough is very troublesome, with dryness of the throat, and difficulty of breathing, the patient may hold his * 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. OF THE MEASLES. 219 head over the steam of warm water, and draw the vapor into his lungs. He may likewise lick a little spermaceti 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 vigor, and there appears great danger of suffocation, the patient must be bled according to his strength, and blistering plasters appli- ed, 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, 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 spirit of vitriol; and if the putrid symptoms increase, the Peruvian bark must be administered according to the circumstances of the case. 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 teaspoonful or two may be occa- sionally given, according to the patient's age, or the violence of the symptoms. After the measles are gone off, the patient ought to be purg- ed, unless the bowels should be duly open without it. If a violent looseness succeed 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 buttermilk, 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 consump- tion 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 * The camphor mixture combined with a fourth part of the water of acetated ammonia, forms a very useful medicine in that particular species of consumption, which frequently succeeds the measles. A. F. B. 220 OF THE SCARLET FEVER. 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.* OF THE SCARLET FEVER. The scarlet fever is so called from the color 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 to- wards 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, with- out any violent sickness. Afterwards the skin is covered with red spots, which are broader, more i florid, and less uniform than the measles. They continue two or three days, and then disappear; after which the cuticle or scarfskin falls off. There is seldom any occasion for medirine 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 and five grains of the latter may be taken thrice a day, or oftener, if necessary. Children and young persons are sometimes seized at the be- ginning 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 blister applied to the neck, and a dose of the syrup of poppies given every night till the patient recovers,! The scarlet fever, however, is not always of so mild a na- * Attempts have been made to communicate the measles, as well as the smallpox, by inoculation, and we make no doubt but in time the practice |nay 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 apply- ing the cotton to a wound, as in the smallpox ; while others recommend a bit of flannel, which has 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 smallpox, may be communicated in various wai s; the most probable, however, is either from cotton rubbed upon the skin as mentioned above, or by introducing a little of the sharp humor, 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. t Sydenham. OF THE BILIOUS FEVER. 221 ture. It is sometimes attended with putrid or malignant symp- toms, in which case it is always dangerous. In the malignant scarlet fever, the patient is not only affected with coldness and shivering, bat 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 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, snakeroot, and the like. The treatment must be in general similar to that of the putrid fever, or of the malignant ulcerous sore throat.f OF THE BILIOUS FEVER., When a continual, remitting, or unremitting fever is accom- panied 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. * Edematous swellings of the ankles are not unfrequent after severe at- tacks of scarlet fever. Sometimes the dropsy becomes general, and destroys the patient. The remedy for this species of dropsy consists in sharp purga- tives of jalap and calomel. Eight grains of the former with three of the latter may be given every second morning. Indeed, it is from neglecting to keep the body sufficiently open during the disease, that this kind of dropsy most generally originates. A. P. B. t 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 quinsy, 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. 222 OF THE BILIOUS 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 inflamma- tory 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 broths, jellies of hartshorn, and the like ; and he may use (he white decoction for his ordinary drink.* 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, this evacuation may be promoted by giving him, three or four times a day, a tablespoonful of Mindererus's spirit! mixed in a cup of his ordinary drink. If the bilious fever be attended with nervous, malignant, or putrid symptoms, which is sometimes the case, the patient must be treated in the same manner as directed under these d'^eases. After this fever, proper care is necessary to prevent a re- lapse. 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. I have looked at fevers, as well as at other disorders, for many years: yet, were any one to ask me, what was good for a fever, I could not tell him, without knowing the particulars of the patient's case. There cannot be a grosser error than that of prescribing to the general name of a disease, though thou- sands of people in this country swallow drugs every day on no better ground. Nor are the inhabitants of Britain the only dupes to this no- tion. I had a patient very lately, a young man from a neigh* boring kingdom, who, after consulting me for his own com- plaints, which were chiefly imaginary, requested that 1 would prescribe for his father and brother, neither of whom I had ever seen. When 1 told him the absurdity of doing it, he went away seemingly much disappointed, and, I dare say, with a far lower opinion of my abilities than he had conceived from report. * See Appendix, White Decoction. t See Appen. Spirit of Minder eras. OF THE ERYSIPELAS, &c. 223 CHAP. XXVI. 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 be- tween 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 at- tacked 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 pas- sions 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.* It may also be occa- sioned 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 a 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 tilled with clear water. One or * 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 oftpn lie down to rest them, when warm and faligutd, upon the damp groun I, where they fall asleep, and lie so long as to catch cold, which occa- sions the er^t-ipelas. This disease may indeed proceed from other causes; but we may \ entire to say, that, nine times out of ten, it is occasioned by cold caught after the body has been greatly heated or fatigued. 224 OF THE ERYSIPELAS, both eyes are generally closed with a 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 inflamma- tion 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 armpit 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 color of the part turns yellow, and the cuticle breaks and falls off in scales, the danger is over. The event of this disease depends greatly upon the constitu- tion of the patient. It is seldom dangerous; but when the constitution is bad, the legs will sometimes swell to a prodigious size, and the cure prove extremely difficult. It has often proved fatal to people in the decline of life, who were of a scorbutic habit, or whose humors were vitiated by irregular living, or unwholesome diet. When the erysipelas is large, deep, and affects a very sensi- ble part of the body, the danger is great. If the red color 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 mortifica- tion, often ensue. Such as die of this disease are commonly carried off by the fever, which is attended with difficulty of breathing, and some- times 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 pa- tient 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, panada, chicken or barley broth, with cooling herbs and fruits, &x. avoiding flesh, fish, strdng drink, spices, pickles, and all other things that may heat and inflame the blood ; the drink may be barley water, and 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 OR ST. ANTHONY'S FIRE. 225 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 mat- ter 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 like- wise promote the perspiration, which has a great tendency to carry off the disease. In Scotland the common people gene- rally 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 re- quires 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 ef- fect. 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 samp 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 ni- tre seldom sits easy on the stomach when taken in large closes. 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, three or 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. Blister- ing 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 29 226 OF THE ERYSIPELAS. suppuration, which may be done by the application of ripening poultices with saffron, warm fomentations, and such like. When the black, livid, or blue color of the part shows a tendency to mortification, the Peruvian bark must be adminis- tered. It may be taken along with acids, 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 spirit of wine, or the tinc- ture of myrrh and aloes, may be applied to the part, and fre- quently 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, decoction of woodst 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, buttermilk, and such like. They should never suffer themselves to be long costive. If this 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 mild purgative. Though I have so strictly forbidden moist applications in the erysipelas, yet I cannot prevail on people to leave them off. Whenever they see inflammation, they think of some poultice, embrocation, or fomentation, all of which do injury twenty times for once they are of the least service; and ought never to be used unless where suppuration is inevitable. An absorbent, which takes up the moisture and cools the skin, answers the purpose much better. What I generally use * Experience has taught the practitioners of London, that erysipelas, under the form which it assumes in the metropolis, very generally requires the use of bark. After premising gentle evacuations of the bowels, this remedy ought to be administered in pretty large and frequent doses. Erysipelas seems frequently to be contagious; for this reason persons should nqt idly visit those who are arflicted by this disease. A. P. B. t See Appendix. OF THE PHRENITIS. 227 is starch powder, spread upon a soft rag, and laid over the parts affected. This may be renewed twice or thrice a day; and it is not to be imagined what ease and comfort it give's to the patient every time. As the erysipelas resembles the gout in many respects, it ought not to be rashly tampered with. Should it be driven from the part affected, it may fix upon a more dangerous one. The alarm is generally greatest, when it removes to, or attacks the face. 1 have, however, known it seize upon the knee, and, after laying the bones bare, prove fatal.* CHAP. XXVII. 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 pri- mary disease in warm climates, and is most incident to persons about the prime or vigor 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 watch- ing, especially when joined with hard study; it may likewise proceed from hard drinking, anger, grief, or anxiety. It is of- ten occasioned by the stoppage of usual evacuations ; as the * There is a peculiar species of Erysipelas in this country termed Shingles, and by the ancients Zona or Zoster, from surrounding the trunk of the body like a belt. It consists of an aggregation of vesicles filled with a limpid or vellowish colored fluid. The eruption makes its first appearance on some snot of the chest, and gradually extends laterally both ways. It is a vulgar, but unfounded opinion, that if the extremities of the eruption meet so as com- pletely to surround the body, the patient must die. As this complaint seems often to be critical, we should not be tod eager to repel it by externals. 11 the eruption suddenly subside, or be driven in by external applications, a paroxysm of asthma is not unfrequently the consequence. To remove this metastasis, stimulant applications are requisite, such as the ointment of yellow resin with an eighth part of the red precipitate, or the citrine ointment, by which the inflammation of the skin is reproduced, and the discharge kept up. The general treatment of this complaint consists in keeping the patient modo rately warm, and giving tepid diluent fluids, till the vesicles begin spontane- ously- to dry. Their desiccation may be promoted by a lotion composed ot a drachm of white vitriol dissolved in eight ounces of rosewater. The com- mon people are in the habit of applying to the shingles writing ink diluted with water. After the eruption is scaled off, the patient should take a few doses of some cooling purgative. A> F- B< 228 OF THE PHRENITIS, OR 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 inflamma- tion of the brain, so as to awake quite delirious. When repel- lents 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, in- deed, is often weak, irregular, and trembling; but sometimes it is hard and contracted. When the brain itself is inflamed, the ptdse is always soft and low; but whpn the inflammation only affects the integuments of the brain, viz. the dura and pia ma- ter, it is hard. A remarkable quickness of hearing is a com- mon 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 unfa- vorable symptom, as arc 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 intes- tines, or of the throat, &c. it is owing to a translation of the disease from these parts to the brain, and generally proves fa- tal. This shows the necessity of proper evacuations, and the danger of repellents in all inflammatory diseases. The favorable 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. Some- times 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 im- INFLAMMATION OF THE BRAIN. . 229 properly 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 cir- culation towards the head. Regimen.—The patient ought to be kept very quiet. Com- pany, 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 soothe 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 humor- ed in every thing. Contradiction will ruffle his mind, and in- crease 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 pro- mise of having them as soon as they can be procured, 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 soothe the passions, and compose the mind. Boerhaave pro- poses several mechanical experiments for this purpose; as the soft noise of water distilling by drops into a basin, and the pa- tient trying to reckon them, &c. Any uniform sound, if low and continued, has a tendency to procure sleep, and conse- quently may be of service. The aliment ought to be light, consisting chiefly of farina-r ceous substances; as panada, and water gruel, sharpened with jelly of currants or juice of lemons, ripe fruits roasted or boil- ed, jellies, preserves, &c.; the drink small, diluting and cool- ing; as whey, barley water, or decoctions of barley and tamar rinds, 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 put- ting a straw, or any other sharp body, up the nostril. Bleeding in the temporal arteries greatly relieves the head; 230 OF THE PHRENITIS. 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 tem- ples. 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 hemorrhoidal vein 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 dis- charge 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 stop- page 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 clys- ters or smart purges, and small quantities of nitre ought fre- quently to be mixed with his drink. Two or three drachms, or more, if the case be dangerous, may be used in the space of twentyfour hours. The head should be shaved, and frequently rubbed with vinegar and rosewater. 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. 1 must further observe, that, though this species of inflamma- tion ought to be treated nearly as other inflammatory disorders are, yet more than ordinary care should be used to keep the patient in a state of as much ease, composure and tranquillity as possible. A strict attention to my former hints on this head will often do more good than the best medicines. It should be considered, that a sore will not bear the touch of a feather, and that the nerves of an inflamed brain are still more unfit to en- dure the least irritation, without torture, and without danger. Even light, sound, or whatever may make a strong impression on the senses, is carried with such rapidity and force to the brain, as to increase the inflammation, and disorder the very organs by which it was conveyed. A docile and sensible nurse is, in such cases, of as much service as the most enlight- ened physician. OF THE OPHTHALMIA. 231 CHAP. XXVIII. 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, he. 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 scrofulous or gouty habit. It may likewise be oc- casioned by hairs in the eyelids 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 pa- tient. 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 dry- ing up scabbed heads, a running behind the ears, or any other discharge of this kind. Inflammations of the eyes often succeed the smallpox or measles, especially in children of a scrofulous 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 232 OF THE OPHTHALMIA, OR him. The eyes are filled with scalding tears, which rush 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 neighboring parts swell, and there is a throbbing or pulsation in the temporal arte- ries, he. 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 on 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 unfavorable symptom. But when the disease is accompanied with a violent pain in the head, and continues long, the patient is in danger of losing his sight. Regimen.—The diet, unless in scrofulous 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 on the eyes.* He should not look at a candle, the fire, or any lumi- nous object; and ought to avoid all smoke, as the fumes of tobacco, or any thing that may cause coughing, sneezine, or vomiting. He should be kept quiet, avoiding all violent efforts, either of body or mind, and encouraging sleep as much as pos- sible. Medicine.—-This is one of those diseases wherein great hurt is often done by external applications. Almost every per- son 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 pres- sure 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 * The best kind of shade for tender eyes is formed by extending green gauze on wire properly constructed. By this contrivance the access of too v much light is effectually impeded, while there is no interruption to the free access of the air, so that the eye.- are not heated by this, as by the common shades of silk, or speotacles of green glass. A. P. B. INFLAMMATION OF THE EYES. 233 as possible. An adult may lose ten or twelve ounces of blood from the jugular vein, and the operation may be repeated ac- cording 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 dipped 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 ne- glected. The patient may take a small dose of Glauber's salts and cream of tartar, every second or third day, or a decoc- tion 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 pa- tient, 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 fre- quently 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, blis- tering 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 on 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 prreat, a poultice of bread and milk, softened with sweet oil or fresh butter, may 30 234 OF THE OPHTHALMIA, OR 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, overnight, more or less according to his age, or the violence of the symptoms. In violent inflammation of one or both eyes, the application of leeches should never be omitted. After the inflammation is gone off, if the eyes still remain wreak 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 scrofu- lous 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 tablespoonfuls, 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 iEthiop's mineral never fails in obsti- nate inflammations of the eyes, even scrofulous 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 ser- * After the active stage of the inflammation has terminated, and the blood- vessels of the eye appear turgid and relaxed, excellent effects are often found lo result from letting a drop or two of the tincture of opium fall into the eye. In this state the eye will bear the application of active stimuli with more ad- vantage than is commonly believed.—In scrofulous inflammation of the eyes, sea bathing, together with keeping the body open by gentle purgatives of sea water, are eminently useful. I lately witnessed a case where the aqueous hu- mor of the eye had become so turbid, that the patient, evidently of a scrofu- lous habit, could hardly distinguish light from darkness, which was almost wholly removed, and sight in a great measure restored, by persisting in a course of sea bathing during the months of summer. A. P. B. INFLAMMATION OF THE EYES. 235 vice 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.* 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 regu- larity, avoiding strong liquor, and every thing of a heating quali- ty. Above all, let them avoid the night air and late studies.f Although inflammation of the eyes proceeds from a great variety of causes! yet 1 find, that most of our pretended eye doctors treat them all nearly in the same way. Whether the inflammation is occasioned by a blow, a scrofulous habit, or a specific infection, still they keep scarifying the inner coats of the eyelids, and cut- ting, and scratching, till they totally extinguish the sight. About twelve years ago, a patient of mine, troubled with an inflamma- tion of the eyes, which had arisen from a venereal taint, was not only weak enough to go to one of those surgeon oculists, but to say, that I was giving him calomel. The other immediately observed, that he never gave his patients mercury ; and did not forget to throw out very broad hints of the impropriety of my treatment. I afterwards saw the patient, and perceiving his credulity wrought upon, I could only bid him look to the end of it. About two years after, he had occasion to go to France, when he consulted one of the most eminent medical men in Paris, who, soon discovering one of his eyes to be irrecoverably lost, took his fee, and left the following laconic remark, instead of a prescription, " Your English surgeon has put your eye out;" and, to this day, the patient wears an artificial eye. * Any foreign body lodged in the eye may be expeditiously removed by passing a small hair pencil between the eyelid and the ball of the eye. In some places the peasants do this very effectually, by using their tongue in the same manner. f As most people are fond of using eye waters and ointments in this and ether 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 Sake. 236 OF THE QUINSY, OR CHAP. XXIX. OF THE QUINSY, OR INFLAMMATION OF THE THROAT. J. HIS 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 tempera- ment. Causes.—In general, it proceeds from the same causes as other inflammatory disorders, namely, an obstructed perspira- tion, 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 quinsy 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 lias been newly plastered, Sec. I know people who never fail toThave 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 quinsy. It may also proceed from bones, pins, or other sharp substances sticking in tlie throat, or from the caustic fumes of metals or minerals, as arsenic, antimony, See. taken in by the breath. This disease is sometimes epidemical and in- fectious. 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 bloocl be let, it is generally covered with a tough coat of a whitish color, and the patient spits a tough phlegm. As the swelling and inflammation INFLAMMATION OF THE THROAT. 237 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 straitness of the breast, and anxiety, the danger is great. Though the pain in swal- lowing be very great, yet, while the patient breathes easy, there is not so much danger. An external swelling is no unfavorable symptom : but if it suddenly falls, and the disease affects the breast, the danger is very great. When a quinsy 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 wrapped round it This 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 in 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 m es- teem for complaints of the throat; and indeed it is of some use. 238 OF THE QUINSY, OR 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 ren- dered more sharp and cleansing, by adding to it a teaspoonful of the spirit of sal ammoniac. Some recommend gargles made of the 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: this 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 symp- toms appear, to bleed in the arm, or rather in the jugular vein, and to repeat the operation if circumstances require it. 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 in- creased according to the age of the patient, and repeated till they have the desired effect. 1 have often known very good effects from a bit of purified nitre, held in the mouth, and swallowed down as it melted. This promotes the discharge of saliva, by which means it an- swers the end of a gargle, while, at the same time, it abates the fever, by promoting the discharge of urine, Sec. The throat ought likewise to be rubbed, twice or thrice a day, with a little of the volatile liniment. This seldom fails to pro- duce 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. INFLAMMATION OF THE THROAT, 239 Blistering the neck, or behind the" ears, in violent inflamma- tions 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 discharging by the application of issue ointment, till the inflammation is gone ; otherwise, on 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 endeavors 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 funnel, 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 tumor 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 inevita- bly perish, unless he can be supported in some other way. This can only be done by nourishing clysters of broth, or gruel with milk, he. Patients have often been supported by these for several days, till the tumor has broken ; and afterwards they have recovered. Not only the swallowing, but the breathing is often prevented by the tumor. In this case nothing can save the patient's life, but opening the trachea or windpipe. 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 spirit. But this gargle is never to be used where there are signs of an inflammation. Those who are subject to inflammations of the throat, in order to avoid this disease, ought to live temperately. $uch as do not choose to observe this rule, must have frequent recourse to purging and other evacuations, to discharge the superfluous humors. 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, especial- ly if cold liquor be drank immediately after it, or the body suf- 240 OF THE MALIGNANT QUINSY, OR fered 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 covering about their necks. I have often known persons, who had been subject to sore throats, entirely freed from this complaint by only wearing a ribband, 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 dan- ger, indeed, in leaving them off after persons have been accus- tomed to them; but surely the inconvenience 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 com- plaint 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 QUINSY, OR PUTRID UL- CEROUS SORE THROAT. This kind of quinsy 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 per- son. This ought to put people on their guard against going near such patients as labor under the disorder; as by this means they endanger not only their own lives, but likewise those of their friends and connexions. Whatever tends to pro- duce putrid or malignant fevers, may likewise occasion the putrid ulcerous sore throat; as unwholesome air, damaged pro- visions, neglect of cleanliness, &x. Symptoms.—It begins with alternate fits of shivering and heat. The pulse is quick, but low and unequal, and generally PUTRID ULCEROUS SORE THROAT. 241 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 dis- ease advances, it turns more of a yellowish color. The tongue is white, and generally moist, which distinguishes this from an inflammatory disease. Upon looking into the throat, it ap- pears swelled, and of a florid red color. Pale or ash colored spots, however, are here and there interspersed, and sometimes one broad patch or spot, of an irregular figure, and pale white color, surrounded with florid red, only appears. These whit- ish spots or sloughs, cover so many ulcers. An efflorescence, or eruption on 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 fre- quently 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. Unfavorable symptoms are, an obstinate purging, extreme weakness, dimness of the sight, a livid or black color of the spots, and frequent shiverings, with a weak, fluttering pulse. If the eruption upon the skin suddenly disappears, or becomes of a livid color, with a discharge of blood from the nose or mouth, the danger is very great. If a gentle sweat breaks out about the third or fourth day, and continues 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 color of the eyes, there is reason to hope for a salutary crisis. Regimen.—The patient must be kept quiet, and for the most part in bed, as he will be apt to be faint when taken out of it. His food must be nourishing and restorative; as sago gruel with red wine, jellies, strong broths, &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 quinsy is entirely 31 OF THE MALIGNANT QUINSY, OR different from that which is proper in the inflammatory. All evacuations, as bleeding, purging, &c. which weaken the pa- tient, 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, chamo- mile 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 be mild, the throat may be gargled with an in- fusion of sage and rose leaves, to a gill of which may be add- ed 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 boil- ing, 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 chil- dren, 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 on 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 snakeroot, may be boiled in an English pint and a half of water to half a pint; to which a teaspoonful of the elixir of vitriol may be add- ed, and an ordinary teacupful 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 tablespoonfuls 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 diets- PUTRID ULCEROUS SORE THROAT. 243 cordium, 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 spirit 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, rhu- barb, 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 gene- rous wine. These, together with a nourishing diet, and riding on horseback, are the most likely means for recovering his strength. The quinsy, being a local disease, is generally caught by ex- posing the throat to a draught of cold air. I know many peo- ple, who are sure to be troubled with this complaint, if they stand or sit near an open window, or continue for any length of time in a room lately washed. There is not a readier or more certain way to catch a quinsy, than sitting near an open window in a carriage, especially during the night, or when the weather is cold or damp. The inflammatory sore throat, though it sometimes comes to a suppuration, generally yields to the method of treatment re- commended in this chapter. Cases, however, occur, where the power of swallowing is lost, and the patient perishes from the mere want of sustenance. I lately saw a very ingenious inven- tion of a young surgeon, by which a man's life was saved in a case of this kind. He fastened a funnel to the skin of an eel, open at both ends; and, by means of a flexible probe, pushed one end down the gullet, till it entered the stomach. After- wards, milk, broth, or whatever was deemed proper for nour- ishing the patient, was put into the funnel, and conveyed to the stomach. Though 1 mention this chiefly with a view of direct- ing others in the like alarming situations, yet it may also serve to confirm an opinion, often avowed .by the late John Hunter, and well illustrated in his own practice, that presence of mind, and a readiness or fertility of mechanical contrivance, may sometimes prove more serviceable in a critical moment, than all the resources of science. But the most dangerous kind of quinsy, as I before observ. 244 . OF THE MUMPS. ed, is that attended with a putrid fever, commonly called the malignant quinsy, or putrid ulcerous sore throat. Wherever the symptoms of this appear, 1 cannot too urgently advise the patient's friends to lose no lime in procuring for him the best medical assistance they can obtain. The delay of an hour may be attended with irreparable injury. OF THE MUMPS. ' The mumps* is a swelling of the glands about the throat, which is occasionally observed to be epidemic in certain dis- tricts of this country. This disease generally makes its ap- pearance in spring, and young persons of both sexes are much more liable to be attacked by it, than those further advanced in life. It is preceded by heaviness, lassitude, and a general sensation of uneasiness, which continue for several days. Stiff- ness, pain, and difficulty of motion, is then perceived about the articulation of the lower jaw. A swelling of the glands situ- ated under the jaws, and diffused over the neck, next takes place, which sometimes increases to so enormous a magnitude, as greatly to disfigure the countenance. There is a good deal of fever, as indicated by the increased frequency of the pulse. About the fourth day from the commencement of the tumefac- tion, the disease is at the height. A gentle moisture then be* gins to exude from the surface of the swelling, accompanied with a general perspiration of the whole body, which, if it be encouraged by keeping warm in bed, and drinking diluent flu- ids, appears to form the natural crisis of the disease, and the whole terminates favorably about the sixth day. But if, from exposure to cold, or improper management, this natural process of the disease be interrupted, a singular trans- lation of the morbid action takes place. The tumors about the throat suddenly subside, and are followed by swellings of the testicles in the male sex, and of the breasts in the female, accompanied with a fresh exacerbation of the fever. If the swellings of these parts be imprudently checked by exposure to * The Angina Parotidoea, commonly denominated the Mumps, is a disease that appears in certain districts of this country, often at distant intervals of time. The proper mode of treating an uncommon malady is not always present to the mind of the local practitioner. As the safety or danger of this complaint depends in great measure on the manner in which it is mana- ged, I have thought it proper to insert an account of the most approved method of treatment in a medical work so generally diffused, and of easy access. A> p p. OF COLDS AND COUGHS. 245 cold, or if they suddenly subside, the brain is apt to become af- fected, occasioning convulsions, delirium, and other dreadful symptoms, which finally terminate in death. In the treatment of this disease, evacuations of all kinds are not only improper, but dangerous. If the bowels are much constipated, they may occasionally be relieved by a clyster ; but active purgatives, and bloodletting, must on no account be employed. The patient ought to keep warm in bed, and en- courage perspiration, by drinking plentifully of diluting liquors, such as mint whey, or balm tea, with a few drops of spirit of hartshorn. The effort of nature to resolve the tumors by exu- dation, should be promoted by covering the parts with soft flannel. If the swellings show a disposition to subside too early, they should be covered with blistering plasters, or rub- bed with the volatile liniment. Should the tumor, when seated in the testicles, suddenly sub- side, and any tendency to delirium manifest itself, the whole scrotum ought, without delay, to be enveloped in a blistering cataplasm, which is made by sprinkling a little of the powder of Spanish flies over the surface of the common poultice. By this means the disease may be arrested in the part occupied by it, and the dangerous consequences of its falling on the brain prevented. It is not an uncommon sequel of this complaint, to find some- times one and sometimes both testicles, after the inflammation has ceased, gradually shrink in size, and finally wither wholly away. The mumps, which in the northern parts of the coun«? try is termed the branks, is decidedly an infectious disease, but there is rarely an instance of a person being attacked by it a second time.' A. P. B. CHAP. XXX. 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 endeavored 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. 246 OF COLDS AND COUGHS. No age, sex, or constitution, is exempted from this disease; neither is it in the power of any medicine or regimen to pre- vent 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 a uniform degree of warmth, such a thing as catching cold would be impossible; but as this cannot be ef- fected 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 raught 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, panada, gruels, and such like. His drink may be wa- ter gruel sweetened with a little honey; an infusion of balm or linseed, sharpened with the juice of bitter 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 in bed, and to en- courage a gentle sweat, which is easily brought on towards morning hy drinking tea, or any kind of warm, diluting liquor. I have often known this practice carry oft* 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 symp- toms of a cold appear, we have reason to believe, that most of the bad effects, which flow from 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 ne- glected, 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 OF COLDS AND COUGHS. 24? 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 remov- ing the malady, will increase it. By this means a common cold may be converted into an inflammatory fever. When those who labor for their daily bread have the mis- fortune 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 con- fine them for a long time, or even to render them ever after unable to sustain hard labor. But even such of the laboring poor as can afford to take care of themselves, are often too foolhardy to do it; they affect to despise colds, and. so 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 pur- suing their journey, even in the severest weather, with this dis- ease on 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 dis- ease will permit, and the weather is mild, to join to the regimen mentioned above, gentle exercise; as walking, riding on horse- back, &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 tenden- cy 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 sel- dom 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 fre- quent, the skin hot and dry, and the patient complains of his 248 OF COLDS AND COUGHS. 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 blister on the back, to give two tablespoonfuls 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 be- ginning, 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. I believe I need not assure the reader of what he will per- ceive in almost every page of this book, that I am far from be- ing an enemy to agreeable and innocent recreations. But some of our amusements are attended with so much injury to the health of thousands, that it would* be carrying indulgence too far to pass them over unnoticed. Public gardens, those places of general resort in the summer season, are as dangerous as they are inviting. Their agreea- ble coolness at the close of a hot day, the gayety of the compa- ny, the charms of the music, and the variety of the other de- corations, concur to render such scenes peculiarly delightful, and to make age, as well as youth, forget the baneful effects of evening dews, and of the night air. In the mean time, perspi- ration is checked, and disease is inhaled at almost every breath. The dampness is in proportion to the heat that preceded it, and is further increased by exhalations from the water, which always forms one of the ornaments or boundaries of the beau- tiful landscape. Ah ! fly from the bewitching spot at an early hour; and think, that even the verdure you tread on, so soft to the foot, and the plants and flowers, so pleasant to the sight and smell, begin, soon after sunset, to emit a sort of volatile poison, and to contaminate the air around you. A little bran- dy, or brandy and water, while there, is the best preservative; but nothing can save you, if you stay long. Again, then, let me urge you to withdraw soon; and, after returning home, some warm and mild liquid, at going to bed, will tend to re- store insensible perspiration, and to prevent the attacks of a cold, or of a fever. But how am I to address myself in a strain of admonition to the frequenters of our theatres, which are often the sources of OF COLDS AND COUGHS. 249 rational pleasure, and where, even at my own advanced period of life, I can hardly refrain from going, when the favorites of the tragic or of the comic muse exert their fascinating powers? It would be writing contrary to the impulses of my own heart, were I to use any dissuasives against such exquisite gratifica- tions. Yet I hope I may suggest some useful hints to guard against disagreeable consequences. In the relaxing atmosphere of a theatre, heated by the num- ber of lights, and by the breath and effluvia of so many per* sons as are crowded there together, cold, weak drink, however grateful to the taste, is extremely dangerous. Thirst may be allayed by sucking an orange or lemon, and other bad effects may be obviated by a little brandy or rum, though these spi- rits, if used too freely, would rather invite than avert the appre- hended evil. After the entertainment, the greatest danger attends the sudden transition from heat to cold. Additional covering should always be prepared to put on, at going out of a theatre; a handkerchief or muff should be applied to the nose and mouth ; and the same precautions used, after getting home, as I have directed in the former ease. Still greater care is necessary in assemblies, where all the other causes of heat are increased by the exercise of dancing. The dances should end with minuets, or the slowest forms of graceful motion ; and time should always be allowed to cool gradually before the breaking up of these gay meetings. On the subject of refreshments or drink, I need not add anything to what I have already suggested. A melancholy instance has lately occurred to me of the fatal consequences of the want of due caution on such occasions. About three years ago, I was fortunate enough to contribute to the recovery of a lady in the early stage of a consumption. I then gave her some very earnest advice to guard against the usual causes of such a com- plaint. But the uninterrupted enjoyment of good health for three years, blotted out of her memory my warnings of danger. In the beginning of last winter, she was tempted to go to the Westminster assembly. She caught cold there; and what is very significantly called a galloping consumption, carried her in a few weeks to the grave. As to the votaries of silly fashion, who rush to Italian operas, and the like unnatural puppetshow performances, they scarce- ly appear worthy of either notice or advice. It is not likely that any argument would make much impression on people, who absurdly sacrifice health and life to the allurements of 32 250 OF A COMMON COUGH. false taste ;—who affect to admire the most extravagant non sense;—who, in the words of the elegant Armstrong, ----" With loudest peals " Applaud the fool that highest lifts his heels; " And with insipid show of rapture die " Of idiot notes impertinently long." 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 consequen- ces, as this shows a weak state of the lungs, and is often the forerunner of 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 this 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. Tvvo tablespoonfuls of the solution of gum ammoniac may be taken three or four limes 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 wa- ter, to which may be added an ounce of common water, and an ounce of balsamic syrup. Two tablespoonfuls 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 tablespoonful 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 muci- lages, are more proper. A cup of an infusion of wild poppy leaves, and marshinallow roots, or the flowers of coltsfoot, may be taken frequently; or a teaspoonful of the paregoric elixir m,iy 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 teacupful three or four times a day.* When a cough is occasioned by acrid humors tickling the * See Appendix, Spanish Infusion. OF A COMMON COUGH. 251 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 humors, and, by taking off their stimulating quality, help to appease the cough.* • In obstinate coughs, proceeding from a flux of humors on the lungs, it will often be necessary, besides expectorating me- dicines, 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 on 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 renew- ed once a fortnight or three weeks. This is, indeed, a cheap and simple medicine, and consequently apt to be despised ; but we will^tyenture 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 ef- fect ; but, if kept on for some time, it will succeed where most other medicines fail. The only inconvenience attending this plaster is the itching which it occasions; but surely this may be endured, consider- ing the advantage which the patient may expect to reap from the application ; besides, when the itching becomes very un- easy, the plaster may be taken off, and the part rubbed with a dry cloth, or washed wjth a little warm milk and water, or spirit. 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 alto- gether in a warm season, t * 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 Dis- pensatory, instead of the common alkaline spirit. 1 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 com- mon oily emulsion an adequate proportion of the Thebaic Tincture, or liquid laudanum. t Some complain that the pitch plaster adheres too fast, while others rind difficulty in keeping it on. This proceeds from the different kinds of pitch 252 OF A COMMON COUGH. But coughs proceed from many other causes besides deflux-. ions upon the lungs. In these cases the cure is not to be at- tempted by pectoral medicines. Thus, in a cough proceeding from a foulness and debility of the stomach, syrups, oils, mu- cilages, 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 when- ever he inspires, or draws rn his breath fully; but in the for- mer this does not happen. The cure of this cough depends chiefly on 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 con- siderable time in the dose of one or two tablespoonfuls twice a day, or as often as it is found necessary, to keep the body gently open. People may make this tincture themselves, by infusing an ounce of hiera picra* in an English pint of white wine, letting it stand a few days, and then straining it off for use.T In coughs which proceed from a debility of the stomach, the Peruvian bark is likewise of considerable service. It may either be chewed, taken in powder, or madelftto 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, he. which are only opium disguised, ten, fifteen, twenty, or twentyfive drops of liquid laudanum, more or less, as circum- stances 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 Jo attempt to remove it without first curing the dis- ease from which it proceeds. Thus, when a cough is occa- sioned 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, 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. * See Appendix, Hiera Picra. t In the state of the stomach productive of this particular kind of cough, beneficial effects are derived from small doses of ipecacuanha. A person may bfsrin with taking; one grain at noon, and another at night, gradually aug- menting the dose till it occasions some degree of nausea. A. P. B. OF THE CHINCOUGH. 253 such medicines as remove these vermin will generally cure the cough ; as bitter purgatives, oily clysters, and such like. Women, during the last month of pregnancy, are often greatly afflicted with a cough, which is generally relieved by bleeding, and keeping the body gently open. They ought to avoid all flatulent food, and to wear a loose, easy dress. A cough is not only a symptom, but is often likewise the fore- runner of diseases. Thus, the gout is frequently ushered in by a very troublesome cough, which affects the patient for some days before the coming on of the fit. This cough is generally removed by a paroxysm of the gout, which should therefore be promoted, by keeping the extremities warm, drinking warm liquors, and bathing the feet and legs frequently in lukewarm water. OF THE CHINCOUGH. This cough seldom affects adults, but proves often fatal to children. Such children as live on 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 chincough is so well known, even to nurses, that a des- cription of it is unnecessary. Whatever hurts the digestion, obstructs the perspiration, or relaxes the solidJi disposes to this disease ; consequently its cure must depepd 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 further ad- vanced 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 pennyroyal 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 chincough 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 dis- eases of children are infectious ; nor is it at all uncommon to find the chincough prevailing in one town or village, when an- other at a very small distance is quite free from it. But what- 254 OF THE CHINCOUGH. ever 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.* 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 in- tention 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 bleed- ing may be requisite. It is generally reckoned a favorable 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.f 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 teapot, with half an English pint of boiling water. If this be disguised with a few drops of milk and a little sugar, they will fnagine it tea, and drink it very greedily. A small teacupful 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 sufficfent. Vomits not only cleanse the stomach, which in this disease is generally loaded with viscid mucus, but they likewise promote perspiration and other secretions, and ought therefore to be re- peated according to the obstinacy oT 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, he. Of these a teaspoonful or two may be given to an infant, twice or thrice a day, as there is occasion. To such as are further advanced, the dose must be proportionally in- creased, and repeated till it has the desired effect. Those who * Some think the air ought.not to be changed till the disease is on the de- cline ; but there seems to be n» sufficient reason for this opinion, as patients have been known to reap benefit from a change of air at all periods of the dis* ease. It is not sufficient to take the patient out daily in a carriage. t Sre Appendix, Vomiting Julep. OF THE CHINCOUGH. 255 cannot be brought to take the bitter tincture, may have an in- fusion 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 medi- cines possess wonderful virtues for the cure of the chincough, and accordingly exhibit them plentifully to patients of every age and constitution, without considering that everything of this nature must load the stomach, hurt the digestion, and of course aggravate the disorder.* 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' pennyroyal tea, and repeated occasionally.! The garlic ointment is a well known remedy in North Britain for the chincough. It is made by beating in a mortar garlic with an equal quantity of hog's lard. With this the soles of the feet may be rubbed twice or thrice a day ; but the best method is to spread it on a rag, and apply it in the form of a plaster. It should be renewed every night and morning, at least, as the garlic soon loses its virtue. This is an exceedingly good medi- cine, both in the chincough,J 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 vio- lent, it will be necessary, instead of it, to apply a blistering * Dr. Duplaml 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 gram d'ff°Iv; ed 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. + Some recommend the extract of hemlock as an extraordinary remedy in the chincough ; but, so far as 1 have been able to observe, it is no way superior to opium, which, when properly administeredjjvill often relieve some of the most troublesome symptoms of this disorder. $ As this disease is evidently spasmodic, I am inclined to think that tonic medicines will in time be found the most proper for its cur*, 256 INFLAMMATION OF THE STOMACH. 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 con- siderable 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 mix- ture, with two or three ounces of any simple distilled water and a little syrup, and taken three or four times a day. CHAP. XXXI. 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 suppu- ration, 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 pro- ceed 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 re- pelled from the extremities, either by cold or improper applica- tions, it often occasions an inflammation of the stomach. Hard or indigestible substances, taken into the stomach, as bones, the stones of fruits, &.c. may likewise have this 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 sick- ness ; 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 INFLAMMATION OF THE STOMACH. 257 to the touch. One of the most certain signs of this disease is the sense of pain, which the patient feels on taking any kind of food or drink, especially if it be either too hot or too cold. When the patient vomits everything he eats or drinks, is ex- tremely restless, has a hickup, 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 pa- tient may deceive the bystanders, and induce them to give him wine, spirit, 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 this 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, or the like. 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 on 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. Flarinel 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 extremes 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 con- veniently used, will be of great service. In this, and all other inflammations of the bowels, an epis- pastic, 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 re- commend in this disease, are mild clysters. These may be INFLAMMATION OF THE INTESTINES. made of warm water, or thin water gruel; and if the patient be costive, a little sweet oil, honey, or manna, may be added. Clysters answer the purpose of an internal fomentation, while they keep the body open, and at the same time nourish the patient, who is often in this disease unable to retain any food on 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 to which mankind are liable. It generally proceeds from the same causes as the inflammation of the stomach ; to which may ba added, costiveness, worms, eating unripe fruits, or great quanti- ties of nuts, drinking hard, windy malt liquors, as stale bottled beer or ale, sour wine, cyder, &,c. It may likewise be occa- sioned by a rupture, by scirrhous tumors of the intestines, or by their opposite sides growing together. The inflammation of the intestines is denominated iliac pas- sion, enteritia, he. 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 there- fore omit these distinctions, lest they should perplej#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 tlie 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 feces are vomited, and the patient is exceedingly weak, with a low, fluttering pulse, a pale countenance, and a disagreeable or offensive breath, there is great reason to fear the consequences will prove fatal. Clammy sweats, black, fetid stools, with a small, intermitting pulse, and a total cessation of pain, are the signs of a mortification already begun, and of approaching death. Regimen.—The regimen in this disease is in general the same as in an inflammation of the stomach. The patient must be kept quiet, avoiding cold, and all violent passions of the mind. His food ought to be very light, and given in small INFLAMMATION OF THE INTESTINES. 259 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 re- peated according to the strength of the patient and the violence of the disease. A blistering plaster is here likewise to be applied immediate- ly over the part where the most violent pain is. This not only relieves the pain of the bowels, but even clys- ters 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 ap- plied 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 soft- ened with sweet oil or fresh butter. These may be adminis- tered every two or three hours, or oftener, if the patient continues costive. If the disease does not yield to clysters and fomentations, re- course must be had to pretty strong purgatives ; but as these, by irritating the bowels, often increase their contraction, and by this 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 intestines, greatly assist the ope- ration of purgatives in this case. What answers the purpose of opening the body very well, is a solution of the sulphate of magnesia. Two ounces of this may be dissolved in an English pint of warm water, or thin gruel, and a teacupful of it taken every half hour till it operates. At the same time, fifteen, twenty, or twentyfive 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 vomit- ing, 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 ob- tained, 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, 260 OF THE COLiU. 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 wa- ter 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 con- tinue too long at a time; and it is often necessary to repeat it several times before it has the desired effect. Jt has sometimes happened, after all other means of procur- ing a stool has been tried to no purpose, that this was brought about by immersing the patient's lower extremities in cold wa- ter, or making him walk on 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. y If the disease proceeds from a rupture, the patient must be | laid with his head very low, and the intestines returned by " gentle pressure with the hand. If this, with fomentations arid A clysters, should not succeed, recourse must be had to a surgi-» cal operation, which may give the patient relief. .^ Such as would avoid this excruciating and dangerous dis- ease, must take care never to be too long without a stool. Some, who have died of it, have had several pounds of hard, dry feces taken out of their intestines. They should likewise beware of eating too freely of sour or unripe fruits, or drink- ing stale, windy liquors, &,c. 1 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 dis^ eases, both in its symptoms and method of cure. It is gene- rally 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 flatulmt, the bilious, the hysteric, the nervous, &c. As each of these requires a particular method of treatment, we OF THE COLIC. 261 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 intes- tines. It is attended with a painful stretching of the affected part. The patient feels a rumbling in his bowels, and is gene- rally relieved by a discharge of wind, either upwards or down- wards. The pain is seldom confined to any particular part, as the wind wanders from one division of the bowels to another, till it finds a vent. V\ hen the disease proceeds from windy liquor, green fruits, sour herbs, or the like, the best medicine on the first appear- ance of the symptoms is a dram of brandy, gin, or any good spirit. The patient should likewise sit with his feet on a warm hearthstone, or apply warm bricks to them ; and warm cloths may be applied to his stomach and bowels. This is the only colic wherein ardent spirit, spiceries, or any thing of a hot nature, may be ventured on. Nor, indeed, are ^hese to be used here unless at the very beginning, before any symptoms of inflammation appear. We have reason to be- lieve, that the colic occasioned by wind or flatulent food might always be cured by spirit and warm liquors, if they were taken immediately on 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 in- testines. Several kinds of food, as honey, eggs, &c. occasion colic in some particular constitutions. I have generally found the best method of cure for these was to drink plentifully of small, di- luting liquors, as water gruel, small posset, toast and water, &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 drin'ting 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 on 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 262 OF THE COLIC. liquors as will promote perspiration ; as weak wine whey, or water gruel with a small quantity of spirit 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 prac- tice of dram drinking; but in this case ardent spirit proves 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- colored bile, which, being discharged, seems to afford some re- lief, 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, acidulated 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, is likewise very proper, or any other thin, acid, opening liquor. Besides bleeding and plentiful dilution, it will be necessary to foment the belly with cloths dipped in warm water, and if this should not succeed, the patient must be immersed in warm water. In the bilious colic the vomiting is often very difficult to re- strain. When this happens, the patient may drink a decoc- tion 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. Clysters, with a proper quantity of Venice treacle or liquid laudanum in them, may likewise be frequently administered. The hysteric colic bears a great resemblance to the bilious. It is attended with acute pains about the region of the stomach, vomiting, &c. What the patient vomits in this case is com- monly of a greenish color. 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 OF THE COLIC. 26S 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 fif- teen, twenty, or twentyfive drops of laudanum in a glass of cinnamon water. The patient may likewise take four or five of the fetid pills every six hours, and drink a cup of pennyroyal tea after them. If assafetida should prove disagreeable, which is sometimes the case, a teaspoonful of the tincture of castor in a cup of penny- royal tea, or thirty or forty drops of the balsam of Peru drop- ped on 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.* The nervous colic prevails among miners, smelters of lead, plumbers, the manufacturers of white lead, &c. It is very common in the cyder countries of England, and is supposed td be occasioned by the leaden vessels used in preparing this liquor. It is likewise a frequent disease in the West Indies, where it is termed the dry bellyache. No disease of the bowels is attended with more excruciating pain than this. Nor is it soon at an end. I have known it continue eight or ten days with very little intermission, the body all the while continuing bound in spite of medicine, yet at length yield, and the patient recover.! It generally, howev- er, 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 bowels, that we shall not insist on 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, fo- mentations, &c. The castor oil is reckoned peculiarly proper in this disease. It may both be mixed with the clysters and given by the mouth.J If the patient remains weak and languid after this disease, he must take exercise on horseback, and use an infusion of the * See Appendix, Antihysteric Plaster. t 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 expense, and will be of service in several other cases, as the recovery of drowned persons, &c. X The dose is from one tablespoonful to two or three, if necessary to open the body. 264 INFLAMMATION OF THE KIDNEYS. Peruvian bark in wine. When the disease ends in palsy, some chalybeate mineral water may be useful. To avoid this kind of colic, people must shun all sour fruits, acid 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 bran- dy or rum, every morning, but should never take spirit 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 in- deed be attended to, as their treatment is very different. But even persons, who are not in a condition to distinguish very ac- curately in these matters, may nevertheless be of great service to patients in colics of every kind, by only observing the fol- lowing general rules, viz. To bathe the feet and legs in warm water; to apply bladders filled with warm water, or cloths wrung out of it, to the stomach and bowels; to make the pa- tient drink freely of diluting, mucilaginous liquors ; and to give him an emollient clyster every hour or two. 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 medi- cines; as spirit 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 con- tractions, or spasms, in the urinary vessels, &c. Symitoms.—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 color ; but in the worst kind of the INFLAMMATION OF THE KIDNEYS. 265 disease it generally continues pale, is passed with difficulty, and commonly in small quantities at a time. The patient feels great uneasiness when he endeavors 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 frorn the colic by the pain being seated further back, and by the difficulty of passing urine, with which it is constantly attended. Regimen.—Everything of a heating or stimulating nature is to be avoided. The food must be thin and light; as panada, 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, decoction of marshmallow 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 certain- ly 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 con- tinue, the operation may be repeated in twentyfoar hours, es- pecially if the patient be of a full habit. Leeches may like- wise be applied to the hemorrhoidal 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 chamomile 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 a stone is lodged in the kidney; but when the gravel or stone is sepa- rated from the kidney, and lodges in the Ureter,* 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 marshmallows. A teaspoonful of the sweet spirit of nitre, with a few drops of laudanum, may » The Ureters are two long and slender canals, one on each side, which car- ry the urine from the basin of the kidneys to the bladder. They are some- times obstructed by small pieces of gravel falling down from the kidneys, and lodging in them. 34 266 INFLAMMATION OF THE BLADDER. now and then be put into 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 chilness, 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 shows that an ulcer is already formed in the kidney, the patient must be careful to abstain from all acrid, sour, and salted provisions; and to live chiefly on mild, mucilaginous herbs and fruits, together with the broth of young animals, made with barley and common potherbs, &c. His drink may be whey and buttermilk that is not sour. The latter is by some reckoned a specific remedy in ulcers of the kidneys. To answer this character, however, it must be drank for a considerable time. Chalybeate waters have like- wise been found beneficial in this disease. They also must be used for a considerable time, in order to produce any salu- tary 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 easy of digestion. They should use moderate exercise, not lie too hot, nor too much on their back, and avoid costive- ness. INFLAMMATION OF THE BLADDER. The inflammation of the bladder proceeds, in a great mea- sure, 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 inclina- tion 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 ne- cessary 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 everything that is of a hot, acrid, and stimulating quality; and should live entirely on small broths, gruels, or mild vegetables. INFLAMMATION OF THE LIVER. 267 A stoppage of urine may proceed from other causes be- sides an inflammation of the bladder; as a swelling of the hemorrhoidal veins ; hard feces 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 medi- cines, or things of an irritating nature, generally increase the danger. I have known some persons kill themselves by in- troducing probes into the urinary passages, to remove, as they thought, something 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 this 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.—Beside the common causes of inflammation, we may here reckon the following: excessive fatness, a scirrhus of the liver itself, violent shocks from strong vomits when the liver was before unsound, an adust or atrabilarian state of the blood, anything that suddenly cools the liver after it has been greatly heated, stones obstructing the course of the bile, drink- ing strong wines and spirituous liquors, using hot, spicy aliment, obstinate hypochondriacal affections, &c. Symptoms.—This disease is known by a painful tension ot 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 yellow- ish color of the skin and eyes. The symptoms here are various, according to the degree ol inflammation, and likewise according to the particular part ol the liver where the inflammation happens. Sometimes the pain is so inconsiderable, that an inflammation is not so much as sus- pected ; 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 hickup, and a pain extending to the shoulder, with difficulty of lying on the leit side, &c, 268 INFLAMMATION OF THE LIVER. 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 hypochondriacal dis- orders by the degree of fever with which it is always attended. This disease, if properly treated, is seldom mortal. A con- stant hickuping, violent fever, and exces6ive thirst, are bad symptoms. If it ends in a suppuration, and the matter cannot be discharged outwardly, the danger is great. When a scir- rhus 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 care- fully avoided, and cool, diluting liquors, as whey, barley water, he. 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 dis- ease, 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. Mud, laxative clysters should be frequently administered ; and, if the pain should, notwithstanding, continue violent, a blistering plaster may be applied over the part affected ; or rather a plaster made of gum ammoniac and vinegar of squills. Medicines which promote the secretion of urine have a very good effect here. For this purpose half a drachm of purified nitre, or a teaspoonful of the sweet spirit 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 pro- moted, but not by warm sudorifics. The only thing to be used for this purpose is plenty of diluting liquor drank about the warmth of 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 fre- quent as to weaken the patient. Loose stools often prove criti- cal, and carry off the disease. INFLAMMATION OF THE LIVER. 269 If an abscess or imposthume is formed in the liver, methods should be tried to make it break and discharge itself outwardly, as fomentations, the application of poultices, ripening cata- plasms, he. 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 pro- mote. When the abscess bursts into the cavity of the abdomen at large, death must ensue ; nor will the event be more favor- able when the abscess is opened by an incision, unless in cases where the liver adheres to the peritonceum, 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.* If the disorder, in spite of all endeavors to the contrary, should end in a scirrhus, the patient must be careful to regulate his diet, he. 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 buttermilk. If he takes anything stronger, it should be fine, mild ale, which is less heatr ing than wines or spirit. We shall take no notice of inflammations of the other viscera. They must in general be treated on the same principles as those already mentioned. The chief rule with respect to all of them is, to let blood, to avoid everything 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. The diseases mentioned in this chapter are generally relieved by warm fomentations externally applied, and duly persisted in, These are made in a variety of ways ; but the Anodyne Fo- mentation, recommended in the Appendix, to which a handful of chamomile flowers may be occasionally added, will answer as well as any. If the fomentations do not remove or abate the pain, recourse must be had to the warm bath, in which the patient is to con- tinue as long as his strength will permit. The want of a proper warm bath may be supplied by some of the portable baths, filled with warm water. The most convenient of these contrivances, which are to be had at the tin shops, is commonly called the slipper bath, from its resembling a slipper in form. A cask, or * I know a gentleman who had several abscesses of the liver opened, and is now a strong and healthy man, though above eighty years of age. 270 OF THE CHOLERA MORBUS, &c. a common tub, may be used for the purpose on an emer- gency, though not so commodious. Inflammations of the stomach and bowels are usually attended with obstinate costiveness^ for the removal of which no small skill and perseverance are often necessary. Sometimes a very mild medicine will operate, where a powerful one has had no effect. I have known a few spoonfuls of castor oil procure a stool, after the failure of strong drastic purges. The means, therefore, should be varied, not hastily discontinued. Where one thing does not succeed, another may be happily employed; and instances are not wanting of the efficacy even of external applications, when the best internal remedies have proved un- successful. CHAP. XXXII. OF THE CHOLERA MORBUS, AND OTHER EX- CESSIVE DISCHARGES FROM THE STOMACH AND BOWELS. JL HE cholera morbus is a violent purging and vomiting, attend- ed with gripes, sickness, and a constant desire to go to stool. It comes on suddenly, and is most common in summer and autumn. There is hardly any disease that kills more quickly than this, when proper means are not used in due time for re- moving it. Causes.—It is occasioned by a redundancy and putrid acri- mony of the bile ; food that easily turns rancid or sour on the stomach ; as butter, bacon, sweetmeats, cucumbers, melons, cherries, and other cold fruits.* It is sometimes the effect of strong acrid purges or vomits ; or of poisonous substances taken into the stomach. It may likewise proceed from violent pas- sions or affections of the mind ; as fear, anger, he. Symptoms.—It is generally preceded by a cardialgia, or heartburn, sour belchings, and flatulencies, with pain of the stomach and intestines. To these succeed excessive vomiting, and purging of green, yellow, or blackishcolored bile, with a distention of the stomach, and violent griping pains. There is, likewise, a great thirst, with a very quick and unequal pulse, and * I have been twice brought to the gates of death by this disease, and both times it was occasioned by eating rancid bacon. OF THE CHOLERA MORBUS, &c. S7f often a fixed, acute pain about the region of the navel. As the disease advances, the pulse often sinks so low as to become quite 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 hickuping, faint- ing, 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 pro- moting the purging and vomiting. For this purpose, the patient must drink freely of diluting liquors ; as whey, buttermilk, 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 color, and afterwards boiled in spring water. If oat bread can- not 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 tablespoonfuls of the saline julep, with ten drops cf laudanum, may be taken every hour till it ceases. The vomiting and purging, however, ought never to be stop- ped 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 weaken- ed by the evacuations, which may be known from the sinking of his pulse, he. recourse must immediately be had to opiates, as recommended above ; to which may be added strong wines, with spirituous cinnamon water, 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 rub- bed 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 re- lapse, 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 infu- 272 OF A DIARRHOEA, OR LOOSENESS. sion of the bark, or other bitter, 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 ap- pearance of dead than of living men. No pulse could be felt; the extremities were cold and rigid, the countenance was ghast- ly, and the strength almost quite exhausted. Yet from this deplorable condition they were both recovered by the use of opiates and cordial medicines. I have frequently had occasion to see this disease, and have sometimes felt it. Yet I never met with an instance in my own practice where it proved fatal, though we are told this often happens. Whether so lamentable an issue be owing to im- proper treatment, or to the extreme weakness of the patient's bowels, I cannot pretend to say, without an exact knowledge of each particular case ; but I am inclined to think, that, when death is the consequence, the antidote, which is opium, has been too long delayed. No time should be lost in administer- ing it, on the first serious alarm, and before the powers of nature are exhausted. What I generally prescribe is laudanum, to be taken in cinnamon or some other cordial water. Ten drops of laudanum may be added to two ounces of simple cin- namon water, and the draught repeated every two hours, or oftener, if necessary. I have found opiates no less successful in diarrhoea, or loose- ness. Ten grains of the powder of bole compounded with opium, given in a glass of cordial water four or five times a day, will seldom fail to check a recent diarrhoea, and, if judi- ciously persisted in, will often cure the most obstinate. I would therefore advise, in such cases, a full reliance on its final effi- cacy, rather than a rash impatience to try other medicines far more uncertain, and perhaps dangerous. But as a looseness may arise from a great variety of causes, how to adapt the mode of medical treatment to each will be explained in the next section. OF A DIARRH(EA, OR LOOSENESS. A looseness, in many cases, is not to be considered as a disease, but rather as a salutary evacuation. It ought, there- OF A DIARRHQ5A, OR LOOSENESS. 273 fore, 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 ob- structed perspiration, the patient ought to keep warm, to drink freely of weak, diluting liquors, to bathe his feet and legs fre- quently 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 dafy or two after the vomit, the same quantity of rhubarb may be taken, and repeated two or three times, if the looseness con- tinues. The patient ought to live on light vegetable food of easy digestion, and to drink whey, thin gruel, or barley water. A looseness occasioned by the obstruction of any customary evacuation, generally requires bleeding. If this does not suc- ceed, 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 al- ways 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 chil- dren generally get their teeth with least trouble. If these loose stools should at any time prove sour or griping, a teaspoonful of magnesia alba, with four or five grains of rhubarb, may be given to/the child in a little panada, or any other food. This, if re- peated three or four times, will generally correct the acidity, and carry off the griping stools. The potio cretacea, or chalk julep, may be administered in doses of two or three spoonfuls after each evacuation ; or a teaspoonful of fine powdered chalk may be mixed in a teacupful of water gruel, and given occa- sionally. A diarrhoea, or looseness, which proceeds from violent pas- sions 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 quan- tities. Opiates, and other antispasmodic medicines, are most 35 274 OF A DIARRHCEA, OR LOOSENESS. proper. Ten or -twelve drops of liquid laudanum may be taken in a cup of valerian or pennyroyal 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 sub- stances 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 sus- pect 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, cafa- plasms, fee. The perspiration ought, at the same time, to be promoted by warm, diluting liquors ; as wine whey, with spirit ol 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 immedi- ately to be changed, or, if that cannot be done, it may be cor- rected by mixing with it quicklime, chalk, or the like. In people whose stomachs are weak, violent exercise imme- diately 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 flavored 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 OF VOMITING. 275 from lean veal, or with a sheep's head, as being more gelati- nous than mutton, beef, or chicken broth. Persons, who, from a peculiar weakness, or too great an irri- tability of the bowels, are liable to frequent returns of this dis- ease, 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 ob- • struct perspiration, and should wear flannel next the 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 sud- denly stopped; from the stoppage of any customary evacua- tions, 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 sto- mach. 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 carriage, &c. It may likewise be excited by violent passions, or by the idea of nauseous or dis- agreeable objects, especially of such things as have formerly produced vomiting. Sometimes it proceeds from a regurgita- tion of the bile into the stomach : in this case, what the patient vomits is generally of a yellow or greenish color, and has a bit- ter 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 indiges- tion, 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 chamomile tea. 276 OF VOMITING. When the retrocession of the gout, or the obstruction of cus- tomary 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, bath- ing the extremities in warm water, opening issues, setons, per- petual 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 pre- vented, 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 add- ed to it. If the spirits be 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. Ha- bitual 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 teaspoonful of which may be taken in a dish of lea, or a little milk, three or four times a day, or of- tener, 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 ef- OF THE DIABETES, &c. 277 feet. The stomach plaster of the London or Edinburgh Dis- pensatory may be applied to the pit of the stomach, or a plas- ter of theriaca, which will answer rather better. Aromatic medicines may likewise be taken inwardly, as cinnamon or mint tea, Vine with spiceries boiled in it, &,c. The region of the stomach may be rubbed with ether, or if this cannot be had, with strong brandy, or other spirit. 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 dis- solving a drachm of the salt of tartar in an ounce and a half of fresh lemon juice, and adding to it an ounce of peppermint wa- ter, the same quantity of simple cinnamon water, and a little white sugar. This draught must be swallowed before the effervescence is quite over, and may be repeated every two hours, or oftener, if the vomiting be violent. A violent vomit- ing 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 man- ner of action. The diet must be so regulated as to sit easy on the stomach, and nothing should be taken that is hard of di- gestion. We do not, however, mean, that the patient should live entirely on slops. Solid food, in this case, often sits easier on the stomach than liquids. CHAP. XXXIV. 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 fol- low the more violent employments, or have been hard drinkers in their youth. Causes.—A diabetes is often the consequence of acute dis- eases, as fevers, fluxes, &c. where the patient has suffered by excessive evacuations. It may also be occasioned by great fatigue, as riding long journeys on a hard trotting horse, carry- ing heavy burdens, running, &c. It may be brought on by 278 OF THE DIABETES, &c. hard drinking, or the use of strong, stimulating, diuretic medi- cines, as tincture of cantharides, spirit 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 mis- take 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 se- crete 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 pa- tient 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.—Everything 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 salep, with milk, are the most proper food. Of animal substances, shell fish are to be preferred ; as oysters, crabs, &c. The drink may be lime water, in which a due proportion of oak bark has been macerated. The white decoction,* 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 on a hard bed or mattress. Nothing hurts the kidneys more than lying too soft. A warm, dry air, the use of the flesh brush, and everything that promotes perspiration, is of service. For this reason, the patient ought to wear flannel next his skin. A large strength- ening plaster may be applied to the back ; or, what will answer better, a great part of the body may be wrapped in plaster. ' Medicine.—Gentle purges, if the patient be not too much * See Appendix, White Decoction. OF THE DIABETES, &c. 279 weakened by the disease, have a good effect. They may con- sist of rhubarb, with cardamom 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 cor- roborants. Half a drachm of powder made of equal parts of alum and the inspissated juice, commonly called Terra Japoni- ca, may be taken four times a day, or oftener, if the stomach will bear it. The alum must first be melted in a crucible ; afterwards they may both be pounded together. Along with every dose of this powder, the patient may take a teacupful of the tincture of roses.* If the patient's stomach cannot bear the alum in substance, whey may be made of it, and taken in the dose of a teacupful three or four times a day. The alum whey is prepared by boiling two English quarts of milk over a slow fire, with three drachms of alum, till the curd separates. Opiates are of service in this disease, even though the patient rests well. They take off spasm and irritation, and at the same time lessen the force of the circulation. Ten or twelve drops of 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 laboring people in the decline of life, called an IJVCOJVTIJYENCY of Urine. But this is very different from a diabetes, as the water passes off involun- tarily 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 occa- sioned by blows, bruises, preternatural labors, he. 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. * See Appendix, Tincture of Roses. 280 OF A SUPPRESSION OF URINE. 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 urin- ary passages, hard feces 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 hemorrhoidal veins, he. Some of these cases require the catheter, both to remove the obstructing matter, and to draw off the urine ; but as this instru- ment 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 on 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 vegeta- bles, as mallows, chamomile 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 on it. Some put the herbs themselves into a flannel bag, and ap- ply them to the part, which is far from being a bad mediod. These continue longer warm than cloths dipped in the decoc- tion, 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 re- moving the spasms of the bladder and parts adjacent. * A bottle made of the India rubber, and properly applied, answers this purpose best. OF THE GRAVEL AND STONE. 281 The food must be light, and taken in small quantities. The drink may be weak broth, or decoctions and infusions of mu- cilaginous vegetables, as marshmallow roots, limetree buds, he. A teaspoonful of the sweet spirit of nitre, or a drachm of Cas- tile 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 temperately. Their diet should be light, and their liquor di- luting. They should avoid all acid 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, he. 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 rheu- matism, 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 alone 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 on motion, especially on horseback, or in a carriage on a rough * Rubbing the abdomen and inside of the thighs with the volatile liniment, composed of equal parts of spirit of hartshorn and oil, will sometimes relieve a suppression of urine. A- ?• B. 36 282 OF THE GRAVEL AND STONE. road ; or from a white, thick, copious, offensive mucous sedi- ment 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 discharg- ing 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, he. Their diet ought chiefly to consist of such tilings as tend to promote the secretion of urine, and to keep the body open. Artichokes, asparagus, spinnage, lettuce, parsley, suc- cory, purslane, turnips, potatoes, carrots, and radishes, may be safely eaten. Onions, leeks, and cellery, 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 marshmallows, parsley, liquorice, or of other mild, mucilaginous vegetables; as linseed, limetree buds or leaves, he. If the patient has been accustomed to generous liquors, he may drink gin and water not too strong. Gentle exercise is proper; but violent motion is apt to occa- sion bloody urine. We would therefore advise, that it should be taken in moderation. Persons afflicted with the 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 an heredi- tary tendency to this disease, a sedentary life ought never to be indulged. Were people careful, on the first symptoms of gravel, to observe a proper regimen of diet, and to take sufficient exer- cise, it might often be carried off, or at least prevented from increasing; but if the same course which occasioned the dis- ease 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, he. The treatment of this case has been fully pointed out under the articles Inflammation of the Kidneys and Bladder, to which we refer. Dr. Whyte 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 OF THE GRAVEL AND STONE, 283 English pint of lime water. The doctor very justly observes, that, though this quantity might be too small to have any sensi- ble 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 recom- mends Spanish soap, and lime water,* to be taken in the follow- ing manner: the patient must swallow every day, in any form that is least disagreeable, an ounce of the internal part of Ali- cant soap, and d*ink three or four English pints of 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 de- grees, and ought to persevere in the use of these medicines, especially if he finds any abatement of his complaints, for seve- ral months; nay, if the stone be very large, for years. 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 mucila- ginous liquor; as veal broth, new milk, linseed tea, a solution of gum arabic, or a decoction of marshmallow roots. The pa- tient must begin with small doses of the lees, as thirty or forty drops, and increase it by degrees, as far as the stomach can bear it.f 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 conside- rable ease in cases where the stomach could not bear anything 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 » See Appendix, Lime Water. t The caustic alkali may be prepared by mixing two parts of quicklime with one of potashes, and suffering them to stand till the lixivium be formed, which iuu.=t 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. 284 OF THE GRAVEL AND STONE. 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 gravellj»complaints. It is o-enerally 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. Of all disorders in the urinary passages, the most tormenting is the stone in the bladder. The means of dissolving it, and bringing it away, though the frequent boast of quacks, have hitherto baffled medical inquiry. The British parliament, in- deed, once paid five thousand pounds for a pretended solvent for the stone, which has long been forgotten. The fact, how- ever, stands on record as a signal proof of the extent to which credulity may be carried, on the one hand, and successful im- posture, on the other. The consistence of such stones varies so much, that there is reason to fear no medicine will ever be found sufficiently strong to dissolve the hardest of them, without destroying the blad- der. Yet experiments on this subject ought not to be discon- tinued, as the object is great, and some hard substances are known to be soluble in seemingly mild ones. I have known several instances where stones, after getting into the urethra, were brought away by means of a bent probe; but how to get them there, is the difficulty. It can only hap- pen while they are small, though I have seen flattish stones brought away in this manner, which measured two inches round. 1 have sometimes thought, that riding on a hard trot- ting horse, or in a carriage on a rough road, might tend to bring down a small stone. .Most people, troubled with the stone, are guilty of one great error. They put off the operation too long. When it is cer- tainly known, that there is a stone in the bladder, and that it is too large to get along the urethra, no time ought to be lost in having it cut out, before the patient's habit becomes too irrita- ble, or the stone is so far increased in size, that it cannot be extracted without a laceration of the parts.* * A teaspoonful of pure magnesia, taken two or three times a day, has o,f Jatebeen discovered to be a most effectual preventive of the gravel and stone. INVOLUNTARY DISCHARGES, &c. CHAP. XXXIV. 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 salu- tary. 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 im- mediately 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 ot 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, in- deed, be sometimes necessary to check the violence of such discharges; but even this requires the greatest caution. In- stances might be given, where the stopping of a small periodical flux of blood from one of the fingers has proved fatal to the health. ,. , • ~ In the early period of life, bleeding at the nose is very com- mon. Those who are further advanced in years are more lia- ble to ha;moptoe, or discharge of blood from the lungs. After the middle period of life, hemorrhoidal 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 ot the blood towards one particular part, as the head, the hemorrhoidal 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 occa- sioned by an obstructed perspiration, or a stricture on the skm, the bowels, or any particular part of the system. But a dissolved state of the blood will likewise occasion 286 OF BLEEDING AT THE NOSE. hemorrhages. Thus, in putrid fevers, the dysenteryvthe scur- vy, the malignant smallpox, &c, there are often very great discharges of blood from different parts of the body. They may likewise be brought on by too liberal a use of medicines, which tend to dissolve the blood, as cantharides,the volatile al- kaline salts, &c. Food of an acrid or irritating quality may likewise occasion hemorrhages; as also strong purges and vomits, or anything 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 hemorrhage 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 hemorrhage must be adapted to its cause. When it proceeds from too much blood, or a tendency to in- flammation, bleeding, with gentle purges and other evacua- tions, will be necessary. It will, likewise, be proper for the patient in this case to live chiefly on a vegetable diet, to avoid all strong liquors, and food that is of an acrid, hot, or stimu- lating quality. The body should be kept cool, and the mind easy. When an hemorrhage is owing to a putrid or dissolved state of the blood, the patient ought to live chiefly on acrid fruits, with milk, and vegetables of a nourishing nature, as sago, salep,&c. His drink may be wine diluted with water, and sharpened with the juice of lemon, vinegar, or spirit of vitriol. The best mfr dicine 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 spermaceti. When an obstructed perspiration, or a stricture on any part of the system, is the cause of an hemorrhage, it may be re- moved by drinking warm, diluting liquors, lying in bed, bath- ing 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 OF BLEEDING AT THE NOSE. 287 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 headache, a phrenzy, and even an epilepsy. In fevers, where there is a great deter- mination 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 com- mon practice to stop the bleeding, without considering whether it be a disease, 'or the cure of a disease. This conduct pro- ceeds from fear; but it has often bad, and sometimes fatal consequences. When a discharge of blood from the nose happens in an in- flammatory 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 pa- tient's life, it ought not to be stopped. But when it returns frequently, or continues till the pulse becomes low, the extremi- ties 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 spirit 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 well beaten up, may be rolled in a powder 288 OF BLEEDING AT THE NOSE. made of equal parts of white sugar, burnt alum, and white vit- riol, and put up the nostril 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 quan- tity 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 of- tener, if the stomach will bear it. If a stronger medicine be necessary, a teacupful 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 con- tinues inwardly. This is very troublesome, and requires par- ticular 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 draw- ing threads up the nostrils, and bringing them out at the mouth, then fastening pieces of sponge, 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 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 possi- ble, 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 state of the blood, the diet should be rich and nourishing; as strong * From ten to twenty drops of the spirit of turpentine in a little water, given frequently, seldom fails to stop a bleeding at the nose, or from any other part. BLEEDING AND BLIND PILES. 289 broths and jellies, sago gruel with wine and sugar, the. Infu- sion 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 hemorrhoidal vessels is called the bleeding piles. When the vessels only swell, and discharge no blood, but are exceedingly painful, the disease is called the blind piles. Persons of a loose, spongy fibre, of a bulky size, who live high, and lead a sedentary, inactive life, arc most subject to this disease. It is often owing to an 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 scorbu- tic habit, or of a melancholy disposition. The piles may be occasioned by an excess of blood, by strong aloetic purges, highseasoned food, drinking great quan- tities of sweet wines, the neglect of bleeding, or other customa- ry evacuations, much riding, great costiveness, or anything 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 oft* diseases. It is peculiarly beneficial in the gout, rheumatism, asthma, and hypochondri- acal complaints, and often proves critical in colics, and inflam- matory fevers. In the management of the patient, regard must be had to his habit of body, his age, strength, and manner of living. A dis- charge, 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 chaly- 37 290 BLEEDING AND BLIND PILES. beate water, orange whey, decoctions or infusions of the as- tringent and mucilaginous plants, as the tormentil root, bistort, the marshmallow 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 quan- tity 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, 1 have known it perform very extraordinary cures in violent hemorrhages, especially when assisted by the tincture of roses; a teacupful 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 hemorrhoidal veins. In the blind piles, bleeding is generally of use. The diet must be light and tbin, 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 flower of brimstone and cream of tartar. These may be mixed in equal quantities, and a teaspoonful taken two or three times a day, or oftener if ne- cessary. Or an ounce of the flower of brimstone and half an ounce of purified nitre may be mixed with three or four ounces of the linitive electuary, and a teaspoonful of it taken three or four times a day. Emollient clysters are here likewise beneficial; but there is sometimes such an astriction of the emus, that they cannot be thrown up. In this case 1 have known a vomit have a very good effect. When the piles are exceedingly 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 spirit of wine to the part, or poultices made of bread and milk, or of leeks fried with butter. If these do not produce a dis- charge, and the piles appear large, leeches must be applied as near them as possible, or if they will fix on 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. BLEEDING AND BLIND PILES. 291 Various ointments, and other external applications, are re- commended 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 oint- ment and half an ounce of liquid laudanum, beat up with the yolk of an egg, may be applied. Perhaps no other cause of the piles is so frequent as the use of aloetic purgatives. It is to be observed, that aloes forms a considerable share of almost all advertised purging pills. A costive habit is more effectually, and much more safely remov- ed by a spoonful of castor oil taken occasionally in an evening. When the piles are very painful, the best external applica- tion is a weak solution of sugar of lead with a little laudanum. An ointment made of one third finely powdered galls, and two thirds hogs' lard, is very useful. When the piles are seated high, relief may frequently be obtained from injections of lime water, or of an infusion of galls. The pain of the piles is very often removed by an emetic, or by taking twice a day thirty drops of balsam of copaiva on a little moist sugar. When a pile has a narrow neck, it is best extirpated by the knife. If the pile be large, or has a broad basis, a double ligature may be passed through it, and tied on each side. When piles are neglected, they are very apt to produce a fistula. This complaint is discovered by a stain of matter on the linen, which, on examination, will be found to proceed from a small orifice in the neighborhood of the anus. Various local remedies are recommended for this complaint. The utility of all of them depends on their power of stimulating the sides of the ulcer into more active inflammation, so as to make them cohere together. On this principle, I think I have seen advantage from taking a wineglass of sea water every night for a month or six weeks. Irritating injections have been used with similar intentions, and have sometimes, when duly persisted in, succeeded. The only certain radical cure for a fistula is a surgical ope- ration, the object of which is to reduce the ulcer to the state of a simple wound, and as such to heal it, This should never be too long neglected. The disease gradually diffuses itself in various directions through the cellular substance surrounding the rectum ; and new openings are formed, which render the complaint more difficult to be removed. There are two ways of performing the operation. One is by passing a silk thread, or piece of flexible gold wire in at the 292 SPITTING OF BLOOD. external orifice of the fistula, and bringing it out at the anus, and then twisting the ends together, which is daily repeated till it cuts its way out. By some timid people this mode of cure is preferred to the knife: and, though kept a secret by some pretenders to medical knowledge, it is as old as the histo- ry of surgery. The incision, however, is the more certain and effectual mode of eradicating the disease ; and, if suffering is to be estimated by duration, the less painful also. SPITTING OF BLOOD. We mean here to treat of that discharge of blood from the lungs only, which is called an haimoploe, 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 be- fore 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 hasmoptoe. Causes.—An haemoptoe 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 this organ, as they value life. They should likewise guard against violent passions, excessive drinking, and ever}rthing 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 windpipe, and so falling down on the lungs, and hurting this tender organ. The obstruction of any customary evacuation may occasion a spitting of blood; as neglect of bleeding or purging at the usu- al seasons, the stoppage of the bleeding piles in men, or the menses in women, &.c. It may likewise proceed from a poly- pus, scirrhous concretion, or anything that obstructs the cir- culation of the blood in the lungs. It is often the effect of a long and violent cough ; in whirh case it is generally the fore- runner of a consumption. A violent degree of cold, suddenly applied to the external part of the body, will occasion an hae- moptoe. 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 SPITTING OF BLOOD. 293 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 Teneriffe, &c. Spitting of blood is not always to be considered as a prima- ry disease. It is often only a symptom, and in some diseases not an unfavorable one. This is the case in pleurisies, perip- neumonies, and sundry other fevers. In a dropsy, scurvy, or consumption, it is a bad symptom, and shows 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, cos- tiveness, great lassitude, flatulence, pain of the back and loins, &c. As these show a general stricture on the vessels, and a tendency of the blood to inflammation, they are commonly the forerunners of a very copious discharge. The above symp- toms do not attend a discharge of blood from the gums or fauces, by which means they may always be distinguished from an hsemoptoe. Sometimes the blood that is spit up is thin, and of a florid red color; and at other times it is thick, and of a dark or blackish color ; nothing, however, can be in- ferred 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 con- stitution, 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 gene- rally fatal. Regimen.—The patient ought to be kept cool and easy. Everything that heats the blood, 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, panada, he. The diet in this case can scarcely 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, buttermilk, and such like. Everything, however, should be drank cold, and in small quantities at a time. He should 294 SPITTING OF BLOOD. 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 medi- cines. 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 teaspoonful of the lenitive elec- tuary 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 frequent- ly 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.* * Dr. Rush of Philadelphia has published some interesting facta concerning the utility of common salt, in curing hemorrhage from the lungs. As this remedy may be obtained everywhere without, difficulty, its effects ought to be made generally known. The following are the doctor's own words:—. VOMITING OF BLOOD. 295 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 stoppage of the hemorrhoi- dal flux in men. It may be occasioned by anything that great- ly stimulates or wounds the stomach, as strong vomits or purges, acrid poison, sharp or hard substances taken into the stomach, he. 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, vomit- ing 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 ex- travasated 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 stopped, otherwise they will irri- tate 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 spirit of vitriol. When there are signs of an inflammation, bleeding may be necessary ; but the patient's weakness will sel- " The mode of giving it, is to pour down from a tea to a tablespoonful of clean, fine salt, as soon as possible after the hemorrhage begins from the lungs. This quantity generally stops it; but the dose must be repeated daily for three or four days, to prevent a return of the disorder. If the bleeding continues, the salt must be continued till it is checked, but in larger doses. I have heard of several instances, in which two tablespoonfuls were taken at one time for several days." " It sometimes excites a sickness at the stomach, and never fails to prodtice a burning sensation in the throat in its passage into the stomach, and conside- rable thirst afterwards." " I have found this remedy to succeed equally well in hemorrhages, whether they were active or passive, or whether they occurred in young or in old peo- ple."—Medical IwaciaiBS, &c. Vol. I. A. P. B. 296 OF BLOODY URINE. dom permit it. Opiates may be of use ; but they must be given in very small doses, as four or five drops of 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 dif- ferent 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 color, 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 ureter, 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 vio- lent 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 shows 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 dis- ease. If the discharge, however, be very great, it may waste the patient's strength, and occasion an ill habit of body, a drop- sy, 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 * Vomiting of blood may frequently be cured by the administration of an active purgative, as ten or fifteen grains of the stomach pill at bed time for three or four nights successively. A. P. B. OF THE DYSENTERY, &c. 297 On an operation, a description of which would be foreign to our' purpose. If it be attended with a plethora, and symptoms of inflamma- tion, 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 smallpox, a putrid fever, or the like. In this case the patient's life depends on the liberal use of the Peruvian bark) wine and acids, as has already been shown. When there is reason to suspect an ulcer in the kidneys or bladder, the patient's diet must be cool, and his drink of a soft, healing, balsamic quality, as decoctions of marshmallow roots with liquorice, solutions of gum arabic, &c. Three ounces of marshmallow 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 dis*- solved in the strained liquor, and a teacupful 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 grumoua blood, by being confined in the vessels, may produce inflamma1- tions, abscess, and ulcers. If, however, the case be urgent, or the patient seems to suffer from the loss of blood, gentle astrin- gents may be necessary. In this case the patient may take three or four ounces of lime water, with half an ounce of the tincture of Peruvian bark, three times a day ; or he may take an ounce or two of the conserve of roses three or four times a day ; drinking a teacupful of the tincture of roses after it; or, if stronger styptics be necessary, a drachm of Armenian bole in a cup of whey may be taken three or four 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. 38 298 OF THE DYSENTERY, &c. Causes.—The dysentery may be occasioned by anything that obstructs the perspiration, or renders the humors putrid ; as damp beds, wet clothes, unwholesome diet, bad air, he. But it is most frequently communicated by infection. This ought to make people extremely cautious in going near such persons as labor under the disease. Even the smell of the pa- tient's excrements has been known to communicate the infection. Symptoms.—It is known by a flux of the belly, attended by 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 chilness, 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 ex- ceedingly troublesome, especially in children. Flatulency is likewise a troublesome symptom, especially towards the end of the disease. This disease may be distinguished from a diarrhoea, or loose- ness, 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, he.. 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 hickuping are bad signs, as they show an inflammation of the stomach. When the stools are green, black, or have an exceedingly disagreeable, cadaverous smell, the danger is very great, as it shows the dis- ease to be of the putrid kind. It is an unfavorable 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 iucreased, and the infection spread, by the neglect of cleanliness ; but in no one more than in this. Everything about the patient should be frequently OF THE DYSENTERY, &c. 299 changed. The excrement 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 acids. The patient must not be discouraged, but his spirits kept up in hopes of a cure. Nothing tends more to render any putrid disease mortal, than the fears and apprehensions of the sick. All diseases of this nature have a tendency to sink and depress the spirits, and when this is increased by fears and alarms from those whom the patient believes to be persons of skill, it cannot fail to have the worst effect. A flannel waistcoat worn next the skin has often a very good effect in the dysentery. This promotes the perspiration with- out 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 pa- tient's diet. Flesh, fish, and everything that has a tendency to turn pu'.rid or rancid o»-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 a medicine. I have often known dysenteries, which were not of a putrid na- ture, cured by it, after pompous medicines had proved ineffec- tual.* Another kind of food very proper in the dysentery, which may be used by such as cannot take the broth mentioned above, is * The manner of making this broth is, to take a sheep's head and feet, with the skin on them, and to burn ihe 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 flavor, and the patient may take a little of it warm, with toasted bread, three or four times a day. A clyster of it may like. wise be given twice a day. Such as cannot use broth made in this way, may have the head and feet skinned ; but we have reason to believe that this injures the medicine. It is not our business here to reason on the nature and qualities of medicine, otherwise this might be shown to possess virtues every way suited to the cure of a dysentery, which does not proceed from a putrid state of the humors. 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 ne- cessary to continue the use of it for a considerable time, and to make it the principal food. 300 OF THE DYSENTERY, &c. 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 tablespoonfuls 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.* In a putrid dysentery the patient may be allowed to eat freely of most kinds of good, ripe fruit; as apples, grapes, goose^ berries, currants, strawberries, &.c. These may either be eaten raw or boiled, with or without milk, as the patient chooses. 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 ex- perience show, that good fruit is one of the best medicines, both for the prevention and cure of the dysentery. Good fruit is in every respect calculated to counteract that tendency to putrefaction, whence the most dangerous kind of dysentery proceeds. The patient in such a case ought therefore to be allowed to eat as much fruit as he pleases, provided it be ripe.1 The most proper drink in this disorder is whey. The dy- sentery 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, * 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 fre^ quently in water, and to drudge 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. f 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 rela- tions, than with any hopes of a cure. * AfteY 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, OF THE DYSENTERY, &c. SOI are all very proper, and may be drank in turns. Chamomile tea, if the stomach will bear it, is an exceedingly 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 ne- cessary to cleanse" the first passages. For this purpose a vomit of ipecacuanha must be given, and wrought off with weak chamomile 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 scru- ples of rhubarb must be taken; or, what will answer the pur- pose 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 doses of ipecacuanha may be taken for some time. Two or three grains of the pow- der may be mixed in a fablespoonful 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 laudanum ia 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 tablespoonful 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 teacupful of the decoction of logwood.* Persons who have been cured of this disease are very liable to relapse ; to prevent which, great circumspection with respect to diet is necessary. The patient must abstain from all fer- mented 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 impor- tance. The patient should go to the country as soon as his strength will permit, and should take exercise daily on horse- back, or in a carriage. He may likewise use bitters infused in wine or brandy, and may drink, twice a day, a gill of lime wa- ter mixed with an equal quantity of new milk. * See Appendix, Decoction of Logwood, 302 OF THE HEADACHE. When dysenteries prevail, we would recommend a strict at- tention 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 pa- tient ought immediately to lake 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 of- ten carry off the disease. In.countries where dysenteries pre- vail, we would advise such as are liable to them to take either a vomit or a purge every spring or autumn, as a preventive. CHAP. XXXV. OF THE HEADACHE. 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, # Sometimes the pain is internal, sometimes external; some- times it is an original disease, and at other times only sympto- matic. When the headache 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 headache is sometimes at- tended with a degree of stupidity or folly. Whatever obstructs the free circulation of the blood through the vessels of the head, may occasion a headache. In persons of a full habit, who abound with blood, the headache 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 headache; as looking long obliquely at any object, wearing anything tight about the neck, a new hat, or the like. When a headache proceed* f:om the stoppage of a running OF THE HEADACHE. 303 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 scarcely hold it up. Sometimes the headache proceeds from the repulsion or re- trocession of the gout, the erysipelas, the smallpox, measles, itch, or other eruptive diseases. What is calked a hemicrania generally proceeds from crudities or indigestion. Inanition, or emptiness, will also occasion headaches. I have often seen instances of this in nurses, who gave suck too long, or who did not take a suiHcient quantity of solid food. There is likewise a most violent, fixed, constant, and almost intolerable headache, 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, epi- leptic fits, and sometimes vomiting, costiveness, coldness of the extremities, &c. The headache is often symptomatic in continual and inter- mitting fevers, especially quartans. It is likewise a very com- mon symptom in hysteric and hypochondriacal complaints. When a headache attends an acute fever, with pale urine, it is an unfavorable symptom. In excessive headaches, coldness of the extremities is a bad sign. When the disease continues long, and is very violent, it of- ten terminates in blindness, an apoplexy, deafness, a vertigo, the palsy, or the epilepsy. 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 humors, and keep the body open; as apples boiled in milk, spinnage, turnips, and such like. The drink ought to be diluting; as barley water, infusions of mild 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 possi- ble, to keep in an erect posture, and not to lie with his head too low. When the headache 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 whoie 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. 304 OF THE HEADACHE. But when the headache 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 pur- gatives 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 headache is occasioned by the stoppage of a run- ning at the nose, the patient should frequently smell to a bottle of volatile salts; he may likewise take snuff, or anything 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 peri- odical headache has been cured by wearing a piece of flannel over the forehead during the night. When the headache arises from a vitiated state of the hu- mors, 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 liquo- rice.* These, if duly persisted in, will produce very happy effects. When a collection of matter is felt under the skin, it must be discharged by an incision; otherwise it will render the bone carious. When the headache is so intolerable as to endanger the pa- tient's life, or is attended with continual watching and delirium, recourse must be had to opiates. These, after proper evacua- tions by clysters, or mild purgatives, may be applied both ex- ternally and internally. The affected part may be rubbed with Bates' 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 pennyroyal tea, twice or thrice a day. This is only to be done in case of extreme pain. Proper evacuations ought always to accompa- ny and follow the use of opiates.t When the patient cannot bear the loss of blood,'his feet ought frequently to be bathed in lukewarm water, and well * See Appendix, Decoction of Sarsaparilla. t When the pain is very violent, and does not yield to small doses of lau- danum, the quantity may be increased. I have known a patient in extreme pain take three hundred drops in twentyfour hours ; but such doses ought on- ly to be administered by a person of skill. OF THE TOOTHACHE. SOp rubbed with a coarse cloth. Cataplasms with mustard or horseradish ought likewise to be applied to them. This course is peculiarly necessary when the pain proceeds from a gouty humor affecting the head. When the headache is occasioned by great heat, hard labor, or violent exercise of any kind, it may be allayed by cooling medicines ; as the saline draughts with nitre, and the like. A little ether dropped into the palm of the hand, and applied lo the forehead will sometimes remove a violent headache. OF THE TOOTHACHE. 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- ache occasioned by neglecting some part of the usual coverings of the head, by sitting with the head bare near an open win- dow, or exposing it to a draught of cold air. Food or drink taken either too hot or too cold, is very hurtful to the teeth. Great quantities of sugar, or other sweetmeats, are likewise hurtful. Nothing is more destructive to the teeth than crack- ing nuts, or chewing any kind of hard substances. Picking the teeth with pins, needles, or anything 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 toothache, especially during the first three or four months of pregnancy. The toothache often proceeds from scorbutic humors affecting the gums. In this case the teeth are sometimes wasted, and fall out without any considerable degree of pain. The more im- mediate cause of the toothache is a rotten or carious tooth. In order to relieve the toothache, we must first endeavor to lessen the flux of humors 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 exceed- ingly good effect in the toothache. It is seldom safe to admi- nister 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. 39 S06 OF THE TOOTHACHE. If this fail, and the pain and inflammation still increase, a suppuration may be expected, to promote which, a toasted fig should beheld between the gum and the cheek; bags filled with boiled chamomile flowers, flowers of elder, or the like, may be applied near the part affected, with as great a degree of warmth as the patient can bear, and renewed as they grow cool: the patient may likewise receive the steams of warm water into his mouth, through an inverted funnel, or by holding his head over the mouth of a porringer filled with warm water. Gargles are likewise of use to promote a discharge. Rob of elder, dissolved in small beer, makes a very proper gargle, or an infusion of sage or mulberry leaves. Such things as promote the discharge of saliva, or cause the patient to spit, are generally of service. For this purpose, bit- ter, 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 on the tooth, or a little of it chewed. Brookes says, he hardly ever knew it fail to cure the tooth- ache. It ought, however, to be used with caution. Many other herbs, roots, and seeds, are recommended for curing the toothache ; as the leaves or roots of millefoil or yar- row chewed, tobacco smoked or chewed, stavesacre, 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 toothache. Opiates often relieve the toothache. 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 af- firms, that there are few cases wherein this will not give relief. If there be a hollow tooth, a small pill made of equal parts of camphor and opium, or a small piece of assafetida, put into the hollow, is often beneficial. When this cannot be had, the hol- low tooth may be filled with gum mastich, wax, lead, cork, or any substance that will keep in it, and keep out the external air. Few applications give more relief in the toothache than blis- tering plasters. These may be applied between the shoulders ; but they have the best effect when put behind the ears, and made so large as to cover a great part of the lower jaw. Burning the nerve within the affected tooth with a hot iron, has frequently given ease; but this operation ought to be per- formed with care. After all, when a tooth is carious, it is often impossible to OF THE TOOTHACHE. 307 remove the pain without extracting it; and as a spoiled tooth never becomes sound again, it is prudent to draw it soon, lest it should affect the rest. Tooth drawing, like bleeding, is very much practised by mechanics, as well as persons of the medi- cal profession. The operation, however, is not without dan- ger, 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.* When a sound tooth has been drawn, if it be replaced immediately, it will grow in again ; and it is now a practice to draw a rotten tooth, and put a sound one from another person in its room.j When the toothache returns periodically, and the pain chief- ly affects the gums, it may be cured by the bark. Some pretend to have found great benefit in the toothache, 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 expense, and cannot do any harm. Electricity has likewise been re- commended, and particular instruments have been invented for sending a shock through the affected tooth. Persons who have returns of the toothache 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 toothache. Of all the aches and pains incident to the human body, I do not know of one more distressing than the toothache. It is not, indeed, dangerous ; but it so much disturbs and deranges every function, as to render the greatest man incapable of thinking or acting with propriety. I know of many things that will ease the raging pain for the moment, but none that will cure it, where the tooth is carious. In this case, I would always re- commend the extraction of the unsound tooth, rather than to. endure the pain for years, and be obliged to submit to the ope- ration at last. It is to be remembered, that a decayed tooth can never get better, or become sound ; and that, by being left in, it only tends to vitiate the rest, and to do mischief. Great care and expertness, however, are necessary in extracting it. * This may always be prevented by the operator's striking on the teeth with any piece of metal, as this never fails to excite tlie pain in the carious tooth. t This practice has for years been totally relinquished, in consequence of the dangerous diseases that were found to result from bringing the living parts of two different animal bodies into intimate union with each other. A. P. B 3Qa OF THE EARACHE, OF THE EARACHE. 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 earache may proceed from any of the causes which produce inflammation. It often proceeds from a sudden sup- pression 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 oc- casions deafness, which is generally reckoned a favorable symptom. When the earache 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. Af- terwards the patient should be made to sneeze, b'y 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 on pouring in oil. When the pain of the ear proceeds from inflammation, it must be treated, like other topical inflammations, by a cooling regimen and opening medicines. Bleeding at the beginning, either in the arm or jugular vein, or cupping in the neck, will be proper. The ear may likewise be fomented with steams of warm water; or flannel bags, filled with boiled mallows and chamomile flowers, may be applied to it warm; or bladders filled with warm milk and water. An exceedingly good me- thod of fomenting the ear is to apply it close to the mouth of a jug filled with warm water, or a strong decoction of chamomile flowers. The patient's feet should be frequently bathed in lukewarm water, and he ought to take small doses of nitre and rhubarb, a scruple of the former and ten grains of the latter, three times a day. His drink may be v\hey, or a 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, and a few drops of the camphorated spirit of PAIN OF THE STOMACH, &c. 309 wine may be put into the ear with wool or cotton. A blister behind the ear, if applied early, will sometimes remove this complaint. When the inflammation cannot be discussed, a poultice of bread and milk, or roasted onions, may be applied to the ear, and frequently renewed till the abscess breaks, or can be open- ed. Afterwards the humors 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; or from 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 hys- teric complaints. It is likewise very common to hypochondri- acal 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 rhu- barb. He ought likewise to take an infusion of chamomile flowers, or some other stomachic bitter, either in wine or wa- ter. I have often known exercise remove this complaint, es- pecially sailing, or a long journey on horseback, or in a car-* riage. When a pain of the stomach proceeds from flatulency, the patient is constantly belching up wind, and feels an uneasy dis- tention of the stomach after meals. This is a most deplorable disease, and is seldom thoroughly cured. In general, the pa- tient ought to avoid all windy diet, and everything that sours on the stomach, as greens, roots, &c. This rule, however, ad- mits of some exceptions. There are many instances of per- sons, very much troubled with wind, who have received great 310 PAIN OF THE STOMACH, &c. benefit from eating parched peas, though this grain is gene- rally supposed to be of a windy nature.* This complaint may likewise be greatly relieved by labor, 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 ad- vised, 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 sheathe and defend the stomach from the acrimony of its contents. When a pain of the stomach proceeds from a translation of gouty matter, warm cordials are necessary, as generous wines, French brandy, he. 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 quantity necessary on these occa- sions. 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 chamomile flowers, or carduus benedictus. If a pain of the stomach proceed from the stoppage of cus- tomary evacuations, bleeding will be necessary, especially in sanguine and very full habits. It will likewise be of use to keep the body gently open by mild purgatives ; as rhubarb or senna. When this disease affects women in the decline of life, after the stoppage of the menses, making an issue in the leg or arm will be of peculiar service. 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 * These are prepared by steeping or soaking peas in water, and afterwards drying them in a pot or kiln till they burst. They may be used at pleasure. OF WORMS. 311 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. Pain of the stomach proceeds from such a variety of causes, that it is difficult to prescribe a medicine for it. The treatment must of course be suited to the nature of the complaint. But I have for some years very generally recommended a plaster, which seldom fails to give relief. Its basis may be any kind of adhesive plaster spread on leather, to which, while warm, a drachm and a half, or two drachms, of powdered opium may be added. It should be large enough to cover nearly the whole region of the stomach, and should be suffered to remain on as long as it will stick.* CHAP. XXXVI. OF WORMS. THESE are chiefly of three kinds, viz. the tarnia, 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 symp- toms, and require almost the same method of treatment as these, 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 intestines, and sometimes in the stomach. The round and short worms commonly lodge in the rectum, or lower portion of the intes- tines, 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 ap- petite, a dry cough, convulsions, epileptic fits, and sometimes a privation of speech. These worms have been known to perfo- * Pain of the stomach is frequently relieved by drinking a cup or two of water as hot as it can be swallowed. This remedy is always safe, and will frequently be found effectual. A. P. B. 312 OF WORMS. rate 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,—swoonings, priva- tion of speech, and a voracious appetite. The round worms, called ascarides, besides an itching of the anus, cause swoon- ings, 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 an 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 owTing to the nurse. Children of the same family, nursed by one wo- man, 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, a 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 color ; griping, or colic pains; an involuntary discharge of saliva, especially when asleep; frequent pains of the side, w ith a dry cough, and un- equal pulse ; palpitations of the heart; swoonings ; drowsiness; Cold sweats ; palsy; epileptic fits, with many other unaccount- able nervous symptoms, which wTere formerly attributed to witch- craft, or the influence of evil spirits. Small bodies in the ex- crements, resembling melon or cucumber seeds, are symptoms of the tape worm. There is no certain symptom of worms but passing them. I lately saw some very surprizing effects of worms in a girl about five years of age, wrho used to lie for whole hours as if dead. She at last expired, and, on opening her body, a num- ber of the teres, or long round worms, were found in her intes- tines, which were considerably inflamed; and what anatomists call an intus susceptio, or involving of one part of the bowels^ithin OF WORMS. 313 another, had taken place in no less than four different parts of the intestinal canal.* Medicine.—Though numberless medicines are extolled for expelling and killing worms,f yet no disease more frequently baffles the physician's skill. In general, the most proper medi- cines 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. Twenty- five or thirty grains of the former, with six or seven of ihe 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. J On the intermediate days the patient may take a drachm of the filings of tin, twice or thrice a day, mixed with syrup, honey, or treacle. Those who do not choose to take calomel, may make use of the bitter purgatives; as aloes, hiera picra, tincture of senna and rhubarb, he. Oily medicines are sometimes found beneficial for expelling worms. An ounce of salad oil and a tablespoonful of common salt may be taken in a glass of red port wine thrice a day, or oftener, if the stomach will bear it. But the more common form of using oil is in clysters. Oily clysters, sweetened with sugar or honey, are very efficacious in bringing away the short round worms called ascarides, and likewise the teres. The Harrowgate water is an excellent medicine for expelling worms, especially the ascarides. As this water is impregnated with sulphur, we may hence infer, that sulphur alone must be a good medicine in this case, which is found to be a fact. Many practitioners give flowers of sulphur in very large doses, and with great success. It should be made into an electuary with * 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. 1 have known these given in delicate constitutions, to the destruction of the patient, where there was not the least symptom of worms. t A medical writer of the present age has enumerated upwards of fifty British plants, all celebrated for killing and expelling worms. t Such repeated doses of calomel are liable to injure the stomach and bow- els, and beside are not necessary as anthelmintics. A few injections of lamp or whale oil will destroy the ascarides. C. 40 314 OF WORMS. 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 flower 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 tablespoonful 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, chamomile flowers, tops of wormword, the lesser centaury, he. The above directions are intended for adults; but for chil- dren the medicines must be more agreeable, and in smaller doses. For a child of four or five years old, six grains of rhu- barb, 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 ethiop's mineral, in a spoon- ful 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 rouud 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 OF WORMS. 315 various ways. We might here mention many other plants, both for external and internal use, as the cabbage bark, he. but think the filings of tin with ethiop's 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, scammony, and calomel, with as much double refined sugar as is equal to the weight of all the other ingredients. These must be well mixed together, and 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. 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 sub- ject to worms, to take a dose of camphorated spirit after meals; as everything that braces and strengthens the stomach, is good both for preventing and expelling these vermin.* In order to prevent any mistake of what I have here said in favor of solid food, it may be proper to observe, that I only made use of that word in opposition to slops of every kind ; not to advise parents to cram their children with meat, two or three times a day. This should only be allowed at dinner and in moderate quantities, or it would create, instead of preventing, worms ; for there is no substance in nature, which generates so many worms, as the flesh of animals when in a state of putre- faction. Meat, therefore, at the principal meal, should be always accompanied with plenty of good bread, and young, ten- der, and well boiled vegetables, especially in the spring, when these are poured forth from the bosom of the earth in such profusion. They promote the end in view, by keeping the body moderately open, without the aid of artificial physic. The ripe fruits of autumn produce the same effect; and, from their cooling, antiputrescent qualities, are as wholesome as the unripe are pernicious. * We think it necessary here to warn people of their danger who buy cakes, powders, and other warm medicines, at random, from quacks, and give them to their children without proper care. The principal ingredient 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 swell- ed, and died on the following day, with all the symptoms of having been poi. soned. S16 OF THE JAUNDICE. I also very earnestly conjure parents not to take the alarm at every imaginary symptom of worms, and directly run for drugs to the quack, or apothecary. They should first try the good effects of proper diet and regimen, and never have recourse to medicines till after unequivocal proofs of the nature of the com- plaint. The danger of advertised nostrums is sufficiently point- ed out and exemplified in the preceding note. CHAP. XXXVII. 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 dyes a white cloth, if put into it, of the same color. There is likewise a species of this disease called the black jaundice. Causes.—The immediate cause of the jaundice is an ob- struction of the bile. The remote or occasional causes are, the bites of poisonous animals, as the viper, mad dog, he.; the bilious or hysteric colic ; violent passions, as grief, anger, he. Strong purges or vomits will likewise occasion the jaundice. Sometimes it proceeds from obstinate agues, or from that dis- ease being prematurely stopped by astringent medicines. In infants, it is often occasioned by the meconium not being suffi- ciently 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, he. 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 color, and the urine, as was observed above, is yellow. The breathing is difficult, and the patient complains of an unusual load or oppression of his breast, There is a heat in the nostrils, a bitter taste in the mouth, loathing of food, sickness of the stomach, vomiting, flatulency, and other symptoms of indiges- tion. If the patient be young, and the disease complicated with no other malady, it is seldom dangerous ; but in old people, where OF THE JAUNDICE. 317 it continues long, returns frequently, or is complicated with the dropsy or hypochondriacal symptoms, it generally proves fatal. The black jaundice is more dangerous than the yellow. Regimen.—The diet should be cool, light, and diluting, con- sisting chiefly of ripe fruits and mild vegetables; as apples boiled or roasted, stewed prunes, preserved plums, boiled spin- nage, &c. Veal or chicken broth, with light bread, are like- wise very proper. Many have been cured by livingalmost wholly, for some days, on raw eggs. The drink should be but- termilk, whey sweetened with honey, or decoctions of cool, opening vegetables ; as marshmallow 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. Pa- tients 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, melanchrjly disposition. Whatever, therefore, tends to promote the circulation, and to cheer the spirits, must have 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 chamomile 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. 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 chro- nic 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 318 OF THE DROPSY. 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 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 lake as much exer- cise as possible, and to avoid all heating and astringent aliments. The two last directions are of far greater importance than some people may imagine. In fact, taking exercise, and keep- ing the body open, are the only assured and rational means of removing a complaint, which generally arises from an obstruc- tion of the biliary ducts. I knew a celebrated physician, who was subject to this disease, and who, whenever it attacked him, mounted his horse, set out on a journey, and never returned till he was well. For my own part, 1 should place more reli- ance on the efficacy of such a method, than on the whole cata- logue of near a hundred specifics mentioned by the late Dr. Short of Sheffield, though I have known instances, where one of them, the decoction of hempseed, as already intimated, was found very beneficial. CHAP. XXXVIII. OF THE DROPSY. THE dropsy is a preternatural swelling of the whole body, or some part of it, occasioned by a collection of watery humor. ft is distinguished by different names, according to the part af- fected, 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 dispo- OF THE DROPSY. 319 sition. It may likewise proceed from drinking ardent spirit, 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 hemorrhoids, 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 diarrhoea, a dysentery, an empyema, or a con- sumption of the lungs. In short, whatever obstructs the perspi- ration, or prevents the blood from being duly prepared, may occasion a dropsy. Svmptoms.—The anasarca generally begins with a swelling of the feet and ankles towards night, which for some time dis- appears 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. After- wards the breathing becomes difficult, the urine is in small quantity, and the thirst great; the body is bound, and the per- spiration 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 shows that the lungs are affected. In the ascites, besides the above symptoms, there is a swelling of the belly, and often a fluctuation, which may be perceived by striking the belly on one side, and laying the palm of the hand on the opposite. This may be distinguished from a tympany by the weight of the swelling, as well as by the fluctu- ation. When the anasarca and ascites are combined, the case is very dangerous. Even a simple ascites seldom admits of a radical cure. Almost all that can be done is, to let off the water by tapping, which seldom affords more than a temporary relief. When the disease comes suddenly on, and the patient is young and strong, there is reason to hope for a cure, especially if medicine be given early. But if the patient be old, has led 320 OF THE DROPSY. an irregular or 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 dipped in wine or a little brandy. This is not only nourishing, but tends to quench thirst. Some have been actually cured of a dropsy by a total abstinence from all liquids, and living en- tirely on 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 be not able to walk or labor, 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 apart- ments warm and dry. If he live in a damp country, he ought to be removed to a dry one, and, if possible, into a warm cli- mate. In a word, every method should be taken to promote the perspiration, and to brace the solids. For this purpose it will likewise be proper to rub the patient's body two or three times a day with a hard cloth, or a flesh brush; and he ought constantly to wear flannel next his skin by day, taking it off by night. 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 re- pealed as often as is found necessary, three or four days inter- vening between the doses. The patient must not drink much after taking the vomit, otherwise he destroys its effect.' A cup or two of chamomile 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 OF THE DROPSY. S21 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 suffi- cient 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 teaspoonful of'the spirit of hartshorn in it. A teacupful of the following diuretic infusion may likewise be taken every four or five hours through the day: Take juniper berries, mustard seed, and horseradish, 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 on. 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 pow- der 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 un- bruised 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 power- ful* 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, how- ever, 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 Mindererirs's spirit in a cup of wine whey three or four times a day. To promote a discharge of urine, the fol- 41 322 OF THE DROPSY. lowing infusion of the London hospitals will likewise be bene- ficial : 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, filler the liquor. A wineglass 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 speedi- ly 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 humors are vitiated, or the bowels spoiled, by long soaking in water, it can hardly be ex- pected that any permanent relief will be procured.! 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 aromatirs, 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 >hould take as much exercise as he can bear without fatigue. He should wear flannel, or rather fleecy hosiery, next his skin, by day, and make daily use of the flesh brush. We have classical authority of two thousand years standing to say, that the dropsy is an obstinate disease; not that the incidental dropsy is incurable, for I have often been so happy as to succeed in the treatment of it; but when the dropsy is accompanied with a scirrhous liver, or a worn out constitution, very little is to be expected from medicine. * If it be desirable, as it generally is to promote the discharge of the serous fluid, whether the skin be punctured, or burst spontaneously, the best means of doing so is by the application of a common cabbage leaf, previously a little warmed. A. P. B. t The very name of an operation is dreadful to most people, and they wish to try everything before they have recourse to it. This is the reason why tapping so seldom succeeds to our wish. I 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. OF THE GOUT. 323 I had lately a singular instance of the efficacy of nitre in a case of dropsy. A young man, a cornet of dragoons, was drop- sical all over, even his face not excepted. After several things had been tried without success, I showed him my quotation from Dr. Brookes, in this chapter. He was desirous of making an experiment with nitre ; and took a drachm of it in a cup of warm ale, for some time, once, and afterwards twice a day, till he was cured.* CHAP. XXXIX. OF THE GOUT. THERE is no disease, which shows the imperfection of medi- cine, or sets the advantages of temperance and exercise in a stronger light, than the gout. Excess and idleness are the true sources 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 ; excess of venery; too free a use of acidulated liquors ; night watching; grief or uneasiness of mind ; an obstruction or defect of any of the cus- tomary discharges, as the menses, sweating of the feet, perspi- ration, he. Symptoms.—A fit of the gout is generally preceded by indi- gestion, drowsiness, belching of wind, a slight headache, sick- ness, and sometimes vomiting. The patient complains of weari- ness 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 * I have repeatedly succeeded in carrying off the effusion of dropsy, by the use of the following pills : Take of elaterium six grains ; of calomel twelve grains ; rub them carefully together, and, with a sufficient quantity of extract of gentian, form into twelve pills. Of these, one may be taken every hour, commencing early in the morning, till they begin to operate. I have known not only quarts, but gallons of water evacuated by stool, after taking this medicine. During the operation, the patient's strength must be supported by strong beef tea, with some wine in it. But even if successful in removing the watery accumulation by this means, a more difficult task still remains to the practitioner, that of preventing its return. A. P. B, 324 OF THE GOUT. frequently an involuntary shedding of tears. Sometimes these symptoms are much more violent, especially upon the near ap- proach of the fit; and it has been observed, that as is the fever wrhich 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 ankle or calf of the leg. This pain is accompanied with a sensation as if cold water were poured on the part, which is succeeded by a shiver- ing, 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, knawed, or torn in pieces. 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 far twenty four hours, from the time of the coming on of the fit : he then be- comes easier, the part begins to swell, appears red, and is cov- ered with a little moisture. Towards morning he drops asleep, and generally falls into a gentle breathing sweat. This termi- nates 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 die 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 perspira- tion, urine, and the other evacuations, la 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 regi- men, 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 ac- OF THE GOUT. 325 customed 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 an- swer this purpose better if a teaspoonful of sal volatile oleosum, or spirit of hartshorn, be put into a cup of it twice a day. It will likewise be proper to give at bed time a teaspoonful 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 wrapped in soft flannel, fur, or wrool. The last is most readily obtained, and seems to answer the purpose better than anything else. The people of Lancashire look on 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 ex- ternal application answer so wrell 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 choose the softest which can be had, and seldom or never remove it till the fit be en- tirely gone off. The patient ought likewise to be kept quiet and easy during the fit. Everything that affects the mind disturbs the paroxysm, and tends to throw the gout on 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 re- moving 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. Evacua- tions by bleeding, stool, he. are likewise to be used with cau- tion ; they do not remove the cause of the disease, and some- times, 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 326 OF THE GOUT. will drive it off altogether; but nothing has yet been found which will do this with safety to the patient. In pain we eager- ly grasp at anything 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. Notwithstanding the acknowledged and frequently ex- perienced danger of tampering with the gout, such is the effect ol intense pain, that I never met with more than two patients who could bear their sufferings with rational composure, or, what is the same thing, without frantic attempts to alleviate them. When the seat of the complaint is in torture, a promise to afford relief, though made by the greatest impostor on earth, is listened to ; and present ease is sought for, at the risk of any future consequences. It is not many years since some persons of the first rank in the kingdom fell victims to the deceptions of a foreign quack, who soothed their impatience of pain, amused them with the charm of fancied recovery, and rendered mo- mentary ease the fatal prelude to inevitable death. It would be as prudent to stop the smallpox from rising, and to drive them into the blood, as to attempt to repel the gouty matter after it has been thrown on 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 fortv drops of laudanum, more or less, accord- ing 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 snakeroot, and orange peel. The diet at this time should be light, but nourishing, and gende 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 1 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, t» OF THE GOUT. 327 conclude, that a fit of the gout, to some constitutions, in the de- cline 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 certain- ly can be no danger in following such a course. It is well known, that the whole habit may be so altered by a proper regi- men, 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.* By this we do not mean sauntering about in an indolent manner, but labor, sweat and toil. These only can render the humors 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 intense thinking. The supper should be light, and taken early. The use of milk, gradually increased, till it becomes the principal part of diet, is particularly recommended. All strong liquors, especially generous wines and sour punch, are to be avoided. We would likewise recommend some doses of magnesia and rhubarb to be taken every spring and autumn ; and afterwards a course of stomachic bitters; as tansy or water trefoil tea, an infusion of gentian and chamomile flowers, or a decoction of burdock root, he. Any of these, or an infusion of any whole- some 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 pro- motes 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 recall and fix it, become absolutely necessary. When the gout affects the head, the pain of the joints ceases, and the swelling disappears, * Some make a secret of curing the gout by muscular exercise. This se- cret, however, is as old as Celsus, who strongly recommends this mode of cure ; and whoever will submit to it in the fullest extent, may expect to reap solid and permanent advantages. 328 OF THE GOUT. while either severe headache, 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 epigrastric region, and total loss of strength, will suc- ceed. 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. Blis- tering plasters ought likewise to be applied to the ankles or calves of the legs. Bleeding in the feet or ankles is also ne- cessary, and warm stomachic purges. The patient ought to keep in bed for the most part, if there be any signs of inflam- mation, and should be very careful not to catch cold. If it attack 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 en- deavor to promote a sweat by drinking warm liquors; and if he should be troubled with a nausea, or inclination to vomit, he may drink chamomile tea, or anything 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 marshmallows or pyrola, 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 imi- tates many other disorders, and, by beins; 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 constitu- tion or manner of living, have reason to expect it, ought like- wise to be very circumspect with regard to its first approach. If the disease, by wrong conduct or improper medicines, be di- ve 'i-ied from its proper course, the miserable patient has a chance to be ever after tormented with headaches, coughs, pains of the stomach and intestines ; and to fall, at last, a victim to its attack on some of the more noble parts. * l.thcr is found to be an efficacious remedy in this case. OF THE RHEUMATISMi 329 OF THE RHEUMATISM. This disease has often a resemblance to the goitt. ft gene- rally attacks the joints with exquisite pain, and is sometimes at- tended with inflammation and swelling. It is most common in the spring, and towards the end of autumn. It is usually dis- tinguished 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; as an obstructed per- spiration, 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 that of 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 pro- duced by wet clothes, damp beds, sitting or lying on the damp ground, travelling in the night, he. 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 humors ; as the scurvy, the lues venerea, obstinate autumnal agues, he. 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 and un- wholesome 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 in- flammation. 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 like- wise to be kept open by emollient clysters, or cool, opening liquors ; as decoctions of tamarinds, cream of tartar, whey, senna 42 S30 OF THE RHEUMATISM. tea, large doses of pounded guaiacum, and the like. The diet should be light, and in small quantity, consisting chiefly of roast- ed apples, groat gruel, or weak chicken broth. After the fever- ish symptoms have abated, if the pain still continues, die patient must keep his bed, and take such things as promote perspira- tion ; as wine whey, with spiritus Mindereri, he. 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 exceed- ingly 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 does not catch cold after bathing. The chronic rheumatism is seldom attended with any con- siderable degree of fever, and is generally confined to some par- ticular 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 obsti- nate, 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, cur- rants or gooseberries boiled in milk, is most proper. Arbuthnot says, " II there be a specific in aliment for the rheumatism, it is certainly whey;" r.nd 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 considers!>ly." 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 teaspoonful 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 blister 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.* 1 have likewise known a plaster of Burgundy pitch, worn See Appendix, Warm Plaster. OF THE RHEUMATISM. 331 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 rub- bing the parts affected with tincture of cantharides. When the common tincture did not succeed, he used it of a double or treble strength. Cupping on the part affected is likewise often very beneficial, and so is 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. To those who can afford the expense, I would recommend the warm baths of Buxton or Matlock in Derbyshire. These have often, to my knowledge, cured very obstinate rheumatisms, and are always safe either in or out of the fit. When the rheu- matism is complicated with scorbutic complaints, which is not 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 tablespoonful 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 com- plaint. It may be infused in wine or ale, or drank in form of tea. The ground ivy, chamomile, 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 imme- diate 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 rheu- matism. We would also recommend exercise, and wearing flannel next the skin. Issues are likewise very proper, espe- cially 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 rheu- matic complaints. The best medicines in this case are bitters and mild purgatives. These may either be taken separately or 332 OF THE SCURVY. 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 wineglasses of it taken daily, as shall be found necessary for keeping the body gently open. In cases where the bark itself proves sufficiently purga- tive, 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. One of the best articles of dress, not only for the prevention of the rheumatism, but for powerful co-operation in its cure, is fleecy hosiery. A medical friend of mine, of long experience and much practice in the isle of Ely, assured me, that the in-r troduction of this manufacture had prevented more rheumatisms, colds, and agues, than all the medicines which had ever been used there. Such of the inhabitants of marshy countries as are in easy circumstances could not, perhaps, direct their charity and humanity to a better object, than to the supplying of their poor neighbors with so cheap and simple a preservative. I have even myself experienced the good effects of such warm cover- ing in the rheumatism, to which I was very subject about thirty years ago ; but have never experienced any attack of it since I took to warm clothing. CHAP. XL. OF THE SCURVY. THIS disease prevails chiefly in cold, northern countries, es- pecially in low, damp situations, near large marshes, or great quantities of stagnant 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 js 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, OF THE SCURVY. 333 we presume, are rather owing to confined air, want of exer- cise, and the unwholesome food eaten by sailors on long voy- ages, than to any specific difference in the disease. Causes.—The scurvy is occasioned by cold, moist air; by the long use of salted or smokedried provisions, or any kind of food that is hard of digestion, and affords little nourishment. It may also proceed from the suppression of customary evacu- ations ; as the menses, the hemorrhoidal flux, &c. It is some- times owing to an hereditary taint, in which case a very small cause will excite the latent disorder. Grief, fear, and other de- pressing passions, have a great tendency both to excite and aggravate this disease. The same observation holds with re- gard to neglect of cleanliness; bad clothing; the want of pro- per exercise; confined air; unwholesome food; or any dis- ease which greatly weakens the body, or vitiates the humors. Symptoms.—This disease may be known by unusual weari- ness, heaviness, and difficulty of breathing, especially after mo- tion ; 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 violetcolored spots; the face is generally of a pale or leaden color. As the disease advances, other symptoms come on ; as rottenness of the teeth, hemorr- hages, 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 pa- tient is often carried off by a dysentery, a diarrhoea, 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 pur- suing a plan directly opposite to that which brings it on. It proceeds from a vitiated state of the humors, 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 de- pressing 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 amuse- ments. Nothing has a greater tendency either to prevent or remove this disease, than constant cheerfulness and good hu- mor. But this, alas ! is seldom the lot of persons afflicted with \he scurvy. They are generally surly, peevish, and morose. 334 OF THE SCURVY. When the scurvy has been brought on by a long use of salted provisions, the proper medicine is a diet consisting chief- ly of fresh vegetables ; as oranges, apples, lemons, limes, tama- rinds, watercresses, 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 chemical acids. All the patient's food and drink should, in this case, be sharpened with cream of tartar, elixir of vit- riol, vinegar, or the muriatic acid. These things, however, will more certainly prevent than cure the scurvy, for which reason seafaring people, especially in 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 chemical 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 got store of fruits, greens, cyder, &c. laid in, and if proper regard were paid to cleanli- ness and warmth, that sailors would be the most healthy peo- ple in the world, and would seldom suffer either from the scurvy or putrid fevers, which are so fatal to this useful class 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 over- takes 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.! * By new bread here, the author doubtless means bread duly ripened, two or three days old, before which bread is never lit to be eaten by any one, sick or well. * C. + Everybody know- how much easier it is to prevent than to cure any disease; but this is particularly true with respect to the scurvy. 1 have therefore recommended the moU assured means of preserving our seamen from its formidable attack.-. Vegetable and mineral acids are certainly the best correctives of the acrimony occasioned by the long use of salted pro- visions. These are one of tlie chief causes of the scurvy, not only at sea, but on land also, where salted and smokedried meats are a favorite and u very customary article of food. It appears from the reports of modern travellers, that the scurvy is almost unknown to the natives of Canada, though they live in a great measure on animal food, but not salted ; while the use of the latter never fails to produce the scurvy. Would it not then be worth while OF THE SCURVY. S35 I have often seen very extraordinary effects in the land scurvy from a milk diet. This preparation of nature is a mix- ture 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 humors, which seems to consti- tute the very essence of the scurvy, and many other diseases. But people despise this wholesome and nourishing food, be- cause it is cheap, and devour With greediness flesh and ferment- ed liquors, while milk is only deemed fit for their hogs. The most proper drink in the scurvy is whey or buttermilk. When these cannot be had, sound 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, marshmallow 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. 1 have often seen patients, who had been reduc- ed 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 con- tinued 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. to make various experiments for preserving meat at sea without salt ? Surely the resources of human invention are not exhausted. The absorbent and antiputrescent properties of sugar are well known ; but it might be deemed too expensive a seasoning. I must leave trials of this sort to persons of more leisure. It is enough for me to suggest the hint. 1 wish it may lead to a dis- covery of so much importance. 336 OF THE SCURVY. All kinds of salad are good in the scurvy, and ought to be eaten very plentifully, as spinage, lettuce, parsley, celery, endive, radish, dandelion, &c. It is amazing to see how soon fresh vegetables in the spring cure the brute animals of any scab or foulness which is on their skins. It is reasonable to suppose, that their effects would be as great on 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 1 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 of kin 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 on tea and other diluting diet, using less salted meat, being more cleanly, better lodged and clothed, &.c.—For the cure of this disease, we would recommend the same course of diet and medicine as in the scurvy. I have met with very few cases of real leprosy in the course of my practice. The dry, scaly eruptions all over the body, which are often the effects of the scurvy, are very liable to be considered as leprous symptoms, and certainly resemble them very much. But no evil can arise even from mistake in this- particular, as the same alterative plan, which is adviseable in the scurvy, will be generally found efficacious in the leprosy. Perhaps, in the latter complaint, we ought to lay a greater stress, if possible, on the benefit of good air, and of frequent changes of the linen worn next the skin. What has been pe- culiarly called the disease of uncleanness, can only be remedi- ed by the practice of the opposite virtue. I have also found, that, after proper means for correcting internal impurities had been used for some time, the complete disappearance of the leper's sores was often safely and effectually promoted by OF THE SCROFULA, OR KING'S EVIL. 337 the ointment for diseases of the skin, mentioned in the Ap- pendix.* The medicinal virtues of the Bath waters, as well as those of Harrowgate, in the cure of the leprosy, are very highly, and, I believe, very justly esteemed. OF THE SCROFULA, OR KING'S EVIL. This disease chiefly affects the glands, especially those of the neck. Children and young persons, of a sedentary life, are very subject to it. If. 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 lia- ble to the scrofula. Causes.—This disease may proceed from an hereditary taint, a scrofulous nurse, &c. Children who have the misfor- tune to be born of sickly parents, whose constitutions have been greatly injured by the pox, or other chronic diseases^ are apt to be affected by the scrofula. It may likewise proceed from such diseases as weaken the habit, or vitiate the humors^ as the smallpox, measles, &c. External injuries, as blows, bruises, and the like,sometimes produce scrofulous 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 humors, or relax the solids, paves the way to the scrofula; 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.t 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 tumor. This often continues for a long time without breaking, and when it does break, it only discharges a thin sanies, or watery humor. Other parts of the * I have lately seen some instances of inveterate eruptions on the face, commonly termed scorbutic, removed by the use of the dulcamara. Take of the stalks of this plant half an ounce, liquorice root two drachms; macerate in two quarts of warm water for two hours, and then boil for ten minutes. Of the strained decoction a teacupful, with a little milk, may be taken three times a day. It must be persisted in for some time. A. P. B. t The scrofula, as well as the rickets, is found to prevail in large manufac- turing towns, where people live grossly, and lead sedentary lives. 43 S38 OF THE SCROFULA, OR KING'S EVIL. body are likewise liable to its attack, as the armpits, groins, feet, hands, eyes, breasts, &x. Nor are the internal parts ex- empt from it. It often affects the lungs, liver, or spleen; and I have frequently seen the glands of the mesentery greatly en- larged by it. Those obstinate ulcers, which break out on the feet and hands with swelling, and little or no redness, are of the scrofu- lous kind. They seldom discharge good matter, and are ex- ceedingly 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 dis- charge a thin ichor. There is not a more general symptom of the scrofula than a swelling of the 'upper lip and nose. It sometimes begins in a toe or finger, which continues long swelled, with no great degree of pain, till the bone becomes carious. * Regimen.—As this disease proceeds, in a great measure, from relaxation, the diet ought to be generous and nourishing, but at the same time light and of easy digestion ; as well fer- mented 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 suffi- cient exercise are seldom troubled with the scrofula. Medicine.—The vulgar are remarkably credulous with re- gard to the cure of the scrofula; many of them believing in the virtue of the royal touch, that of the seventh son,&c. The truth is, we know but little either of the nature or cure of this disease, and where reason or medicines fail, superstition al- ways 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 accounled for. The scrofula, at a certain period of life, often cures of itself; and, if the patient happens to be touched about this time, the cure is imputed to the touch, and not to nature, who is 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 scrofula with strong purgative medicines. People imagine it proceeds from humors which must be purged off, without considering that these purgatives increase the debility and aggravate the, disease. It has indeed been found, that OF THE SCROFULA, OR KING'S EVIL. 339 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, es- pecially 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 scrofula, 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 sub- stance, may use the decoction made in the following manner:— Boil an ounce of Peruvian bark and a drachm of Winter's bark, both coarsely 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 tablespoonfuls, according to the age of the patient, given three times a day; but, in place of this, I now use the compound tincture of bark. The Moffat and Harrowgate waters, especially the latter, are likewise very proper medicines in the scrofula. They ought not, however, to be drank in large quantities, but should be taken so as to keep the body gently open, and must be used /or a considerable time. The hemlock may sometimes be used with advantage in the scrofula. Some lay it down as a general rule, that the sea water is most proper before there are any suppuration or symp- toms 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 may be small at first, and increased gradually as far as the stomach is able to bear it. External applications are of little use. Before the tumor breaks, nothing ought to be applied to it, unless a piece of flan- nel, or someUiing to keep it warm. After it breaks, the sore S40 OF THE SCROFULA, OR KING'S EVIL. 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 scrofula, for which reason people ought to beware of marrying into families affected widi this disease. For the means of preventing the scrofula, we must refer the reader to the observations on nursing, at the beginning of the book. I am now induced to bring into one point of view such of those remarks as immediately relate to the subject of prevention, in order to impress them more strongly on the minds of those who have the care of children. One of the most effectual means of guarding against the scrofula, is a constant attention to keep the child dry and clean, by the immediate removal of all impurities, which not only taint the air and relax the skin, but vitiate the humors of the body, in consequence of the absorption of their most noxious particles through the pores. Washing children frequently, forms a necessary part of this plan. At first, lukewarm water is proper, as being best suited to the newborn infant, on account! of the warm temperature to which he had been accustomed in the- womb, and on account of the delicacy of habit which he may have inherited from his parents. But the warmth of the water should be gradually diminished as the infant gains strength, till it can be used quite cold with great safety and benefit. The cold bath, so essential to the cure of the scrofula., operates with still greater certainty as a preventive. It braces and invigorates the frame, and thus directly counteracts one of tlie principal causes of the evil, which is relaxation. The whole body ought to be washed every morning, and the lower half every night, after which the * The application of the lunar caustic tends very much to promote the cure of scrofulous ulcers, after th* \ have broken, for they should never be ppencd. Tin \ will bear a pretty free daily application of this stimulus, not only with impunity, but advantage. A. P. B. OF THE SCROFULA, OR KING'S EVIL. 341 child is to be instantly wiped dry, and wrapped up in a warm blanket, to guard against the danger of sudden cold, and to se- cure all the advantages of so salutary an operation. My former arguments, in favor of light and loose clothing for children in general, acquire double force when there is the least reason to dread the scrofula. It is little short of murder to keep an infant of a delicate habit smothered in clothes, and panting in a sort of vapor bath caused by the noxious steams of its own body. The covering both by day and by night should be as light as is consistent with due warmth. The linen next the skin, which is always imbibing perspirable matter, must be changed often ; and the same dress ought never to be kept on for more than twelve hours together. Wholesome, unconfined air, and frequent exercise, are grand preservatives from all diseases, but especially from the scrofula. It is not enough to select the most spacious and lofty apartment in the house for the nursery; children should be taken out into the fields every day, particularly about noon, unless the heat be intense, as the most salutary exhalations from the earth then abound, and the air is impregnated with the balmy essence of the sweetest plants and flowers. Cold and wet weather being deemed one of the exciting causes of the scrofula, any wanton exposure to it would be improper ; though, even in this respect, less caution is necessary, if the use of the cold bath be con- tinued every morning. This will brace the thinnest, finest skin, and harden it against the impressions of a damp, chilly atmos- phere. Exercise, besides strengthening the whole habit, and power- fully assisting all the vital functions, has a direct tendency to prevent obstructions of every kind, and those of the glands in particular, which constitute the earliest symptom of the disease in question, On the subject of diet, some little deviations must be made from my general plan, in rearing the child of scrofulous parents, or one that is marked with wrhat may be called a predisposition to this disease, a thin skin, and a general weakness and flac- cidity of the habit. Extraordinary care should be taken to se- cure a very healthy nurse for such a child ; and, after it is weaned, the use of animal food, but light and easy of digestion, should be gradually introduced, and freely allowed at dinner every day. In case of any just apprehensions of the scrofula, we must not trust to a mild regimen, to milk and vegetables, though in general so wholesome and nutritious. They cannot give that tone to the stomach, and that energy to the whole sys- 349 OF THE ITCH. tem, which they now stand in need of. A gross, full diet will certainly occasion humors and eruptions ; but these are very different from the scrofula, and far more easily cured. A pover- ty of the blood, a relaxation of the fibres, those sure attendants, if not the principal causes, of the evil, require the most strength- ening articles both of food and drink. But I must reprobate, above all things, butter in every form, and other oily substances, which are so apt to turn rancid on the stomach, loading it with phlegm, relaxing and impeding its action, inducing a debility of the solids, and occasioning a great number of complaints, as well as glandular obstructions. One of the worst compositions, of which butter or fat always forms a part, is pastry. I really shudder, whenever I see a delicate woman, or a weak child, greedily devouring these palatable poisons. Let it be understood, that I include in this censure gingerbread, pancakes and all trash of the like kind. Indeed, a child of a scrofulous habit should never eat any preparation of flour, except plain, well made, and well baked bread.* OF THE ITCH. Though this disease is commonly communicated by infec- tion, yet it seldom prevails where due regard is paid to cleanli- ness, 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, thighs, legs, he. These pustules are attended with an intolerable itching, espe- cially when the patient is warm in 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 humors; and, if it be suddenly driven in, without proper evacuations, it may occasion fevers, inflammations of the viscera, or other in- ternal disorders. The best medicine yet known for the itch is sulphur, which * Delicate children are greatly injured by the common habit of bibbing too much thin, warm fluid, such as weak tea. They are chiefly enticed to this practice by the sweetness of these drinks. Such children ought not to be permitted to drink any thing sweet, or warm. The stomach is braced by cold applications as well as the skin. A. P. B. OF THE ITCH. 343 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 pow- dered, 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 on 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 like- wise 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 everything warm. The same clothes, the linen excepted, ought to be worn all the time of using the ointment; and such clothes as have been worn while the patient was under the disease are not to be used again, unless they have been fumigated with brimstone, and thoroughly cleansed ; otherwise they will communicate the infection anew.* I never knew brjmstone, when used as directed above, fail to cure the itch ; and I have reason to believe, that, if duly per- sisted in, it never will fail; but, if it be only used once or twice, and cleanliness neglected, it is no wonder if the disorder re- turns. The quantity of ointment mentioned above will generally be sufficient for the cure of one person ; but, if any symptoms of the disease should appear again, the medicine must be re- peated. 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 attend- * 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 be paid to the changing or cleaning of their clothes, which last is by no means aa easy operation. 344 OF THE ASTHMA. ed with fatal consequences. Many of the eruptive disorders to which children are liable, have a near resemblance ; and I have often known infants killed by being rubbed with greasy ointments, that make these eruptions strike suddenly in, which nature 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 foolhardy 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. 1 have known even the mercurial girdles pro- duce 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. Ig- norant 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 unne- cessary 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.* CHAP. XLI. 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 humoral and ner- vous. The former is attended with expectoration or spitting; * The itch is now by cleanliness banished from every genteel family in Britain. It still, however, prevails among the poorer sorts of peasants in Scot- land, and among the manufacturers in England. These are not only suffi- cient 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 atten- tion to cleanliness, they have banished the itch entirely out of their parishes. Why might not others do the same? OF THE ASTHMA. 345 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 like- wise proceed from a bad formation of the breast ; the fumes of metals or minerals taken into the lungs ; violent exercise, es- pecially running; the obstruction of customary evacuations, as the menses, hemorrhoids, &c. the sudden retrocession of the gout, or striking in of eruptions, as the smallpox, measles, &c. violent passions of the mind, as sudden fear or surprise. In a word, the disease may proceed from any cause that either im- pedes the circulation of the blood through the lungs, or pre- vents their being duly expanded by the air. Symptoms.—An asthma is known by a quick, laborious breathing, which is generally performed with a kind of wheez- ing noise. Sometimes the difficulty of breathing is so great, that the patient is obliged to keep in an erect posture; other- wise 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 pud- dings, 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 win^ ter season. As all disorders of the breast are much relieved by keeping the feet warm, and promoting the perspiration, a flannel shirt or waistcoat, worn by day only, and thick shoes* will be of singular service. But nothing is of so great importance in the asthma as pure 44 346 OF THE ASTHMA. 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 remov- ed so far as not to be affected by the smoke. Some asthmatic patients, indeed, breathe easier in town than in the country ; but this is seldom the case, especially in towns where much coal is burnt. Asthmatic persons, who are obliged to be in town all day, ought at least to sleep out of it. Even this will often prove of great service. Those who can afford it ought to travel into a warmer climate. Many asthmatic persons, who cannot live in Britain, enjoy very good health in the south of France, Portugal, Spain, or Italy. Exercise is likewise of very great importance in the asthma, as it promotes the digestion, and greatly assists in the prepara- tion of the blood. 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. In the paroxysm or fit, the body is generally bound. A purg- ing clyster, with a solution of assafetida, 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 fomenta- tions, 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 teaspoonful of the tincture of castor and saffron, mixed together in a cup of valerian tea, twice or thrice a day. Sometimes a vomit has a very good effect. 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 am- moniac, and surh 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 OF THE ASTHMA. 347 four or five pills, made of equal parts of assafetida and gum am- moniac, at bed time.* For the convulsive or nervous asthma, antispasmodics and bracers are the most proper medicines. The patient may take a teaspoonful of the paregoric elixir twice a day. The Perur vian bark is sometimes found to be of use in this case. It may be taken in substance, or infused in wine. In short, everything 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, ob- serve, that not only in the asthma, but in most chronic diseases, issues are extremely proper. They are both a safe and effi- cacious remedy ; and though they do not always cure the dis- ease, yet they will often prolong the patient's life. This disease, though so common with us, is little known in mild climates ; and, on this account, it is always adviseable to try the effect of a change of climate, wvhich has generally been attended with great benefit. 1 have already intimated what little confidence I had in the power of any medicine to perform a radical cure of the asthma; but there are many things that will give the patient ease, and, of course, tend to prolong his life. Much also may be done by regimen, when drugs are of little service ; and 1 would therefore advise asthmatic patients to procure and keep by them rules for their management both in and out of the fit, adapted to their particular cases. By a proper attention to such rules, a man may live many years, and enjoy tolerably good health. I had a patient some time ago, who was often carried home to his wife in an apparently dying state. She felt little alarm, well knowing what was necessary to be done; and she always brought him about. This good woman did no more than may be done by any woman of common sense, if the doctor will deign to instruct her. General rules will not do. They must, as before observed, be suited to the patient's case and consti- tution. For want of some such instructions, which a physician * After copious evacuations, large doses of ether have been found very ef. jlcacious in removing a fit of the asthma. I have likewise known the follow- ing mixture produce very happy effects : To four or five ounces of the solu- tion or milk 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 tablespoonfuls may be taken every three hours. 348 OF THE APOPLEXY. should take the earliest opportunity to give, a patient may suffer severely, before the doctor can be sent for, or any other medical advice or assistance procured.* :--------------------------------------------------------------------!-------------■-----------1------1 CHAP. XLII. OF THE APOPLEXY. THE apoplexy is a sudden loss of sense and motion, during which 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 com- pression of the brain, occasioned by an excess of blood, or a collection of watery humors. The former is called a sanguine^ and the latter a serous apoplexy. It may be occasioned by anything that increases the circulation towards the brain, or prevents the return of the blood from the head ; as intense study ; violent passions ;t viewing objects for a long time ob- * Asthma is a disease more immediately alarming in appearance, than dan- gerous in reality. It is well to be aware, that there is hardly an instance known of a person dying during the asthmatic paroxysm. The duration of life seems even rarely to be shortened by this complaint. The celebrated Dr. Floyer, who wrote on asthma, though he labored under this disease during his whole life, died upwards of eighty years of age. He was of opinion, that he shortened and lightened his fits by drinking some cups of very strong coffee without milk or sugar. I have known more than one asthmatic, who never lay down in bed for a long series of years, and, notwithstanding, during the in- tervals of the fits, enjoyed tolerable health. Much depends on adhering to a dry diet, taking regular exercise, and on abstaining from those things which are known, by individual experience, to disorder the stomach. Considerable bentlit is deriyed, in the nervous asthma, from occasionally taking as much genuine assafetida, made into pills, as is sufficient to keep the body regular. Smoking the herb stramonium shortens the duration of a fit, but does not per- manently cure the disease, nor even diminish the number of paroxysms. A.P.B. t I knew a woman, who, in a violent fit of anger, was seized with a san- guine 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 tn the left ventricle of the brain.. OF THE APOPLEXY. S49 liquely; wearing anything 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 cold bath ; the excessive use of spicenes, or highseasoned 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 nightmare; 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 endeavor to prevent it by bleeding, a slender diet, and opening medicines. In the sanguine apoplexy, if the patient does not die sudden- ly, the countenance appears florid, the face is swelled or puffed up, and the blood vessels, especially about the neck and tem- ples, are turgid ; the pulse beats strong; the eyes are promi- nent and fi?ed, 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 Tn" this species of apoplexy every method must be taken to lessen the force of the circulation towards the head. The pa- tient should he 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 plen- ty of sweet oil or fresh butter, and a spoonful or two of com- mon salt in it, may be administered every two hours; and blis- tering 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 of tartar whey, or common whey with cream of tartar dissolved in it. Or he may take any cooling purge, as Glau- ber's salts, manna dissolved in an infusion of senna, or the like. &50 OF THE APOPLEXY. All kinds of spirit and other strong liquors are to be avoided. Even volatile salts held to the nose do mischief. Vomits, for the same reason, ought not to be given, or anything 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 are here likewise necessary, and the patient may drink strong balm tea. If he be inclined to sweat, it ought to be promoted by drinking small wine whey, or an infusion of carduus benedic- tus. 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 necessa- ry. The patient, is generally relieved as soon as he has dis- charged 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 highseasoned 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 lit- tle blood may be let every spring and fall. Exercise should by no means be neglected ; but it ought to be taken in mode- ration. 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 anything tight about their necks. These last cautions are of far greater importance than such persons may be aware of. The circulation, which is slower during sleep than when awake, is further clogged by a fulness of the stomach. The low posture of the head not only favors, but seems to invite, stagnation ; and tight ligatures round the neck impede the return of the blood from the vessels of the brain, so that an apoplexy not only very naturally, but almost inevitably, follows. Instead of being astonished at the number of those who go to bed in apparent health, and are found dead. OF COSTIVENESS, &c. 351 in the morning, we should consider it as a matter of much more Surprise for a person of a plethoric habit, after unchecked in- dulgence in the pleasures of the table, to go to rest without any regard to the inclination of his head, or the tightness of his collar, and ever to rise again.* CHAP. XLIII. 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 infrequen- cy of stools, which sometimes happens, and which in some par- ticular 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 intes- tines, as in the jaundice; and at other times it proceeds from diseases of the intestines themselves, as a palsy, spasms, torpor, tumors, 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 pe- culiarly hurtful to hypochondriacal and hysteric persons, as it generates wind and other grievous symptoms. Some people, however, can bear costiveness to a great degree. I know per- sons, 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 on a moisten- ing and laxative diet; as roasted or boiled apples, pears, stew- ed 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 bf 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 * Persons inclined to apoplexy derive great benefit from cupping. This operation should never be omitted once or twice a year. A. P. B. ste OF COSTIVENESS, &c. 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 everything that promotes the perspiration; as wearing flannel, lying too long in bed, &c. Intense thought and a se- dentary life are likewise hurtful. All the secretions and ex- cretions 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 spirit, 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. Buttermilk, 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 this purpose is attended with many inconveniences, and often with bad consequences.* 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 sto- mach 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. * The learned Dr. Arbuthnot advises those who are troubled wish costive- ness to use animal oils, as fresh butter, cream, marrow, fat broths, especially those made of the internal parts tff animals, as the liver, heart, midriff, ice. He likewise recommends the expressed oils of mild vegetables, as olives, al- monds, pistachios, and the fruits themselves; all oily and mild fruits, as figs ; decoctions of mealy vegetables; these lubricate the intestines; some sapona- ceous substances which stimulate gently, as honey, hydromel, or boiled honey and water, unrefined sugar, &c. Tlie 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 Jax. He likewise observes, that all watery substauces are lenitive, and that even common water, whey, sour milk, and buttermilk, have this effect; that new milk, especially asses' milk, stimulates still more when it sours on the stomach ; and that whey turned sour will purge strongly. WANT OF APPETITE. 3o3 WANT OF APPETITE. Tins 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 anything that palls the appetite, or is hard of digestion; the immoderate use of strong liquors, tea, to- bacco, 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 proceed from errors in diet, or any other part of the patient's regimen, it ought to be changed. If nausea and retchings show that the stomach is loaded with crudities, a vomit will be of service. After this, a gentle purge or two of rhubarb, or 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 sto- mach, and hurt digestion. After proper evacuations, bitter elixirs and tinctures, with aromatics, may be used. Elixir of vitriol is an excellent medicine in most cases of in- digestion, 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 teaspoonfuls of it taken in wine and water, as above. The chalybeate waters, if drank in moderation, are generally of considerable service in this case. The salt water has like- wise 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 repailt 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, he. 45 354 OF THE HEARTBURN. OF THE HEARTBURN. What is commonly called the heartburn is not a disease of this organ, but an uneasy sensation of heat or acrimony about- the pit of the stomach, which is sometimes attended with anxie- ty, nausea, and vomiting. It may proceed from debility of the stomach, indigestion, bile, the abounding of an acid in the stomach, he. 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 heartburn, if they ride soon after dinner, pro- vided 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 heartburn proceeds from a debility of the stomach, or indigestion, the patient ought to take a dose or two of rhu- barb ; afterwards he may use infusions of the Peruvian bark, or any other of the stomachic bitters, in wine or brandy. Drinking a cup of chamomile tea, with fifteen or twenty drops of elixir of vitriol in it, twice or thrice a day, will strengthen the stomach and promote digestion. Exercise in the open air will likewise be of use. When bilious humors occasion the heartburn, a teaspoonful 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 ali- ments, a dram of brandy or rum may be taken with water. If acidity or sourness of the stomach occasions the heartburn, 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 teacupful of it taken as often as is necessary. Such as do not choose chalk, may take a teaspoonful of pre- pared oyster shells, or of tlie powder called crab's eyes, in a glass of cinnamon or peppermint water. But the safest and best absorbent is magnesia. This not only acts as an absorbent, but likewise as a purgative; whereas chalk, and other absorb- ents 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, whenMiere is occasion. These tilings are now OF NERVOUS DISEASES. 355 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 medi- eines are those called carminatives ; as aniseeds, juniper ber- ries, ginger, canella alba, cardamom seeds, he. These may either be chewed, or infused in wine, brandy, or other spirits ; but these ought never to be used, unless they are absolutely necessary, as they are only drams in a dry form, and very per- nicious to the stomach. 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 Eng- lish 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 tablespoonful of it may be taken oc- casionally for a dose. I have frequently known the heartburn cured, particularly in pregnant women, by chewing green tea. Two tablespoonfuls of what is called the milk of gum ammoniac, taken once or twice a day, will sometimes cure the heartburn. As pregnant women are very subject to this uneasy sensation, they should first consider, whether it proceeds from any of tlm causes already explained: in which case the medicines pre- scribed under each head will probably remove it. But if the internal sense of heat be owing to the state of pregnancy itself; if it arises from the consent between the stomach and the womb, and is not accompanied with much spitting or any acid eructations, the white of an egg, mixed with a little sugar and water, will often afford the only relief that can be expected for some time. CHAP. XX.IV. 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 chf- * The heartburn, if very troublesome, maybe almost immediately removed, by taking fifteen or twenty drops of the purified soap lees, the aqua kali purl of the shops, in a cup of linseed tea, or of milk. A. P. U 356 OF NERVOUS DISEASES. ferent persons, or even the same person at different times, Proteus-like, they are continually changing shape : and on 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 ex^ tremely 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.—Everything 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, he. 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 unfavorable posture of the body, he. 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 on the spirits, but prevents the person from taking proper exercise, by which means the digestion is im- paired, the nourishment prevented, the solids relaxed, and the whole mass of humors vitiated. Grief and disappointment like- wise produce the same effects. I have known more nervous patients, who dated the commencement of their disorders from the loss of a husband, a favorite child, or from some disappoint- ment in life, than from any other cause. In a word, whatever weakens the body, or depresses the spirits, may occasion ner- vous disorders; as unwholesome air, want of sleep, great fa- tigue, disagreeable apprehensions, anxiety, vexation, he. Symptoms.—We shall only mention some of the most general symptoms of these disorders, as it would be both a useless and impracticable 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 blackishcolored 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 intention of wind, and great uneasiness. OF NERVOUS DISEASES. 357 The urine is sometimes in small quantity; at other times very copious and quite clear. There is a great tightness 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 hickup, frequent sighing, and a sense of suffoca- tion, 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 nightmare. As the disease increases, the patient is molested with head- aches, 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, he. The patient is apt to entertain wild imagina- tions, 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 labor 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 reso- lution to persist in any one course till it has time to produce its proper effects. They are likewise apt to imagine that they labor 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; and heavy sup- pers are to be avoided. If they feel themselves weak and faint between meals, they ought to eat a bit of bread, and drink a glass of wine. 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 358 OF NERVOUS DISEASES. water will answer better. Everything that is windy or hard ofi digestion must be avoided. All weak and warm liquors are hurtful; as tea, coffee, punch, he. People may find a tempo- rary 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 suffi- cient resolution, we would by all means recommend this course." Even change of place, and the sight of new objects, by divert- ing 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 bowTels are weak, the body ought to be well guarded against cold, es- pecially 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 other- wise be subject on 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 circula- tion, perspiration, he. Persons who have weak nerves ought to rise early, and take exercise before breakfast, as lying too long in bed cannot fail to relax the solids. They ought like- wise to be diverted, and to be kept as easy and cheerful as pos- sible. There is not anything 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. piedicines. OF NERVOUS DISEASES. 35t» 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, how- ever, to be avoided ; as aloes, jalap, he. 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 the digestion is bad, of the stomach relaxed and weak, the following infusion of Peru- vian 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 rum, for the space of five or six days. A tablespoonful of tlie 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 suffi- cient, 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 im- proper. 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 should 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 regi- * Few days have passed for a considerable time, that I have not had occa- sion to recommend the following tincture to some of my nervous patients, and I have seldom been disappointed with regard to its effects:—Take of compound tincture of the bark and volatile tincture of valerian, each, an ounce ; mix them ; take a teaspoonful in a glass of wine or water three or, four times a day. 360 OF MELANCHOLY. men alone. We shall therefore omit mentioning more medi- cines, 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 ; in- tense thinking, especially where the mind is long occupied about one object; violent passions or affections of the mind, as love, fear, joy, grief, pride, and such like. It may also be occasioned by excessive venery; narcotic or stupefactive poi- sons ; 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 diges- tion, or which cannot be easily assimilated ; from a callous state of the integuments of the brain, or a dryness of the brain it- self. To all which we may add gloomy and mistaken notions of religion. Symptoms.—When persons begin to be melancholy, they are dull; dejected; timorous; watchful; fond of solitude; fretful; fickle ; captious and inquisitive ; solicitous about trifles ; some- times niggardly, and at other times prodigal. The body is gene- rally bound; the urine thin, and in small quantity; the sto- mach and bowels inflated with wind ; the complexion pale; the pulse slow and weak. The functions of the mind are also greatly perverted, insomuch that the patient often imagines him- self dead, or changed into some other animal. Some have im- agined their bodies were made of glass, or other brittle sub- stances, 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 any 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 erup- tions, the bleeding piles, or the menses, sometimes carry off this disease. OF MELANCHOLY. $61 Regimen.—The diet should consist chiefly of vegetables of a cooling and opening quality. Animal food, especially salted or smokedried fish or flesh, ought to be avoided. All kinds of shellfish are bad. Aliments prepared with onions, garlic, or anything that generates thick blood, are likewise improper. All kinds of fruits that are wholesome may be eaten with ad- vantage. Boerhaave gives an instance of a patient, who, by a long use of whey, water, and garden fruit, recovered, after hav- ing evacuated a great quantity of blackcolored 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, pennyroyal, the roots of wild va- lerian, or the flowers of the lime tree, may be drank freely, either by themselves, or sweetened with honey, as the" patient shall choose. The patient ought to take as much exercise in the open air as he can bear. This helps to dissolve the viscid humors, re- moves obstructions, promotes the perspiration, and all the other secretions. Every kind of madness is attended with diminished perspiration ; all means ought, therefore, to be used to promote this 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 a still better effect, if he were obliged to labor a piece of ground. By digging, hoe- ing, 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 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 a 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 aver- sions against particular persons; and the very sight of such 362 OF MELANCHOLY. persons is sufficient to distract their minds, and throw them in- to the utmost perturbation. In all kinds of madness, it is beU ter to soothe and calm the mind, than to ruffle it by contradic- tion. When the patient has much febrile, or mental excitement, evacuations are necessary. In this case he must be bled, and have his body kept open by purging medicines, as manna, rhu- barb, 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 several 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 vine- gar. Haifa drachm of purified nitre may be given three or lour 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. Camphor and musk have likewise been used in this case with advantage. Ten or twelve grains of camphor may be rubbed in a mortar with half a drachm ot' nitre, and taken twice a day, or oftener, if the stomach will bear it. If it will not sit on the stomach in this form, it may be made into pills with gum assa- fetida 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. The anti- monial wine is by some extolled for the cure of madness. It may be taken in a dose of forty or fifty drops, twice or thrice a day, in a cup of tea. We do not mean that all these medicines should be administered at once; but whichever of them is giv- en 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 or cold bathing. Issues may be made in any p.irt of the body, but they generally have the best effect near liie spine. The discharge from these may be greatly promot- ed by dressing them with the mild blistering ointment, and keeping them open by putting into them one or more peas, or pepper corns, or a piece of orris root. The most proper OF THE PALSY. 363 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. Madness or delirium, which proceeds from mere weakness, requires a different treatment. This must be removed by nourishing diet, exercise proportioned to the patient's strength, and cordial medicines. All evacuations are carefully to be avoided. The patient may take frequently a glass of good wine, in which a little Peruvian bark has been infused. 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 affect- ed. 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 aflfected, the case is bad, as it shows 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 anything that prevents the regular exertion of the nervous power on 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 on the brain or nerves ; very cold or damp air; the suppression of customary evacua- tions; sudden fear; want of exercise; or whatever greatly relaxes the system, as drinking much tea,* or cofl'ee. The palsy may likewise proceed from wounds of the nerves them- selves, from the poisonous fumes of metals or minerals, as mercury, lead, arsenic, &c. In young persons of a full habit, palsy must be treated in the same manner as the sanguine apoplexy. The patient must be bled, blistered, and have'his body opened by active clysters * Many people imagine, that tea has no tendency to hurt the nerve?, 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 twentyfour hours. That tea affects the nerves, is likewise evident from its preventing sleep, oc- casioning giddiness, dimness of the sight, sickness, &c. 364 OF THE EPILEPSY. 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, horseradish, &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, es- pecially on the parts affected. Blistering plasters may like- wise 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 anything that makes the patient sneeze, is likewise of use. Some pre- tend to have found great benefit from rubbing the parts affect- ed with nettles; but this does not seem to be any way prefera- ble to blistering. If the tongue be 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 spirit 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 pow- der may be given in a glass of wine three or four times a day. If the patient cannot use the valerian, he may take of sal volatile oleosum, compound spirit 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 medi- cine. The patient ought likewise to chew cinnamon, 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 iplo a wanner climate. OF THE EPILEPSY, OR FALLING SICKNESS. The epilepsy is a^udden deprivation of all the senses, where- in the patient falls suddenly down, and is affected with violent convulsive motions. Children, especially those who are deli- cately brought up, are most subject to it, It more frequently OF THE EPILEPSY. 365 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 unfavorable 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 fluid, in the brain ; a polypus; tumors 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 smallpox, measles, &c. Symptoms.—An epileptic fit is generally preceded by unusual weariness ; pain of the head ; dulness ; giddiness ; noise in the ears; dimness of the 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 his hands; his eyes are distorted ; he starts, and foams at the mouth ; his extremi- ties are bent or twisted various ways; he often discharges his seed, urine, and feces 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 and fasci- nation. It depends, however, as much on natural causes as any other malady; and its cure may often be affected by per- sisting 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, 36G OF THE EPILEPSY. waterfowl, and likewise all windy and oily vegetables, as cab- bage, 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 dange- rous situations, as standing on precipices, riding, deep waters, and such like. £. Medicine.—The intentions oPcure must vary according to the cause of the disease. If the patient be of a sanguine tem- perament, 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 habitual evacua- tions, these, if possible, must be restored; if this cannot be done, others majr 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 ver- min. When the disease proceeds from teething, the gums should he properly divided, 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 between the shoulders. The same method is to be followed, when epileptic fits precede the eruption of the smallpox, 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.* The flowers of zinc have of late been highly extolled for the cure of 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 live limes a day, and gradual- ly to increase the dose as far as the patient can bear it. I have often known this medicine, when duly persisted in, prove bene- ficial. Musk has sometimes been found to succeed in the epilepsy. Ten or twelve grains of it, with the same quantity of factitious * See Appendix, Electuary for the Epilepsy, OF ST. VITUS'S DANCE. S67 cinnabar, may be made up into a bolus, and taken every night and morning. Convulsion fits proceed from the same causes, and must be treated in the same manner, as the epilepsy. OF ST. VITUS'S DANCE. ' The disease termed Chorea, or St. Vitus's Dance, generally attacks young people from the eighth year of their age till the time of puberty; though it has been sometimes found to occur at a more advanced period of life. Females are more liable to it than males. The first symptom of this disease is gene- rally a slight lameness of one leg, which the patient drags a little, and seems to have lost the power of duly regulating its action. The arms next become affected, and are thrown into various contortions, which deprive persons affected with this disease of the power of feeding themselves; and their awkward gesticulations, in attempting to bring articles of food towards the mouth, appear ridiculous. One side of the body is in general more affected than the other. The tongue partici- pates of the general disease of the system, so as to render ar- ticulation nearly unintelligible. If the disease continues long, it materially injures the constitution, sleep becomes disturbed, or is in a great measure prevented, the mental faculties are impair- ed, and revert to childishness; pain is often felt in the stomach, the appetite for food is extremely irregular, being occasionally ravenous, the countenance appears pale and languid, and the body and limbs are much emaciated. The feebleness and debility caused by this disease seem to have influenced the routine of practice hitherto pursued in the treatment of it. The remedies generally recommended are, ac- cordingly, of the tonic class, such as Peruvian bark, steel, bitters, preparations of zinc and copper, cold bathing, and electricity. Notwithstanding the administration of these remedies, chorea has generally proved a tedious and untractable disease, continu- ing to harass the patient for months, and even years, not unfre- quently occasioning permanent injury to the faculties of the mind as well as the powers of the body. Dn. James Hamilton of Edinburgh, in his late valuable pub- lication on " The utility and administration of purgative medi- cines," has promulgated so just a view of the nature and origin of the complaint now under consideration, accompanied with a mode of cure so judicious and successful, that it becomes a duty 368 OF ST. VITUS'S DANCE. to diffuse a knowledge of his opinions and practice as extensive* ly as possible. Respecting the plan of treating this disease, which has hitherto prevailed, the doctor observes, " It is melancholy to reflect, that months and years, the most valuable in respect of after life, should glide on, while an effectual check is given to the im- provement of the mind, the cultivation of useful learning, or the acquisition of necessary arts; with the hazard of permanent fatuity, to a certain extent, or of a grotesque appearance, from the unconquerable remains of irregular motions being imposed on the young sufferers for life. To these certain consequences of protracted chorea, I will add, the danger that attends it. I have no doubt, but that it must have, on some occasions, proved fatal." The remedies, which this enlightened practitioner has found eminently successful in the cure of this disease, consist of active purgatives. From three to five grains of calomel, combined with ten or fifteen of jalap, or a sufficient quantity of the aloetic pill, occasionally interposing a proper dose of the tartarized in- fusion of senna, are so administered as to produce full purging daily, which is to be kept up till the progress of the disease is found to be arrested. The emaciation and apparent debility of tlie subjects of this disease, and the unfounded alarms of their friends, lest these symptoms should be increased by evacuations, are apt to shake the resolution of the practitioner, and prevent him from follow- ing out this practice to a due extent. But the diminution of the involuntary motions, the general appearance of returning health visible in the countenance, and the regularity of the ap- petite for food, are the circumstances that should regulate his conduct; and their presence ought to encourage him to proceed, notwithstanding the weakness of the patient. The quantity of feces discharged during the administration of these medicines is sometimes so enormous as to exceed belief; and this circum- stance affords grounds to suppose, either that their retention, or the torpor and inactivity of the bowels, is a chief source of this complaint. The evacuations from the bowTels ought to be daily and attentively inspected, and the return of their natural ap- pearance and quantity will be found to indicate and keep pace with the renovation of health. Dr. H. adds, " Since 1 have employed purgatives in chorea, I have been disappointed in effecting a cure in one case only." To this statement 1 can add my testimony of the complete success of this mode of treatment in three instances in which I have made trial of it-. OF THE HICKUP. S69 When the complaint is subdued, the complete restoration of health and vigor is best effected by the use of a light and nutri- tious diet, with a moderate quantity of wine, due exercise in the open air, and bathing in the sea, if convenient. A powder, com- posed of f^ve grains of the rust of iron, together with ten of rhu- barb, and an equal quantity of fine sugar, may also be taken every morning for some weeks with advantage.' A. P. B. OF THE HICKUP. The hickup 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 in the stomach; poisons; wind ; inflammations or scirrhous tumors of the stomach, intestines, bladder, midriff, or the rest of the viscera. In gangrenes, acute and malignant fevers, a hickup is often the forerunner of death. When the hickup 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 poi- son be the cause, plenty of milk and oil must be drank, as has been formerly recommended. When it proceeds from an in- flammation of the stomach, he. 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 spirit 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 hickup 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 humor, a gentle vomit and purge, if the patient be able to bear them, will be of service. If it arises from flatulen- cies, the carminative medicines directed for the heartburn must be used. When the hickup 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 spirit of lavender, or the 47 370 CRAMP OF THE STOMACH. volatile aromatic tincture, may be taken frequently. External applications are sometimes also beneficial; as the stomach plas- ter, 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 hickup for above nine weeks. It was frequently stopped by the use of musk, opium, wine, and other cordial and antispasmodic medi- cines, but always returned. Nothing, however, gave the patient so much ease as brisk small beer. By drinking freely of this, the hickup was often kept off for several days, which was more than could be done by the most powerful medicines. The pa- tient was at length seized with a vomiting of blood, which soon put an end to his life. On opening the body, a large scirrhous tumor was found near the pylorus, or right orifice of the stomach. The hickup may be removed by taking vinegar; or by 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 per- sons in the decline of life, especially the nervous, gouty, hysteri- cal and hypochondriacal. If the patient has any inclination to vomit, he ought to take some draughts of warm water, or weak chamomile tea, to cleanse his stomach. After this, if he has been costive, a laxa- tive 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 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 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 * I have frequently seen a very troublesome hickup put a stop to by swal- lowing quickly a glass of the strong soda water in a state of brisk efferve?- cense. The common hickup may in general be removed by taking a pinch of suuff, or anythiug that will cause sneezing. A. P. B. OF THE NIGHTMARE. 371 bladders filled with warm milk and water should be constantly applied to it. 1 have often seen these produce the most happy effects. The anodyne balsam may also be rubbed on the part affected ; and an antihysteric plaster worn on 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, re- course must be had to some spirit, or some of the warm cordial waters. Blistering plasters ought likewise in this case to be applied to the ankles. I have often seen violent tramps and pains of the stomach removed by covering it with a large plaster of treacle of the London Dispensatory. OF THE NIGHTMARE. In this disease the patient, in time of sleep, imagines he feels an uncommon oppression of weight about his breast or stomach, which he can by no means shake off. lie groans, and some- times cries out, though oftener 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 can- not. 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, he. But it is rather a nervous affection, and arises chiefly from indiges- tion. Hence we find that persons of weak nerves, who lead a sedentary life, and live full, are most commonly afflicted with the nightmare. 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 dis- ease ; for which reason those who are afflicted with it ought to avoid all flatulent food. Deep thought, anxiety, or anything that oppresses the mind, ought also to be avoided. The nightmare is frequently occasioned by eating a full meal of animal food, and drinking freely of fermented liquor, after long fasting, and bodily fatigue, by which the whole system is debilitated, and the digestive faculties consequently impaired, 373 OF SWOONINGS. When in this state, the safest thing a person can take is tea, with bread and butter, which will be found to alleviate fatigue much more completely than wine. As persons afflicted with the nightmare 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. Whyte says, he generally found a dram of brandy, taken at bed time, prevent this dis- ease.* This, however, is a bad custom, and in time loses its effect. We would rather have the patient depend on 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 diges- tion 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 nightmare, ought to lake 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 dange- rous, when duly attended to; but w hen wholly neglected, or im- properly 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, on coming into the house, especially if they drink hot liquor, or sit near a large fire. This might easily be prevented by people's 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 anything hot, till the body has been gradually brought into a warm temperature. When any one, in consequence of neglecting these precau- * Brandy, or any other spirit, with hot water, is much better, as a stimu- lant, than the spirit alone. C. OF SWOONINGS. 373 tions, 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 com- plaint, it may 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 prin- ciple of life. Hence it is that fainting fits are so frequent in all crowded assemblies, especially in hot seasons. Such fits, how- ever, 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 ventilat- ed ; and let the weak and delicate avoid such places, particu- larly 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 spirit or 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 assafetida should be applied to the nose. When fainting fits proceed from mere weakness or exhaus- tion, 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, and such like. 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 on his back, with his head low, and should have fresh air ad- mitted into his chamber. His food should consist of nourish- ing broths, s3go 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 spirit 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 374 OF FLATULENCIES, OR WIND. 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 cleanse the bowels by throwing in an emollient clyster. It is common in fainting fits, from whatever cause they pro- ceed, 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 vola- tile salts, Hungary water, spirit of lavender, tincture of castor, and the like; keeping them in a horizontal position, OF FLATULENCIES, OR WIND. All nervous patients, without exception, are afflicted with wind and flatulencies in the stomach and bowels, which arise chiefly from the want of tone or vigor 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 quanti- ty 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.* The list of medicines for expelling wind is very numerous. They often, however, disappoint the expectations both of 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 assafetida and opium; the warm waters, tinctures, and spirits, as the aromatic water, the tincture of woodsoot, the volatile aromatic spirit, ether, &,c. * Many nervous people find great benefit from eating a dry biscuit, espe- cially when the stomach is empty. 1 look on this as one of the best carmina- tive medicines; and would recommend it in all complaints of the stomach, arising from flatulence, indigestion, want of food, &c. OF FLATULENCIES, OR WIND. 375 Dr. Whyte says, he found no medicine more efficacious in expelling wind than ether and laudanum. He generally gave the laudanum in a mixture with peppermint water and tincture of castor, or sweet spirit of nitre. Sometimes, in place of this, he gave opium in pills with assafetida. He observes, that the good effects of opiates are equally conspicuous, whether the flatulence be contained in the stomach or intes- tines ; whereas those warm medicines, commonly called car- minatives, do not often give immediate relief, except when the wind is in the stomach. WTith regard to ether, the doctor says, he has often seen very good effects from it in flatulent complaints, where other medicines failed. The dose is a teaspoonful, mixed with two tablespoonfuls of water.* In gouty cases, he observes, that ether, 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 im- proper to give them warm medicines inwardly,. the doctor recommends external applications, which are sometimes of ad- vantage. Equal parts of the antihysleric and stomach plaster may be spread on 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 tablespoonful well rubbed on the parts at bed time. For strengthening the stomach and bowels, and conse- quently for lessening the production of flatulence, the doctor recommends the Peruvian bark, bitters, chalybeates, and ex- ercise. 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 bet- ter than four or five of the following pills taken every night at bed time:— Take of assafetida two drachms; succotrine aloes, salt of * Though the patient may begin with this quantity, it will be necessary to increase the dose gradually as the stomach can bear it. Ether is now given in considerably greater doses than it was in Dr. Whyte's time. 376 OF LOW SPIRITS. 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 re- lief than any other remedy. With regard to diet, the doctor observes, that tea, and like- wise 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. Whyte has paid great attention to this subject, and as his sentiments on 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 medicines, both for preventing the production, and like- wise for expelling of flatulencies. These effects, however, are not to be expected from sauntering about, or lolling in a carriage; but from labor, 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 aro- matics, 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 intes- tines, or obstruction in the hypochondriacal viscera, aloetic purges will be proper. I have sometimes known the Harrow- gate or Tunbridge water of service in this case. When low spirits proceed from a suppression of the menstru- al, or of the hemorrhoidal flux, these evacuations may either be restored, or some other substituted in their place, as issues, setons, or the like. Dr. Whyte observes, that nothing has such sudden good effects in this case as blee'ding. \ OF HYSTERICAL AFFECTIONS. 377 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 trayel- ling 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 mode- rate use of wine and other strong liquors is by no means hurt- ful ; but, wrhen taken to excess, they weaken the stomach, vitiate the humors, 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 HYSTERICAL AFFECTIONS. * These likewise belong to the numerous tribe of nervous dis- eases, 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 hysterical complaints. In such persons, an hys- terical fit, as it is called, may be brought on by an irritation of the nerves of the stomach or intestines, by wind, acrid humor, or the like. A sudden suppression of the menses often gives rise to hysterical fits. They may likewise be excited by violent passions or affections of the mind, as fear, grief, anger, or great disappointments. Sometimes the hysterical fit resembles a swoon or fainting fit, during which the patient lies as in a sleep; only the breathing is so low as scarcely to be perceived. At other times, the pa- tient is affected with catchings and strong convulsions. The symptoms which precede hysterical 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 throat, 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 hysterical paroxysm is often introduc- * And not unfrequently of the patient, as they are often brought on by a blameable neglect of the means of health. - C. 48 * • 378 OF HYSTERICAL AFFECTIONS. ed 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 hysterical lady. Our aim in the treatment of this disease must be to shorten the lit or paroxysm when present, and to prevent its return. The longer the fits continue, and the more frequently they re- turn, 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 hysterical 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 spirit 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 assafetida, will be pro- per; and, as soon as the patient can swallow, tvvo tablespoon- fuls of a solution of assafetida, or of some cordial julep, may be given frequently.* 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 oft'all at once, but by degrees. The most proper drink is water with a small quantity of spirit. A cool, dry air is the best. Cold bathing, and everything that braces the nerves, and invigorates the sys- tem, is beneficial; but lying too long in bed, or whatever re- laxes 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 in- teresting pursuit. * When hysterical 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 hysterical fits, should not be sent to boarding schools, as the disease may be caught by imitation. 1 have known madness itself brought on by sympathy. * OF HYSTERICAL AFFECTIONS. 379 The proper medicines are those which strengthen the ali- mentary canal and the whole nervous system, as the prepara- tions 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 is a ten- dency 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 medi- cines 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 clys- ters. It is often successful in removing those periodical head- aches, to which hysterical and hypochondriacal patients are sub- ject. Castor has in some cases been found to procure sleep where opium failed ; for which reason Dr. Whyte advises, that they should be joined together. He likewise recommends the antihysteric plaster to be applied to the abdomen* Hysterical 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, camphor, 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 dis- tention of the intestines, or from spasms beginning in them, they may be often lessened or cured by making a pretty strong com- pression upon the abdomen by means of a broad belt. When * Though antispasmodics and anodynes are universally recommended in this disease, yet all the extraordinary cures that I ever knew in hysterical cases, were performed by means qf tonic and corroborating medicines. # 380 OF HYPOCHONDRIACAL AFFECTIONS. spasms or convulsive motions arise from sharp humors in the stomach or intestines, no lasting relief can be procured till these are either corrected or expelled. The Peruvian bark has some- times cured periodical convulsions, after other medicines had failed. OF HYPOCHONDRIACAL AFFECTIONS. This disease generally attacks the indolent, the luxurious, the unfortunate, and the studious. It becomes daily more com- mon in this country, owine, 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, ex- cess of venery, the repulsion of cutaneous eruptions, long con- tinued evacuations, obstructions in some of the viscera, as the liver, spleen, he. Hypochondriacal persons ought never to fast long, and their food should be solid and nourishing. All acescent and windy vegetables are to be avoided. Fleshmeats 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 in- tentions will be best answered by the different preparations of iron and the Peruvian bark, which, after proper evacuations,.. • OF HYPOCHONDRIACAL AFFECTIONS. 381 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 assafetida, with as much of the elixir pro- prietatis 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 assafetida may substitute Spanish soap in its place. Though a cheerful glass may have good effects in this dis- ease, yet all manner of excess is hurtful. Intense study, and everything that depresses the spirits, are likewise pernicious. Though the general symptoms and treatment of nervous dis- orders were pointed out in the beginning of this chapter, yet, for the benefit of the unhappy persons afflicted with these obsti- nate 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 par- ticular 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 disor- ders. In all persons afflicted,with nervous disorders, there is a great delicacy and sensibility of the whole 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 miti- gated by proper care. When induced by diseases, as long or repeated fevers, profuse hemorrhages, 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, he. Ex- cessive grief, intense study, improper diet, and neglect of exer- cise, 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 a uni- versal relaxation and debility of the wmole system. Instances of this are daily to be seen. The loss of a near relation,, or any ■t S82 OF HYPOCHONDRIACAL AFFECTIONS. other misfortune in life, is often sufficient to occasion the most complicated series of nervous symptoms. Such misfortunes, in- deed, are not to be avoided, but surely their effects, by a vigo- rous 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 occa- sioned by grief. It preys on 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.* 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 the digestion, and vitiate the humors. 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 humors. On the other hand, when the food is not sufficiently nourishing, or is taken too seldom, the bowels are inflated with wind, and the humor?, 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 de- bility of the nervous system, with all its dreadful train of conse- quences. But the most general cause of nervous disorders is indolence. The active and laborious are seldom troubled with diem. They are reserved for the children of ease and affluence, who gene- rally 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 labor 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 un- favorable posture, really deserve our pity. We have in a former part of the book endeavored to lay down rules for their conduct; and shall only add, that, where these cannot be com- plied with, their place may, in some measure, be supplied by * Armstrong on Health. OF HYPOCHONDRIACAL AFFECTIONS. 383 the use of bracing and strengthening medicines ; as the Peruvian' bark, with other bitters, the preparation of steel, the elixir of vitriol, and such like. Among many remarkable cases of the nervous kind, which I have often met with, one very lately attracted my notice in a peculiar manner. It was written by the patient himself, a gen- tleman of fortune and of liberal education ; and it might bo justly called a picture from nature, drawn with uncommon sen- sibility and force. The whole account being too long for inser- tion, the following extract may serve as a specimen of the wri- ter's sufferings and descriptive talents. " It is in vain," he says, " that I attempt to impress the faculty with the real state of my sufferings. The symptoms of the disorders are not to be de- scribed, from their unusual pressure on the mind; nor can they be conceived, I believe, by any but those who have suffered under them. They may be said to constitute a phenomenon in the science of diseases. Since I know of no terms to express them in, or language to describe them by, I am obliged to con- tent myself with denominating the disorder and its effects to- gether a menial agony, whose influence creates a real tedium vita. It attacks me sometimes when sitting, sometimes when walking ; and if I were not to throw myself on a bed during the violence of the paroxysm, I should certainly dash myself to pieces. This is accompanied with a lassitude, restlessness, and total incapacity of attending to any concerns in life." The same spirit animated every part of the affecting descrip- tion ; and the case was accompanied with a list of eleven emi- nent physicians, whom the patient had consulted at different times, but whose names I suppress, as their prescriptions did him no good, and did them no honor. When the primary seat of the disease is in the mind, it is stooping to the low tricks of quackery to amuse a patient with false hopes of the efficacy ot any medicine. The disappointment that follows aggravates every painful symptom, and makes the unhappy sufferer look forward to death as the only resource. All 1 prescribe for him is travelling. I should also have willingly inserted here an account of some other nervous affections of an extraordinary nature, had not their length exceeded the limits I prescribed to myself in these supplementary observations. 1 For this very prevalent and distressing class of complaints, there is not any remedy so much to be relied on as the habit of early rising, which necessarily implies that of retiring also at an 384 OF HYPOCHONDRIACAL AFFECTIONS. early hour to rest. The energies of the nervous system be- come exhausted and worn out, by the impressions of external objects on the senses, as well as by the mental exertions, which are perpetually going on while we are awake. Sleep is the means appointed by nature for the renovation of these wasted energies. On waking from a state of sound sleep, we find our- selves, in the proper sense of the word, refreshed. Such re- freshment, however, is chiefly to be expected from that sleep which takes place before midnight. After a certain hour of the evening, even the most healthy persons experience an increased quickness of the pulse. In feeble constitutions, this nocturnal access of fever is still more strongly marked ; and the repetition of it is the true cause of that worn, haggard appearance, by which the votaries, or rather the victims, of fashion may, in general, be distinguished. It is by no means adviseable to cur- ta 1 the natural time of sleep. The great Lord Mansfield, him- self an early riser, and whose long protracted life gives import- ance to his opinion on any subject connected writh the preserva- tion of health, used to counsel his friends, as one of the best means of attaining this blessing " to cultivate sleep." But it must be the sound repose of temperance, wdiich can only be found during the early hours of night, not the perturbed slum- bers of the noonday couch. Nothing, indeed, tends more to de- bilitate the constitution, and, in a special manner, to aggravate every species of nervous complaint, than remaining in bed till a late hour of the morning. Could " the still small voice of reason" expect to be heard in opposition to the imperious mandates of fashion, the present custom of taking the principal meal at so very late an hour of the day, might also be denounced as contributing not a little to produce diseases of the nerves. After the system has been ex- hausted by long fasting, the stomach is suddenly replenished with a quantity of rich food and stimulating liquors, which the empty vessels absorb with an eagerness far beyond their powers to assimilate. Of this, the immediate consequence is drowsi- ness; but, if the flagging spirits be roused by the presence of company, or the free use of wine, the circulation is hurried ; the countenance becomes flushed, and a temporary exhilaration takes place, which must inevitably be compensated by an equi- valent depression during some other period of the natural day. Sleep is disturbed and interrupted, in consequence of the blood vessels of the brain being irritated by the sudden influx of fresh chyle, by which they are distended ; and rendered, more par- ticularly in the supine posture, liable to rupture. May we not OF THE EYE. S85 venture, without being accused of entering too far into theoreti- cal speculations, to attribute, in part at least, to these causes, the augmented frequency of apoplexy, and its melancholy se- quel, palsy,? the palpable increase of which complaints in this country, of late years, is a subject of serious alarm.' A. P. B. CHAP. XLV. DISORDER 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 dis- eases to which these organs are most liable, and to show 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 super- ficial 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 to- tally lost, many things might be done, which are generally neglected, to render the unhappy person both more useful to himself and to society.* v * 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; ar- rived at the highest pitch of learning, without having the least idea of sight. 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 phi- losopher, was master of all the learned languages, and a very considerable adept in the liberal arts. 49 386 OF THE EYE. The eyes are hurt by viewing bright or luminous objects; keeping the head too long in a hanging posture; violent head- aches; excessive venery ; the long use of bitters; the effluvia from acrid or volatile substances; various diseases, as the smallpox, measles, &c.; but, above all, from night watching, and candlelight 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 evacua- tions ; 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 in- flammation, the cold regimen ought to be observed. The pa- tient must abstain from all spirituous liquors. The smoke of tobacco, smoky rooms, the vapors of onions and garlic, and all vivid lights and glaring colors, 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 bjeed or purge every spring and fall. All excess and night studies are to be avoided. Such as do not choose a seton or an issue, will reap 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 ad- mit of a cure ; but when it proceeds from a compression of the nerves, by redundant blood, this 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. 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 sali- vation ; 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- OF THE EYE. 587 spoonful of it taken twice a day, drinking half a pint of the de- coction of sarsaparilla after it. A cataract is an obstruction of the pupil, by the interposi- tion of some opaque substance, which either diminishes or totally extinguishes the sight. It is generally an opacity of the crystalline humor. In a recent or beginning cataract, the same medicines are to be used as in the gutla serena ; and they will sometimes succeed. But when this does not happen, and the cataract becomes firm, it must be couched, or rather ex- tracted. I have resolved a recent cataract by giving the pa- tient frequent purges with calomel, keeping a poultice of fresh hemlock constantly upon the eye, and a perpetual blister on the neck.* The myopia, or shortsightedness, 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 con- vex glass. A strabismus, or squinting, depends on an irregular contrac- tion 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 like- wise 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 in- flammation, and often appear after the smallpox, 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 dis- cutients; 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 bloodshot 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 color. This disorder generally goes off without medi- cine. Should it prove obstinate, the patient may be bled, and have his eyes fomented with a decoction of comfrey roots and * In both these cases electricity merits a trial. 388 OF THE EAR, 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 this 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, &x. When this disease proceeds from an obstruction of the lach-r rymal 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 anything 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. Deaf- ness 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.t * A weeping or watery eye is often the mark of a scrofulous habit. t Though those who have the misfortune to be born deaf are generally suf- fered to continue dumb, and consequently are in a great measure lost to so- ciety, 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 de- monstration, but is actually reduced lo 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 tlie same age, who enjoy all their faculties. They not only read and write with the utmost readiness, but likewise speak, and are capa- ble of holding conversation with any person in the light. What a pity any of the human species should remain in a state of idiotisni, 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. Uraidwood, whose success has far exceeded all former at- tempts this way ; and, indeed, it exceeds imagination itself so far, that no per- son, who has not seen and examined his pupils, can believe what they are ca- pable of.—As this gcn1k-u.au, however willing, is only able to teach a few, OF THE EAR. 389 When deafness is the effect of wounds or ulcers of the ear, or of old age, it is not easily removed. When it proceeds from cold of the head, the patient must he careful to keep his head warm, especially ih 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 re- covers. 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 proceed 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 opodeldoc, or tinc- ture of assafetida, may be mixed together, and a few drops of it put into the ear every night at bed time, stopping them af- terwards with a little wool or cotton. Some, instead of oil, put a 6mall 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 cotton. But these and other applica- tions must be varied according to the cause of the disorder. Though such applications may sometimes be of service, yet they much oftener 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.* 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 public utility, to erect an academy for their benefit. * A new operation for removing deafness has lately been proposed by Mr. Astley Cooper, surgeon, of London. It consists in perforating the tympanum or drum of the ear. As this operation is neither attended with any degree of pain nor of danger, and is frequently successful, it certainly merits a trial in all cases where it may be judged proper. A, P. B. 390 OF THE TASTE AND SMELL. 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 care- fully 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 gradually affects the other. Luxury is highly injurious to these organs. When the nose and palate are frequency stimulated by fragrant and poignant dishes, they soon loose the power of distinguishing taste 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 suppura- tion of the membrane, which lines the inside of the nose, com- monly 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 fetid matter in these 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 evacua- tions, such things as tend to take off irritation, and coagulate the thin sharp serum, may be applied; as the oil of aniseed mixed with fine flour, camphor dissolved in oil of almonds, &c. The vapors 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 recom- mend snuff made of the leaves of marjoram, mixed with the oil of amber, marjoram and aniseed; or a sternutatory of cal- cined white vitriol ; twelve grains of which may be mixed with two ounces of marjoram water, and filtrated. The steam or vapor of vinegar on hot iron, received up the nostrils, is OF THE TASTE AND SMELL. 391 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 addecj a little of the oil of amber. The taste may be diminished by crusts, filth, mucus, apthae, 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 sensations as if the food which the person takes had really a bad taste ; or it may be entirely destroyed by in- juries 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, &x. 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 meantime, the follow- ing things may be of use :—If there be a bitter taste, it may be taken away by vomits, purges, and other things, which evacuate a bile. What is called a nidorous taste, arising from putrid humors, is corrected by the juice of citrons, oranges, and other acids. A salt taste is cured by a plentiful dilution with watery liquors. An acid taste is destroyed by absorbents, and alka- line salts, as powder of oyster shells, salt of wormwood, &c. When ttie sensibility of the nerves, which supply the organs of taste, is diminished, the chewing of horseradish, or other stimulating substances, will help to recover it. * The most efficacious sternutatory, and which will frequently be found use- ful in obstinate headaches, and in complaints of the eyes, as well as in dryness of the nose, and deficiency of smell, is composed of equal parts of the vit- riolated mercury, fine sugar, and powder of liquorice root. These are to be well mixed together. A pinch of this composition, drawn forcibly up the af- fected nostril, a short time previous to going to bed, generally produces a co- pious discharge of watery mucus during the night, without sneezing. A. P. B. 392 OF THE TOUCH. OF THE TOUCH. The sense of touching may be hurt by anything that ob- structs the nervous influence, or prevents its being regularly conveyed to the organs of touching; as pressure, extreme cold, &c. It may likev\ise be hurt by too great a degree of sensi- bility, when the nerve is not sufficiently covered by the cuticle or scarf>kin, or where there is too great a tension of it, or it is too delicate. W'hatever 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 mode of treatment. In a stupor, or defect of touching, which arises from an ob- sii'ction ot 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 pur- pose the spirit of hartshorn, sal volatile oleosum, horseradish, &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. In a work like this, which is wholly designed for popular in- struction, it would have been a useless display of anatomical skill to mention such disorders of the senses as admit of no remedy, because they are owing to a defect in the organization or structure of the brain, whence the nerves, the fine organs of sensation, take their rise. But it may be proper to make a few remarks on one or two general causes of nervous weakness, and of consequent debility or imperfection of the senses, which proceed wholly from our own misconduct. Nothing so much relaxes the nervous system, so much blunts the acuteness of every sense, and destroys its energy, as intem- perance. To say of a man when drunk, that he, has lost his senses, is literally true in the most comprehensive meaning of the word. He can neither see, hear, ta^e, smell nor feel, with exactness; and though he may flatter himself, that, with the return of sobriety, he recovers his senses also, yet they become more and more impaired by every debauch, till frequent repe- titions of the frantic indulgence consign him to blindness, to deafness, and to the grave. Excess in eating produces similar effects, and, like the touch of the torpedo, benumbs every fa- culty. It particularly vitiates the taste and smell, and thus de- feats the chief purposes for which these senses were given,—to OF A SCIRRHUS AND CANCER* 393 inform us of the wholesome or noxious properties of every- thing we eat and drink. Uncleanliness is also highly injurious to the organ's of sensa- tion. Perhaps the benignity of nature is not displayed in any- thing more strongly than in the warnings she gives of this evil, and in her own endeavors to avert it. She has left us so lit- tle to do, that we deserve no pity ibr the severest punishment of our neglecU See how kindly she has guarded the extremi- ties of the nerves all over the body, the interior parts of the nose, the mouth, the ear, the eye, against external annoyance! Observe with what efforts, entirely independent of our will, she strives to relieve these delicate organs from all impurities ! The uneasiness we feel on such occasions ought to rouse our immediate attention. Shall We suffer dirt to gather on the skin, to dull the sense of feeling, to obstruct the pores, and to drive back into the system the noxious particles, which nature endeavors to throw off, when the use of a liitle soap and water would prevent every inconvenience ? Is it too much trouble to wash the ears ; to dip the face, with the eyes open, in a basin of clean water four or five times every morning; to rinse the nose and mouth ; and to keep the tongue clean^ not by scraping it, but by attending to the state of the stomach, of which the tongue is an index ? Some people seem to be as much afraid of water as if they had been bitten by a mad dog; and if they remain obstinate in this antipathy, I can only say, they deserve a far worse end than that of such unfortunate incurables,—to be suffocated in their own filth. CHAP. XLVI. OF A SCIRRHUS AND CANCER. A SCIRRHUS is a hard, indolent tumor, usually seated in some of the glands; as the breasts, the armpits, &c. If the tumor becomes large, unequal, of a livid, blackish, or leaden color, and is attended with violent pain, it gets the name of an occult cancer. When the skin is broken, and a sanies or icho- rous matter, of an abominably fetid smell, is discharged from the sore, it is called an open, or ulcerated cancer. Persons af- ter the age of fortyfive, particularly women, and those who lead an indolent, sedentary life, are most subject to this disease. Causes.—This disease is often owing to suppressed evacua- tions. Hence it proves so frequently fatal to women of a gross 50 394 OF A SCIRRHUS AND CANCER. 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 con- vents 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, celiba- cy, indolence, cold, blows, friction, pressure, or the like. Wo- men often suffer from the last of these by means of their stays, which squeeze and compress their breasts so as to occasion great mischief. Sometimes the disease is owing to an heredita- ry disposition. Symptoms.—This disorder seems often very trifling at the beginning. A hard tumor, about the size of a hazlenut, or perhaps smaller, is generally the first symptom. This will of- ten continue for a long time without seeming to increase, or giving the patient great uneasiness; but if the constitution be hurt, or the tumor irritated by pressure, or improper treatment of any kind, it begins to extend itself towards the neighboring 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 color 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 tumor is very hard, rough, and unequal, with a protuberance, or rising, in the mid- dle ; its size increases daily, and the neighboring veins become thick, knotty, and of a blackish color. The skin at length gives way, and a thin, sharp ichor begins to flow, which corrodes the neighboring parts till it forms a large unsightly ulcer. More occult cancers arise, and commu- nicate with the neighboring glands. The pain and stencb be- come intolerable ; the appetite fails ; the strength is exhausted by a continual hectic fever. At last, a violent hemorrhage, or discharge of blood, from some part of the body, with faintings or convulsion fits, generally put an end to the miserable pa- tient's life. Regimen.—The diet ought to be light, but nourishing. All strong liquors, and highseasoned 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. OF A SCIRRHUS AND CANCER. Medicine.—This is one of those diseases, for which no cer- tain remedy is yet known. Its progress, however, may some- times 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 prevented; but after the disorder has arrived at a certain height, it generally sets all medicine at defiance. When a scirrhous tumor 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. 1 have sometimes discussed hard tumors, which had the appearance of beginning cancers, by a course of this kind.* , Should the tumor, 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 belter. It can answer no purpose to extirpate a cancer after the con- stitution is ruined, or the whole mass of humors corrupted by it. This, however, is the common way, which makes the ope- ration so seldom succeed. Few people will submit to the ex- tirpation 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 sub- limate 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 nightshade, 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 recom- mended 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 * In the incipient stage of cancer, the repeated application of leeches to the part affected, is frequently productive of the most beneficial consequen- ces, and ought never to be neglected. A. P. B. 396 OF A SCIRRHUS AND CANCER. manifest advantage. He advises the patient, however, to be- gin with very small doses, as two or three grains, and to in- crease the dose gradually till some good effect be perceived, and there to rest without further increase. From tvvo 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 conse- quences. The regimen, which the doctor recommends during the use of the medicine, is to avoid farinaceous substances not ferment- ed, 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 can- cer may be resolved by the use of hemlock, but says he has given it for above two years in large doses without any appa- rent benefit; nevertheless, the patient has been cured by per- sisting 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 on 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 hemloc k 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 a 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 decoc- tion of the tops of 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 cata- plasm. 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 im- portance in such a dreadful disorder.* Wort, or an infusion of malt, has been recommended not qnjy * London Medical Essays. OF A SCIRRHUS AND CANCER. 397 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 neighborhood of the cancer have sometimes good effects.* When all other medicines, fail, recourse must be had to opium, as a kind of solace. This will not indeed cure the dis- ease, 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 whole- some 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 on the breasts, or other glandular parts.t In the long catalogue of human afflictions, there is scarcely one to be more dreaded than the cancer. It is no less painful than loathsome ; it kills by inches ; is seldom cured except by the knife ; and even this does not always succeed. I have fre- quently seen small tumors in the breast, which might perhaps have ended in cancers, yield to the camphorated mercurial oint- ment, applied twice a day ; but after the scirrhus had broke and become a cancer, I do not remember having ever seen it cured ; nor do I believe that the whole materia medica can afford a remedy for it. Yet therp are plenty of people in London, who cure cancers ; * In a cancer which had set all medicines, and even surgery, at defiance, I lately saw remarkable effects from an obstinate perseverance m a course ot 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^con- tinued 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 ou"ht not to be washed, she discontinued the practice, and died in a tew 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. t As hemlock is the principal medicine recommended in this disease, we should have given some directions for the gathering and preparing of this plant; but as its different preparations are now kept in the shops, we think it much safe.r for pgople to get them there, with proper directions for using them, ^_^--"" 0F POISONS. and no one, who has a sufficient share of faith, can be at a loss for a cancer doctor. One may see even the fronts of houses inscribed with the words, " Cancers cured here," in large cha- racters. I lately had a patient, who once fancied that her breast was a little cancerous, and, under this impression, was kept for two years in the hands of a female cancer curer, though the lady in reality had not the least symptom of a cancer about her.* But credulity is a disease of the mind still more incurable than cancers. I had occasion, a few years ago, to make several visits at the house of one of the richest merchants in London, whose sister was afflicted at the time with a cancer; and, though she lived in the same house, I was never desired to look at her. Blind credulity prevailed over reason. Her cure was entrusted to an American quack, who knew just as much as my lady's lapdog of the nature and proper treatment of cancers. He only helped to kill her, which the disease might ultimately have done: yet surely she ought to have had better advice. CHAP. XLVII. OF POISONS. i^VERY person ought, in some measure, to be acquainted with the nature and cure of poisons. They are generally taken un- awares, 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 know- ledge is here necessary; the remedies for most poisons being * In a work lately published on cancer by a Mr. Carmichael, a number of cases are adduced in favor of the utility of iron as a remedy in this disease. The preparation of this metal, to which he gives the preference, is the carbo- nate, that is, the precipitate formed by saturating a solution of the salt of steel (ferrum vitriolalum) with the fixed alkali. Us properties are nearly the same as those of the rust of iron, when properly prepared. Of this the patient may take to the extent of a drachm a day, formed into pills, with the addition of any aromatic, to make it sit more easily on the stomach. The same prepara- tion, fintly levigated, may also be advantageously sprinkled on the surface of the sore ; or a wash, made by diluting the muriated tincture of steel with water, may be used. This answers well also as an injection, when the uterus is the seat of the complaint. On the authority of this gentleman, whose prac- tice appears to be founded on experience, and is detailed with candor, in so deplorable a diu-asc, the remedy proposed by him certainly merits a trial. OF POISONS. 399 generally at hand, are 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 excep- tion, 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 occa- sions sickness, with an inclination to vomit. This shows plainly what ought to be done. Indeed, common sense dictates to eve- ry one, that, if anything 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 gene- rally 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 men- tion the boasted antidotes, which have been recommended either for preventing or obviating their effects; but shall content our- selves with pointing qut the poisons most common in this coun- try, 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 quali- ty ; as arsenic, cobalt, the corrosive sublimate of mercury, he. Those of the vegetable kind are generally of a narcotic or stupefactive quality ; as poppy, hemlock, henbane, berries of the deadly nightshade, he* poisonous animals communicate their infection either by the bite or sting. This poison is very different from the former, * A* the state of insensibility of the patient, or various other circumstance?, too often prevent the possibility of discovering what particular kind of poison has been swallowed, it is well to be able to distinguish, if possible, by the ap- parent symptoms, whether it belongs to the vegetable, or to the mineral class. Vegetable poisons are narcotic; they stupify the intellectual powers, and produce drowsiness. Mineral poisons do not affect the mental faculties, but cause excruciating pain, especially in the stomach and bowels. t The best antidote to vegetable, or narcotic poisons, as opium, is to drink plentifully of vinegar or lemon juice, mingled with water. Whereas the deleterious effects of mineral poisons are most effectually coun- teracted by alkaline solutions, as of common potash, or the liver of sulphur, which ought to be copiously administered, dissolved in water. A. V. B. 400 OF POISONS. 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 this will be applicable to every other species of corrosive poison. When a person has taken arsenic, he soon perceives a burn- ing 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, hickuping, faintings, and coldness of the extremities. To these succeed black vomits, fetid 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 salad 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 y and it is never safe to leave off drinking while one particle of the poison remains on the stomach. These oily or fat substances not only provoke vomiting, but likewise blunt the acrimony of the poison, and prevent its wound- ing 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. Vomit- ing 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, marshmallows, and such like. He must likewise take an infu- sion 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 on such things as are of a healing and cooling OF POISONS. 401 quality ; to abstain from flesh and all strong liquors, and to live on 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 corro- sive. 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 quan- tity ; but, as an overdose proves a strong poison, we shall point out its common effects, together with the method of cure. An overdose 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 im- possible to keep him awake. Every method must, however, be tried for this purpose. He should be tossed, shaken, and moved about. Sharp blistering plasters should be applied to his legs or arms, and stimulating medicines, as salt of hartshorn, he. held under his nose. It will also be proper to let blood. At the same time, every method must be taken to make him dis- charge the poison. This may be done in the manner directed above, by the use of strong vomits, drinking plenty of warm water, with oil, he. Mead, besides vomits, in this case, recommends acid medi- cines 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. 51 402 BITES OF POISONOUS ANIMALS. 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, so far as we yet know, all of the dog kind, as foxes, flogs, 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 hap- pens that any person is bitten by the first, that they scarcely 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 follows :—At first he looks dull, shows 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 eye seeming heavy and watery : he now, if not confined, runs panting along with a kind of dejected air, and endeavors to bite every one he meets. Other dogs are said to fly from him. Some think this a certain sign of mad- ness, supposing that they knowr 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, hun- ger, and fatigue. The disease is most frequent after long, dry, hot seasons; and such dogs as live on putrid, stinking carrion, without having enough of fresh water, are most liable to it. When any person has been bitten by a dog, the strictest in- quiry ought to be made whether the animal was really mad. Many disagreeable consequences arise from neglecting to ascer- tain this point. Some people have lived in continual anxiety for many years, because they had been bitten 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 in- duce us, instead of killing a dog the moment he has bitten 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 on by other dogs, and perhaps by men. The creature, thus frightened, beaten, and abused, looks wild, and lolls out BITES OF POISONOUS ANIMALS. 403 4 his tongue as he runs along. Immediately a crowd is after him ; while he, finding himself closely pursued, and taking eve- ry 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 ef- fects 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 im- pose on themselves, and then deceive others. The same medi- cine 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 bitten 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 hav-e the misfortune to be bitten 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 neighboring 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 on the dis- ease itself, but to point out the method of preventing it, we shall not take up time in showing its progress from the first invasion to its commonly fatal end. The common notion, that this poison may lie in the body far many years, and afterwards prove fatal, is both hurtful and ridiculous. It must render such persons as have had the mis- fortune to be bitten very unhappy, and can have no good effects. If the person takes proper medicines for forty days after the 404 BITES OF POISONOUS ANIMALS. time of his being bitten, and feels no symptoms of the disease, there is reason to believe him out of danger. Some have in- deed gone mad twelve months after being bitten, but seldom later. 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 ashcolored ground liverwort, cleaned, dried, and pow- dered, half an ounce; of black pepper, powdered, a quarter of an ounce. Mix these well together, and divide the powder in- to four doses ; one of which must be taken every morning fast- ing, for four mornings successively, in half an English pint of cow's 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; lie must be dipped all over, but not stay in (wilh 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 medi- cine."* 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 efi'ects 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 pow- der, and taken in a gl.iss of arrac 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 snakeroot in powder half a drachm, gum assafetida twelve grains, gum camphor seven grains ; make these into a bolus with a little syrup of saffron." *" 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 bitten by a dog which was really mad, to trust to it alone. Mead was an able phy- sician ; but he seems to have been no great philosopher, and was sometimes the dupe of his own credulity. BITES OF POISONOUS ANIMALS. 405 Camphor may also be given in the following manner: " Take purified nitre half an ounce, Virginian snakeroot in powder two drachms, camphor 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 prevent- ing the effects of the bite of a mad dog. We would not, how- ever, 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 tak- ing 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 medi- cines, we must impute their frequent want of success. Dr. Mead says, that the virtue of his medicines consists in promoting urine. But how a poison should be expelled by urine, wnh only three or four doses of any medicine, however powerful, is not easy to conceive. More time is certainly neces- sary, 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 fre- quently been found to fail, we shall recommend the following course :— . If a person be bitten 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. 406 BITES OF POISONOUS ANIMALS. 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 meantime, we would advise him not to leave off all in- ternal medicines, but to take either one of the boluses of snake- root, assafetida, and camphor ; or one of the powders of nitre, eamphor, and snakeroot, twice a day. These may be used 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 highseasoned provisions. He must avoid strong liquors, and live mostly on 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. 1 have never seen this course of medicine, with proper regi- men, 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 everything 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 bitten 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 on them for some time before its violent symptoms appear. The hydrophobia has been occasioned by the bite of a dog, which showed no other symptoms of the dis- ease, but listlessness and a sullen disposition. Though we do not mean to treat fully of the cure of the hy- drophobia, 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 aban- BITES OF POISONOUS ANIMALS. 407 don the unhappy persons, as soon as they were seized with the disease, to their fate, to bleed them to death, or to suflbcate them between mattresses or feather beds, &c. This conduct cer- tainly deserved the severest punishment! We hope, for the honor 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 eS'ery day receive two, or even three emol- lient clysters. 4. The wound, and the parts adjoining to it, should be rub- bed with 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 Cobb'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, twen- tyfour grains; of musk, sixteen grains.* 7. The following bolus is to be given every night, and to be repeated in the morning, if the patient be not easy, washing it down with the infusion mentioned above:—Take one drachm of Virginian snakeroot in powder; of camphor and assafetida, 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 bitter- ness in the mouth, thirtyfive 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 panada, 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 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 1 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. 408 BITES OF POISONOUS ANIMALS. 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 this is all the viper catchers generally do when bitten, 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,* and afterwards rubbed with warm olive oil. A poultice of bread and milk, softened with olive 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, &x. their stings are seldom attended with danger, un- less 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 found rubbing the part with warm olive oil, or frequently repeated applications of pledgets dipped in laudanum, succeed very well. Indeed, when the stings are so numerous as to endanger the patient's life, which is some- times the case, he must not only have oily poultices, or pledgets moistened with laudanum applied to the part, but should like- wise 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 poison- ous 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 everywhere, and prove often fatal to the ignorant and unwary. This, in- deed, is chiefly owing to carelessness. Children ought early * 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 poisou. 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 olive oil, which will secure him from even the least in- convenu ncy. The Psyli 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 practice the same at this day. BITES OF POISONOUS ANIMALS. 409 to be cautioned against eating any kind of fr.uit, roots, or ber- ries, 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 peo- ple imagine. Poisonous plants have no doubt their use, and they ought to- be propagated in proper places ; but, as they often prove de- structive 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 neighborhood of all towns and villages; which, by the by, are the places where they most commonly abound. I have seen the poisonous hemlock, hen- bane, wolfsbane, and deadly nightshade, all growing within the environs of a small town, where, though several persons, withm 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 expense. Seldom a year passes, but we have accounts of several per- sons poisoned by eating hemlock roots, instead of parsnips, or rome kinds of fungus, which they had gathered for mushrooms. These examples ought to put people on their guard with respect to the former, and to put the latter entirely out of use. Mush- rooms 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 everything 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 them 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 rattlesnake. The prescription is as follows:—'Take of the herbs plantain and horehound, in summer, roots and branches together, a sufficient quantity; bruise them in a mortar, and squeeze out the juice, of which give, as soon as possible, one large spoonful; if the patient be swelled, you must force it down his throat. This generally will cure; but, if he finds no relief in an hour after, you may give another spoonful, which never fails.—If the roots are dried, they must be moistened with a little water. To the wound may be applied a leaf of good tobacco, moistened with rum. 3 We give this on the faith of Dr. Brookes, who says it was the invention of a negro ; for the discovery of which he had his 52 410 DISEASES OF WOMEN. freedom purchased, and a hundred pounds per annum settled on 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: 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, thit it be ex- pelled 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 opi- um, musk, camphor, and assafetida. 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 em- ployments. 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 milkmaid, 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 vigor, yet she certainly never meant, either that the one should be always without, or the other al- ways within doors. The confinement of females, besides hurting their figure and complexion, relaxes their solids, weakens their minds, and dis- orders all the functions of the body. Hence proceed obstruc- tions, 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 ridi- culous. A sound mind depends so much on 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 em- ployed without doors, in the different branches of husbandry, OF THE MENSTRUAL DISCHARGE. 411 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 on both sexes have been already shown, we shall proceed to point out those circumstances in the structure and designation of females, which subject them to peculiar diseases ; the chief of which are, their monthly evacuations,pregnancy, andchildbearing. These, indeed, cannot properly be called diseases ; but, from the delicacy of the sex, and their being often improperly managed in such situ- x ations, they become the source of numerous calamities. OF THE MENSTRUAL DISCHARGE. Females generally begin to menstruate about the age of fif- teen, 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, on her conduct at this period.* If a girl, about this time of life, be confined to the house, kept constantly sitting, and neither allowed to romp about, nor em- ployed 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 vigor decline, and she sinks into a valetudinarian for life. Such is the state of numbers of those unhappy females, who, either from too much indulgence, or their own narrow circumstances, are, at this critical period, denied Uie 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. * It is the duty of mothers, and those who are entrusted 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 igno- rance of what is beneficial or hurtful at this time, are the sources of many dis- eases and misfortunes in life, which a few sensible lessons from an experienc- ed matron might have prevented. Nor is care less necessary in the subse- quent return 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. 412 OF THE MENSTRUAL DISCHARGE. These are in a manner eaten up by the chlorosis, or green sick- ness, 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 humors 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 scrofula, or king's evil, he. 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 vapors 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 fes- tivity. Another thing very hurtful to females about this period of life, is strait clothes. They are fond of a fine shape, and fool- ishly 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 charge, it may come about again ; we therefore think it not improper to mention it. I know many females who, to this day, feel the dreadful effects of that w retched 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. Nature's broad chest in stiffest whalebone casM, Defeats the intention of a perfect waist. After a female has arrived at that period of life when the menses usually begin to flow, and they do nqt appear, but, on OF THE MENSTRUAL DISCHARGE. 413 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, assafetida, 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 as- sisted, will do her proper work. Indeed, she seldom fails, unless where the fault is on our side. This discharge in the beginning is seldom so instantaneous as to surprise females unawares. It is generally preceded by symptoms which foretell its approach; as a sense of heat, weight, and dull pain in the loins; distention and hardness of the breasts ; headache, loss of appetite ; lassitude ; paleness of the counte- nance ; and sometimes a slight degree of fever. When these symptoms appear about tlie age at which the menstrual flux usually begins, everything should be carefully avoided, which may obstruct this necessary and salutary evacuation ; and all means used to promote it; as sitting frequently over the steams of warm water, drinking warm diluting liquors, setting the hips in a bath of warm water, he. After the menses have once begun to flow, the greatest care should be taken to avoid everything that may tend to obstruct them. Females ought to be exceedingly cautious of what they eat or drink at the time they are out of order. Everything that is cold, or apt to sour on the stomach, ought to be avoided ; as fruit, buttermilk, and such like. Fish, and all kinds of food that are hard of digestion, are also to be avoided. As it is im- possible to mention everything that may disagree with indi- viduals at this time, we would recommend it to every female to be very attentive to what disagrees with herself, and carefully to avoid it. Cold is extremely hurtful at this particular period. More of the sex date their diseases from colds caught while they are out of order, than from all other causes. This ought surely to put them on their guard, and to make them very circumspect in their conduct at such times. A degree of cold, that will not in # the least hurt them at another time, will at this period be suffi- cient 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. r 414 OF THE MENSTRUAL DISCHARGE. So far as my observation goes, there are no women in the world so inattentive to this discharge as the English ; and they suffer accordingly, as a very great number of them are obstruct- ed, and many prove barren in consequence. From whatever cause this provision of nature 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 ; riding on horseback. 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. For this purpose, I have of late made use of pills composed of prepared steel, powdered myrrh, and the best aloes, equal parts. These must be formed into pills of the com- mon size, and tvvo or three of them given every night at bed time. The principal medicines, however, are iron, and the Pe- ruvian bark, with other bitters and astringents. Filings of iron may be infused in wine or ale, two or three ounces to an Eng- lish quart, and, after it has stood for two or three weeks, it may be filtered, and about half a wineglass 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 humors, 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 on a spare, thin diet. Her drink should be whey, water, or i^mall 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 afiliction, 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 behavior to females in this situa- tion is also of the last importance. OF THE MENSTRUAL DISCHARGE. 415 An obstruction of the menses is often the effect of other mala- dies. When this is the case, instead of giving medicines to force this discharge, which might be dangerous, we ought by all means to endeavor to restore the patient's health and strength. When this 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 color pale, thevappetite and digestion are bad, to which edematous swell- ings of the feet, dropsies, and consumptions, often ensue. This frequently happens to women about the age of fortyfive or fifty, and is very difficult to cure. It may proceed from a sedentary life ; a full diet, consisting chiefly of salted, highseasoned, or acrid food ; the use of spirituous liquors ; excessive fatigue ; relaxation ; a dissolved state of the blood ; f iolent passions of the mind, he. 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 whence it proceeds. To restrain the flux, the patient should be kept quie#t and easy both in body and mind. If it be very violent, she ought to lie in bed with her head low; to live on a cool and slender diet, as veal or chicken broths with bread; and to drink decoc- tions of nettle roots, or the greater comfrey. If these be not sufficient to stop the flux, stronger astringents may be used, as Japan earth, alum, elixir of vitriol, the Peruvian bark, he* The uterine flux may offend in quality as well as in quantity. What is usually called the fluor albus, or whites, is a very com- mon disease, and proves extremely hurtful to delicate women. This discharge, however, is not always white, but sometimes pale, yellow, green, or of a blackish color. Sometimes it is sharp and corrosive, sometimes foul and fetid, he. It is attend- ed with a pale complexion, pain in the back, loss of appetite, swelling of the feet, and other signs of debility. It generally * Two drachms of alum 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 alum, may take two tablespoonfuls 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. 416 OF PREGNANCY. proceeds from a relaxed state of the body, arising from indo-' lence, the excessive use of tea, coffee, or other weak and watery diet. To remove this disease, the patient must take as much exer- cise 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 exceedingly good effect; and some- times a milk diet alone will perform a cure. The patient ought not to lie too long in 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 like- wise very critical to the sex. The stoppage of any habitual 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 vigor to a very great age. If dig 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, he. 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 Uieir ankles, or in other parts of the body. Such ulcers ought to be considered as critical, and should either be suffered to continue open, or have artificial drains substituted in their stead. Women who will have such sores dried up, are often soon after carried off by acute diseases, or fall into those of a chronic nature. OF PREGNANCY. Though pregnancy is not a disease^ yet this state is often attended with a variety of complaints which merit attention, and which sometimes require the assistance of medicine. Some OF PREGNANCY. 417 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 this period ; and hardly any, except abortion, that can be called dangerous. Pregnant women are often afflicted with the heartburn. 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 shown. Both the headache and toothache are very trou- blesome 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 com- plaints incident to pregnant women might be mentioned, as a cough and difficulty of breathing, suppression and incontinency of urine, &c. j but as all of these have been taken notice of be- fore, 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.* 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 ard, the death of the child; weakness or relaxation of the mother ; great evacuations ; vio- lent exercise ; raising great weights ; reaching too high ; jump- ing, or stepping from an eminence ; vomiting ; coughing ; con- vulsion 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. • - Every mother who procures an abortion does it at the hazard of her life ; vet there are not a few who run this risk merely to prevent the trouble ot bearing and brinjring up children. It is surely a most unnatural crime, and cannot, even in \he most abandoned, be viewed without horror ; but in the d-ecent matron, it is still more unpardonable.----Those wretches who are willing to lend their assistance to women in this business, deserve, in my opi- nion, the most severe of all human punishments. 53 418 OF PREGNANCY. 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 ; sick- ness ; palpitation of the heart; the breasts become flat and soft; the belly falls; and there is a discharge of blood or watery hu- mors 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, fogey weather, if they can help it. VVomen of a full habit ought to use a spare diet, avoiding strong liquors, and everything 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 mattress, with her head low. She should be kept quiet, and her mind soothed and comforted. She ought not to be kept too hot, nor to take anything of a heating na- ture. 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 tablespoonfuls 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 cer- tain time of pregnancy, ought always to be bled a few days be- fore this period arrives. By this means, and observing the regi- men above prescribed, they might often escape this misfortune. Though we recommend due care for preventing abortion, we would not be understood as restraining pregnant women from their usual exercise. This would generally operate the quite contrary way. Want of exercise not only relaxes the body, but induces a plethora, or too great a fulness of the vessels, which are the two principal causes of abortion. There are, OF CHILDBIRTH. 419 however, some women of so delicate a texture, that it is neces- sary for them to avoid almost every kind of exercise during the whole period of pregnancy. OF CHILDBIRTH. Many diseases proceed from the want of due care in childbed ; 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 labor pains are ended, that 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 ex- pel the fetus; 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 childbed, generally recover worst. But this is not peculiar to the state of childbed. Excessive care always defeats its own intention, and is generally more dangerous than none at all.* During actual labor, nothing of a heating nature ought to be given. The woman may now and then take a little panada; and her drink ought to be toast and water, or thin groat gruel. Spirit, wine, 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 labor. Besides, they endanger the woman afterwards, as they often occasion violent and mortal hemorrhages, or dispose her to eruptive and other fevers. When the labor proves tedious and difficult, to prevent in- flammations, 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 * Though the management of women in childbed 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 has any education, or proper knowledge of their business. It is true, that nature, if left to herself, will generally expel the fetus; but it is equally true, that most women, in childbed, 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 be the means of saving many lives. * Was any female ever duly qualified ? 1 believe not, C. 420 OF CHILDBIRTH. butter, and cloths wrung out of warm water applied over the belly. If nature seems to sink, and the woman is greatly ex- hausted with fatigue, a draught of generous wine, or some other cordial, may be given, but not otherwise. These directions are sufficient in natural labors; 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.* Her food should be light and thin, as gruel, anada, &c and her drink weak and diluting. To this rule, owever, there are many exceptions. I have known several women, whose spirits could not be supported in childbed with- out solid food and generous liquors. To such a glass of wine and a bit of chicken must be allowed. Sometimes an excessive hemorrhage or flooding, happens af- ter 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 flood- ing abates.! 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 caraway seeds, 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.J * We cannot help taking notice of that ridiculous custom, which still pre- vails in some parts of the country, of collecting a number of women together on such occasions. These, instead of being useful, serve only to crowd the bouse, and obstruct the necessary attendants. Besides, they hurt the patient with their noise ; and often, by their untimely and impertinent advice, do much mischief. t In a violent flooding: after delivery, I have seen very good effects from the following mixture:—Take of pennyroyal water, simple cinnamon water, and syrup of poppies, each, two ounces, elixir of vitriol a drachm. Mix, and take two tablespoonfuls every two hours, or oftener, if necessary. J Take of crabs1 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 assafetida ia a cup of pennyroyal tea. I OF CHILDBIRTH. 421 An inflammation of the womb is a dangerous and not un- frequent disease after delivery. It is known by pains in the lower part of the belly, which are greatly increased on touch- ing; 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 vomit- ing; a hickup; 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 wa- ter, or by applying bladders filled with warm milk and water to it. A suppression of the lochia, or usual discharges after delive- ry, and the milk fever, must be treated nearly in the same man- ner as an inflammation of the womb. In all these cases, the safest course is plentiful dilution, gentle evacuations, and fo- mentations of the parts affected. In the milk fever, the breasts may be embrocated with a little warm linseed oil, or the leaves of red cabbage may be applied to them. The child should be often put to the breast, or it should be drawn by some other person. Nothing would tend more to prevent the milk fever than put? ting the child early to the breast. The custom of not allowing children to suck for the first tvvo 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 breast, 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 childbed. 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 every four or five hours, till the tumor be either discussed or brought to suppu- ration. 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.* * Suppuration, however, in these cases, should always be prevented if pos- sible. I know of no application so usefuPin removing the swelling, hardies, 422 OF CHILDBIRTH, When the nipples are fretted or chapped, they may be anointed with a mixture of oil and beeswax, or a little powdered gum arabic tiny be sprinkled on them. 1 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 childbed 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 man- na, rhubarb, or cream of tartar; not forgetting to bleed in the first months, and to avoid all sharp air. When the labor is coming on, it is not to be hastened with forcing medicines, which inflame the blood and humors, or put them into unna- tural commotions. Care should be taken, after the birth, that thn natural excretions proceed regularly; and, if the pulse be quick, a little nitrous powder, or some other cooling medicines, should be administered. The mo«t fatal disorder consequent on delivery is the puer- peral, or childbed, fever. It generally makes its attack on 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 the stomach, and bilious vomiting. The pulse is generally quick, the tongue dry, and there is a remarkable depression of spirits and loss of strength. A great pain is usu- ally 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 con- stant inclination to go to stool. The urine, which is very high colored, 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 lumps, heat and tenderness of the breast, as the following. It should be appli- ed every hour or two, pleasantly warm, by bathing the part affected with it three or four minutes, and then covering the breast with it by means of two or three thicknesses of cotton cloth, or one or two of flannel: Dissolve two drachms of sal ammoniac in three gills of water ; add one ounce of spirit, one of vinegar, and one tablespoonful of goose oil. The strength of this lotion should vary with the tenderness and sensibility of the part. It should never be so strong as to give more than a slight and temporary smarting. It frequently answers every good purpose without pro- ducing any pain or uneasiness, c. OF CHILDBIRTH. 423 the fever has continued for a few days, the symptoms of in- flammation 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 as- sistance ought always to be obtained as soon as possible. In women of plethoric constitutions, bleeding will generally be proper at tne beginning; it ought, however, to be used with caution, and not to be repeated, unless where the signs ot in- flammation rise high ; in which case it will also be necessary to apply a blistering plaster to the region of the womb. During the rigor, or cold fit, proper means should be used to abate its violence and shorten ils.duration. For this purpose^ the patient may drink freely of warm, diluting liquors, and, if low, may take now and then a cup of wine whey; warm appli- cations 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 re- quisite 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 o-enerally 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.* The medicine, which 1 have always found to succeed best in this disease, is the saline draught. This, if frequently repeat- ed, will often put a stop to the vomiting, and at the same time lessen the violence of the fever. If1 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 ex- haust the patient, a starch clyster, with thirty or forty drops of laudanum in it, may be administered as occasion shall require; * Midwives ought to be very cautious in administering vomits or purges to women in childbed. I have known a woman, who was recovering extremely well, thrown into the most imminent danger, by a strong purge which was iiveu her by an officious midwife. A 424 OF CHILDBIRTH. 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 the powder of bole combined with opium. Though, in general, the food ought to be light, and the drink diluting; yet, when the disease has been long protracted, and the patient is greatly spent by evacuations, it will be necessary to 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 se- cond, third, or fourth hour, as shall be found necessary. When the stomach will not bear any kind of nourishment1, the patient may be supported for some time by clysters of beef- tea or chicken broth. To avoid this fever, every woman in childbed ought to be kept perfectly easy ; her food should be light and simple, and her bedchamber cool and properly ventilated. There is not anything more hurtful to a woman in this situation than being kept too warm. She ought not to have her body bound too light, 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 breasts ought to be frequently drawn ; and, if they are filled previous to the onset of a fever, they should, on 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 effect- ed by the use of mild clysters and a laxative diet. We shall conclude our observations on childbed women, by recommending it to them, above all things, to beware of cold. Poor women, whose circumstances oblige them to quit their bed too soon, often contract diseases from cold, of which they never recover. It is a pity the poor are not better taken care of in this situation. But the better sort of women run the greatest hazard from too much heat. They are generally kept in a sort of bagnio for the first eight or ten days, and then dressed out to see com- pany. The danger of this conduct must be obvious to every •ne. OF BARRENNESS. 425 The superstitious custom of obliging women to keep the house till they go to church, is likewise a very common cause of catch- ing cold. All churches are damp, and most of them cold; some of them infected by dead bodies ; and consequently they are the very worst places, to which a woman can go to make her first visit, after having been confined in a warm room for a month. OF BARRENNESS. Barrenness may be very properly reckoned among the dis- eases 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, he. ; but it is chiefly owing to an obstruction or irregularity of the menstrual flux. It is very certain that high living vitiates the humors, and prevents fecundity. We seldom find a barren woman among the laboring poor, while nothing is more common among the affluent. The inhabitants of every country are prolific in pro- portion to their poverty; and it would be an easy matter to ad- duce many instances of women, who, by being reduced to live entirely on 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 vas- sals 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 fluids, but induces a general relaxation of the solids; a state highly unfavorable to procreation. To remove this, we would recom- mend the following course :—First, sufficient exercise in the open air ; secondly, a diet consisting chiefly of milk and vege- tables ; thirdly, the use of astringent medicines, as steel, alum, dragon's blood, elixir of vitriol, the Spa or Tunbridge waters, Peruvian bark, &c. ; and lastly, above all, the cold bath. Barrenness is often the consequence of grief, sudden fear, anxiety, or any of the passions which tend to obstruct the men- strual 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. I believe I have never written, and I hope I never shall write, 54 426 DISEASES OF CHILDREN. anything offensive to real modesty. Yet I have not suppressed, from motives of, false delicacy, what I thought might be of im- portance on a subject so closely connected with conjugal happi- ness. The remarks here made, though few and apparently simple, contain all that is really known, in medical practice, of the causes and remedies of barrenness. I therefore wish to put married ladies on their guard against the fallacy of private sug- gestions, and of public advertisements on this head. The things commonly advised by silly nurses, as well as the.grand restoratives of quack impostors, are all of them dangerous stimu- lants, that provoke desire, but enfeeble, instead of strengthening, the powers of nature, and render a weakness, which proper treatment might have removed, absolutely incurable. CHAP. 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 on him; and when it is, he often suffers as much from improper manage- ment as he would have done from neglect. Hence the officious care of parents, nurses, and midwives, becomes one of the most fruitful sources of the disorders of infants.* It must be obvious to every attentive person, that the first 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. Everything that thd 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 * Of the officious and ill judged care of midwives, we shall adduce only *>ne instance,—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 breaptp; 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 on a piece 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. OF THE MECONIUM. 427 affections of the bowels, or what the good women call inward fits, and at last convulsions and death. As these symptoms evidently arise from something that irri- tates the intestines, doubtless the proper method of cure must be to remove 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. This medicine 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 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 like- wise go a considerable way in alleviating those which appear externally, as the rash, gum, or fellon, he. 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 consti- tute 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 newborn infant are filled with a blackish 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 re- tained, or not sufficiently carried off, a little manna, or magnesia, 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 moist sugar, will answer the purpose. 428 THE APHTHiE, OR THRUSH. The most proper medicine for expelling the meconium is the mother's milk, which is always at first of a purgative quality. Were children allowed to suck as soon as they show an inclina- tion for the breast, they would seldom have occasion for medi- cines to discharge the meconium ; but, even where this is not allowed, they ought never to have doses of syrup, oils, and other indigestibJe stuff, crammed down their throats. THE APHTHA, OR THRUSH. The aphthae are little whitish ulcers affecting the whole in- side 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 aphthae are of a pale color, pellucid, few in number, soft, superficial, and fall easily off, they are not dangerous ; but if opaque, yellow, brown, black, thick, or running together, they ou^ht to be dreaded. ' It is generally thought, that the aphtha? owe their origin to acrid humors. 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 in- flaming liquids, 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 constitu- tion on a blaze ? The most proper medicines for the aphthae are vomits, such as have been already recommended, and gentle laxatives. Five grains of rhubarb, and half a drachm of magnesia, may be rub- bed 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 this medicine sometimes occasions gripes, it ought always to be given to infants with caution. Many things have been recommended for gargling the mouth and throat in this disease ; but it is not easy to apply these in very young children ; we would therefore recommend it to the OF ACIDITIES. 429 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 tvvo 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 piece 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 on 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, he. These appearances have induced many to believe, that all the diseases of children were owing to an acid abound- ing in the stomach and bowels ; but whoever considers the matter attentively will find, that these symptoms of acidity are oftener 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 diges- tion hurt, from some other cause, we will venture to say, that the acescent quality of their food is seldom injurious to tlrem. 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, he. show that the bowels abound with an acid, the child should have a little small broth, with light white bread in it; and should have sufficient 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 attend- ed 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 un- less 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 4S0 GALLING AND EXCORIATION. given in any kind of food, or in a mixture, as recommended in the Appendix.* 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. 1 have seldom seen this fail to ease the gripes of in- fants. If it should happen, however, not to succeed, a little brandy or other spirit may be mixed with thrice the quantity of warm water, and a teaspoonful of it given frequently, till the infant be easier. Sometimes a little peppermint water will an- swer this purpose as weil.f 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. Wrhen this is not sufficient, the excoriated parts may be sprinkled with absorbent or drying powders ; as burnt hartshorn, tutty, chalk, crabs' cla\vs 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. Jf the parts be washed with spring water, in which a little white vitriol has been dissolved, it will dry and heal them very power- fully. One of the best applications for this purpose is to dis- solve some fuller's earth in a sufficient quantity of hot water; and, after it has stood till it is cold, to rub it gently on tlie galled parts once or twice a day. Or to wash them gently, now and then, with a mixture of equal parts of rose water and spirit of wine. * See Appendix, Laxative absorbent Mixture. t Twenty drops of the spirit of hartshorn, given in a liitle linseed tea, im- mediately relieves children affected by that acidity of the bowels, which fre- quently attends teething. Much of the acidity of the stomachs of children arise* from the too free use of fermented bread., A. P. B. OF VOMITING. 43* STOPPAGE OF THE NOSE. The nostrils of infants are often plugged up with a gross mucus, which prevents their breathing freely, and likewise ren- ders 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. Wedellus says, if two grains of white vitriol, and the same quantity oielaterium, 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 anything 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.* OF VOMITING. From the delicate state of children, and the great sensibility of their organs, a vomiting or looseness may t be induced by anything that irritates the nerves of the stomach or intestines. Hence these disorders are much more common in childhood m than in the more advanced periods of life. They are seldom, however, dangerous, and ought never to be considered as dis- eases, unless when they arc 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; dr by the sensibility of the nerves being so much increased as to render them unable to bear the stimulus- of even the mildest aliment. When vomiting is occasioned by too much food, it ought to be promoted, as the cure will depend on cleansing the stomach. This may be done by a few grains of ipecacuanha, as mention- ed 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 sensi- * 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. 432 OF A LOOSENESS. bility, 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 laudanum may occasionally be added. In obstinate vomitings, the operation of internal medicines may be assisted by aromatic fomentations made with wine, ap- plied 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 dis- charge, 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 humors, which would otherwise tend to relax the habit. As the principal intention in the cure of a looseness is to evacuate the offending matter, it is customary to give the pa- tient a gentle vomit of ipecacuanha, and afterwards to exhibit small and frequent doses of rhubarb ; interposing absorbent medicines to mitigate the acrimony of the humors. The best purge, however, in this case, is magnesia. It is at the same time absorbent and laxative, and operates without exciting gripes. The wine of ipecacuanha, which acts both as an emetic and fiurge, is also an excellent medicine in this case. By beine; di- uted with water, it may be proportioned to the weakest con- stitution ; 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 patients strength will permit, the medicine ought to be repeated every six or eight hours, till the stools begin to assume a more natural appearance. After- wards a longer space may be allowed to intervene between the doses. When it is necessary to repeat the medicine frequently, % OF ERUPTIONS. 433 the dose ought always to be a little increased, as its efficacy is generally diminished by use. Some, on the first appearance of a looseness, fly immediately to the use of absorbent medicines and astringents. If these be administered before the offending humors 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 teaspoonful 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. Chiloren, while on the breast, are seldom free from crup* tions of one kind or other. These, however, are not often dangerous, and ought never to be dried up but with the great- est caution. They tend to free the bodies of infants from hurtful humors, which, if retained, might produce fatal disor- ders. The eruptions of children are chiefly owi^Jg 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 humors. These must either break out in form of eruptions on 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 flowers of sulphur may be mixed with fresh butter, oil, or hog's lard, and the parts affect- ed frequently touched with it. 55 434 OF ERUPTIONS. The most obstinate of all the eruptions incident to children, are, the tinea capitis, or scabbed head, and chilblains. The scabbed head is often exceedingly difficult to cure, and some- times, 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.* The cure ought al- ways first to be attempted by keeping the head very clean, cut- ting off the hair, combing and brushing away the scabs, &c. If this is not sufficient, let the head be shaved once a week, wash- ed daily with yellow soap, 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 touch- ed with a piece of blue vitriol, or sprinkled with a little burnt alum. While these things are doing, the patient must be confin- ed 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 is- sue in the neck or arm, which may be kept open till the pa- tient 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, afld afterwards suddenly heated. When children are cold, instead of taking exercise to warm themselves gradu- ally, they run to the fire. This occasions a sudden rarefaction of the humors, and a fulness of the vessels ; which being often repeated, the vessels are at last overdislended, 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 pa- tient ought to be purged, and to have the affected parts fre- quently rubbed with mustard and brandy, or something of a * I some time ago saw a very striking instance of the danger of substitut- ing drying medicines in the place of cleanliness and wholesome food, in the Foundling Hospital at Ackworth, where the children were grievously afflict- ed with scabbed heads, and other cutaneous disorders. On 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 tho- roughly clean. This advice, however, was not followed. It was too trouble- some to the servants and superintendents. The business was to be done by medicine ; which was accordingly attempted, but had nearly proved fatal to tlie 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 neighboring country. OF THE CROUP. . 435 warming nature. They ought likewise to be covered with flannel, and kept warm and dry. Some apply warm ashes be- tween cloths to the swelled parts, which frequently help to re- duce 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 trouble- some, but seldom dangerous. They generally heal as soon as the warm weather sets in. OF THE CROUP. Chiloren 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. This disease generally prevails in cold and wet seasons. It is most common on the seacoast, 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 anything 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 flush- ed, though sometimes it is of a livid color. When a child is seized with the above symptoms, his feet should immediately be put into warm water, lie ought like- wise to be bled, 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 shoul- ders, and the child may take frequently a tablespoonful of the following julep:—Take pennyroyal water three ounces, syrup of althea and of poppies, each, one ounce ; mix them together. Assafetida 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 assafetida may be dissolved in one ounce of Mindererus's spirit, and three ounces of pennyroyal water. A tablespoonful of this mixture may be given every hour, or of- tener, if the patient's stomach be able to bear it. If the child 436 OF TEETHING. cannot be brought to take this medicine, two drachms of the assafetida may be dissolved in a common clyster, and adminis^ tered every six or eight hours, till the violence of the disease abates.* 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 con- stantly kept open in some part of their body, by means of a seton or issue, 1 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 dregdful disorder. ' In this rapid and formidable disease, it is best to send at once for medical aid.' C. 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 sensi- bility of the nervous system at this time of life, which is too often increased by an effeminate education. Hence it comes to pass, that children, who are delicately brought up, always suffer most in teething, and often fall by convulsive disorders. About the sixth or seventh month, the teeth generally begin to make their appearance ; first, the incisores, or fore teeth ; next the canini, or dog teeth ; and, lastly, the molares, or grin- * I was lately favored with a letter from Dr. William Turnbull, in, London, a physician of great experience, and who, from his farmer situation on the northeast coast of England, had many opportunities of observing the symp- toms and progress of this dangerous disease. The doctor's sentiments differ vrry little from my own. He observes, that he never found blistering of any service; and recommends cataplasms of srarlic, camphor, and Venice treacle, to be applied both to the throat and soles of lie feet. He likewise recom- mends boluses of camphor, castor, valerian root, salt of hartshorn, and musk, adapted to the age, strength, &c. of the parent; 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 tiro, and afterwards strained for use. OF TEETHING. 4S7 ders. About the seventh year, there comes a new set; and about the twentieth, the two inner grinders, called denies sapi' entia, 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 dog teeth begin to make their way through the gums, the child has startings in his sleep, tumors of the fums, watchings, gripes, green stools, the thrush, fever, difficult . reathing, and convulsions. Difficult teething requires nearly the same treatment as an inflammatory disease. If the body be bound, it must be open- ed 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 limetree flowers; to which about a third or fourth part of milk may be added. If the fever be high, bleeding will be necessary. An emetic, open-.ng the pores of the skin, and the bowels, are also fre- quently adviseable, according to circumstances. Sydenham says, that in fevers occasioned by teething, he ne- ver found any remedy so effectual as two, three, or four drops of spirit of hartshorn in a spoonful of simple water, or other con- venient vehicle, given every four hours. The number of doses may be four, five, or six. I have often prescribed this medi- cine 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 a useless application. When the teeth are cut with difficulty, it ought to be kept on during the whole time of teething. It may be enlarged as oc- casion requires, and ought to be renewed at least once a fortnight. Children are generally at this time disposed to chew what- ever they get into their hands. For this reason they ought never to be without something that will yield a little to the pressure of their gums, as a crust of bread, a piece of liquorice root, or such like. Cutting the gums down to the tooth, at the proper time, is very useful, and should never be omitted in painful dentition. 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 *38 OF THE RICKETS. 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 on weak, watery diet, can neither be expected to bring forth strong and healthy children, nor 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 scrofula, consumptions, or such like diseases. Children be- gotten by men in the decline of life, who are subject to the gout, the gravel, or other chronic diseases, or who have been often afflicted with the venereal disease in their youth, are likewise very liable to the rickets. Any disorder that weakens the constitution, or relaxes the habit of children, as the smallpox, measles, teething, the chin- cough, &c. disposes them to this disease. It may likewise be occasioned by improper diet, as food that is either too weak and watery, or so viscid that the stomach cannot digest it. But nursing is the chief cause of this disease. When the nurse is either diseased, or has not enough of milk to nourish the child, it cannot thrive. But children suffer oftener 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 dan- dled 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 OF THE RICKETS. 439 natural for its age, and does not choose to be moved. The head and belly become too large in proportion to the other parts; the face appears full, and the complexion florid. After- wards, the bones begin to be affected, especially in the more soft and spungy parts. Hence the wrists and ankles become thicker than usual; the spine or backbone puts on an unnatu- ral 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 gene- rally 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. Rickety 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 neg- lects her duty, or does not understand it, she should be chang- ed. 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 sweat- ing 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 meat. If the child be too young for ani- mal food, he may have rice, millet, or pearl barley, boiled with raisins, to which may be added a little wine or spice. His drink may be good claret, mixed with an equal quantity of water. Those who cannot afford claret, may give the child, now and then, a wineglass of mild ale, or good porter. Medicine.—Medicines ate 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 car- ry off the disease ; this must depend chiefly on 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 440 OF CONVULSIONS. used with prudence, as some rickety 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 af- ter 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 humors. 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 choose rather to pass them over, and to recommend a proper regimen as the thing chiefly to be depended on. OF CONVULSIONS. Though more children are said to die of convulsions than of any other disease, yet they are for the most part only a symp- tom of some other malady. Whatever greatly irritates or stimu-^ lates the nerves, may occasion convulsions. Hence infants, whose nerves are easily affected, are often thrown into convul- sions by anything that irritates the alimentary canal : likewise by teething, strait clothes, the approach of the smallpox, measles, or other eruptive diseases. When convulsions proceed from an irritation of the stomach or bowels, whatever clears them of their acrid contents, or ren- ders 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 meantime 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 smallpox or measles, generally go off on these making their appearance. The principal danger in this case arises from the fear and ap- prehension of those who have the care of the patient. Convul- sions are very alarming, and something must be done to appease tlie affrighted parents, nurses, he. 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. OF WATER IN THE HEAD. 441 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, assafetida, 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, he. 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, so 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 j we have reason to conclude, that it is a primary disease, and proceeds \m-. mediately from the brain. When a disease proceeds from an original fault in the formation or structure of the brain itself, we cannot expect that it should yield to medicine. But as this is not always the cause even of convulsions which proceed immediately from the brain, some 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 pe- culiarly 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 like- wise proceed from an original laxity or weakness of the brain ; from scirrhous tumors or excrescences within the skull; a thin, watery state of the blood ; a diminished secretion of urine; a sudden check of the perspiration ; and, lastly, from tedious and lingering diseases, which waste and consume the patient. Symptoms.—This disease has at first the appearance of a slow fever ; the patient complains of a pain in the crown of his head, or over his eyes ; he shuns the light; is sick, and some- times vomits ; his pulse is irregular, and generally low ; though 56 0 442 OF WATER IN THE HEAD. he seems heavy and dull, yet he does not sleep; he is some- times 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 blisters 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 asa- rum, white hellebore, or the like.f 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 instance of a cure being performed in a confirmed dropsy of the brain ; but in so desperate a malady everything deserves a trial.J To look over the long catalogue of infantile diseases in some medical books, one would be inclined to think, that the real de- sign of the authors, though concealed under the show of pre- cision, was to spread alarm through every family. I have had a very different object in view,—to quiet the fears of parents, to direct their attention to the proper treatment of their children, * 1 have Jatelj' lost a patient in this disease, where a curious metastasis seemed to take place. The water at first appeared to be in the abdomen, afterwards iu the breast, aud last of all it mounted up to the brain, where it soon proved fatal. t When the presence of this disease can be ascertained at a sufficiently early period, 1 believe much benefit may be derived by taking away blood pretty freely by means of leeches applied near the temples. 1 lately saw an instance where a child was attacked with every symptom of this disease, by which its parents had previously lost children. Leeches were applied. The puncture made by one of them continued to discharge blood during the whole night; on discovering this accident next morning, the parents were much alarmed for the consequences. From this period, however, the child began to recover, and i> at present in good health. A. P. B. \ 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 practi- tioner of this city, who had all along mistaken the disease for teething. OF SURGERY. 443 and thus to render the use of any medicines almost unnecessary. I have shown the folly of having recourse to physic to bring away the black, viscid, syruplike substance contained in the in- testines of a newborn infant, when the purgative quality of his mother's milk is so admirably suited to this very purpose. The new milk is thin and waterish, but acquires every day greater consistence, and thus affords a more solid aliment to the child, as he becomes more capable of digesting it. If the mother does not vitiate, by her own improper diet, the pure fountains of nour- ishment and health, which nature has kindly given her, the child will neither be troubled with costiveness nor gripes. He will escape those complaints of the stomach, which are occasioned by swallowing crude, inflammatory trash, or still more pernicious drugs. The daily use of the cold bath, and frequent exercise in the open air, will not only preserve him from colds and de- fluxions, but from all the disorders which are the consequences of relaxation and of nervous irritability. A child brought up in the manner I have recommended, will have little to fear, even from external contagion. The firm texture of his skin, like a shield, will almost resist its approach, and the purity of his habit will correct its malignity. The smallpox is the only infectious disease, for which 1 would have him prepare by any particular process, because this process is so easy and certain, besides affording a perfect command both of time and circumstances. CHAP. L. OF SURGERY, TO describe ail 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 not adepts in anatomy. It is amazing with what facility the peasants daily perform operations on brute animals, which are not of a less 444 QF BLEEDING. difficult nature than those performed on the human species : yet they seldom fail of success. Indeed, every man is in some measure a surgeon, whether he will or not. He feels an inclination to assist his fellow men in 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 de- stroy 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 on such emergencies. OF BLEEDING. No operation of surgery is so frequently necessary as bleed- ing. It ought, therefore, to be very generally understood. But though practised by midwives, gardeners, blacksmiths, he. 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, he. It is likewise proper in all topical inflammations, as those of the intestines, womb, bladder, stomach, kidneys, throat, eyes, he. as also in the asthma, sciatic pains, coughs, headaches, rheumatism, the apoplexy, epilepsy, and dysentery. After falls, blows, bruises, or any violent hurt, received either externally or internally, bleeding is often neces- sary. 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 stopped, 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, he. bleeding is improper. OF BLEEDING. 445 Bleeding for topical inflammations ought always to be per- formed 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 circum- stances relating to the patient. It would be ridiculous to sup- pose 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 ex- tent as a robust man. From whatever part of the body blood is to be taken, a ban- dage 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 a 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 charac- ter of being regular practitioners, to bleed their patients in cer- tain 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 on the state of the mind than of the body : besides, it may often be occa- sioned or prevented by the manner in which the operation is performed. Certain hurtful prejudices with regard to bleeding still prevail among the country people. They talk, for instance, of head veins, heart veins, breast veins, he. and believe that bleeding in these will certainly cure all diseases of the parts 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. 446 OF INFLAMMATIONS AND ABSCESSES. extreme danger, they fly to it for relief, whether it be proper or not. Bleeding at certain stated periods or seasons has likewise bad effectsr It is a common notion, that bleeding in the feet draws the blood 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 is obtained. We shall not spend time in describing the manner of perform- ing 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 ex- pert hand. Neither is it necessary to point out the different parts of the body whence blood may be taken, as the arm, foot, forehead, temples, neck, he. These will readily occur to every intelligent person, and the foregoing observations will be suffi- cient for determining which of them is most proper on any par- ticular occasion. In all cases where the intention is merely to lessen the general mass of blood, the arm is the most commo- dious part of the body, in which the operation can be performed. OF INFLAMMATIONS AND ABSCESSES. From whatever cause an inflammation proceeds, it must ter- minate either by dispersion, suppuration, or gangrene. Though it is impossible to foretell with certainty in which of these ways any particular inflammation will terminate, yet a probable con- jecture may be formed with regard to the event, from a know- ledge of the patient's age and constitution. Inflammations hap- pening in a slight degree on colds, and without any previous in- disposition" will most probably be dispersed ; those which fol- low close on 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 re- pcated 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, one fourth of vinegar, and afterwards covered with a piece of wax plaster. OF INFLAMMATIONS AND ABSCESSES. 447 If, notwithstanding these applications, the symptomatic fever increases, and the tumor 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 slow- ly, a raw onion, cut small or bruised, may be spread on the poultice. When the abscess is ripe, or fit for opening, which may easily be known from the thinness of the skin in the most prominent part of it, fluctuation of matter, which may be felt under the finger, and, 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 colors, spread all over it; the tumor 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 basilicon softened with oil of turpentine. All the dressings must be applied warm. With regard to internal medicines, the patient must be support- ed with generous cordials, and the Peruvian bark exhibited in as large doses as the stomach will bear. If the mortified parts should separate, the wound will become a common ulcer, and must be treated accordingly. This article includes the treatment ofc 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 * A whitloe is a very painful complaint, h is generally caused by a small quantity of purulent matter lodged very deep, and compressed by the hard, unyielding skin covering the finger. , The pain may be instantly relieved by making a pretty deep incision with a lancet. The skin should also be rather freely divided, which will prevent the compression of the fungous flesh that is frequently thrown out from a whitloe, and which, when girt by the skin occa- eions great pain. The wound may be dressed with a little Peruvian balsam spread on lint. An incipient whitloe may occasionally be dispersed by im- mersing the part in water as hot as it can be borne. A, F. B. 448 OF WOUNDS. an incision, if necessary ; afterwards, the sore may be dressed with yellow basilicon, 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 one 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 applica- tions. These only promote the cure of wounds so far as they tend to prevent a fever, or to remove any cause that might ob- struct 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 favorable to nature's efforts. With this simple view, we shall consider the treatment of wounds, and endeavor 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 this 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 conside- rable blood vessel is cut, a skilful surgeon ought immediately to be called ; otherwise the patient may lose his life. But some- times the discharge of blood is so great, that, if it be not stop- ped, 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 ol the limbs, the bleeding may generally be stopped by applying a tight ligature or bandage round the member a little above the OF WOUNDS. 449 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 obtain- ed, strong spirit of wine may be used. Some recommend the agaric* of the oak as preferable to any of the other styptics; and, indeed, it deserves considerable encomiums, It is easily ob- tained, and ought to be kept in every family, in case of accidents. A piece of it must be laid on 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 im- proper 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 piece 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 neces- * Dr. Tissot, in his Advice to the People, gives the following direc'tions for gathering, preparing, and applying the agaric:—u Gather in autumn," says he, " while the fine weather lasts, the agaric of the oak, which is a kind of fun- gus, or excrescence, issuing from the wood of this tree. It consists at first of four parts, which present themselves successively : 1. The outward rind of skin, which maybe thrown away. 2. The part immediately under this rind, which is the best of all. This is to be beaten well with a hammer, till it be- comes 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 bleed- ing, and generally falls off at the end of two days. 3. The third part, adher- ing 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 stea,d. It must be applied in the same manner, and has nearly Uie same effects, 57 450 OF WOUNDS. sary. 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 com- mon wax plaster;* 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 or three days; after which it may be removed, and fresh lint ap- plied 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 easi- ly at the 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 basilicon ;t 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 applica- tion is a poultice of bread and milk, softened with a little sweet oil or fresh butler. This must be applied instead of a plaster, and should be changed every four or five hours. If the wound be large, and there is reason to fear an inflam- mation, the patient should be kept on a very low diet. He must abstain from flesh, strong liquors, and everything 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 symp- toms 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. Everything that ruffles the mind, or moves the passions, as love, anger, fear, excessive joy, &c. are very hurtful. They * See Appendix, Wax Plaster. t See Appendix, Yellow Basilicon. OF BURNS. 451 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, where the texture of the skin is not destroy- ed, the first thing to be attempted is to reduce the heat and inflammation. In this case cold water should be applied as soon as possible, and continued till lead water can be obtained, and this should be used for some time, or till the heat and smarting subside, when it should be changed for a mixture of equal parts of lime water and linseed oil, to be shaken togeth- er. In burns not severe, these applications are commonly sufficient to complete the cure. When the burn is violent, or has occasioned a high degree of inflammation, and there is reason to fear a gangrene or morti- fication, the same means of prevention must be used, 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 spirit of wine, tincture of myrrh, or other antiseptics, mixed with a decoction of the bark. In this case the bark must likewise be taken in- ternally, and the patient's diet must be more generous, with wine, &c. As example teaches better than precept, I shall relate the treatment of the most dreadful case of this kind that has occur- red in my practice. A middle aged man, of a good constitu- tion, 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 fre- quently 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 cool- ing regimen, took the saline mixture with small doses of nitre, 452 OF BRUISES. 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 basilicon. W here 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 imme- diately, by which means it often happens that they are neglect- ed. It is needless to give any definition of a disease so uni- versally 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 occasion- ally be added, and to keep" cloths wet with this mixture con- stantly applied to it. This is more proper than rubbing it with brandy, spirit of wine, or other ardent spirit, which is commonly used in such cases. When a bruise is very violent, the patient ought immediate- ly to be bled, and put on a proper regimen. His food should be light and cool, and his drink weak, and of an opening na- ture ; as whey sweetened with honey, decoctions of tamarinds, barley, cream of 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 chamomile flowers, in equal quantities of vinegar and wrater, 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, or oftener. 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 sepa- rates, 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 sqres 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. OF ULCERS. 45S 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 pa- tient's constitution does not suffer by confinement or improper medicine, and to apply nothing to them besides simple oint- ment, spread on soft lint, over which a poultice of bread and milk, with boiled chamomile flowers, or the like, may be put, to nourish the part, and keep it soft and warm. Nature, thus as- sisted, will generally in time operate a cure, by throwing off ^he 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 humors, 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 discharg- ing a thin, watery humor, which is often so acrid as to inflame and corrode the skin ; by the hardness and perpendicular situ- ation 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 re- stored 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 con- stitution be good, they may generally be used with safety. When ulcers either accompany chronical diseases, or come in 454 OF THE FISTULA IN ANO. their stead, they must be cautiously healed. If an ulcer con- duces 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 labor 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 on as their executioners. The most proper regimen for promoting the cure of ulcers is, to avoid all spices, salteoTand highseasoned 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 buttermilk, 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 uker seem hard and callous, they may be sprinkled twice a day with a little red1 precipitate of mercury, and afterwards dressed with the yellow basilicon 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. White, strongly recommends the use of the solution of corrosive sublimate of mercury in brandy, for the cure of obstinate, ill conditioned ulcers. 1 have frequently found this medicine, when given according to the doctor's directions, prove very successful. The dose is a tablespoonful 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 in- formed me, " that he observed washing the sore thrice a day with a solution of a triple strength was very beneficial."* OF THE FISTULA IN ANO. ' Ulcers in the neighborhood of the anus are peculiarly liable to become fistulous, and when in this state are very diffi- * 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 humors to ths sores, and disposes them to heal. ^ OF THE FISTULA IN ANO. 455 cult to cure. A fistula is frequently the consequence of neglected or ill treated piles. The presence of this complaint is discovered by the sensation of a pricking pain on going to stool, which is also perceived during the exertion of coughing or sneezing. On examination, a stain of a pale color, occa- sionally accompanied with a little blood, will be found on the linen ; the feces are also slightly streaked with matter. This matter issues from a small ulcer with one or more orifices, in the neighborhood of the anus, the other extremity of which generally communicates with the internal cavity of the rectum. When this disease is ascertained to be present, costiveness should be guarded against chiefly by means of diet, which ought to be cooling, and consist of ripe figs, roasted apples, and articles of a similar nature. Oatmeal porridge, eaten with milk or beer, for breakfast or supper, rarely fails to keep the body regular. The radical cure of this complaint must depend on the proper application of topical remedies. Much may be done by strict attention to personal cleanliness. The parts should be carefully washed with a sponge and water several times a day, and regularly after going to stool. Stimulent in- jections, as, for example, a solution of corrosive sublimate, or of common culinary salt, or diluted tincture of cantharides, thrown into the fistula by means of a small syringe, or elastic gum bottle, furnished with a conical point, have, when duly persist- ed in, effected a cure. Or the orifice of the fistula may be kept open, and a free passage given to the contained matter, by means of a tent or bougie shaped like a cone, and the ulcer be thus disposed to heal. This disease has also been attempt- ed to be cured by introducing a bougie, or flexible leaden probe into the fistula, passing it through the orifice that com- municates with the rectum, and bringing it out at the anus, then twisting the two opposite extremities together, and occa- sionally tightening them, till they destroy the interposed sub- stance, when the fistula, being reduced to the state of a simple ulcer, heals. „ Drinking any sulphureous mineral water, such as that ot riar- rowgate, improves the constitution in general, and by this means tends to promote the healing of the ulcer. In cold, languid, and what are termed phlegmatic habits, tar water may be taken with considerable advantage. I knew an instance of a fistulous sore, seated near the rectum, being almost healed up by taking regularly half a pint of sea water morning and evening for six weeks together, and believe it might have been completely cured, had tlie person persisted in this course for a sufficient length of time. It is certainly worth while to give any of these i 45.6 OF DISLOCATIONS. remedies a fair trial previous to having recourse to the opera» tion, as even that does not always succeed. Ulcerations about the rectum are frequently symptomatic of affections of the liver. When this is known to be the case, or when they occur about the decline of life, or in persons who have resided long in warm climates, we should not be too busy with our efforts to heal them up. In such persons they seem frequently to operate as salutary drains to the constitution, and to prevent the access of other diseases. Many examples have occurred of persons somewhat advanced in life being attacked by asthma, spitting of blood, paralysis, and even insanity, within a short period of time after undergoing the operation for the radical cure of a fistula, while others, of apparently similar con- stitutions, who have submitted to the inconveniency of a dis- charge, and been attentive to keep the parts clean and warm, have lived to an advanced period of life. Individuals past the meri- dian of life, who determine to undergo the operation for fistula, should never omit to have an issue opened in some other part of the body, which may serve as a succedaneum for the natural drain they are about to obliterate.' A. P. B. CHAP. LI. OF DISLOCATIONS. XX HEN a bone is moved out of its place or articulation, so as to impede its proper functions, it is said to be luxated or dislo- cated. 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 endeavor 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 ex- pert 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, tlie age, robust- f DISLOCATION OF THE JAW. 457 ness, and other circumstances of the patient. When the bone has been out of its place for any considerable time, and a swell- ing 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 at- tempted. All that is necessary after the reduction, is to apply cloths dipped in vinegar or camphorated spirit 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 some- times torn. When these are kept easy till they recover their strength and tone, all goes on very well; but if the injury be increased by too 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 anything, as the teeth of the under jaw do not correspond with those of the upper ; besides, the chin either hangs down or is thrown to- wards one side, and the patient is neither able to speak distinct- ly, 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 down- wards and backwards, by which means the elapsed heads of the jaw may be easily pushed into their former cavities, 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 58 458 DISLOCATION OF THE RIBS. attempt it. A complete dislocation of the neck is instantaneous death. When the neck is dislocated, the patient is immediately de- prived of all sense and motion; his neck swells ; his counte- nance appears bloated ; his chin lies on his breast, and his face is generally turned towards one side. To reduce this dislocation, the unhappy person should imme- diately be laid on 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 pos- ture, he must pull the head with considerable force, gently twist- ing 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 per- form 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, some- times 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 on his belly on a table, and the operator must endeavor 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 re- duce, as neither the hand nor any instrument can be applied internally to direct the luxated heads of the ribs. Almost the only thing that can be done is, to lay the patient upon his belly over a cask, or some convex body, and to move the fore part of the rib inward towards the back, sometimes shaking it. By this f DISLOCATION OF THE ELBOW. 459 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 na- ture 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 armpit; but when it is backward, there appears a protuberance behind the shoulder, and the arm is thrown forwards towards the breast. The usual method of reducing dislocations of the shoulder is to seat the patient on 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 opera- tion, 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 forearm 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 dislo- cation of the elbow; one of them must lay hold of the arm above, and the other below the joint, and make a pretty strong 460 DISLOCATION OF THE THIGH. 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, 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 upwards at the same time, by which means the limb is shorten- ed, 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 on his back, and made fast by bandages, or held by assistants, while, by oth- ers, an extension is made by means of slings fixed about the bottom of the thigh, a little above the knee. While the exten- sion is made, the operator must push the head of the bone out- ward, till it gets into the socket. If the dislocation be outward, the patient must be laid on his face, and, during the extension^ the head of the bone must be pushed inward. Dislocations of the knees, ankles, and toes, are reduced much in the same manner as those of the upper extremities, by mak- ing an extension in opposite directions, while the operator re- places the bones. In many cases, however, the extension alone is sufficient, and the bone will slip into its place merely by pull- ing 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.* • * "When the force of the muscles in very robust persons resists every effort to reduce a dislocated limb, a grain or two of emetic tartar dissolved in water may be administered, and, taking advantage of the general languor and debility that precedes the act of vomiting, the limb may be redaced with facility, t bavc known this plan successfully practised. A. P. $> OF BROKEN BONES 461 CHAP. III. OF BROKEN BONES, &c. THERE is, in most country villages, some person who pre- tends 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 this is impracticable, they must be employed : we shall therefor^ recommend the fol- lowing 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 ne- cessity 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 immediate- ly 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, on 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 462 OF BROKEN BONES. himself, otherwise the action of the muscles may pull the bone out of its place.* It is of great importance to keep the patient dry and clean while in this situation. By neglecting this, he is often so galled and excoriated, that he is forced to keep shifting places for ease. I have known a fractured thigh bone, after it had been kept straight for above a fortnight, displaced by this means, and continue bent for life, in spite of all that could be done. It has been customary, when a bone was broken, to keep the limb for five or six weeks continually on the stretch. But this is a bad posture. It is both uneasy to the patient, and unfavorable to the cure. The best situation is to keep the joint a little bent. This is the posture into which every animal puts its limbs when it goes to rest, and in which few- est muscles are on the stretch. It is easily effected, by either laying the patient on his side, or making the bed so as to favor 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 ope- ration useless. When a fracture is accompanied with a wound, it must be dressed in all respects as a wound. All that art can do towards the cure of a broken bone, is to lay it perfectly straight, and to keep it quite easy. All tight bandages do hurt. They had much better be omitted alto- gether. 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, docs more mischief than would be occasioned by the want * 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 Frac-* tures, lately published by my ingenious friend Mr. Aitkin, surgeon, in Edin- burgh ; wherein this gentleman has not only given an account of the machine* 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. OF STRAINS. 463 of it. Some of the most sudden cures of broken bones, which were ever known, happened where no bandages were appli- ed at all. Some method, however, must be taken to keep the member steady; but this may be done many ways, with- out bracing it with a tight bandage. The best method of retention is by two or more splints made of leather or pasteboard. These, if moistened before they are applied, soon assume the shape of the included mem- ber, and are sufficient, by the assistance of a very slight ban- dage, 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 ankles 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 everything 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 ot 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 in- to an incurable malady what might have been removed by only keeping the part easy for a few days. People in the country generally immerse a strained limb in cold water. This is very proper, provided it be done immedi- ately, and not kept in too long. But the custom of keeping the part immersed in cold water for a long time is certainly dan- gerous. It relaxes, instead of bracing the part, and is more likely to produce a disease than remove one. 464 OF RUPTURES. 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 appli- ed too tight. I have frequently known bleeding near the af- fected 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. A great many external applications are recommended for strains, some of which do good, and others hurt. The follow- ing are such as may be used with the greatest safety : poultices made of stale beer, or vinegar and oatmeal, camphorated spirit 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. OF RUPTURES. Herniae, or Ruptures, are not, as the term that has long teen adopted would lead us to suppose, a rupture of some of the parts, which form the contents of the cavity of the abdo- men or belly, or of both of them. This disease is, in general, the protrusion of a soft part, which yet remains covered by the common integuments, forming a preternatural tumor in the ab- domen ; and they are differently named according to the places where they are situated. The situations of this protrusion are, the groin, scrotum, and labia pudenda ; the upper and fore part of the thigh ; the umbilicus, or navel; and different parts between the interstices of the abdominal muscles. Children and old people are most liable to this disease. In the former, it is generally occasioned by excessive crying, cough- ing, vomiting, or the like. In the latter, it is commonly the effect of blows or violent exertions of the strength, as leaping, car- rying great weights, &c. In both, a relaxed habit, indolence, and an oily or very moist diet, dispose the body to this dis- ease. 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 examin- ed. The protrusion of a very small part of the bowel will oc- casion all these symptoms; and, if not returned in due time, will prove fatal. On the first appearance of a rupture in an infant, it ought to be laid on its back, with its head very low. OF RUPTURES. 465 While in this posture, if the bowel does nonreturn 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 con- siderable time. The method of making and applying rupture bandages for children is pretty well known. The child must, as far as possible, be kept from crying, and from all violent ex- ertions, till the rupture is quite cured. In adults, when the bowel 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 1 have been fortunate enough", however, always to succeed in my attempts to return the bowel, 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 on his back, with his head very low, and his breech raised high with pib lows. In this situation, flannel cloths wrung out of a decoction of mallows and chamomile 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 tumor 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 hands, must with his fingers artfully conduct ^ the bowel in by the same aperture through which it came out. The manner of doing this can be much easier conceived than described. Should these endeavors prove ineffectual, clysters of the smoke of tobacco may be tried. These have been often know 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 opera- tion. Cutting for the hernia is a nice and difficult matter. I would therefore advise surgeons to try every method of return- ing the bowel before they have recourse to the knife. 1 have once and again succeeded by persevering in my endeavors, af- ter eminent surgeons had declared the reduction of the bowel impracticable without an operation.* * 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 mar 59 466 OF CASUALTIES. An adult, after .the bowel has been returned, must wear a truss. 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 be- come quite easy. No person, who has had a rupture after arriving at man's estate, should ever be without one of these trusses. Persons who have a rupture ought carefully to avoid all vio- lent 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. JT 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 on 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 stopped by unwholesome vapor, 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 into a warm bed, is generally hurried away to a church, or a barn, or some other cold, damp house, where, be immediately reduced. By neglecting this, many perish who were not sus- pected to have had ruptures till utter they were dead. 1 have known this happen where half a dozen of the faculty were in attendance. OF SUBSTANCES STOPPED, &c. 467 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 supersti- tious notion, which forbids the body of any person killed by accident to be laid in a house that is inhabited. What the ground of this superstition may be, we shall not pretend to in- quire ; but surely the conduct founded on 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 windpipe or gullet; and, if this is the case, attempts must be made tore- move 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 can- not 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 unhap- py 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 collecting 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 STOPPED BETWEEN THE MOUTH AND STOMACH. Though accidents of this kind are very common, and ex- tremely dangerous, yet they are generally the effect of care- lessness. Children should be taught to chew their food well, and to put nothing into their mouths, which it would be dan- gerous for them to swallow. But children are not the only persons guilty of this piece of imprudence. 1 know many adults, who put pins, nails, and other sharp pointed substances in their mouths on every occasion, and some, who even sleep with the former there all night. This conduct is exceedingly 468 OF SUBSTANCES STOPPED BETWEEN injudicious, as a fit of coughing, or twenty other accidents, may force down the substance before the person is aware.* When any substance is detained in the gullet, there are two ways of removing it,—either by extracting it, or pushing it down. The safest and most certain way is to extract it; but this is not 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 re- ception into the stomach. The substances which may be push- ed 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 pos- sible, to be extracted, especially if these bodies be sharp point- ed, as pins, needles, fishbones, pieces of glass, &c. When such substances have not passed in too deep, we should endeavor to extract them with our fingers; which method of- ten succeeds. When they are lower, we must make use of nip- pers, 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 pincers 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 conducting it, there should likewise be a curve or bend- ing, 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 fishbone, sticks across the gullet, the hook, in such cases, seiz- ing 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 straighten it by their resistance, a kind of rings, made either of wire, wool, or silk, may be used. A piece of fine wire • 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. THE MOUTH AND STOMACH. 469 of a proper length may be bent into a circle, about the middle, of about an inch diameter, and the long unbent sides brought paral- lel, and near each other: these are to be held in the hand, and the circular part or ring introduced into the gullet, in order to be conducted about the obstructing body, and so to extract it. More flexible rings may be made of wool, thread, silk, or small packthread, which may be waxed for their greater strength and consistence. One of these is to be tied fast to a handle of iron wire, whalebone, 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 twisted, as to be moved every way, which must in many cases be a considerable advantage. Another material employed on these unhappy occasions is the sponge. Its property of swelling considerably on being wet is the principal foundation of its usefulness here. If any substance is stopped in the gullet, but without filling up the whole passage, a piece of sponge may be introduced into that part which is unstopped, 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 me 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 piece 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. 1 have often known pins and other sharp bodies, which had stuck in the throat, brought up by causing the person to swal- low a piece of tough meat tied to a thread, and drawing it 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 470 OF SUBSTANCES STOPPED, &c 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 soaielimes occa- sion 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 tick- ling his throat with a feather; and, if this should not succeed, a clyster oi tobacco may be administered. It is made by boil- ing a drachm of tobacco in twelve ounces 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 whalebone, 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 endeavors either to extract or push down the substance must prove ineffectual, they should be discontinued; because the inflammation occasioned by per- sisting 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 re- moved. 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 soothe the irritated parts, but, when thrown in with force, are often more successful in loosen- ing the obstruction, than all attempts with instruments. When, after all our endeavors, 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 on 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. OF DROWNED PERSONS. 471 A proper degree of agitation has sometimes loosened the in- hering body more effectually than instruments. Thus a blow on the back has often forced up a substan6e which stuck in the gullet; but this is still more proper and efficacious when the substance gets into the windpipe. In this case, vomiting ana 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 pa- tient 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 suffo- cated, and all hope of freeing the passage is vanished, so that death seems at hand, if respiration be not restored ; the opera- tion of bronchotomy, or opening of the windpipe, must be direct- ly 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 emergen- cies, we thought proper to mention it, though it should only be attempted by surgeons 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 re- covery. But as several circumstances may happen to have continued life, in such an unfortunate situation, beyond the ordi- nary 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. * No man should attempt to put an instrument down his neighbor's throat when a surgeon can be found to do it. The best instrument either to raise or push down anything in the gullet, is the probang, which is a flexible piece of whalebone, with a conical piece of sponge tied to its end, with the point downwards. C 472 OF DROWNED PERSONS. 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, on 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, he. 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 spirit 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 also to be chafed with volatile spirit. To renew the breathing, a strong person may blow his own breath into the patient's mouth with all the force he can, hold- ing his nostrils at the same time. When it can be perceived, bv 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, alternatelv inflating and de- pressing the lungs so as to imitate natural respiration. If the lungs cannot be inflated in this manner, it may be at- tempted by blowing through one of the nostrils, and at the same time keeping the other close. Dr. Monro, for this purpose, re- commends 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. OF DROWNED PERSONS. 473 When air cannot be forced into the chest by the mouth or nose, it may be necessary to make an opening into the windpipe for this purpose. It is needless, however, to spend time in des- cribing this operation, as it should not be attempted unless by persons skilled in surgery. 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 endeavors prove ineffectual. Where there are no conveniences 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 on hot ashes, co- vering her with others equally hot, putting a bonnet on her head, and a stocking round her neck, stuffed with the same, and heap- ing coverings ever 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. Till the patient shows some signs of life, and is able to swal- low, 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, dipped in warm brandy or other strong spirit; and, as soon as he has recovered the power of swallow- ing, 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 reani- mated ; 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 tablespoonful of which, diluted with water, may be given every quarter of an hour, till the patient has taken five or six doses. Where this medicine is not at hand, a strong infusion of sage, chamo- mile 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. 60 474 OF NOXIOUS VAPORS. 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 adminis- tered. Lastly, though the person should be manifestly reani- mated, 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 infusion. Such persons as have the misfortune to be deprived of the ' appearance 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 being 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 on 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 this fact, that many of those unhappy persons, who have lost their lives by falls, blows, and other accidents, might have been saved by the use of proper means, duly persisted in. OF NOXIOUS VAPORS. Air may be many ways rendered noxious, or even destruc- tive, 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 coal fires. Some, indeed, suppose the danger here proceeds from the sul- phureous oil contained in the coal, 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 OF NOXIOUS VAPORS. 475 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, without due ventilation. 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 vapor which exhales from wine, cider, beer, or other liquors, in the state of fermentation, contains something poisonous, which kills in the same manner as the vapor of coal. Hence tliere is always danger in going into cellars where a large quan- tity 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 vapors arising from them produce the same effects as those mentioned above. For this reason, no person ought to venture into a well, pit, cellar, tomb, or any place that is damp, and has been long shut up, till the air has been sufficiently purified. 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 ex- tinguished, no one ought to enter till the air has been first puri- fied by ventilation. The offensive smell of lamps and of candles, especially when their flames are extinguished, operates like other vapors, though with less violence, and less suddenly. There have, however, been instances of people's being killed by the fumes of lamps which had been extinguished in a close chamber ; and persons of weak, delicate lungs, generally find themselves quickly op- pressed 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 476 EFFECTS OF EXTREME COLD. 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 buck- thorn and tincture of senna, of each two ounces ; or, in their stead, half an ounce of turpentine dissolved in the yelk 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 for- mer part of this chapter, may be used to restore the circulation, warmth, he. Mr. Tossach, surgeon at Alloa, relates the case of a man suf- focated 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. Frevven, of Sussex, mentions the case of a young man who was stupified by the smoke of seacoal, but was recovered by being plunged into cold water, and afterwards laid in a warm bed. The practice of plunging persons suffocated by noxious vapors into cold water would seem to be supported by the com- mon experiment of suffocating dogs in the grotto del cani, and afterwards recovering them by throwing th^m into the neigh-» boring 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 pro- portion of blood towards the brain; so that the patient dies of a kind of apoplexy, preceded by great sleepiness. The tra- veller, in this situation, who finds himself begin to grow drowsy, , should redouble his efforts to extricate himself from the immi- nent 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 EFFECTS OF EXTREME COLD. 477 danger of a mortification, if proper means are not used to pre- vent it. The chief danger in this situation arises from the sud- den application of heat. It is very common, when the hands or feet are pinched with cold, to hold them to the fire; yet reason and observation show, that this is a most dangerous and impru- dent 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 re- gard to animals in this condition. Wrhen 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 re- vived. I have always thought, that the whitloes, kibes, chilblains, and other inflammations of the extremities, which are so com- mon among the peasants in the cold season, were chiefly occa- sioned 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. 478 OF FAINTING FITS, &c. 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 spirit, and other things of a stimu- lating nature, may be applied to the skin, which should be well rubbed with coarse cloths, whipped with nettles, or other stimu- lating things. Some of the ancient physicians are said to have restored to life persons apparently dead, by beating them with rods. Headaches are often occasioned by exposure to intense heat; and in warm climates, where people are very liable to what they call coups de soleil, or strokes of the sun, it is a common custom to lay linen cloths, several times doubled, on the head, and to keep them moistened with very cold water for half an hour, or till the stupor is diminished. This they term drawing the fire out of the head. CHAP. X.XV. 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 quan- tity 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 *£ * OF FAINTING FITS, &c. 479 0 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 frequent- ly in the same person, he should, in order to escape them, con- fine himself to a light diet, consisting chiefly of bread, fruits, and other vegetables. His drink ought to be water or small beer, and he should sleep but moderately, and take much ex- ercise. But fainting fits proceed much oftener from a defect than an excess of blood. Hence they are very ready to happen after great evacuations of any kind, obstinate watching, want of ap- petite, 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, be- ing covered, should have his legs, thighs, arms, and his whole body, rubbed strongly with hot flannels. Hungary water, vola- tile 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, mix- ed with sugar and cinnamon, which is an excellent cordial, may be poured into his mouth. A compress of flannel dipped in hot wine or brandy must be applied to the pit of his stomach, and warm bricks, or bottles filled with hot water, laid to his feet. As soon as the patient is recovered a little, he should take some strong soup or broth, or a little bread or biscuit soaked in hot spiced wine. To prevent the return of the fits, he ought to lake often, but in small quantities, some light, yet strengthen- ing nourishment, as panada made with soup instead of water, new laid eggs lightly poached, chocolate, light roast meats, jel- lies, 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 hap- pen after artificial bleeding are seldom dangerous, generally terminating as soon as the patient is laid on 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 spirit 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 such like ; emollient clysters will likewise be proper, and the patient's strength should afterwards be recruited, by giving him generous cor- dials, and anodyne medicine. 480 OF FAINTING FITS, &c. Faintings are often occasioned by indigestion. This may either proceed from the quantity or qualit}' of the food. When the former of these is the cause, the cure will be best perform- ed by vomiting, which may be promoted by causing the patient to drink a weak infusion of chamomile flowers, carduus bene- dictus, or the like. When the disorder proceeds from the na- ture 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 tilings held to his nose, and those substances which are disa- greeable to him ought immediately to be removed. But we have already taken notice of swoonings, which arise from ner- vous disorders, and shall therefore say no more on this head. Fainting fits often happen in the progress of diseases. In the beginning of putrid diseases, they generally denote an op- pression at the stomach, or a mass of corrupted humors, 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 exter- nalty 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 weak- ness or exhaustion. Dr. Englcman relates the case of a wo- man " in childbed, who, after being happily delivered, sudden- " ly fainted, and lay upwards of a quarter of an hour apparently "dead. A physician was sent for. Her own maid, in the " meanwhile, being out of patience at his delay, attempted to " assist her herself, and, extending herself on her mistress, ap- " plied her mouth to hers, blew in as much breath as she possi- " bly could, and in a very short lime the exhausted woman OF FAINTING FITS, &c. 481 " awaked as out of a profound sleep; when, proper things be- " ing given her, she soon recovered. " The maid, being asked how she came to think of this ex- " p'edient, said, she had seen it practised at Altenburgh, by " midwives, on children with the happiest effect." We mention this case chiefly that other persons may be in- duced 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 restor- ed to life. From whatever cause fainting fits proceed, fresh air is al- ways of the greatest importance to the patient. By not attend- ing to this circumstance, people often kill their friends while they are endeavoring 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 so far as to admit a stream of fresh air. Persons subject to frequent swoonings 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 there- by suspended, the humors 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 pos- sible, to be removed. I have before remarked, but I deem it of importance to re- peat the observation, that itis only when the fainting evidently arises from a fulness of the habit, and is accompanied with a total abolition of feeling and understanding, that bleeding is adviscable. The use of the lancet might otherwise have the most deadly effect. -1 Many persons, even of robust constitu- tions, are very apt to faint on having a vein opened, and losing a little blood. How dangerous, then, must the operation be, when a patient has already fainted, and most probably from 61 482 OF INTOXICATION. extreme weakness and a defect of blood ! I have no doubt but many a murder has been rashly committed in such cases* OF INTOXICATION. The effects of intoxication are often fatal. No kind of poison kills more certainly than an overdose of ardent spirits. Sometimes, by destroying the nervous energy, they put an end to life at once ; but in general their effects are more slow, and in many respects similar to those of opium. Other kinds of intoxicating liquors 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 sto- mach 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 person, when drunk, should be left by himself, till his clothes have been loosened, and his body laid in such a posture as is most favorable for continuing the vital motions, and discharging the contents of the stomach. The best pos- ture for discharging the contents of the stomach is to lay the person on 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 anything 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. 1 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 co- agulated the milk in such a manner, that it could never be di- gested. The safest drink after a debauch is water with a toast, tea, infusions of bnlm, sage, barley water, and such like. If the person wants to vomit, he may drink a weak infusion of chamomile 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 in- toxication, which indicate danger, and proposing a general plan of treatment for persons in this situation, 1 shall briefly OF SUFFOCATION AND STRANGLING. 483 relate the history of a case, which lately fell under my own ob- servation, 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 this situation for several hours, till at length his uneasy manner of breathing, the coldness of the ex- tremities, and other threatening symptoms, alarmed his friends, and made them send for me. 1 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, ap- plying volatile spirit, 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, 1 ordered his legs to be put in- to warm water, and a sharp clyster to be immediately adminis- tered. 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 show 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 neighbor, a few days before, who had been advised to drink a bottle of spirit to cure him of an ague, expired under very similar circum- stances.* OF SUFFOCATION AND STRANGLING. These may sometimes proceed from an obstruction of the lungs, produced by viscid, clammy humors, or a spasmodic * I have seen repeated instances of persons being restored to perfect so- briety, and the complete use of their senses, from a state of mo?t alarming in- toxication, by taking away eight or ten ounces of blood from the nape of the neck, as near the head as possible, by means of cupping glasses. The same effect is produced by taking blood from the arm, but the practice is not per- haps quite so safe ; cupping certainly deserves the preference. A. P. B. 484 OF SUFFOCATION AND STRANGLING. affection of the nerves of this organ. Persons who feed gross- ly, and abound in rich blood, are very liable to suffocating fits from the former of these causes. Such ought, as soon as they arc 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 spasmo- dic 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 drunk ; to a cup of which, a teaspoonful of the paregoric elixir may occasionally be added. Fresh air should be freely admitted to him. Infants are often suffocated by the carelessness or inatten- tion of their nurses.* 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 of Paris, as it was attended with success, and contains almost everything that can be done on such occasions. A nurse having had the misfortune to overlay a child, he was called in, and found the infant without any signs of life ; no pul- sation in the arteries, no respiration, the face livid, the eyes open, dull, and tarnished, the nose full of mucus, the mouth gaping; in sh6rt it was almost cold. Whilst some linen cloths 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 decree of heat, Mr. Janin buried him in them, except the face, placed htm on the side opposite to that on which he had been at first laid, and covered him with a blanket. He had a bottle » * These accidents are not always tlie effects of carelessness. I have known an infant overlaid by its mother being seized in the night with an hysteric fit. This ought to -em* as a caution against employing hysterical women an nurses ; and should likewise teach such women ne\er to lay an in- fant in the same bed with themselves, but in a iiuall adjacent one. OF SUFFOCATION AND STRANGLING. 485 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 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 adviseable 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 adminis- tered 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 twentynine 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 spirit 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 windpipe, 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 show what may be done for the recovery of those unhappy persons who strangle themselves in a fit of despair. 486 PERSONS WHO EXPIRE IN CONVULSIONS. OF PERSONS WHO EXPIRE IN CONVULSIONS. 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 seeming to ex- pire 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 in- fants having been restored to life, after they had to all appear- ance expired in convulsions; but we shall only relate the fol- lowing instance, mentioned by Dr. Johnson, in bis pamphlet on the practicability of recovering persons visibly dead. In the parish of St. Clements in Colchester, a child of six months old, lying on 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 cofhn to be made ; but a neighboring gentlewoman, who used to admire the child, hearing of its sudden death, hastened to the house, and on 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 ; on 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 per- son, were sufficient to restore to life an infant to all appearance dead, and who, in all probability, but for the use of these simple endeavors, 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 spirit, co- vering it with warm ashes or salt, blowing air into the lungs, PERSONS WHO EXPIRE IN CONVULSIONS. 487 throwing up warm, stimulating clysters into the intestines, and such like. When children are dead born, or seem to 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 men- tioned above. These directions may likewise be extended to adults, atten- tion 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 endeavors of persons to- tally ignorant of medicine, in assisting those whose life is sud- denly endangered 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 pub- lic, and to excite the humane and benevolent to exert their utmost endeavors for the preservation of their fellow men. The society for the recovery of drowned persons, instituted at Amsterdam in the year 17G7, had the satisfaction to find, that no fewer than one hundred and fifty 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 u^ed with so much effica- cy in recovering drowned persons are, with equal success, ap- plicable 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 shock- ing 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 endeavors are most likely to be at- tended with success, are all those called sudden deaths from an invisible cause, as apoplexies, hysterics, faintings, raid many other disorders, wherein persons in a moment sink down and seem to expire. The various casualties in which they may be tried are, suffocations from the sulphureous damps of mines, coal pits, he.; the unwholesome air of long unopened vyells or caverns ; the noxious vapors arising from fermenting liquors ; the steams of burning charcoal; sulphureous mineral acids ; ar- senical effluvia. The various accidents of drowning, strangling, and apparent deaths, by blows, falls, hunger, cold, he. likewise furnish op- portunities of trying such endeavors. Those, perhaps, who^ to appearance, are killed by lightning, or by any violent agitation 488 OF COLD BATHING, &c. of the passions, as fear, joy, surprise, and such like, might als« be frequently recovered by the use of proper means, as blowing strongly into the lungs, &.c. The means to be used for the recovery of persons suddenly deprived of life, are nearly the same in ail cases ; they are practicable by every one, who happens to be present at the ac- cident, and require no great expense, and less skill. The great aim is to raetore the warmth and vital motions. This may in general be attempted by means of heat, frictions, 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 dis- couraging circumstances, or to leave off their endeavors 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 labor. It were greatly to be wished, that an institution, similar to that of Amsterdam, was established, on a more extensive plan, in Great Britain ; and that reward was allowed to every one who should be instrumental in restoring to life a person seem- ingly dead.* Men will do much for fame, but still more for money. Should no profit, however, be annexed to these be- nevolent 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. OF COLD BATHING, AND DRINKING THE MINE- RAL WATERS. IN a note subjoined to the "Cautions," given in former edi- tions of this work, concerning the use of the cold bath and of * The author is happy to observe, that, since the first publication of this work, several societies have been instituted in Britain with the same benevo- lent intention as that of Amsterdam, and that their endeavors have proved no less successful. H« is likewise happy to observe, that premiums have been awarded to those who have been active in their endeavors 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 ! OF COLD BATHING, &c. 489 mineral waters, I pledged myself to treat the subject more. at length on a future occasion ; and I now mean to fulfil this pro- mise. The discussion will be naturally divided into two parts. In the first, I shall endeavor to illustrate the extensive utility of the cold bath, in preserving as well as restoring health ; and shall point out the cases where it may be hurtful. I propose, in the second part, to give a particular account of the qualities of the most celebrated mineral waters in our own island, and on the continent;—to specify the diseases wherein they are re- spectively indicated ;—and to lay down the best practical rules for employing them with safety and benefit. I need not enlarge on the importance of such details. Everybody knows, that the best things are liable to the greatest abuse ; and as nature does not afford more active or more powerful medicines than those in question, any error in the application may be, and often is, attended with considerable danger. OF COLD BATHING; WITH REMARKS ON THE CASES IN WHICH THE WARM BATH IS MORE ADVISEABLE. Immersion in cold water is a custom which lays claim to the most remote antiquity. Indeed, it must have been coeval with man himself. The necessity of water for the purpose of clean- liness, and the pleasure arising from its application to the body in hot climates, must very early have recommended it to the human species. Even the example of other animals was suffi- cient to give the hint to man. By instinct, many of them are W to apply cold water in this manner ; and some, when de- prived 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 little consequence : our business is to point out the advantages which may be derived from it, when judiciously resorted to, and the danger attending its improper use. People are apt to imagine, that the simple element of water can do no hurt, and that they may plunge into it at any time with 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 as to become absolutely incurable. Without a proper discrimination with regard to the 62 490 OF COLD BATHING, &c. disease and the constitution of the patient, the most powerful medicine is more likely to do harm than good. The physician, who cured Augustus by cold bathing, killed his heir by the very same prescription. This 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 these elegant and fashionable pieces of luxury. But as no such laws exist in this country, every one does ihdt which is right in his own eyes, and of course many must do wrong. I hope, how- ever, that, when better informed, they will learn to correct errors of so fatal a tendency. Absurd prejudices against cold bathing are not less blameable, on the other hand. Though it should never be prescribed for the cure of diseases, without well considering the nature of each case, it cannot be too earnestly or too generally recommended as a preservative of health. I am therefore sorry to see some modern writers attempting to revive the whimsical and long ex- ploded doctrine of Galen, who said, that immersion in cold water was fit only for the young of lions and bears; and that warm bathing was conducive to the growth and strength of in- fants. How egregiously do the greatest men err, whenever they lose sight of facts, and substitute sallies of wit, or specious arguments, in physic for observations and experience! By these the superior excellence of the cold bath is placed beyond the possibility of a doubt. Its tonic powers are found to be pecu- liarly proper for the lax fibres of young people, rendering them firm and elastic, and enabling tlie vital organs to perform their respective functions with ease and regularity. In other parts of this work I had occasion to describe, with greater minuteness than is now necessary, tlie many good effects of washing children ; and I gave a few directions as to the man- ner of employing this very salutary operation, from the moment of their birth. I showed how the use of the cold bath might be gradually brought about with the utmost safety ; and I am per- suaded, that those who give it a fair trial will readily comply with my further advice, to continue it ever after, except in such rases of indisposition or infirmity as I shall presently notice. Nothing contributes more to the growth, vigor, and firmness of youth, or to the activity and permanent health of manhood, than daily immersion in cold water. It steels the frame against changes of weather, against the impressions of cold or moisture, and many other external injuries. It is of course the best pre- ventive of all those diseases w4iich arise from a relaxed skin, obstructed or profuse perspiration, and nervous weakness. OF COLD BATHING, &c. 491 When the cold bath is used merely as a means of preserving health, in which point of view I am now considering it, one or two plunges or dips of the whole body will be sufficient, though active swimmers may continue their favorite amusement for five or six minutes without injury. Any longer stay might prove dangerous, by not only occasioning an excessive flux of humors towards the head, but chilling the blood, cramping the muscles, relaxing the nerves, and wholly defeating the inten- tion of bathing. For want of a due regard to these circum- stances, young men have often endangered, and sometimes lost their lives. In all cases, it is highly necessary to be rubbed dry at the instant of coming out of the water, and to take exercise for at least half an hour after. A little exercise is also advise- able before bathing, so as to excite a gentle glow or temperate degree of warmth, and thus guard against the bad consequences of a shock, when the body is either chilly or overheated. The like caution should be given against plunging into cold water after dinner, or after much fatigue. For these and many other reasons, the morning or forenoon is very properly recom- mended to persons in health as the best time for bathing. It is the least likely to interfere with their other pursuits or concerns; it washes away any particles of the perspirable matter, that may have remained on the surface of the skin, before they can be reabsorbed ; it affords fresh supplies of vigor and alacrity, to enter on the duties of the day; and, as 1 have already hinted, it fortifies the body against any change? of weather, to which it may be afterwards exposed in a far lighter element. In a stale of perfect health, it may be further observed, that people need not give themselves much trouble to enjoy the advantages of sea bathing in preference to river water, as the grand effect of both is nearly the same, though some consider rations of less moment may concur to render the former more inviting. Among these we must reckon the usual resort of gay company to different parts of the coast in summer, the refresh- ing coolness of the sea air in this season, and the. agreeable stimulus which many persons experience from the action of saline particles, not only in the water, but when they are float- ing in the atmosphere. It. should also be considered, that the temperature of the sea is more uniform than that of rivers, never rising so high, or sinking so low, in any change of weather. But such points of difference arc chiefly interesting to valetudinarians. What I have said of the cold bath, when used ns the means of preventing disease, will throw some light on the propriety of occasionally resorting to it as an important remedy. In cases of peculiar delicacy and danger, it is an instrument which 492 OF COLD BATHING, &c. can only be entrusted to the most skilful hands; but in many other less critical situations, a few plain rules may be of con- siderable service. The first object to be attended to in the use of the cold bath, as a remedy, is, whether the patient is not too much enfeebled to bear the shock. This cannot always be determined by ap- pearances ; but a single experiment will remove all doubt. If the immersion be followed by a pleasant glow, and a sense of increasing alacrity, it is the best proof of its agreeing with the constitution, and of its being likely to have a happy influence on the whole frame. Hence the cold bath is found to be an ex- cellent bracer and restorative in cases of languor, of habitual las- situde, and of muscular or nervous weakness, when arising from much confinement, a sedentary life, intense study, or any of the usual causes of relaxation. But it is always understood, that, in every instance of this sort, a sufficient strength of original stamina still remains to produce a proper reaction of the heart and arteries, on which all the salutary effects of bathing depend. The great efficacy of the cold bath, and particularly of sea bathing, has often been experienced in scrofulous complaints, which are always attended with a relaxation of the fibres, and a strong disposition to languor and indolence. In such cases, sea bathing is not only recommended as a tonic, or bracer, but as a powerful detergent and purifier also, especially if the sea water be used internally at the same time. . No difference of opinion prevails on this head, so far as it relates to the scrofula; but it has been alleged, that sea bathing, though a good preven- tive of the scrofula, could not remove the local effects of the disease when once formed. My own practice in the treatment of scrofulous affections has not been extensive enough to en- able me to speak to this point with a tone of confidence; but the contrary doctrine appears to me supported by the fairest reasoning, and, what is more, by indisputable facts. In the first place, a weak, flaccid habit, and a thin skin, very susceptible of impressions from cold, moist air, are the princi- pal, if not the only predisposing causes of the scrofula. Now the cold bath is the best remedy for both, as it renders the tex- ture of the skin firm, and invigorates the system. By being, therefore, so well adapted to obviate causes, it must, according to one of the surest maxims of medical practice, be very fit to remove effects. The justness of such an inference has been placed beyond a doubt, by the reports of men of professional eminence and veracity, under whose direction, and immediate inspection also, sea bathing has been known to resolve swellings of the glands, as well as to correct the discharge of scrofulous ulcers, and OF COLD BATHING, &c. 493 dispose them to heal. I am therefore very willing to believe, that a regular course of sea bathing, and the internal use of sea water, with the aid of good air, proper exercise, and a light, yet nourishing diet, are the best means, as yet discovered, of checking the progress of the evil, or counteracting its mor- bid effects. But, in order to prevent any possible misconception of my meaning, it may be necessary to add, that my opinion of the efficacy of sea water in scrofulous complaints, is confined to its probable removal of the outward symptoms of the malady, before these have arrived at a certain pitch, or have reduced the pa- tient to a state of extreme debility; in which case, as well as in all internal affections of the scrofula, when it has once fasten- ed on the lungs, or any other vital part, bathing in the sea, or drinking its waters, would be not only useless, but extremely injurious. It would also imply too great a confidence in the salutary virtues of sea bathing, to prescribe it as a remedy for cutane- ous disorders in general. To many of them the warm bath is much better adapted; and the proper choice of the one or the other can only be determined by a skilful physician, after a due consideration of the patient's case. Some eruptions, if im- prudently repelled by the action of cold on the skin, may car- ry back into the habit the seeds of disease, to be deposited, perhaps, on some vital part, in spite of nature's kind efforts to throw them off. But a medical man will not prescribe sea bathing in any case where pimples or blotches appear on the surface, without recommending the internal use of the sea water at the same time, to determine regularly and moderately to the bowels, so as to carry offall impurities, without the least injury to the general health, spirits, or appetite. In the external use of some mineral waters, the same precaution is necessary. Though, as before observed, there may be very little differ- ence between the effects of sea water and of river water of the same temperature, when applied to a sound skin and healthy body, yet the gently stimulant, detergent, and healing properties of the saline impregnation of the former must give it a decisive superiority in many diseases of the surface and habit. It cleanses sores, and forwards the process of granulation. It of- ten disperses tumors that have resisted the most powerful dis- cutient medicines. Even deeply seated ulcers, though beyond the reach of other applications, sometimes yield to the pene- trating action of sea water. We must not forget, however, that its internal use is a necessary auxiliary in all these cases, and others of a similar nature. About half a pint of it, which con- tains somewhat more than a quarter of an ounce of salts, taken 494 OF COLD BATHING, &e. in the morning, immediately on coming out of the sea, and the like dose in half an hour after, will commonly answer the pur- pose of a mild purgative. The quantity may be augmented, or the dose repeated, if requisite, with perfect safety, and little in- convenience. It excites thirst, but seldom nausea, unless the stomach is very irritable, or the patient very squeamish. In chronic diseases, where a cure cannot be expected but from the long continued use of any remedy, it is a great re- commendation of the sea water, that it may be persevered in for a considerable time, without weakening the stomach, the in- testines, or the constitution in general. Instances frequently occur of persons, who keep the body moderately open by its daily use for months together, and yet enjoy, during the whole time, a good appetite, and excellent powers of digestion, with increased vigor both of body and mind. It is always most ad- viseable to make use of the sea water externally and internal- ly, in the manner here directed, only twice or three times a week, till the *palient is encouraged by degrees to employ the salutary process every day. It should also be gradually dis- continued in the same manner, after the desired end is obtained. There are several disorders, besides those alreadjr mention- ed, particularly ardent fevers-, and various cases of local in- flammation and muscular rigidity, in which the external appli- cation of cold water may produce good effects. But many of them require great accuracy of distinction, as well as the utmost judgment and caution in the use of a remedy, which a small mistake, or a small change of circumstances, may render hazardous. In a work like this, designed for popular instruc- tion, it would be improper to encourage rash experiments, by pointing out such niceties in medical practice as are safe only when under the guidance of medical skill. I do not know any thing in its own nature so salutary, and yet so liable to be abused, as the cold bath. I shall therefore proceed to touch on the cases, where the inconsiderate or improper application of such a remedy may prove injurious, and sometimes fatal. It is not merely in the critical cases just alluded to, but in many slighter indispositions, that injudicious immersion in cold water may be attended with very serious consequences. Fe- vers are much oftener produced than cured by cold bathing, if rashly resorted to. Disorders of the intellectual functions, palsies, apoplexies, and death, may be, and are frequently oc- casioned by a single dip, in cases either of extreme nervous de- bility, or of extreme fulness. When 1 reflect on the frantic pre- cipitancy with which I have seen many persons of very weak, and others of very plethoric habit, after a rapid journey from London to some watering place, plunge instantly into the sea, OF COLD BATHING, &c. 495 without the least preparation, so far from being surprized at the numbers who suffer, I am rather astonished that any should escape. In order to prevent the ignorant and the thoughtless from falling victims to their indiscretion, and to guard persons afflicted with particular complaints against the use of an im- proper medicine, I shall point out the principal indispositions, in which the cold bath would be likely to aggravate the symp- toms, and even to endanger the life of the patient. When cold bathing occasions chilness, loss of appetite, lisf- lessness, pain of the breast or bowels, a prostration of strength, or violent headache, it ought to be discontinued. These un- pleasant sensations are the surest proofs, that the actual state of the patient's habit is unfit to bear the shock; and that either the reaction of the heart and arteries is too weak to overcome the cold pressure on the surface, or that the determination to the head, or to some other vital part, is too rapidly increased. Everybody's feelings, after immersion in cold water, are the best criterion by which we can decide on the probability of its good or its bad effects. We might otherwise be deceived by appearances, and be induced to recommend thAold baU^n all cases that might seem to require a tonic and stimulant planAf cure. f* But it may sometimes be dangerous, or at least very detri- mental, to make even a single experiment. In particular affec- tions of the stomach and bowels, as well as in diseases of the lungs or of the brain, and all obstinate obstructions, the effect may be fatal. The late Dr. Smollet, indeed, said, that if he were persuaded he had an ulcer in the lungs, he would jump into the cold bath. In doing so, however, the doctor would certainly show more courage than discretion; and that he was more a man of wit than a physician, every one will allow. A nervous asthma, or an atrophy, may be mistaken for a pulmo- nary consumption: yet, in the two former, the cold bath proves often beneficial, though I never knew it so in the latter. In- deed, all the phthisical patients I ever saw, who had tried the cold bath, were evidently hurt by it. Persons of very full habits, as I have already hinted, run a great risk of bursting a blood vessel, or of causing an inflamma- tion of some important organ, by rushing into the cold bath, without due preparation. People of this description ought by no means to bathe, unless the body has been previously pre- pared by suitable evacuations. They will then derive the ut- most benefit from what might be otherwise attended with irre- parable injury to many of them. 496 OF COLD BATHING, &c. Though I recommended the cold bath in cases of nervous weakness, yet the degree of that weakness should be considered, lest the shock might prove too powerful for extreme debility. Not only women of very weakly and delicate habits, but men also, in the same predicament, as well as puny children, should begin with the warm bath at the same degree nearly as that of animal heat, about 96° of Fahrenheit's thermometer ; and re- duce it gradually in proportion to the increase of the patient's strength and internal powers of reaction. The cold bath is often very necessary to complete a cure, though not always advise- able to begin with. This requires particular illustration. In hysteric and hypochondriacal cases, cold bathing at first has done the greatest mischief, though it may be finally resorted to with good effect, after a preparatory and long continued use of the tepid or lukewarm bath. Its warmth must bevdiminished very slowly, and almost imperceptibly. Nature revolts against all great transitions; and those who do violence to her dictates, have often cause to repent of their temerity. Th^like grajlial diminution of the temperature of tlie water isfco less proper in rheumatic complaints, and in those muscular extractions and convulsive motions, which are called St. Vitus'*s Indeed, it may be laid down as a pretty general rule in that branch of nervous disorders which includes spasms, convulsions, epilepsies, and similar consequences of the debility or irritabili- ty of the system, that we should always begin with the warm bath, and proceed to the cold by the most pleasing and gentle degrees. The chief exceptions to tills rule occur in the treatment of spasmodic affections of the intestines, hooping coughs, and con- vulsive asthmas, in which, though classed under the general head of spasms, the cold bath would at any time be extremely improper. But this prohibition is also implied in my remark on complaints of the bowels and chest in general, the latter includ- ing coughs of every description. When these are the mere consequences of slight irritation or cold, bathing the lower ex- tremities in warm water affords great relief; but immersing the whole body in either the warm or the cold bath, would only ag- gravate the symptoms, when tlie breathing is difficult. As palsies are often occasioned by the inconsiderate use of the cold bath, it cannot be too strictly prohibited where any paralytic symptoms are discoverable. There is no complaint that bears and requires a greater degree of external heat than the palsy, and there is none in which the shock of cold water is OF COLD BATHING, &c. 497 more directly opposite to every curative indication. The hot baths, therefore, whether natural or artificial, and particularly if impregnated with salt, which increases their stimulus, are em- ployed as a sovereign remedy for paralytic affections. Friction, which should never be neglected after bathing, is in these cases of eminent service. In affections of the nervous coat of the stomach, and in cases of indigestion, especially when occasioned by intemperance, cold bathing is as improper as in complaints of the bowels, before taken notice of. But it is the excess of folly, after immoderate drinking, to use the cold bath with a view of alleviating its pain- ful effects next day. It must increase the disorder of the sto- mach, the violence of the headache, and the derangement of the circulation. It may be productive of still worse consequences. The cooling operation may prove far more powerful and more lasting than was expected, and may extinguish for ever the remains of animal heat; or, should nature, by extraordinary efforts, be able to resist the shock, it will probably be attended with symptoms of fever, or with very troublesome eruptions. Many painful affections of the head, as well as those which arise from intoxication, are, indeed, often relieved by what is called the shower bath, or by the affusion of cold water on the part affected, but never by the rash experiment of swimming, or of total immersion. I must take this opportunity to add, that the shower bath is in many other respects a Valuable contrivance. It may be easily procured ; its action can be regulated at pleasure ; and as the water descends like rain, it gently impels the blood towards the lower extremities, and prevents the danger which would arise from its sudden or too rapid determination to the lungs and head in some of the cases already mentioned. In uterine hemorrhages, and other fluxes of blood, when so considerable as to endanger the patient's life or constitution, cold water may be applied with good effect. It also forms a part of the tonic plan to be pursued in an immoderate flow of the menses ; nor is anything more likely to prevent the return of this complaint than cold bathing and drinking chalybeate waters in the intervals of menstruation. But when the discharge of blood is critical, as in some affections of the brain, lungs, he. or is become habitual, as in the piles, to check so salutary an evacuation by the use of the cold bath woold be the height of madness. This is no less true of many critical inflammations, those of the gout for instance, in which cold water or any other repellent would evidently counteract the purposes of nature, and 63 498 OF COLD BATHING, &c. very probably throw the disorder on some vital part. What is called the retrocedent gout frequently arises from some mis- management of this sort, as well as from some particular weak- ness or atony of the system. Cold bathing is a very hazardous experiment to be made by persons subject to the gout, except in the absence of the symptoms, when no indisposition is felt either in the head or stomach, when the extremities are not threatened with pain; and then only in concurrence with the best medical advice. Bathing the lower extremities in warm water is generally and very properly recommended both in the retention and suppres- sion of the menses, to excite the action of the uterine vessels, and, in the latter case, to remove any stricture of these vessels which may be induced by cold or fear. A skilful physician, however, will sometimes meet with cases of a retention of the menses after the usual age, in which the cold bath, if seasonably used at the beginning of the disease, may contribute to restore the tone of the system. The delicacy and general irritability of the habit in a state of pregnancy, as well as the danger of too great a determination of the blood to the womb, clearly forbid the use of the cold bath, unless it should be rendered adviseable by some circumstances of a peculiar nature, of which a medical man of skill and expe- rience is the only proper judge. It is a great and often a fatal mistake to rely on the tonic powers of the cold bath as the best means of repairing the injury done to the constitution by the relaxing influence of hot cli- mates. People, on their return to England after having resided in the East or West Indies, would find the warm bath not only safer, but far more conducive to the recovery of their former strength. I would not have them venture into a bath of a tem- perature under 90° for a considerable time, after which they may gradually diminish its warmth, as before recommended in cases of extreme debility. I might here go into further details, and show how much more salutary the warm bath is than the cold in diseases of the liver and kidneys, and in numberless other cases of internal weak- ness, irritation, or derangement ; but the principles, which I have laid down, may be easily extended to them all; and I hope that the cautions 1 have given will operate as some check on the abuse of the most powerful means of preserving and re- storing health, with which we are acquainted. OF MINERAL WATERS. 499 OF MINERAL WATERS.* The chemical analysis of mineral waters is of considerable importance, as determining the principles in which their active powers reside, and thus enabling the physician to employ them with more advantage and discrimination. Mineral waters include all such fluids as are naturally impregnated with heter- ogeneous matter, which they have dissolved within the bowels of the earth, whether sulphureous, metallic, or saline ; and, as many of these are successfully employed in medicine, they have received the appellation of medicinal waters. They de- rive their peculiarity of character in general either from con- taining carbonic acid, or soda not neutralized, sulphureted hy- drogen, purging salts, earthy salts, or iron ; or from their tem- perature exceeding in a greater or less degree that of the atmos- phere. These waters have also a specification depending on the foreign substances which they contain. Waters impregnat- ed with free carbonic acid gas sparkle when drawn from the spring, or poured into a glass; they have a taste more or less pungent and acidulous, but soon become vapid from exposure to the air. Along with the carbonic acid, there generally are present portions of saline, earthy or metallic matter, chiefly carbonates of lime, magnesia and iron. The quantity of car- bonic acid contained in the mineral waters is very various. WThen highly impregnated with carbonic acid gas, they are grateful from their pungency, sit light on the stomach, and, in a large dose, produce even sensibly a degree of exhilaration; they increase the appetite, and generally have a diuretic effect. They prove useful in dyspeptic affections, from the grateful and moderate stimulus exerted by the carbonic acid on the stomach, aided by the diluent operation of the water; and hence the advantage derived from them in the numerous chronic affections connected with impaired power of the diges- tive organs. They generally also contain some saline sub- stances, which communicate additional powers; and the opera- tion of these is usually promoted, or at least they are rendered more grateful, by the carbonic acid. Those which contain carbonate of soda, as Seltzer water, prove more powerfully diuretic, and are employed with advantage as palliatives in urinary calculus, and in the painful discharge of urine from other affections of the urinary organs. Those waters impreg- * Instead of the usual article on this subject in the Domestic Medicine, we have, with permission, adopted one from Thacher1S Dispessatorv, 4th edition, as better suited to our country, C, 300 OF MINERAL WATERS. nated with iron are more particularly employed in those dis- eases in which that metal is employed. The sulphureous mineral waters owe their distinguishing cha- racter to an impregnation of sulphureted hydrogen; and they are at once recognized by their peculiar fetid smell. They almost uniformly contain saline substances, which modify their powers. From the action of the sulphureted hydrogen, they are employed more particularly in cutaneous affections; and from the combined action of this and the saline matter which generally has a purgative effect, they are further used in dis- eases of the digestive organs, dyspepsia, hypochondriasis, torpor of the intestines, and visceral obstructions; and also in scrofulous affections. They are also applied locally in cutane- ous eruptions, and the warm sulphureous baths have been in particular celebrated for their efficacy under this form of ap- plication. , The saline mineral wafers comprize those in which, without any large proportion of aerial matter, various saline com- pounds, generally neutral, exist. The salts most usually pre- sent are sulphates, muriates, and carbonates; and the bases with which the acids forming these are combined, are soda, magnesia, and lime. These waters are usually aperient, the substances which they hold dissolved being either, so far as can be determined, inert, such as the sulphate and carbonate of lime; or being cathartic, as the greater number of the other compound salts. It has always been remarked too, with re- gard to them, that their cathartic power is greater than could be supposed from the extent of their saline impregnation as determined by analysis; a proof of the influence of dilution in the operation of mineral waters. They are usually employed in diseases, where it is of advantage to stimulate the digestive system, the intestinal canal, and the secreting organs connected with it, or where advantage is derived from moderate and con- tinued evacuations. Hence their celebrity in the treatment of some forms of dyspepsia and hypochondriasis, chlorosis, chronic hepatitis, jaundice, and in scrofula. When these waters are impregnated with carbonic acid, which they frequently are, ihey become more grateful and sit easier on the stomach. When they have an impregnation of iron, they acquire tonic powers, and more efficacy as remedies in amenorrheea, and the other chronic diseases in which this metal is employed. Sea water, in strict chemical arrangement, must be regarded as belonging to the class of saline mineral waters, as it holds dissolved merely various neutral salts, chiefly muriate of soda :ind of magnesia, and sulphate of soda and magnesia, with a OF MINERAL WATERS. 501 little sulphate of lime. It much exceeds, however, in the ex- tent of impregnation, any common mineral water. Its medici- nal powers are similar to those of the saline mineral waters; from the extent of its saline impregnation, it is more active as a cathartic, and this renders it more stimulating than fresh water as a bath. Chalybeate mineral waters owe their characteristic proper- ties chemically and medicinally to an impregnation of iron. The oxide of iron is almost uniformly held dissolved by car- bonic acid, the acid being usually in excess; in a few mineral waters, sulphate of iron is present; but these are rare, and are in general too active to be well adapted to medicinal use. Chalybeate waters have a peculiar styptic taste; they are trans- parent when taken from the spring, but when exposed for some time to the air, a pellicle forms on the surface, and a quantity, generally minute, of ochrey sediment subsides, the water at the same time losing its taste. This change is accelerated by heat. Chalybeate mineral waters are remedies of considerable activity and power. They act as tonics, increasing the strength of the system, raising the force of the circulation, giving tone to the digestive organs, augmenting muscular vigor, and pro- moting the excretions. They are of course employed in those diseases in which iron is principally used, emenorrhoea, chlo- rosis, some states of menorrhagia, leucorrhcea, dyspepsia, scrofula, and various forms of chronic debility. And as iron always succeeds best when given in small doses, and in a state of considerable dilution, the chalybeate waters afford the best form under which it can be prescribed, that which is at once attended with least iwitation,and from which the greatest bene- fit is obtained. The powers of these waters, too, are often aided by the presence of other ingredients. The impregnation of carbonic acid, when it is present in excess, gives them a grateful stimulant quality, which is exerted on the stomach; and saline substances communicate to them an aperient power. It would be foreign to the object of this sketch to attempt a particular history, connected with the various celebrated mine- ral springs, so much resorted to on the European continent, but some account of the principles and medicinal properties ot those of our own country cannot fail of being acceptable, since the most serious consequences frequently result from an indis- criminate employment of these waters. The Ballston mineral waters are those most celebrated in the United States; and the following is the result of their analysis, by an eminent French chemist: 502 OF MINERAL WATERS. 1. Carbonic acid, three times its volume. 2. Muriate of soda, 31 grains. 3. Supersaturated carbonate of chalk, 22 grains. 4. Muriate of magnesia, 12| grains. 5. Muriate of chalk, 5 grains. 6. Carbonate of iron, 4 grains. To the preceding analysis, Dr. Hosack, of New York, has subjoined some valuable " observations on the use of the Ball- slon mineral waters in various diseases." "The Ballston waters have been long known to yield a great quantity of fixed air, and to hold in solution a large portion of iron. By the analysis referred to, it appears that they yield a much larger proportion of fixed air, and that they contain a greater quantity of iron, than any other mineral water that has hitherto been discovered, not excepting that of Vichy, one of the strongest chalybeate waters in Europe. But it appears, that they also contain another substance, the muriate of lime, which, with the other ingredients with which it is associated, promises to be of great and extensive utility. " We are accordingly from this analysis induced to ascribe more virtues to the Ballston waters than physicians have gene- rally believed them to possess. Although much is due to ex- ercise, change of air, and an agreeable occupation of the mind, which the amusements of watering places usually afford, I have no doubt, from the sensible effects produced upon the system by the waters themselves, that they also are productive of great good in a variety of diseases, some of which I shall now briefly enumerate. " 1st. From the effects of the Ballston waters, as a strong chalybeate, they may be employed with advantage in most dis- eases of debility, whether directly or indirectly such. But in those complaints which are attended with an increased excite- ment of the whole system, or with local inflammation, they are manifestly prejudicial. These principles are deducible from the qualities of the waters alone ; but they are also confirmed by the experience and observation of physicians who have at- tended to their operation. "Accordingly, in intermittent fever, dropsy, dyspepsia, hypo- chondriasis, and hysteria, connected with, or proceeding from debility of the digestive organs; in paralysis, chronic rheuma- tism, gout in its chronic state, chlorosis, fiuor albus ; in suppres- sion of the menses when arising from weakness, in worms, and in other diseases of debility, whether of the intestinal canal, or of the whole system, the Ballston waters have been long and justly celebrated. On the other hand, in a plethoric stale of the system, as in pregnancy, in consumption of the lungs, infiam* OF MINERAL WATERS. 503 mation of the liver, acute rheumatism, dysentery, and other dis- eases of an inflammatory nature, in which they are oftentimes resorted to, they invariably do injury. W7e may, perhaps, except from this remark, a species of consumption, which arises in females about the time of puberty, in which, from want of energy in the system, menstruation does not take place at the period in which it usually appears ; dyspepsia ensues, followed with general irritation of the nervous system, pain in the breast, cough, sometimes hemorrhage from the lungs, and ulti- mately terminating in confirmed consumption. These conse- quences have frequently been prevented by a course of iron, and vegetable tonics, aided by generous diet, and exercise, es- pecially riding on horseback. Under similar circumstances, I have no doubt, that the Ballston waters may be serviceable in this species of phthisis in its incipient state; but they should never be employed in diseases of this nature, without the ad- vice of a physician. " 2. From the saline impregnation of these waters, and their operation upon the urinary organs as well as by perspiration, they are indicated in diseases of the kidneys and bladder, in gout, chronic rheumatism, and eruptions upon the skin, all which diseases are most frequently produced by, or connected with a morbid condition of the fluids, and an impaired state of the se- cretions. In these complaints, I have repeatedly prescribed these waters with the best effects. " But according to the foregoing analysis, they contain an ingredient of great value, besides those already enumerated ; I mean the muriate of lime. It appears upon the authority of Dr. Beddoes, Dr. R. Pearson, Dr. Wood, and Dr. Schraud of Vienna, that this substance has lately been discovered to be a remedy for scrofula, which hitherto has been the opprobrium of our profession. It is true, cases have been recorded by Russell and others, of the cure of this disorder by the use of sea water. But as it has been ascertained by chemists, that the muriate of lime enters into the composition of sea water, it is very possible that much of the efficacy of the latter, in this disease, may be derived from the muriate of lime, which it has been found to contain. " But as scrofula is usually attended with a general debility of the system, as well as a morbid condition of the fluids, the Ballston waters will probably be found peculiarly serviceable, inasmuch as they possess the means of invigorating the system, at the same time that they contain the antidote to the peculiar virus of this disease. " But to obtain the benefits of the Ballston waters in any of the diseases which have been noticed, it is necessary, that, in 504 OF MINERAL WATERS. the use of them, as it regards- the time of taking them, the quantity taken, the stage of the disease, and other circum- stances which must govern their exhibition, the directions of the physician are indispensably necessary. As well might the patient make use of any other article of the materia medica without medical advice, as drink these waters in the manner in which they are usually taken. It is but a short time since a very valuable life was destroyed by the imprudent use of them during a state of pregnancy. A few days ago I was con- sulted by two gentlemen, who had left the springs much worse than they had^ gone to them. The one labored under dyspep- sia, attended with habitual costiveness. Neglecting to relieve his bowels, he commenced the use of the waters; the conse- quences were, an aggravation of his disease, followed with fever, acute pain in the head, and other symptoms of general excitement. The other person referred to, had come from Virginia, on account of an obstinate chronic diarrhoea,- attend- ed with great debility, and general emaciation. Without ad- vice, he immediately began to drink the waters to the quantity of several quarts daily. The consequences may be readily im- agined,—an increase of his disease, and a degree of debility from which he with difficulty recovered." OF THE WATERS OF STAFFORD SPRING IN THE STATE OF CONNECTICUT. The waters of Stafford spring have been subjected to a partial analysis by the late Dr. Samuel Willard. Though far from being complete, for the want of proper agents or tests, the results of his experiments favor the conclu- sion, 1st. That " iron is the prevailing ingredient in the water,— that it is held in solution by the carbonic acid,—that, when the water is exposed to the action of the atmospheric air, or is acted on by heat, the acid is extricated, and the iron precipi- tated,—the purple color struck by the vegetable astringents, and by distilled spirits,—the precipitate produced by the caus- tic fixed alkali, and the blue tinge communicated to the water, by calcareous and alkaline prussiates, all indicate the presence of iron. "2d. That the water is also impregnated with the sulphuret- ed hydrogenous gas, its sulphureous smell, its possessing the property of blackening silver, and its receiving a green tinge from the admixture of vegetable purple juices, may be con- sidered as proofs. OF MINERAL WATERS. 505 " 3d. That the water contains aluminous and magnesian earth, its effects on soap, its effervescing with the sulphuric acid, when deposited as a sediment, and the new combination which takes place on the admixture of this acid, induce a belief of this fact." A SHORT ACCOUNT OF THE ARTIFICIAL MINERAL WATERS IN THE UNITED STATES. Taken from Conversations on Chemistry* The extensive utility of many of the natural mineral waters has been long established by the experience of mankind, and sanctioned by the opinions of the first medical practitioners of every enlightened country. The accurate analysis of all the most important and cele- brated mineral waters has been accomplished by men compe- tent to the task; and we are thus informed, not only concern- ing the nature, but the proportion of the ingredients which they contain. They are either solid substances, such as water can dissolve, or gases, capable of being combined with this fluid. To both of these the mineral waters owe their medicinal pow- ers, and to the latter alone, and chiefly to the carbonic acid, their peculiar activity, briskness, and pungency. In the manufacture of artificial mineral waters, the original Water is perfectly imitated, by the addition of all the ingredi- ents in the proper proportions ; and the gas, by a peculiar and very powerful apparatus, is afterwards forced in, till the waters acquire a degree of briskness and activity far surpassing anything which they ever exhibit in nature. The impression, entertained by some, that a perfect imita- tion of the native mineral waters is impossible, is therefore equally contrary to the decisions of good sense, as it is re- pugnant to experience; for in London, in Paris, and in many other great towns, artificial mineral waters are thus fabricated ; and used to great extent. In the artificial waters, we always have it in our power to leave out noxious, or useless ingredients; to substitute others, and to vary the proportions at pleasure. Every species ot mineral waters whatever can be prepared by art; but the prin- cipal ones that have been attempted in this country, are the Ballston, Soda, and the Seltzer waters. 64 OF MINERAL WATERS. BALLSTON WATER. The Ballston water is well known in the United States as a gentle cathartic ; an active diuretic ; a remedy against gravelly complaints; a tonic to the stomach, and generally to the sys- tem ; not to mention its efficacy against rheumatic and cutane- ous complaints, when applied externally, as well as internally. It remains to be added only, that the artificial Ballston water is found by experience to produce the effects of the natural water; it is, however, more powerful, and therefore an equal quantity produces more marked effects. SODA WATER. The soda is not an exact imitation of any natural water, but has been directed by medical men as a remedy in a number of common and troublesome complaints. It is ordered in the pharmacopoeias and dispensatories, and their prescriptions should be followed in this manufacture. It is a complete reme- dy against sourness of the stomach, commonly called heart- burn ; and in most cases of indigestion and weakness of the stomach, it is very useful; gradually restoring the appetite, and with it the tone of the organ. It is a preventive of many of the diseases of the stomach and bowels, which proceed from acidi- ty ; and for the same reason it often removes or prevents the sick headache. As a palliative, and even a remedy, in some cases of urinary calculi and gravelly complaints, it is preferable to the Ballston water. It may prevent, arrest, retard, or re- move the complaint, according to circumstances. The soda water is also a very refreshing, and, to most per- sons, a very grateful drink, especially after heat and fatigue; and may be made a complete substitute for the beverages of which ardent spirits form a part. With wine and sugar it is very grateful. SELTZER WATER. The Seltzer water has long been known, and is one of the most famous of the natural mineral waters of Europe. On ac- count of its agreeable taste and exhilarating effects, it is largely used at table, and as a beverage at all hours. It is a diuretic, and OF MINERAL WATERS. 507 possesses considerable efficacy in nephritic and urinary com- plaints. It is very useful against bilious and dyspeptic affec- tions, and in many cases of cutaneous eruptions. It possesses a peculiar power of allaying feverish irritation, and has done much service in slow hectic fevers. It mixes well with milk, and is thus used with advantage by hectic patients. It is used also with sugar and wine. The manufacture of mineral waters upon correct chemical principles, was undertaken in New Haven, Connecticut, about three years ago ; and, during the last summer, a public establish- ment for this purpose was opened in the same town, under the direction of Professor Silliman. An establishment of the same kind, and under the same direction, was effected in New York, in April of this year, (1809,) by Noyes, Darling, and Co. Fountains of Ballston, Soda, and Seltzer waters were opened in the bar of the Tontine Coffee House. The cisterns are placed in the cellar, and the waters are conveyed into the bar in block tin tubes, which pass up into mahogany pillars, crowned with gilt urns, lettered with the names of the respective waters. The pillars, with their urns, stand a foot apart, and the middle one is raised above the others ; silver stop cocks inserted into the sides of the pillars, give the whole much neatness and rich- ness of appearance. The proprietors of this establishment intend, as wfc under- stand, to open fountains at the City Hotel, in the month of May, in a spacious room, fitted up and ornamented in a hand- some style, and adapted to the accommodation of ladies as well as gentlemen. The Ballston and Seltzer waters are prepared according to an accurate analysis; and in order to give the soda water its proper efficacy, it is made with the full proportion of soda di- rected by the dispensatories. The waters are bottled for ex- portation, in any quantity demanded. Soda water has been made in New York by Mr. Usher, for a year or more,f and has had a good reputation and an exten- sive sale. It has been sold from a fountain, and in stone bot- tles. Wre understand that he is about to extend his establish- ment. There have been, for some time, manufactories of mineral waters in the city of Philadelphia; and we are informed that these waters have been extensively used. To the preceding statement, it remains to be added, that a public establishment of a similar nature has been introduced into the town of Boston, by Mr. John P. Whitwell. The soda and other waters, which he manufactures have acquired con- siderable reputation, and proved extremely salutary and 508 DIET OF COMMON PEOPLE. useful. From the great attention and exertions of the proprie* tor, very satisfactory and beneficial effects have been derived, and the utility of his undertaking is becoming more and more extensive and important. I extract the following from the Emporium of Arts, &c. by Thomas Cooper. " The best method of combining the Seltzer water with a laxative proportion of the purgative salts is the following, which will enable everybody to make, at will, a mineral water, impregnated with cathartic qualities in any proportion that the palate will bear, or the bowels will require, combined with the lively, sparkling qualities of the Seltzer water. Take of super- carbonate of soda, or even the common carbonate, twenty grains, of the common carbonate of magnesia as much; put them in a strong black quart bottle; fill it nearly, but not quite full of water; having previously ready a cork that will fit it. Pour in the quantity of strong vitriolic acid, that you know from previous experiment will barely neutralize that quantity of saline matter. Cork the bottle, and tie down the cork in- stantly. The carbonic acid gas will thus be combined with a solution of Glauber's and Epsom salts, which must be kept in a cool place, In the same manner the dose may be altered or diminished, or sulphate of iron, in the proportion of three or four grains, may be added, if the symptoms of the patient re- quire it, and a mineral water produced more efficacious than aby that nature presents to us. As to the aerated waters generally, 1 am of opinion, that every family should have an apparatus of the kind, in order to make them at any time, for the purpose of medicine and salutary beverage. I found them in a recent complaint of more service than any other prepa- ration. Owing to extreme debility, no medicine or food would stay on my stomach until I drank the Seltzer and soda waters; and I am of opinion, that by their use, sickness may be avoided, and, of course, health preserved." James Cltbush. CHAP. I.VI. OBSERVATIONS CONCERNING THE DIET OF THE COMMON PEOPLE. EXPERIENCE proves, that not a few of the diseases inci- dent to the inhabitants of this country, are owing to their mode of living. The vegetable productions they consume DIET OF COMMON PEOPLE. 509 fall considerably short of the proportion which they ought to bear to the animal part of their food. The constant use of bread and animal substances excites an unnatural thirst, and leads to the immoderate use of beer and other stimulating liquors, which generate disease, and reduce the lower orders of the people to a state of indigence. To teach the poor man how to live cheaper and better, is the design of the following pages. Though the common people of this country live at a greater expense than anywhere else, it does not follow that they live better. They are strong indeed, but by no means healthy; and it is found that, from an attachment to a particular mode of living, they are more liable to disease and death in foreign climates, than the inhabitants of any other country. It is certainly proper, that the poor man should be instruct- ed in everything that can make his little earnings go as far as possible, or which can add to the comfort of himself and family. Nor can economy in living be deemed a trivial vir- tue, in a country where the riches depend on the cheapness of labor. It is alleged, that the English are so much attached to their owm modes of living, that no argument will induce them to make the smallest change. Habits are indeed obstinate things, espe- cially those which relate to diet; but there are proofs that the English are not inflexible, even in this matter. The mode of living among the lower orders has been greatly changed in my time, and, I am sorry to say, not for the better. The people of England have too much good sense not to listen to reason, provided due care be taken to instruct them. But here the people may be truly said " to perish for want of know- ledge." No means have been used to give them proper instruc- tion. Hurtful customs have been suffered to prevail, till they have struck such deep roots, that it will not be an easy matter to eradicate them. The difficulty, however, is not insurmount- able. A few experiments of reform would have the effect to render it as agreeable as it is salutary. Adults have many old prejudices to overcome ; but the case is different in regard to children. They may be taught to use any kind of food, and what they use when young, they will love when old. If I can introduce a different method of feeding children, my purpose will be answered. This alone will, in time, effect a total change in the general mode of living. The late distress of the poor has called forth many publica- tions intended for their relief. Most of them, however, were adapted only for the particular occasion, and not calculated to 510 OBSERVATIONS ON ALIMENT. prevent the return of like evils. The following observations, it is hoped, will have a more permanent effect. They are intend- ed to recommend a plan of living, which will render the people less dependent on bread and animal food for their subsistence, and consequently not so liable to suffer from a scarcity or dearth of either of these articles in future. Particular attention has been paid to the substitutes for bread, as the scarcity of this article proves peculiarly distressing to the poor. It will appear from the following pages, that bread is by no means so much a necessary of life as is generally imagined, and that its place may, in many instances, be supplied by a va- riety of other farinaceous substances. GENERAL OBSERVATIONS ON ALIMENT. No creature eats such a variety of food as man. Intended for an inhabitant of every climate, he devours the productions of them all; and if they do not suit his palate, or agree with his stomach, he calls in the aid of cookery, an art peculiar to him- self; by which many things that, in a crude state, would prove hurtful, or even poisonous, are rendered wholesome and salu- tary. The obvious division of food is into animal and vegetable. To say that man was intended by nature for using either the one or the other alone, would be absurd. His structure and appetite prove that he was formed for both. Judgment, how- ever, is requisite in adjusting the due proportion of each, so as to avoid the inconveniences arising from an extreme on either hand. Though animal food is more nourishing than vegetable, it is not safe to live on that alone. Experience has shown, that a diet, consisting solely of animal food, excites thirst and nausea, occasions putrescence in the stomach and bowels, and finally brings on violent griping pains, with cholera and dysentery. Animal food is less adapted to the sedentary than the labori- ous, and least of all to the studious, whose diet ought to consist chiefly of vegetables. Indulging in animal food renders men dull, and unfit for the pursuits of science, especially when it is accompanied with the free use of strong liquors. The plethoric, or persons of a full habit, should eat sparingly of animal food. It yields far more blood than vegetables taken in the same quantity, and of course may induce inflammatory OBSERVATIONS ON ALIMENT. 511 disorders. It acts as a stimulus to the whole system, by which means the circulation of the blood is greatly accelerated. I am inclined to think that consumptions, so common in Eng- land, are in part owing to the great use of animal food. Though the Phthisis Pulmonalis is not, properly speaking, an inflamma- tory disease, yet it generally begins with symptoms of inflam- mation, and is often accompanied with them through its whole progress. But the disease most common to this country is the scurvy. One finds a dash of it in almost every family, and in some the taint is very deep. A disease so general must have a general cause, and there is none so obvious as the great quantity of salted animal food devoured by the natives. As a proof that scurvy arises from this cause, we are in possession of no remedy for this disease equal to the free use of vegetables. By the uninterrupted' use of animal food, a putrid diathesis is induced in the system, wMch predisposes to a variety of dis- orders. I am fully convinced, that many of those obstinate complaints, for which we are at a loss to account, and find it still more difficult to cure, are the effects of a scorbutic taint lurking in the habit. Improper diet affects the mind as well as the body. The choleric disposition of the English is almost proverbial. Were I to assign a cause, it would be, their living so much on animal food. There is no doubt but this induces a ferocity of temper unknown to men, whose food is chiefly taken from the vegetable kingdom. Though these and similar consequences may arise from the excess of animal diet, we are far from discouraging its use in moderation. In all cold countries it is certainly necessary ; but the major part of the aliment ought nevertheless to consist of vegetable substances. There is a continual tendency in animal food, as well as in the human body itself, to putrefaction,, which can only be counteracted by the free use of vegetables. With regard to the proportion of vegetable food to that of animal, great nicety is by no means required. It must vary according to circumstances, as the heat of the weather, the warmth of the climate, and the like. The vegetable part, how- ever, where nothing forbids, ought certainly to preponderate, and I think in the proportion at least of tvvo to one. The excessive consumption of animal food is one great cause of the scarcity of grain. The food that a bullock affords bears but a small proportion to the quantity of vegetable matter he consumes. 512 OF BREAD. I am no enemy to good fruit, as an article of diet; but fhe greater part of what is used in this country, by the lower orders of the people, is mere trash. Fruit should be eaten in the early part of the day, when the stomach is not loaded with food, and it never ought to be eaten raw till it is thoroughly ripe. ' Cookery, as it administers to luxury, is certainly a useless and pernicious art; but so far as it enables us to obtain a palatable and wholesome diet from simple and cheap materials, it is doubtless a valuable art, and worth, in this respect, far more attention than it has ever yet received. From neglect of this sort of cookery, many things are thrown away, even by the poor, from which a delightful repast might be made, and this is one source of their poverty and suffering ; and from ignorance of this art, many a good vegetable and piece of meat are spoil- ed in the hands of the cook.' C. ______» OF BREAD. Bread, or something resembling it, makes a part of the diet of all nations. Hence it is emphatically denominated the staff of life. It may, however, be used too freely. The late Dr. Fothergill was of opinion, and I perfectly agree with him, that most people eat more bread than is conducive to their health. I do not mean to insinuate, that bread is unwholesome, but that the best things may prove hurtful when taken to excess. A surfeit of bread is more dangerous than of any other food. Omnis repletio mala, repletio panis pessima. The French con- sume vast quantities of bread ; but its bad effects are prevented by their copious use of soups and fruits, which have little or no share in the diet of the common people of England. One important use of bread is to form a mass fit for filling up the alimentary canal, and carrying the nutritious juices along this passage in such a state, as to render them fit to be acted on by the lacteal absorbents, which take up the nourishment, and convey it to the blood. In this light, bread may be con- sidered as a soil from whence the nourishment is drawn. I do not say that bread contains no nourishment, but that its use, as an article of diet, does not solely depend on the quantity of nutriment it contains, but in some measure on its fitness as a vehicle for conveying the nutritious particles through the intes- tinal tubes. Hence it follows, that the finest bread is not always the best adapted for answering the purposes of nutrition. OF BREAD. 513 The richest food will not nourish an animal, unless the ali- mentary canal is sufficiently distended. A dog has been fed on the richest broth, yet could not be kept alive ; while another, which had only the meat boiled to a chip and water, throve very well. This shows the folly of attempting to nourish men on alimentary powders and other concentrated food. The great art, therefore, of preparing food, is to blend the nutritive part of the aliment with a sufficient quantity of some light farinaceous substance, in order to fill up the canal, without overcharging it with more nutritious particles than are necessary for the support of the animal. This may be done either by bread, or other farinaceous substances, of which there is a great variety, as will appear from the sequel. Bread is one of the most expensive modes of using grain, and not adapted to the narrow circumstances of the lower or- ders of the people, as it is burthened with two heavy additional charges, in passing through the hands of both the miller and the baker. Besides, the former often grinds down extraneous mat- ter with the wheat, and the latter as frequently bakes it up with the addition of lime, chalk, alum, and other pernicious sub- stances. Since the articles of diet have become branches of manufacture, the public neither know what they eat, nor what they drink. People imagine, as the finest flour contains the greatest quan- tity of nourishment, that it must therefore be the most proper for making into bread ; but this by no means follows. The finest flour comes the nearest to starch, which, though it may occasionally prove a good medicine, makes bad bread. House- hold bread, which is made by grinding down the whole grain, and only separating the coarser bran, is without doubt the most wholesome. The best household bread I ever remember to have eaten, was in the county of York. It was what they call meslin bread, and consisted of wheat and rye ground together. I am not quite certain as to the proportion, but I think there might be two parts of the former to one of the latter. This bread, when well fermented, eats light, is of a pleasant taste, and soluble to the bowels. After using it for some years, I found that bread made entirely of flour was neither so agreeable to the palate, nor so conducive to health. . Bread is, often spoiled to please the eye. The artificially whitened, drying, stuffing bread, though made of the heart of the wheat, is in reality the worst of any ; yet this is the bread which most people prefer, and the poorer sort will eat no other. 65 514 OF BREAD. All the different kinds of grain are occasionally made into bread, some giving the preference to one, and some to another, according to early custom and prejudice. The people of South Britain generally prefer bread made of the finest wheat flour, while those of the northern countries eat a mixture of flour and oatmeal, or ryemeal, and many give the preference to bread made of oatmeal alone. The common people of Scotland also eat a mixed bread, but more frequently bread of oatmeal only. In Germany the common bread is made of rye, and the Ameri- can laborer thinks no bread so strengthening as that which is made of Indian corn ; nor do I much doubt but the Laplander thinks his bread, made of the bones of fishes, is the best of any. Bread made of different kinds of grain is more wholesome than what is made of one only, as their qualities serve to cor- rect one another. For example, wheat flour, especially the finer kind, being of a starchy nature, is apt to occasion consti- pation. Bread made of ryemeal, on the other hand, proves often too slippery for the bowels. A due proportion of these makes the best bread. For the more active and laborious, I would recommend a mixture of rye with the stronger grains, as peas, beans, barley, oats, Indian corn, and the like. These may be blended in many different ways : they make a hearty bread for a laboring man, and, to use his own language, they lie longer on his sto-' mach than bread made of wheat flour only. Barley bread passes too quickly through the alimentary canal to afford time for con- veying the proper nourishment; but bread made of barley mixed with peas is very nourishing. When potatoes, or boiled grain, are used, bread ceases to be a necessary article of diet. During the late scarcity of bread, I made it a rule not to eat above one half the quantity I used to do, and 1 found no inconveniency whatever from the change. Nay, some told me, that for a considerable time they had left off the use of bread altogether, without experienc- ing any change in the state of their health. A great part of the bread consumed in this country is by children. It is always ready, and when the child calls for food, a piece of bread is put into its hand, to save the trouble of dressing any other kind of victuals. Of many children this is the principal food, but it is far from being the most proper. Children arc often troubled with acidities of the stomach and bowels; and it is well known, that bread mixed with water, flTrd kept in a degree of heat equal to that of the human stomach, soon turns sour. During the late scarcity, many of the laboring men, and OF BREAD. 515 even artificers, could not earn as much money as was sufficient to keep their families in the article of bread only. It is cer- tain, however, that, on a different plan, such families might have liVed very comfortably. Many of the articles of diet are cheaper than bread, and equally wholesome. Above one half of the expense of living might be saved, by a due selection of the articles of diet. The English laborer lives chiefly on bread, which, being ac- companied with other dry, and often salt food, fires his blood, and excites an unquenchable thirst, so that his perpetual cry is for drink. But the greatest consumption of bread is occasioned by tea. It is said that the subjects of Great Britain consume a greater quantity of this herb, than the whole inhabitants of all the other nations of this quarter of the globe. The lowest woman in England must have her tea, and the children generally share it with her. As tea contains no nourishment, either for young or old, there must of course be bread and butter to eat along with it. The quartern loaf will not go far among a family of hungry children, and if we add the cost of tea, sugar, butter, and milk, the expense of one meal will be more than would be sufficient to fill their bellies with wholesome food three times a day. There is reason to believe, that one half the bread consumed in England is used with tea, without one hearty meal ever be- ing made of it. The higher ranks use tea as a luxury, while the lower orders make a diet of it. I had lately occasion to see a striking instance of this in a family, that was represented to me as in distress for want of bread. I sent them a little money, and was informed, that they ran with it directly to the tea shop. To a heavy, sluggish, phlegmatic man, a moderate use of tea may not prove pernicious; but where there is a debilitat- ed stomach and an irritability of fibre, it never fails to do much hurt. With many it has the effect to prevent sleep. Tea will induce a total change of constitution in the people of this country. Indeed, it has gone a great way towards effecting this evil already. A debility, and consequent irrita- bility of fibre, are become so common, that not only women, but even men, are affected with them. That class of diseases, which, for want of a better name, we call nervous, has made almost a complete conquest of the one sex, and is making hasty strides towards vanquishing the other. Did women know the train of diseases induced by debility, and how disagreeable these diseases render them to the other sex, they would shun tea as the most deadly poison. No mars 516 OF BOILED GRAIN. can love a woman eaten up with vapors, or washed down with diseases arising from relaxation. It is not tea taken as a beverage after a full meal, or in a crowded assembly, that I so much condemn, though I think something as elegant and less pernicious might be substituted in its place. The mischief occasioned by tea arises chiefly from its being substituted for solid food. This is so much the case at present, that, had I time to spare, I think it could not be better employed than in writing against this destructive drug. OF BOILED GRAIN. Though farinaceous substances, of one kind or another, make a necessary part of the food of man, yet there can be no reason why sucfl substances should always assume the name and form of bread. Many of them are more-wholesome, and not less agreeable, in other forms. Bread is often used merely to save the trouble of cookery; and, being portable, is the most convenient article of diet for carrying abroad. It does not, however, admit of a doubt, that more grain is eaten boiled, though not in this country, than is made into bread; and that this mode of cookery is the most wholesome. Simple boiling precludes all adulteration, and is an operation much less laborious and artificial than baking. The most general article of diet among mankind is rice. This may be made info a variety of dishes ; but simple boiling is all that is required, to render it a proper substitute for bread. It may either be eaten alone, or with milk. In the east, it is used with meat, in the same manner as we do bread. The people of this country believe, that rice proves injurious to the eyes; but this seems to be without foundation, as it has no such effect on those who make it the principal part of their food. Many other kinds of grain will, when boiled, make good substitutes for bread. Even those which make a harsh and unpleasant sort of bread, are often rendered very palatable by boiling. This is the case with all the leguminous class of plants, as peas, beans, &c. Even oats and barley are more agreeable, as well as more wholesome, when boiled, than made into bread. All allow that peas and beans boiled, when young, are a great luxury; but when old, they are equally wholesome, and when properly cooked, by no means unpleasant. There are few, who do not relish peas pudding, aud even prefer it to OF BOILED GRAIN. SVT bread. Beans are not so fit for this purpose; but they make an excellent ingredient in the poor man's broth, and whoever eats this broth will find little occasion for bread. Peas and beans contain an equal quantity of sugar with wheat, oats, or.barley, and at the same time a greater propor- tion of oil; consequently are more nourishing. This fact is con- firmed by daily experience. On those farms where peas and beans are raised in great abundance, the laborers are much fed on this sort of grain; but when removed to farms where they are fed with other kinds of grain, they soon complain of a diminution of strength, and request a supply of peas meal as formerly. Nature seems to have pointed out the propriety of the ex- tensive use of peas and beans; it being a fact, that when crops of this kind are duly alternated with crops of wheat, barley, or oats, the fertility of the soil may be maintained, without rest or manure, for many years together. Whereas, if the latter be raised on the same soil for several years successively, they render it barren, so that, without rest' or manure, its fertility cannot be preserved. The people in England are but little accustomed to the use of boiled grain, though in many countries it is eaten as a luxu- ry. Boiled barley is a great favorite with the Dutch, and is eaten with milk, butter, or molasses. It is the principal food of the Dutch sailors, who, in general, are both healthy and robust. Barley is one of the best ingredients in soup. Count Rum- ford says, it possesses the quality of lithing, or thickening soups, in a superior degree to any other grain. We have reason, however, to believe, that grits, or coarse oatmeal, will answer this purpose still belter. Oatmeal is frequently made into bread; but it is a much more wholesome, as well as agreeable food, when made into hasty pudding, and eaten with milk. The peasants in many parts of Britain make two meals a day of it, while their chil- dren almost wholly subsist on it; and it is well known, that both old and young, who are thus fed, are healthy and robust. The opinion of oatmeal being healing, and occasioning skin diseases, is wholly without foundation. Bread made of oat- meal, when not leavened, will sometimes occasion the heart- burn ; but this is no proof of its heating quality. Unleavened bread, of wheat or any other grain, produces the same effect on a debilitated stomach. Oatmeal, thoroughly boiled, seldom gives the heartburn. Persons who are fed on oatmeal bread, or hasty pudding, . are not more subject to diseases of the skin, than those who live on wheatmeal. Cutaneous disorders proceed more from 518 OF BOILED GRAIN. the want of cleanliness, than from any particular aliment. The French, so far from thinking that oatmeal is heating, speak of it as possessed of a cooling quality, and even the English give oatmeal, or grit gruel, to lying-in women, and sick people of every description, which shows that they are inconsistent with themselves, in alleging that the blood is fired by the use of oatmeal. A lieutenant of the army, residing at a village within a few miles of Edinburgh, with a wife and ten children, having no other income than his half pay, fed the whole of his children with hasty pudding and buttermilk only, from a conviction that it was the most wholesome and full diet that fell within the reach of his narrow circumstances. They grew apace; and it was the universal remark of the neighborhood, that they were as sprightly, healthy, and robust, as other children, and, at the same time, perfectly free from all skin diseases. Children are seldom well, unless when their bodies are gently open. But this is more likely to be the case when fed on oat- meal and milk, than when their bellies are crammed with a starchy substance made of the finest flour ; yet this in England is the common food of children. I have seen an infant stuffed four or five times a day with this kind of food. There needs no conjurer to tell the consequence. A late author, a man of learning, but the dupe of prejudice, has, by a ridiculous definition, endeavored to represent oats as proper food for horses only. I wish the horses in England de- voured a smaller quantity of this grain, and the people more. Few things would have a greater tendency to lessen the ex- pense of living. The oats in North Britain are of a superior quality, and 1 hope the people will long have the sense to use them as an article of diet. Indian corn is likewise said to make the best food when boil- ed. Count Rumford observes, that of all things it makes the best pudding, and that he has made a hearty meal of it, sauce included, for five farthings. What makes good puddings will make good dumplins, and these will, at any time, supply the place of bread. The Count also remarks, that the negroes in America prefer Indian corn to rice ; and that the Bavarian pea- sants prefer it to wheat; that it might be imported from North America at about four or five shillings a bushel; that, when made into flour, it would cost only one penny farthing a pound ; and that it is highly nutritious, and the cheapest food known. During the late scarcity, a large quantity of this grain was im- ported ; but such is the aversion of the common people of this country to every sort of food to which they are not accustom- ed, that they refused to purchase it, and the merchants were OF BUTTER. 519 very great losers by the importation. On the same principle the Germans, till within these few years, could not be induced to eat potatoes, though now they are become extremely fond of them. The American, the Italian, and the German, all cook Indian corn in the same way as the North Briton does his oatmeal, by making it into hasty pudding. It may be eaten in a variety of ways. Some eat it with a sauce composed of butter and brown sugar, or butter and molasses. Others eat it with milk only. In either way it makes a good, cheap, and wholesome diet, by no means disagreeable to those who are accustomed to The only other grain we shall mention, as best when boiled, is buckwheat: it is of a very mucilaginous nature, and of course highly nutritious. In several parts of Europe, it constitutes a principal part of the food of the lower people. In former times it was eaten in Russia, not by the lower classes only; even the nobility made use of it. Boiled, and then buttered, it was such a favorite of the great Czar Peter, that he is said seldom to have supped on anything else. OF BUTTER. It has been said, that the English have a thousand religions, and but one sauce. It must be allowed that they use butter with almost every kind of food. Butter, though a good article of diet, may be used too freely, and in this country, 1 am con- vinced, this is the case. To weak stomachs it is hurtful, even in small quantities, and, when used freely, it proves prejudicial to the strongest. Butter, like other things of an oily nature, has a constant tendency to turn rancid. This process, by the heat of the stomach, is greatly accelerated, insomuch that many people, soon after eating butter, complain of its rising in their stomachs, in a state highly disagreeable. Oils of every kind are with difficulty mixed with watery fluids. This is the reason why butter floats in the stomach, and rises in such an unpleasant manner. Persons afflicted with bile should use butter very sparingly. Some sceptical authors doubt whether or not aliment of any kind has an effect on the bile. One thing, however, is certain, that many patients, afflicted with complaints which were suppos- ed to be occasioned by bile, have been completely cured by a total abstinence from butter. 520 OF BUTTER. The most violent bilious complaints that I ever met with, were evidently occasioned by food that became rancid on the stomach, as the cholera morbus, and the like. Nor can such complaints be cured, till the rancid matter is totally evacuated by vomiting and purging. But supposing butter did not possess the quality of becoming rancid on the stomach, it may, nevertheless, prove hurtful to digestion. Oils of all kinds are of a relaxing quality, and tend to impede the action of digestion. Hence the custom of giving rich broths and fat meats to persons who have a voracious ap- petite. The free use of butter, and other oily substances, not only tends to relax the stomach, and impede its action, but to induce a debility of the solids, which paves the way to many maladies. In a country where two thirds of the inhabitants lead sedentary lives, a debility of fibre must predominate. Whatever in- creases this debility ought to be avoided. Children, without exception, are disposed to diseases arising from relaxation. Butter, of course, ought to be given to them with a sparing hand. But is this tlje case? By no means. Bread and butter constitute a great part of the food of children, and I am convinced that the gross humors with which they are frequently troubled, are partly owing to this food. As chil- dren abound with moisture, bread alone is, generally speaking, belter for them than bread and butter. 1 have been astonished to see the quantities of butter eaten by gross women, who lead sedentary lives. Their tea bread is generally contrived so as to suck up butter like a spunge. What quantities of crumpets and muffins they will devour in a morning, soaked with this oil; and afterwards complain of indigestion, when they have eaten what would overload the stomach of a ploughman ! Dr. Fothergill is of opinion, that butter produces ihe nervous or sick headache, so common among the women of this country. As a proof of this, it is often cured by an emetic. Oils, in certain quantities, excite nausea, and even vomiting. They must of course prove unfriendly to digestion. A Dutch sailor, we are told, can digest train oil. So may an English sailor; but it would be very improper food for a London lady. To some of the leaner farinaceous substances, as the pota- toe, and the like, butter makes a very proper addition; but eating it with flesh and fish, of almost every description, is cer- tainly wrong.. The meat eaten in this country is generally fat enough without the addition of butter ; and the more oily kinds of fish, as salmon or herrings, are lighter on the stomach, and easier digested, when eaten without it. OF FRUITS AND ROOTS. 521 Butter is rather a gross food, and fitter for the athletic and laborious, than the sedentary and delicate. It is less hurtful when eaten fresh than salted. Salt butter certainly tends to induce skin diseases, and, I am inclined to think, the free use of it at sea may have some share in bringing on that dreadful malady, so destructive to our brave sailors, the sea scurvy. There is a method of rendering salt butter less.hurtful,but it seems not to be known in England. What I mean is, to mix it with an equal quantity of honey, and keep it for use. In this way it may be given to children with greater freedom. In North Britain, this method of mixing butter with honey is well known; and, from a common proverb, I take the custom to be very ancient. Butter, in itself, is not near so hurtful as when combined with certain other things. For example: bread made with butter is almost indigestible, and pastries of every kind are lit- tle better; yet many people almost live on pastry, and it is universally given to children. It is little better, however, than poison, and never fails to disorder their stomachs. The fond mother cannot pass a pastry shop, without treating her darling boy with some of the dainties, and then wonders how he got the cough, or colic. I have known a man, seemingly in perfect health, who, by eating a pennyworth of pastry, as he passed along the street, was seized with such an asthmatic fit, that he was obliged to be carried home, and had nearly lost his life. This occurred whenever he inadvertently ate anything baked with butter. Everything that proves very injurious to health, ought, as far as possible, to be prohibited, by laying a high duty on it. A duty on pastry would be serving the public in more respects than one. It would save many lives, and lessen some tax on necessaries. Cheese, as a diet, is likewise injurious to health. It should never be eaten but as a dessert. It occasions constipation, fires the blood, and excites a constant craving for drink. It is very improper for the sedentary, and hardly to be digested even by the athletic. If men will live on dry bread, poor cheese, salt butter, broiled bacon, and such like parching food, they will find then- way to the ale house, the bane of the lower orders, and the source of half the beggary in the nation. OF FRUITS AND ROOTS. Fruits and roots form a large class of the substitutes for bread. The latter, being produced under ground, are less 66 OF FRUITS AND ROOTS. liable to suffer from the inclemency of the seasons than grain. Men, who wish to inflame the minds of the multitude, may in- veigh against the substitutes for bread; but reason and sound sense say, the more substitutes for bread, the better. W7hen one fails, recourse can be had to another. In warm climates, the inhabitants have many substitutes for bread; and as their seasons,are more uniform than ours, they can generally depend on the plant, or whatever it is, proving productive. The plantain tree, commonly called the Indian fig, which has from time immemorial been cultivated in South America, bears fruit of a sweetish taste, which will dissolve in the mouth without chewing. It is eaten either raw, fried, or roasted. When intended to supply the place of bread, it is gathered before it,is ripe, and eaten either boiled or roasted. The banana is nearly of the same nature, but its fruit is great- ly superior to both in taste and flavor. The inhabitants of the South Sea, or Ladrone Islands, are supplied with bread from a tree, which has been lately import- ed into our West India Islands, and will, it is hoped, be found to answer the same purpose there. It has a slight degree of sweetness, but not much flavor. It resembles new bread, and requires to be roasted before it is eaten. Those who have tasted it, say, that it is in no respect superior to the potato. In some of the West India Islands, the inhabitants supply the place of grain by making bread from the root of a shrub, called the cassada, or cassava. Though, to my taste, this bread is very insipid, yet the natives are fond of it to such a degree, that .1 have known some of them eat it, during their residence in England, in preference to the finest London bread. But the most general substitutes for bread in the West In- dies are the yams. There are three different species of this plant, the roots of which are promiscuously used for bread. They are said to be very nutritious, of easy digestion, and, when properly dressed, are by some preferred to the best wheaten bread. The taste is somewhat like the potato, but more luscious. The negroes generally eat them boiled, and beaten into a mash. The while people have them ground into flour, and make bread and puddings of them. They can be preserve d for^everal seasons, without losing any of their primi- tive goodness. Ot all the substitutes for bread in Europe, the potato is the most extensively useful. This plant is a native of Peru, and has been in Europe about two hundred years. Like most other important discoveries, it made but slow progress, and is still far from being so generally cultivated as it deserves to be. It is, indeed, known in most parts of Europe, but its culture is OF FRUITS AND ROOTS. 523 best understood in Ireland and the northern parts of England. At Harwich, however, the preference is given to the Dutch po- tatoes, brought over by the packets between that-place and Holvoet-Sluys. There is a light, sandy soil in Holland very favorable to the culture of this inestimable root. As this plant thrives in every soil, and seldom suffers from an inclemency of seasons, we must blame ourselves if we suffer a famine to exist. Indeed, no such thing ever can be, where due attention is paid to the culture of potatoes. A far greater quantity of farinaceous food can be raised on an acre of ground planted with potatoes, than sown with any kind of grain. It is not uncommon to have a return of forty for one. They are not so hearty a food as corn, but no man will ever perish for hunger who can have potatoes. Potatoes abound with an insipid juice, which induces some to think, that they are not very nutritious. Facts, however, are against this opinion. Some of the stoutest men we know, arc brought up on milk and potatoes. Dr. Pearson, who has be- stowed some pains in analyzing this root, says, that potatoes and water alone, with common salt, can nourish men com- pletely. They differ in color and consistence, but not materi- ally with regard to their nutritive qualities. Some think the firm kind are the most nutritious; but the Irish, who must be good judges, give the preference to the mealy. The difference, however, depends much on the mode of cooking them. - More than half the substance of potatoes consists of water, and experience shows, that the mode of cooking, which most diminishes the moisture, is to be preferred. In London they are drenched in water, and washed before they are brought to market, which accounts in a great measure for the bad quality of the London potatoes. They are dressed in a variety of ways ; but simple boiling or roasting seems to be all the cooking they require, to render them a proper substitute for bread. Some are fond of making bre^d of them. This, in my opinion, is marring both. Why manufacture anything into bread, which requires only the aid of fire to make it such 1 Nobody thinks of making dough of the bread fruit; but the potato might with as great propriety be^ called the bread root, as it is made into bread by the same* process. Stewed mutton and potatoes make not only a nourishing, but a very palatable dish. The excess of fat of the mutton, which, when otherwise cooked, sustains great loss, is thus pre- served, by being absorbed by the potatoes. It is, however, to be observed, that, when potatoes are used in broths or stews, 524 OF FRUITS AND ROOTS. they ought previously to be boiled, and the water thrown away, as it contains something deleterious. Simple boiling or roast- ing is sufficient to prepare potatoes to supply the place of bread, but when they are intended to serve as a meal, they re- quire something of a softening nature, as milk, butter, or broth. What a treasure is a milch cow and a potato garden, to a poor man with a large family, who lives in the country! Yet, with a little attention from landlords and farmers, almost every man might be so accommodated. What a source of real wealth and population! Men would multiply, and poverty, unless among the profligate, be unknown. Horses are sometimes fed with potatoes, and become very fond of them. With the addi- tion of a small quantity of hay, they are found to be sufficient- ly nourishing. I would beg leave to recommend, both to landlords and farmers, a careful perusal of Earl Winchelsea's excellent letter to Sir John Sinclair, on the advantages of cottagers renting lands. This humane nobleman takes up the matter in a truly patriotic light, and shows th.it farmers, instead of lessening the number of poor, do everything they can to multiply them ; and, I am sorry to say, that, so far as my observation goes, it agrees entirely with his lordship's. Another letter relating to this subject has lately fallen into my hands, a copy of which I shall take the liberty to insert, as it contains, in a few paragraphs, the best practical illustration of the truths I have long been endeavoring to enforce. It was wrritten by Sir John Methuen Poore to Sir William Pulteney; and is dated " Rushall, 4th April, 1801 : " Sir, " I can prove, not by theory, but practice, the benefit of planting potatoes on fallows. In the parish where I reside, the whole of which, except five acres, is my property, there are thirty cottages, containing one hundred and thirtyone poor people. I have, for five or six years past, allotted, free from rent, four acres of land, intended to be sown with wheat the following autumn, for the cottagers to plant with potatoes, by which means each raises from ten to fifteen sacks, equal to two hundred and forty pounds a sack, yearly, in proportion to the number of their children. Each has not only sufficient for his family, but is enabled also to fat a pig. They declare, were I to give among them a hundred pounds, it would not be of so much benefit to them; and it is not one shilling out of my pocket, for I have as good, if not a better crop of wheat from this land, as I have from the other part of the field. "The method I take is this: the latter end of November, I plough the land j the frost during the winter mellows it: the OF FRUITS AND ROOTS. 525 beginning of March following, I plough it again, and harrow it; at both which times I have little to do with my horses: I then divide it into lots; a man with a large family has a larger lot than a single person, or one who has only two or tliree chil- dren, allowing about five perches (of sixteen and a half feet square) to each in a family: they then plant it, and put over their potatoes what manure they have collected the year pre- ceding, (for every cottager has more manure than necessary for this from his fires, and a variety of other things,) and during the summer, after their day's labor is done, they and their wives hoe them \ and as every man works more cheer- fully for himself than for another, they do not suffer a weed to grow. In October they dig them up; and it is the most plea- sant thing imaginable, to see the men, their wives and children, gathering the produce of their little farms, which is to serve them the ensuing winter.—Were this plan generally adopted, the laborers would consume but little corn ; which would sup- ply the manufacturing towns, and we should have no occasion to import. As four acres are sufficient for thirty families, it would take but a small quantity of land from every farm in the kingdom. The way practised here is to plant the potatoes in furrows, eighteen inches apart, and a foot apart in the rows. The land about me is of different qualities; on the hills rather light; in the vale, near the parish, inclining to clay ; but all fit for turnips: the potatoes are planted in the low land, being nearer home. The poor at present will not live entirely with- out bread, as many do in Ireland, though potatoes daily get into use more and more; and I am persuaded, were my plan generally adopted, in two or three years, the laborers in the country would consume but little or no corn. Thirty years ago, the poor in this part of the country would not eat pota- toes, if they could get other roots or vegetables." It is unnecessary to make any comments on this letter, every line of which is dictated by good sense and humanity, as well as by liberal and enlightened policy. I shall only add an earnest wish, that the example of the truly patriotic and benevolent writer may be followed by every man of landed property, and by every considerable farmer in the kingdom ! Some think that the potato, unless it be made into bread, will not keep. An accident taught me the contrary. Many years ago a friend of mine sent me a potato, after it had been roasted in an oven, on account of its singular figure. I laid it on a shelf among some other things of the like kind, and was surprized, on removing them many years after, to find the po- tato quite fresh, though as dry as a bone. On grating it down, it was perfectly sweet; and as fit for making soup as the 526 OF FRUITS AND ROOTS. day it was roasted. I apprehend, that nothing made into bread would have kept so long. Posterity -will hardly believe, that a scarcity of bread could be felt in Britain, at a time when it was known, that a sufficient quantity of farinaceous food could be raised in one county for the inhabitants of the whole island. Let proper encourage- ment be given to the culture of potatoes, and set famine at defiance. Many other domestic roots, sprouts, &c. are very whole- some, and may occasionally supply the place of bread. Of these, Mr. Bryant of Norwich reckons above forty: but we shall only take notice, by way of specimen, of the most useful and productive. It is worthy of remark, that no nation can be very populous, which does not draw a great part of its food from under ground. The Jerusalem artichoke is a native of Brazil, but, having been long cultivated in this country, it is too well known to need any description. From its taste, which is like that of artichoke bottoms, it would seem to be nutritious, and is far from being unpleasant to the palate. Some reckon it windy, but this may be corrected in the cooking, by warm spices; and as the plant is very productive, we would recommend it to be used in the same manner as potatoes, and the other farinaceous roots. Of the esculent roots in this country, the parsnip is reckon- ed the most nourishing. It is likewise of easy digestion, and is agreeSble to most palates. Some, indeed, dislike it on account of its sweetness; but this is a proof of its nutritive quality, su- gar being the most nourishing thing in nature. We are told that, in the north of Ireland, the poor people make beer from this root. There is not any plant that affords a more striking proof of the benefits of culture than the turnip. In its wild state it is good for little or nothing; but when properly cultivated, it not only affords wholesome nourishment for man, but furnishes the principal winter food for cattle. There is a species of this plant which grows in North Britain, called the yellow turnip, which is sweet, and of a superior quality to those produced in the south, particularly about London, which are bitter and stringy, The yellow turnip is the most nourishing, and also the most har- dy in sustaining the winter. It is eaten with milk to cure the consumption and scurvy. Margraaf says, he could extract no sugar from the turnip, which affords ground to conclude, that it is not so nutritive as certain other roots. Not only the root of the turnip, but the tops, when young, make very pleasant greens. The sprouts, if gathered when very tender, make an excellent sallad, OF FRUITS AND ROOTS. 52f The carrot, like the turnip, is good for little in its natural state, being small, tough and stringy. Manured, it grows large, succulent, and of a pleasant flavor. It ought, however, to be eaten young, otherwise it lies on the stomach, and is hard of digestion. It is an ingredient in several soups, and, being solid, may, in some measure, supply the place of bread. Salsafy, skirrets, and the several kinds of beets, are all pleasant and nourishing. They are likewise of easy diges- tion, and may be dressed in a variety of ways. Margraaf has by experiments discovered, that both skirrets and beets con- tain a considerable quantity of sugar. Though extracting a saccharine salt from these plants may be no object while we possess the West India Islands, yet it serves to show, that they possess a quantity of nutritious matter, sufficient to give them a rank among the articles calculated to supply the place of bread. The onion, we are told, was a great favorite in Egypt fouF thousand years ago, and Dr. Hasselquest says, it is not to be wondered at, for whoever has tasted the onions of Egypt must allowr, that none can be better in any part of the globe. There, he says, they are sweet, though in many countries they are strong and nauseous. There they are soft, whereas in northern countries they are hard, and their coats so compact, that they are difficult to digest. This very quality may, however, re- commend them in countries where food is scarce. The doctor observes, that the Turks eat them roasted with their meat as we do bread, and are so fond of them that they wish to be in- dulged with this dish in Paradise. From the doctor's .account one would be induced to believe, that the onion used in Egypt was of a different species from ours; hut I am rather inclined to think it may depend on the mode of culture, as well as on the warmth of the climate and the difference of soil, as we find in the southern parts of Europe they are milder than in the more northerly. In Spain they are very mild, and a root weighing two pounds will grow from a single seed. Onions are dressed in a variety of ways, but, in regard of wholesomeness, there is no method better than simple boiling. By this method of cooking, they are rendered mild, of easy digestion, and go off without leaving any disagreeable heat on the stomach or bowels. Many shun them on account of the strong disagreeable smell they communicate to the breath. Mr. Bryant says, this may be remedied, by eating a few raw parsley leaves immediately after, which will effectually overcome the scent of the onions, and likewise cause them to sit more easy on the stomach. £28 OF BROTHS AND SOUPS. The leek is generally reckoned among potherbs; but as the root is the part chiefly used, the consideration of it comes under the present head of discussion. Indeed, it is as properly a root as the onion, which grows chiefly above ground. The leek, as well as the onion, is said to be a constant dish at the table of the Egyptians, who chop them small, and eat them with their meat. The leek is used as a potherb in most parts of Britain, espe- cially in Wales, where the natives are said to be fond of it. In Scotland a full grown fowl and small piece of salt beef, stewed with a large quantity of leeks, is a very favorite dish. In my opinion, the leek is not so generally used anywhere as it de- serves to be. No ingredient goes into soup that is more whole- some, or that gives it a better flavor, than leeks. They are in many respects medicinal, and, to my taste, as an ingredient in soups, they are greatly superior to the onion, or any other pot- herb whatever. It is a fact worthy of observation, that the boiling of vegetable substances thoroughly, a thing seldom done in England, extri- cates a considerable quantity of air, and makes them less liable to produce flatulency. I could mention a great many more esculent plants, which might occasionally supply the place of bread, but the above specimen is sufficient to show how liberal nature is in supplying man with food, provided he will take the trouble of cultivating and cooking it. Mr. Bryant, in his history of esculent plants, enumerates above four hundred and fifty, each of which affords a wholesome nourishment, and may occasionally be used in place of bread. OF BROTHS AND SOUPS. These may likewise be considered as substitutes for bread. If properly made, they will serve both for bread and drink. Though broth is a dish of the greatest antiquity, and may be considered as extremely delicious, yet it is not a favorite in this country. Here the people are fond of what they call solids ; yet these very solids they make into broth, by swallowing as much drink after them as they can get. The only difference is, the foreigner makes his broth in a pot, and the Englishman makes his in the stomach. A very sensible anonymous writer observes, that in England a pound of meat makes simply a pound of food ; whereas in any other country in Europe, this quantity of animal food, when OF BROTHS AND SOUPS. 529 siewed down with vegetables and barley, will produce an ample meal for half a dozen people. Hence he justly infers that, among the variety of schemes which may have been devised by the humane for relieving the distresses of the poor, a better and more extensive charity cannot be devised than that of instruct- ing them in a new mode of cookery. The same author adds, that the result of his experiments on this subject had exceeded his most sanguine expectations, and that each day gave him fresh proofs of the excellency of his plan for teaching the poor and needy to find themselves in a wholesome and palatable diet, at the cheapest rate, in which little or no bread was required. He concludes by asserting, that there is scarcely a place in this kingdom, where twenty persons may not have a wholesome, hearty, palatable meal, for three shillings. The writer who has paid most attention to the improvement of cookery, for the benefit of the poor, is Count Rumford. In his economical and philosophical essays, he has given such a variety of forms for making wholesome, cheap, and nourishing soups, stews, and other dishes for common use, that little more seems necessary to be said on the subject. I shall only ob- serve, that the mode of living on broths, soups, hasty pudding, and such like, so warmly and justly recommended by the Count, has been practised in the northern parts of this kingdom from time immemorial. There the food of the common people is hasty pudding, with milk, for breakfast and supper, and broth, with vegetables and meat, for dinner. The poorer sort often make broth without meat; but they all use vegetables in great abundance, and sometimes they supply the place of meat with butter. As the hasty pudding and milk make a complete meal, no bread is necessary either at supper or breakfast; nor is much required at dinner, as the broth is made thick with barley, cab- bage, and a variety of other vegetables or potherbs. Cabbage is a favorite ingredient in a Scotchman's broth. It is seldom made without this article, which is not eaten so early as in Eng- land. It is there suffered to grow to maturity, and, when this is the case, there is no plant more productive. This the Ger- mans know well, and make it into sour crout, one of the best antidotes against the scurvy with which we are acquainted. This kind of diet not only saves bread but drink. The la- borer who lives on hasty pudding and soups, seldom has occa- sion for drink ; while he who is burnt up with dry bread and cheese, or salt meat boiled, has a continual thirst, and spends the greater part of his earnings in liquor. This, by acting aj a 67 530 OF BROTHS AND SOUPS. powerful stimulus, may make him do more work for some time, but it generally cuts him off in the middle of his days. The English laborer, who works hard and drinks hard, seldom lives long, and is an old man when he should be in his prime. The roasting of meat is a wasteful mode of cookery, which ought to be avoided by the poorer sort of. people, as much of the substance, and the most nutritive parts, are lost by scorch- ing and what flies off by evaporation. 1 know it will be said, that I recommend slops in place of solid food. They are such slops, however, as the greatest he- roes of antiquity lived on ; and though I have visited most parts of the island, 1 know of no better men than those who live in the manner described above, nor are the people anywhere more healthy, or longer lived. Broth is not only a dish of great antiquity, but one that can be made in a great variety of ways. It receives into its com- position animal and vegetable substances of every kind that are used in diet, and it may be seasoned so as to suit every palate. Indeed, people early accustomed to eat broths properly made, are generally fond of them for their whole lives. It would be difficult to assign a reason why the inhabitants of South Britain should dislike a dish so much relished by other nations. Custom, no doubt, settles all these things ; but how customs arise, is not so clear a matter. If an alteration in diet is to be introduced with effect, it must begin with children. Whatever men are accustomed to eat when young, they gene- rally prefer for the rest of their lives. Were the children in South Britain taught to eat hasty pudding, with milk, for break- fast and supper, and broth, with vegetables and meat boiled in it, for dinner, they would relish these dishes as long as they lived, would find little occasion for bread, and still less for drink ; and would thrive better than on their present food. What parents love themselves, they generally give to their children, without any regard to its being proper for them or not. I have seen a father, who was fond of strong beer, make his yon, an infant, guzzle it at every meal; and the mother, who delights in tea, does npt fail to give it to her daughter whenever she takes it herself. By this conduct, the son becomes a tip- pler, and the daughter sips tea in place of solid food, till she is eaten up with vapors and otheY nervous disorders. Count Rumford says, brown soup is the common breakfast of the Bavarian peasants, to which they occasionally add bread. This he avers is infinitely preferable in all respects to that per- nicious wash, tea, with which the lower classes of the inhabi- OF BROTHS AND SOUPS. 551 tants of this island drench their stomachs, and ruin their consti- tutions. He adds, that a simple infusion of this drug, drank boiling hot, as the poor generally drink it, is certainly a poison, which, though it be sometimes slow in its operation, never fails to produce fatal effects, even in the strongest constitution, where the free use of it is continued for a considerable length of time. The German on his polenta, the American on his mush, and the North Briton on his hasty pudding, can make a hearty breakfast for a tenth part of what a tea breakfast wouhl cost, while it is infinitely more wholesome. It has likewise the ad- vantage that no bread is necessary. I have been often told, when recommending soups to the poor, that they had not time to make them, and that they could not afford fuel on account of its price, as it is dear in great towns. They can, however, find fuel twice a clay to boil a tea- kettle, and time to make the tea, which is a more tedious ope- ration, by far, than making a mess of hasty pudding. For a great part of the year, even the poorest person must have a little fire ; and it would require no more to make a comfortable mess of soup, which is always best when made with a slow fire. The mode of living that I would recommend to the lower orders of the people, with a view to save expense and improve their health, is to substitute occasionally other farinaceous sub- stances in the place of bread, as potatoes, he.; to give up in a great measure the use of roasted, baked, and broiled meats, and to supply their place with broths, soups, stews, and such like, made with a little meat and plenty of vegetables ; to give to children, and to grown people who will eat it, for breakfast, milk porridge, or hasty pudding with milk, small beer, or mo- lasses. This will be found a more wholesome breakfast than tea, while it is much cheaper and requires no bread.* * The celebrated Dr. Huffland, in his Art of prolonging Life, says, the mode- rate use of soups is certainly not hurtful; and it is singular that people should imagine it tends too much to relax the stomach. Does not all our drink, eve« though cold, become in a few minutes a kind of warm soup in the stomach ; and does not the stomach retain the same temperature during the whole day ? Be careful only not to use it hot, in too great quantity at one time, or too watery. It is attended even with great advantages, It supplies the place oi drink, particularly to men of letters, women, and all those who do not drink, or drink very little, except at table, and who, when they give over soup, re- ceive into their blood too little moisture. And it is here to be remarked, that fluids used in the form of soups unite much better and sooner with our juices that when drunk cold and raw. On this account soup is a great preventive of dryness and rigidity in the body, and therefore the best nourishment for old people, and those who are of an arid temperament. It even supplies the place of a medicine. After catching cold, in nervous headaches, colics, and different kinds of cramp in the stomach, warm soup i? of excellent service. It 532 CONCLUSION, CONCLUSION. Though the place of bread may be occasionally supplied by farinaceous roots and other vegetables, yet we would by no means wish to discourage the culture of grain. The culture of grain is the culture of men. While the husbandman is raising food for his fellow creatures, he is laying the foundation of health and longevity to himself and his offspring. Innumerable benefits are connected with the culture of grain. While the artificer is sitting in some awkward posture, breathing confined, and per- haps contaminated air, the cultivator of the soil rises with the sun, eats his wholesome meal of milk and farinaceous food, hies him to the field, where he spends the day in useful labor, in- hales the fresh breezes, and at eve returns home with a keen appetite, to enjoy his simple repast and sound repose. It has been said, as artificers can earn more money than those who cultivate the ground, that arts ought to be encouraged, and grain, if necessary, imported. No manufacture is equal to the manufacture of grain. It supplies food for man and beast, while the surplus, by being exported, enriches the nation. Nor is it subject to the uncertainty of other manufactures. They often depend on fashion and caprice, but the necessaries of life will always find their value somewhere. Though I am convinced that some regulations are wanting for the encouragement of agriculture, I do not consider it as my province to dictate to the wisdom of the legislature. They know their duty, and 1 have reason to believe, that they are inclined to pay it all due atten- tion. 1 will venture, however, to assert, that, if proper encourage- ment were given to agriculture, Britain would at all times not only have a sufficiency of grain for her own consumption, but a surplus for exportation. This would contribute more to her real wealth, the happiness of her people, and the stability of her government, than the increase of her trade, the flourishing of her manufactures, or the extension of her territory. It is matter of real regret and wonder, that Britain, at a time when agriculture is cultivated as a science, should not be able may serve as a proof of the utility, or at least harmlessness of soup, when I remark that our forefathers, who certainly had more strength than we have, used soup ; and that it is used by rustics, who are still stronger than those in refined life ; and that all the old people with whom I ever was acquainted were great friends to it. CONCLUSION. 533 to raise grain for the supply of her own inhabitants, but become every year more dependent on foreign states for even the ne- cessaries of life. Till an adequate remedy can be found for this growing evil, the free use of the various substitutes for bread cannot fail to alleviate the calamities of the poor, and to reduce the price of labor. The great consumption of animal food, and the immense number of horses kept in this country, are to be reckoned among the causes of the scarcity of grain. Mr. Mackie com- putes the number of horses in this country to be about two mil- lions, and that every horse, on an average, consumes the pro- duce of three fertile acres ; consequently, the produce of six millions of fertile acres is annually consumed by horses. These would produce a quantity of grain more than sufficient to main- tain half the inhabitants of Great Britain. Two hundred and sixty thousand of these animals are kept for pleasure. I shall be told that they contribute to health. This I deny. Did our ladies of fashion and fine gentlemen make use of their limbs, instead of being dragged about in carriages, they would both benefit themselves and the public. I shall conclude these re- marks with the advice of the humane and benevolent Thomson: ." Ye gen'rous Britons ! venerate the plough, " And o'er your bills and long withdrawing vales u Let Autumn spread her treasures to the sun, " Luxuriant and unbounded. A,s the sea " Far through bis azure turbulent domain " Your empire owns, and from a thousand shores " Wafts all the pomp of life into your ports i " So with superior boon may your rich soil " Exub'rant Nature's better blessings pour " O'er ev'ry land, the naked nations clothe, " And be the exhaustless gran'ry of a world." APPENDIX. .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 shown. Physicians, however, from a veneration for antiquity, still retain in their lists of medicines many things, which owe their, repu- tation entirely to the superstition and credulity of our ancestors. The instruments of medicine will always be multiplied, in propor- tion 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 pro- portion to the number of simples that entered their composition. The great variety of forms into which almost every article of medi- cine 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 ma- ny 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 ne- cessary as is generally imagined. A few grains of powdered rhu- barb, jalap, or ipecacuanha, will actually perform all that can be done by the different pre'parations 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 ac- quire 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 £36 APPENDIX. ascertain the precise effect of any one medicine, as long as it is com- bined 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 or flavor 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 con- tained in the most reformed dispensatories. The same medicine is seldom exhibited under different forms; and where different medi- cines 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 practi- tioner, 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 genu- ine. They are often adulterated, and ought never to be purchased unless from persons of known veracity. Such of them as are in com- mon use are inserted in the lists of drugs and medicines. Their proper doses and manner of application are mentioned in the practi- cal part of the book, wherever they are prescribed. Such articles of medicines as are to be found in the house or garden of almost every peasant, as barley, eggs, onions, &c. are likewise for the most part omitted. It is needless to swell a list of medicines with such things as can be obtained whenever they are wauted, 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 expense, and that the medi- cine 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 flavor, 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 APPENDIX. 537 them wherever my own observations, or those of other practical wri- ters, on whose judgment 1 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 neces- sary to give the medicine a proper consistence, or the like. The coloring ingredients are likewise for the most part omitted. They increase the bulk and price of the medicine, without adding anything to its value. It would be well if they were never used at all. Medicines are often adulterated for the sake of a color. Acrid and even poisonous substances are, for this purpose, sometimes intro- duced into those medicines, which ought to be most bland and emol- lient. Ointment of elder, for example, is often mixed with verdi- gris to give it a fine green color, which entirely frustrates the in- tention of that mild ointment. Those who wish to obtain genuine medicine should pay no regard to their color. Some regard is likewise paid to expense. Such ingredients as greatly increase the price of any composition, without adding con- siderably 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 gen- erally 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 medi- cines, I have been obliged to the author of the New Dispensatory. The other observations are either such as have occurred to myself in prac- tice, 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 depend- ence 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, mathe- matical exactness here is by no means necessary. 68 538 APPENDIX. 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 on this subject, a great deal must be left to the judgment and skill of the person who administers the medicine. The^bllowing 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 Lat- in ; and some of them show 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 prescrip- tion 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. Many who peruse the Domestic Medicine have expressed a wish, that the catalogue of medicines contained in that book should be more extensive, and likewise that the dose of each article should be ascertained, as they are often at a loss to know how to administer even those*medicines, the names of which they meet with in almost every medical author. To obviate this objection, and furnish a greater scope to those who may wish to employ more articles than are contained in tlie Dispensatory formerly annexed to this work, the following List of Simples and Compounds, taken from the most improved Dispensa- tories, is now inserted. To prevent mistakes, the English name of every medicine is not only used, but the different articles are arranged according to the or- der of the English alphabet, anil the smallest and largest dose placed opposite to each article. The doses, indeed, refer to adults, but may bn adapted to different ages by attending to the above-mentioned rules. Short cautions arc occasionally inserted under such articles as require to be used with care. Though a greater variety of medicines is contained in this than in any former edition of the Domestic Medicine, yet the author would advise tiiose who peruse it, as far as possible, to adhere to simplicity in practice. Diseases arenotenre;! by the multiplicity of medicines, but by their proper application. A few simples, judiciously adminis- tered, and accompanied with a proper regimen, will do more good than a farrago of medicines employed at random. 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 1!2 ounces. An ounce . . 8 drachms. A dn.chm . . 3 scruples. A scruple . . 20 grains. A spoonful is the rn< A gallon 'contains 8 pints. A pint . . 16 ounces. An ounce . . 8 drachms. of half an ounce. APPENDIX. 539 A LIST OF THE MEDICINES COMMONLY USED IN PRACTICE, WITH THEIR PROPER DOSES. ACACIA, the expressed juice, Acid, the acetous -----, muriatic i----, nitrous, diluted ----, vitriolic, diluted Agaric, used externally as a styptic- Aloes Alum -----, burned Amber, prepared Ammoniac, gum —--------, milk of Angelica, the root powdered Anise, the seeds Antimony, crude ---------, calcined ---------, cinnabar of ---------, glass of ---------, tartarized Assafetida ----------, milk of Asarum, to provoke sneezing Balsam of capivi -------Canadian —— of Peru -------of Tolu Bark, cascarilla -----, Peruvian, powder of Bear's foot, powder of the leaves Benzoin, resin of --------, flowers of Bistort, powder of the root Blessed thistle from —, expressed juice of Bole, Armenian ----, French Borax Burdock, powder of the root Calamine stone, levigated, use external. Calomel Camphor . Canella alba, powder of 1 scruple tc 1 scruple 10 drops 15 drops 15 drops > 1 drachm. 1 drachm. 40 drops. 40 drops. 40 drops. 5 grains 30 grains. 6 grains 20 grains. 3 grains \ drachm 12 grains. 1 drachm. 5 grains | ounce \ drachm 10 grains 10 grains 1 scruple 80 grains, 1 ounce. 1£ drachm. 1 drachm. 1 drachm. 1 drachm. 10 grains 1 scruple. \ grain \ grain 6 grains 2 grains. 4 grains. £ drachm. £ ounce 1 ounce. 3 grains 5 grains-. 20 drops 60 drops. 10 grains 1 scruple 10 grains 4 grains 10 grains 1 scruple 10 grains 2 drachms 10 grains 10 grains 10 grains 1 drachm. 2 drachms. 20 grains. 20 grains. 20 grains. 1 drachm. 1 drachm. 2 ounces. 2 drachms. 40 grains. 1 drachm. 1 gr. to 3 gr. alterative. 3 do. to 12 do. purgative. 2 grains $ drachm. 1 scruple 2 drachms. 540 APPENDIX. Cantharidcs Cardamoms Caraway seeds Cascarilla bark Cassia, the pulp Castor Caustic, lunar; use extenal. Catechu Centaury, the lesser Chamomile, in powder Chalk Cinnamon Colocynth Columbo Confection, aromatic ----------, opiate Conserve of roses --------of squills --------of arum •Contrayerva Coriander seed Cowitch, the spiculse of one Crab's claws, prepared Cummin seed from \ grain to 4 grains 5 grains 10 grains 10 grains 2 drachms 8 grains 15 grains 1 scruple 20 grains 20 grains 5 grains 2 grains 10 grains 10 grains 10 grains 1 drachm 20 grains 20 grains 10 grains 15 grains pod mixed with honey or 10 grains 1 scruple 20 grains. 40 grains. 40 grains. 1 ounce. 1 drachm. 30 grains. 1 drachm. 1 drachm. 2 scruples. 1 drachm. 10 grains. 1 drachm. 2 scruples. 2 scruples. 1 ounce. 1 drachm. 1 drachm. 2 scruples. 1 drachm. molasses. 1 drachm. 1 drachm. Dandelion, expressed juice of . 1 ounce 3 ounces. Decoction of hartshorn, half a pint repeated as often as is necessary. of Peruvian bark of the inner bark of the elm of sarsaparilla — compound 1 ounce 4 ounces 4 ounces 4 ounces. 10 oz. daily. 16 oz. daily. ---------of guaicum, 3 drachms to a pint of water. Dragon's blood , . .10 grains Earth, fuller's; use external in excoriations. Electuary of cassia ---------ofscammony ---■---— lenitive, or of senna Elixir of vitriol Elecampane, powder of the root Ether, vitriolic Ethiop's mineral Extract of Peruvian bark cascarilla chamomile ----colocvnth com p. ----gentian ----* hemlock ----liquorice ----logwood ----black hellebore 1 20 30 15 20 30 10 10 10 10 5 10 2 1 10 drachm grains grains drops grains drops grains grains grains grains grains grains grains drachm grains grains A pint daily. 2 scruples. 1 ounce. 2 drachms. 6 drachms. 50 drops. 1 drachm. 2 drachms. SO grains. \ drachm. \ drachm. 1 drachm. 25 grains. \ drachm, 10 grains. £ ounce. \ drachm. 10 grains. APPENDIX. 541 Extract of jalap —— guaiacum white poppies rue savin senna wormwood from 5 grains to 20 grains, 10 grains 20 grains. 1 grain 5 grains, Fern, powder of the root Fennel seed Foxglove, powder of the leaves or a drachm infused in a pint of boil- } ing water, of which a dose is $ Should be administered with caution Flowers of chamomile, powder of ---------elder. 10 grains 10 grains 10 grains 10 grains £ drachm 20 grains h grain 1 ounce. —— rosemary. ----damask roses. ----red ditto. Frankincense Fruits. Almonds. ----—- Curacoa oranges. » ■ Figs dried. ■------French prunes. ------Tamarinds. Galbanum Galls Garlic, cloves of Gentian Germander Ginger Ginseng Guaiacum, wood of. gum resin Gum arabic ----gamboge Hartshorn, prepared ---------, spirits of ---------.caustic, in some mucilagi nous vehicle salt of Hellebore, black white 10 grains 10 grains No.l. 10 grains 15 grains 5 grains 20 grains 10 grains 15 grains 2 grains 20 grains 10 drops 5 drops 2 grains 5 grains 1 grain 20 grains. 30 grains. 30 grains. 30 grains. J ounce. 1 drachm, 3 grains. 10 grains 1 drachm. 10 grains 30 grains. 30 grains. 20 grains. No. 6. 40 grains. 1 drachm. 20 grains. 30 grains. 30 grains. 1 drachm. 12 grains. 1 drachm, 40 drops. 25 drops. 12 grains. 10 grains. 5 grains. Hemlock should always be begun with in very small doses, of one grain or less, and gradually increased as the constitution will bear. See extract of. Honey of squills , . . 10 grains 40 grains. ________roses . . .1 drachm 2 drachms. Hoffman's anodyne liquor , . 20 drops 60 drops. 542 APPENDIX. Jalap, powder of Infusion of gentian, compound ---------- roses — senna Ipecacuanha Iris, florentine Iron, rust of ----, ammoniated ----, tartarized ----, salt of Juniper, powder of the berries Rermes, mineral Kino, gum . . . from 10 grains 1 ounce 2 ounces \ ounce 10 grains 1 scruple 5 grains 2 grains 2 grains h grain 20 grains to Lead, white ----, sugar of Lemon peel. Lichen, ash colored, ground Icelandic, a strong decoction of 1 grain 10 grains 40 grains. 3 ounces. 8 ounces. 2 ounces. 30 grains. 1 drachm. 20 grains. 10 grains. 10 grains. 5 grains. 1 drachm. 3 grains. 30 grains, > \ grain 2 grains. 10 grains 1 ounce 4 ounces 15 drops 40 grains. 4 ounces. 8 ounces. 40 drop: Lime water Lixivium of tartar Linseed, an infusion of one ounce to a quart of water; may be used at pleasure. Liquorice, root of . \ drachm 1 drachm. Litharge. Madder powder Mace Magnesia --------calcined Manna Marsh mallows, root and leaves of Mercury, crude ———-, calcined --------, with chalk --------, corrosive sublimate --------, cinnabar of --------, red precipitate of --------, white ditto --------, yellow emetic, as sternutatory Mezereon, decoct, to a pint of water Millipedes - Musk ------ Mustard seed - Myrrh, gum - Nitre, purified - Nutmeg - i drachm 1 drachm. 10 grains 20 grains. £ drachm 2 drachms. \ ounce \ drachm \ ounce | grain 10 grains \ grain 10 grains use chiefly 1 grain 20 grains 5 grains 1 drachm 10 grains 10 grains 6 grains 2 ounces. 1 drachm. 4 ounces. 2 grains. SO grains. \ grain. 30 grains. external. 3 grains. 2 drachms. 2 drachms. 40 grains. 1 ounce* 1 drachm. SO grains. k drachm. APPENDIX. 543 Oil of almonds - from -----amber, rectified - -----anniseed - -----castor ... - -----cinnamon - -----juniper - -----lemon peel - -----linseed - -----olibanum ... - -----olive ----- -----palm - - - - -----peppermint - ----■ turpentine - - - - Onion, expressed juice of, a powerful > diuretic - - - - -$ Opium - Orange peel. Oyster shells, prepared Oxymel of colchicum - —--------squills - Pennyroyal. Peppermint. Petroleum - Pills, aloetic - ----, of the gums - —-, mercurial - Pitch, Burgundy. Pomegranate, powder of - - Poppy heads. Powder, antimonial £ ounce 10 drops 1 drop 2 drachms 1 drop 2 drops 2 drops £ ounce 5 grains ' \ ounce use external. 1 drop 3 drops. 10 drops 30 drops. \ ounce 2 ounces. i grain 2 grains. to 1 ounce. 30 drops. 5 drops. 1 ounce. 3 drops. 10 drops. 5 drops. 1 ounce. 30 grains. 1 ounce. a drachm i drachm i drachm 10 drops 10 grains 10 grains 10 grains 2 drachms. 1 drachm. 1 drachm. SO drops. 30 grains. 30 grains. 20 grains. 20 grains 1 drachm. 3 grains 6 grains. May be taken according to the directions for James's powder, with which it nearly coincides. ---of contrayerva, compound ---of chalk, compound • with opium 15 grains 20 grains 10 grains 10 grains 30 grains. 40 grains. 40 grains. Powder of ipecacuanha, compound, or Dover's powder - - - - Quassia .....5 grains One drachm to a pint of water for an infusion. Quince seeds, mucilage of, at pleasure, to obtund acrimony. 30 grains. 30 grains. Resin, yellow Rhubarb, powder of Rue powder Sassafras Savin St. John's wort Saffron Sal ammoniac Salt, Epsom 3 grains 10 grains 20 grains 1 scruple 10 grains 20 grains 5 grains 10 grains 2 drachms 20 grains. 40 grains. 40 grains. 1 drachm. SO grains. 1 drachm. 20 grains. 30 grains. 1 ounce. 544 APPENDIX. Salt, Glauber ---of hartshorn ---, Polychrest ——, Rochelle ---of tartar Saunders, red Sarsaparilla, powder of Scammony - Seneca - Senna - Soap - ---- lees - - - Spearmint -* - - Senna - Scurvy grass, expressed juice Snakeroot - Sorrel, juice of, depurated Spirit of lavender ■ Mindererus —— sweet, of vitriol -------------nitre from sal ammoniac -----compound ------fetid Spirits, distilled - Spirit of lavender, common ------- wine, rectified Steel, filings of - Spermaceti - - - - Sponge, burned - Storax - Sulphur - . . . ------, precipitated, of antimony Squill, dried powder -----, fresh - Syrup of poppies - ------- buckthorn ginger Syrups in general Tar • - - - —, water of. A pint daily. Tartar, cream of ------, regenerated ------, soluble ------, emetic, alterative --------------, as emetic Terra japonica 4 drachms 10 grains 20 grains 2 scruples 10 grains £ drachm 20 grains 5 grains 20 grains 20 grains 20 grains 10 drops 10 grains 1 scruple 1 ounce 20 grains 2 ounces 1 drachm 1 drachm 15 drops 15 drops 15 drops 1 drachm 20 drops 1 drachm 5 grains 20 grains 20 grains 10 grains 20 grains 1 grain 1 grain 5 grains i drachm 1 drachm 1 drachm 1 drachm to 2 ounces- 20 grains. \ ounce. 1 ounce, 30 grains. 1 drachm. 40 grains. 20 grains. 40 grains. 40 grains. •A ounce. 30 drops. 2 scruples. 1 drachm. 4 ounces. 40 grains. 4 ounces. 2 drachms. 1 ounce. 40 drops. 40 drops. 40 drops. £ ounce. 1 drachm. 2 drachms. 1 scruple. 1 drachm. 1 drachm. \ drachm. 1 drachm. 4 grains. S grains. 15 grains. ± ounce. 2 drachms. . \ ounce. 2 drachms. 5 grains 1 scruple. 2 drachms 20 grains 2 drachms i grain 1 grain 20 grains Tobacco, an infusion of, 1 drachm to a pint of water; ministered by tablespoonfuls; powerfully diuretic: clyster. See page 470. 1 ounce. 1 drachm. 1 ounce. £ grain. S grains. 40 grains. should be ad- or in form of APPENDIX. 545. Tin, powder of Turmeric Turpentine, spirit of ---------, Venice Tincture of aloes -, compound from •------—— assafetida ---- ■ . Benzoin, compound -----------cantharides /- .----------cardamoms ---------- castor ----------catechu -----------Peruvian bark -----------iron, muriated -----------Columbo -----------gentian, compound -----------guaiacum volatile -----------black hellebore jalap ---------myrrh ---------opium or paregoric elixir --------- rhubarb camphorated, 20 grains to 20 grains 10 drops 20 grains £ ounce £ drachm £ drachm 10 drops 10 drops 1 drachm £ drachm 1 drachm 1 drachm 10 drops 1 drachm 1 drachm 1 drachm 1 scruple 1 drachm 1 scruple 10 drops senna snakeroot valerian -------volatile Tormentil, powder of Turpentine, Venice Turmeric Tutty, levigated ; use external. Valerian, wild, powder of Vinegar, distilled -----.— of squills - _ - _________________, as emetic Verdigris, violent emetic Vitriol, white, as a tonic ------------,as a quickly operatin emetic - - -, blue, emetic ?-s Uva ursi, in powder Water cress, expressed juice of .------• trefoil Waters, any of the simple distilled Wax, white ----, yellow Wormwood, expressed juice White lead 69 1 drachm. 1 drachm. 30 drops. 1 drachm. 1 ounce. 2 drachms. 2 drachms. 40 drops. 40 drops. £ ounce. 1£ drachm. 2 drachms. i ounce. 60 drops. 3 drachms. 3 drachms. 5 drachms. 1 drachm. i ounce. 1 drachm. 40 drops. 1 drachm 3 drachms. £ ounce 2 drachms 1 drachm 1 drachm £ drachm ] 0 grains 1 scruple 1 scruple 20 grains 2 drachms 10 drops £ ounce 1 grain 2 grains 20 grains 1 grain 20 grains £ ounce £ drachm £ ounce 20 grains £ ounce 1 grain 2 ounces. 1 ounce. 2 drachms. 3 drachms. 2 drachms. 1 drachm. 1 drachm. 1 drachm. 2 drachms. 1 ounce. 50 drops. 1 ounce. 2 grains. 5 grains. 1 drachm. S grains. 1 drachm, 2 ounces. 1 drachm. 4 ounces. 1 drachm. 2 ounces. 3 grains, 546 APPENDIX. Wine, aloetic - - from £ ounce to 1 ounce. -----, antimonial - - - 20 drops 2 drachms. -----, ipecacuanha - - - 1 drachm £ ounce. -----, rhubarb - - \ ounce 2 ounces, Zedoary - - - - 10 grains 40 grains. Zinc, flowers of - ■» - 3 grains 10 grains. MEDICINAL PREPARATIONS. BALSAMS. TlIE subject of this section is not the natural balsams, but certain compositions, which, from their being supposed to possess the balsamic qualities, generally go by this 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 at- tended with inflammation. It must be rubbed with a warm hand on the part affected ; or a linen rag, or piece of flannel, moistened with it, may be applied to the part, and renewed every third or fourth hour, or oftener, till the pain abates. If the opium is left out, this will be the Saponaceous Balsam. Locatelli's Balsam.—Take of olive oil, one pint; 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 add 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 dvsentery, hemorrhages, 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; babam of Peru, Wq ounces; hepatic aloes, in powder, half an ounce j > APPENDIX. 547 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 l»eal 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 kidneys, 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 ex- travagant 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 composi- tion. They are generally composed of powders, with a proper quan- tity of syrup, conserve, or mucilage. The lighter powders are com- monly made up with syrup, and the more ponderous, as mercury, &c. with conserve; but those of the lighter kind would be more conve- niently 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 quinsy. Mercurial Bolus.—Take of calomel, six grains; conserve ot 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 ope- rate, a few grains of jalap will be proper next day to carry it oft. 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 hypochondriacal constitutions; but its principal intention is to expel worms. Where a stronger purge is necessary, jalap may be used instead of the rhubarb. 548 APPENDIX. Pectoral Bolus.—Take of spermaceti, a scruple; gum ammoniac, ten grains ; salt of hartshorn, six grains; simple syrup, as much as will make them into a bolus. This bolus is given in colds and coughs of long standing, asthmas, and beginning 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 suppura- tion ; 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 time, and then add two drachms of the sugar of lead. % t Ripening Cataplasm.—Take of white lily root, four ounces; fat figs and raw onions, bruised, of each one ounce; yellow basilicon ointment, two ounces; gum galbanum, half an ounce; linseed meal, as much as necessary. Boil the roots 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 yelk of an egg. Where it is necessary to promote suppuration, this cataplasm may be used by those who choose to be at the trouble and expense of making it. For my pai»t, 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 recall the blood and spirits to a part, as in the palsy and atrophy. They are also of ser- vice 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. APPENDIX. 549 p 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 crumbs of bread and mus- tard 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 on the stomach, and also in larger doses than at any time it can be taken by the mouth. The Peruvian bark may likewise he, with good effect, administered in form of clyster to persons who can- not 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 be done by any other means what- ever. This may be easily effected by means of a pair of hand bellows, with an apparatus fitted to them for this 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 tablespoonfuls of common salt, be added to this, it will be the Purging Clyster. Carminative Clyster.—Take of chamomile flowers, an ounce ; anise seeds, half an ounce. Boil in a pint and a half of water to one pint. In hysterical and hypochondriacal complaints, this may be admi- nistered instead of the Fetid Clyster, the smell of which is so disa- greeable to most patients. 550 APPENDIX. Oily Clyster.—To four ounces of the infusion of chamomile flowers, add an equal quantity of olive 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. Liquefy 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 humors. Forty cr 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; turpentine, dissolved with the yelk of an egg, half an ounce; olive oil, one ounce. Mix them. This diuretic clyster is proper in obstructions of the urinary pas- sages, 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. 10°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 EYEWATERS. Eyewaters 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 in- flammations ; and in that relaxed state of the parts which is induced by obstinate ones. Camphor is commonly added to these compositions ; but as it sel- dom incorporates properly with the water, it can be of little use. Boles and other earthy substances, as they da 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 APPENDIX. 551 the eyes, to allay heat, and restrain the flux of humors. It must be spread on 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 cele- brated collyria. It is a useful application in weak, watery, and in- flamed eyes. Though the slighter inflammations will generally yield to it, yet in those of a more obstinate nature, the assistance of bleed- ing and blistering will often be necessary. When a strong astringent is judged proper, a double or triple quantity of the vitriol may be used. 1 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 choose, 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 add- ing a teaspoonful of brandy. Indeed, common water and brandy, without any 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. 1 have of late been troubled with a rheum in my eyes, for which I have found great benefit, by washing them frequently with rose water. Many experience the like good effect from anointing the eyelids with Smellom's salve. 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 an- swered by a tew 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 ; tormen- til 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 roses, 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, * This eyewater, as it is, I should think quite too strong for general use.—C. 552 APPENDIX. 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 pos- sess 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 pow- ders, as the preparations of iron, mercury, and tin. Conserves are compositions of fresh vegetables and sugar, beaten together into a 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, the leaves of wood sorrel, Sec. Tlie conserve of roses is one of the most agreeable and useful pre- parations 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 effect, however, it must be taken in large 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 uvida 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, ami afterwards in syrup, or a solution of sugar. The article is either preserved moist in the syrup, or taken out and dried, that the sugar may candy on it. The last is Ihe 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. APPENDJX. 553 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 to that of the apothecary. DECOCTIONS. Water readily extracts the gummy and saline parts of Vegetables J 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 with them. Hence watery decoctions and mtu- sions of vegetables constitute a large, and not unuseful, class ot medi- cines. Though most vegetables yield their virtues to water, as well by infusion as decoction, vet 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 AWwa.—Take of the roots of marshmallows, mode- rately dried, three ounces ; raisins, one ounce ; water, three pints. Boil the ingredients in the water till one third ot 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 of the water be consumed. In coughs, and sharp defluxions on the lungs, this decoction may be used for ordinary drink. The Common Decoction.—Take of chamomile flowers, one ounce; elder flowers, and sweet fennel seeds, of each half an ounce ; water, two quarts. Boil them for a little while, and then strain the decoc- tl0A medicine equally good may be prepared by infusing the ingre- dients for some hours in boiling water. This decoction is chiefly intended as the basis of clysters, to which other mgredients 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 chfpto ^ ogwooot"n four pints of water, till one half the liquor is evaporated8 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 teacupful of this decoction may be tlken with advantage three or four times a day. Decoction of the flarfr.-Boil an ounce of the Peruvian bark, coarsely nowdered, in a pint and a half of water to one pint; then strain thePdecoction. If a teaspoonful of the weak spirit of vitriol be 70 55i APPENDIX. added to this medicine, it will render it both more agreeable and effi- cacious. Compound Decoction of the Bark —Take of Peruvian bark, and Virginian snakeroot, coarsely 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 any 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 liquo- rice. Strain the decoction. This may either be employed as an assistant to a course of mercu- rial alteratives, or taken after the mercury has been used for some time. It strengthens the stomach, and restores flesh and vigor 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 Wood. This decoction may be taken, from a pint and a half to two quarts in the day. Decoction of Seneca.—Take of Seneca rattlesnake root, one ounce; water, a pint and a half. Boil to one pint, and strain. This decoction is recommended in the pleurisy, dropsy, rheu- matism, and some obstinate disorders of the skin. The dose is two ounces, three or four times a day or oftener, 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 heartburn. It mav 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 re- APPENDIX. 555 pcated, 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 expense. Anodyne Draught.—Take of laudanum, twentyfive 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 occa- sionally. Diuretic Draught.—Take of the diuretic salt, two scruples; syrup of poppies, two drachms; simple cinnamon water, and com- mon 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 RocheHe 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 on 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; aro- matic tincture, six drachms. Rub the jalap with twice its weight of sugar, and add to it the other ingredients. Sweating Draughts.—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 ser- vice. 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 choose 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 Tighter powders, mix- ed 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. 556 APPENDIX. 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 consis- tence, 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 to- gether, and with a sufficient quantity of simple syrup, reduce the whole into an electuary. A teaspoonful of this electuary, taken two or three times a day, generally proves an agreeable laxative. It likewise serves as a con- venient vehicle for exhibiting more active medicines, as jalap, scam- mony, 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 marshmallows, 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 di?continue the use of it for a few days every now and then. I have added the powdered tin, be- cause the epilepsy often proceeds from worms. Electuary for obstrxicted Menses.—Take of conserve of orange peel, one ounce; steel filings, half an ounce; tartarized iron, two scru- ples ; aromatic powder and powdered rhubarb, of each half a drachm ; syrup, a sufficient quantity. The bulk of a nutmeg of this, taken every morning fasting, will be found an excellent remedy in obstructions of the menstrual evacua- tions. APPENDIX. 557 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 teaspoonful 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 teaspoonful 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 teaspoonful of this electuary may be taken twice a day with con- siderable 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, re- sins, and other similar substances, are likewise rendered miscible with water by the intervention of mucilages. Common Emulsion.—Take of sweet almonds, an ounce; bitter al- monds, a drachm ; water, two pints. Let the almonds be blanched, and beaten up in a marble mortar; adding the water by little and little, so as to make an emulsion; af- terwards 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 558 APPENDIX. 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 tablespoonful 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 on it by little and little, till it is dissolved. This emulsion is used for attenuating tough, viscid phelgm, and promoting expectoration. In obstinate coughs, two ounces of the syrup of poppies may be added to it. The dose is two tablespoonfuls three or tour times a day. Oily Emulsion.—.Take of soft water, six ounces; volatile aromatic spirit, two drachms ; olive 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 prove obstinate, it will succeed better when made with the paregoric elixir of the Edinburgh Dispensatory, instead of the volatile aromatic spirit. A tablespoonful of it may be taken every two or three hours.. EXTRACTS. Extracts are prepared by boiling the substance 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 spirit, 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 te- dious 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. Kuch of them as are generally used, are in- serted in our list of such drugs and medicines as are to be kept for private practice. FOMENTATIONS. Fomentations are generally intended either to ease pain, by tak- ing off tension and spasm ; or to brace and restore the tone and vigor of those parts to which they are applied. The first of these in- tentions 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, astrin- gents, &c. We shall therefore subjoin a few of the most useful med- APPENDIX. 559 icated fomentations, that people may have it in their power to make use of them as they choose. Anodyne Fomentation.—Take of white poppy heads, two ounces; elder flowers, half an ounce; water, three pints. Boil till one pint ia 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 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 diarrhoeas, flatulent colics, uneasiness of the stomach, and retchings to vomit, are frequently abated by fomenting the abdomen and region of the stomach with the warm liquor. « Common Fomentation.—Take tops of wormwood and chamomile flowers, dried, of each two ounces; water, two quarts. After a slight boiling, pour off the liquor. New rum or spirit of wine may be added to this fomentation, in such quantity as the particular circumstances of the case shall re- quire ; but these are not always necessary. Emollient Fomentation.—This is the same as the common de- coction. Strengthening Fomentation.—Take of oak bark, one ounce ; gra- nate peel, half an ounce; alum, two drachms; smith's forge water, three pints. Boil the water with the bark and peel to the consump- tion of one third ; then strain the remaining decoction, and dissolve in it the alum. This astringent liquor is employed as an external fomentation to weak parts; it may also be used internally. GARGLES. However trifling this class of medicines may appear, they are by no means without their use. They seldom, indeed, cure diseases, but they often alleviate very disagreeable symptoms ; as parchedness of the mouth, foulness of the tongue and fauces, &c. They are pecu- liarly useful in fevers and sore thoats. 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 prepar- ed. A little barley water and honey may be had anywhere; and if to these be added as much vinegar as will give them an agreeable 560 APPENDIX. sharpness, they will make a very useful gargle for softening and cleansing the mouth. Attenuating Gargle.—Take of water, six ounces; honey, one ounce ; nitre, a drachm and a half. Mix them. This cooling gargle may be used either in the inflammatory quin- sy, 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 quinsy. 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 marshmallow roots, and two or three figs; boil them in a quart of water till near one half of it be consumed ; then strain out the liquor. If an ounce of honev, and half an ounce of spirit of sal ammoniac, be added to the above, it will then be an exceedingly good attenuating gargle. This gargle is beneficial in fevers, where the tongue and fauces are rough and parched, to soften these parts, and promote the discharge of saliva. The learned and accurate Sir John Pringle, observes, that in the inflammatory quinsy, 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 Ihese humors; 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 are 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 bit- ter 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 ob- tained, by returning the liquor on fresh quantities of the substance, APPENDIX. 561 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 chamomile 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 teacupful 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 tablespoonfuls 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 this medicine are re- quired, a teacupful of it may be taken two or three times a day. Infusion of Carduus.—Infuse an ounce of the dried leaves of car- duus 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 fla- vored 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 oft' 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, mu- cilaginous liquors, and may be taken with advantage as ordinary drink in difficulty of making water; and in coughs and other com- plaints 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 hemorrhages, a teacupful of this gently astringent infusion may be taken every three or four hours. It likewise makes an exceedingly 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. 71 562 APPENDIX. 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 ot the aro- matic 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 teacupful 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 strained liquor add an ounce and a half of the syrup of poppies. In recent colds, coughs, and obstructions of the breast, a teacupful of this infusion may be taken with advantage three or four times a day. Infusion for the Palsy.—Take of horseradish root, shaved, mus- tard seed, bruised, each four ounces ; outer rind of orange peel, on« ounce. Infuse them in two quarts of boiling water, in a close vessel, for twentyfour hours. In paralytic complaints, a teacupful of this warm, stimulating medi- cine 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; boil- ing 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 com- pound spirit of lavender, of each two drachms; syrup of orange peel, an ounce. Mix them. APPENDIX. 563 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 Jidep.—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 tablespoon- fuls of this julep maybe 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 lowfstate of nervous fevers, hickuping, convulsions, and other spasmodic affections, two tablespoonfuls 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 tablespoonful 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 ajulep in this respect, that it receives into its composition not only salts, extracts, and other substances soluble in water, but also earths, powders, and such substances as cannot be dissolved. A mixture is seldom either an elegant or an agreeable medicine. It is nevertheless necessary. Many persons can take a mixture, who are not able to swallow a bolus or an electuary: besides, tliere are medicines which act better in this than in any other form. Astringent Mixture.—Take simple cinnamon water, and common water, ot 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 564 APPENDIX. evacuations, a spoonful or two of this mixture may be taken every four hours, interposing every second or third day a dose of rhubarb. The Astringent Mixture, which I have lately made use of with great success, is prepared thus:— Take powder of bole with opium, two drachms ; cinnamon water and pennyroyal water, of each three ounces; spirituous cinnamon water, six drachms ; simple syrup, one ounce. Mix them, and take a tablespoonful four or five times a day. Diuretic Mixture.-r-T&ke 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 mix- ture 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 ot 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 tablespoonful 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 marshmallows, 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 vrounds, sores, &c. it is beyond a doubt, that the most proper application to a green wound is dry lint. But though APPENDIX. 565 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. Fellow Basilicon Ointment.—Take of yellow wax, white resin, and frankincense, each a quarter of a pound ; melt them together over a gentle fire ; then add, 01 hog's 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 pre- viously melted together, continually stirring them till quite cold. This ointment, which is commonly known by the name of Turner's Cerate, is an exceedingly good application in burns and excoriations, from whatever cause, if fresh prepared. 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 Althcea Ointment. It may be used for anointing inflamed parts, &c. Eye Ointment.—Take of hog's lard prepared, four ounces; white wax, two drachms; tutty prepared, one ounce; melt the wax with the lard over a gentle tire, and then sprinkle in the tutty, continually stirring them till the ointment is cold. This ointment will be more efficacious, and of a better consistence, 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; verdigris, well prepared, two drachms; hog's lard, and mutton suet, prepaied, of each two ounces. Rub the camphor well with the powder; afterwards mix in the lard and suet, continu- ing 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 in- flamed, or very tender. Issue Ointment.—Mix half an ounce of Spanish flics, finely pow- dered, in six ounces of yellow basilicon ointment. This ointment is chiefly intended for dressing blisters, in order to keep them open during pleasure. 566 APPENDIX. Ointment of Lead.—Take of olive oil, half a pint; white wax, two ounces; sugar of lead, three drachms. Let the sugar of lead, re- duced 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 scald- ing, &c. Mercurial Ointment.—Take of quicksilver, two ounces ; hog's lard, three ounces; mutton suet, one ounce. Rub the quicksilver with an ounce of the hog's lard in a warm mortar, till the globules be perfectly extinguished ; then rub it up with the rest of the lard and suet, previously melted together. The principal intention of this ointment is to convey mercury into the body by being rubbed on the skin. Ointment of Sulphur.—Take of hog's 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 on the parts affected, will generally cure the itch. It is both the safest and best application for that purpose, and, when made in this way, has no disagreeable smell. Ointment for Diseases of the Skin.—Take of the ointment, com- monly called unguentum citrinum,a, drachm and a half; flour of brimstone and powder of hellebore, of each an ounce; hog's lard, three ounces; essence of lemon, or oil of thyme, from twenty to thirty drops, to correct the offensiveness of the smell. Make them into an ointment. I have not only known many ordinary affections of the skin cured by this ointment, but even some of a very malignant nature, and ap- proaching to leprosy. White Ointment.—Take of olive oil, one pint; white wax and spermaceti, of each tlu4e ounces. Melt them with a gentle heat, and keep them constantly and briskly stirring together, till quite cold. If two drachms ot camphor, previously rubbed with a small quan- tity of oil, be added to the above, it will make the White camphorated Ointment. Liniment for Burns.—Take equal parts of fresh drawn linseed oil, and lime water; shake them well together in a wide-mouthed botile, so as to form a liniment. This is found to be an exceedingly proper application for recent scalds or burns. It may either be spread on 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 tiiirds of the wax being left out. This liniment may be applied in cases of excoriation, where, on APPENDIX. 56r 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 yelk of an egg, and work them well together. Volatile Liniment.—Take of olive oil, an ounce; spirit of harts- horn, 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 quinsy, a piece of flannel, moistened with this liniment, and applied to the throat, to be renewed every four or five hours, is one ot 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 olive oil, in a mortar, till the camphor be entirely dissolved. This antispasmodic liniment may be used in obstinate rheumatism, and in some other cases accompanied with extreme pain and tension of the parts. PILLS. Medicines which operate in a small dose, and whose disagreeable taste or smell makes it necessary that they should be concealed from the palate, are most commodiously exhibited in this form. No medi- cine, however, that is intended to operate quickly, ought to be made into pills, as they often lie for a considerable time on the stomach be- fore they are dissolved, so as to produce any effect. As the ingredients which enter the composition of pills are general- ly 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 on the stomach, one, two, or three of these pills may be taken, as occasion requires. Deobstruent Pill.—Take salt of steel; Socotrine aloes; myrrh in powder; of each a drachm. Make into forty pills, of which two are to be taken evening and morning. I have found these pills of excellent service in obstructions of the menses. The late Dr. Watkinson made it his dying request, that I would insert this prescription in the " Domestic Medicine," which he said would be immortal, and that« his soul panted for immortality." 568 APPENDIX. Fetid Pill—Take of assafetida, 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. WThen 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 stu- por or giddiness. Mercurial Pill.—Take of purified quicksilver and honey, each ha 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 quanti« ty to give the mass a proper consistence for pills. When stronger mercurial pills are wanted, the quantity of quick- silver 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 may be 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 Mercu- rial Purging Pill. Mercurial Sublimate Pill.—Dissolve fifteen grains of the corro- sive 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 must be formed into one hundred and twenty pills. This pill, which is the most agreeable form of exhibiting the subli- mate, has been found efficacious, not only in cm ring the venereal dis- ease, but also in killing and expelling worms, after other powerful medicines had failed.* For the venereal disease, four of these pills may be taken twice a day ; as an alterant, three; and for worms, tvvo. Plummer's Pill.—Take of calomel, or sweet mercury, and precipi- tated sulphur of antimony, each three drachms ; extract of liquorice, two drachms. Rub the sulphur and mercury well together; after- wards add the extract, and, with a sufficient quantity of the muci- lage of gum arabic, make them into pills. •See a paper on this subject in the Edinburgh Physical and Literary Essays, by tiie iugcuious Dr. John Gardener. APPENDIX. 569 This pill has been found a powerful, yet safe, alterative in obsti- nate cutaneous disorders; and has completed a cure after salivation had failed. In venereal cases it has likewise produced excellent ef- fects. 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 Socotrine 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 th« body gently open, one may be taken night and morn- ing. They are reckoned both tleobstruent and stomachic, and will be found to answer all the purposes of Dr. Anderson's pills, the princi- pal 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. Purgative Pill.—' Take powder of Socotrine aloes, one drachm ; of gum sagapene in powder, half a drachm ; of gamboge, and gum ara- bic in powder, each, one scruple; essential oil of chamomile, ten drops; syrup of buckthorn, a sufficient quantity; beat the whole into a mass, and divide into thirtytwo pills. This pill was contrived by that eminent physician, the late Df. George Fordyce. It is an excellent purgative, where the bowels are torpid, as in paralytic affections. One or two may be taken at bed time.' A. P. B. Pill for the Bile.—Take gum pill and colocynth pill, each a drachm. Beat them together, and make the mass into thirty pills. In bilious and nervous patients, where it was necessary to keep the body gently open, I have found these pills answer the* purpose ex- tremely well. I generally give one over night, and another next morning, once or twice a week. But the dose must be regulated by the effect. Pill for the Jaundice.—Take of Castile soap, Socotrine 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 lass, as is necessary to keep the body open. It will be proper, however, dur- ing their use, to interpose now and then a vomit of ipecacuanha or tartar emetic. Stomachic Pill.—'Take extract of gentian, two drachms; powder- 72 570 APPENDIX. ed 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 invigo- rating the stomach, and keeping the body gently open. Squill Pills.—Take powder of dried squills, a drachm and a half; gum ammoniac, and cardamom seeds, in powder, of each three drachms; simple syrup, a sufficient quantity. In dropsical and asthmatic complaints, two or three of these pills may be taken twice a day, or oftener, if the stomach will bear them. Strengthening Pills.—Take soft extract of the bark, and salt of steel, each a drachm. Make into pills. In disorders arising from excessive debility, or relaxation of the solid9, as the Chlorosis, or green sickness, two of these pills may be taken three times a day. PLASTERS. Plasters ought to be of different consistence, according to the pur- poses for which they are intended. Such as are to be applied to the breasts or stomach, ought to be soft and yielding; while those design- ed 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 makes 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 olive oil, six pints; litharge, reduced to a fine powder, twov pounds and a half. Boil the litharge and oil together over a gentle fire, continually stirring them, and keeping al- ways 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 this 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 j of Bur- gundy pitch, a quarter of a pound. Melt them together. APPENDIX. 571 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; yel- low 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 sup- plied by mixing with any soft ointment a sufficient quantity of pow- dered flies; or by forming them into a paste with flour and vinegar. Blistering plasters prove highly disagreeable to many people, by occasioning strangury. I have therefore of late used a plaster, in which a small quantity of blistering salve has been mixed with the Burgundy pitch plaster. I lay it over the part affected, and suffer it to remain as long as it will stick. The blistering plaster loses its ef- fect in a few hours, whereas this will act for many days, or even weeks, and seldom fails to remove pain, or slight obstructions. Gum plaster.—Take of the common plaster, four pounds; gum am. moniac and galbanum, strained, of each half a pound. Melt them to- gether, and add, of Venice turpentine, six ounces. This plaster is used as a digestive, and likewise for discussing indo- lent tumors. 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 indolent tu- mors, 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 sprin- kle in the pepper, previously reduced to a fine powder. An ounce or tvvo of this plaster, spread on soft leather, and applied to the region of the stomach, will be of service in flatulencies arising from hysteric and hypochondriacal affections. A little of the ex- pressed oil of mace, or a few drops of the essential oil of mint, may be rubbed on it before it is applied. 5,72 APPENDIX. This may supply the place of the Antihysteric Plaster. Warm Plaster.—Take uf gum plaster, one ounce; blistering plas- ter, 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 propor- tion of the blistering j.laster. Wax Plaster.—Take of yellow wax, one pound ; white resin, half a pound; mutton suet, three quarters of a pound. Melt them to- gether. This is generally used instead of the Melilot Plaster. It is a pro- per application after blisters, and in other cases where a gentle diges- tive is necessary. POULTICES. Poultices are often beneficial, even in the most simple form; but more so, when employed to retain more active medicines,—to keep them in contact with the skin,—and to fit it for their absorption. Every nurse knows how to make a poultice. A poor woman, who had received a very dangerous wound in the tendons of her thumb from a rusty nail, called on me some little time since ; as her case properly belonged to the department of surgery, I advised her to apply to the hospital; but the official hirelings there refused to take her in, though I always understood, that they were obliged to take in accidents. It seems, however, that some very con- fined meaning was annexed to this word by the surgeon on duty, and that he did not think the danger of a locked jaw, to be an accident as deserving of his pity and immediate assistance, as a broken arm, or dislocated ankle. The poor woman came back to me ; and, as her situation became every moment more and more alarming, the pain and inflammation having reached as high as the armpit, I advised her to apply to the whole hand and arm a large poultice, with an ounce ot" laudanum sprinkled over it, and to renew the poultice twice a day. This she did with so much success, that the thumb is now quite well, though the accident did not happen above three weeks ago. Alarming as the case was, I had some reason to rely on the efficacy of the poultice, from a former trial somewhat similar. One of those girls, who are employed by bookbinder;- in stitching the sheets, having wounded her finger with the three edged needle used on such occa- sions, soon felt the pain shoot upwards with deadly tendency. I or- dered her to apply the same sort of poultice with laudanum, which had the same happy effect. Both these patients made use of the Common Poultice ; but I pre- fer one made of linseed flour, which is more easily prepared, and keeps moist longer than any other. APPENDIX. 573 POWDERS. This is one of the most simple forms in which medicines can be administered. Many medicinal substances, however, cannot be re- duced 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 consist- ent vehicle, as syrup, conserve, jelly, or honey. Gums, and other substances, which are difficult to powder, should be pounded with the drier ones; but those which are too dry, espe- cially 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 a 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 hemorrhages, one ot these powders may be taken every hour, or every half hour, if the dis- charge be violent. Poicder of Bole.—Take of bole Armenian, or French bole, two ounces; cinnamon, one ounce ; tormentil root and gum arabic, ot 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 oth- er disorders where medicines of this 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 in- digestion, particularly those to which hysteric and hypochondriacal 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 ni- tre, one ounce. Pound them together, and divide the whole into twentvfour doses. 574 APPENDIX. During the first stage of the venereal disease, one of these cooling powders may be taken three times a day, with considerable advantage. Aromatic Opening Powder.—Take the best Turkey rhubarb, cin- namon, and fine sugar, each two drachms. Let the ingredients be pounded, and afterwards mixed well together. When flatulency is accompanied with costiveness, a teaspoonful of this powder may be taken once or twice a day, according to circum- stances. 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 teaspoonful of this powder may be taken twice a day, and washed down with a little wine and water. Sudorific Powder.—Take purified nitre and vitriolated tartar, of each half an ounce ; opium and ipecacuanha, of each one drachm. Mix the ingredients, and reduce them 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 adminis- tered 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 Powder.—Take of tin reduced into a fine powder, an ounce; Ethiop'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 anthelminthic purge may be proper. Purging Worm Powder.—Take the powdered rhubarb,a scruple; scammony and calomel, of each five grains. Rub them together in a mortar for one dose. For children the above doses must be lessened according to their age. If the powder of tin be given alone, its dose maybe considerably in- creased. The late Dr. Alston gave it to the amount of two ounces in three days, and says, when thus administered, that it proves an egregious anthelminthic. He purged his patients both before they took the powder and afterwards. APPENDIX. 675 SYRUPS. Syrups were some time ago looked on 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 fermen- tation ; 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 twentyfive 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 marshmallows may likewise be supplied, by adding to the common syrup a sufficient quantity of mucilage of gum arabic. Those who choose 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 giv- ing medicine to persons afflicted with flatulency. It may be made by infusing two ounces of bruised ginger in two pints of boiling water for twentyfour 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 solvent 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 Pait dissolves likewise those parts of animal substances, in which their peculiar smells and tastes reside. Hence the tinctures prepared with rectified spirit form a useful and elegant class ot medicines, pos- sessing many of the most essential virtues of simples, without being " clogged with their inert or useless parts. Water, however, being the proper solvent of the gummy, saline, and saccharine parts of medicinal substances, it will be necessary, in 576 APPENDIX. 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 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 de- cline. 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 Fetid Tincture.—Infuse two ounces of assafetida in one pint of volatile aromatic spirit, for eight days, in a close bottle, fre- quently shaking it; then strain the tincture. This medicine is beneficial in hysteric disorders, especially when attended with lowness of spirits, and faintings. A teaspoonful of it may be taken in a glass of wine, or a cup of pennyroyal 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.* In rheumatic complaints, a teaspoonful 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 with the roots, to give the tincture a color. In obstructions of the menses, a teaspoonful of this tincture may be taken in a cup of chamomile or pennyroyal 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. * A very good tincture of guaiacum, for domestic use, may be made by in- fusing two or three ounces of the gum in a bottle of rum or brandy. APPENDIX. 577 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 spirit, 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, recom- mended as a proper application to green wounds. Tincture of Opium, or 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 twentyfive drops of this tincture contain about a grain ot opium, the common dose may be from twenty to thirty drops. Sacred Tincture, or Tincture of Hiera Picra.-Take of Socotrine aloes in powder, one ounce ; Virginian snakeroot and ginger, of each two drachms. Infuse in a pint of mountain wine, and ha f a pint ot brandy, for a week, frequently shaking the bottle ; then strain oft the tinThiseis a safe and useful purge for persons of a languid and phleg- matic habit; but it 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 brandy for a week; then-strain the tine ture and add to it four ounces ot fine sugar. This is an agreeable purge, and answers all the purposes of the Elixir Salntis, 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 povvder, two ounces ; spirit of wine, one pint. Infuse for two or tbrpp davs: then strain off the tincture. This % in ended 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, ol: Tolu an ounce and a half; rectified spirit of wine, a pint. Infuse in a gentle hpat till the balsam is dissolved; then strain the tincture. h6TW tincture possesses all the virtues of the balsam. In coughs and other complaints of the breast, a teaspoonful or two of it may be token on a St of loaf sugar. But the best way of using it is in syrup AnTunce'of the tincture properly ™*?™£^£lg™** svrup will make what is commonly called the Balsamic byrup. " 73 578 APPENDIX. Tincture of Rhubarb.—Take of rhubarb, two ounces and a half; lesser cardamom seeds, half an ounce; brandy, two pints. Digest for a week, and strain the tincture. Those who choose to have a vinous tincture of rhubarb may infuse the above ingredients in a bottle of Lisbon wine, adding to it about two ounces of proof spirit. 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 tinc- ture of rhubarb. All these tinctures are designed as stomachics and corroborants, as well as purgatives. In weakness of the stomach, indigestion, laxity of tlie 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 pa- tient, and the purposes it is intended to answer. Tlie Tonic Tincture.—Mix two ounces of the compound tincture of Peruvian bark with the like quantity of the volatile tincture of valerian; and of this mixture a teaspoonful in a glass of wine or water is to be taken three or four times a day. I have long made use of this tincture for the relief of those peculiar affections of the stomach and bowels, such as indigestion, &c which generally accompany nervous diseases. I do not say,that the tinc- ture will cure these complaints, nor do I know of any medicine that will; but where a complete cure cannot be rationally expected, relief is certainly a very desirable object. Paregoric Elixir.—Take of flowers of benzoin, half an ounce; opium, two drachms. 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 chincough. The dose to an adult is from fifty to a hundred drops. Sacred Elixir.—Take of rhubarb, cut small, ten drachms; Soco- trine aloes, in powder, six drachms; lesser cardamom seeds, half an ounce ; brandy, tvvo 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-; Curracoa oranges, one ounce; Virginian snakeroot, half an ounce. Let the ingredients be bruised, and infused for three or four days in two pints of brandy ; afterwards strain out the elixir. This is an excellent stomach bitter. In flatulencies, indigestion, want of appetite, and such like complaints, a small glass of it may be APPENDIX. 579' 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 feces have subsided, filter the elixir through paper, in a glass funnel. This is one of the best medicines which I know for hysterical and hypochondriacal patients, afflicted with flatulencies arising from re- laxation 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 thnce 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 spirit. 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 quan- tity. Pour on it gradually distilled vinegar, till the effervescence ceases. This medicine is useful in promoting a discharge both by the skin and urinary passage. 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 fer- mentation. It is a 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 sys- tem. It likewise promotes the natural secretions, and in some cases excites a copious sweat, where the warm medicines, called alexiphar- mic, 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 poi- sonous substances, when taken into the stomach; and in promoting their expulsion, by the different emunctories, when received into the, blood. Vinegar is not only a useful medicine, but serves likewise to ex- tract, in tolerable perfection, the virtues of several other medicinal substances. Most of the odoriferous flowers impart to it their fra 580 APPENDIX. grauce, together with a beautiful purplish or red color. 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 everything 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 vine- gar, tvvo 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 dan- gerous. 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 use- ful medicine, which he calls the Extract of Saturn, and orders it 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, lor an hour, or an hour and a quarter, taking care to stir them all the while with a wooden spatula. After tlie whole has stood to settle, pour oft" the liquor which is on the top into bot- tles for use. With -his extract, Goulard makes his ve^eto-mineral water,* which he recommends in a great variety of external disorders, as inflamma- tions, 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 vine- gar, 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 headaches, &c. Vinegar of Squills.—Take of dried squills, two ounces ; distilled vinegar, two pints. Infuse for ten days or a fortnight in a gentle de- gree of heat; afterwards strain oft' the liquor, and add to it about a twelfth part of its quantity of proof spirit. This medicine has good effects in disorders of the breast, occasion- ed 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 in- tention 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 * See Collyrium of Lead. APPENDIX. 581 in small closes, 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 on 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 stopped. 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 or two or more of it may be drank 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; co- riander 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 vir- tues of the other vegetable substances. Such impregnation not only renders the water more agreeable to the palate, but also a more effica- cious 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 be wanted, a double or triple quantity of sub- limate may be used. The principal intention of this is to cleanse foul ulcers, and con- sume proud flesh. Styptic Water.—-Take of blue vitriol and alum, each an ounce and a half; water, one pint. Boil them till the salts are dissolved, then fil- ter 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 hemorrhages ; for which purpose cloths or dossils dipped in it must be applied to the part. Tar Water.—Pour a gallon of water on two pounds of 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 *iven of it, yet it possesses some medicinal virtues. It sensibly raises 582 APPENDIX. 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,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 consi- der 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 19 needless to spend time in giving directions for this 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 pennyroyal 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 hysterical 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 pre- ceding. Spearmint Water.—This may also be prepared in the same way as the pennyroyal 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 ; waten two gallons. Distil off one gallon. This water is principally valued on account of its fine flavor. APPENDIX, 583 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 sup- ply 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 teacupful four or five times a day. A number of other wheys may be prepared nearby in the same man- ner ; as orange whey, cream of tartar whey, &c. These are cooling, pleasant drinks in fevers, and may be rendered cordial, when necessa- ry, 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 584 APPENDIX. these effects, have an astringent quality, by which they strengthen the tone of the stomach and intestines, and by this means prove ser- viceable 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 equa,I quantity of any other wine, though it should contain fully as much spirit. From the obvious qualities ofwine.it must appear to be an excel- lent 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 bene- fit 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 solvpnt for extracting the virtues of other medicinal sub-lances; for which it is not ill adapted, being a compound of water, inflammable spirit, and acid ; by which means it is enabled to act on vegetable and animal substances, and also to dissolve some bodies of the metal- lic kind, so as to impregnate it-self with their virtue; as steel, anti- mony, &c. Anthelminthic 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 debili- tated, red wine alone will often prove serviceable. It must, however, have still better effects when joined with bitter and purgative ingre- dients, 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 ; after- wards 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 large dose it generally proves cathartic, or excites vomiting. Bitter Wine.—Take of gentian root, yellow rind of lemon peel, fresh, of 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 ; APPENDIX. 585 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 wineglass, 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 quan- tity of the vitriolic acid. Stomach Wine.—Take of Peruvian bark, coarsely powdered, an ounce; cardamom seeds, and orange peel, bruised, of each two drachms. Infuse in a battle of white Port or Lisbon wine, for five or six days; then strain off the wine. This wine is not only of service in debility of the stomach and intestines, but may also be taken as a preventive, by persons liable to the intermittent fever, or who reside in places where this disease pre- vails. 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 vigor of the system. A glass of it may be taken two or three times a day. PREPARATION OF THE LICHEN ISLANDICUS. ' The lichen islandicus has of late been much extolled as a remedy in pulmonary consumption. Not that it is supposed to possess any peculiar virtues as a pectoral medicine, but is rather to be considered as a nutritious vegetable jelly, which promotes digestion by its slight bitterness, and, at the same time, sufficiently supports the strength, without stimulating the system ; thus affording the powers of the constitution an opportunity of subduing the diseased actions of the lungs. Many animals become very fat, while living solely on the lichen islandicus, a proof, that it affords abundant nutriment. To derive any essential benefit from the use of this article, it must consti- tute the sole subsistence. Persons, who possess sufficient resolution to persist in such a regimen, will find the lichen, prepared according to the following directions, an agreeable article of food : Four ounces of the lichen, cut~into small pieces, are to be boiled in three pints of water, till the quantity be reduced to two. To this add a teaspoonful of fine wheaten flour, and four ounces of refined ?u<*ar; take sixty sweet almonds, and twentyfour bitter ones, blanch* 74 586 APPENDIX. ed ; beat them into a paste, with a small quantity of water ; mingle this with the decoction, and then strain through a linen cloth, pre- viously moistened with warm water. By this process, a nutritious vegetable jelly is formed, which may be poured into moulds, or glasses, and eaten alone, or with milk. The aromatic flavor of the almonds blends itself with, and completely conceals, the peculiar bitter of the lichen, and forms a very palatable, easily digested, and nutritive aliment.' A. P. B. MEDICAL ELECTRICITY. From Tliacher's Dispensatory. TlIE application ' of this subtile fluid to medicinal purposes, was thought of soon after the discovery of the electric shock. At the fii>t introduction of electricity asa remedy, it was very highly cele- brated for its efficacy in a number of diseases; and, after various turns of reputation, its medical virtues seem now to be pretty well established. Tlie medicinal operation of electricity may be referred to it> stimu- lent power. It produces forcible contractions in the irritable fibre; excites Iherefore to action if duly applied; and when in excess im- mediately exhausts irritability. It possesses the important advantage of being easily brought to act locally, and of being confined to the part to which"it is applied, while it can also be employed in every de- gree of force. Electricity is applied to the body under the form of a stream or continued discharge of the fluid, under that of sparks, and that of shock ; the first being more gentle, the second more active, and the last much more powerful than either of tlie others. The stream is applied by connecting a pointed piece of wood, or a metal wire, with the prime conductor of the electrical machine, and holding it by a glass handle, one or two inches from the part to which it is to be di- rected. A very moderate stimulent operation is thus excited, which is better adapted to some particular cases, than tlie more powerful spark or shock. The spark is drawn by placing the patient on the insulated stool, connected with the prime conductor; and, while the machine is worked, bringing a metal knob within a short distance of the part, from which the spark is to be taken. A sensation somewhat pungent is excited, and slight muscular contractions may be pro- duced ; these effects being greater or less, according to the distance at which the knob is held, if the machine be sufficiently powerful. The shock is given by discharging the Leyden phial, making the part of the body, through which it is intended to be transmitted, part of the circuit. The sensation it excites is unpleasant, and the mus- cular contractions considerable if the shock be moderately strong. ^ The general rule for the medicinal employment of electricity, is to APPENDIX. 587 apply it at first under the milder forms, and gradually to raise it, if necessary, to the more powerful. Mr. Cavallo, who has published the latest and best treatise on medical electricity, entirely disap- proves of giving violent shocks, and finds it most efficacious to ex- pose the patient to the electrical aura discharged from an iron or a wooden point ; or, if shocks be given, they should be very slight, and not exceed thirteen or fourteen at a time. In this way he recom- mends it as effectual in a great number of disorders. The patient may be electrified from three to ten minutes; but, if sparks be drawn, they should not exceed the number of shocks abovementioned. Rheumatic disorders, even of long standing, are relieved, and generally quite cured, by drawing the electric fluid by a wooden point from the part, or by drawing sparks through flannel. The operation should be continued for about four or five minutes, repeat- ing it once or twice every day. Deafness, except when it is occasioned by obliteration, or other improper configuration of the parts, is either entirely or partly cured by drawing the sparks from the ear with the glass tube director, or by drawing the fluid with a wooden point. Toothache, occasioned by cold, rheumatism, or inflammation, is generally relieved by drawing the electric fluid with a point imme- diately from the part, and also externally from the face. But when the body of the tooth is affected, electrization is of no use, for it sel- dom or never relieves the disorder, and sometimes increases the pain to a prodigious degree. Swellings, in general, which do not contain matter, are frequent- ly cured by drawing the electric fluid with a wooden point. The operation should be continued for three or four minutes every day, and in obstinate cases it is sometimes necessary to persevere in its use for several weeks. In inflammations of the eyes, the throwing of the electric fluid, by means of a wooden point, is often attended with great benefit; the pain being quickly abated, and the inflammation being generally dis- sipated in a few days. In these cases, the eye of the patient must be kept open ; and care should be taken not to bring the wooden point very near it, for fear of any spark. Sometimes it is sufficient to throw the fluid with a metal point; for, in these cases, too great an irritation should always be avoided, ft is not necessary to continue this operation for three or four minutes without intermission, but af- ter throwing the fluid for about half a minute, a short time may be allowed to the patient to rest and wipe his tears, which generally flow very copiously; then the operation may be continued again for another half minute, and so on for four or five times every day. Palsies are seldom perfectly cured by means of electricity, espe- cially when they are of long standing ; but they are generally relieved to a certain degree ; the method of electrifying, in these cases, is to draw the fluid with the wooden point, and to draw sparks through flannel, or through the usual covering of the parts, if they are not too thick. The operation may be continued for about five minutes a day. Ulcers, or open sores of every kind, even of long standing, are generally disposed to heal by electrization. The general effects are 588 APPENDIX. a diminution of the inflammation, and first a promotion of the dis~ charge of properly formed matter; which discharge gradually lessens, according as the limits of the sore contract, till it be quite cured. In these cases, the gentlest electrization must be used, in order to avoid too great an irritation, which is generally hurtful. To draw or throw the fluid with a vvboden, or even with a metal point, for three or four minutes per day, is fiillv sufficient. Cutaneous eruptions have been successfully treated with electriza- tion ; but in these cases it must be observed, that if the wooden point be kept too near the skin, so as to cause any considerable irritation, the eruption will be caused to spread more; but if the point be kept at about six inches, distance, or further if the electrical machine be very powerful, the eruptions will be gradually diminished till they are quite cured. In this kind of disease, the immediate and general effect of the wooden point, is to occasion a warmth about the electrified part, which is always a sign that tlie electrization is rightly administered. Scrofulous tumors, when they are just beginning, are generally cured by drawing the electric fluid with a wooden or metal point from the part. This is one of tho»e kinds of diseases in which the action of electricitv requires particular!v the aid of other medicines in order to effect a cure more easilv ; for scrofulous affections com- monly accompany a great laxity of the habit, and a general cachexy, which must be obviated by proper remedies. Lacked jaw has in some instances been speedily cured t>y small shot ks passing through the jaws. Nervous headaches, even of long standing, are generally cured by electrization. For in this disease, the electric fluid must be thrown with a wooden, and even sometimes with a metal point, all round the head successively. Sometimes exceedingly small shocks have been administered ; but tiiose can seldom be used, because the nerves of persons subject to this disease are so very irritable, that the shocks, the «.park>, and snmeTin es even the throwing the electric fluid with a wooden point kept very near the head, throw them into convulsion'-. Ameuon-liara, a disease of the female sex, that often occasions the most disagreeable and alarming svmptoms, is often successfully and speedily cured by means of electricity, even when the disease U of long standing, and after the most powerful medicines, used for it, have proved ineffectual. Tlie cases of this sort, in which electrization has proved useless, are so few, and the successful one* so numerous, that the application of electricity for this disease may be justly con- sidered as an efficacious and certain remedv. Small shocks, that is, of about one twentieth of an inch, may be sent through the pelvis ; sparks may be taken through the clothes from the parts adjacent to the seat of the disease; and also the electric fluid maybe transmitted, by applying the metallic or wooden ex- tremities of two diiectors to the hip in contact with the clothes; part of which may be removed, in case they be too thick. These various applications of electricity should be regulated according to the constitution of the patient. The number of shocks may be about twelve or fourteen. The other applications may be continued for two or three minutes; repeating the operation every day. But either APPENDIX. 589 strong shocks, or a stronger application of electricity than the patient can conveniently bear, should be carefully avoided ; for by these means, sometimes disagreeable symptoms are produced. The application of electricity has also been beneficial in other dis- eases beside the abovementioned; but as the facts are not sufficiently numerous to afford the deduction of any general rules, we have thought not proper to take any particular notice of them. We may lastly observe, that, in many cases, the help of other remedies to be prescribed bv the medical practitioner, will be required to assist the action of electricity, which by itself would, perhaps, be useless ; and, on the other hand, electrization may often be applied to assist the action of other remedies, as of sudorifics, strengthening medicines, &c. It not unfrequently happens, that electricity is relinquished as an unsuccessful remedy, when by a more rigid perseverance a cure might have been effected. N. B. The substance of the above article may be found in the Encyclopedia, American edition. « This note should have followed, on page 280, the article on INCONTINENCE OF URINE. The best apparatus for the relief of persons suffering under this disease, which I have seen, is this : \n ivorv tube, one and a half or two inches long, to receive the penis, to be secured to the body by a tape or string passed round its upper end, which is a little larger than its body. Attached to the lower end is a bladder of any convenient size. In the bottom ot the bladder is inserted a screw, through which the urine can be let oft occasionally without removing the apparatus. The bladder is the only part of this contrivance, which is not dura- ble, and this can easily be renewed.' c« COLLECTION AND PRESERVATION OF SIMPLES. From Thacher's Dispensatory. AS the vegetable kingdom presents us with the greatest number of Copies, and" the substances belonging to it are the least constant m S properties, and most subject to decay, it becomes necessary to give a few general rules for their collection and preservation. 590 APPENDIX. Vegetable matters should be collected in the countries where they are indigenous; and those which grow wild, in dry soils, and high situations, fully exposed to the air and sun, are in general to be pre- ferred to those which grow in moist, low, shady, or confined places. Roots which are annual, should be collected before they shoot out their stalks, or flowers; biennial roots in the harvest of the first, or spring of the second year ; perennial, either in the spring, before the sap has begun to mount, or in harvest, after it has returned. Those which are worm eaten, or decayed, are to be rejected. The others are immediately to be cleansed with a brush and cold water, letting them lie in it as short time as possible ; and the fibres and little roots, when not essential, are to be cut away. Roots which consist principally of fibres, and have but a small tap, may be immediately dried. If they be juicy, and not aromatic, this may be done by heat, not exceeding 100° of Fahrenheit; but if aro- matic, by simply exposing them, and frequently turning them in a current of cold, dry air; if very thick and strong, they are to be split or cut into slices, and strung upon threads ; if covered with a tough bark, they may be peeled fresh, and then dried. Such as lose their virtues by drying, or are directed to be preserved in a fresh state, are to be kept buried in dry sand. No very general rule can be given for the collection of herbs and leaves, some of them acquiring activity from age, and others, as the mucilaginous leaves, from the same cause, losing the property for > which they are officinal. Aromatics are to be collected after the flower buds are formed ; annuals, not aromatic, when they are about to flower, or when in flower; biennials, before they shoot; and pe- rennials, before they flower, especially if their fibres become woody. They are to be gathered in dry weather, after the dew is off' them, or in the evening before it falls, and are to be fieed from decayed, withered, or foreign leaves. They are usually tied in bundles, and hung up in a shady, warm, and airy place ; or spread upon the floor, and frequently turned. If very juicy, they are laid upon a sieve, and dried by a gentle degree of artificial warmth. Sprouts are collected before the buds open; and stalks are gathered in autumn. Barks and woods are collected when the most active part of the vegetables are concentrated in them, which happens in spring and in autumn. Spring is preferred for resinous barks, and autumn for the others, which are not resinous, but rather gummy. Barks should be taken from young trees, and freed from decayed parts, and all im-. purities. The same rules direct the collection of woods ; but thev must be taken from very young trees. Among the resinous woods, the heavi- est, which sink in water, are selected. The alburnum is to be re- jected. Flowers are collected in clear, dry weather, before noon, but after the dew is off; either when they are about to open, or immediately after they have opened. Of some the petals only are preserved, and the colorless claws are even cut away ; of others, whose calyx is odo- rous, the whole flower is kept. Flowers which are too small to be APPENDIX. 591 pulled singly, are dried with part of the stalk: these are called heads, or tops. Flowers are to be dried nearly as leaves, but more quickly, and with more attention. As they must not be exposed to the sun, it is best done by a slight degree of artificial warmth. Seeds and fruits, unless when otherwise directed, are to be gathered when ripe, but before they fall spontaneously. Some pulpy fruits are freed from their core and seeds, strung on threads, and dried artificially. Tney are in general best preserved in their natural coverings, though some, as the colocynth, are peeled ; and others, as the tamarind, preserved fresh. Many of these are apt to spoil, or become rancid ; and as they are then not fit for medical use, no very large quantity of them should be collected at a time. The proper drying of vegetable substances is of the greatest im- portance. It is often directed to be done in the shade and slowly, that the volatile and active particles may not be dissipated by too great heat; but this is an error, for they always lose infinitely more by a slow, than by a quick drying. When, on account of the color, they cannot be exposed to the sun, and the warmth of the atmosphere is insufficient, they should be dried by an artificial warmth, less than 100° Fahrenheit, and well exposed to a current of air. When per- fectly dry and friable, they have little smell; but after keeping for some time, they attract moisture from the air, and regain their proper odour. The boxes and drawers in which vegetable matters are kept, should not impart to them any smell or taste; and more certainly to avoid this, they should be lined with paper. Such as are volatile, or of de- licate texture, or subject to suffer from insects, must be kept in well covered glasses. Fruits and oily seeds, which are apt to become rancid, must be kept in a cool and dry, but by no means a warm or moist air. Oily seeds, odorous plants, and those containing volatile principles, must be collected fresh every year. Others, whose properties are more permanent, and not subject to decay, will keep for several years. Vegetables collected in a moist and rainy season, are in general more watery, and apt to spoil. In a dry season, on the contrary, they contain more oily and resinous particles, and keep much better. They ought to be collected annually, and, if they have been kept for a longer period, should be rejected. FAMILY HERBAL. A BRIEF ACCOUNT OF THE PRODUCTIONS OF THE VEGETABLE KINGDOM, he. SHOWING IN ALPHABETICAL ORDER, First, the Part used ; Secondly, its Sensible Properties ; Thirdly, its Medicinal Virtues ; and, lastly, the Mode of Exhibition. Almonds, sweet and bitter.—Part used ; the kernels of the fruit. Sensible properties ; the sweet,oily, bland; the bitter, oily, with a peculiar flavor and bitterness. Medicinal virtues ; the sweet, ob- tunding; the bitter, sedative and diuretic. Mode of exhibition; in substance, the oil being expressed from either kind indifferently. Sweet almonds are employed by trituration in making emulsions, or the milk of almonds. Aloes Socotrine.—From the island Socotora. Aloes Hepatic, or common aloes, from the island of Barbadoes.—Sens. prop, smell, ungrateful; taste, extremely bitter. The Socotrine nave something of an aromatic llavor, which renders them the least disagreeable. Med. virt. purgative, stimulant. Mode of exhib. pill, powder, solution, tincture. American Senna; Cassia Marilandica.—The leaves. This is a shrubby plant, found in various parts of the United States, and is cultivated in gardens for medicinal u»e. The stalks rise to four or five feet in height, and their summits are covered in July and August with brilliant yellow flowers. The cassia marilandica pos- sesses nearly the same virtues of the Alexandrian senna, but is in- ferior to it in point of purgative properties, in the proportion of about one third. The dried leaves are employed in the form of infusion, and in a proper dose are a very useful cathartic. It is apt to occasion griping, if given in substance, but its griping quali- ty may in a great measure he corrected by infusing with the leaves a small quantity of the root of glycvrrhiza, or anise, and employing a large quantity of water. About half an ounce of the leaves, in- fused in half a pint of water, is a proper dose for an adult. As APPENDIX. 593 this article may with facility and profit be cultivated from the seeds, it deserves a more general attention as a cheap and useful medicine. Thach. Disp. Angelica, Garden.—Part used ; the leaves, stalks, seeds. Sens. prop. aromatic. Mode of exhib. chiefly as ingredients in some distilled waters and aromatic tinctures. Anise.—An umbelliferous plant, cultivated in the south of Europe. Part used ; the seeds. Sens. prop, smell, diffusive and aromatic ; taste, sweet and warm. Med. virt. stimulant. Mode of exhib. powder, infusion ; oil also in compound spirit of. Arabic, Gum.—A concrete juice, exuding from a tree growing in Egypt. Sens. prop, mucilaginous. Med. virt. obtunding. Mode of exhib. in mucilage, or strong solution in water, strained ; also in troches, formed with starch, sugar, &c. Arum__See Cuckowpint. Assafetida.—The gummy, resinous juice of a plant growing in Persia. Sens. prop, smell, extremely fetid ; taste, acrid and nauseous. Med. virt. stimulant, antispasmodic, anthelminthic. Mode of exhib. pill, emulsion or milk, tincture. Ash, Prickly ; Aralia Spinosa.—The bark, root, and berries. This is a native of Virginia, and other southern states. The height to which this tree will grow, when the soil and situation wholly agree with it, is about twelve feet. It is a very ornamen- tal shrub, and the stem, which is of a dark brown color, is defended by sharp prickly spines. A decoction of its bark and root has of- ten succeeded, when taken internally, in removing rheumatic complaints. It excites a gentle perspiration. The berries are used to put into a hollow tooth when aching. A tincture of them is also used for the same purpose, both of which afford relief. In Virginia, a spirituous infusion of the berries is much esteemed in vi- olent colic. Thach. Disp. Balm.—A plant with labiated flowers, cultivated in gardens. Part used ; the leaves. ' Sens. prop, smell, very ungrateful; taste, lightly aromatic and roughish. Med. virt. tonic. Mode of exhib. in- fusion or tea, acidulated with lemon juice; is an excellent diluent drink in febrile complaints. Balsam, Canada.—A liquid exudation from a species of pine tree growing in North America. Sens. prop, smell, fragrant; taste, moderately pungent and bitterish. Med. virt. tonic, stimulant. Mode of exhib. in pills, or in a state of solution, united to watery liquids by yelk of egg, or mucilage of gum arabic, honey, or sugar. Balsam of Capivi.—A liquid exudation from a tree growing in Bra- zil. Sens. prop, smell, strong and diffusive; taste, acrid and bitterish. Med. virt. tonic, stimulant, diuretic. Mode of exhib. in pills, dropped on sugar, united to watery liquors by egg or mucilage. Balsam of Tolu.—A thick resinous exudation from a tree growing in South America. Sens. prop, smell, extremely fragrant; taste, mild and "rateful. Med. virt. lightly stimulant, in cold,debilitated habits* -,lso corroborant in gleets and weaknesses. Mode of exhib. in decoction, pills, tincture, and syrup. Bark, Peruvian.—-See Cinchona. 75 594 APPENDIX. v Barley.—A species of corn commonly cultivated; when decorticated, it is usually called French, or Pearl Barley. Med. prop, mucila- ginous, nutritious, obtunding. Mode of exhib. in decoction ; being first decorticated, it is boiled in water; sometimes, blended with figs, liquorice, and raisins, it is taken as a pectoral drink. Barley, when boiled, forms an excellent article of nourishment; a decoc- tion of it, properly acidulated, is one of the best beverages in acute diseases. Blackberry ; two species, the Rubus Villosus, and the Rubus Pro- cumbens, Low or Running Blackberry, or Dewberry.—The roots. These require no description ; but their valuable properties merit the attention of every medical practitioner. In domestic practice, ' the roots of blackberry have acquired great confidence where they have been used for their astringent virtues in the various forms of bowel affections. It is deserving of tlie highest praise, as one of the most active and effectual vegetable astringents, which our country produces. The low blackberry, or dewberry, is the one commonly ?referred, and the root is more astringent than the leaves or fruit. t is exhibited in decoction, in the quantity of a teacupful for an adult, or a tablespoonful for children, several times in a day. One ounce of the root gives to a pint of water the proper strength. The diseases in which it displays its efficacy, are dysentery in its closing stage, chronic diarrhcea, and cholera infantum, to check in- ordinate evacuations, after purgatives have been duly employed. Professor Chapman of Philadelphia, in his practical lectures, has extolled the root of this vegetable as an astringent of superior pow- ers, and thinks it well adapted to a depraved state of the stomach and digestive organs. Dr. Mease, in Ids edition of the Domestic Encyclopsedia, says, " A jelly made of blackberries, when on the turn from red to black, is much used in the United States for the gravel. A friend of the editor, subject to this disease, spoke high- ly in praise of the remedy." It is not improbable, that a decoction of the root would be still more efficacious in the same complaint, and that it may be extended to other diseases also. We may, per- haps, anticipate the time, when this vegetable will be received as an acquisition to our materia medica ; and, as it is a cheap and pleasant medicine, easy to be procured in every situation, it should be recommended to general attention. Thach. Disp. Bole, French.—An earth of the argillaceous kind, impregnated with iron. Sens. prop, absorbent, astringent. Med. virt. desiccative. Mode of exhib. powder, electuary, liniment. Burdock.—A plant with compound flowers contained in prickly heads, growing wild. Part used ; the root. Sens. prop, sweetish, with a slight bitterness and roughness. Med. virt. diuretic and su- dorific. Mode of exhib. decoction ; two ounces of the fresh root boiled in three pints of water till reduced to two pints ; the strained liquor may be drank in the course of twentyfour hours, in scurvy, rheumatism, snd dropsy. Butternut; Jugl.tns Cinerea.—The unripe fruit and the inner bark. This tree is generally known throughout the United States, and is now introduced into the materia medica of the national Pharma- APPENDIX. 595 copoeia. During the American war, the extract, made from the in- ner bark of this tree, attracted the attention of Dr. Rush, and other medical men in our military hospital; and,being frequently admin- istered to patients under the operation of inoculated smallpox, it was proved to be an excellent substitute for jalap or other cathartics. It is now esteemed as a valuable purgative, in doses from ten to thirty grains, not occasioning heat or irritation; and is greatly commended in cases of dysentery. Conjoined with calomel, it is rendered more active and efficacious, especially in bilious habits. In cases of habitual costiveness, the extract of butternut is to be preferred to most other cathartics, as it leaves the bowels in a good state. As tins extract is often very carelessly prepared by the country people, it ought to be prepared by the apothecaries, or practitioners themselves; and, as a domestic medicine of considera- ble importance, it should be adopted by every physician. The bark of the root of this tree will excite a blister; and the bark and shells of the nuts dye a good brown color. A decoction of the in- ner bark is advantageously employed as a cathartic in the disease of horses called the yellow water. The extract should be made from the bark in the month of May or June. The bark of butternut is known to be the basis of the bilious cordial sold in the shops. Thach. Disp. Cajeput Tree; Melaleuca Leucadendron.—The volatile oil. The tree which furnishes the cajeput oil is frequent in the East Indies. The essential oil, obtained by distillation from the leaves and fruit,has a green or yellowish color, a strong fragrant odour, and an extremely pungent taste. It is highly volatile. This oil has been used as a highly diffusible stimulant and antispasmodic, in tympan- ites, hysteria, palsy, chronic rheumatism, and various other diseases of debility. Its dose is three or four drops. It is also applied ex- ternally to relieve rheumatic and gouty pains, and violent head- aches. But its most remarkable effect is in that painful complaint, the toothache. From whatever cause this affection may proceed, whether from a carious tooth, rheumatic acrimony, catarrh, &c. the cajeput oil has generally been found efficacious in removing it, if dropped on lint, and placed in the cavity of the tooth, or even around the gum. Thach. Disp. Calamus Aromaticus, or Sweetscented Flag.—A perennial plant growing in marshy situations. Part used ; the root. Sens. prop. smell, aromatic; taste, warm and bitter. Med. virt. tonic. Mode of exhib. infusion, tincture; also in decoction. Camphor.—A solid concrete, obtained from a tree growing in Japan and Sumatra. Sens. prop, smell, fragrant and penetrating; taste, pungent, with a sense of coolness. Med. virt. stimulant, antispas- modic, diuretic. Mode of exhib. in pill or bolus, in watery emulsion with sugar or mucilage. Externally ; dissolved in oil or rectified spirit, also in ointments and liniments. Canella.—The bark of a tree growing in the West Indies. Sens. prop, smell, aromatic ; taste, warm and pungent. Med. virt. aro- matic, stimulant, stomachic. Mode of exhib. powder; also in the compound tincture of gentian. 59G APPENDIX. Cantharides.—Spanish flies ; insects of the beetle kind, found in the south of Europe. Sens. prop, smell, disagreeable ; taste, highly acrid; caustic. Med. virt. stimulant, vesicating, diuretic. Mode of exhib. internally,In tincture; externally, in powder and extract formed into an ointment and plaster. Caraway.—An umbelliferous plant, cultivated in gardens. Part used, the seeds; they contain a large proportion of essential oil. Sens. prop, moderately warm and aromatic. Med. virt. carmina- tive, stimulant. Mode of exhib. powder, and -ad to be particular- ly corrective of the odour, taste, and griping quality of senna. From these seeds a spirituous water is distilled. Cardamoms, Lesser,—The seeds of a perennial plant growing in the East Indies. Sens. prop, smell, very grateful; taste, warm and pungent. Med. virt. carminative, stimulant, stomachic. Mode of exhib. powder, tincture, which are frequently employed as correctors of medicines of the cold, aperient class. Carrot.—An umbelliferous plant growing wild. Part used ; the seeds. Sens. prop. ligiitly aromatic and pungent. Med. virt. sti- mulant, diuretic. Mode of exhib. powder, infusion, in scorbutic dis- orders and dropsy, and in diuretic drink?. Cascarilla.—The bark of a :!irub growing in the West Indies. Sens. prop, aromatic and bitter. Med. virt. tonic, stomachic. Mode of exhib. powder, infusion, decoction, tincture, and extract. A useful medicine in bilious, remittent, malignant, and intermittent fevers. Castor.—The inguinal glands of the Caster or Beaver. Part used ; the internal friable matter. Sens. prop, smell, strong and ungrate- ful; taste, acrid and nauseous. Med. virt. stimulant, antispasmo- dic. Mode of exhib. pou der, pill, bolus, tincture. Catechu has erroneously been called Japan earth.—It is an extract obtained by infusing the wood of a tree growing in the East In- dies. Sens. prop, astringent, with a degree of sweetness. Med. virt. tonic. Mode of exhib. decoction, infusion, powder, tincture ; in obstinate diarrhoeas, dysenteries, and other preternatural dis- charges. Chamomile.—A trailing plant, with compound flowers, cultivated in gardens. Part used ; the leaves and flowers. Sens. prop, smell, strong; most agreeable in the flowers ; taste, nauseous and bitter. Med. virt. tonic, aperient, antiseptic. Mode of exhib. powder, in- fusion, extract of, formed into pills. Externally ; in decoction for fomentations ; also for clyster with mallow flowers and fennel seeds. Charcoal of Wood ; Carbo Ligni.—Common charcoal of wood, (car- bonous oxide,) or carbon of the Fiench chemists, is a sort of artifi- cial coal, consisting of half burnt wood. It is in the form of solid masses of a black colour, is brittle, and has neither smell nor taste. It is extremely porous, and therefore absorbs light strongly, which accounts for its blackness; tor, the rays of light, striking on the charcoal, are received and absorbed in its pores, instead of being reflected, whence, the body must of necessity appear black. This substance also attracts air from the atmosphere, which it continues to absorb for a considerable time. It is insoluble in water, and a bad conductor of caloric, but an excellent one of elec- tricity. APPENDIX. 597 This substance is found to consist of 63, 86 of carbon, and 36,14 of oxygen. Charcoal possesses a number of singular properties, which render it of considerable importance in many respects. It is incapable of putnfyitjg or rotting, like wood ; and so remarkable is the durabili- ty of this substance, that it may be preserved to an indefinite length of time; for there yet exists, according to Dodart, charcoal made of corn, (probably in the days of Caesar,) which is in so complete a state, that the wheat may be distinguished from the rye. Besides the great advantage which this article affords to the artist and manufacturer, it has been of late employed with considerable suc- cess—First, in correcting the burnt, or empyreumatic taste in ar- dent spirits—Secondly, in depriving rancid oil of its disagreeable flavor—Thirdly, in restoring putrid meat. For these useful pur- poses, it should be previously reduced to powder, and that only used which is fresh prepared, or has been kept in close vessels, that it shall have absorbed no fixed air from the common atmo- sphere. The tainted flavor of ardent spirits, or the unpleasant one of those distilled from grain, may be entirely destroyed, by merely shaking it with powdered charcoal. Charcoal is of still greater utility for purifying water on shipboard. The most offensive water may be rendered perfectly sweet, by merely filtrating it through maple, hickory, or oak coal and sand. New made charcoal, by being rolled up in cloths that have con- tracted a disagreeable odour, effectually destroys it; and the bad taint of meat, beginning to putrify, is in like manner corrected. It is possible that meat surrounded by fresh charcoal, might keep sweet for months. On account of its absorbent and antiseptic properties, this substance promises to be of considerable service in medicine. It has been found to arrest the progress of mortification, when applied in the form of medicated poultice to the affected part, and frequently repeated. In a variety of instances it has been found to have a remarkable effect, in removing habitual cos- tiveness, without inducing an extraordinary degree of weakness, especially if it be mixed with syrup of yellow roses. Many per- sons, afflicted with that disagreeable complaint,a fetid breath, from a costive habit, have obtained effectual relief by taking, two or three times in a day, a tablespoonful of each of the above articles. Charcoal, made from maple wood, or burnt bread, finely powdered, makes a simple, efficacious, and safe tooth powder, which is pre- ferable to any other. It neutralizes, and entirely destroys for a time, any fetor which may arise from a carious tooth. It has late- ly been found to cure tinea capitis, by being sprinkled over the ulcer in fine powder. Charcoal has been employed with good success in ulcerated state of the fauces and gums depending on a disordered stomach. It pos- sesses tonic powers when applied to the alimentary canal, and is useful in pyrosis, in some stages of dysentery with acrid dis- charges, and in putrid fevers. The dose is a tablespoonful of the fine powder dissolved in flour and water twice in a day. In Eu- rope, particularly in the British army, charcoal has been employed 598 APPENDIX. with superior advantages to the Peruvian bark in intermittent and remittent fevers. From half a diachm to two drachms given three or four times during the intermission, or immediately before the expected paroxvsin, will in most cases prove sufficient. Two or three doses have often interrupted the expected paroxysm, and cut short the disease. The most eligible process for preparing charcoal for medicinal uses, free from all impurities and disagreeable taste, is, to enclose small billets of wood in an iron cylinder, having a tube fixed to one end, and distil them until no more smoke and water escape from the tube. Then put out the fire, and close the mouth with clay, until the cylinder cool. The barrels of old guns or pistols, may serve for this purpose ; or the pieces of wood may be put into a pot not closely covered, and surrounded with live coals, until all smoke from the pot shall cease. Then remove the coals and closely lute the cover with clay, until the pot cool. Or pulverize some well burnt common charcoal, and then heat it in a covered crucible to a glowing red, till it cease to give out any inflammable vapor. It should be immediately secured in well stopped glass bottles, and in that way it may be preserved unimpaired for any length of time. Charcoal is one of the greatest nonconductors of heat. This quality renders it applicable to a variety of economical purposes. Tliach. Disp. Cinchona.—The bark of a tree growing in Peru. About the year 1640, the lady of the -panish Viceroy, the Comitis-a del Cinchona, was cured of an obstinate intermittent by this bark; and from the interest which Cardinal de Lugo and the Jesuit brotherhood to«.k in its sale and distribution, it has been called Cardinal de Lugo's powder, Jesuits' bark, &c.; from the place of its growth, Peruvian bark ; or simply, from its preeminent virtues, the Bark. In many foreign countries, it is nevertheless better known by the name of Quinquina, or Cinchona. Sens. prop, smell, peculiar, not agreea- ble; taste, strongly bitter and astringent. Med. virt tonic, anti- septic. Mode of exhib. in powder, electuary, infusion, decoction, or the extract may be given in the form of pills, either alone or with other medicines. The extract is well calculated for weak stomachs that cannot bear much bark in substance. Cinchona finely pow- dered and quilted in the folds of a linen waistcoat, or repeatedly exhibited in the form of a clyster, has frequently proved efficacious in obstinate agues, when every other method has failed; particular- ly with children, and in relaxed habits. Cinnamon.— The bark of a tree growing in the island of Ceylon, and which has been transplanted lately to various other places. Sens. prop, a warm and extremely grateful aromatic and astringent. Med. virt. tonic, stimulant. Mode of exhib. powder, infusion, de- coction, tincture ; also employed in simple, and in a spirituous dis- tilled water, as a vehicle, or sometimes as an adjunct, to various other medicines. Cloves.—The immature flowers and flower cups of a tree growing in the East Indies. Sens. prop.smell, very flagrant; taste, extremely hot and acrid. Med. virt. stimulant, carminative. Mode of exhib. APPENDIX. 599 powder, oil; the former may be employed by infusion, two drachms of cloves to half a pint of boiling water, in doses of three or four spoonfuls, against flatulency, in dyspepsy, and as a vehicle toother medicines. Colocynth, or Bitter Apple.—The fruit of a species of gourd growing in the east. Part used; the fungous medullary pulp. Sens. prop. intensely bitter, acrid, and nauseous. Med. virt. an extremely irri- tating cathartic. Mode of exhib. infusion, powder, pill, extract. Coltsfoot.—A perennial plant with compound flowers, growing wild. Part used ; the leaves and flowers. Sens. prop, mucilaginous, bit- terish, and roughish. Med. virt. obtunding, tonic. Mode of ex'nib. infusion, decoction ; in hectic and pectoral complaints, in the form of tea. Columbo.— A root brought from the island of Ceylon. Sens. prop. smell, slightly aromatic ; taste, intensely bitter. Med. virt. tonic, antiseptic, stomachic, a corrector of putrid bile. Mode of exhib. powder, infusion, tincture. Employed in many instances of dyspep- sy with great advantage, and to stop vomiting. The powder, in doses of ten grains to thirty, joined with equal parts of vitriolated kali, is given with success in acute bilious cases. Coriander.— An umbelliferous plant cultivated in gardens. Part used; the seeds. Sens prop, smell, aromatic; taste, moderately warm. Med. virt. carminative, stomachic. Mode of exhib. infu- sion, powder, tincture. These have the common qualities of other carminative seeds, and, when dried, are generally very agreeable. Infused along with senna, they are more powerful in correcting the odour and taste of this than any other aromatic, and are equally powerful in obviating the griping that senna is very ready to pro- duce; hence coriander seeds are an ingredient in various purgative compositions. Cow Itch.—A papilionaceous plant, growing in both Indies. Part used ; the hairs covering the pods. Sens. prop, mechanically irri- tating. Med. virt. anthelminthic. Mode of exhib. a teaspoonful to a tablespoonful of the medicine, mixed with syrup or molasses, and taken in a morning fasting, occasions no uneasiness in the prima; viae, which are defended by mucus. The worms are said to appear with the second or third dose; and, by means of a purgative dose of the solution of vitriolated magnesia, the stools have consisted chiefly of worms. Crabs' Claws.—The black tips of the claws of the common crab. Sens. prop, absorbent, calcareous. Med. virt. antacid. Mode of exhib. powder. Crabs' Eyes (so called).—Stony concretions found in the head or stomach of the river craw fish. Sens. prop, absorbent, not calcare- ous. Med. virt. antacid. Mode of exhib. powder. Cuckow Pint, Arum, or Wake Robin.—A perennial plant growing wild. Part used ; the root. Sens. prop, extremely hot, pungent, and acrid, especially when fresh. Med. virt. stimulant. Mode of exhib. dose, grains ten or twenty; also in conserve, half a drachm to a drachm, is stimulant and attenuant, and is well suited to phleg- matic habits. This root is knotty, roundish, and white. When it is 600 APPENDIX. collected in the spring, before the leaves shoot, or in autumn, after flowering, it contains a milky juice of very great acrimony. Ap- plied to the tongue, it causes a burning heat, which lasts for many hours, and excites considerable thirst. These painful symptoms may be relieved by buttermilk or oily fluids. Rubbed between the fingers, it blisters and excoriates them ; yet, notwithstanding, it is a corrosive vegetable poison, its acrimony is easily destructible ; by drying, it loses the greatest part or its acrimony, and by repeated washings it is also rendered perfectly mild. A tailor had lately a paralytic stroke, by which he was bereaved of the use of his right hand ; he was advised to rub it frequently with the root of arum, and also to apply a poultice of it to his hand. He is now a great deal better, and can make use of his hand, though not, however, so well as formerly; he has, therefore, been directed to wash his hand ami arm, two or three times a day, with a tepid infusion of this root, mixed with flower of mustard seed ; and then to apply the following antiparalytic embrocation: take a pint of bruised mustard seed, moisten it well with equal parts of spirit of rose- mary and simple spirit of lavender; after the mixture has stood twenty four hours in a very gentle heat, squeeze it by a hand press; the liquid thus obtained is an uniform mixture of the oil with the pungent part of the seed and the aromatic spirits, and is, indeed, worthy of being called—the Essence ot Mustard. Cumin.—An umbelliferous plant, cultivated in the south of Europe. Part used ; the seeds. Sens. prop, smell, strong and ungrateful ; taste, warm and bitterish. Med. virt. stimulant, antiseptic. Mode of exhib. powder, infusion; externally, as a warm poultice, or a di=- cutient plaster. Currant, Black.—The fruit of a native shrub that grows wild in Eng- land, and is cultivated for the sake of its acid, cooling, antiseptic juice, of which a syrup and a rob are prepared, which, is employed in recent catarrhs, attended with sore throat or fever. Currant, Red.—This, like the former, is cultivated for the sake of its pleasant, subacid fruit ; of this a jelly is formed, by boiling the juice with a sufficient quantity of sugar, which is often used as an anti- septic demulcent in sore throats, and, dissolved in water, forms a pleasant,cooling drink in bilious and feverish complaints. Mr. F. S. Stuart, of Billeriacy in Essex, has informed the public, that he was brought to the verge of the grave by a consumption of the lungs, and restored to perfect health by eating three or four pints a day of ripe currants, white and red ; and he mentions other per- sons, who have been recovered from the same disease by the same means. Dandelion.—A plant with compound flowers, growing common. Part used ; the herb and root. Sens. prop, abounding in a milkv, bitterish, subacrid juice. Med. virt. aperient, diuretic, resolvent. Mode of exhib. expressed juice of the heib, decoction and infusion of the root. The root, with sorrel leaves, in broths, taken daily for some months, interposing, now and then, a laxative dose of cream of tartar, has removed hardness of the liver, ascites, and gall stones. Dill.—An umbelliferous plant growing in warm climates. Part used; APPENDIX. 601 the seeds. Sens. prop, mildly aromatic. Med. virt. stimulant. Mode of exhib. a simple distilled water, and an essential oil. Dock; Rumex Britannica.— The yellow rooted Water Dock. The root and leaves. It grows in peat marshes, wet ditches, pools, at the sides of rivers, and in shallow water. It flowers in July and Au- gust, and is succeeded by large seeds. This plant affords a medi- cine of considerable efficacy, when applied externally, -as a wash for spongy, putrid gums; its roots when pulverized have been found excellent for cleaning the teeth. These roots are of a bitter, astringent taste, and have often been employed for the cure of scorbutic and cutaneous disorders, whether administered internally, or applied externally in ointments, cataplasms, lotions, or fomenta- tions. Decoctions of the leaves are, likewise, an efficacious laxa- tive, and have been taken with advantage in rheumatic pains, and chronical diseases, occasioned by costiveness, or by visceral ob- structions. The dose usually given, is a decoction of half an ounce of the fresh roots, or from one to two drachms of them, in a dry state. The Indians, says Dr. Cutler, used the root of water dock with great success in cleansing foul ulcers. It is said, they endeavored to keep it a secret from the Europeans. Dr. Withering says, he saw an ill conditioned ulcer in the mouth, which had destroyed the palate, cured by washing the mouth with a decoction of this root, and drinking a small quantity of the same decoction daily. Thach. Disp. Egg, Hen's.—Part used; the yelk, white, and shell. Sens. prop, yelk, lapid and mucilaginous; white, insipid and mucilaginous. They are both unwholesome and delicate articles of food. Med. virt. the yelk is often used in pharmacy, for suspending oily and resinous substances in water ; the white is used to clarify liquids; the shells, freed from the membrane lining them, and finely levigated, are an absorbent. Two raw, new laid eggs, beaten up in a glass of water, taken in the morning fasting, and repeatedly given every four hours throughout the day, have proved very beneficial in obstinate jaun- dices^occasioned by viscid bile, or gluten obstructing the biliary ducts.—-The yelk of tvvo new laid eggs, beaten up with an ounce and a half (i. e. three tablespoonfuls) of rose water, seasoned by three or four grains of nutmeg, and mixed with half a pint of milk, fresh from the cow, sweetened with powdered sugar candy, or syrup of capillaire, if taken early (i. e. before rising) in the morning, is a safe palliative medicine in pulmonary consumption. The use of it should be persisted in some weeks; malt and spirituous liquors should be avoided, and, to restrain the profuse perspirations to which hectic patients are liable, one to three or four teaspoonfuls of the following electuary may be taken in the morning, when the heats come on ; at noon, and also at bed time. Conserve of roses, tvvo ounces ; diluted vitriolic acid, three drachms; mix. Elder.—A small tree growing in hedges. Part used ; the flowers, berries, and bark. Sens. prop, flowers, fragrant; berries, sweetish \ bark, sweetish and subacrid. Med. virt. flowers and berries laxa- tive. Mode of exhib. infusion of the flowers, laxative ; and, boiled 76 602 APPENDIX. in oil and suet, forms a Cooling emollient ointment; decoction of the bark, emetic and purgative in dropsical cases. The rob, or in- spissated juice of the berries, is cooling and aperient. It is recom- mended in dyspepsy, and debility of the urinary passages, in doses of a drachm to half an ounce or more. Elecampane.—A large plant with compound flowers, growing wild. Part used ; the root. Sens. prop, aromatic, nauseous, bitter, pun- gent. Med. virt. stimulant, aromatic. Mode of exhib. powder, in- fusion, decoction. Elm.—A tall timber tree, of common growth. Part used; the inner bark. Sens. prop, mucilaginous, subastringent. Med. virt. tonic, aperient. Mode of exhib. decoction; the quantity of a pint to a quart a day, prepared by boiling four ounces of the inner bark, bruised, in four pints of water to two pints, to relieve leprous and other cutaneous disorders. Elm; Ulmus Aspera.—The inner bark of the Slippery Elm. We have two species of ulmus or elm in the United States. The red or slippery elm, or American rough leaved elm of Marshal, (ulmus rubra of Mulenburgh,) on account of its many valuable properties, deserves particular mention. It rises to the height of thirty feet, with a pretty strong trunk, dividing into many branches, and cover- ed with a light coloured, rough bark. The leaves are oblong, oval, and sharp pointed, unequally sawed on their edges, unequal at the base, very rough on their upper surface, and hairy underneath. The flowers are produced thick upon the branches, upon short, col- lected foot stalks, and are succeeded by oval, compressed membra- neous seed vessels, with entire margins, containing one oval com- pressed seed. The inner bark, by infusion or gentle boiling in water, affords a great quantity of insipid mucous substance, that is applicable to a variety of important uses. Dr. Mitchell says, it has been beneficially administered in catarrhs, pleurisies,and quinsies; it has been applied as a poultice to tumors, and as a liniment to chops and festers. {[Letter to Dr. North, Amer. Museum, vol. 7th.] The surgeons of our revolutionary army, and also those of General Wayne's army, who defeated tlie Indians in August, 1794, expe- rienced the most happy effects from the application of poultices of the elm bark to gunsnot wounds, which were soon brought to a good suppuration, and to a disposition to heal. It was applied as the first remedy. When tendency to mortification was evident, this bark bruised and boiled in water, produced the most sur- prizing good effects. After repeated comparative experiments with other emollient applications, as milk and bread, and linseed poul- tice, its superiority was firmly established. In old, ill conditioned ulcers, and in fresh burns, equal benefit was derived from it. The infusion of the bark was used with advantage as a diet drink, in pleurisy, and catarrh, and also in diarrhoea and dysentery. Many of the above facts relative to the medicinal qualities of the red elm, were communicated, says the editor of the Domestic En- cyclopaedia, by Dr. Joseph Strong, of Philadelphia, who served as surgeon in the western army; and adds, as a proof of the nutri- ment which it affords, that a soldier who lost his way, supported APPENDIX. 603 himself for ten days upon this mucilage and sassafras. The editor of the abovementioned work, (vol. fid, p. 448,) proceeds to observe, that the red elm tree may be considered as a highly valuable addi- tion to our stock of medicines, exclusively American, and ought to be carefully searched for by the medical gentlemen in the coun- try, and preserved from the indiscriminate axe. The inner bark of the slippery elm, or its mucilage, has been found by recent experience to be singularly beneficial when applied to chilblains, cutaneous eruptions, and various kinds of sores and ul- cers ; and, there is much reason to believe, that its internal use in dysentery, consumption, &c. may be attended with greater advan- tage than is generally imagined. This tree certainly may be re- commended to the particular regard of medical practitioners as a new, and domestic article of our materia medica, whose medicinal virtues will probably be found to merit a large share of confidence. Thach. Disp. Fennel, Sweet.—An umbelliferous plant, growing in the warmer cli- mates. Part used ; the seeds. Sens. prop, smell, aromatic; taste, warm and sweetish. Med. virt. stimulant, diuretic. Mode of exhib. powder, infusion, and simple distilled water. Figs.—The preserved fruit of the fig tree, aperient, obtunding, in emollient decoctions. External I y heated as warm as they can easily be borne, to promote the suppuration of a phlegmon when so situated, that other cataplasms cannot be easily supplied. Fox Glove, Digitalis.—A plant with beautiful gaping flowers, grow- ing wild. Part used ; the leaves. Sens. prop, poisonous, bitterish, very nauseous. Med. virt. strongly cathartic, diuretic, emetic, and sedative. Mode of exhib. infusion, decoction,powder, tincture. In asthmatic and dropsical cases, the powder (which is the least un- certain way of exhibiting this herculean remedy) may be given in doses of a quarter or half a grain, very gradually and cautiously increased to two graing, mixed with one tojtvvo grains of aromatic powder, once in eight or twelve hours, according to the effect. Galls.—Excressences formed on the oak tree by insects in the warmer climates. Sens. prop, strongly astringent. Med. virt. tonic. Mode of exhib. powder, infusion, decoction. Externally applied to parts affected with hemorrhoids, or piles, in the proportion of a drachm of powdered galls mixed with one ounce of hog's lard. Galbanum.—A gummy resinous concrete, obtained from an umbelli- ferous plant growing in Ethiopia. Sens. prop, smell, fetid; taste, bitterish, warm, and pungent. Med. virt. discutient, stimulant, an- tispasmodic. Mode of exhib. pill, emulsion, tincture, plaster. Gamboge.—A gummy resinous concrete, obtained from certain East India trees. Sens. prop, taste, acrid ; colour, deep yellow. Med. virt. emetic, and strongly cathartic. Mode of exhib. pill, emulsion, tincture. Garlic.—A bulbous rooted plant, cultivated in gardens. Part used ; the roots. Sens. prop, smell, very strong, diffusive, and ungrate- ful ; taste, extremely acrimonious and penetrating. Med. virt. in- ternally, stimulant, expectorant, diuretic, laxative, and sudorific; improper for persons of an inflammatory or sanguine temperament, 604 APPENDIX. but an excellent medicine for the aged and phlegmatic. The editor is sorry that the limits prescribed to him will not permit him to add more in recommendation of this useful " Domestic Medicine," than that the juice of garlic dropped on cotton, and applied to the meatus or orifice of the ear, for deafness, till it excite moderate pain and heat, will increase the secretion of mucus in the organ of hearing; that garlic is eaten crude, taken in the form of pill or bolus, and in w'hey. It is often applied with success, in the form of cataplasms, to the soles of the feet, to relieve disorders of the head or breast, and pains of the teeth. Gentian.—A perennial plant, growing in the mountainous parts of Germany. Part used; the root. Sens. prop, intensely bitter. Med. virt. tonic, stomachic. Mode of exhib. infusion, tincture. The extract may be joined with the preparations of iron, and vviih other medicines, and taken in the form of pills, A medicine has been long famous and much employed in this country, under the title of Elixir Stomachicum, or Stoughton's Elixir, in resemblance and me- dical effect coinciding with the compound tincture of gentian. Ginger.—The root is often taken as a carminative and stomachic, prepared as a sweetmeat. This useful root is often directed in powder, being aromatic, cordial, and carminative. It is likewise a useful ingredient in infusions. Guaiacum.—A large tree growing in the West Indies. Part used ; the wood, bark, and resin, or gum. Sens. prop, smell, lightly aromatic ; taste, subacrid. Med. virt. alterative, stimulant, sudorific. Mode of exhib. the wood and bark in decoction ; the gum in pill, bolus, tincture. Before the preparations of quicksilver were discovered to have a specific virtue in curing the venereal disease, guaiacum sold at an immense high price. Hartshorn.—The horns of the male red deer. Rasped and boiled in water, they yield an insipid, obtunding, nutritive jelly. An astrin- gent decoction is prepared by boiling calcined hartshorn with gum arabic, as directed in the Appendix. Honey.—A vegetable juice, collected from flowers by the bee. It is the basis of various medicinal compositions, and its domestic uses are too well known to need recapitulation in the narrow limits to which we are now necessarily prescribed. Hop ; Humulus Lupulus.—The flowers. This perennial plant is a very strong bitter, accompanied with a degree of aromatic flavor, and some astringency ; these are extracted by water by infusion ; by decoction the aromatic flavor is lost. Along with its bitterness it has a narcotic power: of this the popular remedy, sometimes successful, of a pillow of hops to procure sleep in the delirium of fever and in mania, is a proof. It accordingly, when given inter- nally in a full dose, reduces the frequency of the pulse, and pro- cures sleep. It has been employed as an anodyne, either in sub- stance, in the dose of three grains, or under the form of infusion or tincture. A cataplasm or ointment, prepared from it, has been also used as anodyne application to cancerous sores. The hop is an excellent stomachic bitter, highly useful in dyspepsia and other gastric affections. Recently, hop has been administered APPENDIX. 605 in nephritic and calculous affections with such manifest advantage as to obtain high encomiums as a valuable antilithic. A strong infusion of hop proves a certain solvent of the stone out of the body, and it is asserted by high authority, that it seldom fails to alleviate the pain, and increase the secretion of urine, when taken internally. Dr. Barton, however, found by experience, in his own peculiar case, that the use of the highly hopped malt liquors subjected him more frequently to nephritic attacks. The infusion is directed in doses of about a wineglass full every few hours, to the extent of a pint in a day.—See Amer. Mod. Practice, p. 606, 607.— Thach. Disp. Horseradish.—A plant with cruciform flowers, usually cultivated in gardens. Part used ; the root. Sens. prop, acrid, penetrating, with very pungent effluvia. Med. virt. stimulant, diuretic. Mode of exhib. infusion with mustard seed, against dropsical and paralytic complaints ; also in the compound spirit of horseradish. Accord- ing to the late Dr. Withering, an infusion of scraped horseradish in milk makes one of the safest and best cosmetics. Hyssop, Hedge.—A low plant with irregular flowers, growing in gar- dens. Part used ; the herb. Sens. prop, bitter, nauseous. Med. virt. diuretic, violently emetic, and cathartic. Mode of exhib. two to six or eight grains of the powdered root, beginning with a very small dose, which may be gradually increased, against dropsy and worms. It is said to have been serviceable in those cases, given as an infusion, made by adding one drachm of the powdered root to a pint of boiling water, milk, or beer. Dose, a tablespoonful three times a day. Jalap.—The root of a plant growing in the West Indies. Sens. prop. resinous, slightly pungent. Med. virt. strongly purgative. Mode of exhib powder, pill, extract, tincture; a cathartic better suited to cold, phlegmatic, than hot, bilious constitutions. Ipecacuanha.—The root of a plant growing in South America. Sens. prop, bitterish and subacrid. Med. virt. emetic, sedative, sudorific. Mode of exhib. pill, powder, bolus ; also infused in wine. Isinglass.^—A glutinous substance, brought from Russia, prepared from the membranous parts of fishes. Sens. prop, restorative, agglutinat- ing. Mode of exhib. boiled into a jelly with milk, to abate fluor albus, diarrhoeas, and other weaknesses. It is an ingredient in the court sticking plaster. Kino.—A gum resin, from the vicinity of the river Gambia. Sens. prop, astringent, mucilaginous. Med. virt. tonic, obtunding. Mode of exhib. powder, electuary, tincture. In chronic diarrhoeas and dysenteries, in hemorrhages from the uterus, and in diseases arising from laxity of the solids. Lavender.—A bush plant, cultivated in gardens. Part used; the flowering spikes. Sens. prop, smell, fragrant; taste, warm and bit- terish. Med. virt. stimulant, tonic, aromatic. Mode of exhib. in- fusion, simple spirit, compound spirit, essential oil. Lemon.—The fruit of a tree growing in warm climates. Part used ; the juice and rind. Sens. prop, juice, a grateful acid ; rind, a very fragrant aromatic. Med. virt. juice, cooling and antiseptic; rind, stimulant. Mode of exhib. juice, in drinks, with water and sugar; 606 APPENDIX. and combined with alkaline salts. Rind, in infusions and tincture. The syrup mixed with many medicinal preparations for bilious and inflammatory disorders. Linseed.—The seed of the common flax. Sens. prop, unctuous, muci- laginous. Med. virt. obtunding, emollient. Mode of exhib. infu- sion, powder for cataplasms. A bland oil is expressed from them of a disagreeable flavor. Liquorice Root.—A rich, durable sweet. Med. virt. obtunding, and useful in abating thirst. Mode of exhib. powder, infusion, decoc- tion ; extract, either in infusion or slowly dissolved in the mouth. Logwood.—A wood of a tree growing in the Bay of Honduras. Sens prop, sweetish, astringent. Med. virt. tonic. Mode of exhib. decoction, infusion, extract; employed against diarrhoeas and dys- enteries. Mace.—A membrane covering the shell of that fruit, the kernel of which is the nutmeg. Med. virt. tonic. Mode of exhib. expressed oil, an ingredient in the laudanum, or stomach plaster. Mallow, leaves, flowers, and root.—A perennial plant, growing wild. Sens. prop, mucilaginous; the roots sweetish. Med. virt. obtund- ing, emollient. Mode of exhib. decoction, cataplasm. Manna.—A concrete juice, exuding from a kind of ash, chiefly in Ca« labria and Sicily. Sens. Prop, sweet, unctuous. Med. virt. aperi- ent, obtunding. Mode of exhib. solution in watery liquors, electu- ary, syrup. Marjoram, sweet, and wild.—This herb is an ingredient in the com- pound powder of asarabacca, a powder that is equally efficacious with the best herb snuff. Marsh Mallow.—A perennial plant, growing in marshes. Part used; the leaves and root. Med. virt. obtunding. Mode of exhib. pow- der, infusion, and in decoction of barley with a little liquorice root, against catarrhs and nephritic complaints. The root an ingredient in the compound powder of tragacanth, is an elegant syrup, and a useful ointment. Mastich.—A concrete resin, obtained from the Lentisk tree, in the Isle of Chio. Sens. prop, smell, resinous and agreeable; taste, bit- terish and lightly warm. Med. virt. tonic, antiseptic ; chewed, it disguises a fetid breath, and strengthens the gums; it is also occa- sionally used with fragrant substances by wav of fumigation. Meadow Saffron.—A bulbous rooted plant, growing in wet meadows. Part used; the root. Sens. prop, smell, pungent; taste, acrid. Med. virt. strongly cathartic and diuretic. Mode of exhib. an active oxymel is prepared by infusing this root in vinegar, with honey. The dose of this oxymel is a teaspoonful or two in a cup of tea, or of distilled water, as a remedy for the dropsy. If given in a great- er dose at first, or if it is too rapidly repeated, it will occasion bloody stools and other morbid symptoms. Mint, Pepper, or Peppermint.—A plant cultivated in gardens. Part used ; the leaves. Sens. prop, smell, strong and diffusive ; taste, very penetrating, with a sense of coolness. Med. virt, stimulant, carminative, antispasmodic. Mode of exhib. infusion, distilled water, spirit, and essential oil. These are principally used as a do- mestic remedy for flatulent colic. The essential oil is often given in APPENDIX. 607 doses of a few drops on 9ugar, in cramps of the stomach ; but if that organ be in a state of inflammation, it may do much mischief. What is called the Essence of Peppermint, is the rectified oil dis- solved in spirit of wine. Mint, or Spear Mint.—A plant cultivated in gardens. Part used; the leaves. Sens. prop, smell, aromatic; taste, bitterish, roughish, moderately warm and aromatic. Med. virt. tonic, stomachic. Mode of exhib. infusion and a distilled water; also a spirit, and an essen- tial oil. Mulberry.—Of this well known, cooling, antiseptic fruit, a syrup is prepared, to sweeten diluting liquids in bilious and inflammatory disorders. Musk.—A grumous subtance, found in a bag, situated under the belly of an animal of the deer kind, in Thibet and Tartary. Sens. prop. smell, fragrant, extremely powerful, and diffusive ; taste, bitterish, rather acrid. Med. virt. stimulant, antispasmodic. Mode of exhib. bolus, watery mixture. Mustard.—The seeds are stimulant and very pungent. Mode of exhib. in substance; a tablespoonful, with a cupful of an infusion of broom tops, is laxative and diuretic. Infused in wine or water, with fresh shaved horseradish root, it is useful in scorbutic and paralytic disorders. Infused in water, and taken in large doses, it proves emetic. The powder is frequently made into a paste, or soft poul- tice, with vinegar and bread crumb, and applied to benumbed limbs; to pained parts in chronic rheumatism; or to the soles of the feet in the low state of fevers. # ^ Myrrh.—A gummy resinous concrete, brought from the East Indies. Sens. prop, smell, strong, and not ungrateful; taste, very bitter and pungent. Med. virt. tonic, heating, stimulant, antiseptic. Mode of exhib. powder, pill, watery emulsion, spirituous tincture. Nettle, common stinging.—The herb of this well known plant, is herbaceous, subsaline. Med. virt. aperient, diuretic, and cooling. Mode of exhib. decoction or infusion. The expressed juice, in doses from two to three ounces, is useful in inward bleedings and nephritic complaints. Externally, they are employed to whip pal- sied limbs, which they have sometimes restored to sensibility and motion. Nutmegs.—The kernel of the root of an East India tree. Sens. prop. smell, aromatic ; taste,moderately warm, and unctuous. Med. virt. stimulant. Mode of exhib. powder, spirituous distilled water, and an essential oil. Oak, the bark.—Astringent. Med. virt. tonic. Mode of exhib. de- coction, chiefly for external application ; slight intermittents, how- ever, have been cured by giving the powder of this bark in doses ot twenty to thirty grains every three hours, with a cupful of the infu- sion of chamomile flowers. It may be given in jelly, Port wine, or marmelade. Olive Oil, is procured by expression from the fruit of a tree growing in the warmer climates. Sens. prop, inodorous, insipid, unctuous. Med. virt. obtunding, emollient. Mode of exhib. internally, by it- self, or united to watery liquids by mucilaginous matters, or volatile alkalies. Externally, in liniments, ointments, and plasters. 608 APPENDIX. Opium.—The concrete gummy resinous juice of the white poppy, collected in the warm countries of the east. Sens. prop, smell, disagreeable; taste, bitter, somewhat acrid. Med. virt. narcotic, in large doses, sedative in smaller. Mode of exhib. pill, tincture, so- lution. Orange, Seville.—A well known fruit growing in Spain and Portugal. Part used ; the rind and pulp. Sens. prop, rind, bitter and aroma- tic ; pulp, acid. Med. virt. rind, tonic ; pulp, cooling and antisep- tic. Mode of exhib. infusion of the rind ; juice of the pulp in febri- fuge drinks. An elegant stomachic conserve, tincture, and syrup, are formed of the rind ; useful to cool phlegmatic habits. Parsley.—An umbelliferous plant,cultivated in gardens. Part used ; the seed and roots. Sens. prop, roots, sweet, and lightly warm; seeds, aromatic and bitter. Med. virt. stimulant, mildly diuretic. Mode of exhib. the root in decoction, against jaundice, gravel, and suppression of urine. Pennyroyal.—A plant cultivated in gardens. The leaves smell strong, not agreeable ; taste, warm and pungent. Med. virt. stimu- lant, aromatic. Mode of exhib. in infusion, as tea, against uterine obstructions. A water is distilled from it, and an essential oil. Pepper, black.—The fruit of a trailing shrub, growing in the East In- dies, of a heating and stimulating quality. Pimento.—The dry berry of a tree growing in Jamaica. Sen«. prop. smell, grateful and aromatic; taste, moderately warm. Med. virt. stimulant. Mode of exhib. a water distilled from it, and an essen- tial oil ; the latter sinks in water ; the former serves most of the purposes of waters drawn from more costly spices. Pink, Carolina.—This root is celebrated for the expulsion of worms from the alimentary canal ; it sometimes acts unpleasantly on the nervous system. Some order it in doses of ten or fifteen grains, while others advise it in doses of a drachm, alleging, that bad effects more readily happen from small doses, as the large dose generally purges or pukes ; hence we do not recommend this medicine in do- mestic practice. Pitch, Burgundy.—The resin exuding from the common fir tree, sof- tened in warm water, and strained. Med. virt. stimulant. Mode of exhib. in plasters and ointments. Pomegranate Tree—A prickly tree, or shrub, growing in the south of Europe. Part used ; the flowers, and rind of the fruit. Sens. prop, flowers and rind, astringent: fruit, tart, and roughish. Med. virt. tonic, cooling. Mode of exhib. juice of the fruit ;~infu.sion and decoction of the flowers anil rind, against prolapsed rectum and uterus. Sydenham directs the application of a fomentation to be made of an ounce of the rind of pomegranate bruised, with two pints of decoction of oak bark and half a pint of red wine. In colliquative diarrhoeas, accompanying hectic fever, Dr. Mead directed the fol- lowing astringent and nutritive decoction : Take of dried red rose leaves, balustines, pomegranate rind, and cinnamon, of each one drachm ; boil in a pint of cow's milk, adding little bv little, during the boiling, a pint ol water; keep it on the fire till the whole is re- duced to one pint; then strain off, and sweeten with a little sugar. To be taken in repeated draughts in the course of a day. APPENDIX. 609 Poppy, Red, or Corn Rose.—The flowers are very common in corn fields ; they are weakly sedative; a syrup is prepared from them. Its virtues are considerable. Poppy, White.—A plant cultivated in gardens. The heads, or seed vessels, afford a bitter, milky juice, which,'in a concrete form, is opium. Med. virt. anodyne, sedative. Of the expressed decoction, by the addition of sugar, an useful syrup is formed. Of the decoc- tion, strongly expressed and evaporated, an extract is formed, more pure than the opium that is imported. Prunes, Common, or French Prunes.—The fruit of a kind of garden plum tree, growing in France. Med. virt. laxative, cooling ; eaten crude or stewed. Quassia Root.—The woody root of a tree growing in Surinam. Sens. prop, intensely bitter. Med. virt tonic, stomachic, a corrector of putrid bile. Mode of exhib. infusion, extract. It is much used in this country as a succedaneum for hops, to give bitterness to malt liquor, though it deservedly subjects those brewers who employ it, to a very heavy penalty. Strong bitters are very properly exhibited as medicines in intermittent and bilious fevers, in some stomachic complaints, in cachexy, dropsy, and gout; but there is sufficient evidence to prove, that the long continued or habitual use of this class of remedies, has been productive of incalculable mischief Quince.—The fruit of a tree cultivated in gardens. The apple of the quince yields an austere and acid juice. A pleasant, astringent marmalade is prepared from it, which is deemed a preservative against sea scurvy, and covers well the bitter taste of the cinchona bark, which is disagreeable to delicate patients. Raisins.—Grapes dried by the heat of the sun ; they are imported from Spain and the Levant. This fruit is sweet, aperient, and ob- tunding. It is eaten crude, and is an ingredient in pectoral decoc- tions. Raspberry.—The fruit, acid and sweet; cooling, antiseptic. Rattlesnake Root, or Seneca, is a perennial plant, which grows wild in Virginia and Pennsylvania. Sens. prop, acid, hot, pungent. It has no smell. Med. virt. diuretic, expectorant, stimulant. The Senegaro Indians are said to prevent the fatal effects of the bite of the rattlesnake by giving it internally, and by applying it external- ly to the wound. The usual dose of seneca root, is from one to two scruples of the powder; or two or three tablespoonfuls of a decoction, prepared by boiling one ounce of the root in a pint and a half of water till it is reduced to a pint. This is prescribed in pleuritic, rheumatic, and dropsical affections. Rhubarb.—The root of this docklike plant tastes bitterish, somewhat acrid and astringent. Med. virt. tonic, mildly cathartic. Mode of exhib. powder, infusion, tincture. Rose, Damask.—-The flowers of a shrub cultivated in gardens. Sens. prop, very fragrant, bitterish. Med. virt. laxative, odoriferous. The shops keep a syrup, a honey, and a simple distilled water, of roses. _- , Rose, Red.—The flowers of a shrub cultivated in gardens. Med, virt. tonic From these a honey, syrup, and conserve, are prepared. 77 610 APPENDIX. Rosemary.—A shrubby plant, with labiated flowers, growing in gar- dens. Part, used ; the flowering tops. Sens. prop, smell, grateful; taste, warm and pungent. Med. virt stimulant. Mode of exhib. infusion, as tea, against violent headaches and other nervous com- plaints. An essential oil, and the spirit of rosemary are distilled from the tops, which are the principal ingredient in what has gene- rally been called Hungary water. Rosin, Fellow.—Baked turpentine. It is used in forming various ointments and plasters. Rue.—A shrubby plant, cultivated in gardens. Part used ; the leaves. Sens. prop, smell, strong and ungrateful; taste, penetrating and bitterish. Med. virt. antispadmodic, stimulant, anthelminthic. Mode of exhib. powder, infusion as tea, attenuant, deobstruent, for the impeded discharges of hysterical females. The extract may be given in doses of five to twenty grains, in the form of pills. The juice or infusion may be exhibited in a lavement against worms. Saffron.—The filaments of the pistil of a bulbous rooted plant, culti- vated in the fields. Sens prop, smell, aromatic, very diffusive ; taste, warm and bitterish ; colour, high orar-,e. Med. virt. heating, cordial,'stimulant. An elegant syrup is prepared from saffron, and it is an ingredient in several medicinal preparations, not so much on account of any singular virtues it is now supposed to possess, as for the elegant colour it imparts. Externaiiy, saffron is often mixed with emollient and resolvent cataplasms. Sage.—The leaves of a perennial piant, growing in our gardens It is aromatic and bitterish. Med. virt. tonic, sudorific Watery infu- sions of the leaves, mingled with a little lemon or orange juice, proves a useful diluent drink in febrile disorders. Sarsaparilla.—A climbing plant, growing in the Spanish West In- dies. Part used ; the root, and its bark. Sens. prop, smell, fra- grant ; taste, subastrimient and lightly warm. Med. virt. tonic, obtunding Mode of exhib. powder, decoction. Sassafras.—A large tree, growing in the warmer parts of America. The smell of this wood is fragrant; taste, lightly warm. It is em- ployed in stimulating and sudorific decoctions for scorbutic and venereal impurities. Savin.—The leaves of an evergreen prickly shrub, growing in gar- dens. Sens. prop, smell, strong and disagreeable ; taste, hot, acrid, bitterish. Med. virt. stimulant, diuretic. A scruple to half a drachm of the powdered leaves, has been given twice a day, with success, to athletic women, in cases of obstructed menstruation. The fresh leaves of savin may be given in the form of a conserve, or infused as tea, against worms and gouty affections ; or the extract, in the form of pills, may be given in doses from ten to thirty grains, or twenty to thirty drops of the compound tincture in a cupful of pennyroyal tea. In plethoric habits, venesection should precede the. use of savin. Externally, the leaves are applied in the form of powder, or strong infusion, to warts, carious bones, old ulcers, &c. Scurvy Grass.—Garden scurvy grass is a plant of the cruciform sili- quous class, growing in maritime situations, and cultivated in gar- dens. Part used; the herb. Sens. prop, acrid and saline. Med. APPENDIX. 611 virt. aperient, stimulant, antiscorbutic. It is eaten crude, and the juice, which may be taken in doses of an ounce or two, is used with good effect, joined with the juice? (a tablespoonful or two of each) of brook lime, water cresses, and Seville oranges. The fresh leaves of scurvy grass, beaten into a conserve with thrice their weight of fine sugar, may be kept in a close vessel, without any diminution of their virtue, for years. It may be taken in doses of two drachms to half an ounce, twice or thrice a day. Senna.—A pod bearing papilionaceous plant, growing in Egypt, and the east Part used ; the leaves. Sens. prop, smell, ungrateful; taste, nauseous and bitterish. Med. virt. purgative. Mode of exhib. extract, powder, infusion, tincture. To cover the taste of 6enna, coriander seeds are employed; but to prevent its griping, the warmer aromatics, such as cardamom seeds, or ginger, are more effectual. The dose of the extract is from half a drachm to two drachms; it may be given in the form of pills, but the extract is a weak cathartic, and occasions more griping pain in the bowels, un- less joined with an aromatic, than the tincture drawn from the leaves, probably because, that is mingled with carminatives. Snakeroot, Virginian.—A plant growing in North America. Part used ; the root. Sens. prop, smell, aromatic; taste, warm and bit- terish. Med. virt. stimulant, tonic, antiseptic diaphoretic. Mode of exhib. powder, infusion, tincture. Snakeroot was at first recom- mended as a medicine of extraordinary power in counteracting the poisonous effects of the bites of serpents. Both this and contra. yerva are found very useful medicines in typhous fever, and in putrid diseases ; also in eruptive fevers, to determine the disease to the skin and promote the eruptive process. In cases of gangrene, and in obstinate intermittent fevers, the snakeroot is an excellent auxiliary to the cinchona bark. Externally, it is used as a gargle in the putrid sore throat. . Sorrel, Common.—An herbaceous plant, growing wild, and cultivated in gardens. The acidulous herb is cooling, aperient, antiscorbutic. It is eaten crude, and a decoction of it in whey is refrigerant in febrile heats, and cases of bilious and scorbutic acrimony. Sorrel, Wood.—Wood sorrel Is a small perennial plant, growing wild. The leaves are gratefully acid, cooling, and antiseptic ; they are eaten crude; sometimes the expressed juice is taken as a tonic and antiscorbutic. The London College of Physicians order a con- serve of wood sorrel to be kept in the apothecaries' shops, which is given to quench thirst, and to cool the mouth, fauces, and pnmee vise, in bilious remitting fevers. Spermaceti is an unctuous, flaky substance, of a -white colour, and a butyraceous taste, without any remarkable smell; it is prepaied from the fat of the brain of a species of whale. Sens. prop, bland, insipid. Med. virt. obtunding, emollient. Mode of exhib. in sub- stance, combined with watery liquors by means of almonds, gum, or yelk of egg, in pectoral mixtures, or emulsions. Externally, as it readily dissolves in oils and unctuous substances, an elegant cerate and an ointment are formed, which are often used for healing blis- ters, burns, excoriations of the skin, &c. 612 APPENDIX. Sponge.—A substance adhering to rocks in the sea ; the habitation of certain marine insects. Sens. prop, soft, light, porous, elastic, af- fording a marine sodalike salt, when boiled,or calcined. Med. virt. internally, stimulant and resolvent; externally, proper for dilating sinuses by its swelling, and for stopping hemorrhages by its adhesion. Burned in a close vessel till it becomes black and friable, this is used in powder, with some suitable syrup, or conserve, into an electuary; or it may be formed into troches. Burnt sponge may be given in doses of a scruple, or upwards, against scrofulous indurations and* cutaneous foulnesses. Squill, or Sea Onion.-—A bulbous rooted plant, growing on the sandy shores of Spain, Portugal; and Syria. Part used ; the root. Sens. prop nearly inodorous ; taste, nauseous, bitter, and acrid. Med. virt stimulant, emetic, and diuretic. Mode of exhib. the dry root powdered, or in the form of pills, may be given as an alterative ; and to promote expectoration, from one, three, to six grains. From ten grains to a scruple, as an emetic, in pituitous asthma. The London College of Physicians direct the apothecaries under their jurisdiction, to keep a conserve of squills, which may be taken in doses of half a drachm to a drachm. Honey of squills ; dose, half a drachm to two drachms. Squill pills; dose, ten grains to thirty. Oxymel of squills; dose, half a drachm to two drachms. Tincture of squills ; dose, fifteen, thirty, to sixty drops. In doses of one drachm and a half to three or four drachms, it proves emetic. Vinegar of squills; in the dose of twelve drops to thirty or«-sixty ; alterative, cooling, expectorant. Sometimes tvvo drachms, but more frequently half an ounce to an ounce, of that preparation acts as an emetic. Starch is prepared from wheat, in which it forms an important ali- mentary substance. Its demulcent property occasions it to be formed into an officinal lozenge, which may be taken at discretion for allaying the tickling in the throat, which provokes coughing ; and a mucilage is prepared from starch, that often produces excellent effects, both taken in the mouth, and injected as an enema, in di- arrhoea and dysenteries, induced by irritation of the intestines. Tamarind.—The pod of a large tree, growing in the East and West Indies. Part used ; the pulp about the pods. Sens. prop, mildly acid. Med. virt. cooling, laxative. Mode of exhib. eaten preserv- ed with sugar, decoction, infusion, to quench thirst, and rVay im- moderate heat in burning fevers, bilious diarrhoeas, and inflamma- tions of the stomach, liver, and intestines. * When the pulp of "the tamarind is exhibited merely as a laxative, it may be of use to join it with manna. Three drachms of the former, and two of the latter, are usually sufficient to open the body : but to operate moderately as a cathartic, twice or three times as much of both articles are required. Tansy.—This plant grows wiH by road sides, and the borders of fields. It is frequently cultivated in gardens, both for culinary and medicinal uses. Part used ; the leaves and flowers. Sens. "prop. smell, strong and aromatic; taste, bitter. Med. virt. tonic, sto- machic, anthelminthic, and emmenagogue. Mode of exhib. pow- der, half a draclmi to a drachm for a dose, against flatulency and APPENDIX. 61S worms. From two pugils to a handful of the leaves, infused in wine, promotes the menses ; but they are more commonly taken in infusion, and drank as tea. Administered in this way, it is said to be a preventive of the return of the gout. Tar.—A thick, resinous fluid, melted out of old fir and pine trees. Sens. prop, empyreumatic, bitter, pungent. Med. virt. stimulant, diuretic. Mode of exhib. in pills ; also in infusion, called Tar Water, inserted in the Appendix. Externally, tar is employed as an ointment in scald heads, and some cutaneous diseases. Tar, Fossil, or Barbadoes Tar.— A kind of fluid bitumen; found in the West Indies. Sens. prop, smell, disagreeable ; taste, pungent. Med. virt. stimulant, sudorific, pectoral. Mode of exhib. chiefly externally, in liniments, as a discutient, and for preventing para- lytic disorders. Thoroughwort; Eupatorium Perfoliatum. Boneset.—The leaves and flowers. There are numerous species of eupatorium, which are natives of our soil. This species has long been familiarly known throughout the United States by the various names of thoroughwort, boneset, Indian sage, crosswort, vegetable antimony, &c. It grows abundantly in low meadows and marshy situations. The stem is erect, and rises from two to four or five feet, perforating the leaves at each joint, and is hairy or woolly, and branches only at the top. The leaves are horizontal, serrated and rough, from three to four inches long, and about one inch broad at their base, gradually les- sening to a very acute point, of a dark green, and covered with short hairs. The flowers are white, and appeaivin July and Au- gust, forming a corymbus at the termination of the branches. The medicinal properties of this very valuable plant have been accu- rately investigated by Dr. Andrew Anderson, of New York.* His investigation is judicious, and his experiments executed in a man- ner which merits commendation. He has ascertained its chemical properties by accurate analysis, and its medicinal virtues by prac- tical experiments. Hence he deems it warrantable to conclude, that it possesses many properties similar to those which character- ize the cinchona officinalis, the anthemis nobilis, and other valuable articles of the materia medica; but that these virtues reside in greatest quantity in the leaves. As preparations of this plant, the author recommends the decoction of the flowers and of the leaves ; infusions of the same parts ; the leaves in substance pulverized ; and a tincture of the flowers and of the leaves, prepared with proof spirit. This last form is the most pleasant and convenient, and, at the same time, the most pow- erful ; for proof spirit was ascertained to be the best menstruum. Our author does not hesitate to assert, that the chemical properties of E. Perfoliatum, as deduced from experiment, are in very many respects exactly similar to the Peruvian bark ; and that for its ac- tive medicinal virtues, particularly as a sudorific and as a tonic, it will not suffer by comparison with any of the articles drawn from the vegetable kingdom. In addition to his own opportunities of * See his Inaugural Dissertation, published in New York, 1G13. 614 APPENDIX. witnessing the employment of this plant, in different diseases in the New York almshouse, he appeals to the observations and experience of several distinguished practitioners, particularly of Dr. Barton and Dr. Hosack, for the importance and efficacy of this remedy in the treatment of most febrile disorders, particularly in intermitting and remitting fevers, yellow fever, and in other disorders of spe- cific contagion; in many cutaneous affections, and in diseases of general debility. It may however be observed, that if it be exhi- bited as a warm decoction, it often proves emetic, and acts especially on the skin, in producing diaphoresis : if in the form of cold infusion or decoction, or in substance, it acts as a powerful tonic. Dr. An- derson proceeds to detail six cases of intermittent fever in vvhich.after a single evacuant,the thoroughwort effected radical cures; and adds, that the same remedy was administered in almo-t all the instances of intermittents that occurred in the New York almshouse in the year 1812, to the exclusion of the Peruvian bark, and with uniform success. It was given either in decoction, or in powder, from twenty to thirty grains, every second hour during the intermission. In remitting fever, as a sudorific, it produced the most salutary effects; and in those cases where tonics were indicated it proved no less advantageous. In the treatment of yellow fever he ad- duces the high authority of Dr. Hosack and Dr. Bard, who, after proper evacuations, placed almost exclusive dcpcndance on sudo- i ihrs ; and, among tliis class of medicines, the eupatorium, adminis- tered in the form of decoction, was deservedly considered of great value. The disease called by some the petechial or spotted fever, and by others the malignant pleurisy, or typhoid peripneumony, has been more successfully treated by the class of remedies de- nominated sudorifics than by any other : and in many cases of this epidemic, which occurred in the city of New York, in the winter ot 1312-1S, after the proper evacuations bad been employed, the eu- patorium was resorted to, and it- sudorific, its tonic and its cordial properties were clearly demonstrated, and much benefit was de- rived from its use. In some obstinate cutaneous diseases, accord- ing to Dr. Barton, eupatorium lias produced very beneficial effects. During the author's attendance in the New York almshouse, in the year 1819, very liberal recourse was had to this remedy in diseases arising from general debility. In anasarcous affections of the ex- tremities, and in ascites, when it may be considered as a disease of debility, the alcoholic tincture of eupatorium may be safelv recom- mended as an excellent tonic; and in addition to its tonic effects, the properties of a diuretic render the employment of it still more advantageous in cases of this description. * \n infusion of thoroughwort has long been esteemed as an efficacious remedy in bilious colic accompanied by obstinate constipation. It is dire ted to the quantity of a teacupful every half hour till it pro- duce a cathartic effect. In a similar manner "it has been success- fully prescribed in dysentery with the view of both its cathartic and diaphoretic properties. About Iwo quarts of a strono- infus-on. of thoroughwort, with the addition of one ounce of alo^s, form an, excellent purgative for horses and cattle. Thach. Disp. APPENDIX. 615 rragacanth, Gum, is the produce of a very thorny shrub, which grows in the island of Candia, and other places in the Levant. It is without taste or smell, and much more glutinous than gum arabic. On account of its mucilaginous quality,gum tragacanth is employed as an ingredient in forming pectoral troches ; and the compound powder of tragacanth is of service in catarrhal defiuxions and di- arrhoeas, by sheathing the throat, stomach, and intestines, against acrimonious humors. The dose is a scruple to two drachms. Turpentine, Common, is the native resinous juice of various trees, particularly of the pine and fir kind. Chio, or Cyprus turpentine, is procured from a berry bearing tree, or shrub, growing in the Le- vant. Sens. prop, smell, disagreeable in the common, fragrant in the Chio; taste of both is hot, pungent, and bitter. Med. virt. stimulant, tonic, diuretic. Mode of exhib. in pills, or bolus, from a scruple to a drachm and a half. The common is rarely given in- ternally. Chio turpentine may be given in a fluid state, blended with watery liquors, by yelk of egg or mucilage. The rectified oil is extremely powerful, stimulating, detergent, diuretic, and sudori- fic, requiring the utmost caution in its exhibition; blended with honey, it may be given to adults in doses of six, and gradually in- creased to twelve drops. Externally, oil of turpentine is with some practitioners a favorite application in cases of burns and scalds. Turpentine is an ingredient in ointments and plasters. Uva Ursi, or Bear Berries.—An evergreen trailing plant,growing on high mountains. Part used ; the leaves. Sens. prop, bitterish,and snbastringent. Med. virt. tonic, antinephritic. Mode of exhib. powder, in calculus, and most disorders of the urinary passages. Valerian, Wild.—A perennial plant, with aggregated flowers, grow- ing both in dry and moist situations'; in the former, it is the most powerful as a medicine. Part used ; the root. Sens. prop, smell, strong and ungrateful; taste, warm, bitterish, and subacrid. Med. virt. tonic, anthelminthic, antispasmodic. Mode of exhib. powder, infusion, tincture. The powder (which has been highly recommend- ed, also, for dimness of sight) may be given in doses of a scruple to two drachms ; an infusion, as tea, with one or two drachms, may be taken, with the addition of a little mace, which conceals the un- pleasant flavor of valerian. Water Cress.—The leaves of this plant, of the cruciform class, grow- ing common in wet situations, have a pungent taste, and penetrat- ing smell. They are stimulant and antiseptic, when eaten crude, oAhe expressed" juice may be taken in doses of half an ounce to tvvo ounces. Wild Cherry Tree ; Prunus Cerasus.—The bark of the tree and root. The common wild cherry tree is often found in woods and hedges, and is associated with the trees of the forest, growing to the height of forty or more feet, and of a very large size. The bark of the wild cherry tree is powerfully tonic, and has been frequently sub- stituted for the Peruvian bark, with great success. It is slightiy narcotic, and commonly produces drowsiness in those who take it. From the experiments of Mr. C. Morris, of .Virginia, (Inaug. Diss. 1812, Phila.) it appeared, that the bark of the root was more pow- C16 APPENDIX. erful than the bark of the trunk. It has been very useful in dys- pepsia and in consumption of the lungs. The ludians, it is said, use the bark in the cure of syphilis. Very excellent effects have been produced by washing ill conditioned ulcers with a decoction of the bark, and the same has proved anthelminthic. The leaves of this tree are poisonous to certain animals. While this valuable tree abounds in the United States, we act unwisely, says Dr. Mease, in sending thousands of dollars out of tlie country for the Peruvian bark. Cherries that are subacid are, according to Dr. Willich, an excellent article of domestic medicine in the true scurvy, in putrid fevers, and the dysentery; as likewise to those persons, who are liable to obstructions in the alimentary canal. Nor will they be found less salutary to constitutions whose bile is vitiated, whose stomach is troubled with foul eructations, and who are afflicted with an offen- sive breath: all such persons should eat them freely, particularly on an empty stomach. For similar reasons, dried cherries form an excellent article of diet, in acute and inflammatory disorders : where they should be used both in substance and in decoctions, which are equally cooling and antiseptic. Thach. Disp. Willow; Salix Latifolia.—jiroad leaved willow. The bark. This pos- sesses greater medicinal properties than any of the other species of salix; and is now substituted by many British physicians for the Peruvian bark. Three British pamphlets on this subject have been published within a few years; the last, by Dr. Wilkinson, (1803,) is replete with encomiums on the remedy in question. This species of salix may be distinguished by tlie shape of its leaves from all others, except the salix pentandra, or bay leaved willow. But the leaves of the latter are smooth and shining, and of a deeper green ; nor have they the downy appearance on the under surface, vvaich is so remarkable in the salix caprea, or latifolia. It is found in woods and hedges, on hilly situations, and delights in cold, clayey, moist ground. The most proper time to gather the bark, is in May or "June. It should be cut in small pieces, and dried in the shade. This bark is very astringent to the taste, and somewhat bitter, but it loses the latter quality when dry. Dr. Wilkinson directs one ounce and a half of the coarse powder of the bark to be infused in one quart of water for six hours ; then to boil it over a gentle fire for a quarter of an hour, and strain for use : of this the ordinary dose is two or three large spoonfuls, three or four times a day; but in the ague and fever, one or two ounces may be given every third hour, in the interval of the fit. The strong decoction of this bark resembles Port wine in colour, for which, by several who have seen it in vials, it has been mistaken. Dr. Wilkinson relates sixteen cases of disease, in which this bark was employed with decided advantage, and from which, he does not hesitate to assign to it virtues greatly superior to those of the cinchona : in particular, he relates a case of extreme emaciation from an ulcerated foot, which was perfectly cured, after having re- sisted the continued use of Peruvian bark,'and the exertion of the physicians of two public charities. It is doubtless a remedy of APPENDIX. 617 considerable efficacy, and is strongly recommended on account of its cheapness, and the facility of procuring it. It appears to be useful in most cases where the cinchona is usually resorted to. The attention of medical men should be directed to the inquiry, whether the salix latifolia may be found in the United States, as it promises to afford a valuable substitute for the cinchona ; the price of which has become exorbitant, and its quality greatly im- paired by base and fraudulent adulterations. Thach. Disp. Winter Green ; Pyrola Umbellata.—The whole plant. Among the re- cent acquisitions to our materia medica, is pyrola umbellata, ap- pearing first in the medical botany, by Professor Bigelow, and since introduced into our national pharmacopoeia. This vegetable in- habits all latitudes in the United States, growing in shady woods, where it is protected from the sun, and flourishing with un- diminished verdure, even when covered with the snow of win- ter. Six species of pyrola are natives of our soil, but the urn" bellata is the one used in medicine. Under the appellations win- ter green and pipsissewa, the newspapers have teemed with attes- tations of its virtues as a remedy in various diseases. These testi- monies, although in general from persons out of the profession, have, by more correct observation, and by medical authority, been, in a considerable degree, corroborated. It is found in every forest, closely intermingled with another well known ever- green, the boxberry, or chequerberry, and often surrounded by the uva ursi, td which it appears to be allied. The root is creeping, sending up stems at various distances. Stems ascending, hard and woodv at base, somewhat angular, and marked with the scars ot the former leaves. The leaves grow mostly in bunches or whorls, lanceolate, somewhat wedge-shaped, sharply serrate, decurrent on the petiole, smooth, firm, and coriaceous. The flowers appear in June and July, in an imperfect umbel, or rather corymb, ot trom three to six, variegated with purple and white, drooping. The pyrola was employed with considerable success during the re- volutionary war, in typhus, and was viewed as stomachic, tonic, and astringent. The bruised leaves, moistened with brandy, and applied to the skin, produced blisters. The late Professor Barton found it to possess antilithic properties, and not essentially ditler- ent from uva ursi. Professor Smith, of New Haven assures me that in one case of inveterate cancer, he employed the pyrola both internally and externally with such favorable effects, as convinced him, that it possessed some specific virtues as a remedy in this disease. I am informed by Dr. Miller, an experienced surgeon of Franklin, that he is in the practice of applying, by way ofdecoc- lion and cataplasm, the leaves of this plant to chronic indurated tumors which, in many instances, have been dispersed by itsi stim- ulantmd vesicating effects. Professor Bigelow has made this ar- ticle a subject of particular investigation and inquiry; and, from ns medica botany" 1 quote the following, as being worthy of full confidence: « The pyrola umbellata, though scarcely known as a medicine until within a few years past, has at the present day ac- quired a reputation of considerable extent in the treatment of v* 78 618 APPENDIX. rious diseases. Its popular celebrity seems to have originated in its application to the treatment of fever and rheumatism ; but the attention of physicians has been chiefly drawn towards its use in other complaints. The instances in which this plant has received favorable testimonies on medical authority, of its successful use, both in America and Europe, are principally the following: 1. As- a palliative in strangury and nephritis. 2. As a diuretic in dropsy. 3. As an external stimulant, susceptible of useful application to various cases. In the first of these cases, the pyrola is entitled to attention and confidence. Some practitioners in this country have employed it with advantage in the same cases in which arbutus uva ursi is recommended.* Dr. Wolf, the German writer lately cited, has reported a number of cases of ischuria and dysuria, aris- ing from various causes, in which the pyrola, given in infusion, pro- duced the most evident relief, and took precedence of a variety of remedies which had been tried. His method of administering it was to give a tablespoonful of a strong infusion, with a little syrup, every hour. In all the cases he has detailed, small as the dose was, it gave relief in a very short time. In one case its effect was so distinctly marked, that the disease returned whenever the medi- cine was omitted, and was removed on resuming its use. A tonic operation attended its other effects, so that the appetite was im- proved and digestion promoted during the period of its employ- ment. The diuretic properties of the pyrola umbellata, seem to have been fully illustrated by Dr. W. Somerville, in a paper on this vegetable, published in the fifth volume of the London Medico- chirurgical Transactions. The facts presented by this physician afford satisfactory evidence of the power of this medicine to pro- mote the renal excretion, and to afford relief to patients afflicted with dropsy in its various forms. The most distinguished case presented by him, is that of Sir James Craig, the British governor in Canada, who was laboring under a general dropsy, which in its progress had assumed the forms of hydrothorax, anasarca, and as- cites, and which was combined with different organic diseases, es- pecially of the liver. After having tried with little or temporary success, almost every variety of diuretic and cathartic medicines, and submitted twice to the operation of tapping, the patient had recourse to a strong infusion of the pyrola, in the quantity of a pint every twentyfour hours. Although the case was altogether an un- promising one, yet the plant gave relief, not only in the first, but in the subsequent instances of its use. It increased the urinal dis- charge, and, at the same time, produced an augmentation of strength, and an invigorated appetite. Several other cases of dropsy are detailed in Dr. Somerville's paper, in which the pyrola was admin- istered by himself and by other practitioners with decided advan- tage. Dr. Satterly and Dr. Marcet are among those, who have added their observations to the testimonies in its favor. Dr. Somer- ville found his patients to remark, that an agreeable sensation was perceived in the stomach soou after taking the pyrola, and that this * See Dr. Mitchell's Inaugural Dissertation, Philadelphia, 1U03. APPENDIX. 619 wa9 followed in some instances by an extraordinary increase of appetite. He considers it as having in this respect a great advan- tage over other diuretics, none of which are agreeable to the sto- mach, and most of them very offensive to it. He further states, that no circumstance had occurred within his own experience or inior- mation, to forbid its use in any form, or to limit the dose. Dr. Wolf has given one very satisfactory case of the utility ot our plant in ascites. He also found it to alleviate altogether the ardor urinje attendant on gonorrhoea. Such are the important facts, which to my knowledge have been published respecting the internal use of the pyrola umbellata. 1 have administered this plant on various occasions, and attended to its mode of operation. In a number of dropsical cases, when first given, it made a distinct and evident impression on the disease, communicating an increased ac- tivity to the absorbents, followed by a great augmentation ot tne excretion from the kidneys. The benefit, however, with me has been in most instances temporary, and it was found better to omit the medicine for a time, and to resume it afresh, than to continue it until the system had become insensible to its stimulus. Alter suspending it for a week or two, the same distinct operation tooK place on returning to its use, as had been manifested in the nrst instance. It proved in almost every instance, a very acceptable medicine to the patient, and was preferred both tor its sensible qualities and its effects on the stomach, to other diuretics and alter- atives which had been prescribed. The pyrola has been consider- ably employed as an external application m tumors and ulcers or various descriptions. It first acquired notice in consequence ol some newspaper attestations of its efficacy in the cure of cancer. Those persons, who know how seldom genuine ™nc*™oc™™ comparison with reputed ones, will be more ready to allow i the character of curing ulcerous than really cancerous .affections There are undoubtedly manv ulcers, and those frequently of a ma- lignant kind, which are benefited by antiseptic stimulants; and to such the pyrola may be useful. But of its efficacy '^eal cance we require more evidence than is at present possessed, before we ascribe to it the power of controlling so formidable a malady. The pyrola is onefand probably the principal article in a composi- tion possessed by certain Indians as a remedy tor■ scroffula. In the* hands it has obtained very considerable reputation for having effected radical cures ; their n/ode of administration is to macerate the leaves and roots for some time in cold water, and to give a Sacupful three times in a day. « *« t^ctTi-&- nint or more may be given in a day. 1 he extract has been aa Ministered to J eZt of five scruples in twentyfour tmurs, in ,^T-Smail, light seeds, the produce of a species of worm- wood They are brought from the Levant. Sens.prop.smel, Ttrot and ungrateful; taste,very bitter,and subacid Med. virt anTelminthicf Mode of exhib. in substance. To adults the dose L^m a drachm to a drachm and a half, twice a day. Young pa- tients may have five grains to a scruple. 628 APPENDIX. Wormwood, Common.—A compound flowered plant, growing wild, and cultivated in gardens. Part used ; the leaves and flowering tops. Sens prop, smell, strong and ungrateful; taste, extremely bitter, nauseous. Med. virt.tonic, stimulant, antispasmodic, anti- septic, anthelminthic. Mode, of exhib. infusion, as a strengthening bitter, to cure agues, and in worm cases. Wormwood was formerly much used as a bitter against weakness of the stomach, and dys- peptic complaints, in medicated wines and ales. The juice may be exhibited in doses of one to four tablespoonfuls; i. e. half an ounce to two ounces. Externally, wormwood is employed in warm, discutient, antiseptic fomentations. Feast. Barm. Brewer's Foam.—Yeast for medicinal use may be procured from the brewer's vats, or may be prepared in either of the following methods: Thicken two quarts of water with about three or four spoonfuls of rye meal or fine flour; boil for half an hour ; sweeten with half a pound of brown sugar; when near cold, put into it four spoonfuls of fresh yeast, shake it well together in a jug, and let it stand one day to ferment near the fire without being covered. Pour oft' the thin liquor on the top, and cork up the remainder for use. Or boil one pound of clean washed potatoes to a mash, when half cold, add a cupful of yeast and mix it well. It will be ready for use in two or three hours. Or, take one pint of yeast, and add half a pint of molasses and one quart of lukewarm water. Stir these well together, and let it st.ind in a moderately warm place till active fermentation become evident; then it may be kept in a cool place for the patient's use. In warm weather it should be prepared fresh every day. Yeast has acquired considerable celebrity for its virtues in the cure of putrid fever and malignant ulcerous sore throat. It is to be ex- hibited in doses of two spoonfuls every two or three hours; should it purge or gripe, the dose must be diminished. It is also employed as an external application to dangerous ulcers. Thach. Disp. Zedoary.—A root imported from the East Indies. Sens. prop, smell, aromatic; taste,warm and bitterish. Med. virt. tonic,carminative, stimulant, stomachic. Mode of exhib. powder, from ten grains to half a drachm ; or an aqueous infusion, as tea, in cases of want of appetite, unattended with loathing of food, and spasmodic colic. 0 GLOSSARY. Although terms of art have heen sedulously avoided in the composition of this work, and in the various additions that have been subjoined, it is impossible entirely to banish technical phrases when writing on medicine ; and, as several persons expressed their opinion, that a Glossary would render the book more generally intelligible, the following concise explanation of the few terms of art that occur, is 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 the community. Abdomen. The belly, or the lower belly. Abscess. A collection of pus or matter, preceded by inflammation and swelling. Absorbents. Glands, or vessels, that convey the nourishment from the intestines, and the secreted fluids from the various cavities, into the mass of blood. Absorbents. Medicines which have no acrimony in themselves, and which destroy acidity in the stomach and bowels. Acescent. Sour; sharp ; tending to sourness. 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. Alkali. Is an incombustible substance, soluble in water. Potash, and salt of tartar, are alkaline salts. Alvine. Of or relating to the lower cavity of the belly. Anasarca. A species of dropsy in which the thinner parts of the blood are generally effused and retained between the skin and the flesh. Anodyne. A medicine that relieves pain. Anorexia. A want of appetite. Anthelminthic. A medicine to destroy worms. Antiemetics. Medicines which stop vomiting. Antiseptic. Preventive of putrefaction. Antispasmodic. Whatever tends to prevent or remove spasm. Aperient. Opening ; gently purgative. Aphthae. Small, whitish ulcers, or inflammatory erosions appearing in the mouth. Arthritic. Gouty; painful affections of the joints. Ascites. Dropsy of the belly. Astriction. A tightening or lessening; costiveness. Atrabiliary, or Atrabilarian. An epithet commonly applied to peo- ple of a certain temperament, marked by a dark complexion, black hair, spare habit, &c, which the ancients supposed to arise from atrabilis, or the black bile. 622 GLOSSARY. Atrophy. A species of consumption, when the body or some mem- ber of it is not nourished, but decays and wastes away gradually. Attenuant. Such medicines as open the pores of the body, and ren- der more fluid, thick and glutinous humors. Bile, or Gall. A fluid which is secreted by the liver into the gall bladder, and thence passes into the intestines, in order to promote digestion. Bronchotomy. That operation which opens the windpipe by in- cision, to prevent suffocation. Bronchia. The branches of the windpipe dispersed through the lungs. Bubo. A tumor with inflammation in the groin. Cacochymy. An unhealthy state of the body. Calculus. The stone in the bladder. Canker. Eroding ulcers on the gums and tongue, formed without any previous tumor. " The canker," in popular language, is the same as aphthce or thrush. Capillary Vessels. The smallest branches of the veins and arteries. Carbonic Acid Gas. Fixed air, carbonaceous acid, aerial aid. Caries. A rottenness of the bone. Cathartics. Purges. Chalybeate. Impregnated with iron or steel. Chronic. A disease whose progress is slow, in opposition to acute. Chyle. A milky fluid separated from the aliment in the stomach and intestines, and conveyed by the absorbents into the blood, to supply the waste of the animal body. Circulation. The motion of the blood, which is driven by the heart through the arteries, and returns by the veins. Colliquative Evacuations. Dangerous fluxes, with profuse, clammy sweats. Comatose. Sleepy. Constipation. A constriction, or binding together; costiveness. Conglobate Gland. A simple gland. Conglomerate. A compound gland. Contagion. 'A morbid secretion from the living human body, which by inoculation, or by diffusion through the air within a limited dis- tance from its source, may be communicated to a healthy person, independently of climate, season, atmospheric temperature, purity or impurity ; as smallpox, &c. Dr. Buchan, as was common in his day, and too much so in ours, uses contagion and infection as synonymous.' C. 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; pertaining to a crisis. Critical Days. The fourth, fifth, seventh, ninth, eleventh, thirteenth, fourteenth, seventeenth, and twentyfirst, are by some authors de- nominated critical days, because febrile complaints have been ob- served to take a decisive change in these periods. Cruciform. In botany, a plant having a flower consisting or four petals disposed in the form of a cross. Cucurbitaceous. In botany, a species of gourd. Cutis. The skin. Cuticle. The scurfskin. GLOSSARY. 623 Cutaneous. Of or belonging to the skin. Debility. Weakness ; feebleness ; decay of strength. Delirium. A temporary derangement of the mental faculties. Deleterious. Deadly; destructive. Desiccative. Drying; tending to dry. Diaphoretic. Exciting perspiration. Diaphragm. A membrane separating the cavity of the chest from that ot the belly, or abdomen. Diarrhoea. A flux, or looseness 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. Dyspepsia. A difficulty of digestion, or rather a depraved one; as when what is digested becomes acid, or possessed of other morbid qualities. Dyspnoea. A difficulty in breathing. Dysuria, or Dysury. A difficulty or heat in voiding urine. Eccoprotics. Such medicines as gently purge the body. Efflorescence. A spot, or eruptive appearance. Emmenagogue. Medicines which excite the menstrual discharge. Emollient. Softening. Empyreumatic. A smell resembling that of burnt substances. Endemic. A disease peculiar to a certain district of country. Enema, Clyster, or Lavement, are equivalent with each other, and signify any liquid medicine injected into the anus. Epigastric. Belonging to the region or part immediately over the stomach. Epidemic. A disease generally prevalent. Errhine. Medicines to snuff' up the nose, and which, by causing sneezing, purge the head. Exacerbation. The increase of any disease. Exanthemata* Certain wheals or breakings out on the body; efflo- rescences, or pustules. Expectoration. The act of discharging mucus, &c.from the lungs, &c. The matter coughed up. Feces. Excrements. Fetid. Emitting an offensive smell. Fetus. The child before birth, or when born before the proper period, is thus termed. Flatulent. Producing wind. Formula. A prescription. Fungus. Proud flesh. Gangrene. Mortification in its first beginning; caused by a stoppage of the circulation, followed by putrefaction. Gestation. The time of a woman's going with child. Glottis. Is that chink of the larynx, that Ties at the root of the tongue. Cymnasium. The place where gymnastic exercises are taken. These exercises are various and diversified, so as to suit persons of differ- ent age, degrees of strength, &c. The effects of these exertions are, first, to give form and proportion to the several parts of the body in its development; and, secondly, to give force, activity, and adroit- ness to all its complicated organization. 624 GLOSSARY. The purpose of what has been called Medical Gymnastics is, to im- prove and preserve health, or to restore it when impaired or lost. Gymnastic. Exercise taken with a view to preserve or restore health. The ancient physicians reckoned this an important branch of medi- cine. Hmmoptoe. > . . f blood fmm the { Haemoptysis. ) ^ ° Hemorrhoids. The piles. Hemorrhage. Discharge of blood. Hectic Fever. A slow consuming fever, generally attending a bad habit of body, or some incurable and deep rooted disease. Herculean. Powerful; of the greatest force. Hypochondriacism. Low spirits. Hydrogen. Is the basis of inflammable air; it is a constituent ele- ment of water. Hypochondriac viscera. The liver, spleen, &c; so termed from their situation in the hypochondriac, or upper and lateral parts of the belly. Ichor. Thin, bad matter. Imposthume. A collection of purulent matter. Infection. ' The cause of infectious diseases. Infectious gases, efflu- via, or vapors, arise from animal and vegetable substances in a state of putrefaction. Infection arises from heat, filth, and moisture. In- fection produces yellow fever, and all other putrid and malignant fevers, which do not originate from a diseased action of the living body. Infectious disorders are produced by the effluvia of dead and putrid animal and vegetable substances. Contagiou> disorders are the product of morbid secretions in sick animals, affecting ani- mals in health by means of contact, or through the medium of the atmosphere. Infection has been generally confounded with conta- gion. This'is a very unfortunate error, and has led to serious evils, both in the speculative and practical parts of the medical profession. Infection is the offspring of the putrefactive fermentation among the particles of inanimate substances,—while contagion is the result of the action of living, secreting vessels, on the fluids they convey. The dead, putrifying human body* has often occasioned infection, sickness, and death ; but it requires the vascular action of the living cow to produce tlie contagious secretion of the cowpock virus.' C. Inflammation. A surcharge of blood, and an increased action of the vessels, in any particular part of the body, attended with heat, red- ness, swelling, and pain. Inguinal. Has reference to what is commonly called the groin. Lavement. See Enema. Ligature. Bandage. Lixivium. Ley. Lohoch, or Linctus. A medicine to be licked by the tongue, or swal- lowed slowly. Mamma. The nipple. When buried under churches, and in populous places. GLOSSARY. 623 Mammae. The breasts. Meconium. The first, usually darkish, discharges from the infaftit's bowels. Mediastinum. A double membrane, that divides the Thorax or breast into two parts. Mesentery. A double membrane, which connects the intestines to the back bone, and about which they are involved. Miliary Eruption. Eruption of small pustules, resembling the seeds of millet. Morbid. Diseased. Morbific. Causing disease. Mucus. The matter discharged from the nose, lungs, &c. Narcotic. A stupifying opiate. Nausea. An inclination to vomit. Nephritic. A disease belonging to the kidneys and bladder. Nephritics. Are those medicines that have a tendency to break or dissolve stony concretions. Nervous. Irritable. Oxide. A substance formed by the union of oxygen with a basis, as oxide of iron, of copper, &c. Papilionaceous. Having emulgent vessels, like a nipple. Paroxysm. A fit, or the periodical return of a fit; of a disease. Pectoral. Medicines adapted to cure diseases of the breast. Pemphigus. A fever attended by successive eruptions of vesicles, about the size of almonds, which are filled with a yellowish fluid, and subside in three or four days. Perennial. Durable, perpetual. Perspiration. The matter discharged from the pores of the skin, in the form of vapor or sweat. Peritonaeum. A membrane lining the cavity of the belly, and cover- ing the intestines. Pericardium. A membranous bag, containing the heart. Petechial. Small spots on the skin, like flea bites, which come out in some fevers. Phlebotomy. The art or operation of letting blood. Phlegmon. An inflamed tumor, accompanied with heat, redness, and throbbing pain. Phlegmatic. Watery, relaxed. Phlogiston. Is here used to signify something which renders the air unfit for respiration. Phthisis Pulmonalis. Consumption of the lungs. Plethoric. Replete with blood. Polypus. A diseased excrescence, or a substance formed of coagula- ble lymph, frequently found in the large blood vessels. Prcecordia. The parts about the heart. Prolapsus Ani. The falling down of the fundament. Prolapsus Uteri. The falling down of the womb. Pus. Matter contained in a bile. Rectum. The strait gut, in which the feces are contained. Refrigerant. Cooling, refreshing. Regimen. The regulation of diet, &c Sometimes its meaning is extended to every thing tending to preserve health. 79 626 GLOSSARY. Respiration. The act of breathing. Restringent. Binding. Saliva. The fluid secreted by the glands of the mouth. Sanies. A thm, bad matter, discharged from an ill conditioned ulcer. Scirrhous. A state of diseased hardness. Secretion. That function by which different organs separate from the blood various substances destined for particular uses. The liver secretes the bile, the kidneys the urine, the salivary glands the sa- liva, &c—-These secreted fluids, and others, all differ from the blood, the common source, whence they are derived. Sedative. Composing, easing, antispasmodic. Slough. A part separated and thrown oft' by suppuration. Sordes. Filth, dregs. Spine. The back bone. Sternutatory. Causing to sneeze. Sternum. The breast bone, which is situated in the middle of the breast. Styptic. A medicine for stopping the discharge of blood. Subacid. Rather acid ; somewhat sour or tart. Succedaneum. A substitute for another article. Syncope. A fainting fit attended with a complete abolition of sense and motion. Tabes. A species of consumption. Temperament. A peculiar constitution or habit of body, of which there are generally reckoned four; the sanguine, the bilious, the melancholic, and phlegmatic. 'Tenesmus. A continual desire of going to stool, attended with an inability of voiding anything except bloody, slimy matter. Thrush. See Apthce. Typhus, or Typhous Fever. See Nervous Fever. Vaccine. Of or belonging to a cow, or the cowpock. Variolous. Of or resembling the smallpox; a distemper, that is so va- riously diversified, that it requires various methods of management. Venesection. See Phlebotomy. Vermifuge. A medicine to expel worms. Vertigo. ' Giddiness. Vesicatory. A blistering application. Virus. Something poisonous; a morbid secretion. Viscera. The bowels, entrails. The heart, liver, lungs, &c. are so called. Ulcer. An ill conditioned sore. Umbelliferous. Having umbilical vessels, in reference to the navel. There are four ligamentary vessels called by this name. Ureters. Two long and small canals, which convey the urine from the kidnevs to the bladder. Urethra. The canal which conveys the urine from the bladder. • It would extend this glossary beyond its proper limits, to explain every medical term used in this work. I would therefore advise all those who wish to read this, or any other similar book understanding- ly, to use some octavo edition of Robert Hooper's Medical Dictionary.' INDEX. •H.BLUTIONS, Jewish and Mahometan, well calculated for the preservation of health, 113. Abortion, causes and symptoms of, 417. Means of prevention, 418. Proper treatment in the case of, ibid. Abscesses, how to be treated, 269. 446. Accidents. See Casualties. Acids, of peculiar service in consumptions, 173. In putrid fevers, 196. Not suitable in the measles, 217. Acidities in the bowels of infants, the origin of, 429. Method of cure, ibid. Ackworth, foundling hospital at, cause of the children there being afflicted with scabbed heads, and fatal consequences of their ill treatment, 434. note. Addison, his remark on the luxury of the table, 107. Africans, their treatment of children, 28. note. Agaric of the oak, its merits as a styptic, 449. Method of gathering, prepar- ing, and applying it, ibid. note. Agriculture, a healthful, constant, and profitable employment, 71. Is too much neglected in favor of manufactures, ibid. Gardening, the most wholesome amusement for sedentary persons, 74. Ague, a species of fever no person can mistake, and the proper medicine for, generally known, 147. Causes of, ibid. Symptoms, 148. Regimen Tor, ibid. Under a proper regimen will often go off, without medicine, ibid. Medical treatment of, 149. Often degenerates into obstinate chronical dis- eases, if not radically cured, 152. Peruvian bark, the only medicine to be relied on in, ibid. Children, how to be treated in, 153. Preventive medi- cine for those who live in marshy countries, 154. Air, confined, poisonous to children, 42. A free open air will sometimes cure the most obstinate disorders in children, 44. Occupations which injure the health by unwholesome air, 64. 71. The qualities of, act more sensibly on the body than is generally imagined, 90. The several noxious qualities of, specified, ibid. In large cities, polluted by various circumstances, 91. The air in churches, how rendered unwholesome, ibid. Houses ought to be ven- tilated daily, 92. The danger attending small apartments, ibid. Persons whose business confines them to town, ought to sleep in the country, 93. High walls obstruct the free current of air, ibid. Trees should not be planted too near to houses, ibid. Fresh air peculiarly necessary for the sick, 94. The sick in hospitals in more danger from the want of fresh air, than from their disorders, ibid. Wholesomeness of the morning air, 90. The changeableness of, one great cause of catching cold, 130. Tiiose who .keep most within doors the most sensible of these changes, 131. Of the night, to be carefully guarded against, 132. Fresh air often of more efficacy in diseases than medicine, 140. Its importance in fevers, 145. 157. States of, liable to produce putrid fevers, 194. Must be kept cool and fresh in sick chambers under/his disorder, 196. Change of, one of the most effec- tual remedies for the chincough, 253. The qualities of, a material conside- ration for asthmatic patients, 345. The various ways by which it may be rendered noxious, 474. Confined, how to try and purify, 475. Method of C£8 INDEX. recovering persons poisoned by foul air, ibid. Fresh, of the greatest impor- tance in fainting fits, 481. Aitkin, Mr., his treatise on the nature and cure of fractures, recommended, 462. note. Alkali, caustic, recommended in the stone, 283. How to prepare it. ibid. note. Aliment is capable of changing the whole constitution of the body, 81. 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, 82. The quality of, how injured, ibid. A due mixture of vegetables necessary with our animal food, 83. To what the bad effects of tea are principally owing, 84. Water, good and bad, distinguished, ibid. Inquiry into the qualities of fermented liquors, with instructions for the due making of them, 85. The qualities of good bread, and why adulterated by bakers, 86. Ge- neral rules for the choice of food, 87. Ought not to be too uniform, ibid. Meals ought to be taken at regular times, 88. Long fasting injurious, both to old and young, ibid. Breakfasts and suppers, 89. Changes of diet ought to be gradually made, ibid. General observations on, 510. Amaurosis. See Gutta serena. Amusements, sedentary, improper for sedentary persons, 73. Ought always to be of an active kind, 98. Anasarca. See Dropsy. Anger, violent fits of, injurious to the constitution, 120. Tranquillity of mind essential to health, ibid. Animal food, cautions in giving it to children, 33. Animals that die of them- selves, unfit for food, 82. Overdriven cattle rendered unwholesome, 84. The artifices of butchers exposed, ibid. Too great a quantity of, generate* the scurvy, ibid. Injurious to many habits, 510. Animals and plants, the analogy in the nourishment of, stated, 106. Anthony^s Fire, St. See Erysipelas. Aptha. See Thrush. Apoplexy, who most liable to this disorder, 348. Causes, ibid. Symptoms and method of cure, 349. Cautions to persons of an apoplectic make, 350. Cupping frequently beneficial in, 351. note. Apothecaries'1 weights, a table of, 538. Apparel. See Clothing. Appetite, want of, causes and remedies for, 3o3. Arbuthnot, Dr., his advice in the inflammation of the lungs, 165. His advice for persons troubled with costiveness, 352. note. Arsenic, the effects of, on the stomach, 400. Medical treatment, when the symptoms appear, ibid. Arts. See Manufactures. ,'hci.lcs. See Dropsy. Asses'1 milk, why it seldom does any good, 170. Instructions for taking it, 171. Asthma, tlie different kinds of this disorder distinguished, 344. Causes, 345. Symptoms, ibid. Regimen, ibid. Medical treatment, 346, Remedies pro- per in the moist asthma, ibid. -,----— nervous, remedy for, 348. note. Atmosphere. See Air. B. BaWs purging vermifuge powder, preparation of, 315. Balsams, how to prepare, 546. Anodyne balsam, Hid. Locatelli's balsam, ibid. Vulnerary halsam, ibid. Bandages, tight, produce most of the had consequences attending fractured bones, 462. Bark, Peruvian, the best antidote for sailors against disoglers on a foreign coast 70. How to be administered in the ague,. 149. Distinction between the red bark and quill bark, 150. note. A decoction or infusion of, may be taken by those who cannot swallow it in substance, 151. Is often adulte- •■«iUd, ibid. note. Is the only medicine to be depended on in agues, 152. INDEX. 629 How it may be rendered more palatable, 153. May be administered by clyster, ibid. Cold water the best menstruum for exVactingthe virtues of this drug, 175. How to be administered in the putrid fever, 199 i and in the erysipelas, 226. In the inflammation of the eyes, 234. Its efficacy in a malignant quinsy, 242. In the chincough, 256. A good medicine in vomit- ing, when it proceeds from weakness of the stomach, 276. Its efficacy in a diabetes, and how to take it, 279. Is good against the piles, 290 ; and worms, 314. Its use dangerous for preventing a fit of the gout, 326. A good remedy in the king's evil, 339 ; and in the^uor albus, 416. Barley water, how made, 161. Barrenness in women, the general causes of, 425. Course of relief, ibid. Bath waters, good in the gout, 327. Bath, cold, the good effects of, on children, 41. Recommended to the studi- ous, 80. Is peculiarly excellent for strengthening the nervous system, 359. Is good for rickety children, 439. Apoplexies frequently occasioned by the improper use of, 489. Absurd prejudice against, 490. Nothing contributes more to permanent health, ibid. A single plunge or dip sufficient; continu- ing too long in it dangerous, 491. Morning tlie properest time for bathing, ibid. Sea water preferable to river water, ibid. Rules to be observed in the use of, 492. Is peculiarly salutary in scrofulous complaints, ibid. Swel- lings of the glands resolved by seabathing, ibid. Warm bath better adapted for cutaneous disorders, 493. Cautions on the improper use of, 494. 495. Good effects of the shower bath, 497. Cold bath dangerous in the gout, ibid. Warm bath more salutary in diseases of the liver and kidneys, 498. Bath, warm, of great service in an inflammation of the stomach, 257. Bathing, a religious duty under the Judaic and Mahometan laws, 113. Is con- ducive to health, ibid. Bearsfoot, recommended as a powerful remedy against worms, 314. Beds, instead of being made up again as soon as persons rise from them, ought to be turned down and exposed to the air, 92. Bad effects of too great in- dulgence in bed, 97. Damp, the danger of, 132. Soft, are injurious to the kidneys, 278. 281. Beer, the ill consequences of making it too weak, 86. Pernicious artifices of the dealers, ibid. Bells, parish, the tolling them for the dead, a dangerous custom, 122. Biles, 447. See Inflammations and Abscesses., Bilious colic, symptoms and treatment of, 262. ------ 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, 276. Bladder, inflammation of, its general causes, 266. Medical treatment of, ibid. -------, stone, in. See Stone. Blast. See Erysipelas. Bleeding, cautions for the operation of, in fevers, 145. In the ague, 149. Its importance in the acute continual fever, 157. lr. the pleurisy, 162. When necessary in an inflammation of the lungs, 166. Caution against, in n ner- vous fever, 191. In the putrid fever, 200. In the miliary fever, 205. When useful in the measles, 219. Under what circumstances proper in the erysi- pelas, 225. Mode of, proper in an inflammation of the brain, 229. Is al- ways necessary in an inflammation of the eyes, 232. When proper, and improper, in a cough, 250. When proper in the chincough, 254. Is almost the only thing to be depended on in an inflammation of the stomach, 257. And in an inflammation of the intestines, 259. Is necessary in an inflamma- tion of the kidneys, 265. Its use in a suppression of urine, 280. Is proper in an asthma, 346. Is dangerous in fainting fits, without due caution, 374. Cautions proper in the puerperal fever, 423. Is an operation generally per- formed by persons who do not understand when it is proper, 444. In what cases it ought to be had recourse to, ibid. The quantity taken away, how to be regulated, 445. General rules for the operation, ibid. Prevailing pro- 630 INDEX. judices relative to bleeding, ibid. The arm the most commodious part to take blood from, 448. Bleeding at the nose, spontaneous, is of more service, where bleeding is neces- sary, than the operation with the lancet, 287. Ought not to be stopped with- out due consideration, ibid. How to slop it when necessary, ibid. Cautions to prevent frequent returns of, 288. Blind persons, when born so, might be educated to employments suited to their capacity, 385. note. "S Blisters, peculiarly advantageous in the nervous fever, 191. When only to be applied in the putrid fever, 198. When proper in the miliary fever, 205. Seldom fail to remove the most obstinate inflammation of the eyes, 233. A good remedy in the quinsy, 242. Proper for a violent chincough, 255. Is one of the best remedies for an inflammation of the stomach, 257. Are effi- cacious in the toothache, 306. Blood, involuntary discharges of, often salutary, and ought not to be rashly stopped, 285. The several kinds of these discharges, with their usual caus- es, ibid. Methods of cure, 286. -----, spitting of, who most subject to, and at what seasons, 292. Its causes, ibid. Symptoms, 293. Proper regimen in, ibid. Medical treatment, 294. Cautions for persons subject to it, ibid. ——-, vomiting of, its causes and symptoms, 295. Medical treatment, ibid. Bloodshot eye, how to cure, 387. Bloody flux. See Dysentery. Boerhaare, his observations on dress, 104. note. His mechanical expedients to relieve an inflammation of the brain, 229. Boluses, general rules for the preparing of, 547. The astringent bolus, ibid. Diaphoretic bolus, ibid. Mercurial bolus, ibid. Bolus of rhubarb and mer- cury, ibid. Pectoral bolus, 548. Purging bolus, ibid. Bones, the exfoliation of, a very slow operation, 452. Bones, broken, often successfully undertaken by ignorant operators, 460. Regimen to be adopt- ed after the accident, 461. Hints of conduct if the patient is confined to his bed, ibid. Cleanliness to be regarded during this confinement, 462. The limb not to be kept continually on the stretch, ibid. Cautions to be observ- ed in setting a bone, ibid. Tight bandages condemned, ibid. How to keep the limb steady by an easy method, 463. Fractures of the ribs, ibid. Bowels, inflammation of. See Sto7naeh. Boys, the military exercise proper for them, 39. Braiduood, Mr., his skill in teaching the dumb to speak, 383. note. Brain, inflammation of, who most liable to it, with its causes, 227. Symptoms, 228. Regimen, 229. Medical treatment, ibid. Bread, proper food for children, as soon as they can chew it, 33. A crust of, the best gumstick, ibid. The best modes of preparing it in food for children, ibid. Good, the qualities of, and for what purpose adulterated by the bakers, 86. Toasted, a decoction of, good to check the vomiting in a cholera mor- bus, 271. A surfeit of, more dangerous than any other food, 512. The finest not always the best adapted for nutrition, 513. Household bread the most wholesome, ibid. Wheat flour apt to occasion constipation, 414. Different kinds of grain make the best bread, ibid. Consumption of bread increased by drinking tea, 515. Indian corn tlie best food when boiled, 518. Buck- wheat highly nutritious, 519. Various substitutes for bread, 521. Brimstone. See Sulphur. Broth, gelatinous, recommended in the dysentery, how to make, 299. Broths and Soups, various ingredients in the composition of, 528. 529. Gene- ral observations on, ibid. The most wholesome diet for tlie poor, ibid. Warmly recommended by Count Rumford, ibid. Brown soup recommend- ed for breakfast in place of tea, 530. Bruises, why of worse consequence than wounds, 452. Proper treatment of, ibid. The exfoliation of injured bones a very slow operation, ibid. How to cure sores occasioned by, ibid. Burdens, heavy, injurious to the lungs, 65. INDEX. 651 Burgundy pitch, a plaster of, between the shoulders, an excellent remedy in a cough, 251. In the chincough, 255. And for children in teething, 437. Bunals, the dangers attending their being allowed in the midst of populous towns, 91. Burns, slight, how to cure, 451. Treatment of, when violent, ibid. Extraor- dinary case of, ibid. Liniment for, 566. Butchers, their professional artifices explained and condemned, 83. Butter ought to be very sparingly given to children, 35. Used in large quanti- ties very injurious to the stomach, having a constant tendency to turn ran- cid, 519. Bread made with butter not easily digested, 521. Pastries of every kind improper for children, ibid. Cabbage leaves, topical application of, in a pleurisy, 163. In dropsy, 322. note. Camphor, why of little use in eye waters, 550. Camphorated oil, preparation of, 567. Camphorated spirit of wine, 579. Camps, the greatest necessity of consulting cleanliness in, 113. Cancer, its different stages described, with the producing causes, 393. bymp- toms 394. Regimen, and medical treatment, 394. 395. Dr. Storck's me- thod of treating this disorder, 395. Cautions for avoiding it, o97. Credul.ty more incurable than cancers, 398. . . Cancer Scroti, a disorder peculiar to chimney sweepers, owing to want ot cleanliness, 111. note. fl„ Carriages, the indulgence of, a sacrifice of health to vanity, yt>. Carrot, wild, recommended in the stone, 283. ------poultice for cancers, how to prepare, 396. ------properly manufactured, may supply the place of bread, 5Z7. Casualties, which apparently put an end to life, necessary cautions respect- ing, 450. 471. 474. 488. ----------substances stopped in the gullet, 467. ----------drowning, 471. ----------noxious vapors, 474. ----------extremity of cold, 476. , £irf T6ffl6 tl6clt 4#8» Cataplasms, the general'intention, 548. Preparation of the discutient cata- plasm, ibid. Ripening cataplasm, ibid. Cataract, the disorder and its proper treatment described, JB7. Cattle, stall fed, are unwholesome food, 82. Overdriven, are killed in a high fever, 83. The artifices of butchers exposed, tbtd. Cellars, long shut, ought to be cautiously opened, 92. And sunk stories of houses, unhealthy to live in, 133. Of liquors, in a state of fermentation, dan- gerous to enter, 475. How to purify the air in, tbtd. Celsus, his rules for the preservation of health, 136. Charcoal fire, the danger of sleeping in the fume of, 474. •Charity, the proper exercise of, 68. Chtese, as a diet, injurious to health, 521. . Cheyne, Dr., his persuasive to the use of exercise, 97. His judgment of the due quantity of urine, not to be relied on, 129. Strongly recommends Ethi- op's mineral in inflammation of the eyes, 234. Chilblains, cause of, 434. How tocure,t&w*. Childbed women, how to be treated-under a miliary fever, 2U5. Childbed fever. See Fever. - ,,.-.„ „„„,. mq Childbirth, the season of, requires due care after the labor pains are over, 419. Medical advice to women in labor, ibid. Ill effects of collecting a number of women on such occasions, 420. note. How to guard against the| miliary fever, 422. Symptoms of the puerperal fever, *M. Proper treatment of this fever, 423. General cautions for women at this season, 4.4. Children, their diseases generally acute, and delay dangerous, 24 Their dis- orders less complicated, and easier cured, than those of adults, 25.Ate often the heirs of the diseases of their parents, tbtd. Those bom of diseased pa- 632 INDEX. rents, require peculiar care in the nursing, 26. Are often killed or deform- ed by injudicious clothing, 27. How treated in Africa, 28. note. The usual causes of deformity in, explained, 29. Their clothes ought to be fastened on with strings, 30. General rules for clothing them, ibid. Cleanliness an important article in their dress, 31. The milk of the mother the most natural food for, ibid. Absurdity of giving them drugs as their first food, 32. The best method of expelling the meconium, ibid. How they ought to be wean- ed from the breast, ibid. A crust of bread the best gumstickfor them, 33. How to prepare bread in their food, ibid. 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, 34. The food of adults improper for children, ibid. Strong liquors expose them to inflamma- tory disorders, ibid. Ill effects of unripe fruit, ibid. Butter, 35. Honey, a wholesome article of food for them, ibid. The importance of exercise to promote their growth and strength, 36. Rules for their exercise, ibid. Po- verty of parents occasions their neglect of children, 37. The utility of exer- cise demonstrated from the organical structure of children, ibid. Philosophi- cal arguments, showing the necessity of exercise, 38. Ought not to be sent to school too soon, ibid. Nor be put too soon to labor, 40. Dancing an excellent exercise for them, 41. The cold baih, ibid. Want of wholesome air destructive to children, 42. To wrap them up close in cradles, perni- cious, 43. Are treated like plants in a hot house, ibid. The usual faulty conduct of nurses pointed out, 44. Are crammed with cordials by indolent nurses, ibid. Eruptions ignorantly treated by nurses, 45. Loose stools, the proper treatment of, ibid. Every method ought to be taken to make them strong and hardy, 46. Injured by drinking thin water fluids, 342. note. Chincough. See Cough. Cholera Morbus, the disorder defined, with its causes and symptoms, 270. Medical treatment, 271. Churches, the several circumstances that render the air in, unwholesome, 91. Churching of women after laying in, a dangerous custom, 425. Church Yards, the bad consequences of having them in large towns, 91. Cities, large, the air in, contaminated by various means, 91. The bad effects of burying the dead in, ibid. Houses ought to be ventilated daily, 92. The danger attending small apartments, ibid. All who can, ought to sleep in the country, 93. Disorders that large towns are peculiarly hurtful to, ibid. Cleanliness not sufficiently attended to in, ibid. Should be supplied with plenty of water, 100. note. The best means to guard against infection in, 115. Cleanliness, an important article of attention in the dress of children, 13. And to sedentary artists, 73. Finery in dress often covers dirt, 104. Is necessary to health, 111. Disorders originating from the want of, ibid. Is not sufficiently attended to in large towns, 112. Nor by country peasants, ibid. Great attention paid to, by the ancient Romans, ibid. note. Neces- sity of consulting cleanliness in camps, 113. Was the principal object of tlie 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, 114. Cleanliness peculiarly necessary on board of ships, ibid. And to the sick, ibid. General remarks on, ibid. Many disorders may be cured by cleanliness alone, 140. The want of, a very general cause of putrid fivers, 194. Is a great preservative against galling in infants, 430. Cuta- neous disorders proceed from a want of, 433. Clothing, the only natural use of, 27. That of children has become a secret art, ibid. Ought to be fastened on infants with strings instead of pins, 30. Pernicious consequences of stays, ibid. Importauce of cleanliness to chill dren, 31. The due quantity of, dictated by the climate, 102. Should be iuciv;i'(.-d iu the decline of life, ibid. And adapted to the season* ibid Is often hurtful by being made subservient to the purposes of vanity 103 Pernicious consequences of attempting to mend the shape by dre« ibid S-lays,iftW. ShocsjtMrf. Garters, buckles, and other bandages. 104. The per- INDEX. 633 Section of, to be easy and clean, ibid. General remarks on, 105. Wet, the dai^erof, and how to guard against it, 131. Clysters, a proper form of, for an inflammation of the stomach, 257. And for an inflammation of the intestines, 258. Of tobacco smoke, its efficacy in procuring a stool, 263. note. Of chicken broth, salutary in the cholera morbus, 271. Their use in suppression of urine, 280. Ought to be fre- quently administered in the puerperal fever, 423. Of tobacco, to excite a vomit, 470. The general intention of, 549. Preparation of the emollient clyster, ibid. Laxative clyster, ibid. Carminative clyster, ibid. Oily clyster, 560. Starch clyster, ibid. Turpentine clyster, ibid. Vinegar clyster, ibid. Coffee Berries, recommended in the stone, 283. Cold, extreme, its effects on the human frame, 476. The sudden application of heat, dangerous in such cases, 177. How to recover frozen or benumbed limbs, ibid. Cold Bath. See Bath. Colds, frequently occasioned by imprudent changes of clothes at the nmap- proaches of summer, 102. note. Various causes of, specified, 130. Their <:eneral causes, 245. Proper regimen on the symptoms of, appearing, 246. Danger of neglecting the disorder, ibid. The chief secret for avoiding, 248. Public gardens, at the close of a hot day, as dangerous as they are inviting, on account of, ibid. Hints to the frequenters of theatres and assemblies, to guard against, ibid. Melancholy case of a young lady, who died of a cold, contracted at an assembly, 249. . Colic, different species of, 260. Medical treatment of, according to their spe- cies and causes, 261. Bilious colic, 262. Hysteric colic, ibid. Nervous colic, 263. Cautions necessary to guard against the nervous colic, 264. General advice in colics, ibid. Collyria. See Eye Waters. Commerce often imports infectious disorders, 117. Means suggested to guard against this danger, ibid. note. Confections often very needlessly compounded, 551. Preparation oi the Japonic confection, ibid. . Conserves and Preserves, general remarks on, and their composition, bbZ. ui red roses, ibid. Of sloes, ibid. Candied orange peel, tbtd. Constitution, good or bad, the foundation of, generally laid during infancy, 21. Consumptions, the increase of this disorder may be attributed to hard drink- ing 109. Who most liable to, and its causes, 167. Symptoms, 168. Ke- eimen, 169. Riding, ibid. Much benefit to be expected from going a long voyage, ibid. Travelling, 170. Diet, ibid. Great efficacy of milk in, ibid. Medical treatment, 173. _____________, nervous, defined, and the persons most liable to, 176. rropec treatment of, ibid. , ,. , , . ., -, symptomatic, the treatment of, must be directed to the pro- ducing cause, 176. Consumption, means of detecting and preventing, 178. Convulsions, why new born infants are so liable to, 30. The general causes of, 440. Proper treatment of, ibid. Extraordinary recovery of an infant seem- in Waters by infusion, how to prepare; Lime water, 581. Compound lime water, ibid. Sublirr ate water, tbid. Styptic water, ibid. Tar water, tbtd. Waters, simple distilled, their medicinal uses, 582. Preparation of cinnamon water, ibid. Pennyroyal water, ibid. Peppermint water, ibid. Spearmint water, ibid. Rose water, ibid. Jamaica pepper water, 5.83. Waters, spirituous distilled, how to prepare ; Spirituous cinnamon water, 583. Spirituous Jamaica pepper water, ibid. Watery eye, how to cure, 388. W'alkinson, Dr.,his dying request, 567. Weaning of children from the breast, the proper mode of, 33. Weather, states of, which produce the putrid fever, 194. Wells, caution to persons going down in them, 92. note. Deep, ought not to be entered till the air in them is purified, 475. Whey, an excellent drink in a dysentery, 300. And in the rheumatism, 330. Orange whey, how to make, 156. Alum whey, 279. 583. Mustard whey, ibid. . Whitloe, cause and treatment of, 447. note. Whyte, Dr., his remedies for flatulencies, 375. Wind. See Flatulencies. Windows, the danger of throwing them open on account of heat, and sitting near them, 135. Wine, good, almost the only medicine necessary in a nervous fever, 190. Sub- stitute for, ibid. note. Wines, the medicinal properties of, 583. Their use in extracting the virtues of medicinal substances, 584. Preparation of anthelminthic wine, ibid. An- timonial wine, ibid. Bitter wine, tbid. Ipecacuanha wine, tbid. Chaly- beate or steel wine, 585. Stomachic wine, tbtd. Womb, inflammation of, its symptoms, 421. Medical treatment of, tbtd. Women, errors in their education pointed out, 23. Why subject to hysterics, 84. Are better adapted to follow sedentary occupations than men, 97. note. In childbed, often die from their apprehensions of death, 121. Their disor- ders rendered epidemic by the force of imagination, tbtd. • Everything that can alarm them to be carefully guarded against, ibid. Evil tendency of toll- ine bells for the dead, tbid. How exposed to a miliary fever during preg- nancy, 202. Their constitutions injured by living too much within doors, 410. Those who work in the open air almost as hardy as men, tbtd. Ad- vice to, with reference to the menstrual discharge 411. At the com- mencement, ibid. Fluor Albus, with its proper treatment, described, 415. 652 INDEX. Advice to, at the ceasing of the menses, 416. Rules of conduct during pregnancy, ibid. Causes and symptoms of abortion, 417. How to guard against abortion, 418. Treatment in cases.of abortion, ibid. Instructions at the time of childbirth, 419. Cause of the milk fever, 421. How to guard against the miliary fever, 422. The puerperal fever, ibid. General cau- tions for women in childbed, 424. Causes of barrenness, 425. Wool, the best external application in the gout, 325. Workhouses poisonous to infants, 42. Worms, how to treat a looseness produced by, 274. Three principal kinds of, distinguished, 311. Causes, 312. Symptoms of, ibid. Medical treatment lor, 313. Remedy for children, 314. General cautions for preserving children from them, 315. Danger of taking quack medicines for them, ibid. note. Parents advised not to feed them with meat, two or three times a day, as the flesh of animals in a state of putrefaction often generates worms, ibid. Wort, recommended for the scurvy, and proper to drink at sea, 335. Is a powerful remedy in cancerous cases, 396. Wounds, are not cured by external applications, 448. Are cured by nature, ibid. Proper course of treatment, tbtd. How to stop the bleeding, tbid. Caution against improper styptics, 449. Method of dressing them, ibid. Poultices for inflamed wounds, 450. Regimen, tbtd. Wr. ■ ng, hints of advice to those who are much employed in, 77. 79. Y. Yellow Fever, mode of treatment in the early stages of, 200. note. Young animals, all exert their organs of motion as soon as they are able, 36. Z. Zinc, the flowers of, a popular remedy for the epilepsy, 366. MAYNARD & NO YES, ©Haitian &ww »»wwi8ff8» NO. 39, WASHINGTON ST&EET....BOSTON, HAVE an extensive assortment of Medicines, of prime quality, for the use of Physicians and Families, which: they will sell on very favorable terras, and put up in the most careful manner. They prepare PRUSSIC ACID for medicinal purposes, which receives the approbation of the Physicians in this^city. It i» m«Uj put up in phials, and will keep a long time without any apparent change. SODA, ROCHELLE, and SEIDLITZ POW°™ a"PJhK»- by them on a large scale, and are put up in various ^{£*e?™m venience of carrying them safely to any climate. ™;"Xfe££f bers, &c. have been in use several years; and, during the' w^eto* have received a uniform and decided pref™« ^™ *ty*£^fted others, who are good judges of the article, in all parts of the unueu States. Surgical Instruments of the various kinds; Cmmoal^ to., and Chemical Agents and Tests are kept constantly on hand. Academies and Schools can be furnished at short notice. M. & N. keep a large supply of Trusses of the most approved construction; particularly of DR. HULL'S PATENT SELFADJUSTING HINGE TRUSS, Kt^th^X. out of the many, that have occurred, will be mentioned. two years, after having been rapped 30 years; (ha( children the cures are almost universal, MAYNARD & NO YES' INK POWDER AND LIQUID INK, Which have gained a high preeminence in the estimation of the pub- lic, may be had of them in any quantity, which may be desired. Their ink is put up in strong bottles, and is well packed in boxes, so that it can be transported by land or water with perfect safety. RECOMMENDATIONS. Register of Deeds'1 Office, Boston, March 30, 1824. Messrs. Maynard & Noyes, Gentlemen.—I have the satisfaction to inform you, that your Ink answers my expectations; and, from the appearance of the Records in my office, I am of opinion, that its quality is very good, and I recommend it as superior to any I have ever used. Very respectfully, &c. HENRY ALLINE. From Mr. John Fisk, Clerk of Superior Court, and Register of Deeds, Mid- dlesex County, Conn. I have used Messrs. Maynard & Noyes' Ink Powder for eighteen months past, and have found .^superior to any I have ever before used, and cheerfully recommend it for general use. JOHN FISK. Middletown, Dec. 30, 1823. From Mr. Belcher, Master of the Public Writing School, in Derne Streeet Boston. Gentlemen.—In reply to your request of my opinion of the Ink Powder manufactured by you, I have only to observe, that from the experience afforded me of its merits, by using it for three years past, I am enabled to say, that it is in every respect superior to all other Ink Powder of which I have any knowledge. m a* vt J. H. BELCHER. Maynard & Noyes. Patriotic Bank, Washington City, April 10 1824. Messrs. Maynard & Noyes, Gentlemen.—For the last year I have been using your Black Ink. I have been much pleased with it, and have noTiesitation in recommending it to all who are desirous of giving permanency to their WntinS'______ O. CARR, dshier I give my testimony with pleasure in favor of Messrs. MavnarH & Noyes'Ink. ANDREW BOYLE? Chief Clerk Gen. Post Office. APOTHECARIES' HALL. NO. 49, MARLBORO' STREET, OPPOSITE MARLBORO' HOTEL—BOSTON* HAVE FOR SALE, An extensive assortment of Drugs, Medicines, Patent Medicines, Surgical and Philosophical Instruments, Chemical Preparations, Glass Wares, Apothecaries' Utensils, &c. &c. Among them are, VERY SUPERIOR, Pinkroot in hhds.—Bales of Peruvian Bark—do. Chamomile Flow- ers—do. Rosemary do.—do. Gentian Root—do. Snakeroot—do. Co- riander Seeds—do. Caraway do.—do. Squills—do. Orange Peel—do. Elder Flowers—do. Curcuma Root—do Phial Corks—do. Augustura Bark—do. Elastic Gum—do. Senna Leaves—do. Seneca Root. Bbls. of Columbo Root—do. Refined Borax—do. Rasped Quassia- do. Rose Pink—do. Dutch Pink—do. Stone Yellow—do. Fenegreek Seeds_do. Crude Antimony—do. True Epsom Salts—do. Glauber Salts—do Powdered Jalap—do. Powdered Curcuma—do. Powdered Peruvian Bark. . Cases of Cardamom Seeds—do. Magnesia—do. Gum Sandarach— do. Gum Camphor. Also—White Wax—Gum Kino—Gum Scammony—Balsam 1 eru —Cowhao-e—China Root—Calomel—Ipicac—Opium—Rhubarb- Red Precfpitate—Oil of Cloves—Oil of Rosemary—Oil of Almonds- Gum Myrrh—Terra Japonica—Otter—Oil of Peppermint—Od of Aniseed—Oil of Succini— Hemlock—Spruce—Wintergreen—Car- bonate of Iron—Musk—Cobalt—Oil of Juniper—Muriate of Gold- Sal Succinni—Yellow Gum—Sang Draconis—Sugar Lead, &c. ac. Spermaceti—Burgundy Pitch—Corrosive Sublimate, &c. m Boxes. Aqua Fortis, and Oil Vitriol in Carbois—Crude Tartar in Barrels- best cold pressed American Castor Oil, in Barrels and Bottles—Bal- sam Capivi, in Barrels, Jars, &c. &c—with a general assortment ot silver wired and common Tooth Brushes—Court Plaster—Issue 1 las- ters—Gowland's Lotion—Windsor Soap—Pearl Dentifrice, inc. &c. PORTABLE HOT BATHS, &c. &c. with every article usually kept in Drug Stores. PHILOSOPHICAL INSTRUMENTS. Thermometers-Leyden Jars-Galvanic Batteries-Camera Ob- scuras-Electrical Pistols-Hydrastatic Apparatus-Electro Magnet- ic Apparatus—Calorimoters—Tantilus Cups, &c. &c. &c. SURGICAL INSTRUMENTS, Pewter Bed Pans and Syringes, in great variety.-Suspensary Girdles, much approved. ■T7* Orders from foreign Markets, or from Drug Dealers and Phy- ^^^neTbeffi^ea I. and'very particnW attention paid to Physicians' prescriptions. ■••*• ' BOOK AND STATIONARY STORE. ^ CORNER OF COURT AND BRATTLE STREETS, BOSTON, OFFERS FOR SALE A large assortment of Quarto and School Bibles, Testa- ments, Spelling Books and Arithmeticks, with all School Books in general use, by the dozen or single, at the lowest prices. j Demy, Foolscap, and Letter Paper ; Writing and Cyphering • "'] Books. Ledgers, Waste, Invoice, Cash and Note Books, made at his own Manufactory, from the best materials. Quills, Ink, and Ink Powder; Inkstands, Wafers, Sealing Wax, &c. Likewise, Seamen's Journals, Navigators and Coast Pilots. Rodgers's Penknives, Razors and Scissors; warranted good. Fine Water Colours ; Indelible Ink for marking Linen, &tc. Thermometers, Cloth, Hair, and Tooth Brushes. Likewise, Day and Martin's Blacking, with every other Article usually found ^in a Stationary Store. NATIONAL LIBRARY OF MEDICINE NLN D1DSDTST 3 NLM010509593