.*»:•:■:•: ARMY MEDICAL LIBRARY FOUNDED 1836 WASHINGTON, D.C DOMESTIC MEDICINE; FAMILY PHYSICIAN: BEING AN ATTEMPT To render the Medical Art mere generally ufeful, by fhetwing people what is in their own power both with re* fped to the Prevention and Cure of £.1 s r a»£5, ''Cfff". CHIEFLY ntion iof\f^t. Calculated to recommend a proper intention to REGIMEN and SIMPLE MEDICINES. By WILLIAM BUCHAN, M. D. Of the Royal College of Phyficians, Edinburgh. Valetudo fuftentatur notitia fui corporis; et obfervatione, qua* res aut pro-* defle foleant, autobefle ; et continentia in viftu oinni atque cultu, corporis tuendi caufa; et praetermittendis voluptatibus, &c. Cic. de OtEc. Optimum vero medicamentum eft, opportune cibus datus. Celf. de Med. The SECOND AMERICAN EDITION, with confiderable Additions, by the Author. PHILADELPHIA: Printed by Joseph Crukshank, for R. Aitken, at his Book-Stort, oppofite the London Coffee-House, in Front-Street, M.pcc.Lxxiy. *-* ^/^0r*t^^*~ zz t O Sir JOHN PRINGLE, Bart*1 PHYSICIAN TO HER MAJESTt; r ^ GEN?. r;,x\ SIR, TH E character which you" juftly fufc tain in the literary world, your laud- able and fuccefsful endeavours to ex- tend and improve the art of medicine, |he confidence repofed in your fkill by the pub- lic, and the important flation you hold iri the care of the Royal Family, all cohfpiref to point you out as tne moll proper Pa- tron of a Performance which has for its ob- ject the He a l t h of the inhabitants of Great- Britain, ThBSIj iv ft DEDICATION. These^ Sir, were the motives which in-, k duced me to dedicate to you the following t: meets. I wifh they were more worthy of your acceptance ; but, fuch as they are, I freely fubmit them to your candour, and make no doubt of meeting with that indul- gence which is inseparable from great abili- ties. \ That you may long continue an orna- ment to Society, and an honour to the Me- dical Profefhon, is the fincere wifh of, SIR, Your mofl obedient, Humble Servant, Edinburgli, ,....- June 4, 1772. WILLIAM BUCHAN, f PREFACE. WHEN 1 firrt fignified my Intention of publifhing the following fheets, I was told by my friends it would draw on me the refentment of the whole Faculty. As I never could entertain fuch an unworthy idea of phyficians, I was re- folved to make the experiment, which indeed came out pretty much as might have been expeded. By the more felfifh and narrow-minded part of the Faculty, the performance was condemned ; while many of thofe, whofe learning and libera- lity of fentiments do honour to medicine, received It in a manner which at once fhewed their indulgence, and'the falf- hood of the common opinion, that all phyficians nuijf) to conceal their art. Th t reception which the book met with from the public was ftill more flattering, and deferves my molt grateful ac- knowledgments. A perfuafion that fuch a performance might be ufeful, and was even wifhed for by the public, encouraged me to print a large impreffion ; but my moil fanguine expec- tations could never have fuggefted that above five thoufand copies would have been fold in a corner of Britain before an- other edition could be got ready. A sense of gratitude, which public approbation feldom fails to infpire, induced me to beftow fome pains to make the book more generally ufeful, by enlarging the Prophylaxis, or that part which treats of preventing difeafes, and likewife add- ing feveral difeafes which were entirely omitted in the former impreffion. This inevitably retarded the publication of the fecond Edition, and has likewife drawn it out to a greater length than could have been wifhed ; but thefe inconveniences will, I hope, be excufed, as the book is certainly rendered "fs incomplete. The obfervations relative to Nurfing and the Management '■■ Children, were chiefly fuggefted by an extenfive pradice ■lorrr infants, in a large branch of the Foundling-Hofpital, ""I had an opportunity not only of treating the difeafes incident vi PREFACE. incident to Childhood, but likewife of trying different plans of nurfing, and obferving their effeds. Whenever I had ic In my power to place the children under the care of proper nurfes, to inftrud thefe nurfes in their duty, and to be fatisfi- ed that they performed it, very few of them died ; but when, from diftance of place, and other unavoidable circumftances, the children were left to the fdle care of mercenary nurfes, without any one to inftrdd or fuperintend them, fcarce any of them lived. This was fo apparent as, with me, to amount to a proof of the following melancholy fad : That almofl me half of the hitman fpedes perifih in infancy, by riegleft or improper management. This reflection has made me often wifh to be the happy inftrti- ment of alleviating the miferies of thofe fuffering innocents* br of refcuing them from an untimely grave. With this view I had colleded fome obfervations on the public and private means of preferving the lives of children 5 but nrit being able, bn account of neceffary avocations, to prepare tfyem tor the public eye, was obliged to confine myfelf in a great meafure to my former obfervations on this fubjed*. I hope, however, even thefe may be of ufe ; and if ever an opportunity offers of treating the fubjed at more length, I fhall moft heartily em- brace it. . The application of medicine to the various occupations of life was likewife chiefly the refult of obfervatibn. An exten- five pradice for feveral years, in one of the largeft manufac- turing towns in England, afforded me fufficient opportunities of obferving the injuries which thofe ufeful people fuftain from their particular employments, and likewife of trying various methods of obviating fuch injuries. The fuccefs which at- tended thefe trials was fufficient to encourage this attempt, which we hope will be of ufe to thofe who are under the ne- ceffity of earning their bread by fuch employments as are un- favourable to health. We do not mean to Intimidate men,, far iefs to inflnuate that even thofe arts, the pradice of which is attended with fome degree of danger, fhould not be carried on ; but to guard the lefs cautious and unwary again ft thofe dangers which they have it their power to avoid, and which they of- ten, tnrough mere fool-hardinefs, incur. As every occupati- tion in life difpofe* »h*ife who follow it to fome particular di.f- % ., eafes - ■ V ■«!» * Moft of the 1,. s contained in the Firft fl oter were made in the Foundling-Hofp ' ' > jkworth ; and were communicated to the Pub- lic, ahove a dozen yt • On a fmall pamphlet addreflid by the Afctotfr to the Governors ofthat ii'ofpiul. PREFACE. vii cafes more than to others, It is certainly of importance to know thefe, in order that people may be upon their guard againft them. It is always better to be warned of the ap- proach of an enemy than to be furprifed by him, efpecially where there Is ad the patient, by purfuing a wrong plan of regimen. >• y defeats the dodor's endea^e*?s, but renders their; O^ous, I have often known patients killed by an error u'; ;:)i#ien, when they Were ufmg very proper medicines. It wU be faid, the phyi- fician viii PREFACE. fician always orders the regimen when he prefcribes a medi- cine. I wifh it were fo, both for the honour of the Faculty and the fafety of their patients : but phyficians, as well as other people, are too little attentive to this matter. Though many reckon it doubtful whether medicines are more beneficial or hurtful to mankind, yet all agree in allow- ing the necefTny and importance of a proper regimen in dif- eafes. Indeed the very appetites of the fick prove its propri- ety. No man in his fenfes ever imagined that a perfon in a fever, for example, could eat, drink, or condud himfelf in the fame manner as one in perfed health. This part of medicine, therefore, is evidently founded in Nature, and is every way confident with reafon and .common ienie. Had men been more attentive \o it, and lefs fblicitous in hunting after fecret remedies, Medicine had never become an objed of ridicule. Indeed this feems to have been the firftidea of medicine. The ancient phyficians aded chiefly in the charader of nurfes. They went very litae beyond aliment in their prelcriptions ; and even this they generally adminiltered themfelves, attend- ing the fick, for that purpofe, through the whole courfe of the difeafe ; which gave them an opportunity not only of marking the changes of difeafes with great accuracy, but like- wife of obferving the effeds of their different applications, and adapting them to the fymptoms. Th e learned Dr. Arbuthnot afferts, that by a proper at- tention to thofe things which are almoft within the reach of every body, more good and lefs mifchief will be done in acute difeafes than by medicines improperly and unfeafonably ad- miniftered ; and that great cures may be efFeded in clironical diftempers, by a proper regimen of the diet only. So entire- ly do the Dodor's fentiments agree with mine, that I would advife every perfon ignorant of phyfic, to confine his pradice folely to diet, and the other parts of regimen ; by which means he may often do much good, and can feldom do any hurt. To render the book more generally ufeful, however, as Well as more acceptable to the intelligent.part of mankind, I have, in moft difeafes, befides regimen, recommended fome of the moft firnple and approved forms of medicine, and add- ed fuch cautions and diredions as feemed neceffary for their fafe adminiuration. No doubt it would have been more ac- ceptable to many, had it abounded with pompous prefcrip- tions, and promifed great cures in confequence of their ufe ; Lur this was not my plan: I think the adminiftration of me- dicines PREFACE; ix dielnes always doubtful, and often dangerous, and would much rather teach men how to avoid the neceflity of ufing them, than how they fliould be ufed. There are, however, feveral medicines, and thofe of con- fiderable efficacy, which may be adminiftered with great free- dom, and at the fame rime with fafety. Phyficians generally trifle a long time with medicines, before they come to know how to ufe them. Many peafants at prefent know better how to ufe fome of the moft important articles in the materia medica, than phyficians did a century ago ; and doubtlefs the fame: observation will hold with regard to others fome time hence, Wherever we were convinced that medicine might be ufed with fafrry, or whe^e the cure depended chiefly upon it, we have taken care to recommend it* but where it was either highly dangerous, or not very neceffary, it is omitted. 1 have not troubled the Reader with an ufelefs parade of quotations from different authors ; but have nevertheJefs made life of their obfervations where mv own were either defedive* or totally wanting. Thofe 10 whom I have heen moft obliged were, Ramazini, Arbuthnot, Brookes, Cheyne, Mackenzie, and TifTot; the laft of which, in his Avis au Peuple, comes the neareft to my plan of any author which I have feeni. I had indeed concerted, and even executed, a great part of my de- fign before the Dodor's book appeared in this country, other- wife mine had probably never feen the light. Had Dr. Tiffot's plan been as complete as the execution is mafterly, we fliould have had no occafion for any new treatife of this kind foon ; but by confining himfelf to the acute difeafes, he has, in my opinion, left out the moft ufeful part of his fubjed. People in acut as the Baron Van Sweiten, phyfician to their Imperial Majefties, M. Rofen, firft phyfi- cian of the kingdom of Sweden, &c.; but as thefe gentle- men's produdions have never come to my hand, I can fay nothing concerning them. I cannot help wifhing, however, that fome of our diftinguifhed countrymen would follow their b example. x PREFACE. example. There ftill remains much to be done on this fubjetf, and it does not appear to me how any man could better em- ploy his time or taients, "than in eradicating hurtful prejudices, and diffufing ufeful knowledge among the people. 1 know fome of the Faculty difapprove of every attempt of this nature, imagining that it would totally deltroy their influence. But this notion appears to me to be as abfurd as it is illiberal. People in diftrefs will always apply for relief to men of fuperior abilities, when they have it in their power • and they will do this with far greater confidence and readi- nefs when they believe that Medicine is a rational fcience, than when they take it to be only a matter of mere conjedure. I am far, however, from flaming any men.becaufe he differs in opinion from me. Every man has certainly a right to think and ad in thefe matters as he pleafes, nor fhall any one ever be able to draw me into .a difpute upon this fubjed. All I fhall fay with regard to the following Treatife is that I have endeavoured to make it plain and ufeful, and as accurate as my neceffary avocations would permit. The lan- guage indeed is far from being fo corred as I could have wifhi ed ; but where Utility is the aim, even critics are feldom dif- pofed to cenfure an author for a few inaccuracies of ftyle. Such as read the book with a view to this kind of criticifmj will find matter enough, and I fhall be far from defpifing their obfervations ; but, as I would ftill wifh to render the Per- formance more generally ufeful, I fhall e(teem every man my friend who will be fo kind as to point out any thing that may contribute to that purpofe. It was impoffible to avoid fome terms of art; but fuch as are made ufe of are, in general, either explained, or are fuch as moft people underftand. In fhort, I have endeavoured to write down to the capacities of mankind in general ; and, if my Readers do not flatter either themfelves or me, with fome degree of fuccefs. This, however, on a medical fubjed, is not fuch an eafy matter as fome may imagine. It is eafier to make a fho.v of learning than to write plain fenfe, efpecially in a fcience which has been kept at fuch a diftance from com- mon obfervation. It would, however, be no difficult matter to prove, that every thing valuable in the pradical part of Medicine is withm the reach of common fenfe, and that the Art would lofe nothing by being ftripped of all that any per- fon endued with ordinary abilities cannot comprehend INTRODUCTION. f TH E improvements In Medicine, fince the revival o£ learning, have by no means kept pace with thofe of the other arts. The reafon is obvious Medicine has been ftu- died by few, except thofe who intended to live by it as a trade. Such, either from a miftaken zeal for the honour of Medicine, or to raife their own importance, have endeavoured to dif- guife and conceal the art. Medical authors have generally written in a foreign language ; and thofe who were unequal to this tjafk, have even valued themfelves upon couching, at leaft, their prefcriptions, in terms and charadeis unintellible to the reft of mankind. The contentions of the clergy, which happened foon after the reftoration of learning, engaged the attention of mankind, and paved the way for that freedom of thought and inquiry which has fince prevailed in moft parts of Europe with regard to religious matters. Every man took a fide in thofe bloody difputes ; and every gentleman, that he might diftinguifh hlmfelf on one fide or other, was inftruded in divinity. This taught men to think and reafon for themfelves in matters of religion, and at laft totally deftroyed that complete and abfo- lute dominion which the clergy had obtained over the minds of men. The ftudy of law has likewife, In moft civilized nations, been juftly deemed a neceffary part of the education of a gen- tleman. Every gentleman ought certainly to know at leaft the laws of his own country : and, if he were alfo acquainted ■with thofe of others, it might be more than barely an orna- ment to him. The different branches of Philofophy have likewife of late been very univerfally ftudied by all who pretended to a liberal education. The advantages of this are manifeft. It frees the mind from prejudice and fuperftition ; fits It for the inveftiga- tion of truth j induces habits of reasoning and judging pro- perly ; rfi INTRODUCTION, perly ; opens an inexhauftible fource of entertainment; pave? the way to the improvement of arts and agriculture; and qualifies men for ading with propriety in the moft important ftations of life. . Natural History has alfo of late become an objed of general attention. And it well deferves to be fo. Here the ufeful and agreeable are moft intimately conneded. Medi- cine, however, has not, fo far as we know, in any country, been reckoned a neceffary part of the education of a gentle- man. But furely no fufficient reafon can be affigned tor this omiffion. No fcience lays open a more extenfive field of ufe- ful knowledge, or affords more ample entertainment to an in- quifitive mind. Anatomy, Botany, Chymiftry, and the Ma- teria Medica are all branches of Natural Hftory, and are fraught with fuch delight and ufefulnefs, that the man who entirely negleds them has but a forry claim cither to tafte or learning. ' It a gentleman has a turn for obfervation, fays an elegant and fenfible writer*, furely the'natural hiftory of his own fpecies is a more interesting fubjed, and preients a more ample field for the exertion of genius, than the natural hif- tory of fpiders and cockle fhells. We do not mean that every man fhould become a phyfici- an. This would be an attempt as ridiculous as it is impofS- ble. All we plead for is, that men of fenfe and learning fhould be fo far acquainted with the general principles of Medicine, as to be in a condition to derive from it fome of thofe advantages with which it is fraught; and at the fame time to guard themfelves againft the deftrudive influences of Ignorance, Superftition, and Qunckery. As matters Hand at prefent, it is eafier to cheat a man out of his life than of a fhilling, and almoft impoflible either to deted or punifh the offence. Notwithstanding this, people ftill fhut their eyes, and take every thing upon truft that is adminiftered by any pretender to medicine, without daring to afk him a reafon for any part of his condud. Implicit faith, every where elfe the objed of ridicule, is ftill facred here. Many of the Faculty are no doubt worthy of all the confi- dence that can be repofed in them ; but as this can never be the charader of every individual in any profeflion, it would certainly be for the fafety, as well as the honour of mankind, to have fome check upon the condud of thofe to whom they intruft fo valuable a treafure as Health. The veil of myftery which ftill hangs over Medicine, ren- ders it not only a conjedural, but even a fufpicious art. This has * Obfervations on the Duties and Offices of a Phyfician. INTRODUCTION. xiii has been long ago removed from the other fciences, 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 fecure the general efteem of mankind. Its precepts are fuch as every wife man would chufe to obferve, and it forbids' nothing but what is incompatible with true happinefs. Disguising Medicine not only retards its improvement as a fcience, but expofes the profeffion to ridicule, and is injuri- ous to the true interefts of fociety. An art founded on ob- fervation never can arrive at any high degree of improvement, »s long as it is confined to a few who make a trade of it. The united obfervations of all the ingenious and fenfible part of mankind, would do more in a few years towards the im- provement of Medicine, than thofe of the Faculty alone In a great many. Any man can tell when a medicine gives him cafe as well as a phyfician, and if he only knows the name and dofe of the medicine, and the name of the difeafe, it is fufficient to perpetuate the fad. Yet the man who adds one fingle fad to the ftock of medical obfervations, does more real fervice to the art, than he who writes a volume in fup- port of fome favourite hypothefis. Very few of the valuable difcoveries in Medicine have been made by phyficians. They have, in general, either been the effed of chance or of neceffity, and have been ufually oppofed by the Faculty till every body elfe was convinced of their importance. An implicit faith in the opinions of teachers, an attachment to fyftems and eftablifhed forms, and the dread o£ refledions, will always operate upon thofe who follow Medi- cine as a trade. Few Improvements are to be expeded from a man who might ruin his charader and family by even the fmalleft deviation from an eftablifhed rule. If men of letters, fays the author of the performance quoted above, were to claim their right of enquiry into a matter that fo nearly concerns them, the good effeds on Me- dicine would foon appear. Such men would have no feperate intereft from that of the art. They would deted and expofe afTuming Ignorance under the mafk of Gravity and Impor- tance, and'would be the judges and patrons of modeft merit. Not having their underftandings perverted in their youth by falfe theories, unawed by authority, and unbiaffed by intereft, they would canvafs with freedom the moft univerfally receiv- ed principles in Medicine, and expofe the uncertainty of many of thofe dodrines, of which a phyfician dares not fo much as feem to doubt, jdv INTRODUCTION. No argument, continues he, can be brought againft laying open Medicine, which does not apply with equal, if not great- er force, to religion ; yet experience has fhewn, that fince the laity have afferted their right of enquiry into thefe fubjeds, Theology, confidered as a fcience, has been improved, the intereftsof real religion have been promoted, and the clergy have become a more learned, a more ufeful, and a more refpedable body of men, than they ever were in the days of their greateft power and fplendor. Had other medical writers been as honeft as this gentleman, the art had been upon a very different footing at this day. Moft of them extol the merit of thofe men who brought Philo- fophy out of the fchools, and made it the fcience of mankind. But they never confider that Medicine at prefent is in nearly the fame fituation as Philofophy was at that time, and that it might be as much improved by being treated in the fame man- ner. Indeed, no fcience can either be rendered rational or ufeful, but by being fubmitted to the common fenfe and rea- fon of mankind. Thefe alone (lamp a value upon fcience; and what will not bear the teft of-thefe, ought to be rejeded. I know it will be faid, that diffufing medical knowledge among the people, might induce them to tamper with medi- cine, and to truft to their own fkill inftead of calling a phyfi- cian. The reverfe of this, however, is true. Perfons who have moft knowledge in thefe matters, are commonly moft ready both to afk and follow advice, when it is neceffary. The ignorant are always moft apt to tamper with Medicine, and have the leaft confidence in phyficians. Inftances of this are daily to be met with among the ignorant peafants, who, while they abfolutely refufe to take a medicine which has been prefcribed by a phyfician, will fwallow, with greedinefs, any thing that is recommended to them by their credulous neigh- bours. Where men will ad even without knowledge, it is certainly more rational to afford them all the light we can, £han to leave them intirely in the dark. It will alfo be alledged, that laying Medicine more open to mankind would lefTen their faith in it. This would indeed be the cafe with regard to fome individuals ; but it would have a quite contrary effed upon others. I know many peo- ple who have the utmoft dread and horror of every thing prefcribed by a phyfician, but who will, neverthelefs, very readily take a medicine which they know, and whofe qualities they are in fome meafure acquainted with. Hence it is evi- dent, that the dread arifes from the dodor, not from the drug. Nothing ever can or will infpire mankind with an ab- folute INTRODUCTION. xv folute confidence in phyficians, but an open, frank, and un* difguifed behaviour. As long as the leaft fhadow of myftery remains in the condud of the Faculty, doubts, jealoufies, and fufpicions will arife in the minds of men. No doubt, cafes will fometimes occur, where a prudent phyfician may find it expedient to difguife a medicine. The whims and humours of men muft be regarded by thofe who mean to do them fervice ; but this can never affed the general argument in favour of candor and opennefs. A man might as well alledge, becaufe there are knaves and fools in the world, that he ought to take every one he meets for fuch, and to treat him accordingly. A fenfible phyfician will al- ways know where difguife is neceffary ; but it ought never to appear on the face of his general condud. The appearance of myftery in the condud of phyficians not only renders their art fufpicious, but lays the foundations of quackery, which is the very difgrace of Medicine. No two charaders can be more different than that of the honeft phy- fician and the quack ; yet they have generally been very much confounded. The line betwixt them is not fufficiently appa- rent ; at leaft it is too fine for the general eye. Few perfons are able to diftinguifh fufficiently between the condud of that man who adminifters a fecret medicine, and him who writes a prescription in myftical charaders and an unknown tongue. Thus the condud of the real phyfician, which needs no dif- guife, gives a fandion to that of the villain, whofe whole fuc- cefs depends upon fecrecy. No laws will ever be able to prevent quackery, as long as people believe that the quack is as honeft a man, and as well qualified as the phyfician. A very fmall degree of medical knowledge, however, would be fufficient to break this fpell; and nothing elfe can effedually undeceive them. It is the ig- norance and credulity of the multitude, with regard to medi- cine, which renders them fuch an eafy prey to every one who has the hardinefs to attack them on this quarter. Nor can the eVil be remedied by any other means but by making them wifer. Indeed, the moft effedual way to deftroy quackery in any art or fcience, is to diffufe the knowledge of it among mankind. Did phyficians write their prefcriptions in the common language of the country, and explain their intentions to the patient, as far as he could underftand them ; it would enable him to know when the medicine had the intended effed ; would infpire him with abfolute confidence in the phy- fician ; and would make him dread and deteft every^man who pretended to cram a fecret medicine down his throat. * Men, sri INTRODUCTION. Mbn, In the different ftates of fociety, have very different views of the fame objed. Some time age it was the pradice of this country for every perfon to fay his prayers in Latin, whether he knew any thing of that language or not. This condud, though facred in the eyes of our anceftors, appears ridiculous enough to us ; and doubtlefs fome parts of ours will feem as ftrange to pofterity. Among thefe we may reck- on the prelent mode of medical prescription ; and may ven- ture to affirm, that fome time hence, it will appear to have been completely ridiculous, and a very high burlefque upon the common fenfe of mankind. But this pradice is not only ridiculous, it is likewife dan- gerous. However capable phyficians may be of writing Latin, I am certain apothecaries are not always able to read it, and that dangerous miftakes, in confequence of this, often happen. But fuppofe the apothecary ever fo capable to read the phyfi- cian's prefcription, he is generally otherwife employed, and the bufinefs of making up prefcriptions Is left entirely to the apprentice. By this means the greateft man in the kingdom, even when he employs a firft rate phyfician, in fad truftshis life in the hands of an idle boy, who has not only the chance of being very ignorant, but likewife giddy and carelefs. Miftakes will fometimes happen in fpite of the greateft care • but, where human lives are concerned, all poffible methods ought certainly to be taken to prevent them. For this reafon the prefcriptions of phyficians, inftead of being couched in myftical charaders and a foreign language, ought, in my humble opinion, to be conceived in the moft plain and obvious terms imaginable, Diffusing medical knowledge among the people would not only tend to improve the art, and to banifh quackery, but likewife to render Medicine more univerfally ufeful, by ex- tending its benefits to fociety. However long Medicine may have been known in this country, we will venture to fav that many of its moft important purpofes have either been'over- looked, or very little attended to. The cure of difeafes is doubtlefs a matter of great importance ; but the prefervation of nealth is of ftill greater. This is the concern of every man, and furely what relates to it ought to be rendered as plain and obvious to all as poffible. It is not to be fuppofed, that men can be fufficiently upon their guard againft difeafes, Who are totally ignorant of their caufes Neither can the le- giflature, m whole power it is to do much more for preferving the public health than can ever be done by the Faculty, exert that INTRODUCTION. xvii that power with propriety, and to the greateft advantage* without fome degree of medical knowledge. Indeed, men of every occupation and condition in life might avail themfelves of a degree of medical knowledge ; as it would teach them to avoid the dangers peculiar to their refpedive ftations ; which is always eafier than to remove their effeds. Medical knowledge, inftead of being a check upon the enjoyments of life, only teaches men how to make the moft of them. It has indeed been faid, that to live medically it to live miferably : But it might with equal propriety be faid^ that to live reafonably is to live miferably. If phyficians ob- trude their own ridiculous whims upon mankind, or lav down1 rules inconfiftent with reafon or common fenfe, no doubt they will be defpifed : But this is not the fault of Medicine. It propofes no rules that I know, but fuch as are perfedly con- fiftent with the true enjoyment of life, and every way condu- cive to the real happinefs of mankind. We are forry indeed to obferve, that Medicine has hither- to hardly been confidered a popular fcience, but as a branch of knowledge folely confined to a particular fet of men, while all the reft have been taught, not only to negled, but even to dread and defpife it. It will however appear, upon a more ftrid examination, that no fcience better deferves their atten- tion, or is more capable of being rendered generally ufeful. People are told that, if they dip the leaft into medical know- ledge, it will render them fanciful, and make them believe they have got every difeafe of which they read. Perhaps this may be the cafe with thofe who are fanciful before-hand. But fuppofe it were fo with others, they muft foon be un- deceived. A ihort time will fhew them their error, and a lit- tle more reading will infallibly corred it. A fingle inftance will f-hew the abfurdity of this notion. A fenfible lady, rather than read a medical performance, which would Inftrud her in the management of her children, muft leave them entirely to the care and condud of the moft ignorant, credulous, and fuperftitlous part of the human fpecies. Indeed, no part of Medicine is of more general importance than that which relates to the nurfing and management of children. Yet few parents pay a proper attention to it. They leave the fole care of their tender offspring, at the very time when care and attention are moft neceffary, to hirelings, who are either too carelefs to do their duty, or too ignorant to know it. We will venture to affirm, that more human lives are loft by the careleffnefs and inattention of parents and nur- fes; than are faved by the Faculty ; and that the joint and c well-" xtm INTRODUCTION. well-condtf&ed endeavours, both of private perfons and th« public, for vne prefervation of infant lives, would be of more advantage to tbeiety, than the whole art of Mediciae, upon its prefent footing. The benefits of medicine, as a trade, will ever be confined to thofe who are able to pay for them, and of courfe the far greater part of mankind will be every where deprived of them. Phyficians, like other people, muft live by their employment, and the poor muft either want advice altogether, or take up with that which is worfe than none. There are not, how- ever, any where wanting well- difpofed people, of better fenfe, who are willing to fupply the defed of medical advice to the poor, did not th&ir fear of doing ill often fupprefs their incli- nation to do good. Such people are often deterred from the moft noble and praife-worthy adions, by the foolifh alarms founded in their ears by a let of men, who, to magnify their own importance, magnify the difficulties of doing good, find fault with what is truly commendable, and fleer at every at- tempt to relieve the fick which is not conduded by the precife rules of Medicine. Thefe gentlemen muft however excufe me for faying, that I have often known fuch well-difpofed perfoas do much good; and that their pradice, which is generally the refult of good fenfe and observation, affifted by a little medical reading, is frequently more rational than that of the ignorant retainer to phyfic, who, while he is dofing his. pati- ent with medicine, according to the rules of art, often ne- gleds other tilings of far greater importance. Many things are neceffary for the-fick befides medicine. Nor is the perfon who takes care to procure thofe for them* of lefs importance than a phyfician. The poor oftener periflj in difeafes for want of proper nurfing than of medicine. They are frequently in want of even the neceffaries of life, and ftill more fo of what is proper for a fick-bed : no one can imagine, who has not been a witnefs of thefe fituations, how much ood a well-difpofed perfon may do, by only taking cafe to ave fuch wants fuppbed. There certainly cannot be a more neceffary, a more noble, or a more godlike adion than to ad- rainifter to the wants of our fellow-men in diftrefs. While virtue or religion are known among mankind, this condud will be approved ; and while Heaven is juft, it mtift be re- warded ! Persons who do not chufe to adminifter medicine to the fick, may ntven helefs dired their regimen. A very great medical author has faid. That by diet alone all the intentions o^Medk-'r.e, may be .i7\[. e> ..J. No donM a great many of INTRODUCTION, rix them may ; but there are other things, befides diet, which ought, by no means to be negleded. Many hurtful and de- ftrudive prejudices, with regard to the treatment of the fick, ftill prevail among the people, which perfons of better fenfe and learning alone can eradicate. To guard the poor againft the influence of thefe prejudices, and to inftil into their minds fome juit ideas of the importance of proper food, frefh air, cleanlinefs, and other pieces of regimen neceffary in difeafes, would be a work of great merit, and produdive of many hap- py confequences. A proper regimen, in moft difeafes, is at leaft equal to medicine, and in many of them it is greatly fuperior. To affift the well-meant endeavours of the humane and be- nevolent in relieving diftrefs ; to eradicate dangerous and hurtful prejudices ; to guard the ignorant and credulous againft the frauds and impofitions of quacks and impoftors ; and to fhow men what is in their own power, both with regard to the prevention and cure of difeafes, are certainly objeds worthy of the phyfician's attention. Thefe were the leading views in compofing and publifhing the following fheets. They were fuggefted by an attention to the condud of mankind, with regard to Medicine, In the courfe of a pretty long prac- tice in different parts of this ifland, during which the Author has often had occafion to wifh that his patients^ or thofe about them, had been pofTefTed of fome fuch plain diredory for re- gulating their condud. How far he has fucceeded in his en- deavours to fupply this daficiency, muft be left for others to determine ; but if they be found to contribute, in any mea- fure, towards alleviating the calamities of mankind, he will think his labour very well bellowed. CONTENTS, PART I. ©f General Caufes of Dif- eafes. c h a p. i. f\ F Children Page i V^/ —Difeafed Parents c -—Cloathing of Children 7 -—Food u <—Exercife 16 —Air 23 ■^-Nurfes 34 CHAP. II. Of Artificers, &c. 27 i—the Laborious 29 —the Sedentary 3? —-the Studious 40 CHAP. III. Of Aliment 45 CHAP. IV. Of Air 55 C H A P. V. Of Exercife 59 CHAP. VI. Of Sleep and Cloathing 64 CHAP. VII. Of Intemperance 68 CHAP. VIII. Of Cleanlinefs 73 CHAP. IX. Of Infedion 78 CHAP. X. Of the Paffions 82 —Anger ib. ■—Fear 83 —Grief 86 —Love 87 —-Religious Melancholy 88 CHAP. XI. Of the Cuftomary Evacuations Page 89 —Stool 90 1— Urine 91 —Perfpiration 93 -—being affeded by Changes in the Atmofphere ib. —Wet Cloaths 94 —Wet Feet ib. —Night Air • ib. —Damp Beds 95 —Damp Houfes 96 —Sudden Tranfitions from Heat to Cold ib. PART II. Of Difeafes 99 CHAP. XII, General Obfervations ib. CHAP. XIII. Of Fevers uVgeneral 103 CHAP. xiv. Of Intermitting Fevers or Agues 108 CHAP. xv. Of an Acute Continual Fever - 115 CHAP. XVI. Of the Pleurify - 120 —the Baftard Pleurify 126 —the Paraphrenias - ib. CHAP. XVII. '^S Inflammation of the Lungs 127 CHAP. XVIII. Confumptipns - 129 xsii C O N T CHAP. XIX. Slow or Nervous Fever Page 140 CHAP. xx. Malignant, Putrid or Spotted Fever- - - 146 CHAP. XXI. Miliary Fever - 153 CHAP. XXII, Remitting Fever - 158 CHAP, xx j 11. The Smallpox - 161 Indrulaiion - 771 CHAP. XXIV. The Meafles - - »8i -•---Scarier Fever - 185 ----Bilious Fever - 186 CHAP. XXV. St. Anthony's Fire - 187 chap, xx vj, Inflammation of the Brain 19a CHAP, xxvi 1. Inflammation of the Eyes 195 C H A p. XXVIII. The Qninfey - 200 Malignant Ditto - 206 CHAP. XXIX. Colds and Coughs 209 A Common Cough - 212 Hooping Cough - 216 c H A PW XXX. fnfhmmation of the Stomach 219 ------------of the Inteftines 221 Of the Colic - 225 JOil intimation of the Kidnies 229. .----------of the Bladder 232 _---_-----oftheLiver233 HAP. xxxi. C holera Morbus, and \ceffive Difchargej, fr he Stomach and E N T S. Of a Diarrhoea or Loofenefs Page 237 —Vomiting - - 240 chap- XXXII. Diforders of the Kidnies and Bladder - - 243 Of the Diabetes, or Exceffive Difcharge of Urine ib. «—a Suppreffion of ditto 246' —the Gravel and Stone 247 chap, xxxiii. Involuntary Difcharges of Blood * - 250 Bleeding at the Nofe 253 Bleeding Piles - 255 Blind ditto - - 256 Spitting of Blood 25:7 Vomiting of ditto 26q Bloody Urine - 261 ------Flux - - 263 chap, xxxi v. Of the Head-ach - 26$ ------Tooth-ach - 272 -----e-Ear-ach - 275 ■-----Pain of the Stomach 276 chap. xxxv. Of Worms - - 278 chap, xxxvi. Of the Jaundice - 283 chap xxxvii. Of the Dropfy - 286 CHAP. XXXVI1I. , Of the Gout - - 29Q — the Rheumatifm 29$ CHAP, xxxix. Of the Scurvy - 299 -.-----King's evil - 301 1------Itch - - 305 CHAP. XI. OftheAfthma - 308 CHAP. XLI. Of the Apoplexy - 314 chap. xlii. OfCoftivenefs - 314 -^Want of Appetite 3^ ^ C O N T Of the Heart-burn Page 317 CHAP, xliii. Of Nervous Difeafes 318 «—Melancholy - 323 —the Palfy - - 326 -—the Epilepfy, or Falling Sicknefs - - 3 28 —the Hiccup - 331 ^—Cramp of the Stomach 333 —the Night-mare 333 -—Swoonings - 334 —Hyfteric and Hypochon- driac Affedions - 336 chap. xnv. OfPoifons - - 339 >—Mineral Poifons - 340 —Vegetable Poifons 342 Bites of poifonoUs Animals 343 of the mad Dog ib. ——of the Viper - 349 «---of the Rattle-fnake 351 chap. xlv. Diforders of the Senfes 352 *--------of the Eye ib. The Gutta Serena - 3^4 The Catarad - ib. Short- Sightednefs 3 5 j Seeing only at too great Dii- tance - - ib. Squinting - - ib. Specks on the Eyes ib. Bloodfhot Eye - ib. Watery Eye - - lb. Of the Ear*. - - 356 ----Tafte and Smell 358 ----Touch - 360 CHAP. XLVI. Of Scirrhous and Cancer 361 CHAP. XLVI I. Of the Venereal Difeafe 365 ------Virulent Gonorrhoea 367 —Gleets - - 374 ^-Swelled Tcfticle - 376 —Bubot* - 3 7 7 £ N ? S. it IN 1 S, Of Chancres - S7A'.. 373 —a Confirmed Lues or Pox 33i CHAP. XLVI! 1. Difeafes of Women 390 Of the Menftrual Difcr large 391 —Pregnancy - 396 -Child-birth 399 —Barrennefs 402 CHAP. XLIX. Difeafes of Children 403 Of the Meconium 405 ------Aphthae or Thrufh 406 —Acidities 407 Galling and Excoriation 408 Stoppage of the Nofe 409 Of Eruptions ib. —the Croup 411 —Teething 413 —Rickets 4T5 —Convulfions 4'7 —Water in the Head 419 CHAP. h. Of Surgery 420 —Bleeding 421 —Inflammations and Abfccffes ■ t,i\ —Wounds - '*42? —Burns -^ 4 2y —Bruifcs tJ. i O —Ulcers 43* Of Diflocations 43 ">, . \ --.- , ,, ,n1 **lif* TsTf*rr ib. .----------ov the Ribs 4-> of the Shoulder 43O ■----------ov the Elbow 4;^ ----------cf the Thigh ib. ----------oft he Knee ib. ----------oftheAi>cIe ib. ----------of the Toes . ib. Of Broken Bones - 4-8 —Strains - - «$ O —Ruptures " - 'O xxi* CONTENTS* chap. li. Fainting Fits frorn Excels Of Of Ctifualties Page 443 Blood - Page 457 *—Subftances ftopt between the------from a Defed of Blood Mouth and St6mach 445 or Weaknefs - 458 Of Drowned Perfons 449------acrid Vomits or Purges —Noxious Vapours 452 459 ■^—Intoxication - 4C4------Indigeftion ib. Effeds of Cold - 456------difagreedble Smells ib; Other Cafes which require Of fuffocating or ftrangling immediate Affiftance 457 Fits - 460 INDEX of MEDICINES. ' Page A Garic of the Oak 426 Aftringent Broth 265 ____------Powder ib. ----------Decodion 74 ----.------Mixture * 400 Bark, Peruvian - ni .----Infufion of - 112 mixed with Aromatics ib. .----Decodion of 304 Ball's Worm Powder 282 Cerate, Turner's 429 Chalybeat Wine - 139 Cordial Bolus - 144 ------Powder - ib. ------------ditto 145 Decodion of Seneca Root 125 —-------of Logwood 267 i--------of Sarlaparilla 271 -,. —Pedoral 117 White 186 .----i---of Woods 191 Emulfion of Gum Arabic 124 •-------of Gum Ammoniac ib. Eleduary, purging 369 ——«----for the Epilepfy 330 Eve-water - - 200 Gargarifm - 208 Hi era Pi.'ra - 21 ? Page Infufion, Diuretic 288,289 --------Spanifh 213 --------Purging 369 --------Pedoral - 121 Julep, Saline - 114 Lime-water - 262 —Oyfter fhell ditto 249 Liniment, Volatile 123 Mindererus's Spirit 1S7 Muftard Whey - 142 Ointment, Garlic - 218 ------'•—for Itch 306 ---------for the Bite of a mad Dog - - 346 -----——ofBafilicum 428 Pill for Jaundiee - 284 -----Mercurial - 37^ ----of Hemlock - 377 Plafter of Burgundy Pitch 214 ------Hyfteric - 228 ------of Wax - 427 ■------Warm - 297 Powder, Febrifuge 400 ------for the Bite of a mad n ^S - 345» 346 Rofes, Tmdure of 245 Solution of Mercury fublimate 371 --------Purging 369 ----■----for Galling and Ex- coriations - 4oS PAR T PART I. O F T II E GENERAL CAUSES OF- DISEASES. C H A P./) I. OF CHILDREN. rTniHE better to trace difeafes from their original |j caufes, we fhall take a view of the common treat- j| ment of mankind in the flate of infancy. Jn this period erf our lives, the foundations of a good or bad conftition are generally laid; it is therefore of imports ance, that parents be well acquainted with the various caufes which may produce difeafes in their offspring. It appears from the annual registers of the dead, that about one half of the children born in Great Britain die un- der twelve yeaYs of age. To many, indeed*, this may ap- pear a natural evil ; but, on due examination, it will be found to be one of our own creating. Were the death of infants a natural evil, other animals would .be as liable to die young as man ; but this we find is by no titers the cafe. It may fcem ftrange that man, notwithftanding his fu- pcrior reafon, fhould fall fo'farfhort of other animals in the management of his young : But our furprife will foon ceafe, if we confider that brutes, guided by inftincl:, never err in this refpect; while man, trufting folely to art, is feldom right. Were a catalogue of thofe children who perifh an- nually by art alone exhibited to public view, it would aftc- nifh moft people. If parents are above taking care of their children, others muft be employed for that purpofe : Thefe will always enr B deavoys a OF CHILDREN. deavour to recommend themfelves by the appearance of ex- traordinary fkill and addrefs. By this means fuch a number of unneceflary and deftructive articles have been introduced into the diet, clothing, &c. of infants, that it is no wonder fo many of them pcrifh. Nothing can be more prepofterous than for a mother to think it below her to take care of her own child, or to be fo ignorant as not to know what is proper to be done for it. If we fearch nature throughout, we cannot find a parallel to this. Every other creature is the nurfe of its own young, and they thrive accordingly. Were the brutes to bring up their young by proxy, they would fhare the fame fate with thofe of the human fpecies. We mean not, however, to impofeitas a talk upon eve- ry mother to fuckle her own child. This, whatever fpecu- lative writers may alledge, is in many cafes impracticable, and would inevitably prove deftrudtive both to the mother an' child. Women of delicate conftitutions, fubject to low fpirits, hyfteric fits, or other nervous diforc*ers, make very bad nurfes : And thefe complaints are now fo common, that it is rare to find a woman of fafhion free from them : fuch women, therefore, fuppofing them willing, are really unable to fuckle their own children. Almost every mother would be in a condition to give fuck, did mankind live agreeably to Nature : But, whoe- ver confiders how far we have deviated from her dictates, will not be furprifed to find many of them unable to perform that neceffary office. Mothers who do not eat a fufficient quantity of folid food, nor enjoy the benefit of free air and exercife, can neither have wholefome humours themfelves, nor afford proper nourifhment to an infant. Hence child-. ren who are fuckled by delicate women, either die young, or are weak and" fickly all their lives. When we fay that mothers are not always in a condition to fuckle their own children, we would not be underftood as difcouraging that practice. Every mother who can, ought certainly to perform fo tender and agreeable an office. But, fuppofe it to be out of her power, fhe may, neverthe- lefs, be of great fervice to her child. The bufinefs of nurfing is by no means confined to giving fuck. To a woman who abounds with milk, this is the eafieft part of it. Number- lefs other offices are neceffary for a child, which the mother $ught at leaft to fee done. A mother. OF CHILDREN. 3 A Mother who abandons the fruit of her womb, as foon as it is born, to the fole care of an hireling, hardly deferves the name of a parent. A child, by being brought up under the mother's eye, not only fecures her affection, but may reap all the advantages of a mother's care, though it be fuckled by another. How can a mother be better employ-* ed than in ftmerintending the nurfery ? This is at once the moft delightful and important office ! yet the moft trivial bufinefs or infipid amufements are often preferred to it. A ftrong proof both of the bad tafte and wrong education of modern females. It is indeed to be regretted, that more care is not beftow- ed in teaching the proper management of children to thofe whom nature has defigned for mothers. This, inftead of being made a principal, is feldom confidered as any part of female education. Is it any wonder, when females, fo e- ducated, come to be mothers, that they fhould be quite ig- norant of the duties belonging to that character ? However ftrange it may appear, it is certainly true, that many mo- thers, and thofe of fafhion too, are as ignorant, when they have brought a child into the world, what to do for it, as the infant itfelf. Indeed, the moft ignorant of the fex arc generally reckoned moft knowing in the bufinefs of nurfing. Hence, fenfible people become the dupes of ignorance and fuperftition ; and the nurfing of children, inftead of being conducted by reafon, is the refult of whim and caprice*. Were the time that is generally fpent by females in the acquifition of trifling accomplifhments, employed in learn- ing how to bring up their children; how to drefs them fo as not to hurt, cramp, or confine their motions ; how to feed them with wholefome and nouriiLiiio; food ; how to ex- ercife their tender bodies, fo as beft to promote their growth and ftrength : Were thefe made the objects of female in- ftruction, mankind would derive tne greateft: advantages from it. But, while the education of females implies little more than what relates to drefs and public fhew, we have nothing * Tacitus, the celebrated Roman hiftorian, complains greatly of the de- generacy of the Roman ladies in his time, with regard to the care of their offspring. He fays tliat, in former times, the greateft women in Rome ufed to account it their chief glory to keep the houfe and attend their children ; but that now .the young infant was committed to the fole care of fome poor Grecian wench or other menial fervant.—We are afraid, wherever luxury and effeminacy prevail, there will be too much ground for this complaint. 4. OF CHILDREN. nothing to expect from them but ignorance, even in the moft important concerns. Did mothers reflect on their own impoionce, and lay it to heart, they would embrace every opportunity of inform- ing themfelves of the duties which they owe to their infant- offspring. It is their province, not only to form the body, but alfo to give the mind its moft early bus. They have it very much in their power to make men healthy4 or valetudi- nary, ufeful in life, or the pells of fociety. But the mother is not the only perfon concerned in the management of children. The father has an equal intereft in their welfare, and ought to affiit in every thing that re- fpects either the improvement of the body or mind. It is pity that the men fhould pay fo little regard to this matter. Their negligence is^pne leafon why females know fo little of it. Women will ever be defirous to excel in fuch accomplishments as recommend them to the other lex. But men generally keep at fuch adiftance from even the ffnall- eft acquaintance with the affairs of the nurfery, that many Would efteem it an affront, were they fuppofed to know any thing of them. Not lb, however, with the kennel or the ftables : A gentleman of the firft rank is not afhamed to**. give directions concerning the management of his dogs or hoifes, yet would blufh were he furprifed in performing the fame office for that being who derived itsexiftence from him- felf, who is the heir of his fortunes, and the future hope of his country. Even phyficians themfelves have not been fufficiently attentive to the management of children : That has been generally confidered as the fole province of old women, while men of the firft character in pliyfic have ref;fed to vi- fit infants even when fick. Such conduct in the faculty haJ not only caufed this branch of medicine to be neglected, but has alfo encouraged the other fex to affume an abfolute -title to prefcribe for children in the moft dangerous difeafes. The confequence is, that a phyfician is feldom called till the good women have exhaufted all their fkill; when hh attendance can only ferve to divide the blame andappeafe the difconfolate parents. Nurses fhould do all in their power to prevent difeafes ; but, when a child is taken ill, fome perfon of fkill ought immediately to be confulted. The difeafes of children are generally acute, and the leaft delay is dangerous. Were OF CHILDREN. 5 Were phyficians more attentive to the difeafes of infants, they would not only be better qualified to treat them pro- perly when fick, but likewife to give ufeful directions for their management when well. The difeafes of children are by no means fo difficult to be underftood as many ima- gine. It is true, they cannot tell their complaints ; but the caufes of them may be pretty certainly difcovered, by put- ting proper queftions to the nurfes and fuch as are about them. Befides, the difeafes of infants, being lefs compli- cated, are eafier cured than thofe of adults*. It is really aftonifhing, that fo little attention fhould in general be paid to the prefervation of infants. What la- bour and expence are daily beftowed to prop an old totter- ing carcafe a few years, while thoufands of thofe, who mi^ht be ufeful in life, perjrfh without being regarded ! Mankind are too apt to value things according to their pre- fent, not their future, ufefulnefs. Tho' this be of all o- thers the moft erroneous method of eftimation ; yet, upon no other principle is it poffible to account for the general indifference with refpect to the death of infants. One great fource of the difeafes of children is, the un- HEALTHINESS of parents. It would be as reafonable to expect a -rich crop from a barren foil, as that ftrong and healthy children fhould be born of parents whofe conftitu- tions have been worn out with intemperance or difeafe. An ingenious writer obferves f, that on the conftitution of mothers depends originally that of their offspring. No one v/ho believes this will be furprifed, on a view of the fe- male world, to find difeafes and death fo frequent among children. A delicate female, brought up within doors, an utter ftranger to exercife and open air, who lives on tea and other flops, may bring a child into the world, but it will hardly be fit to live. The firft blaft of difeafe will nip the tender plant in the bud : Or, fhould it ftruggle through a few years exiftencc, its feeble frame, fhaken with convul- fions - The common opinion, that the difeafes of infants are hard to difcoyer and difficult to cure, has deterred many phyficians from paying*£»"« ion m them which theV delerve. I can however, from experience, declare that fo difficult to difcover nor fo ill to cure as thofe of adults. This *ehope will induce practitioners to Pr,y more regard to the complaints of their joung fa*icnt«, and net to leave ihn.i intirely in the hands ot eld women. f RouflccuN 6 OF CHILDREN. fions from every trivial caufe, will be unable to perform the common functions of life, and prove a burden to fociety. If, to the delicacy of mothers, we add the irregular lives of fathers, we fhall fee further caufe to believe that child- ren are often hurt by the conftitutions of their parents. A fickly frame may be originally induced by hardfhips or in- temperance, but chiefly by the latter. It is impoflible that a courfe of vice fhould not fpoil the belt conftitution : And, did the evil terminate here, it would be a juft punifhment for the folly of the fufferer; but, when once a difeafe is" contracted and rivetted in the habit, it is entailed On pofte- rity. Whata dreadful inheritance is the gout, thefcurvy, or king's-evil, to tranfmit to our offspring ! How happy had it been for the heir of many a great eftate, had he been born a beggar, rather than to inherit his father's fortunes at the expence of inheriting his difeafes! No perfon who labours under any incurable malady ought to marry. He thereby not only fhortens bis own life, but tranfmits mifery to others : But, when both parties are deeply tainted with the fcrophula, thefcurvy, or the like, the effects muft be ftill worfe. Such will either have no iffue at all, or thofe whom they have muft be miferable in- deed. Want of attention to thefe things, in forming con- nections for life, has rooted out more families than plague, famine, or the fword ; and, fo long as thefe connections are formed from mercenary views, the evil will be continu- ed. In our matrimonial contracts, it is amazing fo little re- gard is had to the health and form of the object. Our fportf- men know, that the generous courfer cannot be bred out of the foundered jade, nor the fagacious fpaniel out of the fnarling cur. This is fettled upon immutable laws. The man who marries a woman of a fickly conftitution, and de- fended of unhealthy parents, whatever his views may be, cannot be faid to a<5t a prudent part. A puny fcrophulous woman may prove fertile ; fhould this be the cafe, the fa- mily muft become an infirmary : What profpect of happi- nefs the father of fuch a family has, we fhall leave any one toiudge. The Jews, by their laws, were, in certain cafes, forbid to have any manner of commerce with the difeafed ; and in- deed to this all wife legiflators ought to have a fpecial re- gard. In fome countries, difeafed perfons have actually been OF CHILDREN. 7 been forbid to marry. This is an evil of a complicated kind, a natural deformity, and political mifchier'j and therefore requires a public confideration. Such children as have the misfortune to be born of dif- eafed parents, will require to be m.ikd with greater care than others. This is the only way to make amends for the defects of conftitution ; and it will often go a great length. A healthy nurfe, wholefome air, and fufficient exercife, will do wonders. But, when thefe are neglected, little is to be expected from any other quarter. The defects of confti- tution cannot be fupplied by medicine. Those who inherit any family-difeafe ought to be very circumfpedt in their manner of living. They fhould confi- der well the nature of fuch difeafe, and guard againft it by a pioper regimen. It is certain, that family-difeafes have often, by proper care, been kept off for one generation ; and there is reafon to believe, that, by perfifting in the fame courfe, fuch difeafes might at length be wholely eradicated. This is a fubject very little regarded, though of the greateft importance, Family-conftitutions are as capable of im- provement as family-eftates ; and the libertine, who impairs the one, does greater injury to his pofterity, than the pro- digal who fquanders away the other. The clothing of an infant is fo fimple a matter, that it isfurprifing how any perfon fliould err with regard to it j yet many children lofe their lives, and others are deformed, by inattention to this article. Nature knows no other ufe of clothes to an infant, but to keep it warm. All that is necefl'ary for this purpofe, is to wrap it in a foft loofe covering. Were a mother left to the dictates of nature alone, fhe would certainly follow this method. But the bufinefs of dreffing an infant has long been out of the hands of mothers, and has at laft be- come a fecret which none but adepts pretend to underftand. From the moft early ages it has bern thought neceffary, ' that a woman in labour fhould have fome perfon to attend her. This in time became a bufinefs ; and, as in all others, thofe who were employed in it firove to outdo one another in the different branches of their profeffion. The dreffing of a child came of courfe to be confidered as the midwife'*' province, who no doubt imagined, that the more dexterity fhe could fhew in this article, the more her /kill would be admired, Her attempts were feconded by the vanity of pa- reftts,* 8 OF CHILDREN. rents, who, too often defirous of making a fliew of the in- fant as foon as it was born, were ambitious to hnve as much * finery heaped upbn it as poffible. Thus it came to be thought as neceffary for a midwife to excel in bracing and dreffing an infant, as for a furgeon to be expert in applying banda- ges to a broken limb ; and the poor child, as foon as it came into the world, had as many rollers and wrappers ap- plied to its body, as if every bone had been fractured in the birth ; while thefe were often fo tight, as not only to gall and wound its tender frame, but even to obftruct the moti- on of the heart, lungs, and other organs neceffary for life. In feveral parts of Britain, the practice of rolling chil- dren with fo many bandages is now, in fome meafure, laid afide ; but it would ftill be a difficult tafk to perfuade the ge- nerality of women, that the fhape of a child does not en- tirely depend on the care of the midwife. So far, however, are all their endeavours to mend the fhape of children from being fuccefsful, that they conftantly operate the contrary way, and mankind become deformed juft in proportion to the means ufed to prevent it. How little deformity of body is to be, found among uncivilized nations ? So little indeed, that it is vulgarly believed they put all their deformed chil- dren to death. The truth is, they hardly know fuch a thing,as a deformed child. Nether fliould we, if we fol- lowed their example. Savage nations never think of ma- nacling their children. They allow them the full ufe of every organ, carry them abroad in the open air, wafli their bodies c. \ ^, :cold water, C5V. By this management, their children become fo ftrong and hardy, that, by the time our puny infants get out of the nurfe's arms, theirs are able to fhift for themfelves. Among brute animals, no art is neceffary to procure a fine fhape. Though many of them are extremely delicate when they come into the world, yet we never find them grow crooked for want of fwaddling-bands. Is nature lefs generous to the human kind ? No : But we take the bufi- nefs out of her hands. Not only the analogy of other animals, but the very feelings of infants tell us, that they ought to be kept eafy and free from all preffurc. They cannot indeed tell their complaints; but they can fhew figns of pain ; and this they i?ever fail to do, by crying, when pinched by their clothes. No fooner z.z they freed from their bracing?, than they * feeir* r OF CHILDREN. 9 eem pleafed and happy; yet, ftrange infatuation ! the mo- ment they hold their peace, they are again committed to their chains. If we confider the body of an infant as a bundle of foft pipes, replenifhed with fluids in continual motion, the dan- ger of pre fill re will appear in the ftrongeft light. Nature, in order to make way for the growth of children, has form- ed their bodies foft and flexible ; and, left they fhould re- ceive any injury from preffure in the womb, has furround- ed the fetus every where with fluids. This fhews the care which nature takes to prevent all unequal preffure on the bodies of infants, and to defend them againft every thing that nij^ht in the leaft cramp or confine their motions. Even the bones of an infant are fo foft and cartilaginous, that they readily yield to the flighteft preffure, and eafily aflame a bad fhape, which can neYer after be remedied. Hence it is, that fo many people appear with high fhoul- ders, crooked fpines, and flat breafts, who were as well pro- portioned at their birth as others, but had the misfortune to be fqueezed out of fhape by the application of flays and bandages. Pressure, by obstructing the circulation, likewife pre- vents the equal diftribution of nourifhment to the different parts of the body, by which means the growth becomes un- equal. One part of the body grows too large, while ano- ther remains too fmall ; and thus in time the whole frame becomos difproportioned and misfhapen. To this we muft add, that when a child is cramped in its clc ^sf\ natural- ly fhrinks from the part that is hurt; and, by putting its body into unnatural poflures, it becomes deformed by ha- bit. Deformity of body may indeed proceed from weaknefs or difeafes ; but, in general, it is the effect of improper clothing. Nine tenths, at leaft, of the deformity amongffc mankind, muft be imputed to this caufe. A deformed bo- dy is not only difagreeable to the eye, but by a bad figure both the animal and vital functions muft be impeded, and of courfe health impaired. Hence few people, remarkably misfhapen, are ftrong and healthy. 1 The new motions which commence at the birth, as the circulation of the whole mafs of blood through the lungs, refpiration, the periftaltic motion, cjV. afford another ftrong argument for keeping the body of an infant free from all C preffure* io OF CHILDREN. preffure. Thefe organs not having been accuftomed to move, are eafily flopped; but, when this happens, death muftenfue. Hardly any method could be devifed more ef- fectually to flop thefe motions than bracing the body too tight with rollers*, bandages, &c. Were thefe to be ap- plied in the fame manner to the body of an adult, for an equal length of time, they could hardly fail to hurt the di- geftion and make him fick. How much more hurtful they muft prove to the tender bodies of infants, we fhall leave any one to judge. Whoever confiders thefe things will not be furprifed^ that fo many children die of convulfionsfoon after the birth. Thefe fits are generally attributed to fome inward caufe; but, in fact, they oftener proceed from our own imprudent conduct. I have known a child feized with convulfion-fits, foon after the midwife had done fwaddling it, who, upon taking off the rollers and bandages, was immediately re- lieved, and never had any convulfion-fits afterwards. Nu- merous examples of this might be given, were they ne- ceffary. It would be fafer to fix on the clothes of an infant with firings than pins, as thefe often gall and irritate their ten- der fkins, and occafion convulfions. Pins'have been found flicking above half an inch into the body of a child after it had died of convulfion-fits, which, in all probability, pro- ceeded from that caufe. Children are not only hurt by the tightnefs of their clothes, but alio by the quantity. Every child has fome degree of fever after the birth ; and, if it be loaded with too many clothes, the fever muft be encreafed. But that is not all ; the child is generally laid in bed with the mother, who is often likewife feverifli ; 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 thefe are combined, which does not feldom hap- pen, they muft encreafe the fever to fuch a degree as will endanger the life of the infant. The danger of keeping infants too hot, will further ap- pear, if we confider, that, after they have been for fome time in the fituation mentioned above, they are often fent into * This is by no me.ns inveighing againft a thing that does not happen. In many parts of Britain at this day, a roller, five or fix fee* in length, is applieJ tightly r.urO the child's body as foon as it is born. OF CHILDREN. IX into the country to be nurfed in a cold houfe. Is it any wonder, if a child, from fuch a tranfition, catches a mortal cold, or contracts fome other fatal difeafe ? When an in- fant is kept too hot, its lungs, not being fufficiently ex- panded, are apt to remain weak and flaccid for life j from hence proceed coughs, confumptions, and other difeafes of the breaft. It would anfwer little purpofe to fpecify the particular pieces of drefs proper for an infant. Thefe will always vary in different places, according to cuftom and the humour of parents. The great rule to be obferved is, That a child have no more clothes than are neceffary to keep it warm, and that they be quite eafy for its body. Stays are the very bane of infants. A volume would not fuffice to point out all the bad effects of this ridiculous piece of drefs. The madnefs in favour of flays feems, how- ever, to be fomewhat abated ; and it is to be hoped the world will, in time, become wife enough to know, that the hu- man fhape does not folely depend upon whale-bone and bend leather*. We fhall only add, with refpect to the clothes of child- ren, that they ought to be kept very clean. Children per- fpire more than adults; and, if their clothes be not fre- quently changed, they become very hurtful. Dirty clothes not only gall and fret the tender fkins of infants, but like- wife occafton ill ftnells; and, what is worfe, tend to pro- duce vermin and cutaneous difeafes. Cleanliness is not only agreeable to the eye, but tends greatly to preferve the health of children. It pro- motes the perfpiration, and, by that means, frees the body from fuperfluous humours, which, if retained, could not fail to occafion difeafes. No mother or nurfe can have any excufe for allowing a child to be dirty. Poverty may oblige her to give it coarfe clothes; but, if fhe does not keep them clean, it muft be her own fault. Nature not only points out the food proper for an in- fant, but actually prepares it. This, however, is not fuf- ficient to prevent forae who think themfelves wifer than na- ture, from attempting to bring up their children without her prowifien. Nothing can fhew the difpofition which mankind have to depart from nature, more than their en- deavouring * Stays made of bend-leather are worn by all the women of lower nation jn many parts of England. ii OF CHILDREN. deavouring to bring up children without the breaft. Tho" mother's milk, or that of a healthy nurfe, is unquefliona- bly the belt food for an infant. Neither art nor nature can atfbrd a proper fubftitute far it. Children may feem to thrive for a few months without the breaft; but, when teething, the fmall-pox, and other difeafes incident to child- hood, come on, they generally perifll. A child, foon after the birth, fliews an inclination to fuck ; and there is no reafon why it fhould not be gratified. It is true, the mother's milk does not always come immedi- ately after the birth ; but this is the way to bring it: Be- fides, the firft milk that the child can fqueeze out of the breaft anfwers the purpofe of cleanfing better than all the drugs in the'apothecary's fhop, and at the fame time pre- vents inflammations of the breaft, fevers, and other difeafes incident to mothers. It is ftrange how people came to think that the firft thing given to a child fliould be drugs. This is beginning with medicine by times, and no wonder that they generally end with it. It fometimes happens, indeed, that a child does not difcharge the meconium fo foon as could be wifhed. This has induced phyficians, in fuch cafes, to give fome- thing of an opening nature to cleanfe the firft paffages. Midwives have improved upon this hint, and never fail to give iyrups, oils, &c. whether they be neceffary or not. Cramming an infant with fuch indigefiible ftpff, as foon :.s ir ;: born, can hardly fail to make it fick, and is more like- ly to occafion difeafes, than to prevent them. Children arc feldom long after the birth without having pnffage both by ftool and urine; though thefe evacuations may be wanting for fome time without any danger. But, if children muft have fomething before they be allowed the breaft, let it be a little thin water-pap, to which m;:y be added an equal quantity of new milk. If this be given, without any wines, fugars, or fpiceries, it will neither heat the blood, load the flomach, nor occafion gripes. Upon the firft fight of an infant, almoft every perfon is flruck with the idea of its being weak, feeble, and wanting fupport. This naturally fuggefts the need of cordials. Accordingly, wines are univerfally mixed with the firft food of children. Nothing can be more fallacious than this way of reafoning, or more hurtful to infants than the con- duct founded upon it. Children need very little food for fome OF CHILDREN. I j fome time after the birth ; and what they receive fhould be thin, weak, light, and of a cooling quality. A very fniall quan'ity of wine, or even fugar, is fufficient to heat and inflame the blood of an infant; but every perfon, conver- fant in thefe matters, muft know,' that moft of the difeafes of infants proceed from the heat of their humours. If the mother or nurfe has enough of milk, the child will need little or no other food before the third or fourth month. It will then be proper to give it, once or twice a day, a lit- tle of fome food that is eafy of digeftion ; as water-pap, milk-pottage, weak broth with bread in it, and fuch like. This will eafe the mother, wijl accuftom the child by de- grees to take food, and will render the weaning both lefs difficult and lefs dangerous. All great and fudden tranfiti- ons are to be avoided in nurfing. For this purpofe, the food of children ought not only to be fimple, but to refera- ble, as nearly as poffible, the properties of milk. Indeed milk itfelf fljould make a principal part of their food, not only before they are weaned, but for a long time after. Next to milk, we would recommend good light bread. Bread may be given to a child as foon as it fhews an incli- nation to chew ; and it may at all times be allowed as much as it pleafes. The very chewing of bread will promote the cutting of the teeth, and the difcharge of faliva, while, by mixing with the nurfe's milk in the ftomach, jt will afford an excellent npurifhrnent. Children difcover an early in- clination to chew whatever is put into their hands. Parents obferve the inclination, but generally miftake the object. Inftead of giving the child fomething which may at once exercife its gums and afford it nourishment, they common- ly put into its hands a piece of hard metal or impenetrable coral. A cruft of bread is the beft gum-flick. It not only anfwers the purpofe better than any thing elfe, but has the additional properties of nourifhing the child and carrying the faliva down to the ftomach, which is too valuable a liquor to be loft. Bread, befides being ufed dry, may be many ways pre- pared into food for children. One of the beft methods is to boil it in water, afterwards pouring the water off, and mixing with the bread a proper quantity of new milk un- boiled. "Milk is both more wholefome and nourifhing this way than boiled, and is lefs apt to occafion coftivenefs. For a child farther advanced, bread may be mixed in veal or t 14 OF CHILDREN. or chicken broth, made into puddings, or the like. Bread is a proper food for children at all times, provided it be plain, made of wholefome grain, and well-fermented ; but, when enriched with fruits, fugars,,or fuch things, it becomes very unwholefome. It is foon enough to allow children animal food when they have got teeth to eat it. They fhould never tafte it till after they are weaned, and even then they ought to ufe it fparingly. Indeed, when children live wholefy on vegeta- ble food, it is apt to four their ftomachs ; but, on the o- ther hand, too much flefh heats the blood, and occafions fevers and other inflammatory difeafes. This plainly points out a due mixture of animal and vegetable food as moft pro- per for children. Few things are more hurtful to children, than the com- mon method of fweetening their food. It entices them to take more food than they ought to do, which makes them grow fat and bloated. It is pretty certain, if the food of children were quite plain, that they would never take more than enough. The exceffes of children are entirely owing to nurfes. If a child be gorged with food at all hours, and enticed to take it, by making it fweet and agreeable to the palate, is it any wonder that fuch a child fhould in time be induced to crave more food than it ought to have ? Children maybe hurt by toolittfeas well as too much food. After a child is weaned, it ought to be fed four or five times a day ; but fhould never be accuftomed to eat in the night; neither fhould it have too much at a time. Children thrive beft with fmall quantities of food frequently taken. This neither overloads the ftomach, nor hurts the digeftion, and is certainly moft agreeable to nature. Writers on* nurfing have inveighed with fuch vehe- mence againft giving children too much food, that many parents, by endeavouring to fhun that error, have run into the oppofite extreme, and ruined the conftitutions of their children. But the error of pinching children in "their food is more, hurtful than the other extreme. Natuie has many ways of relieving hcrfelf when overloaded ; but a child, who is pinched with hunger, will never become a ftrong or healthy man. That errors are frequently committed on both fides, we are ready to acknowledge ; but where one child is hurt by the quantity of its food, ten fuffer from the quality. OF CHILDREN. ,s quality. This is the principal evil, and claims our ftri&eft attention. Many people imagine, that the'fort of food which they love themfelves cannot be bad for their children : But this notion is very abfurd. In the more advanced periods of life we often acquire an inclination for food which, when chil- dren, we could not endure. Befides, there are many things that may agree very well with the ftomach of a grown per- fon, which would.be hurtful to a child ; as high-feafoned, falted, and fmoke-dried provifions, &c. It would alio be improper to feed children with fat meat, ftrong broths, rich foups, or the like. * All ftrong liquors are hurtful to children. Some pa>- rents teach their children to guzzle ale, and other ftrong liquors, at every meal. Such a practice cannot fail to do rqifchief. Thole children feldom efcape the violence of the fmall-pox, meafles, hooping cough, or fome inflammatory difoider. Milk, water, butter-milk, or whey, are the moft proper for children to drink, if they have any thing ftrong- er, it may be fine fmall-beer, or a little wine mixed with water. The ftomachs of children can digeft well enough without the affiftance of warm ftimulants : Befides, being naturally hot, they aie eafily hurt by every thing of a heat- ing quality. iVew things are more hurtful to children^ than unripe fruits. They weaken the powers of digeftion, and four and lelax the ftomach, by which means it becomes a proper neft for infects. Children indeed fhew 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 pro- perly regulated. Fruits are generally of a cooling nature, and correct the heat and acrimony of the humours. This is what moft children want; only care fhould be taken left they exceed. Indeed, the beft way to prevent children from going to Acefs in the ufe of fruit, or eating that which is bad, is to allow them a proper quantity of what is good. Roots which contain a crude vifcid juice fhould be fparingly given to children. They fill the body with grofs humours, and tend to produce eruptive difeafes. This caution is peculiarly neceffary for the poor ; glad to obtain what will fill the bellies of their children for a little money, thev fluff" them two or three times a-day yvith potatoes, or 1 other 16 OFCHILDREN. other crude vegetables. Children had better eat a fmall quantity of food whjph yields a wholefome nourifhment, than be crammed with what their digeftive powers are una- ble properly to affimulate. Butter ought likewife to be fparingly given to chil- dren. It both relaxes the ftomach, and produces grofs hu- mours. Indeed, moft: things that are fat or oily, have this effect. Butter, when falted, becomes ftill more hurtful. Inftead of butter, fo liberally given to children in moft parts of Britain, we would recommend honey. Honey is not only wholefome, but cooling, cleanfing, and tends to fweeten the humours. Chfldien who eat honey are feldom troubled withworms ; They are alfo lefs fubject to cutane- ous difeafes, as itch, fcabbed-head, &c. Many people err in thinking that the diet of children ought to be altogether moift. When children live entirely upon flops, it relaxes their folids, renders them weak, and difpofes them to the rickets, the fcrophuli, and other glan- dular diforders. Relaxation is one of the moft general caufes of the difeafes of children. Every thing therefore which tends to unbrace their folids, ought to be carefully avoided. We would not be underftood, by thefe obfervations, as confining children to any particular kind of food. Their diet may be frequently varied, provided always that fuffici- ent regard be had to fimplicity. Of all the caufes which confpire to render the lives of children fhort and miferable, none has greater influence than the want of proper exercise : Healthy parents, wholefome food, and proper clothing, will avail little, where exercife is negleded. Sufficient exercife will make up' for feveral defects in nurfing; but nothing can fupply the want of it. It is abfolutely neceffary to the health, the growth, and the ftrength of children. THEdefireof exercife is almoft coeval with.life itfelf. Were this principle attended to, many difeafes might be prevented. But, while indolence aod fedentary employ- ments prevent two-thirds of mankind from either taking fufficient exercife themfelves, or giving it to their children, what have we to exped but difeafes and deformity among their offspring ? The rickets, fo deftrudive to children, never appeared in Britain till manufactures began to flourifh and people, attraded by the love of gain, Wt the country to OF CHILDREN. 17 to follow fidentary employments in great towns. It is a- mongft thefe people that this difeaferhieflv prevails, and not only deforms, but kills many of ifreir offspring. The conduct of other young animals fhews the proprie- ty of giving exercife to children. Every other animal makes ufe of its organs of motion as foon as it can, and many of them, even when under no neceifity of moving in queft of food, cannot be reftrained without force. This is evident- ly the cafe with the calf, the h>nb, and moft other \oong animals. If thefe creatures were not permitted to frifk a- bout, and take exercife, they would foon die or become difeafed. The fame inclination appears very early in the human fpccies; but, as they are not able to take exercife themfelves, it is the bufinefs of their parents and nurfes to affift them. Children may be exercifed various ways. The heft: method, while they are li-ht, is to carry them about in the nurfe's arms. ThO gives the nurfe an opportunity of talk- ing to the child, and of pointing out every thing that may pleafe and delight its fancy. Befides, it is much fafer than fwinging zn infant in a machine, or leaving it to the care of fuch as are not fit to take care of themfelves. Nothing can be more foolifli than to fet one child to keep another: this conduct has proved fatal to many infants, and has ren- dered others miferable for life. When children begin to walk, the fafeft and beft me- thod of leading them about is by the hands. The common way, of fwinging them in leading-firings fixed to their backs, has many bad confequences. It makes them throw their bodies forward, and prefs with their whole weight up- on the breaft : By this means the breathing is obftructed, the breaft flattened, and the bowels compreffed ; which muft hurt the digeftion, and occafion confumptions of the lungs, and other difeafes. It is a common notion, that if children be fet upon their feet too foon, their legs will become crooked. There is reafon to believe, that the very reverfe of this is true. Eve- ry member acquires ftrength in proportion as it is exercifed. The limbs of children are weak indeed, but their, bodies are proportionably light; and, had they fkill to direct them- felves, they would foon be able to fupport their own weight. Who ever heard of any other animal that became crooked by ufinz its lees too foon ? Indeed, if a child be not per- J * b D mittri 18 OF CHILDREN. mitted to make ufe of its legs till a confiderable time after the birth, and be. then fet upon them with its whole weight at once, there mavbe fome danger ; but this pro- ceeds entirely from the child's not haw'ng been accuftomed to ufe its legs from the beginning. Mothers of the poorer fort think they are great gainers by n>akin_; their children lie or fit while they themfelves work. In this they are greatly miftaken. By neglecting to give their children exercife, they are obliged to keep them a long time before they can do any thin* for themfelves, and to fpend more on medicine than would have paid for proper care. To take care of their children, is the moft profitable bu- finefs in which even the poor can employ themfelves : But, alas ! it is not always in their power. Poverty often oblig- es them to neglect their offspring, in order to procure the necefOries of life. When this is the cafe, it becomes the intereft as well as the duty of the public to afiift them. Ten thoufand times more benefit would accrue to the State, by enabling the poor to bring up their own children, than from all the * hofpitals that ever can be erected for that purpofe. Whoever confiders the ftructure of the human body, will foon be convinced of the ncceflity of exercife for the health of children. The body is compofed of an infinite number of veffels, whofe fluids cannot be pufhed on without the action and preffure of the mufcles. But, if the fluids remain inactive, obstructions muft happen, and the humours will of courfe be vitiated, which cannot fail to occafion dif- eafes. Nature has frunifhed both the veffels which carry the blood and lymph with numerous valves, in order that the action of every mufcle might pufh forward their con- tents ; but without action, this admirable contrivance can have no effect. The final caufe of this part of the animal ceconomy proves to a demonstration the neceflity of exer- cife for the prefervation of health. Arguments * If it were made the intereft of the poor to keep their children alive, we fliould lofe very few of them. A fmall premium given annually to each poor family, for every child they have alive at the year's end, wou-'d fave more infant-lives than if the whofe reven.de of the crown were expended on hofpitals for this purpofe. This would make the poor efteem fertility a blef- fing ; whereas many of them think it the greateft curfe that can befal then? ; »nd, in place of wifhing their children t» live, fo far does poverty £et the. better of natural affection, that they are often very happy when they die. OF CHILDREN. j9 Arguments to fhew the importance of exercife might be drawn from every part of the animal ceconomy : With- out exercife, the circulation of the blood cannot be proper- ly carried on, nor the different fecrctions duly performed ; without exercife, the humours cannot be properly prepared, nor the folids rendered ftrong or firm. The action of the he.irt, the motion of the lungs, and all the vital functions, arc greatly affifted by exercife. But, to point out the man- ner in which thefe effe&s are produced, would lead us far- ther into the ceconomy of the human body, than moft of thofe for whom this treatife is-intended would be able to fol- low. We fhall therefore only^add, that, where exercife is neglected, none of the animal functions can be duly per- formed ; and, when that is the cafe," the whole conftituti- on muft go to wreck. A good conftitution ought certainly to be our firft object in the management of children. It lays a foundation for their being ufeful and happy in life ; and whoever neglects it, not only fails in his duty to his offspring, but tofocietv. One very common error of parents, by which they hurt the conftitutions of their children, is |he fending them too young to fchool. This is often done folely to prevent trouble. When the child is at fchool, he needs no keeper. Thus the fchoolmafter is made the nurfe; and the poor child is fixed to a feat feven or eight hours a-day, which time ought to be fpent in exercife and diverfions. Sitting fo Ion* cannot fail to produce the worft effects upon the body; nor is the mind lefs injured. Early application weakens the fa- culties, and often fixes in the mind an averfion to books, which continues for life. But, fuppofe**this were the way to make children fcho- lars, it certainly ought not to be done at the expence of their conftitutions. Our anceftors, who feldom went to fchool very young, were not lefs learned than we. But we imagine the boy's education will be quite marred, unlefshe be carried to fchool in his nurfc's arms. No wonder if fuch hot-bed plants feldom become either fcholars or men ! Not only the confinement of children in public fchools, but their.number, often proves hurtful. Children are much injured by being kept in crowds within doors; their breath- ing not only renders the place unwholefome, but, if any one of them happens to be difeafed, the reft catch the in- fection. A finglc child has been often known to commu- nicate 70 OF CHILDREN. nicate the bloody-flux, the hooping-cough, the itch, or o^ ther difeafes, to almcil every individual in a numerous fchool. # But, if fafhion muft prevail, and infants are to be fent to fchool, we would recommend it to tethers, as they value the interefts of fociety, not to confine them too long at a time, but to allow them to run about and pjay at fuch ac- tive diverfions as may promote their growth and ftrengthen their conftitutions. Were boys, inftead of being whipped for fte.ilir.g an hour to run, ride, fwitn, orthelike, encou- raged to employ their time in thefe manly and ufeful exer- cife?, it would produce many excellent effects. It would be of grtr.t fervice 1.0 boys, if, at a proper asje, they were taught the military exercife. This would en- creafe their fhength, infpire them with courage, and, when their country called for their afliftance, would enable them to act in her defence, without being obliged to un- dergo a tedious and troublefome courfe of inftruclions, at a time when they are lefs fit to learn new morons, geftures, &c. An,effeminate education will infallibly fpoil the beft na- tural cc.:7j:uion ; and, if boys are brought up in a ir.ore delicate minner tu:.n even giils ou^ht to be, they never will be men. Nor is the common education of girls lefs hurtful to the c( nftitutien than that of boys. Mifs is fet down to her frame, before fhe r?n puf on her clothes ; and is taught to Believe, that to excel at the needle is the only thing that can inn'O her to general cftcc-m. It is unneccflary here to infill upon the dangerous confequences of obliging girls to fit too much. They are pretty well known, and are too often felt at a certain time of life. But fuppofe this critical peiiod to be got over, gteater dangers ftill awai{*them when they come to be mothers.. Women who hav,e"becn early accuf- tomed to a fedentary life,t generally run gjjat hazard in childbed ; while thofe who have been ufed to romp about, and take fufficient exercife, are feldom in any danger One hardly meets with a girl who can, at the fame'time, boaft;of early performances by the needle, and a good con- ftitution. Cofe and early confinement generally occafions indigeft.ons headachs, pale ccAplexions, pain of the fto- mach, loft of appetite, coughs,^nfurnptions of the lungs, and deformity of body. The laft of thefe indeed is not to be OF CHILDREN. 21 be wondered at, conftdering the aukward poffures in whith girls lit at many kinds of needle-work, and the delicate flexible ftate of their bodies in the early periods of life. Would mothers, inftead of having their daughters in- ftrudted in many trifling accomplifhments, teach them plain woikand houfewilery, and allow them fufficient time to run about in the open air, they would both make them more healthy mothers, and more ufeful members of fociety. I am no enemy to genteel accomplifhments, but would have them only confidered as fecorfdary, and always difregarded when they impair health. Many people imagine it a great advantage for children to be early taught to earn their bread. This opinion is cer- tainly right, provided they were fo employed as not to hurt their health or growth ; but, when thefe fuffcr, fociety, in- ftead of being benefited, is a real lofer by their labour. There are few employments, except* fedentary ones, by which children can earn a livelihood ; and, iftheybefet to thefe too foon, it ruins their conftitutions. Thus, by gaining a few years from childhood, we generally lofe twice as many in the latter period of life, and even render the perfon lefs ufeful while he does live. In order to be fatisfied of the truth of this obfervatioft, one needs only look into the great manufacturing towns, where he will find a puny degenerate race of people, weak and fickly all their lives, feldom exceeding the middle peri- od of life ; or, if they do, being unfit for bufinefs, they become a burden to fociety. Thus, arts and manufactures, though they may increafe the riches of a country, are by •* no means favourable to the health of its inhabitants,. Good policy would therefore require, that fuch people as labour during life, fhould not. be fet too early to work. Every perfon cohvei fant in the breed of horfes, or other working , animals, knows, that, if they be fet to hard labour tdo foOn, they never will turn out to advantage. This is equally true with refpect to the human fpecies. There are neverthelefs various ways of employing young people, without hurting their health. The eafier parts of gardening, huibaridry, or any bufinefs carried on without doors, are moft proper. Thefe are employments which moft young people are fond of, and fbme parts of them may always be adapted to tffer age, tafte, and ftrength. 5t2 OF CHILDREN. Such parents, 'however, as are under the neceifity of cm- ploying their children withindoors, ought to allow them fufficient time for active diverfions. This would both en- courage them to do more work, and prevent their c. lftitu- tions from being hurt. ^ Some imagine, th;it exercife withindoors is fufficient; but they are greatly miftaken. One hour fpent in running* or any other exercife without doors, is worth ten within. When children cannot go abroad, they may indeed be ex- ercifed at home. The beft method of doing this is to make them run about in a long room, or dance. This laft kind of exercife, if not carried to excefs, is of excellent fervice to young people. It cheers the fpirits, promotes perfora- tion, ftrengthens the limbs, chc. 1 knew an eminent phy- fician who ufed to fay, that he made his children dance in- ftead of giving them phyfic. It were well if more people would follow his example. The cold bath may be confidered as an aid to exer- cife. By it the body is braced and ftrengthened, the cir- culation and fecretions promoted, and, were it conducted with prudence, many difeafes, as the rickets, fcrophula, &c. might be prevented. The ancients, who took every method to render children hardy and robuft, were no flrangers to the ufe of the cold bath ; and, if we .r;ay credit report, the practice of immerfing children daily in cold wa- ter muft have been very common ?.mong our ai. x'ftors. The greateft objection to the ufe of the cold br.tn arifes from the fuperftitious pr< judicts of nurfes. Thefe are often fo ftrong, that it is impoftible to bring them to make a pro- per ufe of it. I have known fome of them who would not dry a child's fkin after bathing it, left it fliould deftroy the effect of the water. Others will even put clothes dipt in the water upon the child, and either put it to bed, or fuffer it to go about in that condition. Some believe, that the whole virtue of the water depends upon its being dedicated to a particular faint. While others place their confidence in a certain number of dips, as three, feven, nine, or the like j and the world could not perfuade them, if thefe.do not fucceed, to try it a little longer. . Thus, by the whims of nurfes, children lofe the benefit of the cold bath, and the hopes of the phyfician from that medicine are often fruftrated. j*l OF CHILDREN. 23 We ought not, however, entirely to fet afide the ufe of the cold bath, becaufe fome nurfes make a wrong ufe of it. Every child, when in health, fhould at leaft have its extre- mities caily wafhed in cold water. This is a partial ufe of the cold bath, and is better than none. In winter this may fuffice ; but, in the warm feafon, if a child be relaxed, or feem to have a tendency to the rickets or fcrophula, its whole body ought to be daily immerfed in cold water. Care however muft be taken not to do this when the body is hot, or the ftomach full. The child fhould be dipt only once at a time, fhould be taken out immediately, and have its fkin well rubbed with a dry cloth. Few things are more deftructive to children than con- fined or unwholefome air. This is one reafon why fo few of thofe infants, who are put into hofpitals, or parifh work- houfes, live. Thefe places are generally crowded with old, fickly, and infirm people; by which means the air is ren- dered fo extremely pernicious, that it becomes a poifon to infants. Want of wholefome air is likewife deftructive to many of the children born in great towns. There the poorer fort of inhabitants live in low, dirty, confined houfes, to which the frefh air has no accefs. Though grown people, who are hardy and robuft, may live in fuch fituations, yet they generally prove fatal to their offspring, few of whom arrive at maturity, and thofe who do are weak and deform- ed. As fuch people are not able to carry their children a- broad into the open air, we muft lay our account with lofing the greater part of them. But the rich have not this ex- cufe. It is their bufinefs to fee that their children be daily carried abroad, and that they be kept in the open air for a fufficient time. This will always fucceed better if the mo- ther goes along with them. Servants are often negligent in thefe matters, and allow a child to fit or lie on the damp ground, inftead* of leading or carrying it about. The mo- ther furely needs air as well as her children ; and how can fhe be better employed than in attending them ? A very bad cuftom prevails of making children fleep in final 1 apartments, or crowding two or three beds into one chamber. Inftead of this, the nurfery ought always to be the largeft and beft aired^oom in the houfe. When child- ren are confined in fmall apartments, the air not only be- comes unwholefome, but the heat relaxes their folids, ren- 24 QF CHILDREN. ders them delicate, and difppfes them to colds and many o- ther diforders. Children who are kept within doors all day, and fleep all night in warm clofe apartments, may, with great pro- priety, be compared to plants nurfed in a hot-houle, inftead of the open air. Though fuch plants, by extraordinary care, may be kept alive for fome time, they will never ar- rive at that degree of ftrength, vigour, and magnitude, which they would have acquired in the open air, nor would .th.ey be able to bear it afterwards, fliould they be expofed" to it. Children brought up in the country, who have been ^ccuftomed to open air, fhould not be too early fent to great towns, where it is confined and unwholefome. This is frequently done with a view to forward their education, but proves very hiujfful to their health. All fchoolsand fe- minaries of learning ought, if poffible, to be fo fituated as to have frefh, dry, wholefome air, and fhould never be too much crowded. Without entering into a detail of the particular advan- tages of wholefome air to children, or of the bad confluen- ces which proceed from the want of it, 1 fhall only obferve,v that of feveral thoufands of children which have been under jny care, I do not remember one inftance of a fingle child who continued healthy in a clofe confined fituation ; but have often known the moft obftinate difeafes cured by re- moving them from fuch a fituatjon to an open free air. Hired nurfes are guilty of many faults, which prove fa- tal to infants. It is therefore the duty of parents to watch over their conduct with the greateft care, and to be ex- tremely cautious in the choice of them. One of the moft common faults of thofe who nurfe for hire is to dofe children with ftupifactives, or fuch things as lull them afteep. An indolent nurfe, who does not give a child fufficient exercife Ln the open air to make it fleep, and does not chufe to be difturbed by it in the night, will fel- dom fail to procure for it a dofe of laudanum, diacodium, faffron, or, what anfwers the fame purpofe, a dram of fpi- rits, or other ftrong liquors. Thefe, though they be cer- tain poifon to children, are every day adminiftered by many Wjbo hear the character of very good nurfes. A nurse who has not milk enough is apt to imagine that this defect may be fupplied by giving the child wines, cordial OF CHILDREN. 25 cordial waters, or other ftrong liquors. This isanegregi- ous miftake. The only thing that has any chance to fup- ply the place of the nurfe's milk, muft be fomewhat nearly of the fame quality, as cow's milk, afs's milk, or the like, with good bread. It never can be done by the help of ftrong liquors. Thefe, inftead of nourifhing an infant, never fail to produce the contrary effect. Children are often hurt by nurfes fuffering them to jcry long and vehemently. This ftrains their tender bodies, and frequently occafions ruptures, inflammations of the throat, lungs, &c. The nurfe who can hear an infant cry till it has almoft fpent itfelf, without endeavouring to pleafe it, muft be cruel indeed,, and is unworthy to be intrufted with the care of an human creature. Nurses who deal much in medicine, are always to be fufpected. They truft to it, and neglect their duty. I ne- ver knew a good nurfe who had her Godfrey's cordials, Daffy's elixirs, &c. at hand. Such generally imagine, that a dofe of medicine will make up for all defects in food, air, exercife, cleanlinefs, &c. Allowing children to continue long wet, is another very pernicious cuftom of indolent nurfes. This is not on- ly difagreeable, but it galls and frets the infant, and by re- laxing the folids, occafions fcrophulas, rickets, and other difeafes. A dirty nurfe is always to be fufpected. Nature often attempts to free the bodies of children from bad humours, by throwing them upon the fkin : By this means fevers, and other difeafes are prevented. Nurfes are apt to miftake fuch critical eruptions for an itch, or fome other infectious diforder. Accordingly they take every method to drive them in. In this way many children lofe their lives ; and no wonder, as nature is oppofed in the very method fhe takes to relieve them. It ought to be a rule, which every nurfe fhould obferve, never to flop any eruption without proper advice, or being well affured, that it is not of a critical nature. At any rate, it is never to be done without previous evacuations. Loose ftools is another method by which nature often prevents or carries off the difeafes of infants. If thefe pro- ceed too far, no doubt they ought to be checked ; but this is never to be done without the greateft caution. Nurfes, upon the firft appearance of loofe ftools, frequently fly to the ufe Of aftringents, or fuch things as bind the belly. £ Hence 26 OF CHILDREN. Hence inflammatory fevers, and other fatal difeafes, are occafioned. & dofe of rhubarb, a gentle vomit, or fome other evacuation, fhould always precede the ufe of aftrin- gent medicines. One of the greateft faults of nurfes is concealing the dif- eafes of childien from their parents. This they are ex- tremely ready to do, efpecially when the difeafe is the effect of their own negligence. Many inftances might be given of perfons who have been rendered lame for life by a fall from their nurfe's arms, which fhe, through fear, conceal- ed till the misfortune was paft cure. Every parent who intrufts" a nurfe with the care of a child, ought to give her the ftricteft charge not to conceal the moft trifling difordcr or misfortune that may befal it. We can fee no reafon why a nurfe who conceals any mis- fortune which happens to a child under her care, till it lofes its life, fhould not be punifhed. A few examples of this would fave the lives of many infants ; but, as there is lit- tle reafon to expect that it ever will be the cafe, we would earneftly recommend it to all parents to look carefully after their children, and not to truft fo valuable a treafure en- tirely in the hands of an hireling. The abpve is only a finall fpecimen of the numerous faults wfiich we know are daily committed fey mercenary nurfes. It is hoped, however, that thefe examples will be fufficient to roufe the attention of parents,, and to make them look more ftrictly into the condudt of thofe to whom they commit the care of their infant offspring. Were it practicable to have all children nurfed and edu- cated in the country, we fhouhl lofe very few of them. One feldom fees a country farmer without a numerous offspring, moft of whom arrive at maturity. Many things confpire to thisend. The children of thefe people are generally nurfed by their mothers, they eat plain wholefome food, enjoy the benefit of frefh air, and have plenty of proper exercife; they have rural fports and paftimes fuited to their age, and, as they grow up, find employments adapted to their ftrength, and conducive to their health. In fine, we cannot help joining with the learned Mr. Locke, in recommending the .example of the yeomen and fubftantial farmers, as a model to all in the management of their children. No perfon ought to imagine that thefe things are unwor- thy of his attention. On the proper management of chil- dren OF CHILDREN. 27 dren depend not only their health and ufefulnefs in life, but likewife the faOty and profperity of the ftate to which they belong. Effeminacy ever will prove the ruin of any ftate, where it prevails : and, when its foundations are laid in infahcy, it can never afterwards be wholly eradicated. We would therefore recommend to all parents, who love their offspring and wifh well to their country, to avoid, in the management of their children, every thing that may" have a tendency to make them weak or effeminate, and to tr.kc every method in their power to render their conftituti- ons ftrong, healthy, and hardy. --------------------By arts like thefe Laconia nurs'd of old her hardy fons ; And Rome's unconquer'd legions.urg^d their way, Unhurt thro' every toiMn every clime*. CHAP. II. OF LABOURERS, ARTIFICERS, &c. THAT men are expofed to particular difeafes from the occupations which they follow, is a fact well known ; but how to remedy this evil is a matter of fome difficulty. Moft people are under a neceflity of following the employments to which they have been bred, whether they be favourable to health or not. For this reafon, in- ftead of inveighing, in a general way, againft thofe occu- pations which are hurtful to health, we fhall endeavour to point out the circumftances in each of them from which the danger chiefly arifes, and to propofe the moft rational methods of preventing it. Chymists, founders, glafs-makers, &c. are often hurt by the unwholefome air which they are obliged to breathe. This air is not only loaded with noxious exhalations, but is fo parched, or rather burnt, as to be rendered unfit for expanding the lungs fufficiently, and anfwering the other important purpofes of refpiration. Hence proceed afthmas, coughs, * Armftrong. 28 OF LABOURERS, ARTIFICERS, kc. coughs, and confumptions of the lungs, fo incident to per- fons who follow thefe employments. To prevent thefe ill confluences, as far as poffible, the places where fuch occupations are carried on, ought to be conftru£ted with the utmoft care for difcharging the fmoke and other exhalations, and admitting a free cunent of frefh air. Such artifts ought never to continue too long at work; and when they give over, they fliould fufter themfelves to cool gradually, and put on their clothes be.'bie they go in- to the open air. They ought never to drink large quanti- ties of cold, weak, or watery liquors, while their bodies are hot, nor to indulge'in raw fruits, fallads, or any thing that is cold on the ftomach. Miners, and .all who work under ground, are likewife I hurt by unwholefome air. . The air in deep mines not only lofes its proper fpring and other qualities neceffary for refpi- ration, but is often loaded with fuch noxious exhalations as to become a moft deadly poifon. There is no other method of preventing this, but by promoting a fiee circulation of air in the mine. Miners are not only hurt by unwholefome air, but like- wife by the particles of mefal which adhere to their fkin, clothes, &c. Thefe are abforbed, or taken up into the bo- dy, and occafion palfies, vertigoes, and other nervous dif- orders, which often prove fatal. Fallopius obfcrves, that thofe who work in mines of mercury feldom live above three or four years. Lead, and feveral other metals, are likewife very pernicious to the health. Miners ought never to go to work falling, nor to conti- nue long under ground. Their food ought to be nourifhing, and their liquor generous: Nothing more certainly hurts them than living too low. They fhould, by all means, a- void coftivenefs. This may either be done by chewing a little rhubarb, or taking a fufficient quantity of fallad oil. Oil not only opens the body, but fheaths and defends the inteftines from the ill effetts of the metals. All who work in mines or metals ought to wafh carefully, and to change their clothes as foon as they give over working. Nothing would tend more to preferve the health of fuch people than a ftrict, and almoft religious regard to cleanli- nefs.- Plumbers, painters, gilders, makers of white lead, and ftiany others who work in metals, are liable to the fame dif- eafes OF LABOURERS, ARTIFICERS, &c. 29 eafes as miners, and ought to obferve the fame directions for avoiding them. Tallow-chandlers, boilers of oil, and all who work upon putrid animal fubftances, are likewife liable to fufter from the unwholefome fmells or effluvia of thefe bodies. They^ought to pay the fame regard to cleanlinefs as miners; and when they are troubled with naufea, ficknefs, or indi- geftioo, we would advife them to take a vomit or a gentle purge. Such fubftances ought always to be manufactured as frefh as poffible. When long kept, they not only be- come unwholefome to thofe who manufacture them, but likewife to people who live in the neighbourhood. It would greatly exceed the limits of this part of our fubject, to fpecify the difeafes peculiar to perfons of every occupation ; we fhall therefore confider mankind under the following general claffes, viz. the Laborious, the Sedentary, and the Studious. Though thofe who follow laborious employments are in general the moft healthy of mankind, yet the nature of their occupations, and the places where they are carried on, ex- pofe them more particularly to fome difeafes. Hufbandmen, for example, are expofed to all the viciffitudes of the wea- ther, which, in this country, are often very great and hid- den, and occafion colds-, coughs, quinfies, rheumatifms, fevers, and other inflammatory disorders, and are likewife forced to work hard, and often to carry burdens above their ftrength, which, by over (training the veffels, occafion afth- mas, fevers, ruptures, &c. Those who labour without doors are often afflicted with intermitting fevers or agues, occafioned by the frequent viciffitudes of heat and cold, poor living, bad water, fitting or lying on the damp ground, evening dews, night air, &c. to which thefe people are frequently expofed. Those who bear heavy burthens, as porters, labourers, Sec. are obliged to draw in the air with much greater force, and alfo to keep their lungs diftended with more violence, than is neceffary for common refpirafion : By this mean3 the tender veffels of the lungs are over-ftretched, and often burft, infomuch that a fpitting of blood or fever enfues. Hippocrates mentions an inftance, to this purpofe, of a man, who, upon a wager, carried an afs. The man, he fays, was immediately feized with a fever, a vomiting of blood, and a rupture, Carrying 3o OF LABOURERS, ARTIFICERS, kc. Carrying heavy burdens is often the effe t of mere la- zinefs, which prompts people to do at once wOit fhould be done at twice. It likewife proceeds frequently from brava- do, or an emulation to outdo others. Hence it is that the ftrongeft men are moft commonly hurt by heavy burdens, hard labour, or feats of activity. It is rare to find one who excels in this way, without a rupture, ?. fpitting of blood, 01 fome other difeafe, which he reaps as the fruit of his fol- ly. One would imagine, that the daily inftances we have of the fatal effects of carrying great weights, running, wreflling, &c. would be fufficient to prevent fuch practices. There are indeed fome employrnints which neceffarily require a great exertion of ftrength, as blackfmiths, car- penters, &c. None ought to follow thefe but men of a ftrong body; and they fhould never exert their ftrength to the utnn-ii, nor work too long. When the mufcles are vi- olently ftrained, frequent reft is neceffary, in order that they may recover their tone ; without this, the ftrength and con- ftitution will fdon be worn out, and a premature old age brought on. The erilipelas, or St. Anthony's fire is likewife very in- cident to the laborious. It is occafioned by whatever gives a fudden check to the perfpiration, as drinking cold liquor when the body is waim, wet feet, keeping on wet clothes, fitting or lying on the damp ground, &c. It is impoffible for thofe who labour without doors always to guard againft thefe inconveniencies ; but it is known from experience, that their ill confequences might often be prevented by pro- per care. ' The laborious are often afflicted with the iliac paffion, the colic, and other complaints of the bowels. Thefe are generally occafioned by the caufes mentioned above ; but they may likewife proceed from flatulent and indigeftible food. Labourers eat unfermented bread rrfade of peas, beans, rye, and other windy ingredients. They alfo de- vour great quantities of unripe fruits, baked, ftewed, or raw, with various kinds of roots and herbs, upon which they drink four milk, ftale fmall beer, &c. Suchacompo- fition cannot fail to fill the bowels with wind, and occafion difeafes of thoi'e parts. Inflammations, whitloes, and other difeafes of the extremeties, are very common amongft thofe who labour without doors. Thefe difeafes are often attributed to venom, or OF LABOURERS, ARTIFICERS, &c. 31 or fome kind of poifon ; but they generally proceed either from fudden heat after cold, or the contrary. When la- bourers, milk-maids, &c. come from the field, cold or wet, they run to the fire and often plunge their hands in warm water, by which means the blood and other humours in thofe parts are fuddenly expanded, and, the veffels not yielding fo quickly, a ftrangulation happens, and an in- flammation or mortification enfues. When labourers come home cold, they ought to keep at a diftance from the fire for fome time, to wafh their hands in cold water, and to rub them well with a dry cloth. It fometimes happens, that people are fo benumbed with cold, as to be quite deprived of the ufe of their limbs. In this cafe, the only remedy is to rub the parts affected with fnow, or, where it cannot be had, with cold water. If they be held near the fire, or plunged into warm water, a mortifi- cation will generally enfue- Labourers in the hot feafon are apt to lie down and fleep in the fun. This practice is fo dangerous, that they often wake in a burning fever. Thefe burning: fevers, which prove fo fatal about the end of fummer and begin- ning of autumn, are often occafioned by this means. When labourers leave oft work, which they ought always to do during the heat of the day, they fliould go home, or, at leaft, get under fome cover, where they may repofe themfelves in fafety. Labourers frequently follow their employments in the fields from morning till night, without eating any thinr;. This cannot fail to hurt their health. However homely their fare be, they ought to have it at regular times ; and the harder they work, the more frequently they fhould eat. If the humours be not frequently icplenifhed with frefli nourifhment, they foon become putrid, and produce fevers of fhe very worft kind. > Labourers are extremely carelefs with refpect to what they eat or drink, and often, through mere indolence, ufe unwholefome food, when they might, for the fame ex- pence, have that which is wholefome. In many parts of Britain, the peafants are too carelefs even to take the trou- ble of dreffing their own victuals. Such people would live upon one meal a-day in indolence, rather than labour, thour-h it were to procure them the greateft affluence. Fevers 32 OF LABOURERS, ARTIFICERS, &c. Fevers of a very bad kind are often occafioned among labourers by poor living. When the body is not fufficient- ly nourifhed, the humours become bad, and the folids weak; from whence the moft fatal confequences enfue. Poor living is likewife productive of many of thofe cutane- ous difeafes fo frequent among labourers. It is remarkable that cattle, when pinched in their food, are generally af- fected with difeafes of the fkin, which feldom fail to difap- pear when they are put upon a good pafture. This fhews how much a good ftate of the humours depends upon a fuf- ficient quantity of proper nourifhment. Pcwerty not only occafions, but aggravates, many of the difeafes of the laborious. Few of them have much fore- fight; and, if they had, it is feldom in their power to fave anything. They are glad to make a fhift to live from day to day ; and, when any difeafe renders them unable to work, their families are ready to flar.ve. Here the god-like virtue of charity ought always to be exerted. To relieve the in- duftrious poor in diftrefs, is furely the moft exalted act of religion and humanity. They alone, who are witneffes of thofe fcenes of calamity; can from a notion of what num- bers perifh in difeafes for want of proper affiftance, and even for want of the necefTaries of life. Labourers are often hurt by a foolifh emulation, which prompts them to vie with one another, till they over- heat themfelves to fuch a degree as to occafion a fever, or even to drop down dead. As this is the effect of vanity, jt ought always to be checked by thofe who have the fuperin- tendence of them. Such as wantonly throw away their lives in this manner, deferve to be looked upon in no better light than felf-murderers. It is pity that poor widows and fatherlefs children fhould fuffer by fuch ridiculous conduct: Could we fpeak to the paffions of men, we would bid them think of their wives and children, and then confider of how great importance their own lives are. The office of zfoldier, in time of war, may be ranked atnongft the laborious employments. Soldiers fuffer many hardfhips from the inclemency of feafons, long marches, bad provifions, hunger, &c. Thefe occafion fevers, flux- es, rheumatifms, and other fatal difeafes, which generally do greater execution than the/word, efpecially when cam- paigns are continued too late in the year. One week of cqld OF-.,-. O----r~",rr.S, !:o. 33 cold rainy weather will kill more men, than many months, when* it is dry and warm. Those who have the command of armies, fhould take eare that their foldiers be well clothed and well fed. They ought alfo to finifh their campaigns in due feafon, and to provide their men with dry and well-aired winter-quarters. Thefe rules, taking care, at the fame time, to keep the fick at a proper diftance from thofe in health, would tend great- ly to preferve the lives of the foldiery*. Sailors may alfo be numbered amongft the laborious. They undergo great hardfhips from change of climate, the violence of weather, hard labour, bad provifions, &c. Sailors are of fo great importance both to the trade and fafe- ty of this kingdom, that too much pains can never be be- ftowed in pointing out the means of preferving their lives. One great fource of the difeafes of fea-faring people is excefs. When they get cm fhore, after having been long at fea, without regard to the climate, or their own confti-r tutions, they plunge headlong into all manner of riot, and often perfift till a fever puts an end to their lives. Thus intemperance, and not the climate, is often the caufe whv fo many of our brave failors die on foreign coafts. We would not have fea-faring people live too low ; but they will find moderation the beft defence againft fevers, and many other maladies. Sailors, when on duty, cannot avoid fometimes get- ting wet. When this happens, they fhould change their plothes as foon as they are relieved, and take every proper i1 method * It mufl indeed be acknowledged, that foldiers fuffer no lefs from i. vio- lence and intemperance in time of peace, than from hardfhips in time «t xsr. It" men are idle, they will be vicious. It would therefore be of great impor- tance, could a fcheme be formed for rendering the military, in (jimes of pf.ir-.-, both more healthy an'd more ufeful. Thefe defirable objects might, in our opinion, be obtained, by employing them for lome time every day, arO advancing their pay accordingly. By this means, idlenefs, the mother of vice, might be prevented, the price of labour lowered, public works, as harbours, canals, turnpike-roads, &c. might be made without hurting ma- nufactures ; and foldiers might be enabled to marry, and bring up children. A fcheme of this kind might eafily be conducted, fo as not to deprefs the martial fpirit, provided the men were only fo work five or fix hours every day, and always to work without doors : no foldier fhould be fufTered to work too long, or to follow any fedentary employment. Sedentary employ- ments render men weak and effeminate, and quite unfit for the hardfhips of war ; whereas working for a few hours every day without doors would inure them to the weather, Iracc their nerves, and increafe their ftrength an4, eour?.gc 34 OF LABOURERS, ARTIFICERS, kt. method to reftore perfpiration. They fhould not, in thia cafe, have recourfe to fpirits, or other ftrong liquors, but fhould rather drink fuch as are weak and diluting, of a pro- per warmth, and go immediately to bed, where a found fleep and a gentle fweat would fet all to rights. But the health of failors fuffefs' moft frorfi un-wholefome food. The conftant ufe of falted provifions vitiates their humours, and occafions the fcurvy, and other obftinate maladies. It is no eafy matter to prevent this difeafe in long voyages; yet we cannot help thinking, that rhuch might be done towards effecting fo defireable an end, Were due pains bellowed for that purpofe. For example, various roots, greens, and fruits, might be kept a long time at fea, as onions, potatoes, cabbages, lemons, oranges, tamarinds, apples, &c. When fruits cannot be kept, the juices of them, either frefh or fermented,m may. With thefe all the drink, and even the food of thefhip's company, ought to be acidulated in long voyages. Stale bread and beer likewife contribute to vitiate the" humours. Meal Will keep for a long time on board, of which frefh bread might frequently be made. Malt rod might be kept, and infufed with boiling Water at any time. This liquor, when drank even in form of Wort, is very Wholefome, and is found to be an antidote againft the fcur- vy. Small wines and cyder might likewife be plentifully laid in ; and fhould they turn four, they would ftill be ufe- ful as vinegar. Vinegar is a very great antidote againft difeafes, and fhould be ufed by all travellers, efpecially at fea. Such animals as can be kept alive, ought likewife to be carried on board, as hens, ducks, pigs, &c. Frefh broths made of portahle foup, and puddings made of peas, or other vegetables, ought to be ufed plentifully. Many other things will readily occur to people converfant in thefe matters, which would tend to preferve the health of that brave ani ufeful fet of men. We have reafon to believe, if due attention were paid to the diet, ?.r, clothing, &c. of fea-faring people, that they would be the moft healthy fet of men in the world ; but when thefe are neglected, the very reverfe will happen. 1 he belt medical antidote that we can recommend to fail- ors or foldiers on foreign coafts, is the Peruvian bark. 1 his will often prevent fevers, and other fatal difeafes. About OF LABOURERS, ARTIFICERS, &c. 35 About a drachm of it may be chewed every day ; or if this fliould prove difagreeable, an ounce of bark, with half an ounce of orange-peel, and two drams of fnake-root coarfe- ly powdered, may he infufed for two or three days in an Englifh quart of brandy, and half a.wine-glafs of it taken twice or thrice a-day, when the ftomach is empty. This has been found to be an excellent antidote againft fluxes, putrid, intermitting, and other fevers, in unhealthy cli- mates. It is not material in what form this medicine be itaken. It may either be infufed in water, wine, oripirits, as recommended above, or made into an electuary with fy- rup of lemons, oranges, or the like. The SEDENTARY. Though nothing can be more contrary to the nature of man than a fedentary life, yet, this clafs comprehends the far greater part of the fpccies. Almoft the whole female world, and in manufadturing countries, the major part of the males, may be reckoned fedentary*. Agriculture, the firft and molt healthful of all em- ployments, is now followed by few who are able to carry on any other bufinefs. But thofe who imagine that the culture of the earth is not fufficient to employ all its inha- bitants, are greatly miftaken. An ancient Roman, we are told, could maintain his family from the produce of one a- cre of ground. So might a modern Briton, if he would be contented to live like a Roman. This fhews what an im- menfe increafe of inhabitants Britain might admit of, and all of them live by the culture of the ground. Agriculture is the great fource of domeftic riches. Where it is neglected, whatever wealth may be imported ■from abroad, poverty and mifery will abound at home. Such is, and ever will be, the fluctuating ftate of trade and manufactures, that thoufands of people may be in full em- ployment to-day, and in beggary to-morrow. This can never happen to thqfe who cultivate the ground. They can eat the fru+Lof their labour, and can always by induftry obtain, at leaft, the neceflaries of life. Though * The appellation of fedentary has generally been given only to the ftud'i- pus; we can fee no reafon, however, for refti idling it to them alone. Ma- ny.ajrtificers .play, with.as much, propriety, be denominated fedentary as the ftudious, with this particular difadvantage, that they are often obliged to fit in very aukward poftures, which the iludious r.uJ not do, ufliefs they 36 OF LABOURERS, ARTIFICERS, kc. Though fedentary employments are neceffary, yet thefe feems to be no reafon why any perfon fhould be confined for life to thefe alone. Were fucrremployments intermix- ed with the more active and laborious, they would never do hurt. It is conftant confinement that ruins the health. A man fhall not be hurt by fitting four or five hours a-day ; but if he is obliged to fit ten or twelve, will foon contract, difeafes. But it is not want of exercife alone which hurts feden- tary people ; they often fuffer from the confined air which they breathe. It is very common to fee ten or a dozen tay- lors, or ftay-makers, for example, crouded into one fmall apartment, where there is hardly room for one fingle per- fon to breathe freely. In this fituation they generally con- tinue for many hours at a time, often with the addition of furrdry candles, which tend likewife to walte the air, and render it lefs fit' for refpiration. Air that is breathed re- peatedly, lofes its fpring, and becomes unfit for expanding the lungs. This is one caufe of the phthifical coughs, and other complaints of the breaft, fo incident to fedentary ^ar- tificers. Even the perfpiration from a great number of perfons pent up together, renders the air unwholefome. The dan- ger from this quarter will be greatly increafed, if any one of them happens to have bad lungs, or to be otherwife dif- eafed. Thofe who fit near him, being forced to breathe the fame air, can hardly fail to be infected. It would be a rare thing, however, to find a dozen of fedentary people all found. The danger of crowding them together muft there- fore be evident to every one.- Many of thofe who follow fedentary employments are conftantly in a bending pofture, as fhoemakers, taylors, cutlers, &c. Such a fituation is extremely hurtful. A bending pofture obftructs all the vital motions, and of courfe muft deftroy the health. Accordingly we find fuch artifi- cers generally complaining of indigeftions, flatulencies, headachs, pains of the breaft, &c. The aliment in fedentary people, inftead of being pufhed forwards by an erect pofture, the action of the mufcles, &c. is in a manner confined in the bowels. Hence indigeftions, coftivene'fs, wind, and ,other hypochondriacal fymptoms, 'the conftant companions of the fedentary, Indeed none of the excretions can be duly performed where exercife is wanting, OF LABOURERS, ARTIFICERS, &c. 37 wanting, and when the matter, which ought to be dif- charged in this way, is retained too long in the body, it muft have bad effects, as it is again taken up into the mafs of humours. «. A bending pofture is likewife hurtful to the lungs. When this organ is compreffed, the air cannot have free accefs into all its parts, fo as to expand them properly. Hence tubercles, adhefions, &c. are formed, which often end in confumptions. Befides, the proper action of the lungs be- ing abfolutely neceffary for making good blood, when that organ fails, the humours foon become univerfally depraved, and the whole conftitution goes to wreck. Sedentary artificers are not only hurt by preffure on the bowels, but alfo on the inferior extremities, which ob- flruits the circulation in thefe parts, and renders them weak and feeble. Thus taylors, fhoemakers, &c. frequently lofe the ufe of their legs altogether ; befides, the blood and humours are, by ftagnation, vitiated, and the perfpiration is obftructed: from whence proceed the fcab, ulcerous fores, foul blotches, and other cutaneous difeafes, fo com- mon among fedentary artificers. A bad figure of body is a very common confequence of clofe* application to fedentary employments. The fpine, for example, by being continually bent, puts on a crooked fhape, and generally remains forever after. But a bad fi- gure of body has already been obferved to be hurtful to health, as the vital functions, Sec. are thereby impeded. A fedentary life feldom fails to occafion an univerfal re- laxation of the folids. This is the great fource from whence moft of the difeafes of fedentary people flow. The fcro- phula, confumption, hyfterics, with all the numerous train of nervous difeafes, which now abound, were very little known in this country before fedentary artificers became fo numerous : and they are very little known ftill among fuch of our people as follow active employments without doors, though in the great manufacturing towns at leaft two-thirds of the inhabitants are afflicted with them. It is very difficult to remedy thofe evils, becaufe many who have been accuftomed to a fedentary life, like rickety children, lofe all inclination for exercife ; we fhall, howe- ver, throw out a few hints with refpect to the moft likely means of prcferving the health of this ufeful let of people, which $8 OF LABOURERS, ARTIFICERS, &c. which fome of them, we hope, will be wife enough to ob- ferve. It has been already obferved, that fedeatary artificers are often ljurt by their bending pofture. They ought there- fore to ftand or fit as erect as the nature of their employ- ments will permit. They fhould likewife change their pof- ture frequently, and fhould never fit .too long at a time; but leave off work and walk, ride, run, or do any fcfcing thatavjJJ promote the vital motions. Sedentary artificers are generally allowed too little time for exercife, yet, fhort as it is, they feldom employ it properly. A journeyman taylor or weaver, for example, inftead of walking abroad for exercile and frefh air, at his hours of leifure, chufes often to fpend them in a,public houfe, or in playing At fome fedentary game, by which he generally lofes both his time and his .money. The auk ward, poftures in which many fedentary artificers work, feem rather to b# the effect of cuftom than neceifity. For example, a table might furely-be contrived for ten or a dozen taylors to.fit round, with liberty for their legs either to hang down, or reft upon a foot-board, as they fliould chufe. A place .might likewife be cut out for each perfon, in fuch a manner that hemight fit as conveniently for work- ing as in the prefent mode of fitting crofs-legged. We would recommend to all fedentary artificers the moft religious regard to cleanlinefs. Both their fituation and oc- cupations render this highly neceffary. Nothing would contribute more to preferve fedentary artificers in health, than afttict attention to it; and fuch of them as negle£t it, not only run the hazard of lofin< their health, but of be- coming a nuifance to fociety. Sedentary people ought to avoid food that is windy, or hard-of digeftion, and fhould pay the firidteft regard to fobriety. A perfon who works hard without doors will foon throw off a debauch ; but one who fits has by.no means an equal chance. .Hence it often happens, that fedentary people are feized with-fevers after hard drinking or a feaft. Whon fuch perfons feel their fpirits low, .inftead of running to the tavern for relief, »they fhould ride, or walk in the fields. This would remove the complaint more effectually thaniflrong liquor, and would never hurt the conftitution. Instead of multiplying.particular rules for preferving Jhehealthof the fedentary, wc fhall recommend to them the OF LABOURERS, ARTIFICERS, &c. <& the following general plan, viz. That every perfon who follows a fedentary employment fhould cultivate a piece of ground with his own hands. This he might dig, plant, fow, and weed at Icifure-hours, fo as to make it both an exercife and amufement, while it produced many of the ne- ceffaries of life. After working an hour in a garden, a man will return with more keennefs to his employment within doors, than if he had been all the while idle. Labouring the ground is every way conducive to health. It not only gives exercife to every part of the body, but the very finell of the earth and frefh herbs revive and chearihc fpirits, whilft the perpetual profpect of fomething tuning" to maturity, delights and entertains the mind. We are fo made as to be always pleafed with forhewhat in profpecl, however diftant or however trivial. Hence the happinefs that moft men feel in planting, fowing, building, &c. Thefe feem to have been the chief employments of the ear- ly ages : and, when kings and conquerors cultivated the ground, there is reafon to believe, that they knew as well Wherein true happinefs confifted as we do. It may feem romantic to recommend gardening to ma- nufacturers in great towns ; but obfervation proves, that the plan is very practicable. In the town of Sheffield, in Yorkfhire, where the great iron manufacture is carried on, there is hardly a journeyman cutler who does not poflefs a piece of ground, which he cultivates as a garden. This practice has many fa!utary eftedts. It not only induces thefe people to take exercife without doors, but alfo to eat many greens, roots, &c. of their own growth, which they would never think of purchafing. There can be no reafon why manufacturers in any other town in Great Britain fliould not follow the fame plan. Mechanics are too much inclined to croud into great towns. This fituation may have fome advantages; but ic has likewife its difadvantages. All mechanics who live in the country have it in their power to poliefs a piece of ground ; which indeed moft of them do. This not only gives them exercife, but enables them to live more comfort- ably. So far at leaft as our obfervation reaches, mechanics who live in the country are far more happy than tho'fe in great towns. They enjoy better health, live in greater af- fluence, and feldom fail to rear a healthy and numerous off- fpring. 4© OF LABOURERS, ARTIFICERS, &c. In a word, exercife without doors, in one fhape or an- other, is abfolutely neceffary to health. Thofe who'ne- glect it, though they may for a while drag out life, can hardly be faid to enjoy it. Their humours are generally vitiated, their folids relaxed, and their fpirits depreffed. Of the S T U D I O U S. Intense thinking is fo deftructive to health, that few inftances can be produced of ftudious perfons who are ftrong and healthy, or live to an extreme old age. Hard ftudy always implies a fedentary life ; and, when intenfe thinking is joined to the want of exercife, the confequences muft be bad. We have frequently known even a few months of clofe application to ftudy ruin an excellent conftitution, by inducing a train of nervous complaints, which could never be removed. Man is evidently not formed for continual thought more than for perpetual adtion, and would be as foon worn out by the one as by the other. So great is the power of ,the mind over^the body, that, by its influence, the whole vital motions may be accelerated or retarded, to almoft any degree. Thus cheerfulnefs and mirth quicken the circulation, and promote all the fecrcti- ons; whereas fadneis and profound'thought never fail to re-? tard them. Hence it would appear, that even a degree of thoughtleflhefs is neceffary to health. Indeed, the perpe- tual thinker feldom enjoys either health or fpirits ; while the perfon, who can hardly be faid to think at all, generals ly enjoys both. Perpetual thinkers, as they are called, feldom think long. In a few years they generally become quite ftupid, and exhibit a melancholy proof how readily the greateft blefjings'may be abufed. Thinking, like every thing elfe, when carried to extreme, becomes a vice : nor can any thing afford a greater proof of wifdom, than for a man fre- quently and feafonably to unbend his rnind. This may ge- nerally be done by mixing in cheerful company, active di- verfions, or the like. Instead of attempting to inveftigate the nature of that connedtion which fubfifts between the mind and body, or to enquire into the manner in which they mutually affect. each other, we fhall only mention thofe difeafes to which the learned are more peculiarly liable, and endeavour to point out the means of avoiding them. Studious OF LABOURERS, ARTIFICERS, &c. 41 Studious perfons are very fubjedt to the gout. This painful difeafe is generally occafioned by indigeftion, and an obftructed perfpiration. It is impoffible that the man who fits from morning till night fhould either digeft his food, or have any of the fecietions in due quantity. But when that matter, which fhould be thrown off by the fkin, is retained in the body, and the humours are not duly pre- pared, difeafes muft enfu-j. The ftudious are often afHicteJ with the ftone and gra- vel. E;:ercife greatly promotes both the fecretion and dif- charge of urine ; consequently a fedentary life muft have the contrary effect. Any one maybe faiOfied of this by ob- Orving, that he pailes much more urine by day than in the nitiht, and alio when he walks or rides, than when he r fits. The circulation in the liver bring flow, obftrudtions in that organ can hardly fail to be the confequence of inadti- vity. Hence fedentary people are frequently afflicted with fchirrous'livers. But the proper fecretion and difcharge of the bile is fo neceffary a part of the animal oeconomy, that where thefe are not duly performed, the health muft foon be impaired. Jaundice, indigeftion, lofs of appetite, and a wafting of the whole bid,, feldom fail to be the confe- quences of a vitiated ftate, or obftrudtions of the bile. Few difeafes prove more fatal to the ftudious than con- fumptions of the lungs. It has already been obferved, that this or^an cannot be duly expanded in thofe who do not v tike proper exercife, and where that is the cafe, obftrudti- ons, adhefions, 5:c. will erafue. Not only want of exer- cife, but the pofture in which ftudious perfons generally fit, is very hurtful to the lungs. Thofe who read or write mucii are ready to contract a habit of bending forward*, and often prefs with their breaft upon a table or bench. This pofture cannot fail to hurt the lungs. No perfon can enjoy health who does not properly digeft his food. But intenfe thinking and inactivity never fail to weaken the powers of digeftion. Hence the humours be- come crude and vitiated, try folids weak and relaxed, and the whole conftitution goes to ruin. Long and intenfe thinking often occafions grievous head-achs, which bring on apoplexies, vertigos, palfics, and Oiher fatal difbrders. The beft way to prevent thefe is, never to ftudy too long at one time, and to keep the belly G re^ular^ 42 OF LABOURERS, ARTIFICERS, &c. regular, either by proper food, or taking frequently a little of fome opening medicine. Those who read or write much are often afflicted with fdre eyes. Studying by candle light is peculiarly hurtful to the fight. This'ought to be pradtifed as leldom as noftibie. When it is unavoidable, the eyes fliould be fhaded, and the head fhould not be held too low. When the eyes feel ftiff and painful, they fhould be bathed every night and morning in cold water, to which a little brandy may be added. It has already been obferved, that the excretions are very defective in the ftudious. The dropfy is often occafi- oned by the retention of thofe humours which ought to be carried off in this way. Any perfon may obferve, that fit- ting makes his legs fwell, and that this goes off by eyer- cife ; which clearly points out the method of prevention. Fevers, efpecially of the nervous kind, are often the effect of ftudy. Nothing is fo deftructive to the nerves as intenfe thought. It in a manner unhinges the whole hu- man frame, and not only hurts the vital motions, but dif- orders the mind itfelf. Hence a delirium, melancholy, and even madnefs, are often the effect of clofe application to ftudy. In fine, there is no difeafe which can proceed either from a bad ftate of the humours, a defect of the ufu- al fecretions, or a debility of the nervous fyilem, which may not be induced by intenfe thinking. The moft afflicting of all the difeafes which attack the ftudious is, the hypochondriac. This difeafe feldom fails to be the companion of deep thought. It may rather be called a complication of maladies, than a fingle one. To what a wretched condition are the beft of men often reduced by it ? Their ftrength and appetite fail ; a perpetual gloom hangs over their njinds ; they live in the conftant dread of death, and are continually in fearch of relief from medi- cine, where, alas! it is not to be found. Thofe who la- bour under this diforder, though they be often made the fubject of ridicule, juftly claim our higheft fympathy and compaffion. Hardly any thing can be more prepofterous than for a perfon to make ftudy his fole bufinefs. A mere ftudent is feldom an ufeful member of fociety. He often negledls lhe#oft important duties of life, in order to purfue ftudies of a very trifling nature. Indeed it rarely happens, that any ufeful *•, \ OF LABOURERS, ARTIFICERS, &c. 43 ufeful invention is the effect of mere ftudy. The farther men dive into profound refcarches, they generally deviate the more from common fenfe, and too often lofe fight of it altogether. Profound fpeculations, inftead of making men wifer or better, generally render them abfolute fceptics, and overwhelm them with doubts and uncertainty. Alt that is neceffary for man to know, in order to be happy, is eafily obtained, and the reft, like the forbidden tree, ferves only to incieafe his mifery. Studious perfons, in order to relieve their minds, muft not only difcontinue to read and write, but engage in fome employment or diverfion, that will fo far occupy the thought as to make them forget the bufinefs of the clofet. A folitary ride or walk are fo far from relaxing the mind, that they rather encourage thought.' Nothing can divert the mind, when it gets into a train of ferious thinking, but attention to fubjedts of a more trivial nature. Thefe prove a kind of play to the mind, and confequently relieve it. Learned men often contract a contempt for what they Call trifling company. They are afhamed to be feen with any but philofophers. This however is no proof of their being philofophers themfelves. No man deferves that name who is afhamed to unbend his mind by affociating with the cheerful and gay. Even the fociety of children will relieve the mind, and expel the gloom, which application to ftudy is too apt to occafion. As ftudious people are neceffarily much within doors, they fhould make choice of a large and well-aired place for ftudy. This would not only prevent the bad effedts which attend confined air, but would cheer the fpirits, and have a moft happy influence both on the body and mind. It is faid of Euripides the Tragedian, that he ufed to retire to a dark eave to compofe his tragedies, and of^Demofthenes the Grecian orator, that he chofe a place for ftudy where no- thing could either be heard or feen. With all deference to fuch venerable names, we cannot help condemning their tafte. A man may furely think to as good purpofe in an e- legant apartment as in a cave ; and may have as happy ideas Where the all-cheering rays of the fun render the air whole- fome, as in places where they never reach. * Those who read or write much fhould be very attentive to their pofture. They ought to fit and ftand by turns, al- ways keeping as nearly in an erect pofture as poffible. Thofe who 44- OF LABOURERS, ARTIFICERS, kc. who dictate may do it walking. It has an excellent effedr. frequently to read or fpeak aloud. This not only exercifes the lungs, but almoft the whole body. Hence ftudious, •„ people are greatly benefited by delivering difcourfes in pub- lic. Such indeed fometimes hurt thtmfelves by over-acting their part; but this is their own fault. The man who dies a martyr to mere vociferation merits notour fympathy. The morning has by all medical writers beer, reckon- ed the beft time for ftudy. It is fo. Put it is alfo the moft proper feafon for exercife, while the ftomach is tmpty, and the fpirits refrefhed with fletp. Studious people fhould therefore fometimes fpend the morning in walking, riding, or fome manly diverfions without doors. This would make them return to ftudy with greater alacrity, and would be of more fervice than twice the time after their fpirits are worn out with fatigue. It is not fufficient to take diverfion only when we can think no longer. Every ftudious perfon fhould make it a part of his bufinefs, and fhould let nothing inter- rupt his hours of recreation more than thofe of ftudy. Music has a very happy effect in relieving the mind when fatigued with ftudy. It would be well if every ftudi- ous perfon Were fo far acquainted with that fcience as to a- mufe himfeJf after fevere thought, by playing fuch airs as have a tendency to raife the fpirits, and infpire cheerfulnefs and good-humour. It is the reproach of learning, that fo many of her vo- taries, to relieve the mind after ftudy, betake themfelves to the ufe of ftrong liquors. This indeed is a remedy; but it is a defperate one, and always proves deftructive. Would fuch perfons, when their fpirits are low, get on horfeback, and gallop ten or a dozen miles, they would find it a more effectual remedy than any cordial medicine in the apothe- cary's fhop, or a£ the ftrong liquors in the world. It is much to be regretted that learned men, while in health, pay fo little regard to thefe things ! Nothing is more common than to fee a miferable objedt over-run with ner- vous difeafes, bathing, walking, riding, and, in a word, doing every thing for health after it is gone; yet, if any one had recommended thefe things to him by way of preventi- on, the advice would, in all probability, have been treated with contempt, or, at leaft, with neglect. Such is the weaknefsand folly of mankind, and fuch the want of fore- sight, even in thofe who ou?ht to be wifer than others. .' " With i* OF LABOURERS, ARTIFICERS, &c. 45 With regard to the diet of the ftudious, we fee no rea- fon why they fhould abftain from any kind of food that is wholefome, provided they ufe it in moderation. They ought, however, to be fparing in the ufe of every thing that is four, windy, rancid, or hard of digeftion. Their fuppers fhould always be light, and taken foon in the even- ing. Their drink may be water, fine malt liquor, not too ftrong, good cyder, wine and water, or, if troubled with acidities, water mixed with a little brandy. We fhall only obferve, with regard to thofe kinds of ex- ercife which are moft proper for the ftudious, that they fhould not be too violent, nor ever carried to the degree of exceffive fatigue. They ought likewife to be frequently va- ried, fo as to give action to all the different parts of the bo- dy ; and fhould, as often as poffible, be taken in the open air. In general, riding on horfeback, walking, working in a garden, or playing at fome active diverfions are the beft. We would likewife recommend the ufe of the cold bath to the ftudious. It will, in fome meafure, fupply the place of exercife, and fhould not be neglected by perfons of a relaxed habit, efpecially in the warm feafon. The ftudious ought neither to take exercife, nor to ftu- dy immediately after a full meal. CHAP. III. OF ALIMENT. UNWHOLESOME food, and irregularities in diet, occafion many difeafes. There is no doubt but the whole conftitution of body may be changed by diet. The fluids may be thereby attenuated or corderOcd, rendered mild or acrimonious, coagulated or diluted, to almoft any degree. Nor are its effects upon the folids lefs confider- able. They may be braced or relaxed, hue their fenfibili- ty, motions, &c. greatly increafed or diminifhed, by dif- ferent kinds of aliment. A very fmall attention to thefe things 46 OF ALIMENT. things will be fufficient to fhew, how much the prefervati- on of health depends upon a proper diet. Nor is an attention to diet neceffary for the prefervation of health only : It is likewife of importance in the cure of difeafes. Every intention, in the cure of many difeafes, may be anfwered by diet alone. Its effects, indeed, are not always fo^juick as thofe of medicine ; but they are general- ly more lafting: Befides, it is neither fo difagreeable to the patient, nor fo dangerous as medicine, and is always more eafily'obtained. Our intention here is not to enquire minutely into the nature and properties of the various kinds of aliment in ufe among mankind ; nor to fhew their effects upon the dif- ferent conftitutions of the human body ; but to mark fome of the moft pernicious errors which people are apt to fall into, with refpedt both to the quantity and qualities of their food, and to point out their influence upon health. It is not indeed an eafy matter to afcertain the exadl quantity of food proper for every age, fex, and conftituti- on : But a fcrupulous nicety here is by no means neceffary, The beft rule is to avoid all extremes. Mankind were ne- ver intended to weigh and meafure their food. Nature teaches every creature when it has enough ; and the calls of thirft and hunger are fufficient to inform them when more is neceffary. Though moderation be the chief rule with regard to the quantity, yet the quality of food merits farther confiderati- on. There are many ways by which provifions may be ren- dered unwholefome. Bad feafons may either prevent the ripening of grain, or damage it afterwards. Thefe, indeed, are acts of Providence, and we muft fubmit to them; but furely no punifhment can be too fcvere for thofe who fuffer provifions to fpoil by hoarding them, on purpofe to raife the price. The foundeft grain, if kept too long, becomes unfit for ufe*. Animal, as well as vegetable food, maybe rendered un- wholefome, by being kept too long. All animal fubftan- ces * The poor, indeed, are generally the firft who fuffer by unfound provi- fions ; but the lives of the labouring poor are of <»reat importance to the ftate: Befides, difeafes occafioned by unwholefome food often prove infed"ri- ous, by which means they reach people in every (ration. It is therefore the intereft of all to take care that no fpoilt provifions of any kind be expofed to Tale. OF ALIMENT. 47 ces have a conftant tendency to putrefaction ; and, when that has proceeded too far, they not only become offenfive to the fenfes„ but hurtful to health. JDifeafed animals, and fuch as die of themfelves, ought never to be eaten. It is a common practice, however, in fome grazing countries, for fervants and poor people to cat fuch animals as die of any difeafe, or an; killed by accident. Poverty, indeed, may oblige people to do this ; but they had better eat a fmaller quantity of what is found and wholefome: It would both afford 1 better nourifhment, and be attended with lefs dan- ger. The injunctions given to the Jews, not to eat any crea- ture which died of itfelf, feera to have a ftridt regard to health ; and ought to be obferved by Chrjftians as well as Jews. Animals never die of themfelves without fome pre- vious dife*afe ; but how a difeafed animal fhould be whole- fome food, is inconceivable: Even thofe which^lie by ac- cident muft be hurtful, as their blood is mixed with the flefh, and foon turns putrid. Animals which feed grofsly, as tame ducks, fwine,cjsV. are neither eafily digefted, nor afford wholefome nourifh- ment. No animal can be wholefome which does not take fufficient exercife. Moft of our flailed cattle, hogs, &V. are crammed with grofs food, but not allowed exercife nor free air ; by which means they indeed grow fat, but their humours, not being properly prepared or affimulated, re- main crude, and occafion indigeftions, grofs humours, and oppreffion of the fpirits, in thofe who feed upon them. Animals are often rendered unwholefome by being over-heated. Exceffive heat caufes a fever, exalts the ani- mal falts, and mixes the blood fo intimately with the flefh, that it cannot be feparated. For this reafon butchers fhould be feverely puniihcd who over-drive their cattle. No per- fon would chufe to eat the flefh of an animal which had died in a high fever; yet that is the cafe with all over-drove cattle ; and the fever is often raifed even to the degree of madnefs. But this is not the only way by which butchers render meat unwholefome. The abominable cuftom of filling,the cellular membrane of animals with air, in order to»make them appear fat, is every day pradtifed. This not only fpoils the meat, and renders it unfit for keeping, but is fuch a dirty trick, that the very idea of it is fufficient to difguft I 48 OF ALIMENT. a perfon of any delicacy at every thing which comes from the fhambles. ' Who can bear the thought of eating meat which has been blown up with air from the lungs of a dir- ty fellow, perhaps labouring under the very worft of dif- eafes ? No people in the world eat fuch quantities of animal food as the Englifh ; this is one reafon why they are fo ge- nerally tainted with the fcurvy, and its numerous train of confequences, as indigeftion, low fpirits, hypochondriac- ifm, he. Animal food was furely defigned for man, r.nd, with a proper mixture of vegetables, it will be found the mo't whoHbme ; but, to gorge beef, mutton, pork, fifh, and fowl, twice or thrice a day, is certainly too much. All who value health ought to be contented with making one meal of flefh-nieat in the twenty-four hours, and this ou^ht to onfift of one kind only. The moft obftinate fcurvy has often been cured by a ve- getable dfct ; nay, milk alone will frequently do more in that difeafe than any medicine. From hence it is evident, that if vegetables and milk were more ufed in diet, we fliould have lefs fcurvy, and likewife fewer putrid and in- flammatory fevers. Our aliment ought neither to be toomoift, n^r too dry. Moift aliment relaxes the folids, and renders the body fee- ble. Thus we fee females, who live much .on tea and other watery diet, generallv become weak, apd unable to'digeft folid food ; from whence proceed hyfterics, and all their dreadful confequences*. On the other hand, food that is too dry, renders the folids in a manner rigid, and the hu- mours vifcid, which difpofes the body to inflammatory fe- vers, fcurv.ies, and the like. The arts of cookery render many things unwholefome, which are not fo in their own nature. By^jumbling toge- ther * Much has been faid on the ill efferts of tea in diet. They are, no doubt, numerous; but they proceed rather from the imprudent ufe of it, than from any bad qualities in the tea itfelf. Tea is now the univerfal breakfaft in this part of the world ; but the morning is furely the moft improper time of the day for drinking it. Moft delicate perfons, who, by the by, are the great- eft tea-di inkers, cannot eat any thing in the morning If fuch perfons, af- ter fading ten or twelve hou*s, drink five or fix cups of tea, without eating half an ounce of bread, it muft hurt them. Good tea, taken in moderate qUf.n^' n°,t t0° ftronS» nor to° hot» nor drunk upon an empty ftomach, will feldom do harm ; but if it be bad, which is often the cafe, or fubftitut- cd hi the room of folid food, it muft have many ill eflcfts. OF ALIMENT. 49 ther a number of different ingredients, in order t& make a poignant fauce, or rich foup, the compofit'ton proves al- moft a poifon. All high feafoning, pickles, &c. are only incentives to luxury, and never fail to hurt the ftomach. It we e well for mankind if cookerv, as an art, were entire* ly prohibited. Plain roafting or boiling is all that the fto- mach requires. Thefe alone are fufficient for people in health, and the fick have ftill lefs need of a cook. The liquid part of our aliment likewife claims our at- tention. Water is not only the bafis of moft liquors, but alfo compofes a great part of our folid food. Good water muft therefore be of the greateft importance in diet. The beft water is that which is moft pure, and free from any mixture of foreign bodies. Water takes up parts of moft bodies with which it comes into contact; by which means it is often impregnated with metals or minerals of a hurtful or poifonous nature. The inhabitants cf fome hilly countries have peculiar difeafes, which in all probability proceed from the water. Thus the people who live near the Alps in Switzerland, and the inhabitants of the Peak of Derby in England, have large tumours or wens on their necks. This difeafe is ge- nerally imputed to the fnow-water; but there is more rea- fon to believe it is owing to the the minerals in the moun- tains through which the waters pafs. When water is impregnated wit;h foreign bodies, it ge- nerally appears by its weight, colour, tafte, fmell, heat, or fome other fenfible quality. Our bufinefs therefore is to chufe fuch water, for common ufe, as islighteft, and with- out any particular colour, tafte, or fmell. In moft places of Britain the inhabitants have it in their power to make choice of their water, and few things would contribute more to health than a due attention to this article. But mere in-- dolence often induces people to make ufe of the water that is nearefl them, without confidering its qualities. Before water be brought into great towns, the ftridteit attention ought to be paid to its qualities, as many difeafes may be occafioned or aggravated by bad water; and, when once it has been procured at a great expence, people are unwilling to give it up. The common methods of rendering water clear by filtra- tion, or foft by expofing it to the fun and air, &c. are fo generally known, that it is unneceflary to fpend time in ex- H plaining 5? OF ALIMENT. ' plaining them. We fhall only, in general, advife all to avoid waters which ftagnate lorrg in fmall lakes, ponds, or the like, as fuch waters often become putrid. Even cattle frequently fuffer by drinking, in dry fcafons, water which has flood long in fmall reiervoirs, without being fupplied hy fprings, or frefhened with fhowers. All wells ought to be kept clean, and to have a free communication with the air- When either animal or vegetable fubftances are fuffer- ed to lie at the bottom of wells, they corrupt and taint the water. Even the air itfelf, when confined in wells, be- comes poifonous, and muft render the water lefs wholefome. As fermented liquors, notwithftanding they have been exclaimed againft by many writers, ftill continue to be the common drink of almoft every perfon who can afford them ; we fhall rather endeavour to affift people in their choice of thefe liquors, than pretend to condemn what cuftom has fo firmly eftablifhed. ft is not the moderate ufe of found fer- mented liquors which hurts mankind; it is excefs, and ufing fuch as are ill-prepared or vitiated. Fermented liquors, which are too ftrong, hurt digefti- on, rather than affift it; and the body is fo far from being ftrengthened by them, that it is weakened and relaxed. Many imagine, that hard labour could .not be fupported without drinking ftrong liquors : This is a very erroneous notion. Men who never tafte ftrong liquors are not only able to endure more fatigue, but alfo live much longer than thofe who ufe them daily. But, fuppofe ftrong liquors did enable a man to do more work, they muft neverthelefs wafte the powers of life, and occafion premature old age. They keep up a conftant fever, which exhaufts the fpirits, heats and inflames the blood, and difpofes the body to numberlefs difeafes. But fermented liquors may be too weak as well as too ftrong : When that is the cafe, they muft either be drunk new, or they become four and dead ; when fuch liquors are drunk new, the fermentation not being over, they ge- nerate air in the bowels, and occafion flatulencies ; and, when kept till ftale, they four on the ftomach, and hurt di- geftion. For this reafon all malt-liqours, cyder, &c. ought to be of fuch ftrength as to*keep till they be ripe, and then they fhould be ufed. When fuch liquors are kept too long, though they fhould not become four, yet they gene- rally contradt a hardnefs, which renders them unwholefome. Thus OF ALIMENT. 51 Thus we find that bottled ale hurts the ftomach, occafions the gravel, occ. All families, who can, ought to prepare their own li- quors. Since preparing and vending of liquors became one of the moft general branches of bufinefs, every method has been tried to adulterate them. The great object both of the makers and venders of liquor is, to render it intoxicating. But it is well known that this may be done by other ingre- dients than thofe which ought to be ufed for making it ftrong. It would be imprudent even to name thofe things which are daily made ufe of to render liquors heady. Suf- fice it to fay, .that the practice is very common, and that all the ingredients ufed for this purpofe are of a narcotic or flu- pifadtive nature. But, as all opiates are of a poifonous quality, it is eafy to fee what muft be the confequence of their general ufe. Though they do not'kill fuddenly, yet they hurt the nerves, relax and weaken the ftomach, and fpoil the digeftion, &c. Were fermented liquors faithfully prepared, kept to a proper age, and ufed in moderation, they would prove real bteffings to mankind. But, while they are ill prepared, va- rious ways adulterated, and taken to excefs, they muft have many bad confequences. We would recommend it to families, not only to prepare their own liquors, but likewife their bread. Bread is fo neceffary a part of diet, that too much care cannot be be- flowed in order to have it found and wholefome. For this purpofe, it is not only neceffary that it be made of good grain, but lilgewife properly prepared, and kept free from all unwholefome ingredients. This, however, we have reafon to believe, is not always the cafe with bread prepar- ed by thofe who make a trade of vending it. Their object is rather to pleafe the eye, than to confult the health. The beft bread is that which is neither too coarfe nor too fine ; well fermented, and made of wheat flour, or rather of wheat and rye mixed together. To fpecify the different kinds of aliment, to explain their nature and properties, and to point out their effects in different conftitutions, would far exceed the limits ©four defign. Inftead of a detail of this kind, which would not be generally underftood, and, of courfe, little attended to, we fhall only mention the following eafy rules with refpect to the choice of aliment. PERSONSj 52 OF ALIMENT. Persons, whofe folids are weak and relaxed, ovght to avoid all vifcid food, or fuch things as are hard of digefti- on. Their diet, however, ought to be folid ; and they fhould take plenty of exercife in the open air. Such as abound with blood fhould be fparing in the ufe of eyery thing that is highly nourifhing, as fat meat, rich wine*, ftrong ale, &c. Their food fhould confift moftly of bread and other vegetable fubftances j and their drink Ought to be water, whey, and the like. Fat people fhould not eat freely of oily nourifhing diet. They ought frequently to ufe radifh, garlic, fpices, or fuch things as are heating and promote perfpiration and urine. Their drink fhould be water, coffee, tea, or the like ; and they ought to take much exercife and little fleep. Those who are too lean muft follow an oppofite courfe. Such as are troubled with acidities, or whofe food is apt to four on their ftomach, fhould live much on flefh-meats ; and thofe who are afflicted with hot alkaline eructations, QUght to ufe a diet confifting chiefly of acid vegetables. People who are affected with the gout, low fpirits, hy- pochondriac;, or hyfteric difordcrs, ought to avoid all flatu- lent food, every thing that is vifcid, or hard of digeftion, all faltedor fmoke-dried provifions, and whatever is auftere, 3.cid, or apt to four on the ftomach. Their food fhould be light, fpare, cooj, and of an opening nature. The diet ought not only to be fuited to the age and con- ftitution, but alfo to the manner of life: A fedentary or ftu- dious perfon fhould live more fparingly than one who la- bours hard without doors. Many kinds of foqd will nourifh a peafant very well, which would be almoft indigeftible to a citizen ; and the letter will live upon a diet on which the former would ftarve. Diet ought not tp be. tpo uniform. The conftant ufe of one kind of food might have fome bad effects. Nature teaches us this, by the great variety of aliments which fhe has provided for man, and likewife by giving him an appe- tite for different kinds of food. Those who labour under any particular difeafe, ought to avoid fuch aliments zs have a tendency to increafe it: For example, a gouty perfon fhould not ufe rich wines, ftrong faups, or gravies, and fhould avoid all acids. One who is Sthibled with the gravel ought to ftun all auftere and a- ftringent \ OF ALIMENT. S1 flringent aliments ; and thofe wh» are fcorbutrc fhould not indulge in animal food, Sic. In the firft period of life, our food ought to be light, nourifhing, and of a diluting nature, but frequently ufed. Food that is folid, with a fufficient degree of tenacity, is mot proper for the ftate of manhood. The diet Anted to the laft period of life, when nature is upon the decline, ap- proaches nearly to that of the firft. It fhould he lighter, and more diluting than that of vigorous age, and likewife more frequently taken. It is not only neceffary for health that our diet be whole- fome, but alfo that it be taken at regular period*. Some imagine, that long fafting will atone for excels; but thi&, inftead of mending the matter, generally makes it worfe. WJien the ftjomach and inteftines are over-dif&ended with food, they lofe their proper tone,, and:, by long falling, they become weak, and inflated with wind. Thus, either gluttony or fafting deftroys the powers of digeftion. The frequent repetition of aliment is not only neceffary for repairing the continual wafteof our bodies, but like- wife to keep the humours found and fweet. Our humours, even in the moft healthy ftate, have a conftant tendency to become putrid, which can only be prevented by frequent fupplies of frefh nourifhment: When that is wanting too long, the putrefaction often proceeds fo far, as to occafion very dangerous fevers. From hence we may learn the ne- cefiity of regular meals. No perfon can enjoy a good ftate of health, whofe veffels are either frequently overcharged, or the humours long deprived of frefh fupplies of chyle. Long fafting is extremely hurtful to young people; it vitiates their humours, and prevents their growth and ftrength : Nor is it lefs injurious to the aged. Moft perfons, in the decline of life, are afflicted with wind: This com- plaint is not only increafed, but even rendered dangerous, and often fatal, by long fafting. Old people, when their ftomachs are empty, are frequently feized with giddinefs, headachs, and faintnefs. Thefe complaints may generally be removed by a bit of bread and a glafs of wine, or taking any other folid food; which plainly points out the method of preventing them. It is more than probable, that many of the fudden deaths, which happen in the advanced periods of life, are occafion- ed by fafting too long, as it exhaufts the fpirits, and fills the 54 OF ALIMENT. the bowels with wind ; we would therefore advife people,1 in the decline of life, never to allow their ftomachs to be too long empty. Many people take nothing but a tew cups of tea and a bit of bread, from nine o'clock at night till two or three next afternoon. Such may be faid almoft to fs.il three-fourths of their time. This can hardly fail to ruin the appetite, vitiate the humours, and fill the bowels with wind; all which might be prevented by a folid breakfaft. It is a very common practice to eat a light breakfaft and a heavy fupper. This cuftom ought to be reverted. When people fup late, their fupper fhould be very light; but the breakfaft ought always to be folid. If any one eats a light fupper, goes foon to bed, and rifes betimes in the morning, he will be fure to find an appetite for his breakfaft, and he may freely indulge it. , The ftrong and healthy do not indeed fuffer fo much from fafting as the weak and delicate ; but they run great hazard from its oppofite, viz. repletion. Many difeafes, efpecially fevers, are the effect of a plethora, or too great f-ulnefs of the veffels. Strong people, in high health, have generally a great quantity of blood and other humours. When thefe are fuddenly increafed, by an overcharge of rich and nourifhing diet, the veffels become too much dif- tended, and obftrudtions and inflammations enfue. Hence fo many people are feized with inflammatory and eruptive fevers, after a feaft or debauch. All great and fudden changes in diet are dangerous. What the ftomach has been long accuftomed to digeft, though lefs wholefome, will agree better with it than food of a more falutary nature which it has not been ufed to. When therefore a change becomes neceffary, it ought al- ways to be made gradually; as a fudden tranfition from a poor and low, to a rich and luxurious diet, or the contra- ry, might fo difturb the fundtions of the body as to endan- ger health, or even to occafion death itfelf. When we recommend regularity in diet, we would not be underftood as condemning every fmall deviation from it. It is next to impoffible for people at all times to avoid fome degree of excefs, and living too much by rule might make even the fmalleft deviation dangerous. It may therefore be prudent to vary a little, fometimes taking more, fometimes lefs, than the ufual quantity of meat and drink, provided aXways that regard be had to moderation. CHAP. C 55 ] CHAP. IV. OF AIR. UNWHOLESOME air is a very common caufe of difeafes. Few are aware of the danger arifing from it. People generally pay fome attention to what they eat and drink, but feldom regard what goes into the lungs, though the latter proves often more fuddenly fatal than the former. Air, as well as water, takes up parts of moft bodies with which it comes into contact, and is often fo replenifhed with thofe of a noxious quality, as to occafion immediate death. But fuch violent effects feldom happen, as people are generally on their guard againft them. The lefs per- ceptible influences of bad air prove more generally hurtful to mankind ; we fhall therefore endeavour to point out fome of thefe, and to fhew from whence the danger chiefly arifes. Air may become noxious many ways. Whatever great- ly alters its degree of heat, cold, moifture, &c. renders it unwholefome: For example, that whicnis too hot diffipates the watery parts of the blood, exalts the bile, and renders the whole humours aduft and thick. Hence proceed bilious and inflammatory fevers, cholera morbus,_ &c. Very cold air obftructs the perfpiration, conftringes the folids, and congeals the fluids. It occafions rheumatifms, coughs and catarrhs, with other difeafes of the throat, breaft, &c. Air that is too moift dtftroys the elafticity or fpring of the fo- lids, induces phlegmatic or lax conftitutions, and difpofes the body to agues, or intermitting fevers, dropfies, &c. Wherever great numbers of people are crouded into one place, if the air has not a-/ree current, it foon becomes unwholefome. Hence it is that delicate perfons are fo apt to turn fick or faint in crouded churches, affemblies, or any place where the air is exhaufted by breathing, fires, candles, or the like. In great cities fo many ■ things tend to pollute the air, that it is no wonder it proves fo fatal to the inhabitants. The air in cities is not only breathed repeatedly over, but ia 56 OF AIR. is likewife loaded with fulphur, fmoke, and other exhalati- ons, befides the vapours continually arifing from innumera- ble putrid fubftances, as dunghills, flaughterhoufes, &c. All poffible care fhould be taken to keep the ftreets of large towns open and wide, that the air may have a free current through them. They ought likewife to be kept very clean. Nothing tends more to pollute and contaminate the air of a city than dirty ftreets. It is very common in this country to have church-yards in the middle of populous cities. Whether this be the ef- fect of ancient fuperftition, or owing to the increafe of fuch towns, is a matter of no confequence. Whatever gave rife to the cuftom, it is a bad one. It is habit alone which re- conciles us to thefe things ; by means of which the moft ri- diculous, nay, pernicious cuftoms, often become facred. Certain it is, that thoufands of putrid carcaffes, fo near the furface of the earth, in a place where the air is confined, cannot fail to taint it; and that fuch air, when breathed into the lungs, muft occafion difeafes*. Burying within churches is a practice ftill more deferr- able. The air in churches is feldom good, and the effluvia from putrid carcaffes muft render it ftill worfe. Churches are commonly old buildings with arched roofs. They are feldom open above once a week, are never ventilated by fires nor open windows, and rarely kept clean. This oc- eafions that damp, mufty, unwholefome fmell which one feels upon entering a church, and renders it a very unfafe place for the weak and valetudinary. Thefe inconvenien- ces might, in a great meafure, be obviated by prohibiting all perfons from burying within churches, by keeping them clean, and permitting a ftream of frefh air to pafs frequent- ly through them by openingoppofite doors and windows, &c. Wherever air ftagnates long, it becomes unwholefome. Hence the unhappy perfons confined in jails not only con- tract malignant fevers themfelves, but often communicate them to others. Nor are many of the holes, for we can- not call them houfes, poffeffed by the poor in great towns, much better than jails. Thefe low dirty habitations are the very lurking places of bad air and contagious difeafes. Such * In moft eaftcrn countries i* was cuftomary to bury the dead at fome diftance from any town. As this practice obtained among the Jews, the Greeks, and alfo the Romans, it is ftrangc that the weftern part? of Eu- rope fliould not have followed their example in a cuftom fo truly laudable. OF AIR. .57 Such as live in them feldom enjoy good health; and their children commonly die young. In the choice of a houfe, thofe who have it in their power ought always to pay the greateft attention to free open air. The various methods which luxury has invented to make houfes clofe and warm, contribute not a little to render them unwholefome. No houfe can be wholefome unlefs the air has a free paffage through it. For which reafon houfes ought daily to be ventilated by opening oppofite windows, and admitting a current of frefh air into every room. Beds, inftead of being made up as foon as people rife out of them, ought to be turned down and expofed to the frefh air from the open windows through the day. This would expel any noxious vapour, and could not fail to promote the health of the inhabitants. In hofpitals, jails, fhips, &c. where that cannot be con- veniently done, ventilators fhould be ufed. The method of expelling foul, and introducing frefh air, by means of ventilators, is a moft falutary invention, and is indeed the moft ufeful of all our modern medical improvements. It is capable of univerfal application, and is fraught with nume- rous advantages, both to thofe in health and ficknefs. Air which ftagnates in mines, wells, cellars, &c. is extremely noxious. That kind of air is to be avoided as the moft deadly poifon. It often kills almoft as quickly as lightening. For this reafon, people fhould be very cauti- ous in opening cellars that have been long fliut, or going down into deep wells, or pits, efpecially if they have been kept clofe covered. Many people who have fplendid houfes, chufe to fleep in fmall apartments. This conduct is very imprudent. A bed-chamber ought always to be well aired ; as it is gene- rally occupied in the night only, when all doors and win- dows are fhut. If a fire be kept in it, the danger becomes ftill greater. Many have been ftifted when aflcep by a fire m a fmall apartment. Those who are obliged, on account of bufinefs, tofpend the day in clofe towns, ought, if poffible, to fleep in the country. Breathing free air in the night will, in fame meafure, make up for'the want of it through the day. T^ii*: practice would have a greater effedt in preferving the health of citizens than is commonly imagined. I Delicate S8 O F A I R. Delicate perfons ought, as much as poffible, to avoid the air of great towns. It is peculiarly hurtful to the afth- matic and confumptive. Such perfons fhould fly cities as they would do the plague. The hypochondriac are like- wife much hurt by it. I have often feen perfons fo much af- flicted with this malady while in town, that it feemed im- poffible for them to live, who, upon being removed to the country, were immediately relieved. The fame obfervati- on holds with regard to nervous and hyfteric women. Many people, indeed, have it not in their power to change their fituation in queft of better air. All we can fay to fuch per- fons is, that they fhould go as often abroad into the open air as they can, that they fhould admit frefh air frequently into their houfes, and take care to keep them very clean. It was neceffary in former times, for fafety, to furround cities, colleges, and even fingle houfes, with high walls. Thefe, by obftrudting the free current of air, never fail to render fuch places damp and unwholefome. As fuch walls are now, in moft parts of this country, become ufelefs, they ought to be pulled down, and every method taken to admit a free paffage to the air. Proper attention to Air and Cleanliness would tend more to preferve the health of mankind, than all the endeavours of the faculty. Surrounding houfes too clofely with planting, or thick woods, likewife tends to render the air unwholefome. Wood not only obftrudts the free current of the air, but fends forth great quantities of moift exhalations, which render it con- fiantl) damp. Wood is very agreeable at a proper diftance jy-om a houfe, but fhould never be planted too near it, efpe- cially in a flat country. Many of the gentlemen's feats in England are rendered very unwholefome from the great quantity of wood which furrounds them. Houses fituated in low marfhy countries, or near large lakes of ftagnating water, are likewife unwholefome. Wa- ters which ftagnate not only render the air damp, but load it with putrid exhalations, which produce the moft dangerous and fatal difeafes. Thofe who are obliged to inhabit mar- fhy countries, ought to make choice of the dryeft fituations thfiy can find, to live generoufly, and to pay the flridteft regard to cleanlinefs. If frefh air be neceffary for thofe in health, it is ftill more fo for the fick, who often lofe their lives for want of it. The notion that fick people muft be kept very hot, is fo O F A I R. 5^ fo common, that one can hardly enter the chamber where a patient lies without being ready to faint, by reafon of the hot fuffocating fmell. How this muft affect the fick, any one may judge. No medicine is fo beneficial to the fick as frefh air. It is the moft reviving of all cordials, if it be adminiftered with prudence. We are not however to throw open doors and windows at random upon the fick. Frefh air i« to be let into the chamber gradually, and, if poffible, by opening the windows of fome other apartment. The air of a fick perfon's chamber may be greatly frefh- ened, and the patient much revived, by fprinkling the floor, bed, &c. frequently with vinegar, juice of lemon, or any other ftrong vegetable acid. In places where numbers of fick are crouded into the fame houfe, or, which is often the cafe, into the fame a- partment, the frequent ad million of frefh air becomes ab- folutely neceffary. Infirmaries, hofpitals, &c. often be- come fo noxious, for want of proper ventilation, that the fick run more hazard from them than from the difeafe. This is particularly the cafe when putrid fevers, dyfente- ries, and other infectious difeafes prevail. Physicians, furgeons, and others who attend hofpitals, ouoht, for their own fake, to take care that they be pro- perly ventilated. Such perfons as are obliged to fpend nwich of their time amongft the fick, run great hazard of being themfelves infected when the air is bad. All hofpi- tals, and places for the fick, ought to have an open fituatjr on, at fome diftance from any great town. > CHAP. V, OF EXERCISE. MANY people look upon the neceffity man is \mmmt of earning his bread by labour as a curfe. Be this as it may, it is evident from the ftrudture of the body, that exercife is not lefs neceffary than food for the prefervation pf health : Thofe whom poverty obliges to labour for daily bread, %o OF EXERCISE. bread, are not only the moft healthy, but generally the moft happy part of mankind. Induftry feldom fails to place fuch above want, and activity ferves them inftead of phytic. This is peculiarly the cafe with thofe who live by the cul- ture of the ground. The great increafe of inhabitants in infant colon its, and the common longevity of fuch as fol- low agriculture every where, evidently prove it to be the moft healthful as well as the moft ufeful employment. The love of activity fhews itfelf very early in man. So itrong is this principle, that a healthy youth cannot be re- trained from exercife, even by the fear of punifhment. Our love of motion is furely a ftrong proof of its utility. Na- ture implants no difpofition in vain. It feems to be a ca- tholic law throughout the whole animal creation, that no creature, without exercife, fhould enjoy health. Every creature, except man, takes as much of it as is neceffary. He alone, and fuch animals as are under his direction, de- viate from this original law, and they fuffer accordingly. Inactivity never fails to induce an univerfal relaxati- on of the folids, which occafions innumerable difeafes. When the folids are relaxed, neither thedigeftion, nor any of the fecretions, can be duly performed. In this cafe, the worft confequences muft enfue. How can perfons who loll all day in eafy chairs, and fleep all night on beds of down, fail to be relaxed ? Nor do fuch greatly mend the matter, who never ftir abroad but in a coach, fedan, or fuch like. Thefe elegant pieces of luxury are become fo common, that the inhabitants of great towns feem to be in fome danger of lofing the ufe of their limbs altogether. 'Tis now below any one to walk who can afford to be carried. How ridi- culous would it feem, to a perfon unacquainted with mo- dern luxury, to behold the young and healthy fwinging along on the fhoulders of their felloyv-creatures ! or to fee a fat carcafe, over-run with difeafes occafioned by inactivity, dragged along the ftreets by half a dozen horfes*. Glandular obftrudtions, which are now fo common, generally proceed from inactivity. Thefe are the moft ob- ftinate ^Wt is by no means ncceflity, but fafhion, which makes the ufe of ma- chines fo common I know many people who have not exercife enough to keep their humours from ftagnation, who yet dare not venture to make avi- f;t to their next neighbours, but.in a coach or fcdan, for fear of bei;iglook- ed dow^ipon. Strange that men (hould be fuch fools as to be laughed out of the ufe of their limbs, or to throw away their health, ia order to gratify a piece of vanity, or to comply with a ridiculous falhion. OF EXERCISE. 61 ftinate of all maladies. So long as the liver, kidnies, and other glands, duly perform their functions, health is feldom impaired ; but, when they fail, nothing can preferve it. Exercife is almoft the only cure we know for glandular ob- ftrudtions ; indeed, it does not always fucceed as a remedy; but there is reafon to believe that it would feldom fail to prevent thefe complaints, were it ufed in due time. One thing is certain, that, amongft thofe who take fufficient ex- ercife, glandular difeafes are very little known ; whereas the indolent and inadtive are feldom free from them. Weak nerves are the conftant companions of inactivity. Nothing but exercife and open air can brace and ftrength- en the nerves, or prevent the endlefs train of difeafes which proceed from a relaxed ftate of thefe organs. We feldom hear the adtive or laborious complain of nervous difeafes; thefe are referved for the fonsof eafe and affluence. Many have been completely cured of thefe diforders by being re- duced, from a ftate of opulence, to labour for their daily bread. This plainly points out the fources from whence nervous difeafes flow, and the means by which they may be prevented. It is abfolutely impoffible to enjoy health, where the perfpiration is not duly carried on ; but that can never be the cafe where exercife is neglected. When the matter which ought to be thrown ofTby perfpiration is retained in the body, it vitiates the humours, and occafions the gout, fevers, rheumatifm, &c. Exercife alone would prevent many of thofe difeafes which, cannot be cured, and would remove others where medicine proves ineffedtual. A late author*, in his excellent treatife on health, fays, that the weak and valetudinary ought to make exercife a part of their religion. We would recommend this, not .only to the weak and valetudinary, but to all whofe bufinefs does not oblige them to take fufficient exercife, as fedentary artificers f, fhop-keepers, ftudious perfons, &c. Such ought to ufe exercife as regularly as they take food. This might * Cheyne. jA f Sedentary occupations ought chiefly to be followed by women^^hey bear confinement much better than men, and are fitter for every kind of bufinefs which does not require much ftrengtii. It is ridiculous enough to fee a lufty fellow making pins, needles, or watch-wheels, while many of the laborious parts of hufbandry are carried on by the other fex. The fad is, v/c want men for laborious employmeHts, while one half of the other fex are rendered 62 OFEXERCISE might generally be done without any interruption to bufi» nefs or real lofs of time. No piece of indolence hurts the health more than the modern cuftom of lolling a-bed too long in a morning. This is the general pradtice in great towns. The inhabi- tants of cities feldom rife before eight or nine o'clock; but the morning is undoubtedly the belt time for exercife, while the ftomach is empty, and the body refrefhed with fleep. Befides, the morning-air braces and ftrengthens the nerves, and, in fome meafure, anfwers the_pjjrpofe of a cold bath. Let any one who has been accuftomed to lie a-bed till eight or nine o'clock, rife bvfixor feven, fpend a couple of hours in walking, riding, or any adtive diverfion without doors, and he will find his fpirits cheerful and ferene through the day, his appetite keen, and his body braced and flrength- ened. Cuftom foon renders early riftng agreeable, and no- thing contributes more to the prefervation of health. The inadtive are continually complaining of pains of the ftomach, flatulencies, indigeftions, &c. Thefe complaints, which pave the way to many others, are not to be> removed by medicine^. They can only be cured by a vigorous courfe of exercife, to which indeed they feldom fail to yield. Exercise, if poffible, ought always to be taken in the open air. When that cannot be done, various methods may be contrived for exercifing the body within doors, as the dumb bell, dancing, fencing, &c. It is not neceffary to adhere ftridtly to any particular kind of exercife. The beft way is to take them by turns, and to ufe that longeft which is moft fuitable to the ftrength and conftitution. Thefe kinds of exercife which give action to moft of the bodily organs, are always to be preferred, as walking, running, riding, digging, fwimming, and fuch like. It is much to be regretted, that adtive and manly diver- fions are now fo little pradtifed. Diverfions make people take more exercife than they otherwife would do, and are of the greateft fervice to fuch as are not under the neceifity pf labouring for their bread. As active diverfions lofe ground, thofe of a fedentary kind feem to prevail. Seden- tary j^erfions are of no other ufe but to confume time. In- ™ flead rendered ufelefs for want of occupations fulted to their ftrength, &c. Were girls bred to mechanical employments, we (hould not fee fuch numbers of them profUtste themfelves for bread, nor find fuch a want of meu for the important pUrpof«s of navigation, agriculture, &c. OF EXERCISE. 63 flead of relieving the mind, they often require more thought than either ftudy or bufinefs. Every thing that induces people to fit ftill, unlefs it be fome neceffary employment, ought to be avoided. The diverfions which afford the beft exercife are, hunt- ing, fhooting, playing at cricket, hand-ball, golff*, &c. Thefe exercife the limbs, promote perfpiration, and the o- ther fecretions. They likewife ftrengthen the lungs, and give firmnefs and agility to the whole body. Such as can, ought to fpend two or three hours a-day on horfeback ; thofe who cannot ride fhould employ the fame time in walking, Exercife fhould never be continued too long. Over-.fatigue prevents the benefit of exercife, and weakens inftead of ftrengthening the body. Every man fhould lay himielf under fome fort of necef- fity to take exercife. Indolence, like all other vices, when indulged, gains ground, and at length becomes agreeable. Hence many who were fond of exercife in the early part of life, become quite averfe to it afterwards. This is the cafe of moft hvpochondriac and gouty people, which renders their difeafes in a great meafure incurable. In fome countries laws have been made, obliging every man, of whatever rank, to learn fome mechanical employ- ment. Whether fuch laws were defigned for the preferva- tion of health, or the encouragement of manufacture, is a queftion of no importance. Certain it is, that if gentlemen were frequently to amufe and exercife themfelves in this way, it might have many good effects. They would at leaft derive as much honour from a few mafterly fpecimens of their own workmanfhip, as from the character of having ruined moft of their companions by gaming, or drinking. Befides, men of leifure, by applying themfelves to the me- chanical aits, might improve them, to the great benefit of fociety. Indolence not only occafions difeafes, and renders men ufelefs to fociety, but promotes all manner of vice. To fay a man is idle, is little better than calling him vicious. The mind, if not engaged in fome ufeful purfuit, is conftantly in queft of ideal pleafures, or impreffed with the apprahtn- ^ion * GoltTis a dOerfion very common in North Britain. It is weH calculat- ed for exerciiing the body, and may always be taken in fuch moderation, as neither to over-heat nor fatigue. It has greatly the preference over cricket, tennis, or any of thofe games which cannot be played without violence. 4 64 OF EXERCISE. fionof fome imaginary evil. From thefe fources proceed moft of the miferies of mankind. Certainly man never was intended to be idle. Inadtivity fruftrates the very defign of his creation ; whereas an active life is the beft guardian of virtue, and the greateft prcfervative of health. CHAP. VI. OF SLEEP AND CLOTHING. SLEEP, as well as diet, ought to be duly regulated. Too little fleep weakens the nerves, exhaufts the Ipirits, and occafions difeafes ; and too much renders the msnd dull, the body grofs, and difpofes it to apoplexies, lethargies, and fuch liker A medium ought therefore to be obferved ; but this is not eafy to fix. Children require more fleep than grown perfons, the laborious than the idle, and fuch as eat and drink freely, than thofe who live abftemioufly. Be- fides, the real quantity of fleep cannot be meafured by time} as one perfon will be more refrefhed by five or fix, hours fleep than another by eight or ten. Children may always be allowed to take as much fleep as they pleafe; but, for adults, fix or feven hours is cer- tainly fufficient, and no one ought to exceed eight. Thofe who lie more than eight hours a-bed may flumber, but they can hardly be faid to fleep ; fuch generally tofs and dream away the fore-part of the night, fink to reft towards morn- ing, and dofe till noon. The beft way to make fleep found , andrefrefhing is to rife betimes. The indolent cuftom of lolling a-bed for nine or ten hours, not only makes the fleep lefs refrefhing, but relaxes the nerves, and greatly - weakens the conftitution. Nature points out night as the proper feafon for fleep. Nothing more certainly deftroysthe conftitution than night- wafching. It is great pity that a praftice fo deftruaive to health fhould be fo much in fafhion. How quickly the want of reft in due feafon will blaft the moft blooming complexi- on, or ruin the beft conftitution, is evident from the ghaftly countenances • OF SLEEP AND CLOTHING. 65 countenances of thofe who, as the phrafe is, turn day into night, and night into day. To make fleep refrefhi.ng, the following things are ne- ceffary. Firft, to take fufficient exercife in the open air, through the day ; next to eat a light fupper ; and laftly, to lie down with a mind as cheerful and ferene as poffible. It is certain that too much exercife will prevent fleep, as well as too little. We feldom however hear the adtive and laborious complain of reftlefs nights. It is the indo- lent and flothful who generally have thefe complaints. Is it any wonder that a. bed of down fhould not be refrefhing to a perfon who lolls all day in an eafy chair? A great part of the pleafure of life confifts in alternate reft and motion ; but they who negledt the latter can never relifh the former. The labourer enjoys more true luxury in plain food and found fleep, than is to found in fumptuous tables «nd downy pillows, where exercife is wanting. That light fuppers caufe found fleep, is true even to a proverb. Many perfons, if they exceed the leaft at that meal, are fure to have uneafy nights; and, if they fall a- fleep, the load and oppreffion on their ftomach and fpirits occafion frightful dreams, broken and difturbed repofe, night-mares, &c. Were the fame perfons to go to bed with a light fupper, or fit up till what they eat were pretty well digefted, they would enjoy found fleep, and rife re- frefhed and cheerful. There are indeed fome people who cannot fleep unlefs they have eat fome folid food at night, but this does not imply the necefiicy of a heavy fupper; be- fides, thefe are generally perfons who have accuftomed themfelves to this method, and who do not take a fufficient quantity of folid food through the day. Nothing more certainly difturbs our repofe than anxie- ty. When the mind is not at eafe, one feldom enjoys found fleep. That greateft of human bleffings often flies the wretch who needs it moft, and vifits the happy, the cheerful, and the gay. This is a fufficient reafon why every man fhould endeavour to be as eafy in his mind as poffible when he goes to reft. Many, by indulging grief and anxious thought, have banifhed found fleep fo long, that they could never afterwards enjoy it. Sleep, when taken in the fore-part of the night, is ge- nerally reckoned moft refrefhing. Whether this may be the effect of habit or not, is hard to fay j but, as moft peo- K pie 4 66 OF SLEEP AND CLOTHING. pie are accuftomed to go foon to bed in the early part of/ life, it may be prcfumeu that fleep at this feafon will prove moft refrefhing tp them ever after. But whether the fore- part of the night be beft for fleep or not, furely the fore- part of the day is fitter both for bufinefs and amufement. I hardly ever knew an early rifcr who did not enjoy a good ftate of health. Of CLOTHIN G. The clothing ought to be fuited to the climate. Cuftom has no doubt a very great influence in this article; but no cuftom can ever change the nature of things fo far, as to render the fame clothing fit for an inhabitant of Nova Zcm- bla and the ifland of Jamaica. It is not indeed neceffary to obferve an exact proportion betwixt the quantity of clothes we wear and thevdegree of latitude which we inha- bit ; but, at the fame time, proper attention ought to be paid to it, as well as to the opennefs of the country, the frequency and violence of ftorms, tiff. In youth, while the blood is hot and the perfpiration free, it is lefs neceffary to cover the body with a great quantity of clothes ; but, in the decline of life, when the fkin be- comes rigid and the humours more cool, the clothing fhould be increafed. Many difeafes in the latter period of life pro- ceed from a defect of perfpiration ; thefe may, in fome mea- fure, be prevented by a fuitable addition to the clothing, or by wearing fuch as are better calculated for promoting the difcharge from the fkin, as clothes made of cotton, flannel, &c. « Flannel indeed is now worn by almoft every young fellow. This cuftom is extremely prepofterous. It not only makes them, weak and effeminate, but renders flannel lefs ufeful at a time of life when it becomes more neceffary. No young perfon ought to wear flannel, unlefs the rheu- matifm or fome other difeafe renders it neceffary. The clothing ought likewife to be fuited to the feafon of the year. Clothing may be warm enough for fummer, which is by no means fufficient for winter. The greateft; Caution, however, is neceffary in making thefe changes.. We ought neither to put off our winter clothes too foon, nor to wear our fummer ones too long, In this country, the winter often fets in very early with great rigor, and we have frequently very cold weather even after the commence-. ment « OF SLEEP AND CLOTHING. 67 ment of the fummer months. It would likewife he prudent not to make the change all at once, but to do it gradually ; and indeed the changes of apparel in this climate ought to be very inconfiderable, efpecially among thofe who have paffed the meridian of life. Clothes often become hurtful by their being made fubfervient to the purpofes of pride or vanity. Mankind in all ages feem to have confidered clothes in this view; ac- cordingly their fafhion and figure have been continually va- rying with very little regard either to health, the climate, or conveniency. Even the human fhape is often attempted to be mended by drefs, and thofe who know no better, believe that man- kind would be monfters without its affiftance. AH attempts of this nature are highly pernicious. The moft deftrudive of them in this country is that of fqucezing the ftomach and bowels into as narrow a compafs as poffible, to pro- cure, what is falfely called, a fine fhape. By this practice the action of the ftomach and bowels, the motion of the heart and lungs, and almoft all the vital functions, are ob- flrudted. • Hence proceed indigeftions, fyncopes, or faint- ing fits, coughs, confumptions of the lungs, kfc. The feet likewife often fuffer by preffure. How a fmall foot came to be reckoned genteel, we fhall not pretend to fay; but certain it is, that this notion has made many.per- fons lame. Almoft nine tenths of mankind are troubled with corns : a difeafe that is feldom or never occafioned but by ftrait fhoes. Corns are not only very troublefome, but, by rendering people unable to walk, they may likewife be confidered as the remote caufe of other dileafes. In fixing on the clothes, due care fhould be taken to a- void all tight bandages. Garters, buckles, &c. when drawn too tight, not only prevent the free motion and ufe of the parts Ibout which they are bound, but likewife ob- firudt the circulation of the blood, which prevents the equal nourifhment and growth of thefe parts, and occafions va- rious difeafes. Tight bandages about the neck, as flocks, cravats, necklaces, &V. are extremely dangerous. They obftrua the blood in its courfe from the brain, by which means headachs, vertiges, apoplexies, and other fatal dif- eafes are often occafioned. The perfedion of drefs is to be eafy and clean. JNo- thin°; can be more ridiculous, than for any one to make 3 himfett 68 OF SLEEP AND CLOTHING. himfelf a flave to fine clothes. Such a one, and many fuch there are, would rather remain as fixt as a ftatue from morning to night, than difcompofe a lingle hair, or alter the pofition of a pin. Were we to recommend any parti- cular pattern for drefs, it would be that which is worn by the people called Quakers. They are always neat, clean, and often elegant, without any thing fuperfluous. What others lay out upon tawdry laces, ruffles, and iibands, they beftow upon fuperior cleanlinefs. Finery is only the af- feaation of drefs, and very often covers a great deal of dirt. We fhall only add, with regard to clothing, that it ought not only to be fuited to the climate, the feafon of the year, and the period of life ; but likewife to the tempera- ture and conftitution. Robuft perfons are able to endure either cold or heat better than the delicate; confequently may be lefs attentive to their clothing. But the precife quantity of clothes neceffary for any perfon cannot be de- termined by reafoning. It is entirely a matter of experience, and every man is the beft judge for himfelf what quantity of clothing is neceffary to keep him warm. CHAP. VII. OF INTEMPERANCE, A MODERN author * obferves, that temperance and exercife are the two beft phyficians in the world. He might have added, that if thefe were duly regarded, there would be little occafion for any other. Temperance may juftly be called the parent of health ; but numbers of mankind aa as if they thought difeafes and death too flow in their progrefs, and, by intemperance and deoauch, feem, as it were, to follicit their approach. The danger of intemperance appears from the very con- flruaion of the human body. Health depends on that ftate of the folids and fluids which fits them for the due perform- ance of the vital fundtions ; and, fo long as thefe go regu- larly on, we are found and well; but whatever difturbg them neceffarily impairs health. Intemperance, however, never • RoufTcau. OF INTEMPERANCE. 6* never fails todiforder the whole animal ceconomy ; it hurts the digeftion, relaxes the nerves, renders the different fe- cretions irregular, vitiates the humours, and occafions numbericfs difeafes. Th e analogy between the nourifhment of plants and animals affords a ftrong proofof the danger of intemperance. Moifture and manure*greatly promote vegetation; yet an over quantity of either will entirely prevent it. The beft things become hurtful, nay deftructive, when carried to excefs. From hence we learn, that the higheft degree of human wifdom confifts in regulating our appetites and paffi- ons foas to avoid all extremes. 'Tis that alone which en- titles us to the charafter of rational beings. The flave of appetite will ever be the difgrace of human nature. The Author of nature hath endued us with various paffi- ons, for the propagation of the fpecies, the prefervation of the individual, &c. Intemperance is the abufe of thefe pafii- ons: and moderation confifts in the proper regulation of them. Men, not contented with fatisfying the fimple calls of nature, create artificial wants, and are perpetuallyinfearcfi of fomething that may gratify them; but imaginary wants never can be gratified. Nature is content with little ; but luxury knows no bounds. Hence the epicure, the drunk- ard, and the debauchee feldom flop in their career till their money, or their conftitution fails: Then indeed they gene- rally fee their error when too late. It is impoffible to lay down fixt rules with regard to di- et, on account of the different conftitutions of mankind. The moft ignorant perfon however certainly knows what is meant by excefs ; and it is in the power of every man, if he chufes, to avoid it. The great rule of diet is to ftudy fimplicity. Nature delights in the moft plain and fimple food, and every ani- mal, except man, follows her dictates. Man alone riots. at large, and ranfacks the whole creation in quell of luxu- ries, to his own deftruaion. An elegant writer* of the laft age fpeaks thus of intemperance in diet; " For my " part, when I behold a fafhionable table fet out in all its " mao-nificence, I fancy that I fee gouts and dropfies, fe- " vers and lethargies, with other innumerable diftempers, f lvino- in ambufcade among the difhes." - 7 c. Nor * AdJifoa. 70 OF INTEMPERANCE. Nor is intemperance in other things lefs deftruaive than in diet. How quickly does the immoderate purfuit of car- nal pleafures, or the abufe of intoxicating liquors, ruin the beft conftitution ! Indeed thefe vices generally go hand in hand. Hence it is that we fo often behold the votaries of Bacchus and Venus, even before they have arrived at the prime of life, worn out with difeafes, and hafting with fwift pace to an untimely grave. Did men reflea on the painful difeafes, and premature deaths, which are daily oc- cafioned by intemperance, it would be fufficient to make them fhrink back with horror from the indulgence even of their darling pleafures. Intemperance does not hurt its votaries alone ; the in- nocent .too often feel the direful effeas of it. How many wretched oiphans are to be feen embracing dunghills, whofe parents, regardlefs of the future, fpent in riot and debauch what might have ferved to bring up their offspring in a de- cent manner ? How often do we behold the miferable mo- ther, with her helplefs infants, pining in want, while the cruel father is indulging his infatiate appetites ? Families are not only reduced to mifery, but even ex- tirpated by means of intemperance. Nothing tends fo much to prevent propagation, and to fhorten the lives of children, as the intemperance of parents. The poor man who labours all day, and at night lies down contented with his humble fare, can boaft a numerous offspring, while his pampered lord, funk in eafe and luxury, often languifhes without an heir to his ample fortunes. Even ftates and em- pires feel the influence of intemperance, and rife or fall as it prevails. Instead of mentioning the different kinds of intempe- rance, and pointing out their influence upon health, we fhall only, by way of example, make a few obfervations on one particular fpecies of that vice, viz. the abufe of intox- icating liquors. Every aa of intoxication puts nature to the expence of a fever in order to difcharge the poifonous draught. When this is repeated almoft every day, it is eafy to forefce the confequences. That conftitution muft be ftrong indeed which is able long to hold out under a daily fever ! But fe- vers occafioned by drinking do not always go offin a day •, they frequently end in an inflammation of the breaft, liver, or brain, and produce fatal effeas. Thotjch. OF INTEMPERANCE. ?l Though the drunkard fhould not fall by an acute dif- eafe, he feldom efcapes thofe of a chronic kind. Intoxi- cating liquors, when ufed to excefs, weaken the bowels and fpoil the digeftion; they deftroy the power of the nerves, and occafion paralytic and convulfive diforders ; they like- wife heat and inflame the blood, deftroy its balfamic quali- ty, render it unfit for circulation, and the nourifhment of the body. Hence obftruaions, atrophies, dropfies, and confumptions of the lungs. Thefe are the common ways in which drunkards make their exit. Difeafes of this kind, when brought on by hard drinking, feldom admit of a cure. Many people injure their health by drinking, who fel- dom get drunk. The continual habit of foaking, as it is called, though its effeas be not fo violent, is not lefs per- nicious. When the veffels arc kept conftantly full and up- on the ftretch, the different digeftions can neither be duly performed, nor the humours properly prepared. Hence moft people of this charaaer areafflidted with the gout, the gravel, ulcerous fores in the legs, &c. if thefe diforders do not appear, they are feized with low fpirits, hypochondria- cal diforders, and other fymptoms of indigeftion. Consumptions are now fo common, that it is thought one tenth of the inhabitants of great towns die of that dif- eafe. Hard drinking is no doubt one of the caufes to which we muft impute the increafe of confumptions. The great quantities of vifcid malt-liquor drank by the common peo- ple of England, cannot fail to render the blood fizy and un- fit for circulation ; from whence proceed obftrudtions and inflammations of the lungs. There are few great ale-drink- ers who are not phthifical : nor is that to be wondered at, confidering the glutinous and almoft indigeftible nature of ftrong ale. Those who drink ardent fpirits or ftrong wines run ftill a-reaier hazard; thefe liquors heat and inflame the blood, and tear the tender vefiels of the lungs in pieces; yet fo great is the confumption of them in this country that one would almoft be induced to think the inhabitantylived upon them*. Ths * We may form fome notion of the immenfe quantity of ardent fpirits. confrtmed in Great Britain from this circumflanee, that in the city of Edin- burgh afid its environs, befides th« great quantity of.foreign fpirits duly en- tered, and tne- ftill greater (yiiantity which is fupppfed to be Imuggled, it is computed that above two thanfand.privatc. ftilk are. conftantly employed ia «. preparing 72 OF INTEMPERANCE. The habit of drinking proceeds frequently from misfor- tunes in life. The miferable fly to it for relief. It ailords * them indeed a temporary eafe. But, alas, this folace is fhort lived, and when it is over, the fpirits fink as much below their natural pitch as they had before been railed a- bove it. Hence a repetition of the dofe becomes neceffary, »and every frefh dofe makes way for another, till the unhap- py wretch becomes a flave to the bottle, and at kngth falls a facrifice to what at firft perhaps was taken only as a medi- cine- No man is fo dejedted as the drunkard when his de- bauch is gone off. Hence it is, that thofe who have the greateft flow of fpirits while the glafs circulates freely, are of all others the moft melancholy when fober, and often put and end to their own miferable exiflence in a fit of fpleen or ill humour. Drunkenness not only proves deftruaive to health, but likewife to the faculties of the mind. It is ftrange that creatures who value themfelves on account of a fuperior de- gree of reafon to that of brutes, fhould take pleafure in finking fo far below them. Were fuch as voluntarily de- prive themfelves of the ufe of reafon, to continue ever after in that condition, it would feem but a juft punifhment. Though this be not the confequence of one adl of intoxi- cation, it feldom fails to fucceed a courfe of it. By a habit of drinking, the greateft genius is often reduced to a mere idiot*. Intoxication is peculiarly hurtfuj to young perfons. It heats their blood, impairs their ftrength, and obftruas their growth ; befides, the frequent ufe of ftrong liquors in the preparing a poifonous liquor called Moloffes. The common people have got fo univerfally into the habit of drinking this bafe fpirit, that, when a porter or labourer is fcen reeling along the ftreets, they fay, he has got molajfed.— Surrly this merits public attention. * It is amazing that our improvements in arts, learning, and politenefs have not put the barbarous cuftom of drinking to excels out of fafnion. It is indeed lefs common in South Britain than it was formerly ; but it ftill prevails very much in the North, where this relick of barbarity is miftaken for hofpitality. There no man is fuppofed t<» entertain his guefts well, who does not make them drunk. Forcing people to drink, is certainly the great- eft piece of rudenefs that any man can be guilty of. Manlinefs, complai- fance, or mere good nature, may induce a man to take his glafs, if urged to it at a time when he might as well take poifon. The cuftom oidrinkingtp excefs has long been out of fafhion in France ; and, as it begins to lofe ground among the politer part of the Englilh, we hope it will foon bebanilh- cd from every part of this ifland. OF INTEMPERANCE.- » 73 the early part of life deftroys the good effects of them after- wards. Thofe who make a praaice of drinking generous liquors when young cannot expea to reap any benefit from them as a cordial in the decline of life. Drunkenness is not only a moft abominable vice itfelf, but is an inducement to almoft every other vice. There is hardly any crime fo horrid that the drunkard will not per- petrate for the love of liquor. We have known mothers fell their children's clothes, the food that they fhould have eat, and afterwards even the children themfelves, in order to purchafe the accurfed draught*. C II A P. VIII. OF CLEANLINESS. T'H E want of cleanlinefs is a fault which admits of no excufe. Where water can be had for nothing, it is furely in the power of every perfon-to be clean. The con- tinual difcharge from our bodies by perfpiration renders fre- quent change of apparel neceflary. Changing apparel greatly promotes the fecretion from the fkin, fo neceffary for health. When that matter which ought to be carried oft" by perfpiration, is either retained in the body, or re- absorbed from dirty clothes, it often occafions cutaneous difeafes, fevers, &c. The itch, and feveral other difeafes of the fkin, are chiefly owing to want of cleanlinefs. They may indeed be caught by infe-aion, or brought on by* poor living, un- wholefome food, He. \ but they will feldom continue long where cleanlinefs prevails. To the fame caufe muft we impute the various kinds of vermin which infeft the human body, houfes, &c. Thefe may always be banifhed by cleaniipiefs alone, and wherever they abound, we have rea- fon to believe that it is negleaed. L One * Two women, both notorious drunkards, were executed at Edinburgh fome years ago, for murdering children, acd afterwards felling them to the furgeons for monej_to buy liquor. 7+ * OF CLEANLINESS. One common caufe of putrid and malignant fevers is the want of cleanlinefs. Thefe fevers commonly begin among the inhabitants of clofe dirty houfes, who breathe unwhole- fome air, take little exercife, and wear dirty clothes. 'I here the infection is generally hatched, which often fpreads far and wide, to the deftrudtion of many. Hence cleanlinefs ..may be confidered as an objea of public attention. It is not fufficient that I be clean myfelf, while the want of it in my neighbour affeas my health as well as his own. If dir- ty people cannot be removed as a common nuifance, they ought at leaft to be avoided as infeaious. All who regard their health fliould keep at a diftance even from their habi- tations. In places where great numbers of people are colkaed, cleanlinefs becomes of the utmoft importance. It is well knovn, that infectious difeafes are communicated by taint- ed air. Every thing therefore which tends to pollute the air, or fpread ihe infection, ought, with the utmoft care, to be guarded againft. For this reafon, in great towns, no filth, of any kind, fhould be permitted to lie upon the ftreets. Nothing is more apt to convey infeaion than the excrements of the difeafed. Thefe, in many cafes, arc known to be highly -infeaious. In many great towns the ftreets are little better than dunghills, being frequently covered with aflies, dung, and naftinefs of every kind. Even flaughter-houfes, or killing fhambles, are often to be feen in the very center of great towns. The putrid blood, excrements, &c. with which thefe places are generally covered, cannot fail to taint the air and render it unwholefome. How eafily might this be prevented by aaive magiflrat.es, who have it always in their power to make proper laws relative to things of this nature, and to enforce.the obfervance of them ? We are forry .to fay, that the importance of general cleanlinefs does by no means feem to be fufficiently under- ftood by the magistrates of moft great towns in Britain ; though health, pleafure, and honour, all confpire to re- commend an attention to it. Nothing can be more agree- able to the fenfes, more to the honour of the inhabitants, or more conducive to their health, than a clean town ; nor can any thing imprefs a ftranger with a more difrefpeaful idea of any people than its oppofite. Whatever pretenfions people may make to learning, politenefs, or civilization, we OF CLEANLINESS. 7f; we will venture to affirm, that, fo long as they negka cleanlinefs, they are in a ftate of barbarity*. The peafants in moft countries feem to hold cleanlinefs in a fort of contempt. Were it not for the open fituation of their houfes, they would often feel the bad effeas of this difpofition. One feldom fees a farm-houfe without a dunghill before the door, and frequently the cattle and their matters lodge under the fame roof. Peafants are like- wife extremely carelefs with refpea to change of apparel, keeping their houfes, &c. clean. This is merely the effea of indolence and a dirty difpofition. Habit may indeed render it lefs difagreeable to them, but no habit can ever make it falutary to wear dirty clothes, or breathe unwhcle- fome air f. In camps the ftriaeft regard fhould be paid to cleanli- nefs. By negligence in this matter, infoaious difeafes ar« often fpread amongft a whole army ; and frequently more die of thefe than by the fword. The Jews, during their encampments in the wildernefs, received particular inftruc- tions with refpea to cleanlinefs X- The rules enjoined them ought to be obferved by all in the like fituation. Indeed the whole fyftem of laws delivered to that people has a ma- nifeft tendency to promote cleanlinefs. Whoever considers the nature of their climate, and the difeafes to which they were liable, will fee the propriety of fuch laws. It * In ancient Rome the greateft men did not think cleanlinefs an objetl unworthy of their attention. Pliny fays, the Cloacae, or common gutters for the conveyance of filth and naftinels from the city, were the grejteft of all the public works ; and beftows higher encomiums upon Tarquinius, Agripp:i, and others who made and improved them, than on thofe who at- chieved the greateft conquefts. f As many articles of diet come through the hands of peafants, every me- thod fhould be taken to encourage and promote habits of cleanlinefs among them. This, for example, might be'done by giving a fmall premium to the perfon who brings the cleaneft and beft article of any kind to market, as butter, cheefe, &c. and by punilhing feverely thofe who bring it dirty. The fame method mould be taken with butchers, bakers, brewers, a/id all who are employed in preparing the neceflaries of life. f T'.ou (halt have a place alfo without the camp, whither thou (halt go forth abroad ; and thou (halt have a paddle upon thy weapon : and it (hall be when thou lhalt eafe thyfclt abroad, thou (halt dig therewith, and flialt turn *;ack, and cover O-t which comcth from thee, &c , JJcutcr. chap, xxiii. ver. i*. 13. 76 OF CLEANLINESS. It is remarkable, that, in moft eaftern countries, clean- linefs makes a great part of their religion. The Mahome- tan, as well as the Jewifh religion, enjoins various bathings, wafhings, and purifications. No doubt thefe were defign- ed to reprefent inward purity ; but they were at the fame time calculated for the* prefervation of health. However whim- fical thefe wafhings may appear to fome, few things would tend more to prevent difeafes than a proper attention to ma- ny of them. Were every perfon, for example, after vifit- ing the fick, handling a dead body, or the like, to wafli be- fore he went into company, or fat down to meat, he would run lefs hazard either of catching the infeaion himfelf, or of communicating it to others. Frequent wafhing not only removes the filth and fordes I which adhere to the fkin, but likewife promotes the per- ■' fpiration, braces the body, and enlivens the fpirits. How refreshed, how cheerful, and agreeable does one.feel on be- ing fhaved, wafhed, and fhifted ; efpecially when thefe offices have been- negleaed longer than ufual ! The eaftern cuftom of" wafhing the feet is not only a very agreeable piece of cleanlinefs, but contributes greatly to the prefervation of health. The fweat and dirt with which thefe parts are frequently covered, cannot fail to ob- flrua the perfpiration. This piece of cleanlinefs would often prevent colds and fevers. Were people careful to bathe their feet and legs in luke-warm water at night, af- ter being expofed to cold or wet through the day, they would feldom experience the jll effedts which often proceed from thefe caufes. A proper attention to cleanlinefs is no where more necef- fary than on fhipboard. If epidemical diftempers break out there, no one can be fafe. The beft way to prevent them is to take care that the whole company be cleanly in their clothes, bedding, &c. When infeaious difeafes do break out, cleanlinefs is the moft likely means to prevent their fpreading : It is likewife neceffary to prevent their return- ing afterwards, or being conveyed to other places. For this purpofe, the clothes, bedding, &c of the fick ought to be carefully wafhed, and fumigated with brimfloife. In- feaion will lodge a long time in dirty clothes, and after- wards break Jut in the moft terrible manner. In places where great numbers of fick people are kept, cleanlinefs ought to be moft religioufly obferv- ed OF CLEANLINESS. 77 cd*. The very fmeil in fuch places is often fufficient to make one fitk. It is eafy to imagine what effea that is likely to have upon the difeafed. In an hofpital or infirm- ary, where cleanlinefs is negleaed, a perfon in perfea health has a greater chance to become fick, than a fick per- fon has to get well. Few things are more unaccountable than that neglea, or rather dread'of cleanlinefs which appears among thofe who have the care of the fick ; they think it almoft criminal to fuffer any thing that is clean to come near a perfon in a fever, for example, and would rather allow him to wallow in all manner of filth than change the leaft bit of his linen, c5r. If cleanlinefs be neceffary for perfons in health, it is certainly more fo for the fick. Many difeafes may be cured by cleanlinefs alone ; moft of them might be mitigated by it ; and, where it is negleaed, the flighted diforders are often changed into the moft malignant. The fame miftak- en care which prompted people to prevent the leaft admiffi- on of frefh air to the fick, feems likewife to have induced them to keep them dirty. Both thefe deftruaive prejudi- ces will, we hope, be foon entirely exploded. Cleanliness is certainly agreeable to our nature. We cannot help approving it in others, even though we fhould not praaice it ourfelves. It fooner attraas our regard than even finery itfelf, and often eains efteem where that fails. It is an ornament to the higheft as well as the loweft ftati- on, and cannot be difpenfed with in either. Few virtues are of more importance to fociety than real cleanlinefs. It ought to be carefully cultivated every where; but, in po- pular cities, it fhould be almoft revered. We cannot conclude this article, without recommend- ing the praaice of cleanlinefs, in the warmeft manner, to perfons in every fituation of life. We do not indeed pre- tend to rank it among the cardinal virtues ; but we would recommend it as neceffary for fupporting the honour and dignity of human nature, as agreeable and ufeful to fociety, and as highly conducive to the prefervation of health. 57 CHAP. * As it is impoifible to he thoroughly clean without a fufficient quantity of water, we would earneftly recommend it to the magiflratcs of great towns to be particularly attentive to this article. Moft great towns in Britain are fo fituated as to be eafily fupplied with water ; and thofe peifons who will not make a proper ufe of it, after it is brought to their hand, cert inly de- ferve to be feverely punilhed. The ftreets of great towns, where watsr can be had, ought to be walhcd eycry day. This is the only effectual method for keeping them thoroughly clean ; and, npon trial, we ars perfuadcd, it will be found the cheapeft. C 7» ] C HA P. IX. OF INFECTION. MOST difeafes are infeaious. Every perfon ought therefore, as far as he can, to avoid all communica- tion with the difeafed. ,The common praaice of vifiting the fick, though often well meant, has many ill confequen- ces. Far be it from us to difcourage any adt of charity or benevolence, efpecially towards thofe in diftrefs j but we cannot help blaming fuch as endanger their own or their neighbours lives by a miftaken friendfhip, or an imperti- nent curiofity. The houfes of the fick, efpecially in the country, are generally crowded from morning till night with idlevilitors. It is cuftomary, in fuch places, for fervants and young people to wait upon the fick by turns, and even to fit up with them all night. It would be a miracle indeed fhould fuch always efcape. Experience teaches us the danger of this condua. People often catch fevers in this way, and communicate them to others, till at length they become epidemic. It would be thought highly improper, for one who had not had the fmall-pox, to wait upon a patient in that dif- eafe ; yet many other fevers are almoft as infeaious as the fmall-pox, and not lefs fatal. Some imagine, that fevers prove more fatal in villages than in great towns, for want of proper medical afiiftance. This may fometimes be the cafe ; but we are inclined to think, it oftener proceeds from the caufe above mentioned. Were a plan to be laid down for communicating infec- tion, it could not be done more effeaually than by the common method of vifiting the fick. Such vifitors not on- ly endanger themfelves and their conneaions, but likewife hurt the fick. By crowding the houfe, they render the air unwholefome, and by their private whifpers and difmal countenances, difturb the imagination of the patient, and deprefs his fpirits. Perfons who are ill, efpecially in fe- vers, ought to be kept as quiet as poffible. The fight of ftrai\g« OF INFECTION. y9 ftrange faces, and every thing that difturbs the mind, hurts them. The common praaice in country-places of inviting great numbers of people to funerals, and crowding them into the fame apartment where the corps lies, is another way of fpreading infeaion. The infeaion does not al- ways die with the patient. In many cafes it rather grows ftronger as the body becomes putrid. This is peculiarly the cale of thofe who die of malignant fevers, or other putrid difeafes. Such ought not to lie long unburied : and peo- ple fhould keep, as much as poffible, at a diftance from them. It would tend greatly to prevent the fpreading of infec-' tious difeafes, if thofe in health were kept at a proper dif- tance from the fick. The Jewifh Legiflator, among many other wife inftitutions for preferving health, has been pecu- liarly attentive to the means of preventing infeaion, or de- filement as it is called, either from a dileafed perfon or a dead body. In many cafes the difeafed were to be feparat- ed from thofe in health ; and it was deemed a crime even to approach their habitations. If a perfon only touched a dif- eafed or dead body, he was appointed to wafh himfelf in water, and to keep for fome time at a diftance from fociety. Infectious difeafes are often communicated by clothes. It is extremely dangerous to wear apparel which has been worn by the difeafed, unlefs it has been well wafhed and fumigated, &c. as infeaion may lodge a long time in it, and afterwards produce very tragical effeas. This fhews the danger of buying at random the clothes which have been ufed by other people. Infectious diforders are frequently imported. Com- merce, together with the riches of foreign climtfs, brings us alfo' their difeafes. Thefe do often more than counter- balance all the advantages of that trade by means of which they are introduced. It is to be regretted, that fo little care is commonly taken, either to prevent the introduaion or fpreading of infeaious difeafes. Some attention indeed is generally paid to the plague j but other difeafes pafs unre- garded*. Infection • Were the tenth part of the care taken to prevent the importation of difeafes that there is to prevent fmuggling, it would be attended with many happy confequences. This might cafily be done by appointing a phyfician 80 OF INFECTION. Infection is often fpread in cities by jails, hofpitals, ifc. Thefe are frequently fituated in the very middle of popu- lous towns • and when infeaious difeafes break out in them, it is impoffible for the inhabitants to efcape. Did magistrates pay any regard to the health of the people, this evil might beeafily remedied. Many are the caufes which tend to diffufe infeaion through populous cities. The whole atmofpheie of a large town is one contaminated mafs, abounding with every kind of infeaion, and mult be pernicious to health. The beft advice that we can give to fucb as are obliged to live in large cities, is, to chufe an open fituation ; to avoid narrow, dirty, crowded ftreets ; to keep their own houfes and offices clean ; and to be as much abroad in the open air as their time will permit. It would tend greatly to prevent the fpreading of infec- tious difeafes, were proper nurfes every where employed to take care of the fick. This might often fave a family, or even a whole town, from being infeaed by one perfon. We do not mean that people fliould abandon their friends or re- lations in diftrefs, hut only to put them on their guard a- gainft being too much in company with thofe who are af- fliaed with difeafes of an infectious nature. Such as wait upon the fick in infeaious difeafes, run very great hazard. They ought to ftuff their nofes with tobacco, or fome other ftrong fmelling herb, as rue, tarify, or the like. They ought likewife to keep the patient very clean, and frequently to fprinkle the room where he lies with vinegar, or other ftrong acids ; and to avoid the fmell of his breath as much as they can. Such perfons as attend the fick ought never to go into company without having changed their clothes, wafhed their hands and face, &c. otherwife, if the difeafe be infeaious, they will, in all pro- bability, carry the contagion along with them*. However at every confiderable fea port, to infpe be defired, becaufe moft of the putrid fevers and other in- fedtious diforders break out among the poor, and are by them communicated to the better fort. Were proper at- tention paid to the firft appearances of fuch diforders, and the patients early conveyed to an hofpital, we fhould feldom fee a putrid fever, which is almoll as infeaious.as the plague, become epidemic. - ... C H A P. X. OF THE PASSIONS* TH E paffions have great influence both in the caufe and cure of difeafes. How mind aas upon matter, will, in all probability, ever remain a fecret. It is fuffici- ent for usto know, that there is eftablifhed a reciprocal in- fluence betwixt the mental and corporeal parts, and that whatever diforders the one, likewife affeas the other. Of A N.G E R. The paffion of anger ruffles the mind, diftorts the coun- tenance, hurries on the circulation of the blood, and dif- orders the whole vital and animal funaions. It often oc- cafions fevers, and other acute difeafes ; and fometimes even fudden death. This paffion is peculiarly hurtful to the de- licate, and thofe of weak nerves. I have known a hyfterii: woman lofe her life by a violent fit of anger ; all fuch ought to guard againft the excefs of this paffion with the utmoft care. IT OF THE PASSIONS. S3 It is not indeed always in our power to prevent being angry ; but we may furely avoid harbouring refentment in our breaft. Refentment preys upon the mind, and occafi- ons the moftobftinate chronical diforders, which gradually wafte the conftitution. Nothing fhews true greatnefs of mind more than to forgive injuries: It promotes the peace of fociety, and greatly conduces to our own eafe, health, and felicity. Such as value health fhould avoid violent gufts of anger, as they would the moft deadly poifon. Neither ought they to indulge refentment, but to endeavour at all times to keep their minds calm and ferene. Nothing tends fo much to the health of the body as a conftant tranquillity of mind. Of FEA R. The influence of feary both in occafioning and aggra- vating difeafes, is very great. No man ought to be blamed for a decent concern about life ; but too great a defire to preferve it, is often the caufe of lofing it. Fear and anxier ty, by depreffing the fpirits, not only difpofe us to difeaf- es, but often render thofe difeafes fatal which an undaunt- ed mind would overcome. Sudden fear has generally violent effeas. Epileaic fits, and other convulfive diforders, are often occafioned by \t. Hence the danger of that practice, fo common among young people, of frightening one another. Many have loft: their lives, and others have been rendered ufelefs ever after, by frolics of this kind. It is dangerous to tamper with the human paffions. They may eafily be thrown into fuch dif- order as never again to aa with regularity, But the gradual effeas of fear prove more generally hurtful. The conftant dread of fome future evil, by dwell- ing upon the mind, often occafions the very evil itfelf. Hence it comes to pafs, that fo many die of thefe very dif- eafes of which they long had a dread, or, which had been jmpreffed on their minds by fome accident, or foolifh predic- tion. This, for example, is often the cafe with women in childbed. Many of thofe who die in that fituation are im- preffed with the notion of their death a long time before it happens ; and there is reafon to believe, that this imprefli- on is often the caufe of it. The methods taken to imprefs the minds of women with apprehenfions of the great pain and peril of child-birth are 84 OF THE PASSIONS. very hurtful. Few women die in labour, though many lofe their lives after it; which may be thus accounted for. A woman after delivery, finding herfelf weak and exhauft- ed, immediately apprehends fhe is in danger; but this fear feldom fails to obftrua the neceffary evacuations upon which her recovery depends. Thus the fex often fall a facrifice to their own imaginations, when there would be no danger, did they apprehend none. It feldom happens that two or three women, in a great town, die in child-bed, but their death is followed by ma- ny others. Every woman of their acquaintance, who is with child, dreads the fame fate, and the difeafe becomes; epidemical by the mere force of imagination. This fhould induce pregnant women to defpife fear, and by all means to avoid thofe tattling goffips who are continually buzzing in their ears the misfortunes of others. Every thing that may in the leaft alarm a pregnant, or child-bed women, ought with the greateft care to be guarded againft. Many women have loft their lives in child-bed by the old fuperftitious cuftom, ftill kept up in moft parts of Bri- tain, of tolling the parifh bell for every perfon who dies. People who think themfelves in danger are very inquifitivej and if they come to know that the bell tolls for one who died in the fame fituation with themfelves, what muft be the confequence ? At any rate, they are apt to fuppofe that this is the cafe, and it will often be found a very difficult talk to perfuade them of the contrary. But this cuftom is not pernicious to childbed-women only. It is hurtful in many other cafes. When low fe- vers, in which it is difficult to fupport the patient's fpirits, prevail, what muft be the effea of a funeral-peal founding live or fix times a day in his ears ? No doubt his imaginati- on will fuggeft, that others died of the fame difeafe under which he labours. This apprehenfion will have a greater tendency to deprefs his fpirits, than all the cordials ofwhich medicine can boaft will have to raife them. If this ufelefs piece of ceremony cannot be abolifhed, we ought to keep the fick as much from hearing it as poffible, and from every thing elfe that may tend to alarm them. So far however is this from being generally attended to, that many make it their bufinefs to vifit the fick, on purpofe to whifper difmal ftories in their ears. Such may pafs for fympathizing friends, but they ought rather to be confider- ?4 OF THE PASSIONS. 8<- ed as enemies. All who wifh well to the fick, ought to keep fuch perfons at the greateft diftance from them. A cuftom has long prevailed among phyficians, of prog-* nofticating, as they call it, the patient's fate, or foretelling the iffue of the difeafe. Vanity no doubt introduced this pradtice, and ftill fupports it, in fpite of common fenfe and the fafety of the fick. I have known a phyfician barbarous enough to boaft, that he pronounced more fentences than all his Majefty's judges. Would to God that fuch fentences were not often equally fatal ! It may indeed be alledged, that the doaor does not declare his opinion before the.pa- tient. So much the worfe. A fenfible patient had better hear what the doaor fays than learn it from the difconfo- late looks, the watery eyes, and the broken whifpers of thofe about him. It feldom happens, when the doaor gives an unfavourable opinion, that it can be concealed from the patient. The very embarraffment which the friends and attendants fhew in difguifing what he has faid, is generally fufficient to difcdver the truth. We do not fee what right any man has to announce the death of another, efpecially if fuch a declaration has a chance to kill him. Mankind are indeed very fond of pry- ing into future events, and feldom fail to importune the phyfician for his opinion. A doubtful anfwer, however, or one that may tend rather to encourage the hopes of the fick, is furely the moft fafe. This condua could neither hurt the patient nor the phyfician. Nothing tends more to de- ftroy the credit of phyfic than thofe bold prognofticators, who, by the bye, are generally the moft ignorant of the faculty. The miftakes which daily happen in this way are fo many ftanding proofs of human vanity, and the weak- nefs of fcience*. The vanity of foretelling the fate of the fick is not pe- culiar to the Faculty. Others follow their example, and thofe * Nothing can be more ridiculous, not to fay abfurd, than this piece of medical practice. It may often do mifchief, but can feldom have any good effects ; befides, it can never be reduced to any degree of certainty, unlefs in a few cafes, which are obvious to moft people. Notwithftanding this, many phyficians, and fome of eminence too, value themfelves fo much up- on their fkill in prognoft'xcat'ion, that they feem very much difappointed, nay chagrined, when any one of their patient's is fo happy as to furvive their • Sentence. Such gentlemen muft excufe me for telling them that they very often, and indeed too juftly, render themfelves the objects of laughter, to thofe Ycry perfons whofe day and hour they had fixed many years ago. B6 OF THE PASSIONS. thofe who think themfelves wifer than their neighbours often do much hurt in this way. Humanity furely calls upon every one to comfort the fick, and not to add to their affliaion by alarming their fears.. A friend, or even a phyfician, may often do more good by a mild and fympa- thizing behaviour than by medicine, and fhould never ne- glea to adminifter that greateft of all cordials, Hope. Of GRIEF. Grief is the moft deftruaive of all the paffions. Its tffeas are permanent, and when it finks deep into the mind, it generally proves fatal. Anger and fear being of a more violent nature, feldom laft long; but grief often changes into a fixed melancholy, which preys upon the fpirits, and waftes the conftitution. This paffion ought not to be in- dulged. It may generally be conquered at the beginning j but, when it has gained ftrength, all attempts to remove it are vain. No perfon can prevent misfortunes in life; but it fhews true greatnefs of mind to bear them with ferenity. Many perfons make a merit of indulging grief, and, when mis- fortunes happen, they obftinately refufe all confolation, till the mind, overwhelmed with melancholy, finks under the load. Such condua is not only deftrudtive to health, but inconfiftent with reafon, religion, and common fenfe. Change of ideas is as neceffary for health as change of pofture. When the mind dwells long upon one fubjea, efpecially of a difagreeable nature, it hurts the whole func- tions of the body. Hence grief indulged deftroys the ap- petite and fpoils the digeftion ; by which means the fpirits are depreffed, the nerves relaxed, the bowels inflated with wind, and the humours, for want of frefh fupplies of chyle, vitiated. Thus many an excellent conftitution has been mined by a family-misfortune, or any thing that occafion- ed exceffive grief. It is utterly impoffible, that any perfon of a dejeaed mind fhould enjoy health. Life may indeed be dragged out for a few years: But, whoever would live to a good old age, muft be good-humoured and cheerful. This indeed is not altogether in our own power ; yet our temper of mind, as well as aaions, depends greatly upon ourfelves. We can either affociate with cheerful or melancholy compani- ons, mingle in the amufements and offices of life, or fit ftill OF THE PASSIONS. g; and brood over our calamities, as we chufe. Thefe, an4 many fuch things, are certainly in our power, and from thefe the mmd generally takes its call. The variety of fcenes which prefent themfelyes to the fenfes, were certainly defigned to prevent our attention from being too long fixed upon any one objea. Nature abounds with variety, and the mind, unlefs fixed down- by habit, delights in contemplating new objeas. This at once points out the method of relieving the mind in diftrefs. Turn the attention frequently to new objeas. Examine them for fome time. When the mind begins to recoil, fhift; the fcene. By this means a conftant fucceffion of new ideas may be kept up, till the difagreeable ones entirely difappear. Thus travelling, the ftudy of any art or fcience, readingor writing on fuch fubjeas as deeply engage the attention, will fooner expel grief than the mpft fprightly amufements. It has already been obferved, that the body cannot he healthy unlefs it be exercifed ; neither can the mind. In- dolence nourifhes grief. When the mind has nothing elie to think of but calamities, no wonder that it dwells there. Few people who purfue bufinefs with attention are hurt by grief. Inftead therefore of abftraaing ourfelves from the world or bufinefs, when misfortunes happen, we ought x-y engage in it with more than ufual attention, to difcharge with double diligence the funaions of our ftation, and to mix with friends of a cheerful and focial temper. Innocent amufements are by no means to be negleaed. Thefe, by leading the mind infenfibly to the contemplation of agreeable objedts, help to difpel the gloom which misfor- tunes caft ever it. They make time feem lefs tedious, and have many other happy effeas. Many, when overwhelmed with grief, betake them- felves to drinking. This is making the cure worfe than the difeafe. It feldom fails to end in the ruin of fortune, charaaer, and conftitution. Of LOV E. Lsve is perhaps the ftrongeft of all t^e paffions ; at leaft, when it becomes violent, it is lefs fubiedt to the controul either of the underftanding or will., t .an any of the reft. Fear, anger, and feveral other pafions are neceffary forth? prefervation of the individual, bi' love is neceffary for the continuation of the fpecies itfelf: It was therefore proper that $8 OF THE PASSIONS. that this paffion fhould be deeply rooted in the human! breaft. Though love be a ftrong paffion, it is feldom fo rapid in its progrefs as feveral of the others. Few perfons fall defperately in love all at once. We would therefore advife every one, before he tampers with this paffion, to confider well the probability of his being able to obtain the objea of his love. When that is not likely, he fhould avoid every occafion of increafing it. He ought immediately to fly the company of the beloved objea; to apply his mind attentive- ly to bufinefs or ftudy ; to take every kind of amufement; and, above all, to endeavour, if poffible, to find another objea which may engage his affeaions, and which it may be in his power to obtain. When love becomes a difeafe, it is not eafily cured. Its confequences, in this cafe, are often fo violent, that even the pofteflion of the beloved objea will not always remove them. It is therefore of the greateft importance early to guard againft its influence : but when the paffion has alrea- dy taken too deep hold of the mind to admit of being eradi- cated, the beloved objea ought, if poffible, to be obtained; nor fhould this be deferred for every trifling caufe. Thofe who have the difpofal of young perfons in marriage are too ready to trifle with the paffion of love ; fuch, for the moft fordid confiderations, frequently facrifice the future health, peace or happinefs of thofe committed to their care*. Of RELIGIOUS MELANCHOLY, Many perfons of a religious turn of mind behave as if they thought it a crime to oe cheerful. They imagine the whole of religion confifts in certain mortifications, or de- nying themfelves the fmalleft indulgence, even of the moft innocent amufements. A perpetual gloom hangs upon their countenances, while the deepeft melancholy preys upon their minds. At length the faireft profpeas vanifh, every thing * Even the conduct of parents themfelves in the difpofal of their children in marriage is often very blameable. An advantageous match istheconftan't aim of parents ; while their children often fuffer a real martyrdom betwixt their own inclinations and the duty which they think they owe to their pa- tents. The firft thing which p.rents ought to confult, in di(pofing of their children in marriage, is certainly their own inclinations. Were due regard always paid to thefe, there would be fewer unhappy couples; and the parents -would not have fo often caufe to repent the feverity of their conduct, after a ruined conftitution, or a diftract^d mind, has (hewn them their miftake. OF THE PASSIONS. 89 thing puts on a difmal appearance, and thofe very objeas which ought to give delight afford nothing but difguft. Life itfelf becomes a burden, and the unhappy wretch, perfuaded that no evil can equal what he feels, often puts an end to his own miferable exiftence. It is great pity that ever religion fhould be fo far pervert- ed, as to become the caufe of thofe very evils which it was defigned to cure. Nothing can be better calculated than the Chrifiian Religion, to raife and fupport the mind of its votaries under every affliaion that can befal them. It teaches them that the fufferings of this life are preparatory to the happinefs of the next; and that all who perfift in a courfe of virtue, fhall at length arrive at complete felicity. Those whofe bufinefs it is to recommend religion to others, fliould beware of dwelling too much upon gloomy fubjeas. That peace and tranquillity of mind, which true religion is calculated to infpire, is a more powerful argu- ment in its favour, than all the terrors that can be uttered. Terror may indeed deter men from outward aas of wicked- nefs ; but it will never infpire them with that love of God and real goodnefs, in which alone true religion confifts. To conclude, the beft way to counteraa the violence of any paffion, is to encourage thofe of an oppofite nature, and to keep the mind fo clofely engaged in fome ufeful pur- fuit, as to allow it no time to reflea upon misfortunes. CHAP. XL OF THE CUSTOMARY EVACUATIONS; t TH E principal evacuations from the human body are thofe of Jlool, urine, and infenftble perfpiration. None ot thefe can be long obftruaed without impairing the health. When that which ought to be thrown out of the body is too long retained, it not only occafions a plethora, or too great fulnefs of the veffels, but acquires qualities which are hurt- ful to the health, as acrimony, putrefcence, &c. N Of 90 OF THE CUSTOMARY EVACUATIONS. Of the EVACUATION by STOOL. Few things conduce more to health than keeping the belly regular. When the faces lie too long in the body they vitiate the humours, and when they are too foon dis- charged it is not fufficiently nourifhed. A medium is there- fore to be defired j which'can only be obtained by regulari- ty in diet, fleep and exercife. Whenever the belly is not regular, there is reafon to fufpea a fault in one or other of thefe. Persons who eat and drink at irregular hours, and who eat various kinds of food, and drink of feveral different li- quors at every meal, have no reafon to expea either that their digeflion will be good, or their difcharges regular. Irregularity in' eating and drinking difturbs every part of the animal ceconomy, and never fails to occafion difeafes. Either too much or too little food will have this effea. The former indeed generally occafions loofenefs, and the latter coftivenefs j but both have a tendency to hurt the health. • It would be difficult to afcertain the exaa number of ftools which may be confiftent with health, as thefe differ in the different periods of life, in different conftitutions, and even in the fame conftitution under a different regimen of diet, exercife, &c. It is however generally allowed, that one ftool a day is fufficient for an adult, and that lefs is hurtful. But this, like moft general rules, admits of many exceptions. I have known perfons in perfea health who did not go to ftool above once a week. Such a degree of coftivenefs however is not fafe j though the perfon who labours under it may for fome time enjoy tolerable health, yet at length it will occafion difeafes. One method for procuring a ftool every day is to rife be- times, and go abroad in the open air. Not only the pofture in bed is unfavourable to regular ftools, but alfo the warmth. This by promoting the perfpiration leffens all the other dif- charges. The method recommended for this purpofe, by Mr. Lock is likewife very proper, viz. to folicit nature by going regularly to Jlool every morning whether one has a call or not. Habits of this kind may be acquired, which will in time be- come natural. Persons OF THE CUSTOMARY EVACUATIONS. 91 Persons who^have frequent recourfe to medicine for preventing coftivenefs, feldom fail to ruin their conftitution. Purging medicines frequently repeated weaken the bowels, hurt the digeftion, and every dofe makes way for another, till at length they become as neceffary as daily bread. Thofe who are troubled with coftivenefs ought rather, if fioffible, to remove it by diet than drugs. They ought ikewife to go thinly clothed, and to avoid every thing of an aftringent, or of a heating nature. The diet and other regimen neceffary in this cafe will be found under the article coftivenefs, where this ftate of the bowels is treated as a difeafe. Such perfons as are troubled with a habitual loofenefs, ought likewife to fuit their diet, cjfc. to the nature of their complaint. They fhould ufe food which braces and ftrengthens the bowels, and which is rather of an aftrin- gent quality, as wheat-bread made of the fineft flower, cheefe, eggs, rice boiled in milk, &c. Their drink fhould be red port-wine, claret, brandy and water, water in which toafted bread has been boiled, and fuch like. As a habitual loofenefs is often owing to an obftruaed perfpiration, perfons affeaed with it ought to keep their feet warm, to wear flannel next their fkin, and to take every other method to promote the perfpiration. Further directions with regard to the treatment of this complaint will be found under the article Loofenefs. Of URINE. So many things tend to change both the quantity and appearances of the urine, that it is very difficult to lay down any determined rules for judging of either*. Dr. Cheyne fays, the urine ought to be equal to three-fourths of * It has Cv.'.g beery an obfervation among phyficians, that the appearances of the urine arc very uncertain and very little to be depended on. No one will be furprifed at this who confiders how many ways it may be affected and confequently have its appearance altered The paflions, the ftate of the at- mofphere, the quantity arid quality of the food, the exercife, the clothing, the ftate of the other evacuations, and numberlcfs other canfes, are fufficient to induce a change either in the quantity Sr appearance of the urine. Any one who attends to this, will be aftonifhed at the impudence of thole daring quacks, who pretend to find out difeafes and prescribe to patients from the bare inflection of their urine. Thefe impoftures however are very common all over Britain, a,nd by the amazing credulity of the populace, many cf thorn araafs confiderable fortunes. f 92 OF THE CUSTOMARY EVACUATIONS. of the liquid part of our aliment. But fuppofe any one were to take the trouble of meafuring both, he would find that every thing which altered the degree of perfpiration would alter this proportion, and likewife that different kinds of aliment would afford very different quantities of urine.' Though for thefe, and other reafons, no rule can be given forjudging of the precife quantity of urine which ought to be difcharged, yet a perfon of common fenfe will feldom be at a lofs to know when it is in either extreme. As a free difcharge of urine not only prevents but ac- tually cures many difeafes, it ought-by all means to be pro- moted ; and every thing that may obftrua it fhould be „ carefully avoided. Both the fecretion and difcharge of urine are leffened by a fedentary life, fleeping on beds that are too foft and warm, food of a dry and heating quality, liquors which are aftringent and heating, as red port-wine, claret, and fuch like. Thofe who have reafon to fufpea that their urine is in too fmall quantity, or who have any fymptoms of the gravel, ought not only to avoid thefe things, but whatever elfe they find has a tendency to lcffen the quanti- ty of their urine. When the urine is too long retained, it is not only re- abforbed, or taken up again into the mafs of fluids, but by ftagnating in the bladder it becomes thicker, the more wa- tery parts flying off firft, and the more grofs and earthy re- maining behind. By the conftant tendency which thefe have to concrete, the formation of ftones and gravel in the bladder is promoted. Hence it comes to pafs, that indo- lent and fedentary people are much more liable to thefe dif- eafes, than perfons of a more aaive life. Many perfons have loft their lives, and others have brought on very difagreeable, and even incurable diforders, by retaining their urine too long, from a falfe delicacy. When the bladder has been over-diftended it often lofes its power of aaion altogether, or becomes parahtic, by which means it is rendered unable either to retain the urine or ex- pel it properly. The calls of nature ought never to be poft- poned. Delicacy is doubtlefs a virtue ; but that can never he reckoned true delicacy which induces any one to rifkhis health or hazard his life. But the urine may be in too great as well as too fmall a quantity. This may be occafioned by drinking large quantities of weak watery liquors, by the exceffive ufe of alkaline OF THE CUSTO:vIARY EVACUATIONS. 93 alkaline falts, or any thing that ftimulates the kidnies, or diffolves the blood, bfc. This diforder very foon weakens the body, and induces a confumption. It is difficult to cure, but may be mitigated by ftrengthening diet and a- ftringent medicines, fuch as are recommended under the ar- ticle Diabetes, or exceffive difcharge of urine. Of the PERSPIRATION. Insensible perfpiration is generally reckoned the great-. eft of all the difcharges from the human body. It is of fo great importance to health, that few difeafes attack us while it goes properly on; but when it is obftruaed the whole frame is generally difordered. This difcharge however be- ing lefs perceptible than any of the reft, is confequently lefs attended to. Hence it is, that acute fevers, rheumatifms, agues, tjc. often proceed from this caufe before we are a- ware of its exiftence. It is a true faying, that colds kill more than plagues. On examining patients we find moft of them impute their difeafes either to violent colds, which they had caught, or to flight on?s which had been negleaed. For this reafon, inftead of a critical inquiry into the nature of the perfpira- tion, its difference in different feafons, climates, conftitu- tions, &c. we fhall endeavour to point out the caufes which moft commonly obftrua it, and to fhew how far they may be either avoided, or have their influence counteracted by timely care. The want of a proper attention to thefe cofts. Britain annually fome thoufands of ufeful lives. CHANGES in the ATMOSPHERE. One of the moft common caufes of obftruaed perfpira- tion, or catching cold, in this country, is the changeable-^ nefs of the weather, or ftate of the atmofphere. There is no place where fuch changes happen more frequently than in Great Britain. With us the degrees of heat and cold are not only very different in the different feafons in the year, but often change almoft from one extreme to another in a f«v days, and fometimes even in the courfe of one day. That fuch changes muft affea the ftate of the perfpiration is obvious to every one. The beft method of fortifying the body againft the changes of the weather is to be abroad every day. Thofe who 94 Qf THE CUSTOMARY EVACUATIONS. who keep moft within doors are moft liable to catch cold. Suqh perfons generally render themfelves fo delicate as to feel even the flTghteft changes in the atmofphere, and by their pains, coughs, and oppreffions of the breaft, &c. they become a kind o/ living barometers. WET CLOTHES. Wet clothes not only, by their coldnefs, obilrua the perfpiration, but. their rnoifture, by being abforhed, or taken up into the body, greatly increafes the danger. The moft robuft cqnftitution is not orpQf againft the danger arifing frana we,tclqthes; they daily occafion fevers, rheumatifrns, and other fataj diforders, qven in the young and healthy. It ia impoifihle for people who go frequently abroad to avoid fometimei being wet. But the danger might generali- ty b,e lefijened, if nqt wholly prevented, by changing theif clothes foon ; when this cannot be done, they fhould keep in motion till they be dry. So far are many people from taking thj$ precaution, that they often fit or lie down, in the fields with their clothes wet, and frequently even fleep whole nights in this condition. The frequent inftances which we have of the fatal effeas of this condua oughj certainly to deter Qthers from being guilty of it. W £ T F E E T. Even wet feet often occafion fatal difeafes. The cholic, inflammations of the breaft, the iliac paffion, and cholera morbus, &c. ate often occafioned by wet feet. Habit will, no doubt, render this lefs dangerous ; but it ought, as far as poffible, to be avoided. The delicate, and thofe who are not accuftomed to have their clothes or feet wet, fhould be peculiarly careful in this refpea. NIQHT AIR. The perfpiration is often obftruaed by night-air ; even in fummer, this ought to be avoided. The dews, which fall plentifully after the hotteft day, make the night more dangerous than when the weather is cool. Henm}, in warm countries, the evening dews are more hurtful than where the climate is more temperate. It is very agreeable after a warm day, to be abroad in the cool evening -f but this is a pleafure to be avoided by all who OF T«E CUSTOMARY EVACUATIONS. 9$ who value their health. The effeas of evening-dews are gradual indeed, and almoft imperceptible ; but they are not the lefs to be dreaded : We would therefore advife travel- lers, labourers, and all who are much heated by day, care- fully to avoid them. When the perfpiration has been great, thefe become dangerous in proportion. By not attending to this, in flat marfhy countries, where the exhalations and dews are copious, labourers are often feized with intermit- ting fevers, quinfies, and the like. DAMP BEDS. Sleeping in damp beds feldom fails to obftrua the per- fpiration. Beds become damp, either from their not being ufed, Handing in damp houfes, or in rooms without fire. Nothing is more to be dreaded by travellers than damp beds, which are very common in all places where fuel k fcarce. When a traveller, cold and wet, arrives at an inn, he may by means of a good fire, warm diluting liquor, and a dry bed, have the perfpiration reftored ; but if he be put into a cold room, and laid on a damp bed, it will be more ob- ftruaed, and the worft confequences will enfue. Travel- lers fhould avoid inns which are noted for damp beds, as they would a houfe infeaed with the plague j as no man, however robuft, is proof againft the danger arifing from them. But inns are not the only places where damp beds are to he met with. Beds kept in private families for the recepti- on of ftrangers, are often equally dangerous. All kinds of linen and bedding, when not frequently ufed, become clamp. How then is it poffible, that beds, which are not flept in above two or three times a-year, fhould be other- wife ? Nothing is more common than to hear people com- plain of having caught cold by changing their bed. The reafon is obvious : Were they careful never to fleep in a bed but what was frequently ufed, they would feldom find any ill confequences from a change. Nothing is more to be dreaded by a delicate perfon when on a vifit, than being laid in a bed which is kept on purpofe for ftrangers. That ill-judged piece of complai- fince becomes a real injury. All the bad confequences from this quarter might be eafily prevented in private families, hy caufing their fervants to fleep in the fpare beds, and re- fign them to ftrangers when they come, This is the cuftom 96 OF THE CUSTOMARY EVACUATIONS. of many families in London, and we would earneftly re- commend it to all who value the health of their friends. In inns where the beds are ufed almoft every night, nothing elfe is neceflary than to keep th» rooms well feafoned by fre- quent fires, and the linen dry. DAMP HOUSES. Damp houfes frequently produce the like ill confe- quences j for this reafon thofe who build fhould be careful to chufe a dry fituation. A houfe which ftands on a damp marfhy foil muft be hurtful to the health of the inhabitants. All houfes, unlefs where the ground is exceeding dry, fhould have the firft floor a little raifed. Servants and others, who are obliged to live in cellars and funk flories, feldom continue long in health : But matters ought furely to pay fome regard to the health of their fervants, as well as to their own. Nothing is more common than for people, merely to avoid fome trifling inconveniency, to hazard their lives, by inhabiting a houfe almoft as foon as the mafons, plafterers, &c. have done with it: Such houfes are not only danger- ous from their danapnefs, but likewife from the fiji^ll of lime, paints, &c. The afthmas, confumptions, and other difeafes of the lungs, fo incident to people who work in thefe articles, are fufficient proofs of their being unwhole- fome. Houses are often rendered damp by an unfeafonable piece of cleanlinefs; I mean the pernicious cuftom of wafh- ing rooms immediately before company is put into them. Many people are fure to catch cold, if they fit but a very fhort time in a room that has been lately wafhed ; the deli- cate ought carefully to avoid fuch a fituation, and even the robuft would run lefs hazard by fitting without doors. Peo- ple who are accuftomed to live in dry houfes, ought, as far as poffible, to fliun damp ones, and by all means not to continue long in rooms that have been lately wafhed. SUDDEN TRANSITIONS from HEAT to COLD. But nothing fo frequently obftruas the perfpiration as sudden transitions from heat to cold. Colds are feldom caught, unlefs when people have been too much heated. Heat rarifi.es the blood, quickens the circulation, and in- creafes OF THE CUSTOMARY EVACUATIONS. 97 creafes the perfpiration ; but when thefe are fuddenly check- ed, the confequences muft be bad. It is indeed impoffible for labourers not to be too hot upon fome occafions ; but it h generally in their power to put on their cloth^' when they taave off work, to make choice of a dry place t reft them- felves in, and to avoid fleeping in the open fields. Thefe eafy rules, if obferved, would fave many ufeful lives. Nothing is more common than for people when hot, to drink freely of cold fmall liquors. This condua is ex- tremely dangerous. Thirft indeed is hard to bear, and the inclination to gratify that appetite frequently gets the better of reafon, and makes us do what our judgment difapproves. Every peafant knows if his horfe be permitted to drink his belly-full of cold water after violent exercife, and be imme- diately put into the liable, or fuffered to remain at reft, that it will kill him. This they take the utmoft care to prevent. It were well if they were equally attentive to their own fafety. Thirst may be quenched many ways without fwallowing large quantities of cold liquor. The fields afford variety of acid fruits and plants, the very chewing of which would a- bate thirft. Water kept in the mouth for fome time, and fpit-,out again, if frequently repeated, will have the fame effca. If a bit of bread be eat along with a few mouthfuls of water, it will both quench thirft more efteaually, and make the danger lefs. When a perfon is extremely hot, a mouthful of brandy, or other fpirits, ought to be preferred to any thing elfe, if it can be obtained. But if any one has been fo foolifh, when hot, as to drink freely of cold liquor, he ought to continue his exercife at leaft, till vMiat he drank be thoroughly warmed upon his ftomach. It would be tedious to enumerate all the bad effeas which flow from drinking cold thin liquors when the body is hot. Sometimes this has occafioned immediate death. Hoarfenefs, quinfeys, and fervers of various kinds, are its common confequences. Neither is it fafe when warm to eat freely of raw fruits, fallads, or the like. Thefe indeed have not fo fudden an effea on the body as cold liquors, but they are notwithftanding dangerous, and ought to be avoided. Sitting in a warm room, and drinking hot liquors till the pores are quite open, and immediately going into the cold air, is extremely dangerous. Colds, coughs, and in- O flammations 98 OF THE CUSTOMARY EVACUATIONS. flammations of the breaft, are the ufual effeas of this con- dua : Yet nothing is more common ! Many people, after •having drank warm liquors for feveral hours, walk or ride a number of miles in the coldeft night; while others fit up all night, or ramble about in the ftreets. People are very apt when a room is hot, to throw open a window, and to fit near it. This is a moft dangerous "praaice. Any perfon had better fit without doors than in fuch a fituation, as the current of air is direaed againft one particular part of the body. Inflammatory fevers and con- fumptions have often been occafioned by fitting or Handing thinly clothed near an open window. Nor is fleepingwith open windows lefs to be dreaded. That ought never to be done even in the hotteft feafon. I have known mechanics frequently contraa fatal difeafes, by working ftript at an open window, and would adviie all of them to beware of fuch a praaice. Nothing expofes people more to catch cold than keep- ing their own houfes too warm ; fuch perfons may be faid to live in a fort of hot-houfes; they can hardly ftir abroad to vifit a neighbour, but at the hazard of their lives. Were there no other reafon for keeping houfes in a moderate de- gree of warmth, that alone is fufficient: But no houfe that is too hot can be wholefome ; heat deftroys the fpring and elafticity of the air, and renders it lefs fit for expanding the lungs, and the other purpofes of refpiration. Hence it is, that confumptions and other difeafes of the lungs prove fo fatal to people who work in forges, glaia-houfes, and the like. Some are even fo fool-hardy, as to plunge themfelves when hot in cold water. Not only fevers, but madnefs it- felf has frequently been the effea of this condua. Indeed it locks too like the aaion of a madman to deferve a ferious confideration. We fhall conclude thefe obfervations on the common caufes of catching cold, by recommending it to every one to avoid, with the utmoft attention, all fudden tranfitions from heat to cold, and to keep the body in as uniform a temperature as poffible; or, where that cannot be done, to take care to let it cool gradually. People may be apt to imagine that too ftria an attenti- on to thefe things would tend to render them delicate. So far OF THE CUSTOMARY EVACUATIONS. 99 far however is this from being our defign, that the very firft rule propofed for preventing colds, is to harden the body by enuring it daily to the open air. OF DISEASES. \' CHAP. XII. GENERAL OBSERVATIONS CONCERNING THE KNOWLEDGE AND CURE OF DISEASES. IT is no doubt difficult to obtain fuch a knowledge of difeafes fo as to be able to diftinguifh them from one an- other. This however does not depend fo much upon fcien- tific principles as many imagine. It is chiefly the refultof experience and obfervation. By attending the fick, and carefully obferving the various occurences in difeafes, a great degree of accuracy may be acquired, both in diftinguifhing their fymptoms, and in the application of medicines. Hence fenfible nurfes and other perfons who wait uponj^he fick often know difeafes better than thofe who have been bred to phyfic. We do not however mean to infinuate that a medi- cal education is of no ufe : It is doubtlefs of the greateft: importance, but it never can fupply the place of experience and obfervation. In a former edition we endeavoured, in this place, to lay down rules for diftinguifhing difeafes ; but as it is im- poffible for any one to retain thefe in his memory, we have omitted them, and, in order to fupply their place, have given as full and accurate a defcription of each particular difeafe, in its order, as the nature of our plan would admit. Diseases often refemble one another fo nearly in many of their fymptoms that it is no eafy matter to diftinguifh them. ico OF THE KNOWLEDGE them. When this is the cafe, we have always taken care to point out thole peculiar, or charaaeriftic fymptoms, by which the difeafe is diftinguifhed, and at the fame time to mention thofe which are common to it with other difeafes. By a proper attention to thefe, we hope, the inveftiLation of difeafes will be found to be a lefs difficult matter than rpoft perfons would, at firft fight, be ready to imagine. A proper attention to the age, fex, temper of mind, conftitution, &c. of the patient will greatly affift both in the inveftigation and cure of difeafes. In chi.'dhood the fibres are lax and foft, the nerves ex- tremely irritable, and the fluids thin ; whereas in old age the fibres are rigid, the nerves become almoft iufenfible, and many of the veffels imperviable. Thefe and other pe- culiarities render the difeafes of the young and aged very different, and of courfe they muft require a different method of treatment. Females are liable to many difeafes which do not afflid the other fex : befides, the nervous fyftem being more irri- table in them than in men, theii difeafes require to be treat- ed with greater caution. They are lefs able to bear large evacuations; and all ftimulating medicines ought to be ad- miniftered to them with a fparing hand. Particular conftitutions not only difpofe perfons to peculiar difeafes, but likewife render it neceffary to treat thefe difeafes in a peculiar manner. A delicate perfon, for example, with weak nerves, who lives moftly within doors, muft not be treated, under any difeafe, precisely in the fame manner as one who is hardy and robuft, and who is much expofedjto the open air. The temper of mihd ought to be very carefully attended to in difeafes. Fear, anxiety, and a fretful temper both oc- cafion and aggravate difeafes. In vain do we apply medi- cines to the body to remove maladies which proceed from the mind. When it is affeaed the beft medicine is to tooth the paffions, to divert the mind from anxious thought, and to keep the patient as etify and cheerful as poffible. Attention ought likewife to be paid to the place where the patient lives, the air he breathes, his diet, occupation, &c. Such as live in low marfhy fituations are fubjea to many difeafes which are unknown to the inhabitants of high countries. Thofe who breathe the impure air of cities have many maladies to which the more happy rallies are entire AND CURE OF DISEASES. iox entire ftrangers. Perfons who feed grofsly, and indulge in ftrong liquors, are liable to difeafes which do not aftia the temperate and abftemious, &c. It has already been obferved that the different ccrupati- iins and fituations in life difpofe men to peculiar difeafes. It is therefore neceffary to inquire into the patient's occu- pation, manner of life, &c. This will not only affift us in finding out the difeafe, but will likewife dire£t us in the treatment of it. It would be very imprudent to treat the laborious and the fedentary exaaiy in the fame manner, even fuppofing them to labour under the fame difeafe. It will likewife be proper to inquire whether the difeafe be conftitutional or accidental ; whether it has been of long or fhort Handing; whether it proceeds from any great and fudden alteration in the diet, manner of life, ,&V. The ftate of the patient's belly, and of the other evacuations, ought alfo to be enquired into j and likewife whether heca * with eafe perform all the vital and animal funaions, i.s refpiration, digeftion, &c. Lastly, it will be proper to enquire what difeafes Os patient has formerly been moft liable to, and what ;: r< 1- cines were moft beneficial to him. It will likewife be ne- ceffary to inquire what kind of medicines are moft agreea- ble to the patient, or if he has a ftrong averfion to any par- ticular drug, &c. It has already been obferved that many of the indicati- ons of cure in difeafes may be anfwered by diet alone. The diet is therefore the firft thing fo be attended to in the treat- ment of uifeafes. Thofe who know no better imagine th.t every thing which goes by the name of a medicine poffefks fome wonderful power or fecret charm, and think, if the patient lwallows enough of drugs, that he muft do well. This miftake has many ill confequences. It makes people truft to drugs and neglect their own endeavours ; befides it difcourages all attempts to relieve the fick where medicines cannot be had. Medicines are no doubt ufeful in their own place, and, when adminiftered with prudence, they may do much good; but when they are put in place of every thing elfe, or ad- miniftered at random, which is not feldom the cafe, they muft do mifchief. We would therefore wifh to call the attention of mankind from the purfuit of fecret medicines to fuch things as they are acquainted with. The proper regulation / 102 OF THE KNOWLEDGE regulation of thefe may often do much good, and there is little danger of their ever doing hurt. Every difeafe weakens the digeftive powers. The diet ought therefore, in all difeafes, to be light and of eafy di- geition. It would be as prudent for a perfon with a broken leg to attempt to walk, as for one in a fever to eat the fame kind of food, and in the fame quantity, as when he was in perfea health. Even abftinence alone will often cure a fe- ver, efpecially when it has been occafioned by excefs in eating or drinking. In all fevers attended with inflammation, as pleurifies, peripneumonies, &c. thin gruels, whevs, watery infufion? of mucilaginous plants, roots., &c. are not only proper for the patient's food, but they are likewife the beft medicines which can be adminiftered. iN feversof a flow, nervous, or putrid kind, wherethere are no fvinptoms of j^fLmmation, and where the patient muft be i'upported with cordials, that intention can always be more effeaually anfwered by nourifhing diet and gene- rous wines, than by any medicines yet known. Nor is a proper attention to diet of lefs importance in chronic than in acute difeafes. Perfons affliaed*with law fpirits, wind, weak neryes, and other hypochondriacal af- feaions, generally find more benefit from the ufe of folid food and generous liquors, than fiom all the cordial and carminative medicines which can be adminiftered to them. The fcurvy, that moft obftinate malady, will fooner yield to a proper vegetable diet than to all the boafted anti- scorbutic remedies of the fhops. In confumptions, when the humours are vitiated, and the ftomach fo much weakened as to be unable to digeft the folid fibres of animals, or even to affimulatc the juices of ve- getables, a diet confifting chiefly of milk will not only fup- port the patient, but wiil often cure the difeafe after every other medicine has failed. Nor is an attention to other things of lefs importance than to diet. The ftrange infatuation which has long in- duced people to fhut up the fick from all communication with the external air has done great mifchief. Not only in fevers, but in many other dileaies, the patient will receive more benefit from having the frefh air prudently admitted into his chamber, than from all the medicines which can be given him. , Exercise AND CURE OF DISEASES 103 Exercise may likewife, in many cafes, be confidered as a medicine. Riding on horfeback, for example, will be of more fervice in the cure of confumptions, glandular ob- ) ftruaions, &c. than any medicine yet known. In difeafes which proceed from a relaxed ftate of the folids, the cold bath and other parts of the gymnaftic regimen, will be found equally beneficial. Few things are of greater importance, even in the cure of difeafes, than cleanlinefs. When a patient is fuffered to lie in dirty clothes, whatever perfpires from his body is a- gain reforbed, or taken up into it, which ferves to nourifh the difeafe, and increafe the danger. Many difeafes may be cured by cleanlinefs alone; moft of them may be miti- gated by it, and in all of them it is highly agreeable both to the patient and thofe who attend him. Many other obfervations, were it neceffary, might be adduced to prove the importance of a proper regimen in dif- eafes. Regimen will often cure difeafes without medicine, but medicine will feldom fucceed where a proper regimen '.s negleaed. For this reafon in the treatment of difeafes, we have always given the firft place to regimen. Thofe who are afraid to ufe medicines may confine themfelves to it only. For others, who have more knowledge, we have recommended fome of the moft fimple, but approved, forms of medicine in every difeafe. Thefe however are never to be adminiftered but by people of better fenfe, nor even by them without the precautions which are recommended a- long with them. CHAP. XIII. OF FEVERS IN GENERA", A FEVER is the moft general difeafe incident to mankind. It attacks every age, fex, and conftitu- tion, and affeas every part of the body ; nor is the mind itfelf free from its influence. A fever is known by a quick; pulfe, an increafed heat, a general debility, and a difficut- ic4 OF FEVERS IN GENERAL. ty in performing fome of the vital or animal functions, as breathing, walking, is"c. Fevers are divided into continual, remitting, and in- termitting. By a continual fever is meant that which never leaves the patient during the whole courfe of the difeafe, or which fhews no remarkable increafe or abatement in the fymptoms. This kind of fever is likewife divided into acute, flow, and malignant. The fever is called acute when its progrefs is quick, and the fymptoms violent; but when thefe are more gentle, it is generally denominated flow. When livid or petechial fpots fhew a putrid ftate of the hu- mours, the fever is called malignant, putrid or petechial. A remitting fever differs from a continual only in de- gree. It has frequent increafes and decreafes, or exacerba- tions and remiffions, but never wholly leaves the patient during the courfe of the difeafe. Intermitting fevers, or agues, or thofe which, during the time that the patient may be faid to be ill, have evident intervals or remiffions of the fymptoms. As a fever is nothing elfe but an effort of nature to free herfelf from an offending caufe, it is the bufinefs of thofe who have the care of the fick, to obferve with diligence which way nature points, and to endeavour to affift her ope- rations. Our bodies are fo framed as to have a conftant tendency to expel or throw off whatever is injurious to health. This is generally done by urine, fweat, ftool, ex- peaoration, vomit, or fome other evacuation. There is reafon to believe, if the efforts of nature, at the beginning of a fever, were duly attended to and promot- ed, it would feldom continue longer than twenty-four hours; but when her attempts are either negleaed, or counteraa- ed, it is no wonder if the difeafe be prolonged. There are daily inftances of perfons who, after catching cold, have all the fymptoms of a beginning fever ; but by keeping warm, drinking diluting liquors, bathing their feet in warm wa- ter, ifc. the fymptoms in a few hours difappear, and the danger is prevented. In a word, almoft every fever pro- ceeding from an obftruaed perfpiration, mi- pcar. This is both the moft fafe and elfoaual ir.ethou of cure. An ounce of gentian root, calamus aromaticus and orange-peal, of each half an ounce, whh three or four handfuls of camomile flowers, and an handful of corian- der-feed, all bruifed together in a mortar, may be ufed in form of infufion or tea. About half a handful of thefe in :redicn*s U2 OF INTERMITTING FEVDRS. ingredients may be pu: into a tea-pot, and an Englifh pint of boiling water poured on them. A cup of this infufion drank three or four times a day will ftrengthen the ftomach, and greatly promote the cure. Such patients as cannot drink the watery infufion, may put two handfuls of the fame ingredients into a bottle of white wine, and take a glafs of it twice or thrice a day. If patients drink freely iif the above, or any other proper infufion of bitters, a fmaller quantity of bark than is generally ufed, will be fuf- licient to cure an ague. There is reafon to believe, that fundry of our own plants or barks, which are very bitter and aftringent, would lucceed in the cure of intermitting fevers, efpecially when affifted by aromatics. But as the Peruvain bark has been long approved in the cure of this difeafe, and is now to be obtained at a very reasonable rate, it is of lefs importance to fearch after new medicines. We cannot however omit taking notice, that the Peruvain bark is very often adulterated, and that it requires confiderable fkill to diftinguifh between the genuine and the falfe. 7 his ought t£) make people very cautious of whom they pur* chafe it. Those who cannot fwallow the bark in fubftance, may take it-'^n decoction or infufion. An ounce of bark in powder may be infufed in a bottle of white wine for four or five days, frequently fhaking the bottle, afterward; let the powder fubfide, and pour off the clear liquor. A wine glafs may be drank three or four times a day, or oftener, as there is occafion* If a decoaion be more agreeable, an ounce of the bark, and two drams of fnake- root bruifed, with a dram of fait of wormwood, may be boiled in a proper quantity of water, into half an Englifh pint. To the ftrained liquor may be added an equal quan- tity of red wine, and a glafs of it taken frequently. In obftinate agues the bark will be found much more efficacious when affifted by warm cordials, than taken alone. This I have had frequently occafion to obferve in a country where intermitting fevers were endemical. The bark feldom fucceeded unlefs affifted by fnake-root, ginger, canella alba, or fome other warm aromatic. When the fits are very frequent and violent, in which cafe the fever often approaches towards an inflammatory na- ture, it will be fafer to leave out the ginger, and to add f.lt of tartar in its ftead. But in an obftinate tertian or quartan OF INTERMITTING FEVERS. 113 Quartan, in the end of autumn or beginning of winter, warm and cordial medicines are abfolutely neceffary %. As autumnal and winter agues generally prove much more obftinate than thofe which attack the patient in fpring or fummer; it will be neceffary to continue the ufe of medi- cines longer in the former than in the latter* A perfon who is feized with an intermitting fever in the beginning of winter, ought frequently, if the feafon proves rainy, to take a little medicine, although the difeafe may feem to be cured, to prevent a relapfe, till the return of the warm fea- fon. He ought likewife to take care not to be much abroad in wet weather, efpecially in cold eafterly winds. When agues are not properly cured, they often degene- rate into obftinate chronical difeafes, as the dropfy, jaun- dice, tfrY. For this reafon all poffible care fhould be taken to have them radically cured* before the humours be viti- ated, and the conftitution fpoiled. Though nothing is more rational than the method of treating intermitting fevers, yet, by fome ftrange infatu- ation, more charms and whimfical remedies are daily ufed for removing this than any other difeafe. Thsre is hardly an old woman who is not poffeffed of a noftrum for flop- ping an ague; and it is amazing with what readinefs their pretenfions are believed. Thofe in diftrefs eagerly grafp at any thing that promifes fudden relief; but the fhorteft way is not always the fafeft in the treatment of difeafes. The only method to obtain a fafe and lafting cure, is gradually to affift nature in removing the caufe of the difeafe. Some indeed try bold, or rather fool-hardy experiments to cure agues, as drinking ftrong liquors, jumping into a river, &c. Thefe may fometimes have the defired effea, but muft always be attended with danger. When there is any degree of inflammation, or the leaft tendency to it, fuch experiments may prove fatal. The only patient whom 1 rembember to have loft in an intermitting fever, evident- ly killed himfelf by drinking ftrong liquor, which fome perfon had perfuaded him would prove an infallible remedy. Q^ Many \ In obftinate agues when the patient is old, the habit phlegmatic, the feafon rainy, the fituation damp, or the like, it will be neceffary to mix with two ounces of the bark half an ounce of Virginian fnake-root and a quarter Dt an ounce of ginger, or fome other warm aromatic; but when the fymp- toms are of an inflammatory nature, half an ounce of fait of wormwood, •r fait of tartar, may be added to the above quantity of bark. ii4 OF INTERMITTING FEVERS. Many dirty things are extolled for the cure of intermit- ting fevers, as cobwebs, fnuffings of candles, &c. Though thefe may fometimes fucceed, yet their very naftinefs is fuf- ficient to fet them afide, efpecially when cleanly medicine* will anfwer the purpofe better. .The only medicine that can be depended upon, for thoroughly curing an intermitting fe- ver, is the Permian bark. It may always be ufed with fafe- ty; and I can honeftiy declare, that in all my praaice 1 never knew it fail, when properly applied, and duly perfifted in. Where agues are endemical, even children are often af- fliaed with that difeafe. Such patients are very difficult to cure, as they can feldom be prevailed upon to take the bark, or any other difagreeable medicine. One method of ren- dering this medicine more palatable is, to make it into a mixture with diftilled waters and fyrup, and afterward to give it an agreeable fharpnefs with the elixir or fpirit of vi- triol. This both improves the medicine, and takes off the naufeous tafte. The bark may be adminiftered to children in form of clyfter when they will not take it by the mouth. Wine-whey is a very proper drink for a child in an ague; to half an Englifh pint of which may be put a tea- fpoonful of the fpirit of hartfhorn. Exercife is likewife of confiderable fervice; and when the difeafe proves obftinate, the child ought, if poffible, to be removed to a warm dry air. The food ought to be nourifhing, and fometimes a little generous wine fhould be allowed^:. We have been the more full upon this difeafe becaufe it is very common, and becaufe few patients in an ague apply to phyficians unlefs in extremities. There are however many cafes in which the difeafe is very irregular, being com- plicated with other difeafes, or attended with fymptoms which are both very dangerous, and very difficult to under- ftand. All thefe we have purpofely pafled over, as they would only bewilder the generality of readers. When the difeafe is very irregular, or the fymptoms dangerous, the pitient ought immediately to apply to a phyfician, and ftriaiy to follow his advice. To | I have known children who would rot take the Peruvian hark cured of an intermittent by the following medicine. Let two drams of fait of worm- wood, or fait of tartar, be diflblvcd in three ounces of freih lemon juice; to which may be added two ounces of mint water, or fimple cinnamon water, and the fame quantity of common fyrup. Two table fpoonfuls of this may be giren three or four times a day; and the medicine may b* re- peated as there is oecailon. OF INTERMITTING FEVERS. nS To prevent agues, people muft endeavour to avoid their caufes. Thefe have been already pointed out in the begin- ning of this foaion; we fhall therefore only add one pre- ventive medicine, which may be of ufe to fuch as are cb;>0;ed to live in low marfliy countries, or who are liable to sequent attacks of this difeafe. Take an ounce of the beft Jefuits bark, Virginian fnake-root, and orange-peel, of each half an ounce,* bruife than all together, and infufe for five or fix days in a bottle of brandy, Holland gin, or any good fpirit; afterwards pour off the clear liquor, and take a wine-glafs of it twice or thrice a da;,. This indeed is recommending a dram; but the bitter ingredients in a great meafure take off the ill ef- feas of the fpirits. Thofe who do not chufe it in brandy, may infufe it in wine; and fuch as can bring themfelves to cluew the bark, will find that method fucceed very well. Gentian root, or calamus-aromaticus, may alfo be chewed by turns for the fame purpofe. All bitters feem to be mi- dotes to a^ues, efpecially thofe that are warm and aitiin- dent. CHAP. XV. OF AN ACUTE CONTINUAL FEVER. THIS fever is denominated acute, ardent, or inflam- matory. It moft commonly attacks the young, or thofe about the prime or vigour of life, efpecially fuch as live full, abound with blood, and whofe fibres are ftrong and elaftic. It feizes people at all feafons of the year; but is moft frequent in the fpring and beginning of fummer. CAUSE S.----An ardent fever may be occafioned by any thing that overheats the body, as violent exercife, fleep- ing in the fun, drinking ftrong liquors, eating fpiceries, tlffc. It may likewife be occafioned by whatever obftruas the perfpiration, as lying on the damp ground, drinking cold liquor when the body is hot, night-watching, or the Jike. SYMPTOMS. n6 OF AN ACUTE CONTINUAL FEVER. SYMPTOM S.----A rigour or chillnefs generally tifhers in this fever, which is foon fucceeded by great heat, a frequent and full pulfe, a pain of the head, dry fkin, red- nefs of the eyes, a florid countenance, pains in the back, loins, &c. To thefe fucceed difficulty of breathing, fick- nefs, with an inclination to vomit. The patient complains of great thirft, has no appetite for folid food, is reftlefs, and his tongue generally appears black and rough. A delirium, exceffive reftleffnefs, great oppreftion of the breaft, with laborious refpiration, ftarting of the ten- dons, hiccup, cold, clammy fweats, and an involuntary difcharge of urine, are very dangerous fymptoms. As this difeafe is always attended with daneer, the beft me- dical affiftance ought to be procured as foon as poffible. A phyfician may be of ufe at the beginning, but his fkill is often ®f no avail afterwards. Nothing can be more unaccount- able than the condua of thofe who have it in their power, at the beginning of a fever, to procure the beft medical af- fiftance, yet put it off till things come to an extremity. When the difeafe, by delay or wrong treatment, has become incurable, and has exhaufted the ftrength of the patient, it is in vain to hope for relief from medicine. Phyficians may indeed affift nature; but their attempts muft ever prove fruitlefb, when fhe is no longer able to co-operate with their endeavours. REGIME N.----From the fymptoms of this difeafe it is evident, that the humours muft be too vifcid and acri- monious ; that the perfpiration, urine, faliva, and all the other fecretions, are in too fmall quantity; that the veffels are too rigid, and the heat of the whole body too great: All thefe clearly point out the neceffity of a regimen, calr culated to dilute the blood, deftroy the acrimony of the hu- mours, allay the exceffive heat, remove the fpafmodic flricr ture of the veffels, and promote the fecretions. These important purpofes may be greatly promoted by drinking plentifully of diluting liquors, as thin water- gruel or oatmeal-tea, clear whey, barley-water, balm-tea, apple-tea, (Jc. Thefe may be fharpened with juice of orange, jelly of currants, rafpberries, and fuch like: Orange whey is likewife an excellent cooling drink. It is made by boiling among milk and water a bitter orange fliced till the purd feparates. If no orange can be had, a Jemon, a little cream of tartar, or a few fpoonfuls of vinegar, will have OF AN ACUTE CONTINUAL FEVER. 117 the fame effea. Two or three fpoonfuls of white wine may occafionally be added to the liquor when boiling. If the patient be coftive, an ounce of tamarinds, with' two ounces of ftoned raifins of the fun, and a couple of figs, may be boiled in three Englifh pints of water to a quart. This makes a very pleafant drink, and may be ufed at difcretion. The common peaoral decodlion is likewife a very proper drink in this difeafe. A tea-cupful of it may be taken every two hours, or oftener, if the patient's heat and thirft be very great *. The above liquors muft all be drank a little warm. They may be ufed in fmaller quantities at the beginning of a fever, but more freely afterwards, in order to affift in carrying off the morbid matter by the different excreti- ons. We have mentioned a variety of liquors, that the patient may have it in his power to choofe thefe which are moft agreeable ; and that, when tired of one, he may have recourfe to another. The patient's diet muft be very fpare and light. All forts of flefh-meats, and even chicken-broths, are to be avoided. He may be allowed groat-gruel, panado, or light bread boiled in water ; to which may be added a few grains of common fait, and a little fugar, which will ren- der it more palatable. He may eat roafted apples with a little fugar, toafted bread with jelly of currants, boiled prunes, &c. It will greatly relieve the patient, efpecially in an hot feafon, to have frefh air frequently let, into his chamber. This however muft always be done in fuch a manner as not to endanger his catching cold. It is a common praaice in fevers to load the patient with bed-cloaths, under the pretence of making him fweat, or defending him from the cold. This cuftom has many ill effeas. It increafes the heat of the body, fatigues the patient, and retards, inftead of promoting the perfpi- ration. Sitting * The pefloral decodlion is made by boiling pearl barley, ftoned raifins. and figs, of each two ounces, liquorice root fliced, hajf an ounce, in two Englim quarts, or one Scots pint, of water, till one half be confumed. The barley mould be boiled for fome time before the other ingredients arc put in. If to this decoftion two or three drams of purified nitre be occa- fionally added, it will not only be an agreeable drink, but prove an c*cccd- wggjod medicine. u8 OF AN ACUTE CONTINUAL FEVER. Sitting upright in bed, if the patient be able to bear it, will often have a good effea. It relieves the head, by retarding the motion of the blood to the brain. But this pofture ought never to be continued too long: And if the patient be inclined to fweat, it will be more fate to let him lie ftill, only raifing his head with pillows. Sprinkling the chamber with vinegar, juice of lemon, or vinegar and rofe-water, with a little nitre diffolved in it, will greatly refrefh the patient. This ought to be done frequently, efpecially if the weather be hot. The patient's mouth fhould be often wafhed with a mixture of water and honey, to which a little vinegar may be added ; or with a decoaion of figs in barley- water. His feet and hands ought likewife frequently to be bathed in lukewarm water; efpecially if the head be affeaed. The patient fhould be kept as quiet and eafy as poffi- ble. Company, noife, and every thing that difturbs the mind is hurtful. Even too much light, or any thing that affea« the fenfes, ought to be avoided. His attendants fliould be as few as poffible, and they ought not to be too often changed. His inclinations ought rather to be tooth- ed than contradiaed; even the promife of what he craves will often fatisfy him as much as its reality. M E DICIN E.----In this and all other fevers arifing from an increafed motion and vifcidity of the blood, bleed- ing is of the greateft importance. This operation ought al- ways to be performed as foon as the fymptoms of an in- flammatory fever appear. The quantity of blood to be let, however, muft be in proportion to the ftrength of . the patient, and the violence of the difeafe. If after the firft bleeding the fever feems to rife, and the pulfe feels hard, there will be a neceifity for repeating it a fecond^ and perhaps a third or even a fourth time, which may be done at the diftance of twelve, eighteen, or twenty-four hours from each other, or longer, as the fymptoms re- quire. If the pulfe continues foft, and the patient is to- lerably eafy after the firft bleeding, it ought no$ to be. repeated. If the heat and fever be very great, forty or fifty drops of the dulcified, or fweet fpirit of virtiol, may be made into a draught, with an ounce of rofe-water, two ounces of common water,, and half an ounce of fimple fyrup, or a bit OF AN ACUTE CONTINUAL FEVER. tig a bit of loaf-fugar. This draught may be given to the patient every three or four hours while the fever is violent j afterwards, once in five or fix hours will be fufficient. If the patient be affliaed with reaching, or an inclina- tion to vomit, it will be right to affift Nature's attempts, by giving him weak camomile tea or lukewarm water to drink. If the belly be bound, the patient ought daily to receive a clyfter of milk and water with a little"fait, and a fpoon- ful of fweet oil or frefh butter. Should this not have the defired effea, a tea-fpoonful of magnefia alba, or cream of tartar, may be frequently put into his drink. He may likewife eat tamarinds, boiled prunes, roafted apples, and the like. If about the ioth, nth, or 12th day, the pulfe be- comes more foft, the tongue moifter, and the urine be- gins to let fall a reddifh fediment, there is reafon to expe& a favourable iffue to the difeafe. But if, inftead of thefe fymptoms, the patient's fpirits grow languid, his pulfe finks, and his breathing becomes difficult; with a flupor, trembling of the nerves, ftarting of the tendons, &c. There is reafon to fear that the confequences will be fatal. In this cafe bliftering platters mujt be applied to the head, ancles, infide of the legs or thighs, as there may be occafion; poultices of wheat bread, muftard and vinegar, may likewife be applied to the foles of the feet, and the patient muft be fupported with Cordials, as ftrong wine-whey, negas, fago-gruel, with wine in it, and fuch like. A proper regimen is not only neceftary during the fever, but likewife after the patient begins to recover. By negleaing this, many relapfe, or fall into other difeafes, and continue valetudinary for life. Though the body be weak after a fever, yet the food for fome time ought to be rather cleanfing than of too nourifhing a nature. The perfon fhould take great care not to exceed in any thing. Too much food, drink, exercife, company, &fV. are care- fully to be avoided. The mind ought likewife to be kept eafy, and the perfon fhould not attempt to purfue ftudy, or any bufinefs that requires intenfe thinking. If the digeftion be bad, or the perfon be troubled at times with feverifh heats, an infufion of Peruvian bark in 120 OF AN ACUTE CONTINUAL FEVER. in cold water will be of ufe. It will ftrengthen the ftomach, and help to fubdue the remains of the fever. When the patient*§ ftrength is pretty well recovered* he ought to take fome gentle laxative. An ounce of tama- rinds and a dram of fenna, may be boiled for a few minutes in an Englifh pint of water, and an ounce of manna dif- folved in the decoaion; afterwards it may be ftrained, and a tea-cupful drank every hour till it operates. This dofe may be repeated twice or thrice, five or fix days in- tervening betwixt each dofe. Those who follow laborious employments ought not to return too foon to their labour after a fever, but fhould keep eafy till their ftrength and fpirits be recruited. CHAP XVI. OF THE PjLEURISY. TH E true pleurify is an inflammation of that mem- brane, called the pleura, which lines the infide of the breaft. It is diftinguifhed into the moift and dry. In the former, the patient fpits freely ; but in the latter, lit- tle or none at all. There is likewife a fpecies of this difeafe^ which is called the fpurious or baflurdpleurijy, in which the pain is more external, and chiefly affedts the mufcles between the ribs. The pleurify prevails among labouring people, efpecially fuch as work without doors, and are cf a fanguine conftitution. It is moft frequent in the fpring feafon. CAUSE S.----The pleurify may be occafioned by whatever obftruas the perfpiration; as cold northerly winds; drinking cold liquors when the body is hot; fleeping with* out doors on the damp ground ; wet cloathes; plunging the body into cold water, or expofing it to the cold air, when covered with fweat, &c. It may likewife be oc- cafioned by drinking ftrong liquors; by the ftoppage of ufual evacuations; as old ulcers, iffues, fweating of the O F T II E P L E U R I S Y. 121 feet or hands, &c. the fudden ftriking in of any erupti- on, as the itch, the meafles, or jdie fmall-pox. Thofe who have been accuftomed to blelB at a certain feafon of the year, are apt, if they negfoa it, to be feizeu with a pleurify. Keeping the body too warm by'means of fire, clothes, tffc. renders it more liable to this difeafe. A pleurify may likewife be occafioned by violent exercife, as running, wreftling, leaping, or by fopporting great weights, blows on the breaft, Life. The very make of the body fometimes renders perfons more liable to this difeafe, as a narrow cheft, a ftraitnefs of the arteries of the pleura, &c. SYMPTOMS.----This, like moft other fevers, generally begins with chillinefs and fhivering, which are followed by heat, thirft, and reftleffnefs. To thefe fuc- ceed a violent pricking pain in one of the fides among the ribs. Sometimes the pain extends towards the back-bone, fome times towards the fore-part of the breaft, and at other times towards the fholuder-blades. The pain is generally moft violent when the patient draws in his breath. The pulfe in this difeafe is generally quick and hard, the urine high coloured ; and if blood be Jet, it is co- vered with a tough ciuft, or buffy coat. The patient's fpittle is at firft thin, but afterwards it becomes greffer, and is often ftreaked with blood. REGIME N.----Nature generally endeavours to car- rv off this difeafe by a critical difcharge of blood from fome part of the body, by expeaoration, fweat, loofe ftools, thick urine, or the like. We ought therefore to fecond her intentions by leffening the force of the circulation, relaxing the veffels, diluting the humuors, and promoting expeaoration. For thefe purpofes the diet, as in the former difeafe, muft be cool, flender, and diluting. The patient muft avoid all food that is vifcid, hard of digeftion, or that affords much nourifhment; as flefh, butter, cheefe, eggs, milk, and alfo every thing that is of a heating nature. His drink muft be fweet whey, or decoaions and infufions of the peaoral and balfamic vegetables *. R Barley-water, * Take two table-fpoonfuls of linfeed, a quarter of an ounce of liquorice root fiiccd, and half an ounce of the leaves of coltsfoot. Put thefe ingre- Ai-nts in a clofe veflcl, pour on them an Englifh quart of boiling water, and 1»-1 them iU«>.Uv..r a fire for eight or ten hours; afterwards (train oif 322 OF THE PLEURISY. Barley-water, with a little honey, or jefly dfccur- rants mixed with it, i&likewife a very proper drink.in this difeafe. It is madefy boiling an ounce of pearl-barley in three Englifh pints of water to two, muft afterwards be ftrained. The decoaion of figs, raifins, on the lids,«*WH^Ii warm hand, three or four times * i,y. J24 OF THE PLEURISY. If the flitch continues after repeated bleedings, fomen- tations, c50. a bliftering plafter muft be laid upon the part affeaed, and fflfflred to remain for two days. This not only procures a difcharge from the fide, but attenuates the humours, and by that means affifts in removing the caufe of the difeafe. To prevent a ftranguary when the bliftering plafter is on, the patient may drink freely of the arabic emulfion *. If the patient be coftive, a clyfter of thin water-gruel, or of barlev-water, in which a handful of mallows, or any other emollient vegetable, has been boiled, may he daily adminiftred. This will not only empty the bowels, but have the eiYeci of a warm fomentation applied to the inferior vifcera, which will help to make a derivation from the breaft. The expeaoration, or fpitting, may be promoted by fharp, oily; and mucilaginous medicines. For this pur- pufe, an ounce of the oxymel, or the vinegar offquills, may be added to fix ounces of the peaoral decoaion, and two table-fpoonfuls of it taken every two hours. Should the fquill difagree with the flkmach, two ounces of the oil of fweet almonds, or oil of olives, and two ounces of the fyrup of violets, may be mixed with as much fugar-candy powdered, as will make an eleauary of the confiftence of honey. The patient may take a tea- fpoonful of this frequently, when the cough is troublefome. Should oily medicines happen to prove naufeous, which is fometimes the cafe, a folution of gum ammoniac in bar- lev-water may be adminiftered f. If the patient does not perfpire, but has a burning heat upon the fkin, and paffes very little water, fome fmall dofes of purified nitre and camphire will be of ufe. Two drams * The arabic emulfion is prepared in the following manner: Take an ounce of fweet almonds blanched, and beat them well in a mortar, with an equal quantity of fine fugar. Then dilTolve h^lfun ounce of gum-arabic in an Englilh quart of barley-water warm; let it (land till cool, and afterwards, pour it by little and little upon the almonds and fugar, continually rubbing mem till the liquor becomes uniformly white or milky. Afterwards drain it, and let the patient ufe it for ordinary drink. •J- The folution of gum ammoniac is made in the following manner : Let two drams of "um ammoniac be well rubbed in a mortar, and an Fhg- lifli p'nt of barlev-water gradually poured upon it till it be quite diflolved. Three or four ounces of fimple pennyroyal-water may bo added to the a- tmve quantity, and two table-fpoonfuls*oPlt*r?.ken three or four times a day. OF THE PLEURTSY, 125 drams of the former may be rubbed with five or fix grains of the latter in a mortar, and the whole divided into fix dofes, one of which may be taken every five or fix hours, in a little of the patients ordinary drink. We fhall only mention one medicine more which fome indeed reckon almoft a fpecific in the pleurifv, viz. the decoaion of the feneka rattle-fnake-root f. After bleed- ing and other evacuations, have been premifed, the patient may tak;etwQ? three, or four table-fpqonfuls of this decoai- on, according as his ftomach will bear it, three or four times a day. If it fhould occafion vomiting, two or three oun- ces of fimple cinnamon-water may be mixed with the quantity of decoaion here direacd, or it may be taken in fmaller dofes. As this medicine promotes perfpiration and urine, and likewife keeps the belly eafy, it bids fair for anfwering many of the intentions of cure in a pleurify, or any other inflammation of the breaft. No one will imagine, that thefe medicines are all to be ufed at the fame time. We have mentioned different things, on purpofe that people may have it in their pow- er to chufe ;0and likewife, that when one cannot be ob- tained, they may make ufe of another. Different me- dicines are no doubt neceffary in the different periods of a diforder; and where one fails of fuccefs, or difagrees with the patient, it will be proper to try another. What is called the crifis, or height of the fever, is fometimes attended with very alarming fymptoms, as dif- ficulty of breathing, an irregular pulfe, convuJfive moti- ons, &c. Thefe are apt to fright the attendants, and in- duce them to do improper things, as bleeding the patient, giving him ftrong ftimulating medicines, or the like. But they are only the ftruggles of nature to overcome the dif- eafe, in which fhe ought to be affifted by plenty of dilut- ing drink, which is then peculiarly neceffary. If the patient's ftrength however be much exhaufted by the difeafe, it may be neceffary at this time to fupport him with fre- quent fmall draughts of wine-whey, fmall negus, or the f This decoction is made by boiling an ounce of feneka rattle-fnake root in an Englifli pint and a half of water, till one-third part of the water be ronfumed ; afterwards let it be (trained. n6 pF'THE PLEURISY. When the pain and fever are gone, it will be proper, after the patient has recovered fufficient ftrength, to give bim fome gentle purges, as thofe direaed towards the end of the acute continual fever. He ought likewife to ufe a light diet of eafy digeftion, and his drink fhould be butter-milk, whey, and other things of a cleanfing nature. Of the BASTARD PLEURISY. That fpecies of pleurify which is called the bajlard or fpuriuu:. generally goes off by keeping warm for a few davs, drinking plenty of diluting liquors, and obferving a proper teamen. It is known by a dry cough, a quick pulfe, and a difficulty of lying on the affeaed fide, which laft does not always happen in the true pleurify. Sometimes indeed this difeafe proves obftinate, and requires bleeding, with cupping, and fcarifications of the part affeaed. Thefe, together with the ufe of nitrous, and other poling medi- cines, feldom fail to effea a cure. O f t h e P A R A P H R E N I T I S. The paraphrenitis, or inflammation of the diaphragm, is fo nearly conneaed with the pleurify, and refembles it fo much in the manner of treatment, that it is fcarce ne- ceffary to confider it as a feparate difeafe. It is attended with a '"-'y acute fever, and an extreme pain of the part affeaed, which is generally augmented by coughing, fneezing, drawing in the breath, taking food, going to ftool, making water, cjjV. Hence the patient breathes quick, and draws in his bowels to prevent the motion of the diaphragm ; is reftlefs, anxious, has a dry cough, a hiccup, and often a delirium. A convulfive laugh, or rather a kind of involuntary grin, is no uncom- mon fymptom of this difeafe. Every method muft be taken to prevent a fuppuration, as it is impoffible to fave the patient's life when this hap- pens. The regimen and medicine are in all refpeas she fame as OF THE PLEURfSY. 12? as in the pleurify. We fhall only add, that in this difeafe emollient clyflers are peculiarly ufeful, as they relax the bowels, and by that means draw the humours from the part affeaed. * CHAP. XVII. OF A PERIPNEUMONY, OR INFLA1VL MATION OF THE LUNGS, AS this difeafe affeas an organ which is absolutely neceffary to life, it muft always be attended with danger. Perfons who abound with thick blood, whofe fibres are tenfe and rigid, who feed upon grofs aliment, and drink ftfong vifcid liquors, are moft liable to this difeafe. It is generally fatal to thofe who have a flat breaft,. or narrow cheft, and to fuch as are atfliaed with an afth- ma, efpecially in the decline of life. Sometimes the in- flammation reaches to one lobe of the lungs only, at other times the whole of that organ is affeaed; in which cafe the c'iOaO can hardly fail to prove fatal. When the difeafe proceeds from a vifcid pituitous mat- ter, obftruaing the veffels of the lungs, it is called a fpurious or haflard peripnsumony. When it arifes from a thin acrid defluaion on the lungs, it is denominated a ca- tarrhal perlpyteumony, kc. CAUS K S.----An inflammation of the lungs is fome*- times a primary difeafe, and fometimes it is the confe- quence of other difeafes, as a q'OnOy, a pleurify, &c. It arifes from the fame caufe; as the pleurify, viz. an ob- ftruaed perfpiration from cold, wet clothes, &c. or from an increafed circulation of the blood by violent exercife, the ufe of fpiceries, ardent fpirits, and fuch like. The pleurify and peripneumony aiw> often complicated; in which cafe tha difeafe is called a pleuroperibneumony. S Y Ai P T O M S.----^ Moft of the^ fymptoms of a pleurify likewife attend an inflammation of the lungs; onlv xa8 OF A PERIPNEUMON Y. only in the latter the pulfe is more foft, and the pairi lefs acute ; but the difficulty of breathing, and oppreffion of the breaft, are generally greater. REGIME N----As the the regimen and medicine arc in all refpeas the fame in the true peripneumony as in the pleurify, we fhall not here repeat them, but refer the reader to the treatment of that difeafe. It may not however be improper to add, that the aliment ought to be more flender and thin in this than in any other inflam- matory difeafe. The learned Dr. Arbuthnot afferts, that even common whey is fufficient to fupport the patient, and that decoaions of barley, and infufions of fennel- roots in warm water with milk, are the moft proper both for drink and nourifhment. He likewife recommends the fleam of warm water taken in by the breath, which fer ves as a kind of internal fomentation, and helps to attenuate the impaaed humours. If the patient has loofe ftools, but is not weakened by them, they are not to be ftopped, but father promoted by the ufe of emollient clyfters. It has already been obferved, that the fpurious or baflard peripneumony is occafioned by a vifcid pibwitous matter obftruaing the veffels of the lungs. It commonly at- tacks the old, infirm, and phlegmatic, in winter or wet feafons. The patient at the beginning is cold and hot by turns, has a fmall quick pulfe, feels a fenfe of weight upon his breaft, breathes with difficulty, and fometimes complains of a pain and giddinefs of his head. His urine is com- monly pale, and his colour very little changed. The diet in, this, as well as in the true peripneumony, muft be very flender, as weak broths fharpencd with the juice of orange or lemon, &c. His drink may be thin .water-gruel fweetencd with honey, or a decoaion of the roots of fennel, liquorice, and ,.quick grafs. An ounce of thefe may be boiled in three Englifh pints of water to a quart, and fharpened with a little currant-jelly, or the like. Bleeding and purging are generally proper at the beginning of thi=> lifeafe; but if the patient's fpittle be pretty thick, or Wvll conneaed, neither of them are ne- ceffary. It will be fufficient to affift the expeaoration by fome ofthe foft balfamic medicines, recommended for that purpofe in the pleurify. Bliftering plafters have generally a, good OF A PERIPNEUMONY. 129 a good effea, and ought to be applied pretty early. They may either be applied to the neck or ancles, or both, if neceffary. If the patient does not fpit, he muft be bled according as his ftrength will permit, and have a gentle purge ad- mi niftred. Afterwards his belly may be kept open by clyfters, and the expeaoration promoted, by taking every four hours two tablefpoonfuls of the folution cfgum-am- m miac, recommended in the pleurify. When an inflammation of the breaft does not yield to bleeding, bliftering, and other evacuations, it commonly ends in a fuppuration, which is more or lefs dangerous, according to the part where it is fituated. When this happens in the pleura, it fometimes breaks outwardly, and the matter is discharged by the wound. When the fuppuration happens within the fubftance or body of the lungs, the matter may bedifcharged by ex- peaoration ; but it the matter floats in the cavity of the breaft, between the pleura and the lungs, it can only be difcharged by an incifion made betwixt the ribs. If the patient's ftrength does not return after the in- flammation is to all appearance removed ; if his pulfe con- tinues quick though foft, his breathing difficult and op- prefled ; if he has cold fhiverings at times, his cheeks flufhed, his lips dry; and if he complains of thirft, and want of appetite ; there is reafon to fear a fuppuration, and that a phthifis or confumption of the lungs will enfue. We fhall therefore next proceed to confider the proper treatment of that difeafe. CHAP. XVIII. OF CONSUMPTIONS. A Consumption is a wafting or decay of the whole body from an ulcer, tubercles, or concretion of the lun<--s, an empyema, a nervous atrophy, &c. Dr. Arbuthnot obferves, that in his time confumptions made up above .one tenth part of the bills of mortality in r S anc* 130 O IWC OKSUMPTIONS. and about Lofldfcn. There is reafon to believe they have rather increafed fince; and we know for certain, that they are not lefs fatal in fome other towns in England than in London. Young perfons betwixt the age of fifteen and thirty, of a flender make, long neck, high lhoulders, and flat breafts, are moft liable to this difeafe. Consumptions prevail more in England than in any other part of the world, owing perhaps to the great ufe of animal food and ftrong liquors, the gqneral application to fedentary employments, and the great quantity of pit-coal which is there burnt; to which we may add the perpetual changes in the atmofphere, or variablenefs of the weather. CAUSE S.----It has already been obferved, that an inflammation of the breaft often ends in an impofthume : Confequently whatever difpofes people to this difeafe muft likewife be confidered as a caufe of confumptions. Other difeafes, by vitiating the humours, may likewife occafion confumptions ; as the fcurvy, the fciophuha or kind's evil, the venereal difeafe, the afthma, fmall pox, rr.eafles, &c. As this difeafe is feldom cured, we mall endeavour to point out its caufes the more particularly, in order that people may be enabled to avoid it. Thefe are : -----Want of exercife. Hence it comes to pafs, that this difeafe is fo common amongft the inhabitants of great towns, who follow fedentary employments, and likewife amongft the rich, who arc not under the neceffity of labour- ing for their bread. ----Confined or unwholfor.ie'air. Air which ftagn3tes, or is impregnated with the funics of metals or minerals, is extremely hurtful to the lunOs, :::A often corrodes the ten- der veffels of that neceffary o;gan. -----Violent paflions, exertions, or-affoaions of the mind ; as griff, uifappqintment, anxiety, or clofe applicati- on to the ftudy of abftrufaSrts or fciences, &c. -----Great evacuation's ; as fweating, diarrhoeas, di- abetes, exceffive venery, the fluor albus, an over-difchargc of the mejuftrual flux, giving fuck too long, Uc. _____The fudden ftoppage of cuftomary evacuations; as the bleeding dj§d$<, fweating of the feet, bleeding at the nofe, the menfes, rffues, ulcers, or eruptions of any kind. .----Making a fudden trarfitfon from a hot to a very cold OF CONSUMPTIONS. i3t cold climate, change of apparel, of whateWr greatly leffens the perfpiration. -----Frequent and exceffive debaucheries. Late watch- ing and drinking ftrong liquors, which generally go to- gether, can hardlv fail to deftroy the lungs. Hence the bon companion often falls a facrifice to this difeafe. -----Infection. Confumptions are often caught by fleeping with the difeafed •, for which reafon this fhould be carefully avoided. It cannot be of great benefit to the fick, and muft hurt thofe in health. -----Occupations in life. Thofe artificers who fit much, and are conftantly leaning forward, or preffino- upon the ftomach and breaft, as cutlers, ta\ lors, fhoemakers, cJc. often die of* confumptions. -----Cold. More confurr.ptivs patients date the begin- ning of their diloreers from wet feet, damp beds, night- air, wet clothes, and fuch like, than from all other caufes. SHARP, faline, and aromatic aliments, which heat and inflame the bloody are likewife frequently the caufe of confumptions. We fhall only add, that this diferfe is often owing to an hereditary taint; in which cafe it is generally incurable. SYMPTOMS.----This difeafe generally begins with a dry cough, which often continues for fome months. If a difpofition to vomit after eating be excited by it, there is ftill greater reafon to fear an approaching confumption. The patient complains of a rr.nre than ufual degree of heat, a pain and oopreu;on of the breaft, efpecially after motion ; his fpittle is of a faltifh tafte, and fometimes mixed with blood. He is apt to be fad ; his appetite is bad, and his thirft great. There is generally a quick, foft fmall pulfe ; though fometimes the pulfe is pretty full, and rather h-ird. Thefe are the common fymptoms of a beginning con- fumption. Afterwards the patient begins to fpit a greenifh, whits, or bloody matter. His body is extenuated by the heaic fever and colliquative fweats, which mutually fuccecd one another, viz. the one towards night, and the other in thy morning. A loofenefs, and an exceffive. difcharge of urine, are often troublefome fymptoms at this tin e, and greutlv weaken the patient. There is a burning heat in the palms of the hands, and the face generally flufhts after eating; S 2 the 132 O^/ONSUMPTIONS. the fingers becoine remarkably fmall, the nails are bent in- wards, and the hairs fall off. At laft the fwelling of the feet and legs, the total lofs of ftrength, the finking of the eyes, the difficulty of fwallow- ing, and thecoldnefs of the extremities, fhew the immediate approach of death, which however the patient feldom be- lieves to be fo near. Such is the ufual progrefs of this fa- tal difeafe, which, if not early checked, commonly fets all medicine at defiance. REGIMEN.----On the firft appearance of a confump- tion, if the patient lives in a large town, or any place where the air is confined, he ought immediately to quit it, and to make choice of a fituation in the country, where the air is pure, dry and free. Here he muft not remain^inaarve, but take every day as much exercife as he can bear. * The beft method of taking exercife is to ride on horfe- back, as this gives the body a great deal of motion without much fatigue. Such as cannot bear this kind of'exercife, muft make ufe of a machine. A long journey, as it amufes the mind by a continual change of objeas,' is greatly prefer- able to riding the fame ground over and over. yCare how- ever muft be taken to avoid catching cold from wet cloth^, damp beds, or the like. The patient ought always to fi- nifh his ride in the morning, or at leaft before dinner; other- wife it will oftner do harm than good. At any rate, the. patient muft ride ; his life depends upon it; and it is almoft an infallible remedy, if begun in time, and duly perfifted in. It is pity thofe who attend the fick feldom recommend riding in thib difeafe, till the patient is either unable to bear it, or the malady is Jbe.come incurable. Patients are like- wife apt to trifle with every thing that is in their own power. They cannot fee how one of the common aaions of life fnould piove a remedy-in an obftinate difeafe, and there- fore they rejea it, while they greedily hunt after relief from medicine, merely becaufe they do not underftand it. Those who have ftrength and courage to undertake a pretty lpng voyage, may expea great advantage from it, This, to my knowledge, has frequently cured a confumption after the patie^$.was, to all appearance, in the laft ftage of that difeafe, and where medicine had proved ineffeaual. Hence it is reasonable to^onclude, that if a voyage were undertaken in due time it would feldom fail to perform a OF CONSUMPTI C^l*6. 133 Such as try this method of cure ought to*carry as much frefh provifions along with them as will ferve for the whole time they .are at fea. As milk is not to be obtained in this fituation, they ought to live on fruits and the broth of chic- kens, or other young animals which can be kept alive on board. It is fcarce neceffary to add, that fuch voyages fhould be undertaken, if poffible, in the mildeft feafon, and that they ought to be towards a warmer climate. Those who have not courage for a long voyage may travel into a more fouthern climate, as the fouih of France, bpain, or Portugal; and if they find the air of thefe coun- tries agree with them, they fhould continue there, at leaft till theirhealjth be confirmed. Next to proper air and exercife, we would recommend a due attention to the diet. The patient muft cat nothing that is either heating or hard of digeftion, and his drink muft be of a foft and cooling nature. All the diet muft b: calculated to leffen the acrimony of the humours, and to nourifh and fupport the patient. For this purpofe he muft Itcep chiefly to the ufe of vegetables and milk. Milk alone is of more value in this difeafe than the whole materia medico. Asses milk is generally reckoned preferable to a>-y other; but it cannot always be obtained; befides, it is ge- nerally taken in a very fmall quantity ; whereas to pro- duce any confiderable effeas, it ought in a manner to make the principal part of the patients food. It is hardly to be ex- peaed, that a gill or two of affes milk, drank in the fpace of twenty four hours, fhould be able to produce any con- . fiderable change in the humours of an adult ; arJ wh:a people do not perceive its effeas foon, they lofe hop.?, and fo leave it off. Hence it comes to pafs that this me- dicine, however valuable, very feldom performs a cure. The reafon is obvious; it is commonly ufed too late, is t.ken in too fmall quantities, and 1s not duly perfifted in. I have known very extraordinary effeas from affes milk in obftinate coughs, which threatened a confumption of the lungs ; and do verily believe, if ufed at this period, that it would feldom fail; but if it be delayed till an ulcer is formed, which is generally the^cafe, how can it be ex- peaed to fucceed ? Asses milk ought to be drank, if poffible, in its natural warmth, and, by a grown perfon, in the quantity of half an Englifh pint at a time. Inftead of taking this quantity ni^ht 134 . OrF «C ONSUMPTIONS. night and morning only, the patient ought to take it four * times, or at leaft thrice a-day, and to eat a little light bread along with it, fo as to make it a kind of meal. If the milk fhould happen to purge, it may be mixed with old conferve of rofes. When that cannot be obtained, the powder of crabs claws may be ufed in its ftead. Affes milk is ufually ordered to be drank warm in bed ; but as it generally throws the patient into a fweat when taken in this way, it would perhaps be better to give it after he rifes. Some extraordinary cures in confumptive cafes have been performed by women's milk. Could this be obtained in fufficient quantity, we would recommend it preferably to any other. It is better if the patient can f\\ck it from the breaft than to drink it afterwards. I knew a man who was reduced to fuch a degree of weaknefs in a confumption, as not to be able to turn himfelf in bed. His wife was at that time giving fuck, and the child happening tdfcdie. he fuck- ed her breafts, not with a view to reap any advantage from the milk, but to make her eafy. Finding himfelf*however greatly benefited by it, he continued to fuck her till he be- came perfoaiy well, and is at prefent a ftrong and healthy man. Some prefer butter-milk to any other, and it certainly is a very valuable medicine, if the ftomach be able to bear it. It does not agree with every perfon at firft; and is therefore often laid afide without a fufficient trial. It fhould at firft be taken fparingly, and the quantity gradually increafed, until it comes to be almoft the fole food. I never knew it fucceed unle0 where the patient almoft entirely lived upon Cows milk is moft readily obtained of anv, and though it be not fo eafijy digefted as that of afles or mares, it may be rendered lighter by adding to it an equal quantity of bar- ley-water, or allowing it to ftand for fome hours, and af- terwards taking off the cream. If it fhould notwithstand- ing prove heavy on the ftomach, a tabie-fpoonful of rum . or brandy, and a bit of loaf fugar, may be put into half an Englifh pint. It is not to be wondered, that milk fhould, for fome time, difagree with a ftomach that has not been accuftomed to di- geft any thing but flefh and ftrong liquors, which is the cafe with many of thofe who fall into confumptions. We do not however advife thofe who have been accuftomed to animal OF CONSUMPTIONS. 13c animal food and ftrong liquors, to leave them off all at once* 1 his might be dangerous. It will be neceffary for fuch to cat a little once a-day of the flefh of fome young animal, or rather to ufe the broth made of chickens, veal, lamb, or fuch like. They ou:to increafe it, by heating the blood, while they pall the "appe- tite, relax the folids, and prove every way hurtful to the patient. Whatever is ufed for removing the cough, befides riding and other proper regimen, ought to be medicines of a ftiarp and cleanfing na.ure; as oxymel, fyrup of lemon, &c*. For * Acids feem to have peculiarly good effe&s in this difeafe; they both tend to quench the patient's third and to cool the blood. The vegetable acids, as OF CONSUMPTIONS. r37 For the patient's drink, we would recommend infi.fhmg of the bitter plants, as ground-ivy, the lefTer centaury, ca- momile flowers, or water-trefoil. Thafe kifulions may be' drank at pleafure. They ftrenir.hen the ftomach, promote digeftion, reaify the blood, and at the fame time anfo er all the puaofos of dilutOn, and quench thirft much better than things that are lufcious or f.vcet. But if the patient fp;ts blood, he ought to ufe, for his ordinary drink, in- fuiions or decoctions of the'vilnerary root:-;, pO.nts, &cX- There are many other mucilaginous plants and feeds, of a healing and'agglutinating nature, from ehich decoc- tions or infui:or:s may be pre on red with the fame intention j as the orches, the quince~f.ed, coltsfoot, linfeed, farfapa- rilla, &c. It is not neceffiry to mention the different ways in which thefe may be prepared. Simple infufion or boiling is ail thrit is neceffary, mO the dofe may be at difcretion. The conferva of rofes is here peculiarly proper. It may cither be put into the decoaion above rreferbed, or eat b/ itfelf. ■ No b.-nefit is to be expeacd from t: iflhi2: dofes of this medicine. I w. ver knew it of anv fervice unlefs where three or four ouno.s at le-;ft were ufed daily for a confider- able time. In this way 1 have feen it proclure very extra- ordinary efTeiO, and would recommend it wherever there is a difcharge of blood from the lungs. When the fp it ting up of grofs matter, oppreffion of the breaft, and the heaic fymptoms fhew that an impofthume 0 formed in the lumjs, we vvc.ild recommend the Peruvian bark, that being the only drug which has any chance to counteraa the general undency which the humours then have to putrefaction. An ounce of the bark in powder mav be divided into eighteen or twenty dofes, of which one may be taken every three hours through the dav, in a little fyrup, or a cup cf the patient's ordinary drink. ■ T If * apples, orarge-, lemons, &c. rnnfr to be the moft rr^-r.. We have known patients fut'k the i'.iice of" feveral lemons every day .7 ,'i inafcifeft O.- vantage, and would, +or wiis rcufon, recommend acid vegetables to be taken iu asf reat quantity as the ftomach will bear them. \ Take an ounce of corrOrev-roor, of liquorice and nv.nVmfliO-.v <:^lr-, each half an ounce. Boil them in two Englifh 4'iarts of water to one. A tea-fpoonful of the aci! c'.Oir of vLtri,»l p.l.v he adJtd tu this ieCvttion when cold, ami a tva-ci; :'ul o; it taken four or f^e times a-7>. J38 OF CONSUMPTIONS. If the bark fhould happen to purge, it may be made Into an eleauary, with the conferve of rofes thus: ' Take old confcrve of rofes a quarter of a pound, Pefuvian bark in powder an ounce, fyrup of orange or lemon, as much as will make it of the confidence of honey. This quantity will ferve the patient four or five days, and may be repeated as there is occafion. Such as cannot take the bark in fubftance, may infu: • it in cold water. This feems to be the beft menftruum for extraaing the virtues of that drug. Half an ounce of bark in powder may be infufed for twenty-four hours in half an Englifh piht of water. Afterwards let it be palled through a fine ftrainer, and an ordinary tea-cupful of it taken three or four times a-day. We would not recommend the bark while there are any fymptoms of an inflammation of the breaft ; but when it is certainly known that matter is colleaed there, it is fure- ly one of the beft medicines which can be ufed. Few pa- tients indeed have refolution enough to give the bark a fair trial at this period of the difeafe, otherwife we have reafon to believe, that great benefit might be reapt from it. When it is evident that there is an impofthume in the breaft, and the matter can neither be fpit up nor carried off by abforption, the patient muft endeavour to make it break inwardly, by drawing in the fleams of warm water or vinegar with his breath, coughing, laughing, or bawling aloud, bY. When it happens to burft within the lungs, the matter may bedifcharged by the mouth. Sometimes indeed the burft- ingofthe vomica occafions immediate death, by fuffocating the patient. When the quantity of matter is great, and the patient's ftrength exhaufted, this is apt to happen. At any rate, the patient is ready to fall into a fwoon, and fhould have volatile spirits or falts held to his nofe. If the matter difcharged be thick, and the cough and breathing become eafier, there may be fome hopes of a cure. The diet at this time ought to be light, but reftorative, as fmall chicken-broths, fago gruel, rice-milk, &c. the drink, butter-milk, or whey fweetned with honey. This is like- wife a proper time for ufing the Peruvian bark, which may be taken as direaed above. If the vomica or impofthume fliould difcharge itfelf into the cavity of the breaft betwixt the pleura and the lungs, ihere is no way of rreuing the matter out but by an incifion, as has OF CONSUMPTIONS. 139 has already been obferved. As this operation muft always be performed by a furgcon, it is not neceffary here to defcribe it. We fhall only obferve, that it is not fo dreadful as people are apt to imagine, and that it is the only chance the patient in this cafe, has for his life. A NERVOUS CONSUMPTION, is a wafting or decay of the whole body, without any confiderable degree of fever, cough, or difficulty of breathing. It is attended with indigeftion, weaknefs, and want of appetite, &c. Those who are of a fretful temper, who indulge in fpi- ritous liquors, or who breathe an unwholfome air, are moft liable to this difeafe. * We would chiefly recommend, for the cure of a nervous confumption, a light and nourifhing diet, plenty of exer- cife in a free open air, and the ufe of fuch bitters as brace and ftrcngthen the ftomach ; as the Peruvian bark, gentian root, camomile, cjfe. Thefe may be infufed in water or wine, and a r-lafs of it drank frequently. It will greatly affift the digeftion, and promote the cure of this difeafe, to take twice a-d^v twenty or thirty drops of the elixir of vitriol in a glafs of wine or water. The chalybeate wine is likewife an excellent medicine in this cafe. It ftrengthens the folids, and powerfully affifts nature in the preparation of good blood *. Agreeable amufements, cheerful company, and riding shout, are, however, preferable to all medicines in this dif- eafe. For which reafon, when the patient can afford it, wc would recommend a long journey of pleafure, as the moft: likely means to reftore his health. What is called a fymptomatic confumption cannot be cured without firft removing the difeafe by which it is occanoneJ. Thus, when a confumption proceeds from the fcrophuhor kingfe evil, from the fcurvy, the afthma, the venereal dif- eafe, &c. a" due attention muft be paid to the malady from whence it arifes, and the regimen direaed accordingly. When exceffive evacuations of any kind occafion a con- fumption, they muft not only be reftrained, but the patient's ftrength muft be reftored by gentle exercife, nourifhing diet, and generous cordials, &c. Young and delicate mothers often * The chalybeate wine is made by putting three ounces of the filings o^ fteel or iron into a bottle of Rhenifh wine, and allowing it to divert fo^ three weeks, frequently fluking the bottle : Afterwards the wine muft be", Rioted for ui. A table-fpoonful of it may be taken twice or thrice a-d_ay. 140 OF THE NERVOUS FEVER. often fall into confumptiono by giving fuck too long. As foon as tiiey perceive their ftru.gth u:ul appetite begin to foil, they ought immedhituy to wean the child, or provide anorher nurfe, othcrwiie they cannot expta a cure. before we quit this fubjedt, we y.tuM earncftly recom- mend it to "U who wifh to nvoid confumptions, to take as much exercife without doors as they can, to avoid unwhole- fome air a;,d to ftuuy (obriety. Confumpiior.s owe their preie.it increafe not a little to thefafhion of fitting up late, e.e:in^ hot funpers, and (ptnding every evening over a bowl of hot punch, or a bottle of v/ine. Thefe liquors, when too freely ufed, not only hurt the digeftion, and fpoil the appetite, but heat and inflame the Mood, and fet the whole conftitution on fire. CHAP XIX. OF THE SLOW OR NERVOUS FEVER. NERVOUS fevers have increafed greatly of late years in this ifland, owing doubtlefs to our diffe- rent manner of living, and the increafe of fedentary employ- ments ; as they commonly attack perfons of a weak relaxed habit, who neglea exercife, eat little folid food, ftudy hard, or indulge in fpirituous liquo s. CAUSES.----Nervous fevers may be occafioned by whatever depreffes the fpirits, or impoverishes the blood j as grief, fear anxiety, want of fleep, intenfe thought, Iwing on poor watery diet, fcnripe fruits, cucumbers, melons, mufhrooms, $jng two or three table-fpoonfuls of pow- dered muftard in an Englifh pin^of milk, mixed with an equal quantity of water. After it has boiled fomel|fl)e, a few fpoonfuls of wine may be add- ed to it. This will both make thejeurd feparate more perfectly, and render the whey more cordial. It muft be drained, and a tea-cupfulof it givenfre-, quently for the patient's ordifciry drink. This is not only a very propej- drink, but alfo an excellent medicine. OF THE NERVOUS FEVER. ,43 general fhock which they give, promote the perfpiration, and have many other excellent effeas in flow fevers, where there are no figns of inflammation, and nature wants rou- fing. Such as dare not venture upon a vomit, may clean the bowels by a fmall dofe of Turkey rhubarb, or an infufion of forma and manna. In all fevers, the great point is to regulate the fymp- toms, fa as to prevent them from going to either extreme. Thus, in fevers of the inflammatory kind, where the force of the circulation is too great, or the blood denfe, and the fibres too rigid, bleeding and other evacuations are neceffa- ry. But where nature flags, where the blood is vapid and poor, and the folids relaxed, there the lancet is to be avoid- ed. Hence bleeding is never to be permitted in nervous fe- vers unlefs there be evident figns of inflammation, which is very feldom the cafe. It is the more neceffary to caution people againft bleed- ing in this difeafe, as there is generally at the beginning an univerfal ftriaure upon the veffels, which even to the pati- ent himfelf often gives the idea of a plethora, or too great a quantity of blood. I have known even fome of the profef- fion deceived by their own feelings in this refpea, fo far as to info: upon being bled, when it was evident that the ope- ration was improper*. Though bleeding be improper in this difeafe, yet blif- tering is highly neceffary. Bliftering platters may Reappli- ed at all times of the fever with great advantage ; we would however adyifo people not to make too free with them at the beginning, left there fhould be more occafion for them af- terwards." If the patient be delirious, he ought to be bliflered on the neck, and it will be the fafeft courfe, while the fever contimu?, as foon as the difcharge occafioned by one bliftering plafter abates, to apply another fomewhere elfe, and by that means keep up a continual fucceffion of them till the patient be out of danger. I HAVE * T remember to have attended an apothecary in a nervous fever, who at the bcftinnin-T was fo fully perluaded of the exigence of a plethora, and the ncceflity of bleeding, that when I objected to it, he told me he was fo cer- tain of the necelTity of that operation from his own feelings, that if it was not performed he could not live. He was accordingly bled, but was foon convinced of his error. The blood thewed no bOis of inflammation, and he was rc.narkably work after the operation. 144 OF THE NERVOUS FEVER. I have been more fenfible of the advantage of blifter- ing in this than in any other difeafe. It not only promotes the circulation by ftimulating the folids, but likewife occa- fions a continual difcharge, which may in fome meafure fupply the want of critical evacuations, which feldom hap- pen in this kind of fever. If the patient be coftive through the courfe of the difeafe, it will be neceffary to procure a ftool, by giving him every other day a clyfter of milk and water, with a liule foga,r to which may be added a fpoonful of common fait, if the above does not operate. Skoul'd a violent loofenefs come on, it may be checked, by g.ving the patient frequently a fmall quantity of Venice treacle, or any thing that will promote the perfpiration. A miliary eruption fometimes breaks out about the ninth or tenth day of this fever. As this eruption is often cri- tical, great care fhould be taken not to retard nature's operation in this particular. The eruption ought neither to be checked by bleeding nor other evacuations, nor pufhed out by a hot regimen ; but the patient fhould be fupported by gentle cordials as wine whey, fmall negas, fago-gruel with a little wine, and fuch like. He ought not to be kept too warm ; yet i kindly breathing fweat fhould by no means be checked. Though bliftering and the ufe of cordial liquors are the only things to be depended on in this kind of fever, yet, for thofe who may chufe to ufe them, we fhall mention one or two of the forms of medicine which are commonly prefcrib- ed in it*. In defperate cafes, where the hiccup and ftarting of the tendons have already come on, we have fometimes feen ex- traordinary effeas from large dofes of mufk frequently ex- hibited. This is doubtlefs a great antifpafmodic, and may be given to the quantity of a foruple three or four times a- day. Sometimes it may be proper to add to the mufk a few grains of camphire, and fait of hartfhorn, as thefe tend to promote * When the patient is low, ten grains of Virginian fnake-root, and the fame quantity of contrayerva root, with five grains of Ruffian caftor, all in rO•■ powder, may be made into a bolus with a little of the cordial confection, •r fyrup of faffron. - One of thefe may be taken every four or five hours. The following powder may be ufed for the fame intention. Take wild Valerian root in powder one fcruple, faffron and caftor each four grains. Mix thefe by njhbing them together in a mortar, and give one in a cup of wine whey three or four t'uics a-day. 0F THE NERVOUS FEVER. 145 1 remote perfpiration and urine. Thus fifteen grains of mufk with three grains of camphire, and fix grains of fait of hartlhorn, may be made into a bolus with a little fyrup and given as above. If the fever fhould happen to intermit, which it fre- quently does towards the decline, or if the patient's ftrength fhnuld be wafted with colliquative fweats, ifc. it will be neceffary to give him the Peruvian bark. Half a dram, or a whole dram, if the patient's ftomach will bear it, of the bark in fine powder, may be given four or five times a-day, in a glafs of red-port or claret wine. Should the bark in fubftance not fit eafy on the ftomach, an ounce of it in powder may be infufed in a bottle of Lifbon or Rhenifh wine for two or three days, afterwards it may be ftrained, and a glafs of it taken frequently f. Some give the bark in this and other fevers, where there are no fymptoms of inflammation, without any regard to the remiffion or intermiffioq of the fever. How far future obfervations may tend to eftablifh this praaice we cannot pretend to fay ; but we have reafon to believe that the bark is a very univerfal febrifuge, and that it may be admi- niftered with advantage, in moft fevers where bleeding is not neceffary, or where there are no fymptoms of topical inflam- mation. U CHAP. f The bark may likewife be very properly adminiftered, ajong with other rdials in the following manner : Take an ounce of Peruvian bark, orange r",| half an ounce, Virginian fnak-root two drams, ftffron one dram Let -11 of them be powdered, and infufed in an Englifh pint of the beft brandy
- joined witli acids, almoft perform wonders, even in cOes wkjpre the petechiae had the moft threatening afpea. ButTtG afwer this purpofe, it muft: not? only be given in lar^c. djgjes, buc duly perfifted in. The beft method of adminiftering the bark is certainly in fubftance. An ounce of it in povvuer may be mixt with half an Englifh pint of water, and the fame quantity of red wine, and fharpened with the elixir, or the fpirit of vitriol, which will both make it fiit, eafier on the ftomach, and render it more beneficial. Two or three ounces, of the fyrup of lemon may be added, and two table-fpoonfois of the mixture taken every two hours, or oftencr, if the ftomach will bear it, Thcf 15* PUTRID OR SPOTTED FEVER. Those who cannot take the bark in fubftance may iti* fufe it in wine, as recommended in the preceding difeafe. If there be a violent loofenefs, the bark muft be boiled in red wine with a little cinnamon, and fharpened with the elixir of vitriol, as above. Nothing can be more be- neficial in this kind of loofenefs than plenty of acids, and fuch things as promote a gentle perfpiration. If the patient, be troubled with vomiting, a dram of the fait of wormwood diffolved in an ounce and a half of frefh lemon-juice, and made into a draught with an ounce of fimple cinnamon-water, and a bit of fugar, may be given, and repeated as often as it is neceffary. If fwellings of the glands appear, their fuppuration is to be promoted by the application of poultices, ripening cataplafms, &c. And as foon as there is any appearance of matter in them they ought to be laid open, and the poul- tices continued. I have known large ulcerour. fores break out in various parts of the body, in the decline of this fever, of a livid gangrenous appearance, and a moft putrid cadaverous fmell. Thefe gradually healed, and the patient recovered, by the plentiful ufe of Peruvian bark, and wine, fharpened with the fpirits of vitriol. For preventing putrid fevers we would recommend a flria regard to cleanlinefs, a dry fituation; fufficient ex- ercife in the open air ; wholefome food, and a moderate ufe of generous liquors. Infeaion ought above all things to be avoided. No conftitution is proof againft it. I have known perfons feized with a putrid fever, by only making a tingle vifit to a patient in it; others have caught it by go- ing through a town where it prevailed ; and fome by at^nd- >ingthe funerals of fuch as died of it. When a putrid fever feizes any perfon in a family the greateft attention is neceffary to prevent the difeafe from fpreading. The fick ought to be placed in a large apart- ment, as remote from the reft of the family as poffible; he ought likewife-to be kept extremely clean, and fhould have frefh air frequently let into his chamber ; whatever comes from him fliould be immediately removed, his linen fhould be frequently changed, and thofe in health ought to avoid all unneceffary communication with him. Any one who is apprehenfive of having caught the in- feaion, ought immediately to take a vomit, and to. work it PUTRID OR SPOTTED FEVER. 153 it off by drinking plentifully of camomile tea. This may be repeated in a day or two, if the apprehenfions ftill con- tinue, or any unfavourable fymptoms appear. The perlon ought likewife jo take an infufion of the bark and camomile flowers for his ordinary drink; and before he goes to bed, he may drink ah Englifh pint of prettv ftrong negas, or a few glafles of generous wine. I hava Leen frequently obliged to follow this courfe, when malignant fevers prevailed; and have likewife recommended it to others with conftant foccefs. People gent rally fly to bleeding and purging as antidotes againft infeaion ; but thefe are fo for rrom focuring them, that they often increafe the danger. Tho?e who attend the fick in putrid fevers, ought al- ways to have a piece of fpunye or a handkerchief dipt in vinegar, or juice of lemon, to hold at their nofe. They ought likewife to wafh their hands, and, if poffible,to change their clothes, before they go into company. CHAP. XXL OF THE MILIARY FEVER. THIS fever takes its name from the fmall puftuTes or bladders which appear on the fkin, rcfembling, in fhape and fize, the feeds of millet. The puftu'es are either red or white, and fometimes both are mixed together. The whole body is fometimes covered with puftules; but they are generally more numerous where the fweat is moft abundant, as on the breaft, the back, &c. A gentle fweat, or moifture on the fkin, greatly promotes the erup- tion ; but, when the fkin is dry, the eruption is both more painful and dangerous. Sometimes this is a primary difeafe; but it is much oftencronly a fymptom of fome other malady, as the fma'O pox, mealies, ardent, putrid, or nervous fever, &c. In X all 154 OF THE MILIARY FEVER. * all thefe cafes it is generally the effea of too hot a regimen or medicines. The miliary fever chiefly attacks the idle and the phleg- matic, ot perfons of a relaxed habit. The young and the sued arc more liable to it than thofe in the vigour and prime of life. It is likewife more incident to women than men, efpecially the delicate and the indolent, who, neglcdting exercife, keep continually within doors, and live upon weak wati-vy' diet. Such females are extremely liable to be feized will: this difeafe in childbed, and often lofe their lives by it. CAUSE S.----The miliary fever is fometimes oc- cafioned by violent paffions or affeaions of fhe mind ; as excefiive giicf, anxiety, thoughtfulnefs, LCc. It may like- wife be occafioned by exceffive watching, great evacuati- ons, a weak watery diet, rainy feafons, eating too freely cf cold, watery, unripe fruits, as plums, cherries, cucum- bers, melons, &c. Impure waters, or provifions which have been fpoiled by rainy feafons, long keeping, &c. may likewife caufe miliary fevers. They may alfo be occafi- <,ned by the ftoppage of any cuftomary evacuation, as iffues, fetons, ulcers, the bleeding piles in men, or the menftrual fiux in women, &i. This ciiiLafe in childbed-women is fometimes the ef- fea of great coftivenefs during pregnancy ; it may likewife be occafioned by their exceffive ufe of green unripe fruits, and other unwholefome things, in which pregnant women are too apt to indulge. But its moft general caufe is in- dolence. Such women as lead a fedentary life, efpecially during pregnancy, and at the fame time live grofsly, can hardlv efcape this difeafe in childbed. Hence it proves CAtJC-'nely fotal to women of fafhion, and likewife to thofe women in manufacturing towns, who, in order to affift their hufbands, fit clofe within doors for almoft the whole o! their time. But ameng women who are aaive and la- borious, who live in the country and tr.ke enough ofexeccjfc without doors, this difeafe is very Ihtfo known. b Y M P T O M S.----When this is a primary difeafe, it makes lib auack, like moft other eruptive fevers, with a flight fliiveri;:;_'j which is fucceeded by heat, lofs of ftrength, ■>: 'rr.tifhncO, ifohing,a low quick pulfe, difficulty of breath- ing, with great .;n."aety and oppreflion of the breaft. The patient is reftlefs, and fometimes delirious; the torguc ap- pears OF THE MILIARY FEVER. ic5 pears white, and the hands fhake, with often a burning heat in the palms; and in childbed-women the milk gene- rally goes away, and the other difcharges flop. The patient feels an itching or pricking pain under the fkin, after which innumerable fmall puftules of a red or white colour begin to appear. Upon this the fymptoms generally abate, the pulle becomes more full and foft, the fkin grows moiiler, and the fweat, as the difeafe advances, begins to have a peculiar foetid fmell ; the great load on the breaft, and oppreffion of the fpirits, generally go of, and the cuftomary evacuations gradually return. About the fixth or foventh day from the eruption, the puftules begin to dry and fall off, which occafions a very duhgrcc- able itching in the fkin. It is in^joilible to afcertain the exaa time when the puftules will either appear or go off. They generally come out on the third or fourth day, when the eruption is criti- cal ; but, when fymptomatical, they may appear at any time of the difeafe. Sometimes the puftules appear and vanifh, by turns. When that is the cafe, there is always danger ; but when they go in all of a fudden, and, do not appear agai.-, tiVJ * danger is very great. In childbed-women the puftules are commonly at fi '"£ filled with clear water, afterwards they grow yellovviih. Sometimes they are intsrfperfed with puftufos of a red co- lour. When thefe only appear, the difotfe goes by the name of a r.y'h. R E G I M \i N.-~—In all eruptive fevers, of whatever kind, the chief point is to prevent the foOIsn difappcirmg of the puftules, and to promote their maturation. For this purpofe the patient muft be kept in fuch a temperat\*ic, as neither to pufh out the eru;v:foa too foft, "nor to caufe it retreat prematurely. The diet an 1 drink ought therefore to he in a moderate decree njuriiiifog and cordial; but rijtthsr ftrong nor heating. The patients chamber ought neTther to bekept too hot nor cold :• and he fhould not be too much covered with clothes. Above all, the mind is to be kept eafy and chearful. Nothing fo certainly makes an eruption go in as fear, or the anprt-heniiun <•', danger. The food muft be weak chic.; ;o-biv;h with bread, panado, fogo, or groat-gruel, &c< to a gill of,which may 15& OF THE MILIARY FEVER. be added a fpoonful or two of wine, as the patient's ftrength requires, with a few grains of fait and a little fugar. Good apples roafted or boiled, with other ripe fruits of an opening cooling nature, may be eat. The drink mult be fuited to the ftate of the patient's ftrength and fpirits. If thefe be pretty high, the drink ought to be weak; as water-gruel, balm-tea, or the follow- ing decoaion f. When ohe patient's fpirits arc low, and the eruption does not rife fufficiently, his drink muft be a little more ge- nerous ; as wine whey, or fmall negas, fharpened with the juice of orange or lemon, and made ftronger or weaker as circumftances may require. Sometimes the miliary fever approaches towards a pu- trid nature, in which cafe the patient's ftrength muft be fupported with generous cordia'% joined with acids; and, if the degree of putrefcency be great, the Peruvian baik muft be a l.niuiftred. If the head be much affected, the bel- ly muft be kept, open by emollient clyfters £. ME DI C I N E-----IF the food and drink be properly regulated, there will be little occafion for medicine in this difeafe. Should the eruption however not rife, or the fpirit:; f Take two ounces pf the fhaviivrs of hart (horn, and the fame quantity of fOfiparilla. boil^hem in two Enghlh quarts of" water. To the ftrained de- coOoa add a little white fugar, and let the patient take it for his ordinary drink. i In the co"rr:r:'.um Utcrarium for/.h: vcar 173$, we iv.ve the liiflory of an epidemical miliary fever, which raged at Strafburgh in the months of November, December, and January ;• I'm an uhii.h we lc.rn the neocflily of a temperate regimen in this malady, and likcivifc that i-O iicians are not al- ways the fjrft who difcovc.r the proper treatment of diOlls. " 1 his f. ver made terrible havoc ewer^ajriong rricn of rohuft conftitutions, and all mOi- cine proved in vain. TJiey'were feized in an inftant wi*h hO.-cihifi, yawn- ing, ftretchinjr, and pains in t!ie back, fuccccded by a moft intenfe lieit, it the fame time there was'great lofe of ftrev.O1 a'lJ appetite. Or. the fOnith or ninth day the miliary eruptions appert J, or fpots like rka-hites^ddi prat anxiety, a delirium, reille(Tnefs, and tolling in bed. Isvvdir.^ 'W|^^ t-.l. While matters were in this unhappy fituation, a midwif?, of her own ;..vcorJ, gave to a patient in the height of the difOfe, a clylttrr of rain wat:.T and butter without fait, and for his ordinary drink a qucrt oi- fpririBw.-t; r, i:aif a pi"t of ^eri'.-rous wine, the juice of a L-mop, and fix ounJf of the "vhitell fugar gently boiled till a icum arofe, i.\ n the public w .Iks with the fmall-pox upon them. However well this may fuit the purpofes of boafling inoculators, we cannot help c'linkii < that all the ends of freJh air might be anfwered to the patie-.n*, without expollng thenj in public, to the .^rtat terror and danger ot their fellow-citizen-•, who have not had the difeafe. Surely humanity and ^td policy fhoOJ .O-J. this practice. OF THE SMALL-POX. i'7 r rcat lofs of ftrength render cordials neceflary, we would recommend good wine, which may* he made into negas, with an equal quantity of water, and fforpened wifo the juice of orange, the jelly of curraius, or the like. Wine- whey fharpened as above, is likewife a proper drink in this cafe ; great cure however muft' be taken not to overheat the patient by any of th fe thing?. Thus, inftead of promot- ing* v/onld ret^td the eruption. Sometimes t.ie lifingofthe foiall-pox is prevented by the violence of the fover ; in this cafe the cool refomen is fOi&ly to be cfoerveJ. The parent's chamber ?- Oh not only be kept cool, but he ought lfo wife frequency to be tahen cut of Led, and to be lightly covered with clothes while in it. Excessive rcilOffoTs often prevents the rifing and filling of the fmall-pox. When that happens, gentle opines are nv.een.:ry. Thefe however ought always to be auminiftred with a '.. iring hand. To an infont, a tea-fpoonful of the iyrup of poppies, mav be given every five or fix hours, till it has the defired efoeL An adult will require a r..ole~ fpoonful in order :o anfwerthe fame purpefe. If the patient be troubled wi.h a ftrangury, or fupp-ef- fton of urine, whieh often happens in the fVnali-pox, he fiioulJ be free;gently taken:;1. This not only tends to heat and inflame the blood, but the fceces, by lodging fo long in the body, become acrid and even putrid, from whence bad confequences muft enfue. It will therefore be proper, when the belly is bound, to throw in an emollient clyfter every focond or thiid day, through >6S OF THE S M A L L - P O X.s through the whole courfe of the difeafe. This will greatly cool and relieve the patient. When petechise, or purple, black, or livid fpots appear among the fmall-pox, the Peruvian bark muft immediately be adminiftered in as large dofes as the patient's ftomach can bear. For a child, two drams of the bark in powder may be mixed in three ounces of common water, one ounce of fimple cinnamon-water, and two ounces of the fyrup of orange or lemon. This may be fharpened with the fpirits of vitriol, and a table fpoonful of it given ever, hour. If it be given to an adult in the fame form, he may take at leaft three or four fpoonfuls every hour. This medicine ought not to be trifled with, but muft be adminiftrcd as frequently as the ftomach can bear it, in which cafe it will often produce very happy effedts. I have fre- quently feen the petechial difappear, and the fmall-pox, which had a very threatning afpedt, rife and fill with laud- able matter, by the ufe of the bark and acids. The patient's drink ought likewife in this cafe to be ge- nerous, as wine or ftrong negas acidulated with fpirits of vitriol, vinegar, the juice of lemon, jelly of currants, or fuch like. His food muft confift of apples roafted or boiled, preferved cherries, plums, and other fruits of an acid nature. The bark and acids are not only tieceiTary when the pe- techiae or putrid fymptoms appear, but likewife in the lymphatic or cryftalline fmall-pox, where the matter is thin, and not duly prepared. The Peruvian bark feems to pof- fefs a lingular power of afliftirig nature in preparing lauda- ble pus, or what is called good matter; confequently it muft be beneficial, both in this and other difeafes, where the crifis depends on a fuppuration. I have often obferved where the fmall-pox were flat, and the matter contained in them quite clear and tranfparent, and where at firft they had the appearance of running into one another, that the ufe of a few drams of the Peruvian bark, acidulated as a- bove, changed the colour and confiftence of the matter, and produced the moft happj effedfs. WTien the eruption fubfides fuddenly, or, as the good women term it, when, the fmall-pox flrike in, before they have arrived at maturity, the danger is very great. This is often the effedt, of a hot regimen, or medicines which, at the beginning, pufti out the matter before it has been pr6- perly OF THE SMALL-POX. i6c> perly prepared. When this happens, bliftering plafters muft be immediately applied to the wrifts and ancles, and the patient's fpirits fupported with cordials. Sometimes bleeding has a furprifing effect, in raifing the puftules after they have fubfided ; byt it requires fkill to know when this is proper, or to what length the patient can bear it. Sharp cataplafms however may be applied to the feet and hands, as they tend to promote the fwelling of thefe parts, and by that means to draw the humours to- wards the extremities. The moft dangerous period of this difeafe is what we call the fecondary fever. This generally comes on when the fmall-pox begin to blacken, or turn on the face, and moft of thofe who die of the fmall-pox are carried off"by this fever. Nature generally attempts at the turn of the fmall- pox, to relieve the patient by loofe ftools. Her endeavours this way are by no means to be counteracted, but promot- ed and tne patient at the fame time fupported by food and drink of a nourifhing and cordial nature. If at the approach of the fecondary fever the pulfe be very quick, hard, and ftrong, the heat intenfe, and the breathing laborious, withother fymptoms of an inflammation of the breaft, the patient muft immediatelv be bled, other- wife a fatal peripneumony will enfue. The quantity of blood to be let muft be regulated by the patient's ftrength, age, and the urgency of the fymptoms. But, in the fecondary fever, if the patient be faintifh, ' the puftules become fuddenly pale, and if there be great coldnefs of the extremities, bliftering plafters muft be ap- plied, and the patient muft'be fupported with generous cor- dials. Wine and even fpirits have fometimes been given in fuch cafes with amazing fuccefs. As the fecondary fever is in great meafure, if not whol- ly owing to the abforption of the matter, it would feem highly confonant to reafon, that the puftules, as foon as they come to maturity, fliould be opened. This is every day pradtifed in other phlegmons which tend to fuppurati-i on ; and there feems no reafon why it fhould be lefs proper here. On the contrary, we have reafon to believe, that by this means the fecondary fever might always be lefTened, and often wholly prevented. The puftules fliould he opened wh.en they begin to turn Zr Of t?o OF THE S M A L L-P O X. of a yellow colour. Very little art is neceffary for this operation. They may either be opened with a pair of fcif- fars or a needle, and the matter abforbed by a little dry lint. As the puftules are generally frit ripe on the face, it will be proper to begin with opening thefe, and the others in courfe as they become ripe. The puftules generally fill again a fecund or even a third time ; for which caufe the operation muft be repeated, or rather continued fo 1c :ig as there is any confiderable appearance of matter in the puftules. • We have reafon to believe, that this opeiatior, ratio- nal as it is, has been negledted from a piece of miffoken tm- dernefs in parents. They believe, that it muft give great pain to the poor child; and therefore would rather fee it die than have it thus tortured. This notion however is entirely without foundation. I have frequently opened thd puftules when the patient did not fee me, without his be- ing the leaft fenfible of it; but fuppofe it were attended with a little pain, that is nothing in comparifon to the ad- vantages which arife from it. Opening the puftules not only prevents the reforption of the matter into the blood, but likewife takes off the v n- fion of the fkinj and by that means greatly relieves, the pati- ent. It likewife tends to prevent the pitting, which is a matter of no fmall importance. Acrid matter, by Icfomg long in the puftules, cannot fail to corrode the tender foin ; by which many a handfome face becomes fo deformed as hardly to bear a refemblance to the human figure *. '• • IT is generally neceffary, after the fmall-pox are gone off; to purge the patient. If however the beiiy has been open through the whole couj^of the difefoe, or if butter-milk and other things of an opening nature have been drank freely after the height of the fmall-pox, purging beeomvs lefs neceffary ; but it ought never whollv to be neglected. For very young children, an infufion of fenna and prunes, with a little rhubarb, may be fweetemd with csane, fuo-ar, and given in fmall quantities till it operates Thoft who are farther advanced muft take medicines of a fhatper nature^ For example, a child of five or fix jears of age < , may * Thou*h this operation can never do harm," yet it is only neccKiry when the patient has a great load of fmall pox, or when the mat.tr which they contain is of fo thin and acrid a nature that there is reafon to apprehend bad confequences from its being too like moft other ufeful difcoveries, it has, till of late, made but How progrefs, It muft however be aijhnowlc.l^d, to the honour of this country, that inoculation has met with a more favourable ~e- ception here than among any of our neighbours. It is ftill hoe-ever far from being geneial, which we have reafon to fear wiil ever be the eafe, fo long as the practice continues in the hands of the Faculty. Nodfo:overy can ever be of general utility whilethe prac- tice of it is kept in the hands of a few. Had the inocula- tion of the for il pox been introduced as a fafhion, and not as a medical dfoovery, cr had it been pradtifed by the fame kin^d of operators here as it is in thofe countries from whence we had it, it had long ago been univerfal. The fears, the jealoufies, the prejudices, and the. oppofite interefts of the faculty, are, and ever witt be, the moft effectual obflacles 172 OF THE S M A L L-P O X. to the progrefs of any falutary difcovery. Hence it is that the practice of inoculation never became, in any meafure, general, even in England, till taken up by men not bred to phyfic. Thefe have not only rendered the practice more extenfive, but likewife more fafo, and by acting under lefs reftraint than the' regular practitioners, have taught them that the patient's greateft danger arofe, not from the want of care,-but from the excefs of it. They know very Ihtle of the matter, who impute the fuccefs of modern inoculatorS to any fopenor fkill, either in preparing the patient or communicating the difeafe. Some fo them indeed from a fordid deiite of ingrcfling the whole practice to themfelves, pretend to have extraordinary fecrets or noftrums for predating perfons for inoculation, which never foil of fuccefs. But this is only a pretence calculat- ed to blind the Onorant and inattentive. Common fenfe and prudence alone are fufficient both in the choice of the fubjedt and management of the operation. Whoever is pofleffed of thefe may perform this office for his children whenever he finds it convenient, provided they be in a good ftate of health. This fentiment is not the refult of theory, but of ob- fervation. The ugh few phyficians have had more oppor- tunities of trying inoculation in all its different forms, fo little appears to me to depend on thefe, generally reckoned important circurnftances, of preparing the body, communi- cating the infection by this or the other method, &c. that for feveral years paft I have caufed the parents or nurfes perform the whole themfelve^, and have found that method followed with equal foccefc, while it is free from many in- convenienciesthat attend the other. A critical fituation,"1 too often to be met with, firft put me upon trying this method. A gentleman who had loft all his children except one fon by the natural fmall-pox, was determined to have him inoculated. He told me his intention, and defired I would perfuade the mother and grandmother cifc. of its propriety. But that was impoffible. They were not to be perfuaded, and either could not get the better of the^jt fears, or were determined againft convic- tion. It was always a point with me, not to perform the operation without the con fen t of parties concerned. I there- fore' advifod the father, after giving his fon a dofe or two ef rhubarb, to go to a patient wfio had the fmall-poxof a OF THE S M A L L - P O X. 173 good kind, to open two or tfoee of the puftules, taking up the matter with a little cotton, and as loon as he came home to take his fon apart, and give his arm a flight fcratch with a pin, afterwards to rub the place well with the cotton, and to take no further notice of it. All this he punctual- ly performed ; and at the ufoal period the imall-pox made rheir appearance which were of an exceeding good kind, and fo mild as not to confine the boy an hour to his bed. None of the other relations knew but that the difeafe had Come in the natural way till the patient was well. We do not propofe this as the only method in which the fmall-pox can be communicated. Experience teaches us that it may be done various ways with equal fuccefs. In Turkey, from whence we learned the practice, the women communicate the difeafe to children, by opening a bit of the fkin with a needle, and putting into the wound a little mettei taken fromaripepuftule. Onthecoaftof Barbary they pafs a thread wet with the matter through the fkin, between liie thumb and fore-finger; and in Europe inoculation is generally performed by making a fmall incifion through the cuticle of the arm or leg with a lancet, and laying a bit of thread wet with the matter upon the wound, which is covered with a piece of flicking plafter, and kept on for two or three days. Some of the people in England who make a trade of ino- culation, only open one of the ripe puftules with a lancet, and while it is wet with the matter make a flight incifion in the arm of the perfon to whom they want to communicate the difeafe ; afterwards they clofe up the wound, and leave it without any other dreffing. It is focewifo done with a iancet covered with the dry matter, but this is lefs certain. It frequently fails, and ought never to be depended upon unlefs where frefh matter cannot be had. Indeed, if frefh matter be applied long enough to the fkin, there is no occafion for any wound at all. Let a bit of thread, about half an inch long wet with the matter, be immediately applied to the arm, midway between the fhouldcr and elbow, and covered with a piece of the common flicking plafter, and kept on for eight or ten days. This will fel- dom fail to communicate the difeafe. We mention this method becaufe many people are afraid of a wound; and doubtlefs the moreeafily the operation C3n be performed, it has the greater charge t%become general. Some people imagine 174 OF THE SMALL-POX', imagine, that the difcharge from a wound foffous the erup- tion but there is no great ftrefs to be laid upon this notion ;, Befides, deep wounds often ulcerate, and become troublefome. We do not find that inoculation is at all confidered as a medical operation in thofe countries from whence we learned it. In Turkey it is performed by the womer, and in the Eaft indies by the Brachmins or Priefts. In this country the cuftom is ftill in its infancy; we make no doubt however but it will foon become fo familiar, that pa- rents v/ii! think no more of inoculating; their children, than at prefent they do of giving them a dole of phyfic. No fet of men have it fo much in their power to renier the practice of inoculation general as the cler^'', the great- eft oppofition to it ftill ariiing from fome foruples of con- foience, which they alone can remove. We would recom- mend it to them not only to endeavour to remove the reli- gious objections which weak minds may have to this falu- tary practice, but to enjoin it as a duty, and to point out the danger of neglecting to make ufe of a mean which Providence has put in our power for faving the lives of our offspring. Surely fuch parents as wilfully neglect the means of faving their children's lives, are as guilty as thofe who put them to death. We wifh this matter were duly weighed. No one is more ready to make allowance for human weaknefs and religious prejudices, yet I cannot help recommending it, in the warmeft manner, to parents to confider how great an injury they do their children, by the natural fm7!-pox, how often are the fined fea- tures, and the moft beautiful complexions miferably disfigured ? Whereas in>cul'.'.ion rarely leaves any uf.ly marks or fcais, even v» here the number of puftules on the face have been very ccnliderable, and the fymptonts by no means favourable. And many other grievous complaints, that ar« fre- quently fubf. iuent to the natural fort, feldom follow the artificial. Does not inoculation alfo prevent thofe inexpreffible termors that perpctudly har.ifs perfons who never had this difeafe, informich that when the OuM- pox i$ epidemical, inure villages are depopulated, markets ruined, and the f>ce of dOrefs fpread over the whole country ? From this terror it arifes, fchat juftice is frequently poftponcd, or difcouraged at feffions or ailizes where the fmall-pox rages. Witnefies and juries dare not appear; and, by ivakm of the neceiiary abfence of fome gentleman, our honourable and ukful judges are :~ot attended with that reverence and fplendor due to their office and merit. Does not inoculation in like manner prevent our brave Oilors from being feized with this diftemper on fhipboard, where they miJl quickly fpread the infection among fuch of the crew who never had it before, and where they have fearce any chance to efca ie, being half-ftifled with the clofenefs of their cabins, and but very indilfcreuly nurfed? LaOy, with reiy.rd to the foldicry the miferu-s attending thefe poor creatures, when att:-c!;:-d by the fmall-pox on a march, is inconceivable, without attend- ance, without lodgings, without any accommodation; fo that one of three commonly periihes." 176 OF THE SMAL L-P O X. their children to avoid the fmall-pox, or who refufe to in- oculate them in infancy, confider to what deplorable fix- ations they may be reduced by this miftaken tendernefs. As the fmall-pox has now become a conftitutional dif- eafe in moft parts of the known world, no other choice remains but to render the malady as mild as poffible; this is the only manner of extirpation now left in our power; and, though it may feem paradoxical, the artificial method of communicating the difeafe, could it be rendered uni- verfal, would amount to nearly the fame thing as rooting it out. It is a matter of fmall confequence, whether a difeafe be entirely extirpated, or rendered fo mild as neither to deftroy life nor hurt the conftitution ; but that this may be done by inoculation, does not now admit of a doubt. The numbers who die under inoculation hardly deferve to be named. In the natural way, one in four or five generally dies ; but by inoculation not one of a thoufand. Nay, fome can boaft of having inoculated ten thoufand without the lofs of a fingle patient. I have often wifhed to fee fome plan eftablifhed for rendering this falutary practice universal ; but am afraid I (hall never be fo happy. The difficulties indeed are many; yet the thing is by no means impracticable. The aim is great; no lefs than faving the lives of one-fourth part of mankind. What ought not to be attempted, in order to accomplifh fo defirable an end ? The firft ftep towards rendering the practice univfcrfal, muft be to remove the religious prejudices againft it. This, as aJ^ady obferved, can only be done by the clergy. Tfc?y**muft not only recommend is as a duty to others, but likewife pradtife it on their own children. Example will ever have more influence than precept. The next thing requifite is to put it in the power of all. For this purpofe we would recommend it to the Faculty to inoculate the children of the poor gratis. It is hard that ib ufeful a part of mankind fliould, by their poverty be ex- cluded from fuch a benefit. Should this fail, it is furely in the power of any State to render the practice general, at leaft as far as their domi- nion extends. We do not mean {hat it ought to be enforced by a law. The beft way to promote it would be to employ ^ fufficient number of operators attiie public expence to in- oculate i K OF THE SMAL L-P O X. 177 cu'atc the children of the poor. i^This would only be ne- ceffary till the pradtice became general; afterwards cuftom, the ftrongeft of all laws, would oblige every individual to inoculate his children to p.event reflections. It may be objedted to tlfo fcheme, that the poor would refufo to employ the inoeulators : This- difficulty is eafily removed. A fmall premium to enable mothers to attend -their children while under the difeafe, would be a fufficient inducement; bodes, the fuccefs attending the operation would foon banifh all objections to it. Even confiderations of profit would induce the poor to embrace this plan. They often bring up their children to the age of ten or twelve, and when they^ome to be ufeful, they are fnatched away by this malady, to,_the great lofs of their parents and detriment of the p folfo. The Britifh legiflature fos, of late years, fhewn great attention to the prefervation of infant-lives, by fupporting the foundling-hofpital, &c. But we will venture to fay, if one tenth part of the fums laid out i|i fonpjrting that infti- lution, had been beftowed towards promoting the practice of inoculation of th- fmall-pox among the poor, that not only more ufeful lives had been faved, but the pradtice ere now rendered quite univerfol in this 31 and. It is hot to be imagined what effect example and^Hittle money will have upon the poor ; yet, if left to themfelves, they would go on for ever in the old way, without thinking of any im- provement. We only mean this as a hint to the humane ' and public fpirited. Should fuch a fcheme be approved, a proper plan might eafily be laid down" for the execution of it. But as public plans arc very difficult to bring about, and often, by the felfifh views 0: mifcondudt of thole intruft- ed with the execution of them, fail'of anfwerinp; the noble purpofes for which they were defigned ; we fhall therefore pfont out fome other methods by which the benefits of ino- culation may be extended to the poor. There is no doubt but inoeulators will daily become more numerous. We would therefore have every parifh in Britain to ailow one of them a fmall annual falary for inocu- * lating all the children of the parifh at a proper age. This mfoht be done at a very trifling expence, and it would putT it in the power of all to enjoy the benefit of this falutary invention. A a Two 178 OF THE S M A L L-P O X. Two things chiefly ope^iate to prevent the progrefs of inoculation. The one is a' wifh to put the evil day as far off as poffible. This is a principle in our nature ; and aa inoculation feems rather to be anticipating a future evil, it is no wonder mankind are foaverfeto it. But this objedtion is fufficiently anfwered by the fuccefs. Who in his fenfes would not prefer a lefier evil to-day to a greater to-morrow, provided they were equally certain ? The other obftacfo is the fear of refledtions. This has very great weight with the bulk of mankind. Should the child die, they think the world would blame them. This they cannot bear. Here lies the difficulty which pinches, and till that be removed inoculation will make but fmall progrefs. Nothing however can remove it but cuftom. Make the pradtice fafhionabie, and all objections will foon Vanifh. It is fafhion alone that has led the multitude fince the beginning of the world, and will lead them to the end. We muft therefore call upon the more enlightened part of mankind to fet a pattern to the reft. Their example, though it may for fome time meet with oppofition, will at length prevail. I am aware of an objection to this practice from the ex- pence with which it may be attended ; this is eafily obviat- ed. We do not mean that every parifh ought to employ a Sutton or a Dimfdale as inoeulators. Thefe have by their fuccefs already recommended themfelves to crowned heads, and are beyond the vulgar reach ; but have not others an equal chance to fucceed ? They certainly have. Let them make the fame trial, and the difficulties will foon vanifh. There is not a parifh, and hardly a village in Britain, dtlti- tute of fome perfon who can bleed. But this a far more difficult operation, and requires both more fkill and dexte- rity than inoculation. The perfons to whom we would chiefly recommend the performance of this operation are the -lergy. Moft of them know fomething of medicine. Almoft all of them bleed, and can order a purge, which are all the qualifications neceffary for the practice of inoculation. The priefts a- mong the lefs enlightened Indians perform this office, and why fhould *a Chrifiian teacher think himfelf above it ? Surely the bodies of men, as well as their fouls, merit a part of the paftor's care ; at leaft the greateft Teacher who ever appeared amon^r men feems to hav- thought fo. Should OF THE S M A L L-P O X. 179 Should all other methods fail, we would recommend it to parents to perform the operation themfelves. Let them take any method of communicating the difeafe they pleafe, provided the fubject -be healthy and of a proper age, they will feldom foil to fucceed to their wifh. 1 have known many inftances of parents performing the operation, and never fo much as heard of one bad confequence. A plant- er in one of the Weft India iflands is faid to have inoculated with his own hand, in one year, three hundred of his flaves, who r.otwithftanrling the warmth of the climate, and other unfavourable circumilances, all did well. Common mecha- nics have often to my knowledge, performed the operation with as good fuccefs as phyficians. We do not however nieiii to difcourage thofe who have it in their pow~r from employing people of fkill to inoculate their children, and attend them while under the difeafe, but only to fhew, that where fuch cannot he had, the operation ought not up- on that account to be negledted. Instead of multiplying arguments to recommend this practice, I fhall juft beg leave to mention the method which I took with my own fon, then an only child. After giv- ing him two guide purges, I ordered the nurfe to take a bit of thread which had been previoufly wet with frefh matter irom a pock, and to lay it upon his arm, covering it with a piece of flicking plafter. This fhid on fix or feven days, till it was rubbed of by accident. At the ufual time the fmall-pox made their appearance, and were exceedingly fa- vorable. Sure this, which is all that is generally neceffary, may be done without any fkill in medicine. The fpring and autumn have been ufually reckoned the moft proper feafons for inoculation, on account of the weather being then moft temperate; but it ought to be confidered that thefe are generally the moft unhealthy fea- fons of tie whole year. Undoubtedly the beft preparation for the difeafe is a previous good ftate of health. I have always obferved that children in particular are more fickly towards the end of fpring and beginning of fummer, than at any other time of the year. On this account, I would propofe the beginning of winter as the moft proper for ino- culation ; though on every other confederation, the fpring or autumn would feem to be preferable. The moft proper age for inoculation is betwixt three and five. Many difagreeable circurnftancj: attend inocu- lating 1S0 O F T H E S M ALL-POX. Jating children fboner, which we have not time to enume- rate. Neither fliould the operation be too long delayed. ' When the fibres begin to grow rigid, and children ni.ike ufe of groffer food, the fmall-pox become more dangerous. Children who have conftirutional difeafes, muft never- theless be inoculated. It will often mend the habit of bedv ; but 01-;ht to be performed at a time when thev are moft healthy. Accidental diier.fes fhould always be removed before inoculation. It is generally thought neceffary to regulate the diet for fome time before the difeafe be communicated. In children, however, great alteration, in diet is Ibidem neceffary, their food being commonly of the moft fimple and wholefome kind ; as milk, water-pap, weak broths, bread, light pud- ing, mild roots, and white meats. But children who have been accuftomed to a hotter diet, who are of a grofs habit, or abound with bad humours, ought to be put upon a fpare diet before they be inoculated. Their food fhould be of a light cooling nature ; and their drink whey, butter-milk, and fuch like. We would recommend no other medical preparation but two or three mild purges, which ought to be fuited to the age and ftrenoh of the patient. It is no doubt poffible by purgative and mercurial medicines, and a very cool regimen, to leffon the eruption ; but it feldom happens, that the eruption by inoculation proves tor,» great ; and we have al- ways obferved that thhfe children who had a pretty free erup- tion, aifo where the pox filled wOi, enjoyed the Lift health afterwards. 1 The regimen during the difeafo •muft be th? fame as un- der the natural fmall-pox. 'Fhe patient muft be kept cool, his diet muft be lfoht, and his drink weak and diluting, ts'c. Should any bad fymptoms appear which is feldom the cafe, they muft be treated in the fame way as directed in the na- tural fmall-pox. Purging is not lefs neceffary after the fmall-pox by inoculation than in the natural way, and ought by no means to be neglected *. CHAP. * Tt has been a queftion among phyficians whether any danger would at- tend inoculation fuppofing the patient to have had the difeafe before. This qucftion has generally been anfwered in the negative ; but, from feveral fails which have occurred in my practice, I am inclined to think it merits further confidcration. April 1764, in order to fatisfy her relations, I inoe'u- l?.tcd. [ 181 ] CHAP XXIV. OF THE MEASLES. TH E meafles appeared in Europe about the fame time with the fmall-pox, and have a great affinity to that dileafo. They both came from the Eaft, are both infecti- ous and feldom attack people more than once. The meafles are moft common in the fpring feafon and generally difappear in fummer. The difeafe itfelf, when properly managed, feldom Jatcd a girl about fix years of age, who, there was fome re j fon to believe, had had the fmall-pox before. She had no eruption, except a very few fmall hard piiftules refembliu" warts, which never fuppurated, nor fecmed to contain any matter. They difappeared, and a putrid fever enfued, which ended in an almoft univerfal mortification of the whole body, of which the died. A gentleman of my acquaintance, who pradifed inoculation very exten- fively, had taken as much matter from a patient in the fmall-pox as was fufficient to inoculate 40 or 50 others. For this he had been obliged to open a good many puftules, and, while his hands were daubed with the matter, happening to cut one of his fingers, he immediately put his thumb upon it, to keep in the blood, and held it there for fome time, till a rag was got with which he bound up the wound, and took no further notice .if it. About eight days after he began to feel an unufual wearinefs upon the Jraft motion, and complained of a dull pain of his head and loins, with a liiticfThcfs and want of appetite. On the ninth or tenth in the evening h* complained of Oknefs, and was actually feized with a fyncope or fainting f l. Next morn- ing an eruption appeared, which was pretty unncrfil but thickeft upon the limbs. I ids had indeed more the appearance of a ralh than of the fnrll- *k; but as it appeared about the fame time after receiving the wound that the fmall-pox generally do after inoculation, as the fysnptom.; nrrviou* to to the crup'i'jn w.'re the fam« with th1 e which ufually prtccJe th<. < rjptu :i of the fmall-pox, as the eruption continued upon the (kin about the fame number of days that the fmall-pox,generally do, Cn. there fcemed to be a good deal of reafon to conclude that the difeafe had proceeded from a quan- tity of the variolous matter which had been introduced into the blood by the wound. This patient indeed recovered by the help of medicine and a good conftitution; but had the latter been wanting, which was the cafe with the firft mentioned patient, he might have fhared the fime fate. N. B. This gentleman had had both the fmall-pox and meafles in the na- tural way many years before. Several other cafes have occurred to me where the conftitution feemed f fuOr hy the variolous matter having been introdoced into the blood without producing what could properly be called the fmall-pox. This ought, at leaft, to make prOtitOiers careful not to communicate d1c poifon unlefs where there is a profpeft of exciting the difeafe. Neither ought they to be too folicitous in fupprefling the eruption, as that feems to be the only fafe way in which the virus can be difcharged afta k has got into the blo»d. 182 O F T H E M E A S L E S. feldom proves fatal j but its confequences are often very troublefome. CAUb E.—-—This difeafe, like the fmall-pox, pro- ceeds from infection, and is more or lefs dangerous accord- ing to the conftitution of tlie pat; .nt, the feafon of the year, the climate, cjfV. SYMPTO M S.----The- meafles, like other fevers, are preceded by alternate fits of heat and cold, with fick- nefs and SoO of appetite. The tongue is white but gene- rally moift. There is a fhort cough, a heavinefs of the head and eyes, drowfinefs, and a running at the nofe. Some- times indeed the cough does not come before the eruption has appeared. The eye-lids frequently fwell fo as to occa- fion blindnOs. The patient generally complains of his throat; ana a vomiting or loofenefs often precedes the erup- tion. Theft' ols in children are commonly greenifh ; they complain of an itching of the ffon, and are remarkably peevifh. Bleeding at the nofe is common both befcie and in tne progrefs of the difeafe. » About the fourth day, fmall fpots refembling flea-bites, appear firft iipon the face, then upon the breaft, and after- wards on the extremities : Thefe may be diftinguifhed from the fmall-pox by their foarcely rifing above the fkin. The fever, cough, and difficulty of breathing, inftead of being removed by the eruption, as in the fmall-pox, are ra- ther increafed ; but the vomiting generally ceafes. About the fixth or Oventh day from the time of fickerv ing, the meafles begin to turn pale on the face, and after- wards upon the body j fo that by the ninth day they entire- ly difappear. , The fever however, and difficulty of breath- ing often continue, efpetJMly if the patient has been kept upon too hot a regimen. Petechiae, or purple fpots may likewife be occafioned by this error. A violent loofenefs fometimes focceeds the meaflesy in which cafe the patient's life is in eminent danger. Such as die of the meafles generally expire about .the ninth day from theinvafion, and are commonly carried oflp by a peripneumony, or inflammation of the lungs. The moft favourable fymptoms are a moderate loofenefs, a moift fkin, and a plentiful difcharge of urine. When the eruption fuddenly falls in, and the patient h feized with a delirium, he is in the greateft danger. If the meafles turn too foon of z. pale colour, it is an unfavour- OF THE MEASLES." 1&3 able fymptom, as are alfo great weaknefs, vomiting, reft- leffaefs and difficulty of fwallowing. Purple or black fpots appearing among the meafles, are very unfavourable. When a continual cough, with hoarfenefs fucceeds the difeafe, there is reafon to fufpedt an approaching confump- tion of the lungs. Our bufinefs in this difeafe is to affift Nature by proper cordials, in throwing out the morbific matter, if her efforts be too languid ; but when they are to?> violent, they muft foj reftrained by evacuations, and cool diluting liquors, ciff. We ought likewife to endeavour to appeafe the moft urgent fymptoms, as the cough, reftleflhefs, and difficulty of breath- ing. REGIME N.----The cool regimen is necefTary here as v/ell as in the fmall-pox. The food too muft be ll^ht and the drink diluting. Acids however do not anfwer fo well here as in the fmall-pox, as they tend to exafpcrate the cough. Small beer likewife, though a good drink in the fmall-pox, is here improper. The moft foitable liquors arc decoitions of liquorice with marfh mallow roots and farfaparilla, infufions of linfeed, or of the flowers of elder, balm tea, clarified whey, barley-water, and fuch like. Thefe, if the belly be bound, may be fweetened with honey ; or, if that fhould difagree with the ftomach, a little man- ia may occalionally be added to them. M E D I C IN hi.----The meafles being an inflammatory difeafe, without any critical difcharge of matter, as in the fmall-pox, bleeding is commonly neceffary, efpecially when the fever runs high, with difficulty of breathing, and great oppreffion of the breaft. But if the difeafe be of a mild kind, bleeding may be omitted. Bathing the feet and legs frequently in lukewarm wa- ter botli tends to abate the violence of the fever, and to pro- mote the eruption. The patient is often greatly relieved by vomiting. • When there is a tendency this way, it ought not to be ftopped, but encouraged by drinking lukewarm water, or weak camomile ten. When the cough is verv troublefome, with drynefs of the throat and difficulty of brer.thjng, the patient may hold his head over the fteam of warm wuer and draw the fteam into his lungs. He may likewife lick a little fpermaceu and fugar-candy pounded iS4 OF THE MEASLES. pounded together; or take now and then a fpoonful of the oil of fweec almonds with fugar-candy diffolved in it. Thefe will foften the throat, and relieve the tickling cough. In cafe the meafles fhould fuddenly disappear, it will be neceflary to purfue the fame method which we have recom- mended when the fmall-pox recede. The patient muft be fupported with wine and cordials. Bliftering plafters muft be applied to the legs and arms, and the body rubbed all over with warm flannels. Warm poultices may likewife be ap- plied to the feet and palms of the hands. f When purple or black fpots appear, the patient's drink fliould be fharpened with fpirits of vitriol ; and if the putrid fymptoms increafe, the Peruvian bark muft be adminiftred in the fame manner as directed in the fmall-pox. Opiatus are fometimes neceffarv, but fhould never be given except in cafes of extreme reftleflhefs, a violent loof- nefs, or when the cough is very troublefome. For chil- dren, the fyrup of poppies is fufficient. A tea-fpoonful or two may be occafionally given, according to the patient's age, or the violence of the fymptoms. After the meafles are gone off, it is generally proper to give the patient a dofe or two of phyfic. This may be condudled in the fame manner as directed in the fmall- pox. If a violent loofenefs fucceeds the meafles, itmavbe checked by taking for fome days a gentle dofe of rhubarb in the morning, r.nd an opiate over night; but if thefe do not remove it, bleeding will feldom fail to have that effec). Patients recovering after the meafles fhould be very careful what they eat or drink. Their food for fome time, ought to be light, and in fmall quantities, and their drink diluting, and rather of an opening nature; as butter-milk, whey, and fuch like. They ought alfo to beware of ex- pbfing themfelves too foon to the cold air, leaft a fuffocat- ing catarrh, an afthma, or a confumption of the lungi fhoul en foe. Should a cough, with difficulty of breathing, and other fymptoms of a confumption, remain after the meafles, fmall quantities of blood may be frequently let at proper inter- vals, as the patient's ftrength and conftitution will permit. He ought likewife to drink afles milk, to remove to a free air, if in a large town, and to ride daily on horfeback. He muft keep clofe to a diet confifting of milk and vegetables; OF THE BILIOUS FEVER. 185 if thefe do not fucceed, let him remove to a warmer clis mate *. Of the SCARLET FEVER. The fcarlet fever is fo called from the colour of the pa- tient's fkin, which appears as if it were tinged with red wine. It happens at any feafon of the year, but is moft common towards the end of fummer ; at which time it often feizes wnole families, efpecially children. iT-bcirfos, like other fevers, with coldnefs and fhivering, without any violent ficknefs. Afterwards the fkin is co- vered with red fpots, which are broader, more florid, and lefs uniform than the meafles. They continue two or three days, and then difappearj after which the cuticle or fcarf-fkin falls off. Thire is feldom any occafion for medicine in this dif- eafe. The patient ought however to keep within doors, to abftain from flefh, ftrong liquors and cordials, and to take plenty of cool diluting drink. If the fover run high, the belly muft be kept gently open by emollient clyfters, or fmall dofes of nitre and rhubarb. A fcruple of the for- mer, with five grains of the latter, may be taken thrice a- day, or oftner if neceffary. Children and young perfons. are fometimes feized, at the beginning of this difeafe, with a kind of ftupor and epileptic fits. In this cafe the feet and legs fhould be bathed B b with * Attempt j have been made to communicate the meafles, as well as the fmall-pox, by inoculation, and we make no doul)t but in time the pra&ice will fucceed very well. Dr. Home of Edinburgh fays, he communicated tbe difeafe by the blood. Others have tried this method, and have not found it fucceed. Some think the difeafe would be more certainly communi- cited by rubbing the (kin of apatient who has the meafles with cotton, i:.d and afterwards applying the cotton to a wound, as in the fmall-pox ; uhile others recommend a bit of flannel which had been applied to the patient's (kin, all the time of the difeafe, to be afterwards laid upon the arm or leg of the perfon to whom tbe i> feftion is to be communicated There is no doubt but this difeafe, as well as the fmall-pox, may be communicated various ways; the moft probable however is cither from cotton rubbed upon the (kin an m< ntioned above, or by introducing a little of the (harp humour v hich dilt'lls from the nofe or eyes of the patient into the blood. It is agreed on all hands that fuch patients as have been inoculated had the difeafe very mildly, we therefore wifh the practice were more general, as the mcaflw have of late become very f;.„I. 186 OF THE SCARLET FEVER. warm water, a large bliftering plafter applied to the neck and a dofe of the fyrup of poppies given every night till the patient recovers *. After the fever is gone off the patient ought to be purged once or twice. Of the BILIOUS F K V E R. When a continual, remitting, or intermitting fever is accompanied with a frequent or copious evacuation of bile, either by vomit or ftool, the fover is denominated bilious. In Britain the bilious fever generally makes its appearance about the end of fummer, and ceafes towards the approach of winter. It is moft frequent and fatal in warm countries, efpecially where the foil is marfhy, and when great rains are fucceeded by fultry heats. Perfons who work without doors, lie in camps, or who are expofed to the night air, are moft liable to this kind of fever. If there be fymptoms of inflammation at the beginning of this fever, it will be neceffary to bleed, and to put the patient upon the cool diluting regimen recunmeiuh d in the inflammatory fever. The foline draught recommended p?^ 152 mav likewife be frequently adminiftered, and the pa- tients body may be kept open by clyfters or mild purga- tives. But if the fever fliould remit or intermit, bleeding will feldom be neceffary. In this cafe a vomit may be ad- miniftered, and, if the body be bound, a gentle purge ; a£|ftr which the Peruvian bark will generally complete the cure. In cafe of a violent loofenefs, the patient muft be fup- ported with chicken broth, jellies of hartfnorn, and the like; and he may ufe the white deco:li:n for his ordinary dririj^f. If a bloody flux fhould accompany this iz\ex, it muft be treated in the manner'rcxummsiided under the article dyfentery. When there is a burning heat, and the patient does not fweat, that evacuation may be promoted by giving him, three * Sydenham. •J- The white dccocYion is m.ide by '..oiling two Ounces cf clcb O 'urif- horn prepared, and two or three drams cf gum ai.'.blc, in three \ rO»il. pints of water till only two rvrruiii : Afterwards fOw.7"^ the li^i"*. OF THE BILIOUS FEVER. i87 three or four times a day, a table-fpoonful of Mindercrus's fpirit* mixed in a cup of his ordinary drink. If the bilious fever be attended with the nervous, ma- lignant, or putrid fymptoms^^yhich is fometimes the cafe, the patient muft be treatedjpithe fame manner ai directed under thefe difeafts. After this fover proper care is neceffary to prevent a relapfe. For this purpofe the patient, efpecially towards the end of autumn, ought to continue the ufe of the Pe- ruvian bark for fome time after he is well. He ought like- wife to abftain from all trafhy fruits, new liquors, and and every kind of flatulent, aliment, CHAP. XXV. , OF THE ERYSIPELAS, or. St. ANTHONY'S FIRE. THIS difeafe, which in fome parts of Britain.is called, the roj'c, attacks perfons at any period of life, but is moft common between the age of thirty and forty. Per- fons of a fanguine or plethoric habit, are moft liable to it. It often attacks young people, and pregnant women ; and, fuch as have once been afflicted with it, are very liable to have it again. Sometimes it is a primary difeafe, and at other times only a fymptom of fome other malady. Every part of the body is liable to be attacked by an eryfipelas, but it moft frequently feizej the legs or face, efpecially tho latter. It it moft common in autumn, or when hot wea- ther is fucceeded bv cold and wet. CAUSES.----Toe eryfipelas is frequently occafioned by violent pollens or affections of the mind ; as fear, *i^ ger, *• Spirit of Mindererus is made bv taking any quantity*of tbe Volatile ft! ammoniac, and gradually pouring upon it diltilied vinegar, till the cf- *• ivefcence ceafes ; the mOtur; may be occufio'.ajly ftirred to promote tns .wiujion of the fait. j88 OF THE ERYSIPELAS, ger, &c. It is likewife occaftpned by cold *. When the body has been heated to a great degree, and is immediate- ly expofed to the cold air, fo that the perfpiration is fud- denly checked, an eryfipelaswill often eniue. It may alfo be occafioned by drinkingMjBfccefs, by continuing too long in a warm bath, or by^any thing that overheats th« blood. If any of the natural evacuations be obftrudted, or in too fmall quantity, it may caufe an eryfipelas. The fame effect will follow from the ft »ppage of artificial eva- cuations; as iffues, fetons, or the like. SYMPTOMS.----The eryfipelas attacks with fhi- vering, thirft, lofs of ftrength, pain in the head and back, heat, reftleflhefs, and a quick pulfe ; to which may be added vomiting, and fometimes a delirium. On the fe- cond, third, or fourth day, the part fwells, becomes red3 and fmall puilules appear j at which time the fever gene- rally abates. When the eryfipelas feizes the foot, the parts conti- guous fwell, the fkin Alines ; and, if the pain be violent, it will afoend to the leg;, and will not bear to be touched. When it attacks the face, it fwells, appears red, and the fkin is covered with fmall puftules filled with clear water. One or both eyes are generally clofed with the fwelling , and there is a difficulty of breathing. If the moutli and noftrils be very dry, and the patient drowfy, there is reafon to fufpedt an inflammation of the brain. If the eryfipelas affects the breaft, it fwtils, and be- comes exceedingly hard, with great pain, and is apt to fup- purate. There is a violent pain in the arm-pit en the fide affected, where an abfeefs is often formed. The event of this difeafe depends greatly upon the con- ftitution of the patient. It is feldom dangerous; yet I have knov/n it prove fatal to people in the decline of life, who were of a fcorbutic habit, or whofo humours had been vitiated by irrcgifon living, or unwholefome diet. I? * The C«mtry people in many parts of Britain call this difeafe a llaft, and imagine it proceeds from foul air, or ill wind, as they term It. The truth is, they often lie down to reft them, when warm and fatigued, upon tbe damp ground, where they fall afltv.p, and lie fo long as to catch cold, which soecafions the Eryfipelas. This difeafe may indeed proceed from other caub s, but wc may venture to fay, that nine times out of ten it is occafioned by cold caugiu after the body Las been grc\Oy heated or b.- tigutd. or St. ANTHONY'S FIRE. ify If in a day or two the fwelling fubfides, the heat and ptun abate, the colour of the part turns yellow, and the cuticle breaks and falls off in fcales, the danger is over. When the eryfipelas is large, deep, and affects a very fenfible part of the body, the danger is great. If the red colour changes into a livid or black, it will end in a, mortification. Sometimes the inflammation cannot be dif- cuffed, but comes to a fuppuration; in which cafe fiftu- las, a gangrene or mortification, often enfue. Such as die of this difeafe are commonly carried off by the fever, which is attended with difficulty Of breathing, and fometimes with a delirium and great drowfinefs. They generally die about the feventh or eighth day. REGIMEN.----In the eryfipelas the patient muft neither be kept too hot nor cold, as either of thefe ex- tremes will tend to make it retreat, which is always to he guard.d againft. When the difeafe is mild, it will be fufficient to keep the patient within doors, without con- fining him to his bed, and to promote the perfpiration by diluting liquors, &c. The diet ought to be {lender, and of a moderately cooling and moiftening quality ; as groat-gruel, panado; chicken or barley broth, with cooling herbs and fruits, &c. avoiding flefh, fifh, ftrong drink, fpices, pickles, and all other things that may heat and inflame the blood ; the drink may be barley-water, an infufion of elder flowers, common whey, and fuch like. But if the pulfe be low, and the fpirits funk, the patient muft be fupported with negas, and other things of a cordial nature. His food may be fago gruel with a lit- tle wine, and nourifhing broths, taken in fmall quantities, and often repeated. Great carev however muft be taken not to overheat him. \ MEDICINE.----In this difeafe much mifchief is often done by medicine, efpecially by external applica- tions. People, when they fee an inflammation, immedi- ately think that fomething ought to be applied to it. This indeed is neceffary in large phlegmons ; but in an eryfipelas the fafer courfe is to apply nothing. Almoft all ointments, falves and plafters, being of a «greafy nature, tend rather to obftrudt and repel than promote any dif- charge from the part. At the beginning of thts difeafe ;t is neither fafe to promote a fuppuratfon, nor to rc;:el the Matter 190 OF THE ERYSIPELAS, matter too quickly. The eryfipelas in many refpedts re- fembles the gout, and is to be treated with the greateft caution. Fine wool, or very foft flannel, are the fafe ft applications to the part. Thefe not only defend it from the cxernal air, fo.t likewife promote the perfpi' nic n, which has a great tendency to carrv oft' the uifoife. In Scotland the common puoh.!e gencrallv: apply a mcOly cloth to the parts anecOd, which is far from being im- proper. It is a common thing to bleed in the eryfipelas; but this likewife requires caution. If however the fover he high, the pulfe hard and ftrong, ?nd the patient vigorous, it will be proper to bleeo ; bur the quantity muft be regu- lated by thefe circumffonccs, snd the operation repeated or not as the fymptoms may require. If the patient has been accuftomed to ftrong liquors, and the difeafe attacks his head, bleeding is abfolutely neceifojy. Bathing the foet and legs frequently in lukewarm wa- ter, when the difeafe attacks tie face or brain, has an ex- cellent effect. It tends to make a derivation from the head, and fociom fails to relieve the patient. When bath- ing proves ineffectual, poultices, or fharp fir.aphms, m?.v be applied to the foles of the feet for the fame purpofe. In caffo where bleeding is requifite, it is ILkewife necef- fary to keep the belly gently open. ThO may be effected by emollient clyfters, or fmall dofes of nitre and rhubarb. Some indeed recommend very large dofes of nitre in tOs cafe; but nitre feldom fits eafy on tie ftomach when taken in large dofes. It is however one of the beft medicines in this cafe, and when the fever and inflammation run ffofo, half a foam of it, with fivafor fix grains of rhubarb, may be taken in the patient's 'ordinary drink, three or four times a-day. When the eryfipelas leaves the extremities, and fi.-fo?s the head fo as to occafion a delirium or ftupor, iris abfo- lutely neceffary to open the belly. If clyfters and mild purgatives fail to have this effect, ftronger ones muft be given. Bliftering plafters muft likewife be applied to the neck, or behind the ears, and'(harp cataplafms laid to the foles of the feet. When the inflammation cannot be difcuffed, and the part has a tendency to ulcerate., it will then be proper to promote fuppuration, which may be done by the applica- tion i on St. ANTHONY'S FIRE. iqi tion of ripening poultices with faffron, warm fomentati- ons, and fuch like. When the black, livid, or blue colour of the part fhews a tendency to mortification, the Peruvian bark muft be adminiftred. It may be tfoen along with acids, as re- co.nmcnJcd in the fmall-pox, or in a:-y other form more agree, hie to.the patient. It muft not however be trifled v.foh, as the patient's life is at ftake. A dram may be given every two hours, if the fymptoms be threatening, and cloths dipped in warm camphorated fpirits of wine, or the tincture of myrrh and aloes, may be applied to the part, anu^ frequently renewed. It may likewife be proper in this caie to apply poultices of the bark, or to foment the part affcOed with a ftrong decodtion of it. In what 0 commonly called the fcorb:uf eiyfpdat, which continues for a confiderable time, it will only be neceffary to give gentle laxatives, and fuch things as purify the blood, and promote the perfpiration. Thus, alter the inflammation has been checked by opening medicines, a decodtion cf the fodorific woods, fis ihflafrafs and guaia- cum, with liquoricc-root, may be drank; afterwart^pa courfe of bitters will be proper*. ' Slvh as ere liable to frequent attacks of the eryfipelas ought carefully to guard againft all violent paffions ; to abitain from ftrong liquors, and all fat, vifcid, and highly nourifhing fo;d. They fhould likewife take fufficient ex- ercife, caiefully avoiding the extremes of heat or cold. ThOr food foould confift chiefly of milk, and fuch fruits, hero.-, ujkJ roots, as are of a cooling quality; and their dihfo ought to be fmall beer, whey, butter-milk, and fuch like. They fhould" never fuffer themfelves to be too lorii- ( Olive. If that cannot be prevented by'diet alone, it will be proper to take in.qu?nt!v a gentle dofe of rhu- barb, cre.^n of tartar, the lenitive electuary, or fome other tn.fo purgative. C II A P. * Tlie decoction of woods is made by boiling, of gna:.rcum wood rafped three ounces, raifins of the fun (toned two oencc>, faflafras wood (haved one ounce, liquorice root diced half" an ounce, in an h'.nglilh gallon of water. The guaiacum and raifins may be boiled, over a ;y-title fire, rill about one half of tlie water be confumed, adding, towards Oe end, the faflafras and li'iuoricc. The lkjuor muft be ftrained, and fuiTOed to reft for fome time that tbe fueccs may hObO. An I'.njlifli obit of it may O' drank daily. ♦ [ 192 ] CHAP XXVL OF THE PHRENITIS, or INFLAM- MATION OF THE BRAIN. 4 THIS is fometimes a primary difeafe, but oftener only a fymptom of lome other malady ; As the inflamma- tory, eruptive, or fpotted fever, &c. It is very common however as a primary difeafe in warm climates, and is moft incident to perfons about the prime or vigour of life, ^he paflionate, the ftudious, and thofe whofe ner- vous fyftem is weak, are moft liable to it. CAUSES.----This difeafe is often occafioned by night-watching, efpecially when joined with hard ftudy : It may likewife proceed from hard drinking, anger, grief, or anxiety. It is often occafioned by the ftoppage of ufual evacuations ; as the bleeding piles in men, the cuftomary difcharges of women, &c. Such as imprudently expofe themfelves to the heat of the fun, efpecially by fleeping without doors in a hot feafon, with their heads uncovered, are often fuddenly feized with an inflammation of the „ brain, fo as to awake quite delirious. When repellents « are imprudently ufed in an eryfipelas, an inflammation of the brain is fometimes the confequence. It may likewife be occafioned by external injuries, as blows or bruifes up- on the head, &c. SYMPTOMS.---The^mptoms which ufually precede a true inflammation of tne brain are,'pain of the head, rednefs of the eyes, a violent flufhing of the face, difturbed fleep, or a total want of it, great drynefs of trn fkin, coftivenefs, a retention of urine, a fmall dropping of blood from the nofe, ringing of the ears, and extreme fenfibility of the nervous fyftem. When the inflammation is formed the fymptoms in general are fimilar to thofe of the inflammatory fever. The pulfe indeed is often weak, irregular, and trembling; but fometimes it is hard and contracted. When the brain itfelf is inflamed, the pulfe is always foft and low ; but when the inflammation only affects the integuments of of the brain, viz. the dura and pia mater, it is hard. A remarkable OF THE PHRENITIS, LO. i93 » remarkable quicknefs of hearing is'a common fympton of this difeafe ; but that feldom continues long. Another ufual fymptom is a great throbbing or pulfation in the arteries of the neck and temples. The tongue is often black and dry ; yet the patient feldom complains of thirft and even refufes drink. The mind chiefly runs upon fuch objects as have before made a deep impreflion on it; and Ounetimes, from a follen filence, the patient becomes all of a fudden quite outrageous. A constant trembling and ftaning of the tendons, is an unfavourable fymptom, as are alfo a foppreflion of urine ; a total want of tieen ; a conftant fpitting ; a grind- ing of the teeth, which laft may be confidered as a kind of convulfion. When a phrenitis fucceeds an inflamma- tion of the lungs, of the inteftines, or of the throat, &c. it is owing to a tranflarion of the difeafe from thefe parts to the brain, and generally proves fatal. Hence we learn the ncceflity of proper evacuations, and the danger of re- 'pellents in all inflammatory difeafes. The favourable fymptoms are, a free perfpiration or fweating, a copious difcharge of blood from the nofe, the bleeding piles, a plentiful difcharge of urine which lets fall a copious fediment. Sometimes the difeafe is carried off" by a loofenefs, and in women by an exceffive flow of the menfes. As this diOafe often proves fatal in a few days, it re- quires the moft fpeedy applications. When it is prolonged, or improperly treated, it fometimes ends in madnefs or a kin 1 of ftupdity which continues for life. In the cure, two things are chiefly to be attended to, viz. to leffon the quantity of blood in the brain, and to 1 retard the circulation towards the head. REGIME N.----The patient ought to be kept very quiet. Company, noife, and every thing that affects the fonfes, or di'foros the imagination, increafes the difeafe. Liven too much light is hurtful ; for which reafon the pa- tient's chamber ought to be a little darkened, and he fhould neither be kept too hot nor cold. It is not however ne- ceffary to exclude the company of an agreeable friend, as this has a tendency to foothe and quiet the mind. Neither ought the patient to be kept too much in the dark, left it Ihould occafion a gloomy melancholy, which is too often the confequence of this difeale. C c The 194 OF THE PHRENITIS, or The patient muft, as far as poffible, be foothed and humoured in every thing. Contradiction will ruffle his mind, and increafe his malady. Even when he calls for things which are not to be obtained, or which might prove hurtful, he is not to be pofitively denied them, but rather put off with the promife of having them as foon as they can be obtained, or by fome other excufe. A little of any thing that the mind is fet upon, though not quite proper, will hurt the patient lefs than a pofitive refufal. In a "word, whatever he was fond of, or ufed to be delighted with when in health, may here be tried, as pleafing ftorics, foft mufic, or whatever has a tendency to foothe the paf- fions, and compofe the mind. Boerfoirvc propofes feveial mechanical experiments for this purpofe; as the foft noife of water diftilling by drops into a bafon, and the patient trying to reckon them, &c. Any uniform found, if low and continued, has a tendency to procure fleep and confe- quently may be of fervice. The aliment ought to be light, confiding chiefly of farinaceous fubftances; as panado, and water-gruel fhar- pened with jelly of currants, or juice of lemons, ripe fruit* roafted or boiled, jellies, preserves, &c. The drink fmall, diluting, and cooling; as whey, barley-water, or decoctions of barley and tamarinds, which latter not only renders the liquor more palatable, but likewife more bene- ficial, as they are of an opening nature. MEDICINE S.----In an inflammation of the brain, nothing more certainly relieves the patient than a free dif- charge of blood from the nofe. When this comes of its own accord, it is by no means to be ftopped, but promot- ed, by applving cloths dipped in warm water to the part. When bleeding at the nofe does not happen fpontaneoufly, it may ba provoked by putting a ftraw, or any other fharp body up the noftril. Bleeding in the temporal arteries greatly relieves the head; but as this operation cannot always be performed, we would recommend in its ftead bleeding in the jugular veins. When the patient's pulfe and fpirits are fo low, that he cannot bear bleeding with the lancet, leeches may be applied to the temples. Thefe not only draw off th« blood more gradually, but by being applied nearer to the part affected, generally give more immediate relief. A bis- INFLAMMATION OF THE BRAIN. i95 A discharge of blood from the haemonifodal veins is likewife of great fervice, and ought by all means to be promoted. If the patient has been fubjedt to the bleeding piles, and that difcharge has been ftopped, every method muft be tried to reftore it ; as the application of leeches to the parts, fitting over the fteams of warm water, ftiarp clyfters or fuppofitories made of honev, aloes, and rock- falt. If the inflammation of the brain be occaifoned by the: ftoppage of evacuations either natural or artificial, as the; rnenfes, iffues, fetons, or fuch like, ail means muft be ufed to reftore them as foon as poffible, or to fubftitute others in their ftead. If the p3tientbe coftive, his belly muft be kept open by emollient clyfters, or gentle purgatives ; as manna, rhu- barb, cream of tartar, or fuch like. Thefe may either be given feparately or together in fmall dofes, and repeated as there may be occafion. Small quantities of nitre ought frequently to be mixed with the patient's drink. Two or three drams, or more, if the Cafe be dangerous, may be ufed in the fpace of twen- ty-four hours. The head flipuld be fhaven, and frequently rubbed with vinegar and rofe-water a little warm. Cloths dip- ped in it may likewife be applied to the temples. The feet ought frequently to be bathed in lukewarm water, and foft poultices of bread and milk may be kept conftantly ap- plied to them. If the difeafe proves obftinate, and does not yheld to thefe medicines, it will be neceffary to apply a bliftering plafter to the whole head. CHAP. XXVII. OF THE OPTIIALMIA, or INFLAM- MATION OF THE EYES. THIS difeafe may be occafioned by extemal injuries; as ftrokes, duft thrown into the eyes, &c. It is of- ten caufed by the ftoppage of cuftomary evacuations; as U*e healing of old fores, drying up of iflues, the lup- preffing 196 OF THE OPTHALMIA, or prefling of gentle morning fweats, or of the fweating of the feet, &c. Long expofore to the night-air, efpecially in cold northerly winds, or whatever fuddenly checks the perfpiration, efpecially after the body has been much heated, is very apt to caufe an inflammation of the c\*»... Viewing ("now or other white holies for a h n.g time, or forking ftedfaftly at the fon, a clear fire, or any bright objed!:, will likewife pecaiipn this malady. A fudden tran- fitfon from darknefs to very bright light will often have the fame effect. Nothing more certainly occafions an inflammation of the c)es than night-watching, efpecially reading or wri- ting by candle-light. Drinking fpirituous liquors and ex- cefs of venery, are likewife very hurtful to the eyes. The acrid fumes of metals, and of ieve:0 kinds of fuel, are alfo pernicious. Sometimes an inflammation of the eyes j : j". Is from a venereal taint, and often horn a fcrophu- jous or gouty habit. It miv ljkewife be occafioned by hairs in the eye-lids turningnnwards, and hurting the eyes. Sometimes the difeafe is epidemic, efpecially after wet feafons; and I have frequently known it prove in- fectious, particularly to thofe who lived in the fame houfe with the patient. It may be occafioned by moift air, or living in low, damp houfes, efpecially in perfons who are not accuftomed to fuch fitintions. In children, it often .-■roceeds from imprudently drying up of foabbed heads, a running behind the ears, or any other difcharge of that kind. Inflammations of the eyes often fucceed the fmall- pox or meafles, efpecially in children of a fcrophulous habit. S Y M PTO \1 S.----An inflammation of the eyes is attended with acute pain, heat, rednefs, and fwelling. The patient is not able to bear the light, and fometimes 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 fees flies dancing before him. The eyes are filled with a fcalding rheum, which rufhes forth in great quantities whenever the patient attempts to look up. The pulfe is generally quick and hard, with fome degree of fever. When the difeafo is violent, the neigh-- r-.-jring parts fwell, and there is a throbbing 'Or pulfation in the temporal arteries, fcfr. A 5i.IG.IT INFLAMMATION OF THE EYES. 197 A slight inflammation of the eyes, efpecially from an external caufe, is eafily cured ; bqt when the difeafe is violent, and continues lone, it often leaves fpecks upon the eyes, or dimnefs of fight, and fometimes total blind- nefs. If the patient be feized with a loofenefs, it has a good eftedt ; and when the inflammation paifes from one eye to another, as it were by infection, it is no unfavourable iyim.iom. Bur when the difeafe is accompanied with a vi- o cm pain of the head, and continues long, the patient is in danger of lofing his fight. REGIME N.----The diet, unlefs in fciophulous cafes, can hardly be too fpare, efpecially at the beginning. The patient muft abftain from every thinir of a heating na:ure. His food muft confift chiefly of mild vegetables, weak broths, and gruels. His drink may be barley-water, balm tea, common whey, and fuch like. The patient's chamber muft be darkened, or his eyes (haded by a cover, fo as to exclude the light, but not to piefs upon the eyes. He fhould not look at a candle, the- fire, or any luminous object ; and ought to avoid all fmoke, as the fumes of tobacco, or any thing that may caufe coughing, fncezing, or vomiting. He fhould be kept quiet, avoiding all violent efforts, either of body or mind, and encouraging fleep as much as poffible. MEDICINE.---This is one of thofe difeafes wheiein great hurt is often done by external applications. Almoft every perfon pretends to be pofleffed of a remedy for the cure of fore eyes. Thefe remedies generally con- fift of eye-waters and ointments, with other extern?.! ap- plications, which do mifchief twenty times for once they do good. People ought therefore to be very cautious how they ufe fuch things, as the very preffure upon the eyes of- ten encreafes the malady. Bleeding, in a violent inflammation of the eyes, is always necelfary. This fhould be performed as near the part affected as poffible. An adult may lofe ten or twelve ounces of blood from the jugular vein, and the opera- tion may be repeated according to the urgency of the fymptoms. If it fliould not be convenient to bleed in the neck, the fame quantity may be let irom tlie arm, or any other part of the body. 198 OF THE OPTHALMIA, or Leeches are often applied to the temples, or under the eyes, with good effect. The wounds muft be fuffered to bleed for fome hours, and if the bleeding ftop foon, it may be promoted by the application of cloths dipt in warm water. In obftinate cafes, it will be neceffary to repeat this operation feveral times. Opening and diluting medicines are by no means ta be negledtcd. The patient may take a fmall dofe of Glau- ber's falts and cream of tartar, every fecond or third day, or a decoction of tamarinds with fenna. If thefe be not agreeable, gentle dofes of rhubarb and nitre, a little of the lenitive eledtuary, or any other mild purgative, will anfwer the fame end. The patient at the fame time muft drink freely of water-gruel, tea, whey, or any other weak diluting liquor. He ought likewife to take, at bed-time, a large draught of very weak wine-whey, in order to pro- mote perfpiration. His feet and legs muft frequently be bathed in luke-warm water, and his head fhaved twice or thrice a-week, and afterwards wafhed in cold water. Thi$ has often a remarkably good effect. If the inflammation does not yield to thefe evacuations, bliftering plafters muft be applied to the temples, behini the ears, or upon the neck, and kept open for fome time by the mild bliftering ointment. I never knew thefe, if long enough kept open, fail to remove the moft obftinate inflammation of the eyes; but, for this purpofe, it is of- ten neceffary to continue the difcharge for feveral weeks. When the difeafe has been of long {landing, I have feen very extraordinary effects from a fcton in the neck, or betwixt the fhoulders, efpecially the latter. It fhould he put upwards and downwards, or in the direction of the fpine, and in the middle between the fhc/ulder-blades. It may be dreffed twice a-day with yellow bafilicon. I have known patients, who had been blind for a confiderable time, recover fight by means of a feton placed as above. When the feton is put acrofs the neck, it foon wears out, and is both more painful and troublefome than between the fhoulders; befides, it leaves a difagreeable mark, and does not difcharge fo freely. When the heat and pain of the eyes is very great, a poultice of bread and milk foftened with plenty of fweet oil or frefh butter, may be applied to them, at leaft all night; INFLAMMATION OF THE EYES. 199 night; and they may be bathed with lukewarm milk and water every morning. If the patient cannot fleep, which is fometimes the cafe, he muft take fifteen or twenty drdps of laudanum, or two fpoonfuls of the fyrup of poppies, over night, more or lefs according to his age, or the violence of the fymp- toms. After the inflammation is gone off, if the eyes ftill remain weak and tender, they may be'bathed every night and morning with cold water and a little brandy, fix parts of the former to one of the latter. A method fhould be contrived by which the eye can be quite immerfed in the brandy and water, where it fhould be kept for fome time. I have generally found this, or cold water and vinegar, as good a ftrengthener of the eyes as any of the moft cele- brated collyriums. When an inflammation of the eyes proceeds from a fcrophulous habit, it generally proves very obftinate. In this cafe the patient's diet muft not be too low, and he may be allowed to drink fmall negas, or now and then a glafs of wine. The moft proper medicine is the Peruvian bark which may either be given in fubftance, or prepared in the following manner: Take an ounce of bark in powder, with two drams of Winter's bark, and boil them in an Englifh quart of water to a pint; when it has boiled nearly long enough, add half an ounce of liquorice-root fliced. Let the liquor be ftrained. Two, three, or four table-fpoonfuls, accord- ing to the age of the patient, may be taken three or four times a-day. It is impoffible to fay how long this medi- cine mould be continued, as the cure is fooner performed in fome than others; but in general it requires a confidera- ble time to produce any lafting effects. Dr. Cheyne fays, c That cethiops mineral never fails in obftinate inflammations of the eyes, even fcrophulous ones, if given in a fufficient dofe, and duly perfifted in.' There is no doubt but this and other preparations of mer- cury may be of fingular fervice in opthalmias of long con- tinuance, but they ought always to be adminiftered with the greateft caution, or by perfons of fkill in phyfic. It will be proper frequently to look into the eyes, to fee if any hairs be turned inwards, or prefling upon them, in order that they may be cut off without delay. Such 200 OF THE OPTHALMIA, fcrV. Such as are liable to frequent returns of this difeafe, ovght conftantly to have an iifue in one or both arms. iOeeOOg or purging e the fpring and autumn, will be very beneficial to- fo.\; ^perfons. They ought likewife to live with tlie greateft regularity, avoiding ftrong liquor, and every thing of a heating quality. Above all, let them avoid the night-air and late ftudies. * CHAP. XXVIII. OF THE QJUINSEY, or INFLAM- MATION of the THROAT. THIS difeafe is very common in Britain, and is fre- quently attended with great danger. It prevails in the winter and fpring, and is moft fatal to young peo- ple of a fanguine temperament. CAUSES.---In general it proceeds from the fame caufes as other inflammatory diforders, viz. anobftiuetcd perfpiration, or whatever heats or inflames the blood. An inflammation of the throat is often occafioned by omitting fome part of the covering ufually worn about the neck, by drinking cold liquor when the body is warm, by riding or walking againft a cold northerly wind, or any thing that greatly cools the throat, and parts adjacent. It may like- wife proceed from the neglect of bleeding, purging, or any cuftomary evacuation Singing, fpeaking aloud and long, or whatever ftrains the throat, may likewife caufe an inflammation of that organ. I have often known the quinfoy prove fatal to jovial companions, who, after fitting long in a warm room * As moft people are fond of making ufe of eye-waters in this difeafe, we (hall recommend the following as one of the beft which has fallen uindf.r our obfervation. Take of bolearmeniek finely powdered three ounces; of white vitriol an ounce and a half; of white fu^.r-candy three ounces. Mix t^c-m in a bottle of foft water, and let them ftand for three or four days, frequently making them, Afteiwards the water mult be filtered, and a little of it dropt into the eye twice oi tlukw a-day. A lO'-Ii wet with it muft Ukewife be conftantly kept on the eye. OF THE QV I N S E Y, cifo. 201 room, drinking hot liquors, and linging with vehemence, were fo imprudent as to go abroad in the cold night-air, Sitting with wet feet, or keeping on wet clothes, are very apt to occafion this malady. It is likewife frequently occafioned by continuing long in a moift place, fitting near an open window, fleeping in a damp bed, fitting in a room that has been newly plaftered, &c. I know people who never fail to have a fore throat if they fit even but a fhort time in a room that has been lately wafhed. Acrid or irritating food may likewife inflame the throat, and occafion a qumfey. It may alfo proceed from'bones, pins,r>r other flvirp fubftances lticking in the throat, or from the cauftic fumes of metals or minerals, as arfenic, anti- mony, &c. taken in by the breath. This difeafe is fome- times epidemic and infectious. SYMPTOMS.----The inflammation of the throat is evident from infpedtion, the parts appealing red and fwelled; befides, the patient complains of pain in fwal- lowing any thing. His pulfe is quick and hard, with other fymptoms of a fever. If blood be let, it is ge- nerally covered with a rough coat of a whitifh colour, and the patient fpits a tough phlegm. As the fwelling and inflammation inctraffo the breathing and fwallowing become more difficult; the pain affedts the ears; the eyes generally appear red ; and the face fwells. The patient is often obliged to keep himfelf in an erect pofture, being in danger of fuffocation ; there is a conftant naufea, cr inclination to vomit, and the drink, inftead ofpaffing into the ftomach, is often returned by the noO. The p,)t;ent is frequentlyftarved at laft, merely from an inability of fwallowing any kind of food. When the breathing is labourfous, with ftraitnefs of the breaft and anxiety, the danger is great. Though the pain in ("wallowing be very great, yet while the patient breathes eafy, theio is not fo much danger. An etxernal fwelling is no unfavourable fymptom; but if it fuddenly falls, and the difeafe affects thu breaft, the danger is very great. When a quinfey is the confequence of fome other difeafe, which has already weakened the patient, his fitua- tion is dangerous. A frothing at the mouth, with a fwel- led tongue, a pale, ghaftly countenance, and coldnefs of the extremetiei, we foul fymptoms. Dd REGIMEN. 207 OF THE QJJ I N S E Y, oft REGIMEN.----The regimen in this difeafe is in all refpedts the fame as in the pleurify or peripneumony. The foci muft be light, and in fmall quantity, and the drink plentiful, weak and diluting, mixed with acids. It is highly neceffary that the patient be kept eafy and quiet. Violent affections of the mind, or great efforts of the body, may prove fatal. He fnould not even at:, inpt to fpeak but in a low voice. Such a degree of warmth as to promote a conftant gentle fweat is proper. When the patient is in bed, his head ought to be i ailed a little higher than ufual. It is peculiarly neceffary that the neck be kept warm ; for which purpofe feveral folds of foft flannel may be wrapt round it. That alone will often remove a flight complaint of the throat, efpecially if applied in due time. We can- not here omit obforving the propriety of a cuftom which prevails among the peafants of this country. When they feel any unealinefs of the throat, they wrap a flocking a- bout it all night. So effectual is this remedy, that in many places it panes for a charm, and the flocking is applied with particular ceremonies: The cuftom however is un- doubtedly a good one, and foould never be neglected. When the throat has been thus wrapt up all night, it muft not be expofed to the cold air through the day, but a hand- kerchief, or a piece of flannel, kept about it till the ifolarn- jnaticri be removed. The jelly of black currants is a medicine very much in tfteem for complaints of the throat; and indeed it is of con- fiderable efficacy. It ihould be almoft conftantly kept in the mouth, and fwallowed down leifurely. It may like- wife be mixed in the patients drink, or taken any other way. When it cannot be obtained, tin; jelly of red cur- rants, or of mulberries, maybe ufed in hs f.eaJ. Gargles for the throat are likewife very beneficial. They ni2y be made by adding to half an Englifh pint of the pectoral decodion mentioned page 117, two or tl ro: fpoonfuls of honey, and thefame quantity of currant-jelly. This may be ufed three or four times a-day; and if the patient be troubled with tough vifcid phlegm, the gargle re ay be made more (harp and cleanfing, by adding to it a tea-fpoonful of the fpirit of fal c.nit^rniac. Some recom- mend gargles made of a decoction of the leaves or haik n INFLAMMATION OF THE THROAT. 203 of the blackberry-bufh ; hut where the jelly can be had, thefe a*c unneceffary. There is no difeafe wherein. the benefit of bathing the feet and legs in luke warm water is more apparent; That pradtice ought therefore never to be negledted. 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 ufe a fpare diet, with diluting liquors, at th^ begin- ing of this difeafe, it would feldom proceed to a great height, or be attended with any danger ; but when thefe precautions are neglected, and the difeafe becomes violent, more powerful medicines are neceffary. MEDICINE.----An inflammation of foe tfooit being a moft acute and dangerous diftemper, which fome- times takes off the patient very fuddenly, it will be proper, as foon as the fymptoms appear, to bleed in the arm, or rather in the jugular vein, and to repeat the op ration if circumftances require. The belly fliould likewife be kept gently open. This mav either be done by giving the patient for his ordinary drink a decoction of figs and tamarinds, or fmall doles of rhubarb and nitre, as recommended in the eryfipelas. Thefe may be increafed according to the age of the patient, and repeated till they have the defired effect. I have often known very good effects from a bit of fal prune I, or purified nitre, held in the mouth, and fwal- Jowed down as it melted. This promotes the difcharge of faliva, by which means it anfwers the end of e garble, while at the fame time it abates the fever, by promoting the difcharge of urine, &c. The throat ought likewife to be ruhbel twice or thrice a-.day with a little of the volatile liniment. This feldom fails to produce fome good effects. At the fiime time th-i neck ought to be carefully covered with wool or flannel, to prevent the cold from penetrating the fkin, us this ap- plication renders it very tender. Many other external ap- plications are recommended in this difeafe, as a fwalfofos neft, poultices made of the fungus called Jews ears, album "Tecum, efff. But as we do not look upon any of thefe to be preferable to a common poultice of bread and irilk, we (hall take no further notice of them. Some recommend the gum guaiacum as a fpecific in ttiis difeafe. Half a dram of the gum in novvfor may se made 204 OF THE Q_U I N S E Y, or made into an electuary with the root of elder for a dofe, and repeated occafionallv. Blistering upon the neck or behind the ears in violent inflammations of the throat, 0 very beneficial. After the plafters are taken off, the parts ought to be kept running by the application of fharp ointment, till the inflammation is gone; otherwife, upon their drying up, the patient will be in danger of a relapfe. When the patient has been treated as above, a fuppura- tion feldom happens. This however is fometimes the cafe in fpite of all our endeavdurs to prevent it. When the inflammation and fwelling continue, and it is evident that a fuppuration will enfue, it ought to be promoted by draw- ing the fteam of wann wateT into the throat through a tunnel, or the like. Soft poultices ought likewife to be applied outwardly, and the patient may keep a roafted fig conftantly in his mouth. It fometfoies happens, before the tumour breaks, that the fwelling is fo great, as entirely to prevent any thing from getting down into the ftomach. In this cafe the patient muft inevitable* perifli, uifofo he can be fupported in fome other way. This can only be done by nourifhing clyfters of broth, or gruel with milk, &c. Patients have often been fupported hy thefe for feveral days, till the tumor has broke ; and afterwards they have recovered. Not only the fwallowing, but the breathing is often prevented by the tumor. In this cafe nothing can fave the patient's life, but opening the trachea or wind-pipe. As that has been often done with fuccefs, no perfon, in fuch de- fperate circumftances, ought to hefitate a moment about the operation ; but as it can only be performed by a fur- geon, it is not neceffary here to give any directions about it. When a difficulty of fwallowing is not attended with an acute pain or inflammation, it is generally owing to an obftrudtion of the glands about the throat, and only re-. quires that the part be kept warm, and the throat fre- quently gargied with fomething that may gently ftimulate the glands, as a decoction of figs with vinegar and honey; to which may be added a little muftard, or a fmall quan- tity of fpirits. But this kind of gargle is never to be ufed where there are figns of an inflammation. This fpecies of angina has various names among the common people, as the INFLAMMATION OF THE THROAT. 205 the pap of the throat, the falling down of the almonds of the ears, l$c. Accordingly to remove it, they lift the pa- tient up by the hair of the head, and thruft their fingers under his jaws, &c. all which practices are at beft ufelefs, and often hurtful. Those who are fubjedt to inflammations of the throat, in order to avoid that difeafe, ought to live temperate. Such as do not chufe to obferve this rule, muft have fre- quent recourfe to purging and other evacuations, to dif- charge the fuperfluous humours. They ought likewife to beware of catching cold, and fhould abftain from aliment and medicines of an aftringent or ftimulating nature. Violent exercife, by increnfing the motion and force of the blood, is apt to occafion an inflammation of the throat, efpecially if cold liquor be drank immediately af- ter it, or the body fuffered fuddenly to cool. Thofe who would avoid this difeafe ought therefore, after fpeaking aloud, finging, running, drinking warm liquor, or doing any thing that may ftrain the throat, or increafe the circu- lation of the blood towards it, to take care to cool gradu- ally, and to wrap fome additional coverings about their necks, &c. I have often known perfons who had been fubjedt to fore throats, entirely freed from that complaint by only wearing a ribband, or a bit of flannel, conftantly about their necks, or by wearing thicker flioes, a flannel waift- coat, or the like. Thefe may feem trifling, but they have great effect. There is danger indeed in leaving them off after perfons have been accuftomed to them ; but furely the inconveniency of ufing fuch things for life, is not to be com- pared with the danger which may attend the negledt of them. Sometimes, after an inflammation, the glands of the throat continue fwelled, and become hard and callous. This complaint is not eafily removed, and is often rendered dangerous by the too frequent application of ftrong ftimu- lating and ftyptic medicines. The beft method is to keep it warm, and to gargle it twice a' day with a decoction of figs fharpened a little with a few drops of the elixir or fpirit ;jf vitriol. Op [ 206 ] Of the MAL'GNANT QUINSEY, or FUTRID, ULCEROUS SORE THROAT. This kind of quihfey is but little known in the northern parts of Britain, though, for fome time paft, it has been very fatal in the more fouthern counties. Children are more fubjedl to it than adults, females than males, and the delicate than thofe who are hardy and robuft. It prevails moft in autumn, or after a long courfe of damp, or fultry weafoer. CAUSES.----This is evidently a contagious dif- remper, and is generally communicated by infection. Whole families, and even entire villages often receive the infection from one perfon. This ought to put people upon their guard againft going near fuch patients as labour under the diforder ; as by that means they eadanger not only their own lives, but likewife thofe of their friends and connedti- ons. Whatever tends to produce putrid or malignant fe- vers, may likewife occafion the putrid ulcerous fore throat, as unwholefome air, damaged provifions, neglect of clean- linefs, cjfo. SYMPTOM S.----It begins with alternate fits of fhivering and heat. The pulfe is quick, but low and un- equal, and generally continues fo through the whole courfe of the difeafe. The patient complains greatly of weaknefs and oppreffion of the breaft ; his fpirits are low, and he is apt to faint away when fet upright; he is troubled with a naufea, and often with a vomiting or purging. The two latter are moft common in children. The eyes appear red and watery, and the face fwells. The urine is at firft pale and crude; but, as the difeafe advances, it turns more of a yellowifh colour. The tongue is white, and generally moift, which diftinguifhes this from an inflammatory difeafe. Up- on looking into the throat it appears fwelled, and of a florid red colour. Pale or afh-coloured fpots, however, are here and there interfperfed, and fometi.nes one broad patch or fpot, of an irregular figure, and pale white colour, fur- rounded with florid red, only appears. Thefe whitifh fpots or floughs cover fo many ulcers. An efflorefcence, or eruption upon the neck, arms, breaft, and fingers, about the fecond or third day, is a common fymptoifl OF THE MALIGNANT QLTNSEY, fcfc. 207 fymptom of this difeafe. When it appears, the purging and vomiting generally ceafe. There is ojttn a fli^it degree of delirium, and the face frequently appeVs bloated, and the infideof the noftrilsred and inflamed. The patient complains of a difagreeable pu- trid fmell, and his breath is very offenfive. The putrid, ulcerous throat may be diftinguifhed from the inflammatory by the vomiting and loofenefs with which it is generally ufliere 1 in ; by the foul ulcers in the throat covered with a white or livid coat; and by the exceffive weaknefs of the patient; with other fymptoms of a putrid foyer. Unfavourable fymptoms are, an ohOinate purging, extreme weaknefs, dimnefs ofthe'fight, a livid or black co- lour of the fpots, and frequent ihiverings, with a weak flut- tering pulfe. If the eruption upon the fkin fuddenly difap- pears, or becomes of a livid colour, with a difcharge of blood from the nofe or mouth, the danger is very great. If a gentle {'•/;c be ufed as a gargle, but a little of it fhould frequently be injected with a fyringe to clean the mouth, before the patient takes any niqut or drink. This method is peculiarly ucuflirv for children, who cannot ufe a gargle. PUTRID, ULCEROUS SORE THROAT. 209 wr'-m water, and emollient clyfters given three or four times a-day. After the violence of the difeafe is over, the belly fhould ftill be kept open with mild purgatives ; as manna, fenna, lhubarb, or the like. If great weaknefs and dt.je.5fion of fpirits, or night- fweats, with other fymptoms of a confumption, fhould re- main after this difeafe, we would advife the patient to con- tinue the ufe of the Peruvian bark, with the elixir of vitri- fo and to take frequently a glafs of generous wine. Thefe, together with a milk-diet, and riding on horfeback, are the moft likely means for recovering his ftrength. C 11 A P. XXIX. OF COLDS AND COUGHS. IT has already been obferved, that colds are the effect of an obftrudted perfpiration ; the common caufes of which we have likewife endeavoured to point out, and fhall not here repeat them. Nefoier ftiall we fpend time in enume- rating all the various fymptoms of colds, as they are pretty geneially known. It may not however be amifs to obferve, that almoft every cold is a kind of fever, which only diners in ueoree fro.n fome of thofe that have already been treat- ed of? ' No age, fex, or conftitution is exempted from this dif- eafe : neither is it in the power of medicine to prevent it. The inhabitants of every climate are liable to catch cold, nor can even the greateft circt.nifpedtion defend them at all times from its attacks. Indeed, if the '-men body could be kept conftantly in an uniform degree of warmth, fuch a thing as catching cold would be impoffible: But as that cannot be effodfod by any means, the perfpiration muft be liable to many changes. Stich changes however, when fmall, do not effect the fo-forf; '., when great, they muft prove hurtful. Hence the chief lecret of preventing colds, 210 OF COLDS £ND COUGHS. lies in avoiding, as far as poflible, all extremes either of heat or cold. When oppreflion of the breaft, a fluffing of the nofe, unufual wearinefs, or a pain of the head, cjfY. give ground to believe that the perfpiration is obftrudted, or in other words, that the perfon has caught cold, he ought immediately to leifon his diet, at leaft 'the ufual quantity of his folid food, and to abftain from all ftrong liquors. Inftead of flefh, fifh, eggs, milk, and other nourifhing diet, he may eat light bread-pudding, veal or chicken broth, panado, gruels, and fuch like. His drink may be water-gruel fweetened with a little honey; an in- fufion of balm, or linfeed fharpened with the juice of orange or lemon ; a decoction of barley and liquorice with tamarinds, or any other cool, diluting acid liquor. Above all, hi fupper fhould be light ; as fmall pof- fet, or water-gruel fweetened with honey, and a little toafted bread in it. If honey fhould difagree with the ftomach, the gruel may be fweetened with treacle or coarfe fugar, and fharpened with the jelly of currants. Thofe wno have been accuftomed to generous liquors may take white wine whey inftead of gruel, which may be fweetened as above. The patient ought to lie longer than ufual a-bed, and to encourage a Jentle fweat, which is eafily brought on towards morning, by drinking tea, or any kind^of warm diluting liquor. I have often known this prac- tice carry off a cold in one day, which, in all proba- bility, had it been neglefted, would have coft the pa- tient his life, or have confined him for fome months to his bed. Would people facrifice a little time to eafe and warmth, and practife a moderate degree of arbfli- nence &hen the firft fymptoms of a cold appear, we have reafon to believe, that moft of the bad effects which flow from an obftrudted perfpiration, might be prevented. But, after the difeafe has gathered ftrength by delay, all attempts to remove it often prove vain. A pleurify, a peripneumony, or a fatal confumption of the lungs, are the common effects of colds which have either been totally negledted, or treated improperly. Many attempt to cure e. cold, by getting drunk. But this, to fay no worfe of it, is a very hazardous and fool-hardy experiment. No doubt it may fome- times OF COLDS AND COUGHS. 211 times fucceed, by fuddenly reftoring the perfpiration ; but when there is any degree of inflammation, which is frequently the cafe, ftrong liquors, inftead of re- moving the malady, will increafe it. By this me ns a common cold may be converted into an inflammatory fever. When thofe who labour for their daily bread have the misfortune to catch cold, they cannot afford to lofe a day or two, in order to keep themfelves warm, and take a little medicine, by which means the disor- der is often fo aggravated as to confine them for a long time, or even to render them ever after unable to luftain hard labour. But even fuch of the labour- ing poor as can afford to take care of themfelves, are often too hardy to do it; they affect to defpife colds, and as long as they can crawl about, fcorn to be con- fined by wnat they call a co?nmon cold. Hence it cones to pafs, that colds deftroy fuch numbers of mankind. Like an enemy defpifed, they gather ftrength from de- lay, till, at length, they become invincible. We of- ten fee this verified in travellers, who, rather than lole a day in the profecution of their bufinefs, throw away their lives by purfuing ' their journey with this difeafe upon them, even in the coldeft feafon. It is certain, however, that colds may be too much indulged. When a perfon, for every flight cold, (huts hiinfeTf up in a warm room, and diinks great quanti- ties of warm liquor, it may bring on fuch a general re- laxation of the folids as will not be eafily removed. It will therefore be proper, when the dneale will per- mit, an4 the weather is mild, to join to the regimen mentioned above, gentle exercife ; as walking, riding on horfeback, or in a machine, effr. An obftinate cold, which no medicine can remove, will yield to a proper courfe of exercife when duly perftfted in. Bathing the feet and legs every night in warm wa- ter has a great tendency to reftore the perfpiration. But care muft be taken that the water be not too warm, otherwife it will do hurt. It fhould never be much warmer than new milk, and the patient foould go im- mediately to bed after ufing it. Bathing the feet in warm water, lying in bed, and drinking warm water- gruel, or other weak liquors, will fooner take off a 6 ' fpafnij 212 OF COLDS AND COUGHS. fpafm, and reftore the perfpiration, than "all the^ hot fudorific medicines in the apothecaries fhop. This is all that is nee-nary for removing a common cold; and if this courfe be taken at the beginning, it will fel- dom fail. But when the fymptoms do not yield to abftinence, warmth, and diluting liquois, theie is reafon to fear the approach of fome other difeafe, as an inflammation of the breaft, an ardent fever, cjfe. If the pulfe there- fore be hard and frequent, the fkin hot and dry, and the patient complains of his head or breaft, it will be neceffary to bleed, and to give the cooling opening pow- ders recommended in the foarlet fever, every three or four hours, till they give a ftool. It will likewife be proper to put a bliftering plafter on the back, to give two table-fpoonfuls of the faline mixture ordered page 114, every two hours, and, in fhort, to treat the patient in 'all refpects as for a flight k\cw I have often feen this courfe, when obferved at the beginning, remove the complaint in two or three days, when the patient had all the fymptoms of an approaching ardent fever, or an inflammation of the bieaft. Of a COMMON COUGH. V A cough is generally the effect of a cold, which has either been iinpropefiy treated, or entirely negledted. When it proves obftinate, there is always reafon to fear the confequences, as this fhews a weak ftate of the lungs, and is often the forerunner of a confump- tion. ** If the cough be violent, and the patient young and ftrong, with a hard quick pulfe, bleeding will be pro- per ; but in weak and relaxed habits, bleeding rather prolongs the difeafe. When the patient fpits freely, jlecding is unneceffary, and fometimes hurtful, as it tends to leffen that difcharge. When the coutfoi is not attended with any degree of fover, and the fpittle is vifcid and tough, fharp pedtoral ■medicines are to be adminiftered ; as gum ammoniac, fquills, OF A COMMON COUGH. 213 fquills, &c. The folution of gum ammoniac may be prepared as directed page 124, and two table-fpoonfuls of it taken three or four times a-day, more or lefs, according to the age and conftitution of the patient. Squills may be given various ways ; Two ounces of the vinegar, the oxymel, or the fyrup, may be mixed with the fame quantity of fimple cinnamon water, to which may be added an ounce of common water, and an ounce of balfamic fyrup. Two table-fpoonfuls of this mixture may be taken three or four tines a-dny. A syrup made of equal parts of lemon-juice, honey, and fugar-candy, is likewife very proper in this kind of cough. A table-fpoonful of it may be taken at plea- fure. But when the defluxion is fharp and thin, thefe me- dicines rather do hurt. In this cafe gentle opiates, oils, and mucilages are more proper. A cup of an infufion of wild poppy leaves and marfli-mallow roots, or the flowers of colts-foot, may be taken frequently ; or a tea-fpoonful of the paregoric elixir may be put into the patient's drink twice a-day. Fuller's Spanifh infufion is alfo a very proper medicine in this cafe, and may be taken in the quantity of a tea-cupful three or four times a-day *. When a cough is occafioned by acrid humours tick- ling the throat and fauces, the patient fhould keep fome foft pectoral lozenges almoft conftantly in his mouth; as the Pontefract liquorice cakes, barley-fogar, the com- mon balfamic lozenges, Spanifh juice, &c. Thefe blunt the acrimony of the humours, and by taking off their ftimulatiug quality, help to appeafe the cough. In obftinate coughs, proceeding from a flux of hu- mours upon the lungs, it will,- often be neceffary, be- fides expectorating medicines, to have recourfe to ilfues, fetons, or fome other drain. In this cafe I have often obferved the moft happy effects from a Burgundy-pitch plafter applied between the fhoulders. I have ordered this fimple remedy in the moft obftinate coughs, in a great • The Spanifh infufion is made by infufing in an F-nglifii quart of boiling water, two drams of the fait of tartar, half a drain of fafTron cut into fmall pieces, and an ounce of Spanilh juice likewife cut fmall. Thefe muft Hand in a clofe veflel for twenty-four hours in a gentle O..: ; afterwards !et the infufion be ltraiiud. 214 OF A COMMON COUGH. great number of cafes, and in many different confti- tutions, without ever knowing it fail to give relief, un- lefs where there were evident ffous of an ulcer in the lungs. About the bulk of a nutmeg of Burgundy-pitch may be fpread thin upon a piece of foft leather, ahout the fize of the hand, and laid between the fhoulder- blades. It may be taken off and wiped every three or four days, and ought to be renewed once a fortnight or three weeks. This is indeed a cheap and fimple medicine, and consequently apt to be defpifed ; but we will venture to affirm, that the whole materia medica does' not afford an application more efficacious in al- moft every kind of cough. It has not indeed always an immediate effedt; but, if kept on for fome time, it will fucceed where moft other medicines fail. The only inconveniency attending this plafter is the itching, which it occafions in the part to which it is applied; but furely this may be difpenfed with, eonfi- dering the ad/antage which the patient may expedt, to reap from the application ; befides, when the itching becomes very uneafy, the plafter m?.y be taken off, and the part rubbed with a dry cloth, or wafhed with a little w'.rm milk and water. Some caution indeed is ne- ceffary in difcontinuing the ufe of fuch a plafter; this however may' be fafelv done by making it fmaller by degrees, and at length quitting it altogether; in a warm feafon *. But coughs proceed from many other caufes befides dcfluxions upon the kuigs. In thefe cafes the cure is not to be attempted by pectoral medicines. Thus, in a cough proceeding from a foulnefs and debility of the ftomach, fvrups, oils, mucilages, and all kind of bal- famic medicines do hurt. The ffotnach cough may be known from one that is owing to a fault in the lungs by this, that in the latter the patient coughs whenever he infpires, or draws in his breath fully; but in the former thru does not happen. The * Some compliin that the pitch plafter adheres too faft, fo that they find it difficult to remove it, while others find difficulty in keeping it on. This proceO- from the different kinds of pitch made ufe of, and likewife from the manner of fpreading it. 1 generally find it anfwer beft when mixed with a little bees wax, and fpread as c-cl as pofiiule. The clear, hard, tran- fjjarent pitch anfwer* the pi.ri-ofc L.it. OF A COMMON COUGH. 215 The cure of this cough depends chiefly upon clean- fing and ftrengthening the ftomach ; for which purpofe gentle vomits and b tter purgatives are moft proper. Thus, after a vomit or two, the focred tincture, as it is called, may be taken for a confiderable time in the dofe of one or two table fpoonfuls twice a-day, or as often as it is found neceffary to keep tbe body gently open. People may make this tincture themfelves, by in- fufing an ounce of hiera pier a* in an Englifh pint of white wine, letting it ftaifo a few days, and then (train- ing it off for ufe. In coughs which proceed from a debility* of the ftomach, the Peruvian bark is likewife of confiderable fervice. It may either be chewed, taken in powder, or made into a tincture along with other ftomachic bitters. A nervous cough can only be removed by change of air, and proper exercife ; to which may be added the ufe of gentle opiates. Inftead of the faponaci#us pill, the paregoric elixir, &c. which are only opium dif- guifed, ten, fifteen, twenty, or twenty-five drops of li- quid laudanum, more or lefs, as circumftances require, may be taken at bed-time, or when the cou^h is moft troublefome. Immerfing the feet and hands in warm water will often appeafe the violence of a nervous couoh. When a cough is only the fymptom of fome other mafody, it is in vain to attempt to remove it without firft curing the difoifo from which it-proceeds. Thus, when a cough is occafioned by teething, keeping the belly open, fcarifying the gums, or whatever facilitates the cutting of the teeth, likewife appeafes the cough. In like manner, when worms occafion a cough, fuch medicines as remove thefe will generally cure the cough ; as bitter pur- gatives, oily clyfters, and fuch like. Women, during the laft months of pregnancy, are of- ten greatly afflicted with a cough, which is generally re- lieved by bleeding, and keeping the belly open. They ouo-ht to avoid all flatulent food, and to wear a loofe eafy drefs. A cough * The pov !'. 1 called hieri picra is made^by poviuding together, of Soco- trine aloes four ounces, Virginian lnake-root and ginger, each, half an •unce. 216 OF A COMMON COUGH. A cough is not only a fymptpm, but is often like- wife the forerunner of difeafes. Thus, the gout is fre- quently inhered in by a very troublefome cough, which affects the patient for fome days *before the coming on of the fit. This cough is generally removed by a pa- roxyfm of the gout, which fliould therefore be promoted, by keeping the extremities warm, drinking warm liquon, and bathing the feet and legs frequently in lukewarm water. Of the HOOPING-COUGH, or CHIN-COUGH, This cough feldom affects adults, but proves often fatal to children. Such children as live upon thin wa- tery diet, who breathe unwholefome air, and have too little exercife, are moft liable to this difeafe, and ge- nerally fuffer moft from it. The chin-cough is fo well known, even to nurfes, that a defcription of it is unneceffary. Whatever hurts the digeftion, obftrudts the perfpiration, or relaxes the folids, difpofes to this difeafo: Confequently its cure muft depend upon clcanffog and ftrengthening the ftomach, bracing the folids, and, at the fame time, promoting per- fpiration, and the different fecretions. The diet muft be light, and pf eafy digeftion; for children, good bread made into pap or pudding, chicken- broth, with other light fpoon-meats, are proper; but thofe who are farther advanced may be allowed fago- gruel, and if the fever be not high, a little boiled chicken, or other white meats. The drink may be pen- ny-royal tea, fweetened with honey or fugar-candy, fmall wine-whey ; or, if the patient be weak, he may fome- times be allowed a little negas. One of the moft cffodtuil remedies in the chin-cough is change of air. This often removes the malady even when the change feems to be from a purer to a lefs. wholefome air. This may iri fome meafure depend on the patient's being removed from the place where the infection prevails. Moft of the difeafes of children are infectious; nor is it at all uncommon to find the chin- cough prevailing in one town or village, when another, at OF THE HOOPING-COUGH, tfc. 217 at a very fmall diftaj«| is fjuite fre"e from it. But, whatever be the caufe, we are fure of the fact. No time ought therefore to be loft in removing the patient at fome diftance from the place where lie caught the difeafe, and, if poflible, into a more pure and warm air *. When the difeafe proves violent, and the patient is in danger of being foffoe.itfo by the cough, he ought to be bled, efpecially if there be a fever with a hard full pulfe. But as the chief IVention of bleeding is to prevent a rupture of the blood-veiiels of the lungs, and to render it more fafe to give vomits, it will feldom be neceffary to repeat the operation ; yet if there be fymp- toms of an fol animation of the lungs, a fecond, or even a third bleeding may be requifite. It is generally reckoned a favourable fymptom when a fit of coughing makes the patient vomit. This cleanfes the ftomach, and greatly relieves the cough. It will therefore be proper to promote this difcharge, either by camomile-tea or lukewarm water; and when thefe are not fufficient, fmall dofes of ipecacuanha may be given. A child of three or four years of age may take five or fix grains; and to others, lefs or more muft be given accord- ing to their age and ftrength. It is very diffofot to make children drink after a vo- mit. I have often feen them happily deceived, by infu- fing a fcruple or half a dram of the powder of ipecacu- anha in a tea-pot, wich half'an Englifh pint of boiling water. If this be difguifed with a few drops of milk and a little fugar, they will imagine it tea, and drink it very greedily. A fmall tea-capful of this may be given every quarter of an hour, or rather every ten minutes, till it operates. When they begin to puke, there will be no occafion for drinking anv more, as the water already on their ftomach will be foffoOn:. . F f Vomits' * Some think the air ought not to be changed till the difeafe be on the decline; but there feems to be no fusficient reafon for this opinion, as pa- tients have been known to ie:>.p benefit from a change of air at all periods of thc-dil- fe. It is not fufficient to carry the patient out daily in a ma- chine. This feldom anfvvers any good purpofe; but often hurts the patient by giving him cold. If lie goes out at all, it ou^'.ic to be on foot or horfe- back. >i8 OF-T*E HOOPI.N'G-COUGH, Vomits notvoniy ^atrfiflj .tfi^jftomach, which in this Ofe.ife is generally loaded with vncid phlegm, but they likewife promote the perfpiration and other fecretions ; and ought .therefore to be repeated according to the obftfoacy cf the difeafe. They fhould not however be too ftrong ; gentle vomits frequently repeated are both lefs dangerous, ar.J more beneficial than ftrong ones. As the patient is generally coftive, it will be proper to keep his belly gently open. The beft medicines for, this purpofe are rhubarb and its preparations, as the fy- rup, tindture, cifo. Of thefe- a tea-fpoonful or two may be given to an infant twice or thrice a-day, as there is oc- cafion. To fuch as are farther advanced, the dofe muft be proportionally increafed, and repeated till it has the defired effect. Thofe who cannot be brought to take the bitter tfodturc, may have an infufion of fenna and prunes, fweetened with manna, coarfe fugar, or honey; or a few grains cf rhubarb mixed with a tea-fpoonful or two of fyrup, or currant jelly, fo as to difguife the tafte. Moft children are fond of fyrups and jellies, and feldom refufe even a difagreeable medicine when mixed with them. Many people believe that oily, pedtoral, and balfamic medicines poffefs wonderful virtues for the cure of the chin-cough, and accordingly exhibit them plentifully to patients of every age and conftitution, without confider- ing that every thing of this nature muft load the ftomach, hurt the digeftion, and of courfe aggravate the diforder. The millepedes, or woodlice, are greatly recommended for the cure of a chin-cough. Thofe who chufe to make ufe of thefe infects, may infufe two ounces of them bruifed in an Englifh pint of fmall white-wine for one night. Afterwards the liquor may he ftrained through a cloth, and a table-fpoonful of it given to the patient three or four times a-day. Opiates are fometimes neceffary to allay the violence of the cough. For this purpofe a little of the fyrup of poppies, or five, fix or foven drops of laudanum, ac- cording to the age and conftitution of the patient, may be taken in a cup of hyfop or penny-royal tea, and re- peated occafionally. The garlic ointment is a well-known remedy in North- Brfofoi for the chin-cough. It is made by beating in a mortar garlic with an equal quantity of hogs-lard. With this or C H I-N-C O U G H. 219 this the foles of the feet may* be rubBed twice or thrice ■ a-day; but the beft method is to fpread it upon a rag, and apply it in the form of plafter. It fhould be renewed every night and morning at leaft, as the garlic foon lofos its virtue. This is an exceeding good medicine both in the chin-cough, and in moft other coughs of an obftinate nature. It ought not however to be ufed when the pa- tient is very hot or feverifli, left it increafe thefe fymp- toms. The feet fhouhi be bathed once every two or three diys in lukewarm water; and a Burgundy-pitch plafter kept conftantly betwixt the fhoulders. But when the dif- eafe proves very violent, it will be neceffary, inftead of it, to apply a bliftering plafter, and to keep the part open for fome time with iffue-ointment. When the difeafe is prolonged, and the patient is free from a fever, the Peruvian bark, and other bitters, are the moft proper medicines. The bark may either be taken in fubftance, or in a decoction or infufion, as is moft agree- able to the patient. 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 dram or two fcruples will be proper. Some give the extract of the bark with cantharides ; but to manage this requires fome fkill and attention. It is more fafe to give a few grains of caftor along with the bark. A child of fix or foven years of age may take feven or eight grains of caftor, . with fifteen grains of powdered bark, for. a dofe. This may be made into a mixture with two or three ounces of any fimple diftilled water, and a little fyrup, and taken three or four times a-day. CHAP XXX. INFLAMMATION OF THE STOMACH AND OTHER VISCERA. ALL inflammations of the bowels are dangerous, arid require the moft fpeedy affiftance; as they frequent- ly end in a fuppuration, and fomejirhes in a mortification, which is certain death* CAUSES. 220 INFLAMMATION OF THE STOMACH CAUSES.----An inflammation of the ftomach may proceed from any of the caufes which produce an in- flammatory fever; as cold liquor drank while the body is warm, obftrudted perfpiration, the fudden ftriking in of any eruption, &c. It may likewife proceed from the acrimony of the bile, or from acrid and ftimulating fub- ftances taken into the ftomach ; as ftrong vomits or purges, corrofive poifons, r.nd fuch like. When the gout has been repelled from the extremities, either by cold or im- proper ^applications, it often occafions an inflammation of the ftomach. Hard or indiseftable fubftances taken into the ftomach, as bones, the iucifo of nuts, &c. may likewife have that effect. SYMPTO M S.----It is attended with a fixed pain and burning heat in the ftomach ; great reftleffnefs and anxiety ; a fmall, quick, and hard pulfe ; vomiting, or at leaft, a naufea and ficknefs ; excefive thirft; coldnefs of the extremities; difficulty of breathing; cold clammy fweats; and fometimes convulfions and fainting fits. The ftomach is fwelled, and often feels hard to the touch. One of the moft certain figns-^f this difeafe is the fenfe of pain, which the patient feels upon taking any kind of food or drink, efpecially if it be either too hot or cold.* When the patient vomits every thing he eats or drinks, is extremely reftlefs, has a hiccup, with an intermitting pulfe, and frequent fainting fits, the danger is very great. REGIMEN.——All acrimonious, heating, and irri- tating food ana drink are carefully to be avoided. The weaknefs of the patient may deceive the by-ftanders, and induce them to give him wines, fpirits, or other cordials; but thefe never fail to increafe the difeafe, and often occa- fion fudden death. The inclination to vomit may likewife Impofe on the attendants, and make them think a vomit neceffary , but that too is almoft certain death. The food muft be light, thin, cool, and eafy of di- geftion. It muft be given in fmall quantities, and fhould neither be quite cold nor too hot. Thin gruel made of barley or oatmeal, light to.iired bread diffolved in boiling water, or very weak chicken broth, are the moft proper. The drink fliould be clear whey, barley water, water in which toafted bread has been boiled, or decoctions of emol- lient vegetables ; as liquorice and marfhmailow roots, farfapariila, &c MEDICINE,. AND OTHER VISCERA. 221 MEDICINE.----Bleeding in this difeafe is abfo- lutely neceffary, and is almoft the only thing that can be depended on. When the difeafe proves obftinate, it will often be proper to repeat this operation feveral times, nor muft the low ftate of the pulfe deter us from doing fo. The pulfe indeed generally rifes upon bleeding, and fo long as that is the cafe operation is fafe. Frequent fomentations with lukewarm water, or a decoction of emollient vegetables, are likewife beneficial. Flannel cloths dipped in thefe muft be applied to the region of the ftomach, and removed as they grow cool. They muft neither be applied too warm, nor fuffered to continue till they become quite cold, as either of thefe ex- k tremes would aggravate the difeafe. The feet and legs ought likewife to be frequently bathed in lukewarm water, and warm bricks or poultices may be applied to the foles of the feet. In this and all other inflammations of the bowels, an epifpaftic, or bliftering plafter, applied over the part af- fected is one of the beft remedies I know. I have often ufed it, and do not recolledr. one inftance wherein it did not give relief to the patient. The only internal medicines which we fhall venture to recommepd in this difeafe, are mild clyfters. Thefe may be made of warm water, or thin water-gruel, and if ihc patient be coftive, a little fweet oil, honey or manna, may be added. Clyfters anfwer the purpofe of an in- ternal fomentation, while, they keep the belly open, and at the fame time nourifh the patient who is often, in this difeafe, unable to retain any food upon his ftomach. For thefe reafons they muft not be negledted, as the patient's life may depend on them. INFLAMMATION OF THE INTESTINES. This is one of the moft painful and dangerous difeafes that mankind is liable to. It generally proceeds from the fame caufrs as the inflammation of the ftomach; to which may be added coftivenefs, worms, eating unripe fruits, or great quantities of nuts, drinking hard windy malt liquors, as ftale bottled beer or ale, four wine, cyder, &c. It may likewife be occafioned by a rupture, by fcirrhous tumours 222 INFLAMMATION OF THE INTESTINES. of the inteftines, or by their oppofite fides growing to* gether. The inflammation of the inteftines is generally divided into the Iliac paffion, the Enteritis, Uc. according to the name of the parts affected. The treatment however is nearly the fame whatever part of the inteftina! canal be the feat of the difeafe ; we fhall therefore omit thefe dif- tindtions, left they fhould perplex the reader. The fymptoms- here are nearly the fame as in the fore- going difeafo; only the pain, if poffible, is more acute, and is fituated lower. The vomiting is likewife more violent-, and fometimes even the excrements, together with the clyfters and foppofitories, are difcharged by the mouth. The patient is continually belching up wind, and ha$ often an obitruction of his urine. While the pain fhifts, and the vomiting only return? at certain intervals, and while the clyfters pafs downwards, there is ground to hope; but when the clyfters and faces are vomited, and the patient is exceeding weak, with a low fluttering pulfe, a pale countenance, and a difagree- able or ftinking breath, there is great reafon to fear that the confequences will prove fatal. Clammy fweats, black foetid ftools, with a fmall intermitting pulfe, and a total ceifation of pain, are figns of a mortification, already be gun, and of approaching death. REGIMEN.----The regimen in this difeafe is in general the fame as in an inflammation of the ftomach. The patient muft be kept quiet,avoiding cold, and all violent paflions of the mind. His food ought to be very light, and given in fmall quantities: his drink weak and dilut- ing ; as clear whey, barley-water, and fuch like. MEDICINE.---Bleeding in this, as well as in. the inflammation of the ftomach, is of the greateft im- portance. It fhould be performed as foon as the fymptoms appear, and muft be repeated according to the ftrength of the patient, and the violence of the fymptoms. A blistering plafter is here likewife to be applied im- mediately over the part where the moft violent pain is. This not only relieves the pain of the bowels, but even clvfters and purgative medicines, which before had no ef- fefo, will operate when the blifter begins to rife. Fomentations and laxative clyfters are by no means to be ommitted. The patient's feet and legs fhould fre- quently INFLAMMATION OF TriE INTESTINES. 223 quently be bathed in warm water; and cloths dipped in it applied to his beliy. Bladders filled with warm water may likewife be applied to the region of the navel, and warm bricks, or bottles filled with warm water, to the foles of the feet. The clyfters may be made of barley- water or thin gruel wilh fait, and foftened with fweet oil or frefh butter. Thefe may be adminiftred every two or three hours or oftentr, if the patient continues coftive. If common clyfters have not the defired effect, we would recommend the fmoke of tobacco. It may be blown into the bowels through an inverted pipe. This may be repeated in a fhort time, unlefs the effect of the firft renders it unneceffary. If the difeafe docs not yield to clyfters and fomentati- ons, recourfe muft be had to pretty ftrong purgatives ; but as thefe by irritating the bowels often increafe their con-- tradtion, and by that means fruftrate their own intention, it will be neceffary to join them with opiates, which, by aihying the pain, and reljxing the fpafmodic contracti- ons of the guts, greatly aflift the operation of purgatives in this cafe. What anfwers the purpofe of opening the belly very well, is a folution of the bitter purging falts. Two ounces of thefe may be diffolved in an Englifh pint of warm water, or thin gruel, and two or three table-fpoonfuls given every half hour till it operates. At the fame time fifteen, twenty, or twenty-five drops of laudanum may be given in a glafs of pepper-mint or fimple cinnamon water, to appeafe the iiritation and prevent the vomit- ing, ifc. Acids have often a very happy effect in flaying the vomiting, and appeafing the other violent fymptoms of this difeafe. It will therefore be of ufe to fharpen the patient's drink with cream of tartar, juice of lemon j or,1 when thefe cannot be obtained, with vinegar. But it often happens that no liquid whatever will ftay on the ftomach. In this cafe the patient muft take purging pills. I have generally found the following anfwer very well. Take jalap in powder, and vitriolated tartar, of each half a dram, opium one grain, Caftile foap as much as will make the mafs fit for pills. Thefe muft be taken at one dofe, and if they do not operate in a few hours, the dofe may be repeated. 224 INFLAMMATION OF THE INTESTINES, If a ftool cannot be procured by any of the above means, it will be neceffary to immerfe the patient in warm water up to the breaft. I have often feen this fucceed when other means had been tried in vain. The patient muft continue in the water as long as he can eafily bear it without faint- ing, and if one immerfion has not the defired effect, it may be repeated as foon as the patient's ftrength and fpirits are recruited. It is more fafe for him to go frequently into the bath than to continue too long at a time ; and it is often neceffary to repeat it feveral times before it has the defired effect. Great care muft be taken that the water be not too warm. It has fometimes happened, after all other means of procuring a ftool had been tried to no purpofe, that this was brought about by immerfing the patient's lower ex- tremities in cold water, or making him walk upon a wet pavement, and dafhing his legs and thighs with the cold water. This method, when* others foil, at leaft merits a trial. It is indeed attended with fome danger; but a doubtful remedy is better than none. In defperate cafes it is common to give quickfilverj This may be given to the quantity of feveral ounces, or even a pound, but fliould not exceed that *. When there is reafon to fufpedt a mortification of the guts, this medi- cine ought not to be tried. In that cafe it cannot cure the patient, and will only haften his death. But when the obftrudtion is occafioned by any caufe that can be removed by force, quickfilver is not only a proper medicine, but the beft that can be adminiftered, as it is the fitteft body we know for making its way through the inteftinal canal. If the difeafe proceeds from a rupture, the patient muft be laid with his head very low, and the inteftines returned by gentle preffure with the h^nd. If this, with fomenta- tions and clyfters, fliould not fucceed, recourfe muft be had to a furgical operation, which may give the patient relief. Such as would avoid this excruciating and dangerous difeafe, muft take care never to be too long without a ftool. * When oniekfilver is given in too large quantities it defeats its own ' intention, as it pulls down the bottom of the ftomach by its great weight, which prevents its getting over the Pylorus. In this cafe I have fometimes been obliged to haog up the patient Ly fhe hetls in order that it might be fe difcharged by his mouth. * INFLAMMATION OF THE INTESTINES. 225 ftool. Some who have died of it ha^e had feveral pounde of hard, dry faces taken out of their guts. They fhould likewife beware of eating too freely of four or unripe fruits, or drinking ftale windy liquors, &c. I have known it brought on by living too much on baked fruits, which are feldo.n good. It likewife. proceeds frequently from cold caught by wet clothes, &c. but efpecially from wet feet. Of thc COLIC. The colic has great affinity, both in its fymptoms and method of cure, with the two preceding difeafes. It is ge- nerally attended with coftivenefs and acute pain of the bowels; and requires diluting diet, evacuations, fomenta- tions, bfc. Colics arc varioufly denominated according to their caufes, as the flatulent, the hilious, the hyfteric, the ner- vous, &c. As each of thefe requires a particular method of treatment, we fhall point out their moft general fymp- toms and the means to be ufed for their relief. The flatulent, or wind-colic, is generally occafioned by an inuifcreet ufe of unripe fruito, meats of hard digeftion, windy vegetables, fermenting liquors, and fuch like. It may likewife proceed from an obftnfokd perfpiration, or catching cold. Delicate people, whofe digefti/e powers are weak, are moft liable to this kind of colic. The flatulent colic may either affect the ftomach or in- teftines. It is attended with a p.finfui ftretching of the affected part. The patient feels a* rumbling in his guts$ and is generally relieved by a difcharge of wind either up- wards or downwards. The pain is feldom confined to any particular part, as the vapour wanders from one divifion of the bowels to another, till it finds a vent. When the difeafe proceeds from windy liquor, green fruit, four herbs, or the like, the beft medicine on the firft appearance of the fymptoms is a dram of brandy, gin, or any good fpirits. The patient fhould likewife fit with his feet upon a warm hearth-ftone, or apply warm bricks to them ; and warm cloths may be applied to his ftomach and bowels. G g This i26 OF THE COLIC. This is the only polic wherein ardent fpirits, fpiceries, or any thing of a hot nature, may be ventured upon. Nor indeed are they to be ufed here unlefs at the very begin- ning, before there be any fymptoms of inflammation. We have reafon to believe, that a colic occafioned by wind or flatulent food might always be cured by foil its and warm liquors, if they were taken immediately n. on perceiv- ing the firft uneafinefs ; but when the pain 0> continued for a confiderable time, and there is reafon to fear an in- flammation of the Rowels is already begun, all hot things are to be avoided as poifon, and the patient is to be treated in the fame manner as for the inflammation of the in- teftines. Several kinds of food, as honey, eggs, &c. occafion colics in fome particular conftitutions. I have generally found, the beft method of cure for thefe was to drink plentifully of fmall diluting liquors, as water-gruel, fmall poffet, water with toaited bread foaked in it, &c. Colics which proceed from excefs and indigeftion ge- nerally cure themfelves, by occaiioning vomiting or purg- ing. Thefe difcharges are by no means to be ftopped, but promoted by drinking plentifully of warm water, or Weak poffet. When their violence is over, the patient may take a dofe of rhubarb, or any other gentle purge, to carry off the dregs of his debauch. Colics which are occafioned by wet feet, or catching cold, may generally be removed at the beginning, by bathing the feet and legs in warm water, and drinking fuch warm diluting liquors as will promote the per epila- tion, as weak wine-whey, or water-gruel with a imall quantity of fpirits in it. These flatulent colics, which prevail fo much among countr/ people, might generally be prevented were they careful to change their clothes when thev get wet. They ought likewife to take a dram, or to drink fome warm liquor after eating any kind of green traih. We do not mean to recommend the practice of dram-di inking, but in this cafe ardent fpirits prove a real medicine, and indeed the beft that can be adminiftered. A glafs of good pepper- mint water will have nearly the fame effect as a ghu* of brandy, and, in fome cafes, is rather to be preferred. 'I he bilious colic is attended with very acute pains about the region of the navel. The patient complains of great thirft, OF THE COLIC. 227 thirft, and is generally coftive. He vomits a hot, bitter, yellow-coloured bile, which being difcharged, feems to afford fome relief, but is quickly followed by the fame violent pain as before. As the diftemper advances, the propenfity to vomit fometimes increafes fo as to become al- moft continual, and the proper motion of the inteftines is fo far perverted, .that there are all the fymptoms of an im- pending iliac paffion. If the patient he young and ftrong, and the pulfe foil and frequent, it will be proper to bleed, after which cly- fters may be adminijterech Clear whey or gruel, fharpened with the juice of lemon, or cream of tartar, muft be drank freely. Small chicken broth, with a little manna diffolved in it, or a flight decoction of tamarinds, are likewife very proper, or any other thin, acid, opening liquor. Besides bleeding and plentiful dilution, it will be ne- ceffary to foment the belly with cloths dipped in warm water, and if this fhould not fucceed, the patient muft be immerfod up to the breaft in warm water. Mild purgatives are here likewife neceffary, as the le- nitive eledtuary, manna, cream of tartar, or the bitter purging falts, which will anfwer very well. Thefe may he diffolved in water, and given in the fame manner as di- rected in the inflammation of the inteftines. If thefe me- dicines will not ftay on the ftomach, it will be neceffary to join an opiate with them. Such as are liable to frequent returns, of the bilious colic fhouid ufe flefh fparingly, and live chiefly upon a lfoht-vegetable diet. They fhould likewife take frequently a°dofe of cream of tutar with tamarinds, or any other cool acid purge. The hyfteric colic bears a great refemblance to the bi- lious. It is attended with acute pains about the region of the ftomach, vomiting, es\\ But what the patient vomfos in this cafe, is commonly of a gicenifh colour.- There is 3 great finking of the fpirits, with dejection of mind and difficulty of breathing, which are the charaaeriftic fymp- toms of this diforder. Sometimes it is accompanied with the jaundice, but this generally goes off cf its own acccru in a few days. In this colic all evacuations, as bleeding, purging, yo- mitino-, fjfo. do hurt. Every thing that weakens the pa- tientAir finks :hc fririt?, u to be avoided. If however the. 223 OF THE COLIC. the vomiting fhould prove violent, lukewarm water, or" fmall poffet, may be drink to cleanfe the ftomach. After- wards* the patient may take fifteen, twenty, or twenty-five drops of liquid laudanum in a glafs of cinnamon-water. This may be repeated every ten or twelve hours till the fymptoms abate. The patient may likewife take four or .five of the foetid pills every fix hours, and drink a cup of pennyroyal-tea after them. If aifafcetida fliould diiigree with the patient, which is fometimes the cafe, a tea-fpoonful of the tindturc of caftor in a cup of ponnyroy'l tea, or thirty or forty drops of the balfam of iforu dropped upon a bit of loaf- fugar, may be taken in its ftead. The anti-h)fteric plafter may alfo be ufed, which has often a good effect *. The nervous colic prevails chiefly among miners, fmelters of lead, plumbers, the manufacturers of white lead, &c. It is very common in the cyder counties of England, and is fuppofed to be occafioned by the leaden veffels ufed in preparing that liquor. No difeafe of the bowels is attended with more excru- ciating pain than this. Nor is it foon at an end. I have known it continue eight or ten days with very little, inter- miffion, the belly all the while continuing bound in fpite » pf medicine, yet at length yield, and the patient recover. It generally however leaves the patient weak, and often ends in a pally. The general treatment of this difeafe is fo nearly the fame with that of the iliac paffion, or inflammation of the guts, that we fhall not infift upon it. The belly is to be opened by mild purgatives given in fmali dofes, and fre- quently repeated, and their operation muft be affifted by foft oily clyfters, fomentations, &c. The Bartadoes tar is faid to be an efficacious medicine in this difeafe. It may be taken to the quantity of two drams thr.ee times a-day, or oftener if the ftomach will bear it. This tar, mixed with an equal quantity of ftrong rum, * The anti-hyfleric plafter Is made by melting together, of galbanum three ounces, tacamahaca in powder, and yellow wax, each an ounce and an half; venice turpentine, cummin feeds in powder, and afTifoetida, each one ounce. A fufficient quantity of this may be Ipread upon a piece of foft leather and apjilied to the region of the ftomach. I have generally found it have the beft effe€t when thirty or forty drops of laudanum were rubbfo upon the furface of the plafter. OF THE C O £ I C. 229 rum, is likewife proper for rubbing the fpine, in cafe any tingling, or other fymptoms of a palfy afe felt. When the tar cannot be obtained, the back may be rubbed with ftrong fpirits, or a little oil of nutmegs or of rofemary. If the patient remains weak and languid after this dif- eafe, he muft take exercife on horfeback, and ufe an infu- fion of the Peruvian bark in wine. .When the difeafe ends in a palfy, the bath-waters are found to be extremely pro- per. To avoid this kind of colic, people muft fhun all four fruits, acid and auftere liquors, cjrV. Thofe who work in lead ought never to go to their bufinefs fafting, and their food fhould be oily or fat. They'may take a glafs of fal- lad oil, with a little brandy or rum every morning, but fhould never take fpirits alone^ Liquid aliment is beft for them; as fat broths, &c. but low living is bad. They fhould frequently go a little out of" the tainted air, and fhould never fuffer themfelves to be coftive. Sundry other kinds of this difeafo might be mentioned, but too many diftindtions would tend only to perplex the reader. Thefe already mentioned are the rnoft material, and fliould indeed be attended to, as their treatment is very different. But even perfons who are not in a condition to diftinguifh very accurately in thefe matters, may never- thelefs be of great fervice to patients in colics of every kind, by only obferving the following general rules; viz* To bathe the feet and legs in warm water; to apply blad- ders filled with warm water, or cloths dipped in it, to the ftomach and bowels; to make the patient drink freely of diluting mucilaginous liquors ; and, laftly, to give him an emollient ciyfter every two or three hours. INFLAMMATION of the KIDNEYS. CAUSES.----Tr>is difeafe may proceed from any of thofe caufes which produce an inflammatory fever. It may likewife be occafioned by wounds, or bruifes of the kid- neys ; fmall ftones or gravel lodging within them; by ftrong diuretic medicines ; as fpirits of .turpentine, tincture of cantharides, &c. Violent motion ; as hard riding or walking, efpecially in hot weather, or whatever drives the blood 230 INFLAMMATION OF THE KIDNEYS. blood too forcibly into the kidneys, may occafion this ma, lady. It may likewife proceed from lying too foft, too much on the back, involuntary contradtions, or fpafrns, in the urinary veffels, tjfc. • SYMPTOMS.---There is a fharp pain about the region of tne kidneys, with fome degree of fever, and a ftupor, or dull pain in the thigh of the affected fide. The urine is at firft clear, and afterwards of a rcd- difti colour, but in the worft kind of the difofe it gene- rally continues pale, is paffed with difficulty, and com- monly in fmall quantities at a time. Tlie patient feels great uneafinefi when he endeavours to walk or fit up- right. He lies with more eafe. on the affected fide than on the found ; and has generally a naufea or vomitmg, re- fembling that which happens in the colic. This difeafe however may be diftinguiftied from the colic by the pain being feated farther back, and by the difficulty of palling urine, which is a conftant fymptoiri of the former, but does not always happen in the latter. REGIME N.----Every thing of a heating or ftimu- lating nature is to be avoided. The food muft be thin and light; as panado, fmall broths, with mild vegetables, and the like. Emollient and thin liquors muft he plentifully drank ; as clear whey, or balm-tea fweetened with honey, decoitions of m.irihmallow-roots, with barley and li- quorice, £ffo. The patient, notwithftanding the vomiting, muft conftantly keep lipping fmall quantities of thefe or other diluting liquors. Nothing fo faielv and certainly abates the infl immation, and expels the obftrudting caufe, as copious dilution. The patient muft be kept eafv, quie:, and free from cold, fo long as any fymptoms of inflamma- tion appear. MEDICINE.----Bleeding is generally neceffary, efpecially at the beginning. Ten or twelve ounces may be let from the arm or foot with a lancet, and if che pain and inflammation continue, the operation may be re- peated in twenty-four hours, efpecially if the patient; be of a full habit. Leeches may likewife be applied to the haemorrhoidal veins, as a difcharge from thefe will greatly relieve the patient. Cloths dipped in warm water, or bladders filled with t it, muft be applied to the part affected, and renewed as they grow cool. If the bladders be filled with a decoction oi INFLAMMATION OF THE KIDNEYS. 231 of mallows and camomile flowers, to which a little faffron is added, and mixed with about a third part of new milk, it will be ftill more beneficial. Emollient ci) Iters ought frequently to be admini- ftered ; and if thefe do no: open the belly, a little fait and hone/ or manna may be added to them. The lame courfe is to be followed where gravel or a ftone is lodged in tbe kidney ; but when the gravel or ftone is feparated from the kidney, and lodges in the Ure- ter*, it will be proper, befides the fomentations, to rub the part with a little fweet oil, and to give gentle diu- retics ; as juniper-water fo.'eeter.cd with the fyrup of mo fo -mallows, or a tea-fpoonful of the fweet fpirits of nitre, now and then in a cup of the patient's drink. He ou.rht likewife to take exercife on horfeback, or in a coach, if he be able to bear it. When the difeafe is protracted foyoifo the feventh or eighth day, and the patient complains of a ftupor, and hea- viness of the part, has frequent returns of chillnefs, Shiver- ing, &c. there is reafon to fufpect, that matter is forming in foe kidney, and that an ahftefs will enfoe. When matter in the urine fhews, that an ulcer is al- ready formed in the kidney, ur, in order to promote the purging. After thefe evacuations have been continued for fome time, a decoction of toafted oat-bread may be drank to ftop the vomiting. The bread fhould be toafted till it is of a brown colour, r.:ui afterwards boiled in fprirg-water. If oat-bread cannot he fofo, wheat-bread, or oat-meal well toafted, nr-y be ufo! in its ftcad. If this does not put a ftop to the vomiting, two table-fpoonfuls of the faline julep, with ton drops of laudanum, may be taken every hour till it ccafi.3. The vomiting and purging however .ought never to be ftopped too foon. So long as thefe. difcharges do not weaken the patient they are falutary, and may be allowed to go on, or rather ought to be promoted. But when the patient is weakened by the evacuations, which may be known from the finking of his pulfe, isc. recourfe muft immediately be had to opiates, as recommended above ; to which may be added, ftrong wines with foirituous cinnamon waters, and other generous cordi- als. Warm nega?, or ftrong wine-whey, will likewife he neceffary to fupport the patient's fpirits, and promote OF THE CHOLERA MORBUS, cjc. 237 the perfpiration. His legs fhould be bathed in warm water, and afterwards rubbed with flannel-cloths, or wsapped in warm blankets, and warm bricks applied to the foles of his feet. w When the violence of the difeafe is over, to prevent a relapfe, it will be neceffary, for fome time, to continue the ufe of fmall doffo of laudanum. Ten or twelve drops may be taken in a glafs of wine, at leaft twice a-day, for eight or ten days. The patient's food ought to be nourifhing, but taken in fmall quantities, and he fhould ufe modeiate exercife. As the ftomach and inteftines are po nerally much weakened, an infufion of the bar!;, or other bitters, in fmall wine, may be drank for foioc tunc. Though pnyficians are feldom called in due time In this difeafe, tiiey ought not to defpair of relieving the pa- tient even in the moft defperate circumftmces. Of this I lately fiw a very ftriking inftance in an old man and his fon, who had been both feized with it about the middle of the night. 1 did not fee them till next morning, when they had much more the appearance of dead than of living men. No pulfe could be felt; the extremities were cold, and rigid ; the countenance was ghaftlv, and the ftrength almoft quite exhauftcd. Yet from t:\is dep' rable condi- tion they were both iCvO\ered by the u.j of opiates and corJi.il medicines. Of a DIARRHOEA, 02. LOOSENESS. A looseness, in many cafes, is not to be confidered as a difeafe, but rather as a fiilutary evacuat-.on. It ought therefore never to be ftopped unlefs when it continues too lon«x, or evidently weakens the patient. As this how- ever fometimes happens, we ftiall poin: out the rnoft com- mon caufes of a loofenefs, with the method of treatment proper in each cafe. When a loofenefs is occafioned by catching cold, or an obftrudted perfpiration, the patient ought to keep warm, to drink freely of weak diluting liquors, to bathe his feet and legs frequentlr in lukewarm water, to wear flannel next the fkin, and to take every other method to ■reftore the perfpiration. 238 OF A DIARRHOEA, or LOOSENESS. In a loofenefs wnich proceeds from excefs or repletion, a vomit is the proper medicine. Vomits not only cleanfe the ftomach, but promote all the fecreii^hs, which renders them of great importance in carrying W" a debauch. Half a dram of ipecacuanha in powder will anfwer this pur- pofe very well. A day or two after the vomit, the fame quantity of rhubarb may be taken, and repeated two or three times, if the loofenefs continues. The patient ought to live upon light vegetable food of eafy digeftion, and to drink whey, thin gruei, or barley-water. A looseness occafioned by the obftrudtion of any cu- ftomary evacuation, generally requires bleeding. If that does not fucceed, other evacuations may be fubftituted in the room of thofe which are obftrudted. At the' fame time, every method is to be taken to reftore the ufual dif- charges, as not only the cure of the difeafe, but the pa- tient's life may depend on this. ' A periodical loofenefs ought never to be ftopped. It is always an effort of nature to carry off fome offending matter, which, if retained in the body, might have fatal effects. Children are very liable to this kind of loofenefs, efpecially while teething. It is however fo far from being hurtful to them, that fuch children generally get their teeth with leaft trouble. If thefe loofe ftools fliould at any tirrie prove four or griping, a tea-fpoonful of magne- fia alba, with four or five grains of rhubarb, mav be given to the child in a little panado, or any other food. This, if repeated three or four times, will generally correct tha acidity, and carry off the griping ftools. A diarrhoea or loofenefs which proceeds from violent paffions or affections of the mind, muft be treated with the greateft caution. Vomits in this cafe are highly im- proper. Nor are purges fafe, unlefs they be very mild^ and given in fmall quantities. Opiates, and other anti- fpafmodic medicines are moft proper. Ten or twelve drops of liquid laudanum may be taken in a cup of valerian or penny-royal tea, every eight or ten hours, till the fymp- toms abate. Eafe, cheerfulnefs, and tranquillity of mind, are here of the greateft importance. When a loofenefs proceeds fr*om acrid or poifonous fubftances taken into the ftomach, the patient muft drink large quantities of diluting liquors, with oil or fat broths, to promote vomiting and purging. Afterwards, if there be OF A DIARRHOEA, or LOOSENESS. 239 be reafon to fufpect that the bowels are inflamed, bleeding will be neceffary. Small dofes of laudanum may likewife be taken to remote ihe irritation on the bowels. When the gou^repelled from the extremities, occa- fions a loofenefs, it ought to be promoted by gentle dofes of rhubarb, or other mild purgatives. The gouty matter is likewife to be drawn towards the extremities by warm fomentations, cataplafms, foV. The perfpiration ought at the fame time to be promoted by warm diluting liquors ; as winc-whey with fpirits of hartfhorn, or a few drops of liquid laudanum in it. When a loofenefs proceeds from worms, fuch medicines ought to be ufed as kill or carry off thefe vermin; as powder of tin, with purges of rhubarb and calomel, cjfc. The proper dofes of thefe medicines will be pointed out when we come to treat of difeafes occafioned by worms. A looseness is often occafioned by drinking bad wa- ter. When this is the cafe, the difeafe generally proves epidemical. When there is reafon to believe, that this or any other difeafe proceeds from the ufe of unwholefome water, it ought immediately to be changed, or, if that cannot be done, it may be corrected by mixing with it quick-lime, chalk, or the like. In people whofe ftomachs are weak, violent exercife immediately after eating will occafion a loofenefs. Though the cure of this is obvious, yet it will be proper, befides avoiding violent exercife, to ufe fuch medicines as tend to brace and ftrengthen the ftomach, as infufions of the bark, with other bitter and aftringent medicines, in white wine. Such perfons ought likewife to take frequently a glafs or two of oh! red port, or good claret. Person's who, from a peculiar weaknefs, or too great an irritability of the bowels, are liable to frequent re- turns of this difeafe, fhould live temperately, avoiding crude fummer fruits, all unwholefome food, and meat9 of hard dfoeftion. They ought likewife to beware of cold, moifturc, or whatever may obftruct the perfpiration, and fhould wear flannel next their fkin. All violent paffions as fear, anger, life, are likewife carefully to be guarded againft. OF ( 240 ) OF V O H I T 1J G, Vomiting may proceed from various caufes ; as ex-' cefs in eating or drinking ; foulnefs of the ftomach ; the.' acrimony of the aliments; a tranflation of the morbific? matter of ulcers, of the gout, the eryfipelas, or other1' difeafes, to the ftomach. it may likewife proceed from a loofenefs having been too fuddenly ftopped, or from the ftoppage of any cuftomary evacuation, as the bleeding piles, the ?nc:ifes, C5fo Vomiting may proceed from a weaknefs of the ft< mach, the colic, the iliac paflion, a rupture, a fit of the gravel, worms, or from any kind of poifon taken into the ftomach. It is an ufual fymptom of injuries done to the brain ; as contufions, compreffions, cfffo It is likewife a fymptom of wounds, or inflammations of foe diaph-v.grri, inteftines, fpleen, liver, kidneys, life. Vomiting may he occafioned by unufual motions ; as failing, being drawn backwards in a cart or coach, &c. It may likewife be excited by violent paffions, or by the idea of naufoais or difagreeable objedO, efpecially of fuch things as have formerly produced vomiting. Sometimes it proceeds from a regurgitation of the bile into the ftomach : in this cafo what the patient vomits is generally of a yel- low or i-recnifh colon;, and has a bitter tafte. Perfons who arc fifo; fl to nervous affodiions, are often fuddenly feized with violent fits of vomiting. Laftly, Vomiting is a common fymptom of pregnancy. In this cafe it gene- rally comes on about two weeks after the ftoppage of the menfes, and continues during.the firft three or four months. When vomiting proceeds from a foul ftomach or in- digeftion, it is not to be confidered as a difeafe, hu'. as the cure of a difeafe, It ought therefore to be promoted by drinking lukewarm water, or thin gruel. If this docs not put a ftop to the vomiting, a dofe of ipecacuanha may be taken, and worked off with weak camomile- tea. When the retroceffion of the gout, or the obftrudtion of cuftomary evacuations occafion vomiting, all means muft be ufed to reftore thefe difcharges} or,"if that can- not V- OF VOMITING. 241 not be effected, their place muft be fupplied by others, as bleeding, purging, bathing the extremities in warm water, opening iifues, fecoj^ perpetual bhfters, &c. When vomitinjws the effect of pregnancy, it may generally be mitigated by bleeding, and keeping the belly gently open. The bleeding however ought to be in fma.i quantities at a time, and the purgatives fhould be of the mildeft ^kind, as fig;,, ftewed prunes, manna or fenna. Pregnant women are moft apt to vomit in the morn- ing, immediately after getting out of bed, which is ow- ing partly to the change of pofture, but more to the emptinefs of the ftomach. It may generally be prevented by taking a difh of tea, or fome light breakfolt in bed. Pregnant women who are afflicted with vomiting, ought to be kept eafy both in'body and mind. They fhould nei- ther allow their ftomachs to be filled with the decodtion may be kept continually upon it. Some put the herbs them- felves into a. flannel-bag, and applv them to the part, which is for from being a bad method. Thefe continue longer warm than cloths dipped in the decodtion, and at the fame time keep the part equally moift. In all obftrudtions of urine the body ought to be kept open. This is not however to be attempted by ftrong pur- gatives, but by emollient clyfters, or gentle infufiqns of fenna and manna. Clyfters in this cafe not only open the belly, but anfwer the purpofe of an internal fomentation, and greatly affift in removing the fpafms of the bladder and parts adjacent. The OF A SUPPRESSION OF URINE. 247 The food muft be light, and taken in fmall quantities. The drink may be weak broth, or decoctions and infu- fions of mucilaginous vegetables, as marfhmallow-roots, lime-tree buds, &c. A tea-fpoonful of the fweet fpirits of nitre, or a dram of Caftile-foap, may be frequently put into the patient's drink; and, if there be no inflammation, he m3y drink fmall gin-punch without acid. Persons fubjedt to a foppreflion of urine ought to live very temperate. Their diet fhould be light, and their li- quor diluting. They fhould avoid all acids and ftrong wines, fhould take fufficient exercife, lie hard, and avoid ftudy and fedentary occupations. Of the GRAVl^L and STONE. When fmall ftones are lodged in the kidneys, or dif- charged along with the urine, the patient is faid to be af- flicted with the gravel. If one of thefe ftones happens to make a lodgment in the bladder for fome time, it accumu- lates frefh matter, and at length becomes too large to pafs off with the urine. In this cafe the patient is faid to have the ftone. CAUSES.----The ftone and gravel maybe occafioned by hi~h living ; the ufe of ftrong aftringcnt wines; a fe- dentary life; lying too hot, foft, or too much upon the back; the conftant ufe of water impregnated with earthy or ftony particles ; aliments of an aftringent or windy na- ture, b"c. It may likewife proceed from air hereditary dif- pofition. Perfons in the decline of life, and. thofe who have been much afRidted with the gout or rheumatifm, arc moft fubjedt to it. SYMPTOMS.---Small ftones or gravel in the kidneys occafion pain in the loins; ficknefs; vomiting , and fometimes bloody urine. When the ftone defcends into the ureter, and is too large to pafs along with eafe, all the above fymptoms are increafed ; the pain extends towards the bladder; the thigh and leg of the affeaed fide are be- numbed ; the tefticles are drawn upwards, and the urine is obftrudted. A stone in the bladder is known from a pain at the time, as well as before and after making water j from the urine 248 OF THE GRAVEL AND STONE. urine coming away by drops, or flopping fuddenly when it was running in a full ftream; by a violent pain in the neck of the bladder upon motion, efpecially on horfeback, or in a coach in a rough road ; from a white, thick, copi- ous, ftinking, mucous fedirnent in the urine; from an itch- ing in the top of tfie penis ; from an inclination to go to ftool during the difcharge of urine ; from the patient's paffing his urine more eaiily when lying than in an erect pofture; from a kind of conyulfive motion occafioned by the fharp pain in discharging the laft drops of the urine : and, laftly, from founding or fearching with the c ithater. REGIMEN.----Perfons afftidfod wifh the gravel or ftone fhould avoid aliments of a windy or heating na- ture, as fait meats, four fruits, r, grief, and o'ther violent paffions, will likewife occafion the piles. I have often known them brought on hy cofi, efpecially about the anus. A pair of thin breeches will oc- cafion the diforder in a perfon who is fubjedt to it, an 3 fometimes- even in thofe 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 reckoned a difeafo. It is even more fofotary than bleeding at the nofe, and often prevents or carriei off difeafes. It is peculiarly .beneficial in the gout, rheumatifm, aflhma, and hypochondriacal ^complaints, and often proves critical in cciics, and inflammatory fevers. In the ;reliant of this difeafe regard muft be had to the path.,:-4, rObit of body, his age, ftrength, and manner of living. A ^.'(charge which might be exceffive and prove hurtful to one, ma;, be very moderate, and even falutarv to another. That only is to be efteemed dangerous which continues too long,' and is in fuch quantity, as to wafte the patient's ftrength, hurt the digeftion, nutrition, and other functions neceffary to life. When this4 is the cafe, the difcharge muft be checked by a proper regimen, and afoingent medicines. The DIET muft be cool but nounfoi..2:, confiding chiefly of bread, miUc, 2& OF THE BLEEDING milk, cooling vegetables and broths. The DRINK may be chalybeate water, orange whey, decoctions or infufions of the aftrincent and mucilaginous plants, as the tormentil root, biftort, the marfli-mallow roots, &c. Old conferve of red rofes is a very good medicine in this cafe. It may he mixed with new milk, and taken in' the quantity of an ounce three or four times a-day. This medicine is in n~> great repute, owing to its being feldom taken in fuch, quantity as to produce any effects ; but when taken as here diredfod, and duly perfifted in, I have'known it perform very extraordinary cures in violent haemorrhages, efoecially when affoted by the tindrure of rofes ; a tea-cup- ful of which may be taken about an hour after every dofe of the conferve, The Peruvian bark is likewife proper in this cafe, both* as a ftrengthener and aftringent. It may be taken in red wine, fharpened with the-fpirit of vitriol. The bleeding piles are fometimes periodical, and return regularly once a month, or once in three weeks. In this cafe they are always to be confidered as a falutary'difcharge, and by no means to be flopped. Some have entirely ruin- ed their health by flopping a periodical difcharge of blood, from the haemorrhoidal veins. In the blind piles bleeding is generally of ufe. The diet muft be light and thin, and the drink cool or diluting. It is likewife neceffary that the belly be kept gently open; This may be done by fmall dofes-of the flowers of brim- ftone and cream of tartar. Thefe may be mixed in equal quantities, and atea-fpoonful taken two or three times a-o w, or as often as is neceffary to keep the bellv eafy. Or'an ounce of the flowers of brimftone and half an ounce of purified nitre may be mixed with three or four ounces of the lenitive electuary, and a tea-fpoonful of it taken three or four times a-day. : Emollient clyfters are here likewife beneficjal ; but there is fometimes fuch an aftiidfion of the anus, that they cannot be thrown up. In this cafe I have known a vomit have an exceeding good effect. When the piles are exceeding painful and fwelled, but difcharge nothing, the patient muft fit over the fteams of warm water. He may likewife apply a linen-cloth dipped in warm fpirits of wine to the part, or poultices made or bread and milk, or of leeks fried wi-h butter. If thefe do not AND BLIND PILES. 257. not produce a difcharge, and the piles appear large, leeches muft be applied as near them as poffible, or, if they will fix upon the piles themfelves, fo much the better. When leeches will not fix, the piles may be opened with a lancet. The operation is very eafy, and is attended with no danger. Various ointments, and other external applications, are recommended in the piles; but I do not remember ever to have feen any effects from thefe worth mentioning. Their principal ufe is to keep the part moift, which may be done as well by a foft poultice, or an emollient cata- plaffn. When the pain however is very great, a liniment made of two ounces of emollient ointment, and half an ounce of liquid laudanum, beat up with the yolk of an egg, may be applied. SPITTING of BLOOD. We mean here to treat of that difcharge of blood from the lungs only which commonly goes by the name of an hamoptoe, or fpitting of blood. Perlons of a flender make, and a lax fibre, who have long necks and (trait breafts, are? moft liable to this difeafe. It is moft common in the fpring, and generally attacks people before they arrive at the prime or middle period of life. It is a common obfer- vation, that thofe who hav» been fubjedt to bleeding at the nofe when young, are afterwards moft liable to an hte- nioptoe. CAUSE S.----An htemoptoe may proceed from ex- cefs of blood, from a peculiar weaknefs of the lungs, or a bad conformation of the breaft. It is often occafioned by exceflive drinking, running, wreftling, finging, or fpeak- ing aloud. Such as have weak lungs ought to avoid all violent exertions of that organ, as they value life. They fhould likewife guard againft violent paffions, exceflive t'rinking, and every thing that occafions a rapid circulation of the blood. - This difcO.e may likewife proceed from wounds of the lungs. Thefe may eitrier be received from without, or they may be occafioned by hard bodies getting into th; wind-pipe, and fo falling down upon the lungs, and hurt- ing that tender organ. The obftrudtion of any cuftomary L 1 ' evacuation. 25S SPITTING OF BLOOD. evacuation may occafion a fpitting of blood ; as the negleft of bleeding or purging at the ufual feafons, the ftoppage of the bleeding piles in men, or the menfes in women, cjrV. It may likewife proceed from a polypus, fchirrous concre- tions, or any thing that obftructs the circulation of the blood in the lungs. It is often the effedt of a long and violent cough ; in which cafe it is generally the forerunner of a confumption. A violent degree of cold fuddenly ap- plied, to the external parts of the body will occafion an haemoptoe. It may likewife be occafioned by breathing air which is too much rarified to be able properly to expand the lungs. This is often the cafe with thofe who work in hot places, as furnaces, glafs-houfes, &c. It may likewife happen to fuch as afcend to the top of very high mountains, a3 the peak of Teneriff, &c. Spitting of blood is not always to be confidered as a primary difeafe. It is often only a fymptom, and in fome cafes not an unfavourable one. This is the cafe in pleuri- fies, peripneumonies, and fundry other fevers. In a drop- fy, fcurvy, or confumption, it is a bad fymptom, and fhews that the lun^s are ulcerated. SYMPTOMS.---Spitting of blood is generally preceded by a fenfe of weight, and oppreffion of the breaft, a dry tickling cough, hoarfenefs, and a difficulty, of breathing. Sometimes it is ufhered in with fhivering, colduefs of the extremities, coftivenefs, great laflitude, fla- tulence, pains of the back and loins, &c. As thefe fhew a general ftricture upon the veffels, and a tendency of the blood to inflammation, they are commonly the forerunne.s cf a very copious difcharge. The above fymptoms do not attend a difcharge of blood from the gums or fauces, by which means thefe may always be diftinguifhed from an h?emoptoe. Sometimes the blood that is fpit up is thin, :\nd of a florid red colour ; and at other times it is thick, and of a dark or hlackifh colour : nothing however can be inferred from this circumftance, but that the blood has Iain a longer or fhorter time in the breaft before it was ditchargea. Spitting of blood, in a ftrong healthy perfon, of a found conftitution, is not very dangerous; but when it attacks the tender and delicate, or perfons of a weak lax fibre, it is with difficulty removed. When it proceeds from a fchirrous or polypus of the lungs, it is bad. The danger is SPITTING OF BLOOD. 259 ii greater when the difcharge proceeds fiom the rupture of a large veffel iban of a fmall one. When the extravafated blood is not fpit up, but lodges in the breaft, it corrupts, and greatly increafes the danger. When the blood pro- ceeds from an ulcer in the lungs, it is generally fatal. REGIME N.----The patient ought to be kept cool and eafy. Everything that heats the body, or quickens the circulation, increafes the danger. The mind ought likewife to be foothed, and every occafion of exciting the paffions, avoided. The diet fliould be foft, cooling, and flender; as rice boiled with milk, fmall broths, barley- gruels, panado, effo. The diet, in this cafe, can foaice be too low. Even watcr-gruel is fufficient to fupport the patient for fome days. AH ftrong liquors muft be avoided. The patient may drink milk and water, barley-water, whey, butter-milk, and fuch like. Every thing however fhould be drank cold, and in fmall quantities at a time. He fhould obferve the ftricteft filence, or at leaft fpeak with a very low voice. M E D I C I N E.----This, like the other involuntary difcharges of blood, ought not to be fuddenly ftopped by aftringent medicines. More mifchief is often done by thefe than if it were fuffered to go on, It may however proceed fo far as to weaken the patient, and even endanger his life, in which cafe proper means rnuft be ufed for reftraining it. The belly fhould be kept gently open by laxative diet-; as roafted apples, ftewed prunes, 6v. If thefe fhould not have the effect, a tea-fpoonful of the lenitive electuary may be taken twice or thrice a-day, as is found neceffary. If the bleeding proves violent, ligatures may be applied to the extremities, as diredtcd for bleeding at the nofe. If the patient be hot or feverifli, bleeding and fmall dofes of nitre will be of ufe ; a fcruple or half a dram of nitre may be taken in a cup of his ordinary drink twice or thrice a-day. His drink may likewife be fharpened with acids, as juice of lemon, or a few drops of the fpirit of vitriol j or he may take frequently a cup of the tincture of rofes. Bathing the feet and legs in lukewarm water, has like- wife a very good effect in this difeafe. Opiates too are fometimes beneficial ; but thefe muft be adminiftered with Caution. Ten or twelve drops of laudanum may be given in 260 SPITTING OF BLOOD. in a cup of barley-water twice a-day, and'continued fbt fome time, provided they be found beneficial. The conferve of rofes is likewife a very good medicine in this cafe, provided it be taken in fufficient quantity, and long enough perfifted in. It may be taken to the quantity of three or foujjLounces a-day; and, if the patient be troubled with a^ugh, it fhould be made into an elec- tuary with balfamic fyrup, and a little of the fyrup of poppies. If ftronger aftring-ents be neceffary, fifteen or twenty drops of the acid elixir of vitriol may be given in a glafs of water, three or four times a-day. Those who are fubjedt to frequent returns of this difeafe, fhould avoid all excefs. Their diet fhould be light and cool, confifting chiefly of milk and vegetables. Above all, Jet them beware of vigorous efforts of the body, and vio- ient agitations of the mind. VOMITING of BLOOD. This is not fo common as the other difcharges of blood which have already been mentioned ; but it is very dangerous, and requires particular attention. Vomiting of blood is generally preceded by pains in the ftomach, ficknefs and naufea, and is accompanied with great anxiety, and frequent fainting fits. This difeafe is fometimes periodical ; in which cafe it is lefs dangerous. It often proceeds from an obftrudtion of the menfes in women ; and fometimes from the flopping of the haemorrhoidal flux in men. It may be occafioned by any thing that greatly ftimulates or wounds the ftomach, as ftrong vomits or purges, acrid poifons, fharp or hard fubftances taken into the ftomach, &c. It is often the effect: of obftrudlions in the liver, the fpleen, or fome of the other vifcera. It may likewife proceed from external violence, as blows or bruifes, or from any of the caufes which produce inflammation. A great part of the danger in this difeafe arifes from the extravafated blood lodged in the bowels, and becoming putrid, by which means a dyfentery or putrid fever may he occafioned. The beft way of preventing this, is to keep the belly gently open, by frequently exhibiting emol- lient VOMITING OF BLOOD 261 lient clyfters. Purges muft not be given till the difcharge is ftopt, otherwife they will irritate the ftomach, and in- creafe the diforder. All the food and drink muft be of a mild cooling nature, and taken in fmall quantities. Even drinking cold water has fometimes proved a remedy. When there are figns of an inflammation, bleeding may be neceflary; but the patient's weakne(s^v/ill feldom permit it. Aftringents can feldom be ufed, as they ftimulate the ftomach, and of courfe increafe the difeafe. Opiates may be of ufe ; but they muft be given in very fmall dofes, as four or five drops of liquid laudanum twice or thrice a-day. After the difcharge is over, as the patient is generally troubled with gripes, occafioned by the acrimony of the blood lodged in the inteftines, gentle purges will be ne- ceffary. Of BLOODY URINE. This is a difcharge of blood from the veffels of the kid- neys or bladder, occafioned by their being either enlarged, broken, or eroded. It is more or lefs dangerous according to the different circumftances which attend it. When pure blood is voided fuddenly without inter- ruption and without pain, it proceeds from the kidneys ; but if the blood be in fmall quantity, of a dark colour, and emitted with heat and pain about the bottom of the belly, it proceeds from the bladder. When bloody urine is occafioned by a rough ftone defcending from the kidneys to the bladder, which wounds the ureters, it is attended with a fharp pain in the back and difficulty of making wa- ter. If the coats of the bladder are hurt by a ftone, and bloody urine follows, it is attended with the moft acute pain, and a previous ftoppage of urine. Bloody urine may likewife be occafioned by falls, blows, the lifting or carrying of heavy burdens, hard riding, or any violent motion. It may alfo proceed from ulcers or erofions of the bladder, from a ftone lodged in the kidneys, or from violent purges, or fnarp diuretic me- dicines, efpecially cantharides. Bloody urine is always attended with fome degree of danger; but it is peculiarly fo when mixed with purulent matter, as this fhews an ulcer fomewhere in the urinary paffages. 162 O F B L Q O D Y URINE. paffages. Sometimes this difcharge proceeds from excefs of blood, in which cafe it is rather to be confidered as 9 falutary evacuation than a difeafe. If the difcharge how- ever be very great, it may watte the patient's ftrength, and occafion an ill habit of body, a dropfy, or a confumpti- on, &c. The treatment of this diforder muft be varied according to the different caufes from which it proceeds. When it is owing to a ftone in the bladder, the cure depends upon an opeiation ; a defcription of which would be foreign to our purpofe. If it be attended with a plethora, and fymptoms of in- flammation, bleeding will be neceffary. The belly muft likewife be kept open by emollient clyfters, or cooling purgative medicines ; as cryftals of tartar, rhubarb, manna., or fmall dofes of lenitive electuary. When bloody urine proceeds from a diffolved ftate of the blood, it is commonly the fymptom of fome malignant difeafe; as the fmall-pox, a putrid fever, or the like. In this cafe the'patient's life depends on the liberal ufe of the peruvian bark and acids, as has already been fhewn. When there is reafon to fufpect an ulcer in the kidneys or bladder, the patient's diet muft be copl, and his dtink of a foft, healing, ballamic quality, asdecodtions of marfh- mallow roots with liquorice, folutions of gum-arabic, &e. Three ounces of marfh-mallow roots, and half an ounce of liquorice, may be boiled in two Englifh quarts of wa- ter to one ; two ounces of gum-arabic, and half an ounce of purified nitre, may be diffolved in the ftrained liquor, and a tea-cupful of it taken four or five times a-day. The early ufe of aftringents in this diffafe has-often bad confequences. When the flux is ftopped too foon, the grumous blood, by being confined in the veffels, may pro- duce inflammations, ablcefs, and ulcers. If however the the cafe be urgent, or the patient feems to fuffer from the lofs of blood,- gentle aftringents may be neceffary. In this cafe the patient may take three or four ounces of * lime- water, with half an ounce of the tincture of Peruvian bark three times a-day. Of « * Lime-water is prepared by pouring two Englifh gallons of water gradu- ally upon a p., and of quick-lime; when the ebullition is over, let the uhole. ftand to fettle for two days, then filter the li^'iur through p-pcr. It Ihould be kept in velTcls clofely flopped. C **3 ) Of the DYSENTERY, or BLOODY FLUX. This difeafe prevails in the fpring and autumn. It is very infedtious, and often epidemical. Perfons are moft liable to it who are much expofed to the night-air, or who live in places where the air is confined and unwholefome. Hence it often proves fatal in camps, on fhipboard, in jails, hofpitals, and fuch like places. CAU S ES.----This difeafe may be occafioned by any thing that obltrudts the perfpiration, or renders the humours putrid ; as damp beds, wet clothes, unwholefome diet, air, cfo. But it is moft frequently communicated by in- fection. This ought to make people extremely cautious in going near fuch perfons as labour under the difeafe. Even the fmell of the patient's excrements has been known to communicate the infection. SYMPTOM S.---It is known by a flux of the bel- ly attended with violent pain of the bowels, a conftant in- clination to go to ftool, and generally lefs or more blood in fhe ftools. It begins, like other fevers, with chillnefs, lofs of ftrength, a quick pulfe, great thirft, and an incli- nation to vomit. The ftoojs are at firft greafy or frothy, afterwards they are ftreaked with blood, and, at laft, have frequently the appearance of pure blood, mixed with fmall filaments refembling bits of fkin. Sometimes, however, there is no blood in the ftools through the whole courfe of the difeafo When the patient goes to ftool, he feels a hearing down, as if the whole bowels were falling out, and fometimes a pr.rt of the inteftine is actually protruded, which proves exceeding troublefome, efpecially in children. This difeafe may be diftinguifhed from a diarrhoea or loofenefs, by the acute pain of the bowels, and the blood which generally appears in the ftools. It may be diftin- guifned from the cholera morbus by its not being attended with fuch violent and frequent fits of vomiting, &c. When the dyfentery attacks the old, the delicate, or fuch as have been wafted by fcorbutic, confumptive, or other lingering difeafes, it generally proves fatal. Vomit- ing and hiccuping are bad figns, as they fhew an inflam- mation of the ftomach. When the ftools have an exceed- ing difagreeable fmell, are green, black, or mixed with fmall fc64 OF THE DYSENTERY, fmall glandular fubftances, or bits of fkin, the danger ia great. It is an unfavourable fymptom when clyfters arc immediately returned ; but ftill more fo, when the paflage is fo obftinately fhut, that they cannot be injedted. A weak, pulfe, coldnefs of the extremities, with difficulty of fwallowing, and convulfions, are figns of approaching death. REGIME N.----Nothing is of more importance in this difeafe than cleanlinefs. It contributes greatly to the recovery of the patient, and no lefs to the fafety of fuch as attend him. In all contagious difeafes the danger is in- creafed, and the infection fpread, by the neglect of clean- linefs ; but in none more than this. Every thing about the patient fhould be frequently changed. The excrements fliould never be fuffered to continue in his chamber, but removed immediately, and buried under ground. A con- ftant ftream of frefh air fhould be admitted into the cham- ber ; and it ought frequently to be fprinkled with vinegar, juice of lemon, or fome other ftrong acid. The patient muft not be difcouraged, but his fpirits kept up in hopes of a cure. Nothing tends more to render any putrid difeafe mortal, than the fears and apprehenfions of the fick. All difeafes of this nature have a tendency to fink and deprefs the fpirits, and when th^t is increafed by fears and alarms from thofe whoio the patient believes to be perfons of fkill, it cannot fail to have the worft effects. A flannel waiftcoat worn next the fkin has often a very good effect in a dyfentery. This promotes the per- fpiration without over-heating the body. Great caution however is neceffary in leaving it off. I b^ave often known a dyfentery brought on by imprudently throwing off a flan- nel waiftcoat before the feafon was fufficiently warm. For whatever purpofe this piece of drefs is worn, it fliould ne- ver be left off but in a warm feafon. In this difeafe the greateft attention muft be paid to the patient's diet. Flefh, fifti, and every thing that has a ten- dency to turn putrid or rancid on the ftomach, muft be ab- flained from. Apples boiled in milk, water-pap, and plain light pudding, with broth made of the gelatinous parts of animals, may be eat. Gelatinous broth not only anfwers the purpofe of food, but likewife of medicine. I have % often or BLOODY-FLUX. 265 often known dyfenteries cured by it, after pompous medi- cines had proved ineffectual*. Another kind of food very proper in the dyfentery, which may be ufed by fuch as cannot take the broth men- tioned above, is made by boiling a few handfuls of fine flour, tied in a cloth, for fix or feven hours, till it becomes as hard as ftarch. Two or three table-fpoonfuls of this may be grated down, and boiled in fuch a quantity of new milk and water as to be of the thicknefs of pap. This may be fweetened to the patient's tafte, and taken for his ordinary food f. The patient may likewife be allowed to eat fieely of moft kinds of good ripe fruit ; as apples, grapes, currant- berries, ftrawberries, cjfo. Thefe may either be eat raw or boiled, with or without milk, as the patient chufes. The prejudice againft fruit in this difeafe is fo great, that many believe it to be the common caufe of dyfenteriei;. This however is an egregious miftake. Both reafon and experience fhew, that good fruit is one of the beft medi- cines, both for the prevention and cure of the moff dan- geious kind of dyfentery. In a dyfentery ariffoT from a putrid ftate of the humours, fruit is in every refpeel calcu- lated to counteract that tendency to putrefaction, from M m whence * The manner 6f making this brotli is, to take a fheep's head and feet with the (kin upon them, and to burn the wool off with a hot iron. After- wards to boil them till the brotli'ir,q'iite a-.jclly, A little cinnamon or mace may be added to giye the broth an agreeable flavour, and the patient may take a little of it warm with toafted'bread, three or four times --Jay. A clyfter of it may likewife be giveri twice a-day. Such as cannot ufe the broth nude in diis way, may have the head and feet lkinned ; but we have reafon to believe that this huits the medicine^ It is not our bpfinefs here to reafon upon the nature and qualities of medicines, otherwife this might be fliewn to poflcfs virtues every way Oited to the cmc of a dyfentery which does not proceed from a putrid ftate of the humours. C::e thing we know, which is preferable to all reafoning, that whole families have often been cured hy it, after they had ufed many other medicines in vain. It will however be pro- per that the patient take a vomit, and a dole or two of rhubarb, before he begins to life the broth. It will likewife be neceilary to continue the ufe of it for a considerable time, and to make it the principal food. p The learned Dr. Rutherford, late profeflor of medicine in the univerfi- ty of Edinburgh, ufed to mention this medicine in his public lectures with great dncomiums. He directed itvtobe made by t\ing thrc-j or four handfuls of the fined flour, as tight as poflible, in a linen rag, afterwards to dip it frequently in water, and. to^dridge the outfidc with flour till a cake or crult was formed arou id it. Which prevents the water from foakijig into it while boiling. It is then to be boiled till it becomes a hard dry mai's, as directed above. This, when mixed with milk and water, will not only anfwer the purpofe of food, bat may likewife bv given in cfo tiers. 266 OF THE, DYSENTERY, whence all the danger proceeds. The patient in fuch a cafe ought therefore to be allowed to eat as much fruit as he pleafes, provided it be good *. The moft proper drink in this difoi'der is whey. The. dyfentery has often been cured by the ufe of clear whey, alone. It may be taken both for drink, and in form of clyfter. When whey cannot be had, barley-water fharpen- ed with cream of tartar may be drank, or a decodtion of barley and tamarinds ; two ounces of the former and one of the latter may be boiled in two Englifh quarts of water to one. Warm water, water-gruel, or water wherein hot iron ha? been frequently quenched, are all very proper, and may be drank in turns. Camomile tea, if the ftomach will bear it, ^ an exceeding proper drink. It both ftrengthens the ftomach, and by its antifeptic quality tends to prevent a mortification of the bowels. M E D 1 C 1 N E.----At the beginning of this difeafe it is always neceffary to cleanfe the firft paffages. For this purpofe a vomit of ipecacuanha muft be given, and wrought off with weak camomile-tea. Strong vomits are feldom neceflary here. A fcruple, or at moft half a dram of ipe- cacuanha, is generally fufficient for an adult, and fome- times a very few grains will fuffice. The day after the vo- mit, half a dram, or two fcruples of rhubarb, muft be taken. This dofe may be repeated every other day for two or three times. Afterwards fmall dofes of ipecacuanha may be taken for fome time. Two or three grains of the pow- der may be mixed in a table-fpoonful of the fyrup of pop- pies, and taken three times a-day. These evacuations, and the regimen prefcribed above* will often be fufficient to effect a cure. Should it how- ever * I lately faw a young man who had been feized with a dyfentery in North America. Many things had been tried there for his relief, but to no purpofe. At length, tired out with difapprintments from medicine, and re- duced to fkin and bone, he came over to Britain, rather with a view to die among his relations than with any hopes of a cure. After taking fueidry medicines here with no better fuccefs than abroad, I advifed him to leave off the ufe of drugs, and to truft entirely to a diet of milk and fruits, with gen- tle exercife. Strawberries was the on'y fruit he could procure at that feafon. Thefe he cat with milk twice, and fometimes thrice a-day. The confequence was, that in a fhort time his (tools were reduced from upwards of twenty in a day, to three or four, and fometimes not fo many. He rfed the other fruits as they came in, and was, in a few weeks, fo well as to leave that (part of the country where 1 was, with a view to rtturn to America. or BLOODY-FLUX. 267 ever happen otherwife, the following aftrin^ent medicines may be ufed. . A clyster of ftarch or fat mutton-broth, with twen- ty or thirty drops of liquid laudanum in it, may be admi- niftered twice a-day. At the fame time an ounce of gum- arabic, and half an ounce of gum-tragacanth, may be dif- folved in an Englifh pint of barley-water, over a flow fire, and a table-fpoonful Of it taken every hour. If thefe have not the defired effect, the patient may take, four times a-day, about the bulk of a nutmeg of the Japonic confetlion, drinking after it a tea-cupful of the de- coction of logwood *; O 4) Persons who have been cured of this difeafe are very liable to fuffer a relapfe ; to prevent which$ great circum- fpedtion with refpedt to the diet is neceffary. The patient muft abftain from all fermented liquors, except now and then a glafs of good wine ; but he muft drink no kind of malt-liquor. He muft likewife abftain from animal food,, as fifh and flefh, and muft live principally upon milk and vegetables. Gentle exercife and wholefome air are likewife of im- portance. The patient fhould go to the country as foon as his ftrength will permit, and fhould take exercife daily on horfeback, or in a carriage. He may likewife ufe bit- ters infufed in wine or brandy, and may drink twice a-day a gill of lime-water mixed with an equal quantity of new milk. When dyfenteries prevail, we would recommend a ftridt: attention to cleanlinefs, a fpare ufe of animal food, and the free ufe of found ripe fruits, and other vegetables. The night air is to be carefully avoided, and all communica- tion with the fick. Bad fmells are likewife to be fhu.nned» efpecially thofe which arife from putrid animal fubftances. The office-houfes where the fick go are carefully to be a- voided. When the Firft fymptoms of the dyfentery appear, the- patient ou^ht immediately to take a vomit, to go to bed,, and drink plentifully of weak warm liquor, to promote a fweat. * The decoction oi logwood is made by boiling three or fonr ounces of the (havings of that wood in two F.nglilh quarts of water till one half be con fumed ; adding towards the end two drams of cinnamon bark. This de- cpftion gives the (tools a rejdifb colour; but the pat ie at needs not be a- larmcd at tint appearance. 268 OF THE DYSENTERY,^: fweat. This, with a dofe or two of rhubarb at the begin- , ning, would often carry off the difeafe. In countries where dyfenteries prevail, we would advife fuch ?.s are li- able to them, to take either a vomit or a dole of phyfic everv fpring and autumn, as a preventive. There are fundry other fluxes of the belly, as the LI- EN TERY and COELIAC PASSION, which, though lefs dangerous than the dyfentery, yet merit % confident.enf Thefe difeafes generally proceed from a re- laxed ftate of the ftomach and inteftines, which is fome- * times fo great, that the food paffes through them without almoft any fenfible alteration ; and the patient dies merely from the want of nourifhment. Wthen the lientery or cceliac paffion fucceed a dyfente- ry, they often prove fatal. They are always dangerous in old age, efpecially when the conftitution has been broken by excefs or acute difeafes. If the ftools be very frequent, and quite crude, the thirft great, with little urine, the mouth ulcerated, and the face marked with fpots of differ- ent colours, the danger is very great. The treatment of the patient is in general the fame as in the dyfentery. In all obftinate fluxes of the belly, the cure muft be attempted, by firft cleaning the ftomach and bowels with gentle vomits and purges. Afterwards fuch a diet as has a tendency to brace and ftrengthen the bowels, with opiates end aftrihgent medicines, will generally per- fedt the cure. The fame obfervation holds with refpedl to a'TE- NEbMUS, or frequent defire of going to ftool. This difeafe refembles the dyfentery fo much, both in its fymp- toms and method of cure, that we think it needlefs to in- ft ft upon it. CHAP; c 269 y CHAP. XXXIV. OF THE HEAD-ACH. ACHES and pains proceed from very different caufes, and may affect any part of the body ; but,we fJfoll point out thofe only which occur moft frequently, and are attended with the greateft danger. When the head-ach is flight, and affects a particular part of the head only, it is called cephalalgia ; when the whole head is affedled cephalaa ; and when en one fide on- ly, hemicrania. A fixed pain in the forehead, which may be covered with the end of the thumb, is called the clavis hyjlericus. There are alfo other diftindtions. Sometimes the pain is internal, fometimes external; fometimes it is an original difeafe, and at other times only fymptomatic. When the head-ach proceeds from a hot bilious habit, the pain is very acute and throbbing, with a confiderable heat of the part affeaed. When from a cold phlegmatic habit, the pati- ent complains of a dull heavy pain, and has a fenfe of cold- nefs in the part. This kind of head-ach is fometimes at- tended with a degree of ftupidity or folly. Whatever obftruas the free circulation of the blood through the veffels of the head, may occafion a head-ach. In perfons of a full habit, who abound with blood, or other humours, the head-ach often proceeds from the fup- preffion of cuftomary evacuations ; as bleeding at the nofe, fweating of the feet, cifo. It may likewife proceed from any caufe that determines a greater flux of blood towards the head ; as coldnefs of the extremities, hanging of the head, iefc. Whatever prevents the return of the blood from the head will likewife occafion the head-ach ; as looking long obliquely at any objea, wearing any thing tight about the neck, cifo. When a head-ach proceeds from the ftoppage of a run- ning at the nofe, there is a heavy, obtufe, prefling pain in the fore part of the haad, in which there feems to be fuch a weight, 270 Or T H t HEAD-ACH. a weight, that the patient can fcarce hold it up. When it is occafioned by the cauftic matter of the venereal difeafe, it generally affocts the fkull, and often produces a caries of the bones. Sometimes the. head-ach proceeds from the repulfion, or retroceffion of the gout, the eryfipelas, the fmall-pox, meafles, itch, or other eruptive difeafes. What is called a hemicrattia generally proceeds from crudities or indigeftion. Inanition or emptinefs, will alfo occafion head-achs. I have often feen inftances of this in nurfes wh.) gave fuck t .1 long, or who did not take a fufficient quantity of folid food. There is likewife a moft violent, fixed, conftaBt^ and almoft intolerable head-ach, which occafions great debility both of body and mind, prevents fleep, deftroy s the appetite, caufes a vertigo, dimnefs of fight, a noife in the ears, convulfions, epileptic fits, and fometimes vomit- ing, coftivenefs, coldnefs of the extremities, cifo. The head-ach is often fymptomatic in continual and intermitting fevers, efpecially quartans. It is likewife a very common fymptom in hyfteric and hypochondriac com- plaints. When a head-ach attends an acute fever, with pale urine, it is an unfavourable fymptom. In exceffive head- achs, coldnefs of the extremities is a bad fign. When the difeafe continues long, and is very violent, it often termi- nates in blindnefs, an apoplexy, deafnefs, a vertigo, the palfy, epilepfy, &c. In this difeafe the cool regimen in general is to be ob- ferved. The diet ought to confift of fuch emollient fub- ftances as will correct the acrimony of, the humours, and keep" the belly open ; as apples bailed in milk, fpinage, tur- nips, and fuch like. The drink ought to be diluting; as barley-water, infufions of mild mucilaginous vegetables, decoctions of the fudorific woods, ciO. The feet and legs ought to be kept warm, and frequently bathed in luke- warm water; the head fliould be fhaved, and bathed with water and vinegar. The patient ought, as much as pofli- ble, to keep in an erea pofture, and not to lie with his head too low. When the head-ach is owirnj; to excefs of blood, or an hot bilious conftitution, bleeding is neceffary. The pa- tient may be bled ill the jugular vein, and the operation repeated OF THE HEAD-ACH. vfx repeated if there be occafion. Cupping alfo, or the appli- cation of leeches to the temples, and behind the ears, will be of fervice. Afterwards a bliftering plafter may be ap- plied to the neck, behind the ears, or to any part of the head that is moft affeaed. In fome cafes it will be proper to'blifter the whole head. In perfons of a grofs habit, ifo fues or perpetual blifters will be of fervice. The belly ought likewife to be kept open by gentle laxatives. But when the head-ach proceeds from a copious vi- tiated ferum ftagnating in the membranes, either within or without the fkull, with a dull, heavy, continual pain, which will neither yield to bleeding nor gentle laxatives, then more powerful purgatives are neceffary, as pills mad© of aloes,, refin of jalap, or the lifo\ It will alfo be necef- fary in this cafe to blifter the whole head, and to keep the back part of the neck open for a confiderable time by a perpetual blifter. When the head-ach is occafioned by a ftoppage of a running at the nofe, the patient fhould frequently fmeil to a bottle of volatile falts; he may likewife take fnuff, or any thing that will irritate the nofe, fo as to promote a dif- charge from it; as the herb maftich, ground-ivy, cifV. A hcmicrania, efpecially a periodical one, is generally owing to a foulnefs of the ftomach, for which gentle vo- mits muft be adminiftered, as alfo purges of rhubarb. Af- ter the bowels have been fufficiently cleared, chalybeate- waters, and fuch bitters as ftrengthen the ftomach, will be neceffary. When the head-ach arifes from a vitiated ftate of the humours, as in the fcurvy and venereal difeafe, the patient, after proper evacuations, muft drink freely of the decoaion of woods, or the decodtion of farfaparilla with raifins and liquorice*. Thefe promote perfpiration, fweeten the hu- mours, and", if duly perfifted in, will produce very happy effeas. When a colfoaion of matter is felt under the (kin, it muft be difcharged by an incifion, otherwife it will render the bone carious. When the head-ach is fo intolerable as to endanger the patient's life, or is attended with continual watching, de- lirium, * This is made by boiling three minces of frefh farfaparilla, an ounce of raifins, and half an ounce of liquorice, in three Knglilh quarts of water t»- •nt. The liquor mull be Itrair.cJ, a.A an lOglii'i pint of it drank daily. 272 OF THE HEAD-ACH. lirium, &c. recourfe muft be had to opiates. Thefe, after proper evacuation by clyfters, or mild purgatives, may be applied both externally and internally. The affeaed part may be rubbed with Bate's anodyne balfam, or a cloth dipped in it may be applied to the part. The patient may, at the fame 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 cafe of extreme pain. Proper evacuations ought always to accompany and follow the ufe of opiates. When the patient cannot bear the lofs of blood, his feet ought frequently to be bathed in lukewarm water, and well rubbed with a coarfe cloth. Cataplafms with muftard or horferadifh ought likewife to be applied to them. This courfe is peculiarly neceffary when the pain proceeds from a gouty humour affeaing the head. When the head-ach is occafioned by great heat, hard labour, or violent exercife of any kind, it may be allayed by cooling medicines j as the faline draughts with nitre, and the like. Of the TOOTH-ACH. This difeafe is fo well known, that it needs no defcrip- tion. It has great affinity with the rheumatifm, and often fucceeds pains of the fhoulders and other parts of the body. It may proceed from obftruaed perfpiration, or any of the other caufes of inflammation. I have often known the tooth-ach occafioned by negleaing fome part of the ufual coverings of the head, by fitting with the head bare near an dpen window, or expofing it any how to a draughtof cold air. Food or drink t.ken either too hot, or too cold, is very hurtful to the teeth. Great quantities of fugar, or other fweet meats, are likewife hurtful. Nothing is more deftruaive to the teeth than cracking nuts, or chewing any kind of hard fubftances. Picking the teeth with pins, needles, or with any thing that may hurt the enamel with which they are covered, does great mifchiefj as the tooth is fure to be fpoilt whenever the air gets into it. Pregnant woment are very fubjea to the tooth-ach, efpecially during the firft three or four months of pregnancy. The tooth- ach often proceeds from fcorbutic humcurs affodting the e. urns, OF THE TOOTH-ACH. 273 gums. In this cafe the teeth are fometimes wafted, and fall out without any confiderable degree of pain. The more immediate caufe of the tooth-ach is a rotten or carious tooth. In order to relieve the tooth-ach, we muft firft endea- vour to draw off the humours from the part affeaed. This may be done by mild purgatives, bleeding, and foihing the feet frequently in warm water. The perfpiration ought likewife to be promoted, by drinking freely of weak wine- Whey, or other diluting liquors, with fmall dofes of nitre. Vomits too have often an exceeding good effea in the tooth-ach. It is feldom fofe to adminilfor opiates, or any kind of heating medicines, or even to draw a tooth till proper evacuations have been premiffod, and thefe alone will often effot the cure. Next to evacuations we would recommend fom:nting the p.:rt with warm water, or decoaions of emollient ve- getables. Bags filled with boiled camomile flowers, fOwerj of elder, or the like, may be applied to the part affeaed, with as great a degree of warmth as the patient can bear, and renewed as they grow cool. The patient may likewife receive the fleams 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, CSV. Gargles are likewife of ufe to make a difcharge from the part. Rob of elder diffolved in fmall beer makes a very proper gargle, or an infufion of fage or mulberry- leaves. Such things as promote the difcharge of faliva, or caufe the patient to fpit, are always proper. For this purpofe bitter, hot, or pungent vegetables may be chewed ; 2s gentian, calomus-aromaticus, or pellatory of Spain. Al- len recommends the root of yellow water flower-de-luce in this cafe. This root may either be rubbed upon the tooth, or a little of it chewed. Brookes fays, he hardly ever knew it fail to eafe the tooth-ach. Many other herfo, roots, and feeds, are recommended for curing the tooth-ach ; as the leaves or roots of miile- foil or yaTrow chewed, tobacco fnoke.l or chewed, ftaves acre, or the feeds of muftard chewed, &c Thefe bitter, hot, and pungent things, by occaffoning a great flow of faliva, frequently give eafo in the to-oth-ach. ' N n OriATEs 274 OF THE TOOTH-ACH. Opiates often relieve the tooth-ach. For this purpofe" a little cotton wet with laudanum may be held between the teeth; or a piece of fticking plafter, about the bignefs of a fixpence, with a bit of opium in the middle of it, of a fize not to prevent the fticking of the other, may be laid on the temporal artery, where the pulfation is moft fenfi- ble. De la Matte affirms, that there are few cafes wherein this will not give relief. If there be a hollow tooth, a frnall pill made of equal parts of camphire and opium, put into the hollow, is often beneficial. When this cannot be had, the hollow tooth may be filled with gum maftich, wax, lead, or any fubftance that will flick in it, and keep out the external air. Few applications give more relief in the tooth-ach than bliftering plafters. Thefe may be applied betwixt the fhoulde;s, but they have the beft effect when put behind the ears, and made fo large as to cover a part of the lower- Jaw- After all, when a tooth is carious, it is often impoffi- ble to remove the pair, without extraaing it; and, as a fpoilt tooth never becomes found again, it is. prudent to draw it foon, left: it fhould affoa the reft. Tooth-draw- ing, like bleeding, is very much praaifed by mechanics at well as perfons of the medical profeffion. The operation however is not without danger, and ought always to be per- formed with care. A perfon unacquainted with the ftrudture of the parts will be in danger of breaking the jaw-bone, or of drawing a found tooth inftead of a rotten one. When the tooth-ach returns periodically, and the pain chiefly affeas the gums, it may be cured by the bark. Some pretend to have found great benefit in the tooth* jich, from the application of an artificial magnet to the af- fected tooth. We fhall not attempt to account for its.mode of operation, but, if it be found to anfwer, though only in particular cafes, it certainly deferves a trial, as it is at- tended with no expence, and cannot do any harm. ■ Persons who have returns of the tooth-ach at certain feafons, as fpring and autumn, might often prevent it by taking a dofe of phyfic at thefe times. Keeping the teeth clean has no doubt a tendency to prevent the tooth-ach. The beft method of doing this is to wafti them daily with fait and water, or with eold water alone* OF THE TOOTH-ACH. 275 alone. All brufhing and fcraping of the teeth is danger- ous, and, unlefs it is peiformed with great care, does mif- t chief* Or the EAR-AC II. This diforder chiefly affeas the membrane which liaes the inner cavity of the ear called the meatus auditorius. It is often fo violent as to occafion great reftleflhefs and anxi- ety, and even delirium. Sometimes epileptic fits, and other convulfive diforders, have been brought on by ex- treme pain in the ear. The car-ach may proceed from any of the caufes which produce inflammation. It often proceeds from a fudden fuppreflion of perfpiration, or from the head being expofed to cold when covered with fweat. It may alfo be occafion-* ed by worms, or other infeas getting into the ear, or being bred there; or from airiy hard body fticking in the car. Sometimes it proceeds from the tranflation of morbific mat- ter to the ear, This often happens in the decline of malig- nant fevers, and occafions deafnefs, which is generally reckoned a favourable fymptom. When the ear-ach proceeds from infers, or any hard body fticking in the ear, every method muft be taken to re, move them as foon as poffible. The membranes may be re- laxed by dropping into the ear oil of fweet almonds, or olive oil. Afterwards the patient fhould be made to fneeze, by taking fnuff, or fome ftrong flernutatory. If this fhould not force out the body, it muft be extraaed by art. I have feen infeas, which had got into the egr, come out of their own accord, upon pouring in oil, which is a thing they cannot bear. When the pain of the ear proceeds from infl.unmation, it muft be treated like other topical inflammation?, 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 likewife be fomented with fteams of warm water, or flannel bags filled with boiled mallows and camomile flowers may be applied to it Warm; or bladders filled with warm milk and water. An fxceeding good method of fomenting the ear is to apply it 9 Cfofo ?;G OF THE EAR-ACH. clofe to the mouth of a jug filled with warrti water, or g ftrong focodtion of camomile flowers. The patient's foet fhould be frequently bathed in luke-, warm water, and he ought to take foiall dofes of nitre and rhubarb, viz. a foruple of the former, Wrten grains of the Luter three times a-day. His drink may be whey, or de- coctions of barley and liquorice with figs cr raifins. The parts behind the ear ought frequently to be rubbed with camphorated oil, or a little of the volatile liniment. When the inflammation cannot be difcufled, a poultice of bread and milk, or roafted onions, may be applied to the ear, and frequently renewed, till the abfeefs breaks, or can be opened. Afterwards the humours may be diverted from the part by gentle laxatives, blifters, or iffues; but the -difcharge muft not be fuddenly dried up by any external ap- plication. PAIN of the STOMAC H. This may proceed from various caufes; a3 indigeftion ; wind ; the acrimony of the bile; fharp, acrid, or poifon, ous fubftances taken into the ftomach, foY. It may like- wife proceed from worms ; the ftoppage of cuftomary evaT cuations; a tranflation of gouty matter to the ftomach ; or the like. # Women in the decline of life are very liable to this dif- eafe, efpecially fuch as are affliaed with hyfteric com- plaints. It is likewife very common to hypochondriac men of a fedentary and luxurious life. In fuch perfons it often proves fo extremely obftinate as to baffle all the powers of medicine. When the pain of the ftomach is moft violent after eat- ing, there, is reafon to fufpea that it proceeds from fome fault either in the digeftion or the food. In this cafe the patient ought to change his diet, till he finds what kind of food agrees beft with his ftomach, and fhoul 1 continue chiefly°to ufe that. If a change of diet does not remove the complaint, the patient may take a gentle vomit, and af- terwards a dofe or two of4 rhubaib. He ought likewife to take an infufion of camomile flowers, or fome other fto- machic bitter either in wine or water. I have clien known exercife PAIN OF THE STOMACH. i7f exercife remove this complaint, efpecially failing, or along journey on horfeback, or in a machine. When a pain of the ftomach proceeds from flatulency, the patient is conftantly belching up wind, and feels art uncafy diftenfion of the ftomach after meals. 1 his is a moft deplorable difeafe, and is feldom cured. In general, the patient ought to avoid all windy diet, and every thing that fours on the ftomach, as greens, roots, cjfo. This rule however admits of fome exceptions. There are many inftances of perfons very much troubled with wind, who received great benefit from eating parched peafe, though that grain is generally fuppofed to be of a windy nature *. This complaint may likewife be greatly relieved by exercife, efpecially digging f, walking, or riding. I have found the elixir of vitriol anfwer very well in flatulencies. Fifteen or twenty drops of it may be taken in a glafs of wine, or a cup of camomile-tea, twice or thrice a-day. When a pain of the ftomach is occafioned by the fwallowins of acrid or poif nous fubftances, they muft be difcharged by vomit; this may be excited by butter, oils, or other foft things, which flieath and defend the ftomach from the acrimony of its contents. When pain of the ftomach proceeds from a tranflaticn of gouty matter, warm cordials are neceffary, as generous wines, French brandy, &c. Some have drank a whole bottle of brandy or rum, in this cafe, in a few hours, without being in the leaft intoxicated, or even feeling the ftomach warmed by it. It is impoffible to afc&rtain the quantities neceffary upon thefe occafions. This muft be left to the feelings and difcretion of the patient. The fafer way however is not to go too far. When there is an inclination to vomit, it may be promoted by drinking an infufion of camomile flowers or carduus henediclus. If a pain of the ftomach proceeds from the ftoppage of cuftomary evacuations, bleeding will be neceffary, efpeci- ally in fanguine and very full habits. It will likewife be of * Thefe are prepared by fleeping or foaking peafe in water, and after- wards drying them in a pot or kiln till they be quite hard. They may be ni7d at pleafure. t One of the moft obftinate cafes of this kind I ever met with was in a (hoemnkcr. After trying nurnberlefs medicines to no purpofe, I advifed him to turn gardener, which he did, and has. cvcr lincc enjoyed very good fo-alth. «/8 PAIN OF THE STOMACH. of ufe to keep the belly gently open by mil J purgatives; as rhubarb or fenna, &c. When this difeafe affects women in the decline of life, after the ftoppage of the menfes, making an iffue in the leg or arm will be of peculiar fervice. When the difeafe is occafioned by worms, they muft be deftroyed, or expelled by fuch means as are recommend- ed in the following feaion. CHAP XXXV. OF WORM S. THESE are chiefly of three kinds, viz. the tcenia, or tap&-w*irm; the teres, or round and long worm; and the afcarides, or round and fhort worm. There are many other kinds of worms found in the human body; but as they proceed, in a great meafure, from fimilar cauf ;, have nearly the fame fymptoms, and require almoft the fame method of treatment, we ffiall not fpend time in enu- merating them. The tape-worm is white, very long, and all over-joint- ed. It is generally bred either in the ftomach or fmall in- teftines. The round and long worm is likewife bred in the fmall gui .s, and fometimes in the ftomach. The round and fhort worms commonly lodge in the reclum, or what is called the end-gut, and occafion a difagreeable itching about the fifot. The long round worms occafion fqucamifhnefs, vomit- ing, a difagreeable breath, gripes, loofenefs, fwelling of the belly, fwoonings, loathing of food, and at other tirnej a voracious appetite, a dry cough, convulfions, epileptic fits, and fometimes a privation of fpeech. Thefe worms have been known to perforate the inteftine?, and get into the cavity of the belly. The effeas of the tape-worm are nearly the fame witfothofe of the long and round, but ra-. ther m^re violent. Andry fays, the following fymptoms particularly at- tend the foliumx which is a fpecies of the tape-worm, viz. fv/ocr.ipg^ . OF WOk M'8. 279 fwoonings, privation of fpeech, and a voracious appetite* The round worms called afcarides, befides an itching of the anus, caufe fwoonings, and tenefmus, or an inclinati- on to go to ftool. CAUSES.----Worms may proceed from various caufes ; but they are feldom found except in weak and re- laxed ftomachs, where the digeftion is bad. Sedentary perfons are more liable to them than the aaive and labori- ous. Thofe who eat great quantities; of unripe fruit, or who live much on raw herbs and roots, are generally fub- jea to worms. They are often a fymptom of fevers, and other acute difeafes. There feems to be a hereditary dif- pofition in fome perfons to this difeafe. I have often feen all the children of a family fubjedt to worms of a particu- lar kind. They feem likewife frequently to be owing to the nurfe. Children of the fome family, nurfed by one woman, have often worms, when thofe nurfed by another have non?. Children are more' liable to this difeafe than adults j though infants on the breaft are feldom troubled with it. To this however there are feveral exceptions. I have feen a child who paffed worms before it was three months old. They were indeed of a very particular kind, being real ca- terpillars. Some of them were above an inch long ; they had red heads, and were fo brifk as to jump about; they liv.d feveral days after the child had paffed them. Another child fuckled by the fame woman paffed the fame kind of worms when upon the breaft, and both children fuffered extremely before the worms came away. S Y M P T O M S.---The common fymptoms of worms, are palenefs of the countenance, and, at other times, art univerfal flufhing of the face ; itching of the nofe, this however is doubtful, as children pick their nofes in all dif- eafes ; ftarting, and grinding of the teeth in fleep ; fwell- ing of the upper lip ; the appetite fometimes bad, at other times quite voracious; loofenefs; a four or ftinking breath; a hard fwelled belly ; great thirft; the urine frothy, and fometimes of a whitifh colour; griping, or colic pains ; an involuntary difcharge of faliva, efpecially when afleep ; frequent pains of the fide, with a dry cough, and unequal puife ; palpitations of the heart; fwoonings ; drowfinefs ; cold fweats; palfy; epileptic fits, with many other unac- countable nervous fymptoms, which were formerly attri- buted 2Sq o f w o r m $. buted to witchcraft, or the influence of evil fpirits. Small bodies in the excrements rcfembling melon or cucumber feeds are fymptoms of the tape-worm. I lately faw fome very furprifing effeas of worms irl a girl about five years of age, who ufed to lie for whole hours as if dead. She at laft expired, and upon opening her body a number of the teres, or long round worms, were found in her guts, which were confiderably inflamed ; and wfoit anatomifts call an intuffufceptio, or involving of one part of the gut within another, had taken place in no leii than four different parts of the inteftinal canal. MEDICINES.—Though numberlefs medicines are extolled for killing and expelling worms*, yet no^difeaftf more frequently baffles the phyfician's fkill. In general, the moft proper medicines for their expulfion are ftrong purgatives ; and to prevent their breeding, ftomachic-bit- ters, with now and then a glafs of good wine. The beft purge for an adult is jalap and calomel. Five" and twenty or thirty grains of the former, with fix or fe- ven of the latter, mixed in fyrup, may be taken early in the morning for a dofe. It will be proper that the patient' keep the houfe all day, and drink nothing cold. The dofe may be repeated once, or twice a-week, for a fortnight or three weeks. On the intermediate days the patient may take a dram of the powder of tin, twice or thrice a-day, mixed with fyrup, honey, or treacle. Those who do not chufe to take calomel may make ufe of the bitter purgatives ; as aloes, hiera picra, tinaure of fenna and rhubarb, &c. Oily medicines are fometimes found beneficial for ex- pelling worms. An ounre of fallad oil and a table-fpoon- ful of common folt, may be taken in a glafs of red port wine thrice a-day, or oftener if the ftomach will bear it. But the more common form of ufing oil is in clyfters. Oily clyfters fweetened with fogar or honey, arc very effi- cacious in briuging a,way the fhort round worms called af- carides, and likewife the teres. The Harrowgate water is an excellent medicine for ex- pelling worms, efpecially the afcarides. As this water evi- dently abounds with folphur, we may hence infer, that fulphur * A medical writer of the prcfent age has enumerated upwards of Ory Britifh plants, all famous for killing and expelling worms out of the body. OF WORMS. s>8i fulphur alone muft be a good medicine in this cafe ; v/hich is found to be a foa. Many praaitioners give flour of ful- phur in very large dofes, and with great fuccefs. It fhouiJ be made into an eleauary with honey or treacle, and taken in fuch quantity as to purge the patient. Where Harrowgate water cannot be obtained, fea-wa- ter may be ufed, which is far from being a contemptible medicine in this cafe. If fea-water cannot be had, com- mon fait diffolved in water maybe drank. I have often feen this ufed by country nurfes with very good effea. But worms, though expelled, will foon breed again, if the ftomach remains weak and relaxed ; to prevent which, we would recommend the Peruvian bark. Half a dram of bark in powder may be taken in a glafs of red port wine, three or four times a-day, after the above medicines have been ufed. Lime-water is likewifo good for this pur- pofe, or a tablefpoonful of the chalybeate wine taken twice or thrice a-day. Infufions or decodions of bitter herbs may likewife be drank ; as the infufion of tanfy, water- trefoil, camomile-flowers, tops of wormwood, the lelfer ■centaury, cjV. The above direaions are calculated for adults ; but for children the medicines muft be more agreeable, and given in fmaller dofes. For a child of four or five years old, ten grains of rhu- barb^ five cf jalap, anJ two of calomel, may be mixed in a fpoonful of fyrup or honey, and given in the morning. The child fhould keep the houfe ail day, and take nothing cold. This dofe may be repeated twice a-week for three or four weeks. On the intermediate days the child may take a foruple of powdered tin and ten grains of sethiops mineral in a fpoonful of treacle twice a-day. TheO dofes muft be increafed or diminifoed according to the age of the patient. Bisset fays, the great bafford black hellebore, or bear's fat, is a moft powerful vermifuge for the long round worms. He orders the decoaion of about a' dram of the green leaves, or about fifteen grains of the dried leaves in powder, for a dofe to a child betwixt four and feven years of age. This dofe is to be repeated two or three times. He adds, that the green leaves mi.de into a fyrup with coarfe fugar is almoft the only medicine he has ufed for mund worms for three years paft. Before prefling out the juice, he moiftcns O o the zXi 6 , WO R M S. '■ r • • ' v the bruifed leaves wit Vinegar, which ccrcas the medfo tine. The dofo »* j I'.a-fpoo'rful at jjed-4ime, and one or two next morning. I have frequently known thofe big bellies, which in children are commonly reckoned a fifon of worms, quite re- moved by giving, them white foap in their pottage, or other food. Tanfy, garlic, and rue, are all good againft worms, and may be ufed various ways. We might here mention many other plants, both for external and internal ufe, but think the powder of tin with aethiops mineral, and the pur- ges of rhubarb and calomel are more to be depended on*. Parents who would preferve their children (torn worms ought to allow ihem plenty of exercife in the open air ; to take care that their food be wholefome'and fufficiently fo- lid ; and, as far as poflible, to prevent their eating raw herbs, roots, or green trafhy fruits. It will not be amifs to allow a child who is fubjea to worms, a glafs of red wine after meals; as every thing that braces and ftrength'- ens the ftomach is good both for preventing and expelling thefo vermin f. ' CHAP. 1 Ball's purgiag Termlfuge powder is a very powerful medicine. It is made of equal parts of rhubarb, fcammony, and calomel, with as much dou* ble-refined liigar as is eqnal to the weight of all the other ingredients. Thefe muft be well mixed together, and reduced to a fine powder. The dofe for a child is from ten grains to twenty, once or twice a-week. An adult may take a dram for a dofe. | We think it neceflary here to warn people of their danger v»ho buy cakes, powders, and other worm-medicines, at random from quacks, auil •rive them to their children without proper care. The principal ingredient in moft of thefe medicines is mercury, which is never to be trifled with. I lately faw a shocking inftance of the danger of this conduit. A girl whohad taken a dofe of worm-powder, bought of a travelling quack, went out, and perhaps was fo imprudent as to drink cold water, during its operation. She immediately A\tiled, and died that very day, with all the lymjterns tf having been poifoned. r r C ^3 : C H A P. XXXVI. OF THE JAUNDICE. THIS difeafe is firft obfervable in the wlpite of the eye, which appears yellow. Afterwards the whole fkm puts on a yellow appearance. Tlie urine too is of a faffron hu^ and dies a white cloth of the fame colour. There is another fpecies of this difeafe called the Black Jaundice. CAUSE S.---The immediate caufe of the jaundice is an obltruaion of the bile. The remote or occafional caufes are, the bites of poifonous animals, as the viper, mad dog, &c. the bilious or hjfteric colic ; violent pOli- ons, as grief, anger, &c. Strong purges or vomits will likewife occafion the jaundice. Sometimes it proceeds from obftinate agutes, or from that difeafe being prematurely ftopped by aflringent medicines, In infants it is often oc- cafioned by the meconium not being fufficiently purged off. Pregnant women are very fubjea to it. It is likewife a fymptom in feveral kinds of fevers. Catching cold, or the ftoppage of cuftomary evacuations, as the- ?ner.fs, ths bleeding piles, iffues, cifo. will occafion the jaundice. SYMPTOM S.—The patient at full complains of exceffive wearinefs, and has great averlion to every kind of7 motion. His fkin is dry, and he generallv feels a kind of itching or pricking pain over the whole body. The ftools are of a whitifh or clay colour, and the urine, as was ob- ferved above, is yellow. The breathing is difficult, audi the patient complains of an unufual load or oppreflinn on his breaft. There is a heat in the noftrils, a bitter tafte in the mouth, loathing of food, ficknefs at the ftomach, vo- miting, flatulency, and frequently all objeas appear to the eye of a yellow colour. If the patient be young, and the difeafe complicated with no other malady, it is feldom dangerous ; hut in old people, where it continues long, returns frequently, or is complicated with the dropfy or hypochondriac fymptom^ it generally proves fatal. The black jaundice ib more. dangerous than the yellow. REG I MEN.— 284 OF THE JAUNDICE. REGIME N.----The diet fhould be cool, light, and diluting, confiding chiefly of ripe fruits and mild vege- tables ;° as apples boiled or roafted, fltwed prunes, pre- fervcd pluirr-, boiled fpinage, cifo. Veal or chicken broth, with Ifoht bread, are likewife very proper. The drink fhould be butter-milk, whey fweetened with honey, or decoaions of cool opening vegetables ; as marfh-mallow roots, with liquorice, &c. ri he patient fhould take as much exercife as he can bear, cither on horfeback or in a machine ; walking, running, and even jumping, are likewife proper, provided he can bear them without pain, and there be no fymptoms of inflam- mation. Patients have been often cured of this difeafe by a long journey, after medicines had proved ineffeaual. Amusements are likewife of great ufe in the jaundice. The difeafe is often occafioned by a fedentary life, joined to a dull melancholy difpofition. Whatever therefore tends to promote the circulation, and to cheer the fpirits, muft have a good effea ; as dancing, laughing, finging, csV. M ED I C I N E.----If the patient be young, of a full fanguine habit, and complains of pain in the right fide, about the region of the liver, bleeding will be neceffary. After this a" vomit muft be adminiftered, and if the difeafe proves obftinate, it may be repeated once or twice. No medicines are more beneficial in the jaundice than vomits, efpecially where it is not attended with inflammation. Half a dram of ipecacuanha in powder will be a fufficient dofe for an adult. It may be wrought off with weak camomile- tea, or lukewarm water. The belly muft likewife be kept open by mild purgatives. Caftile foap, if taken in fufficient quantities, anfwers this purpofe very well. It may be taken from half an ounce to an ounce daily, for a confiderable time. As few people have refolution to fwallow fuch large quantities of foap, I generally give pills made of foap, aloes, and rhubarb, which anfwer the fame intention, in a fmaller dofe. They may be prepared'and taken as under*. Fomenting '■* Take focotrine aloes and Turkey rhubarb in powder, of each two drams, C-iftile foap an ounce. Beat them all together, with a little fyrup, into a proper confiflence for pills. Let them be formed into pills of an ordinaly fize, and five or fix of them taken t.'.ice or thrice a-day. They muft be con- tinued for fome time, and the quantity regulated by the patient's ftools, o$ v. hich he ought at leaft to have two every day. OF THE JAUNDICE. 285 Fomenting the parts about the region of the ftomach and liver, and rubbing them with a warm hand or flefh- brufh, are likewife beneficial; but it is ftill more fo for the patient to fit in a veffel of warm water up to the breaft. He ought to do this frequently, and fhould continue in it as long as his ftrength will permit. Many dirty things are recommended for the cure of the jaundice; as lice, millipedes, &c. But thefe do more harm than good, as people truft to them, and neglea more valuable medicines ; befides, they are feldom taken in fuf- ficient quantity to produce any effeas. People always ex- fiea that fuch things fhould aa as charms, and confequent- y feldom perfift in the ufe of them. Vomits, purges, fo- mentations, and exercife, will feldom fail to cure the jaun- dice when it is a fimple difeafe; and when complicated with the dropfy, a fchirrous liver, or other chronic com- plaints, it is hardly to be cured by any means. Numberless Britifh herbs are extolled for the cure of this difeafe. The author of the Medicina Britannica men- tions near a hundred, all famous for curing the jaundice. The foa is, this difeafe often goes off of its own accord ; in which cafe the laft medicine is always faid to have per- formed the cure. 1 have fometimes feen confiderable bene- fit, in a very obftinate jaundice, from a decoaion of hemp- feed. Four ounces of the feed may be boiled in two Eng- lifh quarts of ale, and fweetened with coarfe fugar. The dofe is half an Englifh pint every morning. It may be con- tinued for eight or nine days. I have known Harrowgate fulphur-water cure a jaun- dice of very long flanding. . It fhould be ufed for fome time, and the patient muft both drink and bathe. The foluble tartar is likewife a very proper medicine in the jaundice. A dram of it may be taken every night and morning in a cup of tea or water-gruel. If it does not ope# the belly, the dofe may be increafed. Persons fubjea to the jaundice ought to take as much exercife as poffible, and to avoid all heating and aftringent aliments. CHAP. I 286 ] C H A P. XXXVII. OF THE DROPSY. TH E dropfy is a preternatural fwelling of the whole body, or fome part of it, occafioned by a colleaion of watery humour. It is diftinguifhed by different names, according to the part affeaed, as the anafarca, or a colleaion of water under the fkin ; the afcites, or a colleaion of water in the belly ; the hydrops pecloris, or dropfy of the breaft ; the hydrocephalus, or dropfy of the brain, 6rV. CAUSES.----A very common caufe of the dropfy is a hereditary difpofition. It may likewife proceed from drinking ardent fpirits, or other ftrong liquors. It is true, almoft to a proverb, that great drinkers «iie of a dropfy. Tfie want of exercife is alfo a very common caufe of the dropfy. Hence it is juftly reckoned among the difeafes of the fedentary. It often proceeds from exceflive evacuations, as frequent and copious bleedings, ftrong purges often re± peated, frequent falivations, &c. The fudden ftoppage of cuftomary or neceffary evacuations, as the menfes' the hae- morrhoids, fluxes of the belly, cs'c. may likewife caule a dropfy. I have often known the dropfy occafioned by drinking large quantities of cold, weak, watery liquor when the body was heated by violent exercife. A low, damp, or marfhy fituation is likewife a frequent caufe of it. Hence it is a common difeafe in moift, fiat, fenny countries. It may alfo be brought on by a long ufe of poor watery diet, or of vif- cpus aliment that is hard of digeftion. It is often the effea of other difeafes, as the jaundice, a fchirrus of the liver, a violent ague of long continuance, a diarrhoea, a dyfen- tery v an empyema, or a confumption of the lungs. In fhort, whatever obftruO.s the circulation of the blood, or prevents its being duly prepared, may occafion a dropfy. SYMPTOMS.---This difeafe generally begins with a fwelling of the feet and ancles towards nfoht, which, far fome time, difiiApears in the morning. In the evening M the OF THE DROPSY. 287 the parts, if prefled with the finger, will pit. The fwelling gradually afcends towards the belK, which at length grows big. When it is ftruck with the hand, a fluauation may be felt, and fometimes heard. Afterwards the breathing becomes difficult, the urine is in fmall quantity, and the thirft great j the belly is bound, and the perfpiration is greatly obftruaed. To thefe fucceed torpor, heavinefs, a flow wafting fever, and a troublefome cough. This laft is generally a fatal fymptom, as U fiiews that the lungs are affeaed. When the difeafe comes fuddenly on, and the patient is young and ftrong, there is reafon to hope for a cure, ef- pecially if medicine be given early. But if the patient be old, has led an irregular or a fedentary life, or if there be reafon to fufpea that the liver, lungs, or any of the vifcera are unfound, there is gfeat ground to fear that the confluences will prove fatal. REGIMEN.----The patient muft abftain, as much as poffible, from all drink, efpecially weak and watery li- quors, and muft quench his thirft with muftard-whey, or acids, as juice of lemons, oranges, forrel, or fuch like. His aliment ought to be dry, of a beating and diuretic qua- lity, as toafted bread, the flefh of birds, or other wild ani- mals, roafted ; pungent and aromatic vegetables, as gar- lic, muftard, onions, crefTes, horfe-radilh, rocambole, fha- lot, iffc. He may alfo eat fea-bifcuit dipt in wine or a lit- tle brandy. This 19 not only nourifhing, but tends to quench thirft. Some have been aauaily cured of a dropfy by a total abftinence from all liquids, and living entirely upon focli things as are mentioned above. If the patient muft have drink, the fpaw-water, or Rhenifh wine, with diuretic medicines infufed in it, are the beft. Exercise is of the greateft importance in a dropfy. If the patient.be able to walk, dance, or run about, he ought to continue thefe exercifes as long as he can. If he be not able co walk or run, he muft ride on horfeback, or in a carriage, and the more violent the motion fo much the bet- ter, provided he can bear it. His bed ought to be hard, and the air of his apartments warm and dry. If he lives in a damp country, he ought to be removed into a dry one, and, jf poffible, into "a warmer climate. In a word, every method muft be taken to promote the perfpiration and to brace the folids. For this purpofe it will likewife be proper to a$8 OP THE DROPSY.. to rub the patient's body, two or three times a-day, with a hard cloth or the flefh-brufh, and he ought conftantly to Wear flannel next his fkin. M E D I C I N E.-—If the patient be young, his con- ftitution good, and the difeafe has come on fuddenly, it may generally be removed by ftrong vomits, brifk purges^ and fuch medicines as promote a difcharge of fweat and urine. For an adult half a dram of ipecacuanha in pow- der, and half an ounce of oxymel of fquills, will be a pro- per vomit. This may be repeated three or four times, if neceffary, three or foUrdays intervening betwixt each dofe. The patient muft not drink much after the vomit, other* wife he deftroys its effea. A cup or two of camomile-tea will be fufficient to work it off. Betwixt each vomit, on one of the intermediate daysj the patient may take the following purge: Jalap in powder half a dram, cream of tartar two drams, calomel fix grains. Thefe may be made into a bolus with a little fyrup of pale rofes, and taken early in the morning. The lefs the pa- tient drinks after it the better. If he be much griped, he may take now and then a cup of chicken-broth. The patient may likewife take every night at bed-time the following bolus: To four or five grains of camphor add one grain of opium, and as much fyrup of orange-peel as 16 fufficient to make them into a bolus. This will gene- rally promote a gentle fweat, which fliould be encouraged by drinking now and then a fmall cup of wine-whey, witR a tea-fpoonful of the following diuretic infufion may likewife be taken every four or five hours through the day*. As this difeafe is very apt to return ; after the water has been drained off, to prevents its colleaing again, the pa* tient muft continue to take exercife, to ufe a dry diet, and fuch medicines as ftrengthen and brace the folids, as wine with fleel or bark infufed in it; warm and aromatic bitters infufed in wine or brandy are likewife proper, as the Vir- ginian fnake-root, canella alba, orange-peel, cjfe. The pa- tient * Take juniper-berries, milliard leed, av\<\ horfe-rOifh. of each half an ounce, afhes of bioom half a pound ; infufe them in a quart of Rhenifh wine or ftrong ale for a few days, and afterwards ftrain off the liquor. Such as cannot take this infufion, may ufe the decoclion of feneka-root, which i* loth diuretic and fudorific. OF THE DROPSY. 289 ticnt muft avoid all great evacuations, and ou^ht, if he can, to make choice of a dry warm fituation. The above courfe will often cure an incidental dropfy, if the conftitution be good ; but when the difeafo proceeds from a bad habit, or an unfound ftate cf ths vifcera, ftrong purges and vomits.are not to be ventured upon. In this cafe the fafor courfo is to palliate the fymptoms by the ufe v* foch medicines as promote the fecretions, and to fupport the patient's ftrength by warm and nourifhing cordials. The fecretion of urine may be greatly promoted by ni- tre. Brookes fays, ho knew a young woman who was cured of a dropfy by taking a dram of nitre every morning in a draught of ale, after fhe had been given over as incurabfo. The powder of fquills is likewife a good diuretic. Six or eight grains of it, with a fcruple of nitre, may be given twice a day in a glafs of ftrong cinnamon water. Ball fovs, a large fpoonful of unbruifed muftard-feed taken every nfohc and morning, and drinking half an Englifh pint of the de- codion of the tops of green broom after it, has performed a cure, after other powerful mediciiies had proved incf- fcfiual. I have feen extraordinary effeas from cream of tartir in this difeafe. It promotes the difcharges by ftool ,ini urine, and will cften perform a cure when duly perfifted in. The patient may begin by taking an ounce every fecond or third day, and may increafe the quantity to two or even to three ounces, if the ftomach will bear it. This quantity is not however to be taken at once, but divided into three or four dofes. To promote perfpiration, the patient may ufe the de- cpaion of feneka-root, as direaed above ; or he may take two fpoonfuls of Mindererus's fpirit in a cup of wine-whey three or four times a-day. The diuretic infufion of the London Hofpitals is likewife a very proper medicine in this difeafe fo When other means fail, recourfe muft be fofo to tapping and fcarifications. Thefe often give eafe, though they feldom produce a radical cure. P p CHAP. * Take of zedoary root, two drams; dried fquills, rhubarb, and junipcr- berries bruifed, of each a dram,; cinnamon in powder, three drams ; f:lt <>f wqrmvyood, a dram and an half: infufe in an Engliih pint and a half of old hock wine, and when fit for ufe, Our tbe O.uor. A wine glajs of it 'Vav 0 taken three, or four times a-day. [ 290 ] chap, xxxvm. OF THE GOUT. THERE is no difeafe which fhews the imperfeaion of medicine, or fets the advantages of temperance and exercife in a ftrongcr light than this. Few who pay a proper regard to thefe are troubled with the gout. This points out the true fource from whence that malady origi- nally fprung, viz. excefs and i^lcmfs. It likewife fhews us that the only fafe and efficacious method of cure, or rather of prevention, muft depend, not upon medicine, but on temperance and activity. Though idlenefs and intemperance are the principal caufes of the gout, yet many other things may contribute to bring on the diforder in thofe who are not, and to in- duce a paroxvfm in thofe who are fubjea to it, as intenfe ftudy; too free an ufe of acid liquors; night-watching; grief or uneafinefsof mind ; an obftru6tion or defoa of any of the cuftomary difcharges, as the menfes, fweating of the feet, perfpiration, &c. S Y M P T O M S.----A jit of the gout is generally preceded by indigeftion, drowfinefs, wind, a flight head- ach, ficknefs, and fometimes vomiting. The patient com- plains of wearinefs and dejeaion of fpirits, and has often a pain in the limhs, with a fenfation as if wind or cold water 0 were paffing down the thigh. The appetite is often re- markably keen a day or two before the fit, and there is a ilight pain in paffing urine, and fometimes an involun- tary fhedding of tears. Sometimes thefe fymptoms are much more violent, efpecially upon the near approach of the fit; and fome obferve, that as the fever which ufhers in the gout is, fo will the fit be ; if the fever be fhort and foarp, the fit will be fo likewife ; if it be feeble, long, and lingering, thefit will be fuch alfo. But this obfervation can only hold with refpea to very regular fits of the gout, The regular gout generally makes its attack in the fpring, or beginning of winter, in the following manner: About two or three in the morning, the patient is feized vvith OF THE fJOUT. 291 with a pain in his great toe, fometimes in the heel, and at other times in the ancle or calf of the leg. This pain is accompanied with a fenfation, as if cold water were poured upon the part, which is fucceeded by a fhivering, with fome degree of fever. Afterwards the pain increafes, and fixing among the fmall bones of the foot, the patient feels all the different kinds of torture, as if the part were ftretch- cd, burnt, fqueezed, gnawed, or torn in pieces, cffo. The part at length becomes fo exquifitely feniible, that the pa- tient cannot bear to have it touched, or even fuffer aiiy perfon to walk acrols the room. The patient is generally in exquifite torture for twenty- four hours, from the time of the coming on of the fit: He then becomes eafier, the'part begins to fwell, appears red, and is covered with a little moiflure. Towards morn- ing he drops aifoep, and generally falls into a gentle breathing fweat. This terminates the firft paroxyfm, a number of which conftitutes a fit of the gout ; which is longer or fhorter according, to the patient's age, ftrength, the feafon of the year, and the difpofition of the body ta this difeafe. The patient is always worfe towards night, and eafier in the morning. The paroxyfms hov/ever generally grow milder every day, till at length the difeafe is carried off" by perfpiration, urine, and the other evacuations. In fome patients this happens in a few days ; in others, it requires weeks, and in fome, months, to finifh the fit. Thofe whom age and frequent fits of the gout have greatly debi- litated, feldom get free of it before the approach of fum- mer, and fometimes not till it be pretty far advanced. REGIMEN.----As there are no medicines, yet known, that will cure the gout, we fhall confine our ob- fervations chiefly to regimen, both in and out of the fit. In the fit* if the patient be young and ftrong, his diet ought to be thin and cooling, and his drink of a di- luting nature; but where the conftitution is weak, and theu patient has been accuftomed to live high, this is not a pro- per time to retrench. In this cafe he muft keep nearly to his ufual diet, and fhould take frequently a cup of ftrong negas, or a glafs of generous wine. Wine-whey is a very proper drink in this cafe, as it promotes the perfpiration without greatly heating the patient." It will anfwer this purpofe beuer if a tea-fpoonful of fal volatile oleofum, or fpirits tcyi OF THE GOUT. fpirits of haftfhorn, be put into a cup of it twice a-day. It will likewife be proper to give at bed-time a tea-ipoonful of the volatile tinaure of guaiacum.in a large draught of warm wilu-whey. This will greatly promote perfpiration through the night. As the moft fafe and efficacious method of discharging the gouty matter is by perfpiration, this ought to be kept up by all means, efpecially in the sffeaed part. For this purpofe the leg and foot fhould be wrapt in foft flannel, fur, or wool. The laft is moft readily obtained, and feems to.anfwer the purpofe better than any thing elfe. The people of Lancafhire look upon wool as a kind of fpecific in the gout. They wrap a great quantity of it about the fog and foot affeaed, and cover it with a fkin of foft drefled foather. This they fuffer to continue for eight or ten days, and fometimes for a fortnight or three weeks, or longer if the pain does not ceafe. 1 never knew any external appli- cation anfwer fo well in the gout. I have often feen it ap- plied when the fwelling and inflammation were very great, with violent pain, and have found all thefe fymptoms re- lieved by it in a few days. The wool which they ufe is generally greafed, and carded or combed. They chufe the fofteft which can be had, and feldom-oc never remove it till the fit be entirely gone off. The patient ought likewife to be kept quiet and eafy during the fit. Every thing that aftfoas the mind difturbs the paroxyfm, and tends to throw the gout upon the nobler parts. All external applications that repel the matter are to be avoided as death. They do not cure the difeafe, but remove it from a fafer to a more dangerous part of the body, where it often proves fatal. A fit of the gout is rather to be confidered as Nature's method of curing a difeafe than •the difeafe itfelf, and all that we can do, with fafety,\isto promote her intentions, and to aflift her in expelling the enemy in her own way. Evacuations by bleeding, ftool, &c. .are lihswife to be ufed with caution ; they do not remove the caufe of the difeafo, and fometimes by weakening the patient prolong the fit: But, where the.conftitution is able to bear it, it will be of ufe to keep the belly gently open by diet, or very mild laxative medicines. Many things will indeed fhorten a fit of the gout, and fome will drive it off altogether; but nothing has yet been fouivi vvbich will do thi> with fafety to the patient. In pain we OF THE GOUT, -9 j we eagerly grafp at any thing that promifes immediate eafe, and even hazard life itfelf for a temporary relief. This is the true reafon why fo many infallible remedies have been propofed for the gout, and why fuch numbers have loft their lives by the ufe of them. It would be as prudent to ftop the fmall-pox from rifing, and to drive them into the blood, as to attempt to repefthe gouty matter after it has been thrown upon the extremities. The latter is as much au effort of Nature to free herfelf from an offending caufs as the former, and ought equally to be promoted. When the pain however is very great, and the patient is reftlefs, thirty or forty drops of laudanum, more or lefs, according to the violence of the fymptoms, may be taken at bed-time. This will eafe the pain, procure reft, pro- mote perfpiration, and forward the crifis of the difeafe. After the fit is over, the patient ought to take a gen- tle dofe or two of the bitter tfoaure of rhubarb, or fome other warm ftomachic purge. He fhould alfo drink a weak infufion of ftomachic bitters in fmall wine or ale, as Gen- tian, or bark with cinnamon, Virginian fnake-root, and orange-peel. The diet at this time fhould be light, but nourifhing, and gentle exercife ought to be taken on horfe- fock 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 diforder, or rendering the fit, if it fliould return, lefs fevere. This however is not to be attempted by medicine. I have fre- quently known the gout kept off for feveral years by the Peruvian bark and other medicines; but in ail the cafes where I had occafion to fee this tried, the perfons died fud- denly,, and, to all appearance, for want of a regular fit of the gout. One would be apt, from hence, to conclude, that a fit of the gout, to fome conftitutions, in the decline of life, is rather falutary than hurtful. Though it may be dangerous to flop a fit of the gout by medicine, yet if the conftitution can be fo changed by diet and exercife, as to leffen or totally prevent its return, there certainly can be no danger in following fuch a courfe. It is well known that the whole habit may be fo foered by a proper regimen, as quite to eradicate tnis tiifeafo; and thofe only who have fufficient refolution to pcifift i,n fuck a cburfe, have reafon to cxpea a cure. The ftgr+ OF THE GOUT1. The courfe which we would recommend for preventing the gout, is as follows: In the firft place, univerfal tem- perance. In the next place, fufficient exercife. By this we do not mean fauntcring about in an indolent manner, but labour, fweat, and toil. Thefe only can render the hu- mours wholefome, and keep them fo. Going early to bed, and riling by times, are alfo of great importance. It is likewife proper to avoid night ftudies, and all intenfe thought. The fupper fliould be light, and taken early, All ftrong liquors, efpecially generous wines and four punch, are to be avoided. Wz would likewife recommend fome dofes of magnefid aiba and rhubarb to be taken every fpring and autumn; and, afterwards a courfe of ftomachic bitters, as tanfy or wat^r-Oefoil-tea, an infufion of gentian and camomile flowers, or a decoaion of burdoek-root, He. Any of thefe, or an infufion of any wholefome bitter that is more agreeable to the patient, may be drank for two or three weeks in March' and Oaober twice a-day. An iffae or* crpetual blifter has a great tendency to prevent the gout. f thefe were more generally ufed in the decline of life, they would not only often prevent the gout, but alfo other chronic maladies. Such as can afford to go to Bath, will find great benefit from- bathing and drinking the water. It both promotes digeftion and invigorates the habit. When the gout attacks the head or lungs, every me- thod muft be talcen to draw it towards the feet. They muft be frequently "bathed in warm water, and acrid cata- plafms applied to the foles. Bliftering plafters ought like- wife Ofo'be applied to the ancles or calves of the legs. Bleefong in the feet or ancles is alfo neceffary, and warm ftomachic purges. The patient ought to keep in bed for the moft part, if there be any figns of inflammation, and fhould be very careful net to catch cold. If itjpttacks the ftomach with a fenfe of cold, the moft warm cardials are neceffary; as ftrong wine, cinnamon- water,' peppermint-water, and even brandy or rum. The patient fhould keep his bed, and endeavour to promote a fweat by drinking warm liquors ; and if he fhould be* troubled with a naufea, or inclination to vomit, he may drink camcrnile-tea or any thing that will make him vo- mit freely. When OF THE GOUT. 295. When the gout attacks the kidneys, and imitates gra- vel-pains, the patient ought to drink freely of a decocfion of marfh-mallows, and to have the parts fomented with warm water. An emollient clyfter ought likewife to be given, and afterwards an opiate. If the pain be very vio- lent, twenty or thirty drops of laudanum may be taken in a cup of the decoaion. Persons who have had the gout fhould be very atten- tive to any complaints that may happen to them about the time when they have reafon to expea a return of the fit. The gout i nitates many other diforders, and by being miftaken for them, and treated improperly, is often divert- ed from its regular courfe, to the great danger of the pati- ent's life. Those who never had the gout, but who, from their conftitution or manner of living, have reafon to expea it, ought likewife to be very circumfpea with regard to its firft approach, If the difeafe, by wrong condua or im- proper medicines, be diverted from its proper courfe, the rhiferable patient has a chance to be ever after tormented, with head-achs, coughs, pains of the ftomach and intef- tines ; and to fall, at laft, a viaim to its attack upon fome pf the more noble parts. Of the RHEUMATISM. This difeafe has great affinity to the gout. It generally attacks the joints with exquifite pain, and is fometimes at-. tended with inflammation and fwelling. It is moft com- mon in the fpring and towards the end of autumn, -t is ufually diftinguifhed into acute and chronic; or the rheu- matifm with and without a fever. CAUSE S.----The caufes of a rheumatifm are fre- quently the fame as thofe of an inflammatory fever; viz. an obftruaed perfpiration, the immoderate ufe of ftrong liquors, and the like. Sudden changes of the weather, and all quick tranfitions from heat to cold, are very apt to occafion the rheumatifm. The moft extraordinary cafe of a rheumatifm that I e^ver faw, where almoft every joint of the body was diftortcd, was in a man who ufed to work one part of the day by the fire, and the ether part of it in \he water. Very obftinate rheurnatifms have likewife been brought $96 OF THE RHEUMATISM. brought on by perfons, not accuftomed to it, allowing their foet to continue long wet. The fame effeas are often pio- duced by wet clothes, damp beds, or lying upon the ground, efpecially in the night. The rheumatifm may likewife be occafioned by excef- five evacuations, or the ftoppage of ufual difcharges. It is often the effea of chronic difeafes, which vitiate the hu- mours ; as the fcurvy, the lues venena, obftinate autum- nal agues, cffo. The rheumatifm prevails moft in low, damp, marfhy countries. It is likewife very common amongft the pooler fort oi peafants, who are ill clothed, live in low, cold hoiifes, and eat eoaife unwholefome food, which contains but little nourifhment, and is not eafily digefted. SYMPTOMS.---The acute rheumatifm com- monly begins with wcarinefs? fhivering, a quick pulfe, reft- Jeffnefs, thirft, and other fymptoms of fever. Afterward? the patient complains of flying pains, which are increafed by the leaft motion. Thefe at length fix in the joints, which are often affeaed with fwelling and inflammation. If blood be let in this difeafe, it has generally the fame ap* pearance as in the pleurify. In this kind of rheumatifm the treatment of the patient is nearly the fame as in an acute or inflammatory fever. If he be youm' and ftrong, bleeding is neceffary, which may be repeated according to the exigencies of the cafe. The belly ought likewife to be kept open by emollient clyfters, or cool opening liquors ; as decoaions of tamarinds, cream* tartar-whey, fenna tea, and the like. The diet fhould bq light, and in fmall quantity, confifting chiefly of roafted apples, groat-gruel, or weak chicken-broth. After the feverifh fymptoms have abated, if the pain ftill continues, the patient muft keep his bed, and take fuch things as promote perfpiration ; as wine-whey, with fpiritus Minde- reri,\£c. The patient may likewife take, for a few nights, at bed-time, in a cup of wine-whey, a dram of the cream of tartar, and half a dram of gum guaiacum in powder. W'&rm bathing, after proper evacuations, has often dk exceeding good effea. The patient may either be put in- to a bath of warm water, or have cltfths wrung out of it applied to the parts affeaed. Great care muft be taken that he do not catch cold after bathing, Th*' OF THE RHEUMATISM. 297 The chronic rheumatifm is feldom attended with any Confiderable degree of fever, and is generally confined to fome particular part of the body, as the fhoulders, the back, or the loins. There is feldom any" inflammation or fwelling in this cafe. Perfons in the decline of life are moft fubjea to the chronic rheumatifm. In fuch patients it often provesextremely obftinate, and fometimes incurable. In this kind of rheumatifm the regimen fliould be near- ly the fame as in the acute. Cool and diluting diet, con- fiding chiefly of vegetable fubftances, as ftewed prunes, coddled apples, currants or goofeberrics boiled in roilk, is moft proper. Arbuthnot fays, " If there be a fpecific in aliment for the rheumatifm, it is certainly whey ;" ami adds, " That he knew a perfon fubjea to this difeafo, who could never be cured by any other method but a diet of whey and bread." He likewife fays, " That cream of tartar in water-grucl, taken fur feveral days, will eaO rheumatic pains confiderably." This I have often expe- rienced, but found it always more efficacious when joined with gum guaiacum, as already direaed. In this cafe the patient may take the dofe formerly mentioned twice a-day, and likewife a tea-fpoonful of the volatile tinaure of gum guaiacum, at bed-time, in wine-whey. This courfe may be continued for a week, or lono-er, if the cafe proves ojftinate, and the patient's ftrength will permit. It ought then to be omitted for a few days, and repeated again. At the fame time leeches or a bliftering plafter may be applied to the part affeaed. What I have generally found anfwer better than either of thefe, in cb-» ftinate fixed rheumatic pains, is the zuarm plafler *. 1 have likewife known a plafter of Burgundy-pitch worn for fome time on the part affeaed give great relief in obftinate rheu- matic pains. My ingenious friend Dr. Alexander' of Edinburgh fays, he has frequently cured very ohftin:it.j rheumatic pains by rubbing the part affoaed with tinaure of cantharides. When the common tinaure did not fuc- ceed, he ufed it of a double or tteble ftrength. Cupping „ Q_q upon * The warm pLiflrr is made by melting over a a^ntlefire an ounce of "r'.im plafler and two drams of blidering plafler. A proper qun.uity of this may be fpread upon foft leather, and applied to the part affectjd. It fhould be taken orl'and wiped once in three or four days; and may !.+ renewed once a foin.j^iit. 298 OF THE RHEUM AT IS M. upon the part affeaed is likewife often very beneficial, and is greatly preferable to the application of leeches. Though this difeafe may not feem in the leaft to yield , to medicines for fome time, yet they ought ftill to be per- Tifted in. Perfons who are fubjea to frequent returns of the rheumatifm, will often find their account in ufing me- „ dicines, whether they be immediately affeaed with the dif- eafe or not. The chronic rheumatifm is fimilar to the gout in this refpea, that the moft proper time for ufing medicines to extirpate it, is when the patient is moft free from it. To thofe who can afford the expence, we would re- commend the warm baths of Buxton or Matlock in Der- byfhire. Thefe have often cured very obftinate rheuma- tifms, and are always fafe either in or out of the fit. When the rheumatifm is complicated with foorbutic complaints, which is not feldom the cafe, the II urrowgatc waters and thofe of Moffat are proper. They fhould both be drank and ufed as a warm bath. There are feveral of our own domeftic plants which may be ufed with advantage in the rheumatilm. One of the beft is the white muftard. A table-fpoonful of the feed of this plant may be taken twice or thrice a-day, in a glafs i of water or fmall wine. The water-trefoil is likewife of great ufe in this complaint. It may be infufed in wine or ale, or drank in form of tea. The ground-ivy, camomile, and feveral other bitters, are alfo beneficial, and may be ufed in the fame manner. No benefit however is to beex- peaed from thefe unlefs they be ufed for a confiderable time. Excellent medicines are often defpifed in this cafe, becaufe they do not perform a cure inftantaneoufly ; where- as nothing would be more certain than their effea, were they ufed for a fufficient length of time. The want of perfeverance in the ufe of medicines is one of the principal reafons why chronic difeafes are fo feldom cured. Cold bathfoj, efpecially in fait water, often cures the rheumatifm. We would alfo recommend riding on horfe- back, and wearing flannel next the fkin. lifues are like- wife very proper, efpecially in the chronic rheumatifm. If the pain affoas the fhoulders, an iffue may be made in the arm ; but if it affeas^the loins, it fhould be put in the leg or thigh. Rheumatic perfons ought to make choice of a dry warm air, to avoid getting wet as much as pofffole, and to make frequent ufe of the flefh-brufh. C H A P. ^1 C 299 ] C If A P. XXXIX. OF THE SCURVY. TH I S difeafe prevails chiefly in cold northern coun- tries, efpecially in low damp fituations, near large marfhes, or great quantities of ftagnating water. -Sedentary people of a dull melancholy difpofition are moft fubjea to it. It proves often fatal to failors on long voyages, parti- cularly in fliips that are not properly ventilated, have many people on board, or where cleanlinefs is negleaed. CAUSE S.----The fcurvy is occafioned hy cold moift air; by the long ufe of fa!ted or fmoke-dried provifions, or of any kind of food that is hard of digeftion, art 1 affords little nourifhment. It may alfo proceed from the foppref- fion of cuftomary evacuations ; as the menfes, the haemorr- hoidal flux, &c. It is fometimes owing to a hereditary taint, in which cafe a very fmall caufe will excite the la- tent diforder. Grief, fear, and other deprcfling paffions, have a great tendency both to excite and aggravate this dif- eafe. It may likewife proceed from neglca of cleanlinefs ; bad clothing ; the want of proper exercife; confined ajr ; unwholefome food ; or from any difeafe which greatly weakens the body or vitiates the humours. S Y M P T O M S.----This difeafe may be known by unufual wearinefs, heavinefs, and difficulty of breathinLr, efpecially after motion ; rottennefsof the gums, which ar preferved ones may be ufed ; and where thefe are want- ing, recourfe muft be had to the chymical acids. All the patient's food and drink fhould in this cafe be fharpened with cream of tartar, elixir of vitriol, vinegar, or the fpi- rit of fea-fait, ifc These things however will more certainly prevent than, cure the fcurvy ; for which reafon fea-faring people, efpe- cially on long voyages, ought to lay in plenty of them. Cabbages, onions, goofebenies, and many other vegetables, may be kept a long time by pickling, preferving, &c. and when thefe fail, the chymical acids, recommended above, which will keep for any length of time, may be ufed. We have reafon to believe, if ftiips were well ventilated, had OF THE SCURVY. 30T good ftorc of fruits, greens, cyder, (Jc. laid in, and if pro- per regard were paid to cleanlinefs and warmth, that failors would be the moft healthy people in the world, and would feldom fuffor either from the fcurvy or putrid fevers, which are fo fatal to that ufeful fet of men ; but it ii too much „ the temper of fuch people to defpife all precaution ; they will not think Of any calamity till it overtakes them, when it is too late to ward off the blow. It muft indeed be owned, that many of them have it not in their power to make the provifion we are fpeaking of; but in this cafo it is the duty of their employers to make it for them ; and no man ought to engage in a long voyage without having thefe articles fecured. I have often feen very extraordinary effeas in the fcur- vy from a milk-diet. This preparation of nature is a mix- ture of animal and vegetable properties, which of all others is the moft fit for reftoring a decayed conftitution, and re- moving that particular acrimony of the humours, which feems to conftitute the very effence of the fcurvy, and many other difeafes. But people defpife this wholefome and nou- rifhing food, becaufe it is cheap, and devour with greedi- nefs, ffofh, and fermented liquors, while milk is only deem- ed fit for their hogs. The moft proper drink in the Scurvy is whey or butter- milk. When thefe cannot be had, found cyder or perry may be ufed. Wort has likewife been found to be a proper drink in the fcurvy, and may be ufed at fea, as malt will keep during the longeft voyage. A decoaion of the tops of the fpruce fir is likewife proper. It may be drank in the quantity of an Englifh pint twice a-day. Tar-water may be ufed for the fame purpofe, or decoctions of any of the mild mucilaginous vegetables ; as farfaparilla, marfhmallow- roots, iffc. Infufions of the bitter plants, as ground-ivy, the lefler centaury, marfh trefoil, &c. are likewife benefi- cial. I have feen the peafants in fome parts of Britain ex- prefs the juice of the 1 aft-mentioned plant, and drink it with good effeas in thofe foul fcorbutic eruptions with which they are often troubled in the fpring feafon. The Ilarrowgate-water is certainly an excellent medi- cine in the fcurvy. I have often feen patients who had been reduced to the moft deplorable condition by that difeafe, greatly relieved by drinking tne fulphur-water, and bathing in it. The Chalybcate-war,er may alfo be ufed with advan- tage, 30a OF THE SCURVY. tage, efpecially with a view to brace the ftomach after drinking the fulphur-water, which, though it fliarpens the appetite, never fails to weaken the powers of digeftion. A slight degree of fcurvy may be carried off by fre- quently fucking a little of the juice of a bitter orange, or a lemon. When the difeafe afteas the gums onlv, this prac- tice, if continued for fome time, will generally carry it off. We would however recommend the bitter orange as great- ly preferable to lemon ; i{ feems to be as good a medicin-, and is not near fo hurtful to the ftomach. Perhaps our own forrel may be little inferior to either of them. All kinds of falad are good in the fcurvy, and ought toy be eat very plentifully, as fp'inagc, lettice, parfley, celery, endive, radiih, dandelion, &c. It is amazing to fee how foon frefh vegetables, in the fpring cure the brute animals of any fcab or foulnefs which is upon their fkins. It is reafon- able to fuppofe that their effeas would be as great upon the human fpecies, were they ufed in proper quantity for a fuf- ficient length of time. , The Leprosy, which was fo common in this country long ago, feems to have been near a-kin to the fcurvy. Per- haps its appearing fo feldom now, may be owing to the in- * habitants of Britain eating more vegetable food than for- merly, living more upon tea and other diluting diet, ufing lefs faked meat, being more cleanly, better lodged and clothed, &c. For the cure of this difeafe we would recom- mend the fame courfe of diet and medicine as in the fcurvy. Of the SCROPHULA, or KING'S EVIL. This difeafe chiefly affeas the glands, efpecially thofe of the neck. Children and young perfons of a fedentary life are very fubjea to it. It is one of thofe difeafes that may be removed by proper regimen, but feldom yields to medi- cine. The inhabitants of cold, damp, marfhy countries are moft liable to the fcrophula. CAUSES.----This difeafe may proceed from a here- ditary taint, infeaion from a fcrophulous nurfe, 13c. Chil- dren who have the misfortune to be born of fickly parents, whofe conftitutions have been greatly injured by the French pox, or other chronic difeafes, are apt to be affeaed with OF THE KING'S EVIL. 303 the fcrophula. It may likewife proceed from fuch difeafes as weaken the habit or viti ite the humours, as the fmall- pox, meafles, &c. External injuries, as blows, bruifes, and the like, fometimes produce fcrophulous ulcers ; but we h«ive reafon to believe, when this happens, that there has been a predifpofition in the habit to this difeafe. In fhort, whatever tends to vitiate the humours or relax the folids, paves the way to the fcrophula ; as the want of proper ex- ercife, too much heat or cold, cc-nfined air, unwholefome food, bad wattir, the long ufe of poor, weak, watery ali- ments, the neglea of cleanlinefs, c*rV. Nothing tends more £0 induce this difeafe in children than allowing them to con- tinue long wet. SYMPTOM S.---At fiift fmall knots appear under the chin or behind the ears, which gradually increafe in number and fize, till they form one large hard tumour. This often continues for a long time without breaking, and when it does break, it only difcharges a thinfanies or wate- ry humour. Other parts,of the body are likewife liable to its attack, as the arm-pits, groins, feet, hands, eyes, breafts, Cfo Nor are the internal parts exempt from it. It often af- fects the lungs, liver or fpleen ; and I have frequently feen the glands of the myfentery greatly enlarged*by it. These obftinate ulcers which break out upon the feet and hands with fwelling, and little or no rednefs, are of the fcrophulous kind. They feldom difcharge good matter, and are exceeding difficult to cure. The white fwellingt of the ioints feem likewife to be of this kind. They are wjth dif- ficulty brought to a fuppuration, and when qpened they only difcharge a thin ichor. There is not a more general fymptom of the fcrophula than a fwelling of the upper lip and nofe. REGIMEN.----As this difeafe proceeds, in a great ficafure, from relaxation, the diet ought to be generous and nourifhing, but at the fame time light and eafy of di- geftion ; as well fermented bread, made of found grain, the ffofh and broth of young animals, with now ami then a ^lafs of generous wine or good ale. The air outfit to be open, dry, and not too cold, and the patient fhould take as much'exercife as he can bear. This is of the utmoft importance. Children who have enough of exercife are feldom troubled with the fcrophula. MEDICINE. f 304. OF THE SCR OP HULA, M E D I C I N E.----The vulgar are remarkably ere* dulous with regard to the cure of the fcrophula, many of them believing in the virtue of the royal touch, that of the feventh fon, &c. The truth is, we know but little either of the nature or cure of this difeafe, and where reafon or medicines fail, fuperfHtion always comes in their .place. Hence it is, that in difeafes which are the moft difficult to underftand, we generally hear of the greateft number of miraculous cures being performed. Here, however, the deception is eafily accounted for. The fcrophula, at a certain period of life, often cures of itfelf; and, if the pa- tient happens to be touched about this time, the cure is im-J| puted to the touch, and not to nature, who is really the phyfician. In the fame way the infignificant noftrums.of quacks and old women often gain applaufe when they de- ferve none. There is nothing more pernicious than the cuftom of plying children in the fcrophula with ftrong purgative me- dicines. People imagine, it proceeds from humours which muft be purged off, without conlidering, that thefe purga- tives increafe the relaxation and aggravate the difeafe. It has indeed been found that keeping the belly gently open, for fome time, efpecially with fea-water, has a good effea ; but this fhould only be given in fuch quantity as to procure one, or at moft two ftools every day. Bathing in the fait- water has likewife a very good effea, efpecially in the warm feafon.' I have often known a courfe of bathing in falt- water, and drinking it in fuch quantities as to keep the bel- ly gently open, cure a fcrophula, after many medicines had been tried in vain. When falt-water cannot be obtained, the patient may be bathed in frefh-water, and his belly kept open by fmall quantities of fait and wateu, or fome ether mild purgative. Next to cold bathing and drinking the falt-water, we would recommend the Peruvian bark. The cold bath mly be ufed in fummer, and the bark in winter. To an adult half a dram of the bark in powder may be given, in a glafs of red wine, four or five times a-day. Children, and fuch as cannot take it in fubftance, may ufe the decoaion *. Thb * The deco&ion may be made by boiling an ounce of Peruvian bark and a dram of Wintet's bark, both jjraf.ly powdered, in an Englifh quart of watu • * KING'S EVIL. 3o5 The Moffat and Hairrowgate waters, efpecially the lat- ter, are likewife very proper medicines in the fcrophula. They ought not however to bo drank in large quantities, but fhould be taken fo as to keep the belly gently open, and muft be ufed for a confiderable time. External applications are of little ufe. Before the tumour breaks, nothing ought to be applied to it, unlefs a piece of flannel, or fomething to keep it warm. After it breaks, the fore may be drelfed with fome digeftive oint- ment. What I have always found to anfwer bell, was the yellow bafilicon mixed with about a fixth or eighth part of * its weight of red precipitate of mercury. The fore may be dreffcd with this twice a-day ; and if it be very fungous, and does not digeft well, a larger proportion of the preci- pitate may be added. Medicimes which mitigate this difeafe, though they do not cure it, are not to be defpifed. If the patient can be kept alive by any means till he arrives at the age of puber- ty, 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 fo apt to com- municate to their offspring as the fcrophula, for which rea- fon people ought to beware of marrying into families af- feaed with this difeafe. For the means of preventing the fcrophula, we muft refer the reader to the obfervations on nurfing, at the be- ginning of the book. Of the ITCH. Though this difeafe is commonly communicated by in- feaion, yet it feldom prevails where due regard is paid to cleanlinefs, frefh air, and wholefome diet. It generally appears in form of fmall watery puftules, firft about the wrifts, or between the fingers ; afterwards it aflcas the arms, legs, and thighs, £3c. Thefe puftules are attended R 1 with water to a pint: towards the end \\:.\f an ounce of fliced liquorice-root, ani a handful of railins may be adJ-.-d, which will both render the dccoftion Lsfs ..iijgrceabk-, uiul make it take up m«re of the bark. The liquor muft be (trained, and two, three, or four tablc-ff oo.ifuls, iccoriinj to the ajje * tl.e oaticut, given iOit tii*;<-:. a-day. 306 O F T H E I T C H. with an intolerable itching, efpecially when the patient is warm a-bed, or fits by the fire. Sometimes indeed the fkin is covered with large blotches or fcabs, and at other times with a white fcurf, or icaly eruption. This laft is called the dry itch, and is the moft difficult to cure. The itch is feldom a dangerous difeafe, unlefs when it is rendered fo by neglea or improper treatment. If it be fuffered to continue too long, it may vitiate the whole mafs of humours ; and, if it be fuddenly drove in, without pro- per evacuations, it may occafion fevers, inflammations of the vifcera, or other internal diforders. The beft medicine yet known for the itch is fulphur,., which ought to be ufed both externally and internally. The parts moft affoaed may be rubbed with an ointment made of the flowers of fulphur two ounces; crude fal am- moniac, finely powdered, two drams ; hog's lard, or but- ter, four ounces. If a foruple or half a dram of the effence of lemon be added, it will entirely take away the difagres- ablc fmell. About the bulk of a nutmeg of this may be rubbed upon the extremities, at bed time, twice or thrice a-week. It is feldom neceffary 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 ftop too many pores at the lame time. Before the patient begins to ufe the ointment, he ought, if he be of a full habit, to bleed and take a purge or two. .It will likewife be proper, during the ufe of it, to take every night and morning as much of the flower of biimftone, and cream of tartar, in a little treacle or new- milk, as will keep the belly gently open. He fhould be- ware of catching cold, fhould wear more clothes than ufual, and tak£ every thing warm. The fame clothes, the linen excepted, ought to be worn all the time of ufing the oint- mest; and fuch clothes as have been worn* while the pati- ent was under the difeafe, are not to be ufed again, unlefs they have been fumigated with brimftone, and thoroughly cleaned, otherwife they will communicate the infection aiu-w. I nzver knew brimftone, if ufed as direaed above, fail to cure the itch; and I have reafon to believe, that, if duly pcrfifted in, it never will fail; but if it be only ufed once or twice, and cleanlinefs negleaed, it 13 no wonder if the diforder returns. The quantity of ointment menth- >*QCd O F T H E I T C H. 307 ened above will generally be fufficient for the cure of one perfon ; but, if any fymptoms of the difeafe fhould appear again, the medicine may be repeated. -It is both more fafe and efficacious when perfifted in for a confiderable time, than when a large quantity is applied at once. People ought to be extremely cautious left they take other eruptions for the itch ; as the ftoppage cf thefe may be attended with fatal confequences. Many of the eruptive diforders to which children are liable, have a near refem-\ blance to this difeafe ; and I have often known infants kill-* ed by being rubbed with greafy ointments that made thefe eruptions ftrike fuddenly in, which nature had thrown out to preferve the patient's life, or prevent fome other malady, Much mifchief is likewife done by the ufe of mercury in this difeafe. Some perfons are fo fool-hardy as to w'aith the parts affeaed with a ftrong folution of the corrofive fublimate. Others ufe the mercurial ointment, without taking the leaft care either to avoid cold, keep the belly open, or obferve a proper regimen. The confequences of foch condua may be eafily guefled. I have known even the mercurial girdles produce tragical effeas, and would advife every perfon, as he values his health, to beware how he ufes them. Mercury ought never to be ufed as a medi- cine without the greateft care. Ignorant people look up- on thefe girdles as a kind of charm, without confidering that the mercury enters the blood. As fulphur is both the moft fafe and efficacious mediciue for the itch, we fhall not recommend any other. Other medicines may be ufed by perfons of fkill, but are not to be ventured upon by the ignorant. Those who would avoid this deteftable difeafe ought to beware of infoaed perfons, to ufe wholefome food, and to ftudy univerfal cleanlinefs *. CHAP. * The itch is now by cleanlinefs banifhed from every genteel family irt Britain. It ftill however prevails among the poorer fort of peasants in Scot- land, and yet more among the manufacturers in England. Thefe are not only fufficient to keep the feeds of the difeafe alive, but to fpread the int^c-s tion among others. It were to be wifhed that fome effectual method coo'J be devifed for extirpating'it altogether. Several country clergymen have ' >! lerian-tea, twice or thrice a-day. Sometimes a vomit has a very good effoa, and fnatches the patient, as it were, from the jaws of d^ath. This however will be more fafe after other evacuations have been premifed. In the moift afthma, fuch things as promote expeaora- . tion or fpitting ought to be ufed ; as rtie fyrup of fquills, gum-ammoniac, and fuch like. A common fpoonful of j the forup.or oxymell of fquills, mixed with an equal quan- tity of cinnamon-water, may be taken three or four times a-day ; and four or five pills made of equal parts of afafce- tida and gum-ammoniac may be taken every night at bed- time. ""• For the convulfive or nervous afthma, antifpafmodics and bracers are the moft proper medicines. The patient may fake a tea-fpoonful of foe paregoric elixir twice a-day. The foruvian bark is likewife proper in this cafe. It may be tr.-en in fubftance, or infufed in wine. In fhort, every thin that braces the nerves, or takes off fpafm, may be of ufe i a nervous afthma. It is often relieved by the ufe of affes folk ; I have likewife known cows milk drank warm in the morning have a very good effea in this cafe. In every fpecies of afthma, fotons and iffues have a good effea; they may either be fet in the back or fide, and fhould never be allowed to dry up. We fhall here, once for all, obfervc, that not only in the afthma, but in moll chronic ,difeafes, ilfues are extremely proper. They are both a fafe and efficacious remedy ; and though they do not always cure the difeafe, yet they will often prolong the \ patient/s life. CHAP, C.3" ] C II A P. XLI. OF THE APOPLEXY. TH E apoplexy is a fudden lofs of fenfe and motion, wherein the patient is to all appearance dead ; the heart and lungs however ftill continue to move. This dif- eafe, by a little care, might often be prevented, but can feldom be cured. It chiefly attacks fedentary perfons of a grofs habit, who ufe a rich and plentiful diet, and indulge in ftrdng liquors. People in the decline of life are moll fubjea to the apoplexy. It prevails moft in winter, efpe- cially in long rainy feafons, and very low flares of foe ba- rometer. C AU S E S.—.The immediate caufe of an apoplexy is a compreffion of the brain, occafioned by an effuf^oft of blood, or a colleaion of watery humours. The former is called a fanguine, and the latter a ferous apoplexy. It may be occafioned by any thing that increafes the circulation towards the brain, or prevents the return of the blood from the head ; as intenfe ftudy ; violent paffions * ; viewing objeas for a long time obliquely ; wearing any thing too tight about the neck ; a rich and luxurious diet; fuppref- fion of urine; fuffering the body to cocl fuddenly after having been very hot; continuing long in a warm bath ; the exceflive ufe of fpiceries, or high-feafoned food ; ex- cefs of venery ; the fudden ftriking in of any eruption ; fuf- fering iffues, fetons, crV. fuddenly to dry up, or the flop- pag;e of any cuftomary evacuation ; a mercurial falivation pufhed too far, or fuddenly checked by cold ; wounds or bruifes on the head ; long expofure to exceffive cold; poifonous exhalations, fofo. / SYMPTOMS, * I knew a woman who in a violent fit of anger was feized with a lan- crinc apoplexy. She at firft complained of extreme pain, as if daggers had k , :hru]t turouth her head, as fie erpnfcd it. Afterwards (he became co- rmtOe her pulfe ftmk verv low, and was exceeding flow. By bleeding, blillcrin-r, and otO-r evacufoons, fhe was k-;i alive lor a'.out a fortnight. When her head was op, , large .,-,f.t;. U ...rvavOa-a blood was found in the kit venule!,; of the biain. 312 OF THE APOPLEXY. SYMPTOMS, and method of cure.——The ufual forerunners of an apoplexy are giddinefs, pain and iwim- ming of the head ; lofs of memory ; drowfinefs; noife in the ears ; the night-mare ; a fpontaneous flux-of tears, and laborious refpiration. When perfons of an apopleaic make obferve thefe fymptoms, they have reafon to fear the ap- proach of a fit, and fhould endeavour to prevent it by bleeding, a flender diet, and opening medicines. In the fanguine apoplexy, if the patient does not die fuddenly, the countenance appears florid, the face is fwell- ed or puffed up, and the blood-veflels, efpecially about the neck and temples, are turgid j the pulfe beats ftrong ; the eyes are prominent and fixed, and the breathing is difficult, and performed with a fnorting noife. The excrements and urine are often voided fpontaneoufly, and the patient is fometimes feized with a vomiting. In this fpecies of apoplexy every method muft be taken to leffen the force of the circulation towards the head. The patient fhould be kept perfoaiy eafy and cool. His head fhould be raifed pretty high, and his feet fuffered to hang down. His clothes ought to be loofened, efpecially about the neck, and frefh air admitted into his chamber. His garters fhould be tied pretty tight, by which means the motion of the blood from the lower extremities will be re- tarded. As foon as the patient is placed in a proper pof- ture, he fhould be bled pretty freely in the neck or arm, and, if there be occafion, the operation may be repeated in two or three hours. A laxative clyfter with plenty of fweet oil, or frefh butter, and a large fpoonful of common fait in it, may be adminiftered every two hours ; and bliftering plafters applied betwixt the fhoulders, and to the calves of the legs. As foon as the fymptoms are a little abated, and the pa- tient is able to fwallow, he ought to drink freely of fome diluting opening liquor, as a decoaion of tamarinds and liquorice, cream-tartar whey, or common whey with cream of tartar diffolved in it. Or he may take any cooling purge, as Glauber's falts, or manna diffolved in an infufion of fen- na, or the like. All fpirits and other ftrong liquors are to be avoided. Even volatile falts held to the nofe do mifchief. Vomits, for the fame reafon, ought not to be given, nor any thing that may increafe the motion of the blood to- wards the head. In OF THE APOPLEXY. 313 Iw the ferous apoplexy, the fymptoms are nearly the fame, only the pulfe is not fo ftrono-, the countenance is lefs florid, and the breathing lefs difficult. Bleeding is not fo neceffiiry here, as in the former cafe. It may however generally be performed once with fafety and advantage, but ihould not be repeated. The patient fhould be placed in the fame pofture as direaed above, and fhould have blifter- ing. plafters applied, and receive opening clyfters in the fame manner. Purges are here likewife neceffarv, and the patient may drink ftrong balm tea. If he be inclined to fweat, it ought to be promoted by drinking fmall wine- whey, or an infufion of carduus benediaus. A plentiful fweat kept up for a confiderable time, has often carried off a ferous apoplexy. When apopleaic fymptoms proceed from opium, or other narcotic fubftances taken into the ftomach, vomits are neceffary. The patient is generally relieved as foon as he has difcharged the poifon in this way. Persons of an apopleaic make, or thofe who have been attacked by it, ought to ufe a very fpare and flender diet* avoiding all ftrong liquors, fpiceries, and high-feafoned food. They ought likewife to guard againft all violent paffions, and to avoid the extremes of heat and cold. The head fhould be fhaved, and daily wafhed with cold water. The feet ought to be kept warm, and never fuffered to continue long wet. The belly muft, by all means, be kept Open either by food or medicine, and a little blood may be let every fpring and fall. Exercife fhould by no means be negleaed 5 but it ought to be taken in moderation. No- thing has a more happy effea in preventing an apoplexy* than iffues or perpetual blifters ; great care however muft- be taken not to fuffer them to dry up, without opening Others in their flead. Apopleaic perfons ought never to go to reft with a full ftomach, or to lie with their heads low, or wear any thing too tight about their necks. Sf CHAP. L 3H J CHAP. XLII. OF COSTIVENESS. WE do not here mean^o treat of thofe aftriaions of the Dowels which are the fymptoms of difeafes, as of the colic, the iliac-paSfioh, &c. but only to take notice of that infrequency of ftools which fometimes happens, and which in fome particular conftitutions may occafion difeafes. ~ Costiveness may proceed from an exceffive heat of the liver ; drinking rough red wines, or other aftringent li- quors ; too much exercife, efpecially on horfeback : It may likewife proceed from along ufe of cold, infipid food, which does not fufficiently ftimulate the inteftines. Sometimes it is owing to the bile not defcending to the inteftines, as in the jaundice ; and at other times it proceeds from difeafes of the inteftines themfelves, as a palfy, fpafms, tumors, a cold dry ftate of the inteftines, o c. Excessive coftivenefs is apt to occafion pains of the head, vomiting, colics, &c. It is peculiarly hurtful to hy- pochondriac and hyfteric perfons, as it generates wind and other grievous fymptoms. Persons who are generally coftive fhould live upon a moiftening and laxative diet, as roafted or boiled apples, pears, ftewed prunes, raifins, jjruels with currants, butter, honey, and fugar, &c. Broths with fpinage, leeks, and other foft pot-herbs, are likewife proper. Rye-bread, or that which is made of a mixture of wfo-.u and rye together, ought to be eat. No perfon troubled with coftivenefs fliould eat wheat bread alone, especially that which is made of fine flower. The beft bread for keeping the belly folu- ble is what in fome parts of England they call meflin. It is made of equal parts of wheat and rye; or more commonly of two parts of the former to one of the latter. Costiveness is increafed by keeping the body too warm, and by every thing that promotes the perfpiration ; as wear- OF COSTIVENESS. 315 ing flannel, lying too long a-bed, tjfc. Intenfe thought, a'.ki a fedentary life, are likewife hurtful. All the fecreti- ons and excretions are promoted by moderate exercife with- out doors, and by a gay, cheerful, fprightly temper of mind. The drink fhould be of an opening quality. All ardent fpirits, auftere and aftringent wines, as port, claret, cifo. ought to be avoided. Malt-liquor that is fine, and of a moderate ftrength, is very proper. ...Butter-milk, wfoy, and other watery liquors, are Irkewife (proper, and may bz drank in turns, as the patient's inclination direas. Those who are troubled with fcwlivenefs ought, if pof- fible, to remedy it by diet, as the conftant ufe of medicines for that purpofe is attended with many inconveniences, and often with bad confequences^. I never kr)ew any one get; into a habit of taking medicine for keeping the bell) open, who could leave it off. In time the cuftom becomes ne- ceffary, and generallv ends in a total relaxation of the bow- els, indigeftion, lofs of appetite, wafting of the ftrength, and death. When the belly cannot be kept open without medicine, we would recommend gentle dofes of rhubarb to be taken twice or thrice a-week. This is not near fo injurious to the ftomach as aloes, jalap, or the other draftic purgatives fo much in ufe. Infufions of fenna and manna may like- wife be taken, or half an ounce of foluble tartar diffolved in * The learned Dr. Arbuthnot advifes thofe who are troubled with cof- tivenefs to ufe animal oils, as frefh butter, cream, marrow, fat broths, efpecially thofe made of the internal parts of animals, as the liver, heart, midriff, Sec. He likewife recommends the cxprefTidoils of mild vegetables, as olives, almonds, paftaches, and the fruits t'lemfelves ; all oily and mild fruits, as figs; decoctions of mealy vegetables; thefe lubricate the inteftines; fome fiponaceous fubftances which Itimulate gently, as honey, hydromel, or boiled honey rnd water, unrefined fi]gar, &c. The doctor obferves, that fuch lenitive fubftances are proper Or perfons of dry atrabilarian conftitutions, who are fubject to aftriclion of the belly, and the piles, sr.d will operate when ftronger medicinal fubftances are fometimes ineOtlLO; but that fuch lenitive diet hurts thofe whofe bowels are weak and lax. He l.koOfe obferves, that all watery fubftances are lenitive, and that even common water, whey, four milk, and butter-milk have that ef- fea;---------That new milk, efpecially affes milk, ftimuhtes Hill moie \jlien it fours on the ftomach ; and that whey turned four will purge ftrong- ly ;—That moft garden fruits are likewife laxative ; and that fome of tOn „ as grapes, will throw fuch as take them immoderately, into a cholera mo.- inis, or incurable diarrhcea. 316 OF COSTIVENESS. in water-gruel. About the fize of a nutmeg of lenitive e- leauary taken twice or thrice a-day, generally anfwers the purpofe very well. WANT of APPETITE. This may proceed from a foul ftomach; indigefticn; the want of fixe air and exercife ; grief; fear ; anxiety, of any of the deprefling paffions ; exceflive heat; the ufe of i:;cng broths, fat meats, or any thing that palls the appe- tite, or 15 hard of digeftion ; the immoderate ufe of ftrong liquors, tc-i, tobacco, opium, cjfc. The patient ought, if poffible, to make choice of an open dry air ; to tAe exercife daily on horfeback or in a carriage; to rife betimes ; and to avoid all intenfe thought. He fhould ufe a diet of'eafy digeftion ; and fhould avoid exceflive heat and great fatigue. , . If want of appetite proceeds from errors in diet, or any other part of the patient's regimen, it ought to be changed. If naufea and reachings fhew that the ftomaclfois loaded with crudities, a vomit will he of fervice. After this a gentle purge or two of rbubarb, or any of the bitter purg- ing lalts, may be taken. The patient ought next to ufe an infufion in wine of fome of the ftomachic bitters ; as gen- tian-root, Peruvian bark, or orange-peel. He may alfo eat orange-peel or ginger candied. Though gentle evacuations be neceffary, all ftrong purges and vomits are to be avoided, as they weaken the ftomach and hurt digeftion. After proper evacuations, bitter elixirs, and tinaures with aromatics may be ufed. The patient may take, twice a-day, a common fpoonful of the ftomachic tincture; or, if he be coftive, the fame quantity of the bitter tinaure of rhubarb. Elixir of vitriol is an excellent medicine in moft cafes of indigeftion, weak- nefs of the ftomach, or want of appetite. Twenty or thirty drops of it may be taken twice or thiice a-day in a glafs of wine or water. It may likewife be mixed with the tinaure of the bark, two drams of the former to an ounce of the latter, and a tea-fpoonful of it taken in wine or wa- ter, as above. The WANT OF APPETITE. 3l7 The chalybeate-waters, if drank in moderation, are ge- nerally of confiderable fervice in this cafe. The falt-water has likewife good effeas ; but it muft not be ufed too free- ly. The waters of Harrowgate, Scarfborough, Moffat, and moft other fpaws in Britain, may be ufed with advan- tage. We would advi/ie all who are afHiaed with indrgef- tion and want of appetite, to repair to thefe places of pub- lic rendezvous. The very change of air, and the cheer- ful company, will be of fervice ; not to mention the ex- ercife, diffipation, amufements, &c. Of the HEART-BURN. What is commonly called the heart-burn is not a dif- eafe of that organ, but an uneafy fenfation of heat or acri- mony about the pit of the ftomach, which is fometimes attended with anxiety, naufea, and vomiting. It may proceed from debility of the ftomach, indigefti- on, bile, the abounding of an acid in the ftomach, &c. Perfons who are liable to this complaint ought to avoid ftale liquors, acids, windy or greafy aliments;, and fhould never ufe violent exercife foon after a plentiful meal. I know many perfons who never fail to have the heart-burn, if they ride foon after dinner, provided they have drank ale, wine, or any fermented liquor; but are never troubled with it when they have drunk rum or brandy and water without any fugar or acid. When the heart-burn proceeds from debility of the fto- mach or indigeftion, the patient ought to take a dofe or two of rhubarb ; afterwards he may ufe infufions of the Peruvi- an bark, or any other of the ftomachic bitters, in wine or brandy. Exercife in the open air will likewife be of ufe, and every thing that promotes digeftion. When bilious humours occafion the heart-burn, a tea- fpoonful of the fweet fpirit of nitre in a glafs of water, or a cup of tea, will generall give eafe. If it proceeds from the ufe of greafy aliments, a dram of brandy or rum may be taken. If acidity or fournefs of the ftomach occafions the heart- burn, abforbents are the proper medicines. In this cafe an ounce of powdered chalk, half an ounce of fine fugar, and a quarter of an ounce of gum-arabic, may be mixed in an * Englifk 3i.8 OF THE HEART-BURN. Englifh quart of water, and a tea-cupful of it taken as often as is neceffarv. Such as do not chufe chalk may take a tea-fpoonful of prepared oyfter-fhells, or of the powder called crabs-eyes, in a glafs of cinnamon or peppermint water. But the fafeft and beft abforbent is magnefia alba. This not only aas as an abforbent, but likewife as a pur- gative ; whereas chalk, and other abforbents of that kind, are apt to lie in the inteftines, and occafion obftruaions. This powder is not difagreeable, and may be taken in a cup of fea, or a glafs of mint water. A large tea-fpoonfol fs the ufual dofe; but it may be taken in a much larger quantity when there is occafion. If wind be the caufe of this complaint, the moft proper medicines are thofe called carminatives j as anifeeds, juni- per-berries, ginger, cannella alba, cardamom feeds, OV. Thefe may either be chewed, or infufed in fpirits or wine. One of the fafeft medicines of this kind is the tinaure made by infilling an ounce of rhubarb, and a quarter of an ounce of the lefler cardamom'feeds, in an Englifh pint of brandy. After this has dmefted for two or three clays, it muft be ftrained, and four ounces of white fugar-candy add- ed to it. It muft fland to digeft a fecond time till the fugar be diffolved. A table-fpoonful of it may be taken occafionally for a dofe. I have frequently known the heart-burn cured, efpe- cially in pregnant women, by chewing green tea. CHAP. XLIII, OF NERVOUS DISEASES, OF all difeafes incident to marnkjnd, thofe of the nervous kind are the moft complicated and difficult to cure. A volume would not be fufficient to point out their various fymptoms. They imjf&te almoft every difeafe j OF NERVOUS DISEASES. 3^ and are feldom alike in two different perfons, or even in the fame perfon at different times. Proteus-like, they are continually changing fhape ; and upon every frefh attack, the patient thinks he feels fymptoms which he never expe- rienced before. Nor do they only affea the body ; the mind likewife foffers, and is often thereby rendered ex- tremely weak and peevifh. The low fpirits, timoroufnefs,- melancholy, and ficklenefs of temper "which generally at- tend nervous diforders, induce many people to believe, that they are entirely difeates of the mind ; but this change of temper is rather a confequence, than the caufe of ner- vous difeafes. CAUSES.----Every thing that tends to relax or weaken the body, difpofes it to nervous difeafes, as indo- lence, exceflive venery, drinking too much tea, or other r weak watery liquors, frequent bleeding, purging, vomit- ) ing, &c. Whatever hurts the digeftion, or prevents the . proper affimilation of the aliment, has likewife this effea; / as long fafting, excefs in eating or drinking, the ufe of windy, crude, or unwholefome aliments, an unfavourable pofture of the body, &c. Nervous diforders often proceed from affeaions of the mind ; as grief, difappointments, anxiety, intenfe ftudy, fot. Indeed few ftudious perfons are entirely free from thern. Nor is this at all to be wondered at; intenfe think- ing not only preys upon the fpirits, but prevents the perfon from taking proper exercile, by which means the digeftion is impfoed, the nourifhment prevented, the folids relaxed, , and the whole mafs of humours vitiated. Grief and dis- appointment likewife produce the fame effeas. I have known more nervous patients, who dated the commence- ment of their diforders from the lofs of a hufband, a fa- vourite child, or from fome dil'appointment in life, than from any other caufe. In a word, whatever weakens the body, or depreffes the fpirits, may occafion nervous difor- ders, as unwholefome air, wantof foep, great fatigue, difo i^ceeable apprehenfions, vexatiom &c. SYMPTOMS.---WeTfofll only mention fome of the moft general fymptoms of thefe diforders, as it would be both an ufe lefs and impraaicaMe tafk to point out the w!v>le. They generally begin with windy inflations or dillenfions ot the ftomach and inteftsnes ; the appetite and digeftion are ufually bad; yet fometimes there is an un- common 320 OF NERVOUS DISEASES. common craving for food, and a quick digeftion. The food often turns four on the ftomach ; and the patient is troubled with vomiting of clear water, tough phlegm, or a blackifh-coloured liquor refembling the grounds of coffee. Excruciating pains are often felt about the navel, attended with a rumbling or murmuring noife in the bowels. The belly is fometimes loofe, but more commonly bound, which occafions a retention of wind and great urieafinefs. The urine is fometimes in fmall quantity, at other times very copious and quite clear. There is a great ftraitnefs of the breaft, with difficulty of breathing; violent palpitations of the heart; fudden fluftiings of heat in various parts of the body ; at other times a fenfe of cold, as if water were poured on them ; flying pains in the arms and limbs ; pains in the back and belly, refembling thofe occafioned by gra- vel ; the pulfe very variable, fometimes uncommonly flow, and at other times very quick ; yawning, the hiccup, fre- quent fighings and a fenfe of fuffocation, as if from a ball or lump in the throat; alternate fits of crying and convul- five laughing ; the fleep is unfound, and feldom refrefhing; and the patient is often troubled with the night-mare. As the difeafe increafes, the patient is molefted with headachs, cramps, and fixt pains in various parts of .the body ; the eyes are clouded, and often affeaed with pain and drynefs; there is a noife in the ears, and often a dul- nefs of hearing ; in fhoft, the whole animal funaions are impaired. The mind is difturbed on the moft trivial oc- cafions, and is hurried into the moft perverfe commotions, inquietudes, terror, fadnefs, anger, diffidence, &c. The patient is ^pt to entertain wild imaginations, and ^ttrava- gant fancies j the memory becomes weak, and the reafon fails. Nothing is more charaaeriftic of this difeafe than a conftant dread of deaih. This renders thefe unhappy per- fons who labour under it pe'evifh, fickle, impatient, and apt to run from one phyfician to another; which is one reafon why they feldom reap jiny benefit from medicine, as they have not fufficient refolution to perfift in any one courfe till it has time to produce its proper effeas. They are likewife apt to imagine that they labour under difeafes from which they are quite free, and are very angry if any one attempts to fet them right, or laugh them out of their ridiculous notions. REGIMEN. OF NERVOUS DISEASES. 321 R E G I M EN.----Perfons affliaed with nervous dif- eafes ought never to faft long. Their food fhould be foliu and nourifhing, but of eafy digeftion. Fat meats, and heavy.fauces, are hurtful. All excefs fhould he carefully avoided. They ought never to eat m.?re at a time than they can eafily digeft : but if'they feel themfelves weak and fofot between meals, they oiight to eat a bit of bread, and drink a glafs of wine. Heavy fuppers are to be avoided. Though wine in excefs enfeebles the body, and impairs the faculties of the mind, yet taken in moderation, it ftrengthens the ftomach, and promotes digeftion. Wine and water is a very proper, drink at meals : but if wine fours on the fto- mach, or tO- patient is much troubled with wind, brandy and water will anfwer better. Every thing that is windy,^ or hard of digeftion, muft be avoided. All weak and warm liquors'are hurttul, as tea, coffee, punch, ctO. People r.i;i. find a temporary relief in the ufe of thefe, but they always increafe the malady, as they weaken the flomach, and hurt digeftion. Above all tiling5, drams are to be a- voided. Vv hatever immediate eafe the patient may feel from the ufe of ardent fpirits, they are fore to rggravate the malady, and prove certain poifons at laft. Thefe cau- tions are tfo' more neceffarv, as moft nervous people are pe- Ciiharly fond of tenand nrdent fpirits; to the life of which many of them fall a viaim. Exercise in nervm.s diforders is foperior to all medi- cines. "Riding on .horfeback is generally efleemed the beft, as it gives motion to the whole body, without fatiguing it. I have known fome patients, however, with whom walk- ing agreed hotter, and others who were moft benefited by riding in a carriage. Every one ought to ufe that which he finds moft beneficial. Long fea-v6yages have an excel- lent effea ; and to thofe who can afford to take them, and have fufficient refolution, we would by all means recom- mend this courfe. Even change of place, and the fight of new objeas, by diverting the mind, have a great tendency to remove thefe complaints. For this reafon a long jour- ney, or a voyage, is of much more advantage than riding fhort journeys near home. A cool and dry air is p#Dper, as it braces and invigo- rates the whole body. Nothing tends more to refox an.! enervate than hot air, efpecially that which is rendered fo by great fires, of ftoves in fmall apartments. But wh< n Tt the 322 OF NERVOUS DISEASES. 'he ftomach or bowels are weak, the body ought to be well uarded againft cold, efpecially in winter, by wearing a thin flannel waiftcoat next the fkin. This will keep up an equal perfpiration, and defend the alimentary c'anal from many impreffions, to which it would otherwife be fubjea, upon every fudden change from warm to cold weather* Rubbing the body frequently with a flefh-bruih, or a coarfc linen cloth, is likewife beneficial, as it promotes the cir- culation, perfpiration, fcfo. Perfons who have weak nerves ought to rife early, and take exercife before breakfaft, as lying too long a-bed cannot fail to relax the folids. They ought likewife to be diverted, and to be kept as eafy and cheerful as poffible j as nothing hurts the nervous" fyftem, or weakens the digeftive powers more than fear, grief, or anxiety. MEDICINES.----Though nervous difeafes are feldom radically cured, yet their fymptoms may fometimes be alleviated, and the patient's life rendered, at leaft, more comfortable, by proper medicines. When the patient is coftive, he ought to take a little rhubarb, or fome other mild purgative, and fhould never fuffer his belly to be long bound. All ftrong and violent purgatives are however to be avoided, as aloes, jalap, c5V. 1 have generally feen an infufion of fenna and rhubarb in brandy anfwer very well. This may be made of any ftrength, and taken in fuch quantity as the patient finds neceffary. When digeftion is bad, or the ftomach relax- ed and weak, an infufion of the Peruvian bark and other bitters may be, ufed with advantage*. Few things tend more to ftrengthen the nervous fyflera than cold bathing. This praaice, if duly perfifted in, will produce very extraordinary effeas ; but when the liver or other vifcera are obftruaed, or otherwife unfound, the cold bath is improper. The moft proper feafons for it arc fummer and ajltumn. It will be fufficient, efpecially for perfons of a fpare 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 afte»coming out, it is improper. t In * Take of Peruvian hark an ounce, gentian-root, orange-peel and corian* der-fted, of each half an ounce ; let thefe ingredients be all bruifed in a nior* tar, al»d infufed in a bottle of brandy or whifky, for the fpace of five or fix days. A tal>le-fpoonful of the ftrained liquor may be taken in half a jlafs pf water an hour before breakfaft, dinner and fupper. OF NERVOUS DISEASES. 323 In patients affliaed with wind, I have always obferved . the greateft benefit from the acid elixir of vitriol. It may . be taken in the quantity of fifteen, twenty, or thirty drops, twice or thrice a day, in a glafs of water. This both ex- pels wind, ftrengthens the ftomach, and promotes digef- tion. Opiates are greatly extolled in thefe maladies; but as they only palliate the fymptoms, and generally afterwards increafe the difeafe, we would advife people to be extreme- ly fparing in the ufe of them, left habit render them at laft abfolutely neceffary. It would be an eafy matter to enumerate many medi- cines which have been extolled for relieving nervous dif- orders ; but whoever wifties for a thorough cure muft ex- pea it from regimen alone; we fhall therefore omit men- tioning more medicines, and again recommend the ftriaeffc attention to diet, air, exercise, and amusements. Of MELANCHOLY. * Melancholy is that ftate of alienation or weaknefs of mind which renders people incapable of enjoying the plea- fures, or performing the duties of life. It is a degree of infinity, and often terminates in abfolute madnefs. CAUSE S.----It may proceed from a hereditary dif- pofition ; intenfe thinking, efpecially where the mind is long occupied about one objea ; violent paffions oraffeai- ons of the mind, as love, fear, joy, grief, over-weening pride, and fuch like. It may alfo be occafioned by excef- five venery ; narcotic or flupefaaive poifons; a fedentary life; folitudej the fuppreffion of cuftomary evacuations ± acute fevers, or other difeafes. Violent anger will change melancholy into madnefs ; and exceffive cold, efpecially of the lower exfremities, will force the bLg^into the brain, and produce all the fymptoms of madnWj It may like- wife proceed from the'ufe of aliment that is hard of digef- tion, or which cannot be eafily affimilated ; from a cal- lous ftate of the integumefip ofe the brain, or a drynefs of the brain itfelf. To alJ^'hich we may add gloomy or miftaken notions of religion. SYMPTOM S.---When perfons begin to be me- lancholy, they are timorous j watchful j fond of folitude j fretful i 324 ' OF MELANCHOLY. fretful; fickle; captious and inquifitive; folicitous aboqt trifles; fometimes niggardly, and at other times prodigal. The belly is-generallv bound ; the urine thin, and in fmall quantity ; the ftomach and bowels inflated with wind ; the complexion pale ; the pulfe flow and a-ciL The fonai- onsof the mind are alfo greatly perverted, in fo much that the patient offon imagines himfelf dead, or changed into fonu other animal, borne have imagined their bodies were made of ghfoa, or other brittle fubffonces, and were afraid to move left they fhould be broken to pieces. The unhap- py pa font, in tms cafe, unlefs carefully watched, is apt to put an end to his own miferable life. When the difeafe is owing to an obftruaion of cufto- mary evacuations, or any bodily diforder, it is eafier Cured than when it proceeds from affoaions of the mind, or an hereditary taint. A difcharge of blood from the nofe, loofonef, fcabby eruptions, the bleeding piles, orthemen- fes, fometimes carry off this difeafe. OLE G I M ICdtf----The diet ought to confift chiefly of vegetables of a cooling and opening quality. Animal food, efpecially failed or fmoke-dried fihorifofo, ought to be avoided. All kinds of fliell-fifh are bad. Aliments pre- pared with onions, garlic, or any thing that generates thick blood, are likewife improper. All kind of fruits that are wholefome may be eat with advantage. Boerhaave gives an inftance of a patient who, by a long ufe of whev, water, and garden-fruits, recovered, after having evacuat- ed a great quantity of black-coloured matter. Strong liquors of every kind ought to be avoided as poifon. The moft proper drink is water, whey, or very fmall beer. Tea and coffee are improper. If honey agrees with the patient, it may be eat freely, or his drink may be fweetened with it.' Intulfons of balm-leave-., penny-royal, the roots of wfO valerian, or the ffo.vcrsAfrthe ii:r.e-fce, m ■■■'/ be diaiiytftt:!/, either by themfelv^, or fweetened with honey, 3^"the patient fhall chuie. The patient ought to take as much ejffrciie in the open air as h..- can b^ar,.^ This hjiej to diffolve the vifcid hu- mouis, it removes obfir>i»c^i;^^p re motes the perfpiration, and all the of;. .O'Ocretions. Every kind of madnefs is at- tended with a diminifhed perfpiration ; all means ought therefore to be ufed to promote that neceffary and falutacy difcharge. Nothing cm have a more direa tendency to increafe OF MELANCHOLY. 32$ increafe the dif-afe than confining the patient to a clofe apartment. Were he forced to ride or walk a certain num- ber of miles every,day, it would tend greatly to alleviate his diforder : but it would have ftill a better effea, if he were obliged to labour a piece of ground. By digging, hoeing, planting, fowing, cjfo. both the body and mind would be exercifed. A long journey, or a voyage, efpeci- ally into a warmer climate, with agreeable companions, has often very happy effeas. A plan of this kind, with a ftria attention to diet, is a much more rational method of cure than confining the patient within doors and plying him with medicines. M E D I C I N E.----In the cure of this difeafe great regard muft be paid to the mind. * When the patient is in a low ftate, his mind ought to be foothed and diverted with varietyof amufements, as entertaining ftories, pailim-Js, mufic, &c. This feems to have been the method of curing melancholy among the Jews, as we.learn from the ftor/of King Saul; and indeed it is a very rational one. Nothing; can remove difeafes of the mind fo effeaually as ap'pli: ..- ons to the mind itfelf, the moil efficacious of which is mu- fic. The patient's company ought likewife to confift of fuch perfons as are agreeable to him. People in this ftate are apt conceive unaccountable averfions againf| particular perfons ; and the very fight of fuch perfons is fufficient to diftraa their minds, and throw them into the utmoft per- turbation. When the patient is high, evacuations are neceffary. In this cafe he muft be bled, and have his belly kept open by purging medicines, as manna, rhubarb, cream of tar- tar, or the foluble tartar. I have feen the laft have very happy effoas. It may be taken in the dofe of half an ounce, diffolved in water-gruel every day, for fundry weeks, or ,even for months, if neceffary. More or lefs may be given according as it operates. Vomits Jkave likewife a good effea ; but they muft be pretty ftrong, otherwife they will not operate. Camphire and mufk have likewife been ufed in this cafe with advantage. Ten or twelve grains of camphire may be rubbed in a mortar with half a dram of nitre, and taken twice a-day, or oftener, if the ftomach will bear it. If it will not fit upon the ftcmach in this form, it may be made 326 OF MELANCHOLY. made into pills with gum afafoetida and Ruffian caftor, and taken in the quantity above direaed. If mufk is to be ad- miniftered, a fcruple or twenty-five grains of it may be made into a bolus with a little honey or common fyrup, and taken twice or thrice a-day. We do not mean that all thefe medicines fhould be adminiftered at once ; but which- ever of them is given, muft be duly perfifted in, otherwife no benefit can be expeaed. As it is very difficult to induce patients in this difeafe te take medicines, we fhall mention fome outward applicati- ons which fometimes do good ; the principal of thefe are iffues, fetons, and warm bathing, llfues may be made in any part of the body, but they generally have the beft ef- fea near the fpine. The difcharge from thefe may be greatly promoted by dreffing them with the mild bliftering ointment, and keeping what are commonly called the orrice peas in them. The moft proper place for a feton is be- tween the fh;ulder-blades; and it ought to be placed up- wards and downwards, or in the direction of the fpine. Of the PALSY. The palfy is a lofs or diminution of fenfe or motion, or of both, in one or more parts of the bodv. It is more or lefs dangerous, according to the importance of the part affeaed. A palfy of the heart, lungs, or any part necef- fary for life, is mortal. When it affeas the ftomach, the inteftines, or the bladder, it is highly dangerous. If the face be affeaed, the cafe is bad, as it fhews, that the dif- eafe proceeds from the brain. When the part affeaed feels cold, is infenfible, or waftes away, or when the judgment and memory begin to fail, there is fmall hopes of a cure. CAUSE S.----The immediate caufe of palfy is what- ever prevents the regular exertion of the nervous power upon any particular mufcle or part of the body. The oc- cafional and predifpofing caufes are various, as drunken- nefs; wounds of the braii, or fpinal marrow; preffure upon the brain or nerves j very cold or damp air ; the fup- preflion of cuftomary evacuations ; fudden fear; want of exercife : or whatever greatly relaxes the fyftem, as drink- ing OF THE PALSY. $2? ing much tea *, or coffee, tfc. The palfy may likewife proceed from wounds of the nerves themfelves, from the poifonous fumes of metals or minerals, as mercury, lead, arfenick, cffV. In young perfons of a full habit, the palfy muft be treat- ed in the fame manner as the fanguine apoplexy. The pa- tient muft bled, bliftered, and have his belly kept open by fharp clyfters or purgative medicines. But, in old age, or when the difeafe proceeds from relaxation or debility, which is generally the cafe, a quite contrary courfe muft be pur- fued. The diet muft be warm and attenuating, confifting chiefly of fpicy and aromatic vegetables, as muftard, horfe- radifh, &c. The drink may be generous wine, muftard- whey, or brandy and water. Friction with the flefh-brufb, or a warm hand, is extremely proper, efpecially on the parts affected. Bliftering plafters may likewife be applied to the affeaed parts with advantage. When this cannot be done, they may be rubbed with the volatile liniment, or the nerve-ointment of the Edinburgh difpenfatory. One of the beft external applications is ekaricity. Thefhocks fhould be received on the part affeaed j and they ought daily to be repeated for feveral weeks. Vomits are very beneficial in this kind of palfy, and oujht to be frequently adminiftered. Caephalic fnuff, or r.ny thing that makes the patient fneeze, "s likewife ufeful. Some pretend to have found great benefit from rubbing the parts affeaed with nettles ; but thi6 does not feem to be any ways preferable to bliftering. If the tongue be affeaed, the patient may gargle his mauth frequently with brandy and muftard ; or he may hold a bit of fugar in his mouth wet with the palfy-drops or compound fpirits of lavender. The wild valerian root is a very proper medicine in this cafe. It may either be taken in an infufion with fage- leaves, or half a dram of it in powder may be given in a glafs of wine three times a-day. If the patient cannot ufe the valerian, he may take of fal volatile eleofum, compound fpi- rits of lavender, and tinaure of caftor, each half an ounce; mix * Many p»ople imaginej that tea has n« tendency to hurt the nerves, and that drinking the fame quantity of warm water would be equally pernicious. This however feems to be a miftake. Many perfons drink three or four cups of w'arm milk and water daily, without feeling any bad confequences ; yet the fame quantity of tea will make their hands ibake for twenty-four hours. -zS OF THE'PALSY. mix thefe together, and take forty or fifty drops in a glafi of wine, three or four times a-day. A table-fpoonful of muftard-feed taken frequently is a very good medicine. The patient ought likewife to chew cinnamon bark, gin- ger, or other warm fpicerios. Exercise is of the utmoft importance in the palfy ; but the patient muft beware of cold, damp, and moift air. He ought to wear flannel next his fkin ; and, if poffible, fhould remove into a warmer climate. Of the EPILEPSY, or FALLING SICKNESS. The epilepfy is a fudden deprivation of all the fenfcs, wherein the patient falls fuddenly down, and is affeaed with violent convulfive motions. Children, efpecially thofe who are delicately brought up, are moft fubjea to it. It more frequently attacks men than women, and is very difficult to cure. When the epilepfy attacks children, there is reafon to hope it may go off about the time of pu- berty. When it attacks any perfon after twenty years of age, the cure is difficult; but when after forty, a cure is hardly to be expeaed. If the fit continues only for a fhort fpace, snd returns feldom, there is reafon to hope; but if it continues long and returns frequently, the profpea is bad. It is a very unfavourable fymptom when the patient is feized with the fits in his fleep. CAUSE S.----The epilepfy is fometimes hereditary. It may likewife proceed from frights of the .mother when with child ; from blows, bruifes, or wounds on the head ; a colleaion of water, blood, or ferous humours in the brain; a polypus; tumours or concretions within the fkull; exceffive drinking ; intenfe ftudy ; excefs of venery; worms; teething; fuppreffion of cuftomary evacuations; too great emptinefs or repletion ; violent paffions or affec- tions of the mind., as fear, joy, C5V.; hyfteric afteaions; contagion received into the body, as the infeaion of the fmall-pox, meafles, &c. SYMPTOM S.----An epileptic fit is generally pre- ceded by unufual wearinefs j pain of the head ; dulnefs ; giddinefs; noife in the ears j dimnefs of fight; palpitation of OF THE EPILEPSY. 379 t?f the heart; difturbed fleep ; difficult breathing ; the bow- els 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 ftream of cold air afcending towards his head. In the fit, the patient generally makes an unufual noife ; his thumbs are drawn in towards the palms of the hands ; his eyp are diftorted ; he ftarts, and foams at the mouth ; his extremities are bent and twilled various ways ; he often difcharges his feed, urine, and fceces involuntarily; and is quite deftitute of all fenfe and reafon. After the fit is over, his fenfes gradually return, and he complains of a kind of flupor, wearinefs, and pain of his head ; but has no re- membrance of what happened to him during the nt. The fits are fometimes excited by violent affoaions of the mind, a debauch of hquor, exceflive heat, cold, or the like. This difeafe, from the difficulty of inveftigating its caufes, and its ftrange fymptoms, was formerly attributed to the wrath of the gods, or the agency of evil fpirits. In modern times it has often, by the vulgar, been imputed to witchcraft or fafcination. It depends however as much upon natural caufes as any other malady 5 and its cure may often be effeaed by perilling in the ufe of proper means; REGIME N.----Epileptic patients ought, if poffible, to breathe a pure and free air. Their diet ihould be light but nourifhing. They ought to drink nothing ftrong, to to avoid fwines fLfh, water-fowl, and likewife all windy and oily vegetables, as cabbage,, nutsj-cifr. They ought to keep themfelves cheerful, carefully guarding againft all violent paffions, as anger, fear, C5V. Exercise is likewife of great ui'e ; but the patient muft: be careful to avoid all extremes either of heat or cold, all dangerous natations, as Handing upon precipices, riding deep waters, and fuch like ; as any thing that makes him giddy, is apt to occafion a fit. M E D I C I N E.----The inte.ntions.of cure muft vary according to the caufe of the difeafe. If the patient be of a fanguine temperament, and there be reafon to fear an ob- ftruction in the brain, bleeding and other evacuations will be neceffary. ^"fon the difeafe is occafioned by the flop- page of cuffonnny evacuations, thefe, if poflible, muft he reflored: if this cannot be dune, ethers may be fubftituted U u ■ in 330 OF THE EPILEPSY, in their place. Iffues or fetons, in this cafe, have often a very good effea. When there is reafon to believe that the difeafe proceeds from worms, proper medicines muft be ufed to kill or cany off thefe vermin. When the difeafe proceeds from teething, the belly fhould be kept open by emollient clyfters, the feet frequently -bathed in warm water, and, if the fits prove obftinate, a bliftering plafler may be put betwixt the fhoulders. The fame method is to be followed, when epileptic fits precede the eruption of the fmall-pox, or meafles, ciff. When the difeafe is hereditary, or proceeds from a wrong formation of the brain, a cure is not to be expeaed. When it is owing to a debility, or too great an irritability of the nervous fyftem, fuch medicines as tend to brace and ftrengthen the nerves may be ufed, as the Peruvian bark, preparations of fteel, c5V. * Colee-atch fays, that the mifletoe cures an epilepfy as certainly as the Peruvian bark does an intermittent fever. The dofe to an adult is half a dram of the powder, four times a-day, drinking after it a draught of a ftrong infufi- on of the fame plant. Though this medicine has not been found to anfwer the high encomiums which have been paf- fed upon it, yet in obftinate epileptic cafes it deferves a trial. It muft however be ufed for a confiderable time, in order to produce any falutary effeas. Musk has fometimes been found to fucceed in the epi- lepfy. Ten or twelve grains of it, with the fame quantity of foaitious cinnabar, may be made up into a bolus and taken every night and morning. Sometimes * Fuller recommends the following electuary as a moft excellent anti-epi- leptic. Take Jefuits bark in powder three ounces, Virginian fnake-root powdered one ounce, as nmeh fyrnp of pasony or cloves as is fufficient td form it into a foft electuary. The dofe to an adult is a dram, or about the fize of a nutmeg, morning and evening. Jt muft be continued for three or four months, anJ afterwards repeated, three orfour days before the new and full moon, for fome time. Mead likevffife recommends an c-leftnary of a fimilar nature for the epilep- fy, on!v he ulls Valerian-root in place of the fnake-root. It mod be taken in the fame manner as the above. The patient ounht always to be bled, and to take a purge or two before he begins to ufe thefe medicines. They will likewife have a better effect if the patient drinks a tea-cupfulqf the decoction of g:<::: icuin after each dofe. It may be made by boiling two ounces of guai- acum lhavings, and one ounce of raifins of the fun ftoned, in two Englifh quarts of water to one. Strain the liquor, ap.d afterwards let it ftand to fit- il», then pour off the cleafefrom the feces. or FALLING SICKNESS. 53i Sometimes the epilepfy has been cured by elearicity. Convulsion fits proceed from the fame caufes, and muft be treated in the fame manner as the epilepfy. There is one particular fpecies of convulfion fits which commonly goes by the name of St. Vitus's dance, wherein the patient is agitated with ftrange motions and gefticula- tions, which by the common people are generally believed to be the effeas of witchcraft. This difeafe may be cured by repeated bleedings and purges; and afterwards ufing the medicines prefcribed above for the epilepfy, vi». the Peru- vian bark, and fnake-root, &c. Chalybeate-waters are found to be beneficial in this cafe. The cold bath is like- wife of fingular fervice, and ought never to be-negledted when the patient can bear it. Of the HICCUP. The hiccup is a fpafmodic or convulfive affeaion of thz ftomach and midriff, arifing from any caufe Lhat irritates their nervous fibres. It may proceed from excefs in eating or drinking; from a hurt of the ftomach ; poifons; inflammations or fchirrous tumours of the ftomach, inteftines, bladder, midriff, or the reft of the vifcera. In gangrene?, acute and malignant fevers, a hiccup is often the forerunner of death.,. When the hiccup proceeds from the ufe of aliment that is flatulent, or hard of digeftion, a draught of generous wine, or a dram of any fpiritous liquor, will generally re-*- move it. If poifon be the caufe, plenty of milk and oil muft be drank, as has been formerly recommended. When it proceeds from an inflammation of the ftomach, &c. it is very dangerous. In this cafe the cooling regimen muft be obferved. The patient muft be bled, and take frequently a few drops of the fweet fpirits of nitre in a cup of wine- whey. His ftomach muft likewife be fomented with cloths dipped in warm water; or bladders filled with warm milk and water applied to it. When the hiccup proceeds from a gangrene or mortifi- cation, the Peruvian bark, with other antifeptics, are the only medicines which have a chance to fucceed. If the hiccup be a primary difeafe, and proceeds from a foul fto- jnach, loaded either with a pituitous or a bilious humour, * a gentle 332 OFTHEHICC U P. a gentle vomit and purge, if the patient be able to bear them, will be of fervice. If it arifes from flatulencies, the carminative medicines, direaed for the heart-burn, muft be ufed. When the hiccup proves very obftinate, recourfe muft be had to the moft powerful aromatic and antifpafmodic medicines. The principal of thefe is mufk ; fifteen or twenty grains of which may be made into a bolus, and re- pe.tcd occafionally. Opiates are likewife of fervice ; but tfo-y muft be ufed with caution. A bit of fugar ("lipped in compound fpirits of lavender, or the volatile aromatic tinc- ture, may be taken frequently. External applications are fometimes alfo beneficial ; as the ftomach plafler, or a ca- taplafm of the Venice treacle of the Edinburgh or London difpenfatory, applied to the region of the ftomach. I latklv' attended a patient who had almoft a conftant hiccup for above nine weeks. It was frequently ftopped by the ufe of mufk, opium, wine, and other cordial and anti- fpafmodic medicines, but always returned. Nothing how- ever gave the patient fo much eafe as brifk fmall beer. By drinking freely of this, the hiccup was often kept off for feveral days, which was more than could be done by the moft powerful medicines.. The patient was at length feiz- ed with a vomiting of blood, which foon put an end to his life. Upon opening the body, a large fchirrous tumour >vas found near the pylorus or right orifice of the ftomach. CRAMP of the STOMACH. This difeafe often feizes people fuddenly, is very dan- gerous, and requires immediate affiflance. It is moft inci- dent to perfons in the decline of life, efpecially the gouty, hyfteric, and hypochondriac. If the patient has any inclination to vomit, he ought to take fome draughts of warm water, or weak camomile tea, to clean his ftomach. After this, if he has been coftive, a laxative clyfter muft be given. He ought then to take laudanum. The beft way of adminiftering it, is in a cly- fter. Sixty or feventy drops of liquid laudanum may be given in a clyfter of warm water. This is much more-cer- tain than laudanum given by'the mouth, which is often vomited, CRAMP OF THE STOMACH. 333 vomited, and in fome cafes increafes the pain and fpafms in the ftomach. If the pain and cramps return with great violence, after the effeas of the anodyne clyfter are ever, 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 mufk, and half a dram of the Venice treacle. In the mean time, the ftomach ought to be fomented with cloths dipped in warm water ; or bladders filled with warm milk and water, fhould be conftantly applied to it. I have often feen thefe produce the moft happy effeas. The ano- dyne balfam may alfo be rubbed on the part affeaed ; and an antihyfteric plafter worn upon it, for fome time after the cramps are removed, to prevent their return. In very violent and lafting pains of the ftomsch, fome blood ought to be let, unlefs the weaknefs of the patient makes it improper. When the pain or cramps proceed from a fuppreffion of the menfes, bleeding is of ufe. If they be owing to the gout, recourfe muft be had to fpirits or fome of the warm cordial waters. Bliftering plafters ought likewife, in this cafe, to be applied to the ancles. I have often feen violent cramps and pains of the ftomach removed by covering it with a plafter of Venice treacle. Of the NIGHT-MARE. In this difeafe the patient, in time of fleep, imagines he feels an uncommon oppreffion or weight about his breaft or ftomach, which he can by no means fhake off. He groans, and fometimes cries out, though oftener he attempts to fpeak in vain. Sometimes he imagines himfelf engaged with an enemy, and, in danger of being killed, attempts :o run away, but finds he cannot. Sometimes he fancies himfelf in a houfe 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 dafhed to pieces fuddenly awakes him. This diforder has been fuppofed to proceed from too much blood ; from a flagnation of blood in the, brain, Juno-s, iffc. But it is rather a nervous affection, and arifes chiefly from indfocftion. Hence we find that perfons of • weak 334 OF THE NIGHT-MARE. weak nerves, who lead a fedentary life, and live full, are moft commonly affliaed with the night-mare. Nothing tends more to produce it than heavy fuppers, efpecially when ate late, or the patient goes to bed foon after. Wind is likewife a very frequent caufe of this difeafe; for which reafon thofe who are affliaed with it ought to avoid all fla- tulent food. Deep thought, anxiety, or any thing that oppreffes the mind, ought alfo to be avoided. As perfons affliaed with the night-mare generally moan, or make fome noife in the fit, they fliould be waked, or fpoken to by fuch as hear them, as the uneafinefs generally goes off as foon as the patient is awake. Dr. Whytt fays, he generally found a dram of brandy, taken at bed-time, prevent this difeafe. That, however, is a bad cuftom, and, in time, lofes its effea. We would rather have the patient depend upon the ufe of food of-eafy digeftion, cheerfulnefs, exercife through the day, and a light fupper taken early, than to accuftom himfelf to drams. A glafs pf peppermint-water will often promote digeftion as much as a glafsi of brandy, and is much fafer. After a perfon of weak digeftion however has ate flatulent food, a dram may be neceffary; in this cafe we would recommend it as the moft proper medicine. Persons who are young, and full of blood, if troubled with the night-mare, ought to take a purge frequently, and ufe a fpare diet. « Of SWOONING S. People of weak nerves or delicate conftitutions are very liable to fwoonings or fainting fits. Thefe indeed are fel- dom dangerous when duly attended to; but when wholly negledted, or improperly treated, they often prove hurtful, and fometimes fatal. The general caufes of fwooning are, fudden tranfitions from cold to heat; breathing air that is deprived of its proper fpring or elafticity ; great fatigue; exceffive weak- nefs; lofs of blood ; long fafting; fear, grief, and other violent paffions or affeaions of the mind. It is well known, that perfons who have been long ex- pofed to cold, often faint or fall into a fwoon, upon coming » into OF S W O O N I N G S. 335 into the houfe, efpecially if they drink hot liquor, or fit near a large fire. This might eafily be prevented by peo- ple taking care not to go into a warm room immediately after they have been expofed to the cold air, to approach the fire gradually, and not to eat or drink any thing hot, till the body has been gradually brought into a warm tem- perature. When any one, in confequence of negkaing thele precautions, falls into a fwoon, he ought immediately to be removed to a cooler apartment, to have ligatures appli- ed above his knees and elbows, and to have his hands and face fprinkled with vinegar. He fhould likewife be made to finell to vinegar, and fhould have a fpoonful or two of water, if he can fwalfow, with about a third pa 1 of vine- gar mixed with it, poured into his mouth. If thefe fliould not remove the complaint, it will be neceffary to bleed the patient, and-afterwards to give him a clyfter. KAs air that is breathed frequently lofes its elafticity or fpring, it is no wonder if perfons who refpire in it often fall into a fwoon or fainting fit. They are, in this cafe, deprived of the very principle of life. Hence it is that fainting fits are fo frequent in all crowded affemblies, efpecially in hot feafons. Such fits however muft be con- fidered as a kind of temporary death ; and, to the weak and delicate, they fometimes prove fatal. They ought therefore with the utmoft care to be guarded againft. The method of doing this is obvious. Let aifembly rooms, and all other places of public refort, be large and well ven- tilated ; and let the weak and delicate avoid fuch places, particularly in warm feafons. A person who faints in fuch a fituation, ought imme- diately to be carried into the open air ; his temples fhooid be rubbed with ftrong vinegar or brandy, and volatile fpi- rits or falts held to his nofe. He fhould be laid upon his back with his head low, and have a little wine, or fome other cordial, poured into his mouth, as foon as he is able to fwallow it. If the perfon his been fubjea to hyfteric fit*-, caftor or afafcetida fhould be applied to the nofe, or burnt feathers, horn, or leather, cifo. When fainting fits proceed fiom mere weakneTs or ex- hauftion, which Ts often the cafe after great fatigue, long fafting, lofs of blood, or the like, the patient muft be fup- ported with generous cordials, as jollies, wines, fpiritous • liquors, 336 " OF S W O O N I N G 3. liquors, &c. Thefe however muft be givcji at firft in very fmall quantities, and increafed gradually as the patient is able to bear them. He ought to be allowed to lie quite ftill and eafy upon his back, with his head low, and fhould have frefh air admitted into his chamber. His food fhould confift of nourifhing broths, fago-gruel with wine, new milk, and other things of a light and cordial nature. Thefe things are to be given out of the fit. All that can be done in the fit is, to let him fmell to a bottle of Hungary-water, eau de luce, or fpirits of hartfhorn, and to rub his temples with warm brandy, or to lay a eomprefs dipped in it to the pit of'the ftomach. In fainting fits that proceed from fear, grief, or other violent paffions or affeaions of the mind, the patient muft be very cautioufly managed. He fhould be fuffered to re- main at reft, and only made to fmell to feme vinegar. Af- ter he is come to himfelf he may drink freely cf warm le- monade, or balm tea, with fome orange or lemon peel in it. It will likewife be proper, if the fainting fits have been long and fevere, fo clean the bowels by throwing in an emollient clyfter. It is common in fainting fits, from whatever caufe they proceed, to bleed the patient. This praaice may be very proper in ftrong perfons of a full habit ; but in thofe who are weak and delicate, or fubjea to nervous diforders, it is dangerous. The proper method with fuch people is to expofe them to the free air, and to ufe cordial and ftimu- lating medidncs, as volatile falts, Hungary-water, fpirits of lavender, tiifoture of caftor, &c. Of HYSTERIC and HYPOCHON- DRIAC AFFECTIONS. These likewife belong to the numerous tribe of nervous diforders, which may juftly be reckoned the reproach of medicine. We would have treated of them at greater length, but for this reafon, that they are difeafes which nobody chufes to own ; and indeed it would be better if their names were never mentioned. One cannot tell a lady fhe is hyfteric, without affronting her; nor fay that a gen- tleman is hypochondriac, without in fome meafure infi- nuating OF HYSTERIC AFFECTIONS, &c. 337 nuating that he is mad, or at leaft whimfical. But although thefe names were liable to no fuch unfavourable acceptati- on, they are by no means proper, and for that reafon ought to be difcontinued. Physicians are not more at a lofs to account for the fymptoms of thefe diforders than to prcforibe medicines for removing them. There are indeed.fo many nervous anti- dotes daily puffed away, that one would be apt to think no perfon could long labour under any difeafe of this nature. But, alas ! whoever trufts to thefe, will be fure to meet with a difappointment. Nervous difeafes proceed either from difagreeable affeaions of the mind, or from errors in the regimen, and can only be cured by removing the one, or reaifying the other. . Though this truth is well known to phyficians, yet they are often obliged to difguife it. Patients who labour under nervous difeafes, are generally very fond of medicine; and when they are not fwallowing drugs, they think them- felves negleaed. For this reafon the doaor muft either give medicine, or lay his account with being difmiffed. Nothing indeed is more charaaeriftic of the difeafe, than an inclination to confult new phyficians. Hence few per- fons of fortune who are nervous, fail to confult every phy- fician they meet with. Nor do they ftop here; but gene- rally take the advice of every quack and old woman, how- ever ignorant or contemptible : but, though fond of advice, they feldom follow it fo long as to reap any benefit from it. Fickle and unfteady, they fly from one thing to another, till at length, tired out with difappointments, and defpair- ing of relief, they fink under a load of calamities. Would fuch perfons, inftead of hunting after medicines, and flying from one phyfician to another, perfift fteadily in a proper plan of regimen, they might often render life to- lerably eafy, and fometimes even agreeable*. This how- ever requires more refolution than moft people are mailers X x of. * It were to be wifhed, in difeafes where the cure depends chiefly upon 'the patient's own endeavours, that no medicines wore prescribed at all. Wherever phyficians order medicine, patient's will truft to it ; and when that is the cafe, it is ten to ore but their own endeavours are negleaed. fhe Dhvfician therefore, who has fo much hardinefs and honefty asto give advice Without medicine, is, in many cafes, the moft likely to perform a cure, as it puts the patient upon exrrtinjr his own powers; which he will never do i« Ion- as i,e\as any faith'in medicine. 338 OF HYSTERIC AND of. They will fwallow a drug becaufe it is foon over, and they expea immediate relief from it; but can by no means think of purfuing a plan that*requires patience and perfe- verance, and which perhaps ftrikes at the root of fome of their moft darling enjoyments. The general caufes and fymptoms of thefe difeafes having been pretty fully pointed out in the beginning of this chapter, under the general title of nervous diforders, we fhall not repeat them. It may not however be impro- per to add, that from whatever fource thefe diforders may fpring, their principal feat feems to be the alimentary ca- nal, at leaft moft of their fymptoms arife from thence : as flatulence; indigeftion ; naufea and vomiting ; the hyfteric globe ; cramps of the ftomach, &c. All thefe fhew a weak and relaxed ftate of the ftomach and inteftines ; to which, if we add an over-degree of fenfibility of the nervous fyftem, we fhall be able to account for moft of the fymptoms de- nominated nervous, hyfleric, or hypochondriac. This view of nervous difeafes plainly points out the in- tentions of cure, viz. to ftrengthen the nerves, and pro- mote the digeftion. But as this can only be done by la- bour, fimple food, and free air, we muft again beg leave to recommend an attention to thefe. The lazy, the indolent, and the luxurious, will defpife this advice : but fuch are incurable, and deferve to fuffer. I have known the moft obftinate nervous difeafes cured by labour, but never knew them yield to medicine. Some of their fymptoms may in- deed for a time be mitigated by it, but that is all it can do. The perfons moft liable to thefe diforders are, the lazy, the luxurious, the unfortunate, and the fedentary. For the two firft-of thefe claffes we fhall prefcribe nothing, us the cure is in their own power ; and to the third we can only recommend hope, amufements, iSc. The fourth, however, merits our further attention, both becaufe it comprehends a great number of the ufeful part of mankind, and likewife becaufe it is often out of their power to alter their fituation. Many of them might however do a great ileal, if they wruld. For example, the clergy are almoft fo a man hypochondriac, and ofien poor, yet think it much below them to labour. I have betn abl^to perfu.ide fon o of them to threfh, &cs others to dig; nor did fuch ever fol to get well. Let the reft follow then example, or t,:ke excr-ii-.' in wh-it way tloy pleafe. A» ii> in.foif.iit girls, who HYPOCHONDRIAC AFFECTIONS. 339 who are eat up with hyfteric fits merely becaufe they will not v/ork, I fee no reafon why they ihould not be font to the workhoufe, and put upon hard labour. This would be both a benefit to themfelves and the fociety to which they belong. Those, however, who are willing to take exercife, but whofe occupations confine them to the houfe, and perhaps to an unfavourable pofture, really deferve our pity. We have, in a former part of the book, endeavoured to lay down fome rules for their condua ; and fhall only add, that where thefe cannot be complied with, or fail of having the defired effxfol, their intention may, in fome meafure, be anfvvered by the following medicines, viz. the Peruvian baik, with other bitters ; preparations of fleel; afafcetida; elixir of vitriol ; infufions of Valerian-root, penny-royal, cjfo The various ways of preparing and ufing thefe has already been pointed out*. C H A P. XLIV. OF POISONS. EVERY perfon ought, in fome meafure, to be ac- quainted with the nature and cure of poifons. They are generally taken unawares, and their effeas are often fo fudden and violent,, -j not to admit of delay, or allow time to procure the affiflance of phyficians. Happily indeed no great * Some p?ople will think it ftrange that we fhould recommend labour to t!.: clergy ; but they ought to confider that the regulations of fociety can never alter the laws of our nature ; .agd, if man muft either labour or be-fick, furely no fet of men have any title to an exemption fir>m the general rule. The monkifh notion that a clergyman ou ht rather to beg than dig, has more bad confequences than we chufe to name It muft however be acknowledg- ed, that a'clergyman who has the charge of a parifh may find fufficknt ex- ercife, if he chufes to uks it, without either threlhing, digging, or plowing. 34o . OF POISONS. great degree of medical knowledge is here neceffary; the remedies for moft poifons being generally at hand, or eafily obtained, and nothing but common prudence needful in the application of them. The vulgar notion, that every poifon is cured by fome counter-poifon, as a fpecific, has done much hurt. People believe they can do nothing for the patient, unlefs they know the particular antidote to that kind of poifon which he has taken. Whereas the cure of all poifons taken into the ftomach, without exception, depends chiefly on dis- charging them as foon as poffible. There is no cafe whesreir the indications of cure are morcobviouo than in this. Poifon is feldom long in the ftomach before it occafions ficknefs, with an inclination to vomit. This fhews plainly what ou^ht to be done. In- deed common fenfe diaates to every man, that, if any thin;; has been taken intv the ftomach which endangers life, it ought immediately to be difcharged. Were this duly regarded, the danger arifing from poifons might gene- foflly be avoided. The method of prevention is obvious, c.j ,d the means are in the hands of every man. 3. We fhall not take up ahe reader's time with a detail of the ridiculous notions which have prevailed among igno- ftiunt people in different ar*;es with regard to poifons ; nei- ther fhall we mention tl e boafted antidotes which have been recommended either for preventing or obviating their icffeas; but fhall content ourfelves with pointing out the -Apifons moft common in this country, and the means of avoiding their dangerous tonfequences. Poisons either belong to the mineral, the vegetable, or the animal kingdom. > Mineral poifons are commonly of an acrid or corrofive quality; as arfenic, cobalt, the corrofive fublimate of mercury, C3fo 3 Those of the vegetable kind are generally of a narcotic or ftupefaaive quality ; as poppy, hemlock, henbane, ber- ries of the deadly night-fhade, &c. Poisonous animals communicate their infeaion either by the bite or fting. Thfi poifon is very different from the former, and only produces its effeas when received into the body by a wound. i MINERAL POISONS.^Arfenic is the moft com- mon of this clafs j and, as the whole of them aie pretty fi- milar OF POISONS. $4t milar both in their effeas and method of cure, what is faid with refpea to it, will be applicable to every other fpecies of corrofive poifon. When a perfon has taken arfenic, he foon perceives a burning heat, and a violent pricking pain in his ftomach and bowels, an intolerable thirft, and an inclination to vo- mit. The tongue and throat feel rough and dry ; and, if proper help be not foon adminiftered, the patient is feized with great anxiety, hiccuping, faintings, and coldnefs of the extremities. To thefe fucceed black vomits, foetid ftools, with a mortification of the ftomach and inteftines, which are the immediate foreru.iners of death. On the firft appearance of thefe fymptoms, the patient fhould drink large quantities of new milk and falad oil till he vomits; or he may drink warm water mixed with oil. Fat broths are likewife proper, provided they can be go ready in time. Where no oil is to be had, frefh butter may be melted and mixed with the milk or water. Thefe things are to be drank as long as the inclination t- vomit continues. Some have drank eight or ten Engl ' quarts before the vomiting ceared ; and it is never fafe > have off drinking while one pa tide of the poifon remain; in the ftomach. These oily or fat fubftances not only provoke vomitin0, but likewife blunt the acrimony of the poifon, and prevent its wounding the bowels ; but if they fhould not make the perfon vomit, half a dram or two fcruples of the powder cc ipecacuanha muft be given, or a few fpoonfuls of the opt mel or vinegar of fquflls may be mixed with the w.ter which he drinks. Vomiting nay likewife be excited by tickling the infide of the throat with a feather. Should thefe methods however fail, half a dram of white vitriol, or five or fix grains of emetic tartar muft be adminiftered. If tormenting pains are felt in the lower belly, and there is reafon to fear, that the poifon has got down to tfo; inteftines, clyfters of milk and oil muft be very frequently thrown up ; and the patient muft drink emollient decocti- ons of barley, oatmeal, marfhmalfows, and fuch like. He muft likewife take an infufion o. fenna and manna, a folu- tion of Glauber's falts, or fome other purgative. AFTER the poifon has be evacuated, the patient oucrht, for fome time, to live upon fuch things as are of a healing and cooling quality; to abftain from flefh and al 342 OF POISONS. ftrong liquors, and to ljve upon milk, broth, gruel, light puddings, and other fpoon-meats of eafy digeftion. His drink fhould be barley-water, 'infeed tea, or infufions of anv of the mild mucilaginous vegetables. VEGETABLE POISONS, befides heat and pain of the ftomach, commonly occafion fome degree of giddi- nefs, and often a kind of ftupidity or folly. Perfons who have taken thefe poifons muft be treated in the fame man- ner as for the mineral or corrofive. Though the vegetable poifons, when allowed to remain in the ftomach, often prove fatal; yet the danger is gene- rally over as foon as they are difcharged. Not being of fuch a cauftic or corrofive nature, they are lefs apt to wound and inflame the bowels than mineral fubftances ; no time however ought to be loft in having them expelled the ftomach. Or:'JM, being frequently taken by miftake, merits par* ticular attention. It is ufed as a medicine both in a folid and liquid form, which latter commonly goes by the name of laudanum. It is indeed a vr.luable medicine when taken in proper quantity; but as an over-dofe proves a ftrong poifon, we fhall point out its common effeas, together with the method of cure. Too great a quantity of opium generally occafions great drowfinefs, with .ftupor and other apopleaic fymptoms. Sometimes the perfon has fo great an inclination to fleep, that it is almoft impoffible to keep him awake. Every me- thod muft however be tried for this purpofe. He fhould be toffed, fhaked, and moved about. Sharp bliftering plafters fliould be applied to his legs or arms, and ftimulating me- dicines, as falts of hartfhorn, for. held under his nofe. It , will alfo be proper to let blood. At the fame time every method muft be taken to make him difcharge the poifon. This may be done in the manner direaed above, viz. by the ufe of ftrong vomits, drinking plenty of warm water with oil, &c. Mead, befides vomits, in this cafe, recommends acid medicines with lixivial falts. He fays, that he has often given fait of wormwood mixed with juice vt lemon in re- peated dofes with great fuccefs. If the body fhould remain weak and languid after th1? poifon has been difcharged, nourifhing diet and cordials will be proper ; but when there is reafon to fear that the ftomach fo OF POISONS. 343 ftomach or bowels are inflamed, the greateft circumfpeaion is necciicny both with regard to food and medicine. OF THE BITES OF POISONOUS ANIMAL S.-We fhall begin with the bite of a mad dog, as it is both the moft common and dangerous anirr.al- poifon in this country. The creatures naturally liible to contraa this difeafe are, fo for as we yet know, all of the dog-kind, viz. fox- es, dogs, and wolves. Hence it is called the rabies canina, or dog-madnefs. Of the foft we have none in this ifland 5 and it fo feldom happens that any perfon is bit by the firft, that they foai-ce delcrve to be taken notice of. If fuch a thing fhould happen, the method of treatment is precifcly the fame as for the bite of a mad dog. The fymptoms of madnefs in a dog are as follow : At firft he looks dull, fhews an averfion to food and company : He does not bark as ufual, but feems to murmur, is peeviih, and apt to bite ftrangers : His ears and tail droop more than ufual, and he appears drowfy : After he begins to loll oli his tongue, and froth at the mouth, his eyes feeming heavy and watery: He now, if not confined, takes off, runs panting along with a kind of dejeaed air, and endeavours to bite every one he meets. Other dqgs are faid to fly from him. Some think this a certain fign of madnefs, foppofing that they know him by the fmell; but it is not to be de- pended on. If he efcaoes being killed, he feldom runs a- bove two or thiee days, till he dies exhaufted with heat, hunger, and fatigue. This difeafe is moft frequent after long dry, hot feafons ; and fuch dogs as live upon putrid ftinking carrion, without having enough of frefh water, are moft liable to it. When any perfon is bit by a dog, the ftriaeft enquiry ou~ht to be made, whether the animal be really mad. Many difagreeable confequences arife from neglecting to rfcertain this point. Some people have lived in continual anxiety for many years, becaufe they had been bit by a dog which they believed to be mad ; but, as he had been kill- ed on the fpot, it was impoffible to afcertain the foa. Thjs fhould induce us, inftead of killing a dog the moment he has bit any perfon, to do all in cur power to keep him alive, at leaft till we can be certain whether he be mad or not. Many oircumftances may cur-tribute to make people imafone a ytopia, or feeing only at too g-,:at a dijlance, are diforders which depend on the original ftnOhiro or figure of the eye, therefore ad- mit of no cure. 'Yhz inconveniences arifing from them may however be, in fome meafure, remedied by the help of proper glaffes. The former requires the aid of a con- ^ cave, and the latter of a convex glafs. A flrabifnus, or fquinting, depends upon an irregular contraaion of the mufcles of the eye from a fpafm, palfy, epilepfy, or an ill habit. Children often contraa this dif- order by having one of their eyes too much expofed to the light. They may likewife acquire it by imitation from a fquinting nurfe or playfellow, £sV. As this diforder can hardly be cured, parents ought to be careful to prevent it. Almoft the only thing which can be done for it is, to con- trive a mafk for the child to wear, which will enly permit him to foe in a flrait direaion. Spots or fpecks on the eyes, are generally the effoa of in- flammation, and often appear after the fmall-.p->x, tha meafles, or violent ophthalmias. They are verv difficult to cure, and often occafion total blindnefs. if ihc fpecks are foft and thin, they may fometimes be taken off by gen- tle cauftics and difoutients; as vitriol, the juice of celan- dine, csV. When thefe do not fucceed, a furgical operati- on may be tried ; The fuccefs of this however is always very doubtful. The blood-fhot eye may be occafioned by a fuoke, a fall, retching, vomiting, violent coughing, cifV. I have fre- quently known it happen to children in the hooping-cough. It appears at firft like a bit of fcarlet, and is afterwards of a livid or blackifh colour. This diforder generally goes off without medicine. Should it prove obftinate, the patient may be bled, and have his eyes'fomented with a decoaion of comphry roots and elder flowers. A foft pouhice may be applied to the eyes ; anii the body fliould be kept open by g;.itle purgatives. The watery, or weeping eye, is generally occafioned by a relaxation or weaknefs of the glandular parts of the eye. Thefe mav be braced and ftrengthened by bathing the eye with brandy and water, Hungary-water, rofe-water with white vitriol diffolved in it, cifo. Medicines" which make a revulfion are likewife proper; as mild purgatives, perpe- tual 356 DISORDERS OF THE EYE, tual blifters on the neck, bathing the feet frequently ia lukewarm water, &c. When this difeafe proceeds from an obftruaion of the lachrymal dua, or natural paffage of the tears, it is called a fiflala lachrymalis, and can only be cured by a furgicaj operation. Of the EAR. The funaions of the ear may be injured by wounds, ulcers, or any thing that hurts its fabric. The hearing may likewife be huit by exceffive noife; violent colds in the head ; fevers; hard wax, or other fubftances fticking in the cavity of the ear; too great a degree of moiflure or diynefs of the ear. Deafnefs is very often the effea of old age, and is incident to moft people in the decline of life. Sometimes it is owing to an original fault in the ftruaure" or formation of the ear itfelf. When this is the cafe, it admits of no cure; and the unhappy perfon not only con- tinues deaf, but generally likewife dumb, for life*. When * Though thofe perfons who have the misfortune to be horn deaf are ge- nerally fuffered to continue dumb, and confeqnently are in a great meafurs loft to fociety, yet nothing is more certain than that fuch perfons can be taught, not only to read and write, but alfo to fpeak, and to underftand what others fay to chem. Teaching the dumb to fpeak will appear paradoxi- cal to thofe who do not confider the formation of founds is merely mechani- cal, and may be taught without the affiftance of- tiie ear This is not only capable of demonftration, but is actually reduced to practice by the ingenious Mr. Thomas Braid wood of Edinburgh. This gentleman has, by the m»tj» force of genius and replication, brought the teaching of dumb perfons to fuch a degree of pei-fiCTion, that his fcholars are actually more forward in their education th:>ii thiife of the fame age who enjoy all their faciiO.es. They not only read and write with the utmoft readineis, but likewife fpeak, and arc capable of holding converfation with any perfon in the light. What a pity any of the human fpecies fhouJd remain in a ftate of idiotifm who ar? capable of being rendered as ufeful.'and intelligent as others ! We mention this not only from humanity to thofe who have tlie misfortune to be born deaf, hut alfo in jufticc to Mr. Braidwood, whofe fuccefs has far exceeded ail former attempts this way; and indeed it exceeds imagination itfelf fo far, that no perfon who has not feen- and examined his pupils can believe what they are capable of.—As this gentleman, how ver willing, is only able to teach a few, and as the far greater part of thofe who are born deaf cannot afford to attend him, it would be an act of great humaniry, as well as of pub- lic utility, to erect an academy for their behoof. DISORDERS OF THE EAR. 357 When deafnefs is the effect of wounds or ulcers of the ears, or of old age, it is not eafily removed. When it pro- ceeds from cold of the head, the patient muft be careful to keep his head warm, efpecially in the night; he fhould likewife take fome gentle purges, and keep his feet warm, and bathe them frequently in lukewarm water at bedtime. When deafnefs is the effea of a fever, it generally goes off after the patient recovers. If it proceeds from dry wax fticking in the ears, it may be foftened by dropping oil into them ; afterwards they muft be fyringed with warm milk and water. If deafnefs proceeds from drynefs of the ears, which mav be known by looking into them, half an ounce of the oil of fweet almonds, and the fame quantity of liquid apo- deldoch, or tinaure of afafcetida, may be mixed together, and a few drops of it put into the ear every night at bed- time, flopping them afterwards with a little wool or cotton. Some, inftead of oil, put a fmall flice of the fat of bacon into each ear, which is faid to anfwer the purpofe very well. When the ears abound with moiflure, it may be drained off by an iffue or feton, which fhould be made as near the affeaed parts as poflible. Some, for the cure of deafnefs, recommend the gall of an eel mixed with_ fpirit of wine, to be dropped into the ear; others, equal" parts of Hungary-water and fpirit of lavender. Etmuler extols amber and mufk ; and Brookes fays, he has often known hardnefs of hearing cured by putring'a grain or two of mufk into the ear with cotton- wool. But thefe and other applications muft be varied ac- c.-' fong to the caufe of the diforder. Though fuch applications may fometimes be of fervice, *yet Oty much oftener fail, and frequently they do hurt. M. ih... the eyes nor ears ought to he tampered with ; they ait tender organs, and require a very delicate touch. For this reafqn. what we would chiefly recommend in deafnefs, is to keep the head warm. From whatever caufe the dif- -,foer proceeds, this is always proper; and I ha/e known more benefit from it alone, in the moft obftinate cafes of deafnefs, than from all the medicines I ever uftd. Or [ 358 ] Of the TASTE and SMELL. Though thefe fenfes are not of fo great importance to man in a ftate of fociety, as the fight and hearing, yet, as the lofs of them is attended with fome inconveniency, they deferve our notice. They are feldom to be reftored when loft, which ought to make us very attentive to their prefer- vation, by carefully avoiding whatever may in the leaft prove injurious to them. As there is a very great affinity betwixt the organs of tafting and fmelling, whatever hurts the one generally affeas the other. Luxury is highly injurious to thefe organs. When the nofe and palate are frequently ftimulated by fragrant and poignant difhes, they foon lofe the power of diflin- guifhing taftes and odours with any degree of nicety. Man, in a ftate of nature, may perhaps have thefe faculties as acute as any other animal. The fenfe of fmelling may be diminifhed or deftroyed by difeafes; as, the moiflure, drynefs, inflammation or fuppuration of that membrane which lines the inlide of the nofe, commonly called the olfaaory membrane; the com- preflion of the nerves which fupply this membrane, or fome fault in the brain itfelf at their orfofo. A defedt, or too great a degree of folidity, of the fmall fpungy bones of the upper jaw, the caverns of the forehead, C3V. may likewife impair the fenfe of fmeiling. It may alfo be injured by a colleaion of foetid matter in thofe caverns, winch keeps conftantly exhaling from them. Few things are more hurt- ful to the fenfe of fmelling than taking great quantities of fnuff. When- the nofe abounds with moiflure, after gentle e- vacuations, fuch things as tend to take off irritation, and coagulate the thin fharp ferum, may be applied,; as the oil cf anifc mixed with fine flour ; camphire diffolved in oil of almonds, foV. The vapours of amber, frankincenfe, gum- maftic, and benjamin, may likewife be received into the nofe and mouth. For moiftening the mucus when it is too dry, fome re- commend fnuff made of the leaves of marjoram, • mixed with oil of amber, marjoram, and anifeed ; or a ffernuta- tory of calcined white vitriol i twelve grains of which may bo OF THE TASTE AND SMELL. 353 be mixed with two ounces of marjoram-water, and filtrat- ed. The fteam or vapour of vinegar upon hot iron received up the noftrils is likewife of ufe for foftening the mucus, opening obftruaions, cifo. If there be an ulcer in the nofe, it muft be dreffed with fome 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 cafe, the folution of the corrofive fublimate in brandy may be taken, as direaed in the gutta ferena. The ulcer oujght likewife to be wafhed with it; and the fumes of cinntfbar may be received up the noftrils. If there "be reafon to fufpea that the nerves which fup- ply the organs of fmelling are inert, or want ftimulating, volatile falts, ftrong fniiffs, and other things which occafi- on freezing, may be applied to the nofe. The forehead may likewife be anointed with balfam of Peru, to which may be added a little of the oil of amber. The tafte may be diminifhed by crufts, filth, mucus, apthse, pellicles, warts, Lfc covering the tongue: It may be depraved by a fault of the faliva, which, being dif- charged into the mouth, gives the fame fenfation as if the food which the perfon takes, had really a bad tafte; or it may be entirely deftroyed by injuries done to the nerves of the tongue and palate. Few thmgs prove more hurtful ei- ther to the fenfe of tailing or fmelling than obftinate colds, efpecially thofe which affea the head. When the tafte is diminifhed by filth, mucus, &c. the tongue ought to be foraped and frequently wafhed with a mixture of water, vinegar, and honey, or fome other de- tergent. When the faliva is vitiated, which feldom hap- pens, unlefs in fevers or other difeafes, the curing of the diforder is the cure of this fymptom. To relieve it how- ever in the mean time, the following things may be of ufe : „ If there be a bitter tafte, it may be taken away by vomits, w purges, and other things which evacuate bile: What is ^called a nidorous tafte, arifing from putrid humours, is corrected by the juice of citrons, oranges, and other acids : A fait tafte is cured by plentiful dilution with watery li- quors : An acid tafte is deftroyed by abforbents and alka- line falts, as powder of oyfter-fhells, fait of worm- wood, cifo. When 360OF THE TASTE AND SMELL. When the fenfibility of the nerves which fupply the organs of tafte feems to be diminifhed, the chewing of horferadifh, or other ftimulating fubftances, will help to recover it. Of the TOUCH. The fenfe of touching may be hurt by any thing that obftruas the nervous influence, or prevents its being re- gularly conveyed to the organs of touching ; as preffure; extreme cold, &c. It may likewife be hurt by too great a degree of fenfibility, when the nerve is not fufficiently cover- ed by the cuticle or fkarffkin, or where there is too great a tenfion of it, or it is too delicate. Whatever diforders the funaions of the brain and nerves, hurts the fenfe of touch- ing. Hence it appears to proceed from the fame general caufes as palfy and apoplexy, and requires nearly the fame method of treatment. In aflupor, or defoa of touching, which arifes from an obftrudtion of the cutaneous nerves, the patient muft firft be purged ; afterwards fuch medicines as excite the aaion of the nerves, or ftimulate the fyftem, may be ufed. For this purpofe, the fpirit of hartfhorn, fal volatile oleofttm, horferaddifh, csV. may be taken inwardly j the difordered parts, at the fame time, may be frequently rubbed with frefh nettles or fpirit of fal ammoniac. Bliftering plafters and finapifms applied to the parts will likewife be of ulf, as alfo warm bathing, efpecially in the natural hot baths. CHAP. C 361 3 CHAP. XLVI. OF A SCHIRRUS AND CANCER. ASCHIRRUS is a hard indolent tumour feated in fome of the glands; as the breafts, the armpits, cfo. It tne tumour becomes large, unequal, of a livid, blackifh or leaden colour, and is attended with violent pain, it gets the name of an occult cancer. When the fkin is broken, and a fanies or ichorous matter of an abominably foetid fmell is difcharged from the fore, it is called an open or ul- cerated cancer. Perfons after the age of 45, particularly women, and thofe who lead an indolent fedentary life, are moft fubjea to this difeafe. CAUSE S.—:—This difeafe is often owing to fuppref- fed evacuations ; hence it proves fo frequently fatal to wo- men of a grofs habit, particularly old maids and widows, about the time when the menftrual flux ceafes. It may likewife be occafioned by exceflive grief, fear, anger, reli- gious melancholy, or any of the depreffing paffions. Hence the unfortunate, the choleric, and thofe perfons who de- vote themfelves to a religious life in convents or monafte- ries, are often affliaed with it. It may alfo be occafioned by the long continued ufe of food that is too hard of digef- tion, or of an acrid nature; by barrennefs ; celibacy ; in- dolence ; cold ; blows ; friaion ; preffure ; or the like. Women often fuffer from the laft of thefe by means of their ftays, which fqueeze and comprefs their breafts fo as to occafion great mifchief. Sometimes the difeafe is owing to an hereditary difpofition. SYMPTOM S.——This diforder feems often verr frifling at the beginning. A hard tumour about the fize cf a hazle nut, or perhaps fmaller, is generally the firft fymp- tom. This will often continue for a long time witbe'io feeming to increafe, or giving the patient great uneafineO; but if the conftitution be hurt, or the tumour irritated by preffure, or improper treatment of any kind, it begins to. 362 OF A SCHIRRUS AND CANCER. extend itfelf towards the neighbouring parts by pufhing out a kind of roots or li libs. It then gets the name of cancer^ from a fancied refemblance betwixt thefe limbs and the claws of a crab. The colour of the fkin begins to change^ which is firft red, afterwards purple, then bluifh, livid, and at laft black. The patient complains of heat, with a burning, gnawing, fhooting pain. The tumnur is very hard, rough, and unequal, with a protuberance, or rifing, , in the middle ; its fize increafes daily, and the neighbour- ing veins becomes thick, knotty, and of a blackifh colour. The fkin at length gives way, and a thin, fharp ichor begins to flow, which corrodes the neigbouring parts till it forms a large unfightly ulcer. More occult cancers arife, and communicate with the rteighbouring glands. The pain and flench become intolerable; the appetite fails; the ftrength is exhaufted by a continual heaic fever; at laft, a violent haemorrhage, or difcharge of blood, from fome part of the body,) with faintings, or convulfion fits, generally put an end to the miferable patient's life. REG i MEN.----The diet ought to be light, but nourifhing. All ftrong liquors, high-feafoned and falted provifions, are to be avoided. The patient may take 3s much exercife as he can eafily bear; and fhould ufe every method to divert thought, and amufe his fancy. All kinds of external injury are carefully to be.guarded againft, par- ticularly of the affeaed part, which ought to be defended from all preffure, and even from the external air, by cover- ing it with fur or foft flannel. M E E> I C I N E-----This is one of thofe difeafes for which no certain remedy is yet known. Its progrefs how- ever may fometimes be retarded, and fome of its moft dif- agreeable fymptoms mitigated by proper applications. One misfortune attending the difeafe is, that the unhappy pati- ent often conceals it too long. Were proper means ufed in due time, a cancer might often be cured ; but, after the *± diforder has arrived at a certain height, it generally fets a]l medicine at defiance. ^^T When a fchirrous tumour is firft difcovered, the patient ought to obferve a proper regimen, and to take twice or thrice a-week a dofe of the common purging mercurial pill. He may likewife be bled; and the part affeaed may be gently rubbed twice a-day with a little of the mercurial ointment, and kept warm with fur cr flannel. His food '■■•■■" :•..■• * muft OF A SCHIRRUS AND CANCER. 363 ihuft be light, .and he may drink daily an Englifh pint of the decoaion of woods or forfaparilla. I have fometimes difcuffed hard tumours, which had the appearance of be- ginning cancers, by a courfe of this kind. Should the tumour however not yield to this treatment, but; on the contrary, become larger and harder, it will be proper to extirpate it. Indeed, whenever this can be done with fafety, the fooner it is done the better. It can anfwer no purpofe to extirpate a cancer after the conftitution is ruined, or the whole mafs of humours corrupted by it. This however is the common way, which makes the ope- ration fo feldom fucceed. Few people will fubmit to the extirpation till death flares them in the face ; whereas, if it were done early, the patient would be in no danger of lofing his life by the operation, and it would generally prove a radical cure. When the cancer is fo fituated that it cannot be cut off,' or, if the patient will not fubmit to the operation, fuch medicines as will mitigate or relieve the moft urgent fymp- toms may be ufed. Dr. Home fays, that half a grain of the corrofive fublimate of mercury, diffolved in a proper quantity of brandy, and taken night and morning, will often be of fervice in cancers of the face and nofe. He likewife recommends an infufion of the folanum, or night- fhade, in cancers of the breafts. But the medicine moft in repute at prefent for this difo eafe is hemlock. Dr. Stork, phyfician at Vienna, has of late recommended the extraa of this plant as very efficaci- ous in cancers of every kind. The Dr. fays he has given fome hundred weights of it without ever hurting any body, and often with manifeft advantage. He advifes the patient however to begin with very fmall dofes^ as two or three grains, and to increafe the dofe gradually till fome good ef- fea be perceived, and there to reft without further increafe. From two or three grains at firft, the Dr. fays he has in- creafed the dofe to two, three, or four drams a-day, and finds that fuch dofes may be continued for feveral weeks without any bad confequences. The regimen which the Dr. recommends during the ufe of the medicine, is to avoid farinaceous fubftances not fer- mented, and too acrid aromatics. He fays, good wine will not be hurtful to thofe who are accuftomed to it, nor a moderate ufe of acids; and adds, that the patient fhould live 364 OF A SCHIRRUS AND CANCER. live in a pure free air, and keep his mind as quiet and1 cheerful as poflible. The Dr. does not pretend to fix the time in which a cancer may be refolved by the ufe of hemlock, but fays he • has given it for above two years in large dofes without any * apparent benefit; neverthelefs, the patient has been cured by perfifting in the ufe of it for half a year longer. This is at leaft encouragement to give it a fair trial. Though »*sfcwe are far from thinking the hemlock merits thofe extrava- gant encomiums which the Dr. has beftowed upon it, yet, in a difeafe which has fo long baffled the boafted powers of medicine, we think it ought always to be tried. The powder of hemlock is by fome preferred to the ex- traa. They are both made of the frefh leaves, and may be ufed nearly in the fame manner. Dr. Nicholfon of Ber- wick fays, he gradually increafed the dofe of the powder from a few grains to half a dram, and gave near four drams of it in the day with remarkably good effeas. The hem- lock may alfo be ufed externally either as a poultice or fo- mentation. The fore may likewife be kept clean by in- jeaing daily a ftrong decoaion of the tops and leaves into it. Few things contribute more to the healing of foul for- did ulcers of any kind than keeping them thoroughly clean. This ought never to be negleaed. The beft application for this purpofe feems to be the carrot poultice. The root of the common carrot may be grated, and moiftened with as much water as will bring it to the confiflence of a poul- tice or cataplafm This muft be applied to the fore, and renewed twice a-day. It generally cleans the fore, eafes the pain, and takes away the difagreeable fmell, which are objeas of no fmall importance in fuch a dreadful diforder*. Wort, or an infufion of malt, has been recommended not only as a proper drink, but as a powerful medicine in this difeafe. It muft be frequently made frefh, and the pa- tient may take it at pleafure. Two, three, or even four Englifh pints of it may be drank every day for a confider- able time. No benefit can be expeaed from any medicine in this difeafe unlefs it.be perfifted in for a long time. It is of too obftinate a nature to be foon removed ; and, when it admits of a cure at all, it muft be brought about by in- ducing an almoft total change of the habit, which muft al- ways * London Medical Eflays. OF A SCHIRRUS AND CANCER. 365 ways be a work of time. Setons or iffues in the neigh- bourhood of the cancer have fometimes good effeas. When all other medicines fail, recourfe muft be had to opium, as a kind of folace. This will not indeed cure the difeafe, but it will eafe the patient's agony, and render life more tolerable while it continues. To avoid this dreadful diforder, people ought to ufe wholefome food j to take fufficient exercife in the open air ; to be as eafy and cheerful as poffible ; and carefully to guard againft all blows, bruifes, and every kind of preffure upon the breafts or qther glandular parts*. CHAP. XLVII. OF THE VENEREAL DISEASE. IN a former edition of this book the veneral difeafe was omitted. The reafons however which at that time in- duced me to leave it out, have upon more mature confide- ration vanifhed. Bad confequences, no doubt, may arife from ignorant perfons tampering with medicine in this dif- order j but the danger from that quarter feems to be more than balanced by the great and folid advantages, which muft arife to the patient from an early knowledge of his cafe, and an attention to a plan of regimen, which, if it does not cure the difeafe, will be fure to render it more mild, and lefs hurtful to the conftitution. It is peculiarly unfortunate for the unhappy perfons who contraa this difeafe, that it ftill lies under a fort of difgrace. This renders difguife neceffary, and makes the patient ei- ther conceal his diforder altogether, or apply to thofe who promife * As hemlock is the principal medicine recommended in this difeafe, v- would have given fome direaions for the gatheri.j.' and preparing of that plant ; but as its different preparations are nrw kept in the ftiops, we think it much fafer for people to get them there, with proper direftions for ufiug them. 366 OF THE VENEREAL DISEASE. promife a fudden and fecret cure ; but who in faa only re- move the fymptoms for a time, while they fix the difeafe deeper in the habit. By this means a flight infeaion, which might have been cured by regimen alone, is often converted into an obftinate, and fometimes incurable ma- lady. Another, unfavourable circumflance attending this difeafe is, that it affumes a variety of different fhapes, and may with more propriety be called an affemblage of dif- ^eafesj than a fingle one. No two difeafes can require a more different method.of treatment than the venereal dif- order does in its different ftages. Hence the folly and dan- ger of trufting, to any particular noftrum for the cure of this difeafe, muft be obvious to all. Such noftrums are however generally adminiftered in the fame manner to all who apply for them, without the leaft regard to the ftate of the difeafe, the conftitution of the patient, the degree of infeaion, and a thoufand other circumftances which are of the utmoft importance. Though the venereal difeafe is generally the fruit of unlawful love, yet it may be communicated to the inno- cent as well as the guilty. Infants, nurfes, midwives, and married women whofe hufbands lead diffolute lives, are often affeaed with it, and frequently loofe their lives by not being aware of their danger in due time. The unhap- py condition of fuch. perfons will certainly plead our ex- cufe, if any excufe be neceffary, for endeavouring to point out the fymptoms and cure of this too common difeafe. To enumerate all its different fymptoms, however, and to trace the difeafe minutely through its various ftages, would require a much larger fpace than we have allotted to this part of our fubjea ; we fhall therefore confine our obfervations chiefly to circumftances of importance, omit- ting fuch as are either trifling, or which occur but feldorm We fhall likewife pafs over the hiftory of the difeafe, with the different methods of treatment which it has undergone, fince it was firft introduced into Europe, and many other circumftances of a fimilar nature ; all of which, though jjtty might tend to amufe the reader, yet could afford him Httle or no ufeful knowledge. Of [ 3^7 3 Pf the VIRULENT GONORRHOEA. The virulent gonorrhoea is an involuntary difcharge of infeaious matter from the parts of generation in either fex. It generally makes it appearance within eight or ten days after the infeaion has been received ; fometimes indeed it appears in two or three days, and at other times not before the end of four or five weeks. Previous to the difcharge, the patient feels an itching with a fmall degree of painin the genitals. Afterwards a thin glary matter begins to diftill from the urinary paffage which ftains the linen, and occafions a fmall degree of titillation, particularly in the time of making water ; this, gradually increafing, arifes at length to a degree of heat and pain which are chiefly per- ceived about the extremity of the urinary paffage, where a flight degree of rednefs and inflammation likewife begin to appear. As th^ diforder advances, the pain, heat of urine, and running increafe, while frefh fymptoms daily enfue. In men the ereaions become painful and involuntary, and are more frequent and foiling than when natural. This fymptom is moft troublefome when the patient is warm in bed. The pain which was at firft only perceived towards the extremity, now begins to reach all up the urinary paf- fage, and is moft intenfe juft after the patient has done making water. The running gradually recedes from the colour of feed, grows yellow, and at length puts on the ap- pearance of matter. When the diforder is arrived at its height, all the fymp- toms are more intenfe ; the heat of urine is fo great, that the patient dreads the making of it, and, though he feels a conftant inclination this way, yet it is rendered with the greateft difficulty, and often onlv by drops : the involun- tary ereaions now become extremely painful and frequent; there is alfo a pain, heat, and fenfe of fulnefs about the feat, and the running is plentiful and fharp, of a brown, greenifh, and fometimes of a bloody colour. By a proper regimen and medicines, the violence of the fymptoms gradually abates ; the heat of urine goes oft"; the involuntary and painful ereaions, and the heat and pajn about the feat become eafier ; the running alfo gradually decreafesj OF THE VIRULENT GONORHCEA. 368 decreafes, grows whiter and thicker, till at laft it entirely difappears. By attending to thefe fymptoms, the gonorrhoea may be pretty readily diftinguifhed from any other difeafe. There are however fome few diforders for which it may be miftaken, as an ulcer in the kidnies or bladder, the fluor elbus or whites in women, &c. But in the former of thefe, the matter comes away only with the urine, or when the fphinaer of the bladder is open ; whereas in a gonorrhoea, the difcharge is conftant. The latter is more difficult to diftinguifh, and rnuft be known chiefly from its effeas, as pain, communicating the infeaion, isfc. REGIME N.----When a perfon has reafon to fufpea that he has caught the venereal infeaion, he ought moft ftriaiy to obferve a cooling regimen, to avoid every thing of a heating nature, as wines, fpirituous liquors,*rich fauces, fpiced, falted, high-feafoned, and fmoke-dried provifions, cifo.-; as alfo all aromatic and ftimulating vegetables, as onions, garlic, fhallot, nutmeg, cinnamon, mage, ginger, and fuch like. His food ought chiefly to conlift of mild vegetables, milk, broths, light puddings, panado, gruels, C5fo His drink may be barley-water, milk and water,-de- coaions of marfhmallows and liquorice, linfeed tea ; or, if the patient has been accuftomed to live high, fmall beer pr weak negas. Venereal pleafures and violent exercifes of all kinds, efpecially riding on horfeback, are to be avoid- ed. The patient muft beware of catching cold, and when the inflammation is violent, he ought to keep his bed. MEDICIN E.----A virulent gonorrhoea can feldom be cured fpeedily and effecfually at the fame time. The patient ought therefore not to expea, nor the phyfician to promife it. It will often continue for two or three months, and fometimes for five or fix, even where the treatment has been very proper. Sometimes, indeed, a gonorrhoea may be cured at the beginning by aftringent injeaions. Thefe may be prepared by diffolving half a dram of fugar of lead in fix ounces of rofe-water. Of this the fill of a fmall fy- ringe may be thrown up the urethra five or fix times a-day a little warm, and continued till the running flops. Purges are of very great importance in the gonorrhoea. They ought not however to be of the ftrong or draftic kind. \Vhatever raifes a violent commotion in the body increafes the OF THE VIRULENT GONORRHOEA. 36$ the danger, and tends to drive the difeafe deeper into the habit. Procuring two or three ftools every fecond or third day for the firft fortnight, and the fame number every fourth or fifth day for the fecond, will generally be fuffici- ent to remove the inflammatory fymptoms, to diminifh the runnings and to change the colour and confiflence cf the matter, which gradually becomes more clear and ropy as the virulence abates*. When the inflammatory fymptoms run high, bleeding is always neceffary at the beginning. This operation, as in other topical inflammations, muft be repeated according to the ftrength and conftitution of the patient, and the ve- hemence and urgency of the fymptoms. Medicines which promote the fecretioh of urine are likewife proper in this ftage of the diforder. For this pur- pofe, an ounce of nitre and two ounces of gum arabic, pounded together, may be divided into twenty-four dofes, one of which may be taken frequently in a cup of the pa- tient's drink. If thefe fhould make him pafs his urine fd often asto become troublefome to him, he mar either take them lefs frequently, or leave out the nitre altogether, and take the fame quantity of magnefia alba in its Head. When the pain and inflammation are feated high to- wards the neck of the bladder, it will be proper frequently to throw up an emollient clyfter, which, befides the bene- fit of procuring ftools, will ferve as a fomentation to the inflamed parts. Injeaing frequently a little milk and wa- B b b ter, • If the patient can fwallo'w a folution of falts and manna, he may take 6k drams, or, if his conftitution requires, an ounce of the tonr.er, with half an ounce of the latter. Thefe may he diflblyed in half an F.ry lib pint of boiling water, whey, or thin water-gruel, and taken earty in we morn- '"If an infufion of fenna and tamarinds be more agreeable, two drams of the former, and an ounce of the latter, may be. infufed all night in halt an Englilh pint of boiling water. The infufion may he ftrained next morning, and half -n ounce of Glauber's falts diflblved in it. A fmall tea-cupful of this infulion may betaken every half hour till it ^crates Should the patient prefer an elcftuiry, the following w.ll be found to an- fwer very well. Take of the lenitive eleauary four ounces, jalap in powder two drams, rhubarb one dram, and a. much of the fyrup ,-; pale rofes as wil ferve to make the whole into a foft electuary. Two tea-fpoonfuU or this m;.V be taken over night, and about the fame quantity next morning, every 'Ta/that the patient diufes to take a purge the dofes of the_ above medi- cines may b/:r.crcai;d or diminifhed according as the patient finds ;t necef- farv. 370 OF THE VIRULENT GONORRHOEA. ter, or linfeed tea about the warmth of new milk, up the urethra, by means of a fyringe, will likewife be of ufe*, The genitals ought alfo to be bathed, or rather foaked in warm milk and water, two or three times a-day j which not only keeps them clean, but tends to take off" the ftric- ture of the veffels, and to blunt the acrimony of the hu* mours. We have reafon to believe, that bathing, injeai- ons, and fomentations, if duly perfifted in, would have far more influence in the cure of this difeafe than is generally imagined. Soft poultices, when they can conveniently be applied to the parts, are of great fervice. They may be made of the flower of linfeed, or of wheat bread and milk, foften- ed with frefh butter or fweet oil. When poultices cannot be conveniently ufed, cloths wrung out of warm water, or bladders filled with warm milk and water may be applied. I have often known the moft excruciating pains, during the inflammatory ftate of the gonorrhoea, relieved by one or other of thefe applications. Few things tend more to keep off inflammation in the fpermatic veffels, than a prope.r trufs for the fcrotum. It ought to be fo contrived as to fupport the tefticles, and fhould be worn from the firft appearance of the difeafe till it has ceafed fome weeks. This treatment will fometimes remove the gonorrhoea fo quickly, that the perfon will be in doubt whether he really laboured under that difeafe. This, however, is too favourable a turn to be often expeaed. It more frequent- ly happens that we are only able to procure an abatement or remiffion of the inflammatory fymptoms, fo far as to make it fafe to have recourfe to the great antidote merturyi which in all obftinate venereal cafes feems to be abfolutelt neceffary for completing the cure. When bleeding, purging, fomentations, and the other things recommended above, have eafed the pain, foftened the pulfe, relieved the heat of urine, and rendered the in- Voluntary ereaions lefs frequent, the patient may begin to tife mercury in any- form that is moft agreeable to him. One of the moft common preparations of mercury ufed in this cafe is calomel. Two or three grains of it may be made into a pill with crumb of bread, or formed into a bo- lus with conferve of hips, and taken every other night at bed-time. The dofe may be gradually increafed to eight ©r ten grains, Should OF THE VIRULENT GONORRHOEA. 371 Should the patient be purged or griped in the night by the mercury, he muft take an infufion of fenna, or fome other purgative, and drink freely of water-gruel, to pre- vent bloody ftools, which are very apt to happen fhould the patient catch cold, or if the mercury has not been du- ly prepared. When the bowels are weak, and the mercury is apt to gripe or purge, thefe difagreeable confequences may be prevented by making the above quantity of calomel into a bolus, with half a dram, or two fcruples of diafcor- dium, or the Japonic confeaion. After the pill or bolus has been repeated three or four times, a purging potion muft be given, to carry off the mercury, and prevent a fa- livation. To prevent the difagreeable circumftance of the mer- cury's affeaing the mouth, or bringing on a falivation, it may be combined with purgatives. With this view the laxative mercurial pill has been contrived, the ufual dofe of which is half a dram, or three pills, night and morning, to be repeated every other day ; but the fafer way is for the patient to begin with two, or even with one pill, gradual- ly increafing the dofe.. To fuch perfons as can neither fwallow a bolus nor a pill, mercury may be given in a liquid form, as it can be fufpended even in a watery vehicle, by means of gum-ara- bic ; which not only ferves this purpofe, but likewife pre- vents the mercury from affeaing the mouth, and renders it in many refpeas a better medicine*. It happens very fortunately for thofe who cannot be brought to take mercury inwardly, and likewife for per- fons whofe bowels are too tender to bear it, that an ex- ternal application of it will anfwer equally well, and, in feme refpeas, better. It muft be acknowledged, that mercury taken inwardly for any length of time, greatly weakens and diforders the bowels ; for which reafon, when a plentiful ufe of it becomes neceffary, we fhould prefer rubbing to any other mode of application whatever. The * TO.e quickfilver one dram, gum-arabic reduced to a mucilage, two drains; let the quickfilver be rubbed with the mucilage, in a marble mortar, unt;l the globules of mercury entirely difappear : afterwards add gradually, (till continuing the trituration, half an ounce of balfamic lyrup, and eight ounces of finrle cinnamon water. Two table-fpoonfuls of this folution may be t-iken niOt and morning. Some reckon this the beft form in whic.i ^lOOin or can be exhibited fpr the cure of a gonorrhoea. 37? OF THE VIRULENT GONORRHOEA. The common mercurial, or blue ointment, will anfwer Very well. Of that which is made by rubbing together equal quantities of hog's lard and quickfilver, about a dram may be ufed at a time. The beft time for rubbing it on is at nijjht, and the moft proper place the inner fide of the thighs. The patient fhould ftand before the fire when he rubs, and fhould wear flannel drawers next his fkin all the time he is ufing the ointment. If ointment of a weaker or ftronger kind be ufed, the dofe muft be in- creafed or diminifhed-accordingly. If, during the ufe of the ointment, the inflammation of fhe genital parts, together with the heat and feverifhnefs, fhould return, or if the mouth fhould grow fore, the gums tender, and the breath become offenfive, a dofe or two of Glauber's falts, or fome other cooling purge, may be taken, and the rubbing intermitted for a few days. As foon, however, as the figns of a fpitting are gone off, if the vi- rulency be not quite correaed, the ointment muft be re- peated, but in fmaller quantities, and at longer intervals, fhan before. Whatever way mercury is adminiftered its ufe muft be perfifted in as long as any virulency is fufpea- ed to remain. During this, which may be called the fecond ftage of the diforder, though fo ftria a regimen is not neceffary as in the firft or inflammatory ftate, yet intemperance of every kind muft be avoided. The food muft be light, plain, and of eafy digeftion : and the greateft indulgence that may be allowed with refpea to drink is, a little wine diluted with a fufficient quantity of water. Spirituous liquors are to be avoided in every fhape. I have often known the inflam- matory fymptoms renewed and heightened, the running in- creafed, and the cure rendered extremdy difficult and te- dious, by one fit of exceffive drinking. When the above treatment has removed the heat of urine, and forenefs of the genital parts j when the quanti- ty of running is confiderably leffened, without any pain or fwelling in the groin or tefticle fupervening ; when the pa- tient is free from involuntary ereaions; and laftly, when the running becomes pale, whitifh, thick, void of ill fmell, and tenacious or ropy ; when all or moft of thefe fymptoms appear, the gonorrhoea is arrived at its laft ftage, and we may gradually proceed to the ufe of gentle aftringents, or agglutinating medicines. Thefe, however, ought always to OF THE VIRULENT GONORRHOEA. 373 to be ufed with caution. When the contagion is removed, the running will generally ftop of itfelf ; and when it does not, there is ftill reafon to fear, that the virolency is not completely fubdued. But this will foon appear ; for, if the contagion be not removed, upon flopping the running, fwelled tefticles, a fore throat, buboes, or fome other fymptom of the pox, will enfue. When this happens, the running muft be again promoted by purges, and more mercury muft be u(OJ. That we may proceed with caution, and not give too fudden a check to the difcharge, gentle aftringcnts may be mixed with purgative medicines, and taken in the following manner : To two ounces of the lenitive eleauary, add cream of tartar and powdered rhubarb, of each half an ounce ; balfam of capivi, an ounce and a half. Let thefe be made into an electuary, with the fyrup of pale rofes, and about the bulk of a large nutmeg taken evening ani morning for a dofe. If no bad fymptoms enfue from ufing the above, ftrong- er aftringents, if neceffary, may be adminiftered, as the Venice turpentine, the Peruvian balfam, balfam of Gile- ad, cjfV. it thefe balfams fhould occafion naufea or fick- hefs, the patient, inftead of them, may take fifteen or twenty drops of the acid elixir of vitriol, in a glafs of red wine or water, twice a-day. Should the running, notwithftanding the ufe of thefe medicines, ftill continue, but without any figns of viru- lency, recourfe muft be had to aftringent inje£tions. For this purpofe a little gum-arabic may be diffolved in three or four ounces of rofe-water, to which ten or twelve grains of the fugar of lead may be added. Two er three drams of this may be daily injeaed up the urethra with a fmall ly- ringe. It fhould be ufed a little warm, and may b& made ftronger as the cafe requires. During this courfe, a proper regimen is likewife to be obferved. The patient ought to take gentle exercife in the open air, but Ihould avoid great heat and fatigue. His diet ought to be drying and agglutinating, as bifc:.it, rice, mil- let, jellies of hartfhorn/and other things of a ftrcngthen- ing nature. His drink may be Briftol water, red port or claret, with the addition of a little water. All excefs is carefully to be avoided, and whatever may have a tendency to weaken or relax the habit. 374 OF THE VIRULENT GONORRHOEA. If all thefe means fhould prove ineffeaual, and not- withstanding the virulency is perfeaiy cured, a running fhould ftill remain, the diforder is then den n.inated a gleet; the proper treatment whereof we fhall next endea- vour to fhew. Of GLEETS. A gonorrhoea frequently repeated or improperly treated, often ends in a gleet, which may either proceed from re- laxation, or from latent ulcers in fome of the parts which had been the feat of the gonorrhoea. It is however of the greateft importance in the cure of the gleet, to know from which of thefe caufes it proceeds. When the difcharge proves very obftinate, and receives little or no check from aftringent remedies, there is ground to fufpea that it is owing to ulcers; but if the drain is inconftant, and is chiefly obfervable when the patient is ftimulated by vene- real ideas, or upon ftraining to go to ftool, we may rea* fonably conclude that it is chiefly owing to relaxation. In the cure of a gleet proceeding from relaxation, the principal defign is to brace, and reftore a proper degree of tenfion to the debilitated and relaxed veffels. For this pur- pofe, befides the medicines recommended in the laft ftage of the gonorrhoea, the patient may have recourfe to ftrong- er and more powerful aftringer.ts, as the peruvian bark*, alum, vitriol, galls, tormentil, biftort, balauftines, CSV. While the patient is taking thefe medicines the cure may be promoted by aftringent injeaions, fuch as are re- commended in the laft ftage of the gonorrhoea, to which a few grains of alum, or white vitriol, may occafionally be added. The laft remedy which we fhall mention in this cafe is the cold bath, than which there is not perhaps a more powerful bracer in the whole compafs of medicine. It ought * The peruvian hark may be combined with other aftringents, and pre- pared in the following manner : Take of peruvian hark bruifedfix drams, of frefli galls bruifed two drams ; boil them in a pound and a half of water to a pound : to the ftrained liquor add three ounces of the fimple tincture of the bark. A fmall tea-cup full of this may he taken three times a-day, adding to each cup fifteen or twentj irons of the acid elixir of vitriol, OF GLEETS; #$ 6ught never to be omitted in this fpecies of gleet, unlefs there be fomething in the conftitution of the patient which renders the ufe of it unfafe. The chief objeaions to the ufe of the cold bath are, a full habit* and an unfound ftate of the vifcera. The danger from the former may always be leffened, if not removed by Weeding; but the latter is an infurmountable obftacle, as the preffure of the water, and the fudden contraaion of the external veffels, by throw- ing the blood with too much force upon the internal parts are apt to occafion ruptures of the veffels or a flux of hu- mours upon the difeafed organs. But where no objeaiori of this kind prevails, the patient ought to plunge over head in water every morning fafting, for three or four weeks to- gether. He fhould not however ftay in above three or four minutes, and fhould take care to have his fkin dried as foon as he comes out. The regimen proper in this cafe is the fame as was men- tioned in the laft ftage of the gonorrhoea : the diet muft be drying and aftringent, and the drink Spa, Pyrmont, or Briftol waters, with which a little claret or red wine may fometimes be mixed. When the gleet does not in the fmalleft degree yield to thefe medicines, there is reafon to fufpea that it proceeds from ulcers, In this cafe,, recourfe muft be had to mercu- ry, and fuch medicines as tend to correa any predominant acrimony with which the juices may be affeaed, as the decoaion of china, farfaparilla, faflafras, or the like. Mr. Fordyce fays, he has feen many obftinate gleets of two, three, or four years ftanding, effoaually cured by a mercurial inunaion, when almoft every other medicine had been tried in vain. Dr. Chapman feems to be of the fame opinion; but fays, he has always found the mercury fuc- ceed beft in this cafe when joined with terebinthinate and other agglutinating medicines. For Which reafon the doc- tor recommends pills made of calomel and-Venice turpen- tine* ; and defires that their ufe may be accompanied with a decoaion of guaiacum or farfaparilla. The * Take Venice turpentine, boiled to a fufficient degr-re of hnrdnefs, half an ounce, calomel half a-dram. Let thefe l>» mixeJ ai>d formed into fixty pills, of which five or f;x may be taken ni^'.t and mornipg. If, during the ufe of thefe pills, the mouth fliould grow lore, or the breath become olfen- ftve, they muft be dilcontinued till thefe fymptoms difappear. 376 OF GLEETS. The laft kind of remedy which we fhall mention for tbe cure of ulcers in the urinary paffagc, are the fuppurating candles or bougies ; as thefe are prepared various ways^ and are generally to be got ready made, we fhall not fpend time in enumerating the different ingredients of which they are compofed, or teaching the manner of preparing them : Before a bougie be introduced into the urethra, however, it fliould be fmeared all over with fweet oil$ to prevent it from ftimulating too fuddenly ; it may be fuffered to con- tinue in from one to feven or eight hours, according as the patient can bear it. Obftinate ulcers are not only often healed, but tumours and excrefcences in the urinary paf- fages taken away, and an obftruaion of urine removed, by means of bougies. Of the SWELLED TESTICLE. The fwelled tefticle may either proceed from infeaiort lately contraaed, or from the venereal poifon lurking in the blood : the latter indeed is not very common, but the former frequently happens both in the firft and fecond ftages of a gonorrhoea ; particularly when the running is unfea-: fonably checked, from catching cold, hard drinking, ftrong draftic purges, violent exercife, the too early ufe of aftrin- gent medicines, &c. In the inflammatory ftage bleeding is neceffary, which muft be repeated according to the urgency of the fymptoms. The food muft be light, and the drink diluting. High- feafoned food, flefh, wines, and every thing of a heating nature, are to be avoided. Fomentations are of Angular fervice. Poultices of bread and milk, foftened with frefh butter or oil, are likewi/e very proper, and ought conftant- >y to be applied when the patient is in bed : when he is up, the tefticle fhould be kept warm, and fupported by a bag or trufs, which may eafily be contrived in fuch a manner as to prevent the weight of the tefticle from having any effea. ° J If it fhould be found impraaicable to clear the tefticle by the cooling regimen now painted out, and extended ac- cording to circumftances, it will be neceffary to lead the pa- tient through fuch a complete antivenereal courfe as fhall enfure him againft any future uneafinefs. For this pur- pofe* OF THE SWELLED TESTICLE. 377 pof«, befides rubbing the mercurial ointment on the part, if free from pain, or on the thighs, as direaed in the go- norrhoea, the patient muft be confined to his bed, if necef- fary, for five or fix weeks, fufpending the tefticle all the while with a bag or trufs, and plying him inwardly with ftrong decoaions of farfaparilla. > When thefe means do not fucceed, and there is reafon to fufpect a fcrophulous or cancerous habit, either of which may fupport a fchirrous induration, after the venereal poi- fon is correaed, the parts fhould be fomented daily with a decoaion of hemlock, the bruifed leaves of which may likewife be added to the poultice, and the extraa at the fame time taken inwardly*. This praaice is ftrongly re- commended by Doaor Stork in fchirrous and cancerous cafes; and Mr. Fordyce affaires us, that, by this method he has cured difeafed tefticles of two or three years Handing, even when ulcerated, and when the fchirrus had begun to be affeaed with pricking and lancing pains. Of BUBOES. Venereal buboes are hard tumours feated in the groin, occafioned by the venereal poifon lodged in this part. They are of two kinds, viz. fuch as proceed from a recent infection, and fuch as accompany a confirmed lues. The cure of recent buboes, that is, fuch as appear foon after impure coition, may be firft attempted by difperflon, and, if that fliould not fucceed, by fuppuration. To pro- mote the difperfion of a buboe, the fame regimen muft be obferved as Was direaed in the firft ftage of a gonorrhoea. The patient muft at the fame time be bled, and take fome cooling purges, as the decoaion of tamarinds and fenna, Glauber's falts, and the like. If, by this courfe, the fwel- ling and other inflammatory fymptoms abate, we may fafe- ly proceed to the ufe of mercury, which muft be continu- ed till the venereal virus is quite fubdued. But if the buboe fhould, from the beginning, be at- tended with great heat, pain, and pulfation, it will be proper to promote its fuppuration. For this purpofe the r C c c patient * The extrafl of hemlock may hs made into pills, and taken in the man- ner direaed under the article C.\ in : eR, 378 OF BUBOES. patient may *oe allowed to ufe his ordinary diet, 2nd to take now and then a glafs of wine. Emollient cataplafms, confifting of bread and milk foftened with oil or frefh but- ter, may be applied to the part; and, in cold conftitutions, where the tumour advances flowly* white-lily roots boiled, or fliced onions raw, and a fufficient quantity of yellow bafilicon may be added to the poultice. When the tumour is ripe, which may be known by its conical figure* the foftnefs of the fkin, and a fluauation of matter plainly to be felt under the finger, it may be open- ed either by cauftic or a lancet, and afterwards drefied with digeftive ointment. It fometimes, however, happens that buboes can nei- ther be difperfed nor brought to a fuppuration, but remain hard, indolent tumours. In this cafe the indurated glands muft be confumed by cauftic ; but if they fhould become fchirrous, they muft be diffolved by the application of hem- lock both externally and internally, as direaed in the fchirrous tefticle. Of CHANCRES. Chancres are fuperficial, callous, eating ulcers, which may happen either with or without a gonorrhoea. They are commonly feated about the private parts, and make their appearance in the following manner. Firft a little red pimple arifes, which foon .become pointed at top-and is filled with a whitifh matter inclining to yellow. This pimple is hot, and itches generally before it breaks: after- wards it degenerates into an obftinate ulcer, the bottom,of which is ufually ^covered with a vifcid mucus, and whofe edges gradually become hard and callous. Sometimes the firft appearance refembles a fimple excoriation of the cuti- cle ; which, however, if the caufe be venereal, foon Be- comes a true chancre. A chancre is fometimes a primary affeaion, but it is much oftener fymptomaiical, and is the mark of a con- firmed lues. Primary chancres difcover themfelves foon after impure coition, and are generally feated in parts co- vered OF CHANCRES. 379 388 OF A CONFIRMED LUES OR POX, When the venereal difeafe has been negleaed, or im- properly treated, it often becomes a diforder of the conftU tution. In this cafe the cure muft be attempted by refto- ratives, as a milk-diet, the decoaion of farfaparilla, and fuch hke, to which mercury may be occafionally added. It is a common praaice in North Britain to fend fuch pati- ents to drink goat-whey. This is a verv proper plan, provided toe n-.feaion has been totally eradicated before- hand ; but when that is not to the cafe, and the patient trufts to the whe. for finifhing his cure, he will often be diiappoimed. I have frequently known the difeafe return W'th all its virulence after a courfe of goat-whey, even when that courfe had been thought quite fufficient for com- pleting the cure. One of the moft unfortunate circumftances attending patients in this difeafe, is the neceffity they are often laicf, under of being foon well. This induces them to take me- dicines too faft, and to leave it off too foon. A few grains more of medicine, or a few days longer confinement, would often be fufficient to perfect the cure; whereas by the neglea of thefe, a fmall degree of virulence is ftill left in the humours, which gradually vitiates, and at length, contaminates the whole mafs. To avoid this, we would advife that the patient fhould never leave off taking medi- cine immediately mpon the difappearing of the fymptoms, but continue it for fome time after, gradually leffening the quantity, till there is fufficient ground to believe that the difeafe is entirely eradicated. It is not only difficult, but abfolutely impoffible, toaf- certain the exadt degree of virulence that may attend the difeafe; for which reafon it will always be a much fafer rule to continue the ufe of medicine too long, than to leave it off too foon. This feems to be the leading maxim of a modern praaitioner of fome note for the venereal difeafe, who always orders his patient to perform a quarantine of forty days, during which time he takes forty bottles of, I fuppofe, a ftrong decoaion of farfaparilla, or iome other anti-venereal fimple. Whoever takes this method, and adds a fufficient ahforb the frefh matter as it was generated. The patient at the fame time took every day half a grain of the corrofive fublimate of mercury, diflblved in an ounce of brandy, and drank an Englifh quart of the decodtion of farfa- parilla. By. this treatment, in about fix weeks, he was perfectly cured ; c.:iAk what was very remarkable, a part of the penis was actually regenerated. OF A CONFIRMED LUES OR POX. 389 a fufficient quantity of fome aaive preparation of mercury to the decoaion, will feldom fail to cure a confirmed lues. It is peculiarly unfortunate for the cure of this difeafe, that not one in ten of thofe who contraa it are either able or willing to fubmit to a proper plan of regimen. The pa- tient is willing to take medicine ; but he muft follow his bufinefs, and, to prevent fufpicions, muft eat and uiink like the reft of the family. This is the true fource of nine tenths of all the mifchief arifing from the venereal difeafe. I never knew the cure attended with any great difficulty or danger where the patient ftriaiy followed the phyfician's advice ; but a volume would not be fufficient to point out the dreadful confequences which proceed from an oppofite condua. Scirrhous tefticle*, ulcerous fore throats, cari- ous boqes, and a rotten progeny, are a few of the bleffings derived from this fource. , There is a fpecies of falfe reafoning, with regard to thisilifeafe, which proves fatal to many. A perfon of a + found conftitution contraas a flight degree of the diforder. He gets well without taking any great care, or ufing much medicine, and hence concludes, that this will always be the cafe. The next time the difeafe occurs, though ten times more virulent, it is treated in the fame manner, and the conftitution is ruined. Indeed the different degrees of virulence in the fmall-pox are not greater than in this dif- eafe, though, as the learned Sydenham obferves, in fome > cafes the mofl fkilful phyfician cannot cure, and in others the moft ignorant old woman cannot kill the patient in that diforder. Though a good conftitution is always in favour of the patient, yet too great ftrefs may be laid upon it in this difeafe. It does not appear from obfervation, that the moft robuft conftitutioh is cble to overcome the virulence of the venereal contagion, after it has got into the habit. In this cafe a proper courfe of medicine is al- ways indifpenfibly neceffary. Although it is impoffible, on account of the different degrees of virulence, hfc. to lay down fixed and certain rules for the cure of this difeafe, yet the following general plan will always be found fafe, and often fuccefsful, viz. to bleed and adminifter gentle purges during the inflamma- tory ftate, and as foon as the fymptoms of inflammation are abated, to adminifter mercury, in any form that may 390 OF A CONFIRMED LUES OR POX. be moft agreeable to the patient. The fame medicine, affifted by^the decoaion of farfaparilla and a proper regi- men, will not only fecure the conftitution againft any fur- ther progrefs of a confirmed pox, but will generally per- form a complete cure. CHAP. XLVIII. DISEASES OF WOMEN. WOMEN, in all civilized nations, have the ma- nagement of domeftic affairs; and it is very proper they fhould, as nature has made them lefs fit for the more aaive and laborious employments. This indulgence, how- ever, is generally carried too far ; and females, inftead of being benefited by it, are greatly injured, from the want of exercife and free air. To be fatisfied of thi?, one need only compare the frefh and ruddy looks of a milk-maid with the pale complexion of thofe females whofe whole bu- finefs lies within doors. Though Nature has made an evident diftinaion between the male and female with re- gard to bodily ftrength and vigour, yet fhe certainly r ever meant, either that the one fhould be always without,' or the other always within doors. The confinement of females, befides hurting their fi- gure and complexion, relaxes their folids, weakens their minds, and diforders all the funaions of the body. Hence proceed obftruaions, indigeftion, flatulence, abortions, and the whole train of nervous diforders. Thefe not only unfit women for being mothers and nurfes, but often ren- der them whimfical and ridiculous. A found mind depends fo much upon a healthy body, that where the latter is wanting, the former is rarely to be found. 1 have always obferved, that women who were chiefly e-mployed without doors, in the different branches of huf- bandry, '% Diseases of women, ^i bandry, gardening, and the like, were almoft as hardy as their hufbands, and that their children were likewife ftrong and healthy. But as the bad effeas of confinement and inaaivity upon both fexes have been already fhown, we fhall proceed to point out thefe circumftances in the ftruc- ture and defign of females, which fubjea them to peculiar difeafes ; the chief of which are, their monthly evacuations, pregnancy, and child-btariug. Thefe indeed cannot proper- ly be called difeafes themfelves, but from the delicacy of the fex, and their being often improperly managed in fuch fituations, they become the fource of numerous calamities. Of the MENSTRUAL DISCHARGE. Females generally begin to menftruate about the age ef fifteen, and leave it off about fifty, which renders thefe two periods the moft critical of their lives. About the firft appearance of this difcharge, the conftitution undergoes a Very confiderable change, generally indeed for the better, though fometrmes for the worfe. The greateft care is now neceffary, as the future health and happinefs of the female depends, in a great meafure, upon her condua at this period. If a girl about this time of life be confined to the houfe, kept conftantly fitting, and neither allowed to romp about, nor employed in any aaive bufinefs, which gives exercife to the whole body, fhe becomes weak, relaxed, and puny ; her blood not being duly prepared, fhe looks pale and wan j her health, fpirits, and vigour decline, and fhe finks into a valetudinary for life. Such is the fate of numbers of thofe unhappy females, who, eitfler from too much indul- gence, or their own narrow circumftances, are, at this critical period of life, denied the benefit of cxCrcife and free air. A lazy indolent difpcfition proves likewife very hurt- ful to o-irls at this period. One feldom meets with com- plaints from obftruaions amongft the more aaive and in- duftrious part of the fex ; whereas the indolent and lazy are feldom free from them. Thefe are, in a manner, eat up by the chlorofls, or green-ficknefs, and other difeafes of this nature. We would therefore recommend it to all who wiih to efcape thefe calamities, to avoid indolence and in- aaivity, 3 are to be avoided, and every method taken to amufe and enter- tain the fancy. CHAP. XLIX. DISEASES OF CHILDREN. MISERABLE indeed is the lot of man in the ftate of infancy. He comes into the world more helplefs than any other animal, and ftands much'longer in need of the proteaion and care of his parents ; but, alas ! this care is not always bellowed upon him ; and when it is, he * Dr Chvnc avers, that want of children is oftener the fault of the male than of the female, and ftrongly recommends a milk and vegetable diet to the former as well as the latter; adding, that h.s rr.cnd Dr. Taylor whom he calls the Milk-do£tor of Croydon, had hrought iaudry opulent fair Mies in his ncichbourhood, who had continued fome years after marriage without progeny, to have feveral fine children, by keeping both parents, for a con- fiderable'time, to a mil* and ve^uble diet. 404 DISEASES OF CHILDREN. he often fuffers as much from improper management as he would have done from neglea. Hence the officious care of parents, nurfes, and midwives, becomes one of the moft fruitful f.urces of the diforders of infants*. It muft be obvious to every attentive obferver, that the firft difeafes of infants arife chiefly from their bowels. Nor is this in the leaft to be wondered at, as they are in a man- ner poifoned with indigeftible drugs and improper diet as foon as they come into the world. Every thing that the ftomach cannot digeft may be confidered as a poifon ; and unlefs it can be thrown up or voided by ftool, it muft oc- cafion ficknefs, gripes, fpafmodic affeaion? of the bowels, or what the good women call inward fits, and at laft con- vulfions and death. As thefe fymptoms evidently arife from fomewhat that irritates the inteftines, doubtlefs the proper method of cure muft be to expel it as foon as poffible. The moft fafe and effeaual method of doing this is by gentle vomits. Five or fix grains of the powder of ipecacuanha may be mixed in two table-fpoonfuls of water, and fweetened with a lit- tle fugar. A tea-fpoonful of this may be given to the in- fant every quarter of an hour, till it operates; or, what will more certainly anfwer the purpofe, a grain of emetic tartar may be diffolved in three ounces of water fweetened with a little fyfup, and given as above. Thofe who are not fond of ufing the emetic nrtar, may give fix or feven drops of the antimoniai wine, in a tea-fpoonful of water er thin gruel. These medicines will not only cleanfe the ftomach, but will, generally, likewife open the belly ; ihould this,-how- ever, not happen, and, if the child be coftive, fome gentle pur^e will be neceffary : for this purpofe fome manna and pulp of caffia may be diffolved in boiling water, and givs-n in * We (hall only here adduce one inftance of theofficious care of midwives, yiz. the common practice of torturing infants by fqueezing their breafts, to draw off the milk, as they call it. Though a fmall quantity of moifture is generally found in the breafts of infants, yet, as they are certainly not in- tended to give fuck, this ought never to be drawn off. I have feen this cru- el operation bring on hardnefs, inflammation, and fuppuration of the breafts; hut never knew any ill confequences from its heing omitted. When tbe breafts are hard, the only application that we would recommend is a foft Iioultice, or a little of the diachylon plafter, fpread thin upon a bit of foft eather, about fhe fizc of half a crown, and applied over each nipple. Thefe may be fuxTcred to continue till the hardnefs be gone off. DISEASES OF CHILDREN. 405 in fmall quantities till it operates; or, what will anfwer rather better, a few grains of magnefia alba may be mixed in any kind of food that is given to the child, and continu- ed till it has the defired effect. If thefe medicines be pro- perly adminiftered, and the child's belly and limbs frequent- ly rubbed with a warm hand before the fire, they will fel- dom fail to relieve thofe affbaions of the ftomach and bow- els from which infants fuffer fo much. These general direaions include moft of what can be done for relieving the internal diforders of infants. They will likewire go a confiderable length in alleviating thofe which appear externally, as the rafh, gum, or fellon, l3c. Thefe, as was formerly obferved, are principally owing to too hot a regimen, and confequently v/ill be moft com- monly relieved by gentle evacuations. Indeed, evacuati- ons of one kind or other, conftitute a principal part of the medicine of infants, and will feldom, if adminiftered with prudence, in any of their difeafes, fail to give relief. Of the MECONIU M. The ftomach and bowels of a new-born infant are fill- ed with a blackifh-coloured matter, of the conliftence of fyrup, commonly called the meconium. This is generally paffed foon after the birth, by the mere effort o^ nature; in which cafe it is not neceffary to give the infant any kind of medicine. But if it fhould be retained, or not fuffici- ently carried off, a little manna or magnefia alba may be given, as mentioned above ; or, if thefe fhould not be at hand, a common fpoonful of whey, fweetened with a little honey, may be given. # The moft proper medicine for expelling the meconium is the mother's milk, which is always, at firft, of a purgative quality. Were children allowed to fuck as loon as they fhew an inclination for the breaft, they would feldom have occafion for medicines to difcharge the meconium ; but even where this is not allowed, they ought never to have daubs of fyrup, oils, and other indigeflible fluff, crammed down their throats, The [ 406 ] The APHTHoE or THRUSH. The aphthae are little whitifh ulcers affeaing the who!? infide of the mouth, tongue, throat, and ftomach of in- fants. Sometimes they reach through the whole inteftinal c;:nal ; in which cafe they are very dangerous, and often put an end to the infant's life. If the aphthae are of a pale colour, pellucid, few in number, foft, fuperficial, and fall eafily off, they are not dangerous ; but if opake, yellow, brown, black, thick, or running together, they are bad. It is generally thought that the aphthae owe their origin to acid humours; we have reafon 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 dofed with wine, punch, cinnamon waters, or fome other hot and inflaming liquors, almoft as foon as it is born. It is well known that thefe will occafion inflam- matory diforders even in adults ; is it any wonder then that they fliould heat and inflame the tender bodies of infants, and fet, as it were, the whole conftitution on a blaze ? The moft proper medicines for the aphthae are thofe of a cooling and gently opening nature. Five grains of rhu- barb and half a dram of magnefia alba may be rubbed to- gether, and divided into fix dofes, one of which may be giren to the child every live or fix hours till they operate. Thefe powders may either be given in the child's food, or a litde of the fyrup of pale rofes, and may be repeated as often as is found neceffary to keep the body open. Many things have been recommended for gargling the mouth and throat in this difeafe; but it h not eafy to ap- ply thefe in very young infants ; we woiOJ therefore re- commend it to the nurfe to rub the child's moulfh frequent- ly with a little borax and honey; or with the following mixture: Take fine honey an oui.ee, borax a dram, burnt alum half a dram, rofe-water two. drams; mix them to- gether. A very proper application in this cafe, is a foluti- on of ten or twelve grains of white vitriol in eight ounces of barley-water. Thefe may be applied with the finger, or by means of a bit of foft rag tied to the end of a probe. Of C 407 ] Of ACIDITIES. The food of children being, for the moft part, of an acefcent nature, it readily turns four upon the ftomach, efpecially if the body be any way difordered. Hence it conic- to pafs, that molt difeafes of children are accompa- nied with evident figns of acidity, as green ftools, gripes, fcfr. Thefe appearances have induced many to believe, that all the difeafes of children were owing to an acid abounding in the ftomach and bowels ; but whoever con- ftders the matter attentively, will fir.d, that thefe fymptoms of acidity are oftener the effea than the caufe of their dif- eafes. Nature evidently intended, that the food of children fhould be acefcent ; and until the body be difordered, or the digeftion hurt, from fome other caufe, we will venture to fay, that the acefcent quality of their food is feldom in- jurious to thtm. Acidity, however, is dften a fymptom of diforders in children, and, as it is fometimes a trouble- fome one, we fhall point out the method of relieving it. When green ftools, gripes, purgings, four fmells, crO. fhew, that the bowels abound with an acid, the child fhould have a little fmall broth inftead of milk, with light white bread in it ; and fhould have fufficient exercife in or- der to promote the digeftion. It has been.cuftomary in this cafe to give the pearl-julep, chalk, crabs eyes, and other teftaceous powders. Thefe indeed, by their ii'iOOo- ent quality, may ccrrea the acidity ; but they are attend- ed with this inconvenience, that they are apt to lodge in the bowels, and occafion coftivenefs, which may prove very hurtful to the infant. For this reafon they fhould ne- ver be given unlefs mixed with purgative medicines ; as rhubarb, manna, or fuch like. The beft medicine which we know, in all cafes of aci- dity, is that fine infipid powder called magnefia alba. It purees, and, at the fame time, correas the acidity; by which means it not only removes the difeafe, but carries off its caufe. It may be given in any kind of food, from ten grains to a tea-fpoonful, according to the age of the patient. I have often known it anfwer very well when .given 40$ OF ACIDITIES. given in the following manner : Take of magnefia alba two dram?, fine rhubarb in powder half a dram,-peppermint- water and common water, of each two ounces, as much fyrup of fugar as will make it agreeable. Shake the bottle, and give the child a table-fpoonful three or four times a- day. When an infant is troubled with gripes, it ought not at firft to be dofed with brandy, fpiceries, and other hot things, but fhould have its body opened with an emollient clyfter, or the medicine mentioned above ; and at the fame time a little brandy may be rubbed on its belly with a warm hand before the fire. I have feldom feen this fail to eafe the gripes of infants. If it fhould happen, however, not to fucceed, a little brandy or other fpirits may be mixed with twice its own quantity of water, and fweetened with a little fugar, and a fpoonful of it given frequently till the child be eafier. Sometimes a little peppermint-water will anfwer this purpofe very well. GALLING and EXCORIATION. These are very troublefome to Children. They happen chiefly about the groin and wrinkles of the neck, under tlie arms, behind the ears, and in other parts that are moiften- ed by the fweat or urine. As thefe complaints are, in a great meafure, owing to want of cleanlinefs, the moft effeaual means of prevent- ing them are, to wafh the parts frequently with cold wa- ter, to change the linen often, and, in a word, to keep the child, in all refpeas, thoroughly clean. When this is not fufficient, the excoriated parts may be fprinkled with abforbent or drying powders ; fuch as, burnt hartfhorn, tutty, chalk, crabs claws prepared, cVv. * When the parts affeaed are,very fore, and tend to a real ulceration, it will be proper to add a little fugar of lead to the pow- ders ; or to anoint the place with a little camphorated ointment. If the parts be wafhed with fpring-water, in which a little white vitriol has been diflolved, it will dry and heal them very powerfully. STOP- * One of the beft applications for this purpofe, is to diflblve fome fuller's earth in a fufficient quantity of hot water ; and after it has ftood till it is Cold, to ruo it t^ntly upon the galled parts once or twice a-day. [ 4cg ] STOPPAGE of the NOSE. The noftrils of infants are often plugged up with a grofs mucus, which prevents their breathin? freely, and likewife renders it difficult for them to fuck or fwallow. - Some, \v this cafe, order, after a fuitable purge, two or three grains of white vitriol diffolved in half an ounce of marjoram water, and filtered, to be applied now and then to the noftrils with a linen rag. Wedelius fays, If two grains of white vitriol, and the fame quantity of elaterium, be diffolved in half an ounce of marjoram water, and ap- plied to the nofe, as above direaed, that it brings away the mucus without fheezing. In obftinate cafes thefe things may be tried ; but we have never foun'd any thing neceffary, befides rubbing the nofe at bed-time with a little greale, fweet oil, or frefh butter. This refolves the filth, and renders the breathing more free. O ¥ ERUPTIONS. Children, while on the breaft, are feldom free from eruptions of one kind or other. Thefe however are not often dangerous, and ought never to be flopped but witri the greateft caution. They tend to free the bodies of in- fants from hot and acrid humours, which, if retained, might produce fatal diforders. The eruptions of children are chiefly owing to the fol- lowing caufes, viz. improper food, and neglea of cleanli- nefs. If ,a child be fluffed at all hours with food that its ftomach is not able to digeft, fuch food, not being properly affimilated, inftead of nourifhing the body, fills it with grofs humours. Thefe muft either break out in form of eruptions upon the fkin, or remain in the body, and occa- fion fevers and other internal diforders. That neglea of cleanlinefs is a very general caufe of eruptive diforders, muft be obvious to every one. The children of the poor, and of all who defpife cleanlinefs, are almoft conftantly G g g found! 410 OF ERUPTIONS. found to fwarm with vermin, and are generally covered with the fcab, itch, and other eruptionr-. When eruptions are the effea of improper food, or want of cleanlinefs, a proper attention to thefe alone will gene- rally be fufficient to remove them. If this fhould not be the cafe, fome drving medicines will be neceffary ; but they fhoujd never be applied without the greateft caution. If drying medicines are applied, the body ought at the fame time to be kept open, and cold is carefully to be avoided. We know no medicine that is mote fafe for drying up cu- taneous eruptions than fulphur, provided it be fparingly ufed. A little of the flowers of fulphur may be mixed with frefli butter, oil, or hog's lard, and the parts affeaed fre- quently touched with it. The moft obftinate of all the eruptions incident to chil- dren are, the tinea capitis, or fcabbed head, and chilblains. The fcabbed head is often exceeding difficult to cure, and fometimes indeed the cure proves worfe than the difeafe. I have frequently known children feized with internal dif- orders, of which they died foon after their fcabbed he;, '5 had been healed by the application of drying medicines*. The cure ought always firft to be attempted by keeping the head very clean, cutting off the hair, combing and brufhing away the fcabs, &c. If this be not fufficient, let the head be fliaved once a-week, or oftener; and wafh- ed daily with foap-fuds, or lime-water. Should thefe fail, a plafter of black pitch may be applied, in order to pull out the hair by the roots. And if there be proud flefh, it fliould be touched with a bit of blue vitriol, or fprinkled with a little burnt alum. While thefe things are doing, the patient muft be confined to a regular light diet, his bel- ly fhould be kept gently open j and c. Id, a* far as poflible, ought * I fome time ago faw a very ftriking inftance of the danger of fubftitut- ing drying medicines in the place of cleanlinefs ;-tO wholefome food, in •!■« Foundling Hofpital at Ackworth, where the children were grievoufly afflict- ed with fcabbed heads, and other cutaneous diforders. 1 found upon en- quiry, that very little attention was paid ather to the propriety orfoundnef* of their provifions, and that cleanlinefs was totally neglected ; .'cc-jrJir»!v I advifed that they fhould have more whclefome food, and be kept thorough !j clean. This advice however was not followed. It was too troublefome to the fervants, fuperintendants, &c. The buOcfs was to be done by medi- cine ; which was accordingly attempted, but had near proved fatal to tlie whole houle. Fevers and other internal diforders immediately appeared, and, at length, a putrid dyfentery, which proved lb infectious that it carri- ed ofi a great ff.any of the children. OF ERUPTIONS. 4n eught to be avoided. To prevent any bad confequences from flopping this difcharge, it will be proper, efpecially in children of a grofs habit, to make an iffue in the neck or arm, which may be kept open till the patient becomes more ftrong, and the conftitution be fomewhat mended. Chilblains commonly attack children in cold weather. They are generally occafioned by the feet or hands being kept long wet or cold, and afterwards fuddenly heated. When children are cold, inftead of taking exercife to warm themfelves gradually, they run to the fire. This occafions r. fudden rarefaaion of the humours, and an infanStion of of the veffels ; which being often repeated, the vends are, at laft, over-diftended and forced to give way. To prevent it, violent cold and fudden heat muft he equally avoided. When the parts begin to look red and fwell, the patient ought to be purged, and to have the af- filed parts frequently rubbed with muftard and brandy, or fomething of a warming nature. They ought likewife to be covered with flannel, and kept warm and dry. Some apply warm afhes betwixt cloths to the fuelled parts, which frequently help to reduce them. When there is a fore, it -mult be dieffed with Turner's cerate, or fome other drying ointment; as the ointment of tutty, the plafter of cerufs, &c. Thefe fores are indeed troublefome, but feldom dan- gerous. They generally heal as foon as the warm weather fets in. Of the CROUP. Children are often feized very fuddenly with a great difficulty of breathing, which, if not quickly relieved, proves mortil. This difeafe is known by vari< us names in different parts of Britain. In the Eaft coaft pf Scotland it is called the croup. On the Weft they call it the chock or fluffing. In fome parts of England, where I have ob- ferved it, the good women call it the rifing of tbe lights. It feems to be a fpecies of aflhma, attended with very acute and violent fymptoms. This difeafe generally prevails in cold and wet leafons. It is moft common upon the fea-coaft, and in low marfliy countries. Children of a grofs and lax habit are moft liable to 412 O F T H E C R O U P. to it. I have fometimes known it hereditary. It general- ly attacks children in the night, after having been much expofed to damp cold eafterly winds through the day. Damp houfes wet feet, thin fhoes, wet clothes, or any thing that obftruas the perfpiration, may occafion the croup. It is attended with a frequent pulfe, quick and labori- ous breaking, which is performed with a peculiar kind of Croaking noife that may be heard at a confiderable diftance. * The voice is fharp and fhrill, and the face is generally much flufhed, though fometimes it is of a livid colour. When a child is feized with the above fymptoms, his feet ihould immediately be put into warm water. He ought likewife to be bled, and to have a laxative clyfter admini- ftered as foon as poffible. He fhould be made to breathe over the fteams of warm water, or an emollient decoaion, and emollient cataplafms or fomentations may be applied round his neck. If the fymptoms do not abate, a blifter- ing plafter muft be applied round the neck, or betwixt the ihoulders, and the child may take frequently a table-fpoon- ful of the following julep : Take penny-royal water three Dunces, fyrup of althea and balfamic fyrup, each one ounce-, mix them together. Som-, in this cafe, recommend afafoetida. It may both be given in form of a clyfter, and taken by the mouth. Two drams of afafcetida may be diffolved in one ounce of Mindfrerus's fpirit, and three ounces of penny-royal water. A table-fpoonful of this mixture may be given every hour, or oftener if trie patient's ftomach be able to bear it. If the child cannot be brought to take this medicine, two drams of the afafcetida may be diffolved in a common clyf- ter, and adminiftered every fix or ei^ht hours, till the vio- lence of the difeafe abates. To prevent a return of the diforder, all thofe things which occafion it muft be carefully avoided ; as wet feet, cold damp eafterly winds, &c. Children who have had frequent returns of this difeafe, or whofe conftitution feems to difpofe them to it, ought to have their diet pro- perly regulated ; all food that is vifcid or hard of digeftion, - and all crude, raw, trafhy fruits, are to be avoided. They ought likewife to have a drain conftantly kept open m |bme part cf their body, by means of a feton cr iffue. I OF THE CROUP. 413 have fometimes known a Burgundy pitch plafter, worn continually betwixt the flioulders for feveral years, have a very happy crlcct in preventing the return of thn> dreadful diforder. Of TEETHING, Dr. Arbuthnot obferves, that above a tenth part of in- fants die in teething, by fymptoms proceeding from the ir- ritation of the tender nervous parts of the jaws, occafion- ing inflammations, fevers, convulfions, gangrcner, &c. Thefe fymptoms are, in a great meafure,-owing to the great delicacy and exquifitc fenfibility of the nervous fyftem at this time of life, which is too often increafed by an ef- feminate education. Hence it comes to pafs, that children who are delicately brought up, always fuller m»ft in teeth- ing, and often fall by convullive diforders. "Aeout the fixth or feventh month the teeth generally begin to make their appearance ; firft the incifires, or tore- teeth ; next the car.ini, or dog-teeth ; and laftly, the ,W,,- res, or grinders. About the feventh >ear, there comes a new fet7 and about the twentieth, the two inner grinders, called dentes fapientia, the teeth of wifdom.^ Children, about the time of cutting their teeth, fiver much, and have generally a loofenefs. "When the teething is difficult, efpecially when the dog-teeth begin to make their way through the gums, the child has ftartings in his fleep, tumours of the gums, inquietude, watchings, gripes, green ftools, the thrufli, fever, cifiicult breathing, and convulfions. , Difficult teething is, in all refpefls, to be treatea r.s an inflammatory difeafe. If the belly be bound, it muft be opened either by emollient clyfters or gentle purgatives'5 as manna, magnefia alba, rhubarb, fenna, or the .ike. The food fhould be light, and in fmal] quanntv; t.ie di Irink plentiful, but weak and diluting, asintuuonsof bairn, or of the lime-tree flowers; to which about a tr.ird or fourth part of milk may be added. If the fever be very high, bleeding w::t be nccefbrv ; but this, in very young children, ou-.it ahva;^ to^ :-e 4T4 O Fv TEETHING. Sparingly performed. It is an evacuation which they bear the worft wf any. Purging, vomiting, o: fweating, ;:gne much better with them, and are generally more beneficial. Harris however obferves, that, when an inflammation ap- pears, the phyfician will labour in vain, if the cure be not begun with applying a leech under each ear. If the child be feized with convullion fits, a bliftering plafter may be applied betwixt the fhoulders, or one behind each ear. Dr. Sydenham fays, that in fevers occafioned by teeth*0^- ing, he never found any remedy fo effeaual as two, three, or four drops of fpirits of hartfhorn in a fpoonful of Ample water, or other convenient vehicle, given every four h^u:s. The number of dofes may be four, five, or fix. 1 have often prefcribed this medicine v/ith fuccefs, but always found a larger dofe neceflary. It may be given from five .v drops to fifteen or twenty, according to the age of the child. In Scotland, it is very common, when children are cutting their teeth, to put a fmall Burgundy pitch plafter between their fhoulders. This generally eafes ihe tickling cough which attends teething, and is by no means an ufe- 3cfs application. When the teeth are bred with difficulty, it ought to be kept on during the whole time of teething. It may be enlarged as occafion requites, and ought t«> be renevyed, at leaft, once a fortnight. Several things have been recommended for rubbing the gums, as oils, mucilages, &c. ; but from thefe much is not to be expected. If any thing of this kind is to be ufed, we would recommend a little fine honey, which may be rubbed on with the finger three or four times a-day. Children are generallv at this time difpofed to chew what- ever they get into their hands. For this reafon they ought never to Ce without fomewhat that will yield a little to the preffure of their gums, as a cruft of bread, a w..x-candle, a bit of liquorice-root, or fuch like. With regard to cutting the gums, we have feldom known it of any great advantage, in obftinate cafes how- ever it ought to be trieJ. It may be performed by the finger nail, the edge of a fix-penny piece that is worn thin, or any fharp body which can be with fafety intro- duced into the mouth. * In order to render the teething lefs difficult, parents ought to take care that their children's food be light and wholefome, OF TEETHING. 415 wholefome, and that their nerves be braced by fufiricnt exercife wiihout doors, the ufe of the cold bath, &c. Were thefe things duly regarded, tew children would a:c of teething. Of the RICKETS. This difeafe g- nerally attacks chi.'Jren betwixt the -..•--: of nine months and two years. It appeared firft in Eng- land, about the time when manufaaures be^an to be in- * troduced, and ftiil prevails moil in towns where the inha- bitants follow fedentary employments, by which means they neglea either to take proper exercife themfelves, or to give it to their children. CAUSES.----One caufe of the rickets is difeafed parents. Mothers of a weak relaxed habit, who neglect exercife, and live upon weak watery diet, can neither be expeaed to bring forth ftrong and healthy children, or to be able to nurfe them, after they are brought forth. Ac- cordingly we find, that the children of fuch women gene- rally die of the rickets, the fcrophula, confumptions, or fuch like difeafes. Children begotten by men in the de- cline of life, who are fubjea to the gout, the gravel, or other chronic difeafes, or who have been often affeaed with the venereal difeafe in their youth, are likewife very liabie to the rickets. Any diforder that weakens the conftitution, or relaxes the habit of children, as the fmall-pox, meafles, teething, the hooping-cough, &c. difpofes them to this difeafe. It mav likewife be occafioned by improper diet, as food that is either too weak and watery, or fo vifcid that the ftomach cannot digeft it. Bad nurfing is the chief caufe of this difeafe. When the nurfe is either difeafed, or has not enough of milk to nouriih the child, it cannot thrive. But children fu "er oftener by want of care in nurfes than want of food. Al- lowing an infant to lie or fit too much; or not keeping it thorot-Oily clean in its clothes,-has the moft pernicious effeas.0 The want of free air is likewife very hurtful to chil- dren in this refpea. When a nurfe lives in a clofe. fmall houO, 4i6 OF THE RICKETS. houfe, where the air is damp and confined, and is too in* dolent to carry her child abroad into the open air, it will hardly efcape this difeafe. A healthy child fhould always be in motion, unlefs when afleep; if it be fuffered to lie, or fit, inftead of being tofled and dandled about, it will not thrive. S Y M P T O M S.----At the beginning of this difeafe the child's flefh grows foft and flabby ; its ftrength is dimi- nifhed; it lofes its wonted cheerfulnefs, looks more grave and compofed than is natural for its age, and does not chufe to be moved. The head and belly become too large in proportion to the other parts; the face appears full, ajad the complexion florid. Afteiwards the bones begin to be affeaed, efpecially in the more foft and fpungy parts. Hence the wrifts and ancles become thicker than ufual; the fpine or back-bone puts on an unnatural fhape ; the breaft is likewife often deformed ; and the bones of the arms and legs grow crooked. All thefe fymptoms vary ac- cording to tfie violence of the difeafe. The pulfe is gene- rallv quick, but feeble ; the appetite and digeftion, for the moil part, bad j the teeth come flowly and with difficulty, and they often rot and fall out afterwards. Ricketty chil- liien generally have great acutenefs of mind, and an under- itanding above thth years. Whether this is owing to their being more in the con ,.:.iiy of adults than other children, or the preternatural enlargement of the brain, is not ma- terial. REGIME N.----As this difeafe is always attended with evident figns of weaknefs and relaxation, our chief ai -n in the cure muft be to brace and ftrengthen the folids, and to promote digeftion and the due preparation of the fluids. Thefe important ends will bo beft anfwered by wholefome nourifhing diet, fuited to the age and ftrength of the pati- ent, open dry air, and fufficient e;.ere:fi\ if the child has a bad nurfe, who either negleas her duty, cr does not un- derftand it, fhe fhould be changed. If the feafon be cold, the child ought to be kept warm ; and when the weather is h;>t, it ought to be kept cool ; as fweating is apt to weaken it; and too great a decree cf cold has the fame ef- fOt. The limbs fliould be rubbed frequently with a warm hand, and the child kept as cheerful as poffible. ^ The diet ought to be light and dry, as good bread, roafted flefh, occ Bifcuit is generally reckoned the beft bread 3 OF THE RICKETS. 41; bread; and pigeons, pullets, veal, rabbets, or mutton roafted or minced, are the moft proper flefh. If the child be too young for flefh-meats, he may have rice, millet, or pearl barley boiled with raifins, to which may be added a little wine and fpice. His drink may be good claret, mix- ed with an equal quantity of water. Thofe who cannot afford claret, may give the child now and then a wine glafs of fine mild ale. M E D I C I N E.----M«dicines are here of little avail. The difeafe may often be cured by the nuife, but feldom by the phyfician,. In children of a grofs habit, gentle purges or vomits may fometimes be of ufe ; but they will never* carry off" the malady. That muft depend upon bracing alone : For which purpofe, befides the regimen mentioned above, we would recommend the cold bath, efpecially in the warm feafon. It muft however be ufed with prudence, as fome ricketty children cannot bear it. The beft time for ufing the cold bath is in the morning, and the child fhould be well rubbed with a dry cloth im- mediately after he comes out of it. If the child fhould be weakened by the cold bath, it muft be difcontinued. Sometimes iffues have been found beneficial in this difeafe. They are peculiarly neceffary for children who abound with grofs humours. An infufion of the Peruvian bark in wine or ale, is likewife of ufe ; but it is fcarce pof- fible to bring children to take it; We might here mention many other medicines which hava^been recommended for the rickets ; but, as there is far more danger in trufting to thefe than in negkaing them altogether, we chufe rather to pafs them over, and to recommend a proper regimen as the only thing to be depended on. Of CONVULSIONS. Though more children are faid to die of convulfions than of anv other difeafe, yet they are for the moft only a fymptom of fome other malady. Whatever greatly rrntates oWimulate* the nerves, may occafion convulfions. Hence infants whofe nerves are eafily affeaed, are often thrown into convulfions by any thing that irritates the alimentary H h h canal 3 418 OF CONVULSIONS. canal; by teething; ftrait clothes; the approach of the fmall-pox, meafles, or other eruptive difeafes. When convulfions proceed from an irritation of the fto- mach or bowels, whatever clears them of their acrid con- tents, or renders thefe mild and inoffenfive, will generally cure the convulfions. Wherefore, if the child be coftive^ the beft way will be to begin with a clyfter, and afterwards to give a gentle vomit, which may be repeated occafional- ly, and the body in the mean time kept open by gentle dofes of magnefia alba, or fmall quantities of rhubarb mix- ed with the powder of crabs claws. Convulsions which precede the eruption of the fmall- pox, &c. generally go off upon thefe making their appear- ance. The principal danger in this cafe arifes from the fears and apprehenfions of thofe who have the care of the patient. Convulfions are very alarming, and fomething muft be done to appeafe the affrighted parents, nurfes, &c. Hence the unhappy infant often undergoes bleeding, blif- tering, and feveral other operations, to thfc great danger of j its life, when a little time, bathing the feet, and throwing in a mild clyfter, would have fet all to rights. When convulfion fits arife from the cutting of teeth, befides gentle evacuations, we would recommend bliftering and the ufe of aritifpafmodic medicines, as the tinaure of foot, afafcetida, or caftor. A few drops of any of thefe may be mixed in a cup of white-wine whey, and given oc- cafionally. When convulfions proceed from any external caufe, as the preffure occafioned by ftrait clothes or bandages, &c. thefe ought immediately to be removed ; though in this cafe taking away the caufe will not always remove the ef- fea, yet it ought to be done, as it is not likely that the patient will recover fo long as the caufe which firft gave rife to the diforder continues to aa. When a child is feized with convulfions without having any complaint in the bowels, or fymptoms of teething; or any rafh, or other difcharge which has been fuddenly dried up, we have reafon to conclude that they are a pri- mary difeafe, and proceed immediately from the brain. Cafes of this kind however happen but feldom, which is very fortunate, as little can be done to relieve the miliary patient. When a difeafe proceeds from an original fault in the formation or ftruaure of the brain itfelf, we cannot expea OF CONVULSIONS. 419 expea that it fliould yield to medicine. But, as this is not always the caufe even of convulfions which proceed imme- diately from the brain, fome attempts fhould be made to remove them. The chief intention to be purfued for this purpofe, is to make fome derivation from the brain, by blif- tering, purging and the like. Should thefe fail, iffues .or fetons may be put in the neck, or between the fhoulders. Of WATER in the HEAD. Though water in the head, or a dropfy of the brain, may affea adults as well as children, yet, as the latter are more peculiarly liable to it, we thought it would be moft: proper to place it among the difeafes of infants. CAUSES.----A dropfy of the brain may proceed from injuries done to the brain itfelf by falls, blows, or the like ; it may likewife proceed from an original laxity or weaknefs of the brain ; from fcirrhous tumours or excref- cences within the fkull; a thin watery ftate of the blood; a diminifhed fecretion of urine; and, laftly, from tedious and lingering difeafes which wafte and confume the pa- tient. SYMPTOM S.----This difeafe has at firft the ap- pearance of a flow fever; the patient eomplains of a pain in the crown of his head, or over his eyes ; he fhuns the light; is fick, and fometimes vomits ; his pulfe is irregu- lar and generally flow : though he feems heavy and dull, yet he does not fleep ; he is fometimes delirious, and fre- quently fees objeas double ; towards the end of this com- monly fatal difeafe, the pulfe becomes more frequent, the pupils are dilated, the cheeks flufhed, the patient becomes comatofe, and convulfions enfue. MEDICIN E.----No medicine has hitherto been found fufficient to carry off a dropfy of the brain. It is laudable however to make fome attempts, as time or chance may bring, to light what at prefent we have no ideas of. The medicines generally ufed are, purges of rhubarb or jalap with calomel, and bliftering plafters applied to the •ck or back part of the head. To which we would beg leave to add diuretics, or medicines which promote the fe- cretion 420 OF WATER IN THE HEAD. cretion of urine, fuch as are recommended in the common dropfy. A difcharge from the nofe ought likewife to be promoted by caufing the patient fnuff the powder of afarum, white hellebore, or the like. CHAP. L. OF SURGERY. TO defer ibe the various operations of furgery, and to point out the different difeafes in which thefe opera- tions are neceffary, would extend this article far beyond the limits fet to it: We muft therefore confine our obfer- vations to fuch cafes as moft generally occur, and in which proper affiflance is either not afked, or not always to be obtained. Though an acquaintance with the ftruaure of the hu- man body is indifpenfibly neceffary to qualify a man for being an expert furgeon ; yet many things may be done to fave the lives of their fellow men in emergencies by thpfe who are no adepts in anatomy. It is amazing with what facility the peafaiats. daily perform operations upon brute animals which are not of a lefs difficult nature than many of thofe performed on the human fpecies ; yet they feldom fail cf fuccefs. < Indeed every man is in fome meafure a furgeon whe- ther he will or not. He feels an inclination to affift his fellow-creatures in diftrefs, and accidents happen every hour which give occafion to exercife this feeling. The feelings of the heart however, when not direaed by the judgment, are apt to miflead. Thus one, by a rafh at- tempt to fave his friend, may fometimes deftroy him ; while another, for fear of doing amifs, ftands ftill and fees his bofom friend perifh, without fo much as attempting to relieve him, even when the means are in his power. As every good man would wifh to fleer a courfe different from either of thefe, it will no doubt be agreeable to hin^to Icnow what ought to be done upon any fuch emergencies. Of [ 4" ] Of BLEEDING. No operation of furgery is fo frequently nxtffaty aa bleeding ; it ought therefore to be very generally un'let- ftood. But though pradtifed by Mid wive;., Gardeneis, Blackfmiths, &c. we have reafon to believe that very few know when it is neceffary. Even phyfician? themfelves thave been fo much the dupes of fafhon in this article, zz to render it the fubjea of fatire and ridicule. It is how- ever an operation of great importance, and muft, when feafonably and properly performed, be of lingular fervice to thofe in diftrefs. Bleeding is proper at the beginning of all inflamma- tory fevers, as pleurifies, perfpneumonies, tjfe. It is like* wife proper in all topical inflammations, as thofe c*f the inteftines, womb, bladder, ftomach, kidnies, throat, eyes, err. ; as alfo in the afthma, fciatic pains, coughs, head- achs, rheumatifms, the apoplexy, epilepfy and bloody-flux. After falls, blows, bruife?, or any violent hurt received either externally or internally, bleeding is neceffary. It is likewife neceffary for perfons who have had the misfortune to be flrangled, drowned, fuffocated with foul air, the fumes of metals, or the like. In a word, whenever the vital motions have been fuddenly ftopt from any caufe whatever, except in fwoonings occafioned by mere weak- nefs or hyfteric affeaions, it is proper to open a vein. But in all diforders proceeding from a relaxation of the folids, and an impoverifhed ftate of the blood, as dropfies, caco- chymies, isfc. bleeding is improper. Bleeding for topical inflammations ought always to be perfomed as near the part affeaed as poflible. When this can be done with a lancet, it is to be preferred to any other method, but where a vein cannot be found, recourO muft be had to leeches or cupping. The quantity of blood to be let muft always be regulat- ed by the ftrength, age, conftitution, manner of life, and other circumftances relating to the patient. It would be •idicalous to fuppofe that a child could bear to lofe as much blood as a grown perfon, or that a delicate lady fhould be bled to the7ame extent as a rcbuft man. • r From 422 OF BLEEDING. From whatever part of the body blood is to be let, a bandage muft be applied betwixt that part and the heart. As it is often neceffary, in order to raife the vein, to make the bandage pretty tight, it will be proper in fuch cafes, as foon as the blood begins to flow, to flacken it a little. The bandage ought to be applied at leatt an inch, or an inch and half, from the place where the wound is intended to be made. Persons not fkilled in anatomy ought never to bleed in a vein that lies over an artery or a tendon, if they can avoid it. The former mav eafily be known from its pulfa- tion or beating, and the latter from its feeling hard and tight like a whip-cord under the finger. It was formerly a rule, even among thofe who had the charaaer of bOing regular pr?.clitioners, to bleed their pa- tients in certain difeafes till they fainted. Surely a more ridiculous rule could not be propofed. One peifon will faint at the very fight of a lancet, while another will lofe almoft the whole blood of his body before he faints. Swooning depends more upon the ftate of the mind than of the body ; befides, it may often be occafioned or prevent- ed by the manner in which the operation is performed. Children are generally bled with leeches. This, though fometimes neceffary, is^a very troublefome and un- certain pradtice. It is impoffible to know what quantity of blood is taken away by.leeches ; befides, the bleeding is often very difficult to ftop, and the wounds are not eafily healed. Would thofe who praaife bleeding take a little more pains, and accuftom themfelves to bleed children, they would net find it fuch a difficult operation as they imagine. Certain hurtful prejudices with regard to bleeding ftill prevail among the country people. They talk, for in- ftance, of head-veins, heart-veins, breaft-veins, &c. and believe that bleeding in thefe will certainly cure all difeafes of the parts from whence they are fuppofed to come, with- out confidering that all the blood-veffeIs arife from the heart, and return to it again ; for which reafon, unlefs in topical inflammations, it fignifies very little from what part of the body blood be taken. But this, though a foolifh prejudice, is not near fo hurtful as the vulgar notion, thit the firft bleeding will perform wonders. This belief makes them often poftpone the operation when neceffary, in or- der OF BLEEDING. 423 tier to referve it for fome more important occafion, and when they think themfelves in extreme danger they fly to it for relief, whether it be proper or not; bleeding at cer- tain flated periods or feafons has likewife bad effeas. It is likewife a common notion that bleeding in the feet draws the humours downwards, and confequently cures difeafes of the head and other fuperior parts; but we have already obferved that, in all topical affedtions, the blood ought to be drawn as near the part as poffible. When it is 'neceffary however to bleed in the foot or hand, as the veins are fmall, and the bleeding is apt to ftop too foon, the part ought to be immerfed in warm water, and kept there till a fufficient quantity of blood be let. We fhall not fpend time in defcribing the manner of performing this operation. That will be better learned by example than precept. Twenty pages of defcription would not convey fo juft an idea of the operation as feeing it once performed by an expert hand. Neither is it neceffary to point out the different parts of the body from whence blood may be let, as the arm, forehead, temp.hr-, neck, csV. Thefe will readily occur to ever intelligent perfon, and the foregoing obfervations will be fufficient for determining which of them is moft proper upon any particular occafion. In all cafes where the intention is only to leflen the general mafs of blood, the arm is the moft commodious part of the body in which the operation can be performed. Of INFLAMMATIONS and ABSCESSES. From whatever caufe an inflammation proceeds, it muft terminate either by difperfion, fuppuration, or gangrene. Though it is impoffible to foretel with certainty in which of theTe ways any particular inflammation will terminate, yet a probable conjeaure may be formed with regard to the event, from a knowledge of the patient's age and conftitu- tion. Inflammations happening in a flight degree upon cold*, and without any previous indifpohtron, will molt probablv be difperfed ; thofe which follow c ofe upon a fe- ver, or happen to perfons of a ^rofs habit of body, will ge- » *r nerally 424 OF INFLAMMATIONS,^. nerally fuppurate ; and thofe which attack very old peo* pie, or perfons of a dropfical habit, will have a ftrong ten- dency to gangrene. If the inflammation be flight, and the conftitution found* the difperfion ought always to be attempted. This will be beft promoted by a flender diluting diet, plentiful bleeding and repeated purges. The part itfelf muft be fomented, and, if the fkin be very tenfe, it may be embrocated with a mixture of three-fourths of fweet oil, and one-fourth of vinegar, and afterwards covered with a piece of wax plafter. If, notwithftanding thefe applications, the fymptomatic fever encreafes, and the tumour becomes larger, with vio- lent pain and pulfation, it will be proper to promote the fuppuration. The beft application for this purpofe is a foft poultice, which may be renewed twice a-day. If the fup- puration proceeds but flowly, a raw onion cut fmall or bruifed may be fpread upon the poultice. When the ab- fcefs is ripe or fit for opening, which may eafily be known *rom the thinnefs of the fkin in the moft prominent part of it, a fluauation of matter which may be felt under the fin- ger, and, generally fpeaking, an abatement of the pain, it may be opened either with a lancet or by means of cauftic. , Fhe laft way in which an inflammation terminates is in a gangrene or mortification, the approach of which may be known by the following fymptoms : The inflammation lofes its rednefs, and becomes dufkifh or livid ; the tenfion of the fkin goes off, and it feels flabby ; little bladders fill- ed with ichor of different colours fpread all over it; the tumour fubfides, and from a dufkifh complexion becomes black ; a quick low pulfe, with cold clammy fweats, are the immediate forerunners of death. When thefe fymp- toms firft appear, the part ought to be dreffed with Lon- don treacle, or a cataplafm made of lixivium and bran ; fhould the fymptoms become worfe, the part muft be fca- rified, and afterwards dreffed with bafilicum foftened with oil of turpentine. All the dreffings muft be applied warm* With regard to internal medicines, die patient muft be fupported with generous cordials, and the Peruvian bark exhibited in as -Jarge dofes as the ftomach will bear it. If the mortified parts fhould feparate, the wound will become a common ulcer, and muft be treated as fuch. This OF INFLAMMATIONS,^. 425 This article includes the treatment of all thofe difeafes, which, in different parts of the country go by the names of hiles, impoflhumes, whitlows, he. They are all abfceffes in confequence of a previous inflammation, which, if poffible, ought to be difcuffed ; but when this cannot be done, the fuppuration fhould be promoted, and the matter difcharged by an incifion, if neceffary ; afterwards the fore may he dreffed with yellow bafilicum, or fome other digeftive oint- ment. Of WOUNDS. No part of medicine has been more miftaken than the treatment cr cure of wounds. Mankind in general believe* that certain herbs, ointments, and plafters are poffeffed of wonderful healing virtues, and imagine that no wound can jbe cured without the application of them. It is however a faa, that no external application whatever contributes towards the cure of a wound, any other way than by keep- ing the parts foft, and defending them from the external air, which may be as effeaually done by dry lint as by the moft pompous applications, while it is exempt from many of the bad confequences attending them. The fame obfervation holds with refpea to internal ap- plications. Thefe only promote the cure of wounds fo far as they tend to prevent a fever, or to remove any caufe that might obftrudt or impede the operations of Nature. It is Nature alone that cures wounds; all that Art can do is to remove obftacles, and to put the parts in fuch a condition as is the moft favourable to Nature's efforts. With this fimple view, we fhall confider the treatment of wounds, and endeavour to point out fuch fteps as ought to be taken to facilitate their cure. The firft thing to be done when a perfon has received a wound is to examine whether'any foreign body be lodged in it, as wood, ftone, iron, lead, glafs, dirt, bits of cloth, or the like. Thefe, if poflible, ought to be extradted, and the wound cleaned, before any dreffings be applied. When that cannot be effeaed with fafety, on account of the pa- tient's weaknefs, or lofs of blood, they muft be fuffered to 1 | tSUIu.il 426 OF WOUNDS. remain in the wound, and afterwards extraaed when he is more able to bear it. When a wound penetrates into any of the cavities of the body, as the breaft, the bowels, tftc. or where any confiderable blood-veffel is cut, a fkilful furgeon ought im- mediately to be called, otherwife the patient may lofe his life. But fometimes the difcharge of blood is fo great, that if it be not ftopt* the patient may die even before a furgeon, though at no great diftance, can arrive. In this cafe, fomething muft be done by thofe who are prefent. If the wound be in any of the limbs, the bleeding may ge- „ nerally be ftopt by applying a tight ligature or bandage round the member a little above the wound. The beft method of doing this is to put a ftrong broad garter round the part, but fo flack as eafily to admit a fmall piece of flick to be put under it, which muft be twilled, in the fame manner as a country-man does a cart-rope to fecurc his loading, till the bleeding flops. Whenever this is the cafe, he muft take care to twift it no longer, as ftraining it too much might occafion an inflammation of the parts, and endanger a gangrene. In parts where this bandage cannot be applied, various other methods may be tried to ftop the bleeding, as the ap- plication of flyptics, aftringents, &c. Cloths dipped in a folution of blue vitriol in water, or the flyptic water of the Difpenfatories, may be applied to the wound. When thefe cannot be obtained, ftrong fpirits of wine may be ufed. Some recommend the Agaric * of the oak.as preferable to any * Dr. Tifiot, in his Aiv'.ce to tie Psople, gives the following directions for gathering, preparing, and applying the agaric.----" Gather in autumn-, fays he, while the fine weather lafts, the 3garic of the oak, which is a kind o? fungus or exerefcence iiTuing from the wood of that tree. It conlifts at firft of four parts, Which prefent themfelves fucceflively : i. Tke outward rind or lkin, which mav be thrown away. z. The part immediately undct this rind, fvhich is the beft of all. This is to be beat well with a hammer, till it becomes foft and very pliable. This is the only preparation it re- quires, and a flice of it of a f roper fize is to be applied diiecllv over the burfting open blood-veiTeb. It eonftringes and brings them clofe together, floras the bleeding, aad generally falls off at the end of two daysv 3. The third part adhering to the fecond may ferve to ftop the bleeding iiom the fmailer velTels; and the fourth and laft part maybe reduced to powder as conducing to the fame purpofe.-------Where the agaric cannot be ha«f, iponge may be ufed in iu ftead. It muft be applied in the i7mc manner, and has nearly the fame effects. OF WOUNDS. 427 any of the other ftyptics ; and indeed it deferves confider- able encomiums. It is eafily obtained, and ought to be kept in every family, in cafe of accidents. A piece of it muft be laid upon the wound, and covered with a good deal of lint, above which a bandage may be applied fo tight as to keep it firmly on. Though fpirits, tinaures, and hot balfams may be ufed, in order to ftop the bleeding when it is exceffive, they are improper at other times. They do not promote but retard the cure, and often change a fimple wound into an ulcer. People imagine, becaufe hot balfams congealthe blood, and feem, as it were, to folder up the wound, that they therefore heal it; but this is only a deception. They may indeed ftop the flowing blood, by fearing the mouths of the veffels; but, by rendering the parts callous, they obftrua the cure. In flight wounds which do not penetrate much deeper than the fkin, the beft application is a bit of the common black flicking plafter. This keeps the fides of the wound together, and prevents the air from hurting it, which is all that is neceffary. When a wound penetrates deep, it is not fafe to keep its lips quite clofe; this keeps in the mat- ter, and is apt to make the wound feller. In this cafe the beft way is to fill the wound with foft lint, commonly call- ed caddis. It however muft not be fluffed in too hard, otherwife it will do hurt. The caddis may be covered with a cloth dipped in oil, or fpread with the common wax * plafter ; and the whole muft be kept on by a proper bandage. We fhall not fpend time in describing the different ban- dages that may be proper for wounds in different parts of the body ; common fenfe will generally fuggeft the moft commodious method of applying a bandage; befides, de- fcriptions of this kind are not eafily underftood or remem- bered. The firft dreffing ought to continue on for at leaft two days; after which it may be removed, and frefh lint ap- plied as before. If any part of the firft dreffing flicks fo clofe - * The wax plafter is made by melting together over a flow fire, a pound of yellow wax ; white refin, and mutton fuet, of each half a pound. This not only fupplies the place of melilot plafter, formerly fo much in vogue, \,\\t makes a very proper applicauon tp flight wounds, and to large ones after they are nearly healed. 423 OF WOUNDS. elofe as not to be removed with eafe or fafety to tht pati- ent, it may be allowed to continue, and frefh lint dipped in fweet oil laid over it. This will foften it fo as to make it come oft" eafily at next dreffing. Afterwards the wound may be drefled twice a-day in the fame manner till it be quite healed. Thofe who are fond of falves or ointments, may, after the wound is become very fuperficial, drefs if, with the yellow bafilicum* ; and if fungous, or what is call- ed proud flefh, fhould rife 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 moft proper application is a poultice of bread and milk, foftened with a little fweet oil or frefli butter. This muft be applied in- ftead of the plafter, and fliould be changed two or three times a-day. If the wound be large, and there is reafon to fear an inflammation, the patient fhould be kept on a very low diet. He muft abftain from flefh, ftrong liquors, and every thing that is of a heating nature. If he be of a full habit, and has loft but little blood from the wound, he muft be bled ; and, if the fymptoms be urgent, the operation may be repeated. But when the patient has been greatly weak- ened by lofs of blood from' the wound, it will be dangerous to bleed him, even though a fever fhould enfue. Nature fhould never be too far exhaufted. - It is always more fafe to allow her to ftrnggle with the difeafe in her own way, than to fink fhe patient's ftrength by exceffive evacuations. Wounded perfons ought to be kept perfeaiy quiet and eafy. Every thing that ruffles the mind,' or moves the paf- fions, as love, anger, fear, exceffive joy, cift. are very hurtful. They ought* above all things; to abftain frorn venery. The belly fhould be kept gently open either by laxative clyfters, or by a cool vegetable diet, as roafted ap- ples, ftewed prunes, boiled fpinnage, &c. - •• Of * The ointment called yellow bafilicum is prepared in the following man- lier : Take of olive oil an Englifh pint, yellow wax, yellow refin, and Bur* gundy pitch, of each one pound ; common turpentine three ounces. Melt the wax, refin, and pitch, along with the oil over a flow fire ; after taking them from the fire, add the turpentine, and, whilft the mixture remains hot, ftrain it. f 4*9 3 Of BURNS. In flight burns which do not break the fkin, it is cuf- tomary to hold the part near the fire for a competent time, to rub it with fait, or to lav a comprefs upon it dipped iri fpirits of wine or ..brandy. But when the burn has pene- trated fo deep as to blifter or break the fkin, it muft be dreffed with fome iemollient and gently drying ointment of calamine, commonly called Turner's cerate*. This may J>e mixed with an equal quantity of frefh olive oil, and fpread upon a foft rag, and applied to the part affeaed. When this ointment cannot be had, an egg may be beat up with about an equal quantity of the fweeteft falad oil. This will ferve very well till a proper ointment can be pre- pared. When the burning is very deep, after the firft two or three days, it ihould be drefled with equal parts of yel- low bafilicum and Turner s cerate mixed together. When the burn is violent, or has occafioned a high degree of inflammation, and there is reafon to fear a gan- grene or mortification, the fame means muft be ufed to prevent it as are recommended in other violent inflammati- ons. The patient, in this cafe, muft live low, and drink freely of weak diluting liquors. He muft likewife be bleu, and have his belly kept open. But if the burnt parts be- come livid or black, with other fymptoms of mortification, it will be neceffary to bathe them frequently with warm camphorated fpirits of wine, tinaure of myrrh, or other antifeptics mixed with a decoaion cf the bark. In this Cafe the bark muft likewife be taken internally, and the patient's diet muft be more generous. Of ' Turner's cerate may be prepared by diflblving half a pound of yellow waxin arl Engftfti pint of olive oil, over a flow fin-. As the mixture cooh, and begins to grow ftitT, half a pound of calamine prepared muft he fprinkied iuto it, keeping conftantly ftirring them together till the cerate is grown quite cold. t 430 ] Of BRUISES. Bruises are generally produaive of worfe confequence3 than wounds. Tbe danger from them does not appear immediately, by wrfich means it often happens that they are negleaed. It is needlefs to give any definition of a difeafe fo univerfally known; we fhall therefore proceed to point out the method of treating it. In flight bruifes it will be fufficient to bathe the part with warm vinegar, to which a little brandy or rum may be added, and to keep cloths wet with this mixture con- ftantly applied to it. This is more proper than rubbing it with brandy, fpirits of wine, or other ardent fpirits, which are commonly ufed in fuch cafes. In fome parts of the country the peafants apply tp a rer cent bruife a cataplafm of frefh cow-dung, with very hap- py effeas*. When a bruife is very violent, the patient ought im- mediately to be bled, and put upon a proper regimen. His food fhould be light and^cool, and his drink weak, and of an opening nature; as whey fweetened*with honey, de- coaions of tamarinds, barley, cream-tartar^hey, and fuch like. The bruifed part muft be bathed with vinegar and water, as direaed above ; and a poultice 'made by boiling crumb of bread, elder-flowers, and camomile-flowers, in equal quantities of vinegar and water, applied to it. This poultice is peculiarly proper when a wound is joined to the bruife. It may be renewed two or three times a-day. As the ftruaure of the veffels is totally deftroyed by a violent bruife, there often enfue's a great lofs of fubftance, which produces an ulcerous fore very difficult to cure. If the bone be affeaed, the fore will not heal before an exfo- liation takes place, that is, before the difeafed part of the bone feparates, and comes out through the wound. This is often a very flow operation, and may even require feve- ral years to be completed. Hence it happens, that thefe fores .£- * I have often feen thiseataplafm applied to violent contufions occafioned by blows, falls, bruifes and fuch like, and never once knew it fail to have a good effect. t of bruises. 43* fores are frequently miftaken for the King's-evil, arid treat* ed as fuch, though, in faa, they proceed folely from the injury which the folid parts received from the blow*. Of ULCERS. Ulcers may be the confequence of wounds, bruifes^ or impofthumes improperly treated ; but they generally proceed from an ill ftate of the humours, or what may be called a bad habit of body. When this is the cafe, they ought not to be haftily dried up, otherwife it may prove fatal to the patient. Ul- cers happen moft commonly in the decline of life ; 2nd perfons who neglea exercife, and live grofrly, are moft li- able to them. They might often be prevented by retrench- ing fome part of the folid food, or by opening artificial drains, as iffues, fetons, or the like. An ulcer may be diftinguifhed from a wound by its dif- charging a thin watery humour, which is often fo acrid as to inflame and corrode the fkin ; by the hardnefs and per- pendicular fituation of its fides or edges, by the time of its duration, tffcf It requires* confiderable fkill to be able to judge when an ulcer ought to be healed, and when not. In general, all ulcers which proceed from a bad habit of body fhould be fuffered to continue open at leaft till the conftitution be fo far changed by proper regimen, or the ufe of medicine, that they feem difpoied to heal of their own accord. Ul- cers which are the effea of malignant fevers, or other acute difeafes, may generally he healed with fafety after the health has been reftored for fome time. The cure ought not how- ever to be attempted too foon, nor at any time without the ufe * Patients in this fituation are pellered with different advices. Every one who fees them propofes a new remedy, till the fore is, in a manner, poifon- ed with various and oppofite applications, and is often at length rendered ah- foluuly incurable. The beft method of managing fuch lores is, to ta!-:e care that the patient's conftitution does not fuffer by confinement, or impro- per medicine, and to apply nothing to t!;em but fome fimpleointmcnt fpread iitwi foft lint, over which a poultice of bread and milk, with boiled camo- mile flowers, or the likj, may be put to nourifh the part, and keep it foft arid warm. Nature, thus affifted, will generally in time operate a cine, by throwing o^the JilO.fci r-r:.s of the bone, :.fttr which the fore foyn iunls. *3* OF ULCERS. ufe of purging medicines and a proper regimen. Wherl wounds or bruifes have, by wrong treatment, degenerated into ulcers, if the conftitution be good, they may general- ly be healed with fafety. When ulcers either accompany chronical difeafes, or come in their ftead, they muft be cautioufly healed. If an ulcer conduces to the patient's health, from whatever caufe it proceeds, it ought not to be healed; but if, on the contrary, it waftes the ftrength, and confumes the patient by a flow fever, it fhould be heal- ed as foon as poflible. We would earneftly recommend a ftria attention to thefe particulars, to all who have the misfortune to labour under this diforder, particularly perfons in the declirie of life; as we have frequently known people throw away their lives by the want of it, while they were extolling and generoufly rewarding thofe whom they ought to have look- ed upon as their murderers. The moft proper regimen for promoting the cure of ul- cers, is to avoid all fpices, falted and high-feafoned foodj all ftrong liquors, and to leffen the ufual quantity of flefh- meat. The belly ought to be kept gently open by a diet confifting chiefly of cooling laxative vegetables, and by drinking butter-milk whey fweetened with honey, or the like. The patient ought to be kept cheerful, and fhould take as much exercife as he can eafily bear. When the bottom and fides of an ulcer feem hard and callous, they may be (prinkled twice a-day with a little red precipitate of mercury, and afterwards dreffed with the yellow bafilicum ointment. Sometimes it will be neceffary to have the edges of the ulcer fcarified with a lancet. Lime-water has frequently been known to have very happy effeas in the cure of obftinate ulcers. It may be ufed in the fame manner as direaed for the ftone and gravel. My late learned and ingenious friend, Dr. Whytt, ftrongly recommends the ufe of the folution of corrofive fublimate of mercury in brandy, for the cure of obftinate ill-conditioned ulcers. I have frequently found this medi- cine, when given according to the Doaor's direaions, prove very fuccefsful. The dofe is a table-fpoonful night and morning ; at the fame time wafhing the fore twice or thrice a-day with it. In a letter which 1 had from the Doc- tor OF ULCERS. 433 tor a little before his death, he informed me, te That he obferved wafhing the fore thrice a-day with the folution of a triple ftrength was very beneficial." Of DISLOCATIONS. When a bone is moved out of its place, or articulation^ fo as to impede its proper funaions, it is fajd to be luxated or diflocated. As this often happens to perfons in fitnati- ons where no medical affiftance can be obtained, by which means limbs and even lives are frequently loft, we fhall endeavour to point oqt the method of reducing the moft common luxations, and thofe which require the moft im- mediate affiftance. Any perfon of common fenfe and refo- lution, who is prefent when a diflocation happens, may often be of more fervice to the patient than the moft expert furgeon can after the fwelling and inflammation have come on. When thefe are prefent, it is difficult to know the ftate of the joint, and dangerous to attempt a reduaion j and by waiting till they are gone off, the mufcles become fo relaxed, and the cavity filled up, that the bone can ne- ver afterwards be retained in its place. A recent diflocation may generally be reduced by ex- tenfion alone, which muft always be greater or lefs accord- ing to the ftrength of the mufcles which move the joint, the age, robuftnefs andjother circumftances of the patient. When the bone has been out of its place for fome time, and a fwelling or inflammation has come on, it will be necef- fary to bleed the patient, and, after fomenting the part, to apply foft poultices with vinegar to it for fome time before the reduaion be attempted. All that is neceflary after the reduaion is to keep the part eafy, and to apply to it cloths dipt in vinegar or camphorated fpirits of wine. Many bad confequences proceed from the neglea of this rule. A dif- location feldom happens without the tendons and ligament* of the joint being ftretched and fometimes torn. When thefe are kept eafy till they recover their ftrength and tone, all eoes on very well, but if the injury be increafed by too frequent an exertion of the parts, no wonder if they be found weak and difeafed ever after. [ 434 3 DISLOCATION of the JAW*. The lower jaw may be luxated by yawning* blows^ falls, chewing hard lubftances or the like. It is eafily known from the patient's being unable to fhut his mouth or eat any thing, as the teeth of the under-ja'w do not correfpond with thofe of the upper ; befides, the chin either hangs down or is thrown towards one fide, and the patient is neither able to fpeak diftinaiy nor to fwallow without confiderable difficulty. The ufual method of reducing a diflocated jaw, is to fet the patient upon a low ftool fo as an affiftant may hold the head firm by prefling it againft his breaft. The ope- rator is then to thruft his two thumbs, being firft wrapped up with linen cloths that they may not flip, 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 prefs it ftrongly downwards and back- wards, by which means the elapfed heads of the jaw may be eafily pufhed into their former cavities. The peafants in fome parts of the country have a peculiar way of performing this operation. One of them puts a handkerchief under ihe patient's chin, then turning his back to that of the patient, pulls him up by the chin fo as to fufpend him from the ground. This method often fucceeds, but we think it a dangerous one, and therefore recommend the other. DISLOCATION of the NECK, The neck may be diflocated by falls, violent blows or the like. In this cafe, if* the patient receives no affiftance j he foon dies, which makes people imagine the neck was broken: It is however, for fhe moft part, only partially diflocated, and may be reduced by almoft any perfon who has resolution enough to attempt it. A complete difloca-» tion of the neck'is inftantaneous death. When A DISLOCATION OF THE NECK. 435 When the neck is diflocated, the patient is immediate- ly deprived of all fenfe and motion ; his neck fwells, his countenance appears bloated ; his chin lies upon his breaft, and his face is generally turned towards one fide. To reduce this diflocation, the unhappy perfon fhould immediately be laid upon his back on the ground, and the operator muft place himfelf behind him fo as to be able to lay hold ot his head with both hands, while he makes a refiftance by placing his knees againft the patients fhoul- ders. In this pofture he muft pull the head with confider- able force, gently twilling it at the fame time, if the face be turned to one fide, till he perceives that the joint is re- placed, which may be known from the noife which the bones generally make when going in, the patient's begin- ning to breathe, and the head continuing in its natural pofture. This is one of thofe operations which it is more eafy to perform than defcribe. I have known inftances of its be- ing 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 fhould be fuffered to reft for fome days till the parts recover their proper tone, DISLOCATION of the RIBS. As the articulation of the ribs with the back bone is very ftrong, they are not often diflocatdd. It does however fometimes happen, which is a fufficient reafon for our taking notice of it. When a rib is diflocated either up- wards or downwards, in order to replace it the patient fhould be laid upon his belly on a table, and the operator muft endeavour to pufh the head of the bone into its proper place. Should this method not fucceed, the arm of the difordered fide may be fufpended over a gate or ladder, and, while the ribs are thus ftretched afunder, the heads of fuch as are out of place may be thruft into their former fitua- Those diflocations wherein the heads of the ribs are forced inwards, are both moft dangerous and the moft dif- ficult to reduce, as neither the hand nor any inftrument csia 436 DISLOCATION OF THE RIBS. can be applied internally to direa the luXated heads of the ribs. Almoft the only thing that can be done is, to lay the patient upon his belly over a cafk, or fome gibbous body, and to move the fore-part of the rib inwards toward the back, fometimes fhaking it; by this means, the heads of fhe luxated ribs will fometimes flip into their former place* DISLOCATION of the SHOULDER. The humerus or upper bone of the arm may be diflo- cated in various direaions : It happens however moft fre- quently downwards, but very feldom direaiy upwards. It may be known by a depreffion or cavity on the top of the fhoulder, and an inability to move the arm : When the diflocation is downward or forward, the arm is elongated, and a ball or lump is perceived under the arm-pit; but when it is luxated backward, there appears a protuberance behind the fhoulder, and the arm is thrown forwards to- ward the breaft. The ufual method of reducing diflocations of the fhoul- der is to feat the patient upon a low ftool, and to caufe an affiftant to hold his body'fo that it may not give way to the extenfion, 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 caufes it to be tied behind his own neck ; by this, while a fufficient ex- tenfion is made, he lifts up the head of the bone, and with his hands direas it into its proper place. There are vari- ous machines invented for facilitating this operation, but the hand of an expert furgeon is always more fafe. In young and delicate patients, I have generally found it a very eafy matter to reduce the fhoulder by extending the arm with one hand, and thrufting in the head of the bone with the other. In making the extenfion, the arm ought always to be a little bent. » PIS- [ 437 3 DISLOCATION of the ELBOW, The bones of the fore-arm may be diflocated in any di- reaion. When this is the cafe, a protuberance may be pblerved on that fide of the arm towards which the bone is pufhed, from which, and the patient's inability to bend his arm, a diflocation of this joint may eafily be known. Two afliftants are generally neceffary for reducing a fliflocation of the elbow ; one of which muft lay hold of the arm above, and the other below the joint, and make a pretty ftrong extenfion, while the operator returns the bones into their proper place. Afterwards the arm muft be bent, and fufpended for fome time with a fling about tlie peck. , Luxations of the wrift and fingers are to be reduced in the fame manner as thofe of the elbow, viz. by making an e>.tenfion in different direaions and thrulting the head of (the bone into its cavity. DISLOCATION of the THIGH. When the thigh bone is diflocated forward and down- ward, the knee and foot are turned out, and the leg is longer than the other ; but when it is difpkced backward, it is ufually pufhed upward at the fame time, by which means the limb is fhortened and the foot is turned inwards. When the thigh bone is difplaced forward and down- ward, the patient, in order to have it reduced, muft be laid upon his back, and made faft by bandages, or held by af- fiftants, while by others an extenfion is made by means of flings fixt about the bottom of the thigh a little above the kne'e. While the extenfion is made, the operator muft pufh the head of .the bone outward, till it gets into the focket. If the diflocation be outward, the patient muft be laid upon his face, and, during the extenfion, the head of the bone muft be pufhed inward. Dislocations of the knees, ancles and toes are reduced much in the fame manner as thofe of the upper extremi- ties. 43S DISLOCATION OF THE THIGH. ties, viz. by making an extenfion in oppofite direaions, while the operator replaces the bones. In many cafes, however, the extenfion alone is fufficient, and ,the bone will flip into its place merely by pulling the limb with fuf> ficient force. Of BROKEN BONES. There is in moft country villages fome perfon who pretends to the art of reducing fraaures. Though in ge- neral fuch perfons are very ignorant, yet fome of them are very fuccefsful ; which evidently proves, that a fmall de- gree of learning, with a fufficient fhare of common fenfe and a mechanical head, will enable a man to be ufeful in this way. We would however advife people never to truft fuch operators, when an expert and fkilful furgeon can be had ; but when that is impraaicable, they muft be em- ployed ; we fhall therefore recommend the following hints to their confideration : When a large bone is broken, the patient's diet ought, in all refpeas, to be the fame as in an inflammatory fever. Pie fliould likewife be kept quiet and cool, and his belly fhould be opened either by emollient clyfters, or, if thefe cannot be conveniently adminiftered, by food that is of an opening quality; as flewed prunes, apples boiled in milk, boiled Ipinnage, and the like. It ought however to be here remarked, that perfons who have been accuftomed to l:ve high, are not all of a fudden to be reduced to a very low diet. This might have fatal confequences. There is oft- en a neceffity of indulging even bad habits, in fome mea- fure, where the nature of the difeafe might require a dif- ferent treatment. It will generally be neceffary to bleed the patient im- mediately after a fraaure, efpecially if he be young, cf a full habit, or has, at the fame time, received any bruife or contufion. This operation fhould not only be performed foon after the accident happens, but if the patient be very feverifh, it may be repeated next day. When feveral of the ribs are broken, bleeding is peculiarly neceffary. If any of tbe large bones which fupport the weight of the body be broken, the patient muft keep his bed for fe- veral OF BROKEN BONES. 439 viral weeks. It is by no means neceffary however that hq fhould lie all this while, as is cuftomary, upon his back. This fituation finks the fpiiits, galls and frets the patient's fkin, and renders him very uneafy. After the fecond week he may be gently raifed up, and may fit feveral hours, fup- ported by a bed-chair, or the like, which will greatly re- lieve him. Great care however muft be taken in railing him up, and laying him down, that he make no exertions himfelf, otherwife the aaion of the mufcles may pull the bone out of its place*. It is of great importance to keep the patient dry and clean while in this fituation. By negleaing this, he is often fo galled and excoriated, that he is forced to keep fhifting places for eafe. 1 have known a fraaured thigh bone, after it had laid ftrait for above a fortnight, difplaced by this means, and continue bent for life, in fpite of all ttiat could be done. It has been cuftomary when a bone was broken to keep the limb for five or fix weeks continually upon the ftretch. But this is a bad pofture. It is both uneafy to the patient and unfavourable to the cure. The beft fituation is to keep the limb a little bent. This is the pofture into which every animal puts its limbs when it goes to reft, and in which feweft mufcles are upon the ftretch. It is eafy ef- feaed by either laying the patient upon his fide, or making the bed fo as to favour this pofition of the limb. Bone-setters ought carefully to examine whether the bone be not mattered or broken, into a great many pieces. In this cafe it will generally be neceffary to have the limb taken off, otherwife a gangrene or mortification may en- fue. The horror which attends the very idea of an ampu- tation, often occafions its being delayed in fuch cafes till too late. When •Various pieces of machinery hare been contrived for counteracting the force of the mufcles, and retaining the fragments of broken bones ; but as defcriptions of thefe without drawings would be of little uie, I mail refer the reader to a cheap and ufeful performance on the nature and cure effrfures, Uciv publillied by my ingenious friend Mr. Aitken furgeon in Ld.nburgh ; whims that gentlemen has not only given an account of he machines rc- wtiereiQ tnac Sc authors, but has likewife added feveral commenced m fradlure£y iormer , ^ ^ ^ ^ SS~ «d?o cafes whe« P^ents with broken tones are obliged w be tranf- porte'd from enc place to another. 440 OF BROKEN BONES. When a fraaure is accompanied with a wound, it muft be dreffed in all repfec"ts as a common wound. All that art can do towards the cure of a broken bone, is to lay it perfeaiy ftraight, and to keep it quite eafy. All tight bandages do hurt. They had much better be wanting altogether. A great many of the bad confequen- ces which fucceed to fraaured bones are owing to tight bandages. This is one of the ways in which the excefs of art, or rather the abufe of it, does more mifchief than would be occafioned by the want of it. Some of the moft fudden cures of broken bones which were ever known* happened where no bandages were applied at all. Some method however muft be taken to keep the member fleady 5 but this may be done many ways without bracing it with a tight bandage. The beft method of retention is by two or more fplints made of leather or pafteboard. Thefe, if moiftened before they be applied, foon affume the fhape of the included member, and are fufficient, by the affiftance of a very flight bandage, for all the purpofes of retention. The bandage which we would recommend is that made with twelve or eighteen tails. It is much eafier applied and taken off than rollers, and anfwers all the purpofes of retention equally well. The fplints fhould always be as long as the limb, with holes cut for the ancles when the fraaure is ia the leg. In fraaures of the ribs, where a bandage cannot be properly ufed, an adhefive plafter may be applied over the part. The patient in this cafe ought to keep himfelf quite eafy, avoiding every thing that may occafion fneez- mg, laughing, coughing, or the like. He ought to keep his body in a ftraight pofture, and fliould take care that his ftomach be conftantly diftended, by taking frequently fpme light food, and drinking freely of weak watery li- quors. The moft proper external application for a fraaure is txycrate, or a mixture of vinegar and water. The banda- ges fhould be wet with this at every dreffing. Op r 44* j Of STRAINS* Strains are often attended with worfe confequences than broken bones. The reafon is obvious j they are ge-» nerally negleaed. When a bone is broken, the patient is obliged to keep the member eafy, becaufe he cannot make ufe of it; but when a joint is only ftrained, the perfon, finding he can ftill make a fhift to move it, is forry to lofe his time for fo trifling an ailment. In this way he deceives himfelf, and converts into an incurable malady what might have been removed by only keeping the part eafy for a few days. Country people generally immerfe a ftrained limb in cold water. This is very proper, provided it be done im- mediately, and not kept in too long. But the cuftom of keeping the part immerfed in cold water for a long time, is certainly dangerous. It relaxes inftead of bracing the part, and is more lfkely to produce a difeafe than remove one. Wrapping a garter, or fome other bandage, pretty tight about the ftra'ined part* is likewife of ufe. It helps to reftore the proper tone of the veffels, and prevents the aaion of the parts from encreafing the difeafe. It fhould not however be applied too tight. 1 have frequently known bleeding near the affeaed part have a very good effea: But what we would recommend above all things is eafe. It is more to be depended on than any medicine, and feldom fails to remove the complaint** Of RUPTUkES; Children and very old people are moft liable to this difeafe. In the former it is generally occafioned by excef- L 1 1 five * A ereat many external applications are recommended for (trains, fome Of which do good and others hurt. The following arc fuch as may be ufed with the greLd fafety, viz. poultices madeof Kale beer or vinegar and oat- meal camphorated fpirits of wine, Mindererus's fpirit, volatile liniment, volatile aromatic fpirit diluted with a double quantity of water, and the cant* »«« fomentation, with tbe addition of brandy or fpirit of wine. 442 O F R'U P T V R E S. five crying, coughing, vomiting, or the like. In the lat- ter it is commonly the effea of blows or violent exertions of the ftrength, as leaping, carrying great weights, Cffc. In both, a relaxed habit, indolence, and an oily or very moift diet, difpofc the body to this difeafe. On the firft appearance of a rupture in an infant, it ought to be laid upon its back, with .its head very low. While in this pofture, if the gut does not return of itfelf, it may eafily be put up by gentle preffure. After it is re-; turned, a piece of flicking plafler may be applied over the part, and a proper trufs or bandage muft be conftantly worn for a confiderable time. The method of making and applying thefe rupture-bandages for children is'pretty well known. The child muft, as far as poflible, be kept from crying, and from all violent motion, till the rupture is quite healed. In adults,, when the gut has been forced down with great violence, or happens, from any caufe, to be inflam- ed, it is often very difficult to return it, and fometimes quite impraaicable without an operation, a defcription of which is foreign to our purpofe. As I have been fortu- nate enough however always to fucceed in my attempts to return the gut, without having recourfe to any other means than what are in the power of every man, I fhall very briefly mention the method which I generally purfue. After the patient has been bled, he muft be laid upon his back, with his head very be low, and his breech railed high with pillows. In this fituation flannel-cloths wrung out of a decoaion of mallows and camomile-flowers, or, if thefe are not at hand, of warm water, muft be applied for a confiderable time. A clyfter made of this decoaion, with a large fpoonful of butter and a little fait, may be after- wards thrown xfp. . If thefe fhould not prove fuccefsful, recourfe muft be had to preffure. If the tumour be very hard, confiderable force will be neceffary; but it is not force alone which fucceeds here. The operator, at the fame time that he makes a preffure with the palms of his hand, muft with his fingers condua the gut in by the fame aperture through which it came out. The manner of dojrjg this, can be much eafier conceived than defcribed. Should all thefe endeavours prove ineffeaual, clyfters of the fmoke of tobacco muft be tried. Thefe have been often known to fucceed where every other method failed. Ax OF RUPTURES. 44^ An adult, after the gut has been returned, muft wear a fteel-bandage. It is needlefs to defcribe this, as it may always be had ready-made from the artills. Such bandages are generally uneafy to the wearer for fome time, but by cuftom they become quite eafy. No perfon who has had*a rupture after he arrived at man's eftate, fhould ever be without one of thefe bandages. Persons who have a rupture ought carefully to avoid all violent exercife, carrying great weights, leaping, run- ning, and the like. They mould likewife avoid windy aliment and ftrong liquors; and fhould carefully guard againft catching cold. CHAP. LI. OF CASUALTIES. IT is certain that life, when to all appearance loft, may often, by due care, be reflored. Aceidents frequently prove fatal, merely becaufe proper means are not ufed to counteraa their effeas. No perfon ought therefore to be •looked upon as killed by any accident, unlefs where the "frxuaure of the heart, brain, lungs, or fome organ necef-- fary to life is evidently deftroyed. The aaion of thefe or- gans may be fo far impaired as even to be for fome time imperceptible, when fife is by no means gone : In this cafe, however, if the fluids be fuffered to grow cold, it will be impoffible to put them again in motion, even though the folids fhould recover their power of aaing. Thus, when the motion of the lungs has been ftopt by unwhole- fome vapour, the aaion of the heart by a ftroke on the breaft, or the funaions of the brain by a blow on the headr if the perfon be fuffered to grow cold, he will in all pro- bability continue fo ; but, if the body be kept warm, as foon as the injured part has recovered its power of aaing, 444 OF C A S U AX TIES. the fluids will again begin to move, and all the vital func- tions will be reftored. It is a horrid cuftom immediately to confign over to death every perfon who has the' misfortune by a fall, a blow, or the like, to be deprived of the appearance of life. The unhappy perfon, inftead of being carried into a warm houfe, and laid by the fire, or put in a warm bed, is ge- nerally hurried away to a church, a barn, or fome other cold damp houfe, where, after a fruitlefs attempt has been made to bleed him, perhaps by one who knew nothing of the matter, he ia given over for dead, and no further no- tice taken of him. This condua feems to be the refult qf ignorance, fupported by an ancient fuperftitious notion, which forbids the body of any perfon fuppofed to be killed by an accident to be laid in an houfe that is inhabited, What the ground of this luperltition may be, we fhall not pretend to enquire; but furely the condua founded upon it is contrary to 3II the principles of reafon, humanity, and common fenfe, When a perfon feems to be fuddenly deprived of life, our firft bufinefs is to enquire into the caufe, We ought carefully to. oqferye whether any fubftance be lodged in the windpipe or gullet; and, if that is the cafe, attempts muft be made to remove it, When unwholefome air is the caufe, the patient ought immediately to be removed out of it. If the circulation be fuddenly flopped, from any caufe what- ever except mere weaknefs, the patient fhould be bled. If the blood does not flow, he may be immerfed in warm wa- ter, or rubbed with warm cloths, &c. to promote that evacuation. When the caufe cannot be fuddenly removed, our great aim muft be to keep up the vital warmth, hy rubbing the patient with hot cloths, covering his body with warm fand, afhes, or the like. We fhall npw proceed to treat more fully of thofe ac- cidents, which, without immediate affiftance, would often prove fatal ; and tq point out the moft likely means for re- lieving the unhappy fufferers ; hut as we have been greatly anticipated in this part of our fubjea by the learned and humane Dr. Tiffot, we fhall content ourfelves with felea- ing fuch of his obfervations as feem to be the moft impor- tant, and adding fuch of our pwn as have occurred in the ?ourfe of praaice. Or C 44S ] Of SUBSTANCES STO?T BETWEEN thk MOUTH and STOMACH. Though accidents of this kind are very common, and extremely dangerous, yet they are generally the effea of careleffnefs. Children fhould be taught to chew their food well, and to put nothing into their mouths which it would be dangerous for them to fwallow. But children are not the only perfons guilty of this piece of imprudence. I know many adults who put pins, nails, and other fliarp-pointed fubftances in their mouths upon every occafion, arid fome who even fleep with the former there all night. This con- dua is exceedingly incautious, as a fit of coughing, or twenty other accidents, may force over the fubftance be- fore the perfon be aware. When any fubftance is detained in the gullet, there are two ways of removing it, viz. either by extraaing it, or pufhing it down. The fafeft and moft certain way is al- ways to extraa or draw it out, but this is not always the eafieft; it may therefore be more eligible fometimes to thruft it down, efpecially when the obftruaing body is of fuch a nature, that there is no danger from its reception into the ftomach. The fubftances which may be pufhed down without danger are, all common nourifhing ones, as bread, flefh, fruits, and the the like: All indigeftible bodies, as cork, wood, bones, pieces of metal, and fuch like, ouo-ht, it poffible, to be extraaed, efpecially if thefe bodies be fharp pointed, as pins, needles, hfh-bones, btts of glafs, cifV, . When fuch fubftances have not paffed in too deep, we fhould endeavour to extraa them with our fingers, which method often fucceeds. When they are lower, we fhould make ufe of nippers, or a fmall pair of foreceps fuch as ftirgeons ufe. But this attempt to extraa rarely fucceeds if the fubftance be of a flexible nature, and has defcended far into the gullet. , , ..' If the fingers and nippers fail, or cannot be duly appli- ed crotchet?, a kind of hooks, muft be employed. Thefe may be made at once, by bending a piece of pretty ftrong lliaJ iron 446 SUBSTANCES. STOPT BETWEEN iron wire at one end. It muft be introduced in the flat way, and for the better conduaing it, there fhould like- wife be a curve or bending at the end it is held by, to ferve as a kind of handle to it, which has this further ufe, that it may be feeured by a ftring tied to it,- a circumftance not to be omitted in any inftrumentemploved on fuch occafions, to avoid fuch ill accidents as have fometimes enfued from thefe inftruments flipping out of the operator's hand. Af- ter the crotchet has paffect below the fubftance that obftrua's the paffage, it is drawn up again, and hooks up the body along with it. The crotchet is alfo very convenient, when a fubftance fiv.ievv..at flexible, as a pin or fifh-bone, flicks acrofs the gul'er, the h-.ok, in fuch cafes, feizing them a- bout their middle ;'.art, crooks and thus difengages them ; or, if they are very brittle fubftances, it ferves to break them. When the obftruaing- bodies are fmall, and only ftop up a part of the paffage, and which may either eafily elude the hook, or ftraiiren it by their refiftance, a kind of rings, made either of wire, wool, or fiik, may be ufed. Apiece of fine wire of a proper length may be bent into a circle, about the middle, of about an inch diameter, and the long unbent fides brought parallel, and near each other: thefe are to be held in the hand, and the circular part or ring introduced into the gullet, in order to be condu&ed about the obftruaing body, and fo to extraa it. More flexible rings may be made of wool, thread, filk, or fmall pack- thread, which may be waxed for their greater ftrength and confiftence. One of thefe is to be tied faft to a handle of iron wire, whale-bone, or any kind of flexible wood, and by this means introduced, in order to furround the ob- ftruaing fubftance, and to draw it out. . Several of thefe rings paffed through one another may be ufed, the more certainly to lay hold of the obftruaing body, which may be involved by one, if another fhould mifs it. Thefe rings have one advantage, which is, that when the fubftance to be extraaed is once laid hold of, it may then, by turning the handle, be retained fo ftrongly in the ring thus twifted, as to be moved every way, which muft in many cafes be a confiderable advantage. Another material employed on thefe unhappy occafi- ons, is the fponge. Its property of fwelling confiderably en being wet, is the principal- foundation of its' ufefulnefs here. THE MOUTH AND STOMACH. 44; here. If any fubftance is ftopt in the gullet, but without filling up the whole paffagc, a bit of fponge may be intro- duced into that part which is unftopt, and beyond the fub- ftance. The fponge foon dilates, and grows larger in this moift fituation, and indeed the enlargement of it may be forwarded by making the patient fwallow a few drops of water. Afterwards it is to be drawn back by the handle to which it is faftened, and as it is now too large to return through the fmall cavity by which it was conveyed in, it draws out the obftruaing body along with it. The compreffibility of fponge is another foundation of its ufefulnefs in fuch cafes. A pretty large piece of fponge may &ecompreffed or fqueezed into a fmall fize, by winding a firing or tape clofely about it, which may be eafily un- wound and withdrawn, after the fponge has been intro- duced. A bit of fponge may likewife be compreffed by a piece of whalebone fplit at one end, but this can hardly be introduced in fuch a manner as not to hurt the patient. I have often known pins, and other fharp bodies which had ftuck in the throat, brought up by caufing the perfon to fwallow a bit of tough meat tied to a thread, and drawing it quickly up again. This is fafer than fwallowing fponge, and will often anfwer the purpofe equally well. When all thefe methods prove unfuccefsful, there re- mains one more, which is, to make the patient vomit j but this can fcarcely be of any fervice, unlefs when fuch ob- ftruaing bodies are fimply engaged in, and not hooked or ftuck into the fides of the gullet, as in this cafe vomiting might fometimes occafion further mifchief. If the patient can fwallow, vomiting may be excited by taking half a dram or two fcruples of ipecacuanha in powder made into a draught. If he is not able to fwallow, an attempt may be made to excite vomiting, by tickling his throat with a feather, and if that fhould not fucceed, a clyfter of tobacco may be adminiftered. It is made by boiling an ounce of tobacco in a fufficient quantity of water; this has often been found to fucceed, when other attempts to excite vo- miting had failed. When the obftruaing body is of fuch a nature that it may be fafely pufhed downwards, this may be attempted by means of a wax candle oiled, and a little heated, fo as to make it flexible; or a piece of whalebone, wire, or flexible wood, with a fponge faftened to one end. Should 44*$ SUBSTANCES STOPT BETWEEN Should it be impoffible to extraa even thofe bodies which it is dangerous to admit into the ftomach, we muft then prefer the leaft of two evils, and rather run the ha- zard of pufhing them down, than fuffer the patient to pe-» rifh in a few minutes ; and we ought to fcruple this refo- lution the lefs, as a gieat many inftances have happened, where the fwallowing of fuch hurtful or indigeftible fub-* fiances has been followed by no diforder. Whenever it is manifell, that all endeavours either to extraa or pufh down the fubftance, muft prove ineffeaualj they fhould be difcontinued ; becaufe the inflammation oc- cafioned by perfifting in them might be as dangerous as the obftrcaion itfelf. Some have died in confequence *f the inflammation, even after the body which caufed the ob- ftruaion had been entirely removed. While the means recommended above are making ufe of, the patient fhould often fwallow, or if he cannot, he fhould frequently receive by injeaion, through a crooked ' tube or pipe that may reach down to the gullet, fome emollient liquor, as warm milk and water, barley-waterj or a decoaion of mallows. Injeaionsof this kind not on- ly foften and footh the irritated parts ; but, when thrown in with force, are often more fuccefsful in loofening the obftruaion, than all attempts with inftruments. When, after all our endeavours, we are obliged to leave the obftruaing body in the part, the patient muft be treat- ed as if he had an inflammatory difeafe. He fhould be bled, kept upon a low diet, and have his whole neck fur- rounded with emollient poultices. The like treatment muft alfo be ufed, if there be any reafon to fufpea an in- flammation of the paffages, though the"obftruaing body be removed. A proper degree of agitation has fometimes loofened the inhering body more effeaually than inftruments. Thus a blow on the back has often forced up a fubftance which ftuck in the gullet; but this is ftill more proper and effica- cious when the fubftance get3 into the wind-pipe. In this cafe, vomiting and fneezing are likewife to be excited. Pin?, which ftuck in the gullet, have been frequently dif- charged by riding on horfeback, or in a machine. When any indigeftable fubftance has been forced down to the ftomach, the patient fhould ufe a very mild and fmocth diet, confifting chiefly of fruits and farinacious ; mealy THE MOUTH AND STOMACH. 449 mealy fubftances, as puddings, pottage, and foups. He fhould avoid all heating and irritating things, as wine, punch, pepper, and fuch like; and his drink fhould be milk and water, barley-water, or whey. When the gullet is fo ftrongly and fully clofed, that the patient can receive no food by the mouth, he muft be nou- rifhed by clyfters of foup, gelly, and the like. When the patient is in danger of being immediately fuffocated, when all hope of freeing the paffage is vaniflied, and death feems at hand, if refpiration be not reftored ; the the operation of bronchotomy, or opening of the wind-pipe, muft be direaiy performed. As this operation is neither difficult to an expert furgeon, nor very painful to the pati- ent, and is often the only method which can be taken to preferve life in thefe emergencies, we thought proper to mention it, though it fhould only be attempted by perfons fkilled in furgery, Of DROWNED PERSONS. When a perfon has remained a quarter of an hour un- der water, there can be no confiderable hopes of his reco- yery. But as feveral circumftances may happen to have continued life, in fuch an unfortunate fituation, beyond the ordinary term, we fhould always endeavour to afford them the moft effeaual relief, and never to give them up as irrecoverable too foon, fince it has often been known, that until the expiration of two* and fometimes even of three hours, fuch perfons have exhibited fome tokens of life. The intention which fhould be purfued is, that of un- loading the lungs and brain, and reftoring the natural warmth and circulation, kc. Though cold was by no means the caufe of the perfon's death, yet it will prove an effeaual obftacle to his recovery. For this reafon, after ftripping him of his wet clothes, his body muft be ftrongly rubbed for a confiderable time with coarie linen cloths as warm as they can be made, and as foon as a well-heated bed can be got ready, he may be laid in it, and the%ubbing fhould be continued. Warm cloths ought likewife to be frequently M m m applied 450 OF DROWNED PERSONS. applied to his ftomach and bowels, and hot bricks, or bot- tles filled with warm water, to the foles of his feet. Blff.ding will likewise be of fervice to renew the cir- culation. Ten or twelve ounces of blood may be taken from any part of the body, if a vein can be found ; but as the veins or the arm will feldom bleed upon fuch occafions, it wili be proper to*try thofe of the neck, which are both moft apt to blc^d, and afford the moft fudden relief to the brain. In order to renew the breathing, a ftrong perfon may blow his own breath into the patient's mouth with all the force he can ; or, what will generally fucceed better, the fmoke of tobacco may he blown into the lungs, by means of a pipe 01 funnel*. The fume of tobacco fhould like- wife be thrown up as fpeedily and plentifully as poffible in- to the inteftines in form of clyfter. There are various contrivances for this purpofe, and common fenfe will ge- nerally fuggeft which is the moft commodious upon fuch emergencies. The ftrongeft volatiles fhould likewife be applied to the nofe, as fpirit of hartfhorn, fal volatile oleofum, burnt fea- thers, and fuch like. The nofe may likewife be tickled with a feather, and the powder of dried marjoram, tobac- co, or rue blown up the noftrils. The temples and pit of the ftomach may be frequently rubbed with warm brandy or fpirits of wine, a few drops of which may likewife be put into the mouth by means of a feather. Should thefe endeavours prove unfuccefsful, the pati- ent may be put into a warm bath, or laid among warm afhes, hot dung, fand, or fuch like. Dr. Tiffot mentions an inftance of a girl who was reftored to life, after fhe had been taken out of the water, fwelled, bloated, and to all appearance dead, by laying her naked body upon hot afhes, covering her with others equally hot, putting a bonnet round her head, and a flocking round her neck fluffed with the fame, and heaping toverings over all. After fhe had remained half an hour in this fituation, her pulfe returned, fhe recovered her fpeech, and cried out, I freeze, I freeze-, a little * I have known a pig drowned and reftored. to life two or three times fuc- eeffively, by blowing air into its mouth with a pair of bellows, and laying it before the fir«. * OF DROWNED PERSONS. 451 a little cherry-brandy was given her, and fhe remained bu- ried, as it were, under the afhes for eight hours; after- wards fhe was taken out, without any other complaint ex- cept that of laffitude or wearinefs, which went off in a few days. The doaor mentions another inftance of a man who was reftored to life, after he had remained fix hours under water, by the heat of a dung-heap. As foon as the patient discovers any motion, he may take frequently a table-fpoonful of the oxymel of fquills diluted with warm water; or, if that medicine is not at hand, a ftrong infufion of fage, camomile-flowers, or car- duus benediclus, fweetened with honey, may be ufed in its ftead ; where nothing elfe can be had, fome warm water, with the addition of a little common fait, fhould be given. We are by no means to discontinue our affiftance as foon as the patients difcover fome tokens of life, fince they fometimes expire after thefe firft appearances of recovering. The warm and ftimulating applications are ftill to be con- tinued, and fmall quantities of fome cordial liquor ought frequently to be adminiftered. Laftly, though the perfon fhould be manifeftly re-animated, there fometimes remain an oppreffion, a cough and feverifhnefs, which effeaually conftitute a difeafe. In this cafe it will be neceffary to bleed the patient in the arm, and to caufe him to drink plen- tifully of barley-water, elder-flower tea, or any other foft peaoral infufion. The direaions with refpea to perfons who have been flrangled are fo nearly the fame with thofe for drowned peo- ple, that we think it unneceffary to mention them. The ge- neral intention is the fame, viz. to renew the circulation, refpiration, &c. which muft be attempted by bleeding, blowing warm air into the lungs and inteftines, and apply- ing warm fubftances, as afhes, fait, or fuch like, to the whole furface of the body. Such perfons as have the misfortune to be deprived of the appearances of life by a fall, a blow, or the like, muft alfo be treated nearly in the fame manner as thofe who tw been for fome time under water. I have feen a perfon 1 ftunned by a fall from a horfe, that for above fix hours o- fcarcely exhibited any figns of life ; yet this man, by beOg bled, and proper methods taken to keep up the vital warmth, recovered, and in a few days was perfeaiy well Dr. Alexander gives an inftance to the fame purpofe, in the Edinburgh 452 OF DROWNED PERSONS. Edinburgh Phyfical and Literary Eff.ys, of a man why? was to all appearance killed b) a blow on the breaft, but recovered upon being immerfed for lome tim^n waim wa- ter. Thefe, find otlier inftances of a fimilar nature which might be adduced, amount to a full p/oot of this faa, that many of thofe unhappy perfons who lofe their lives by falls, blows, and other accidents, might be faved by the ufe cf preper means duly pcrftfleJ in. * « Of NOXIOUS VAPOURS. Air may be many ways rendered noxious, or even de- ftrudive to animals. This may either happen from its vi- vifying principle being deftroyed, or from fubtie exhalati- ons with which it ib impregnated. v Thus air that has paf- fed through burning fuel is neither capable of fupporting fire nor the life of animals. Hence the danger of fleeping in clofe chambers with charcoal fires. Some indeed fup- pofe the danger here proceeds from the fulphurous Oil con- tained in the charcoal, which is fet at liberty and diffufe'd all over the chamber ; while others imagine it is oWing to the quality of the air of the room being altered by the fire alone. Be this as it may, it is a fituation that ought care- fully to be avoided. Indeed it is dangerous to fleep in a fmall apartment With a fire of a*ny kind. The vapour which exhales from wine, cyder, beer, or other liquors, ,in the ftate of fermentation, contains fome- thing poifonous, which kills in the like manner with the vapour of coal.> Hence there is always danger in going into cellars where a large quantity of thefe liquors is in a ftate of fermentation, efpecially if they have been clofe fhut up for fome time. There have been many inftances of perfons ftruck dead on entering fuch places, and of others who have with difficulty efcaped. When fubterraneous caves, that have been very long fhut, are opened, or when deep wells are cleaned, which 'have not been emptied for feveral years, the vapours arifing; from them produce the fame effeas as thofe mentioned above. For this reafon no perfon ought to venture into a well, pit, cellar, Or any place that is damp, and has been long fhut up, till the ajr has been fufficiently purified, by burning OF NOXIOUS VAPOURS. 453 burning gunpowder in it. It is eafy to know when the air of fuch places is unwholefome, by letting down a lighted candle, thro^jng in burning fuel, or the like. If thefe continue to burn, people may fafely venture m ; but where they are fuddenly extinguifhed, no one ought to enter till the air has been firft purified by fire. The offenfive ftink of lamps and of candles, efpecially when their flames are extinguifhed, operate like other va- pours, though with lefs violence, and, lefs fuddenly. There have, however, been inftances of people killed by the fumes of lamps which had been extinguifhed in a clofe chamber ; and perfons of weak delicate breafts generally find them- felves quickly oppreffed in apartments illuminated with many candles. Such as are fenfible of their danger in thefe fituations, and retreat feafonably from it, are generally relieved as foon as they get into the open air ; or, if they have any remain- ing uneafinefs, a little water and vinegar, or lemonade, drank hot, affords them relief. But when they are fo far noifoneq], as to have loft their feeling and underftanding, the following 'means muft be ufed for their recovery : The patient fhould be expofed to a very pure, frefli, and open air; and volatile falts; or other ftimulating fub- ilances held to his nofe. He fhould next be bled in the arm, or, if that does not fucceed, in the neck. His legs ought" to be put into warm water, and well rubbed. As foon as he can fwallow, fome lemonade, or water and vi- negar, with the addition of a little nitre, may be given Nor are fharp clyfters by any means to be negleaed ; thefe may be made, by adding to the common clyfter, fyrup of buckthorn and tinaure of fenna, of each two ounces; or, in their ftead, half an ounce of Venice tur- pentine diffolved in the yolk of an egg, may be added. Should thefe things not be at hand, two or three large fpoonfuls of common fait may be put into the clyfter. 1 he fame means, if neceffarv, muft be ufed to keep up the na- tural warmth, circulation, &c. as were recommended in 'the former part of this chapter. [ 454 1 Of INTOXICATION. The effeas of intoxication are often fatal. No kind of poifon kills more certainly than an overdofe of ardent fpirits. Sometimes indeed, by deftroying the nervous energy, they put an cad to life at once, but in general their effeas are more flow, and in many rtfpedts fimilar to thofe of opium. Other kinds of intoxicating liquors may prove fatal when taken to excefs, as well as ardent fpirits, but they may generally be difcharged by vomiting, which ought always to be excited when the ftomach is overcharged with li- quor. More of thofe unhappy perfons who die intoxicated, lofe their lives from an inability to condua themfelves, than from the deftruaive quality of the liquor. Unable to walk, they tumbledown, and lie in fome aukward pofture, which obftruas the circulation or bieathing, and often continue in this fituation till they die. No drunk perfon fhould be left by himfelf till his clothes have been loofened, and his body laid in fuch a pofture as is moft favourable for continuing the vital motions, difcharging the contents of the ftomach, C3V. The beft pofture for difcharging the contents of the ftomach is to lay the pet fon upon his belly ; when he falls aflcep he may be laid on his fide, with his head a little raifed, and particular care muft be taken that his neck be no way bent, twilled, or have any thing.too tight about it. The exceffive degree of thrift occafioned by drinking ftrong liquors, often induces people to quench it, by taking what is hurtful. I have known fatal confequences even from drinking freely of milk after a debauch of wine or four punch ; thefe acid liquors, together with the heat of the ftomach, having coagulated the milk in fuch a manner that it could never be digefted. The fafeft drink after.a de- bauch is water with a toaft, tea, infufions of balm, fage, barley-water, and fuch like. If the perfon wants to vomit, he may drink a weak infufion of camomile-flowers, or luke- warm 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 INTOXICATION. 455 Instead of giving a detail of all the different fymptoms of intoxication which indicate danger, and prop«fing a ge- neral plan of treatment for perfons in this fituation, I fhall briefly relate the hiftory of a cafe which lately fell under my own obfervation, wherein moft of thofe fymptoms ufually reckoned dangerous occurred, and where the treat- ment was fuccefsful. A young man, about fifteen years of age, had, for a hire, drunk ten glaffes of ftrong brandy. He foon after fell fall afleep, and continued in that fituation for near twelve hours, till at length his uneafy manner of breath- ing, the coldnefs of his extremities, and other threatening fymptoms, alarmed his friends, and made them fend for me. I found him ftill faft afleep, his countenance ghaftly, and his fkin covered with a cold clammy fweat. Almoft the only figns of life remaining, were, a deep laborious breathing, and a violent commotion or agitation of his bowels. I tried to roufe him, but in vain, by pinching, fhak- ing, applying volatile fpirits, and other ftimulating things, to his nofe, cjc. A few ounces of blood were likewife let from his arm, and a mixture of vinegar and water was poured into his mouth; but as he could not fwallow, very little of this got into the ftomach. None of thefe things having the leaft effea, and the danger feeming to encreafe, I ordered his legs to be put into warm water, and fometime after a fharp clyfter to be adminiftered. This gave him a ftool, and was the firft thing that relieved him. It was af- terwards repeated with the fame happy effea, and feemed to be the chief caufe of his recovery. He then began to fhew fome figns of life, took drink when it was offered him, and came gradually to his fenfes. He continued, however, for feveral days weak and feverifh, and com- plained much of a forenefs in his bowels, which gradually went off, by giving him a flender diet, and cool mucilagi- nous liquors. This vouno- man would probably have been fuffered to die, without a°ny affiftance bein-called, had not a neigh- bour a few davs before, who had been advifed to drink a bottle of whifky'to cure him of an ague, expired under very fimilar circumftances. EFFECTS [ 456 ] EFFECTS of COLD. When cold weather is extremely fevere, and a perfotl is expofed to it for a long time at once, it proves mortal, in confequence of its congealing the blood in the extremi- ties, -and forcing; too great a proportion of it up to the brain ; fo that the patient dies of a kind of apoplexy, which is preceded by a great fleepinefs. The traveller, in this fituation, who finds himfelf begin to grow drowfy, fhould redouble his efforts to extricate'himfelf from the imminent danger he is expofed to. This fleep, which he might con* fider as fome alleviation of his fufferings, would, if indulg* ed, prove his laft. Such violent effeas of cold are happily not very com- mon in this country; it frequently happens, however, that the hands or feet of travellers are fo benumbed or froz- en, as to be in danger of a mortification, if proper means are not ufed to prevent it. The chief danger in this fitua- tion arifes from the fudden application of heat. It is very common, when the hands or feet are pinched with cold, to hold them to the fire, yet reafon and obfervation fhew, that this is a moft dangerous and imprudent condua. Every peafant knows, if frozen meat, fruits, or roots of any kind be brought near the fire, or put into warm water, they will be deftroyed, by rottennefs, or a kind of mortification ; and that the only way to recover them, is to immerfe them for fome time in very cold water. The fame obfervation hoUs with regard to animals in this con- dition. When the hands or feet are greatly benumbed with cold, they ought either to be imrncrfed in cold water, or rubbed with fnow, till they recover their natural warmth and ienfibility ; after which the perfon may be removed in- to an apartment a little wa-rmer, and may drink fome cups of tea, or an infufion of, elder-flowers fweetened with ho- ney. Every perfon muft have obferved when his hands were even but flightly affeaed with cold, that the beft way to warm them was by wafhing them in cold water, and continuing to rub them well for fome*time. When Effects of cold. 457 When a perfon has been fo long expofed to the cold, » that all appearances of life are gone, it will be neceffary to rub him all over with fnow or cold water; or, what will | anfwer better, if it can be obtained, to immerfe them in a bath of the very coldeft water. There is the greateft en- couragement to perfift in the ufe of thefe means, as we are affured that perfons who had remained in the fnow, or had been expofed to the freezing air during five or,fix fucceflive days, and who had difcovered no marks of life for feveral hours, have neverthelefs been revived. I have always thought, that the whitlows, kibes, chil- blains, and other inflammations of the extremities, which are fo common amongft the peafants of thi§ country in the cold feafon, Were chiefly occafioned by their fudden transi- tions from cold to heat. After they have been expofed to 1 an extreme degree of Cold, they immediately apply their ■ hands and feet to the fire, or, if they haye Occafion, plunge f them into warm water, by which means, if a mortification I does not happen, an inflammation feldom fails to enfue. | Moft of the ill confequences from this quarter might be i eafily avoided, by only obferving the precautions metitiofi£ | ed above; I I ■■ <| Other CASES which REQUIRE IM- MEDIATE ASSISTANCE. Strong and healthy perfons, who abound with bloody are often feized with fuddert fainting-fits,, after violent ex- [ fcrcife, drinking freely of warm or ftrong liquors, expofure to great heat, intenfe application to ftudy, or the like. | In fuch cafes the patient fhould be made to fmell to fome i vinegar. His temples, forehead, and wrifts ought ^it the- U fame time to be bathed with vinegar mixed with ah equal I quantity of warm water ; and two or three fpoonfuls of vi- negar, with four or five times as much'water* may, if he ! can fwallow, be poured into his mouth. 5 If the fainting proves obftinate, or degenerates 'into a j Jyncope, that is, an abolition of feeling and underftandin§, j the patient muft be bled. After the bleeding, a clyfter 1 will be proper, and then he fhould be kept eafy and quiet,- i N n n only 458 OTHER CASES WHICH REQUIRE only giving him every half hour a cup or two of an infufi- on of any mild vegetable, with the addition of a little fugar and vinegar. When fwoonings* which arife from this caufe, occur frequently in tfife fame perfon, he fhould, in order to efcape them, confine himfelf to a light diet, confifting chiefly of bread, fruits, and other vegetables. His drink ought to be water or fmall beer, and he fhould fleep but moderately* and take much exercife; But fainting-fits proceed much oftener from a defca^ than an excefs of blood. Hence they are very ready ta happen after great evacuations of any kind ; obftinate watching ; want of appetite, or fuch like. In thefe an al- moft directly oppofite courfe to that mentioned above muft be purfued. The patient fhould be laid in bed, and being covered* fhould have his legs, thighs, arms* and his whole body rubbed ftrongly With hot flannels. Hungary water* vola- tile falts, or ftrong fmelling herbs* as rue, mint, or rofe- mary, may be held to his nofe. His mouth may be wet with a little rum or brandy > and* if he can fwallow, fome hot wine* mixed with fugar and cinnamon, which is an excellent Cordial, may be poured into his mouth. A com- prefs of flannel dipt in hot wine or brandy muft be applied to the pit of his ftomach, and warm bricks, or bottles fill- ed with hot water* laid to the feet. As foon as the patient is recovered a little, he fhould' t^ke fome ftrong foup or broth, or a little bread or bifcuit foaked ia hot-fpiced wine. To prevent the return of the fits, he ought to take often, but in fmall quantities, fome light yet ftrengthening nourifhment* as panado made with foup inftead of water/new laid eggs lightly poached, cho- colate, light roafted meats, jellies, and fuch like. These fainting-fits, which are the effea of bleeding* Or of the violent operation of purges, belong to this clafs. Such as happen after artificial bleeding are feldom danger- ous, generally terminating as foon as the patient is laid up- on the bed ; indeed perfons fubjea to this kind fhould al- ways be bled lying, in order to prevent it. Should tbe fainting, however, continue longer than ufual, fome vine- gar may be fmelt to* and a little, mixed with fome water* fwal lowed.' WhsS IMMEDIATE ASSISTANCE. 459 When fainting is the effea of too ftrong or acrid purges or vomits, the patient muft be treated in all refpeas as if he had taken poifon. He fhould be made to drink plenti- fully of milk, warm water, and oil, barley-water, or fuch like; emollient clyfters will likewife be proper, and the patient's ftrength fhould afterwards be recruited, by giving him generous cordials, and anodyne medicines. Faintings are often occafioned by indigeftion. This may either proceed from the quantity or quality of the food. When the former of thefe is the caufe, the cure will be beft performed by vomiting, which may be promoted by caufing the patient to drink a weak infufion of camomile flowers, carduus henediclus, or the like. When the difor- der proceeds from the nature of the food, the patient, as in the cafe of weaknefs, muft be revived by ftrong fmells, &c. but the moft effential point is, to make him fwallow a large quantity of light warm fluid, which may ferve to drown, as it were, the offending matter, to foften its acri- mony, and either to effea a difcharge of it by vomiting, pr force it down into the inteftines. Even difagreeable fmells will fometimes occafion fwoon^ ings, efpecially in people of weak nerves. When this hapr pens, the patient fhould be carried into the open air, have ftimulating things held to his nofe ; and thofe fubftances which are difagreeable to him, ought immediately to be removed. But we have already taken notice of fwoonings which arife from nervous diforders, and fhall therefore fay no more upon that head. Fainting-fits often happen in the progrefs of difeafes, In the beginning of putrid difeafes, they generally denote an oppreffion at ftomach, or a mafs of corrupted humours, and they ceafe after evacuations either by vomit or ftool. When they occur at the beginning of malignant fevers, they indicate great danger.' In each of thefe cafes, vine- gar ufed both externally and internally is the beft remedy during the paroxyfm, and plenty of lemon-juice and wa- ter after it. Swoonings which happen in difeafes accom- panied with great evacuations, muft be treated like thofe which are owing to weaknefs, and the evacuations ought to be reftrained. When they happen towards the end of a violent fit of an intermitting fever, or at that of each exa- cerbation of a continual fever, the patient muft be fup. ported by fmall draughts of wine and water, ~:-. 460 OTHER CASES WHICH REQUIRE Suffocating or strangling fits likewife require immediate affiftance. They proceed either from an infarc- tion of the lungs, produced by vifcid clammy humours, or a fpafmodic affeaion of the nerves in that organ. Perfons who feed grofsly, and abound with blood, are moft liable to fuffocating fits, from the former of thefe caufes. Such ought, as foon as they are attacked, to be bled, to receive an emollient clyfter, and to have frequently a cup of any kind of warm diluting liquor, with a little nitre in it, gi- ven them/ They fhould likewife receive the fteams of hot vinegar into their lungs by breathing. Nervous^ and afth- matic people ate moft fubjea to fpafmodic affeaions of the lungs* In this cafe the patient's legs fhould be immerfed in warm water, and the vapour or fteam of vinegar be ap- plied as above. He may alfo be made to fmell to burnt pacer, feathers, or leather, and frefh air fhould be very frt■_!y- admitted to him. /rom whatever caufe fainting fits may proceed, frefh air is always of the greateft importance to the patient. By not attending to this circumftance, people often kill their friends, while they are endeavouring to fave them. Alarm- ed a: the patient's fituation, they call in a croud of people to his affiftance, or perhaps to witnefs his exit, whofe breathing exhaufts the air, and increafes the danger. There is not the leaft doubt but this praaice, which is very com- mon among the lower fort of people, often proves fatal, efpecially to the delicate, and fuch perfons as fall into fainting-fits from mere exhauftion or the violence of fome difeafe. No more perfons ought ever to be admitted into the room where a patierft lies*' in a fwoon than are abfo- iutely neceffary for his affiftance, and the windows of the apartment fhould always be opened* at leaft as far as to ad- mit a ftream of frefh air. Persons fubjea to frequent^fwoonings, or fainting-fits', fhould neglea no means to remove the caufe of them, as their confequences are always hurtful to the conftitution. fevery fainting-fit leaves the perfon in dejeaion and weak- nefs ; the fecretions are thereby fufpended, the humours difpofed to ftagnation, coagulations and obftruaions are formed, and, if the motion of the blood be totally inter- cepted, or very confiderably checked, polyfufes are formed in the heart, or larger veffels, the confequences of which are always dangerous, and often fatal. The only kind of ••••■■•' f'woon- IMMEDIATE ASSISTANCE. 461 fwoonings not to be dreaded, are thofe which fometimeii mark the crifis in fevers ; yet even thefe ought, as foon as poffible, to be removed. Before we conclude/we muft beg leave earneftly to recommend to the reader a particular attention to the con- tents of this chapter, and a fteady perfeverance in the ufe of fuch means as are therein pointed out, for recovering perfons who have had the misfortune to be fuddenly de- prived of life by any accident, Were it neceffary, we could bring many well-attefted proofs of the happy fuccefs which has attended fuch perfeverance, even in cafes where ^here was very little reafon to have expeaed it. It would alfo be an eafy matter to adduce numerous arguments to recommend and enforce the praaice of thefe humane and benevolent offices; but all thefe, we are perfuaded, would be fuperfluous. Every good man muft feel the ftrongeft propenfity, upon fuch emergencies, to do all in hi$ power to preferve the life of an ufeful citizen, a beloved friend, pr even of an enemy; nor can any pleafure e«qual that which a generous mind experiences, when fuch endeavour^ are crowned with fuccefs. m\\ E EN D, v # # V \- ''£^^^,7^^ llst^xSftyrt "*/)n/v> (776--------- gM*4s"*s* gwSbJLhiA ^LOaA?/*" ^>-?^ j i \ : li %l ■■-? *?>, "'.A *i ■4 '* Me4.Hlst. 3313d I77* <7J ★ * ARMY * * MEDICAL LIBRARY Cleveland Brunch Xv.v.v. "X'rV.VtV .■/■W.w %vav«v ■ I ii i»♦ .• m mm v«w»* 8» * VAW/i'n^"" *A j-' •' A.*. ^M^7-;- SiV*'W-<' 7"0 »,V i iT/>f < 7i J <>■ <■';■'• i'■-'• >" < ' ■ W^^MfCfy' WWW^WKW'